PORTLAND, Maine -- A Maine Civil Liberties Union survey of the health of inmates in the state's prison system demonstrates a need for better treatment of mental health and substance abuse problems, according to a report released Tuesday. The MCLU also concluded that the system should improve its response to inmates with physical illnesses and conditions, increase its dental health services and expand efforts to help inmates stop smoking.
      The 11-page survey, which was completed anonymously by about two-thirds of the 1,900 inmates in seven Maine prisons, found that 70 percent of respondents reported that their overall health was good. But nearly 60 percent said they had substance abuse problems and 38.5 percent said they have a mental illness. About 60 percent were smokers when they entered prison, compared to about 24 percent of the adult population statewide. And 49 percent reported dental problems. Slightly more than 1 percent of inmates reported being infected with HIV, while nearly 11 percent said they had hepatitis C. In both cases, the report indicated that the low numbers may reflect limited testing by the state.
      The survey was conducted last May and June by researchers from the Edmund S. Muskie School of Public Service at the University of Southern Maine. The MCLU said its goal was to determine the strengths and weaknesses of the prison health care system and help determine whether its resources are adequate.
      The primary provider of health care services for Maine prison inmates is Correctional Medical Services, a managed care company based in St. Louis. Mental health services are handled by two other providers, one for psychiatry and one for counseling services.
      The survey was based on the inmates' own impressions. The report said the results were not compared to other data or to Department of Corrections records, in part because the department's record keeping is limited. The department worked with the MCLU on the survey, and Denise Lord, associate commissioner, said there was little in the report that she found surprising. Expressing agreement with many of the recommendations, Lord said her department has "made significant improvements since the survey was conducted but there is still work to be done."


Brain Mapping May GuideTreatment for Depression
Carey Goldberg, Boston Globe- 1/6/2004

     For the first time, researchers have mapped what happens in the brain when a patient recovers from depression using cognitive behavioral therapy, a common form of psychological treatment aimed at breaking the bad habits of thought that bring people low. The changes in the pattern of brain activity are quite different from those observed when patients recover with antidepressant drugs, and in some areas, even opposite, according to findings reported yesterday.
     The mapping may provide a first step toward using brain scanning to determine which patients should receive antidepressants and which should receive psychological training, a decision that is now often based on trial and error, said Dr. Helen Mayberg, the study's senior author. "This experiment lays the groundwork for looking for different markers that will help to optimize the treatment for a given individual; that's the really cool part," said Mayberg, a professor of psychiatry and neurology who conducted the study while at the University of Toronto but recently moved to Emory University in Atlanta.
     Researchers also predict that the study could help raise the public standing of cognitive behavioral therapy, a series of lessons that trains patients to recognize their negative thoughts -- "I'm worthless" or "it's hopeless" -- and combat them with facts. More highly directed and shorter-term than ordinary talk therapy, the psychological practice is already solidly established and is routinely paid for by insurance companies, but it tends to get much less attention than antidepressant drug therapy.
     The scanning study's importance is "that you can see such a solid physical finding from a psychological treatment," said Dr. Bruce M. Cohen, president of McLean Hospital in Belmont. He was not involved in the research. More broadly, Cohen added, the findings represent "one more step toward answering the question: What is happening in the brain when it's depressed? What happens when you change the way you think or take a drug and change the way you feel?"
     Mayberg and colleagues used a brain-scanning technique called positron emission tomography to analyze for 15 to 20 sessions the brain metabolism of 14 subjects whose depression lifted considerably after cognitive behavioral therapy. They found, among other things, that some areas in the cortex -- the outer rind of the brain associated with higher functions, such as thinking -- appeared to become less active, seemingly because patients learned to ruminate and worry less. With antidepressants, those regions became more active.
     In essence, Mayberg said, depression stems from a malfunction not in a single spot in the brain, but in a network or circuit of brain connections. The study, published in this month's Archives of General Psychiatry, helps to contrast the two main approaches to fighting it. "The network can reset itself via inputs working from a bottom-up perspective -- that, I think, is how drugs work -- while cognitive therapy works by influencing top-down inputs, turning down rumination and worry areas," said Dr. Zindel Segal, a University of Toronto psychiatry professor who worked on the study.
     "Top-down" cognitive therapy begins with the cortex and its higher thinking functions; "bottom-up" drug therapy begins with the deeper, more primitive parts of the brain such as the brain stem and limbic system, which affect emotions and basic bodily functions. Each eventually affects the other through a complex network that remains little understood. An estimated one-fifth of Americans suffer from prolonged depression at some point.
     Insurance companies generally pay for cognitive therapy, which costs between $50 and $100 per session, but they sometimes only cover the talk therapy. Studies have shown that cognitive therapy is not only at least as effective as antidepressant drugs for some patients, but that many are less susceptible to relapse, said Aldo Pucci, president of the National Association of Cognitive-Behavioral Therapists. Patients typically attend an average of 16 sessions, replete with homework, and come away with new skills that last much longer.
     The therapy works, Segal said, by helping patients become aware of their negative "self-talk" and how it interacts with their mood. For example, he said, if patients have thoughts like "I'm unattractive," they are more likely to accept that thought as fact. Cognitive therapy helps them "develop a capacity to talk back to this depressive propaganda."
     There are no national statistics available on how many people perform or undergo cognitive therapy, Pucci said, but his nine year old association already has 5,000 members. "We maintain that for the overwhelming majority of people who are depressed, it's their thinking that causes their depression, not some biochemical problem," he said. The study, he said, "just supports what we've already been saying." Cognitive behavioral therapy "doesn't need the support, but certainly we'll take it," he said. In fact, the study does not address the origins of depression, but it did suggest a basic aspect of antidepression therapy that surprised Mayberg: Drugs and cognitive therapy appear to operate on two different tracks, with no "final common pathway," she said.

