Noteworthy News Articles on Mental Health Topics, March 8-14, 2006

A `Desire Not To Feel Anything'
Tina A. Brown, Hartford Courant- 3/8/2006

Rising to the top of the country's financial services industry wasn't easy for Allan Baker, the son of sanitation and domestic workers who fought his way out of a poor section of Washington, D.C. His father, who never supported his ambitions, was even abusive at times, yet Baker excelled, a federal judge was told Tuesday. Baker graduated from Providence College and rose through the ranks of some of the countries largest insurance companies, including Aetna and ING U.S. Financial Services.
     But being at the top, especially during corporate restructuring at ING over the last five years, came with its challenges. The 6-foot-6 former college basketball star sunk into a "deep depression" as his job as vice president of ING's division of brand management forced him to take part in the layoffs of some 400 people, including some of his friends. And it was that depression, his supporters told the judge, that led Baker to use crack.
     Baker, 54, tried balancing the pressures at his job by volunteering tirelessly to promote African-American scholars at his alma mater, and by serving on the boards of prestigious institutions, including the Old State House, the United Way of Greater Hartford and the Hartford Symphony, It wasn't enough, and Baker turned to crack cocaine to anesthetize his pain. His dependence on crack was motivated by a "desire not to feel anything," Baker's lawyer, David J. Monz, said. "He shut down," Monz said, and became "clinically depressed."
     With no opposition from prosecutors, U.S. District Court Judge Alfred V. Covello on Tuesday sentenced Baker to six months of house arrest and three years of probation for using a telephone to purchase large quantities of crack cocaine from a major distributor in Hartford. Baker, who faced the possibility of three years in prison, also was ordered to pay a $10,000 fine and to continue with drug treatment.
     At his sentencing, Baker, a recovering addict who is actively in drug treatment and counseling, spoke about the case for the first time. "Your honor I'd like to personally apologize to my family and friends. This is not a place where I saw myself coming, but I'm here today," Baker said. Others asked the judge for leniency. His sister Lucy Berry said knowing of Baker's depression helped her to understand his addiction. "I heard his pain and was definitely able to relate," she said. "I love him deeply and I love him unconditionally." The Rev. Harry Elliott of St. Mary's Episcopal Church in Manchester asked the judge to consider Baker's contributions to the community. "I'm not going to tell you Allan is a saint or a perfect man," he said.
     Federal authorities linked Baker to Maurice Bennefield, a convicted drug dealer who was tied to a large crack cocaine distribution ring in the Hartford area that became the target of "Operation Big Boy," a sting by federal, state and local officials. While Bennefield was a distributor, Baker was a buyer. Authorities say Baker bought about 7 grams of crack cocaine in August 2004, which is generally considered distribution quantity. Baker pleaded guilty in October 2005 to using the telephone to arrange purchases of the drug from Bennefield. The original charges, filed in an October 2004 indictment, alleged that Baker was a member of a conspiracy to purchase and distribute crack cocaine, but the U.S. attorney's office dropped those charges.
     Even before his arrest in late 2004, Baker entered a drug treatment facility in Florida. Since that time, his therapist Mary Anne Costerella said, Baker has made "significant progress" and now understands and accepts the disease. "He has replaced fear with hope, honesty and self-love," she said. "He would not benefit from incarceration."
     Assistant U.S. Attorney Raymond F. Miller, who did not make a recommendation about whether Baker should go to prison, shared with Covello transcripts of federal wire taps, in which Baker calls himself "Big Al with the Benz" and "Uncle Al," before ordering as much as 5.25 grams of crack cocaine from Bennefield during the early hours of the morning.Miller left it up to Covello to decide "what constitutes a just and proper sentence."
     In deciding against prison time, Covello said he considered a number of factors, including Baker's lack of a criminal history, the fact that he pleaded guilty and accepted responsibility almost immediately, and his strong support in the community. "You are an extremely fortunate man, not just for all the support you have here today. You had your life put in a crucible. Most of us have to wait until the hereafter," Covello told Baker. Baker said later, "I'm just relieved it's over. I hope to start putting my life back together and doing something significant in the community."



Smoking In U.S. Declines Sharply
Marc Kaufman, Washington Post- 3/8/2006

Americans smoked fewer cigarettes last year than at any time since 1951, and the nation's per capita consumption of tobacco fell to levels not seen since the early 1930s, the association of state attorneys general reported yesterday. Using data the federal government gathers when it collects taxes on cigarette sales, the group found a 4.2 percent decline in 2005 alone and an overall drop of more than 20 percent since tobacco companies reached a legal settlement with the states in 1998.
      Association leaders and other tobacco-control advocates hailed the decline as a sign that sometimes-controversial developments triggered by the $246 billion settlement have been effective. The drop was a result, they said, of factors that include the sharply higher cost of cigarettes, restrictions on cigarette advertising and a shift in public perceptions as the dangers of smoking are more aggressively and widely publicized.
     "I think we're reaching a tipping point, where the image of tobacco is that it's unhealthy and dangerous, and not glamorous like years ago or neutral like the cigarette companies say now," said Tom Miller, Iowa's attorney general and a co-chairman of the tobacco committee of the National Association of Attorneys General. "We've seen a big drop in cigarette smoking, but I think we can still cut the smoking rate substantially more," he said.
     Cheryl Healton, president of the American Legacy Foundation, a tobacco-control group initially funded by the legal settlement, said the continuing decline suggests that the national health goal of reducing smoking rates even further by 2010 is within reach. "We're on target to exceed the national goal" of having no more than 15 percent of youths and 12 percent of adults smoking, Healton said. Few of the other national health goals adopted in 2000 appear to be achievable, she said, "but this is one battle we're winning."
     Federal studies show that about 21.7 percent of high school students still smoke, as do 20.9 percent of adults -- about 45 million Americans 18 and older. Tobacco use remains the leading preventable cause of death, causing more than 400,000 deaths a year.
     The decline in smoking began more than 20 years ago but accelerated after the settlement. Healton said the drop is a result of fewer people starting the habit, more people quitting and many cutting back on the number of cigarettes they smoke. Some of those trends were unrelated to the settlement, such as the decisions by 12 states, the District, Puerto Rico, and hundreds of cities and counties to ban smoking in public buildings, including restaurants and bars. "With all the restrictions in place now on smoking in public areas, it's just difficult to smoke as much as before," Healton said. She said the sharp increase in the price of cigarettes since the settlement -- from an average of $1.74 a pack in 1997 to $3.16 in 2004 -- has been especially important in reducing the number of young people who start smoking.
     Michael Neese, spokesman for Philip Morris USA, said the company has always expected that the settlement would bring about "meaningful change." A call to R.J. Reynolds Tobacco Co. was not returned. The association's study found that about 378 billion cigarettes were sold in the United States last year. That was the lowest number since 1951, when the population was half of what it is today. The heart of the agreement reached between the states and the tobacco industry in 1998 is the $246 billion being paid to settle lawsuits over cigarette-related health costs. Tobacco companies generally passed their costs along in the form of higher prices, which in turn reduced cigarette sales.
     But Miller and other tobacco-control advocates said yesterday that the agreements have also helped change the public's view of smoking. With the banning of ads such as those featuring the character "Joe Camel" and the expansion of aggressive anti-smoking ad campaigns, they said, the message that many young people are getting is dramatically different from the one of 10 years ago, when teenage smoking was on the rise. "The long-term trend is perfectly clear and consistent," said Mark Greenwald, director of the Tobacco Project for the association of state attorneys general. "What we have is an enormous social change in terms of what is considered acceptable behavior."
     Although the steep decline in cigarette sales has been a public health boon, it has become something of a financial problem for some states. Because industry payments to states are based to some extent on the number of cigarettes sold, the settlement revenue has dropped. The 46 states that signed the settlement initially expected about $6.5 billion this spring, for instance, but the tobacco companies have said that they may be entitled to cut the payments by as much as $1.2 billion this year. Some of that decline would be the result of dropping sales, and some could come from other adjustments allowed under the settlement.
     In particular, the tobacco companies have said, the agreement allows them to reduce payments if their collective market share falls below a certain threshold -- something they say occurred in 2003. The states disputed that interpretation and the issue is in arbitration. But Iowa Attorney General Miller said states are ready for reductions in tobacco payments that are based on declining sales, and even welcome them. "We knew from the beginning that if we succeeded in changing the cigarette culture, that sales would drop and so would our payments," he said. "But states deal with rising and declining revenues all the time, and this is one decline we're quite happy to see."



