Noteworthy News Articles on Mental Health Topics, August 17- , 2005




Annual Cost Of Secondhand Smoke
Theo Francis, Wall Street Journal- 8/17/3005

The effects of secondhand tobacco smoke cost the U.S. economy nearly $10 billion a year, ranging from medical bills to lost hours on the job, according to a study commissioned by insurance actuaries. While the study, to be released today, probably won't affect current litigation against tobacco companies, it could encourage insurers to consider separate pricing for nonsmokers exposed to tobacco smoke, attorneys say.
      A smaller proportion of nonsmokers have been exposed to secondhand smoke in recent years, but the study concludes that direct medical costs total about $5 billion annually, while indirect costs, including lost wages and costs related to disabilities, total about $4.7 billion. Members of the Society of Actuaries and a researcher at Georgia State University business school arrived at these figures after reviewing more than 200 studies published since 1964.
     Among the medical conditions more common among those exposed to secondhand smoke, the researchers concluded, are sudden infant death syndrome and chronic pulmonary disease, as well as asthma and spontaneous abortion. "If you look at any one individual, the probabilities are pretty low, but if you happen to be the one who gets lung cancer, it's significant to you," said Donald F. Behan, the study's lead author and a senior research associate with Georgia State University's J. Mack Robinson College of Business. "There seems to be a relatively greater impact on children than adults."
     The study eventually could lead life and health insurers to charge more to insure people exposed to what the industry calls environmental tobacco smoke, according to Tim Harris, a member of the actuarial society's board of governors and a principal in St. Louis with actuarial firm Milliman Inc. For now, tests to gauge exposure to tobacco smoke are costly and imprecise, Mr. Harris added, but some insurers could decide to ask applicants about exposure at home or work.
     Edward L. Sweda, senior attorney with the Tobacco Products Liability Project at Northeastern University School of Law in Boston, said a study pinning down the costs of secondhand smoke is likely to be more helpful in the public-policy debate over smoking bans than in current litigation against tobacco companies.

WASHINGTON — More teens are saying there are drugs in their schools, and those who have access to them are more likely to try them, said a Columbia University survey released today. Twenty-eight percent of middle-school-student respondents reported that drugs are used, kept or sold at their schools, a 47 percent jump since 2002, according to the 10th annual teen survey by Columbia's National Center on Addiction and Substance Abuse. The number of high schoolers saying drugs are at their schools rose 41 percent in the last three years, to 62 percent, the survey said.
      Twelve- to 17-year-olds who report that there are drugs in their schools are three times likelier to try marijuana and twice as likely to drink alcohol than teens who say their schools are drug free, the survey showed. "Availability is the mother of use," said Joseph Califano Jr., the center's president. "We really are putting an enormous number of 12- to 17-year-olds at great risk."
       Most of the teens surveyed — 58 percent — said the legality of cigarettes has no effect on their decision to smoke or abstain, and 48 percent said the fact that marijuana is illegal doesn't affect whether they use or don't use the drug . Meanwhile, the survey found teens who viewed drugs as morally wrong were significantly less likely to try them, as were those who felt their parents would be "extremely upset" to discover drug use.
      The report found that teens who confided in their parents were at much lower risk of drug abuse than teens who turn first to another adult. "If this survey does anything, it really shouts to parents: You cannot outsource your responsibility to law enforcement or the schools," Califano said. "I think when parents feel as strongly about drugs in the schools as they do about asbestos in the schools, we'll start getting the drugs out of the schools."
      The survey also found that teens who say they watch three or more R-rated movies in a typical month — about 43 percent — are seven times likelier to smoke cigarettes and six times likelier to try alcohol than teens who do not watch R-rated movies. The correlation between R-rated movie watching and the risk of substance-abuse remains even after controlling for age, the report said. This was the first time the annual survey asked about R-rated movies. "There's no question the correlation is very strong and it obviously wants further study," Califano said.
      The survey was conducted by phone and involved 1,000 randomly selected teens aged 12 to 17 years old and 829 parents. Twenty-six percent of the teens said someone nearby could hear their answers. The margin of sampling error is plus or minus 3.1 percentage points for the teens and plus or minus 3.4 percentage point for the parents.
      On the Net: National Center on Addiction and Substance Abuse: http://www.casacolumbia.org

ATLANTA -- A drug that promotes lean muscle growth in cattle may be turning up in heroin on the East Coast, sickening users and stoking fears of a wave of such poisonings, U.S. health officials said. Traces of clenbuterol were found in the urine of eight reported heroin users who became ill in New York and Connecticut in the first three months of 2005, according to the Centers for Disease Control and Prevention. Legal in some countries but not in the U.S., clenbuterol has also been linked to 18 other cases that surfaced in New York and four states along the Atlantic coast around the same time, according to the CDC report.
      Many of those sickened developed dangerously rapid heart rates and palpitations, chest pain and hypotension. The majority said they had snorted rather than injected what they thought was heroin before becoming sick. "The 26 cases described in this report likely represent a fraction of actual cases of clenbuterol poisoning," the CDC said in its report, the first published investigation into the problem.
   The federal agency said it was possible that those sickened earlier this year had taken pure clenbuterol that was sold to them as heroin. It urged health-care providers and others dealing with heroin users to be aware of the symptoms associated with ingestion of clenbuterol. The warning came one week after six people died of apparent heroin overdoses in lower Manhattan.



