Noteworthy News Articles on Mental Health Topics, October 1-8, 2005

There are "no famously sane poets," writes the British psychoanalyst Adam Phillips. He might have added that there are no famously sane mathematicians, few notoriously even-keeled guitarists. On the stage of our cultural history, "the sane don't have any memorable lines." So begins "Going Sane," Phillips's unraveling of sanity. This book, like previous ones such as "On Kissing, Tickling, and Being Bored," brings his original and accessible readings of psychoanalytic thought to bear on some unexamined phrases of daily life. Historically, he argues, sanity has been consigned to one of two fates: it's either been ignored because it's not dramatic enough (Hamlet gets all the good lines), or it's been written off by cultural critics (in a mad world, grumble malcontents from Rousseau to Foucault, only the crazy are authentic). Some of his categorical claims are inflated. Richard Ford's Frank Bascombe and Raymond Chandler's Philip Marlowe, for example, spring to mind as imaginatively sane literary characters. Nevertheless, his broad story of sanity's humble position in a madness-crazed culture is persuasive. We have detailed iconographies of insanity, but few compelling definitions of sanity.
       Phillips has inherited the tradition of psychoanalysts as philosophers of happiness. His lucid essays reveal a concrete hope that psychoanalytic insight might reduce human anguish. More is at stake, he believes, than just the definition of a single word. He fears that our reluctance to ask ourselves exactly what sanity means might be thwarting our attempts to attain it. The problem is our tendency to romanticize madness. The mad "have traditionally been idealized, if not glamorized, as inspired; as being in touch . . . with powers and forces and voices" otherwise reclusive. Sanity, on the other hand, is described -- when it is described at all -- as a matter of moderation, self-control and mechanical rationality. It's easy to absorb the lesson that the mad are idiosyncratic and complex while the sane are pedestrian. Sanity may represent our nominal ideal, but Sylvia Plath and John Nash are the box-office draws.
     Phillips thus suggests that the question "Why don't we talk about sanity?" is equivalent to "Why do we talk so much about madness?" His answer is deceptively simple: we find madness captivating because "it can refer to what we most treasure about ourselves, and to what most horrifies us about ourselves."
     "Going Sane" explores how our talk about madness embodies this ambivalence. For example, we use a lexicon of insanity to describe the appetites of infants, with their insatiable needs and aggression. Infantile madness is the inability to bear the frustration of unsatisfied desires. From childhood Phillips moves on to our sexual obsessions, another arena pervaded by insanity talk. The "madness of love" entails risks -- of encountering the forbidden, of being swept away by irrational lust -- that no "sane" person, i.e., someone who prizes security and the stable ego, would ever take. "Sane sex," he notes, "is a contradiction in terms." And he takes on three of the most faddish versions of contemporary insanity: autism, schizophrenia and depression. These diagnoses identify madness as the state of mind that doubts the ideals sane people take as self-evident. Autists and schizophrenics keep some distance from human relationships and shared meanings. Depressives lack desires, and thus can't always imagine why life might be worth living.
     In each of these cases, Phillips identifies how we've taken what could be normal psychological responses to our unpredictable lives, such as impulsiveness, risk taking, antisociability and malaise, and presented them only as pathological behaviors. We have deeply conflicted feelings, for example, about impulsivity: we want neither to be as impulsive as infants nor as measured (and uninteresting) as robots. We use madness, Phillips thinks, to hide this troubling ambivalence. Afraid of giving free rein to our impulses, we name rationality as a prevailing value of sanity and ascribe impulsiveness to madmen. Then we glorify these madmen, since they unhesitantly brandish what we've denied ourselves. We would like to have some of these "powers and forces and voices" back in our arsenal.
     Phillips proposes that if we stop disguising this natural ambivalence as madness, we might have a better chance of recovering these resources. We might, in turn, lead freer lives. He interprets every pathological symptom as a gambit, every disorder as a survival strategy that has outlived its usefulness and become destructive. A depressive response might be reasonable in adjusting to loss, for example, provided it's not allowed to metastasize into despondency. Mental health becomes less a matter of composure and more a matter of being open to any resource that might help us cope with difficulty. Sanity as it's been historically conceived "allows us neither our full range of emotional reactions to situations -- whether terror, bewilderment or ecstasy -- nor our most effective forms of self-protection against them." Phillips has ingeniously expanded sanity to include madness.
     This reclamation-by-expansion is a familiar trope for Phillips. So is his insistence that our linguistic practices -- in this case how we use the word "sanity" -- replace necessary ambivalence with confusing vagueness, and cause more suffering than they need to. In an earlier book, "On Flirtation," he similarly reinterpreted one word's role in our language game. Like madness, flirtation contains what we simultaneously dread and desire: in this case, uncertainty. We often dismiss flirtation as the saboteur of commitment, but Phillips suggests we diminish ourselves by doing so. Flirting with possibility is often just a way of reminding ourselves that we own our own decisions. By intensifying the feeling that we choose our commitments, uncertainty strengthens them. Phillips's airy linguistic treatments coalesce almost imperceptibly into practical hints: flirtatious behavior can deepen fidelity; it's appropriate to feel crazy sometimes. He's useful in a way that most philosophers rarely are.
     Although it's one of Phillips's finest and most broadly appealing books, "Going Sane" suffers from a curious repetitiveness. His other writing is economical to the point of aphorism, but here he overstates his case: sanity is "something we can't get excited about," it is "dull," "uninspired" and so on. And on. Phillips describes unconscious cunning so convincingly, however, it's hard to read him seriously and still interpret this tic as a mere error. What is it about sanity-as-blandness that made Phillips so defensive? Sanity is a goal of psychoanalysis. Phillips seems to fear that if we perceive sanity as uninspiring, we will perceive psychoanalysis as banalizing. Psychoanalysis, in this view, could strip us of our eccentricities and tailor us to the uniform requirements of sanity. But that fear makes sense only if we persist in portraying the sane as well-adjusted but boring. By redefining sanity as an ever-widening horizon of possibly successful behaviors, Phillips recoups peculiarity for sanity. His sanity is anything but boring.
     This defensiveness is thus unnecessary. Like the best of his writing, "Going Sane" begins with abstract semantics and ends with a specific tale of how we might be better off if we used some basic words in some different ways. With each new book, Phillips has made psychoanalytic thought livelier and more poetic than ever; he has nothing to apologize for.

