From Therapy's Lenny Bruce: Get Over It! Stop Whining!
Dan Hurley, New York Times- 5/4/2004

On a recent Friday evening, nearly 200 people came to the Albert Ellis Institute in Manhattan to watch a master performance — call it stand-up psychotherapy — by a legend. As he has on nearly every Friday night for more than 30 years, Dr. Albert Ellis, the 90-year-old psychologist who invented rational emotive behavioral therapy and wrenched psychotherapy out of the age of Freud and into the age of Dr. Phil, was demonstrating his no-nonsense, confrontational, obscenity-laden technique before a packed house on East 65th Street.
      "Do you know why your family is trying to control you?" he asked a volunteer who joined him at the front of the room. "Because they're out of their minds," he said, adding an unprintable adjective between "their" and "minds." Another volunteer, Kristin Bell, spoke of her sister who had been killed by a drug dealer eight years before. "Why can't you understand that some people are crazy and violent and do all kinds of terrible things?" Dr. Ellis asked. "Until you accept it, you're going to be angry, angry, angry."
      It is Dr. Ellis's conviction that people can always rationally choose to change and that a psychotherapist's job is to nudge them, gently or otherwise, in the right direction. That view has defined his career and has helped usher in an emphasis on quick results over profound insights. Even so, his exhortations to give up anger did not prevent him, less than an hour later, from shouting, "Get out, get out, get out!" when his path out of the room and into the elevator to his penthouse apartment was blocked by the crowd. "I wasn't upset," he insisted later. "I'm just very firm. I was determined to get them the hell out of the way."
      Dr. Ellis has, throughout his life, been firmly determined to let nothing stand in his way, not the critics who have derided him and his methods, not the gastrointestinal infection that nearly killed him last year and resulted in the removal of his colon, not the profound deafness that now forces him to wear headphones and his guests to shout into a microphone. If anything, the controversy surrounding his reputation as a kind of Lenny Bruce of therapy has only increased his influence.
      In July 1982, a review of psychotherapy journals found him to be the most frequently cited author of works published after 1957. That month, he was also ranked as the second most influential psychotherapist in a survey of clinical psychologists, beaten by Carl Rogers, founder of the far gentler school of client-centered psychotherapy. No. 3 was Freud. "I believe he's a major icon of the 20th century and that he did help to open up a whole new era of psychotherapy," said Dr. Aaron T. Beck, an emeritus professor of psychiatry at the University of Pennsylvania and the founder of cognitive therapy, which is also based on rational thinking.
      Dr. David B. Baker, a professor of psychology at the University of Akron and the director of its Archives of the History of American Psychology, said Dr. Ellis's confrontational approach posed a direct challenge to the drawn-out process of Freudian psychoanalysis. "His idea and system of confronting irrational thoughts doesn't give you a lot of time to reflect," Dr. Baker said. "He's going to challenge you, confront you, and be very directive."
      On a recent morning at his institute, Dr. Ellis laid out his principles for 50 visiting psychotherapists who had arrived for a three-day workshop. "All humans are out of their minds," he began, adding another expletive. "They're not only disturbed. They get disturbed about their disturbances." Just because people do not like adversity, they decide that it should not exist, Dr. Ellis complained. "They say, `You disturbed me,' or, `It disturbed me,' or, `My mother disturbed me,' " he said. "They won't accept responsibility for their own disturbance. They refuse to accept the way it is. And then they get depressed about their depression. They rage about their rage. They're screwballs." To counter people's natural tendency toward self-criticism, Dr. Ellis says, "I teach U.S.A., Unconditional Self-Acceptance: You always accept you no matter what you do." Also on his list are Unconditional Other Acceptance ("Nobody is evil, even if they do evil things") and Unconditional Life Acceptance ("You always accept things, no matter how they are").
      Therapists can help people, he said, by giving them what he terms rational coping statements to overcome their irrational self-destructive beliefs. For example, Dr. Ellis said, when preparing to take on a risky challenge, patients should be encouraged to say they would like to do well, but too bad if they don't. In one exercise that Dr. Ellis promotes, patients are encouraged to imagine situations that normally provoke extreme fear, panic or rage. Holding the imaginary situations in their minds, the patients are asked to change the feeling to acceptance. Practiced daily for a month, the exercise can help people change their most deep-seated feelings about situations, he said.
      Unlike Dr. Beck, who subjected his methods and techniques to careful scientific testing, Dr. Ellis's insights have evolved, in great part, from personal experiences. At 19, when he was, by his own estimate, painfully shy of women, he set himself a task. Hanging around a bench in the New York Botanical Garden in the Bronx one summer, he decided that he would speak to every single woman who sat down alone. In one month, he approached 130 women. "Thirty walked away immediately," he said. "I talked with the other 100, for the first time in my life, no matter how anxious I was. Nobody vomited and ran away. Nobody called the cops." In one month, he said, "I completely got over my shyness by thinking differently, feeling differently and, in particular, acting differently." So successful was the transformation that in the 50's and early 60's he built his reputation as a sexologist, writing best-sellers like "Sex Without Guilt" and "Science of Love." There was criticism. But he did not care. "I just kept going and going and going," he said. "Kinsey was much better known. But he wasn't read. They were reading my books."
      With a doctorate in clinical psychology from Columbia and a large psychotherapy practice that specialized in sex and marriage therapy, Dr. Ellis became disgusted with traditional methods after spending — or, as he put it, "wasting" — six years in psychoanalysis. He turned to Greek, Roman and modern philosophers — and his own experience. A result was rational-emotive-behavioral therapy, whose focus, he decided, would be not on excavating childhood, but on confronting the irrational thoughts that lead to self-destructive feelings and behavior. "The trouble with most therapy," Dr. Ellis said, "is that it helps you to feel better. But you don't get better. You have to back it up with action, action, action."
      Among his peers, the reactions were quick — and brutal. "I was hated by practically all psychologists and psychiatrists," he said. "They thought it was superficial and stupid. They resented that I said therapy doesn't have to take years." Yet Dr. Ellis has never stopped saying anyone can change his life, usually without medication.
      Now living on the top floor of the institute that bears his name, Dr. Ellis refuses to give in to the depredations of age. "I'll retire when I'm dead," he said. His health problems, he insisted, were little more than annoyances. "When they said they might have to take my colon out, I told them, `That's too bad if you have to, but what else can we do?' " he said. "I don't think it's terribly unfair. The Buddha said life is suffering. But he forgot to add that for older people, it's much more suffering."
      Married and divorced twice without children, Dr. Ellis was in an open relationship for 37 years that ended a year ago. These days, he works, as he always has, pretty much around the clock. Since nearly dying last year, he has written four more books, sending the total over 70. "While I'm alive," he said, "I want to keep doing what I want to do. See people. Give workshops. Write, and preach the gospel according to St. Albert."

