| Noteworthy News Articles on Mental Health Topics, January
23-28, 2006 Potent Mexican Meth Floods In as States Curb Domestic Variety Kate Zernike, New York Times- 1/23/2006 DES MOINES -- In the seven months since Iowa passed a law restricting the sale of cold medicines used to make methamphetamine, seizures of homemade methamphetamine laboratories have dropped to just 20 a month from 120. People once terrified about the neighbor's house blowing up now walk up to the state's drug policy director, Marvin Van Haaften, at his local Wal-Mart to thank him for making them safer. But Mr. Van Haaften, like officials in other states with similar restrictions, is now worried about a new problem: the drop in home-cooked methamphetamine has been met by a new flood of crystal methamphetamine coming largely from Mexico. Sometimes called ice, crystal methamphetamine is far purer, and therefore even more highly addictive, than powdered home-cooked methamphetamine, a change that health officials say has led to greater risk of overdose. And because crystal methamphetamine costs more, the police say thefts are increasing, as people who once cooked at home now have to buy it. The University of Iowa Burn Center, which in 2004 spent $2.8 million treating people whose skin had been scorched off by the toxic chemicals used to make methamphetamine at home, says it now sees hardly any cases of that sort. Drug treatment centers, on the other hand, say they are treating just as many or more methamphetamine addicts. And although child welfare officials say they are removing fewer children from homes where parents are cooking the drug, the number of children being removed from homes where parents are using it has more than made up the difference. "It's killing us, this Mexican ice," said Mr. Van Haaften, a former sheriff. "I'm not sure we can control it as well as we can the meth labs in your community." The influx of the more potent drug shows the fierce hold of methamphetamine, which has devastated many towns once far removed from violent crime or drugs. As Congress prepares to restrict the sale of pseudoephedrine, the cold medicine ingredient that is used to make methamphetamine, officials here and in other states that have recently imposed similar restrictions caution that they fall far short of a solution. "You can't legislate away demand," said Betty Oldenkamp, secretary of human services in South Dakota, where the governor this month proposed tightening a law that last year restricted customers to two packs of pseudoephedrine per store. "The law enforcement aspects are tremendously important, but we also have to do something to address the demand." Here, officials boast that their law restricting pseudoephedrine, which took effect in May, has been faster than any other state's in reducing methamphetamine laboratories. Still, when Mr. Van Haaften, director of the Governor's Office of Drug Control Policy, surveyed the local police, 74 percent said that the law had not changed demand, and 61 percent said supply had remained steady or increased. In a survey of treatment professionals, 92 percent said they had seen as many or more methamphetamine addicts; the state treated 6,000 in 2005 and expects to treat more than 7,000 this year, based on current trends. Some health officials said abuse among women, typically the biggest users of methamphetamine, was rising particularly fast. While seizures of powdered methamphetamine declined to 4,572 in 2005 from 6,488 in 2001, seizures of crystal methamphetamine increased, to 2,025 from one. Federal drug agents tend to describe ice as methamphetamine that is at least 90 percent pure. Officials here say much of their crystal methamphetamine is less pure - "dirty ice," they call it. But either is far more potent than homemade powdered methamphetamine; a "good cook" yields a drug that is about 42 percent pure, but around 25 percent is more common. And in the first four months after the law took effect here, average purity went to 80 percent from 47 percent. Other states have seen the same. "The Mexican drug cartels were right there to feed that demand," said Tom Cunningham, the drug task force coordinator for the district attorneys council for Oklahoma, the first state to put pseudoephedrine behind pharmacy counters, in 2004. "They have always supplied marijuana, cocaine, and heroin. When we took away the local meth lab, they simply added methamphetamine to the truck." A methamphetamine cook could make an ounce for $50 on a stovetop or in a lab in a car; that same amount now costs $800 to $1,500 on the street, the police say. "Our burglaries have just skyrocketed," said Jerry Furness, who represents Buchanan County, 150 miles northeast of Des Moines, on the Iowa drug task force. "The state asks how the decrease in meth labs has reduced danger to citizens, and it has, as far as potential explosions. But we've had a lot of burglaries where the occupants are home at the time, and that's probably more of a risk. So it's kind of evening out." When the state surveyed the children in state protection in southeastern Iowa four months after the law took effect, it found that 49 percent were taken from parents who had been using methamphetamine, the same percentage as two years earlier, even as police said they were removing fewer children from homes with laboratories. Some law enforcement officials say that addicts may find the crystal form more desirable. "If they don't have to mess with precursor chemicals, it's actually a bit easier on them, and safer," said Kevin Glaser, a drug task force supervisor for the state highway patrol in Missouri, which last year led the nation in methamphetamine lab seizures. But the switch has also increased the risks. "People are overdosing; they're not expecting it to do this much," said Darcy Jensen, director of Prairie View Prevention Services in South Dakota. "They don't realize that that fourth of a gram they're used to using is double or triple in potency." Federal officials say there are 1.4 million methamphetamine addicts in the United States, concentrated in the West, where the drug began to take hold in the late 1980's, and the Midwest and South, where it moved in the mid- and late 1990's. Drug enforcement officials have always said that 80 percent of the nation's supply comes from so-called super labs, those able to make 10 pounds or more. But in some counties here, officials say that all the methamphetamine came from mom-and-pop labs that made the drug by cooking pseudoephedrine with toxic farm and household chemicals. Law enforcement focused on the laboratories because they were so destructive: the police found children who had drunk lye thinking it was water, or went without food as parents went through the long binge-and-sleep cycles of using. Laboratories in homes, motels, abandoned farm buildings or cars frequently exploded, or dumped their toxic chemicals into drains or soil. Small police departments spent much of their time attending to contaminated sites. More than 30 states have restricted pseudoephedrine in some way. Nine have put it behind pharmacy counters, and Oregon now requires a prescription to obtain it. Addicts and cookers have proved to be skilled at getting around the restrictions; as