Stay-at-Home Dads Learn the Ropes, Fight Perceptions
Kate Rice, ABC News- 11/24/2003

Once a week, in playgrounds, a bookstore and similar kid-friendly places around the bedroom community of Huntington, N.Y., a playgroup meets regularly. The children are infants, toddlers and preschoolers. Their parents come equipped with strollers, bottles, sippy cups and diapers. Their conversation is about children and marriage. Yet, there might be a little more talk about sports and a little less about fashion than in other playgroups because this is a group of stay-at-home dads.
     The Huntington area of Long Island is classic suburbia, where mothers tended to stay home while fathers took the train into New York City to work. But this group of about 10 guys opted to stay home with the kiddies while their wives go to the office.  They're at home because they and their wives didn't want to turn over their kids to daycare centers, babysitters or nannies. And for one reason or another — usually economic — it made more sense for them to be Mr. Dads (at-home dads cringe at the "Mr. Mom" title).
     Bill White, one the dads in the Long Island playgroup, says that he and his wife had both been commuting to the city to demanding jobs with lots of travel when his wife got pregnant. "We decided us both having a career wasn't sensible," says White. "We didn't want a nanny raising our child." White says that his wife had the better future (as well as what at the time were valuable stock options), so he stayed home. How long will this last? Could be for a while — they're contemplating child number two.
     Over and over again, interviews with at-homes produce the same kind of story. Jay Massey, executive director of www.slowlane.com , an online resource for at-home dads, had just sold one business and was starting another when his wife, Joann, got pregnant. She had just finished graduate school and started a new job, making it a bad time for her to take a break.  So he modified the business plan to make it home-based, partnering with another dad in a neighboring state. His son is now in school, but Massey remains at home, now as a work-at-home dad. He works, but doesn't leave for the office.
    These dads aren't staying home just for economic reasons. They want to be home with their kids — and sometimes are the one more suitable for the job.   "I'm probably the more nurturing one, and she's on a career path she absolutely loves," says Steve Klem, an at-home dad who is chatmaster of AOL's DadChat. He had always thought he'd be the one going to work while his wife stayed home. But she pulled down the bigger salary, so it made more sense for Klem to stay home.
    At-home dads range from tattooed bikers to ex-lawyers. But they experience the same kinds of rewards, seeing the day-to-day development of their children. Psychology professor Bob Frank, one-time stay-at-home dad and work-at-home dad, and author of Parenting Partners: How To Encourage Dads to Participate in the Daily Lives of Their Children, says at-home dads strengthen parental involvement. His research found improved communication in couples. Working mothers walk in the door and immerse themselves in their children, far more so than many working dads do. That strengthens the bond between parents and children.
    Mothers often are suspicious of a lone dad popping up in their midst on the playground — although once reassured are often quite welcoming. At-home dads can feel isolated — more so than women — because they are less inclined to reach out to others for help, says Massey. That's why Web sites as www.slowlane.com , www.athomedad.com  and dozens of regional sites such as White's own www.nystayathomedad.com   (Slowlane.com lists URLs for at home dad sites by region) can be so helpful. Guys are often more inclined to use a tool for a solution. The eighth annual At Home Dad Convention, which usually attracts about 100 men, was held Saturday, Nov. 22, in Chicago.
    The routine can be tough for couples, as well. Spouses may have different goals, for example. She may think he's home until the children are in college, while he's thinking nursery school. She may think he's going to play homemaker Harriet to her working Ozzie. He might still expect her to make dinner. It takes planning and discussion. Couples also have to grapple with the perceptions of others. Society at large is generally baffled by at-home dad, says Peter Baylies, founder of the At Home Dad Newsletter and Network. "It's 'Why don't you get a job?'" he says.
    Libby Gill, media consultant, coach and author of Stay-at-Home Dads: The Essential Guide to Creating the New Family, says dads can respond by educating people, using humor, or simply ignoring what people say. Her husband stayed home with their children, now 9 and 13, because her job had a bigger paycheck and better benefits, and he was open to the idea. The couple recently divorced, but he remains the primary caregiver.
    Having dad at home can also make it easier when mom goes back to work while the baby is still an infant. Massey's wife, Joann, was absolutely miserable about going back to work after their son was born. The only thing that made it possible was the fact that Jay was home taking care of him, she says. Had her only option been sending her son to daycare, she could not have done it, she says. These days, whenever Jay talks about getting an office outside the home, "I do all I can to thwart it. I just love having him there."
