Noteworthy News Articles, June 1-6, 2005

MIAMI - On a recent evening at the Village, a drug rehabilitation center for adolescent girls here, a work by the artist Lorna Simpson was projected on a cinderblock wall in the dining room. Side-by-side photographs on a wooden accordion screen depicted a girl with a toy boat on her lap and the same girl with clasped hands, along with the words, "Marie said she was from Montreal/ although/ she was from Haiti." Like every other piece that had been projected in the previous hour, the artwork, "Screen No. 1" (1986), elicited a burst of responses from the 12 girls in the room. "A lot of times when you come to a different country you are ashamed of the way people observe you and talk about you -- so you say you're from somewhere else," a girl named Ashley commented. "Why Montreal instead of Haiti?" asked the instructor, Jillian Hernandez, an educator from the Museum of Contemporary Art in North Miami. "Montreal and Haiti are both based on the French language, and maybe Montreal seemed more high-class," offered another girl, Brittany. "How does the imagery go along with the text?" Ms. Hernandez asked. "Why is there a boat in that picture?" "They actually call Haitians 'boats,' " Ashley reported. "I didn't know that - there you go!" Ms. Hernandez said. "I know that some kids who come for MOCA's after-school programs don't say they're Haitian because they get teased in school. So here the artist is talking about the shame that some people have about their own heritage and how they lie to protect themselves."
      That a Lorna Simpson work dealing with complex issues of personal identity might be immediately accessible to girls from difficult backgrounds makes perfect sense to Ms. Hernandez. It was her idea to use contemporary artists who are women as therapeutic examples for such girls in such workshops, which got under way in Miami-Dade County last year. The outreach program, called Women on the Rise!, has been introduced by the Museum of Contemporary Art at six centers for teenage girls coping with juvenile detention, drug abuse, sexual and physical violence or emotional disorders. Among the artists covered are Louise Bourgeois, Ellen Gallagher, Ana Mendieta, Shirin Neshat and Carrie Mae Weems, whose art explores the emotional terrain of female sexuality, body image and ethnicity that these teenagers negotiate every day. "A lot of girls I work with are into the segment of hip-hop culture that's very misogynist and violent," Ms. Hernandez said. "You have more girls in gangs, which I think gives them a false sense of empowerment."
     Reflecting a nationwide trend, the number of girls entering Florida's juvenile justice system for committing violent crimes rose by 24 percent between 1993 and 2003 -- compared with a 2 percent increase for boys in the same period, according to the state's Department of Juvenile Justice. "When they learn about these women artists, who have had blows dealt to them and have struggled just to be able to practice art, it provides them with unexpected role models," Ms. Hernandez said. "They identify heavily with Ana Mendieta, for instance, who was told by her high school art teacher she was no good and yet she continued on." (Ms. Mendieta was exiled from Cuba to the United States without her parents in 1961, at age 12.) "A lot of them have been through the foster care system," Ms. Hernandez said of the workshop participants. "A lot of them have immigrant families. They understand the difficulty of coming to the United States and not knowing the language."
     When educators at the Museum of Contemporary Art first contacted juvenile centers to gauge interest, they found that nothing remotely like the program existed. If the centers had any art programs at all, they were of the craft variety -- quilting, knitting, making macaroni necklaces. So Adrienne von Lates, the museum's curator of education, and Ms. Hernandez put together a curriculum of four two-hour workshops that could easily be offered at each center. To date, the program has served some 400 girls.
     Appearing scarcely older than a teenager herself, Ms. Hernandez, 25, is quick to establish a rapport with each group, a relationship somewhere between mentor and big sister. The first hour is like a college-level art history class: she gives an overview of the artists being discussed, shows slides and opens the room to discussion. The language in the reading material on the artists is sophisticated; as the girls read it aloud, and Ms. Hernandez reviews any words or ideas that are difficult. "A lot of these girls suffer from low expectations," she said. "I really come at them expecting a lot, and very often they will meet me at that level."
     In the second hour, the teenagers work on an art project inspired by an artist they have just studied and that usually involves photography or collage. At the Village, one of the Lorna Simpson pieces, "Stereo Styles" (1988), consisted of 10 photographs of African-American women depicted from behind in identical dress, with only the hair styled differently. Running along the bottom of the serially mounted photos was the text: "Daring, Sensible, Severe, Long & Silky, Boyish, Ageless, Silly, Magnetic, Country Fresh, Sweet." The girls then each found a partner so they could photograph each other's hair from behind. "It's this idea of what hair says about you," Ms. Hernandez told the girls, many of whom had been playing with each other's hair before the workshop began and greeted the project with enthusiasm. One girl was concerned that her hair fell under the "boyish" category. "I think Lorna Simpson's talking about labels, and I think she's criticizing those labels," Ms. Hernandez said. Another chose to focus on the wildly curly tips of her subject's brown hair; another zoomed in so closely on a bun it seemed abstract.
     A popular art project in the program is based on a series of collages in which the Kenya-born artist Wangechi Mutu cobbled together pieces of advertisements from beauty magazines and assembled them to create disfigured women as a way of questioning cultural ideals of perfection.
     As part of "Women on the Rise!," all the groups except those at the Miami-Dade Juvenile Detention center visit the Museum of Contemporary Art. For most of them, it is the first time they have ever been to a museum.
     This spring, groups took in shows by Ms. Gallagher and Ms. Bourgeois, whom they had previously studied in workshops. "I wasn't sure that they would relate to someone who was so different from them in terms of background, but they loved Louise Bourgeois," Ms. Hernandez said. (Many works by Ms. Bourgeois, now 93, who was born into an upper-middle class family in Paris, were inspired by her troubled relationship with her father.) "One of her sculptures is of a woman's body that looks like it could be pregnant and there's a knife hovering over it," Ms. Hernandez said. "The girls suggested all these stories like, 'Maybe this woman's pregnant and she doesn't want the baby.' Or, 'Maybe this woman was raped or maybe this woman wants to kill herself.' They can deal with something that may have to do with them personally but without making themselves vulnerable."
     When Ms. Hernandez leads the workshop on Ms. Mendieta, she always has the girls read this quotation from the artist: "I know if I had not discovered art, I would have been a criminal." "I ask them what they think about that," she said. "They may say, 'I can see how if I'm feeling really angry about something, maybe I can write in a journal or draw instead of acting on something that may hurt me later.' " "That's the lesson that gets through," she continued. "I don't know if it will change anything they do, but at least they have tools to come at it differently."

