Kids of Addicts Bear Scars As Meth Sweeps Rural Areas
Judith Graham, Chicago Tribune- 3/7/2004

FLORA, Ill. -- Misty Cobb's four children lived in fear. Donnie was afraid of the men who beat up his mother, a methamphetamine addict, and who turned on the boy when he tried to protect her. Michael was afraid of what he found around his mom's house: used needles, handguns, drugs in plastic bags and a constant stream of drugged-out strangers. Carissa wasn't sure if her mom would survive her violent, chaotic, drug-addicted lifestyle, or if she'd lose her forever. Jessica, the youngest, was afraid of Cobb, who would go into paranoid rages when coming down off drugs. "She'd hit me in the face and drag me by the hair and slap me on my back," she says matter-of-factly. Over time, all four children were taken away to live with their fathers, grandparents or other relatives. High on meth, Cobb neglected to visit or call them for weeks or months on end.
      Children are paying an enormous toll as a meth epidemic sweeps through rural Illinois and much of the Midwest. Frightened, neglected kids are living in homes with parents who think only of their next high. Abused, abandoned children are pouring into the child-welfare system. In parts of southern Illinois, as many as half of child-welfare cases being handled by social service agencies are now meth-related, agency officials report. The children involved often come from squalid, dangerous homes, where toxic brews cook on portable burners set up in bedrooms, and chemicals are stored in refrigerators, according to child-welfare workers, police, narcotics investigators and parole officers.
      The scars inflicted in meth homes are long-lasting. "I don't trust nobody, not even my friends," says Donnie Simpson, Cobb's 19-year-old son, whose bright blue eyes flash with anger while describing his hurt. "They don't know what I've been through."

Meth spreading fast
Until a few years ago, little attention was paid to children exposed to meth, the fastest growing illegal drug in the country. Kids were a distraction when police broke into houses and made drug arrests. Gradually, though, awareness began to build that meth wasn't like heroin, cocaine, crack or even marijuana, at least not in the Midwest. Unlike these drugs which come from outside the U.S., meth was being home-cooked by addicts eager to use the drug, not sell it on the streets. Most were young adults in their 20s and 30s, prime child-bearing and child-rearing years, according to the national drug statistics.
      Virtually all the meth circulating in Illinois is made in small labs. Last year, 971 labs were busted, up 43 percent from 677 labs in 2002, according to newly released data by the Illinois State Police. Kids are discovered at these crime sites 30 to 40 percent of the time, police officials report. In another measure of meth's spread in Illinois, admissions to publicly funded treatment facilities soared to 3,582 in fiscal 2003, compared with 2,149 the year before, according to new data from Illinois' Office of Alcoholism and Substance Abuse.
      Illinois is beginning to address what this epidemic means to children. On Jan. 1, a new state law doubling prison sentences for people who cook meth around children went into effect. "These children are exposed to a very, very violent lifestyle of drug using, drug dealing, and drug manufacturing," says Bruce Liebe, who oversees the clandestine lab program for the state police. "Once their parents are addicted, nothing but getting the drug seems to matter."

Kids' private terror
Each time the kids' school or neighbors would call the Department of Children and Family Services on Cobb--there were eight incidents, according to department records--she'd clean up her act temporarily, park the kids with family members or just move to another small Illinois town. "Addicted people are good at covering their tracks and good sprinters: they're able to show significant accomplishments over a short distance and, quite frankly, trick our system sometimes," says Bill Peyton, administrator for the southern region of the Illinois DCFS.
      No one kept track of what was happening to Cobb's kids. "I've seen her get beat by multiple people all the time. There was blood everywhere," says Donnie Simpson. "I'd try to get in the middle, to keep them off her, but I'd get hit. "We'd walk in (after school) and we'd find syringes, drug paraphernalia everywhere. Sometimes she'd be gone for a day. Sometimes longer," says Donnie. "You never really knew when she'd be back. You never knew where your next meal would come from, or even where you'd live the next day. I was just scared all the time," Donnie says quietly, speaking to an outsider for the first time about what he and his family went through.
      Part of meth's thrill is a high that can last for 8 to 12 hours, and that can keep constant users up for more than a week at a time. Sleep-deprived, meth addicts become paranoid and dangerous. Then they crash, falling into a deep sleep that often lasts for days. "If you even looked at my mom wrong, she'd pick you up and throw you against the wall and punch you in the face. This happened hundreds of times," says Donnie, who didn't start fighting back until he was in his teens. "She was like a monster."
      Only now are officials beginning to track how many child-welfare cases in Illinois are related to drugs, including meth. Though hard numbers aren't available yet, "definitely, the numbers of children we are taking into protective custody because of meth is on the rise," says Peyton. Neighboring Iowa's experience is better documented and highlights how much damage the epidemic is doing to families. In 2001, after the horrific death of a toddler living with her meth-addicted mother, Iowa became the first state in the U.S. to create a new category of child abuse: manufacturing a dangerous drug in the presence of a child. The next year, the first official count of meth-related cases came in. About 468 Iowa children were found in homes with illegal labs; another 397 babies were born to mothers addicted to meth and cocaine.
      Meanwhile, in August, Carol Gutchewsky, community liaison for Iowa's Department of Human Services looked in-depth at 1,469 active child-welfare cases in 16 southwestern counties. Some of the children were living at home; others had been put in protective custody. After interviewing social workers, Gutchewsky discovered that 49 percent of these cases involved meth in one way or another. "We're using up foster home slots for these children from meth families," she said. The trend appears similar in Illinois, where about half of the new foster care cases being handled by Lutheran Social Services of Illinois' southern region are meth-related, according to regional director Larry Johnson.
      Recognizing the nexus between meth and child abuse and neglect, the Illinois State Police and Illinois Children and Family Services are developing a drug-endangered children's program, modeled after a program from California. Under the program, set to roll out this year, police will contact child-protection workers immediately when youngsters are found at a meth site and gather evidence of child harm as part of their criminal investigation. In turn, child-welfare staff members will take responsibility for making sure children receive medical attention and are placed in safe settings.

