Noteworthy News Articles on Mental Health Topics, May 17-28, 2006



Meth Addict Hopes His Pain Helps Others
Associated Press, 5/21/2006

CAPE GIRARDEAU, Mo. -- Wide-eyed and appearing catatonic, Shawn Bridges couldn't muster any talk from his hospital bed, his gaunt, tattooed body wracked by years of abusing the powerfully addictive witch's brew of chemicals that is methamphetamine. The footage from the documentary the 34-year-old trucker commissioned about his slow, agonizing decline does the talking for him. And he hopes the 29-minute film, shot by a southern Illinois television videographer, speaks volumes to children and others headed down a similar path to drug addiction. By his family's account, Bridges already died twice, his heart so ravaged by meth over the years that it stopped and had to be shocked back into beating. ''The bottom half of his heart is dead,'' his dad laments on camera.
      As the documentary ''No More Sunsets'' shows, Bridges' life now isn't much. Largely bedridden, his constant companions are the catheter that funnels the urine out of his body and the feeding tube sticking from his stomach. When he does speak, it's in guttural slurs. ''Ahmmmmmmm collllllllllllllllllllllld,'' Shawn, dressed in boxer shorts and sweat socks, said recently from a hospital-style bed wedged into his father's living room. His dad hustled to blanket him. ''I'd say he's got a 34-year-old body on the outside with 70- to 80-year-old man on the inside,'' Jack Bridges says of his son. ''You see what meth has done to my son and what my son has let it do to him. ''If the documentary helps just one person stay away from this terrible poison, it's worth it.'' Bridges prays his son's story sways the young, including the 12 million people ages 12 and older the U.S. Department of Health and Human Services says reported in a 2002 national survey that they had used meth at least once in their lifetime.
     According to federal estimates, roughly 28,000 people sought treatment for meth addiction across the country in 1993, accounting for nearly 2 percent of admissions for drug-abuse care, according to the Substance Abuse and Mental Health Services Administration. But just a decade later, the meth-related admissions numbered nearly 136,000 -- more than 7 percent of the national total for drug-abuse treatment.
     The man who shot and narrates the film calls it a cautionary tale. ''He's dying because of the decisions he's made,'' Chip Rossetti says in the film. ''Long ago, he chose to give in to temptation. Long ago, he chose a life of drugs. But he wasn't always that way.''
     Bridges' story is one of tragedy and torment. Family members say he forever was haunted by the dreary day in 1976 when younger brother Jason, barely a year old, died in a car wreck. Shawn was just 4 and nowhere near the wreck but inexplicably blamed himself, wanting to trade places with his dead sibling, his father says. Bridges' parents were lenient with Shawn, convinced their ''wishy-washy'' disciplining would ease the grieving, his father says. It backfired. ''We didn't realize we were making a little monster of him,'' Jack Bridges says.
     By 16, Shawn was a high school dropout, a partier with little regard for authority. He struggled accepting his parents' divorce in 1996 and drifted in and out of his own relationships. Between two failed marriages and a girlfriend, he fathered three daughters. Jack Bridges insists he didn't suspect his son was doing drugs; if the boy was using, he artfully hid it. But Jonathan Bridges says in the documentary that he witnessed his brother's addiction and how it tormented him. Twice, Jonathan Bridges says, his brother tried to kill himself. When Shawn tried to hang himself from a tree, the rope snapped. When he purposely veered into an oncoming vehicle's path after a night of heavy partying, Jonathan was there to grab the wheel and avoid the wreck.
     At 26, Shawn had a heart attack his father blames on meth, a concoction that can include such toxic chemicals as battery acid, drain cleaner and fertilizer. When pressed by his dad, Shawn admitted using the drug. Several years ago, Shawn sought redemption from Buddy Walls, the former southern Illinois pastor to Shawn's grandparents. He told Walls of his struggles with drugs, talked of wanting to get clean from a drug he said made him feel bulletproof. ''He was really struggling,'' recalls Walls, now living in Springfield, Mo. ''I told him, 'Get your heart right with the Lord.' I just wanted him to feel comfort from that, if nothing else. He was truly sorry for what he'd done.''