Chicago Mentally Ill Find Guidance After Jail
Michael Higgins, Chicago Tribune- 1/6/2004

     Stricken with severe mental illness, Robin West was homeless off and on for more than 20 years, sleeping on CTA trains or at O'Hare International Airport. It was a dreadful life for the 46-year-old woman, and for Cook County taxpayers, it was dreadfully expensive. Like many people in her predicament, West cycled repeatedly through Illinois' jail and prison systems, requiring tens of thousands of dollars in scarce resources. Between 1988 and 2000, West was arrested more than 75 times for offenses such as trespassing, panhandling, disorderly conduct and drug abuse, court records show. But for the last year and half, West has managed to stay housed and out of trouble, thanks to one of two small but promising programs that Illinois corrections officials say could help many of the state's homeless mentally ill.
      The programs, run by Thresholds, a social service agency in Chicago that aids the mentally ill, use outreach workers to track severely mentally ill inmates released from Cook County Jail and a state prison in Downstate Dwight. The workers visit participants--every day in most cases--to make sure they stay on medication, stay off the streets and receive job training or disability payments. Officials are buoyed by a Loyola University Chicago study in 2001 that concluded that Thresholds' program reduced jail and hospital stays by more than 80 percent for the first 30 participants, saving the state and county more than $1 million in a year. The program for inmates released from Cook County Jail, begun in 1997, now has about 70 participants.
     West joined in 2001. Living in Rogers Park, West said she is off drugs and, in the last 19 months, has had no trouble with police. "It's a very big change," West said. "But something had to change in my life. I was tired of going to jail."
      The program at Dwight Correctional Center is in its infancy, with 12 participants. But it, too, has impressed state officials. "They've taken people who have been back and back and back into the system ... and they've really had some wonderful success stories," said Amy Ray, acting manager of mental health for the state Department of Corrections. This month, a coalition that includes Thresholds staff and members of the John Howard Association, a prison reform group, will hold its first meeting. The coalition plans to look at issues surrounding the release of mentally ill inmates, including ways to expand or improve the Thresholds program. One potential proposal would ease state privacy laws so an inmate's mental health records could be accessed by state mental health officials after the inmate is released.
     Mental health advocates lament that jails and prisons have become the nation's new psychiatric hospitals, warehousing people whose psychiatric conditions lead them to commit the same, often minor, offenses again and again. About 16 percent of jail and prison inmates have some type of mental illness, the U.S. Justice Department reported in 1999.
      In theory, newly released inmates who received psychiatric medication in jail or prison should find a stable place to live, then promptly visit a mental health clinic to ensure that their treatment continues uninterrupted, said John Fallon, who directs the programs for Thresholds. In practice, severely mentally ill inmates may have a hard time finding housing. They may not have a clinic nearby or have good transportation. They typically have to wait 30 days for an appointment, Fallon said. Or the inmates simply may not be able to navigate the system. Leaving prison, "you've got, usually, $10," Fallon said. "You've got two weeks of medication and a phone number to a mental health clinic. These are people who have trouble finding their way to something a block and a half away. It's a hard road." Without treatment, the former inmates can become overwhelmed by delusions, unreasonable fears or disorganized thoughts. They often commit the same offenses that got them locked up in the first place or use street drugs in an attempt to relieve their symptoms.
     Ami Guerra, 43, of Chicago was selected for the jail program in 2000 after what she estimates to be at least 25 trips to jail and 25 stays in psychiatric hospitals over two decades. Diagnosed with schizophrenia as a teenager, Guerra was frequently homeless as an adult. After a shaky start in the jail program, Guerra has not been arrested in more than a year. "I had a rough road with Thresholds staff in the beginning," Guerra said. "I would go into these moods where I would walk the streets. They would look for me and find me and say, `Ami, get in the van. Where have you been?' ... They never gave up on me." On the streets, she was sometimes a crime victim, Guerra said. One beating left her with a long scar on her forehead. In the program, Guerra has her own apartment, takes medication and works as a janitor for a company associated with Thresholds. "I can think clearly," she said. "I can take care of myself. I can cook. I can clean. ... I'm happy for a change."
      Fallon promotes the programs as a good deal for taxpayers. Cost is about $1,000 per participant per month, he said. Keeping the same person at Cook County Jail for a month costs about $1,800, plus money for treatment. State prison costs run from about $1,800 per month for male inmates to $2,500 per month for women, prison officials said. A one-month stay at a state psychiatric hospital can cost $15,000 or more.
      When starting the programs, Thresholds chose people whose illness had repeatedly led them to jail or state mental hospitals. One early participant had been arrested 135 times and spent about 400 days in jail and 10 years in state psychiatric hospitals over a 21-year period, Fallon said. Fallon estimated the total cost to the state and county for that person was about $1.5 million. Since joining the program five years ago, that former inmate has spent only 14 days in jail and has been to a private hospital once, for less than a month, Fallon said.
      Fallon said more than 1,000 inmates in Cook County Jail take psychiatric medication on any given day. "We're really just taking an eyedropperful of folks who need this service," he said. West, meanwhile, is simply glad to be off the streets and proud of the new life she has begun to carve out for herself. "I spent more time in jail than I did out of jail. I don't plan on going back," she said.

