New Book Clears the Air About an Unspeakable Crime
Susan Reimer, Baltimore Sun- 2/15/2004

On the morning of June 20, 2001, shortly after her husband, Rusty, left for his job at NASA in Houston, Andrea Yates drew a tub full of water in the guest bathroom and, one by one, held her five children face down in the water until they stopped struggling and drowned. She carefully placed the bodies of John, Paul, Luke and 6-month-old Mary on a bed and covered them with a sheet. The oldest, 7-year-old Noah, was the last to die. He put up a fight, and his body was left floating in the tub. Calmly, Andrea Yates called 911 and asked for a policeman to come to the house. Then she called her husband and told him he needed to come home. "Is anybody hurt?" Rusty Yates asked in panic. "Yes," Andrea answered. "Who?" "The kids." "Which ones?" Rusty asked. "All of them," she answered.
     Thus did one of the most unspeakable crimes, committed by a woman of unfathomable mental illness, unfold. It is the subject of a new book by journalist Suzanne O'Malley, Are You There Alone?, a haunting title taken from the question the 911 dispatcher asked when trying to determine what in heaven's name had happened to the woman on the other end of the phone. The murder of her children by Andrea Yates began a national debate that continues and is the cornerstone of the appeal that will be filed this month by her attorneys.
     On one side are those, including the woman district attorney who prosecuted her, who believed that Andrea Yates should be executed. That, by her own confession, she knew what she was doing when she killed her children. On the other side are her supporters, who wanted to know just how crazy you have to be to get a a verdict of not guilty by reason of insanity. Andrea Yates had tried to kill herself twice. She had been hospitalized for psychiatric problems four times. She was regularly catatonic. She hallucinated. She said Satan was inside her and the only way to save her children from him was to pack them off to heaven.
     Today, Andrea Yates drifts in and out of her mind in Rusk Penitentiary in Texas. She is serving a life sentence and will be eligible for parole in 2041, when she is 77. Her husband, Rusty, at first vilified as an uptight engineer whose religious fundamentalism required Andrea to mass-produce children for whom she was too ill to care, never misses the twice-monthly visits he is allowed.
     O'Malley, who believes that Andrea Yates is the victim of a bungling and insensitive mental-health system, doomed by an equally insensitive criminal-justice system, is a player in her own narrative. Andrea Yates was saved from a possible death-penalty sentence when O'Malley was able to prove, with just minutes to spare, that a key prosecution witness had lied: There had never been an episode of Law & Order -- Andrea's favorite television show -- that had depicted a mother claiming postpartum depression after murdering her children. The witness said Yates had been inspired by the show.
     O'Malley's detailed recounting of Andrea's mental-health records dispels the early theory that she killed her children while suffering from a bad case of the baby blues. And her book also corrects the widely held impression that her husband bent her to his will until, like a dry twig, she snapped. Instead, hospital records show what a tireless and devoted nurse he was to her and what an advocate he was for her against an uncaring mental-health system. His only mistake may have been -- and he admits this -- introducing her to the itinerant preacher whose pronouncements about sinful Mother Eve may have caused Andrea to believe she had to kill her children to save them.
     The book also makes it clear that Rusty Yates knew how ill his wife was, and lived in constant fear that Andrea would try to harm herself again. He brought his mother to town to watch over her and, in fact, Dora Yates was minutes from the house when Andrea made the 911 call. "I just never thought she'd hurt the children," he says. Rusty moved into an apartment and put the family home up for sale, but not before his brother smashed that fateful bathtub into bits. Rusty visits Andrea every two weeks at Rusk, where she appears to drift between psychosis and mania. Once a month, he is allowed to be in the same room with her, and he holds her hands and talks softly to her.
     He has established a Web site, yateskids.org, with pictures of the children, in an effort to draw attention to the mental health of women, made complex by the flood of hormones that accompanies child-bearing. He isn't dating and he can't think about divorce, he said in news reports that accompanied the publication of the book, but he said he is "excruciatingly lonely." He holds out hope that a successful appeal will mean that Andrea is placed in the kind of psychiatric hospital that can help her get well. But he fears that, too. He doesn't know how a mentally healthy Andrea could live with what she has done.

U.S. Is Working to Make Painkillers Harder to Obtain
Marc Kaufman, Washington Post- 2/15/2004