     Soon after that, what Shawn thought was pneumonia was diagnosed as congestive heart failure, his heart enlarged two or three times its normal size, his father says. The back of that vital muscle was stretched so thin doctors feared it would burst, Jack Bridges adds. Shawn insisted to relatives he had quit using meth, famous for fatally damaging a chronic user's heart and other internal organs because it puts the body in overdrive for prolonged periods.
     A little more than a year ago, Shawn was spitting up blood. When his heart quit, doctors brought him back. His weight continued diving because he couldn't keep food down. His epiphany came months later, when he told Walls he'd like to find someone to videotape him going through his ''nightmare, so the kids can see the pain I'm feeling.'' '''I know I'm dying,''' Walls recalls Bridges saying. ''But he had a real desire to live to get his story out. ''
     Walls eventually contacted Rossetti, a videographer for WSIL-TV in Carterville, Ill. To Rossetti, the project wasn't ''about just what drugs did to this guy. This is about what drugs did to his entire family and everyone he knows.'' For now, the documentary -- available for $20 from the Web site of Rossetti's production company -- closes on the note that Shawn's fate is ''yet to be determined.'' If he dies, that signoff will be updated.
     Mike Townsend, who heads the Partnership for a Drug-Free America's programs to curb meth demand, said any impact by the documentary would hinge on whether teens or others could relate to Bridges and ''see themselves in that world'' someday. Jonathan Bridges wouldn't wish that on anybody. ''It just really hurts seeing him the way he is,'' he says in the documentary, wiping away tears. ''As soon as he knows he's done good, he'll be able to go home.''
      On the Net: Rossetti Productions: http://www.rossettiproductions.com
Partnership for a Drug-Free America: http://www.drugfree.org/Meth

When Colleges Go on Suicide Watch
Julie Rawe & Kathleen Kingsbury, Time Magazine- 5/22/2006

Anne Giedinghagen wanted desperately to stay in school. Having struggled with depression and anorexia since the sixth grade, the rail-thin Cornell junior was meeting regularly with a therapist at the university's counseling center in Ithaca, N.Y But late last fall, when she told her therapist about her increasingly strong urge to kill herself, Giedinghagen received an ultimatum from the school she loved so much: she had to get better or she would have to leave. So she did what any crafty 20-year-old would do. She tried to carve out a third option--feigning improvement by, as she put it, acting "as normal as I could." When she agreed to spend her winter break at a psychiatric hospital, the university stopped threatening to kick her out. But afterward, says Giedinghagen, "I felt like I had to hide how I was doing from my doctor, my counselor, my nutritionist, so that I could stay."
     Giedinghagen is one of thousands of troubled college students who each year are forced to make such stark choices. With two recent court rulings holding that college administrators may be held partly responsible for student suicides-which total some 1,100 a year nationwide, making suicide the second leading cause of death among college students, after motor-vehicle accidents-many universities have hastily adopted mandatory-leave policies in an effort to reduce the risk of self-inflicted, on campus deaths. But a tragic result, say psychiatrists and student advocates, is that emotionally distressed students may be less willing to come forward and get the professional help they need.
     Another unintended consequence: hypervigilant colleges are getting sued by students who allege they are being discriminated against for being mentally unstable. The U. S. Department of Education last year warned at least a handful of schools that receive federal aid that the Americans with Disabilities Act protects people with mental problems. Several students who were suspended after threatening to commit suicide are in the process of suing their schools; others have been offered settlements before their cases reached the courts. In a sign of just how flummoxed the world of higher education has become over the issue of suicide, United Educators, which insures more than 1,100 colleges and secondary schools, issued a bulletin last month noting that when dealing with emotionally distressed students, schools are left "with the quandary of being sued no matter what they do:'
     That is particularly alarming since the number of students diagnosed as mentally fragile appears to be rising. The 2005 National Survey of Counseling Directors, conducted by the University of Pittsburgh, found that 95% of directors reported an increase in the number of freshmen who arrive on campus already taking psychiatric medicines. "A lot of students who may not have gone to college five years ago are able to attend today because their illness has been recognized earlier and they are on medication;' says Joanna Locke, a program officer at the Jed Foundation, a New York City-based college suicide-prevention and outreach program.
