Colorado Sex Offender Challenges New Probation Rules
Associated Press, 5/11/2002

BOULDER - A convicted sex offender will be allowed to attend his daughter's high school graduation, despite new probation guidelines requiring that every parent attending the ceremony approve. Richard Tschoepe, a former physical therapist, pleaded guilty in 1997 to sexually assaulting a patient. He was sentenced to two years in jail and 10 years of probation. Since then, the Sex Offender Management Board has enacted guidelines stipulating that adult sex offenders cannot have contact with any children without permission of the parents. The probation office has already kept Tschoepe from attending his children's soccer games.
    Prosecutors argued that would have put the June 1 commencement ceremony for Fairview High School off limits to Tschoepe, 52. Boulder District Judge Morris Sandstead decided Thursday that Tschoepe could attend but held off on deciding whether two dozen other guidelines put in place after Tschoepe's 1997 sentencing should apply to him. Sandstead ordered attorneys to file briefs before he rules.
    Last fall, the probation office brought Tschoepe's requirements up to the new standards, published in 1999. Shortly after that, Tschoepe was ordered to move out of his home for a brief time after two deceptive responses on a polygraph test, and he is no longer allowed to be alone with his children without his wife present. Tschoepe testified he may not have entered into the plea deal had he known he would be held to standards not recognized when he was sentenced.

Treating the Priest, Under Church's Wing
Caryle Murphy, Washington Post- 5/11/2002

The red brick building in Silver Spring is set amid acres of wooded land. A sign near the front door with its name -- St. Luke Institute -- is inconspicuous to passersby on the street. Keeping a low profile is important, because most of the 70 residents are troubled Roman Catholic priests, a quarter of them accused of molesting children. Founded in 1981 by a priest-psychiatrist who later died of AIDS, St. Luke is one of a handful of church-sponsored treatment programs across the country that U.S. bishops have turned to for assistance in dealing with priests who abuse children. In some instances, court records have revealed, priests accused of abuse were sent periodically to these treatment centers and then returned to ministry.
    As the Catholic Church staggers under the scandal of bishops covering up for pedophile priests, St. Luke and places like it are facing new scrutiny. Critics question whether such centers have been lenient in their recommendations on a priest's future, whether they have the independence to honestly advise bishops and whether they have contributed to the climate of secrecy that has pervaded the church's handling of pedophiles. "I guess it reminds me of Enron," said Robert J. McAllister, associate medical director of Taylor Manor Hospital, a psychiatric hospital in Ellicott City. Like the bankrupt energy company with too-cozy accountants, the church is "sort of doing their own evaluations [of priests], and I think they do it partly for the benefit of the secrecy," he said.
    St. Luke's medical staff, which includes non-Catholics, uses therapies common in secular programs for sexual disorders. But the institute, named for the patron saint of healing, also is infused with Catholic spiritual ideals, including a belief in the possibility of rehabilitation -- even for some child abusers. The very notion that some abusive priests can change their behavior is at odds with calls from many rank-and-file Catholics for bishops to adopt a "one strike and you're out" rule at their meeting next month in Dallas -- a policy that would remove priests from ministry after a single incident of child molestation.
    St. Luke "has a good staff and bases its treatment on a solid medical model," said A.W. Richard Sipe, a former priest and California psychologist who has treated priests with sexual disorders. "The difficulty comes in making any prediction about future lapses," he said. Although the institute's staff is "more cautious now," Sipe said, "in the past they were . . . much more hopeful about the outcome of treatment than they are today."
    Such criticisms are rejected by the Rev. Stephen J. Rossetti, St. Luke's president and chief executive. "We are closely tied to the church," said Rossetti, a psychologist. "At the same time, we are a free-standing organization, and the bishops expect us to tell them the truth. And we do." Rossetti said that of 121 priests treated at St. Luke for child molestation since 1997, only three are known to have offended again. That rate, he added, is similar to earlier surveys of priests treated there. After treatment, the institute indicates to the priest's bishop "how much of a risk this person is," Rossetti said. Its recommendations typically include suggestions for continued supervision and therapy and a stipulation of "no unsupervised contact with minors," he added. "It's up to the church to decide whether or not he goes back to ministry."
    Luisa M. Saffiotti, a psychologist in private practice in the District, worked at St. Luke until 1996. "My experience with them was overwhelmingly that the clinical teams . . . bent over backwards to be cautious," she said. Most staffers, she added, "are parents themselves, and there is great sensitivity that we need to protect children."
    Rossetti did not discuss how often bishops have heeded St. Luke's recommendations. But in at least one high-profile case, they did not. Former priest John Geoghan, who was accused of molesting about 130 children in the Archdiocese of Boston, was a patient at St. Luke in 1989 and 1995. In 1989, according to media reports based on Massachusetts court papers, the institute determined that Geoghan was a "homosexual pedophile" at high risk of committing further abuse. Nevertheless, he was returned to parish work, and he molested again. He was sentenced in March to serve nine to 10 years in prison.
    Michael R. Peterson, a psychiatrist who converted to Catholicism and became a priest, founded St. Luke to help alcoholic priests. It later began treating child abusers and then added programs to help nuns. Today, at any one time, about 25 percent of its residents are being treated for molesting minors. The rest are there because of a variety of other ills, including other sexual disorders, depression, alcoholism, overeating, prescription drug addiction and spending compulsions. Two-thirds of its clients are men, and the average stay is four to seven months.
    On a recent tour of the facility, Rossetti was at pains to point out that it is not a prison, but also not a place where priests can hide from the law. "The front doors are unlocked -- people can walk out," said the former Air Force intelligence officer who has worked in the field of sex abuse for a dozen years, most of them at St. Luke. At the same time, if an arrest warrant is issued for a resident, "we will turn them in within hours," he said. "We just couldn't get away with harboring criminals."
    Although St. Luke's 70 beds were occupied that day, an eerie quiet filled the building, because most residents were in supervised activities. Doors to their empty bedrooms were ajar. In one, a teddy bear sat alone on a chair. In the chapel, a modernistic sculpture of Christ in the process of resurrecting -- still looking beaten down and suffering -- hangs over the altar.
    Bishops send accused priests to the facility for week-long psychological evaluations to determine the nature of their problems and the type of treatment needed. Both the priest and his bishop are given copies of the final report, Rossetti said. If further treatment is recommended, priests who have abused minors are put through a months-long residential program whose first goal is to bring down the wall of denial commonly built by such perpetrators, Rossetti said. "This is not summer camp," he added. "Our society fosters a victim mentality. That doesn't work here. You need to . . . take responsibility. This is a place of truth-telling."
    The program also includes cognitive behavioral and psychodynamic, or talk, therapy, Rossetti said. "A minority" of abusers, he said, are given Depo-Provera to lower their sexual drive. Clients also have art and drama therapy, and those with compulsive sexual addictions are placed in 12-step programs. An important aspect in treating child abusers, Rossetti added, is forcing them to acknowledge the pain and trauma they inflict on their victims. "They have to realize the harm they are causing," he said. "If they don't, they are not going to get better." St. Luke also operates as a halfway house for those who complete the program.
    The facility gets most of its $6.1 million annual operating budget from dioceses, which pay rates of $120 to $350 per day for their priests, depending on which program they are in. The Washington Archdiocese declined to say how much it has paid the institute for its priests' treatment in recent years.
    Rossetti makes a distinction between pedophiles, who molest prepubescent children, and ephebophiles, who are sexually attracted to teenagers. In general, he said, ephebophiles are more likely to be treated successfully and less likely to re-offend. Sipe, the California psychologist, said he also has found that to be true.
    But other experts in sexual disorders disagreed. "I think there are differences of opinion on that," said Frederick S. Berlin, founder of the Sexual Disorders Clinic at Baltimore's Johns Hopkins Hospital, explaining that he had not found ephebophiles more treatable than pedophiles. But he agrees with Rossetti that some priests who have committed abuse can be returned to a restricted ministry under close supervision. "I'm not going to tell the church what its policies should be," he said, but "clinically, I've seen that to be the case." From the standpoint of community safety, Berlin added, "you can make a case that the church may be able to do more" by keeping such priests under church supervision than by letting them loose in society.
    Rossetti, who is a consultant to the U.S. Conference of Catholic Bishops on the issue of child sex abuse, contends that a "one strike and you're out" rule would unfairly punish priests who successfully change their behavior through treatment and who accept supervision while working in jobs that do not involve children. He also acknowledged that such a rule could have an impact on St. Luke, because priests headed for dismissal may not be inclined to enroll in its programs. Rossetti said he sees no conflict between his spiritual commitment, including a belief in rehabilitation, and therapeutic realities. "Any good therapist has hope for his clients," he said. "If you don't have hope, you can't expect the clients to have hope. . . . At the same time, we have to be realistic about what we can and cannot do. The fact is that we regularly discharge people who basically are not making progress."

