Girls in Juvenile Rehab Program Battle Wildfires
Rebecca Cook, Associated Press- 9/7/2002

NASELLE, Wash. -- Crystal Horne has been burned before. The quarter-sized pink scars on her left forearm testify to that. And, for a time, the 17-year-old girl with an anarchy-symbol tattoo and flame-red hair seemed destined to burn out: drinking heavily, dealing and using drugs, running from police. But when her bad deeds landed her in juvenile prison, she found a calling that turned her stubborn energy into a saving grace: Fighting wildfires.
    Horne now leads an all-girl firefighting team of juvenile offenders from Naselle Youth Camp, in the southwest corner of Washington state. There, car thieves and gang members learn to put axes, shovels and chain saws to good use. They plant trees, clear brush and maintain trails, while training and hoping for a big wildfire to fight. This summer, she and the other girls watched on TV as firefighters battled fierce blazes in Oregon, Colorado and other Western states but not in Washington. They itched to prove themselves. ''I like this,'' Horne says, ''It's something I can say I did good at.''
    The girls wake at 6:05 a.m. every weekday. Horne, her hair now faded to its natural strawberry-blonde, leaves a stuffed animal on her bed and a ''Chicken Soup for the Cat and Dog Lover's Soul'' on her desk. Waiting outside their dorm after breakfast, the sleepy girls light up as foreman Sid Hicklin ambles into view. Lanky and tan from years in the bright sun, Hicklin worked in law enforcement before joining the Department of Natural Resources.
    Supervising the girls is unlike any other job. ''They take everything I say to heart. I can't be so critical,'' he says. ''Some of their backgrounds are really devastating. You just have to build them back up.'' He's learned a lot they don't teach in forestry school. He knows who's taking new medication, whose father just died, who's in or out of the ever-shifting cliques. His daily log has notes like, ''Girls are nit picky. Told them to work without talking.'' The one thing he doesn't know is what crimes the girls committed. He says he never asks.
    When Hicklin stops the crew truck at an overgrown crossroads, the girls climb out past a blue-and-gold decal on the door with the words, ''Hicklin's Angels.'' ''Let's go,'' he calls to them. ''Three saws this morning.'' New girls take a while to build the muscle needed to cut trails, saw branches and run chain saws. ''I wasn't used to working that hard,'' says Cassandra Carey, 15, of Lynnwood. ''You start to get the hang of it and you start to get in shape. It starts to build your self-esteem.'' Carey has earned a blue hat, a mark of leadership, while serving time for possession of stolen property. It's the first time she's felt like a leader. Following her friends got her the gang tattoo below her eye three dots for ''Mi Vida Loca,'' my crazy life that she now wants removed. ''I always feel stupid because I've committed crimes. I feel looked down upon,'' she says. ''You come here and it's like they don't even care. You're working so hard, your mind just is free.'' She proudly remembers the time they cleaned a cemetery. Some old women had been unable to do it and afterward they thanked the girls. Carey notes with some surprise, ''It's fun to do good once in a while.''
    Washington used to have several youth rehabilitation centers like Naselle. After years of budget cuts, now Naselle's the only one. Naselle staff are nervous about next year's anticipated state budget crisis. The camp has four boys' fire crews and one for girls. Everyone else works, too, whether in maintenance, the sign shop, the garden or the fish farm. After work, they go to school and counseling. Superintendent Thomas Quinn wants them to learn social responsibility. He thinks it sinks in. Last winter, the 150 inmates raised $3,000 to ''adopt'' a local family for Christmas. Recently a Naselle graduate called the camp, demanding to speak to a boys' crew foreman. Sirens wailed in the background, and everyone assumed the worst. But the boy had become an emergency medical technician; he wanted to thank the foreman.
    The fire crew program has not been without problems. In June 2001, two boys beat their foreman and left him for dead. The severely injured foreman survived. Now security staff accompanies the crews. Generally, Hicklin trusts the girls until they give him reason not to. In return, the girls adore Hicklin. He's like a father to them. They notice how he talks about his wife and family with obvious love. ''On the outs,'' their term for outside world, ''you don't see a lot of that,'' Horne says. The girls believe Hicklin would never put them in danger even if they got their wish, the chance to work on a wildfire. They'd get to leave the camp, sleep in tents and eat good food, maybe even talk to boys. They'd also get paid, though not as much as professional firefighters.
    Amy Earl, a sometimes surly 17-year-old from Tacoma, loves fire crew. ''I like knowing I'm saving people's lives,'' she says. She was charged with criminal assistance to murder after her boyfriend killed a friend. The same boyfriend gave her three sexually transmitted diseases and urged her to drop out of school. He's serving a life sentence for murder. She believes fire crew put her on a different path. ''My saw breaks down, I have to fix it,'' she says. ''Now it's like, I'm my own woman and I don't need anybody to make decisions for me. It's time to realize it's not a game any more, this is life.''
    As summer wanes, the girls finally get their chance. On Aug. 18, they go to a 100-acre fire near Spokane not big by wildfire standards, but it is threatening several homes. Some people give the all-girl crew odd looks, but they quickly prove themselves by extinguishing all the hot spots in their area. ''Everyone was really surprised,'' Horne says. ''When they realized just seven girls did all that work, they were like, 'Wow.'''
    As advertised, they eat well. They're impressed by the flavored coffee creamers, which they have never seen before. The work is tough, a lot of hauling water hoses and running up and down hills. The air is so smoky their skin turns black even under their clothes and three girls get nosebleeds. But they persist. The girls can't talk to outsiders on a fire, but Horne appreciates when people wave or call ''thanks!'' ''It's given me an opportunity to do what I can, to be a leader,'' she says. ''On that big fire, y'know, I kinda felt free a little bit. I want to keep doing that.''
    Naselle Youth Camp on the Net: http://www.naselle.wednet.edu/nycs/nycs.html

Connecticut Workers Should Have Focused on Boy's Mental Health
Associated Press, 9/7/2002

HARTFORD, Conn. -- Social workers should have done more to help a 12-year-old Meriden boy who committed suicide nine months ago, according to an internal report by the state child welfare agency. In a report obtained by The Hartford Courant, Department of Children and Families officials concluded that social workers focused too much on Daniel Scruggs' truancy and educational needs instead of the obvious emotional and mental health problems he struggled with before his death.
    In the days before he hanged himself in his closet, Daniel Scruggs was reportedly so fearful of bullies that he would often defecate in his pants to be sent home. The seventh-grader took his own life on Jan. 2. Family members said Daniel was regularly picked on by other students at Washington Middle School because of his body odor, poor hygiene and dirty or mismatched clothes. Daniel missed 74 of 78 school days before his death because of fear of being bullied, said his mother, Judith Scruggs. Scruggs, 51, has pleaded innocent to charges of risk of injury to a minor in connection with Daniel's death. She could face 10 years in prison if convicted.
    The DCF report says social workers were aware of Daniel's emotional problems, yet they closed his case six days before he hanged himself. The social workers said they were satisfied that Judith Scruggs was doing her best to get her son to school and confident no further intervention was needed. ''Treating the case from an educational neglect perspective, the supervisor and the investigator did not fully evaluate Daniel's serious emotional and behavioral issues,'' the report said. ''The response to Daniel's issues were fragmented, and as a result Daniel did not receive the help he needed.''
    The Courant reported that, in response to its questions about the report, DCF Commissioner Kristine Ragaglia has called for better training of supervisors and new guidelines to make sure caseworkers address all the problems they encounter in a case. ''While no one could have predicted (Daniel's) tragic death, this case highlights the need for our department and society as a whole to broaden our view of how we can better respond to children in crisis,'' Ragaglia said in a statement.
    Ragaglia said the department has already responded to the urgent need for adolescent mental-health care by launching its Community KidCare statewide mental health initiative. KidCare created community-based mental health service systems in each region of the state to help parents and children get the counseling and other support services they need. KidCare services were not up and running in Daniel's hometown of Meriden until three weeks after his death, although some limited psychiatric help was available, including a state psychiatric social worker and a local child guidance clinic. The internal report criticized Daniel's social workers for not seeking more outside help and for not providing his family with sufficient information about available services.
    The report notes that Judith Scruggs called Daniel's social worker the morning her son killed himself to get information about programs that might help him. The investigator told her she would check on some programs and get back to her. Before the worker had a chance to return the call, Judith Scruggs called back and said her son was dead.
    Child Advocate Jeanne Milstein declined to discuss the case Friday because her office is currently investigating Daniel's death. Milstein is expected to release the findings of her investigation by the end of the month or early October. Jury selection for Judith Scruggs' criminal trial is slated to begin in Meriden Superior Court on Sept. 24. Scruggs' attorney, M. Hatcher Norris, said he had seen the DCF internal report, but chose not to comment before the trial. He expects DCF social workers will be called as witnesses.

