Suicide Too Frequently a Foe for Military
Hugo Martin, Los Angeles Times- 4/16/2003

One of the first casualties of the war with Iraq came more than a week before allied forces dropped the first bomb or fired the first bullet. Marine Pfc. James R. Dillon Jr., who had just turned 19 in the Kuwaiti desert, apparently took his own life, stepping into a portable toilet at a Marine staging area and shooting himself in the head with an M-16 rifle. Dillon, a Pennsylvania native who trained in Twentynine Palms, left his comrades wondering if the pressure of the approaching war had been too much for the young man.
    The death highlights a problem that has plagued the military, particularly the Marines, for years. Suicide is the second leading cause of death in the military and a problem so serious it prompted the Defense Department to call recently for increased suicide-prevention efforts. Accidents, including motor vehicle crashes, are the leading cause. Suicides claimed the lives of 118 active-duty servicemen and women in 2001 -- almost the number of American deaths so far in Iraq. The overall suicide rate in the U.S. military is slightly higher than the rate for the nation's civilian population. But the military suicide rates are at least 30% lower when compared with those of civilians in the same age, gender and racial groups. Still, military officials worry that the suicide rate appears to be on the rise in the Marines, the youngest and smallest of the nation's fighting units.
    Marine Corps Gen. James L. Jones issued a statement in November warning that the number of suicides in the Corps for the fiscal year starting in October 2002 was on a pace that would double the 20 suicides of the previous 12 months. "We must focus our attention on ensuring every possible measure is taken to battle this tragic and senseless loss of life," he said.
    According to Marines and other experts, the higher suicide rates could be attributed to several factors: Marines are typically younger than their counterparts in the other military branches; the Marine Corps has a reputation for imposing higher standards on its members; and there is a pervasive attitude that any Marine who speaks openly about personal problems will be branded as weak or psychologically troubled. Often, young Marines who feel pressure in trying to live up to the demands of the Corps will turn to alcohol to cope with the stress, said Candice Kirk, who retired last year after four years in the Corps. "You have these young guys and, for the first time, no one is checking up on them, so they start drinking," she said.
    The average age of an enlisted Marine is 18 1/2, according to the Department of Defense. Many young Marines have entered the Corps without the maturity or social skills needed to cope with typical life problems, said Larry Stratton, a retired Marine who oversees suicide- prevention efforts at the Marine Corps Air Ground Combat Center in Twentynine Palms. "They get a 'Dear John' letter or a 'Dear Jane' letter, and to them that is the end of the world," he said.
    Joseph Matoush, a retired Navy chaplain who served during the 1991 Persian Gulf War, suggested that some Marines become frustrated because they expect the Corps to teach them a skill they can turn into a career after they return to civilian life. But he said many Marines learn only how to fire a weapon -- a skill that does not translate to many civilian jobs.

A Military Mind-Set
Another possible factor is the image of a Marine as a tough-as-leather warrior impervious to pain -- an attitude that the Marine Corps acknowledges can make it difficult for young Marines to talk about their personal problems. Daniel Clark, a psychologist with the Washington State Patrol and an expert on suicides in law enforcement and the military, said the biggest challenge is breaking down the military mind-set that a soldier who talks about personal issues will never get promoted. "There is a lot of investment in covering things up that we would not see in the civilian population," he said.
    That situation is similar in the Navy, according to Petty Officer 3rd Class Miguel Rodriguez, who is aboard the aircraft carrier Nimitz in the Persian Gulf. He said in an e-mail that many sailors don't feel comfortable talking about their troubles. "If you need help, they have a chaplain you can go talk to, but not many people do that," he said. "They just suck it in. It is true that most people have that attitude that they are supposed to be tough. That's why it's hard, if not impossible, to talk to them about any problems."
    The Marines have taken several steps to reduce suicides. The Corps has distributed a suicide-prevention kit, including a video and brochures that give tips on recognizing warning signs. The short video shows Marines and sailors acting out the warning signs. There's a scene in which one sailor tells another: "My wife is leaving me and my life ain't worth two cents right now. As a matter of fact it ain't worth living." The narrator says Marines and sailors should feel obligated to report such comments to a chaplain or a commander. The brochures, emblazoned with the words, "Taking action/Saving lives," cite depression, impulsive anger, substance abuse and isolation as things to watch for. They include suggestions on where to get help.
    At the base in Twentynine Palms, experts have increased the number of suicide-prevention lessons to at least one briefing a week. And the Navy has distributed posters that say: "It's OK to get help. Getting help is a sign of strength." The Navy also has a new system to improve the tracking of suicides by recording the age, gender and background of each decedent and the likely factors that led to the suicide.
    Suicide-prevention experts in the military believe the potential for suicides drops during war because the troops turn their thoughts to the task at hand and away from marital concerns, financial worries and career problems -- the topics most often blamed for triggering thoughts of suicide. It is too early to tell if rates have dropped since the Iraq conflict began in March. "As long as they are kept busy at war, I don't think that suicide is as big a threat," said Matoush, the retired Navy chaplain. But he and other military experts say the risk could rise again after troops return home to face personal problems they left behind. Because of that danger, the Army and Marine Corps have adopted new procedures in the last decade to help troops readjust to life after an extended deployment. As part of the effort, chaplains and commanders "debrief" family members about potentially suicidal behavior.

Returning Home
Meanwhile, troops returning home will meet with chaplains and other trained workers to talk about any problems they may face after reentry. "I think we will be in a much better position than we have been in the past," said Stratton, of the Marine base in Twentynine Palms. The suicide rate in the U.S. military in 2001 was 12 deaths per 100,000, according to the Defense Department. The overall suicide rate in America is just under 11 deaths per 100,000. But according to military researchers, the suicide rate of civilian Americans with the same demographic characteristics as members of the armed forces is 17 to 20 deaths per 100,000. Experts and military officials note that the suicide rate in the Air Force has dropped dramatically since its suicide-prevention program was restructured in 1994. Suicide rates in the Air Force dropped from 16 deaths per 100,000 in 1994 to 5.6 deaths per 100,000 in 2001, according to the Defense Department.
    Instead of giving high-ranking commanders sole responsibility for combating suicide, the Air Force gave chaplains, family support groups and officials in other units the training to recognize signs of depression and other suicide indicators. As part of the effort, Air Force commanders also sought to shatter the impression that a good service member must keep his problems to himself, urging its members to confide in friends, comrades and others about personal problems.
    Other branches of the military have adopted some of the Air Force's techniques, but not all have had the same success. The Marine Corps has consistently had the highest suicide rate of all the branches. In the last few years, that rate has jumped from a low of 11.7 deaths per 100,000 in 1997 to 16.2 deaths per 100,000 in 2001, according to the Defense Department.
    No one is certain why Dillon shot himself in the Kuwaiti desert March 13, only four days after his 19th birthday. Some Marines in his unit told a reporter that Dillon had been considered the quiet "little brother" who worried that he would not be able to perform under fire. "He got overwhelmed at how proficient others were in his platoon," 1st Sgt. Miguel Pares told a reporter traveling with the battalion. "He was afraid that somebody would get killed because he was too slow." But Dillon's family and friends in Mercer, Pa., say they still can't believe that Dillon -- whom they called "Jamie" -- would take his own life. His stepfather, Sam Snyder, who raised Dillon from age 5 to 16, said Dillon joined the Marines because he wanted to be on the side of justice. Snyder said he believes Dillon probably shot himself by accident. "You are going to have to show me evidence to prove to me that it was intentional," he said. Dillon graduated from high school in 2002 and soon after reported for Marine boot camp. On his birthday, March 9, Dillon's comrades in the 3rd Battalion of the Light Armor Reconnaissance outfit surprised him with a "Happy Birthday" serenade. He died four days later.