Has the Romance Gone? Was It the Drug?
Anahad O'Connor, New York Times- 5/4/2004

For most people taking antidepressants, the risk of a diminished sex drive may seem like a worthwhile sacrifice for the benefits from the drugs. Up to 70 percent of patients on antidepressants report sexual side effects, yet the number of Americans who take the drugs has ballooned since Prozac was introduced in the late 1980's. Last year, studies show, doctors in the United States wrote 213 million prescriptions for antidepressants.
      But what if the sexual side effects of the drugs, often considered little more than a nuisance, had more serious consequences, impairing not only sexual desire in some people, but also the ability to experience romance? The question, which experts are beginning to ask, was at the center of a talk this weekend at the annual meeting of the American Psychiatric Association in New York. Dr. Helen E. Fisher, an anthropologist at Rutgers, presented findings that suggest, she says, that common antidepressants that tinker with serotonin levels in the brain can also disrupt neural circuits involved in romance and attachment. "We know that there are real sexual problems associated with serotonin-enhancing medications," said Dr. Fisher, author of "Why We Love: The Nature and Chemistry of Romantic Love" (2004). "But when you cripple a person's sexual desire and arousal, you're also jeopardizing their ability to fall in love and to stay in love."
      Dr. Fisher and a colleague, Dr. Anderson J. Thomson Jr., have studied the brains of people in love and pored over research from the last 25 years on the neurological basis of romance. Three brain systems, all interrelated, the researchers say, control lust, attraction and attachment. Each runs on a different set of chemicals. Lust is fueled by androgens and estrogens. Attachment is controlled by oxytocin and vasopressin. And attraction, they say, is driven by high levels of dopamine and norepinephrine, as well as low levels of serotonin. As a result, they say, increasing levels of serotonin with antidepressants can cripple the sex drive but also set off an imbalance among the three systems. Drs. Fisher and Thomson are submitting a scientific paper on the subject for publication this year.
      "There are two lines of evidence on this," Dr. Thomson, a psychiatrist at the University of Virginia, said. "The first is the well-documented frequency of sexual side effects. But when you actually talk to patients who have diminished libido and you ask how it affects them, you discover that it has an enormous impact on their romantic lives."
      Often, the change is subtle. Drs. Fisher and Thomson point to case studies of people who gradually find their emotions blunted and their ability to see attractive features in others lost. The researchers also point to more extreme cases like people who say losing their sex drives caused romantic feelings toward longtime spouses to evaporate suddenly. "Everyone is distinctly different," Dr. Fisher said. "Some people are so securely attached that this isn't going to change things for them. But people should be aware that these drugs dull the emotions, including the positive ones that are central components of romantic love."



Marijuana Abuse Is Up Among U.S. Adults
Associated Press, 5/4/2004

CHICAGO -- Habitual marijuana use increased among U.S. adults over the past decade, particularly among young minorities and baby boomers, government figures show. The prevalence of marijuana abuse or dependence climbed from 1.2 percent of adults in 1991-92 to 1.5 percent in 2001-02, or an estimated 3 million adults 18 and over. That represents an increase of 22 percent, or 800,000 people, according to data from two nationally representative surveys that each queried more than 40,000 adults.
     Among 18- to 29-year-olds, the rate or abuse or dependence remained stable among whites but surged by about 220 percent among black men and women, to 4.5 percent of that population, and by almost 150 percent among Hispanic men, to 4.7 percent. Among all adults ages 45 to 64, the rate increased by 355 percent, to about 0.4 percent of that population.
     The report, published in Wednesday's Journal of the American Medical Association, was led by Dr. Wilson Compton of the National Institute on Drug Abuse, who said the rise in dependence was probably due at least partly to increases in the potency of pot over the past decade. Also, the figures may indicate that baby boomers ``bring their bad habits with them into old age,'' he said.
     The researchers said adults were considered marijuana abusers if repeated use of the drug hurt their ability to function at work, in school or in social situations, or created drug-related legal problems. Drug users were considered dependent if they experienced increased tolerance of marijuana, used it compulsively and continued using it despite drug-related physical or psychological problems. Overall use of the drug -- that is, casual use and habitual use -- remained stable at around 4 percent, or more than 6 million adults.
     ``This study suggests that we need to develop ways to monitor the continued rise in marijuana abuse and dependence and strengthen existing prevention and intervention efforts,'' said Dr. Nora Volkow, the institute's director. Programs that target young black and Hispanic adults are particularly needed, she said. Increases in dependence among young minorities may reflect their growing assimilation into sectors of white society where marijuana use is more accepted, Compton said. Researchers from the National Institute on Alcohol Abuse and Alcoholism contributed to the report.
     On the Net:
JAMA http://jama.ama-assn.org
NIDA: http://www.drugabuse.gov
NIAAA: http://www.niaaa.nih.gov

Doctor Tells Story of Life Spent Studying Serial Killers
Sharon Cohen, Associated Press- 5/8/2003

