| Noteworthy News Articles on Mental Health Topics, January
1-9, 2006
Terry Martin Hekker, New York Times- 1/1/2006 A while back, at a baby shower for a niece, I overheard the expectant mother being asked if she intended to return to work after the baby was born. The answer, which rocked me, was, "Yes, because I don't want to end up like Aunt Terry." That would be me. In the continuing case of Full-Time Homemaker vs. Working Mother, I offer myself as Exhibit A. Because more than a quarter-century ago I wrote an Op-Ed article for The New York Times on the satisfaction of being a full-time housewife in the new age of the liberated woman. I wrote it from my heart, thoroughly convinced that homemaking and raising my children was the most challenging and rewarding job I could ever want. "I come from a long line of women," I wrote, "most of them more Edith Bunker than Betty Freidan, who never knew they were unfulfilled. I can't testify that they were happy, but they were cheerful. ...They took pride in a clean, comfortable home and satisfaction in serving a good meal because no one had explained that the only work worth doing is that for which you get paid." I wasn't advocating that mothers forgo careers to stay home with their children; I was simply defending my choice as a valid one. The mantra of the age may have been "Do your own thing," but as a full-time homemaker, that didn't seem to mean me. The column morphed into a book titled "Ever Since Adam and Eve," followed by a national tour on which I, however briefly, became the authority on homemaking as a viable choice for women. I ultimately told my story on "Today" and to Dinah Shore, Charlie Rose and even to Oprah, when she was the host of a local TV show in Baltimore. In subsequent years I lectured on the rewards of homemaking and housewifery. While others tried to make the case that women like me were parasites and little more than legalized prostitutes, I spoke to rapt audiences about the importance of being there for your children as they grew up, of the satisfactions of "making a home," preparing family meals and supporting your hard-working husband. So I was predictably stunned and devastated when, on our 40th wedding anniversary, my husband presented me with a divorce. I knew our first anniversary would be paper, but never expected the 40th would be papers, 16 of them meticulously detailing my faults and flaws, the reason our marriage, according to him, was over. We had been married by a bishop with a blessing from the pope in a country church filled with honeysuckle and hope. Five children and six grandchildren later we were divorced by a third-rate judge in a suburban courthouse reeking of dust and despair. Our long marriage had its full share of love, complications, illnesses, joy and stress. Near the end we were in a dismal period, with my husband in treatment for alcoholism. And although I had made more than my share of mistakes, I never expected to be served with divorce papers. I was stunned to find myself, at this stage of life, marooned. And it was small comfort that I wasn't alone. There were many other confused women of my age and circumstance who'd been married just as long, sharing my situation. I was in my teens when I first read Dickens's "Great Expectations," with the tale of Miss Haversham, who, stood up by her groom-to-be, spent decades in her yellowing wedding gown, sitting at her cobweb-covered bridal banquet table, consumed with plotting revenge. I felt then that to be left waiting at the altar with a church full of people must be the most crushing thing that could happen to a woman. I was wrong. No jilted bride could feel as embarrassed and humiliated as a woman in her 60's discarded by her husband. I was confused and scared, and the pain of being tossed aside by the love of my life made bitterness unavoidable. In those first few bewildering months, as I staggered and wailed though my life, I made Miss Haversham look like a good sport. Sitting around my kitchen with two friends who had also been dumped by their husbands, I figured out that among the three of us we'd been married 110 years. We'd been faithful wives, good mothers, cooks and housekeepers who'd married in the 50's, when "dress for success" meant a wedding gown and "wife" was a tenured position. Turns out we had a lot in common with our outdated kitchen appliances. Like them we were serviceable, low maintenance, front loading, self-cleaning and (relatively) frost free. Also like them we had warranties that had run out. Our husbands sought sleeker models with features we lacked who could execute tasks we'd either never learned or couldn't perform without laughing. Like most loyal wives of our generation, we'd contemplated eventual widowhood but never thought we'd end up divorced. And "divorced" doesn't begin to describe the pain of this process. "Canceled" is more like it. It began with my credit cards, then my health insurance and checkbook, until, finally, like a used postage stamp, I felt canceled too. I faced frightening losses and was overwhelmed by the injustice of it all. He got to take his girlfriend to Cancun, while I got to sell my engagement ring to pay the roofer. When I filed my first nonjoint tax return, it triggered the shocking notification that I had become eligible for food stamps. The judge had awarded me alimony that was less than I was used to getting for household expenses, and now I had to use that money to pay bills I'd never seen before: mortgage, taxes, insurance and car payments. And that princely sum was awarded for only four years, the judge suggesting that I go for job training when I turned 67. Not only was I unprepared for divorce itself, I was utterly lacking in skills to deal with the brutal aftermath. I read about the young mothers of today - educated, employed, self-sufficient - who drop out of the work force when they have children, and I worry and wonder. Perhaps it is the right choice for them. Maybe they'll be fine. But the fragility of modern marriage suggests that at least half of them may not be. Regrettably, women whose husbands are devoted to their families and are good providers must nevertheless face the specter of future abandonment. Surely the seeds of this wariness must have been planted, even if they can't believe it could ever happen to them. Many have witnessed their own mothers jettisoned by their own fathers and seen divorced