Men and women benefit emotionally from being together, whether they are married or cohabiting. And both have problems after a split, British researchers say, but there are some surprising differences. "One of the most striking findings is that cohabiting seems to be beneficial to men's mental health and less beneficial to women's mental health," says lead researcher Dr. Stephen Stansfeld, a professor of psychiatry at Queen Mary University of London.
     The findings are reported in the current issue of the Journal of Epidemiology and Community Health. Stansfeld's team studied the responses 4,430 men and women under 65 gave on a mental-health questionnaire. The subjects took part in the annual British Household Panel Survey, a survey launched in 1991 that compiles information from 5,000 British households and 10,000 adults.
Researchers found that women who stayed single all their lives seemed to have rather good mental health, while men who stayed single all their lives did not. "Choosing to be single seems to be good for women," Stansfeld says, "but not so good for men."
     In addition, he says, the breakup of a marriage -- particularly of several marriages -- seemed to be more damaging to women's mental health. The researchers found that men who broke up with their first partner, whether they had been married or living together, had poorer mental health compared with men who had stayed with their first partner. But men who cohabited with a new partner after a divorce had better mental health than did men who had stayed single or remarried. Women who had stayed with their partners, whether they had been married or living together, had better mental health than did women who had not. However, the more breakups they had experienced and the more subsequent relationships they had had, the more their mental health deteriorated. Stansfeld speculates that this may be because women who go through several relationships may suffer feelings of low self-worth.
     While long-term relationships were better for the mental health of both sexes, men who married did significantly less well emotionally than did those who simply lived with their partners. However, women did better emotionally if they married. Of all those surveyed, women who remained alone after divorce had the worst mental health, as did women who remained alone after breaking up with a live-in partner. In addition, Stansfeld's group found, women took longer to recover from an ended relationship than did men.
     The difference between men and women in their reaction to cohabitation may be because of women wanting more security in a relationship, Stansfeld says. "In cohabiting," he says, "there isn't as much security as implied by marriage. "On the whole," he adds, "women are probably better at looking after themselves than single men. Men tend to rely on one person, usually their spouse, while women tend to have a wider circle of friends and a broader social network."
     Kelly Raley, an associate professor of sociology at the University of Texas in Austin, questions some of the research's conclusions. "This study does not adjust for the fact that people with better mental health are probably more likely to stay partnered," she says, "and to repartner, given that they split. These associations cannot be interpreted as proof that marriage or cohabitation causes good mental health." Raley says that she's "not sure that findings established from a British population translate to what people experience in the United States."
     Dr. David Katz, an associate clinical professor of public health at Yale University in New Haven, Conn., thinks the study contains some valid conclusions. "In terms of basic biology," he says, "men are clearly more disposed to sequential relationships than women. . . . Women do not benefit from this kind of instability biologically, and are best served by long-lasting, stable relationships." Katz adds: "This research shows that what biology would predict, psychology and sociology corroborate."

Blame Biology, Not Parenting, New Anorexia Theory Suggests
Ellen Ruppel Shell, Boston Globe- 1/2/2004

     Anorexia, the most lethal of psychiatric disorders, afflicts as many as 1 percent of young women and about a tenth as many men, and casts a Svengalian spell, leading its victims to willingly starve themselves in the midst of plenty. Now, psychologist Shan Guisinger has developed a radical new view of anorexia that she says explains both the bizarre features of the illness -- self starvation and hyperactivity -- and its resistance to treatment by traditional psychotherapy. Anorexia, she contends, is not primarily a psychological condition brought on by a troubled childhood -- as is often thought -- but a disorder based in biology, specifically in the appetite regulation mechanism in the brain. Her theory postulates that anorexics have a biological adaptation to weight loss that causes their bodies to shut off hunger signals, and to ratchet up physical activity, even as their flesh melts away. "Anorexics are often told to stop dieting, to listen to their body and to give it what it wants," Guisinger said. "But the reality is that they are listening to their bodies, and their bodies are telling them not to eat. The truth is, they have to stop listening."
     Guisinger, who has treated eating disorders in private practice in Missoula, Mont., for nearly two decades, trained in evolutionary biology in the late 1970's before getting a doctorate in clinical psychology at the University of California at Berkeley. This background, coupled with her upbringing on a farm in Washington state, convinced her that Freudian and other purely psychological explanations for anorexia were inadequate.
"We sometimes forget that humans are animals first," she said, describing her theory, which she published this fall in the prestigious Journal of Psychological Review. "And a number of animals are able to turn off hunger when they have something better to do." Gray whales, for example, won't eat while they're migrating, even if food is plentiful. Laboratory rats starved down to 70 percent of their body weight stop eating and become hyperactive, spinning up to 12 miles a day on their tiny exercise wheels.
     Guisinger's "Adapted to Flee Hypothesis" traces the roots of human anorexia back more than 11,000 years to the late Pleistocene era, when nomadic foragers migrated around the globe. At that time, the biological capacity to suppress hunger and move quickly and tirelessly in search of food may have offered an adaptive advantage, just as it appears to offer an advantage to migrating animals. "Today, genetically susceptible people who lose a good deal of weight may trigger this archaic adaptation," she said. "And that's what underlies their illness."
Critics scoff that a potentially fatal disorder that suppresses fertility in women is hardly "adaptive." But Guisinger does not argue that anorexia per se helps an individual survive and reproduce in the modern world. Rather she says that anorexics suffer from a toxic distortion of the innate mechanisms that kept our ancient ancestors alive. Daniel le Grange, director of an eating disorders program at the University of Chicago says Guisinger's idea has "a ring of truth about it, because those who survived in ancient times must have had a gene to allow them to starve well." Indeed, the very intractability of anorexia suggests that it had some adaptive function in human evolution: Being wired into the brain through eons of history, it is far less likely than learned behaviors to respond favorably to traditional psychotherapy.
