HHS To Propose Increased Funding To Narrow Drug Treatment Gap
U.S. Newswire, 2/1/2002

WASHINGTON--HHS Secretary Tommy G. Thompson today announced that President Bush will propose an increase of $127 million for his five-year drug treatment initiative to reduce the 'treatment gap' in the United States --the difference between the number of people who need treatment for an illicit drug problem and those who receive the treatment and services necessary to rebuild their lives. The President's proposal is for the second year of this five-year initiative. ''There continues to be a great need to expand our nation's capacity to treat people who are addicted to illegal drugs,'' Secretary Thompson said. ''This administration is committed to supporting local programs that combat the personal despair and community disintegration brought by drug addiction.'' The proposed funding will allow states and local communities to provide treatment services to approximately 546,000 individuals, an increase of 52,000 over fiscal year 2002. The funding will be administered by HHS' Substance Abuse and Mental Health Services Administration (SAMHSA).     
    SAMHSA's National Household Survey on Drug Abuse found in 2000 that approximately 800,000 people who needed treatment for an illicit drug problem received treatment at a specialty facility. Of the 3.9 million people who needed but did not receive treatment in 2000, an estimated 381,000 reported that they felt they needed treatment for their drug problem. This estimate includes 129,000 people who reported that they had made an effort but were unable to get treatment and 252,000 who reported making no effort to get treatment.
    John P. Walters, the nation's Drug Czar, noted that the President's proposed budget reinforces the administration's commitment to providing effective drug treatment, and emphasized the importance of encouraging those in need to seek help. ''The funding increases proposed by the President will provide critical resources where they are needed most: at the local level,'' said Walters. ''Bolstering the treatment system will make it even more important to engage friends, spouses, and employers of drug users in the 'compassionate coercion' that is so often necessary to help drug users help themselves.''
    HHS' fiscal year 2003 budget will request an increase of $127 million for the President's drug treatment initiative, providing increased funding for the Substance Abuse Block Grant (an additional $60 million) and for competitive drug treatment grants (an additional $67 million). The Substance Abuse Block Grant is the cornerstone of states' substance abuse programs, providing approximately 51 percent of all public funds expended for substance abuse treatment and support for 10,500 community-based organizations. The President's initiative brings total requested funding for substance abuse treatment and prevention activities under SAMHSA to $2.3 billion.

13-Year-Old Sex Offender Moved Again After Violating Parole
   Ruth Teichroeb, Seattle Post-Intelligencer- 2/2/2002

A 13-year-old sex offender who gained notoriety because the state can't find him a stable home has been sent to a state juvenile institution on a parole violation. For the second time in a month, the state was forced to move the boy amid an uproar from frightened residents -- this time in the rural community of Seabeck. Kitsap County Sheriff Steve Boyer said his deputies discovered earlier this week that the boy made a threatening gesture on Jan.10, eight days before the Department of Social and Health Services placed the teenager in the Seabeck foster home.
    While living in an Island County foster home, the boy allegedly pointed a mechanical pencil at a member of his DSHS support team and made a threatening comment, Boyer said. "Under the circumstances, it should have been investigated," Boyer said. "I don't consider it a minor incident." DSHS said the boy's alleged victim "did not feel threatened," so the incident was not reported to law enforcement, the agency said in a statement yesterday. Kitsap County authorities reported the incident to the boy's parole officer and Anacortes police. That prompted the boy to be moved Thursday night to the Echo Glenn juvenile center in North Bend, Boyer said.
    There had not been any problems with the boy since he was sent to the Seabeck foster home on Jan.18, Boyer said. But neighbors had protested loudly about living near a Level 3 sex offender, the most likely to reoffend. They complained that police would not be able to respond quickly enough in the rural area. Police had to warn residents at a community meeting Wednesday to not engage in "vigilante stuff," the sheriff said. "There was talk of guns and this and that," Boyer said.
    The boy served a nine-month sentence last year at Echo Glenn after being convicted of attempting to rape a pregnant woman in an Alderwood Mall bathroom last year. He has also been accused of attacks on a 9-year-old girl and a 7-year-old boy. After being released from Echo Glenn Dec. 31, the boy spent several weeks sitting in the Oak Harbor DSHS office on weekdays -- and nights and weekends at a temporary foster home in Everett. The cost was estimated at $28,800 a month. DSHS official Marilyn Perry said the boy can stay up to 30 days at Echo Glenn, and will then return to foster care.
    But David Cousineau, director of Seattle Children's Home, said finding appropriate treatment for the boy in Washington state may now be next to impossible. "He's become so notorious that I don't know if any facility can properly care for him," said Cousineau, who offered almost a month ago to house the boy in his locked treatment center. DSHS refused, saying the boy did not qualify for a locked treatment facility. Cost and "turf battles" within DSHS appear to be contributing to the confusion about how to handle the boy, Cousineau said. "All of this really points out how we fail our sickest children," Cousineau said.

