Noteworthy News Articles on Mental Health Topics, April 19-25, 2006

The real story, painstakingly pieced together by David's brother, Ken, is even sadder. "The Boy Who Fell Out of the Sky" is a mesmerizing tale of family crisis, mental illness and unfulfilled promise. There was no great novel, and there was never going to be one. David Dornstein, attractive and precocious, should have been programmed for happiness and success. He had an Ivy League education and lofty ambitions. But by the time he died, at 25, his existence was so marginal and his mental state so unstable that several close friends, on learning of the Pan Am crash, feared that he might have had something to do with it. "I thought he'd gone too far this time," one told the author.

"David was a writer," Mr. Dornstein states at the outset. That's not exactly true, although David, older by six years, certainly dreamed of being a great author. While still an adolescent, he filled countless spiral-bound notebooks with an unending torrent of words, many of them directed at an adoring future audience of critics, scholars and enraptured readers.

Random thoughts, poems, dream images, bizarre theories, pretend interviews, scalding self-critical passages and the outlines of impossibly grandiose projects all found their way into these notebooks, a harrowing record of desperation and futility. "For a time, he told people he was trying to write down every thought that had ever occurred to him," Mr. Dornstein writes. Many of them were gathered, along with loose manuscript pages, in a large box that their author labeled "The Dave Archives."

Things went wrong early for David Dornstein. His parents divorced when he was 8, after his mother suffered a mental collapse that sent her to a private institution. In sifting through "The Dave Archives" and interviewing his brother's former girlfriends, Mr. Dornstein uncovered strong evidence that a friendly neighbor had begun sexually abusing his brother around this time.

At Brown University, where David wrote a column called "Tortured Ravings" for the college newspaper, he unraveled. Obsessively scribbling in his notebooks until the wee hours, living on junk food and sleeping on floors, he fantasized about producing great literature but failed even to turn in assignments.

"I keep thinking that some mystical force will take hold of me and propel my writing into the land of the enchanted," he wrote. "It never happens."

David, previously a remote figure in Ken Dornstein's life, began fixating on his younger brother. Gripped by a sense of failure, he wrote 10-page letters, crazily confessional and often filled with advice, as if he could guide his little brother toward the dazzling success that he himself would never achieve. They make bizarre reading. "You are beautiful, and your nature is a narcotic to me, my time is not ever so blissful and rich and fulfilling as when I am in contact with you," he once wrote. In another letter, he asked, "Won't you ever tell me of your lovers?" Ken was not yet 15 at the time.

Ken Dornstein, who once worked on insurance-fraud cases for a small detective agency, is a diligent investigator. He travels to Lockerbie and searches for clues and traces. He interviews his brother's friends near and far. After two Libyan intelligence agents are put on trial for the Pan Am bombing, he flies to the Netherlands in 2001 to witness the verdict.

Some of this pays off, and some doesn't. It's an open question, half the time, whether Mr. Dornstein's motives are personal or literary. "The Boy Who Fell Out of the Sky" is polished to a high gloss, with every transition perfectly in place. A cool narrator, like Nick Carraway in "The Great Gatsby," Mr. Dornstein records emotionally wrenching events but keeps his distance, and he can be strangely uninquisitive in treating disturbing material, like his romantic relationship with his brother's most important girlfriend, now his wife.

This approach can also make for high drama. At one point, Mr. Dornstein decides that he needs to track down his brother's abuser. The ensuing confrontation, a series of verbal thrusts, feints and evasions, has a chilling authenticity. The abuser, calm and cheerful, gladly takes a trip down memory lane and shares his thoughts about David, without once taking the bait and incriminating himself. Did it happen or not? There's just enough ambiguity in the circumstances surrounding past events to disarm Mr. Dornstein.

In a writing class with Robert Coover, David Dornstein wrote the first draft of a work he thought might be his ticket to immortality. It would be a fictional autobiography, the story of an unknown young writer who dies in a plane crash, leaving behind a cache of papers and notebooks that the narrator stitches together into the story of the writer's life. Someone else, it turns out, lived to write that book.

The question for the Supreme Court in an argument on Wednesday was whether the state's approach meets the basic test of fairness, or due process of law.

The court has never ruled that the Constitution requires a state to allow an explicit insanity defense, and four states — Kansas, Utah, Idaho and Montana — have in fact abolished such a defense.

But in those states, a defendant is permitted to present evidence of diminished mental capacity to negate the prosecution's assertion that he acted with criminal intent, an element that it is the state's burden to prove beyond a reasonable doubt.

In Arizona, by contrast, such evidence is barred from the trial. A defendant who relies on an insanity defense may request a verdict of "guilty except insane," which requires the defendant to demonstrate insanity under a statutory definition that is narrower than that in all but a handful of states.

Most states use either a two-part definition of insanity known as the M'Naghten rule, which stems from an English legal decision in 1843, or a modern and broader variant of the rule. The M'Naghten rule permits a defendant to show that because of a mental illness, he either did not know "the nature and quality" of the criminal act, or did not know that "he was doing what was wrong."

When the Arizona Legislature established the "guilty except insane" verdict in 1993, it eliminated the first prong of the M'Naghten definition, meaning that a defendant could not be found insane unless he could demonstrate that at the time of the crime, he did not know his conduct was wrong.

The result was that Mr. Clark, the teenager in Flagstaff, was barred from arguing that his delusions caused him to believe that he was shooting a space alien rather than a police officer. That prohibition, his lawyer, David I. Goldberg, told the court on Wednesday, meant that Mr. Clark did not receive a fair trial.