Meet Robert. And Tommy And Bobby & Wanda
Michael Lemonick, Time Magazine- 10/6/2005

Back in 1990, Robert Oxnam was on top of the world. He had parlayed an academic career as a China scholar into the presidency of the prestigious Asia Society, the leading sponsor of cultural,
educational and artistic contact between the U.S. and Asia. And because the late '80s were a time of increasing political unrest in China--culminating in the 1989 Tiananmen Square massacre--Oxnam, now 62, was frequently tapped by political leaders to help them figure out how to deal with the Chinese. He even accompanied former President George H.W. Bush as an on-the-ground adviser on a goodwill trip to China in the late 1990s.
     At the same time, however, Oxnam's private life was falling apart. He suffered from alcoholism and bulimia and flew into frequent, irrational rages. Several nights a week, as he admits in his courageous new memoir, A Fractured Mind (Hyperion; 285 pages), he performed what he calls his addiction ritual. "It required;' he writes, "two packs of cigarettes, Polish sausage, a gallon of ice cream, a two-pound bag of peanuts, a bottle of scotch, and a pornographic movie
on the VCR."
     Then things got really bad. One day, what seemed like seconds after he had begun a session with his psychiatrist, Dr. Jeffrey Smith, the doctor informed his astonished patient that their time was up. "I spent this past 50 minutes;' he told Oxnam, "talking with ... Tommy. He's full of anger. And he's inside of you." In short, Smith explained, Oxnam was suffering from what used to be called multiple-personality disorder. (It's now known as dissociative identity disorder.) Like Sybil, the character in the 1970s book and TV movie, he had several independent identities--11 in all, he would eventually discover--some old, some young, some male, some female, many of them known to one another but not to the "real" Robert Oxnam.
     "It was just an utter shock, Oxnam tells TIME, "as if an earthquake had just hit. My second reaction was that this was hogwash. It had to be a doctor pulling a scam." Eventually he accepted the diagnosis, and Smith began teasing out the hidden personalities, helping Oxnam discover them one by one. In order to help others who might be suffering--and, says Oxnam, "to offer a look at the multiple nature that is in all of us"--he wrote A Fractured Mind. Unfortunately, the book dwells on Oxnam's personalities in excruciating detail, allowing each to speak with its own voice until the readers' eyes glaze over. It's like listening to a long, very complicated story involving people you have never met and cannot keep straight. There's Tommy and Robert and Wanda and Bobby and the Witch and the Librarian and Eyes, and they all live in the Castle, and ... you get the idea.
     Finally, to the relief of all, we meet Baby, who reveals that Oxnam was physically,verbally and sexually abused as a young child--the ultimate explanation for his later addictions and multiple identities. Indeed, experts in dissociative disorder believe that childhood abuse is often the reason behind multiple personalities. Says Smith: "When a child is in an unbearable situation, he or she can sometimes split off from that experience, leaving behind someone who's able to handle inhuman degrees of pain, and soon that part of the person's being takes on a personality of its own. Once that happens one time, it begins to be a preferred way of coping:" That is how, he explains, a new negative experience can give birth to a new personality.
     It sounds reasonable enough--but although dissociative identity disorder has an entry in the DSM-IV, psychology's official manual, it's still highly controversial. "I believe he believes he had all those separate personalities; says Joe Scroppo, a clinical psychologist and director of North Shore University Hospital's Forensic Psychiatry Program in Manhasset, N.Y, "but I don't think that's necessarily the way it is:" Studies have suggested that patients can be convinced that they have memories of childhood sexual abuse that never actually occurred. And sometimes, says Scroppo, therapists use multiple personality as a metaphor for a patient's mental state, and then the patient--and therapist--begin to mistake the metaphor for reality.
     Oxnam and Smith don't buy it. And whether or not Oxnam really was all those different people, his book is a brave effort to explain how a troubled man found a way to get better. He's already down from 11 personalities to three, he says, and they've hammered out a working relationship.