Illinois Reopens Probe of Suicide at Maryville
Chris Fusco & Tom Novak, Chicago Sun Times- 9/7/2002

Illinois' child welfare agency has reopened its investigation into a girl's suicide this year at Maryville Academy's City of Youth, responding to a state psychologist's report that staff ignored warning signs she might try to kill herself. The report also alleges that staff altered a document, removing statements that the 14-year-old girl had threatened suicide three days before she hanged herself. This seems to "fit a pattern" where Maryville staff failed to immediately summon mental health help for severely troubled kids the state places there, including those trying to kill themselves, the report said.
    The teen, Victoria Petersilka, was found hanging Feb. 9 from the shower head in a bathroom of a group home at the Des Plaines campus. Her suicide came three days after she was told that a potential foster family in Wisconsin had rejected her. The girl's therapist had requested that Maryville staff supervise her at that time because of her previous suicidal behavior. She had been released from a psychiatric hospital in December, had tried to overdose on aspirin in January, was saving up her prescribed medication in the same month--common behavior in a person contemplating suicide--and her therapist had warned staff that she could be a danger to herself after the foster family's rejection.
    On the night she hanged herself, Victoria was able to lock herself in a bathroom, saying she was going to take a shower, sources told the Chicago Sun-Times on Friday. A staff member checked on her at 7:28 p.m., got no response and went looking for someone with a key. It took a couple of minutes to find that key and open the door, according to sources. Victoria was still breathing when she was found, but she died 12 hours later. She had come to Maryville after both of her adoptive parents died.
    The Illinois Department of Children and Family Services reopened its investigation after psychologist Ronald H. Davidson sent a seven-page report Wednesday to DCFS Director Jess McDonald. At McDonald's urging last year, Maryville brought in Davidson to review its programs because of escalating violence caused by a growing population of mentally ill kids. "I've turned it over to our inspector general . . . to see if there's anything that might have contributed to the subsequent suicide,'' McDonald said. Davidson's report, McDonald said, indicates that the girl may not have had "adequate supervision.''
    Maryville's executive director, the Rev. John Smyth, did not respond to two Sun-Times inquiries to discuss the situation. DCFS Inspector General Denise Kane had previously investigated the suicide, the normal procedure when a state ward dies. "Was there actually an attempt to alter records? I won't comment on that until Denise completes her investigation,'' McDonald said.

Altered documents
The document-altering allegation stems from two versions of an "unusual incident report'' filed by a Maryville staffer three days before Victoria hanged herself. The original report contained statements that she "was going to kill herself" and that "she was going to leave and kill herself." This first report also had a check mark in the box stating "suicidal/homicidal ideation.'' The later version of the report did not include those statements, and the box was empty. It was this version of the report that was given to the DCFS inspector general during her first investigation. She now has a copy of the original version.
    Davidson's report said he discovered the two versions two days after the girl died. He went to Smyth and warned him that Maryville could be violating federal and state laws if an inaccurate report were filed on Victoria's death. "While this is a complex and convoluted case, there are certain basic elements that are quite simple, beginning with the legal and ethical obligation to tell the whole truth, however embarrassing or painful such facts might turn out,'' Davidson wrote. "[E]ven the perception of such wrongful acts would have disastrous consequences for Maryville's public reputation, including the likelihood that Medicaid reimbursements might be suspended until officials could ensure that the agency was submitting data that accurately reflected events as they occurred."
    Smyth, according to Davidson's report, later explained that he was told the suicide references in the original report were made up to give staff a reason to physically restrain the girl, who was attacking the staff member with a dog chain and marbles. All this, Davidson states in his own report, "makes the truth virtually unknowable.'' Davidson's report also states that Maryville "should leave no room for even the perception of a 'cover-up' since anything less than full and immediate disclosure in a case involving the death of a child will raise suspicions forever."

Other incidents
Davidson's findings that Maryville staff didn't immediately call for clinical help in the case of Victoria are strikingly similar to two attempted suicides that occurred at Maryville this summer, five months after the girl hanged herself. "Our concerns were fed by a sense that this case seemed to fit a pattern . . . namely, that high-risk behaviors in very disturbed youths were sometimes minimized or even ignored by clinically inexperienced staff,'' according to the report by Davidson, who heads the University of Illinois at Chicago's mental health policy program.
    In July, a 9-year-old boy was rescued from hanging himself and then sent to bed without consultation from a mental health professional, the Sun-Times reported Friday. Six days earlier, Smyth had delayed staff's attempts to hospitalize a girl who had spent two days running in front of cars and threatening to drown herself, according to a DCFS report.
    In Victoria's case, Davidson wrote, a series of events should have prompted Maryville staff to call in a mental health consultant to immediately evaluate her on three occasions.
*On her Jan. 1 visit to the potential foster home in Wisconsin, the girl had taken an overdose of aspirin.
*Upon her return to Maryville on Jan. 2, staff discovered her stashing four Paxil tablets in her bedroom--a sign that she might be stockpiling pills for a future attempt to kill herself.
*On Feb. 6, after learning that she was being rejected by the Wisconsin foster family, the teen became violent, slamming marbles over a staffer's head as he restrained her. That incident alone should have prompted a call for a psychiatric consultation, sources say. That didn't come until the next day. On Feb. 7, Victoria met with Maryville's part-time psychiatrist, Dr. John Costigan.
    "She insisted she was not having thoughts of hurting herself," Costigan told the Sun-Times. "This was a girl who was giving a lot of mixed messages. I was thinking maybe she needed a different level of care.'' Costigan said he has been told "there may have been information that wasn't given to me. If there was stuff that wasn't told to me that should have been told to me, would things have been different for her? I don't know. That's all conjecture."

Smyth's Clout Has Grown With Maryville
Chris Fusco & Tom Novak, Chicago Sun Times- 9/8/2002

The Rev. John P. Smyth can be found on golf courses across the Chicago area about two dozen times a year, but he hates the game. "I hate it. I don't golf. I stand there like an idiot and shake everybody's hands," Smyth said. So why does he do it? To raise $1.4 million to send 200 kids to college. His kids. Smyth, 68, has taken on the nurturing role of a father to thousands of children since 1962, when he arrived on Maryville Academy's main campus in Des Plaines. It was his first job as a priest. Eight years later, he was running the place. And he still is. "When I took over Maryville, there was nothing," said Smyth, who grew up on Chicago's Northwest Side. "Cardinal [John] Cody said sink or swim.''
    The former Notre Dame basketball star who turned down a chance to play pro ball has built an incredible legacy, endearing himself to the state's politicians, industrialists, union leaders and newspaper columnists. "I was there in 1966 when it was just a couple of cold buildings. [Smyth] got those homes built. He raised the money," said Jimmy Lago, a former child-welfare worker who now is chancellor of the Archdiocese of Chicago, which oversees Maryville.
    Twenty-five years ago, Smyth got $1.5 million from the state to run Maryville. Over the years, he has added new facilities and locations for crack babies, pregnant teens, developmentally disabled children and other abused and neglected children. Today, Maryville receives $63 million a year from taxpayers to serve as many as 500 kids a day at 22 facilities. As the state funds have poured in, so have private donations, including estates people have left him, ticket sales from golf outings and the Chuckwagon, the carnival-like event held at Maryville's City of Youth campus every summer. It has helped Smyth amass a $130 million endowment as of last year. Most of that money is invested in stocks, bonds and securities. Smyth taps into his organization's money for about $1 million each year to pay tuition bills for the small percentage of Maryville kids accepted into colleges.
    Those who aren't, he at least tries to set on the straight and narrow. That has become harder to do at Maryville. For the first time in his 40 years at Maryville, state officials are knocking Smyth's program, saying his family-teaching model exacerbates violent behavior among the ever-increasing number of mentally ill kids he gets from the Illinois Department of Children and Family Services. "He doesn't like people watching over him,'' said DCFS Director Jess McDonald.
    Actually, many people, including DCFS officials, say Smyth wields so much power in state government that he, not McDonald, actually runs the state's child welfare system. Those people point to Smyth's close relationships with politicians such as his former seminary classmate Phil Rock. Maryville's state funding soared during the 1980s, while Rock was president of the Illinois Senate and, at the same time, on Maryville's board of directors. "Smyth can get the governor on the phone faster than Jess can,'' said one child-welfare expert.
    McDonald doesn't deny that Smyth wields enormous influence over the child-welfare system--clout that allowed Smyth to operate under far fewer rules than most other providers. Until last month, Smyth had the power to transfer kids from one Maryville facility to another without consulting DCFS, something non-Catholic child care agencies were not permitted to do "There's a perception that Father Smyth has undue influence all over the place,'' McDonald said. "He has historically been a huge force in child welfare. He has unusual stature from years and years of doing work before there was a DCFS. He has influence in so many areas that other providers don't enjoy. He has earned it.'' Such power also has instilled fear. "It is my belief that if I ever infuriated him, he could have made a call and I'd be out of a job that day,'' said a former top DCFS official. "This is a guy that could raise enough muscle to raise people out of significant positions at DCFS. But I don't think he's that kind of guy."
    Indeed, many people portray Smyth as a gentle giant. He's someone who will put an arm around a kid's shoulder and take him outside to shoot jump shots on the basketball court. It is evident by visiting the Des Plaines campus, where guests are greeted by a statue of Smyth tossing a boy into the air. It was designed by the same sculptor who crafted the Michael Jordan statue outside the United Center.
    Smyth also bestows awards upon major benefactors and friends. The award is a smaller statue of Smyth tossing a child. Gov. Ryan got one this summer, a few weeks after he agreed that Smyth could have another $4.5 million despite the state's money crunch. Ryan also has given Maryville money from his political campaign fund. When the governor decided to cleanse his fund of the $175,000 in tainted donations he got from the licenses-for-bribes scandal, he gave $25,000 to Maryville. Smyth said he had no problems taking the money. Likewise, Smyth gladly accepted $8,000 from Rosemont Mayor Donald E. Stephens last year when Stephens wanted to give away campaign donations from a former friend charged with federal crimes. "I've never run from people,'' Smyth said. "I know Donald Stephens because he's been out here 40 years. If he wants to give a gift to Maryville . . . I'm proud of that.''
    Smyth recently had a quadruple bypass and now spends three days a week in cardiac rehab at Holy Family Hospital. Despite the troubles at the main campus and efforts by child-welfare advocates to reform Maryville, Smyth says he has no plans to retire. He wants Maryville to continue to care for children just as it has since 1883. "What do these kids need?" Smyth said. "Their ego has to be built up. They have to learn how to trust. They have to learn they have God-given talents."

