The state Department of Mental Health is investigating two private psychiatric institutions from which Bradley Burns allegedly escaped three weeks before a judge sent him to Bridgewater State Hospital, where authorities say he strangled a patient. During the escapes, Burns choked a staff member at one of the private facilities and choked a patient at the other, according to police reports. Also the state Department of Correction, which operates the state psychiatric hospital in Bridgewater, announced yesterday that it plans to establish a panel to review why Burns was allowed access to other patients, despite his recent history of choking assaults. Burns is charged with killing William Mosher, 32, on Saturday by strangling him with a torn piece of a T-shirt.
      Lester Blumberg, chief of staff for the Department of Mental Health, declined yesterday to discuss the scope of the agency's investigations of the two private hospitals. However, two employees at one of the private facilities said state investigators were focusing on whether information about Burns's behavior -- including allegations about the choking incidents -- was properly passed along with him as he moved from one facility to the next. The employees, who had access to information the state requested as part of the investigation, spoke on condition of anonymity.
      Burns, 29, escaped from McLean Hospital in Belmont on Aug. 7 by putting a headlock on a Cambridge woman and demanding that he be taken to the ground floor of the administration building, according to a Belmont police report. Hours later, he was captured by police and eventually taken to Arbour-HRI Hospital in Brookline. When a supervisor at Arbour-HRI was asked to approve his admission, she was not told about the alleged violent hostage-taking incident at McLean, according to the supervisor's report, which was prepared for investigators as part of the Department of Mental Health review.
      In the report, obtained by the Globe, the supervisor said she was told Burns had escaped from McLean, but little more. ''I asked why he was not going back there. And I believe they told me 'because they don't want him,' " said the report, which is dated Tuesday. After being admitted to Arbour-HRI, Burns allegedly attacked an elderly patient there by wrapping something around his neck and choking him while backing into an elevator to the lobby, according to a police report and an eyewitness account. Burns went from Arbour-HRI to a McDonald's restaurant a couple of blocks away, where he tried to rob a 69-year-old clerk by choking him, police said. Burns was arrested there by Boston University police.
      A spokeswoman for McLean said an internal review was underway, but declined to comment further, citing patient confidentiality. Gary M. Gilberti, group director of Arbour-HRI Hospital, also declined to comment, but said that, in general, people are evaluated for dangerousness and the level of care they require before being admitted. But Evan Shapiro, a mental health counselor at Arbour-HRI Hospital for 13 years, said in an interview yesterday that the facility ''isn't equipped to handle criminally violent patients." ''We have no security at this hospital -- we're just not an appropriate place for someone like him," Shapiro said of Burns.
      Mosher's family and others have questioned why the state Department of Correction allowed Burns to have access to other patients at Bridgewater, given that there were police reports about his recent history of three choking incidents. Kelly Nantel, a spokeswoman for the Department of Correction, said earlier this week that a review of the killing indicated there were no lapses in policies and procedures and that staffing was adequate at the time. Yesterday, while continuing to maintain that policies and procedures were followed, Nantel conceded that ''the policies and procedures may need to be changed, maybe enhanced in some cases."
      A Department of Correction statement said the panel will conduct a ''comprehensive review of the psychiatric and forensic management" of Burns and Mosher. ''It is critical that we conduct an in-depth analysis of the events leading up to the alleged homicide," Correction Commissioner Kathleen M. Dennehy said in the statement.

Growing Number Are Seeking Help for Sleep Disorders
Alice Chang, Cox News Service- 9/3/2004

WASHINGTON - Greg Carter knew he had sleeping problems, but when he caught himself dozing at the wheel, he looked for help. A specialist diagnosed sleep apnea, which causes sleepers to stop breathing and keeps them from getting a good night's rest. With the help of a high-tech breathing-assistance device, "I woke up to a new life," said Carter, 50, of Centerville, Ohio.
      Carter belongs to a growing group of 70 million Americans — about one in four — who have had difficulty sleeping, according to the National Institutes of Health. He's also among those benefiting from treatments developed in recent years by the science of sleep medicine.
Carter used to snore so much that his wife couldn't sleep in the same room. She also noticed that when Carter was sleeping, he would stop breathing for up to 30 seconds at a time. "She'd actually wake me up and tell me to breathe, it got so bad," he said.
      Finally, the driving episode prompted Carter to visit the Kettering Medical Center Sleep Disorders Center in Dayton, Ohio. In an overnight sleep study, doctors hooked up him up to monitoring equipment and discovered he stopped breathing 52 times that night. Doctors prescribed a shoebox-sized machine that pushes air through a mask into his nose, forcing him to breathe. Before treatment, he slept only three hours a night. Once Carter began using the machine, he slept through the night and had enough energy to exercise during the day. That helped him lose 85 pounds from his 300-pound frame. "It's amazing what it did for me," Carter said. "I'm a changed person."
      Sleep apnea, commonly linked with obesity, has increased in adults and children as obesity rates have grown. Up to 18 million people suffer from the condition. Researchers also believe insomnia, the chronic inability to get enough sleep, has become more common in the nonstop modern world. "The Internet never shuts down," said Donna Arand, clinical director of the Kettering Sleep Disorders Center. "More businesses are open for 24 hours a day, so you can shop for groceries ... around the clock." Edward Stepanski, director of the Rush Sleep Disorders Service and Research Center in Chicago, said all-night cable television and working overnight or on rotating shifts can also contribute to difficulties falling and staying asleep.
      While most sufferers' conditions remain undiagnosed, sleep medicine, an industry that began in the late 1970s, is ballooning. Ten years ago, the American Academy of Sleep Medicine had accredited 277 centers, but that number has nearly tripled to 728. Experts say the soaring numbers are because of greater awareness among doctors and the public.
      Some of the most popular remedies for insomnia, according to Dr. Susan Esther of the Carolinas Sleep Services in Charlotte, N.C., are a combination of behavioral treatments and medication. "We try to avoid nightly use of medicine," Esther said. "With chronic issues, it's rare that a pill will be a quick fix." Behavioral treatments include practicing good sleep habits, such as waking up at the same time every day, and cognitive therapy, which helps patients avoid anxiety about insomnia.

