Crackdown Falters as 2 Rulings Favor N.Y.'s Adult Homes for Mentally Ill
Clifford J. Levy, New York Times- 1/14/2004

In the last two years, the Pataki administration has worked to toughen its scrutiny of the state's adult homes for the mentally ill, dispatching squads of inspectors to determine whether residents are being neglected and demanding fines as high as $55,000 for health and safety violations. But now, the administration's enforcement efforts are in disarray and it is expected to abandon 70 cases against adult homes after two judges determined that health inspectors had violated state law and regulations governing how they document their visits to the homes.
      The rules say the inspectors are required not only to detail violations in their reports, but also to specify how the violations should be corrected. They failed to do so, the judges ruled. As a result, some of New York's most notorious adult homes are likely to avoid punishment for serious problems -- places like the 216-bed Brooklyn Manor, where inspectors said they discovered that rooms were infested with flies, chronically ill residents were left unsupervised and psychotropic medication was distributed haphazardly, if at all.
      The collapse of the enforcement efforts is a significant setback for the Pataki administration, which has often cited its stepped-up inspections and stiff fines as evidence that it was cracking down on abuses. Advocates for the mentally ill called the flawed inspections another unfortunate chapter in the history of the homes.
      Statewide, roughly 15,000 mentally ill people live in more than 100 adult homes, which have been a cornerstone of the mental health system since New York began closing its dismal psychiatric wards in the 1960's.
      Robert Kenny, a spokesman for the State Health Department, said the department was disappointed in the judicial rulings and had revised its practices so that future inspections will be conducted properly. He said the department was considering changing state regulations to enable it to more readily go after homes repeatedly found to be in violation. "It's sad that some adult home operators would rather spend their energy and resources finding ways to skirt their responsibility to provide quality service and care to residents, rather than taking appropriate steps to address the violations," Mr. Kenny said.
      The judicial rulings hinge on a section of state law and regulations for adult home inspections. Last summer, in a case brought by a group of adult homes, a judge in State Supreme Court in Albany decided that inspectors had failed to specify the corrective measures, and said all future inspection reports were required to include them. While the state had asserted in court papers that it was required to spell out corrective action only where it was not obvious, it did not appeal the decision.
      Late last month, one of the Health Department's own hearing officers for the first time dismissed a case against an adult home, based on the rationale of the State Supreme Court decision. "It would not be appropriate to impose civil penalties in this case, due to the department's violation of its own regulations dealing with the content of inspection reports," wrote the hearing officer, Stephen Fry, who is an administrative law judge. Judge Fry wrote that to rule against a home based on a flawed inspection report "would send the message that it is acceptable for the department to decline to comply with the regulations that apply to itself, but it is not acceptable for a facility to fail to comply in full with those portions of the regulations that apply to it."
      State officials acknowledged that Judge Fry's sternly worded decision is expected to apply to all pending cases against homes. In all, the fines in those cases amount to hundreds of thousands of dollars, officials said. The State Health Department has not formally dropped the remaining cases, but Jeffrey J. Sherrin, a lawyer who represents many adult home operators and who brought the two cases challenging the flawed inspections, said it had no choice. "The homes expect that in implementing the decisions, the department will act fairly, and all pending enforcement proceedings will be withdrawn," Mr. Sherrin said.
      The homes' operators have said that recent inspections have been onerous and unfair. They have asserted that the state continues to require the homes to shoulder more responsibilities while failing to increase the fees it pays them. Lisa Newcomb, executive director of the Empire State Association of Adult Homes and Assisted Living Facilities, said the group was reviewing the legal decisions and was not yet sure about their ramifications.
      To pursue troubled homes, state health officials will now have to conduct entirely new inspections and, if violations are not quickly corrected, begin the legal process of seeking fines. The state will not be able to use previous reports to bolster the cases, officials said. "It's terribly unfortunate that the state has dropped the ball on this," said Geoff Lieberman, executive director of the Coalition of Institutionalized Aged and Disabled, one of the few advocacy groups that represents adult home residents. "As has happened over the years, the people who have suffered will continue to suffer - adult home residents. We believe that there are many places where actions need to be taken to improve homes."



Group Therapy Helps Ease Burden of AIDS in Uganda
Marc Lacey, New York Times- 1/15/2004