Wightman, of Hull, faces one count of practicing psychology without a license, six counts of filing false healthcare claims and insurance fraud, and 26 counts of larceny of more than $250, according to a Suffolk County grand jury indictment.

Wightman allegedly stole money from 26 patients and their families by enlisting them to sign on as patients under the false belief that she was a psychologist and had a doctorate, said Glenn Cunha, chief of the attorney general's insurance and unemployment fraud division.

''These people relied on that," he said of Wightman's credentials. ''They had children with some serious problems that needed attention and treatment from a professional who was licensed and educated as a psychologist."

Instead, they found out that Wightman has not received a doctoral degree in psychology as required by state law to practice, authorities said.

Twenty years ago, Wightman received a bachelor of arts degree from Emerson College and in 1996 a master's degree in counseling psychology from Lesley University. But according to officials, she allegedly paid $1,299 for a doctorate degree in psychology from Concordia College & University, an online institution based in the Republic of Dominica that is not recognized by Massachusetts.

Wightman, who has an unlisted phone number, could not be reached for comment yesterday.

Known as Boston adult-entertainment royalty, Wightman is a local legend.

In a 1993 interview with the Globe, Wightman said she came to Boston from Chicago at 18 and applied for a job at the Naked i club in the Combat Zone. She said a savvy club owner dubbed her Princess Cheyenne because of her exotic costumes, and soon Wightman became a Boston celebrity.

By the time she was 27, Wightman married, gave up stripping, and moved to a quiet street in Hanover where she worked as an athletic trainer. But she soon resumed stripping at the Foxy Lady, a club in Providence, according to the article. Eventually, she pursued other careers and interests, including counseling.

Five years ago, Wightman formed South Shore Psychology Associates in Hingham with a former schoolmate and held 99 percent interest in the company, according to the indictment. The company has since moved to a neighboring town.

Massachusetts law requires that psychologists earn a doctoral degree in psychology from a program recognized by the state and that they be licensed with the state Division of Professional Licensure. Wightman never applied for a license, state officials said.

Wightman has been ordered to stop practicing as a psychologist; however, she has continued to treat patients as a psychotherapist, a designation that does not require state licensure, officials said.

''In Massachusetts literally anyone can hang out a shingle and call themselves a psychotherapist," said Anne Collins, director of the Massachusetts Division of Professional Licensure.

Collins said her office first learned of Wightman after she was featured on a television newscast on FOX25 Undercover in February.

After that, calls flooded her office from patients accusing Wightman of unprofessional behavior and billing issues.

An investigation found that Wightman allegedly had met with patients, most of whom were children under 18, since 1998. The investigation also found that Wightman allegedly helped patients obtain reimbursement for her services from health insurance providers by fraudulently representing herself as a psychologist. She has been summonsed for arraignment Oct. 20.