Gambling Treatment Program May Fold
Phuong Cat Le, Seattle Post-Intelligencer- 4/16/2003

OLYMPIA -- The first time she sat down to play poker, Faye Cates won so much that she went out and paid cash for a new Pontiac Firebird. She was on such a roll, she thought she'd never lose. Even when she did, she felt her luck would turn. She played slot machines day in and day out, remembering to eat only when someone came around with a free meal ticket. To feed her gambling urges, she refinanced her car, sold her diamond ring and stole her son's seven credit cards so she could gamble some more. She kept gambling for years, even as her husband filed for divorce, her adult son stopped talking with her and her health deteriorated. When she was arrested for credit card fraud, she sought help from the state.
    In November, Washington began helping pathological gamblers such as Cates get treatment in a pilot project started with a one-time $500,000 from lottery proceeds. This year, even as the Legislature considers expanding gambling to raise much-needed revenues, money for the treatment program likely will run out in June. Advocates are lobbying to have treatment included in any gambling expansion proposal.
    The proposal with the most traction would allow the state lottery to run as many as one keno game every four minutes. The governor supports expanded keno, and it is part of the House budget to be unveiled today. "To me, if the state is going to sponsor something that creates a kind of an addiction, they should also be responsible for treatment," said Sen. Jim Honeyford, R-Sunnyside, who sponsored one of the bills to continue treating compulsive gamblers. His bill and a related House measure died in fiscal committees this year, leaving Cates without help to pay for counseling sessions after June. "We are trying to treat people, and we'd hate to pull the plug as it's getting started," said Rep. Alex Wood, D-Spokane, who sponsored the House bill.
    Caught in the debate are people like Cates, a 56-year-old Richland mother who never gambled until watching her friend play 10 years ago. Their casual weekend trip to La Center turned into two weeks of non-stop gambling. "It was such a high," Cates said. "It was power. ...I was hooked." When she lost at poker, she switched to slots. She played it all, from card rooms to Indian casinos to the lottery. Some days she'd drive 70 miles to one casino and play until it closed at 4 a.m. Then she'd drive 150 miles in the opposite direction to find another casino. "I felt like a boa constrictor was around me," she said. "I wouldn't leave the casinos, win, lose or draw. Every time I left I was broke."
    Not everyone who gambles ends up like Cates, says Dr. Charles Maurer, a Seattle clinical psychologist who has treated gamblers for 22 years. Most people can gamble socially without harmful effects, he said. Gary Hanson, executive director of the non-profit Washington State Council on Problem Gambling, said a comprehensive program that includes treatment can keep addiction rates down. Treatment "would save the state in the long run," Hanson said. The non-profit council has gotten money from the state Gambling Commission, Indian tribes and the state lottery for public awareness programs. But it hasn't gotten money for direct treatment until last fall, when the Legislature set aside $500,000 from the new multi-state lottery game Mega Millions. That money boosted the state from the bottom to the lower third among states in terms of funding for problem gambling, Maurer said. The Oregon Lottery, for example, sets aside 1 percent of annual proceeds, or about $3.2 million, for treatment.
    In Washington, the state lottery helps pay for a toll-free help line, gambling awareness ads and announcements and periodic studies. But the lottery spent only $108,000 on responsible gambling from 1999 to 2001, while it spent $15 million on advertising and research during that period. The amount for responsible gambling went up to $622,000 in 2001-03, but advertising held at $15 million.
    Cates exhibited many signs of compulsive gambling, which the American Psychiatric Association first listed as a mental disorder in 1980. At one point, she gambled seven days a week, often not leaving her chair unless she was pulled off and "comped" a free night's stay. She played to chase her losses. She lied, cheated and stole to get money. Often she'd gamble rather than buy insulin for her diabetes. Her husband's weekly paycheck would hit their checking account at 4 a.m. every Friday. By 4:30 a.m., she'd be headed to a casino. By night, the money was gone. She stole her son's credit cards and racked up more than $28,000 in debt, sinking his credit record. Some nights the whistles of slot machines never left her. "When I came home, I could hear that machine, like it was calling me back," she said. The more she lost, the more desperate she became.
    Last fall while buying lottery tickets, she noticed a toll-free number where problem gamblers could get help. She wrote it down but didn't call. Weeks later, over Thanksgiving, police officers came to her home at dawn and took her, still dressed in her nightgown, to the Benton County Jail. She was released after 11 days and faces 13 months in prison. Awaiting trial and on the brink of suicide, she recalled the help line. She remembered the sign posted above the number read: Win your life back. She called from a pay phone, and the hot-line operator told her about the state's treatment program. People were lining up for the program even before it was publicized. Now, there's so much demand that many of the 25 treatment providers trained through the program can't take more clients. "If the state lets the treatment program die, particularly such a small amount of money, it'll be terrible," Hanson said. Cates started treatment in December. "I'm praying that it continues because I need help, and many people need help. ... The urges never go away."

Social Costs
* In 1999, 5 percent of the state's population had gambling problems or had a more severe disorder of pathological gambling during their lives -- a percentage that held steady from 1993. That translates to between 144,600 and 270,900 people.
* Average total cost to treat a problem gambler in Washington: $1,700
* Estimated economic and (i.e., bankruptcy, arrests, health care costs, legal fees): $10,555 over an average problem gambler's lifetime.
* In 2002, gambling was a $1.13 billion enterprise in Washington:
-- Tribal casinos $515 million
-- Card rooms $245 million
-- Lottery $156 million
-- Pull tabs $141 million
-- Horse racing $37 million
-- Bingo $34 million
* Last year, the Washington State Council on Problem Gambling, a non-profit, received $150,000 from the state Gambling Commission, which is funded with fees and licenses from the gambling industry; $622,000 from the state Lottery Commission; and $144,000 from Indian tribes.
* The council's toll-free hot line: 1-800-547-6133, or visit www.wscpg.org on the Internet.

