Noteworthy News Articles on Mental Health Topics, March 1-7, 2006
Connecticut Mental Health Group Closing
Eduardo Porter, New York Times- 3/2/2006 For four decades, the number of women entering the workplace grew at a blistering pace, fostering a powerful cultural and economic transformation of American society. But since the mid-1990's, the growth in the percentage of adult women working outside the home has stalled, even slipping somewhat in the last five years and leaving it at a rate well below that of men. While the change has been under way for a while, it was initially viewed by many experts as simply a pause in the longer-term movement of women into the work force. But now, social scientists are engaged in a heated debate over whether the gender revolution at work may be over. Is this shift evidence for the popular notion that many mothers are again deciding that they prefer to stay at home and take care of their children? Maybe, but many researchers are coming to a different conclusion: women are not choosing to stay out of the labor force because of a change in attitudes, they say. Rather, the broad reconfiguration of women's lives that allowed most of them to pursue jobs outside the home appears to be hitting some serious limits. Since the 1960's, tens of millions of women rejiggered bits of their lives, extracting more time to accommodate jobs and careers from every nook and cranny of the day. They married later and had fewer children. They turned to labor-saving machines and paid others to help handle household work; they persuaded the men in their lives to do more chores. At the peak in 2000, some 77 percent of women in the prime ages of 25 to 54 were in the work force. Further changes, though, have been proving harder to achieve, stretching the daily challenge facing many mothers at nearly all income levels toward a breaking point. "What happened on the road to gender equality?" said Suzanne M. Bianchi, a sociologist at the University of Maryland. "A lot of work happened." Consider Cathie Watson-Short, 37, a former business development executive at high-technology companies in Silicon Valley. She pines to go back to work, but has not figured out how to mesh work with caring for her three daughters. "Most of us thought we would work and have kids, at least that was what we were brought up thinking we would do — no problem," Ms. Watson-Short said. "But really we were kind of duped. None of us realized how hard it is." Professor Bianchi, who studies time-use surveys done by the Census Bureau and others, has concluded that contrary to popular belief, the broad movement of women into the paid labor force did not come at the expense of their children. Not only did fathers spend more time with children, but working mothers, she found, spent an average of 12 hours a week on child care in 2003, an hour more than stay-at-home mothers did in 1975. Instead, mothers with children at home gained the time for outside work by taking it from other parts of their day. They also worked more over all. Professor Bianchi found that employed mothers, on average, worked at home and on the job a total of 15 hours more a week and slept 3.6 fewer hours than those who were not employed. "Perhaps time has been compressed as far as it will go," she suggested. "Kids take time, and work takes time. The conflicts didn't go away." Indeed, the research suggests that women may have already hit a wall in the amount of work that they can pack into a week. From 1965 to 1995, Professor Bianchi found, the average time mothers spent doing paid work jumped to almost 26 hours a week from 9 hours. The time spent on housework fell commensurately, to 19 hours from 32. Then the trend stalled. From 1995 to 2003, mothers, on average, spent about the same amount of time on household chores, but their work outside the home fell by almost four hours a week. "Looking toward the future," said Francine D. Blau, a professor of economics at Cornell University, "one can question how much further increases in women's participation can be had without more reallocation of household work." This is having broad repercussions for the economy. Today, about 75 percent of women 25 to 54 years old are either working or actively seeking a job, up from around 40 percent in the late 1950's. That expansion helped fuel economic growth for decades. But the previous trend flattened in the early 1990's. And since 2000, the participation rate for women has declined somewhat; it remains far below the 90 percent rate for men in the same age range.
Valerie Reitman, Los Angeles Times- 3/4/2006 In a ceremony in the heart of downtown's skid row on Friday, about $70 million skimmed from the wealthiest Californians was transferred to help thousands of mentally ill and homeless people in Los Angeles County. It was the first cash infusion to arrive from a novel initiative that imposed a 1% additional tax on those earning more than $1 million a year. Voters approved Proposition 63, or the Mental Health Services Act, in November 2004, the only such public fundraising plan specifically aimed at improving mental health care and services. It is expected to deliver about $700 million more annually into community-based mental health care programs around the state. In Los Angeles, the first county to receive an allocation, an estimated 18,000 adults and children are expected to benefit this year from creation or expansion of such programs as around-the-clock counseling and support, rental subsidies and help finding permanent affordable housing, treatment for alcohol and drug problems, and drop-in centers and counseling for teenagers leaving foster care. Much of the funding will be aimed at coordinating services for about 5,000 people with chronic and persistent mental illnesses — including not only psychiatric care but also housing, jobs, clothes and even friendship. That means essentially doing "what Los Angeles Times columnist Steve Lopez has done for Nathaniel," said county mental health Director Marvin J. Southard, referring to the homeless virtuoso cellist whom Lopez has befriended and written about. The state has allocated the $300 million available in the first year according to a formula that weighs poverty levels; the number of uninsured, homeless and mentally ill; and the cost of living in each county. Forty-two counties have submitted three-year plans detailing their proposals for additional services and prevention