one state imposes a law, bordering states see an increase in laboratories. Oklahoma recently linked its pharmacies by a computer database to track sales after discovering that cooks were going county-to-county buying from several pharmacies a day. Iowa's law passed unanimously. As in other states, officials say the number of laboratories had already begun to decline, most likely because cooks feared they would be caught because there was so much public attention on the problem. The law resulted in a decline of at least 80 percent. Police found 138 laboratories from June to December, down from 673 for the same period the year before. The state had hit a high of 1,500 lab busts in 2004, but with the law, had 731 for 2005, and expects just 257 this year. Law enforcement says the costs of policing and cleaning up labs will drop to $528,000 next year from $2.6 million in 2004. But here and in many of the states with recent pseudoephedrine restrictions, frustration with the stubborn rate of addiction has moved the discussion from enforcement to treatment and demand reduction. That discussion, officials say, will be much tougher. After listening to Mr. Van Haaften's report on the effects of the law this week, State Representative Clel Baudler, a former state trooper who now heads the public safety committee for the Iowa General Assembly, charged his committee to come back to the next meeting with strategies to reduce demand. "My fear is, when I ask what they think we should do, they'll say 'I don't know,' " Mr. Baudler said in an interview afterward. "We've increased penalties, we've increased prison time, we're still not getting in front of it." Officials say they never advertised the law as one that would reduce methamphetamine addiction. Still, they are surprised at how the drug has hung on. "Things that are highly destructive, including diseases, tend to be self-limiting," said Arthur Schut, president of the Mid-Eastern Council on Chemical Abuse in Iowa City, and a member of the state's drug policy advisory council. "This has been devastating. It's remarkable how quickly people are damaged by it." Mr. Van Haaften, too, knows that it was too much to hope that the law would reduce demand. Still, he says, "I had a little hope." "I knew of the addictive nature, but in my heart, I believed people didn't want to deal with dealers," he said. "They have guns, it's dangerous, if you make your own it's safer. I hoped for a dip, but the availability did not allow that to happen." Secret Lives of Bingers and Nighttime Noshers Sally Squires, Los Angeles Times- 1/23/2006 Though less serious than anorexia or bulimia, compulsive overeating is still risky.One woman from San Francisco summed up her eating problem this way: "I rarely overeat when I'm around other people…. All my friends marvel at how 'good' I am. They don't know what goes on behind closed doors! When I'm home alone, I have very little self-control," she says. "I will devour anything that isn't nailed down … and I feel disgusting afterward." Such habits aren't rare. Many people "attempt to control their eating during the day and then lose control at the end of the day when they're starving," says psychologist Gayle Brooks, clinical director of the Renfrew Center's Florida office. The center treats eating disorders and has clinics throughout the East Coast. "That's when this can move into compulsive behavior." This "disordered eating" — a form of compulsive overeating — is considered less serious than the better-known disorders, anorexia or bulimia. Although there appears to be a spectrum of disordered eating, two types in particular are under study. One is binge-eating disorder, which involves compulsively eating up to a day's worth of calories in two hours or less. The other is night-eating syndrome. People with this syndrome either eat at least 25% of daily calories after dinner, as a bedtime snack, or wake up at least three times a night to eat. These extra calories add up, not only to unwanted pounds, but also to an increased risk for heart disease, diabetes, arthritis, sleep apnea and certain types of cancer. Exactly how many people are affected is unknown. But clinical experience and a few studies suggest that about 2% of the general population has disordered eating. That means these syndromes occur more frequently than anorexia and rival the incidence of bulimia, says University of Pennsylvania psychologist Kelly C. Allison. Plus, Allison says, plenty of people "suffer from these things at a sub-clinical level as well." Though binge eating and night eating may seem similar, research suggests that they are two distinct conditions. An occasional bout of overeating or a couple of midnight feeding frenzies are not likely signs of illness. But when such episodes are frequent or severe, there may be a problem. Here are some ways to assess — and possibly control — problem eating: • Ask: Am I in control? Craving food well beyond satisfying hunger is a warning sign of disordered eating. So is difficulty stopping. So if you find yourself frequenting all-you-can-eat restaurants or regularly standing in the kitchen sampling the chocolate cake, then the chips, then a spoonful of ice cream and so on, you might have a problem. • Check how much you eat after dinner. Constant noshing is a warning sign. Large bedtime "snacks" to help you sleep can be a symptom of night-eating syndrome as can stowing food in the bedroom. • Eat breakfast. Even if you binged the night before, eating breakfast is the best way to get back on track. A recent Yale University study examined the eating patterns of nearly 200 obese men and women with binge-eating disorder and found that breakfast was the most skipped meal. • Consume at least three meals daily. It may help control overeating. People with disordered eating often skip meals, find themselves justifiably ravenous, then have trouble feeling satisfied when they do eat. In the Yale study, which was published in the journal Obesity Research, participants with binge-eating disorder who ate three meals per day weighed significantly less and had significantly fewer binges than those with the disorder who regularly skipped meals. • Close the kitchen at night. There's no evidence to suggest that calories consumed at night are metabolized any differently than during the day. But closing the kitchen means you're less likely to engage in mindless eating. "So figure out a reasonable time to get out of the kitchen after you have cleaned up," Allison says. For the same reasons, avoid eating in front of the television. • If overeating persists, seek medical assistance. Left untreated, disordered eating can quickly add pounds. Consider psychotherapy to treat underlying depression, anxiety or other emotional problems that may fuel eating. Nutritional counseling and exercise training may also help. And a small study at the University of Pennsylvania found that the antidepressant Zoloft may be helpful in treating some people with night-eating syndrome. Although many antidepressants can lead to added weight, Zoloft appears to be "weight neutral," Allison says, so it's unlikely to add pounds. Study: Walking Helps Depressed Patients Associated Press, 1/23/2006 AUSTIN, Texas -- Just 30 minutes of brisk walking