    Tips for moms and dads:
*Slow down. Baylies came home to a 6-month-old who took two two-hour naps a day. "It seemed so slow," he recalls. But once you make that transition, the bond you build with your child simply gets stronger.
*Stay abreast of what's happening in your profession as much for your mental health as in anticipation of the day that you go back to work. If you're a CPA, keep up your accreditation. Frank had a private practice as a psychologist, taught part-time and ran summer camps for kids.
*In doubt? Consider leaving yourself an escape hatch. Bill White, in Huntington, N.Y., Web master of www.nystayathomedads.com, worked part-time for his company from home while his wife was on maternity leave before deciding to be a full-time at-home dad. Now that his son, age 4, is in nursery school a few mornings a week, he works as a part-time mortgage broker and volunteer fireman.
*Having either parent at home is not economically feasible for many families. You don't have to be an at-home parent to be an involved parent. Look for wiggle room in your schedules — arrange to leave work early to make games or special events, for example. Coach sports teams, attend recitals and concerts, listen to kids talk about their day, have dinner together. The parent Massey uses as his model is a naval officer who ships out for weeks at a time.

Double Whammy: Mental Illness and Aging
Abigail Trafford, Washington Post- 11/25/2003

It's a bad marriage of two prejudices, ageism and crazyism. Working together, they are doubly vicious, throwing up medical barriers against people of a certain age who suffer a mental illness. The results are predictable. The majority of these people don't get the care they need. The treatment they do get is often substandard. They tend not to get the latest, most effective medications. They are rarely offered psychotherapy or even properly evaluated for a mental disorder. And they have the highest suicide rate of any age group -- victims of an act of violence that is largely due to untreated or mistreated depression.
    Last week, leaders in mental health and aging gathered in Washington to design ways to reduce the dual stigma faced by millions of Americans who are seen as both as over the hill and mentally ill. The stereotype worms its way into public perception: Aunt Ethel has macular degeneration -- no wonder she's depressed. Poor old Dad -- just didn't want to live after the heart attack. And the homeless man on the corner mumbling to himself -- crazy old coot.  This is prejudice. It's fueled by the myth that going mad is a normal part of growing old. It is reinforced by the stereotype that older people are too set in their ways to respond to treatment. 
    The surgeon general has warned that this dual prejudice is hazardous to health. There are some unique aspects for older adults. They suffer more chronic medical conditions and suffer more loss of relationships. "It's easy for the informed physician or family member to say, 'If I had all these problems, I would want to die,' " said psychiatrist Stephen J. Bartels of Dartmouth-Hitchcock Medical Center in Lebanon, N.H. The individual internalizes that message, too. "All these things come together so that older adults get less access to mental health care than any other age group. It's a perfect storm."
    Depression in older people is not a normal response to having a heart attack, breaking a hip or getting diagnosed with cancer. It needs to be treated in addition to the other medical conditions. Depression is not a normal part of grief. Feeling sad over losses -- the death of loved ones, the loss of function or status -- is part of grieving and moving on. But incapacitation by hopelessness for months on end needs to be treated, just as diabetes or leukemia needs to be treated.
    Last week's stigma roundtable, sponsored by the federal Center for Mental Health Services, sought to spread a message of hope. The strongest voices came from those who have recovered from mental illness and enjoy meaningful lives.  Sometimes a mental disorder does not emerge until late in life. George Kotwitz, 66, of Yukon, Okla., had his first episode of depression when he was about 50. It was triggered by a catastrophic financial reversal. He had built up a successful fire and casualty insurance business, and after he sold it the deal went sour. "I lost everything. I lost my house. I went into bankruptcy," he said. "I lost the ability to read and tell you what I was reading. I lost the ability to function. I lost all confidence."   The break came at a family party. "I started screaming" and he ran outside, he recalled. "I realized I had gone crazy." His wife came after him and got him to a hospital.
    On the long road to health, he's been hospitalized nine times. "I finally realized I had a major part in my recovery," he said. "I became more assertive. I would tell the doctor, 'I don't like these side effects. I'm not going to stand for it.' " He tried more than 15 drugs before finding two that worked for him. "It's wonderful. I started setting goals for myself. I started associating with people." Now he's working again, looking after his wife of 43 years, helping others with mental illness. "Find a reason for hope," he said. "Quality of life becomes mental wellness."
