Study Aims to Sort Out Alcohol Usage
Associated Press, 7/26/2004

WASHINGTON -- Alcohol is the Dr. Jekyll and Mr. Hyde of the medical world: Drinking too much causes serious problems, while drinking a little may help many people's health. How many drinks provide just the benefits and not the harm? It depends on whether a person is most at risk of heart disease, diabetes or breast cancer. But there is one bottom line: Five or six drinks only on Saturday night will provide no benefits, while a drink or two a night might. So concludes an exhaustive new analysis by the National Institutes of Health that sorts out a plethora of sometimes conflicting research on alcohol's effects.
      The review was prompted by cardiologists' complaints that patients suddenly were asking if they should start imbibing, and how much. Other research is overturning the dogma that people at risk of diabetes should abstain; still more links even light drinking to breast cancer. Adding confusion, people are vulnerable to more than one disease as they age. A 50-year-old woman with breast cancer in the family might get very different advice on alcohol than one who's pre-diabetic with high cholesterol.
      Hence NIH's review. ``We are not encouraging anybody to start drinking,'' stresses Lorraine Gunzerath of the NIH's National Institute on Alcohol Abuse and Alcohol, who led the analysis published last month in the journal Alcoholism: Clinical & Experimental Research. After all, alcoholism remains a major health problem, and people with liver disease may not tolerate even moderate drinking. Instead, the report, aimed at people who already drink some, concludes that to get alcohol's potential health benefits, how much those people can consume must be customized by their age, gender and overall medical history.
      For many of these diseases, ``If you do drink moderately now, fear ... is not a reason to stop,'' explains Gunzerath. ``Some people have said, `Should I stop now because there's diabetes in my family?' Well, if you're a moderate drinker, there's some protection.''
      As population-wide advice, consuming two drinks a day for men and one a day for women is linked to lower mortality and unlikely to harm, the review found. Men shouldn't exceed four drinks on any day, and women three -- bingeing is simply bad. But NIH's disease-by-disease findings provide better details:
--Studies consistently show that in people 40 or older, consuming one to four drinks daily significantly reduces the risk of heart disease, the nation's leading killer. In contrast, five or more drinks daily markedly increases heart risk. However, frequency seems key. Consuming smaller amounts several times a week -- one or two daily or every other day -- is most heart-protective. It apparently takes low, regular alcohol exposure to help raise levels of the body's so-called good cholesterol, the HDL type, and to thin blood.
--The alcohol-breast cancer link remains controversial. Some studies suggest a small increase in risk, that roughly 9 in 100 nondrinkers may get breast cancer by age 80 compared with 10 in 100 women who consume two drinks a day. Per person, that's a tiny risk. But women whose mothers or sisters had breast cancer, or those taking post-menopausal estrogen replacement, are at greater risk from alcohol. Those women, Gunzerath says, must weigh the fear of breast cancer against their risk of heart disease in deciding whether to avoid alcohol.
--One to two drinks a day several days per week seems to lower the risk of Type 2 diabetes, a disease rising at epidemic proportions. Low levels of alcohol apparently help the body use insulin to process blood sugar better. The benefit was seen among the overweight and those with ``metabolic syndrome,'' a cluster of pre-diabetic weight-related symptoms that include high blood pressure and poor cholesterol.
--There's no known safe level of alcohol consumption during pregnancy, but what about while breast-feeding? Nursing mothers who want an occasional drink should consume it several hours before the next feeding, enough time to metabolize the alcohol so little reaches the infant. And contrary to folklore, alcohol does not aid lactation but temporarily decreases milk production. How much is a drink a day? Five ounces of wine, 12 ounces of beer or 1.5 ounces of distilled spirits. To help people add that up, consumer groups are pushing for alcohol containers to list serving sizes and the moderate-drinking advice; the Alcohol and Tobacco Tax and Trade Bureau hasn't yet responded.



Children Often Blame Themselves for Parent's Stress
Barbara F. Meltz, Boston Globe- 7/26/2004

