Noteworthy News Articles on Mental Health Topics, March 1-12, 2010

1 in 4 Parents Buys Unproven Vaccine-Autism Link
Associated Press, 3/1/2010

CHICAGO -- One in four U.S. parents believes some vaccines cause autism in healthy children, but even many of those worried about vaccine risks think their children should be vaccinated. Most parents continue to follow the advice of their children's doctors, according to a study based on a survey of 1,552 parents. Extensive research has found no connection between autism and vaccines. ''Nine out of 10 parents believe that vaccination is a good way to prevent diseases for their children,'' said lead author Dr. Gary Freed of the University of Michigan. ''Luckily their concerns don't outweigh their decision to get vaccines so their children can be protected from life-threatening illnesses.''
      In 2008, unvaccinated school-age children contributed to measles outbreaks in California, Illinois, Washington, Arizona and New York, said Dr. Melinda Wharton of the U.S. Centers for Disease Control and Prevention. Thirteen percent of the 140 who got sick that year were hospitalized. ''It's fortunate that everybody recovered,'' Wharton said, noting that measles can be deadly. ''If we don't vaccinate, these diseases will come back.''
     Fear of a vaccine-autism connection stems from a flawed and speculative 1998 study that recently was retracted by a British medical journal. The retraction came after a council that regulates Britain's doctors ruled the study's author acted dishonestly and unethically.
     The new study is based on a University of Michigan survey of parents a year ago, long before the retraction of the 1998 study. However, much has been written about research that has failed to find a link between vaccines and autism. Mainstream advocacy groups like Autism Speaks strongly encourage parents to vaccinate their children. ''Now that it's been shown to be an outright fraud, maybe it will convince more parents that this should not be a concern,'' said Freed, whose study appears in the April issue of Pediatrics, released Monday.
     Some doctors are taking a tough stand, asking vaccine-refusing parents to find other doctors and calling such parents ''selfish.'' A statement from a group practice near Philadelphia outlines its doctors' adamant support for government recommended vaccines and their belief that ''vaccines do not cause autism or other developmental disabilities.'' ''Furthermore, by not vaccinating your child you are taking selfish advantage of thousands of other who do vaccinate their children ... We feel such an attitude to be self-centered and unacceptable,'' the statement says, urging those who ''absolutely refuse'' vaccines to find another physician. ''We call it the manifesto,'' said Dr. Bradley Dyer of All Star Pediatrics in Lionville, Pa. Dozens of doctors have asked to distribute the statement, Dyer said, and only a handful of parents have taken their children elsewhere. ''Parents have said, 'Thank you for saying that. We feel much better about it,''' Dyer said.
     The new study is based on an online survey of parents with children 17 and younger. It used a sample from a randomly selected pool of nationally representative participants. Households were given Internet access if they didn't already have it to make sure families of all incomes were included. Vaccines weren't mentioned in the survey invitation and vaccine questions were among others on unrelated topics.
     Twenty-five percent of the parents said they agreed ''some vaccines cause autism in healthy children.'' Among mothers, 29 percent agreed with that statement; among fathers, it was 17 percent. Nearly 12 percent of the parents said they'd refused a vaccine for their children that a doctor recommended. Of those, 56 percent said they'd refused the relatively new vaccine against human papillomavirus, or HPV, which can cause cervical cancer. Others refused vaccines against meningococcal disease (32 percent), chickenpox (32 percent) and measles-mumps-rubella (18 percent). Parents who refused the HPV vaccine, recommended for girls since 2006, cited various reasons. Parents who refused the MMR vaccine, the shot most feared for its spurious autism link, said they'd read or heard about problems with it or felt its risks were too great.
     The findings will help doctors craft better ways to talk with parents, said Dr. Gary S. Marshall of the University of Louisville School of Medicine and author of a vaccine handbook for doctors. ''For our children's sake, we have to think like scientists,'' said Marshall, who was not involved in the new study. ''We need to do a better job presenting the data so parents understand how scientists have reached this conclusion that vaccines don't cause autism.''
     On the Net: Pediatrics: http://www.aap.org/

For age is opportunity no less
Than youth itself, though in another dress,
And as the evening twilight fades away
The sky is filled with stars, invisible by day.

