A Film Review of Frederick Wiseman's "Domestic Violence"
David Denby, The New Yorker- 2/11/2002

In Frederick Wiseman's new documentary, "Domestic Violence," which is set largely at a shelter for battered women in Tampa, Florida, some of the women are sullen and abashed and so quiet that they seem to have relinquished the right to be indignant over what has happened to them. But others are blazingly articulate, their stories leaping from them in magnificent tirades. There is one woman in particular whom no one who sees this film will ever forget--a powerhouse, forty years old, with strong hands, glittering dark eyes, and a small mouth that contracts with rage. She is sitting in a group session, sharing stories with other women, and, among many other things, she says this:

My kids did not have to endure what I endured, because my husband of sixteen years tried walking into my daughter's room, and I took a frying pan and hit him upside the head with it, and split his head open, and I told him if he ever touched her in a way that was unbecoming I'd kill him, because I wasn't gonna have her go through what I went through . . . And it hurts really, really, really, really bad to know that you would marry somebody that would do something like that to your children.

That was the end of their marriage. But we later learn from the woman that she fell into a Punch-and-Judy relationship with another man. She may have saved her children, but she could not save herself.
    The other women do not hit back, and many of them have been knocked around for years, staying with men who broke their bones or came after them with knives. They stayed because of children; or because they didn't have control of their bank accounts; or because their husbands locked up their wallets at night and took them away during the day; or because they had lost themselves in a labyrinth of dependency. One woman in her fifties, frankly amazed at her own lurid tales, describes how she finally escaped into the night, naked and bloody, running down the center of a road (she thought that her husband might have been hiding in the bushes). She made it to a friend's house and from there, presumably, to the shelter. "Domestic Violence" is a chronicle of victimization in which the women's suffering is increased by their knowledge that they have been partly complicit in it. As the history of the frying-pan fighter suggests, there was something in the women, or at least in some of them, that drew them to violent men and kept them near those men for years. But a termination point has been reached: the women in the shelter have left. The film is fervently devoted to the near-impossible act of walking out.
    "Domestic Violence" which plays through February 12th at Film Forum and will eventually air on PBS, is the thirty-first of Wiseman's documentaries. Most of them are about American institutions, good and bad, beginning with "Titicut Follies," his muckraking portrait of a facility for the criminally insane, made in 1967. Judged both as reporting and as art--many of the films have a poetic density of structure--it is a series without parallel in movie history. In every film, Wiseman omits titles, narration, and any sort of explanation. He thrusts us into the middle of things, and though at first it's hard to look at some of the women in "Domestic Violence," we are soon looking and listening very closely, trying to sort out the hints and allusions and repetitions. What do the stories mean? What are the patterns? (The film differs from the usual TV exposition of abuse in that Wiseman senses that these knots can never be neatly untangled.) With a hundred or so hours of footage to choose from, Wiseman organizes his material not by topic but organically, weaving scenes together for moral and emotional intricacy and suggestiveness. In the end, after more than three hours, our effort of attention becomes so intense that we are cleansed of squeamishness and fear.
    The initial scenes are set in the morning, and the movie, which was shot over a period of two months, then passes through afternoon and nighttime episodes, as if traversing a single day; the point, of course, is that this mayhem occurs every day in America. It's a mortifying national portrait. In a brief prologue, we see Tampa's glass office towers, then Wiseman retreats to cruddy-looking stores and strip malls along the highways leading out of the city, and from there to broken-down neighborhoods of tract homes and mangy gardens. It's America at its most incoherent, where collections of workers and shoppers live without much community, and people fall through the cracks.
    After the prologue, Wiseman joins the cops, picking up where he left off thirty-three years ago in "Law and Order." In that eye-opening picture, made during the heyday of the counter-culture, the Kansas City police force came off not as "pigs" but as men presented with domestic situations that their training had not prepared them for. Decades of psychology and social work have since intervened: the Tampa police we see in "Domestic Violence" are very good at calming people down. In the first scene, they confront a strutting shirtless male, maybe sixty years old. His on-again, off-again partner, a grandmother with lank hair, has called the police because he has been walloping her. As the cops take him away, the woman says, "I don't want nothing to happen to him." Then, in a wail, "He's got to let me go!" "Domestic Violence" examines the ambiguous nature of human bonds, the nightmare versions of romance and family love. Virtually all the people we see, male and female, insist that they love the ones they torment.
    Additional scenes with the police follow, and then a long central section about life in the Spring, Tampa's largest shelter for battered women and their children. The women come in bruised, bandaged, and they submit to an extensive interview. After seeing the wrangling couple at the beginning of the movie, we may think that all the women at the shelter are uneducated, but that stereotype quickly gets revised. One woman, so ashamed that she can hardly speak, has a doctorate; her husband, it turns out, resents her education. An elegant elderly woman turns up after tearing herself away from a man who has bullied her and their children for almost fifty years. At the shelter, every woman, young and old, is given a bed and some work to do; the young children go to a school in the building.
    The teachers work with the children's drawings, teasing out their traumas. Like teachers everywhere, they instruct by asking questions. Only here the questions go like this: What do you do when an angry dad shows up? (You go upstairs and call the cops.) The scenes with the children are perhaps the most heartrending. Having been abused themselves, or having merely witnessed violence, some of them, we hear repeatedly, have abused their younger sisters or brothers. Like some malignant curse in an unfathomable Greek myth, the desire to commit violence cannot be expunged; it repeats itself through the generations. At the shelter, the staff does what it can to establish new relationships for the women, many of whom have never had anyone who would listen to them. The woman who fought her husband, for instance, tells her story for the first time and experiences, she says, a greater burst of happiness than she has ever known.
    The movie appears to end with a modest expression of hope, but Wiseman has a sinister episode waiting for us. As the women talk, we hear a great deal about men: violent but sweet-talking men, magicians who put women under a spell. But where are they? The men threaten to become unreal. Then Wiseman adds another sequence with the police. This time, a man has called them. He could be a cousin of the ranting old macho in the opening sequence. Drunk, sixtyish, shirtless, he has a long blond mustache and long hair and a courtly manner, like a deep-voiced grandee of the Old South. It's his house, and he wants his girlfriend thrown out, because, he says, she won't talk to him and he might do her harm. He speaks to the police as if it were their problem, and he had nothing to do with it. But the woman, who has a soft, pleading manner, is ill and has nowhere to go, and she desperately wants to get some sleep. The police reason with the man, but in this case there's nothing they can legally do, and, in the end, as a feeling of horror hits us like a wave, they leave them to spend the night together.

Charges in Priest Abuse Allegations Unlikely Without Victim Names
Ken Maguire, Associated Press- 2/11/2002

BOSTON -- The Roman Catholic Archdiocese of Boston has yet to forward the names of victims of suspected pedophile priests to prosecutors, some of whom are growing impatient as they consider filing charges against the priests. Without names of victims and victims willing to participate in a prosecution district attorneys say they can't investigate priests accused of child molestation. It's too early to threaten subpoenas to obtain names, they say, but they haven't ruled it out.  ''We've made it known to the archdiocese that we need those names in order to proceed, and we expect them to be provided to us in a timely fashion,'' said Anson Kaye, spokesman for Middlesex District Attorney Martha Coakley, whose office has received 24 priests' names. ''Should those names not be provided to us in a timely fashion, we would consider all our options,'' he said.
    Last month, Cardinal Bernard Law announced the archdiocese would report past allegations of child sex abuse. The change in policy came after documents in the case of defrocked priest John Geoghan showed at least some church officials knew of the accusations against him, but did not alert authorities. The archdiocese records go back 40 years, Law said, and are being ''combed and combed again.'' So far, the names of 80 accused priests have been given to authorities.  The archdiocese has not confirmed it will provide victims names. A spokesman Saturday would only say ''the process is ongoing.'' Archdiocese communications director Donna Morrissey did not return a call for comment.
    Former Norfolk County prosecutor Timothy Flaherty said subpoenas are district attorneys' best weapons. They could convene a grand jury to investigate instances of illicit sexual conduct by priests in the archdiocese, and issue grand jury subpoenas to the archdiocese for records relating to any abuse, said Flaherty, now a criminal defense lawyer. They also could ''demand appearances, by subpoenas, of the hierarchy of the archdiocese or any other person with personal knowledge of record keeping conducted by the church internally,'' he said.
    Some of the allegations date back to the 1950s. The statute of limitations is 10 years for rape of an individual who was under 16. ''That's a central issue to whether many of these cases (will) be prosecuted someday,'' said David Procopio, spokesman for acting Suffolk District Attorney Elizabeth Keeley, who received 24 names of accused priests. ''It would seem that quite a few are time-barred.'' Procopio said if they don't have victims names soon, ''we will demand more forcefully.''
    Phil Saviano, regional coordinator for the New England chapter of the Survivors Network for Those Abused By Priests, said victims feel safer identifying themselves because authorities are taking the issue seriously ''for the first time.'' ''Victims are becoming empowered like I've never seen it in my life. They know they can come forward and not be ridiculed, and they're likely to be believed,'' said Saviano, 49, who as a child was molested by a priest.
    Law has been under increasing public pressure since Geoghan was convicted Jan. 18 of sexual molestation. The cardinal subsequently announced a policy of ''zero tolerance'' for sexual abuse and initially gave authorities names of 40 accused priests. He said none was active, but in the past week, eight active priests were suspended because of allegations of abuse. Returning from the Vatican, Law acknowledged on Friday ''there's some individuals that needed to be removed that had not been.'' He said again Sunday that to his knowledge there are no active priests with any accusations against them.
    A poll released the same day by The Boston Globe and WBZ-TV found 58 percent of local Catholics believe Law has done a poor job handling the allegations and 48 percent believe he should resign. The survey of 800 Catholic adults had a margin of error of plus or minus 3 percentage points. On Sunday, Law spoke at Cathedral of the Holy Cross and was interrupted by applause when he told the congregation that he would not step down. ''Archbishop is not a corporate executive. He's not a politician,'' Law said during Mass. ''When there are problems in the family, you don't walk away. You work them out together with God's help.''