ABC News Tries Hypnosis on Two Smokers
ABC News, 5/11/2002

Terry Singleton, a convention coordinator from California, started smoking at age 17. Quitting has always been a struggle. "I'd smoke while I chewed the gum," she told ABC News' Good Morning America, laughing. "I'd smoke while I drank the tea." Likewise, after 16 years of smoking, ABC producer Chris Francescani is determined to quit. "It's like the boy who cried Marlboro," Francescani said. "You know, it's not something that I expect people to believe in me, because they've seen me try and fail so many times." Now, it's become a matter of pride. "I'm sick of it," Francescani said. "I'm sick of smoking. It's unhealthy. It's unattractive. It's undignified. I don't want to be obligated anymore to this sort of hourly addiction." He and Singleton agreed to let Good Morning America use their cases to put hypnosis to the test, to see how well it works to help fed-up smokers quit their habits.

Many Turn to Hypnosis
Each year, tens of thousands of people visit hypnotists in the hope of curing their addictions. According to a Stanford University study, 50 percent of smokers undergoing hypnosis quit after just one hypnotic session. After two years, 25 percent remained smoke-free. "It's an area that I don't know anything about … so that's a little freaky for me," Singleton said. "But if it means becoming a non-smoker, it's worth it."
    Hypnosis works best on behavior — not root causes, particularly those in which genes may play a strong role, so alcohol and drug abuse have proved resistant to change through hypnosis. Weight loss also is hard because it is fueled by such a complicated set of emotional and genetic factors. Published studies show that severely obese people lost just 14 pounds, and motivation was key. Perhaps that's because hypnosis works best with simple instructions, and someone can't simply say, "Don't eat." But a person can just stop smoking. And for many, a simple, self-hypnotic technique may help them win what seems an impossible battle.

Barely Noticed
ABC News asked father and son doctors David and Herbert Spiegel, both psychiatrists and clinicians of hypnotism and addiction, to take on Singleton and Francescani — to hypnotize them into quitting cigarettes. It would take just 60 minutes. "For my body, smoking is a poison," Francescani said under hypnosis. "I need my body to live," Dr. Herbert Spiegel said. "I need my body to live," Francescani repeated.
    Afterwards, both were surprised that the experience was not more intense. "First of all, I thought that it would definitely be more eventful, … less voluntary of me," Singleton said. "I never once felt that I was under any spell," Francescani said. "You know, I didn't feel that he had any power over me."
    In fact, that's a big misconception about hypnosis, experts say. There's no deep trance, no loss of control. Subjects are completely aware the entire session. "In fact, you're not taking away control," said David Spiegel, who is affiliated with the Stanford University School of Medicine. "You're teaching control by telling them they have a greater ability to control how their body feels."

Some Success
But did it work for Singleton and Francescani? The jury's still out. Two weeks later, Francescani said his battle against smoking had become easier — "hard but … manageable." "Before, it was impossible, and now it's possible," Francescani said. "I'm not sure what he did to make it possible, but my body's calmer now, it doesn't freak out every 20 minutes, you know, when you don't have a cigarette." He added that knowing there would be follow up on his case on national television "certainly helped" him refrain from lighting up.
    Singleton did smoke about 10 cigarettes in the week after her hypnosis — well down from her normal consumption — but like Francescani, also found it easier to resist. "I can go all day without smoking," she said. "I get with my girlfriends and I'll have a cigarette. I think it's made a difference or maybe it's the guilt factor. Everybody at work's rooting for me, you know. Everybody's expecting you to quit, you know?"

 Texas HMOs Losing Mental Health Appeals
Polly Ross Hughes, Houston Chronicle- 5/13/2002

AUSTIN -- A striking pattern of insurers wrongfully denying mental health care has emerged in a new study showing that Texans who appeal HMO decisions usually win. More than half of all HMO denials for medical care were overturned when submitted for an independent review, but that spiked to 70 percent for mental health care, according to the Consumers Union report.
    "The important thing about the mental health and substance abuse issues is they are so difficult," said Lisa McGiffert, a Consumers Union health policy analyst. "I think often families are worn out and they feel pretty hopeless that there's any real help. The thing this report shows is there is help," she said.
    The Texas Department of Insurance can assign an independent physician to review a contested denial at the patient's request. Usually two or three appeals by health providers will have already been denied by the HMO. The idea was inserted into a 1997 law passed by the Legislature which made Texas the first state in the nation to allow medical malpractice lawsuits against HMOs. Former Sen. David Sibley, R-Waco, authored the bill, arguing that the act of refusing to pay for treatment was in fact practicing medicine.
    The study reviewed 263 cases in which HMOs denied treatment during six months of last year, from March to September. When patients exercised their right to appeal the HMO, 144 denials were overturned in part or completely. The reviews are conducted by doctors who have been deemed to have no conflict of interests or monetary interest in the outcome. Their sole determination is whether a procedure denied is actually medically necessary.
    Certain categories of appeals were most commonly requested. Denials for mental health or substance abuse treatment made up 100 of the cases reviewed, while 60 appealed denial of longer hospital stays or treatment of physical illness. Nineteen involved prescription drugs and 16 concerned surgical treatment for obesity. "Mental health and substance abuse treatment constitute only 8 percent of the nation's medical care costs," the study noted. "Yet, these conditions together accounted for 38 percent of care denials sent for review in our sample." Of the reviews studied, 46 involved treatment for mental illness, of which 32 denials by HMOs were overruled. Within the mental health category, independent reviewers overturned 7 out of 11 denials of treatment for such eating-related ailments as anorexia nervosa, bulimia nervosa and binge eating disorder.
    The study said that HMOs often chose to cut short hospital stays for patients with eating disorders based primarily on how much weight they had gained. However, those who were released too soon often returned in worse condition. The report describes a case in which the independent review organization agreed with the HMO decision to release a woman from the hospital. At a residential treatment center, however, she became panic-stricken when she spotted food in the refrigerator. She began bingeing and purging again, became increasingly depressed and attempted suicide. "There comes out of this a real question about the decisions being made related to the types of ailments that bring together mind and body," said Kathy Mitchell of Consumers Union, who worked on the study as an editor. HMOs also had a high rate of overturned denials -- 70 percent -- for gastric bypass surgery to treat severe obesity. The independent reviews also overturned 59 percent of insurer denials for substance abuse treatment.
    Kim McPherson, a public policy analyst at the Mental Health Association in Texas, said the Consumers Union's discoveries regarding mental health denials confirms what her group often hears anecdotally. "Our suspicion has been, in the desire to save money, plans are looking for the low fruit on the trees," she said. "It definitely looks as if the industry's targeted mental health as a place where they can achieve health savings on the backs of the most vulnerable people in the system." McPherson said it appears that the prevailing stigma and discriminatory attitudes surrounding mental illness might lead HMOs to believe it is one area where belt-tightening won't cause a consumer or employee backlash.
    Leah Rummel, executive director of the Texas Association of Health Plans, attributed the higher rate of overturned denials to the fact that mental health is a more nuanced and complex form of illness. "Mental health in itself is very subjective. They are very complicated cases," she said. She said, when appealing to an HMO, providers must explain the dangers in moving a patient from inpatient to outpatient treatment. Sometimes, it's a communication breakdown. "The one thing this does show, in most cases, the managed care companies are providing services, and members generally are happy," Rummel said. "Those who do not receive services are probably minimal."
    Requests for independent reviews are surprisingly rare, but consumer advocates think patients likely don't know their rights and the provider might not either. "If I was running a health plan, I'd want to look at these independent review statistics. If I was getting overturned more than half the time, I could be doing something wrong," McGiffert said. "Part of it is counting on a bunch of people not following through."

California Sex Offenders Seek End to Extra Jail Time
Anna Gorman, Los Angeles Times- 5/13/2002

