Study: Cocaine Use Explains Higher Depression Rates
Malcolm Ritter, Associated Press, 1/1/2003

NEW YORK -- Chronic cocaine use harms brain circuits that help produce the sense of pleasure, which may help explain why cocaine addicts have a higher rate of depression, a study suggests. It's not clear whether cocaine kills brain cells or merely impairs them, or whether the effect is reversible, said study author Dr. Karley Little. But it's bad news for cocaine addicts in any case, he said. ''I personally wouldn't want to lose 10 or 20 percent of my reward-pleasure center neurons, or have them just deranged or not working right,'' said Little, of the Ann Arbor, Mich., Veterans Affairs Medical Center and the University of Michigan. He and colleagues studied brain samples taken during autopsies from long-term, heavy cocaine users. Their results were reported in the January issue of the American Journal of Psychiatry. Little said the research did not reveal whether the brain impairment resulted from years of use or just recent use before death.
    Stephen Kish, head of the human brain laboratory at the Center for Addiction and Mental Health in Toronto, said researchers have ''always considered cocaine to be a dangerous drug'' because of its potential for addiction and harm to the heart. ''We now have to add to the list (of risks) a damaging effect of cocaine on the brain, which was something we never expected before,'' Kish said. The research provides ''a piece of the puzzle'' in explaining why cocaine users run a higher risk of depression, said Dr. Deborah Mash, a neuroscientist at the University of Miami School of Medicine.
    It remains unclear whether cocaine causes depression or whether people start using the drug because they are depressed. But in either case, Mash said, the study suggests brain changes could ''light the fuse'' for depression in a cocaine user who is prone to it. The study also suggests that the brain changes could cause the depression commonly seen during cocaine withdrawal, Mash said.
    In the study, Little and colleagues studied brain autopsy specimens from an area called the striatum in 35 cocaine users and 35 non-users of similar age and sex. They measured levels of a protein called VMAT2, which is found in brain cells that signal each other with a chemical called dopamine. Dopamine neurons form circuits that are critical for the brain to feel pleasure.
    The study found that cocaine users' VMAT2 levels were lower on average. That could mean dopamine neurons had been damaged or killed an effect not observed in animal studies or that they were making less VMAT2, which suggests they also were making less dopamine, Little said. A person with impaired or missing dopamine neurons could have difficulty feeling pleasure and might become depressed, said Little, who added that researchers will now compare the number of dopamine neurons in the autopsy specimens. The study found hints that VMAT2 levels were lower in cocaine users with severe depression than in other users, but statistical analysis suggested this could be a coincidence. Little said the link is strengthened when other data are taken into account.

Boston Rape Crisis Center Refuses Judge's Order
Associated Press, 1/1/2003

SALEM, Mass. -- A rape crisis center is refusing a judge's order to release a teen-age victim's counseling records, saying the alleged rapist's lawyers wrongfully learned of her counseling by questioning her grandmother. A judge Monday ordered the Women's Resource Center to turn the record logs over to the lawyer for Manuel Valverde, who is charged with rape. The center refused and the judge took the matter under advisement, but indicated he may fine the center up to $500 a day. Last week, the state's highest court ruled in a different case that victims cannot assume their records are private and must actively assert their right to keep their medical and psychiatric reports secret.
    Wendy Murphy, a lawyer representing the center, said the 16-year-old girl's grandmother, after being told by a defense investigator that he was with the court, told him that her granddaughter had sought counseling. ''One of the reasons we refused to comply is because of the manner by which they got the information,'' Murphy said. Paul R. Rudof, a public defender for Valverde, did not return a phone message seeking comment. Murphy asked the judge to put a hold on any fines he might impose until after she appeals his decision. Another hearing was scheduled for Jan. 27.

N.Y. Law Mandates Licensing for Mental Health Therapists
Seanna Adcox, Associated Press, 1/1/2003

ALBANY, N.Y. -- Gov. George Pataki signed a bill into law that mandates licensing for New Yorkers who provide non-drug mental health treatment, such as marriage and family counseling. The measure sets education and training requirements for therapists earning the title ''mental health counselor,'' and defines the levels of care they can offer. It protects patients by ensuring they receive help from a qualified professional, said state Sen. Kenneth LaValle, a bill sponsor. ''People have literally hung a shingle on their door saying they are family and marriage counselors, who had absolutely no educational training,'' said the Suffolk County Republican. ''They did nothing but talk to people. You can find a good friend and do the same thing.''
    The Legislature unanimously passed the measure in June, after a 28-year push by the state chapter of the National Association of Social Workers. Pataki signed it into law earlier on Dec. 9. Neither the National Association of Social Workers nor the New York State Psychological Association returned messages Tuesday.
    ''The key battle was that psychiatrists felt it would be eroding their scope, their professional turf,'' LaValle said. The New York State Psychiatric Association is pleased with the approved compromise, which provides greater, not less, distinction between psychiatrists and therapists, said Dr. Barry Perlman, the group's president. Psychiatrists already are licensed and regulated by New York state. The law does not affect their oversight. ''It's a good day for psychologists, and more importantly, it's a good day for their patients,'' said Alan Lubin, vice president of New York State United Teachers. The law ''will help those suffering from mental illness receive the diagnosis and treatment they need.''
    The law formally recognizes four areas of therapy marriage and family, creative arts, mental health and psychoanalysis and spells out the qualifications counselors must have to receive licenses in those concentrations. Generally, qualifications include a master's or higher postgraduate college degree in counselors' areas of expertise, the ability to pass a state certification examination and at least 3,000 hours of training and practice.
    The law prohibits therapists from prescribing medicine and performing surgery or electro-convulsive therapy. It also requires therapists to refer patients suffering from a serious mental illness, such as bipolar disorder or schizophrenia, to a doctor for a medical evaluation a requirement lauded by the state Psychiatric Association, Perlman said. Currently, the state Education Department offers a voluntary mental health counselor license, secured by about 30,000 of the 80,000 professionals in the field. The law establishes a board of experts in the field to oversee the profession, as the state Education Department does for other 38 professions it licenses, such as architecture and accounting. It also directs the Education Department to issue regulations setting up licensing standards and to implement the system between Sept. 1, 2003, and Jan. 1, 2005. The full licensing requirement does not go into effect until Jan. 1, 2006.

Survey: Binge Drinking Is Up In U.S.
Associated Press, 1/1/2003

CHICAGO -- Binge drinking is on the rise in the United States and is climbing fastest among 18- to 20-year-olds, who are too young to drink legally, according to a government survey. Episodes of binge drinking, defined as having five or more drinks in a sitting, increased 17 percent among all adults between 1993 and 2001, and shot up 56 percent among 18- to 20-year-olds, the telephone survey found. The survey was conducted by the Centers for Disease Control and Prevention. The findings were published in today's issue of the Journal of the American Medical Association.
    Adults ages 21 to 25 went on drinking binges an average of 18 times in 2001, according to CDC. Those ages 18 to 20 did so an average of 15 times. The drinking age in the United States is 21. Binge drinking among all adults in 2001 increased to 1.5 billion episodes, or an average of more than seven times per person. That is up from about 1.2 billion episodes, or about six times per person, in 1993. The average number of episodes for other age groups in 2001: nine for those ages 26 to 34; almost seven for those ages 35 to 54; and almost three for those 55 and older. Men had 12.5 episodes in 2001, compared with 2.7 for women. Hispanics had 8.4 episodes, while whites had 7.4 and blacks 5.4.
    Researchers think their study still may underestimate the scope of binge drinking. Psychiatrist Daniel Angres, who heads an alcohol and drug dependency program in Chicago, said popular culture promotes binge drinking. "We have, really, a public health problem that is in some ways becoming epidemic in proportion," Angres said. CDC researchers analyzed results for every other year between 1993 and 2001. The number of participants ranged from 102,263 in 1993 to 212,510 in 2001.

The 'I' in The 'I Think, Therefore I Am'
Amy Ellis Nutt, Newhouse News Service- 1/1/2003

Maps are the tools of dreamers. A map gives substance to possibility, truth to discovery. In the 16th and 17th centuries, cartographers were called "world describers." In the 21st century, it is neuroscientists who are pushing back the boundaries, attempting to describe that final terra incognita, the human mind. In 1637 the mind was front and center when Descartes announced, "I think, therefore I am." Having proven his own existence, the French philosopher then asked himself the mother of all follow-up questions: "What is this 'I' that I know?"
    Nearly four centuries after Descartes essentially threw in the philosophical towel, Todd Feinberg, a neurologist at Beth Israel Medical Center in New York City, and Julian Keenan, an experimental psychologist at Montclair State University in New Jersey, say they are close to mapping the place in the brain where the sense of self is formed. Feinberg, author of "Altered Egos: How the Brain Creates the Self," treats patients who have neurological damage, studying how their injuries have robbed them of the key ingredients of their identity. For many of his patients, stroke, disease and physical trauma -- especially in the right hemisphere of their brains -- have resulted in a kind of self-alienation. They are people whose brains have lost their way.
    Keenan, author of the soon-to-be-released "The Face in the Mirror," is researching those same ingredients through experiments that involve magnetic stimulation of the brains of healthy subjects, testing for the thing that he believes makes us uniquely. human: self-recognition. Among all the species on the face of the Earth, human beings alone inquire about who they are. Feinberg and Keenan are among a small band of scientists reaching through the mists of memory and emotion to explain how this could be.