Up to a quarter of all women suffer from depression during pregnancy, and many are reluctant to take antidepressants. Now a new study suggests that acupuncture may provide some relief during pregnancy, even though it has not been found to be effective against depression in general.
      The Stanford University study recruited 150 depressed women who were 12 to 30 weeks pregnant, and randomly assigned 52 to receive acupuncture specifically designed for depressive symptoms, 49 to regular acupuncture and 49 to Swedish massage. Each woman received 12 sessions of 25 minutes each; those given acupuncture did not know which type they were getting. (In the depression-specific treatment, needles are inserted at body points that are said to correspond to symptoms like anxiety, withdrawal and apathy.) After eight weeks, almost two-thirds of the women who had depression-specific acupuncture experienced a reduction in at least 50 percent of their symptoms, compared with just under half of the women treated with either massage or regular acupuncture.
     The findings appear in the March issue of Obstetrics & Gynecology. The lead author, Rachel Manber, a professor of psychiatry and behavioral sciences at Stanford, said the results suggested that some symptoms of depression during pregnancy might be related to physical discomfort that is alleviated by acupuncture. Still, the results were striking, she said.

Study Finds Cohabiting Doesn’t Make a Union Last
Sam Roberts, New York Times- 3/3/2010

Couples who live together before they get married are less likely to stay married, a new study has found. But their chances improve if they were already engaged when they began living together. The likelihood that a marriage would last for a decade or more decreased by six percentage points if the couple had cohabited first, the study found.

Parity Law Requires Mental Health Benefits
Sandra Goodman, Washington Post- 3/3/2010