Turning life around
It was the prospect of losing all her children after getting caught in a drug bust in July 2001 that finally got Misty Cobb off meth. But for years, she'd acted like she didn't care. "When we got busted, four of us women in this drug house, we had 15 kids between us, 18 years to 2," says Cobb, who was charged with a Class 4 felony for unlawful possession of drugs. "How were these kids living? We didn't know. Most of the time, I didn't even know where my kids were ... If we made a phone call to our kids, we thought we'd done something and then it was over for the next month. "I'd just get high again and try not to worry about it."
      By then, her oldest son, Donnie, had dropped out of high school and was living in an abandoned building, depending on handouts from friends. Eric Patterson, Cobb's former husband, had won custody of her two middle children, Michael and Carissa Patterson, who rarely saw their mom. Cobb's youngest, Jessica Highsmith, 12, was taken away after her mother's arrest and sent to live with Cobb's mother, June Martin, 65. Martin now has custody of the girl, who for years had struggled with severe asthma while living in homes filled with meth smoke. Today, her asthma is under control.
      This is how Michael, now 17, tried to jolt Cobb out of denial several years ago in a letter: "Mom, why is Jess not going to school ... Donnie needs specks (glasses) and you are not trying to do anything about it. ... If you were the mom you are supposed to be you will stop partying and doin drugs ... and always sleeping in. And get a job. And leave them guys alone till your life is right ..." Michael, who has a gentle manner, still feels the sting at school, where it's common for kids to tease him. "It's hard with so many people knowing what your mom did. They think you're not worth anything. I just put my head down," says the boy, who says he wants to be a probation officer.
      Schools need to be aware of signs that something could be going wrong: unexplained absences, students so tired they can't focus after their drug-using parents have kept them up all night, says Chris Boyd, chief probation officer for Clay County, who has worked closely with Cobb and her children.
      Beating all the odds--fewer than 10 percent of meth addicts stay off drugs the first time they try to recover--Cobb successfully ended probation Dec. 18 and has been trying to build a new life. Remarried for the sixth time, she and her husband, Vance, are running a construction business in Flora. Donnie and Carissa have come to live with Cobb again, in part to try to recover some of the childhoods they never had. Carissa, 15, still is trying to process all her conflicting feelings. "I get mad at my mom because she shouldn't have done all the bad things she done, but I feel sad because she hurt herself," says the girl who, like her siblings, vows she will never try drugs. "I seen my mom lying in her bed and she was so little. She was just curled up in a ball, all awful, and she couldn't talk to us or anything. I don't want what happened to her to happen to me," says Carissa.
      For her part, every day Cobb has to face kids who shrink away when she tries to give them a hug. The guilt she once tried to drown out comes flooding in now, even as she struggles to find a way to be a mother again and keep rejecting the draw of drugs. "Looking at the situation sober, I can see what happened. These kids have to struggle now just to get through every day of life because of what I've done," this former addict says. "It isn't something I think they'll ever get over."

Case of Spalding Gray Baffles
Justin Glanville, Associated Press- 3/7/2004

NEW YORK -- Nearly two months after actor-writer Spalding Gray walked out of his Manhattan apartment and disappeared, his wife holds out hope that he will return unharmed. "Everyone that looks like him from behind, I go up and check to make sure it's not him," Kathleen Russo said in a recent phone interview. "If someone calls and hangs up, I always do star-69. You're always thinking, `maybe.'
     Police said they have received 36 tips since Gray's disappearance Jan. 10, including several accounts from reliable witnesses who believe they saw Gray on the Staten Island Ferry the night he vanished. Russo has said she fears he may have tried to jump off the boat. Gray 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 passerby talked him down.
     Most of the tips have led nowhere, officials said. One came from a former police officer who thought he saw Gray in a diner in Newburgh, N.Y., about 60 miles north of New York City. But when police reviewed tape from the diner's surveillance camera from that day, they saw no sign of the actor. A woman in Beverly Hills, Calif., snapped a photograph of a man she thought was Gray and sent it to Russo. It wasn't him. "Spalding had one of those faces. People often told him, `You look really familiar.' He looks like a professor they once had or something," Russo said.
      With his wiry gray hair and intelligent eyes, Gray, 62, projected an academic air in the 18 theatrical monologues he wrote and performed beginning in 1979. Several were made into films, including "Swimming to Cambodia" (1987), which begins as a memoir of his appearance in the film "The Killing Fields," and "Gray's Anatomy" (1996), a humorous recounting of his quest to cure an eye condition. He also played roles in feature films and on Broadway. His monologues were intensely autobiographical but did not convey the depths of his periodic depressions, according to Richard Schechner, founder of the Performance Group, a downtown Manhattan theater troupe Gray joined in 1970.
     "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," Schechner said after Gray's disappearance. Gray addressed those inner conflicts in the monologue, "It's a Slippery Slope," in which he tells the audience he had to overcome a deep depression associated with his turning 52 -- the age of his mother when she committed suicide. More recently, Gray acknowledged that a head-on car crash in 2001 left him particularly despondent about his physical limitations.
     Russo has two sons, ages 11 and 6, and a stepdaughter with Gray. She has been frustrated that she has nothing to tell them beyond "Dad's missing, and the police are looking." The lack of certainty has been equally painful for Russo. She and Gray spent much of every day together since their marriage 10 years ago, sharing meals and often hiking or biking. She has relied on the companionship of relatives and friends, and has been reading books about other people who have lived through the disappearance or suicide of a loved one. She also tries to be "as present as possible" for her children, with whom she has been planning a vacation to Arizona. She still hopes that Gray will turn up unscathed. Still, Russo said, "He's had some kind of accident, either intentional or not." In the absence of news, the family can only wait. "If you can imagine, it's pretty awful," she said. "There's no closure, no answers -- no definitive outcome."