programs. Los Angeles received the largest county allocation and is expected to get about $250 million over the next three years. This year's $70 million includes $45 million for programs, with the remainder to cover one-time expenditures. The county hasn't decided which agencies and programs will get the funds. Reviews by county officials and a community board will begin Tuesday. More money will go to programs in downtown Los Angeles and other areas with high numbers of homeless, impoverished and mentally ill residents. The St. George Hotel, which provides permanent housing in skid row, plans to apply for a share of the money to supplant its federal grant, which will soon expire, that allowed it to hire a full-time nurse and part-time psychiatrist to help those with long histories of mental illness. "They've been magical in getting people connected with other services," said Admas Kanyagia, a program manager at Skid Row Housing Trust, a private, nonprofit organization that runs the facility. Though the extra funding from the initiative is the largest windfall for mental health programs in generations, it represents just 7% more than the county's current mental health budget of $1.1 billion, which covers programs for about 250,000 county residents. For the state, it will pump an additional 10% to 15% into the current $3 billion spent on outpatient mental health programs. "What's so ambitious is that we're really trying to leverage that 10%-15% into changing the whole system to implement those programs that are most efficient," said Stephen W. Mayberg, director of the California Department of Mental Health. "It's ambitious to be the tail that wags the dog, but we're trying to do that." Programs that aim to provide for all of a person's needs have been shown to substantially reduce time in jail, emergency rooms and psychiatric hospitals. Investing $15,000 in an individual could spare the state the $130,000 annual cost for each individual in a state psychiatric institution, Mayberg said. Hooked on Online Psychics Alex Williams, New York Times- 3/5/2006 For Sarah Lassez — a winsome actress who has appeared in more than 20 movies, alongside actors like Matthew Modine, Rose McGowan and Dennis Hopper — the seemingly inevitable Hollywood bout with addiction she experienced a few years ago was accompanied by the usual handmaidens of a habit: career uncertainty, romantic turbulence and nagging fears of future obscurity. At her darkest moments it cost her $1,000 a month, more than her rent. But perhaps worst of all was the effect her addiction had on those around her. It made them want to burst out laughing. "If they didn't laugh out loud, you could tell they were repressing it," said Ms. Lassez, who points out that she was addicted not to drugs or alcohol, but to psychics. "It does sound silly." Over the last 10 years this graduate of New York University, daughter of two computer scientists and otherwise rational adult in her 30's found herself spending more money on the services of tarot readers, palmists, clairvoyants and clairaudients (they hear voices) than some young actors spend on their cars. She paid one woman to read the sediment swirls at the bottom of a cup of Greek coffee. But most costly, she said, were the countless psychics on Web sites like Keen.com, Kasamba.com, and Asknow.com. They are always available, at all hours of the night, utterly anonymous. At her worst, Ms. Lassez would call six in a day. Her life was unraveling at $4.99 a minute. "I never considered myself to have an addictive personality," she said. "I never even had a problem with cigarettes or caffeine. But it literally felt like a high." Now recovered — sort of — Ms. Lassez has taken on an unlikely second career: patron saint to other "psychic addicts," who she said are numerous, if largely silent because of shame. She has started an online support group, www.psychicjunkie.net, to help others like herself and has completed "Psychic Junkie: A Memoir," written with Gian Sardar, chronicling her struggle. Simon Spotlight Entertainment is to publish the book, which was originally written as a self-help book, in July. But while Ms. Lassez might be the most visible person to go public with her struggle she is not, psychics and self-described addicts say, the only one suffering from it. The impulse to consult the paranormal for guidance in life can, like gambling fever, strike people of any level of education, intelligence or social status. It can become a form of faith healing for people suffering anxiety, particularly in professions like acting, where the swings of fortune can be sudden, mystifying and sometimes cruel. As Ms. Lassez recounted, the gratification gained by calling psychics —she would find her prophesied dark-eyed man, she would win a Golden Globe — was instant. "You call them, hear what you want to hear," she said. "I would instantly feel good, for a few minutes, maybe a few hours." She added, "I lost my mind," sounding a bit perplexed herself. If psychic addiction is a budding epidemic, Ms. Lassez is well out in front of the scientific curve in exploring it, said John W. Welte, a psychologist and senior research scientist at the Research Institute on Addictions at the State University of New York at Buffalo. Dr. Welte said he had never heard of any research on the subject or of the subject itself. Still, he did not discount the possibility that one could develop the same patterns of emotional dependence on the supernatural as others develop with behavioral addictions like gambling: overpowering urges to chase a brief but powerful high, followed by increasing tolerance, thus the need for the subject to increase the dose continually to get the same effect. "I'm generally skeptical of weird addictions," Dr. Welte said, but "if someone is pressing on, even though they suffer from severe negative consequences, that is clearly addictive behavior." Others who say they have suffered from the affliction consider the consequences negative. Cheryl Hardy, a corporate communications executive in Austin, Tex., recalls being so overcome with career anxiety on her graduation from the University of Pennsylvania a decade ago that she "maxed out" her credit cards paying telephone psychics for job advice. "Panic is what makes you pick up the phone," Ms. Hardy, 33, said. "You go right down the list, calling all the psychics until you find the person who's going to tell you the magic