friends trying to rear children with marginal financial and emotional support. These young mothers are often torn between wanting to be home with their children and the statistical possibility of future calamity, aware that one of the most poverty-stricken groups in today's society are divorced older women. The feminine and sexual revolutions of the last few decades have had their shining victories, but have they, in the end, made things any easier for mothers? I cringe when I think of that line from my Op-Ed article about the long line of women I'd come from and belonged to who were able to find fulfillment as homemakers "because no one had explained" to us "that the only work worth doing is that for which you get paid." For a divorced mother, the harsh reality is that the work for which you do get paid is the only work that will keep you afloat. These days couples face complex negotiations over work, family, child care and housekeeping. I see my children dealing with these issues in their marriages, and I understand the stresses and frustrations. It becomes evident that where traditional marriage through the centuries had been a partnership based on mutual dependency, modern marriage demands greater self-sufficiency. While today's young women know from the start they'll face thorny decisions regarding careers, marriage and children, those of us who married in the 50's anticipated lives similar to our mothers' and grandmothers'. Then we watched with bewilderment as all the rules changed, and the goal posts were moved. If I had it to do over again, I'd still marry the man I married and have my children: they are my treasure and a powerful support system for me and for one another. But I would have used the years after my youngest started school to further my education. I could have amassed two doctorates using the time and energy I gave to charitable and community causes and been better able to support myself. But in a lucky twist, my community involvement had resulted in my being appointed to fill a vacancy on our Village Board. I had been serving as titular deputy mayor of my hometown (Nyack, N.Y.) when my husband left me. Several weeks later the mayor chose not to run again because of failing health, and I was elected to succeed him, becoming the first female mayor. I held office for six years, a challenging, full-time job that paid a whopping annual salary of $8,000. But it consumed me and gave me someplace to go every day and most nights, and as such it saved my sanity. Now, mostly retired except for some part-time work, I am kept on my toes by 12 amazing grandchildren. My anachronistic book was written while I was in a successful marriage that I expected would go on forever. Sadly, it now has little relevance for modern women, except perhaps as a cautionary tale: never its intended purpose. So I couldn't imagine writing a sequel. But my friend Elaine did come up with a perfect title: "Disregard First Book." Parenting Got You Down? You're Not Alone, Says Study Elizabeth Agnvall, Washington Post, 1/3/2006 Just as we're taking down the tree, organizing the new toys and stepping onto the scale comes a study finding that may make us wonder why we do it all: Parents are more likely to be depressed than people who do not have children. Published last month in the Journal of Health and Social Behavior, the study of 13,000 U.S. adults found that parents, from those with young children to empty nesters, reported being more miserable than non-parents. The researchers analyzed data from a national survey of families and households that asked respondents how many times in the past week, for example, they felt sad, distracted or depressed. Unlike earlier studies, this one found moms and dads equally unhappy. So: After all the sleepless nights and drowsy mornings, the cycles of feeding and throwing up, the American Girl doll accessories bought on credit, the toothpick models of the solar system and the algebra tutors . . . we would have been happier without it all? In a word, says study author Robin Simon, an associate professor of sociology at Florida State University, yes. "Parents don't do as well as non-parents," she said. Simon's own kids -- she has an adult daughter and a teenage son -- were unimpressed by the study results. "They're like 'Whatever,' " she said. For her part, Simon felt oddly cheered: "It's validating and consoling to know that you're not alone." But how can the findings stand? Politics, culture and history -- to say nothing of those annoying Baby Gap ads -- all reinforce the message that having children is the greatest pleasure in life. Michael Lewis, professor of pediatrics and psychiatry and director of the Institute for the Study of Child Development at the Robert Wood Johnson Medical School in New Brunswick, N.J., says that the idea of parenthood as pure joy "was always a bit of a wonderful myth." He said he's surprised the study findings were not even more negative. Over the last 150 years, he said, children have moved from being an economic advantage to an economic burden in the United States. We used to be able to send children to work in the fields; older kids tended to the babies. When not pressed into service, they mostly stayed out of the way. With the advent of Dr. Spock, the parenting industry, obligatory music and soccer lessons and a colossal marketplace that propels kids to desire and parents to guilt, children have become the center of the household. Consider the "Mom's Letter to Santa" e-mail that went zapping around just before Christmas: the mom is hiding in the laundry room using a crayon to write her wish list on the back of a receipt while the laundry is between cycles: She wants a car with fingerprint-resistant windows, a radio that plays only adult music, a television that won't broadcast programs with talking animals and a place where she can talk on the phone in peace. "It would be helpful if you could coerce my children to help around the house without demanding payment as if they were the bosses of an organized crime family," she writes to St. Nick. It's Not You -- Really Lewis himself has somehow worked through all of this with his four kids. While he's sure he had the messiest children in town -- he once found the skeleton of a decayed mouse under his son's bed -- he's raised a doctor and a lawyer. One child is in college and the fourth is in high school. Still, he