Noteworthy News Articles on Mental Health Topics, April 7-18, 2006
The people who escaped from collapsed or damaged buildings on Sept. 11, 2001, were several times as likely to suffer from breathing problems or psychological trauma if they were caught in the cloud of trade center dust and debris that covered lower Manhattan, researchers at the U.S. Centers for Disease Control and Prevention said. ''The trauma of being caught in the cloud itself, the whole experience had an impact on their ... psychological health later on,'' said Dr. Robert M. Brackbill, a CDC doctor working with the World Trade Center Health Registry, which has been tracking the health of more than 71,000 people who worked at ground zero or were in the area on Sept. 11. Friday's study drew from preliminary interviews with 8,418 adults in the registry who escaped from the twin towers, the collapsed Seven World Trade Center and more than 30 buildings that suffered extensive damage on Sept. 11. More than 70 percent escaped from the twin towers. The interviews took place more than two years after the attacks, between Sept. 5, 2003, and Nov. 20, 2004, and did not involve medical examinations. Follow-up surveys are planned this month. ''We are just beginning to learn about the health effects of the worst day in New York City's history,'' said Daniel Slippen, a survivor of the attacks and a member of the registry's community advisory board. ''It is critical to know whether these physical and mental effects will continue, diminish or grow worse over time.'' City officials in charge of the registry say it will likely take 20 years or more to determine whether 9/11 exposure led to increased cancer deaths or illnesses among survivors. The study said more than six in 10 were caught in the clouds of trade center dust that enveloped the area. Those people were nearly three times as likely to have respiratory problems, 40 percent more likely to experience severe psychological problems and five times more likely to report suffering a stroke, Brackbill said. More than 56 percent of the survivors said they had new or worsening respiratory ailments, including sinus problems, shortness of breath and a persistent cough. More than 43 percent sustained a physical injury on Sept. 11; the most common were eye injuries. Almost all of the people studied witnessed at least three events likely to cause psychological trauma, such as the collapse of the towers, the deaths or injuries of others or people jumping from the twin towers, the study said. More than 64 percent of the survivors said they were depressed, anxious or had other emotional problems, and nearly 11 percent were in severe psychological distress at the time of their interview, the study said.
The findings, from the city's community health survey, a telephone poll of 10,000 randomly selected adults conducted each year since 2002, confirm what many New Yorkers suspect — that life in the nation's most populous city can be difficult and lonely. Thirteen percent of adults who answered the city's survey last year reported that their mental health was "not good" on 14 or more days of the month, compared with 10 percent in a similar national survey that measured "frequent mental distress," like stress, depression or other emotional problems. The data will be presented today in a conference at Hunter College organized by Dr. Neal L. Cohen, a former city health commissioner. Dr. Lloyd I. Sederer, the executive deputy commissioner for mental hygiene at the health department, said he believed that the higher rate of "frequent mental distress" reported by city residents was statistically significant, although the precise reasons were not clear. "I wish we knew, in a way that we could say with confidence, why that difference is," he said. The survey also contains a separate set of questions, which asked adults whether in the past month they had felt hopeless, nervous, worthless or restless; whether they had felt so sad that nothing could cheer them up; and whether they had felt that "everything was an effort." Those questions, developed by Ronald C. Kessler, a Harvard Medical School professor, measure "nonspecific psychological distress." The department, in a paper that is also being presented today at Hunter College, found that rates of such psychological distress were higher in 2003 among women; Hispanics; people who were divorced, widowed or separated; and people who were poor, ill or chronically unemployed. Only 40 percent of people who reported such distress in 2003 had received counseling or medication for mental illness within the past year. Cited as the most common barriers to mental health treatment were cost (41 percent); not wanting or needing help (11 percent); shame, fear and other beliefs about mental illness (10 percent); procrastination and logistical barriers (each 8 percent); and lack of access to care and negative perceptions of treatment (each 6 percent). The remaining 10 percent cited other reasons. "You put that all together and it adds up to a major public health problem," Dr. Sederer said. "These are common disorders, they're highly prevalent, they are disabling, they cause great human suffering, and they interfere with functioning." Mental illness increases the risk of dying from untreated medical conditions, like diabetes or high blood pressure, and from suicide, he said. In 2004, the city began urging doctors to use a simple questionnaire to screen for depression. This month, the city will bolster that effort with an advertising campaign urging New Yorkers to see a primary-care doctor if they experience signs of depression. The study of the 2003 data will be published in the May issue of The Journal of Urban Health. The lead author is Katharine H. McVeigh, a psychiatric epidemiologist for the city. Bonnie D. Kerker, the city's assistant health commissioner for epidemiology services, said the two measures of distress in the survey were only an approximation of the true prevalence of mental disorders. "There are limitations to self-reported data, although we think it's a fairly good estimate of what's going on in New York, especially over time," she said. The Centers for Disease Control and Prevention, in their Behavioral Risk Factor Surveillance System, an annual national survey, uses the same questions the city uses to measure "frequent mental distress," but does not use the Kessler questions. The city's Department of Health and its Department of Mental Health, Mental Retardation and Alcoholism Services were merged in July 2002, and a key theme of today's conference will be how to better integrate mental health into the regular health care system.