Training a Narrow Lens on Bulgarian Addicts
Jeannette Catsoulis, New York Times- 6/1/2005

Ever since Kevin Spacey was given heroin through his toes on a 1988 episode of "Wiseguy," drug-dependent characters have been lurching across entertainment culture with the regularity of commercial breaks. Recently, and perhaps inevitably, the hunter-gatherers of reality television have entered the fray, and the fictional addicts of "The Shield" and "The Wire" have been joined by the troubled subjects of a confrontational new program, "Intervention."
      All of which is to say that bestowing the title "Invisible" on a documentary about addiction is, to Western eyes at least, more than a little quaint. But when the New York-based filmmaker Konstantin Bojanov returned to his home country, Bulgaria, in 2000, he was appalled to discover that heroin addiction, almost unknown there before the fall of the Berlin Wall in 1989, was a virtual epidemic. Choosing six addicts, whose ages ranged from 18 to 39, Mr. Bojanov spent three years gaining their trust and "hoping to provide a glimpse" into their lives.
     The problem is, absent the imagination of a scriptwriter, the life of the average addict simply isn't all that interesting. Parking the camera directly in front of his woozy subjects, Mr. Bojanov dutifully records rambling tales of abuse and neglect and disenchantment, occasionally allowing us a close-up of a weeping abscess or a bloody syringe. Rusty, dusty and rubble-strewn, the film's palette is so depressing that a sudden blurry shot of colored rooftops is as unexpected and uplifting as a Titian in a crack den. And though each character is living a distinctly personal tragedy, the filmmaker's antipathy to context or coherence effectively bars us from all but the most fleeting emotional involvement.
     But there is one deeply troubling scene toward the end as a 39-year-old addict named Remi appears to overdose. Under the calm eye of the camera, a drug-addled friend thumps Remi's chest and fishes for his tongue, and for an endless moment the fundamental ethical friction at the heart of the documentary process itself comes sharply into focus. I was reminded of the director Steve James and his documentary "Stevie," about a disturbed young man. Recalling a catastrophic incident during shooting, Mr. James described himself as the "idiot" who stood by filming as his subject went out of control. I'm sure Mr. Bojanov can relate.
     Invisible- Produced and directed by Konstantin Bojanov; in Bulgarian, with English subtitles; director of photography, Hristo Bozajiev; edited by Stela Georgieva, Mr. Bojanov and Boryana Alexandrova; music by Masami Tomihisa, J. J. McGeehan and Bonnie (Prince) Billy; released by Konstantin Bojanov Projects. At the Two Boots Pioneer Theater, 155 East Third Street, at Avenue A, East Village. Running time: 89 minutes. This film is not rated.

Scientists have found the chemical equivalent of the perfect sales pitch: a hormone that makes us more trusting than we normally are. Volunteers in a study were told they were participating in a decision-making experiment. Those who inhaled the hormone, which occurs naturally in the brain, were more likely to entrust others with large sums of money than were volunteers who inhaled no hormone.
      The experiment has profound implications about the nature of human trust. Researchers said their finding might lead to cures for people with disorders that prompt them to hold others at arm's length, but they acknowledged that the chemical, which is widely used in medicine, could be misused. The experiment, involving 128 participants, was conducted by scientists at the University of Zurich and other academic centers. Researchers had some volunteers inhale oxytocin and then examined how they and those who inhaled a placebo invested money in a mock transaction. The transaction involved taking a risk: handing over money to a "banker" who had the option of returning the investment with a profit or withholding principal and profit, leaving the investor with nothing. The experiment was a measure of the trust that the investors had in the bankers. Volunteers who inhaled oxytocin were more likely to trust the banker with money and risk larger sums, the researchers said in an article published yesterday in the journal Nature. The scientists said they made sure the chemical was not merely enhancing risk-taking behavior by substituting bankers with computers. Without the interaction with a human, the hormone had no effect.
     Oxytocin did not alter the behavior of the bankers, which strengthened the researchers' belief that the hormone was influencing trust. Bankers did not need to trust investors, because they were taking no risk. A banker's decision to return money was more a question of fairness, which oxytocin did not affect.
     Trust is central to virtually every positive social relationship, from intimate love and friendships to financial transactions and politics, but little had been learned about its biological correlates in the brain, researchers said. Oxytocin is known to be activated in a range of social relationships in many animals, but this is the first time scientists have shown that it can serve as a switch to enhance trust in human relationships.
     Ernst Fehr, director of the Institute for Empirical Research in Economics at the University of Zurich and one of the scientists who conducted the experiment, said the peak effect of oxytocin was seen after about 50 minutes and it wore off after two hours. "Some may worry about the prospect that political operators will generously spray the crowd with oxytocin at rallies of their candidates," said neurologist Antonio R. Damasio of the University of Iowa, who has long studied the neurobiology of human emotions and who wrote a commentary accompanying the study. At the same time, he added in an interview, politicians and marketers were probably already triggering the natural release of oxytocin in the brains of audiences through their campaigns. "I am more alarmed about the manipulations of marketing than the possibility of oxytocin sprays," he said.
     Ethicists and theologians said manipulating the brain at a neurochemical level was different from ordinary kinds of persuasion. David A. Hogue, a theologian and pastoral psychologist at Garrett-Evangelical Theological Seminary in Chicago, said that "anytime we are working directly on the central nervous system, it feels much more intrusive." Brent Waters, an associate professor of Christian social ethics at the seminary, which is affiliated with Northwestern University, questioned whether trust could be so easily reduced to chemical constructs. "The experiment presupposes a highly diminished and reductionistic understanding of what trust means," he said.
     Damasio, the neurologist, said it was inevitable that science was going to learn more about the biological correlates of trust and other human emotions. He said he saw no reason such knowledge should affect notions of human dignity and agency. "The question is do you want to preclude yourself from understanding, do you want to deny yourself the entire compass of knowledge that can come from science?" he asked.
     Fehr and the study's other authors acknowledged the potential for misuse of oxytocin, but he argued that it was no different than any other prescription product. Regulation, he said, could limit abuse. Hogue, the theologian and pastoral psychologist, said the research held out the possibility of reconciliation between individuals and the potential of healing rifts between political groups, even nations: "While spraying oxytocin on one's political or religious adversaries may be strategically difficult, comprehending the biological correlates of trust could conceivably offer promising avenues for reassessing and reconciling conflict."