Attorneys for eight repeat sex offenders are accusing the state of acting unconstitutionally by housing the men, who have already completed their prison sentences, in Los Angeles County jails rather than in hospitals and by denying them mental health treatment during their stays. The inmates are awaiting court hearings to determine whether they will be committed to state hospitals under California's Sexually Violent Predator Act, which took effect in 1996 and was clarified by a recent state Supreme Court decision.
    The attorneys have asked judges to order their clients placed in the hospitals during the hearing process, which can last years. They filed motions saying that the inmates, who are alleged to have mental disorders, are being treated like prisoners rather than patients. After receiving the motions, Superior Court Judge David S. Wesley brought the cases into one courtroom in March and has heard testimony for several weeks. His pending decision could apply to 112 men who committed their sex crimes in Los Angeles County.
    "Anecdotally, I've been hearing a lot of horror stories, so I thought it was time to look into this," Wesley, assisting supervising judge of the criminal division, said in an interview. "I'm not saying these are good people. I'm saying they are still human beings." Though Wesley is still studying the laws, he said he is inclined to believe it is only right to provide the inmates mental health services. "If we are going to house these people on the premises, we should be giving them treatment," he said.
    The sex predator law allows judges or juries to commit repeat sex offenders to state hospitals after their prison terms have ended. The process is twofold. After release from prison, the offender is transferred to a county jail, where he is arraigned and then participates in a hearing to determine if there is probable cause to believe he may commit new sexually violent crimes. If probable cause is found, the inmate is sent to Atascadero State Hospital until his trial, which will determine whether he should be committed to the hospital for two years. For that to happen, at least two mental health experts must have determined that the inmate presents a "substantial danger" to society because he is likely to attack again. The Los Angeles County Jail is home to 51 repeat sex offenders, some of whom have been awaiting probable cause hearings for more than three years, jail officials said.
    Wesley issued an order in March to the state attorney general and Department of Mental Health asking them to show why the offenders should not be housed in a state hospital and receive mental health treatment pending their probable cause hearings. "I want to see what's wrong," Wesley said. "I just want to know how people can be detained for so many years without treatment and without trial."
    The attorney general's office, representing the Mental Health Department, responded in writing that the state has no legal responsibility to provide treatment until offenders arrive at Atascadero State Hospital after their probable cause hearings. "There is no law saying we should bring treatment into the local county jail, and there is definitely no law saying they should be transferred to another facility," said Deputy Atty. Gen. Karen Ackerson-Brazille, who added that the housing issue has been raised in other counties as well.
    Department of Mental Health spokeswoman Nora Romero said the attorneys are responsible for their clients' lengthy waits in county jail because they often seek postponements of the court hearings. "If they really want treatment, all they have to do is go forward with the probable cause hearing," she said. The attorneys counter that it takes a long time to gather case histories, get their clients evaluated and argue legal issues that arise. Attorney Jonathan Mandel said that at one client's request, he sacrificed that time and moved forward with the probable cause hearing so the client could get transferred from jail to the hospital. "Nobody wants to rush, because you want to prepare," he said. "But if you don't rush, they're sitting in jail."
    Attorney Todd L. Melnik said it is unconstitutional for his client to be forced to wait in jail rather than a hospital for his probable cause hearing, because he has already been punished for his crime. His client, Barry Blake, finished his state prison term for assault in May 2000. But because of two prior convictions on sex charges, he has been waiting to see if he will be committed to a hospital before being released into the community. Melnik has asked that Blake be placed in a hospital pending those hearings. A 1999 California Supreme Court decision upholding the predator law as constitutional said that it was not designed to be punitive and should treat the offenders "not as criminals, but as sick persons." Melnik said the law is being applied in a punitive way. "Here he has been in county jail for two years, not getting a lick of treatment," Melnik said. "If these guys are really mentally ill, then why aren't we doing more to rehabilitate them?"
    Melnik, along with the other attorneys, is arguing that a recently amended section of the state Penal Code says a sex offender must be housed in a facility that "can continue the person's program of treatment, provide adequate security, and minimize interference with the person's program of treatment." If the person is not receiving such treatment, the law says the court should order the person transferred to another facility, such as a state hospital. The state attorney general's office, however, argues that the section applies only to repeat sex offenders who are in outpatient programs--of which there are currently none.
    In Los Angeles, repeat sex offenders are housed in the Twin Towers jail downtown and are segregated from the general jail population for their own safety. "It's manpower-intensive," said Senior Deputy Paul Schrader. "Anytime they go anywhere, we have to make sure the other inmates are either locked down or placed in another area."
    Assistant County Counsel Kevin Brazile, who represents the Sheriff's Department, said jail officials are trying to treat the offenders like civil detainees rather than criminals by housing them in a dorm area and giving them some special privileges, such as more access to vending machines and cable television. They also can have more personal belongings than regular inmates, Brazile said. "But it's a jail, so there's only so much we can do with them," he said. Brazile said the jail does not have the resources or the authorization to provide sex offender treatment. The county Mental Health Department said it doesn't have the expertise or funding to treat the inmates either.
    Not only are the men being denied mental health treatment in county jail, their attorneys said, they also do not have regular access to education, rehabilitation programs or religious services. They receive inconsistent medical treatment and are subject to strip searches, their attorneys said. Until Judge Wesley ruled otherwise, the men were shackled when they were brought into court.
    Deputy Public Defender John Douglas, who represents four inmates who are at Atascadero and will be brought to Los Angeles for their trials, is asking that his clients be placed in a facility run by the state or county mental health departments to receive required treatment for those detained due to mental illness. The state, he said, "can't just wash their hands of these guys because they're currently in local custody."
    During one of the hearings in Wesley's courtroom, repeat sex offender Kenneth Ciancio said he had not received treatment since December 1998, when he arrived at Los Angeles County Jail to await his probable cause hearing. His case is taking a long time in part because he has been contesting the state's claim that he even qualifies under the law to be considered a sexually violent predator. During the hearing, the judge read aloud a letter from the California Department of Corrections congratulating Ciancio on completing his prison sentence and saying that the department hoped he would reenter the community successfully someday. Asked about the letter, Ciancio said, "I'm still hoping that day comes."

Children Are Paying a Hidden Price for 9/11
N.R. Kleinfield, New York Times- 5/14/2002