The Trouble With Self-Esteem
Lauren Slater, New York Times Magazine- 2/3/2002

Take this test:
1. On the whole I am satisfied with myself.
2. At times I think that I am no good at all.
3. feel that I have a number of good qualities.
4. I am able to do things as well as most other people.
5.1 feel I do have much to be proud of.
6.1 certainly feel useless at times.
7. I feel that I am a person of worth at least the equal of others.
8. I wish I could have more respect for myself.
9. All in all, I am inclined to. feel that I am a failure.
10. I take a positive attitude toward myself.
    Devised by the sociologist Morris Rosenberg, this questionnaire is one of the most widely used self-esteem assessment scales in the United States. If your answers demonstrate solid self-regard, the wisdom of the social sciences predicts that you are well adjusted, clean and sober, basically lucid, without criminal record and with some kind of college cum laude under your high-end belt. If your answers, on the other hand, reveal some inner shame, then it is obvious: you were, or are, a teenage mother; you are prone to social deviance; and if you don't drink, it is because the illicit drugs are bountiful and robust.
    It has not been much disputed, until recently, that high self-esteem--defined quite simply as liking yourself a lot, holding a positive opinion of your actions and capacities--is essential to well-being and that its opposite is responsible for crime and substance abuse and prostitution and murder and rape and even terrorism. Thousands of papers in psychiatric and social-science literature suggest this, papers with names like "Characteristics of Abusive Parents: A Look at Self-Esteem" and "Low Adolescent Self-Esteem Leads to Multiple Interpersonal Problems." In 1990, David Long published "The Anatomy of Terrorism," in which he found that hijackers and suicide bombers suffer from feelings of worthlessness and that their violent, fluorescent acts are desperate attempts to bring some inner flair to a flat mindscape.
    This all makes so much sense that we have not thought to question it. The less confidence you have, the worse you do; the more confidence you have, the better you do; and so the luminous loop goes round. Based on our beliefs, we have created self-esteem programs in schools in which the main objective is, as Jennifer Coon-Wallman, a psychotherapist based in Boston, says, "to dole out huge helpings of praise, regardless of actual accomplishment." We have a National Association for Self-Esteem with about a thousand members, and in 1986, the State Legislature of California founded the "California Task Force to Promote Self-Esteem and Personal Social Responsibility." It was galvanized by Assemblyman John Vasconcellos, who fervently believed that by raising his citizens' self-concepts, he could divert drug abuse and all sorts of other social ills.
    It didn't work. In fact, crime rates and substance abuse rates are formidable, right along with our self-assessment scores on paper-and-pencil tests. (Whether these tests are valid and reliable indicators of self-esteem is a subject worthy of inquiry itself, but in the parlance of social-science writing, it goes "beyond the scope of this paper.") In part, the discrepancy between high self-esteem scores and poor social skills and academic acumen led researchers like Nicholas Emler of the London School of Economics and Roy Baumeister of Case Western Reserve University to consider the unexpected notion that self-esteem is overrated and to suggest that it may even be a culprit, not a cure.
    "There is absolutely no evidence that low self-esteem is particularly harmful," Emler says. "It's not at all a cause of poor academic performance; people with low self-esteem seem to do just as well in life as people with high self-esteem. In fact, they may do better, because they often try harder." Baumeister takes Emler's findings a bit further, claiming not only that low self-esteem is in most cases a socially benign if not beneficent condition but also that its opposite, high self-regard, can maim and even kill. Baumeister conducted a study that found that some people with favorable views of themselves were more likely to administer loud blasts of ear-piercing noise to a subject than those more tepid, timid folks who held back the horn. An earlier experiment found that men with high self-esteem were more willing to put down victims to whom they had administered electric shocks than were their low-level counterparts.
    Last year alone there were three withering studies of self-esteem released in the United States, all of which had the same central message: people with high self-esteem pose a greater threat to those around them than people with low self-esteem and feeling bad about yourself is not the cause of our country's biggest, most expensive social problems. The research is original and compelling and lays the groundwork for a new, important kind of narrative about what makes life worth living -- if we choose to listen, which might be hard. One of this country's most central tenets, after all, is the pursuit of happiness, which has been strangely joined to the pursuit of self-worth. Shifting a paradigm is never easy. More than 2,000 books offering the attainment of self-esteem have been published; educational programs in schools designed to cultivate self-esteem continue to proliferate, as do rehabilitation programs for substance abusers that focus on cognitive realignment with self-affirming statements like, "today I will accept myself for who I am, not who I wish I were." I have seen therapists tell their sociopathic patients to say, "I adore myself" every day or to post reminder notes on their kitchen cabinets and above their toilet-paper dispensers, self-affirmations set side by side with waste.
    Will we give those challenges of our notions about self-esteem their due or will the research go the way of the waste? "Research like that is seriously flawed," says Stephen Keane, a therapist who practices in Newburyport, Mass. "First, it's defining self-esteem according to very conventional and problematic masculine ideas. Second, it's clear to me that many violent men in particular, have this inner shame; they find out early in life they're not going to measure up, and they compensate for it with fists. We need, as men, to get to the place where we can really honor our natural human grace."
    Keane's comment is rooted in a history that goes back hundreds of years, and it is this history that in part prevents us from really tussling with the insights of scientists like Baumeister and Emler. We have long held in this country the Byronic belief that human nature is essentially good or graceful, that behind the sheath of skin is a little globe of glow to be harnessed for creative uses. Benjamin Franklin, we believe, got that glow, as did Joseph Pulitzer and scads of other, lesser, folks who eagerly caught on to what was called, in the 19th century, "mind cure." Mind cure augurs New Age healing, so that when we lift and look at the roots, New Age is not new at all. In the 19th century, people fervently believed that you were what you thought. Sound familiar? Post it above your toilet paper. You are what you think. What you think; you think. In the 1920's, a French psychologist, Emile Coue, became all the rage in this country; he proposed the technique of autosuggestion and before long had many citizens repeating, "Day by day in every way I am getting better and better."
    But as John Hewitt says in his book criticizing self-esteem, it was maybe Ralph Waldo Emerson more than anyone else who gave the modern self-esteem movement its most eloquent words and persuasive philosophy. Emerson died more than a century ago; but you can visit his house in Concord, Mass., and see his bedroom slippers cordoned off behind plush velvet ropes and his eyeglasses, surprisingly frail, the frames of thin gold, the ovals of shine, perched on a beautiful desk. It was in this house that Emerson wrote his famous transcendentalist essays like "On Self-Reliance,". which posits that the individual has something fresh and authentic within and that it is up to him to discover it and nurture it apart from the corrupting pressures of social influence. Emerson never mentions "self-esteem" in his essay, but his every word echoes with the self-esteem movement of today, with its romantic, sometimes silly and clearly humane belief that we are special, from head to toe.
    Self-esteem, as a construct, as a quasi religion, is woven into a tradition that both defines and confines us as Americans. If we were to deconstruct self-esteem, to question its value, we would be, in a sense, questioning who we are, nationally and individually. We would be threatening our self-esteem. This is probably why we cannot really assimilate research like Baumeister's or Emler's; it goes too close to the bone and then threatens to break it. Imagine if you heard your child's teacher say, "Don't think so much of yourself." Imagine your spouse saying to you, "You know, you're really not so good at what you do." We have developed a discourse of affirmation, and to deviate from that would be to enter another arena, linguistically and grammatically, so that what came out of our mouths would be impolite at best, unintelligible at worst.
    Is there a way to talk about the self without measuring its worth? Why, as a culture, have we so conflated the two quite separate notions -- a) self and b) worth? This may have as much to do with our entrepreneurial history as Americans, in which everything exists to be improved, as it does, again, with the power of language to shape beliefs. How would we story the self if not triumphantly, redemptively, enhanced from the inside out? A quick glance at amazon.com titles containing the word "self " shows that a hefty percentage also have improvement or enhancement tucked into them, oftentimes with numbers, something like 101 ways to improve your self-esteem or 503 ways to better your outlook in 60 days or 604 ways to overcome negative self-talk. You could say that these titles are a product of a culture, or you could say that these titles and the contents they sheathe shape the culture. It is the old argument: do we make language or does language make us? In the case of self-esteem, it is probably something in between, a synergistic loop-the-loop.
    On the subject of language, one could, of course, fault Baumeister and Emler for using "self-esteem" far too unidimensionally, so that it blurs and blends with simple smugness. Baumeister, in an attempt to nuance, has tried to shade the issue by referring to two previously defined types: high unstable self-esteem and high well-grounded self-esteem. As a psychologist, I remember once treating a murderer, who said, "The problem with me, Lauren, is that I'm the biggest piece of (expletive) the world revolves around." He would have scored high on a self-esteem inventory, but does he really "feel good" about himself? And if he doesn't really feel good about himself, then does it not follow that his hidden low; not his high, self-esteem leads to violence? And yet as Baumeister points out, research had shown that people with overt low self-esteem aren't violent, so why would low self-esteem cause violence only when it is hidden? If you follow his train of thinking, you could come up with the sort of silly conclusion that covert low self-esteem causes aggression, but overt low self-esteem does not, which means concealment, not cockiness, is the real culprit. That makes little sense.
    "The fact is," Emler says, "we've put antisocial men through every self-esteem test we have, and there's no evidence for the old psychodynamic concept that they secretly feel bad about themselves. These men are racist or violent because they don't feel bad enough about themselves." Baumeister and his colleagues write: "People who believe themselves to be among the top 10 percent on any dimension may be insulted and threatened whenever anyone asserts that they are in the 80th or 50th or 25th percentile. In contrast, someone with lower self-esteem who regards himself or herself as being merely in the top 60 percent would only be threatened by the feedback that puts him or her at the 25th percentile. . . . In short, the more favorable one's view of oneself, the greater the range of external feedback that will be perceived as unacceptably low"
    Perhaps, as these researchers are saying, pride really is dangerous, and too few of us know how to be humble. But that is most likely not the entire reason why we are ignoring flares that say, "Look, sometimes self-esteem can be bad for your health." There are, as always, market forces, and they are formidable. The psychotherapy industry, for instance, would take a huge hit were self-esteem to be re-examined. After all, psychology and psychiatry are predicated upon the notion of the self, and its enhancement is the primary purpose of treatment. I am by no means saying mental health professionals have any conscious desire to perpetuate a perhaps simplistic view of self-esteem, but they are, we are (for I am one of them, I confess), the "cultural retailers" of the self-esteem concept, and were the concept to falter, so would our pocketbooks.
    Really, who would come to treatment to be taken down a notch? How would we get our clients to pay to be, if not insulted, at least uncomfortably challenged? There is a profound tension here between psychotherapy as a business that needs to retain its customers and psychotherapy as a practice that has the health of its patients at heart. Mental health is not necessarily a comfortable thing. Because we want to protect our patients and our pocketbooks, we don't always say this. The drug companies that underwrite us never say this. Pills take you up or level you out, but I have yet to see an advertisement for a drug of deflation.
    If you look at psychotherapy in other cultures, you get a glimpse into the obsessions of our own. You also see what a marketing fiasco we would have on our hands were we to dial down our self-esteem beliefs. In Japan, there is a popular form of psychotherapy that does not focus on the self and its worth. This psychotherapeutic treatment, called Morita, holds as its central premise that neurotic suffering comes, quite literally, from extreme self-awareness. "The most miserable people I know have been self-focused," says David Reynolds, a Morita practitioner in Oregon. Reynolds writes, "Cure is not defined by the alleviation of discomfort or the attainment of some ideal state (which is impossible) but by taking constructive action in one's life which helps one to live a full and meaningful existence and not be ruled by one's emotional state."
    Morita therapy, which emphasizes action over reflection, might have some trouble catching on here, especially in the middle-class West, where folks would be hard pressed to garden away the 50-minute hour. That's what Morita patients do; they plant petunias and practice patience as they wait for them to bloom. Like any belief system, Morita has its limitations. To detach from feelings carries with it the risk of detaching from their significant signals, which carry important information about how to act: reach out, recoil. But the current research on self-esteem does suggest that we might benefit, if not fiscally than at least spiritually, from a few petunias on the Blue Cross bill. And the fact that we continue, in the vernacular, to use the word "shrink" to refer to treatment means that perhaps unconsciously we know we sometimes need to be taken down a peg.
    Down to ... what? Maybe self-control should replace self-esteem as a primary peg to reach for. I don't mean to sound Puritanical, but there is something to be said for discipline, which comes from the word "disciple," which actually means to comprehend. Ultimately, self-control need not be seen as a constriction; restored to its original meaning, it might be experienced as the kind of practiced prowess an athlete or an artist demonstrates, muscles not tamed but trained, so that the leaps are powerful, the spine supple and the energy harnessed and shaped.
    There are therapy programs that teach something like self-control, but predictably they are not great moneymakers and they certainly do not attract the bulk of therapy consumers, the upper middle class. One such program, called Emerge, is run by a psychologist named David Adams in a low budget building in Cambridge, Mass. Emerge's clients are mostly abusive men, 75 percent of them mandated by the courts. "I once did an intake on a batterer who had been in psychotherapy for three years, and his violence wasn't getting any better," Adams told me. "I said to him, `Why do you think you hit your wife?' He said to me, `My therapist told me it's because I don't feel good about myself inside."' Adams sighs, then laughs. "We believe it has nothing to do with how good a man feels about himself. At Emerge, we teach men to evaluate their behaviors honestly and to interact with others using empathy and respect." In order to accomplish these goals, men write their entire abuse histories on 12-by-12 sheets of paper, hang the papers on the wall and read them. "Some of the histories are so long, they go all around the room," Adams says. "But it's a powerful exercise. It gets a guy to really concretely see." Other exercises involve having the men act out the abuse with the counselor as the victim. Unlike traditional "suburban" therapies, Emerge is under no pressure to keep its customers; the courts do that for them. In return, they are free to pursue a path that has to do with "balanced confrontation," at the heart of which is critical reappraisal and self-- no, not esteem - responsibility.
    While Emerge is for a specific subgroup of people, it might provide us with a model for how to reconfigure treatment--and maybe even life--if we do decide the self is not about how good it feels but how well it does, in work and love. Work and love. That's a phrase fashioned by Freud himself, who once said the successful individual is one who has achieved meaningful work and meaningful love. Note how separate this sentence is from the notion of self. We blame Freud for a lot of things, but we can't blame that cigar-smoking Victorian for this particular cultural obsession. It was Freud, after all, who said that the job of psychotherapy was to turn neurotic suffering into ordinary suffering. Freud never claimed we should be happy, and he never claimed confidence was the key to a life well lived.
    I remember the shock I had when I finally read this old analyst in his native tongue. English translations of Freud make him sound maniacal, if not egomaniacal, with his bloated words like id, ego and superego. But in the original German, id means under-I, ego translates into I and superego is not super-duper but, quite simply, over-I. Freud was staking a claim for a part of the mind that watches the mind, that takes the global view in an effort at honesty. Over-I. I can see. And in the seeing, assess, edit, praise and prune. This is self-appraisal, which precedes self-control, for we must first know both where we flail and stumble, and where we are truly strong, before we can make disciplined alterations. Self-appraisal. It has a certain sort of rhythm to it, does it not? Self-appraisal may be what Baumeister and Emler are actually advocating. If our lives are stories in the making, then we must be able to edit as well as advertise the text. Self-appraisal. If we say self-appraisal again and again, 101 times, 503 times, 612 times, maybe we can create it. And learn its complex arts.

