Noteworthy News Articles on Mental Health Topics, November 9-17, 2006 Because of the storm damage, only two of New Orleans' 11 hospitals are fully functioning. What's more, one of the closed facilities is the sprawling Charity Hospital, which police officers had relied on to drop off people at any hour. ''You knew they were safe. You knew they would get the care they needed. You don't know either of those things now,'' said James Arey, a psychologist who commands the police crisis negotiation team. People who need medication can't find it or can't afford it, and the storm's aftermath has made life more stressful, as well, Arey said. ''Life is hard in this town now,'' he said. A federally funded study published in the Bulletin of the World Health Organization found that mental health problems in the region roughly doubled in the months after Katrina, to 11.3 percent. Take Kenneth Breaux, who said he was diagnosed with a form of schizophrenia years ago. Breaux, 44, was jailed in June 2005 but got caught in the judicial vacuum following Katrina and languished behind bars until last April, when he pleaded guilty to simple criminal damage and was released for time served. Advocates say Breaux hasn't been able to get the medication he's taken for years because he's been homeless and unemployed since the storm, and he cannot find family members. ''He's getting no help,'' said Katie Schwartzman, an attorney for the Louisiana American Civil Liberties Union who spoke with Breaux after his release in April. Today, he's back in jail on a theft charge. Getting help has perhaps never been more challenging. Before Katrina there were 480 psychiatric beds in the New Orleans area. Now there are perhaps 200, said Dr. Jeffery Rouse, deputy psychiatric coroner for Orleans Parish. Arey said police officers typically become involved if a person is disabled, suicidal or homicidal. ''I'd say most of those are going right back onto the streets with no help,'' he said. Police are answering an average of 185 mental-health calls a month, Arey said. That's down from a pre-Katrina monthly average of 350. But before the storm, the city's population was 454,000 compared to fewer than 190,000 now. The downsized police force finds itself shopping for hospitals willing to accept the mentally distressed among five area hospitals with working emergency rooms, one in New Orleans and four in neighboring Jefferson Parish. None specializes in mental crisis, and officers say most appear hesitant to deal with mental cases. Although federal law requires hospitals to examine and stabilize people regardless of ability to pay, Arey said it's frequently ignored. ''We routinely have officers sitting in these hospitals two, four, six, eight hours trying to talk some nurse -- with her arms folded -- into taking this patient,'' Arey said. Complicating the problem, Arey said, is that many people handled by police, especially the poor, do not have health insurance. Often, he said, they are discharged by hospitals without long-term treatment. The problem for emergency rooms is just as tough, said Dr. Richard Manthey, an emergency room doctor at Ochsner Hospital in Jefferson Parish. Before Katrina, his emergency room examined about one patient a day undergoing a psychiatric crisis, Manthey said. Now, it frequently sees 12 a day. ''The amount of upheaval it causes is pretty dramatic,'' Manthey said. ''These are disruptive patients, often violent, usually loud, yelling, not wanting to stay in a room.'' Without Charity Hospital, police can book a psychiatric suspect into Orleans Parish Prison. While it keeps someone who is potentially harmful to themselves or others off the street, it doesn't guarantee they'll get the proper treatment. A prison spokeswoman said the jail spends $10,000 to $12,000 a month on psychiatric medication -- 21 percent of the total it spends on pharmaceuticals. There are one full-time, board certified psychiatrist, and two part-time psychiatrists to treat 2,000 inmates. A Visual Chronicler of Humanity's Underbelly, Draped in a Pelt of Perversity Manohla Dargis, New York Times- 11/10/2006 In Leopold von Sacher-Masoch’s novel about humiliation and marble-white flesh, “Venus in Furs,” a seductress named Wanda taunts the man who would be her slave, “And so now fur arouses your bizarre fantasies?” Impatient for the inevitable answer (yes, and how), Wanda begins “coquettishly draping herself in her splendid fur, so that the dark, shiny sables flashed delightfully around her breasts, her arms.” From such turgid lust and swollen prose a perversion is born, as well as a slow-burn Velvet Underground song. The new film “Fur: An Imaginary Portrait of Diane Arbus” is a fantasy of a different order. Its marble-white Venus is Nicole Kidman, who here wears a conceit rather than a sable. The film’s core idea is that Arbus, who trained her photographic gaze on nudists, twins, grimacing children and the retarded, liberated her muse by coaxing out her inner freak. The film conjures a conduit to her liberation in the furry form of Lionel, a neighbor played by Robert Downey Jr. The actor’s involvement is something you need to take on faith, since he spends most of the film covered in fur, a costume that suggests the bewitched prince in Cocteau’s “Beauty and the Beast” and makes Mr. Downey look like an immaculately groomed Shih Tzu. “Fur” is a folly, though not a dishonorable one. It was directed by Steven Shainberg, whose last feature, “Secretary,” was a tender love story about a shy masochist and the boss who spanks his way