The fractured self
Todd Feinberg hunches in his chair as his theory of the fractured self is played out in front of him in a simple game of cards. An elderly couple sitting across from him are playing war, in which two players simultaneously pick up cards from their own halves of the deck and place the cards next to one another. Whoever has the card with the higher face value wins the round. Sylvia is moving the game along at a clip, and it's clear why. Every time she picks up a card from her own pile with her left hand, she is compelled to pick up a card from her husband's pile with her right hand.
    Feinberg, a psychiatrist as well as a neurologist, is fascinated. Quite literally, Sylvia's right hand doesn't know what the left hand is doing. Only occasionally and seemingly unconsciously, does Sylvia realize that her right hand is meddling with the game, and when she does, she places the hand between her knees and squeezes it to try to keep it from misbehaving.
    The 72-year-old woman, who owns an antique store in New Jersey with her husband, suffers from alien hand syndrome, a rare neurological condition. A stroke several months ago damaged Sylvia's corpus callosum, a broad band of 200 million fibers that bind together the left and right hemispheres of the brain. Signals from the left hemisphere, which would normally inhibit the actions of Sylvia's right hand, are not getting through to the other side of the brain. The result is that her right hand seems to have a life of its own.
    When she speaks to her husband on the phone from her room in the Center for Head Injuries at JFK Johnson Rehabilitation Institute in Edison, N.J., she cradles the receiver with her left hand, but her right hand frequently reaches out and disconnects the call. When she eats with her left hand, her right hand will wipe the table with an imaginary cloth. And when she plays checkers, she moves her own piece with her left hand, and then her opponent's with her right. Sylvia, for all intents and purposes, is a woman of two minds. Which is why, says Feinberg, she not only has a damaged brain, she has a fractured self.
    "Alien hand syndrome tells us a lot about brain unity," says the 51-yearold doctor. "It tells us that there is no consciousness or mind that does not require cerebral integration. If you destroy or damage the corpus callosum, there are times at which the brain can act as though it was possessed of two minds, two consciousnesses, two independent entities."

'The ghost in the machine'
Descartes thought the mind and body were two separate entities. The body was a physical organ, a complex machine that walks, eats and sleeps, and the mind was a disembodied spirit, intangible and unobservable but altogether real. In 1949, British philosopher Gilbert Byle said Descartes' dualism was preposterous. An independent, invisible secret agent inhabiting the body? That would mean there was a "ghost in the machine." Ryle rejected the idea of two separate entities. There was, he contended, no intangible self, no "homunculus," or miniature man, directing a person's thoughts and actions from the inside. Instead, a person simply was his thoughts and actions, and the world was processed entirely by the gelatinous gray and white matter inside our skulls. The mystical mind was out, the hard-wired brain was in.

How does the brain become 'me?'
The idea that the puzzle of brain activity could be assembled into a single, subjective consciousness has perplexed Feinberg for most of his life. How does a three-pound lump of matter become a "me"? "The first thing that I remember discovering in life was that I had a brain," says Feinberg, founder and chief of the Yarmon Neurobehavior & Alzheimer's Disease Center at New York's Beth Israel Medical Center. "I couldn't have been more than 6 years old, and one day I said to myself: `I have thoughts and I have experiences. I have consciousness. But where are they? Where are they located? How come I can't see them? How come they can't be touched and measured and weighed?' And I just could not believe that. Ever since, I've been obsessed with the mind."
    In truth, the life of any one mind is irremediably closed, colored by experiences and bounded by the uniqueness o f individual perspective. "The mind is its own place," wrote Ryle, "and in his inner life each of us lives the life of a ghostly Robinson-Crusoe ... blind and deaf to the workings of one another's minds and inoperative upon them."
    "There is no way to find out if your experience of the color red, for instance, is like my experience of the color red," says Martha Farah, director of the University of Pennsylvania's Center for Cognitive. Neuroscience in Philadelphia. "But if you define consciousness as mental content -- the information contained in thoughts that is reportable by the person, and which they can reflect on and talk about -- then, in that sense, consciousness is a valid subject of scientific study."
    It is the content of consciousness that particularly interests Feinberg. Subjective experience can't be seen or heard or touched. It simply is. Feinberg calls this the "transparency problem." There is a second aspect to self-awareness that deepens the mystery, the "binding problem", which is: How do billions of different neurons come together to form a single unified self, and if we know where the neurons are located,, why can't we find the self?

The arm of another
In many of the alien hand cases Feinberg has seen, the limbs act in violent opposition. When one of Feinberg's patients tried to buton his shirt with his right h his left hind unbuttoned it. When he picked up a forkful of food with his right hand, the left hand knocked it away. Another patient reported that her left hand tried to strangle her while she slept.
    "The thing that grabs one's attention here," says Feinberg excitedly, "is the fact that you have two hemispheres in one person with competing and conflicting attentions, and that highlights the incredible unification in normal intact individuals. ... The sense of the self is the sense of a unified self, of personhood."
    Some of Feinberg's patients suffer from asomatognosia, in which they deny or misidentify a part of their own body after it has been paralyzed by stroke. In all of the cases Feinberg has seen, the damage was to the patients' right hemisphere, causing them to attribute ownership of their left arm to another person -- a relative, a stranger -- or even a pet. Some patients try to throw the disowned arm out of bed. Others, trying to acclimate, create stories about the arm, give it nicknames such as "Toby" or "Silly Billy," or simply refer to it as "a canary claw," "a sack of coal" or "dead wood." Feinberg's research has shown a peculiarly gender-specific phenomenon associated with asomatognosia. Women frequently will mistake their left arm for their husband's arm. Men will frequently mistake their left arm for the arm of their mother-in-law.
    There is no cure for most of these patients, but over weeks and sometimes years, their symptoms often diminish and even disappear -- a testament to the resourcefulness of the damaged brain. Feinberg says the sense of identity is probably a mixture -- what he calls a "nested hierarchy" -- of coordinated functions arising out of several areas of the brain. But he also believes the right hemisphere is dominant as the source of the self.

Testing self-recognition
Julian' Keenan's belief is stronger, and more specific. The right hemisphere isn't simply dominant in the formation of self-awareness, he says, it is essential. "I think there actually is a center" of the self, says Keenan as he leans back in a chair in his office at Montclair State University. "There are definite neural correlates of higher-order consciousness that, if you mark them out, the person is no longer conscious, no longer capable of self-awareness."
    Just a tenth of an inch beneath the furrowed ridges of gray matter that cover the right front side of the brain, he contends, is a layer of tangled cell tissue that makes us, uniquely human. While acknowledging there may be other similarly minuscule areas of the brain than contribute to consciousness, the 32-year-old experimental cognitive psychologist has come to the conclusion that the right prefrontal cortex -- located just above the right eye -- is the primary source of self-awareness.
    Two years ago, while conducting postdoctoral research in behavioral neurology at Harvard Medical School, Keenan created an unusual experiment to test for "self-face recognition," which he regards as the hall-mark of higher consciousness. "What we know, as far as self-face recognition is concerned, is that it's reserved for a very few species," says Keenan, who is married and lives in Jersey City, N.J. "Only chimpanzees, orangutans and humans have the ability to recognize an image as their own. So what we wanted to do was see where in the brain that takes place."
    Volunteering as test subjects were five people about to undergo brain surgery for severe epilepsy at Boston's Beth Israel Deaconess Medical Center. During the presurgical evaluation of each patient, the two hemispheres of the brain were anesthetized, one at a time, while the patient stayed conscious and alert. After each hemisphere was numbed, Keenan and his colleagues showed the person a photograph with a morphed image blending the patient's face with that of a famous person's -- Marilyn Monroe or Princess Diana for the women, Bill Clinton or Albert Einstein for the men. After the testing, each patient was presented with two conventional photos, one of himself or herself and one of the famous person. They were asked which was the one they remembered seeing under anesthesia.
    The results were startling. When the right hemisphere was anesthetized, four of the five recollected seeing only the famous person. With the left hemisphere numbed, all five patients remembered the morphed picture as a photo of themselves alone. "We really saw that the right hemisphere was the big player in self-recognition," says Keenan, "and in particular the right prefrontal cortex." His conclusion: That is where the self resides.

Using 1ight to see the dark
While Keenan and Feinberg are traditional materialists, believing that the mind is nothing more than brain functions, others, like Daniel Dennett, a cognitive scientist at Tufts University, believe the mind is nothing at all-- that mental states don't arise from neural states, they ARE neural states. Dennett once said of consciousness: "It's like fame. It doesn't exist except in the eye of the beholder." William James, the pioneering 19th-century philosopher and psychologist (and brother of novelist Henry James), said that using language to describe introspection was like "trying to turn up the gas (light) quickly enough to see how the darkness looks."
    Keenan, however, believes the science of consciousness can transcend linguistic limitations. In a new series of experiments at Montclair State, he is using a device called a transcranial magnetic stimulator to measure how active each hemisphere of the brain is in tasks involving self-recognition. When gently placed against the skull, the stimulator -- which looks oddly like a thick, metal Mardi Gras mask -- creates a magnetic field that painlessly deactivates a specific area of the brain for a moment as brief as a hundred-thousandth of a second. When the device is held over, the area of the right prefrontal cortex -- the area Keenan believes is the source of self-recognition -- subjects routinely take a fraction of a second longer than normal to recognize their face on the computer screen. When the stimulator is held over the left frontal region, nothing happens. "Again and again, what we're seeing is that the processes of self-evaluation are preferential the right hemisphere," says Keenan "And it is that ability to recognize one's own face that appears to be a hallmark of consciousness. To know that our own face is ours inevitably requires knowledge of the self. Without self-knowledge, it would be seemingly impossible to recognize who we are."
    Farah, the Penn neuroscientist, whose primary research is in the neural correlates of cognition, believes self-recognition studies are helping to advance the scientific study of the mind. "A lot of the work on sense of self and the brain is pretty flaky," she says, "but Keenan's and Feinberg's work is credible. Keenan has found distinctive patterns of brain activity that correlate with processing one's own face compared to other people's, and Feinberg finds that certain brain lesions disrupt a person's ability to recognize their own face or arms as belonging to them. This tells us that one's sense of physical self is the result of specific brain systems."
    Keenan believes t hat in the next 10 years he will know enough to have a new map of the brain with more precise coordinates of the self. Describing subjective experience may forever be elusive; describing what it is that makes us most human, he says, is not. That's all Feinberg is looking to do, too, and he believes the search is profoundly important: "You could argue that aside from intelligence, the sense of the self is probably the greatest human achievement. Without that sense of being a being, where would we be?"