Let's face it. We all get angry at our children. "It's the other side of the intense love we also feel for them," says lecturer and parent educator Nancy Samalin, author of the best-selling book
"Love and Anger, The Parental Dilemma" (Penguin). "I didn't even know I had a temper until I had children," she says.
     Most of us know not to act on our rage. Rather than spank, hit, berate, or otherwise abuse our children, we count to 10, take deep breaths, bite our tongues, or, as Samalin is fond of saying, "Use a four-letter word that ends in FT: E-X-I-T." But what about those lesser moments? What about when it's not fury we're expressing but simple annoyance and irritation brought on by accumulated stress that we've come to accept as normal life? It can come from such diverse corners of our lives as having bored kids on our hands now that school is out, the high cost of gas, or how road construction is going to screw up traffic this summer. "Just as some people get sunburnt while others tan, some children go into a tailspin just because Mom or Dad expresses mild impatience," says psychotherapist Claudia Luiz.
     This has a lot to do with temperament; some children just are more sensitive than others. But Luiz, a clinical researcher at the Boston Graduate School of Psychoanalysis, thinks there is more to it. She says parents are under more stress than most of us realize and that it leads to less patience, more resentment, and potentially more children who think their parents are angry with them, even if they aren't.
     Samalin agrees. "The busier and more stressed we are, the more it makes us critical and impatient. Even if we don't think we are coming across as angry, that's how it can seem to children," she says. Let's be clear: It's not that we can never be angry. The expression of negative feelings is important in parenting; it's how children learn right from wrong and how they learn to regulate and cope with their own unhappiness and frustration. "Getting angry isn't what ruins a relationship," says Samalin. "How you express it, that's another story."
     Here's the problem: Children of all ages feel responsible for parents' anger. They tend to take it personally and blame themselves. Some children are thick-skinned, but the more often even those children are left to interpret a cranky mood, a snappish voice, or a pressured command, the more likely they are to feel it as anger. The child who is sensitive to it absorbs it in bigger doses, says Chicago psychologist Bernard Golden, a specialist in anger management and author of "Healthy Anger" (angermanagementeducation.com). "The more that happens, the more it affects the way children feel about themselves," he says. Most typically, they become angry ("What's wrong with me?") and act on that anger sometimes geting into trouble, sometimes withdrawing from their parents. What's more, over time, parents' reaction to stress becomes the model for how children deal with stress and anger.
     You're late for your 9 year-old's doctor appointment, you're sitting in a long line of traffic at a major intersection, and you've missed the green light for the third cycle. Your daughter is flipping through radio stations. Suddenly you snap at her. "I can't stand that noise! Shut it off!"
Surely that's irritation born of stress. But does a 9-year-old know that? Only if you tell her, says family support specialist Diane Clarke Delehanty of the South Boston Neighborhood House, a multiservice family agency. "If you say, `Whoa, I didn't mean to snap like that. I guess this traffic is getting to me,' you've offered a positive role model of how to handle stress and anger," she says, and you've removed any chance for her to misinterpret what you said.
     Parents typically are good about being remorseful or offering an explanation for anger when their blow-up is out of character. Even when it's not, Golden advises offering an explanation ("I was so frightened that you ran out in the street, it made me angry. It's a very dangerous thing to do.") and instructions for next time ("I'm going to help you remember this rule: Never run into the street.").
The problem with anger that's the result of stress is that most parents don't even realize it's happening. "It takes a lot of self-awareness," says Delehanty.
     Which is why Luiz says it's not enough to recognize how our anger affects our children. In addition, she says, "Parents need to learn to de-stress." She isn't talking yoga and exercise, although there's nothing wrong with either. She wants parents to allow themselves to meet their own emotional needs, starting when children are infants, and she offers herself as an example:
     Until recently, she would wake up at 7 a.m. on Saturday with her daughters, Miranda and Zoe, now 4 and 7. "I felt too guilty to let them sit in front of the TV," she says. It took her years to see that this was backfiring and causing family stress. "This was my one morning to chill. I resented that they wanted to sit in my lap and talk to me and kiss me when all I wanted was to drink my coffee and stare into space," she says. It wasn't until they stopped wanting to be in her lap that she realized they were distancing themselves from her, a classic sign that they perceived her as angry with them. "My guilt produced stress that caused crankiness they saw as anger," she says.
     Now there's a new Saturday morning routine. "I get them a bowl of cereal, they watch TV, my husband and I drink our coffee and read the paper. If I want to stare into space, I can. If I want to go back to bed, that's OK, too. When we come together at 9 o'clock, everybody's in a good mood," she says.

