| Noteworthy News Articles on Mental Health Topics, January
29-31, 2006 Virginia Man Pleads Guilty in Online Pornography Case Kurt Eichenwald, New York Times- 1/29/2006 The man, Gregory J. Mitchel, 38, was an administrator of several illegal Web sites and admitted in his plea to producing and distributing child pornography through the Internet. In that role, the Justice Department said, Mr. Mitchel filmed boys engaging in sex acts and received money from Web site subscribers who paid monthly fees for viewing live and recorded videos. Mr. Mitchel was arrested after being implicated by Justin Berry, a 19-year-old who was featured in a December article in The New York Times about teenagers who operate for-pay pornography sites that show images of themselves transmitted by Webcams. Mr. Mitchel has since begun naming other adult men who were actively involved in the sexual exploitation of children, court records show. Mr. Berry, who beginning at 13 was enticed by adults he met online into performing sex acts in front of his Webcam, operated pornography sites featuring his own image for five years. In discussions with a Times reporter in July, Mr. Berry agreed to abandon his business and tell law enforcement about adult men who he knew were sexually exploiting and abusing children. Mr. Berry was granted immunity and is now a federal witness. In interviews with The Times and the government, Mr. Berry said Mr. Mitchel had molested him over several years and had begun sexually exploiting as many as six other children. At the time of his arrest, Mr. Mitchel was days away from escorting an under-age boy to a Las Vegas hotel, according to records of his online conversations. Law enforcement officials said they had recovered more than 600 pornographic images of children on Mr. Mitchel's computers, which were seized at the time of his arrest in September. Through evidence provided to the government, Mr. Berry has identified as many as 1,500 adult men who gave him money and gifts over several years for his sexual performances on camera. Mr. Mitchel was among a number of adults identified by Mr. Berry as having assisted minors in the establishment, operation and marketing of illegal Webcam pornography sites. In a hearing on Friday in Federal District Court in Roanoke, Va., Mr. Mitchel pleaded guilty to four felonies involving the production, sale, distribution and possession of child pornography. As part of a plea agreement, two related charges involving the receipt and advertising of child pornography were dropped. Because of a previous conviction on a child pornography charge, Mr. Mitchel faces a minimum sentence of 25 years in prison. Mr. Mitchel first encountered Mr. Berry as a member of one of the teenager's pornographic Web sites and began communicating with him through online instant messaging. Soon after, Mr. Mitchel traveled to Mexico to meet Mr. Berry, then 16, and molested him, officials said. More than a year later, Mr. Berry tried to abandon his illegal business, but Mr. Mitchel had preserved many of the teenagers' pornographic videos and images, posting them on new sites he established. For months, Mr. Mitchel encouraged Mr. Berry to return to the pornography business and posted periodic updates about his efforts on a Yahoo message board he set up for the teenager's fans. Early last year, Mr. Berry, who by then was abusing both cocaine and marijuana, agreed to become business partners with Mr. Mitchel on a new site called justinsfriends.com that the older man had registered. The site, which charged members $29.95 a month for password-protected access, went fully active in early June. Over the weeks that followed, numerous pornographic videos of Mr. Berry and other young men and boys were posted on it. But less than a month after the site went up, Mr. Berry left the business and reported Mr. Mitchel to the authorities. Two Decembers: Loss and Redemption Anne Marie Feld, New York Times- 1/29/2006 On the afternoon my mother died, she left work early. Her day as a computer programmer at Chase Manhattan Bank had skidded to an abrupt stop courtesy of a systemwide computer failure, and all employees got the afternoon off. It was late December. My 16th birthday. Gray, snowless, cold enough to make the lawn crunch underfoot, but close enough to Christmas to make a few uncrowded hours seem like a gift. Or in my mother's case, a curse. Rather than enjoying some last-minute shopping or hitting the couch, she methodically cleared her desk, drove the Honda home, fired up a pot of Turkish coffee and hanged herself in our garage. Twenty years later my father insists that she wouldn't have died that day if the systems hadn't gone down. He might be right. Work gave my mother a structure that sealed the madness inside, if only for small chunks of time. Idleness brought trouble. My memories of my mother all have her working at something: cooking, staying up all night scraping wallpaper, poring over fat textbooks to get her master's degree. In home movies my sister and I, long-limbed and small-bodied, dance and do gymnastics in the