    In other instances, people have lived with a chronic mental disorder -- and other prejudices -- for years. Sometimes there is a mellowing out of the disease. Janet Stiles, 72, of Manchester, N.H., had her first episode at age 28, after having three children. "One morning I couldn't get out of bed," she recalled. The doctor diagnosed "hysteria." "I was furious," she said of this first encounter with crazyism and sexism. She was eventually diagnosed with schizophrenia and treated with medication. She stopped taking drugs almost 20 years ago and continued treatment with cognitive therapy. Meanwhile, she got involved in the community, took up swimming and then went to work. Since retirement, she and her husband have kept busy and enjoy their five grandchildren.
    Hikmah Gardiner, 74, of Philadelphia works for the Mental Health Association of Southeastern Pennsylvania. In the beginning she had to fight the dual stigmas of crazyism and racism. When she was in her twenties, she was misdiagnosed as having schizophrenia -- because the doctor said that's what African Americans get when they get a mental illness, she recalled. She self-medicated with alcohol. "Then I had two problems," she said. She became homeless. One day, a friend took her to a doctor. She attended AA meetings. She found a good psychologist. That was 40 years ago.  What gives her pleasure today? "In addition to sex?" she joked. "That's part of life." And she finds fulfillment in her work and her great-grandsons. "The difference between a saint and a sinner is the saint keeps trying," she said.
    These voices of hope chip away at the stigma wall, brick by brick. But it will take a massive change in the health care community to tear it down. Starting with Medicare: There's no parity in treating mental and physical illnesses in Medicare. Older people have a 50 percent co-pay for seeing a psychotherapist. And as for medications, they are still waiting for a prescription drug benefit that will give them good access to this mainstay of treatment.



The Delicate Balance of Pain and Addiction
Barry Meier, New York Times- 11/25/2003

Over the past two decades, conflicting medical ideas have surfaced about narcotic painkillers, the drugs that Rush Limbaugh blames for his addiction while being treated for chronic back pain. And both of them, not surprisingly, have centered on the bottom-line question: just how great a risk of abuse and addiction do narcotics pose to pain patients?
    Throughout much of the last century, doctors believed that large numbers of patients who used these drugs would become addicted to them. That incorrect view meant that cancer sufferers and other patients with serious pain were denied drugs that could have brought them relief. But over the past decade, a very different viewpoint has emerged, one championed by doctors specializing in pain treatment and drug companies eager to broaden the market for such drugs. It held that these medications posed scant risk to pain patients, and some experts now believe that it also had unfortunate consequences because it caused, among other things, physicians to develop a false sense of security about these drugs. "The pendulum went in two opposite directions," said Dr. Bradley S. Galer, group vice president for scientific affairs at Endo Pharmaceuticals, which manufactures two widely used narcotics, Percodan and Percocet. "Luckily, now the pendulum is focusing where it should be, right in the middle."
    The reassessment of narcotic risk comes at a time of skyrocketing rates of misuse and abuse of such drugs. Medical experts agree that most pain patients can successfully use narcotics without consequences. But the same experts also say that much remains unknown about the number or types of chronic pain sufferers who will become addicted as a result of medical care, or "iatrogenically" addicted. The biggest risk appears to be to patients who have abused drugs or to those who have an underlying, undiagnosed vulnerability to abuse substances, a condition that may affect an estimated 3 to 14 percent of the population. Dr. James Zacny, an associate professor at the University of Chicago and a leading narcotics researcher, said there was a dearth of data about the long-term risks that narcotics pose. "We don't know a lot about the rate of iatrogenic addiction," he said.
    It is not unusual for views about particular drugs and their hazards to change over time. But a look at the shift in medical thinking about the risk of addiction shows a struggle that was waged both as a guerrilla war among doctors and a high-powered drug industry initiative. It was also an effort that, while seeking a laudable goal, inaccurately portrayed science. Modern views about the threat posed to patients by narcotics were shaped in the mid-1980's when pain treatment experts reported that cancer patients treated with such drugs did not exhibit the type of euphoria displayed by people who abused narcotics. That led some physicians to argue that strong, long-acting narcotics could also be used safely to treat patients with serious pain unrelated to cancer, like persistent back pain or nerve disorders.