For Addicts, Killer Dope Must Be Good Dope
Alan Feuer, New York Times- 8/18/2005

The addict, maybe more than anybody else, understands the hard nature of certain truths. A habit is a habit, after all, and sometimes only dope can scratch the itch. "Your desperate seeker that's sick and needs a fix don't care," said a man called Bane, who says he has been on and off heroin for almost 20 years. "They want the high, and in an act of desperation, they'll disregard things." Even, he said, if they see someone overdosing.
      Bane is 34 and, like many addicts on the street, goes by a name of his own choosing. He was sitting yesterday in Tompkins Square Park with friends and strangers alike -- men like Skywalker, Dante and L.E.S. Jewels -- talking of the recent round of overdoses in the neighborhood and passing back and forth a newspaper with the headline, "Bad Smack."
     The police and health officials are trying to determine whether a lethal batch of opiates or cocaine caused the deaths of at least six people who apparently overdosed on heroin or a combination of heroin and cocaine in Lower Manhattan in the last week. They include a homeless man who was discovered in a storage center in SoHo and another man found dead on the floor of a portable toilet near Pier 54 on the West Side. But there were also two young college girls who died -- Mellie Nicole Carballo and Maria Pesantez, both 18 -- and it is they and they alone, the addicts say, who have brought the attention of the wider world.
     The addicts, after all, have been through this before. In 1991, they say, it was the Tango and Cash brand, a synthetic drug called fentanyl, which, being sold as heroin, killed 17. Three years later, it was China Cat, a blend of heroin so pure it killed a baker's dozen in less than a week.
     The recent rash of deaths has inspired caution in the park, but also bravado. The thinking is that killer dope is strong dope, something to test yourself against; if the stuff is deadly, it must be good. "I died four times in one day, and I'm still here," said L.E.S. Jewels, a skinny 35-year-old from nowhere in particular. Under his left eye there are four blue tattooed dots. They stood, he said, for the four times he overdosed last week. "People figure if they can handle it, it means the dope is good. It means they have more tolerance for the stuff."
     Jewels may soon be heading out of town -- maybe out to Eugene, Ore., he said, to stay with friends. He mostly gets around by freight train. His meals are often from soup kitchens and are almost always free. It is his belief that a tainted batch of heroin came to town sometime last week. It may have been cut or sprayed with something poisonous, he said, or exposed to some sort of toxin in a warehouse or a truck. The brand, or stamp, that knocked him out four times was from a blue bag, he said, though another in a clear bag also knocked him out.
     If you are wondering, by the way, what it feels like to overdose four times in a 10-hour period, Jewel is not much help. He doesn't remember a thing about how it felt. "You just don't know it's coming," he said of an overdose. "It hits you and the next thing you know, you're surrounded by E.M.T.'s." The rumors are moving through the park: don't buy from so-and-so; the blue bags are bad; the clear bags are bad. Some say the brown powder is the deadly stuff. Some say the gray. "There's a lot of concern with people asking what stamps people are dying from and where they're copping," said a sinewy man named Travis, who is 30. "I was told that one of the bad stamps was XXX - like the Vin Diesel movie."
     The uncertainty has led to addict speculation - anything to minimize the risks. "There's ways to be smart about taking chances," said a dreadlocked girl named Shannon, 24. First of all, she said, don't buy from strangers. And take a half-dose at first, not a whole. "You can always do more, but you can't do less." Skywalker, in his dingy woolen cap, suggested having someone else try the batch first. It was noted that the kings of old once did that sort of thing. He smiled to himself and laughed. Eddie's way has been to just stay drunk the last few days -- after all, no heroin, no worry. Eddie is young but will not say how young. He's been around, though. He had "a 10-year San Francisco habit," he said.
     Then the man from the outreach center came by. His name was Van Asher and he had a pretty dog. He started telling people not to drink on heroin, since alcohol and dope were both depressants that slowed the heart. "If you're drinking and doing opiates," he said, "do the opiates first because, with them, there's no quality control."
     It has upset Mr. Asher that "all the sudden, everybody's talking about killer dope, when I know several people who've died at roughly the same time who apparently were not newsworthy because of their compromised life situations." He mentioned a man named Face, who, he said, was brain dead from an overdose last week. Then he mentioned Christopher Korkowski, 24, a hairdresser found dead last Wednesday in his apartment on Avenue B. Mr. Korkowski was never mentioned by the papers, Mr. Asher said, until "two attractive college students" died. "Then he became a footnote."
     Of course, it all makes sense to Raumy, a 20-year-old man who is something of the resident philosopher. Raumy takes no drugs, he said -- in fact, he said, he does not even drink. His job, according to him, is to act as the designated baby sitter for all of his addict friends. "A junkie's looked down upon as a waste of skin and a Social Security number," Raumy said, waxing philosophical again. "The funny thing is, there's no such thing as a bad batch. It's all bad. Eventually, you're still going to die."