Denise Camp was resigned to the double standard that had long applied to her medical bills, forcing her to skimp on other expenses so she could pay for mental health treatment. While visits to her internist for physical problems required a $20 co-pay, her weekly therapy sessions with a social worker cost $50 and trips to the psychiatrist who prescribed her medication were $75. A similar disparity applied to medicines: Drugs to treat the crippling depression that ended her engineering career cost her twice what she paid for an antibiotic.
      But recently, Camp's insurance coverage changed -- for the better. The 50-year-old Baltimore resident, who now runs a drop-in center for recovering psychiatric patients, is paying the same charge for physical and mental health treatments: a co-pay of $10 per visit and $25 for each prescription. "I have to use mental health benefits no matter what," said Camp, who is insured through her employer. "This is going to make it more affordable for me."
     Camp is among an estimated 140 million Americans, most of them covered by group insurance plans provided by employers, who are the beneficiaries of a sweeping new federal law designed to guarantee parity in insurance coverage. The law, which took effect for most plans Jan. 1, applies to groups of more than 50 employees and is designed to end what Health and Human Services Secretary Kathleen Sebelius called "needless and arbitrary limits on care." Higher deductibles, steeper co-pays and other restrictions are no longer allowed for mental health and substance abuse treatment. The law does not apply to individual insurance policies, nor does it require group plans to provide mental health and substance abuse treatment, although most do.
     Several weeks ago the Obama administration issued 154 pages of regulations governing implementation of the law, which was sponsored by the late Sen. Paul Wellstone (D-Minn.) and former Sen. Pete V. Domenici (R-N.M.). Passed with broad bipartisan support and signed into law by President George W. Bush in 2008, the measure is widely regarded as the last major piece of health legislation passed by Congress. The rules, which are subject to a comment period, are scheduled to take effect July 1.
     Officials of key business and insurance industry groups said they were displeased that the regulations were "more expansive" than they believe lawmakers intended. Mental health advocates applauded the rules, which they said would help ensure that Americans battling schizophrenia, for example, receive the same level of care provided to those facing leukemia.
     "This is a great boon for people like me who use these benefits," said Peter Schroeder, 36, a computer scientist in Berkeley, Calif., who has received treatment for depression and alcohol abuse. "These are serious conditions that get really expensive really quickly," said Kirsten Beronio, a vice president of Mental Health America, an advocacy group based in Alexandria.
     Some families, she noted, have gone bankrupt trying to pay for treatment. In extreme cases, parents of troubled children who need expensive, intensive services have been forced to temporarily relinquish custody to the state so that their children could qualify for services paid by Medicaid. William C. Moyers, a vice president at Hazelden, a network of substance abuse treatment centers based in Minnesota, says he hopes the law will encourage those who need help to seek it. Hazelden, he said, spends $6 million annually providing aid to patients whose insurance covers only a portion of the cost or runs out after 30 days. Inpatient substance abuse programs can cost more than $20,000 per month. "These are employed, middle-class people with private insurance," Moyers said.
     Federal officials estimate that complying with the law will increase premiums nationwide by four-tenths of 1 percent, or about $25.6 billion over 10 years. Employers are free to drop mental health and substance abuse coverage and are allowed to manage claims to determine if treatment is medically necessary, just as they do now for physical ailments, but the standards can no longer be more stringent. Plans are also allowed to exclude treatment for certain illnesses, such as eating disorders, as long as state law does not mandate coverage. There is also an escape hatch: Plans that can prove that their costs increased by more than 2 percent in the first year can file for an exemption.
      "We are concerned that plans are going to try and find ways around it," Beronio said. "And we're concerned about the lack of awareness in general" about the new law. A recent study in the journal Psychiatric Services of a 10-year-old parity law in California found that nearly half of the Californians polled did not know about it.
     Business groups say they are particularly unhappy that federal rules prohibit separate deductibles for medical and mental health treatment. But most said they did not think their members would drop coverage. "I'd say we're both wary and skeptical," said E. Neil Trautwein, a vice president of the National Retail Federation. "We're going to scrutinize anything" that results in additional cost.
     Pamela Greenberg, chief executive officer of the Washington-based Association for Behavioral Health and Wellness, a group composed of eight companies that manage mental health benefits for 147 million Americans, said that prohibiting separate deductibles may have unintended consequences. A limited number of plans, she said, required a lower deductible for mental health and substance abuse in an effort to persuade more people who need treatment to seek it. "You don't need to do that with arthritis or cancer," she said. "No one's embarrassed to get help" for those conditions. Greenberg said that it is unclear whether companies will decide to "cut back and cover fewer conditions. That's not a place we want to go."
     Advocates rejected the view that the regulations were onerous. Employers and insurers "still have enormous tools and leverage to control inappropriate" or excessive treatment, said Andrew Sperling, director of federal legislative advocacy for the National Alliance on Mental Illness. "Most people don't go for treatment because this is fun or take psychiatric drugs for recreation," said Irvin Muszynski, a lawyer at the American Psychiatric Association. Mental health and substance abuse expenditures, he said, account for a fraction of total health-care expenditures, "so what is everyone freaking out about?"
     Several studies have concluded that parity expands coverage without significantly increasing costs. An influential analysis in the New England Journal of Medicine in 2006 found that President Bill Clinton's 1999 parity directive affecting the Federal Employees Health Benefits Program improved access to mental health services without increasing costs.
     The regulations also require insurers to explain the criteria used to evaluate or deny a claim, which HHS said "must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits." Schroeder, president of the Mental Health Association of California, said that would be particularly helpful for consumers and their doctors. "For many of us, medical necessity has been a big black box," he said. Schroeder said his insurer once suggested he attend a free support group instead of therapy, and in the past granted permission for only three sessions at a time, requiring his therapist to "spend an hour on the phone convincing them that three more visits were medically necessary."
     Although it is not widespread, advocates say they have received scattered reports from around the country of employers dropping coverage rather than making changes to comply with the law. Woodman's Market, a grocery store chain that employs 2,800 people and is based in Janesville, Wis., is among them. "We can't have an open checkbook," company vice president Clint Woodman told the Capital Times in Madison. "If an employee went to a psychiatrist and ran up a million dollars, it would come out of our pockets," he said.
     When asked about an employee who incurred similar expenses after a cancer diagnosis, Woodman said in the Capital Times: "Cancer is different. That's an identifiable physical situation." But to Camp, the view that psychiatric treatment is less deserving is shortsighted. "Mental health is just as important as physical health," she said. "You don't have one without the other."