It's hard to write this sentence: There is something women don't do as well as men. Sleep. So what's a woman to do? If you are swayed by advertising, the easy answer is to take a pill. Americans spend more than $2 billion on prescription sleep medicines. Since women are twice as likely as men to have difficulty falling and staying asleep, according to research at the National Institutes of Health, they are likely to be spending much of that money. The market for sleeping pills is expected to grow substantially, and drug companies are bullish about pitching these to women, even though some experts question whether such medicines are necessary.
      One of the most ubiquitous advertisements for sleeping pills is for Ambien, the current market leader. Sales of the drug, made by Sanofi-Aventis, a French company, increased 17.8 percent in the United States last year and reached $1.5 billion. Ambien currently has 86 percent of the United States market share for prescription sleep medicine, the company said. A new sleeping pill, Lunesta, came on the market in April. Unlike Ambien, which is indicated for use of a week to 10 days, Lunesta, manufactured by Sepracor, is approved for up to six months' use by the Food and Drug Administration. Lunesta is being backed by a $60 million marketing campaign. Women will be treated to their own set of ads. Two new drugs are also in the pipeline for F.D.A. approval: Ramelteon, from the Japanese drug maker Takeda Pharmaceutical, and Indiplon from Pfizer.
     The ads and the drug company Web sites suggest that these drugs are safe, and imply that they may even be necessary, noting that lack of sleep is cited as a factor in heart disease, obesity and other complications. Poor sleep is blamed for lack of sex, missed workdays and car accidents, too. And to look good, of course, you have to get rest.
     These messages nestle neatly with prevailing attitudes that women have about themselves. Many women say, for example, that sleep is something they should be able to master. "Some women think they are failing at sleep," said Dr. Gary K. Zammit, who is the director of the Sleep Disorders Institute at St. Luke's-Roosevelt Hospital in Manhattan and an expert in clinical pharmacology; he is also a consultant and has done research for most sleep medicine on the market. He described one patient who saw sleep as one more item on her to-do list.
     Over-the-counter drug companies have caught on to this desire for more sleep. Recently, a Tylenol PM ad in three women's magazines suggested that the pill could help prevent acne and dry skin. "Women have always been the target for sleep aids," said Kathy Fallon, director of communications for McNeil Consumer and Specialty Pharmaceuticals, which makes Tylenol. "They sleep less and they tend to medicate." She said that the ad was inspired by a 2001 article in The Journal of Investigative Dermatology that found that stress from lack of sleep could cause skin problems.
     It's enough to make women do just about anything to get some rest. There are lots of products and services that capitalize on this anxiety and promote the idea that sleep is a luxury: masks, teas, DVD's. In May, the Neiman Marcus catalog included a $1,250 traveling sleep kit from Chanel with a silk eye mask, silk pillow and cashmere socks. But women may still resort to a pill to get to sleep.
     Celeste Lee, 42, a furniture designer in Manhattan, has had lifelong trouble falling and staying asleep. About 10 years ago, Stephanie Casado, 29, a lawyer in Philadelphia, stopped sleeping well. Cory Olsen, 26, a part-time bartender in Manhattan who also works in financial services, has trouble sleeping on weekends when she finishes her bar shift. Ms. Olsen takes Ambien, prescribed by her doctor; Ms. Casado takes Ativan, which she gets over the Internet; and, Ms. Lee takes whatever prescription sleeping pills she can get from her friends, who, these days, are taking either Ambien or Xanax. Though these women say that not sleeping is frustrating, they are not concerned about their drug use. "It's perceived as if they are benign," Ms. Lee said. "They are these tiny little things, and because you believe that having a good night's sleep allows you to perform better, it's a happy drug." Ms. Olsen takes half of an Ambien pill most Sunday mornings when she arrives home from her bartending job. She says she is too wired to sleep after mixing martinis until dawn. And on Sunday nights, when she knows she needs to get a good night's sleep before heading to her day job, she takes the other half of the pill. "It's O.K. if I have an aid every once in a while if I get a good night's sleep," she said.
     The notion that it's fine to use a pill to schedule sleep when it's convenient is a relatively new concept, said Dr. Meir Kryger, professor of medicine at the University of Manitoba and author of "A Woman's Guide to Sleep Disorders." "We don't know if it's a good thing or a bad thing," Dr. Kryger said.
     Some doctors and other experts think that sleeping pills may do more harm than good. "The idea that you take a sleeping pill, you sleep better and do better the next day is just not true according to data," said Dr. Daniel F. Kripke, research professor of psychiatry at the University of California, San Diego. Dr. Kripke runs his own Web site, darksideofsleepingpills.com. "There's a lot of scare talk about automobile accidents," he said. "The best evidence is that sleeping pills cause the auto accidents." Dr. Kryger said that sleep medications could be useful, but added that "the most important thing with insomnia is to make a diagnosis." He stressed the importance of treating the underlying disorder, not simply the insomnia.
     A recent study published in the Archives of Internal Medicine suggested that cognitive behavioral therapy may be more effective than Ambien in the long term. "The data are quite clear; good sleep hygiene goes a long way to solving intransigent moderate insomnia problems," said Dr. Carl Hunt, director of the National Institutes of Health's National Center on Sleep Disorders Research. Sleep hygiene means making sure your bedroom is comfortable, your pillow plumped, your lights are dimmed and nothing can distract you from falling asleep.
     Part of good sleep hygiene is living healthfully, including exercising and limiting caffeine and alcohol. That worked for Ann Peterson, 41, a caterer and mother of three who lives in a Seattle suburb. When Ms. Peterson was 37, she woke every night for two months around 2 a.m. and stayed awake for hours. "I thought I was going crazy," she said. Her doctor diagnosed depression and put Ms. Peterson on an antidepressant, which she hated and stopped taking. Soon after, Ms. Peterson started doing yoga and occasionally taking a natural sleep aid called Calms Forté. She doesn't watch TV or read in bed. Instead, she does the corpse pose, the last pose in a yoga session. "Then I'm snoring!" she said.

