Study Finds No Ritalin Link to Later Drug Abuse
Reuters News Service, 1/6/2003

CHICAGO, Jan. 5 -- There is no convincing evidence that giving hyperactive children stimulants like Ritalin leads to drug abuse later in life, researchers reported today. The finding confirms results from 11 previous studies, the researchers said, adding that they hoped it would dispel public concerns about the stimulants, which are chemically similar to cocaine. "The present results indicate that clinicians probably need not fear that the stimulant treatment of children with attention-deficit/hyperactivity disorder is predisposing those children to later drug use, dependence or abuse," said the report, published in the January issue of Pediatrics, the journal of the American Academy of Pediatrics.
    The study, at the University of Massachusetts Medical School and the Medical College of Wisconsin, kept track of 147 hyperactive children for 13 years, into adulthood. Some were treated with stimulants, primarily methylphenidate, the ingredient in Ritalin, a brand sold by Novartis. The report concluded that there was no "consistent or convincing evidence that stimulant treatment in childhood or during adolescence was associated with risk for adolescent or adult substance use, the frequency of such use in adulthood or the likelihood of having a substance dependence or abuse disorder."
    The study covered use of 10 legal and illegal drugs including alcohol, tobacco, heroin, marijuana, cocaine, hallucinogens and hashish. In the United States attention deficit disorder is diagnosed in 3 percent to 5 percent of children. Symptoms are a reduced ability to concentrate, difficulty in organizing tasks and belongings and hyperactive, impulsive behavior.

Psychologist: Murder Suspect Suffered From Stress Disorder
Associated Press, 1/7/2003

SPRINGFIELD, Mass. -- The 18-year-old student charged with murdering his school counselor suffered from post-traumatic stress disorder before the killing, a psychologist testified at a hearing requested by prosecutors. Bernice Kelly of the Law & Psychiatry Service of Massachusetts General Hospital testified Monday that Corey Ramos was traumatized by a childhood kidnapping and at least two other events. ''My opinion was that he was not capable of forming the intent to commit murder, and that his intent was to defend himself,'' Kelly said during a hearing in Hampden Superior Court.
    Ramos' trial is scheduled for Jan. 21. He has pleaded innocent to charges of murder, carrying a dangerous weapon and possession of a dangerous weapon on school grounds. He is being held without bail at the Hampden County Correctional Center in Ludlow. Prosecutors say Ramos stabbed Theodore Brown, his counselor at the alternative Springfield High School, because he was angry at being repeatedly asked to remove his sweatshirt hood. Several students witnessed the stabbing, police said. Ramos' lawyer, Alan Black, said his defense will include the argument that Ramos' psychological problems affected his mental state the day Brown was killed. But prosecutors are questioning the validity of Kelly's findings, and asked for the hearing. Judge Thomas J. Curley Jr. will rule on whether a jury will hear Kelly's testimony.
    Kelly testified that when Ramos was 6, he and a small girl were kidnapped from a ''day-care arrangement'' by five teen-agers. Kelly said the girl was sexually assaulted by the kidnappers, and it is unclear if Ramos was also molested. Kelly said Ramos also witnessed his mother being hit when he grew up, and was hit by his sister's father.
    Kelly said people with post-traumatic stress disorder typically suffered one or more traumas, and may experience flashbacks, hallucinations, sleeplessness, irritability and outbursts of anger. Kelly said she performed inkblot and other psychological tests on Ramos during three visits from late 2001 to mid-2002. Prosecutors said questions have been raised in psychological journals about the use of inkblot tests on defendants. Assistant District Attorney Brett Vottero raised concerns about the reliability of a test to inventory trauma symptoms. ''There may be times where opinions may not be properly supported,'' Vottero said.

Protection Orders Don't Always Work
L.L. Brasier & John Masson, Detroit Free Press- 1/7/2003

Marie Moses Irons, Laura Smart and Vicki Sue Keller-Wendt were sisters in fear. The women -- they didn't know each other -- each sought court orders against men they once loved but who now wanted to harm them. And the court orders did no good. Irons' husband hacked her to death with an ax Dec. 29 as she slept next to the couple's 2-year-old child, police say. Just six days earlier, she had obtained a personal protection order, prohibiting him from coming near her. Keller-Wendt and two others were murdered outside the Isabella County Courthouse in March by her ex-husband, who had repeatedly violated a personal protection order. Smart was shot and wounded by her husband in February following a custody hearing in Macomb County court.
    In the eight years since personal protection orders became more readily available under Michigan law, experts have come to see some of the orders' limitations. The orders are often useful, but some experts are saying they can spur violence in other cases. If a violent spouse or ex-spouse wants to kill badly enough, the orders are worthless.
    "They are an essential tool, but where they don't work is at the end of a relationship that has been getting progressively more violent," said Wayne County Circuit Judge Richard Halloran, who has heard 70,000 personal protection orders requests over the last 4 1/2 years. He handles about 1,500 petitions a month, most of them related to fears of domestic violence. The orders are usually effective because most people are intimidated enough by the power of law to behave, he said. "I call it the bigger bully theory," Halloran said. "In essence, I have more power and control, and I can say to him, 'You write her another letter, you'll be spending the next 93 days behind bars, making new friends.' "
    That sometimes doesn't work, especially when the abuser or stalker is mentally ill or obsessed with his victim. Irons' husband had been hospitalized for emotional problems in the weeks before her death. Halloran said that when a situation involves "someone with psychological or mental problems, then it is time to have a safety plan in effect, to consider a shelter or other safe place."
    Hedy Nuriel, director of Haven, a domestic violence shelter and counseling service in Oakland County, said her staff carefully questions victims of violence before encouraging them to get a personal protection order. "A personal protection order is not for everybody," Nuriel said. "It doesn't stop bullets. . . . And for a lot of guys, they get angrier than before. If she believes that's the case, then we look at other options." Nuriel said having a safety plan is "the critical thing. If she knows he is so enraged that he's going to come after her, then she has to plan for her escape." Nuriel's shelter and others help victims come up with tailor-made safety plans, because each situation is different. Some women will seek shelter with relatives; others have enough money to move away. Some have transportation, others don't. And many have children, requiring additional planning. "Sometimes it comes down to making sure they have enough clothes for the kids . . . Things you need to think about," she said.
    The number of personal protection orders sought in the metro Detroit area has remained fairly constant during the last five years. Between 3,000 and 4,000 petitions are filed in Oakland County each year and Macomb County gets 2,000 to 2,500 each year. Wayne County Circuit Court handles about 18,000 annually. Judges review the petitions to determine whether they are legitimate. Between 80 and 90 percent are approved and placed in a statewide law enforcement computer system, alerting police that there is a court order in place.
    For the most part, orders provide a sense of safety. A 1998 study by the Women's Survival Center in Oakland County surveyed 485 people who had obtained personal protection orders. Four out of five said they found them effective in ending the fear and violence. Police said the process gives them an effective tool in combating violence in most cases.
    Prior to the new PPO laws, police could not arrest an abusive spouse simply because he or she showed up at the home. Now, if there is an order keeping the spouse away, police can get out their handcuffs. "It's a far better system now," said Oakland County Sheriff's Capt. Michael McCabe, whose department handles dozens of domestic violence complaints a week. "It used to be nearly impossible in the case of family fights for law enforcement to do anything, except ask the person to leave," McCabe said. "At least with a PPO, you have a violation of a court order, and judges come down pretty hard in those cases."
    Domestic violence cases with PPOs are priority runs on a par with armed robberies and other major crimes when they come in to 911 dispatchers, McCabe said. But even that approach would not have saved Irons, Smart or Keller-Wendt, McCabe said. "It's not a perfect world," he said. "There is only so much a police officer can do. How can we prevent something like that?" For additional information, contact the National Domestic Violence Hotline at 800-799-7233.

Most Women Overdrawn at Sleep Bank, Expert Says
Associated Press, 1/7/2003

Women generally don't get enough sleep, says a University of Michigan specialist. For most women, the problem is poor sleep hygiene, such as not relaxing before bedtime. But other women may suffer serious sleep disorders, such as apnea. "Sleep problems are pretty common in women," said Dr. Beth Malow, an associate professor of neurology and director of the General Clinical Research Center Sleep Program at the university health system. "I think as women get older, they have more problems with their sleep. And, at various times in a woman's life, whether it's when a woman starts menstruation, gets pregnant, or begins menopause, there are differences in sleep," she said in a recent statement.
    National Sleep Foundation figures show nearly 40 million American men and women suffer from sleep disorders, but more women are affected. Not getting enough sleep can result in daytime sleepiness, increased accidents, lapses in concentration and health problems. Insomnia, which makes it difficult to fall asleep or stay asleep, is the most common sleep disorder in women. A sleep foundation poll shows 53 percent of women aged 30 to 60 have trouble sleeping often or always. It's often cyclical, Malow said. Malow said treatments she prefers are behavioral techniques that involve muscle relaxation, combined with some medication.