YOTERA, Uganda - There is no word for depression in Luganda, the local language, but until about a year ago Josephine Namaganda was most certainly suffering from just that. She shunned her grandchildren, preferring to cry alone in her hut. She lacked the energy to work, which meant that her fertile farmland became overrun with weeds. She wished she were dead. Mrs. Namaganda was not alone. Researchers who visited 30 villages in southwestern Uganda three years ago found 21 percent of the people surveyed showed depression. They traced the problem to AIDS.
     In villages along Lake Victoria, some of Africa's earliest AIDS cases were discovered 20 years ago. The disease has devastated the area, dotting the fertile landscape with graves. Uganda's government has made strides in reducing its overall infection rate, but the lakefront remains a trouble spot. One aggravating factor is the havoc that depression can wreak on those infected or those who have seen family members die one after another. Researchers have responded with a new group-therapy program. And they have found that in the African bush, as elsewhere, treating people's minds can help their bodies rebound. "You see people who in the beginning don't want to live anymore who start becoming productive," said Cephas Hamba, a group facilitator with World Vision, a relief organization that conducted the research with experts from Johns Hopkins and Columbia universities.
     Mrs. Namaganda lost her husband to AIDS, and 6 of her 12 children have died, some from related ailments. She now cares for nine grandchildren, tiny ones with big eyes who have had no choice but to suffer through her low moments with her. She says she reached rock bottom in 2002, when she discovered that she, too, was infected with H.I.V., the virus that causes AIDS. "I locked myself in the bedroom and I chased all the children outside," she recalled. "I beat them whenever they came around. They would say, `Grandma, where's the food?' I'd say, `Let's all die.' "
     Then one day last year, a World Vision counselor invited her to share her woes with her neighbors. At first she sent the counselor away, but eventually she agreed to listen. A session was convened, and after many long silences, people began opening up. They shared their suffering. They recalled the funerals. Once they came to trust one another, each revealed his or her H.I.V. status.
And their depression lifted.
     The therapy study was conducted with 15 groups of up to a dozen people each -- segregated by sex to encourage confidences. Each group met 90 minutes a week for four months. Results indicate that 6.5 percent of those who underwent therapy still suffered from major depression. In a control group without therapy, 54.7 percent remained depressed. "Group interpersonal psychotherapy was highly efficacious in reducing depression," read an article on the research in the June 2003 issue of the Journal of the American Medical Association. "A clinical trial proved feasible in the local setting. Both findings should encourage similar trials in similar settings in Africa and beyond."
     Mrs. Namaganda began sleeping through the night. She picked up her hoe and started working her fields, growing corn, bananas and nuts. Before the researchers came along, locals described their suffering using two terms. In Luganda, "yo'kwekyawa" means hating oneself. "Okwekubagiza" means pitying oneself. Nobody had any idea that talking could make one feel good enough to get out of bed.
     The researchers had had similar doubts. They ruled out antidepressants because of the cost and a lack of health services. They worried that psychotherapy might not translate well in the local culture. "So much attention is being paid to AIDS but so little is being done about the mental health aspects of the disease," said Paul Bolton of the Boston University School of Public Health, who led the project while he was at Johns Hopkins. "Depression devastates people's ability to function."
By using local facilitators, the researchers found that talking through one's woes works just as well on a straw mat as on a couch.
     One of the study participants, Maria Prisca Namugerwa, said she had been so afraid before the therapy that AIDS would kill her that she had thought about taking her life before the disease did.
The researchers said that for ethical reasons, nobody who entertained active thoughts of suicide had been included in the study. But many of those who took part said they had thought about it. At a recent group therapy session, Mrs. Namugerwa smiled broadly as she described how she used to toss and turn at night. She now sleeps peacefully, she said, adding, "The group told me my life was worth something."
     In a group session for men, Livingstone Ntale got the strength to visit a clinic to determine if he was H.I.V.-positive. Though the results confirmed his fears, he said the group discussions changed his attitude so much that he took his wife for testing, too. Her test was negative, and they now live with the hope that she, at least, will be around to rear their 10 children, some of whom were borne by Mr. Ntale's first wife, who died of AIDS. "My philosophy now is, `I could die tomorrow but I could live another 50 years,' " Mr. Ntale said. "I used to pick up the hoe and start working, but then I'd stop. I'd think, `Why should I bother?' " Others who have benefited include Justine Nalweyiso, who learned to control her urges to abandon her three children, and Gormet Nayiga, who no longer thinks she is going to die every time she does not feel well.
     The therapy sessions drew participants together so effectively that many have continued meeting. Some have also used their counseling groups to start business ventures together. Women weave multicolored mats. Men pool their money to buy chickens and goats.
     Lwanga Lawuli, 65, who has lost all his relatives to the disease, said he considered the half dozen men in his group to be his brothers. The best thing about the discussions, he said, is the comfort of knowing that he will have people around to take care of him if he falls ill.
     Like so many others, Abdul Hakim Ssempijja thought he had AIDS but was too terrified to find out for sure. He, too, got tested, and he, too, found the virus was in his blood. But talking about his woes, he said, has given him strength. "This group didn't take the virus out of my body," he said. "I still fall sick. I am still weak. But at least now I'm living."
     At one recent session, Mr. Lawuli chastised a fellow member, George Lubulwa, for failing to get tested. Mr. Lubulwa said he was fairly sure that he is H.I.V.-positive but would rather live without the certainty. He feared falling into depression again if the test is positive. His wife, he said, definitely could not handle the news. "He keeps telling us he'll go get tested," countered Mr. Lawuli. "But he doesn't do it." Mr. Lubulwa's big smile faded and he looked down solemnly. "I respect your advice," he said. "I'm still looking for the right time." There was an awkward silence. Then Mr. Lubulwa spoke again. "Let me tell you a secret close to my heart," he said. "I want a child. If I'm positive or my wife is positive, and we know it, maybe we won't get one." The men sitting around him had no mercy. They told him sternly that the child might be born infected, spreading the disease into a new generation. And they told him that his wife might not have the virus yet and that he might infect her. "I think I should go get tested," Mr. Lubulwa said finally.

On His Feet, After Many Battles With an Unseen Foe
Judy Tong, New York Times- 1/16/2004

Oscar Gonzalez remembers that it was just a couple weeks after he first tried heroin that he said to himself, "I don't want to use no more." But it was not as easy as that. He spent the next 31 years fighting and failing, trying to kick his habit. Mr. Gonzalez, 54, had been handed his first bag of heroin when he was 19, a recent arrival to the Bronx from the Dominican Republic. At the time it was normal practice for someone to trade a bag of heroin -- which cost about $2 -- for a safe place to shoot up. Some people asked him if they could swap a bag for his brother's apartment and then kept coming back until Mr. Gonzalez found himself with five bags of heroin. With the free bags in his hand and pressure from some new friends, he decided to just "taste it." After two weeks, he tried to quit for the first time. He failed for the first time, too.
      The only treatment available at the time, Mr. Gonzalez said, was methadone. But, "methadone is like another drug," he said, and only eases the physical pain of quitting. He was on and off methadone for 10 years, using it to balance his heroin use, and held a steady job as a machine operator, married and had children. And for a time, he said, his life just spiraled downward, as he found himself using up to two or three bags a day; he lost his job, his wife, his two girlfriends and his three children.
      One day he passed his brother, Nicholas Gonzalez, a pastor at the Pentecostal Temple of the Living God Church in the Bronx, on the street. His brother had been looking for him -- and Mr. Gonzalez had been hiding in shame. His brother took him to the Hope Christian Center, a drug treatment facility in the Bronx. He was clean for a couple of years after that, but says he realizes now that he did not make it all the way because he tried to do it on his own. He started using heroin again in the early 90's and over the next several years became homeless. After two more failed attempts at treatment, his latest, and he hopes last, attempt was with the National Recovery Institute in Manhattan in 2000.
      What was different about this time? First, Mr. Gonzalez said, he had at last had enough. And second, he said, it worked because he had a support network and was finally listening, even if he did not like what he heard. "When I used to go to the group, it helped me out a lot to recognize what I really had to work out."
      After graduating from the program, he moved into a group apartment run by New Vistas, a transitional housing program of the Neighborhood Coalition for Shelter, a beneficiary of the Federation of Protestant Welfare Agencies. The federation is one of seven charities supported by The New York Times Neediest Cases Fund. When Mr. Gonzalez moved in, he was given a lodging kit. The Neighborhood Coalition got $3,000 in Neediest Cases money to pay for 14 lodging kits, which included the basics needed for a new home: things like a blanket, an iron and pots and pans. After six months, he moved to St. Anthony's in the Bronx, a single-room-occupancy residence, where he now lives. Sitting in the shared kitchen recently, he talked about where he would like to be. Now, he works in a Queens factory as a packer. He visits his children and grandchildren, whom he sees every Sunday at church. He hopes to earn his high school equivalency diploma, and is also considering becoming a counselor to other addicts. "I would let them know that there is hope."

Teen Habits Die Hard for Middle-Aged
ABC News, 1/16/2004

A surprisingly high number of 35-year-old American women and men abuse alcohol and use illicit drugs. So says a University of Michigan study in the January issue of the American Journal of Public Health. The study of 7,541 people found more than 32 percent of men reported heavy drinking, defined as at least five drinks in a row, at least once in the two weeks before they were surveyed.
     Nearly 13 percent of men and 7 percent of women reported the use of marijuana in the previous month. Eight percent of women and 7 percent of men reported they misused prescription drugs in the previous year. "We found that substance abuse was surprisingly prevalent at the start of midlife. And we also found that it is not restricted to stereotypical drug users with low socioeconomic status," study author Alicia Merline, of the U-M Institute for Social Research, says in a prepared statement. She and her colleagues found professionals are as likely to use marijuana as people in other jobs. Nearly 10 percent of men with professional jobs reported marijuana use.

