Noteworthy News Articles on Mental Health Topics, October 26-31, 2005



U.S. Alters Test Policy On Psychiatric Drugs
Shankar Vedantam, Washington Post- 10/26/2005

The government will back down from a plan to require long-term studies of new psychiatric drugs before allowing them on the market, regulators said yesterday.

The reversal of the recently adopted policy came after a panel of experts unanimously recommended against requiring such studies as a condition of approval. While such studies are needed, the experts said, delaying decisions on new medications would hurt patients.

The panel's vote came after it heard a barrage of complaints from industry executives, academic researchers and patient advocates. All the critics predicted that the policy would lead to delays in bringing new drugs to market while providing little new information that may not apply to most patients. They also warned that the policy would cause drug companies to scale back on developing new drugs because of the potential increase in expense and risk.

The new plan, which the Food and Drug Administration had begun to implement over the past six months, called for companies to conduct studies for as long as half a year before seeking approval of new drugs. Like many other medications, psychiatric drugs are typically approved on the basis of positive results from two short-term studies, each of which may last only eight weeks.

Because physicians routinely prescribe psychiatric drugs for much longer periods, the FDA had started demanding longer-term data, as do regulators in the European Union, said Thomas P. Laughren, director of FDA's Division of Psychiatry Products. After the emphatic rejection by the panel yesterday, Laughren said regulators will "back off."

Criticism of the plan was voiced in all 15 presentations made at the panel meeting yesterday, prompting the chairman of the advisory panel, University of Florida psychiatrist Wayne Goodman, to implore his fellow scientists to mount an argument in favor of the requirement, if only to play "devil's advocate." But all the panelists agreed with the academic researchers, patient advocates and industry executives from Merck and Co., Wyeth Pharmaceuticals, Eli Lilly & Co. and other companies in stressing that the new federal requirement would have adverse consequences.

In the real world, as many as half of all psychiatric patients switch medications after three months of treatment, and as many as 70 percent switch after six months, said David Michelson, executive director for neuroscience medical research at Eli Lilly, which makes Prozac and other psychiatric drugs.

Asking companies to conduct trials that show that medications work for six months or longer will lead to trials that focus on the small subset of patients who do well for such long periods, rather than on the majority that do not, Michelson and others said. As a result, added Gary Sachs, a Harvard University researcher who testified at the meeting, such data will be of little help to clinicians in the real world who usually have to deal with less predictable cases.

"I believe the public interest is not served by this requirement, and it could cause a lot more harm and confusion than benefit," Sachs told the panel. "It would be telling someone with a heart attack that we have a drug that we know works, but we can't give it because we don't yet know whether it would prevent further heart attacks."

Sachs and other experts said "effectiveness studies" that can guide clinicians about which drug to try first, and when patients should stop taking a medication, are very valuable -- but their complex design and requirements mean they are best conducted at public expense by research institutions such as the National Institute of Mental Health.

While that institute does fund such studies, Sachs said, "their commitment to do that is substantially less than we would wish."

The frail-looking former religious brother faced charges of raping two boys yesterday as one of his accusers looked on and sobbed.

Edward Anthony Holmes, 64, softly pleaded not guilty in Suffolk Superior Court to six counts of rape of a child, five counts of indecent assault and battery on a child under 14, five counts of indecent assault and battery on a child over 14, and one count of photographing a nude child.

Holmes is accused of raping the children during the 1970s and early 1980s while he was a resident counselor at the now-defunct Nazareth Child Care Center in Jamaica Plain, said Audrey Mark, an assistant district attorney. Holmes was ordered to post $15,000 cash bail and stay away from children under age 16.

One of his two accusers, now a 39-year-old carpenter, sat on the wooden bench in the courtroom, clutching it with his hands and crying loudly. Holmes never looked at him.

''You don't know how hard this is," the man said moments before he entered the courtroom. ''The last time I saw him I was 4 feet, 65 pounds."

Asked what was done to him, he responded: ''The unthinkable."

Holmes was living in Washington near his family for more than a decade, supporting himself as a secretary for a monastery, said his lawyer, Jeanne Carol. ''He maintains his innocence," she said.

Around 1964, Holmes joined the Congregation of the Sacred Hearts of Jesus and Mary, said the Rev. David P. Reid in a telephone interview yesterday. The Roman Catholic community, based in Fairhaven, is under the auspices of the Diocese of Fall River.

Holmes left the community in 2002, Reid, the congregation's provincial, said. He declined to give the reason but said it was not related to the allegations.