Soldiers’ Stories
Elizabeth Samet, New York Times Book Review- 3/7/2010

THE UNTOLD WAR: Inside the Hearts, Minds, and Souls of Our Soldiers
By Nancy Sherman
Illustrated. 338 pp. W. W. Norton & Company. $27.95

In a “nasty, dark little room” beneath British Army headquarters in Cairo, a bored Lieutenant Lawrence methodically extinguishes a match between his fingers.
“You’ll do that once too often,” a soldier tells him. “It’s only flesh and blood.”
“You’re a philosopher,” Lawrence ­replies.
When another soldier attempts the same feat, he immediately recoils in pain: “It damn well hurts,” he tells Lawrence.
“Certainly it hurts.”
“But what’s the trick, then?”
“The trick,” Lawrence declares, “is not minding that it hurts.”
     This scene from the beginning of David Lean’s 1962 film “Lawrence of Arabia” has come to serve as an emblem of T. E. Lawrence’s stoicism (or masochism, depending on whom you ask), but the rest of Lean’s epic reveals the near impossibility of a soldier’s “not minding” the physical and psychological pains incurred in war.
     “The Untold War: Inside the Hearts, Minds, and Souls of Our Soldiers,” by Nancy Sherman, attempts, as its subtitle indicates, to expose the complexities of the soldier’s “inner war.” Sherman rightly construes it as a national “duty” to understand the soldier’s “healthy struggle . . . to remain alive to civilian sensibilities without losing the . . . steel and resilience” essential to military service and to facilitate healing of the psychic rifts war can cause. This is not a duty Americans have always been keen to embrace.
     Sherman, a professor at Georgetown, approached it by listening to “soldiers’ stories through the dual perspectives of moral philosophy and psychoanalysis.” Philosophy, she contends, provides an ideal framework for interpreting the testimony of combat veterans because it “sharpens the distinctions, maps the conceptual terrain, presses us to make more systematic or coherent what confuses or defies sense.” Describing her project as “a philosophical ethnography,” she explains that “the insights of . . . Plato, Aristotle, Cicero, Seneca, Epictetus, Marcus Aurelius, Montaigne, Kant, Nietzsche and Freud . . . help to analyze soldiers’ voices, but in turn, soldiers’ voices bring to life these thinkers’ ideas.” She also recruits Homer and Shakespeare to the cause.
     A sequel of sorts to Sherman’s “Stoic Warriors: The Ancient Philosophy Behind the Military Mind,” “The Untold War” is likewise animated by the author’s admiration and affection for the many soldiers and sailors she has encountered in the course of her research. A number of these contacts were established while Sherman held the United States Naval Academy’s first distinguished chair in ethics (1997-99). Sherman alludes to her visiting professorship at Annapolis with a frequency that can make her sound insecure about her ethnographer’s status. Yet the soldiers and sailors whom she interviewed clearly like and trust her; that ought to have been enough.
     The book is at its most powerful documenting the stories of veterans, from Bob Steck, a radio operator who wrestled with “a sense of taint” for decades after returning from Vietnam, to Dawn Halfaker, an accomplished basketball player as a West Point cadet, who lost an arm to a rocket-propelled grenade while serving in Iraq. Stories like these fulfill Sherman’s goal of humanizing soldiers by enabling us to see them as individuals with distinct, particular responses to psychological and physical wounds.
     But “The Untold War” is caught between two worlds. Evocative contemporary testimony overwhelms the book’s philosophical framework, while tantalizing quotations from philosophy and literature are often decontextualized, their connections to contemporary military realities abbreviated. Sherman cites Montaigne’s claim that he always kept his position as mayor separate from himself as evidence of his confidence in our capacity to compartmentalize professional and personal identities and moralities. But she omits the passage later in the same essay in which the ever elusive Montaigne insists that morality and honor “are not qualities . . . to protect behind a mask.” His endorsement of “Stoic impassability” notwithstanding, Montaigne also admits the difficulty of preserving professional detachment against the force of private emotion: “Yet that does not mean that this stratagem of mine has relieved me of all difficulties or that I have not often found it very hard to master or bridle my emotions.”
     To explain the difficulty of shifting from the rigors of war to the rhythms of peace, Sherman cites a line from Shakespeare’s “Coriolanus” — Aufidius’s assessment that Coriolanus’s nature is unable to move “from th’ casque to th’ cushion” — but she quotes it in a vacuum and misattributes it to “Macbeth,” a play with a vastly different perspective on soldiering. Kant’s observations on the nature of military obedience are considered without reference to late-18th-century debates over European standing armies, while the rich theorizing about obedience that runs throughout American military history from George Washington to the “revolt of the generals” against Donald Rumsfeldis ignored in favor of a discussion of Shakespeare’s “Henry V,” in which Sherman unquestioningly accepts Henry’s momentary self-pity and manipulative rhetoric as evidence of compassion.
     The discussions of Shakespeare are symptomatic of a somewhat cavalier treatment of literary texts. The plays, for instance, do not appear in the lengthy bibliography. Moreover, in a book so dependent on the stories soldiers tell themselves and the world, there is surprisingly little use made of 20th-century theories of narrative, especially those formed at the intersection of psychoanalysis and literary criticism.
     Like the work of some of the ancient philosophers on whom Sherman relies, this book comprises a series of energetic lectures rather than an organically developed whole. That fact, by itself, is not a negative, but it has the effect of leaving some discussions, especially those involving the morality of war, feeling unfinished. Sherman proposes that our current engagements are “dirtier than most,” but she is reluctant to pursue the stakes of that claim for the moral accountability of soldiers. Her discussions of professionalism largely exclude the extant literature on the “professional military ethic” and fail to pursue potentially illuminating analogies to medicine, law and policing.
     Sherman is rigorous when analyzing the relationship between Stoic philosophy and military culture. She carefully delineates Stoicism’s utility as a kind of armor for the soldier going to war as well as its limitations as an effective response to the wounds received there. She argues persuasively that “the military cannot afford to neglect the fact that emotions, just like skill and physical endurance, need cultivation and expression.”
     The American military has also recognized the limits of stoicism. The Army, for example, has started a suicide-prevention campaign, committed to treating soldiers with post-traumatic stress disorder, and begun to field “master resiliency training” as part of its program of “comprehensive soldier fitness.” Gen. Carter F. Ham last year revealed his own struggle with combat stress, and Maj. Gen. Mark Graham, after losing two sons, one in combat and one to suicide, has emerged as a strong proponent of the Army’s concentration on the mental welfare of soldiers. The “trick” is no longer in “not minding” the pain but in finding a way to understand it.

