Noteworthy News Articles on Mental Health Topics, October 21-31, 2006



Living With Love, Chaos and Haley
Pam Belluck, New York Times- 10/22/2006

PLYMOUTH, Mass. — When Haley Abaspour started seeing things that were not there — bugs and mice crawling on her parents’ bed, imaginary friends sitting next to her on the couch, dead people at a church that housed her preschool — her parents were unsure what to think. After all, she was a little girl. “I thought for a long time, ‘She’s just gifted,’ ” said her father, Bejan Abaspour. “‘This is good. Don’t worry about it.’ ”
      But as Haley got older, things got worse. She developed tics — dolphin squeaks, throat-clearing, clenching her face and body as if moving her bowels. She heard voices, banging, cymbals in her head. She became anxiety-ridden over run-of-the-mill things: ambulance sirens, train rides. Her mood switched suddenly from excitedly chatty to inconsolably distraught. “It’s like watching ‘The Sound of Music’ and ‘The Exorcist’ all at the same time,” Mr. Abaspour said.
     For her family, life with Haley, now 10, has been a turbulent stream of symptoms, diagnoses, medications, unrealized expectations. Diagnosed as a combination of bipolar disorder with psychotic features, obsessive-compulsive disorder, generalized anxiety disorder and Tourette’s syndrome, her illness dominates every moment, every relationship, every decision. Haley’s fears, moods and obsessions seep into her family’s most pedestrian routines — dinnertime, bedtime, getting ready for school. Excruciating worries permeate her parents’ sleep; unanswerable questions end in frustrated hopes. “The first time we took Haley to the hospital, I guess I expected that they would put it all back together,” said her mother, Christine Abaspour. “But it’s never all back together.”
      At least six million American children have difficulties that are diagnosed as serious mental disorders, according to government surveys — a number that has tripled since the early 1990’s. Most are treated with psychiatric medications and therapy. The children sometimes attend special schools. But while these measures can help, they often do not help enough, and the families of such children are left on their own to sort through a cacophony of conflicting advice. The illness, and sometimes the treatment, can strain marriages, jobs, finances. Parents must monitor medications, navigate therapy sessions, arrange special school services. Some families must switch neighborhoods or schools to escape unhealthy situations or to find support and services. Some keep friends and relatives away. Parents can feel guilt, anger, helplessness. Siblings can feel neglected, resentful or pressure to be problem-free themselves. “It kind of ricochets to other family members,” said Dr. Robert L. Hendren, president-elect of the American Academy of Child and Adolescent Psychiatry. “I see so many parents who just hurt badly for their children and then, in a sense, start hurting for themselves.”
     Ms. Abaspour, 39, struggles to master the details of Haley’s illness, to answer her obsessive questions, to keep her occupied. Mr. Abaspour, 50, who long believed that “Haley was going to grow out of it,” has been gripped by anxious thoughts and intrusive images that rattle him to tears on the hourlong commute to his job as an anesthesia engineer at a Boston hospital. He imagines people being crushed by trucks, someone hurting Haley, his own death. Haley’s sister, Megan, 13, has been so focused on Haley and determined not to add to her family’s burden that in June, after a quarrel with her parents, she tied a T-shirt around her neck in a suicidal gesture. “I feel like she gets all the problems and I feel like I have to take some of that off of her,” Megan said. “It’s really difficult a lot to try to stay away from babying her and helping her. I try to stay still but it just hurts, it hurts inside.”
     Haley, with her shy smile and obsidian eyes, is increasingly aware of her own problems, although she cannot always express exactly what is going on inside. “My mind says I need some help” is the way she explained it recently. Her illness has caused great financial strain; although the Abaspours have health insurance, they have been forced to draw on their savings and lean heavily on their credit cards for living expenses. Still, they have bought a trailer in a New Hampshire campground because there Haley finds occasional solace, and relatives nearby understand the family’s ordeal. The family wrestles with deciding whom to tell about Haley’s illness, and what to say. Her worst symptoms are most visible at home and less apparent at the public school and the state-financed therapeutic after-school program she attends. Her parents say she works hard to hold herself together during the day and then later, feeling more comfortable with her family, falls apart.
     This disparity in behavior is not uncommon, said Dr. Joseph A. Jackson IV, Haley’s psychiatrist, and “parents often get the brunt.” Because of the contrast in Haley’s public and private behavior, her parents are wary of telling people that she is mentally ill, as they might not notice. “I don’t want anybody to pity her,” Mr. Abaspour said. But they also get frustrated when teachers or relatives play down the seriousness of Haley’s illness, or conclude that she is being manipulative or that another child-rearing approach would help. In the middle of last year, for example, a teacher did not understand Haley’s need to leave the classroom to quiet the voices or relieve anxiety. Haley grew so frustrated that she “would sit there in her chair and cry,” her father said. The parents pressed school officials to switch her to another class. “We’re sick and tired of trying to prove it to people,” Ms. Abaspour said. Her husband added, “Everybody thinks they have the solution. When Joe Schmo comes over for a drink, he says, ‘Try this, this will work.’ No, it won’t.”