notes, even when children are doing well, "there are always issues to deal with. One hopes that it gets better. Parenting is never done. It's an endless task. Lots of pleasure, but a lot of pain." His advice: If life as a parent leaves you gloomy, realize that it's not you. It's your . . . situation. "Don't think you are crazy" for feeling low, he said. This study shows that "lots of people are feeling the same way." Meredith Small, a Cornell University anthropologist and author of "Kids: How Biology and Culture Shape the Way We Raise Our Children," sees cultural forces conspiring to make life lousy for parents. "Western culture is the worst place to be if you want to be a parent," she says. "If you look at any other culture, people would think that this is nutty." She said parents have never been as alone as they are in the United States today. In places like India, lots of people sleep in one big house. When the baby wakes up at 2 a.m., six people are available to help. Higher birth rates mean there are older children to take care of the younger ones. Worldwide, she says, 90 percent of child care is done by other children. Even in many European countries, things are better; working mothers -- and sometimes fathers -- are paid a portion of their salaries to stay home during the first year or more with their young children. Parents get six weeks of vacation and extra time off to take care of sick kids. Good child care is subsidized by the government. College and graduate schools are paid for by the government. Here, Small said, nuclear families aren't large enough. "Parents are tired, they are overworked, they are extended, they are irritated and they've got nobody to help them." So short of sending the kids back into the fields, having more babies, inviting the neighbors to live with us or charging the kids rent, what's an overwhelmed parent to do? Family therapist Neil Bernstein, who has offices in the District and Virginia, offers this simple advice: "Get a life." For the record, he doesn't necessarily accept the study's conclusion that people with children are more depressed. Still, "What parents need to know and should take away from this is that it's important to look after your own mental health, not to live vicariously through your child," he said. People should have their own interests and look after their relationships the same way they look after their children. And if it all seems too overwhelming, it's worth seeking help from a professional. "Being a good parent does not mean being totally absorbed in your children," he said. Bernstein, who has been treating Washington area children and families for 25 years and has grown children, cites his own experience. "Not only did parenting not make me depressed, but it was without question the happiest years of my life," he says. "I wouldn't trade them for anything, and I couldn't imagine being anywhere near as comfortable or happy with myself had I not been a parent." And for those who have chosen not to have children? Simon said her study validates that their choice might just be the healthiest one of all. "At least if you're going to do it," she says to those contemplating parenthood, "know what you're getting into." FDA to Examine New Ways to Study ADD Drugs Associated Press, 1/4/2006 WASHINGTON -- Reports of sudden deaths, strokes, heart attacks and hypertension in both children and adults taking drugs to treat attention deficit hyperactivity disorder are spurring new government study into the medications' safety. Sales of drugs to treat ADHD have increased sharply in recent years, with use growing at a faster rate among adults than children, according to a recent study by Medco Health Solutions, a prescription benefit manager. Spending on ADHD drugs soared from $759 million in 2000 to $3.1 billion in 2004, according to IMS Health, a pharmaceutical information and consulting firm. The Food and Drug Administration said it had received reports of what it called ''serious adverse events'' -- including deaths -- in association with the therapeutic use of the drugs. The agency considers the reports ''rare though serious,'' FDA spokeswoman Susan Bro said Wednesday. The FDA's Canadian counterpart, Health Canada, yanked the ADHD drug Adderall XR from the market for six months last year in response to reports of 20 sudden deaths and 12 strokes in adults and children using the drug. A number of the cases involved children with structural heart defects. The panel eventually concluded there was inadequate evidence of increased harm from Adderall XR compared with other available therapies -- a conclusion the FDA also reached based on data on hand. Now the U.S. regulatory agency is asking its Drug Safety and Risk Management advisory committee to examine ways of studying further the potential cardiovascular risks of the drugs. The few studies that have looked at longer-term use of ADHD drugs provide little information on those risks, the FDA said. ''It almost sounds like cox-2 inhibitor redux,'' said committee chairman Dr. Peter Gross, referring to cox-2 painkillers like Vioxx and Bextra pulled from the market because of evidence they can raise the risk of a heart attack or stroke. ''The issue of drug treatment of attention deficit disorder in children has been a controversial one without this issue of cardiovascular risk too. It adds another concern to what will certainly be an interesting conversation,'' said Arthur Levin, the FDA committee's consumer representative. A posting to the FDA Web site did not identify any of the drugs by name. However, the most commonly used ADHD drugs include Adderall XR, made by Shire Pharmaceuticals, and Ritalin, made by Novartis Pharmaceuticals Corp. Various other companies make generic versions of Ritalin as well. Shire spokesman Matthew Cabrey said the company hadn't been told of the meeting but added it may send representatives. Novartis did not immediately return a call seeking comment. The committee's Feb. 10 meeting will include updates on FDA actions on cox-2 drugs as well as a recently begun patient, doctor and pharmacist registry program for the anti-acne drug Accutane and its generic competitors. Separately, the committee also will discuss the FDA's Drug Safety Oversight Board, an internal, government employee-only panel created nearly a year ago. The board is supposed to monitor FDA-approved medicines once they're on the market and