The case, Clark v. Arizona, No. 05-5966, is an appeal from the Arizona Court of Appeals, which affirmed Mr. Clark's conviction and life sentence for the crime of intentionally killing a police officer.

Mr. Goldberg offered the justices an analogy: "A person thinks he is squeezing a lemon, but it turns out to be his sister. He knows that killing his sister is wrong, but not that squeezing a lemon is wrong."

In focusing only on knowledge of right and wrong, Mr. Goldberg said, the Arizona law was constitutionally deficient in not permitting Mr. Clark to present a full defense. "A person could know in the abstract that killing is wrong, but not know that they were killing a person," he said.

Much of the debate during the argument centered on whether Arizona's narrowed definition of insanity made a practical difference. The state's lawyer, Randall M. Howe, chief counsel in the Arizona attorney general's office, asserted that nearly all those defendants who could have claimed that they did not understand the nature of their actions, the part of the definition that Arizona has eliminated, could also demonstrate that they did not know their acts were wrong.

"I won't pretend that under some theoretical, hypothetical scenario, that might not occur," Mr. Howe said, "but it is very difficult to imagine."

In any event, he said, "the state has discretion to define insanity as it sees fit."

Several justices appeared troubled, Justice John Paul Stevens among them. Could a defendant who "thought he had a mission in life to kill Martians," he asked, be convicted of murder for killing a person whom he thought was a Martian?

Mr. Howe replied, "If he truly believed he was shooting an alien, he would certainly have a very strong case for insanity." But he said that on the evidence found by the trial judge in this case, which was heard without a jury, Mr. Clark knew he was killing a police officer and, in fact, had planned the crime in advance.

The justices also had questions about Arizona's refusal to permit evidence of diminished capacity in rebuttal to the state's evidence of criminal intent. Mr. Goldberg, Mr. Clark's lawyer, said the refusal was unconstitutional "because it allows the state's evidence to go uncontested."

The state argued at the trial that Mr. Clark intentionally lured the police by driving around a residential neighborhood late at night with loud music blaring from his car. Mr. Goldberg said that under Arizona's rule, he was not permitted to argue that the purpose of the loud music was to drown out the voices that his client was hearing as the result of his illness.

Chief Justice John G. Roberts Jr. asked Mr. Howe, the state's lawyer, why the state could bar evidence of mental illness when it could not bar other types of evidence, like a defendant's inability to understand English, that might also be relevant to the question of intent. "What is it about mental capacity that allows you to exclude that type of evidence?" the chief justice asked.

Mr. Howe replied that the impact of mental illness on a defendant's ability to formulate the intent to commit a crime was "just too complex a question to ask a jury or judge to decide."

Solicitor General Paul D. Clement also argued on Arizona's behalf. While federal law applies to both parts of the insanity definition, Mr. Clement said in his brief, "the United States has an interest in ensuring that Congress retains authority to revise the standard."

Narcolepsy Drug Eyed for Cocaine Users
Associated Press, 4/24/2006

WASHINGTON -- The hottest topic in cocaine addiction is another drug -- a medicine already sold to wake up narcoleptics.

Hundreds of cocaine users are testing whether that legal pill, called modafinil, could help them kick the addiction, and there's early evidence that it may.

In addition to blunting cocaine's notorious cravings, modafinil might also counter the damage that cocaine wreaks on users' brain circuits -- damage that in turn fuels the cycle of addiction.

The prospect of that double-whammy has the National Institutes of Health spending $10.8 million researching modafinil as a potential cocaine treatment. Results from the first of three key clinical trials could arrive by year's end.

Scientists are cautious: In a hunt spanning two decades, no one has found a medication to help treat cocaine addiction, and there's no guarantee that modafinil will pan out.

But for Dr. Nora Volkow, director of NIH's National Institute on Drug Abuse, the narcolepsy medicine tops the list of promising potential therapies. It may help restore proper function of a crucial brain chemical, dopamine, that addiction hijacks.

And in describing why he's hopeful, one leading researcher recounts the man who accused his drug dealer of selling bad coke before realizing modafinil had kept him from getting high -- and several other modafinil testers who told of flushing cocaine down the toilet.

''I've been treating cocaine-addicted patients for something like 25 years, more, and I've never heard of anybody throwing away cocaine,'' says Dr. Charles Dackis of the University of Pennsylvania, who led a pilot study that suggested modafinil more than doubled addicts' chances of going cocaine-free for at least three weeks.

That study enrolled just 62 people, but the results were significant enough for NIH to fund new research -- at Pennsylvania, the University of Texas in Houston, Boston University and other sites -- enrolling about 650 cocaine users to see if modafinil really does work.

The main side effect so far: insomnia, not surprising as modafinil is sold today to help narcolepsy patients fend off that neurologic disease's sudden sleep attacks.

Addiction specialists gave it a look because even though modafinil isn't a classic stimulant, it triggered something in the brain to also improve patients' mood, energy levels and ability to concentrate -- effects that might counter cocaine withdrawal. Then came the surprises:

--Cocaine intensely stimulates the brain's pleasure centers, producing not just a ''buzz'' or a ''rush,'' but outright euphoria. In a small safety study to ensure that modafinil didn't make cocaine worse, some users found the once-a-day pill blocked that high. ''We didn't expect that at all,'' Dackis says.

--Potentially more important, he says, modafinil seems to increase activity in the prefrontal cortex, the brain's decision-making command center and the spot that allows reasoning to override impulse or emotion. Cocaine reduces activity in that key brain region, making it even harder for would-be quitters to ignore cravings and resist another hit.