Drug Problem Surges in Rural U.S.
Fox Butterfield, New York Times- 2/11/2002

PRENTISS, Miss. -- The trophy houses, with wrought-iron gates and grand-columned entryways, keep popping up on little country roads here, in clearings in the piney woods and near doublewide trailers. Sometimes there is a luxury car or two in the driveway. In the affluent suburbs of Boston, New York or Dallas, these homes might belong to successful doctors, lawyers or software company owners. But Prentiss, a small town in south-central Mississippi, has no industry or affluent professional class in the conventional sense. The last sizable factory moved to Mexico three years ago, leaving an unemployment rate of 25 percent. Instead, the police say, many of these houses belong to drug dealers, made rich by a flourishing business in crack cocaine, methamphetamines, marijuana and OxyContin, the prescription painkiller. They are the most visible manifestation of an explosion of rural drugs and crime that is overwhelming local law-enforcement agencies and bringing the sort of violence normally associated with poor neighborhoods of big cities. The upsurge has been felt across the United States from Maine to Oregon and from Georgia to Texas, even as drug use in most large cities has been declining.
    In December, for example, Ron Jones, one of five members of the Prentiss Police Department and the son of the police chief, was shot to death as he entered an apartment to serve a search warrant for drugs. It was the most recent of 14 homicides in the last two years in Jefferson Davis County, which has 14,000 residents, giving the county a homicide rate of 50 per 100,000. That is higher than the rates of Detroit, Washington and New Orleans, cities that regularly rank among the highest homicide rates in the nation. Nationwide, while the rate of arrests in drug crimes has fallen 11.2 percent in cities with more than 250,000 residents over the last five years, it has risen 10.5 percent in rural areas, according to the FBI. Even more striking, from 1990 to 1999, the last year for which figures are available, the percentage of drug-related homicides tripled in rural areas but fell by almost half in big cities.
    To measure the problem another way, a continuing survey of drug use among junior high and high school students by the University of Michigan has found that crack is now more widely used among 8th-, 10th- and 12th-graders in rural areas than among those in metropolitan areas. Methamphetamine use is now highest in rural areas among all three grades and heroin use is about equal in urban and rural areas, the survey found.
    The spread of drugs in the countryside is uneven, the experts say. In Washington County, for instance, at the far northeastern corner of Maine, prosecutions in crimes involving OxyContin are 10 times what they were in 1998, say law-enforcement officials, who estimate that at least 1,000 of the county's 35,000 residents are addicts. "It's gone beyond the epidemic stage," Sheriff Joe Tibbetts said. "I can't think of a family in Washington County that hasn't been scathed by it in some way." His officers' families are among those who have been affected, Tibbetts said.
    In Dawson County in central Nebraska, the problem is methamphetamine. "The percentage of meth-related crimes is through the roof," said Paul Schwarz, an investigator with the county sheriff's office. In the state as a whole, officials discovered 38 methamphetamine laboratories in 1999; last year they discovered 179. "If there is a battle going on out there," Schwarz said, "we're honestly not winning it."
    Similarly, in Douglas County, a vast timber, farming and fishing area in southwestern Oregon, Lt. Mike Nores of the sheriff's department estimates that 12 percent to 14 percent of the 103,000 residents are making, selling or using drugs, particularly methamphetamines and marijuana. Drug use and trafficking account for 80 percent of all crime in the county, including killings, Nores said.
    One reason for the growth in rural drug problems, federal officials say, is that aggressive prosecution in cities has led dealers to seek safety in the farms and forests of rural counties, which have far fewer law-enforcement officers. "We've seen drugs and crime migrate to the rural areas in the past several years to get away from law enforcement," said Tony Soto, director of the Gulf Coast High Intensity Drug Trafficking Area in New Orleans, a task force of federal, state and local law-enforcement authorities established by the White House Office of Drug Policy Control.
    Observers site the poverty and isolation of rural areas as keys to their growing drug trade. "You have many rural areas that are persistent poverty areas, in essence rural ghettos," said Joseph Donnermeyer, professor of rural sociology at Ohio State University. "They were once isolated and were protected by that, with lower crime, but now better communications have broken down that buffer so they begin to resemble poor neighborhoods of big cities, where people are segregated by poverty."

Former Michigan Drug Addict Gets Grant to Help Other Users
Associated Press, 2/11/2002

PONTIAC, Mich. -- David Whiters spent several years abusing heroin. But the 43-year-old Whiters, formerly of Pontiac, is not using drugs anymore. He's spent the last several years of his life educating himself and helping others battle addiction. And the first-year doctoral student at the University of Georgia School of Social Work has received a $1 million federal grant to aid his efforts to teach recovering addicts to be lobbyists and leaders in substance abuse treatment and education. "It's a movement that is similar in a lot of ways to the gay rights movement and the civil rights movement," he said in a recent phone interview with The Oakland Press in Pontiac. "It's a lot of the same principles."
    Whiters doesn't hide his past problems when advocating for his cause. "I'm one of the ones the federal government is proud of because I'll tell the whole world," he said of his past drug abuse. He is working to convince people dealing with substance abuse that they are best qualified to speak on the issue because they have lived with it. He wants to reduce the stigma associated with drug and alcohol addiction to help recovering addicts become advocates.  Whiters said the stigma that comes with substance abuse leads most recovering addicts to remain as anonymous as possible. That anonymity makes it difficult for government officials to see the benefits of treatment programs that need funding.
    He recently organized a one-day conference to convey his message to 500 recovering addicts. Whiters wants to bring some to Washington, D.C. to help persuade lawmakers to spend money on treatment programs rather than new prisons. The $1 million grant came from the Center for Substance Abuse Treatment, a branch of the Substance Abuse and Mental Health Services Administration in the U.S. Department of Health and Human Services. It will be used for program costs, a full-time administrative assistant and stipends for addicts who serve as advocates. He will receive $200,000 annually for five years. Ollie Whiters, David's mother, said he frequently returns to Pontiac to visit. She is proud of her son for overcoming his past problems to help others. "He's always trying to help someone," she said.

Court Contends With Journalists Covering Yates Trial
Carol Christian, Houston Chronicle- 2/11/2002

Janet Warner realizes that journalists are paid to be persistent, but she still marvels that they don't understand the word "no." "I find myself having to repeat myself a lot because they don't want to listen," she said. "When you say `no,' they say, `that's not an answer.' But it is. It's just not the answer they're hoping for." Warner, special projects coordinator for Harris County's criminal district courts, has the job of dealing with reporters covering capital murder trials. Since June 20, a great deal of her time has been spent on preparations for the trial of Andrea Pia Yates, the Clear Lake mother accused of drowning her five children in the bathtub of their home in the 900 block of Beachcomber. "This case has kept me very busy from the beginning," said Warner, whose work includes coordinating capital murder trials for all 22 criminal district courts.
    Judge Belinda Hill, who is hearing the Yates case, has allotted 50 seats for the media. Those were snapped up before the Jan. 4 application deadline -- with one reporter coming from Germany and one from England -- but every day Warner gets more requests. "I had a lady call me from Canada the other day," Warner recalled. "I said, `I'm sorry, I don't have any media seats left.' "She said, `Well, I'm just going to come down and hope I can stand in line.' "
    During the trial, which is expected to last two to three weeks, the courthouse at 301 San Jacinto will be ringed with television satellite trucks. Reporters have been asking Warner and her boss, Harris County Courts Administrator Jack Thompson, for an "audio room," a place where they could listen to trial proceedings without being inside the courtroom. "One station said, `Isn't there a hallway or an office that adjoins the courtroom?' " Warner noted. "I said, `Yeah, but that little office is probably 10-by-10 and they have three staff members sharing it.' We just don't have any room."
    Another consideration is that Judge Hill's orders regarding media coverage prohibit taping the proceedings other than the lawyers' opening and closing statements and the verdict announcement, which will be videotaped.  If there were an audio room, it would require staffing to make sure no one taped the testimony, Warner said.  Guidelines for the media are up to each judge's discretion, and Warner said Hill's primary concern is a fair trial.
    Six days after the Yates children were drowned, Hill imposed a gag order on lawyers, witnesses and investigators in the case, prohibiting them from discussing the case with reporters. "I know it's been harder for the media because of the gag order, but we've negotiated as much as we could for the media," Warner said. "We know they have a job to do, but you've got to understand her point of view also. We've got to ensure that the proper atmosphere is going to prevail."
    In the case of Yates, one complicating factor is limited space in the courthouse. Because of the June flooding, the new Criminal Justice Center at 1201 Franklin is still under repair, and the criminal courts are squeezed back into their former headquarters. But now, 22 felony courts and 15 misdemeanor courts are meeting in a space that formerly accommodated about two-thirds that many. Precinct 1 Justice of the Peace David Patronella also hears cases in the building. Daily docket calls for all those courts bring thousands of people through the doors -- defendants, attorneys, spectators, jurors, witnesses, and various court officials. The space crunch has judges sharing courtrooms. Hill shares hers with Judge Joan Campbell of the 248th State District Court, who will use the 130-seat auditorium each day between 8 a.m. and 10:15 a.m. for her docket call.
    As soon as bailiffs clear the courtroom after Campbell's docket call, Yates' trial will move into the somber space with a high ceiling, dim lighting and bad acoustics. Testimony is expected to last until 5:30 or 6 p.m. each day, with breaks. If a trial or hearing comes up in Campbell's court, Warner said she would try to juggle space for it somewhere else, such as the basement area that used to be a cafeteria and is now a courtroom.
    Meanwhile, Warner coordinates logistics for all capital murder trials, which happen every business day in Harris County's courts. During the Yates trial, four other death-penalty cases are scheduled to be tried. Warner is responsible for making sure that all five trials run smoothly, but one of her biggest concerns at the moment is dealing with the 50 reporters who will cover the Yates trial. "Since I've been involved in this, I have the utmost respect for school teachers," she said. "It's like keeping your little classroom together and watching to make sure everybody's behaving. I don't make many friends with the media when we come around to this."