The findings have been published in local news media, helping to draw attention to topics, like domestic abuse and honor killings, that have long been considered taboo in this conservative society. The study was carried out under the supervision of the quasi-governmental General Union of Women, which oversees the welfare of Syria's women. The study included nearly 1,900 families, selected as a random sample, including a broad range of income levels and all regions. The men and women in each family were questioned separately. "In Syria there was simply no data on violence against women; formal studies hadn't ever been done before," said Shirin Shukri, a manager of the project at the United Nations regional office in Amman, Jordan. "The issue of violence against women was kept silent here for many years. But we're making people in Syria aware that this is something that happens everywhere in Europe, in Asia, in the United States, and this is opening up discussion." Hana Qaddoura, a spokeswoman for the General Union of Women, said that breaking the silence on domestic abuse was an essential first step to combating violence. Many Syrians, she said, do not believe that violence in the home "counts" as violence. "There are some forms of violence against women that our society doesn't even see as violence," Ms. Qaddoura said. "It all depends very much on education and income level, but many people see a woman who is beaten as being in a bad relationship; they don't see her as a victim of violence." The women's union said it would try to develop programs to protect women, in response to the study's findings. Advocates of women's rights here say that though the findings of the Syrian study are fairly similar to domestic abuse statistics in other countries, the fact that the official silence on the subject has been broken is in itself a meaningful step. "The most surprising thing is that for the first time in Syria, a semigovernmental organization, the women's union, has admitted that there is a problem," said Maan Abdul Salam, a campaigner for women's rights. Bassam al-Kadi, a rights advocate, said the report was part of a growing openness about many forms of domestic abuse. He has been working on a public information campaign to curb the practice known as honor killings — the killing of women who are believed to have dishonored their families by engaging in illicit sex. "Until two years ago, discussion of honor killing was banned in the Syrian media," Mr. Kadi said. "The incidents might be discussed individually, as 'accidents,' but talking about honor killing as a phenomenon was forbidden. Now these subjects are becoming much more open." Women's advocates say that though any attempt to broaden discussion of domestic violence is welcome, they have seen little effort by the government to address the topic in practical terms. Shelters for battered women are few and poorly publicized, and there are no formal channels for abused women to seek assistance. "As it is now, there are still no mechanisms to report violence against women," Mr. Abdul Salam said. "We hope that this study will soon lead to practical action on the ground." What's Holding Up the Sandman? Jane Brody, New York Times- 4/11/2006 Americans' use of sleeping pills is skyrocketing, up nearly 60 percent since 2000, with about 42 million prescriptions filled last year. Experts surmise that "modern lifestyles" and the accompanying stress of too much to do in too little time are largely responsible for the growing need for the drugs. That may be true. But I see an altogether different explanation for the flagrant use of sleeping pills. In the last decade, there has been a sea change in the kinds of drugs available to induce sleep, and these drugs have been widely promoted in print and on television. You could hardly have missed that pale green luna moth (sans antennas) drifting over peaceful sleepers in ads for Lunesta, which has joined Ambien, Sonata and others in a new class of sleep aid. A Tempting Offer Unfortunately, with the ease of writing and filling a prescription and the mostly good press these new drugs have gotten to date, millions of people are now taking them without first exploring the reasons for their sleep problems and possible nondrug routes to cure them. Insomnia can have serious underlying causes. Failure to diagnose and treat these causes merely perpetuates the need for sleep medications, allows a health problem to worsen and in some cases can prove life-threatening. No one questions the value of a good night's sleep. Whether you are biologically programmed to sleep 4 hours, 10 hours, or, like most people, 7 or 8 hours a night, failure to get the amount of sleep you need can impair learning and memory, problem-solving ability, safety, emotional stability, immune defenses, cardiovascular health and even body weight. Sleep-deprived people tend to be irritable, impatient, moody, unable to cope well with stress and too tired to do the things they enjoy. Their appetite-controlling hormones are disrupted and may lead to overeating and weight gain. Resulting daytime sleepiness can impair work performance and result in accidents. Insomnia describes various forms of sleep disturbances that result in unrefreshing sleep or too few hours of sleep: difficulty falling asleep, frequent awakenings, waking up too early and being unable to fall back to sleep. Insomnia is classified medically according to its cause and duration. It can be a primary disorder caused by a biochemical or neurological disruption of a person's ability to sleep. Among these are restless leg syndrome, characterized by maddening sensations that compel sleepers to kick their legs when they lie down; obstructive sleep apnea, in which breathing periodically stops and sometimes awakens the sleeper; and circadian rhythm disorders, in which a person's sleep-wake cycle is out of whack. Treatments are available for all primary sleep disorders, but sleeping pills are not among them. With regard to duration, transient insomnia, which usually lasts no more