     The pressure to inoculate schools from legal liability has sometimes led them to come across as shockingly insensitive. In a case study of apparent hamhandedness, Jordan Nott had spent a less than 48 hours in the psychiatric I ward he checked himself into, in 0 October 2004, when he received a terse letter from George Washington University informing the sophomore that he had been suspended for being a danger to himself and others. "It was a huge slap in the face," says Nott, 20. "They don't hand out this letter that says, `We want you to get help. What it says is, `You've been suspended; you've been barred from campus: " The letter went on to explain that if he returned to campus, he would be arrested. Rather than contest the suspension, he switched schools and is now suing for compensatory damages. A spokeswoman for G.W.U. says that because Nott's suspension fell within the school's disciplinary system, the wording of that letter may have seemed impersonal. However, she stresses, "the goal here was to protect a life"
     But how, exactly, does yanking a kid out of college count as protection? "A lot of suicidal people don't just kill themselves, says Peter Lake, a higher-education law professor at Stetson University in Deland, Fla. "They also can hurt others, even if it's unintentionally." Schools steadfastly reserve the right not to let one person's disturbing behavior disrupt anyone else's educational experience. And they argue that their mandatory-leave policy can force emotionally distressed students to get the best possible help. Gary Pavela, a judicial-policy expert at the University of Maryland and author of a book on student suicide, says the approach is designed for "getting rid of troubled lads, getting them into the hands of others, as soon as possible"
     Litigious parents are also to blame for the tough line. After Elizabeth Shin died in 2000 in a dorm-room fire at M.I.T within hours of threatening to kill herself, the sophomore's parents filed a $27 million lawsuit against her psychiatrists, as well as her house master and a dean of student life, for failing to take adequate precautions. (They had scheduled an appointment to see her the following day.) When a judge last year refused to throw out the suit, alarm bells went off in administrative offices across the country. "To hold a university liable for simply trying to help a student is extraordinary, says Nelson Roth, Cornell's deputy university counsel, explaining why the school joined six others in supporting M.I.T. in the case. Shin's death was a tragedy, Roth says, "but not every tragedy warrants a lawsuit"
     Although the Shins settled last month for an undisclosed amount-and publicly admitted that their daughter's death appeared to be accidental-the case has had a chilling effect on student-services professionals and has led to more frequent use of emergency-leave policies. But after several students complained about getting summarily booted, the Department of Education's Office for Civil Rights started informing schools that a person should be considered a direct threat only when there is "a high probability of substantial harm and not just a slightly increased, speculative or remote risk:' In other words, there needs to be a detailed evaluation and at least some opportunity for students to make a case for why they should be allowed to stay.
     Many schools are trying to emulate the University of Illinois, which requires students who express suicidal thoughts to see a counselor for four sessions if they want to remain in school. More than 1,800 students have gone through the program since it was launched in the early '80s, and none have committed suicide. Only one participant was forced to leave.