can immediately boost the mood of depressed patients, giving them the same quick pick-me-up they may be seeking from cigarettes, caffeine or binge eating, a small study found. Researchers at the University of Texas at Austin found that people suffering from depression who walked on a treadmill for 30 minutes reported feeling more vigorous and had a greater sense of psychological well-being for up to an hour after completing the workout. Those patients and another group that sat quietly for 30 minutes both reported reductions in negative feelings such as tension, depression, anger and fatigue. But only the group that exercised said they felt good after the session, according to the study, published in the December issue of the journal, Medicine and Science in Sports and Exercise. Lead researcher John Bartholomew said the study reinforces past research that has found consistent exercise, along with medication and counseling, can help people overcome depression. However, Bartholomew's is among the first to show that exercise can have a positive effect right away. ''It's not something you have to do for 10 weeks and it's not something you have to do at a high intensity,'' said Bartholomew, an associate professor of kinesiology and health education. ''You should derive a benefit very early on in the process, and hopefully that is the kind of thing that will motivate them to continue to engage in the behavior.'' The study, funded by Future Search Trials, an Austin medical research company, involved 40 people between the ages of 18 and 55. All were recently diagnosed with major depressive disorder, were not taking antidepressants and did not regularly exercise. Twenty patients were assigned to exercise for 30 minutes, while the others sat quietly for the same amount of time. They were surveyed five minutes before the session and five, 30 and 60 minutes afterward. The positive mood effects from walking were sizable, lifting their feelings of vigor to near-normal levels, the study said. But the results were short-lived, returning to pre-exercise levels within an hour. While the study shows depressed people who self-medicate with cigarettes, caffeine or food binges could get similar positive feelings from exercising, experts said it won't be easy to persuade them to replace bad habits with walking or shooting hoops. It's hard enough to get healthy adults to exercise. ''For people who are severely depressed, that may not be something I'm really going to hang my hat on,'' said Dr. Erik Nelson, an assistant professor of clinical psychiatry at the University of Cincinnati College of Medicine. But for mildly to moderately depressed patients, exercise may lessen feelings of helplessness and isolation, he said. ''People shouldn't feel like the only thing they can do is take their medicine and wait till they feel better,'' Nelson said. ''This kind of shows there are things you can do to help yourself in the short term.'' A Shocker: Partisan Thought Is Unconscious Benedict Carey- New York Times- 1/24/2006 Liberals and conservatives can become equally bug-eyed and irrational when talking politics, especially when they are on the defensive. Using M.R.I. scanners, neuroscientists have now tracked what happens in the politically partisan brain when it tries to digest damning facts about favored candidates or criticisms of them. The process is almost entirely emotional and unconscious, the researchers report, and there are flares of activity in the brain's pleasure centers when unwelcome information is being rejected. "Everything we know about cognition suggests that, when faced with a contradiction, we use the rational regions of our brain to think about it, but that was not the case here," said Dr. Drew Westen, a psychologist at Emory and lead author of the study, to be presented Saturday at meetings of the Society for Personality and Social Psychology in Palm Springs, Calif. The results are the latest from brain imaging studies that provide a neural explanation for internal states, like infatuation or ambivalence, and a graphic trace of the brain's activity. In 2004, the researchers recruited 30 adult men who described themselves as committed Republicans or Democrats. The men, half of them supporters of President Bush and the other half backers of Senator John Kerry, earned $50 to sit in an M.R.I. machine and consider several statements in quick succession. The first was a quote attributed to one of the two candidates: either a remark by Mr. Bush in support of Kenneth L. Lay, the former Enron chief, before he was indicted, or a statement by Mr. Kerry that Social Security should be overhauled. Moments later, the participants read a remark that showed the candidate reversing his position. The quotes were doctored for maximum effect but presented as factual. The Republicans in the study judged Mr. Kerry as harshly as the Democrats judged Mr. Bush. But each group let its own candidate off the hook. After the participants read the contradictory comment, the researchers measured increased activity in several areas of the brain. They included a region involved in regulating negative emotions and another called the cingulate, which activates when the brain makes judgments about forgiveness, among other things. Also, a spike appeared in several areas known to be active when people feel relieved or rewarded. The "cold reasoning" regions of the cortex were relatively quiet. Researchers have long known that political decisions are strongly influenced by unconscious emotional reactions, a fact routinely exploited by campaign consultants and advertisers. But the new research suggests that for partisans, political thinking is often predominantly emotional. It is possible to override these biases, Dr. Westen said, "but you have to engage in ruthless self reflection, to say, 'All right, I know what I want to believe, but I have to be honest.' " He added, "It speaks to the character of the discourse that this quality is rarely talked about in politics." This Is Your Brain on Schadenfreude James Gorman, New York Times- 1/24/2006 Now that schadenfreude, which I always thought meant "shades of Freud" but actually means taking pleasure in someone else's misfortune, has been located in the brain, I am awaiting news on the location of ennui, angst, misery, malaise and "feeling pretty." I was actually hoping for anomie as well, but that was when I thought it was something like ennui. Apparently, if we are to believe the several dictionaries I consulted, anomie isn't exactly a state of mind but a kind of disconnected lack of direction or morals. I think my expectations are reasonable. After all, brain scans - which were used in the detection of schadenfreude - have clearly reached the level of sophistication required to identify states of mind described by complicated German words. Soon they will advance to states of mind truly expressible only in French, and ultimately to the kind of internal experience until now captured only in our best musical comedies. Tania Singer at University College London and her colleagues, who published a schadenfreude paper in Nature, were not actually searching for schadenfreude when they used functional magnetic resonance imaging to watch the brains of subjects in