Noteworthy News Articles on Mental Health Topics, October 9-17, 2005
Clifford J. Levy, New York Times- 10/9/2005 In April, Kansas tightened its drunken-driving law. It was nothing surprising: since the days when Carry Nation took a hatchet to its speakeasies, the state has tended to have a low drinking rate and an even lower tolerance for the recklessly inebriated. Yet just a month later, the state relaxed its ban on the Sunday sale of liquor. In some parts, it is now as easy to buy a bottle of gin after church as a stick of butter. A Fast Track to Toilet Training for Those at the Crawling Stage Tina Kelley, New York Times- 10/9/2005 Hannah Rothstein, 7 months old, has double thighs and a dimpled bottom, but very svelte German underwear. She can still fit into her birth-to-3-month-old clothes because she lacks her peers' familiar bulge in the rear. She can sleep all night without a diaper. And during the day, every so often, after her mother, Melinda, of Newton, Mass., places her on a plastic potty and makes a little "pss-wss-wss" sound like the one used to call a cat, Hannah uses the toilet. For many parents in the United States, the idea of potty training before a baby is able to walk, or even before age 2, is not just horrifying but reprehensible -- a sure nightmare for parents and baby, not to mention a direct route from the crib to the psychiatrist's couch. But a growing number of parents are experimenting with infant potty training, seeing it as more sanitary, ecologically correct and likely to strengthen bonds between parent and child. About 2,000 people across the country have joined Internet groups and e-mail lists to learn more about the techniques of encouraging a baby -- too young to walk or talk -- to go in a toilet, a sink or a pot. Through a nonprofit group, Diaper Free Baby (www.diaperfreebaby.org), 77 local groups have formed in 35 states to encourage the practice. One author's how-to books on the subject have sold about 50,000 copies. "It's just so simple," said Lamelle Ryman, who recently attended a support meeting at an apartment on the Upper West Side. Ms. Ryman, the mother of 7-month-old Neshama, added, "I feel like it's been such a gift in our relationship." To be sure, adoption of the approach in the West is in its infant stage, so to speak. Moreover, the philosophy behind it flies in the face of Spock-influenced child-rearing. Dr. Benjamin Spock, the last word in child rearing for many American families through much of the 20th century, recommended against any training in the first year, believing that it could lead to rebellion later through bedwetting. Once, however, breastfeeding was also a rarity, until conversations among mothers, supported by medical research and encouragement from doctors, nurses and midwives, pushed it during the 1970's to the mainstream of child care practices, where it remains today. With early toilet training, there is a broad body of knowledge and experience to draw on. Parents in at least 75 countries, including India, Greenland, embrace the practice, with Chinese babies often wearing pants with split bottoms for easy squatting (available for $1 in Chinatown, according to savvy mothers in New York). Some parents who adopt children from other countries say they are startled to find that their babies arrive ready to use the toilet. More than 50 percent of the world's children are toilet trained by the time they turn 1, according to Contemporary Pediatrics magazine. From birth, the reasoning goes, infants are aware of their needs to eliminate, and although their muscles are not developed, they can soon learn to go on cue. Conversely, by relying on disposable diapers, modern parents are in effect teaching babies to ignore the signs that they have to go, making potty training at a later age more difficult. Ingrid Bauer, author of "Diaper Free! The Gentle Wisdom of Natural Infant Hygiene" (Natural Wisdom Press, 2001), believes it is easiest to begin toilet training in the first six months. To start, parents are taught to hold the baby by the thighs in a seated position against their stomachs and to make an encouraging hiss or grunt. With practice, parents learn their child's rhythms; some parents sleep next to their children and keep a potty at arm's reach, or diaper their babies overnight. For families who practice the technique, the advantages are many: savings in the cost of diapers, which can reach $3,000 a child; less guilt about contributing to the 22 billion disposable diapers that end up in landfills every year; no diaper rash, and a nursery that doesn't reek of diaper pail. They also note that age 2, a common age for toilet training, is a time of notorious willfulness and a terrible age to start teaching any child anything. Most important, they say, is an increased emotional bond with the baby, forged by the need for the parent to pick up on subtle signs and act on them quickly. Proponents of the practice use the phrase "elimination communication." "It is enhancing that interaction and closeness, the intimacy between baby and mother," said Thomas Ball, a psychologist in California who is helping develop a documentary about the technique. "Here's another set of cues the child is giving that may be ignored or may be responded to." Unquestionably, in a child-rearing culture that thrives on sanitation and parental convenience, the prospect of supervising 20 deposits a day in the first busy months of infancy is daunting. "It doesn't sound like anything I would ever even attempt to try," said Erinn Marchetti, who has two preschool-age children and was shopping recently at Toys "R" Us in Times Square. "It's hard enough when they're 2 and 3." Another mother in Toys "R" Us, who offered her opinion but wanted to remain anonymous, was aghast at the notion. "Have you read Freud?" she asked, worrying about the method's long-term effects. "I imagine it's going to come out in sexual ways." Dr. T. Berry Brazelton, the renowned child-rearing expert, said parents need not worry about psychologically damaging their child. Dr. Brazelton, author of "Toilet Training: The Brazelton Way" (Da Capo Press, 2004), has always advocated a child-centered approach to training: do it when a child is ready, without too much pushing or even encouraging. "I'm all for it, except I don't think many people can do it," he said of elimination communication. "The thing that bothers me about it is today, probably 80 percent of women don't have that kind of availability." He said he did wonder if children trained as infants would rebel against it later. "Are they going to run into some withholding afterward, when the child realizes, 'Hey, this wasn't up to me, this was up to my mommy and I'm not going to put up with it.' " As with breastfeeding, a turn toward infant potty training would represent a leap into the past. Before the 1800's, babies in Western societies were swaddled, which restrained them and contained their wastes, Laurie Boucke said in "Infant Potty Training" (White-Boucke Publishing, 2002), one of several books she has written that advocate the technique. When cleanliness became a virtue in the 19th century, Ms. Boucke wrote, infants were regularly held over a chamber pot until they learned the habit of using it. The American Academy of Pediatrics, in its current "Toilet Training" pamphlet, says children have no control over bladder or bowel movements when they are younger than a year and little control for six months afterward. "Even if you're getting them to go in a pot as a young infant, I don't know if it will have any long-term impact for all the effort you have to go through," said Dr. Mark Wolraich, author of the academy's "Guide to Toilet Training" (Bantam Books, 2003). "The risk is, if it's not working and the parents are frustrated, they're creating more negative interactions with their child." But parents of diaper-free babies said working with a child's signals is a rewarding and worthwhile experience. A mother in Medford, Mass., Sarabeth Matilsky, said elimination communication helped strengthen her bond with her son, Ben, who began using a potty when he was about 10 weeks old and who was colicky as an infant. "When I started doing this, I got to start seeing him as a little person with abilities," she said, noting that her son had become much happier after she learned to read his cues, and that he no longer cried before every diaper change. At two recent meetings of support groups, mothers and one father shared signals their babies gave: kicking, nose-rubbing, getting loud, getting quiet, hiccupping, feeling warm to the touch, shivering. Ms. Boucke, the author, noted that many fathers really enjoy infant potty training. "They can't breast-feed, but they can work on the other end," she said. "Some dads get really good results." She knows it can be challenging, she said. "I tell people, you cannot be a perfectionist with this," Ms. Boucke said. "No one is going to be there all the time. They won't have a life." Benedict Carey & Dan Hurley, New York Times- 10/11/2005 In a drama worthy of a field that thrives on conflict, a bitter feud has erupted between Albert Ellis, one of the most provocative and influential figures in modern psychology, and the Upper East Side psychotherapy institute he founded almost a half-century ago. Dr. Ellis, 92, has filed a lawsuit against the Albert Ellis Institute, after the institute kicked him off its board of directors and canceled his popular Friday evening seminars. Dr. Ellis and his defenders claim that the nonprofit institute has fallen into the hands of psychologists who are moving it away from the revolutionary therapy techniques pioneered by Dr. Ellis in the 1960's and 1970's. The lawsuit, reported on Sunday by The New York Post, charges that the board acted improperly in removing Dr. Ellis and seeks his reinstatement, as well as unspecified damages. But Daniel Kurtz, a lawyer for the institute, said that the board acted out of economic necessity: payouts to Dr. Ellis for medical and other expenses were jeopardizing the institute's tax-exempt status and its viability, he said. Dr. Ellis, who lives above the institute on East 65th Street, has been in declining health since an infection that nearly killed him several years ago and has daily nursing care. In the last year, the dispute has turned personal. Some board members have said they were uncomfortable with Dr. Ellis's confrontational style and eccentricities, and saw him as a liability, said Andy Hopson, a volunteer consultant hired by the institute at Dr. Ellis's urging. And some of Dr. Ellis's supporters have hinted that the institute's current managers are little more than overpaid self-promoters, intent on turning the institute into an outlet for pop psychology in the style of Dr. Phil, according to Mike Abrams, a psychologist in private practice in New Jersey who has worked with Dr. Ellis. The board also fired Dr. Ellis's assistant, whom he has now married, a fact that he has interpreted as additional evidence of personal animosity on the part of board members. In an interview from his bedside yesterday, Dr. Ellis said that neither money nor his health was the most important issue in the dispute. It is natural for any psychological institute to change and adapt with the times, he said, "but it's unusual for them to change and go completely against the main principles" of its founder "and still call it the Albert Ellis Institute, and say they're doing the therapy, which they are not." The history of psychology is replete with personality clashes between charismatic gurus and their students, perhaps the most famous being the break between Sigmund Freud and his disciples Carl Jung and Alfred Adler in the early 1900's. But historians say that the current quarrel is unusual, given the relationship between Dr. Ellis and the institute. "I can't think of anything else where somebody had a theory and a practice and an institute in their name and that there was a coup going on internally over it," said David Baker, a professor of psychology at the University of Akron and director of the Archives of the History of American Psychology there. "This sounds nasty." Dr. Baker said of Dr. Ellis: "He's always been provocative. He may not be willing to change with the times, and the times change -- that's something we know from the lessons of history." In a typical Friday evening session, Dr. Ellis -- stooped in recent years, with a wisp of white hair and large black glasses -- would advise, cajole and entertain groups of 100 or more students, psychologists and others looking for answers, often lacing his comments with obscenities for effect. "Do you know why your family is trying to control you?" he barked at one attendee at a seminar last year. "Because they're out of their minds!" Most therapists thought Dr. Ellis was off-track when he founded the institute in 1959 and used it as a platform to promote a revolution in psychotherapy. At the time, psychotherapy drew its methods and inspiration from Freudian theory, which held that mental distress could be traced to unconscious conflicts rooted in early childhood. In a radical departure, Dr. Ellis insisted that therapists spend less time probing distant childhood experiences and concentrate instead on what was happening in people's lives at the moment. In his own practice, he had observed that people's conscious personal philosophies and beliefs -- the need to be appreciated, the fear of never finding anyone to love -- often drove them to despair and distraction. Dr. Ellis devised a method for exposing and defusing these habits, called rational emotive behavior therapy. Around the same time, a psychiatrist, Dr. Aaron Beck, now at the University of Pennsylvania, developed similar techniques, and the two men are considered the fathers of cognitive behavior therapy. Subsequent research has shown that the therapy is as effective as medication -- and sometimes more so -- in treating depression, relieving anxiety and ameliorating other types of distress. Dr. Ellis was a board member at the institute for 46 years and hired most of its employees. But his personal style began to wear on some in management years ago, according to psychologists who have worked at the clinic. "I have worked with Dr. Ellis for years, and truly he is a first-class genius," Dr. Abrams said, "but that genius does not cross into every domain, and management is not his strength. I've told him that to his face." By early 2004, with Dr. Ellis in declining health, the board began to negotiate with him about his future role at the institute, Mr. Kurtz