Teen Suicide and Feelings of Failure
Joel Rubin & Sandra Murillo, Los Angeles Times- 1/1/2005

"Dear Family," Velia Huerta Victorino began her handwritten letter. "Sorry for what I did, but I had to. No one liked me anymore. All my friends left me because what people were saying." At the bottom, Velia drew a heart, signed her name and, in a postscript, wrote, "I was 15." A few hours later, as her mother slept nearby, the girl hanged herself from a beam in the living room of her family's San Bernardino home.
      In the 10 weeks since Velia's death, her mother and sister have angrily blamed the suicide on what they said were years of bullying by other girls that eventually became unbearable. But although it is tempting to look for easy answers, the tragedy — like most teen suicides — isn't simple to sort out. Her death, a month after a friend of Velia's hanged himself, has unsettled the working-class neighborhood in which she lived, prompting school officials, neighbors and classmates to try to puzzle out what drove Velia to kill herself — and what could prevent similar tragedies. From conversations with Velia's family and others who knew her, and from documents in her school file, a portrait emerges of an isolated, tormented girl who fought often with others and had been suspended from school several times, once for threatening a teacher. Velia also had had a troubled home life with a mother who struggled to help control her daughter's anger.
      In 2002, more than 4,200 Americans aged 10 to 24 committed suicide, making it the third highest cause of death in that age group. Most, experts say, suffered from depression or other mental illnesses that left them vulnerable and unable to cope. Velia may have been no different, according to several experts. "The combination of mental illness, the perception that you have a problem that is unsolvable and coping skills that don't work tends to lead to death," said Joan Asarnow, a UCLA psychologist and national expert on teen suicide.
      Born into a family that dates back generations in the blue-collar streets of San Bernardino, Velia was the youngest of five children. When she was little, her parents divorced. Over the years that followed, the family moved frequently, subsisting on welfare, child support payments and Social Security. By the time she turned 12, Velia had attended at least three elementary schools. As early as second grade, records show, Velia had "behavioral problems" and was struggling to read and write. Teachers described a girl who could turn in moments from sweet to angry and who had trouble making and keeping friends. Her mother, Evangelina Huerta, doesn't dispute the description. "That was just my Velia," she said, "like a Jekyll and Hyde. There were times when she was as sweet as an angel and times when I was like 'God, where did this child come from?' "
      A second-grade teacher commented in a report, "Velia does a lot of teasing and hitting…. She needs peace-building skills," and by fourth grade, her records show, Velia was frequently reprimanded for hitting others and acting out in class. Throughout elementary and middle school, she consistently missed more than a month of classes each year.
      As she grew into a teenager, Velia's family continued to disintegrate around her. In 2000, an uncle was killed in a drive-by shooting, and soon after, her grandmother was hospitalized with cancer. In 2002, her closest brother, Mario, was sentenced to seven years in prison for stabbing a friend who had allegedly attacked Velia's older sister, Angie. "Her brother being sent away was devastating for her," Huerta said. "It was like someone being dead." The same year, the family was evicted from its home after falling more than 15 months behind in rent.
      The instability and loss seemed to take a toll on Velia. She began trying to impress girls by picking fights and acting tough, according to school assessments and her neighbors. Her aggression led to frequent confrontations in which she was slapped in the hallways or jumped by girls after school, friends and her mother said. The anger management classes she was required to attend did little to help. In one particularly bad brawl, police were called to school after Velia hurled a chair at a group of girls, her mother said.
      "It is so easy to look at girls like Velia and just see a bully," said Rachel Simmons, author of "Odd Girl Out: The Hidden Culture of Aggression in Girls." "We forget that inside is a girl who needs help." A study by the Centers for Disease Control and Prevention found that more than 60% of high school students who attempted suicide also were violent toward others.
      Her mother tried to help but was unsure what to do. Once, Huerta said, when Velia was in a rage, she took her daughter outside and challenged her to a fight, hoping it would help her get out some aggression. "Velia said, 'OK, you hit me first,' " Huerta recalled. "So I pushed her and she punched me…. But I allowed it because this is the only way that she could learn. I said to her, 'Get it out of you. It has to stop now.' " But it did not stop.
      In November 2003 came an even more serious warning sign. After a teacher discovered Velia scribbling a list of the "top ten ways to kill yourself and love yourself," Velia's mother got a call from the school about it, she said. "I said, 'She's just writing it. She's not going to do it.' " Velia was placed under psychiatric evaluation for several days at a Chino hospital. Asarnow, the UCLA psychologist, emphasized the importance of such interventions for children contemplating suicide. Adolescents who have made previous suicide attempts, she noted, are at risk of trying again to kill themselves.