A raised eyebrow was all it took. She waited until a year after the breakup, until after he had proposed to the other woman -- a model, did he mention that? -- and the new couple had begun planning the wedding. That's when she ran into a mutual friend who had spent a few days staying with her ex. "And you were, uh, comfortable staying there?" she said to the friend. What are you talking about? he said. And then the eyebrow arched, and voilà, suspicions about her former boyfriend's sexual orientation were loosed. "Yes, I'm a Scorpio, so I'm un peu vindictive," said the woman, who swore certain payback if her name appeared in this newspaper.
      Vindictive, perhaps, but also fundamentally protective. Revenge may be frowned upon, viewed as morally destitute, papered over with platitudes about living well. But the urge to extract a pound of flesh, researchers find, is primed in the genes. Acts of personal vengeance reflect a biologically rooted sense of justice, they say, that functions in the brain something like appetite. Alternately voracious and manageable, it can inspire socially beneficial acts of retaliation and punishment as well as damaging ones. The emerging picture helps explain why many people who think they are above taking revenge find themselves doing nasty, despicable things, and how unconscious biases pervert what is at bottom a socially functional instinct. "The best way to understand revenge is not as some disease or moral failing or crime but as a deeply human and sometimes very functional behavior," said Dr. Michael McCullough, a psychologist at the University of Miami. "Revenge can be a very good deterrent to bad behavior, and bring feelings of completeness and fulfillment."
      Retaliatory acts, anthropologists have long argued, help keep people in line where formal laws or enforcement do not exist. Before Clint Eastwood and Arnold Schwarzenegger, there was Alexander Hamilton, whose fatal duel with Aaron Burr was commemorated this month on the banks of the Hudson River. Recent research has shown that stable communities depend on people who have "an intrinsic taste for punishing others who violate a community's norms," said Dr. Joseph Henrich, an anthropologist at Emory University in Atlanta.
      In one experimental investing game involving four players, for example, people pay to punish others who contribute meager amounts to the shared investment pool. In another, a one-on-one exercise in sharing a sum of money, people often reject any offer from a partner that is not split 50-50 or close to it, denying both players a payoff. The participants are typically strangers who will not see each other again, Dr. Henrich said, so they are not penalizing others to develop an equitable relationship in the future. They are retaliating to enforce the rules that hold the game -- and, theoretically, the community -- together.
      Using brain-wave technology, Dr. Eddie Harmon-Jones, a neuroscientist at the University of Wisconsin, has found that when people are insulted, they show a burst of activity in the left prefrontal cortex, a part of the brain that is also active when people prepare to satisfy hunger and some cravings. This increased activity, Dr. Harmon-Jones said, seems to reflect not the sensation of being angry so much as the preparation to express it, the readiness to hit back.
      The expression itself is all pleasure. In one recent experiment, psychologists demonstrated that students who were ridiculed were far less likely to avenge themselves on an offensive peer if they had been given a bogus "mood-freezing pill," which they were told blocked the experience of pleasure. "We've shown many times that expressing anger often escalates and leads to more aggression," said Dr. Brad Bushman, a psychologist at the University of Michigan who conducted the study, "but people express it for the same reason they eat chocolate."
      Savoring the taste can be satisfying enough. When Kurt Raedle, 40, a salesman in Kansas City, Mo., had a new leather jacket stolen from a party, he fantasized about getting his hands on the thief. A month later, a friend spotted the rascal wearing the jacket at a bar and helped Mr. Raedle track him down. Mr. Raedle said he telephoned him. "He was guilty, and he wanted to mail the jacket to me, but I said no. I wanted him to return it, in person, to my parents' house. I wanted him to face the parents of someone he'd stolen from." The penalty: a half-hour discourse on morals and life lessons from Mr. Raedle's father, all 6 feet 4 inches and 250 pounds of him.
      This kind of payback is closer to what sociologists and philosophers call just-deserts retribution. Dr. John M. Darley, a professor of psychology and public affairs at Princeton University, said such actions involve a deliberate effort to tailor the retribution to the crime, often taking into consideration as many relevant details about the offender and the offense as possible.
      In some cases it may be possible for people to assuage their feelings of outrage by publicly protesting the injustice. In one 2003 study, Dr. Harmon-Jones tracked the brain-wave patterns in students who had just been told the university was considering big tuition increases. They all got angry, he said, but signing a petition to block the increases seemed to give many some satisfaction.
      Yet the nature of appetite-like urges, scientists say, is to err on the side of excess. Although soup and salad might suffice, hungry people dream of the dinner buffet. Likewise, those who feel wronged very often overdo it, engaging in extravagant, almost sensual fantasies of payback -- of wrecking a household, snuffing a career, dancing on a grave. "Think of the urge as kind of hunger, a lust, a deficit the brain is seeking to fill," Dr. McCullough said, "and you can see why revenge fantasies can be so delicious."
      When people are committed to a relationship, studies suggest, they usually content themselves with a perfunctory quid pro quo for the day's small abuses: He's not helping with the party, let him find his own food. She's burning money on the cell phone, time to misplace it. People are exquisitely sensitive, if not always conscious, of this subtle give and take and usually manage it without lashing out. But wisecracks or other offenses that challenge people's most cherished beliefs about themselves -- their discretion, their generosity, their toughness, their intelligence -- can prompt a craving for payback that goes much deeper.
      "You're talking about small events in everyday life that can look insignificant until they touch some old conflict, some longstanding betrayal or shame the person carries," said Dr. Irwin Rosen, a psychoanalyst in Topeka, Kan., who studies the role of revenge in pathology. Dismayed and ashamed at their own vulnerability, some people exact the revenge on themselves, Dr. Rosen said. What looks like self-defeating behavior or even masochism is fueled by a deep desire to hurt someone close. One of his former patients, a 32-year-old doctor, was drinking herself out of a career and had left a trail of ex-husbands, he said -- partly, it came out in therapy, to get revenge on a brilliant father who had insisted on flawless devotion from his children.
      Most vengeful acts are covert, researchers say, traveling in whispers and unforwarded phone calls, in knowing glances and nasty rumors. Few people want to look vindictive. "The ideal," said Dr. Robert Baron, a psychologist in the school of management at Rensselaer Polytechnic Institute in Troy, N.Y., who has studied workplace reprisals, "is to ruin the other person without him knowing what happened, without him knowing if anything happened."
      Dr. Baron estimates that the ratio of indirect to direct acts of revenge is at least 100 to 1. As protective as this indirection is, however, it gives people a false sense of control. A person who feels deeply offended may respond with a half-payback -- missing an appointment, lapsing into grim silence for a short period. This common ploy, Dr. Rosen said, allows people to feel they have retained the moral high ground. Consciously or not, they are giving themselves wiggle room to exact more payback, if they wish, because they have not delivered the full measure. "The whole time you're saying to yourself, 'At least I haven't sunk to their level,' " Dr. Rosen said.
      The problem, psychologists say, is that one man's restrained response is another's body blow. While acts of vengeance may be carefully measured, their impact is ultimately unpredictable, and they may invite the kind of backlash that turns a small grudge into a lawsuit. Many people Dr. Baron interviewed had waited for years to get even with others who had themselves probably forgotten the offense, plotting until they got an opportunity to "torpedo their enemy's career," he said. During the interviews, some even rubbed their hands together at the memory, like cartoon villains.
      Chuck Moore, 52, a retired salesman living in Loveland, Ohio , said his mother had canceled his father's funeral at the last minute because she did not want anything good said about the man. "People came. The church was closed. Motto: watch out, the last word is by the living," Mr. Moore said in an e-mail message.
      Researchers have found a number of ways people can peaceably satiate their hunger for revenge: Work to feel empathy for the other person. Savor what advantages you do have. Pledge to behave even if the urge for vengeance lingers -- to behave, if not to forgive. Think for a while about the nasty things you have done.
      But there is another option, said John Sawyer, 44, a Denver businessman who lived daily with an urge to exact revenge after being shot one February night in 1987 during a botched robbery attempt. It took Mr. Sawyer six months to recover physically from the gunshot wound, and about a year before he stopped being angry at the three men who hurt him. "I felt that forgiving them was its own kind of revenge," he said. "It showed they hadn't defeated me; it was like I had risen above what happened, and above them."

