California Judges Extend Drug Rehab for Felons
Anna Gorman, Los Angeles Times- 1/16/2002

A state appellate court ruled Tuesday that judges can allow defendants convicted of felonies in recent years to receive drug treatment under Proposition 36. The ruling, which could affect hundreds of defendants convicted of minor drug use, will help clear up confusion among California judges over who is eligible for the initiative. The 2nd District Court of Appeal in Los Angeles issued the published opinion a few days after hearing oral arguments.
    Approved by 61% of state voters in November 2000, Proposition 36 allows defendants convicted of using, possessing or transporting drugs for personal use to receive treatment instead of jail time. But the statute read that defendants who have been convicted of serious or violent felonies are eligible for drug treatment only if they have been out of prison for five years. Since Proposition 36 took effect more than six months ago, judges have been divided about whether they had the power to dismiss prior felony convictions for the purposes of sentencing a defendant to drug treatment. Los Angeles County Superior Court Judge Ana Maria Luna said she believed Proposition 36 did not allow her that power.
    Luna praised Tuesday's ruling for enabling her to place defendants who need help into rehabilitation programs. But she said judges should be cautious when they refer defendants with violent felony convictions to treatment programs. "In exercising that discretion, the court is going to have to look at the overall criminal behavior of the individual . . . and if the person is at a point in their life that they are ready for treatment," Luna said. In October, the same appellate court cleared up another area of disagreement when it ruled that the initiative applies to cases of nonviolent offenders convicted but not sentenced before the measure took effect July 1.
    Tuesday's ruling came in the case of Ronald Lee Varnell, who was charged in May 2001 with possession of methamphetamine. Prosecutors argued that Varnell was not eligible for Proposition 36 treatment because he was convicted in 1995 of assault with a deadly weapon and was released three years before last year's drug arrest. Defense attorneys asked the judge to dismiss the conviction and refer Varnell to drug treatment. Superior Court Judge Joan Comparet-Cassani agreed to the dismissal so Varnell's sentence would be cut in half to 16 months in prison, but she denied his request to enter a drug treatment program.
    In their 17-page ruling, the appellate justices wrote that judges have long had the authority under state law to dismiss prior felony convictions for purposes of sentencing. Because the statewide proposition did not prohibit the use of that law, the justices wrote that "we must conclude that power, firmly embedded in our criminal jurisprudence, coexists with the sentencing scheme at issue." The justices directed Comparet-Cassani to hold a new sentencing hearing for Varnell, but did not require her to place him in drug treatment.
    Deputy Public Defender Alex Ricciardulli said the appellate court decision empowers trial judges and "further extends the umbrella of rehabilitation" to defendants who would have been disqualified otherwise. But Marc Nolan, who argued the case for the state attorney general's office, said the ruling "doesn't necessarily change the result in this case or in any other case." The ruling doesn't say judges have to dismiss convictions to make defendants eligible for Proposition 36, he said. Nolan said his office has not decided whether to appeal the court's decision.

At the Cradle Café, Therapy for the Troubled Mind
Ian Fisher, New York Times- 1/16/2002

PRAGUE--You can sit for hours in Ivo Lorenc's comfy café here and not notice exactly what is going on: a painting on the wall, for instance, shows a winter scene so cherry it is possible to miss that the snowmen have gathered in a subtle pack and are stabbing someone in the snow. With carrots. The Czechs have a gift for drawing out the poison from human darkness, and that is what Mr. Lorenc is up to here. The painting is by a man with a history of mental illness, but there is no sign to advertise that fact. Of the café's six workers, three are recovering from serious mental illness. "You never know who is who," Mr. Lorenc said, "and that is fair."
    Mr. Lorenc, 37, is the kind of person careful not to make himself sound too interesting. So in deference to his manner of speaking, it is best to put things plainly: when he was in college, his mother fell into a psychotic depression, which forced her in and out of Soviet-era mental hospitals. It changed him too. Now he makes his money--not a lot--in real estate. But just over a year ago, with loans from friends but no other help, he opened Kolibka, or the Cradle, a café downtown with an excellent selection of coffee and wine. It is also one of the few businesses here where mentally ill people work beside what he calls "so-called normal people" without doctor's supervision.
    The notion came from painful visits to his mother during stays in hospitals like prisons and treatment like electroshock. Other patients either had nothing to fill their days, he said, or were saddled with mindless make-work that was not helping them. "There was very little for them to do as a substitute for a real life," he said. Over time, it occurred to him that the routine of a regular job might help.
    He makes clear this is not meant to save the world: only five patients have worked here. Two have done well, two have left and one is just starting. It is not a charity either: the café is supposed to make money some day, though it has not yet. Rather, it is one man's attempt "to give the illusion of usefulness for some time," Mr. Lorenc said, amid the dropped glasses, imperfect service and occasional logical gaps that go with employing recovering psychotics. "Ours is a very low level," he said. "It's worked for two people out of four. But you know them. It's personal. You can judge for yourself whether it is helpful or not." When his mother is well enough she visits the café, he said. And likes it too.
    Under Communism, mental illness and its treatment held a particular stigma (dissidents were sometimes put in mental wards), and even now the mentally ill here have few chances. "The general portrait here of a mental patient is sort of the caricature you see in American films, of the violent psychotic killer," said Lucie Broukalova, director of Green Doors, an agency affiliated with Ondrejov Daily Sanatorium, a mental institution in Prague.
    Since 1997, the hospital has sponsored three cafes staffed by patients, but under doctors' direct supervision. So, Ms. Broukalova said, it was a pleasant surprise when Mr. Lorenc asked if the hospital could recommend patients well enough to work on their own. It is, as far as she knows, the only commercial venture here devoted to helping the mentally ill. A small victory is worth noting, Mr. Lorenc said: so far, any angry, irrational outbursts have not come from the employees. "From the customer's side, yes. Not the other way around."
    Mr. Lorenc's father, who died in 1970, was a surgeon. His sister is a doctor, his brother a psychiatrist. But he has never held such a regular job: he studied math, played saxophone for an underground band, then put his precise English to work translating for foreign reporters in 1989 when the nation slipped through its bloodless Velvet Revolution. Later he worked with a partner rehabilitating dilapidated apartments in Prague--which he still does.
    At 30 years old, in 1995, Mr. Lorenc won a spot in the elite psychology program at Charles University with the idea that he might take a different path from what he saw wrong in Czech mental health practice. "It was a great disillusion," he said. He was frustrated with professors who he said were Communist holdovers--one of whom gave a lecture two years into Mr. Lorenc's studies that made him finally quit. "That was it," he said. "It was time to do something more practical."
    The next year, he found a wreck of an old coal cellar and, with friends, built a bar. Kolibka opened in October 2000. It is a pleasant, smoky café, the sort that can make tourists feel they have stumbled into something authentic. The first mentally ill employee was a young woman, a cello player and artist. Mr. Lorenc said the two of them worked out the basics. Such as: all employees, regardless of mental history, would be paid the same.
    On balance, he said, it works, though it is still early. The service, while not bad, is not as good as with professional waiters, he said. The first worker was rehospitalized because her condition worsened. She is back now. Once, a worker budding with confidence asked to open the café on her own. The next day, the bar was set up perfectly, but she was not ready. "She was sitting in darkness," Mr. Lorenc said. "I said: 'It's pretty dark here. Maybe it scares people off if it is so dark.' She said, 'I though it looked better that way.'" Next time, she turned on the lights.

