Insanity Defense Seen As Long Shot in McDermott Trial
Denise Lavoie, Associated Press- 4/1/2002

CAMBRIDGE, Mass-- When police responded to a shooting at the Wakefield offices of Edgewater Technology on Dec. 26, 2000, they found Michael ''Mucko'' McDermott sitting motionless in a chair, an AK 47-style semiautomatic rifle beside one foot, a 12-gauge shotgun beside the other. As officers arrested him, he said only, ''I don't speak German.''
    As McDermott, 43, goes on trial Monday in the killings of seven of his co-workers, his lawyer will argue that he was legally insane at the time of the shootings, suffering from schizophrenia and unable to understand what he was doing. Prosecutors say McDermott, a software engineer, knew exactly what he was doing and methodically planned the killings. They will present evidence that he packed up four guns and a stockpile of ammunition to take to work with him that day and planned the shootings as revenge for the company's plan to garnishee his wages to pay back taxes he owed to the IRS.
    McDermott's lawyer, Kevin Reddington, plans to call three psychiatrists who will testify that McDermott has schizophrenia, a severe mental disorder characterized by delusions and hallucinations. He will ask the jury to find McDermott innocent by reason of insanity, arguing that McDermott's mental illness made him unable to appreciate the wrongfulness of his conduct.
    The use of an insanity defense is seen by some lawyers as a defense of last resort because in most cases, it fails. Defense lawyers point to the case of Andrea Yates, the Texas mother who was convicted March 12 for drowning her five children by jurors who rejected her insanity defense. ''If anyone was insane killing her own children she was, but the jury didn't even buy that,'' said Boston defense attorney Stephen Hrones. ''In McDermott's case, even assuming that he has psychiatrists who will say he was mentally ill, that he was just propelled into doing this ... the government is going to bring out all this evidence of planning. There was a motive it isn't like this just came out of nowhere,'' Hrones said.
    Boston attorney Norman Zalkind used an insanity defense when he represented a Framingham man who killed and mutilated his wife in 1995 after she complained that he burned their ziti dinner. Richard Rosenthal beat his wife to death with a rock, then impaled her heart and lungs on a stick because he believed she was an alien coming to kill him, Zalkind said. ''He was very, very crazy; as insane as you can get but after five days, the jury still came back and said guilty,'' Zalkind said. In the McDermott case, he said, ''The act itself is extremely crazy, but the question is, what kind of sympathy is the jury going to have when there are seven victims?''
    If the jury were to find McDermott innocent by reason of insanity, he would be sent to a state mental health hospital for an initial evaluation. If the court then ordered him committed, he would be reevaluated after six months, and then annually, to determine whether he would remain committed.
    Attorney Joseph Balliro, who used an insanity defense unsuccessfully last year in the murder trial of Dr. Richard Sharpe, a dermatologist convicted of killing his wife, said the biggest hurdle faced by defense attorneys is jurors' fears that the defendant will eventually be released from a psychiatric hospital. ''When they look at him and listen to what he has admitted doing this horrible crime they are concerned about whether or not some psychiatrist says in a year or two that he's no longer a danger to the community and he'll get released,'' Balliro said.
    Psychiatrists say the public has become more understanding about schizophrenia and other mental illnesses, thanks in part to films that have portrayed patients in a more sympathetic light. The Oscar-winning movie, ''A Beautiful Mind,'' starring Russell Crowe, told the story of mathematician John Forbes Nash, who struggled with schizophrenia for years before winning the Nobel prize for economics.
    Whether that new understanding will affect jurors in criminal cases is still an open question, said Dr. Richard Warner, a Boulder, Colo.-based psychiatrist who works with police departments, judges, businesses and community groups to try to humanize schizophrenia. ''I think it's possible that we might be at the beginning of a process that might affect attitudes of people on juries, but we've got to recognize that we've seen decades of entertainment media depictions of people with mental illness that are totally different than the depiction in ''A Beautiful Mind,'''' Warner said. ''That (movie) was one strike against stigma, but it may be quite a long process. It's quite hard to change attitudes.''
    Numerous Edgewater employees will be called by prosecutors during the trial, according to a company spokeswoman. Prosecutors have said McDermott targeted specific workers in the shooting rampage, including Rose Manfredi, who broke the news to him about the IRS decision to garnishee his wages. In interviews shortly after the killings, employees said McDermott appeared calm and friendly the morning of the shootings.

Teen Mental Health Targeted in Rhode Island Schools
Associated Press, 4/1/2002

PROVIDENCE, R.I. --The federal government has approved a $350,000 grant to launch mental-health care programs at select schools in Pawtucket and Providence. The programs will offer outpatient services such as social-skills training, anger management and mental-health assessments.
    ''There is a tremendous shortage of outpatient mental health professionals for kids in the state,'' said Dr. Gregory Fritz, medical director at Bradley. ''The need is massive.'' Fritz, who is also the director of child and adolescent psychiatry at Brown University Medical School, said the surgeon general in 1999 reported that 20 percent of youths ages 9 to 17 had diagnosable psychiatric disorders. Only 20 percent of emotionally disturbed youngsters received help. Their problems are not always severe and can include learning disabilities and anxiety disorders.
    Rep. Patrick Kennedy, D-R.I., secured the money as a member of the House Appropriations Committee's Labor-Health and Human Services and Education Subcommittee. He said the Columbine High School shootings have forced the mental health of teen-agers into the national spotlight. In Pawtucket, the money will be used for Bradley's School-Based Adolescent Mental Health Project, expected to be available to students next fall. In Providence, a portion of the grant is earmarked to boost the Mental Health and Wellness Initiative at Hope High School, a project of the group Health and Educational Leadership for Providence.

Study Links 3-Generation Home, Behavior Problems
Alison McCook- Reuters News Service- 4/1/2002

NEW YORK -- Teen mothers are often encouraged to seek help from their parents, but a recent study shows that some young children may not benefit from living in a three-generation household. An examination of the living situations of troubled children born to teens shows that, for some, living with their grandmother may be associated with an increased risk of having behavior problems. "It's as though the grandmother is a risk factor," said lead author Dr. Maureen M. Black of the University of Maryland in Baltimore.
    Speaking with Reuters Health, Black explained that the study is not meant to "grandmother bash." She said she has witnessed first-hand how grandmothers can, in some cases, save a child's life. Rather, she suspects that increased behavior problems do not stem from the grandmother, but from other factors linked to why the three generations are living together. Black said young children who no longer lived with their grandmothers may be better off because their mothers are functional enough to live on their own. The least capable mothers, who may be more likely to have troubled children, needed to remain in their parents' houses. In other words, "the most functional mothers graduate," Black said.
    In the April issue of Pediatrics, Black and her colleagues examined the living situations of low-income families with children between 4 and 5 years old who were born when their mothers were younger than 19. Among the 194 young mothers in the study, 32% appeared to suffer from depression--a condition common among teen mothers, who may be unprepared for the responsibilities that come with raising a child. Thirty-nine percent of their children had been the subject of a report filed to the Child Protective Services, claiming maltreatment. And 26% of the children lived in three-generation households.
    Black's team found that the children most likely to have behavior problems--such as acting out or having temper tantrums--had been maltreated, had a depressive mother and still lived with their grandmothers. Abused children with a depressive mother who did not live with their grandmothers were slightly less likely to have behavior problems, although the risk was still higher than for other children. Most notably, Black found that children of healthy moms who had never been abused were more likely to have behavior problems if they still lived with their grandmothers than if their mothers had moved out.
    While problems associated with three-generation households could stem from the functional ability of mothers, Black added that young mothers can sometimes have difficulty living with their parents. As teen mothers begin to grow up, being in their mothers' household can produce "role confusion," in which the young mother tries to be a teenager and a mother at the same time. Simultaneously, the grandmother can have trouble "trying to parent her daughter, at the same time assume some responsibility for her grandchild," Black said.
    Black said she believes the best thing policymakers could do for young mothers is to encourage their independence, thus helping them to resolve the tension of being both a child and an adult. If young mothers are able to finish school and get a job, "they're more likely to stand on their own two feet, and be able to move forward," Black explained. And while teen mothers of infants may need help from their own mothers, once the child and the mother get a bit older, Black said they may begin to require different types of support. In those situations, the best thing a grandmother can do, Black suggested, involves "allowing the teen mother to be a mother, and supporting her in that role."