      When Velia returned to her classes, she was still far from emotionally healthy. In an annual assessment a month after the hospitalization, school officials wrote that Velia "claims 'nobody likes me' at school (unable to give any reasons)" and that "she could not offer any suggestions to make her happy, other than returning to the hospital. ('They treat me nice.') Her drawings suggest: inadequacy, rejection, anxiety, low self-esteem, helplessness, insecurity, and poor interpersonal relations."
      But despite such obvious indications of trouble, weekly counseling sessions that followed the hospitalization were cut off in February, Velia's father, Rudy Victorino, said. A psychiatrist had recommended putting Velia on "some sort of medication," but her father says he was opposed. "I said to the doctor, 'My daughter's not like that.' I don't believe in giving kids drugs."
      By the end of last school year, Velia had been suspended from school for more than 20 days, once for threatening to hurt a teacher after he took her cellphone away in class. A judge warned her that if she was suspended again, she would be sent to juvenile hall. With that threat hanging over her head, Velia seemed to try to change her ways. A summer school session went well, and she entered her freshman year at Pacific High School determined to stay out of trouble, said both her mother and Alyssa Vasquez, a classmate who had befriended Velia. Other girls still challenged Velia to fight, but Velia resisted. "I'd be standing right next to her," Alyssa said, "And she would say, 'I ain't even going to fight, I ain't even going to let it go down like that.' She just didn't want to be like that anymore."
      And there was someone new in Velia's life: 15-year-old Steven Vega Jr., whom she had begun casually dating, according to her sister. On Sept. 28, less than a month before Velia killed herself, Steven closed his bedroom door, attached a thick speaker wire to a belt and hanged himself from his bunk bed. Velia's sister Angie said that although Velia was upset over Steven's death, she became even more distraught when rumors spread at school that she had been the last to see him alive and had encouraged him to commit suicide.
      Copycat suicides in the United States are not uncommon, especially among teens and young adults imitating friends or acquaintances who have killed themselves. Researchers have found that every year in the United States, between 100 and 200 teenagers die in these "suicide clusters."
      On Friday, Oct. 22, Angie left a note for Mike O'Connor, who runs the peer counseling program at Pacific High School and works with the school's at-risk students, asking him to speak to Velia. O'Connor, who said he was unaware of Velia's earlier hospitalization, called Angie to tell her he would meet with Velia on Monday. But he never got the chance.
      About 6:30 on Sunday evening, Oct. 24, Velia woke from a nap and ate some leftovers with her mother. Afterward, she called a girl she considered a friend to ask about a homework assignment. By the time she hung up, Velia was in tears. She called Alyssa Gonzalez, one of her few friends. "She was really sad" about the phone call, Alyssa recalled. "She said that the girl had said that everyone at school thought she was a joke and that it would be better if she just wasn't around. "Velia asked me, 'What if I wasn't around? Would they stop talking about me? Would you miss me?' I told her not to listen to them, that it was just words. She said she'd see me tomorrow."
      Turmoil in peer relationships is common for teenage girls, UCLA's Asarnow said, but Velia's problems with her friends do not by themselves explain why she killed herself. Asarnow speculated that, like 90% of adolescents who kill themselves, Velia probably suffered from depression or another mental illness that left her unable to handle the strong, and typical, desire among teenage girls for friendship. She was also a teenager, and teens are impulsive.
     About 9:30 that Sunday evening, Huerta walked into the kitchen to find her daughter at the table writing what may well have been her suicide note. (The next day, family members found drafts of the suicide letter in the trash.) Later, about 11, the two crawled under the heavy blankets on their mattress and turned on the television. "Nobody likes me, Mom. I don't have any friends," Huerta recalled Velia's saying. "I'm your friend," she replied before drifting off to sleep.
      When he arrived at school Monday morning, Mike O'Connor was met by Angie, hysterical and screaming, "This school killed my sister!" O'Connor was stunned. As far as he knew, Velia had never threatened suicide. Ten days before her death, Pacific High officials had requested Velia's records from her middle school, which would have included health reports, but it appears they were not sent. Other than O'Connor, school and district officials declined to comment on Velia, citing student privacy laws. "There are kids who are acutely depressed," O'Connor said. "In Velia's case, we didn't know. I work with kids that say, 'I'm suicidal.' I don't leave their side. If I'd have known, I would have done an intervention."
      Velia's father, a devout Roman Catholic who believes those who commit suicide will not see heaven, spent weeks after his daughter's death going from priest to priest, finally finding some comfort from one who told him that "God loves children" and that he felt Velia's hurt and that he would protect her. He is still devastated by Velia's death. "I thought I knew my daughter," he said, "but I guess I didn't know her that well."