words." Dona Murphy of Lake Bluff, Ill., said she similarly ran up thousands of dollars in debt when working as a corporate personnel executive in 2002, trying to fill a spiritual hole in her life. "Often, what you need is not a reading," Ms. Murphy, 48, said. "There is something in there you are not getting: intellectually, emotionally, in terms of social stimulation. At that point you're in trouble." For those who develop an unhealthy dependency on mediums, Ms. Lassez said, important decisions are changed, and fundamental assumptions of self are altered. Take the time that a psychic foresaw Ms. Lassez's marrying the star of a popular television show, which she declined to name out of tact. (She found that actor "particularly unattractive and untalented.") Undaunted, Ms. Lassez set about studying pictures of him and watching him on television to nudge her destiny along. But while the problem is rarely discussed, it is common in psychic circles, several psychic readers and their clients said. "The addiction problem is huge, and it's getting worse," said Pamela Fletcher, an aura reader in Abita Springs, La., who runs her business through six Web sites. Online is where the real action is. Few sites require any proof of qualification, Ms. Fletcher said. With a splashy home page and a few grandiose promises — "I will help you with all problems," promises Psychic Troy, a reader listed on Keen.com — psychics can build a national clientele. Ms. Lassez's first taste of the paranormal came a decade ago on location for a film in Detroit, when — on a whim — she dropped in on a tarot reader to get her mind off a breakup and an argument on the set. The psychic spread out 10 cards on the kitchen table in a Celtic cross, a standard tarot pattern. The 10th card, which supposedly augurs the subject's future, was the Star. To any young actress the meaning would be clear. By the time she left Detroit, she had her own tarot deck. Ms. Lassez acknowledged that most people's embarrassment about the behavior keeps them even from disclosing it, let alone seeking help. She said she found it absurd that a belief system so at odds with critical thinking could gain so strong a pull in her life. "I really believed in it, even though most of the predictions weren't coming true," she said. In her willingness to suspend disbelief Ms. Lassez is not alone, even among educated and intelligent people, psychologists said. James Alcock, a psychology professor at York University in Toronto, who has studied the belief in the paranormal, considers himself a confirmed skeptic but pointed out, "If you look at the Gallup polls, the majority of people believe in the paranormal." Most people, he explained, particularly those with any religious training at all, are raised to live under two different belief systems: the rational, which governs most decisions in life, and the transcendental, which guides matters of spirituality and faith. Therefore for some people it is only a small leap to let their transcendental impulses creep into their daily affairs, especially when anxiety over career, finances or romance is involved. Faith, in whatever form it takes, Dr. Alcock said, can provide great comfort, even a sense of empowerment. People who feel they have the stars on their side often feel an edge over mere mortals. "We all have pockets of irrationality," he said, "and those pockets tend to be activated at times we're motivated by greed or fear." Greed and fear pretty much describe the state of mind within the entertainment business. So just as there are no atheists in foxholes, there would appear to be few skeptics in Hollywood. "It's the level of uncertainty," said Justeane Kenzer, a clairvoyant in Hollywood, who charges $200 for a 30-minute session. She said that actors tend to be heavy users of psychic services. "Becoming an actor is like playing the lottery." Ms. Kenzer said she had done readings for more than one cast member of "Desperate Housewives," including Eva Longoria, and that consulting psychics is something of an open secret in Hollywood. "L.A. is full of control freaks," she said. "Everyone just wants to know how their thing is going to turn out." For Ms. Lassez her reliance on clairvoyants only increased as she evolved from being a potential next-big-thing ingénue with a William Morris agent into a struggling actress and then at one point to a low-level marketing employee at an Internet company. Eventually she hit bottom and went to a therapist, who suggested she attend a 12-step program. "The problem was there weren't any 12-step programs that were appropriate," she said. Ms. Lassez finally made the decision to get clean, she said, when she stumbled onto a message board on Yahoo moderated by devotees of psychics. There she read tales of dozens of people who had troubles like hers. She began reaching out to them, mostly online, sharing stories. Those stories involved tens of thousands of dollars of debt and postponement of career and romantic decisions, waiting on predictions that were never going to come true. So after a long and painful recovery she now wants to spread the word. "It's not like I'm proud of it," she said of her addiction, but "if I can stand here and laugh at myself about it, it has to help." Besides, things in her life are much better now. She has been reborn as a something of an indie-movie queen. She has three films pending release, including "Mad Cowgirl," a surrealist slasher cum kung fu movie, in which she stars. Still, Hollywood being Hollywood, she never knows when the winning streak will end. Speaking from her home in the Silver Lake section of Los Angeles, she admitted to the occasional relapse. She never did throw away her tarot cards. "Those cards," she said, "are probably sitting on my bed right now." Irreconcilable Differences No Two Alike : Human Nature and Human Individuality By Judith Rich Harris. 