MADD Has Aggressive Agenda
Mark O'Keefe, Newhouse News Service- 1/1/2003

Alcohol related driving fatalities have plunged. Drunkenness no longer gets big laughs, as it did in the 1970s when slurring of speech and hiccuping were comedy gags. "Designated driver" has become part of the public's vocabulary, particularly on New Year's Eve. And through Jan. 5, motorists in all 50 states will be tested at sobriety checkpoints in the toughest nationwide crackdown ever on drunken driving.
    Much of the credit goes to a single charity animated by constructive rage -- Mothers Against Drunk Driving. Yet the group is not satisfied. With a slogan of "Get MADD all over again," it is launching a 2003 agenda so aggressive its critics have labeled it neo-prohibitionist. MADD officials counter that it's absurd to suggest the group wants to outlaw alcohol consumption, but that if you drink, even if it's only a glass of wine with a meal, you simply shouldn't drive.
    "Drunk driving is not an accident," said MADD President Wendy Hamilton, who lost a sister, a nephew and a cousin to alcohol-related crashes. "When you hit an icy patch, when a child runs in front of your car, that's an accident. But when someone chooses to put that key into the ignition after drinking it becomes a crime."
    MADD sees as a potential vehicle for its agenda next year's congressional reauthorization of the Transportation Equity Act, a massive spending bill. The MADD agenda includes:
• Stepping up enforcement of drunken-driving laws, particularly through highly publicized sobriety checkpoints.
• Penalizing repeat drunken driving offenders by taking away their licenses for a year or more and putting them in jail for at least 10 days.
• Adopting tougher standards for alcohol advertising seen by children and urging stricter enforcement of "zero tolerance" state laws that snatch the licenses of underage drinkers who drive.
• Developing a $1 billion-a-year National Traffic Safety Fund. When asked where the money to pay for this would come from, Hamilton suggested a half-a-penny increase in gasoline taxes, a small investment, she said, when you consider alcohol-related crashes cost an estimated $60 billion a year.
• Increasing beer excise taxes to equal taxes on distilled spirits.
    Raising taxes with a conservative president in the White House and Republicans in control of Congress will be difficult, especially when organizations dependent on alcohol work against MADD, which was founded in 1980 and has headquarters in Irving, Texas. "I think MADD's mission has shifted from getting and keeping drunk drivers off the road to attacking the product, point of sale, advertising and level of taxation paid on beer," said David Rehr, president of the National Beer Wholesalers Association, which Fortune magazine ranks as the eighth most powerful lobbying group in Washington. "I think this neo-prohibitionist agenda will ultimately catch up with MADD and destroy it, whether it's five years from now, 10 or 15. You can't sustain policies at odds with the behavior of the average American and continue to get support."
    John Doyle, executive director of the American Beverage Institute, a Washington-based trade association of restaurants, takes a similar tack. "They're trying to say, `You're the problem, I'm the problem, the guy down the street having a beer at the restaurant is the problem' and we say, 'Bull!"' said Doyle.
    Doyle credits MADD for shifting the attitudes of an entire culture -- no small task -- and said MADD's battle to reduce drunken driving has essentially been won. To "feed 'their fund-raising machine" and sustain a $45 million annual budget, Doyle contends MADD must redefine its problem, targeting social drinkers who are less impaired driving a drink or two than they would be if they used a hand held cell phone behind the wheel.
    According to the latest tax return filed with the Internal Revenue Service, MADD took in $44.3 million in revenue in the fiscal year ending June 30, with $26.3 million of that coming from direct public support and $8.4 million in government grants. The rest came from program service revenues, membership dues and interest. MADD earned a C- grade in July from the American Institute of Philanthropy, which grades according to the percentage of each $100 raised going to salaries, fund-raising costs and other expenses, as opposed to good works. On the other hand, in December 2001, Worth magazine listed MADD as one of its 100 best charities.
    Perhaps the strongest measure of MADD's effectiveness came this December, when the federal government released its most comprehensive look at drunken-driving accidents over the past two decades, roughly the same period MADD has been in existence. The national rate of alcohol related fatalities per 100 million vehicle miles traveled plummeted 62 percent between 1982 and 2001.
    Friends and foes alike credit MADD as a driving force in reducing that number. But Hamilton warns it's no time to get complacent. That's because about 17,000 people continue to lose their lives in such crashes annually, a figure that has held relatively constant since 1994, after more than .a decade of dramatic drops.
    "When I see that 17,000 number, along with a trend line that has hit a plateau and is starting to go up; I find it disturbing, disheartening and alarming," said Hamilton. When asked about her critics and the charge of neo-prohibitionism, Hamilton shook her head in disgust. She has heard that argument before, particularly when MADD urged Congress to pass a law requiring all states to adopt a.08 blood alcohol content standard by September 2003 or lose millions of dollars in federal highway funds. When President Clinton signed that law in 2000, 18 states and the District of Columbia had .08 laws. Since then, at least 16 more states have adopted .08 as their standard.
    The notion that drunken-driving deaths have sunk about as low as they can realistically get "should be unacceptable to each and every one of us," said Hamilton. The American Beverage Institute's slogan of "drink responsibly, drive responsibly" won't work she said, because drinking and driving can't safely go together. Police across the country are taking a similar hard line, in stark contrast to the prevalent attitude decades ago, when many people who were caught driving drunk for the first time were given only a ride home and a warning.
    At a Dec. 18 news conference in Washington announcing the nationwide sobriety check-points, North Miami (Florida) police Chief William Berger said motorists can and will be prosecuted if they show signs of impairment, even if their blood level is below their state's standard. "If you choose to drive after drinking, the government will give you a ride," said Berger. "But you will go directly to jail and you will not pass 'Go.' Your bond will be more than $200."
    To visually illustrate the damage of drunken driving, the news conference was held at the MCI Center in Washington, D.C., a sports arena with a seating capacity slightly higher than the 17,448 who lost their lives in alcohol-related crashes in 2001. That figure is significantly down from the 43,945 who lost their lives in alcohol-related accidents In 1982, but up slightly from the 17,380 who died in 2000.
    Before MADD, it was erroneously thought that statistics showing fatalities could move public opinion on drunken driving, said Charles Hurley, who heads the National Safety Council's traffic safety group. "Unfortunately, the bigger number you put up there, the more unreal it becomes to the general public," said Hurley, a former MADD board member. National Highway Traffic Safety Administration head Jeffrey Runge said: "MADD made this issue more than just statistics. MADD brings the issue home. "MADD talks about people. They talk about families and the losses they've experienced from this. The public listens to that."

Cocaine Damages the Brain's Pleasure Cells
Nancy Deutsch, ABC News- 1/2/2003

Cocaine users seek pleasure, but the more they indulge in the drug, the less likely they are to feel the pleasure they're seeking. That's the finding of a new study that shows cocaine damages brain cells that trigger the feelings of pleasure. The drug also exerts its most serious effects on those who are clinically depressed, the researchers found.
    This is the first time research shows what happens "in those humans with the most clinically significant cocaine dependency problems," says Dr. Karley Little, chief of the Veterans Affairs Healthcare System in Ann Arbor, Mich., and lead author of the study in the January issue of the American Journal of Psychiatry. "Ninety-five percent of studies of drug abuse are in animals," he adds. "We're showing the change in humans."
    The researchers looked at postmortem brain samples of 35 known cocaine users and 35 non-cocaine users, used as controls. All were matched for age, sex, race, and cause of death. All of those known to use cocaine "had cocaine in their system when they died," although cocaine itself was not the direct cause of death in most cases, Little says. Many died in car accidents or of cocaine-related heart disease, and "a fair number were murdered."
    What the brain samples showed is that those who took cocaine had problems with the amount of dopamine their brains produced, and how it was released by the brain. Dopamine is a chemical known to be released to signal pleasure. "It is essential and coordinates pleasure," Little says, "but it's not the pure sensation."
    Cocaine initially sets in motion changes in brain cells that disrupt the flow of dopamine. It blocks transporters that bring dopamine back into cells. This causes dopamine to build up outside of cells and bind with other receptors, signaling pleasurable feelings repeatedly. This explains the "high" that cocaine users crave, Little explains. However, the continuous use of cocaine led to lower dopamine levels in the study subjects. Less dopamine was being produced, and there was less of the protein known as VMAT2, which lives in the cells and helps prepare dopamine to be released again. Finally, there was less indication that VMAT was available for binding. The cells involved in the functioning of dopamine either fall asleep or die in those who regularly use cocaine, Little says. While animal studies have indicated some of these brain changes, the change in humans is to a much more significant degree, he notes. "It's an overwhelming change in neurons. The changes in the VMAT protein are a little unprecedented," he says.
    Another interesting finding is that "we found these changes correlate with a symptom." Notably, cocaine users known to be depressed had the most significant changes in their dopamine levels, Little says. Seven of the cocaine users they examined had been diagnosed with depression, and these seven were the ones who showed the most striking decrease in dopamine being released and increase in reuptake of the chemical. "We don't know why the reaction is more severe in the depressed," Little adds, but he speculates that they may have a different response to cocaine and "that's why it makes it harder for these people to stop. Our study is telling us a lot more about the worse patients."
    The researchers next plan to count dopamine neurons to see if there are actually less of them in the cocaine users, Little says. He doesn't think the neurons have died off. "It's more likely they're turned way down. We're not sure if they go back to normal once a person stops taking cocaine," he adds.
    Thomas W. Clark, a research associate at Health and Addictions Research, Inc., believes this study "helps to show cocaine addiction is a real physical problem. There are changes in brain function and structure consequent to cocaine use." Little says the relevant message of his finding is that cocaine causes harm. "It's important to convey to people who might be tempted to take cocaine that there's a chance they might damage part of their brain," he says.