Blunt-Talking Professor Stirred up Maryville Plot
Chris Fusco & Tom Novak, Chicago Sun Times- 9/9/2002

Ronald H. Davidson has been called "the hatchet man" or the "junkyard dog" for the state's child-welfare chief. Depending on whom you talk to, he's also the man to blame for many of the problems at Maryville Academy or the man who will save the place. Davidson, 58, is director of the University of Illinois at Chicago's mental-health policy program. For the last eight years, the Illinois Department of Children and Family Services has employed him to examine 175 child-care facilities, including several out-of-state sites where the state was shipping its most troubled kids.
    What Davidson found at the out-of-state facilities shocked him. Wards of the state were in deplorable conditions, he said, and getting virtually no help. Meanwhile, taxpayers were paying exorbitant costs for their care. Davidson wrote dozens of hard-hitting reports that led to the closing of several facilities and brought back nearly 800 wards of the state. "We zeroed-out the out-of-state scandal," Davidson said. "For 25 years, Illinois had been hiding its children under other states' rugs."
    Child-welfare programs in Illinois, he said, had grown "fat and happy" serving kids who would now be placed in less restrictive, and less costly, foster homes. That kind of blunt talk has earned him a reputation in the child-welfare world. "He is known as [DCFS Director] Jess McDonald's institutional proctologist. He's very bright, very aggressive," said Brooke Whitted, a lawyer who often does work for Maryville. "He doesn't hesitate to write a negative report about his own employer if he feels that's what the kids need. He's the kind of guy you want." Said McDonald: "It's his job to find something wrong. It's our job to correct it. That's the harder job."
    In May 2001, at McDonald's suggestion, Maryville's executive director, the Rev. John P. Smyth, called in Davidson to do a review. DCFS officials had been noticing increasing violence in the Maryville system. The review was sparked by the increased number of mentally disturbed kids taken in by Maryville since the state curtailed out-of-state placements. Maryville was not retooling its programs to meet those kids' needs, DCFS said.
    "He's the hatchet man. He goes out and closes things for DCFS," Smyth said. "I wanted Ron Davidson to come in here and rip Maryville apart." Davidson did. He and his staff observed two Maryville campuses in suburban Des Plaines--its flagship City of Youth and the smaller Scott Nolan Center. They documented examples of kids fighting kids, kids fighting staff and, in their view, a general loss of control at both campuses.
    The first incident Davidson saw at Nolan convinced him Smyth's method for treating kids, called the family teaching model, didn't work for youths in need of psychiatric care. The model, Davidson concluded, has a way of exacerbating violence because it doesn't take into account the structure that mentally ill kids need or their propensity to disobey authority.
    In the Nolan incident, a youth disrupting a therapy session was banging on a door as a staff member told him he was being disrespectful. "She's continuing to talk, and he's continuing to pound," Davidson recalled. "He then proceeds to march in to the day room with staff, of course, following him and teaching to him as he goes. "He sits down in front of the TV, reaches for the clicker and turns on the TV. The staff, of course, are continuing to teach to him and, by now, they're joined by at least two other staff. Every time they attempt to say something, the volume goes up another notch . . . Teach, teach, teach. Click, click, click . . . to the point where the TV is at its loudest. "The remote control was a lovely metaphor because he was teaching to us . . . that he was the one that was in control of this unit."
    Now, based on work that Davidson has done and Smyth has praised, a new treatment model is in place at Nolan and a new psychiatrist is running the place. The family teaching model has been replaced with a program to organize virtually every minute of a kid's day. All staff were retrained. Surveys of employees now show they feel more safe and in control at Nolan. DCFS chief McDonald also sees the reforms working.
    Smyth plans to bring similar changes to two of the 27 group homes on his main campus, said Davidson, who envisions a psychiatrist associated with UIC eventually being brought in to run Maryville. Maryville then could become a training ground for future mental health professionals, making use of interns, medical and other graduate students. "I want to get this facility to the point a year from now where we can start attracting trainees and treating it as a learning center for professional education," Davidson said. "There are thousands of people across this state thankful for what Father Smyth has done over the past 40 years. My name is at the top of the list. "Maryville is too important an institution to let it fail, and I do not intend to let it fail." Smyth remains 'part of solution'
    Friday's Sun-Times article on Maryville accurately set forth some problems and issues at that facility. But the real question is whether any other facility or any other program could deal with these very disturbed children in a better fashion. Until five years ago, Father Smyth ran what was easily the best child-care facility in Illinois and probably the nation. But he was caring for relatively normal state wards. Then the Illinois Department of Children and Family Services argued, with some justification, that out-of-state psychiatric facilities into which the agency had dumped hundreds of children were doing a very poor job, and at great taxpayer expense, of caring for these children. They brought the kids back to Illinois and refused to send other children, equally traumatized, out of state. To exacerbate the crisis that was about to occur, Illinois had been gradually shuttering all state-supported psychiatric facilities for youngsters. So at that point, DCFS was stuck with scores of emotionally disturbed children and no place to put them.
    These children were thus on a greased path heading right toward the Illinois state penal system. Into this breach stepped Father Smyth. DCFS did not give Father Smyth additional resources; nor did he ask for them. Father Smyth, perhaps rightfully and perhaps wrongfully, felt that he and his staff at Maryville could give these youngsters something they had never experienced in their life: unconditional love and support. He believed that this would assist in turning the kids around. Perhaps more importantly, Father Smyth was the provider of last resort, other than the streets or the prisons.
    The past for most of these children, before they came to Maryville, was that they had been horribly abused, neglected and abandoned by their parents, and then in many cases, more abused and neglected by DCFS' child welfare system. Many have been in more than 20 foster placements, and not a few have been abused in those foster placements. The fact that they became embroiled in altercations and/or exhibited self-destructive tendencies is not exactly a shocking disclosure.
    And of course, there is a future for these children. As far as I know, none of the seriously disturbed children that Maryville has assisted in the last several years has ended up in the penitentiary. None is homeless. Some are in college. Some are working, and some are grappling to make productive lives for themselves.
    In other words, we have given Father Smyth and Maryville the most difficult, uncared for and abused children in our child welfare system, and when the kids act out, as act out they will and should, we somehow think that Father Smyth and Maryville are part of the problem. Frankly, Father Smyth and Maryville have been part of the solution--no, they have been the only solution. Had they not been there, at least in my judgment, the situation would have been far worse.
    Recognizing some of the problems at Maryville, we suggested that Father Smyth plug in a clinical component which, with DCFS' help, he agreed to do. But, frankly, that clinical component is only a tiny part. More than anything else, these children want what only Father Smyth and the Maryville staff have provided: unconditional love and support. If that is taken away, the clinical program will be an absolute disaster. But as long as Father Smyth remains on the job, the children in this state who need him the most will be well taken care of.