into her heart. The film was funny and modest, and it treated the putative perversions of its characters with the kind of good, gracious humor that insists on respect for everyone involved. “Fur” is a more ambitious work, in part because of Ms. Kidman, whose talent cannot obscure that she has been grievously miscast and left to indulge her mannered coyness. The fetish of casting high-wattage movie stars, no matter how badly they fit the role, is one of the maladies of contemporary independent and quasi-independent filmmaking. In 1971, at age 48, Arbus swallowed a large number of barbiturates and then, perhaps to make sure that she had finished the job, slit her wrists. Born Diane Nemerov into a wealthy New York family (her brother was the poet Howard Nemerov), she met Allan Arbus, played by Ty Burrell, when she was 14 and married him as soon as she was legal. He introduced her to photography and she served as his assistant. Together they worked for fashion magazines and on advertising campaigns, including those for her family’s department store, Russeks, which was known for its furs. According to Arbus’s biographer, Patricia Bosworth, Diane’s father understood how to drape women in ermine. “Fur,” he said, “creates a protective image.” One woman’s protective image is another woman’s sexual fetish is another woman’s fictional gamble. In “Fur,” Mr. Shainberg’s screenwriter, Erin Cressida Wilson, who also wrote “Secretary,” twists the classic Freudian concept of sexual fetishism, having apparently decided that the best way to explain Arbus’s singular perspective on the world is to transform her into a fetishist. Thus, in this formulation, Lionel, her fuzzy neighbor, becomes a kind of walking, talking fetish, a means — to freedom, creativity, imagination and what Ms. Bosworth calls the dark world — that will usher her into a new realm. This sounds more promising than what materializes on screen largely because Mr. Shainberg and Ms. Wilson have turned Arbus’s life into a neurotic fairy tale. Maybe they just got hung up on the repeated mentions of the word fur in the opening chapter of Ms. Bosworth’s biography. Whatever the case, they, like their subject, wander into dangerous territory, though without the same inspired results. In 1957, Arbus stopped working with her husband and began wandering New York after dark taking photographs. It’s instructive that the film doesn’t mention that she also studied with the photographer Lisette Model, whose interest in everyday people, with their odd shapes and suffering faces, was an obvious influence. The idea that art can also arise from example and instruction just wouldn’t jibe with the film’s vision of an otherworldly kingdom in which hard work, ego and depression of the sort that probably claimed Arbus’s life have no place. And, so, in “Fur,” the Park Avenue princess leaves the bright world and climbs up, up, up to Lionel’s enchanted garret filled with objets d’exotica and mounds of fur as neatly coiled as sleeping cats. Through her furry friend, she meets an armless woman, a dominatrix and many dwarves. She lets down her hair, goes sleeveless and abandons her husband and children to squalor. Ms. Kidman bears no physical resemblance to Arbus, who was small and dark and seemed very much tethered to the earth, perhaps because that is where she found the grist for her genius. Tall, pale and almost transparently thin, Ms. Kidman floats through the beautiful production design like a feather. She whispers to Lionel, who whispers in return. What are they saying? Damned if I could hear. What’s Wrong With a Child? Psychiatrists Often Disagree Benedict Carey, New York Times- 11/11/2006 Paul Williams, 13, has had almost as many psychiatric diagnoses as birthdays. The first psychiatrist he saw, at age 7, decided after a 20-minute visit that the boy was suffering from depression. A grave looking child, quiet and instinctively suspicious of others, he looked depressed, said his mother, Kasan Williams. Yet it soon became clear that the boy was too restless, too explosive, to be suffering from chronic depression. Paul was a gifted reader, curious, independent. But in fourth grade, after a screaming match with a school counselor, he walked out of the building and disappeared, riding the F train for most of the night through Brooklyn, alone, while his family searched frantically. It was the second time in two years that he had disappeared for the night, and his mother was determined to find some answers, some guidance. What followed was a string of office visits with psychologists, social workers and psychiatrists. Each had an idea about what was wrong, and a specific diagnosis: “Compulsive tendencies,” one said. “Oppositional defiant disorder,” another concluded. Others said “pervasive developmental disorder,” or some combination. Each diagnosis was accompanied by a different regimen of drug treatments. By the time the boy turned 11, Ms. Williams said, the medical record had taken still another turn — to bipolar disorder — and with it a whole new set of drug prescriptions. “Basically, they keep throwing things at us,” she said, “and nothing is really sticking.” At a time when increasing numbers of children are being treated for psychiatric problems, naming those problems remains more an art than a science. Doctors often disagree about what is wrong. A child’s problems are now routinely given two or more diagnoses at the same time, like attention deficit and bipolar disorders. And parents of disruptive children in particular — those who once might