''We knew nothing about the allegations until after he had left," Reid said. He said he has known Holmes since the 1960s and described him as a ''kind, caring, gentle soul."

''All these alleged actions, they are a shock to us," Reid said.

Prosecutors from Suffolk District Attorney Daniel F. Conley's office began investigating the allegations after the two accusers came forward in 2003. They decided to pursue criminal charges, according to the alleged victim who was present yesterday, after Holmes was named in the $85 million global settlement between the Archdiocese of Boston and sex abuse victims in the summer of 2003.

A grand jury convened in August and voted to indict Holmes last month, said David Procopio, Conley's spokesman. Washington police arrested him last Friday.

Holmes worked at the Nazareth Child Care Center from 1971 to 1985, Mark said. The center, run by the Daughters of Charity, for 121 years served as a residential program for children who needed a place to stay before being placed in foster care. The children were housed in the 10 cottages on the 35-acre property in Jamaica Plain. The center closed in 1985, partly because of financial difficulties, according to an August 1985 Globe article.

During his tenure at the center, Holmes was also a supervisor at one of the cottages, Mark said, adding that he used his position to convince the children that only he had the authority to let them leave, she said.

''He would ensure in that process that the children complied with his sexual demands," she said during the arraignment.

Holmes allegedly began abusing the first accuser, a 10-year-old, in 1976. The abuse continued until 1980, when the child turned 14. He began abusing the second boy, a 9-year-old, in 1977 and stopped in 1983, when the child turned 15, Mark said.

He allegedly photographed the second accuser during the assaults, she said. In 1989, while he was living in Milton, his housemate found numerous photographs of Holmes and a young boy engaged in sexual activity, Mark said.

In May 2004, "Father Joe: The Man Who Saved My Soul," by Tony Hendra, the satirist and former National Lampoon editor, was published to ecstatic acclaim. An account of Hendra's 40-year relationship with a charismatic Benedictine monk, the Rev. Joseph Warrilow, the book received a cover review in these pages from Andrew Sullivan, who said it belonged "in the first tier of spiritual memoirs" and noted that it "spares us no detail of his own iniquities as a parent." Frank McCourt likened "Father Joe" to the writings of St. Augustine, and Don Imus promoted it as a Father's Day gift for six weeks.

Very soon, however, there was trouble in paradise. A letter to the editor appeared in The New York Times Book Review claiming that Hendra had overstated his role in creating the movie "This Is Spinal Tap"; "I think Tony Hendra is at least one confession away from salvation," its author, one of the writers of the film, observed.

That might be two confessions away. An investigative report by N. R. Kleinfield headlined "Daughter Says Father's Confessional Book Didn't Confess His Molestation of Her," also in The Times, followed within weeks. Jessica Hendra, 39, had contacted the newspaper after reading "Father Joe" and accused her father of having omitted three episodes of sexual abuse from his redemption narrative. Kleinfield spoke with two therapists who had treated her and three of her friends, one of whom she had told of the abuse at the age of 12. Her mother, who initially pleaded ignorance to Kleinfield, later called him back to say that her former husband had actually confessed the last episode to her. (Tony Hendra has called the allegations "outrageous.")

Jessica Hendra's memoir, "How to Cook Your Daughter," written with Blake Morrison, a journalist, provides details of her father's behavior and character that she asserts he omitted from "Father Joe." But rather than being a systematic refutation of his confessional, it is an exorcism from which the reader emerges shaken and aghast.

The books of the two Hendras could not be more different, although the man who wrote the first is clearly identifiable, if far darker, in the second. His prose in "Father Joe" is agile and ironic; hers rarely rises above pedestrian reportage. The reader comes away convinced that Tony Hendra glosses over far too much in his story, but also that Jessica Hendra provides more specifics about the mechanics of bulimic vomiting than is absolutely necessary. Hendra père accuses himself of largely ignoring his first family (he has two children from a previous marriage, which ended in divorce, and three children from his current marriage), while his daughter's book portrays him as far too ominously present, even when he disappears for days at a time.

The Hendra family values depicted in "How to Cook Your Daughter" include mental cruelty, explosive rages and exposure to danger (speeding drunk through the Holland Tunnel, leaving cocaine in the refrigerator), as well as orgiastic drug binges and full frontal nudity with his Lampoon cronies. Jessica Hendra's mother seems to have protected her from none of it. There were also violent or perverse photo shoots featured in National Lampoon - one of Jessica, her sister and other children dressed as child pimps and prostitutes is on the book's cover - and enough instances of physical neglect that, if true, make one wonder how the girls avoided being removed by child welfare authorities.