    One leader of this initiative, known as the "pain management movement," was Dr. Russell Portenoy, who is now chairman of the pain medicine and palliative care department at Beth Israel Medical Center in New York. And soon Dr. Portenoy and others were pointing to studies that they said backed up their contention that the risk of powerful narcotics to pain patients was scant. "There is a growing literature showing that these drugs can be used for a long time, with few side effects and that addiction and abuse are not a problem," Dr. Portenoy said in a 1993 interview with The New York Times.
    Drug companies amplified that theme in materials sent to doctors and pharmacists. For example, Janssen Pharmaceutica, the producer of Duragesic, called the risk of addiction "relatively rare" in a package insert with the drug. Endo termed the risk "very rare" in presentations to hospital pharmacists. Purdue Pharma, the manufacturer of the powerful narcotic OxyContin, distributed a brochure to chronic pain patients called "From One Pain Patient to Another," contending that it and similar drugs posed minimal risks. "Some patients may be afraid of taking opioids because they are perceived as too strong or addictive," the brochure stated. "But that is far from actual fact. Less than 1 percent of patients taking opioids actually become addicted."
    The trouble, however, was that studies that looked at the experience of pain patients who used long-acting narcotics for extended periods of time did not exist. So narcotics advocates like Dr. Portenoy and drug companies like Purdue Pharma had looked elsewhere, at surveys of patients whose use of narcotics was limited. And those reports were not always put into proper context.
    A frequently cited survey of narcotics use, taken in 1980, found "only four cases of addiction among 11,882 hospitalized patients." A director of that survey, Dr. Hershel Jick, an associate professor of medicine at Boston University, said his study did not follow patients after they left the hospital and did not address the risk of narcotics when they were prescribed in outpatient settings.
    In another case, advocates of increased narcotics use also misstated a study's results. It involved a study of chronic headache sufferers conducted at the Diamond Headache Clinic in Chicago that some pain care specialists repeatedly claimed had found only "three problem cases" among some 2,000 patients. While the Diamond Headache Clinic did treat 2,369 patients in the study period, just 62 were studied because they met the criteria of having used painkillers alone or in combination with barbiturates for six months before entering the clinic. And the report's findings were far different from the way they were characterized by narcotics advocates. It concluded, "There is a danger of dependency and abuse in patients with chronic headaches." Dr. Seymour Diamond, the clinic's director, said in a recent interview that neither pain experts nor narcotics manufacturers like Purdue Pharma who cited his study contacted him to discuss how they planned to use it. And he added that he believed that it was mischaracterized. "It distorts the picture and it clearly underplays the risks," Dr. Diamond said.
    In a recent interview, Dr. Portenoy said he now had misgivings about how he and other pain specialist used the research. He said that he had not intended to mischaracterize it or to mislead fellow doctors, but that he had tried to counter claims that overplayed the risk of addiction. Still, he and others acknowledge, the campaign by pain specialists and drug companies has had consequences. "In our zeal to improve access to opioids and relieve patient suffering, pain specialists have understated the problem, drawing faulty conclusions from very limited data," Dr. Steven D. Passik, a pain management expert wrote in a 2001 letter published in The Journal of Pain and Symptom Management. "In effect, we have told primary care doctors and other prescribers that the risk was so low they essentially could ignore the possibility of addiction."
    Today, some narcotics manufacturers like Endo have changed or are changing the way they present abuse and addiction information. For example, Purdue Pharma, while maintaining the accuracy of its past position, now states in patient information that it does "not know how often patients with continuing (chronic) pain become addicted to narcotics but the risk has been reported to be small." Ligand Pharmaceuticals, which manufactures a time-released form of morphine under the brand name Avinza, makes a similar statement. For its part, a spokeswoman for the federal Food and Drug Administration, Kathleen K. Quinn, said the agency believed that "the risk of addiction to chronic pain patients treated with narcotic analgesics has not been well studied and is not well characterized."
    In a letter to The New York Times, Purdue stated that it had found no cases of iatrogenic addiction in a recently completed long-term study of chronic pain patients suffering from osteoarthritis, diabetes and low pain back. Purdue did not identify where it planned to submit the study for publication although the company said it involved an older group of patients whose average age was 55. Such results are encouraging. But several pain experts said that the full risks of narcotics will not be fully known until these drugs are tested in a wide range of pain patients of different ages and conditions. "You may have a study telling how uncommon these problems are in patients over 50," Dr. Portenoy said. "But what does that tell you about the risks to younger patients or those patients who walk into a doctor's office with a history of substance abuse or psychological problems."



