Statute of Limitations Targeted in Abuse Cases
Jonathan Finer, Washington Post- 2/17/2005

BOSTON -- The day after the sentencing of one of the most notorious figures in this region's three-year-old clergy abuse crisis, lawmakers and victims advocates said Wednesday they are building momentum to repeal statutes of limitations that have prevented other abusers from facing lawsuits and prosecution. Under Massachusetts law, rape cases must be brought within 15 years of the incident being reported to law enforcement or, in the case of a child, 15 years of the accuser's 16th birthday, whichever comes first. Other sex crimes have shorter statutes of limitations.
      As a result, few priests implicated in the ongoing scandal in the Roman Catholic Church have faced charges, leading to widespread frustration among abuse victims. "We need to allow victims to deal with their victimization and come forward at a time that's appropriate to them," state Rep. Ronald Mariano (D) said at the statehouse in a news conference with abuse victims and a bipartisan group of legislators.
      On Tuesday, Paul R. Shanley was sentenced to 12 to 15 years in prison for raping an altar boy in the 1980s. The case could be tried only because Shanley left Massachusetts in the early 1990s, stopping the countdown to the statute's expiration.
      Mariano is sponsoring three bills, which have attracted 46 co-sponsors. Two would eliminate the civil and criminal statutes of limitations. If passed, the change in the criminal law would not apply retroactively, meaning priests currently protected from prosecution would remain so. A third bill would remove the $20,000 limit on liability awards when charitable organizations, such as churches, are found to have facilitated sex crimes. The Boston archdiocese far exceeded that cap in making payments for its landmark 2003 settlement with more than 500 victims. A similar series of bills filed in 2002 never emerged from the state House Judiciary Committee, though those initiatives had fewer co-sponsors, legislators said. The support of 81 members of the House and 21 members of the Senate would be needed for passage.
      At least four states -- California, Connecticut, Illinois and Missouri -- have scaled back criminal and civil statutes of limitations on sex crimes since 2002, said David Clohessy, director of the Survivors Network of Those Abused by Priests. Similar initiatives have failed, or are still being considered in many other states. "Massachusetts tends to set the pace on child protection in general and clergy abuse in particular, so this could have a very powerful impact across the country," Clohessy said.
      Corey Welford, a spokesman for Massachusetts Attorney General Thomas F. Reilly, who has stressed the difficulty of prosecuting decades-old abuse cases, said Reilly "has been meeting with victims' groups and prosecutors, and is keeping an open mind on this issue."

Antidepressant Safety Debate May Include Adult Patients
Benedict Carey, New York Times- 2/18/2005

The yearlong debate over whether antidepressant drugs increase the risk of suicide in some children may soon widen to include adults, as English and Canadian scientists are reporting findings from three new analyses of suicide risk in people over age 18 who have taken the medications. The new findings are mixed, and apparently contradictory, and likely to encourage both patient advocates who believe that antidepressants like Prozac have hidden dangers, and manufacturers who insist that the medications are safe, experts said.
      One of the reports, an analysis of data on antidepressants from previous studies, found that adults taking the drugs were twice as likely to attempt suicide as those receiving a dummy pill or other treatments, but no more likely to complete the act. The two other reports found no significant link between the medications and suicide. Suicide attempts occurred in less than 0.5 percent of the more than 200,000 people included in the three studies. All three papers appeared yesterday in the online version of The British Medical Journal.
      "There has been a phenomenal amount of pressure to study this issue in adults," in part because of the debate over the risk in children, said Dr. John Geddes, a professor of epidemiological psychiatry at Oxford University and the co-author of an accompanying editorial in the journal. Dr. Geddes was not involved in the studies and has received research money from drug makers. "We know a certain amount of negative evidence on these drugs has been suppressed, and the more information we have on them in the public domain, the better to guide clinical practice," he said.
      In the early 1990's, a panel of experts convened by the Food and Drug Administration concluded that there was not enough evidence to link drugs like Prozac and Zoloft to increased suicide risk and most psychiatrists say that the drugs are more likely to prevent suicide. But regulators in the United States and Britain recently issued warnings that the drugs, known as selective serotonin reuptake inhibitors, or S.S.R.I.'s, could raise the risk of suicidal thinking in a small number of children and adolescents. The F.D.A. is scrutinizing suicide attempts by adults reported in drug trials. The risk is extremely difficult to determine, experts say, in part because suicide attempts are rare.
      In one of the new analyses, researchers at the University of Ottawa re-evaluated data from 345 antidepressant trials for depression and other conditions, involving 36,455 men and women. The investigators found 143 total suicide attempts, and found that the rate was twice as high in people who were taking S.S.R.I.'s as it was in those getting placebo pills, or some other form of therapy "Many people are on these drugs, which makes the rare risk very important," said Dr. Dean Fergusson of the University of Ottawa, who is a lead author of the study.
      Dr. David A. Freedman, a clinical trials expert and statistician at the University of California, Berkeley, who was not involved in any of the studies, said that reviews of this kind are not a very reliable way to determine risks. Moreover, he said, the Ottawa study presumed that all antidepressants affected everyone the same way in terms of suicide risk. "This is like saying your reaction to Prozac is the same as mine to Zoloft, which we know isn't true," he said. "This assumption exaggerates the significance of their findings." Dr. Fergusson disagreed, saying the assumption of uniform effect gave a conservative estimate.
      In another analysis, also in the British journal, doctors evaluated data from 477 trials involving 40,826 people, which were submitted by drug companies to British regulators for safety review. "We found no evidence that S.S.R.I.'s increased the risk of suicide," and weak evidence that the drugs increased the risk of self harm, the authors concluded.
      The third study analyzed case records of 146,095 people prescribed antidepressants for the first time from 1995 to 2001. The researchers found no evidence of increased suicide risk in adults taking S.S.R.I.'s compared with people of the same age and similar histories taking other types of antidepressants.
      Given that studies report suicidal behavior in a number of ways, experts are skeptical that reviews of trial data will resolve the issue. "We have machinery to pull diamonds from the earth, but we don't have machinery to pull truth from data in these studies," Dr. Freedman said. Psychiatrists said the studies were not likely to change how they treat patients: the drugs tend to increase agitation and unusual behavior in the first few weeks after the treatment is started, when patients need to be closely monitored, they said.