Success at 14, Despite Autism
Ralph Blumenthal, New York Times- 1/16/2002

In the strange world of outsider art, Jonathan Lerman, at 14, is already an insider. Autistic yet prodigiously artistic in the way of savants who display extraordinary talents, he suddenly began drawing at 10, breaking through autism's isolating walls with a deluge of intensely rendered, sometimes comical and oddly familiar faces that one art writer compared to the work of George Grosz and Francis Bacon.
    Science is still struggling to understand what two Harvard neurologists have called "the pathology of superiority," the linkage of gift and disorder that explains how someone unable to communicate or perform simple tasks can at the same time calculate astronomical sums or produce striking music or art. Some studies have found that the fetal damage to the left side of the brain results in overcompensation by the right side and special gifts.
    People with severe mental deficits and such gifts are called savants, from the French verb savoir, to know. (The term idiot savant has been discarded.) Earlier renowned child art savants included Wang Yani of China, who painted an astounding panel of monkeys at age 5 in 1980 and 4,000 other acclaimed works within three years, and the autistic English schoolgirl referred to only as Nadia, who at age 5 in 1973 sketched a forshortened horse and rider worthy of a Renaissance master.
    Jonathan, born when the family lived in Queens, seemed normal at first, said his mother, Caren, a surgical nurse. But as she wrote in an unpublished memoir she called "The Solitary Heart," he cried uncontrollably at his first birthday party and soon began lapsing into long silences. He knew a few words but mostly used gestures to convey his needs. "When our friends would come over to our house, he would find a wall, lie along its side and stare at it for hours," she wrote. "We began to wonder why he ignored us when we called out his name, and why he'd pull out clumps of his hair when he became upset about something. He would sing the alphabet song, count to 12 and even learned to identify some body parts. Then one day, without any warning, those milestones in Jonathan's growth simply began to fade away." It was, Ms. Lerman recently recalled, "like someone slowly turned the water off."
    Jonathan's parents took him from specialist to specialist. Finally, before Jonathon was 3, a neuropsychiatrist on Long Island diagnosed "autistic pervasive developmental disorder," a life-long condition that would keep him from properly communicating or understanding what he saw, heard or felt. Autistic people, they learned, are prone to extreme hyperactivity and unusual passivity, and 80 percent fall below normal intelligence, although many display peak skills in the arts, mathematics or memorization.
    The Lermans--he by nature introverted, she extroverted--went through intense grieving and searched for explanations. (They are now divorcing but still closely share Jonathan's upbringing.) Ms. Lerman came to think his condition was either genetic or virus-induced in utero. The hired a speech therapist and other specialist, and when Jonathan was 3 they moved to Vestal to enroll him in a behavior-modification program at Binghamton.
    Raising him was heartbreaking, Ms. Lerman recalled. At the circus he embarrassingly helped himself to his neighbor's popcorn. In a restaurant he once grabbed a stranger's piece of birthday cake. Mortified, she explained the problem and the table sent over another piece for Jonathan. At a lake he heedless stepped on the bodies of sunbathers to reach his blanket. For a while his diet consisted exclusively of hamburgers, french fries and Coke. Later he added pizza, but the pieces had to be triangular with very little cheese, no bubbles and no oregano. He watched a lot of television. "He was the only 3-year-old who knew who Ted Koppel was," Mr. Lerman said. "He knows all of the sitcoms. It looks like he's not paying attention but he knows all of them."
    Jonathan showed no particular aptitude for art but drew strange doodles. His parents started taking him to museums. Picasso at the Guggenheim Museum did not move him, but at the Metropolitan Museum, he tried to touch the blank eyes of the Roman sculptures. A van Gogh exhibition at the National Gallery of Art in Washington mesmerized him.
    Mrs. Lerman's father, Bert Markowitz, insisted that Jonathan had promise. "He used to say, 'He'll surprise you, you'll see,'" Ms. Lerman recalled. In 1997, when Jonathon was 10, his 75-year-old grandfather died. Jonathan became very upset, his mother said, asking constantly where he was and when he could be visited in heaven. Not long after that, while Jonathan was enrolled in a program in the local Jewish Community Center, Ms. Lerman got a call from his helper, Eryn Hartwig. "You got to come over to see what he's doing," she said. Ms. Lerman asked wearily, "What, holding the other kids hostage?" "No," came the answer. "He's drawing."
    And what drawings. Flowing from Jonathan's clutched charcoal, five and ten sheets at a sitting, came faces of throbbing immediacy, harrowing and comical. Some, hauntingly specific, seemed to portray people Jonathan knew. "I didn't know what I had on my hands," Ms. Lerman said. She thought her father's death might have unlocked something within Jonathan. "I became spiritual," she said. "Like, he's orchestrating this."
    In the magazine Raw Vision, devoted to outsider art, she looked up some galleries and called to see if any would look at Jonathan's work. None seemed interested. Mr. Schuss of K. S. Art gave her a hearing but counseled patience, "Lady," he told Ms. Lerman, "he's only 10 years old, let him draw." But then, he said, "As soon as I saw the slides, I flipped." Within two years Jonathan, at 12, had his first solo show. To what extent Jonathan knows the hit he has made is not clear. "Jonathan's capacity to understand is not that great," Ms. Lerman said. "I said, 'People really love your art,' and he was happy."

Sixth Juror Picked for Yates Trial
Carol Christian, Houston Chronicle- 1/16/2002

A sixth juror -- and the fifth woman on the panel -- was selected Wednesday in the capital murder trial of the Clear Lake mother who has confessed to drowning her five children in a bathtub. The newest juror is a 35-year-old South Carolina native who is married and has two children, ages 10 and 13. She formerly worked as a legal secretary. There was no discussion in court of her education level.
    Selection of 12 jurors and two alternates for the trial of Andrea Pia Yates, 37, is in its second week and could take another three to four weeks, state District Judge Belinda Hill has said. Yates, who has pleaded not guilty by reason of insanity, appeared tired Wednesday and at times seemed to nod off. When the judge asked her if she agreed with the lawyers' decisions regarding panel members, she clearly answered, "Yes," each time.
    The sixth juror has been married 17 years to a childhood friend, a former Marine Corps recruiter who is now vice president of a building security company. When she heard June 20 about Yates drowning her five children, the juror said her initial reaction was that "something was wrong mentally." Asked by prosecutor Kaylynn Williford if that was still her opinion, she said it was "just kind of disbelief." Defense lawyer Wendell Odom asked her if the emotional aspects of the case would bother her. "No. It would have a few years ago," she said. "But I can just grant you I'll cry. There's no doubt in my mind about that." Prosecutors and defense lawyers resume individual interviews today.

Doctors Who OK'd Geoghan Lacked Expertise
Michael Rezendes & Matt Carroll, Boston Globe- 1/16/2002