The first couple of weeks after the disaster, Calla Perkins was bursting with anger: She expressed her fury in ways she would regret. She sometimes hit and kicked her cats and dog. "I'm so angry I don't know what to do," her mother, Laurel Emery, said Calla told her. When Calla, who is 8, walked past a sign advertising World Trade Center pictures, she would kick it. She would carry her stuffed animals to the bathroom, announcing the trade center was falling and she had to get them to safety.
    Then she calmed down. But recently, she has regressed. She is in second grade at Public School 89, near ground zero. Ever since her relocated class, minus about half its students, returned to the school building at the end of February, she has become very aggressive, reverting to behavior she displayed in kindergarten. She has been pushing and striking other children, and calling them names. Fire trucks and smoke make her edgy. "I'm doing good sometimes," said Calla, who is getting counseling to try to smooth out her anxieties. "I'm scared of noises and sirens." But she was evasive about saying much more. "I feel bad when I talk about it," she said.
    Eight months after Sept. 11, most children in New York seem to have bounced back and returned to rooting for the Yankees or Mets, flocking to "Spider-Man" or playing in their soccer league with the same childhood zeal they showed in living their lives before Sept. 11. But many others continue to struggle to find their old bearings. Sometimes they are seemingly carefree children. Sometimes they are living children's lives with adult worries.
    The scope of the problem was underscored by a recently released study conducted for the Board of Education. It concluded that roughly 200,000 of the 712,000 public school children in grades 4 through 12 were candidates for some sort of mental health intervention -- at least a visit with a mental health professional -- because of the lingering trauma of Sept. 11.
    Many behavioral changes showed up immediately after the attack -- the 8-year-old girl who hid in her closet day after day, children who, at 7 and 8, resumed bed-wetting, children who simply stopped doing their homework -- and then subsided. But others have manifested themselves more recently, undoubtedly compounded by the other cruel dramas of the past months -- anthrax, the Rockaways plane crash, the Middle East bombings.
    Every time one 5-year-old girl hears a sad song on the radio, she asks, "Is that about the World Trade Center?" Some of Calla's classmates have taken to carrying good luck charms to school, hoping they will ward off the world's evil. Other children harbor revenge fantasies, mental health experts say. There are children who speak of suicide, though it's not easy to trace the precise origins. After all, children had problems before 9/11, too.
    Children often disclose their emotions differently than adults, and many do not talk about them, psychologists point out. With the passage of time, the connections become more elusive. Many children will recover with time alone. Left to fester, however, trauma can have a long life. Claude Chemtob, a psychologist specializing in trauma and disaster who has been working with some of the downtown schools, said disaster research showed that without treatment, symptoms could persist for years. He said, for example, studies indicated that children showed effects from a 1972 flood in West Virginia as long as 20 years later.
    The most keenly affected children in New York, of course, are those who lost a parent. But many others, including those who neither live downtown nor go to school there, continue to suffer, in ways large and small. "As more people recover and are back to normal, the kids who are slower to recover know if they complain of their fears, they will be avoided," Dr. Chemtob said. "And so they go underground." And, as Robert Abramovitz, chief psychiatrist of the Jewish Board of Family and Children's Services, added, "One thing we know from other conditions where kids are privately suffering: if you take a history from parents, they're not terribly aware of how depressed the kid is."
    Melanie Chu was sipping multiple hot chocolates with her friend after the school day. She is 8 and in third grade at P.S. 89. Melanie has had her difficulties processing the shock of 9/ 11. Her ongoing fears sometimes drive her to hide beneath a table in class, her mother, Carol Chu, said. When she goes to her piano lessons, she sometimes acts up and ducks under the piano. She dreads being atone and insists on sharing her brother's room. He is 10 and less enthusiastic about it.
    Not only downtown children feel convulsive changes in their lives. One quiet afternoon a few weeks ago, Kate Brassel, 17, was sitting with several friends in the library of the Convent of the Sacred Heart School on the Upper East Side, where she is a senior. A helicopter flew by outside the window: They all became unnerved. The incident caused them to do something they really had not done, which was talk about the effects of Sept. 11 on them. "We had sort of forced ourselves not to think about it personally, because the kids downtown had it so much worse," Kate said. "It sort of seemed selfish to say, 'Oh, poor me,' when those other kids had it so much more traumatic. I mean, I live 100 blocks away."
    But they found that they, too, had been rattled. She said she significantly curtailed her social life all winter. "I didn't go see plays or go out to dinner or go shopping," she said. "Normally I did it a lot. A lot of things seemed pointless and unimportant. A couple of friends were the same way. Now I've started to force myself to go out. I've started to reintroduce myself to having fun with friends." She added: "I've had sleeping problems lately. But I don't know if it's school. There's a lot of stress at school."
    Her friend and classmate, Rima Ibrahim, who lives in Park Slope, Brooklyn, said, "I feel like that day took away some of my innocence." Things that once seemed significant, like her school uniform's being perfectly pressed, no longer do. "I know that my friends feel more anxious, like we always need to be worried, that we are not invincible and anything can happen to us when we least expect it," she wrote in an e-mail message.
    At P.S. 253 in Brighton Beach, Brooklyn, which has a sizable Muslim enrollment, considerable hostility has arisen between non-Muslim and Muslim children, not so much right after Sept. 11, but right now. Shirley Pierantoni-Pineiro, the director of the After-School Corporation's program at the school, says fear and tension are palpable among the students. Children become damp-eyed and do not seem to know why. They want to call their parents. "They say, `Mommy, are you O.K?' " she said. " `What about Daddy? Are you sure you're going to pick me up?' This is happening now."
    So many children cannot make the bad thoughts stop. Nicole Goodkind, 12, who lives in Battery Park City and is in seventh grade at P. S. 89, said; "At night I have thoughts that come into my head like Osama bin Laden will come into my room. I know that won't happen, but I still have those thoughts. They started about a month ago. Whenever I hear a loud noise, I can't sleep. I know it's not rational, but I had a dream two weeks ago that Osama bin Laden made a kid throw up all over downtown. And I'm scared of dead people: I have my grandfather's ashes in our home, and that scares me." She added: "When I hear a loud noise, I have to open my blinds and look out. Sometimes I think there's an atom bomb."
    Joe Begley mentioned how Sept. l l had become an unwelcome demarcation point for him. He is 14, lives in Battery Park City and is in eighth grade at Our Lady of Pompeii School in Greenwich Village. "I use 9/11 as marking point," he said. "Have I done something before 9/11 or after? When did I start guitar? That was after. When did I start art classes? That was before. It's weird It's on my mind all the time." Not long ago, he had to do a group project for science. Others chose topics like Siamese twins, alcohol, cocaine. His group settled on biological terrorism. Learning so much about the subject, he said, "made me feel better and also scared." He went on: "I take great caution in everything I do. When I'm in a very populated area, I look around at the people. I try to avoid going m tall buildings."
    His brother, Peter, l2, said he was squeamish about tunnels. "I used to love tunnels," he said. "Now I imagine dying in a tunnel because it's blown up" He feels tense when he goes through the tunnel to visit his grandmother in Queens. "I imagine the water coming in and dying a slow death," he said. His sister, Kelley, 11, says she has been averse to planes. When the family discusses vacation possibilities, her response always is, "That's fine, as long as we go by train." The other day, her mother suggested Italy. Kelley said, "Now how do you get to Italy by train?"
    Taurean Malofsky had her eye on the clock. It was close to 6:30 in the evening. At last, time for bed. She is 15 and goes to Manhattan Village Academy on 23rd Street. She lives in Washington Heights. She did not know anyone killed in the trade center. Still, she has found herself profoundly affected. In particular, pity for the children who lost parents has suffused her heart. To a large extent, Sept. 11 has blighted her life. "I can't have fun," she said. "I feel that way. I just can't have fun." She finds herself unable to ride the subways alone. She used to keep an activity-packed teenage schedule. She hung out after school. She went shopping and to movies with friends. Bedtime was around 10.
    Now she usually hurries home after school, tackles her homework and turns in by 6 or 6:30. When friends invite her to go out, she begs off. "I just don't want to do anything," she said. "I fail to see the point. I don't want to be outside my house too much. I can't be at anyone else's place for too long. I have a fear of being outside. The only place I feel I can be safe is here."
    Awful dreams haunt her. In one dream, her school was blown up by planes. In another, her mother walked into water and died. She wishes she could snap out of it, but she cannot. "I try to focus on being happy," she said. "I'm trying to not be depressed. As a teenager, there are so many things I could do. It's crazy to waste my time." She has not seen a counselor. She said she did not want to. Instead, every day she confides her painful thoughts to her diaries. She does not know when the demons will relax their grip on her. Meanwhile, she seeks solace in her bed. Sleep never comes easily. During the 20 minutes or so it takes her to nod off, she always says a prayer. "I'm really scared," she said "I don't want to go to sleep and wake up and something else happened. I really don't want something else to happen. And so I pray, Please let me wake up and be alive. Please don't let anything else happen."

Dying to Be Thin: Parents Channel Their Grief
Alan Bernstein, Houston Chronicle- 5/16/2002

They were torn by grief and shock in the jagged hours after their teen-age daughter killed herself. But Linda and Robert "Pat" Melton made at least one courageous move. They made sure that the published death notice for Alexis Marie Melton, 17, a junior and a member of the drill team and National Honor Society at Cypress-Fairbanks High School, contained this phrase at the end: "In lieu of flowers, the family has requested contributions be made in honor of Alexis to the National Eating Disorders Association, 603 Stewart St., Suite 803, Seattle WA 98101, 206-382-3587."
    The words did many things. They sent the message that eating disorders were part of the suffering that led to Alexis' death in the early hours of April 21. They served as a pointed reminder that anorexia, bulimia and associated psychological diseases can be deadly for others like Alexis. And they struck a blow against the stigma about eating disorders that usually keeps the diseases from being mentioned on the obituary page even though anorexia alone is thought to take 1,000 lives a year in the United States. "What they did was a brave thing," National Eating Disorders Association program director Holly Hoff said about the Meltons. Across the country, donations are directed to the organization in such cases about 10 times a year, she said.
    But for the Meltons, boldness born of sorrow did not end there. A few days ago, they sat in the living room of their spacious, immaculate house in Cypress and patiently explained the story to a reporter. A photo portrait of Alexis, their youngest daughter, was on display in an oval frame at the bottom of the staircase. Alexis had acknowledged her struggle with eating disorders, researched the issues, even presented a report about them to a high school class. So taking that acknowledgment a step further, into the death notice that appeared in the Houston Chronicle, seemed somewhat natural. "If the experience with Alexis has influence in helping (others) get help, that would be something good to come out of this," her mother said.
    In the days after Alexis' death became known, friends and strangers left flowers and ribbons on the Meltons' front lawn. The yard sign that had proudly announced Alexis' membership in the Brigade, Cy-Fair High's drill team, was turned into a shrine. A bunch of flowers was left with a note from a girl on the drill team at a nearby school in the far northwest suburbs of Houston. In the note, the girl faced up to the fact that she, too, has an eating disorder. "She felt the need to come and show her support and identify with what Alexis had gone through," Linda Melton said.
    Alexis was born in Webster. The family spent seven years in Connecticut because of her father's work with a chemical company, from which he has now retired. Alexis' physical development came relatively early. For one thing, she was taller than most of her peers in elementary school. Her parents say that in hindsight, that may have planted the seeds of extreme self-consciousness about her body image.
    Before the Meltons moved back to the Houston area, Alexis was suffering from bulimia nervosa. In this disease, people binge on food, often while feeling out of control, and then in fear of gaining weight, they cause themselves to vomit or take laxatives or exercise excessively. The Meltons sent Alexis to a counselor in Connecticut. Eventually the counselor told the family that Alexis had conquered the disease. "We believed that the problem was gone," Linda Melton said.
    But after moving to a subdivision in the Cypress-Fairbanks area and starting eighth grade, Alexis developed anorexia nervosa, in which sufferers severely restrict their food intake. Often their perception of their body image has been disturbed and they have an inordinate fear of gaining weight. The family sent Alexis to a dietitian. She tried ice skating for recreation but didn't like the fact that the exercise was adding bulk to her legs. She took up dancing at school and was eating frequently. But as her parents found out later, her bulimia had returned.
    A pert student with dark bangs, Alexis was intensely interested in doing well and looking her best. "She put a lot of pressure on herself," her mother recalled. In that respect, Alexis fit a profile that counselors often encounter when they treat eating disorders. Experts say the victims are often high-achieving perfectionists who feel their emotional ground has been pulled from beneath them by major life transitions, social problems or traumatic events. Controlling food intake gives a sense of power to insecure people, especially youngsters, who think the rest of their lives are beyond their control, experts say. Modern American culture's emphasis on beauty, dieting and body image gets much of the blame for putting external pressures on sufferers of eating disorders. And most experts agree that eating disorders are growing in the United States, affecting about 5 million people every year, according to the National Institute of Mental Health.
    Alexis became depressed a few months ago, according to her father. Her parents say that after researching eating disorders and reading books by former sufferers, she was burdened with the notion that it would take several years to recover. She got psychological counseling. Alexis tried to commit suicide in January. She was hospitalized for several days and placed on anti-depression medication that was designed to also help curb bulimia. "We knew we were facing severe depression and an eating disorder," her father said. "Actually, we thought we had it under control." Later, her parents would find out that Alexis, for unexplained reasons, did not always take her anti-depression medicine.
    At home in the early hours of a Sunday four weeks ago, Alexis shot herself to death -- a dramatic fact that school counselors revealed to her classmates at Cy-Fair High later in the week. Her parents' courage is framed by a reluctance to discuss the details of her death. Saying that they want to keep the focus on Alexis, they declined to be photographed for this article. At Alexis' funeral April 26, some of her friends said farewell by writing with markers on her casket, which was selected by her parents especially for that purpose.
    Did the bright, athletic teen-ager take her life because of depression, eating disorders or both? No one knows, and the question may be beside the point. People with eating disorders may be more prone to depression, but depression does not cause eating disorders, said Jana Rosenbaum, a clinical social worker who directs the eating disorders program at Baylor College of Medicine. Patients with anorexia nervosa -- which is thought to take more lives than any other mental illness -- may suffer depression and unstable moods because of poor nutrition, she explained. With one or more of the main treatments for eating disorders -- psychotherapy, nutrition counseling and medication -- 70 percent of patients are cured, Rosenbaum said. But insurance companies often are reluctant to pay for treatment, she said.
    Eating disorders are a hot topic of conversation on middle and high school and college campuses. Celebrities have confessed to struggles with the diseases. But Rosenbaum agreed with the Meltons that there is too little known about eating disorders. "One resolution to this may be that someone will dedicate their life to an issue like this," Alexis' solemn father said. Then he returned to the part of the obituary that urged contributions to help fight eating disorders. "If just a dime out of every dollar can help," he said, "that would be a lot better than flowers."