NASHVILLE -- Seeking to defuse a growing confrontation with members of Congress and local officials over drug policy, the Bush administration dispatched the attorney general and two other top officials here on Thursday to promise that the government was committed to battling methamphetamine. "You can tell President Bush considers it a serious threat that he had three of his cabinet members here today," Attorney General Alberto R. Gonzales said in a speech to judges, antidrug advocates and graduates of a treatment program at Davidson County Drug Court, adding, "I can tell you, as a father, I care about this." The administration also vowed to make $16.2 million available in grants for treatment.
      For several years the White House has focused the national antidrug strategy on marijuana, arguing that it is the most widely used drug, particularly among high school students, and can be a gateway to more serious drug use. Officials have continued to emphasize that in recent months, even as law enforcement officials across the country pleaded for more help fighting meth, a drug made using chemicals commonly found in cold medicine or on farms. But local officials and members of Congress from both parties have argued increasingly loudly that meth, which is highly addictive, is the real problem. They say the administration has virtually ignored the problem despite the devastation it has caused in many parts of the middle of the country - increasing crime, crowding jails and leaving more children neglected or abandoned.
     The federal officials here Thursday insisted that no drug took precedence. "We believe you can walk and chew gum at the same time," John Walters, the director of the White House Office of National Drug Control Policy, told reporters after the speeches. "The issue here is not meth or marijuana. We're concerned about substance abuse generally." "We are not ignoring problems," Mr. Walters added.
     The comments here were remarkably different from ones earlier this summer when a spokesman for the drug policy office told Newsweek that people were "crying meth." In addition, other officials have said it makes sense to focus on marijuana, because there are about 15 million users of it, compared with about 1 million users of meth. The debate is also percolating among drug policy experts. Some argue that meth is the preoccupation of the moment and should not drive policy; others say the administration should seize the opportunity to disrupt a relatively new drug market. "It seems to be very unlikely that increasing attention to marijuana is going to greatly affect marijuana use, but getting out in front of meth while the epidemic is still in the nascent stages might," Mark A. R. Kleiman, a professor of public policy at U.C.L.A. and director of the university's drug policy analysis project, said in an interview.
     But Joseph A. Califano Jr., president of the National Center on Addiction and Substance Abuse at Columbia University, said, "If you don't reduce the use of marijuana, you can't possibly reduce illegal drug use because marijuana is far and away the most used drug." Still, the administration provoked a political furor when officials with the drug policy office seemed to play down results of a National Association of Counties survey, released in July, in which 500 local law enforcement officials nationwide called meth their No. 1 scourge.
     When administration officials doubted the local officials' characterization of meth as an epidemic, the 100-member bipartisan meth caucus in Congress, as well as the rural caucus and members of districts particularly hard hit by the drug sent angry letters. The letter from the meth caucus noted that 58 percent of those surveyed by the county association said that meth was their biggest problem and that cocaine was a distant second at 19 percent, and marijuana third at 17 percent. "Clearly, these results show our nation's drug control strategy should make methamphetamine a top priority," the letter said. At a House hearing in July, Representative Mark Souder, Republican of Indiana, sharply criticized a deputy in the drug control policy office and demanded that the White House acknowledge meth as "the most dangerous drug in America." "This committee is trying desperately to say, 'Lead!' You're the executive branch," Mr. Souder said. Scott Burns, the drug policy deputy, argued that law enforcement officials in the Northeast would laugh if told that meth was an epidemic, because heroin was the bigger problem in their region. But Mr. Burns also promised to relay the message to the White House.
     Still, while the Bush administration billed the event on Thursday as both a spotlight on current efforts against meth and an announcement of new programs, the officials largely emphasized what they had already done. "We've been very, very active already," Mr. Gonzales said. The officials said they would support Congressional efforts to limit individual sales of pseudoephedrine, the cold medicine that is the key ingredient in methamphetamine, and to monitor the importing of that ingredient more closely.
     Michael O. Leavitt, the secretary of health and human services, said his agency would grant $16.2 million in grants for treatment. Mr. Walters said the drug policy office would begin running new advertisements this fall for the first antimeth media campaign. (Of the 67 print advertisements in the current antidrug campaign, most focus on marijuana, and only one mentions methamphetamine.) And Mr. Gonzales said he would direct United States attorneys to seek "the harshest penalties possible" against meth cooks.
     But their new initiatives fell short of what members of Congress from states hit hard by meth have asked for -- mostly, the restoration of federal money that the police have used to fight the drug. "While this is an improvement," Representative Ken Calvert, Republican of California and co-founder of the meth caucus, said, "we still need a better national and international strategy to stop meth production, smuggling, and reduce usage."
     Senator Jim Talent, Republican of Missouri and co-author of a bill to restrict sales of pseudoephedrine, said, "While the administration should be applauded for recognizing the need for additional resources to fight meth and to provide additional funding for treatment, their plan is inadequate because it doesn't go far enough to restrict products containing pseudoephedrine."
     Representative Brian Baird, Democrat of Washington, criticized the administration for cutting certain grants, which give money to the local police, to states that allow the use of medical marijuana. "It's like you're focused on two kids having a wrestling match, meanwhile two guys are squaring off with sawed-off shotguns," Mr. Baird said. "That's how it's been with this administration."