Pediatric Doctors Support Gay Adoption
Jeremy Manier, Chicago Tribune- 2/4/2002

Same-sex couples make good parents and should have full rights to adopt children, the American Academy of Pediatrics says in a sweeping report that brings the influential doctors' group into a stormy social and legal debate. The report, which appears in Monday's AAP journal Pediatrics, is based on studies that show children whose parents are gay or lesbian fare as well as children raised by heterosexual parents, according to experts with the Elk Grove Village-based group. The group is recommending that its 55,000 pediatricians advocate for laws allowing gays and lesbians to co-adopt with their partners, which opens the door for children to gain certain medical and legal protections.
    An escalating battle over adoption by same-sex parents has been brewing in many states, including a federal court ruling last year that upheld Florida's ban on such adoptions. An Illinois law that would give preference in adoptions to heterosexual couples was killed in committee last year. Groups that oppose such adoptions condemned the AAP's position, saying it injects politics into the question of children's welfare. Yet in Illinois and other states that do not prohibit such adoptions, experts say the issue has moved beyond politics as gay and lesbian parents inch closer to the mainstream.
    The report maps new territory for the AAP, whose widely followed recommendations include childhood vaccinations and the proper sleeping position for infants. The main reason for the new policy is to seek stability for children who have homosexual parents, said Dr. Barbara Howard, a pediatrics researcher at Johns Hopkins University and a member of the committee formulating the report.
    Most states do not have laws that address adoption by homosexuals, leaving their children vulnerable, Howard said. In some states, it is difficult for gays and lesbians to adopt the children of their partners--leading to possible custody battles if the legal parent dies. Besides resolving custody matters, adoption by a co-parent ensures the child of support payments if the couple separate and health benefits if one parent is laid off. "Our intent is to safeguard the rights of children who happen to have a homosexual parent," Howard said.
    Conservative leaders who disagree with the report said it ignores the benefits children get from growing up with a mother and a father. "This is part of a campaign to normalize homosexual relationships and accord them a status equivalent to marriage," said Ken Connor, president of the Washington, D.C.-based Family Research Council. "Children should not be pawns in a political shell game."
    Experts say the number of adoptions by same-sex couples has increased in recent years as many state courts have removed legal barriers. The AAP estimates that between 1 million and 9 million children have at least one homosexual parent, though exact figures are elusive because states such as Illinois do not track adoptions by same-sex parents.
    For Miriam Pickus and Jane Jarcho, a Chicago couple with two adopted daughters, the decision to start a family was very personal. Pickus and Jarcho, both lawyers who have been together for 12 years, said they talked about having kids for years before finally adopting their first daughter, Becca, now 5, from an orphanage in China. By the time they adopted 3-year-old Jodie two years ago, their lives had gained a new focus, built around comforting routines of diaper changes and bedtime stories. "In many respects we are just like heterosexual families with their children," said Pickus, who works with the Chicago Commission on Human Relations. "Before having kids, one way I identified myself was as a gay person. Since then, I think of myself primarily as a parent." Becca described her unconventional family in ordinary terms. "That's my sister Jodie, that's my mom Pick and that's my other mom Jane," Becca said, lifting her head briefly from a coloring book.

`No significant difference'
Until the last decade, few studies had tracked how children fare with homosexual parents, experts said. But recent research on more than 300 children from such homes shows that they have normal intelligence, mental health and social skills, Howard said. "There appears to be no significant difference between children raised by homosexuals or heterosexuals, even in sexual preference," she said.
    One psychiatric journal's 1997 study of young adults with lesbian mothers showed that they were more likely to have at least a brief same-sex relationship than those who had heterosexual parents. "But in each group, similar proportions of adult men and women identified themselves as homosexual," the AAP report said.
    Such studies do not resolve what Connor considers a central flaw in adoptions by homosexuals: the lack of a mother and father who can be role models and guide a child's development. "Fathers masculinize their sons, mothers civilize them," Connor said. "It's a mistake to minimize their roles." No study has found confusion about gender identity in children from same-sex households, the AAP report said.
    Pickus and Jarcho were surprised by how easily their daughters picked up traditional feminine behavior. "These two want to wear dresses and tights every day, and they want to be Cinderella," Jarcho said. "Anyone who's a parent can tell you there's nothing you can do about those sorts of things." "We probably didn't have a stitch of pink clothing in this house before the kids came, and now it's everywhere," Pickus said.
    Some studies suggest that same-sex households may confer some advantages on children, such as more tolerance of diversity, according to the AAP report. One study found that teachers perceived children of lesbian parents to be especially protective of younger children. Howard conceded that many of the studies suffered from small sample sizes and the possibility of biased results--unhappy families seldom agree to take part in such research. Still, she said, "Most research on parenting doesn't have much better evidence than this."

Florida's law upheld
The question of whether homosexuals could care for children as well as married heterosexual couples could was central in last year's federal court ruling upholding Florida's ban on gay and lesbian adoption. Florida's law dates from 1977, when singer Anita Bryant launched a campaign against homosexuality called "Save Our Children." Last August, U.S. District Judge James Lawrence King denied a challenge to the law by several gay foster parents, including a couple who won a foster parenting award from the agency that placed their children. The plaintiffs plan to file an appeal in the case on Feb. 13, said their attorney Michael Coles, head of the American Civil Liberties Union's lesbian and gay rights project. Coles said a consequence of the law is that it denies stable homes for children who may be difficult to place with heterosexual couples. Two of the three foster children being raised by Coles' clients, Steven Lofton and Roger Croteau, are HIV-positive. Connor of the Family Research Council said the answer is to encourage adoption by heterosexuals. "I can't think of any circumstances where it's in the best interests of a child to support or promote adoption by homosexuals," Connor said.
    Only two other states prohibit same-sex adoptions. Mississippi bans same-sex couples from adopting children, and Utah limits adoptions to married heterosexual couples. New Hampshire lifted its ban on same-sex adoptions in 1999. An Illinois Appellate Court in 1995 ruled that unmarried couples have the same adoption rights as other parents. Pickus and Jarcho were among the first of many same-sex couples spurred by the ruling to co-adopt. "There are enough stresses on any family, gay or straight, without having to worry about legal wrangling if one of us died," Pickus said.
    On the Net:
AAP: http://www.aap.org
Lambda Legal Defense and Education Fund: http://www.lambdalegal.org
Focus on the Family: http://www.family.org

A Look at Moms and Daughters in Adolescence
ABC News, 2/5/2002

For many moms with teenage daughters, two major events in each of their lives coincide: moms in their 40s are approaching menopause, just as their daughters are grappling with adolescence. ABCNEWS Medical Correspondent Dr. Nancy Snyderman and co-author Peg Streep explore these parallel worlds in their new book, Girl in the Mirror. Read an excerpt below:

"We do not grow absolutely, chronologically. We grow sometimes in one dimension, and not in another, unevenly. We grow partially. We are relative. We are mature in one realm, childish in another. The past, present, and future mingle and pull us backward, forward, or fix us in the present. We are made up of layers, cells, constellations." — Anais Nin