Some Sleeping Pill Users Range Far Beyond Bed
Stephanie Saul, New York Times- 3/8/2006

With a tendency to stare zombie-like and run into stationary objects, a new species of impaired motorist is hitting the roads: the Ambien driver. Ambien, the nation's best-selling prescription sleeping pill, is showing up with regularity as a factor in traffic arrests, sometimes involving drivers who later say they were sleep-driving and have no memory of taking the wheel after taking the drug. In some state toxicology laboratories Ambien makes the top 10 list of drugs found in impaired drivers. Wisconsin officials identified Ambien in the bloodstreams of 187 arrested drivers from 1999 to 2004. And as a more people are taking the drug — 26.5 million prescriptions in this country last year — there are signs that Ambien-related driving arrests are on the rise. In Washington State, for example, officials counted 78 impaired-driving arrests in which Ambien was a factor last year, up from 56 in 2004.
      Ambien's maker, Sanofi-Aventis, says the drug's record after 13 years of use in this country shows it is safe when taken as directed. But a spokeswoman, Melissa Feltmann, wrote in an e-mail message, "We are aware of reports of people driving while sleepwalking, and those reports have been provided to the U.S. Food and Drug Administration as part of our ongoing postmarketing evaluation about the safety of our products." A spokeswoman for the F.D.A. said the drug's current label warnings, which say it should not be used with alcohol and in some cases could cause sleepwalking or hallucinations, were adequate. "People should be aware of that," said the spokeswoman, Susan Cruzan.
     While alcohol and other drugs are sometimes also involved in the Ambien traffic cases, the drivers tend to stand out from other under-the-influence motorists. The behavior can include driving in the wrong direction or slamming into light poles or parked vehicles, as well as seeming oblivious to the arresting officers, according to a presentation last month at a meeting of forensic scientists. "These cases are just extremely bizarre, with extreme impairment," said Laura J. Liddicoat, the forensic toxicology supervisor at a state-run lab in Wisconsin who made the presentation. Her presentation, which reported on six of the cases, was made at a meeting of the American Academy of Forensic Sciences, where her counterparts from other parts of the country swapped similar tales.
     Several of Ms. Liddicoat's cases involved drivers whose blood revealed evidence of Ambien overdoses. In one of them the driver, who was also taking the antidepressant citalopram, crashed into a parked car, was involved in another near collision, then drove over a curb. When confronted by police, he did not recall any of the recent events, according to the presentation. Ms. Liddicoat did not describe any of those cases as sleep-driving — in fact, she said she had not heard of that defense — and it is possible that some drivers' claims of driving while asleep may be mere Ambien alibis. But some medical researchers say reports of sleep-driving are plausible.
     Doctors affiliated with the University of Minnesota Medical Center who have studied Ambien recently reported the cases of two users who told doctors they sleep-drove to the supermarket while under the drug's influence. Neither of the patients remembered the episode the next day, according to Dr. Carlos Schenck, an expert in sleep disorders who is the lead researcher in the study. "Luckily, neither of them got hurt," said Dr. Schenck, who added that sleep-driving — which really occurs in a twilight state between sleep and wakefulness — was more common than people generally suspect. He said he believed that Ambien was an excellent sleep agent, but that patients need to be better warned about its potential side effects.
     The traffic cases around the country include that of Dwayne Cribb, a longtime probation and parole officer in Rock Hill, S.C. Mr. Cribb says he remembers nothing after taking Ambien before bed last Halloween — until he awoke in jail to learn he had left his bed and gone for a drive, smashed into a parked van and driven away before crashing into a tree. Mr. Cribb is still facing charges of leaving the scene of an accident. A registered nurse who lives outside Denver took Ambien before going to sleep one night in January 2003. Sometime later — she says she remembers none of the episode — she got into her car wearing only a thin nightshirt in 20-degree weather, had a fender bender, urinated in the middle of an intersection, then became violent with police officers, according to her lawyer. The woman, whose lawyer says she previously had a pristine traffic record, eventually pleaded guilty to a reduced charge of careless driving after the prosecutors partly accepted her version of events, said the lawyer, Lloyd L. Boyer.
     Many states do not currently test for Ambien when making impaired- driving arrests. But a survey still under way by a committee from the forensic sciences group and the Society of Forensic Toxicologists found that among laboratories that conduct tests of drivers' blood samples for two dozen states, 10 labs list Ambien among the top 10 drugs found in impaired drivers, according to Dr. Sarah Kerrigan, a forensic toxicologist in Houston involved in that survey.
     Ms. Liddicoat, in Wisconsin, is among experts who suggest that Ambien may need a stronger warning label. Others arguing that case include doctors, Ambien users and defense lawyers. "Doctors are handing out these drugs like Pez," said William C. Head, an Atlanta lawyer who is one of the nation's leading defense lawyers specializing in impaired-driving cases.
     The F.D.A., which would have to order any labeling changes, says it is not aware of any pattern of problems with the drug. Still Ms. Cruzan, in response to a reporter's question, said the agency would look into unusual sleepwalking episodes. Including the notifications from Sanofi, which as a matter of policy the F.D.A. declined to discuss, the agency did receive 48 "adverse event" reports in 2004 involving Ambien use without other drugs. They involved three cases of sleepwalking, six reports of hallucinations and one traffic accident.
     Ambien's competitors — Lunesta by Sepracor and Sonata by King Pharmaceuticals — are not as widely used in this country, and do not seem to be cropping up with any frequency on police blotters. Ambien sales last year reached $2.2 billion, according to IMS Health. Among the three drugs, Ambien accounted for 84 percent of prescriptions dispensed.
     A federal prosecutor was persuaded that Ambien played a part in a well-publicized case last summer involving not a car but an airliner. A US Airways flight from Charlotte, N.C., to London last July was diverted to Boston, after a passenger who had taken Ambien became "like the Incredible Hulk all of a sudden," according to his lawyer. The man, Sean Joyce, a British painting contractor, became agitated, tore off his shirt and threatened to kill himself and fellow passengers, according to court documents. If convicted, Mr. Joyce could have faced a maximum sentence of 20 years in jail for interfering with a flight crew, according to his lawyer, Michael C. Andrews. But under a plea agreement Mr. Joyce was sentenced to five days already served, after the prosecutor accepted his story that his eruption, which he said he could not recall at all, occurred as a result of taking one Ambien pill and drinking two individual-serving bottles of wine. Many of the impaired-driving cases involve people who drank alcohol before taking Ambien. Mr. Cribb, for instance, said he had two beers with dinner before he took the drug and went to bed.
     Sanofi-Aventis says that while sleepwalking may occur while taking Ambien, the drug may not be the cause. It also notes that the warnings with Ambien, including those in its television ads, specifically instruct patients not to use it with alcohol and to take it right before bed. Alcohol has sometimes been shown to cause sleepwalking, and it can also magnify Ambien's effects, according to Dr. Mark Mahowald, director of the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center, who is also involved in Dr. Schenck's study. In the past, the center has received grant funding from Sepracor, Lunesta's maker, but Dr. Mahowald said that none of the researchers currently received any funding from sleeping pill companies.
     Ambien's alcohol warning is apparently ignored by many people. But Mr. Head, the defense lawyer, says he has concluded that no one should take Ambien the same evening they have been drinking alcohol. "Not even a toast," he said. Mr. Head is now defending a man in Decatur, Ga., who, after having three drinks one night, said he took two Ambien and was in bed watching David Letterman's monologue on television. Without realizing it, the man says, he got back out of bed and behind the wheel and was arrested on multiple charges that included driving on the wrong side of the road.
     Too many other people taking Ambien also evidently disregard the other label guidelines. Ann Marie Gordon, manager of Washington State's toxicology lab, said that many of those arrested reported that they took Ambien while driving so it would "kick in" by the time they got home. "Hello — it kicked in before you got home?" Ms. Gordon said. "That's not a good thing. I'm amazed at the number of people who do that."
     But misuse of the drug may not explain all the cases. The nurse near Denver took a single Ambien and went to bed, according to her lawyer, Mr. Boyer of Englewood, Colo. Mr. Boyer said that only when the woman returned home after her arrest did she discover a partly consumed bottle of wine on her counter — unopened when she went to bed, she said — leading her to suspect she had begun drinking after taking Ambien.
     Research by Dr. Schenck and others elsewhere have found evidence that Ambien users engaged, unawares, in various middle-of-the-night behaviors. In a study published in 2001, researchers at the Mayo Clinic Sleep Disorders Center reported on five cases of unusual nighttime eating, sometimes while sleepwalking, in patients taking Ambien. The chief of physical medicine and rehabilitation for the VA North Texas Health System in Dallas, Dr. Weibin Yang, said he became aware of Ambien's potential side effects while at another hospital treating a 55-year-old patient after hip surgery. The man, who had no history of sleepwalking, walked into a hospital corridor one night, where he urinated on the floor. On another night, he got out of bed and told nurses he was going to church. Dr. Yang said the patient was also taking other medications, but the sleepwalking stopped when Ambien was discontinued. The patient, he said, had no recollection of either event. Dr. Yang said such experiences persuaded him that people could drive, without realizing it, after taking Ambien.
     Meanwhile in South Carolina, Mr. Cribb, who has already pleaded guilty to driving under the influence, still faces a charge of leaving the scene of an accident. He says he has sworn off Ambien. "There has to be a stronger warning," he said, "about what this drug does to you."