Art Therapy Is Displayed --and Lived
Jon Anderson, Chicago Tribune- 4/2/2002

For the crowd that showed up Sunday to view "Touched: Healing With Art" in a side-street art gallery in Rogers Park, many of the benefits of art therapy were on the wall. There was humor. "Early on, reservations were proposed to isolate us from you. Could we have built casinos?" wondered one drawing, part of a juried show of works by individuals whose lives have been touched by HIV, the virus that causes AIDS. There was poignancy, in a handcrafted wooden box with an etched glass top, like a see-in coffin. Titled "Bernard's Pen Collection," it contained 15 ballpoint pens, laid out in the shape of a fan. Each one carried the logo of the manufacturer of a drug considered helpful in battling what has become a worldwide scourge. Other works dealt with such themes as "reforming life," "loss and hope" and "midnight demons/daylight's relief."
    What they reflected were ambiguities of life that have fascinated the afternoon's lecturer, Don Seiden, professor emeritus at the School of the Art Institute. "I was in this field before there was a field," Seiden began, going back 40 years to his early days as a sculptor, an art teacher--and a part-time worker in the psychiatric wing of Rush-Presbyterian-St. Luke's Medical Center. There he first saw the healing benefits of encouraging patients to express themselves in art, a process that allowed them to vent inner conflicts, bring a measure of order to life, accept dualities, reach out to others.
    "I have become more and more convinced that if anything in the world speaks to the joy of living, or gives a reason for living, it is the making of art," he said, urging his audience to look around at the gallery works. All the art is done by clients of BEHIV, a support agency located next door that seeks a better existence for people with HIV and AIDS. "These people are in danger--all the time," Seiden said. "Why do they make art? Why not commit suicide?"
    Art therapy, he suggested, "takes into account the need to make meaning of one's whole life experience." Isolation, a source of much pain, is escaped by entering into a community that, through art, shares information. That was the message Seiden carried back to his superiors at the School of the Art Institute years ago, eventually persuading them to set up a master's degree program in art therapy. Now a respected elder in a growing discipline, Seiden helped train many of the 6,000 art therapists now practicing in medical and community settings across the country.
    His mission, then and now, is to encourage patients to make art--as they see it. "The world is so complicated, confused. It's angry. Joyful. There are multiple meanings to everything. Today's world presents the same problems that have gone on throughout history. Art helps us tolerate ambiguity," he said.
    Therapy, he observed, has been a component of art ever since the days of cave paintings, when hunters defused their fear of wild animals by capturing their images in pictures, bringing about a measure of control. It could even help now in the Middle East, he suggested. "If they could sit down at peace talks and externalize some of their emotions, they'd save us all a lot of trouble," he said, as a number of heads nodded in agreement.

More California Students Training as Drug Counselors
Lisa Leff, Los Angeles Times- 4/2/2002

Oxnard College's Intervention and Recovery class is an eclectic group--from an elegantly dressed Ojai mother who has lost a daughter to heroin to ex-gang members from La Colonia and reformed meth dealers. They are all studying to become certified drug and alcohol counselors through the addictive disorders program--one of the state's oldest college-based training grounds for chemical dependency professionals.
    "You have everybody, all the way from 17- or 18-year-olds up to grandparents. You have your recovering alcoholics or drug addicts--the ones who got themselves together before they had to go to prison--and you have a lot of parolees in the room," said student Kris Giles, 33, of Newbury Park. "We are all on the same level." Spurred by statewide efforts to raise standards for drug counselors and the passage of Proposition 36, which mandated treatment over jail time for certain low-level drug offenders, enrollment in this and similar programs at 26 other community colleges has exploded. This semester, Oxnard's program has more than 400 students, compared with 275 a year ago.
    Nearly all the students are in recovery or have a family member with a drug or alcohol problem, said William Shilley, 73, a former priest turned family therapist who founded the program in 1981. To become certified, students must complete 720 hours--about two years of course work--and 250 hours of field experience.
    For most of the students, enrolling in an academic program with a fixed schedule is a huge step. Many have histories that include childhood sexual abuse, domestic violence, prostitution or addiction. They have limited education and struggle with financial difficulties. "They are all walking miracles because they have been through an awful lot and they have done one of the most difficult things to do in life, which is change their lifestyle," Shilley said. Many program alumni now hold leadership positions at alcohol and drug rehab facilities in Ventura, Santa Barbara and Los Angeles counties.
    Shilley teaches most of the 19 courses in the Oxnard College program's curriculum. As a founding member of the California Assn. for Alcohol/Drug Educators, he also travels around the state setting up continuing education courses, lobbying lawmakers and advising drug and alcohol treatment programs. "Bill is the professional in the state," said association President Angela Stocker, director of the College of San Mateo's addictive disorders program. "He has done more to raise the standards for counselors than any one person."
    The students see Shilley as a mentor and compassionate father figure. "He looks for the best in everyone and makes them feel like he respects them and cares personally about them," said Deborah Goldberg of Westlake Village, who with her husband, Leonard, were Shilley students a decade ago when their daughter was using drugs. With Shilley's help, the Goldbergs established Visions for Recovery, a nonprofit group that raises money for alcohol and drug prevention programs.
    Students say they attend the program as a way to make up for the years and relationships they lost to their addictions. "It blows me away that I have so much knowledge from my personal research that I can help someone else," said Elizabeth Humphrey, 38, who has been sober for three years and enrolled in the program last fall. "The best counselors are people in recovery because we already know the games, we know the manipulation, and we know the conning. We can't be fooled."
    Shilley estimates that about half his students end up completing the program. Some decide that drug counseling does not pay enough and pursue other careers. Others leave when they have a relapse. A few find that their pasts catch up with them. This semester, for example, two students dropped out because they were sent to jail. But many find the strength to continue. One is the mother of a former pupil who couldn't get off heroin. The Ojai woman said she has not seen her 23-year-old daughter since November and doesn't know where she is, but thinks using her child's old textbooks and sitting in the same classroom she once did gives her hope.

Internet Making Steady Inroads Into Health Care
Bill Berkrot, Reuters News Service- 4/2/2002

NEW YORK -- When Internet pioneer Jim Clark took his third brainchild public in 1999, he boldly pronounced that Healtheon would fast become the world's biggest company and ''fix the U.S. health-care industry'' in the process. While he may have helped launch the Internet revolution with Netscape, Clark's grandiose design to gain control of the $1.5 trillion health-care industry via the Internet proved a pipe dream and his former firm, now WebMD (HLTH.O), has yet to show a profit.
    ''We were probably a little naive in how quickly we expected to inject ourselves into the process ... thinking we could come in and be a bull in a china shop and alter the whole terrain in short order,'' admits ''Kittu'' Kolluri, a key member of Clark's team at both Silicon Graphics and Healtheon. ''That has happened in certain other industries which have been a little more receptive to the injection of technology,'' added Kolluri, who is now reunited with Clark at Mountainview, California-based technology firm Neoteris, with Kolluri as chief executive and Clark a key investor and chairman. Clark and his Healtheon adventure were prominently featured in the book ''The New New Thing'' by Michael Lewis, author of ''Liar's Poker.''
    As Hillary Clinton found in trying to reform U.S. health care as first lady in the early 1990s, Clark was taking on a multiheaded beast that is mightily resistant to ''fixing.'' But the Internet is making inexorable inroads into every facet of the health-care industry, if at a snail's pace compared with Clark's original vision. ''It just doesn't happen in health care; nothing's ever been adopted overnight,'' said Anthony Vendetti, an industry analyst for Gruntal & Co. ''The Internet will fundamentally change the way health care is practiced ... but we're talking a minimal five-year process,'' Vendetti said of the evolutionary rather than revolutionary pace.
    Sam Karp, chief information officer of the California HealthCare Foundation, agreed with that assessment. ''We're at least five years out before in a significant way we're going to see all the benefits that the Internet has to offer,'' said Karp, whose organization just launched iHealthBeat (http://www.ihealthbeat.org), a free service aimed at care providers offering the latest information on the Internet's impact in health care. ''We think it has extraordinary potential and the fact that we're through this hype of the dot-com world, and the collapse of it, doesn't mean that many of the benefits that the Internet offers to health care won't be achieved. It's just going to take a lot longer to achieve them,'' Karp said.
    Analysts say the jury is still out on WebMD, which under Clark's original Healtheon model was going to position itself as the prime Internet go-between for care providers, patients and insurance companies, eliminating paperwork while making money on each transaction. ''They (WebMD) have a couple of real businesses that they purchased by acquisitions ... but in terms of figuring out how to capitalize on the Internet, they are still struggling to figure out how they're going to do that,'' Vendetti said.
    WebMD Chief Executive Martin Wygod said this month he expected the company to show its first profit before one-time charges this year. Shares in the company were trading at about $7.60 last week, compared with a high of $105 in May, 1999, before the technology bubble burst. Part of the problem for investors and boon to consumers is the plethora of health-care Web sites -- more than 20,000 by some estimates -- many offering free medical advice. ''The rub is there's too much good free information on the Web to make money charging for access to information on the Web,'' Banc of America Securities analyst Patrick Hojlo said. Kolluri still believes WebMD's name recognition gives it a leg up on the competition and the ability to attract advertising revenue. ''If you are able to establish your credibility in the minds of people you can actually make money off of that,'' he said.
    While health-care Web sites try to figure out how to turn profits and make money for investors or risk following those who didn't into cyberspace oblivion, several companies are embracing ''e-health'' technology, creating devices to connect doctors and patients through the Internet or wireless Web. Minneapolis-based Medtronic (MDT.N), for example, has developed its CareLink patient monitoring system, which gives patients the ability to send data from implanted cardiac devices to doctors from home or work via the Internet. Others companies are also developing ambulatory monitoring devices that could dramatically reduce office visits or trips to the hospital.
    VivoMetics, based in Ventura, California, has developed the LifeShirt, which it hopes will gain FDA approval and hit the U.S. market this year. The shirt is embedded with sensors that continuously monitor more than 30 vital signs. The data, collected by a small computer in a hip pocket of the shirt, can be transmitted to health-care providers. Technology such as the LifeShirt, says VivoMetrics President Paul Kennedy, could give people in countries with inferior health-care access to U.S. doctors without expensive overseas trips, or, for example, transform the way clinics deal with sleep disorders by allowing patients to be monitored from their own beds under normal sleeping conditions.
    Despite all the innovations, concerns over confidentiality could slow the availability of patient information to doctors or insurance companies accessible on the Internet. And many longtime doctors remain resistant to spending money on new computer technology or the time to learn to navigate cyberspace. But an inevitable changing of the guard will eventually eliminate that intransigence.
    ''When we've analyzed (Internet) usage rates for medical residents and medical students compared with older practice-based physicians it's a wide chasm,'' said Amith Viswanathan, a health-care industry analyst and consultant with San Jose, California-based Frost & Sullivan. ''We're seeing usage rates of 85 (percent to) 90 percent with medical students and less than 30 (percent to) 40 percent with private practice doctors. Give it five years, it will clearly be different,'' Viswanathan said. But it remains to be seen who will figure out how to reap the billions of dollars of which Clark once grandly predicted his former company would seize the lion's share. Said Gruntal's Vendetti: ''I think we're a long way from determining who's going to be successful, profitable and an eventual winner in this case.''