Doctor Founds Ministry to Fight Meth Addiction
Bill Boovey, Associated Press- 9/4/2004

CHATTANOOGA, TENN. - Dr. Mary Holley has witnessed the ravages of methamphetamine.
As an obstetrician in Albertville, Ala., she estimates about 10 percent of her pregnant patients are addicted. One was "high as a kite. Comes in dilated 9 centimeters. She is pushing out her baby. I am trying to get the clothes off this woman so I can deliver this baby and a gun falls out of her bra," Holley said.
     But the methamphetamine epidemic in Appalachia has now become a personal crusade for Holley: Four years ago, her brother Jim shot and killed himself after a struggle with meth addiction.
"After he died, I started looking into it as a physician, as a scientist," Holley wrote on her Web site. "What is this drug that destroyed his life in just two years?"
     A photo of her brother appears on the Web site for Mothers Against Methamphetamine, or MAMa, a Christian ministry that Holley founded last year to fight the drug. The group already has chapters in Tennessee, Georgia, Oklahoma, Missouri and Ohio, and Holley said the Web site gets about 6,000 hits a month, including about 25 a day from "parents wanting to know what to do with their kid." Mothers Against Meth has worked with churches to start addiction support groups, similar to Alcoholics Anonymous. And the MAMa Web site offers pamphlets that detail the dangers of meth. "People don't realize what this drug is doing," Holley said. "One look at the brain scan in my pamphlets will change that attitude."
     Meth targets the central nervous system. People who use the stimulant tend to hallucinate and become aggressive, in some cases violent. Their children are often neglected or abused. Meth can be cooked using cheap, over-the-counter ingredients: ephedrine and pseudoephedrine from cold tablets, red phosphorous from matchbook strike plates, ether from engine starter fluid, iodine and sulfuric acid from drain cleaner. The epidemic is spreading quickly across the country, particularly in rural, mountainous areas. The U.S. Drug Enforcement Administration estimates Tennessee accounts for 75 percent of meth lab seizures in the Southeast.
     Holley, who is a Christian, believes drug addiction is "primarily a spiritual disease, not a social disease." "When I talk to these kids, about 20 percent (of meth users) are basically healthy kids who made a bad decision. About 75 percent are broken, hurting people, abused and battered as kids," she said. "They use this drug because it works. It makes them feel better. They have been rejected and humiliated and miserable people all their lives. It just makes everything better. This stuff works."
     She said a religious approach to treating addiction is the only solution. "Law enforcement is helpless. They can't possibly bust every lab. They can't keep them in jail long enough for them to heal," Holley said. "Education is helpless. They lack the resources and the moral authority to change the situation."
     Tennessee is among 14 states picked by the U.S. Department of Health and Human Services to receive grants for expanded drug abuse treatment. Gov. Phil Bredesen, who plans to propose meth-battling initiatives in 2005, said much of the $17.8 million will be used for treatment. Bredesen's meth task force has recommended using "faith-based and community-based treatment options."
     "I don't see a lot of success with the secular programs," Holley said. "They have diluted God out of it. As they have diluted God out of it, they have diluted their effectiveness. Christian rehab centers that keep them for a full year have about 80 percent rate keeping them clean long term. Secular is 20 to 30 percent."
     Dr. Sullivan Smith, a member of Bredesen's meth task force, said the panel is "looking at some options to expand existing drug and alcohol programs." He said the federal grant would hopefully be spent with "an emphasis on treating methamphetamine addicted people." "I think there is hope, but not in the system we are currently working with," Smith said. "What we are doing now isn't working. It's a revolving door."
      On The Net: MothersAgainst Methamphetamine: www.mamasite.net


Sex Crimes May Be Starting Younger
Liz Austin, Associated Press- 9/4/2004

DALLAS - The arrest of a 12-year-old boy on charges that he molested a 4-year-old girl at a fast-food restaurant playground may point to a growing problem of sexually aggressive children, child-abuse experts say. The boy was arrested Wednesday in suburban Houston on charges of indecency with a child and aggravated sexual assault. Police would not discuss in detail what happened to the girl, other than to say her mother said she'd been touched inappropriately. The arrest came a week after the Dallas Independent School District expelled two first-grade boys after one performed a sex act on another during class. While their teacher passed out textbooks, one boy slipped beneath his classmate's desk and performed oral sex on him, district spokesman Donald Claxton said.
      Anecdotal evidence suggests that the number of sexually inappropriate incidents among children is increasing, though it is difficult to track such cases, said Sharon K. Araji, a University of Alaska sociology professor who wrote a book on understanding sexually aggressive children. The problem may be worsening because children are exposed to more graphic sexual imagery at a younger age through racier television programming, the increased availability of Internet pornography and declining parental supervision, clinical psychologist Toni Cavanagh Johnson said. Some sexually aggressive children also are victims of sexual abuse, she said. All children mimic things they've seen at home or on television, but normal sexual experimentation in the elementary years usually doesn't go far beyond "I'll show you mine, you show me yours" play, Araji said.
      The Dallas school district, however, handled about 25 cases of kindergartners who committed sexual assault last year, Claxton said. While he declined to release details, "suffice it to say there were some fairly graphic things that happened last year involving younger kids," he said.
      There are 1,331 juveniles 16 and younger registered on Texas' sex-offender database, Texas Department of Public Safety spokeswoman Lisa Block said. While children 10 and older can be prosecuted in Texas, Block could not break down the number by age.
      The Fort Bend County District Attorney's Office, which is handling the 12-year-old boy's case, receives two or three similar cases each month, said Tyra McCollum, the assistant district attorney in charge of the juvenile division. "Unfortunately we see it quite often," she said. "It's obviously not as common as theft or drugs. It's also not unusual."
      The 12-year-old boy, who is not being identified because of his age, is being held in a juvenile detention center while prosecutors weigh the case. Prosecutors can seek one of two punishments if he is convicted, McCollum said. The lighter sentence would allow the court to have jurisdiction over him until his 18th birthday. He could face up to 40 years in prison under the harsher punishment.
      In the Dallas case, an investigator with Child Protective Services also will examine the boys' home lives for an explanation of their behavior, agency spokesman Geoff Wool said. In such situations, Wool said, CPS caseworkers talk with the child's parents about age-appropriate activities and try to make sure the child is not being abused or abusing others.
      While criminal prosecutions are appropriate in severe cases or for repeat offenders, it is important for authorities to make sure sexually aggressive children and their families get counseling, Araji said. Many adult sex offenders began behaving inappropriately at a young age, she said. "If we get these children when they're very young, when they're beginning the sexually aggressive behavior, we would have a much greater success rate in stopping sexual abuse from continuing," Araji said.