Smoking, Drinking on Rise in Military
Robert Burns, Associated Press- 3/8/2004

WASHINGTON -- Cigarette smoking and heavy drinking are on the rise in the military, particularly among younger troops, and many in the armed forces report feeling stress in their work, a Pentagon health survey says. Drug use, however, is holding steady far below the rate for civilians.
     The survey identified what Pentagon officials called a sizable group of military members who are having problems with stress and mental health without necessarily seeking help. Almost half of the respondents said seeking mental health counseling probably or definitely would damage their careers.
     The results released Monday are from a survey conducted in the fall of 2002, just before tens of thousands of troops deployed to the Persian Gulf in preparation for the invasion of Iraq. Dr. William Winkenwerder, assistant secretary of defense for health affairs, told a Pentagon news conference that survey data was as yet unavailable to measure mental health conditions among the 120,000 or so American soldiers who spent the past 12 months at war in Iraq.
     The Army has studied suicides, which rose sharply last July, as the toll on American troops rose from the insurgency, but later fell to levels similar to peacetime averages. It found that many suicides were associated with failures of personal relationships and financial problems.
     Of the 12,756 troops who responded to the Pentagon's 2002 survey, conducted at 30 military installations worldwide, about one-third said they felt a lot of stress in their military duties. An additional 30 percent said they felt some stress. The most frequently cited sources of stress for men were deployment (18.9 percent) and separation from family (18.7 percent); the women cited changes in personal life (21.4 percent), separation from family (21.2 percent) and deployment (19.6 percent). Injuries, illness and workplace accidents were twice as common among those who described themselves as stressed.
     The survey found that 5 percent of all who participated said they had considered suicide or self-injury within the year prior to the survey, and it found that heavy users of alcohol had more problems with workplace stress than abstainers, by a margin of 40 percent to 30 percent.
     In specific findings:
--The share of military members categorized as heavy drinkers (having five or more drinks on a single occasion at least once a week) rose to 18.1 percent from 15.4 percent in the previous survey in 1998. When the survey was first done in 1980 that figure was about 21 percent.
--Military personnel aged 18 to 25 showed significantly higher rates of heavy drinking (27.3%) than civilians (15.3%).
--Cigarette smoking rose from 30 percent in the 1998 survey to 34 percent in the latest survey. This was the first increase recorded in the seven times military members have been questioned on this since 1980. In that first survey 51 percent were smokers. In the civilian U.S. population, about 31 percent are smokers today, according to figures provided by the Pentagon.
About 30 percent said they had taken up smoking since joining the military. Last fall military medical authorities said they found in investigating 19 cases of severe pneumonia among soldiers in and around Iraq that most had taken up smoking shortly before falling ill.
--The percentage who reported use of illicit drugs was 3.4 percent, up from 2.7 percent in 1998 but not a statistically significant change, according to Robert M. Bray of RTI International, which conducted the survey under contract to the Pentagon. He said the 3.4 percent for the military compares with about 12 percent for the civilian population of the United States.
--Forty-one percent of women said they were under a great deal or a fairly large amount of stress stemming from being a woman in the military. Women in the Navy had the highest rate (49 percent), followed by women in the Army (46 percent), Marine Corps (44 percent) and Air Force (31 percent).
     In measuring overall job satisfaction, 65 percent indicated they were either satisfied or very satisfied with their current assignment. Satisfaction was highest in the Air Force (72 percent) and lowest in the Army (61 percent). Males and females indicated similar levels of satisfaction.
      On the Net: Survey results in full: www.tricare.osd.mil/main/news/art0514.html

Spalding Gray, 62, Actor and Monologuist, Is Confirmed Dead
Shaila Dewan & Jesse McKinley- 3/9/2004

A body that surfaced in the East River on Sunday was identified by the city medical examiner yesterday as that of Spalding Gray, the confessional monologuist and actor who disappeared two months ago. The cause of death had not yet been determined, but the police were investigating reports that Mr. Gray, who had a history of depression, had committed suicide by jumping off the Staten Island ferry, said Paul J. Browne, the chief spokesman for the Police Department.
     Mr. Gray, 62, practiced the art of storytelling with a quiet mania, transforming his travels, fascinations and traumas into such acclaimed works as "Swimming to Cambodia" and "Monster in a Box." He almost always appeared seated behind a simple desk, with a glass of water and some notes.
     The news of his death ended a painful limbo for Mr. Gray's friends and family, during which they answered calls from fans and followed up on reported sightings, including one at a diner in New Jersey. There seemed to be little hope: the police had traced one of Mr. Gray's final calls to a pay phone at the ferry terminal, and he had previously threatened to jump off a ferry. But for his wife, Kathleen Russo, their two young sons and Mr. Gray's stepdaughter, there had been no final answer.
The suspense grew more agonizing in its final hours, when the family received a call on Sunday night from an Associated Press reporter who told her a body had washed up near Greenpoint in Brooklyn wearing black corduroy pants. That was what Mr. Gray had been wearing when he was last seen on Jan. 10. At that point, Ms. Russo had not yet heard from the police, a friend of the family said.
     Spalding Gray's older brother, Rockwell Gray, said he had been holding out hope that his brother would be found alive until he talked with Ms. Russo early yesterday, before the medical examiner's findings were announced. "She told me it seemed almost certain it was his body they had found," said Mr. Gray, an English professor at Washington University in St. Louis.
     Many knew that Spalding Gray, who spoke publicly of infidelity, depression and a sometimes pained conscience, had his fair share of emotional turmoil. But by the late 1990's, it seemed he had begun wanting to put that behind him. He had safely passed the age, 52, at which his mother had killed herself. He had told countless audiences of surviving near-drowning, "psychic surgery," claustrophobic attacks and what he described as the inescapable letdown of real life. But as he eventually settled into a domestic bliss he had once resisted -- fatherhood, a home on Long Island, daily yoga -- darkness and cynicism had retreated, at least somewhat, from his performances.
While he was on vacation in Ireland in 2001, though, a devastating car accident fractured his skull and crushed his hip, sending Mr. Gray into a profound depression.
     After his disappearance, an article in New York magazine chronicled Mr. Gray's despair after the accident and his ineffectual attempts to recover through surgery, physical therapy and antidepressants. He checked himself into a psychiatric hospital in June 2002, the article said. Back home, he sometimes left answering machine messages and notes saying he intended to kill himself.
The police confirmed some of this account, saying that more than once, Mr. Gray had to be talked down from a bridge on Long Island.
     Still, last October, he began performing "Life Interrupted," a monologue about the accident, and while the performances were often disjointed and unpolished, those close to him viewed his return to the stage as a hopeful sign. On the day he disappeared, Mr. Gray was scheduled to fly to Aspen, Colo., for a ski clinic, a gift from Ms. Russo in celebration of his partial physical recovery. He loved skiing, and had rhapsodized on it in a piece called "It's a Slippery Slope." His flight was canceled because of bad weather. Instead, he took his sons, Theo and Forrest, to see "Big Fish," a movie about a son and his dying father. Afterward, he said he was going to visit some friends. He never reached their house.