foreground while my mother lurks in the background, washing dishes or zooming diagonally through the frame on her way somewhere else. Though my mother worked full time, my sister and I never lifted a finger in that house. It was spotless, without the piles of clutter and tides of dust that mark my own house. My mother's madness seeped in so quietly that my father, an optimist to the end, was able to ignore it, believing that it would get better on its own. In our house questions about what we did and how we felt went unasked. Or if asked, unanswered. My sister and I ate alone in our bedrooms beside flickering black-and-white televisions. I wasn't told about my mother's two earlier attempts at suicide and would never have guessed. In my mind suicidal people raved and ranted. Madwomen were locked into attics, where they would moan and rattle chains. Occasionally they set fire to country estates. They certainly weren't grocery shopping or dropping the kids off at the community pool on their way to the office. From fielding calls on the yellow rotary-dial phone in the kitchen, I knew that my mother saw a therapist, a woman named Barbara, whom she tried to pawn off as a friend. I knew better. My mother didn't have friends. When I was 14, my mother started sleeping on the living room floor and wearing a dark gray ski hat with three white stripes. She seemed to drink nothing but gritty coffee and red wine poured from gallon bottles stored under the kitchen sink. She would send me into the pizzeria to pick up our pie, convinced that the men spinning crusts were talking about her behind her back. As I limped along in my teenage bubble, very little of this registered as alarming. This was how all families were. As my mother's madness amplified, she came to believe that our house was bugged and that her boss was trying to hurt her. But as long as there was a computer program to write or a carpet to vacuum, she could be counted on to do it and do it well. In her insistence upon getting things done, on living an ordered life, my mother managed to miss out on the nourishing aspects of family life and life in general: laughing at silly things, lying spooned on the couch with your beloveds, sharing good food, the tactile delight of giggling children crawling all over you. Without this, family life is an endless series of menial tasks: counters and noses to wipe, dishes and bodies to wash, whites and colors to fold, again and again in soul-sucking succession. On the morning of the day my mother died, I headed toward the door to catch the 7:10 bus to school. My mother and 12-year-old sister were just waking up in their sleeping spot on the gray carpet in the living room. They sang "Happy Birthday" to me, my mother's beautiful, low singing voice frosted with my sister's tinny soprano. Eight hours later I stepped off the Bluebird bus, looking forward to an afternoon of "One Life to Live" and "All My Children" and was disappointed to see my mother's car in the driveway. I dropped my knapsack on the window seat, stroked the dog's dusty ears and called, "Mommy?" Her purse sat on the table. I checked all the rooms but found them empty. Then I opened the door to the garage and stopped breathing. I shut the door, ran up the stairs and outside, and sat on the cold concrete stoop, looking up the street. House after split-level house stretched along the curved road with one thing in common: no one was home. All of the parents in my neighborhood worked, and since I had taken the early bus home from school, the kids were still gone as well. I sat hunched over my legs, arms circling my shins, as my heart slowed. Finally I stood up, slowly opened the screen door, went back into the house and dialed 911. In the days that followed, my father, sister and I sloshed through a sea of awkwardness. The wife of a friend of my father's bought me a dress to wear to the funeral, a maroon velvet Gunny Sax monstrosity with puffed sleeves and lace trim. Regular funerals are hard enough; the funeral of a suicide tests even the most socially skilled. When all the robotic "Thank you for comings" had been finished, my sister tried to open the coffin when no one was looking. My father stopped her just as she was about to lift the lid. "I just wanted to see her," she explained, almost inaudibly. Other details needed handling, providing my first, metallic taste of the kind of chores that come with adulthood. For the first time in my life, a formal party had been planned for my birthday at a local catering hall. The party favors — clear Lucite boxes filled with Hershey's Kisses, decorated with pink and silver hearts — sat in bags in the garage, waiting. But there would be no party. I picked up the phone and said, over and over, "I'm sorry, my Sweet 16 is canceled." By the time I was done, cold sweat ran down my wrist, wetting my sleeve. I didn't cry. On the day the party was to be held, I stood in Loehmann's with my father. My mother's dress for the occasion, a gray wool sheath with long sleeves, lay on the counter. The clerk told my father that the garment couldn't be