Mental Health Courts Help Afflicted
Associated Press, 2/18/2005

BOISE, Idaho -- Peggy Reese spent much of the last decade ricocheting from one psychotic episode to the next, trying to smooth out the rough edges of her life with methamphetamine, heroin, alcohol -- anything she could find. Except the help she really needed. ``I got busted, thank God. It's a good thing, because I was going to prison and didn't want to. The judge offered to let me go to mental health court instead,'' Reese said. ``I would not be alive, would not be here, without the mental health court.''
     The Idaho court is the brain child of Judge Brent Moss. He was tired of seeing drug addicts sent to prison, without treatment, when many were trying to self-medicate to control a mental illness they did not understand. ``When I was doing drug court five years ago, we could immediately see that there are people who are failing. We couldn't get them through. Though they were getting clear of drugs, they didn't like the way it felt to be sober,'' Moss said. The judge realized that mentally ill defendants were not getting the help they needed -- and he thought they were getting -- in prison. ``I was naive,'' Moss said.
      Tom Beauclair, director of the state Department of Corrections, told lawmakers last month that prisons are not properly equipped to deal with the mentally ill. ``If I had to rank two issues that are very big problems for the Department of Corrections, it's drugs and mental health,'' Beauclair said.
      Before her introduction to Moss, they were big problems for Reese as well. Reese's 5-foot, 5-inch frame weighed just 85 pounds. But that frail body carried a heavy burden: an addiction to drugs and alcohol and a myriad of mental illnesses that Reese can recite like a litany. ``I'm bipolar, with obsessive compulsive disorder, schizoaffective with mood disorder and psychotic episodes, and I have disassociative disorder, which is basically multiple personality disorder with a new name,'' Reese said. ``That's why I used so much drugs, and I've been doing them since I was 13. When I was 19 I was doing heroin. I was manufacturing methamphetamine.''
      Though they made her feel better, the drugs did not help her mental illness. When she was ordered to prison for a methamphetamine conviction, the sentencing judge -- Moss -- offered her an alternative. If Reese would successfully complete mental health court, he said, she could avoid her prison sentence. But graduating from mental health court was no easy task. ``The first 90 days, your life is absolutely scripted,'' Moss said. Court volunteers and workers from other agencies check in with the defendant -- sometimes two or three times a day -- making sure they are taking medication, staying clean of illicit drugs and even paying rent and keeping their homes clean. Participants must take part in therapy, classes about their illness and support groups.
      Lance Hill, 40, who entered mental health court after a violent dispute with his girlfriend and a police officer, said the classes and therapy taught him to recognize the symptoms of his bipolar and schizoaffective disorder before they get out of hand. ``I would become agitated easier before. I do have a temper, I was very angry. Before it was just different, like I wasn't in control of myself, like some other force was driving me. But I learned about the illness, about how I respond and how I can change behaviors,'' Hill said. ``If you don't want to change when you go in there, you're not going to last very long. You'll go back to jail, back to an institution or die because you're not trying to help yourself or anything,'' Hill said.
      Participants join Alcoholics Anonymous or other addict support groups. But Reese found that dealing with her mental illness reduced her craving for illegal drugs. ``But once they get you so you're on medication and compliant, and they check on you every night to make sure you're OK, it gets better. Now I'm not even drinking. I've been clean 19 months with no relapse, not even a thought of it,'' Reese said. ``Isn't that incredible? You don't know what you're feeling, why you're feeling it until someone teaches you.''
      The success of the Rexburg court has prompted Kootenai County officials to start one. Soon, Moss hopes, mental health courts could spring up throughout Idaho. ``If you could see the before and after pictures of these people in two years, no one would recognize them. It just takes time, and once they graduate, it's almost like you're a father, you're so proud of them,'' Moss said.
      Now graduates, Reese and Hill are believers in the program. They both take part in a support group for mental health court alumni. Reese said the court did more than heal her mind -- it healed her family as well. ``My daughter just called to tell me, 'I love you and have a nice day,''' Reese said, her voice heavy with emotion. ``We've never had that kind of relationship before. I have a grandson, and I can remember him growing up now. With her childhood, it's kind of in and out because I was drugged. I have a life now.''