More Americans Support Gay Adoption
Daniel Merkle, ABC News- 4/2/2002

N E W Y O R K— Public support for allowing gay couples to adopt children has risen to a slim plurality in the latest ABC News poll. Sampling, data collection and tabulation for this poll were done by TNS Intersearch. Supporters of same-sex adoption now outnumber opponents, if only slightly, for the first time in 10 years of polling on the subject. Forty-seven percent think gay couples should be legally permitted to adopt while slightly fewer, 42 percent, disagree. Opponents, once firmly in the majority, now hold a minority view. Their ranks are down 23 points since a 1994 poll and 15 points since 1998. There has been renewed debate on this issue since talk show host Rosie O'Donnell spoke out last month against a 1977 Florida law that prohibits adoption by homosexuals.
    There are large cleavages in the American public on this issue. Most younger adults, women, and those with more education support adoption by homosexuals. Older adults, men, and the less-educated don't. There are also regional differences. Majorities in the East and Midwest are supportive; most in the South are not. Partisanship plays a large role in these views. Most Democrats and Independents support adoption by gays, while Republicans oppose it by a 2-1 margin.

Permit Gay Adoption?
Date of Poll Yes- 47 % No- 42%
10/15/98 yes- 35% No- 57%
6/16/94 Yes- 28% No- 65%

Support for Gay Adoption — the Breakdown
Sex
Men Yes- 38% No- 51%
Women Yes- 55% No- 33%
Age
18-34 Yes- 55% No- 33%
65+ Yes- 35% No- 52%
Education
Less Than H.S. Yes- 37% No- 52%
Some College, and up Yes- 51% No- 37%
Region
East Yes- 55% No- 34%
Midwest Yes- 52% No- 38%
South Yes- 39% No- 52%
West Yes- 48% No- 36%
Party Affiliation
Democrat Yes-56% No- 30%
Republican Yes- 29% No- 60%
Independent Yes- 54% No- 37%

Methodology
This ABC News survey was conducted by telephone March 27-31, 2002, among a random national sample of 1,031 adults. The results have a three-point error margin. Sampling, data collection and tabulation by TNS Intersearch of Horsham, Pa.

Hidden Plague of Alcohol Abuse by the Elderly
Jane E. Brody, New York Times- 4/2/2002

Alcohol abuse by seniors: experts call it a hidden epidemic. Hidden because its symptoms often mimic or are masked by common physical and mental infirmities of aging. Hidden because doctors rarely ask about when and how much their older patients drink or what effect alcohol may have on their lives. Hidden because older people and their relatives are often in denial about the extent and effects of their drinking habits. Hidden because the amount of alcohol now causing trouble had no untoward social or physical effects in middle age. Hidden because many of the hallmarks of excessive drinking -- like missing work or being noticeably intoxicated -- may not be noticed among retirees who live alone.
    Although problem drinking is less common over all among older people, as the population ages, increasing numbers of older adults are getting into trouble with alcohol, often with an amount of alcohol that most would not consider immoderate. In some cases, even moderate consumption can cause or aggravate ailments associated with aging or cause dangerous interactions with medicines older people take. While few would deny a healthy older person a glass of wine or that cocktail be fore dinner, the nation's experts on alcohol are now urging greater restraint for drinkers over 65 and asking people in and out of the medical field to pay more attention to the drinking habits of older adults.
    On April 11, National Alcohol Screening Day, thousands of people at 2,000 sites across the country will have a chance to have their drinking patterns assessed anonymously and the findings discussed with trained counselors. To find the nearest screening site, call (800) 405-9200 or, on the Web, consult mentalhealthscreening.org. Screening is urged even if alcohol is not a problem for you but may be for someone you care about.
    An older person may have never had a previous alcohol problem, but various circumstances common among older people can increase the risk of alcohol abuse. Retirement may result in a loss of structure, self-esteem and income and an increase in loneliness and boredom. Other losses -- of spouses, friends, physical well-being or independence -- as well as pain or sleep problems may also prompt older people to turn to alcohol.

Changing Effects of Alcohol
Because the body that is consuming alcohol at 65 or beyond is not the same as the one that drank at 45, the effects of a given amount of alcohol can be greatly exaggerated in an older person. As people age, they lose lean body mass (muscle and bone) and acquire a greater percentage of body fat. This results in a decrease in body water, and since alcohol is soluble in water, not fat, a given amount of alcohol reaches higher concentrations in the blood of an older person.
    In addition, as people age; there is a decline in a stomach enzyme -- alcohol dehydrogenase -- that starts to break down alcohol before it reaches the bloodstream. This further increases the blood alcohol level and places an extra burden on the liver, where most alcohol metabolism takes place. Furthermore, with advancing age, blood flow through the liver declines as does kidney function, so alcohol is eliminated more slowly from the blood.
    Older women are especially at risk because they are usually smaller, have less lean body mass and lower levels of alcohol dehydrogenase than men, all factors that result in a higher blood alcohol levels than men experience. In fact, at any age women reach higher levels of intoxication than men do per dose of alcohol. All told, blood alcohol levels in older people typically are 30 percent to 40 percent higher than in younger people who consume the same amount of alcohol. But even at equivalent blood alcohol levels, older people are more likely than the middle aged to experience intoxication, cognitive difficulties and problems with balance and coordination. In other words, tolerance for alcohol declines, and the risks of excessive drinking rise with age.
    Add to this the interactions between alcohol and some 150 prescription and over-the-counter medications, and you have the potential for disaster resulting from immoderate alcohol intake by older people, most of whom take drugs for conditions like arthritis, depression, hypertension and heart disease. Among the common drugs that can interact badly with alcohol are acetaminophen, antidepressants, aspirin and other nonsteroidal anti-inflammatory drugs, digoxin, heparin, hypoglycemics and sleep aids.
    Certain ailments common among older people can be worsened by alcohol, among them gastrointestinal bleeding, depression and anxiety, cognitive impairment, cirrhosis and other liver diseases, hypertension and cardiac arrhythmias, osteoporosis and impaired immunity. And while many people believe that alcohol before bed aids their sleep, in fact, alcohol interferes with normal deep sleep and commonly results in middle-of-the-night insomnia. Be aware, too, that reflexes slow with advancing age, a problem greatly worsened by alcohol for anyone who tries to drive soon after drinking even a small amount. Many people who live into their 90's and beyond attribute their longevity in part to their daily cocktail or glass of wine.
    Though this may sound like an attempt to justify a bad habit, in fact studies of tens of thousands of people here and abroad have found that regular moderate alcohol intake diminishes the risk of heart disease and possibly stroke, probably by raising blood levels of protective H.D.L. cholesterol and estrogenic substances.
    Moderate alcohol consumption has also been linked to a reduced risk of dementia in people over 55. The key word here is moderate. For younger adults, moderate is defined as no more than two drinks a day for men and no more than one drink a day for women. But for healthy men and women over 65, the new definition of moderate offered by the National Institute on Alcohol Abuse and Alcoholism is no more than one drink a day, and some experts suggest that older women would be wise to cut that amount in half.

