Study: Men and Marriage
Lee Dye, ABC News- 8/14/2002

Men are waiting longer and longer for that first trip to the altar, and researchers at Rutgers University say they have figured out why. Men don't need to get married to get what they want these days — mainly sex — so they feel comfortable in putting off that long term commitment until they have a few bucks in the bank, and a mortgage to pay off. Those are among the conclusions in the latest annual report issued by the National Marriage Project at Rutgers, a long term research program aimed at understanding why marriage has declined in this country by one third since 1970.

More Mature — and Stubborn
Men are now waiting on average until the age of 27 to marry, compared to 25 for women, but that doesn't mean they are against marriage as an institution, according to the co-directors of the project, David Popenoe, a behavioral scientist and professor of sociology at Rutgers, and Barbara Dafoe Whitehead, a marriage expert. Men, they conclude, just aren't in any hurry. "The good news is that men who marry later may be more financially stable and emotionally mature," says Popenoe. The bad news is they may be so set in their ways that they are lousy at making the compromises that help a marriage get over the rough spots.
    The researchers conducted eight meetings with 60 "not-yet-married" men in northern New Jersey, Chicago, Washington, D.C., and Houston. The men were ages 25 to 33, and none of them were gay. The researchers note that most people think it's men, not women, who are "dragging their feet about marriage," and they state "our investigation of male attitudes indicates that there is evidence to support this popular view." The primary reason given by men for taking their sweet time: They can get sex without marriage more easily now than in the past. And they aren't all that interested in having children anytime soon, which is of concern to the researchers because the biological clock is clicking on the women they will someday expect to mother their kids.
    Many of the conclusions won't come as much of a surprise to anyone who has observed the current state of mating rituals. When men pick up a girl in a bar, for example, they aren't looking for a long-term partner. A one night stand is more likely on their minds. The participants also indicated that they want a woman who is able to take care of herself, which is somewhat of a reversal from the macho old world attitudes of just a generation or two ago. But here's a conclusion that is right out of the age of romantic novels:

What Men What
"Most of the men in these groups want to marry at some future time in their lives," the researchers conclude. "They expect their marriages to last a lifetime. Like the majority of young adults today, they are seeking a `soul mate."' But all that can wait. There doesn't seem to be anyone pushing them toward the altar anyway. "Today's young men encounter few, if any, traditional pressures from religion, employers or society to marry," the researchers state, although they do get a bit of ribbing from parents who want grandchildren and colleagues who have already made that trip to the altar. One area that concerns many men, according to the research, is the fear of failure. They see friends who are too willing to give up at the first sign of disharmony, and there's no question that marriage is not an easy institution to maintain.
    The researchers believe marriage has a much better chance of surviving if both partners expect it to last a lifetime. Attitude at the opening gun seems to be very important. But here's a line from the report that is worth pondering: "Men see marriage as a final step in a prolonged process of growing up." Not surprisingly, some of the guys who participated in the project are still living with their parents.

Top 10 List
For the record, here are the 10 top reasons why men are "slow to commit:"
1. They can get sex without marriage more easily than in times past.
2. They can enjoy the benefits of having a wife by cohabiting rather than marrying.
3. They want to avoid divorce and its financial risks.
4. They want to wait until they are older to have children.
5. They fear that marriage will require too many changes and compromises.
6. They are waiting for the perfect soul mate, and she hasn't yet appeared.
7. They face few social pressures to marry.
8. They are reluctant to marry a woman who already has children.
9. They want to own a house before they get a wife.
10. They want to enjoy single life as long as they can.

Cuts in Michigan Mental Health Care Worry Staff, Patients
Emilia Askari, Detroit Free Press- 8/16/2002

Diagnosed with a mood disorder related to schizophrenia, Roberta Davis, a 32-year-old former nurse sometimes hears imaginary voices. She has attempted suicide 10 times and spent several months in a state mental hospital before being discharged three years ago. Now, as change sweeps through the state's programs for the uninsured mentally ill, Davis and others like her say they feel as if their lives are crumbling. She worries that her clubhouse with activities for people with mental illness may close or that she may no longer be able to buy her medicines, which cost almost $900 a month, as a result of funding cuts.
    Government-funded services for people with mental problems have endured budget cuts before. But this summer has been the worst, especially in Wayne County, home to more than half of the Michiganders who use tax-supported programs for the mentally ill or developmentally disabled, according to many state mental health service providers. Ten percent or about $50 million of Wayne County's budget for the uninsured mentally ill has been cut this year. The agency operates on an annual budget of more than half a billion dollars.
    The budget showdown comes to a head today, when state officials plan to visit Wayne County and make a recommendation on whether the current bureaucracy that delivers mental health services here will continue or be replaced by a private business. A state committee, called the Specialty Services Board, will vote on the recommendation Aug. 27.
    In the meantime, people like Davis are left wondering. "I don't think there's going to be enough money for us," Davis said earlier this month as she sat in a clubhouse office where she specializes in writing letters to public officials. "This is where I get my sense of accomplishment, my sense of responsibility and community. If I didn't have the support of the clubhouse, I probably would wind up in the hospital again."
    Michigan's struggle to reform financing of services for the uninsured mentally ill and developmentally disabled is mirrored in other states across the country. The sluggish economy has dealt many states the most severe revenue shortfalls since the early 1990s. Regulators nationwide are cutting budgets -- and they're taking an especially hard look at mental health and prescription drugs for the uninsured -- two areas that have helped fuel a rapid increase in state Medicaid costs over the past few years.
    In Wayne County, administrators are trying a particularly dramatic change: they're setting up health maintenance organizations for the uninsured mentally ill and developmentally disabled. If it works, it could serve as a model for the rest of the country, advocates say. But critics say that the cuts and administrative changes are making it harder for people with mental problems to get help quickly. Many clients and families of people with mental illness and developmental disabilities complain that cuts are only shifting the burden of care for the mentally ill from hospitals and community-based counselors to prisons.
    They point to the case of Ronald Alexander, a 57-year-old man prone to walking in the middle of the street and talking to the sky. His family tried to get him treated by psychiatrists at Riverside Hospital, but Alexander was discharged to the Cadillac Nursing home in Detroit. There, prosecutors say, he hit two other residents, inflicting fatal injuries. Alexander is now in jail awaiting trail on homicide charges. "If they had treated him for his mental problems," his estranged wife, Gloria Alexander said recently, "maybe this wouldn't have happened." It's an argument even some state lawmakers back.

Uncertainty is certain
"People who are depressive, suicidal and homicidal are turned away from state psychiatric hospitals," said state Rep. Virg Bernero, a Lansing Democrat who has a schizophrenic brother and takes a special legislative interest in mental health issues. "It's outrageous. These folks can lead productive lives. They have something to contribute. But they need help."
    Across Michigan, uncertainty over the long-term future of the safety net for the mentally ill is prompting many career counselors and social workers to seek other employment. At Community Living Services, a nonprofit that provides services to people with developmental disabilities in Wayne County, about 25 percent of the staff is new since this spring. The entire staff of the agency took a 20-percent 1-month pay cut in May, said Jim Dehem, the agency's president and chief executive officer. In the suburbs, the Macomb-Oakland Regional Center, which provides mental health services to 4,500 people, has had to cut its budget by $1 million a month since spring.
    Staff turmoil means fewer and fewer mentally ill Michiganders using public services receive consistent counseling from the same person -- a key element in mental therapy. Things such as transportation services that used to ensure that mentally ill clients arrived for their counseling sessions have been slashed, leaving increasing numbers of mentally ill people to navigate the bus system alone or skip their appointments with counselors altogether.
    Some programs have been cut completely, including one that brought counselors to students at risk of dropping out of several Detroit middle schools. Another program that administrators fear may not weather the impending changes helps mothers like Lorena Gutierrez, who are having trouble bonding with their babies. After meeting once or twice a week for the past few months with a counselor, Gutierrez said her relationship with her 1-year-old son, Maximiliano, has changed completely. "Now, sometimes when I'm away from him I'll come home early just to be with him," she said recently as she chatted with her counselor on the porch of her southwest Detroit home.