Methadone Overdose Deaths on Rise in Maryland
Associated Press, 1/7/2004

BALTIMORE -- Methadone overdose deaths have shot up dramatically in Maryland over the past six years, the state medical examiner's office said. Methadone is used to alleviate heroin addiction and is a powerful painkiller. In Maryland, 29 people have died from methadone intoxication through November 2003, according to figures from the state Office of the Chief Medical Examiner. That's compared to three deaths in 1998. While the deaths represent 4 percent of the 662 deaths caused by illegal and abused prescription drugs during the period, officials said they are concerned by the emerging trend. ``We're paying attention to it,'' said Peter Luongo, director of the state's Alcohol and Drug Abuse Administration.
     Clinics that distribute methadone to drug addicts have been a source of dispute, often igniting fierce opposition from communities. But health care officials say they doubt such clinics are the source of the abused methadone. The distribution of methadone is subject to tight controls at the 45 drug treatment clinics in Maryland, said Luongo and other state and local officials. ``We have had no diversion from any methadone clinics that would cause us to have any concerns that drug treatment is a source'' of these deaths, Luongo said.
     Health officials and researchers concede that more research must be been done to determine whether those who died in Maryland were enrolled in addiction treatment programs, used methadone legitimately for pain treatment or illicitly obtained and abused the drug.
     In addition to Maryland, Maine, Virginia, North Carolina and Florida have also dealt with rising cases of methadone-related overdose deaths. The trend is part of a nationwide increase in the abuse of powerful painkillers over the past decade, statistics show. From 1994 to 2001, the number of emergency department visits involving abuse of narcotic painkillers more than doubled, from nearly 42,000 to more than 90,000, according to the federal Drug Abuse Warning Network, which monitors emerging drug threats.


University of Chicago Sex Study Sees Love, Loneliness
Peter Gorner, Chicago Tribune, 1/9/2004

     The typical Chicagoan is now single for about half of his or her adult life, a shift that has had a major impact on cultural institutions and the ways people interact, University of Chicago researchers reported Thursday as part of a broad look at sexuality in the city. While people of other generations tended to marry shortly after entering the work force and remain married to the same spouse, today's marriages occur later in life and often are briefer. That trend has led to new ways of coping, such as elaborate networks in which singles search for companionship and sex. "Chicagoans are destined to spend half their lives as single people, and half their single years will be spent alone," said sociologist Edward O. Laumann, leader of the research team. "Yet, we already know that sexual well-being is very much associated with happiness and the quality of life. The implications for the future are troubling."
      The survey also found that sexual opportunities are different for men and women and are defined by racial group, neighborhood and sexual orientation. African-Americans who live on the South Side generally do not look to West Side neighborhoods for partners, for example, and people on the North Side rarely go to the South Side. Society in general has not caught up with the changes in sexual partnering, the results indicate. For instance, gay men and gay women who are victims of domestic violence have few resources available to them.
      The researchers call the Chicago Health and Social Life Survey the first representative sampling of the sex life of a major city. For the survey, 50 interviewers from the university-affiliated National Opinion Research Center conducted in-depth personal interviews with 2,114 men and women, ages 18 to 59, in the city and nearby suburbs. The researchers also talked to 160 community representatives, including police, social workers, clergy and others. The information was kept confidential and the team had no difficulty getting people of different cultures to respond, Laumann said.
      The survey found that, on average, Chicagoans stay married for 18 years, cohabit for 3.7 years and either are unattached or dating the rest of the time. Families, communities and local religious organizations also were found to exert enormous power in the shaping of sexual relationships. But the change in behavioral norms brought about by early sexual maturity, cohabitation, late marriage and prevalence of divorce have consequences for city-dwellers. "Women often have a harder time remarrying," Laumann said. "Many already have kids, and men may not want to raise other men's children." A man in his 40s will seek a woman who is five to eight years younger, forcing older women to change their strategies for meeting partners, Laumann said. "Even though they tend to be conservative and less permissive in their sexual attitudes, they may find themselves going to bars by themselves," Laumann said. "That's not what they were doing in their 20s."
      Sexual behavior is significantly limited by such factors as neighborhood, ethnicity, sexual preference and friends, the researchers found. In heavily Latino neighborhoods, for example, the influence of family, friends and the church remains strong. However, among young upper-income people on the North Side, the workplace and college were the most important meeting places.
      The survey uncovered the importance of an emotion neglected by previous researchers: jealousy. "The rise in cohabitation has increased domestic violence because people who cohabit are much more likely to experience jealousy," Laumann said. "Because of the lack of commitment in a `cohab,' people enter it being a lot more mistrustful."
      The researchers found that adultery breaks up Chicago area marriages at a rate of about 4 percent a year. However, when the adultery occurs among people who are living together but unmarried, the defection rate jumps to 15 to 20 percent. "That means fighting increases, and with it the likelihood of physical violence," Laumann said. "These are fragile relationships, and domestic violence because of sexual jealousy is a problem in all the communities we studied."
      For the survey, the researchers concentrated on four Chicago neighborhoods for case studies. Included were questions about sexual partners, birth-control methods, lifetime sexual history, social networks, neighborhood characteristics, attitudes about religion, sexuality and sex roles and domestic violence.
      The results of the survey will be published in a book, "The Sexual Organization of the City," to appear in spring. It represents the third part of a trilogy by the U. of C. team that began in 1994 with the national sex survey published as "The Social Organization of Sexuality." That was followed by "Sex, Love and Health in America: Private Choices and Public Policies," published in 2001.
      Other researchers welcomed the new survey, which was funded by the National Institute of Child Health and Human Development and the Ford Foundation. "Just as in his previous work, Dr. Laumann is the new Kinsey," said Eli Coleman, director of the human sexuality program at the University of Minnesota, referring to the late Alfred C. Kinsey, the prominent sex researcher. "Laumann provides us with the data to really understand the sexual behavior of people today. This is extremely important as we face the myriad sexual health problems in America," Coleman said. Daniel Greenberg, a sociologist and sex researcher at New York University, has specialized in studying homosexuals. "Laumann includes them in his research but also includes everybody else," he said. "The study of sex in a big city has not been done before. It's a major advance."