Combat-Related Stress Can Last a Lifetime
Associated Press, 2/18/2005

WEST LAFAYETTE, Ind. -- Freshly home from World War II, Reni Winter's father charmed his way into her mother's heart, and the two married. Slowly, however, the violence he'd witnessed at Okinawa began to haunt him, and he became abusive. As a young child, Winter knew Marine Lance Cpl. Jerry Joseph Ohana only as the man who called occasionally from an institution. At 7, those calls stopped when her mother decided to cut him out of their lives. ``We were forbidden to mention his name,'' said Winter, 50.
      Hundreds of thousands of veterans like Ohana were institutionalized with war-related psychiatric problems after World War II. Thousands of others among the 4 million surviving veterans are still struggling with post-combat trauma. The National Center for Post-Traumatic Stress Disorder estimates that one of every 20 World War II veterans suffers from the disorder, with symptoms such as bad dreams, irritability and flashbacks. Many never got help, in part because few people knew what to look for 60 years ago. The Army sent psychiatrists into battle with the troops, but there was little awareness of post-traumatic stress disorder then. ``We didn't even know how to spell it, let alone pronounce it,'' said retired Col. Bob Jones, 87, of Clarksville, Tenn., who was hit by a tank while serving in World War II with the 101st Airborne Division. Others saw seeking help as a sign of weakness. In 1943, then-Lt. Gen. George S. Patton called two soldiers hospitalized for what was called combat fatigue ``cowards'' and slapped them.
      Herman Eickhoff, 80, of Mount Vernon still has nightmares about the eight months he spent in a German POW camp during World War II. In one, he's working as a prisoner, repairing German railroads. Sirens blare as American forces drop bombs around him, unaware he is on the ground. ``It always comes back to you,'' Eickhoff said of his wartime experience. Unlike today's veterans, he can't confide in his war comrades because nearly everyone in his 1st Infantry Division platoon was killed or seriously injured. ``There was none of them left,'' said Eickhoff, a retired carpenter. ``It was that bad.''
      Combat-related stress disorders became more widely recognized after the Vietnam War. Today, recruits undergo psychiatric screening before they enlist and receive counseling and screening once they come home. There's also medication to treat those with war-related trauma. Yet the stigma associated with postwar trauma persists. An Army study published last summer in the New England Journal of Medicine found that one in eight troops coming home from Iraq reported symptoms of post-traumatic stress, but only about 40 percent were interested in getting help. Some said they worried about how peers would view them, or that it would affect their careers.
      Jeffrey Matloff, program director of the post-traumatic stress disorder team at the Veterans Affairs San Diego Health Care System, said troops need to realize they aren't alone. ``It's a normal reaction to the abnormal events of being in combat,'' Matloff said. Jones, who recovered from his injuries and later fought in Korea and Vietnam, agreed. ``I think it's good that people get this attention,'' he said. ``A lot of people, when they come back, they're bitter, they're hard-nosed, they're rough. They believe in force. They've got to be retooled mentally.''
      For Ohana, that retooling never occurred. He was diagnosed with paranoid schizophrenia and spent nearly 50 years in the care of the VA. After years of searching, Winter found him in 1988 in a VA home in New York. She began arranging to have him moved to Indiana, but he died Dec. 2 at 76 in Montrose, N.Y. With modern medicine, Winter said, ``Who knows what kind of life he could have led? The sacrifice that he gave ... it's just as valid a sacrifice as anyone who give their life or is wounded.''

In 2004, 1,000 Alleged Abuse by Priests
Alan Cooperman, Washington Post- 2/18/2005

More than 1,000 people reported to civil or church authorities in 2004 that they had been sexually abused as children by Roman Catholic priests, the second-largest number of allegations for any year on record, the U.S. bishops' conference said yesterday. During 2004, the church spent $157 million on legal settlements and other costs related to sex abuse. It received allegations against 756 priests and deacons, half of whom had previously been named in similar accusations. It temporarily removed more than 300 clergy members and permanently defrocked 148, church officials said.

      The new statistics, which appeared in the U.S. Conference of Catholic Bishops' second annual report on the sexual abuse crisis in the church, showed the heavy toll that the four-year-old crisis continues to take on the church's finances, its clergy and the trust of its laity. The figures released yesterday bring the total number of alleged victims since 1950 to 11,750, the number of accused priests to 5,148, and the church's expenses to more than $840 million. Three dioceses have declared bankruptcy.
      But the 2004 figures do not fundamentally alter the patterns found last year in a major study of sexual abuse in the church from 1950 to 2002. As in the past, about 80 percent of the 1,083 victims who came forward in 2004 are male, and the majority said they were between the ages of 10 and 14 when the abuse began. Most of the alleged incidents took place in the 1960s and '70s. Also as they have in the past, victims' advocates and church officials disagreed on how to interpret the figures. Kathleen L. McChesney, a former FBI official who is leaving this month as head of the church's Office of Child and Youth Protection, said at a news conference that 22 incidents, or 2 percent of all the allegations reported last year, were fresh cases involving abuse of minors that occurred in the previous 12 months. She hailed that as evidence that the number of new cases "is declining."
      David Clohessy of St. Louis, national director of the support group Survivors Network of Those Abused by Priests, told reporters outside the church's news conference that 22 fresh incidents is hardly "cause for joy." In fact, he said, it is probably just a small fraction of the true number, because last year's major study by the John Jay College of Criminal Justice found that child victims typically suffer in silence for 20 to 30 years before reporting clergy abuse. Interpretation of the statistics was also complicated by a lack of data for 2003. That is because the John Jay study compiled statistics for each year from 1950 to 2002. Then the bishops voted to update the study annually beginning in 2004.
      The peak number of allegations reported in any prior year on record was in 2001, when the abuse scandal erupted in Boston. More than 3,300 alleged victims came forward that year. In 2002, the number of allegations dropped to about 750, about the same number that was reported annually in the mid-1990s.
      McChesney also said yesterday that 96 percent of the 195 U.S. dioceses were found in a second annual round of audits to be fully in compliance with the sex abuse policy, known as the Charter for the Protection of Children and Young People and adopted by the bishops in Dallas three years ago. The archdioceses of Washington and Baltimore and the dioceses of Richmond and Arlington were among those in compliance. McChesney said the church spent $20 million in 2004 on efforts to prevent sex abuse, including police background checks on 32,073 priests and more than 750,000 lay people who work with children in Catholic schools and parishes.
      Barbara Blaine of Chicago, president of the Survivors Network, said that the audits are largely irrelevant because they focus on whether each diocese has strict policies in place, rather than determining how well the policies are carried out. "Every diocese in America last year was cited, even praised, by auditors for three examples of ineffective steps: employee codes of conduct, formal communication plans and having a point person to take incoming abuse allegations," Blaine said. "Is there one priest who molested one girl because he'd never read an employee code of conduct telling him child rape is wrong?"
      Blaine and other advocates said the most effective step bishops could take would be to release the names of all priests who face credible allegations, which has been done in fewer than a dozen dioceses. They also accuse some bishops of trying to evade the core promise in the Dallas Charter, which required permanent removal of any priest who has committed sexual abuse involving a minor. According to the report, at least 42 priests "remain in active ministry pending a preliminary investigation" of abuse charges.
      McChesney acknowledged that the church has no policy on how long a preliminary investigation should take or how it should proceed. "Many victims/survivors, accused clergy, review board members, and the laity remain confused about the exact procedures that are to be followed," the report said. The president of the U.S. bishops' conference, Bishop William S. Skylstad of Spokane, Wash., said he would not "second-guess the decisions of individual bishops" but that, in his opinion, "if there is a credible allegation of abuse, the priests [should be] immediately removed."
      The figures on abuse allegations released yesterday included no breakdowns by diocese and no names of priests or victims. More than 90 percent of all U.S. dioceses voluntarily reported their abuse statistics for 2004, but 71 percent of the 158 Catholic religious orders in the country, such as Jesuits and Franciscans, provided their data.