Spiritual Psychotherapy A Path Around a Stigma
Steven Gray, Washington Post- 2/11/2002

At first, Renee Jackson chalked it all up to a case of the blues, stoked, perhaps by the Devil himself.  So she prayed. Her father died, and the melancholy deepened. Pleas to God failed to lift her, but she feared turning to professional therapists because of the stigma it carried among blacks. When she did, she found the medicine and psychotherapy they proffered as sterile as a textbook, devoid of any spiritual solace. "All those things are good," the 46-year-old Southeast Washington woman said of the therapists' suggestions, but they felt foreign to her. Then, the pastor of her Prince George's County church referred her to Baraka Pastoral Counseling Center in Largo, a hugely popular ministry that five years ago was among the nation's first to offer a culturally sensitive, Christianity-based mental health program for blacks.
    For black Christians accustomed to turning to their religion in times of distress, Baraka's unusual blend of gospel music, prayer and psychotherapy was like manna. The independent clinic now has about 1,000 clients -- and a waiting list of middle-class black parents eager for black therapists for themselves and their teenagers. Baraka and others like it have broken through a barrier in black culture, which tends to look down on those who seek treatment for mental illness. And the timing is critical.
    In a report last year, U.S. Surgeon General David Satcher referred to the culturally imposed stigma of mental illness and poor access to quality care as reasons that people of color suffer a "disproportionate burden" of mental illness. Blacks are less likely than non-Latino whites to suffer from major depression. But 15 percent suffer from somatization -- the manifestation of a psychological problem through a physical disability -- compared with 9 percent of whites, the surgeon general's report concluded. And although whites are nearly twice as likely as blacks to commit suicide, the suicide rate among black males ages 10 to 14 has increased 233 percent in the last two decades, compared with 120 percent among their white counterparts.
    In another survey cited in the report, "Mental Health: Culture, Race and Ethnicity," 85 percent of black respondents described themselves as "fairly religious" or "very religious" and said that prayer is their most common coping mechanism. And only 34 percent of blacks responding to a National Mental Health Association survey said they would take an antidepressant prescribed by a doctor, compared with 69 percent of all respondents. Another significant factor in mental health care among blacks is the cost: Nearly 1 in 4 blacks is uninsured, compared with about 1 in 6 of the total U.S. population. "The church is critical, because it embodies so much of the culture and history of black people. The opportunity to make progress lies in the church," Satcher said.
    Mental health experts offer varying explanations for blacks' traditional aversion to mental health care, beginning with a deep distrust of medical culture shaped by well-documented instances in which blacks were used as virtual guinea pigs for research. The experts also suggest a perception among many blacks that only whites seek therapy and that white therapists do not understand black cultural nuances. Misdiagnoses have often followed, they say. The idea of mental illness also runs counter to blacks' view of themselves.
    "After 250 years of slavery and 150 years of barbaric apartheid, we tend to see ourselves as strong, so mental illness seems like a weakness," said Harvard University psychiatry professor Alvin F. Poussaint, a leading expert on the mental health of blacks. At the same time, he added, "we're used to thinking that life is the blues, that it's normal, that you have to deal with it." Pastoral counseling is hardly a new concept, but few of the American Association of Pastoral Counselors' more than 3,000 members are black. And few pastoral counseling centers such as Baraka's, are affiliated with mostly black churches.
    Seven years ago, psychotherapists within the congregation at Ebenezer African Methodist Episcopal Church in the Fort Washington section of Prince George's expressed alarm at the increasing incidence of depression among their largely black, Christian clientele. Equally troubling was their clients' unwillingness to seek further professional help, primarily because of their faith's heavy insistence on perseverance and praying away pain. "There's some apprehension" about discussing mental illness, acknowledged the Rev. Jo Ann Browning, co-pastor at Ebenezer, which has more than 10,000 members. "Just saying the phrase . . . it's jarring." For many of the church's affluent members, "pastoral counseling," Browning said, feels safer than "mental health care."
    But if any church was to shatter the stigma of mental illness, socially progressive Ebenezer ought to be it, said the therapists who lobbied the church to underwrite Baraka's launch. The creation of a mental health care ministry meant breaking a "Jesus-only" formula that bluntly dismissed professional counseling. "And to say the pastor doesn't have to be the end-all, be-all is a challenge," said Michele Balamani, the executive director of Baraka and a psychotherapist who also is an ordained minister.
    When prayer did not quell Renee Jackson's depression, she turned to Baraka. "This is a satanic force sent to destroy me," she told herself, hoping to regain composure. "And if he can get your mind, he's got everything else." Baraka's therapists casually referred to instances of depression in the Bible, including Elijah, who entered a despondent state of seclusion. Their use of rhythm-and-blues gospel music during massage sessions was soothing. The therapists prescribed standard medicines to ease Jackson's depression and placed their hands across her head in prayer. And, just like other therapists, they asked her to retrace her upbringing, recalling patterns of depression and what triggered the bouts. Jackson's depression has lessened significantly, and she can now say the word without flinching. Without Baraka, she said, she "probably would still have been battling depression. Now, when I get up, whatever I'm going through, God's presence is with me. So all is going to be well."
    The surgeon general's report strongly encouraged mental health care providers to make a more earnest effort to understand the nuances of the nation's ethnic and racial cultures. Recognizing the dearth of research on this topic, the National Institute for Mental Health last month awarded Howard University's College of Medicine a $6.5 million grant to study mood and anxiety disorders among blacks.
    Universities nationwide, meanwhile, are rushing to increase the small number of mental health professionals of color. Blacks, for instance, account for only 2 percent of psychiatrists, 2 percent of psychologists and 4 percent of social workers, according to the surgeon general's report. "Culture is one of those things that has to be addressed. For a therapist not to deal with it is like ignoring a whole part of the patient," said Ekwenzi Gray, 27, a black psychology graduate student at Howard University who contemplated suicide as a teenager.
    Doris Berringer, a 48-year-old black District entrepreneur, spent weeks searching for a black therapist for her foster children and eventually found Progressive Life Center, an Afrocentric mental health clinic in the city. Initially, she took her children to white psychotherapists, who had urged her to accept their placement in special-education courses. "I wanted to prepare my kids for college, push them, and they thought it was a joke," she said. They also recommended that she not force her children to sit together for the family's Sunday dinner and that she order a "timeout" after their temper tantrums, she recalled. But, Berringer said, "In growing up, when we had issues, our parents dealt with it" using a tougher form of discipline, which the black therapists affirmed. "We're working with black kids, and at some point, you have to deal with kids from a holistic perspective."