Use, Abuse Linked to Teen Habits
The researchers also found a strong link between cigarette smoking at age 35 and a person's high school experience. People who smoked in Grade 12 were 12 times more likely to be smokers at age 35, compared to those who had never smoked by their senior year of high school. The odds of being a smoker were 42 times greater for people who were daily smokers when they were in Grade 12. Even just trying cigarettes in high school increased the odds of smoking at age 35 by more than three times compared to people who never tried cigarettes in high school.
     The researchers identified similar patterns for episodic heavy drinking and for the use of marijuana and illicit drugs. For example, people who drank heavily in Grade 12 were three times more likely to be heavy drinkers at age 35 than those who weren't heavy drinkers when they were high school seniors. People who had tried marijuana by Grade 12 were eight times more likely to use marijuana at age 35. And those who had tried any other illicit drug other than marijuana by their senior year were five times more likely to use cocaine and three times more likely to misuse prescription drugs at age 35.
     The study found married women and men are much less likely to smoke, drink heavily, use marijuana or other illicit drugs, or to misuse prescription medicines than people who are single, divorced or separated.


Anti-Tobacco Efforts Have Grown Over 40 Years
David Wahlberg, Atlanta Constitution- 1/16/2003

ATLANTA -- Smoke filled airplanes, offices and schoolyards 40 years ago when the first surgeon general's report on the hazards of tobacco was released -- on Jan. 11, a Saturday, to minimize the impact on Wall Street. Today, smoking rates have dropped by half, cigarette ads are banned from radio and TV, and most smokers have tried to quit. But health authorities say the decline in smoking rates has reached a plateau. Tobacco marketing exceeds $11 billion a year. And states have spent much of their $40 billion windfall in tobacco lawsuit settlement money to balance budgets.
     Have the anti-smoking victories outweighed challenges? Most experts seem to call it a draw.
"The world is certainly a different place," said Tom Glynn, director of cancer science and trends at the Atlanta-based American Cancer Society.. But Dr. David Satcher, a former surgeon general and current director of the National Center for Primary Care at Morehouse School of Medicine, said smoking remains the nation's leading cause of preventable death. "Despite all that we know about smoking and health, over 50 million people (in the United States) are still smoking," he said.
     In 1964, Surgeon General Leroy Burney released his landmark 387-page report. The nation rallied against tobacco. Congress required warning labels on cigarette packages the next year and banned radio and TV ads in 1969. The government required nonsmoking sections in airplanes in 1973 and now bans smoking on all U.S. flights. And the rate of smoking began a steep decline: from 43 percent in the mid-'60s to 35 percent in the mid-'70s. It's now at just below 23 percent.
     Additional studies connected smoking to other types of cancer -- of the larynx, esophagus, mouth, bladder, cervix, pancreas and kidneys -- and found harmful effects in fetuses, such as low birth weight and respiratory distress. Researchers also discovered that nonsmokers suffer, leading the Environmental Protection Agency to classify secondhand smoke as a carcinogen in 1993.
     The decline in smoking has helped reduce lung cancer death rates in men by nearly 2 percent a year since 1991, with about 93,000 deaths a year now. Deaths among women haven't dipped, however, staying at about 80,000 a year, due to a slower decline in smoking among women.

Many Knew Daniel Was a Troubled Boy, But No One Helped.
Helen O'Neill, Associated Press- 1/17/2004

EDITOR'S NOTE -- There were national headlines last fall when a Connecticut jury blamed Judy Scruggs for her son's suicide following testimony that she kept a horribly messy house. But a close examination of the case by The Associated Press found that others involved in the boy's life failed him.