The idea for this book came out of a series of conversations between two women who'd become friends — you know, those conversations that sound as if they're just a series of disconnected thoughts but, in the end, head off in an important direction. During the writing of Necessary Journeys: Letting Ourselves Learn from Life, Peg and I had spent hours and hours talking; even though the book was done, our talking wasn't. No matter where the conversation started, we'd end up talking about ourselves and the past, where we found ourselves now, our changing bodies (in your forties, perimenopause appears to be with you every waking moment), and, of course, our daughters. All three of the girls — I have two, Kate and Rachel, and Peg has one, Alexandra — seemed to be on the cusp of change. At the time, Kate was just starting seventh grade after a rather miserable, friendless year in sixth, and was starting to go through puberty. Alexandra had just started going to a large middle school for sixth grade, and Peg had her heart in her mouth. Rachel, my youngest, was suddenly acting up like crazy. We live on opposite coasts but the various "horror" stories we swapped, gleaned from friends and neighbors whose kids were already in the midst of adolescence, all had a basic theme: Adolescence was something we'd have to cope with, get through, somehow. It did not, by all accounts, sound like fun.
    But, as we talked, we also began to wonder: What happens to the mother in all this? In truth, just as our girls approached adolescence, we found our own lives changing. The years that comprised our forties seemed, on reflection, less a time of settling in than moving forward and, in the wake of that forward motion, we each raised new questions about how we saw the rest of our lives rolling out. The inevitable winding down of our reproductive systems wasn't just a matter of my dealing with forgetting my keys everywhere and even my wallet once (at a bookstore signing!) or Peg's coping with her fibroids but, instead, re-envisioning ourselves. We both thought it hugely important — if rarely mentioned — that these stages in female life, adolescence and midlife, often coincide in the lives of mothers and daughters. We got to wondering out loud: How did the changes in her daughter affect a mother's sense of self? Conversely, how was a girl's experience of adolescence affected by where, in life, her mother found herself?
    We'd also both gotten to a place where other women were more important than ever in our lives, and, in conversations with friends, the centrality of the mother-daughter relationship to the formation of self came up again and again. For our parts, while each of us was enormously influenced by the love and example of our fathers, there were important ways in which we each had been shaped by our mothers. Between us, though, there were monumental differences. My own relationship with my mother had always been marked by love, trust, and support; Peg's on the other hand, was never close and had become, when she was an adolescent, deeply painful. She remained fully estranged from her mother during her adulthood. When I became a mother, I struggled to accept the ways in which I mothered differently than my mother had —and in my eyes she was a master at it. When Peg became a mother; she felt she had to invent motherhood from scratch. Our experiences were at the opposite ends of a spectrum but had something in common nonetheless: To mother, each of us had to try to emerge from our mother's shadow, whether it was beneficent or dark and looming. Most of the women with daughters we knew described relationships to their own mothers that fell somewhere in between our own but confirmed the importance of those relationships.
    Girl in the Mirror is different from other books on parenting adolescents not just because it focuses almost exclusively on the mother-daughter dyad but because it is essentially optimistic in tone. We see the challenges of adolescence as an opportunity — for women to grow into greater consciousness even as their daughters go through the exercise of testing their wings by testing their mothers. Mothering is hard work, and there's no question that the work of mothering an adolescent is not exactly easy. But — and it is a big "but" — there is much to be learned from the experience. It may not, in the end, be entirely "coincidental" that two stages of female life — adolescence and midlife — so often coincide. Even those of you who are still some years away from midlife will experience it in a slightly different form when that stage coincides with your daughter's early adulthood.
    Unlike many other books, Girl in the Mirror isn't based on individual case studies — I am a physician, not a psychologist. Instead we've had the privilege and opportunity to draw on the amazing amount of research done on adolescence in the last decade, little of which ever makes it into the popular press. We've been lucky, too, to have had the cooperation of specialists and researchers who've shared their work and their thoughts with us in telephone interviews and e-mail exchanges. Last but not least, we've had the help of other mothers across the country (and a few fathers too) who were willing to share their experiences with us. Our thank-yous to all who helped can be found on page vii.
    Writing this book has itself been a journey. We've learned that much that passes for popular wisdom about adolescent girls isn't and that some of our own ideas about adolescence needed radical adjustment. By looking at mothers and daughters, we've gained new understanding of the meaningful ways in which women are possessed of unique talents and perspectives on the world, different in kind from those possessed by men. Ultimately, though, this book is about growth. Apart from infancy, the growth during adolescence is unparalleled in the human life cycle; the changes in our daughters will be physical, cognitive, emotional, and social in scope. While decidedly different from the growth our daughters will experience, this same period offers the mothers of daughters a unique opportunity to grow and change as well. Some 150 years ago, the writer George Elliot wrote that "our consciousness rarely registers a growth within us anymore than without us; there have been many circulations of the sap before we detect the smallest sign of a bud." We wrote this book so that each of us can become not simply better caretakers of our daughters' flowering but better gardeners of our own inner selves.

Doctor Was Troubled But Not Depressed, Therapist Says
Alice Dembner, Boston Globe- 2/5/2002

Weeks after she was disciplined by the Dana-Farber Cancer Institute for her role in two chemotherapy overdoses, Dr. Lois Ayash began seeing a therapist who found that she was worried about the future but experiencing a ''full and happy'' personal life, the therapist testified yesterday via videotape. Dr. Mary Anne Badarocco, psychiatrist in chief at Beth Israel Deaconess Medical Center, said she saw Ayash as a private patient from August 1995 through September 1996. She testified at the request of The Boston Globe in Ayash's defamation lawsuit against the newspaper and Dana-Farber.
    Ayash was not suicidal and did not show signs of clinical depression, Badarocco said. She did not feel helpless or hopeless and was able to function normally in her everyday life, the psychiatrist said. ''But she was very troubled by the hospital's decision that she could not see patients,'' Badarocco said.
    The hospital had barred Ayash from seeing patients while the two overdoses were being investigated. One patient, Boston Globe health columnist Betsy Lehman, died and a second patient was severely injured in an experimental breast cancer treatment designed and run by Ayash. The overdoses were mistakenly ordered by another physician in November 1994 and were discovered by a data clerk in February 1995, more than two months after Lehman died. Ayash was reprimanded for failing to discover the overdoses sooner.
    Badarocco also said Ayash complained about feeling betrayed by colleagues at the hospital and upset by stories in the Globe that she considered unfair, although the Globe articles were not a major focus of the therapy sessions.   According to Badarocco, Ayash told her that she was suing the hospital and the Globe because she wanted to clear her name, even though she knew that might make it harder for her to find another job in Massachusetts. ''She said she wasn't a vengeful person. ... Her motive was justice,'' said Badarocco.
    In her suit, Ayash alleges that the hospital defamed her by suggesting that she covered up the overdoses, discriminated against her as a woman, breached her contract, and violated her privacy. She also alleges that a Boston Globe reporter and a hospital executive inflicted emotional distress. Also, she alleges that the Globe libeled her in its coverage. The charges against the Globe have been upheld by a judge as a penalty against the newspaper for not revealing confidential sources.
    Because Ayash was suing for emotional distress, she waived her right to keep her therapy records private. Badarocco's treatment notes, which were entered into evidence, indicate that Ayash grew less troubled by her work situation, even as she was prevented from returning to her former duties at the hospital. By September 1996, just days before she was notified that she would be laid off the following summer, Ayash decided she no longer needed therapy.
    Also yesterday, Dr. Paul Richardson, who was on duty at Dana-Farber the night Lehman died of the overdose, said Ayash never asked him if he had checked to see if Lehman had gotten the correct chemotherapy dose. Ayash testified earlier in the trial that she didn't check the dose herself and therefore didn't discover the overdose because she thought Richardson had.
    Richardson and a research nurse, Mary McCauley, who was a close friend of Ayash, both testified that Ayash had distanced herself from colleagues and kept to her office following the discovery of the overdoses. When the hospital was ready to allow her to resume treating patients in their high-dose chemotherapy research group in August 1995, both Richardson and McCauley told superiors they didn't think Ayash would fit in. Dr. Donald Kufe, a hospital administrator, also testified yesterday that he never told Ayash that the hospital would ''squash her like a bug'' if she sued. Ayash testified last week that Kufe had told her that in a 1995 meeting.