Young Killer: Bad Seed or Work in Progress?
Erica Goode, New York Times- 11/25/2003

If the 12 jurors presiding over Lee Malvo's fate in a Chesapeake, Va., courtroom find him guilty, they will then have to decide if death is an appropriate punishment for crimes committed by a 17-year-old. Mr. Malvo, now 18, is accused of participating in the sniper attacks that terrorized the Washington area last fall. The arguments over whether to execute young offenders have traditionally rested on legal and societal grounds. Those opposed to imposing the death penalty have, for example, argued that teenagers have a long future ahead of them and have the capacity to change their behavior. But in recent years, scientists have also joined in the debate over how young a defendant must be for the death penalty to be excluded as an option. An increasing number of studies, these researchers say, show that the brain continues to develop through late adolescence, as do crucial mental functions like planning, judgment and emotional control.
    In a paper appearing in the December issue of the journal American Psychologist, Dr. Laurence Steinberg, a psychologist at Temple University and the director of the MacArthur Foundation Research Network on Adolescent Development and Juvenile Justice, argues that on the basis of such studies, young offenders should be viewed under the law as less guilty than adults. The scientific evidence argues for a legal approach "under which most youths are dealt with in a separate justice system and none are eligible for capital punishment," wrote Dr. Steinberg and Dr. Elizabeth S. Scott, of the University of Virginia School of Law, in the paper.
    Twenty-one states allow the death penalty for offenders who committed their crimes as juveniles. In 16 states, including Virginia, 16 is the minimum age at which offenders become eligible for execution; 5 states set the minimum age at 17. In August, the Supreme Court of Missouri found the death penalty unconstitutional for offenders under 18 when their crimes were committed. Missouri's attorney general has petitioned the United States Supreme Court to take up the issue.
    Not everyone agrees that the young offenders should be spared the harshest punishment. Robert Blecker, a professor of criminal law at New York Law School, said he would "almost never" favor execution as a penalty for crimes committed by offenders younger than 18, "but almost never is not never." "The bottom line for me," said Mr. Blecker, who describes himself as a retributionist advocate of the death penalty, "is that in very rare instances it seems to me that juveniles can demonstrate a viciousness and callousness, a cruelty by which they can deserve to die."
    Dr. Steinberg, however, believes that the evidence for adolescents' social and biological immaturity should inform society's response to their crimes. In a recent interview, he discussed the studies and his conclusions.
Q. You argue that juvenile offenders should be seen as less guilty. What is it that in your view diminishes their culpability?
A. One argument we have made is that if, under the law, someone who did something and couldn't foresee the consequences is not viewed as completely responsible, then adolescents as a class might be less responsible than adults because they do not think through the future consequences of their actions as reliably as adults do.
    One can make the same argument for the control of impulses. Crimes that are committed out of passion are punished less severely than crimes committed under other circumstances. So if, in fact, adolescents are more likely to act out of passion in general, then this might indicate that they have diminished capacity in that respect.
    The second argument has more to do with the conditions of a criminal act. The legal argument here is that you can ask whether a reasonable person would have behaved in the same way under similar circumstances. And we argue that the reasonable adult standard is not the same as the reasonable adolescent standard. We know, for example, that adolescents are less able to resist peer pressure than adults are. Let me give you a concrete example: If I told you that a crime was committed by a group of people, in which an individual was pressured by the group saying, "You're chicken!" "We dare you to do it!" and so forth — and if I told you that it was a 12-year-old, you would probably view it differently than if I told you it was a 22-year-old, even though the amount of pressure might be the same in each condition.
Q. Many people believe that a brutal murder committed by a 16-year-old offers a glimpse of the kind of adult that teenager will become. Is it possible to judge which adolescents are simply "bad seeds"?
A. It would be very difficult to look at someone who is 15 or 16 and say with any degree of certainty that we know what that person is going to be like when he is 25, that he is a bad person. There is a fairly extensive body of research that indicates that there are many people who engage in antisocial behavior during adolescence who stop at the end of adolescence or in early adulthood. In fact, that's the normative pattern.