The Drug Enforcement Administration is working to make one of the nation's most widely prescribed medications more difficult for patients to obtain as part of its stepped-up offensive against the diversion and abuse of prescription painkillers. Top DEA officials confirm that the agency is eager to change the official listing of the narcotic hydrocodone -- which was prescribed more than 100 million times last year -- to the highly restricted Schedule II category of the Controlled Substances Act. A painkiller and cough suppressant sold as Lortab, Vicodin and 200 generic brands, hydrocodone combined with other medications has long been available under the less stringent rules of Schedule III.
      The DEA effort is part of a broad campaign to address the problem of prescription drug abuse, which the agency says is growing quickly around the nation. But the initiative has repeatedly pitted the agency against doctors, pharmacists and pain sufferers, and it is doing so again with the hydrocodone proposal. Pain specialists and pharmacy representatives say that the new restrictions would be a burden on the millions of Americans who need the drug to treat serious pain from arthritis, AIDS, cancer and chronic injuries, and that many sufferers are likely to be prescribed other, less effective drugs as a result.
      If the change is made, millions of patients, doctors and pharmacists will be affected, some substantially. Patients, for instance, would have to visit their doctors more often for hydrocodone prescriptions, because they could not be refilled; doctors could no longer phone in prescriptions; and pharmacists would have to fill out significantly more paperwork and keep the drugs in a safe. Improper prescribing would carry potentially greater penalties.
      The DEA says the change is necessary because hydrocodone is being widely misused -- with a 48 percent increase in emergency room reports of hydrocodone abuse from 1998 to 2001. The drug, a semisynthetic chemical cousin of opium, produces a morphine-like euphoria if taken without a medical purpose but generally does not produce a similar "high" in patients with severe or chronic pain. Hydrocodone was one of several prescription painkillers that radio talk show host Rush Limbaugh acknowledged last year that he was addicted to. "Hydrocodone is one of the most abused drugs in the nation," said Christine Sannerud, deputy chief of the drug and chemical evaluation section of the DEA. "The agency thinks it would be wise to move it to Schedule II, because that would help a lot in terms of reducing abuse and trafficking." DEA officials would not say when they might begin the process of changing the schedule, but other federal officials said they understand that the DEA wants to act soon.
      Under the federal Controlled Substances Act of 1970, the DEA places all narcotic or mind-altering drugs into one of five "schedules," and the medications are more or less available based on the potential dangers they pose and benefits they provide. Morphine-based hydrocodone, when combined with aspirin, acetaminophen or other common analgesics, has been a Schedule III drug since the act went into effect.
      The DEA effort comes as the agency is already embroiled in a dispute with many pain specialists over the use -- and alleged overprescribing -- of another powerful painkiller, OxyContin. Scores of doctors have been arrested on felony charges of conspiracy, drug trafficking and even murder in connection with their prescribing. Although the agency says the prosecutions are needed to shut down "pill mills" and stop unscrupulous doctors, many pain specialists say that the agency has become overzealous and that some doctors are refusing to prescribe needed painkillers because they fear DEA investigation. "Rescheduling the drug will bring more hoops and barriers to getting access to the drugs, and it may prevent some minimal amount of abuse," said Richard Payne, president of the American Pain Society. "But my concern is that it will come at the cost of denying access to thousands of patients."
      Susan Winkler of the American Pharmacists Association said her organization is concerned that the "ripple effects" would be substantial and negative. "Our members and doctors would have increased liability if [hydrocodones] are rescheduled, and that will inevitably reduce prescribing," she said. "We urge the DEA to make sure their decision is based on science and will make the situation better, not worse."
     Reflecting the complexity of the issue, the Florida legislature tightened rules on hydrocodone in 2000. At the request of state enforcement officials, lawmakers made the same change that the DEA wants. But in 2001, after patients and health care providers protested loudly, Florida repealed it. The process of changing the classification of a controlled drug is cumbersome and time-consuming and involves a formal review by the Food and Drug Administration, a listing in the Federal Register and a public comment period. The DEA, however, has the final authority.
      The DEA's Sannerud said hydrocodones have become an increasing problem as the number of Americans taking the drug skyrockets. According to statistics from IMS Health, which collects information about prescription drugs, the number of hydrocodone prescriptions rose from about 80 million in 1999 to 100 million in 2002. That is about four times as many prescriptions as are written annually for oxycodone, the active narcotic in the high-profile drug OxyContin. Hydrocodone has been made for decades but, because most brands are less profitable off-patent drugs, it is generally not heavily marketed. Two generic versions, distributed by Tyco Healthcare/Mallinckrodt and Watson Pharmaceuticals Inc., were listed by IMS Health as the third and sixth most prescribed drugs in the nation last year.
      Sannerud said the DEA has contacted several companies that make hydrocodone and not heard any strong opposition to a schedule change. Several of the larger manufacturers, however, said in interviews they were not aware of DEA's plans. Sannerud said her agency took up the issue because of a citizen's petition filed by a doctor in Upstate New York, Ronald Dougherty. The doctor, who runs an inpatient drug recovery center outside Syracuse, said he had sent letters for years urging the rescheduling annually. "With all the focus on OxyContin, the abuse of hydrocodones has been very underappreciated," said Dougherty, who remarked that almost a quarter of his patients are addicted it. Charles Cichon, president of the National Association of Drug Diversion Investigators Inc., representing both law enforcement and prosecutors, said his group has urged rescheduling for years. "This is widely accepted to be the nation's most abused prescription drug, and a big reason why is that it's Schedule III and can be called in by a doctor," he said. "That opens the door to a lot of abuse."
      But John T. Farrar, a pain specialist at the University of Pennsylvania and a consultant to the FDA advisory panel on analgesics, said taking away a doctor's ability to call in a hydrocodone prescription would have serious consequences for patient care. "There's really no substitute that doctors would be allowed to call in," Farrar said. "That means many patients would probably be getting other Schedule III drugs that are less effective for their pain, while drug abusers will just find another source."



Clinic Seeks Vermont OK for Take-Home Treatment Plan
Associated Press, 2/15/2004

BURLINGTON, Vt. -- Vermont's first methadone treatment center has submitted an application to the state Department of Health to allow some of its patients to take doses of the medication home with them. Officials at the Chittenden Center said the take-home program would be more convenient for patients who travel long distances to seek treatment for opiate addiction. Officials said about 15 patients would be eligible to take part in the program, freeing up space on the center's lengthy waiting list. "We've lost patients who are traveling three hours each way," said Warren Bickel, director of the center. "Three hours each way, seven days a week, 52 weeks a year is not consistent with therapeutic recovery."
     The Health Department is working out the final details of the center's proposal so it can approve the application, said Commissioner Paul Jarris. Jarris, who supports the take-home plan, said his department needs to ensure that the program complies with federal guidelines. Some 44 other states already have take-home methadone programs.
     The Burlington clinic did not ask to dispense take-home methadone when it applied for its original permit from the Health Department in 2002. "The expectation is that we realize this is part of an experiment," Bickel said. The center was the first of its kind in the state to provide methadone after the Legislature legalized it in 2000 as a treatment for opiate addiction. "Our goal here is to allow people to return to a normal life," said Jarris.
     Officials will have to establish rules strict enough to regulate the amount of methadone leaving the clinic, but not so strict that they become a burden on the patients who can take the medication home, Bickel said. Patients who qualify for the take-home program must meet numerous requirements, including having a stable home life and a safe place to store the methadone. Bickel said he can think of around 15 patients at the clinic who would qualify for the plan. "For somebody on the least restrictive level of care, they're our A students," Bickel said.



