Noteworthy News Articles on Mental Health Topics, August 1-12, 2005

In Germany, Jung Biography Includes Family Denial
Doreen Carvajal, New York Times- 8/3/2005

PARIS -- For the Swiss heirs of Carl Gustav Jung, the problems with an acclaimed new American biography begin with the first sentence: "The child who became the world-renowned psychologist C. G. Jung was christened Karl Gustav II Jung." Incorrect, insists a family representative of the fiercely protective Jung estate: the Roman numeral came later. Correct, counters Deirdre Bair, the award-winning author of "Jung: A Biography," which has ignited a ferocious tug-of-title with Jung's family in advance of its publication in Germany: "Scholarly documents I consulted support what I wrote."
      But that's the least of it. The family's list of disputed facts spans almost 12 pages, from the red sail of a boat to the architectural style of a bridge over the Rhine. More substantively, some of Jung's relatives question the reliability of patient diaries cited in the book that hint at sexual liaisons with Jung. They also scoff at a description of Jung's wife, Emma, that says her children "believed that she had warm feelings, but never showed them." But most of all they resent Ms. Bair for not seeking their approval for statements they made during interviews with her.
     Now, in a compromise that is extremely rare in publishing, the German subsidiary of Random House has agreed to insert two pages of the Jung family's version of descriptions and facts into a translation being published this fall by one of its imprints, Knaus Verlag. The family originally approached Little, Brown & Company, the publisher of the original English-language version in 2003, to seek changes in new editions and translations. But so far only the German publisher has agreed to the family's request.
     "We're between two dangers," said Rainer Dresen, the general counsel for Random House in Germany. "If we hadn't done anything we could have been sued by the heirs. If we do anything we can be sued by the author because she doesn't want to change it. It's just a question of who will attack us. So we thought we would make a compromise."
     Paul Aiken, the executive director of the Authors Guild in New York, which represents writers on copyright and free speech issues, said the inserted material, even if tucked back in the notes section, presented a serious problem. "We've never heard of anything like this," he said in a telephone interview. "It really undermines the author's credibility and authority even if it's mostly inconsequential details. It's like putting a negative book review on the cover."
     For Ms. Bair's part, "I feel like someone broke into my house and tried to rearrange my furniture," she said in a telephone interview, calling the compromise a dangerous precedent. "Anyone could say an author didn't get it right and then demand to include their own version," she continued "This is damaging to every concept of the freedom to write." Throughout Europe, and particularly in Germany, invasion of privacy lawsuits from celebrities like Princess Caroline of Monaco have forced book publishers and newspapers to adopt defensive measures, from self-censorship to scorning certain biographies. As a result, a title sold in the United States without legal pressures faces new risks when it crosses borders to countries with tougher privacy restrictions. The ties between family and writer began cordially enough when Ms. Bair began her research eight years ago. The author of biographies of Simone de Beauvoir and Anaïs Nin, Ms. Bair won a National Book Award in 1981 for her study of Samuel Beckett.
     To explore Jung's life, which has been the subject of many biographies, she plumbed the archives of his professional papers, although she said she could not get access to some personal material, including his diaries and letters between Jung and his wife. She did, however, arrange interviews with at least 10 Jung relatives, including Ulrich Hoerni, a grandson who heads the family committee of Jung's estate in Switzerland.