MERIDEN, Conn. --- The cemetery is cold and damp, and the mother shivers as she places a bouquet of dried flowers on her child's grave. She offers a silent prayer. She still clings to the thought that somehow her son's suicide meant something. Look at all that has happened because of Daniel, she says, pointing to the state's new anti-bullying laws and changes in the ways state agencies deal with troubled children. "God sent him on a mission," she says, "and he accomplished it."
     But Judy Scruggs knows her answer is not good enough. Two years after her 12-year-old hanged himself, she cannot visit his grave without being reminded that she has been convicted in connection with his death. And she cannot escape the questions that still hang heavy in the air. What if there had been a hero for Daniel -- a guidance counselor, or a teacher, or a social worker? What if his mother had been his hero? Would Daniel Scruggs be alive?
     There were no heroes in the life of Joseph Daniel Scruggs, except the ones he made up with his younger neighbor -- his best and only friend, John Murphy. They wrestled imaginary bad guys to the ground. They felled them with homemade spears. They dreamed about having magic powers like Harry Potter. "He was just a fun kid," said John, now 11.
     But John didn't see Daniel's other life, the one at Washington Middle School where he was shoved into desks and punched, where his things were stolen, where once his head was pulled back so far his neck nearly snapped. Small and slight, weighing just 63 pounds, Daniel had a pixie face and huge blue eyes and a different way of dealing with the world. He wore mismatched clothes -- camouflage pants and a plaid shirt -- and often he wore the same clothes for days. Sometimes, when he was jeered, he lashed back, only to get suspended for fighting. More often, he fled in tears.
     His mother considered him something of a genius, and everyone thought he was smart. In sixth grade his IQ was rated in "the very superior range" of 139. But sometimes he babbled in baby talk, or made strange chanting sounds, or hid under his desk. His breath smelled. He soiled himself in class. Other students nicknamed him "stinky." One teacher later told investigators that she held her nose whenever she passed him.
     There were indications Daniel had attention deficit disorder, that he suffered from depression. There were hints of all sorts of problems. But for all the signs of a child in crisis, no one intervened other than to document that Daniel was troubled -- not teachers, not the guidance counselor, not the police officer stationed at the sprawling urban school. In fact, a damning report by the state child advocate's office would later suggest that when Daniel skipped school for weeks at a time, no one seemed to care. It was easier not to deal with Daniel Scruggs. It was easier to look the other way.
     No one knows what happened that January night when Daniel meticulously tied one end of a dark blue tie decorated with wolves around a bar in his closet, and tied the other end around his neck. Daniel and half sister Kara, then 17, had been up late, watching the movie "Pearl Harbor" and eating spaghetti. Their mother, a teacher's aide in Daniel's school, who also worked part-time in Wal-Mart, had gone to bed early.
     One of many regrets of Judy Scruggs is that she didn't check on Daniel when she heard a banging from his room that night. She didn't check on him in the morning either, assuming he was asleep in the large closet -- his "fort" -- where he often slept. It wasn't until she got home that afternoon that she asked Kara to get her brother.
     For months after his Jan. 2, 2002 death, Daniel's sweet smile seemed everywhere -- radiating from newspapers, television news and national magazines. Students came forward with tales of how Daniel had been a walking target, picked on almost daily. The state child advocate's office investigated. Parents formed an anti-bullying organization. The state legislature passed anti-bullying laws.
     There was so much guilt and so much blame -- and at the heart of it all, a question no one could answer. What drove the seventh-grader to take his own life? The school blamed Daniel. He was a bright child, staff told investigators. If he applied himself and behaved, things would have been better for him. "Many of the professionals interviewed intimated a level of acceptance for the way Daniel was treated," the child advocate's report stated later. "Their statements implied that . . . he was bringing it on himself through his own anti-social actions." The mother blamed the school, saying it should have protected her son from bullies. She hired a lawyer and filed suit.
     In an extraordinary move, police blamed the mother, saying conditions in the home, where clutter filled the rooms and a putrid smell filled the air, amounted to criminal neglect. On April 23, 2002, nearly four months after Daniel's death, they charged Scruggs, then 50, with risk of injury to a minor. "They might as well have charged me with murder," she says bitterly.
     Judy Scruggs is a small, rumpled woman with short blonde hair and eyes swollen from tears. She has no criminal record, other than the one in connection with her son's death. Her living room is still the cluttered mess described in the police report, and she apologizes for it. "Granted, I'm not the best housekeeper," Scruggs said. "But I loved Daniel and he loved me and nobody can judge me on that."
     But many have judged Scruggs: the media, the schools, her own family. After Daniel's death, her 26-year-old son, Marc Griffin, went public with his anger against the mother he felt had abandoned him, leaving him and his two older sisters to be raised by grandparents. Scruggs says she wishes she had been a better mother to her three older children. She says she tried to do better with Kara, whose father died in a drowning accident, and with Daniel, whose father abandoned the family when his son was an infant. She even found a job in Daniel's school, hoping to watch out for the son she knew was different. Scruggs shakes her head at how ironic that sounds now.
     At home, Scruggs described a happy child, always rustling up concoctions for dinner or curling up in his closet with Harry Potter books. He talked about being a motorcycle cop, but his mother thought he'd wind up a stage performer. Daniel was always so dramatic. At school, she knew he was picked on by one student in particular. When Scruggs rebuked the boy for targeting her son, Daniel was furious. "Mom!" he cried. "You've only made things worse."
     Detective Gary Brandl's face contorted when he described Scruggs' 3-bedroom apartment on Camp Street on the day of Daniel's death. From the outside, he thought the pale green house looked "cute." Inside, living conditions were "appalling and unsafe," Brandl wrote in the arrest affidavit, with "piles of debris, clothing, junk and other clutter." And the boy's twisted body lying amid the mess.
     The veteran detective agonized over the arrest, knowing how heartless it would seem. In the end, he said, the evidence was overwhelming, and not just because of the clutter. Daniel had used his mother's credit card to access Internet pornography; kitchen knives were found lying near the boy's body; and years ago, when Daniel was a baby in Virginia, the state had briefly investigated neglect allegations. "This isn't about bullying," Brandl said. "This was a straightforward case of neglect." But even he acknowledged others should have helped Daniel. Why, Scruggs asks, is she the one labeled a criminal?
     No one knows why Daniel chose to end his life the night before the start of school, or whether the date had any significance. His life had been on a downward spiral for so long. His grandparents died within months of each other at the end of 2000. Then Kara suffered a miscarriage. Daniel, struggling with a transition to middle school, seems to have become lost in the family's troubles. The sweet, gifted child described by elementary school teachers disappeared. By the fall of 2001, Daniel stopped doing homework. His mother could no longer get him to bathe. At home, he spent more and more time in his closet. At school, he spent more and more time in fights. Later, witnesses would tell investigators that Daniel was tormented daily -- pushed into bleachers in the gym, his food thrown on the floor.
     On Dec. 4, 2001, Scruggs met with school officials and complained about the "verbal and physical intimidation," saying it was the reason for his poor attendance. According to the minutes, officials concluded that Daniel "had initiated many of the incidents by passive-aggressive behavior."
Once, after a friend told her Daniel's life had been threatened, Kara confronted her brother.
"Is anyone messing with you?" she asked, "'Cause I'll come in and beat them up."
"NO!" Daniel cried. "I'm fine. I can take care of myself."
     There were many people who should have taken care of Daniel. There were even some who tried: the drama teacher who gave him a part in "Fiddler on the Roof," the Cub Scout leader who took him camping. But for the most part, professionals who could have intervened -- teachers, the guidance counselor, the principal, the school nurse, social workers, the truancy officer -- did little other than document his problems and give his mother lists of community services.
     The school did transfer him to a class for disturbed children two months before he died. And they talked to Daniel himself. He told everyone the same thing. He was afraid to go to school. "What could I do," his mother said, "carry him? By Christmas of 2001, Daniel had missed 45 out of 78 days.
     Later, it was easy to blame Scruggs for not being a better parent. Too easy, said Connecticut child advocate Jeanne Milstein. "When a parent is unable or unwilling to take care of a child," she said, "the law has established a safety system for that child, people mandated to report to the appropriate authorities if they see a child in trouble." "That safety system," Milstein said, "failed Daniel at every level."
     A 41-page report, prepared by Milstein's office, described in chilling detail, the extent of that failure: "The child welfare system, the juvenile justice system, the educational system, and his family all failed to see the symptoms of physical and mental illness that Daniel was presenting in his truancy, poor hygiene and poor school performance. The adults involved in the young boy's life simply assumed he refused to do better." The report, issued a year after Daniel's death, doesn't gloss over the mother's responsibility. But it reserves ultimate condemnation for the school staff and state social workers. On Oct. 26, 2001, the guidance counselor called the state's child abuse and neglect hot line saying, "Daniel is out of control." "Daniel has become a very uncooperative young man," she wrote the same day. "The major areas of concern are his extremely poor hygiene and his refusal to attend school."
     On Dec. 4, in response to the hot line call, a social worker from the state Department of Children and Families visited Scruggs' home. "The children have proper space and bedding and there is adequate food in the house," she reported, adding that Daniel's problem was one of "educational neglect" that should be handled by the school. The department closed the case on Dec. 27. Six days later Daniel hanged himself. "No one took responsibility for the child's death," Milstein's report concluded. "Everyone was responsible."
     The fallout from the child advocate's report was swift. The state Department of Children and Families vowed to investigate. School officials however, insisted that they had gone out of their way to help Daniel. School superintendent Elizabeth Ruocco said the report didn't focus enough on the child's home problems.
Other school officials, including the nurse and guidance counselor, refused comment. So did prosecutor James Dinnan, who, for two weeks last fall tried to persuade a jury that the mother's neglect contributed to her son's death. "A cluttered home is not a crime," Scruggs' lawyer, M. H. "Reese" Norris told the court, arguing that the bullies who tormented Daniel and the teachers who failed him were the cruel and neglectful ones. Dinnan used photographs of the house to suggest a level of neglect and dysfunction far deeper than piles of debris. Parents, he argued, are ultimately responsible for the welfare of their children.
     Later, the five men and one woman on the jury said it was police photographs of three kitchen knives strewn in the closet near Daniel's body that convinced them. They acquitted Scruggs of all but one of the charges brought against her, but found her guilty on one count of risk of injury. Norris has filed an appeal. "We'll fight this," Norris assured Scruggs. "It's not over yet."
     Scruggs wasn't so sure. She had lost her son. She had lost her jobs. (Wal-Mart fired her after her conviction, and the school gave her a severance package.) And she faces a possible sentence of up to 10 years, although her lawyer says she will probably receive probation. It will never be over, she thought, as she pushed her way through the media mob outside the court. In her mind Scruggs can still hear Kara's scream. And she can still see her son, neck bent, palms blue, the life choked out of him by the tie she had given him for Christmas. Once she went to a psychic, searching for reassurance that the end had been quick, that there hadn't been much pain. But only Daniel can tell her that. And he didn't leave a note.
On the Web: http://www.oca.state.ct.us/