Study: Nicotine May Enable Cancer
Associated Press, 1/3/2003

Nicotine makes smoking addictive and is bad for the heart, but 60 other cigarette chemicals are blamed for causing cancer. Now some biochemists say nicotine might help set the stage for those chemicals to do their dirty work. Certain tobacco chemicals trigger cellular genetic damage. Damaged cells are supposed to commit suicide; if they do not, the damage accumulates enough to turn cancerous. Nicotine activates an enzyme reaction that inhibits cellular suicide, according to new research by scientists at the National Cancer Institute.
    Nicotine starts activating the enzyme, called Akt, within minutes, while cancer-causing genetic damage takes hours to begin, NCI researchers report in yesterday's Journal of Clinical Investigation. That suggests nicotine -- along with other chemicals that also block cell suicide -- may make cells more vulnerable to the cancer-causers.
    "Nicotine is not a carcinogen, and we're not trying to make that argument," said Phillip Dennis, the study leader. But "it may have a permissive effect" for cancer formation. Scientists discovered nicotine may block cell suicide 10 years ago, said nicotine expert Neal Benowitz of the University of California at San Francisco. But the new research uncovers the enzyme involved.

Social Worker in Missouri Resigns
Associated Press, 1/3/2003

SPRINGFIELD, Mo. -- A Missouri social worker has resigned, saying she was being made a scapegoat in the death of a 2-year-old foster child. Kristy Hardy quit Thursday from her job as Greene County supervisor for the state Division of Family Services -- the first county official to resign in a statewide shakeup of the Department of Social Services. Hardy was the supervisor in the case of Dominic James, whose father has publicly blamed her and another social worker for the little boy's death. Kathy Martin, director of the state department of Social Services, also resigned during the shakeup.
    In Hardy's letter to her boss, Carmen May, who leads the DFS Greene County office, she wrote: "This resignation is a result of the last conversation we had in which you made it clear I am to be the scapegoat for the problems and current difficulties" the family services system is experiencing in Greene County. Hardy said her superiors approved of decisions she and a social worker made in Dominic's case. "I want people to know I left for the right reasons," she said. "I left because of the stress of the job and I had no choice. Carmen made it clear to me, I resign or be fired."
    Hardy, who also sent her resignation to Gov. Bob Holden, intends to write a letter to the governor explaining problems with the system he pledged to fix after Dominic's death. "People shouldn't be looking at the front-line workers. The problem isn't with the front-line workers," Hardy said. "The problem is with local management."
    May was out of the office Thursday and unavailable for comment. Deb Hendricks, director of communications for the Department of Social Services, said she wouldn't respond to Hardy's comments. "We'll just let her resignation stand," said Hendricks. "We have accepted her resignation." Sidney James, Dominic's father, has blamed Hardy and another social worker for his son's death. "If I wasn't guilty of anything, I wouldn't quit my job," James said. "I would stand up and fight."
    Records obtained by the Springfield News-Leader show that Hardy and the other social worker decided to send the toddler back to the foster home of John and Jennifer Dilley, despite concern from other members of the team assigned to look out for Dominic's welfare, including his biological parents. John Dilley has been charged with second-degree murder; prosecutors say he shook Dominic to death.
    Holden ordered an independent investigation into the Greene County foster care system after Dominic's death. Investigators Dick Dunn and retired Judge Frank Conley wrote in their report that the local system was "dysfunctional" and had suffered a "complete breakdown."
    Hardy acknowledged she and her co-worker consulted after other team members wanted the child moved and decided to return Dominic to the Dilleys. However, she explained the concerns expressed by other team members to her superiors and they agreed the boy should go back into the foster home. "That's what the job is, it's always the worker on the line, the worker's supervisor on the line. The others are protected," Hardy said.

Study Finds Tenfold Increase in Autism
New York Times, 1/3/2003

Autism is more than 10 times as prevalent today as it was in the 1980s, according to the largest study ever in the United States on the problem. Some of the increase is the result of widened definitions of the disorder, researchers say, but the explanation for the rest of the increase is unknown. The study, conducted in metropolitan Atlanta in 1996, found that 3.4 in every 1,000 children ages 3 to 10 had mild to severe autism that year. In the late 1980s, 4 to 5 in every 10,000 children were thought to be afflicted. The higher prevalence rate, described in today's issue of the Journal of the American Medical Association, is in line with rates found in recent but smaller studies in the United States and abroad in which the autism prevalence was 4 to 6 children in 1,000. The researchers, from the federal Centers for Disease Control and Prevention, said the prevalence rates they found would mean that at least 425,000 Americans under age 18 have some form of autism, including 114,000 children under age 5. Dr. Marshalyn Yeargin-Allsop, an epidemiologist at the National Center on Birth Defects and Developmental Disabilities, led the study.

Some of the increased prevalence can be explained by changes in the definition of autism, a brain disorder in which normal social interaction is difficult or impossible. In recent years, the definition has been widened to include milder forms of the disorder. Most experts say they believe that autism results from an interplay of genes and unknown environmental factors. "No strong candidate environmental exposures have been identified," said Dr. Eric Fombonne, an autism expert at McGill University and Montreal Children's Hospital in Quebec. "Claims of an association with measles-mumps-rubella immunization have not been borne out by recent studies, and evidence for causal association with other exposures, such as mercury-containing vaccines, is weak," Fombonne said.

FDA OKs Prozac for Depressed Children
Associated Press, 1/4/2003

WASHINGTON—Prozac is now formally available for depressed children. Psychiatrists have prescribed the world's best-known antidepressant, and similar competitors, to their youngest patients for years, despite a shortage of studies proving they work in children. But the Food and Drug Administration declared Friday that there's finally proof that Prozac alleviates depression in children 8 years and older, the first drug among the newer antidepressants, which boost the mood regulator serotonin, to win such approval.

Maker Eli Lilly & Co. said it didn't intend to market Prozac for children. Still, putting child-specific information on Prozac's FDA-mandated label means more doctors, not just depression specialists, may prescribe it. The FDA also approved Prozac's use in children with obsessive-compulsive disorder, the third serotonin-enhancing drug to win that designation.

Prozac side effects are similar for adults and children, including nausea, tiredness, nervousness, dizziness and difficulty concentrating, the FDA said. But children have one unique side effect: In one study, children and teenagers taking Prozac grew a little more slowly a half inch less in height and 2 pounds less in weight over a period of 19 weeks than similarly aged children taking a dummy pill. No one yet knows if the Prozac patients catch up or how big a concern that is, said the FDA's Dr. Russell Katz. Lilly agreed to further study the side effect. Up to 25 percent of U.S. children and 8 percent of teenagers suffer depression, the FDA said. Additionally, about 2 percent of the population has obsessive-compulsive disorder, and at least a third of those cases began in childhood.

Psychiatrists welcomed the FDA's move. "It made sense to prescribe these drugs, but yet everyone who did it felt a certain amount of anxiety that we didn't have all the data," said Dr. Lois Flaherty of the American Psychiatric Association. Manufacturers have little incentive to study adult drugs in children if they expect desperate pediatricians will use the medicines anyway. In 1998, the FDA tried to require more pediatric testing, but a federal court recently threw out that requirement.

Drugmakers Deny Inventing a Disorder
Reuters News Service, 1/4/2003

Pharmaceutical companies yesterday rejected a published account claiming they had invented a new disorder known as female sexual dysfunction to build a market for Viagra and similar drugs among women. An article in the British Medical Journal said researchers with close ties to the industry had defined the new disorder at company-sponsored meetings over the past six years to encourage use of the same medicines that have helped men with impotence.

The author of the article, Australian Financial Review journalist Ray Moynihan, said widely reported statistics that 43 percent of women older than 18 had female sexual dysfunction were misleading. He traced the origin of the definition of the condition to a May 1997 meeting of researchers and drug company representatives at a Cape Cod hotel. Moynihan said the 43 percent figure gained prominence when two authors with ties to Viagra's maker, Pfizer Inc., used it in a 1999 article in the Journal of the American Medical Association.