Is Psychoanalysis Science or Is It Toast?
Daphne Kerkin, New York Times Book Review- 9/5/2004

Almost from the moment of its inception in the opening decades of the 20th century, when its cigar-addicted founder -- the son of a wool salesman from Galicia in Poland -- published his preposterous-sounding, sex-fixated theories about the baroque motives that lie behind observable human behavior, the mongrel of a discipline known as psychoanalysis was in a struggle for its life. A mixture of science, angst and imaginative reconstruction based on the often exotic symptomatology (including inexplicable paralyses and arcane fetishes) that plagued the patients who presented themselves at Sigmund Freud's gemutlich office at 19 Berggasse in Vienna, ''the talking cure'' was always the object of derision as much as of excitement. Karl Kraus, the scathing Viennese wit, was early to the name-calling, describing psychoanalysis as the disease it purports to cure. Sartre consigned to the dustbin of bad faith Freud's ''double-dealing'' division of the psychic whole into the ego and id. And Nabokov wrote off the whole business -- especially its erotic reductionism -- as ''mumbo-jumbo''; we must remember, Humbert Humbert sardonically points out, ''that a pistol is the Freudian symbol for the Ur-father's central forelimb.''
      The real blows to this hybrid enterprise, however, would come less from writers or cultural observers than from the relatively new academic disciplines of the philosophy and history of science. (As Frank Sulloway has noted with some dismay, ''to humanists, Freud is an epic poet and a hero of literature.'') Perhaps the most devastating assault was mounted in the 1960's by Karl Popper's gold standard for empirical verifiability. He posited that for a theory to be scientifically valid it had to be capable of being falsified. Since psychoanalysis depended for its lifeblood on inference from the patient's own subjective recounting of dreams, fantasies and childhood memories rather than empirical data, this criterion left a gaping hole in its very center. In other words, if no one could effectively disprove the Oedipal complex, then no one could effectively prove it. Or, as another critic, Frank Cioffi, saw it, the core problem was the field's underlying apriorism: ''What a psychoanalytic explanation tells us is itself.''
      In truth, the cultural status of psychoanalysis -- notwithstanding W. H. Auden's declaration in his 1939 poem, ''In Memory of Sigmund Freud,'' that the doctor's views, however faulty at times, had become ''a whole climate of opinion''- has always been shaky outside a coterie of true believers. So too have its vulnerabilities always been glaringly evident: For one thing, what, exactly, would a psychoanalytic cure look like? What signposts indicate that, as Freud famously put it, neurotic misery has been converted to ordinary unhappiness? Partly in response to external hostility and partly as a result of the paranoid, kingmaking tendencies of Freud himself, who in 1923 established a ''Secret Committee'' of the elect, complete with talismanic rings, zealous gatekeepers have vigilantly patrolled the property. All of this has presented difficulties to anyone wishing to document the movement's vertiginous, embattled history, though many have tried. Biographies of Freud and his circle abound, with a shelfload just on the women around him, including his sister-in-law and confidante, Minna Bernays (whose relationship with Freud has been subject to intense scrutiny by those convinced they were lovers), and his mother, whose death her ''goldener Sigi,'' by his own account, failed to grieve. Among the more specialized analyses are various attempts to take up the vexed issue of Freud's Jewish heritage, a subject that has found its most skewed presentation in a small book by Edward Said, ''Freud and the Non-European.'' Based on his reading of ''Moses and Monotheism,'' in which Freud ventured his belief that Moses was an Egyptian, Said argues that Freud would have been innately sympathetic to the plight of Palestinians. ''Secrets of the Soul'' offers itself as a comprehensive, nonpartisan corrective to this situation. A professor of history at the New School University, Zaretsky is the founder of the journal Socialist Review and has written a previous book on the effects of capitalism on private life. He has divided ''Secrets of the Soul'' -- the title derives from a 1926 film made by G. W. Pabst (the year before, Sam Goldwyn had offered Freud $100,000 to help think up ''a really great love story'') -- into three broadly thematic parts charting the rise and fall of the Freudian empire. These analyze, respectively, the ''charismatic origins'' of psychoanalysis; the global reach of the movement's influence as it took up increasingly charged social issues like homosexuality and feminism, and underwent changes through exposure to two world wars; and, finally, its heyday during the 50's, followed by the gradual fragmentation of its introspective ethos as it met up with 60's feel-goodism and the effort in the United States to legitimize the profession by medicalizing it.
      Zaretsky's structure intentionally ''mirrors the trajectory of the second industrial revolution'' (the first being the transition from an agricultural to a factory-based society), in its heyday in the 1860's and 70's, the years of Freud's childhood and youth. The second industrial revolution began with the ''Fordist'' (after Henry Ford) era -- a term Zaretsky confusingly invokes to describe both a mass-production economy and the human changes it brought about. It appeared, he writes, as a liberating force against the ''petty spite and brutal tyranny'' of the Victorian workplace, ushering in a rise in literacy, economic growth, political reform and technological innovation -- as well as new pressures exerted by a shift from the ideals of thrift and self-control toward the ''sexualized dream worlds'' of mass consumption.
      Similarly, the Freudian weltanschauung (which, as Zaretsky points out, refined and particularized the idea of an unconscious that had been floating around in amorphous form since medieval times, rather than discovering it) was a release from a moral definition of autonomy to a personal one. As such it was perfectly attuned to the tenor of the times, which was leading away from a 19th-century identification with the collective public sphere to a modernist focus on the private self. Fin-de-siecle Vienna was electric with the shock of the new post-Enlightenment thinking, much of it concerned with recasting hidebound notions of character, gender and sexuality. The groundwork for Freud's audacious theories had been laid by theorists like Havelock Ellis, Krafft-Ebing and especially Freud's mentor and eventual rival, the neurologist Wilhelm Fliess, whose ''Relations Between the Nose and Women's Sex Organs'' was published in 1897, two years before Freud's ''Interpretation of Dreams.'' But it was Freud, with his astonishing energy, shrewd instincts and imperial vision, who forged the scattered (and often scattershot) theories of like-minded colleagues into a radical movement. It offered secular salvation to the lost and credulous 20th-century traveler by suggesting that the way out of the existential woods was to retrace one's steps through the royal road of the unconscious and from there to a liberating self-discovery. Of course, in our age the triumph of the pharmaceutic has overtaken the triumph of the therapeutic; for all but a select few the cost-effective discussion of dosages has replaced the expensive discussions of dreams. And so the convictions of one era become the spurned beliefs of another.
      ''Secrets of the Soul'' is an unremittingly ambitious book, and reflects its author's Herculean immersion in an enormous amount of material. It is also, alas, marred by pedantic writing and infelicitous sociological jargon like ''the resanctification of domesticity grounded rationalization in the individual's life cycle.'' More troubling is that, for all its wide-ranging references and evenhanded sorting out of clashing views, Zaretsky's account is haunted by the ghosts of Max Weber and Antonio Gramsci as much as by those of Josef Breuer and Melanie Klein. The sometimes wandering narrative is constructed along lines that rarely deviate from the author's broader adherence to an implicitly economic, fundamentally Marxist understanding of world events.
      In the end, what is most interesting about ''Secrets of the Soul'' is its tone of reluctant elegy. The ambivalent emotions -- half-admiring, half-resistant -- that Freud inspired from the start are very much evident here, and they give Zaretsky's discussion a lively if somewhat congested quality of interior debate. He approaches his subject rather like a rueful coach eyeing a once-promising player now permanently sidelined. Psychoanalysis, he announces at the outset, was ''almost instantly recognized as a great force for human emancipation,'' only then to go on in the very next sentence to pronounce it ''a degraded profession, a pseudoscience whose survival is now very much in doubt.'' This ragingly paradoxical assessment is indicative, I think, of both the threat and the promise that the ''unmasking trend'' of psychoanalysis poses, with its ''systematic search,'' as Henri F. Ellenberger characterized it, ''for deception and self-deception and the uncovering of underlying truth.''
      So here's the $64,000 question: Is Freud ''no more,'' as Sergei Pankejeff, (a k a the Wolf Man, who was in treatment with him for five years and flitted in an out of analysis for the next 70) asserted when interviewed shortly before his death? (''In reality,'' Pankejeff said, ''the whole thing looks like a catastrophe. I am in the same state as when I first came to Freud.'') More to the point, does anyone care, or has the whole debate devolved into a Jewish joke: ''Oedipus, schmoedipus, what does it matter so long as the boy loves his mother?'' Certainly pyschoanalysis has ceased to arouse the passions it once did (except, perhaps, in its house organs and in the pages of the The New York Review of Books, where the latest fusillade from the arch anti-Freudian, Frederick Crews, targets Rorschach tests). Still, it bears noting that Freud is a canonical figure, up there with Darwin and Marx, whose influence pervades everyday discourse. (Not long ago, in an episode of the ghoulish ''Six Feet Under,'' one of the characters points out smugly to another that ''even funeral directors have to beware of transference.'') The continuing effort to reconceive him and his ''suave texts,'' as Crews snidely calls them, as literary masterpieces has been given fresh impetus by Penguin's new translations of the major works by non-analysts, with introductions by scholars from different fields.
      ''Pray don't think of me,'' the emotionally disabled Alice James wrote to her brother, the novelist Henry James, ''simply as a creature who might have been something else, had neurotic science been born.'' The problem as far as critics of the couch are concerned, of course, is not that she might have been different, but that she more than likely would have been exactly the same. But, as Janet Malcolm once quietly observed, people go into analysis because they are in pain. At its best, pyschoanalysis is about the art of listening, and perhaps James would have felt less alone with her pain. As for me, I wouldn't give up on the wily old witch-doctor just yet: psychoanalysis, having incorporated some of his ideas and rejected others, has in fact moved far beyond him, while neuroscience -- in the form of M.R.I. (or magnetic resonance imaging tests) evidence of unconscious mental processes -- has been confirming basic tenets of analytic thought. The final verdict is not in, and as one plain-spoken, assuredly un-Freudian thinker once said, ''It ain't over till it's over.''