Adventuresome Singles Can Try Psychotherapy's TheraDate
David Crary, Associated Press, 9/9/2002

NEW YORK -- Undeterred by the qualms of many experts, a New York psychoanalyst is trying to create a dating service in which men and women would be matched up by people who know them intimately their therapists. The service, which is signing up clients but not yet pairing them, is open only to people undergoing psychotherapy. In contrast to standard, self-composed dating pitches ''great sense of humor, loves the outdoors'' clients of TheraDate will be assessed on such factors as obsessiveness, defense mechanisms and nervous tics.
    TheraDate's creator, Frederick Levenson, is convinced such data, obtained from confidential questionnaires completed by a client's therapist, can be the building blocks for compatible long-term relationships. He also believes that people in therapy are attracted to others with similar experiences. ''The smartest people are the ones in therapy,'' he said. ''They're wonderful people, very bright, very funny.''
    TheraDate would operate initially in New York City and Los Angeles, and possibly expand later assuming enough clients enroll. More than 200 people in each city have applied since March, but Levenson says matchmaking won't begin until the two pools of singles reach 750. Charter members are paying $800 each, to be refunded if too few clients join, and the annual fee would be $2,000 for those signing up after operations start. TheraDate, which plans to offer up to eight dates annually, is restricted to people who have undergone therapy within the past two years. They must gain the cooperation of their therapist, who fills out the questionnaire and submits it to TheraDate therapists who will do the matchmaking.
    Some mental health experts suggest that assisting in matchmaking for a client, even indirectly, is an improper role for a therapist. ''It's supposed to be a solitary, straightforward relationship,'' said Stanford University psychologist Thomas Nagy. ''The moment a therapist moves into some secondary role like acting as a facilitator for a dating service it can play havoc with the relationship.'' Nagy, who chaired an ethics task force for the American Psychological Association, said TheraDate might produce some happily-ever-after marriages but also some damaging encounters. ''We're always looking at worst-case scenarios,'' he said. ''That's where ethics violations come, where lawsuits come.''
    Levenson rejects any suggestion that TheraDate would be unethical, saying its questionnaires are comparable to forms that therapists routinely submit to clients' health insurance companies. He attributes his peers' skepticism to excessive caution, and contends that therapists should be more engaged in efforts to curb divorce and promote happier marriages. ''We have developed something that can be so helpful to this country not to do it would be unethical,'' Levenson said. ''All we need now is for the mental health profession to recognize that we can provide a service and stop scoffing at new ideas.''
    A basic premise of TheraDate is that similarities attract, even if that means having similar problems. ''Statistically, 'opposites attract' is a myth,'' Levenson said. ''Similarity of psychodynamics is what makes for good chemistry, and other dating services have no way of getting at it.'' TheraDate's questionnaires seek information about sexual attitudes and relations with parents. They also ask therapists if a client's sense of humor is sarcastic, if an interest in sports is obsessive. Other questions seek to eliminate applicants with violent tendencies or serious emotional disturbances.
    Levenson says he can't guarantee that all ''bad apples'' will be uncovered in advance, but he believes TheraDate will screen more effectively than traditional dating services. He also is heartened that numerous therapists who routinely undergo therapy themselves have signed up as clients.
    Stanley Woll, a psychologist at California State-Fullerton who has studied matchmaking, agreed with Levenson that similarities attract. ''But I'm not as confident that the therapist has better understanding of what a client is suited for in terms of dating,'' Woll said. ''Maybe it's good to match an obsessive with an obsessive, but that doesn't seem obvious to me.''
While therapy clients as a whole tend to be wealthy, Levenson says TheraDate will welcome members who obtain low-cost therapy, perhaps through a religious counselor or a public health clinic. ''We've got applicants who are police officers and nurses, and someone who's worth $43 million and worried that everyone he meets is after his money,'' Levenson said.
    Levenson is confident that TheraDate's matchmaking formula will work he has tested it in blind studies using the psychological profiles of happily married spouses. However, he knows some dates will end unhappily and says that prospect shouldn't deter therapists from participating. ''Therapists get blamed for everything anyway,'' he said. ''We're supposed to be grown-ups who can handle that.'' On the Net: TheraDate: http://www.theradate.com

Massachusetts Budget Cuts End Free Mental Health Care For Poor
Associated Press, 9/9/2002

BOSTON -- Free mental health services for most of the state's working poor have been terminated as part of $13.8 million in cuts to the Department of Mental Health budget. For decades, low-income workers could obtain free therapy if they had depression, anxiety or anger management problems. Now, Commissioner Marylou Sudders has ordered community health centers to provide free services only to the severely mentally ill. That means depressed mothers, recently released inmates and illegal immigrants, who cost the state $1.8 million a year in services, will no longer benefit from gratis mental health care.
    The services are currently used by 800 Boston residents, but the community clinics are no longer accepting new clients, Kenneth Duckworth, the department's medical director, told The Boston Globe. New clients or those with illnesses not severe enough will be referred to private care, he said. ''The whole system of community care for people with mental illness is being dismantled, and the impact is going to last for generations,'' said Dr. Mary Ann Badaracco, chief of psychiatry at Beth Israel Deaconess Medical Center. Some say patients required to go to private care providers will cease treatment. ''My experience is what happens is people don't take the referrals,'' Sudders said. ''They say, 'We will manage the best we can'.''

Connecticut Creates Mental Health Crisis Teams
Susan Haigh, Associated Press- 9/9/2002

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

Abuse Victims Need Plan Before Leaving Home
Pamela Yip, Knight Ridder Tribune- 9/9/2002

DALLAS -- For Thelma, attaining financial independence felt like a matter of life and death. She was in an abusive marriage, and it was crucial that she save enough money so she could leave and whisk herself and her two children to safety and a new life. But she faced a formidable obstacle: her husband. "He controlled everything in the family," said Thelma, who doesn't want her last name used because she's still in hiding from her husband.
    Financial dependence is a key factor for women in abusive relationships, domestic violence experts say. "That and fear are probably the two main reasons a woman stays," said Paige Flink, executive director of the Family Place in Dallas, which provides services to domestic violence victims. "The control of finances is a huge issue."
    It's essential that women reclaim their financial lives so they gain the ability and confidence to leave the abuser, experts say. "Our hope is that as women start to reclaim their financial lives, they will be empowered to reclaim the rest of their lives as well," said William Anthes, president of the National Endowment for Financial Education, which educates consumers about personal finance.
    But before you take any action, keep in mind one overarching point: Your safety and the safety of your children come first. Don't do anything that would further endanger you and your children. "When you're in a situation like that, you cannot save," Thelma said. "A lot of us leave with the clothes on our back." That's what happened to her and her two children when they left their home a year ago.
    If you can safely do so, begin building up resources. Start saving as much you can in a separate bank account that's in your name only. Or stash some cash with a trusted friend or relative. "I have them start with small steps, and that is to open a checking account and start putting away -- even it's $5 a week, just so they can see something grow and gain some confidence," said Lauren De Cillis, director of the Galerstein Women's Center at the University of Texas at Dallas. Open a post office box and have your own bank statements sent there. "Every woman should have some money of her own, no matter what the situation is," Anthes said. "Being financially independent gives women more options." If your abuser gives you shopping money, pocket any money you save. "If you are paid in cash or tips, hide the money," Anthes said.
    If you're not employed, "take a job, any kind of job, to develop a work history, to develop a habit and to develop resources that maybe you can salt away a little at a time," De Cillis said. But it's not that easy. "One of the financial issues facing women who are trying to escape abusive relationships is that the abuser frequently compromises their ability to earn income by making it difficult for them to be successfully employed," said Kerrin Darkow, coordinator of the Family Violence Response Program at Mercy Medical Center in Baltimore. That's a common strategy abusers use, says Jan Langbein, executive director of Genesis Women's Shelter in Dallas. Thelma's husband insisted that she tell him how much she earned and that she pay all the household bills.
    Have an emergency evacuation box that contains key legal documents such as birth certificates, Social Security cards, financial statements, medical records and insurance policies. "You're going to need those documents to open bank accounts, to get government assistance," said Sally Daniels, clinical coordinator of the Supportive Living program at the Family Place. The documents also will help thwart abusers' efforts to prevent victims from starting a life of their own, experts say. Put your emergency evacuation box in a safe place where you can quickly grab it when you leave. Another way is to put important documents in a bank safe deposit box.
    In the meantime, take a financial inventory. All women should know the status of their family's finances, but women in abusive relationships have an even more urgent need to know what they own and what they owe. Make a list of everything you own alone and with your abuser. Also, list debts you have in both names. In a divorce, the information will help you get a fair settlement. You're not alone in your dilemma, although you may feel like it. You can call the National Domestic Violence Hot Line, 800-799-7233.