Nevada Proposes Helping Problem Gamblers
Associated Press, 2/20/2005

CARSON CITY, Nev. -- Linda C. finally sought help for her compulsive gambling after she came home from a devastating night at a Las Vegas casino and, staring at two handguns on her kitchen counter, contemplated suicide. Nine years later, she's a peer counselor for compulsive gamblers in Las Vegas. But she's only somewhat hopeful about a proposal from Gov. Kenny Guinn to use $200,000 in state money over the next two years to help create a program for other problem gamblers. ``I think it's highly needed,'' said Linda, 57, who spoke on the condition her last name not be used. ``But, personally, $200,000 is just a joke.''
      The funding would mark the first time the state has put any money toward helping people addicted to gambling -- a particular problem around Las Vegas and Reno. Other states with far less in casino revenues and a shorter history of legalized gambling contribute much more. The governor considers the program a ``first step,'' said his spokesman, Greg Bortolin, and hopes to get at least $200,000 in matching funds from the casino industry. ``I think symbolically this is the first time the state has ever made a commitment,'' Bortolin said. ``What we're doing is encouraging the industry to step up and do the right thing.''
      Nevada's commercial casinos rake in nearly $10 billion a year, by far the highest amount of any state, according to the American Gaming Association's 2003 statistics. While all states except Utah and Hawaii have some form of legalized gambling, just 17 provide funding for problem gambling programs, according to Keith Whyte, executive director of the National Council on Problem Gambling. New Jersey, a distant second in casino revenues with more than $4 billion, gives at least $600,000 to problem gambling programs each year, according to Edward Looney, executive director of the New Jersey Council on Problem Gambling. But in Nevada, the casino industry contributes the bulk of the money that goes to the problem, ``hands down,'' said Carol O'Hare, executive director of the Nevada Council on Problem Gambling, which runs a hot line and conducts awareness campaigns. Mike Willden, director of the state's Department of Human Resources, estimates the industry contributes nearly $1 million to a problem gambling center in Las Vegas and O'Hare's council.
      Experts estimate that 1 to 2 percent of the population are pathological gamblers and up to 4 percent have a less severe problem, said Christine Reilly, executive director of the Institute for Research on Pathological Gambling and Related Disorders. In Nevada, those numbers are a bit higher -- Willden said there are nearly 100,000 people in Nevada, or 6.4 percent, with some level of gambling problems.
      Alan Feldman, senior vice president of public affairs for MGM Mirage, said it's appalling the state hasn't put up funding before. He called the proposed contribution small, especially compared to the $1.83 billion the state expects to collect over the next two years from gambling and live entertainment taxes. Republican state senators from Reno and Las Vegas are among lawmakers proposing legislation to ensure the state budgets enough money to fund training for counselors and contracts with treatment facilities. ``The problem is a lot greater than people say,'' said Sen. Randolph Townsend, of Reno.
      Arnie Wexler, a recovering compulsive gambler who conducts responsible gambling workshops, agrees the money is a long time coming. But he couldn't be happier to see the governor's initiative. ``This is a wonderful start and I commend the governor for doing what he's doing,'' he said.
      On the Net:
American Gaming Association: http://www.americangaming.org
National Council on Problem Gambling: http://www.ncpgambling.org
Nevada Council on Problem Gambling: http://www.nevadacouncil.org



'Perfect Madness': The Mommy Trap
Judith Shulevitz, New York Times Book Review- 2/20/2005