Last week, Cardinal Bernard F. Law said it was ''tragically incorrect'' for him to assign a known pedophile, John J. Geoghan, to a new parish in 1984. But Law said the decision was based on ''psychiatric assessments and medical opinions that such assignments were safe and reasonable.'' Yet Dr. Robert W. Mullins, one of the two doctors who declared Geoghan to be ''fully recovered'' in 1984, was a general practitioner who acknowledged yesterday that he has no credentials in psychotherapy or psychiatry. The other doctor, who saw Geoghan as a patient in 1980 and wrote evaluations of Geoghan in 1984 and 1989, is a psychiatrist, but Dr. John H. Brennan had no background in treating sexual offenders, according to records kept by the state. In addition, in 1977, before Brennan's 1980 treatment of Geoghan, Brennan was charged in a civil lawsuit with sexually molesting one of his patients. Brennan settled the lawsuit later in 1980; the woman who filed it received $100,000. Donna M. Morrissey, a spokeswoman for the Boston Archdiocese, said she would not respond to questions about the two doctors because the matter is in litigation. A review of public court records shows that Mullins, now retired, and Brennan were the two local doctors whose opinions were cited by the Archdiocese of Boston before it allowed Geoghan to continue as a parish priest.
    During assignments to parishes in Dorchester and Weston in the 1980s and early 1990s, Geoghan continued to sexually abuse children, according to allegations in some of the 90 pending sexual molestation lawsuits filed against him. In the 25 cases in which Law is a defendant, the cardinal's decision-making will be a critical factor in determining whether he and other church officials are liable for Geoghan's acts.
    A.W. Richard Sipe, a former priest and psychotherapist who has written extensively on clergy sex abuse, said an evaluation of a pedophile by a general practitioner should not have been used by the church in deciding whether to allow Geoghan to return to parish work. ''That absolutely does not count. It's no better than something coming from a woman in a pew who says her rosary every day,'' Sipe said. David Finkelhor, a sociologist at the University of New Hampshire and author of four books on the sexual abuse of children, said he found the church's reliance on doctors without a specific expertise in sexual abuse astonishing. ''Nobody with training or experience working with sex offenders would give that kind of blanket assurance, even in the 1980s,'' Finkelhor said. ''It was well-known by then that sex offenders were highly likely to repeat the behavior.''
    When Law first acknowledged last summer that he knew of Geoghan's abusive past when he reassigned him to St. Julia's in Weston in 1984, the cardinal's lawyer defended the decision. Writing in the archdiocesan newspaper, the Pilot, Wilson D. Rogers Jr. said, ''Each assignment of John Geoghan, subsequent to the first complaint of sexual misconduct, was incident to an independent medical evaluation advising that such assignment was appropriate and safe.''
    On the surface, church documents the Globe obtained from a public court file appear to support Rogers's assertion. For example, in 1980 - after Geoghan admitted molesting seven boys in one extended family in Jamaica Plain - a church chronology declares that Geoghan ''saw Dr. Brennan for psychoanalysis; Dr. Mullins for psychotherapy.'' But the Globe's review of the two doctors' credentials revealed that Mullins was for years a family physician - a general practitioner - with a practice on Corey Street in West Roxbury. He lives on Celia Road, within four blocks of Geoghan's home on Pelton Street. In a brief interview yesterday, Mullins, 75, confirmed he had practiced general medicine and said he had no background in psychotherapy. He refused to answer any other questions. The church's chronology of Geoghan's treatment from 1980 to 1994 shows psychiatrist Brennan joining Mullins in providing a favorable evaluation in 1984, declaring, ''No psychiatric contraindications or restrictions to his work as a parish priest.'' In 1989, after Geoghan - with Law's knowledge - was hospitalized again after more victims complained, the archdiocese again turned to Brennan, whose evaluation was almost identical to his 1984 opinion: ''no psychiatric contraindication to Fr. Geoghan's pastoral work at this time.''
    Brennan did not return calls from the Globe. One of his attorneys, Tory A. Weigand, said he could not comment on the issue. And Morrissey, the church spokeswoman, would not respond to a request for a list of Brennan's qualifications. But a state agency evaluating a second case of alleged sexual misconduct against Brennan in the early 1990s said his specialties were ''psychopharmacology with supportive therapy'' and electric shock treatments. The agency also said ''Brennan's major interests have been in treating substance abuse [alcohol or drug] patients, and patients with major psychoses such as schizophrenia, bipolar disorder, and dual diagnoses.'' The second accusation of sexual misconduct with a female patient, made in a civil suit filed in 1992, was heard by a Suffolk County jury that found no liability against Brennan. An appeal of the case is pending.
    Finkelhor, the specialist in studying child sexual abuse, said it is crucial that accused pedophiles be evaluated by experienced practitioners because those who habitually molest children are typically intelligent conversationalists. ''[Child abusers] sound like capable, competent people who can deal with their problems, when in fact they cannot. ... That is one reason it is so dangerous to have them treated by nonspecialists,'' said Finkelhor, the director of the Crimes Against Children Research Center at UNH.
    Sipe, for his part, also wondered whether Mullins and Brennan had the objectivity to provide the independent evaluations that Rogers cited in his letter to The Pilot. ''The danger is you're getting a rubber stamp, a good Roman Catholic who thinks that all priests are good,'' Sipe said. In fact, at the time Brennan treated Geoghan in 1980, Brennan was connected to the church in at least two ways: He was director of psychiatric education at St. Elizabeth's Hospital in Brighton, a Catholic-affiliated institution; and he routinely accepted patient referrals from a priest well-known as a psychologist in the Boston area.
    In an affidavit filed by Brennan in one of the sexual misconduct cases filed against him, Brennan said that the woman who accused him in 1977 of molesting her was referred to him by the late Rev. Fulgence Buonanno. Buonanno, Brennan said, was a priest and psychologist at St. Anthony's Shrine in downtown Boston. When told of Brennan's affiliations with the church and Buonanno, Sipe said, ''That is not an objective opinion. It is coming from someone getting referrals and making a living at least in part from the archdiocese.''
    Among the written questions that Morrissey would not answer was whether Law or other church officials knew about the 1977 sexual misconduct suit against Brennan or the $100,000 settlement. ''We are unavailable to respond to your specific questions at this time, as it would be inappropriate due to pending litigation,'' she wrote in a statement faxed to the Globe. Mitchell Garabedian, the attorney handling the 25 lawsuits that name Law as a defendant, would not comment on the specific credentials of Mullins and Brennan but said, ''It is the plaintiffs' position that the cardinal did not act reasonably given what he knew at the time.''
    The woman who filed the 1977 lawsuit also brought a formal complaint against Brennan at the state Board of Registration in Medicine. The board took no action at the time. In 1989, almost a decade after the lawsuit was settled, the board dismissed the complaint. But in its written decision, board chairman Dr. Andrew G. Bodnar wrote that ''were there not a substantial lapse of time,'' the board might have reopened the case ''for further explanation and/or a further evidentiary hearing on the psychiatric issues.''
    The second sexual molestation lawsuit against Brennan was filed in 1992 by Jean Palermo, another former patient who accused Brennan of sexually molesting her numerous times in the late 1970s. Palermo's pending appeal is based on her claim that the presiding judge in her case did not allow testimony from the woman who filed the earlier lawsuit. In a separate action, Palermo accused Brennan of sexually molesting her, in a complaint to the state Board of Registration in Medicine. The complaint was dismissed. Brennan, both at trial and in the hearings, denied he ever had sex with Palermo or the woman who filed the 1977 lawsuit.

Supreme Court Hears Appeal in HMO Case
Jan Crawford Greenburg, Chicago Tribune- 1/17/2002

WASHINGTON -- Several U.S. Supreme Court justices appeared hesitant Wednesday to endorse an Illinois law that allows patients to turn to an outside reviewer when their health maintenance organizations rule that a proposed treatment is not medically necessary. Taking up what could be one of the most important cases of the term, several justices suggested that the Illinois law must take a back seat to a federal law that regulates employee benefits and is less friendly to patients seeking to overturn HMO decisions. The court's ruling in the case could have far-reaching consequences affecting tens of millions of workers who participate in HMO plans. Illinois is one of 40 states with laws allowing workers to seek independent review when an HMO denies a proposed treatment. The outside reviewer's decision can force the HMO to pay.
    That's what happened in the case before the court. Debra Moran of suburban Chicago turned to the state law after Rush Prudential HMO Inc. refused to pay for surgery to correct a painful and debilitating nerve condition in her shoulder. Moran had consulted an out-of-network doctor for the specialized surgery after conservative treatments failed to work, and her primary-care physician agreed with her approach. The HMO, however, said the surgery was not medically necessary and that it would pay only for a less complicated and expensive treatment.

Surgery cost $95,000
Moran, a speech therapist, paid $95,000 to have the surgery anyway, after a Rush-affiliated surgeon said the HMO's proposed treatment carried only a one-third chance of success, but an equal chance of adverse consequences, including paralysis. After the surgery, she again asked the HMO to pay. A state court ordered the independent physician review, as outlined in the new Illinois law. An outside physician, who was an expert in plastic and reconstructive surgery at Johns Hopkins Medical Center, found the surgery was medically necessary. "All Debra Moran has ever sought in this case was the benefit she's entitled to ... which saved her right arm," her lawyer, Daniel Albers, told the justices Wednesday.
    Justice Antonin Scalia immediately jumped in, framing the issue at the heart of the case. "The question is," Scalia said, "who is to decide if she got what she was supposed to get?" To answer that question, the justices must decide whether a federal employee benefits law takes precedence over the Illinois Health Maintenance Organization Act. In hour-long arguments Wednesday, Scalia and Justice Anthony Kennedy and Chief Justice William Rehnquist seemed to suggest the federal law would win out.
    That law, the Employment Retirement Income Security Act, or ERISA, is complex and murky, thanks in no small part to decisions by the Supreme Court. Passed in 1974 to regulate employee pension plans, the law also covers health benefits. The federal law generally takes precedence over state laws regulating employee benefit plans. But there are exceptions, and that is what both sides argued over on Wednesday.
    Rush Prudential is promoting the federal law, which would make it more difficult for patients to overturn HMO decisions. Its attorney argued Wednesday that the Illinois law setting up the independent review is invalid because it conflicts with the federal law. States have no business interfering with employee benefits plans, because that is the exclusive domain of the federal law, argued attorney John G. Roberts Jr. Cases under that federal law can be "exceedingly complicated," but the HMO's point is a "straightforward" one, Roberts said: States can't force HMOs to abide by the decision of an independent reviewer because that creates a different remedy than those set out in the federal law; and only the federal law can set forth remedies for employees whose benefits have been denied. "This is a remedy," Roberts said of the state law scheme. "If you don't like what the HMO has done with your benefits claim, you get to go to an independent state review and get it overturned."
    Albers, Moran's lawyer, maintained that the state could step in and create the review process. He urged the court to uphold the U.S. Court of Appeals for the 7th Circuit in Chicago, which ruled that the Illinois law doesn't conflict with the federal law. Albers argued that the state law regulates insurance, not employee benefits. The federal law makes clear that insurance regulations are a state, not federal, concern, he said. "The Illinois law is an insurance law that doesn't conflict with ERISA," Albers said.
    The Bush administration, which filed court papers siding with Moran, made a slightly different point. Edwin Kneedler, deputy solicitor general, said the Illinois law does not conflict with ERISA because it does not provide a different in-court remedy. Instead, it allows for medical professionals to make "highly judgmental medical judgments."

AMA supports patient
The American Medical Association also is supporting Moran's position, arguing in court papers that independent-review laws are necessary to protect patients from potential abuses. Other groups supporting Moran say the federal law provides little help for people at odds with their HMOs over treatment decisions. Mary Ellen Signorille, a lawyer for AARP Foundation Litigation, which filed papers in the case, said that Moran would have been forced to wage an expensive court battle before her surgery had the new state law not been in place. She probably would have lost because she would have had to show her HMO acted arbitrarily, Signorille said.
    But the American Association of Health Plans, supporting Rush Prudential, argues that complying with different state rules will divert employers' resources and drive up costs. When the court took the case last summer, many observers speculated it would quickly become irrelevant because Congress was poised to pass a patients' bill of rights, creating a uniform system of independent review. But Congress failed to do so, putting the court at center stage.