I Feel, Therefore I Am
Emily Eakin, New York Times- 4/19/2003

In the middle of the 17th century, Spinoza took on Descartes and lost. According to Descartes' famous dualist theory, human beings were composed of physical bodies and immaterial minds. Spinoza disagreed. In "The Ethics," his masterwork, published after his death in 1677, he argued that body and mind are not two separate entities but one continuous substance. As for Descartes' view of the mind as a reasoning machine, Spinoza thought that was dead wrong. Reason, he insisted, is shot through with emotion. More radical still, he claimed that thoughts and feeling are not primarily reactions to external events but first and foremost about the body. In fact, he suggested, the mind exists purely for the body's sake, to ensure its survival For his beliefs, Spinoza was vilified and -- for extended periods -- ignored. Descartes, on the other hand, was immortalized as a visionary. His rationalist doctrine shaped the course of modern philosophy and became part of the cultural bedrock. But it seems history may have sided with the wrong man. For more than a decade, neuroscientists armed with brain scans have been chipping away at the Cartesian facade. Gone is Descartes' lofty Cogito, reasoning in pristine detachment from the physical world. Fading fast are its sophisticated modern incarnations, including the once-popular "computational model," according to which the mind is like a software program and the brain like a hard drive.
    Lately, scientists have begun to approach consciousness in more Spinozist terms: as a complex and indivisible mind-brain-body system. And now Dr. Antonio Damasio, the head of neurology at the University of Iowa Medical Center in Iowa City and leading anti-Cartesian crusader, says that Spinoza was right in other ways as well. In particular, Dr. Damasto argues in his new book, "Looking for Spinoza:. Joy, Sorrow and the Feeling Brain" (Harcourt, 2003), the philosopher anticipated one of brain science's most important recent discoveries: the critical role of the emotions in ensuring our survival and allowing us to think. Feeling, it turns out, is not the enemy of reason, but, as Spinoza saw it, an indispensable accomplice. "Science is proving Spinoza more current," Dr. Damasio said over tea his hotel during a recent visit to New York. "He intuited the basic mechanism of the emotions."
    A slight, fine-featured man with elegant manners and a shock of white hair, Dr. Damasio, 58, exudes old-world charm. His conversation is a velvet murmur that hints at his Portuguese roots; his passion is in his hands, which slice the air in quick, graceful movements as he speaks. And these days, his pronouncements carry considerable weight. His theories are technical (he distinguishes between feelings and emotions and talks of an elaborate "body loop "). And in their details they are sometimes controversial. But his reaal emphasis on affect -- or feelings -- strikes most experts as beyond dispute. "His contributions at the human level have been remarkable," said Jaak Panksepp, a neuroscientist and director of Affective Neuroscience at the Falk Center for Molecular Therapeutics at Northern University in Evanston, Ill. "He's done some of the most spectacular brain-imaging work that shows us what emotions are like in the brain."
    In short, Dr. Damasio is at the forefront of what neuroscientists are calling an "affect revolution" that is turning decades of scientific wisdom on its head and, reverberating through other fields as well. "Academics are throwing themes into the study of emotion with the rapturous intensity of a love affair," The Chronicle of Higher Education reported in February, in an article that included a list of 25 recent scholarly books, from philosophy and history to literature and political science, all devoted to affect in way or another.
    And while Dr. Damasio hardly deserves all the credit for this trend, thanks to his breakthrough research and two previous, surprisingly accessible books -- "Descartes' Error: Emotion, Reason and the Human Brain" (1994) and "The Feeling of What Happens, Body and Emotion in the Making of Consciousness" (1999) -- he can take a good deal. He is required reading in literature seminars. Writers like Ian McEwan and David Lodge have acknowledged his work in their novels. He's even inspired a piano concerto, "Body Loops," and a quintet that was given its premiere at Lincoln Center last week..
    "For students of the humanities, the key neurophysiological insight of our time is that which has been so eloquently expressed by Antonio Damasio," declared Jonathan Bate, a Shakespeare scholar at the University of Liverpool in the Times Literary Supplement last December. "The division between reason and passion, or cognition and emotion (an opposition that goes all the way back to Aristotle), is, from a neurological point of view, a fallacy." Dr. Damasio and other researchers, he added, "have brought us close to the possibility of a scientifically verifiable investigation of the hypothesis -- which in various forms has a very long history -- that literature may have been genetically evolved to do cognitive work precisely by stimulating the emotions."
    All the talk about affect marks the demise of a long-upheld scholarly taboo. In the late 19th century, science's leading lights regarded feelings as a natural subject for exploration. Darwin devoted a book to emotional expression in humans and animals, Freud based his theory of mental pathology on unsuccessful emotional repression, and the American psychologist William James weighed in with a body-based theory of emotion strikingly similar to Spinoza's own. But by the early 20th century, science had fallen sway to behaviorism and affect was off limits. Human beings, it was thought, could be understood purely by observing what they did. Internal mental states were dismissed as irrelevant. As Dr. Damasio put it, "Neuroscience gave the cold shoulder to emotion." Feelings, he said, were considered "elusive, indescribable, too subjective."
    When Dr. Damasio began to study affect in the late 1980's, it was by accident, not design. He had moved to the United States from Lisbon in the 1970's to work with Norman Geschwind, a Harvard neurologist and expert on brain lesions. In 1976, Dr. Damasio and his wife, Hanna Damasio, also a neurologist, became professors at the University of Iowa, where he acquired a reputation as' an authority on language, memory and Alzheimer's disease. But it was his work with brain-damaged patients with impaired decision-making skills that led him to wonder about emotions. "I was forced to think about emotions because of those patients with frontal lobe damage," Dr. Damasio said. "They had incredible problems with social behavior that had normally been attributed only to cognitive disturbances. I was very struck by the fact that they had clear disturbances of emotion. I started thinking that emotions might play a role in making decisions and choices in a normal way."
    Typical of his patients was Elliot, a man in his 30's who had suffered frontal lobe damage as a result of a brain tumor. Elliot performed normally on intelligence tests but could no longer make choices, prioritize tasks, manage his time or -- as a consequence -- hold down a job. To make a living, he embarked on harebrained business schemes with shady partners that ended in bankruptcy. Then Dr. Damasio discovered that Elliot was unable to feel. He spoke of the tragic events of his life without emotion. Shown pictures of gruesome accidents and natural disasters, he registered no reaction. When Dr. Damasio tested other patients with similar brain damage he found the same striking combination of impaired reason and impaired affect. When Dr. Damasio presented his findings in "Descartes' Error," the book was greeted as a breakthrough. (An international best seller, it has been translated into 24 languages.) "It's one thing to have a speculative theory about the role of reason and the role of emotions," said Patricia Churchland, a neurophilosopher at the University of California in San Diego. "For the first time, his lab really showed that you can't shut off all the emotions from rational decision-making."
    Neuroscience has since converged around the idea that emotions are central to cognition -- and thus survival. But just why and how remain more open questions. In his second book, "The Feeling of What Happens," Dr. Damasio speculated that emotions and feelings were crucial to the evolution of consciousness and, along with it, a sense of self. In "Looking for Spinoza," he tackles the mystery of how affect works. His theory is both elaborate and counterintuitive, involving a chain reaction that begins when an emotion (defined as a change in body state in response to an external stimulus) triggers a feeling (the representation of that change in the brain as well as specific mental images). In other words, feelings do not cause bodily symptoms but are caused by them: we do not tremble because we feel afraid; we feel afraid because we tremble.
    Still more provocative is his Spinozist conclusion, that the mind's primary focus is the body: "The mind exists for the body, is engaged in telling the story of the body's multifarious events, and uses that story to optimize the life of the organism." Such a notion, he concedes, "departs radically from traditional wisdom and may sound implausible at first glance." After all, he points out, "we usually regard our mind as populated by images or thoughts of objects, actions and abstract relations, mostly related to the outside world rather than to our bodies."
    And despite Dr. Damasio's assurances that he has neurobiology on his side, not every expert is willing to endorse the notion yet. Writing in The New York Times Book Review in February, Colin McGinn, a philosopher at Rutgers University, called the theory "unoriginal" and "false," arguing that it had been thoroughly debunked when William James and another psychologist, Carl G. Lange, introduced it 120 years ago.
    Scientists, however, have been less dismissive. "Damasio's data is very important and very robust," Mr. Panksepp said. "His theory is more controversial. But his approach, by focusing on the nature of body representations of the brain, is essential to make progress on how affective experience emerges in the mind." Most delighted, perhaps, are Spinoza scholars. Heidi M. Ravven, a professor of the philosophy of religion at Hamilton College, said his work prompted her to write a 70-page paper on Spinoza and neuroscience. "I realized everything he said confirmed Spinoza," she said. "I was just jumping out of my skin."

Boys and Feelings
Carolyn Poirot, Fort Worth Star-Telegram- 4/20/2003

"Boys are supposed to shut up and take it, to keep it all in. It's harder for them to release or vent without feeling girly. And that can drive them to shoot themselves," says Scotty, 13. "I think that other boys, like me, hold emotions in. I think they also have difficulty talking about things that bother them. Boys are expected to be tough. They are told to shake it off when they are hurt. They are thought of as being weak when they cry," says Grant, 16. "Most boys don't talk a lot about feelings or try to help each other when they are having hard times. Most boys are afraid to let other people know their real feelings, so they hide their anger and, They don't want to risk having other people make fun of them." "I'm concerned about how people would feel if I told them I was down. They would see me as a guy with problems. It's not a cool thing. It's just not cool to say, `I've got problems. I'm depressed,' "says Michael, 17.
    Scotty, Grant and Michael are among dozens of adolescent boys who speak out for themselves regarding drugs, sex, violence, sports, girls, school, parents and the "Boy Code," in William Pollack's book "Real Boys' Voices." The "Boy Code" is a set of old rules that demand boys to hide emotions like fear, hurt, shame and even compassion. The code makes boys feel ashamed of expressing what might be perceived as weakness or vulnerability. Boys should be stoic, stable and independent, tough and dominant, the code says. "They fear they will be bullied, humiliated, beaten up and even murdered if they give voice to their truest feelings," says Pollack, an assistant clinical professor of psychology at Harvard Medical School and director of the Centers for Men and Young Men at McLean Hospital, an affiliate of Massachusetts General Hospital. "From infancy, boys get pushed into a box. I call it a straitjacket," Pollack said in a recent telephone interview. "Boys are constantly reminded of society's rigid expectations of men: Men should be more aggressive than caring, more macho than emotionally expansive, more dispassionate and adventurous than nurturing and socially connected."
    It's OK for boys to say they are stressed out; it's not OK to admit they are depressed or have problems, says Tracy Underwood, a clinical psychologist who works with children and adolescents in Fort Worth. "When it's excessive, every little thing you do irritates them, like fingernails scratching a chalk board," Underwood told a group of parents meeting recently at a Fort Worth school to discuss Pollack's 1999 best seller, "Real Boys - Rescuing Our Sons From the Myths of Boyhood."
    Pollack has served on the National Campaign Against Youth Violence and is a consultant for the Safe Schools Initiative, a collaborative effort of the Secret Service and the U.S. Department of Education. Pollack worked with young people from Littleton, Colo., after the 1999 Columbine High School shootings and says the "Columbine Syndrome" has made America more afraid of boys and boys more afraid of being male. "Seventy percent of school shooters are boys. In the sample we studied, they were all boys," he notes. " In 93 percent of juvenile homicides, both the perpetrators and the victims are boys. Boys are three to four times more likely to commit a serious crime -- five times more likely to commit a violent crime against another person. Between the ages of 12 and 18, they are four to six times more likely to take their own lives than girls that age." One reason is that boys keep their fears and hopes, depression and dreams to themselves. Boys feel as if they are failing at "being manly" when they share their feelings or ask for love, affection or understanding.

Getting behind the mask
• Honor a boy's need for silence. Timing is everything. Let him choose when to talk.
• Create highly accessible shame-free zones, safe places, programs or regularly scheduled events where he can unwind, let loose, be his real self.
• Connect through activity or play (an activity the boy likes, be it sports, catching frogs or baking cookies).
• Avoid shaming.
• Make brief statements and wait. Do not lecture.
• Share your experiences (if relevant). It lets your boy know he's not alone.
• Be quiet and listen.
• Convey how much you admire and care about him.
• Give him regular periods of undivided attention and listening space.
• Don't prematurely push him to be 'independent'
• Encourage the expression of a wide range of emotions.
Source: "Real Boys' Voices" (Penguin Books, $14)

Teens With Depression on the Rise
Sue Shellenbarger, Wall Street Journal- 4/21/2003