said. The two sides could not come to agreement about Dr. Ellis's payment or title, Mr. Kurtz said, and in July, institute officials canceled the Friday evening sessions that had been a staple there for 30 years. Dr. Ellis's lawyer, Michael de Leeuw, said: "Either these people really believe he is losing it, which he is not -- in which case their lack of sympathy and fairness is appalling -- or it's a palace coup. "They have created a lot of animus. It's not what anyone would want to do to a guy who's 92 and the founder of a major school of psychology, especially one from whom they have all been directly enriched." Mr. Kurtz said that the board's action in no way challenged the importance of Dr. Ellis's contributions but that those contributions were ultimately irrelevant to the ouster. "We had someone who was working part time by any standard and who received financial benefits in the range of $500,000 to $600,000; it was just an outrageous situation," he said, referring mostly to medical benefits. Mr. Kurtz, an expert in the laws governing nonprofits, said that in the nonprofit world, "there's something called founder's syndrome, and this is an extreme case of that: he sees this as something he can use as he wishes, and he can't." Michael Broder, the director of the Institute, said yesterday that the action by the board was not personal and was within the law. Dr. Ellis's lawyers responded that Dr. Broder himself earned more than $200,000 last year and that Dr. Ellis's expenses were legitimate, especially given his modest salary -- less than $50,000 a year -- and his years of devotion to the institute. Mr. Hopson said that the personal friction between Dr. Ellis and top managers was evident. "It became apparent to me very quickly in my interviewing process that the relationship between Dr. Broder and Dr. Ellis was tenuous at best," he said. "Dr. Ellis didn't trust Dr. Broder and was frustrated that even though he was president of the board, Dr. Broder often ignored his directives." Mr. Hopson said that Dr. Ellis also believed that Dr. Broder was manipulating the board. "He frequently lamented to me that he didn't trust Dr. Broder," Mr. Hopson said. In his new identity as a therapist unaffiliated with the Albert Ellis Institute, Dr. Ellis said he has been seeing a few clients. He said he does not hate those who removed him from the institute, nor is he angry about it. "I think it's unfair, but they have the right as fallible, screwed-up humans to be unfair, that's the human condition," he said. Special Forces Suicides Raise Questions DENVER -- Chief Warrant Officer William Howell was a 15-year Army Special Forces veteran who had seen combat duty all over the world. Sgt. 1st Class Andre McDaniel was a military accountant. Spc. Jeremy Wilson repaired electronics. Others are not so sure. Steve Robinson, a former Army Ranger and veterans' advocate, said he suspects there were problems in the men's unit -- namely, a macho refusal to acknowledge stress and seek help. "It could be that there's a climate there that creates the stigma which prevents people from coming forward," said Robinson, executive director of the National Gulf War Resource Center. "The mentality of this particular group seemed to be `Ignore what you think and feel and keep doing your job and don't talk to me about that (expletive) combat stress reaction stuff.'" Special Forces soldiers specialize in what the Army calls "unconventional warfare"--commando raids, search-and-destroy missions, intelligence gathering. They go through specialized psychological screening. They also undergo rigorous physical training and learn survival techniques and other skills, including foreign languages. Howell, 36, a father of three, shot himself March 14, 2004 -- three weeks after returning from Iraq -- after hitting and threatening to kill his wife, Laura. She said she did not see any warning signs until the night he threatened her. "You look back every day and think what could I have done different. I can't think of anything," she said. She said she did not know of any connection between her husband and the two other soldiers, and did not know them or their families. But she agreed with Robinson that Special Forces soldiers might have a more difficult time than other military personnel overcoming the stigma associated with seeking counseling. "My husband would probably see getting help as a weakness," she said. "Even as mature and old and experienced as he was, he may look at it as `I can handle it, it's not that bad.'" Special Forces officials said the Colorado-based unit experienced heavy combat in Iraq. Two members were killed in the first half of 2004 -- one by a roadside bomb, another in a vehicle rollover. Another member, former Staff Sgt. Georg-Andreas Pogany, was sent home and charged with cowardice when the sight of the mangled body of an Iraqi caused a panic attack and prompted him to ask for psychological help. Charges against Pogany were later dropped, and he received a medical discharge. Staff Sgt. Kyle Cosner, spokesman for the 10th Special Forces Group, declined to comment. Grant said unit morale appears high because the unit's soldiers re-enlist at a rate that is among the highest in the command. She also said chaplains trained in counseling and suicide intervention are available to members of the 10th Special Forces Group and their families, and every Army unit's commanders are required to provide regular suicide prevention training. The Army says its overall suicide rate in 2003 was 12.8 per 100,000 active-duty soldiers, while the rate in the general U.S. population was 10.5 per 100,000, according to the Centers for Disease Control and Prevention. Military officials contend the 2003 figure for the Army was skewed by a spike in suicides among soldiers in Iraq and Kuwait; the 2004 rate was 11 per 100,000, Army spokeswoman Maj. Elizabeth Robbins said. An Army surgeon general's report said the suicide rate among soldiers sent to Iraq and Kuwait in 2004 was 8.5 per 100,000. The Army has learned much about mental health in recent years and is working to improve treatment and ease soldiers' reluctance to seeking help, Robbins said. Robinson has been pushing military leaders to stop using paper questionnaires to screen for problems among returning soldiers and switch to face-to-face meetings with mental health professionals. "There have been improvements, but it's been like pulling teeth from a lion's mouth to get the Department of Defense to do things they're not willing to do because of the dollars," he said. Laura Howell said she blamed Lariam, an Army-issued anti-malaria drug, for her husband's suicide. The drug's manufacturer, Roche Pharmaceuticals, says side effects can include anxiety, paranoia, depression, hallucinations and psychotic behavior. Pogany, the soldier unhinged by the sight of a mangled corpse, also believes the drug played a role in his case. Roche and the military maintain the drug is safe, and it is among the drugs recommended by the CDC for preventing and treating malaria. Wilson, 23, hanged himself in the post barracks July 9, about a month after returning from Iraq. The Associated Press was unable to find members of his family. McDaniel, 40, a father of two, shot himself in August 2004, six weeks after he