The arc of a troubled life
In the Bedell family's first interview since the shooting, Jeffrey, the youngest of three siblings, opened up about Patrick's once promising life path and decline into mental disarray, as well as how the family has been coping with its link to his headline-dominating act of violence. A close family friend, Reb Monaco, a San Benito County supervisor, also helped trace the arc of Patrick Bedell's increasingly troubled life.
      Jeffrey Bedell said he was having dinner at home with friends in Sacramento when he learned what his brother had done. His father called and told him to turn on the news. "He said, 'Your brother has fired shots at the Pentagon,' " said Jeffrey Bedell, removing his tortoise-shell glasses and rubbing tears from his face. "I turned on the television, and I called George Washington's hospital and spoke to an FBI agent and doctor. The doctor told me he 'expired.' He said they did everything they could but that when he was brought to the hospital, he was not physiologically alive."
     Learning that his brother -- once a roommate and a confidant -- had committed such violence convinces Jeffrey Bedell that he never grasped the full extent of Patrick's rage. His brother, Jeffrey said, never expressed a desire to use a firearm. But his parents had warned authorities that Patrick was missing and possibly armed. Jeffrey said he first learned of his brother's interest in guns last month, when the family discovered that he had a credit card charge to a gun shop in Rancho Cordova, near Sacramento. He apparently had tried to purchase a gun, and the family learned that he failed a background check. "I was very surprised. There was no reason he needed one," Jeffrey said. Jeffrey said he learned from his mother that Patrick made a purchase at a Washington area gun shop before Thursday night's shooting. "There was a credit card charge at some gun shop in Silver Spring, Maryland," Jeffrey said.
     Attempts to talk to the injured officers Saturday were unsuccessful. Chris Layman, a spokesman for the Pentagon Force Protection Agency, said officials were not allowing interviews with them.