than a week, is typically associated with a short-lived situation or stress: jet lag, a new job, a temporary illness or pain, a deadline or exam, overexcitement, a change in sleep schedule or sleeping in a strange place. Short-term insomnia usually lasts several weeks but can run to six months. It commonly results from a more persistent stress: loss of a loved one, divorce, a new job, financial difficulties, a serious illness or environmental disturbances like noise. Chronic insomnia, which afflicts 10 to 15 percent of the population, can stem from serious physical or emotional problems that persist for many months or years. Medications taken for other health problems can also result in chronic insomnia. Coping with the sleep problem requires identifying the underlying health factor causing it and treating that condition appropriately. Simply taking a sleep aid is not the solution, though that or other drugs may be part of the treatment. For example, anxiety disorders and persistent depression are common psychiatric causes of chronic insomnia, as are bipolar disorder, panic disorder and post-traumatic stress disorder. Some depressed people sleep too much; others can't sleep enough, typically awakening early in the morning and being unable to go back to sleep. The treatment for the resulting insomnia is to acknowledge and treat the underlying emotional disorder — with psychotherapy, cognitive behavioral therapy and often psychotherapeutic medication. Physical causes of chronic insomnia include heart disease, diabetes, obstructive pulmonary disease, chronic reflux, restless leg syndrome, incontinence, hyperthyroidism, chronic headaches, painful arthritis, fibromyalgia and other chronic pain syndromes, epilepsy, Parkinson's disease, advanced cancer, dementia and sleep apnea. Women are more likely than men to suffer from chronic insomnia. In pregnant women insomnia may last several months. During and after menopause, many women are plagued with frequent hot flashes that can disrupt sleep for months or years. Creating a Cycle The list of medications that can interfere with sleep is long indeed. They include corticosteroids, decongestants, diuretics, anticonvulsants, antihypertensives, bronchodilators, MAO inhibitors, thyroid hormone, theophylline, beta blockers and stimulants for the central nervous system. Recreational drugs can also be a problem. Among those that interfere with sleep are stimulants, caffeine, nicotine and alcohol. The infamous nightcap may help you fall asleep initially, but later in the night alcohol disrupts sound sleep. Rather than simply write a prescription for a sleeping pill, a physician should try to find the cause by taking a thorough history. Depending on the findings, the history may be followed by a physical exam, especially important if the patient has any of the physical causes of insomnia, or if sleep apnea or restless leg syndrome is suspected. Sometimes spending a night or two in a sleep laboratory is needed to find a cause for insomnia. Many people with sleep apnea are unaware of the dozens of "microawakenings" that cause excessive daytime sleepiness and increase their risk of dying early from heart disease.
The scientists compared 8 people who used tanning salons 8 to 15 times a month with 8 who visited no more than 12 times a year. Their findings appear this month in The Journal of the American Academy of Dermatology. At each of four visits, participants took increasingly larger doses of either a placebo or Naltrexone, which blocks opioid receptors and induces withdrawal symptoms in those addicted to opioids. Each was randomly assigned to tan for 10 minutes under either an ultraviolet light or an identical-looking nonultraviolet light. Frequent tanners who received a placebo exhibited greater preference for the ultraviolet light compared with nonfrequent tanners. No adverse effects were reported among the infrequent tanners at any dose of Naltrexone, but at a 15-milligram dose, four of the eight frequent tanners began to experience nausea or jitteriness, consistent with opiate withdrawal. Ultraviolet radiation, the authors suggest, may produce endorphins, which have properties like opioids. The results suggest a physiological explanation for previous reports, including one last year in Archives of Dermatology, that some people are obsessive sunbathers. "I don't think we've proven that tanning is addictive," said Dr. Steven R. Feldman, senior author of the paper and a professor of dermatology at Wake Forest. "But people aren't tanning just to look good. Anyone who goes to the beach and lies out in the sun knows how pleasant and relaxing it is."| Boston Globe, 4/11/2006 CHICAGO -- The rise in autism cases is not evidence of an epidemic but reflects better diagnosis of autism by schools, according to a study released last week. Government health authorities have been trying to allay widely publicized concerns that vaccines containing the mercury-containing preservative therimerosal, which is no longer used, were behind an autism epidemic. There may be as yet unknown environmental triggers behind autism, study author Paul Shattuck of the University of Wisconsin at Madison said, but his research suggests that the past decade's rise in autism cases was more of a labeling issue. Autism was fully recognized in 1994 by all US states as a behavioral classification for schoolchildren, who receive individualized attention whatever their diagnosis, he wrote in the journal Pediatrics. Subsequent increases in the number of autism cases have varied widely by state, but the average prevalence among 6- to 11-year-olds enrolled in special education programs increased from 0.6 per 1,000 pupils in 1994 to 3.1 per 1,000 in 2003. During the same period, diagnoses of mental retardation fell by 2.8 per 1,000 students, and diagnoses of learning disabilities dropped by 8.3 per 1,000 students. Autism is a spectrum of disorders caused by abnormal brain development that can lead to diminished social skills as well as unusual ways of learning and reactions to