Bryant Case Has Chilling Effect on Report of 'Acquaintance Rape'
Denise Lavoie, Associated Press- 9/5/2004

BOSTON -- In the 1970s, rape crisis counselors celebrated when states began to pass laws designed to stop lawyers from discrediting victims with salacious details about their sex lives. But three decades later, after all 50 states approved such rape shield laws, the Kobe Bryant case has shown that even those protections are not enough to prevent the most intimate details of an alleged victim's life from becoming public and sometimes even fair game for the trial.
      A series of courtroom blunders in the Bryant case led to the unintended public disclosure of the accuser's name and allegations about her sex life. Prosecutors dropped the case last week after the 20-year-old woman said she would no longer participate. "She was dragged through the mud publicly and through the Internet, through mistaken circulation by the court of her name and one-sided narratives about her sexual history," said Michelle Anderson, a law professor at Villanova University who specializes in rape law. "Rape victims fear that their sexual history will be put on trial, and this case, unfortunately, is not going to be encouraging," Anderson said.
      The accuser said Bryant raped her after the two met during a tour of the Colorado resort where she worked and ended up kissing in his room. She said the encounter turned violent and she told Bryant "no" at least twice. Bryant said the two had consensual sex.
      Under an exception to the Colorado rape shield law, the judge ruled that the defense would be allowed to present evidence about the woman's sexual activity in the three days surrounding the encounter. Bryant's defense claimed the woman had multiple sex partners in those days and suggested her injuries could have been caused during sex with someone other than Bryant. Details of those claims were inadvertently released to the media, making the woman's sex life a hot topic of talk radio and Web chat rooms.
      That kind of mistake could stop other rape victims from coming forward, advocates said. "The problem isn't necessarily what information is actually allowed to be brought into court -- the problem is other parts of the system that potentially allow for this to get out," said Sarah Graham Miller, a spokeswoman for the Rape, Abuse & Incest National Network. "In a lot of these high-profile cases, they are tried in the media and they are tried by people standing around water coolers," she said.
      Some advocacy groups said the judge's ruling allowing limited information about the woman's sex life was appropriate given the circumstances. At times, presenting information about the accuser's sexual history is essential to giving defendants a fair trial, some argue. "Everybody thinks that if you go into the sexual history of alleged victims, it is just to embarrass them, but the reason is that her state of mind is the issue in the case," said defense attorney Roy Black, who successfully defended William Kennedy-Smith against rape charges in 1991. "You've got to show something that bears upon her state of mind on the date in question," he said. "If her sexual history has no bearing on her consent, then it should be excluded."
      Susan Howley, director of public policy and victim services at the National Center for Victims of Crime, said the bigger problem evident in the Bryant case is the "continued public misunderstanding of the frequency and impact of acquaintance rape." "There's still a public reluctance to believe that a person can be raped by someone they know or someone they're on a date with," Howley said. "A lot of people believe at worst there was a miscommunication between the two people, not that the woman was raped."
      Miller, whose organization runs the national sex abuse hot line, said reporting of rape has been increasing in recent years. Currently, estimates suggest less than half, or about 40 percent of rape victims, report their attacks, but that is up from about 20 percent a decade ago, Miller said. But she said rape counselors are concerned that the Bryant case will set back efforts to make victims feel that if they report their rapes, their attackers will be brought to justice. "Victims have to believe the system is encouraging them to come forward, to go to the hospital and to prosecute their offenders," she said.