     Walter Kaye, a psychiatrist and professor of psychiatry at the University of Pittsburgh says the physiological component of the illness is extremely powerful. "Anorexia is a very homogeneous disorder," he said. "People who have it have about the same symptoms. They also tend to say the same things, act the same way. When you see that kind of pattern, it says biological."
Numerous scientific studies show that weight loss from any cause -- be it dieting, depression, or even surgery or physical illness -- can initiate the anorexic cycle in the genetically inclined. Nearly half its victims struggle with the disease throughout their lives.
     Cynthia Bulik, a professor of psychiatry at the University of North Carolina at Chapel Hill who has studied anorexia since the mid-1980s, said that while important, psychological treatments for the disorder fail if they don't first address the physiological aspects. She points out that anorexics, like all starving people, tend to be unreliable witnesses of their own experience. "You can't do deep psychotherapy with someone whose brain is not working," she said. Anorexics have chronically high levels of cholecystokinin, serotonin, and dopamine, chemicals that signal satiety in the brain. They also have low levels of appetite promoters, such as galanin and norepinephrine. Hence their brains are chronically lying about the body's need for food, or at best passing on a distorted view.
     The National Institute of Health is sponsoring a study to uncover the genetic variance underlying this neurochemical deception. The goal is both to predict who among us has the potential to become anorexic, and to sort out subsets of anorexics who may respond to various treatments. Bernard Devlin, a statistical geneticist and professor of psychiatry at the University of Pittsburgh is, along with Kaye, one of the principal investigators in the NIH study. Part of his effort involves looking for the genes that make anorexics vulnerable to environmental triggers. "We have found some genomic regions that we believe are associated with behaviors that predict anorexia, and we're hoping to eventually narrow it down to specific genes, or combinations of genes," Devlin said.
     Such insights offer support for a family-centered approach to treating adolescent anorexia that enlists parents to help make eating non-negotiable, as they would taking life-saving medicine. It's a time-consuming method, but one that can help break the cycle of blame, guilt, denial, and self loathing underlying the illness and contributing to its lethality. Psychologist le Grange, who first encountered this family-based therapy at the Maudsley Hospital in London over a decade ago, says that a recent study concluded that most patients treated with this approach regained health, and remained healthy five years after treatment. Feeding the disease, le Grange said, often reveals that family psychopathology is a symptom rather than a cause of the disorder.
     Guisinger is an enthusiastic supporter of the Maudsley approach, which her theory rationalizes, and she is hopeful that a wider acceptance of her theory will lead to other effective treatments, as well as encourage patients and their families to seek professional help early, when it is most likely to be effective. "Understanding the symptoms of anorexia as an archaic biological adaptation can free psychotherapists, physicians, and parents from unjustified blaming," she said. "And that in itself is a big step toward curbing this devastating disease."

LOVELL, Wyo. — Tucked under the snowcapped wall of the Big Horn Mountains, with its cattle and horse ranches and large Mormon church, this could be "that sleepy little town everyone wants," said Nick Lewis, the police chief. Except for one thing. Lovell, population 2,264, and two nearby towns have become infested by methamphetamine. In the past two years, about 70 people from this small slice of northwestern Wyoming have been convicted of buying or selling methamphetamine, with more arrests and convictions expected soon, the authorities say. Methamphetamine-related crimes now consume half the time of Chief Lewis's seven-officer force.
      Burglaries have mushroomed, one suspected witness's house was firebombed and the State Department of Family Services has taken children away from parents so incapacitated by methamphetamine that they forgot to feed them. Many people have simply quit work and ended up selling drugs to pay for methamphetamine, a powerful manufactured stimulant that produces bursts of energy and euphoria but can lead to depression, violent paranoia and brain damage. Methamphetamine is also draining precious money out of Lovell, which has already lost three of its four groceries, its Sears, its movie theater and two of its few factories.
      What is happening in Lovell is happening across much of Wyoming, the least populated state in the country, where methamphetamine use is now more than twice the national average, according to the federal Substance Abuse and Mental Health Services Administration. Methamphetamine use and crime are also overrunning rural counties in Iowa, Nebraska, Kansas, Colorado, North Dakota and the Texas Panhandle, law enforcement officials say.
      In Iowa, rapidly growing methamphetamine use is behind a surge in thefts of tractors and other heavy farm equipment, as well as burglaries in vacant farmsteads, said Todd Johnson, the Audubon County sheriff. The methamphetamine trade has thrived in Audubon County for a number of reasons. Methamphetamine is easy to cook locally, Sheriff Johnson said, because his county of 450 square miles has only 10 law enforcement officers, and one of the drug's main ingredients — anhydrous ammonia — is an agricultural fertilizer that lies about in abundant supply in bags on isolated farm fields, almost waiting to be stolen. Home-cooked methamphetamine is now so common in Iowa, and so toxic, that the Legislature has made manufacturing it around children a form of child abuse. In its first count, the Iowa Department of Human Services found almost 500 children who were exposed to cooking methamphetamine in 2002.
      Similarly, in Colorado, police officers and firefighters in rural communities often scrub down young children who have been crawling on the floor in houses where their parents have been cooking methamphetamine, said Susan Dreisbach, a research anthropologist at the University of Colorado at Denver.