New York Puts Mental Patients in Homes Illegally, Groups Say
Richard Perez-Pena, New York Times- 3/8/2006

New York State regularly sends patients from mental hospitals to nursing homes, where it illegally houses hundreds of them without the care they need and often under conditions that approach imprisonment, according to legal groups designated by the state to represent the disabled. Those groups said they would file a lawsuit today in Federal District Court in Brooklyn, accusing New York State of violating several federal laws and claiming that many of the mentally ill patients who have been moved from state psychiatric hospitals into the nursing homes should instead be back in their own neighborhoods, living independently but with government help.
      The groups say that they have talked with the Pataki administration for years, seeking to end the practice, but that the problem has worsened. They say more than 1,000 former psychiatric patients could now be in nursing homes in New York and New Jersey. They charge that 500 to 600 are in two New Jersey homes alone, nearly twice as many as in 2002 when the practice first came to light. The groups charge that the nursing homes do little more than medicate the mentally ill residents and do not adequately provide the services that the state is legally required to offer — treatment by psychiatrists and social workers, and training in everyday skills like shopping and cooking. The mentally ill residents, who have not been declared a threat to themselves or others, are generally not allowed to leave the nursing homes and in many cases are even restricted to their floors most of the day, the groups say. "The state is warehousing people in nursing homes who don't need nursing home care, and not providing the services that they do need," said Cliff Zucker, executive director of Disability Advocates Inc., one of the groups filing the suit. Those who are sent out of state, he said, are isolated from family and other sources of support.
     Jill Daniels, a spokeswoman for the state's Office of Mental Health, which runs the psychiatric hospitals, said the patients were being properly discharged to nursing homes, and that the state was following federal guidelines about doing so. She said they were all screened and deemed in need of nursing home care. And she said the residents were receiving proper "clinical treatment."
     The suit does not accuse the nursing homes of wrongdoing, but it draws a disturbing picture of life there for the patients, arguing that the homes are simply not equipped to handle them. It says that one plaintiff, Bradley W. — the suit does not use full names to protect patients' privacy — was discharged last year from Rockland Psychiatric Center in Orangeburg, N.Y., to a nursing home in New Jersey, "and is required to wear an electronic wristband on his wrist that would signal an alarm if he tried to leave." Edwin T. "is permitted to leave the floor and go outside only at designated times to smoke and to play basketball," it says, and Lisa H. is not allowed to go to her church. "Carlos S. sees the psychiatrist once per month, for medication purposes only."
     Under Gov. George E. Pataki, the state has cut the population of its psychiatric hospitals by more than half, to about 4,000, in part to save money. Throughout that effort, people who work with the mentally ill have complained that for many of those patients, the state did not provide the right alternatives to hospitalization. The state has placed thousands of people in large adult homes where, The New York Times reported in 2002, many were merely warehoused, neglected and even abused.
     Patients and lawyers and other professionals working on their behalf contend that the ideal setting for many people released from mental hospitals is "community-based housing" — either small group residences or individual apartments — paid for by the state, with an array of support services and a high degree of independence. But for years, the Pataki administration discharged people from hospitals much faster than it added community housing. In the last three years, the state committed itself to increasing this housing by several thousand units, but the demand still far exceeds the supply.
     For the last decade, the state has also sent large numbers of people from mental hospitals to nursing homes, and it has been accused of doing so as a way to save money. The state, for instance, pays the entire cost of community housing for the mentally ill, but when those people are instead placed in nursing homes, the costs are paid by Medicaid, and thus split among the federal government, the state and local governments.
     Roger A. Bearden, a lawyer for Disability Advocates, said, "In discharge papers, the clinical reason given time and time again for sending them to the nursing homes is 'medication management,' which is and can be performed in the community." Disability Advocates is one of several nonprofit legal groups named by the state, under a federal grant program, to represent people with disabilities. Another group with that same state designation, New York Lawyers for the Public Interest, is helping represent the plaintiffs in the suit. One of the plaintiffs in the case is Sidney Hirschfeld, director of one of four Mental Hygiene Legal Service offices that are part of the state court system, created by state law to do similar work for the mentally ill.
     The suit accuses New York State of violating the Americans With Disabilities Act, a 1990 federal law, by unnecessarily segregating mental patients from the population at large and preventing them from taking advantage of other government services. When The Times reported in 2002 that New York had placed hundreds of former psychiatric patients in nursing homes in New Jersey, Gov. James E. McGreevey, the New Jersey governor then and other New Jersey officials protested the practice and said they were unaware that the practice was so common. They dropped the matter the next year, saying that they had found nothing inappropriate about the practice, and had concluded that it did not cost New Jersey any money. The suit focuses primarily on the two large New Jersey homes, Andover Subacute and Rehabilitation Center II, in Sussex County, and Lincoln Park Care Center, in Morris County, but it also names nine others in Queens, mostly on the Rockaway Peninsula.