For months, Angela Kimball hid her teenager's mental illness from her co-workers and boss. She slipped quietly out of the office at lunch to tend to school problems and care for her son, who has bipolar disorder. Then, she composed herself and returned to work as if nothing had happened. But after her child, then 13, attempted to hang himself in the basement one evening, she could no longer hide her anguish. Kimball had intervened and saved his life, but at work the next day she lost it. Her boss found her crying at her desk and offered her the day off. She opted to stay, knowing her son was safely under his psychiatrist's care. "Frankly," Kimball, then a bookkeeper for an Internet-design firm, told her boss, "it's a relief" to be away from home for a little while.
    Teens are reporting more serious and complex mental illnesses than ever. A study of 13,257 students at Kansas State University in Manhattan, Kan., found that while the number of college students using the center stayed about the same over the past 13 years, the number seen for depression doubled. Those with suicidal thoughts tripled. Relationship troubles used to top the list of student problems, but now it's stress and anxiety -- more ominous markers of poor mental health.
    Evidence, is growing, too, that many teens' mental-health problems are being neglected by busy, distracted or uninformed adults. In any of the groups of 200 to 300 teenagers periodically screened for mental-health problems by the nonprofit Positive Action for Teen Health, at least one is actively planning to commit suicide that day, says Laurie Flynn of Columbia University's Carmel Hill Center for Early Diagnosis & Treatment, which runs the program at 70 sites nationwide. "When we talk to these kids, they're clearly in great trouble. They're obviously in great pain," says Flynn. "And when we ask, `Why didn't you tell anybody about this? 'they say to us, `Nobody ever asked.' "
    Suicide is the third leading cause of death among 15- to 24-year-olds, after accidents and homicides. Parenting a mentally ill child poses daunting challenges. If you suspect your child is troubled, psychiatrists advise facing the problem squarely. "When you see a change in behavior, that's a red flag," says Harold Koplewicz, head of the New York University Child Study Center and author of "More Than Moody," a book on teens. Watch for altered sleep, social or eating patterns; a plunge in grades; forsaking a beloved hobby; moodiness, irritability, isolation, or an abrupt or marked tendency to avoid adults. To discuss your concerns, focus on the changes in behavior that worry you, rather than making judgements or affixing labels. If your teen resists your efforts to help, keep trying and, of course, seek professional help.

Therapy Helps Whole Families
Tracy Davis, Ann Arbor News- 4/21/2003

Mary Zaman has dealt with her illness for years. But just five months ago, the 63-year-old Ypsilanti resident began attending group therapy sessions that are making that job easier. The sessions were started by the Washtenaw Community Health Organization to help people diagnosed with schizophrenia and other mental illnesses, their families and their friends cope with daily life and better understand one another. The program has gotten such rave reviews -- 90 percent of the participants say they look forward to coming to meetings -- that organizers plan to add several more groups this fall. "It's a wonderful thing and it helps us to be as independent as possible in times of crisis," Zaman said. "Not only does it help us problem-solve, but it gets us together with people with the same diagnoses. It's reassuring to be with people who have similar problems. We understand each other to some extent."
    The groups were started two years ago as part of the health organization's ongoing mission to better integrate physical and mental health care of the medically indigent or those on Medicaid. The organization is a partnership between Washtenaw County and the University of Michigan. The general philosophy of the sessions is to get the consumers and the family members or good friends to come together, said David Neal, associate director of the organization and an assistant professor of psychiatry at the University of Michigan.
    Held separately for people diagnosed with schizophrenia, bipolar disorder and severe depression, the therapy groups meet every other week. When clients and family members begin, they receive information about their condition, their treatment options and the importance of taking their prescribed medication. At the start of a meeting, clients and their families check in with each other to see how people are feeling. That helps develop socialization skills. The group then selects a couple of issues to discuss and find solutions for, such as dealing with substance abuse, anxiety, pain or housing troubles. For example, someone who is feeling afraid or upset comes away from the group with a list of ideas for dealing with those situations. After the space shuttle Columbia broke apart on re-entry Feb. 1, Zaman said she was frightened, but she referred to her list of ideas for dealing with stressful situations. Lying down for a rest or having a glass of warm milk work well for her, she said.
    Another important part of the program is the presence of family and friends at the sessions. "One of the things we hear stories about is 'My relations with my family are so strained I could not have them go to my group.' So they don't have to bring their family members," Neal said. "But by going and listening to other families, and how they feel ... consumers have said, 'I now feel differently about my family; I don't have as much resentment.' "
    Observing the interactions of other family members without the emotional presence of their own parents, siblings or children makes it easier to view issues from other perspectives, Neal said. The same is true of family members listening to the troubles other clients have with their own families. The discussions also help clients understand the impact on families when they fail to take their medications. "To have another consumer sit there and say, 'I didn't think I needed to take them but here's what happened when I didn't.' ... People can accept those kind of things. Consumers are much more likely to take their medications and take them appropriately," Neal said. "We have family members who had no contact with families and now they're meeting outside of these groups as well."
    Kathy Reynolds, executive director of the health organization, said that partnership among the participants is a key part of the therapy. "It's a powerful intervention because it allows consumers to work with other consumers and families to work with other families," she said. "It's a much more powerful interaction than just a therapist working with one client." Reynolds, who has worked in the field for 25 years, also said she can see the success. "I think it's one of the most promising programs or interventions we have implemented in the county in my career," she said.
    Mary Ruffalo, a professor in the U-M School of Social Work who has surveyed participants, also said the sessions are working. "The ... data support that consumers and family members who participate in the groups report improved family relationships and an increased understanding of what it is like to live with the challenges of a mental illness," she said.
    Participants of the program hope that the educational part of the sessions also helps the general public better understand the day-to-day difficulties of those who deal with mental illness. "I hope (coverage of such programs) will help with the stigma associated with mental illness," Zaman said.

Montana Balks at Open Container Law
Associated Press, 4/22/2003

HELENA, Mont.— Montana lawmakers are about to go home for the year without banning open liquor containers in cars and trucks, a decision one activist against drunken driving blames on the state's cowboy culture. "I think there's still perhaps some carry-over from people whose view is their individual rights are being trampled on," said Bill Muhs, president of a local chapter of Mothers Against Drunk Driving.
    According to the National Conference of State Legislatures, 13 states do not have open-container bans that meet federal standards. Muhs said the bans are cheap and effective at reducing drunken driving, but critics have stalled efforts at the Montana Capitol to enact one by raising the specter of increasing police power.
    Republican state Rep. Jim Shockley, who has led the push against a ban, said such a law would be mostly a feel-good measure. He suggested greater enforcement of laws already on the books would do more to curb drunken driving. Shockley also said advocates of tougher restrictions shouldn't try to change Montanans' attitudes about drinking and driving. "It's not their business to change our culture," Shockley said. "If they don't like our culture, they should go somewhere else." Driving is a necessity in Montana, the fourth largest state. Driving 550 miles from North Dakota to Idaho is the equivalent of driving from Portland, Maine, to Richmond, Va.
    Montana's rebellious streak has always been visible when it comes to conforming with federal highway safety demands. More than two decades ago, legislators railed against the federally imposed speed limit of 55 mph by making violations punishable by just a $5 fine. And for three years after the 55 mph speed limit disappeared, Montana drivers were allowed to go as fast as they wanted on most highways, as long as it was "reasonable and proper" based on conditions and traffic.
    Statistics suggest driving in Montana is becoming increasingly dangerous. Montana's highway traffic fatality toll for 2002 at 268 was the highest in nearly two decades, state officials say. Fatal highway crashes involving alcohol have jumped more than 30 percent between the first four months of 2002 and 2003. And Montana remains the only state to flunk a 2002 study of drunken driving laws sponsored by MADD. Officials said it was the first time a state received an "F" since MADD began rankings a decade ago.
    While the Montana Legislature has refused to ban open containers, it did strengthen other laws dealing with drinking and driving this session. It lowered the blood-alcohol limit from 0.10 percent to 0.08 percent and made alcohol tests mandatory for drivers after serious accidents. It also increased fines and jail time for drunken driving convictions. But lawmakers are expected to wrap up the session this week without taking on open containers.
    Muhs said his job always has been tougher than that of counterparts in most other states. After all, he noted, Montana was one of the last states to raise the legal drinking age to 21. "So here we are, the last state to enact some of the most fundamental drunken driving laws," Muhs said.

Is Addiction a Matter of Choice?
John Stossel, ABC News- 4/22/2003

"The United States has elevated addiction to a national icon. It's our symbol, it's our excuse," says Stanton Peele, author of The Diseasing of America. There are conflicting views about addiction and popular treatments. So, we talked with researchers, psychologists and "addicts" and asked them: Is addiction a choice? Publicity about addiction suggests it is a disease so powerful that addicts no longer have free will. Lawyers have already used this "addict-is-helpless" argument to win billions from tobacco companies.
    Blaming others for our "addictions" is popular today. In Canada, some lawyers are suing the government, saying it is responsible for getting people addicted to video slot machines. Jean Brochu says he was unable to resist the slot machines — that he was "sick." He says the government made him sick, and his sickness led him to embezzle $50,000. Now, he's suing the government to restore his dignity and pay his therapy bills.
    Psychologist Jeff Schaler, author of Addiction Is a Choice, argues that people have more control over their behavior than they think. "Addiction is a behavior and all behaviors are choices," Schaler says. "What's next, are we going to blame fast-food restaurants for the foods that they sell based on the marketing, because the person got addicted to hamburgers and french fries?" Well, yes, actually. Two weeks after he said that some children sued McDonald's, claiming the fast-food chain made them obese. They lost the first round in court, but they're trying again.