     While Illinois rarely advocates taking time off from school, Cornell pushes a hundred or so of its students each year to take a voluntary medical leave that allows them not only to get help but also to de-stress. In Giedinghagen s case, it didn't take long for her to realize her fake-it-till-youmake-it strategy wasn't working. By April, she says, "the stress was so bad that I knew if I stayed at Cornell one more week, I would kill myself." After lengthy discussions with her therapists, the double major in German and neurobiology agreed to head home last month to Kansas City, Mo., with plans to enter a psychiatric hospital. Five weeks later, slid s disappointed that Cornell hasn't made any follow-up calls to see how she's doing. But Cornell's deputy counsel Roth has an explanation: "Once the student is gone or goes home, the individual becomes the responsibility of parents. Our obligation ends:"



FDA Approves First Generic Lexapro
Associated Press, 5/22/2006

WASHINGTON -- The first generic version of Lexapro, one of the most widely prescribed antidepressants, with more than $2 billion in sales last year, received federal approval Monday. Ivax Corp. of Miami, part of Israel's Teva Pharmaceutical Industries Ltd., becomes the first company cleared to make a generic version of the prescription drug, according to the Web site of the Food and Drug Administration.
      The agency approved 5, 10 and 20 milligram doses of the drug, also called escitalopram oxalate, for the treatment of major depression. Lexapro, the brand-name version of the drug, is made by New York-based Forest Laboratories Inc.
     In 2005, Lexapro was the No. 2 antidepressant in the United States, behind Zoloft, with 29.6 million prescriptions filled, according to IMS Health, a prescription information provider. Lexapro's U.S. sales last year were $2.1 billion.
      On the Net: Food and Drug Administration: http://www.fda.gov/




Comebacks and Crashes: A Way of Life
Serena Roberts, New York Times- 5/22/2006

John Daly's hair is flawless: hay-bale blond to belie his 40 years, neatly clipped to boyish perfection. From there, he is a riveting mess. If customers splitting chicken wings or waitresses wearing tank tops knew him, couldn't quite place him or had never seen him before, all were fixated on Daly after his black limo rolled up to Hooters in Midtown Manhattan last week.
     In a gray pullover and jeans, with a gold-. and-diamond lion's head medallion fit for a Soprano around his neck, Daly wedged his physique behind a picnic table on the restaurant patio. He placed a pack of cigarettes next to a roll of paper towels kept on the tables as a substitute for napkins and asked a friend: "What's the name of our driver, Rock?. Well, let's get him some wings. I think he'd like that." Daly then greeted a waitress named Jasmine with a cheerful hello, a menu request for the driver and an order for himself: steak sandwich with curly fries. "How do you want your steak cooked?" she asked. "Kill it," he said in country-speak for well done.
     Daly has never lost his Arkansas-honed accent, though he has been a lost soul all over the map. He has never surrendered his Southern identity, though he has succumbed to Tennessee whiskey. He has never played the victim to an abusive father, though he has been haunted by suicidal thoughts. "I know myself better than most people could know themselves, maybe, because I've been through rehab," he said over lunch.
     The drlnking tales and the Betty Ford visits, the slot-machine obsessions and the squandered millions, his past wives and his incarcerated wife, and his sex droughts, romps and corresponding golf slumps and streaks are detailed in an unvarnished voice for his book, "My Life In and Out of the Rough," published this month by HarperCollins. But this is not a melodramatic James Frey-esque, self-pity memoir with a saccharine message of healing through darkness complete with a tidy epiphany. This is not a superstar's self-deification vehicle designed to buff his everyman goodness, either.
     Daly is an unpolished man of loose ends, of addictions unconquered, of flaws unhemmed, of a life's journey mired in stop-and-go traffic. This is John Daly. And as Mark Knopfler and Emmylou Harris sing it, "This is us." He is a work in progress. Aren't we all? "Life isn't tied with a bow," he said. There is a ribbon, though. There is a universal theme that laces through his fits of despair, anger, confusion and four marriages. "I just wanted to be loved by somebody," he admitted.
     He has searched for love, like everyone. Of the many relationships portrayed in his book - and every wife has a special section - Daly describes a dynamic with his father that is revealing in its heartbreak. "I love my father, but I didn't have Tiger Woods's dad," Daly said. As a child, Daly sought solace on a baseball field --to play golf. Alone for hours, he would chip to first base, carve flop shots to the pitcher's mound and mimic sand saves by piling up dirt near home plate. His football-consumed buddies labeled him with gay slurs for his pursuits, but Daly ignored them.