returned from Iraq. He had recently been arrested for allegedly arranging to have sex with an undercover officer who had posed on the Internet as a 13-year-old girl. Meth Threat In Connecticut Described Gregory Seay, Hartford Courant- 10/12/2005 David Parnell once personified the worst of methamphetamine addiction. High on the stimulant, he mentally and physically abused his second wife and tormented their children. Paranoia led Parnell to shoot holes in the walls of his home and to stalk his postal carrier with a gun, thinking the mailman was an undercover agent. Hopeless from a 23-year drug addiction that began with marijuana, Parnell blew his face apart with a rifle. Rather than ending his life, the shot put him on the road to recovery and launched his personal crusade to end the nationwide meth problem, one that threatens Connecticut. Parnell, 38, a former drug dealer from Martin, Tenn., shared his testimony Tuesday in Hartford with a panel of state officials from law and drug enforcement and treatment, environmental protection and public health and welfare. The drug is making inroads into the state, according to a three-year survey by the Hispanic Health Council released Tuesday at the symposium. The Hartford-based council's study found that meth availability and abuse is growing in Hartford and suburbs such as Glastonbury and West Hartford. "If they get ahead of it now, they'll never end up like Tennessee, in the top five for manufacture of methamphetamine," Parnell said. "They talk that you've already found four labs. I really believe that if they find one, they've missed 10." Chief State's Attorney Christopher Morano moderated the two-hour symposium at the Legislative Office Building to educate state officials about the meth threat and to consider ways to confront it. Morano and other state officials agreed that the best weapon against meth would be a coordinated effort centered on arrests, prison time, prevention and treatment. Also, state officials said, changes in public policy should be considered. Foremost, Morano said, "is limiting the precursor ingredients - the pseudoephedrine." Morano gave a slide show depicting the drop in meth lab seizures in Oklahoma, Iowa and Tennessee after those states enacted laws banning over-the-counter sales of cold remedies containing the ingredient that gets meth users high. Thirty-seven states now limit retail sales of pseudoephedrine. Connecticut failed last year to adopt a similar proposal. "If we can control that, we can control one of the key collateral problems," Morano said. Morano and his committee of agencies - including the departments of public safety, public health, environmental protection, consumer protection, mental health and addiction services, children and families and the state child advocate - will formulate a list of recommendations. The recommendations will be presented to Gov. M. Jodi Rell by early November, he said. Evidence is mounting that Connecticut's encounters with meth are increasing. Aside from the bust of two East Hampton meth labs and one in New Fairfield this year, the Hispanic Health Council survey has found use growing in the state. The health council, with funding from the federal Centers for Disease Control and Prevention, tracked a diverse population of about 240 drug users annually on Hartford streets, starting in 2003. Based on ongoing interviews with participants and other sources, meth use is growing and the drug is easier to get, said Merrill Singer, the survey's chief investigator. Less than a year ago, users reported meth was hard to get in Hartford, requiring a trip to New Haven or New York City, Singer said. In recent months, meth users say, it "would only take one phone call" or a visit to a Hartford home or club to score the drug, he said. Moreover, respondents claimed they could get meth in some of the city's suburbs, namely West Hartford and Glastonbury. One sign that there is a gap between demand and availability is that users say the street price of meth remains steep. New Haven Police Chief Francisco Ortiz said Tuesday's session was an eye-opener, and that he will share what he learned with his patrol and narcotics commanders and fellow police chiefs. He said he was encouraged that the meth problem is not viewed solely as a law enforcement issue, but as a public-health threat. "This is dynamite in more ways than one," Ortiz said. When a Spiritual Search Turns into a Compulsion Tom Dunkel, Baltimore Sun- 10/12/2005 Show me, Lord, where I can obtain help: and if I have to follow a little dog to obtain the cure I need, I am ready to do just that. A troubled Inigo de Loyola — founder of the Jesuit order, a man whose unquestionably pure heart eventually earned him canonization as St. Ignatius Loyola — wrote those words more than 450 years ago. Surprisingly, he was racked by fears of spiritual unworthiness, to the point of contemplating suicide. Were he alive now, Loyola might be diagnosed as having scrupulosity, a little-known, narrowly targeted obsessive-compulsive disorder in which individuals are consumed by religious and moral fervor. Today, however, Loyola wouldn't have to search far for help. In fact, he could find it at the institution that bears his name. Joseph Ciarrocchi, a priest turned clinical psychologist, is head of the pastoral counseling department at Loyola College in Maryland. He's also author of "The Doubting Disease," published in 1995 and widely regarded as the first practical guide to scrupulosity. "It's unbelievable what people suffer in private," Ciarrocchi says, "and to all outward appearances, they're functioning." St. Ignatius repeatedly attended confession, repenting the same sins over and over. (Martin Luther, likewise presumed to have had scrupulosity, did the same thing to try to soothe his perpetually uneasy conscience.) Ciarrocchi has had patients who spend as much as 12 hours a day praying. He says he once treated a Third World-based priest who, after conducting his weekly outdoor Mass, would crawl on the ground searching for slivers of Communion wafer. In his mind, a priest had to be perfectly fastidious about discharging his holy responsibilities or else risk the wrath of God. An estimated 1% to 3% of Americans wrestle with obsessive-compulsive disorder, according to the National Institute of Mental Health. Abnormalities in the brain's production of the chemical serotonin are known factors. Genetic and environmental causes also are suspected to come into play. Most people with obsessive-compulsive disorder exhibit symptoms such as continual hand-washing, hoarding, and constant checking of doors, locks and appliances. These behaviors have been given exposure in the TV show "Monk," about a detective with the condition, and movies such as "The Aviator," based on the life and compulsions of billionaire Howard Hughes. For a smaller minority, however, the disorder manifests itself as scrupulosity, body dysmorphic disorder (preoccupation with one's physical appearance), olfactory reference syndrome (body odor paranoia) or less-common phobias. "Like all OCD behaviors there's a spectrum of severity," says Bruce Hyman, a psychotherapist in Hollywood, Fla., and co-author of "The OCD Workbook: Your Guide to Breaking Free From Obsessive-Compulsive Disorder." Hyman considers