Missing Actor Gray Long Battled His Fears
Justin Glanville, Associated Press- 1/17/2004

NEW YORK -- Before he disappeared last week, Spalding Gray had been performing early versions of a new work that had long bedeviled him - a monologue about a car wreck more than two years ago that left him physically and emotionally scarred. The subject matter was harrowing even by the standards of a performer who, in 18 monologues since 1979, has touched on such sensitive topics as his mother's suicide, his struggles with writer's block and his search for spirituality.
But for Gray, publicizing his thoughts has never been about just performing. It's how he comes to terms with the events of his life.
     "It's a way of framing his experience and coping with a series of loose ends," says his brother, Rockwell Gray, an English professor at Washington University in St. Louis. "The introspection was a big part of the strength that made these things so much more than sit-down comedy, as some people called them. There is a lot of mind to them."
     His family last saw him Jan. 9, when he walked away from his SoHo apartment without his wallet after having seen the movie "Big Fish" with his wife, Kathleen Russo, and one of his sons. There have been subsequent reports that he was seen on the Staten Island ferry later that night, and Russo has said she fears he may have tried to jump off the boat. Gray officially becomes a missing person Monday.
     Dealing with his thoughts on stage "pretty much comes naturally to him," Russo says. "This is a man who never had stage fright. It's the perfect suit for him." "Swimming to Cambodia," the piece for which he may be best known, begins as a memoir of his appearance in the film "The Killing Fields" but veers into digressions on love, Cambodian politics and nuclear warfare. Other works include "Monster in a Box," which riffs on his failed attempts to finish a novel, and "Gray's Anatomy," a humorous recounting of his quest to cure an eye condition. All three monologues were made into films.
     In each monologue, Gray cuts an instantly recognizable figure: a slight, wire-haired man seated behind a desk, equipped with only a microphone, a glass of water and a spiral notebook. His only movement is his expansive gestures and darting eyes. Yet the defining feature of his work is its intensely autobiographical nature. Real figures in his life -- wives, children, work associates -- appear often, in sometimes less-than-flattering portrayals. "He was a pioneer in saying that the border between the private and public is a very blurry boundary," says Richard Schechner, founder of The Performance Group, a downtown Manhattan theater troupe Gray joined in 1970. Schechner directed the actor in off-Broadway productions of "Mother Courage" and Jean Genet's "The Balcony," among others.
     But while Gray has acknowledged insecurities in his monologues, he never conveyed the depths of his periodic depressions, Schechner says. "His theatrical persona was of someone who always saw the humor and irony in life, but as an actual person, he battled depression and fears," he says.
A particularly low period came after Gray's auto accident in Ireland in 2001, when a van plowed into a car he, his wife and three others were driving during a vacation to celebrate his 60th birthday. He suffered a fractured skull, a broken hip and nerve damage, injuries from which he has yet to recover fully. An avid skier and hiker, Gray became despondent about his physical limitations. "I have lost my sense of humor since the accident," he told The Salt Lake Tribune in March 2003. "I get up to walk, and I limp and I remember the accident."
     He tried suicide several times, including an attempt in late 2002 to jump off a bridge near his second home at the east end of Long Island. A passer-by talked him down. Even his family, which had been the subject of an affectionate recent monologue called "Morning, Noon and Night," no longer provided solace, he told several interviewers. He has a stepdaughter and two sons with Russo, whom he married 10 years ago. "I used to criticize him all the time: Just don't reflect on things too much, don't overanalyze, just go on," Russo says.
     Gray had been giving readings of his piece about the car accident - "Life Interrupted" - as recently as two weeks ago. He had struggled for years to shape his thoughts on the incident, Russo says. "He could talk about the car accident but he didn't know where to go after that. Until he has distance it's tough for him to write about something," she says.
     An agony-filled week after his disappearance, his friends and family are left ruminating over the same unanswerable questions: How could he leave the family that had once given him so much joy? Was the master of introspection too inwardly focused for his own good? Yet the family remains hopeful. "As far as I'm concerned, the story is still open," Rockwell Gray says. "My hope is still that he will be able to continue and come back." "I'm not prepared to speak of him in the past yet," says Schechner. "He could still very well turn up - he's lived in many ways a wondrous life."

Police, Mentally Ill Can Make Lethal Combination
Roma Khanna & Steve McVicker, Houston Chronicle- 1/18/2004