Doctors Find Recovery Is Aided by Hypnosis
Benedict Carey, Los Angeles Times- 1/10/2004

Hypnosis transports some people beyond serenity and absorption to a state of pure silliness. A solemn voice whispering to relax, breathe deeply and imagine a waterfall can bring to mind high school séances, Ouija boards, Woody Allen routines. Yet the very same technique, the same voice, can move others to climb mountains. After a fall on a climbing expedition that mangled her ankles, Priscilla Morton, a 48-year-old New Orleans social worker and mountaineer, discovered that she was afraid to step off the curb and onto the street, much less climb again. Using a program of hypnosis, she was able to ascend to the 19,347-foot summit of Mt. Cotopaxi in Ecuador. Self-hypnosis "was the only way I could deal with the fear, the cold, the steepness, the exhaustion," Morton said.
     Once mainly the province of entertainers, mystics and New Age healers, hypnosis is now gaining a foothold in mainstream medicine. At teaching hospitals such as those at Mount Sinai School of Medicine in New York and Harvard Medical School, hypnotists work with some surgical patients to help speed recovery. Many of the country's 1,000 or so certified hypnotherapists now get referrals from physicians on cases ranging from irritable bowel syndrome and heart disease to managing the pain of childbirth and cancer. In some studies, 50% to 70% of people who have tried it say hypnosis has helped them to feel better or heal faster. Such reports have encouraged its use for everything from weight loss to smoking cessation, with varying results.
     But is the evidence strong enough to justify sessions that can cost $100? Most doctors are skeptical. For every person who learns to manage chronic pain, they say, several others manage only a yawn or a shrug. To earn widespread respect, hypnotherapists are going to have to reach more people, more consistently. "At this point, the therapy is certainly not well accepted by most physicians and surgeons," said Guy Montgomery, an assistant professor of biobehavioral medicine at the Mount Sinai School of Medicine.
      The answer may be to teach hypnotizability, or suggestibility, as it's sometimes called. In more than a dozen studies over the last decade, men and women of various ages demonstrated they could learn to fall into a hypnotic trance more easily and deeply. "Now the idea is to find what is most effective in getting them there, from a low level of suggestibility to a higher one," said Steven Lynn, a psychologist at the State University of New York at Binghamton who's conducting a large federally funded study on the subject. "You do that and you not only increase the number of people who would benefit but also widen the range of its applications."

The hypnotic state
Researchers long thought that suggestibility was a stable trait, like a person's IQ or leaping ability, that couldn't be improved on much. Yet there's little evidence that it's related to innate gullibility or a person's imaginative powers. Personality isn't a deciding factor either; researchers have found no strong relationships between hypnotic suggestibility and traits such as neuroticism, extroversion or intellectual curiosity.
      Attitude does seem to matter - in particular, skepticism - and for good reason. Since an Austrian physician named Franz Mesmer first popularized the use of trance-like states as a method of treating anxiety and hysteria in the 18th century, the technique has appealed to all variety of charlatans and healers, as well as to Hollywood scriptwriters, who've had fun using it to brainwash, possess and otherwise manipulate characters and plot. Movies such as "Whirlpool" (1949), "The Manchurian Candidate" (1962) and almost any Dracula film have defined hypnosis in the public imagination as a form of demonic mind control, and that image itself may undermine people's hypnotizability.
      So psychologists trying to teach hypnotic suggestibility often start with a simple explanation of what hypnosis is and what it's not. Being hypnotized does not turn a person into an automaton or a puppet, for instance; almost always it's a mundane experience, as familiar as a daydream. The therapist might have a person simply stare at a spot on the wall, for instance, then gradually relax, feeling his or her arms getting lighter and lighter, as if the bones were hollow, say, as if connected to helium balloons. Highly hypnotizable people often are best at demystifying the trance. "You're not losing control, like in the movies," said climber Morton, who described her experiences in a recent issue of the American Journal of Clinical Hypnosis. "It's more like you drift off a little. You're temporarily distracted by a particular image or lost in thought, like when you drive home from work and arrive without remembering how you got there. It's a very natural state, the kind we go into all the time, and it helps to think of it that way." In several studies, research psychologists have found that a straightforward description of the sensations and images that occur during hypnosis can also help skeptics and other trance resistors become more suggestible.
      In his ongoing project, Lynn shows volunteers a videotape of highly hypnotizable people explaining their sensations and what they thought about while in a trance. On one video clip, a hypnotist has a subject clasp his hands together and then imagine they're welded together. The hypnotized man suddenly cannot separate his hands; they're stuck. "If I stopped imagining and admitted to myself that they could come apart, then of course I could have made them come apart," he explains afterward on the tape. "But I figured that's not the point of the suggestion. The point is to get involved in the make-believe, no matter what. So, I just kept imagining that my hands were welded blocks of steel and did this until the suggestion was over."
      Using imaging technology, neuroscientists have taken pictures of people's brains during hypnosis. The snapshots show a decrease of arousal in the cortex, the brain's manager and planner, and an increase of activity in areas involved in focusing attention. This makes some sense to psychologists who practice and study hypnosis. While in the trance, a person is usually concentrating on bringing to mind some vivid image, which could account for heightened attention. The drop in cortical arousal accompanies a decline in moment-to-moment alertness. In effect, psychologists say, the person is conscious enough to hear and understand suggestions such as "You will feel strong and healthy after surgery" or "You will feel calm and relaxed when taking the test," without applying his or her usual skepticism or irony. If the suggestions are helpful, the theory goes, they may become a part of the person's subconscious memory. "This is all happening beneath the level of consciousness, so the suggestions are not something the person has to think about or remember," said Marc Schoen, a Los Angeles psychologist and assistant clinical professor at the UCLA School of Medicine who has used hypnosis for more than 20 years.