U-M Focusing on Depression
Tracey Davis, Ann Arbor News- 3/9/2004

For most of her life, Ann Coulouris cried every day. She was the overly sensitive child, the serious one. And to her, it seemed normal. The year before she started college, Coulouris, at her mother's urging, talked with her family physician about how she felt. She was prescribed an antidepressant medication for premenstrual dysphoric disorder, a severe form of PMS. It helped, for a while. But the year she transferred to the University of Michigan, as a sophomore, thoughts of suicide became so frequent and so vivid she became alarmed. She called her family and went to the psychiatric emergency room. "For a couple of months, I was terrified every day I would feel that way again," said Coulouris, a fourth-year student from Saginaw. "That down point was worse than any down point I had ever had. All I could think was, `I don't ever want to feel that way again.' And so far I haven't." With new medicine and regular sessions with a therapist and psychiatrist, she finally asked what to call this thing that gripped her sometimes. She had moderate to severe depression, her psychiatrist replied.
     Coulouris is far from alone. She believes she has suffered from depression since she was a child. But for many, depression often surfaces for the first time during college years. People in late adolescence and early adulthood may be more prone to the onset of depression, partly because of many life changes. Sleep deprivation, irregular schedules, the pressures and freedoms of being away from home, making new friends and adjusting to academic pressures, the biochemical assault from drinking or drug use can all exacerbate existing depression or bring it on for the first time.
     Some 19 million American adults, almost 10 percent of the adult population, have a depressive illness, according to the National Institute of Mental Health. The World Health Organization categorizes depressive illnesses as the leading causes of disability in the world. In 2000, the American College Health Association reported that 10 percent of college students had been diagnosed with depression sometime in their lives. Some estimates run as high as 15 percent. And a 2002 national survey found that more than 80 percent of 274 directors of campus counseling centers thought the number of students with severe psychological disorders had risen over the last five years.
    At the University of Michigan, as many as 20 percent of the several thousand students who seek counseling and psychological services annually are depressed, said Donna Champine, a clinical assistant professor in the psychiatry department and a staff psychiatrist at U-M's Counseling and Psychological Services program. That's why the University of Michigan is holding its annual Depression Conference on Tuesday and Wednesday. Organizers hope to share research and learn new things about trends in depressive illness among young adults. The ultimate goal is better treatment and, someday, prevention.
     A key focus this year, the second year U-M has held a depression conference, is the link between depression and the effects of sleep, stress and alcohol on the disease's onset and progression. "It's a problem that really does require all of our national attention for several reasons," said Dr. John Greden, chair and executive director of the Michigan Depression Center. "The age of onset of depressive syndromes is really during young adulthood. ... Since depression is a genetically influenced and stress-influenced disorder, what else happens when you go off to college? "You experience a whole set of new stresses. There are new demands, new social and perhaps sexual challenges, pressures with grades, money, all of them tend to peak."
     Picture a string of Christmas tree lights. That's the circuitry of the brain. Nowadays, you can buy a string in which, if one light breaks, the rest of the string still works. But for the old strings of lights, one broken or malfunctioning bulb sets off a reaction that makes the whole string go haywire. That's similar to the brain of someone who suffers from depression. Neurotransmitters are the wiring in the brain. They pass along signals to light up centers of the brain that govern feelings like sadness, pleasure, pain, appetite and decisionmaking.
     Scientists believe that external factors like sleep deprivation, overuse of alcohol, and stress can disturb this delicate balance of chemistry. "All those functions are intertwined," Greden said. "If you stir one up, it often sets up the other." And eventually out goes the string of lights, and a person who is prone to or genetically predisposed to depression plummets into its depths.
     Most alarming, perhaps, is that scientists have discovered depression, left untreated, has long-term effects on the brain. Some affected areas that control stress, memory and fear appear to shrink under the onslaught of depression, Greden said. But recent research has shown that trends can be reversed with treatment. The other good news is that health care providers are getting better at screening for depression, Champine and Greden say.
     Thanks to the efforts of people like Coulouris, and conference speakers and fellow depression sufferers Kay Redfield Jamison, a psychologist, and Tampa Bay Buccaneers football player John Howell, the stigma associated with depressive illnesses is beginning to abate. That helps people come forward to seek help, Champine said. The conference is co-sponsored by the Michigan Depression Center and the Rackham School of Graduate Studies. Speakers include directors of three of the National Institutes of Health; Jamison, who authored a book on her illness; and the 26-year-old Howell, who last June went public about his struggle with depression and his success in receiving treatment.
     Champine hopes the conference will help get the word out to people that depression is a treatable illness that they should not feel ashamed of. "If someone is experiencing depression, it is in no way a sign they are weak, or have a character flaw, or haven't handled things," she said. "Hopefully, the more people can learn and understand about depression, the more willing they'll be to seek treatment, which can be life-saving." Coulouris agrees. "Mental illness is something that requires a great responsibility and great strength on the part of the person who is dealing with it," she notes, crediting her supportive family and friends. "It's not something you can still be happy through and look at the bright side."




Long Before Oprah, a Celebrity Bared Her Soul
Barron Lerner, New York Times- 3/9/2004