Visions and Voices
From birth, it was clear that “I was dealing with something different,” Ms. Abaspour said. Displaying a photo album with picture after picture of Megan all smiles and Haley “crying, crying, crying,” she added, “We just thought we had a very difficult child.” Yet exactly what was wrong puzzled them for years, and even now, Ms. Abaspour said, “Every day it’s something new, I swear.”
      While increasing awareness of childhood mental illness has helped many children and families, it can also create a misimpression that everything can be treated, said Dr. Glen R. Elliott, chief psychiatrist at the Children’s Health Council, a community mental health service in Palo Alto, Calif., and the author of “Medicating Young Minds: How to Know if Psychiatric Drugs Will Help or Hurt Your Child.” That can make families with complex cases feel “either genuine confusion or pretend certainty,” Dr. Elliott said.
     The Abaspours decided to speak with a reporter about Haley’s illness and its impact on their family because they hoped it would help other families and make society more hospitable for children like their daughter. Talking about it was sometimes emotional, especially for Mr. Abaspour, whose eyes often clouded with tears. But they also said they found it useful to articulate their feelings.
     When Haley was 3 or 4, a pediatrician blamed tonsillitis-induced sleep apnea, predicting that after her tonsils were removed, “ ‘you’ll see a totally different child,’ ” Ms. Abaspour recalled. “We thought, ‘This is what is wrong with our child. This is our answer,’ ” she said. Preschool teachers suggested a learning disability. Later, Haley repeated first grade. The Abaspours consulted therapists about the visions of friends in the liner of the family’s pool and riding with Haley on her bike, and the voices criticizing her or telling her to touch a certain table. When a neurologist ruled out medical causes like Lyme disease, Ms. Abaspour recalled, her husband said, “I think we should just give her a placebo — it’s all in her head.” They got a cat, “though we weren’t cat people,” Ms. Abaspour said. Then they got another because the first was “not the type of cat that Haley could throw over her shoulder and squeeze.”
     New symptoms kept emerging. For a while, when she was about 7, the voices “were telling her she was a boy,” Ms. Abaspour said. “She had to constantly prove to them that she wasn’t.” Haley became obsessed with penises, which she called “bums.” She claimed to see them though she was looking at fully clothed men and boys, her mother said. “Then she felt guilty. She would come up to me and whisper, ‘I saw his bum, I saw his bum.’ The bus driver or the little boy, anyone. It was constant.” To halt the whispering, Ms. Abaspour suggested that they share a private signal: Haley could flash a thumbs-up after a sighting. Haley also seemed preoccupied with death, and on a highway would say that voices told her, “If that license plate didn’t say such and such, she was going to die,” her mother said. Once, Mr. Abaspour recalled, Haley “kept yelling that she wants to start over.”

The Treatment Puzzle
When she was almost 8, Haley visited Dr. Jackson at his office at the Cambridge Health Alliance. He was struck by the results of a screening: Haley met full criteria for virtually every mental disorder listed. “Her symptoms,” he said, “suggested anxiety, morbid thoughts, obsessions possibly of a sexual nature, frequent fluctuations in mood, periods of euphoria, giddiness, irritability, rapid speech, auditory and visual hallucinations, thought disorganization, vocal tics, distractibility, poor socialization in school, sensory integration issues, attention impulse disorder, manic behavior, sleep disturbance.” Dr. Jackson wondered if the voices and the friends, which Haley told him were “nowhere but everywhere,” were schizophrenic-like hallucinations or milder thought distortions. He also saw Haley’s mood swing from anxiety about a “disturbing dream in which her mother was killed” to euphoria, as she gleefully drew a large, brightly colored butterfly and a self-portrait with a too-big smile and a skirt that ballooned as if she were floating. The pictures, he said, “scream” manic sensibility, suggesting bipolar disorder.
      Dr. Jackson prescribed an antipsychotic, Risperdal, one of a dozen drugs Haley would try. Some helped initially, but the voices returned or side effects developed. Huge pills or bad-tasting liquid made Haley gag or throw fits. “It was horrible, horrible, horrible,” her mother said, “and she’d pull us into it because we had to make her take it.” Lithium caused weight gain: clothes that fit her one day no longer did the next.
     When Haley was 81/2, Mr. Abaspour said, “Let’s drop all of these medications and see what happens.” He said, “I wanted to see her true self.” The results chastened them. “You see her fine one day,” Mr. Abaspour said. “The second day comes and she’s fine and you say, ‘You see, honey, there’s nothing wrong with her.’ Then it’s the third day and she goes crazy and you feel like an idiot.”
     Haley resumed taking Risperdal. Then, abruptly, her condition worsened. “She couldn’t function, she couldn’t go to school,” said Ms. Abaspour, who took Haley to a hospital; she had to handle the crisis with her husband away in London. In the emergency room, Haley was manic and hyperarticulate, Ms. Abaspour recalled. “I was a basket case.” When Mr. Abaspour returned and saw Haley “like a zombie” in a hospital full of out-of-control children, his first reaction was, “She can’t be in here.” But the eight-day hospital stay made him grasp the severity of her illness. “You look at an X-ray and you say it’s a fracture,” he said. “But this thing. ... Before then, there wasn’t solid evidence.” A year later, school halls “would get scary because the voices would get louder,” so Haley constantly visited the school’s nurse and psychologist, her mother said. “She was going out of her mind.”
     Haley was hospitalized again, and another antipsychotic drug, Abilify, muffled the voices. “I remember thinking, ‘Am I supposed to be happy about this?,’ ” Ms. Abaspour said. She was grateful that something helped but distressed at the suggestion that Haley was psychotic. The Abilify has not soothed Haley’s anxiety or stopped her outbursts. And despite increases in the dosage, back are the voices (four boys and a girl), the tics (eye squinting and hand clenching) and the “bums.”
     Dr. Jackson, her psychiatrist, said Haley’s biggest asset was her “very caring family” that was “seeking ways to shore themselves up” to better help her. Ms. Abaspour said: “We ask ourselves sometimes, ‘Why? Why did it happen to us?’ Other times we see a child bald, going through chemotherapy. That’s the thing about this — it’s on the inside, you can’t see it.”