Book Review of "Can Love Last?
The Fate of Romance Over Time by Stephen A. Mitchell
Judith Shulevitz, New York Times Book Review- 2/11/2002

Why is it so hard to commit to someone or to get someone to commit to you or, for that matter, to stay in a committed relationship? Advice to the lovelorn may seem like a frivolous subject for this book review, but consider all the brow-furrowing books that ponder these questions. Public policy analysts fret about declining marriage rates. Evolutionary psychologists posit genetic motives for philandering. Biologists, historians, economists and anthropologists--they all have their big theses.
    None of them, however, helps us to understand love as we experience it personally. No matter how much lip service we pay to the larger sweep of biology and history and to the thought that we no more control our fates than does plankton caught in the backwash of a cruse ship, few of us will avoid entirely those long and lonesome nights in which we blame ourselves for falling out of love or not taking it when it was offered or failing to find any at all. There are only three places to look for insight into such matters: women's magazines and other platitudinous divisions of the self-help industry; fiction, which in its quest for the specific shies away from the applicable; and the frequently maligned discipline of psychoanalysis, whose practitioners are among the few trained to deal with these issues concretely, one on one, as well as abstractly, and to measure success in the most modest increments of decreased misery.
    Stephen, A Mitchell, who died two years ago at the unripe age of 54, was a leading American psychoanalytic theorist who was also devoted to the Sisyphean task of helping patients live life more fully. (Mitchell is best known for his contributions to the field of relational psychoanalysis, which holds, contra Freud, that people are the products of an innate need to interact with others, not of impersonal drives like sex and the death wish, and that our sense of self is woven into a web of intimate relations; it is not a thing unto itself.) "Can Love Last? The Fate of Romance Over Time" is Mitchell's posthumous contribution to the effort to give greater depth and texture to daily existence. In it, he ventures to explain why we allow our love lives to grow stale and dull. His answer is blunt and a little cruel. Love, he says, doesn't fade on its own. We do our best to kill it, even when we want it to live. Particularly when we want it to live, because we can't stand how naked and unsettled deep romantic longings can make us feel.
    To understand how this works, you have to understand Mitchell's psychoanalytic habit of flipping everything we take for granted onto its head. Do we feel too safe in our relationships and fantasize about something more exciting? Mitchell argues that the real fantasy is our conviction of safety, a sort of theatrical backdrop that partners jury-rig so that each may avoid what lurks behind the familiar façade of the other. Husbands believe their wives are devoted. Wives believe their husbands are dependable. Each ignores evidence to the contrary. Both act in accordance with the other's beliefs. Each, when this collusive contrivance disintegrates, exclaims, "He/she is not the person I thought he/she was!" Mitchell calls this illusory deadening "a protective degradation, a defense against the vulnerability inherent in romantic love."
    Sex? Together we do what we can to strip it of enigma and power, since without a patina of dullness it is too destabilizing to sustain, involving as it does "multiple surrenders, relinquishments of self-control . .. immersion in the sensations and rhythms of the other." Aggression? Perfectly natural. Love makes us aggressive because it makes us scared, and we respond to threat with anger. The problem arises when we channel our aggression into subtly denigrating the other, which reduces his or her power over us but also his or her allure. Idealization? A very good thing, in Mitchell's opinion. Idealization exercises both the passions and the imagination and allows us to correct our blinkered vision so as to better see the true wonder of things.
    Mitchell, in short, is more Romantic than romantic. Like some methodologizing William Wordsworth, he places his faith in the redemptive capacity of the imagination. This is another of his ways of upending conventional thought. Freud thought fantasy clouded reality. Mitchell and the post-Freudian thinkers he draws upon say that fantasy -- in the sense of allowing oneself to perceive things or people as more beautiful or valuable than other people consider them to be -- is a window into a reality beyond the walls of ordinariness, walls we have built out of necessity, certainly, but also out of a self-defeating urge to lessen the intensity of authentic experience.
    But how are we to learn to keep our wattage high enough to tolerate this somewhat alarming sounding authenticity? Here is where Mitchell's plain-spoken style grows slightly misty. Psychoanalysis seems to be required. You'd have to have a strong sense of self to withstand life as he envisions it--and a dose of healthy narcissism, in order to forestall the withering fear of self-dramatization that might otherwise impede an embrace of life as a grand emotional adventure. Philosophical sophistication wouldn't hurt, either. Mitchell invokes Nietzsche, who thought that to live keenly we need to grasp life's tragic fragility, and even its futility. Nietzsche's image for tragic man or woman was of one who keeps building sand castles even while aware of the incoming tide.
    It is one of the charming if unintended ironies of this book that Mitchell takes as his icon Nietzsche's builder of sand castles but avoids the philosopher's dark, Germanic tone. Most of the analytic case studies offered as examples end relatively well. Cheerful, open and humane -- you'd definitely have wanted. him as your analyst -- Mitchell reminds us that psychoanalysis is at heart a hopeful profession, notwithstanding its minimal guarantees. After all, no one would do what analysts do, over the course of years and with results that are impossible to measure, without a deep faith in people's ability to make themselves happier. This devotion to self-improvement may explain why psychoanalysis became so popular in the United States, even as it remained marginal in Europe.
    And yet personal progress is exactly what the tragic sense of things casts into doubt. Can we really do better? Or can we just learn to put up with everyday desperation with a more generous dollop of grace? Mitchell overestimated psychoanalysis, if he thought that a psychoanalytic book on love (as opposed, say, to an actual analysis) would ever help anybody. On the other hand, he was probably right when he said that consistently overestimating is the more satisfying way to live.

Ecstasy: The New Cocaine?
ABC News, 2/11/2002

Calling it the "rave generation's cocaine," a nonprofit antidrug group is putting out a stern warning about Ecstasy, an increasingly popular drug that is being embraced by more and more teens. "We're finding it alarming," Ginna Marston, the executive vice president of the Partnership for a Drug-Free America told Good Morning America. "Teen drug use is down and holding steady, but Ecstasy use is going up steadily."
    A synthetic stimulant that comes in a pill, Ecstasy used to be the province of 20-somethings who used it at dance clubs or all-night raves, but now it is drawing the teen set. The number of teens using Ecstasy has jumped 20 percent since last year, and 71 percent since 1999, with an estimated 2.8 million teens at least trying the drug once, according to a PDFA study released today on Good Morning America. Starting today, the nonprofit coalition is launching a series of public service announcements warning of the dangers of Ecstasy.
    The new study, which looked at 6,937 teens across the country, found that more than 12 percent of teens had tried Ecstasy at least once in 2001, compared to previous studies that found usage rates of 10 percent in 2000, seven percent in 1999, and five percent in 1995, the PDFA reported. Overall teen drug use has been diminishing since 1997 and remained stable between 2000 and 2001, but Ecstasy has been the exception, the only type of drug that is attracting more teens. It is now about as widely used by teens as cocaine, crack, heroin, LSD or methamphetamines. Marijuana remains the most widely used drug, with 41 percent of teens reporting that they have tried it.

Cocaine Marketing Strategy
Experts say the big problem with Ecstasy is its image — one that is so positive, it is almost as though some clever marketing wizard came up with a campaign for it. Though current statistics show that most teens will never try the drug, experts worry that the hype surrounding it could prompt the number of teens using Ecstasy to double. Dubbed the "love drug" or the "hug drug" or just "X," Ecstasy accelerates the release of serotonin in the brain, creating an intense high, and filling the user with feelings of love and acceptance, emotions that teens crave most. "I loved it," said Clarissa McKennie, a former Ecstasy user who said she started using the drug at the age of 13 when older friends told her it would raise her self-esteem.
    Word in the school hallways is that the drug will give users a great high with low risk. It is a reputation similar to the one that cocaine enjoyed in the 1980s, when that drug's use was buoyed by widespread social acceptance and aggressive word of mouth, Marston said. Teens view the drug as only slightly more dangerous than alcohol, tobacco, marijuana and inhalants. Though its street names make it sound benign, Ecstasy is a potent and potentially dangerous "cocktail mix of acid and speed," that can cause brain damage, Marston said. McKennie, who is now in a long-term residential treatment program, had this warning for her peers: "It is not the fun that you seem to have when you're on it.... It's a dangerous drug."

Side Effects of ‘Love Drug’
   Ecstasy, known scientifically as methylenedioxymethamphetamine, or MDMA, is a synthetic, psychoactive pill that induces feelings of euphoria, and has properties similar to amphetamines and hallucinogens. It dramatically raises blood pressure, heart rate and body temperature, and can lead to muscle breakdown, as well as kidney and cardiovascular system failure. In heavy doses, it can be lethal and addictive, damaging neurons in the brain. Ecstasy-related emergency room visits increased from 421 in 1995 to 4,511 in 2000, according to the federal Substance Abuse and Mental Health Services Administration.
    The use of Ecstasy can also have psychological impacts and cause brain damage, research has found. "After someone uses Ecstasy, they can have depression or mood problems several days or weeks later," Dr. Terry Horton of the Phoenix House treatment center said. "It doesn't always require taking a lot of it." Studies have also documented that Ecstasy damages sensitive parts of the brain, leading to memory and learning problems that can be long-lasting, Horton said. "That's frightening, especially at a time in their lives when brains are developing," he said.
    Experts say that parents can look for the following signs of drug use:
Being involved in a peer group that has trouble with the law
Truancy
Dishonest behavior
School performance suffers greatly, extracurricular activities fall off
Moodiness
    These signs are specific to Ecstasy:
Possession of pacifiers, used to stop jaw clenching, as well as lollipops, candy necklaces, mentholated vapor rub
Sore jaw, from clenching teeth, part of the drug's after-effects
Confusion
Depression
Severe anxiety
Headaches, dizziness
Panic attacks
Paranoia
Vomiting or nausea, from hangover, or after-effects.
    Teens who are on Ecstasy may show the following signs while actually on the drug: trance-like state, blurred vision, chills or sweating, confusion, faintness, paranoia or severe anxiety, transfixed by sights and sounds, unconscious clenching of the jaw, grinding teeth, very affectionate. They may also wear child-like costumes, such as angel wings, and glow sticks or glowing jewelry, or carry teddy bears and pacifiers. Another sign: bringing multiple water bottles to parties or raves, or leaving empties in their bedrooms or cars.