action. Their primary interest was variation in levels of empathy, which can be detected by the activity in "pain-related areas" like the "fronto-insular and anterior cingulate cortices" of the brain when a person is watching someone else in pain. First the experimental subjects watched people playing a game in which some cheated (bad people) and others played fair (good people). Then they watched the same people suffering from a painful stimulus. The empathy circuits lighted up in both men and women when bad things happened to good people. When bad things happened to bad people, the women in the study were still empathic. But not the men. Not only did they show less empathy toward bad people, but the reward center in the left nucleus accumbens lighted up. All that translates as "Serves him right!" I wouldn't exactly call that schadenfreude, although Nature made it the core of its press release and most news coverage emphasized the big German word. Dr. Singer didn't actually put the word in her paper, either, but in an interview she defended the idea that the emotion she was viewing came under the heading of schadenfreude. She did acknowledge that the word included other feelings. When someone slips and falls on the ice, celebrities have wardrobe malfunctions and rich people lose money, your reward center may light up. Sometimes envy inspires schadenfreude. Sometimes it's just a good camera angle. Another example, not mentioned in the Nature press release, might be when a competitor, say the journal Science, publishes papers by Dr. Hwang Woo Suk that turn out to be fabricated and you (Nature) publish a paper by the same author about an improbably cloned Afghan hound that has held up to scrutiny so far. There is a small flaw in my wish to see what part of the brain lights up when Maria sings "I Feel Pretty" in "West Side Story." With brain scans, a lot depends on context. What Dr. Singer and colleagues saw was a reward center lighting up and the empathy circuits dimming. She said the same reward center might also be active in anticipation of chocolate, for instance, and in drug addiction. Still, even if we need to bring in context, there is a great big world of emotions and mental activity out there to be scanned. There's amusement, bemusement and disillusionment. One could be dazed, or confused, or dazed and confused. Would those be different? Not to mention the blues. There are the morning blues, the poor man's blues, the white boy blues, the Chicken Cordon Blues and the "blues you get from trying to keep your Uncle Bill from dying and he afterward forgets you in his will." Are they all the same? These questions may not be answered in my lifetime, but I hope for the resolution of one question that has always plagued me, the difference between ennui and boredom. Suppose one performed brain scans of adolescents refusing to do their homework, prisoners serving life sentences and graduate students suffering from ennui. Based on the self-assessments of adolescents I know, I predict that the prisoners and the adolescents will show similar brain activity - anger toward the warden turned inward. I don't know where that happens in the brain, but I'm betting the graduate students are just going through periods of involuntary celibacy and trying not to be obvious about their desperation. A New Diagnostic Guide With a Touch of Personality Benedict Carey , New York Times- 1/24/2006 The encyclopedia of mental disorders known as the Diagnostic and Statistical Manual is built on a principle that many therapists find simplistic: that people's symptoms are the most reliable way to classify their mental troubles. The manual, often called the D.S.M., does not speculate about internal thoughts or unconscious assumptions, which researchers say are all but impossible to scientifically standardize. The result, many psychotherapists believe, is a document that is comprehensive but shallow, ultimately too superficial to capture the complexity of human motivation, the depth of emotional pain. Students, clinicians and especially patients yearn for some discussion of these dimensions, they say, some guide to understanding the human stories behind the checklists of symptoms for everything from depression to agoraphobia. Now, in an effort to provide more of this context, a coalition of organizations representing psychoanalytically oriented therapists has produced a diagnostic manual of its own. Unlike most psychiatrists, psychoanalysts focus their efforts on understanding the meaning and the psychological roots of mental suffering, rather than on diagnosing mental disorders and treating them with drugs or less intensive methods of talk therapy. The new guidebook, unveiled Saturday at the annual meeting of the American Psychoanalytic Association, is modeled on the standard diagnostic manual in its format and its title, the Psychodynamic Diagnostic Manual. But it emphasizes the importance of individual personality patterns, like masochistic, dependent or depressive types, which are found in many people but which qualify as full-blown disorders only at the extremes. The manual incorporates several new elements, like case histories and brief psychic X-rays into what many people who suffer from mental disorders are feeling. Four other groups, including the International Psychoanalytic Association and the American Psychological Association, collaborated on the manual. A working draft of it was provided to The New York Times. "It is meant to be a complementary" to the psychiatric association's manual, said Dr. Stanley Greenspan, a professor of psychiatry and pediatrics at George Washington University medical school in Washington, who proposed the new guide and coordinated the writing. "We wanted to say to therapists: find out and discover the nature of the internal experience before you pigeonhole a person based on symptoms only," Dr. Greenspan said. Once the personality patterns are understood, he added, "you would see if the person was interested in exploring broader goals for himself, looking at these patterns through therapy." The D.S.M., he said, offers little that is relevant to guide such therapy. Few expect the new manual to have much effect on the psychiatric association's diagnostic franchise. The 1980 version of the D.S.M. laid a scientific foundation for the field, which had previously based treatment decisions on Freudian theory and the experience of individual therapists. Standardized diagnoses gave researchers a basis for testing many drug treatments and short-term talk therapies popular today. Dr. Robert Spitzer, a professor of psychiatry at Columbia and the principal architect of the 1980 D.S.M., said that the new manual was impressive but that the authors "now have to demonstrate that it's reliable and feasible to use clinically." "That's not going to be easy; it's very complex," Dr. Spitzer said. The new guidebook, some experts said, is partly intended to reassert the value of psychoanalytic thinking before it is lost for good. "Psychoanalysts have recognized that they are getting more and more outside the mainstream," said Dr. Drew Westen, a professor of psychiatry and psychology at Emory University in Atlanta. "And this project is an attempt to say, Wait, there is