      In Nebraska, crime has increased fourfold since methamphetamine became a serious problem in the mid-1990's, as migrant workers brought in to work in the meatpacking plants began dealing the drug, said Glenn Kemp, the drug investigator for the Adams County Sheriff's office in central Nebraska. "We never had a big crime problem in Nebraska till meth," Mr. Kemp said. "But now we have a lot of stabbings and shootings in our little towns and every homicide goes back to meth."
      Law enforcement officials in North Dakota tell a similar story. "Meth is the single most serious law enforcement issue that North Dakota is facing, and has ever faced," said Wayne Stenehjem, the state attorney general. The number of methamphetamine labs seized in North Dakota jumped to 97 in 2002 from zero in 1998 and will be higher again when the 2003 numbers are tabulated, according to the Drug Enforcement Administration. Tim Gillespie, the police chief in Emerado, N.D., a town of 500, said he had to draw his gun more last year alone than in his previous 20 years in law enforcement because of methamphetamine-related arrests in which suspects pulled weapons.
     To the experts, methamphetamine is both a symptom of rural decline, as people give up on faltering farms and factories, and a cause that makes the decline worse. In this dual role, methamphetamine acts much like crack did in big cities in the 1980's, said Mark Kleiman, a professor of public policy at the University of California at Los Angeles. But on Main Street in Lovell, people do not talk about the ravages of methamphetamine. "We lie to ourselves," said Pat Crank, Wyoming's attorney general. "We say Wyoming is God's country. We have that big sky, and those mountains. We can't have meth."
      Becky Hultgren, a 43-year-old optical assistant in Lovell, knows the bitter truth. She still remembers the day her children came home from high school and said their classmates had told them, "Your aunt is the coolest person in town." To Mrs. Hultgren, that was not a compliment. She said that her sister, Colet Dover, 41, was a methamphetamine addict who had been giving drugs to her teenage sons and selling it to other students. Ms. Dover had been fired from her job as a nurse for stealing painkillers. In early October, she was sentenced to seven years in federal prison as part of a joint federal, state and local investigation that has resulted in the dozens of convictions here.
      Statistics on drugs in rural areas are sketchy, because law enforcement is spread thin across these vast parts of the nation. But the available figures do tell a story. From 1995 to 2002, drug abuse arrests fell 23 percent in cities with a population of 250,000 or more, but rose 21 percent in rural counties, according to a study by James Alan Fox, a professor of criminal justice at Northeastern University, using F.B.I. data. Similarly, for youths 12 to 17, the highest level of drug abuse is in rural counties, according to a 2002 household survey done for the Substance Abuse and Mental Health Services Administration.
      There is also relatively little research on why methamphetamine has become the drug of choice in the rural West and why it is continuing to surge in popularity. Bruce Mendelson, a researcher with the Alcohol and Drug Abuse Division of the Colorado Department of Human Services, thinks part of the reason is that the wide open spaces in the West make it easier to set up underground labs to cook methamphetamine, a chemical stew. Methamphetamine is also cheaper than cocaine, Mr. Mendelson said, and its high lasts 8 to 16 hours, compared with a couple of hours for cocaine. "For people in rural areas, doing hard-working blue collar jobs in a bad economy trying to earn a few extra bucks, meth helps you stay up longer and work longer," he said. Federal surveys have consistently shown that methamphetamine is largely a drug of whites, the less affluent, and those living in rural areas and west of the Mississippi, said Professor Kleiman of U.C.L.A.
      Methamphetamine's appeal to the less affluent makes towns like Lovell particularly vulnerable, because of the profound demographic changes that Wyoming is undergoing. The state is growing older faster than any other state, said Jonathan Schecter, executive director of the Charture Institute in Jackson, Wyo. "Basically, Wyoming is in a demographic death spiral," Mr. Schecter said. "For the first time, Wyoming now has more people 35 and older than there are 34 and younger." As the number of school-age children has plummeted, four high schools from smaller towns around Lovell have been consolidated into one. And the decline is continuing. The number of students in the remaining high school in Lovell shrank to 160 this year from 194 in 1999. The result of this change, Mr. Schecter said, is that people in their 20's and 30's left behind in places like Lovell tend to be less educated, often high school dropouts, and work at low-paying jobs or not at all. Most of those convicted from the Lovell area fit this description, said Kurt Dobbs, the director of the Division of Criminal Investigation of the Wyoming Attorney General's office.
     Another similarity between the methamphetamine problem in Lovell and in states like Nebraska and Colorado, law enforcement officials say, is that the dealers are often Mexican migrant workers, many of them illegal immigrants, who came to work for low wages on farms or in meatpacking plants or mines.
      In Lovell, violent crime has not jumped with the advent of methamphetamine, as happened in many cities with crack. But property crime has skyrocketed, as addicts commit burglaries or break into cars. Ms. Dover wrote bad checks, ran up the debt on her credit cards to $60,000 and spent a $90,000 settlement she received after her husband died in an industrial accident, said her sister, Mrs. Hultgren. Then there is the personal toll. Ms. Dover's two sons, now in their early 20's, have their own addiction problems to overcome, Mrs. Hultgren said. Last year the sisters went back to the small town in southern Utah where they were born into a Mormon family for their grandmother's funeral. "Relatives kept asking me, where's Colet?" Mrs. Hultgren said. "I said, `This is Colet, right here,' " Mrs. Hultgren said. "But they couldn't recognize her; the drugs had aged her so much."

Among the many gripping moments in the video for Good Charlotte's recent single "Hold On," the most gripping of all may well be a close-up shot of an ordinary-looking middle-aged man — not a band member or an actor but Bob Burt, a high school coach who lost his 19-year-old daughter to suicide. "It's not the right order of things," he says, his face creasing in grief. "You're not supposed to bury your children, they're supposed to bury you."