CHICAGO - The television cast an eerie glow in the dingy motel room but the doctor wasn't watching. She was waiting impatiently for an important call -- one that would tell her the killer was dead. About 3 a.m., word came: John Wayne Gacy, the serial killer who prowled the Chicago streets preying on lonely runaways and murdered 33 young men and boys, had been executed. Dr. Helen Morrison headed out to a nearby hospital where she donned scrubs and Latex gloves to assist in Gacy's autopsy.
     For Morrison, it was a strange final chapter to her 14-year history with the clown-turned-killer.
The forensic psychiatrist had interviewed Gacy many times, listening to his rants, raves, lies, boasts, explanations and evasions. Now she was back for something else: Gacy's brain. Morrison had made arrangements to have the brain examined in the name of science to see if there was anything -- tumors, scars, disease -- that made it abnormal.
     When the autopsy was over, Morrison drove home with Gacy's brain in a glass jar on the passenger seat of her Buick. It took several calls to find a pathologist who would do the tests, and a few weeks later an express-mail envelope arrived at her office. She had eagerly awaited the findings, but was not surprised by the summary: "Just one simple line," she says. "Normal brain."
     For nearly 30 years, Helen Morrison has probed the brains of serial killers -- though, until Gacy, she'd never held one in her hands. From the sweaty walls of a Brazilian jail to a bleak, fortress-like, century-old prison near the Mississippi River, Morrison has logged thousands of hours interviewing and studying some of the most terrifying criminals. There is much she has learned, but much more still to explore. "What makes a serial killer? After all these years, I still don't know," she says in a cool, soothing voice. "We try to give them motives, but they don't have any. They just do it."
     Morrison, who tells her story in her new memoirs -- "My Life among the Serial Killers," written with Harold Goldberg -- has interviewed or studied more than 80 of these murderers. She also has spoken with their relatives, read their diaries, exchanged correspondence, consulted with their lawyers, examined photos of victims -- and in Gacy's case, collected some of his prison art.
     She has found what she calls "a cookie-cutter syndrome," a striking similarity in serial killers: They tend to be hypochondriacs, chatty, remorseless men who are addicted to the most brutal acts - stabbings, strangulation, rape - and see their victims as inanimate objects. "You say to yourself, 'How could anybody do this to another human being?' " she asks. "Then you realize they don't see them as humans. To them, it's like pulling the wings off a fly or the legs off a daddy long legs. .... You just want to see what happens. It's the most base experiment." These killers, she says, have recounted details of horrendous crimes to her as calmly as if they were reciting grocery lists.
     Among those she has interviewed: Ed Gein, the inspiration for the movie, "Psycho," a grave-robber-turned-killer who fashioned his Wisconsin farmhouse into a human butcher shop; Robert Berdella, a Kansas City man who tortured and drugged his captives; Bobby Joe Long, a Florida sexual predator. She also has studied serial killers from hundreds of years ago.
     On the surface, serial killers, who are almost always men, can appear normal, affable, even charming -- up to a point. "They are so garrulous," she says. "They are so capable of going on and on until they start breaking down. ... It's like cracking open an egg and finding a yolk that's already broken. There's no white and yellow. It's all the same."
     Morrison believes serial killers can't be rehabilitated and if set free, they'd surely commit more murders. (She supports the death penalty.) She also doesn't see a sexual motivation in their crimes, believing they stop developing psychologically as infants. Some other experts disagree with her theories, saying serial killers aren't all alike, have motives and their sexuality is closely intertwined with their violence.
     Morrison's first step into this dark world came as a young doctor in the late 1970s when she met Richard Macek, a suspect in several brutal killings of women in Illinois and Wisconsin. Newspapers dubbed him "The Mad Biter" for bite marks left on victims. In a bizarre twist, he had his teeth pulled before being arrested. Entering the prison, Morrison expected to find a menacing, wild-eyed hulk. Instead she was greeted by a baby-faced, exceedingly polite man who acted as if she had stopped by for a friendly chat over coffee.
     And yet, there was something so chilling, so empty about him. "I'd never seen a person who had absolutely no humanity," she says. She remembers how one day a hypnotized Macek described setting a fire at the home of two murder victims. He began moaning as if being burned, then suddenly, out of nowhere, she says, red blisters, as big as dimes, emerged on his fingers. To this day, she doesn't know how that happened.
     Macek, she says, flirted with her (calling her "Boops") and taunted her, once tracking her down by phone at her motel the night before a visit and telling her he was standing outside. He was not.
She has no idea how he found her. Nor does she know how Gacy got her home address and, she says, sent her a handmade, crayon-colored Christmas card before she ever met him, with a warped inscription: "Peace on earth. Good will to men ... and boys." "They all seem to have the capacity to find out information," Morrison says. It's one reason she says she didn't name her husband, a neurosurgeon, or their two sons, 10 and 17, in her book. Morrison lives in separate worlds and is intent on keeping it that way; she says she never talks with her sons about her interviews with serial killers.
     With her conservative navy suit, brooch, pearls and blond hair tucked neatly in a bun at the nape of her neck, Morrison, who declines to reveal her age, has the genteel look of someone heading out to an afternoon tea. She is a devotee of the opera and symphony who likes to vacation in Brazil.
Serial killers are just part of her work. She also has a psychiatric practice treating addicts, autistic children, HIV patients and the mentally retarded, among others. But her work with killers is what has thrust her into the TV and radio spotlight, though she says she's not one to share any insights at parties or her son's hockey practice. "I am probably not the most approachable person in the world," she says.
     Morrison says she has never become friends with or been fond of killers she has interviewed. Nor has she become jaded when hearing of their terrible crimes. There are times, she says, when graphic photos of victims have left her nauseated, when details of the crimes have left her reeling.
And for those who think that a serial killer is someone like the fictional Hannibal Lecter, the erudite, Chianti-drinking, fava-bean-eating cannibal, she says forget it. "He may be educated, he may be suave, he may look debonair," she says, "but he doesn't hold it together like that."
      Helen Morrison still has John Wayne Gacy's brain - though she won't say exactly where she keeps it. She stores it in a plastic bag and hopes that one day DNA or other scientific advances may lead to new tests. The question of why people do such terrible, inhuman things is as intriguing to her as it was when she first began asking it. "Is there an answer? Not yet," she says. "There is no answer at all. I think that's what keeps me going. That search for anything that could make this less of a mystery."