Paroled Sex Offenders Get Polygraph Tests
Associated Press, 1/17/2002

FLINT, Mich. -- More than 60 sex offenders on parole in Genesee and Lapeer counties are getting lie detector tests to help investigators keep an eye on their activities. The parolees spend three to four hours with a polygraph examiner and are usually asked about 10 questions supplied by a parole officer related to their activities outside of prison.
    The state Department of Corrections has been using polygraph tests since March to test the honesty of sex offenders, and similar programs are in place in Detroit and Muskegon. "We look for precursors or triggers that could result in repeat offenses," Tom Combs, a Corrections Department special programs manager, told The Flint Journal for a Wednesday story.
    The tests are scored as pass, fail or inconclusive, but results alone are not cause to send an offender back to prison. Instead, the tests can be used to open investigations into a parolee's activities. Offenders are asked questions about everything from pornography to online habits, Combs said. For example, an offender in Detroit who assaulted children at a bike repair shop he ran was asked under polygraph if he still fixes bikes for children.
    One Flint man who refused to take a polygraph reconsidered when officials threatened to send him back to prison if he didn't consent. He eventually passed the test. "The hammer of re-incarceration is a good tool to have," said Matt Davis, a Corrections Department spokesman. Each parolee will be tested several times. Unlike drug tests, which are conducted on a random basis with no warning, the polygraphs are scheduled in advance.  The state spent about $40,000 to start the program but plans to have offenders eventually pay for the costs. Parolees are required to reimburse the taxpayers the $450 cost of the first polygraph, $350 for subsequent tests and therapist costs.
    So far, the tests in Genesee and Lapeer counties have not resulted in any admissions of criminal activity, Combs said. However, officials did open an investigation into one Genesee County man after he failed the test. The program isn't without its critics. The American Civil Liberties Union views the program as a violation of the Fourth Amendment protection against illegal search and seizure, said Ed Bullard, co-chairman of the Flint ACLU.  "There are other investigative means that are tried and true that aren't an invasion of privacy," Bullard said.

Ecstasy Lures Detroit Metro Kids
Marsha Low, Detroit Free Press- 1/17/2002

Josh Kushnereit took his first sip of alcohol and his first hit of pot at age 10. By 15 he was immersed in the club scene, attending raves in Detroit's abandoned buildings and warehouses. There he would roll on ecstasy, crystal meth and ketamine until the sun rose. Every waking moment was consumed by his chase for the next fix. Stories like Kushnereit's are becoming familiar with many of the 600 police officers, educators, drug enforcement agents and counselors who gathered in Southfield on Wednesday to discuss the growing popularity of ecstasy and the drug scene.
    "It was an escape that made me feel comfortable and accepted," said Kushnereit, 17, of Rochester Hills. "During that time my family was nonexistent. I was getting high at lunch. I had no morals or self-respect. My life was about getting high, and raves were a place where you could eat drugs and be OK." When Kushnereit's life crashed he was admitted to Pathway Family Center in Southfield, a long-term treatment program for teens addicted to drugs or alcohol. He's been clean for two years. He earned all A's in school last year. And now he has dreams for the future and hopes to attend college. But he is one of few who manage to escape the clutch of drugs, experts said.
    Drug use among teens is on the rise across the country and ecstasy is the hands-down favorite, experts at the conference said. The aspirin-sized pill is used predominantly by white, suburban teens, said David Gauvin, a Washington, D.C.-based drug science officer for the Drug Enforcement Administration. An average teen user will swallow five ecstasy pills a night and be high for eight to 12 hours. The effect: heightened senses. And users will stop at nothing to enhance the high.
    To tantalize the sense of smell, teens wear masks smeared with Vicks VapoRub. Pacifiers and lollipops are chewed and sucked to alleviate teeth grinding -- a side effect. Electronic and techno music is played loudly to stimulate the eardrums and body with thumping sound waves. And the desire for touch will have teens stroking, massaging and having sex with other party goers. "Diseases are being spread in these clubs because there's a lot of sharing and sexual activity," Gauvin said. Ecstasy use results in temporary impotence in men, and police are beginning to see Viagra at clubs and raves. Teens are stealing it from parents and drug dealers are distributing it, creating a new market for the popular prescription drug, Gauvin says. Also alarming is the emergence of the predator -- older men who attend raves and drug parties to prey on teens high on ecstasy and longing for physical stimulation, said Ken Krygel, a retired drug enforcement officer for the Detroit Police Department who continues to investigate drug parties.
    Michigan educators say that despite the absence of local data about adolescent drug use, anecdotally they know that narcotics are easy to obtain and that more kids are using them. Last year, 62 percent of high school teens across the country said ecstasy is easy to find and buy at $20 to $30 a tablet, Gauvin says. That's not a surprise when only 30 percent of the ecstasy being distributed, or 11 million pills, was confiscated by drug enforcement officers in 2001, he says.
    Teens are creative about hiding the drug. The most common tactics include mixing the pills in large bags of Skittles or M&M's or melting Tootsie Rolls in a microwave, placing the ecstasy pills inside and reshaping the candy. "This is not going away," said Myrna Baugh, a counselor at Anderson High School in Southgate. "Every year things get worse. Kids are using at school and at parties. This is our future and I'm here to find out how we stop from having a brain-dead future."
    Medical studies show that ecstasy use kills brain cells immediately, causing memory loss and difficulty concentrating. It depletes the body of serotonin, leading doctors to anticipate a surge in depression among this generation by 2010. Body temperature rises -- 115 degrees is the highest temperature linked to ecstasy use. When things go really wrong the drug can cause uncontrollable bleeding, the blood to congeal, cardiovascular collapse and even death.
    Still, many teens are willing to take the chance. "Normal adolescent behavior means a teen will search for their identity and take a lot of risks," said Lisa Pangrazzi, an addiction counselor for Pathway. "The ones who become addicted feel lonely, and getting high is an easy way to alleviate that pain. It's also an easy way to get accepted by a peer group because all you've got to do is drink something, smoke something or swallow a pill."

Beautiful Mind Has Mixed Success in Portraying Mental Illness
ABC News, 1/17/2002

Mental health experts are applauding A Beautiful Mind for creating a better understanding of schizophrenia, although some say the Hollywood version of John Nash's life does sometimes take liberties with medical realities.  In the movie, Russell Crowe plays Nash, a brilliant mathematician who came up with the game theory of economics and won the Nobel Prize, decades later, in 1994. At age 31, he develops schizophrenia and suffers a mental breakdown. Because of his hallucinations and bizarre behavior, Nash is eventually placed on anti-psychotic drugs. But in the film, he stops taking the drugs after finding that they dull his senses, emotions and sex drive. Instead, he gets a handle on the disease through sheer force of will.
    About 1 percent of the population will develop schizophrenia in their lifetime, and more than 2 million Americans suffer from it in a given year. Experts say that only one in five will recover completely — and they probably won't be able to do it through willpower alone. "Crowe does a brilliant job of portraying the mannerisms, and some of the behaviors of a schizophrenic — the best I have ever seen on the screen," Dr. Ken Davis, chairman of psychiatry at Mount Sinai School of Medicine in New York, told ABCNEWS.com. "On the other hand, the notion that willpower can really overcome schizophrenia is ludicrous."

Drugs, Therapy and Emotional Support
Contrary to public perception, schizophrenia is not the same as having a split personality or a multiple personality. People with schizophrenia have trouble distinguishing between what is real and what is imaginary, and may be withdrawn or have trouble expressing normal emotions in social situations. To manage the illness over a lifetime, most schizophrenics rely on a combination of medications, therapy and the support of friends and family.
    In the film, Nash relies on anti-psychotic drugs during the worst periods of his illness, and his illness flares up when he is not taking them, then seems to improve. "The truth is, the vast majority of schizophrenics will only have partial recovery, and that only with the help of the medication," ABCNEWS' Dr. Tim Johnson said. "But [medication is] not so useful in controlling or helping the social isolation that so many schizophrenics experience."
    Some doctors are worried that schizophrenic patients who see the film might come to believe they're smart enough to beat their illness without medication. "I have not seen the movie, but many of my patients have," said Dr. Adelaide Robb of Children's National Medical Center in Washington. "I do not think that patients should go off medication and rely on willpower. People who are highly intelligent cannot just will away psychotic symptoms."

A Positive Message
Despite Nash's rejection of medication, one doctor said the movie does send a positive message about willpower.  "Some individuals with schizophrenia suffer needlessly from the idea that they have absolutely no control over the illness," said Dr. Steve Lamberti, an associate professor of psychiatry at the University of Rochester in Rochester, N.Y. "While one cannot simply will the disease away, many people do learn to cope effectively with schizophrenia."  Although in the movie, Nash copes with his symptoms by ignoring his hallucinations, another active way to exercise willpower is to participate actively in treatment, Lamberti said. Davis said Nash is an unusual case because he ultimately learned to ignore his hallucinations. "Although he continued to believe his delusions he would not let them consume him," Davis said.