--Modafinil also increases the ability to think strategically, a means of weighing variables and risks to make decisions, says Frank Vocci, NIDA's pharmacotherapy chief.

''The effects on cognitive processes are very subtle, and very interesting,'' Vocci says -- and that's the reason that of half a dozen medications being studied as potential cocaine treatments, the government's biggest emphasis is on modafinil.

Cocaine is highly addictive: About 16 percent of people who try it become hooked, often rapidly. In 2003, the latest data, the government estimated that more than 1.5 million Americans were dependent on or abusing cocaine, and more reported recently experimenting with it.

Addictions in general rewire the brain, says Volkow, the NIDA director. Drugs cause a feel-good rush by increasing amounts of the brain chemical dopamine. The brain reacts by tamping down regular dopamine production, making users feel lousy between hits and setting up the cycle of addiction.

At the same time, the dopamine surge also creates memory circuits that eventually establish so-called ''cue-induced cravings'': If an addict passes the crack house or sees friends he did drugs with, his brain literally sends a strong impulse to use again.

''One of the strategies of course, in terms of treatment ... is how can we help recover the function of the dopamine system, so the person that's addicted can become sensitive to natural stimuli,'' Volkow explains.

Modafinil seems to affect chemicals that in turn regulate dopamine production, a different pathway than cocaine takes in altering normal dopamine, and thus one that might counter it, adds Dackis.

''You can't assume this is going to work,'' he cautions. But if it pans out, a drug that could help cognition instead of just numb cravings would be ''a big benefit in treatment.''

Their deaths, in addition to the death two months ago in a possible suicide of a former Einstein student, have rattled the tightknit Kensington school community. Although some parents of Einstein students had yet to hear of Wednesday's incident, others were connecting the three deaths and expressing concern about the stresses of teenage life.

Chatter spread on blogs, with stunned students wondering how the deaths could have happened and whether they could have done anything to prevent them.

On Thursday, Einstein Principal James Fernandez gathered the junior class in the auditorium to announce the death of Elisabeth Stanford, 16. He made a similar announcement to members of the senior class and brought in grief counselors and a crisis team to talk to students.

"It's so difficult to make an announcement that a student has died," he said. "You don't know how kids are going to take the news."

At 4 p.m. Wednesday, Stanford, of Silver Spring, stood on the train tracks in Rockville as a CSX train approached, police said. Since then, the teenager's family and friends have struggled to understand why a thoughtful girl who was enrolled in the school's prestigious International Baccalaureate program and who dreamed of becoming a wildlife biologist would end her life so violently.

On March 5, Kanishke Karunaratne, 16, also of Silver Spring, shot himself in his bedroom. He was also in the IB program, which prepares students to pass a series of exams to earn a diploma that is accepted at universities internationally. He was also captain of a team that appeared twice on WNBC's "It's Academic" competition.

Neither had given any indication that anything was amiss, their families said.

Standing in the doorway of her brick house, Stanford's mother, Sherri Odegaarden, said yesterday that she was shocked by her daughter's suicide. The midterm grades she received Wednesday, a few hours before she died, were not what she was capable of, Odegaarden said, but on her report card, Elisabeth wrote, "This has nothing to do with grades." It was the only note she left, her parents said.

About two years ago, Stanford began seeing a therapist for problems her mother said involved "philosophical teen angst" unrelated to academics.

Uday Karunaratne, sitting in his living room decorated with Asian artwork, described Kanishke as "the perfect son" and said he shared his parents' dream that he would one day attend Oxford University in England. His fallback choices were the Massachusetts Institute of Technology and Harvard and Stanford universities.

The teenager liked to play violent video games, which concerned his parents so much that two days before his death, his father forbade him to play them. The next day, Karunaratne took SAT preparation classes from 2 to 6 p.m., and the following day, he slept unusually late, until about noon, his father said.

Uday Karunaratne said he told his son to wake up and noticed that his son's computer screen was damaged. His son pointed to the computer and said, "This ruined my life!" his father recalled.

After leaving to check his e-mail, Uday Karunaratne heard the gunshot. Kanishke had found his father's .22-caliber handgun and turned it on himself. Uday Karunaratne said that he and his son used the gun for target practice and that he thought he had hidden it well.

Kanishke's sister, Samantha, 18, a student at the University of Nottingham in England, said yesterday that she believes a combination of academic pressure and the sudden denial of her brother's outlet -- video games -- may have made him snap.

"Of course, my parents didn't like [the games], but when they took that away, he didn't have that release," she said.

Karunaratne left no note, but his father said he believes that academic pressure played a role in his suicide. He called the Odegaardens to console them after Stanford killed herself.

Some parents said this weekend that three deaths occurring so close together has them worried that the pressures of academics and teenage life are too much for some kids to handle. In February, a former Einstein student was killed by a train in an incident that his father said has been a ruled a suicide. The father said he does not believe the ruling. However, parents at the school said the three deaths and the connection to trains have left them unnerved.

"I'm really, really concerned about this -- particularly after the second one," said Karen Schulz, the mother of a recent Einstein graduate and a psychotherapist for adolescents and their families. "I'm concerned that kids will start to see this or view this as an acceptable way to solve a problem," she added.

"Something is terribly wrong here," said Kay Romero, the mother of two Einstein graduates and an incoming Einstein freshman. "Is there too much stress on kids?"

Schulz and other parents, including the Odegaardens, said they do not blame the IB program. Schulz said she worries that "there's a certain contagion factor, that [kids will think] this is how we solve problems -- and it's not."