Indicting the Drug Industry's Practices
Janet Maslin, New York Times- 9/6/2004

Dr. Marcia Angell is a former editor in chief of The New England Journal of Medicine and spent two decades on the staff of that publication. If much of that time was devoted to reviewing papers on pharmacological research, it must have been spent in a state of near-apoplexy. Her new book is a scorching indictment of drug companies and their research and business practices. "Despite all its excesses, this is an important industry that should be saved - mainly from itself," she writes. This turns out to be one of her book's more forgiving pronouncements, since the rest of it is devoted to assertions of shady, misleading corporate behavior. If she is accurate in her assumptions about big drug companies' feistiness and tenacity, Dr. Angell is likely to be on the receiving end of angry rebuttals. She is sometimes vague enough to leave room for such attacks. ("I have heard that morale in some parts of the F.D.A. is extremely low, and I can certainly understand why it might be.") But over all, Dr. Angell's case is tough, persuasive and troubling. Arguing that in 1980 drug manufacturing changed from a good business into "a stupendous one," thanks to changes in government regulations. She adds, "Of the many events that contributed to their sudden great and good fortune, none had to do with the quality of the drugs the companies were selling."
      In the past, drug discoveries made through government research remained in the public domain. Beginning in 1980 those breakthroughs could be patented, even if their research was sponsored by the National Institutes of Health. As a consequence, Dr. Angell says, patent shenanigans have reshaped the drug business, as have the recent government regulations that expedite direct-to-consumer drug advertising. "Once upon a time, drug companies promoted drugs to treat diseases," Dr. Angell writes. "Now it is often the opposite. They promote diseases to fit their drugs."
      Consider the consumer who exclaims, in Dr. Angell's words, "Omigosh, this Clarinex ad makes me realize I have hay fever!" According to her book, this individual is being snookered in several ways. First of all, there is the drug itself: she calls Schering-Plough's Clarinex a "me too" variant of the same company's popular allergy drug Claritin. But Claritin's patent expired in 2002, so the new version has been heavily marketed. Dr. Angell maintains that while Claritin was approved as a hay fever remedy, Clarinex is an improvement only because it has been approved for the treatment of both indoor and outdoor allergies. "It was approved for the additional use only because the company decided to test it for that use," she says.
      And why all the advertising? "If prescription drugs are so good, why do they need to be pushed so hard?" she asks, citing Nexium, Lipitor and Paxil as other me-too products with whopping ad campaigns. As for Nexium, the new purple heartburn pill meant to replace Prilosec (which went off patent in 2001), Dr. Angell proposes a "big bang theory of Mom's cooking." She invites the reader to imagine a single, protean meal that has spun off "a seemingly inexhaustible supply of leftovers" in the form of renamed and repackaged versions of established drugs. "It wouldn't have done to call it 'Half-o'-Prilosec,' but that is what it was," she says about Nexium. "The big drug companies are competing not so much to find new drugs but for the limited number of drugs to license," she argues. The enormous research-and-development budgets that are invoked to justify high drug prices, she claims, also pay for questionable forms of education for doctors and all manner of barely concealed incentives for them to prescribe certain drugs. While much of this material is drawn from investigative reporting published in magazines and newspapers, Dr. Angell effectively heightens its impact by shaping it into one long, angry accusation.
      "The Truth About the Drug Companies" is unrelenting enough to sound scoldy and pedantic at times. (Dr. Angell is now a senior lecturer at Harvard Medical School.) And the book repeats certain complaints in ways indicative of padding. But Dr. Angell's overall questions about drug companies' finances, their influence on government regulation and their methods of testing new medicines are enhanced by her dogged, contentious tone. Though she proposes a list of changes at the book's end, in hopes of improving the way drug companies operate, her most-repeated suggestion is one of her most persuasive. Why, she asks, should new drugs be tested against placebos, and sometimes tested in such high doses that their effectiveness is guaranteed? Why shouldn't they be tested in equivalent doses against drugs that already exist - and already work?
      While awaiting the storm of rebuttal sure to greet Dr. Angell's version of the facts, her readers will be galvanized to look at the drug industry with closer scrutiny. Is the new pink and lavender pill called Sarafem really just Prozac in a different casing? Has the Eli Lilly company really tested it on children (one way of extending an exclusive patent) yet sold it as a remedy for premenstrual problems? And is erectile dysfunction actually caused by watching the Super Bowl, on the evidence of so many Viagra, Levitra and Cialis ads? In a book as alarming as Dr. Angell's, the last thought is what passes for a joke.

Sixth NYU Student in Year Commits Suicide
Associated Press, 9/6/2004

NEW YORK -- A 23-year-old graduate student at New York University jumped to her death Monday on campus, the sixth such death involving an NYU student in the past year. University spokesman Josh Taylor said the woman, a second-year graduate student at the school of performing and media arts, ``died as a result of an apparently intentional fall'' from the Tisch School of the Arts. Police identified her as Joann Mitchell Levy, 23. She lived with her parents nearby in Greenwich Village, police spokeswoman Detective Mindy Diaz said. The NYU community's ``deepest sympathies go out to the student's family and friends,'' Taylor said.
      Five other NYU students have jumped to their deaths in the past year, and the medical examiner ruled four of the deaths as suicides, Taylor said. The medical examiner ruled one death as accidental related to the student's use of hallucinogenic mushrooms. Two of the students jumped from the 10th floor of the university's Elmer Holmes Bobst Library. Three others jumped from apartment houses or other Manhattan buildings.
      ``The incidents of the past year have given us a lot of pause and time for reflection,'' Taylor said. ``While we'll never really know what causes someone to take an action like this, it's critical for members of the NYU community to remember that taking one's own life is never the right solution.''