A young actress experiences great success early in her career. She begins drinking or using drugs, leading to erratic behavior and lost roles. Then, with the help of family and friends, she realizes the error of her ways and enters rehabilitation. Within two years, she turns her comeback into a best seller, then a made-for-television movie. It is, these days, a familiar story. But 50 years ago, when the actress Lillian Roth wrote "I'll Cry Tomorrow," a harrowing account of her descent into alcoholism, celebrities were not in the habit of baring their souls in public. The book was an instant sensation, selling more than 100,000 copies in a few months. It was eventually translated into 18 languages. A 1955 Hollywood film based on the book earned an Oscar nomination for Susan Hayward.
     But Roth's account of her own struggle also helped change the way Americans view drinking problems. Reviewers praised the book as courageous. Although other Hollywood stars had written autobiographies, none had provided such lurid and graphic details. "Few personalities who have lived a life such as has Lillian Roth would dare to write with similar frankness," The Atlanta Constitution wrote at the time. The public was even more effusive, sending Roth thousands of congratulatory letters. Many of the letter writers had themselves been alcoholic or ill or had loved ones who were in that situation, and saw her story as inspiring. One, a 15-year-old girl, wrote that her mother was "drunk all of the time." Roth later persuaded the woman to enter Alcoholics Anonymous, as she herself had done. "I'll Cry Tomorrow" was published at a time when drinking was receiving great attention. For decades, Prohibitionists had labeled alcohol as evil. But with the repeal of Prohibition in 1933, attention shifted from the elimination of alcohol to the treatment of alcoholism.
     Dr. Michelle McClellan, a historian at the University of Georgia, writes in a forthcoming book, "Altering American Consciousness," an edited volume on the history of substance use, that convincing the public that alcohol abuse was "a disease, not a vice or simple bad habit resulting from a lack of willpower," was crucial to this transformation. In this climate, Roth's book had a large impact. "Roth was one brave girl to write it," said Dr. Joan K. Jackson, a retired sociologist who in the 1950's studied alcoholism. At that time, she said, the public equated alcoholism with bums on Skid Row. "As a woman, and a movie star, Roth showed this was not true," Dr. Jackson said.
     Roth's path from stardom to desperation and back again was a troubled one. Not surprisingly, she had a stage mother, Katie Silverman, who wanted her daughter to be a singer and actress. By 1918, at age 8, Lillian Roth was on stage, billed as "Broadway's Youngest Star." She played vaudeville with performers like Georgie Jessel, George Burns and Gracie Allen and the Marx Brothers,with whom she would later appear in "Animal Crackers." By her late teens, she had moved to Hollywood, starring in films like "Honey," "Paramount on Parade" and Cecil B. DeMille's extravaganza "Madam Satan."
     But, as is common in such stories, Roth's personal life was not so charmed. At the age of 5, she later wrote, a man fondled her. Her father, Arthur, was a heavy drinker. In her early 20's, her fiancé died of tuberculosis. Soon afterward, Roth began to drink heavily. She was drinking when she impulsively married her first husband. (She had several failed marriages.) Roth wrote that she drank upon awakening and always carried a concealed bottle. Her stage work dried up when she showed up drunk.
     Things got even worse after her 1940 marriage to Mark Harris, who, she said, beat her. "Suddenly his fist exploded in my face," Roth wrote. "A pinwheel of flame whirled in my eyes." In 1945, the actress was admitted to a psychiatric hospital for six months. But her sobriety did not last. Soon she was drinking again and contemplating suicide.
     But rather than taking her life, Roth chose another course. The final pages of "I'll Cry Tomorrow" describe how she entered A.A.'s 12-step program and became permanently sober. A happy marriage followed, as did stage work - and religion. In 1948, Roth, born Jewish, became a Roman Catholic. In 1953, she appeared on the popular television show "This Is Your Life," whose host was Ralph Edwards. Millions of Americans heard about her 16-year struggle with alcoholism and her remarkable return to stardom. "I'll Cry Tomorrow" was published the next year.
      The book helped to destigmatize alcoholism, but Roth's most vivid legacy is that she told her story. Indeed, it has become de rigueur for celebrities to go public with their illnesses, chronicling their experiences with diseases like prostate cancer (Robert Dole), hepatitis C (Pamela Anderson), or spinal cord injuries (Christopher Reeve). Other celebrities, including Betty Ford, have also chronicled their battles with alcoholism and addiction. More recently, the actor Michael J. Fox and the comedian Margaret Cho have written about their drinking problems.
     What motivates celebrities to go public with their problems? Some experts say that in a star-obsessed culture, anything that happens to celebrities is seen as newsworthy. Altruism, and the wish to help others with the same difficulties, may play a role, said Michael J. Green, an internist and bioethicist at the Pennsylvania State College of Medicine. But confession can be self-serving, as well, raising financial conflicts of interest that Dr. Green finds "very worrisome." For example, celebrities, like the actors Rob Lowe and Kathleen Turner, have come under fire for promoting drugs for various medical disorders without disclosing that they were being paid by pharmaceutical companies. Roth herself was aware of the potential for criticism, noting that some people had accused her of exploiting A.A. for her personal gain.
     By the late 1950's, her career had rebounded. In 1962, she returned to Broadway, playing Elliott Gould's mother in "I Can Get It for You Wholesale." She worked steadily until her death, in 1980, at 69.

Defying Psychiatric Wisdom, These Skeptics Say 'Prove It'
Erica Goode, New York Times- 3/9/2004