Defining a Drink
A study in the mid-1990's revealed that 15 percent of men and 12 percent of women 60 and older visiting a primary care clinic regularly drank more. than one drink a day. Depending on the group studied, 2 percent to 10 percent of older adults have been found to abuse alcohol. What is "a drink"? It is 12 grams of pure alcohol, the amount found in a 12-ounce beer, a 5ounce glass of wine or a shot of 80-proof distilled liquor. In ordering a drink, the amount of alcohol served may be considerably more than "one drink." You would be wise to measure out the specified amount of your favored beverage at home so you can recognize when you are served far more than the recommended amount.

Washington State To Cut Some Drug Sentences
Associated Press, 4/3/2002

OLYMPIA, Wash.— A bill signed by Washington's governor will reduce sentences for some drug crimes and use the money saved by the state to help pay for treatment programs. Gov. Gary Locke signed the legislation Monday. The bill sets new sentencing guidelines for drug crimes, slashing sentences for certain nonviolent offenders. For example, a heroin and cocaine violation that currently carries penalties of 21 to 27 months now will be punished at 15 to 20 months.
    Shorter sentences allow the state to spend less on prisons. Seventy-five percent of the savings will go counties for drug courts and court-ordered treatment programs, with the rest earmarked for state Department of Corrections treatment programs. "For nonviolent offenders, treatment works," Locke said. "Investing in treatment will enable us to free up more prison cells for the violent offenders who belong in prison." A similar bill passed the state Senate last year but never got to a floor vote in the House.

Priest Treatment Unfolds in Costly, Secretive World
Ellen Barry, Boston Globe- 4/3/2002

As far as his parishioners knew, the Rev. Jay Mullin was on ''sick leave,'' and would be absent from his Plainville pulpit until he felt better. In truth, he had crossed over into a secretive world of church-funded psychiatry. He flew south in 1992 to a clinic outside Washington, D.C., where a doctor flashed images of children in sexual positions and attached a device to him to measure his arousal. Accused of molesting a boy 22 years earlier, he had been ordered by Cardinal Bernard Law to spend several days at the St. Luke Institute, a Catholic psychiatric hospital in Maryland. He checked in, looked around at the priests from around the country - some who, like him, had been accused of sexual misconduct - and gradually realized how deep the problem ran. ''I wasn't aware there was any place like that,'' recalled Mullin, who denies the abuse charge. ''Seeing all of it, I thought, the bishops know where they're sending all of us. They know the magnitude of the problem.''
    For decades before the case of defrocked priest John Geoghan elevated clergy sexual abuse into a national crisis, the Catholic Church was spending millions of dollars to quietly treat accused sex offenders in a constellation of psychiatric hospitals -- some independent, some church-affiliated -- advertised in the back pages of religious publications. The facilities frequently used were the St. Luke Institute in Maryland; the Servants of the Paraclete centers in Jemez Springs, N.M., and St. Louis; the Institute of Living in Hartford, which featured a special clergy program; and the Southdown Institute in Canada.
    Since the 1970s, psychiatrists at these facilities have treated accused priests with one-on-one therapy, feminizing hormones, and sex addiction support groups. They sent their reports to bishops, estimating the risk of a relapse, then released the priests. Such treatment is typically paid for by the diocese, and has cost the church at least $50 million over the last 25 years, estimated A. W. Richard Sipe, a psychologist and ex-priest who treated clergy for 40 years.
    A few, like Geoghan, were treated again and again, at numerous centers, and each time slid back into their predatory behavior. Victims, especially those who were molested after the priest had completed treatment, are beginning to wonder exactly what was going on inside the costly psychiatric centers. ''No institution can police itself,'' said David Clohessy, national director of the Survivors Network for those Abused by Priests. ''If the church wants to restore trust, leaders should be more open about these treatment facilities. If chemical companies said, `Just trust us -- send us your dioxins; we'll clean them up,' the public would be wary.'' The centers denied repeated requests by the Globe for visits, citing privacy rules. Boston Globe Staff will produce a book on the abuse scandal in the church..
    Psychiatrists from Johns Hopkins University and McLean Hospital who have worked with priests at the behest of the church said they believed chuch authorities had made good-faith efforts to enlist the nation's top specialists in the slippery, ever-changing field of treating sexual disorders.
    But two weeks ago, psychiatrists at the Institute of Living in Hartford accused church leaders of intentionally disregarding their clinical advice, sometimes with disastrous results. The institute, a secular psychiatric hospital situated on a leafy 35-acre campus, had developed a specialized program for treating clergy, and had been seeing a handful of priests every year. The two-decade relationship was shaken after New York Cardinal Edward Egan cited the institute's psychiatric reports to justify his decisions to return priests to the ministry, where some reoffended. Top psychiatrists then told reporters at The Hartford Courant that church leaders had used psychiatrists' advice as cover to rush potentially dangerous priests back into ministry. ''I found that they rarely followed our recommendations,'' said Leslie Lothstein, director of clinical psychology at the institute. ''They would put [priests] back into work where they still had access to vulnerable populations.''
    Lothstein's comments mark a new chapter in the relationship between the church and psychiatrists. As recently as 1952, the church was so resistant to behavioral sciences that a Vatican official declared it a sin to undergo psychoanalysis. But in treating priests, the church has leaned increasingly on psychiatry, funding six-month stays for priests even as managed care cut psychiatric stays to a week for most Americans. It has not been a perfect collaboration. In the last few months, critics have blasted church officials for ignoring sexual abuse charges. Some insiders, like Egan, have suggested that part of the blame should be spread to psychiatrists who routinely provided them with independent evaluations.
    Seven years ago, Minneapolis psychologist Gary Schoener got a call from a rattled John Roach, archbishop of Minneapolis and St. Paul. Roach asked Schoener to review records the archdiocese had received from the centers that had been treating priests: the St. Luke Institute, the now-defunct House of Affirmation, and the Servants of the Paraclete in New Mexico. ''The archbishop said, `For God's sake, are we getting bad advice?''' Schoener recalled. ''Are they using the wrong tests? Are they misinterpreting them? Is one of the centers better than the others?''
    Schoener reported back a few weeks later. He had been impressed by the psychiatric reports, which he said would pass muster in secular hospitals. But he faulted the centers for accepting the church's investigations at face value, for failing to contact victims, and for leaving responsibility for follow-up to the priest's diocese. In short, the psychiatrists were working for the church. They ''wanted to be liked,'' Schoener said. ''The mindset of these folks was to get him back there, that somehow the guy was fixable,'' said Schoener. ''They are a key part of the mistake. ''It's not that I don't blame the church. I blame them both.''

`We just get an intuition'
The treatment centers had been born in a rush of Christian compassion. On a blustery night during the depths of the Depression, the Rev. Gerald Fitzgerald heard a knock on the back door of his rectory in Brighton and gave food and a coat to a beggar who, as he walked into the dark, turned around and said he, too, was once a priest. That was the genesis of the Brothers of the Paraclete, a religious order whose mission was to care for troubled priests. In 1947, in New Mexico, Fitzgerald opened a retreat for troubled or alcohol-abusing priests.
    Sexual misconduct was not part of the mission then. When Fitzgerald was asked about treating child molesters, he recommended buying a small Caribbean island and isolating them there, said the Rev. Peter Lechner, the current servant general of the Brothers of the Paraclete. By the mid-1960s, though, the Paraclete retreat began welcoming an increasing number of pedophiles and, more commonly, ephebophiles, or adults who are sexually aroused by pubescents, usually males, Lechner said.
    Throughout the 1960s, sexual disorders were treated through psychoanalysis, and the Paraclete Center lagged behind even in that. It wasn't until the 1970s that Jemez Springs began to ''approach modern standards,'' Lechner said, with regular therapy and an in-house psychiatrist. In 1976, the Paracletes opened the first treatment center in the world for psychosexual disorders; by 1995, according to a deposition, psychiatrist Jay Feierman had consulted with 1,000 priests about sexual disorders. ''They knew more than anybody in the world,'' said Sylvia Demarest, a Houston attorney who later represented victims of Jemez Springs patients.
    A Rocky Mountain News reporter who spent a week at the center in 1987 described an atmosphere that encouraged emotional exploration. Priests there had psychodrama therapy and role-playing, and wept together. Therapists encouraged them not to repress sexual impulses. Feierman, the program's chief psychiatrist, complained about the church's message that a priest is ''not allowed to be affectionate, he's not allowed to be in love, he's not allowed to be a sexual being.''
    As for the decision to release a priest, Michael Foley, codirector of the program, told the reporter it was a matter of gut feeling. ''We just get an intuition that they're going to work out,'' Foley said. On rare occasions, that gut feeling was wrong. Of the 2,000 priests who were treated at Jemez Springs from 1947 to 1968, 10 committed criminal acts after leaving, Lechner said. Among the ''graduates'' from the 1960s and 1970s were men accused of long lists of molestations, like the Rev. James Porter, Jason Sigler, the Rev. Rudy Kos, the Rev. David Holley, and Andrew Christian Anderson - some of whom molested children when the Paracletes sent them out on weekends to officiate in local parishes.
    In 1993, the Paraclete center was forced to pay $525,000 and stipulate $7.6 million more from insurers to settle lawsuits with 25 plaintiffs who alleged they were molested by Porter, according to reports. They also settled with 17 plaintiffs suing Holley, who is serving a 275-year sentence for molesting children. Bruce Pasternack, a lawyer who defended alleged victims in the Porter case, said the treatment center made New Mexico the world's ''dumping ground for ecclesiastical waste.'' Demarest, who represented Kos's victims, still speaks with contempt of the treatment Kos received. ''I can tell you what the atmosphere was. They flew in fresh fish and special food items and they went on hikes in the mountains and they were released over the weekend into local parishes where they continued to abuse children,'' said Demarest. ''There is not one single shred of evidence that anyone gave one whit about the victims.''
    In 1994, the Paraclete fathers shut down the sexual disorders treatment center in New Mexico. They would not rebuild it, although 13 sex offenders now live in the Paracletes' Vianney Renewal Center in a wooded suburb outside St. Louis. ''We closed the mother house [in New Mexico] because we had been getting a lot of publicity,'' said Lechner. ''We like to have people come, and want to come, and we feel it's very important that they feel appropriate security.''