returned. My father looked at the clerk and said very quietly, "But she died." They took the dress back. And as soon as I could, I fled. First to college, then to a place as far from Long Island as I could manage: San Francisco. Every night I would shimmy into a short black dress, tights and platform boots and belly up to small scarred stages, staring at would-be Kurt Cobains, or boys in porkpie hats whaling Louis Armstrong covers, or nodding my head to the beat as shaved-bald D.J.'s spun in corners of warehouses while hundreds of people raved, shaking water bottles over their heads until the sun shot weak rays through dirty skylights. My rent was $365. I had some savings; work seemed optional, as did stability. Over the next decade I would have 10 apartments, 13 jobs and at least as many boyfriends. I met Dave at a film festival, while waiting in line to see a movie called "Better Than Sex." We started seeing movies together, always picking films with "Sex" in the title. Months after we had run out of movies about fornication with no signs of doing so ourselves, he finally kissed me under a lamppost outside his front door. I was wearing knee-high black leather boots. He was wearing sheepskin slippers. He phoned every day. He listened. He smiled a lot. He told me I was beautiful. He made up rap songs about our love. He wanted to talk about everything, from politics to my period. He wanted children. He was, as my best friend's father said, "a good citizen." We found a house together, a 1920's cottage on a street of Spanish Mediterranean houses in every color of the rainbow. We split the down-payment 50-50 and started packing. Driving alone through a torrential downpour to sign the title for our house, I lost it. I didn't do stable. I convinced myself that Dave was a con man planning an elaborate sting to separate me from my down payment. The year we had spent together was the setup for the graft. Now I was going to be out $25,000 and a boyfriend. It was a hop, skip and a jump from there to standing at the side of the road, homeless and utterly alone, the victim of aiming too high. My hands were shaking when I pulled up outside the title company. Dave was standing there, holding an umbrella, waiting to walk me the 10 feet from the curb to the building. Eight months later, just back from our honeymoon, he carried me up our wonky front steps and across the threshold before collapsing from exertion on the blue sofa in our office. Another eight months after that, a plastic stick with a pink line told us that our remodeling plans were going to have to wait. On my first visit the ob-gyn calculated the baby's due date: my birthday. I was terrified that my day of personal infamy would be shared by the next generation of my family. Friends spun it beautifully: "It'll be healing. It'll give you back that day." The contractions didn't hit hard until Christmas night, four days after I turned 36. Fifty-six hours after the first tremors hit my abdomen, three hours after the epidural wore off, I pushed my daughter into the world. I wasn't thinking about my mother. Or about my sister, who stayed at the head of the bed, cheering me on when I thought my body would rip in two. Or about Dave, who watched tearfully as Pascale poured out. I thought nothing, and just lay there, shocked by pain and exhaustion. But when they finally returned her raw, chickenlike body to me after bathing her, my first thought was that she looked like my mother. Exploring Mental Illness and Battling Her Own Barron Lerner, New York Times- 1/31/2006 Lucy Freeman, who died at the end of 2004, thought that there was nothing wrong with being crazy. As a reporter for The New York Times in the 1940's and 50's she worked to remove the stigma of mental illness, even writing a revealing book that chronicled her own psychoanalysis. Ms. Freeman's efforts recall a heady time in the history of psychiatry, when two competing groups, the followers of Sigmund Freud and those who favored physical manipulation of the brain, each believed it had found a "cure" for mental illness. We know more today, but all the answers are not in. Ms. Freeman was born in 1916, the daughter of Lawrence Greenbaum, a prominent New York lawyer, and his wife, Sylvia. In 1940, after graduating from Bennington College, she became one of the few women on the reporting staff of The Times. Seven years later, she married William Freeman, an editor. But Ms. Freeman had a troubled personal life. As she said in her 1951 book "Fight Against Fears," she was angry, unhappy and unable to sleep. She also had a series of ailments, including sinus headaches. That Ms. Freeman turned to a psychoanalyst was not surprising. The teachings of Freud, who believed that emotional problems in adulthood resulted from unresolved childhood conflicts, were at the height of popularity then, and his solution was psychoanalysis — spending years revisiting one's life history with a trained therapist. Still, Ms. Freeman's family and friends were displeased with her decision to go into analysis, responding, she said, with "skepticism, jeers