A respected family
In Hollister and surrounding San Benito County, a largely agricultural region, the Bedell family has long burnished a respected reputation. Oscar John Bedell, known as "O.J.", moved to Hollister about 60 years ago and worked for a bank. His son Oscar John Bedell Jr. moved here with his wife, Karen "Kaye" Bedell, after both served in the military in Germany in the 1960s. The couple had three children: Patrick, born in 1973, then Matthew in 1974 and Jeffrey in 1976.
      Jeffrey Bedell and Monaco recounted that Patrick was considered "hyperintelligent" by the community when he was growing up. Even as a 3- or 4-year-old, Patrick wanted to go to the library to pick up books "way above his grade level," his brother said. Monaco said: "There was competitiveness I observed in the three boys, more of an intellectual competitiveness. There was always intellectual banter, sometimes really, really humorous."
     Later, Patrick warmed to nonfiction, including European history and literature about physicist Stephen Hawking. But he joined few if any clubs. "While he was an outgoing kid, he would also isolate himself. He would go into his room and read. It wasn't like he was a social outcast. But he wasn't a joiner," Monaco said. "People in the news have speculated if he did this by himself or not. He was not a joiner," Jeffrey Bedell said.
     Patrick was perpetually in and out of school, enrolling in undergraduate or graduate programs and sometimes auditing courses. Jeffrey could not recall whether he had worked anywhere. In 1999, the brothers lived together in Berkeley, when Jeffrey was a senior on his way to law school and Patrick was auditing a physics course. "It was fantastic. I had my bed, and he had a futon. We would go to the café, and I'd be studying, he'd be studying. . . . It was wonderful," Jeffrey said.
     The brothers parted ways when Patrick moved to Austin to live with a woman he met at a bookstore at the University of California at Davis. Jeffrey did not want to name the woman, who he said was pursuing a graduate degree in literature. "I think she appreciated his intelligence. He was charming and very funny, and he was very kind and considerate," Jeffrey said. "It was fantastic to go out with them. I dearly love her."
     But in the early 2000s, Patrick's curiosity and skepticism changed to an off-putting perspective laden with conspiracy theories. He smoked marijuana frequently. One time, Monaco said, Patrick asked him for his cellphone. Monaco handed it over, and Patrick removed the battery. "He said, 'That's how they can listen to us,' " Monaco said. The Bedells pleaded with him to seek medical help, but he refused. "I would have conversations with him, trying to convince him to stop smoking marijuana, that it was making his thinking more disordered, but he was not receptive to that," Jeffrey said. At one point, Patrick brought Monaco to a neighborhood and paced back and forth in front of a home. "He said, 'Those people spy on me at night.' " The family contacted local authorities, but there was nothing it could do unless Patrick consented.
     Late last year, Patrick attended a housewarming party at Jeffrey's new home in Sacramento. "He was actually lucid and fun to be around. . . . He was interested in developing a different currency," Jeffrey recalled.
     But the end began in January, when Patrick went missing, was pulled over for speeding in Texas and was caught with marijuana. Jeffrey talked to the state trooper and found out his brother was headed to the East Coast, where it was supposedly "warmer." Jeffrey said: "I tried calling him. He never picked up. I left him voice mails." Two days after Patrick's death, Jeffrey said: "I had my first dream about him last night. He was there, and I could hear him talking. That's how I knew it was a dream."