Manifestoes blast their way into the popular consciousness on two kinds of fuel: recognition (we see ourselves in them) and rage (we can no longer tolerate the injustice they describe). Judith Warner's ''Perfect Madness: Motherhood in the Age of Anxiety'' brims with both. She clearly means for her denunciation of American-style mothering to do for overstressed 21st-century upper-middle-class American women what Betty Friedan's ''Feminine Mystique'' did for underemployed 20th-century ones. ''Perfect Madness'' is not half as good as ''The Feminine Mystique'' -- not as painfully accurate or cleverly argued -- but, like Friedan, Warner channels a big, explosive feeling, which she identifies as frustration at ''the mommy mystique'' or, more resonantly, ''this mess.'' Since I and other mothers I know expend a great deal of energy trying to quash the suspicion that our once carefully groomed resumes now look as shabby and unpromising as our toy-strewn homes and lumpy midsections, I read most of Warner's long and somewhat repetitive book in a single sitting, and so, I think, will fellow travelers on the mommy track. The mess, c'est moi; the injustice is that it doesn't matter how committed I am to my work or how efficient I become. As soon as I began bearing children I hit, not a glass ceiling, but a brick wall. It is no longer cool to say stuff like this, not even in female company. After God knows how many thousands of books, articles and talk shows on the rapid-aging process human resources professionals politely call ''the work-life balance,'' we have had about as much as we can stomach on the subject. We are not zesty, pie-eyed, would-be superwomen. We acknowledge life's limitations and the needs of our children and adjust our ambitions accordingly. On the other hand, just because we have issue fatigue, that doesn't mean we don't have an issue. Judith Warner, a biographer of Hillary Clinton and Newt Gingrich and the co-author of a book with Howard Dean, interviewed 150 mostly well-off women, about half of them in and around Washington, and wrote up her observations in a breathy women's-mag style that would seem to disqualify her somewhat for the job of filtering out the chatter and identifying the threat to our emotional and economic security. (She confined her interviews largely to upper-middle-class women because, she says, images of upper-middle-class motherhood tend to crowd out all other kinds in magazines and on television and therefore exert an outsize pressure on discussions of the subject -- a claim with merit, but still a remarkably circular way of going about things.) Then again, as the defense secretary recently said, you go to war with the army you have.
     And so, to war. Warner has two points to make. The first is that, in affluent America, mothering has gone from an art to a cult, with devotees driving themselves to ever more baroque extremes to appease the goddess of perfect motherhood. Warner, who has two children, made this discovery upon her return from a stay in Paris, where, she says, mothers who benefit from state-subsidized support systems -- child care, preschools, medical services -- never dream of surrendering jobs or social lives to stay home 24/7 with their kids. In the absence of such calming assistance, however, American moms are turning themselves into physically and financially depleted drones.
      The truth of this last observation is perceptible on even a short visit to any faintly tony suburb, though it's doubtful that only mothers have lost their sense of proportion. Parents no longer set up metal swing sets in corners of their backyards; they hire professionals to erect sprawling wooden castles that consume half the lawn. Parents line up at 5 a.m. to get slots in just the right neighborhood preschool and bring their children to specialists upon noticing the slightest delay in speech or motor coordination. Desperate to maximize their children's levels of attachment and developmental capacity, they turn marital beds into family beds, flash ''Baby Einstein'' cards at their 3-month-olds, enroll toddlers in nonstop improving activities, and give up quiet evenings at home to plan Girl Scout cookie drives -- ''Girl Scout cookie meetings? At 8 o'clock at night?'' exclaims Warner. (That last surely is a mother-only activity.) The ex-professional stay-at-home mothers who, like haughty high priests, identify each new form of self-sacrifice set the pace for the still working ones, some of whom leave their jobs to keep up.
      Warner tends toward hyperbole, but she strikes me as right about the basic phenomenon. In a society that measures status in consumer goods and hard-to-come-by symbols of achievement -- grades, awards, brand-name colleges -- the scramble for advantage is bound to propel American upper-middle-class parents into exponentially goofier displays of one-upsmanship. Try giving your 3-year-old an old-fashioned cake-and-balloon birthday party at home, with neither facilitator nor gift bags, and you'll see that Warner's onto something, and that it's harder to opt out than you'd think. Allison Pearson was a lot funnier about the anthropology of parental rivalry in her novel, ''I Don't Know How She Does It,'' and incidentally revealed that elites use their children to jockey for status in other developed nations, not just in the United States. (Pearson's hyperjudgmental mothers lived in London.) But then, fiction is always better on the details than sociology.
      There's more than just detail, however, to back up the theory that parents put in more time than they used to. According to the Families and Work Institute's most recent five-year study of the national work force, children receive on average one hour more of parental attention on work days than they did 25 years ago. Translated out of the levelling language of statistical averages, that means many, many hours of helping with homework, cheering at basketball games and schlepping to music classes. (Interestingly, the study says that it's men who are putting in the extra hour, while working women spend the same amount of time as before: 3.4 hours per workday. Men now average 2.7 hours.) Insofar as Warner implies that these new standards of parenting are driving women from the work force, she may be exaggerating. She is right to observe, however, that something is taking them out of action. A 2002 Census Bureau report shows that from 1998 to 2000 the percentage of women in the work force with small children declined from 59 to 55 percent, reversing a general upward trend; 13 percent more children were being raised at home by full-time mothers in 2002 than in 1994.
      These changes may seem relatively small, but small changes can have cascading effects. Mothers experience them at the most personal level. Take the woman who decides to scale back when her baby is born. Her smaller paycheck makes her husband feel that he must bring in a bigger one, or at least make sure not to slip into a lower income bracket. That means longer hours and less time at home. Before long, the wife cuts back her hours even more to cope with the increased housework, shopping and cooking she has to do, and to care for the baby, who, as he gets older, needs more love and educational enrichment, not less. Soon she is wondering whether to keep her expensive part-time baby sitter (who is probably looking around for a full-time position) and whether her career, now barely recognizable as such, is worth what it costs to maintain it. ''Was I really a good enough writer to justify the sacrifice?'' Warner wondered when she found herself in that situation. ''Or should I, at long last, just hang it up?''