Five years after the Houston Police Department began training to better deal with people in mental crisis, such interactions continue to end violently, with an officer shooting someone with mental problems. HPD officers have shot at least nine people with known mental illness in the past five years, seven of them fatally, according to a Houston Chronicle review. In at least six other shootings, the victim's behavior suggests a possible mental episode. Four of those shootings were fatal.
     The number of shooting deaths is comparable to the findings of a similar review undertaken after the Jan. 20, 1999, shooting death of Sheryl Ann Seymour, a schizophrenic woman who was shot by an HPD officer after brandishing a kitchen knife. Seymour's death propelled the issue into public view, and HPD months later began to assemble a cadre of officers trained to intervene with people in mental crisis. That training has led to significant, measurable improvements. Almost 25 percent of HPD officers are on the Crisis Intervention Team, about the recommended average, and officers have taken a steadily increasing number of people to the hospital for psychiatric help instead of jail. "We have improved our ability to deal with people in crisis," acting Police Chief Joe Breshears said. "We are better prepared to recognize these individuals and deal with those situations."
     Yet these efforts are diminished by key shortcomings, such as the failure to deploy crisis-trained officers when they are most needed. HPD records show that on average, the Crisis Intervention Team responded to less than 27 percent of the calls for a CIT member received in the last six months of 2003. Emergency 911 dispatchers often fail to identify calls about people experiencing mental problems, assigning untrained officers to handle the crucial first interactions with them, according to both advocates and critics of the training program, including Breshears. Furthermore, officers complain that the department has not provided adequate access to nonlethal weapons.
     The Chronicle reviewed the initial reports from 167 shootings by Harris County law enforcement officers from 1999 to the present. In the nine HPD shootings involving known mentally ill people, only one of the officers who fired his gun had received crisis intervention training, according to department records, and CIT officers attempted to intercede before only one other shooting. In September 1999, the Chronicle identified six people known to be mentally ill who were killed by an HPD officer in the five years before the CIT was developed. The relatively constant number of fatal shootings, even as the total number of police shootings declined, suggests that the department's strides in crisis intervention have had little impact on the most serious encounters. "No one can make a case to say that things have improved when the numbers haven't changed," said Arlene Kelly, whose daughter, Colleen, suffered from chronic depression. Police, responding to reports that she was suicidal, shot and killed her when she did not drop a bag they feared contained a gun. It did not.
     Quantifying the number of police interactions with the mentally ill is, at best, complicated. Unlike age, race and home address, police can rarely report a person's mental status. Even if it were recorded, experts say, a population of people who have never been diagnosed and have little access to mental health care would remain uncounted. Texas ranks 47th among states in per capita spending on mental health. For example, among those shot over the past five years is a man who charged at a police officer with a screwdriver as the officer investigated reports of a suicide in progress. In another case, family members told police that a man shot to death after a five-hour standoff with a SWAT team had been depressed. No conclusions were reached immediately about these people's mental health. But even without the borderline cases, some say, HPD's record of shooting people with mental illness exposes an enduring problem.
     "This is a cultural issue," said Kelly, who helped found Civilians Down, a support group that monitors police shootings, after her daughter's death. Kelly has found that most officers still are unprepared to provide the type of help needed by people who are suicidal, paranoid or delusional.
"It is cop culture to intimidate you and use force," she said. "They are taught to look at all situations through the same lens."
     Others argue that violence sometimes is inevitable when the lives of police -- trained to use force when in danger -- and the mentally ill -- whose sickness may make them appear dangerous -- intersect. "You have to understand that it is very difficult for police officers to assess whether they are dealing with a mentally ill person instantaneously, because there are doctors who take hours to come up with a diagnosis," said David Klinger, a University of Missouri-St. Louis professor and expert on police shootings. "The sorts of behaviors that could be indicative of mental impairment could also be signs of a lot of things that could make a person dangerous."
     Calling such shootings unfortunate, Breshears said the safety of both the officers and others present must be a priority. "We try to teach them to combine CIT training and safety training," he said, "but when an officer is put in a dangerous situation, they have to take what action is necessary."
     One of the most publicized fatal encounters was the shooting death of Seymour, who was killed after she called paramedics to take her to a psychiatric hospital. A diagnosed schizophrenic, Seymour knew she was having an episode. When the paramedics arrived, accompanied by police, she was fully psychotic. A slight woman who stood barely 5 feet tall, Seymour advanced with a kitchen knife and police shot her. The death prompted questions about HPD's protocol and why officers had not used a nonlethal weapon to subdue Seymour. Shortly afterward, then-Police Chief C.O. Bradford expanded the deployment of weapons such as Tasers, hand-held devices that deliver electric shock, that previously were given only to sergeants. He also initiated a review of police shootings.
     Later in 1999, HPD implemented a program that would come to be known as the Crisis Intervention Team and that had been in development for years. Sixty officers received intense training on dealing with the mentally ill. The next year, Bradford insisted that every officer receive at least eight hours of training. In the past five years, the all-volunteer CIT has grown to about 650 officers.
     Officer Frank Webb coordinates CIT training, which comprises a 40-hour initial course and an annual eight-hour refresher course. The training includes classes on improving an officer's communication skills and role-playing in simulated mental health-related situations. Perhaps the most important part of the course, Webb said, is the interaction officers have with a mentally ill person.
"It really does work," Webb said. "And it's almost paradoxical. (Police officers) are used to using force to get people under control. But in these situations, by taking a less authoritative approach you end up having more control over the person."
     The strides HPD has made in its approach to the mentally ill seem insignificant to Belinda Stomski, whose suicidal daughter died after a confrontation with police. Rachel Michelle Taylor, 28, had just recovered from years of debilitating back problems and gotten a job when her life ended. Suffering from severe depression, Taylor woke up angry on Nov. 23, 2002. Stomski said she left the house in a rage and attempted to kill herself by crashing her truck into a tree. "She came back to the house and just kept saying, `I can't do this myself; I can't do this myself,' " Stomski said. "And then she picked up the phone and pretended to be me and told the 911 dispatcher that she was having problems with her daughter." When the police arrived, Stomski met them in the driveway. "She is not in her right mind," she told them. The officers, according to Stomski, began to discuss how to get Taylor out of the house. She came out of the house on her own, with a gun. Stomski struggled with her daughter and tried to persuade her not to shoot. The officers pulled Stomski away out of concern for her safety and shot Taylor. "I know my Rachel's case is different because she had a gun and that they call this sort of thing suicide by cop," Stomski said. "But I just wish there had been someone there who might have known how to talk to her, who might have known what to do."
     Police supervisors and mental health advocates both say 911 dispatchers must improve their methods for identifying when to call a CIT officer and for deploying trained officers promptly. Even Breshears refers to dispatch as a "continuing problem." Maj. Sam Cochran, who leads the Memphis, Tenn., police department CIT, considered among the best in the nation, said the situation is not always so clear when the calls come into the emergency center. Memphis dispatchers receive regular refresher training, including a 16-hour course they recently completed, he said.
     When the Houston program began, all dispatchers and call-takers received a two-hour block of instruction on how to identify scenes where a CIT-trained officer should be the primary unit, said Webb, who thinks it is time for more instruction. "I'd like to see the numbers (where CIT is the first responding unit) a little higher than they are," Webb said. "It's been about three years since we did the original (dispatch) training. And we're trying to get back in now and retrain them." Breshears said the problem has been addressed with training, but, with turnover and other factors, it returns over time.
     Sgt. Johnnie McFarland, who supervises HPD dispatchers, takes exception to singling out them and call-takers. "If they feel more training is needed, that's all fine and good," McFarland said. "I agree with a refresher course. But the problem I have with it is, are there enough CIT units on the streets? And do they have enough (nonlethal) tools like Tasers and bean bags if it comes to that?"
     Two incidents in February 2000 demonstrate the utility of nonlethal weapons. In the first, a man was standing in the street striking passing vehicles with a baseball bat. He began to swing at responding officers, who used a beanbag shotgun to subdue the man and take him to the hospital without further problem. That same week, a mentally ill man accosting pedestrians on a downtown sidewalk became combative. Officers subdued him with a Taser and took him to the hospital. They obtained a mental health warrant so that he could be evaluated and treated.
     Yet, Hans Marticiuc, president of the Houston Police Officers Union, said officers do not have enough access to nonlethal weapons; though HPD has expanded its stock of alternative weapons, officers are still limited to one per patrol district. "There is no doubt that we have improved, but if this is a priority the department needs to make a commitment to things like making more nonlethal weapons available," he said. Breshears said he was unaware of such complaints but is willing to look into them. As Marticiuc sees it, the fate of progress on these issues lies in the hands of the new mayor and a police chief, who has yet to be named. "When you looked at it, this issue came to the forefront and changes were made under Chief Bradford," he said. "Where we go from here and what type of commitment we get from the department is to be determined."