Voices More Common Than Visions
In the movie, Nash sees nonexistent "people" and carries on conversations with them. It makes for glitzy filmmaking, but it's certainly not what your average schizophrenic experiences, experts say. "The movie's portrayal of Dr. Nash seeing and conversing with life-like 'people' is not what most individuals who suffer from schizophrenia experience," Lamberti said.
    Instead, most schizophrenics are besieged by one or more voices that seem to come out of thin air. Those who do have visual hallucinations tend to see things that are distorted, almost "cartoonish," not lifelike as they were in the film, Johnson said. The movie was on target when it came to delusions, which are typical for schizophrenics, experts say. Nash believed he was doing top-secret government work that could save the United States and that he was being followed by Russians. Doctors would call the former a grandiose delusion and the latter a paranoid delusion, Lamberti said. Both types are common.

Medicine Can’t Cure All
While in a mental institution, Nash is treated with insulin coma therapy, in which patients are given insulin to induce a comatose state that lasts about 15 to 60 minutes. The results, as shown in the movie, are horrific. The treatment has been discredited and is no longer used. "The difficulty in the treatment, and side effects, as well as its inability to sustain remission, led to its disuse," Davis said. Insulin therapy ended, in part, because of the introduction of anti-psychotic drugs.
    In the movie, Nash has hallucinations and delusions even when taking his medications. When he doesn't take them, he loses control. But the medications aren't able to address some of his negative symptoms, such as difficulty concentrating, social withdrawal and lack of motivation. "The movie's message that medications are an important part of treatment, although they aren't a cure-all, is an accurate message," Lamberti said.
    Doctors say it is also significant that Nash seems to benefit from the loving support of his wife, played by Jennifer Connelly, and by being in the familiar environs of Princeton University while he is recovering. "An environment that is structured, predictable and supportive is helpful for most individuals with schizophrenia," Lamberti said. "The movie also showed how important family support is to those who suffer from schizophrenia. The importance of family support has been increasingly recognized in the field of psychiatry over the past 20 years, and new forms of family education and treatment have been developed."

Screening for Mental Illness in Students Difficult, Experts Say
Arlene Levinson, Associated Press- 1/18/2002

After failed law student Peter Odighizuwa allegedly stormed the Appalachia School of Law and killed the dean, a professor and a student, acquaintances said they knew he was troubled. But screening college applicants for instability and removing students with serious mental health problems can be difficult, experts say.
    Federal laws bar admissions officers from asking about mental illness, and clamp a shield of privacy over information about students once they're enrolled. Add the communal setting and the culture of openness on college campuses and they are as vulnerable as any community. ''The whole range of behaviors and problems you have in small towns, you have in universities,'' said Debra Stewart, president of the Council of Graduate Schools. ''They're small towns.''
    Unlike small towns, however, there are some extra rules. The Americans with Disabilities Act prevents schools from asking about any mental illness in admissions, and requires the school to accommodate afflicted students which they gladly do, said Barmak Nassirian, policy analyst for the American Association of Collegiate Registrars and Admissions Officers. ''Regrettably, there isn't a whole lot institutions are allowed to do prior to the commission of a nefarious act,'' Nassirian said. A ''hunch'' is not enough to keep someone out of the classroom, he said, ''just because somebody is very passionate shall we say in their discourse.''
    The Family Educational Rights and Privacy Act generally prevents schools from revealing student records to anyone outside the school. This became controversial after the Sept. 11 attacks. A survey of registrars found 220 schools had been contacted by at least one agency seeking student information 50 schools by more than one agency from a group that included the FBI, the Immigration and Naturalization Service and state and local police.
    Most of the time, campuses are generally peaceful havens. ''There's no national pattern of violence on college campuses,'' said Sheldon Steinbach, general counsel for the American Council on Education, which represents higher education groups. ''You're dealing with isolated instances that are basically idiosyncratic and very difficult to prevent.''
    But privacy protections need not be a barrier to safer campuses, said Scott Doner, public safety director at Valdosta State University in Georgia. Odd or scary behavior should be reported to campus police, who can check it out, he said. That's a lesson learned from the high school shootings in recent years: the shooters often talked about their plans. ''A lot of pepole do not want to get involved,'' said Doner, president-elect of the International Association of Campus Law Enforcement Officers. ''But I think because of what happened on Sept. 11, and going all the way back to Columbine, people are beginning to realize they can make a difference.''
    On the Net:
Federal Educational Rights and Privacy Act: http://www.ed.gov/offices/OM/fpco/ferpa1.html
Americans With Disabilities Act: http://www.ed.gov/offices/OCR/docs/hq9805.html

 

After Teens Go Bad, Parents Often Get the Blame
Michelle Locke, Associated Press- 1/18/2002

BERKELEY, Calif. -- The first question for many people after young American John Walker Lindh was found fighting with the Taliban in Afghanistan was: What was he doing there? But the next question was: Where were his parents in all of this? What were they thinking when they bankrolled their son's travels in search of an Islamic ideal, first in Yemen as a 17-year-old and later in Pakistan and Afghanistan as a young adult?
    After practically every school shooting or other act of wrongdoing by a teen-ager, the sins of the children are visited on their fathers and mothers in sometimes fiercely critical post-mortems of their parenting. ''People assume that there's a very direct correspondence between what kids do and what their parents did for them or to them,'' said James Garbarino, who talked with the parents of one of the Columbine High School gunmen for his recent book, ''Parents Under Siege.'' For his part, Garbarino says that parents are not necessarily to blame for what their children do.
    In recent weeks, the spotlight has been put on the parents of Charles Bishop, the 15-year-old who crashed a small plane into a Tampa, Fla., high-rise, leaving a suicide note expressing support for Osama bin Laden. Also in the news were the parents of Richard Reid, the 28-year-old accused of trying to detonate explosives in sneakers during a trans-Atlantic flight.
    The criticism of Marilyn Walker and Frank Lindh, Lindh's estranged parents, has been scathing, and has been aimed at both their actions and their environment liberal, wealthy Marin County just north of San Francisco. There has been speculation that Lindh lost his moorings amid the confusion of his parents' separation and his mother's own spiritual wanderings, which ultimately led her to convert to Buddhism. It didn't help when his parents said immediately after their son's arrest that he is a ''good boy'' and that they had supported his pilgrimage to world trouble spots. Lindh's ''road to treason and jihad didn't begin in Afghanistan. It began in Marin County, with parents who never said, `no,''' columnist Jeff Jacoby wrote in The Boston Globe.
    His parents, after weeks of silence, said through their lawyer that they still love and support their son. Lindh's parents had paid for his solo trip to Yemen, one of the world's most dangerous places for Westerners, despite misgivings that prompted Marilyn Walker to repeatedly call representatives of the Yemen Language School, seeking assurances that he would be OK. Lindh repeatedly got in trouble with authorities there. He considered himself a more pious Muslim than most Yemenis, and made illegal attempts to meet with militants, according to those who encountered him. During a second trip to the Middle East eight months later, he sent an e-mail from Pakistan asking for more money. His father wired him $1,200, and Lindh was off to meet bin Laden. Lindh's parents did not see him again until he appeared on CNN, a wounded and disheveled prisoner. ''Clueless,'' is one of the milder epithets that has been aimed at Lindh's parents.
    The parents of Eric Harris and Dylan Klebold, the teen-agers who in 1999 killed 12 students and a teacher at Columbine High School and then committed suicide, were similarly criticized. In that case, the criticism was not that the parents were too tolerant, but that they were ignorant they should have known about their boys' dark fantasies and weapons cache.
    Phyllis York, co-founder of Toughlove International, which urges parents to set limits on unruly offspring, said she is not surprised at the criticism. ''We live in a culture where parents don't count, yet they're blamed as scapegoats,'' she said. Child psychiatrist Dr. Elizabeth Berger sees fear behind the outrage. ''When a person in an unexpected way does something grotesque, it is terrifying,'' she said. ''Everyone says, `Lord, there but for the grace go I.' Rather than tussling with that humbling and humanitarian idea, frequently they push that away by asserting `This could not possibly be me.'''
    Child experts agree: Teens are good at fooling their parents. Garbarino asked freshmen at Cornell University, presumably a group of high-achievers, if they had hidden anything scary from their parents. They had, everything from suicidal leanings to drug busts. Berger, author of ''Raising Children With Character,'' would not comment on the Lindh household and said no outsider can deliver a clinical analysis of what is surely a complex situation. She said she does not absolve parents from all responsibility, but in general, ''one cannot work backward from a troubled offspring and assert that the parents zigged when they should have zagged.''
    On the Net:
Toughlove: http://www.toughlove.org
Berger's site: http://www.parentingbyheart.com

Colorado Bill Would Trim Mentally Ill Inmates' Rights
Julia C. Martinez, Denver Post- 1/18/2002