RESOURCES
Possible signs of anorexia nervosa:
· Resistance to maintaining normal body weight
· Intense fear of gaining weight
· Disturbed perception of body image
· Infrequent or absent menstrual periods (in females who have reached puberty)
Possible symptoms of anorexia nervosa:
· Dangerously low body temperature or white blood cell count, heart problems, brittle bones
Possible signs of bulimia nervosa:
· Recurrent episodes of eating binges, accompanied by a sense of lack of control over eating
· Recurrent inappropriate follow-up behavior to avoid weight gain, such as self-induced vomiting, misuse of laxatives and excessive exercise
· Self-image unduly influenced by body shape and weight
Possible physical symptoms of bulimia nervosa:
· Swelling of the feet, hands and cheeks
· Dental, throat and intestinal problems
For information and treatment referrals from the National Eating Disorders Association:
· www.nationaleatingdisorders.org
· 800-931-2237

Survey: Fewer Teens Lighting Up
Erin McClam, Associated Press- 5/17/2002

ATLANTA -- Smoking among U.S. high school students has dropped to its lowest level in a decade, the government said Thursday, crediting steep cigarette taxes and school programs that discourage youngsters from taking up the habit. Just 28.5 percent of high-schoolers in a nationwide survey last year reported they had smoked a cigarette in the previous month -- down from 36.4 percent five years ago, the Centers for Disease Control and Prevention said. The rate is the lowest since 1991, when 27.5 percent of high school students said they smoked. The figure had climbed for most of the 1990s before reversing in 1999. "This is terrific news," said Matthew Myers, president of the Campaign for Tobacco-Free Kids. "This is dramatic evidence that the combination of tax increases and prevention programs are the equivalent of a vaccine."
    The average retail price of cigarettes jumped 70 percent from December 1997 to May 2001, and CDC analysts said studies by health economists show that high cost deters many youngsters from smoking. Many states are pushing for even higher taxes on cigarettes, particularly as they look for ways to raise money in a tough economy. State taxes range from 2 1/2 cents a pack in Virginia to $1.50 in New York. The CDC said teens appear to be getting the anti-smoking message pushed by national media campaigns, and school-based anti-tobacco programs also appear to be sinking in. Health officials would like to see all the factors expanded in coming years. They want the high school smoking rate no more than 16 percent by 2010. "The rates are starting to turn around, but we need a continued effort," said Dr. Terry Pechacek of CDC's Office on Smoking and Health.
    In the latest data, smoking among freshmen, sophomores, juniors and seniors all showed sharp declines from the highs of the 1990s. Seniors still said they smoke most often -- 35.2 percent -- and freshmen the least, at 23.9 percent. In the survey, an anonymous questionnaire given to 13,601 students, 63.9 percent of high school students said they had taken at least one puff of a cigarette in their lifetimes. That was down from 70.2 percent in 1997. And 13.8 percent said they were frequent smokers, defined as having smoked on at least 20 days in the previous month. That figure was 16.7 percent in 1997.
    In 1998, tobacco companies agreed to pay $246 billion to settle lawsuits from states and accepted unprecedented restrictions on advertising and marketing. Some states use money from the settlement to pay for anti-smoking programs. Mark Smith, a spokesman for tobacco giant Brown & Williamson, said the figures are good news. But he denied that raising cigarette prices contributes to a decline in teen-age smoking. He said that when prices go up, teens simply turn to other places to find cheaper cigarettes. "Kids, unfortunately, are not price-sensitive," he said. "They can afford to buy a $100 pair of sneakers. There's much more disposable income in the hands of children than ever before."

Study: 400,000 New Yorkers Experienced PTSD After Sept. 11
Will Lester, Associated Press- 5/18/2002

ST. PETERSBURG BEACH, Fla. -- New Yorkers took an emotional battering after the terrorist attacks, says a study that suggests more than 400,000 city residents have experienced post-traumatic stress disorder. ''There was a very large impact on the population of New York,'' said researcher Michael Bucuvalas, whose firm has extensive experience measuring stress from disasters. ''A lot of that has persisted, but the population is getting better.''
    Researchers had previously released results taken in October and November, covering Manhattan below 110th Street. On Saturday, they announced the findings from the second wave of surveys, which included residents throughout the city during January and February. The number of residents who have experienced post-traumatic stress disorder since Sept. 11 related to the attacks was put at 7 percent, or 425,000. The estimate of people experiencing the disorder related to the attacks over the last month was 140,000. Post-traumatic stress disorder symptoms include nightmares, anxiety, irritability or outbursts of anger. The symptoms are usually present for at least two weeks. Health officials say the existence of certain groups of these symptoms qualifies as post-traumatic stress disorder.
    Researchers are conducting a third wave of interviews including the city's suburbs such as Long Island and northern New Jersey. Almost half a million residents have experienced a serious episode of depression since the attacks and about 212,000 in the last month. Bucuvalas estimated about half of that was related to the attacks. The study will also examine the impact of such a high number of psychological stress victims on the health system. ''Part of our analysis will focus on increased use of mental health facilities,'' Bucuvalas said. ''All of a sudden, half a million people need treatment.''
    The study found that Hispanics were very likely to experience higher rates of the disorder, though Bucuvalas said it is unclear why. Also, people who had experienced other stressful life situations were more likely to have the stress disorder. For some, the disorder has persisted because they were used to seeing the twin towers each day, either from work or home.
    The study is being done in conjunction with the New York Academy of Medicine. Funding for this wave of the research was supplied by the Sept. 11 Fund, the Commonwealth Fund and the National Institute on Drug Abuse. The results were released at the annual meeting of the American Association for Public Opinion Research. The survey is being done by the New York research firm Schulman, Ronca and Bucuvalas Inc.

Michigan Kills 'Too Drunk' Defense
Jennifer Brooks, Detroit News- 5/20/2002

HOLLY -- Intoxicated teens try to burn down their high school. A husband fires a shot at his wife and baby to prove he's sober enough to handle a firearm. A man barricades himself in a house in an armed standoff with police. All try to get out of charges by arguing they were too intoxicated to know what they were doing. Now the state legislature is slamming the door on this obscure defense with newly passed legislation that will eliminate the so-called voluntary intoxication defense -- as 10 other states also have done. The bill, introduced by a Republican representative from Holly, was backed by the state Supreme Court, prosecuting attorneys and law enforcement groups. It won final passage recently and awaits Gov. John Engler's signature.
    Assistant Prosector Anica Letica of Oakland County has seen the "I-was-too-drunk" defense argued in cases of child abuse, domestic violence and the incident with the husband and the handgun. In that case, a bullet hit his infant's crib after missing his wife as she held their baby. The husband argued, unsuccessfully, that he was too drunk to form the intent necessary to commit a crime. Like most people who attempt an intoxicated-offender defense, his argument failed to persuade the jury. "We're not saying this has been a successful defense. What we're saying is that this (repeal) is much better public policy," Letica said. "It's a strange defense. It just seems so counter to everything we believe about personal responsibility," the assistant prosecutor added. "We've seen that some people drink to embolden themselves to commit a crime."
    State Rep. Ruth Johnson, R-Holly, sponsored the legislation that passed May 9. "It's an outrage that a person can be legally excused from the consequences of his or her actions because of drunkenness or drug abuse," Johnson said. "This bill makes individuals who commit a crime responsible for their behavior."