A Spotless Mind May Ease Suffering, But Erase Identity
Sharon Begley, Wall Street Journal- 8/21/2005

As a teenager, the woman had suffered a horrific rape, the memory of which she carried into adulthood. The slightest mention, on television or in conversation, of a child being harmed left her short of breath and bathed in sweat. She regularly relived the trauma in nightmares and flashbacks. Once, when she was having her hair done, a radio show began to discuss sexual assaults of children; she sprang from her chair and fled the salon.
      For her and for every other victim of post-traumatic stress disorder, or PTSD, bad memories are only the beginning. Recalling a traumatic memory, scientists now think, does something even worse than trigger the disabling physiological response the woman suffered: It "reconsolidates" the memory, wiring it more strongly into the mind. Emerging evidence that remembering a trauma strengthens that memory is inspiring controversial studies in which people take a drug that may block memory reconsolidation, leaving the memory intact but weakened, and extinguishing the emotion associated with it. That raises a troubling question: Will the drug rob people of an essential, even defining, aspect of their selves?
     It is no mystery why traumatic memories are so vivid. Compare your recollection of Sept. 11, 2001, with that of Sept. 10, 2001. "When we experience something traumatic, stress hormones such as noradrenalin are released from the brain stem and reach the amygdala," says Roger Pitman of Harvard Medical School, Boston. "The amygdala tells the memory-processing hippocampus to remember better, burning in the memory of that event." Because memories run on chemicals, they can be altered by chemicals. Compounds called beta blockers, which treat hypertension, are the brain's version of pushy people who sneak into company parking spaces reserved for particular employees. The beta blockers occupy the beta receptors in the amygdala that noradrenalin ordinarily fits into. Just as an employee can't go to work if she can't park, noradrenalin can't burn memories into the brain if it can't get into the receptor.
     In a 2002 pilot study, Dr. Pitman and colleagues gave a beta blocker, propranolol, to people arriving at an emergency room after accidents, and for 10 days after. Three months later, the patients had fewer PTSD symptoms, and weaker memories of their trauma, than ER patients given a placebo. When reminded of their accident, they recalled it with less suffering than the placebo group. "We interpret that as saying that propranolol interferes with the consolidation of traumatic memories," Dr. Pitman says. "The result is that you don't remember a traumatic experience any better than an ordinary one." The memory loses its emotional sting.
     Scientists also have seen hints that propranolol can intervene in memories long after they form. Given to lab rats that have learned to associate a tone with an electric shock, for instance, it erases the animals' fear of the impending shock enough that they no longer freeze in terror when the tone sounds. "The theory is, when you reactivate a memory, it needs to be reconsolidated in order to be well retained," says Dr. Pitman. "In animals, propranolol interferes with this. If it does the same in people, you have another shot at helping them." Even though the original memory was consolidated, maybe drugs can weaken it and strip it of its emotion when it is recalled.
     That is what psychiatrist Margaret Altemus of Weill Medical College of Cornell University, New York, and colleagues hope to find out. In their study, PTSD patients take a pill whenever they recall the trauma and succumb to panic, as the rape victim did in the salon. If the theory is right, propranolol should sever the link between memory and terror. The patients will recall the horror, but not be so crippled by it.
     Proponents of the therapy take offense at those who caution against yet another drug that tinkers with the mind and the brain. At a time when we seem to drug every mental quirk from shyness to fidgetyness, it seems cruel and hypocritical to draw a line at alleviating the suffering of people with PTSD. Also, lifting the paralyzing emotion of traumatic memories could enable victims to use their experiences to alleviate the suffering of others. Critics see the prospect of white-washing memories differently. Some worry that propranolol could be abused, perhaps desensitizing soldiers, or even terrorists, so that they could commit atrocities, unconstrained by bad memories.
     Others who don't go quite that far still have concerns. "We are, in essence, the sum of our memories," says Andrew Solomon, author of the 2002 best-seller "The Noonday Demon," about his battle with depression. "To work through the trauma of a memory is important and valid; to eliminate that memory and its essential affect is to rob us of some of our deep humanity." He also worries about the slippery slope. "PTSD is an acute illness that should be treated, but the temptation to start knocking out painful day-to-day memories could become irresistible," he says. "Obliterating something that makes us human is, to me, a terrifying prospect."