Colorado Suicide Rates Soaring
Karen Auge, Denver Post- 2/12/2002

Most likely to try are teenage girls and women between 15 and 24, using pills. Most likely to succeed are men, 35 and older. They use guns. Suicide has been a problem in Colorado for decades. Currently, the state has the nation's 10th highest suicide death rate. In any given year, 600 Coloradans kill themselves; nearly 10,000 seriously consider it. Treating those who try costs the state nearly $58 million a year. Suicide is, Gov. Bill Owens said Monday, "a devastation," that is "all too prevalent in Colorado."
    A report issued Monday has tried to answer the enduring questions of who is committing suicide in Colorado, why, and what to do about it. The report, "Suicide in Colorado," sponsored by The Colorado Trust, offers details on the victims and makes several suggestions on prevention. But, Owens said, "there is no clear answer as to why" suicide is a chronic problem, not only in Colorado but elsewhere in the West. The report includes actions that might show someone is considering suicide, such as giving away favorite possessions, exhibiting noticeable change in behavior, experiencing sudden happiness after a long depression and making statements about a desire to die.
    The report also found that only half the people at risk for suicide in Colorado seek professional help. Researchers identified 239 suicide resources around the state, from hotlines to treatment facilities, and pointed out that Colorado is one of the few states with a government department dedicated to fighting suicide. The Office of Suicide Prevention was created in June 2000. Still, those resources are "not entirely adequate," said John Moran, president of The Colorado Trust. Moran said Colorado needs a comprehensive approach, one that includes screenings in schools, churches and elsewhere in the community, and treatment.
    Many Colorado counties lack sufficient mental health treatment services, and those that do have them report that they are seriously strained, said Kaia Gallagher, of the Center for Research Strategies, which compiled the report.  Of 17 community mental health centers - centers that treat patients who have no insurance or limited means to pay - 14 have waiting lists of people who want help, Gallagher said. "Our young people need all the help we can give them. People need all the help we can give them," Owens said. But he cautioned that the state can't do it all - especially in a year when state money is tight. "We have to be more aggressive in trying to prevent suicide where it happens," which is in the cities, towns and counties, he said.

New Indiana Mental Health Clinic Tailored to Amish Values
Associated Press, 2/12/2002

GOSHEN, Ind. -- A new mental health clinic tailored to the needs of the Amish is proof that one size does not necessarily fit all when it comes to social services. Until the Rest Haven clinic opened last month, members of Amish communities surrounding this northern Indiana city came to a county-run center for mental health care.  Elkhart County's Oaklawn Community Mental Health Center has long catered to Amish needs, and included Amish on its board of directors.
    However, Amish clients often found themselves side by side with drug addicts and alcoholics in surroundings that sometimes clashed with traditional Amish values. "The TV was a big issue. They had it blaring, and it was annoying to people who didn't feel good," Marlon Schrock, an Amish member of Rest Haven's board of directors, told The Indianapolis Star for a story published Tuesday. Many Amish patients "got very close to the non-Amish community," added Lee Hochstetler, chaplain at Oaklawn. "A number of Amish did leave the church."
    So four years ago, leaders of northern Indiana's Amish churches began considering alternatives. The result is a $420,000 center in Goshen, a dozen miles from Indiana's border with Michigan and near Indiana's largest Amish settlement in Elkhart and LaGrange. Rest Haven is the first mental health clinic designed for Indiana's estimated 30,000 Amish residents, and one of a few of its kind nationwide. Small Amish-run clinics exist in Ohio and Michigan, but they do not offer professional counseling, Hochstetler said. Rest Haven is supervised by Oaklawn, but run by Amish. Amish patients pay a price set by the center's board of directors, which contracts with Oaklawn for counseling services.
    Outside the clinic, a horse-and-buggy hitch is located in front of the simple gray building. The 15 bedrooms are spartan -- white walls and white curtains. Amish receive the same counseling and psychological services as the non-Amish patients at Oaklawn, Hochstetler said, and some Amish patients use prescription medicine. But when it comes time for group therapy and other mingling, the Amish follow their own path. Those with illnesses such as depression or schizophrenia typically address their problems in keeping with Amish values concerning faith in God and separation from the modern world. "We're different, but everybody's human," Schrock said. "If somebody has a problem, we need to take care of them."
    As in modern society at large, many Amish don't believe in seeking help for mental illness, said Steven Nolt, a history professor at Goshen College who studies the Amish. They are not opposed to using medicine for matters of the body, he said. But many Amish are skittish about seeking help for matters of the mind, believing them to be matters for God to heal. "Part of the reluctance is that there's a feeling that mental health workers don't understand the Amish community," Nolt said. But now, with a separate facility, the Amish can treat problems with a mix of psychology and spirituality. "They don't mind being here longer," Hochstetler said. "They're in a group where they feel comfortable."

Maxey Training School Plans to Begin Layoffs
Associated Press, 2/12/2002

GREEN OAK TOWNSHIP, Mich. -- W.J. Maxey Boys Training School plans to layoff 27 employees in the next two weeks in the first phase of a downsizing effort that could mean as many as 123 job cuts. Maureen Sorbet, deputy director of Michigan's Family Independence Agency said the state wants to cut workers because the maximum security facility's population has dropped from nearly 560 in the mid-1990s to about 300 young men and boys, ages 12-21. "The number of youths committing crime is down nationally," Sorbet told The Detroit News. "There are fewer youth coming into our facilities."
    Attorneys for Maxey workers represented by AFSCME Council 25 are fighting the proposed layoffs.  Eric Frankie, the attorney representing the Maxey employees, said the center violated its own rules by failing to meet with union officials to discuss the impact of the layoffs and isn't following seniority lists as required.   Livingston County Circuit Court Judge Stanley Latreille ordered the two sides to meet within the next 10 days before the cuts can go into place.
    It costs $288 a day to treat and house one child at Maxey, which houses youth convicted of violent crimes such as assault, rape and murder. The layoffs are expected to save millions of dollars, Sorbet said. The state had tried to lay off about 130 of the 500 staff members in November. But Latreille temporarily halted the cuts after union representatives filed an emergency injunction. Dan Beaton, of the Attorney General's office, criticized the union representatives Monday. "It's not for them to come into court every time we lay off a state employee," Beaton said. "There's absolutely no basis for them to come into the courthouse."

'Beautiful'—but Not Rare—Recovery from Schizophrenia
Sandra G. Boodman, Washington Post- 2/12/2002

The end of "A Beautiful Mind," the Oscar-nominated movie based loosely on the life of Nobel Prize winner John Forbes Nash Jr., depicts the Princeton mathematician's emergence from the stranglehold of paranoid schizophrenia, the most feared and disabling of mental illnesses. Moviegoers who have watched the cinematic metamorphosis of actor Russell Crowe – from the disheveled genius who furiously covers his office walls with delusional scribblings to the silver-haired academic perfectly at home in the rarefied company of fellow laureates in Stockholm – might assume that Nash's recovery from three decades of psychosis is unique.
    But mental health experts say that while Nash's life is undeniably remarkable, his gradual recovery from schizophrenia is not. That contention is likely to surprise many people, including some psychiatrists, who continue to believe the theory, promulgated a century ago by Sigmund Freud and his contemporaries, that the serious thought and mood disorder is a relentless, degenerative illness that robs victims of social and intellectual function, invariably dooming them to a miserable life in a homeless shelter, a prison cell or, at best, a group home.
    Psychiatric researchers who have tracked patients after they left mental hospitals, as well as a growing number of recovered patients who have banded together to form a mental health consumer movement, contend that recovery of the kind Nash experienced is not rare. "The stereotype everyone has of this disease is that there's no such thing as recovery," said Washington psychiatrist E. Fuller Torrey, who has written extensively about schizophrenia, an illness he has studied for decades and one that has afflicted his younger sister for nearly half a century. "The fact is that recovery is more common than people have been led to believe. . . . But I don't think any of us know for sure how many people recover."
    The notion that Nash's recovery is exceptional "is very pervasive even though the facts don't support it, because that's what generations of psychiatrists have been taught," said Daniel B. Fisher, a board-certified Massachusetts psychiatrist and activist who has fully recovered from schizophrenia for which he was hospitalized three times between the ages of 25 and 30. "Many of us who have spoken about our recovery are confronted with the statement that you couldn't have been schizophrenic, you must have been misdiagnosed," added Fisher, 58, who holds a PhD in biochemistry and went to medical school after his hospitalizations.
    The belief that recovery from schizophrenia occurs only occasionally is belied by at least seven studies of patients who were followed for more than 20 years after their discharge from mental hospitals in the United States, Western Europe and Japan. In papers published between 1972 and 1995, researchers found that between 46 and 68 percent of patients had either fully recovered – they had no symptoms of mental illness, took no psychiatric medication, worked and had normal relationships – or were, like John Nash, significantly improved but impaired in one area of functioning. Although the patients received a variety of treatments, researchers speculate that the improvement may reflect both an ability to manage illness that accompanies age coupled with the natural decline, beginning in the mid-forties, in the levels of brain chemicals that may be linked to schizophrenia.
    "One reason nobody knows about recovery is that most folks don't tell anybody because the stigma is too great," said Frederick J. Frese III, 61, who was hospitalized 10 times for paranoid schizophrenia in his twenties and thirties. Despite his illness, Frese, who considers himself "definitely not fully recovered but in pretty good shape," earned a doctorate in psychology and was, for 15 years, director of psychology at Western Reserve Psychiatric Hospital in Ohio, the state's largest mental hospital. Frese holds faculty appointments at Case Western Reserve University and Northern Ohio Universities College of Medicine. He has been married for 25 years and is the father of four children as well as past president of the National Mental Health Consumers Association. These achievements are hardly consistent with the prognosis Frese was given at 27, when a psychiatrist told him he had a "degenerative brain disorder" and would probably spend the rest of his life in the state mental hospital to which he had recently been committed.