      The "Hold On" video is an avowed attempt by this double-platinum pop-punk band to talk suicidal kids back from the brink. "Hold on if you feel like letting go / Hold on, it gets better than you know," the singer Joel Madden keens as the black-clad, heavily tattooed band plays in a dilapidated little house whose walls are scrawled with words like "fear," "lonely" and "pain." The music breaks for a series of other heart-rending sound bites from friends and relatives of those who have committed suicide.
      Made in conjunction with several suicide prevention organizations, the video closes as a tearful young woman, her voice breaking, says: "It's O.K. to get help. You're going to miss out on so much." A black screen lists hot line phone numbers and the Web address of the American Federation for Suicide Prevention. "It's almost like a public service announcement," Mr. Madden recently told MTV.com. If so, it's a hugely popular one: "Hold On" is a big hit on MTV, played heavily and featured on the channel's "Total Request Live," which showcases viewers' favorite videos. (It's not the only song on Good Charlotte's latest album, "Young and the Hopeless," that addresses suicide; another is called "Day That I Die.")
      "Hold On" is a perfect specimen of a new strain of teenage-oriented music — call it therapy rock — that uses the language of punk music to address, and sometimes even attempt to assuage, many adolescents' powerful feelings of alienation and despair. Of course rock has long addressed itself to the emotionally wounded teenager. What's new is this genre's astonishing frankness, its wide popularity and its active, earnest attempt to lend troubled fans a helping hand.
      Consider Blink-182. With more than 10 million albums sold, it's one of the biggest bands in the country. Its new self-titled release is punctuated by evocations of depression like "I'm so lost, I'm barely here/ I wish I could explain myself but words escape me/ It's too late to save me." "Adam's Song," from Blink-182's previous album, was based on a fan's suicide note; it profiled a character struggling to overcome hopeless thoughts. (Unlike the real-life inspiration, the song's protagonist survives his crisis.)
      With their messages of care and support, these bands give the lie to the hoary stereotype of the nihilistic punk rocker. And not only do some of them make videos that are specifically designed to serve a public health function; they've found other novel ways to guide their fans through emotional troubles.
      The annual Take Action Tour, mostly featuring punk-derived "screamo" bands, raises depression and suicide awareness and benefits the National Hopeline Network (which oversees the anti-suicide hot line 800-784-2433). This summer the network sent a gleaming new semi full of information on the popular Warped Tour, which featured Rancid, the Used and AFI among many major acts. (The benefit album "Take Action, Volume 3" includes multimedia content based on "Suicide: The Forever Decision," a book by Dr. Paul Quinnett, as well as a self-test for depression.)
Some songs in this genre are downright prescriptive, counseling kids to be patient and tenacious through the lonely, bewildering years of adolescence. (Many other tracks merely depict depression, in hopes that teenagers might at least find comfort in knowing someone else understands what they're going through).
      In "Hang On" (not to be confused with Good Charlotte's "Hold On") the pop-punk band Smashmouth exhorts, "Things are gettin' weird/ Things are gettin' tough/ Nothing's makin' sense/ But you keep on lookin' up." Virtually every song on the bad-boy pop-punks Sum 41's hit record "Does This Look Infected?" is about profound alienation, depression or imminent emotional breakdown, but on "Hell Song" the band urges listeners to look for solutions, instead of wallowing in despair: "Everybody's got their problems/ It's just a matter how you solve them/ And knowing how to change the things you've been through." Other songs recommend solidarity: "I was confused/ And I let it all out to find/ that I'm not the only person with these things in mind," Linkin Park's Chester Bennington sings on the band's hit single "Somewhere I Belong."
      In 1967 the Beatles sang "Getting Better All the Time," whose lyrics now read like a gentler version of the prototypical therapy rock song. (Sure enough, Smashmouth covers the song on "The Cat in the Hat" soundtrack.) Four years later the Who famously sang, "Don't cry, don't brace your eye/ It's only teenage wasteland" on the classic rock staple "Baba O'Riley." Heavy metal and industrial rock have profiled psychological imbalance for decades, and many current bands worship the 80's mope-rockers the Cure. (Robert Smith of the Cure even sings a tune on the new Blink-182 album.) But therapy rock has its most direct roots in the genesis of American punk rock, a movement founded by a tiny coterie of troubled misfits and outcasts. The pioneering Southern California punk band Black Flag's landmark 1978 debut EP was called "Nervous Breakdown" and themes of insanity, alienation and depression have been a hallmark of punk lyrics ever since.
      The first stirrings of therapy rock's introduction to a mass audience came in the early 90's, when alternative rock, inspired by punk music and led by Nirvana, apotheosized a generation of disaffected and confused latchkey kids. "Lots of music now comes from Nirvana, and a lot of people identify with what Kurt Cobain was saying," said William, 16, of New York City. In what many interpreted as the defining event of a generation, Cobain killed himself with a shotgun blast in April 1994. The tuneful punk revivalists Green Day picked up the ball of teen angst in the mid 90's, and thereafter various pop-punk bands ran with it all the way to commercial glory. American youth welcomed songs about the emotional difficulties of being a teenager. The audience for therapy rock was always there, it was just waiting for punk rock's popularity to catch up with it.