Megan’s Heartache

I pretend no one is around me when my sister is there.
I feel a constant hurt inside.
I touch a rainbow of joyfulness in my mind when my sister and I are FINALLY having a fun
laugh together.
I worry that when one day I die, I won’t be there to help my sister.
I cry to the stars, pleading them to take me away from this madness at mind.

A Mother’s Stoicism
Christine Abaspour, the youngest of four girls raised by a divorced mother, knew what she wanted early in life. At 19, she left Massachusetts, joined a sister in Florida and became a waitress. At 25, she met her husband-to-be, who was 11 years older. She was engaged in two weeks, married in nine months and a mother a year later. “We both wanted to have children right away, like you wouldn’t believe,” she recalled.
      Ms. Abaspour said that she had no regrets, and that Haley “was given to us for some reason, and I keep waiting for the day when I realize why.” Still, the experience has tested her stamina, and she avoids capitulating to Haley’s whims and outbursts by imposing structure, consistency, even distance. “I’m her mother,” Ms. Abaspour said. “I try to make it a better world for her, a more comfortable world. I stay very strong for her and very encouraging for her. If she comes out of a meltdown, I’ll say, ‘I knew that you could.’ I don’t make her feel totally hopeless. It doesn’t give me any satisfaction, though, because I still feel helpless. Unfortunately it just bites you in the face all day long.” Ms. Abaspour’s stoic approach, which her husband appreciates but cannot always emulate, is “a good coping skill for parents,” Dr. Elliott, of the Children’s Health Council, said. “It’s what happens to a family system when you’ve got a source of chaos in the middle of it.”
     After getting Haley ready for school, Ms. Abaspour feels she has already lived an entire day. In the afternoon, “Haley walks in the door and I just want to hold her and give her a big kiss like most kids,” Ms. Abaspour said. “Instead I get a frown and tears and ‘Ooh, I had such a stressful day.’ ” She said that every evening, a distraught Haley will “say to me her same 12 questions: ‘What’s going to happen when I need to go to school and I can’t leave the classroom?’ or ‘What do I have to look forward to today?’ ” By bedtime, Ms. Abaspour said, “your heart’s just breaking.”
     To slake Haley’s thirst for “something to do,” Ms. Abaspour keeps her involved in activities outside of school. Otherwise, the family ends up stopping for ice cream or concocting other outings, because unstructured time allows Haley to focus on the voices and anxiety. “Staying home is not an option,” Ms. Abaspour said. “Honestly I could not keep her busy. Sometimes being around here on a Saturday or Sunday, it’s almost toxic. She has multiple episodes — it’s like living hell.”
     Haley’s fears of noises, crowded streets and surprises force the Abaspours to forgo amusement parks, apple picking or other traditional family activities. When relatives visit “and you think it’s going to be relaxing and we’ll watch movies and eat popcorn — that doesn’t happen in this family,” Ms. Abaspour said. Instead, there are mood cycles, as when Haley marched around announcing, “I’m going to make a really great art project,” then fell apart, wailing, “I don’t know what to do.” Ms. Abaspour stays unflustered. When Haley bawled, “I don’t have any markers,” her mother replied, “Oh, don’t tell me you don’t have.” But she found Haley a T-shirt to cut up and draw on, saying, “If I can get her to do that kind of chop, chop, chop, mark, mark, mark, it kind of brings her back.”
     Ms. Abaspour said she had watched “everyone else in the family rush over to her, and I won’t become a part of that. I make her be responsible for her own feelings because I can’t be responsible for those. You still have to be a regular parent. Honestly, she has to learn to soothe herself.”
     But Ms. Abaspour doggedly monitors Haley’s progress. This summer, she visited Haley at day camp and was dismayed that the child frequently declined to participate, asking for the nurse. Sitting out the swim period one day, Haley, wearing a “Keep It Cool” T-shirt, listed her feelings on a worksheet: “stressed, axxouis, sick, shacky.” At lunch, she mostly licked salt off pretzels. Asked to choose a word-card matching her emotions, she picked “overwhelmed.”
      Ms. Abaspour worries that as Haley becomes a teenager, her poor social skills might get her “mixed up with the wrong kids” or lead her to use illegal drugs. So she arranges play dates, but if friends are unavailable “it’s the end of the world,” she said. If they are available, she said, Haley anxiously asks, “What do I say, Mommy?”
     Ms. Abaspour was recently laid off from a medical assistant’s job. Her former co-workers understood her need to interrupt work to deal with Haley’s needs, she said, and “didn’t look at me and say, ‘Her child’s crazy.’ ” Now she fears she will not find an employer who is as tolerant, though the family needs the income. Haley’s illness, the Abaspours were dismayed to discover, does not qualify for disability assistance.
     In August, Ms. Abaspour arranged an elaborate 50th-birthday surprise party for her husband. They were “not always on the same page” about Haley at first, she said, but their strong marriage helps her handle the strain. So do bright spots, she said, like the day Haley “really kissed me.” Still, she can get overwhelmed. Sometimes she bolts awake at night, but she declines medication. “I can’t climb in a shell and stay there forever,” she said, “although it seems like some days where I’d want to be.”

A Father’s Anxiety
As a young man, Bejan Abaspour worried, especially about family. Twenty years ago, for example, when his sister’s son was born, “I pictured my nephew getting Super Glue in his eyes and I was calling my sister saying, ‘Make sure you keep Super Glue away from him.’ ”

But the worries were not that intense — until Haley’s illness. After that, the intrusive thoughts and images got worse, horrific scenes in which he imagines himself as bystander or thwarted rescuer. “I’ll be driving next to a semi tractor-trailer truck and all of a sudden I will picture someone getting crushed by the wheel,” he said. “It’s usually an older lady or a kid. You get them out from under the truck, but it doesn’t stop. I’m in the emergency room, trying to help. I’m at the funeral. Then very easily, the tears come.”