Obsessive-Compulsive Behavior & Child Care
Stacey Colino, Washington Post- 3/8/2006

When each of her three kids was an infant, Nichole Ahern of Chevy Chase had recurring visions of tumbling down the stairs with the baby in her arms. Last fall, Mindy Walker of Westchester, N.Y., had fleeting thoughts of letting her infant daughter drop out of her arms. Adele Morgan of Hillsborough, N.J., says that the challenges of caring for her first baby made her think about putting him in the microwave or throwing him off the deck when he wouldn't stop crying. None of these women ever harmed their babies, and all are successful, loving mothers. And these kinds of intrusive, unwanted thoughts -- mild versions of those associated with obsessive-compulsive disorder (OCD) -- are extremely common among new parents.
      In a study of 85 new mothers and fathers conducted at the Mayo Clinic in Rochester, Minn., researchers found that 89 percent experienced distressing, intrusive thoughts related to their infants: images of the baby suffocating or being contaminated with germs, or worries about the baby having an accident, being harmed or kidnapped.
     Most new parents take these unwanted thoughts in stride, and try to neutralize them by reassuring themselves, checking on the baby or enlisting support from others, the study found. "For most parents, this is just mental noise," says Jonathan Abramowitz, a psychologist and director of the OCD/Anxiety Disorders Program at the Mayo Clinic. "They dismiss it and move on." Abramowitz admits to having had these thoughts as a new parent himself: While burping his daughters when they were infants, he sometimes considered what would happen if he whacked them too hard. While giving them baths, he occasionally wondered how hard it would be to drown a child.
     But some new parents get very troubled about these thoughts. "People tend to become more distressed by these bad thoughts if they interpret them as meaningful or if they believe they should be able to control their thoughts," Abramowitz says. "They're the ones that develop problems." Indeed, some women -- like Morgan-- develop clinically significant symptoms of OCD during pregnancy or the postpartum period -- a phenomenon that is vastly under-recognized, experts say.
     While reliable statistics on postpartum OCD are lacking, the lifetime incidence of OCD in the general population is believed to be 2 to 3 percent. What distinguishes OCD symptoms from normal intrusive thoughts is partly the extent to which these ideas are anxiety provoking, irrepressible and persistent. "To have a real obsession, it's an intrusive, unbidden thought, idea, or image that comes to your mind that you do not want and actively try to resist," explains Gerald Nestadt, a professor of psychiatry at the Johns Hopkins Medical Institutions in Baltimore. "You can't get rid of the thought."
     Shortly after Vicky Valentine Henry, of Glen Allen, Va., gave birth to her son in March 2001, she began having distressing thoughts: While driving, she'd envision stopping short and her son flying through the windshield. She had fleeting visions of drowning him in the bath. Checking on him repeatedly during the night, to make sure he was still breathing, left her exhausted. She began feeling hopeless, worthless and guilty -- all signs of postpartum depression. But it wasn't until she saw a TV report about postpartum depression and OCD that she realized her experience was not unique. Although her obsessive thoughts and compulsive behaviors subsided by the time her son was 9 months old, Henry needed talk therapy, an antidepressant, family support and her religious faith to gradually regain her balanced mood. "And I began thoroughly enjoying motherhood," says Henry. "I only wish it could have happened sooner." She is now a volunteer state coordinator for Postpartum Support International, a group dedicated to postpartum mental health.
     Some experts believe postpartum OCD occurs primarily in women who already have the condition, sometimes in a mild and undiagnosed form. Complicating matters, postpartum depression and OCD often go together, but many women and their clinicians focus exclusively on the depressive symptoms. Yet a study at Case Western Reserve University in Cleveland found that postpartum depression is accompanied by obsessive thoughts in 57 percent of new mothers.
     The extensive media coverage of mothers who kill their kids (as in the widely reported 2001 incident where Andrea Yates drowned her five children) makes some new parents with intrusive thoughts worry whether they're headed down a similar path. In most cases they are not. But just being exposed to such stories can fuel the thoughts, Abramowitz says. "You read things in the news, and it's normal to incorporate that into your experience."
     Not long ago, Diana Dell, an assistant professor of psychiatry and obstetrics-gynecology at the Duke University Medical Center in Durham, N.C., treated a woman with recurring fears during pregnancy that she might put her baby in the dryer. "It came from some dumb thing she saw in a movie," Dell recalls. "She recognized that these thoughts were irrational . . . but just having them caused her to be anxious." With the help of medication and therapy, the mother fared well, Dell reports, and so did the baby.
     There are key differences between obsessive thoughts and postpartum psychosis, explains Shaila Misri, a reproductive psychiatrist and director of the reproductive mental health program at BC Women's Hospital and Health Center in Vancouver, B.C. Obsessive symptoms tend to be "repetitive, unwanted thoughts that the person is aware are not normal even though she is unable to stop them," she explains. With psychotic symptoms, "the repetitive, unwanted thoughts are actually delusional, and the person who is having them believes they are real." While women with OCD rarely harm their children, Misri adds, "those with postpartum psychosis are in very real danger of doing so." But "postpartum OCD can and sometimes does evolve into psychosis, and that is why you have to watch it," Misri says. One of her patients had OCD during pregnancy, became psychotic during the postpartum period, and killed her baby. It was, Misri says, "a very extreme case."
     Many new parents overcome unwelcome thoughts without professional help. But when the obsessive thoughts or compulsions interfere with a parent's ability to function or bond with the baby, or if they cause considerable anxiety and distress, it's time to seek help, experts say. Yet there's often a "don't ask, don't tell" dynamic surrounding this subject in the physician's office, experts say. While many doctors screen for postpartum depression these days, few ask about intrusive thoughts, Misri says. Meanwhile, new mothers often feel guilt and shame and stay silent. "A lot of times people are afraid to mention these symptoms because they think if other people knew, they'd lock them up or take the baby away," Dell says. "When I ask new mothers if they're having unwanted, intrusive thoughts, they are often quite relieved to hear that this happens to other people and that there are probably some biological reasons for this . . ."
     Postpartum OCD is diagnosed like any other form of OCD -- according to criteria published in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Treatment for mild cases generally involves cognitive behavioral therapy, a form of talk therapy that helps patients identify and control irrational thoughts. For more severe cases, antidepressant or antipsychotic drugs are often used. The trouble with CBT "there's a time issue for someone who's trying to take care of a baby and is very sick," says Dell. "Medications can give a more rapid response." Says Nestadt, "The very sad thing is that many people who have experienced an onset or exacerbation of OCD during pregnancy or the postpartum period and didn't receive or respond to treatment may be unwilling to have other kids after the experience. . . . To have OCD and worry constantly day after day is dreadful."