Alzheimer's Prevention: Maintaining the Brain
Bruce Taylor Seeman, Newhouse News Service- 1/2/2004

Can Alzheimer's disease be avoided by exercising the brain? As with many matters of the mind, the question is tangled in complexity and uncertainty. But the evidence is growing, researchers say. "The data doesn't point to one particular activity said Elizabeth Edgerly, a clinical psychologist and expert who is leading training for the Alzheimer's Association's "Maintain Your Brain" workshops. "What it shows is a relationship between those who remain intellectually active and reduction of risk. We cannot say, `Do a crossword puzzle every day, and that will help.' What we can say is challenging yourself in a variety of ways is good for brain cells."
     In Chicago this fall, when the Association rolled out its first-ever community workshop on keeping the brain healthy, it included tips not only on diet and exercise, but on the benefits of brain stimulation and social interaction. The association expected about 20 bank employees to attend the inaugural event. But the standing-roomonly crowd neared 100. "Fear is a big motivating factor," said Dr. Samuel Gandy, director of the Farber Institute for Neurosciences of Thomas Jefferson University in Philadelphia and an adviser to the Alzheimer's association. "The disease is so common. And it's a horror to watch. The person you know in your family or social circle just fades away."
     Indeed, a recent association survey showed people 55 to 65 worried. more about getting Alzheimer's than any health problem except heart disease -- more even than cancer. But only about half those surveyed said they were actually doing something to keep their brains healthy--whether through diet, exercise, intellectual stimulation or social activities.
     The federal government spends nearly $700 million a year on Alzheimer's research, much of it aimed at understanding the pathology that leads to brain erosion and to test drugs that might slow or halt cognitive decline.
     Currently, four drugs are prescribed for the disease -- three for mild to moderate cases, the fourth for more advanced patients. There are no drugs for prevention, even for people with a family history of Alzheimer's. But many believe drugs will one day feature in this role. "The hope is we would be able to identify those individuals who are at risk, using neuroimaging or other biological markers, so that when we do have drugs available to delay progression or prevent Alzheimer's, we know who is at highest risk," said Dr. Neil Buckholtz, chief of the Dementias of Aging Branch of the National Institute on Aging. "That's the long-term direction."
     Developing such drugs, however, could take decades. Because Alzheimer's unfolds so slowly (some are sick for 15 years before symptoms appear) and because it strikes an organ of such complexity, it is exceedingly difficult to study. Clinical trials must be large and expensive to be definitive. And so increased attention is being paid to everyday behaviors that seem to reduce risk None is a guarantee. But, said Gandy, "we have some very tantalizing leads."
     Exercise appears to stimulate brain processes that boost "cognitive functioning," according to the National Institutes of Health. It apparently also sets in motion cellular mechanisms that protect the brain from damage and promote repair. Other variables are under investigation. People with high blood pressure, high cholesterol or diabetes are at higher risk. Inflammation may be a factor. And scientists say there is compelling evidence that invigorating the brain itself may delay or prevent the disease.
     Yaakov Stern, a clinical neuropsychology professor at Columbia University, researches why people with more advanced education seem to fare better. He and others subscribe to the concept of "cognitive reserve" -- that those with more developed minds are somehow able to reach for back-up brain power to compensate, at least temporarily, for the damage'of Alzheimer's. "You have two people with the same pathology," Stern explained. "One can do better than the other, look more intact than the other. What is that person doing differently inside the brain? If we understand, it might lead us to remediation therapies." Stern is scanning the brains of volunteers while they complete a set of tasks, hoping to detect how the more educated, more exercised mind operates differently.
     Research already completed, meanwhile, suggests that keeping the mind at work strengthens brains cells and the connections between them, and may even create nerve cells. Scientists only recently established the revolutionary finding that brain cells develop throughout life, not just during the fetal period as once was believed. Now it's agreed that new neurons grow into adulthood, at least in some portions of the brain.
     German scientists and NIH-funded researchers at the Salk Institute for Biological Studies in La Jolla, Calif., found that mice who lived in "enriched environments" --- running wheels, plastic tubes, nesting materials -- had more neurons in the hippocampus portion of their brains and were better at learning tasks. Another study of older mice showed that increased physical and mental activity, even when started in middle age, enhanced generation of new neurons and improved learning and exploratory behavior. And a 2003 sturdy published in the New England Journal of Medicine showed the odds of getting dementia were lower in people who regularly read, played cards or board games, solved crossword puzzles or played a musical instrument.
     The best strategy, according to the Alzheimer's Association, is to embrace variety in your intellectual life -- stay curious and involved, attend lectures, volunteer in community groups. Some of these activities may reduce stress, also regarded as a risk factor, and exercise parts of the brain vital for socialization. Spending time with friends, experts say, requires lots of brain work -- remembering where you saw them last, what they said then, and what they're saying now. "If you're visting with friends, you're really trying to focus on this person's life," Edgerly said. "There's so much going On."



Can This War-Weary Marriage Be Saved?
Christopher Berkey, Associated Press- 1/2/2005

HOPKINSVILLE, Ky.-- When Sgt. Jose Bermudez returned from Iraq, he came home to a new baby and a troubled marriage. "We were on the brink of divorce," his wife, Mandy, said as the couple ate lunch recently with their three children, all under age 3. The Bermudezes are among 300 couples with the 101st Airborne Division, based at Fort Campbell, Ky., who have attended "marriage enrichment" seminars put on by the Army in hopes of saving war-ravaged relationships.
      With studies showing divorce rates as high as 21 percent among couples where one spouse has been sent off to war, the Army is spending $2 million on various marriage programs, including vouchers for getaways. "I've been in the Army 20 years and I've never seen the Army pay for programs like this," said Lt. Col. Chester Egert, chaplain for the 101st.
      One Army program teaches couples about forgiveness and communication skills. It includes a 40-hour course with lessons on the dangers of alcohol and tobacco and how to recognize post-traumatic stress. Soldiers who complete it are rewarded with promotion points and a weekend retreat with their spouse. "If you learn those skills, you can make an impact on the number of divorces, and the number, we think, of reports of physical violence," said Col. Glen Bloomstrom, director of ministry initiatives for the Chief of Chaplains. To make the program more popular, commanders are encouraged to give their soldiers time off to attend. Baby-sitting is often provided. "What we're trying to do is change the culture, that it's O.K. to work on your marriage and take some time, and invest in your lifelong relationship - especially now when we're asking so much of your military spouses," Colonel Bloomstrom said.
      Sergeant Bermudez, 26, said it seemed as if everyone he knew at Fort Campbell was either getting a divorce or contemplating one. Many couples want to get things decided because the division has been alerted it could return to Iraq as early as midyear. At Fort Campbell and elsewhere, many couples married right before one spouse left for Iraq. Others, like the Bermudezes, have been married longer but still have spent little time together.
      The Bermudezes met in 2000 and married six months later. He was later deployed to Kosovo and Iraq. "We didn't know each other that well," said Mandy Bermudez, 25. "That's part of the problem." Sergeant Bermudez was in Iraq when their second child was born, and his wife became pregnant with the third while he was home on a two-week leave. Mandy Bermudez said another problem with their marriage was that her husband had trouble adjusting to the routine she had established for herself while he was in Iraq. Finding affordable day care has also been a major source of stress, she said. She said the two joined a church, and "it turned our marriage around." The couple decided to stay together. "I can't leave these three kids with her," Sergeant Bermudez said. "It's worth it to try and work it out."
      The Army's recent foray into marriage counseling was started in the late 1990's by a chaplain in Hawaii working with a unit with a high number of divorces. In 2001, laws were changed to allow the Army to pay for lodging and meals for the retreats. The effort is similar to another series of Army programs to help returning soldiers reconnect emotionally with spouses and children. Those programs began after four wives at Fort Bragg, N.C., were killed in 2002, and their husbands were suspected.
      Colonel Egert said the Army's effort did not just make for stronger families -- it made for better soldiers. "Soldiers will come apart in Afghanistan and Iraq," he said. "They'll absolutely collapse if they think their wife is going to leave them or their husband is going to leave them. I've seen soldiers hospitalized because they absolutely had a nervous breakdown because they were worried about their families." Added Colonel Bloomstrom, "You are really giving something that the couples know they need, at a time they may be receptive to hear it."