The figure comes from a reanalysis of a 1992 survey of 1,500 women, who were asked whether they had experienced any of seven sexual difficulties for more than two months during the previous year. The sexual difficulties included a lack of desire for sex, anxiety about sexual performance and difficulties with lubrication.

A Pfizer spokeswoman denied the allegations that the company invented female sexual dysfunction, saying that Viagra -- and upcoming rival products from Eli Lilly and Icos, and from Bayer and GlaxoSmithKline -- had yet to be approved for use in women. Pfizer made $1.5 billion from Viagra in 2001

Staying Home for the Teen Years
Susan Levine, Washington Post- 1/4/2003

Susan Dykstra worked through two pregnancies, delivered two boys and each time returned to the office quicker than some people master diapering. She kept working as her sons started crawling, kept working during their play group years, kept working when they began elementary school. Long hours, frequent travel – such were the demands of an executive career. And Dykstra, investment analyst, vice president, was a high-energy career woman. But two years ago, as Case hit 10th grade and Gregory eighth, their mother quit. Packed up the files, stepped off the corporate track. At the very stage when parents often expect to be providing less attention, Dykstra and her husband thought their family needed more. So for the first time in her life, she became a stay-at-home mom in McLean.

Ever since women entered the job market in force in the '70s and '80s, then commenced having babies in the '80s and early '90s, the angst of working parents has centered primarily on young children and day care. Ditto the most emotional public debates, the ones fueled by conflicting experts and family values politics. Nowadays, though, some households are considering different issues. With children slouching toward adulthood, parents who never took off during those initial years are rethinking priorities. Some radically modify office hours or arrange lengthy leaves. Others clock out for good. Given the potential pitfalls of the middle school transition, or how suddenly high school comes and goes, they want to be available in ways that seem perhaps more important than when sons and daughters were little.

"I'm just here for him now," explained Joy Gough of Arlington, who retired early from the International Monetary Fund in August so she could savor the last two years before her son heads to college. "Somebody said, 'Oh, did you stop work because he was a problem?' And I said, 'No, he's a good boy.'‚"

The return on investment can be significant. In the last decade, studies repeatedly have shown that parents continue to hold major influence with adolescents. "We've tended to think that it's okay for parents to step back a little and let other adults play more of a role. The research doesn't support that," noted A. Rae Simpson, author of "Raising Teens," a synthesis of more than 300 studies that the Harvard School of Public Health published in 2001.

Savvy parents realize teenagers require as much attention as toddlers, not just to solve problems but also to avert them. There are more bases to check, more challenges to monitoring behavior. Confidences are not shared on demand. "Being the parent of a teenager is indeed time-consuming," Simpson stressed. "It takes reflection to think through what teenagers need and what teenagers are trying to say."

While federal labor statistics indicate that more than eight in 10 adolescents have working mothers, the data provide little insight on how parents adjust their schedules as children grow older. According to a business coalition called Corporate Voices for Working Families, the gap between when teenagers get out of class and parents walk in the door can stretch to 25 hours a week – frequently, unsupervised hours that may invite trouble.

Parents who choose to stay home with this age face skepticism: Why are you doing this now? Or surprise: "Wow," one colleague told Dykstra, "you're the last person I would have expected to make this decision." Or, most typically, envy: "So many people said they wished they could do it, too – men and women," recalled Kathleen Drew of Chevy Chase. "I think it says parents want to be with their children, want to spend more time with [them] while the children are still around."

Drew is five years removed from her former job as a network television producer. After unrelenting evening and weekend hours away, as well as tag-team parenting with her New York-commuter husband, she resigned because she wanted to ensure a solid rapport with her son before he hit any teen turbulence. "If you're going to do this, do it before he stops talking to you," a friend advised.

She has filled her break – her preferred term – with Sam's soccer and baseball games (which she had never attended), his basketball team (which she organized and manages), a stint as PTA president and mentoring at school. Sam is 13 and happy to have her. "It's a full-time job," Drew said, cheerfully. "It's just not the one I had."

She admits her attitude would have been less sanguine earlier in her career when she was making her mark. It is a common sentiment; at this point in life, these parents say, they've already accomplished much of what they had intended professionally and reached a more secure place financially. They've accumulated expertise and seniority. That's particularly true of women who delayed childbearing until their late thirties or early forties.

For those who cut back hours rather than cut out entirely, time has been on their side in other ways, too. Working from home, working as a consultant, telecommuting and teleconferencing no longer are unusual ideas. And between fax machines and cell phones, the Internet and e-mail, few assignments are infeasible.

Mostly, it is women who divert, but not exclusively. At the Stilwell house in Alexandria, Dad has been meeting the school bus since 1996. "It's amazing the things they come home and tell me," Mike Stilwell said. But the catch is: "You have to be there when they're ready and willing to talk." His boy was turning 10 and his girl 8 when he and his wife sat down to figure how to restore sanity on the home front. Everything was a mad rush between the office and sports practices and other activities. With a third child on the horizon, that seemed destined to get worse. The couple agreed that her career at Fannie Mae would take precedence over his in fleet management. Ever since, he has been their children's central presence mornings and afternoons – chauffeur, coach, confidant, taskmaster. "We're committed to it because we've seen the difference it's made," with improved grades and fewer pressures, Stilwell said. Yet some days, dirty diapers would be easier to deal with. "At least you knew what the outcome was going to be," he joked.

No one knows how many other parents would make the same choices if corporate policies were more flexible and savings accounts better padded. Organizations such as the Family and Home Network, a nonprofit group based in Fairfax County, and Mothers & More, a national group out of Illinois, advocate for parents to be able to share generously in all stages of their children's growing up.

When parents of adolescents pick home over work, it helps counter "the notion that once your child hits 5 or 6, they're cooked," said Joanne Brundage, who founded Mothers & More in her living room in 1987. "You kind of kid yourself. You think to yourself that they're independent individuals without the need for a lot of parental support. It gets harder to see when they need you." Until, that is, things start to blow up.

Teenagers don't necessarily view greater parental contact as positive. Joy Gough remains amused over 16-year-old Matthew's first reaction. "He was a bit horrified. 'What? you're going to be home? You're going to make me do my homework?'‚" Sausage-and-pancake breakfasts have softened him slightly, as has his mother's willingness to drive him and friends around. This year, she'll have total flexibility as Matthew applies to colleges. "We'll be able to travel to colleges and check them out," he said. He's still weighing other pros against the cons. "It was such a shocker, when someone who's really demanding tells you she's going to be around all the time."

In McLean, the catalyst for Dykstra's metamorphosis was younger son Gregory and the disaster of sixth grade. He went away to a special program in New England the following year, and his parents felt one of them had to be around more when he returned. Maybe it would benefit older brother Case, too; both boys had been "spoiled to death" by their beloved nanny, Dykstra realized. "I was a little bit more worried about them missing Helen," she said with a laugh. Greg remembers the conversation with not a hint of trauma. "I was happy," he said. "Suddenly we were going to see more of our mom. . .‚. I was only in eighth grade, but I still understood the importance of her job. I was shocked but excited that she would give that up for us, that she would make that sacrifice." The changes day to day have become routine. Instead of the nanny in the kitchen making lunches, it's Mom. And it's Mom picking them up from high school, and Mom sewing 18-foot-long togas for Latin Club, and Mom nearby to talk. In between, Dykstra is working again, but as a consultant on specific projects, for a limited number of hours a week. She misses the intellectual stimulation of her previous work, but she has no regrets. Her time at home has been well spent, she said.

Posting of Sex Offenders' Photos Blocked
Chicago Tribune, 1/4/2003

INDIANAPOLIS, INDIANA -- The Indiana Supreme Court temporarily blocked a new state law on Friday requiring sheriffs to post photographs and addresses of convicted sex offenders on the Internet. The state Sheriff's Association had planned to begin posting the pictures and information by Monday, but the justices put the law on hold until they can decide whether it is constitutional.

The Indiana Civil Liberties Union claims the law violates the rights of sex offenders, who already are listed in a registry that does not include photos and addresses. Other critics have said the changes would make it more difficult for offenders to find jobs and would expose them to harassment, violence and identity theft.

A Mother's Deadly Struggle For Her Sanity
Ellen Barry, Boston Globe- 1/5/2003

As she neared her 35th birthday, LaVeta Jackson tried to lift her spirits, writing notes to herself in her graceful, schoolteacher handwriting: ''You're going to be 35 in less than 30 days,'' wrote Jackson, a single mother living in Mattapan. ''Do something special.'' In a careful column, she listed her goals:
God first
Bills paid off
100-pound weight loss
Read at least 1 novel a month
Get your files organized
Come up with a daily schedule from waking up to going to bed
    But she was already in deep forest, and it was getting deeper. On a July afternoon in 2002, a man descended into a stuffy basement and found Jackson sitting on a blanket, marked with self-inflicted stab wounds, beside the bodies of her 3-year-old son and 6-year-old daughter. She had slit both of their throats with a kitchen knife. Minutes later, she was shot to death by three police officers who described a woman leaping out of the darkness brandishing the knife and covered in blood.
    Six months after she died, the story of Jackson's mental illness and treatment has never been pieced together, even for the relatives who live in the house where it happened. It wasn't that she didn't get care: During the year before she killed her children, Jackson had come under the supervision of two well-meaning families, two psychiatric hospitals, two state agencies, psychiatrists, therapists, and social workers.
    A Globe investigation of all available information about Jackson's case suggests that the problem was not a lack of services, but a system that erects walls between doctors, state agencies, and caregivers in the community. In the earliest stage of her psychiatric treatment, Jackson bounced from doctor to doctor, shouldering the responsibility of taking an antipsychotic medication that made her miserable. Ashamed, or proud, or wary, she kept all details of her treatment from the relatives of her ex-boyfriend -- the closest thing she had to an extended family in Boston. When those relatives tried to ask medical personnel about her illness, they were met repeatedly with silence and a recital of medical confidentiality laws. Finally, her caregivers themselves had poor lines of communication, so that none had a complete picture of her decline -- and the responsibility dissipated into the space between agencies.
    ''The question this raises for all of us is, who was clinically in charge of the care and treatment of LaVeta Jackson?'' said Marylou Sudders, the outgoing commissioner of the Department of Mental Health. In the end, the one person who was fully responsible for her care was the person least able to handle that responsibility. For all the help she got, and all the people watching out for her, no one knew the full picture of what was happening to LaVeta Jackson except LaVeta Jackson.