322pp. W. W. Norton & Company. $26.95. William Saletan, New York Times Book Review- 3/5/2006 Judith Rich Harris calls "No Two Alike" a "scientific detective story." The mystery is why people — even identical twins who grow up in the same home with the same genes — end up with different personalities. The detective is Harris herself, a crotchety amateur, housebound because of an illness, who takes on the academic establishment armed only with a sharp mind and an Internet connection. Harris the author scrupulously follows clues; Harris the protagonist drives the story forward through force of character, arriving at a theory of personality that could be said to describe herself. Eight years ago, Harris's book "The Nurture Assumption" set academic psychology on fire by attacking the notion that parenting styles shape children. Scholars, irked by this upstart former textbook writer and grad-school reject, scorned her argument. In her new book, Harris tries to embarrass her critics while synthesizing her work into a theory of personality. "No Two Alike" is two books: a display of human weakness, and a display of scientific courage and imagination. Every detective has a favorite method. Harris's is behavioral genetics, which attempts to tease out the genetic bases of behavior. To sort genetic from environmental factors, you study people with the same genes but different environments: identical twins raised apart. Or you study people with different genes but the same environment: adoptive siblings raised together. Using this method like scissors — holding one variable steady while slicing against it with the other — Harris shreds popular theories of personality formation. Does home environment — parenting style, marital harmony, the use or rejection of day care — shape a child's personality, making her more agreeable, less aggressive or more extroverted? Nope. Research shows that twins don't turn out more alike if they're raised together than if they're raised apart. Nor do adoptive siblings. And when you compare apples to apples — making sure that each parent-child unit in a study is as genetically related as any other — being raised in one home rather than another, on average, makes no difference. Maybe a certain type of home environment affects children with some genes one way and children with other genes the opposite way? Sorry, says Harris, the data show no such patterns. Furthermore, she writes, since twins raised together have the same genes and environments, gene-environment interactions can't explain why they turn out differently. Do kids turn out differently because parents treat them differently — based on birth order, for example? If so, you'd expect siblings raised together, in manifest birth order, to differ more than siblings raised apart. But they don't. If parents don't shape children, what does? Harris realigns her scissors and cuts again. She looks for studies that pit the influence of parents against the influence of the larger environment. Children raised in Canada by parents born in Hong Kong become Canadian. When parents have an accent but most of the neighborhood doesn't, their children lose the accent. The village, not the family, prevails. Why? Because that's what makes evolutionary sense. If your parents raise you poorly, Harris argues, you're better off diluting the damage. If they dote on you, you're better off adjusting to the tougher social world in which you'll have to find your way. Throughout most of human evolution, parents had little time for children old enough to run around. They learned from one another and from watching adults. From this evolutionary logic, Harris builds a theory of personality based on three systems in our brains. The socialization system absorbs language, customs and skills, making us more alike. Mommy and Grandma wear dresses; you're a girl, so you want a dress too. The relationship system distinguishes people so we can deal with each one appropriately. Crying gets milk from Mommy but not Grandma; Billy is gentle, but Bobby hits people. Even random differences are important: Anne helped you with your homework, but her twin sister owes you a dollar. You find ways to tell people apart because you have to. Harris offers a variety of interesting evidence for these systems: brain scans, animal studies and neurological diseases that knock out one system but not the other. She sprinkles her book with humor, but spends much of it savoring acrimonious relationships. No grudge is forgotten; no enemy spared. They key to understanding this behavior, and the mystery, is her third system: status. Harris portrays herself as a hard-nosed lay scientist hunting and slaying academic frauds. And slay them she does. Years ago, at an academic conference held shortly after the publication of "The Nurture Assumption," a researcher named Stephen Suomi chided her, in what she calls a "scornful voice," for ignoring gene-environment interactions. Suomi "wasn't afraid of a little woman from New Jersey," she writes. "Maybe he should have been." Harris spends the next dozen pages hunting down and eviscerating Suomi's research, calling it "vaporware" — a term used in the software industry to describe a product that's announced in order to scare off competitors but then never materializes. Later, she sinks her teeth into the researcher Frank Sulloway, who has argued that personality is shaped by birth order. When his work was questioned by another researcher, Harris writes, Sulloway refused to show his data to skeptics he called "unqualified." Her persuasive scientific critiques of both men are overshadowed by her seeming determination to humiliate them. Hell hath no fury like this little woman scorned. Hence the status system. Your socialization system figures out how to conform to your group. Your relationship system figures out how to get along with each person. Your status system figures out how to compete. It monitors people's reactions, gathering information about how smart, pretty, weak or talented they think you are. It looks for virtues, activities and occupations at which you're most likely to best your peers. It notices tiny differences between the way people regard you and the way they regard others in your peer group, or even your twin. By choosing pursuits based on these differences, it magnifies them. It drives you to be different. This is the paradox behind the book's subtitle. Human nature causes human individuality; the mental systems that we share are also the ones that distinguish us. But if these three systems are, as Harris concludes, the "perpetrators" of individuality as we know it, the mystery of how we got here gives way to the mystery of where we're going. The perpetrators remain at large. The evolutionary forces that gave us distinctive personalities don't end here. Human nature isn't finished with human individuality, or with itself. Harris attributes half of our traits to genes, noting the roughly 50 percent personality correlation between