 

Connecticut Nixes Psychiatric Hospital For Adolescents
Colin Poitras, Hartford Courant- 3/11/2006

A proposed 36-bed inpatient psychiatric hospital for troubled adolescents in Ledyard is not needed, state officials announced Friday in a decision heralded as a big win for advocates of smaller, community-based care. The $3.1 million hospital had been proposed by the owners of the Stonington Institute, a private, for-profit company based in North Stonington where former Republican state Sen. William Aniskovich serves as the executive director. The Stonington Institute already operates several inpatient programs in North Stonington, including a 45-bed residential treatment facility for youth and a 63-bed rehabilitation program for substance abuse clients, as well as several outpatient centers in eastern Connecticut.
      Plans called for the proposed hospital to have four beds for adolescents in acute or serious emotional, behavioral or psychiatric crisis, with another 32-beds set aside for troubled youths between the ages of 12 and 18 who had stabilized but still needed close inpatient supervision and "sub-acute" care. At a public hearing earlier this year, Aniskovich explained that the new hospital would provide badly needed inpatient adolescent psychiatric beds in Connecticut, particularly in eastern Connecticut. He mentioned a Governor's Blue Ribbon Commission report of 2000 that highlighted the problem of youths in crisis languishing in hospital emergency rooms or stuck in costly hospital rooms because of a lack of available alternatives for care. Aniskovich said that since his company opened a four-bed adolescent psychiatric unit for girls a year ago it has had up to 49 girls on a waiting list. But after reviewing the data more closely, state Office of Health Care Access Commissioner Cristine A. Vogel ruled that the Stonington Institute had failed to demonstrate a clear and compelling need.
     The financial success of the new hospital relied predominately on state Medicaid funds and direct referrals from the state Department of Children and Families. Yet Vogel noted that both the DCF and the Department of Social Services are moving away from large institutions and are instead focusing their therapeutic efforts on new, smaller group homes, specialized foster homes and in-home services for families in need of counseling and care.
     Connecticut Child Advocate Jeanne Milstein praised Vogel's decision as a step in the right direction. "I commend Commissioner Vogel for the thoroughness of her review," Milstein said. "This is a real victory for kids. It's a very significant decision in that we're stopping the building of more big boxes. We can now focus our attention on developing long-overdue home- and community-based treatment."
     Officials at New London's Lawrence & Memorial Hospital and other regional treatment programs were worried about the increased competition for inpatient care and were watching the Stonington plan closely. At least one was pleased by Vogel's decision. "We believe the final decision was pretty clear," said Kelly Anthony, an L&M hospital spokesman. "At a time when the state is developing community-based treatment and support programs for children ... a large adolescent psychiatric hospital doesn't represent the best way to meet the individual needs of adolescents in our region."
     The Stonington Institute proposed the new hospital after it was acquired by one of the nation's largest and most rapidly growing hospital chains, Universal Health Services Inc. of Delaware. Stonington also brought in a former high-ranking DCF official, former deputy commissioner Thomas Gilman, to coordinate the project. A six-term veteran of the legislature and at one point the Senate's second-highest-ranking Republican, Aniskovich was one of the few outspoken supporters of former Gov. John Rowland during the time the governor's office was being investigated for the improper handling of state contracts. Some critics questioned the thoroughness of Vogel's review and approval of the $40 million Stonington-Universal sale in 2004 (a public hearing was never held) and were concerned Vogel, a Rowland appointee, might rubberstamp the proposed hospital plan.
     It was unclear Friday how Vogel's decision would impact Universal's $40 million investment in the company. In 2004, the DCF was forced to renegotiate its multimillion-dollar contract with the facility after concerns were raised about approximately $500,000 in unexplained costs billed to the state.
     Publicity about Stonington's sale to Universal and its questionable bills to the state may have cost Aniskovich re-election in 2004. Aniskovich lost to relatively unknown Democrat J. Edward Meyer in the race for the 12th Senate District in Branford. Meyer's campaign focused on Aniskovich's ties to the embattled former governor and his problems managing the Stonington Institute.



The War at Home
Falling Through the Earth: A Memoir
By Danielle Trussoni.
240 pp. Henry Holt & Company. $23.
Kathryn Harrison, New York Times Book Review- 3/12/2006