Mr. Abaspour said he sometimes pictured Haley “getting lost somewhere, or someone’s going to hurt her. I’m involved and trying to get the guy who did it to stop. Sometimes I kill him. Sometimes it doesn’t get that far.”

Other times, he said, he imagines his death, seeing his family “at the funeral home and I’m laying there. I try to see what’s going on at home, how Meggie’s reacting to my death, how Haley’s reacting, what Christine is going through.”

He rehashes things Haley has said, like wanting to “start over” or her question: “When I get really old, can I come back home? Will you be there?”

He wonders if his worrying laid genetic groundwork for Haley’s illness, “if I’m the cause of what Haley’s going through.”

Until recently, Mr. Abaspour, who also has trouble sleeping, told no one about his agonizing thoughts, not even his wife.

“I didn’t want to burden her,” he said. “I can handle it. So what if I’m driving to work and I cry? So what if I only sleep for four hours?”

But last spring, the family’s therapist noticed “I had certain problems,” he recalled. She encouraged him to tell his wife whenever he had disturbing thoughts. Mr. Abaspour said he hoped that confronting his own anxiety would help “get to the bottom of what Haley’s going through.”

He added, “It doesn’t matter for me, but for Haley.”

Families once kept illnesses like Haley’s quiet, afraid of being shunned or disparaged.

Public acceptance has grown, but some misperceptions and prejudice remain, and families feel conflicted: they want people to understand so the child can get appropriate help, but they also fear that Haley will be mocked or ostracized.

“If they keep it a secret then they’re bad parents,” Dr. Elliott said. “If they start spewing diagnoses, they’re subject to criticism because they’re not taking responsibility, just laying it on the illness. Or they’re social pariahs because there are some people who think that mental illness is contagious.”

Like other families, the Abaspours sometimes hesitate to publicly label their daughter mentally ill. But they also want people to know, and they get frustrated if people do not fully accept or understand it, or see her symptoms “as a manipulative thing, or they feel like they can fix it themselves, maybe by distracting her,” Ms. Abaspour said.

Her own family now understands and is very supportive, but it took some convincing, she said.

“My mother would say, ‘She’ll be fine, she’ll be fine, there’s nothing wrong with her,’ ” Ms. Abaspour said. “My sister says, ‘Well, she didn’t act like that when she was over here.’ ”

Mr. Abaspour has not told most of his family, who live in England, because they might worry excessively or not understand.

He told his sister, but “she was like I was when I first encountered the situation — disbelief or denial,” he said. His sister, he said, has not told her husband or her 20-year-old son, which created an odd atmosphere when they visited the Abaspours in August. “When Haley did have one of her little episodes, they were all like, ‘oh, oh,’ and they wondered why we weren’t running over to her,” Ms. Abaspour said. “I would like to talk to them more about it. If she had diabetes, they’d know she had diabetes.”

When, after reading a book for children with bipolar disorder, Haley said, “I can’t wait to go to school and tell everybody I’m bipolar,” the Abaspours were torn.

They discouraged her from announcing the diagnosis. But Haley did tell her classmates, “ ‘I have a lot of noise going on in my head and sometimes I feel anxious and sometimes I have to take a walk.’ ”

Some day, the Abaspours hope, Haley will have more effective drugs and better coping skills, and society will be more tolerant, so she can lead an independent life. But they have no illusions.

“This is not going away,” Ms. Abaspour said. Not for Haley or her family. “The overflow of what Haley has is what has made all of us what we are today.”



Two Documentary Films on Suicide
Dennis Lim, New York Times- 10/22/2006

Steve Irwin, the Crocodile Hunter, who perished last month of a stingray stab, once declared, “If I’m going to die, I want it filmed.” (He got his wish.) It’s doubtful that any of the two dozen people who jumped to their deaths off the Golden Gate Bridge in 2004 ever issued such a request, but they were filmed all the same. Some of them are the unwitting stars of a disturbing documentary called “The Bridge.” Having drawn both fire and praise when it screened at the Tribeca Film Festival and the San Francisco International Film Festival last spring, it opens at the IFC Center this Friday.

Aiming to chronicle a year in the life of a suicide magnet, the film’s director, Eric Steel, and his crew embarked on a marathon deathwatch: they staked out the bridge from sunrise to sunset every day from Jan. 1 to Dec. 31. A few cameras were fixed; others were continuously manned and fitted with telephoto lenses. With some of the suicides that made it into the film — which inserts this harrowing footage amid interviews with friends and family of the deceased — the camera jerks downward, following the jumper along the four-second, 250-foot fall.

“It’s indescribably difficult to watch someone die,” Mr. Steel said in a recent interview. But he added that “The Bridge” was his attempt to raise awareness about suicide prevention: “It’s a way of getting you to witness something that’s a really terrible problem.”

Another new documentary, while also focused on suicide, takes an altogether calmer look at a very different kind of death. “Exit” (opening at Film Forum this Wednesday) details the operations of the Exit Society, which facilitates assisted suicides for the terminally ill in Switzerland. The film, directed by Fernand Melgar, concludes with one such “self-deliverance.”

“I had promised myself not to film last moments,” Mr. Melgar said in an e-mail message, but he changed his mind after observing the bond between patients and their volunteer “guides.” He set ground rules with his cinematographer: “We agreed to film the person’s face just until they took the potion. What happened next was intimate, and it was not our place to shoot it.”

“Exit” recalls Allan King’s “Dying at Grace” (2003), an equally steely and compassionate portrait of terminal illness. With their consent, Mr. King closely monitored five patients at a palliative care ward in Toronto through their final months — in some cases, up until their final breaths.