'Acquainted With the Night': Troubled Children and Troubled Parents
Barbara Ehrenreich, New York Times Book Review- 5/9/2004

Try this for a foretaste of hell: Your marriage has gone up in flames. Your son has to be hospitalized for repeated outbreaks of rage -- running out of his classroom, to start with, and continuing right on out of school. Your daughter has taken up ritualized self-mutilation with a razor blade, drinking, pot smoking, sex and gobbling down Tylenol by the bottleful. (The other son is fine -- just bitterly estranged from you.)
     So what do you do when you find yourself cast as ''Dad'' in what appears to be a parody of the stock suburban-dysfunction novel? Well, you could do some research and write a book about dealing with children's and teenagers' mental illness. This was the choice that led to Paul Raeburn's harrowing new book, ''Acquainted With the Night: A Parent's Quest to Understand Depression and Bipolar Disorder in His Children,'' and it was, no doubt, a healthy one. He got to distance himself, as only a writer can do, from the ugly drama at home, while at the same time producing a work that will surely be a help to thousands of similarly distraught parents.
      God knows they could use some help. Raeburn, a former editor at BusinessWeek, reports that 20 percent of American children and adolescents experience ''a diagnosable mental illness'' in the course of a year. The first symptom -- a suicide attempt, an eating disorder or a simple refusal to sit still in school -- generally throws the family into the clutches of what could be called our mental health ''system,'' though words like ''maze'' or ''mess'' would seem more to the point.
      There are scores of therapists listed in the Yellow Pages, and there are still quite a few inpatient facilities for the severely out of control. But nothing links these various elements of potential care. The therapists, who all march to their own theoretical and pharmaceutical drummers, have no reliable connections to the hospitals, nor do the hospitals have any means of providing follow-up care for the patients they discharge. And, although the problem had not surfaced when Raeburn was writing, there is now the further worry that antidepressants may actually predispose some young users to suicide.
      Then there is the matter of payment. Between 1988 and 1998, Raeburn reports, managed-care plans cut their spending on psychiatric treatment by 55 percent, putting mental health services almost out of the reach of middle-class families like his own, never mind the poor. Hence, no doubt, the fact that three-quarters of children and teenagers who receive a diagnosis of mental illness get no care for it. The insurance companies would make a nice villain here -- and I'm for villainizing them wherever possible -- except for the fact that mental illness is, from an actuarial point of view, a rather squishy concept. Denying payment for the treatment of unruly or self-destructive behavior is not exactly on a par with denying antibiotics for meningitis. Take Raeburn's distressed son, Alex, the first of his children to require care: the drama of the first 100 pages or so of ''Acquainted With the Night'' is the family's progression through various therapists for him, each offering a different diagnosis and different drug regimen, until they finally settle on a diagnosis -- ''bipolar disorder'' -- which is so wildly faddish it's become a casual term of high school invective. You can't help wondering whether that is really Alex's problem or simply the disorder du jour.
      Then there is the question, never fully addressed in this book, of whether we should be in such a rush to medicalize behavior like that of Raeburn's children anyway. When Alex first dashes out of school in a fit of anger, Raeburn is almost comically eager to get the problem ''fixed'' by the appropriate professionals and the boy back in school. Yet the reader can see reasonable causes for unreasonable behavior all around: not only has the parents' marriage degenerated into a screaming standoff, but the father -- our narrator -- has a few issues himself. He's more than a bit of a puritan, for example, carping about his wife's consumption of a nightly Bud Light or two, demanding that his suicidal daughter be deprived of cigarettes by her inpatient facility, and losing it completely when Alex peroxides his hair.
     Worse, he can't control his own rages -- at one point shoving Alex down so hard onto a toilet seat that the toilet bowl cracks. Unless the Raeburn family favored balsa wood bathroom fixtures, this would seem to be the moment to pack the father -- rather than the son -- off to the psychiatric lockup. In fact, the greatest source of suspense in the first two-thirds of the book is whether Raeburn will come to realize that he has become, as the pop shrinks say, a toxic presence in his children's lives.
     He does eventually, sort of, and his struggle to comprehend his own mistakes may be the most moving part of his book. But there's another issue with this family that our narrator never entirely faces up to: he's not around much, except to weigh in as the heavy. Raeburn works 8 to 10 hours a day in New York City, commutes for three hours, and comes home expecting to spend the evening moonlighting as a freelance writer (hence, in part, his refusal to indulge in a beer with his wife). Imagine the genders reversed, with a mother writing about her attempts to keep up with a high-powered career while the kids try on one psychiatric symptom after another. How sympathetic would we be with her demand, for example, that the family delay dinner until she gets home at night?
      There is a mother on the scene here too, and she works part time herself, but, as Raeburn himself would probably admit, we can hardly expect to get a fair impression of her from him. Besides, social ills by the textbookful have been dumped on the working mother. What about the working dad? Single moms are routinely excoriated for failing to provide their children with a father, but how many married couples can be said to do it? The reader may find herself yelling at the narrator to slow down, spend some time with these kids, home-school them if you have to -- at least give up the night job! But no, he piles on an additional project -- the research for this book. Yes, it's also an attempt to understand his children, but it becomes one more thing taking him away from them.
      In the end, though, Raeburn seems as much a victim as anyone else in this story, or at least caught up in the same anxiety-producing, psychosis-generating system as his children are. Why is he moonlighting anyway? So they can afford the pricey suburb where he ''desperately'' wanted to live because of its high-quality -- read: high-pressure -- public schools. Thus each generation is condemned to scramble along on its own treadmill, with the gears of family life making murderously tight connections between the two.
      Throughout his ordeal, Raeburn clings to the notion that mental illness is biologically based -- meaning accompanied and sometimes caused by physical changes in the brain -- and of course it is. But this does not mean that we are born with our psychoses, only with the potential to develop them. Furthermore, the causality works both ways. Not only can physical conditions in the brain predispose us to aberrant behavior, but subjectively experienced states, of stress or rejection, for example, can alter the chemistry of the brain. So when huge and growing numbers of affluent young people start displaying the kinds of behavior labeled A.D.D., depression and bipolar disorder, it may be time to stop talking about brain chemistry, or even family pathology, and start looking for ''something in the water'' -- in this case, broad social causes.
      Could there be an incoherent rebellion under way against the relentless pressure to achieve, which kicks in now at the preschool stage? It may be a clue that the symptoms of many childhood psychiatric disorders seem to preclude schoolwork and attendance. Maybe the only problem with the kids is that they have been watching their own high-achieving parents, and they have seen where all that leads.