sensations. As many as 6 in 1,000 children are ultimately diagnosed with it to some degree, according to the Autism Society of America. Shattuck's analysis was challenged in an accompanying commentary by autism researcher Craig Newschaffer of Johns Hopkins Bloomberg School of Public Health in Baltimore. ''We do not know whether individual children have switched classifications, and, of course, we can never know whether a given child in a particular birth cohort would have been classified differently had they been born either earlier or later. At best, analyses of this type are merely trying to determine if trends in one classification have the potential to offset those in another," he wrote. There is a clear need for definitive studies into the roles played by genetic susceptibility and environmental triggers in autism, Newschaffer wrote. But when Janssen sponsored its own studies comparing the two drugs, Risperdal came out ahead in three out of four. In fact, when psychiatrist John Davis analyzed every publicly available trial funded by the pharmaceutical industry pitting five new antipsychotic drugs against one another, nine in 10 showed that the best drug was the one made by the company funding the study. "On the basis of these contrasting findings in head-to-head trials, it appears that whichever company sponsors the trial produces the better antipsychotic drug," Davis and others wrote in the American Journal of Psychiatry. Such studies make up the bulk of the evidence that American doctors rely on to prescribe $10 billion worth of antipsychotic medications each year. Davis pointed out the potential biases in design and interpretation that produced such contradictory results. Other experts note that industry studies invariably seek to boost the image of expensive drugs that are still under patent. Moreover, they say, the trials are relatively brief and test drugs on patients with simpler problems than doctors typically encounter in daily practice. By contrast, when the federal government recently compared a broader range of drugs in typical schizophrenia patients in a lengthy trial, two medications that stood out were cheaper drugs not under patent. The medication that worked best for patients with severe, intractable schizophrenia was clozapine, whose sales lag well behind every other drug in its class. And an earlier leg of the study found that the largely unused drug perphenazine had about the same risks and benefits as far more expensive competitors that are widely assumed to be safer. Reliance on industry-sponsored studies is not limited to psychiatry, but experts say the problem is exacerbated in areas of medicine where the goal of trials is not to demonstrate cures but to measure symptomatic relief, which allows more latitude in how the results are interpreted and marketed. Now a growing chorus of experts is asking whether the research establishment needs to be reoriented toward publicly funded studies that might better guide clinical decisions and the billions of tax dollars the government itself spends on treatment. "A perfectly independent agency has to be set up that says, 'Here are the areas where trials must be done,' " said Drummond Rennie, deputy editor of the Journal of the American Medical Association. "There will be two classes of trials -- the believable ones and the non-believable ones." The problem is not that companies fabricate results, experts say. Researchers, in fact, want drugmakers to sponsor more studies, not fewer. But ostensibly valid industry studies can be misleading in multiple ways, Davis said. Some use too low a dose of a competitor's drug, while others choose statistical techniques that show their drug in the best light. Virtually all test drugs on patients with relatively straightforward problems. Davis warned that the circular results he found could undermine the confidence of clinicians and patients, and even cast doubt on medications that are genuinely superior. He and Rennie also questioned academic researchers' role in these studies. Davis, who joked in an interview that he no longer gets to fly first class to Tokyo and Monte Carlo since he stopped accepting money from pharmaceutical companies, guessed that 90 percent of industry-sponsored studies that boast a prominent academic as the lead author are conducted by a company that later enlists a university researcher as the "author." "We know that happens all the time," Rennie said. "The only reason that the company wants a non-company person as an author is to give credence to an advertisement. . . . The whole entire paper from start to finish is an advertisement. It is a much more subtle and telling ad than anything they can publish as an ad." Drugmakers defend their studies, and Davis emphasized that the drugs do help patients. But doctors, he said, cannot afford to take the results at face value. Sara Corya, medical director for neuroscience at Eli Lilly, a company Davis singled out for praise for the quality of its studies, said that conflicting results do not cancel each other out, and that they help clinicians understand the strengths of different drugs. Corya and Davis noted that Lilly has strict rules to prevent author-shopping. "The reality is that even in head-to-head comparisons, study results will differ for a variety of reasons, some transparent, some opaque," added Mariann Caprino, a spokeswoman for Pfizer, whose antipsychotic drug Geodon did not perform as well as Zyprexa in two trials funded by Eli Lilly. Pfizer's own studies found that Geodon was superior to Zyprexa in one trial and inferior in another. "What this all means," Caprino said, "is there is no substitute for the judgment and experience of the clinician in selecting among a fortunately broad palette of medicines." But several experts say industry-sponsored trials are failing to answer the questions doctors really need answered: Which drug works best for which patient? Are differences in drugs worth the differences in cost? How many patients are likely to recover entirely, rather than just show progress