     Mr. Hoerni objected in particular to the passage that accused his grandmother of not showing her feelings, and he included that objection among those compiled by the family and sent to the original publisher, Little, Brown: "People who knew her, myself (U. Hoerni) included, experienced without any doubt that Emma did show her feelings. Furthermore, D. Bair interviewed at the most three of five 'children.' She can hardly have a clear idea of the situation."
The Jung relatives were even more incensed that Ms. Bair decided not to let them see their quotations before they were published. Ms. Bair said she agreed to show them only if she used them. To avoid delays, she said she chose to quote only statements they had repeated elsewhere in other interviews or in other writings. "She refrained from obtaining approvals for the publication of statements by some of the heirs, which resulted in a false and misleading presentation of some of these statements," Mr. Hoerni wrote in response to a reporter's questions. "We feel obliged to draw the publisher's attention to the shortcomings of the book without commenting on the author's interpretations."
      After the book was published, the Jung family remained largely silent, according to Ms. Bair, who said she sent them copies. American critics praised the book as a thorough and balanced portrait of Jung's ambition, arrogance and original thinking. The Jungs did not express their qualms until nearly seven months later, Ms. Bair said, when Little, Brown received a letter from Mr. Hoerni demanding withdrawal of the book. A series of exchanges followed for months between Little, Brown's attorney and a Swiss lawyer for the Jungs before Little, Brown finally said that "we do not see any specific, substantiated factual errors or any other basis" to halt the book. But in June Ms. Bair said she was contacted by her agent and told that Knaus Verlag, the German imprint of Random House, had agreed to insert some information from the Jung family.
     Her first reaction was to block the book in Germany, even though Little, Brown owned the foreign rights. She then sought to add her own response to the family's claims in the book, but was rebuffed by the German publisher because of concerns that her blunt protest about the "forced intrusion" could ignite a lawsuit. "I was going to disown it," she said, but backed down when she realized she might face legal consequences. As for the Jung family, they say they deserve the right to express themselves. "By drawing the publisher's attention to factual errors, we exercise our own right of free speech," Mr. Hoerni said.
     When the biography comes out in the fall in Germany, about two pages of information from the Jung family will be incorporated into the notes section with about 40 annotations, said Claudia Vidoni, the publisher of Knaus Verlag, who stressed that Ms. Bair's text will not be changed. Ms. Bair said she had not yet seen the proposed annotations, and Ms. Vidoni said the edition was unfinished.
     In the last few months, the debate has spread to Jung Society meetings and online Jungian forums. Sonu Shamdasani, who is also the author of a Jung biography, published a book critical of the treatment of the psychologist by other biographers, "Jung Stripped Bare" (Karnac Books, 2004), in which he took aim at Ms. Bair for using anonymous sources to raise questions about Jung's relationships with patients. Andrew Samuels, a specialist in Jungian studies and a professor of analytical psychology at the University of Essex in Britain, said he looked over the list of errors compiled by the Jung family and found "nothing there that undermines the conclusions of the book in any substantial way." "But," he added, "the true issue is not anymore about the biography, but the manner in which Jung as a cultural icon is handled by the heirs."