Mental Health Care to Increase for Veterans
Associated Press, 2/9/2004

WHITE RIVER JUNCTION, Vt. -- Outpatient, mental health and neurological care will expand at the Veterans Affairs hospital under a government restructuring of health care services.
The main goal of the plan is to bring the nation's VA facilities "in line with 21st century care" and bring health care closer to where veterans live, said VA Secretary Anthony J. Principi.
      The Veterans Affairs Department announced a major restructuring plan Friday that includes $6.1 billion in spending increases, the closing of three hospitals and an upgrade of several outdated facilities. The plan calls for building two hospitals, in Nevada and Florida, and closing three others, in Pennsylvania, Ohio and Mississippi. The agency also will add or remove medical services at dozens of other hospitals and clinics nationwide.
      There will be no closures or reductions in services at either the White River Junction or Manchester, N.H., hospital under the 10-year plan called "Capital Asset Realignment for Enhanced Services," or CARES, said James Thompson, public affairs officer at the Manchester, Vt. hospital. Vermont has outpatient clinics in Bennington, Colchester and Rutland. New Hampshire has four: Conway, Littleton, Portsmouth, Tilton and Wolfeboro.
      As part of the expansion of mental health services, a social worker at the Bennington clinic who is now available once per week to see veterans will be available three times per week. The change will take effect in this month, said to Gary De Gasta, Director of Medical Services at the White River Junction VA. VA officials hope to hire mental health specialists for the Rutland clinic, which De Gasta described as the "most lacking," as well as for the Littleton, N.H., clinic. Veterans from those two towns now travel to White River Junction for mental health treatment. The Vermont hospital also could win funding for a new floor that would range in size from 20,000 to 50,000 square feet, De Gasta said. The facility now has about 500,000 square feet. "It would give us an opportunity to see more patients," said De Gasta.
      Vermont has about 60,000 veterans and New Hampshire has 133,000 veterans, according the VA's web site. About 22,000 veterans from both Vermont and New Hampshire were treated in Vermont's VA system last year, while 20,000 veterans were treated in New Hampshire.

'Mind Wide Open': This Is Your Brain
Jonathan Weiner, New York Times Book Review- 5/9/2004

On Page 1 of ''Mind Wide Open,'' Steven Johnson quotes Franz Kafka: ''How pathetically scanty my self-knowledge is compared with, say, my knowledge of my room. . . . There is no such thing as observation of the inner world, as there is of the outer world.'' On the facing page, Johnson shows us an image of his own brain, as seen in an M.R.I. scan.
     Until recently, introspective people could lie on a couch and free-associate, or sit at a desk and write ''The Metamorphosis.'' People couldn't look into themselves directly to explore what Gerard Manley Hopkins called, wistfully, our ''inscapes.'' But now we can. With M.R.I.'s, PET scans and many other high-tech mirrors that neuroscientists are holding up in front of us, we can see right through our own foreheads and begin to watch our mental apparatus in action.
      In ''Mind Wide Open,'' Johnson makes himself his own test subject to see what the neuroscientists can show us about our attention spans, talents, moods, thoughts and drives -- our selves. He got the idea for this voyage of self-discovery a few years ago while he was hooked up to a biofeedback machine. Lying on a couch with sensors attached to his palms, fingertips and forehead made him feel nervous, and he started cracking jokes with the biofeedback guy. The machine was designed to monitor adrenaline levels, like a lie detector. With each joke he made, the monitor displayed a huge spike of adrenaline: ''I found myself wondering how many of these little chemical subroutines are running in my brain on any given day? At any given moment? And what would it tell me about myself if I could see them, the way I could see those adrenaline spikes on the printout?''
     Johnson writes the monthly Emerging Technology column for Discover magazine, and is a contributing editor at Wired. He knows how to make complicated science clear and easy to follow, and his style is cheerful, honest, friendly, self-deprecating -- and laced with those nervous jokes. He also knows how to find what he calls ''long-decay ideas,'' ideas that will stay with us a long time before the last traces vanish from our minds. In his last book, ''Emergence,'' he explored the ways in which the complicated behavior of brains, software, cities and ant heaps can emerge from the vastly simpler behavior of their smallest working parts -- from collections of nerve cells, bits and bytes, citizens and ants. Here he writes about some of the ways that the behavior of what we like to call our selves emerges moment by moment from all kinds of separate tools and workshops in the brain, which neuroscientists call modules.
      Johnson begins with a gift that most of us take for granted: mind reading. Even before we can talk, almost all of us know how to read subtle hints in the faces, voices and gestures of the people who hover around our cribs. That is, we can do by instinct what neuroscientists are just learning to do with scanners and monitors. Normally we're aware of this gift only when we meet people who don't have it -- those who are severely or partly autistic and may be more or less mind-blind.
      To learn about his own mindreading abilities, Johnson takes a famous test devised by the British psychologist Simon Baron-Cohen. In the test, you are shown a series of 36 different pairs of eyes on a computer screen. Each pair has a distinctive expression. For each, you have to choose one adjective from a set of four that Baron-Cohen provides. Multiple choice: is this pair of eyes despondent, preoccupied, cautious or regretful? Johnson finds that he has an instant gut reaction to each pair of eyes. But when he looks harder, he feels less and less sure what he sees. (''I am going to flunk this test,'' he writes. He decides to go with his hunches and gets an A.)
      Our innate ability to read people's faces is outside conscious thought. As with breathing or swallowing, we can't explain how we do it. Baron-Cohen and others believe that the skill depends partly on the amygdala, one of the brain's emotional centers. He has made brain scans of people taking his reading-the-eyes test using functional M.R.I., which reveals which parts of the brain are working hardest from moment to moment. When most people try to decode the emotion in a pair of eyes, their amygdalae light up. When autistic patients do it, their amygdalae are much dimmer.
      In other chapters, Johnson explores some of the fear messages that are controlled by his amygdala: traumatic fears that were triggered by a near catastrophe when a storm blew in the picture window of his apartment above the Hudson River. He explores our brain chemistry, describing some of the natural drugs with which we dose ourselves without knowing it: adrenaline, oxytocin, serotonin, dopamine, cortisol. He learns how to recognize which natural high he is riding, or which bad trip he is enduring, hour by hour, along with some useful lessons about the ways our brains' drugs affect our memories. There's also a chapter about his sojourn in a $2 million functional M.R.I. machine, in which he reads a passage by the Nobel Prize-winning neuroscientist Eric Kandel, and then a passage of his own. The test proves that nothing makes a writer's brain light up like reading his own words.
      Johnson's preoccupations, the weather systems of his own inner life, keep cycling back chapter after chapter: his horror when that window blew in and almost killed his wife; his moments of tenderness gazing at their sleeping newborn son. As he explores his inner world and the mental modules that help to shape it, we begin to feel that we are right in there with him -- and we have a new sense of what it means to be human.
      The best chapter is the last, when Johnson takes stock of the current view of the mind. It is obvious now that Freud's most basic insight was correct -- there is more going on in there than we are aware of. There is much more going on than even Freud guessed, with his simple schematics of ego, superego, id. This is not new news, but Johnson brings it all alive. He concludes, ''Even the sanest among us have so many voices in our heads, all of them competing for attention, that it's a miracle we ever get anything done.''
      This is an entertaining and instructive ride inward to a place that looks less familiar the better we get to know it. As Johnson says, ''It's a jungle in there.'' ''If a lion could talk we would not understand him,'' Wittgenstein said. ''Mind Wide Open'' takes the point closer to home. If every part of our brain could talk, we would not understand ourselves.