in the right direction? Head-to-head trials of similar medications may show statistical differences in how they perform, but those differences may not mean very much for doctors and patients, said Robert Rosenheck, a Yale psychiatrist. What a clinician wants to know is whether the patient she is treating will get better on a drug, said Thomas R. Insel, director of the National Institute of Mental Health. "If they are not going to get well, what is the better approach? The public is less interested in statistical significance and more interested in clinical significance." The difference between the two was highlighted by the recent study of antipsychotic drugs funded by the National Institute of Mental Health. Rather than focus on how some symptom or side effect waxes and wanes, the government trial focused on the big picture: How do typical schizophrenia patients fare on the drugs over the long term? The results were sobering: Regardless of the drug, three-quarters of all patients stopped taking it, either because it did not make them better or had intolerable side effects. The discontinuation rates remained high when they were switched to a new drug, but patients stayed on clozapine about 11 months, compared with only three months for Seroquel, Risperdal or Zyprexa, which are far more heavily marketed -- and dominate sales. "Clozapine is better by far than the other antipsychotics," said Carol Tamminga, a psychiatry professor at the University of Texas Southwestern Medical Center at Dallas, who wrote an editorial in the American Journal of Psychiatry about the trial. "The question is: Why do doctors not use it?" The drug requires more careful monitoring to prevent potentially fatal bone-marrow toxicity, she said, but a national monitoring program ensures it is used properly. Tamminga agreed that marketing may play a role in why the drug is not used more often. "Clozapine is less marketed," she said. "It is off patent. Even when it was on patent, it has never been as actively marketed as the other drugs." The government study also provided the big picture missing from company-sponsored trials, said Jeffrey Lieberman, a Columbia University psychiatrist who led the first phase of the study: "The drugs work, but only so well. They are not meeting expectations." By focusing on the horse race -- which drug is marginally better -- industry studies obscure the reality that better drugs are needed overall, agreed Rennie, who is a professor of medicine at the University of California at San Francisco. "Finding the 100th similar antipsychotic drug is not where the research should be," he said. "It should be to develop new drugs, not 'me, too' drugs." Rennie said that government agencies such as the Centers for Medicaid and Medicare Services and the Department of Veterans Affairs that disburse billions of dollars for treatment should rely on publicly funded studies. "There are lots of questions that drug companies are not going to be primarily interested in," agreed Robert Temple, a senior official at the Food and Drug Administration. He has long been a personal advocate of what he calls a "national problems laboratory." But Uwe Reinhardt, a political economist at Princeton, said drug companies, device manufacturers and even physicians are reluctant to delve into questions of cost-effectiveness because such inquiries may find that the latest, most expensive treatment is not worth the cost. "I have come to believe a lot of inefficiency is quite deliberate and supported by Congress," he said. "One person's inefficiency is another person's income."
The Food and Drug Administration approved Vivitrol, spokeswoman Laura Alvey said. Cambridge, Mass.-based Alkermes Inc. will make the injectable form of the drug, also known as naltrexone. Cephalon Inc., of Frazer, Pa., will market and sell it. The companies hope monthly injections of the drug, to be administered at a doctor's office, will prove an easier regimen for alcoholics to follow than the daily pill. The drug is to be used in conjunction with counseling or group therapy, the companies said. ''Daily adherence to a medication is challenging for most people, and even more challenging for people with alcoholism,'' said Richard Pops, Alkermes' chief executive officer. The drug works by blocking neurotransmitters in the brain believed to be associated with alcohol dependence, diminishing the craving for alcohol. Pops said the drug's price wouldn't be decided until its U.S. launch in late June. He didn't offer sales predictions and said initial marketing would not include direct-to-consumer advertising. Naltrexone initially won FDA approval for treating alcoholism in 1994. It first was sold to treat narcotic dependency. Other drugs to treat alcoholism include Antabuse, which has been sold since 1948. The market for Antabuse and naltrexone has been limited, with annual sales in the low tens of millions of dollars. Vivitrol will carry the strongest warning prescription drugs can bear. The black-box warning will caution patients that the drug can cause liver damage, said Dr. Elliot Ehrich, Alkermes' vice president. The pill form of the drug bears a similar warning, which says liver damage was observed at higher-than-recommended doses. Frank Baldino, chairman and chief executive officer of Cephalon, said 2.2 million Americans are seeking treatment for alcoholism, among the 9 million who are alcohol-dependent. On the Net: Food and Drug Administration: http://www.fda.gov/ The Internet bristles with animosity toward Flanagan's written opinions and personal choices. Familiar charges of elitism hound the well-heeled, former stay-at-home mom for judging others' household decisions. Holes in her arguments are pried open to ridicule. She is called an amateur, a know-it-all and a nobody unjustly handed perches at both The Atlantic Monthly and The New Yorker. But here's what I think really bothers Flanagan's critics: No matter how vociferously they disagree with her on some things, they find themselves agreeing with much of what she writes. One suspects