The Virginia Board of Medicine has suspended the license of a prominent Chantilly pain doctor who has been named in court papers as a target of a far-reaching federal investigation into prescription drug abuse, officials said. The board accused Joseph K. Statkus of overprescribing powerful narcotics and failing to monitor patients, some of whom became addicted, according to state records. In one instance, he kept prescribing opioids for a 16-year-old auto accident victim despite warnings from other doctors that she was too young to handle the medicine, according to a July 15 board order that suspended Statkus's license for one year. The girl distributed her medication to other teens and adults in Loudoun County, the board said.
      Statkus denied wrongdoing and defended his record of helping patients in chronic pain who had nowhere else to turn. "My record-keeping could have been better, but did I do anything wrong in how I took care of patients? No, I do not believe I did," he said in an interview last week at his office, where staffers were busy trying to place his patients with other doctors. "I have never done anything for a patient that I am ashamed of, never," he added.
     Court documents name Statkus as one of two major targets in a longstanding federal investigation of 60 to 80 physicians, pharmacists and patients suspected of distributing OxyContin and other potent narcotics. More than 50 people have been convicted. The other major target, pain management specialist William E. Hurwitz, was found guilty last year of running a drug conspiracy out of his McLean office and is serving a 25-year prison sentence. With Hurwitz's conviction and the recent medical board action, prosecutors are taking a fresh look at Statkus, said law enforcement sources, who spoke on condition of anonymity because no charges have been filed.
     Prosecutors moved against Hurwitz because he was a nationally known leader in the pain management community who was profiled on "60 Minutes" and because they had evidence that his prescriptions often found their way into a lucrative black market. Statkus had more than 800 patients when his license was suspended; most were in Northern Virginia. Hurwitz had patients in 39 states. Jurors convicted Hurwitz of trafficking that caused the death of one patient and seriously injured two others. "There is certainly bad behavior with Statkus, but it's different from Hurwitz," one law enforcement source involved in the investigation said.
     Statkus, 49, a former U.S. Navy doctor and anesthesiologist, said he was "shocked" by the medical board's suspension and plans to appeal. He provided a copy of an earlier proposed medical board order, dated the week before the board's July 15 meeting, that would have put him on probation and required him to take classes in record-keeping and addictive medicine. He said he had no idea why board members decided on the harsher penalty. "This was a bait-and-switch. It took me completely by surprise," he said. William L. Harp, the medical board's executive director, would not comment on Statkus or any specific case.
     The federal investigation, "Operation Cotton Candy," has helped fuel a nationwide debate over the growing field of pain management. Advocates for those in chronic pain say the government is targeting licensed doctors who prescribe legal drugs for patients in dire need. But Paul J. McNulty, the U.S. attorney in Alexandria, said only a small number of doctors who, like Hurwitz, "crossed the line between a physician and a drug trafficker," need to fear prosecution. He characterized the investigation as active: "You find one trafficker, and the tentacles reach into different communities and different directions, and you pursue those individuals." McNulty would not comment on Statkus but said any criminal charges brought in the investigation must meet a high legal standard -- proving that a doctor "knowingly distributed controlled substances, and not for medical purposes."
     An FBI affidavit alleges that Statkus knew that at least one of his patients was distributing some of her prescribed medication. The affidavit, filed in 2002, says Statkus was expressly told that one of his patients, Shirley Ann Coleman, "was a drug dealer" and was distributing Dilaudid in Northern Virginia and in Kentucky. Coleman pleaded guilty to drug-conspiracy charges in 2002. The Virginia Medical Board's findings against Statkus say that he learned from an anonymous letter that the 16-year-old auto accident victim was also distributing her medication. Only then did Statkus request a urine screen, the board said. When the girl tested positive for several drugs, Statkus stopped treating her. Statkus defended his treatment of the girl. "We had to give her something to control her pain. Here was a kid in her teenage years, and she had arthritis," Statkus said. "The amount of medication we gave her wasn't a lot, but that little bit, it looked like she was sharing it with classmates."
     The board faulted Statkus's treatment of eight patients overall, including one who was given the narcotic Roxicodone for a panic disorder, which the board called "contrary to sound medical judgment." Statkus said the medication was actually for her pain but that when it wore off the patient went through withdrawal and began having panic attacks.