The Disability Movement Turns to Brains
Amy Harmon, New York Times- 5/9/2004

No sooner was Peter Alan Harper, 53, given the diagnosis of attention deficit disorder last year than some of his family members began rolling their eyes. To him, the diagnosis explained the sense of disorganization that caused him to lose track of projects and kept him from completing even minor personal chores like reading his mail. But to others, said Mr. Harper, a retired journalist in Manhattan, it seems like one more excuse for his inability to "take care of business." He didn't care. "The thing about A.D.D. is how much it affects your self-esteem,'' Mr. Harper said. "I had always thought of myself as someone who didn't finish things. Knowing why is such a relief.''
      As the number of Americans with brain disorders grows, so has skepticism toward the grab bag of syndromes they are being tagged with, from A.D.D. to Asperger's to bipolar I, II or III. But in a new kind of disabilities movement, many of those who deviate from the shrinking subset of neurologically "normal" want tolerance, not just of their diagnoses, but of their behavioral quirks. They say brain differences, like body differences, should be embraced, and argue for an acceptance of "neurodiversity." And as psychiatrists and neurologists uncover an ever-wider variety of brain wiring, the norm, many agree, may increasingly be deviance. "We want respect for our way of being," said Camille Clark, an art history graduate student at the University of California at Davis who has Asperger's syndrome, a form of autism often marked by an intense interest in a single subject. "Some of us will talk too long about washing machines or square numbers, but you don't have to hate us for it."
      Last month, Ms. Clark helped start an Internet site called the Autistic Adults Picture project (http://www.isn.net/~jypsy/AuSpin/a2p2.htm), where dozens of people list their professions and obsessions next to a photograph. The idea is to show normal-looking people, whose peculiarities stem from their brain wiring - and who deserve compassion rather than exasperation.
      Overcoming the human suspicion of oddity will be hard, the more so because the biological basis of many brain disorders can't be easily verified. Usually, all anyone has to go on is behavior. "It's a tough one," wrote one participant in an online discussion of Asperger's syndrome. "Was that woman," he asked, just "unwilling to think about others' feelings, not caring about whether she's boring me with the minute details of her breakfast wrap?" Or, he asked, was she "really truly incapable of adapting herself to social mores?"
      Science is beginning to clear up such questions, said Dr. Antonio Damasio, a neurologist at the University of Iowa Medical Center, by identifying distinct brain patterns and connecting them to behavior. But, he added, only society can decide whether to accommodate the differences. "What all of our efforts in neuroscience are demonstrating is that you have many peculiar ways of arranging a human brain and there are all sorts of varieties of creative, successful human beings," Dr. Damasio said. "For a while it is going to be a rather relentless process as there are more and more discoveries of people that have something that could be called a defect and yet have immense talents in one way or another."
      For example, when adults with A.D.D. look at the word "yellow" written in blue and are asked what the color is and then what the word is, they use an entirely different part of the brain than a normal adult. And when people with Asperger's look at faces, they use a part of the brain typically engaged when looking at objects.
      Dr. Damasio and others compare the shifting awareness about brain function to the broader conception of intelligence that has evolved over the last two decades, driven in part by the theory of Howard Gardner, a Harvard education professor, that children who don't excel in "traditional" intelligence -- the manipulation of words and numbers -- may shine in other areas such as spatial reasoning or human relations.
      Skeptics, like Mr. Harper's family, and some medical professionals argue that clinicians are too quick to hand out a diagnosis to anyone who walks through the door. In an effort to rein in the number of diagnoses, the American Psychiatric Association imposed a new criterion in its latest edition of the Diagnostic Statistical Manual: an individual must now suffer from "impairment" to qualify as having one of its 220 psychological disorders. "We're not adequately differentiating normal from pathological if we just use the criteria that are in the syndrome definitions," said Dr. Darrel A. Regier, director of research for the American Psychiatric Association.
      The definition of "impairment,'' however, remains vague. And many clinicians chafe at the manual's rigid diagnostic criteria. "Say the diagnostic category for a depressive disorder is four out of eight symptoms, and you have two," said Dr. John Ratey, a Harvard University psychiatrist. "What are you, just miserable?"
      For patients, being given a name and a biological basis for their difficulties represents a shift from a "moral diagnosis" that centers on shame, to a medical one, said Dr. Ratey, who is the author of "Shadow Syndromes," which argues that virtually all people have brain differences they need to be aware of to help guide them through life. But the most humane approach, some experts argue, may lie in redefining the expanding set of syndromes as differences rather than diagnoses.
"We're doing a service on the one hand by describing many more of these conditions and inviting people to understand themselves better," said Dr. Edward Hallowell, a leading authority on A.D.D. "But when we pathologize it we scare them and make them not want to have any part of it. I think of these as traits, not disorders."
      Knowing you are a mild depressive, for instance, could induce you to exercise often. A bipolar person could adapt their lives to fit their mood swings, or treat them with drugs if that works better. And a neurologically tolerant society would try to accommodate as well as understand behavior that remained aberrant.