A renewed crisis
The latest crisis in mental health funding started this spring, when state officials announced they wanted to completely revamp the bureaucracy that funnels millions of dollars annually to county community mental health boards. These boards contract with a variety of nonprofit agencies to deliver a wide range of services to uninsured people who are mentally ill or developmentally disabled. State officials required that the community mental health boards serving each county reapply for the right to serve as the local funnel for government money for the mentally ill.
    Agencies serving several counties -- Monroe, Manistee and Benzie, for example -- decided they will close, handing over management of their clients to bureaucrats in adjacent counties. The state accepted the applications of most other county community health boards, ensuring that services would continue, although at a reduced funding level.
    Scrambling to increase efficiency, Wayne County officials have created six competing mental health HMOs for uninsured Wayne County residents with emotional or developmental problems. Under a new system called Your Choice, each person with mental illness or a developmental disability will choose to affiliate with one of the six new HMOs. The organizations will be paid a fee for each client that will be based on the client's past need for services.
    Lots of details remain to be worked out, but Patti Kukula, interim director of the Detroit-Wayne County Community Mental Health Board, is confident that the system will work. She said she thinks that today's visitors from the state department of community health will agree, giving the green light to the HMO plan and forgetting about their threatened privatization of mental health services in the county. Kukula's optimism was buoyed earlier this month when the department gave the Detroit-Wayne board $800,000 in grants for new services, including special mental health programs for Native Americans and the deaf. "We're just gunning as if this thing is going to happen," she said.

 Eating Disorders Rooted in Childhood
Janice Billingsley, ABC News- 8/16/2002

As early as age 11, girls are more worried than boys about their weight. Even worse, while boys shed their concerns about being overweight as they mature, girls become more even more worried that they're too fat, new research shows.
    The study looked at more than 2,000 students in Glasgow, Scotland, at ages 11, 13 and 15. The researchers found the percentage of boys worried about being overweight dropped from 30 percent to 23 percent from the ages of 11 to 15. Meanwhile, the percentage of girls worried about their weight jumped from 40 percent to 70 percent over the same period.
    Yet during this time, the prevalence of being overweight among all the students went up only one percentage point. "People have known this anecdotally, but it is interesting to see it in the data," says University of Glasgow researcher Helen Sweeting, lead author of the study. "And to have tracked so many children through three ages adds weight to the results." The study appears in today's issue of the Journal of Epidemiology and Community Health.
    "This seems to be a significant validation of previous, smaller studies on attitudes towards weight," adds Connie Diekman, head of the nutrition department at Washington University in St. Louis, who treats college women with eating disorders. "It is clear that the college women exhibit effects of eating disorders that started well before they came here," Diekman says. "This study provides a lot of insight to see how their processes of thought begin."
    For the study, the researchers used data from a large health survey of schoolchildren in the Glasgow area. School nurses examined the students at ages 11, 13 and 15 to determine their body mass index (BMI), a measure of body fat based on height and weight. The children also filled out questionnaires that asked them if they were worried about putting on weight and if they were on a diet.
    Predictably, the average BMIs increased as the children got older. The girls' BMIs increased slightly more than the boys' because girls gain more fat during adolescence. However, the girls' worries about weight mushroomed while the boys' concerns diminished. At age 11, for instance, 30 percent of both boys and girls who were overweight said they were dieting. But by age 15, only 16 percent of the overweight boys were on a diet, while 48 percent of the overweight girls were dieting. Similarly, even those girls in the "medium-weight" brackets were much more likely to be dieting than the boys as they got older. At age 11, 8 percent of medium-weight girls were on diets, while 4 percent of medium-weight boys reported dieting. By age 15, 26 percent of medium-weight girls were on diets, compared to only 3 percent of medium-weight boys.
    Sweeting says the data show the need for more education about appropriate weights, especially for girls. "I wonder if we've lost sight of what's OK, and what's normal for weight," she says. "Girls need to get the message as to what's healthy. They do need more body fat than boys. It's important," agrees Diekman, who's also a spokeswoman for the American Dietetic Association.

Pot Is Easy To Find and Buy, Teens Say
Detroit Free Press, 8/21/2002

WASHINGTON -- Teenagers say marijuana is easier to buy than cigarettes or beer -- one in three say they can find it in a matter of hours -- but only 25 percent say they've tried it, according to a national survey released Tuesday. When the National Center on Addiction and Substance Abuse polled 1,000 teens ages 12-17 last winter, 27 percent said they could buy marijuana in an hour or less; another 8 percent said it would take a few hours. For the first time since the study began in 1996, marijuana edged out cigarettes and beer as the easiest drug for teens to buy. It was also the first time that most teens reported their schools being drug free: 63 percent said there were no drugs at the schools they attended.
    In 2000, 45 percent gave that response. No survey was taken in 2001. The survey didn't specify whether drugs were easy or difficult to buy at school. Student drug use has been dropping for the past four or five years because communities have begun financing antidrug programs, said Gerald Tirozzi, executive director of the National Association of Secondary School Principals. More than half of students surveyed said they don't drink alcohol in a typical week, and nearly as many said they have never had a drink. While one in four students said at least one parent smokes cigarettes, 69 percent said they have never smoked.
    The survey also found that:
* 8 percent of students said there's a teacher at their school who uses illegal drugs.
* 55 percent said they'd report someone they saw using drugs at school.
* 56 percent said they'd report someone they saw selling drugs at school, the highest level since 1996.
* 24 percent said drugs are the most important problem facing people their age, highest among several problems such as crime, peer pressure,
sexuality and the environment.
    The survey had a 3.1-percentage point margin of error.

Mental Impairment Key to California Verdict
Stacy Finz, San Francisco Chronicle- 8/21/2002

Was Cary Stayner too mentally impaired to plan the murders of three Yosemite tourists, or was he an organized killer living out his longtime sexual fantasies of death and torture? That's the question that the jury in Stayner's triple-murder trial in San Jose will soon be mulling over. After six weeks of viewing boxes of evidence and listening to hours of testimony -- including dueling psychiatric experts and Stayner's recorded confession -- the panel of nine men and three women is expected to begin deliberations in the guilt phase of the trial this week.
    "These are terrible charges," defense attorney Marcia Morrissey acknowledged to the jury on Tuesday. "These are terrible crimes. . . . Cary Stayner killed these women. And it is very hard not to be overwhelmed by these deaths." She then asked the jurors, who range from a truck driver to a social worker, to try to put aside their emotions and carefully weigh the evidence in the case. "The question is whether his brain -- his reasoning ability -- was so damaged, so impaired that he didn't form the mental state that is required for the crimes that are charged."
    But lead prosecutor George Williamson argued that Stayner isn't mentally impaired, but instead is cunning like a fox. He said the defendant had premeditated the killings and later given FBI agents a "blow by blow" description of how he had carried out his crimes. Morrissey and Williamson spent much of Tuesday afternoon making their closing arguments and are expected to finish sometime today. Relatives of the victims sat elbow to elbow in the first few rows of the San Jose courtroom, relieved that the ordeal that began for them in early 1999 may soon be coming to an end. Stayner's relatives have not attended any of the proceedings, but they are listed as potential witnesses if the case goes to a penalty phase.
    Dressed in an olive green button-down shirt and a pair of khakis, Stayner quietly sat, wedged between his two attorneys. He has pleaded not guilty by reason of insanity. Defense psychiatrists and psychologists testified that Stayner's brain is damaged and that he suffers from a variety of mental disorders, including depression, obsessive-compulsive disorder and pedophilia. Stayner's attorneys say that from the time he was a small boy he has been plagued by violent fantasies. By 1995, they claim, he was having trouble controlling the morbid daydreams and had to be rushed from work, where he was suffering a break down, to the emergency room of a Merced hospital. In February 1999 -- when he killed Carole Sund, 42, her 15-year-old daughter, Juli, and their 16-year-old friend Silvina Pelosso at the Cedar Lodge, outside Yosemite National Park -- the violent images had all but taken over. Stayner, according to Morrissey, was having difficulties distinguishing between reality and fantasy.
    Williamson described a different picture of the 41-year-old defendant. He said not only did Stayner have the capacity to plan the killings by preparing a so-called "killing kit," complete with gun, rope, knife and duct tape, but he preyed on those most vulnerable. He also, according to Williamson, had the foresight to clean up the murder scene and leave misleading evidence to throw off investigators. "This isn't some rabid, delusional, frenzied guy," the prosecutor said. "He's organized. He's in control."
    Williamson called for the jurors to return first-degree murder verdicts for all three victims as well as find him guilty on six special circumstance counts. Those charges include: murder while committing a burglary, while committing a sexual assault, while committing a kidnapping and while committing a robbery. Any one of the special circumstances, if proved, would make Stayner eligible for a death sentence. "There's no other rational conclusion you can draw from this one," Williamson said. "You got it straight out of the defendant's mouth. We don't need an interpretation by some psychiatrist or psychologist trying to spin this thing. We don't need a PET (positron emission tomography) scan to tell us. He told us. We don't need any Rorschack. He tells us."
    Jurors will be instructed that if they don't find that Stayner planned and premeditated his attacks, they could return a lesser verdict of second-degree murder. If they convict him of either first- or second-degree murder, there will be a sanity phase in the trial. At that time the defense will attempt to prove that Stayner was insane at the time of the killings and didn't know right from wrong. If the jurors find him guilty of first-degree murder with a special circumstance and find him sane, there will be a penalty phase. During that part of the trial, jurors would decide whether to send Stayner to prison for the rest of his life or to San Quentin's death row.