OCEAN CITY, MD-- Gov. Robert L. Ehrlich Jr. (R) on Saturday proposed strengthening penalties and stepping up oversight of sex offenders, offering the latest in a flurry of initiatives from Maryland politicians on the issue. "The insidious nature of this problem requires us to make Maryland a model," Ehrlich said during an address to an annual gathering of the Maryland Association of Counties that traditionally has served as a preview of coming legislation
      Ehrlich proposed that more of the most violent sexual offenders receive life prison sentences and that those who are released be subject to lifetime electronic monitoring. He also said that all sex offenders should be required to appear twice a year in person to update registry listings. Under current law, some offenders are free to mail in annual updates.
     Ehrlich's address, which focused largely on crimes against children, came just days after Baltimore Mayor Martin O'Malley, a Democratic gubernatorial hopeful, offered a package of statewide proposals on the same subject. O'Malley's six-point plan incorporated an initiative unveiled last month by Attorney General J. Joseph Curran Jr. (D) to require lifetime supervision for the most dangerous categories of sex offenders. O'Malley also proposed a controversial plan to require child sex offenders -- whom O'Malley said cannot be rehabilitated -- to wear ankle bracelets for life that would allow law enforcement officials to track their locations with Global Positioning System technology. Florida is adopting that system. Steve Kearney, an O'Malley spokesman, said Saturday that Ehrlich's plan is "much weaker" than O'Malley's. Even requiring twice-a-year in-person appearances, he said, would continue a flawed "honor system" under which offenders can provide false addresses. A state task force is looking at the range of offenders who would be subject to electronic monitoring under Ehrlich's plan. But the mayor's plan would likely apply to a far broader range of people than Ehrlich's.
     During his news conference last week at City Hall, O'Malley demonstrated how Baltimore uses the technology to track the location of city garbage trucks and argued that it could help authorities learn whether registered offenders are visiting schools, playgrounds and other areas frequented by children.
     Sex offenders are an easy political target because they have few sympathizers. The issue of tracking them is all but certain to be taken up during the next session of the Maryland General Assembly, which begins in January, as state lawmakers running for reelection in 2006 also highlight the issue.
     Montgomery County Executive Douglas M. Duncan, another Democratic gubernatorial hopeful, Saturday accused O'Malley and Ehrlich of trying to score political points with the issue. "Clearly, the state of Maryland is failing to get the job done when it comes to protecting the public from sexual predators," Duncan said in a statement. "Better tracking, more reliable databases and a serious commitment to this issue are all needed. However, the political gamesmanship that is being played does nothing to prevent attacks or help the victims of these horrendous crimes."
     Questions about Maryland's system came to light last month with the arrest of a convicted rapist accused of killing his 13-year-old stepdaughter in Baltimore County. Although the suspect was included in the state's sex offender registry, he had failed to update his registration for years.
     But the offices of several Maryland prosecutors suggested last week that the state is not experiencing a significant uptick in sexual offenses. The issue, they said, has been largely driven by a series of cases across the country that have exposed vulnerabilities in the way states track offenders. Convicted sex offenders were charged in the killings of two Florida girls in separate incidents this year. And last month, police in Idaho arrested a registered sex offender in the kidnapping of an 8-year-old girl and her 9-year-old brother. The boy's remains were found in a campground, but the girl was returned home safely.
     During a radio interview previewing his speech Saturday, Ehrlich brushed off anticipated criticism that he was a newcomer to the issue, relaying work he had done on the issue nearly two decades ago while a member of the House of Delegates. "My activism predates this as a particularly hot public policy issue," Ehrlich said on WBALin Baltimore.
     Sen. Brian E. Frosh (D-Montgomery), chairman of a committee that has jurisdiction over sexual offender legislation, said in an interview that it is premature to predict what might pass next year. "There certainly seems to be a bandwagon effect here," Frosh said. "It's an ugly crime, and certainly one we want to stamp out, but it doesn't seem to be raging out of control."
     In his address yesterday, Ehrlich said he would provide an additional $700,000 in his proposed budget next year to help law enforcement agencies improve sex offender registries. He also pledged increased penalties for those who fail to comply. Ehrlich also announced a new Web site, http://www.socem.info/ , that will include information on sex offenders who do not keep their registrations current. Some local jurisdictions already provide such information on their Web sites. Another initiative by Ehrlich would allow interested citizens to help find missing children by receiving "Amber Alerts" over their cell phones.