Patient control
Like other therapists who specialize in hypnosis, Schoen has treated everything from social anxiety to pain from cancer and cancer treatment. Typically, he works with people once a week for six to eight weeks. When effective, the therapy blunts emotional over-reactions to a particular person, situation or drug side effect, say, that normally would intensify pain, interrupt sleep or otherwise trigger anxiety. With practice, many people learn to do this on their own. In effect, they adapt the therapist's methods to put themselves into a brief trance, reinforcing suggestions or thoughts they've found helpful during a session - self-hypnosis.
      Schoen may also use traditional cognitive therapy, in which people learn to consciously identify these same emotional triggers, then avoid them altogether (if possible) or calm themselves before getting upset. But when hypnosis is successful, he said, no conscious mental effort is necessary to short-circuit a painful emotional reaction. "It just doesn't happen; you don't feel the same fear, the same apprehension," he said. "In that sense, it's a form of desensitization."
      Henry Polic II, a movie and TV actor in his 50s best known for his work in the 1980s series "Webster," got a referral to Schoen last summer during treatment for malignant skin cancer. Polic was on a drug and radiation regimen that caused a paralyzing nausea, plus swelling blisters in his mouth so severe that he had trouble speaking and swallowing. While hypnotized, the actor imagined himself in Key West, Fla., at sunset, as he remembered it from a vacation years ago. Meanwhile, Schoen was informing him that the water washing on the sand was clearing his body of illness and relaxing his tissues. It took a few sessions, but the swelling dropped by about half, Polic estimated, and the blisters near the back of his throat disappeared. "Gone, and I mean gone; I could swallow again," he said. "I have no idea how that happened, but it did."
      Nor does anyone else know. Distraction may play an important role, some doctors say. It's well known, for instance, that the brain can virtually shut down pain signals when preoccupied; many athletes and soldiers have known the surprise of suddenly discovering a cut or wound once the fray is over, well after suffering the injury. If nothing else, those who respond to hypnosis have learned to escape into their imaginations for a time. But there's more going on, and many psychologists argue that it has to do with the placebo effect, the self-fulfilling belief that a condition has been treated.
      In 1995, a team of researchers from the University of Connecticut reviewed six weight-loss studies that compared the effect of cognitive therapy -- identifying eating triggers and defusing them -- with and without hypnosis. About 70% of the overweight people who got hypnosis lost more weight and kept it off longer than those who got only talk therapy. In a 2002 look at 20 studies on hypnosis and surgical pain, Mount Sinai researchers found that adding hypnosis to standard post-surgical care sped recovery almost 90% of the time, in terms of levels of pain, anxiety and the need for painkillers. "The hypnosis seems to change expectations, in the same way that a placebo does," said Montgomery, an author on both studies, "and this change appears to have a strong effect on what people actually experience." Montgomery, like other psychologists, is now running a study of hypnosis on people undergoing surgery, in this case breast cancer patients. On the day before surgery, a trained hypnotist puts the patients into a trance for about 15 minutes, telling them that they'll feel "healthy, full of energy, strong," after their operations.

The motivation factor
There's reason to believe that even a very short -- i.e. relatively inexpensive -- approach could lessen a patient's pain and drug use after surgery, psychologists say. For whatever their personal views of hypnosis, people awaiting surgery have one thing going for them that many others don't: motivation. It doesn't take a psychologist to explain why people going under the knife have tremendous anxiety, not only about the success of the operation but also about complications and recovery. They long for hypnosis to work. "You have to really want to do what the hypnotist is suggesting you do, for obvious reasons," said psychologist Lynn. His preliminary results suggest that most people on the low end of the suggestibility scale can learn to be two to three times more hypnotizable than before, once they overcome skepticism and resistance to imagining and they establish a rapport with the therapist.
      For cancer patient Polic, hypnosis has helped make the difference between living in misery and leading an active life, with the luxury of being able to laugh now and then. He doesn't feel like a million bucks, but his skin isn't burning and he's not crippled with nausea. Using CDs of recorded hypnotism sessions, he has learned to put himself into a brief trance when needed, when side effects flare. "I was never a skeptic of hypnosis, but I'm amazed so far at what a difference it has made," he said. He is due for another round of drug therapy today. On Thursday, he's scheduled for another hypnosis session. "I'm headed back to Key West."