Routine Screening for Depression Urged
Shankar Vedantam, Washington Post- 5/20/2002

PHILADELPHIA-- A top independent advisory panel today recommended that doctors begin routinely screening all patients for depression, saying that America's primary care doctors are missing and mistreating more than half of all cases of the common mental disorder. Asking all patients who walk into offices for tests, physicals and appointments two simple questions about whether they have experienced some of the warning signs of depression can swiftly begin to identify 90 percent of people who suffer from major depression, according to the U.S. Preventive Services Task Force. The panel is a highly influential group of scientists that sets widely followed standards on topics ranging from prostate cancer screenings to mammograms.
    The recommendation is the latest manifestation of the growing recognition that depression is one of the most common -- and most commonly undiagnosed and untreated -- chronic illnesses. About 19 million American adults suffer from depression, and estimates suggest that as many as two-thirds do not get treatment. The new recommendations could bring many of these people into treatment and add millions to the numbers who are taking antidepressants such as Prozac.
    Two-thirds of patients with depression are treated in primary care settings. Primary care doctors also see most patients whose depression goes undiagnosed, as people come through clinics for routine outpatient care. "Primary care doctors have done only a modestly good job in recognizing and treating depression," said Michael Pignone, a University of North Carolina researcher who analyzed the issue for the task force. "Only half of cases are recognized in primary settings, and less than that are properly treated." The task force did not find sufficient evidence to recommend routine depression screening for children and adolescents.
    Two questions ought to become part of the basic repertoire of every patient visit, the task force recommended in an announcement that coincided with the American Psychiatric Association's annual meeting here: "Over the past two weeks, have you felt down, depressed or hopeless?" and "Over the past two weeks, have you felt little interest or pleasure in doing things?"
    If a patient answers yes to either question, the task force recommended that doctors offer patients written or oral questionnaires. These ask more specific questions and establish whether the problems are transient or persistent. If the problems have lasted throughout the previous two weeks, and have interfered with the patient's ability to perform day-to-day tasks, doctors may make a diagnosis of depression.
    "Most patients who are depressed have some diminished function," said Alfred Berg, a professor at the University of Washington in Seattle and the chairman of the task force. "They don't take pleasure in activities, they are not productive, can't concentrate, are often sleep-deprived, don't eat well, have headaches or low back pain. If you go through a formal assessment, you find the depressed patients aren't doing as well."
    But screening is only the first step in the task force's recommendation. "Asking, 'Are you depressed?' and having the patient say, 'Yes,' and then moving on doesn't cut it," Berg said. "You have to have access to the right therapy or medicines. Patients must have access to medicines. There should be follow-up if the patient doesn't show up two weeks later."
    Berg and Pignone said medicines and psychotherapy are effective treatments, and some previous research has found the combination more effective than either alone. Both said it was important that the responsibility for implementing the new recommendation not be left to physicians alone, but to health systems and managed-care plans.
    That is important because many plans do not offer coverage for psychotherapy, and some do not offer the same level of coverage for medicines compared with physical disorders. Perhaps more important, managed care is structured so that doctors are reimbursed for patient visits -- meaning that doctors have no financial incentive to follow up on their patients as regularly as is needed.
    Under a health system that encourages patient follow-up care, a doctor or nurse would call a patient a couple of weeks after they are started on treatment to ask how they are doing, said Pignone, whose research is being published today in the Annals of Internal Medicine. If the patient is doing poorly, the doctor could recommend another visit. If the patient is doing better, the doctor can tell the patient not to miss work for an appointment.
    The task force is widely considered to be more conservative and evidence-based than specialist organizations. Its government funding separates recommendations from personal and financial conflicts of interest. Because its members do not come from any one medical specialty, they tend to have a practical approach, and the task force focuses on issues in which the scientific evidence conclusively shows a large difference.

Nasty Clique Behavior Among Girls Draws New Attention
Cecelia Goodnow, Seattle Post-Intelligencer- 5/21/2002

Karyssa Albrecht is only 13, but she's grown a tough skin. All her friends have -- or so they say. How else do you survive middle school? It's like this, Karyssa explains, as girls around her nod agreement. You're walking down the school hallway minding your own business, and -- Bam! -- the harassment starts. Karyssa Albrecht, 12, raises her hand to make a point about the effects of clique behavior during a weekly Girls RAP meeting at Hamilton Middle School, where her friend Samantha Acevedo, 14, lends support. And it's coming from other girls. "I think the favorite words in their vocabulary are ho, slut and, well, you know, 'female dog,'" says Karyssa, an eighth-grader at Seattle's Hamilton Middle School. "I wouldn't be able to walk down the halls (last year) without someone yelling that at me," she says. "Even in sixth grade that happened to me. So girls are just, like, really mean."
    Anyone over the age of 11 knows adolescence is a jungle. But scholars are taking a critical new look at the darker social dynamics of the "wonder years." First it was the playground bully. Now the buzz is about mean girls. This spring at least three new books sound an alarm over mean-spirited cliques and their tools of oppression, from shunning and name-calling to rumor-mongering. The official term is "relational aggression." "I have been getting crap from people, from girls, since first grade." -- Gabriela Antonino, 14
    "This is girlhood's dark, dirty secret," says Rachel Simmons, 27, author of "Odd Girl Out: The Hidden Culture of Aggression in Girls" (Harcourt, 296 pages, $25). Simmons, who interviewed several hundred girls in three regions of the country, found that behind-the-scenes aggression is "epidemic" among adolescent girls, especially ages 10 to 14.
    It's not that girls are evil trolls or have a mean gene. Rather, Simmons says girls -- especially white, middle-class girls -- face such a heavy cultural mandate to be "nice" that they have no approved outlet for anger or conflict. So they often take their aggression underground. "A lot of girls," says Simmons, "think the way to be nice is to be mean behind each other's back."
    And it's not just a handful of troublemakers, says Rosalind Wiseman, author of "Queen Bees & Wannabes" (Crown, 338 pages, $24). Her book, pitched squarely at parents, offers get-real tips and insights into a world that's largely hidden from adult view. She tells readers that power plays are deeply ingrained in the culture of what she calls Girl World, and their own sweet daughter may be one of the perps. "A lot of kids do really nasty things, and they're not mean kids," says Wiseman, who attributes the behavior to power-brokering within cliques. "What girls learn is to please the people in power. For the most part, they don't fight the system."
    Wiseman hopes to change that. As co-founder of a violence-prevention program called Empower, Wiseman, 33, has worked nationwide with thousands of girls and boys (yes, boys have cliques, too) in the past decade. Empower, based in Washington, D.C., grew out of Wiseman's own painful high school experience as the popular girlfriend of a physically abusive high school boy who was considered a cool catch. She thinks -- and other experts agree -- that many girls are being groomed for abusive relationships by the middle-school culture of rivalry and backstabbing, where dissent results in ostracism and abandonment. If nothing else, relational aggression undermines girls' sense of trust, because no one -- not even former friends -- will tell the victim why she is being shunned. "These girls," says Simmons, "are having lasting damage done to their self-esteem and probably lasting damage to their ability to form healthy relationships with girls and boys."
    Unable to express aggression openly, some girls turn it against themselves, says clinical psychologist Sharon Lamb, author of "The Secret Lives of Girls" (The Free Press, 255 pages, $24). She says the outcome can be depression, eating disorders and hyper self-criticism. "Girls," writes Lamb, "aggress against themselves."

Constant scrutiny
It's a Tuesday afternoon at Hamilton Middle School. Class is out, and the six teens who clock in to the weekly Girls RAP meeting are powering up on juice and chocolate pudding. They stretch and chatter and sprawl and dance in place to a private inner beat   From left, Samantha Acevedo, Angela Strong, Barbara White, Karyssa Albrecht and Gabriella Antonino listen during a recent Girls RAP meeting, a program created by the non-profit agency Powerful Voices, to enhance girls' success.
    Cliques? Mean stuff? Yeah, they know all about that. Barbara White, 15, who has the flinty, knowing manner of a young Jodie Foster, explains how boy meanness is different from girl meanness. "There's a big difference," she says. "Guys, when they're mean to each other, they're, like, making fun of each other and dissing each other's moms and stuff and play-wrestling. "Girls just spread nasty rumors. And they always think there's gotta be fighting. Everybody makes everything so much drama." "I think it takes longer for girls to cool down," says Samantha Acevedo, 14, a quiet, ponytailed girl in denim jacket and jeans. "Like, for example," Samantha says, "maybe two guys get in a fight and the next day they'll be cooled down. But girls, the next day they'll come to school and they'll still be at the same pace as they were before." Karyssa says girls don't settle their disputes one-on-one. They build alliances, which complicates and prolongs the disagreement. "With girls," Karyssa says, "they have to get their friends involved, and they have to get their friends involved."
    Respect is a big issue at Girls RAP, an after-school program, created by the non-profit agency Powerful Voices, to enhance girls' success. RAP stands for "Rights! Action! Power!" Offered at four Seattle middle schools, Girls RAP groups have 12 members -- most from different neighborhoods, ethnic groups and cliques. Few of them associate during the school day, so maintaining sisterhood within the group takes effort. Meetings open with the girls in a circle, hand in hand, uttering a one-word pledge: "Respect!"
    But that doesn't mean they find respect in the school corridors. Their clothes -- their bodies -- face constant scrutiny and critique from other students. And no one measures up. Samantha blames the pressure created by media images of the perfect bod, the cool clothes. But one of the others, a petite girl known as Gabi, cuts in. "So you have that stereotypical body -- and everybody hates you for it," she says bitterly. At 14, Gabi -- full name Gabriela Antonino -- has delicate good looks and a normal, shapely figure. Yet she derides herself as skinny because other kids call her anorexic or bulimic. "I eat more than a lot of people in here and I'm still skinny," Gabi says in frustration. "Some people threaten me all the time because I'm skinny." But another girl -- strikingly pretty and normal in every way -- gets called fat because she has curvy cheeks. "You can't win either way," Barbara and Samantha say in unison. "Really, if you think about it," adds Barbara, "none of us really like our bodies."