An on-and-off relationship
At 34, Jackson was tinkering with her resume and daydreaming, a close friend said, about establishing a Web site selling ''big ladies' lingerie.'' Raised outside Hartford by a single mother, she had moved to Boston in the early 1980s to attend Chamberlayne Junior College, a plan that was interrupted by her first pregnancy. By the year 2000, Jackson was caring for three children: her son Scott Murphy Jr., a bouncy 1-year-old; her 4-year-old daughter, Sydney, who wore tiny gold hoop earrings; and an 11-year-old son from an earlier relationship. She had an on-and-off relationship with the father of Scotty and Sydney, an occasional construction worker named Scott Murphy. But with her own family two hours away in Connecticut, she had been absorbed into Murphy's warm, prosperous clan -- his aunt Mable, his half-sister Michele, and his mother, Vera.
    Friends thought of her as, above all, gentle: ''Miss LVJ,'' as her friend Hermina Cooper affectionately put it, was a mother so attentive that she once snapped at Cooper for wiping Scotty's face with a dishrag. (''I said, `Girl, I'm from the South. We wash him with anything we can get him with,''' Cooper snapped back.) LaVeta was a closet smoker of Newport Lights and so tenderhearted that she wept with regret when she accidentally insulted an officemate. Insecurity nagged at her: Embarassed that neither of the boyfriends who fathered her children had wanted to marry her, she ordered a gold ring off the Home Shopping Network and wore it to work like a wedding ring, friends said. ''All LaVeta wanted in this life was a husband and her kids and a house,'' said Cooper, who worked with her at Cablevision in the late 1990s.
    At home, where Scott Murphy came and went intermittently, her life was moving further from that ideal. Police records describe a relationship that had become turbulent and abusive; in 1997 and 1999, Murphy- - who is 6 feet 5 inches tall and 300 pounds -- was charged with family abuse after three separate altercations with Jackson, once when she was seven months' pregnant with Scott Jr. After little Scotty was born, she quit her job because she could not get a pay raise and more flexible hours, Cooper said. Suddenly, she was a single mom looking for a job. But she kept her troubles to herself, Cooper said. ''LaVeta always told me, `People tell you what they want you to know,''' Cooper said. ''She told me, `You won't know if I'm happy or sad.'''
    In the last job she had, during the spring of 2000, her sensitivity curdled into paranoia. She began to read secret messages in innocuous lettering and see innuendo in pieces of mail. At work, entering data at the Harvard University Health Services, Jackson was so sure co-workers were talking about her that, said her supervisor, Marjorie Fisher, ''no amount of reassurance ... could ease her mind.'' Although Jackson was ''a very, very capable employee,'' the distraction was so extreme that Fisher fired her after two months.
    The fears proliferated through that last summer. Jackson told friends that the upstairs neighbors toyed with her water supply, so the water was too hot for her children when she bathed them, and that someone had tapped her telephone line. When she left the apartment on Cummins Highway in the morning, she would turn on a tape recorder to capture sounds of the intruders she was certain were ''walking in and changing things around,'' according to relatives; Scott's half-sister Michele Slade, a soft-spoken accountant, remembers a strange evening when Jackson brought the cassette tapes over and asked family members to listen to them. Increasingly, she saw people following her.
    Put together, these episodes look like clear indicators of mental illness. But at the time, the signs were anything but clear. As state officials would later point out, looking at a single mother with legitimate concerns about violence, it was hard to know which fears were unreasonable -- and as a close friend said, low-rent apartments do have thin walls and nosy neighbors. Fearful of night intruders, Jackson had stopped sleeping in her bedroom and spent nights on the couch, with a long-bladed kitchen knife tucked between the cushions.
    By the spring of 2001, she had begun to act more erratically. Overcome by terror, she would wake her sleepy children in the middle of the night and deliver them, half-dressed, to their grandmother's house. Once she took her kids to Logan Airport, trying to board a plane with vague plans and no money. She started talking about someone who wanted to kill her, even going to a police station to report it, Michele Slade said. On June 1, she got into an agitated state and told members of the Murphy family she was leaving town with the children. When they tried to prevent her from leaving, she broke her own car window with a brick. A family member called 911, but when police arrived, they found a woman in control, Slade said. ''When they came, she stopped everything she was doing,'' Slade said. ''They asked what was going on. She looked at me, she was as normal as ever. She said, `I don't know what she's talking about.'''

In the maze of the system
Doctors found an answer in the form of medication. On the June day when she broke the car window, police delivered Jackson to the emergency room at Beth Israel Deaconess Medical Center -- where she tried to run out of the hospital, requiring staff to put her in four-point mechanical restraints, according to hospital records provided to the Globe by her family.
    The medication was Risperdal, an antipsychotic frequently prescribed for the symptoms of schizophrenia, and Jackson didn't like it. LaVeta had always resisted taking medicine -- her sister, Tish Jackson, remembered having to restrain her for allergy shots when she was a child. When Tish visited the hospital from Hartford, LaVeta was storing tablets of Risperdal under her tongue, then crushing them inside window sills or hiding them, wrapped in tissue, in her bra. She begged her friend Cooper to help her escape the hospital, and Cooper was sympathetic. ''What I started attributing it to was the medication,'' Cooper said. ''In the beginning, there was nothing wrong with LaVeta, nothing.''
    After two weeks on Risperdal, Jackson was behaving normally enough for Beth Israel Deaconess to release her, deeming her no danger to herself or others. Before releasing her though, the hospital informed the state Department of Social Services about her crisis, and the department sent a worker to determine whether Jackson was a fit parent. Vera Murphy sat with Jackson as the worker asked if she would sign a paper promising that she would take the medication. Jackson was ready to agree, but then she hesitated. ''No; this is my body. Nobody can make me do anything with my body,'' she said, recalled Murphy and her daughter, who was also present. Jackson crossed her signature out with stabbing strokes of the pen.
    That decision flipped a switch in the system. Based on her refusal, DSS approached a family court judge on June 14, arguing that Jackson's children were ''in danger as a result of her paranoia. Mother refuses to take her medication prescribed to alleviate psychoses, and this results in her behaving in erratic ways. ... The patient's five-year-old daughter reportedly told her grandparents that the patient sleeps with a knife under her bed because of paranoid feelings.'' The children were placed in the custody of Scott's half-sister, Michele.
    For Jackson, the loss felt catastrophic. Days later, she was back at Beth Israel Deaconess, again brought by the Murphy family, according to the hospital record: ''She, on initial intake interview, believed that she was afraid of something but she would not reveal the nature of this fear or its contents,'' read the hospital discharge papers, which drew on the accounts of Scott Murphy's family. ''In a state of fear and anxiety the patient flew to New York to visit a friend. She lost all of her money at LaGuardia airport under uncertain circumstances. She tried to buy plane tickets from airline companies to reportedly go to Bermuda or Florida. The airline company would not allow her to buy a ticket nor board any airplane because of the odd erratic behavior she was displaying in the airport.''
    The doctors took her case seriously, and another switch was flipped. The state of Massachusetts grants its citizens the right to refuse antipsychotic medication up to a point, and then those rights are stripped. In a guardianship hearing, hospital personnel must argue their case before a district judge, proving that a patient is ''not capable of making informed decisions'' about his or her treatment. On July 5, a judge came to this conclusion about Jackson, granting her doctors a six-month monitoring period.
    In the end, the hospital kept her for more than a month -- an extraordinary duration in the age of managed care. With the right to force treatment, Jackson's doctors opted for an older antipsychotic, Haldol, presumably because it could be injected into her muscles, giving Jackson no option but to take it. The medication worked: ''She was noted to be less guarded, less suspicious and more open with staff and peers,'' the hospital's discharge papers read. ''She gained moderate insight into her illness and the need for treatment medication.'' Her diagnosis was ''psychosis not otherwise specified,'' meaning she had hallucinations and delusional thinking, but did not yet meet the criteria for major mental illnesses, such as schizophrenia and bipolar disorder.
    On July 19, Jackson was released into the custody of her mother, Ava Marie Lyle, who lives in Hartford. Among her papers were instructions for a bewildering new life. From her new medications, they said, she could expect to experience any or all of the following side effects: weight gain, blurred vision, drowsiness, shuffling walk and jerky movements of the head, face and neck. She had been given an ''Emotion Regulation Handout'' that suggested that she ''do what she was afraid of doing over and over again''; a ''Discharge Care Plan'' advised her to ''notify your doctor if: depressed, suicidal.'' Her next Haldol shot was due to come from Dr. Angelo Carrabba, a gynecologist who employed Mrs. Lyle as a medical technician. But the follow-up plan apparently did not go as planned. It was a matter of weeks before LaVeta Jackson found a hunting knife. She was back in the hospital for a third time.