Needless to say, “The Bridge” would not be nearly as powerful with its horrors merely recounted or otherwise occluded. But what is the nature of that power?

Mr. Steel said he called the authorities every time he saw someone climb the guardrail, and as a result might have saved six lives. “The Bridge” has helped the campaign for a suicide barrier, although as reported in The New York Times in August, authorities believe that local news media attention on the film has led to an increase in suicides and suicide attempts.

The ethical responsibilities of spectatorship are front and center when it comes to images of real death. Whether or not it intends to, “The Bridge,” with its unblinking and arguably invasive camera, forces the viewer into the position of a voyeur.

“I sat there for a year and watched this,” Mr. Steel said. “That’s the experience I wanted to share.” He said he hoped the combination of the bridge scenes and the family testimonials would lead to a greater understanding of “what led these people to that spot.”

But empathy is a curious and perhaps elusive intent for any film that flirts with snuff. Mr. Steel’s camera, helplessly and safely parked on dry land a good mile from the jumpers, illustrates the problem: the gulf between the living and the dying can never be bridged.

That four-screen dramatic film is the only work among her “human dramas,” as she calls them, that is autobiographical. It was shown this year at the National Museum Wales in Cardiff, where in March Ms. Ahtila won the Artes Mundi international prize (about $74,000) for contemporary art with a human context. In April, her film “Ground Control,” about extraterrestrial contact, was viewed by 400,000 people a day on four billboard-size screens installed in busy sections of Tokyo.

This week Ms. Ahtila is coming to New York for Wednesday’s opening of her 14-minute film installation “The Wind” at the Museum of Modern Art. It will be accompanied by showings of her related feature-length film, “Love Is a Treasure.”

Sitting in her pristine studio here, which adjoins Crystal Eye, the film production company of her husband, Ilppo Pohjola, Ms. Ahtila described her medium as “moving images of stories that have already happened.”

She is primarily a fiction writer who draws on the world of human psychosis, mainly female, to transform individual case studies of mental illness into an imaginary dream world. By breaking the logical sequence of the narration, she introduces a Cubist interpretation of events that emphasizes perception over causality.

A no-nonsense woman of 47, dressed casually in jeans, a brown sweater and black running shoes, Ms. Ahtila is surrounded in her studio by warehouse shelving with neat upright file boxes and the kind of Finnish modern design elements — bright orange and red couches, a sleek water pitcher and glasses — that make visits to Helsinki so visually satisfying. Between films, she concentrates on serial photography; her current subject is women and Christian iconography. A Fra Angelico poster hanging on her studio wall states: “And every woman will be a walking synthesis of the universe.”

Ms. Ahtila views her film work more as theater than cinema, a new art that sets a stylized stage for fiction. Working in close collaboration with her cast, she often finds that an actor’s interpretation will improve her original concept of a character. During full production, script pages are pinned to the studio wall and she depends on a crew — cinematographer, set and prop designers, lighting and sound specialists, wardrobe and makeup people — for the technical and visual quality of her films.

But when she visited New York in January 2005, it was without a script or film crew, and the city was engulfed in a major snowstorm. She filmed the streets at night herself from her hotel window in Chelsea and around Madison Square Park, capturing the same enticing luminosity as that of a winter night in Helsinki. Thus began a chain of events — “a string of pearls,” she calls it — that became “The Hour of Prayer.” The film tells the story of Luca’s death from bone cancer, but is really about the stillness and emptiness of grief and the loss of what Ms. Ahtila calls “sensory surroundings.”

From those early scenes of New York, the film cuts to the winter landscape of her country cottage on a Finnish lake. It is evident when one views this landscape of icy waters against dense forests, shot as a still life and given greater depth by the zigzag configuration of rectangular screens, that her art belongs as much to the tradition of Finnish landscape painting from the early 20th century as to the world of film. (She began her art studies in Helsinki, rebelling against the prevailing abstract tradition, before studying film in London and Los Angeles.)

“Watching the darkness and cold energy of water, especially under the stars on an autumn night, has taught me how to understand space and the element of time,” she said, “and from this space come the words.” For her, landscape precedes the narrative. Most of her films are in Finnish with English subtitles, though “The Hour of Prayer” is spoken in English by a Finnish actor.

Though her gallery installations are close to the feature-length film versions she makes, their multiple screens provide more visual material from different perspectives. Ms. Ahtila’s specifications include directions for designing the galleries in which the installations are shown. For her film “The House,” which was also shown in Cardiff, the screens were framed in red, blue and green, and the gallery incorporated loose plywood boards set against the walls — tokens of both physical and mental deconstruction.

In “The House,” the character Elisa drives to her country house, in a lush woodland setting, and first describes realistically her surroundings and imaginatively appointed rooms. Then everything falls apart.

“I think the living room or my house is breaking down,” she says, alarmed by hearing her car (shown in miniature) driving across the living room wall. “I can’t keep things out anymore, can’t preserve its own space.” As disassociated noises impinge on the interior, she finds herself floating among the treetops. After she blocks out the windows with black curtains, a cacophony of urban sounds overtakes her psyche, along with an image of a passenger ship disembarking refugees, symbolic of displacement.

For those who recall watching Ingmar Bergman’s “Persona” with anxiety as two women played out their psychological struggle at a seaside house, Ms. Ahtila’s films, though unsettling in subject matter, have the opposite effect. By drawing viewers into the spatial region of the film, they evoke empathy and even intimacy.

“As a visual artist, Ahtila best captures in these films the slippery intersection between fantasy and reality,” said Laurence Kardish, senior curator of film and media at the Museum of Modern Art. He selected “The Wind” for the MoMA show, he said, for its cinematic appeal and because it was the one that spoke to him most directly.