Neil Bernstein, a Bethesda adolescent psychologist and the author of "How to Keep Your Teenager Out of Trouble and What To Do if You Can't," said that although three incidents are probably not enough to term it a contagion, parents do have some cause to worry.

"In general, with any trend, with each occurrence the likelihood of another occurrence goes up," he said, adding, "Teenagers are highly suggestible -- there's no question about that."

Noting that the rate of teen suicide has been fairly stable in recent years, he said that stepping in front of a train is highly unusual for teens and that most take pills, a method more likely to fail.Officials of the 140,000-student Montgomery County school system would say little about the deaths or comment on academic pressure. "Any suicide is tragic," Superintendent Jerry D. Weast said. "My heart goes out to the families."

Two days before Stanford's death, Einstein's Parent Teacher Association hosted a program on helping students deal with academic stress.

Fernandez said that students were "sad and concerned" and that several teachers were also deeply affected. He said that the school will operate as normal but that the deaths will not be ignored.

Hundreds of people attended a vigil for Karunaratne a few days after he died, and fellow students spoke of how he would stay up until 3 a.m. helping them with their schoolwork, determined that they understand it, his father said.

Stanford's funeral will be held at noon today at Collins Funeral Home in Silver Spring.

Over the weekend, friends of Stanford shared their confusion and sorrow on xanga.com, a site where some students post their Web logs.

"What is it about life?" one person wrote. "Why do people feel the need to give theirs up?"

Wrote another: "Why does it seem like as soon as we start to heal, something else goes wrong?"

Analyze This
Benedict Carey, New York Times- 4/25/2006

He began his long and transcendent career in a nondescript laboratory on the Adriatic Sea, dissecting eels. Freud’s earliest scientific drawings, from his 20’s, are careful renderings of neurons and fibers under the microscope, in tissue from fish and the human brainstem. He examined hundreds of the animals, working long hours amid stench and slime, peering through a microscope at countless tissue samples, in search of an organ that had eluded earlier anatomists — male testicles. "Since eels do not keep diaries," the investigator, 19-year-old Sigmund Freud, wrote to a friend in the spring of 1876, the only way to determine gender was to cut and slice, "but in vain, all the eels which I cut open are of the fairer sex." He ended the letter by sketching an eel, swimming through the text, its face fixed with a slight, Mona Lisa smile.
     Beginning May 11, the New York Academy of Medicine will exhibit the largest collection of Freud's drawings ever assembled, including several pieces from private collectors that have not been displayed in public. The drawings, some embedded in letters and scientific essays, chart the evolution of the Austrian neurologist's thinking, from his early and lesser-known devotion to marine anatomy to the psychological theory that would alter forever humans' conception of themselves and launch a discipline, psychoanalysis, that dominated psychiatry for half a century. The American Psychoanalytic Association and the New York Psychoanalytic Society and Institute collaborated in the exhibition.
      Freud's methods have fallen from favor in recent decades, but science historians say that his investigation of the unconscious more than a century ago stands as a revolutionary achievement that still informs many therapists' understanding of memory, trauma and behavior. The exhibit is one of many events being held around the world this spring to commemorate the 150th anniversary of Freud's birth, May 6, 1856. These include scholarly lectures, conferences and films, as well as lighter fare, like "On the Couch: Cartoons from The New Yorker," at the Museum of the City of New York, running through July 23.
     Freud's drawings were serious science, the eel doodle notwithstanding. In the latter part of the 19th century, German researchers considered drawing to be instrumental to scientific discovery, both as a way to capture the microscopic detail of nerve cells, for example, and to illustrate theories of how the brain might work, said Lynn Gamwell, the curator of the exhibit and the director of the Art Museum at the State University of New York at Binghamton. "Einstein once said that when he thought about science, he thought visually, he thought in pictures, and this appears to be the case with Freud," said Dr. Gamwell, a professor of science history.
     Freud's drawings tell a story in three acts, from biology to psychology, from the microscope to the couch. The first, from Freud's college years into his mid-20's, took place in laboratories, where he examined the nervous systems of crayfish and lamprey, among other animals. The 21 drawings from this period would look familiar to anyone who used a microscope in high school, but on closer inspection betray compulsive detail. One, titled, "On the structure of the nerve fibers and nerve cells of the river crayfish," depicts four types of nerve cells and minutely details the elements in the nuclei, the cell bodies shaded so carefully that they appear three-dimensional, alive, alien eyeballs bobbing in space. In another sketch, of the spinal anatomy of the lamprey, nerve fibers braid together like climbing vines, with cells hung throughout like clusters of ripening grapes.