Whiny Kid's Behavior Can Be Changed
Gregory Ramey, Cox News Service- 8/21/2005

DAYTON, OHIO - I couldn't wait to leave my friend's house the other night. For most of the time I was there, his 7-year-old boy . was complaining, arguing and whining. His parents were patient and understanding, but nothing they said or did seemed to matter. "He's so different from his sister," said my friend. "I guess he was just born that way, and we have to accept him as he is."
     I don't like being around whiny children. These youngsters are never satisfied with anything their parents do for them. When given affection and attention, they demand more. When taken someplace special, -they complain when it is time to leave. They constantly whine that their siblings are treated better than they are. Life is a constant negotiation with an ungrateful child whose wants are endless. Parents feel there is nothing they can do to ever please such a child. Do parents have to accept the fact that some children are just born this way? I don't think so.
∎ Provide feedback to your child. When I've worked with these children in therapy, they seem genuinely surprised when given feedback about their behavior. We'll roleplay various situations, and they laugh when I use a whiny voice. "That isn't the way other people hear me talk, is it?" they ask.
The time to speak with your child about this behavior is not at a time of crisis. Wait for a calm time of the day. Be specific about your concerns. Don't talk about "atitude" or being "ungrateful." Instead, discuss and demonstrate specific behaviors such as one's tone of voice or repeating the same demand once an answer has been given.
∎ Don't ever give in. I've been asked many times why children act this way. Children whine because it works -- they get their way. If you have a whiny child, try this. For one week never give in to your children if they ask for something in a whiny tone of voice. By the end of the week, you'll see dramatic changes in their behaviors.
∎ Notice Improvements. As your child begins to improve, notice and compliment those changes. Feedback is particularly important during the first few days, as your child learns that the old ways of getting things no longer work. Focus on the impact on the entire family. "It's so much more pleasant around here when you ask for things in a nice tone of voice."
∎ Be a good role modal. One of the toughest things about being a parent is that you are always "on." Everything we say and do is a lesson to our children. Pay attention to how you deal with frustration, anger and life's daily annoyances.
∎ Help someone else. Whiny children are very self-centered. They expect and demand that everyone meet their wants and needs. The world revolves around them. Try involving your child in helping someone else. Perhaps it is an elderly neighbor who needs a homecooked meal or a handicapped child in the classroom. Volunteers get more than they give, and this can be a very helpful lesson for children. Whiny children can be difficult, but don't give up or give in. Try something different today.
      Gregory Ramey is a child psychologist and vice president for outpatient services at Children's Medical Center of Dayton.

Josh was a man in his 40's I'd been treating for depression. His wife had given birth to their first child, a girl, three days before. "Congratulations," I said. "She's beautiful. A miracle," he responded. "Amazing, isn't it?" I agreed, remembering the first time I held my own daughter. "Just incredible." He shrugged, shook his head. His foot started tapping. "You were ... there?" he asked me, tentatively. "I mean, for the delivery?"
      There. I could hear the other questions coming. I have heard them many times from men whose wives had given birth days or weeks before our sessions. Even when I had been treating these men for a year or more, they always seemed uncharacteristically hesitant to broach this topic. "I was," I said. I waited. He nodded. "Incredible, isn't it?" "It's a lot of things," I said, giving him permission to say more. He relaxed a bit. The tapping of his foot slowed. "Where were you? The head of the bed?" That was almost always the next question. "Just about the whole time," I said. He winced. "I probably should have stayed up there, too." "Why's that?" "You know," he said with a smile. He couldn't bear to say it. "You saw more than you wanted to?" I asked. The smile left his face. "I just can't get it out of my mind." "What about it?" "Nothing." I waited. "I mean," he went on, "how are you supposed to go from seeing that to wanting to be with ... ?" He stopped, but his eyes kept asking the question. "Right," I said. "It gets easier with time, for just about everyone."
     Although no one seems to talk publicly about the problem, Josh is only one of dozens of men who have confided to me that witnessing the births of their children has made it difficult for them to be attracted to their wives, at least in the short run. They seem to have trouble seeing them as sexual beings after seeing them make babies, trouble reverting to a mind-set in which their wives' sexual anatomy is just that -- not associated with images of new life emerging through the birth canal.
     In the age of the "new man," very little consideration is given to the potentially negative side effects of togetherness in the delivery room. Every man I have spoken with over the past few years knows he is expected to be with his wife when his child comes into the world. How can anyone explain sitting out such a life-changing moment in the waiting room? The trouble is that the moment turns out to be both intensely beautiful and potentially traumatic.
     It is miraculous to see a baby's head emerge, and it can also be shocking. It is riveting to see an umbilical cord connecting mother and baby, but it can also be very disturbing. It is exciting to be asked by a doctor to cut that umbilical cord, but also potentially very frightening, even for otherwise rather fearless men. And not every man gets over it. Several men have confessed to me that they never regained the same romantic view of their wives that they had before seeing them deliver children. "They ended up having to cut her open to get the baby," one patient told me. "I saw it. I mean, how am I supposed to get that out of my head? Every time I look at the scar, it's like I'm seeing it again."
     In the most striking cases, the symptoms that men experience come close to post-traumatic stress disorder, with its roots in the witnessing of an event that involves a threat to the physical integrity of self or others and responding with intense fear, helplessness or horror. The symptoms, as my patients have reported, include recurrent and intrusive distressing recollections of the event and efforts to avoid recalling it.
     I do not believe that most men suffer these symptoms. But some do. And predicting which men will be vulnerable to them is nearly impossible in a social climate in which men who admit reticence about being present in the delivery room risk being labeled throwbacks. The fact that the subject is taboo also means that a man who is traumatized by the experience may be retraumatized again and again, with each child born to him. "Honestly," one man, married for 12 years, told me, "I think one of the main reasons I don't feel attracted to my wife is that I saw her give birth three times. It's like I know too much about that part of her." The mystery is gone. And while there are other contributing factors to the loss of passion in the man's marriage, one of them does seem to be his presence in the delivery room, three times.
     And I'm not sure that the delivery is the only cause of men's psychological struggles during their partners' pregnancies. I myself recall feeling as if the clinical focus on childbirth during prenatal classes, including the detailed descriptions of the placenta and the meconium, took away from the wonder of the process, rather than adding to it. I don't know what is gained by showing the cross-sectional anatomy of a woman's torso to her lover.
     Whether the father is present in the delivery room is a couple's personal decision, of course. But it is a decision that involves potential gains and potential losses, and too few couples realize that fact or are willing to talk about it. Women may want to consider the risks as they invite their partners to watch them bring new life into the world. For some of the passion that binds them together may leave their lives at the very same time.