Dear Diary: Self-Help Journals on Web
Homa Zaryouni, Wall Street Jorunal- 8/6/2005

Forget the old diary or diet journal. Journals have grown into a mainstream tool for lifestyle change and are rapidly migrating to the Internet. An array of paper and digital journals promise to keep you on your diet, organized, healthy and adhering to all manner of New Year's resolutions. Many mental-health professionals endorse the idea of recording day-to-day events to harness behaviors in need of change. "You become more aware," says Kate Hays, a psychologist who has hosted journal-writing workshops in Toronto and New Hampshire. "It makes you conscious that if you eat this piece of cake with this many calories you will have to write it down," she says.
      But a number of new products, many online, go way beyond writing down meals and exercise, and instead prod users to scrutinize why they do what they do. Myselfhelp.com, a password-protected service that claims 1,000 subscribers from 31 countries, includes an online journal aimed at supplementing professional therapy for depression, stress, guilt and eating disorders. Unlimited access costs $15 a month. An additional site, tell-me-about-it.com, offers a password-protected journal but also provides visitors with a place to publicly vent about everyday irritants from traffic to work to relationships. The site sells a variety of online courses, computer tutorials, books and software -- $4.95 for a book titled "Anger: Win the War" and $79 for anger-management software.
     America Online's Web site has a journal section at http://pc.channel.aol.com/journals that lets the writer choose whether to keep the entries private or share them with others. Diaryland.com, a site with more than 6,000 journal writers, allows nonmembers to browse the entries if the members have agreed to make their entries public.
     Christine Kringle, a student at Hocking College in Ohio, keeps a public journal on AOL. Ms. Kringle says she likes convenience, especially the ability to write entries while using Instant Messenger. She figures she spends about two hours a week on the journal, and finds it therapeutic. "It helps me vent," she says. Ms. Kringle finds the feedback helpful but refrains from posting her most personal thoughts in a public entry. For that, she keeps a poetry journal on paper -- and reads only the best of it to friends. "My strongest emotions are there, and I don't want to allow others to see how vulnerable I am in my poetry," she says.
     Some proponents, including Dr. Hays, say these journals -- both online and paper -- can be powerful self-help tools to cure depression and other mental illness. A journal can do one of the functions of a therapist by giving the patient a way to express his or her deepest thoughts, Dr. Hays says.
     Skeptics, however, say a journal's use is limited, and still others see a darker side. "People who write notes and commit suicide, still commit suicide," says Harold Koenig, a psychiatrist at Duke University. "To have another human being help you through counseling will reduce the probability of suicide." Journals, he notes, can reinforce thoughts and habits, both negative and positive. "It is possible for people to start thinking negatively, as well as it is possible to start thinking positively," Dr. Koenig says.
     Nanci Pradas, a psychologist in Stow, Mass., who created several programs for Myselfhelp.com, cautions that journals the public can read and comment on can hurt the writer, especially one who is in search of mental stability. Comments on a journal entry can be unnecessarily scathing, slashing the writer's self-esteem. "People can say anything on these message boards, and some of these people aren't the healthiest," Dr. Pradas says. For individuals who insist on keeping a public journal, she recommends one that is moderated by a professional. Some patients who have experienced severe trauma may shun all forms of journals, afraid to dwell on bad memories, she says. In those cases, she says she recommends journals along with a therapist and counsels that a patient's bottled-up feelings can surface later in unhealthy ways.
     Besides the pain of remembering traumatic experiences, a journal might leave some people with a nagging worry that their deepest secrets might be revealed. Dr. Hays recalls, for example, an instance in which a journal played a prominent role in a divorce case.

Whatever Happened to Crack Cocaine?
Stephen Dubner and Steven Levitt- New York Times Magazine- 8/7/2005