Prozac Concerns Intensify
Liegh Hopper, Houston Chronicle- 9/6/2004

The fatal shooting last month of a Galveston doctor by his 10-year-old son, who was taking Prozac, is fueling ongoing concerns about the use of antidepressants by pediatric patients. Most medical experts don't believe antidepressants prompt violent acts. Rather, it's the brew of emotional difficulties prompting the prescription in the first place — plus access to a gun — that can boil over into a destructive act. "Children who are depressed can have violent impulses either self-directed or other-directed as symptoms of their difficulty," said Dr. Jon Sergeant, a psychiatrist for 25 years who heads child psychiatry at Ben Taub General Hospital. "To the best of anyone's knowledge, it doesn't look as though (antidepressants) in and of themselves make children act in a suicidal or violent way."
      The Aug. 27 death of Dr. Rick Lohstroh came at a time when the U.S. Food and Drug Administration was already re-examining antidepressant side effects in children. This month, the FDA will hold a public meeting to discuss the issue and take suggestions for labeling changes and possible regulatory actions. "The general clinical consensus is that the potential benefit of these medications far outweighs the risk," said Dr. David Fassler, a child psychiatrist at the University of Vermont. "There's still plenty we don't know."
      Prozac, introduced in 1987 as the first of a new generation of antidepressants, initially spawned worries about teenage suicide. Scientific studies ultimately dispelled those concerns, and last year, the FDA approved Prozac for use in children. Recent studies have shown that Prozac, combined with psychotherapy, produces the best chance of recovery for children with depression — better than either drugs or therapy alone. However, uncertainty persists about side effects in pediatric patients. No one knows the long-term effects of the drugs on a child's brain. In June 2003, a study of Paxil, a drug similar to Prozac, suggested an increased risk of suicidal thoughts in children compared with those taking a placebo.
      In March, the FDA issued a public health advisory asking antidepressant makers to warn users of the need to closely monitor for worsening depression or the emergency of suicidal behavior, particularly at the beginning of therapy or when a dose is increased or decreased. Prozac and nine other antidepressants known as SSRIs — or selective serotonin reuptake inhibitors — are the focus of the new warning. The FDA said anxiety, agitation, panic attacks, insomnia, irritability, hostility and impulsivity have been reported as side effects by adult and pediatric patients. The FDA hasn't concluded the drugs are to blame but said patients with these symptoms might be at increased risk for depression or suicidal behavior.
      Deborah Geisler, the 10-year-old boy's mother, said a psychiatrist prescribed Prozac for her son in early August after he was diagnosed with depression and anxiety. He started with a 10-milligram dose and gradually moved to higher doses. A week before the shooting, Geisler said, the boy started taking a once-a-week, time release dosage of 90 milligrams. He took his second 90-milligram pill just hours before the shooting, she said.
      Dr. Andrew Harper, an associate professor of child psychiatry at the University of Texas Medical School at Houston, said such a dose would be "reasonable" for an adult and probably appropriate for a child, although the long-acting form hasn't been well-studied in kids. Harper said drug side effects of hostility or impulsiveness most likely would result in verbal aggression or perhaps a thrown punch rather than a multi-step plan to use a gun. "I think it would be extremely rare," Harper said.
      Information about whether the boy was in psychotherapy was not available. Geisler and her ex-husband had gone through a contentious divorce, finalized last year, and the shooting occurred when the father arrived to pick up his sons. "An acrimonious divorce puts a lot of pressure on a child," said James Bray, a Baylor College of Medicine psychologist who focuses on children, stepfamilies and the issue of divorce. "If a child has emotional or behavioral problems prior to the divorce, that kind of stress can accentuate ... those sorts of issues."
      Experts highlight two safety recommendations for children beginning treatment for depression or anxiety: Make sure there is no access to firearms or to potentially lethal drugs. Prozac, Harper said, can strengthen children's resources and enable them to deal with troubling situations, but the drug won't prevent them from reacting to family stress. The drug will neither drive a child to use a gun nor stop a child who is planning to use a gun, he said.

Life for a 16-Year-Old After Sexual Assaults
Laura Potts, Detroit Free Press- 9/7/2004

She was 12 when she was raped by two men entrusted with her care: her father and her mother's boyfriend. She spoke up, and was locked up. Four years later, Ciera Parks of Detroit wishes she'd never told anyone about the sexual assaults. Maybe, she says, she would still be home with her mamma if she'd kept the painful episodes to herself. "It ain't my fault that I got raped at age 12," she sobbed recently, tugging at the black sweatshirt she's required to wear in the Wayne County Juvenile Detention Center. "Why they keep locking me up? I never committed no crime."
      In 2001, Ciera's father, Todd Stigall, 37, was convicted of one charge of second-degree criminal sexual conduct for which he served six months in the Wayne County Jail. He also was fined $495 for court costs and given three years of probation, which ended in March 2004. Jerry McGhee, LaShone Parks' boyfriend at the time who lived with the family, is serving five to 15 years at the Straits Correctional Facility in Kincheloe after being convicted of two counts of second-degree criminal sexual assault and one count of first-degree criminal sexual assault. McGhee, 53, also had felony firearms and armed robbery convictions, and is eligible for parole in 2006.
      Ciera, meanwhile, has been in and out of the detention facility, psychiatric hospitals, foster care and other placements since telling her mother and police about the assaults. She said she wants help dealing with the depression and anxiety attacks spurred by the attacks, but she wants to work on it at home, where she has a close relationship with her mother, younger sister and her mother's goddaughter. That's why she keeps running away from placements, and it's why she's again at the detention facility. "I never wanted to see this place again," the 16-year-old said in late August, a day after Wayne County sheriffs took her back to the facility she had been released from in April. It was the third time she was sent to the facility for running away or being involved in a fight when in placement.
      Parks said she originally started Ciera in counseling when she was 5 and diagnosed with Attention Deficit Hyperactive Disorder. The mother and daughter had ups and downs over the years, but it wasn't until they reported the rapes that Ciera was removed from the home by Child Protective Services workers, Parks said. "My daughter is locked up for something someone else did," Parks said. Protective services workers told Parks then that her one-bedroom house wasn't suitable for the family and placed Ciera with an aunt.
      She was then taken to Vista Maria, a Dearborn Heights residential treatment facility for abused, neglected and troubled girls. It was the beginning of years of running away, ending up in another placement and repeating the pattern. She also started cutting herself and threatened to kill herself. "She would cut herself real bad, and now she's got scars that won't go away," Parks said. "It hurts me to see that she puts that pain to her body like that. She's got to get some help."
      From July 2002 until September 2003, Ciera was at the Barat House,a Detroit residential facility where she and Parks said she made major strides toward recovery. "She got the support she needed there," said Parks, 36. "There she had all her counseling, she was able to deal with the rape. She needed to know that she was not the only one going through that."
      Parks said she completed parenting and anger-management classes and was participating in individual and family counseling with Ciera. She also found a house she hoped the protective services workers would consider suitable, but she said she hasn't been able to get them to do an inspection. When Ciera's caseworker determined she was doing well enough to move from the Barat House to a more independent foster care home, things fell apart again. Parks said Ciera didn't get the counseling or support she needed, and Ciera said she was threatened by her foster sister.
      In December, Ciera was sent to the detention facility, where she's become a regular face in the girls' mental health ward. A judge has ordered her there twice for running away from placements, including her most recent escape. This spring, Ciera was transferred from the facility to another home for girls in Redford. But after a month, she said she ran away because staff workers ignored her when she reported a fight and she was afraid of the other girls.
      Parks said she told Ciera's caseworker in May that her daughter had turned up at her home, and that she wanted to get her help. But, Parks said, nothing happened until the two officers picked up Ciera on Aug. 18 and took her back to the Wayne County Juvenile Detention Facility. "I haven't run away from home, I've run to home," Ciera said.
      At the facility, she has regular individual and group counseling, access to a psychiatrist and therapist, art therapy and other mental health care. But Ciera said she dreads it when the heavy steel door to her cell clanks shut and she's left alone, missing church, her friends and, especially, her family. "It hurts to see them walk out the door and you can't go with them," she said of her family's visits. "I missed all my teenage years being in the system."
      LaShone Parks wants Ciera back in her west-side home, where she said the girl was dealing with her depression and anxiety, playing catcher on a softball team, getting baptized, and preparing to start her senior year of high school. But because she ran away from her last placement, she'll remain in the detention facility until a judge determines where she's allowed to go next.
      Ciera, who said she loves school, is eager to start classes and get back to her church, God's House of Prayer on 25th Street in Detroit. She also lights up when she talks about following in the footsteps of a favorite cousin by going to college in Alabama, how proud she is of her 13-year-old sister and the comfort she gets from the church. "I really want to turn myself around to God," she said.
      But for now, Ciera waits to get out of lockup. Alone on the ward one day, she couldn't stop her tears. A worker wiped her face and smoothed her short hair. "You gotta think ahead," said Pam Kriss, a care worker with a mother's touch. "You're a hell of a girl, and I know you're going to be a hell of a woman. You just gotta stay strong."