have been called delinquents, or simply “problem children” — say they hear an alphabet soup of labels that seem to change as often as a child’s shoe size. The confusion is due in part to the patchwork nature of the health care system, experts say. Child psychiatrists are in desperately short supply, and family doctors, pediatricians, psychologists and social workers, each with their own biases, routinely hand out diagnoses. But there are also deep uncertainties in the field itself. Psychiatrists have no blood tests or brain scans to diagnose mental disorders. They have to make judgments, based on interviews and checklists of symptoms. And unlike most adults, young children are often unable or unwilling to talk about their symptoms, leaving doctors to rely on observation and information from parents and teachers. Children can develop so fast that what looks like attention deficit disorder in the fall may look like anxiety or nothing at all in the summer. And the field is fiercely divided over some fundamental questions, most notably about bipolar disorder, a disease classically defined by moods that zigzag between periods of exuberance or increased energy and despair. Some experts say that bipolar disorder is being overdiagnosed, but others say it is too often missed. “Psychiatry has made great strides in helping kids manage mental illness, particularly moderate conditions, but the system of diagnosis is still 200 to 300 years behind other branches of medicine,” said Dr. E. Jane Costello, a professor of psychiatry and behavioral sciences at Duke University. “On an individual level, for many parents and families, the experience can be a disaster; we must say that.” For these families, Dr. Costello and other experts say, the search for a diagnosis is best seen as a process of trial and error that may not end with a definitive answer. If a family can find some combination of treatments that help a child improve, she said, “then the diagnosis may not matter much at all.” At the playground, in the gym, standing in line at the grocery store, parents swap horror stories about diagnoses, medications or special education classes. Their children are often as fluent in psychiatric jargon as their mothers and fathers are. “The change in attitude is enormous,” said Christina Hoven, a psychiatric epidemiologist at Columbia University. “Not long ago people did all they could to hide problems like these.” Attention deficit disorder is perhaps the most straightforward diagnosis. Elementary school teachers are often the ones who first mention it as a possibility, and soon parents are answering questions from a standard checklist: Does the child have difficulty sustaining attention, following instructions, listening, organizing tasks? Does he or she fidget, squirm, impulsively interrupt, leave the classroom? These behaviors are so common, particularly in boys, that critics question whether attention disorder is a label too often given to boys being boys. But most psychiatrists agree that while many youngsters are labeled unnecessarily, most children identified with attention problems could benefit from some form of therapy or extra help. They are less certain about the children — perhaps a quarter of those seen for mental problems, some experts estimate — who do not fit any one diagnosis, and who often go for years before receiving a satisfactory label, if they receive one at all. These youngsters collect labels like passport stamps, and an increasing number end up with the label Paul Williams received: bipolar disorder. An Illness Under Dispute Until recently, psychiatrists considered bipolar disorder to be all but nonexistent in children under 18. Today, it is the fastest growing mood disorder diagnosed in children, featured on the cover of news magazines and on daytime talk shows like “The Oprah Winfrey Show.” The explosion of interest in bipolar disorder came after the approval of several drugs, called antipsychotics, or major tranquilizers, for the short-term treatment of mania in adults. Beginning in the 1990s some researchers began to argue that bipolar disorder was underdiagnosed in adults. Soon, several child psychiatrists were arguing that the illness was more common than previously thought in children too. Some experts who made those arguments had ties to manufacturers of antipsychotic drugs, financial interests disclosed in professional journals. But the message struck a chord, particularly with doctors and parents trying to manage difficult children. Parents whose children have been given the label tend to adopt the psychiatric jargon, using terms like “cycling” and “mania” to describe their children’s behavior. Dozens of them have published books, CDs, or manuals on how to cope with children who have bipolar disorder. A recent Yale University analysis of 1.7 million private insurance claims found that diagnosis rates for bipolar disorder more than doubled among boys ages 7 to 12 from 1995 to 2000, and experts say the rates have only gone up since then. Katherine Finn, a 14-year-old who lives in Grand Rapids, Mich., said she was grateful for the growing awareness of the disease. Possessed by feelings of worthlessness as early as the fourth grade, Katherine said that by the sixth grade she “threw my sanity out the window.” She became impulsive, loud, and abrasive, she said, adding, “I would blurt things out in class, I would moo like a cow, act like a little kid, just say the most random stuff.” A psychiatrist promptly diagnosed the problem as bipolar disorder, after