Key players in Stayner trial
-- The victims: Carole Sund, 42, her 15-year-old daughter, Juli, and their friend, 16-year-old Silvina Pelosso, who was visiting from Argentina. The three traveled from the Sund home in Eureka to vacation at Yosemite National Park. Authorities say they were killed between the night of Feb. 15, 1999, and the morning of Feb. 16, 1999, while staying at the Cedar Lodge near the park.
-- The defense team: Marcia Morrissey, a private Los Angeles lawyer who specializes in death penalty cases, was appointed by the court to represent Stayner. Michael Burt, a San Francisco deputy public defender, was also court- appointed.
-- The prosecutors: George Williamson, a Solano County deputy district attorney and an expert in prosecuting death penalty cases, is on loan to Mariposa County. Michael Canzoneri, a supervising deputy state attorney general who specializes in homicide cases, is also on loan to Mariposa County. Kim Fletcher, a Mariposa County assistant district attorney.
-- The judge: Thomas C. Hastings, Santa Clara County Superior Court judge who came out of retirement to preside over the case. He has presided over several high-profile murder cases, including Richard Allen Davis, who was convicted of killing Polly Klaas.-- The Sund family members: Jens Sund, Carole's husband and Juli's father, has been attending the trial in San Jose. Carole Sund's parents and Juli's grandparents, Francis and Carole Carrington, have temporarily moved from Eureka to the South Bay to attend the trial. If the case moves to a penalty phase, all three are expected to testify for the prosecution.
-- Silvina's family members: Raquel and Jose "Pepe" Pelosso have moved from their ranch in Las Varillas, Argentina, and taken up temporary residence in the Bay Area to attend the trial. They are expected to testify if the case moves to a penalty phase.
-- The defendant: Cary Stayner, a 41-year-old former handyman at the Cedar Lodge and the older brother of Steven Stayner, who was abducted in 1972 and held hostage for seven years before escaping and returning home. Cary Stayner is currently serving a life sentence for the murder of Joie Armstrong, a 26- year-old Yosemite naturalist, in July 1999.

Michigan Sex-Offender Registry to Open
Associated Press, 8/21/2002

LANSING, Mich. -- The public will once again have access to Michigan's sex offender registry under a ruling issued Wednesday by a federal appeals court. Michigan's registry, which was made public through the Internet in 1999, gives people the names and addresses of convicted sex offenders. The registry had been unavailable to the public since June 3, when U.S. District Judge Victoria Roberts ruled it was unconstitutional in a case involving a convicted sex offender who wants his name off the list. Roberts later amended her decision to allow police to maintain a sex offender registry. But that decision still kept it closed to the public. The 6th U.S. Circuit Court of Appeals overturned Roberts' ruling Wednesday, saying the registry should remain public while it considers the case. The court said the harm that could be caused by keeping the site closed outweighed any harm that might be caused to the defendant.
    On the Net: Michigan's sex offender registry, http://www.mipsor.state.mi.us

 A New View on Youth Violence
Anand Vaishnav, Boston Globe- 8/22/2002

A seven-year study of several hundred Springfield children challenges the notion that youth violence has strong roots in poverty, gender, and race, pointing instead to such factors as excessively violent households and painfully shy behavior. The study released yesterday by professors at the Harvard Graduate School of Education and Brandeis University suggests statistically what people know intuitively: The amount of aggression children witness in their parents -- from ''smacking kids on the bottom to beating them up, from people yelling at each other to physical fights'' -- is a powerful predictor of how violent the children will become, said author Kurt W. Fischer, a professor of education and human development at Harvard. That doesn't mean that every sibling spat or parental disagreement will automatically breed thugs. But Fischer, who conducted the study with Brandeis University psychology professor Malcolm W. Watson, said constant violence at home shows up in children later in life.
    ''Anything beyond an occasional swat on the bottom is a problem,'' said Fischer, who directs the Mind, Brain, and Education program at Harvard. ''We all have tempers, we all can lose it, and we need to figure out what we're going to do when we lose it - so when that circumstance happens, we know how to walk away or do something else other than beating up our kids, grabbing them by the throat, twisting their arms, hitting them.
    In a related finding that baffled some specialists, Fischer and Watson also uncovered a much smaller connection between child violence and family income, race, or gender. Previous studies have shown that boys are more violent than girls, that children raised in poor neighborhoods are more likely to exhibit violent tendencies. Fischer said it's a matter of degree: Boys and girls might show the same level of problem behavior, though the kinds of crimes they commit are different.
    Howard Spivak, a professor of pediatrics at Tufts University School of Medicine who has studied aggression in children, found it ''perplexing'' that the study found few links between socioeconomic status and youth violence. ''That's not necessarily consistent with the work of many other people,'' said Spivak, director of the Tufts University Center for Children. ''And that depends on what other things they controlled for and how large their subgroups are. ... It certainly raises questions that deserve further study.'' Fischer and Watson also found that alienated children are more likely to bottle up their resentment until it explodes in violence, such as the perpetrators of school shootings.
    Through five years of interviews and visits, researchers studied 440 Springfield children ages 7 to 13. There were equal numbers of boys, girls, whites, blacks, and Latinos, and equal numbers of income levels. The National Institute of Child Health and Human Development financed the study. The research shows the need for better parenting techniques and for closer, earlier monitoring of children, said Edward De Vos, director of the Center for Violence and Injury Prevention at Education Development Center Inc., a Newton-based nonprofit education and health organization. ''The emphasis on family and exposure to violence in the home speaks to where much of the emphasis needs to be ...'' De Vos said. ''It speaks to the importance of early prevention and intervention.''