From an early age, Grace Mahoney's life was ruled by fear. She recalls having her first panic attack in nursery school, and "it kind of progressed from there," said Ms. Mahoney, 38, of Jackson Hole, Wyo. The attacks would strike randomly, even waking her up. She became so frightened of having an attack that she avoided situations where she didn't have control. "We would visit my uncle in New York who lived on the 39th floor and my father would walk up all 39 flights with me because I wouldn't get in the elevator," she said. Ms. Mahoney never told anyone about her distress. "Adults would say, 'Oh, she's just shy,' " she said. "But I was scared and depressed." Finally, at age 18, she was diagnosed with panic disorder, a serious anxiety condition.
      According to the National Institute of Mental Health, anxiety disorders affect 19.1 million people in the United States, and women have twice the risk as men. Their effects can be devastating. "These disorders cause as much interference in functioning as the most severe chronic physical disorders like pulmonary disease or cardiovascular problems," said David H. Barlow, the director of the Center for Anxiety and Related Disorders at Boston University. Studies show that these disorders account for billions a year in medical costs. Symptoms can mimic illnesses like heart attacks, and sufferers are three to five times more likely to see doctors and six times more likely to be hospitalized.
     Anxiety disorders include panic disorder, which are episodes of intense fear; phobias, which are irrational fears of a place or thing; generalized anxiety disorder, which is chronic worrying; post-traumatic stress disorder, linked to a traumatic event; and obsessive-compulsive disorder, which involves repetitive behavior or disturbing thoughts. Many disorders overlap. For instance, the fear of having a panic attack can lead to phobias. During a panic attack - a type of fight-or-flight response, a mechanism that protects us from danger -- the autonomic nervous system activates the adrenal glands to produce adrenaline and noradrenaline. Blood rushes to the large muscle groups, the heart beats rapidly, breathing accelerates -- giving the person greater abilities to run from or fight a predator. But when there's nothing to be afraid of, the response itself becomes scary.
     Why are women more at risk for these disorders? While no one knows all the reasons, experts say that genes and environment play a large role. "We have genes that predispose us to anxiety," Dr. Barlow said. "Yet many people have these genes and never suffer any untoward consequences. There has to be interaction with learning and environment, so the environment turns on the genes." Early learning experiences set off these genes, he said. "Despite the advances we've made, most girls are not socialized to experience as much mastery and control as boys are."
     What about hormones? "They don't seem to play into the genesis of these disorders as far as we know," Dr. Barlow said. But hormonal fluctuations may exacerbate anxious symptoms, said Dr. Catherine Birndorf, director of the Payne Whitney Women's Program at NewYork-Presbyterian Hospital. "It's the up and down in the menstrual cycle that can lead to disregulation of brain chemistry, which may increase vulnerability."
     Disorders tend to show up during adolescence and up to mid-30's. A stressful event is often a catalyst. "It's usually within six months to a year after someone has gone through some major stress," said Jerilyn Ross, president of the Anxiety Disorders Association of America and a psychotherapist who treated Ms. Mahoney. "They get through it fine and then seemingly out of the blue they have a panic attack or they start worrying obsessively."
     The encouraging news is that most anxiety disorders are treatable with therapy or medication, or both. The first line of defense is cognitive behavioral therapy, which focuses on changing distorted thinking and confronting painful situations. Medications like selective serotonin reuptake inhibitors and older tricyclics are commonly prescribed. Benzodiazepines are sometimes used shortterm but they can be habit forming.
     In future, anti-anxiety medication will become much more focused, which may reduce side effects, said Dr. Michael Liebowitz, director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute. "The search is on for more discrete drugs that will only hit certain receptors" in the brain, he said. "People are working on the dopamine system, seratonin system, the GABA system and other targets."
     The crucial step is to get help. Anxiety disorders will make your world smaller and smaller, Ms. Ross said. "You start turning down a promotion because you're afraid to fly, or you start taking roundabout ways to avoid going over a bridge, and then you start avoiding all bridges. Left untreated, these disorders will seep into all areas of your life."

Mental Health Tests for Kids Spark Debate
Bonnie Miller Rubin, Chicago Tribune- 6/52005