    But we are not very good at looking at a group of adolescents who have committed bad acts, whether of delinquency or crime, and identifying those kids who are going to be career criminals. We're doing a study now where we're seeing if we can improve risk prediction, following the lives of close to 1,400 juvenile offenders and looking at their sociological characteristics, their attitudes, their intelligence, you name it, to see if we can develop better models of which kids are going to re-offend and which are not. But I can tell you from the literature that we're not good at doing this with adults, and we're even worse with kids who are still developing. You may think you will be able to pick out the bad seed, but you will be wrong more often than you are right.
Q. Can studies of brain development help decide what the minimum age for the death penalty should be?
A. I don't think science will ever tell us, This is the perfect chronological age where we should draw the line. The new brain science indicates that brain maturation is going on much later in development than people had thought, so there is some reason, perhaps, to say that 17-year-olds are not the same as adults. There is evidence of structural change in the prefrontal cortex, which is the area that governs what we call executive function, higher order cognitive skills like planning. Changes of the sort that lead to improved information processing are still taking place late in adolescence.
    The two types of changes there is the best evidence for are synaptic pruning and myelinization. Synaptic pruning is the process by which unnecessary nerve synapses are eliminated. It's like eliminating all the unpaved roads in the brain and replacing them with superhighways. Myelinization is the further development of white matter, which serves as insulation for the cells through which nerve impulses are being transmitted. Just as with the wiring in your home, electricity flows better through well-insulated wiring than poorly insulated wiring.
    A second type of evidence has to do with improved connection between the limbic system, which is deep inside the brain and which is where a lot of emotional stimuli are processed, and the prefrontal cortex, which is the center of decision-making activity. We believe, we don't know for sure, but we believe that this might lead to an improvement in decision making, so that, in the younger adolescent's brain, it's more likely that a very strong emotion will overwhelm rational decision making.
    What we don't know, and where I think we need to be cautious, is how these structural changes actually play out in behavior. Right now, the links between the brain changes that have been identified and the behavioral changes that have been identified are speculative. I think that the speculation is probably correct, but I think we need to be very cautious.
Q. Will the Malvo case have ramifications for how juvenile criminals are punished?
A. It will be really interesting to see what happens. People who are opposed to the juvenile death penalty were gaining a lot of momentum in this argument until the sniper case. The case is interesting for a number of reasons. First, the crime is so heinous that it's in the category of crimes where the seriousness of the crime often trumps consideration of mitigation. Second, it's interesting because Malvo is very old for a juvenile: he's 18 now, and he was close to 18 when he allegedly committed the crime. At the same time, he's very young looking, and that may affect the jury's deliberation about whether his immaturity mitigates his blameworthiness.
    I think that it's also interesting to watch because of the particular argument that's being made about mitigation, which is an argument about influence. I think that, if it is in fact proven that he was influenced by this older man to commit the crime, then it ought to mitigate his responsibility, but I'm not sure a jury will agree with that. I think the question in this trial is, in the real world, when these things are happening day to day, should we expect an ordinary 17-year-old to be able to resist the pressure of an older person who has some control over him? The jury is going to ask whether an ordinary 17-year-old in this situation would have the wherewithal to walk away from it.



Lawyer for Church Says He Hid Own Sexual Abuse
Laurie Goodstein, New York Times- 11/25/2003

For five years, Robert P. Scamardo defended the Roman Catholic Diocese of Galveston-Houston against lawsuits by people who claimed to have been sexually abused by priests. As general counsel, he vigorously resisted accusers, he said, fending off their lawsuits and collaborating with church officials to send them away quietly, with as little money as possible.
    He said he felt good about his job until one negotiating session with a gray-haired woman who said, through tears, that the molesting she suffered long ago was still causing her depression, marital strife and sexual problems. "You can't possibly understand," she insisted. Mr. Scamardo said he desperately wanted to tell her, "Yes, I do."
    Of the thousands of people who have fought the church over sexual abuse charges, Mr. Scamardo is the only one known to have fought from both sides. While representing the church as a trusted insider, Mr. Scamardo said, he was secretly struggling to cope with his own sexual abuse as a teenager by a priest and a lay youth minister. The conflict between his inner and outer selves brought anguish, thoughts of suicide and finally a confrontation with the diocese. When he sought compensation from the church as an abuse victim this year, he came up against a bishop and lawyers aggressively guarding church assets.