     Daly is stubbornly self-made, not a product of a parent's blueprinted dream. His father drank at home, worked on the road and often vented his anger during spankings. "Dad, he'd use anything at hand: belt, stick, garden hose, whatever," Daly wrote. "And he hit hard." On the same page, Daly added, "Dad could be mean when he was drunk, and he was drunk a lot back then."
     Are alcohol and anger linked in Daly's DNA? Daly writes about how he has battled drinking demons and how he has ripped up rooms from cabinets to curtains, but is he like his father? "Two things I learned from my dad: Don't take out my anger on anyone but myself and don't hit my kids," Daly said. His revelations can sound more like denials. "I'm not an alcoholic," Daly said: "I'm allergic to alcohol. He mostly drinks beer these days. And as a substitute for Jack Daniel's, he gambles.
In Daly's estimation, gambling has cost him "$3.8 million a year since 1992." That was the year after Daly, an unknown with a faint mustache and go-for-broke golf swing, defied the earth's balance to capture the P.G.A. Championship as the, ninth and final alternate.
     Does he feel undeserving of success?, Daly's book is a chart of celebration and self-destruction and selflessness. What money he hasn't lost, he has given away to strangers. Once, Daly met a soldier returning from Iraq who was going through a divorce, among other troubles. As the story goes, Daly reached into his pocket and pulled' out $4,000 for the soldier. When asked about it, Daly said, "I was just like, man, go start over."
     Daly knows resilience. He has led the Tour in a category called "bounce back" -- how often a player follows, say, a bogey with a birdie. . It's the category of comebacks. Daly maybe on course for another one. In two weeks, his wife, Sherrie, will be out of prison after a five month sentence for a federal money laundering conviction. In two weeks, his current swing hiccups may end. As he'll tell you, Daly is at his best when surrounded by good lovin'. "I just want to go home; get a great big hug and a French kiss and feel like I'm loved," Daly said.
     Who can't identify with that? As Daly departed Hooters, buxom waitresses surrounded him for a photo, an electrician asked for his autograph, and there, waiting at the curb, was a diminutive driver with a box of wings in his hand. Daly crawled into the limo with a spot of ketchup on his pants. Is there a more riveting mess?

A Career That Has Mirrored Psychiatry's Twisting Path
Benedict Carey, New York Times- 5/23/2006

The patient, Keith, was a deeply religious young man, disabled by paranoia, who had secluded himself for weeks in one of the hospital's isolation rooms. In daily therapy sessions he said little but was always civil, seemingly pleased to have company and grateful for a cigarette and a light. Until one spring morning, when he wrestled the lighter from his therapist's hand and held it to his own head — igniting his hair. "I grabbed him and was slapping at the flames, and he immediately became passive," said Dr. Thomas H. McGlashan, the man's therapist. "He went limp and pulled a blanket over his head." He added, "That patient, that experience, changed everything for me."
     In a career that has spanned four decades, Dr. McGlashan, now 64 and a professor of psychiatry at Yale, has with grim delight extinguished some of psychiatry's grandest notions, none more ruthlessly than his own. He strived for years to master psychoanalysis, only to reject it outright after demonstrating, in a landmark 1984 study, that the treatment did not help much at all in people, like Keith, with schizophrenia. Once placed on antipsychotic medication, Keith became less paranoid and more expressive. Without it, he quickly deteriorated.
     Dr. McGlashan turned to medication and biology for answers and in the 1990's embarked on a highly controversial study of antipsychotic medication to prevent psychosis in high-risk adolescents. But doctors' hopes for that experiment, too, withered under the cold eye of its lead author. Early this month, Dr. McGlashan reported that the drugs were more likely to induce weight gain than to produce a significant, measurable benefit.