The Other Brain Also Deals With Many Woes
Harriet Brown, New York Times- 8/23/2005

Two brains are better than one. At least that is the rationale for the close -- sometimes too close -- relationship between the human body's two brains, the one at the top of the spinal cord and the hidden but powerful brain in the gut known as the enteric nervous system. For Dr. Michael D. Gershon, the author of "The Second Brain" and the chairman of the department of anatomy and cell biology at Columbia, the connection between the two can be unpleasantly clear. "Every time I call the National Institutes of Health to check on a grant proposal," Dr. Gershon said, "I become painfully aware of the influence the brain has on the gut." In fact, anyone who has ever felt butterflies in the stomach before giving a speech, a gut feeling that flies in the face of fact or a bout of intestinal urgency the night before an examination has experienced the actions of the dual nervous systems.
      The connection between the brains lies at the heart of many woes, physical and psychiatric. Ailments like anxiety, depression, irritable bowel syndrome, ulcers and Parkinson's disease manifest symptoms at the brain and the gut level. "The majority of patients with anxiety and depression will also have alterations of their GI function," said Dr. Emeran Mayer, professor of medicine, physiology and psychiatry at the University of California, Los Angeles. A study in 1902 showed changes in the movement of food through the gastrointestinal tract in cats confronted by growling dogs.
     One system's symptoms -- and cures -- may affect the other. Antidepressants, for example, cause gastric distress in up to a quarter of the people who take them. Butterflies in the stomach are caused by a surge of stress hormones released by the body in a "fight or flight" situation. Stress can also overstimulate nerves in the esophagus, causing a feeling of choking.
     Dr. Gershon, who coined the term "second brain" in 1996, is one of a number of researchers who are studying brain-gut connections in the relatively new field of neurogastroenterology. New understandings of the way the second brain works, and the interactions between the two, are helping to treat disorders like constipation, ulcers and Hirschprung's disease.
     The role of the enteric nervous system is to manage every aspect of digestion, from the esophagus to the stomach, small intestine and colon. The second brain, or little brain, accomplishes all that with the same tools as the big brain, a sophisticated nearly self-contained network of neural circuitry, neurotransmitters and proteins. The independence is a function of the enteric nervous system's complexity. "Rather than Mother Nature's trying to pack 100 million neurons someplace in the brain or spinal cord and then sending long connections to the GI tract, the circuitry is right next to the systems that require control," said Jackie D. Wood, professor of physiology, cell biology and internal medicine at Ohio State.
     Two brains may seem like the stuff of science fiction, but they make literal and evolutionary sense. "What brains do is control behavior," Dr. Wood said. "The brain in your gut has stored within its neural networks a variety of behavioral programs, like a library. The digestive state determines which program your gut calls up from its library and runs."
     When someone skips lunch, the gut is more or less silent. Eat a pastrami sandwich, and contractions all along the small intestines mix the food with enzymes and move it toward the lining for absorption to begin. If the pastrami is rotten, reverse contractions will force it -- and everything else in the gut -- into the stomach and back out through the esophagus at high speed. In each situation, the gut must assess conditions, decide on a course of action and initiate a reflex. "The gut monitors pressure," Dr. Gershon said. "It monitors the progress of digestion. It detects nutrients, and it measures acid and salts. It's a little chemical lab." The enteric system does all this on its own, with little help from the central nervous system.
     The enteric nervous system was first described in 1921 by Dr. J. N. Langley, a British physician who believed that it was one of three parts -- along with the parasympathetic and sympathetic nervous systems -- of the autonomic nervous system, which controls involuntary behaviors like breathing and circulation. In this triad, the enteric nervous system was seen as something of a tag-along to the other two.
     After Langley died, scientists more or less forgot about the enteric nervous system. Years later, when Dr. Gershon reintroduced the concept and suggested that the gut might use some of the same neurotransmitters as the brain, his theory was widely ridiculed. "It was like saying that New York taxi drivers never miss a showing of 'Tosca' at the Met," he recalled.
     By the early 80's, scientists had accepted the idea of the enteric nervous system and the role of neurotransmitters like serotonin in the gut. It is no surprise that there is a direct relationship between emotional stress and physical distress. "Clinicians are finally acknowledging that a lot of dysfunction in GI disorders involves changes in the central nervous system," said Gary M. Mawe, a professor of anatomy and neurobiology at the University of Vermont.