Inmates sent to the state's mental hospital would be denied the same rights given other mental patients there under a controversial measure before the Colorado legislature. The legislation, among other things, would allow prison and jail officials to transfer inmates to a state mental facility for evaluation if they "appear" to be mentally ill, would take away their rights under the current state mental health care and treatment law, and would make it legal to forcibly administer medication to them once they are there, even before they've been proven "dangerous to themselves or others."
    The legislation, if passed, would propel Colorado "back to the ice ages," a Denver attorney said. "Some of the things they are trying to do in this bill are on their face unconstitutional," said Kathleen Mullen, lead counsel on a major federal lawsuit being brought against the state with regard to the rights of forensics patients - those charged with a crime or found guilty by reason of insanity - at the state hospital. "One example is that (the bill says) you can medicate someone in a state facility without proving that they are dangerous to themselves or others. That has been declared unconstitutional by both state and federal courts," Mullen said. "The state can't take away their constitutional rights. That's going back to the ice ages."
    But the sponsor of House Bill 1143, Rep. Joyce Lawrence, a Republican from Pueblo, home to the state mental hospital, said the bill doesn't take away rights. "The problem has been that when inmates are in the forensics unit, they could be dangerous to themselves or others," Lawrence said. "They could be bringing in contraband or other things that can be used in a manner that is harmful to themselves or others. "They haven't lost their rights," she said, "because once you're in jail or in the Department of Corrections you lose those rights."
    Lawrence said the bill was prompted by a federal lawsuit pending in U.S. District Court in Denver. She said the legislation could affect the lawsuit. "It should affect it because you clearly make your statement that they don't have 27-10 rights when they come into the unit from the DOC or from jail," Lawrence said, citing the health statute that outlines patients' rights. Lawrence said passing the legislation would benefit the state by eliminating some patient lawsuits. "The benefit is you don't have huge lawsuits that tie us up in court and involve big payouts," she said.
    Ken Lane, spokesman for the attorney general's office, said the bill became necessary after several patients brought the federal lawsuit claiming, among other things, that they have a right to have personal cellphones and laptops while housed in the maximum-security unit of the state hospital. A judge ruled in 1999 that the same "standard of care" should apply to both civil patients and criminally committed forensic patients, Lane said. Because of the lawsuit, other patients are now trying to get phones, computers and visits, he said.
    The attorney general's office does not believe the 1999 ruling gives criminal mental patients the same "rights" listed in the mental health act that apply to civil patients, Lane said. Some of those rights include having "ready access" to telephones, visitors and letter-writing materials. The bill would still give them the right to consult with an attorney or, after 72 hours in the mental ward, to contest their transfer to the state hospital. Lawyers in the federal lawsuit, including Mullen, believe the ruling does extend those same rights.
    Senate Majority Leader Bill Thiebaut, D-Pueblo, an attorney, said he is considering carrying Lawrence's bill in the Senate but has questions that need answers before he decides. "What we need to be careful of is that we're dealing with forensics patients, and we need to be sure they're being treated properly, but at the same time we need to make sure that workers in our facilities are safe," Thiebaut said. "I need to determine what rights are being taken away . . . what are the justifications," Thiebaut said. "These people are sort of different in the sense that they've been admitted through the court. . . . So what does that do to their status? Is that enough to distinguish them from the civilly committed patients?"

Study: Stress Takes Toll on Brain
Lauran Neergaard, Associated Press- 1/18/2002

WASHINGTON— Short bouts of stress caused the brain cells of mice to become hypersensitive for weeks, says a new report seeking to uncover the molecular root of post-traumatic stress disorder. It's not clear if human brain cells react the same way. But the research, by Israeli scientists, is generating interest among scientists struggling to unravel traumatic stress in the aftermath of terrorism. ``It's a tantalizing new lead,'' said Rockefeller University professor Bruce McEwen, who researches stress effects on the brain.
    Anyone who has ever experienced trauma knows such experiences can leave you nervous, easily startled. It's one way the body protects itself from future harm, by learning from a bad experience. But in some people, this protective mechanism goes too far, leading to high anxiety, nightmares and flashbacks known as post-traumatic stress disorder. No one knows just what happens to switch a normal stress response to an abnormal, hyper response.
    But in Friday's edition of the journal Science, Hermona Soreq and colleagues at Hebrew University argue a key player is a brain protein called acetylcholinesterase, or AChE, that is important in helping messages jump from one neuron to the next. Soreq exposed mouse brain cells to AChE-affecting chemicals, including the stress hormone cortisol, and examined the brain tissue of mice stressed in such ways as forcing them to swim. Within minutes, relatively short periods of stress caused the mice to produce a usually rare, abnormal version of AChE that doesn't provide the same help in neuronal signaling. That somehow left the mice's neurons hypersensitive. Brain scans found higher levels of electrical activity that lasted for weeks, a lengthy effect Soreq called surprising.
    Soreq also works for an Israeli drug company attempting to create an AChE-targeting treatment for traumatic stress. One of the mouse cell studies suggested a chemical called EN101 could be a candidate for further study. Sometimes, ``we need stress responses. ... We need to be more alert, we need neurons to be active when the situation calls for that,'' Soreq said. But, ``our findings show that traumatic experiences as well as certain chemicals do have long-lasting effects, and that repeated stress may cause cumulative effects.'' Soreq cites similarities in symptoms between patients with post-traumatic stress disorder and people poisoned by agricultural chemicals that target the cholinergic system. That system is involved in how the brain stays vigilant. AChE interactions with other brain chemicals have also been associated with memory and behavior.
    But it's far from the only theory behind post-traumatic stress disorder, cautioned Rockefeller's McEwen. On Jan. 29, he is hosting a special lecture in New York City for people worried about the effects of the Sept. 11 terrorist attack, where scientists from five universities will put into laymen's terms all that is known about stressing the brain. Based on a study that blocking certain cell receptors inhibits the formation of bad memories, some researchers are exploring whether beta-blocking drugs might prove stress-protective, McEwen said. Other research shows the actual brain circuitry in a region called the amygdala changes after an animal is stressed, findings generating intense interest. Even newer studies suggest trauma victims whose bodies produced less of the stress-related hormone cortisol in the aftermath were more likely to develop post-traumatic stress disorder.
    The disorder ``is a very complicated phenomenon in which various hormones in the body and various systems in the brain may all be involved,'' McEwen notes. While Soreq's abnormal AChE may indeed play a role, ``it's far from clear exactly how and where.'' But regardless of what causes post-traumatic stress, the good news is ``the brain is very resilient. Many of these changes are not irreversible,'' he said.

No Such Thing As a 'Typical' Serial Killer
Scott Sunde, Seattle Post-Intelligencer- 1/16/2002