learning that there was a history of the disease on her mother’s side of the family. Katherine began taking drugs that blunted the extremes in her mood, and she now is doing well at a new school. “It hit me like a Mack truck when I heard the diagnosis, but I knew right away it was correct,” said her mother, Kristen Finn, who is writing a book about her experience. Still, many psychiatrists believe that, although childhood bipolar disorder may be real in families like the Finns, it is being wildly overdiagnosed. One of the largest continuing surveys of mental illness in children, tracking 4,500 children ages 9 to 13, found no cases of full-blown bipolar disorder and only a few children with the mild flights of excessive energy that could be considered nascent bipolar disorder — a small fraction of the 1 percent or so some psychiatrists say may suffer from the disease. Moreover, the symptoms diagnosed as bipolar disorder in children often bear little resemblance to those in adults. Instead, the children’s moods seem to flip on and off like a stoplight throughout the day, and their upswings often look to some psychiatrists more like extreme agitation than euphoria. “The question with these kids is whether what we’re seeing is a form of mania, or whether it’s extreme anger due to something else,” said Dr. Gregory Fritz, medical director of the Bradley Hospital, a psychiatric clinic for children in Providence, R.I. Dr. Ellen Leibenluft, a research psychiatrist at the National Institute of Mental Health, argues that children who are receiving a diagnosis of bipolar disorder fall into two broad groups. The children in one group, a minority, have mood cycles similar to those of adults with bipolar disorder, complete with grandiose moods, and a high likelihood of having a family history of the illness. Those in the other group have severe problems regulating their moods and little family history, and may have some other psychiatric disorder instead. “It is a mistake to lump them all together and assume they are all the same,” Dr. Leibenluft said. “It may be that the disorder has different dimensions and looks different in different kids.” For parents with a child who is frantic and possibly dangerous, these distinctions may be academic. The medications may blunt their child’s extreme behavior, which may be all the confirmation they need. For others, though, the uncertainties about childhood bipolar disorder loom larger. They wonder whether mania really explains what their child is going through, and if not, what it is that is being treated. Evelyn Chase of Richmond, Va., said that a neurologist drove home his diagnosis of bipolar disorder in her 10-year-old son by pulling out “a copy of Time magazine and slamming the article in front of me.” Ms. Chase said her son seemed to react most strongly to abrupt changes in the environment and to certain dyes and chemicals. “I used the bipolar diagnosis for school and getting services, but I don’t think it covers his behaviors,” she said. For Paul Williams, the diagnosis simply feels like a temporary stop. In his short life, Paul has taken antidepressants like Prozac, antipsychotic drugs used to treat schizophrenia, sleeping pills and so-called mood stabilizers for bipolar disorder, in so many combinations that he has become nonchalant about them. “Sometimes they help, sometimes they don’t,” he said. “Sometimes they make me feel like another person, like not normal.” In recent months, his mother said, Paul seems to have improved: he visibly tries to control himself when he is upset and usually succeeds. He is an eager Mets fan who loves reading Harry Potter and the Goosebumps series. He gets out and plays baseball and football, like any 13-year-old boy. But he has grown tired of telling his story to doctors, and neither he nor his mother expect that bipolar disorder will be the last diagnosis they hear. In Search of Clarity The specialists who manage children’s psychiatric disorders are trying to bring more standards and clarity to the field. Harvard researchers are completing the most comprehensive nationwide survey of mental illness in minors and hope to publish a report next year. And a recent issue of the journal Child and Adolescent Psychology was entirely devoted to the subject of basing diagnoses in hard evidence. Given the controversies, one of the articles concludes, “we acknowledge that tackling the issue may be tantamount to taking on a 900-pound gorilla while still wrestling with a very large alligator.” Dr. Darrel Regier of the American Psychiatric Association, who is coordinating work on the next edition of the association’s diagnostic manual for mental disorders, due out in 2011, said that researchers would focus on drawing distinctions among several childhood disorders, including bipolar disorder and attention deficit disorder. “We wouldn’t disagree that criteria for these disorders currently overlap to some degree,” Dr. Regier wrote in an e-mail message, “and that a significant amount of research is under way to disentangle the disorders in order to support more specific treatment indications.” Until that happens, parents with very difficult children are left to read the often conflicting signals given by doctors and other mental health professionals. If they are lucky, they may find a specialist who listens carefully and has the sensitivity to understand their child and their family. In dozens of interviews, parents of troubled children said that they had searched for months and sometimes years to find the right therapist. “The