Bed Sharing On Rise
Barbara Meltz, Boston Globe- 1/7/2003

Like many parents in the United States, Morgan and Jim Henderson of Wellesley, Mass. bought a crib. Unlike most of the rest of them, they didn't use it. Once Jacob was born, "it didn't make any sense to have him sleep anyplace else but in our own bed," says Morgan. Jim went along at first only because it was practical: Morgan nursed and it was easy to have the baby right there. But Jacob stayed until he was 2 1/2 and no longer nursing and, somewhat to his surprise, Jim came to love having him there. When
    Rhiannon came along, there was no question that she would share their bed, too. Today, Jacob is 7 and Rhiannon 4. Both go to sleep each night in their own beds in separate rooms, but it's not unusual for Morgan and Jim to wake up and find one or both asleep beside them. "We're pretty laid back about it," says Morgan.
    Much of the rest of the country is not. Bed-sharing is controversial here. It's also on the rise. With a growing multicultural population that accepts bed-sharing (transcultural researcher Martin Maldonado says many parents who immigrate here often are astounded at the assumption that a baby would sleep in a room away from the mother), and with breast-feeding fast becoming a national norm, estimates are that about 25 percent of all parents sleep with a baby in their bed. The most dramatic increase in the past 10 years is among white parents, up from about 5 percent to 20-25 percent, according to researcher James J. McKenna, director of the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame. The numbers of African Americans who bed- share has remained steady at 50 percent, and the number of Latino parents has gone from 60 percent to 70 percent, according to Maldonado, an infant psychiatrist at the Menninger Clinic in Topeka.
    Bed-sharing has traditionally been frowned upon in this country, where individuality--including the ability to sleep independently--is highly valued. The argument against it has been that if children sleep with their parents, it compromises their ability to sleep alone and creates psychological problems. Proponents say infants and young children have a natural need to sleep with their mother and that bed sharing leads to a healthy sense of self and to stronger, closer parent-child relationships.
    New research contradicts at least part of the "anti" argument. A longitudinal study reported in the August issue of the Journal of Developmental Behavioral Pediatrics shows that children who bed-share are no more likely to have emotional problems later in life than children who don't. McKenna reports that three other studies show that bed-sharing children handle stress and independence as well as other children.
    As for emotional closeness, even pediatricians who once pooh-poohed it as a reason to bed-share are less likely to do so today. Renown pediatrician T. Berry Brazelton is among those whose position has shifted. "We didn't used to have so many mothers working all day, away from their kids, or so many single parents who don't want to be separated at night," he says.. "Stress in general is another reason (that parents want to do it); 9-11, the threat of war. Everyone feels a greater need for emotional closeness these days. I never wanted to sleep with any of my kids, except if they came to our bed sick or upset. Today, I tell parents to make an individual, informed decision." Brazelton and co-author Joshua D. Sparrow have a new book on sleep coming out this winter, "Sleep the Brazelton Way" (Perseus).
    The key word here is informed. Numerous studies link bed-sharing with infant death, typically by smothering. The American Academy of Pediatrics' official position on bed sharing with a baby 12 months or younger is that it "may be hazardous." It recommends co-sleeping (baby in the same room, not the same bed) in the first 12 months of life. The dangers to be aware of include:
• Loose bedding or quilts.
• A bed with a sag, or a waterbed
• A parent who drinks, even a little, takes any drugs, or is obese. The risk is of sleeping so deeply you aren't aware of your baby.
• More than three people in the bed. The risk is the baby could be crushed against the headboard or wall.
    When parents are aware of the dangers, when they plan ahead to be creative about sexual intimacy, and when they proceed . because they believe in it for philosophical reasons, bed-sharing typically works. It typically doesn't work if one parent consistently doesn't sleep well or is otherwise unhappy with the arrangement; if parents do it because they feel guilty about time spent away from their baby; or if bed-sharing happens by default because a child is unable to sleep on his or her own.
    "That's when parents get resentful," says Children's Hospital pediatrician Richard Ferber, internationally recognized pediatric sleep specialist and author of "Solve Your Child's Sleep Problems" (Simon & Shuster). There's one other reason Ferber says bed-sharing may not work: " People don't realize that young kids can be very restless sleepers."
    Even when bed-sharing does work, at some point it needs to end, typically at age 3 or 4. At the Hendersons, it happened because Morgan was pregnant, Jacob was growing, they had a queen-size bed, and everyone was cramped. "When we offered Jacob the chance to have his own bed in his own room, he was happy to have his own space," says Jim. There was a transition time, and there were plenty of nights when Jacob slept with them after Rhiannon was born (they had a king-sized bed by then), but by and large it went smoothly.
    That's not always the case. Child developmental specialist Claire Lerner of Zero to Three, a nonprofit group dedicated to young children's healthy development, recommends incremental steps for the transition: First, a child sleeps in her own bed or crib in your room; then a parent sleeps with her (all night) in her room; then the parent stays only long enough for her to fall asleep; then just sits with her for a few minutes. It's a process that can take months, Lerner says.
    With a child 5 or older who has difficulty making the transition, Ferber recommends asking, "What is it you need in order to be able to sleep on your own?" Sometimes it's something simple, like knowing he's not alone in that part of the house. How you respond once she's in her own room and wants to come into your bed during the night depends on how strongly you feel about not having her there. If you really don't want her (or even if only one of you doesn't), you need to take her back to her own room to sleep and be prepared to do that whenever it happens. (Also, be prepared to stay with her until she falls back to sleep.) "If you go backward for even one night, the inconsistency will be confusing and you'll maintain the behavior for a longer period of time," says Lerner. However, if you don't mind having her in the bed now and then, it doesn't matter if she stays.
    For the Hendersons, wherever their children sleep is fine. "Rhiannon is the most independent 4-year-old I've ever met," says her mother, and Jacob enjoys sleep-overs at friends' and relatives' as much as the next 7-year-old. As for Jim, he may be the strongest proponent in the house. "I love waking up in the morning and seeing my family right here with me, in our family space," he says. "It's where our family began, it's where we are. It's very powerful for me."

33,000 Sex Offenders Elude California
Associated Press, 1/7/2003

SAN JOSE, Calif. — California has lost track of more than 33,000 convicted sex offenders, despite a law requiring rapists and child molesters to register each year for inclusion in the Megan's Law database. "We don't know where they are," acknowledged Margaret Moore, who until recently ran California's sex offender registry. Sex offenders are not checking in with law enforcement, which in most cases is a felony. And many overworked police departments are not following up.
    Experts say sex offender databases nationwide have fallen short of their promise. "It's not only in California," said Laura Ahearn, executive director of Parents for Megan's Law, a national victims' rights group. "We're expecting sex offenders to be reporting their addresses and that's the problem."
    According to 2002 data provided to The Associated Press after repeated requests over nine months, the state does not know the whereabouts of at least 33,296 sex offenders, or 44 percent of the 76,350 who registered with the state at least once. These rapists and child molesters vanished after registering. The total number of convicted sex offenders whose whereabouts are unknown may be even higher: No one knows how many offenders never registered at all after leaving prison. Failing to register could put high-risk offenders in jail for up to three more years, but most police departments are not enforcing the law. No one knows how many of these missing sex offenders have struck again. But nationally, 52 percent of rapists are arrested for new crimes within three years of leaving prison, according to the U.S. Justice Department.
    Among those missing is Richard Flick, convicted of molesting four young children in the 1980s and '90s. Flick was freed from Atascadero State Hospital in 1999 despite warnings from the hospital staff that he hadn't resolved his sexual attraction to children. Even he said it would be "disastrous" to be released without supervision. A search of the database turned up nothing about him.
    The 1996 law is named for 7-year-old Megan Kanka, a New Jersey girl who was raped and killed by a child molester who had moved in across the street. All states have similar laws designed to warn communities about the presence of such ex-cons. Megan's Law databases are supposed to help the public and police monitor convicted sex offenders by keeping track of their home and work addresses and other personal details. Adults can search the database at sheriffs' offices or police departments. But no one audits California's database for accuracy. State Justice Department officials cannot even say how much the program costs.
    Attorney General Bill Lockyer touts the sex offender database as a valuable tool for the public, one that is updated daily and available in 13 languages. But when presented with the AP's findings the first-ever analysis of the database's accuracy he acknowledged changes are needed. "Our system is inadequate, woefully inadequate," he said. "It can only be improved by putting money into the local law enforcement agencies. It's a matter of resources."
    Former state Assemblywoman Barbara Alby, the child advocate who wrote California's Megan's Law, said she was appalled by the findings. "We've got to put some teeth in the law for law enforcement," she said. "We should tie some of their funding to making sure this is getting done."
    Some states take a firmer approach. In Washington, law enforcement officers go to sex offenders each year to confirm their information, rather than relying on ex-cons to report in. Only 10 percent of that state's 17,105 offenders could not be found, said Toni Korneder, Washington's Criminal History Records Manager.
    Among the bright spots in California are Los Angeles and San Jose, which spends $600,000 on a staff of seven people working full-time to monitor 2,700 rapists and child molesters. In San Jose at least, police say they can instantly identify every known molester living or working nearby as soon as they learn of an attack on a child. Most other local efforts are less organized and understaffed. "We could definitely use some help," said Detective Terry Chew, the lone officer responsible for tracking Sacramento's 1,945 registered sex offenders. He said he thinks 300 or more are not complying, but "there's so many of them out there, it's hard to keep track."