All in a (Scientifically Monitored) Night's Sleep
Donald G. McNeil, Jr.,New York Times- 7/27/2004

I haven't slept well for years. If I set an alarm for 6:30 a.m., my eyes open at 5, and I try to doze to the radio. I drink four cups of coffee a day. I don't think I have ever fallen asleep at the wheel, but I often pull over nodding off. I used to work nights, which first threw my rhythm off. But I liked having days with my daughters and not being a creature of habit, perhaps because my father, who slept nine hours a night, was someone you could set a clock by. Lately, though, it had gotten ridiculous. So when the new sleep lab at Downstate Medical Center in Brooklyn offered to let me bring my pillow over for a test snooze, I jumped.
      True sleep disorders can be serious. Apnea sufferers whose blocked throats suppress their blood-oxygen levels below 80 percent saturation can die of arrhythmia or stroke. Narcoleptics suffer car accidents and fall down stairs. People with REM (rapid eye movement) behavior disorder, who lack the normal muscle paralysis that keeps most sleepers from acting out their dreams, have been known to beat and choke their spouses. Even gentle sleepwalkers, who are not dreaming but in deep sleep, have started cars and typed e-mail messages. (I had a childhood friend whose habit almost cost him his life. He was visiting another buddy, whose single mother had a gun. She drew a bead on the "burglar" downstairs before realizing it was Tommy in his pajamas bouncing off the furniture.)
      Also, I had some bad omens. I have been informed, not always gently, that I snore. Five years ago, I moved to France and had to find a new dentist. He took one look at my teeth and told me I ground them so fiercely at night that three were near breaking. I was skeptical, since he was proposing $10,000 worth of repairs. To prove his point, he made me a plastic mouth guard. Within two weeks, I had worn grooves in it. A month later, the very tooth he said was the weakest split in half -- on a baguette, to add insult to injury. I also have a sillier symptom. If I am forced to converse as I drop off, I babble nonsense -- something sleep experts call hypnagogic utterance.
      The sleepmeisters at Downstate told me to show up at 7 p.m. for a physical, so I could be wired up and hit the sack at 9. I protested that this didn't remotely mimic my life. I get home after 8, make dinner with three glasses of wine, talk to my 14-year-old or watch TV, and conk out after 11. Relenting slightly, Dr. Roger Q. Cracco, the neurology department chairman, said that I could have a later bedtime, but that alcohol and coffee were out. "I like a martini before dinner," he said, "but alcohol decreases REM sleep and slow-wave sleep. We want to see the patient's regular pattern."
      The lab's bedrooms, with urn-motif wallpaper and framed floral prints, were meant to recall hotel rooms. But the oxygen outlets, food trays and bed restraints all muttered "hospital." Dr. Chun Bai, the lab's director, asked about snoring, postprandial napping, irritability, medications, caffeine and alcohol, and whether I ever dozed off at stoplights, at lunch or while talking. I scored 9 out of 24 on an Epworth Test, which he said predicted that I would have mild apnea. He checked my reflexes for evidence of mini-strokes. None. Then he looked in my mouth, and his eyes opened wide. My uvula - the punching bag in the back of the throat - is apparently twice as long as normal. With my "crowded" airway, he said, I was lucky not to have a receding jaw or a huge tongue. Being 40 pounds over my high school weight made me the "upper edge of normal," he politely pointed out, but another 10 pounds would be a problem.
      An hour later, I had five brain-wave electrodes glued to my scalp, two eye-movement detectors on my cheeks, two beneath my chin for muscle tone, two on my chest for heart rhythms, and two on my legs for twitching. I had chest and stomach belts for breathing, an airflow sensor in my nostrils, an oxygen saturation monitor on my finger and a "snore mike" taped to my neck.
      And so to sleep. Surprisingly, although I was wired up like the Bride of Frankenstein and watched by a camera, I drifted off almost instantly. I remember waking at 4 a.m. to look at my watch. After that, I had a dream - a pleasant one, even though it involved being chased through a strange city by a family whose hats I had stolen. At 5:30 I put on my radio. At 6, Pandi Perumal, the lab's technical director, said it was time to get up. My teeth hurt, but otherwise I felt good. "You really snored," he said, laughing. "Loud?" I asked. "A lot?" "Oh, yes." So my ex was right.
      Dr. Bai came in early and read the computer record of my night. First the good news: I had the "sleep efficiency" of a teenager: I was out for 97 percent of the allotted seven hours. I reached REM sleep in 68 minutes -- fast, but still above the 60-minute mark that suggests clinical depression. My heartbeat was regular. Then the bad news: I had partially woken not once but 57 times when my blood oxygen dropped. I had three snoring episodes more than 30 minutes long. My "jerk count" -- the number of times I woke myself twitching -- was 4. It sounded bad. I met any private insurer's criteria for apnea and was just one jerk short of a diagnosis of periodic limb movement disorder. But in fact, Dr. Bai said, my sleep apnea was mild. The lab had one 400-pound patient who woke 800 times a night. My blood oxygen never fell below 87 percent. My heart seemed untroubled.
      The next test was for sleep latency, which ought to be called power napping. Despite a night's sleep, I had to shut my eyes for 20 minutes at 9 a.m., 11 a.m. and 1 p.m. and see what happened. I was told I'd be home by lunchtime. At sunset, I was still trying to pass. The only subject I have ever flunked twice in a row was in kindergarten: Ability to Relax. Apparently, I have improved. I lay in the darkness, my mind wandering, but each time I got the 20-minute knock, I said I had not slept. The computer, however, insisted I had. Not only that, but I had gone into dream sleep during four of my five naps. So, Dr. Bai said, I had two of the four symptoms of narcolepsy: hypnagogic behavior and short REM latency.
      He asked about the others: falling asleep on the spot and collapsing when startled. Did I, he wanted to know, drop my coffee when I heard surprising news? No, I said. That would be tough on a journalist. Well then, he said, over all I had the mild obstructive apnea of 10 percent of men my age and the chronic sleep deprivation of a medical student. I could try losing weight, drinking less and going to bed earlier, he said, or a dental appliance, or some very unpleasant surgery. But he suggested a trial on a CPAP machine. One semi-sleepless month later, I was ready.