Alcohol Deaths Spur Change on Reservation
Associated Press, 1/2/2005

MISSOULA -- The Flathead Indian Reservation is shifting its focus to children and retooling tribal policies following the drinking deaths of four boys in a six-month period. The deaths, starting in late 2003, stunned the Confederated Salish and Kootenai Tribes, but inspired a gritty resolve to help children deal with alcohol without underestimating the power of generations of alcohol abuse. ``It seems like we've got some good things going, but I think we can't forget that we are fighting something that has been a problem for our people for hundreds of years,'' said Tony Incashola, head of the Salish Cultural Committee. ``Sometimes there's a sense of 'Hey, what can we really do?' but you can't let that stop you from trying.''
      Tyler Benoist died first. The 14-year-old spent the night drinking with friends in November 2003 and was found dead of smoke inhalation in a burned trailer in Pablo. Authorities said he had passed out with a blood-alcohol level of 0.233. Three months later, Tyler's 11-year-old brother, Justin, and another boy, Frankie Nicolai, vanished from Ronan Middle School. A friend found their bodies three days later. Tests concluded alcohol poisoning killed Frankie, whose blood-alcohol level was 0.50 percent, more than six times the drunken-driving threshold in Montana. Justin, whose blood alcohol was 0.20 percent, died from a combination of alcohol poisoning and hypothermia. No one was charged in the case. In May, 15-year-old Joey DuMontier drank most of a fifth of whiskey and died in a chair at a home northeast of Ronan. Sentencing is scheduled Jan. 22 for Richard Lopez, 21, of Ronan who pleaded guilty to providing at least some of the alcohol.
      Tribal leaders knew something had to be done. For a while, the response appeared mostly symbolic through rallies, walks and get-togethers held to generate ideas and allow the public to grieve. ``I think all the rallies and events were a way for people to feel like they were doing something,'' Incashola said. ``A rally is a way, on one hand, to show support, but it's also a way to say 'Well, what else can we do?' This was so big that people had a very difficult time imagining how we could really respond to it.'' In recent months, the tribal council has stepped up, appointing a team to identify ways the government can better respond to children's needs and outlining tribal policy regarding children in a tribal children's code. The tribes also recently took part in a training program that should ultimately lead to formation of a drug court. The court would be family oriented, with neither children nor adults treated in isolation. ``You're dealing with the family as a unit, so the whole system is essentially gathered around the family,'' said Teresa Wall-McDonald, who heads the tribes' Department of Human Resources and Development.
      Tribal elders have also become more involved by connecting with tribal programs that deal with children. ``They're coming at this from the perspective of making sure that we find ways to connect with the positive values of the past,'' Incashola said. ``A lot of elders have felt helpless and hopeless about passing down the value of family, so there's a real push there to see if we can do something about that.''
      Despite the changes, grief is never far away on the reservation in northwestern Montana, he said. ``When you lose young people, I think it's something you never quite get over,'' Incashola said. ``There will always be something that makes you remember what happened. Those are wounds that never quite heal, but they also make you remember what you ought to be doing to make sure the same thing doesn't happen again.''
      Information from: Missoulian, www.missoulian.com

W.Va. Faces Mental Health Care Crisis
Associated Press, 1/2/2005

CHARLESTON, W.Va. -- West Virginia hospitals spend more on patients suffering from psychosis than on any other diagnosis and almost doubled their mental health spending over four years. The increased spending, shortage of beds at state-run psychiatric hospitals and the fifth-highest suicide rate in the country indicate a mental health crisis in West Virginia, according to an investigation by the Sunday Gazette-Mail of Charleston.
      Mental health care problems are difficult to solve because of the stigma surrounding mental illness, said Eugenie Taylor, acting commissioner at the state Bureau of Health and Health Facilities. ``If this was any other disease, there would be a groundswell of support for change,'' she said. State hospitals in 2003 spent $101 million treating psychosis, up from $52 million four years earlier, according to the state Health Care Authority.
      The state Supreme Court reports that the number of ``mental hygiene petitions'' -- which are requested by police, social workers and family members to commit people to mental hospitals -- has increased by 45 percent between 1999 and 2003. Meanwhile, the number of mentally ill people in regional jails has almost doubled in four years, from 5,862 in 2000 to an estimated 11,000 in 2004. More than one in four inmates received mental health services last year, up from one in five in 2000, and the number of mentally ill inmates is growing faster than the total population. Both state-run psychiatric hospitals had empty beds four years ago, but by last year they had become so overcrowded that more than 1,000 patients had to be sent to private facilities at a cost of $3.5 million. A record 290 West Virginians committed suicide in 2001, while another 277 took their own lives in 2002. Those totals were up from 224 suicides in 1998, according to the state Bureau for Public Health.
      A recent report by the state Department of Health and Human Resources says mental health providers spent $90 million more than they should have during the 1990s. When federal officials demanded a payback, former DHHR Secretary Joan Ohl arranged to have the debt forgiven in exchange for the state turning over mental health payments to a managed care company to cut costs. Because of that deal, the state's community mental health centers lost 40 percent of their Medicaid funding in just two years, according to the report. As a result, the number of group home beds dropped from 203 to 84, and caseworkers could not visit clients at home as often, according to a DHHR memo. They had less time to help clients pay their bills or the rent, and inpatient programs to treat substance abuse were cut or eliminated. State officials have responded by replacing some lost Medicaid money with state funds over the last two years, and have appointed an ``overbedding task force'' to address crowding at the state psychiatric hospitals, Taylor said.
      On the Net:
Bureau of Health and Health Facilities: www.wvdhhr.org/bhhf
Bureau of Public Health: www.wvdhhr.org/bph