'Jung': In the Archives
Robert S. Boynton, New York Times Bood Review- 1/11/2004

     Carl Jung's relationship with Sigmund Freud was probably doomed from the start. They met in Vienna on March 3, 1907, after having corresponded for a year. Freud sought a gentile to champion his ''Jewish science.'' Jung yearned for an influential father figure; Freud anointed Jung ''his scientific 'son and heir.' '' In 1910, according to Jung's ''Memories, Dreams, Reflections,'' Freud made a request: ''Promise me never to abandon the sexual theory. . . . We must make a dogma of it, an unshakable bulwark.'' Against what, asked Jung. ''Against the black tide of mud . . . of occultism.''
      What did Jung's face look like at that moment? After all, not only did Jung have growing misgivings about Freud's theories of sexual repression, his past was a veritable cornucopia of occultism: as a child, he participated in family seances run by his cousin; his mother, a delusional hysteric with a multipule personality, believed their house was haunted by ghosts; and Jung's dissertation (''On the Psychology and Pathology of So-Called Occult Phenomena'') was sympathetic to the paranormal. By 1913, the Freud-Jung friendship was over. ''The rest is silence,'' Jung wrote.
      Freud and Jung represent the twin therapeutic impulses of the modern age: neurotic self-scrutiny versus New Age spiritual redemption. Freud, the essential Enlightenment figure, meant for psychoanalysis to free man from the elements (the unconscious, superstition) that deprived him of autonomy. Jung, the German Romantic, for whom individuation meant returning to the archaic and the mystical, complained that Freud's biological theories excluded the very Dionysian, polygamous spirituality essential to the fully realized life. Freud wrote about sex; Jung had it.
      While writing her comprehensive biography, ''Jung,'' Deirdre Bair discovered that the battles between Freudians and Jungians are as nothing compared with the internecine war raging in the Jung world: ''In a field whose history is inflamed by the quasi-religious status of its pioneers, partisans have been vocal. . . . Anyone who undertakes to write about him is confronted by the many charges against him.'' Much ink has been spilled over Jung since his death in 1961; in ''The Jung Cult'' and ''The Aryan Christ,'' for instance, Richard Noll characterized Jung as an ambitious charlatan who lifted his central insights from other scholars. For its part, the Jung family has maintained an iron grip on his archives, refusing access to many of his writings, and even those by long-deceased colleagues. Bair, the author of biographies of Samuel Beckett, Anais Nin and Simone de Beauvoir, circumnavigated most of the family's restrictions, noting only that she couldn't use any document ''unless a member of the family has read it first,'' and that she had to know in advance which files she wanted to see, ''because even the card catalog was tightly restricted.''
      What is the Jung family so determined to hide? Jung's parents, Paul Jung, a minister, and Emilie Preiswerk, were poor and unhappily married. Both were the 13th child in their families, which was regarded as a good sign. Jung's father eventually became the pastor in a mental hospital. Carl, the first of their children to live past infancy, born on July 26, 1875, in the small town of Kesswil, Switzerland, was an introverted, solitary boy who, in keeping with family tradition, had dual personalities (''a clumsy, awkward, mathematical dunce of a boy living in real time at the end of the 19th century'' and ''an old man living in the 18th century who dressed in high-buckled shoes, wore a powdered wig and drove a fine carriage'') and mystical visions, including one of God dropping excrement on a cathedral.
      Jung studied medicine at the University of Basel, incorporating a multitude of other fields -- mythology, anthropology, comparative religion -- into his work. He became a psychiatrist and worked at the prestigious Burgholzli Mental Hospital, where he developed a series of language association experiments that brought him fame throughout Europe and America. When nearly 28, he married Emma Rauschenbach, the second-richest heiress in Switzerland. Economic independence liberated Jung intellectually, encouraging him to test the boundaries of early-20th-century European psychiatry and to expound on the consciousness not only of individuals but of civilization itself.
      Jung came to believe that the key to decoding the conditions of neurosis lay within the history of civilization and mythology. Sexual repression and family issues were of secondary importance to him; ''Don't waste your time,'' Jung tells a patient who has the gall to mention her mother. With his eye on history, he developed the concepts -- archetypes, New Age, collective unconscious, synchronicity, anima, the two dimensions of personality (extroverted, introverted), man's four basic functions (thinking, feeling, sensation and intuition) - that made him famous.
      Bair is less interested in the content of Jung's ideas than in his life, which is just as well. Many of Jung's intellectual passions -- alchemy, phrenology, astrology, U.F.O.'s -- are as woolly and suspect as his life story is vivid and dramatic. From 1914 on, he maintained a public ''unorthodox emotional triangle'' with his wife and a former patient, Toni Wolff, whom he called his ''other wife.'' He treated writers like Thornton Wilder and Hermann Hesse, and was acquainted with James Joyce, whose schizophrenic daughter he saw. Bair has unearthed fascinating new material about Jung's role as ''Agent 488,'' briefing the Office of Strategic Services' spy-recruiter Allen W. Dulles on the psychology of Nazi leaders. Back in Washington, Jung's comments ''figured importantly in the agency's operational policies.'' In 1945, Jung's ideas for persuading the German public to accept defeat were read by the supreme allied commander, Gen. Dwight D. Eisenhower.
      Bair's stated goal is to rise above the fray and answer the questions most often posed about Jung: Was he an anti-Semite? Was he a womanizer? Was his psychological theory a form of religion? She largely succeeds. Painstakingly fair, she digs up and scrutinizes sources with an admirable, if sometimes exhausting, thoroughness.
      In a particularly perceptive chapter, ''Falling Afoul of History,'' Bair explores Jung's conduct during World War II, which he spent in neutral Switzerland. Even as Jewish psychoanalysts were being purged in 1933, Jung accepted the presidency of the International General Medical Society for Psychotherapy, which meant working with Matthias Heinrich Goring, Hermann's cousin. Jung vowed to resign on three occasions, and was finally kicked upstairs to a figurehead position of ''honorary president,'' which he held until 1940. Bair makes a convincing case that Jung was neither personally anti-Semitic nor politically astute. Rather, he played all sides: letting himself be used by the Nazis to legitimate their racial theories, belittling Freud (''insofar as his theory is based in certain respects on Jewish premises, it is not valid for non-Jews''), even as he tried to help other Jewish analysts.
      Bair argues that Jung's overriding goal was to rescue psychotherapy, to ''see to it that it maintains its position inside the German Reich,'' as he claimed. The sentiment shrinks in importance when one realizes just whose school of psychotherapy he was protecting. Pluralism was never Jung's (or Freud's) strong suit. Bair occasionally goes too far, as when she insists that the man -- so canny and manipulative in every other dimension of his life -- was naive in his dealings with the Nazis. In this respect, Jung's case resembles that of another charismatic intellectual, the philosopher Martin Heidegger, who was much more of a collaborator than Jung. These ambitious men were not naive; they were overconfident about their ability to manipulate the Nazis and were hopelessly outplayed.
      Perhaps in reaction to the violence of the Jung partisans -- pro and con - Bair is relentlessly judicious, often preferring to draw the reader's attention to contradictory evidence rather than to draw conclusions. The result is a more academic book than she perhaps intended: some of these disputes, after all -- Jung's falling-outs with minor figures, the authorship of insignificant memos - could well have been relegated to end matter. As a result, the book sometimes reads more like an effort to assemble a puzzle than to offer a cohesive narrative. Still, Bair has presented a balanced, full-blooded portrait of a tremendously flawed and divisive figure. It will be praised by scholars, read by the general public and loathed by the partisans -- just as a good biography should be.