     These are the work of someone who loved the laboratory, scholars say, and who seemed to invest even his earliest efforts with a sense of importance, a conviction that he was about to break something big. "That is the way Freud's mind worked," wrote Ernest Jones, a disciple of Freud's, in his 1953 biography, "The Life and Work of Sigmund Freud." "When he got hold of a simple but significant fact he would feel, and know, that it was an example of something general or universal," Dr. Jones wrote.
     By his late 20's, Freud had gained some experience with patients and, in a second phase of his career, he began to focus on brain function rather than descriptive anatomy. One drawing from this period, meant to illustrate the brain's auditory system, is as spare and geometric as a Calder sculpture, with fibers running between neural regions. The sketch is meant to represent specific pathways in the brain, but the depiction is dramatically more abstract than his earlier work.
     In another, from an unpublished essay titled, "Introduction to Neuropathology," looping lines connect several nodes in a diagram intended to show how areas of the brain represent the body, arms, face, hands. "It is no exaggeration to say that this insight is the precise point at which the mind — that aspect of the organism which represents the body not concretely but rather functionally, abstractly and symbolically — entered Freud's scientific work," Mark Solms wrote in a commentary that accompanies the drawings. Dr. Solms, a psychoanalyst and professor of neuropsychology at the University of Cape Town, translated the works from the original German.
     At the time these drawings appeared, many neurologists presumed the body was somehow mirrored in the brain, perhaps altered in form but recognizable, intact. Yet in this sketch and others like it, Freud said the brain worked differently, that its fibers and cells "contain the body periphery in the same way as a poem contains the alphabet, in a complete rearrangement," based on a body part's function, not its location, Dr. Solms writes. Later research supported Freud's conception.
     To capture what was running through the young scientist's own mind in this period, the mid-1880's, might require a Goya or a Lucian Freud, an artist familiar with longing and euphoria, frustration and deep anxiety. For Freud was in love, engaged in a tumultuous courtship with Martha Bernays of Vienna, complete with feuds with her mother and brother. He was experimenting with cocaine, on himself and on others, for a variety of mental and physical ailments, with increasingly disastrous results. And he was consumed by anxieties about his purpose, his scientific future and, most of all, his income.
     Full-time research appointments were hard to secure at the time, especially for Jews, and Freud's scientific work provided very little income. He was desperately trying to raise money to pay for his wedding. "He started taking in patients out of economic necessity," said Dr. Charles Brenner, a psychoanalyst and the author of "An Elementary Textbook of Psychoanalysis." "Had he had a rich father, or not been a Jew, he would have stayed in the lab for the rest of his days," Dr. Brenner said. "But because he had to treat patients with psychogenic illnesses, it forced him to keep searching for treatments to help him in his own work."
      This part of Freud's career — the third phase, — has become as familiar as Einstein's thought experiments with the streetcar or Darwin's ruminations on finches. Freud became fascinated by the case of a young German woman, known to history as Anna O., a colleague's patient. Anna O. suffered from debilitating hallucinations and paralysis that dissipated when she talked about the symptoms. Freud experimented with this "talking cure" and found it soothed several of his own patients who were suffering from similar psychosomatic symptoms, then called hysteria.
     From 1892 to 1895, he refined his therapy to include free association, encouraging patients to trace the threads of their memory, back to when their symptoms first surfaced, and beyond, to earliest childhood. On these excavations, and in his self-analysis, Freud gathered the evidence on which he built his famous theory of the basic geography of the psyche: the primal id, the rational ego and the censorious superego.
     He continued drawing diagrams to illustrate his findings. The first purely psychoanalytic drawing, Dr. Solms said, appeared in an 1894 letter from Freud to his friend and colleague, Dr. Wilhelm Fleiss. The style is reminiscent of earlier sketches — looping lines connecting nodes — but the nodes now represent psychological processes like memory, not physical locations in the brain. A few years later, the diagrams become much more abstract: A sketch from 1900 illustrating the mental processes involved in dreaming looks like a bar graph. A diagram completed in 1898, "The Psychical Mechanism of Forgetfulness," resembles the schematic for an air-conditioning system, complete with arrows and boxes.
     But by 1900, when Freud's groundbreaking book "The Interpretation of Dreams" appeared, the transformation from anatomist to psychologist was complete. His love of anatomy had long ago waned; his commitment to drawing had not. "I see no necessity to apologize for the imperfections of this or of any similar imagery," Freud wrote of the dream diagrams. "Analogies of this kind are only intended to assist us in our attempt to make the complications of mental functioning intelligible." He continued, "So far as I know, the experiment has not hitherto been made of using this method of dissection in order to investigate the way in which the mental instrument is put together, and I can see no harm in it. "We are justified, in my view, in giving free reign to our speculations so long as we retain the coolness of our judgment," Freud wrote, "and do not mistake the scaffolding for the building."