Power plays
Author Wiseman says it's not just media images that shred girls' self-esteem. Images create an ideal, but it's girls themselves who enforce the standards. That epiphany also has occurred to Ann Muno, program director for Girls RAP. She says it's not just a problem of boys harassing girls, or teachers ignoring girls, it's the girls themselves. "It just became immediately apparent," Muno says, "that what we're dealing with is the power of these relationships." On one hand, friendships are crucial to girls' ability to thrive in adolescence. Wiseman says that even cliques aren't inherently bad. "I think some of the most intense relationships girls are ever going to have is with those best-friends-for-life in sixth and seventh grade," Wiseman says. "That's where they learn intimacy."
    The problem comes when girls use friendships as tokens of power. The most popular girls, experts say, are those who most closely fit the stereotype of femininity -- just as the coolest guys fit the traditional masculine mold. The setup creates problems for both aggressor and victim. "Because 'nice' is a stereotype of what girls have been brought up to be," Wiseman says, "they sacrifice their personal boundaries because they don't want to be seen as confrontational."

Meanness hurts
"How many of you have been hurt by other girls?" Six hands shoot up at the Girls RAP meeting. It's unanimous. "How many of you have hurt other girls?" Five hands. Then a sixth creeps upward as Gabi says she spread a rumor once, but only to get back at a girl who threatened to beat her up. The girls project an air of world-weary indifference to the pain that changes hands daily. "I've been teased so many times," says Angela Strong, 13, "that, before, I used to go home and cry to my mom and I'd try to take revenge on them and get them in trouble. But I've gotten so used to it, it doesn't bug me anymore." "I've been teased in school since I was in fourth grade," says Barbara. "People have been saying that I'm a slut. It gets to me sometimes, but I won't let them see that." "I have been getting crap from people, from girls, since first grade," Gabi says in a flat, resigned tone. Karyssa, outwardly confident and clearly a leader, has an air of bravado about the rumors she has endured, the names she's been called. But deep down, it smarts. "It has bugged me a lot," Karyssa admits. "I have sat and kind of cried, 'Why would they do this to me?' 'Cause half the people that say stuff about me, I don't even know. Like the high school that I'm going to next year, there's this girl who hates my guts, and I've never met her."
    Most of these girls have heard of Dawn-Marie Wesley, a 14-year-old from a Vancouver, B.C., suburb who hanged herself with a dog leash in November 2000. Her suicide note said several girls, including at least one former friend, had threatened to kill her for spreading rumors. On March 28, a British Columbia court convicted one of the teen tormentors of criminal harassment. Another girl was acquitted and a third awaits trial. Barbara says she can relate to Dawn-Marie's ordeal. "I completely understand what this girl was going through," she says, as other girls murmur agreement.
    But they express startlingly little faith in their parents' ability to grasp their own social pressures. "I think sometimes parents don't take our problems seriously," Gabi says. "My mom will be like, 'Oh, you'll get over it.'" "That's why a lot of kids go to the counselor -- because a lot of parents don't listen," says Renee Washington, a seventh-grader. "It's like, if you didn't want to have the responsibility of kids coming home and saying stuff to you," says Renee, "then you shouldn't have had kids in the first place."

Clear behavior rules needed
Listening is the first step, but it's not enough, experts say. Girls must learn to decipher clique behavior and the assumptions about femininity that drive them. Muno says it's about "holding up mirrors" and helping girls develop new skills in working with girls, "coupled with different expectations of what it takes to be powerful." Ideally, experts say, girls should be taught how to handle conflicts on their own. Renee agrees. A strong, formidable teen, she now discourages friends from trying to enlist her as a bodyguard or enforcer when someone threatens to beat them up. "I won't do it," Renee says. "I'm like, 'You've got to handle it on your own.' It's like, 'I'm not the one who's always going to be the protector.'"
    Simmons, the "Odd Girl Out" author, says schools must create clear rules about social aggression. Yet -- despite their own travails -- the Hamilton Girls RAP teens are cool to the idea. How would you enforce the rules? How would it change anything? The mean girls still wouldn't like you, they object. "I'm not saying you expel kids for rolling their eyes at each other," Simmons responds. "But there need to be deterrents. "Kids think they can get away with this. And they're right."

How parents can help
In an ideal world, schools and parents would work together to reverse the culture of girls' social aggression. As author Rachel Simmons says, "The peer culture is its own universe with its own rules, and it's a powerful subculture. We really need all the resources available to change it." But parents can do a lot on their own. Here are tips from Simmons, author Rosalind Wiseman and others.
* Listen, just listen, when your daughter spills her frustration about social disputes.
* Get the whole story. Kids tend to give information in bits and pieces and often omit their own contribution to the problem. So don't go off half-cocked (especially to the other girl's parents).
* Acknowledge your own daughters' potential for mean behavior. Even the nicest girls get caught up in social intrigue.
* Hold her accountable if she messes up, but affirm your love for her. Girls say the worst punishment is to lose their parents' respect. (But ground her anyway.)
* Beware of conference-call capacity, a common tool of manipulative sneak attacks. Here, the caller coaxes a girl to state her candid opinion of a mutual friend, while secretly inviting the friend to listen in. These engineered betrayals are designed to turn friends against each other.
* Model good social behavior. Don't gossip or backstab.
* Help your daughter analyze clique dynamics and encourage aspirations beyond cute clothes and hairstyles. (But don't create another impossible ideal. If she likes Seventeen magazine and occasionally says she's fat, don't freak.)
* If your daughter is a non-starter as Miss Popularity, take heart. The social fringe can be a haven from the relentless pressure to conform.
* Realize that girls sometimes say they're fat (or ugly, etc.) to avoid appearing conceited, a big sin in Girl World. Yet the rules require that they heap on compliments when their best friend puts herself down.
* Watch your language. The word "cliques" makes girls defensive. Keep any discussion of social groups neutral and distant, focusing on girls' social groups in general, not on your daughter and her friends.

Supreme Court to Rule on Sex Offense Law
Associated Press, 5/21/2002

W A S H I N G T O N— The Supreme Court agreed Monday to consider a constitutional challenge to some registries of known sex offenders, the second case the court will hear involving lists meant to keep tabs on potentially dangerous sex criminals. The court said it will hear an appeal from Connecticut, where a federal judge struck down the state's sex offender registry last year. The judge found that the law violated the constitutional rights of past offenders, because their names were placed on the list without a chance to prove they are no longer dangerous to society. The New York-based 2nd U.S. Circuit Court of Appeals agreed, and the registry is no longer publicly available.
    The case could affect more than 20 states with similar laws requiring community notification based on the offender's record rather than an individual evaluation of his or her current likelihood to repeat the crime. A high court ruling against Connecticut could force states to hold separate hearings for sex criminals to assess whether their names, addresses or other identifying information will be made public.
    All states have laws requiring some kind of list of sex criminals, but some provide the public with names of only those offenders deemed dangerous. Still other states have hybrid laws, making the names public in the cases of serious sex crimes, but taking a case-by-case approach when the crime is considered less egregious. The registry laws are usually called Megan's law, after Megan Kanka, a New Jersey girl raped and killed in 1994 by a neighbor who was a convicted sex offender. Her parents didn't know his history when he moved in across the street. The registries take conviction records already publicly available through police or court records, and compile them in one place. Information on Connecticut sex offenders is still publicly available on the old piecemeal basis.
    The Bush administration backed Connecticut in asking the Supreme Court to step in. "Megan's laws serve vital government interests by assisting law enforcement and enabling American communities to better protect themselves, and in particular their children," the administration's top Supreme Court lawyer wrote in court papers. Solicitor General Theodore Olson noted that federal law requires states to have a registry, or face a reduction in federal funding. Twenty-three states and the District of Columbia also filed a friend-of-the-court brief backing Connecticut. The Supreme Court will hear the case in the term that begins next fall.
    The court will also hear a separate constitutional challenge to laws in about a dozen states that publish names, addresses or other personal information about convicted sex offenders on the Internet. The question in that case is whether such publicly available lists, which include names of people who long ago served their sentences, amount to unconstitutional double punishment for the same crime.
    Connecticut's registry was also available over the Internet, but that factor was not the key to the case the high court agreed to hear Monday. The registry was created in 1998 and operated by state police. Users could search by town for lists of resident sex offenders. It listed the names, addresses and, in most cases, pictures of nearly 2,100 offenders. The Web site received 150,000 hits per month, state police said. Two anonymous sex offenders sued the state, claiming they are no longer a danger to society and should not be stigmatized. The men claimed the registry violated their constitutional right to fair treatment in the courts by denying them a chance to keep their names off the list.
    According to the Justice Department, laws similar to Connecticut's are in force in: Alabama; Delaware; the District of Columbia; Florida; Georgia; Illinois; Indiana; Louisiana; Maryland; Michigan; Mississippi; Missouri; New Mexico; North Carolina; Oklahoma; South Carolina; Tennessee; Texas; Utah; Virginia; West Virginia and Wisconsin. The case is Connecticut Department of Public Safety v. John Doe, 01-1231.