California Judges Say New Drug Law Is Working
Anna Gorman, Los Angeles Times- 2/5/2002

About 30% of Los Angeles County defendants sentenced to drug rehabilitation rather than prison or county jail under Proposition 36 either failed to show up or dropped out of treatment programs in the first six months the new law was in effect, officials said. However, judges and county officials say they are pleased with the early results, considering drug users are the ones being served by California's novel sentencing program.
    "The preliminary indication is that this is working," said Carol Morris Lowe, director of planning for the county Alcohol and Drug Program. "We're going to have to refine it and tweak it, but I think it's a good start." Proposition 36, approved in 2000 by 61% of the voters, requires that nonviolent drug offenders convicted of possession, use or transportation of drugs for personal use be offered treatment and probation rather than being locked up. The effectiveness of the law is being closely watched in other states, including Michigan, Ohio and Florida, where the proposition's authors are planning similar ballot measures.
    Of the 4,329 defendants sentenced to drug-treatment programs in Los Angeles County from July 1 to year's end, 69%, or 3,008, were still receiving treatment at the end of the year, according to numbers recently made available by the Alcohol and Drug Program. A few participants had already finished their treatment by Dec. 31. Bench warrants were issued for several hundred defendants who failed to return to court. No statewide statistics are yet available, but counties are collecting data individually. In Orange County, 67% of the 1,978 defendants referred for drug treatment were still in programs at the end of December. San Diego County reported about 54% of its 1,578 defendants still in treatment. The numbers in Ventura County were higher--81% of the 992 people referred were in programs at year's end. Officials across the state pointed out that the statistics were preliminary. "We'll have a much better picture of how this is all going to shake out when we have a full year of data," said Los Angeles County Superior Court Judge Ana Maria Luna, who is heading a countywide task force on the law.
    The task force made several findings based on statistics from the first six months:
* Although the initiative was touted as a way to get first- and second-time offenders into treatment, the average participant has been arrested 14 times previously and has two felony and five misdemeanor convictions.
* Four of five participants are men. More than half are 36 years old and older. The racial breakdown is 36% Latino, 30% African American, 30% white, 2% Asian and 2% other.
* Fifteen percent of participants were deemed severely addicted to drugs and required residential treatment. Forty-one percent were referred to the lowest level of treatment, outpatient meetings several times a week. The bulk--44%--were assigned to day programs lasting several hours per session.
* Drug Court participation is down about 23% since Proposition 36 took effect. Drug Court participants complete a yearlong treatment program that involves frequent counseling, testing and court appearances.

Necessary Tools Lacking, Judge Says
Superior Court Judge Ellen DeShazer, who handles both Drug Court and Proposition 36 cases, said that she believes in treatment but that the ballot measure was poorly written and inadequately funded. She also said the law lacks serious sanctions and that defendants have too many chances to fail. The proposition "doesn't give the court all the tools it needs to make it work," she said. "It's like a bark and no bite. It doesn't give you the same leverage." In Drug Court, judges can throw noncompliant participants in jail immediately.
    Elsewhere in the state, participants are more severely addicted than expected, said Del Sayles-Owen, deputy director of the California Department of Alcohol and Drug Programs. That has created a shortage of residential beds in some counties, she said. Despite worries in Los Angeles County that there would not be enough courtrooms or treatment centers to handle the influx of drug defendants, officials said last week that the law has put stress on county resources but not overwhelmed them. County Probation Department Bureau Chief Dave Davies said there have been about 40% fewer defendants than anticipated participating in drug treatment. That's partly because nearly 300 eligible defendants refused treatment, officials said. Many of them chose a short stay in county jail over drug treatment, which can last up to a year. "It would have really strained the system had the numbers come through that we were expecting," Davies said.
    But probation officers, judges and treatment providers said the county still needs more than its state-allotted $30 million to make Proposition 36 work. Additional funds could pay for more lawyers and court staff to handle cases, as well as more drug counselors and probation officers to supervise defendants, they say.
    The head of a Gardena-based center, Larry Gentile, said that the influx of clients from Proposition 36 has not been as heavy as he anticipated, but that the number is rising. As of December, 42% of his outpatient clients were Proposition 36 enrollees. Some staff members at his Behavioral Health Services work six days a week and into the night, Gentile said.
    Sponsors of the ballot measure said its goals were to save the state money, reduce the prison population, lower addiction rates and increase public safety. The California prison population dropped by about 4,355 inmates from last July 1 to Dec. 31, according to the state Department of Corrections. However, that decrease is only partly because of Proposition 36, said department spokesman Russ Heimerich. Treatment is far cheaper than incarceration. A year in prison costs the state an average of $25,600, while treatment ranges from $840 to $7,400, according to the Northern California-based Drug Policy Alliance, which championed the initiative. "It has had an immediate impact in that we are starting to see some people diverted who might normally have had felony convictions," Heimerich said. "But it's not going to have a huge impact on the [prison] population until further down the road."
    When it comes to reducing addiction, Luna, the superior court judge, said that she would like to see even more defendants follow through on their drug treatment, but that she recognizes the challenges. Some of the defendants, she said, are homeless, have been battling drug addiction their entire lives or suffer from mental illness. Many also lack motivation, she added. "They don't have the resources to provide for their basic needs--shelter, food, medication," Luna said. "This is not just a matter of going to meetings. They have issues that go far beyond that." Participants are required to visit an assessment center for evaluation and then to enroll in a treatment center, often without money or transportation to do so. The county needs to make it possible for defendants to go directly from court to treatment centers, said Bob Mimura, director of the county's Criminal Justice Coordinating Committee. "There are a lot of little hurdles," he said, each one making it more difficult to remain off drugs. Then there is the problem of drug testing during treatment, which is not funded under the law. Thus defendants or treatment centers have had to pick up the costs. A new law set aside $8.4 million statewide for testing, but Los Angeles County has yet to receive its $2-million share.

Personal Stories Are Heartening
The Drug Policy Alliance expects 60% to 70% of defendants to complete treatment. Dan Abrahamson, director of legal affairs for the group, said there are many personal stories from people who are already benefiting from Proposition 36. "For us, that's what it was about," he said. Superior Court Judge Rita Miller said defendants in her courtroom have similarly inspiring stories. One recovering addict had his first sober Thanksgiving with family members in 20 years.
    William Anderson, 52, hopes he will be a Proposition 36 success story. A heroin user for 25 years, he said he has been locked up several times for drug violations. On Halloween night, he was picked up again. "I got tired of going to jail," Anderson said. "I got tired of waking up in the morning sick." He appeared before Miller last week for a progress report. Anderson said he had not used drugs since he was sentenced Jan. 14. Miller congratulated Anderson for enrolling in a program.

Underground Pro-Anorexia Views Linger on the Web
Leslie Goldman, Chicago Tribune- 2/5/2002

Did you know that curling into the fetal position quells the hunger pains of a weeklong self-imposed starvation? Or that the calorie-free sugar substitute Equal, dipped into like Lik-A-Maid, satisfies a sweet tooth during a fast? What, nobody told you? You didn't know? Well, your daughter does. And she learned it right at home on the family computer. Until late last summer, the pro-anorexia community existed almost entirely underground, an Internet-borne movement predicated on the belief that anorexia and bulimia are desired states-sacrosanct, even. Cloaked by the Web's protective screen, sites such as "Stick Figure" and "My Goddess Ana" ("Ana" and "Mia" are pet names for anorexia and bulimia, respectively) hosted chat rooms for women striving toward emaciation. On these sites, ordinary objects took on horrific new meaning: Turn down the thermostat 10 degrees to induce calorie-burning shivers. Iceberg lettuce and red wine vinegar make a tasty, non-caloric meal.
    When SELF Magazine broke the story last August, media outlets nationwide, including Oprah Winfrey and Fox News, glommed on almost immediately, inadvertently catapulting sites such as "Anorexic and Bulimic Rec Room" into the limelight. "I have never seen an outpouring of reactions like we've received," said SELF Magazine editor-at-large Beth Howard, who edited the breakthrough piece by writer Michelle Gotthelf. "This is an ominous use of the Internet. By and large, people were shocked. There were a lot of people who had no idea this existed."
    But 16-year-old Ariel Jastromb already did. Since the 6th grade, Jastromb has subscribed to Vogue. When she was a toddler, she ran away from her mother in Bloomingdale's, only to be found engrossed in conversation with a pack of teenagers, debating the pros and cons of blush. Two years ago, in an attempt to shed weight for a school dance, she embarked on a brutally strict diet that would soon see 45 pounds melt from a 5-foot-4 frame that didn't require dramatic weight loss.
    Ironically, when Jastromb was engaging in her anorexic and bulimic behaviors, she knew nothing of the pro-anorexia sites. Rather, she would frequent legitimate eating-disorder-awareness sites, scouring the pages of diagnostic criteria to better understand the profile of the "perfect anorexic."
    Now in recovery, the Highland Park High School junior volunteers with the National Association of Anorexia Nervosa and Associated Disorders, headquartered in her hometown, and recently embarked on a sort of pro-anorexia sting operation for ANAD. Last summer Jastromb began logging on to the sites, ingratiating herself into the pro-anorexic community. There, she saw what she described as stomach-churning images of girls purging, and digitally altered "Thinspiration" photographs of already-thin women such as Gisele, the 5-foot-11 supermodel who has been lambasted by some eating-disorder organizations for perpetuating an unattainable physical ideal.
    "From the moment I said, `Hi,' they were immediately accepting," Jastromb recalled of her foray onto the now-defunct myfriendana site. "While there is a huge level of competition, they are constantly trying to bring people in. "They discussed group fasts, and they had a `Detention Room' for people who broke down and ate a cracker," she continued. "It was very self-punishing. Everyone had a problem with their family and everything in their lives seemed chaotic. Their eating disorder was the only thing they had left." Indeed, as the lay public grows increasingly aware of these sites, pressure on private Web servers to remove the chat rooms has prompted an aggrieved outcry from pro-anorexics, who fear being stripped of their primary means of support.