Testosterone Buoys Spirits of Depressed Men
ABC News, 1/8/2003

A testosterone boost may lift the moods of depressed men who don't respond to antidepressants. A study in the latest issue of the American Journal of Psychiatry says that men who don't respond to antidepressants may have low testosterone levels, and efforts to restore those levels to normal seem to improve their depression.
    In screening the testosterone levels of 54 depressed men who didn't benefit from antidepressants, researchers at McLean Hospital in Belmont, Mass., found that a relatively large number -- 43 percent -- of the men had low testosterone levels. The researchers gave 19 of those men a testosterone replacement gel along with antidepressants, while the other five received antidepressants and a placebo. The subjects were between the ages of 30 and 65.
    Over the next eight weeks, those who received the testosterone gel showed significant improvements compared to those who didn't get the gel. Areas of improvement included mood, feelings of guilt and anxiety, as well as improved sleep, appetite and libido. Side effects from the treatment were modest; one man withdrew from the study due to difficulty urinating.
    The researchers caution that the findings are preliminary, and larger studies are needed. However, they say the initial results suggest that men who don't respond to antidepressants may have reduced testosterone levels, and doctors should consider screening for that problem. McLean Hospital is a psychiatric affiliate of Harvard Medical School.

Court Weighs Mental Tests in Slaying Case
Megan Tench, Boston Globe- 1/8/2003

The psychological tests of a Springfield student charged with fatally stabbing his school counselor will be the focus of another court hearing next week, according to a Hampden County prosecutor. Bernice Kelly of the Law and Psychiatry Service of Massachusetts General Hospital will testify at the trial of Corey Ramos, but at the Jan. 17 hearing, prosecutors will try to limit the doctor's testimony and will question the validity of certain parts of the psychological tests, said Assistant District Attorney Brett Vottero.
    On Monday, Kelly testified in a hearing that Ramos, 18, suffered from post-traumatic stress disorder before the killing, a condition stemming from a childhood kidnapping and other events. Prosecutors had called for Monday's hearing hoping the judge would ban the doctor from testifying, but withdrew their motion. ''The doctor can testify,'' said Alan Black, Ramos's attorney. Black said his defense will include the contention that his client's psychiatric problems affected his mental state the day of the killing. Ramos has pleaded not guilty. His trial is scheduled Jan. 21.
    Prosecutors say that on Dec. 5, 2001, Ramos repeatedly stabbed Rev. Theodore Brown at Springfield High School after the counselor told Ramos to remove his sweatshirt hood. According to police reports, Brown had spotted Ramos in the hallway in between classes wearing the hood, an item banned at the alternative school. The counselor followed Ramos into a classroom, where the two argued, police said. Ramos allegedly then pulled out a knife and stabbed Brown several times in the chest and abdomen. Brown died at Baystate Medical Center.

Court Upholds Use of Lie Detectors in Monitoring Sex Offenders
David B. Caruso, Associated Press- 1/8/2003

PHILADELPHIA -- Sex offenders who have been paroled or placed on probation can be forced to take routine lie detector tests as a condition of their freedom, a federal appeals court ruled. The 3rd U.S. Circuit Court of Appeals said Tuesday that such mandatory tests are constitutional as long as the subjects can refuse to answer questions that might implicate them in crimes.
    The ruling, by a three-judge panel, upholds a growing national practice of using polygraphs to monitor rapists, child molesters and other sex-crime convicts who have completed their prison terms but have been judged by psychologists to be likely to commit another crime. The 3rd Circuit directly covers only Pennsylvania, Delaware, New Jersey and the Virgin Islands. But the ruling's influence could be broader. Courts and lawyers in other states can cite it as a precedent.
    The case involved Albert M. Lee, 36, a Delaware man who pleaded guilty in 2000 to possessing child pornography and having sex with a 15-year-old girl he met through the Internet. A judge sentenced Lee to almost four years in prison. He also ordered Lee to submit to frequent polygraph examinations after his scheduled 2004 release.
    Lee's attorney, Christopher S. Koyste, argued that ordering someone to answer questions as part of a polygraph test violates the Fifth Amendment protection against self-incrimination. But Circuit Judge Robert J. Ward disagreed, saying that while Lee had to submit to the polygraph, he was free to refuse to answer specific questions. ''Should Lee choose to terminate the interview and exit the room while being questioned, he may do so by having the machine detached from him in a matter of moments,'' Ward wrote. He said if a question would incriminate Lee, he can invoke the Fifth Amendment and remain silent without consequences. Koyste said he is considering whether to appeal.
    Courts have banned lie detectors from being used as evidence in most criminal trials. And in October, the National Research Council said lie detectors also should not be used to screen government employees. The council's report said a ''century of research'' has provided little evidence that the tests are accurate. That finding has already been cited by lawyers challenging routine exams for people on probation and parole. In Colorado, for example, a truck driver convicted of sexual assault filed suit in December seeking to halt that state's practice of forcing some sex offenders to take a lie detector test every six months.
    On the Net: 3rd U.S. Circuit Court of Appeals: http://www.ca3.uscourts.gov
 

Chilling Memories of a Violent First Love
ABC News, 1/8/2003

When Kristen Rambler first started dating her boyfriend in their senior year of high school, he dazzled her with roses and declarations of love, but soon sweet times gave way to violence. The first time her boyfriend Keith pushed her was at a high school graduation party in North Huntington, Pa. Later, while they were both in college, he beat her enough to leave bruises, and ended up spending the night in jail. After nearly a year of on-and-off abuse, Rambler told Keith in the summer of 2001 that she couldn't see him until he got help. The next day, he went to her parent's home with a gun, shot a male friend of hers who was trying to help her escape, and held a gun to her head before turning it on himself and committing suicide.
    Since the incident, Rambler, 20, has gotten professional help, but now she has advice for other young women in her situation. "Try to get out if you can," Rambler, a student at the University of South Carolina told ABCNEWS' Good Morning America. "You keep thinking this person's going to change, but they're not." Rambler's story, which she first told in the November issue of CosmoGirl magazine, is certainly extreme, but the issue of physical abuse among teens is common. One in five teenage girls are victims of dating violence, according to a recent study by the Harvard School of Public Health.

Realizing He Had a Problem
She often blamed herself for the beatings, and said that her boyfriend seemed like two different people. "He was very romantic," she said. "He would always tell me how much he loved me." On their one-month anniversary, he bought a rose for her at school, and when she got home, she found 11 more roses on her porch. She said her boyfriend called her often, took her out on dates, never asked her to pay and always said "I love you."
    But the very day they graduated high school, they were at a graduation party later, and she first saw his violent side. He had already been drinking when she arrived at the party that night. "He yelled across the room at me 'where's the ice' in a very rude way," Rambler said. She was embarrassed and snapped back at him, and he came over to where she was and pushed her into a treadmill. "That's when I realized he had a violent side," she said.
    The next day, he sent her an e-mail, saying he hated men who hurt women, and he didn't know why he did it. He also wrote that he loved her, and asked for forgiveness. She did, but that wasn't the end of the violence. Rambler said Keith attacked her again over the summer after she accidentially spilled some furniture polish on his carpet. "He took my hair and he dragged me to the floor and pounded my head against the floor and the metal bunk beds," Rambler said. After it was over, she said Keith began crying and begged for her forgiveness. "I loved him and I didn't want to leave him," Rambler said. "He was my first love."

Valentine’s Day Attack
Things reached a peak one Valentine's Day, when she paid Keith a surprise visit at his college on a weekday. They had seen each other the previous weekend, but she was able to break away from school. She had gotten a rose for him, but she said Keith freaked out and said she was trying to make him feel bad because he didn't have anything for her. "He started beating me very badly and the police were called," Rambler said. She escaped and asked the school's resident assistant for help, and Keith was arrested that night. Police took pictures of her bruises, but they didn't require medical attention.
    After the Valentine's Day fight, Keith asked her to drop the charges so that his future career wouldn't be ruined. She agreed, but the prosecutor didn't believe Rambler's story that she was the one who attacked him. The trial was set for late summer. When her friends saw her bruises Rambler would say that she had been in a fight with another girl, but they knew she was lying, and wasn't the type. They told her she deserved better than a boyfriend who beat her. But, one of the problems was that Keith tried to make her stay away from friends and family.