    In an interview in Houston, Mr. Scamardo provided a window into how church lawyers worked to deter lawsuits, minimize the church's payouts, limit coverage for therapy and keep any settlements secret. It was always the church, he said, that insisted on inserting confidentiality clauses in the settlements — never the victims, as many bishops have contended. He said that while the eruption of the scandal last year had made bishops more likely to express compassion toward victims, the church's lawyers were still playing hardball behind the scenes. And he said he was certain there were many more abusive priests and victims than have become public.
    Mr. Scamardo said he left his post when the dissonance between his past and his present became so unbearable he began to think of suicide. Three weeks ago, after months of wrangling, he signed a financial settlement with the Diocese of Austin, where he said the abuse occurred. "If they're playing the game with me like that this year, then nothing has changed," Mr. Scamardo said.
    Bishop Gregory M. Aymond of Austin declined to give an interview, but said in a statement: "I deeply regret any pain Mr. Scamardo may have suffered and pray that he will know God's healing. While we cannot change the past, the diocese has established extensive programs to prevent sexual abuse in our parishes and schools in the future." The statement said the diocese had paid for "extensive counseling for Mr. Scamardo." In the Diocese of Galveston-Houston, where Mr. Scamardo worked, Msgr. Frank H. Rossi, the chancellor who hired him, and Bishop Joseph A. Fiorenza declined to comment, saying they wanted to protect his confidentiality as a former employee. Annette Gonzales Taylor, the director of communications for the diocese, said that she had worked with Mr. Scamardo and considered him a friend but that she and others had no idea he was carrying such a burden until soon before he left. "Robert is a very good man, and he was a very valued employee here," she said. "We were heartbroken, devastated when we learned from him what had happened."
    Mr. Scamardo, 44, said he still struggled not to feel ashamed about what happened when he was 15 and the newly elected president of the Catholic Youth Organization for the Diocese of Austin. He was invited to a convention of the Texas Catholic Conference in San Antonio and, he said, did not raise questions when the Rev. Dan Delaney, director for youth ministry for the Austin Diocese, arranged for them to share a hotel room. That night, Mr. Scamardo said, he awoke to find Father Delaney on top of him, masturbating him. Mr. Scamardo said he ran into the hallway. The priest never mentioned the matter, he said. Mr. Scamardo said he soon told James Reese, the lay youth minister at Sacred Heart Parish in Austin, who listened sympathetically — then sexually abused him on several occasions.
    The Diocese of Austin said neither of the men accused of abuse was now in ministry. Reached by telephone in Houston, Mr. Delaney said he remembered Mr. Scamardo "vaguely." Asked whether he had sexually abused him, Mr. Delaney said, "I don't have any comment on that, thank you," and hung up. In a letter to Mr. Scamardo in March, Bishop Aymond wrote that Mr. Delaney had been laicized by the Vatican in 1987. Mr. Reese was enrolled as a seminarian for the Diocese of Austin as recently as September 2002. But he was dismissed immediately after Mr. Scamardo identified him as one of his abusers, the bishop said. Mr. Reese, reached by phone in Austin on Saturday, said, "While it may be true we did have a relationship, I don't think it's the way he says." He added of Mr. Scamardo: "I hope he heals, I really do. I've been praying a lot for him. But any explanation I might give might deter from that healing because I don't remember the events the way he does."
    For 27 years, Mr. Scamardo said, he went into "shutdown" about the abuse, telling no one else. Instead, he studied to be a priest at the Pontifical Gregorian University in Rome, but dropped out a year before ordination when he became aware he could never be celibate. He worked on Capitol Hill, married and had three children but never told his wife about the abuse. He went to law school, was hired by a firm in Houston and was headed for partner, he said. In 1997, Monsignor Rossi, an old seminary classmate, recruited him to work as general counsel in the Galveston-Houston diocese. Mr. Scamardo said he was idealistic about serving the church but blind to "something unhealthy" about his decision.
    Church lawyers at that time, he said, were reeling from a recent jury decision in Dallas to award $119.5 million to 11 plaintiffs who had been sexually abused by a priest, Rudolph Kos. The lesson for the church's lawyers, Mr. Scamardo said, was "these are not the sort of cases you want to get in front of a jury." So, he said, he devoted about half of his time as general counsel to negotiating with sexual abuse victims, investigating their claims and finding ways to limit the church's liability. He estimated that he handled cases involving 20 to 30 victims but said he dealt only with those who retained lawyers and sued. There were more victims who contacted the chancery without intending to sue, he said.