Suicide Prevention Under Review Following Priest's Death
Stephen Manning, Associated Press- 5/21/2002

LANHAM, Md. -- A psychiatric institution that specializes in treating Roman Catholic clergy accused of sexual abuse is tightening suicide prevention methods after a priest hanged himself there last week. The suicide of the Rev. Alfred Bietighofer, who was found Thursday in his dormitory room at St. Luke Institute, was the first at the suburban Washington center in its 25-year history. ''We were caught off guard,'' the Rev. Stephen J. Rossetti, the institute director, said Monday. ''In this current crisis there is a particular need to be more vigilant.''
    St. Luke is one of a handful of centers in North America that specialize in treating clergy for sexual disorders and other psychiatric conditions. Officials at the centers say recent public attention on sexual abuse among the clergy has put more pressure on patients already suffering from great shame and often depression.
    The Southdown Institute in Ontario, Canada, said it began changing procedures six months ago, including more frequent room checks for priests who may be at risk. ''I think we are all on alert concerning the fragility of the population we are treating,'' said Dr. Donna Markham, Southdown's president.
    Rossetti said changes at St. Luke will likely include aggressive monitoring of any priests facing child abuse allegations, even if they deny suicidal tendencies. At-risk priests have frequent check-ins with institute staff and are kept away from instruments that could be used to commit suicide, Rossetti said.
    Bietighofer, 64, was at St. Luke for evaluation after two men accused him of sexually abusing them in the 1970s and early 1980s. Police and the institute have revealed little about why Bietighofer killed himself, citing patient privacy. But psychologists say the entire priesthood faces tremendous public scrutiny in the wake of widespread allegations of abuse and cover-ups by church authorities. ''We tend not to think of what it is like for the accused individual,'' said Dr. Fred Berlin, a sexual disorders expert at Johns Hopkins University School of Medicine and a former St. Luke board member. ''They face the prospect of their reputation being besmirched, losing their livelihood or even being incarcerated,'' he said.
    Suicides for any reason are rare among the priesthood, said A.W. Richard Sipe, a psychologist and former priest who studies sexuality in the church. Bietighofer's was the first he knew of at a religious treatment center. Last month, the Rev. Don Rooney, 48, of the Cleveland Diocese shot himself to death after being accused of molesting a girl. In Ireland, the Rev. Sean Fortune committed suicide in 1999 while facing 66 counts of molesting and raping teen-age boys.

Challenges for Gay Teens and Seniors
ABC News, 5/21/2002

When Charlotte Haas was a young woman in the 1950s, there were no activists in the streets to encourage her or support her if she decided to disclose that she was a lesbian. So, Haas did what a lot of gay people did a generation ago. She kept it quiet, fought it, and found herself living a heterosexual life that never felt quite right. If Haas were a young lesbian today, she would find a world that's far more open and tolerant of homosexuality. But she might still encounter hostility — from classmates who are encountering gay people for the first time, from parents unable to adjust to a child's sexual difference, and from clergy who interpret God's word as opposing homosexuality.
    Looking at people, young and old, who identify themselves as homosexual raises familiar questions. Is being gay a lifestyle choice, a genetic predisposition, a sin? Is it a matter of choice? There's very little agreement about homosexuality in straight America. Men, women and teens who are living openly gay lives have wrestled with these questions themselves. And they've had just as much difficulty arriving at a satisfying answer. The only agreement is that the presence of openly gay people has grown in the United States. In 1983, 24 percent of Americans said they had a gay friend or acquaintance, according to a Gallup poll. That percentage soared to 62 percent in 2000, according to a survey by the Kaiser Family Foundation.

Once Upon a Time
    Haas describes her past life as the epitome of what many Americans want. "I had everything that was the American Dream," she says. "I had a lovely home, a cottage in the woods, two children, a good husband who provided well. But I wasn't really happy and I thought, 'Well, I can make the choice. I'll just forget about this feeling I have, and it'll go away.' But it didn't."
    Haas' story reflects just how much people struggle to accept their sexuality when their society tells them it's unacceptable. Like many lesbians and gays of her generation, Haas gradually came to believe that she had no choice about her sexuality. Her choice was whether she could live with it or not. About 88 percent of the lesbian, gay and bisexual community believes that sexual orientation cannot be changed. But only about 38 percent of the general public believes that to be true, according to the Kaiser survey.
    But life is different now for Haas. A retired high school teacher, Haas is living with her lesbian partner of nine years, Pam Wilson, in the nation's first all-gay retirement community, the Palms of Manasota, near Bradenton, Fla. Haas and Wilson moved to the Palms from a "straight" retirement community, where they still felt pressure to keep their relationship hidden. Haas says she and Wilson were always asked, "'Where's your husband?' or 'Why aren't you married?' "
    Like Haas, Wilson also had been married and raised children. Admitting her homosexuality was no easy task. "I felt very guilty for hurting my family, my husband. I felt like I should have never married, and I felt like I hurt my children," Wilson says. Now, Haas and Wilson are grateful to be able to display simple affection for each other without meeting awkward stares or unkind comments. "We walk around holding hands, and no one is going to look cross-eyed at us," Haas says. Wilson adds, "We can hug each other in public."

The Consequences of Coming Out
The retirees at the Palms are among the estimated 1 million to 3 million elderly Americans who are gay, lesbian, bisexual or transgender. Studies project this population will rise to between 4 million and 6 million in 2030. And Randy Rudder, a teenager in Roanoke, Va., may be among that population. It took the residents of the Palms literally a lifetime to "come out," but Rudder and many of his peers are confronting their homosexuality in their adolescence. And the decision to do so comes at a price. Rudder dropped out of high school in his senior year. "I was faced with harassment by different students at school and I just got tired of it basically and I had to stop going," he says.
    Rhonda Chattin, now 28, also dropped out of school. When she came out, her mother offered to give her all the help she needed. But by help her mother meant help to get rid of her interest in homosexuality. Chattin's mother saw homosexuality as a matter of choice. Chattin didn't, and her mother eventually rejected her. When Chattin came home from a date when she was 19, her mother told her to pack her bags. Two police officers escorted her out of the house. Chattin says she and her mother have since patched up their relationship. "Parents go through the same coming-out process as their child does. And sometimes they get the same result of acceptance as a homosexual does. They go through the denial and anger," says Chattin.

Parents and Religion
Chattin now works with kids dealing with their own homosexuality, and says the toughest issues kids face stem from their parents and religion. Christianity calls it an "abomination." Abdulmubdee Shakir, a Muslim cleric in Roanoke, says homosexuality "is an evil and we cannot tolerate it." The most tolerant response among Christian leaders appears to be the "love the sinner, hate the sin" approach. This would grant acceptance to homosexuals in their community — as long as they remain celibate.
    Stephen Brown, another Roanoke teen who came out, says his parents' strong Christian beliefs made it impossible for them to accept him. "My parents now are like, 'Maybe you're just mentally ill. You're going to get over it.' … 'Well, maybe you have a demon. We'll cast it out of you.' I don't think that's going to happen," Brown says.

A Public Face of Gay America
When Americans describe homosexuals as "outrageous," "deviant," or "confrontational," they may get their impression from gay pride parades, where flamboyant costumes and groups with names like "Dykes on Bikes" are cheered. Events like this may give Middle America the impression that homosexuality is a lifestyle of excess.
    But the retirees at the Palms and the teens in Roanoke don't bear that out. Charles Showard, 80, bristles when speaking of these in-your-face activists. "It gives the gay community a bad name," he says. "And for gays to go out in public and make a public display of that sort, to me, is rather vulgar and demeaning against the gay community."
    Billy Bruce Wagener, a retired college professor who lives at the Palms, had a different reaction when he went to a gay pride event. "Here are people who are saying, 'I am.' I was, I was in tears," Wagener says. "I stood on the sidewalk and cried, because I kept saying I couldn't have done that when I was growing up, and I wanted so much to get out there and walk, yeah, with the first three rows. Even though I wasn't dressed for it."