They have been called assassins and parasites. They receive hate mail from the proponents of a variety of popular psychotherapies. The president-elect of the American Psychological Association has accused them of being overly devoted to the scientific method. But the ire of their colleagues has not prevented a small, loosely organized band of academic psychologists from rooting out and publicly debunking mental health practices that they view as faddish, unproved or in some cases potentially harmful.
     In journal articles and public presentations, the psychologists, from Emory, Harvard, the University of Texas and other institutions, have challenged the validity of widely used diagnostic tools like the Rorschach inkblot test. They have questioned the existence of repressed memories of child sexual abuse and of multiple personality disorder. They have attacked the wide use of labels like codependency and sexual addiction. The challengers have also criticized a number of fashionable therapies, including "critical incident" psychological debriefing for trauma victims, eye-movement desensitization and reprocessing, or E.M.D.R., and other techniques. "These guys are sort of the Ralph Naders of psychology," said Dr. David Barlow, director of the Center for Anxiety and Related Disorders at Boston University.
     Yet the psychologists are hardly cranks. Their criticisms reflect a widening divide in the field between researchers, who rely on controlled trials and other statistical methods of determining whether a therapeutic technique works, and practitioners, who are often guided by clinical experience and intuition rather than scientific evidence. "I started to become very concerned by the practices that I was seeing our field tolerating and, in some cases, actively embracing," said Dr. Scott Lilienfeld, a professor of psychology who has emerged as a de facto leader of the group.
     In 1988, a group of researchers, concerned that the American Psychological Association, the dominant professional organization, was not placing enough emphasis on science, split off and formed the American Psychological Society. The society now counts close to 15,000 members, its executive director, Dr. Alan Kraut, said. The association has 155,000 members. Dr. Lilienfeld, who resigned from the psychological association in 2001, after a dispute over the organization's handling of a journal article he had written, says many clinical psychologists are out of touch with research findings. "As in the case of medicine, practitioners have to be informed about the most recent and most credible findings," he said.
     One survey, according to Dr. Lilienfeld, who is an author of the 2003 book "What's Wrong With the Rorschach," found that a vast majority of practicing psychologists did not read even one scientific journal article a month and that some doctoral programs in clinical psychology no longer required research training. "Many practitioners, because they don't keep up with the scientific literature, may be using suboptimal and, in some cases, even dangerous treatments," Dr. Lilienfeld said.
     Two years ago, he founded The Scientific Review of Mental Health Practice, a journal whose stated goal is to present "objective investigations of controversial and unorthodox claims in clinical psychiatry, psychology and social work." Two issues of the journal have been published. In it, authors have examined "fact and fiction" in the treatment and investigation of autism; a paper evaluated "neurotherapy," a technique used for attention deficit disorder; and a critique by Dr. Eric Mart, a forensic psychologist in New Hampshire, questioned the scientific and legal basis of Munchausen syndrome by proxy, in which parents, usually mothers, make their children sick to draw attention to themselves.
     In a "mission statement," the journal's editorial board notes that "a wide variety of unsubstantiated or untested treatments" and psychological tests have flourished in recent years. "Although some of these techniques may ultimately prove to be effective," the statement continues, "it is disturbing that the frequency of their use greatly outstrips their evidentiary base."
     The muckraking has not always been welcomed by others in the field. Dr. Richard McNally, a professor of psychology at Harvard who has conducted research on repressed memories, E.M.D.R. and other problems, said he had received threatening letters, e-mail messages and telephone calls from angry practitioners. "All you're doing is your science," Dr. McNally said. "But in the trauma field, you're going to make somebody upset, period."
     Dr. Mart, author of "Munchausen's Syndrome by Proxy Reconsidered," has drawn fire from psychiatrists who defend the diagnosis. Dr. Marc Feldman, a psychiatrist in Alabama who has written extensively about Munchausen's, said Dr. Mart "makes his career" out of defending accused mothers. "He has a powerful financial interest," Dr. Feldman said. Dr. Mart said he did not disagree that some mothers abused their children by making them sick. But the term Munchausen's by proxy "has taken on a life of its own," he said, and the condition is grossly overdiagnosed. In most cases, Dr. Mart said, the proper term is simply "medical abuse." He added that Munchausen's experts like Dr. Feldman also received fees for testifying in court. "I would be a much richer man today if I had gotten in on the pro-Munchausen side of things," he said.
     Dr. Lilienfeld said he welcomed such give and take. "If you criticize people, you have every right to expect criticism in return," he said. Still, his Rorschach assessment, written with Dr. James Wood of the University of Texas at El Paso and Dr. Howard N. Garb of the Wilford Hall Medical Center in San Antonio, drew angry responses. An irate therapist, Dr. Lilienfeld recalled, wrote in an Internet posting that the the authors deserved "one bullet for each of the three assassins."
      Such intense reactions, Dr. Lilienfeld and others in the group said, are not surprising. "Many of the practitioners of these methods resent the notion that researchers should dictate or constrain what they do," he said. That resentment, some experts said, has grown stronger at a time when psychotherapists are under increasing financial pressure and insurers are loath to underwrite the cost of talking therapies.
     Some experts, among them Dr. Barlow of the Center for Anxiety and Related Disorders, have argued that psychologists can counter such pressures by building up the scientific evidence for the effectiveness of different forms of psychotherapy. Like medicine, these experts contend, psychology should have clinical practice guidelines, and psychotherapists should favor treatments that are backed by evidence from controlled clinical trials over treatment whose effectiveness is supported by anecdotes and case histories only. In fact, more than 50 leading doctoral programs in clinical psychology have joined to promote their training in "empirically supported" psychotherapies. At least two forms of psychotherapy, cognitive behavioral therapy and interpersonal therapy, have been demonstrated in studies to be effective for a variety of disorders. The two therapies have been standardized in manuals that describe how they are practiced.
     Some clinicians say that their work with troubled patients can never be captured by experimental trials and that traditional science has little relevance in the consulting room, where psychotherapists often deal with problems far more complex than those addressed by "cookbook" psychotherapies.
Dr. Ronald Levant, president-elect of the American Psychological Association, said Dr. Lilienfeld and others had gone overboard in their enthusiasm for scientific vetting of therapeutic techniques.
"Their fervor about science borders on the irrational," Dr. Levant, a professor of psychology at Nova Southeastern University in Florida, said. "The problem in clinical psychology is that we don't have science to cover everything we do, and that's true for medicine, as well." He added that psychologists "recognize that we need to find a way to show we are being accountable," but that many practitioners "question the very narrow standards that are being raised." In fact, at an annual meeting of the psychological association, a Canadian psychologist reportedly began a session by asking, "How can I escape from the clutches of the psychotherapy police?"
     The association, Dr. Lilienfeld said, has not done enough to shore up scientific standards and weed out pseudoscientific or potentially harmful therapies. "The A.P.A. has been exceedingly reluctant to impose ethical limitations or sanctions on members who engage in either unvalidated or potentially harmful mental health practices," he wrote in the first issue of the new journal. A spokeswoman for the association, Rhea Farberman, responded: "We do have an ethics code and we do have an ethics education and enforcement program. We put a lot of resources into educating our members about their ethical obligations and enforcing the code through a complaint procedure."
     The debate is likely to continue, and the push for stronger evidence will gain ground.
"People resist change," Dr. Barlow said. But the efforts of psychologists like Dr. Lilienfeld, he added, ensure that important questions are discussed. "On some things, we'll come down on one side," he said. "On some, we'll come down on the other. But at least these things are seeing the light of day."

Bipolar Teen and Family win the Struggle For Peace
Desiree Cooper, Detroit Free Press- 3/9/2004