Report: 11,000 Clergy Abuse Claims Filed
Associated Press, 2/16/2004

NEW YORK - A draft of the upcoming national survey of sex abuse claims against Roman Catholic priests has been viewed by CNN, which reported Monday that 4,450 clergy have been accused of molesting minors since 1950. The draft survey said 11,000 abuse claims have been filed against the U.S. churchmen during that period, CNN reported. The survey is being overseen by the National Review Board, a lay watchdog panel the American bishops formed, and conducted by researchers from the John Jay College of Criminal Justice in New York.
     John Jay refused to comment on the CNN report, while board members contacted Monday by The Associated Press wouldn't say whether or not the latest statistics were accurate. They stressed the report is not finished, and that any numbers tallied so far could change before the study is released Feb. 27. The figures are roughly in keeping with a trend the AP reported on last week.
Some individual dioceses have released the abuse statistics they compiled for the national survey, and the AP has been tracking those reports. Through Monday, 84 of 195 U.S. dioceses had reported claims with 1,413 clergy accused of abuse since 1950. Tens of thousands of priests worked in those dioceses during that period.
     The number of accused clergy is already much greater than the scope of abuse previously estimated by victims' groups and the media. "I would hope that the public would kind of withhold any immediate judgment until they get the full story on Feb. 27th," said Leon Panetta, the former Clinton White House chief of staff and a National Review Board member. Robert S. Bennett, a prominent Washington attorney and another review board member, said survey drafts are circulating only among board members and John Jay researchers. No bishops have seen the draft, said Bennett, who also is overseeing the board's investigation into the causes of the clergy abuse crisis. The results of that inquiry will also be released Feb. 27. "Both the National Review Board report and the John Jay study are still in the process of being written," Bennett said. "People should wait until then to draw their conclusion."
     Bishop Wilton Gregory, president of the U.S. Conference of Catholic Bishops, said in a statement that he has not seen the drafts and can't comment on any numbers until a final report is issued at month's end. "I want to reaffirm that the bishops requested these studies so that we could understand as fully as possible what caused this terrible occurrence in the life of our community to make sure that it never happens again," Gregory said. The bishops commissioned the unprecedented survey as part of a series of reforms meant to restore trust in their leadership. The 84 dioceses that released their statistics have reported 2,990 abuse claims so far.
     CNN reported that the draft survey said 78 percent of those abused were between the ages of 11 and 17, and that more than half the accused priests had a single allegation filed against them.
It said the report blames the sex abuse crisis on the bishops' failure to grasp the gravity of the problem, their misguided willingness to forgive and their emphasis on avoiding scandal, among other things. Victim advocates say the survey ultimately will underestimate the number of cases because it is based on self-reporting by bishops.

Tests Suggest Some Predisposed to Smoke
Associated Press, 2/16/2004

WASHINGTON -- If you're easy to anger, you might have a brain especially susceptible to nicotine. Scientists using powerful scanners have documented nicotine triggering dramatic bursts of activity in certain brain areas -- but only in people prone to anger and aggression, not more cheerful, relaxed types. Researchers made the discovery when studying people wearing nicotine patches. Intriguingly, the nicotine jazzed up the brains of not just smokers who are aggressive, but of nonsmokers, too -- and at very low doses.
     It's the first biological evidence that people with certain personality traits are more likely to get hooked on smoking if they ever experiment with cigarettes. And it may help explain why it's so much easier for some people to kick the addiction than others, says psychiatrist Steven Potkin of the University of California, Irvine, who led the study. It's almost, he says, as if some people are born to smoke.
     Other scientists won't make that leap, noting that it's not clear how much of a person's personality is genetic and how much stems from childhood environments. Smoking habits, too, can depend greatly on whether people grew up surrounded by smokers and the social and cultural conditions under which they try to quit. Still, ``we're looking for the variety of things that could make people likely to smoke, and this could be one of them,'' says William Corrigall of the National Institute on Drug Abuse. It also has important implications for teenagers. Adolescents are prone to periods of aggression before parts of the brain that control impulse and behavior finish forming -- and smokers almost universally pick up the habit as teens.
     If doctors could predict who's most at risk of getting hooked after their first few cigarettes, perhaps they could better target those people with smoking prevention programs. Previous surveys had suggested that Type A personalities are more likely to be big smokers, especially when nervous or irritated. Also, some scientists have put smokers into brain scanners while infusing them with nicotine, to see what brain areas the drug targets. But Potkin's study took the crucial step of adding nonsmokers to the mix. And he asked 86 people to do various tests -- such as computer games that showed who were the sore losers -- while a PET scanner monitored their brain activity before and after receiving low- or high-dose nicotine patches or a sham patch. ``No one has looked at nicotine in this way,'' says Kenneth Perkins, a psychiatry professor at the University of Pittsburgh who also is studying predictive traits of smoking.
     The PET scans showed no brain effects of nicotine on people whose personalities were more relaxed and cheerful. But in people rated as having more hostile tendencies -- easier to anger, more impatient or irritable -- nicotine triggered dramatic changes in activity in brain regions important for controlling emotion and social response.
     For some people, nicotine increased energy metabolism, for others, it decreased, depending on dose. But despite the common assumption that nicotine can be calming, actually ``nicotine made them even more aggressive,'' Potkin says. ``They may smoke to feel better, but they don't feel better.'' That's a curious finding, Perkins says, but it may be because the study used different doses. Low nicotine doses sometimes stimulate brain activity while high doses suppress other activity.
The next step: Seeing how the brain reacts when people smoke instead of having carefully controlled doses of nicotine administered via a patch. For that study, Potkin can't induce nonsmokers to start smoking, so he'll compare regular smokers to people who puff a few cigarettes every so often.

When Bipolar Masquerades as a Happy Face
Richard Friedman, M.D., New York Times- 2/17/2004