Michigan Mental Health Agency Rebuilds
Emilia Askari, Detroit Free Press- 8/22/2002

Buoyed by a successful visit from state regulators last week, mental health officials in Wayne County are anticipating a vote of approval Tuesday from a state panel that oversees government health contracts. Earlier this year, state officials had talked of closing the troubled Detroit-Wayne Community Mental Health Board. However, interim director Patti Kukula appears to have saved the 35-year-old agency that serves 46,000 mentally ill and developmentally disabled people. Most are uninsured.
    Kukula said she was ecstatic to learn this week that U.S. Health and Human Services Secretary Tommy Thompson has written to the nation's governors urging them to create agencies similar to health maintenance organizations like those created in Wayne County for people with disabilities. Wayne County's new system, is being touted as a model for public mental health care reform. "We're really doing what he is urging the other 49 states to do," Kukula exulted Tuesday. "Wayne County is leading and the federal government is trying to get everyone else to follow."
    Thomas Hamilton, director of the disabled and elderly health programs group for the federal government, agreed that the program sounds like a model. "Michigan has been one of the leaders in developing new methods of person-centered planning," he said Tuesday. "We're very interested in the results that they're going to be able to show."
    Called "Your Choice," the Wayne County system is scheduled to take effect Oct. 1. It will allow most uninsured residents of the county to select from six large nonprofits for treatment. Each group oversees a raft of mental health programs. If the plan is endorsed by the state panel next week, Wayne County patients who don't like the mental health service they're receiving will be free to shop around. Kukula said she hopes the competition will foster better care at lower costs to taxpayers.
    State officials set up the framework for such a system in 1998 when they began requiring county officials across the state to give more choice to users of publicly funded mental health services. Wayne County was required to offer the greatest level of flexibility because it is home to more than half of the people who use the services. Developing a plan to do that took several years.
    To perfect the plan, Kukula hired a bevy of experts. The national accounting firm Deloitte & Touche has provided actuaries to determine how much the new HMO-like organizations will be paid for each client. Wayne State University professors are developing protocols for best mental-health practices. Soon, they will begin training counselors. Later, the professors will evaluate the counselors. Meanwhile, a medical consulting firm is scrutinizing new admissions to area psychiatric hospitals in an effort to contain rampaging hospital bills.
    All this is taking place as change sweeps through the public agencies that oversee mental health services in each Michigan county. In many counties, especially Wayne, these services have been buffeted by budget cuts. Kukula has slashed $35 million from her agency's budget since spring. "We've had to cut down some hours in our adult clinical program. It's been a pretty painful summer," said Roberta Sanders of New Center Community Mental Health Services, who noted that she already has had to lay off two staff people. Many mental health service providers are worried that more cuts are around the corner, especially for programs that focus on preventive mental-health treatment, such as those that support the development of children.
    Critics of the new system worry that it will give agencies an incentive to scrimp on programs that serve people with milder illnesses or disabilities because these clients will bring in fewer state dollars than people with more severe problems. Kukula insisted that all clients should be well served under the new system. That's true only if the state panel approves Wayne County's plans as Kukula expects. If the panel rejects the county's plans, it could open the door for private companies to step in.
    Geralyn Lasher, spokeswoman for the state Department of Community Health, confirmed Tuesday that last week's trip by state mental-health regulators to Wayne County "did go well." But she declined to speculate on whether Wayne County's plan will be approved by the state Specialty Services Panel when it meets Tuesday in Lansing. Kukula had a less restrained view of how the visit went. "Fabulously," she said. "They walked in saying that it was incredible to them the change they had seen and the professionalism."
    Meanwhile, officials in the northern Michigan counties of Manistee and Benzie have sued the state over a Department of Community Health plan to move control of mental-health services in Manistee and Benzie to an adjacent county. Lasher said Tuesday that county officials there failed to meet a February deadline for applying to control the funds.

Connecticut Creates Mental Health Crisis Teams
Susan Haigh, Associated Press- 8/23/2002

HARTFORD, Conn. -- An eerily familiar fear rippled through Connecticut's small Cambodian population last year when terrorists lashed out at the United States. Televised scenes of planes crashing into the World Trade Center and Pentagon dredged up memories of previous violence and torture. Many of the estimated 3,500 Cambodians knew from personal experience that something even worse could be lurking around the corner. ''People were stockpiling rice. There wasn't rice to be had in Danbury the first day because people were ready to move,'' said Mary Scully, program director at the West Hartford-based Khmer Health Advocates, a Cambodian-American health organization.
    The Cambodians' experience is one of many reasons behind a new and far-reaching effort by the Department of Mental Health and Addiction Services and the Department of Children and Families to do a better job of protecting mental health in times of disaster both natural and man-made. On the day of the attacks, Gov. John G. Rowland dispatched DMHAS crisis teams to Fairfield County train stations, hoping to provide comfort to the soot-covered commuters who escaped New York. Nearly 30,000 Connecticut residents commute into Manhattan each day.
    But for many of the counselors, it was an unusual job request. They were used to helping clients with mental illness or someone with a psychiatric episode. Many weren't familiar with treating the mental trauma triggered by a disaster. And a wide variety of people were affected the commuters, the Cambodians and other refugees, elderly residents, children, minorities and even emergency personnel.
    ''All of (the crisis teams) did a wonderful job,'' said Julian Ford, director of the state's new Center for Trauma Response Recovery and Preparedness. But many felt unprepared. There had been only two other disasters where DMHAS staff were dispatched to help families of victims: the 1987 collapse of the L'Ambiance Plaza in Bridgeport, which killed 28 construction workers, and the 1979 Windsor Locks tornado that ripped through the Bradley Air Museum, killing three people. ''We know that there were people who were missed,'' said Wayne F. Dailey, spokesman and senior policy adviser at DMHAS. ''We had some level of understanding. It wasn't adequate to the needs of the community.''
    SAMHSA, the federal Substance Abuse and Mental Health Services Administration, asked Connecticut to examine its needs and eventually awarded the state a $1.95 million grant. A year after the tragedy, state officials working with the University of Connecticut Health Center and Yale University have set up five regional teams of trained mental health crisis workers. So far, about 400 behavioral health professionals both state workers and private agency employees, as well as some community members have completed three stages of training, including sessions on reaching out to different groups in the community. There are about 50 to 90 members on each team. Those numbers could grow, given the tremendous interest from volunteers. ''They want to give back to their community and they want to help the community feel safer,'' said Ford, an associate professor at the UConn Health Center who helped train the volunteers.
    The teams will back up American Red Cross mental health volunteers, filling in where needed, going to schools to meet with children, assisting emergency workers and visiting nursing homes and churches. They will also work with the state Office of Emergency Management and local authorities, taking instructions from the commander at the scene.
    Dailey said the state wants to change the mindset of emergency response. Traditionally, people think about public safety and public health needs. Following the terrorist attacks, more people realize the importance of behavioral health when a major disaster occurs. ''The major purpose of terrorism is to terrorize, and being terrorized is a psychological event,'' said Dailey, who holds a Ph.D. in psychology. ''For every medical victim, there are many more psychological victims.''
    On the Net: http://www.ctrp.org

Bullying Common, Students Say
Gregory Roberts, Seattle Post-Intelligencer- 8/23/2002

It's a jungle out there in the middle schools of King County: nearly eight in 10 eight-graders say they've been picked on by bullies, and 40 percent of those victims say it happens often, according to data cited yesterday by public health officials. The report on bullying and bias-based harassment in schools comes a year before school districts must adopt written anti-bullying policies in accordance with a law passed by the Legislature last spring. The information in the report was drawn by the Seattle-King County Department of Public Health from a 1999 survey of Seattle teens and a 2000 survey of adolescents statewide.
    Despite the high rate of incidents, the report noted some signs of improvements, such as a decline in the number of Seattle high school students reporting harassment, from 59 percent in 1995 to 50 percent in 1999. And the picture has brightened further since then, Seattle Superintendent Joseph Olchefske said. Between the 1998-99 and 2001-02 school years, the total number of incidents of bullying, harassment and weapons violations declined 44 percent in the city's public schools, according to school district figures.
    Seattle schools have stressed a zero-tolerance approach to violence or threats of violence, calling on teachers and administrators to take every incident seriously and to deal with it, even if flexibility is allowed in their approach, he said. "Our principals and assistant principals have really embraced this," Olchefske said. "They view violence and harassment as an academic issue, not just a behavior issue." He said that as students who attended elementary schools under the new policies move up in grades, the climate in middle schools and high schools should improve.
    Andy Robbins, who starts ninth grade at Ballard High School next month, could attest to that. "In eighth grade, everyone's a lot nicer," he said of his 2001-02 school year at Whitman Middle School. Though not a victim of harassment himself, he said he's witnessed some examples: "People just messing around, making fun of people's clothes, or stuff they say."
    Kari Lombard, who will be a sophomore at Garfield High, said she's sometimes been hassled at school. But, she said, "There isn't really a lot of confrontation. Other girls insult people behind their backs." Boys, too, can be part of the problem, she said. "They'll just sort of pick on each other and insult each other for being geeky," she said. "And occasionally guys get into fights." Discussions of bullying and related issues took place in school assemblies and meetings, both students said. Seattle schools have already adopted a policy on bias-based harassment and are drafting an overall anti-aggression policy to comply with state law, a spokeswoman said. Other report highlights include:
* Between 21 and 30 percent of King County public school students in grades 6-12 said they were bullied "a lot" or every day; 48 to 50 percent said they were bulled "sometimes."
* The most common type of bullying involved name-calling and insults, followed by being the object of rumors or lies. Less common are pushing, hitting or tripping and physical threats.
* In Seattle middle and high schools, 32 percent of the students reported they were harassed based on their race or ethnicity. The most commonly harassed group were Hispanics/Latinos; the least, African Americans.
* Girls were more than twice as likely to be among the 34 percent of Seattle teen students harassed because of gender.
* Of the 6 percent of Seattle students harassed because of sexual orientation, almost all were homosexual or bisexual.
* Harassment victims were more likely to bring guns to school, get in fights and contemplate suicide, according to the Seattle data.
    Highline School District Superintendent Joseph McGeehan said his district, too, is cracking down on bullying and harassment, which he said seems more likely to be related to race, ethnicity or sexual orientation than in years past. "I certainly can recall from my own eighth-grade experience that putting one another down and knocking one another was part of our culture in school, and obviously it still is," he said. "But I think the issues are far more serious today."