A Secret Society of the Starving
Mim Udovitch, New York Times Magazine- 9/8/2002

Claire is 18. She is a pretty teenager, with long strawberry-blond hair, and she is almost abnormally self-possessed for a girl from a small town who has suddenly been descended upon by a big city reporter who is there to talk to her, in secret, about her secret life. She is sitting on the track that runs around the field of her high school's football stadium, wearing running shorts and a T-shirt and shivering a little because even though we are in Florida -- in the kind of town where, according to Claire, during "season" when you see yet another car with New York plates, you just feel like running it down -- there's an evening chill.
    Claire's is also the kind of town where how the local high school does in sports matters. Claire herself plays two sports. Practice and team fund-raisers are a regular part of her life, along with the typical small town-Florida teenage occupations -- going to "some hick party," hanging out with friends in the parking lot of the Taco Bell, bowling, going to the beach. Another regular part of her life, also a common teenage occupation, is anorexia -- refusal to eat enough to maintain a minimally healthy weight. So she is possibly shivering because she hasn't consumed enough calories for her body to keep itself warm. Claire first got into eating disorders when she was 14 or 15 and a bulimic friend introduced her to them. But she was already kind of on the lookout for something: "I was gonna do it on my own, basically, just because, like, exercise can only take you so far, you know? And I don't know, I just started to wonder if there was another way. Because they made it seem like, `You do drugs, you die; be anorexic and you're gonna die in a year.' I knew that they kind of overplayed it and tried to frighten you away. So I always thought it can't be that bad for you."
    Bulimia -- binge eating followed by purging through vomiting or laxatives -- didn't suit her, however, so after a little while she moved onto anorexia. But she is not, by her own lights, anorexic. And her name isn't Claire. She is, in her terms, "an ana" or "pro-ana" (shortened from pro-anorexia), and Claire is a variation of Clairegirl, the name she uses on the Web sites that are the fulcrum of the pro-ana community, which also includes people who are pro-mia (for bulimia) or simply pro-E.D., for eating disorder.
    About one in 200 American women suffers from anorexia; two or three in 100 suffer from bulimia. Arguably, these disorders have the highest fatality rates of any mental illness, through suicide as well as the obvious health problems. But because they are not threatening to the passer-by, as psychotic disorders are, or likely to render people unemployable or criminal, as alcoholism and addiction are, and perhaps also because they are disorders that primarily afflict girls and women, they are not a proportionately imperative social priority.
    They have been, however, topics of almost prurient media fascination for more than 20 years -- regularly the subject of articles in magazines that have a sizable young female readership. In these forums, eating disorders are generally depicted as fundamentally body-image disorders, very extreme versions of the non-eating-disordered woman's desire to be thin, which just happen, rivetingly, to carry the risk of the ultimate consequence. "So many women who don't have the disorder say to me: `Well, what's the big deal? It's like a diet gone bad,"' says Ellen Davis, the clinical director of the Renfrew Center of Philadelphia, an eating disorder treatment facility. And it is so different from that; women  with the vulnerability, they really fall into an abyss, and they can't get out. And it's not about, `O.K., I want to lose the 10 pounds and go on with my life.' It's, `This has consumed my entire existence."'
    And now there's pro-ana, in many ways an almost too lucid clarification of what it really feels like to be eating disordered. "Pain of mind is worse than pain of body" reads the legend on one Web site's live-journal page, above a picture of the Web mistress's arm, so heavily scored with what look like razor cuts that there is more open wound than flesh. "I'm already disturbed," reads the home page of another. "Please don't come in." The wish to conform to a certain external ideal for the external ideal's sake is certainly a component of anorexia and bulimia. But as they are experienced by the people who suffer from them, it is just that: a component, a stepping-off point into the abyss.
    As the girls (and in smaller numbers, boys) who frequent the pro-E.D. sites know, being an ana is a state of mind -- part addiction, part obsession and part seesawing sense of self-worth, not necessarily correlating to what you actually weigh. "Body image is a major deal, but it's about not being good enough," says Jill M. Pollack, the executive director of the Center for the Study of Anorexia and Bulimia, "and they're trying to fix everything from the outside." Clairegirl, like many of the girls who include their stars --height, weight and goal weight -- when posting on such sites, would not receive a diagnosis of anorexia, because, she is not 15 percent under normal weight for her height and age.
    But she does have self-devised rules and restrictions regarding eating, which, if she does not meet them, make her feel that she has erred -- "I kind of believe it is a virtue, almost," she says of pro-ana. "Like if you do wrong and you eat, then you sin." If she does not meet her goals, it makes her dislike herself, makes her feel anxiety and a sense of danger. If she does meet them, she feels "clean." She has a goal weight, lower than the weight she is now. She plays sports for two hours a day after school and tries to exercise at least another hour after she gets home. She also has a touch of obsessive-compulsive disorder regarding non-food-related things -- cleaning, laundry, the numeral three: ("Both anorexia and bulimia are highly O.C.D.," says Pollack. "Highly.)
    And she does spend between one and three hours a day online, in the world of pro-ana. Asked what she likes best about the sites, Claire says: "Just really, like at the end of the day, it would be really nice if you could share with the whole world how you felt, you know? Because truthfully, you just don't feel comfortable, you can't tell the truth. Then, like, if I don't eat lunch or something, people will get on my case about it, and I can't just come out and tell them I don't eat, or something like that. But at the end of the day, I can go online and talk to them there, and they know exactly what I'm going through and how I feel. And I don't have to worry about them judging me for how I feel."
    Pro-Ana, the basic premise of which is that an eating disorder is not a disorder but a lifestyle choice, is very much an ideology of the early 21st century, one that could not exist absent the anonymity and accessibility of the Internet, without which the only place large numbers of anorexics and bulimics would find themselves together would be at inpatient treatment. "Primarily, the sites reinforce the secretiveness and the `specialness' of the disorder," Davis says. "When young women get into the grips of this disease, their thoughts become very distorted, and part of it is they believe they're unique and special. The sites area way for them to connect with other girls and to basically talk about how special they are. And they become very isolated. Women with eating disorders really thrive in a lot of ways on being very disconnected. At the same time, of course, they have a yearning to be connected."
    Perfectionism, attention to detail and a sense of superiority combine to make the pro-ana sites the most meticulous and clinically fluent self-representations of a mental disorder you could hope to find, almost check lists of diagnostic criteria expressed in poignantly human terms. Starving yourself, just on the basis of its sheer difficulty, is a high-dedication ailment -- to choose to be an ana, if choice it is, is to choose a way of life, a hobby and a credo. And on the Web, which is both very public and completely faceless, the aspects of the disorder that are about attention-getting and secret-keeping are a resolved paradox. "I kind of want people to understand," Clairegirl says, "but I also like having this little hidden thing that only I know about, like -- this little secret that's all yours."
    Pro-ana has its roots in various newsgroups and lists deep inside various Internet service providers. Now there are numerous well-known-to-those-who-know sites, plus who knows how many dozens more that are just the lone teenager's Web page, with names that put them beyond the scope of search engines. And based on the two-week sign-up of 973 members to a recent message-board adjunct to one of the older and more established sites, the pro-ana community probably numbers in the thousands, with girls using names like Wannabeboney, Neverthinenuf, DiETpEpSiUhHuh! and Afraidtolookinthemirror posting things like: "I can't take it anymore! I'm fasting! I'm going out, getting all diet soda, sugar-free gum, sugar-free candy and having myself a 14-day fast. Then we'll see who is the skinny girl in the family!"
    That ana and mia are childlike nicknames, names that might be the names of friends (one Web site that is now defunct was even called, with girlish fondness, "My Friend Ana"), is indicative. The pro-ana community is largely made up of girls or young women, most of whom are between the ages of 13 and 25. And it is a close community, close in the manner of close friendships of girls and young women. The members of a few sites send each other bracelets, like friendship bracelets, as symbols of solidarity and support. And like any ideology subscribed to by many individuals, pro-ana is not a monolithic system of belief.
    At its most militant, the ideology is something along the lines of, as the opening page of one site puts it: "Volitional, proactive anorexia is not a disease or a disorder. . . . There are no VICTIMS here. It is a life style that begins and ends with a particular faculty human beings seem in drastically short supply of today: the will. . . . Contrary to popular misconception, anorectics possess the most iron-cored, indomitable wills of all. Our way is not that of the weak. . . . If we ever completely tapped that potential in our midst . . . we could change the world: Completely. Maybe we could even rule it."
    Mostly, though, the philosophical underpinnings of pro-ana thought are not quite so Nietzschean. The "Thin Commandments" on one site, which appear under a picture of Bugs Bunny smiling his toothy openmouthed smile, leaning against a mailbox and holding a carrot with one bite taken out of it, include: "If thou aren't thin, thou aren't attractive"; "Being thin is more important than being healthy"; "Thou shall not eat without feeling guilty"; "Thou shall not eat fattening food without punishing thyself afterward"; and "Being thin and not eating are signs of true willpower and success." The "Ana Creed" from the same site begins: "I believe in Control, the only force mighty enough to bring order into the chaos that is my world. I believe that I am the most vile, worthless and useless person ever to have existed on this planet."
    In fact, to those truly "in the disorder" -- a phrase one anonymous ana used to describe it, just as an anonymous alcoholic might describe being in A.A. as being "in the rooms" -pro-ana is something of a misnomer. It suggests the promotion of something, rather than its defense, for reasons either sad or militant. That it is generally understood otherwise and even exploited ("Anorexia: Not just for suicidal teenage white girls anymore" read the home page of Anorexic Nation, now a disabled site, the real purpose of which was to push diet drugs) is a source of both resentment and secret satisfaction to the true pro-ana community. Its adherents might be vile and worthless, but they are the elite.