At 45, my patient Bruce was at the pinnacle of his career, with a lucrative law practice. Then his life was cruelly turned upside down by two medical events, a crushing first episode of major depression and a series of strokes from untreated hypertension. For many years, Bruce struggled with severe depression and high blood pressure without much headway. Then something strange happened. He suddenly pulled out of the depression and dove into his work. Not only that, but he felt the surge of energy and self-confidence that he used to have. No hurdle seemed too high or problem unsolvable, he recently recalled.
      No one questioned his renewed energy and vigor, because he had always been vivacious. Nor did his combative behavior and ever increasing volume of provocative e-mail messages to friends and colleagues raise a suspicion that something might be seriously amiss. Betting that his future earnings would more than cover large expenses, he put off filing his state tax returns. No one seemed to recognize just how impaired his judgment had become. Even the judge who placed him on probation for failure to file tax returns missed the real story.
      When I met Bruce in a consultation, he spoke loudly and rapidly, and I had difficulty interrupting him. It wasn't hard to figure out that he had been living with an unrecognized and untreated psychiatric illness that had driven him to the edge of ruin — bipolar disorder, also known as manic depression. Like most diseases, bipolar disorder comes in different shapes and sizes and can be difficult to diagnose. Few people or physicians would miss classic bipolar disorder, with its cyclic episodes of severe depression and full-blown mania. After all, there is nothing subtle about mania, grandiose and often psychotic thinking, elated mood, superhuman energy and libido and reckless judgment. But a milder form of mania, called hypomania, is not obvious at all, especially in someone like Bruce who happens to be temperamentally dramatic and lively. That is because hypomanic people feel very happy, have lots of energy, need little sleep and are generally fun to be with. And they certainly do not run to doctors complaining of happiness.
      So it is easy to see how hypomania could masquerade as cheerful character. In the same way, dysthymia, hypomania's dark twin, has often been confused with gloomy temperament, when in fact it is a treatable form of low-grade depression. Unlike depression, though, hypomania is intrinsically pleasurable. It is a better-than-well state that often confers a heightened sense of creativity and power. So what is the down side to hypomania? Well, it can subtly and sometimes powerfully impair a person's judgment. After all, exuberance and supreme confidence can blind someone to the potential consequences of decisions.
      Despite obvious financial constraints, Bruce went through long periods of extravagant spending with an inflated sense of his own power and ability. The results proved catastrophic. Not only that, but hypomania is very often an unstable state that cycles into periods of depression, which are sometimes very severe. When that happens, as in Bruce's case, it is called bipolar type 2 disorder.
      Bipolar disorder is a potentially fatal illness, because 10 to 20 percent of patients commit suicide, the National Institute of Mental Health says. According to a survey sponsored by the institute, the prevalence of bipolar disorder is 1.1 percent. That estimate covers just people with the classic form of the disorder. A more recent survey by Dr. Robert M. Hirschfeld, published in The Journal of Clinical Psychiatry in 2003, found significant bipolar symptoms in 3.7 percent of the United States population. About 20 percent of people identified as bipolar in the survey had been given correct diagnoses, and most had not received effective treatment. The study also found a much higher rate of bipolar disorder, 9.3 percent, among patients 18 to 24 years of age.
      The very different rates reported in these two surveys reflect different questions, definitions and methods to diagnose bipolar disorder. If a survey includes the milder types, as the above study did, the prevalence will be much higher. In fact, the whole spectrum of bipolar disorder is very broad. Some people learn for the first time that they have bipolar disorder when they are treated for depression. That's because antidepressants can precipitate mania in 5 to 10 percent of people with no histories of mania.
      Depression is associated with decreased activity of important neurotransmitters like serotonin and norepinephrine. The converse is hypothesized for mania. Because antidepressants significantly increase the availability of those neurotransmitters, they can spark mania in some biologically vulnerable people. So can "recreational" drugs like cocaine and methamphetamine, which instantly flood the brain with another neurotransmitter that regulates mood, dopamine. The problem is that the milder types of bipolar disorder are often hard to recognize as an illness because the symptoms are chronic and less severe. In contrast, a person who develops a florid acute disease, whether appendicitis or full-scale mania, is obviously ill to any casual observer, because the contrast between the normal base line and the illness is stark.
      Bruce, his family and friends, as well as his physicians were all taken in by his hypomania masquerading as mere happiness. In effect, they mistook his bipolar illness for his personality. In the end, Bruce has responded very well to lamotrigine, an anticonvulsant mood stabilizer. Some time after, he was calm and rational and had an even mood. It was only then that he was able to see clearly the illness that nearly destroyed him. Now he is beginning to put the pieces of his life back together.

N.Y. Keeps Forced Mental Health Treatment
Associated Press, 2/17/2004

ALBANY, N.Y. -- The state's highest court on Tuesday upheld ``Kendra's Law,'' which allows caseworkers, family members and even roommates to seek a court order to force a mentally ill patient to comply with treatment. At least 40 other states have similar statutes, according to Tuesday's Court of Appeals decision. The law was named for Kendra Webdale, 32, who died in January 1999 after she was pushed in front of a New York City subway train by a schizophrenic who did not take his medicine.
     Lawyers for another mental patient, identified only as K.L., argued the law, which took effect in 2000, is unconstitutional because it violated patients' due process protections. K.L., who suffers from a bipolar disorder, had a history of hospitalizations and refusal to take medication. Attorneys argued the treatment can't be forced unless the patient is mentally incapacitated. They also argued that it was unconstitutional to detain patients who refuse to take their medication for up to 72 hours without a hearing. State Attorney General Eliot Spitzer intervened in the case and defended the constitutionality of the law. In its 6-0 decision, written by Chief Judge Judith Kaye, the court said the law was an effort to enable mentally ill persons to lead more productive and satisfying lives, ``while at the same time reducing the risk of violence.''
     The New York Civil Liberties Union criticized the decision for allowing people to be detained without hearings on whether they're a threat to themselves or others. ``We are concerned ... about protecting society from violence by people who present an imminent danger of harming themselves or others, but this decision needlessly erodes the rights of persons who don't present such a danger,'' Executive Director Donna Lieberman said. K.L.'s attorney, Dennis Feld, also said he worries the law may go too far at the expense of the mentally ill. ``Some of the rights that we felt were involved ... just didn't seem to be recognized by the court,'' Feld said. ``We felt there was more than just a minimal violation of liberty.''

Emotional Bullying Continues to Scar Grade Schoolers
ABC News, 2/17/2004

Starting in the third grade, Felicia Flores, now 11, was tormented for two years by a girl she once considered a friend. What started as demands to do her bidding escalated into taunting and teasing by the bully and her followers. "They said that I sucked, I was a jerk, I was a liar," said Felicia, who attends school in northern California. "They called me Miss Prissy Perky Piggy. When they call you names, it hurts really bad. And sometimes you just wonder why they're calling you that."
     Seeing children being physically bullied while their schoolmates do nothing is difficult. Last week, the story of a 12-year-old beaten on the school bus shocked the nation and left many people wondering how young bullying starts. A recent study estimates that 160,000 students skip school every day just to avoid the painful harassment that makes each school day unbearable.

A Cry for Help
In a letter found by her mother, Felicia cries out for help. "I hate my life, I wish I were dead because no one cares or understands me," Felicia wrote. "My friends were the only people that I can talk to, but now I can't. Lately I have thought about killing myself. Nobody cares except my mom." Her mother, Gloria Valdez, can never forget the day she read Felicia's letter. "I saw the note that she wrote," Valdez, said, crying. "That she hated her life because the school didn't understand her, that the principal didn't understand, that she had no friends, and that I was the only one who understood her." Felicia used to tell her mother that she didn't want to go to school, or pretend that she was sick to avoid doing so. "I couldn't go to school because my eyes were so red from crying and puffy, because I got no sleep," Felicia said. "I was angry because I couldn't stick up for myself. It was really hard for me."