update physicians and patients with emerging information on risks and benefits. Gross said he had concerns about the board's impartiality and independence, as well as its relationship to his committee and the very similar work it does. On the Net: Food and Drug Administration: http://www.fda.gov Medco Health Solutions: http://www.medcohealth.com/ Daughters Drink More than Moms Recognize Kristina Herrndobler, Hearst Newspapers- 1/4/2006 WASHINGTON -- Mothers significantly underestimate how much alcohol their teenage daughters drink, according to a study funded by a national organization of alcohol producers. In hopes of improving mother-daughter dialogue about underage drinking, the organization launched a public awareness campaign in December called "Girl Talk: Choices and Consequences of Underage Drinking." Through its Web site (www.girlsanddrinking.org), an Internet blog, informational booklets for mothers, and a media partnership with The N, a Nickelodeon nighttime cable TV network for teens, the campaign aims to help parents talk to their high school-age daughters about alcohol. It advises moms that they shouldn't lecture or overreact. Instead, mothers should be approachable, keep the conversations real and personal, discuss the risks of alcohol and make it clear that underage drinking is not OK under any circumstances. Girl Talk also has the official endorsement of the U.S. Women's National Soccer Team Association and soccer star Kristine Lilly, who has won two Olympic gold medals. "We know that parents are the most significant influence in their teens' decision to drink or not to drink," said Susan Molinari, chair of The Century Council, a non-profit organization that works to fight drunken driving and underage drinking. The Century Council is funded by alcohol producers such as Bacardi U.S.A. Inc., Hood River Distillers Inc. and Pernod Ricard USA. Parents need to "have the conversation early, but also often," said Molinari, who served in Congress from 1990 to 1997 and is the mother of two daughters, during a news conference at the National Press Club. The survey of 322 mother-daughter pairs found that 30 percent of 16- to 18-year-old girls say they drink with friends, but only 9 percent of their mothers thought their daughters were drinking. Joanna Kauffmann, a 17-year-old senior at a public high school in Alexandria, Va., says almost all of her friends drink socially. Kauffmann said high school students associate drinking with being older and independent, and they use alcohol--beer mostly--to escape the stresses of school. Kauffmann's mother, Judy Harmatz, said that she has always told her daughters that drinking is dangerous and illegal, but she tells them if they find themselves drinking, they should call her for a ride instead of driving home. "I guess my conversations focus on the safety issues of not drinking and driving," Harmatz said. Alcohol has a greater impact on women's health than men's, said Phyllis Greenberger, the president and CEO of the non-profit Society for Women's Health Research. After consuming comparable amounts of alcohol, women have higher blood alcohol content than men of the same age, even with allowance for size differences, Greenberger said. "It is so important for mothers and daughters to hear these messages," Greenberger said. Brain Protein May Be Linked to Depression Lauran Neergaard, Associated Press- 1/5/2005 WASHINGTON -- Scientists have discovered a protein that seems to play a crucial role in developing depression, a finding that may lead to new treatments for the often debilitating illness -- and fundamental understanding of why it strikes. Although problems with the mood-regulating brain chemical serotonin have long been linked to depression, scientists don't know what causes the disease that afflicts some 18 million Americans -- or exactly what serotonin's role is. The newly found protein, named p11, appears to regulate how brain cells respond to serotonin, researchers from Rockefeller University and Sweden's Karolinska Institute report Friday in the journal Science. ''We're all very excited about this discovery,'' said Nobel laureate Paul Greengard, a Rockefeller neuroscientist who led the research. ''People have been looking for modulators of serotonin for a long time.'' Said Oxford University pharmacologist Trevor Sharp, who reviewed the work: ''This finding represents compelling evidence that p11 has a pivotal role in both the cause of depression and perhaps its successful treatment.'' Most depression medications used today are members of the Prozac family that work by making more serotonin available to brain cells. They stem from a theory that depression patients might not have enough serotonin, a neurotransmitter, or chemical that carries signals between nerve cells. Then scientists discovered the serotonin connection was more complicated, dependent on how well the neurotransmitter binds to receptors, or docking ports, on cell surfaces. Fourteen different serotonin receptors have been discovered. The new research focuses on one of those receptors, dubbed the ''1B'' receptor, that seems to play a particularly big role in major depression. Greengard and colleagues discovered that the p11 protein increases the numbers of these receptors on the surfaces of cells, mobilizing them so they're available for serotonin to do its job. That led to a series of remarkable experiments, using mice as well as brain tissue saved from the autopsies of depressed patients, that found: --Depressed people have substantially lower levels of p11 in their brain tissue than the non-depressed. So did a breed of mice, called ''helpless'' mice, that exhibit depression symptoms. --Then the mice were given two older antidepressants -- one known as a tricyclic, the other an MAO inhibitor -- and electric shock therapy. Each treatment increased the amount of p11 in mice brains, even though each therapy is known to work in different ways. --So the researchers bred mice that had no p11-producing gene. They acted depressed, and had fewer 1B receptors and less serotonin activity than regular mice. They also were less likely to improve with depression medication. Mice genetically altered to produce extra p11 acted in just the opposite way -- no depression-like behavior, and their brain cells carried extra serotonin-signaling receptors. ''It's a very important finding,'' said Dr. Thomas Insel, director of