Outside Cindy Lang's Brownstown Township home hangs a wind chime of crystal angels, a talisman against the violence and abuse that raged indoors for three years. In the front hall, there's a patch where someone rammed an angry hand through the wall. Once, when Lang came home from the hospital after being treated for stress, she had a desk thrown at her. Police and Emergency Medical Services came to her home so often, she went door to door to apologize to the neighbors. "Whenever the violence started," said Lang, a 35-year-old homemaker, "my mother would lock my son in the room while I tried to calm things."
     Many victims of domestic violence eventually escape their tormentors, but for Lang, that wasn't an option: Her abuser was her 13-year-old, bipolar daughter, Tiffeny. Cindy Lang and her husband, Dennis, 34, tried for years to get their daughter help, but the lack of long-term mental health facilities made it difficult. "Finally, someone told us to try to get her arrested," Cindy Lang said. "We were at the end of our rope, so that's what we did."
     Increasingly, parents with children who are mentally ill are turning to the juvenile justice system for help. During the 1990s, the Engler administration closed most of the state-run, long-term mental health facilities in favor of community-based treatment. Today there is only one state mental hospital for children -- the 94-bed Hawthorne Center in Northville.
     The private sector was to make up for the need, but the number of private beds also has declined. "In 2001, there were 523 beds for children who needed long-term residential treatment," said Susan McParland, executive director of the Michigan Association for Children with Emotional Disorders. "That's down from 996 beds in 2000."
     The dearth of residential care facilities has made it hard for Michigan's most disturbed children to get adequate care. "So they end up with us," said Leonard Dixon, executive director of the Wayne County Juvenile Detention Facility. Dixon is also president of the National Juvenile Detention Association. "We serve over 3,000 kids a year, and 60 percent of them have some mental health problem." Nationally, it's estimated that between 60 percent and 75 percent of juveniles in custody have one or more mental health problems, added Dixon. "A lot of parents believe that the juvenile justice system can help," McParland said. "But parents don't realize that they will lose custody, and their children will be caught in the juvenile system, no better off."

'Anything to get help'
In 2000, Tiffeny was almost 13 when the dimpled girl with dark hair and alabaster skin started to change. Her moods varied wildly and her grades plummeted. "I couldn't control myself," said Tiffeny, now 16. "The smallest thing would set me off." "We wondered: Is this puberty?" said Cindy Lang, who once found a friend's note in Tiffeny's book bag urging her to slit her parents' throats while they slept.
     Fearful that Tiffeny had fallen in with the wrong crowd, the Langs sent her to Arizona to live with her favorite grandmother while the family moved from Lincoln Park to Brownstown Township.
Tiffeny did better in Arizona -- for a while. "I was angry at my family for sending me away," Tiffeny said recently. "I couldn't express the pain inside of me, so I started cutting myself. The blood was like my tears, because I couldn't cry."
     When Tiffeny smashed her grandmother's furniture and broke the windows, the Langs brought her home and took her to Harbor Oaks in New Baltimore, where she was evaluated. She was diagnosed with a severe form of bipolar disorder, characterized by extreme mood swings, destructive outbursts, hypersexuality and extreme sensitivity to rejection and failure, according to the National Institute of Mental Health.
     When the Langs realized their daughter was ill, they sought treatment but couldn't find any residential programs covered by their insurance. "We were told that the only way to get our daughter help was to wait until she got violent and call the police," said Dennis Lang, who drives a concrete truck. After one of Tiffeny's violent episodes at home in summer 2002, police arrested her. But she was placed on probation for six months and didn't get any help. According to Cindy Lang, no officer ever contacted the family during the probation. "Things were getting worse," she said. "I went over a month without sleeping because I was so scared that Tiffeny would . . . hang herself."
     In October 2002, Tiffeny collapsed in her ninth-grade classroom from an overdose of prescription drugs she allegedly obtained from a schoolmate. She was suspended for 45 days. Tiffeny's parents got her a part-time job at a local pizza parlor. She'd been working there several weeks before the Langs learned that Tiffeny had been walking into the front door and out of the back. Soon after, Tiffeny was missing for a day and a half. "On the day we found her, we got a letter from the court saying that she'd successfully completed her probation," Cindy Lang said. "She'd had an overdose, been expelled from school and been a runaway, and no one from the court ever knew it." The Langs insisted on a hearing before the case was dismissed. In December 2002, Tiffeny pleaded for the court to intervene. When asked if she knew what was going to happen, Tiffeny said, "Yes, but I would do anything to get help."

More like prisoners
According to the Office of Juvenile Justice and Delinquency Prevention, when it comes to treating delinquents with mental disorders, detention centers nationally suffer from inadequate screening procedures, unqualified staff, a lack of funding for special programs and a public mandate to treat children more like prisoners than patients. Luckily for Tiffeny, the Wayne County facility is rare in that it offers a complement of mental health resources.
     Most kids aren't that lucky. McParland has represented many families whose children languished in juvenile detention or suffered abuse in detention centers ill-equipped to handle mental illnesses.
One was D., a Birmingham 17-year-old whose mother called the police in 2001 when D. attacked his brother. The mother, Ann, thought the police would help her take the child to a hospital for help. Instead, D. was charged with assault, taken into custody and sent to a Lansing area detention center against his parents' wishes. The center lacked the staff to treat his Asperger's Disorder, a disease similar to autism that leaves its victims unable to relate socially or to express emotions. "He was catatonic," Ann said. "He couldn't eat because he thought there were germs or chemicals in the food. They kept treating him like he was just being rebellious, but that was a manifestation of his illness. He was seeing a psychiatrist about once a week there, but it wasn't enough."
McParland intervened. D. was released after 14 months.

Fighting back
In February 2003, the court placed Tiffeny at Vista Maria, a 121-year-old organization established by the Sisters of the Good Shepherd. Its 40-acre, college-like campus in Dearborn Heights is home to about 160 girls, many of whom are abused, neglected, truant and/or substance abusers.
Fortunately for Tiffeny, Vista Maria opened a $2.5-million, 15,000-square-foot mental health building in 2002. Trained psychiatrists and therapists helped stabilize Tiffeny, administered her medications, offered individual and family therapy and educated her about her disease.
     In January, after nearly a year at Vista Maria, Tiffeny went home. Although it hasn't been easy to reclaim her life, the high-schooler is making straight A's. She takes her younger brother, who used to be terrified of her, to the movies. She goes bowling weekly with her dad. "Now I feel like I can choose where I want to go in life," said Tiffeny, who wants to go to college -- but not before getting a cosmetology license. "Some said this was a losing battle. Well, I have fought back. I don't like to lose." Said Cindy Lang: "How many kids are out there on the street or in jail when they have an illness like Tiffeny's? I'm full of anger that we had to go this route. Imagine watching them take your child into custody . . . to this day, I'm looking for my heart back."