If you rely on the news media for your information, you probably think that crack cocaine is a thing of the past. If you rely on data, however, you reach a different conclusion. Measuring the use and impact of a drug like crack isn't easy. There is no government Web site to provide crack data, and surveying dealers is bound to be pretty unreliable. So how can you get to the truth of crack use?      One way is to look at a variety of imperfect but plausible proxies, including cocaine arrests, emergency-room visits and deaths. Unlike the volume of news coverage, the rates for all of these remain shockingly high. Cocaine arrests, for instance, have fallen only about 15 percent since the crack boom of the late 1980's. Cocaine-related deaths are actually higher now; so are the number of emergency-room visits due to cocaine. When combined in a sensible way, these proxies can be used to construct a useful index of crack.
     And what does this index reveal? That crack use was nonexistent until the early 1980's and spiked like mad in 1985, peaking in 1989. That it arrived early on the West Coast, but became most prevalent in the cities of the Northeast and Middle Atlantic States. And that it produced a remarkable level of gun violence, particularly among young black men, who made up the bulk of street-level crack dealers. During the crack boom, the homicide rate among 13- to 17-year-old blacks nearly quintupled. But perhaps the biggest surprise in the crack index is the fact that, as of 2000 -- the most recent year for which the index data are available -- Americans were still smoking about 70 percent as much crack as they smoked when consumption was at its peak.
     If so much crack is still being sold and bought, why aren't we hearing about it? Because crack-associated violence has largely disappeared. And it was the violence that made crack most relevant to the middle class. What made the violence go away? Simple economics. Urban street gangs were the main distributors of crack cocaine. In the beginning, demand for their product was phenomenal, and so were the potential profits. Most crack killings, it turns out, were not a result of some crackhead sticking up a grandmother for drug money but rather one crack dealer shooting another -- and perhaps a few bystanders -- in order to gain turf.
     But the market changed fast. The destructive effects of the drug became apparent; young people saw the damage that crack inflicted on older users and began to stay away from it. (One recent survey showed that crack use is now three times as common among people in their late 30's as it is among those in their late teens and early 20's.) As demand fell, price wars broke out, driving down profits. And as the amount of money at stake grew smaller and smaller, the violence also dissipated. Young gang members are still selling crack on street corners, but when a corner becomes less valuable, there is less incentive to kill, or be killed, for it.
     So how can it be that crack consumption is still so high? Part of the answer may have to do with geography. The index shows that consumption is actually up in states far from the coasts, like Arizona, Minnesota, Colorado and Michigan. But the main answer lies in the same price shift that made the crack trade less violent. The price has fallen about 75 percent from its peak, which has led to an interesting consumption pattern: there are far fewer users, but they are each smoking more crack. This, too, makes perfect economic sense. If you are a devoted crackhead and the price is one-fourth what it used to be, you can afford to smoke four times as much.
     But as crack has matured into a drug that causes less social harm, the laws punishing its sale have stayed the same. In 1986, in the national frenzy that followed the death of Len Bias, a first-round N.B.A. draft pick and a cocaine user, Congress passed legislation requiring a five-year mandatory sentence for selling just five grams of crack; you would have to sell 500 grams of powder cocaine to get an equivalent sentence. This disparity has often been called racist, since it disproportionately imprisons blacks.
     In fact, the law probably made sense at the time, when a gram of crack did have far more devastating social costs than a gram of powder cocaine. But it doesn't anymore. Len Bias would now be 40 years old, and he would have long outlived his usefulness to the Boston Celtics. It may be time to acknowledge that the law inspired by his death has done the same.
     Stephen J. Dubner and Steven D. Levitt are the authors of "Freakonomics: A Rogue Economist Explores the Hidden Side of Everything." More information on the academic research behind this column is at www freakonomics. com.