scrupulosity to be one of six basic obsessive-compulsive types, but adds that it's comparatively rare. "I may get two cases a year," he says. "For a guy who sees almost exclusively patients with OCD, that's a very small number." Charles Mansueto is director of the Behavior Therapy Center of Greater Washington in Silver Spring, Md. The center has treated thousands of obsessive-compulsive patients, and Mansueto estimates that about one in 50 are cases in which scrupulosity is the dominant symptom. "Many people who are scrupulous have a notion that they're being watched," he says, "and one false move, it's curtains." He recalls an Orthodox Jewish teenager who made so many promises to God — to drink only so many sodas a day, to visit 7-Eleven only so many times a week, to never switch radio stations midsong — that keeping track of them got logistically impossible. It became debilitating. "He couldn't move," Mansueto says. "He literally couldn't get out of his chair." A few years of psychotherapy helped. So did a mock cleansing ritual Mansueto arranged with the boy's rabbi that absolved him of having to adhere to all those tangled promises. "I went to that young man's wedding and know his children," Mansueto adds. "He's light years away from where he was when he was in the depths." People with this type of disorder are among the least-likely obsessive-compulsive sufferers to get treatment. It's often difficult for them, as well as friends and relatives, to know where the line is separating extreme piety from obsessive ritual. In addition, the disorder still carries a social stigma. Some patients undergo therapy for years before they feel comfortable revealing their secrets regarding the condition, according to Dr. Gerald Nestadt, professor of psychiatry at the Johns Hopkins School of Medicine. "Without question," Nestadt says, "people will tell you about their sex lives or criminal behavior before they'll tell you about their OCD symptoms." Scrupulosity probably dates to the 9th or 10th century as an identifiable — although at the time unnamed — condition. Loyola's Ciarrocchi notes this is when the Catholic Church instituted confessions. Priests, as a result, had occasion to come into contact with hyper-confessors. Nowadays, Ciarrocchi says, scrupulosity is commonly encountered in adolescents who are in the process of developing moral and religious values, and in adult converts newly infused with spiritual beliefs. A 28-year-old firefighter in the Washington area falls into the latter category. The man, who requested anonymity, was raised a non-practicing Jew, but became a Christian about 10 years ago while serving in the Air Force. The first five months of his new life were blissful. Then he became increasingly scrupulous. He would retreat into his room for hours at a time, memorizing about 300 Bible verses word for word. He'd dissect church sermons and agonize over his prospects of salvation. " 'Do you really think I'm saved?' He'd probably ask me that 10 times a day," his wife says. "It became a huge tormenting thing for me," he says. "I started fearing I was never converted or saved. I would have blasphemous thoughts, cursing God in my mind. I'd have to pray to get rid of it." A pastor recommended counseling, and after two years, it is working. "Even though it's still a struggle for me, now I realize it's a disease," he says. The standard modes of intervention are medication — antidepressants such as Zoloft and Paxil are often prescribed — and cognitive-behavior therapy, in which patients learn to manage their impulses through graduated, controlled exposure. "You want to accept the intrusive thought," Ciarrocchi says, "but reject the compulsion." Treatment has about a 60% success rate, experts say. That doesn't mean obsessive-compulsives will be cured. But they can gain control of their illness. "It's important to teach them strategy," Ciarrocchi says. "You're only going to be in therapy a limited time, but OCD is for life." Understanding scrupulosity Obsessive-compulsive disorder is estimated to occur in 1% to 3% of the population, about the same incidence as schizophrenia. Scrupulosity is a form of obsessive-compulsive disorder in which people become preoccupied with religious and moral behavior, often lapsing into eccentric rituals. For more information, consult these sources: • Obsessive-Compulsive Foundation: (203) 401-2070 or http://www.ocfoundation.org . • Anxiety Disorders Assn. of America: (240) 485-1001 or http://www.adaa.org . • The Scrupe Group, a self-help Web community devoted to scrupulosity: groups.yahoo.com/group/the_scrupe_group. Va. Violent Deaths Are Mostly Suicides Jamie Stockwell, Washington Post- 10/12/2005
Longtime nurse examiners praised Madigan's efforts. "We're finally seeing the light at the end of the tunnel," said Sharon Dimitrijevich, program director for Lake County SANEs and ER director at Midwestern Regional Medical Center in Zion. "Those of us who have been at it a long time have always felt like we've been solo. But we don't feel like that anymore." Nurse examiners have been around since the late 1970s, but the first pilot programs in Illinois began in 1999, putting the state well behind some others, including Indiana and Texas. Experts estimate there are 200 to 300 registered nurses in Illinois who have gone through SANE training, but no one has an exact number of how many are practicing. The International Association of Forensic Nurses lists 27 nurses in the state certified as adult- and adolescent-care sex-assault examiners, but certification is a relatively new process and not required by the state. With no statewide coordination, SANE programs in Illinois have been scattershot. Some counties, such as Lake, Kane, DuPage and several Downstate, are relatively well-staffed, while others, especially in rural areas, have few or none. Nor does the state have a certification program or standardized training curriculum. Individual hospitals issue guidelines for SANE programs, while the nurses seek accreditation from the forensic nurses association. "Illinois has better laws for rape victims than many states ... but by contrast, the SANE program doesn't have a real coordinated history," said Lyn Schollett, an attorney for the Illinois Coalition Against Sexual Assault, a statewide network of 33 rape crisis centers. "Mostly it's happened when individual communities have come up with the funds for training." Securing funding is critical to expanding the programs, experts say. Madigan said she asked for a three-year commitment from the Illinois Criminal Justice Information Authority, which allocates state and federal funds for helping crime victims, but received a one-year grant of a little more than $150,000. That will pay the new coordinator and cover three weeklong training courses of 40 to 60 nurses each. "We're happy with that, of course, but we'll continue to look for funding to make sure we have more of these nurse examiners available," Madigan said. "Every single time we've offered this training, we've had waiting lists. "We want to make sure that there are enough nurses that are trained as [SANEs] that wherever a victim shows up, they don't have to wait for somebody or to have someone who is not trained to do the evidence collection." Indeed, much of the