      Others take a more pragmatic approach to the newly available information about how the brain works. In his recent book, "Mind Wide Open: Your Brain and the Neuroscience of Everyday Life" (Scribner), Steven Johnson undergoes a barrage of neurological tests to learn more about his own quirks. "For a long time when scientists talked about the brain it was, 'the human brain functions this way,' '' Mr. Johnson said. "But the great promise of this moment is that we can begin to understand what makes us different as well as what makes us all alike. Enough about the human race - I want to hear about me." Mr. Johnson, who found himself to be better at language than visual processing, said his wife used to get annoyed when he couldn't recall details about a house they were planning to renovate. Now, he says, they understand that she is better at visual tasks, and he tries harder to compensate.
      Many of those who advocate greater tolerance for brain quirks caution that it should not serve as an excuse for individuals to behave inappropriately. "It's not a get-out-of-jail-free card," Dr. Ratey said. "It's an awareness of what you need to do or accept about yourself and then decide, 'Do I want to fit in more or not?' '' The answer, increasingly, may be "not." Many A.D.D. adults say their condition contributes to their creativity, and some with Asperger's are now critiquing those they call "neurotypicals."
      On Internet sites like the Institute for the Study of the Neurologically Typical (isnt.autistics.org), autistics satirize the cultural fascination with deviance. "Neurotypical individuals," states the Web site, "find it difficult to be alone" and "are often intolerant of seemingly minor differences in others." "Tragically," it adds, "as many as 9,625 out of every 10,000 individuals may be neurotypical."

Debate Renewed Over Executing the Mentally Ill
Mike Tolon, Houston Chronicle- 5/10/2004

On a warm September afternoon almost a dozen years ago, Kelsey Patterson walked out of his East Texas home in Palestine with a .38-caliber pistol in his hand and a single purpose in his head.
He walked to an oil distribution company 100 yards or so from his front door and, without warning, shot its owner in the back of his head as he stood on a loading dock. When the man's secretary came out of the office to see what was going on, he shot her as well. Then Patterson ambled back to his house, put down the gun, removed all of his clothes save for a pair of orange socks and stood in the middle of the street waiting for police to arrive. He later explained that he did not want the officers to think he still had a gun hidden in his clothing. He may have been crazy, but he wasn't stupid.
     Patterson's reason for killing Louis Oates and Kay Harris was never understood, perhaps even to Patterson himself. The logic of the schizophrenic mind often is indecipherable. To anyone who knew him, however, the act was hardly surprising. He had shot two co-workers before without provocation and whacked another over the head with a 2-by-4.
     On May 18, the state that never formally prosecuted him for the earlier assaults -- everyone acknowledged that he was too seriously mentally ill to bother -- is scheduled to execute him for the last one. This makes no sense to his attorney or to those who advocate for the mentally ill. They see in Patterson an example of a failed mental health system and a person too sick to have the same criminal culpability as a normal defendant. "There are compelling reasons for not executing capital offenders who suffer debilitating mental illnesses that are similar to the reasons society will no longer tolerate the execution of the mentally retarded," attorney Gary Hart wrote on Patterson's behalf in a clemency petition to Gov. Rick Perry and the Board of Pardons and Paroles. "Execution of someone like Kelsey whose paranoid schizophrenia is severe and chronic serves neither the retributive nor the deterrent functions the death penalty was intended for." Moreover, Hart added, but for the failure of the state's mental health and criminal justice systems to deal effectively with Patterson and his mental illness in previous years, he likely never would have killed Oates and Harris in the first place.

Warning signs
Patterson spent much of the two decades before the crime in and out of state mental hospitals.
Shortly before Patterson's deadly outburst, family members familiar with his tendency to spiral into violent behavior when he went off his medications said they tried to convince the local sheriff's department and mental health workers to do something about him, to no avail. Until he did something or threatened somebody, authorities told the family, there was nothing that could be done.
     When he finally did something, it was so drastic that the district attorney decided to try to send him to death row so that the community would be forever protected. The capital murder prosecution was at the very least ironic, given that in one of his earlier assaults in Palestine the charges were dismissed because of his acutely psychotic state. Prosecutors were able to extract a promise that he would move to Dallas (where he later committed another assault).
     Hart claims Patterson never should have been ruled competent to stand trial in the capital case. His behavior was so bizarre that he had to be removed from the courtroom at times. But the enduring irony of his final prosecution is that he may well have been legally sane at the time of the killings. The legal standard requires only that prosecutors prove the defendant knew his action was wrong. If a defendant called the police after killing someone, as did Andrea Yates, or like Patterson simply expected them to arrive, that can be evidence enough to prove knowledge of wrongness.
That's one of the reasons many mental health advocates want the mentally ill to have some protected status when it comes to capital punishment.