      I hate to think what America would be like should even the small number of women who could afford it decide just to hang it up. One imagines the halls of law firms, businesses, universities and newsrooms slowly thinning out of all but the youngest women, who, over time, would tend to be confined to jobs that don't lead anywhere, since no boss would want to see his investment in a fast-track employee rewarded by her leaving to have a baby. At the moment, more women than men get master's degrees and as many women as men get professional degrees, but that, too, could change, if a diminished idea of what women are capable of starts deflecting them from even beginning serious careers. (That a dearth of women in a particular field leads directly to doubt about their suitability for that field was made amply clear by the controversy last month over whether women lack the genetic capacity to succeed as professors of math and science. Maybe they do and maybe they don't, but you don't need genetics to explain why women might fail to rise to the top of a profession that requires an 80-hour workweek.)
      This leads to Warner's second point, which is more openly political than her first. Our neurotic quest to perfect the mechanics of mothering, she says, can be interpreted as an effort to do on an individual level what we've stopped trying to do on a society-wide one. In her view, it is the lack of family-friendly policies common in Europe that backs American mothers into the corner described above -- policies that would promote ''flexible, affordable, locally available, high-quality'' day care; mandate quality controls for that day care; require or enable businesses to give paid parental leave; make health insurance available for part-time workers; and so on.
      Unfortunately, Warner doesn't say how we might organize to get such policies passed in a rightward-drifting, Europe-hating America. She is content merely to criticize social conservatives, on the one hand, and old-school feminists, on the other, for making such legislation unthinkable. (Some feminists fear that a focus on motherhood and the needs of children will distract from the goal of workplace equality, though I think Warner overstates their influence.) Nor does she grapple with research that suggests a downside to European-style family legislation. One typical study, for example, argues that cushy state supports for Swedish mothers have weakened the bonds of marriage in that society and undermined the family. Such arguments (in my opinion) often lack context -- any signs of dissolving family ties, such as rising levels of divorce, that you can point to in Europe tend to be worse in the United States -- but Warner ought to have dealt with them.
      In the end, she acknowledges that life isn't perfect for French mothers, either. ''There is a price they pay for the wonderful (and expensive) benefits they enjoy: a pervasive and all-but-unchallenged kind of institutional sexism,'' she writes. ''It can keep women of childbearing age from being hired. And can condemn others to being fired when they fully avail themselves of the 'rights' so readily accorded to them.'' Warner signs off after conceding this point, as if to say, c'est la vie, but I think it goes to the heart of the problem. We can and should write more maternal supports into law, but until we change our bedrock assumptions about what the proper balance of work and life should be, women will always pay a price for interrupting their careers to have children. Non-upper-middle-class women who have no choice but to keep working will continue putting in the kinds of days that make them strangers to their children, while those with more options will either tear their hearts out at not exercising them or drop out of the work force and apply their skill at climbing career ladders to pushing their children up them.
      There is reason to believe -- to hope -- their children will resist. The Families and Work Institute study cited above found that, compared with members of the baby boom generation, younger college-educated workers seem markedly less willing to sacrifice everything to advance in their careers. Many of the younger workers yearn to work fewer hours, and say they would turn down promotions if the new jobs required longer days and more work brought home -- claims that may well prove untrue in practice, but nonetheless say a lot about the people making them. More young professionals rank their families as equal in importance to their jobs, or even greater. More young women than men hold these views, not surprisingly, but what is surprising is how many more young men interviewed in 2002 disagreed with the statement that it is ''much better for everyone involved if the man earns the money and the woman takes care of the home and children,'' compared with young men interviewed 25 years earlier. You could dismiss this as just the young folk regurgitating the gender ideology they learned in school, except that more young fathers also ''walk the talk,'' in the jargon of corporate America: they spend an average of one more hour a day with their children than baby boomers do.
      Which brings us back to overparenting. Warner deplores its dangers both to us and to our children, who, she says, are likely to wind up as spoiled, callow, allergy-prone, risk-averse success machines with no inner lives. I rather doubt it. Social scientists and commentators have been warning of the ill effects of overparenting since parental advice books first began appearing in bookstores, but each new generation seems about as agreeable or disagreeable as the last. For all its excesses, overparenting is still preferable to its alternative, which was depicted with quiet sadness by the sociologist Arlie Russell Hochschild in her 1997 book, ''The Time Bind.'' Hochschild studied a Fortune 500 company with exemplary work-life balance policies for both men and women and discovered that few mothers and almost no fathers took advantage of them. Some were afraid of losing their jobs; some couldn't cope with the fear that they'd be diminished in their bosses' eyes; some wanted overtime pay; but a majority eventually admitted that they liked life in the office and even on the plant floor better than life at home. Work was orderly and companionable. Home crackled with the anger and acting-out of children cycled through jury-rigged baby-sitting arrangements and yanked through their lives like tiny factory workers keeping pace with a speedup.
      Hochschild interviewed only workers employed by the company, not those who had dropped out to stay home, so hers was a world perhaps overly drained of nurture. But the majority of women now work, and given the growing gap between the wealthy few and the less-wealthy many, that probably won't change. With the rise of the service economy and companies that spread their production process across several continents, Americans are more likely to be working longer and during evenings and weekends, making child care even more complicated. What Hochschild forces us to consider is that we're losing the ability to imagine a world in which we work less and at more reasonable hours, and therefore that we no longer bother to fight to bring that world into being. It is our own internalized workaholism that threatens to devour us and our children -- that, and the increasingly untenable absence of a public infrastructure of care.
      Overparenting has a lot in common with overwork. Both make economists happy, because they lead us to buy more stuff, whether that stuff is baby-wipe warmers or gourmet meals delivered after hours to our offices. Both are powered by fear of a loss of face. But the two also come into conflict, and therein may lie one route to salvation. It is mothers caught between overparenting and overwork who have the strongest incentive to push back against the forces that drive them. I wouldn't go so far as to echo what one writer recently said in The New York Times Magazine, which is that mothers opting out of their careers herald a new revolution, because revolutions tend to end badly, and this one seems pretty inauspicious. But insofar as mothers with jobs and mothers without them could conceivably band together to form a very large interest group, we do represent a whopping opportunity for change. Whether we take that opportunity depends on whether we can pull ourselves out of our mess long enough to persuade those around us to clean up theirs.