Looking for a forum
Some subscribers plan to form private support groups to "keep on track and give each other the motivation we need," as written on one site. "Anorexics need a forum like this because it feels like a safe place to express ourselves."
    In several attempts to contact the creators of these Web sites, most were unresponsive, but the following posted explanation provides a glimpse into their mind-set: "I've been contacted by the media, and I've seen my friends put themselves at risk in the media, hoping for the chance to get someone out there to see us as the humans we are instead of the sick, evil monsters we are not. ... I know these women. I know how much they hurt and how fragile their sense of peace is right now. I know how deeply wounded and betrayed they feel when their struggles for life-in-death are ripped apart in these cruel ways."
    Dr. Vivian Hanson Meehan, president of ANAD (National Association of Anorexia Nervosa and Associated Disorders), knows this outlook well. When Meehan initially was alerted to the pro-anorexia phenomenon by an ANAD resource person, the grim nature of the sites left her and her colleagues astounded. "I thought they were horrible," Meehan said. "The only purpose I could see was to reinforce the anorexic attitude and normalize the negative thoughts that accompany it. It inspires them toward more destructive behavior." Examples she listed include "pictures of an extremely thin woman lying on a bed, naked, reading ... women with their shirts open and a sidelong view of their ribcage, every rib showing."

An air of secrecy
According to Meehan, the Web forum proves particularly treacherous by promoting an air of secrecy, a familiar climate for eating-disorder sufferers, their friends and family. "Contacts through Web sites allow them to boast of their prowess and receive tips on behaviors which they may not have guessed," Meehan said.
    Although Michelle Aielli, a 24-year-old book publicist in New York, has never personally battled an eating disorder, some of her close friends have. Aielli said she found herself mesmerized by the pro-anorexia Web sites e-mailed to her by a friend in early October. "People have never showcased anorexia like this showcases anorexia," she said. "Eating disorders are constantly being viewed in a very dark shadow. Now it's being brought to the forefront."
    Meehan seconds this observation. "Being anorexic is terribly lonely," she said. "These are people who don't know they're ill. They feel the need to find like-minded people to bolster their ability to continue this lifestyle." Meehan's use of the word "lifestyle" is evocative, because eating disorders are diagnosable mental illnesses, currently affecting 8 million Americans, 90 percent of them female. But, as she pointed out, many pro-anorexics see their disorder as a choice, posting warnings such as the following: "Warning: Please do not enter this site if you are recovering from anorexia. I will not be held responsible for `making you sick,' even though I believe anorexia is not a disease but a lifestyle.

"Nothing tastes as good as feeling thin."
Experts in the field point out that eating disorders are not about food, just as rape is not about sex and alcoholism is not about the drink. "Thinness becomes a unique achievement," Meehan said, "providing control over part of their lives in which they feel no control." Eating disorders claim the highest mortality rate of any psychiatric illness, about 6 percent, according to ANAD. In fact, angry posts such as "This site killed my best friend" pepper remaining chat rooms (Jastromb said naysaying visitors were vilified by Web site members).

Permanent damage
Physical effects of anorexia, such as loss of menses, compulsive exercise, malnutrition and dehydration, can cause permanent physiological and psychological repercussions. Among them: osteoporosis, infertility, heart attack, depression. Treatment costs can range from $30,000 per month for inpatients to $1,000 or more per day for outpatient therapy and medical monitoring, according to ANAD.
    SELF Magazine's Howard said a primary goal in writing the article was striking a sensitive balance between informing people and driving them to the sites. "We weighed the pros and cons to avoid the potential danger of helping susceptible people perpetuate their eating disorder via what the sites call `triggering images,'" such as digitally altered photos As Jastromb remembered, "There was one split second where I totally questioned my state and thought, `Maybe I should lose weight.' It was that convincing, after months and months of therapy."
    Disturbing as this Web content may be, it is not uncommon for sites to be hosted by women with frilly, childlike nicknames: "Angelface" or "Gummibearz," for example. The paradox between the little-girlishness of their identities and the despair of their reality is, Meehan said, representative of the anorexic archetype. Although many are successful, juggling academically hectic schedules with numerous friends, "underneath these are women who are really hungry for love and security."
    Not that all sufferers were raised in loveless environments. Alluding to "The Golden Cage," Hilda Bruch's renowned tome on anorexia, Meehan said that "the eating-disordered girl is quite often the most loved child in the family. But their negative thoughts are so great, they cannot accept the love they are given."

What can parents do?
Yahoo! and Terra Lycos have both removed scads of pro-anorexia sites from their networks. "If we ever see a site that is damaging or threatening in any way, we take it down, because it violates our terms of service," Lycos public relations manager Kathy O'Reilly said. She added that surfers are empowered via an "S.O.S." button to be pressed in response to viewing potentially harmful material. The button automatically links to a site moderator.
    DePaul University law professor Jeffrey M. Shaman, a former president of the American Civil Liberties Union in Illinois, said private companies such as Yahoo! possess editorial discretion to override free-speech arguments. "They are fully justified in taking them down, and I would urge them to do just that." The government, on the other hand, cannot: 1st Amendment rights apply to the Internet.
    As pro-anorexia chat rooms are plucked from the underground, parents may breathe a collective sigh of relief. But increasingly covert sites may spring up, and the Internet is still muddled with pornography, said Larry Magid, who founded safekids.com to help parents and their children navigate the Web safely. "The Internet can be safe," Magid said. "Discuss [these sites] with them. Tell them, `Just because a site looks good and says it's OK to live on 400 calories per day doesn't mean it is.'"

Drawing the line
Should an especially industrious young teen deploy the free-speech argument, Magid said, it is key to distinguish between free speech and parental control. "People have a legal right to publish this material, just as white supremacists have a legal right to spread their ideology," he said. "But that doesn't mean parents have to permit their kids to look at it." An analogous situation: not allowing a teenager to see R-rated movies.
    At SELF, Howard encouraged parents to avoid using words such as "diet" around the house. Rather, discuss "eating healthfully" and be accepting of different body types. "To the extent that you are able to accept and love your own body," she said, "you are only helping your daughter and other young girls." Meehan and other authorities urge women with eating disorders to seek help from legitimate organizations and Web sites. Although they may not realize it now, "we're not mad at them," Meehan said. "It's not that we feel anything toward them except a desire to help them live better lives. Anorexia doesn't enhance a person's life. It just makes them miserable."

A Rare Day: The Movies Get Mental Illness Right
Erica Goode, New York Times- 2/5/2002

It was 1980 and the patient in Dr. Glen Gabbard's consulting room had a pressing request. She had just seen "Ordinary People," she told him, and in the movie, Judd Hirsch, who played the therapist, hugged Timothy Hutton, who played the suicidal patient. "It really helped him a lot," the woman said, "so I was wondering if you could hug me." Dr. Gabbard explained to the young woman that "Ordinary People" was a movie. "This is therapy," he said, "and we need to use words." "Yes, I know it was a movie," the patient replied, "but the hug helped a lot."
    Where does the public get many of its ideas about psychiatry and mental illness? From Hollywood, of course. And Hollywood, said Dr. Gabbard, who has spent many years examining the rendering of his field in the movie theater, has mostly preferred distortion and stereotype over more true-to-life representations. Yet inaccurate as such portraits are, they are also compelling. "People don't make distinctions between what's reality and what's on the great silver screen," Dr. Gabbard said.
    At the Menninger Clinic in Topeka, Kansas, where he trained as a psychoanalyst and later became medical director, patients often asked him to hypnotize them so they could recover repressed memories. "I'd say, 'Why do you want that?'" Dr. Gabbard said. "And they'd say, 'I saw it in "The Three faces of Eve."'" Dr. Gabbard came by his passion for movies naturally: his parents are professional actors. And after a while, psychoanalyzing psychiatry's relationship with the motion pictures became a hobby, eventually resulting in the 1987 book "Psychiatry and the Cinema," written with his brother, Dr. Krin Gabbard, a professor of comparative literature at the State University of New York at Stony Brook. As an added perk, Dr. Gabbard noted, his sideline gave him "an excuse to watch bad movies and call it part of my work." "I can really get into bad movies," he added.
    Yet very occasionally, he said, screenwriters and directors who tackle the subject of mental disorders and their treatments get it right. In Dr. Gabbard's view, "The Sopranos" is the best depiction of psychotherapy "ever to appear on film or television." (His new book, "The Psychology of the Sopranos," is scheduled for publication by Basic Books this summer.) And "A Beautiful Mind," Ron Howard's award-winning drama chronicling the genius and the battle with schizophrenia of the mathematician John Forbes Nash Jr., who won the Nobel Prize for economics in 1994, is as accurate a portrait of the illness as Hollywood has ever produced. In a recent conversation, Dr. Gabbard placed "A Beautiful Mind" in context.

Q. How has schizophrenia typically been portrayed in the movies?
A. First of all, in most films, a distinction is not made between serious mental illness and schizophrenia. It's only in recent years that schizophrenia itself has been defined in any way approaching reality. Out of over 400 films depicting psychiatric treatment, I can think of less than five that I would call accurate. One was "I Never Promised You a Rose Garden," based on Hannah Greenberg's book. And one other film that was fairly accurate was "Benny and Joon." But inaccuracy goes back as far as 1909 to a D.W. Griffith film called "The Maniac Cook." In this film, a cook becomes distressed and starts attacking her employers and is led away by the police. She escapes and first plans to kill her employers in their bed with a kitchen knife, but instead kidnaps the baby and puts it in the oven to roast.