They used to just call it a bad temper and tell you to count to 10. Then came bunches of guys sitting around in circles and learning ''anger management." Now, increasingly, the catchphrase is ''Intermittent Explosive Disorder." Researchers delving into pathological anger report that it is more widespread than anyone had suspected. And that their understanding of its biological roots is deepening, raising prospects of better treatment. ''It's not simply bad behavior," said Emil Coccaro of the University of Chicago, a leading anger researcher. ''There's a biology and a psychology and a genetics and a neuroscience behind this, and you can come up with strategies for intervention just like for anything else, like diabetes or hypertension or depression."
      For all the buzz about phenomena like hockey dads and the recent road rage incidents, it was only this summer that researchers got definitive data on how common such volatility is. A national study found that at some point in their lives, about 5 percent of people have such frequent, serious blow-ups that they qualify as suffering from Intermittent Explosive Disorder, a full-fledged psychiatric diagnosis. It is twice as common in men as in women and tends to begin before age 20. The numbers translate into many millions of circles of trembling misery and anxiety. Wives live in fear of their otherwise sweet husbands' next tirade, and wonder if they dare bring children into such a violent world of wrath. Husbands find that sometimes, the smallest provocation of their wives brings on a firestorm. Parents struggle to understand why a son puts his fist through things, kicks pets, or screams at siblings. Is this a character issue? Or a medical problem?
     Specialists say that their growing knowledge does not excuse such explosions, but it can help explain them. A picture has begun to emerge of what happens in the rage-prone brain, and a central culprit appears to be the chemical messenger that newer anti-depressants have made a household word: serotonin. In broad terms, serotonin -- active in the frontal, ''thinking" part of the brain -- is needed when a person stops a bad impulse. When someone is low on serotonin, that brake can get weak.
     Brain structure may also play a role. ''In people with impulsive aggression, there's more chaos in the front part of the brain," said Dr. Jon Grant, an associate professor of psychiatry at the University of Minnesota in Minneapolis. So some of the problem may lie in the very formations of the nerves, suggesting that genes or development may be at fault. Childhood abuse is also common in people with the disorder, suggesting that environment, too, plays an important role.
     It gets even more complicated. Other brain chemicals are involved -- perhaps some that influence the ''gas" rather than the ''brake." And studies have found psychological differences in the anger-prone, compared with others. Tests show that they are likelier to believe other people have hostile intentions, for example. Despite such insights, specialists readily acknowledge that biologically, impulsive anger -- like so much in the brain -- remains largely a mystery. But in recent years they have begun to use educated guesses to try a wide array of drugs to fight it.
     None of the drugs has federal approval specifically for Intermittent Explosive Disorder, but doctors and researchers have been prescribing them ''off-label," and report that they can often help, though not always and not everyone. Anti-depressants of the Prozac generation sometimes bring results, they say; so do mood stabilizers, and drugs that were used initially to stop seizures.
     A major, federally funded study published last month in the American Journal of Psychiatry found that among autistic children, risperidone, a newer anti-psychotic drug, could reduce violent outbursts for up to six months with few side effects. Risperidone has prominent effects on serotonin, so the study's positive results underscore the importance of serotonin in impulsive aggression, said its lead author, Dr. James McCracken.
     Therapy helps as well, specialists say. When well-run, anger management groups can prove effective, they say, and so does individual therapy that helps patients recognize their problematic reactions and find ways to defuse themselves.Treatment can involve training in relaxation, habits of thought (like thinking, ''Maybe he wasn't trying to make you mad"), and coping skills like walking away when things start to get hot. ''Between both medication and therapy, I'd say probably the majority of people can find some relief," Grant said. Once, anger problems tended to lead many straight to jail; now, ''We can offer people some real hope about what might allow them to get better control over this."
     No miracle drug appears to be on its way, though. For now, researchers predict that they will be largely limited to clinical trials using existing drugs, because drug companies are unlikely to push hard for specific anti-rage agents. For one thing, Coccaro pointed out, company lawyers are scared that if violent patients go onto a drug and then commit violence again, the company could be held liable.
     There is a broader problem, too, he wrote in a recent journal editorial: People who explode are not very lovable. No celebrity is likely to volunteer to be a poster child for Intermittent Explosive Disorder. And philanthropists are less likely to contribute to research aimed at helping people viewed as perpetrators rather than patients or victims.
     The patients themselves can be problematic as well, resisting treatment even when surrounded by wrecked lives. ''People say, 'I don't have an illness, I have an anger -- It's not I who have a problem, it's you," said Ronald Kessler of Harvard University, who led the national study on how common mental illnesses are. Often, he said, patients have already lost jobs and spouses before they seek help.
     Some specialists say they also hope that now that it is clear how common impulse disorders are, they will get more attention, despite the obstacles, from researchers and grantmakers. Kessler's study found that when all the impulse disorders are lumped together, from compulsive gambling to Attention Deficit Disorder, they are even more common than mood problems like depression. ''The social implications are huge," said McCracken, a professor of psychiatry at the University of California at Los Angeles. Think, he said, of the impact of violence and compulsions like gambling, both on the perpetrators and people around them. ''I think a deeper understanding of these impulse disorders and better-identified treatment choices could have profound benefits for society," he said.

Frequency of anger disorder
A June study estimated that roughly 1 in 20 people has had ''intermittent explosive disorder" -- a form of destructive, uncontrolled anger -- during their lifetime. The disorder, considered an impulse-control problem, is most common among 18-29 year-olds and its prevalence declines with age.