the National Institute of Mental Health, which funded the research. ''This gives us a new set of targets for drug development,'' but also ''suggests a whole new area of investigation for trying to ... ultimately discover does this have anything to do with why some people get depressed and others don't.'' The researchers don't yet know whether a genetic defect or some other factor is responsible for altering p11 levels. ''The p11 is upstream of the receptor, and now the question is what is upstream of the p11,'' Greengard said. But Sharp noted that bouts of depression often are associated with serious stress, and that p11 is part of a protein family known to be sensitive to certain stress-related hormones Greengard's lab now is researching the potential for p11-related therapies. But the discovery likely will aid research into other diseases that also depend on cell-based receptors. ''We're finding that other molecules control other receptors, so I think this may open up quite a major new area of approach to developing therapeutic drugs,'' Greengard said. On the Net: Government depression information: http://www.nimh.nih.gov The Elusive Mr. Sandman Hilary Waldman, Hartford Courant- 1/5/2006 Here's a wake-up call for the 30 million people in the United States for whom bed has become the enemy - a place where night after night they hope to burrow into restful and refreshing slumber but wind up battling with the pillows and blankets as they watch the hours flash along on the digital clock and know that morning will only bring exhaustion and frustration. Sleep, it turns out, is a lot like weight loss and heart health. There are pills that can help, but like diet and exercise, learning to get a better night's sleep depends on lifestyle changes, hard work and practice. "In many instances, sleep habits are learned over time," says Susan Rubman, a psychologist at the sleep disorders center at New Britain General Hospital. When sleep becomes a problem, it is often because people have unwittingly fallen into destructive patterns, not at all unlike the overweight person who stops for a bag of doughnuts every day on the way to work. Insomnia is defined as the inability to fall asleep or stay asleep. It is different from physiological problems such as sleep apnea and restless-leg syndrome, which also interfere with sleep but can best be treated medically. Of an estimated 70 million people in the United States who have sleep problems, about 30 million struggle with insomnia. Most of the time insomnia is caused by anxiety or other mood disorders. Sometimes it is just the routine stresses of the day that keep people up at night - the sales meeting in the morning, the checkbook badly out of balance, the kids' demands for help with homework, the vacation that must be planned and paid for. Sometimes, a couple of sleepless nights can snowball into a nightmare of its own, so that the very sight of the bed sets off a lather of anxiety. The companies that make sleep medications such as Ambien and Lunesta would like you to believe that a little pill can magically summon the sandman. Apparently 8.6 million people believe it, too. That's how many people took prescription drugs to help them sleep in 2004, according to an analysis of insurance claims by Medco Health Solutions, a company that administers prescription-drug plans. But sleep specialists say that pills are no more than a band-aid. They may work for a night or two, but after several weeks, patients report taking more and more pills and never sleeping better. "You should not be locked into a situation where you're taking these pills seven days a week," says Dr. Keith Dixon, a sleep specialist at Gaylord Hospital in Wallingford. Rubman says more than half the people who seek sleep counseling at the New Britain center are taking prescription, over-the-counter or herbal sleep remedies - none of which are working. While the newer prescription sleeping pills can help with short-term sleep problems, such as jet lag, the National Institutes of Health in June recommended that talk therapy - including relaxation training and counseling targeted at anxiety and erroneous beliefs about sleep and sleep loss - should be the first line of treatment for insomnia. "Drugs are not the only approach to treating chronic insomnia," says Dr. Carl Hunt, director of the National Center on Sleep Disorders Research at the National Institutes of Health. The first step for many is to throw out the notion that everybody needs eight hours of sleep, experts say. Some people function well with seven hours of sleep, others need 10. But one of the worst ways to ensure enough shut-eye is to get into bed before you are drowsy, even though the alarm is set to ring eight hours later. "Going to bed early doesn't mean you're going to get more sleep," Rubman says. If you've been in bed for 20 minutes and are still awake, get up, Rubman and Dixon both say. Tossing and turning only reinforces the idea that bed is a hateful place where you try and try but are unable to rest. Leave the room, find a comfortable spot with low light and perform some kind of restful activity, perhaps knitting or light reading, experts suggest. Do not return to bed until you are sleepy, but do not allow yourself to fall asleep anywhere but in bed. Be careful that the activity you choose is not so stimulating and enjoyable that you are actually rewarding yourself for waking up during the night. Dr. Daniel McNally, director of the sleep disorders center at the University of Connecticut Health Center in Farmington, recalls one of his patients who got up, had a bowl of ice cream and watched "Law and Order" re-runs when she couldn't sleep. "Sure," says McNally, "I'd get up too to have ice cream and watch `Law and Order.'" For his patients whose looping anxieties keep their heads spinning on the pillow, Dixon at Gaylord suggests an exercise: Take a pile of index cards and label one with the name of every problem that keeps you awake at night. One card could perhaps be labeled "Finances"; another, "I hate my job"; another, "What am I going to cook for dinner tomorrow?" On each card write out a plan for how you plan to approach the problem today, tomorrow and next week. Keep the index cards next to the bed. When one of the worries disrupts your sleep, check the card, assure yourself that you have a plan, then put it in the drawer and go to sleep. Patients who