'Kids Will Be Kids'
Eventually, the stress of the bullying did make Felicia physically ill -- with painful migraines and chronic stomachaches. "The hard part was when I addressed it with the school, no one understood," Gloria Flores said "They basically said 'Oh, kids will be kids.'" Not only did Felicia's school minimize her pain, but they ultimately asked Gloria to find another school for both of her children.
     From the start of kindergarten to the end of first grade, children are bullied every three to six minutes -- and those young victims are more likely to be depressed and suicidal later in life, according to a study from Wichita State University published in the Nov. 2003 edition of Child Development.
     It was second grade when Allie Ludwig, now 10, was surrounded on this playground by six girls and terrorized because she refused to listen to schoolyard gossip. One girl said, "We've got her, we've got her," making Allie feel as though she could not escape. "I felt really scared," said Allie, whose family lives in Portland, Ore. Allie said. "I felt sick to my stomach also. Because you don't know what's going to happen. "I got mad because I said stop and they didn't." Her mother was angry too. "I was really mad because the kids that were doing this to her were her friends," Trudy Ludwig said. "And I just didn't know how to deal with this. I needed to figure out how to help my child deal with the kids rather than me fighting her battles."

An Anti-Bullying Curriculum
Frustrated by the lack of information on young bullies, Trudy researched and wrote her own book My Secret Bully. She has traveled to dozens of school districts to drive home her message of empowerment. Luckily for Trudy and Allie Ludwig, her school, has a conflict resolution program, but Trudy says schools and parents need to recognize that emotional bullying is far more complex and insidious than fights, especially when it goes undetected. "I think schools really need to pay attention more to defining bullying as name calling, insulting, gossiping, spreading rumors," Trudy Ludwig said. "Those are blatant forms of aggression that kids think are normal."
     Allie says she has learned how to stand up for other kids, instead of just letting bullies have their way. "I've learned that it's good to stand up for kids and not just be there and watch," Allie said. "You have to do something. Otherwise it's going to happen again and again." Felicia knows that feeling. "Emotional bullying is way harder than physical bullying," Felicia said. "Because if you just get hit, then you can go home and it's over with. But emotional bullying stays with you."

Tackling the Problem
According to a study by the U.S. National Educational Association, 78 percent of bullying in schools is verbal, so it must be actively addressed by teachers, administrators, parents and children.
Schools: One extremely successful program at an Illinois school district addressed bullying head-on, by first identifying which children are being targeted. The students themselves were asked to anonymously write down the name of a bullied child, which ultimately created a confidential list of victims. Teachers can work with that information, keeping an eye on the children being bullied, pairing them with a more popular friend and changing seat assignments to get them away from their tormentors.
Parents: When they become aware of bullying, parents should respond immediately, alerting the school to see what their bullying policy is. Make sure the school is pro-active in addressing the problem.
Students: Your child should know that it's not OK if someone says, 'I'll only be your friend if you do my homework,' or worse. They should know the difference between getting mad and being mean. Friends can have arguments, but bullies are abusive. Let children know that when they come up against bullies, it's OK to tell an adult.

Many Women Stay Quiet About Sexual Dysfunction
ABC News, 2/18/2004

It's the kind of thing no one wants to talk about, but it's the kind of thing that can destroy a relationship. What it is … is sex. In the case of many couples, it's the absence of sex. While Americans have grown accustomed to seeing advertisements for all sorts of products aimed at treating male sexual dysfunction, there hasn't been much talk about women's libidos or sexual health.
A recent study concluded that almost half the adult women in America are not happy with their sex lives and they don't know why. Many are too embarrassed to talk about it with their partners, or to get help. But more and more women are finally beginning to admit to an awful feeling they've avoided discussing. Sex isn't enjoyable for them.

Female Sexual Dysfunction
"Women are feeling more entitled to their sexual response and are being more proactive about doing something about it," says sex therapist Laura Berman. She and her sister, Dr. Jennifer Berman, a urologist, are pioneers in the new field of female sexual dysfunction, or FSD. According to a study published in the Journal of the American Medical Association in 1998, some 43 percent of sexually active women of all ages experienced sexual dysfunction.
     The Bermans say FSD includes four particular complaints: trouble achieving orgasm, not being aroused properly, pain during sex, and the one they hear most often: low libido. Often, doctors have told women that their problems are emotional, not physical. But the Bermans feel differently. In their work, the Bermans emphasize the importance between the mind and the body and physiological responses to emotional issues.

Sorting Out the Emotional From the Physical
Low libido is the most common female sexual complaint, and the Bermans recommend couples counseling. To help a woman overcome her lack of sexual desire, they often begin with a three-hour, mind/body exam by talking with her about her feelings. After getting her perspective, they will talk with her partner. They will then examine the woman's medication history. It turns out that a wide variety of medications can affect sex drive, from antihistamines to antidepressants to birth control pills.
     They sometimes recommend discontinuing birth control pills and sometimes even prescribe a very small dose of testosterone, a controversial new treatment being offered to women. Some doctors consider testosterone the female Viagra, even though the Food and Drug Administration hasn't cleared it for treating FSD, and some women report negative side effects like facial hair and acne.

Too Quick to Diagnose and Prescribe?
Leonore Tiefer, a New York psychologist and sex therapist, is one of a small but vocal number of critics who say doctors shouldn't quickly turn to drugs to cure women's sexual complaints. "It's easy to get a pill, but pills have side effects and they have interaction problems and they're being given to young people," she says. "Are they supposed to take it their entire life?" In fact, Tiefer insists that lagging sex drive is just a normal part of life for many women, especially those overwhelmed by work and children, and that medicine isn't the answer.
     Jennifer Berman disagrees. "The reality is … that there are medical reasons why women experience sexual dysfunction," she says. "We didn't create them. We didn't make it happen. It's the way it is. Were just acknowledging their existence." To learn more about the Bermans' work, visit their Web site: www.newshe.com.