Suzanne Cahalan knew there was a problem when her 4-year-old daughter started stealing from friends and relatives. But it took eight years before the Wheaton mother of four finally found out that the girl suffered from bipolar disorder.
Such delays in diagnosis make a powerful case that youngsters should be monitored closely for mental health problems, according to children's advocates who are drafting a plan to increase awareness in Illinois schools about depression, anxiety and other disorders, as well as the need to screen children when warning signs occur. "Our daughter lost some crucial growing-up time," said Cahalan, an attorney. "If we had known earlier, we could have sought appropriate treatment to alleviate some of her symptoms. We could have saved not only her, but our entire family from some very terrifying days."
      Critics say that such initiatives are what is truly terrifying. Conservative and anti-government Web sites have been buzzing for months about how such plans will lead to children being forcibly tested, unfairly labeled--and even drugged. Most of all, opponents say that watching out for mental disorders is the responsibility of parents, not institutions. "The purpose of school is to educate," said Fran Eaton, a lobbyist who represents the Illinois Family Institute, Concerned Women of America and other conservative groups in Springfield. "At a time when the U.S. is lagging behind other nations in math and science, is this what we should be doing? Do we really want the state involved in determining emotional and social development?"
     The idea of being more proactive gained momentum after President Bush's New Freedom Commission on Mental Health found in 2003 that only 20 percent of troubled children receive treatment, and it called for schools to play a bigger role. Congress allocated $20 million for states to develop a range of programs, emphasizing prevention, early identification and intervention. "This is not a hunt to find mental illness. It's about trying to support children so they can be healthy," said Barbara Shaw, chairwoman of the Illinois Children's Mental Health Partnership, the task force developing the plan to improve access to treatment for youth from preschool through adolescence. A new draft of the plan is due on the governor's desk by month's end. "Children have been kicked out of day care centers, failed in schools and generally suffered needlessly," Shaw said. "Through better screening, parents will have more information to help them help their children."
     Assessment tools are already used by primary care physicians, in early childhood programs and a variety of school settings. Questionnaires that evaluate mood and behavior--such as the TeenScreen Program developed at Columbia University--are used to identify those at high risk for depression and other mood disorders. A sample question asks: "In the past month, how much of a problem have you had with feeling unhappy or sad?" Responses range from "1, no problem" to "5, very bad problem."
     In the primary grades, one popular questionnaire is Ages and Stages, which is filled out by parents. In all cases, trained personnel, such as school psychologists, do the scoring. If concerns are identified, parents are encouraged to get further information. Any follow-up is at the discretion of the parent, officials said, just as it is when a child is identified as needing eyeglasses. "Here we have something that can really help kids," said Dr. Louis Kraus, head of child and adolescent psychiatry at Rush University Medical Center. "If schools are just to educate, then why do we require a physical exam or that vaccines are up-to-date? It makes sense to use schools . . . because that's where the kids are."
     The Chicago Public Schools system has hired a consultant from the University of North Carolina to help more preschool teachers figure out when a child's problems are serious enough to require help such as special education services. School leaders hope to get budget approval for mental-health screeners and teacher training for about 25 schools beginning in the fall.
     As with cancer or diabetes, mental illness is most responsive to therapy when caught early, said Dr. Carl Bell, a child psychiatrist and president of the Chicago Community Mental Health Council. When left untreated, mental illness places children at higher risk for dropping out of school, substance abuse, criminal activity and suicide. School officials already patrol for everything from tuberculosis to head lice, and mental illness should be no different, he said. "All they're doing is jacking it up a notch," said Bell, calling this one of the most urgent public health issues of the day. "We're at the point where it's going to become unethical not to do these things--just as, in 2005, it is not ethical to deny a child a polio or a smallpox shot."
     However, anti-government and anti-psychiatry groups--nationally as well as in Illinois--believe the diagnosis of mental illness is subjective, at best. And they contend that such ambitious plans come with a built-in profit motive. "The stakeholders in this campaign have a financial interest in inflating the roster of children and adults who get labeled mentally ill," said Vera Hassner Sharav, president of the Alliance for Human Research Protection, a patient advocacy group. More screened kids means more money for psychiatrists and the pharmaceutical industry, she said. Kraus scoffed at that notion. "Most of us are so overwhelmed by demand that the concept that we're pushing for this to line our pockets is a joke."
     A conservative newsletter, the Illinois Leader, helped fuel the controversy by reporting that testing would be mandatory and done without parental consent. Officials say this is not true. Nevertheless, when the Illinois partnership--made up of representatives from more than 30 health, education and child advocacy groups--delivers a new draft, it will spell out more explicitly that any screening would be voluntary and by parental permission.
     The furor started to bubble up last fall, when the partnership held public forums at five locations around the state, including Chicago. One common fear is that all students would be screened, not just those exhibiting troubling behavior. Eaton, the lobbyist, said private citizens shared their experiences with her, recalling how they were different from other students and did not fit the mold. In today's climate, "they were confident that they would be stigmatized as mentally ill. It was very painful to listen to." "Testing for kids in foster care or corrections--we have no objections with that," she said. "It's the idea that every child is seen as having a potential need for mental health care is where we have a problem."
     Tweaking the language of the proposed plan doesn't placate State Sen. Chris Lauzen (R-Aurora), who calls it an overreach of government. "When I listened to constituents on this issue, I heard real fear in their voices . . . that their kids would be labeled; that other classmates might not want to play with them," Lauzen said. Proponents say one way to erase the stigma is to bring mental health into the mainstream. They also argue that it is unpredictable behavior, not the results of an assessment, that separates children from their peers.
     The eight-year lag experienced by Cahalan's daughter from onset of symptoms to diagnosis and treatment is fairly typical, experts say. At age 12, the girl finally received the medications that tamed her mood swings. She will study nursing at a local college this fall. Still, Cahalan laments the squandered years. "If my kid had asthma or leukemia, I'd want her labeled at an early age," she said. "I feel like she lost her childhood . . . and we can't ever get that back."

Targeting Marijuana Saps Anti-Drug Effort, Critics Say
Stevenson Swanson, Chicago Tribune- 6/5/2005

NEW YORK -- A new government anti-marijuana campaign has reignited a long-smoldering debate over how dangerous the most widely used illegal drug in America really is and whether it should be the central focus of the nation's war on drugs. Headlined "Marijuana and your teen's mental health," an advertisement appearing in newspapers and magazines nationwide cites scientific studies in the last seven years that have found that regular use of marijuana in the teenage years can put users at risk of depression, suicidal impulses and schizophrenia later in life. "Still think marijuana's no big deal?" the ad asks parents.
     Yes, responds one leading advocate of decriminalizing marijuana. "If you want to focus on problem drugs in the U.S., marijuana is the last drug you would focus on," said Ethan Nadelmann, executive director of the Drug Policy Alliance, which favors treating marijuana like alcohol: a legal product that is regulated, taxed and illegal for minors to use. "We have methamphetamine out there, we have heroin, we have OxyContin, we have booze, we have cigarettes. To make statements that marijuana in the hands of teenagers is this dangerous threat, it's ludicrous."
      And last week, Nobel Prize-winning economist Milton Friedman and more than 500 other economists endorsed a report that said state and federal coffers could reap a net gain of $13.9 billion if marijuana were legalized. The study by Harvard University economist Jeffrey Miron estimated that law enforcement would save $7.7 billion, while taxes on the drug could amount to $6.2 billion. Miron's study was largely funded by the Marijuana Policy Project, a Washington, D.C., lobbying group that supports liberalizing marijuana laws.