`Better living through chemistry'
In 1981, a new kind of priest set about building a new kind of treatment center. The Rev. Michael Peterson was a psychiatrist before he converted to Catholicism and entered the priesthood. An experienced substance abuse counselor, he established a private Catholic hospital called the St. Luke Institute. Priests with alcohol troubles checked into a blue-tiled institutional building flanked by two schoolyards in a predominantly African-American neighborhood outside Washington, D.C.
    By the mid-1980s, they were joined by an increasing number of priests who had been accused of sexual misconduct. As patients like Geoghan, Kos, the Rev. Gilbert Gauthe, and Monsignor Michael Harris moved in next door, neighbors were not informed. They saw priests come and go - polite, middle-aged white men from around the country - and were told that they were ''in training,'' said Nannie Presley, who lived across the street for 14 years. (The center relocated to a spacious campus in Silver Spring, Md., complete with three tennis courts, a handball court, and a basketball court, in 1997.)
    The Rev. Stephen Rossetti, president of St. Luke Institute, refused to be interviewed for this story, saying that publicizing treatment of sexual offenders can make priests reluctant to be treated there. Less than 25 percent of St. Luke's patients are there because of sexual misconduct, he said.
    Priests who arrived at St. Luke after allegations of sexual misconduct found themselves hooked up to CAT scans and electro-encephalograms to measure brain waves, working puzzles for aptitude tests, and -- most controversially -- stripped down for a penile plethysmograph, which measures a man's level of arousal based on the circumference of his penis. The priests nicknamed the test the ''peter meter,'' said the Rev. Nicholas Driscoll, who was treated for depression and alcohol abuse at St. Luke for six months in 1986.
    Mullin arrived for an evaluation in 1992. He still shudders when he remembers the plethysmograph, and the pleas he made to the Archdiocese of Boston to exempt him from the test. On the ride back to St. Luke Institute, he said, his driver pulled over and got out of the car so he could cry alone, Mullin said. ''They're observing me. They're videotaping it,'' he told a Globe reporter. ''They finish up with kiddie porn, my first introduction to the whole pornographic industry. It was not a joy by any shape.'' The archdiocese settled the claim against Mullin about five years ago -- against his protests, he said -- and reassigned him to a parish in Wayland. Last year, he was informed that his assignment at St. Joseph's Manor was terminated. He now lives in Harwich.
    Patients sometimes found themselves on medications they had never heard of -- they joked that St. Luke's motto was ''better living through chemistry,'' Driscoll said. The facility was at the forefront of prescribing Depo-Provera, which inhibits sexual arousal in men, and Driscoll recalled priests who took day trips to the Library of Congress to read up on the drug and its side effects. Mullin was so alarmed by the ''tranquilized'' appearance of priests there that he asked to be sent elsewhere.
    Geoghan, who was sent to St. Luke Institute for assessment in 1989 and again in 1995, complained to Edward Messner, his Massachusetts psychiatrist, that it was ''cold, mechanistic'' and occasionally ''contemptuous'' of the priests who visited. He preferred the Institute of Living, where he spent three months in 1989, and where therapists had focused on his grief over his father's death. ''He described his 10 days at St. Luke Institute [as] very troubling with fear, anxiety, distress, hurt,'' said Messner in a deposition. ''The staff was confrontational and tried to get him to admit wrongdoing.''
    Meanwhile, the staff had its own battles to fight against bishops who questioned their open discussion of sex, said the Rev. Thomas Doyle, who befriended Peterson and coauthored with him a 1985 study of sex abuse by priests. Peterson, who was openly gay before converting to the priesthood, died of AIDS in 1987. ''He often said to me that one of the more difficult things he had to deal with were the critical questions'' from bishops, said Doyle, a canon lawyer who is now an Air Force chaplain in Germany. ''You have to ask them what they fantasize about when they masturbate. The bishops would be all bent out of shape. Dirty movies, they called them. Poor Doc Peterson was having a hell of a time.''
    Whatever the objections of bishops, St. Luke never ran out of patients. The institute's 70 beds - which St. Luke's president, Rossetti, told the Catholic News Service cost dioceses about $300 a day, have been full since the center opened. Today, less than 3 percent of sex offenders reoffend after leaving St. Luke, Rossetti said in the same interview. Past mistakes were the fault of mental health professionals who did not have reliable information about pedophiles, he said. ''Where does the blame lie? Blame psychology,'' he said.

`They kept the transgressions silent'
Psychiatrists have been mostly silent about the treatment they provided to offenders. Lothstein, from the Institute of Living, would not return phone calls for this article, nor would authorities at St. Luke and the St. John Vianney Center, which is run by the Archdiocese of Philadelphia. Some psychiatrists have come to the defense of the church. Lechner, head of the Paraclete Center, and Dr. Donna Markham, president of Southdown Institute, both said church leaders have been forthcoming with case histories and compliant with their recommendations. Others said even specialists may have dispensed bad advice.
    ''The missing link in this story as I know it is that there have been substantial efforts on the part of the church to deal with some of this through therapeutic channels,'' said Philip Levendusky, a Harvard Medical School associate professor and McLean Hospital psychiatrist who for two years in the late 1990s oversaw an eight-bed residential program for priests with sexual disorders. ''They did go to the top of the ladder. They weren't going to facilities that would put a religious spin on [sexual disorders]. They went to really legitimate assessment facilities.''
    Others, though, said the church has manipulated psychiatric expertise. Sipe treated clergy at Seton Psychiatric Institute and served on the board of St. Luke Institute for two years. He said the earnest efforts of good therapists have fallen on deaf ears for three decades. ''Psychiatry and psychotherapy has been misused by the church in this crisis,'' Sipe said. ''Bishops oftentimes did not give the whole story, but kind of dumped the priests there and just let the psychiatrists `puzzle it out themselves.' They kept the transgressions silent under the guise of confessional material.'' Then, he said, there were errors of compassion. ''Psychiatrists are kind of hopeful people,'' Sipe said. ''As clinicians and as clergymen, we don't tend to give up on people.''