Uncontrollable Impulses?
"Impulse control disorder" is the excuse Rosemary Heinen's lawyer used to explain Heinen's shopping. Heinen was a corporate manager at Starbucks who embezzled $3.7 million, which she then used to buy 32 cars, diamonds, gold, Rolex watches, three grand pianos, and hundreds of Barbie dolls. In court a psychiatrist testified Heinen was unable to obey the law, and shouldn't be given the seven-year prison sentence she was facing. The judge, however, did put Heinen behind bars, sentencing her to 48 months.
    The "helplessly addicted" defense seemed to work better for the Canadian gambler. The judge gave Brochu probation and told him to see a psychologist. His mother paid back the $50,000 he stole. Now Brochu and his lawyer are seeking $700 million on behalf of all addicted gamblers in Quebec, claiming the government is responsible for getting them addicted, too.

Calling Addiction a Disease
Many scientists say addicts have literally lost control, and that they suffer from a disease. The National Institute on Drug Abuse calls drug addiction a "disease that will waste your brain." This is our government's official policy. And government-funded researchers, like Stephen Dewey of Brookhaven National Labs, tend to agree. They say their studies of addiction in monkeys and rats show that addiction is a brain disease. "Addiction is a disease that's characterized by a loss of control," says Dewey. Dewey takes his message to schools, showing kids brain scans that he says prove his point. He tells students that addiction causes chemical changes that hijack your brain.

Genetic Destiny?
Dewey and other researchers say our genes predispose some of us to addiction and loss of control. Researchers at Harvard University believe they may have found one of those genes in the zebrafish. When researcher Tristan Darland put cocaine on a pad and stuck it on one side of a fish tank, fish liked the feeling they got so much that they hung around the area, even after the cocaine was removed. Then Darland bred a family of fish that had one gene altered. These fish resisted the lure of the cocaine. Darland says this shows that addiction is largely genetic. "These fish don't know anything about peer pressure. They either respond or they don't respond to the drug," he says.
    At the Medical College of Wisconsin, Dr. Robert Risinger scans the brains of human addicts while they watch a video of people getting high on crack. It's what they call a "craving" video. He then shows them a hard-core sex film. The brain scans show the addicts get more excited by the craving videos. The drugs become more powerful than sex — because addiction's a disease that changes your brain, says Dewey. I asked Dewey if he was suggesting that drug users don't have free will. "That's correct," he said. "They actually lose their free will. It becomes so overwhelming." But if they don't have free will, how come so many people successfully quit?

Is the Disease Message Harmful?
Addiction expert Sally Satel acknowledges drug addiction and withdrawal is "certainly a very intense biological process." But she is one of many experts who say the addiction-as-brain-disease theory is harmful to addicts — and wrong. She also thinks it's unhelpful to take away the stigma associated with drug abuse. "Why would you want to take the stigma away?" she asks. "I can't think of anything more worthwhile to stigmatize."
    "People need to get rid of the idea that addiction is caused by anything other than themselves," says James Frey, author of A Million Little Pieces, a book about his experience as an addict. Frey says he took just about every drug, from alcohol to crack. Yet Frey says he wasn't powerless. He scoffs at Dewey's claim that addicts' brains compel them to keep taking drugs. Many doctors agree, saying you can still choose not to take drugs, even if they do cause changes in your brain. "You can look at brains all day," Satel says. "They can be lit up like Christmas trees. But unless a person behaves in a certain way, we wouldn't call them an addict."

Environment and Choice
In fact, some researchers cite experiments that they say prove that addiction is a matter of choice. In Canada, researchers gave rats held in two different environments a choice between morphine and water. The rats in cages chose morphine; the rats held in a nicer environment preferred the water.
    Whether you get addicted also depends on how you're treated. At Wake Forest University, male monkeys lived together for three months, and established a pecking order. The monkeys who'd been bullied by the "boss monkeys" banged a lever to get as much cocaine as they could. But the dominant monkeys, just by virtue of being dominant, had less interest in the drug. "It's just like the human world," says Dr. Michael Nader, who conducted the experiment. "Individuals that have no control in their job show a greater propensity for substance abuse than those that have control," Nader says. These comparisons suggest that addiction is a choice — not a disease that takes away free will.
    The message from the treatment industry is that drug users need professional help to quit. What they seldom say is that people are quitting bad habits all the time without professional help. In fact, some studies suggest most addicts who recover do so without professional help. For example, during the Vietnam War, thousands of soldiers became addicted to heroin. The government tracked hundreds of soldiers for three years after they returned home. They found 88 percent of those addicted to narcotics in Vietnam no longer were.

Quitting Is the Rule, Not the Exception
Even tobacco companies now admit nicotine is addictive, but does that mean it really denies smokers' freedom? You seldom hear about those people who just quit … on their own. No one's saying it's easy to quit. But it may surprise you that quitting is not the exception, it's the rule. Most people who've used heroin or cocaine have quit. Since 60 percent of smokers have quit — that's 50 million Americans — it seems obvious that people do have free will.
    But the drug research establishment insists most addicts are enslaved, that they don't have free will. Dewey says just because 50 million people have quit smoking doesn't mean that an addiction to smoking isn't a disease. Yes, it does, says Schaler. Schaler also says the use of the word "disease" is important, particularly in terms of the money "addicts" are spending to get help. "If you say it's a choice not a disease, well then insurance companies may not reimburse for that. … If you say it's a choice, then the tobacco companies may not be slammed for millions of dollars."

Treatment Trap?
Some experts say the treatment industry is taking advantage of people in desperate situations. "We're selling nicotine patches, we're selling the Betty Ford Center. We tell people, 'You can never get over an addiction on your own. You have to come to us and buy something to get over an addiction.' It's not true, and it's dangerous to tell them that," says Peele.
    Former addict Frey agrees. His parents did pay for him to go to the expensive Hazeldon Treatment Center, but Frey says he didn't buy into the messages the center offered in counseling and therapy. "I stopped because I have my own 12-step program and the first 11 steps don't mean [expletive] and the 12th is don't do it. And I didn't do it." Frey and other former addicts say choosing is what it takes, making that decision. "You can't tell people, 'This is all you're fault and there's nothing you can do about it,' " says Frey. "You have to tell them, 'This is all your fault and you can make it all better if you want to.' " Frey says he still gets drunk. Now he just does it differently. "I get drunk on walking my dogs, I get drunk on, you know, kissing my wife. I get drunk on a good book. Getting drunk is just doing something that feels good."

Web Resources
National Institute on Drug Addiction: http://www.drugabuse.gov/NIDAHome.html
National Institutes of Health: National Institute on Alcohol and Alcohol Abuse: http://www.niaaa.nih.gov/
Dr. Sally Satel: http:// www.aei.org/satel
Stanton Peele: http://www.peele.net/
Dr. Jeffrey Schaler: http://www.schaler.net/
Brookhaven National Laboratories: http://www.bnl.gov/pet/studies.htm
Dr. Stephen L. Dewey: http://www.chemistry.bnl.gov/SciandTech/BCIN/PET/dewey.htm
Medical College of Wisconsin Functional Imaging Research Center: http://www.firc.mcw.edu/
Dr. Michael Nader, Wake Forest University School of Medicine: http://www.wfubmc.edu/physpharm/faculty/nader
Harvard researcher Tristan Darland: http://www.pnas.org/cgi/content/full/98/20/11691
"What works? A summary of Alcohol Treatment Research," Reid Hester, William Miller: http://www.behaviortherapy.com/whatworks.htm

12 Step Programs
Alcoholics Anonymous (AA): http://www.alcoholics-anonymous.org/
Narcotics Anonymous (NA): http://www.na.org/
Cocaine Anonymous (CA): http://www.ca.org/
Debtors Anonymous (DA): http://debtorsanonymous.org/
Gamblers Anonymous (GA): http://www.gamblersanonymous.org/
Overeaters Anonymous (OA): http://www.oa.org
Nicotine Anonymous: http://www.nicotine-anonymous.org/
CoDependents Anonymous (CoDA): http://www.codependents.org
Sexaholics Anonymous (SA): http://www.sa.org
Sex & Love Addicts Anonymous (SLAA): http://www.slaafws.org

Non 12-Step Support Programs
Rational Recovery: http://www.rational.org/
Smart Recovery: http://www.smartrecovery.org/

Thousands Give Up Children to Get Mental Illness Care
Shankar Vedantam, Washington Post- 4/22/2003