identical twins. She figures that "evolution provided humans with a certain amount of plasticity in behavior so they can profit from their experiences." When hominids developed "subtle and multidimensional" abilities to read minds and adjust behavior, it became "advantageous to be able to modify patterns of social behavior on a long-term basis." Ultimately, however, long-term behavior modification is at odds with itself. As our minds become subtler and our occupations less stable, short-term modifications suited to the situation at hand become more advantageous than permanent modifications. This is already happening, according to her theory. The reason parental influence doesn't control children's behavior outside the home is that they adjust to context. "Children are capable of generalizing — of learning something in one context and applying it in another — but they do not do it blindly," Harris observes. At home, where you're the younger sibling, you yield. At school, where you're one of the bigger kids, you don't. And unlike other animals, you can shuffle your self-classifications. In seconds, you can go from acting like a girl to acting like a child to acting like a New Yorker. In short, the evolutionary logic that makes us different from one another will gradually make us different from ourselves, context by context. Personality — behavior that is "consistent across time and place," as one textbook puts it — will fade. We'll miss characters like Harris, the little woman from New Jersey who boasted of giving psychologists a "wedgie" and tried to solve the puzzle of human nature. There won't be another one like her. Scant Drop Seen in Abortion Rate if Parents Are Told Andrew Lehren & John Leland, New York Times- 3/6/2006 For all the passions they generate, laws that require minors to notify their parents or get permission to have an abortion do not appear to have produced the sharp drop in teenage abortion rates that some advocates hoped for, an analysis by The New York Times shows. The analysis, which looked at six states that introduced parental involvement laws in the last decade and is believed to be the first study to include data from years after 1999, found instead a scattering of divergent trends. For instance, in Tennessee, the abortion rate went down when a federal court suspended a parental consent requirement, then rose when the law went back into effect. In Texas, the rate fell after a notification law went into effect, but not as fast as it did in the years before the law. In Virginia, the rate barely moved when the state introduced a notification law in 1998, but fell after the requirement was changed to parental consent in 2003. Since the United States Supreme Courtrecognized states' rights to restrict abortion in 1992, parental involvement legislation has been a cornerstone in the effort to reduce abortions. Such laws have been a focus of divisive election campaigns, long court battles and grass-roots activism, and are now in place in 34 states. Most Americans say they favor them. "It's one of the few areas that the U.S. Supreme Court has allowed states to legislate, so it's become a key for lowering the abortion rate," said Mary Spaulding Balch, director of state legislation for the National Right to Life Committee. Ms. Balch said she believed that consent laws were effective. Yet the Times analysis of the states that enacted laws from 1995 to 2004 — most of which had low abortion rates to begin with — found no evidence that the laws had a significant impact on the number of minors who got pregnant, or, once pregnant, the number who had abortions. A separate analysis considered whether the existence or absence of a law could be used to predict whether abortions went up or down. It could not. The six states studied are in the South and West: Arizona, Idaho, South Dakota, Tennessee, Texas and Virginia. (A seventh state, Oklahoma, also passed a parental notification law in this period, but did not gather abortion data before 2000.) Supporters of the laws say they promote better decision-making and reduce teenage abortions; opponents say they chip away at abortion rights and endanger young lives by exposing them to potentially violent reaction from some parents. But some workers and doctors at abortion clinics said that the laws had little connection with the real lives of most teenagers, and that they more often saw parents pressing their daughters to have abortions than trying to stop them. And many teenagers say they never considered hiding their pregnancies or abortion plans from their mothers. "I would have told my mother anyway," said a 16-year-old named Nicole, who waited recently at a clinic in Allentown, Pa., a state that requires minors to get the permission of just one parent. Nicole's mother and father are divorced, and it was her mother she went to for permission to have an abortion. "She was the first person I called," Nicole said. "She's like a best friend to me." Abortion rates have been dropping nationwide since the mid-1980's, most precipitously for teenagers. But in three states — Arizona, Idaho and Tennessee — the percentage of pregnant minors who had abortions rose slightly after the consent laws went into effect. When the Times study compared the first full year after a state began enforcing a parental law with the last full year before the law, it found that abortions among minors dropped an average of 9 percent. But in the same period, the rates for pregnant 18- and 19-year-olds, who were not affected by the law, dropped by 5 percent, suggesting that most of the drop among minors was associated with other factors that affected minors and adults alike. "There are ongoing trends that are pushing both birth rates and abortion rates down significantly, and those larger trends are more important than the effect of these laws," said Ted Joyce, an economist at Baruch College in New York who has studied parental involvement laws. He found they had limited effects on small subgroups of minors but little impact over all. Of the remaining decline in teenage abortion rates in the Times study, Dr. Joyce said that some of it might be attributed to minors going out of state for abortions. The health departments in these states do not track data on such abortions, but in three previous studies of states where such data were available, completed before 1991, two found that any drop in minors' abortions was matched by an increase