In February of 1968, Daniel Trussoni, "a cocksure country boy from a family who thought war would make him a man," arrived in Vietnam. Rather than remain an ordinary grunt in the 25th Infantry Division, he volunteered for a "suicide mission" that would afford him a measure of glory as well as higher pay. What it cost him, and his family, is the subject of a memoir, "Falling Through the Earth," the first book by his daughter and namesake, Danielle Trussoni. Lewis Carroll's "Alice's Adventures Under Ground" provides the author with an apt title; not only had her father been a "tunnel rat," hunting the Vietcong in their notorious subterranean city, but like the eternally young and bemused Alice, Trussoni anticipates revelation from a plunge that will deliver her to the other side of the world. There she intends to make sense of the father whose demons removed her childhood from the family hearth and set it, precariously, on a barstool in a neighborhood dive called Roscoe's.
      Trussoni already understood herself as a daddy's girl when, 11 years old, she happened upon a page in her mother's diary. Drawn in colored pencil was a bar graph that "quantified how much" her mother believed the various members of the family loved her. While Danielle's younger sister rated a 9 out of a possible 10 and her brother scored just a bit higher, Danielle and her father each got a 4. "Mom had balanced the books," Trussoni concluded, "and the two of us didn't measure up." In retrospect the graph would appear to be an ingenuous effort by her mother to predict the damage of the divorce her husband and children didn't know she was plotting; in the moment it confirmed Trussoni's perception that she and her father were bound together, in opposition to the rest of the family.
     Despite the fact that custody of all three children went to his wife, when Dan Trussoni moved out, Danielle followed him: to the other side of the tracks; to a motherless kitchen; to smoke-filled evenings spent in the company of barflies; to lonely nights made lonelier still by the sounds of "married women, divorced women, women with kids, women with tattoos, women with twin sisters: more and more women. . . . screeching and moaning from his bedroom"; and, eventually, to what she believed to be the source of all these dislocations — her father's experience in Vietnam.
     More than 30 years after his tour of duty, Danielle Trussoni set out to discover what happened to the man her father had been before he went to war. She'd heard his stories; she'd studied the pictures he took in Vietnam, including a "trophy photo of his kill," a young man "on a bed of elephant grass. Bullet holes peppered his chest." She'd seen the enemy skull he kept as a kind of fetish. And she knew about Thomas Goodman, the comrade whose death haunted her father. Maybe if she were to descend into the underworld of her father's war, she could begin to understand how it had assumed the power to reach beyond him and ravage his family.
     "Two parts stubborn, one part insane," Daniel Trussoni had believed he "could handle the worst the war had to offer and come out unscathed." Whether naïve, self-destructive or afflicted with hubris, he chose to do battle beneath the jungle floor, in a maze of sweltering, claustrophobic passages that connected arsenals, hospitals and propaganda presses, as well as kitchens and bedrooms — sinister warrens whose entries were hidden and whose byways were mined and tripwired. If it sounds like hell, it was.
     "Falling Through the Earth" cuts back and forth between Trussoni's father's career as a soldier and the subsequent dissolution of his marriage and family. Using her own visit to Vietnam as a means of accessing and revivifying war stories her father, who died last month, told her, Trussoni strings scenes he described into a coherent sequence. When she recounts going down with a guide into the Ben Duoc tunnels (about 45 miles from Ho Chi Minh City, they are the only extant tunnels, preserved as a memorial and as a draw for tourists), the reader understands that penetrating the dank and ill-lit labyrinth is a kind of spell she casts on herself, willing her physical penetration of the actual landscape of her father's past to vouchsafe her entrance into his psychic landscape, territory she must explore in order to understand her father's rage, his alcoholism and his inability to maintain emotional connection to the people he loves. Then, perhaps, she can forgive him and transcend the tough-girl persona she cultivated for a father who rewarded strength and turned his back on frailty.
     Narratives composed of two or more strands present the risk that one will emerge as more gracefully and completely realized, and thus more compelling to the reader. In this case, despite life-and-death stakes, war takes a back seat to family drama, at least in part because the author can report viscerally and intimately only on what she has experienced herself. Too, the central conceit of "Falling Through the Earth" — that a trip to a remote place can transport one to a remote time — is marred by the inclusion of a subplot that introduces a feeling of forced suspense. Upon her arrival in Ho Chi Minh City, Trussoni is unnerved by her wordless transaction with a native in "mirrored aviator sunglasses," a menacing character who, she somehow knows, "wanted to hurt me." The man, never identified, comes to represent the author's vulnerability and panic in Vietnam; he stalks her during her visit and makes himself equally unwelcome on the page, appearing to have been summoned into the text by Trussoni's insistence on taking possession of what isn't, in the end, available to her: her father's experience of war. "Was this how Dad felt in Vietnam — scared and alone, in unfamiliar territory?" she asks herself of her fear of the stranger. "The sense that with a single misguided step he would fall into enemy hands?" That the stalker turns out to be a red herring makes his inclusion the single significant flaw in what is otherwise a finely tuned account of the relationship between Trussoni and her father, a man who betrays the people he loves, visiting on them torments he can't, despite his best effort, contain.
     "That must have been some scary 'Heart of Darkness' " business, a fellow tourist remarks when Danielle explains the mission of a tunnel rat. "Mega-scary," she concurs, but the story she has to tell is less that of a civilized man's encounter with madness and savagery than it is a father-daughter romance scripted after "Bluebeard." Like the bride in the fairy tale, Trussoni can't allow her father his private bloody chamber filled with evidence of carnage. She must open it, confront it and live with what she sees: dismemberment not of the enemy but of the soul who has held her in his thrall for all of her life — her father. The affection, respect and humor she brings to the task of revealing this complicated individual is testimony both to her creative abilities and to the generosity of her spirit.



Band of Sisters
This Changes Everything: The Relational Revolution in Psychology.
By Christina Robb.
454 pp. Farrar, Straus & Giroux. $30
Annie Murphy Paul, New York Times Book Review- 3/12/2006