Ecstasy Death Points Out Need for More Adolescent Services
Sarah Coffey, Associated Press- 2/18/2004

HARTFORD, Conn. -- Makayla Korpinen's short life was marked by domestic violence, an alleged rape, and alcohol and drug abuse. Her death at 16 from an overdose of Ecstasy was preventable and reveals the need for more state services targeted at adolescents, according to report released Wednesday by the state's child advocate.
     The state Child Fatality Review Panel conducted an 18-month investigation into Korpinen's death, the first in Connecticut linked directly to Ecstasy. It found that the East Hampton teenager did not receive adequate care from her mother, her school, her physician or the state. She fell into a gray area of state services, in between childhood and adulthood, Child Advocate Jeanne Milstein said. Adolescents and their caregivers don't receive the same level of support as young children, and adult services don't address their specific needs, she said.
"We don't blame anybody. But there certainly are contributing factors," Milstein said. Appropriate residential care, after-school, parenting and other programs tailored specifically to deal with adolescents would help bridge the gap, she said. "Makayla's death is a wake up call. Her death was tragic but preventable," she said. The Department of Children and Families should review its programs and reallocate resources in its $600 million annual budget toward adolescent care where appropriate, she said. Additional funding may also be required to pay for more programs, she said. "We need to look at the money and see what programs are effective," she said.
     Gary Kleeblatt, spokesman for the Department of Children and Families, said late Wednesday he hadn't seen the report. Makayla's death "underscores the danger of illegal drugs," he said. The DCF is making progress providing more programs for adolescents, including treatment services, but there is room for improvement, he said.
     The report highlighted the dangers of the use of Ecstasy. A 2000 survey by the state Department of Mental Health and Addiction showed 4 percent of 9th and 10th graders took Ecstasy within a 30-day period of the survey, up from 2.3 percent in 1997. Almost 7 percent of those students admitted taking the drug over their lifetimes.
     Makayla was at a house party with other teens on May 17, 2002 when she drank beer from a keg and took Ecstasy. She went into seizures and died in her mother's arms four days later of multiple organ failure and acute renal failure. According to the report, Makayla was a quiet kid who got along with her family and didn't cause trouble. Because of that, her school and physician didn't provide counseling to help her deal with her father's death from a car accident when she was 3 years old, the report says. Her father's death is believed to have been alcohol-related, and a family history of alcohol abuse put Makayla at risk to abuse herself, the report said. She received failing grades in school, but after extensive testing wasn't labeled as needing special education or help, despite showing signs of depression and bipolar disorder, the report says. Her exposure to her mother's violent boyfriend and her family's frequent moves may have also contributed to the risk of substance abuse, the report says.
     Makayla told her mother, Catherine Korpinen, that she was raped by two boys in the summer of 2001 when the family was living in Florida, but her mother didn't entirely believe her, the report says. Makayla tried to commit suicide shortly thereafter and was hospitalized for 10 days and diagnosed with depression. Her mother was very "permissive" and didn't lay down a lot of rules for her daughter, so when she tried to prevent Makayla from dating a boy four years older the teenager rebelled and ran away from home, the report said.
     Police were unable to return her to her mother's home because state law doesn't allow them to. Police can search for runaways and report their whereabouts to families and caregivers, built they are not required to return them home because legal matters concerning 16 and 17-year-olds are handled in adult court. A bill in pending in the legislature that would consider teenagers juveniles until they are 18.

On the Therapist's Couch, a Jolt of Virtual Reality
Sam Lubell, New York Times- 2/19/2004

The red curtain opens to reveal an intimidating auditorium. A bored audience stares back at you. One person in the crowd seems to be falling asleep; another coughs loudly and stretches his neck. You notice that your palms are sweaty. Your stomach is fluttering. You wonder whether you will pass out. But this is no ordinary panic attack: it is a virtual scene that was created to help people overcome anxiety about public speaking. This slice of virtual reality and other similarly stressful scenes are the work of a Georgia-based company called Virtually Better, which creates virtual environments with 3-D imaging software for use by psychologists, psychiatrists and researchers.
      A few years ago, the full impact of a bored audience could only be imagined by a patient with a therapist's help, or in some cases recreated at great cost with mockups and actors. But with recent advances in research and improvements in hardware and software, virtual reality has become a tool to help patients overcome fears and anxieties. "It's a therapist's dream," said Albert Rizzo, a research assistant professor of engineering at the University of Southern California and a licensed psychologist who has created classroom and party scenes to treat attention deficit disorder and social anxieties. "To help people deal with their problems, you must get them exposed to what they fear most."
      While the techniques are beginning to catch on with some therapists and researchers -- Virtually Better says that 60 are now using its system, for example, in treatment or study -- many mental health experts remain wary. While therapists who use virtual reality systems say they have had success with many patients, they acknowledge that the field is still in its early stages. "There's not proof that any of this is working," said Joann Difede, an associate professor of psychiatry at Weill Medical College of Cornell University, who has helped create virtual therapeutic scenes. For example, there has been no large-scale study to test the effectiveness of virtual therapy, although some individual therapists, including Dr. Difede, claim a success rate exceeding 90 percent.
      As with other virtual environments, the scenes created by Virtually Better, Dr. Rizzo, Dr. Difede and others are made by combining video images of real people with effects generated by programs like 3D Studio MAX and DeepPaint. To take them in, a patient wears a helmet with screens extending over each eye that create a lifelike stereoscopic view, and a motion sensor that adjusts the scene to correspond to the head position. The helmet also has headphones that can adjust sound to correspond to movement. To enhance the realism, some users, like Robert Reiner, a Manhattan psychologist, employ vibrating platforms to simulate movement. And Virtually Better is experimenting with odors created through the use of various chemicals. Levels of intensity can also be adjusted. A public speaking scene, for example, can be adjusted for the size and attentiveness of the audience, while a virtual airplane flight may be smooth or turbulent. The patients work with therapists before and after the virtual sessions to learn coping techniques.
      "The more realistic the environment, the better," said Ken Graap, the chief executive of Virtually Better and a doctoral candidate in clinical psychology at Emory University in Atlanta. Mr. Graap started the company with Larry Hodges, a former professor at Georgia Tech who is now a professor of computer science at the University of North Carolina at Charlotte. The company has also employed a psychologist, Libby Tannenbaum, who treats patients in conjunction with the virtual reality scenes at the company's offices in Decatur, Ga.
      No one would mistake the virtual scenes for reality, but they are convincing enough to evoke patient response. Dr. Reiner said that patients sometimes have panic attacks when they first try virtual reality. He described a patient who ran out of his office still wearing the helmet because a virtual scene had stirred up such intense anxiety.
      The problems that can be tackled with virtual therapy are many. Virtually Better has created scenes of a glass elevator and a bridge to address fear of height, an airplane cabin for those who fear flying and a thunderstorm to diminish fear of bad weather. The treatment of substance addiction, too, is being investigated. Several researchers are testing to see whether virtual exposure to drugs, alcohol and cigarettes can trigger cravings, and thus help patients learn to resist them. Virtually Better has created scenes of a virtual bar and crack house for that purpose. To treat post-traumatic stress, Virtually Better has programmed a Vietnam scene to help veterans confront memories they may be blocking out. Dr. Difede and others at Weill Cornell, collaborating with researchers and engineers from the University of Washington, have created a re-enactment of the terrorist attacks on the World Trade Center to help those coping with their aftermath.
      Such applications give researchers and therapists hope that the technique will catch on. Dr. Difede said that while virtual therapy is now being used as a supplement to therapy that relies on a patient's imagination, it may someday even become the treatment of choice. Yet proponents acknowledge that some providers of mental health care are wary. "People are weirded out by this," Dr. Reiner said. "If someone's in a comfortable practice and they're not interested in technology, why would they do this?" Cost is also an issue. Virtually Better leases its software to clinical therapists for $400 per month. This includes full technical support and upgrades. The company charges researchers a flat fee of $3,500 to $10,000 for the software. Headsets with trackers range from $2,000 to $20,000.
      Dr. Reiner and his staff at Behavioral Associates offer a sliding scale, charging patients $75 to $350 a visit --- about 10 percent more than for conventional therapy -- based on their ability to pay. Some patients say that the virtual experience is worth the cost. Jill Greenberg of Manhattan was so fearful of flying that she would rarely board a plane. She once even turned down an all-expenses paid shopping trip to Paris. After 12 sessions of virtual therapy over three months as Dr. Reiner's patient, Ms. Greenberg now steps onto planes without a second thought. "I wouldn't believe it if it weren't me," she said.