and outright disapproval." One acquaintance told her, "You're crazy if you go to a psychiatrist." This type of response stemmed from the prevailing beliefs of the era, which viewed mental illness scornfully and its victims as deviants. Compounding this stereotype was the reliance on imposing state hospitals, like the one depicted in the 1948 Hollywood film "The Snake Pit," to house people with severe schizophrenia or depression. In truth, many psychiatrists were trying to convert such institutions from overcrowded, custodial facilities to state-of-the-art medical centers. Believing that mental illness stemmed from organic problems within the brain, psychiatrists had devised a series of treatments, including electroshock therapy and lobotomy. It was these advances that Ms. Freeman relentlessly publicized as The Times's reporter on mental health. Writing scores of articles like "Action Now Urged on Mental Cases" and "State Mental Care Entering New Era," she willingly blurred the roles of reporter and advocate. But Ms. Freeman's heart lay in promoting psychoanalysis, which she believed had greatly improved her own condition, most likely a severe form of neurosis. By helping her confront her childhood conflicts, which included hating her mother, having sexual feelings for her father and envying her siblings, her analyst, she said, had cured her headaches and eased her psychological pain. Psychoanalysis, she wrote, "is part of today's struggle for survival." Ms. Freeman and her analyst saw unexplored childhood and adult fears as the cause of mental illness — even of psychotic conditions like schizophrenia. As she wrote, fear had "incited the anger, the hatred, the guilt" and thus "split me into pieces." Not surprisingly, perhaps, this emphasis on fear had great currency during the cold war, leading former mental patients to start "Fight Against Fear" clubs across the nation. From our modern perspective, viewing fear as the cause of most mental illnesses seems quite outdated. Even Freud had intended that only neurotics, as opposed to people with more severe diseases, explore their childhood conflicts. Moreover, recent studies have demonstrated that disorders like schizophrenia have a genetic basis and result from chemical abnormalities in the brain. While lobotomy has been abandoned, electroshock therapy is still used to treat depression. And over the last 50 years, scientists have developed numerous effective medications to treat psychosis and other symptoms of mental illness. Meanwhile, the grand claims made by Ms. Freeman and others for psychoanalysis have been challenged. Researchers argue that the effectiveness of psychoanalysis, like other medical interventions, needs further validation through studies. Lucy Freeman wanted to hear none of this. According to her niece, Dale Schroedel, she remained "absolutely devoted and committed to Freud even when he became archaic." Many therapists still agree with Ms. Freeman. Analysis, and its less intensive cousin, psychotherapy, remain a cornerstone of psychiatric practice. Ms. Freeman eventually wrote 78 books, many of them addressing the connection of emotions and health. In so doing, she further fought the stigma that plagued her and others suffering from mental illness. "By saving them," she wrote, "in some way I also saved myself." After Polite Sessions, Letters Filled With Anti-Semitism Ronald Pies, New York Times- 1/31/2006 Each day, I would dread checking my office mailbox, wondering if another of the overstuffed envelopes with their huge scrawled addresses would turn up. After a few months, my patient had learned that all he needed on the envelope was my last name and our mental health clinic's nine-digit ZIP code. The post office unfailingly delivered his missives. Some days, six or seven letters would arrive at once. Then there would be weeks when I heard nothing at all from him, leaving me to wonder if he was dead or perhaps plotting my death. It was hardly funny at the time, but my patient gave new meaning to the phrase "insane bigotry." There was no question that that he suffered from chronic paranoid schizophrenia. He had been seen at our clinic for many years before I was on the staff, and his pathology was voluminously documented. But it seemed that I was the first Jewish psychiatrist to treat him — and this had fueled a psychotic fire that seemed truly infernal. To look at the man, you might think he had wandered over from some university lecture hall, or perhaps a monastery. Tall, slender, and impressively austere, he reminded me of the actor Max von Sydow, though his face was framed by a huge pair of black horn-rimmed glasses. Trained by the Jesuits, my patient had wound up as a teaching assistant at a small Eastern college. Though recognized for his brilliance in theology, he was also seen as quite mad. In addition to claiming that the dean was out to poison him, he had threatened his department head and several students. To his everlasting fury and bitterness, he had been asked to leave the university or face incarceration. I never learned the origin of my