It began, fittingly enough, in intimate conversations among friends. Relational psychology — based on the idea that connection, not individuation, is the key to human nature — emerged out of discussions among a small group of female psychologists and psychiatrists in the mid-1970's. All of them lived and worked in the Boston area, a kind of Metaphysical Club in Birkenstocks and wooden jewelry.
      In "This Changes Everything," Christina Robb sets out to tell their story, and it gets off to an engaging start: "In 1975, inside a radius of about five miles, three revolutionary projects were afoot," she writes. Robb, a former Boston Globe reporter, focuses in turn on Carol Gilligan, author of the feminist classic "In a Different Voice," about the moral decision making of girls and women; Jean Baker Miller, a trailblazer in the psychology of women who advocated a warmer, more reciprocal relationship between patient and therapist; and Judith Lewis Herman, a clinician and researcher whose work (sometimes done in collaboration with Lisa Hirschman) called attention to sexual violence within the family.
     At the heart of each of these projects was the assumption, as Robb puts it, that "the connections between and among everything and everyone are at least as important as what they connect." This idea went hard against the grain of traditional psychology, which held up the independent, autonomous (and invariably male) self as the pinnacle of development and the primary object of study. Drawing on their personal experience and on their involvement in the women's movement, these thinkers started a homegrown movement of their own. When she sat down to write what would become "In a Different Voice," for instance, Carol Gilligan was a 39-year-old unpublished part-time assistant professor of psychology at Harvard. The essay, Robb tells us, was "Xeroxed and handed and mailed from friend to friend" before it was finally published in an education journal and, in 1982, as a book.
     "This Changes Everything" is full of such intriguing details; Robb meticulously documents the process by which an insight grows into a school of thought. Her early chapters evoke the heady excitement of a time when a total transformation of society seemed possible and even inevitable. The title is borrowed from an exchange between Robb and Jean Baker Miller, who says to the author, "I just hope you really understand, and can get it across, that this changes everything." Robb needs no convincing. She often refers to her subjects by their first names, noting that of the dozens of psychologists she interviewed "several of them had become friends" by the time she started the book, "and are closer friends now"; the book itself is dedicated to three "pioneers of relational psychology." Such partiality, candidly acknowledged, might not pose a problem, except that Robb seems to be actively courting the approval of those she writes about. She is less an inquiring reporter than a faithful scribe, recording their pronouncements without question or challenge.
     And there is much here that calls out for challenge, beginning with the increasingly dubious concepts that have followed on the theorists' original observations. "Relational asking," "connected knowing," "being-in-relation," "self-in-diversity," "en-couraged," "feeling-thoughts" — these grotesqueries describe "a new way of doing science," according to Robb, "a standpoint that is a true alternative to objectivity." This alternative is something called "holding": "Instead of experimenting and then concluding that something is or is not true, the 'holding' scientist holds on to her or his experience of relationship with the subject and makes deductions in the context of that relationship."
     This sounds like something far less than science, but Robb grants it a generous benefit of the doubt. Her indulgence extends even to the more portentous utterances of Gilligan, who speaks of working on "the Edge," in the vital mode she calls "To Be," trying to head off "the Accident," when the desire for connection collides with an unfeeling patriarchy. Robb not only fails to analyze, or at least adequately explain, this windy nonsense, but ventures to add some of her own, writing of Gilligan: "She found the lost treasure of women's voices underwater. Then she hid her knowledge of women and girls there to keep it safe." By now the feeling-thoughts of many readers will verge on exasperated annoyance.
     And yet the idea that relationships are critical to our mental health is an important one — so important that the movement that produced it deserves the tribute of a trenchant examination. What is the intellectual back story on the study of relationships, for example? Despite Robb's contention that "we can't even show love exists if we turn to psychology much before" the arrival of Gilligan et al., the field had in fact cultivated a rich body of work on one such connection, the mother-infant bond: from the "wire monkey" experiments of Harry Harlow, to the attachment theories of John Bowlby, to the psychoanalytic formulations of D. W. Winnicott. It was Winnicott who said that, viewed apart from a mother, "there is no such thing as a baby" — a stark statement of the indispensability of relationships made more than three decades before the relational "revolution."
     Also neglected or dismissed are contemporary skeptics of this school of thought. Although Robb warns that it is "under assault," she offers dark innuendo in place of a vigorous defense. Of conservative commentator Christina Hoff Sommers, a forceful critic of Gilligan, Robb writes, "I believe her work is a protective mask for masculinity and its privileges." More troubling, Robb does not grapple with a growing body of reputable research that undercuts some of these psychologists' most familiar claims, like the notion that girls suffer a dramatic loss of self-esteem at adolescence.
     And finally, while we're assured that relational psychology "changes everything," the book provides very little evidence of its real-world effects. Instead we get empty testimonials: the theorists' ideas will "revolutionize society as well as psychology," Robb writes, paraphrasing Jean Baker Miller. Robb, of course, concurs: "And as the years of my preparation for this book went on, every psychologist and psychiatrist, every social worker, every patient or client I interviewed echoed her, often in the same words. And I began to notice that they were right."
     Robb has written what amounts to an authorized biography of the movement, with all the bland boosterism and careful avoidance of controversy the genre requires. The book has the feel of a project perhaps too long in the making; the author's lengthy immersion in the material, and her close identification with her subjects, has left her unable to discern these thinkers' broadest blind spot: an idealization of relationship that denies the very real value of autonomy. Anyone who has watched a young child revel in her ability to finish a task "all by myself," who has felt relief at the end of an unhappy relationship, who has savored a solitary afternoon, knows that humans hunger for independence as well as connection. It's a point made persuasively, if inadvertently, by Gilligan herself. At one point, her recent departure from Harvard is broached. Gilligan explains that she took a professorship at New York University because she needed a place where she felt "free," where she would not be (in Robb's words) "alternately idealized, valorized, vilified, trivialized or ignored." All the things, that is, that people do to one another in relationships. Even the queen of connection needs her space.



Gay Teens Are Using the System
Seema Mehta, Los Angles Times- 3/12/2006

Gay high school students across California are increasingly using the courts and political activism to fight individual cases of discrimination and to promote tolerance. The moves, educators and legal observers say, come at a time of exponential growth in the number of gay student clubs and an acceptance of homosexuality on high school campuses that would have been unheard of a decade ago. "It's a reflection of the students' desire to not just not be beat up, but to actually have full equality," said Carolyn Laub, executive director of the Gay Straight Alliance Network in San Francisco. "They want to be treated just the same" as their straight classmates.
     Recent examples abound: A lesbian teen sued Garden Grove educators to defend her right to kiss her girlfriend on campus. Bakersfield students sued their district after a principal barred the school newspaper from printing articles about homosexuality that identified gay students by name — even with their parents' permission. Los Angeles Unified settled a harassment suit brought by students by pledging to provide antibias training to students and staff at Washington Prep High School.
     For the last two years, gay students in Los Altos in the Silicon Valley have sparked an off-campus controversy by urging city leaders to create a Gay Pride Day. And hundreds of gay, lesbian and transgender youths converged Monday on Sacramento to champion proposed legislation that would allow the state to withhold funds from districts that fail to abide by a California law that protects gay students from discrimination. Some contend the students are being used as pawns by adult gay activists and argue that school is no place for such volatile issues. "They are being manipulated by the adults to push the gay agenda," said Richard Ackerman, president of the Pro-Family Law Center in Temecula. "My kids should be going [to school] to learn math, reading, writing. It shouldn't be an opportunity for someone else to … destroy the values I have worked so hard to instill in my children."
     But while the American Civil Liberties Union, the Gay Straight Alliance Network and other organizations are involved in lawsuits and political activism, officials with these groups say they are providing legal and organizational help to students who are picking their own battles. "More and more students are realizing, 'Wow, when the principal censors my speech just because it has something to do with sex orientation, that's something that violates the law,' " said Christine Sun, an ACLU attorney representing students in the Garden Grove and Bakersfield cases.
     California schools are seen as more tolerant of students' sexual orientation than those in many other states. In 1999, the state was among the first to outlaw discrimination against gay students. Debates over whether to allow same-sex prom dates or after-school gay-straight alliance clubs are rare in California; by comparison, Utah legislators, to give one example, recently debated a bill that would allow educators to ban such clubs.
     Wayne Joseph, a Chino Valley Unified School District administrator and former high school principal, said school campuses have become more tolerant on sexual issues in recent years. "Kids are willing to express who they are much more openly, and they're not as repressed," said Joseph, an educator for more than 30 years. The activism is fueled by gay students who are being increasingly visible on high school campuses, according to Ritch Savin-Williams, a Cornell University professor and author of "The New Gay Teenager" who has studied gay youth for more than two decades.
     California has more than 500 school-based gay-straight alliance clubs, up from about 40 eight years ago. Several academic studies have found that gay teenagers are coming out, on average, by age 15 or 16 — earlier than ever. And their straight peers tend to be more tolerant of gay rights issues than their parents' generation, according to a recent poll released by Hamilton College in New York showing that 74% of American high school seniors support some form of civil union or gay marriage. "Before, it was more that 'I have an identity and I don't want to be harassed because of it,' " Savin-Williams said. "Now it's, 'This is who I am, these are my attractions, desires, arousals and love affairs, and I have a right to them.' That subtle shift is a very important one because it reflects a sense of empowerment."
     Garden Grove senior Charlene Nguon, 17, is suing the school district for discrimination, arguing that she was punished for being affectionate with her girlfriend on campus while straight classmates exhibiting the same behavior went unchallenged. Nguon is also accusing officials of outing her to her mother and forcing her to transfer to another school to separate her from her girlfriend. In addition to seeking damages and expunging Nguon's disciplinary record, the lawsuit seeks policy changes that would prohibit administrators from selectively enforcing discipline or censoring students because of their sexual orientation. "I don't want things happening to other students that have happened to me," she said. "I just want equality, a safe learning environment for everyone, so gay students don't have to go to school and get suspended for kissing their partner."
     In Northern California, the gay-straight alliance club at Los Altos High School has become increasingly active in its seven years on campus. What began as a forum for students to meet and talk has grown into an effort to leave a larger mark on the community, including hanging "safe zone" posters in classrooms and sponsoring an annual campus film festival of PG-rated gay-themed movies. Two years ago, the teens started lobbying City Hall to proclaim a Gay Pride Day. The effort was initially snubbed, but the council relented after the issue drew attention from adult gay-rights activists and the wider community. The students won a proclamation that year but have since been rebuffed.
     Alyssa Paris Smyth, 18, who graduated last June, was born a male but is in the process of becoming an anatomical female. A member of the Los Altos club while in high school, she said she was crushed when the group's request was denied. "I've lived in Los Altos all my life, and my parents have lived here a very long time. It's my hometown," said Smyth, who began wearing makeup at 14, started taking hormones at 16 and is preparing to get breast implants this year. "My own City Council rejecting the proclamation felt like they were rejecting me." Students plan to keep trying to change council members' minds and hope to hold a parade as well, according to Ruth Gibbs, the student club advisor and administrative secretary. "At first, they were crushed. Now they are getting angry," she said.
     Gay teenagers are also mobilizing in a type of activism more common to college students. About 500 gay, lesbian and transgender youths and their straight allies gathered Monday in Sacramento to lobby for legislation that would force compliance with a 1999 law that offered protection to students who are gay or perceived to be gay. In addition to requiring that sexual orientation and gender identity be included in a school's discrimination policy, the proposal would ensure that teachers and staff are trained to deal with harassment and require documentation of any complaints. Stevie Marino, a senior at Lakewood High School and a lesbian, said she felt it was her duty to attend the rally. "For change to occur, it's more important that young adults go and represent ourselves instead of having adults go and speak for us," she said.