Thousands of American parents are turning their children over to social workers or the police because it is the only way for the children to receive treatment for mental illnesses, a national report concluded yesterday. More than 12,700 children were placed in the child welfare or criminal justice systems in 2001, the General Accounting Office said in the first attempt by the federal government to assess the scope of the problem.
    And that number may be a small fraction of the actual total: The GAO report said 32 states, including the largest five, did not provide data on how many children with mental illness were sent to child welfare agencies to receive treatment, largely because the information did not exist. Data on the number who ended up in the criminal justice system were based on just 30 counties nationwide. Neither the states nor the federal government has systematic data about the extent of the problem. As a result, smaller states and counties accounted for the largest numbers in the report. Minnesota reported 1,071 cases of children being placed with child welfare services to get treatment. Although Pima County in Arizona said 1,750 children had been placed in its juvenile justice system for this reason, Philadelphia counted 500. Los Angeles provided no estimate.
    Parents took these drastic steps because they were unable to cope with their mentally ill children or because of the cost of care, insurance problems or lack of access to services, the report said. Outpatient treatment can run as much as $100 a day, and residential inpatient care can exceed $250,000 a year. But many private insurance companies do not offer coverage for mental illnesses that is comparable to that for physical ailments -- an imbalance that President Bush and some in Congress have vowed to end.
    "This is a real tragedy," said David Fassler, a child and adolescent psychiatrist in Burlington, Vt. "Families should never have to give up custody of a child in order to receive critical mental health services. As a society, we are letting our kids down." The problem apparently affects families from a range of financial backgrounds, and adolescent boys were the ones most frequently turned over to social workers or the police, largely because they "exhibited behavior that threatened their safety and the safety of others." Fassler said adolescent boys with mental illnesses are more likely to "act out," and adolescent girls with similar conditions tended to "act in" and become withdrawn. Appropriate evaluation and treatment, he said, could control the risk of such violent behavior in children with mental illness.
    The GAO said families with mentally ill children reached the crisis point through a variety of circumstances: One Kansas family reported that three children in the home had refused to live with their brother, who has bipolar disorder, or manic depression, because he "is very aggressive, and has molested other children in the past." An Arkansas woman reported having to quit her job because she had to care full-time for a sick grandchild. And a Maryland family with a child who was both developmentally disabled and mentally ill found that facilities for developmentally disabled children turned the boy away because of his mental illness, while facilities that served the mentally ill rejected him because of his disability.
    "There are services in short supply, and there are difficulties in eligibility for different programs," said Diana Pietrowiak, one of the authors of the GAO report. "For example, Medicaid officials in three states said some children lose eligibility because their family's income increased beyond the threshold," and families can't afford the care on their own. Sometimes, she added, mentally ill children are shunted in and out of treatment as the family's income fluctuates and the children acquire and lose eligibility for Medicaid coverage.
    Budget crunches in states are almost certainly making the problem worse. The report noted that New Jersey has limited the number of children who need the highest level of care to 180 a year. But juvenile justice officials in the state estimate that at least 500 children under their supervision need such care. There is also a chronic shortage of highly trained child psychiatrists as a result of low rates of reimbursement and insurance coverage, said Rep. Patrick J. Kennedy (D-R.I.), one of the members of Congress who asked the GAO to conduct the study.
    Kennedy, Fassler and others said that more efficient use of existing resources, such as matching children with less critical needs with less expensive providers, could help keep families out of crisis. So could better prevention efforts. "Most of our mental health system is based on the crisis management model," Kennedy said. "The real challenge in bringing the costs down and to be more effective is to do more prevention and early intervention as well as more community-based support services."
    The GAO report found that communities that were able to lower the incidence of mental illness and keep troubled children and families intact were those that focused on prevention and flexibility. In Shawnee County in Kansas, the Children, Youth and Families Resource Center offers psychological, medical and emotional services under one roof. A program called "Success by Six" helps children before they reach school age. Social workers visit newborns in hospitals, screen families at risk and conduct home visits. "Getting rid of turf battles and the feeling of we're all in this together leads to a different organization," said Brenda Mills, chief executive of the center. Still, she said, coming budget cuts may hurt prevention programs. "Dollars are getting squeezed, and they are pulling dollars away from things that are working."

 Tapping Away Stress
Amy Whitesall, Ann Arbor News- 4/23/2003

Bronwen Gates will try just about anything this side of bungee jumping, and when a therapist friend offered to teach hero self-help tool called Emotional Freedom Technique (EFT), Gates was eager to learn. But it was what she experienced that day that made her eager to teach. "It was very powerful for me because I can be skeptical, despite what some people might say," Gates said. "I'm not a pushover. It has to work" EFT helps people unload negative emotions and ease physical symptoms without needles, drugs or discomfort. Unless looking silly makes you uncomfortable, that is. But many find the benefits are worth a few self-conscious moments of tapping, humming, counting and eye-rolling.
    One part of the EFT sequence involves repeating an affirming statement. The commonly used default goes like this: "Even though I (fill in the blank with the thing you want to overcome), I deeply and completely accept myself." The first time she tried it, Gates chose to target her lack of self acceptance, making her statement, "Even though I don't accept myself, I deeply and completely accept myself."
    When they started out, Gates says, she would have rated the intensity of that feeling at a nine or 10 on a scale of 1-10. They tapped through the sequence three or four times, and as the negative feeling got less and less intense, Gates got more and more drowsy. "So much tension had been created by this lack of acceptance," says Gates, who could barely keep herself awake to drive home. "I really knew this was powerful stuff.
    Gates, a longtime Ann Arborite who now lives in Hamburg, has been leading monthly workshops in EFT since October. EFT is part of a field of healing called energy psychology. Practitioners say it opens up the body's energy system and the negative emotions -- blockages for the system --just go away. If you're comfortable with the idea of the body as a system of energy, that's easy to get your mind around. But if it all sounds too holistic for you, don't worry. EFT can be explained in simple physiological terms. Though it's still experimental and few local mainstream health providers know about it, there's a small and growing body of research on it. Besides, one of the things that makes EFT attractive, Gates says, is that you don't have to believe in anything.
    It may help to think of EFT as the intersection between acupuncture, psychology and basic human physiology. It's a way of relieving stress by rubbing or tapping on a series of points on the face, chest and hands while focusing on the thing that caused the stress in the first place. Many of the tapping points, in fact, are spots--like the temples or the bridge of the nose --that we instinctively rub when we're stressed.
    The rubbing or tapping stimulates the body chemistry that neutralizes the stress response, teaching the body a new way to react to that stressor. Whether the negative emotion disappears completely right away or in degrees, with each repetition, practitioners say the change is usually immediate and often permanent. The routine takes just a few minutes, and once people are taught the technique, they .can perform it on themselves whenever they need. it.
    Gates stresses that EFT doesn't fix everything, but also that there seems to be no harm in trying it on just about anything. It can help with issues ranging from post-traumatic stress disorder to weight loss to pain management. Metapsychologist Marian Volkman, who's done trauma resolution work for more than 30 years, says it's great for neutralizing phobias. It doesn't replace doctors or psychiatrists, but those who use it say it's a simple way to cut loose some emotional baggage.
    "It's awesome," says Ed Donnan, a friend and client of Gates. Donnan decided to try to apply it to an addiction that had been part of his life for 20 years. "I stumbled on to the topic." he says. "It was interesting to me, but I thought `This can't work. It's just too simple.' Then I went and did some work with Bronwen, and it was on stuff that was fairly big to me, stuff I'd been hanging onto. It helped an enormous amount. If 10 was the worst, it's now like a one, maybe a half. The craving is gone; there's not a need for it any more." Donnan, an auto industry sales consultant, has used EFT to help get himself through tense business situations, going into the bathroom for a few minutes to tap away his fear of letting people down and emerging calm and in control.
    Gates' clients and students range from the thoroughly open-minded to the fairly skeptical. She encourages the latter to lighten up a little. The information isn't meant to be threatening. "What I'm doing is teaching you the technique so when you leave here you can use it," she says. "If you don't like some of what I say, leave it. It's just like any class."
    One of the reasons some people have a hard time taking EFT seriously may be that it looks goofy. A round of EFT may only take a few minutes, but that time is spent tapping on different parts of the face, chest and hands, repeating the affirming statement mentioned above, counting, humming and making a series of eye movements. "It's pretty hard to wrap your wits around," says Volkman, who uses EFT with some of her clients. "I tap along with them so they can see where I'm tapping. That makes it easier for them and they feel less stupid. It makes them feel more comfortable."
    Volkman says the downside of EFT is that it works so quickly that the client may never get at the underlying stuff that caused the negative emotions. But she says in some cases it's a really good fit. When one woman -- who could only afford a single one-hour session -- came to her for help with a test anxiety that threatened to derail her career plans, EFT did the trick. In fact, they laid the test anxiety to rest in half an hour. The woman, Volkman says, went on to pass her nursing boards and get on with her life.
    The quick-fix aspect adds to some people's skepticism, but Volkman points out that if it doesn't work the client hasn't invested much time, and if it does they walk away feeling empowered "You take a pill and it makes the pain go away, ' and that's pretty easy," says Caterina Donnan. "I'm sure there was a time when people were skeptical about that, too."