Aging Puts Stress in Perspective
E. J. Mundell, Reuters News Service- 8/23/2002

CHICAGO -- Young twenty- and thirtysomethings worried about pressures they might face in middle age can breathe a sigh of relief: According to researchers, their most stressed-out time may be right now. In a large survey of US adults aged 25 to 74 years of age, just 8% of young adults said they had even one stress-free day in a given week, compared with 12% of mid-lifers and 19% of those over 60.
    The difference appears to be one of attitude, according to researcher Dr. David Almeida of the University of Arizona in Tucson. "We're finding that older people are mellowing a bit," he said. "According to this research, the older we get, you kind of realize that 'hey, it's not worth getting upset about the small things."' He presented the findings here Friday at the annual meeting of the American Psychological Association. As we age and take on the responsibilities of career and family, many of us may look back wistfully at what we imagine was a relatively carefree youth. But is our nostalgia deceiving us?
    In their study, Almeida and his colleagues examined data from a large government survey of over 1,000 American adults known as the National Study of Midlife in the United States. As part of the study, researchers telephoned participants every evening for 8 consecutive evenings, quizzing them on the amount and type of stressors they had faced that day.
    "And we found that, in sheer number of stressors that people reported, there was no difference between younger adults and midlife adults," Almeida said. But while these daily hassles tended to really upset those aged 25 to 39, "boomer" types aged 40 to 59 were more likely to shrug them off. "For example, being stuck in traffic. The younger people in our sample would report that as more disruptive, more upsetting, than older people," Almeida said. The key was "people's own perceptions, how they view their stressors," he said.
    But the nature of what stresses us out as we age appears to change as well. In our 20s and 30s, "it was likely to be over some interpersonal tension or disagreement they have with somebody," such as a lover, coworker or friend, Almeida said. "Whereas midlife adults, their stressors were more related to being overloaded or having too many demands made on them." This makes sense, he said, because midlife is typically our most productive period, with many of us forced to juggle the demands of career, spouse, children and aging parents.
    For the third group in the study, those aged 60 to 74, one concern--health problems--puts all others in the shade. At this age, "we're going to deal with the little things much better--so we perceive things as being less severe," Almeida said. However, "the stresses that do happen to people are out of their control and they are most often related to close friends and relatives being sick. So when they do happen they have more of an impact." But the oldest age group still beat out the others when it came to overall trouble-free days: While young and middle-aged individuals reported significant stressors on an average of about 3 out of the 8 study days, that number dropped to close to 2 days among those 60 and over.
    Overall, young women reported the most stress, and older men the least. "Men and women had similar amounts of overloads of demands, similar amounts of arguments and tensions," Almeida said. But women's daily anxieties were much more likely to be focused on family and friends. "Something like 'my friend is having problems with her husband,' 'my child is sick, or 'my child is in trouble at school.' We call these network stressors--they happen within our network of friends and family. Women reported three times as many of these network stressors as men did," according to Almeida.
    He added, "Not only do women report more of these network stressors, when they happen, women are more reactive, more likely to be upset and actually feel sick from them. Whereas men, they don't report them, and when they do report them it really doesn't get to them as much." Instead, men tend to fret over workplace tensions and financial issues, perhaps focusing on their traditional male role as "breadwinner."
    Overall, it may be a comfort to know that our attitudes toward life's troubles mellow with age. In fact, Almeida believes this late-life mellowing may be the logical result of a more stressful, drama-heavy youth. "Obviously, if older adults are dealing better with their stressors, they've probably learned from them," he said. "You have to experience it in order to master your environment. In fact, midlife people, when they talk about having stress, oftentimes they will say, 'I guess I feel good that I could get everything done today.' So there might be some positive outcomes."

Ban on Paxil TV Ads Delayed
Paul Wilborn, Associated Press- 8/23/2002

LOS ANGELES -- A court-ordered deadline to pull national TV commercials that claim the anti-depressant Paxil is not habit-forming was delayed to Sept. 12, an attorney said Friday. The postponement from Sept. 1 will give the U.S. Food and Drug Administration time to respond in court. The FDA had asked U.S. District Judge Mariana Pfaelzer to rescind a decision that grew out of a civil lawsuit. FDA officials said they were worried the ruling interferes with how the agency regulates drugs and drug companies. The judge's decision to delay the ban came during a conference call with the parties involved, said Karen Barth, an attorney's for plaintiffs suing the makers of Paxil. Lawrence Bachorik, a spokesman for the FDA, confirmed that the judge had issued a stay but did not elaborate. The civil lawsuit against Paxil producer GlaxoSmithKline was filed on behalf of 35 patients who claimed they suffered withdrawal symptoms such as nausea, fever, and ''electric zaps'' to their bodies.
    In a filing Tuesday, the FDA said there were often side effects when patients stop taking certain medications ''abruptly,'' but the agency labels drugs as habit-forming only when such drugs ''cause drug-seeking behavior, often with the user escalating the dose for psychological or physical gratification.''
    Pfaelzer found that in other countries, labels on the drug warn of adverse reactions when use of the drug is discontinued. The commercials were ''misleading and created inaccurate expectations about the ease of withdrawal from the drug,'' Pfaelzer ruled Monday. Surging U.S. sales of Paxil and the asthma drug Advair led to a 15 percent increase in second-quarter profits for London-based GlaxoSmithKline PLC. Global sales of Paxil grew 29 percent.

Michigan Drug Measure Proposes Treatment Over Prison
Associated Press, 8/26/2002

Michigan voters could help decide whether one convicted cocaine dealer should spend time behind bars or receive treatment. Instead of sentencing Simon Rincon on Friday, circuit Judge Timothy Pickard agreed to a defense request to adjourn until after the Nov. 5 election. One likely ballot measure is the Michigan Drug Reform Initiative, a proposal to provide treatment for first- or second-time drug offenders rather than sending them to prison.
    Rincon faces a mandatory 10-year sentence, defense attorney Robert Jameson said. Rincon, 37, denies police allegations that he was a major cocaine dealer. Instead, Jameson said Rincon was selling to support his own cocaine habit. "We need to treat these people as opposed to just locking them up," Jameson said. Pickard, who has frequently criticized lawmakers' interference with judges' sentencing powers, agreed to delay Rincon's sentencing to see how the election might affect the case.
    Rincon originally faced a mandatory 20- to 30-year prison term after police reported finding more than a quarter-kilogram of cocaine and a handgun in his home in Jasper. A narcotics team searched the home Jan. 31 and arrested Rincon. After his arrest, officials said Rincon was a major local dealer, responsible for distributing 10 kilograms of cocaine a year. Since his arrest, Rincon has remained in the Lenawee County Jail in lieu of a $300,000 bond. Last month, Rincon pleaded guilty to a reduced charge of possession with intent to deliver 50 to 225 grams of cocaine, which carries a mandatory 10- to 20-year sentence.
    Petitions circulated by the Michigan Campaign For New Drug Policies are to be reviewed today by the Michigan Board of Canvassers to determine whether there are enough valid signatures to put the question on the ballot. "There was no problem with the petitions and the board is expected to approve them," Michigan Secretary of State spokeswoman Elizabeth Boyd said. The backers of the plan submitted more than 450,000 signatures last month to state elections officials. The group needed the signatures of more than 300,000 registered voters.