something that this tradition really has to offer." The most striking proposal in the new manual is its insistence that personality be evaluated first, and symptoms considered secondary. The first section of the book describes 14 different personality patterns. It also restores others that were dropped from recent editions of the D.S.M., like sadistic, masochistic and passive-aggressive personality patterns. "The D.S.M. is a taxonomy of diseases or disorders of function. Ours is a taxonomy of people," the new manual declares. Drawing on personality research, the new guidebook identifies two types of depression. In one, people begin to feel exceedingly weak and helpless, say, after a breakup, to the extent that they wish "to be soothed, helped, fed and protected." These types of people have difficulty expressing anger for fear of losing any relationship, especially the connection with the therapist. Their despair reflects in part a deep fear of abandonment. The other type of depression develops in people who are far more focused on themselves than on others, and become severely self-critical. They feel that they have failed to meet expectations and that they do not deserve the love or approval of others, and they lose faith in their ability to make good decisions. Fantasies of humiliation are common. The intensity of their thoughts "may be disturbing by itself," the manual reads. Distinguishing these underlying patterns may be at least as important in planning treatment as describing symptoms, if not more so, psychoanalysts say. Either type of person may benefit from an antidepressant, but to effect more fundamental and lasting change, both types may have to address the source of their habitual self-punishment or neediness, whether that means exploring early family experience, everyday conscious assumptions or some combination of the two through psychotherapy. "Many therapists out there already are familiar with these ideas, whether they use family system approaches, or short-term cognitive therapies, but we wanted to provide some guide to the process," said Dr. Nancy McWilliams, a psychologist at Rutgers University who wrote much of the new manual. For all its references to new research, the psychodynamic manual still relies on many observations by Freud. It traces the source of many anxiety disorders to Freud's "four basic danger situations," described in 1926: the loss of a significant other; the loss of love; the loss of body integrity; and the loss of affirmation by one's own conscience. "I think it's a wonderful idea to broaden the scope of the current diagnostic manual, to give a sense of context, richness, and detail to the understanding of mental disorders," said Dr. Theodore Millon, dean and scientific director of the Institute for Advanced Studies in Personology and Psychopathology in Coral Gables, Fla., who read a summary of the new manual. But, he continued, if the manual is "too doctrinaire, too dependent on a single psychoanalytic viewpoint, that could be a problem; it would be seen as simply too narrow." The new manual also incorporates case histories into the description of personality patterns and symptoms. (The D.S.M. casebook is separate.) Some are composites that do not seem to add much; others describe people who have sought therapy and whose stories have a human pulse. One describes a 40-year-old lawyer whose career plateaued for reasons neither he nor his wife could pinpoint. He was a loyal friend, a devoted husband, a person often sought out for his clear, decisive advice. But he "waits to be discovered as the expert," the manual says, and dithers when making decisions about his own life. A scuba diver, he daydreams about life as an undersea explorer. He fantasizes about "the one who got away," a woman from his past he felt he should have married. Using the standard diagnostic manual, this man would probably receive a diagnosis of moderate depression and most likely get a prescription for an antidepressant to start, said Dr. Greenspan, who is familiar with the case. Using the new diagnostic manual, he is identified as having mildly compulsive, masochistic and self-critical tendencies that predispose him to passivity and feelings of worthlessness. The manual leaves the case there: it is a guide to diagnosis, not treatment. The lawyer himself decided to pursue psychotherapy to address his basic personality patterns, and his mood and relationships began to improve, Dr. Greenspan said. Whether the world's psychotherapists, or the public, will find the new manual helpful remains to be seen. But few experts doubt that there is an appetite for a guidebook that adds to the D.S.M.. "Honestly," Dr. McWilliams said, "most of the people who come in for therapy do so for a kind of sickness of the soul, or for some interpersonal disaster. It's very artificial to chop them up into these symptom syndromes." Edward Wyatt, New York Times- 2/25/2006 Two men who say they attended a Minnesota drug and alcohol rehabilitation center with the author James Frey said in interviews that they believed his overall description of his experience was accurate but added that they could not corroborate many of the specifics in Mr. Frey's book "A Million Little Pieces." The two men, one a state judge in Louisiana who in June was convicted of mail fraud, were offered to The New York Times as witnesses by Mr. Frey's publishers, Doubleday and Anchor Books, imprints of Random House, to back up the accuracy of his descriptions in the book. Their names and telephone numbers were given in response to comments from former employees of Hazelden, the Minnesota rehabilitation center reportedly attended by Mr. Frey, who have said his portrayal of the treatment experience there was false and misleading. Mr. Frey has admitted to embellishing his past, but has maintained that his experiences in drug rehabilitation were real. Alan J. Green, a Louisiana state judge, said he appeared in Mr. Frey's book as Miles, a federal appeals court judge. In a telephone interview Monday, he said he was a roommate of Mr. Frey's at Hazelden's main campus in Center City, Minn.; Mr. Frey himself has not named the treatment center he attended. "Over all, I think he gave a pretty accurate description," Judge Green said of the book. But, he added, "there may have been some differences in how I would have described things." Asked about particular incidents in the book, like scenes of fighting between patients or violent treatment of one patient by another, Judge Green said, "There may have been some pushing and shoving, but as far as knock-down-drag-outs, I don't recall ever witnessing anything like that." Asked about Mr. Frey's medical condition - the author describes arriving with a hole in his cheek and having his nose rebroken and reset at Hazelden - Judge Green said, "If a person needed medical treatment, they would be taken out to a local medical facility." In June, Judge Green was convicted of mail fraud in Federal District Court in New Orleans on charges involving two $5,000 cash payments that he accepted from a local bail bonds company. The conviction resulted from an investigation of racketeering charges in the Jefferson Parish courthouse. Judge Green, who has been suspended from the bench, is