Next EFT workshops
• Where: Parkway Center, 2345 South Huron Parkway
• When: May 19,63"30 p.m./ June 14,1:30-4:30 p.m.
• Cost: $40 ($20 deposit holds your place)
• More information: (734) 424-2744

For information online
• www traumaheal.com - Judith Swack, immunologist and proponent of energy psychology. Offers a more scientific look at EFT.
• www.emofree.com - Gary Craig, widely recognized as the founder of EFT. Includes a free downloadable manual.
www.eftupdate.com - Patricia Carrington, psychiatry professor with expertise in stress management.

Lawsuit on Products Kids Can Inhale to Get High
ABC News, 4/23/2003

"Huffing," popular among some teens and pre-teens, is the practice of inhaling chemical substances — such as glue, paint or paint thinner — to get high. Sometimes children will put products like fingernail polish remover or cement in a bag and inhale it. The practice can be deadly, said Dr. Drew Pinsky, an addiction expert and ABCNEWS consultant. "There is an acute danger with this behavior, something called sudden sniffing death syndrome, where the circulating levels of adrenaline can sensitize the heart and people can die suddenly," Pinsky said. Some people have also had suffocating experiences from huffing. Chronic huffing can also dissolve parts of the brain, Pinksy said. The National Inhalant Prevention Coalition gets reports of about 100 to 125 deaths a year caused by huffing, but many parents do not realize that common household products can be dangerous to their children.
    The JFK Center for Civil Rights has asked a California judge to order the national chain stores to change their business practices and repay the money that came from sales of products to minors that could be used for huffing. The center sent out minors to several stores in suburban Los Angeles to see if they could buy paint thinner. "We found out that actually none of the retailers that we looked at were doing anything to enforce that law," said the JFK center's attorney, Oscar Valencia. "No child was ever asked for an ID. As a a matter of fact, one particular store put a happy face on a child as old as 10 years old who purchased a product, paint thinner, and on the first sentence on the back of the can is a warning." The manufacturer's warning is that the product contains toluene, which is potentially deadly to these kids, he said. The suit, filed April 11 in Superior Court in San Bernandino, Calif., alleges the retailers are violating a 1979 California law that forbids selling products that contain toluene to minors. Toluene is a common industrial solvent found in inks, paints, lacquers, resins, cleaners and glues.

Sold, No Questions Asked
Jeff Wynton, executive director of the JFK Center for Civil Rights, said that he acknowledges that the law can be difficult to enforce, given that potentially dangerous products are sold at drug stores, as well as home improvement stores. But, stores should have a button on their registers, just as they do for cigarettes, to confirm that they have checked IDs before the purchase of such items is completed, he said. "It's a simple measure for them to take when they enter the product in their inventory," Wynton said. "They put a command in their program that when it's scanned, it says check ID. They do that with cigarette and alcohol purchases. This product is harmful to kids, and this law has been on the books for 20 years."
    Home Depot spokeswoman Kathryn Gallagher said the chain has procedures to prevent the sale of some of the store's 35,000 products to minors. For instance, spray paints are in a cage, and cashiers who scan those particular items receive a prompt telling them to ask the buyer for identification to prove their age. The company also said that clerks are told to check identification and not sell the products to children. Lowe's and Target representatives had no immediate comment. "I'm surprised Home Depot is saying this, because we looked at various stores and not one store checked the child's ID," Valencia said.

Repeated Use Can Cause Brain Damage
Pinsky said there are two groups of products that children can abuse to get high. One is aerosols, such as spray paint and hairspray. The second is solvents such as gasoline, lighter fluid, nail polish remover, model airplane glue, spot removers or typewriter correction fluid. Inhalants are not addictive, but people tend to abuse them. "Even huffing one time can potentially kill," Pinsky said. "For instance, kids have died from huffing in cars when all the oxygen was depleted in the car. Others have died after huffing in a pool and drowning. But repeated use can cause brain damage as well as learning disabilities and memory problems." Laws to try to prevent huffing do not seem to work, and locking up the products at home is not realistic, he said. "Educating kids and close parental supervision are the better answers," Pinsky said. Parents who are worried that their children are huffing should look for the following signs: rashes around the nose and mouth; red, glassy eyes; recurrent upper respiratory problems; passive-aggressive/ irritable behavior; sudden decrease in personal hygiene; and intense mood swings.

Michigan Chided on Mental Health Services
Laura Potts, Detroit Free Press- 4/23/2003

Michigan makes it difficult for mental health patients to get their medication. The state also makes it hard for patients and their advocates to understand their managed care rights. And the state does little to prohibit or discourage insurers from charging higher fees or restricting mental health services in comparison to physical health care. Those are the three areas where Michigan received "F" grades and ranked last among all states and the District of Columbia, according to a national mental health study being released today. The State Mental Health Assessment Project evaluated state policymakers' work in mental health services. It was conducted by the National Mental Health Association (NMHA). Marcie Lipsitt, whose 14-year-old son has bipolar disorder, wasn't surprised at the study's findings. "Because we continue to segregate illnesses in the brain, they aren't quite worthy of the same medical treatment," she said. "What's in place isn't even close to sufficient."
    The state is working with advocates and the state Legislature to improve the areas outlined in the study -- mental health parity, managed care protections for patients and access to medications -- said Geralyn Lasher, spokeswoman for the Michigan Department of Community Health. But, she added, "in the overall field of mental health, there are many areas where Michigan would be at the top of the list," compared with other states. One such area would be emphasizing community-based care, she said. The purpose of the study was to "really raise public awareness about the lack of investment and prioritization in mental health services," said Erica Malik, program director at the NMHA.
    The assessment project is the first such study by the NMHA and began in September 2000 with a grant from the W.K. Kellogg Foundation's Community Voices project, which seeks to open a national debate about health care access and quality. The NMHA gathered data and based its grades on the three categories. The study's sources included the National Conference of State Legislatures; the Kaiser Commission on Medicaid and the Uninsured; the Judge David L. Bazelon Center for Mental Health Law, and the American Psychological Association. Michigan is not among the 33 states that prohibit or discourage higher fees or more restrictions on mental health services than on physical health care.
    Both Gov. Jennifer Granholm and Janet Olszewski, director of the Michigan Department of Community Health, have said they support mental-health parity laws, and Sen. Bev Hammerstrom, R-Temperance, has introduced legislation to achieve parity. Mark Reinstein, president and CEO of the Mental Health Association in Michigan, an affiliate of the national association, said such new laws would "end one of the last major forms of socio-economic discrimination that is legal in this state." In the two other categories -- managed-care protections and access to medications -- Michigan has made some progress, Reinstein said, but still has a long way to go. The state's medical prior-authorization program often produces lengthy waits for Medicaid patients who need prescription drugs to treat things such as schizophrenia. Michigan's safety net for patients who are dissatisfied or harmed because of inadequate health care coverage also is lacking, according to the study. Reinstein said if patients are "dissatisfied with their care and treatment, at some point in time they should have the opportunity to take that concern outside" the state health care system. Michigan's Patient's Bill of Rights provides protection, Lasher said. But she said the state is trying to do a better job of making sure patients know what rights are available to them.
    Lipsitt of Franklin said people with mental illness should be afforded the same rights and benefits as those who have ailments such as heart disease and diabetes. "I simply want my son and others to live the best quality of life they can have." Elizabeth Boyd, the governor's spokeswoman, said "the commitment is there" to improve mental health care in Michigan. Meanwhile, Reinstein said, "I hope it's a call to action, that it tells everyone with any interest in this issue that we've got a tremendous amount of work to do. The situation is beyond critical here."

Sufferers of Hair-Pulling Disorder Speak Out
ABC News, 4/25/2003

"My head is ugly. Think of an 80-year-old man with no hair — that's what I look like," said Recob. At 19, Recob is smart and athletic, but the college junior just can't stop pulling out her hair. She suffers from trichotillomania, "trich" for short. Recob has never shown her head to anyone outside her family and says she never will. As odd as Recob's case may sound, it is not rare. An estimated 4 million women and 2 million men across the country are doing this to themselves. Recob says she can go only two or three days without pulling her hair. "I don't understand it. I don't understand why I pull my hair out. It's not my fault. I don't do it on purpose. If I could stop I would," she said.

A ‘Body Focus Disorder’
Doctors aren't sure what causes trichotillomania. It usually starts in early adolescence. Researchers speculate that it's caused by a grooming gene gone berserk. Despite what it looks like, it's not self-mutilation, it's not triggered by trauma, and because there are no obsessive thought patterns involved, it is not considered an obsessive-compulsive disorder. Instead, trich is a "body focus disorder," similar to severe nail biting or extreme skin picking. The condition is chronic and there is no cure.
    Recob has tried everything she can think of to quit — from wearing stocking caps to bed at night or mittens on her hands to drug therapy. "I was on Anafranil, BuSpar, Luvox, Neurontin, Ambien, Zoloft, Prozac," she said. Sadly, none of it worked. Doctors believe, for some people, a combination of antidepressants and behavior modification can help. But for some patients, like Recob, these therapies simply do not work.