Not Everybody Recovers
No mental health expert – nor any of the eight recovered schizophrenia patients interviewed for this story – would suggest that recovery or even marked improvement is possible for all the 2.2 million Americans afflicted with the confounding illness that typically strikes in late adolescence or early adulthood. Sometimes schizophrenia, which is believed to result from an elusive combination of biological and environmental factors, is simply too severe. In other cases medications have little or no effect, leaving people vulnerable to suicide, which claims more than 10 percent of those diagnosed, according to epidemiological studies.
    For others, mental illness is complicated by other serious problems: substance abuse, homelessness, poverty and an increasingly dysfunctional mental health system that favors 10-minute monthly medication checks, which are covered by insurance, over more effective but time-consuming forms of support, which are not.
    The improvement seen in many schizophrenia patients as they reach their fifties and sixties generally affects only the most acute psychotic symptoms such as vivid hallucinations and imaginary voices. Patients rarely revert spontaneously to the way they were before they got sick, experts say, and many in whom the disease burns out are left with the emotional flatness and extreme apathy that also characterize schizophrenia.
    While a growing number of mental health workers agree that recovery occurs, there is no consensus on how to define or measure it. Academic researchers typically adhere to a strict definition of recovery as a return to normal functioning without reliance on psychiatric drugs. Others, many of them ex-patients, embrace a more elastic definition that would encompass people like Fred Frese and John Nash, who continue to have symptoms they have learned to manage. "I'd say there's a gradation of severity of illness and a gradation of recovery," said Francine Cournos, a professor of psychiatry at Columbia University who directs a clinic in Manhattan for people with severe mental illness. "The number of people who wind up completely symptom-free and without relapse is probably small. But everyone we treat we can help."

A Bleak Prognosis
In 1972, Swiss psychiatrist Manfred Bleuler published a landmark study that appeared to refute the teachings of his eminent father, Eugen Bleuler, who in 1908 coined the term schizophrenia. The elder Bleuler, an influential colleague of Freud's, believed that schizophrenia had an inexorable downhill course, much like premature dementia. His son, curious about the natural history of the disease, tracked down 208 patients who had been discharged from one hospital an average of 20 years earlier. Manfred Bleuler found that 20 percent were fully recovered, while another 30 percent were greatly improved. Within a few years research teams in other countries essentially replicated his findings.
    In 1987 psychologist Courtenay M. Harding, then at the Yale University School of Medicine, published a series of rigorous studies involving 269 former residents of the back wards of Vermont's only state mental hospital, where they had spent years. Widely considered to have been the sickest patients in the hospital, they had participated in a 10-year model rehabilitation program that included housing in the community, training in jobs and social skills and individualized treatment. Two decades after they completed the program, 97 percent of the patients were interviewed by researchers. Harding, a former psychiatric nurse who expected only modest improvement, said she was stunned to discover that about 62 percent were judged by researchers to be either fully recovered – they took no medication and were indistinguishable from people who had no diagnosable mental illness – or functioned well but had not recovered in one area. (They took medication or heard voices.) A study comparing the Vermont patients to a matched group in Maine, a state with much more parsimonious mental health services, found that 49 percent of the Maine patients had recovered or improved significantly.
    So why has the almost universally gloomy prognosis for schizophrenia persisted in the face of convincing empirical evidence to the contrary? "Psychiatry has always clung to a narrow medical model," observed Harding, who directs Boston University's Institute for the Study of Human Resilience. "Psychiatric dictionaries still do not have a definition of recovery," but speak instead of remission, which "carries the heavy time bomb of impending illness," she observed. Columbia's Francine Cournos, an internist as well as a psychiatrist, agrees. "A lot of research is done in academic settings, and a lot of people who get seen there are sicker," she said. "And if you're working in a state hospital, all you ever see are the sickest patients." Psychiatrists traditionally have not made a distinction between symptoms and the ability to function, Cournos added. "It's important to remember that there is a difference between the two. We've had patients here who are very high-functioning and psychotic, including a woman who ran a very high-powered executive program but at work wouldn't write anything down. She coped by memorizing everything she had to do because it drowned out the voices."

Tale of Two Former Patients
The lives of Dan Fisher and Moe Armstrong illustrate the possibilities of recovery. The two men have a lot a lot in common: They are neighbors in Cambridge, Mass., they are the same age, they both work with psychiatric patients, are well-known mental health advocates and they both have been hospitalized for schizophrenia. By any measure, Fisher has recovered completely. Armstrong is the first to say he has not.
    Fisher's unusual odyssey from schizophrenic to psychiatrist embodies the most optimistic vision of recovery. For the past 28 years, Fisher said, he has taken no psychiatric medication. He has not been hospitalized since 1974, when he spent two weeks at Washington's Sibley Hospital. He has been married for 23 years, is the father of two teenagers and shuttles between a community mental health center where he has worked as a psychiatrist for 15 years and the National Empowerment Center, a nonprofit consumer organization he helped found a decade ago. A few weeks ago he attended a White House meeting on disability issues.
    Fisher was first diagnosed with schizophrenia in 1969. Armed with an undergraduate degree from Princeton and a PhD in biochemistry from the University of Wisconsin, he was 25 and investigating dopamine and its role in schizophrenia at the National Institute of Mental Health when he suffered his first psychotic break. "I put more and more energy into my work, and I literally felt that I was the chemical I was studying," said Fisher, who recalled that he was desperately unhappy and that his first marriage was unraveling. "And the more I believed my life was being run by chemicals, the more suicidal I felt." He was hospitalized briefly at Johns Hopkins Hospital, where his father was on the medical faculty, given Thorazine, a powerful antipsychotic, and soon returned to his lab.
    The following year Fisher was hospitalized again, this time for four months at Bethesda Naval Hospital, across the street from his lab. A panel of five psychiatrists diagnosed him as schizophrenic and he left his job. After his discharge from Bethesda, Fisher decided that he had to make some radical changes. He jettisoned his once-promising career as a biochemist and decided, with the encouragement of his psychiatrist and his physician brother-in-law, to become a doctor so he could help people.
    In 1976 Fisher graduated from George Washington University School of Medicine, then moved to Boston to complete a psychiatry residency at Harvard. He passed his board exams and began practicing at a state hospital and seeing private patients. In 1980 his career as a consumer advocate was launched when he disclosed his psychiatric history on a Boston TV talk show. A decade later he helped found the National Empowerment Center, a resource center for psychiatric patients funded by the federal Center for Mental Health Services.
    "I'm sure it helped me that I came from a professional family and I was educated," Fisher said of the factors that led to his recovery. "What helped me recover was not drugs – which were one tool I used – it was people. I had a psychiatrist who always believed in me, and family and friends who stood by me. Changing my career and following my dream – becoming a doctor – was very important."
    Moe Armstrong – Eagle Scout, high school football star, decorated Marine – has come a long way from the nomadic decade that began when he was 21, following his psychiatric discharge from the military after combat in Vietnam. Between 1965 and 1975, Armstrong said, he lived on the streets of San Francisco, in the rugged mountains of Colombia and in his parents' house in southern Illinois, "where I wore a housecoat and told everyone I was St. Francis." He received no treatment but developed an addiction to alcohol and drugs.
    In the mid-1970s, Armstrong sought mental health treatment through the Veterans Administration. He managed to stop drinking and using drugs and moved to New Mexico, where he graduated from college, earned a master's degree and became known as a mental health consumer advocate. In 1993 he moved to Boston and became director of consumer affairs for a nonprofit company that provides services to the mentally ill. Six years ago he met his fourth wife, who has also been diagnosed with schizophrenia; the couple lives in an apartment they bought several years ago.
    For Armstrong, every day is a struggle. "I have to continually watch myself," said Armstrong, who has taken pains to arrange his life in a way that minimizes the chance of a relapse. He takes antipsychotic medication, eschews movies because they often make him feel "over-amped" and tries to be in "supportive, gentle, loving environments."  "I have many more limitations than other people, and that's very hard," Armstrong said. "And I had to give up the notion that I would be Moe Armstrong, career soldier, which is what I wanted to be. I think I've recovered as much as I have because I'm still the guy that's the scout, looking for the way out."