scheduled to be sentenced next month and could face up to 20 years in prison. Mr. Frey's publisher also offered the testimony of a man named Richard, who said he was a Houston lawyer and accountant but who would not disclose his last name. He said he was in the same unit at Hazelden as Mr. Frey. In a telephone interview, Richard said Mr. Frey's descriptions were "pretty much" accurate, but he, too, disagreed about whether physical confrontations between patients were as prevalent as Mr. Frey describes. "I saw a lot of edginess, people getting in each other's faces, but I don't remember any knock-down-drag-outs," he said. Asked about Mr. Frey's descriptions of card playing and gambling among patients during group lectures, Richard said: "I don't know about gambling. Not in the lecture hall." In a statement, Mr. Frey said, "It appears that my fellow patients in treatment have essentially corroborated my account, and any differences are incidental." Studies Link Psychosis, Teenage Marijuana Use Carey Goldberg, Boston Globe- 2/26/2006 Researchers are offering new ammunition to worried parents trying to dissuade their teens from smoking marijuana: Evidence is mounting that for some adolescents whose genes put them at added risk, heavy marijuana use could increase the chances of developing severe mental illness -- psychosis or schizophrenia. By Lee Romney, Los Angeles Times- 2/26/2006 ATASCADERO, Calif. — Several hundred employees of the state mental hospital here packed a meeting room Wednesday to decry a crisis in staffing that they say has strained their psyches and imperiled their safety. Many broke down in tears as they shared stories of beatings by patients, nightmares and stressed personal relationships that have followed two years of frequent back-to-back, 16-hour shifts. The meeting was called by a grass-roots group and attended by representatives from the offices of state legislators from the Central Coast. "I take care of … staff who have been assaulted," said Tim Foster, a nurse at Atascadero State Hospital's urgent-care unit, his voice cracking. "I see them firsthand. This has got to stop. We will have an incident of loss of life. We're headed that way. "Sacramento," he said, "Please, please come to your senses and remedy this situation." The meeting comes months after a brutal assault on a diminutive psychiatric technician by two patients here. Atascadero, whose patients are funneled through the criminal justice system, has seen a 66% jump in hitting, kicking and other aggressive acts against staff members in the last two years, according to state statistics. Such assaults at Metropolitan State Hospital, in Norwalk, doubled in the same period. On Wednesday, members of the California Assn. of Psychiatric Technicians picketed at that hospital to demand an end to mandatory overtime shifts that they say leave staff and patients there more vulnerable to assault or injury. "Excessive overtime leads to poor patient care," said one sign. "Exhausted & Overworked — if I wanted to be incarcerated, I would have committed a crime," another said. Metropolitan spokeswoman Cathy Bernarding said the hospital was reviewing the union's grievances and would meet with its representatives Friday. Staff members at other facilities — Napa State Hospital and Patton State Hospital — have raised similar concerns. A new facility at Coalinga has received only 150 patients so far but already is having difficulty recruiting staff, according to employees from Coalinga who attended the Atascadero meeting. California Department of Mental Health spokeswoman Kirsten Macintyre said in a telephone interview that the department's top brass had not been invited to the meeting. She said, however, that they were aware of the problems and searching for legislative and other solutions. Atascadero State Hospital Executive Director Mel Hunter sat quietly through the three-hour meeting, saying afterward that employees' distress would not be ignored. The hospital, which had been more than 100 patients above its licensed capacity of 1,275, dipped below that level this week, Hunter said. He added that he was working closely with Sacramento to attract more employees. Though the issues play out at all the state hospitals, it is Atascadero that has seen the greatest staffing shortage, with a quarter of budgeted positions vacant — even more if one counts staffers taking leave due to work-related injuries. Some of them turned out Wednesday, along with others beaten so badly that they will never return. Stephen Baird-Gann was beaten unconscious and suffered a broken nose, collapsed sinus and some brain damage that rendered him too disabled to return, he said. As his mother sat behind him, other staffers approached Baird-Gann to hug and kiss him. "I can't go back and won't go back," he quietly told the crowd. "For those who have been assaulted and went back, God bless you, but that's not me." The toll on personal lives was clear as employees recounted struggles with addiction, physical illness, exhaustion and marital strife. Family members also spoke up. Among them was Dave Hanson, a burly man whose wife has worked as a psychiatric technician at the hospital for 27 years. Though she long enjoyed her work, he said, he now often wakes her, screaming, from nightmares in which she is being assaulted. She has just over a year until retirement, but Hanson said he doubts that she will make it. "She has migraines now and cries two or three times a week, and I can't do anything about it," he said. "I'm a biker…. I've been one ever since I could throw my leg over a Harley, and I can't help my little wife." Then Hanson too cried. Many employees who spoke noted that the hospital has been forced to accept particularly aggressive criminals. Some workers suggested a moratorium on new patients until more employees could be hired. They also called on legislators to make it a felony for a patient to assault a staff member. Assemblyman Sam Blakeslee (R-San Luis Obispo) plans to introduce such legislation. When his field representative, Ann Hatch, addressed the crowd, some people heckled her, saying that a previous attempt to pass such a law — by state Sen. Abel Maldonado (R-Santa Maria) — had failed. Maldonado said in a telephone interview after the meeting that he doubted such a measure would pass now either. But "I want to sit down with [the department] and Blakeslee and come up with a big-picture solution," he said. "People in any workplace deserve to be safe." Listening with concern at the meeting were Rae Belle Gambs, the San Luis Obispo County president of the National Alliance for the Mentally Ill, and the national organization's California president, Ralph Nelson. Gambs praised Atascadero staff members as "angels" for caring for her son, but decried the lack of community mental health care that could have prevented him from being committed to an institution. Nelson echoed her concerns, adding that he feared rage among staff members could lead some to see all patients as enemies. Judge Rips State on Care for Mentally Ill Children Scott Allen, Boston Globe- 1/27/2006 Massachusetts has illegally forced thousands of mentally ill children ''to endure unnecessary confinement in residential facilities" because the