Backlash Against Gambling Industry
Jane Lampman, Christian Science Monitor- 2/19/2004

The images of gambling in America are a far cry from a generation ago: Thrilled lottery winners display giant checks and tell which part of their dreams they plan to fulfill first. Catchy TV ads portray the bright lights, happy faces, and seductive action at nearby casinos, and promise "the wonder of it all." Gaming and wagering offers in Las Vegas now come wrapped in attractive family-vacation packages. Once seen as a shady business with a sleazy ambience, gambling has won increasing respectability. Two-thirds of Americans now call it "morally acceptable," and even more have participated in one form or another in the past year. State governors, facing huge budget deficits, often include gambling-expansion plans in their electoral platforms or budget proposals.
Yet despite the wider acceptability, the public seems ambivalent. As state politicians become "gambling czars" and casinos proliferate, many citizens are mounting a battle to contain it.

Casinos, Lotteries Rejected
In fact, last year, 42 out of 45 proposals for expansion in 30 states were defeated, according to the National Coalition Against Legalized Gambling. Five states rejected lotteries; six turned down first-time casinos; and the fight over slot machines in racetracks tallied 19 against 2. "With the favorability ratings and gambling in 48 states, you'd think it would be flying off the shelves, but it isn't," says the Rev. Tom Grey, the Methodist minister who founded the coalition, which collaborates with local antigambling groups.
     Does this reflect a public backlash? The casino industry says "no," that defeats come largely because other gambling interests don't want competition. "Whenever a change in the mix is proposed -- to have a riverboat casino in a state with a lottery and horse-racing, for example -- you'll normally find the main opposition comes from existing gambling in the state or in adjacent states," says Frank Fahrenkopf, head of the American Gaming Association (AGA). This is clearly a factor in some defeats. In others, however, citizen groups can claim the victory.
     In Maine, for instance, a group that started around the kitchen table sparked the defeat of a casino proposed by Indian tribes and a Las Vegas interest by marshaling grass-roots support against gambling across the political spectrum. "We had no gambling-interest backing," says Dennis Bailey, a public relations executive who led the effort. They got a big boost when L.L. Bean joined the fray, followed by other businesses. "Gambling isn't seen as a sin any more, but there's just way too much," Bailey explains. "The backlash is against casinos. The industry just doesn't know when to quit." For Maine residents, it's an issue of quality of life and image. "They don't want the state's image to change from "lighthouses, lobsters, potatoes, and woods" to "casinos, slot machines, and dancing girls" says Bailey.
     At the same time, another ballot initiative for slots at racetracks passed. The group had decided not to try to fight both initiatives at once, what they now term a strategic mistake. "We think we can get it back to another vote," Bailey says. And yet, Fahrenkopf says, many economically depressed communities have benefited from gambling. In Iowa last year, for example, all 11 counties that voted on eliminating riverboats or racinos (slots at racetracks) opted to keep them.

Moral Objections & Addictions
Various polls show 25 to 38 percent of Americans have religious or moral misgivings about gambling, but many are reluctant to press their case in terms of personal morality. Those who object to gambling on religious grounds tend to see it as incompatible with God's role in human life and as a subversion of the Protestant work ethic. "Those in the evangelical tradition would argue that everything belongs to God and you're not using what God has placed in your hands in a responsible way," says Tony Campolo, head of the Evangelical Association for the Promotion of Education. "Also, earning money is a spiritual responsibility, and we shouldn't try to get it for nothing."
     But there are those who are willing to press for action based on broader moral concerns. Campolo and more than 150 other religious leaders sent an open letter to the U.S. Congress in 2002 urging that it begin to address "the pain and devastation" that gambling has wrought on society.
A National Gambling Impact Study had revealed such unsettling consequences that the commission conducting it called for a pause in gambling expansion. The study found that 15 million Americans were "at-risk gamblers," 2.5 million were "pathological gamblers," and pathological gambling occurred proportionately more often among the young, less educated, and poor. It led to destructive and criminal behaviors affecting families and communities, and played a part in some 2 million divorces. About 1 in 5 compulsive gamblers attempts suicide, and the actual suicide rate is higher than for victims of any other type of addiction. Another study found that 25 to 40 percent of revenues in casinos came from people with some form of addiction, and estimated the economic impact of problem gamblers to be $13,200 per problem gambler per year.