patient's virulent anti-Semitism — some of my colleagues have argued that such bigotry is itself a kind of mental illness — but it was expressed in nearly every letter I received. "Jews don't live long" or "The Jews must pay for killing our Lord" were typical themes. But my patient was far too clever to make any direct threats against me. He knew that if he did so, we would have grounds to petition the court for an involuntary commitment. No, his threats were allusive, oblique and sometimes baroquely ingenious, along the lines of "Sic transit piesius Monday." Thus Pies will die on Monday? Who knew? With each such veiled threat, our clinical staff met to assess the actual danger. We never had enough evidence to fill out a so-called pink paper for involuntary hospitalization. My patient understood this well, and usually presented himself wearing a compressed cat-who-ate-the canary grin. And yet, in our sessions, the man was a model of refined politesse. Our dialogues went something like this: "So tell me, Doctor," he would say, removing his glasses for emphasis, "What do you think of St. Anselm's argument proving the existence of God? Don't you think it is transparently circular?" Because my patient had refused virtually all my medical instructions and recommendations — including my repeated pleas that he take adequate doses of an antipsychotic medication — I decided I would engage him on the level he seemed to desire. And since theology has been a longstanding interest of mine, this was not entirely unpleasant. "Well," I would reply, "as far as Anselm goes, it does seem circular to begin by assuming the existence of the very being whose existence is in doubt." "Ah!" my patient would exclaim, extending his glasses toward me. "Just so, Doctor, just so!" The rock-hard facade of his psychosis never opened to reveal any inkling of pain, loneliness or despair, yet I suspected that these currents ran deep in him. Once, when he complained that he missed his old books on theology, I offered to lend him some of mine. He stared at me for a moment with a mixture of astonishment and rage — how dare I bestow an act of kindness upon him! — and then said simply, "That would be acceptable, Doctor." Over the course of a year, I developed a peculiar fondness for this brilliant and tortured man. I never replied to any of his threatening letters, and he, in turn, never lifted a finger against me. (It is, after all, a myth that psychiatric patients are a dangerous and violent lot.) When his letters were reasonable, and even gracious, I would respond in kind. He got no better, but he grew no worse. Finally, I had to inform my patient that I was leaving the center for another position. He grew very still during this last session, as if drawing a cloak around his vulnerability. On his way out the door, he extended his hand to me for the last time — a cold and frail bit of bone — and said, "I do have a very serious illness, don't I, Doctor?"
A Neglected Subject Pursued Exposure Is Widespread Growing Up Faster
Colin Poitras, Hartford Courant- 1/31/2006 MIDDLETOWN -- Five male patients at a state-run psychiatric hospital for children face rioting charges after they ripped out a phone line and tried to steal a worker's car keys before barricading themselves in a room over the weekend, a state official and other sources said Monday. The incident at Riverview Hospital For Children and Youth occurred less than a week after employees protested over conditions in the facility, contending that the hospital is increasingly unsafe because of the volatile mix of patients. "We continue to be concerned about the issues that the staff are raising and we're going to continue to meet with them and work to make Riverview Hospital the best hospital it can be," said Gary Kleeblatt, a spokesman for the state Department of Children and Families, which runs the 98-bed facility off Silver Street. Sunday's riot marks the third serious incident of unrest at a DCF-run or -licensed facility in eight weeks. On Dec. 2, a teenage girl was injured and nine others arrested in a melee at the Touchstone residential treatment center in Litchfield. On Jan. 3, a dozen youths were arrested after a riot at the Mount Saint John school for boys in Deep River. Police seized a steak knife, a screwdriver and makeshift brass knuckles. No weapons were used in Sunday's incident at Riverview, state officials said. Riverview is Connecticut's only state-run psychiatric hospital for children ages 5 to 17 who have serious psychiatric illnesses such as schizophrenia, severe depression and bipolar disorder. Hospital staff members say the facility is accepting increasingly volatile youths, including some sent from the juvenile courts for assessments. Some of the youths are juvenile delinquents who have explosive conduct disorder and whose violent behavior disrupts the care of other patients, staff at the hospital say. Sources said that between 11 p.m. and midnight Sunday, a group of boys in the hospital's 11-bed Lakota Unit came out of their rooms and started confronting and arguing with staff. A