In addition to “The Wind,” the museum will show Ms. Ahtila’s recent feature film “Love Is a Treasure,” which it acquired for its permanent collection. It is a composite of five stories about women, featuring “Ground Control,” “The Wind” and “The House.” Throughout the film, local scenes of contemporary Finnish architecture, port activity and aerial highway views figure prominently.

For the installation of “The Wind,” the Modern is painting the gallery Ms. Ahtila’s specified lipstick red (Pantone 186C), which offsets the film’s bluish palette and fierce red accents. In a chaotic interior further disarranged by a turbulent wind, the dysfunctional Susanna, a somewhat overweight, inveterate hand-biter, recites her woes, insecurities and disappointments: “I never thought I would end up seeing a psychiatrist. I thought rather that I would become a psychiatrist myself.”

Susanna finds threatening the three real or imagined lithe girls who enter her space, which she systematically destroys through escalating self-destructive acts. The action takes place under the watchful eye of a blowfish that Ms. Ahtila and her set designer discovered in a Thai restaurant in Helsiniki.

Still, when Susanna overturns a bookcase, spilling its contents, the viewer may share a moment of satisfaction. And who will not identify with her piles of unread newspapers, which a male friend comes over to iron “so the black won’t rub off on my fingers”?

In another scene, Susanna opens and lines up all her (phallic) lipsticks and crushes them with a board. There are bits on politics, social issues, education and much else besides, all in an action-packed 14 minutes.

Summing up Ms. Ahtila’s achievement in portraying this debilitating aspect of the human condition, Mr. Kardish said, “She translates that moment when the mind, under severe emotional stress, liberates itself from actuality.”



FDA Gives OK for Schizophrenia Treatment
Associated Press, 10/23/2006

LONDON -- AstraZeneca PLC said Monday that it has received approval from the U.S. Food and Drug Administration for a new formulation of its popular Seroquel schizophrenia treatment, making it the first medicine to treat both the manic and depressive sides of bipolar disorder.

Seroquel, launched by the Anglo-Swedish company in 1997, is already used to treat acute manic episodes associated with bipolar disorder and schizophrenia. The FDA approval adds the treatment of patients with depressive episodes.

Seroquel is one of AstraZeneca's top-selling drugs, with total sales of $2.8 billion last year. The company has filed for similar regulatory approval in Canada and the European Union.

''Treating acute bipolar disorder with a single medication may help patients adhere to their medication regimen,'' said John Patterson, executive director of development for AstraZeneca.

About 7 million adult Americans have bipolar disorder, a condition that strikes people in their teens and late 20s and causes episodes of mania and depression.

Previous anti-psychotic drugs had side effects giving patients tremors and restlessness. Newer drugs such as Seroquel, Eli Lilly & Co.'s Zyprexa, Johnson & Johnson's Risperdal and Bristol-Myers Squibb Co.'s Abilify are intended to have fewer side effects and dominate a market worth around $16.2 billion.

The FDA decision to approve the new treatment in the United States was based on an eight-week study of 1,045 patients with bipolar depression.

Patients were randomly assigned to take Seroquel or a placebo containing no medicine. Those taking Seroquel showed greater improvement in bipolar depression symptoms, overall quality of life, and satisfaction related to functioning, the company said.

The new formulation involves a once-daily dose of the treatment. The current immediate-release formula tablets are approved for dosing two to three times a day.

AstraZeneca shares were 0.3 percent higher at 3,516 pence ($65.83) on the London Stock Exchange.

Death With a Plan and a Departure Date
Stephen Holden, New York Times- 10/25/2006

The focus of “Exit: The Right to Die,” Fernand Melgar’s earnest documentary about assisted suicide, is so narrow that the movie plays like a stodgy promotional film for the Swiss organization Exit A.D.M.D., which helps terminally ill patients end their own lives.

Exit, based in Geneva, has 10,000 members, of whom, we’re told, the youngest is 21 and the oldest 103. It has more requests for help than it can accommodate. Switzerland is one of only a handful of countries worldwide to allow assisted suicide. In the United States only Oregon permits it.

To watch this somber movie is like visiting a funeral home and being bombarded with the soothing voices of salesmen spouting euphemisms that obscure the fact of death as surely as the scent of lilies obscures its smell. Suicide becomes “self-deliverance.” Volunteers who provide the terminally ill with a fatal cocktail of barbiturates and who remain with them during their final minutes are “escorts.”

The movie concentrates on escort-patient relationships in which the volunteer escorts interview applicants and help those who are accepted prepare and sign a statement of intent and choose a departure date. In the movie’s view, these volunteers are heroic men and women who, at enormous psychic cost to themselves, befriend their clients and rescue them from unbearable pain and suffering.

Great care is taken to make sure that the dying, many of whom suffer from cancer and multiple sclerosis, are unwavering in their wish.

The organization is strict about whom it will help. Those with severe depression are turned away unless that depression is connected with a terminal illness. Only Swiss residents are eligible because there is the fear that if Exit accepted people from other countries, Switzerland might become a mecca for euthanasia tourism.

At one organizational meeting, members debate the request of a couple, both 82, who wish to die together, although only one is ill; as much as the members sympathize with the couple, that request is denied.

The focus of “Exit: The Right to Die” is so limited that the movie never broaches the religious issues surrounding assisted suicide. And it touches on the legal issues only tangentially.

The potential for abuse, should legally assisted suicide become widespread, isn’t addressed, although it is easy to imagine any number of situations that are not as clear as the movie’s case studies.

Although Exit is connected to a worldwide network of organizations in the movement for the right to die with dignity, that movement is mentioned only in passing.