Patterns: Preventing Women's Migraines
John O'Neil, New York Times- 7/27/2004

Many women who suffer migraines tell their doctors that their headaches are related to the onset of menstruation. Two studies released yesterday lend support to that link and to the idea of timing medication to the menstrual cycle as a preventive measure. Both studies were published in the journal Neurology.
      The lead author of one of the studies, Dr. E. Anne MacGregor of the City of London Migraine Clinic, said that in general about half of women with migraines say their headaches come on more often and with greater severity just before menstruation. Earlier studies had not found evidence of the connection, Dr. MacGregor said, because women with migraines connected to the menstrual cycle and women whose migraines were not connected canceled each other out.
      The new study overcame that difficulty by comparing the onset and severity of attacks within a group of 155 women who all had suspected menstrual migraines, she said. Entries in diaries the women were asked to keep showed that they were more than twice as likely to suffer migraines during the first three days of menstruation as they were on other days, and that the menstrual migraines were more than three times as likely to be severe as those at other times.
      The second study found that fewer than half the women who took an anti-migraine drug, frovatriptan, before and during the onset of menstruation suffered headaches, compared with two-thirds of women given a placebo.
      Dr. MacGregor said women suffering migraines should use diaries to discern patterns in attacks, and a fertility monitor if they are uncertain about predicting menstruation. Even without preventive medicine, "women in our study reported that this helped them to feel more in control of their migraine," she said.

Vermont May Have Mobile Methadone Clinics
Associated Press, 7/27/2004

ST. JOHNSBURY, Vt. -- Plans to use two mobile methadone clinics to help heroin addicts in the Northeast Kingdom won't be rolling by Oct. 1 as planners had originally hoped. Barbara A. Cimaglio, director of alcohol and drug abuse programs for the Vermont Department of Health, said the mobile methadone clinics would have to be approved by the state. She said there was a need for more meetings and community input before the first dose of methadone could be dispensed. "We will do things as best as we can to move forward," Cimaglio said. "We would rather see this right than quick."
      San Francisco-based Detoxification Programs Inc. has won the bid to run the first-ever mobile methadone clinic program in the state. The company will be doing business in Vermont as Vermont Behavioral Health Services. Currently, Vermonters are traveling to Massachusetts and New Hampshire locations to obtain doses of methadone. "The bottom line is we want to go where the people are," Cimaglio said.
      Vermont Behavioral Health plans to dispense methadone at both sites daily for a minimum of two hours. It will develop a comprehensive mobile treatment program for opioid-dependent adults in the Northeast Kingdom. Services will include drug treatment, including methadone and buprenorphine, substance abuse and mental health counseling, primary medical care and ancillary human services.

A Father's Fight for Mental Health
Lorinda Bullock, Detroit Free Press- 7/27/2004

Paul Raeburn's children, Alex and Alicia, present a sensitive subject. Combined, they have endured fits of rage, suicide attempts, self-mutilation and behavior that landed them in the backseat of police cars. But it wasn't their fault. Bipolar disorder and depression were the culprits that drove the sharp changes in Alex and Alicia's personalities. Despite difficult times, Alex, 19, and Alicia, 17, have persevered, which is a hopeful sign for parents of other troubled children, Raeburn says.
      He wrote "Acquainted with the Night: A Parent's Quest to Understand Depression and Bipolar Disorder in His Children" (Broadway Books, $24.95) to bring attention to a topic often shrouded in silence. Bipolar disorder also is known as manic depression. Symptoms include extreme changes in mood, energy levels and behavior. The book is not a step-by-step guide telling parents what to do to miraculously save their mentally ill children. Instead, "this is one book, one family's story, to try to say, 'We've got to pay more attention to this,' " Raeburn says. "There are millions of kids and parents out there who are really, really suffering."
      Raeburn is a Dearborn Heights native who now lives in New Jersey and works in New York City. He joined Business Week as science editor in 1996 after spending 15 years as chief science correspondent for the Associated Press. He has written several other books, including "The Last Harvest: The Genetic Gamble That Threatens to Destroy American Agriculture" (University of Nebraska Press, $12) and "Mars: Uncovering the Secrets of the Red Planet" (National Geographic, $40).
      Raeburn originally wanted to "write a book about mental illness in children and look at the research and what progress was being made." He planned to discuss his personal story only briefly in the introduction. But after three years of thinking about whether the book should be straight science or straight from the heart, he chose the latter path and decided to weave his own family's story into facts and figures about the mental health care system and children.
      Raeburn relied on personal experiences, more than 1,000 pages of his children's medical records and interviews with the children, including his eldest son, Matt, 22,who doesn't have a mental illness. Alicia even allowed her father to read her diary and use excerpts in the book. Raeburn's biggest challenge was learning to share a frightening and frustrating story with strangers that showed his family at its worst. "It was very hard to tell, partly because I was making very personal things public, and it was also reliving very painful experiences," he says.