Fake Nostalgia for a Pre-Therapy Past
Erik Kolbel, New York Times- 3/9/2010

Old Gus sat on his customary bar stool in the corner, tossing down the bourbon and tossing out the barbs. “I can tell you one thing,” he announced, as I recall. “Back in my day, you didn’t have young kids going around talking to shrinks, yakking about their fee-ee-ee-lings, getting all doped up on medications. “Back in my day, kids were kids! We worked out our problems on our own. We didn’t go crying to some stranger with a whole bunch of initials after his name.”
      Gus was ridiculing a conversation a fellow therapist and I were having about a 13-year-old she was treating for depression and acute anxiety. I didn’t rise to his bait, but it wasn’t because I had no interest in defending my profession. Rather, as with the college guys at the other end of the bar lamenting yet another epic collapse by their beloved Jets (this was before the team got good), it was that I’d heard the complaint so often it had become tiresome.
     Not that Gus was entirely wrong. A greater percentage of young Americans than ever receive treatment — talk therapy, medication or both — for psychological disorders, and the number is steadily rising. But when I think about what life was like in my day (I’m in my mid-50s, and Gus is probably 20 years older), I’m not so sure this is a bad trend.
     One of my most vivid and least cheerful childhood memories is how discouraged I felt when it dawned on me that most of my peers could sit down for an hour or so at a time and plow through homework assignments without fidgeting, getting out of their chairs, pacing the floor or succumbing to the distractions of their rooms. Nor was environment the determining factor; I found it difficult to sit still and concentrate in the classroom, glued to my desk, with an assignment right in front of me and the teacher hovering over me. It was never a matter of resenting the work or not knowing how to do it. To my reckoning, it was just physically impossible to be still and focus on a task for more than a few minutes at a time.
     With this as a part of my past, the first time I read the criteria for attention deficit hyperactivity disorder — “often fails to give close attention to details or makes careless mistakes in schoolwork ... fails to finish schoolwork, chores or duties” and so on — my only surprise was that they didn’t include “Prefers G.I. Joe or flipping through baseball cards to civics lessons and pop quizzes.” In short, I was an A.D.H.D. kid, lacking only a diagnosis. And now that I know that the condition was a result of my body’s inherent inability to manage the flow of neurotransmitting chemicals like dopamine and serotonin, all of my parents’ heated entreaties to “buckle down” and “pay attention to what’s in front of you” were about as useful as telling a nearsighted child to see clearly without glasses.
     As I grew into adulthood, I was left with a string of unanswerable but concentric questions: Could medication have helped me to concentrate on my schoolwork? If so, would I then have been a more industrious student? And if I had been a more industrious student, could I have developed more of a passion for reading and for learning? And if I had developed that passion, would I be a happier, better, more productive human being? If, and if, and if ... I’ll never know.
     And while my own life is dogged by the possibility of unfulfilled possibility — what might have been had I been treated — what really haunts me is the memory of full-blown tragedy in the lives of some of my childhood friends. I think of a pretty but perpetually sullen girl named Maureen, her body scarred for life by an abusive mother who (as Gus would say) was not above giving her daughter what for. Or a tall, lanky guy named Dave, a star athlete with Hollywood looks who stunned us all by putting a gun to his head and taking his life.
     To their horrific stories, I could add the countless quotidian ones of seemingly normal, everyday kids who endured overbearing siblings or bullying classmates, who didn’t get included in the secret, invited to the prom or chosen for the volleyball team, whose father one morning just up and left the family because he got a better offer from another woman. Those who just couldn’t work out their problems on their own (Gus again). Who knows how much more bearable their lives might have been if they had received the proper intervention?
      It was only much later in life that I began to appreciate the many insidious ways in which psychological well-being can be altered by things outside a child’s command. Most children exercise very little power over the decisions that affect their lives. They don’t decide who their parents are, where their family will live, where they will attend school, when they will reach puberty, who will or will not befriend them. They have limited control over their athletic skills, their looks, their wit, or whether, in the great Serengeti that is their schoolyard, they will be predator or prey. They are as much the subject of their story as its author.
     At toxic moments, the insights to be gained from a professional who takes this stuff seriously (and in some instances the medications that can bring calm to chaos) are eminently useful to the child who is looking for a narrow path through some very difficult years. Of course, there will always be critics. “Look at me,” Gus declaimed as my friend and I wound down our conversation. “My old man was a drunk, and I didn’t turn out too bad,” he told us proudly, one word slurring into the next.