Teen with History of Mental Illness Fights the Shadows
Laura Potts, Detroit Free Press- 9/7/2004

Monique Murray has never met her biological mother, but the two are never far apart. At 16, Monique struggles with the same anguish caused by schizophrenia that her birth mother has lived with for years, said Cynthia Hunter of Detroit, who is her legal guardian and who has raised Monique since infancy. The nightly terror of shadows and the daily torment of voices are the same things that drove Monique to hoard knives and shudder at things others can't see or hear.
      But Hunter has a better life planned for the teen she considers her own little girl, and she has spent years guiding Monique through the outdated public mental health system in hopes of helping Monique achieve her dreams. "I would like to see my daughter at peace, to put all these demons behind her," Hunter said.
      That's meant more than a decade of counseling and therapy, multiple stays in psychiatric hospitals, time in the Wayne County Juvenile Detention Facility's mental health ward and, finally, placement in the Adrian Training School, a youthful offender facility where she will stay until at least December. It's a familiar story for children with severe mental illness, such as schizophrenia, bipolar disorder or depression. Increasingly, experts say, those children are ending up in the juvenile justice system, where they finally get some kind of the treatment they need.
      A 2003 study by the President's New Freedom Commission on Mental Health found that 66 percent of boys and nearly 75 percent of girls in juvenile detention have at least one mental disorder. If they don't receive adequate, continual treatment, experts say, children with mental disorders may commit a crime or become a danger to themselves and others, forcing police to intervene.
      Advocates say most juvenile detention facilities lack good-quality mental health care and are more expensive than other treatment options. The cost of incarceration for one year can far exceed $35,000, according to the American Civil Liberties Union. The Adrian Training School, for example, costs $287 per day for each resident, and it's more than $300 at the Wayne County Juvenile Detention Facility. Outpatient community services such as therapy and social-skills training are much less expensive and enable children to get better in a familiar setting and with the support of family members, experts say.

Finding the right care
Susan McParland, executive director of the Michigan Association for Children with Emotional Disorders, has led the movement to get children with mental disorders out of detention facilities and into appropriate treatment. Her nonprofit organization, based in Southfield, recently started a project to push for reforms in Michigan's juvenile justice, mental health and public education systems. "Too many children are being detained and incarcerated because they exhibit behaviors linked to their illness that are mistaken for delinquent acts," McParland said. In fact, 36 percent of families surveyed by the National Alliance for the Mentally Ill reported their children were in the juvenile justice system because mental health services weren't available.
      That kind of "reliance on late-stage interventions is a pretty bad way to go," said Christopher Burley, deputy director of communications for the Bazelon Center for Mental Health Law, a Washington, D.C., advocacy organization for people with mental disabilities. "A lot of kids are needlessly going into crisis because the system just isn't geared to anything else," Burley said. "Every day that policymakers fail to act on this is another night that 2,000 kids across this country are going to bed in juvenile detention facilities because they can't find mental health services in the community."