nurses' training is in collecting evidence of sexual assault and handling that evidence in ways that will hold up in court. For example, although they use the same "rape kits" standard in most emergency rooms, they are better-trained in how to handle the swabs and label the bags to maintain integrity of the evidence. They also learn how to question a potential victim to help find DNA, such as asking if they remember being bitten or kissed in any particular place. "I know we're going to get better evidence when the collectors understand what we need, why we need it and how to get it," said David Metzger, a forensic scientist who oversees evidence collection for the Illinois State Police. SANEs may also administer treatments for sexually transmitted diseases or the so-called morning-after pill to prevent pregnancy. In recent years the examiners have begun using the colposcope, an electronic microscope that can detect vaginal injuries not visible to the eye. That is critical because rape cases often hinge on whether a person agreed to have sex, not whether prosecutors have found the culprit. "DNA has changed things, but ... identity is not an issue in most rape cases," Schollett said. Beyond that, nurse examiners are volunteers and passionate about the work. "I think they have the special sensitivity and desire to work with these victims. They have to have chosen to do this," said Lynn Osborn, associate director of the Lake County Council Against Sexual Assault. The nurses go through a 40-hour training course and must complete a certain number of supervised real-life tasks--exams, evidence collection--before applying for certification. Many nurses train in Indiana at the Ft. Wayne Sexual Assault Treatment Center, where the weeklong course costs $600. Some pay for training themselves, but many are sent by hospitals that have received state grants. "A true SANE program is when you have 24/7 coverage," said Nancy Salamie, an emergency-room nurse and trained examiner at Edward Hospital in Naperville. "The goal is for every sex-assault patient to have a SANE nurse." The hardest part can be finding nurses who want to do the work, which can be mentally draining and require them to appear as witnesses in court. That was part of the challenge at Midwestern Regional Medical Center, which began its program in the late 1990s and is now fully staffed. "It involved finding people who are passionate and can provide the best care possible to sexual-assault victims," said Anne Meisner, senior vice president of patient care services. "We have staff who are very committed to this. We're very proud of them." Gene May Be Linked to Tourette's Syndrome Reuters News Service, 10/13/2005 WASHINGTON - Researchers said today they have found a gene that helps cause Tourette's Syndrome, but that many other genes are also likely to be involved in the complex disorder Tourette's may affect as many as one in 100 people and is marked by muscle and vocal tics including repeated sudden movements or vocalizations. Children with Tourette's also often have attention deficit hyperactivity disorder, obsessive-compulsive disorder or depression. In a report published in Friday's issue of the journal Science, Dr. Matthew State of the Yale University School of Medicine and colleagues at several other institutions said a gene called SLITRK1 appears to contribute to some cases of Tourette's. "This finding could provide an important clue in understanding Tourette's on a molecular and cellular level," State said in a statement. "Confirming this in even a small number of additional TS patients will pave the way for a deeper understanding of the disease process." State and colleagues looked for unusual patients with a clear genetic anomaly. They found a boy who was the only member of his family with Tourette's, and who had a gene inversion on chromosome 13. A gene inversion occurs when a section of chromosome appears to have broken off and flipped before being reinserted. Looking at the ends of this section, the researchers found one gene, called SLITRK1, that is active in brain cells and is associated with the growth and interconnection of neurons. Then they screened 174 more people with Tourette's, comparing their SLITRK1 gene to the version found in people who do not have the syndrome, and found a genetic mutation. This one gene variation is unlikely to hold all the answers to Tourette's, State said. "I think there is general consensus at this point that there are likely to be multiple genes, likely interacting, and probably different sets of genes in different people, that contribute to TS," he said. Adolescence, Without a Roadmap Claire Scovell LaZebnik, New York Times- 10/16/2005 At least he's good-looking," I say to my husband whenever the subject of our oldest son's dating future comes up. And he is good-looking, our son, with his blue eyes, wavy hair, broad shoulders and warm smile. He's also got a deep voice (he works at it) and a gentle manner. It's hard to believe girls won't fall in love with him. And maybe they will. But he also has autism. When he's tired or sick, he forgets words or uses them incorrectly; often it requires enormous effort just for him to maintain a conversation. It's as if he has no native tongue and essentially has had to memorize our language word by word. Melissa Healy, Los Angeles Times- 10/17/2005 You might call it melancholy on steroids — a muscular mixture of fast-driving, heavy drinking, hard-charging cussedness. For perhaps 3 million American men yearly, that's the plotline for depression. For almost 24,000 men yearly, the final scene is suicide. Often, there is no cry for help, no river of tears, no abyss of sadness. Just a violent, tragic bolt from the blue. In the United States, a man is four times more likely than a woman to commit suicide, according to government statistics. Yet, he is only half as likely to be diagnosed with depression. That stark disconnect underscores a simple fact about depression in men: It often does not look like the mixture of sadness, guilt and withdrawal that dominates diagnostic descriptions and popular perception of the disease. As a result, a man's depression is often missed — by loved ones, by physicians, by the sufferer himself. The costs are steep: in lives hobbled, jobs lost, relationships ruined. Some professionals even tally the toll in prison terms, substance-abuse statistics and shattered communities. But today the diagnosis of depression is in the midst of a long-overdue makeover, as medical and mental health professionals have come to recognize that in at least half of depressed men, the recognizable litany of symptoms don't really fit. 