state did not provide adequate care for them at home, a federal judge ruled yesterday, handing a major legal victory to advocates for low-income children who rely on the state-run Medicaid program for their healthcare. Maria Sacchetti and Tracy Jan, Boston Globe- 1/28/2006 ARLINGTON -- The suicide of a popular Arlington High lacrosse player this week and the subsequent arrest of two of his schoolmates on drug charges have sent this community reeling, with school officials promising swift action to crack down on drug use among students. The school has grappled with grieving students and upset parents since Monday, when police say 17-year-old Cameron O'Connor shot himself in the head at his family's home after a gathering with friends Sunday evening. Police say O'Connor and others drank alcohol and took drugs during the gathering. Helping Patients Help Themselves Garret Condon, Hartford Courant- 1/28/2006 Psychologists Stuart W. Alpert and Naomi Lubin-Alpert have taught their approach to psychological treatment to mental-health professionals around the world for 30 years. But for 20 years, the married couple also have taught it to laypeople who want to learn how to help themselves. Many students have returned again and again to the once-a-week class and group discussion at the Hartford Family Institute in West Hartford, which was founded by the Alperts. They say they keep coming back because the Alperts' approach, called body-centered Gestalt psychotherapy, has helped them transform their work lives and their relationships. Rabbi Donna Berman, 49, director of Hartford's Charter Oak Cultural Center, says traditional therapy has helped her from the neck up, but that the approach she is learning in the Human Relations Program at the institute is a whole-body approach. And it's light years away from the traditional patient-therapist dynamic. "You're doing it with a guide," Berman says. "Somebody wise once said to me, `If you're mountain-climbing and you're stuck behind a rock, you really need somebody on the outside who can see the way out.'" It may seem odd that psychologists and other therapists are sharing their trade secrets of personal change and discovery. However, mental-health professionals have been shifting in recent decades from all-powerful healers to co-equal coaches and teachers who help patients - now often called "clients" - help themselves. Once restricted to the couch and the 55-minute session, psychotherapists now teach classes and workshops, expound before TV-studio audiences, write self-help books, create websites and author countless DVDs, CDs and MP3s. In a survey of psychologists published in 2000, 82 percent said they recommend self-help groups to their psychotherapy patients; 85 percent recommend self-help books. Nearly half also "prescribe" movies that they believe will be therapeutically useful for patients. The lead author of the survey, John C. Norcross, professor of psychology at the University of Scranton, says the trend toward behavioral self-help is driven by a number of factors: Self-help can be cheap and is often somewhat effective. Studies have shown that 12-step programs like Alcoholics Anonymous, for example, can work for many people. Privacy is often an issue. Www.myselfhelp.com, a $15-a-month subscription website, offers behavior-change exercises for people with such problems as depression, eating disorders and insomnia. The site is supposed to be used in conjunction with therapy, according to the website's president, psychologist Richard Bedrosian of Northborough, Mass., but many subscribers are on their own and in settings where they feel they need privacy. "We've had people join up for our services from the armed forces over in Iraq and Afghanistan," he says. Norcross says managed care has curbed people's access to behavioral health care specialists, and, moreover, it's very American to want to go it alone. The trend perhaps goes back to Socrates with his trademark question-and-answer coaching program. But the more recent origins of the movement date from the late 19th century, with philosopher-psychologist William James and other colleagues dubbed the "functionalists," who attempted to reshape the then-new science of psychology into a more helpful field, according to Robert Henning, associate professor of psychology at the University of Connecticut. "William James took a very pragmatic view of how to take control over your life," Henning says. James suggested, for example, that troubled individuals should manage their depression by becoming more physically and socially active. This was certainly not the approach of Sigmund Freud, the father of psychotherapy, for whom a patient was just a patient. "He had much more of a treat-people-as-patients type of an approach," Henning says. "And it was mostly up to the psychiatrist to diagnose and help someone recover." More recently, the success of 12-step groups and the emergence of cognitive behavioral therapy as a leading mode of psychotherapy have tipped the balance of power toward the patient. Cognitive behavioral therapy - used especially for depression, anxiety and phobias - emphasizes the identification and rewiring of one's harmful self-images and behavior. Psychologist Jean Cirillo of Massapequa, N.Y., says cognitive behavioral therapy typically involves the use of "homework" for clients between sessions - both because it's very much in the spirit of the therapy, and because insurers typically limit the number of therapy sessions and therapists seek to maximize the impact of short-term therapy. "Usually, it involves having the patient run some play out there between sessions, if only to bring material to the next session," Cirillo says. For example, she says, if she has a patient who is afraid of making a fool of himself, she might ask him to walk a banana on a string in public. Cirillo, a 20-year veteran of psychotherapy, has seen the shift from therapist-goddess to therapist-facilitator more clearly than most. She has done hundreds of television and radio talk shows, was the staff psychologist for the "The Jenny Jones Show" show and has done psychological screening of participants on a number of reality TV shows, including "Flavor of Love" and "Making the Band." When she and her colleagues appear on TV, she says, they are "helping the masses who might not have access to a therapist" - or who might not go even if they do have access. The University of Scranton's Norcross estimates that three-quarters of Americans with mental-health or substance-abuse problems do not receive professional help. But rugged individualism has its limits. "As optimistic as I am about self-help, it's a double-edged sword," Norcross says. "It assumes that people can reliably diagnose their problem. For many people it's an open question, and for many others it flatly cannot be done." But for those who can - or want to give it a try - the field of behavioral self-help can lead beyond a quick fix. Lisa Campo, a 49-year-old real estate agent from West Hartford, credits the Human Relations Program, which she began seven years ago, with helping her find more "texture" in her life and work. "I've come to love my career, to look at it from a different perspective," Campo says. "There is much more