    The usual elements of most sites are pretty much the same, although the presentation is variable enough to suggest Web mistresses ranging from young women with a fair amount of programming know-how and editorial judgment to angry little girls who want to assert their right to protect an unhealthy behavior in the face of parental opposition and who happen to know a little HTML. But there are usually "tips" and "techniques" -- on the face of it, the scariest aspect of pro-ana, but in reality, pretty much the same things that both dieters and anorexics have been figuring out on their own for decades. There are "thinspirational" quotes - "You can never be too rich or too thin"; "Hunger hurts but starving works"; "Nothing tastes as good as thin feels"; "The thinner, the winner!" There are "thinspirational" photo galleries, usually pretty much the same group of very thin models, actresses and singers - Jodie Kidd, Kate Moss, Calista Flockhart, Fiona Apple. And at pro-ana's saddest extreme, balancing the militance on the scales of the double-digit goal weight, there are warnings of such severity that they might as well be the beginning of the third canto of Dante's "Inferno": "I am the way into the city of woe. I am the way to a forsaken people. I am the way into eternal sorrow"
    The pro-ana version of which, from one site, is: "PLEASE NOTE: anorexia is NOT a diet. Bulimia is NOT a weight-loss plan. These are dangerous, potentially life-threatening DISORDERS that you cannot choose, catch or learn. If you do not already have an eating disorder, that's wonderful! If you're looking for a new diet, if you want to drop a few pounds to be slimmer or more popular or whatever, if you're generally content with yourself and just want to look a bit better in a bikini, GO AWAY. Find a Weight Watchers meeting. Better yet, eat moderate portions of healthy food and go for a walk. However, if you are half as emotionally scarred as I am, if you look in the mirror and truly loathe what you see, if your relationships with food and your body are already beyond "normal" parameters no matter what you weigh, then come inside. If you're already too far into this to quit, come in and have a look around. I won't tell you to give up what I need to keep hold of myself."
    Most of the pro-ana sites also explicitly discourage people under 18 from entering, partly for moral and partly for self-interested reasons. Under pressure from the National Eating Disorders Association, a number of servers shut down the pro-ana sites they were hosting last fall. But obviously, pretty much anyone who wanted to find her way to these sites and into them could do so, irrespective of age. And could find there, as Clairegirl did, a kind of perverse support group, a place where a group of for the most part very unhappy and in some part very angry girls and women come together to support each other in sickness rather than in health.
    Then there's Chaos -- also her Web name -- who like her friend Futurebird (ditto) runs an established and well-respected pro-E.D. site. Chaos, whom I met in Manhattan although that's not where she lives, is a very smart, very winning, very attractive 23-year-old who has been either bulimic or anorexic since she was 10. Recently she's been bingeing and purging somewhere between 4 and 10 times a week. But when not bingeing, she also practices "restricting" -- she doesn't eat in front of people, or in public, or food that isn't sealed, or food that she hasn't prepared herself, or food that isn't one of her "safe" foods, which since they are a certain kind of candy and a certain kind of sugar-free gum, is practically all food. ("You're catching on quickly," she says, laughing, when this is remarked on.) Also recently, she has been having trouble making herself throw up. "I think my body's just not wanting to do it right now," she says. "You have the toothbrush trick, and usually I can just hit my stomach in the right spot, or my fingernails will gag me in the right spot. It just depends on what I've eaten. And if that doesn't work, laxis always do."
    Chaos, like Clairegirl, is obsessive-compulsive about a certain number (which it would freak her out to see printed), and when she takes laxatives she either has to take that number of them, which is no longer enough to work, or that number plus 10, or that number plus 20, and so forth. The most she has ever taken is that number plus 60, and the total number she takes depends on the total number of calories she has consumed.
    While it hardly needs to be pointed out that starving yourself is not good for you, bulimia is in its own inexorable if less direct way also a deadly disorder. Because of the severity of Chaos's bulimia, its long-standing nature and the other things she does -- taking ephedra or Xenadrine, two forms of, as she says, "legal speed," available at any health food or vitamin store; exercising in excess; fasting -- she stands a very real chance of dying any time. As it is; she has been to the emergency room more than half a dozen times with "heart things." It would freak her out to see the details of her heart things in print. But the kinds of heart things a severe bulimic might experience range from palpitations to cardiac arrest. And although Chaos hasn't had her kidney function tested in the recent past, it probably isn't great. Her spleen might also be near the point of rupturing.
    Chaos is by no means a young woman with nothing going for her. She has a full-time job and is a full-time college student, a double major. She can play a musical instrument and take good photographs. She writes beautifully, well enough to have won competitions. But despite her many positive attributes, Chaos punishes herself physically on a regular basis, not only through bulimia but also through cutting - hers is the live-journal page with the picture of the sliced-up arm. To be beheld is, to Chaos, so painful that after meeting me in person, she was still vomiting and crying with fear over the possible consequences of cooperating with this story a week later. "Some days," she says of her bulimia, "it's all I have."
    One thing that she does not have is health insurance, so her treatment options are both limited and inadequate. So with everything she has going for her, with all her real-world dreams and aspirations, the palpitating heart of her emotional life is in the pro-E.D. community. As another girl I spoke with described herself as telling her doctors: "Show me a coping mechanism that works as well as this and I'll trade my eating disorder for it in a minute."
    And while in some moods Chaos says she would do anything to be free of her eating disorders, in others she has more excuses not to be than the mere lack of health insurance: she has a job, she is in school, she doesn't deserve help. And what she has, on all days, is her Web site, a place where people who have only their eating disorders can congregate, along with the people who aspire to having eating disorders -- who for unknowable reasons of neurochemistry and personal experience identify with the self-lacerating worlds of anorexia and bulimia.
    Futurebird, whom I also met in Manhattan, says that she has noticed a trend, repeating itself in new member after new member, of people who don't think they're anorexic enough to get treatment. And it's true, very much a function of the Internet -- its accessibility, its anonymity --that the pro-ana sites seem to have amplified an almost diagnostic category: the subclinical eating disorder, for the girl who's anorexic on the inside, the girl who hates herself so much that she forms a virtual attachment to a highly traumatized body of women, in a place where through posts and the adoption of certain behaviors, she can make her internal state external.
    Futurebird and Chaos are sitting in a little plaza just to the south of Washington Square Park, with the sun behind them. Futurebird is a small African-American woman. As she notes, and as she has experienced when being taken to the hospital, it is a big help being African-American if you don't want people to think you have anorexia, which is generally and inaccurately considered to be solely an affliction of the white middle class. Futurebird has had an eating disorder since she was in junior high school and is now, at 22, looking for a way to become what you might call a maintenance anorexic -- eating a little bit more healthily, restricting to foods like fruits and whole-grain cereal and compensating for the extra calories with excessive exercising.
    Like Chaos, she is opposed, in principle, to eating disorders in general and says that she hates anorexia with a blind and burning hatred. AIthough she also says she thinks she's fat, which she so emphatically is not that in the interest of not sounding illogical and irrational, she almost immediately amends this to: she's not as thin as she'd like to be. Both she and Chaos would vigorously dispute the assertion that the sites can give anyone an eating disorder. You certainly can't give anyone without the vulnerability to it an eating disorder. But many adolescent girls teeter on the edge of vulnerability. And the sites certainly might give those girls the suggestion to . . . hey, what the hell, give it a try.
    "What I'd like people to understand," Futurebird says, "is that it is very difficult for people who have an eating disorder to ask for help. What a lot of people are able to do is to say, well, I can't go to a recovery site and ask for help. I can't go to a doctor or a friend and ask for help. I can't tell anyone. But I can go to this site because it's going to quote-unquote make me worse. And instead what I hope they find is people who share their experience and that they're able to just simply talk. And I've actually tested this. I've posted the same thing that I've posted on my site on some recovery sites, and I've read the reactions, and in a lot of ways it's more helpful."
    In what ways? "The main difference is that if you post -- if someone's feeling really bad, like, I'm so fat, et cetera, on a recovery site, they'll say, that's not recovery talk. You have to speak recovery-speak." "Fat is not a feeling," Chaos says, in tones that indicate she is echoing a recovery truism. "And they'll use this language of recovery" Futurebird continues. "Which does work at some point in the negative thinking patterns that you have. But one tiny thing that I wish they would do is validate that the feeling does exist. To say, yes, I understand that you might feel that way. And you get not as much of that. A lot of times people just need to know that they aren't reacting in a completely crazy way."
    The problem is that by and large, the people posting on these sites are reacting in a completely crazy way. There are many, many more discussions answering questions like, "What do you guys do about starvation headaches?" than there are questions like, "I am feeling really down; can you help me?" And in no case, in answering the former question, does anyone say, "Um . . . stop starving yourself" A site like Futurebird's, or like the message board of Chaos's, are designed with the best intentions. But as everybody knows, that is what the way into the city of woe, the way to a forsaken people and the way into eternal sorrow are paved with.
    What Clairgirl, sitting shivering on the running track, would say today is that when she reaches her current goal weight, she will stay there. But she can't ever really see herself giving ana up altogether. "I don't think I could ever stop, like, wanting to not eat. Like, I could keep myself from eating below 300 calories a day. But I could never see myself eating more than 1,000," she says, wrapping her arms around her knees. "I consider myself to be one of the extreme dieters. Like, I could never want to be -- I mean, it would be so awesome to be able to say a double-digit number as your weight, but it would look sick, you know?" (Clairegirl is 5 feet 7 inches.)
    And what about the people on the pro-ana sites who are not so happy, who describe the disorder as a living hell, who are in very bad shape? "Those girls have been going at it a lot longer than me. But you can't ever really say that ana isn't a form of self-hatred, even though I try to say that. If I was truthfully happy with myself, then I would allow myself to eat. But I don't. And it's kind of like a strive for perfection, and for making myself better. So I can't honestly say there's no. . . " She trails off, and gazes up, as if the answer were written in the night sky, waiting to be decoded. "Like, you can't say that every ana loves herself and that she doesn't think anything is wrong with her at all," she says. "Or else she wouldn't be ana in the first place."