Insanity Verdict Rarely a Way Out
Michele Kurtz, Boston Globe- 4/3/2002

As defense lawyer Kevin Reddington prepares to argue that Michael McDermott was so mentally ill that he wasn't criminally responsible for killing seven co-workers, he'll want to leave jurors with the impression that McDermott will spend the rest of his life in a mental institution if acquitted. That may be true, but no one can say for sure. And if he were released at some point, the public would have a hard time finding that out.   Data compiled by the Globe from state agencies show that of the roughly 50 murder defendants acquitted by reason of insanity since 1970, 15 have been released from state custody. The rest remain at Bridgewater State Hospital or other psychiatric facilities, or have died.
    Defense lawyers have long said that a major reason jurors hesitate to acquit mentally ill defendants is that they fear they'll be back on the street in a matter of months or years. The lawyers also argued that with insane murder defendants, that's simply untrue.  Defense lawyer Joseph Balliro Sr., who failed to persuade a jury that Gloucester dermatologist Richard Sharpe was insane when he killed his estranged wife, wanted jurors to be told the chances of someone like Sharpe being freed if he were acquitted by reason of insanity. A judge refused to do so. ''In the real world,'' Balliro said, ''these guys don't get out in a year or two or three. They spend a lifetime in there.''
    Records obtained from the state Department of Mental Health show that most people acquitted of first- or second-degree murder by reason of insanity spend a decade or more in state mental institutions. At Bridgewater State Hospital, where defendants found not guilty of murder by reason of insanity are nearly always sent, five men who were acquitted of murder in the 1970s are still there three decades later. In 11 of the 15 cases in which someone acquitted of murder was discharged from a psychiatric facility, they had spent between seven and 23 years institutionalized. Information on the other four cases was not readily available. Of the 15 people released, two have been sent back to state hospitals. In one case, the person was found incompetent to stand trial on an indecent exposure charge and in the other instance, the person was charged with kidnapping and again found not guilty by reason of insanity, said Marylou Sudders, commissioner of the state Department of Mental Health.
    The Globe obtained records from the DMH and from Bridgewater. Patient names were not included, only the dates they were admitted, and when -- if ever -- they were released. For those who are released, the DMH provides assistance, from residential facilities to clinical services, Sudder said, but participation is strictly voluntary.
    McDermott, 43, of Haverhill, is the latest in a string of high-profile murder defendants who have used the insanity defense. Jury selection continues today. McDermott has a lengthy psychiatric history that includes prior stays in mental hospitals. Reddington intends to argue that his client was suffering from schizophrenia and other mental illnesses on Dec. 26, 2000 when he opened fire at Edgewater Technology in Wakefield. Reddington contends that McDermott belongs in a mental hospital, not in prison.
    Prosecutors argue that McDermott knew what he was doing, shooting his colleagues in a rage because Edgewater was planning to seize part of his wages for back taxes at the request of the Internal Revenue Service. Prosecutors will show that McDermott placed a bag filled with guns and ammunition near his desk the night before the killings and had made out a will.
    In Massachusetts, a person can be found not guilty by ''lack of criminal responsibility'' if the jury finds he suffered from a mental disease or defect that kept him from knowing what he was doing was wrong, or that prevented him from stopping himself. Although precise figures are not available, court officials and lawyers believe that many of the 50 or so insane murder defendants acquitted in Massachusetts in the last 32 years were found not guilty by a judge, not a jury. Defendants can waive their right to a jury trial in second-degree murder cases, but not in first-degree cases. When a person is found not guilty of murder by reason of insanity in Massachusetts, the judge in the case generally commits him to Bridgewater for evaluation.
    After 40 days of evaluation, the hospital or prosecutors in the case can petition to have the person committed for six months. A judge conducts a hearing to determine whether the person is mentally ill and a danger to himself or others. In the case of a former murder defendant, there's rarely a doubt. After six months, the court conducts another hearing on the person's status. If the judge orders that he stay in the institution, he'll begin having annual reviews. If staff at Bridgewater determines that the person no longer needs strict security he can be transferred to a Department of Mental Health facility, Sudders said. In those cases, the person is still reviewed annually at a hearing before a judge. ''For some people, that's gone on for as long as they've lived,'' said Maurice Richardson, a former state judge who is an assistant professor in the psychiatry department at the University of Massachusetts Medical School.
    While attorneys can ask the judge to tell jurors what happens if someone is acquitted by reason of insanity, Balliro and other defense lawyers argue that telling jurors that the prosecution can petition the court to have the defendant committed and that his status will periodically be reviewed isn't good enough. Jurors, they say, should be given detailed statistics about the results of insanity acquittals. ''Jurors do not want the responsibility that someone could kill again,'' said attorney J.W. Carney Jr., who unsuccessfully used an insanity defense for Kenneth Seguin, the Holliston man convicted of murdering his wife and children in 1992. James Alan Fox, a criminal justice prefessor at Northeastern University, predicted that if McDermott is found not guilty by reason of insanity, ''He'll never get out. The nature of his crime was so horrific, he'll never get out.''

Detroit Officials Fear Teen Moms Are Falling Through Cracks
Associated Press, 4/3/2002

DETROIT -- Administrators of facilities geared toward young homeless mothers say their programs are helping some girls by giving them a place to live and raise their children. But they worry that others are falling through the cracks because of a state law requiring that girls younger than 18 have the permission of a parent or guardian before entering a program.
    Illene Bosley of Genesis House I, which is run by the Detroit Rescue Mission Ministries, said she turned away a dozen girls in February as a result of the requirement. "Legally, there is nothing I can do," Bosley told the Detroit Free Press for a Wednesday story. "When I've called the police to say I have a minor child on the streets, they've said it was a low-priority phone call. ... These girls are falling through the cracks."
    Genesis is one of four programs in Detroit that help homeless girls who are pregnant or moms. All are financed largely by a federal grant obtained by the Wayne County Family Independence Agency to address a need that surfaced around 1996 with welfare reform. At that time, the law changed so minors could not receive a welfare check unless they lived in an environment supervised by an adult and stayed in school. The shelter programs were designed to fill a void for girls who could not live at home.
    But because many of these girls are minors, the FIA and the shelter programs set up a policy requiring parental approval before entering the programs, said Kelly Rogers Ruffing, a Wayne County FIA analyst. But program directors said they often have no choice but to leave the girls homeless if the parents will not approve. And sometimes getting a parent to sign is not possible. Lois Goodwin, program manager at the Lula Belle Stewart Center's program, said many of the girls have been on their own for so long, they don't know where their parents are.
    But life radically changes for the teens who do get parental permission. The Detroit Rescue Mission program is housed in a 100-year-old farmhouse. Each of the moms has her own room, which she shares with her child. "It's just like having your own house," said Nicole Johnson, 17, whose son, Steven Milner, is 1. "You come down before 7 a.m., then go to school, then come back. We have chores and classes we have to do."

Psilocybin & Schizophrenia Bring On the Voices
A.O. Scott, New York Times- 4/3/2002

"The White Sound," the first film by Hans Weingartner, offers a harrowing glimpse into the unraveling mental world of a young man with schizophrenia. Mr. Weingartner's approach to the disease, which plunges its victims into a complex, nightmarish second reality, is neither as glibly spectacular as Ron Howard's Hollywood rendition in "A Beautiful Mind" nor as harsh and disjointed as Harmony Korine's Dogma 95 version, "Julien Donkey Boy." Rather than using cinematic technique to immerse us in the inner world of mental illness, the director takes us to its threshold, to the narrow, permeable boundary between ordinary daily life and madness.
    Lukas (Daniel Bruhl), a shy 21-year-old, moves to Cologne to join his big sister, Kati (Anabelle Lachatte), and her boyfriend, Jochen (Patrick Joswig), in a haphazard bohemian household. At first Lukas enjoys city life, with its late-night parties and pub crawls, its early morning bong hits and hallucinogenic picnics. But he soon starts feeling strange and behaving oddly. When he misreads a movie schedule and shows up at the theater on the wrong night, he flies into an obscene, paranoid rage. Later, after taking psilocybin mushrooms with Kati and Jochen, Lukas begins to hear voices and to believe he can read his sister's hostile, hateful thoughts. Even after the drug wears off, the voices persist, mocking and humiliating him and goading him toward some dreadful, unspecified action. It takes a while for his housemates to figure out what is happening to him, and his sister is reluctant to accept the eventual heartbreaking diagnosis.
    Mr. Weingartner manages to keep the film's perspective poised between Lukas and those around him. We hear the voices in his head, but we can only imagine, from reading the young man's face and watching his agitated gestures, what they signify to him. Mr. Bruhl does a brilliant job of conveying the volatile mix of terror, disorientation and manic glee that overcomes Lukas in the throes of his illness. There is not a shred of theatricality in his performance.
    For his part, the director allows himself a few cinematic indulgences. After his first hospitalization, Lukas finds a job in a mannequin factory. Its workshop, full of severed heads and uncanny not-quite-human figures, would give a moderately sensitive person bad dreams. For someone prone to delusions and auditory hallucinations, it seems like the worst possible environment. And, sure enough, once Lukas stops taking his medicine (thanks to some amazingly stupid advice from Jochen), he begins to hear the mannequins talking about him.
    In the last part of the film, the young man falls in with a van full of latter-day hippies, whose nonjudgmental, communitarian way of life seems to have, at least for a while, a therapeutic effect. Ultimately, of course, there is no way out for Lukas, an insight that Mr. Weingartner handles with a bit of equivocation. He concludes his sympathetic, balanced portrayal of schizophrenia on a note that struck me as overly romantic, gesturing toward an outworn mystical view of mental illness as a source of insight and perhaps even a form of enlightenment. The end of "The White Sound," which will be shown today and tomorrow in the New Directors/New Films series at the Museum of Modern Art, ' is unsatisfying, but that might be the point. Lukas's is not the kind of experience that can be wrapped up neatly or easily made sense of.