The Therapeutic Mind Scan
Paul Raeburn, New York Times Magazine- 2/20/2005

Psychiatrists are among the few doctors who don't look at the organs they treat. Imagine an orthopedist setting a bone without taking an X-ray. It would be like an auto mechanic diagnosing a faulty radiator without popping the hood. You would think he was a crook. Yet that is just what psychiatrists typically do. Instead of looking at the brain, they rely on interviews, experience, hunches and trial and error.
     But that could soon change. Brain-scanning technology has already helped researchers identify abnormalities in the lobes of people with A.D.H.D., bipolar disorder, schizophrenia and other psychiatric ailments. Studies also suggest that it's possible to track physical changes resulting from the use of psychotherapy or medication. If scanners could uncover the signs of distinct mental illnesses in the soft folds of the brain, the way X-rays can reveal a tumor, and monitor treatment effectiveness, they would revolutionize psychiatry.
      Scientists are in near-universal agreement that that day has not yet come. But Dr. Daniel G. Amen, a controversial child and adult psychiatrist based in Newport Beach, Calif., says that psychiatrists should be using the scans now -- or risk ill serving their patients. ''How can you change the brain without looking at it?'' Amen asks. ''It's unconscionable to me.'' Amen says he has performed more than 25,000 scans on his patients during the past 14 years using a technique called Spect, or single photon emission computed tomography. And he says he believes that the scans are an essential tool for determining diagnosis and treatment. His first clinic, in Fairfield, Calif., was so successful that he has established three others, in Newport Beach, Calif.; Tacoma, Wash.; and Reston, Va., where he opened his doors last June.
      For $3,000 -- a sum that may or may not be covered by insurance, because the technique is experimental -- Amen will give you a clinical evaluation that includes two brain scans. He will then devise a treatment plan that can include standard drugs and talk therapy along with less conventional, unproved remedies like biofeedback and dietary supplements. It's important to remember that the abnormalities he claims to see on his scans may not be responsible for a given illness; they could just as easily have been caused by the illness. And it's impossible to know how many of Amen's patients have been helped, because he hasn't published studies that would enable others to evaluate the effectiveness of his treatments.
      But his apparent success in attracting patients suggests that the failings of conventional psychiatry are significant. Patients often spend years receiving the wrong treatment because psychiatric diagnosis is often more art than science. A cardiologist can run you through a battery of tests and tell you with near certainty whether you've had a heart attack. (Not all nonpsychiatric ailments are that easily diagnosed, of course.) Psychiatrists rely on the Diagnostic and Statistical Manual of Mental Disorders, known as the D.S.M. Published by the American Psychiatric Association, it is a catalog of checklists that psychiatrists use to distinguish one illness from another. A diagnosis of mania, for example, requires psychiatrists to identify three or more of a list of symptoms, including ''inflated self-esteem,'' an ''increase in goal-directed activity'' and an ''excessive involvement in pleasurable activities that have a high potential for painful consequences.'' If the patient makes the cut, it's mania, one hallmark of bipolar disorder. If the patient doesn't quite make the cut -- if he or she doesn't meet enough of the criteria -- then it technically isn't bipolar disorder, no matter how sick the patient may be. And if the D.S.M. says it isn't bipolar disorder, the treatment is unclear, and it probably won't be covered by insurance.
      Many researchers have been scornful of Amen's salesmanship and science. Stephen P. Hinshaw, chairman of the psychology department at the University of California at Berkeley, likens his claims to snake oil. But even they agree that we may be moving toward the diagnostic Holy Grail. Dr. Hilary Blumberg, a psychiatrist at the Yale University School of Medicine and the Department of Veterans Affairs, has used a technique called functional magnetic resonance imaging, or f.M.R.I., to show, for example, that patients with bipolar disorder demonstrate -- on average -- less activity in the orbitofrontal cortex, just above the eyes, than do people without the illness. But the difference emerges only when Blumberg and her colleagues do a statistical comparison of a group of people with bipolar disorder and a group without it. The technique is not yet refined enough to spot bipolar illness in an individual, Blumberg says.
      One of the most exciting recent findings was reported just two months ago, when Dr. John Port of the Mayo Clinic, using a technique called magnetic resonance spectroscopy, was able to measure levels of five brain chemicals in different regions of the brain. The levels of the chemicals inside nerve cells indicate how those neurons are functioning. Port found that patients with bipolar disorder exhibited a unique chemical fingerprint. ''When we compared all the bipolars in any mood state with their matched normal control subjects, we found that two areas of the brain were significantly different,'' he says. Dozens of researchers across the country are pursuing similar research with bipolar disorder and other psychiatric disorders, using variations of the f.M.R.I. and spectroscopy techniques, Port says.
      Port also says that his study brings him very close to the point at which he can make a diagnosis on individuals: ''The technology is good, but the question now is, Is it good enough? We have to check it and make sure it will be clinically useful.'' He is in the process of writing a grant proposal seeking financing for a study to answer that question, perhaps in the next two or three years. And he's not the only one approaching that goal.
      So where does this leave Amen? ''I could tell you a hundred cases off the top of my head where imaging has made an enormous difference in someone's life,'' he says. One of those people is Amen himself, who has had his own brain scanned eight times. He has also scanned his children, and he has a warning for prospective suitors: ''If you date my daughter for more than four months, you have to get scanned.''
      Sam Goldstein, a neuropsychologist at the University of Utah who has known Amen for a decade, is skeptical of Amen's apparent ability to diagnose almost any psychiatric illness. ''If you have an ailment, he can find it,'' Goldstein says. ''That's one aspect of pseudoscience -- it claims to do everything.'' Stephen Hinshaw adds that Amen is exploiting families who are desperate for help. ''Making claims before the evidence is out there does families a lot of harm,'' he says.
      Diagnosing psychiatric illnesses will probably always be more difficult than diagnosing a heart attack. Amen says that he's simply following the instincts he developed in his first medical job, as a 19-year-old X-ray technician in the Army. ''When you don't know,'' he says, ''you take a look.''