Breaking It Off
After the Valentine's Day incident, she got back together with Keith, hiding it from her family, but she decided to break it off over the July Fourth holiday, when she was on vacation with her family. Her friends and family didn't want her to see him anymore, and she worked up the courage to call him on July 10, and told him that until he got professional help, she wanted nothing to do with him The next day Rambler was planning to go swimming with a mutual friend of theirs, Ryan. But just before he was supposed to pick her up, Keith showed up at her parent's home. Rambler said Keith was crying and telling her that he loved her, but she asked him to leave. That's when he pulled a gun out of one pocket, and bullets out of the other. Rambler ran out of the house just as her friend Ryan pulled up. She jumped in the car and told him to drive away. Keith was chasing the car with a gun. At the end of a road was a cul-de-sac, and Ryan told her to get out of the car and run into the woods. She heard a gunshot and saw Ryan fall. She called his name, and then Keith started running toward her. When he caught up with her in a driveway, Rambler said he held the gun to her head before turning it on himself. A neighbor who had seen it all and called police came out and got her. Ryan, who had been shot in the arm, had also made it into that neighbor's house.
    Later, Rambler found an e-mail from Keith with "I'm Dead" as the subject heading. It was a suicide note saying he was going to kill himself because that is the only way to prove he really loved her. She would always be his "kitten," he wrote. Her feelings toward Keith change from day to day, Rambler said. She does think he had a mental problem, but she'll always have a place in her heart for him, because he was her first love.

 
Illinois Woman Exonerated in Daughter’s Death
ABC News, 1/9/2003

When Tabitha Pollock appeared before a grand jury investigating the death of her 3-year-old daughter, she thought she was testifying to help convict her boyfriend, who had confessed to hitting the child hard on the back of the head. Pollock was reeling from the news that her little girl, Jami Sue, had some 100 bruises on her body when she died — most of them invisible to the naked eye. Pollock and her parents had begun to suspect that the "accidents" Jami Sue and her 5-year-old brother, Preston, had been having were in fact physical abuse. But then she had another shock. After her testimony, she says, she was asked to wait in the hallway. A few minutes later, prosecutors told her she was being arrested. The grand jury had indicted her on the same charge as her boyfriend: first-degree murder. She was handcuffed and taken to the jailhouse next door.
    Although Pollock said she had never seen her boyfriend raise his hand to her children, prosecutors argued that as a parent she should have known her children were being mistreated, and that she was equally responsible. "In Illinois, the law is that a parent has a legal duty to protect their small children from harm," Terry Patton, the current Henry County prosecutor, explained to Primetime. At the time of the crime, in 1995, Illinois law required parents to intervene if they knew or should have known that their child was in danger, he said, adding, "If you are going to bring a helpless, defenseless child into this world, you have got a duty to protect that child. Nobody else can." Pollock, then 25, was convicted of first-degree murder and sentenced to 36 years in prison. Her boyfriend, Scott English, was convicted in a separate trial and given life in prison, though his sentence was later reduced.

Hope for a Good Relationship
Pollock had moved in with English in 1995, bringing three of her four children — Jami Sue, Preston, and 2-year-old David, her son with English — to live with him in his parents' home in Kewanee, Ill. Pollock had had a string of bad relationships, and she and her parents thought English marked a change in her luck. He seemed to care for her children, on one occasion spontaneously popping out to bring them ice cream from Dairy Queen. "I really thought he was something," she says.
    But a month after she moved in, English woke her at 5 a.m. and told her something was wrong with Jami Sue. "He said in a slightly raised voice — he wasn't yelling, he wasn't panicked ... 'Tabitha, get up. Your daughter's not breathing.'" Pollock ran into her daughter's room, found that she had no pulse, and yelled at English to call 911. At the hospital, doctors worked frantically to save the girl, but after an hour they came out and told Pollock they could not save her.
    An autopsy showed that Jami Sue had been struck so hard on the head that her brain swelled to twice its normal size and that she had suffocated. The investigation also revealed that her body was covered in some 100 bruises, most of them visible only under ultraviolet light. Police called English in for questioning and he admitted almost immediately that he had hit Jami Sue twice on the back of the head, once forcefully and a second time with less force. He said he did not know why he did it, but prosecutors believed he struck the girl out of anger.

With Hindsight, Warning Signs
Pollock says she was shocked to hear of her boyfriend's admission. "It didn't seem real that he was the person who caused my daughter's death," she says. But when she and her parents began piecing together how English might have done such a thing, they began to look at him in a different light. Since they moved in, Jami Sue and Preston had seemed to have one accident after another. But each time, Pollock says, English and his parents said there was an innocent explanation: When Jami Sue fell down the stairs, she had tripped on David's bottle; when she got bruises, it was from playing with other children. And when Jami Sue she went to the hospital for stitches three days before her death, the explanation was that she fell while brushing her teeth and hit her head on the bathroom cabinet, Pollock says.
    She also remembered that Jami Sue and Preston once told her that English had choked them, but that at the time he had reassured her it was all a misunderstanding. With hindsight, Pollock says, she has no doubt that English was abusing her children. But at the time, she says she believed his explanations. "If he's telling me this and his parents are telling me this, why would I doubt it?"
    Prosecutors would later use these incidents to argue that Pollock should have known about the abuse. "There was not just one sign, not just two, but over and over and over again," Patton told Primetime. "At some point in time you have to say that is enough — you knew that abuse was taking place." Patton concedes that Jami Sue's was not the type of case where her injuries were readily visible, but he believes that Pollock had a special obligation as a parent to detect the abuse, even if none of the other adults around the girl — Pollock's parents, English's parents, the doctors who gave her stitches — were aware of it. "She is that child's parent. … A parent needs to be a parent," he says.

Complete Exoneration
After five years in prison, all of Pollock's appeals had been denied and she had lost custody of her remaining children. She says she was becoming depressed, even suicidal. At her parents' urging, she wrote one last letter, to the Center on Wrongful Convictions at the Northwestern University School of Law, which has attracted national attention for helping exonerate innocent prisoners, including nine men who were on death row.
    Pollock's letter was one of 17,000 the center received that year, but the law student who reviewed it brought it to a meeting and suggested the center look into the case. Jane Raley, one of the center's attorneys, remembers it as "an incredible letter. … This woman writes and says that she was asleep in another room when her boyfriend killed her child, and that she was convicted because she should have known that her boyfriend was dangerous. … We became outraged and we said, 'This is wrong. We've got to do something.'"
    Raley believed that the prosecutors had misinterpreted the law, and she persuaded the Illinois Supreme Court to examine the case. On Oct. 18, 2002, the court granted Pollock a complete exoneration, overturning her conviction and ordering her freed from prison. The court ruled that the prosecutors' argument that Pollock "should have known" about the abuse did not meet the standard of Illinois law. Furthermore, the court ruled that "the evidence simply does not support the inference that Jami was the victim of an ongoing pattern of abuse that the mother knew about and sanctioned," and barred prosecutors from retrying the case.
    Two months later, on Dec. 12, Pollock, now 32, walked out of the Lincoln Correctional Center after seven years behind bars. She was met by her parents and her son Preston, now 12. Later that day, as darkness fell, she went to see the headstone marking Jami Sue's grave for the first time, and told her she could rest in peace.

N.Y. To Provide Help For Mentally Ill Released From Prisons
Associated Press, 1/9/2003

NEW YORK -- New York City has agreed to provide treatment to mentally ill prisoners upon their release from the city's jails, a published report said. Under the terms of the agreement, which will settle a class-action lawsuit when passed, the city will provide mentally ill inmates with assistance and treatment to help them maintain psychiatric stability, The New York Times reported in Thursday editions. For many years, Rikers Island jail released most mentally ill prisoners with just a $3 MetroCard and $1.50 in cash the standard practice for other prisoners.
    In August 1999, a class action lawsuit was brought on behalf of seven mentally ill prisoners, and a year later Justice Richard Braun of the State Supreme Court granted an injunction in the suit. Since then, the city has offered mentally ill people treatment upon their release from prisons. Braun called Wednesday's agreement ''excellent and very comprehensive,'' the Times said. The agreement will now be submitted to members of the class for comment. A public hearing will then take place before Braun accepts the deal as final.

Harvard’s Dark Secret
ABC News, 1/9/2003

B O S T O N— The roaring '20s was a time of experimentation and change, yet homophobia was strong in society and its institutions, even at Harvard. While doing research on a another story last summer, Amit Paley, a reporter for Harvard University's Crimson newspaper, stumbled upon a file marked "Secret Court Files, 1920," in the university's archives. The discovery led Paley to 500 pages of documents that described an underground court that convened to investigate and expel gay students.