Complaints Surface About Stopping Paxdil
Brian Reid, Washington Post- 8/27/2002

Paxil, the world's best-selling antidepressant, has become the target of growing complaints that stopping the drug causes severe side effects ranging from flu-like symptoms to electric-shock-like sensations in the brain that patients have labeled the "zaps." This marks the first time that one of the new generation of antidepressant medications, often described as non-habit-forming, has been accused of being addictive.
    The patient complaints, which previously circulated chiefly on electronic bulletin boards and specialized Web sites, became more public last week when a federal judge in California ordered the drug's maker, GlaxoSmithKline, to pull TV ads that boast the drug is "not habit-forming." The judge later put that ruling, which said the ads may have underplayed the drug's possible role in causing withdrawal symptoms, on hold. Both Glaxo and the Food and Drug Administration (FDA) have challenged the decision, part of a California court case brought on behalf of Paxil users.
    At stake, potentially, is the treatment of thousands of U.S. patients on Paxil, which brought Glaxo almost $3 billion in revenue last year and was prescribed more than 70 million times in the last decade. That growth has been driven in part by an expanding list of uses. Paxil is approved for the treatment of depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, post-traumatic stress disorder and generalized anxiety disorder.
    The judge's initial action highlights concerns that have dogged the drug since it was introduced a decade ago. Although Paxil has become a staple of pharmacologic treatment for depression and anxiety, the very chemical attributes that make it a wonder drug for some patients may also contribute to symptoms when the drug is stopped.
    A member of a class of drugs known as selective serotonin reuptake inhibitors (or SSRIs), which includes Prozac and Zoloft, Paxil works by ensuring that the chemical serotonin, which the brain sends from one nerve cell to another, reaches its destination. (In depressed individuals, serotonin is often reabsorbed by sender cells before it can be transmitted.) Over the course of treatment, brain cells adapt to the presence of the drug, changing their physical properties.
    Paxil, however, breaks down more quickly than Prozac and Zoloft. Once Paxil is stopped, the levels of the drug in the cells drops quickly, say medical experts, triggering the kinds of problems that prompted the lawsuit against Glaxo. One patient involved in the California suit, Pamela Fikter, described the sensation as "like I was going crazy," according to court documents. "I was dizzy, light-headed, uncoordinated. . . . I was so terrified that something very serious must be wrong with me." Reports of similar ailments in patients who had stopped taking Paxil began showing up in the medical literature within a few years of the drug's 1992 U.S. debut.
    By the late 1990s, clinical studies offered evidence that the symptoms associated with discontinuing use of the drug -- ranging from flu-like ailments and nausea to dizziness, insomnia and electric-shock-like sensations in the brain -- appeared more often in patients treated with Paxil than in patients treated with other psychotropic drugs. That has spawned a network of Web sites and bulletin boards, with names like quitpaxil.org, devoted to spreading information on the side effects. And it prompted Baum, Hedlund, Aristei Guilford & Schiavo, a California law firm that had represented antidepressant users in past suits, to launch legal action last summer claiming that Paxil patients had been misled and asking for punitive damages against Glaxo, the world's second-biggest drug maker.
    The evidence from the medical research and the side effect reports submitted to the FDA have convinced experts on both sides of the issue that some patients who stop taking the drug -- especially those who halt it abruptly -- will experience symptoms as the drug washes out of their system.

The 'Withdrawal' Question
But causality is hotly debated. Last December, Glaxo changed Paxil's label, under FDA direction, to include reports of symptoms following discontinuation of the drug. The change reads pointedly that the symptoms "may have no causal relationship to the drug." It also never mentions the word "withdrawal." Still, the change gave doctors FDA-sanctioned instructions to be on alert for the problem, encouraging physicians to recommend "a gradual reduction in the dose rather than abrupt cessation."
    Where disgruntled Paxil patients and Glaxo have parted ways is not on whether the symptoms exist but rather whether the symptoms are the mark of a habit-forming drug or just a mild, expected consequence of treatment. The patients in the lawsuit refer to the side effects as "withdrawal symptoms" that can make stopping the drug disabling. The drug maker refers to the same effects as "discontinuation" symptoms.
    A final ruling in favor of the plaintiffs, who are seeking reimbursement for their Paxil prescriptions and for medical treatment in addition to punitive damages, could harm both Glaxo's bottom line and the drug's image. "Clearly, we disagree with the ruling and we don't believe that the ads were misleading," said Alan Metz, Glaxo's vice president for clinical development. "There is no evidence that Paxil is addictive." The FDA backed the company's position, arguing in a court filing that "FDA scientists that have considered this very issue do not regard Paxil to be habit-forming."
    Distinguishing between a drug that is addictive and one that has side effects associated with going off it is the key to Glaxo's contention that the drug isn't habit-forming. The company and the FDA note that other non-addictive drugs, such as steroid treatments and some high-blood-pressure medications called beta blockers, also leave patients at risk of problems when they stop taking the medications. But the FDA says neither those drugs nor Paxil prompts the kind of "drug seeking" behavior associated with addictive drugs like opium or cocaine.
    "Patients ask me, 'Is this habit-forming?' I say no," said Fred Goodwin, a professor of psychiatry at George Washington University Medical School and the former head of the mental health branch of the National Institutes of Health. "But if you stop it suddenly, your body isn't going to like it very much."
    But other doctors and patients say Glaxo shouldn't dismiss ill effects as common, expected events, even if Paxil users don't act like cocaine addicts. "The way they phrase it, you would think that most of the withdrawal is mild," said Joseph Glenmullen, the Harvard psychiatrist who wrote "Prozac Backlash." "Clearly, this is withdrawal and that's what it should be called. . . . It's like throwing a car that's going 60 miles an hour into reverse. The cells were making adaptation to living with the drug 24 hours a day."

Online Approach Attacks Binge Drinking
Rodney Thrash, Detroit Free Press- 8/27/2002