Factors That May Support Recovery from Schizophrenia
Sandra G. Boodman, Washington Post- 2/12/2002

The saga of Nobel Prize winner John Forbes Nash Jr., whose 30-year battle with schizophrenia is the subject of the movie "A Beautiful Mind" (and of Sylvia Nasar's far more accurate biography of the same name), illustrates some of the factors psychiatric researchers and ex-patients say foster recovery. "What the movie communicated is that recovery is possible, and in Nash's case the main elements we know to be effective were there," observed psychologist Xavier Amador, deputy executive director of research at the National Alliance for the Mentally Ill, an advocacy group.
    These factors, which include medical and social support, decent housing and encouragement, do not guarantee improvement, nor does their absence make recovery impossible. They include:
Age and onset. Studies have found that people who are older and whose symptoms appear suddenly do better. According to psychiatrist E. Fuller Torrey, 75 percent of people diagnosed with schizophrenia are 17 to 25. Nash was 30 when his illness struck abruptly; he was already a full professor at the Massachusetts Institute of Technology and had written the doctoral dissertation that would earn him a Nobel Prize in economics 45 years later. A person who had major problems in childhood, or who is diagnosed as a high school senior, may find recovery harder.
Managing Medication. Powerful antipsychotic drugs help some people enormously, while others get little or no relief from the vivid hallucinations, imaginary voices or persistent delusions that are the hallmarks of schizophrenia. In the movie, Nash says drugs helped him recover. But Nasar writes that Nash took no medication after 1970 "and indeed during most periods when he wasn't in the hospital during the 1960s." She speculates that this helped preserve his intellect and protect him from the disabling neurological side effects that are associated with long-term use of antipsychotics.
    Psychologist Courtenay M. Harding, who has published several studies of patients discharged from the back wards of Vermont's state mental hospital, said that 50 percent of patients who fully recovered or significantly improved took no psychiatric medication at the time of the study, while another 25 percent used the drugs only when they felt they needed them.
    Learning how to manage the more disturbing side effects of drugs is vital, patients say. Psychiatrist Beth A. Baxter, 38, of Nashville, has taken Clozapine for seven years. The drug helped her return to practicing medicine full-time and to live independently -- but caused her to gain 100 pounds. (Substantial weight gain is a common side effect of many newer drugs.) "I joined a health program last year and I've lost 65 pounds so far, and I'm really proud of that," said Baxter.
Avoiding street drugs and alcohol. Nash did not have a substance abuse problem, but a lot of people with schizophrenia do. One study has estimated that 47 percent of people with schizophrenia have a co-existing drug or alcohol problem, which can worsen psychotic symptoms and seriously impede recovery.
Supportive relationships (and a decent place to live).Intense loneliness and social isolation are among the biggest problems for people with schizophrenia. The relationships Nash had with fellow mathematicians were essential to his eventual recovery, but the single most important factor in Nash's recovery was the bond with his remarkable wife, Alicia. She fed, housed and cared for him even after she divorced him, and never wavered in her devotion to him or her belief in his extraordinary talent. Most people who have recovered credit the steadfast encouragement of another person who they say believed in them: a therapist, teacher, counselor, nurse or, less often, a family member.
Productive work. For some patients this might involve starting in a sheltered program, then gradually moving to more challenging employment with people who are not mentally ill. "Clinics and day treatment centers can be like little ghettos" that expose patients only to the behaviors and problems of people with similar disorders, observed psychiatrist Daniel B. Fisher.
    In Nash's case, the Princeton campus functioned as a therapeutic community. His bizarre behavior was mostly tolerated, and he was granted access to lecture halls and libraries and offered human contact without being forced to make it. As his schizophrenia receded, Nash participated in seminars and made friends with a few graduate students. Later he was given unrestricted access to a computer, which he taught himself to use, and began writing intricate programs.
    After a nine-month hospitalization, Beth Baxter worked at a greenhouse growing basil, then moved into a job as a consumer mental health advocate. After that she joined a psychiatric crisis team and progressed from part-time to full-time work.
Coping strategies. Learning about schizophrenia, recognizing the warning signs of relapse and developing practical coping strategies are crucial. Even after recovery "people still go through periods of severe distress, but then so does everyone," Fisher said. "It's a question of what happens in those states."
    Cognitive therapy, a behavioral treatment that focuses on a rational evaluation of thoughts and practical ways to reduce symptoms, has proven to be beneficial. "We try to help people identify whether their symptoms make sense, so they can ask themselves: 'Does it seem likely that I'm the president?' " New York psychiatrist Francine Cournos said. "You can teach insight." Amador notes that Nash essentially undertook a form of cognitive therapy on his own. "He rationally evaluated the advantages and disadvantages of responding to his delusions," Amador said.
Persistence. A reluctance to give up -- or to accept a prognosis of doom -- can be seen in Nash's story and was a factor mentioned by all eight ex-patients interviewed. It is also a trait researcher Courtenay Harding said was widespread among the Vermont patients who got better. Resilience appears to be related to basic personality traits and is largely untouched by mental illness, Torrey said. "I was told by one psychiatrist that I would spend the rest of my life in the hospital taking medication," recalled psychologist Patricia Deegan, 47, who was hospitalized for the first time as a 17-year-old high school senior. Instead she managed to earn a doctorate in clinical psychology and helped found the National Empowerment Center in Lawrence, Mass., a resource center for recovering psychiatric patients. Recently she adopted a child as a single mother and has begun directing a program at Boston University. Deegan said she has not taken psychiatric medication or been hospitalized since 1994. "For me," she said, "recovery was all about rejecting a life as an invalid and believing I could be something more."

Bush Aims to Cut U.S. Drug Abuse by 25% in 5 Years
Ken Guggenheim, Associated Press- 2/12/2002

WASHINGTON -- President Bush set a goal Tuesday of cutting drug abuse by 25 percent in five years through greater efforts toward prevention, treatment of addicts and improved law enforcement. Bush announced his administration's drug-fighting strategy, which also seeks a 10 percent drop in illegal drug use in two years. "We've got a problem in this country: Too many people use drugs," he said. "This is an individual tragedy, and as a result it is a social crisis."
    The administration says Bush's budget proposal for next year, announced last week, would spend 6 percent more for treatment and 10 percent more for drug interdiction. Overall, $19.2 billion would be spent on fighting drugs, which would be a 2 percent increase over the current budget. Bush said some of the most important anti-drug work will have to come not from the federal government, but from communities, religious groups and families. He called for "armies of compassion," directed through religious institutions, to send the message that "We love you. We love you so much we're going to convince you not to use drugs in the future." "There is a moral reason for this fight," Bush said to lawmakers, ambassadors and anti-drug officials in the East Room of the White House. "Drugs rob men and women and children of their dignity and their character. Illegal drugs are the enemies of ambition and hope."
    While the anti-drug strategy includes some new programs, including a $5 million Parents Drug Corps, and much of it emphasizes a need to make existing programs more effective. Among the priorities are identifying people who need treatment but are unlikely to seek it, such as the homeless; helping recovering addicts stay clean; and doing more to disrupt drug traffickers' finances and distribution.  White House drug policy director John Walters said it also is important to change public attitudes. "We have to undermine the cynicism that people are always going to use drugs at roughly the same amount that they're using now. That's not true. And my goal is to demonstrate that's not true," he said.
    The report comes two months after Walters was confirmed for the Cabinet-level post over the objections of some top Democrats. A protégé of former drug policy director William Bennett, Walters was seen as being more focused on punishing traffickers and fighting drugs abroad than in helping drug users through treatment programs.  One Democrat who opposed Walters, Senate Judiciary Committee chairman Patrick Leahy, said he welcomed Bush's call for a "balanced approach." "Drug treatment, education and prevention cut crime and addiction and deserve larger roles in our drug policy," Leahy, D-Vt., said.

Study: Mild Depression and Eroding Immunity
New York Times, 2/12/2002

Scientists have long known that there is a link between serious depression and the ability to ward off diseases. But a new study suggests that even mild depression can weaken the immune system in older people if it goes on long enough. Writing in the current Journal of Abnormal Psychology, researchers from Ohio State University said that among people they had monitored for 18 months, those who reported symptoms of depression had measurably lower immune responses, as determined through blood samples. The symptoms probably need to occur over a long period to affect the immune system, said the lead author, Dr. Lynanne McGuire, now of the Johns Hopkins medical school. "It wasn't someone having a bad week or a bad day," Dr. McGuire said. In this case, many of the people studied were under considerable stress, since they were the spouses of dementia patients taking part in a broader study.
    In all, the researchers examined 78 adults, with an average age of about 72. Of these, 22 were judged to be mildly to moderately depressed after taking a standardized questionnaire about their emotional well-being. The immune system generally declines as people age, leaving them more vulnerable to disease and less equipped to recover quickly. So anything that accelerates that deterioration is of concern, the researchers said. Moreover, they found, the older the person, the worse the effect even mild depression seemed to have. Still, the study does not mean that mildly depressed elderly people necessarily need to be taking antidepressants, Dr. McGuire said. She said they might well benefit from simple therapy, or even just someone making sure they were getting enough physical activity.