After the Adoption, a New Child and the Blues
Laurie Tarkan, New York Times- 4/25/2006

When Dr. Michele Zembow, 45 and single, adopted a 15-month-old girl, Kaydi, from China five years ago, the two fell in love instantly. Dr. Zembow had taken three months off work to ease the transition. "I thought it would be like a vacation, this wonderful time with the baby," she said. Instead, she felt overwhelmed by the round-the-clock demands of the baby. She experienced anxiousness, had bouts of weepiness and felt somewhat isolated and lost. At times, she found herself yelling and short-tempered with Kaydi, whom she adored. "I had an anxious type of depression," said Dr. Zembow, a psychologist in Maplewood, N.J. "I felt like I had this romanticized, idealized version of what it would be like that was not at all true." Dr. Zembow had no one to turn to. She spent many of her days taking her daughter to the park for relief, social contact and a change of scenery.
      Many adoptive parents feel delirious with happiness when bringing home their child. Yet for some, this joy can be short-lived and dissolve into what experts call post-adoption depression. For some, it is simply a low mood, for others a full-fledged plunge into despair. But most suffer secretly because of the shame and guilt of not being entirely happy over something they had chosen and, in many cases, worked so hard to get.
     Post-adoption depression is recognized among adoption professionals, but there is no research on the syndrome. It is not adequately addressed by many adoption agencies, say experts, and is not widely understood by the public, including those who embark on adoption. "It's like where postpartum depression was 10 to 15 years ago," said Pamela Kruger, a co-editor of "A Love Like No Other" a new collection of essays by adoptive parents. "Parents can be blindsided by it, they're expecting it to be this joyous moment and not expecting to have these feelings," Ms. Kruger said.
     Like postpartum depression, post-adoption depression can be difficult for women to acknowledge even to themselves, and even more difficult to admit to friends and family members. Karen Foli, co-author, with her husband, Dr. John Thompson, of "The Post-Adoption Blues," said of the parents they interviewed for the book, "They chose to be a parent of adoption, they've wanted it for so long, and they're dumbfounded and feel tremendous guilt and shame admitting they have anything less than positive feelings." And unlike new mothers who suffer from postpartum depression, they cannot explain their symptoms by a drop in estrogen levels. Society tends to put adoptive parents on a pedestal, making it even harder for them to admit ambivalence or depressed feelings.
     Experts say it is not clear how common post-adoption depression is. "I don't get the sense that it's prevalent, but it's out there," said Adam Pertman, author of Adoption Nation and executive director of the Evan B. Donaldson Adoption Institute, a nonprofit organization. No research has been done on the problem. But in a 1999 survey sent out by Harriet McCarthy to subscribers to an online listserve for parents in the Eastern European Adoption Coalition, 77 percent of those who reported post-adoption depression said their symptoms lasted from two months to more than a year. Seventy percent felt that the depression had interfered with the transition and bonding with their new children. Only 8 of the 94 people who reported post-adoption depression said they had been advised by their agencies that the syndrome even existed.
     According to psychologists who work with adoptive parents, the stress of being a new parent, sleep deprivation and a lack of support may put women at risk. And some adoptive mothers may be saddened if they do not "feel love at first sight" or immediately bond with a child.
     Mary and Claude Knobler had two children of their own. But they decided to adopt Nati, a 5-year-old Ethiopian boy whose mother was infected with the virus. Nati arrived with a large personality, vibrant and affectionate, and though her husband and children embraced him right away, Ms. Knobler said she could not. "I thought of myself as a person who could love all children," she said. "The love for this child did not come the moment we picked him up at the airport, and that was upsetting to me." She said she felt sad, confused and overwhelmed, and began to grieve the loss of her family as she knew it. "We wanted to help this child, but in accepting a fully formed person into your life, you're changing what you know," she said. Her sadness and grief eventually faded as she grew to love her new son.
     Ms. Foli, who adopted a girl from India, experienced similar feelings. "The idea of being a loving supportive mom was an important part of myself," she said. "When it just didn't come about with my daughter, I was devastated." She said she was depressed for a year, and in that time did not interact as well with her daughter as she had hoped.
     On the other hand, some parents are saddened if an adopted child does not immediately bond with them, a phenomenon that is more likely to occur in older children who have lived in orphanages or who have been through the foster care system. Some parents who have biological children may mourn the loss of their existing family and become distressed that the demands of the new child take time from the others. If infertility or miscarriages preceded the adoption, a woman may still dwell on her lost pregnancy or inability to have a biological child. And some parents endure a long process to adopt a child, filled with anxiety, delays and other obstacles.
     Mark Lerner, a psychologist and president of the American Academy of Experts in Traumatic Stress, said that with so much of their focus on acquiring the child, parents were less likely to concentrate on what life would look like once the child came home. "When they do ultimately get through all the hurdles of acquiring the baby, they find themselves dealing with things they didn't anticipate," Dr. Lerner said.
     Adopting an older child, some experts say, can be more difficult if the child has developmental and behavioral problems and the parents are inexperienced at dealing with such challenges. "It can be very stressful," Dr. Lerner said, adding that parents are not usually prepared for how difficult it can be. "A statement I hear over and over from parents is, 'I didn't sign up for this.' "
     Some adoption agencies are beginning to address the issue of post-adoption depression by offering more services to parents after they adopt. "The good agencies are trying so hard to cover the bases," said Ms. McCarthy, "but if somebody hands you a piece of paper that said to be aware of post-adoption depression, the first thing you think is, 'I'm not going to get that,' and you toss it," she said. Some parents are reluctant to show any signs of unraveling in front of agency counselors who conduct post-placement visits, and often the depression begins months after the adoption, when connections to the agency have been lost.
     A number of medical groups have cropped up with a specific focus on the medical and psychological needs of adopted children and their families, and there are a growing number of psychologists who focus on adoption. Experts recommend that adoptive parents find someone to talk to, perhaps joining one of many online groups for adoptive parents. "Support groups have made a huge difference to thousands of adoptive parents' lives," Ms. McCarthy said. Experts recommend that parents who are experiencing signs of depression or anger see a physician or a psychologist to discuss treatments like antidepressants and talk therapy. But in many cases, it may be enough simply to get more help and more support. Dr. Zembow said that when she hired a nanny about 10 weeks after she brought Kaydi home, her depression lifted. "She was my savior," Dr. Zembow said.

Sometimes the Truth Is Not What Sets You Free
Elissa Ely, M.D., New York Times- 4/25/2006