'Their way of weeping' Some depressed men may be plagued by impotence and loss of sexual interest, but others may become wildly promiscuous. Many complain of depression's physical symptoms — sleep troubles, fatigue, headaches or stomach distress — without ever discerning their psychological source. Compared to women suffering depression, depressed men are more likely to behave recklessly, drink heavily or take drugs, drive fast or seek out confrontation. Instead of acting like they are filled with self-doubt, depressed men may bully and bluster and accuse those around them of failing them. For many men, anger — a masculine emotion that one "manages" rather than succumbs to — is a mask for deep mental anguish. "That's their way of weeping," says psychologist William Pollack, director of the Centers for Men and Young Men at McLean Hospital in suburban Boston and an expert on depression in men. Dr. Thomas Insel, director of the National Institute of Mental Health, likens the shift now taking place among psychologists and psychiatrists to one that is taking hold in other areas of medicine. In the diagnosis of, say, heart disease, physicians have come to recognize that men and women can have the same illness, but their symptoms often look very different. In any given year, says Insel, 6.4 million men will be diagnosed with depression — and many health professionals think that number may be far too low. Insel's institute has launched a broad campaign to raise awareness of the depression that affects men. Steve Klepper is one of those men. For almost two decades as an aerospace machinist in San Diego, a coffee-fueled Klepper worked so much overtime that he was able to buy a family home by himself. At work, he says, he was short-tempered and had little patience for his co-workers' blather about friends and family. At home, he would drink himself numb virtually every night. By his own admission, he "acted very much like a jerk" to women and friends, and suffered constant stomach problems and skin rashes. He thought frequently of suicide. Today, Klepper manages his condition with medication, and leads a San Diego support group for those suffering depression and bipolar disorder. He finds it hard to fathom why no one ever called his evident depression what it was. But he knows why it's a hard diagnosis for a man to admit to himself. "It's embarrassing to be sad," he says. "And the difference between being sad and lazy is hard to distinguish." Neither tears nor indolence, it seems, are manly virtues. "Depression equals vulnerability and shame and lack of functioning. That takes away the man's masculinity — and for men, that takes away the sense of self," says Pollack, author of "Real Boys: Rescuing Our Sons from the Myths of Boyhood." In the American ethos, Pollack says, "a man who's vulnerable is not even a man any more…. It's the equivalent of being psychologically castrated." Pollack and a small but growing number of depression experts say it's time for the mental health profession to expand its definition of depression so it is better recognized in men. They are pushing for a new category of depression — Pollack calls it "male-based depression" — to be incorporated into the new "Diagnostic and Statistical Manual," the bible of the mental health profession that is being updated. The reformers could easily cite Bill Maruyama as male-based depression's Exhibit A. As a Japanese-American kid growing up in Inglewood after the Watts riots, Maruyama outwardly nurtured a demeanor that was all "swagger and bravado" but in reality it was a veneer hiding the torment of rising depression. Alone, in secret, he often cried. Years later, as a young Los Angeles lawyer, Maruyama spent his paychecks as quickly as they came in. Driving along the winding cliff-side roads of Mulholland Drive, he would thrill at the fantasy of driving off the edge, and speed up, just to tempt fate. Behind the wheel, in the line at a coffee shop or at home with a romantic partner, he would fly into a rage at the least provocation. The death of both his beloved parents within the span of three years sent him finally falling into the abyss of depression and spurred him to seek professional help. It was no easy move. Among tradition-bound Asian Americans of his parents' generation, "depression is a sign of weakness and that weakness is a shame on the family," says Maruyama. "And to bring shame on the family, you may as well just commit suicide." Maruyama, instead, sought out a psychotherapist — a decision "that saved my life," he says. While he does not take medication, he stays in touch with a therapist, mindful that "you're like a recovering alcoholic, you can always slip back." As they work to overhaul the long-held view of depression as a predominately "women's disease," mental health reformers are following a growing trend of openness among depressed men. In the worlds of business, sports and politics, a few influential sufferers have broken their silence in recent years, helping to put a male face on the disease. One of them is business mogul Philip E. Burguieres, once the youngest chief executive of a Fortune 500 company. In the early 1990s, Burguieres says he was an outwardly successful workaholic problem-solver. But he never slept more than a few hours at a time — and inside, worry gnawed at him so furiously, "I almost wanted to peel my skin off," he says. In 1991, after wrestling for weeks with a particularly intractable business challenge, Burguieres passed out in his office. A psychiatrist bluntly told him he was clinically depressed and prescribed medication, psychotherapy and participation in a mental health support group. Burguieres dismissed her recommendations out of hand. By 1996, his depression was back with a vengeance, and at age 53 he bowed out as chief executive of an energy services company, citing "health reasons." For almost a year before doing so, he had fantasized obsessively about committing suicide. But "almost to the day I committed myself, I could fake it," says Burguieres. "I could put on my blue suit and my red tie and look good for a couple of hours, then come home and collapse." In recent years, Burguieres, now owner of the NFL's Houston Texans, has spoken to many business groups about his depression. And so many fellow businessmen have confided their own, similar stories that Burguieres believes the disease is "chronic and widespread in the executive office," and growing harder to ignore. More visible still are the athletes who have gone public. In November 2002, Milwaukee Bucks power forward Jason Caffey announced he needed time away from basketball to get treatment for his depression, prompting sympathetic attaboys from crusty Milwaukee fans and sports columnists. In May 2003, four-time Superbowl quarterback Terry Bradshaw embarked on a multi-city campaign sponsored by GlaxoSmithKline, maker of the antidepressant Paxil, to discuss his own lifelong depression and urge sufferers to get help. "Taking the first step toward a diagnosis and treatment was one of the bravest thing I've ever had to do," said Bradshaw. Bravery, indeed, is a central theme of the National Institute of Mental Health's campaign, now entering its third year. Featuring a series of national radio, television and print advertisements called "Real Men, Real Depression," it urges those who may suffer from the disorder to get treatment. A firefighter, a former Air Force sergeant, a lawyer and others talk about their symptoms and how they finally broke their silence and, with help, got relief. The advertisements stress to men that "It Takes Courage to Ask for Help." Cultural stigma This month, the campaign will begin distributing a new series of public service announcements aimed at some of depression's most underserved sufferers: Latinos. The Spanish-language ads are expected to begin airing in large, Spanish-speaking markets such as Los Angeles by the end of this