The Spotlight at the End of the Tunnel
Daniel J. Wakin, New York Times- 1/3/2005

Twice, she insisted on elective sinus surgery just to obtain more painkillers. Once, she pretended that a flood had ruined her medication so she could get a prescription refilled. There were times when she was so stoned on Percocet that she had no memory of actually singing, a self-described "junkie" whom the Metropolitan Opera banished from its stage. Andrea Gruber's tales of addiction pour out like the rich, deep tones of her soprano voice, which again will be heard in the title role of "Turandot" at the Met starting tonight. "Try being a functioning junkie at the Metropolitan Opera," Ms. Gruber, 39, said in an interview at the opera house. "I felt like such a fraud." Often, she would time a large dose for right before a major aria or duet toward the end of a performance, trying to achieve maximum numbness when the applause came. "I felt unworthy," Ms. Gruber said.
      With the precision of a recovering addict, she explained that she had been free of dependence on painkillers and tranquilizers for eight and a half years. Finally settling into the major operatic career that was predicted for her nearly two decades ago, she said the time had come for her to talk about her descent into addiction and her climb back out.
      Why now? Her past would arise anyway with the interviews that come with success, she said. Going public fulfills the need of the recovering addict to proclaim sobriety and make amends. Maybe it will help other people, whether addicted to alcohol or drugs. Hence, Ms. Gruber said, she is discussing her drug problems for the first time in the United States, starting with an article in the current Opera News, which is published by the Metropolitan Opera Guild. She rehearsed the part in interviews a year ago with several Italian publications. "I believe it's important for people to know that there are people in all walks of life who come from hell and fight their way out," she said.
      Ms. Gruber, who lives on the Upper West Side, said she knew that some people would consider her speaking out a publicity ploy, or a gimmick to draw a wider audience to what some consider an elite art form. "Fine, I'm a big girl," she said. And she said she recognized the risk of being known as opera's recovering addict. "I don't want to be a cliché," she said. "But I will show you my tattoo," she added without missing a beat. She turned around, raised her shirt, and there it was on her lower back, the first five notes and words of "In questa reggia," Turandot's aria from Act II. It is one of Ms. Gruber's signature roles.
      The gesture was in keeping with her earthy and sometimes profane manner. Her eyes crease when she smiles, and the laugh is a big, soprano laugh. Beyond opera, her musical tastes run to a bad-girl mix of Janis Joplin, Eminem and 50 Cent. At 5-foot-71/2, Ms. Gruber weighs a relatively svelte 180 pounds, down about 140 from her peak before gastric bypass surgery - another potentially touchy subject, in a world of heavyset performers, that Ms. Gruber seems to relish discussing.
      Her addict past appears to be fairly unusual in the opera world, Ms. Gruber and several opera house executives said, although there are singers who have struggled with alcoholism. They reason that drug addiction is rare in opera, unlike in the pop music world, because the physical and mental toll would render singers unable to perform. And maybe classical singers are just "squarer," Ms. Gruber said. But her story does shed light on the pressures of building a significant opera career; on the hunger for big, new voices; on the conflicts between overweight singers and opera management.
      Ms. Gruber's life was troubled from early on. She was born and grew up on West End Avenue near 103rd Street on the Upper West Side, the daughter of two history professors. She attended the private Bank Street School until she was asked to leave after seventh grade. She said she began smoking marijuana about the age of 11. At the Putney School in Vermont, she tripped on acid her first week as a freshman. But it was also at Putney, as a talented but unmotivated flutist, that she began studying voice at 16. "The only constants in my life were trouble and drugs and music," she said.
     She managed to win a place at the Manhattan School of Music, where her drug use continued. "I was the kid who was freebasing cocaine in the bathroom during the middle of vocal lit class," Ms. Gruber said. She said she also used heroin in her teenage years. Midway through her time in music school, she did her first of three stints in rehab, at Phoenix House in Manhattan, and left nonprescription drugs behind.
      But after a root canal, she was given a prescription for Percocet and began a decade of abusing prescription medication, with her habit reaching dozens of pills a day. Ms. Gruber said that she used her skills as an actress to manipulate doctors into prescribing the drugs. "I'm talking about just junkie scams," she said -- like the supposed flood and the sinus surgeries.