Mental health alert
      The renewed war of words regarding a drug that has been prevalent in American society for some 40 years erupted in early May when John Walters, the Bush administration's drug czar, launched the government's latest print and broadcast ad campaign. "A growing body of evidence now demonstrates that smoking marijuana can increase the risk of serious mental health problems," said Walters, whose official title is director of the Office of National Drug Control Policy.
     One recent report, by the Substance Abuse and Mental Health Services Administration, found that adults who had used marijuana before age 12 were twice as likely to have experienced a serious mental illness in the past year as those who began smoking it after 18. Among early users, 21 percent reported suffering a serious mental health problem, compared with 10.5 percent among those who started smoking marijuana later. The study was based on interviews with almost 90,000 adults.
     Other studies cited by the drug control office, which will spend $120 million on public-education advertising this year, have found that teenagers who smoke marijuana weekly are three times more likely than non-users to have suicidal thoughts and that some teenage users have a higher risk of developing schizophrenia as adults. "We are very concerned about marijuana for a very good reason," said David Murray, a policy analyst for the drug control office. "It's so prevalent, so widespread in the population. There's a public-health responsibility here. This is not an innocuous drug."
     A University of Michigan study found last year that 34.3 percent of high school seniors and 11.8 percent of 8th graders had smoked marijuana in the previous 12 months. Drug use among teenagers has been falling since 1996, the study noted.
     Teenagers are the targets of the government anti-marijuana campaign because officials believe that use of marijuana early in life can lead to harder drugs such as cocaine or heroin later. And adolescents may feel they are fully grown, but they aren't. "The evidence is now pretty significant that central nervous system development is not complete in adolescents, and the use of this drug may have effects on the maturation of their central nervous systems," said Dr. Richard Suchinsky, a psychiatrist who oversees the Department of Veterans Affairs' addiction programs. "It inhibits certain functions, such as cognition, judgment and the ability to postpone gratification," Suchinsky said.
     But critics of the government's war on drugs say the latest studies do little to advance what is already known about marijuana and do not prove that the drug is responsible for mental illness. Children and teenagers who are predisposed to have mental health problems may be more likely to try marijuana, they say. "There's a question about whether there's a causality," said the Drug Policy Alliance's Nadelmann. "What's interesting about marijuana, you can't even find a presidential candidate now who will say he has never used it. We all know people who have smoked marijuana for periods of time, and they're all doing fine."

D.C. vs. California
Ten states have approved marijuana for medical use by cancer patients and others who appear to benefit from its relief of severe nausea. That has set up a classic states' rights confrontation between the federal government and one such state, California. In a case pending before the U.S. Supreme Court, federal authorities argue that they can override state medical marijuana laws. The 9th U.S. Circuit Court of Appeals ruled in the case that federal officials had overstepped their constitutional boundaries when they raided the homes of patients who were growing marijuana for their own use. The Supreme Court is expected to issue its opinion before the current session ends later this month.
     The war on drugs, whose law enforcement, public education and other components cost an estimated $35 billion a year, has come under fire lately not only from groups such as the Drug Policy Alliance, which favors a heavier emphasis on treatment and prevention, but also from some conservative organizations such as the American Enterprise Institute, a Washington think tank. In a March assessment of the war on drugs, the institute reported that the number of drug offenders in jail has ballooned tenfold since 1980 with little evidence that the tactic has led to markedly less drug use in the general population. "Despite this massive investment of tax dollars and government authority, the United States still has the worst drug problem among Western nations," the study concludes. The study also questioned the efficacy of pursuing marijuana users, a pursuit that has grown dramatically as a proportion of the war on drugs in the last decade.
     Between 1990 and 2002, the number of drug arrests rose from about 1.1 million to more than 1.5 million, with 80 percent of that increase coming from marijuana arrests, according to a recent report by The Sentencing Project, which examined FBI data to draw its conclusion that the war on drugs has increasingly turned into a campaign against just one drug--marijuana. Murray, of the anti-drug office, criticized the report for "data-slicing" by choosing as its starting point a period when the nation was battling an epidemic of crack cocaine and when cocaine arrests were abnormally high. "What appears to be a policy choice is in fact a natural response by law enforcement to a change in use patterns," he said.

Extent of use cited
Despite longstanding concerns about the addictive power of heroin and cocaine and growing worries about methamphetamine, which is often manufactured in household labs, a spokesman for the drug policy office said the government's emphasis on marijuana is justified by its status as the most widely used drug among minors. "If you are trying to get useful information into parents' hands, this is the more educative way to go," said spokesman Tom Riley.
     But Mitch Earleywine, a psychology professor at the University of Southern California, believes that the campaign overstates the dangers of marijuana and runs the risk of backfiring among teenagers, who are already skeptical of adults. "My big worry is that if you tell a 14-year-old that if you smoke pot, you're going to become psychotic, and then he tries it and nothing happens, you lose credibility," said Earleywine, author of "Understanding Marijuana." "So when you tell him that using meth will make your brain smaller, which it absolutely will, he'll think, `You lied to me about the marijuana, so I think I'm going to smoke this meth.'"