      Since commercial success and punk credibility are virtually antithetical, the new pop-punk bands embrace themes of emotional distress as a way of asserting their authenticity and musical lineage. (They cleave to punk orthodoxy musically as well, having progressed remarkably little from early Southern California punk bands like the Descendents and Bad Religion.) As a result therapy rockers fetishize depression like gangsta rappers fetishize the thug life, publicizing their plight while asserting their credibility. Just as the group Public Enemy once called rap the "CNN of the streets," therapy rock claims to report from the front lines of suburbia. In other words, it's cool to be bummed out. And it sure sells records.
      The popularity of therapy rock may in part be a reaction to the shallow kiddie-pop and testosterone-addled "nu metal" of recent years, making sincerity and relentless introspection the new rebellion. But even considering the adolescent penchant for magnifying ordinary personal woes into downright apocalyptic melodrama, therapy rock addresses some sober realities. According to the National Center for Injury Prevention and Control, the adolescent suicide rate has about tripled since the 1950's, and suicide is the third-leading cause of death for people 15 to 24 (behind accidents and homicide). Each year about 5,000 young people kill themselves, and several times that number try. The numbers have tailed off somewhat in recent years but only, some experts say, because of the rise in antidepressant prescription drugs.
      "If all the bands are singing about this, I can't see how you can't see it as a voice for what the youth are thinking," says the Blink-182 singer-guitarist Tom DeLonge. It may be the very fact of pop success that's spurring bands to write these songs. With huge sales figures comes a deluge of needy fans, some of whom say they literally owe their lives to the band. "Every day we read letters from fans saying that the stress of life, the pressure with family and losing love is too much to bear," Mr. Madden of Good Charlotte noted in a recent news release. "Once you actually start selling records, and you actually figure out that people are listening to you," says Mr. DeLonge, who recently became a father, "then you start thinking about it, going, `Wow, you don't want to influence them in a bad way.' " Performers like Marilyn Manson, Ozzy Osbourne and Judas Priest have faced public condemnation and even legal action after accusations of influencing kids' behavior adversely, so rock musicians know that, whether it's appropriate to do so or not, the public holds them accountable.
      But these musicians' motivations run deeper than that. Punk is a vast support group for misfits, a community united by alienation. That strong sense of community is the same impulse that leads even the most hardened body-slammers to help up those who have fallen in the mosh pit. Likewise, punk bands — and even bands who merely grew up on punk — look out for their fans. The difference now is that they enjoy a vastly bigger community than ever, and that the bands have cast themselves more directly as trusted peers. And adolescents seem more than ready to listen. Raised in a culture of therapeutic self-examination, the current generation of teenagers may be more alert to — and articulate about — their troubles than their predecessors. "I think it's just becoming less of a taboo subject and more people are talking about it and being aware of it," said Saara, 16, from Rockville Centre, N.Y. "Everyone knows someone who's gone through it." Steve Pedulla, of the emo band Thursday — whose recently released "War All the Time" is virtually a concept album about coping with suicidal urges — agrees. "Kids are more self-aware now," he said.
      Suicide and depression may also, however, be among the few remaining dangers that still bear a sense of romantic fascination. In the late 50's, for example, when teenagers first became a major presence on the road, there was a profusion of car crash songs — so many that the songs constituted a subgenre of their own. The 60's and 70's saw a host of anti-drug songs; in the 80's fear of AIDS manifested itself in pop music. Those are no longer the cutting-edge topics of youth culture. But partly as a result of school shootings, depression and its consequences retain their edge.
      Even for kids who aren't severely troubled, pop-punk has become a medium for ritual soundings of distress. Like a high-school version of the blues, it's a cathartic shout-out to the hellhounds on one's trail. "A lot of kids are depressed about school and friends, and instead of hearing happy music they'd rather hear something that's sadder than they are — it makes them feel better," says 16-year-old William. "They don't want to hear about why things are so great." The bands say they hope that this new line of pop discourse will have an actual effect on kids' lives. "It's good that it's out there," the Blink-182 bassist-singer Mark Hoppus says. "It opens dialogue. It makes people able to talk to one another about things. And hopefully it makes things better, you know?"
      Dr. Dan Romer, research director of the Adolescent Risk Communication Institute of the Annenberg Public Policy Center, says no significant studies have been made of whether this music has a therapeutic effect. "Not enough attention has been paid to the stuff that's actually pretty valuable to young people," he said. "Unfortunately most of the time we spend trying to find out if it's bad for people." Indeed, there is some concern that songs decrying suicide could actually encourage it. A 1999 Surgeon General's report concluded that "suicide can be facilitated in vulnerable teens by exposure to real or fictional accounts of suicide."
      Much to Blink-182's horror, the ultimately life-affirming "Adam's Song" was found playing on repeat when Greg Barnes, a teenage survivor of the Columbine massacre in Colorado, hanged himself in May 2000. "It affected us really strongly because that song was a song of hope," Mr. DeLonge said, the pain still clear in his voice. "When we were writing it, we knew specifically that we did not want kids to think it was something that we thought was cool or rad. We didn't endorse it in any way."
      Judging by a visit to the Good Charlotte online message board (http://www. goodcharlotte.com/board/index.php?s=), however, plenty of other teenagers are getting valuable support from songs like "Adam's Song" and "Hold On." "Just a week or so ago my friend was going to kill herself, then she saw the `Hold On' video," said a Good Charlotte fan named Ann, 14, of Columbus, Ohio. "It stopped her from slitting her wrists. I just don't want to think about what would have happened if that video didn't come on."
      Kelly, 15, of Grove City, Ohio, said in an interview conducted via Instant Message, "As disappointing as it is, most kids listen to famous people a lot more than their parents or a teacher." Lee Huff, president-elect of the National Association of School Psychologists, said that although he devoutly wished parents and schools were more involved, he approved of rock bands counseling young people about depression and related issues. "Bless their hearts," he said. "It certainly goes a long from talking about killing bitches and whores and cops and everything else doesn't it? If kids listen to rock music more than they listen to a teacher in a classroom, God bless us that they're getting the message."