Supreme Court
In 2001, the U.S. Supreme Court used the case of Atkins v. Virginia to reverse its earlier Penry decision and outlaw execution of the mentally retarded. The mental deficiencies of the retarded do not justify exempting them from criminal sanctions, the court concluded, but they do diminish their personal culpability.
     Johnny Paul Penry was first convicted and sentenced to death in 1980 for the rape and slaying the year before of Pamela Moseley Carpenter, 22, in Livingston. In 1989, the U.S. Supreme Court overturned Penry's conviction and death sentence because the Texas court did not consider the evidence of mental retardation. Penry was tried and convicted again in 1990, and appealed a second time. The Supreme Court overturned his death sentence in 2001 because the district court in 1990 did not wait for the Texas Legislature to change state law so that jurors could consider evidence of mental retardation in capital murder cases. Penry was sentenced to death a third time in 2002. He remains on death row.
     Mental health advocates argue the same reasoning should apply to mentally ill defendants. "The logic of Atkins, that talks about how mental retardation adversely impacts cognition ... certainly applies in some cases to people with mental illness, and almost certainly in this case, with someone who is delusional at best and whose cognitive abilities are clearly not normal," said Ron Honberg, legal director for the National Alliance for the Mentally Ill.
     The difficulty in adopting an Atkins standard for the mentally ill, Honberg noted, comes from the difficulty in defining mental illness. If a diagnostic approach to defining it were used, some would argue that personality disorders, which apply to many prison inmates, including some of the most feared, would constitute a form of mental illness, Honberg said. Exempting sociopaths -- think Ted Bundy or John Wayne Gacy -- from the death penalty because of a personality disorder would never find public acceptance.
     "There are so many different levels of mental illness that you can't exclude them all," said death penalty expert Dudley Sharp, a former policy analyst with the Houston-based victim rights organization Justice For All. "Is mental illness kleptomania? Depression? Antisocial behavior? Should they be excluded (from capital punishment)? No. The defense attorney can use that as mitigation in the punishment phase of the trial."
     Honberg, however, said that mental illness is so little understood by most jurors, and so feared by many, that even bringing it up can invite harsher punishment, not lenience. Still, he recognizes that Sharp's opinion is widely held and that exempting the mentally ill from execution might be impossible to sell politically.
     And for those hoping the U.S. Supreme Court will embrace the matter, he pointed out that one of the linchpin arguments of the prevailing justices in Atkins concerned an "evolving standard of decency." They recognized that many states had already passed legislation protecting the mentally retarded, indicating public opinion had shifted. There has been no such movement with respect to mental illness.

Renewed attention
But in the wake of Atkins, attention is beginning to fall on the condemned mentally ill. Patterson and Scott Panetti have been the subjects of lengthy reports by Amnesty International and brought the state unwelcome publicity. Panetti had a long history of treatment for schizophrenia in Wisconsin and Texas before he killed his estranged wife's parents in Gillespie County in 1992, a few weeks before Patterson killed Oates and Harris. He was scheduled for execution in February before receiving a stay from a federal judge.
     "This is an issue that the Supreme Court is going to have to revisit," said Michael Mello, a law professor at Vermont Law School and experienced capital murder lawyer. "I do believe the justices are going to see enough of those cases that they are going to reach a tipping point eventually, as they did in Atkins. Between Penry and Atkins, those justices let a lot of mentally retarded people be killed."
     The state does not dispute that Patterson is delusional and has been so for years. His paranoia is so pervasive that he believes just about anyone connected to his case, including his own lawyers, is part of a vast conspiracy against him. He has claimed that local authorities in Palestine forced him to commit the murders by implanting medical devices in his brain.
     As Hart tries to convince federal courts that he is not competent to be executed, Patterson continues to pen scores of incomprehensible letters to judges, lawyers, district clerks and the Anderson County district attorney insisting that they recognize his "amnesty rights." Just as he has for years, Patterson claims he has been given a permanent stay of execution by the Texas Court of Criminal Appeals based on actual innocence. For his part, Patterson has insisted since he was first arrested that he is not mentally ill. He will not cooperate with mental health professionals assigned to evaluate him -- even with his execution imminent -- so convinced is he that they are part of the conspiracy to do him in.



Severely Ill Kids Aren't More Prone to Depression in Adulthood
Jane E. Allen, Los Angeles Times- 5/10/2004

Children who have grown up with serious diseases might be expected to grow into adulthood plagued by anxiety and depression. Instead, they become thriving young adults no more prone to major psychiatric illnesses than their peers. "Although we have historically thought of children with chronic or life-threatening illnesses as vulnerable and at risk for adjustment problems, our work has found they are quite resilient," said Cynthia Gerhardt, a pediatric psychologist at Columbus Children's Research Institute in Ohio. "What we don't see are diagnoses of post-traumatic stress disorder, anxiety disorders, major depressive disorders," she said.
      Gerhardt and colleagues from Columbus Children's Research Institute and Children's Hospital of Pittsburgh studied 139 young adults, ages 18 to 20, who had been recruited at ages 8 to 15 for a study of childhood illness. All had been treated for cancer (except brain tumors), sickle cell disease or rheumatoid arthritis. Researchers compared them to 146 healthy classmates who also had been recruited years earlier. Gerhardt presented the findings May 1 at the Pediatric Academic Societies' annual meeting in San Francisco.