Q. Violence is often linked with schizophrenia on the screen, is it not?
A. Yes, this stereotype of the homicidal maniac has been one of the primary myths perpetrated by the cinema about the seriously mentally ill. A more modern version of this can be seen in the "Halloween" series, where the Michael Myers character is the Devil himself.
    Another stereotype has been to portray schizophrenia inaccurately as split personality. In "Me, Myself and Irene," the recent Jim Carrey film, you saw that. But probably the classic film of this ilk would be "Psycho." In what appears to be a severely psychotic individual, we see Norman Bates taking on the personality of his mother and dressing like her and becoming a killer of women who arouse him sexually And then, of course, there is Brian De Palma's 1980 film, "Dressed to Kill," Which has a similar theme.
    Yet another stereotype grows out of the R.D. Laing and Thomas Szasz idea that mental illness either does not exist or is an enlightened expression of rebellion against a crazy society. An example of this would be "A Fine Madness," in which Sean Connery plays a poet with writer's block, and he is shown as a free spirit who is fighting alone against the psychiatric establishment. The other film of this type is "King of Hearts," a French film, in which Alan Bates plays a Scottish soldier sent on a mission to disarm a bomb in a small French town. All the townspeople except the patients in the local mental hospital have been evacuated. And the patients take over the town and show themselves as a fun-loving group capable of creating a utopian society.
    One other stereotype I might mention I've called the zoo specimen. You see this in films like "Snake Pit" and "Marat Sade," the 1966 film based on the play. In "Snake Pit," for example, Olivia de Havilland is hospitalized and comments on the similarity between the patients on the wards and animals in their cages in a zoo.

Q. What makes "A Beautiful Mind" noteworthy in its approach to mental illness?
A. Overall, it's one of the better portrayals, if not the best, of what the disease is like. As the title implies, it shows that someone with schizophrenia can be capable of having a beautiful mind--in the sense of making significant contributions in an academic field, having loving relationships, helping students.
    One of the things I liked about the film was that they showed that in the long term, some people can actually return to functioning despite the illness, that they can learn to manage it in the same way a diabetic learns to manage diabetes. The other thing is that they portrayed the kind of chronic struggle that both the patient and the family goes through around complying with medication, and around trying to adjust to the psychotic thinking by ignoring it and recognizing it as not real. That was nicely depicted.
    Also, it portrays medication as effective and useful. To put this in context, when we wrote "Psychiatry and the Cinema," we could only find one film that really showed the effectiveness of psychiatric medication, and that was "As Good as It Gets." But one reading of that film would be that it was the love of Helen Hunt rather than the medication that cured Jack Nicholson. In "A Beautiful Mind," it's clear that when he does take medication he gets better, and when he's cheeking it and hiding it he doesn't.

Q. Are there ways in which the portrait of schizophrenia in "A Beautiful Mind" departs from realism?
A. The major departure would be the emphasis on visual hallucinations. The vast majority of hallucinations in schizophrenia are auditory, that is, hearing voices. On the other hand, the cinematic medium demands visual representations of the inner world. In a novel, you can have a first-person narrator describe in detail what's going on in his mind. But in the movies, there has to be some way of visually representing a delusional world.

Q. Doesn't the film romanticize mental illness, for instance in association genius with schizophrenia?
A. Of course it romanticizes mental illness. The job of a filmmaker is to fill the seats at the theater. So the entire arc of John Nash's life and marriage is all romanticized. The idea that madness and genius are very closely related is also a recurring theme in Hollywood cinema. We can think of recent examples like "Pollock" and most films about musicians, like Mozart in "Amadeus," will show a connection between genius and madness.
    But the research suggests that there is probably a much closer relationship between genius or extraordinary talent and manic depressive illness than schizophrenia. Schizophrenia causes such a global deterioration that works of genius would be very difficult to sustain. Even when a person is successfully treated with medication and various kinds of therapy there is usually a continued deficit in functioning. And you can see that pretty well portrayed in the end of "A Beautiful Mind." We're not led to believe that Nash has been completely restored to his previous level of functioning.

Q. Do the images of mental illness in the movies arise from misconceptions that already exist in the culture, or vice versa?
A. Well, let's look at things historically. There were times when mental hospitals in the United States charged admission so the public could gawk at the mentally ill. So we have this tradition of looking at the mentally ill as strange, exotic and totally different than Me. And the movies, to some degree, appropriate a pre-existing stigma that was rampant in the society. But there's another aspect we ought to bring up. The Hollywood cinema operates on cultural mythology. In fact, I would say that just as the ancient Athenians went to the theater and got their sense of what it means to be human from Sophocles, contemporary citizens in the United States learn what it means to be human from the movies. So that both the Greek dramas and modern American movies are mythopoetic in that sense.
    One of the things we see in movies about psychiatry or mental illness is a mythic narrative that audiences want to see rather than a mirror held up to reality. And we really can't expect Hollywood to give us the stark reality that we see in psychiatric hospitals or psychiatric outpatient clinics. For example, in the movie, John Nash looks like Russell Crowe, Mrs. Nash looks like Jennifer Connelly. He gives a stirring speech at the Nobel Prize ceremony that he never really gave. The homosexual relationships he had in real life and his divorce are also excluded from the movies.

Q. Do you think that people who see "A Beautiful Mind" will start to think differently about mental illness?
A. I think there is an educational benefit. It shows that someone with schizophrenia can be very intelligent, can retain a sense of humor and can persevere with this illness. And it does educate the public that this can strike anybody, and even people who are talented and gifted. The fact that Russell Crowe is playing the character with schizophrenia is also very significant. Russell Crowe is becoming the John Wayne of our era. Here's a guy who just won the Oscar for playing in "Gladiator." If this masculine, sexy movie star can be connected in people's minds with serious mental illness. Then there is a certain cachet. We live in a celebrity-mad culture. And the association of something with celebrity has tremendous influence.

Concerns Over Crowded Psychiatric Hospitals
Jane E. Allen, Los Angeles Times- 2/5/2002

Psychiatric hospitals are more crowded than they've been in years, a new report says, raising concerns about whether they can accommodate the growing need for mental health and addiction services. And as more hospitals close or consolidate, reducing the number of available beds, that puts additional pressure on those that are still open.
    Information collected by the National Association of Psychiatric Health Systems indicates that hospital occupancy was up 11% from 1999 to 2000, and up 24.4% since 1996. However, patients aren't staying in psychiatric hospitals as long as in years past. They averaged a 10-day stay in 2000 and 1999; back in 1991, their stays averaged 23.1 days. The bigger emphasis on treating mental health and addiction through outpatient care is reflected in higher numbers of outpatient visits and outpatient admissions, the association reported in its 2001 annual survey. Its member hospitals each typically saw 1,223 inpatients in 2000.

Making the Most of Positive Role Models
New York Times, 2/5/2002

Mentoring the programs and other efforts to provide positive role models to adolescents in the hope of steering them away from risky behavior have been on the rise, although over the years there has been little solid evidence on the effectiveness of positive role models. Now a new study from the University of California at Los Angeles School of Public Health, published in the Archives of Pediatrics and Adolescent Medicine, sheds light on teenagers' views on the role models.
    Researchers surveyed 749 teenagers and came up with these findings:
* Youths who named role models they knew personally had better grades and higher levels of self-esteem than those whose role models were known to them only through the media. The two groups scored better than those who said they had no role models. There was no overall difference in substance abuse.
* Teenagers who had the most positive feelings about their ethnic group were the most likely to have role models they actually knew, while those with the weakest sense of ethnic pride were the least likely to have role modes.
* Most youths selected role models of the same sex and ethnic group as themselves. Those who chose sports figures, almost all boys, were less likely to report having used drugs in the week before the survey than those who chose other kinds of celebrities.
    The study's leas researcher, Dr. Antronette K. Yancey, said one clear message emerged from the survey: people who are involved in trying to help adolescents should try to provide a diverse group of possible role models.

Maine Bill to Mandate Mental Health Coverage Is Scaled Back
Associated Press, 2/6/2002

PORTLAND, Maine -- A legislator seeking to mandate expanded insurance coverage for mental illnesses and substance abuse treatment has agreed to amend his proposal so that it applies only to health plans covering groups of 20 or more people.  Even with the change, the bill introduced by Rep. Benjamin Dudley, D-Portland, faces opposition from members of the business community who fear it will drive up premiums and force some employers to eliminate health coverage.
    ''Somebody is going to have to pick up the bill and the problem is you have employers with groups of 20 or 25 people that can't afford health insurance today,'' said Peter Gore, a health care analyst for the Maine State Chamber of Commerce. Dudley's original bill would have required all insurance plans to cover all mental illnesses and substance abuse treatment the same way they cover other illnesses and injuries.
    Current law says health plans for 20 or more people must provide the same coverage for only seven listed mental illnesses that they do for other injuries and illnesses. Those seven are autism, schizophrenia, bipolar disorder, paranoia, panic disorder, major depression and obsessive compulsive disorder. Plans for individuals and groups of fewer than 20 people must list this coverage as an option under the current law.
    The Legislature's Banking and Insurance Committee appeared sharply divided on Dudley's bill. It also is considering another proposal, put forth by state Sen. Lloyd LaFountain, D-Biddeford, which would call for a more modest mandate of expanded mental health coverage. LaFountain, the Senate chairman of the committee, wants to require plans serving 20 or more people to reimburse residential treatment centers and licensed clinical professional counselors for services to people diagnosed with any of the seven conditions listed in the current law.
    Dudley's proposal got a tentative 5-4 endorsement from committee members who were present at a work session Tuesday. Dudley, who is a member of the committee, said he is willing to compromise further to get a bill passed.