Social Workers Embattled but Not Embittered
David Crary, Associated Press- 1/4/2003

NEW YORK - When social workers make the news, the news is usually bad. Nine New Jersey child welfare workers fired after four badly malnourished boys are found in their adoptive home. A newly hired caseworker raped during a home visit in Ohio. A Wisconsin social worker charged with failing to report the abuse of a 16-month-old child who died. In many states, social workers complain of excessive caseloads, low salaries and a perennial lack of appreciation for their profession. "The good work they do is not often seen," said Ronald Feldman, a professor of social work at Columbia University. "It's the tragedies that get all the attention."
     Why then does a front-line social worker like Trevor John love what he calls "grunt work" - a job that repeatedly brings him face-to-face with heartbreak, anger and cruelty? "I'm an agent for change -- that's the gratification I get," said John, 31, a New York City social worker since 1997. "I'm the one who puts the first foot into that family's home -- we're the first responders when something goes wrong with children. Within three or four weeks, you're engaged with that family and you begin to see a change."
     John, who grew up in New York, works for the Administration for Children's Services in a program that tries to help troubled families stay together, rather than remove children and place them in foster care. "They used to call us baby snatchers," John said. "But now we have more preventative services. I've gotten thank-you letters; one family sent me a photo of their child graduating from first grade." John majored in sociology at Syracuse University and joined the New York City agency as it was still struggling with aftershocks of one of its worst horror stories - the 1995 beating death of 6-year-old Elisa Izquierdo. The city conceded that child welfare officials knew Elisa was at risk for abuse but did not adequately monitor her case.
     New York City's record has improved since then. Initiatives like John's Family Preservation Program have boosted the morale of social workers and enabled the city to cut by almost half the number of children moved from their own families into foster care. From a national perspective, however, social work remains an often-embattled profession. Some examples:
o Mississippi's Department of Human Services has been pleading with legislators for more money to ease a severe shortage of social workers. In Harrison County, on the Gulf Coast, caseloads rose as high as 128 per worker - more than six times the recommended load. About two dozen counties have had only one social worker, on call 24 hours a day.
o In Akron, Ohio, 250 social workers have been on strike since July; their union contends that caseloads are two or three times higher than the levels reported by management. A newly hired caseworker, unable to complete her safety training because of the strike, was raped in November during a home visit, allegedly by the father of a child she was monitoring.
o State social workers in New Jersey have been struggling to keep up morale in the face of repeated tragedies that have rocked the Division of Youth and Family Services. Last January, a 7-year-old boy's battered body was found after the agency closed his case. In October, nine agency employees were fired after four malnourished teenagers - one of them weighing only 45 pounds - were removed from their adoptive home. High-ranking officials cast doubts on claims by social workers that the teens' home had been visited regularly. Said New Jersey's now-departed Human Services Commissioner Gwendolyn Harris, "I had staff that were either incompetent, uncaring or who had falsified records."
     However, leaders of New Jersey's social workers unions said at least some of the fired workers had little or no connection to the case and were being used as scapegoats by an agency with a long history of financial and management problems. "It's hard to attract people, and even harder to retain them," said Paul Alexander, whose Communications Workers of America Local 1034 represents some New Jersey caseworkers. "If people end up thinking they can be prosecuted for making mistakes, I don't know how you can attract anybody."
     Walter Kalman, head of the New Jersey chapter of the National Assn. of Social Workers, said some of the state's problems arose from hiring caseworkers with inadequate experience or training. Pay, which starts at about $35,000 in both New Jersey and New York, is also a problem, he said. Kalman said morale had sunk so low that some social workers were embarrassed to acknowledge working for the Division of Youth and Family Services. "It's pretty depressing for people in those jobs," he said. "Every day you see someone breaking down in tears." But Kalman said the unions should be more willing to acknowledge that individual workers, as well as the overall system, could bear some of the blame. "There are people who shouldn't be in this field," he said. "If you don't care about what you do, you don't belong here."
     The high-profile tragedies are triggering an overhaul of New Jersey's entire child welfare system, and several other states are operating under court orders to do the same. One common theme is pressure to toughen the professional requirements for social workers. "We shouldn't perpetuate the myth that all one needs is a good heart," said Gary Bailey of Boston, president of the National Assn. of Social Workers. "States are realizing the risk of having an uncredentialed person doing this work."
     Although states are required by law to provide certain levels of child welfare services, their "clients" are relatively poor and powerless. The result, experts say, is limited political clout for social workers. "Child welfare is usually given a lower priority vis-a-vis sectors with higher profiles: police, fire departments, economic growth and development," said Feldman, the Columbia professor. "There's no doubt in my mind we could be saving billions of dollars if we could develop preventative programs. But the problems tend to be out of sight and out of mind until disaster hits."
     In the eight years since the Elisa Izquierdo tragedy, New York City's Administration for Children's Services has sought to improve its performance and its social workers' morale by emphasizing teamwork and encouraging creative, community-based approaches to problems. "People used to be afraid to make the wrong decision," the agency's commissioner, William C. Bell, said. "If they did, the caseworker and the supervisor were fired, but the system would stay the same." "Now," Bell said, "if you're doing your best, you're going to be supported."