depth and contour to it." Making Marriage (Like) Work Craig Stoltz, Washington Post- 1/28/2006 Scott Haltzman, a psychiatrist and Brown University professor, has been studying marriages both in his clinical work and via his Web site, http://www.secretsofmarriedmen.com/. His new book, "The Secrets of Happily Married Men" (Jossey-Bass, 2006), collects what he says are the guy behaviors that lead to happy marriage. As his Web site says, he's "out to save marriages, one husband at a time." Haltzman believes conventional marital therapy often tries to make men more like women -- you know, getting in touch with their feelings, talking about their feelings, feeling their wives' feelings, etc. But this approach is doomed to failure, he says, largely because men and women are equipped with such different hardware from the neck up. While accounting for the inevitable exceptions (and the hazards of stereotyping), Haltzman says that due to differences in brain structure and chemistry, men are inclined to cull the savannah for food; women maintain the cave. Women communicate; men fix. Women remember events and emotions; men remember the dimensions of the deck. Men are from cerebral cortex, women are from amygdala, so to speak. So, if a guy doesn't have the right tools to cope with conventional marriage counseling -- yet wants a good marriage -- what can he do? Use the male habits and male skills that serve him well at work, at play, in competition, in the field and in other venues where he thrives. View marriage as your most important task, Haltzman urges men, and pursue success as you would anything else that matters. The assumption is it's a lot more pleasant, and the payoffs far greater, to live with a woman who is satisfied, secure and feeling loved compared to one who is none of the above. Make this your job, he says. This sounds good. But Haltzman's honey-do list is awfully long, starting with a happy-marriage job description that makes a 40-hour work week look like a hobby by comparison. He also encourages guys to take advantage of their logical, accomplishment-oriented inclinations and collect data, make observations and create to-do lists. Which is enough to make any man, upon reading the "secrets" ponder: Okay, fine, it's a lot of work but it's (probably) worth it. But first, let's have a look at the book that tells women the eight things they need to do (to adopt Haltzman's language) to "win your husband's heart forever." Anyway, following are the eight guy "secrets" Haltzman shares. 1. Make Marriage Your Job. Premise: Guys have skills and habits developed at work that can be successfully applied to marriage. Details: If men are to accept marriage as a job, they need a job description. Here's Haltzman's: Love, honor and respect her; be sexually and emotionally faithful; listen without being judgmental; support her ambitions; try to understand how she is different emotionally; be honest at all times and keep promises; share in child care and domestic work; be as attentive, fun-loving and adoring as you were during courtship; and be affectionate. This is no part-time gig. 2. Know Your Wife. Premise: You think you know your wife, but you haven't really been paying attention. Do your research. Details: Citing the old therapists' joke (there are two times men don't understand women: (1) before marriage and (2) after marriage), Haltzman urges guys to do what guys do: Collect data. Observe her in mundane situations where she reveals herself: at the sidelines at a kid's game; when she's with her best friend; at a restaurant or coffee shop; and before, during and after sex. Here is where you will discover who she really is, not who she says she is. For detail and accuracy, Haltzman recommends creating a "Daily Observation Chart" (!) to record her activities. He appears to be serious about this. 3. Be Home Now. Premise: Guys evolved as prowlers and hunters, not home-tenders. But to make a marriage work, you've got to spend a lot of time around the cave. Details: "To . . . build a lasting marriage, you have to be there, in person, day by day, Mr. Regular, at home, in the building -- and that's that." And why don't more guys do this? Haltzman says men need to be honest about why they often leave the cave, returning only to feed, sleep and lie with their mate: to avoid conflict, loss of control, domestic responsibilities, intimacy or . . . having to grow up. But if men are sufficiently present at home -- and attentive while present -- the payoff is "direct and bountiful . . . love, friendship, support, emotional nourishment, peace of mind, fun, intimacy and sexual satisfaction." 4. Expect Conflict; Deal With It. Premise: Fights are inevitable, but you can control them. Details: "You can . . . stop the mounting tensions in their tracks," Haltzman says, not by doing what guys are inclined to do (dig in and fight to the death) but by using various higher cerebral strategies. For instance, take advantage of a woman's natural inclination to nurture by softening your tone. And stymie escalation by not letting emotion drive something you say or do. 5. Learn to Listen. Premise: Listening does not come naturally to male humans, who are more inclined to act. But it can be learned, to great benefit. Details: Stand still while she talks. Turn off the TV. Look directly at her. Use verbal nods to show that you're listening. If it's important, seek clarification. If not, just let her talk. 6. Aim to Please. Premise: "In the workplace . . . men are masters of relationship-building." So: Bring this skill home. Details: Treat your wife at least as well as you would a valuable client, co-worker or employee: Greet her warmly, ask how she is, see what she needs and how you can help. Do thoughtful favors, anticipate desires and entertain and offer gifts as appropriate. 7. Understand the Truth About Sex. Premise: Men. Women. They're different! Details: In response to the old women-want-slow-intimacy/men-want-to-get-down-to-business conflict, Haltzman planks out a by-the-numbers program consisting of five "gears" that men need to move through, sort of like a sporty transmission. First gear is holding hands, kissing, etc. Second gear gets more emotional and private. Third is playful. Fourth is getting awfully close, and fifth is where guys usually wanted to be from the beginning. Attend to the earlier stages, the author says, and the fifth is more likely -- and better. 8. Introduce yourself. Premise: Enough about her. Time to let her know "this is who I am, this is what I need." Details: Take inventory of who you are, Haltzman says, which is something that can get lost in the shuffle of a busy married life. Then, assuming you've mastered the seven "secrets" above, your efforts to meet your own needs -- doing stuff together that you like, hanging with the guys, taking occasional solo sorties, playing sports, cultivating personal interests and hobbies -- won't be greeted as if they are threats or acts of abandonment. Well, those are the Big Eight, the things that Haltzman says characterize husbandly behavior in good marriages. The key question is, have any men read this far? And if you're a woman wondering how you can get your husband to read this . . . well, that tells us plenty, doesn't it? |