      Still, she won a coveted place in the Young Artists program at the Met in 1989, and that year, precociously, she was asked to perform as the Third Norn from "Götterdämmerung" for a Met recording. "That was how good and promising she was at the very beginning," said Jonathan Friend, then and now the Met's artistic administrator. "The voice was big, rich, and the top was not a problem for her." Her stage debut at the Met came in that role the next year. Critics and opera aficionados began calling her a bright new light on the vocal scene. Her first starring role at the house was in "Ballo in Maschera" in late 1990, with Luciano Pavarotti. The performance won critical praise. "I was stoned out of my gourd on Percocet," Ms. Gruber said. Her deficiencies were obvious enough to prompt James Levine, the Met's music director, to ask her not to sing the next performance. "I was a mess," she said. "I had no business singing 'Ballo in Maschera' onstage at the Met."
      Her career sputtered along, with a few successes mixed with cancellations. She had trouble memorizing dialogue and missed rehearsals. Her vocal cords would swell when, numbed by the drugs, she would push her vocal mechanism. Cortisone shots would bring down the swelling, and the cycle would continue. She said she felt lucky not to have damaged her voice, although Mr. Friend said he would be "exceptionally surprised" if she had not done at least some harm. "Somehow I managed to function well enough not to get fired while I was singing," Ms. Gruber said. "I was just not rehired."
      Then came a disastrous Met performance of "Aida" in 1995. She recalled that at one point when she was unable to hit a note, the Met orchestra's concertmaster at the time, Raymond Gniewek, looked up at her and just shook his head. The Met -- her hometown opera house, where her career began and was nurtured -- cut its ties and bought out her contract. "Joe wants you out," she said her representative told her, meaning Joseph Volpe, the house's general manager. Mr. Volpe said he did not now remember what her problem was. "She wasn't singing well," he said. "I decided we shouldn't continue having her perform." Mr. Friend, too, said that the nature of her problems were unclear and that the Met did not have the responsibility to intervene. "The fact is, the Met is not her voice teacher, her parents, her boyfriend, her whatever," he said. "We have a relationship with her, but our obligation is to the institution." Mr. Friend added that he was heartbroken by her decline and what seemed at the time as her failure to fulfill her early promise.
      In the mid-90's, Ms. Gruber receded into relative obscurity on the opera scene. "Put it this way: I was not the shining star for the future," she said. Only Speight Jenkins, the general director of the Seattle Opera, maintained faith, casting her in three operas during the decade. "I believe that Andrea had the capacity to come through it because she was so strong willed," Mr. Jenkins said.
      In 1996, she was hospitalized in Vienna with a blood clot in her leg. There, while doctors were trying to control her withdrawal symptoms, she was so desperate for drugs that she reached into the toilet to retrieve pills she had just vomited up. Her next stop was the Hazelden clinic in Minnesota, where she began a year and a half of withdrawal and recovery.
      As she recuperated, her weight ballooned. Because of her girth, Ms. Gruber said, she was told she would not be asked back to the Vienna State Opera and was dismissed from the Salzburg Festival. She bears grudges to this day. "I was sober, I got my life together, and all of a sudden I was too fat," she said with disgust.
      Her career rehabilitation took a major step forward in 1999, when Mr. Friend heard her sing well in San Francisco and took a chance, engaging her for several performances in "Nabucco" at the Met in 2001. She was hired to sing "Turandot" at the house in the fall of 2002, a triumphant return that brought cheers from the chorus. A well-reviewed "Nabucco" came the next year.
      Ms. Gruber lives next door to a firehouse, Ladder 25, and felt the loss of firefighters at close quarters on Sept. 11, 2001. Like many others, she experienced a "life is short" moment, and she decided to have gastric bypass surgery. "I said, I don't want to spend a second thinking what it's like to live in this body," she said. "It changed my life. I can feel my mechanism. I can run around the stage like a monster. I can sing things in one long breath rather than three or four."
      Now, with a boyfriend in West Virginia (a relationship that blossomed during a six-week e-mail courtship), her beloved golden retriever, Max, at home and engagements through 2008 at the Met, Ms. Gruber professes to be happy. Striding through the opera house's basement after a laughter-filled "Turandot" rehearsal one day recently, she heard repeated variations of "It's great to have you back!" Security guards greeted her by first name. She walked out to 65th Street and yelled out to the traffic: "Mamma need a taxi! Take me home!"