     Trevor John, who is working toward a masters degree with financial help from his agency, said the new approach had given him and his colleagues more confidence. "You don't have that sense of being thrown out to the wolves," he said. "Now, you have six or seven collective ideas, and you feel more secure in making a decision." Aspects of the job remain difficult -- especially when John encounters an infant or toddler who has been beaten or sexually abused. "You learn to cope, you learn to deal with it, but you don't get used to it," he said. He was philosophical when asked if his profession was underappreciated. "To make an impact on our country, to help shape the future, you have to work with these children and their families," he said. "Regardless of how people feel, we're there to help."

Court: Drugs Can't Be Forced on Inmates
Associated Press, 1/5/2004

     SAN FRANCISCO -- Mentally ill inmates cannot be forced to take anti-psychotic drugs, the California Supreme Court ruled Monday in a decision that affects hundreds of prisoners across the state. The 6-1 decision concerns California inmates who have done their time for their convictions but have been found to be mentally unfit for release to the community. Those inmates are housed at state mental institutions until they are deemed fit for return to the community. If they refuse anti-psychotic medication, the state cannot force them to take the drugs unless a judge authorizes it, the court ruled. A judge must find that the inmate is incompetent to refuse treatment and is immediate danger to himself or others.
     The case involved Kanuri Surgury Qawi, sentenced to four years in 1991 for assault and battery. On parole, he was arrested for stalking a sales clerk he claimed was his wife. While incarcerated the second time, authorities diagnosed him with paranoid schizophrenia, and he has repeatedly been kept from the community. In 2000, he challenged his involuntary treatment and said the drugs' side effects were unbearable.

Patience, Love Replace Their Drugging Days
Courtland Milloy, Washington Post- 1/5/2004

     During a convention at the Renaissance Hotel in downtown Washington this past weekend, one of the organizers made a heartwarming announcement: Those in attendance represented 3,617 years of recovery from drug addiction. Individual clean time ranged from 24 hours to more than 50 years, the organizer said, and every one of those million or so drug-free days was regarded as a gift from God.
     No signs advertised the convention, and nothing about the attendees made them stand out from other hotel guests -- except, perhaps, all of the hugging that occurred in the lobby and wherever else they happened to meet. That, indeed, might have been the giveaway. For this was a gathering of grateful, recovering addicts brought together by the unpaid "trusted servants" of the self-supporting East of the River Area group of Narcotics Anonymous. The river is the Anacostia, east of which are some of the most drug-plagued neighborhoods in the District. Many who attended the three-day convention, which began Thursday, started using drugs in those neighborhoods. But thanks to the 12-step Narcotics Anonymous program -- which is based on the same spiritual principles as Alcoholics Anonymous -- they are now free from the bondage of active addiction.
     "I was in another society within a society before coming to NA," one convention speaker said. "I mean, normal people just don't sleep in abandoned houses. Like, normal people just don't be in an abandoned house with their network of people. We got on stuff we had on for six or seven months. And the bathtub is full of feces. Dead rodents everywhere. And we in this joint arguing over who's gonna get the last hit. That's how the end was for me." Another speaker said: "I came to NA weighing 80 pounds soaking wet. One day, my mother walked right past me and didn't even recognize her child."
     This was the fifth convention held by the East of the River committee, an achievement that reflected a growing spirit of cooperation, patience and love among and for those once considered spiritually bankrupt. One speaker told how overwhelmed she was by a federal narcotics indictment titled The United States of America v. [her name], only to realize later that "not even the whole United States could make me stop using drugs." She was in pain, she said, and could not break the habit. But through NA, "I learned to get through the pain and not just try to stop it. I learned how to cope, not cop." Continuing her journey of recovery, she was eventually admitted to a nursing school. "I went from the DEA list to the dean's list," she said.
     The most important mission for recovering addicts, according to NA literature, is to try to carry the program's message of recovery to addicts who are still suffering. And there are many. District health officials say that of the 60,000 known drug addicts in the city, about 10,000 are receiving help of any kind.
     For those in NA who try to carry that message, a certain spiritual fitness invariably helps. "What can I do?" one speaker asked. "Struggle with grace. Pitch in and do whatever needs to be done and don't complain. I need to remember that it's not about the person or the act -- it's about doing something for God. And if I miss that and get consumed with self, I'm stuck." Another speaker said: "How did I stop using? By surrendering and coming to believe in something greater than myself. . . . It's not just to stop using, but to give love with no strings attached."
     The convention featured a New Year's Eve gala, a fashion and comedy show and a jazz brunch, among other activities -- proof that life could be enjoyed without alcohol or drugs. And the Renaissance Hotel was about as far from an abandoned building as a person could get. Thousands of dollars that might otherwise have been lost in a crack house or a heroin shooting gallery had gone toward spiritual uplift and a recommitment to helping others. As for those 3,617 years of sobriety: simply miraculous. "That represents a lot less chaos on the streets," a conventioneer noted. To say nothing of a lot fewer tormented souls.

Trials End Parents' Hopes for Autism Drug
Andrew Pollack, New York Times- 1/6/2004

For several years, an experimental drug, secretin, has offered an unlikely ray of hope for some desperate parents of children with autism. Discovered accidentally by the mother of an autistic boy and licensed to a small biotechnology company led by the father of two autistic girls, secretin has advanced through clinical trials even as study after study showed it had little or no effect. Now, the largest and most definitive clinical trial of secretin has been completed, and it, too, showed that the drug was no better than a placebo in improving the social interaction of young children with autism. The failure, announced yesterday by the company, Repligen, of Waltham, Mass., casts doubt on whether secretin will ever get to market as a treatment, dealing a blow to scores of parents and some doctors who advocated its development.