AlcoholEdu isn't like the typical just-say-no-to-drugs-and-alcohol lecture some college students dread during freshman orientation, course creators say.
The program:
* Pre-test: A 20-minute assessment measures knowledge, attitudes and behaviors.
* Two-hour presentation: Charts and diagrams offer information about alcohol and its effects on the body.
* Exercises: Quiz questions, interactive situations and case studies.
* Final exam: A 25-minute test provides a record of the student's comprehension.
* It's online. It takes three hours. You can complete the course whenever and wherever you want. And the message is drink responsibly. It's a message members of one college sorority can't ignore come fall.
    Kappa Alpha Theta, which has chapters at the University of Michigan, Michigan State University and Albion College, recently mandated the course for members. The mandate comes amid recent studies finding an increase in college binge drinking, particularly among women 18 to 23. Binge drinkers are defined as women who consume four or more alcoholic beverages in one sitting or men who consume five or more drinks in one sitting.
    Despite a Harvard University study that found stable trends among college-age men and women nationwide in 2001, the number of female binge drinkers at U-M jumped between 1999 and 2001, according to a study released in March. Last year, 51 percent of U-M undergraduate women said they engaged in binge drinking, up from 42 percent in 1999, figures from the U-M Substance Abuse Research Center show. Overall, binge drinking rose at U-M from 45 percent in 1999 to 50 percent in 2001. MSU, on the other hand, is an anomaly, said Jasmine Greenamyer, an alcohol health educator at Olin Health Center. One-third of MSU women binge-drank in 2002, down from 47 percent in 2000. The overall results are even more promising, Greenamyer said. The percentage of binge drinkers plummeted from 62 in 2000 to 39 in 2002.
    At U-M, senior Monica Rose said some of her peers, especially students new to college life, can't differentiate between moderate drinking and getting smashed, something AlcoholEdu attempts to address. Many students "don't know when enough is enough," said Rose, president of the Panhellenic Association, an organization of 15 U-M sororities. "There's a glamorous appeal when you first start college. People tend to forget what alcohol abuse can be." Rose, who hasn't taken an AlcoholEdu course but is familiar with its format, said its educational approach and the medium through which it is delivered will probably make college students receptive. It's a stark contrast to the traditional, preachy speakers that come to campus, she said.
    But Henry Wechsler, the lead author of the Harvard study and director of college alcohol studies at the Harvard School of Public Health, said that educational tools alone don't reduce binge drinking. "What the campus is doing above and beyond just education . . . they all enhance each other," said Brandon Busteed, founder and CEO of Outside the Classroom, the Boston-based health-education company that developed AlcoholEdu. "Schools using just one approach will see much less in behavioral change." The course is free to any student at a college that is in partnership with Outside the Classroom.
    Wechsler said that in addition to educational tools, colleges need "to have policies on campus and enforcement of these policies." One of the policies he proposes is possible disbandment of Greek organizations that have repeated alcohol violations. "I think we have to take a very hard line with fraternities given what's gone on the last decade," he said. But Robyn Hoffman, president of U-M's Kappa Alpha Theta chapter and a junior from Weston, Mass., said binge drinking isn't a problem that's exclusive to the Greek community. "For all the flak they get, it's unfair," said Hoffman, listing a slew of educational programs U-M Greeks sponsor throughout the school year to address binge drinking. Mary Jane Beach, national president of Kappa Alpha Theta, said she hopes the program is effective in her organization. "We can't wait to see the results," she said. "Hopefully, we'll have a good story to tell."

Psychiatric Group to Study Abuses in China
Elisabeth Rosenthal, New York Times- 8/27/2002

Beijing -- The world's leading psychiatric association voted Monday to send a delegation to China to look into charges that Chinese psychiatric hospitals are being used to silence political and religious dissidents. Officials of the World Psychiatric Association, which is meeting in Yokohama, Japan, said Chinese health officials have been cooperative so far. A preliminary fact-gathering delegation is scheduled to travel to China in the spring.
    But the resolution fell far short of steps proposed by human rights advocates and some other psychiatrists, who insist that systematic psychiatric abuses in China are rampant, perhaps even more severe and widespread than they were in the former Soviet Union. A resolution proposed by Britain's Royal College of Psychiatrists demanded a more independent commission and urged the association to consider barring the Chinese Psychiatric Association if evidence of abuse is found. "The decision is very disappointing," said Robin Munro, a human rights scholar whose research on psychiatric abuse in China largely brought the topic onto the agenda this year. "The WPA is sidelining itself and tarnishing its own reputation."
    Whether China routinely uses its psychiatric hospitals to imprison political or religious troublemakers has lately been a subject of hot debate, with international experts holding wildly divergent opinions. That debate has taken on a particular urgency in the last two years, with repeated charges that members of the banned Falun Gong spiritual movement have been committed to institutions not because they are mentally ill, but because they hold unconventional beliefs. Munro's recent report catalogs numerous tales of Falun Gong members in psychiatric hospitals receiving powerful medicines and electroshocks. Falun Gong says that more than 300 members have been committed and a few have died during the hospitalizations.
    But Dr. Arthur Kleinman, a psychiatrist at Harvard University who has spent decades collaborating with his Chinese counterparts, said the current charges are groundless. He said that while the psychiatric commitment of troublemakers was common in the Mao Zedong years, it is extremely rare today. "There is no systematic abuse by the state," he said in a phone interview. "We're talking about problems with a small number of psychiatrists at a small number of hospitals that have been suborned by the police." He noted that Chinese psychiatrists had told him that security authorities did occasionally present them with recalcitrant Falun Gong members for evaluation. But they said that if no mental illness was diagnosed, the patient was immediately removed from the hospital. He and others have noted that the commitment process is less predictable in China than in the West, but they say that is not because of system-wide malpractice but because of the relative inexperience and powerlessness of Chinese psychiatrists. Of the 13,000 doctors working in mental health in China only about 1,000 are fully trained, he said. Many are only partially licensed, allowed to treat chronic patients but not permitted to diagnose new ones, for example. In China, as in the West, police can bring detainees who are deemed potentially mentally ill to a hospital for a psychiatrist's exam. In most Western countries, though, there are strict time limits on how long a person may be legally hospitalized for such a test, generally 24 hours. In China, such determinations can last for months.

A Rebel Psychiatrist Calls Out to His Profession
Claudia Dreifus, New York Times- 8/27/2002

 When Dr. J. Allan Hobson, 69, a Harvard psychiatrist and dream researcher, arrived for an interview, he had a notebook filled with his writings, photographs of his extended family and renderings of his summer house in Italy. "This will help introduce me," Dr. Hobson said. "If believe you need to get to know about me quickly," he added, demonstrating an easy informality and perhaps belying the stereotypes about uptight psychiatrists.
    But then, Dr. Hobson, director of the Laboratory of Neurophysiology at the Massachusetts Mental Health Center, is known as a convention-defying psychiatry rebel. His books include "The Dreaming Brain," "The Dr. J. Dreaming Drugstore" and "Dreaming as Delirium." His latest work, "Out of Its Mind: Psychiatry in Crisis: A Call for Reform," written with Jonathan A. Leonard, (Perseus, $17) and just published in paperback, is an exhortation to reorganize the profession he has practiced more than 40 years.
Q. In a nutshell, why has psychiatry gone "out of its mind"?
A. Because it's lost its way. In I980, when I first went into it, the specialty felt very coherent. But psychiatry, at the time, was being held together by psychoanalysis. Over the years, psychoanalysis became "the god that failed." At the same time that many psychiatrists became disillusioned with psychoanalysis, they failed to pick up on its humanistic implications, the idea that people, on a one-to-one basis, could help each other. Finally, there's been the unwitting success of medication, which enabled psychiatrists to empty the mental hospitals without really caring for patients.
Q. Has psychiatry "lost its way" partly because of the economics of mental health financing?
A. Oh, absolutely. The states no longer take responsibility for the mentally ill. There's a constant call for privatizing the care of these people, which is impossible. No one will ever be able to make any money off this kind of business, It's silly. These people have severe handicaps. Even if they're walking around the streets on Thorazine or whatever, they're still very impaired people. When I began my training, I couldn't have anticipated the emptying of the mental hospitals and seeing people on the streets. But these are the most disenfranchised of the disenfranchised, and almost no one speaks up for their interests. My own institution, Massachusetts Mental Health Center, which is located on a very prime piece of medical real estate, is constantly threatened with closure.
Q. Why did psychoanalysis become "the god that failed"?
A. I think people became disillusioned with psychoanalysis, because it was, ultimately, a strange way of caring for people. There was this tendency in the psychoanalytic world to imply that everything was psychodynamic.
    In my own training, I saw things that seemed cruel and that I believe, partly, led to the downfall of psycho analysis. Very strange, for instance, was this business of distancing one self from patients in order to obtain what was thought of as a crucial objectivity. Even stranger was the idea of blaming mothers for what happened to their kids. Or worse, blaming the patients themselves. This notion that everything was psychodynamic, I think, led to poor patient care. During my years of training, I was told, for instance, to control psychosis with psychoanalysis, which couldn't work. I was told that I shouldn't give anyone medication because it would muck up transference. I mean, I was dealing with catatonic schizophrenia people who were really, really crazy.
    Then came the revolution of psychopharmacology, and suddenly the pendulum swung the other way. Psychotherapy was down the drain, including the more useful parts, like humanistic psychology and an understanding of the unconscious. At the same time the field was declining, there have been tremendous breakthroughs in the brain sciences. I want to say to medical educators, "We've finally got what Freud always wanted, the chance to make a psychology based on brain science."
Q. How would you reorganize medical training so that you'd attract better and more students to your specialty?
A. I'd tell them that they have a chance to work on one of the last great medical frontiers, which psychiatry could be. This is a field where they'll have license to 'talk about psychology and physiology and philosophy, all together. Where else can you do that? I'd make the courses exciting. There was a professor named Fred Barnes at Brown University who's always said it is astonishing the way psychiatrists had managed to mess up the field and make it unexciting. In his psychiatry courses, he had actors come in and act out these little dramas for medical students The students got hooked emotionally by what they saw. The rest was easy.
Q. Let's return to the clinical part of your work. Considering the state of mental health care, if you were an ordinary citizen with run-of-the-mill health insurance and a teenager showing schizophrenic symptoms, where would you go for help?
A. I would be at a loss. It's devastating. The families watch their kids founder, because, in most cases, there's no place for them to go. I've got a brain-damaged son. He's 40 now, and we've managed well. Part of the reason is that we found good outside help. Ian lives in a group home. He supports himself completely. And he's a happy man. He comes to see my younger children, 6-year-oId twins, and he's very involved with them. Of course, I would have liked a different scenario for Ian, but I feel ennobled by this boy. Every time I see him, I feel better. And this is a feeling that I believe should be engendered in psychiatrists as they care for their patients. I still have patients that I saw in the beginning of my career. With the seriously ill patients, on the whole, they don't stop being mentally ill, but they can do well. They can do better because a doctor cares for them. And you can be clever with the medications, restrained about their use. Probably the most important thing you can do is to give them a sense of human place with you.
Q. The recent film "A Beautiful Mind" has brought issues of mental illness into the public consciousness. As a therapist, have you found it a useful tool?
A. I suspect a lot of people have taken to this movie because it appears in some ways to simplify, even romanticize, mental illness. I know, for instance, someone whose own personal history is very troubled. She's just rhapsodic about it. She thinks of herself as miraculously cured, and she's not. Most people don't like the reality of mental illness. You can't just say, as some do, that being straightforward with patients will get them well. They don't get well easily, and sometimes they don't at all. What psychiatrists and the patients' families need to do is be straightforward, not abandon the person, not get impatient not feel like we're a failure if we don't cure them. We're dealing with chronic long-term disability, and nobody likes it. You don't want to have it. And you don't want a family member to have it. But it happens.