'Soft Addictions' Hard to Kick
Evelyn Theiss, Newhouse News Service- 6/5/2005

Watching reruns of "Seinfeld" that you've seen a dozen tunes. Bidding on eBay. Reading magazines and tabloids for celebrity gossip. Collecting knickknacks. Checking game scores on ESPN. Watching CNN during most of your waking hours. In dribs and drabs, habits like these consume our days.
     Judith Wright says spending our time like that costs us much more in hours and dollars than we think The Chicago-based-life coach and author has a name for such time-- or money-wasters: soft addictions. The problem with soft addictions, she says, is that "We end up eventually spending thousands of hours, and maybe thousands of dollars, on them. Then we hit a certain point in our lives and we wonder: Where has it all gone? Where has my life gone?" That's why she titled her book "There Must Be More Than This: Flnding More Life, Love and Meaning by Overcoming Your Soft Addictions" ($23, Broadway).
The journey toward "more" was one. that Wright herself made. She grew up in the factory town of Flint and was an overachiever, even as a young girl. She made a list of things that she wanted to accomplish, and did She became an excellent student and her class valedictorian, she became a student leader; president of a halfdozen clubs at school; she took dance lessons, read voraciously and, in short, "thought if I kept doing more, I'd be happy. But I never got there." She also noticed the adults around her, many of them people who worked in factories by day and "checked out" by drinking beer; and watching TV every night:. "None of them seemed happy, either."
     Wright thought getting out of Flint was one answer. So she went
to college, got her degree in education and achieved national prominence as an educator of people with disabilities. She lost the extra weight she had had since childhood, and married her college sweetheart "I thought for sure I'd be happy then, especially once I got thin," she said. She wasn't. "Even though I stopped eating so much, I was still obsessed with food --with shopping, reading recipes, cooking spending so much time on that," she says. "I knew something was missing -- it was like I wasn't really living.
     "One day, I made a decision -- a profound commitment to shift the fabric of my life," says Wright. "I didn't know how to do it, but I knew I wanted to feel more, experience more, be more conscious." She became a life coach, and got out of a marriage that she realized had little intimacy A few years later, she married a man named Bob Wright, who was also a life coach. They founded the Wright Institute for Lifelong Learning in Chicago. At their center, the Wrights often worked with people recovering from addictions, usually to alcohol or drugs. "We noticed that people would do phenomenal work, learn new coping skills, become more effective in their lives, and then they'd
just stop," says Wright. Clients would report that after they did some training, they'd go home, and feelings -- perhaps of anxiety or sadness -- would come up. "And they'd eat ice cream, or watch TV, or do something else to avoid them."
     Judith Wright came up with the term "soft addictions" for the things people would do to distract themselves from feelings they didn't want to have. She wanted people to think about what dreams they had deferred through these habits, and what hungers -- usually for intimacy, connection with others, selfawareness -- weren't being addressed
     So what makes something a soft addiction? Wright says it's usually a matter of balance. Watching a TV show that you've looked forward to -- what she calls "destination TV" -- is one thing. Zoning out while flipping channels or mindlessly watching four sitcoms in a row is another thing. "Yes, I know people need to relax, but don't tell me that four hours in front of the TV or computer is making you feel really good," she says. "We think soft addictions help us relax, but when we do too much of whatever it is, we feel depleted."
     Wright is not alone in her theories about: distraction. Psychologists have noted how inventions of the past two decades -- including iPods, the Internet, e-mail and cell phones -- have brought us ever more distractions. And staying busy with distractions is a way to avoid what's really going on inside ourselves, says Dr. William Adams, a training and supervising analyst at the Cleveland Psychoanalytic Institute. "There are a great many people who absolutely do not know what's going on inside their minds, and they manage by activity -- often, the more of it the, better -- to avoid their inner world," says Adams, a Harvard Medical School graduate who has been practicing for 55 years. And without that inner life, therapists says, we can't relate to other people, which results in relationships that are shallow rather than intimate.
     The other problem with soft addictions, says Wright, is their cost not just in time, but money.
She's had clients with an addiction to caffeine who went to coffee shops several times a day. "For some, that added up to thousands of dollars a year," she says. "But the same person would say how she had a dream to travel but never had the money -- then figured out she was spending about $1,500 a year on lattes." The greatest loss, says Wright, is in relationships. "What most of us are really hungry for is human connection," says Wright "But we cover that up by feeding ourselves with distractions. We tune out to each other"
     Rich Lyons, 40, of Chicago, owns an information technology consulting firm. He and his wife began working with the Wrights several years ago. Both came from families with an alcoholic history, so they appreciated the cost of any kind of distracting addiction. Rich Lyons' included eating sugary foods when he felt anxious, always having the TV on, working compulsively -- with weights--even through injuries -- and shopping for the latest gadgets. "What I learned was with the sugar, I was stuffing my feelings," he says. "Other times when I felt anxious, I'd just get busy with something."
      Lyons learned about how he avoided his feelings, and then began to spend some quiet time reflecting on his emotions. He also started to share them with his wife, and began to spend more time talking to and doing things with his two daughters. His professional life also improved. "We do so much more as a family now," he says. "We'll play board games instead of watching TV or we'll do things outside. "Even on sales calls now, I have genuine interaction with people -- it's not just about getting their money. "I find life much more satisfying. I feel more nourished, and connected."

Mental Illness Can Start in Childhood
Associated Press- 6/6/2005

CHICAGO -- Most mental illness hits early in life, with half of all cases starting by age 14, a survey of nearly 10,000 U.S. adults found. Many cases begin with mild, easy-to-dismiss symptoms such as low-level anxiousness or persistent shyness, but left untreated, they can quickly escalate into severe depression, disabling phobias or clinical anxiety, said Ronald Kessler, a Harvard Medical School researcher involved in the study.
      That so many cases begin in people so young -- three-fourths start by age 24 -- ''is just staggering'' and underscores the need for better efforts at early detection and treatment, Kessler said. ''These disorders have really become the chronic disorders of young people in America,'' said Dr. Thomas Insel, director of the National Institute of Mental Health, which helped fund the research.
     The findings, published in the June issue of Archives of General Psychiatry, were based on face-to-face interviews conducted with people ages 18 and older in 2001 through 2003. The new figures also show that the prevalence of mental illness nationwide has stabilized for the first time since the end of World War II, Kessler said. About 46 percent of people surveyed said they had experienced a mental illness at some point in their lives, and about 26 percent said they had within the previous year -- rates similar to those reported in a 1994 version of the survey. Before the earlier survey, rates had steadily increased since the mid-1940s, Kessler said. The previous increase was probably at least partly due to better detection and awareness, Kessler said.
     The overall prevalence rate is probably an underestimate because the study included only English-speaking adults and excluded rarer illnesses such as schizophrenia and autism. Most ailments were mild. Only about one-fifth of those who reported any mental disorder within the past year had a serious illness, meaning their daily activities were severely affected.
     On the Net:
Archives: http://www.archgenpsychiatry.com
NIMH: http://www.nimh.nih.gov