    The Diocese of Galveston-Houston has not made public how many of its priests have been accused, said Mrs. Gonzales Taylor, the director of communications. Research published in The New York Times in January found five accused priests in that diocese, but Mr. Scamardo said he was aware of more. This is true for many dioceses, said some church officials who were unwilling to be named but who knew partial results of a survey the bishops have commissioned to assess the extent of the abuse. That report is to be released in February.
    Mr. Scamardo said that throughout the 1990's, Bishop Fiorenza consistently removed priests credibly accused of abuse. But, Mr. Scamardo said, the bishop told parishes only that priests were leaving for "personal reasons" or "medical leave of absence." "They assume that all sorts of people are going to fabricate claims, as if everyone wants to be known as a sexual abuse victim," Mr. Scamardo said.
    Most victims' cases were beyond the statute of limitations, so the diocese could offer little to settle a case, perhaps just the cost of a short course of therapy, he said. If that failed, he said, church lawyers would petition to have cases dismissed on First Amendment grounds, arguing that the government must not meddle in church matters. The settlements always had a confidentiality clause. Like other diocesan lawyers, Mr. Scamardo said, he often added a clause specifying how much the victim would have to pay the church for breaking confidentiality.
    The standard approach was to offer to pay only for the victims' counseling, and even this came with strings attached, he said. The diocese kept a list of preferred therapists and limited the number of sessions it would pay for. A year of counseling was considered generous, Mr. Scamardo said. He said he found that unfair, saying it had taken three years of counseling before he began to talk about his sexual abuse.
    And yet, by all accounts, Mr. Scamardo was an aggressive and successful advocate for the diocese. George E. Cire, a Houston lawyer who represented a family that sued the church in 2000, said: "Certainly he was not overly sympathetic to the victims. Not that he was overly confrontational with them, but he just didn't give in." "My guess is he took such a hard stance just to cover up any sympathy he may have been feeling for the victims," Mr. Cire said.
    Mr. Scamardo said his anguish built gradually. First there was the gray-haired woman. Then a victim he had met committed suicide. In June 2002, with the scandal in Boston propelling victims forward, Mr. Scamardo said he got an e-mail message from a man who said he had been abused by Dan Delaney — the priest in the hotel room. Mr. Scamardo said it dawned on him then: a man abused by a priest as a teenage boy had spent most of his legal career defending priests who abused teenage boys. By August 2002, Mr. Scamardo said, he was thinking about suicide. A victim walked out of a mediation session, and Mr. Scamardo said he felt "like the enemy."
    In September, he wrote long letters to Bishops Fiorenza and Aymond revealing his abuse. He asked Bishop Aymond to help pay for a month at a residential treatment center north of Dallas. He stayed nearly three months, which cost the Austin diocese $33,443. He went back to work, but felt awkward, he said . While he had been a frequent visitor to Bishop Fiorenza's office, now he could not get in, he said. He declared his intention to resign, and asked for a little time. Meanwhile, regarding it as a friendly negotiation, Mr. Scamardo wrote the bishop of Austin suggesting a settlement of $437,500 to cover medical bills for him and his family, lost income, pain and suffering.
    In a March 25 response, which Mr. Scamardo shared with The Times, Bishop Aymond, who began serving in Austin in 2001, apologized profusely and said he wanted to help. He reminded Mr. Scamardo that his claim was beyond the statute of limitations, and countered with $50,000 plus medical expenses for 12 months. Since insurance would not cover it, the bishop warned, "any financial settlement would be taken from the money that is given by the parishioners on Sunday in the collection."
    Mr. Scamardo, angry and offended, began looking for a lawyer. Within 10 days, the Diocese of Galveston-Houston hired a new general counsel. Mr. Scamardo quit in May. On Oct. 29, he signed a settlement with the Diocese of Austin for $250,000. He has opened his own law practice in Houston. He says he does not think he can emotionally handle sexual abuse cases but may serve as an expert witness in trials. He said he prayed and believed in God "more than ever." But the last time he went to church was on the Feast of the Pentecost in June. "I have a lot of grief because my whole belief system in the church is just gone," he said.