      "We're horrified at the thought of this being dropped," said Jan Henry of Chattanooga, Tenn. The drug, which Ms. Henry said she bought from overseas sources and others at up to $10,000 a year, had helped her son Andrew speak and sleep. "It's life to us," she said. "My parents mortgaged their home for us," she added.
      The secretin story shines a light on the difficulty of developing a drug for autism, an often debilitating condition whose incidence seems to be rising sharply and for which there are no approved drugs. Experts estimate that the United States has more than 100,000 autistic children. Children with the condition have difficulty communicating or forming relationships, and they often have repetitive actions.
      The development of the drug has at times been a battle between the hopes of parents and the more dispassionate science of some experts. Some advocates say the experts too easily dismissed the drug because it was developed outside conventional academic channels or drug companies. "This is the type of thing you see all the time in medicine, where things that get strong patient and parental advocacy and don't come through the normal channels of discovery get dismissed," said Dr. Jeff Reich, a neurologist and senior analyst at Merlin Biomed, an investment fund in New York that owns shares of Repligen.
     Some experts say that parents see what they want to see and that the drug simply does not work when measured more objectively. "We now have multiple, multiple studies showing secretin is not better than placebo," Dr. Fred R. Volkmar, a professor of child psychiatry at Yale, said. "I would say it's time to shift our attention elsewhere."
     Secretin is a natural hormone that stimulates the pancreas to release juices that aid digestion. A synthetic version is approved for use in diagnosing pancreatic disorders. In 1996, Parker Beck, an autistic boy in New Hampshire, was given secretin to help diagnose gastrointestinal problems, which afflict many children with autism. His mother, Victoria Beck, soon noticed an improvement in his development and began to suspect the secretin. When the Becks tried to obtain more treatments for Parker and his medical records from the University of Maryland, where he had the diagnostic procedure, they were rebuffed, Mrs. Beck said. The family then learned that the university was applying for a patent on using secretin in autism. When the Becks told the university their history, the university listed her as an inventor and assigned her the patent rights. She in turn licensed them to Repligen, whose president, Walter C. Herlihy, has two autistic daughters.
      The news was reported on television and in newspapers in 1998 and 1999 and led to a flurry of interest in secretin. Some parents obtained the version for pancreatic disorders. Some ordered it from overseas. But some small studies sponsored by the National Institutes of Health showed that secretin had no benefit beyond that from placebos. Repligen conducted a larger trial that involved three doses. That test was also not convincing but the drug seemed to show some effect in younger children.
      The company began a Phase III study, usually the last stage before regulatory approval, involving 132 younger children, from 2 years 8 months to 4 years 11 months, who were given six doses each intravenously. The results announced yesterday showed that the recipients of the drug did not improve more than those who received the placebo when evaluated by parents or psychologists. Repligen stock lost more than 40 percent of its value, dropping $1.77, to $2.39. "It's a sad day," Dr. Herlihy, the chief executive, said in an interview. He said the company would decide whether to keep developing the drug for autism after further analyzing the data and conferring with the Food and Drug Administration in the coming months.
     But Dr. Herlihy and some doctors in the trial are not ready to concede. They said one reason that the trial might have failed is that it is difficult to measure improvements in autistic children. The drug did show an effect for a subset of children with higher I.Q.'s. Also, the term "autism" probably covers a wide range of conditions. Secretin may work for some patients, but the effects would be diluted in testing on a broad population. "I remain convinced there's a subset of children who benefit from secretin," said Dr. Paul Millard Hardy, a behavioral neurologist in Hingham, Mass., in the trial. One of his patients, Jeremy McGlone of Kingston, Mass., was in the trial. Jeremy's father, Shayne McGlone, acknowledged that he did not know whether his son received the drug or the placebo, although he speculated that it was the drug. "He started looking at me in the eyes a lot more," Mr. McGlone said. "As a father, that's something you want your kid to do."
     Parker Beck, 10, has improved greatly and no longer takes secretin, his mother said. Anticipating royalties from secretin sales, Mrs. Beck and her husband, Gary, set up the National Autism Outreach Foundation last summer in Highlands Ranch, Colo. But now the royalties will apparently not arrive. "We'll find other ways to raise money for it," Mrs. Beck said.

Mental Health: Double-Teaming Depression
John O'Neil, New York Times- 1/6/2004

Cognitive therapy and medication are regarded as equally effective in treating depression. But they work in very different ways, according to a study released yesterday comparing brain scans of depressed patients before and after treatment. The study, which was published in The Archives of General Psychiatry, involved 14 patients who attended 15 to 20 sessions of therapy and 13 comparably depressed patients who were treated with paroxetine, an antidepressant better known by its brand name, Paxil. The cognitive therapy provided for the patients aimed to reduce depression by teaching them to recognize and derail negative habits of thought.
     The study's senior author, Dr. Helen Mayberg of the Rotman Research Institute of Toronto, said scientists had speculated that the therapy had a "top down" action on the brain: changes beginning in the cortex, the area dealing with higher reasoning, go on to affect other areas of more basic functioning. By contrast, research has suggested that antidepressants work as "bottom up" agents, working first on areas like the limbic system that play a big role in memory and basic emotions.
      The brain scans supported this analysis, the study said. The scans showed that the therapy led to changes in the use of parts of the frontal cortex that were not changed in the patients who took Paxil. Those patients, by contrast, showed changes in the brain stem and parts of the limbic system where the cognitive therapy appeared to have no effect. Dr. Mayberg said the findings could help explain why a combination of the two approaches was often better than either one alone. "They're having effects on areas that don't overlap," she said. Since some patients respond to one kind of therapy but not the other, the research could lead to better tailoring of treatment, she said.