There were also, tragically, tender moments between Jessica and the gifted, magnetic father she adored and with whom she identified so closely that she got thrown out of a Brownie troop for cursing like him.

In two episodes -- one sickening, the other exhilarating -- this memoir rises above simply rebutting her father's view of the truth and becomes literature of moral power. The scene as recounted in the book in which she tells her therapist that her father forced her to perform oral sex on him when she was 6, that he threatened to leave home if she did not comply and tucked her in afterward, is intercut with excerpts from the Lampoon piece the book is named for, written just months before the night she describes. Its details eerily symbolize and presage the abuse ("People so often ask, 'How do I tell when my daughter is ready for the table?' Well, there's always some little variation, but generally the exact age falls somewhere between the fifth and sixth birthdays"). The other is an inner dialogue in which Jessica Hendra decides to go public with her accusations and take the consequences.

And what of the spiritual issues raised in "Father Joe"? In researching a book I wrote about forgiveness a few years ago, I asked religious leaders whether an unrepentant abusive parent would merit absolution. A rabbi stated that there should be no forgiveness without contrition. Jessica Hendra agrees: "I believe in what Father Warrilow preached: that everything can be forgiven. But first, there has to be acknowledgment, real acknowledgment, of the transgression." From what is presented here, a reader has to conclude that Tony Hendra does not yet qualify. Father Joe may not have saved him, but in writing her book, his daughter may have saved herself.

Jeanne Safer is a psychoanalyst and author, most recently, of "The Normal One: Life With a Difficult or Damaged Sibling."

Come Clean: Are You Buried in Clutter?
Joseph Verrengia, Associated Press- 10/31/2005

Karen Lowe looks a little lost, even in her own apartment. Board games and puzzles teeter over the hamster's cage. A green metal desk spills toys and papers like a jackknifed truck in what should be the dining room. Upstairs, a computer shoots wires like kudzu around her bedroom.
Her daughter's room down the hall? Don't go there. Lowe's Boulder, Colorado-area home convulses with clutter. The chaotic accumulation of stuff is more than a quirk in her otherwise orderly life as a software engineer. The mess has become her shameful secret. Most friends have never visited her apartment and she lives in fear someone might drop by. Worse yet; her daughter Elphey, 12, is developing the same unkempt habits. Ashamed and seemingly paralyzed, Lowe finally hired experts to help get her unruly habitat under control.
     Her story offers hope to the tens of millions of Americans like her who live under the anarchy of their possessions. To many observers, clutter reflects the mind-set of the modern household -- overburdened, disorganized and compulsive. To others, clutter is a broader symbol of a ravenous culture dependent on. easy credit, piling up debt and consuming a lion's share of the world's resources without considering ering the consequences. "People's homes are a reflection of their lives," says Los Angeles psychologist and organizational consultant Peter Walsh. "It, is no accident that people have a huge weight problem in this country, and clutter is the same thing. Homes are an orgy of consumption."
     The obesity analogy isn't a joke. While personal spending drives much of the U.S. economy, the resulting clutter from all that shopping is so pervasive that some researchers wonder if it might have a deeper, biological component, similar to overeating. Their speculation borrows from evolutionary theory. Modern humans developed some 100,000 years ago as hunters and gatherers living in fundamentally harsher circumstances. Today, we are surrounded by abundance, but our bodies have remained genetically programmed to eat everything in sight and store calories to survive winter, drought and famine. To some nutrition experts, it's a primary reason two-thirds of Americans are overweight.
     Similarly, our forebears saved anything that could be materially useful because they had to make everything from scratch. Clutter emerged alongside industrial specialization and mass production in the 19th century, and it was then that the biological need to save everything morphed into a desire to acquire. Suddenly, the rising middle class was buying items once reserved for royalty. Tea sets. Mantelpiece figurines. Forks used only to eat fish.
And the opportunities to acquire have only skyrocketed. The old corner store stocked fewer than 1,000 items. Today, a Wal-Mart SuperCenter covers a quarter-million square feet -- that's nearly six acres -- and carries 130,000 products.
     Yet scientists have difficulty quantifying clutter. It is a private problem that most, people -- like Lowe -- sweep under the bed and shove behind closed doors. On cable TV at least three reality shows are devoted to clutter management. On the Learning Channel, "Clean Sweep" employs psychologist Walsh; it has filmed more than 200 episodes unloading people's junk. Fifty cities in 17 states have chapters of Clutterers Anonymous, a 12-step recovery program
     For some, clutter results from more than rampant shopping. It suggests widespread social discontent. "People hold onto stuff like their kids' old clothing as a way of holding onto the past," Walsh says: "Or they keep things they think they might need someday as a way to control the future."