that were such readers to open Flanagan's essay collection, "To Hell With All That," without knowing its provenance, they would page through it eagerly, nodding and sighing and chuckling to themselves. Flanagan writes with intelligence, wit and brio. She's likable. It turns out Flanagan is an equal-opportunity satirist, neither the feminist turncoat nor nouveau Phyllis Schlafly that her detractors presume her to be. (Flanagan calls herself a liberal who is "not entirely incapable of good old-fashioned feminist rage.") Her résumé — former teacher and failed novelist — is hardly that of an ideological crusader. So while she mocks the radical feminist Alix Kates Shulman, author of a 1970 marriage contract that called for absolute equality at home, as someone who has "earned herself a spot on almost any short list of very silly people," she goes on to explain: "I am reluctant to make too much sport of her document. . . . I am a wife and mother of young children in a very different time from Shulman's, a time that is in many respects more brutal and more brutalizing . . . a time that has made hypocrites of many contemporary feminists in ways that Shulman and her sisters in arms were not hypocrites." What's more: "You have to give those old libbers their due: they spent a lot of time thinking about the unpleasantness of housework and the unfairness of its age-old tendency to fall upon women." Flanagan's major points — that most women hate housework but want to be good at it anyway, that women say they want men to contribute an equal share in the domestic arena but don't want to sleep with the kind of men who do, that married people should have sex — are hardly revolutionary (or counterrevolutionary, for that matter). What makes Flanagan's book original and vital is that she is a realist, willing to acknowledge the essential gray areas in too often polarized positions. As it stands, sensitivities are so attuned to the slightest insult of any one of women's myriad work-life choices that Flanagan's simplest observations — for example, when a woman works something is lost — are taken as an indictment of working women. Yet any working mother can see the truth in such a statement: time spent working = less time with children = something lost. What's appalling is that pointing this out raises such ire. Not that Flanagan doesn't deserve some censure. Though she is less feisty in the book than in her magazine articles (here she dismisses a controversial screed she wrote for The Atlantic on working women and nannies as "convoluted and slightly insane" and herself at the time as "a fanatic with a nut cause"), she commits some of the same mistakes. She surrounds kernels of truth with cavalier half-truths; calls assumptions into question, but doesn't always provide convincing answers. Take dinnertime. In order to resurrect that font of nostalgia, the postwar family dinner, she writes, "we would need to revive the cultural traditions that created it: the one-income family, the middle-class tendency toward frugality and the understanding that one's children's prospects won't include elite private colleges and stratospheric professional success, both of which may hinge on tremendous achievements in the world of extracurricular activities." It's not so much what Flanagan says, but what she fails to mention. No faulting an economy that demands overwork and skimps on child-care benefits. No questioning that Mom's the one who cooks. No challenging the idea that kids must be scheduled to the max in order to make the Ivies. To all this, Flanagan might say, "I was being ironic!" But she's also trying to make important points. These are undermined by a feckless urge to poke fun. It's easy to seize on one of her throwaway lines, however amusing, as evidence of insensitivity or ignorance. She can come across as a self-satisfied classroom prankster, grinning at her own impolitic gibes and daring her targets to cry. Even as Flanagan's detractors can take her too seriously, Flanagan doesn't always take herself seriously enough. The book is somewhat repetitive, as if she assumes readers won't bother to read straight through, surprising because the previously published material has been substantially reworked. More distressing are Flanagan's contradictions, which make it easy to dismiss her. Like many contrarians, she spends too much time arguing against everyone else and not enough time considering her own opinions. She rails against doctrinaire feminists, yuppie parents, stay-at-home moms, political correctites and wives who won't put out. But she's often as guilty as her targets. She mocks boomers who pal around with their kids, then takes vacations at family-friendly resorts where she splashes about with her children. She laments her generation's failures at household maintenance, then admits she's "far too educated and uppity to have knuckled down and learned anything about stain removal" herself. Self-deprecating, yes. But also hypocritical. Yet even dyed-in-the-wool Flanagan haters might enjoy reading her make fun of herself. Mocking her own stint as a listless stay-at-home mom with nanny, she writes: "I would switch on MSNBC, feed and change the babies, and put on the teakettle. At last, the 'Today' show would begin. I would watch straight through and with an intensity of which the producers could only have dreamed." When she leaves her "oppressive apartment," she is frantic, lurching around with pent-up frustration. Loathing the inner housewife, indeed. The love in the book's subtitle seems to refer to Flanagan's mother. At heart, "To Hell With All That" is an attempt to understand, commemorate and legitimize her mother's life as a housewife and nurse, two underappreciated female vocations. She opens her book in the emptiness of her recently dead and dearly loved mother's home and closes with the difficulty she has facing cancer without the comfort of a mother's presence. If it seems as if Flanagan wants to turn back the clock to an era of capable and solicitous homemakers, you can understand why.