When Grief Takes Hold Of the Body
Robert Klitzman, M.D., New York Times- 9/10/2002

At 8:30 a.m. on Sept. 11, from her office on the 105th floor of the World Trade Center, my sister Karen talked to her best friend. No one ever heard from Karen again. Since then, her identical twin, Donna, my older sister, Sue, my mother and I have struggled with feelings of anxiety, depression, guilt and unfairness, as we seek to find understanding and "closure. " I thought my training as a psychiatrist would help, but it has been quite the opposite.
    The past year has forced me to cross the border from provider to patient, and it taught me how much I did not know.  I tried writing a eulogy, relating only the good parts of Karen's life, but I couldn't. With me, she was often headstrong and feisty, qualities that made her successful in business and tennis. Yet, I loved her -- her smile, exuberance and wit. Together, we had grown up and gone to birthday and holiday celebrations and to the opera. Still, it felt taboo to say that she was not a saint.
    Not until my sister Sue told me what she was going to say -- that Karen was not perfect but we loved her anyway -- was I able to write my speech, giving a full portrait of her as a person, able to write of her good qualities without seeming false, and able to refer to some of the difficulties in a loving way. I saw what I had been taught but never experienced or understood as much until now: that the grief over the loss of an ambivalent relationship can be far harder than the grief would be otherwise.
    In the first few weeks, I helped organize a memorial service and a fellowship in her name Then my body gave out. For three months, I could not sleep. As a result, I had a flu that would not leave me. I could not get out of bed and was not interested in reading books, seeing movies or listening to music. Yet I was surprised when friends told me they thought I was depressed. "No, I'm just sick," I said, resisting the idea. I had studied Freud, but suddenly, for the first time in my life, I had physical symptoms of depression. I was amazed at how much more related to the body than to the emotions the experience was -- how my body had just given way beneath me.
    For the first time, I fully appreciated what my patients had to undergo, how hard it is to put the experience of depression into words. It was also hard to accept that I had a mental illness. I felt weak and ashamed; and I appreciated, as well, the embarrassment and stigma my patients felt. I went to psychotherapy, memorial events, my temple, and for the first time a Buddhist service, and a psychic who claimed to communicate with Karen -- though as a physician, I was wary. I sat in Central Park, for the first time in my life doing nothing for hours. Traditionally, psychiatry teaches that psychotherapy alone is best for coping with loss. Psychiatrists still debate whether antidepressants may help or hurt the process of grief.
    Yet after weeks of insomnia and feeling down, I began taking an antidepressant. I felt weird medicating the loss; it would not bring her back. But I appreciated anything that might allay the pain. To my surprise, the medication helped. I thought of grief-stricken patients I had treated in my training and recalled that we were told not to prescribe any drugs. I now got more done, but it was still difficult. I had to sign a death certificate, and we had to peek up all her belongings and sell her apartment.
    I took her toothpaste, indented by her fingers, but as I used it up, felt sad again. I got her fax machine, yet had to delete her name and number, and type in my own, making me feel I was taking it away. As 12 months pass, we have debated what a fitting legacy for Karen would be, and how we should spend the anniversary. Should we go to ground zero or to the beach that she loved? I do not have any answers yet, but one thing I know: I, as a psychiatrist, will never be the same, or look the same way at the problems that patients or their families face with depression or grief. The difficulties were far more complicated and long-lasting than I would ever have imagined; closure has been far more elusive. The lessons were painful, but I am grateful for them.

Some Friends, Indeed, Do More Harm Than Good
Mary Duenwald, New York Times- 9/10/2002

Friends are supposed to be good for you. In recent years, scientific research has suggested that people who have strong friendships experience less stress, they recover more quickly from heart attacks and they are likely to live longer than the friendless. They are even less susceptible to the common cold, studies show.
    But not all friends have such a salutary effect. Some lie, insult and betray. Some are overly needy. Some give too much advice. Psychologists and sociologists are now calling attention to the negative health effects of bad friends. "Friendship is often very painful," said Dr. Harriet Lerner, a psychologist and the author of "The Dance of Connection." "In a close, enduring friendship, jealousy, envy, anger and the entire range of difficult emotions will rear their heads. One has to decide whether the best thing is to consider it a phase in a long friendship or say this is bad for my health and I'm disbanding it."
    Another book, "When Friendship Hurts," by Dr. Jan Yager, a sociologist at the University of Connecticut at Stamford, advises deliberately leaving bad friends by the wayside. "There's this myth that friendships should last a lifetime," Dr. Yager said. "But sometimes it's better that they end."
    That social scientists would wait until now to spotlight the dangers of bad friends is understandable, considering that they have only recently paid close attention to friendship at all. Marriage and family relationships -- between siblings or parents and children -- have been seen as more important. Of course, troubled friendships are far lass likely to lead to depression or suicide than troubled marriages are. And children are seldom seriously affected when friendships go bad. As a popular author of relationship advice books, Dr. Lerner said, "Never once have I had anyone write and say my best friend hits me."
    Dr. Beverley Fehr, a professor of psychology at the University of Winnipeg, noted that sociological changes, like a 50 percent divorce rate, have added weight to the role of friends in emotional and physical health. "Now that a marital relationship can't be counted upon for stability the way it was in the past, and because people are less likely to be living with or near extended family members, people are shifting their focus to friendships as a way of building community and finding intimacy," said Dr. Fehr, the author of "Friendship Processes."
    Until the past couple of years, the research on friendship focused on its health benefits. "Now we're starting to look at it as a more full relationship," said Dr. Suzanna Rose, a professor of psychology at Florida International University in Miami. "Like marriage, friendship also has negative characteristics." The research is in its infancy. Psychologists have not yet measured the ill effects of bad friendship, Dr. Fehr said. So far they have only through surveys and interviews figured out that it is a significant problem. The early research, Dr. Fehr added, is showing that betrayal by a friend can be more devastating than experts had thought.
    How can a friend be bad? Most obviously, Dr. Rose said, by drawing a person into criminal or otherwise ill-advised pursuit. "When you think of people who were friends at Enron," she added, "you can see how friendship can support antisocial behavior." Betrayal also makes for a bad friendship. "When friends split up," said Dr. Keith E. Davis, a professor of psychology at the University of South Carolina, "it is often in cases where one has shared personal information or secrets that the other one wanted to be kept confidential."
    Another form of betrayal, Dr. Yager said, is when a friend suddenly turns cold, without ever explaining why. "It's more than just pulling away," she said. "The silent treatment is actually malicious." At least as devastating is an affair with the friend's romantic partner, as recently happened to one of Dr. Lerner's patients. "I would not encourage her to hang in there and work this one out," Dr. Lerner said. A third type of bad friendship involves someone who insults the other person, Dr. Yager said.  One of the 180 people who responded to Dr. Yager's most recent survey on friendship described how, when she was 11, her best friend called her "a derogatory name." The woman, now 32, was so devastated that she feels she has been unable to be fully open with people ever since, Dr. Yager said,
    Emotional abuse may be less noticeable than verbal abuse, but it is "more insidious," Dr. Yager said. "Some people constantly set up their friends," she explained. "They'll have a party, not invite the friend, but make sure he or she finds out." Risk takers, betrayers and abusers are the most extreme kinds of bad friends, Dr. Yager said, but they are not the only ones. She identifies 21 different varieties. Occupying the second tier of badness are the liar, the person who is overly dependent, the friend who never listens, the person who meddles too much in a friend's life, the competitor and the loner, who prefers not to spend time with friends. Most common is the promise breaker. "This includes everyone from the person who says let's have a cup of coffee but something always comes up at the last minute to someone who promises to be there for you when you need them, but then isn't," Dr. Yager said.
    Some friendships go bad, as some romantic relationships do, when one of the people gradually or suddenly finds reasons to dislike the other one. "With couples, it can take 18 to 24 months for someone to discover there's something important they don't like about the other person," said Dr. Rose of Florida International. "One might find, for example, that in subtle ways the other person is a racist. In friendships, which are less intense, it may take even more time for one person to meet the other's dislike criteria."
    Whether a friendship is worth saving, Dr. Lerner said, "depends on how large the injury is." "Sometimes the mature thing is to lighten up and let something go," she added. "It's also an act of maturity sometimes to accept another person's limitations." Acceptance should come easier among friends than among spouses, Dr. Lerner said, because people have more than one friend and do not need a full range of emotional support from each one.
    But it the friendship has deteriorated to the point where one friend truly dislikes the other one or finds that the friendship is causing undue stress, the healthy response is to pull away, Dr. Yager said, to stop sharing the personal or intimate details of life, and start being too busy to get together, ever. "It takes two people to start and maintain a friendship, but only one to end it," Dr. Yager said.
    Friendship, because it is voluntary and unregulated, is far easier to dissolve than a marriage. But it is also comparatively fragile, experts say. Ideally, the loss of a bad friendship should leave a person with more time and appreciation for good ones, Dr. Lerner said. "It is wise to pay attention to your friendships and have them in order while you're healthy and your life and work are going well." she said. "Because when a crisis hits, when someone you love dies, or you lose your job and your health insurance, when the universe gives you a crash course in vulnerability, you will discover how crucial and life-preserving good friendship is."