seek help for insomnia at a sleep session can expect to participate in weekly counseling sessions, either individually or in groups, for about five or six weeks. Insurance usually pays for sleep therapy, but not always. Patients learn relaxation techniques and other strategies for getting a better night's sleep. But as with diet and exercise, there is no such thing as an overnight miracle. It takes work and practice for people to change their sleep habits. "Most people leave sleeping better than they were when they came in," says Rubman, whose counseling sessions are always full, with people waiting to get in. "There is a healing process, so they might get better over time." Interest Grows in Childhood Memory Marina Pisano, San Antonio Express News- 1/6/2006 SAN ANTONIO - The girl with the long blond hair is the first to shoot up her hand when the class of second-graders hears the question: What is your very earliest childhood memory? Reagan Nentwich recalls that at 3, she went horseback riding in the park with her dad on a big brown horse, and she was scared. Later, the 7-year-old goes back even further. "When I was a little baby, we were eating lunch at my mom's favorite restaurant, and she was wearing her favorite vest. I accidentally threw up on it 'cause I was really sick I was 18 months old. I remember it." Reagan's memory maybe a combination of what she actually recalls and what her mother has told her about the event. But it is possible Reagan remembers much of it, says childhood memory researcher Carole Peterson, a psychologist at Memorial University. of Newfoundland. "There does seem to be a very occasional memory as young as a year and a half. We found them in (our) research." Peterson is an expert in childhood memory and childhood amnesia, and here a definition is in order. Childhood amnesia, or infantile amnesia as it is known, is the inability to remember things from very early in our lives. Most adults have childhood amnesia. With some exceptions, their earliest memories are usually from 3, 4 or 5. It turns out, however, that this amnesia sets in long before adulthood. With her groundbreaking memory research, Peterson is the first to systematically delineate the onset of "childhood amnesia" in children -- that's autobiographical memory, not the remembering of letters and numbers or skills like riding a bike. In a study of 136 subjects, 6 to 19 years old, Peterson found that 6- to 9-year-olds can recall earlier events than older children, and that at about age 10, children have entered an "adult state" of remembering. That means that childhood amnesia has set in, and they don't have memories any earlier than about age 3. Her work was published in the August issue of the journal Memory. Among Peterson's findings, children usually give snapshot memories, not long narratives. Only about 25 percent of their remembrances were traumatic. Many were mundane things like recalling a flower growing out of a crack in the sidewalk. Girls have more emotion-laden memories than boys, and boys more memories associated with play. Teens have more negative memories than younger kids, perhaps the researcher says, because they are defining events in their lives. In looking at college-age adults, she found men don't have as much access to very early memories as women do. Just why the paradox of childhood amnesia occurs is not at all clear yet, although there are several theories. The whole field of childhood memory has seen a spurt of interest and research in recent years. That is partly because of more advanced techniques in behavioral research and greater understanding of brain structures through the work of neuroscientists. Duke University memory researcher and psychology professor Patricia Bauer points out that these studies are vital because cause memory is the foundation of thinking, planning and problem-solving. And the fascination with childhood memory, the narrative of our early years, is basic in obvious ways. "A lot of our self-definition is tied up in these stories that we remember and that we tell about ourselves. Essentially, it's really a big part of who we are and who we think we are. It's our story," Peterson says. As science tells us, memory is complicated, and several parts of the brain contribute to the formation of memories. Two brain structures that are central to encoding and retrieving memories are the prefrontal cortex, in the cortical region of the frontal lobe, and the hippocampus, in the temporal lobe. The first directs attention and holds information, while the hippocampus turns information gathered from many areas of the brain into a consolidated memory. Bauer explains that the prefrontal cortex drives the retrieval process, while the hippocampus is important in forming memories. "There's a period of 15 years during which this memory system is building and fine-tuning and becoming more efficient. So even though you're remembering things, you're still forgetting things," Bauer says. She uses the "glue" analogy to explain childhood amnesia. Think of a memory as a collection of features and elements. that are glued together into a representation of something in the past. "Over time, the glue that holds these elements together into a united representation starts to fade and you lose some of the elements. You forget specifics," she says." Fear Is Making the Rounds at California State Hospitals Lee Romney, Los Angles Times- 1/8/2006 ATASCADERO, Calif. — By the time most colleagues heard the emergency alert, Wahida Abdeen-Poncelot was unconscious, her blood pooling beneath her. Her head was gashed, a kneecap shattered. The diminutive psychiatric technician had just worked a double shift at Atascadero State Hospital, a mental institution for patients funneled through the criminal justice system. As she headed for the door of her unit that November night, a patient slammed her against a wall. After a co-worker grabbed the attacker, a second patient jumped Abdeen-Poncelot. She might have died had a third patient not intervened. Raymond Albert Lopez, 34, later told hospital police that his alleged accomplice, 29-year-old Lynford Jay Perry, gave him "uppers" in a bathroom as they planned the attack. "He hit her and I finished her off," said Lopez, who with Perry is facing charges of attempted murder and conspiracy. Brutal, premeditated attacks are rare, but this one sent tremors through the ranks at Atascadero, which