William Hathaway, Hartford Courant- 4/18/2006 Long-term exposure to stress hormones can cause the anxiety associated with depression, neuroscientists at Harvard Medical School and McLean Hospital in Boston say. Researchers have long known that people with depression tend to have high levels of the stress hormone cortisol. However, it has been unclear whether the hormone triggers depression or is the product of depression. Some studies have also suggested that long-term stress, such as caring for a chronically ill parent or spouse, was more damaging to health than sudden or acute cases of stress. In a study published in the current issue of Behavioral Neuroscience, scientists gave one group of mice stress hormones for 24 hours and another group stress hormones over a period of 18 days. Mice given stress hormones in their water over the longer period of time showed much more evidence of anxiety, researchers said. They were much less likely to emerge from a dark compartment and enter a brightly lit area than mice that received the hormones for the shorter time. The startle response of mice given stress hormone over the longer period was also muted, another symptom of anxiety and depression. The experiment may help explain why nearly half of people with Cushing's disease - a malfunctioning adrenal gland that causes production of too much cortisol - have depression and anxiety. "Our results suggest that chronically high levels of cortisol ... can increase anxiety on one hand and dull responses to external stimuli on the other," the authors wrote.
Jane Brody, New York Times- 4/18/2006 Faith Sullivan of Minneapolis was having a really hard time getting a good night's sleep. For years, she had slept about seven hours a night. Then, in her late 50's, something changed. After going to bed at 10 or 11 p.m., she would wake up around 3 a.m., unable to fall back to sleep. No, neither depression nor hot flashes were disrupting her night's rest. It was caffeine. She never drank caffeinated coffee in the evening, but she often had it as a midafternoon pick-me-up. Though she found it hard to believe that coffee at 4 p.m. could disturb her sleep at 3 a.m., at the suggestion of a friend she tried cutting it out. The result was striking. Within a day, she was back to sleeping seven hours a night. While not every insomniac's problem is so easily solved, many if not most of the millions of Americans who now rely on sleeping pills could cure their insomnia simply by changing their living and sleeping habits. Food, Drink and Drugs Alcohol is a sedative. It's O.K. with dinner but ill-advised as a nightcap. When broken down by the body, alcohol lightens sleep and can cause early awakening. Likewise, a large meal before bed makes many people sleepy initially, but can result in disrupted sleep. This is not to suggest you should go to bed hungry. Rather, stick to a light snack, preferably one high in carbohydrates or the amino acid tryptophan, the precursor of serotonin, which reduces anxiety and relaxes the brain. Good choices include warm milk, turkey, chicken, whole-grain bread or crackers, cereal with milk and banana, and low-calorie popcorn. But at bedtime avoid spicy and fatty foods, which can cause indigestion. Of course, there are many excellent health reasons for quitting smoking. But for the insomniac, the stimulant effects of nicotine may prove most persuasive. Nicotine raises blood pressure and heart rate and stimulates the brain, countering the slowdown you need to get a good night's sleep. If you are on medication (prescribed or over-the-counter) and having trouble sleeping, check with your doctor to see if a drug could be the cause. Often, another medication that does not disrupt sleep can be substituted. Several over-the-counter pain remedies, like Excedrin and Tylenol, come in a "PM" version free of caffeine but with an antihistamine that makes people sleepy. Sometimes sleep environment is the problem: noise from the street or a neighbor, or a snoring bed mate. Try using earplugs, a white noise machine or a fan that hums to block out the disruptive sounds. If you can get a snorer to sleep on a side instead of the back, it may get rid of the raucous noise. Is your bed comfortable? Remember the three bears? Although firm mattresses are often recommended for back support, some people sleep better on a mattress that conforms more to their bodies. Also choose a pillow that supports your head in a position that does not strain your neck. Good sleepers can do anything they want in bed. But those with insomnia are advised to use their beds only for sleeping and sex. No watching television, reading, knitting or what-have-you. The bed should be associated with sleep. Select a comfortable blanket with the appropriate warmth and weight. I find it almost impossible to sleep well under a heavy cover, a blanket that is too hot, or any blanket or sheet that is tucked in at the foot or side. Consider the sheets as well. Is the fabric irritating? Keep the room cool. A sleeping temperature of 60 to 65 degrees is best for most people, even in the dead of winter. In hot weather, use a floor or ceiling fan to create a breeze, or an air-conditioner set at about 70 degrees. Light can be more disruptive than many people realize. Even the dial of a luminous clock can disturb some people's sleep. Cover or move the clock, use blinds or dark shades or drapes on bedroom windows if they are exposed to street lights or passing headlights, or wear an eye mask. However, if you are likely to get up during the night to use the bathroom, use a flashlight or night light to reduce the risk of falling. If you know you have to get up at a special time, perhaps earlier than usual, set an alarm clock or timer lest your anxiety awaken you several times during the night to see what time it is. People who have trouble sleeping do best if they maintain a consistent sleep