Pleasure, Pain and Shame
The relentless, uncontrollable urge to pull has a profound effect on people's lives. "The emotional impact is very deep. People feel very ashamed of their pulling," says Jennifer Raikes, who suffers from a relatively mild form of trich and has made a documentary film, Bad Hair Life, about the disorder.
    Filming a support group she helped form, Raikes captured a startling glimpse into the hidden world of trich. "I can't explain it to you, I can only show it to you," said one woman in the group, weeping as she removed her wig. "At various times," Raikes said, "I pulled all my eyelashes out and most of my eyebrows. It started as a game, actually. I was pulling my eyelids away from my eyeball. It made a sucking noise. I was just playing and an eyelash came out. And I guess I was intrigued by that. It felt good."

A Maddening Compulsion
"Some people get a distinctly pleasurable sensation at the moment they pull. It's kind of a pleasurable pain," said psychologist Fred Penzel, author of The Hair Pulling Problem: A Complete Guide to Trichotillomania. Penzel has worked with hundreds of sufferers and says whatever pleasure is derived, is immediately replaced by regret and shame. "I've heard people refer to themselves as freaks," said Penzel. "'I'm disgusting. Who would ever want me? Who would ever have anything to do with anybody who's as crazy as I am?' " Trich sufferers are not crazy, Penzel said. But for some people, the inability to stop nearly drives them mad.
    Mandi Line said her compulsion drove her to thoughts of suicide. "There are definitely points where you want to die," Line said. "I didn't hate my life, but I thought, 'Well, God, if I'm not alive, then I don't pull my hair.' " Line was a child model, homecoming queen and beauty pageant contestant. But her modeling days were cut short due to trich. "I was supposed to go to Miss Teen California and then I was set back by my hair," she said, adding, "Who's going to come out in the swimsuit category with a headband on?"
    Line, who is now a wardrobe stylist in Hollywood, is a stunning young woman, but she says her compulsion has gotten worse. The night before her interview with 20/20's JuJu Chang, Line said she spent several hours in her room pulling out her hair. She described her ritual to Chang: "There are certain spots that I pull from, and I go there, and I get it, and you can like hear … the popping of it pulling out. … I do it so fast now though. I pull it out, bite it. Pull it out, bite it. I don't swallow anything, but I bite the root, and make this popping noise. I have no idea why."

Sufferer Confronts Her Fear
Line says she has told some friends and co-workers about her disorder, but she's never been able to bring herself to expose her uncovered head. She decided to show 20/20 because, she said, she wants to confront her fear of ridicule and stop hiding. "I'm just so sick of nobody knowing what this is," she said. Despite her desire to show the world the physical effects of her hair pulling, intense feelings of shame nearly overpowered her resolve to show us. She cried, but she didn't back down.
    Line has sworn off all drugs and therapy to deal with her compulsion. She says she's finally learned to accept herself, hair or no hair. She says the most rewarding part of her journey has been the chance to be a role model at a summer camp for girls suffering from trich. Line tries to comfort and encourage girls struggling with this compulsion. She said she wants young girls with trich to know it's still OK to be confident: "You don't have to be quiet and not talk to people because you think that you're ugly. You can still be cool and have no hair."

Massachusetts Detox Centers Feel State Fiscal Crunch
Brenda J. Buote, Boston Globe- 4/26/2003

Christina Whitley is out of bed for the first time in three days. She's watching coverage of the war in Iraq on a small television in a Danvers detox center. This is her third trip to rehab in as many years. Twice before, she has tried to stay clean. Twice before, she has failed. "I'm hoping things will be different this time, you know? But who knows what will happen once I leave," said Whitley, one of the thousands of patients who lost her Mass Health Basic insurance benefits on April 1. Her stay in detox is being funded by taxpayer dollars, with monies from the state Department of Public Health.
    Whitley, who is a patient at CAB Health and Recovery Services Inc. in Danvers, is among the few fortunate enough to receive care after losing her publicly funded health insurance coverage. On April 1, some 36,000 low-income residents lost their Mass Health Basic benefits. And taxpayer dollars now being used at CAB Health, the region's largest drug-treatment agency, and other treatment centers to help the poor and uninsured will run out next month.
    Whitley's three-year heroin habit has wreaked havoc on her body and her life. Her job and home are both gone, lost to her addiction. Her former fiance, an iron worker, is now just a friend, a shoulder to cry on when things get tough. They broke off their engagement last summer, shortly after Whitley botched an attempt to stay off drugs. "I'm just tired, tired of using and tired of losing everything that means anything to me," said Whitley, 31, who got addicted to opiates after a skiing accident. A doctor had prescribed Percocet to help Whitley cope with the pain of a torn ligament in her right knee. When the prescription ran out, Whitley started using Oxycontin, then heroin.
    Whitley spoke last week in an interview at CAB Health. The agency expects to admit about 3,000 patients this year, half the number admitted last year, said Kevin Norton, president and CEO of the agency. Norton noted that CAB Health this month reduced the number of beds at its Danvers inpatient detox center from 71 to 30. And, like other detox centers across the state, CAB Health also eliminated altogether its second-stage, step-down program, which provided counseling and recovery services for patients like Whitley following their discharge from the detox center.
    The state's fiscal woes, coupled with the Mass Health cuts, have had a devastating impact on drug treatment services for people suffering with addiction and struggling toward sobriety, Norton said. The cuts at CAB Health were made April 1, after Governor Mitt Romney slashed funding for second-stage substance abuse treatment programs halfway through the fiscal year. As a result of those cuts, the nearly 1,000 beds that were available at detox centers statewide in January have been reduced to about 560. In the coming fiscal year, which begins July 1, that figure will drop to about 420 beds, according to officials at the Massachusetts Department of Public Health, meaning that fewer than 60 beds will be available in the suburbs north of Boston. "Because of the state's current financial emergency, the choice was made to preserve the medically necessary beds, so what you're seeing eliminated is the step-down program," said Roseanne Pawelec, spokeswoman for the state health department.
    In the absence of such step-down programs, Norton and other experts warn that emergency rooms and community health centers will face increasing demands for substance abuse treatment services, and crime and needle-transmitted diseases will climb. "The wait time in our emergency rooms has already increased dramatically because of the unavailability of substance abuse treatment beds," said Kenneth J. Sklar, administrative director of psychiatry and mental health services for North Shore Medical Center, which operates Salem Hospital in Salem and Union Hospital in Lynn. "We have a limited capacity for inpatient detox services -- only four beds on a medical floor at Salem Hospital, and those beds are often filled. With the lack of available treatment, the ER becomes a revolving door for individuals who need care and are not receiving care."
    By the time they seek help, most addicts are destitute. Like Whitley, they have lost their jobs and the support of friends and family. Few can afford private treatment or carry health insurance. Last year, only 3 percent of CAB Health's patients had private health plans, Norton said. "For the most part, the patients we see have health insurance of one kind or another," said Samuel M. Migdole, director and CEO of the North Shore Counseling Center in Beverly, which operates an outpatient substance abuse program. "In the past, if someone came to us without insurance, we would refer them to CAB Health or the hospitals, but now, with the cuts to Medicaid and the lack of detox beds, the question is, What do we do with them? We try to help them when we can, and adjust fees when we can, but we depend on fees to operate."
    Betty Funk, president and CEO of the Mental Health and Substance Abuse Corporations of Massachusetts, estimated that as many as 15,000 people will lose detox coverage in the coming months as a result of the governor's spending reductions, coupled with cuts to Mass Health Basic made by the Legislature last year and the looming loss of Medicaid dollars in fiscal 2004. "We're working to try to get a new minimal benefit created that would cover these support services," said Funk, who is laboring on behalf of the statewide trade association, whose members are the primary providers of mental health and substance abuse services in Massachusetts. "It's our top priority."
    If the Legislature fails to reinstate funding for second-stage care, many people suffering with drug or alcohol addiction will relapse, according to James Q. Purdy, vice president of inpatient behavioral health for the Northeast Hospital Corporation, which manages Beverly Hospital in Beverly and BayRidge Hospital in Lynn. Both hospitals provide behavioral health services, which incorporate mental health and substance abuse treatment. "When support services are lost and these folks lose their benefits, they leave detox and then show up in the emergency room, in much worse shape and in need of more intense services," Purdy said.
    Advocates said the decision to pare treatment services could not come at a worse time. In the past 10 years, heroin has become more potent and more popular. In 2000, there were 363 overdose-related deaths in Massachusetts, up from 94 in 1990, according to figures compiled by the state Department of Public Health.
    At CAB Health last week, Whitley was trying to figure out what she would do once she was discharged from the detox center. Would she try to find a bed at an area homeless shelter or crash with a friend? "I want to get into an outpatient treatment program so that I can live my life without using," said Whitley. "Get a job. Maybe get married. I'd like to get my boyfriend back, but the more time that passes, the less chance I have."