male clinician and two female employees were assigned to the unit at the time. Sources said the boys surrounded the man and tried to get him to turn over his keys but he refused. When one of the female workers tried to use the phone to call for help, the boys pulled the phone line out of the wall, sources said. The youths then barricaded themselves in a room and tried to smash a large exterior window, which broke off its hinge. One of the boys was cut when the window broke. The wound was not serious and was treated by a hospital nurse. Sources said the boys intended to escape through the window but were stopped by a Connecticut Valley Hospital police officer who was called to the scene and was outside near the window. Authorities would not release the names or ages of the boys involved. All face charges of inciting to riot, disorderly conduct, criminal mischief, unlawful restraint and threatening, Kleeblatt said. Several of the boys were moved to other units after the incident. Three On A Couch Anthony Lane, New Yorker- 1/9/2006 The unearthing of the Sabina Spielrein story, since the relevant papers were discovered in 1977, has become a minor industry. Spielrein came from a Russian Jewish family of respectable means and bad nerves--ideal ground for the new discipline of psychoanalysis. As a teenager, in 1904, she entered a Zurich asylum, in the care of Jung, and fell in love with him. Both parties appealed to Sigmund Freud, no less, for help in the resolution of their plight. Elisabeth Marton, in her unruffled documentary, "My Name Was Sabina Spielrein," uses reconstructions (in mild doses, considering the force of the material), though the still photographs bear more telling witness. Spielrein herself, growing from patient into practitioner, pioneered the psychoanalytic study of children; she married unhappily and later returned to Russia, where she and her daughters were murdered by German troops in 1942. Her life was far from wasted, but the withering of her happiness turns Marton's movie into the saddest of testimonials. Low Insulin Levels Might Be Linked to Alzheimer's, Schizophrenia Scott Allen, Boston Globe- 1/30/2006 A small but growing chorus of scientists is becoming convinced that insulin is just as important to the brain as it is to the body. The body needs insulin to convert sugar in the bloodstream to energy. People whose bodies either don't make enough insulin or don't process it correctly develop Type 1 or Type 2 diabetes, which can lead to poor circulation, kidney failure, blindness, and death. The role of insulin in the brain is less clear, but this much is certain: When brain cells are deprived of insulin, they die. Now researchers are discovering that a breakdown in insulin-processing in the brain plays a role in mental illnesses. Perhaps even a driving role. Dr. Suzanne de la Monte, a neuropathologist at Rhode Island Hospital in Providence, believes that Alzheimer's disease could be called ''Type 3 diabetes." And C. Anthony Altar, president of Maryland-based Psychiatric Genomics, refers to schizophrenia as ''diabetes of the brain." Though researchers are still answering basic questions about insulin's role in mental illness, the potential impact of their work is dramatic. Until now, research on the ravages of Alzheimer's has centered mainly on the amyloid plaques that build up in the brain as the disease progresses, while scientists have focused on a breakdown in brain cell communication to explain schizophrenia, in which victims often become delusional and erratic as brain tissue dies. If the insulin researchers are right, those problems could be secondary to a more fundamental breakdown in the way brain cells process insulin to generate energy and protect themselves against death. Whether an insulin shortage ''causes the disease, contributes to the disease, or it's the brain's response to injury we don't know yet," said Dr. Jesse Roth, geriatrician-in-chief of the North Shore Long Island Jewish Health System, who has studied insulin's role in the brain since the 1980s. Doctors who treat Type 2 diabetes are already concerned about whether their patients are at greater risk of developing diseases of the brain later in life. Studies have shown that diabetic patients are at greater risk of Alzheimer's, but researchers have assumed that diabetes is just one of several risk factors. Likewise, people with schizophrenia are at least twice as likely to develop Type 2 diabetes, but until now, scientists have attributed that to the unhealthy lifestyle of schizophrenics as well as the medications they take. ''We need to do the basic science, because we need to be sure," said Dr. C. Ronald Kahn, president of the Joslin Diabetes Center, who is concerned that the current Type 2 diabetes epidemic could foreshadow an explosion of mental illness. Kahn's research also suggests that insulin problems in the brain, in turn, may make people more vulnerable to Type 2 diabetes. Lab mice genetically modified to block insulin processing in the brain became obese and showed signs of diabetic insulin resistance. ''If