Recovering Addicts' Perspective on Marijuana Is Far From Hazy
Dana Parsons, Los Angeles Times- 2/13/2002

At first, she was just goofin,' slouched in her chair and acting as if she didn't really want or need to be there. Too cool for the room. Others had spoken, had talked about their marijuana addiction, but 18-year-old Darlene [in keeping with the spirit of anonymity at the meeting, I'm using different first names for participants] didn't look like one to open up. She was at this meeting of Marijuana Anonymous as part of a court referral and looked for all the world like the most bored student who ever sat in a world history class.
    Toward the end of the hour-long meeting, during a slightly awkward few moments of silence, she sensed people looking at her. "What do you say?" she said, meaning she didn't know what was expected. "Like, how it's been?" You don't have to talk if you don't want to, someone else said. She began. "It took me six times, in and out of jail," she said. "I [messed] up a lot." She went on to say she'd stolen up to $300 from her mother on occasion, mostly to get high. She used speed and alcohol, but as for the others in MA, marijuana is the drug of choice.
    Darlene thinks she's turned it around. She's graduated from high school, is about to complete her court-appointed time in a group home and believes she'll reconcile with the father of her baby. By the time she had finished her few minutes of talking, she wasn't laughing anymore. "I didn't like my life, but it wasn't drugs that [messed] up my life. I did it. It was my choice."
    Marijuana Anonymous members meet almost every night in Orange County. On this night, they're on the second floor of the Sister Elizabeth Building near St. Joseph Hospital in Orange. The group originated in Orange County more than 15 years ago and is patterned after the 12-step program for recovering alcoholics or other addicts.
    I came because a few months ago, I wrote about an Orange County Sheriff's Department raid on a marijuana farm. In light of what seems to be a softening of the public's mood regarding pot use, my glib take was to ask whether the deputies' time was well-spent. I won't be nearly as glib on the subject in the future. I don't know if marijuana is addicting or not, but these people believe it is. That's probably all that matters.
    Before the meeting, 45-year-old Jim was warming up the coffee. "The widespread belief is that [pot smoking] is not a big deal, that you really don't get addicted to it," he says. "We call ourselves addicts. I say I'm in recovery and definitely was addicted. I smoked daily for 13 years." Those in the group of 16 drug users who chose to talk described lives overrun by their need to smoke pot. They talked about friends and relatives left in their wake, about lives they thought would be more enjoyable if they could get high.
    "I'm about to turn 14," Cleo says. "I know I'm pretty young to be in these meetings." She started smoking pot when she was about 8 or 9, she says. "I was a real pot head back then. I could say I'm an addict, but it's taken me a long time to say whether I'm an addict or not. I'm only 14. What does a 14-year-old know? But I started smoking at 8 and did it all the way to 14. That's a long time. Normal kids don't do that." She concluded by thanking everyone in the room for supporting her. Gloria, 17, has been coming to MA for 18 months. Her first drug arrest, she says, was at 10. She experimented with heroin at 11. "Now I'm clean," she says. "I think how stupid I was."
    Many of us play down pot-smoking. Many people have smoked it for years, without apparent disabling effects. While we smile knowingly as well-known figures like singer Willie Nelson talk about his recreational use, we probably should also remember those who have lost themselves in the haze of pot smoke. "This meeting works," Gloria told the first-time attendees. "You find friends here. You find honesty here. You find out who you really are."

Delaware Lesbian May Be Responsible for Child Support
Associated Press, 2/13/2002

WILMINGTON, Del. -- A lesbian being sued by her former partner for child support should be considered a parent even though she and the boy have no biological connection, a court commissioner has ruled. Both women should be considered mothers to the 4-year-old boy they chose to have through in-vitro fertilization, Family Court Commissioner John Carrow said. He ordered both women to attend a child support hearing at a later date.  The decision, handed down Feb. 5, was made public this week. If it is upheld on appeal, it will set a precedent in Delaware by expanding who can be held legally responsible for caring for a child, experts said. ''It's definitely a leap,'' said attorney Joel Tenenbaum, chairman-elect of the American Bar Association's family law section. ''It absolutely expands the definition of a parent.''
    There have been at least four similar cases fought in California, Pennsylvania and Washington state. Shannon Minter, legal director for the National Center for Lesbian Rights in San Francisco, said that a key issue is whether both parents consented to the creation of the child. When a married couple uses artificial insemination, there is an automatic presumption that the husband is the father, he said. In two cases in Pennsylvania during the last year, courts ordered non-biological mothers to pay child support because they had consented to their child's creation, Minter said. In Washington state, a trial court ruled that the former partner of a biological mother was not a parent and did not have to continue to pay child support. An appeals court agreed the former partner was not liable and found that the only people required to support a child as a parent are those who are biologically related to a child or who adopt a child. The California case is still pending.
    The women in the Delaware case were referred to in court records by pseudonyms, Carol and Karen Chambers.  Karen, the biological mother through in-vitro fertilization, said she was relieved by the ruling. ''Now, he is going to be supported the way he should be, and she is not going to be able to bring babies into the world and not have any responsibility for them,'' said Karen, who sued Carol for $550 a month in child support in 2000.
    Carol's attorney, Felice Glennon Kerr, said Carrow went too far in interpreting state law. ''It's a real stretch of the statute to think the legislature intended there to be more than one mother or father,'' Kerr said. Carol had argued that because their relationship was not legally recognized as a marriage in Delaware, the state should not force her to help support the boy.
    Before the decision, if a homosexual couple raising children together in Delaware split up, only the person with custody had legal responsibility for supporting the children. ''It's another step toward the day when those children of gay couples have the same legal protections as children whose parents are heterosexual,'' Minter said. Nationally, about 14 million children have homosexual parents, according to a book on same-sex parenting cited by Carrow in his ruling.
    On the Net:
Human Rights Campaign: http://www.hrc.org
National Center for Lesbian Rights: http://www.nclrights.org

Drug Company Advertising Increasingly Targeting the Patients
Linda A. Johnson, Associated Press, 2/14/2002

TV viewers are right if they are feeling barraged by commercials for the likes of Vioxx, Prilosec, Claritin and Viagra: Drug company advertising aimed at ordinary people instead of doctors tripled in the United States between 1996 and 2000 to nearly $2.5 billion a year. Advertisements targeting consumers account for 15 percent of U.S. spending to promote medications, up from almost 9 percent in 1996, a study found. Spending that targets doctors including visits from sales representatives, free samples and medical journal ads slipped from 91 percent to 84 percent during the same period, according to researchers at Harvard University and the Massachusetts Institute of Technology.  The researchers analyzed data on media advertising and sales of individual drugs, examining trends since 1996, the year before the Food and Drug Administration issued rules for television ads on prescription drugs. The study appears in Thursday's New England Journal of Medicine.
    Critics such as Dr. Sidney Wolfe of Public Citizen Health Research Group argue that drug ads aimed at ordinary people encourage use of expensive, sometimes unnecessary medicines, appeal to patients' emotions, undermine the doctor-patient relationship and rarely tell patients about the drugs' success rate, alternative treatments and other key information. The pharmaceutical industry argues the ads inform and empower consumers, prompt many to see their doctor about an untreated health problem and nudge others to take their prescription drugs more faithfully.
    The researchers found the biggest jump has been in TV commercials, with a seven-fold increase in spending from $220 million to $1.6 billion between 1996 and 2000. Sixty percent of the print and broadcast ads were for just 20 medications, including the arthritis drugs Vioxx and Celebrex, the ulcer drug Prilosec, Viagra for impotence and the allergy drugs Claritin, Allegra and Zyrtec. Total spending on prescription drug promotion grew about 70 percent, from about $9.2 billion in 1996 to $15.7 billion in 2000, the same rate of growth as drug sales had during that period.
On the Net:
http://www.nejm.com
http://www.hsph.harvard.edu

Maryland House Panel Questions Domestic Abuse Bill
Daniel LeDuc, Washington Post- 2/14/2002

Some of Maryland's most powerful officials have lined up to support a seemingly straightforward move to give District Court commissioners authority to put temporary restraining orders on people accused of domestic violence. It seems straightforward to Lt. Gov. Kathleen Kennedy Townsend (D) and House Speaker Casper R. Taylor Jr. (D-Allegany), who have made it a legislative priority. It seems straightforward to Attorney General J. Joseph Curran (D) and Court of Appeals Chief Judge Robert Bell, who have urged approval. It seems straightforward to the Maryland State Police, chiefs of police and sheriffs who support the proposal. And it seems straightforward to the state Senate, which passed similar legislation last year and is considering it this year.
    But the proposal's advocates came in for skeptical questioning yesterday from House Judiciary Committee members. "If a woman is harassed, we want to make sure she's protected," said the committee chairman, Del. Joseph F. Vallario Jr. (D-Prince George's). "The problem is, is [the new system] going to be abused? You're taking away [from a suspected abuser] his kids. You're taking his home away from him." Vallario said he expected the proposal to be approved, "but we've got a lot of work to do on it."
    The legislation would ask voters in November if they want to change the state constitution to allow District Court commissioners to grant protective orders at night and on weekends to shield people who say they are victims of domestic abuse. The orders would be in place until a judge could review the case the next time court was in session.
    Currently, such orders can be granted only during regular court hours. The only protection for victims in evenings and on weekends is to ask for criminal charges against someone they claim is abusing them. "The vast majority of domestic violence occurs outside regular business hours," said Townsend, who along with other advocates testified yesterday at both House and Senate hearings. "When a victim finally gets the courage to leave an abusing relationship, she needs to know the courts will welcome her. Even Home Depot is open 24 hours a day."
    Maryland is the only state in the mid-Atlantic region that does not have a system that allows domestic abuse victims to seek protection orders outside business hours, according to Del. Ann Marie Doory (D-Baltimore), president of Women Legislators of Maryland and vice chairman of the Judiciary Committee. District Court commissioners already are on call 24 hours a day, ruling on probable cause questions in criminal cases and setting bail when suspects are arrested. Curran said that it would not be a significant expansion of their authority to allow them to grant temporary protective orders.
    But several committee members said they were not convinced. Del. Dana Lee Dembrow (D-Montgomery) said he want to ensure that the temporary protective orders would have a set expiration period. Del. Kenneth C. Montague Jr. (D-Baltimore) questioned how the commissioners are trained and how frequently their job performance is reviewed. And Vallario said he was unhappy with the current wording of what voters would actually vote on in November to make a constitutional change. "It doesn't say anything about booting you out of the house," he said. "I'm not sure this is clear to voters."