has seen a 66% jump in hitting, kicking and other aggressive acts against staff in the last two years. There were 374 such assaults between July 2004 and June of last year, up from 225 two years prior. The jump is not the worst in the state's five-hospital system; such incidents at Metropolitan State Hospital in Norwalk more than doubled. But psychiatrists, nurses and others at Atascadero say they face particular peril because the facility is taking on increasingly combative patients in already-crowded wards just as it contends with an unparalleled staffing shortage. As it stands, the Central Coast facility houses the state's largest share of mental patients likely to be violent — including criminal defendants acquitted by reason of insanity, mentally ill parolees and those who have completed parole but pose too much of a threat to be released. Staffers fear that the danger grows with every shift. "In 16 years here I've never felt unsafe," said Dr. William Walters, a psychiatrist and vice chief of the medical staff that covers 75 severely ill parolees in two units — Abdeen-Poncelot's among them. "I now feel I'm just waiting to get hit." The trend is a jarring setback for a facility that took a national lead more than 15 years ago in calling attention to violence as an occupational hazard. Through its Clinical Safety Project, the hospital dramatically reduced serious staff injuries, trained employees to manage aggressive patients and enlisted patients in counseling peers. But a recent analysis by Atascadero officials shows that the rate of assaults against staff members by patients considered the most volatile — on parole or confined beyond their parole terms — has tripled since January 2003. Atascadero houses the largest proportion of such patients, called "mentally disordered offenders," and their numbers are growing. Staffers say a key factor in the upheaval at the hospital is court rulings in 2004 that granted the patients the right to refuse psychotropic medications. Clinical Safety Project director Colleen Love stressed that the hospital has been successful over time in reducing serious injuries that curtail work duties or require more than first aid, but those recently have climbed as well — from 69 in 2003 to 76 in 2004 and 81 last year. The increased violence and injuries come as the state's mental hospitals face intensive scrutiny by the U.S. Department of Justice. That agency, however, has previously focused mainly on violations of patients' rights, including possible overmedication and excessive use of restraints, not staff security. Indeed, federal investigators issued reports on Metropolitan and Napa State hospitals that were highly critical of staff members' failure to prevent patients from harming themselves or other patients. The agency only recently completed reviews of Atascadero and San Bernardino's Patton State Hospital — which is reeling from two recent killings of patients by their peers. Now Atascadero, like other hospitals in the system, is poised to shift to a new model of care that is less restrictive for patients, offering them more autonomy, interaction with peers and individualized treatment. Though many staff members support the concept of this "recovery model" — pioneered at Metropolitan — they fear that it requires far more manpower to be carried out safely. As it stands, more than a quarter of Atascadero's budgeted positions for nurses, psychiatric technicians, psychiatrists and other caregivers were vacant last January — compared with a 12% vacancy rate at Patton and 2% at Metropolitan and Napa, according to the most recent state data. The shortages at Atascadero, which houses more than 1,300 patients and has more than 2,200 budgeted staff positions, are worse still when staff members who are on leave — many due to assaults or stress — are included. In one program that includes the hospital's high-stress admissions units and its medical unit, 10% were on extended leave as of Dec. 1. In a report issued after a survey of Atascadero last month, inspectors with the hospital accrediting agency, the Joint Commission on Accreditation of Healthcare Organizations, noted that a quarter of full-time nursing slots and a third of psychiatrist positions were vacant. They said failure to promptly reverse the trend would result in "diminishing safety for patients and staff." Psychiatrists and nurses note that many colleagues have left recently for a new state hospital in Coalinga and the nearby California Men's Colony, which they consider safer — though less therapeutic — because of the presence of armed guards. The departure of colleagues only worsens conditions for employees who stay. "It's sort of a downward spiral," acknowledged Atascadero Executive Director Mel Hunter, who has pressed Sacramento officials to offer better pay and incentives. Stephen Mayberg, director of the state Department of Mental Health, called staffing constraints systemwide "legitimate and really problematic for us…. Vacancies are difficult, and running all our hospitals at or above capacity all the time just gives us no breathing room." Unable to keep pace with a growing, more challenging patient population, the state has turned to overtime. After two more housing units opened in November 2004, mandatory back-to-back shifts became common. In June 2005, nurses and psychiatric technicians worked 25,733 hours of overtime — a 67% increase since June 2003. Atascadero also is relying increasingly on less-experienced staff — including students as young as 18. The night Abdeen-Poncelot was assaulted, the first staffer to respond from her own unit was a student who ran to call 911 instead of helping to restrain the attackers, hospital police reports show. (Police had already been summoned through pager devices that all staffers carry.) Even experienced staff increasingly fill in on units where they have no established relationships with patients. "I hear it all the time," said Dr. John Cannell, a psychiatrist and union steward: "I don't know the patient. I'm a float." Moreover, the number of more typically aggressive mentally ill offenders — many of them emergency transfers from overcrowded prisons — has grown, administrators said. The toughest arrive directly from prison seclusion, and often find themselves free to roam through units or cavernous hallways and courtyards. By law, they are subject to restraint only if deemed