year. Latino cultural taboos against depression run deep, says Rodolfo Palma Lulion, one of the men profiled in the campaign. As a Latino man, Palma found it hard to confront the notion that depression had seized hold of him, and he found it even harder to talk to his family. "My mom was a social worker, so she knows about depression," says Palma. "But it was always demonstrated as weakness, or as a phase. It wasn't something you deal with with a professional. It was something that stays in the family." Latinos certainly are not alone in that view. A 1996 survey by the National Mental Health Assn. found that 63% of African Americans said they considered depression "a personal weakness," compared with 54% of all those who responded. John Head knows that stigma well. In the 1990s, Head was a rising reporter with the Atlanta Journal-Constitution, an African American man with a lovely home and family. He ran every day — sometimes twice a day — in a frenetic bid to outrun his sadness. But he could not outrun the feeling that he was a fraud, undeserving of his growing recognition. He ruminated that affirmative action may have given him an unfair advantage. From the time he was small, "I was told that I had to be a man" — and that meant no crying, no admission of the sadness he could not escape. His family, he believed, would think less of him if he sought treatment; his employer and co-workers would think him less capable of doing his job. Even physicians and mental health professionals who have come to recognize depression's unexpected manifestations in men are careful to avoid what psychologist Pollack calls "the D-word" when they first suspect it. Dr. Kevin Brown, a family physician in the Crenshaw district, says that with men in general — and his predominantly African American and Latino patients in particular — he reaches for other words to open a conversation about depression. "I tend to use the words 'under stress' more often than not, and people can definitely relate to that," Brown says. A referral to a mental health counselor or a psychological support group "is definitely almost a no-no," he says, because "there's usually more machismo or bravado about men's ability to handle whatever emotional problems they might have."
Brown says that in men who do not appear to have reached a state of crisis, he may first prescribe an antidepressant. Only after a few follow-up visits, when he has gained a patient's trust, would he suggest counseling. Brown, who is African American, suspects that among males in the population he serves, depression is quite common and largely unrecognized. Most of it, he suspects, plays itself out on the streets, in gangs and behind the tinted windows of cars. "I can only guess the numbers of those who do not get help, and I think we see the effects of this in the criminal justice system," he says. This view of young male African Americans' behavior has gained resonance in the last two decades, as suicide rates among black males from age 10 to 19 have risen steeply. In his 2000 book, "Lay My Burden Down," Harvard Medical School psychiatrist Dr. Alvin F. Poussaint writes that an epidemic of suicide among young black males is only part of hopelessness and self-hate among African American men: Drug use, alcoholism and violent behavior have their roots in depression too. But admitting to depression, says Head, is "something that men don't do, and especially black men don't do." Head did seek help for his depression. But he first moved out on his family, convinced that his wife and sons would be better off without him. Alone in his apartment, he conducted what he calls "a dress rehearsal" for suicide, tying off a rope, checking a chair for its height, ensuring that he could kick it away. Head did not kick the chair away from under him that day. He went to his wife, who, horrified by his admission, helped him plot a quiet search for help. Many in his family first learned of the depths of his despair — and of his climb back to mental health — with the publication of his book, "Standing in the Shadows: Understanding and Overcoming Depression in Black Men." Now, as he crisscrosses the country talking about his book, Head see signs of change upon the landscape of American men. There once was a time when mostly women would come to hear him. Their concern for their secretly depressed male friends, relatives and partners were evident in their urgent questions. Today, says Head, "I'm seeing more men who're willing to come to these forums, and who stand up and say, 'This is the first time I've ever stood up,' " and acknowledged their mental anguish, says Head. "That kind of thing gives me hope that things are changing." Talking about the `D-word' It is a refrain heard so commonly by psychologists and psychiatrists that it could be the opening to an inside-the-profession joke: "This guy trudges into my office, collapses into the chair and says, 'My wife/partner/friend sent me. She says I'm depressed.' " The man seldom believes it himself. But as the symptoms are coaxed from the patient — changes in appetite, fitful sleep, low energy — resistance often drops away. And a willingness to get treatment can emerge. But the first step for many men, is to hear, "I think you're depressed" from someone close to them — someone who has seen first-hand his anxiety, mood swings, sleep problems. f you suspect depression in your friend or partner, do not downplay the changes you see or criticize his behavior harshly. Instead, say you're worried about his mood or behavior. Tell him that depression is common in men, and doesn't always look, or feel, like sadness. Explain that treatments — "talk therapy" and/or antidepressants — bring relief in four of five cases. Next, urge him to talk about his behavioral changes with his physician, a community health clinic worker or a trusted religious advisor. They can make referrals to psychiatrists or psychologists. If your friend, spouse or partner talks about suicide — even in jest — do not dismiss it, and do not shrink from probing his intentions and getting help for him. A suicide-prevention hotline should be your first call. Where to find help • The National Institute of Mental Health has launched a public awareness campaign on men and depression, with lots of personal stories, advice and resources: http://www.menanddepression.nimh.nih.gov . • The federal Substance Abuse and Mental Health Services Administration maintains a large database of places to seek help for any mental illness: (800) 789-2647 or http://www.mentalhealth.samhsa.gov/databases . • The Depression and Bipolar Alliance, at http://www.dbsalliance.org , has information about support groups across the country. • The National Alliance for the Mentally Ill offers information, support and referrals to those with depression and their families. It maintains affiliates across the country, including crisis numbers by county. Go to http://www.nami.org or http://www.namicalifornia.org . • Suicide-prevention hotlines are available around the clock, including the National Hopeline Network at (800) 784-2433 and the National Suicide Prevention Lifeline at (800) 273-8255. Or check for local listings and agencies on suicidehotlines.com/california_south.html.
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