Gay Teens, Texas Educators Discuss Harassment Issues
Paige Hewitt, Houston Chronicle- 4/4/2002

Lamar High School junior Colin Ferguson, 16, is an openly gay teenager and seeks equal rights of protection at his HISD school. Colin Ferguson will admit to deliberately staying away from school, saying he knew what awaited him in class. "I was going to face hatred," said Ferguson, a 16 year-old student at Lamar High School who is gay. Often taunted because of his somewhat effeminate ways, Ferguson said he won't forget the day last October when a classmate told him "fags are going to hell." After that, the male classmate threatened to beat him up after school.
    Ferguson was among a few gay teen-agers who on Wednesday shared their experiences of harassment with principals in the Houston Independent School District at a two-hour training session called "Healing the Hurt." The session covered a variety of school-related issues involving gay, lesbian, bisexual and transgender students. Top school officials said HISD is among the first major districts in the nation to host such an event, a partnership with area rights groups -- including Parents, Family and Friends of Lesbians and Gays of Houston (PFLAG) and Houston Area Teen Coalition of Homosexuals (HATCH).
    During the training, HISD board president Laurie Bricker said that providing all students with a safe and harassment-free learning environment is an "absolute necessity." "I have to tell you that tolerance of all is very important in my life," she said. "It's my guiding principal ... Discrimination is not to be accepted in any of our schools."
    Last June, a study by The Human Rights Watch reported homophobic slurs are commonplace at schools. The report, which was based on research interviews in seven states with 140 students and 130 teachers, school administrators, counselors and parents, also said the slurs interfere with a student's education and are often ignored by campus administrators.
    Jon Davidson, senior counsel for Lambda Legal Defense and Education Fund Inc., said schools are going to have to address issues relating the rights of gay students, particularly because children are increasingly "coming out." Schools, he said, can either try to prevent harassment before it happens, deal with it appropriately when it does, or they can face dealing with it later, perhaps in lawsuits. Pointing to legal cases in other states, such as New York, California and Georgia, that involve the rights of gay students, Davidson said many schools around the country fail to "follow some basic principles." "We are not here today to tell you how to feel about homosexuality," he told the principals. "All students must be treated with safety and common decency ... There are very serious consequences if this is not taken seriously. Schools, he said, need to cultivate a climate of tolerance. And when problems arise, all school employees, even the likes of bus drivers, should acknowledge the problem, intervene and report incidents, promptly investigate the matter and apply policies or laws.
    Davidson is currently representing 21-year-old Derek Henkle in a lawsuit against a Nevada school district, as well as one of Henkle's former teachers, whom he claims failed to stop the harassment. Henkle, who spoke at Wednesday's session, said that a few years ago, when he was enrolled in the rural Nevada school, a few students tied a rope around his neck and then threatened to drag him from behind a vehicle on the highway in front of the school. Henkle said he endured "daily nightmares" of being taunted at school and spat upon while riding on the school bus. The lawsuit contends school employees failed to protect him. Henkle, now a public relations manager for a California museum, urged HISD principals to take all harassment seriously. "If there's one thing I want you to leave with today, it's that these situations start with words," he said. "When it is not stopped, it escalates."
    One way students and schools are addressing their concerns is by establishing groups commonly called Gay-Straight Alliances. Approximately 1,000 alliances exist around the nation, with about 15 in Texas high schools. Students at Wednesday's session said two HISD schools have an alliance. Bellaire High School lists one on its Web site. But finding a teacher to sponsor the group is difficult, they said. Lee Longoria, a junior at Reagan High School, said that was the case at his campus. Teachers, he said, were afraid of being labeled. Longoria also told principals about some of his personal experiences. For him, the harassment was at its worst in middle school. "It really messed me up for a long, long time," he said. But school life now, he said, has been good, with an occasional exception.
    One of his teachers, he said, can be insensitive. When someone recently whistled in class, the teacher told the student to stop, and then said that only "queers and shipmates" whistle, Longoria said. "I wanted to report it," he told the principals. "But I didn't ... It's like the `n' word. The same thing you feel when you hear the `n' word. I feel that same way when I hear `queer.' " Brian Richardson, also a student at Reagan, told principals about being called derogatory names by his peers. "More than anything," he said. "They scare me." Still, Richardson said, his high school is generally "very pleasant."
    At the end of the session, the floor was opened for questions. One administrator spoke. He urged the students who spoke to work harder when communicating their problems to administrators. "I appreciate the courage you've shown," the administrator said. " ... But we need to be able to communicate." Ferguson told the administrator that talking about such personal matters can be very difficult emotionally for teen-agers. Davidson, the attorney, threw in a suggestion. "These subjects should not be taboo," he said. "Let students know that it's OK to come talk about these issues."

Michigan Pain Management Center Reflects Treatment Trend
Associated Press- 4/4/2002

FARMINGTON HILLS, Mich. -- A new medical practice here is dedicated to managing aches and pains of various kinds and shows how the specialty of pain management is increasing as the nation's population ages and understanding of pain grows. A member of Gov. John Engler's committee on pain and symptom management, Dr. Dennis Dobritt recently left his position as director of the pain management center at Providence Hospital and Medical Centers in Southfield to open Tri-County Pain Consultants in Farmington Hills. Dobritt remains chairman of the pain management committee at the hospital and also serves as a diplomate of the American Board of Pain Medicine, The Detroit News reported in a Thursday story.
    The pain center, which opened in February, is affiliated with several Detroit area hospitals. It's dedicated to treating chronic pain, such as headaches, arthritis and back pain. It offers a variety of methods including rehabilitation and behavioral therapy in addition to medicines and procedures. "What is totally different about this medical group is that its dedicated strictly to pain management," said Dobritt, who noted there are only a handful of similar practices in Michigan.
    While most hospitals have long had pain management programs, the few outpatient pain management practices owned by doctors have noted an increase in competitors. The Michigan Head Pain & Neurological Institute in Ann Arbor, for example, was founded in 1978 by Dr. Joel Saper. That company started out treating head pain but now treats other painful disorders as well. "The last five years have brought an increasing number of pain programs," Saper said. "What's happened over the last couple of years is a movement to create comprehensive pain care systems." Many medical specialists treat pain, such as neurologists, anesthesiologists, psychologists, neurosurgeons and physical therapists. But many of them have different and sometimes contradictory treatment approaches. The benefit of a pain clinic is the variety of services they can offer patients, Saper said.
    Part of the growth of the pain management specialty is reflective of the changes in the way medicine views pain and demographics. Many physicians now accept that untreated pain damages the body, causing complications and longer hospital stays. Yet studies have shown that most pain is not appropriately treated, resulting in needless suffering and costs.
    The American Pain Society reports that pain costs about $100 billion annually in medical expenses and lost work days. Back pain, for example, causes chronic disability for 1 percent of the U.S. population and another 1 percent is temporarily disabled by it. And more than 40 million Americans have arthritis, a number that is expected to grow as baby boomers age. "The field of pain management is evolving," said Dr. Fred Davis, co-founder of Michigan Pain Consultants of Grand Rapids, which was among the first full-time pain management practices in the state. Dobritt is modeling his new practice after that 18-year-old firm, which now covers an eight-county area in western Michigan, serves 60,000 patients a year at 12 clinical sites and has seen annual growth of 20 percent a year.

Lawyers Submit Notice of Appeal in Yates' Conviction
Lisa Teachey, Houston Chronicle- 4/4/2002

Lawyers for Andrea Pia Yates filed documents Wednesday showing they plan to appeal her conviction. Despite her lawyers' claims that she was insane, the 37-year-old Clear Lake mother was found guilty last month of drowning her children in the bathtub and was sentenced to life in prison.
    The actual appeal does not have to be filed for several weeks, defense lawyer George Parnham said Wednesday after filing the notice of appeal in state District Judge Belinda Hill's court. Parnham said he and co-defense lawyer Wendell Odom will represent Yates on the appeal. "The appellate process begins and we'll see where it takes us," Parnham said. "Ultimately, the case will be appealed to the (state) court of appeals, to perhaps the (Texas) Court of Criminal Appeals and if necessary into our federal system."
    Although the documents filed Wednesday do not state the grounds for the appeal, Parnham and Odom previously have said that they are looking at several aspects. Yates' lawyers claim, for one, that prosecutors sought the death penalty only to get a more conservative jury panel that would be less sympathetic to an insanity defense. The appeal also could state that jurors should have been allowed to hear that Yates could have been held in a mental institution indefinitely if acquitted by reason of insanity.
    Harris County District Attorney Chuck Rosenthal said the latter argument is erroneous because Texas law mandates the person be reviewed regularly. The U.S. Supreme Court already has ruled it unconstitutional to indefinitely imprison the mentally ill after doctors have pronounced them well enough to be released. "Realistically, someone who is found not guilty by reason of insanity could get out in as little as 60 days," Rosenthal said.
    Parnham and Odom have said that they believe their best bet in the Texas appellate courts involves the testimony by the prosecution's expert psychiatrist, Dr. Park Dietz. He testified that Yates may have gotten the idea from a television show about a woman who drowned her children and was acquitted by reason of insanity. A few days later, after Yates was convicted, it was discovered that the show, allegedly an episode of Law & Order, never happened. Parnham and Odom also said Dietz used evidence from a prior competency hearing in the trial, which they said is a violation of state law.