Gambling vs. Taxation
While gambling is presented today as simply "another entertainment option," opponents say, people are becoming more aware of its economic and social costs. In Maryland, civic and religious groups are fighting the governor's proposals to put slot machines at racetracks. Kevin McGhee, a pastor in Laurel, Md., and president of the local clergy association, says, "Every study we've looked at shows that within 25 miles of these slot- machine venues, the problems of addiction escalate dramatically." His group and some local African-American churches "are fighting this quite aggressively," he says. "Maryland already has a lottery that was supposed to be once a week and has evolved into many times a day."
     The governor faces a huge budget deficit, but opponents says the slots won't solve the problem any more than the lottery has. "It's political expedience to use gambling rather than taxation," McGhee adds. "We've said people need more courage. We're trying to help them find their moral backbone." Most troubling to many people is the role of state governments. States were the regulators and law enforcers of gambling until they shifted -- starting with New Hampshire in 1964 -- to running and promoting state lotteries. (Fahrenkopf calls this "the real seminal event in changing America's perception of gambling. How could gambling be morally wrong if state government was doing it?" )
     Robert Goodman, a professor at Hampshire College who has done economic studies on gambling, contends the state's role conflicts with its primary concern for the welfare of citizens. "Each time government has a shortfall in revenues and tries to raise it by getting people to gamble more, that raises serious issues," he says. Most surveys show this shifts the burden of paying for public services to lower-income residents. While Gallup found that about the same percentage of people from each income group play the lottery, the average amount gambled by those with incomes under $20,000 was two to five times that of higher income groups. And heavy state promotion of the lottery can be manipulative. Goodman recalls, "The Illinois lottery would have billboards in poor black neighborhoods saying, 'This is your ticket out.'"
     Lance Dodes, a Boston psychiatrist who heads a gambling treatment center, says the advent of the lottery has dramatically changed the profile of compulsive gamblers. "A problem that used to apply only to men is now an equal opportunity event," he says. Many young people are getting hooked on campuses, too. "We talk about people becoming addicted to gambling, but essentially, governments have become addicted to these revenues; and it will never be enough," Goodman cautions.
     Don Feeny, research director of the Minnesota State Lottery, agrees it can't fill the role of taxation. In his state, the lottery funds less than 2 percent of the budget. "Can it ever raise the money taxation does? Absolutely not. Can it do it as efficiently? No." But, he adds, the public seems to prefer a lottery to taxation.
     While the antigambling forces had many victories in 2003, Grey says they're going to be short-lived unless "we raise a real army." He'll keep traveling the country to buck up local coalitions, as he's been doing since his initial battle against riverboat gambling in Galena, Ill., in 1992. He argues the case from the standpoint of "social morality:" "It's not good economics, it's not good public policy, and it's not good for the quality of life," he says. "Any society that preys on the pathology of some people to support education or another good cause, that's not just."

Study Says Empathy May Cause Real Pain
Associated Press, 2/19/2004

WASHINGTON -- When someone says, ``I feel your pain,'' the person really may. A groundbreaking study shows that some of the same brain regions involved in feeling physical pain become activated when someone empathizes with another's pain. And when it's time to feel better, thinking that a drug helps can make it so, according to a different brain-scanning study that finally caught the power of placebo in action.
     The studies, reported in Friday's edition of the journal Science, provide important new evidence of the power of the mind, said Dr. Jon Levine, a pain specialist at the University of California, San Francisco, who reviewed the research. ``Very likely the same part of the brain which is affected by empathy for pain, and therefore suffering, is the area that also our mind or our expectation has to deal with if we're going to get control of that pain,'' Levine said.
     In the empathy study, British researchers recruited 16 couples. One at a time, the women were put into brain scanners called MRI machines; the men sat nearby. The women could see only their loved one's hand and a computer screen. The women and men got brief electric shocks to the hand. The computer screen flashed who would get the next shock and whether it would be mild or very sharp. When the women got shocked, the MRI showed how their brain's entire pain network activated, researchers reported. They registered feeling the jolt and how much it stung, from sensory brain regions, as well as how much it made them suffer -- the ``affective'' or emotional regions. But when the men got shocked, part of the women's pain network sprang into action, too -- not sensory regions but emotional ones. They knew when the men were being shocked only by watching the computer screen.
     The lead researcher, Tania Singer of University College of London, likened it to vivid feeling when imminent pain is imagined and the heart speeds up before the actual sensation arrives.
Men were not studied for their reaction to how women responded to a shock. Singer did not tell the couples that she was studying empathy so as not to rig the results. But she later asked the women to describe how they felt when their partner was zapped. ``They indicated it was as unpleasant'' when the man got zapped as when they did, Singer said. ``What they say matched what I saw in the brain activity.'' She also rated their degree of empathy, using questions such as how easily they cry at movies. The more empathetic their nature, the more emotional brain activity there was. It was not ``emotional contagion,'' like how one person's yawn can set a whole room to yawning, because the women could see only their partner's hand, Singer said. Instead, the women were using the same brain areas that anticipate one's own pain.
     In the second study, volunteers put inside MRI machines had either electric shocks or heat applied to the arm. The pain activated all the expected neural pathways, researchers from the University of Michigan and Princeton University reported. Then, researchers smeared on a cream they said would block the pain. In fact, it was a regular skin lotion. When the volunteers were zapped again, they reported significantly less pain -- and pain circuits in the brain showed they really felt better. Those were the same brain regions that respond to painkilling medication. Then researchers spread on cream again, this time telling the volunteers it was a placebo -- and they hurt all over again.
     Doctors long known have known the placebo effect is real. It is one reason that they talk up the benefits of a drug as they write the prescription. But the effect has been assumed to be psychological, Levine said. The study provides ``a novel and important insight into the fact that placebo is in fact due to a physiological attenuation of the pain signal,'' he said.
     As for empathy, Singer now is studying whether people can sense a stranger's suffering as much as a loved one's. Is empathy a learned trait or a genetic one? Her study suggests it is a completely automatic response that varies merely in its degree, meaning it probably is hard-wired into our brains through evolution. After all, Singer said, empathy serves two important survival functions: bonding between people, especially mother and child, and the ability to predict others' actions, such as whether someone in pain is a threat.