Paying for Their Son's Overdose
Bryan Robinson, ABC News- 9/11/2002

The last thing Mary and Lewis Hockenbury — and even New Jersey prosecutors — expected was the grand jury to charge them for their son's fatal heroin overdose. Leonardo DiPasquale, 18, died at his parents' home of a heroin overdose in July 2001. Prosecutors say DiPasquale was with two friends, Christine Curtin and Erica Poch, when he overdosed almost immediately. Assistant prosecutor Katharine Errickson said that Curtin and Poch did not take a comatose DiPasquale to the hospital immediately because they did not want to get in trouble. They allegedly drove around with DiPasquale for approximately two hours before finally contacting his parents.
    Last month, New Jersey prosecutors got their wish when a grand jury indicted three people in the case — Curtin and Poch on charges of second-degree reckless manslaughter and drug distribution for allegedly providing DiPasquale with the drugs and causing his death, and James Bowkley for alleged drug distribution.

An Unexpected Indictment
However, grand jurors went a step further: they also indicted DiPasquale's parents, the Hockenburys, for reckless manslaughter, sparking debate about parental liability and whether parents can be held responsible for their adult children's drug-induced death. "I had not really anticipated the grand jury charging the parents with anything," said Errickson. "There was certain conduct by the parents after they were contacted that the grand jury believed was reckless conduct and led to Leo's death. There were conscious steps taken by the parents at that point that the grand jury considered reckless."
    According to prosecutors, DiPasquale had overdosed before and he was also charged previously for drug distribution in another person's fatal drug overdose. Errickson could not comment on the specific allegations against the Hockenburys because they have not been made public yet, and the parents are awaiting arraignment. She only said that they were being charged for their actions after learning about their son's condition, not for their son's drug use. "The allegations against them have very little to do with what he took. The heroin and other substances he took had very little to do with the allegations against them," Errickson said. "He was 18 years old, he was an adult and still lived with them and under New Jersey law they had no legal responsibility for his heroin taking or for not taking heroin."

A Legal Duty to Get Medical Attention — for Adult Children?
Attempts to hold parents responsible for their children's activities are not unprecedented. According to the National Conference of State Legislatures, 25 states have parental liability laws of some kind. Many of these laws are applied in cases such as school truancy.  However, in recent years, parents have been charged with recklessness for hosting parties for their teenage children where alcohol was served to minors. Victims of school shootings in Littleton, Colo., in West Paducah, Ky., and in Jonesboro, Ark., have filed lawsuits against the parents of the juvenile shooters for allegedly being aware of their children's preparation for the mass school shooting and doing nothing about it. Most of the lawsuits have ended in settlements. What makes the Hockenbury case different is that they are not being held responsible for what their son — their adult son — did to someone else. They have been charged for what he did to himself and their alleged role in preventing him from receiving the life-saving medical attention he needed.
    The Hockenburys are also being held responsible for their adult child — a charge seemingly more common in young children, particularly in clashes between religion and modern medicine. Authorities in Attleboro, Mass., focused on religious sect members David and Rebecca Corneau in 1999 after their newborn son died. Investigators believed the couple withheld modern medical treatment from their son because of their religious beliefs.
    In theory, according to the grand jury, the Hockenburys are as responsible for their adult son's emergency medical treatment as they were when he was 3 years old. Parents may not be able to be held liable for their children's drug use, but some experts say they do have an obligation to get them medical attention if they see they are in danger of dying. "Relatives who live in the same household do owe a legal duty to rescue each other if they know someone's been poisoned," said Sandra Guerra Thompson, professor of law at the University of Houston Law Center. "One interesting question is the issue of causation — who is at fault for having been the cause of his death?"
    Still, there is debate over whether people also have a legal obligation to get medical attention for their relatives, or any non-relatives who may overdose or need some kind of emergency care while in their home. "Certainly, there is a parental obligation with minor children, but with their adult children and people who may not be related, I don't think so," said James Snyder, associate law professor at William and Mary Law School in Virginia. "Even with married couples, I don't think there's a legal obligation to call for help. If you're married and your spouse overdoses, I don't think a you can be prosecuted if you don't call. The states don't have 'Good Samaritan' laws for those situations. … You have a duty to not hurt, not to help."

Focusing on Reasonable People, Not Parents
Experts say prosecutors will have to prove that the Hockenburys either did something or failed to do something that prevented their son from receiving life-saving medical treatment and therefore caused his death. Prosecutors will have to prove that DiPasquale would have lived if not for his parents' alleged recklessness. They may also have to overcome arguments that DiPasquale's death was caused more by his friends' alleged recklessness than his parents' actions.
    "I'm sure there are going to be a lot of parents out there who would think they have a hard enough time telling a 16-year-old what to do, let alone an 18-year-old," said David Smolin, professor of law at Samford University in Alabama. "Still, in terms of liability, it comes down to action or failure to act: When did they realize their son needed medical attention and what did they do or fail to do? What it also comes down to is how foreseeable was the harm that you're charging him with? Was the risk of death foreseeable?"
    To New Jersey prosecutors, experts say the grand jury indictment may not be so much about parental liability but rather the Hockenburys' reaction to their son's overdose as reasonable people. "Prosecutors seem to be veering away from the parental liability and responsibility issue and seem to treating it in a way where they would ask what would any reasonable person have done in a similar situation," said Jennifer Rosato, law professor at Brooklyn Law School. "One question to ask is whether they took on an extra responsibility to get their son care when he was brought home and therefore leave themselves responsible for getting medical attention for him."
    But what if DiPasquale's ingestion of heroin was a suicide? He had previously overdosed. Some say his intentions are irrelevant and only the actions of his parents and friends are key to the case. "I don't think it really matters legally what he intended to do, if the facts show that the parents knew about his problem and failed to act, it is fair to say that they caused his death," Thompson said. "It really comes down to what happens if there's a poisoning, which is essentially what he did here, it doesn't really matter why the person did what he did. If the parents know that a person is in need of emergency care and they didn't respond or failed to act, they could be held responsible for causing the death."
    Mary and Lewis Hockenbury will be arraigned within the next 30 days and Errickson expects defense attorneys to file a motion to have the charges against them thrown out. If the manslaughter charges against them are upheld and they are convicted, the Hockenburys could face up to 10 years in prison.