Rate of Binge Drinking in Pregnancy Unchanged
Reuters News Service- 4/4/2002

NEW YORK — Many women of childbearing age are not getting the message about the adverse effects of alcohol use during pregnancy, according to a report in the April 5th issue of the Morbidity and Mortality Weekly Report. "Even with all the interventions and messages out there, we have not seen a significant decrease in alcohol use among women of childbearing age," Dr. Jasjeet Sidhu of the National Center for Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention in Atlanta, Georgia, told Reuters Health.
    The Center for Disease Control team used data from the Behavioral Risk Factor Surveillance System for 1991-1999 to analyze trends in alcohol use among women aged 18 to 44. Of the more than 107,000 women interviewed about their alcohol use between 1995-1999, nearly 4,700 (4%) were pregnant at the time of the interview. The overall prevalence of any alcohol use--defined as at least one drink--during pregnancy increased from 12.4% in 1991 to 16.3% in 1995, but declined thereafter to 11.4% in 1997 and 12.8% in 1999.
    However, the rates of binge drinking, defined as having five or more drinks on any one occasion, and frequent drinking, defined as having seven drinks per week or five or more drinks on any one occasion, among pregnant women remained "substantially unchanged." For binge drinking, the rates in 1995, 1997 and 1999 were 2.9%, 1.8% and 2.7%, respectively. For frequent drinking, the rates were 3.5%, 2.1% and 3.3%, respectively. Among nonpregnant women aged 18 to 44, rates of any alcohol use and binge drinking also remained stable. For any use, the rates were 53.2% in 1995, 52.8% in 1997 and 53.3% in 1999. For binge drinking, the rates were 11.2% in 1995, 10.8% in 1997 and 12.3% in 1999, the report indicates.
    These findings, Sidhu told Reuters Health, parallel results reported last week in the College Alcohol Study indicating that more than 40% of US college students still binge drink, a figure which has remained constant for almost a decade. "Healthcare professionals who provide care for women of childbearing age should routinely screen for alcohol use," Sidhu told Reuters Health. "All childbearing age women should receive messages about the adverse effects of alcohol use during pregnancy," he said.
    SOURCE: Morbidity and Mortality Weekly Report 2002;51:273-276.

Plea, Sentencing End Zantop Murder Case
Marcella Bombardieri & Douglas Belkin, Boston Globe- 4/5/2002

NORTH HAVERHILL, N.H. — In a day of wrenching courtroom drama, teenagers Robert W. Tulloch and James J. Parker stood before the children of their victims, their own parents, and an array of reporters yesterday to accept responsibility for the murders of two Dartmouth College professors.
    At two riveting hearings just hours apart in the Grafton County Courthouse, Tulloch pleaded guilty to two counts of first-degree murder for the slayings of Half and Susanne Zantop while Parker, his partner, was sentenced on a plea bargain to 25 years to life for his role in the crime. Tulloch, who had originally planned to plead not guilty by reason of insanity, was automatically sentenced to life in prison without the possibility of parole. The hearings closed one of the most notorious murder cases in New England's memory and dramatically sealed the fate of childhood friends from a tiny Vermont town who committed a crime that garnered national headlines.
    In the fullest account to date, the chief prosecutor detailed the twisted path the two teenagers took over a year's time, as they went from petty burglaries and stealing mail for credit card numbers, to planning home-invasion robberies with commando knives, and digging graves in advance for at least one intended murder. They didn't plan everything, though, and the prosecutor said that after killing the Zantops, Tulloch and Parker drove from the murder scene to Barnes & Noble to browse for books about how to cope with being a killer. The coldness of the crime was in stark contrast to emotional victim-impact statements delivered by the Zantops's children.
    With her sister by her side, Veronika Zantop told the court about enduring ''absolute horror, disbelief, pain, sadness, and anger'' at the murder of her parents. Tulloch and Parker, however, had starkly different reactions to the tear-filled statements. Parker wept during his hearing, and asked to speak to the women before he was sentenced. When Judge Peter W. Smith gave him permission to address the daughters, Parker remained seated for nearly a minute in the hushed courtroom, breathing deeply, wrestling with his emotions; when he rose to speak, he abandoned his notes. ''I'm sorry,'' he said, anguish in his voice and face. ''There's not much more I can say. I'm just really, really sorry.'' In a press conference after the hearing, Parker's mother said she hopes the victims' families can now find healing and forgiveness. Tulloch, presenting the image of an iron-cold killer, locked eyes with the sisters and the Zantops's friends in the courtroom. He wore a faint smirk throughout his hearing, showed no remorse, and did not make a statement.
    Justifying the punishments, New Hampshire Senior Assistant Attorney General Kelly Ayotte repeatedly described Tulloch, 18, as the instigator in their trail of criminal activity. ''It was our sense that Tulloch was the leader,'' she said in a news conference after the two hearings. ''Tulloch was a year older and if you remember back to high school, the difference between a junior and a senior can seem significant. ''That being said,'' she added, ''what James Parker did is significant in this crime.''
    During Tulloch's plea hearing, Ayotte said he was the one who first suggested they turn to crime to get the $10,000 they calculated would pay for a move from their hometown of Chelsea, Vt. to Australia. It was Tulloch, she said, who suggested they should kill their robbery victims to eliminate witnesses and ''so they could be, quote-unquote, bad-asses when they went to Australia.'' It was Tulloch who first reached for a knife to attack Half Zantop, Ayotte said, and Tulloch who paused in the midst of murder to instruct his friend to slash Susanne Zantop's throat. In his first police interview after being captured in Indiana, Ayotte said, Tulloch expressed regret — for ruining his and his best friend's lives. Quoting from their police interview, Ayotte said Tulloch kept repeating, ''I'm sorry, Jimmy,'' and lamented the harm he'd done himself. ''It's a house of cards,'' Ayotte quoted Tulloch as saying. ''It took me 17 years to build and I just blew it down, and I can't build it up again.''
    Before both teenagers were sentenced, Ayotte gave Smith a detailed description of how the crime evolved, much of it based on Parker's cooperation with authorities: About a year earlier, Tulloch and Parker dreamed of escaping the drudgery of Chelsea for adventure in Australia, but needed the money to go. They contemplated a range of crimes, all of which failed: stealing cars, obtaining credit-card numbers through stolen mail or lifting them from the Web. They stole an all-terrain vehicle, but couldn't sell it on the Internet without a title. Within months, they settled on home invasion and murder. They planned to obtain the residents' credit cards, ATM cards and PIN numbers, then kill the occupants and wrap their bodies in plastic bags for burial. They even dug a grave in advance on the property of an abandoned house nearby, Ayotte said.
    In one attempt on July 19, 2000, the teens cut one resident's phone lines, then Tulloch knocked at the door and claimed his car had broken down as Parker hid nearby. But the homeowner came to the door armed with a gun. Frightened, Tulloch and Parker scaled back for awhile and reverted to stealing mail. But they soon grew restless and revisited their robbery-murder scheme, arming themselves with military-style assault knives.
    In January 2001, a man who answered the door in Rochester, Vt., said he was too busy working on his indoor pool to participate in their ruse — a fake environmental study. ''After the failed attempt, they were frustrated. Again their plan hadn't been carried out,'' Ayotte said. ''They came up with the idea that people in Hanover, N.H., have a lot of money.'' The young men chose Trescott Road in the nearby village of Etna, N.H., first surveying one house, but losing their nerve on the way up the driveway. On Jan. 27, they tried the Zantops's next-door neighbors, who weren't home.
    Their next target: the Zantops's secluded, contemporary home. When they knocked on the door, Tulloch carried a backpack with the commando knives, duct tape, plastic ties to bind their victims, and notebooks for their ruse. Half Zantop answered, agreed to participate, and invited them in his study. As his wife prepared lunch, Half, Parker and Tulloch talked for more than 10 minutes, as Parker pretended to take notes. At the end of the interview, Half suggested they get in touch with a friend who could help them. When he couldn't find the friend's number in the phonebook, he began searching for it in his wallet. Noticing Zantop's cash, Tulloch drew one of the knives while the professor's back was turned, then knocked him into a bookcase and began stabbing him. Hearing her husband's screams, Susanne Zantop rushed into the room, but Parker grabbed her. It was Tulloch, however, who ''looked over at James Parker and told him to slit Susanne Zantop's throat.'' Parker complied. Tulloch stabbed Susanne Zantop with such force the blade of the knife pierced her skull. After the murders, the two pocketed the $340 in cash and burned Half Zantop's wallet and credit cards. Tulloch changed out of his blood-soaked pants at home, and then the two drove to Burlington, Vt., browsing a Barnes & Noble bookstore for books on the psychology of killing, briefly flipping through one about how soldiers grapple with their emotions after taking a life.
    During the hearing, attorney Richard Guerriero, who had advised Tulloch to plead not guilty by reason of insanity, told Smith that his client's guilty plea ''was against our advice.'' But, ultimately, Tulloch wanted to spare his family the trauma of a trial. There is a possibility that Tulloch and Parker will end up serving at least part of their time together in New Hampshire State Prison at Concord, where they were taken after the hearings. But they could be transferred to other facilities at some point.
    Although the day's events revealed much about a crime long considered unfathomable, it did not clarify precisely what moved two top students to undertake a campaign of mayhem. A source who has spoken at length with Tulloch said their inspiration was in part to see if they could cross moral boundaries and ''create their own destiny.'' A reporter yesterday asked Ayotte, who has devoted more than a year to this difficult case, for her explanation. ''What would cause two young members of our society to do this type of crime?'' Ayotte said. ''I can't answer that for you.''