Boston Area Mental Health Services Widened
Brenda J. Buote, Boston Globe- 1/18/2004

     As President Bush continues to push plans to improve access to mental health services nationwide, several hospitals in Boston's northern suburbs are taking steps to enhance their care of people with behavioral or mental health needs. In recent months, hospitals from Lynn to Newburyport have invested tens of thousands of dollars in programs that seek to improve medical treatment for those who suffer from problems ranging from depression and anxiety to psychotic disorders such as schizophrenia.
     Several area hospitals -- including Anna Jaques Hospital in Newburyport, Salem Hospital, and Union Hospital in Lynn -- have behavioral health experts on-call 24 hours a day and carefully monitor patient records in hopes of detecting early any pattern of mental illness. In addition to those efforts, Melrose-Wakefield Hospital and behavioral health professionals in Beverly integrate acute and psychiatric care.
     The holistic approach helps curb costly emergency room visits and shortens the length of time patients remain in the hospital, according to health officials at Hallmark Health, owner of Melrose-Wakefield Hospital, and Health and Education Services Inc. of Beverly, which provides behavioral health services to patients of the Northeast Health System. The health care system operates Addison Gilbert Hospital in Gloucester, Beverly Hospital, the Hunt Center in Danvers, and BayRidge Hospital in Lynn.
     "An elderly patient who is a diabetic and suffers from depression has several health care needs," said Janet Lensing, systems director of behavioral health for Hallmark, the health care system that includes Lawrence Memorial Hospital in Medford and the Malden Medical Center, as well as Hallmark Health VNA Inc., which provides home health care services to about 650 patients in Malden and 23 other communities north of Boston. "Traditional medical units could treat the diabetes, but would not be able to treat the depression, and a traditional psychiatric unit would be able to treat the depression, but would not address the diabetes," Lensing said. "By integrating our services, we are able to treat both simultaneously; it cuts down on the amount of time a patient spends in the hospital and results in a better outcome."
     Individuals who are mentally ill are three times more likely than the general population in Massachusetts to die of suicide, homicide, or accidental injury, according to the state Department of Mental Health. The mentally ill also have higher rates of cardiovascular and respiratory diseases than the general population, and often receive inadequate physical health care. In an effort to improve those statistics and better the lives of residents who grapple with behavioral health issues, Health and Education Services last month launched a program that integrates acute care and mental health services by providing primary care for the seriously and persistently mentally ill. "Because seriously and persistently mentally ill patients often do not receive the routine primary care they need, illness, and mortality rates for this group are typically higher than that of the general population," noted Judith Boardman, vice president for quality management at Health and Education Services. "By placing a qualified health care professional in the behavioral health setting, we hope to improve their access to care and create a model of integration that is sustainable and can be replicated throughout the entire Northeast Health System."
     Those who suffer from mental illness often have difficulty accessing appropriate medical care, and many have no health insurance or primary care doctor, according to health advocates. As a result, they often end up seeking emergency care for minor injuries and illnesses. Health and Education Services offers acute care to mentally ill patients one day each week at its Salem clinic. So far, about a dozen patients are enrolled in the program. Boardman would like to expand the program to 150 patients and this month secured a $20,000 grant from Blue Cross-Blue Shield of Massachusetts to aid the effort.
      "The nurse is very thorough," said Ken Gilbert, 54, who was among the program's first patients. Gilbert has a primary care physician but prefers to visit the Salem clinic because it's within walking distance of his house. He suffers from depression and high blood pressure, which must be closely monitored. Nurse practitioner Kathleen Belmonte ''takes the time to answer all of my questions," Gilbert said. ''Right now, she's helping me get my diet under control by making a list of the foods I can eat, and the ones I need to avoid."
     Boardman said the human services agency decided to provide primary care to mentally ill patients at its Federal Street clinic after completing a six-month study last year. The study found that mentally ill patients used the emergency departments at Beverly Hospital and Addison Gilbert six times more frequently than the general population. The study also found that when mentally ill patients were given access to primary care, they were able to better manage chronic diseases, such as diabetes and hypertension. As a result, they visited the emergency room less frequently. During the study, emergency department visits fell 42 percent among patients who had access to the nurse practitioner at the Salem clinic, Boardman said.
     The goals of the area programs are in line with Bush's efforts to improve mental health services across the country. The president's Freedom Commission on Mental Health, established in April 2002, strives to reduce the stigma attached to mental illness, improve access to mental health services, eliminate disparities in mental health services, and provide better coordination between mental health services and primary health care, according to the commission's mission statement.
The goal of the commission is to ensure "everyone with a mental illness at any stage of life has access to effective treatment and supports -- essentials for living, working, learning, and participating fully in the community."

Anger Management Counseling Is Increasingly Recommended
Martin Miller, Los Angeles Times- 1/19/2004

Anger is practically a daily ritual of our lives. From Los Angeles' traffic-choked freeways to the pop culture scene, it seems we can't get to work without someone flashing an inappropriate finger or to bed without witnessing the latest celebrity fit or fisticuffs on the Jerry Springer show. Angry outbursts are now almost expected and encouraged as much for their sheer entertainment as for their redemptive value when used to explain away bad behavior. Just ask anyone who has worked on a television show or movie set in Hollywood. And most recently, baseball great Pete Rose blamed his gambling and lying in part on anger — something called "oppositional defiant disorder," a condition characterized by physical aggression and usually associated with children.
      Into this stewing societal caldron has come "anger management," whose aim is to teach people to handle hot emotions without losing control. The past doesn't matter so much, as it does with psychotherapy, as the "now." Courses lay out how to deal with anger in the moment — a strategy that promises to improve personal relationships and lessen the chance of blowing up and getting fired or tossed in jail.
      In recent years, the workplace, long-suffering spouses and the judicial system are chiefly responsible each year for channeling tens of thousands into anger management classes — and those figures are expected to rise. Every time a celebrity — from boxer Mike Tyson to actress Shannen Doherty — was ordered to attend anger management classes, the program got a boost in name recognition, and many instructors noticed an uptick in clients.
      Last year's "Anger Management," a film that co-starred Jack Nicholson, who in real life once smashed a car windshield with a golf club during a traffic dispute, heightened the program's national profile. In fact, anger management instructors say, the comedy helped remove some of the shame angry clients had in asking for help. "It's part of the zeitgeist," said Redford Williams, director of behavioral medicine at Duke University Medical Center in Durham, N.C.
      In the last couple of years, more and more business and governmental organizations have enlisted anger management services not only to treat hotheaded employees but also to stave off problems before they emerge. Federal postal workers, state prison guards and business leaders — who can pay more than $2,500 for one-on-one "coaching" — have taken workshops and seminars for anger management. Some medical schools, such as the University of Miami's, are putting medical students through special training to help them better cope with their own — and their patients' — anger.
      The judicial system has created the biggest demand for anger management training. Judges across the country use the programs as a means to ease overcrowding in prisons and jails, and unclog courtroom calendars, said Pam Hollenhorst, associate director of the Institute of Legal Studies at the University of Wisconsin in Madison, who led one of the few comprehensive studies of anger management research. It may cost a county jail from $50 to $100 a day to lock up a defendant for road rage, physical assaults or disturbing the peace. Or the courts can release the defendant and order him to enroll in an anger management course. "For these kinds of offenses, I think the courts were finding that putting someone in jail for two to six months wasn't doing the trick," said Jerry Deffenbacher, a professor of psychology at Colorado State University who studies anger and anger management. "So anger management developed as another tool to attack the problem."
      Anger management classes can vary quite a bit. But most share basic principles of psychology — understanding, identifying and learning to control angry emotions and employing relaxation techniques to minimize the physiological responses to anger. Most classes, usually led by instructors with backgrounds in social work or counseling, help clients decide what is worth getting angry over and what isn't. And when anger is appropriate, how to behave assertively — not aggressively and destructively — to get what you want. Programs, which may last from 10 weeks to almost a year, cost from $150 to about $1,000. In part because of the quick rise in popularity of such classes, no local, state or national standards govern what should be taught in anger management or who is qualified to teach it. Although precise figures are difficult to come by, some estimate that about 7,000 people have been trained nationwide to teach anger-related courses.