point is that not everything is A.D.H.D., not everything is bipolar, and it doesn’t happen like you see in the movies,” said Dr. Carolyn King, who treats children in community clinics around Detroit, and has a private practice in the nearby suburb of Grosse Pointe Farms. “Kids often have very subtle symptoms they can mask for short periods of time,” Dr. King said, “and the most important thing is to observe them closely, and get a complete history, starting from birth and straight through every single developmental milestone.” She added, “A speech delay can look like anxiety,” an obsessive private ritual like mania. Or struggling children, in the end, may look only like themselves, with a unique combination of behaviors that defy any single label. Camille Evans, a mother in Brooklyn whose son’s illness was tagged with a half-dozen different diagnoses in the last several years, said she concluded, after seeing several psychiatrists, that the boy’s silences and learning difficulties were best understood as a mild form of autism. “That’s the diagnosis that I think fits him best, and I’ve just about heard them all,” Ms. Evans said. The label is not perfect, she said, but it is more specific than “developmental delay” — one diagnosis they heard — and does not prime him for aggressive treatment with drugs like attention deficit disorder or bipolar disorder would. He has not responded well to the drugs he has tried. “Most important for me,” Ms. Evans said, “the diagnosis gives him access to other things, like speech therapy, occupational therapy and attention from a neurologist. And for now it seems to be moving him in the right direction.”
The most commonly diagnosed mental disorders in younger children include attention deficit hyperactivity disorder, or A.D.H.D., depression and anxiety, and oppositional defiant disorder. All these labels are based primarily on symptom checklists. According to the American Psychiatric Association’s diagnostic manual, for instance, childhood problems qualify as oppositional defiant disorder if the child exhibits at least four of eight behavior patterns, including “often loses temper,” “often argues with adults,” “is often touchy or easily annoyed by others” and “is often spiteful or vindictive.” 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 1990s. But there is little convincing evidence that the rates of illness have increased in the past few decades. Rather, many experts say it is the frequency of diagnosis that is going up, in part because doctors are more willing to attribute behavior problems to mental illness, and in part because the public is more aware of childhood mental disorders.
She knew they couldn't swim and thought she was sending them to heaven. God had commanded her to sacrifice her three boys, her most precious possessions, Harris later told psychiatrists. Passersby said she seemed dazed, disoriented. The 23-year-old mother was arrested as she pushed an empty stroller away from Pier 7. Harris was charged with three counts of murder and has pleaded not guilty by reason of insanity. Her trial is scheduled to begin this week; if convicted, she faces life in prison. Now 24, Harris remains in the psychiatric section of the San Francisco County jail. Public defender Teresa Caffese calls her the rare client who ''doesn't have a mean bone in her body.'' Her family says Harris is mentally ill and needs to be treated in a mental institution, rather than incarcerated in a prison. But prosecutor Linda Allen says that's a decision for a jury. Legal experts say proving legal insanity is always a tall order. ''The burden of proof is on her,'' said Pete Kossoris, a former Ventura County prosecutor. ''She has to show that, by reason of some mental defect or disease, she didn't know the nature of what she was doing or that it was wrong.'' During pretrial hearings, Harris sat in court smiling slightly, eyes downcast. She laughed and talked to herself; she sometimes rocked back and forth. At least three mental health professionals have diagnosed paranoid schizophrenia. She's also borderline mentally retarded, with an IQ of 69, according to her lawyer. Caffese contends Harris never intended to murder her children. ''She was trapped inside an overwhelming delusion, one that kept telling her to take her kids and 'put them in the water' to send them to Jesus,'' Caffese said in a recent court filing. ''And that is what she believes she did.'' She said Harris believes her children are in heaven -- her youngest now potty-trained, her eldest in school. She sends God postcards written in crayon. The case is a tragedy, conceded Allen, the prosecutor, but added that Harris must be punished nonetheless. ''She walked around the pier and cried because she loved her children, showing that she understood she had killed them and that they were gone,'' Allen said in court documents. ''Even if defendant thought she was sending her children to heaven, she was doing so by killing them.'' Avis Harris, 43, said her daughter was an outgoing and well-behaved girl who rarely got in trouble. She regularly attended Bible study and church services, often with her grandmother. ''She was very strung out on God,'' Avis Harris said in a recent interview with The Associated Press, along with her sister Joyce. ''She believed that God could do anything.'' LaShuan Harris was 15 when she became involved with the 21-year-old man who would father her children. When she got pregnant at 16, her mother considered pursuing criminal charges against the man. ''She was happy