this is correct, the public health implications are huge," he said. Ironically, some doctors had latched onto insulin as a possible treatment for mental illness in the mid-20th century, when ''insulin shock therapy" became popular as a last-ditch treatment for schizophrenia. The treatment pumped patients so full of the hormone that they would go into a diabetic coma. While some schizophrenics, such as John F. Nash Jr., the mathemetician portrayed in the movie ''A Beautiful Mind," showed improvement from the shock treatment, up to 10 percent of the patients died, and by the early 1960s, insulin therapy had gone onto the scrapheap of medical history. When Roth began his research for the National Institute of Health 25 years ago, most neurologists agreed that insulin played a negligible role in brain chemistry. Insulin levels in the brain were low compared with levels in the rest of the body, and the brain seemed to have limited need for the hormone. But Roth's team at NIH demonstrated that brain cells possess insulin receptors to grab the hormone as it floated by and took pictures of insulin binding to receptors in rats' brains. They argued that insulin plays a complex role in brain cells, from cell repair to self-defense. Far from being a bit player in the brain, Roth suggested that insulin ''has a very rich job description." When de la Monte started her insulin research in the early 1990s, the neuropathologist was amazed that few scientists had built on Roth's work. She used a chemical treatment to drastically reduce insulin levels in the brains of rats and found that they developed Alzheimer's symptoms, including large-scale cell death. Immediately, she said, ''I knew we had to stop everything we're doing and focus on Alzheimer's." In recent years, De la Monte's lab has shown that the brain actually produces insulin itself rather than relying on insulin from the pancreas that circulates in the rest of the body. Last year, in a study of brain samples from 45 Alzheimer's patients, de la Monte found that the number of insulin receptors in the frontal cortex, the center of intellect, drops by 80 percent in advanced cases of the disease, meaning that the cells don't get the insulin they need to survive. ''Insulin disappears early and dramatically in Alzheimer's disease," said de la Monte, who also teaches pathology at Brown University Medical School. ''Many of the unexplained features of Alzheimer's, such as cell death and tangles in the brain, appear to be linked to abnormalities in insulin signaling." Of course, other Alzheimer's researchers say it's too soon to say that insulin defects are the most important cause of the disease. Large-scale studies have also shown that high blood pressure, obesity, and cardiovascular disease put people at higher risk of Alzheimer's. ''It is a real stretch to call Alzheimer's disease Type 3 diabetes," said Dr. Hugh C. Hendrie, co-director of the Center for Alzheimer's Disease and Related Neuropsychiatric Disorders at Indiana University. He believes the disease probably has more than one cause. The connection between insulin defects and schizophrenia is even less well established. About three years ago, researchers at Psychiatric Genomics detected a strange pattern in the brains of deceased schizophrenia patients. In the hippocampus, the brain region responsible for memory and learning, they found low levels of activity in genes that govern the breakdown of sugars and energy production, suggesting an insulin-processing problem Last year the researchers discovered that the same 14 genes that are missing in the brains of schizophrenics are also missing in muscle tissue of diabetics. What's more, they were able to boost production of the deficient genes in the lab by adding insulin or insulin-like growth factor, a protein that is similar to insulin. ''We were quite stunned," said Altar of Psychiatric Genomics, which is now focusing on potential treatments for schizophrenia that would increase the activity levels of the genes. ''There's a whole series of steps that may prevent the schizophrenic brain from responding to insulin." Of course, Altar's insulin theory remains new and largely untested, so even those who hope he is right, such as the Stanley Medical Research Institute, which is funding him, are cautious. But Roth of the Jewish Medical Center said, ''Whether he's right in detail I don't know, but he's right in principle." So far, very few insulin-based treatments for diseases of the brain have reached human trials. However, physicians from the Veterans Affairs Puget Sound Health Care System and the University of Washington are about to study whether insulin delivered in a nasal spray can improve the memory of people with early-stage Alzheimer's disease. But de la Monte is convinced that one day, insulin therapies could help the nation's 4 million Alzheimer's patients, and maybe even Parkinson's disease patients, too. ''It opens the door to many other approaches to a disease that we don't really have any therapies for," she said.
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