A long masking
The day an ambulance came to get her at her mother's Hartford apartment, Jackson seemed to understand the dangers inside her. It was early September 2001, and she had been in Connecticut for about a month when she confessed to family members that she had found a knife in her stepfather's car and she felt like killing herself. Already, she had ''threatened herself plenty of times,'' said her sister, Tish. ''She said she was going to run in front of a bus.'' She was asking for help, they say: Rosa Valdez, who lives with Jackson's sister in Hartford, remembers waiting for the ambulance while Jackson lay on a couch, almost motionless. She whispered that she was glad they were coming for her, Valdez said. Jackson spent about a week in the Institute of Living, a psychiatric hospital in Hartford. But as she improved, she told the people around her less and less about her illness.
    As Christmas approached, she moved back to Boston suddenly, without getting medical referrals and without even telling her sister, Tish Jackson said. With her Mattapan apartment gone, she asked if she could stay with her ex-boyfriend's relatives -- his half-sister Michele Slade, who had temporary custody of Scott and Sydney, and his mother, Vera. The family took her in willingly, and even helped her to find a counselor. They thought she had recovered.
    There was no discussion of danger. Vera Murphy even remembers laughing with Jackson when she looked back on things that she did when she was sick, like dash into houses to escape imaginary enemies. She remembers long conversations the two of them had during the trial of Andrea Yates, the Texas mother who drowned her five children. ''I told her, you'll probably end up like the lady down in Texas who killed her children,'' Murphy said. ''She said, `Nothing could make me do that ... She said, `No, no, no.'''
    But she did not tell them she had felt suicidal in Hartford. Neither did she speak to them about her medications, which had become more complex -- in July, after the funeral, a family member found in her purse prescription bottles of two antidepressants, Prozac and Desyrel, one antipsychotic, Zyprexa, and a sleep medication, Ambien. Not until after her death did they hear the names of her medicines. They couldn't do what families routinely do to care for mentally ill loved ones: Make sure they take their medication every day, and watch closely to see if their behavior changes, always prepared to contact a psychiatrist if something seems to be going wrong.
    In fact, there were laws that allowed her to keep her treatment to herself. Every time Scott's relatives asked medical personnel about her mental condition -- at Beth Israel Deaconess and later at Dimock Community Health Center -- they had been told the information was confidential. As far as they knew, Jackson's problem was that she was ''moody,'' said Slade, who allowed Jackson and her children to live in her house. It did not occur to them to monitor her medication. ''The whole time she was living with me, I never saw her take a pill,'' she said.
    Jackson was not the only one who held back medical information. In the spring, when Jackson appealed for custody of her children, DSS began to investigate her mental state, contacting her past caregivers. Aside from the six weeks she spent at Beth Israel Deaconess, she was seen regularly at Hartford Behavioral Health, a nonprofit clinic funded by the Connecticut Department of Mental Health and Substance Abuse. And for the six months after she returned to Boston, she had weekly therapy at the Dimock Community Health Center. DSS was assured that Jackson was keeping her appointments, taking her medication, and ''lacked homicidal or suicidal ideation,'' said Harry Spence, commissioner of the Department of Social Services.
    But in the investigation, a key fact never came to light, according to Spence -- DSS never knew Jackson had been hospitalized a third time, or that she had threatened her own life. The only reference to that incident, he said, was a ''cryptic reference'' on handwritten discharge notes from the Institute of Living that Jackson herself had supplied. ''We didn't know it,'' he said. ''Certainly it would have added a cautionary note that was not there for us.'' Spokespeople for Hartford Behavioral Health, Dimock, Beth Israel Deaconess, and the Institute of Living declined to comment to the Globe on any aspect of Jackson's case, saying confidentiality laws prohibited them. On June 4, confident that Jackson's mental state was stable, DSS closed the case and returned the custody of Scott and Sydney Murphy to their mother.
    Until toxicology tests are completed, it will be unclear whether Jackson stopped taking her medications after that, or whether they had been suddenly changed, as she told Scott's relatives. For her part, Tish Jackson speculates that her sister stopped taking her pills as soon as she had what she wanted: ''They drilled it into her head, you take your medications and we'll give your kids back,'' she said. Whatever the reason, Jackson changed faster than anyone could have imagined.
    In the weeks before her death, she had become painfully self-conscious about a new set of side effects: Her beautiful, luminous skin suddenly turned spotty and rough; she gained so much weight that she was ashamed to see her mother and sister in Hartford. After an upsetting visit, during which she got into a fistfight with Tish, LaVeta Jackson seemed to drop down a well. She slept during the day, openly chain-smoked Newports, stopped eating. She began to walk around Michele Slade's house with a scarf around her neck, complaining of stiffness, Slade said. She was vacant, wordless, stared straight through people. When Vera Murphy asked about her strange behavior, she said it was a new medication. Murphy remembers her saying: ''I've got so I can't even think. My mind's running away with me. I got so I can't sleep.''
    Mable Graham, the 74-year-old matriarch and problem-solver-in-chief of the Murphy family, took matters into her own hands. Graham's knowledge of mental illness was patchy, but better than many of those around her; 25 years ago, after moving to Boston from North Carolina, she received training as an auxiliary police officer and learned, as she puts it, the three types of mentally ill people: Those who sit and stare; those who kill themselves; and those who kill other people. And long experience had taught her that psychiatrists could pose a danger to the civil rights of black people -- once, she urged an ill sister-in-law to drive all night from North Carolina to Boston for psychiatric care, because ''people in the South, if you have a nervous breakdown, that was the end of you.''
    With Graham as her advocate, Jackson's final interactions with the mental health system ticked away one by one. A week before the murder, Graham made a call to Jackson's therapist at Dimock to alert her to the strange new behavior. She was told that Jackson's case was confidential, and was offered a contact number for the Boston Emergency Services Team, a mobile psychiatric emergency unit, Graham said. Not realizing Jackson was dangerous, Graham didn't call.
    Five days before the murder, Jackson's DSS caseworker visited for the last time to say goodbye before leaving Boston, Slade said. Four days before the murders, on Friday, Graham walked with Jackson into Beth Israel Deaconess Medical Center. The two women were directed to the psychiatric ward and told that her former psychiatrist was no longer practicing there, but they were allowed to leave a message for another doctor, Graham said. Jackson refused to go to the emergency room. ''I said, `LaVeta needs help. I said, `Give her a shot. Just give her a shot,''' Graham said. The two women then went back home. There, Jackson dipped into the same dark silence. Six-year-old Sydney knew something was wrong, said Slade. She would look up at her mother, asking, ''Are you thinking again, Mama?''

`I didn't do nothing'
She was thinking. The night before she killed her children, Jackson asked Mable Graham to drive her to Wal-Mart, where, Graham now believes, she bought a large bottle of cough syrup. These are the details that Graham goes over and over these days, sitting in her kitchen over cups of tea. The wailing and the falling of mourners are finished in her house now, replaced by a ceaseless repetition of details. Jackson had begun to clutch her children even closer, so that relatives had to persuade Jackson to allow them to leave the house for a street fair.
    Now, when she remembers the peculiarities of that Monday, Graham shakes her head slowly. How Jackson left Wal-Mart with the cough syrup and told Graham to pick her up for a therapy appointment at 10:30. How she said, ''I'll need some help with little Scotty in the morning.'' How she left $6 -- probably the last money she had -- balled up on the seat of Graham's car. The rest is known in snapshots. At 7:30 in the morning, Michele Slade passed by Jackson's room, and noticed something odd: Jackson and her children were all sleeping in the same small bed. Slade moved to prepare strawberry milk for Scotty, as she did every morning, but Jackson said, from the bed, that she had already given it to him. Slade peered down at the child and noticed another strange thing: normally chirpy, he was so groggy he could barely raise his head. Jackson asked Slade if anyone was home, and Slade said she wasn't sure. It was the last thing she said before she left for work. We know that Jackson took her children -- Slade believes she carried them, drugged with the cough medicine -- out the kitchen door and into the basement.
    Donald Moore, Slade's boyfriend, is a meat manager at Stop 'n' Shop and still bears the faint accent of the North Carolina farm where he grew up. He can describe the scene in the basement so calmly, he figures, because he ''cuts meat for a living.'' He climbed down the winding stairs into the basement at a few minutes before 4. She was sitting on a blanket that had been spread on the concrete floor, with a kitchen knife in her hand, he said. The children were lying behind her, their throats cut. There was very little blood.
    As far as Moore could tell, she had been there all day -- he suspects she spent the day trying to kill herself. She had filled a sink with water, Moore said, and placed an electric carpet shampooer in it, and plugged it in, but the water apparently kept draining out of the sink. She had stabbed herself in the side with the knife, but ''I don't think anyone could kill themselves that way,'' he said. When he walked in, she looked up at him strangely.
    ''I didn't do nothing,'' she said, when he asked her what she had done. He climbed the stairs and called the police, and when they arrived, they stood at the top of the stairs, hollering out: ''Police coming down, police coming down.'' When they reached the bottom of the stairs, she appeared, wielding a knife, police have said. The officers opened fire, fatally injuring her. Upstairs, Moore listened as round after round of ammunition exploded in the basement. ''It sounded like a war,'' Moore said.