that she was pregnant. She was thrilled,'' said Avis Harris. ''She was doing good. I didn't want her to be a follower. I wanted her to be a leader.'' It was months before Harris would allow anyone else to hold Treyshun, her firstborn. Later, her aunts took care of the boy while Harris worked as a nurse's assistant at a convalescent home. Five years later, a second son, Taronta, was born. Harris was 21 and living on her own for the first time. ''There was a lot of stress on her at that time,'' Avis Harris said. And the cracks began to show. She saw bugs in the linens at work. She would fail to recognize her own name. She stared through people instead of at them, and giggled and laughed to herself. She stayed awake all night and talked on the phone with no one at the other end, her mother said. Harris had her first psychotic episode in February 2004, when she tried to jump out a window, her family said. Doctors prescribed Haldol, a drug used to treat schizophrenia, but she stopped taking it. She ended up at a homeless shelter, and she got pregnant again. Harris' case is proof that mental illness can overcome even a mother's love for her own children, Caffese said. Avis Harris believes the system let her daughter down. Joyce Harris doesn't know whom to blame. ''My niece is sick. She needs the help that wasn't given to her before. A tragic thing had to happen,'' she said. ''I love and miss my nephews. On Oct. 19, four people were lost, but one is still here. Don't make her suffer because she's sick. She needs help.'' Fix Michigan Prison Mental Health Care Now, Judge Says David Ashenfelter, Detroit Free Press- 11/14/2006 The fatal case November 2005: Timothy Joe Souders, 21, of Adrian begins prison term for assault. July 31, 2006: Souders put in isolation for disobeying staff. Aug. 2: Souders strapped to his concrete bed for flooding his sink and kept there for most of the next five days Aug. 6: Takn to his cell, he collapses. Later, he is pronounced dead at a hospital. A federal judge on Monday ordered sweeping mental health care changes for Michigan's prisons in Jackson to prevent the mistreatment and death of inmates. U.S. District Judge Richard Enslen suggested a prayer be said for those who have already died in custody. "Any earthly help comes far too late for them," he said in a scathing opinion in which he chastised health-care providers in the prison for collecting their pay while ignoring the needs of those in their care. "Here is the basic message: You are valuable providers of life-saving services and medicines. You are not coatracks who collect government paychecks while your work is taken to the sexton for burial," he wrote.
But the HBO production, which appears tonight, is a documentary by a compassionate and detached photographer, and not a novel by an inflamed polemicist, and thus its point of view is more passive-aggressive than Ken Kesey’s. That’s O.K. The upthrown hands of the filmmaker, Lauren Greenfield, come through anyway: clearly the treatment for anorexia, even at the Renfrew Center in Florida, one of the plushest eating-disorders clinics in the country, is exasperating. Infuriating, even. Women and girls are tossed out of Renfrew when their insurance runs out, or for trumped-up boarding-school-style infractions of rules that have nothing to do with putting on weight and leading joyful lives, and everything to do with tyranny and convoluted recovery-movement styles of deploying power. “Thin” is a melodrama. Every viewer should put aside his or her feelings about anorexia and try to imagine being shipped to a place like this for a habit turned obsessive and destructive — work, exercise, housecleaning — and see how the institutional condescension might come across. Nurse Ratched’s frank wickedness would almost be a relief in the context of the fake sympathy displayed here. During their stay at this dopey, well-meaning place, the emaciated patients are treated to patronizing encouragement, a capricious merits-and-demerits system and open contempt. These impressionable patients are also force-fed weird jargon about the primacy of the “community” (officious nurses, patients, orderlies, therapists and nutritionists they have to endure for months at most) and its “safety.” Many don’t seem to mind this, although the viewer can’t help wishing that they had more food and fun, and fewer lectures and tribunals. Moreover, the “integrity” of the patients, which mostly means their willingness to rat out fellow inmates for common young-women stuff like swearing, smoking in the bathroom, getting tattoos and trading prescription pills, is constantly called into question. It’s exhausting. And after all this restraining of their evil ways, the women can only conclude that they are undisciplined, depraved and out of control, though to look at their gaunt forms and hear about their seriousness of purpose, you can hardly imagine that willpower is what they lack. Ms. Greenfield shows many scenes that are out of view of the staff. We see Brittany’s lunch with her mother, who talks about nothing but her own food restrictions. There’s Polly’s trip to the tattoo parlor, where the tattooist advises her to eat six small meals a day if she wants to lose weight. And finally there’s Alisa’s laborious puke session as soon as she’s discharged. These scenes strongly suggests that Renfrew is missing the point. The biggest problem at the hospital may be the profoundly simpleminded responses of the staff to the patients. One staff member calls a patient a “bad seed”; another calls a