Montana House Dumps Bill to Protect Gays
Associated Press, 2/21/2005

HELENA, Mont. -- The Montana House on Monday killed a bill that would have extended the state's hate crimes law to protect gays. The bill would have made it a crime to target people based such factors as age, economic condition, disability, gender or sexual orientation. It was rejected 54-46. State law already outlaws intimidating or harassing someone because of race, religion, color, creed or national origin. Offenses carry a minimum two-year prison term.
      Debate focused mainly on whether the law should cover crimes against gays and lesbians. Republicans, who accounted for all but five of the opponents, warned the bill would stifle free speech and could prevent clergy from speaking out against homosexuality in their sermons. Supporters said the bill aimed to protect people who could be targeted because they belonged to a certain group. Similar bills have failed in each of the six preceding legislative sessions. A similar bill in the state Senate has been stalled in committee since January.

A Host of Anxiety Drugs, Begat by Valium
Nicolas Bakalar, New York Times- 2/22/2005

Among famous inventors, Leo H. Sternbach may not immediately leap to mind. But this May in Akron, Ohio, Dr. Sternbach, who is 96, will be inducted into the National Inventors Hall of Fame. He holds more than 240 patents, but perhaps his most famous invention, in collaboration with colleagues, is a chemical compound called diazepam, better known by its brand name, Valium.
      One of the earliest benzodiazepines, Valium was approved by the Food and Drug Administration in 1963 as a treatment for anxiety, and it would become not only the country's best-selling drug, but an American cultural icon. Referred to knowingly in Woody Allen movies, enshrined as "Mother's Little Helper" in the Rolling Stones song, condemned as poisonous in best-selling books, Valium reached the height of its popularity in 1978, a year when Americans consumed 2.3 billion of the little yellow pills. But by the 1980's its reputation for creating abuse and withdrawal problems was well known, and the new selective serotonin reuptake inhibitors like Prozac were widely considered better treatments for anxiety and panic disorders.
      Still, the benzodiazepines -- there are now more than a dozen others available besides Valium -- never disappeared. They are still widely prescribed and, in the view of many doctors, extremely effective in treating not only anxiety and panic disorder, but bipolar illness, insomnia, catatonia and alcohol and drug withdrawal. "The key is to use them correctly," said Dr. Eric Hollander, director of clinical psychopharmacology at Mount Sinai School of Medicine in New York.
      Using them correctly is not so simple. Benzodiazepines cause sedation, which can be either therapeutic or a side effect, depending on the patient's ailment. Dr. Steven Roose, professor of clinical psychiatry at Columbia University, said that for anxiety the "S.S.R.I.'s are still the first-line treatment, but they can initially cause an exaggeration of anxiety symptoms." "Pretreating with benzos can prevent this," Dr. Roose continued, citing Ativan, which "can be used for the sleep problems that S.S.R.I.'s can cause, although it should be used only for a brief term."
      The use of benzodiazepines in drug withdrawal may seem paradoxical, since they can be addictive themselves. But the newer longer-acting benzodiazepines like Klonopin may have fewer withdrawal problems than the older drugs because they are metabolized more slowly and leave the body gradually.
      Even though they don't usually induce euphoria, benzopiazepines can become street drugs of abuse for their sedating effect, and some cocaine users like them to "chill out." The benzodiazepines can also impair motor function, especially during the first weeks of treatment, and cause temporary memory impairment. The drugs do not help with depression, so those with both anxiety and depression, a common combination, may be better off with the double effect of the S.S.R.I.'s. People who use alcohol as self-medication for anxiety are not good candidates for benzodiazepines, which can be deadly when combined with drinking.
      Perhaps most notoriously, there is the danger of addiction, but some believe that may be exaggerated. "My view is that the risk of dependency and tolerance is overblown," said Dr. Michael Craig Miller, assistant professor of psychiatry at Harvard and editor in chief of The Harvard Mental Health Letter. "People being treated for anxiety are not looking for a high; they're looking for relief from their anxiety symptoms, and if benzos give it to them, that's good."

Patterns: Women's Brains on Nicotine
John O'Neil, New York Times- 2/22/2005

Nicotine acts on male and female brains differently, a new study has concluded. But oddly enough, it found that one of the drug's major effects was to make women's brains work more like men's. According to the research, to be published in March in The International Journal of Neuropsychopharmacology, earlier work established differences in cigarette use: women tend to take fewer and shorter puffs, have less success with nicotine replacement therapy and are more affected by "cues" that set off a desire to smoke.
      To look for a biological basis for the differences, the researchers gave a group of 119 smokers and nonsmokers tests while their brain activity was being monitored. With the placebo patch, women generated more brain activity than men, particularly in areas that govern attention, mood, short-term memory and task organization. When the subjects were given nicotine, these differences diminished greatly: brain metabolism decreased among women and increased in men.
      The lead researcher, Dr. Stephen G. Potkin of the University of California, Irvine, said the findings suggested a biological difference in the way nicotine is metabolized. That means that differences in smoking patterns and in quitting may have a biological basis and not be just "a consequence of different ways of inhaling or a different number of cigarettes smoked," he said.