`You have to bare your soul'
Unlike Andrea Yates, LaVeta Jackson's crime never became a national news story, and the reactions stirred by it have been quiet ones: At the funeral, where relatives waved fans and moaned in anguish, pastor Karen Bryant got cries of assent when she said only Satan could be at fault. Scott Murphy, who would not comment for this article, is exploring a wrongful-death suit on behalf of his children against the psychiatrists who treated Jackson, and Jackson's sister is considering her own legal action. Scott's Aunt Mable thinks idly about returning to the reception desk at Beth Israel Deaconess and ''making sure those three young ladies that sit at that desk be removed.''
    No public agency has found wrongdoing in the case. Last week, the Police Department completed its internal investigation of Jackson's shooting, said David Meier, chief of the homicide unit at the Suffolk district attorney's office. The office will review the investigation and decide whether the shooting should be investigated by a grand jury, which has the authority to issue criminal charges. Within five to seven weeks, special toxicology tests will determine whether LaVeta Jackson was taking her medication at the time of her death, Meier said.
    In November, Spence, the DSS commissioner, announced that an internal review board found the social worker had not made any errors, since she had relied on the testimony of psychiatrists. In an interview, he said he was grateful that neither Jackson nor any caregiver had been scapegoated after the three deaths. ''Could LaVeta Jackson's case have been averted if, if, if ... Those ifs could go all the way to the federal government,'' he said. ''It is important to acknowledge the existence of tragedy.''
    But to relatives of LaVeta Jackson and her children, this is not a satisfying conclusion. Thirty years after America's leaders began a great push to empty mental institutions, their frustration should stand as a warning. Centuries ago, a patient such as Jackson would likely have been cared for in the same small community where she became ill. Fifty years ago, the same patient would likely have been sedated and locked away for many years in a crowded state hospital. Today, the mental health care system treats seriously mentally ill people with the optimism that arrived with modern antipsychotic medications -- once a patient has been stabilized on medication, the hope is, she can be allowed to return to a normal life.
    There is one problem with that.  Once released from the hospital, LaVeta Jackson found herself too often alone with the burden of her illness. Alone to gain weight, to sprout blemishes, to develop tremors and tics, to face old parking tickets and calls from a bill collector, to watch her 3-year-old bond with another woman, and finally, to apply for Section 8 housing supplements and disability payments and food stamps and to coordinate her own medical care.
    This is a difficult task for the most able person; for Jackson, it was impossible, said Sudders. ''She got good pieces of care,'' the mental health commissioner said. ''There were pockets of really excellent care. But who was clinically in charge to make sure that all these pieces came together and the family caring for her was involved and her kids got good services? Basically, we said she is responsible for her care. A good treatment requires a strong alliance. It should not be a singular responsibility on one person. It should be a shared responsibility.'' ''When something this awful happens, you have to stop and literally rethink everything you do,'' Sudders said. ''When LaVeta Jackson kills her children and then is killed, you have to bare your soul and examine yourself.''
    Charles Baker, health care adviser to Governor Mitt Romney, would not comment on the particulars of the Jackson case. But he said he sees it as ''one of the fundamental challenges of the next few years'' to gather together the diverse strands of a person's needs into a single, ongoing relationship, so that there are fewer botched handoffs, and fewer people lost in them.
    LaVeta Jackson's friends and relatives knew she was not the kind of person who asked for the help she needed. On the day before she killed her children, Vera Murphy took her to the supermarket and offered to pay for groceries for her family. Knowing her children were hungry, Jackson wandered through aisles full of food with a wire shopping cart for half an hour and came back, miserably, with a single loaf of bread. The same thing happened with the crowd of psychiatrists and social workers and counselors and outreach workers who got to know her during the last year of her life: In fact the helpers were there. Jackson wanted to get better, too. But they missed each other in the dark.

Use of PCP Rebounding In D.C. Area
David A. Fahrenthold, Washington Post- 1/5/2003

PCP, a drug known for its unpredictable and often violent high, has surged in popularity after spending years on the margins of Washington's narcotics culture, according to police and health workers. The drug is most often ingested by smoking "dippers," cigarettes soaked in a PCP solution, and its resurgence has been charted in emergency rooms, detox clinics and, most prominently, several bizarre homicides in areas from the District to Charles County. Adopted by a new generation, PCP's sudden return has surprised authorities who saw it nearly erased by crack cocaine. "A lot of adults, they don't know about the dipper. But the kids know," said Theophus A. Brooks, who works with D.C. public school students on the Youth Gang Task Force. "You smoke it, and sometimes you're all right. And sometimes you smoke it, and your mind snaps."
    PCP, whose chemical name is phencyclidine hydrochloride, was developed in the 1950s as an anesthetic and is snorted, smoked and eaten as an illegal recreational drug. It was popular in the Washington area in the 1970s and 1980s, usually sprayed on cigarettes stuffed with tobacco, marijuana or parsley. The drug was then called "Sherm," "the Love Boat" or "Buck Naked" because so many of its users shed their clothes while high.
    But when crack cocaine took over inner-city markets, PCP became a "redneck drug," according to Thomas H. Carr, director of the Washington-Baltimore High Intensity Drug Trafficking Area, a federal program that aids law enforcement and drug treatment. In this region, PCP held on mainly in poor neighborhoods in areas such as Dundalk, in Baltimore County, and the Yorkshire area of Prince William County.
    Then, in 2001, a new form of PCP more convenient for users and dealers began appearing in force in Prince George's County and Northeast and Southeast Washington. Now, dealers holding small vials of yellowish liquid let customers dip cigarettes in PCP for $5 to $25 apiece. Smoking dippers gives four to six hours of an unpredictable, often violent high.
    Use of the drug still lags behind use of marijuana and cocaine, but any number of statistics can mark the increase in PCP use. Detoxification patients in the District now test positive for PCP six times more often than in 1999. The Prince George's County police laboratory, which tests all drugs seized in the county, received more than 115 PCP samples in 2002 -- up from eight in 2000. D.C. police estimate that they saw the drug four times as often in 2002 as in 2001. "It was a pretty phenomenal change," said Christopher Wuerker, an emergency room physician at Washington Hospital Center. "It seemed to go from a drug that was out there and you'd see it occasionally, to seeing it constantly."
    Inspector Hilton Burton of the D.C. police Major Narcotics section said that someone may have set up a PCP lab in the D.C. area but that, if so, authorities do not know its location. The biggest manufacturers of the drug have always been Los Angeles street gangs, who ship their product to the East Coast, Burton said.
    For dealers, there are enormous profit margins: A one-ounce vial costs $300 to $450, and selling the drug by the dip can yield twice that. Authorities in Baltimore raided a home in November and found more than 30 gallons of PCP and ingredients to manufacture more -- a potential street value of $50 million to $100 million. Authorities think another PCP lab may be operating.
    One night before Christmas, undercover officers from the D.C. police Narcotics Strike Force approached a dealer in the 1200 block of 18th Street NE, a wretched dead-end strip east of Trinidad where two suspected PCP customers were killed last year. "Gimme two dips," the officer said, and the dealer retrieved a small vial from a hiding place alongside concrete steps. Police swarmed over the area a few minutes later and found two vials of the drug -- one with tiny bits of tobacco still swirling in the bottom. "That's PCP," said Sgt. Wilfredo Manlapaz. Most likely, police say, it was powdered PCP mixed with ether. Searching the nearby weeds with flashlights, officers found a loaded 9mm pistol hidden inside a foam carryout container.
    Some of last year's most startling homicides have involved the use of PCP. In October, police say, 18-year-old William Sanders shot and killed Melvin R. Douglas, 42, a man he considered his stepfather. A detective said Sanders, who had been smoking PCP for several days, "got this thing in his mind that Douglas had killed his real father 20 years ago." Sanders allegedly shot Douglas several times in the head, then stuffed his body in the back of Douglas's taxicab and drove to the Reliable Cab Association garage at 45 Q St. NW. There, the detective said, Sanders asked for help disposing of a body. A cab association employee called police.
    On Oct. 24, 2001, Jeffery E. Allen, a homeless man from the District, smoked three dippers before getting into a car with four other men who took him to Charles County, according to testimony from his trial in August. Allen testified that he got the dippers from friends on Fifth Street NW. The next morning, Allen stabbed to death one of the Charles County men; he was convicted in August of first-degree felony murder.
    The drug has been tied to other violence. A woman believed to be high on PCP approached D.C. police officer Mark McConnell in the 400 block of Seventh Street SE on Dec. 13 and asked him for directions to College Park. As McConnell started to answer, she put a pistol to his head and fired. McConnell ducked in time to avoid injury, police said, but the shot was so close he had gunpowder on his face.
    At least twice in recent months, D.C. medical workers have had to stop their ambulance and bail out because a PCP user they were transporting became unruly, said Kenneth Lyons, who heads the city's medic union. Some of those hurt the most have been teenagers. Bridget T. Miller, another member of the D.C. schools Youth Gang Task Force, said she has known students who have almost killed themselves with overdoses of PCP, and one student who pulled out a gun and shot himself the first time he smoked a dipper. Miller said she has a simpler view of the brutal drug's new popularity: Its horror stories are its best advertisement. "It's crazy," she said. "But a lot of them, if . . . they see a drug out there and it has effects like that, they're dying to buy it."