Court Says Thimerosal Did Not Cause Autism
Associated Press, 3/12/2010

WASHINGTON -- The vaccine additive thimerosal is not to blame for autism, a special federal court ruled Friday in a long-running battle by parents convinced there is a connection. While expressing sympathy for the parents involved in the emotionally charged cases, the court concluded they had failed to show a connection between the mercury-containing preservative and autism. ''Such families must cope every day with tremendous challenges in caring for their autistic children, and all are deserving of sympathy and admiration,'' special master George Hastings Jr. wrote. But, he added, Congress designed the victim compensation program only for families whose injuries or deaths can be shown to be linked to a vaccine and that has not been done in this case.
      The ruling came in the so-called vaccine court, a special branch of the U.S. Court of Federal Claims established to handle claims of injury from vaccines. It can be appealed in federal court.
     The parents presented expert witnesses who argued mercury can have a variety of effects on the brain, but the ruling said none of them offered opinions on the cause of autism in the three specific cases argued. They testified that mercury can affect a number of biological processes, including abnormal metabolism in children.
     Special master Denise K. Vowell noted that in order to succeed in their action, the parents would have to show ''the exquisitely small amounts of mercury'' that reach the brain from vaccines can produce devastating effects that far larger amounts ... from other sources do not. The ruling said the parents were arguing that the effects from mercury in vaccines differ from mercury's known effects on the brain. Vowell concluded that the parents had failed to establish that their child's condition was caused or aggravated by mercury from vaccines.
     Friday's decision that autism is not caused by thimerosal alone follows a parallel ruling in 2009 that autism is not caused by the combination of vaccines with thimerosal and other vaccines.
     The cases had been divided into three theories about a vaccine-autism relationship for the court to consider. The 2009 ruling rejected a theory that thimerasol can cause autism when combined with the measles-mumps-rubella vaccine. After that, a theory that certain vaccines alone cause autism was dropped. Friday's decision covers the last of the three theories, that thimerosal-containing vaccines alone can cause autism.
     The ruling doesn't necessarily mean an end to the dispute, however, with appeals to other courts available. The new ruling was welcomed by Dr. Paul Offit of Children's Hospital of Philadelphia, who said the autism theory had ''already had its day in science court and failed to hold up.'' But the controversy has cast a pall over vaccines, causing some parents to avoid them, he noted, ''it's very hard to unscare people after you have scared them.''
     On the other side of the issue, a group backing the parents' theory charged that the vaccine court was more interested in government policy than protecting children. ''The deck is stacked against families in vaccine court. Government attorneys defend a government program, using government-funded science, before government judges,'' Rebecca Estepp, of the Coalition for Vaccine Safety said in a statement. SafeMinds, another group supporting the parents, expressed disappointment at the new ruling. ''The denial of reasonable compensation to families was based on inadequate vaccine safety science and poorly designed and highly controversial epidemiology,'' the goup said.
     The advocacy group Autism Speaks said ''the proven benefits of vaccinating a child to protect them against serious diseases far outweigh the hypothesized risk that vaccinations might cause autism. Thus, we strongly encourage parents to vaccinate their children to protect them from serious childhood diseases.'' However, while research has found no overall connection between autism and vaccines, the group said it would back research to determine if some individuals might be at increased risk because of genetic or medical conditions.
     Meanwhile, in reaction to the concerns of parents, thimerosal has been removed from most vaccines in the United States.
     In Friday's action the court ruled in three different cases, each concluding that the preservative has no connection to autism. The trio of rulings can offer reassurance to parents scared about vaccinating their babies because of a small but vocal anti-vaccine movement. Some vaccine-preventable diseases, including measles, are on the rise.
     The U.S. Court of Claims is different from many other courts: The families involved didn't have to prove the inoculations definitely caused the complex neurological disorder, just that they probably did. More than 5,500 claims have been filed by families seeking compensation through the government's Vaccine Injury Compensation Program, and the rulings dealt with test cases to settle which if any claims had merit.
     Autism is best known for impairing a child's ability to communicate and interact. Recent data suggest a 10-fold increase in autism rates over the past decade, although it's unclear how much of the surge reflects better diagnosis. Worry about a vaccine link first arose in 1998 when a British physician, Dr. Andrew Wakefield, published a medical journal article linking a particular type of autism and bowel disease to the measles vaccine. The study was later discredited.