It gave him satisfaction, though nothing else did, to tell us the harrowing stories of his life. The early years: Russian roulette with his father's gun, his sister killed by a rampaging truck, a brother who took pleasure in obscure but unforgettable forms of abuse. The wild middle years: gangs and deaths by deliberate violence. The despairing years: chaos, random fatherhood, slicing himself with knives just to see his blood run, breaking bones in drunken rages by punching walls. The present: homelessness and suicide attempts, which had brought him to a psychiatric ward and then, reluctantly, to the clinic.
      All through the first year here, he told terrible stories. "My life's a punishment for the things that went wrong," he said. The girlfriend who had died in his arms, the gang buddy he'd buried after an overdose; each memory seemingly darker than the last. He came in thin, grim and intoxicated, and he could not promise to return the next month. Yet he did. There was something else to tell.
     His depression began to clear. He moved into a sober house, began a day program, gave clean urine samples each week and considered looking for a maintenance job. One day, he arrived with a new expression. He said he had reunited with an old girlfriend. It turned out they had a grown daughter together. Now, though he had never known her before, he was helping to plan her wedding. Imagine: father of the bride.
     Each meeting after that was filled with giddy details. She wanted orchids and a waterfront reception. He would wear a purple tux. There would be a white limo and a DVD. He was taking out a loan to finance the affair. He was also spending every weekend with his old girlfriend and new daughter, the sudden family. Just recently, they had told him he was going to be a grandfather. Imagine. There were no more stories about badges of violent honor, no lists of reasons to die. "You can only lay in the slop so long," he said. He put on weight, grinned from a double chin, and talked about another wedding — maybe the father of the bride would marry the mother of the bride. This loan was bleeding him already, for heaven's sake.
     His stories were so full of light that a student therapist on the team finally thought to call the halfway house for corroboration. The staff listened with surprise. The patient had never mentioned any girlfriend or daughter to them. He stayed in his room at night and did not mingle with the other guys. He never got phone calls. He was always home on weekends, and utterly solitary. They encouraged him to socialize. But he never went anywhere, ever.
      The student, properly astounded, presented this at the team meeting. Suddenly everything in the history began to waver. Maybe all the stories — harrowing as well as fantastic — had been untrue. No one doubted his depression. But maybe he had trapped himself in a mine of his own construction, and now shame required him to keep digging. If we did not confront him on his dishonesty, weren't we colluding with him? Gently encouraged but respectfully insisted upon, the truth would free him to change his life — the real one.
     It sounded right, the high therapeutic path. But it felt wrong. Why insist on truth, when the stories were growing happier and happier? They had begun full of horror, and were now full of dreams. He was living them earnestly in his mind, if not in his life. He was sober. He had a happy double chin. Wasn't he better for dreaming? Our team has agreed to disagree. The student, who earnestly wants to help, has decided to begin a firmer line of inquiry. I have decided to listen unquestioningly and will not ask to see the wedding album. In the end, our divisions don't matter. The patient himself will decide what he wants to know and what he will imagine.



Addicts Seek Out Drugs Blamed for Deaths
Associated Press, 4/25/2006

CAMDEN, N.J. -- After Ellen Krips' cousin died of an overdose of extremely potent drugs last week, the heroin addict's first thought was not how she could avoid the bad junk. It was more like: I have to get some of that stuff. A bad batch of drugs for sale on the streets of Philadelphia and southern New Jersey has killed at least nine heroin users over the past two weeks. And while authorities are warning people to stay away from the stuff, they are afraid some junkies are drawing the wrong lesson. Like Krips, 32, they are intrigued by the possibility of a powerful new high.
      Investigators are trying to determine exactly what is in the stuff, which is being sold as heroin under such names as ''Flatline'' and ''Capone.'' Since Friday, about 70 people have been hospitalized. Tests done in one community show that what was sold as heroin was mostly fentanyl, a drug 80 times more powerful than morphine. It is used to treat chronic pain and as anesthesia for open-heart surgery. No heroin was in the batch. Medical experts say fentanyl, which has been harming Chicago-area addicts for a few months and has shown up mixed with heroin in Cleveland and elsewhere this year, can cause breathing problems and make users feel as if they are suffocating.
     William Gamble, 40, said he was sickened last week. Hours after a state trooper warned him that ''Flatline'' was dangerous, Gamble bought three, $10 doses of ''Capone.'' He, his wife and another man shot up in an abandoned house. The men passed out quickly, but both survived and were not hospitalized. His wife was not affected.
     Warnings from police, counselors and news outlets have had the opposite effect on some addicts. ''If I tell someone I OD'd, they're coming to find that bag,'' said Gamble, who goes through seven or eight bags of heroin a day. Authorities arrested 11 heroin users in Camden last week in an effort to track the drugs back to the dealers and their suppliers. By Tuesday, those dealers had not been found. Some public health officials estimate that 10,000 people in the Philadelphia area are addicted to heroin. With major airports and seaports nearby, Philadelphia, New Jersey and New York dealers are known to sell heroin in highly pure forms.
     Johnny ''J.B.'' Brown, a drug counselor who cruises the streets of this impoverished city in an RV, offering HIV tests and other services for drug users and prostitutes, has been trying to warn users. ''You being careful out there? You know, there's some bad dope,'' Brown said Monday as a steady stream of drug users approached for snacks, condoms and bleach kits to clean their needles. All of them said they have heard about the killer drugs. But they said stuff so strong that it kills is impossible to resist. And even if they wanted to avoid the bad stuff, they might not be able to, since it is never clear which bag might contain fentanyl or some other deadly substance. ''It's like Russian roulette,'' said addict Michelle Galante, 28, of Swedesboro, ''just like any drug.''
     Stephen Marcus, medical director of the New Jersey Poison Control Center, said he hopes more publicity about the dangerous drugs will help uncover similar problems elsewhere. But he also knows that every news report might serve as a commercial for drug dealers. ''Will this make the drug abusers go out particularly looking for the stronger stuff?'' he asked. ''If it does, it's a double-edged sword.''