patient “sneaky,” and says, “I don’t trust her as far as I can throw her.” Why do these so-called professionals talk like carping schoolmarms? Anorexics notoriously inspire annoyance in other people; it’s not clear why. Maybe, in their self-discipline, they make the rest of us feel slovenly. (Interestingly, many of the staff members are overweight.) Or maybe it’s just depressing to see someone do herself in. But people who treat anorexics must overcome that distaste. It’s not just Mr. Kesey’s heroic madmen who deserve our patriotic sympathies for their anti-institutionalism. As “Thin” makes clear, the quirky girls with their calorie obsessions and their steadfast determination to resist life’s imperatives are impressively powerful too. The rare moments when the patients smile suggest that a decent therapist or a friend might be able to help these women without so much chastisement. Brittany clearly enjoys the food mischief of her mother; maybe they come together in less destructive, but equally vain, pursuits, like makeup or shopping. When Polly and Shelly flop around on a bed together, they seem joyful. Clearly both need some irreverent slumber-party friendships. And when the beautiful and charismatic Alisa talks in a kind of solemn, self-assured way about life’s lessons, she becomes happy. HBO’s Web site, HBO.com, says she has recovered (after a post-Renfrew relapse) and become a teacher. Like little else here, that seems absolutely right. THIN
Now, in a growing standoff between the government of Florida and its judges, the state is being threatened with steep daily fines if it does not comply. And at least one judge has raised the possibility that the secretary of the Florida Department of Children and Families could go to jail for contempt of court. “This type of arrogant activity cannot be tolerated in an orderly society,” Judge Crockett Farnell of Pinellas-Pasco Circuit Court wrote in an Oct. 11 ruling. State law requires that inmates found incompetent to stand trial be moved from county jails to psychiatric hospitals within 15 days of the state’s receiving the commitment orders. Florida has broken that law for years, provoking some public defenders to seek court orders forcing swift compliance. With the state now rebuffing even those orders, a rising number of mentally ill inmates, now more than 300, have been left without treatment in crowded jails because the state’s 1,416 psychiatric beds are full. Two mentally ill inmates in the Escambia County Jail in Pensacola died over the last year and a half after being subdued by guards, according to news reports. And in the Pinellas County Jail in Clearwater, a schizophrenic inmate gouged out his eye after waiting weeks for a hospital bed, his lawyer said. Public defenders in Miami-Dade County describe psychotic clients who have hallucinated, mutilated themselves and attempted suicide while awaiting transfer to hospitals. The state says that shortages of beds and financing have made compliance impossible, and that court orders forcing the transfer of certain inmates are unfair to those who have waited longer. Most judges have responded skeptically, asking why the Department of Children and Families has not sought more state money as the number of committed inmates has soared. The agency cut its budget by $53 million this year, which public defenders say makes no sense given the inmate crisis and the state’s $8 billion budget surplus. In one of the toughest rulings to date on the subject, Judge Farnell said last month that he would start fining the department $1,000 a day for each mentally ill inmate who stayed in the Pinellas County Jail longer than 15 days. The judge, based in Clearwater, expressed outrage about the agency’s “conscious decision” to ignore court orders. Judges in Broward, Hillsborough and Miami-Dade Counties are also weighing motions to force the department to comply with the law or to hold it in contempt for letting the mentally ill pile up in unsuitable jails. The department appealed after three state judges in Miami ordered it to take custody of several inmates last month, but a panel of the Third District Court of Appeal indicated last week that it might rule against the department and its secretary, Lucy D. Hadi. “It strikes me that ultimately you’ve got contempt issues,” Judge Frank A. Shepherd said during oral arguments, “and Ms. Hadi may be going to jail.” The problem is not unique to Florida, although it is especially severe in Miami-Dade County, which has one of the nation’s largest percentages of mentally ill residents, according to the National Alliance for the Mentally Ill, an advocacy group. A Justice Department study released in September found that 64 percent of inmates in county jails around the nation reported mental health problems within the last year. Many are arrested for petty crimes, advocates say, yet remain in jail an inordinately long time because there is nowhere else for them to go. Only 40,000 beds remain in state psychiatric hospitals around the nation, down from 69,000 in 1995. Advocates for the mentally ill say that community-based treatment programs, which were supposed to replace psychiatric hospitals after the deinstitutionalization movement of the ’60s and ’70s, have not begun to make up for the loss. Long waits for beds are especially common in the nation’s urban areas. Last week, 307 mentally ill inmates were waiting for one of Florida’s 1,416 psychiatric beds, and 72 percent had waited longer than 15 days. The state has three psychiatric hospitals with secure