The film begins with an escort’s visit to a dying woman named Micheline who signs a declaration of intent. In the final scene it returns to her home to observe the final ritual. Despite the humanity and courage exhibited by the members of Exit, the film is inescapably grim.

The Right to Die
Written (in French, with English subtitles) and directed by Fernand Melgar; directors of photography, Camille Cottagnoud and Stefan Bossert; edited by Karine Sudan; produced by Mr. Melgar and Jean-Marc and Mathieu Henchoz; released by First Run/Icarus Films.

Options to Banish Phobias
Vikki Conwell, Cox News Service- 10/26/2006

ATLANTA - Time (and her family) flew right by as Kathy Heart kept her feet planted firmly on the ground. "I told myself that I could fly anytime I wanted to, but I just didn't want to," said the Atlanta woman, who did not see her relatives in New Jersey for 20 years. "Then I had to realize that I really couldn't."
     The irrational, uncontrollable fear of certain situations, places or objects, coupled with physiological reactions such as intense breathing, pounding heart and sweating, paralyzes about 6.3 million people in the United States. Phobias can disrupt daily routines and alter lives as sufferers avoid the triggers, which include:
• Animals. The most common specific phobias include dogs, snakes, insects or mice.
• Situations such as flying, riding in a car or on public transportation, driving, going over bridges or in tunnels or being in a closed-in place.
* Natural environment such as storms, heights or water.
* Blood, injection, injury. These involve a fear of being injured, of seeing blood or of invasive medical procedures, such as blood tests or injections.
     Other phobias include. fear of falling down, a fear of loud sounds and a fear, of costumed characters such as clowns. "Perfectly high-functioning, rational people can have an irrational fear of something," says Jeannie Ingram, a licensed counselor with Decatur Psychotherapy Group. The key is not to let the phobia take over your life, she says.
     A rational fear of snakes is healthy, says Raymond Crowel of the National Mental Health Association, referring to someone walking in the woods or working in their yard. "But if you're on a city street downtown looking for snakes, that's a preoccupation and a phobia," he says.
     While some phobias develop during childhood, most occur during adolescence and early adulthood in response to a stressful event associated with a place or object.
     One day during church, Terrie McSorley felt like the walls were caving in around her. Her heart began to race, her palms became sweaty, and she could not catch her breath. Panicked, McSorley hurried to the back of the sanctuary for relief. The anxiety dissipated but returned each time she entered the building. Eventually, McSorley stopped attending service, and within two years, her fears had escalated to where she could not leave home without a companion. "I was not living my life; I was just surviving," says the mother of six, who later sought treatment with a psychologist. Now, "I can do everything that I want and need to do."

Common fears
* Arachnophobia. Fear off spiders. (Half of women and 10 percent of men have a fear of spiders.)
• Aviophobia. Fear of flying. .
* Agoraphobia. Hear of any place or situation where escape might be difficult or help unavailable.. .
* Claustrophobia. Fear of being trapped in confined spaces.
* Acrophobia. Fear of heights.
* Brontophobia. Fear of thunder.
* Necrophobia. Fear of death or dead things.

Treatment options
Phobias are highly treatable, said Rebecca Beaton, director of the Anxiety &. Stress ' Management Institute in Atlanta. Here are some treatment options:
• Cognitive-behavior therapy. Irrational beliefs are addressed as clients think through situations. and draw conclusions based on facts. They use reapsuring words, such as "I can do this," "Anxiety is normal, and it will pass," or "I've made negative predictions before, and nothing bad has happened." Clients construct a hierarchy of fears from least to greatest and are gradually exposed to what frightens them (starting with an imagined or virtual setting and moving into the real environment) until fears diminish. Prolonged exposure desensitizes.clients to feared objects or situations as self-talk helps work through them.
* Meditation/deep breathing. Slow, deep, abdominal breaths reduce the production of stress hormones such as adrenaline and cortisol and reduce blood pressure and heart rate. Anxiety is tied to a physical response, so the body cannot be anxious when it is relaxed.
* Workbooks raise awareness of the origin of fears, introduce the concept of rational self-talk and typically include a journal.
• Support groups help to remove isolation and should be facilitated by a therapist.
* Medications. For shortterm treatment, low doses of tranquilizers such as Valium and Xanax may be prescribed. They can be very addictive and should be used sparingly. For more generalized anxiety selective serotonin reuptake. inhibitors (such as Lexipro, Zoloft or Paxil) or selective norepinephrine reuptake inhibitors may be effective.

Relaxation guide
Practice these techniques so that when you're in an uncomfortable situation, you can use these to relieve your anxiety.
1. Sit in a comfortable chair or lie down on a flat surface;
2. Place one hand on your stomach, just above your navel. Place the other hand on your chest.
3. Breathe in slowly and try to make your stomach rise a little.
4. Hold your breath for I one second.
5. Breathe out slowly and let your stomach go back down. Make your exhalation slower and longer than your inhalation.
6. Do this for five to 10 minutes.
Source: Raymond Crowel, National Mental Health Association

Virtual reality
The latest advancement in treating phobias employs videogame technology to gradually expose patients to their fears while helping them talk about and cope with their experiences. Virtual reality -- simulated, three-dimensional environments experienced through gogglelike video screens and earphones -- augments traditional therapy by creating realworld scenarios in a controlled setting.
     "Instead of a clinician taking a client to a bridge to look out over the bridge, we can bring the bridge to the client," said Ken Graap, president and chief executive of Virtually Better, an Atlanta company that builds and markets virtual reality systems to treat phobias of heights, public speaking, storms and flying. During sessions, clinicians can manipulate and repeat scenarios based on the client's anxiety level. "The only way to overcome any fear is to face it," Graap said. "Everything else is avoidance."
     About eight hours of ' treatment, at an average cost of $160 an hour, is recommended to treat most phobias.