Divorce Has Weakened Baby Boomers' Family Ties
Kathleen O'Brien, Newhouse News Service- 4/25/2006

At first, the only thing setting the earliest baby boomers apart was their sheer number. They acted much like their parents' generation when it came to life's milestones. By age 20, nearly half of the first wave of boomers were married. Once married, they started having children. The similarity ended there.
     Now, as the boomers born in 1946 reach age 60, they have experienced more family disruption than their parents could have imagined. Love has been a bumpy journey. As a result, they head into their senior years far more likely to be divorced, remarried, co-habiting or living alone.      Demographers warn such disruption could leave this generation with weaker family ties, making them more vulnerable as they age and need help. "Many of these ties are going to be frail," says Mary Elizabeth Hughes, a Duke University sociologist who has studied the boomers. "They don't have the glue that previous ties did." While every generation has seen some of its members divorce, remarry or live alone, those numbers are all bigger for the group Hughes calls the "early boomers," those born from 1946 to 1955.
     Consider Jim and Claudia Burns of Whippany, N.J. These two "class of '46" boomers have five marriages between them. She's on her third; he's on his second. Claudia isn't exactly proud of her two previous divorces, but she isn't ashamed of them, either. "I have a theory," she says . philosophically. "I believe I needed a different husband for each stage of my life. I feel like there was a reason for each person." As she and Jim approach their third wedding anniversary this June, she says emphatically: "This time is it. We just know it."
     Sociologist Hughes says of the generation born between 1946 and 1955, "We're rewriting the books here." She makes the following observations about boomers:
∎ They are twice as likely to live alone as their parents' generation. While the percentage is not huge --just 11 percent -- it reflects a striking break with the past. Hughes is quick to say she doesn't equate living alone with being lonely, or being without support. "You. could be living alone but you could have tons of friends filling the gap. "Living alone is only one piece of the puzzle -- a huge piece. But other social connections matter, too," she says. "When living alone becomes a problem is if you need help."
∎ By age 40, a third of early boomer women were divorced. By contrast, only 13 percent of their parents' generation were divorced by that age. It is a myth, however, that early boomers began the divorce revolution. Their older siblings, the War Babies of 1936-45, were the generation that actually led the upsurge in divorce. But early boomers then went on to surpass them. (And their rate was topped in turn by the younger boomers, those born 1956-64.) Many of those divorced boomers remarried, but not all. "Remarriage rates for them are on the high side, but not high enough to compensate for all the divorces," Hughes says.
∎ Raised to look on cohabitation as "shacking up," early boomers nonetheless came to adopt living together as an acceptable way to form a family. Even in middle age, 4 percent were living with non-relatives; the figure was a paltry 1 percent for their parents. "It simply wasn't in people's repertoire," Hughes says. "Now, however, people view it as an option." With the children grown, couples no longer need marriage to confer legitimacy on their offspring, and they may well want to remain single to protect pension benefits or inheritances. (An unknown amount of the cohabiting reflects gay relationships.)
     The most common living arrangement for those turning 60 this year is the traditional one: living with one's spouse. In the 2000 Census, such a family configuration accounted for 61 percent of early boomer households -- an 11 percent drop from their parents at that same stage in life. While some of those are second or even third marriages, many are couples still in first marriages and coming up on their 40th anniversaries.
     Claudia Burns, the boomer now on her third -- "and last!" -- marriage, says her first husband was instrumental in helping her reach her goal of becoming a teacher. He was from what she describes as "the right side of the tracks," and his mother other was a teacher. That marriage foundered 10 years later as she felt his support wane. By then, the couple had two children. It took her only six months to decide on divorce; it didn't occur to her to try marriage counseling. "In hindsight, I didn't give him a chance," she says. Her second marriage lasted 25 years -- many of them unhappy as strains developed over her, "warm and fuzzy" mate's de facto role as a house-husband. Still, she resisted divorce for years until it was obvious counseling had failed. "I thought, `Two is bad. I am not going to be divorced again. I am not going to be Elizabeth Taylor!'" she says
     She and Jim met when she was a last-minute guest at a friend's New Year's Eve party in Atlanta, where she lived at the time. Jim was there visiting his adult children and had a flight home the next day. He called her that evening and every day they were apart since then. Their long-distance courtship was high-tech, with Saturday night "dates" on the Internet, using Web cameras. This time, she believes, she has finally gotten it right -- both in her choice of mate and in her expectations. "We haven't had a single fight," she says.

Will boomers after aging?
The level of divorce experienced by the early boomers is worrisome, Hughes says because marital status affects both health and wealth. Married people live longer. The divorced are at greater risk for health problems, even after remarriage. Demographers call it divorce's "health scar." Finances take a big hit as well, as the family's assets are spread over two households.
     The concern is that such continued churning of family roles may make some extended families less likely to help once old age sets in. Will adult children look after an elderly step-parent with the same devotion they would show a parent? If Mom remarries, then dies, will her children feel obliged to look after her second husband? If the remarriage took place when the children were small, the resulting bonds may be as strong as blood ties, Hughes says. But if the remarriage happens after the kids have left the nest, what then?
     In some divorces, the father ends up seeing far less of his children--a problem that has always been viewed from the perspective of the needs of the child. But what about later in life, when the tables turn? "We're used to thinking about dads who abandon their kids," Hughes says. "Well, when those guys are old, they're not going to have their kids around to help."
     Compounding that worry is speculation that boomers may continue their pattern of "serial monogamy" even as they become senior citizens. Divorce is traditionally rare among the elderly; the stress of child-rearing is over, and any marriage lasting so long is likely to be hearty. anyway. So
there is reason to believe the oldest boomers are done with divorce. Yet that may be an outdated assumption. After all, says Hughes, this generation upended expectations at every stage of life. It may continue to divorce, remarry or cohabit well into old age. Claudia Burns is sure she won't be one of those, in part because each of her two previous divorces taught her essential lessons about marriage. "This time, when we married, we didn't try to change each other," she says.