a threat to themselves or others. One patient in an admissions unit last month gouged his hand with a staple torn from a magazine while yelling, "I'm from Pelican Bay…. I'll take you all out!" an incident log shows. He then tackled staffers. Aggressive behavior has increased with recent court decisions that allow patients — including the mentally disordered offenders — to refuse medications, many staff members said. "Not only did they start refusing their psychiatric meds, they started refusing their diabetes meds and their lab work," Walters said. Medication can be forced on patients deemed by doctors to pose an "imminent danger" to themselves or others. But those who receive such emergency medication are entitled to an on-site hearing with two psychiatrists, a psychologist and a social worker, and follow-up hearings at the 14-day and 180-day mark. It's a time-consuming, labor-intensive process. Atascadero has held more than 320 in-house proceedings for mentally disordered offenders since December 2004 — far more than any other state hospital. The more experienced workers rely on their powers of persuasion. When parolees refuse medication, seven-year psychiatric technician Hollie Thomspon approaches them an hour or so later to quietly coax. "I tell them, 'Hey, medication is part of treatment,' " she said. In general, however, staff members say patients' refusal of drugs has led to increased aggression in the wards. Joan Trabucco, a psychiatric technician, said every female worker in her admissions unit had been hit within the last three months. In one unit, staffers who had worked the morning shift recently described patients' moods to their evening replacements. One had been refusing meds for about a month. "I think he's really cracking," a psychiatric technician observed. "He is," the daytime shift leader replied, "and when he goes off, it's really going to be something else." Love said patient overcrowding is partly to blame. In 2005, the hospital began doubling up parolees in single rooms and housing them in former office space. Close quarters might have caused assaults against fellow patients and staff members to spike, Love said. She said the problem is all the harder to contain because staffers are exhausted from overtime shifts. Some relief came when officials began moving sexually violent predators — who generally are not assaultive — to the state's newest mental hospital in Coalinga three months ago. However, more typically aggressive patients have replaced them. Administrators and staff stress that most patients are docile. But the growing number of repeat aggressors has created a profound sense of fear in the wards. Toni Martin, a 19-year veteran, was struck repeatedly in August by a patient who had intermittently refused medication. "He just said, 'You're in with them' and started pounding me," she recalled. Martin, named "Nurse of the Year" before her assault, returned from a two-month leave nervous and wary. As staff members responded to a violent episode weeks later, she said, she huddled at the nurses' station and cried. "It always comes back to you," she said, "every time a friend gets slammed or hurt." Many caregivers are suffering from high blood pressure, depression and ulcers, they said. In growing numbers, they are submitting notes from their doctors ordering them to forgo overtime. Pamela Garofalo, a 25-year employee, reached her limit last summer when a colleague with mounting blood pressure had a stroke. She began distributing a series of fliers and e-mails encouraging employees to refuse certain voluntary overtime shifts. Psychiatrists also are speaking out, warning Mayberg, Atty. Gen. Bill Lockyer and other state officials that further tragedy is guaranteed if staffing shortages continue. We "can no longer live with the violence at our hospital," Cannell wrote in a Dec. 29 letter to the governor and two local legislators. Meanwhile, Abdeen-Poncelot, who declined to be interviewed, is trying to heal. Her husband, a nurse at Atascadero, said she is scared and withdrawn, and cries when she passes the hospital's freeway exit. Hunter declined to comment on the attack, citing the ongoing prosecution. But he said "being assaulted is not a work requirement … we can prevent or eliminate assaults." He hopes the "recovery" treatment model ultimately will help reduce violence by giving patients more individual attention. But success rests, he acknowledges, on beefed-up staffing, and it is unclear how that will occur. "There's a lot of anger," said David Powell, a nurse who works in the hospital's urgent-care unit, recalling the night Abdeen-Poncelot was carried in on a backboard, blood matting her black hair. "It could have been avoided." Tourette's Case Shows Holes in Disability Law Associated Press, 1/9/2005 MERRIMACK, N.H. -- A teenager's experience at a movie theater is raising questions about how federal law protects those afflicted with Tourette's syndrome and the rights of a business to respond to its customers. Jennifer Irizarry, 13, went to see ''The Chronicles of Narnia" at Cinemagic on Dec. 26. Before the opening credits, several other movie-goers complained about her high-pitched squeaks and vocal outbursts. She said a manager led her to the lobby and threatened to eject her if she had another outburst. But theater management denies that she was asked to leave. ''What I told her was between me and her, but she wasn't forced to leave," said Jamie Pinard, the theater's general manger. Realizing that her condition would worsen under the stress of being singled out in front of her friends, Irizarry decided to leave. She and her parents accuse the theater of violating the Americans with Disabilities Act, but the law may not apply in her case. Andrea Pia Yates pleaded not guilty by reason of insanity in the drowning deaths of her children during her first court appearance since her capital murder conviction was overturned last year. Appearing calm and wearing glasses and an orange jumpsuit, Yates stood next to her attorney before State District Judge Belinda Hill, who set a new trial date of March 20. Yet her attorney, George Parnham, said Yates was "terrified'' at the prospect of another trial and seeing evidence connected to her children's deaths, who Yates admitted to drowning in the family's bathtub on June 20, 2001. "She loves her children so much,'' he said after today's court appearance. |