‘Taint Other Students’
"Members of the secret court considered themselves to be defenders of morality at the university, and they felt the very existence of people who were gay and even those who knew of homosexuality at the university, were some sort of force that would taint other students," Paley said. "I think they considered it some sort of contagious disease," he said.
    The witch hunt began when Harvard sophomore Cyril Wilcox committed suicide by inhaling gas in his family's home. When the Wilcox family found personal letters revealing the young man's gay life at school. They implored the university to investigate. "They pinpointed the ringleader as a student named Roberts, whose father was a congressman," Paley said. "He used to have parties in his room in Perkins Hall with other men from Boston who came in, people dressed in drag, women dressed in men's clothing," he said. In all, 14 men were interrogated by the secret court. They were pushed to reveal the deepest and most graphic details of their lifestyle as they were tried for the crime of being homosexual. Seven college students, a dental school student, a recent graduate and four men who were not connected to Harvard were told to leave the campus and Cambridge.
    A member of the secret court wrote a letter to U.S. Rep. Ernest William Roberts after the congressmen's son and the other men were dismissed. "The president has instructed me to advise your son to leave the university at once," the member wrote Roberts. "His offense has nothing to do with low scholarship. It is not gambling or drink or ordinary sexual intercourse … the matter is altogether the most distressing thing that has occurred since I've been in this office," he wrote. Many of those investigated were ruined for life. One of the interrogated students killed himself after his session with the secret court. Those accused passed away long before Harvard's dark secret was discovered, but for a while it seemed the school might never let it come out.

University Balked at Sharing Information
When Paley asked school administrators for the letters, he said they were hesitant to release everything. "I wrote a letter to the dean of the college asking for permission, and he said "There's no need-to-know basis" and that, you know, there are privacy interests of the students involved, and we don't want to release them to you at all," Paley said.
    Stephanie Skier, a leader of a campus gay activist group at Harvard, said everyone should be aware of what happened at the university, even though more than 80 years have passed since the secret court convened. "I think from any journalistic or historical perspective, it's definitely been brought out, from the, the perspective of clear activism or, or gay, lesbian, bisexual, transgender community, it's something that is part of our community that we want brought out, and, and remembered," she said.
    It took six months of appeals and extensive research to learn the names of students which had been kept secret by the university in the interest of privacy, but the Crimson eventually revealed the secret court. Harvard University issued an apology over the incident in late November. "Whatever attitudes may have been prevalent then, persecuting individuals on the basis of sexual orientation is abhorrent and an affront to the values of our university," said Lawrence H. Summers, the president of Harvard University. "We are a better and more just community today because those attitudes have changed as much as they have," he said. Skier says statements from university officials won't resurrect the dignity of the victims, or repair ruined lives. "They should give degrees to the students who were expelled in this process of the court," Skier said.

N.Y. Psychiatrist Held on Gun Charges
Associated Press, 1/9/2003

MINEOLA, N.Y. -- A psychiatrist was ordered held without bail on weapons charges Thursday after he allegedly told a patient that he planned a killing spree, then bought a pistol and silencer. Dr. Richard Karpf, 50, pleaded innocent to charges of second- and third-degree criminal possession of a weapon. The most serious charges carry a penalty of up to 15 years in prison. Additional charges of conspiracy to commit murder were being considered, Nassau County Assistant District Attorney Fred Klein said.
    The prosecutor said Karpf paid $1,600 for a .22-caliber automatic handgun, a silencer, and four clips of ammunition and told his murder plans to an undercover officer, who he thought was an unlicensed gun dealer. "He indicated to the undercover police officer ... that he wanted to shoot the people point blank in the head and the heart," Klein said. Karpf was arrested Wednesday outside a Home Depot. "I deny all of that, none of that is true ... It's a mistake," he said as he was led into court.
    Police began monitoring Karpf after the patient told authorities about two weeks ago that the psychiatrist had mentioned the murder plot and had tried to procure a gun from him. Klein said the patient told authorities that Karpf planned to kill his victims all at one time, dismember them and dispose of them in the ocean. Investigators have not determined who the intended victims were, although Klein indicated one may have been another of Karpf's patients. No motive has been determined, Klein said.

Job Seekers Relying on Personal Coaches
Diane E. Lewis, Boston Globe- 1/10/2003

Faced with the task of finding work in a down economy and unsure what career to pursue or how to focus her job search, Amanda Hamberg is using the $5,000 Christmas gift she received from her grandfather to hire a personal career coach. Hamberg, a 22-year-old art history major who graduated in December from Boston College with a bachelor of arts degree, is counting on coaching -- a service that usually caters to midcareer professionals in transition -- to help her choose a profession and acquire the skills to land an entry-level job in that field. ''Everything seems really tough,'' she said of the job market. ''I went to some office staffing agencies, but they don't have any opportunities. It's difficult to find work. The career center at Boston College was very helpful, but having a coach gives me more personal time.''
    Call it the one-on-one solution: In the job hunt, some newly minted graduates like Hamberg are turning to personal coaching in hopes of besting the competition and finding work. Ruth Robbins, senior career counselor at the Five O'Clock Club in New York, says college graduates with financial resources have always sought personalized help, ''but it is now increasing because of the economy and because new grads feel it is very, very hard to find work.''
    Robbins's hourly rate: $85 per hour for young clients. Robbins said she started working with one young client in the middle of the college student's senior year. ''I worked with her on a resume, and with getting her a job in hospital administration,'' said Robbins, who helped the client land an entry-level job in the health care industry.
    Career coaching services have long been used by established professionals seeking personal assistance from counselors who also act as mentors. Most career coaches use personality tests or vocational assessments to determine the work clients are best suited for. Then they help them map out strategies for securing an interview and, hopefully, an offer of employment.
    ''Typically, people come for help in midlife,'' said Lauren Mackler, a Newton career coach. ''They want to make a change. Or they've been downsized four or five times. They want to find a way to start a business or find out what else is out there. So the kids' coming is unusual, and it's mostly driven by anxious parents. The kids don't have much perspective. They don't know what to do.'' Mackler's practice consists mostly of executives and midcareer professionals in the $80,000 to $250,000 salary range. She charges all clients $1,500 for a two-month coaching program of eight 90-minute sessions. In recent months she has worked with a college grad and a student who left school to find her niche.
    Take 22-year-old Maggie Sayer. Aware that she needed assistance finding a career path, she went to see Mackler last year at the urging of her father. Sayer, a history major who attended Hamilton College in New York before leaving school her junior year, meets with Mackler at least once every two weeks. She says the coach helped her focus on her interests and set personal goals. Though Sayer has not yet settled on a career, she does have a new goal: to finish her education at a college Mackler selected that offers a small coeducational environment and an independent study program. ''The idea has always been that with a liberal arts education you can go anywhere and do anything, but you still need help figuring it out,'' said Sayer. ''I didn't even know what's out there. I've got friends who graduated in 2002, and they still haven't found jobs. They're lucky enough to know where their interests lie, but they do not know how to get to those jobs.''
    After Christmas, Hamberg went to see Frank Faggiano, owner of Faggiano Consulting LLC at South Market in Faneuil Hall Marketplace. A former human resource professional and executive, he started the company last year after friends asked him to help their children find work and job leads. He currently coaches five clients who are recent college graduates. Faggiano began by conducting an interview with Hamberg. At his request, Hamberg also began taking the Campbell Interest and Skill Survey, or CISS, one of several assessments that measure vocational interests and skills. The test focuses on careers that require postsecondary education and is often given to people who are bound for college or college educated.
    Once Hamberg completes the test, Faggiano will send it for analysis to a consulting firm in Portland, Maine. The report he gets back should offer clues as to how confident Hamberg is in her ability to perform skills in a particular vocation. He will later conduct a three-hour assessment of her skills. ''Kids are very concerned about the jobs not being out there,'' said Faggiano, who charges $5,000 for a package that includes helping young clients negotiate a salary when they receive an offer and advice for succeeding in a firm's cultural climate. ''There is real tension about this. I want to help them get jobs, but I also see my role as helping them figure out what it is they want to do and how to get there. '' Faggiano said he helps his clients with resume writing, sourcing, and strategizing. He also uses his own contacts to help them network with people who know where the entry-level jobs are. ''This is a game of persistence,'' he said.
    Last year, more than 1 million jobs were eliminated from corporate payrolls. As a result, campus hiring was down more than 36 percent in 2002, according to the National Association of Colleges and Employers, or NACE. It maintains that graduates with degrees in certain specialized fields such as accounting and the health care professions should have an easier time finding work. ''Liberal arts graduates are not on the list of the top 10 graduates who are more likely to be hired,'' said NACE spokeswoman Camille Luckenbaugh. ''Many of these graduates are facing competition from the people they graduated with and the people who already graduated. These kids are young, they are just getting out of college, and they are not very business-savvy. Career coaching takes the search a step further. It's a perk for these kids.''
    While there is no guarantee that hiring a coach will lead to a job, Lisa Shields has high hopes for an upcoming interview. Shields, 23, of Boston, wasn't sure what route to pursue when she got her bachelor of arts degree from Dickinson College in Carlisle, Pa., last May. After taking the CISS assessment test, however, the former sociology major had a better idea: a career in the travel industry or working with people from foreign countries. She has an interview today with a local travel agency, and she says she got the interview through Faggiano. He knew someone in the travel industry and passed on the contact, Shields said.