     The big question is which comes first, physiology or psychology? The enteric and central nervous systems use the same hardware, as it were, to run two very different programs. Serotonin, for instance, is crucial to feelings of well-being. Hence the success of the antidepressants known as S.S.R.I.'s that raise the level of serotonin available to the brain. But 95 percent of the body's serotonin is housed in the gut, where it acts as a neurotransmitter and a signaling mechanism. The digestive process begins when a specialized cell, an enterochromaffin, squirts serotonin into the wall of the gut, which has at least seven types of serotonin receptors. The receptors, in turn, communicate with nerve cells to start digestive enzymes flowing or to start things moving through the intestines. Serotonin also acts as a go-between, keeping the brain in the skull up to date with what is happening in the brain below. Such communication is mostly one way, with 90 percent traveling from the gut to the head.
     Many of those messages are unpleasant, and serotonin is involved in sending them. Chemotherapy drugs like doxorubicin, which is used to treat breast cancer, cause serotonin to be released in the gut, leading to nausea and vomiting. "The gut is not an organ from which you wish to receive frequent progress reports," Dr. Gershon said.
     Serotonin is also implicated in one of the most debilitating gut disorders, irritable bowel syndrome, or I.B.S., which causes abdominal pain and cramping, bloating and, in some patients, alternating diarrhea and constipation. "You can run any test you want on people with I.B.S., and their GI tracts look essentially normal," Dr. Mawe said. The default assumption has been that the syndrome is a psychosomatic disease. But it turns out that irritable bowel syndrome, like depression, is at least in part a function of changes in the serotonin system. In this case, it is too much serotonin rather than too little.
     In a healthy person, after serotonin is released into the gut and initiates an intestinal reflex, it is whisked out of the bowel by a molecule known as the serotonin transporter, or SERT, found in the cells that line the gut wall. People with irritable bowel syndrome do not have enough SERT, so they wind up with too much serotonin floating around, causing diarrhea. The excess serotonin then overwhelms the receptors in the gut, shutting them down and causing constipation. When Dr. Gershon, whose work has been supported by Novartis, studied mice without SERT, he found that they developed a condition very much like I.B.S. in humans. Several new serotonin-based drugs -- intestinal antidepressants, in a way -- have brought hope for those with chronic gut disorders.
     Another mechanism that lends credence to physiology as the source of intestinal dysfunctions is the system of mast cells in the gut that have an important role in immune response. "During stress, trauma or 'fight or flight' reactions, the barrier between the lumen, the interior of the gut where food is digested, and the rest of the bowel could be broken, and bad stuff could get across," Dr. Wood said. "So the big brain calls in more immune surveillance at the gut wall by activating mast cells." These mast cells release histamines and other inflammatory agents, mobilizing the enteric nervous system to expel the perceived intruders, and causing diarrhea. Inflammation induced by mast cells may turn out to be crucial in understanding and treating GI disorders. Inflamed tissue becomes tender. A gut under stress, with chronic mast cell production and consequent inflammation, may become tender, as well.
     In animals, Dr. Mawe said, inflammation makes the sensory neurons in the gut fire more often, causing a kind of sensory hyperactivity. "I have a theory that some chronic disorders may be caused by something like attention deficit disorder in the gut," he said. Dr. Gershon, too, theorizes that physiology is the original culprit in brain-gut dysfunctions. "We have identified molecular defects in the gut of everyone who has irritable bowel syndrome," he said. "If you were chained by bloody diarrhea to a toilet seat, you, too, might be depressed."
     Still, psychology clearly plays a role. Recent studies suggest that stress, especially early in life, can cause chronic GI diseases, at least in animals. "If you put a rat on top of a little platform surrounded by water, which is very stressful for a rat, it develops the equivalent of diarrhea," Dr. Mayer said. Another experiment showed that when young rats were separated from their mothers, the layer of cells that line the gut, the same barrier that is strengthened by mast cells during stress, weakened and became more permeable, allowing bacteria from the intestine to pass through the bowel walls and stimulate immune cells. "In rats, it's an adaptive response," Dr. Mayer said. "If they're born into a stressful, hostile environment, nature programs them to be more vigilant and stress responsive in their future life."
     He said up to 70 percent of the patients he treats for chronic gut disorders had experienced early childhood traumas like parents' divorces, chronic illnesses or parents' deaths. "I think that what happens in early life, along with an individual's genetic background, programs how a person will respond to stress for the rest of his or her life," he said. Either way, what is good for one brain is often good for the other, too.
     A team of researchers from Penn State University recently discovered a possible new direction in treating intestinal disorders, biofeedback for the brain in the gut. In an experiment published in a recent issue of Neurogastroenterology and Motility, Robert M. Stern, a professor of psychology at Penn State, found that biofeedback helped people consciously increase and enhance their gastrointestinal activity. They used the brains in their heads, in other words, to help the brains in their guts, proving that at least some of the time two brains really are better than one.