Like Drugs, Talk Therapy Can Change Brain Chemistry
Richard A. Friedman, M.D., New York Times- 8/27/2002

After six years of twice-weekly psychotherapy sessions, Eric had plenty of insight. But his anxiety level had barely changed. He was still bedeviled by a ceaseless urge to wash his hands and shameful and repetitive violent thoughts. Out of desperation and against the wishes of his therapist, he visited my office to discuss the possibility of medication. "I thought I could understand my way out of my obsessive compulsive disorder," he recalled recently. "I wanted to be able to do it on my own, without medication." What he did not remember was his vehement opposition to psychotropic medication on the ground that it was not natural and would change his brain chemistry.
    Of course, he was right. Like Eric, many patients and therapists share the view that psychotherapy is preferable to pharmacotherapy because it is more "natural" and because it supposedly gets to the root of the patient's problem. They are convinced that self-understanding will bring relief, whether the problem is anxiety, depression or obsessional thinking. Insight is a prerequisite of happiness, the theory goes, and well-being achieved without the hard work of psychotherapy is artificial and inauthentic. But new evidence suggests that the talking cure and psychotropic medication have much more in common than had been thought. In fact, both produce surprisingly similar changes in the brain.
    Take Eric's obsessive compulsive disorder. It hobbles patients with unwanted thoughts, often violent or sexual, that play in the mind like a broken record. Owing to the sometimes lurid nature of the thoughts, the treatment mainstay had for years been psychoanalytically oriented therapy to unlock the sexual and aggressive conflicts presumed to underlie the symptoms. There was just one problem. That form of psychotherapy rarely, if ever, worked for those patients, a point now widely accepted by most psychoanalysts themselves.
    But two seemingly different treatments can be highly effective: a form of talk therapy called cognitive-behavior therapy and a class of antidepressants called selective serotonin reuptake inhibitor antidepressants, or S.S.R.I.'s, drugs like Prozac and Zoloft. It is well known that patients with the disorder have altered serotonin function compared with normal controls.
    Brain imaging that uses PET scans, or positron emission topography, has shown that the disorder is associated with functional hyperactivity of the caudate nucleus, a structure buried beneath the cerebral cortex. Some researchers hypothesize that the caudate is part of a subcortical circuit that acts as a kind of filter, sifting out extraneous thoughts and impulses. In obsessive compulsive disorder, they theorize, the subcortical filter malfunctions, allowing the unwanted thoughts to reach the cortex and then on to consciousness.
    In a study by Dr. Lewis Baxter at the U.CL.A. School of Medicine, patients with the disorder who responded to either a reuptake inhibitor like Prozac or cognitive behavior therapy over 10 weeks showed virtually the same changes in their brains, decreases in the activities of the caudate nuclei and, thus, changes toward normal function. When patients improved, the changes in their brains, as shown in the PET scans, looked the same regardless of whether they had received antidepressants or psychotherapy.
    An S.S.R.I. works, in part, by enhancing the neurotransmitter serotonin, whose activity is often abnormal in people with obsessive compulsive disorder and depression. Cognitive behavior therapy focuses on changing distorted patterns of thinking. The intriguing finding from the PET scans is not limited to O.C.D. Two studies of patients with depression, reported last year in The Archives of General Psychiatry, compared the effects of interpersonal psychotherapy with an antidepressant on brain function, as observed in PET scans. In those studies, the depressed patients received interpersonal therapy, a short-term talk treatment that focuses on the effects of social relationships and major life events on mood.
    In one study, a 12-week trial that compared an S.S.R.I., Paxil, to interpersonal psychotherapy. Dr. Arthur Brody, also at U.C.L.A., found that depressed patients who responded to either treatment had nearly identical changes in their brain function, a decrease in the abnormally high activity seen in the prefrontal cortex before treatment. In the second study, Dr. Stephen D. Martin at the research unit of Cherry Knowle Hospital in Sunderland, England, reported that six weeks of Effexor, an antidepressant that enhances both serotonin and norepinephrine, and interpersonal therapy produced similar effects in those depressed subjects who responded either to medicine or to psychotherapy. Each had shown an increase in the activity of the basal ganglia, a subcortical brain structure. Although the observed changes with psychotherapy and antidepressant were similar in that study, they were not identical. Subjects with interpersonal therapy but not Effexor also had activation of a brain area called the cingulate gyrus, which responds to serotonin in the brain and has a role in regulating mood.
    The studies show that pharmacotherapy, and psychotherapy can produce remarkably similar effects on functional brain activity. But does that mean that antidepressants and psychotherapy are really equivalent? In a word, no. Psychotherapy alone has so far been largely ineffective for diseases like schizophrenia, where there is strong evidence of structural, as well as functional, brain abnormalities: So it seems that if the brain is severely disordered, then talk therapy cannot alter it. But it is clear that talk therapy can alter brain function. The reason may come from the elegant work of a Nobel Prize-winning psychiatrist and neurobiologist, Dr. Eric Kandel. Studying the simple and well-mapped nervous system of a sea slug, Aplysia, Dr. Kandel showed that learning leads to the production of new proteins and, in turn, to the remodeling of neurons.
    Sea slugs exposed to the controlled-learning condition that produced long-term memory ended up with double the number of neuronal connections as the untrained animals. In essence, Dr. Kandel has proved that learning involves the creation of new neuronal connections. The clear implication for humans is that learning literally changes the structure and function of the brain. Now it may seem a big leap from a snail to a human. But if psychotherapy is thought of as a form of learning, then when therapists talk to patients, they cause them to learn, perhaps changing their brain function and, perhaps, for the long run.
    In the end, Eric chose cognitive behavior therapy and improved drastically. Through exposure to those situations that he feared like messy dirty places, he became desensitized to them and lost his compulsion to wash. Had he chosen an antidepressant, chances are that he would also have improved. If psychotherapy produces nearly the same brain changes as pharmacotherapy, then the boundary between mind and brain is purely artificial -- even unnatural.