in minors getting abortions out of state. Previous research on the effects of parental notification laws has been slender and has produced contradictory conclusions. All were hampered by inconsistencies in the ways states gather and report data. The Times analysis was limited by its focus on just six states, but it avoided the possible distortions of including states that gather data in inconsistent ways. Phillip B. Levine, an economics professor at Wellesley College, examined nationwide survey results from 1985 to 1996, a time when many parental involvement laws were put in place, and found that the laws were associated with about one-eighth of the total drop in minors' abortions in those states. Much of the drop was associated with other factors, which might include the economy, availability of abortion, changes in mores and other trends. "It's not surprising it's not popping out," Dr. Levine said of the small drop found in the Times analysis. "There is nothing overwhelmingly staggering" in the change associated with the laws. Supporters of parental involvement laws say they allow parents to help their children make an important health care decision, as parents would on any other surgical procedure. For Cathi Harrod, interim president of the Center for Arizona Policy, who lobbied for 15 years for her state's parental consent law, getting minors to involve their parents in their medical decisions was reason enough for the laws, whatever the impact on overall abortion rates. Arizona's law went into effect in 2003. Ms. Harrod said she believed that there was a groundswell of women who have had regrets about their own abortions and that as they made their feelings known, "we think the numbers will go down as minors learn more about their options." Either way, she said, her organization will push for stricter standards and more public accountability for judicial bypass through access to judges' records. But providers interviewed in 10 states with parental involvement laws all said that of the minors who came into their clinics, parents were more often the ones pushing for an abortion, even against the wishes of their daughters. "I see far more parents trying to pressure their daughters to have one," said Jane Bovard, owner of the Red River Women's Clinic in Fargo, N.D., a state where a minor needs consent from both parents. "As a parent myself, I can understand. But I say to parents, 'You force her to have this abortion, and I can tell you that within the next six months she's going to be pregnant again.' " Renee Chelian, director of Northland Family Planning Centers in the Detroit area, said she had had to call the police on parents who wanted their daughters to have abortions, "because they threaten physical violence on the kids." Ms. Chelian added that the laws might have unseen effects, including driving some teenagers to try to abort their pregnancies on their own. "Kids talk among themselves," she said. "When we tell them they need to go to court or tell their parents, that's when they tell us there's a Web site" for chemicals or herbal remedies that claims to induce abortions. Nearly all state parental involvement laws allow for minors to bypass their parents by going through a judge. Providers interviewed in 10 states all said that the process was generally not cumbersome, but that some girls would be afraid to go to court. For Nicole, the 16-year-old in the Allentown clinic, the hard part was telling her estranged father. "It was my choice to tell him," she said. "It hurt him, but he understands and is there for me. So in a way it brought us closer together." Attention Surplus? Re-examining a Disorder Paul Steinberg, M.D., New York Times- 3/7/2006 The recent recommendation that Ritalin and other medications for attention-deficit disorder carry the most serious allowable warning will certainly slow the explosive growth in the use of those drugs. That was the intention of some members of the Food and Drug Administration advisory committee that called for the packaging alert, known as a black-box warning. But the recommendation and concerns about growth in the use of these drugs may force us to think about the disorder, known as A.D.H.D., in new and different ways, from an evolutionary and contextual standpoint. Every generation likes to believe that it is witnessing the most dramatic epoch in history. In the case of the current Western world, that belief may indeed be accurate, particularly in light of the striking changes of the last 30 years. As the business writer and consultant Peter Drucker pointed out, most people in the United States, Japan and parts of Europe are "knowledge workers." We live in an information age, in a knowledge-based economy. For those of us who have "attention-surplus disorder" — a term coined by Dr. Ned Hallowell, a psychiatrist in Boston who has A.D.H.D. — this knowledge-based economy has been a godsend. We thrive. But attention disorder cases, up to 5 to 15 percent of the population, are at a distinct disadvantage. What once conferred certain advantages in a hunter-gatherer era, in an agrarian age or even in an industrial age is now a potentially horrific character flaw, making people feel stupid or lazy and irresponsible, when in fact neither description is apt. The term attention-deficit disorder turns out to be a misnomer. Most people who have it actually have remarkably good attention spans as long as they are doing activities that they enjoy or find stimulating. As Martha B. Denckla of the Kennedy Krieger Institute in Baltimore has noted, we should probably be calling the condition something like "intention-inhibition disorder," because it is a condition in which one's best intentions — say, reading 50 pages in a dense textbook or writing a 10-page paper in a timely fashion — go awry. Essentially, A.D.H.D. is a problem dealing with the menial work of daily life, the tedium involved in many school situations and 9-to-5 jobs. Another hallmark, impulsivity, or its more positive variant, spontaneity, appears to be a vestige from lower animals forced to survive in the wild. Wild animals cannot survive without an extraordinary ability to react. If predators lurk, they need to act quickly. This vestige underscores the fact that human genetic variability, the fact that we are not all simply clones of one another, has allowed us to survive as a species for 150,000 years in a variety of contexts and environments. In