Poor Children Exposed to Smoke at Risk
Associated Press, 3/9/2004

NEW YORK -- Poor children whose mothers breathed secondhand smoke during pregnancy are at even greater risk for development problems, a study has found. Children whose mothers were exposed to secondhand smoke have reduced scores on cognitive development tests at age two, when compared with children from smoke-free homes, according to a study by the Columbia Center for Children's Environmental Health. But cognitive development scores are even lower among poor children whose mothers not only breathed secondhand smoke while pregnant, but may have lived in inadequate housing without proper nutrition, the study found. The findings ``show, for the first time, that urban children exposed to both conditions experience a kind of double jeopardy with consequences persisting into early childhood and possibly beyond,'' Dr. Virginia Rauh, principal author of the study, said in a statement.
     Researchers studied 226 babies born to nonsmoking women in Washington Heights, Harlem and the south Bronx. Their findings will be published in the Neurotoxicology and Teratology journal this spring. The study is part of a broader research project that examines the health effects on pregnant women and their babies exposed to air pollutants from exhaust, commercial fuels, tobacco smoke and pesticides.

U-M Stresses Access to Mental Health Aid
Tracy Davis, Ann Arbor News- 3/10/2004

With a new Web site, printed resource guides and maps to services, the University of Michigan is trying to improve access to student mental health cervices in an effort to reach those students before they get into a crisis. They are the first in a series of changes to come out of a three-year examination of student mental health services. "We have good programs in place, but the network was complicated," said Royster Harper, vice president for student affairs. If students can access programs and services more easily, people who need them might be more likely to seek help, she said.
     College-age people are more likely than any other age group to suffer mental health problems, partially because of the stresses of a changing environment. According to the group's report, seven of every 100,000 college students die annually by suicide. The University of Michigan loses up to three students every year to suicide, said Bob Winfield, director of University Health Service. Suicide is the second-leading cause of death among 15- to 24-year-olds.
     Additional recommendations from the Mental Health Work Group include dealing with the stigma associated with mental illness. Depression is estimated to affect nearly one in 10 adults, according to the National Institute of Mental Health, but feelings of shame and cultural barriers often prevent people from seeking help, officials said.
     The Web site, www.umich.edu/~mhealth, may help by increasing visibility and awareness, Winfield said. "Six months or a year ago, if a student needed help, they would be lost," Winfield said. "It's just a huge change. We believe it's really going to reduce barriers."
     Recommendations also include increasing funding and staffing, and improving and formalizing referral processes. The university has also implemented a withdrawal and readmission policy for
students who need to leave school for mental health reasons. The resource guide will be available later this spring. Costs associated with the entire project mostly involve staff time so far. University officials say later plans, such as a 24-hour hotline and increasing mental health services in general, will require funding that has not yet been allocated. The resource guide will cost about $1 per copy to print; Winfield estimated the first printing would produce about 10,000 copies.



New Pill Helps With Smoking and Weight
Associated Press, 3/10/2004

NEW ORLEANS -- Tackling two big problems at once, a new pill in development appears to double people's success quitting smoking while also helping them lose considerable amounts of weight. The drug is in the final stages of testing and could be available in a year or two. It works in an entirely new way, taming urges for food and cigarettes by blocking the same circuits in the brain that make pot smokers hungry.
     Doctors say the drug, called rimonabant, will probably be marketed both for dieting and smoking cessation, but it is likely to be especially appealing to people beset by both problems.
``We think this might be the ideal compound for people who are overweight and smoke,'' said Dr. Robert Anthenelli of the University of Cincinnati. He directed one of two studies on the drug that were released Tuesday at a meeting in New Orleans of the American College of Cardiology. The development could offer a well-timed one-two punch against Americans' gravest health concerns. Smoking is the country's top killer, accounting for 435,000 deaths in 2000. The combination of poor diet, obesity and physical inactivity are right behind, with 400,000 deaths.
     Doctors who heard data on the new pill said that while better living habits should still be the foundation of good health, a new pill could be an important boost for those who cannot accomplish it through willpower alone. ``We tell people to diet and exercise, and that advice doesn't seem to be very effective,'' said Dr. Raymond Gibbons of the Mayo Clinic, who called the latest results ``very provocative.''
     The research was financed by the drug's developer, the French firm Sanofi-Synthelabo, which plans to seek U.S. approval to sell it under the brand Acomplia after more studies are finished next year. Doctors say the drug is also noteworthy because it takes a fresh approach to helping people overcome their yen for food and tobacco. It is the first of a class of medicines that block the so-called endocannabinoid system.
     Marijuana makes people ravenous by stimulating this circuitry. The same biological machinery serves crucial everyday purposes by helping the brain regulate hunger and probably other urges, including alcohol craving. Overeating and smoking can overstimulate this system, which in turn propels people to eat and smoke still more. By temporarily blocking the body's ability to receive these signals, experts believe they can return the system's working to normal.
     In the larger of the two studies, Dr. Jean-Pierre Despres of Laval University in Quebec City enrolled 1,036 overweight volunteers, all with big potbellies that put them at especially high risk of heart problems. They were urged to cut 600 calories a day and randomly given either rimonabant or dummy pills. After a year, those who got the higher of two doses of rimonabant had lost an average of 20 pounds and trimmed three inches from their waistlines. Nearly half of them took off 10 percent of their body weight. By comparison, those on placebos lost just five pounds. Those getting rimonabant improved in other ways, too. Their levels of HDL, the protective good cholesterol, rose 23 percent, while their triglycerides fell 15 percent.
     Despres said people taking the drug simply felt less hungry. In an earlier phase of the research, he could tell which volunteers were on the medicine by watching who passed up chocolate cake at the buffet table. ``The bottom line is we found a spectacular drop in waistlines and changes in many other risk factors that are beyond what you would ordinarily expect,'' Despres said.
     Anthenelli's study tested the drug for 10 weeks on 787 pack-a-day smokers who wanted to quit but could not. A longer follow-up will see how well they stay off, but in the short run, 28 percent shunned cigarettes for at least a month, compared with 16 percent on dummy pills. Especially important, Anthenelli said, is that those on the drug gained little or no weight, and a third of the successful quitters actually took off pounds at the same time. Ordinarily, smokers gain six to 10 pounds when they quit. Some people had minor digestive side effects at first, but they usually went away.
     ``This is good news. The drug shows promise,'' said Dr. Sidney Smith, cardiovascular chief at the University of North Carolina. ``However, I strongly believe lifestyle changes should be the foundation of what we do. I would not want to see patients turn to a pill as the first approach.''
In all, seven large studies with rimonabant are in the works. They involve 6,600 volunteers who want to lose weight and 6,500 who want to quit smoking.