Suicide Attempts Linked to Weight Perception
Associated Press- 6/6/2005

CHICAGO -- Suicidal impulses and attempts are much more common in teenagers who think they are too fat or too thin, regardless of how much they actually weigh, a study found. Using actual body size based on teens' reports of their height and weight, the researchers found that overall, overweight or underweight teens were only slightly more likely than normal-weight teens to have suicidal tendencies. But teens who perceived themselves at either weight extreme -- very fat or really skinny -- were more than twice as likely as normal-weight teens to attempt or think about suicide. The study was based on a nationally representative 2001 survey involving 13,601 students in ninth through 12th grade. The findings appear in the June issue of Archives of Pediatrics & Adolescent Medicine, published Monday.
      About 19 percent said they had considered suicide in the previous year and about 9 percent said they had attempted it. About 65 percent of students were in the normal-weight range, but only about 54 percent perceived themselves as ''about the right weight.'' Some thought they weighed too much; others thought they were too thin.
      'Suicide ideation was more likely even among students whose perceptions of body size deviated only slightly from `about the right weight,''' said lead author Danice Eaton, a researcher at the Centers for Disease Control and Prevention. Because nearly half of the students perceived themselves as too thin or too heavy, ''these results suggest that a sizable proportion of students may be at increased risk'' for suicide, the researchers said.
     Perceptions of being very overweight were linked with an increased risk for suicide attempts among whites. But black and Hispanic students who saw themselves as being very overweight were no more likely to say they had attempted suicide than blacks and Hispanics who thought they were about the right weight. The link between perceptions of being very underweight and an increased risk for suicide attempts existed for whites, blacks and Hispanics alike.
     The study did not determine which came first -- perceptions of extreme weight or suicidal tendencies. But the results suggest that extreme weight perceptions might be a suicide warning sign, the researchers said. In an accompanying editorial, Dr. Alain Joffe of Johns Hopkins University said widespread media images of perfect bodies might help shape adolescent perceptions of normal. But he said it is also possible that adolescents who are already concerned with body image pay more attention to media images.
     On the Net: Archives: http://www.archpediatrics.com

Class Helps Kids Kick Their Anger
Annemarie Mannion, Chicago Tribune- 6/6/2005

Dominic Parrilli drew hoots of approval and raucous applause from his classmates when he summoned the concentration and proper technique to break a brick paver block with the palm of his hand during martial arts therapy class at his Oak Forest school. Parrilli, a 15-year-old from Palos Hills who acknowledges he struggles with controlling his anger, said a greater feat is learning to use the power of concentration to manage his behavior in other settings. "When I got mad, I used to feel like, OK, you're dead. I'd just want to hurt you," Parrilli said. "Now when I get into a verbal fight, I focus on resolving it instead of letting it go further."
      Parrilli credits his improved ability to manage his anger to martial arts therapy. He was one of about two dozen students in 2nd grade through high school who took part this semester in the therapy program at Southwest Cook County Co-Op, a school for children with emotional, developmental and behavioral problems.
     The program appears to be unique in the state, officials say. They, along with teacher Sue McAley, a martial arts instructor and licensed counselor from Lemont, would like to see it launched in other alternative schools. "With this population, it's hard to get them invested in anything. But they really look forward to this. When it's early in the morning and they're talking about going to martial arts therapy, that's huge," said Allison Bean, a social worker at the school. The class was divided into separate sessions for the older and younger children.
     As counter-intuitive as it may seem, McAley said the kicks, stances, punches and grappling of martial arts are a good way for children with behavioral problems to channel their aggression, control their impulses, learn to focus and act more appropriately inside the classroom and out. "That's the whole martial arts paradox. It's not so much fun to hit someone when they can hit you back," McAley said.
      For younger kids who have a hard time concentrating, McAley challenged them to do exercises, such as holding a particular stance to help develop concentration and be grounded in their bodies rather than distracted by their environment. In the older class, some participants towered over McAley and easily outweighed her. Nonetheless, she did not hesitate to don boxing gloves to spar with them or to wrestle. "I'm 5 foot 2; I took a couple of them down," she said. "They realized that a small person with focus can overcome a larger force."
     McAley's class was a fusion of various martial arts including karate, boxing and tae kwon do. Unlike standard martial arts training, she said therapy puts a greater emphasis on behavior modification. Throughout a recent class, for instance, she constantly reminded students of the power of their words and of how negative input can affect the outcome of a task. McAley urged them to support a boy taking numerous tries at breaking the brick. "If he walks away thinking he can't do this, then what else in life will he walk away from, thinking he can't do it?" she asked.
      Bean said she has noticed kids monitoring their own behavior and that of others. "It's surprising to see the older kids remind each other when they're using too much force or getting too aggressive," she said. "They keep each other in check." Compared to their behavior in initial classes, McAley said her pupils have improved greatly. "As opposed to flying into chairs and slamming down gloves, I've actually seen them smile when they spar and one guy will say to the other, `Good point,'" she said. Although McAley wants them to internalize the lessons in self-control, she warns them not to use their roundhouse kicks or jabs outside the classroom.
     At the final session of the school year, the students were challenged to break a paver block and a piece of wood, and even to lay on a bed of nails. The classroom grew silent as McAley dropped a green apple on the nails to show students they were real. Parrilli laid on the bed of nails and said he was able to maintain concentration and felt no pain while doing it. After class, with a Band-Aid wrapped around his little finger, Nelson Polk, 17, of Country Club Hills, said he also felt no pain when he broke the paver block in two pieces. "Five minutes later, I was like, `Oh. I hurt my finger,'" he said. "I cut my finger, but it was all worth it."