Outbursts and hospital stays
Raeburn knew there was trouble behind Alex's occasional jokes and outbursts in class once he saw his son on a gurney with his hands and feet restrained. Alex was 11 at the time. The book describes how Alex became upset that an art lesson had been canceled. He screamed at his teacher, ran down the hallway and smashed the glass face of a clock with his fist before running out of the school and across a field. It took two policemen to wrestle him to the ground, drag him to their squad car and take him to a local hospital.
      Less than two weeks after the incident, Alex entered another hospital because his medications were making him worse. He was picking fights in school and threatening suicide. In the following years, his behavior bounced from acceptable to out of control. By seventh grade, he was sent to Four Winds Hospital in Katonah, N.Y., 90 miles from home. His last hospital stay, at a drug treatment facility, came during his junior year in high school.
      Raeburn's long and difficult mission during those years was to get adequate help for his son and, eventually, his daughter. That meant sending them to far-away psychiatric hospitals for children. Alex saw six psychiatrists before finally being diagnosed with bipolar disorder and took five different drugs before finding the right ones: lithium and Depakote, the two drugs now used most often to treat bipolar disorder. It also meant pushing for more hospital time and paying out of pocket for child psychiatrists who didn't accept insurance.
      Raeburn studied federal laws that require public schools to provide alternative instruction when all of a school's special education resources are exhausted. The result: Ridgewood (N.J.) Public Schools paid the $20,000 in tuition for Alex to attend a special school for one year and eventually paid for eight months of special instruction for Alicia.
      Even the high-quality New Jersey suburban school Raeburn's children attended could not provide adequate services to help them. Raeburn says that although Alex has just completed his freshman year at Johnson State College in Vermont, he was not prepared for college. Alicia, who just completed her junior year in a Ridgewood school, has had to work hard to get back on track. Because of their hospitalizations and placement in special schools, the children missed a lot of their regular school and often lagged behind.
      Raeburn writes about his inner conflict over having to send his children to special schools when they didn't have learning disabilities: "They're bright. They can be just fine. But they have therapeutic issues, and they need the therapy. They need the treatment. They need the supportive environment." During those difficult years, Alex had thousands of dramatic mood swings, and his self-esteem remained dangerously low, despite high IQ test results. Once, he ran outside the house and threatened to kill everyone in his family. He screamed that he would be dead by morning. Suddenly shivering uncontrollably, he walked back to the house, and asked his mother: "Was that really me out there? What happened to me?" Raeburn says in the book. By the time Alex entered ninth grade at Ridgewood High, progress finally was being made. But Alicia's troubles were just beginning to surface.

Self-mutilation and alcohol
At age 12, Alicia attempted suicide by swallowing an entire bottle of Tylenol. This was the first of several suicide attempts. Alicia also was admitted to Four Winds. She says she read a book about teens and depression in which one teen wrote about cutting. She started cutting herself, too. She told her father that the sight of blood trickling from her arm was "strangely calming." In 2000, Alicia, then in the seventh grade, was diagnosed with borderline personality disorder. Self-mutilation in the form of cutting or burning is a sign of this disorder, along with such impulsive behaviors as binge eating, drinking, drug abuse and shoplifting. Alicia engaged in all of those behaviors.
      By eighth grade, Alicia was drinking alcohol, having sex and shoplifting. On more than one occasion, she was picked up by the police for possession of alcohol. "After years of trying to help Alex deal with his problems, I was now completely overwhelmed by what was happening with Alicia," Raeburn writes. At age 14, Alicia was admitted to the Devereux Beneto Center in Malvern, Pa., where she had to adhere to a strict schedule and where, based on her behavior, she could earn points to enjoy privileges such as calling home twice a week. She stayed at Devereux for seven months. Alicia was given a number of drugs throughout her illness, but she now takes Lexapro, an often-prescribed antidepressant.

Parents suffer, too
The children's ordeal put stress on their parents' relationship and caused constant arguing about how to handle them. Raeburn writes that the arguing hindered Alex's and Alicia's progress and led him and his wife to divorce. "Parents should look at how they interact with their kids but not be so hard on themselves when they do make mistakes," Raeburn says. "Bad parenting does not cause depression. Bad parenting does not cause bipolar disorder."
      Raeburn admits to responding with anger when his children behaved badly. "I went overboard in terms of anger and negative kinds of reactions to their illnesses. At the same time, kids who have mental illnesses can also do things they shouldn't be doing." Raeburn, who has remarried, says parents have to balance sensitivity with setting limits. He is hopeful about his children, but not the health care system. "I have no hesitation in saying that the quality of psychiatric care for children in this country is abysmal. I can't think of any other area in our health care system that does a worse job."
      In an effort to change the quality of the mental health care system, President George W. Bush established the President's New Freedom Commission on Mental Health in 2002. In its final report, the panel wrote: "Mental illness is the only category of illness for which state and local governments operate distinct treatment systems, making comprehensive care unavailable in the larger health care system. Ultimately, this situation must change." To read the complete report, go to www.mentalhealthcommission.gov.
      Fighting for adequate treatment for children and pushing for policy changes on how that treatment is administered and paid for is the prevailing theme throughout Raeburn's book. "Somebody told me early on, 'If you want to get help for your kids, you're going to have to fight,' " Raeburn says. "If parents really press, appeal every decision, really make a case with the insurance company, have the children's doctors make a case with the insurance company, it can sometimes get you better coverage. "The noisiest, angriest, most insistent people will get better care than the people who take the more mild-mannered approach."
      Raeburn says his children are "on an upward, steady curve" now, but it has required understanding and patience on the part of everyone. Alex now lives on his own and is considering becoming a psychology major. Alicia is looking at colleges. Raeburn trusts that better days are ahead. "Parents who are going through these difficult years should keep some hope and continue to believe that things will get better because very often these troubled kids do get better as they get older," he says.

By the numbers
* About 15 million U.S. children and adolescents a year experience a diagnosable mental illness.
* Six to 9 million of them have significant serious emotional disturbances, including anxiety disorders, attention-deficit disorder, eating disorders, schizophrenia, Tourette's syndrome, autism and Asperger's syndrome.
* There are only 6,000 child psychologists in the United States. That number hasn't changed in a decade. That is one psychologist for every 1,000 sick children. For help, The American Academy of Child & Adolescent Psychiatry has a Web page with a Find a Child and Adolescent Psychiatrist link. Go to www.aacap.org.

Sources
* The New Freedom Commission on Mental Health, established by President Bush in 2002. Its analysis of mental health treatment in the United States was based on a 1999 report by then-Surgeon General David Satcher. The study is the most current and widely cited report.
* The American Academy of Child and Adolescent Psychiatry.
* "Acquainted with the Night: A Parent's Quest to Understand Depression and Bipolar Disorder in His Children" by Paul Raeburn.