Domestic Abuse Can Have Cultural Bent
Kayce T. Ataiyero, Chicago Tribune- 10/7/

While most abusive relationships share common issues of power and control, culture and religion can also play significant but often little understood roles in domestic abuse, says an activist who works with an immigrant community in Chicago.

Some abusers are skilled at using a person's immigration status as a weapon, threatening to turn them over to authorities or, in the case of a woman, to take their children, said Kiran Siddiqui, program director of Apna Ghar Inc., a domestic violence agency serving Asian women.

These abusers control their victims by withholding green cards or threatening to get them deported, said Siddiqui, who will speak Friday at Harper College in Palatine at "Not in My Neighborhood," a symposium on domestic violence.

Victims often stay with abusers because they see no other option, she said.

"They stay with the abusive relationship," she said. "It's the whole notion that no matter what, it is my responsibility to keep this family together."

The event, sponsored by the Family Violence Coordinating Council of the 3rd Municipal District of Cook County Circuit Court, is being held to mark Domestic Violence Prevention Month.

The program will explore the dynamics of domestic violence in various communities, cultures and religions as well as the barriers to violence prevention. It is geared toward law enforcement, community activists and social workers.

Kim Tasson, an event organizer who works for the Circuit Court, said the goal is to "educate the community on family violence and on resources for victims as well as abusers."

Keynote speaker Lydia Walker, an Arkansas-based domestic violence trainer, said it is important to include diversity in discussions about preventing domestic abuse.

"It is not just about understanding the function of powerlessness in our society but to get people who do this work to broaden their knowledge" and experience with a diverse population, she said.

Better cultural awareness will help law enforcement overcome the barriers that keep families from seeking help, she said.

Walker is a former steering committee member of the National Coalition Against Domestic Violence.

The symposium also will include discussions about domestic violence in the African-American, Latino, Polish and other communities.

Other issues will focus on the needs of some disabled populations.

Katy Yost, manager of independent living services for the Lake County Center for Independent Living in Mundelein, plans to discuss how officers should interact with deaf people so they can defuse a situation quickly and effectively.

Yost, who works with the deaf community, said officers should be mindful of the role of body language with deaf people.

"They may appear to be more agitated or visually responsive in a way that makes them appear more aggressive" than they are, she said.

Amy Rubin, national outreach manager for Jewish Women International, said that fundamentally, domestic abuse is the same across religions and cultures. The role of religious groups, she said, is to provide support for victims and counseling for abusers.

But Rubin said that response should be proactive, rather than occurring after someone has been abused.

"It is all about healthy relationships and healthy homes and strong, empowered people," she said. "We know that people are turning to the faith community. I think it is incumbent upon us to help build on all levels."


Just One Rule: Eat
Shari Roan, Los Angeles Times- 10/7/2005

By the spring of 2001, Chrissie Henneberg had become excessively thin, almost skeletal. But even as the pounds fell away — 35 in all — the once normal-weight teenager laced up her sneakers every day for a five-mile run.

She denied there was a problem. But her increasingly worried parents, who had been planning to send the 17-year-old to college in the fall, took her to a family doctor, then to a clinic specializing in eating disorders.

The news wasn't good. "They said she was severely anorexic and needed to go into the hospital right away," said her mother, Jeanne Moulton. "That was a real blow to us."

But, devastated though they were, the Palo Alto family did not embark on the traditional treatment for anorexia. That approach — lengthy psychotherapy that often views the family as a cause or contributor to the problem — entrusts patients to arrive at their own decisions. Instead, the family participated in a novel treatment that is gaining favor — and some criticism — across the country. Its early stage has a single goal: Get the kid to eat.

Already used at about half a dozen U.S. clinics, including a program at Stanford University, where Chrissie was treated, so-called family-based treatment casts no blame.

Parents, and even siblings, enter therapy with the patients, learning how to out-maneuver the attempts to avoid food. They prepare all meals for the patients, eat with them, cheer them on and work closely with therapists.

"The family has an integral role in the promotion of their daughter's recovery, and that is a real shift from before," says Dr. Jennifer Hagman, an eating disorders specialist at the Children's Hospital in Denver. "The family starts on Day 1 learning how to take care of their child."