     Through it all, he has remained optimistic, restless, hopeful that he is close to understanding some of schizophrenia's secrets. In a way, his work mirrors the history of psychiatry itself, its conflicts and limits, its shift away from talk therapy to drugs and biological explanations for illness. And for those who want a sense of what direction the field will take next — and how — Dr. McGlashan may serve as a kind of bellwether. "Basically, you're talking about a person who can walk into an extremely hostile environment and deliver bad news; I don't know how to describe him better than that," said Dr. Wayne Fenton of the National Institute of Mental Health. He is a former colleague of Dr. McGlashan's at Chestnut Lodge, a psychiatric hospital in Rockville, Md., closed in 2001. "At the lodge, he stood up and, in essence, told all these giants of psychotherapy that there was not a shred of evidence that what they were doing with schizophrenia patients was helping, much less curing the disorder," Dr. Fenton said. "And the therapies were being advertised as cures."
     Dr. McGlashan is recognizable from a distance, a lean figure striding across the grounds of the medical school as if against a strong wind, chin forward beneath a mop of white-gray hair. On a typical day, he visits with adult patients at a state mental hospital in the morning and with adolescents in a private institute in the afternoon. He is a deliberate presence, solemn for long periods; but then he will remark on something absurd and tip backward with laughter. This unsettling combination — gravity punctuated by sudden levity — may help explain his comfort with the world of psychosis.
      "I thought he was the Antichrist when I first met him; I thought all the therapists were," said Keith, the patient at Chestnut Lodge who changed Dr. McGlashan's thinking in 1982. "But in the end I liked his sense of humor, and he liked mine, and I keep in touch with him." Keith, who is now 47 and spoke by telephone only on the condition that his last name not be used, said he set his hair on fire that day because he was terrified that a great tribulation was at hand, during which he would be dragged by his hair before the devil. "I really believed it was coming, any moment, and there was no way to escape," he said. "I still believe it's coming, but not right now; I'm not afraid of it."
     Dr. McGlashan joined the staff of Chestnut Lodge at a time when psychoanalysis was in ascendance in psychiatry, nowhere more so than at the lodge, which became known for its commitment to treat severe mental illness without antidepressants, antipsychotic drugs or electroshock therapy. It was thrilling just to be there, Dr. McGlashan recalled, hearing so many accomplished therapists offer seemingly powerful ideas about what troubled patients and why.
     At the time he was treating Keith, Dr. McGlashan was pursuing a study for the hospital's owner, Dr. Dexter Bullard, to track patients years after treatment. Their records were revealing artifacts, detailing thousands of interactions in which therapists, steeped in psychoanalytic theory, tried to interpret patients' every word and gesture. In one account, a psychiatrist described an outing when he bought a patient an ice cream cone. The patient refused it vehemently. "This was very exasperating to me," the therapist wrote. "She never did accept the cone, and I had to throw it away. I thought of it at the time as having represented a kind of rape situation to her."
     Yet in his analysis of 446 cases, Dr. McGlashan found that about two-thirds of the former patients with schizophrenia who had been treated with psychoanalysis were functioning poorly and struggling in their relationships and in their jobs, if they had them. Their lives were no better than those of similar patient groups who had received little psychotherapy or none at all. "I felt like people at the lodge had become lost in the process," he said. "We would have all these erudite conversations, talking about interpretations, and meanwhile the patient is crumpled in the corner of his or her room." Chestnut Lodge changed some of its policies as a result of the study, allowing more drug treatment, job training and other programs.
     Dr. McGlashan's intensity, and willingness to reverse course, was evident even in childhood. An ardently religious boy, he grew up with two sisters near Rochester, where his father worked at Kodak. In middle school, the youngster pored through the Bible, to the dismay of his father and the bemusement of his mother. The devotion was isolating, Dr. McGlashan remembers, creating a mostly private world of mystery and awe. Then in his first year of high school, he met other Christian students, who belonged to a group devoted to proselytizing. He was reluctant to join, and his father sensed it. "He saved me," Dr. McGlashan said. "He picked me up after a meeting and said it was O.K. to pull back" from the group. "He was giving me permission."