Just Do It: Writer's Block
Laura Miller, New York Times Book Review- 1/11/2004

     Writer's block, like insomnia, is a subject of keen interest to those who have it and great tedium to those who do not. In both cases, the near-hysterical pitch of self-pity, fed by panic and isolation, makes the sufferer hard to sympathize with even after you've tasted the same misery yourself. ''Sometimes it takes all my resolution and power of self-control to refrain from butting my head against the wall,'' Joseph Conrad wrote to a friend. ''I want to howl and foam at the mouth but I daren't.'' At least the insomniac's plight is medical; everyone must sleep. If you complain of not being able to write, you might be answered by the likes of Gore Vidal, who retorted to legions of sufferers: ''You're not meant to be doing this. Plenty more where you came from.''
      Alice W. Flaherty, a neurologist at Massachusetts General Hospital and the author of ''The Midnight Disease: The Drive to Write, Writer's Block and the Creative Brain,'' wouldn't go so far as to label writer's block an illness, but she's interested in what causes it. Could there be a biochemical aspect to the problem? And if so, might there be a cure beyond the usual self-help nostrums? Flaherty is intrigued by the neurological dimensions of writing in general, not because she has endured writer's block (although she has) but because she has gone through episodes of its opposite: hypergraphia, or compulsive writing.
      Just how much writing is too much remains a tricky question. Flaherty, who twice, under the influence of postpartum mood disorders, found herself scribbling obsessively, explains, ''My writing felt like a disease: I could not stop, and it sucked me away from my family and friends.'' Scientists studying the effects of temporal lobe epilepsy, for which hypergraphia is a symptom, tested for it by asking patients for letters describing their state of health. Most responded with answers under 100 words; those with hypergraphia sent back 5,000. Flaherty detects a ''general distrust of writers who are too productive'' whatever the cause, but varying according to genre. If you're a prolific popular writer like Stephen King or Isaac Asimov, people are far less likely to make nasty cracks about your output than if you're a literary novelist like Joyce Carol Oates. Entertainment may be allowed to flow like wine, but art is supposed to ooze forth slowly and painfully, like blood.
      A little envy-tinged scorn is easy to take, though, compared with the horrors of the blank page. Flaherty believes ''there are perhaps only two types of writer's block, high energy and low energy.'' The low-energy type may be a symptom of treatable depression, which ''afflicts writers at a rate 8 to 10 times higher than the general population.'' High-energy block comes from an excess of anxiety, thereby demonstrating something called the Yerkes-Dodson law, which Flaherty describes as ''venerable,'' although it was a small revelation to me.
      In a 1908 study, Robert M. Yerkes and John D. Dodson, who were doing research in comparative psychology at Harvard, found that ''both very low and very high levels of arousal interfere with performance.'' In other words, too much motivation, as well as too little, can trigger writer's block, and this explains why ''the bigger the project, the bigger the block.'' Coleridge may be the most famous example of this syndrome; he produced pages of essays, correspondence and journalism -- to the point of hypergraphia, in fact -- but when it came to the form that mattered most to him, poetry, he had a tendency to choke. The letter from Conrad quoted above goes on and on about his own inability to write.
      A friend of mine once invented a ''cure'' for minor blocks that unwittingly jibed with Yerkes and Dodson's findings: to counteract a procrastination, create a bigger one. Think up a grand, long-term, world-changing project -- something like Mr. Casaubon's ''Key to All Mythologies'' from ''Middlemarch,'' or that old reliable, the Great American Novel -- and in your mind invest it with such life-defining importance that everything you do that doesn't contribute to realizing it becomes a waste of time. As long as meeting this week's deadline is a way of avoiding the really big thing that you ought to be doing instead, it becomes much easier. A pretty feeble ruse, perhaps, but it works.