The Benefits of Quitting Smoking At Any Age
Christine Haran, ABC News- 7/28/2004

Today, few, if any, smokers are unaware of the harm their habit is inflicting on their bodies. But not all of them may be aware that quitting at any age can help reduce their risk of a life cut short by a smoking-related illness and improve the quality of that life. Two recent studies demonstrate that quitting at a young age can reverse most health risks associated with smoking, and one suggests that quitting at any age can potentially add years to your life.
      A study published in the June 2004 issue of Health Services Research involved analysis of data from two studies involving more than 20,000 men and women over the age of 50, who were interviewed about their smoking habits and their physical, emotional and social health. The study researchers, of Duke University Medical Center in Durham, N.C., found that, among people aged 50 to 54, male heavy smokers lost about two years of healthy life compared to non-smokers and lived about two years less, while female heavy smokers lost more than one-and-a-half years of healthy life and lost 1.44 years of life. In contrast, researchers found that the people who quit smoking between the ages of 35 and 45 had lived as long and in as good health as people who had not smoked. "Messages concerning the effect of smoking on disability and quality of life may be more likely to invoke changes in smoking behavior than are messages about loss of life years," the study authors wrote.
      More positive news comes from a 50-year study following 34,439 male doctors published in the June 26th issue of the British Medical Journal that found quitting smoking by age 30 reduced almost all risk associated with smoking and that quitting by age 50 cut risk in half. "The findings of the benefit of giving up at different ages were not surprising for us," says lead author Sir Richard Doll, an emeritus professor of medicine at Oxford University in England, who published the first paper confirming the link between smoking and lung cancer. "But we had not previously shown them so clearly."
      The British study also found that smoking from youth nearly triples the death rate from all causes, including lung cancer, chronic obstructive pulmonary disease and heart disease and stroke. "Regular cigarette smoking deprives people, on average, of 10 years of life." Sir Doll says. "Some people, of course, losing much more and others less." The heartening news for smokers, however, is that it's never too late to achieve health benefits from quitting.



Texas Mental Health Agency Wants Fewer Patients
Rosanna Ruiz, Houston Chronicle- 7/29/2004

Facing a projected $17 million shortfall, the Mental Health and Mental Retardation Authority of Harris County will ask Texas officials to lower the number of patients it must treat under a state-mandated plan in which only the sickest would receive outpatient care. Executive Director Steven Schnee said Tuesday that he will ask the Texas Department of Health Services to allow MHMRA to cut its treatment target from 8,830 patients to 8,400. "There is no way we are going to be able to deliver the enhanced array of services for the number of people in the system," Schnee told the agency's board. Uncertainty about whether the state would agree to let the county serve fewer patients prompted the MHMRA board of trustees to postpone a vote on the agency's 2005 budget until next month.
      In Harris County, there are about 90,000 people who have some form of mental illness. MHMRA serves about 8,800 adults and 1,800 children and adolescents each month. Schnee had previously estimated about 530 people would be "disengaged" from outpatient services as a result of last year's sweeping legislation.
      The new law requires mental health agencies to implement a businesslike approach to rationing treatment dollars called "disease management." Under that model, outpatient care is offered to the sickest patients — those diagnosed with schizophrenia, bipolar disorder or severe clinical depression. Those eligible would receive medication, more frequent visits, counseling and, at times, housing and job-placement assistance. Those with less-severe mental illnesses would be eligible for services in times of crisis.
      The problem, critics say, is that the state is requiring agencies to increase services but is not providing additional funding to cover the costs. Schnee said fully implementing the program would cost $17 million more than the local authority is budgeted. About $7 million of that would be in the area of services for children and adolescent patients.
      In addition to reducing the number of patients, Schnee said he will ask the state to approve an alternative that would create two classes of MHMRA patients: those eligible for disease-management care and those who would continue to receive minimal services. Should the state reject MHMRA's alternative plan, Schnee said, the agency will be "forced into a contractual relationship that, on its face, won't succeed." Nonetheless, he said, MHMRA will do its best to make the program fit. Last year, the Harris County authority, the largest community mental health agency in the state, spent $52.7 million in state funds on mental health, including operation of the county psychiatric center.

Film Review; Erotic Suspense After Mistaken Identity
Stephen Holden, New York Times- 7/30/2004