California High Court to Reexamine Sexual Predator Law
Maura Dolan, Los Angeles Times- 2/6/2002

Patrick Ghilotti and other sexual predators may returned to the streets after successfully completing a state-mandated mental health program. The California Supreme Court, in a Sacramento hearing today, will grapple with a 1996 state law that says sexual predators confined to a state hospital after their prison terms can be released only if experts determine they are no longer likely to offend again. The predictability of recidivism is a question that has long tantalized mental health experts and social scientists. Study upon study has been performed to determine the percentage of sex offenders who will attack again after being returned to society.
    But whether any individual sex offender will be among those who commit more crimes is extremely difficult to predict. The language of the law does not always translate in psychiatry, and vague legal standards often fail to reflect the realities of predicting future threats. "It's like weather forecasting," said R. Karl Hanson, a Canadian government researcher who is a leader in the field of predicting future sexual violence. "You are predicting a probability, like a 30% chance of rain tomorrow. You can't say it will or it won't rain."
    California is one of at least 15 states with laws that allow sex offenders convicted of multiple crimes to be committed to state hospitals after completing their prison terms. More than 1,200 offenders nationwide are behind bars because of those laws. Only a few convicted predators have been released across the country--too few to study recidivism rates.
    Ghilotti, 45, was to be the first in California to graduate from hospital confinement under the state's sexual predator law. After he spent four years at Atascadero State Hospital, three mental health experts licensed by the state concluded that he should no longer be confined. Ghilotti was convicted of four rapes and admitted to six others. He served a 12-year prison term for his most recent rape. Just as he was supposed to walk out of Atascadero, the California Supreme Court intervened. The court took his case on an accelerated schedule in December and squeezed Ghilotti's hearing onto today's calendar.
    The state's law has long been interpreted to require the release of sexual predators from state hospitals if two independent mental health experts determine they are no longer dangerous. Three experts have said Ghilotti should be released. But Gov. Gray Davis and Atty. Gen. Bill Lockyer contend that Ghilotti will probably attack again if returned to society, and the California Supreme Court will decide whether the law provides a vehicle for confining him longer.
    The court's ruling in People vs. Ghilotti, expected within 90 days of the oral arguments, will shape the future for hundreds of sex offenders in California. One of the major issues before the court is the correct legal interpretation of the phrase "likely to engage in acts of sexual violence." If the court eventually comes up with a legal standard for those words, the mental health experts who evaluated Ghilotti or a judge may have to determine whether the experts' findings complied with the legal language.
    Legal scholars who specialize in mental health issues want the courts to devise standards based on numerical probabilities. Those would conform to what scientists are able to provide, the scholars say. "We should at least know what ballpark we are in, whether we are talking 51% likelihood or 90% likelihood," said Hastings law professor David Faigman, who teaches science in the law and constitutional law. "I think the Constitution demands that degree of certainty." But appellate panels instead tend to offer vague standards that are left to lower-court judges and juries to interpret.
    "Courts never define 'likely' or 'probable' in quantitative terms," said John T. Monahan, a psychologist who holds a chair in the law at the University of Virginia. "There have been a number of studies of judges asking them what they meant by such terms as 'likely' and 'probable.' The results are all over the map." Prosecutors in the Ghilotti case said "likely" should be defined as a "significant chance, not minimal," something less than "more likely than not" and more than "merely possible." But Faigman said a standard based on a "significant" danger is too vague. "Significant might be 25% or 45%," the law professor said. Ghilotti's lawyers argue that likely means more likely than not. Monahan, however, said that standard may not make sense to the public. "That would mean that a court would have to discharge somebody with a 49% probability of committing a violent act," he said. "That would be an awfully high probability. We would certainly never tolerate a 49% likelihood of harm in other circumstances, such as the siting of a nuclear power plant," he said.

Sentencing Reforms Created Problems
W. Lawrence Fitch, director of the Office of Forensic Services for the Maryland Mental Hygiene Administration, said new sexual predator laws around the nation stem from sentencing reforms that had unintended consequences. Until about two decades ago, convicted sex criminals served indeterminate sentences. Most left prison on parole after about six years, but the especially dangerous convicts were imprisoned far longer, Fitch said. When states decided to impose fixed sentences, they based the length of the prison terms on the average amount of time sex offenders had been serving, Fitch said. That meant "the really bad guys" got out with the rest, he said.
    Washington was the first state to pass a sexual predator law. It was approved amid public horror over a parolee who raped and sexually mutilated a 7-year-old boy six months after leaving prison in 1989. Predator laws are continually being scrutinized by courts. "The real objection to these laws is whether we have any business putting these people in psychiatric hospitals," Fitch said, "or are we just using them to incapacitate criminals."
    Predator laws generally require a finding of a mental abnormality, a personality disorder or a diagnosed mental disorder before an offender can be committed to a state hospital. But the legal criteria are not particularly based in psychiatry. Mental abnormalities "can include all kinds of conditions that are nothing like mental illnesses that people would have to be hospitalized for," Fitch said. Sexual predators are driven to rape or molest not because of their sexual disorder, but largely because they are antisocial, a common trait among criminals, Fitch said. "The sexual disorder shapes the individual's behavior, but it is the personality disorder that drives it," he said. "There are a lot of people who are pedophiles and would prefer children, but they don't molest children. They get their kicks through pornography."
    Faigman said society has "selected sex offenses as a type of behavior we want to label madness." "There is no reason why you couldn't take exactly the same doctrine and apply it to muggers and burglars," he said. "We have decided to label a particular danger that we find objectionable as a mental abnormality, which only has meanings in the law and has no meanings in psychiatry."
    Although sex offenders are less likely than other felons to offend again after their release, the rates of relapse are not reassuring. During the first four years after release, 10% to 15% of the felons commit another sex offense, researchers say. A study of sex offenders who were eligible for the sexual predator program in Washington but instead were freed found recidivism rates of about 20% within a few years after release, according to Eric Janus, a law professor at William Mitchell College of the Law in St. Paul, Minn.
    The longer an offender is out, the more likely he is to commit another sex crime. Hanson, the Canadian researcher, studied child molesters over 20 years. Nearly 40% of them molested again, he said. Predictions of future violent sexual behavior hinge heavily on the inmate's record. Those who are younger, who attacked strangers, who had a poor relationship with their mothers and who are unmarried are at higher risk than others, researchers said.

Offenders Learn to Manage Impulses
   Treatment for those offenders typically involves teaching them strategies to avoid situations that might prompt them to attack again and to empathize with victims. The men are not cured of their sexual deviation, but they learn to manage their impulses, researchers say. "Our best guess at this point is that well-designed, effective treatment can lower recidivism rates by about 30% to 40%," Hanson said.
    Experts say these offenders should be closely monitored after they leave confinement. If Ghilotti is released, he will not be required to do anything more than register as a sex offender. He has said, however, that he will voluntarily take medication to reduce libido, wear a monitor to show his location and undergo therapy. Hanson, in a 1981 study of about 400 sex offenders, found a higher rate of repeat crimes among sexual predators taking medication to reduce sex drive. That may be because the medication was given to the highest-risk offenders, he said.
    The U.S. Supreme Court has upheld the constitutionality of sexual predator laws, and the state high court has ruled that California's law is constitutional. To meet constitutional requirements, the laws must be aimed at treatment and cannot serve as a mere pretext to keep dangerous felons behind bars. The  Court ruled last month that the offenders cannot be locked up beyond their prison terms without proof that they have serious difficulty controlling their behavior. "The court is clearly concerned about the difference between civil commitment because of the incapacity to control behavior in the future and the ordinary recidivism risk," said J. Clark Kelso, a professor at McGeorge School of Law. "The court wants to draw a distinction between that so you can't use a sexually violent predator law simply to exact additional retribution." Kelso said constitutional problems arise if men are locked up "when you can't make a showing that they are more likely than not to be a danger." California's predator law allows sex offenders who have committed at least two violent sex crimes to be committed to a mental hospital for two-year intervals if a court decides they are likely to commit another offense. After the two years, the inmate can petition for release.
    Reports by evaluators who found Ghilotti no longer met the requirements for commitment have not been made public. "This is a population that is not very sympathetic and, therefore, none of us feels terribly aggrieved that Mr. Ghilotti's rights might be trampled upon," Faigman said. "But the beauty of the Constitution is that it protects us, you and me, when everybody else thinks we are most despicable."