Ruling in Canada May Boost Legality of Marijuana
Associated Press, 1/10/2003

TORONTO -- A judge ruled Thursday that Canada's medical marijuana program was unconstitutional for failing to provide a legal source of the drug to patients authorized to use it, a decision that could lead to limited decriminalization as early as this year. The ruling gives the federal government six months to solve the problem, or have the program considered "of no force and effect." The ruling applies to the medical marijuana program that took effect in July 2001.
    Justice Minister Martin Cauchon said he intends to propose legislation in the next few months that would make the penalty for possession of small amounts--probably less than an ounce--similar to a traffic ticket, leaving no criminal record. Thursday's court ruling challenged the regulations that allow Canadians suffering from terminal illnesses and chronic conditions such as arthritis to legally smoke marijuana.
    Eight U.S. states have taken some kind of step toward permitting the medicinal use of marijuana: California, Washington, Oregon, Alaska, Hawaii, Maine, Nevada and Colorado. The U.S. Supreme Court, however, ruled in 2001 that there is no exception in federal law for people to use marijuana.

When the Brain Disrupts the Night
Erica Goode, New York Times- 1/7/2003

Awake, Jim Smith was an amiable and popular man. As the director of public works in the small town of Osseo, Minn., he could be counted on to make house calls day or night, attending to burst pipes or broken water mains. In fall, he hunted deer with buddies, who affectionately called him Smitty. In summer, he took his family pan fishing for crappie. It was only when Mr. Smith fell asleep that something changed. Wrapped in slumber, he would shout obscenities, kick the walls, punch the pillows. Sometimes, he hit his wife, Dee, in the back or grabbed her by the hair. One night, dreaming that he was putting a wounded deer out of its misery, he came close to breaking his wife's wrist. "I just didn't sleep real sound," Mrs. Smith recalled. "Once he started talking or swearing, I would be afraid that the next thing, he would be swinging his fists."
    In an earlier century, Mr. Smith might have undergone exorcism to expel the demons that possessed him when his eyes closed. In the 1960's, psychiatrists might have traced his problem to repressed aggression and prescribed a sojourn on the analytic couch. But in the last two decades, researchers have begun to systematically investigate a variety of disorders -- called parasomnias -- involving odd or dangerous behavior during sleep. One is called REM behavior disorder, in which people act out their dreams. This was the diagnosis Mr. Smith received in 1987 when he sought, treatment at the Minnesota Regional Sleep Disorders Center in Minneapolis.
    Parasomnias are more common than was once thought, researchers are finding. They can be successfully treated, and most have nothing to do with mental illness. At the same time, research on such sleep problem is challenging basic assumptions about sleep and wakefulness, showing that the borders between the two states are far from clearly demarcated. And in the case of REM behavior disorder, one of the most studied parasomnias, investigators are finding surprising links to physical illness.
    For example, at the annual meetings of the Associated Professional Sleep Societies in June, Dr. Carlos H. Schenck, a psychiatrist and senior scientist at the Minnesota sleep center, and Dr. Mark W. Mahowald, a neurologist and the director of the clinic, will present findings indicating that of 26 otherwise healthy patients in whom REM behavior disorder was diagnosed in the 1980's, 17 went on to develop Parkinson's disease. Other studies, at the Mayo Clinic and elsewhere, have found associations between the sleep disorder and other neurodegenerative diseases related to Parkinson's, including a form of dementia known as Lewy body disease and an illness called multiple system atrophy. Mr. Smith, now 72 and retired, learned in May 2001 that he had Parkinson's.
    The connection between REM behavior disorder and Parkinson's is the latest twist in a story that began 20 years ago, when a retired grocer named Donald Dorff came to Dr. Schenck complaining of what he called "violent moving nightmares." In one such dream, Mr. Dorff, believing he was a quarterback heading for 'a touchdown, ran forcefully into his bedroom dresser. Wiring his new patient up in the sleep laboratory, Dr. Schenck discovered that Mr. Dorff's violent behavior occurred during periods of rapid eye movement, or REM, sleep, a stage that account for 20 to 25 percent of nighttime repose in humans and that shows up often in electroencephalogram recordings as a pattern of electrical activity similar to that seen during waking. Most dreaming takes place in REM sleep.
    During REM, the brain dispatches signals to the muscles; telling them to perform the movements would be appropriate if the person were awake. In most sleepers, however, another brain circuit also kicks into action during REM to prevent the dreamer from carrying out those instructions. Nerve cells transmit chemical messages that paralyze all muscles in the body except the diaphragm, one small muscle in the ear and the muscles that move the eyes.
    Mr. Dorff's problem appeared to be that the normal paralysis of REM was missing. The same was true for four other elderly patients, described by Dr. Schenck and his colleagues in a 1986 report documenting the first human cases of the disorder. In fact, the researchers realized, the patients were acting a lot like a group of laboratory cats studied in the mid-1960's by a French sleep expert, Dr, Michel Jouvet. Trying to locate the regions of the brain responsible for REM sleep, Dr. Jouvet and his colleagues destroyed cells in an area of the brainstem called the pons. Even with this damage, the cats still entered REM sleep, lying still, they stood up, looked around and sometimes stalked prey.
    Subsequent studies, by Dr. Adrian Morrison at the University of Pennsylvania School of Veterinary Medicine, showed that the extent of the behavior exhibited by the animals during REM depended on where in the pons the lesions were made. For example, when the cell damage encompassed nerve pathways extending from the amygdala, a brain structure involved with emotion, the cats would attack humans or other cats.
    As with Mr. Dorff, who died in 1999, and Mr. Smith, studies show that more than 80 percent of patients who show up at sleep disorder clinics with REM behavior disorder are men, middle-aged or older, and most, Dr. Schenck said, are noticeably placid and good-natured in their waking life. Many display rhythmic movements of their legs even during non-REM or slow-wave sleep.  Most patients also report unusually vivid dreams (sometimes beginning long before they start acting them out) in which they are being threatened or attacked or engaging in active sports.
    One man dreamed that his boss was chasing him with a hatchet; another that he was being pursued by a lion, said Dr. Bradley F. Boeve, a neurologist at the Mayo Clinic who studies REM behavior disorder and Parkinsonian illnesses. Sometimes, Dr. Schenck said, a husband will awake from a dream in which he is protecting his wife from danger, only to find that in fact he has been pummeling her. "She wants to know why he's beating up on her and he says, 'I'm not, I'm beating up this man,' " Dr. Schenck said. In other cases, patients have no memory of what stirred them to action. On a hunting trip, for example, Mr. Smith leaped abruptly from bed and began singing "God Bless America," to the amusement of his bunkmates. But he could not recall the dream that inspired this burst of patriotism.
    An increasing number of studies link REM behavior disorder to neurological disease. The damage to the pons that in animals suspends paralysis during REM sleep is not regularly found in humans with the disorder. And it is not yet entirely clear how the sleep problem is connected to neurodegenerative illnesses later in life. But recent work by Dr. Jerome Siegel at the University of California at Los Angeles offers another piece of the puzzle and may help explain a possible connection to Parkinsonian diseases. Neurons in particular areas of the midbrain, just above the pons, have a potent effect in suppressing muscle tone, Dr. Siegel has found. In rats, damage to those areas produces muscle movements during REM similar to those seen in human patients with the sleep disorder. And the nerve cells in those regions are very close to, and interconnected with, neurons in a midbrain center known to suffer cell damage in Parkinson's. "Given the connection between REM behavior disorder and Parkinson's," Dr. Slegel said, "the hypothesis that we're pursuing is that the degenerative process that causes Parkinson's may spread to the region responsible for inhibiting muscle tone" or vice versa.
    Brain scans of patients have added to the suspicion that the sleep disorder in some way signals the beginning of Parkinsonian disease. In 2000, Dr. Honka Eisensehr of the University of Munich reported finding a kind of "Parkinsonian fingerprint" -- a reduction in the enzyme that transports the messenger chemical dopamine in the striatum, the region of the midbrain where Parkinson's originates -- in the brain scans of patients with REM behavior disorder who did not yet have any other signs of neurological disease.
    In a development that experts call troubling, sleep clinics are also seeing a number of patients who develop some symptoms associated with REM sleep disorder while taking Prozac, Zoloft or others of the newer generation of antidepressant drugs called selective serotonin reuptake inhibitors or S.S.R.I.'s A 1992 study by scientists at the Minnesota sleep clinic found that 20 of 41 patients taking Prozac for depression or obsessive-compulsive disorder exhibited "extensive, prominent eye movements" during light non-REM stages of sleep, a phenomenon the researchers have called "Prozac eyes." In one patient, the eye movements were still present 19 months after the man stopped taking the antidepressant. Other reports suggest that some people taking the drugs experience muscle jerks or other movements during sleep or waking. Dr. John Winkelman, the medical director of the sleep health center at Brigham and Women's Hospital in Boston, said he had seen a number of patients who developed REM behavior disorder while taking S.S.R.I's. "A couple of people threw themselves out of bed," Dr. Winkelman said.
    No one yet knows how common such side effect are, or their implications -- if any. And other drugs -- barbiturates and stimulants, for example -- can also contribute to REM behavior disorder. But the findings, the experts say, should encourage doctors to prescribe responsibly. "The drugs are very effective," Dr. Mahowald said. "But it's the physician's responsibility to make sure the patient's condition is severe enough to warrant prescribing a neuroactive agent." On the other hand, some psychiatric drugs are effective in treating the sleep disorder. Dr. Boeve said he found the antidepressant Seroquel helpful for some patients. What eventually kept Mr. Smith from inflicting further damage on his wife was clonazepam, a tranquilizer that Dr. Schenck and other experts have shown almost always calms patients' turbulent nights. "It helped right away," Mrs. Smith said.
    REM behavior disorder is the only parasomnia routinely associated with violence. But sleepwalkers have also been known to stab their relatives, molest children or confidently stride out of third-story windows, in states varying from confused wakefulness to partial arousal to the deepest stages of non-REM or slow-wave sleep. Other sleep disorder patients, who suffer from a condition called nocturnal dissociative disorder, awaken and leave their beds to reenact scenes of physical or sexual abuse, sometimes cutting themselves with razors or banging their heads against the wall. Afterward, they remember nothing about their nighttime behavior.
    Reports of violence during slumber date back to the ancient Greeks. In Homer's "Odyssey," Eipenor, the youngest of Odysseus' crew, wakes suddenly from a drunken nap and runs off the roof of a house, breaking his neck. Simon Fraser, a 19th-century Scot who killed his 18-month-old son by dashing him against the wall, said he did so while dreaming that a wild beast had jumped on the bed and was attacking the boy. "I am guilty in my sleep, but not guilty in my senses," he insisted.
    More recently, the defendants in several murder cases have used sleep as a defense, in one instance successfully: a Canadian, Kenneth Parks, was acquitted after experts testified that he was in a somnambulistic state when, in May 1987, he drove 14 miles to the house of his inlaws, where he stabbed his mother-in-law to death and nearly killed his father-in-law. Such cases, Dr. Mahowald said, make it clear that sleep and waking are hardly distinct states. In many normal people, he said, detailed neurophysiological studies of the brain show that the signs of sleep persist for an hour after awakening, though an EEG indicates that the person is already fully awake. "Most people's concept is that the entire brain is in one state of being, and that's just not true," Dr. Mahowald said. "You can have parts of the brain that are awake while others are asleep."