Meditation Gives Brain a Charge, Study Finds
Marc Kaufman, Washington Post- 1/3/2005

Brain research is beginning to produce concrete evidence for something that Buddhist practitioners of meditation have maintained for centuries: Mental discipline and meditative practice can change the workings of the brain and allow people to achieve different levels of awareness.
      Those transformed states have traditionally been understood in transcendent terms, as something outside the world of physical measurement and objective evaluation. But over the past few years, researchers at the University of Wisconsin working with Tibetan monks have been able to translate those mental experiences into the scientific language of high-frequency gamma waves and brain synchrony, or coordination. And they have pinpointed the left prefrontal cortex, an area just behind the left forehead, as the place where brain activity associated with meditation is especially intense. "What we found is that the longtime practitioners showed brain activation on a scale we have never seen before," said Richard Davidson, a neuroscientist at the university's new $10 million W.M. Keck Laboratory for Functional Brain Imaging and Behavior. "Their mental practice is having an effect on the brain in the same way golf or tennis practice will enhance performance." It demonstrates, he said, that the brain is capable of being trained and physically modified in ways few people can imagine.
      Scientists used to believe the opposite -- that connections among brain nerve cells were fixed early in life and did not change in adulthood. But that assumption was disproved over the past decade with the help of advances in brain imaging and other techniques, and in its place, scientists have embraced the concept of ongoing brain development and "neuroplasticity." Davidson says his newest results from the meditation study, published in the Proceedings of the National Academy of Sciences in November, take the concept of neuroplasticity a step further by showing that mental training through meditation (and presumably other disciplines) can itself change the inner workings and circuitry of the brain.
      The new findings are the result of a long, if unlikely, collaboration between Davidson and Tibet's Dalai Lama, the world's best-known practitioner of Buddhism. The Dalai Lama first invited Davidson to his home in Dharamsala, India, in 1992 after learning about Davidson's innovative research into the neuroscience of emotions. The Tibetans have a centuries-old tradition of intensive meditation and, from the start, the Dalai Lama was interested in having Davidson scientifically explore the workings of his monks' meditating minds. Three years ago, the Dalai Lama spent two days visiting Davidson's lab.
      The Dalai Lama ultimately dispatched eight of his most accomplished practitioners to Davidson's lab to have them hooked up for electroencephalograph (EEG) testing and brain scanning. The Buddhist practitioners in the experiment had undergone training in the Tibetan Nyingmapa and Kagyupa traditions of meditation for an estimated 10,000 to 50,000 hours, over time periods of 15 to 40 years. As a control, 10 student volunteers with no previous meditation experience were also tested after one week of training.
      The monks and volunteers were fitted with a net of 256 electrical sensors and asked to meditate for short periods. Thinking and other mental activity are known to produce slight, but detectable, bursts of electrical activity as large groupings of neurons send messages to each other, and that's what the sensors picked up. Davidson was especially interested in measuring gamma waves, some of the highest-frequency and most important electrical brain impulses.
      Both groups were asked to meditate, specifically on unconditional compassion. Buddhist teaching describes that state, which is at the heart of the Dalai Lama's teaching, as the "unrestricted readiness and availability to help living beings." The researchers chose that focus because it does not require concentrating on particular objects, memories or images, and cultivates instead a transformed state of being.
      Davidson said that the results unambiguously showed that meditation activated the trained minds of the monks in significantly different ways from those of the volunteers. Most important, the electrodes picked up much greater activation of fast-moving and unusually powerful gamma waves in the monks, and found that the movement of the waves through the brain was far better organized and coordinated than in the students. The meditation novices showed only a slight increase in gamma wave activity while meditating, but some of the monks produced gamma wave activity more powerful than any previously reported in a healthy person, Davidson said. The monks who had spent the most years meditating had the highest levels of gamma waves, he added. This "dose response" -- where higher levels of a drug or activity have greater effect than lower levels -- is what researchers look for to assess cause and effect.
      In previous studies, mental activities such as focus, memory, learning and consciousness were associated with the kind of enhanced neural coordination found in the monks. The intense gamma waves found in the monks have also been associated with knitting together disparate brain circuits, and so are connected to higher mental activity and heightened awareness, as well.
      Davidson's research is consistent with his earlier work that pinpointed the left prefrontal cortex as a brain region associated with happiness and positive thoughts and emotions. Using functional magnetic resonance imagining (fMRI) on the meditating monks, Davidson found that their brain activity -- as measured by the EEG -- was especially high in this area.
      Davidson concludes from the research that meditation not only changes the workings of the brain in the short term, but also quite possibly produces permanent changes. That finding, he said, is based on the fact that the monks had considerably more gamma wave activity than the control group even before they started meditating. A researcher at the University of Massachusetts, Jon Kabat-Zinn, came to a similar conclusion several years ago.
      Researchers at Harvard and Princeton universities are now testing some of the same monks on different aspects of their meditation practice: their ability to visualize images and control their thinking. Davidson is also planning further research. "What we found is that the trained mind, or brain, is physically different from the untrained one," he said. In time, "we'll be able to better understand the potential importance of this kind of mental training and increase the likelihood that it will be taken seriously."

Perceptions: Drunk, and Out of Your Depth
Eric Nagourney, New York Times- 1/4/2005

People who drink and drive may be at higher risk for accidents in part because the alcohol makes it harder to perceive depth, new research has found. The study, which appears in the current issue of Psychological Science, explored depth perception that is tied to movement, called motion parallax, not the better-known kind of depth perception that people enjoy because of binocular vision. The researchers, led by Dr. Mark Nawrot of North Dakota State University, were trying to understand how small eye movements are related to motion parallax.
      Fifteen volunteers were asked to take part in a series of computer tasks while a tracker mounted to their heads followed their eye movements. They were then asked to drink enough vodka to bring them near the blood-alcohol level generally considered a sign of intoxication, and given the tests again. The volunteers had much more difficulty performing tests involving motion parallax the second time. The type of depth perception being studied helps drivers judge their distance from obstacles, the report said.
      "In cases when we're driving, this motion parallax is what's so important in kind of giving us the spatial layout," Dr. Nawrot said. Knowing this, the researchers did not allow their volunteers to drive home. "We let their blood alcohol decline to a sufficient value, and then we called a taxi," Dr. Nawrot said.

After Food and Shelter, Help in Coping With Unbearable Loss
Benedict Carey, New York Times- 1/4/2005