essence, attention-deficit disorder is context driven. In many situations of hands-on activities or activities that reward spontaneity, A.D.H.D. is not a disorder. Ultimately, if studies show convincing evidence that children and adults have been harmed by medications for attention disorder, cardiologists will have every obligation to tell us to halt their use. But a more fundamental societal accommodation would be highly beneficial — to recognize that each child and adult learns and performs better in certain contexts than others. As Arthur Levine, president of the Teachers College at Columbia University, has noted, future teachers will be able to individualize and customize the education of students. Some children and young adults with attention disorder may need more hands-on learning. Some may perform more effectively using computers and games rather than books. Some may do better with field work and wilderness programs. If it is indeed a context-driven disorder, let's change the contexts in schools to accommodate the needs of children who have it, not just support and accommodate the needs of children with attention-surplus disorder. For those with attention disorder who wish to be full participants in a knowledge-based world, medications equalize their opportunities. The drugs should and can be used only as needed in the context of dealing with the tedium of school or the drab paperwork of some jobs. Cardiologists, biostatisticians and consumer advocates may clamor, appropriately or inappropriately, to reduce the use of the medications. But unless we go back to the caveman world, some people will find the drugs increasingly necessary to succeed as knowledge workers in a drastically transformed modern world. Study Details Link of Drugs and Thoughts of Suicide Benedict Carey, New York Times- 3/7/2006 Antidepressant drugs raise the small risk of suicidal thoughts and behavior in depressed children and adolescents, scientists at the Food and Drug Administration are reporting today in a detailed published account of findings they reached in 2004. The study, an analysis of 4,582 patients in 24 drug trials, is the first widely published evaluation of data that the agency reviewed that year. The analysis found that about four children and adolescents of every 100 who took the drugs reported suicidal thoughts or behavior, twice the number among those who took dummy pills. The publication of the study is not likely to alter the debate about the relative risks and benefits of antidepressant treatment, experts said. No one in the trials committed suicide, and the suicide rate among adolescents has dropped significantly since doctors began prescribing the drugs to minors in the early 1990's. But some experts said publication of the report, in today's issue of The Archives of General Psychiatry, may make it harder to deny that antidepressants like Prozac, Zoloft and Effexor cause a worsening in a small number of children and adolescents with depression, stirring in them thoughts of suicide they would not otherwise have had. The findings so impressed F.D.A. officials in 2004 that they voted then to require a suicide warning on the drug's labels, "and we felt and still feel that was the right thing to do," said Dr. Thomas Laughren, director of the agency's Division of Psychiatry Products, who was a co-author of the study. Still, a spokesman for the American Psychiatric Association, Dr. David G. Fassler, a child and adolescent psychiatrist in Burlington, Vt., said the study had yet to clarify the relationship between suicidal thinking and behavior. "It shows that kids taking the medications are twice as likely to tell the clinician about suicidal thinking," Dr. Fassler said, not whether there is a significant difference in the incidence of suicide attempts. Many Couples Must Negotiate Terms of 'Brokeback' Marriages Katy Butler, New York Times- 3/7/2006 One hour into "Brokeback Mountain," Amy Jo Remmele began to cry, and not just for the woman on-screen, standing in a doorway in Riverton, Wyo., watching her husband embrace a man. "When I saw that look in her eyes, I thought, 'Oh, yeah.' Even though I never saw my husband with another man, I knew exactly how that woman would have felt," said Mrs. Remmele, a respiratory therapist in rural Minnesota. On June 1, 2000, Mrs. Remmele, then 31, discovered her husband's profile on the Web site gay.com. The couple stayed up all that night weeping and talking. Soon afterward, 10 days before she gave birth to her second child, Mrs. Remmele's husband went off to spend a couple of nights with his new boyfriend. "I tried to talk him out of it, and he left anyway," Mrs. Remmele said. "I was devastated." Three months later the couple divorced. Mrs. Remmele — now married to a farmer who raises cattle, corn and soybeans — is one of an estimated 1.7 million to 3.4 million American women who once were or are now married to men who have sex with men. The estimate derives from "The Social Organization of Sexuality," a 1990 study, that found that 3.9 percent of American men who had ever been married had had sex with men in the previous five years. The lead author, Edward O. Laumann, a sociologist at the University of Chicago, estimated that 2 to 4 percent of ever-married American women had knowingly or unknowingly been in what are now called mixed-orientation marriages. Such marriages are not just artifacts of the closeted 1950's. In the 16th century, Queen Anne of Denmark had eight children with King James I of England, known not only for the King James Bible, but also for his devotion to male favorites, one of whom he called "my sweet child and wife." Other women include Constance Wilde, Phyllis Gates, Linda Porter, Renata Blauel and Dina Matos McGreevey, wed respectively to Oscar Wilde, Rock Hudson, Cole Porter, Elton John and James E. McGreevey, the former governor of New Jersey. Although precise numbers are impossible to come by, 10,000 to 20,000 such wives have contacted online support groups, and increasing numbers of them are women in their 20's or 30's. On the whole these are not marriages of convenience or cynical efforts to create cover. Gay and bisexual men continue to marry for complex reasons, many impelled not only by discrimination, but also by wishful thinking, the layered ambiguities of sexual love and authentic affection. "These men genuinely love their wives," said Joe Kort, a clinical social worker in Royal