Nearly four decades ago, Dr. Elisabeth Kübler-Ross outlined what she recognized as five stages people go through after the diagnosis of an incurable illness: denial, anger, bargaining, depression and finally acceptance of their impending death. She recognized that people approaching the end of life might seesaw between the various stages, but that those who reached “acceptance” were most likely to die in peace with the least trauma to their survivors. Indeed, hospice care practically demands that people who are dying reach acceptance, since they must accept only comfort care and give up all treatments aimed at staving off their demise.

Still, there are many people who choose to continue fighting for life, leaving no therapeutic stone unturned, until they take their last breath. There are people who will not acknowledge that they have a fatal illness, remaining in denial even as their bodies shrink under the onslaught of disease. There are people who weather their medical storm in fury because they are being robbed of their future. There are people who cannot emerge from depression over the prospect of losing everyone they love.

Can these people, who never achieve acceptance, also have a good death? The answer seems to be yes, although the consequences for survivors may sometimes be less than desirable.

Nails Polished to the End
Dr. Joseph Sacco, a palliative care specialist at Bronx-Lebanon Hospital Center in New York, tells about a patient, Mrs. Santana, in his book, “On His Own Terms,” the story of his father’s losing battle against lung cancer. Mrs. Santana had terminal cancer and was near death, but she never uttered the words “cancer” or “death.” During her final hospital stay, she maintained her lifelong elegance and dignity, polishing her nails, grooming her hair, always cheerful and calm, until the day she died.

Dr. Sacco’s father, Joe, on the other hand, kept insisting he would “beat this thing,” even as his breathing became ever more labored and his weight dropped by half. Though Dr. Sacco, based on his training, thought his father should come to accept his fate, he felt he had no choice but to humor the dying man and play along.

Joe’s death was peaceful enough, occurring as it did on his terms. But it took its toll on Dr. Sacco, who laments: “Had my father not been frozen by fear, he might have been able to talk openly and reaffirm his knowledge that his son really did love him. Instead, paralyzed by the implication that death was imminent, he brushed me aside with a wave of the hand and the comment that he wasn’t going to die.”

Dr. Greg A. Sachs’s father-in-law, Al, who also had lung cancer, chose to have no treatment for his disease and spent not one day of his remaining 18 months in the hospital. As Dr. Sachs told it in The Journal of the American Medical Association (Nov. 15, 2000), Al spent the year “straightening out files; reconciling accounts and labeling everything in the house, including fuse boxes and cabinet drawers, so that his wife would be able to find everything when he was gone.” According to an agreed-upon plan, Al died peacefully at home surrounded by his loving family, with his distressing end-of-life symptoms assuaged by morphine, anti-anxiety medication and oxygen.

No Easing Existential Suffering
But as Dr. Sachs tells it, Al’s equanimity about dying, his methodical preparations and his gentle demise did not ease the family’s pain as he lay dying, for they knew Al didn’t want to die and nobody in the family wanted to lose him.

Dr. Sachs explained that for survivors, “some of the suffering is existential or spiritual” and even the best end-of-life care cannot ease that kind of suffering.

He cautioned his fellow physicians against “painting too rosy a picture of end-of-life care” and creating unreasonable expectations of “spiritual growth” and “transcendence.”

But while no one is likely to rejoice at losing a loved one, having people die in accordance with their wishes is, in my experience, far less painful than the alternative, which all too often involves futile medical rescue efforts that patients do not want and that can get in the way of comforting end-of-life conversations and reconciliations.

When my mother-in-law’s cancer recurred four years after treatment, she chose, at 84, not to have anything done that might prolong her life. And no one dared to contradict this decision by a woman who had always lived life on her own terms and was determined to die that way.

A Chance to Say Goodbye
Living will in hand and fully in control of her faculties, she entered the hospital hemorrhaging, and at her request a “Do Not Resuscitate” notice was posted on her door. The family was called, and all had a chance to say goodbye unimpeded by machines, tubes and medical personnel. Twelve hours later, she was gone, leaving behind a sad but grateful family. Her minister, at her bedside until the end, said he had never before seen such a peaceful death.

Dr. Karen E. Steinhauser and colleagues at the Veterans Affairs Medical Center in Durham, N.C., examined the constituents of a good death for patients, their families and health care providers. The 85 study participants had no trouble describing a “bad death” — having inadequately treated pain while receiving aggressive but futile cure-directed therapy.

Patients felt disregarded, family members felt perplexed and concerned about suffering, and providers felt out of control and feared that they were not providing good care. Decisions not previously discussed usually had to be made during a crisis. Families unprepared for what happens when death is imminent often panicked and rushed the patient to the hospital, where last-ditch and usually futile attempts at resuscitation were made, when both patient and family would have preferred a home death.

The study identified six components of a good death, described in The Annals of Internal Medicine of May 16, 2000:
*Pain and symptom management. Pain, more so than dying itself, is too often the cause of acute anxiety among patients and their families.
* Clear decision making. Patients want to have a say in treatment decisions.
* Preparation for death. Patients want to know what to expect as their illness progresses and to plan for what will follow their deaths.
* Completion. This includes reviewing one’s life, resolving conflicts, spending time with family and friends, and saying good-bye.
* Contribution to others. Many people nearing death achieve a clarity as to what is really important in life and want to share that understanding with others.
* Affirmation. Study participants emphasized the importance of being seen as a unique and whole person and being understood in the context of their lives, values and preferences.

This study says that dying can, and should, be a much less painful experience for many more people and their loved ones than it now is.