Under the family-based approach, parents can inform the child that, if she cannot eat most of her food, she will have to consume a liquid supplement. Further, refusal to eat has consequences, such as not being allowed to attend a social event or return to school. Parents use social pressure too, by not allowing anyone, including siblings, to leave the table until the child with the eating disorder has eaten a sufficient amount.

"The rules were laid down. There was a diet and we had to follow it," Moulton recalls. "She was cooperative, but she was super sensitive about certain things."

Yearning to attend college in the fall, Chrissie frequently became frustrated with her parents' intensive management of her life and what she believed were insults.

"I remember one of the first days I was back from the hospital," says Chrissie, now 21 and a recent graduate of Pomona College. "I had prepared this big plate of food for dinner. My dad looked at it and said, 'You get to have a real feast.' To me, that was the most upsetting thing he could have said. It was like I was pigging out."

The summer was marked by occasional tears, accusations, tensions — and meals that took center stage. Gradually, the dedication paid off.

"I could see how much effort my parents were making," Chrissie says. "I guess that is the most important thing: I knew how much they were learning and how hard they were trying."

With Chrissie on her way to recovery, her parents kept up their end of the bargain, allowing her to go away to college while she continued therapy. She suffered no relapses and today considers herself healthy.

Hard-earned healing
Families who use the method admit it's not easy. But in the world of eating disorders, nothing is.

Such disorders include anorexia nervosa, in which a distorted body image leads a person to deliberately restrict food, and bulimia, in which an obsession with food causes cycles of bingeing and purging. Compulsive exercise is common in both syndromes.

The conditions affect an estimated 8 million Americans, men and women of all ages and races. But they occur most often in teenage girls.

The last few decades have produced only incremental advances in treating the disorders, which are among the most lethal of any psychiatric illness, experts say. An estimated 5% to 10% of anorexics eventually die as a result of the illness.

Recovery is hard-earned and relapse is common. Two-thirds of anorexics report their illness lasted more than five years, according to the National Assn. of Anorexia Nervosa and Associated Disorders, and only half consider themselves cured.
Chronic illness can result in a ruptured stomach; serious heart, kidney and liver damage; osteoporosis; tooth or gum erosion and esophageal tears. Deaths usually result from heart failure or suicide.

With little scientific evidence to show what works best, most therapists say they use a variety of treatments.

One approach includes individual psychotherapy to explore the possible causes of the disorder, such as anxiety about growing up, body changes associated with puberty and cultural pressures on girls to be thin.

Another traditional approach examines ways in which the family may be a factor, including unhealthy parent-child relationships, communication problems and conflict avoidance.

These approaches, though helpful to many patients, do not result in widespread success. And families of children with eating disorders often can't find treatment programs in their area or are turned away for lack of insurance or because of a long waiting list.

"What most of us get is really very crappy," says Laura Collins, a Virginia-based journalist who recently wrote a book about her experience with the new, family-focused approach. "Right now, it's like a 911 call and the first ambulance that comes, you take."

Unlike the traditional approaches, family-based therapy focuses almost exclusively on the symptoms of the disorder rather than the cause.

The method is universally known as the Maudsley approach, named after the renowned London hospital where it originated. It relies on weight gain and changing eating behavior by enlisting the family's help in managing the patient from meal to meal, day to day.

Collins and her husband discovered the approach on the Internet. At that point, she recalls, the family was desperate. Their 14-year-old daughter had suddenly refused almost all sustenance, losing 21 pounds in seven weeks.

Among the first four therapists the family contacted, two were not taking new patients, one did not return their calls and one didn't take their insurance.

They considered a hospital inpatient program two hours from their home but did an about-face on admission day when it became clear that the parents would be largely excluded from the therapy.

So the couple decided to treat her at home. They calibrated her meals to pack in the most calories possible. They sat at the table with her until she ate, sometimes remaining there for hours.

"It was hard to know when one meal ended and another began," Collins says.

Their daughter was not allowed to do anything or go anywhere until the meal was taken. She was not allowed to close the door to the bathroom, lest she force herself to vomit. Exercise was forbidden.

In private, the parents cried. But their daughter began to gain weight. She was physically stable after one month and back to her original weight after four months. It took several more months before she achieved a normal, healthy eating pattern, Collins says.

"It was the hardest thing I ever did, but I have no regrets," says Collins. "I compare it to the alternative of turning my child over to a stranger with uncertain results and at great expense."