Oak, Mich., who has counseled hundreds of gay married men, including a minority who stay in their marriages. Many, he said, considered themselves heterosexual men with homosexual urges that they hoped to confine to private fantasy life. "They fall in love with their wives, they have children, they're on a chemical, romantic high, and then after about seven years, the high falls away and their gay identity starts emerging," Mr. Kort said. "They don't mean any harm." Helen Fisher, a research anthropologist at Rutgers University, said in an interview that human partnerships are shaped by three independent neurochemical brain-body systems, responsible respectively for sexual attraction, romantic yearning and long-term attachment. "The three systems are very fickle. They can act together, or they can act separately," Dr. Fisher said. This, she said, helps explain why people can be wildly sexually attracted to those they have no romantic interest in, and romantically drawn to — or permanently attached to — people who hold no sexual interest. "Once the system is triggered, it's so chemically powerful that you can easily overlook everything about that person that doesn't work for you," Dr. Fisher said. "Even straight people have fallen in love with people they could never make a life with," she said. This is cold comfort to women who lose not only the men they love, but also their faith in how to parse reality. "A lot of women feel that they were just used as covers, but I know in my heart of hearts he loved me," Mrs. Remmele said. "You can't fake the way he used to look at me. "I had no suspicions whatsoever. He's very masculine looking. It's not like he had Barbra Streisand or show tunes on." Mr. Kort, however, said that women should look deeper. "Straight people rarely marry gay people accidentally," he wrote in a case study of a mixed-orientation marriage published last September in Psychotherapy Networker, a magazine for which this reporter is the features editor. Some women, Mr. Kort said, find gay men less judgmental and more flexible, while others unconsciously seek partnerships that are not sexually passionate. But that sort of speculation infuriated Michele Weiner-Davis, a marriage therapist and author. "That's psychobabble," Ms. Wiener-Davis said. "A lot of gay people don't know they're gay. So how in the world are their spouses supposed to have some sort of gaydar?" She continued, "Therapists should deal with the real issues — the shock to her system, that her husband wasn't who she thought he was and the impact on her own identity." In the months after the discovery, Mrs. Remmele said, her husband left her alone with the baby on many evenings as he explored desires he had never dared to acknowledge. "So many of the gay spouses, they've denied themselves for so long, and it's like they're going through teenage-hood," Mrs. Remmele said. "I don't know if they really realize how much they're hurting their spouse." At first, Mrs. Remmele told nobody. "We live in a small rural community, and people just aren't openly gay here," she said. "I didn't want people making fun of him." About two-thirds of the women who contact the International Straight Spouse Network in El Cerrito, Calif., eventually divorce, said Amity Pierce Buxton, 77, a retired school administrator who founded the group in 1992 and has been researching the topic since 1986. Despite their shock and their anger, many women, especially those criticized by gay husbands for being too sexually demanding, are relieved to understand what was wrong. The remaining third of those she has studied try to preserve their marriages, Dr. Buxton said. Half of those stay married for three years or more. More than 600 such couples belong to online support groups. In a 2001 study, published in The Journal of Bisexuality, of 137 still-married gay and bisexual men and their wives, Dr. Buxton found that most lived in suburbs and medium-size cities and had been married for 11 to 30 years. Only tiny percentages lived in rural areas, where family privacy may be harder to maintain. The survival of even a small minority of these marriages calls into question the conceptual shoe boxes into which human partnerships, affection, attraction, commitment and sexuality are often jammed. Describing their permutations and combinations turns out to be much more complicated than checking a box on a form labeled "gay," "bisexual" or "straight." One woman in her 50's, who asked to be identified only as Trillian, out of concern for her husband's privacy, said that she and her husband formally divorced after she discovered his secret sexual life seven years ago, but they quickly decided to stay together. She has a satisfying monogamous sexual relationship with him, while he also has sex with men. "He tried to go back in the closet, but the more research I did on the subject, the more I realized this is an integral part of the person," she said. "You can't just turn it off like a light switch. My husband is the man of my dreams, and I could not face the rest of my life with the man of my dreams being miserable and guilt ridden over being gay." She and her husband, together for 24 years, live in Ohio and work in manufacturing plants. Paulette Cormack, a teacher who lives in Napa, Calif., has been married to her husband, Jerry, a retired city planner, for 36 years. For 34 years, Mrs. Cormack said in an interview, she has known that although she and her husband are sexually active together, his erotic desires otherwise focus almost exclusively on men. "It's not easy, but I truly do love him," Mrs. Cormack said. Mr. Cormack is now involved with another married gay man, and Mrs. Cormack has had extramarital relationships. Neither has explicitly discussed this with their son, who is 25. They remain intensely committed to each other. Last year Mr. Cormack nursed Mrs. Cormack through four months of treatments for cancer of the fallopian tubes. She eventually made a fully recovery. "What is intimacy?" pondered Mr. Cormack, as the couple sat in a coffeehouse in Berkeley, Calif., after watching "Brokeback Mountain" with others in similar situations. He added: "I am totally committed on all levels to Paulette. I felt so intimate with her when I was caring for her during her cancer treatments — to me, that's a stronger expression of love than whether I'm having anonymous sex with a man."
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