beds. “This is a national problem, and it’s a direct reflection of the lack of adequate beds and coordination between the criminal justice and mental health systems,” said Ronald S. Honberg, legal director of the National Alliance for the Mentally Ill. In Miami, an average of 25 to 40 acutely psychotic people live in a unit of the main county jail that a lawyer for Human Rights Watch, Jennifer Daskal, described as squalid after visiting last month. Seventeen such inmates are currently waiting for state hospital beds, said Valerie Jonas, a county public defender, adding that the number has been as high as 30 in recent weeks. Ms. Daskal said that some of the unit’s 14 “suicide cells” — dim, bare and designed for one inmate — were holding two or three at a time, and that the inmates were kept in their cells 24 hours a day except to shower. None of the mentally ill inmates receive group or individual therapy, she said in an affidavit. Officials with the Department of Children and Families have argued that the agency cannot be held in contempt when it simply has no more beds, and that it could not have anticipated this year’s sharp rise in commitments. In June 2005, they said, only 125 inmates were waiting for hospital beds, of which 38 percent had waited longer than 15 days. “We are at the moment on a daily basis trying to find a short-term solution to the bed shortage,” said Al Zimmerman, a spokesman for the department. “We are trying to find ways to pay for additional space, pay for additional beds.” The department requested and received money for about two dozen new secure beds this year, and it has asked for 38 next year. Each bed costs $100,000 a year, Mr. Zimmerman said. Ms. Jonas, the public defender, said it was unconscionable that the department would not ask for more. “Given they’ve got a wait list of over 300 and they’re running all over the state claiming inability to comply,” she said, “where do they get off requesting only 38 new beds?” Yet Mr. Honberg said that putting more mentally ill inmates in state hospitals should not be the ultimate goal. The treatment they get there often skims the surface, he said, and many end up deteriorating when they return to jail, only to end up on the wait list for a hospital bed again. “You have large numbers of people sent to state hospitals not for therapeutic purposes, but for purposes of making them competent to proceed to trial,” Mr. Honberg said. “We’re not going to solve these problems until we invest adequate resources into services that work for people before they get to jail.”
Manohla Dargis, New York Times- 11/17/2006 The sight of young people going down the drain is never pleasant, particularly when there are needles jabbed in their arms. It isn’t just that watching anyone probe his or her veins with a sharp tends to be pretty gross; it’s also that the ritual of heroin addiction, from the bent spoon to the elastic band snapping against the agonized flesh, has become a cinematic cliché. It doesn’t help matters that stories about heroin addicts are all alike: they shoot up, they nod out, they jones. Some users clobber old ladies for their purses; others roll up to the bank in a sleek ride and make a painless withdrawal. But it’s always the same story, always. The Australian film “Candy” doesn’t add anything substantively new to that story, though it has been nicely directed by Neil Armfield, known in his country for his theater work, and features striking performances from Heath Ledger and Geoffrey Rush. Mr. Ledger plays Dan, a low-key charmer with a dewily pretty girlfriend, Candy (Abbie Cornish), and a growing appetite for heroin. The story opens shortly after Candy starts shooting heroin instead of snorting it, a decision that almost ends her life but also seems to strengthen the bond between the couple, who soar high and then higher. To abuse a famous line from another film: they’re young, they’re in love, and they shoot up, which they do with increasing frequency and with increasingly calamitous effect. Adapted from a novel by Luke Davies, who wrote the screenplay with Mr. Armfield, “Candy” unfolds in separate movements rather coyly announced by title cards, including “heaven” and “earth.” Since, as Neil Young sings, “every junkie’s like a setting sun,” Dan and Candy can only spiral down, down, down, which they do in predictable fashion. As they hopscotch from pawn shop to whore house and beyond, Mr. Armfield invests their progressively bleak spaces and situations with a grungy patina that somehow never seems dirty enough, filthy enough, grotesque enough. Even when the couple are screeching at each other, in the throes of a deep druggy need or drifting along in a narcotic haze, the roses in Ms. Cornish’s cheeks remain disconcertingly in bloom. Mr. Ledger, by contrast, looks and plays the part of the scheming user exceptionally well. He’s deep in the character’s skin right from the start. If he seems especially comfortable in the role, it may be because he’s speaking in his own accent; he doesn’t appear to be clenching his jaw the way he sometimes does when he plays an American character, or maybe he’s just coming into his own as an actor. He’s very fine, which isn’t half as unexpected as the equally shaded performance delivered by Mr. Rush, who also has the chewiest, densest role. As Casper, a professor with a seemingly endless supply of drugs and lovers, Mr. Rush leads you into a room that, for all its despair, you don’t want to vacate anytime soon. CANDY
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