Providing psychological services for millions who have lost family members, homes and communities in Sri Lanka, Indonesia and other countries will become critical in the coming weeks, officials from the World Health Organization, Unicef, and other relief agencies say. The scope of the emotional fallout will be impossible to predict. The first priority, the officials said, is to deliver food, shelter and drinking water. But the United Nations has already set up a network for counseling in Sri Lanka and, on Friday, sent mental health workers to the Maldives.
      Any natural disaster takes a steep emotional toll, the experts said, but this one is distinguished by its sheer size and scale. Studies of earthquakes, fires, hurricanes and other disasters that have devastated communities find that a majority of survivors eventually learn to live with awful memories and to work through their grief. But a significant number suffer either chronic mental distress or a more immediate emotional numbness that can isolate them from others. "At this point we have to be very careful not to label as a mental health problem this natural psychological response to being displaced in a split second, to seeing that everything you had now no longer exists," said Dr. Rachel Yehuda, director of the traumatic stress program at Mount Sinai School of Medicine and the Bronx Veterans Affairs Hospital. Those who are deeply scarred emotionally will need long-term care, she said, not a few hours or days of emergency care by grief counselors or other mental health workers.
      After suffering a violent injury, or witnessing a catastrophe, some 5 percent to 10 percent of people suffer from lingering nightmares, moodiness, nervous exhaustion and other symptoms of post-traumatic stress syndrome, researchers say. These symptoms are considered worrisome if they become chronic; they can appear months or even years after the crisis. Yet the rates of severe traumatic reactions can be much higher among people sitting directly in the impact zone of a seemingly apocalyptic event. After a 1988 earthquake that leveled the Armenian town of Spitak, killing half its schoolchildren, researchers from the University of California, Los Angeles, found that more than half the town's children suffered from post-traumatic stress and depression. The rate was less than half that in Gumri, some 30 miles away, and was negligible in Yerevan, the capital, 50 miles away. "It's very clear, the more extreme the experience, the higher the risk of severe psychological reactions," said Dr. Alan Steinberg, one of the study's authors. "Those people who were on the beach in this case, or close, are going to be at highest risk" of chronic emotional distress.
      Even in areas farther inland, psychiatrists say, the grieving among people who have lost homes and family members may be complicated by the trauma and violence. When the final memory of a lost loved one is violent, or suffused with guilt or helpless rage, experts say, it interferes with the natural ability to mourn loss, leaving people numb, at risk for serious depression, and cut off from others around them. "If there's a signature image of this catastrophe, it's the loss of children, the parents right there struggling for their own lives but unable to protect or save their children," said Dr. Robert Pynoos, co-director of the National Center for Child Traumatic Stress, and a professor of psychiatry at the University of California's Neuropsychiatric Institute in Los Angeles. The risk that this prolonged grief can cause depression is greater still, experts say, when the death of a loved one is not confirmed, or the body is swept into a mass grave without being identified - as has occurred in some areas hit by the tsunami.
      In such circumstances, when the normal cultural rituals surrounding death are disrupted, wild rumors often circulate, experts say. In 1985, volcanic ash and rubble killed some 80 percent of the inhabitants of the Armero, Colombia, sweeping away the bodies. For months afterward, there were stories and "sightings" of some of the dead wandering in far-off places. Only after the corpses were found two years later and proper ceremonies were conducted, did the survivors accept their loss, according to a World Health Organization report.
      In 2001, a fire in Lima, Peru, killed some 270 people, charring many bodies beyond recognition and depriving families of identifiable remains to bury and mourn. In the resulting confusion, rumors circulated that relief workers were stealing cadavers for medical experimentation, or selling harvested body parts, the W.H.O. report said.
      In the weeks and months to come, experts say, relief workers can help dispel such rumors, as well as identify survivors who are at risk of prolonged depression or traumatic stress. The health organization has issued guidelines for relief workers on how to deal with traumatized victims, and a group affiliated with the University of Oslo is planning a program to provide information on counseling to teachers and others in the areas hardest hit by the disaster.

Bipolar Alcoholics Helped by Seizure Drug
Associated Press, 1/4/2005

PITTSBURGH -- A drug used to control seizures can help people with bipolar disorder and alcoholism stop or reduce drinking, University of Pittsburgh Medical Center researchers reported. The drug, valproate, is already used to treat bipolar disorder, also known as manic depression, which is marked by episodes of depression and mania.
      More than 2 million adults, or 1 percent of the adult population, have bipolar disorder, according to the National Institutes of Mental Health, which funded the study along with the National Institute of Alcohol Abuse and Alcoholism. Many people with bipolar disorder also abuse alcohol or other drugs. ``Having the combination (bipolar disorder and alcoholism) really complicates the treatment for both of them,'' said Dr. Ihsan Salloum, the study's lead author and an associate professor of psychiatry at the University of Pittsburgh School of Medicine.
      People with bipolar disorder who drink may not stick with their bipolar medication and drinking can complicate it, leading to both increased episodes and increased severity, Salloum said. That can lead to increased hospitalizations and use of costly psychiatric services. Also, people with bipolar disorder and alcoholism are more likely to commit suicide, he said.
      The study, which Salloum said is the first to examine both disorders and how to treat them together, appears in the January edition of Archives of General Psychiatry, published Monday. Researchers followed 54 patients diagnosed with both disorders for six months. Patients were given their standard treatment, usually a combination of lithium (a common bipolar disorder treatment) and counseling plus valproate or a placebo.
      Of those taking valproate, 44 percent reported heavy drinking days -- defined as five or more drinks daily for men and four or more for women -- compared with 68 percent in the placebo group. And the valproate group had about half as many drinks on heavy drinking days than those in the placebo group. The study also found that those taking valproate were able to stay away from heavy alcohol use for about a month longer than the placebo group. It also found that the valproate group had fewer heavy drinking days than the placebo group.
      Some doctors prescribing valproate to treat bipolar patients who are also alcoholics have noticed its effect on drinking and Salloum's findings back that up, said Dr. Kathleen Brady, a Medical University of South Carolina psychiatry professor who has studied valproate and who peer-reviewed the study. ``I think it was a really well-done study and I think the findings are important,'' she said. ``This is going to help people who treat bipolar disorders with alcohol dependency.'' Brady said the results were modest, but ``clearly demonstrated that valproate added to lithium had better outcomes'' than lithium alone. Salloum acknowledged the relatively small study size, adding that it can be difficult to recruit and retain such patients. He said he hopes others will replicate the study.
      Dr. Mark A. Frye, an associate professor of psychiatry at UCLA and director of its bipolar disorder research program, said he was familiar with Salloum's study, but didn't review it. He also called the findings important, saying that studies routinely exclude one disorder or the other. As for the small size, he said studies that are the first of their kind are important because they establish findings, which can then be further evaluated.
      On the Net:
University of Pittsburgh Medical Center: www.upmc.com
Archives of General Psychiatry: www.archgenpsychiatry.com