Tailoring Treatments for Teenage Drug Users
Howard Markel, New York Times- 1/7/2002

In many respects, Michael Lagana is a typical 17-year-old. A junior at Dundalk High School in Maryland, he carries a full load of courses, loves playing football, and works after school selling newspaper subscriptions. He began smoking marijuana at 14. At 16, he was smoking three fat marijuana cigarettes a day or drinking a couple of 40-ounce bottles of malt liquor. Donna Lagana, Michael's mother, began to worry last June when she discovered some marijuana among Michael's things. He assured her then that it was "not a problem." But Michael's drug and alcohol use only escalated. In September, after he drank a fifth of brandy in less than an hour, he passed out and was taken to the emergency 'room for acute alcohol poisoning.
    Although Michael steadfastly refused to see a drug abuse counselor, his parents worried that he might pose a threat to himself or others. As a result, Mrs. Lagana petitioned the Baltimore County Circuit Court to order him to undergo a substance abuse evaluation. The court agreed, and within a few hours, Michael was picked up from school and taken to a local hospital. There he was examined by an addiction specialist and was soon admitted to Mountain Manor, an alcohol and drug treatment center for teenagers in Baltimore. It was, Mrs. Lagana recalls, "the hardest day of my life." "How could I have not noticed it before?" she asked.
    Last month, researchers at the University of Michigan reported that the use of alcohol, nicotine and marijuana among high school students across the nation was declining. Nevertheless, levels of teenage drinking and drug use remain stubbornly high. At least 53 percent of all American adolescents have tried an illicit drug by the time they have finished high school, according to the Michigan researchers.
    The Centers for Disease Control and Prevention reported last week that from 1993 to 2001 the rate of binge drinking episodes among drinkers 18 to 20 increased by 56 percent, compared with an increase of 35 percent for all American adults. Binge drinking was defined as five or more drinks at a sitting, with the intention of becoming drunk. To highlight the continuing problems, a number of doctors who treat substance abuse among adolescents will give a report to all members of Congress and every state governor on Thursday. The report, by a group called the Physician Leadership on National Drug Policy, describes teenage alcohol and drug abuse as a national public health problem.
    Dr. Aaron Hogue, a psychologist and a researcher at Columbia University's National Center on Addiction and Substance Abuse, said that last year's reported decline in drug use by teenagers did not mean the problem was going away. "I am not sure that these general trends, as important as they are, speak directly to those kids who have the most severe substance abuse problems and are in the greatest need of treatment services," Dr. Hogue said. Also, because the brains of teenagers are still developing, many experts believe they are at greater risk for becoming addicted. A number of studies have shown that teenagers who begin using illicit drugs before they are 15 are eight times as likely to develop substance abuse problems as those who start at 18 or later.
    Anna Joseph, a 15-year-old who lives in Ann Arbor, is among those who have avoided drugs. "I don't feel I need them to have a good time," she said. For her, a major deterrent has been seeing other teenagers at school whose lives became messed up because they were dependent on drugs. Philip Anderson, a 17-year-old from Ferndale Md., who began using drugs at 10 and has abstained for over a year, explains that young people try drugs for a lot of reasons. "I got into drugs because I thought it was fun," he said. "Some kids see their parents using them. Others see their friends using them and feel pressured to do the same. Some are just curious."
    Dr. Marc Fishman, a psychiatrist at Mountain Manor and a faculty member at Johns Hopkins, said: "Many adults trivialize how bad these drugs really are. They say it's just pot or booze, what's the big deal? But it is a big deal when it involves children." Also, many experts say more treatment programs tailored to teenagers are needed. Dr. David Lewis, a physician at Brown University and the lead author of the physician group's report said: "You can't just apply, the adult model to teenagers. We need a new investment for what we know works for children." The physician group wants more money devoted to prevention and treatment and less money spent on incarcerating juvenile drug offenders.
    Effective drug treatment programs for teenagers, many addiction experts say, are different from those that work for adults. Parents and other family members have to be involved, and treatment has to allow for continued school work. Also, because teenagers' thought processes often differ from those of adults, different approaches to psychological counseling are required. More than half the adolescents enrolled in .drug rehabilitation programs also have some other psychiatric problems -- including attention deficit disorder, depression and trauma from sexual or physical abuse -- that have to be recognized.
    Several studies show that illicit drug use is reduced by 50 percent among teenagers one year after completing substance abuse treatment, although fewer than half are still abstaining five years later. The physicians' report says that these rates of relapses and compliance are similar to those seen in programs for other chronic, relapsing diseases like diabetes and asthma, where patients sometimes do not take their medicines.
    Another problem is a shortage of treatment programs. The report found that 10 percent of students who needed drug abuse treatment received it, and of those who did receive it, 25 percent received enough. Dr. Jeremiah A. Barondess, president of the New York Academy of Medicine, said: "If we had less than the needed facilities to treat diabetes, we would be labeled as heartless and accused of practicing medicine that is immoral if, not criminal. I can think of no other disease that is deliberately underfunded in such a manner."
    What is more, the report says that many pediatricians feel uncomfortable treating addiction problems and that financial reimbursement in the form of Medicaid or third-party health insurance is limited. About 44 percent of all referrals for substance abuse treatment are sent by the juvenile court system, compared with 22 percent from schools, 17 percent from themselves or family and 5 percent from health care professionals. The rest of the referrals come from a variety of sources. The physicians' report calls for training judges and criminal justice workers to collaborate with health care professionals in proceedings called drug courts that use the court system to send juvenile drug offenders into treatment.
    As for Michael. Lagana, he is not taking his sobriety for granted. "When I was using drugs," he said, "I just didn't think it was such a big deal. Since I began treatment four months ago, I've realized that I almost lost my life."