schedule, going to bed and getting up at about the same time every day, including weekends and holidays. This keeps your body programmed with a predictable sleep-wake cycle. But if you stay up until 2 a.m. and sleep until noon on Sunday, you may have a hard time falling asleep at 11 Sunday night and getting up at 6 or 7 Monday morning. Despite the known rejuvenating value of a "power nap" for ordinary people, those with insomnia are advised not to nap during the day lest they disrupt a hard-won sleep-wake cycle. A nap is no substitute for a full night of restful sleep. Go to bed only when you feel sleepy and allow yourself 15 or 20 minutes to fall asleep. If sleep won't come, get up and do something relaxing: — take a warm bath, read a dull book, have a glass of warm milk. Go back to bed when you feel sleepy again. The worst thing to do when you can't sleep is to worry about the fact that you're not sleeping. Instead, try to envision a relaxing scene or activity, like basking in the sun or watching waves, or count sheep sleeping in a meadow. Exercise regularly, but not within three hours of bedtime. Nondrug Treatments Another approach is guided imagery and meditation. With it, patients learn to focus on pleasant, nonstimulating images. Or biofeedback may be used to achieve muscle relaxation. A third technique may seem counterintuitive to someone who is already not getting enough sleep. It's called sleep restriction therapy, and its goal is to exhaust patients until sleep is inevitable. Patients are allowed to sleep for only a few hours at first, with the time gradually increased as insomnia wanes. If all this fails to cure your insomnia, the final option is to consult a sleep specialist. The National Sleep Foundation — at 1522 K Street NW, Suite 500, Washington, 20005, at (202) 347-3471, or on its Web site, sleepfoundation.org, can help you find a nearby sleep center. Nicholas Bakalar, New York Times- 4/18/2006 Getting too little sleep may be a significant risk factor for high blood pressure. In a study of more than 4,800 men and women, people ages 32 to 59 who got five hours of sleep a night or less were about 60 percent more likely to develop hypertension than those who slept six to eight hours. The trend was the same even after controlling for depression, alcohol consumption, smoking, pulse rate, obesity, diabetes and other variables. The study appeared this month in the Online-First issue of the journal Hypertension. Researchers used data from a large epidemiological study, following subjects over a 10-year period. The participants had standardized medical examinations and answered questions about their health habits, including sleep patterns. The scientists excluded from the analysis anyone who already had hypertension, and over the next 8 to 10 years, they recorded the incidence of newly diagnosed cases of high blood pressure, or in a few cases, the cause of death. "It's been known for a long time that sleep disorders are associated with hypertension," said James E. Gangwisch, the lead author of the study and a postdoctoral fellow at Columbia's Mailman School of Public Health, "but that could be for reasons besides not getting enough sleep. This is the first study that shows a relationship between short sleep duration itself and high blood pressure." The researchers did not find the connection between sleep deprivation and hypertension in the older group of subjects, those 60 to 86. The authors suggest that this may be because people with hypertension, obesity and diabetes are less likely to survive into their later years, or because lack of sleep in younger people is more closely associated with obesity than it is in those over 60. Dr. Meir Stampfer, chairman of the department of epidemiology at the Harvard School of Public Health, said that the findings were of moderate interest. "This study suggests that sleep duration may contribute to hypertension," Dr. Stampfer said, "but the magnitude of the association is modest compared to dietary factors," especially being overweight, "the main driver for hypertension." He was not involved in the study. Getting more than the average amount of sleep had no effect, either protective or helpful. People who got nine or more hours of sleep were no less likely to have high blood pressure than those who slept six to eight hours. While many factors contribute to high blood pressure, lack of sleep appears to be an independent cause, according to Dr. Dolores Malaspina, a co-author of the paper. "Normally during sleep our heart rate and blood pressure are lower," Dr. Malaspina explained. "In people deprived of sleep over a long period of time the average work done by the heart increases, and that can lead to irreversible changes in the heart and blood vessels." Dr. Malaspina is a professor of clinical psychiatry at Columbia. Lack of sleep may also increase the effect of other hypertension risk factors, the authors suggest. It is probable, they write, that short sleep duration leads to obesity by influencing insulin sensitivity and the enzymes that control appetite. Short sleep duration is associated with irritability, impatience, pessimism and stress — factors that may reduce the ability to follow healthy diet and exercise regimens. The researchers concede that the study has certain weaknesses. The sleep duration figures depend on self-reports — not always reliable. And, the scientists were unable to rule out the possibility that lack of sleep was itself an early symptom of hypertension that was diagnosed later. Because hypertension often goes undiagnosed, the scientists had no way of knowing whether sleep-deprived participants were more or less likely to seek treatment and get a diagnosis than those with normal sleep patterns. Analysis of data from another large epidemiological study cited in the paper found that 30 percent of people with high blood pressure were unaware they had it. |