      Depressed or not, writers have been disappointingly unimaginative in their responses to writer's block. One exception is the tiny literary genre of books written to explain the nonexistence of other books. The genre is so tiny, in fact, that I know of only two worthwhile examples. The first is ''Why I Have Not Written Any of My Books,'' by Marcel Benabou. For years I owned a copy but refrained from reading it because I knew the author was affiliated with Oulipo, the avant-garde literary movement. I feared that my love for the book's title would be tarnished if I discovered the book itself to be one of the group's typically lumbering and self-satisfied frolics. Also, not reading it seemed to be in the spirit of the enterprise.
      Recently, I relented and discovered that ''Why I Have Not Written Any of My Books'' is a witty catalog of all the vanities, attitudes and delusions that writers employ to escape their work. Benabou explains, for example, that he never attempted a first book because it could be only a rough sketch of a more fully realized book to come later, and what would be the point of writing something so premature? Also, ''you have to live'' before you write, a motto that loses some impact when Benabou notes that ''it was of course by dint of purely literary references that I exhorted myself not to be snared too soon by the nets of literature.''
      The second example is Geoff Dyer's ''Out of Sheer Rage: Wrestling With D. H. Lawrence,'' a painfully funny account of how Dyer came not to write his ''sober, academic study'' of the man ''who had made me want to become a writer,'' a project conceived as a way of putting off writing yet another book, a novel. In ''Out of Sheer Rage'' Dyer achieves a Cartesian state of procrastination, leading his readers through so many densely nested layers of avoidance as he travels the world visiting Lawrence's haunts that not writing about Lawrence becomes an end in itself. Ordinarily, I would not read a treatise on writer's block, or a travelogue, or, especially, a study of D. H. Lawrence, yet I relished ''Out of Sheer Rage.'' Whatever tortures produced it, that makes it art in my book.

Foundation Works to Dispel Stigma Surrounding Mental Illness
Associated Press, 1/11/2004

BINGHAM FARMS, Mich. -- On Oct. 4, 1993, Joseph Laurencelle -- an accomplished athlete in high school and college who went on to be an elementary school teacher and coach -- put a gun to his head and fired. His suicide at the age of 26 came four years after he was diagnosed with bipolar manic depression. Until that moment, his father, Michael Laurencelle, a Bingham Farms developer, says he understood little about the effect depression -- and its stigma -- can have on one who suffers from it. While his son's suicide devastated him, it also prompted him to set up a foundation in his son's name to help educate young people about mental illness. "Joe had a difficult time accepting that he had a bipolar disease," Laurencelle told The Daily Oakland Press for a Sunday story. "I did, too."
      Much of the work of the Joseph L. Laurencelle Foundation is to promote acceptance and understanding of mental illness. The foundation has developed a program that goes into area high schools to educate teenagers about the signs and symptoms of depression. It also created, funded and produced a documentary entitled: "No Ordinary Joe: Erasing the Stigma of Mental Illness." The film documents Joseph Laurencelle's battle with his illness, defines mood disorders and discusses chemical imbalances in the brain, said Gary May, his first little league football coach and the program's producer and creator. "The whole effort is to help erase the stigma surrounding mental illness, to be a better friend," May said. "It's a feel-good message."
      Joseph Laurencelle's illness was no secret to his family and friends. But those closest to him say they missed his calls for help. "We all downplayed it because Joe wanted it that way," May said. "Joe would say, 'I know there is a demon I have to control inside of me.' When he called for help, we didn't hear it. We just heard Joe being himself."
      Novi District Judge Dennis Powers also knows the effects of the illness all too well. His son, Michael, suffers from bipolar manic depression and is serving a 2-20 year prison sentence for breaking his girlfriend's jaw and fracturing her skull. Powers spent years trying to get help for his son. "When a person is (physically) ill, we'll deal with that," Powers said. "But the small part -- the one percent we don't understand, the mentally ill -- we don't know how to deal with it and we don't want to handle it. We hide it. "We package them and we send them off and forget about them. We've forgotten that they are people, even though they don't think the way we do."