The world is full of experts on serial murder. Just walk the true-crime aisle of your local bookstore and look at the titles. Or punch in "serial murder" on an Internet search and watch the links roll in. But don't believe everything you read, and know that most of the common wisdom about serial murder is probably wrong. So what is the profile of a serial killer?
    "They say there are no stupid questions. But that is," said Robert Ressler, who has spent much of the past 30 years studying murders and serial killings, first with the FBI, then as a consultant. "What is a serial killer like? It's like saying what is a journalist like or what is a policeman like or what is a minister like." Ressler interviewed dozens of murderers and other offenders in prison and was an FBI profiler. He was a consultant or researched such cases as the Los Angeles Night Stalker and such killers as Ted Bundy and John Wayne Gacy. He's learned enough not to apply generalizations when it comes to serial murder. The killers might pick women or men, adults or children. The motivations might be sexual. They could be racial. Some killers keep souvenirs of their victims; other take grisly trophies, such as body parts, to maintain in a place of honor in their homes. And yet in countless investigations of serial killings, frustrated police put in a call for a profiler. They want to know what sort of person could do this and what sort of person they should be looking for.
    The search for the Green River killer was no exception. In the 1980s, King County police turned to an FBI profiler, John Douglas, who provided a report on the possible characteristics of the killer responsible for the deaths of a growing number of women. Court documents have kept the profile and follow-up work that Douglas did a secret, but some details of a possible suspect have come out: a white man in his 20s or 30s who is divorced and frequents prostitutes. The problem, at least one key investigator said, is that Douglas' work was general enough to rule in nearly everyone who cruised Pacific Highway looking for a streetwalker. Investigators later used the profile to persuade a judge to issue a search warrant for the home of Gary Ridgway in the 1980s. He was arrested and charged with four of the killings late last year, after DNA tests allegedly linked him to evidence from the bodies of three of the victims.
    In the early 1990s, investigators still were searching for a Green River Killer. They turned to Dr. John Liebert, a local psychiatrist who had been a consultant to the task force investigating the murders. "I did screen a number of suspects with the remaining people in the task force. I don't know if this individual (Ridgway) was one of them or not," Liebert said. "They would bring me records of individuals and go over them with me and ask my opinions as to whether I thought they were excellent suspects or fair suspects or, in some cases, whether in my opinion they could be ruled out." Liebert said he doesn't remember his exact profile of the Green River Killer. But he does remember advising investigators that possible suspects with histories of severe mental illness could be ruled out. A person with such a history of mental illness "doesn't have the capabilities of doing damage over a long time in a large geographic area."
    There are dangers in profiles. Robert Keppel, a former detective and consultant to the Green River task force, takes Douglas' profile to task. In his book on the Green River killings, Keppel describes the profile as so broad that it could have included any number of men in King County. Douglas did not respond to repeated requests for an interview. In fact, investigators acknowledge that men other than Ridgway met the profile. In 1986 -- a year before Ridgway's home was searched -- investigators got a warrant to search the home of a different man. Investigators also used Douglas' work to obtain that search warrant.
    On the other hand, investigators may do themselves no favor by limiting themselves to the outlines of a more narrowly drawn profile. "They are very invisible," Liebert said of serial killers. "If you look for the obvious, you don't get it. But they are usually right in front of your face." Don't believe what so-called experts dish out, Keppel warned. One bit of serial-killer wisdom, he noted, is that the murderer is typically unemployed. He ticked off serial killers or suspects who held down good jobs. Ridgway, for example, worked the same job for more than 30 years. Robert Yates, who has admitted to a killing spree of prostitutes in Spokane, worked in an aluminum plant.
    After a bomb went off in 1996 at the Olympics in Atlanta, law enforcement reportedly came up with a suspect who fit the profile of a lone bomber: security guard Richard Jewell. But Jewell was innocent, which the Justice Department later admitted. There was criticism in the Atlanta Journal-Constitution that a profile was developed in a rush, then became a focal point of the investigation, rather than a tool. Jewell's attorney, Lin Wood, said the profile was the work of the newspaper and that the FBI never developed a profile. A federal law enforcement agent did remark at one point that Jewell might fit the profile of someone who would do the bombing to become a hero, Wood said. Jewell is suing the Atlanta newspaper.
    Today, experts who have done profiling are hesitant to make snap judgments about Ridgway and his life. At most, Liebert and Ressler were willing to say that certain of Ridgway's characteristics would not rule him out. Ridgway is white and was in his 30s when the murders were occurring. He has been married three times, had several girlfriends and has admitted to police that he has an addiction for prostitutes. All of that, Ressler said, could be consistent with a suspect. Ridgway has been described as meticulous, both in appearance and on the job. He worked in a truck factory, applying blueprints for painting. "Anybody that would do this much and eludes apprehension for this long has to be meticulous," Liebert said. Co-workers said Ridgway could be gregarious. That's a characteristic that wouldn't rule him out, Liebert said. "John Wayne Gacy had his photo taken with the governor of Illinois. Ted Bundy was active in politics, and people at the (University of Washington) law school couldn't believe it was him."
    Co-workers and others say Ridgway seemed at times religious, reading the Bible at work and trying to save the souls of those around him. Ressler said suspects could "seek spiritual support for what they are doing." Liebert said he suggested to the task force that the suspect might be religious. "It could be a diversion to lead people away from him," he said. Bellevue psychologist Edward Schau, who is not an expert on serial killings, is trying to sell a book on what he believes is the Christian symbolism in the Green River killings. He said in an interview that he believes the killer had a deep understanding of religion and religious symbols. Carol Christensen is one of the women Ridgway is charged with killing. Schau noted her name includes the word "Christ" and two fish -- symbols of Christ -- were left on her body. An empty bottle of wine was on her stomach, and a mound of sausage was left in her hands. To Schau, that is blood and flesh, which also carry heavy religious meaning. He finds symbols of the trinity in the triangular rocks placed in the vaginas of some of the victims. He notes that one victim was found buried with small pieces of plastic, including one with the number "15" on it. The Book of Hosea in the Bible notes that 15 shekels of silver was the price to redeem a prostitute or adulterer.
    Many of the Green River victims were prostitutes or runaways. Some experts say such women are perfect targets of opportunity for a serial killer. "They're not missed. Prostitutes are easy. You say, 'Hey, lady, what's going on? Let's go for a ride.' And they hop in the car," Ressler said. Liebert said serial killers who murder prostitutes select victims about whom police may find out little. "When you're dealing with that particular population, you don't get valid information about the victims. There is not a lot of trust between the police and the population he (the Green River Killer) tended to go after."

Montana Law Against Serving Drunks Booze Tough to Enforce
Bob Anez, Associated Press-1/19/2002

HELENA, Mont. -- Just when is someone too drunk to be served up another drink at a bar? An Associated Press review of 700 liquor violations in Montana over the past decade found just four instances in which businesses were cited for serving booze to someone already drunk. The problem, say law officers and industry representatives, is determining when a customer is too drunk for another drink. ''It's a very difficult situation for everybody,'' said Jeff Bryson, investigative chief for the state Justice Department, which oversees liquor licenses. ''The bar industry doesn't want to be in the business of serving drunk customers but it's not always easy for a bartender to tell,'' he said. ''And what about police? Are they supposed to take a breathalyzer into a bar and say 'OK, everybody, line up against the wall and let's see who is already drunk?'''
    Last August, House Majority Leader Paul Sliter was killed when the car in which he was riding rolled down an embankment on a winding dirt road west of Helena. Shane Hedges, Gov. Judy Martz's policy adviser, was driving and later pleaded guilty to negligent homicide in the death of his best friend. Tests showed his blood-alcohol level was 50 percent above the legal limit. The popular bar and restaurant where the two spent the evening was not cited. Leo Gallagher, the county prosecutor, said investigators were unable to determine if Hedges was clearly drunk when he was sold his last drink that night. ''I never thought there was sufficient evidence to charge'' the bar, Gallagher said. ''Everyone said Shane looked fine as he left.''
    In 2000, Montana had the nation's second-highest rate of alcohol-related traffic deaths, trailing only Mississippi. A total of 110 people died in alcohol-related traffic accidents, a rate of 12.19 alcohol-related traffic fatalities per 100,000 residents. State law forbids alcohol from being sold to ''any person apparently under the influence of alcohol.'' Administrative penalties range from $250 for a first offense to license revocation for a fourth offense. The law also states those giving alcohol to someone ''visibly intoxicated'' can be responsible for injury or damage that person causes because of his drunken condition.
    In one of the few cases in which a tavern was held liable, a Great Falls bar owner was ordered in 1993 to pay $750,000 in damages to a customer injured when another patron left the bar drunk and drove his vehicle through the tavern's wall. Mark Staples, attorney for the Montana Tavern Association, said that decision, upheld by the state Supreme Court in 1999, put bar owners on notice they have little legal protection if a drunken customer is served alcohol and illegal behavior later can be traced to that intoxication.
    Helena Police Chief Troy McGee said state law offers little direction to bartenders. ''The law doesn't say how drunk you have to be before you can't be served,'' he said. ''It's in the judgment of whoever is doing the arrest.'' And Gallagher said placing blame can be next to impossible in tavern settings. ''When you have a large group of people at a table, drinks are served. How can you hold somebody liable when it's unclear who at the table is drinking and who is driving?'' he said. Bryson, the Justice Department official, said putting undercover officers in bars to watch if drunk customers are being served is impractical. Enforcing drinking laws is up to local law enforcement agencies, he said and most lack the manpower for such operations.

Focus on Anger May Help to Curb 'Road Rage'
Louis Jacobson, Washington Post- 1/21/2002