Effectiveness questioned
Moreover, there is scant research on anger management to suggest whether these programs work. A few small studies, mostly involving prison inmates and juvenile offenders, have suggested the classes are helpful in discouraging aggressive behavior, but there is no conclusive evidence that they do any good within the general population. Mental health professionals aren't convinced the programs work. The American Psychological Assn., based in Washington, D.C., and representing psychologists, has said that such programs can be beneficial. But the American Psychiatric Assn., an Arlington, Va.-based group that represents 35,000 physicians, has not taken an official position. "We don't really know enough about what type of anger management program is best," said the University of Wisconsin's Hollenhorst. "Or for whom it works, under what circumstances, or for how long."
      Without regulation, some advocates of anger management programs are concerned that the field won't be taken seriously and that its reputation could suffer. "There are as many ways to approach anger management as there are people," said W. Doyle Gentry, a clinical psychologist and director of the Institute for Anger Free Living in Lynchburg, Va. "And it's created a lot of confusing, even bizarre, methods that can't be taken seriously. I mean, if they ask you to beat a mattress with a tennis racquet to work out your anger, it's not going to do you any good."
      Anger management advocates say California is poised to take the lead in setting standards for the field. In 2001, the state became the first in the nation to enact a law giving judges the power to order drivers charged in road rage cases to complete anger management courses in addition to, or in lieu of, suspending driving privileges.
      Regulations to standardize anger management are slowly being drafted, modeled on techniques used in domestic violence prevention programs, said George Anderson, a psychotherapist and founder of Anderson & Anderson, an anger management business in Los Angeles that claims to have trained about 4,500 instructors. Anderson, who helped author the state's domestic violence legislation, has been working with Assembly Speaker Herb Wesson (D-Culver City) and other state leaders to establish standards for materials, teacher qualifications and an overall curriculum for anger management. But given the state's current budget crunch, progress isn't expected any time soon. "The state isn't going to have the money to implement it now," said Anderson, who gets nearly 40% of his clients from county court referrals. "It would amount to an unfunded mandate, and those are ignored."
      Further complicating efforts to regulate the profession is the American Psychiatric Assn.'s designation of anger as a symptom of other, more serious, mental disorders and not a genuine condition of its own, say advocates. Without the kind of recognition accorded such disorders as major depression, the field of anger research is unlikely to attract much funding. Dr. Darrel A. Regier, the director of research at the American Psychiatric Assn., said anger management programs lacked a body of research demonstrating their effectiveness, adding that designing such studies won't be easy. It is likely, he said, that many people who go through anger management training have other conditions, such as bipolar disorder or substance abuse problems, that would predispose them to aggressive behavior. That would pose a difficulty for researchers trying to evaluate the programs. Beyond that, other critics contend that dozens of hours of anger management cannot miraculously change years of negative behavior, particularly if the person returns to the same environment that allowed it to fester.
      Advocates agree that one key area of research must be resolved: Does anger management help people who are placed in such programs involuntarily? Although no figures are available, anecdotal evidence indicates a majority of participants go to classes grudgingly or unwillingly, as a means to avoid fines, jail time or the loss of employment. "If you get a guy who is saying, 'I don't have a problem, the world just needs to get off my back,' he's probably not going to change," said Deffenbacher, the Colorado State University researcher who is working with the federal Centers for Disease Control and Prevention in Atlanta to study what types of programs might be effective for road rage drivers. "If we're going to require anger management interventions, we really need to find out if they work and under what conditions."
      Denial of anger isn't the only indication someone might be having trouble with their temper. In addition to the obvious clues — excessive drinking, physical fights, hair-trigger tempers — psychologists say high levels of anger over time can cause physical illness, including headaches and upset stomachs. Psychologists quickly add that feeling or showing anger in and of itself doesn't mean it's time to enroll. Anger is a natural, even healthy, response to certain situations. Without industry standards, there's no consensus on exactly when someone should seek anger management treatment. But generally, most in the field agree that people whose bad tempers erupt daily or alienate family, friends or co-workers are probably good candidates. (Likewise, constant, silent stewing, even when not expressed, is widely regarded as a sign it is time to seek help.)

Easing job stress
On a recent Saturday morning in Los Angeles, a group of four people have come to an introductory class offered by Anderson & Anderson at its Wilshire Boulevard offices. Some of the students are interested in becoming instructors; others hope to gain better control of their own anger. Renee Moncito operates a family services agency in Los Angeles where tensions can run high. Moncito said she was looking for ways that she and her staff can cope with stress. "You have to stay in a 'help' mode," said Moncito. Television producer Carol Trussell said she had witnessed her share of screaming, yelling, even fistfights on Hollywood sets, and she was looking for a way to improve the workplace atmosphere. "I've had several employees, good employees, who have come to me and said, 'Sorry, I'm leaving. I'm not going to take this. I don't care how much you pay me.' " she said. "The networks and the studios are beginning to realize anger is an issue in our business that we have to deal with."
      Anderson's classes focus on different topics each session — strategies for handling high-risk situations in one class, developing emotional intelligence in another. But this morning's class was introductory, and the students were asked to explain to the group what had brought them there. The class included one man — a young husband and new father — who said his wife had urged him to seek help after he erupted in anger at her when she put their toddler to sleep for a nap without a diaper. "I've been told I'm a mean person," he said with his head bowed. "I'm very hard on people who don't see things my way," said the man, who asked that his name not be used. "I know what the solution is, but I can't seem to do it when I'm angry."