Hoarding (just in case)
"Might need someday" is a common refrain for the 35-year old Lowe. Paperwork, toys, cookbooks and clothing spread. from one room to the next. "We put off housekeeping to spend time on just about anything that we like better than tidying up," Lowe concedes.
     The National Study Group on Chronic Disorganization, an association of professional organizers, has established a household clutter assessment scale. At Levels 4 and 5, people face eviction for filling their refrigerators with old newspapers and blocking fire exits with rubbish. Often, these boarders need psychological treatment.
     Psychologists estimate that 3 million Americans never throw anything out -- even old newspapers and yogurt cups -- in a twisted logic of perfectionism and fear. These boarders have a form of obsessive-compulsive disorder. Too often, they wind up entrapped and injured by their own junk. Hoarding research focuses on changes to a region of the brain connected with decision-making, problem-solving and anticipating rewards. At UCLA, patients receive a radioactive form of the sugar glucose before being examined by positron emission tomography. The PET scanner's color-coded images show which brain areas use the most glucose and are working hardest. In this small experiment, the hoarders have lower activity in a certain part of the brain when compared to other patients with obsessive-compulsive disorder. They also had lower activity in a
related region of the brain when compared to healthy volunteers.
     But how does the brain react at the moment of truth, when a person must decide whether to throw something away? At Connecticut's Hartford Hospital, patients reclined in a magnetic resonance imaging scanner, which images brain function by tracking blood flow. On a video link, psychologist David Tolin held up their junk mail and asked whether to save it or run it through a document shredder. The hoarders' brains showed activity spikes in one part of the brain. "Their brains screamed that they were making an error" Tolin said. "So they put down the mail and clutter builds up."

Just a habit
Not everyone who lives in a cluttered home is a compulsive hoarder and people who are messy might not need a brain scan. But increasingly they are seeking professional help. Lowe contracted with Aricia LaFrance, a suburban Denver psychologist, and organizational consultant. She describes Lowe as a Level 2 on the household clutter scale, but warns she could get worse. "She says; her mother is this way and now her daughter is this way. So there is a cycle that we need to break," LaFrance says.
     The purge requires three consecutive August weekends with Lowe doing "homework" on closets and junk piles during the week An entire afternoon is reserved for Elphey's room. At 12, her Lil' Bratz dolls mingle with teenage hip-hugger fashions that cascade in knee-keep waves from her bunk bed across the floor. Elphey retreats to her top bunk and pulls a leopard-print blanket over her head. Her mother stands on the bottom bunk and, resting her chin on' the top mattress, speaks quietly to the curled shape. After several minutes, Low starts back downstairs. Elphey slams her bedroom door with such force that the bannister shivers. Her mother winces. "She's going to work on her closet," Lowe explains: she doesn't want anyone to watch."
     Social forces contribute to clutter, too. The chief culprit: Easy money. Americans use 1.2 billion credit cards and carry an average total of $8,562 in consumer debt. A surprising villain: Technology. Just consider how the entertainment industry has lurched from record players to 8-tracks, cassette tapes, CDs, VCRS, DVDs and now digital downloads.
     One area where technology should reduce clutter is documents, but the paperless office has not materialized. Lowe and LaFrance agree to combine file boxes and digital storage, and they banish the file cabinet to the alley along with the desk Cooking trends spawn drawerfuls of specialized gizmos. Does anybody really need both a tomato corer and a tomato slicer?
     Lowe balks at discarding several bottles of fruit-flavored syrup - mango, kiwi, raspberry - that cost $10 apiece "I MIGHT make an Italian soda," she protests. "Or," LaFrance counters, "you could just go to Starbucks and buy one."
     By September, Lowe's apartment is ready for company. The brown floral print sofa sports a snappy denim blue slipcover. The hamster has been moved. Monopoly and Clue rest neatly on the living room shelves. Instead of the monster desk, a blonde wood table and chairs gleam beneath the dining room chandelier. Elphey has donated three huge trash bags of clothing. Together, she and her mother have hauled out dozens of bags and boxes. They admire the front closet as if it was an oil painting. The coats hang straight. Snowboots are matched on a rack, ready for winter. Suddenly, the gnarly mountain biker in Apartment 17 staggers past Lowe's open front door, wrestling the hideous file cabinet with the faux oak veneer. "Hey, look what I found out in the alley," he announces. "Got to get organized"