Over the past few years, Americans have expressed growing alarm at "road rage" -- assaults perpetrated by angry drivers against other motorists. But for every incident of criminality, there may be hundreds of cases of frustrated drivers lashing out in more limited ways, such as cursing or yelling. As commuting patterns grow longer and longer, tendencies toward "angry driving" are attracting increasing attention from researchers. "Our reading of the literature is that aggressive driving may be as large a risk factor for accidents as driving under the influence of alcohol," said Edward B. Blanchard, a psychology professor at the State University of New York at Albany. "It's a problem that really needs to be addressed."
    The study of driving anger is relatively new. Not only is there no officially recognized mental health disorder that covers driving anger, but no recognized disorder includes anger as the primary determinant. But Jerry Deffenbacher, who teaches at Colorado State University, is one of a number of psychologists who believe that more attention is needed. Deffenbacher argues that even run-of-the-mill angry drivers can make life difficult for others, as well as themselves. "When people commute for an hour a day, just think about how much blood pressure is being raised, how many teeth being gnashed, how many interpersonal relationships are being damaged," Deffenbacher said. "It's the wear and tear, the sandpaper on the soul. As a therapist, that's what I'm worried about."
    Deffenbacher began studying angry drivers in the late 1980s, several years before a widely publicized American Automobile Association study made road rage a commonly understood phenomenon. Deffenbacher published his first paper on the subject in 1994 and continues to expand his lines of inquiry. Conceptually, he distinguished angry drivers from aggressive drivers. "Aggressive driving is behavior that puts someone at risk -- but you could be a rapid lane changer who is as happy as a clam," Deffenbacher said. By contrast, angry drivers tend to express emotional reactions through cursing and shouting, but they generally don't respond in ways that endanger the safety of their fellow motorists.
    Deffenbacher devised a questionnaire to gauge the driving habits of his students at Colorado State. Some of the measures he designed determined how angry his subjects got while behind the wheel. Others categorized how those drivers reacted to frustrating situations on the road. Once Deffenbacher had used the questionnaire to determine the angriest and least-angry drivers in the group, he gave members of those top and bottom groups a diary to record their actual driving experiences. The diaries demonstrated that the differences between high- and low-scorers were paralleled by the subjects' behavior. High-anger drivers in the study reported 2.7 times as many angry incidents as the low-anger drivers did. Over the course of a 300-driving-day year, that would mean that the high-anger drivers would become angry 729 times, compared with only 270 for the low-anger drivers. In addition, the diaries showed that high-anger drivers tended to become more intensely angry. High-anger drivers rated the intensity of their angry outbursts as 60 on a scale of 1 to 100. Low-anger drivers, by contrast, experienced outbursts that rated only 27.
    Then, Deffenbacher took his research a step further. He brought in high- and low-anger drivers to use a video game simulator in his laboratory. The simulator offered Deffenbacher's subjects three situations: a country road with no traffic; a three-lane urban highway with slow-moving traffic; and a twisting, rural road in which the driver is stuck behind a slow-moving vehicle. While drivers in both groups reacted calmly to the easy country drive, the high-anger drivers were likelier to become angry in the two more frustrating situations. Moreover, the high-anger drivers drove in ways that were more likely to cause accidents. They followed more closely behind the cars in front of them, and they experienced "crashes" at twice the rate of low-anger drivers.
    So if high-anger drivers are more likely to cause havoc, Deffenbacher asked, why are they the way they are? The answer isn't clear. Deffenbacher does know that it doesn't have to do with gender: Men and women displayed roughly similar patterns of behavior. It also isn't a factor of spending a lot of time behind the wheel, because high- and low-anger subjects reported driving roughly the same number of trips and miles. Nor did it come from behaviors learned from the students' parents. When Deffenbacher gave diaries to the parents of his test subjects, he found that the parents' driving behaviors bore little correlation to those of their children. (In general, the parents were less angry behind the wheel than their children were, except that they expressed higher anger at the illegal behavior of other drivers.) Deffenbacher plans to study other possible factors next -- perhaps the driving habits of the subjects' friends, or their degree of exposure to violent video games. Efforts to link driving anger to an anger that expresses itself more generally shows a correlation, but not a strong one, Deffenbacher said.
    Even though he hasn't yet pinpointed a root cause of driving anger, other experts say they are impressed with Deffenbacher's findings. "He is a top-notch researcher, and his stuff is cutting-edge," said Raymond DiGiuseppe, a psychology professor at St. John's University. Deffenbacher has also made progress in treating angry drivers. Partially funded by the Centers for Disease Control and Prevention, he subjected small groups of high-anger drivers to eight weekly sessions in which they learned coping techniques and exercises that promote relaxation and attitude adjustment. After five studies, he said, "I think a tentative and optimistic answer is yes, we can help angry drivers." Based on the results from their driving diaries and a comparison to a control group that took part in no sessions, treated subjects typically lowered their anger levels from the 85th percentile to the 50th percentile, a level that is average for the population at large. Driving behaviors generally improved quickly and remained at that new level during one-month and one-year follow-up assessments, Deffenbacher said.
    Deffenbacher acknowledges that caution is advised. It is hard to tell whether self-reported diaries will be as conclusive as, say, independent monitoring devices in cars. Deffenbacher's universe of college students also may be unrepresentative of the population as a whole. On the brighter side, Blanchard of SUNY-Albany has reported positive results from treatment sessions he has conducted with a far less cooperative group than Deffenbacher's -- drivers referred to him by the local criminal justice system.
    While no one envisions required therapy sessions for large segments of the driving public, the findings suggest that willing participants as well as those facing less appealing judicial options may benefit from inexpensive group treatment. "We treat depression not just because depressed people can become suicidal," Deffenbacher said. "We treat it because depression makes people unhappy and miserable."

Experts Say Murder Suspect's Behavior Narcissistic, Psychopathic
Bryan Denson, The Oregonian - 1/21/2002

PORTLAND, Ore. - As Christian Longo's wife and three young children lay in the cold, dark trays of a Portland morgue last month, he was seen smiling on a warm, white beach in Cancun, Mexico. As mourners buried his family in a snowy Ann Arbor graveyard Jan. 7, Longo was hanging out on another Mexico beach, where he went sightseeing and flashed the peace sign at someone snapping his photo. And as he returned to Portland in handcuffs on a Tuesday evening flight from Houston, the man accused of killing his family and dumping their bodies in two coastal inlets was still smiling, according to passenger Greg Hope. "When I first walked on the plane, I walked back to use the restroom and he was chatting with the two (sheriff's deputies) sitting next to him," said Hope, who owns an Albany, Ore., travel agency. "If you didn't know who he was or what he was there for, you just wouldn't believe it. It was so strange to see the guy smiling and talking as though nothing had gone on."
    But the 27-year-old Longo's demeanor - before and after his Jan. 13 capture in Mexico - scarcely surprises psychologists who study criminal behavior. If Longo is indeed guilty of slaying his 34-year-old wife, MaryJane, and their 4-year-old son and two daughters, ages 2 and 3, his behavior fits the chilling pattern of a criminal psychopath whose family no longer was useful and was "homicidally dismissed," said three psychologists who have followed news accounts of the case.
    The psychologists immediately caution that they've neither met nor interviewed Longo, nor are they connected to the case. But they've followed the national manhunt for Longo, who became one of the FBI's most wanted fugitives. And they have applied their expertise in studying criminal behavior to what they know of the case. They said Longo's failure to carefully hide his identity on the run fits the pattern of someone whose grandiose sense of self convinced him he was too smart to be caught. And Longo's record as a con man and thief, they say, is evidence that he was capable of making the leap to more serious crimes.
    "This is a psychopathic crime," said Michael F. Abramsky, a forensic psychologist whose practice in the Detroit suburbs is 29 miles from the Longos' former home in Ypsilanti Township. "This is cold-blooded, a murder for convenience." Men kill children much less frequently than women do, making infanticide perhaps the only violent crime category in which women lead men, said Abramsky. A man who kills his family typically turns himself over to authorities, commits suicide or gets into a standoff with police, according to J. Reid Meloy, a San Diego forensic psychologist and author of "The Psychopathic Mind: Origins, Dynamics and Treatment." But a psychopath would likely kill his family with an escape plan in mind, he said.
    Psychopaths are people who, for reasons psychologists don't yet understand, operate without consciences. They are unable to bond with other people or feel compassion. Frequently they see other humans, even family members, as obstacles to their own pursuits.  Abramsky said Longo's record of fraud and theft - including a felony conviction for counterfeiting checks, then drawing them in his own name - demonstrates a kind of grandiosity and narcissism common to psychopaths. "They think they're smarter than everybody else, that they can get away with things that other people can't," he said. "And as a result of that, sometimes they're sloppy."
    Sloppy couldn't begin to describe the series of blunders Longo made during a 2,700-mile fugitive odyssey from Waldport, Ore., to Tulum, Mexico. The FBI thinks Longo left a stolen van traced easily to him on the parking lot of a Wilsonville, Ore., auto dealership. He was seen there twice eyeing a sport-utility vehicle that later was stolen from the lot. He fled to San Francisco, according to the FBI, where he stayed in a downtown hostel and applied for work at a Starbucks. He apparently carried his own passport, abandoned the stolen SUV at an airport monitored by nearly 1,000 security cameras and left belongings inside later traced to him, authorities said. He used identification misappropriated from a Newport, Ore., man to buy an airline ticket and board a plane for Cancun, the FBI said.  Once on Mexico's sunny Caribbean coast, he never changed his appearance. He used his middle and last names and told at least one person where he was heading, the FBI reported. Longo even allowed himself to be photographed and kept a journal of his travels.
    It's not that he wanted to get caught, the psychologists speculated, but that he figured he could stay one step ahead of his pursuers. "There were a lot of people much smarter than he was, but he didn't recognize them as such," said Sheila Deitz, an Englewood, Colo., forensic psychologist who said she is fascinated by the case. "Unfortunately, there are smart psychopaths and dumb ones, and - if he did it - he fits the latter category." Deitz theorized that Longo - an insulin-dependent diabetic, debt-plagued businessman and former Jehovah's Witness - might have been resentful about his many responsibilities. "Here was a guy who was trying to overthrow responsibility," she said, "and he did it in his own way."
    Meloy said it would not surprise him, if indeed Longo is guilty of the killings, to learn that he mimicked love for his family while planning to kill them. "That's a classic psychopathic maneuver, where humans are only objects of gratification," said Meloy. "When they no longer serve any useful purpose, they are dismissed. "They can," he added, "be homicidally dismissed."