Collins was aided by the book "Treatment Manual for Anorexia Nervosa: A Family-Based Approach," co-written by Dr. James Lock, director of the eating disorders program at Stanford's Lucile Salter Packard Children's Hospital. The book has become a bible for therapists who want to try the method.

Lock says he turned to the method when he grew frustrated over his patients' high relapse rate after hospitalization or an intensive outpatient program.

Moreover, Lock found that most studies of eating-disorder treatments were in adults — and the results weren't promising.

In one study of 21 anorexic girls conducted at the Maudsley Hospital, 90% of the patients treated with the method had a good outcome after one year compared with 18% of the patients who received individual therapy.
n a study published in January in the Journal of the American Academy of Child and Adolescent Psychiatry, Lock and Daniel le Grange, director of the eating disorders program at the University of Chicago Hospitals, found that after an average of 17 sessions, 56% of the anorexic patients receiving family-based therapy (the term they prefer) had a good outcome, 33% had an intermediate outcome and 11% had a poor outcome. The study consisted of 45 patients.

Turning parents into quasi-therapists has a practical side too. A two-week hospitalization for anorexia can easily cost $50,000, and insurance coverage varies widely.

Some insurance plans, experts say, will authorize hospitalization only when a patient reaches a precarious physical state. Others will cover only a limited number of outpatient therapy sessions.

"Parents are having to do this out of necessity," says Nancy Zucker, director of Duke University's Eating Disorders Program.

A promising method
The family-based approach has the best chance of success, experts say, when relatives work closely with a therapist and other professionals, such as a nutritionist.

Various clinics have adapted the method to their programs. Some begin with hospitalization; some include parent support groups.

At Children's Hospital in Denver, the program can begin during hospitalization. Parents, and even siblings, come to the hospital and eat every meal with the patient and the therapist.

Families are able to view how the therapist entices the patient to eat with encouragement and choices. ("You don't have to drink the milk, but you must drink something other than water.")

"We teach them how to make this dreaded experience tolerable," Hagman says. "But it's really a partnership instead of me telling them this is what you're going to do."

Parents in control
At Stanford, once a child begins therapy at home, Lock has the family bring in a typical dinner and eat with him in his office to see what they're eating and observe the interactions during the meal.

But in all the programs, control is only gradually ceded to the patient.

Families in the intensive first stage often must take time from work, enlist friends and relatives to help watch the patient and cancel virtually everything else in their lives for weeks or months.

Justin Roberts, now a 165-pound high school senior, weighed 87 pounds when he was hospitalized at Stanford four years ago. His heart rate was half of normal and doctors told the Roberts family that Justin was near death.

The eighth-grader had been struggling to eat normally for almost a year and, said his mother, Susan, "if you said anything to him about it, he'd go into a rage."

After a two-week hospitalization and 20-pound weight gain, the family was sent home with instructions on how to "re-feed8" Justin.

"Justin wanted to get better," Susan says. "I think he appreciated the fact that we were all in it together. It wasn't just about him. It was about all of us."

The family catered to his every dietary whim as long as it was about consuming food, not spurning it. "If he came downstairs and said, 'I feel like ice cream,' it was like, 'OK, we're there,' " Susan recalls.

The approach establishes the parents as the guardians of their child's health — a necessity when a child is critically ill, Lock says.

Under a more traditional approach to eating disorders, therapists are reluctant to impinge on a teenager's budding sense of autonomy.

"Silence gives this disorder a lot of power," Zucker says. "Parents fear saying the wrong thing. But that keeps you from saying, 'Did you eat today?' "

Not everyone is enamored of the family-based method. Some parents object to what they perceive as coercion of the child during the re-feeding stage, and Collins says some parents have accused her of force-feeding her child and of being abusive.

And many therapists simply doubt that parents can be reliable allies in the treatment process.

"Therapists cringe when they first hear about it because what many of us see in the trenches is that the parents are a huge problem," says Carolyn Costin, clinical director of Monte Nido, a Malibu treatment center. "The mother herself can't eat or the father has no relationship with the daughter."

Nicole M. Bourquin, a therapist in Lake Forest, says many parents are too busy to assist in their child's therapy.

"My experience is that the family dynamics are not healthy enough for that kind of pressure to be put on the parents or the child," she says. "What usually happens is the more pressure the parents add to the child, the worse off the kids are going to be."

Another frequent criticism of the method is that it doesn't analyze the root causes of the eating disorder.