Lifetime frequency of:
Any mental disorder- 46.4 percent
Any impulse-control disorder- 24.8 percent
Conduct disorder- 9.5 percent
Attention-deficit/hyperactivity disorder- 8.1 percent
Intermittent explosive disorder- 5.2 percent
SOURCE: Archives of General Psychiatry, June, 2005

SPRINGFIELD, Mass. --A federal judge said Tuesday that he's heard "significant evidence" that the state isn't doing all it should to help care for mentally ill children. U.S. District Judge Michael Ponsor said he'll likely issue a ruling next month as to whether Massachusetts is violating federal Medicaid requirements by not giving poor families enough services to help tend to their children's emotional problems at home.
      But as lawyers for nine Massachusetts families who are suing the state delivered their closing arguments in a trial that began in April, Ponsor agreed that they presented "significant evidence that there are children who are falling through the cracks." James Burling, a lawyer for the plaintiffs, said there are 60,000 children in the state with extreme cases of serious emotional disabilities. He said about a quarter of those children are eligible for Medicaid benefits.
     But instead of giving most of those children the care that could help treat them in their homes, Burling said state providers are quick to hospitalize them. "What Massachusetts does too much of is put these children in institutions," Burling said. "Home-based care is the alternative to institutionalization."
     Deirdre Roney, a lawyer for the state, said Massachusetts is meeting federal mandates. "These children do get better," she said, adding that all required services "are provided when they're needed, not all the time."
     But Ponsor said the plaintiffs made a good case trying to prove the state has not done an adequate job helping the children navigate through the services they're entitled to. "The defendant has failed -- almost miserably -- in case management," the judge said.

Common Characteristics
Aerobic activity that burns 2,000 to 3,500 calories a week is considered the amount of exercise to attain and maintain optimal health. This would entail 40 to 60 minutes of cardiovascular exercise four to six times a week. Beyond that, there are no added health benefits, but there is an increased risk of exercise-induced injuries.
     Excessive exercise can damage tendons, ligaments, bones, cartilage, joints and muscles and not give minor injuries a chance to heal. Instead of building muscle, too much exercise can lead to muscle breakdown. Girls and young women may stop menstruating and start losing bone, as if they were in menopause. Excessive exercise can also release loads of free radicals, which can cause mutations and may increase cancer risk.
     But it is not so much the amount of activity that defines the obligatory exerciser as it is its effects. Some people's bodies can handle more physical stress than others. While there is no clear definition of obligatory exercise, there are telltale signs that exercise is becoming too important to a person and creating undue physical and psychological stress. These indicators were outlined by Molly Kimball, dietitian at the Ochsner Clinic Foundation:
* Continuing to train even when ill or injured.
* Experiencing anxiety when a workout is missed.
* Constantly talking about their sport, training schedule and diet
* Neglecting other important areas of life.
* Justifying excessive exercise as necessary to their sport.
* Having friends and family notice a loss of perspective.
      Obligatory exercisers often report some of the symptoms seen in athletes who overtrain, the article reported. They include anxiety, apathy, chronic fatigue, decreased appetite, depression, hostility, mental exhaustion, mood changes, changes in values and beliefs, diminished self-image, impaired concentration, emotional isolation, sore muscles and disturbed sleep. People may also become substance abusers, particularly of drugs thought to enhance performance.