When a Child Is Excluded by Peers
Sandra Boodman, Washington Post- 3/14/2006

It's a time-honored stereotype: the social outcast who ignores the derision of classmates to become a straight-A student, the kid who madly waves his or her hand in a desperate attempt to answer the teacher's every question. Yet the reality, it seems, is starkly different: Researchers who followed 380 Midwestern children from the ages of 5 to 11 found that those who were chronically rejected by their classmates were more likely to withdraw from school activities and scored lower on standardized tests than their more popular peers. "We're talking about kids whose classmates don't let them sit with them in the cafeteria," said lead researcher Eric S. Buhs, an assistant professor of educational psychology at the University of Nebraska-Lincoln. "This is what happens when a whole group demonstrates, 'We don't want you around.' "
     Many educational experts regard peer exclusion as a form of bullying and agree that group rejection is more insidious and harder to address than overt one-on-one acts such as shoving a classmate into a locker or spreading vicious gossip. Ostracism is, they say, particularly devastating to its victims: the only girl not invited to a classmate's sleepover or the boy no one wants to play with at recess.
     Peer-group rejection, Buhs and his co-authors report in a study funded by a grant from the National Institutes of Health, starts as early as kindergarten. It appears to affect boys and girls equally. And it often triggers a vicious circle that can cause long-term psychological damage and impair a child's academic performance. Exclusion obviously makes it difficult for a child to join group activities, so the victim disengages from school as a way of avoiding further abuse. Withdrawal acts as a "persistent signal to classmates" that rejected children are not members of the group and reinforces the ostracism, noted the researchers, whose study appears in the current issue of the Journal of Educational Psychology. Academic achievement can be hampered by diminished participation in class. Buhs's team found that students who were rejected by their peers in kindergarten tended to become children who were chronically rejected in older grades. By fourth grade they scored measurably lower on standardized reading and math tests than their classmates.
     Ted Feinberg, assistant executive director of the 23,000-member National Association of School Psychologists, headquartered in Bethesda, said he was surprised and disturbed by the study's findings. Most research on the effects of peer-group exclusion has focused on secondary school students, he said, not on young children. "My initial impression is that young kids are more malleable and can bounce out of this, but this study suggests that this is not the case," Feinberg said. "It's really important for people not to slough this off" and dismiss it as childish behavior that is best ignored -- or tolerated.
      "Social isolation is one of the most devastating things you can do to a human being; I don't care how old you are," said Rosalind Wiseman, a veteran educator in the District and the author of "Queen Bees and Wannabes," the bestselling book about girls and cliques that became the basis for the movie "Mean Girls." "How are you supposed to concentrate on your schoolwork when all you can think about is 'Everybody hates me'?" Wiseman asked. Some kids, she said, obsess about the problem, while others withdraw and try to avoid school as much as possible.
      Wiseman, co-founder of the Empower Program, an anti-bullying and violence prevention group that works with public and private schools in the Washington area, said that educators have become increasingly aware of the problem of exclusion, one reason for the growing emphasis on group projects. But, she added, the problem of peer rejection is "very difficult stuff to know how to handle well." Often, she said, it involves confronting what bullying experts call "the provocative victim" -- a child with poor social skills who repeatedly fails to pick up cues and gets singled out as a target. Researchers who study bullying have found that these children frequently alternate between anxious withdrawal and overt aggression.
     In Buhs's study, aggression was linked to exclusion. Children who were rated by their peers and teachers as more aggressive in kindergarten were more likely to be excluded by their classmates in fourth grade. To assess acceptance, researchers asked students how much they liked to play with each classmate and how often other kids said bad things about them or barred them from activities. Teachers were asked to rate each child's acceptance by classmates, to report whether a child was aggressive or withdrawn, and how frequently a child sought to leave the classroom or go home from school.
      Wiseman suggests that parents who learn their child is being ostracized try to "avoid freaking out, calling the school and saying, 'I'm coming over right now' to fix it." Instead they should try and remain calm and work with the school to solve the problem, which might involve individual training in social skills for the child. Parents, she added, can enroll their child in an out-of-school activity based on a passion that can become the basis of a bond shared with other children, such as astronomy, horses or Japanese anime. One of the most important first steps for parents, she said, is to listen carefully. "You tell the child you're sorry that this is happening," Wiseman advised. "Then you say, 'Together you and I are going to work on this.' " ·