Harder than it sounds
Hunter can attest to the difficulties of getting help for Monique, whom she took in as a infant. Monique born addicted to illegal drugs, and the girl's schizophrenic mother could not take care of her. Hunter knew from the start that she would have to be vigilant about Monique's fragile health. Like a colicky baby, Monique would "holler from sunup until sundown," eventually passing out, Hunter said. Nothing would appease her and Hunter, who gave birth to her first child soon after taking in Monique, was at a loss. Because of the in utero drug addiction, Monique also suffered physical problems, including hair and tooth loss. But when Hunter sought medical help, "they used to just throw your kids on Ritalin," she said.
      When Monique was 7, Hunter noticed her digging into her skin with a nail and rushed her to Aurora Healthcare, a Detroit psychiatric hospital, for help. During the next few years, Monique was in therapy several times a week and seemed to be making progress until the visual and auditory hallucinations started when she was a preteen. At 14, she was diagnosed with schizophrenia, Hunter said. Around that time, the family also started noticing kitchen knives disappearing, along with Hunter's diabetic supplies, such as needles. Searching Monique's bedroom, Hunter found the knives -- "three big ones and one little one" -- hidden under the bed. The knives, Monique told her mom, were for protection from the shadowy man she saw in the corner, who threatened to kill her and told her to harm others. "She shakes real bad when these voices bother her. She breaks into a cold sweat," Hunter said. "She might see shadows about four times a week, only at night, but during the day, she hears voices. We catch her talking to them. I'll see her lips moving."
      Hunter got Monique into residential treatment at Havenwyck Hospital in Auburn Hills, and, when the child got home, sharp objects were kept locked in the trunk of a car. Hunter would retrieve the knives each time she needed them, placing them back in the trunk when she was finished and sleeping with the car keys in her hand. Hunter also made sure Monique stayed on her medication to control the auditory and visual hallucinations, and moved her into a middle bedroom where street lights couldn't cause shadows at night.
      Through the years, Hunter attentively saw to Monique's counseling, medication and other needs, but "just when you get used to one therapist, because of a lack of funds, you're booted out the door," Hunter said. Because of Medicaid caps, Monique's treatment frequently was interrupted when benefits ran out. Later, when funding was re-established, Monique was often under the juristiction of another agency, which would refer her to a different therapist. Monique suffered from the disruptions, hesitating to open up to new therapists about her painful past, Hunter said. Each time she lost services because of funding, "they're introducing you to somebody else and she was tired of telling people the same thing over and over and over."
      Without the stability of regular mental health care, Monique's paranoia eventually turned into aggression. At home, she was becoming more unstable and violent, "flipping out and going after the whole house" with her fists, bricks or anything sharp she could get her hands on, Hunter said. Finally Hunter, who had always kept Monique's outbursts under control or taken her to psychiatric hospitals when needed, called the police. The then-15-year-old was charged with felonious assault and taken to the Wayne County Juvenile Detention Facility. "It took her almost to get a felony charge in order to get the proper help," Hunter said.
      Some experts say treatment in juvenile detention facilities, while not ideal, is better than nothing. "They're good services in the wrong place for a lot of kids," McParland said, noting that in Michigan, "Wayne County has gone the furthest in attempting to provide services for kids." The Wayne County Juvenile Detention Facility, near Greektown in downtown Detroit, holds 196 kids up to age 17. About 56 boys and girls are in its mental health wings. For the children -- most but not all of whom are accused of crimes -- it's often a revolving door, facility staffers said.
      Many of the children in the mental health wards aren't facing charges but are in the detention center on "courtesy holds," awaiting placement in foster care or other housing. If, while in a placement, the kids' "mental health needs were too severe to service them, they send them back to us," said Tisha Walt, senior psychologist at the facility. This is where Wayne County's most dangerous adolescents and those who have fallen through the system coexist, maintaining a strict regimen of school, meals, therapy and other supervised activities. They rarely go outside, and things such as television, mail and visits are closely monitored. "This is not where these children need to be," said Drucilla Wilson, the facility's quality assurance manager. "We're just glad that we have services available to them."
      McParland said, "Incarceration not only sends a negative message about the child's worth, it has horrible consequences. "Kids with mental illness or emotional disorders in these settings are very vulnerable to physical and sexual assaults, worsening of symptoms, and the suicide numbers are four times more than the general population of teens," McParland said.
      Despite the facility's prison-like appearance, many of the boys and girls in the mental health wings said they are content, or at least feel safe, in such a structured environment. For those whose chaotic lives had at times meant going hungry, being neglected or being the victims of violence, the facility offers a welcome stability while they work through their feelings in group and individual therapy. "These kids witness a lot -- shootings, abuse of their parents. It's not all biological; a lot of it's environmental," Walt said. Many of the detainees are "kids who are out there on the streets, running drugs, and you know what they like to do? They'll color in a coloring book or watch PG movies because they never got a chance to do that," Walt said.
      The staffers in the mental health wings are trained in basic psychology or child development, and the ratio of workers to residents is about 1-to-7, versus 1-to-10 in the general population, Wilson said. Still, Wilson said when the court determines it's time for a detainee to be released, "it just tears our hearts . . . because we don't have the authority to follow up with them" with appropriate mental health services. Depending on why they were detained, they're either sent to the adult prison system, to a supervised living situation or home on probation, and sometimes with a tether. But without reliable services on the outside, recidivism is high, Wilson and Walt said. "If we can get them back on the right track they can be contributing members of society," Walt said. "But you see the kids keep coming back and it can be disheartening." Parents "feel torn because they don't want to" have their kids incarcerated "but they don't want them running the streets," Walt said.
      After pleading guilty to the felonious assault charge in January, Monique was sent to the Adrian Training School with a judge's recommendation that she receive anger-management counseling, Hunter said. The medium-security facility for 12- to 20-year-olds has about 90 male and female residents who live and go to school and counseling on the campus, and sometimes do community service projects around Adrian, said Kate Hanley, interim director of the Bureau of Juvenile Justice at the Family Independence Agency. The Adrian facility has about 110 staffers, including a psychiatrist, psychologist and teachers, and, on average, the kids serve 9 months to a year in the facility before returning to the community, Hanley said. The only other such facility is in Escanaba, and both accept kids from all over Michigan.
      Hunter said Monique desperately wants to come home, and misses her parents and eight siblings, but she also knows she needs the help she gets at Adrian. She has good and bad days, but recently has had setbacks, Hunter said. It's difficult for Hunter, who doesn't have a car, to get to the facility about 75 miles from her east-side Detroit home. She said Monique's caseworker is supposed to drive her to Adrian every few weeks, but has only taken her once. A bus goes to Jackson for about $30 round trip, but then Hunter would have to take a taxi nearly 40 more miles to Adrian. With a household of young children, she can't afford the cost or the time away.
      The seperation is hurting Monique, Hunter said, and during a visit in early August, she showed her mom deep cuts she'd made in her arms. She's periodically in the suicide prevention unit. "She's under a lot of stress, and that's her way of relieving it," Hunter said of the self-mutilation. "I'm really worried about what's going to happen to her in there. She's getting worse because I can't see her."

The family suffers, too
The family also misses Monique, who is an engaging and loving big sister when she's medicated and feeling well, said Hunter, who plans birthday parties for all of her children. She never got to throw Monique's Sweet 16 party, nor does she get to take her shopping or hold her close when Monique hears voices that tell her to kill herself. "We haven't gotten to do any mother-daughter things since she was 13," Hunter said. "I'm not able to watch her grow up . . . through her teenage years. I break down, but I have to stay strong for my other kids." When she's at home, Monique creates elaborate meals, raps and writes poetry, Hunter said. She dotes on her younger siblings, whom she now sends video messages through Hunter's cell phone. Monique says she wants to go to culinary school when she gets older, but Hunter worries that there won't be a safety net for Monique's mental health needs. With Monique in Adrian, Hunter concedes, she can "still communicate with my child instead of seeing her in the grave." "She's mom's little girl no matter what."