In Patrice Leconte's sardonic psychological thriller, ''Intimate Strangers,'' Sandrine Bonnaire portrays a Gallic answer to one of Alfred Hitchcock's sleek blond women of mystery. Imagine the Grace Kelly of ''Rear Window'' or the Kim Novak of ''Vertigo'' sprawled seductively on an analyst's couch, smoking cigarettes and confiding her sexual frustration to a repressed, wide-eyed shrink who is obsessed with her. ''Intimate Strangers,'' directed by Mr. Leconte from a screenplay by Jérôme Tonnerre, establishes its mood of playful erotic suspense in the first 10 minutes and sustains its cat-and-mouse game between therapist and patient through variations that are by turns amusing, titillating and mildly scary.
      The film's running joke is its revelation at the outset that the shrink, William Faber (Fabrice Luchini), is not really a therapist but a repressed, lonely tax accountant whose good friend and recent romantic partner, Jeanne (Anne Brochet), has left him for a gym rat (Laurent Gamelon). Ms. Bonnaire's troubled character, Anna, has accidentally strayed into the wrong office, on the same dark floor where the psychoanalyst she intended to consult, Dr. Monnier (Michel Duchaussoy), practices a few doors away. Before William has a chance to correct Anna's mistake, she begins pouring out the story of her dysfunctional marriage, and he finds himself too intrigued to come clean. As he points out later, a tax accountant's relationship to a client parallels a psychotherapist's. Both professions involve knowing personal secrets and making decisions about what to reveal and what to hide.
      ''Intimate Strangers'' takes place less in the real world than in the realm of voyeuristic fantasy -- in other words, in the realm of film itself, which allows us to ogle beautiful people under the cover of darkness. And Ms. Bonnaire is something to ogle. The film, which opens today in New York, presents longing as a kind of romantic science fiction in which the what-if? is risk free, and it is more delicious to imagine a transcendent passion than to engage in the messy, potentially disappointing mechanics of actual consummation.
      Another variation on the same idea drives the recent and wonderful Italian film ''Facing Windows,'' in which attractive neighbors who have surreptitiously observed and desired each other finally connect and face reality. Both films involve a lot of staring out of windows and gazing at reflections.
      ''Intimate Strangers'' is also a riff on the Henry James novella ''The Beast in the Jungle,'' whose protagonist spends his life frozen in the expectation of a remarkable destiny that never materializes. Midway in Anna's therapy, William, whose inability to respond to her subtle romantic signals recalls the paralysis of James's protagonist, lends her the novella. On returning it, she complains about its sad ending.
      A dumpy, slightly effeminate middle-aged man with scared saucer eyes, Mr. Luchini's William (who secretly dances around his apartment to Wilson Pickett's ''In the Midnight Hour'') is another of the movie's jokes. It's difficult to explain Anna's discreet romantic interest in him except as a comic illustration of the notion that opposites attract. ''Intimate Strangers'' has great fun puncturing the mystique of psychoanalysis. When William calls on Dr. Monnier to seek Anna's telephone number, the doctor withholds it but charges William for a session. Monnier, who has more than a passing resemblance to Freud, is as greedy as he is grandiose. He offers William free advice over lunch, then makes him pick up the tab. While they dine, he offers his own pompous (nonsensical) variation on Freud's question ''What do women want?'' (''Once ajar, the door to female mystery is hard to shut again'') and plants the notion in William's head that Anna's abusive husband may be imaginary. William, with his shyness and a sense of propriety that camouflage a burning curiosity, proves a much better therapist than his professionally accredited neighbor.
      Other characters who dart in and out of the movie include Williams's nosy, disapproving secretary, Mrs. Mulon (Hélène Surgère); Anna's wildly jealous husband, Marc (Gilbert Melki), who is aroused by the fantasy of his wife sleeping with William; and Chatel (Urbain Cancelier), a client of Monnier's whose elevator phobia Anna endeavors to cure after encountering him on the way to a session. In the spirit of the best Hitchcock, ''Intimate Strangers'' is seriously light. Or is it lightly serious? ''Intimate Strangers'' is rated R (Under 17 requires accompanying parent or adult guardian) for its frank sexual talk.
INTIMATE STRANGERS
Directed by Patrice Leconte; written (in French, with English subtitles) by Jérôme Tonnerre; director of photography, Eduardo Serra; edited by Joëlle Hache; music by Pascal Estève; production designer, Ivan Maussion; produced by Alain Sarde; released by Paramount Classics. Running time: 104 minutes. This film is rated R.
WITH: Sandrine Bonnaire (Anna), Fabrice Luchini (William), Michel Duchaussoy (Dr. Monnier), Anne Brochet (Jeanne), Laurent Gamelon (Luc), Hélène Surgère (Mrs. Mulon), Gilbert Melki (Marc) and Urbain Cancelier (Chatel).



Analysis Lays Out Conflicts in Health Benefits of Alcohol
Lauran Neergaard, Associated Press- 7/31/2004

WASHINGTON - Alcohol is the Dr. Jekyll and Mr. Hyde of the medical world: Drinking too much causes serious problems, while drinking a little may help many people's health. How many drinks provide just the benefits and not the harm? It depends on whether a person is most at risk of heart disease, diabetes or breast cancer. But there is one bottom line: Five or six drinks only on Saturday night will provide no benefits, while a drink or two a night might. So concludes an exhaustive new analysis by the National Institutes of Health that sorts out a plethora of sometimes conflicting research on alcohol's effects.
      The review was prompted by cardiologists' complaints that patients suddenly were asking if they should start imbibing, and how much. Other research is overturning the dogma that people at risk of diabetes should abstain; still more links even light drinking to breast cancer. Adding confusion, people are vulnerable to more than one disease as they age. A 50-year-old woman with breast cancer in the family might get very different advice on alcohol than one who's pre-diabetic with high cholesterol. Hence NIH's review.
      "We are not encouraging anybody to start drinking," emphasizes Lorraine Gunzerath of the NIH's National Institute on Alcohol Abuse and Alcohol, who led the analysis published in the journal Alcoholism: Clinical & Experimental Research. After all, alcoholism remains a major health problem, and people with liver disease may not tolerate even moderate drinking.
      Instead, the report, aimed at people who already drink some, concludes that to get alcohol's potential health benefits, how much those people can consume must be customized by their age, gender and overall medical history. For many of these diseases, "If you do drink moderately now, fear ... is not a reason to stop," explains Gunzerath. "Some people have said, 'Should I stop now because there's diabetes in my family?' Well, if you're a moderate drinker, there's some protection."
      As population-wide advice, consuming two drinks a day for men and one a day for women is linked to lower mortality and unlikely to harm, the review found. Men shouldn't exceed four drinks on any day, and women three — bingeing is simply bad.
The National Institutes of Health study reached these conclusions.
• Four for 40 : Studies consistently show that in people 40 or older, consuming one to four drinks daily significantly reduces the risk of heart disease, the nation's leading killer. In contrast, five or more drinks daily markedly increases heart risk. Frequency seems key. Consuming smaller amounts several times a week — one or two daily or every other day — is most heart-protective.
• Link questioned: The alcohol-breast cancer link remains controversial. Some studies suggest a small increase in risk, that roughly 9 in 100 nondrinkers may get breast cancer by age 80 compared with 10 in 100 women who consume two drinks a day. Per person, that's a tiny risk. But women whose mothers or sisters had breast cancer, or those taking post-menopausal estrogen replacement, are at greater risk from alcohol.
• Lowered risk: One to two drinks a day several days a week seems to lower the risk of Type 2 diabetes, a disease rising at epidemic proportions.