"It relies on the fact that the underlying dynamics don't need to be worked out first. I don't think that's right in all cases," Costin says.

But Lock says parents can more easily help the child if they are absolved of blame.

"If you blame parents, they become isolated, withdrawn, ineffective and often feel incompetent," says Lock. "That isn't how you want any parent with a sick child to feel. You want them to feel helpful and like they are the agents for their child."


Early signs
Eating disorders often start with specific behaviors. A person may be developing a disorder if he or she:

•  Stops coming to dinner or skips breakfast, but always has an excuse.

•  Gradually eliminates more foods from his or her diet.

•  Is inflexible about eating, such as eating only certain foods or only at certain times of the day.

•  Withdraws from friends to avoid social gatherings that may include food or because of preoccupation with weight loss.

•  Becomes overextended with activities and always stressed out. (Eating disorders often occur in children who are top performers in a sport or at school.)

•  Makes excuses about not eating.

•  Has a tough time setting personal limits.

•  Is a perfectionist.

•  Tries to please everyone.

Source: National Eating Disorders Assn.

Resources
•  National Eating Disorders Assn.: The country's largest nonprofit organization on eating disorders supports research and advocacy, provides educational materials and support for families, and offers referrals for treatment. (800) 931-2237, http://www.NationalEatingDisorders.org .

•  National Assn. of Anorexia Nervosa and Associated Disorders: The nonprofit group provides information and lobbies for insurance parity and research on eating disorders. It also offers treatment referrals. (847) 831-3438, http://www.anad.org .

•  "Help Your Teenager Beat an Eating Disorder," by Dr. James Lock and Daniel le Grange. A book for parents on family-based treatment by doctors who are researching the method.

•  "Eating With Your Anorexic," by Laura Collins. A mother's first-person account of family-based treatment.

•  "Just a Little Too Thin," by Michael A. Strober and Meg Schneider. This book helps parents recognize the early signs of an eating disorder and what to do about it.

•  "I'm, Like, So Fat!," by Dianne Neumark-Sztainer. An eating disorders expert offers guidance for parents on helping teens make healthy choices about food.

Study: Married Women Have More Sexual Woes
Chicago Tribune, 10/8/2005

Married women are more likely to have sexual difficulties than single women or married men, according to a U.K. survey in the October issue of the medical journal Sexually Transmitted Infections.

Women were significantly more likely than men to say that over the past year they had experienced problems including lacking interest in sex, anxiety about performance, pain, and or inability to have an orgasm, according to the survey of 11,161 men and women 16 to 44 years of age from 1999 until 2001.

Sexual fulfillment is an important part of sexual health, said lead researcher Catherine Mercer, a physician at the Centre for Sexual Health and HIV Research at the University College in London. Many sexual problems stem from a lack of communication and child-care stress, and for men a history of physical problems, Mercer found.

"Understanding factors associated with reporting sexual problems and recognizing that such factors may be partnership specific is an important step towards improving our understanding of sexual function and thus improving the provision of care and support available," Mercer said in her study.

Married women and mothers with young children were more likely to report sexual problems, which also included trouble lubricating, than single women. Married or cohabiting men were significantly less likely to say they had sexual problems than single men, the study found.

Men reported problems with their sex lives, including trouble maintaining an erection, if they drank more than the recommended amount of alcohol or if within the past five years they had had a sexually transmitted disease, which may lead to pain, premature ejaculation or impotence, also called erectile dysfunction.

Women and men who reported a poor first experience were more likely to report problems, and those who felt they could not talk to their partner about sex were about twice as likely to report problems with their sex lives. Older age was also associated with reporting sex life problems for both men and women.

Pfizer Inc.'s Viagra, introduced in 1998, was the first drug to be approved for the treatment of sexual dysfunction in the U.S., where it today competes with products including Schering-Plough Corp. and GlaxoSmithKline PLC's Levitra and Eli Lilly & Co. and Icos Corp.'s Cialis (this sentence as published has been corrected in this text). More than 30 million men in the U.S. suffer from some type of erectile dysfunction, according to Bayer.

"Despite its prevalence, sexual dysfunction is often endured in silence," said David Goldmeier of the Jane Wandsworth Sexual Function Clinic at St. Mary's Hospital in London, in a written comment. "Studies suggest that as many as 54 percent of women and 35 percent of men have problems, but fewer than 11 percent of men and 21 percent of women seek help."