Binge Drinking Studied
Washington Post, 1/7/2003

Time to sober up after that New Year's Eve bacchanal: A new study shows that binge drinking -- taking more than five drinks on one occasion -- is on the rise, and that it costs billions of dollars and leads to tens of thousands of deaths on the roads and tens of thousands more murders, suicides and assaults.
    Unlike chronic drinking, acknowledged as a disease, binge drinking is laughed off as a deserved celebration or rite of passage, says Timothy Naimi, an epidemiologist at the Centers for Disease Control and Prevention (CDC), whose study appeared in the Jan. 1 Journal of the American Medical Association. But half of the 100,000 alcohol-related deaths each year are due to binges, says Naimi, who found that binge drinkers are 14 times more likely to drive when impaired than non-binge drinkers. The National Highway Traffic Safety Administration reported in December that more than 40 percent of the 42,116 motor vehicle deaths in 2001 were alcohol-related.
    Naimi and colleagues analyzed a biannual CDC phone survey of about 200,000 people on health issues. Reported binge-drinking episodes rose from 1.2 billion in 1993 to 1.5 billion in 2001, an increase Naimi says can't be explained by population growth. And because people tend to underreport drinking behavior, Naimi says, the study underestimates the problem.
    Surprisingly, young adults overall are not the problem many think they are. Those in the more populous 26-to-55-year-old age group accounted for a far bigger proportion -- 69 percent -- of binge episodes. But drinkers between 18 and 25 who binge do it more often than others, with an average 15.3 episodes per year for 18-to-20-year-olds and 18 per year for 20-to-25-year-olds. The typical binge drinker is a young (under age 26) white or Hispanic male, says Naimi. African American men and women binge less, as do residents of the Southeastern United States. And a large percentage of bingers classify themselves as "moderate" drinkers, defined as men who ordinarily take two drinks per day and women who take one. This shows a wide gap between perception and reality, says Mary Dufour, deputy director of the National Institute on Alcohol Abuse and Alcoholism, based in Bethesda. "There's a big difference between having one or two drinks a day and having 14 drinks on a Friday and Saturday night," she says.
    No one's sure why binge drinking is going up. Under Healthy People 2010, the government aims to decrease binge drinking to 6 percent of the adult population by 2010. According to the Healthy People data, as many as 17 percent of adults admit to binge drinking within the past month. Naimi suggests increased alcohol taxes, to make it harder for young drinkers to buy liquor, and wider adoption of laws that penalize people for driving with blood-alcohol levels over .08 percent. Thirty-five states and the District have such standards, according to Mothers Against Drunk Driving.

Psychiatrist Was Enraged at Patient Who Tried to End Relationship
Frank Eltman, Associated Press, 1/10/2003

MINEOLA, N.Y. -- A day before a psychiatrist was arrested on weapons charges in an alleged mass killing plot, he became enraged when a patient sought to end their year-long sexual relationship, chasing the woman out of his office and onto a Long Island street, the woman's lawyer said Friday. ''My client came to Dr. Karpf for help,'' said attorney Ruth E. Bernstein, refusing to identify her client other than to say she was an unemployed woman in her late 30s. ''Instead, she was manipulated and abused by him. ... He is a predator and he preyed on my client who was sick and defenseless and came to him for help.''
    Dr. Richard Karpf, 50, of Great Neck, was being held without bail following his arrest Wednesday while allegedly attempting to buy an automatic handgun, silencer and four clips of ammunition from an undercover police officer posing as a gun dealer. The arrest came after another one of the psychiatrist's patients told police that Karpf had confided in him about a plot to kill up to six people. Karpf allegedly had asked the patient to help him obtain a handgun, silencer and ammunition. Police set up a sting operation and arrested Karpf in a Westbury Home Depot parking lot on Wednesday afternoon.
    Karpf, whose office is in Garden City, was charged with second- and third-degree criminal possession of a weapon. If convicted of the most serious charges, he could face up to 15 years in prison. His lawyer, Glenn H. Morak, insisted Friday that his client was innocent and complained that the doctor, who has no criminal record, should have been granted bail. Karpf is due back in court on Monday for a brief procedural hearing, said a spokesman for Nassau County District Attorney Denis Dillon.
    Bernstein held a press conference in Mineola on Friday following media reports about her client's relationship with Karpf. ''It is imperative for the public to understand that this case is not about love, this case is not about an affair,'' Bernstein said. ''A doctor cannot have an affair with a patient. This case is about a sick man who should never have been a doctor who engaged in improper sexual contact with a sick patient who came to him for help.'' Bernstein said her client recently realized that the sexual relationship which took place almost exclusively in the confines of Karpf's office had to end and confronted him on Tuesday. ''She went to him with the best of intentions, to be able to work it out, because she had very deep feelings for him,'' Bernstein said. ''He actually was verbally abusive to her and cursed at her and physically chased her out of the office.'' Bernstein said her client was led ''to believe this was going to be therapeutic for her,'' and intends to file a complaint with the state Health Department.
    Kristine Smith, a Health Department spokeswoman, said Friday that Karpf had ''no previous disciplinary actions'' in his file. Although she said she could not comment about ongoing investigations, she noted it was department policy to investigate any allegations of medical misconduct and take appropriate action. Authorities said they have not determined a motive for the alleged plot, nor have they disclosed the potential targets. A police spokesman said Friday that detectives were interviewing many of Karpf's patients. Prosecutors have indicated they are ''seriously considering'' bringing additional charges of conspiracy to commit murder and were expected to bring the case to a grand jury.
    Karpf graduated in 1980 from the medical school at the Universidad Autonoma de Guadalajara, in Mexico. He completed a residency in psychiatry at Bergen Pines County Hospital in Paramus, N.J., and is certified by the American Board of Psychiatry and Neurology.

Violence Puts Focus on Mental Health Services
Ellen Barry and Sarah Schweitzer, Boston Globe- 1/11/2003

Spurred by two recent violent standoffs between mentally ill individuals and police officers, lawmakers and community leaders yesterday called for better coordination in the treatment and tracking of mentally ill people, even as many fear those services will suffer cutbacks in the face of the state's fiscal crisis. ''It's become all too clear that the community as a whole is vulnerable when people are not getting the treatment they need,'' said the Rev. Raymond Hammond, chairman of the criminal justice division of the Black Ministerial Alliance.
    The heightened concern comes after an episode on New Year's Day in which Jermaine Berry, a 20-year-old whose family and attorney say is schizophrenic, allegedly shot two police officers, and another last July in which police say LaVeta Jackson, a 36-year-old Dorchester woman with a psychiatric disorder, slit the throats of her two children and was then shot to death by officers. Jackson, who had been diagnosed with various illnesses -- an unspecified psychosis, bipolar disorder, and major depression -- was hospitalized three times in two states and received therapy from two mental health centers during the year before her death.
    To community members, the two cases are evidence of cracks in the long-term mental health care system. The cases are now prompting painful discussions, including a meeting this week between a Boston police official and African-American clergy members and community activists. The meeting was held at the Ella J. Baker House, where outreach workers have had a 14-year relationship with Berry and his three brothers. Next month, clergy members will hold a forum to continue the discussion. ''This is absolutely forcing a public conversation, and that is the good part,'' said state Senator Dianne Wilkerson, a Roxbury Democrat.
    And yet, with a fiscal crisis underway and options limited, there is a sense of frustration. Wilkerson said that funding for mental health care is woefully short, leaving caseworkers with too many cases to manage. ''The administration and the Legislature are going to be challenged in the reality of our economic situation, but they must draw a line in the sand -- a line that we just simply cannot go beyond,'' Wilkerson said. Wilkerson said she also will call for a reevaluation of the way services are administered and delivered to the mentally ill, which can be piecemeal and uncoordinated - as appeared to be the case with Jackson.
    In marked contrast to other violent episodes involving police and civilians, community leaders said few residents bear anger toward the police. Indeed, they say, both police and residents share a feeling of vulnerability -- and an urgent desire to prevent the intrusion of the criminal justice system in the care and control of the mentally ill. ''It's not anger at the police I'm hearing,'' Hammond said. ''It's concern about how to get people in trouble the help they need from the service providers who can help.''
    Yet the reality, police and community residents say, is that severely mentally ill people are often released into the community - where they routinely encounter police officers. When approaching households known to have mentally ill members, police use nonlethal force first, said Boston police spokeswoman Mariellen Burns. In an episode last July that ended in the death of Daniel Furtado, police initially attempted to negotiate with Furtado, then fired high-velocity bean bags at him, and then pepper spray. An officer then shot Furtado, who was reportedly coming at them with a hatchet.
    In a growing number of states and municipalities, police officers now receive training to deal with mentally ill citizens. State Senator Cynthia Creem, a Newton Democrat, has filed a bill requiring such police training. It has not yet been assigned to committee, said Mark Fine, Creem's chief of staff. ''We had started to see more stories about ... issues relating to violent interactions between law enforcement and people with mental illness,'' Fine said. ''It just started to look like a pattern.''
    Within the community, some say what's needed is better communication between mental health providers, such as social workers, and teachers, pastors, and store owners - a prospect limited by privacy requirements. ''I'd like to see more outreach and have more people involved in helping the mentally ill,'' said Nation of Islam minister Don Muhammad, spiritual leader of Muhammad's Mosque No. 11 in Grove Hall. ''We need better relationships with our agencies and departments -- not just money thrown at the situation.''