Treating the Problem
But, the article said, obligatory exercisers may not readily admit to any of those symptoms and behaviors because of their need to appear healthy and normal. They do not want to be seen as "sick, weak, inadequate or needing help from anyone," the experts wrote. It may be the task of parents, coaches, friends or other athletes to urge the person to get help to regain a healthier perspective. The obligatory exerciser must be made to understand that "recovery periods, mandatory days of rest and the body's need to regenerate contribute to peak performance," the experts wrote. In contrast, continuing to pursue a relentlessly punishing course of activity can only lead to diminished performance.
      The physician runner they cited was advised to reduce his training schedule. In two weeks, his physical symptoms disappeared and his mood improved. He was encouraged to look closely at his overcommitment to training and to learn relaxation exercises. With a therapist's help, he sought to develop alternatives to "his driven thoughts about training."
     Ms. Kimball, the dietitian, suggested that when obligatory exercisers were unable to turn things around on their own, "meeting with a therapist, nutritionist or other health professional" could help them understand and deal with underlying problems that might drive disordered behavior. Of course, prevention is preferable. For those involved in competitive activities, it is critically important for parents and coaches to avoid overemphasizing winning and pushing players into regimens that can become counterproductive.




Talk Therapy Succeeds in Reducing Suicide Risk
Benedict Carey, New York Times- 8/9/2005

After a year of debate over whether antidepressant drugs increase the risk of suicide, a new study finds that a standard brand of talk therapy may offer the best chance to save those at the highest risk of taking their own lives. The therapy cut almost by half the risk of suicide attempts in extremely suicidal patients, many of whom were already taking drugs for depression, the researchers found.
      The study, published in the Aug. 3 issue of The Journal of the American Medical Association, is the largest and most rigorous test of a psychotherapy technique in people whose attempts to end their lives have been serious enough to land them in hospitals, experts said.
     Studies of depression treatments typically exclude such patients, in part because they are 30 to 40 times as likely to kill themselves as people who have not made serious suicide attempts. "That you could cut by half the number of attempts in this population in just 8 to 10 sessions of therapy is something to write home about," said Steven D. Hollon, a professor of psychology at Vanderbilt University, who was not a part of the study. Dr. Hollon added: "These are the kinds of people who wouldn't qualify for 90 percent of the treatment trials out there. But if you don't ever include them, you don't know what works for them. No guts, no glory."
     In the study, Dr. Gregory K. Brown, a psychologist, and Dr. Aaron T. Beck, a psychiatrist, both of the University of Pennsylvania, led a research team that recruited 120 people who were seen in the emergency room of the university hospital after trying to kill themselves. The patients had multiple problems, including drug addiction, depression and homelessness, and half were followed closely by case managers and referred for counseling services, if necessary. Once every week or so, the other half arrived for cognitive therapy, a counseling technique in which people learn to head off or diffuse self-defeating thoughts before acting on them. The researchers intended the therapy to address the patients' lives, their specific hopes and fears and the factors that had prompted them try to end their lives, Dr. Brown said.
     A man who "felt like giving up" after a relationship problem learned that this thought itself had the effect of giving him permission to use drugs, which invariably make the situation worse, Dr. Brown said.
     As they neared the end of the therapy, the participants relived their most painful moments, let themselves feel the tug of suicide and then devised strategies to divert themselves from thinking more about it. "We would then see if these techniques reduced the sense of hopelessness, and if so, they could be discharged from therapy," Dr. Beck said. "It was a kind of dress rehearsal." The patients who stumbled at rehearsal continued seeing the therapist for a longer time, he said.
     The investigators followed the two groups, detailing repeat suicide attempts in interviews. After a year and a half, 13 of the men and women who received cognitive therapy tried again to kill themselves, compared with 23 in the other group. No one in either group completed a suicide. Over all, those who received cognitive therapy scored significantly lower on measures of depressive mood and hopelessness.
      Researchers working with people whose problem has been diagnosed as borderline personality disorder, which carries a high risk of suicide, have also reported reduced numbers of attempts with the therapy. But therapy aimed at borderline patients is long term, typically lasting a year or more.
     In the new study, the course of therapy was short for a reason, Dr. Beck said. Highly suicidal people, particularly those with drug problems who are socially marginalized, do not typically have the patience or energy for longer courses of therapy. The researchers are setting up a study of the therapy in community mental health centers, training counselors to use the technique with people hospitalized after suicide attempts. "We'll see what happens in the real world," Dr. Beck said. "That will be the true test."