     He graduated second in his high school class and studied chemistry at Yale. He then entered the University of Pennsylvania's medical school, where, during a psychiatry rotation, he met his future. He interviewed a middle-aged Philadelphia businesswoman, who described to him a tortuous plot being hatched against her, involving family members and the F.B.I. "I thought, 'She can't possibly believe this,' " Dr. McGlashan said.
     He was hooked. Psychosis was isolating, too, and deeply mysterious even to scientists who spent their lives thinking about it. By the 1990's, most psychiatrists believed schizophrenia to be a genetically based brain disorder involving developmental changes that occurred well before the first full-blown psychosis. No one knew precisely what those changes were, but studies strongly suggested that they were real. Moreover, psychiatric clinics periodically saw adolescents who seemed to be experiencing mild, prepsychosis symptoms. They were "prodromal," in the medical jargon, perhaps destined to develop a full-blown psychotic episode, perhaps not.
     Dr. McGlashan and several others saw in these converging threads a possibility: maybe treating young people with drugs before they became psychotic would prevent the illness, and perhaps even help illuminate its cause. Dr. McGlashan recalled patients at Chestnut Lodge who had spent decades receiving daily psychotherapy, to no avail, before receiving antipsychotic drugs and reclaiming some portion of normal life. One woman spent 18 years at the lodge, barefoot, unkempt, closeted in her room. One day, he said, he looked out a window and saw her going for a morning walk, smartly dressed, wearing shoes; she had recently been given medication and began taking daily walks. "What right did we have denying her that?" he asked. "Small changes in a person's life, which I think is what we can expect, can make a big difference."
     The risks of using drugs to try to prevent psychosis seemed to him moderate. New antipsychotics were becoming available, and, though they could have serious side effects, they appeared to be more tolerable than the older generation of drugs, and to reduce the risk of debilitating, Parkinson's disease-like side effects. So Dr. McGlashan began a study, financed in part by Eli Lilly, giving medication to adolescents considered at high risk for developing psychosis. But almost immediately, there were difficulties.
     The test that Dr. McGlashan developed to identify those at high risk proved less reliable than he had hoped, meaning many adolescents would be exposed to drugs needlessly. Participants for the trial were hard to recruit. Mild psychosislike symptoms are rare in adolescents; and some who came in chose to continue seeing Dr. McGlashan or another psychiatrist but did not enter the study.
     An ethical debate over the wisdom of early treatment ensued, and not everyone thought the potential benefit was worth the risk. "Given the likelihood that psychosis is delayed and not prevented by the drugs, and given the severe side effects of the drugs, this is an idea that needs to be taken with great caution," said Dr. Steven E. Hyman, a professor of neurobiology at Harvard and a former director of the National Institute of Mental Health. And in 2000, Vera Sharav, a prominent patient-protection advocate, wrote to government officials calling the experiment unethical, because "healthy children — who are not capable of voluntary, informed consent — are being put at high risk of harm for experimental purposes."
     Officials from the federal Office for Human Research Protection began an investigation. About a year later, the agency concluded that the researchers needed to strengthen their informed consent documents to emphasize the side effects of the medication. The researchers made the required changes, and the trial continued. But in a paper published this month, the authors reported that more than two-thirds of the participants had dropped out, rendering the trial inconclusive. Moreover, those on medication gained an average of about 20 pounds.
     The entire process, almost 10 years in the making, has altered Dr. McGlashan's thinking again. "I'm more pessimistic about all this now," he said. "I don't think the drugs can prevent full-blown psychosis, only delay it." He added, "I think more than ever we need to follow a group of prodromal adolescents who get no drug treatment to see more clearly what happens and refine our understanding of what the prodrome is."
     Sitting in his office on a recent Tuesday morning, after having seen three patients taking a total of 10 drugs, Dr. McGlashan sighed. "I've never written so many prescriptions in my life," he said. He said he had recently gotten a call from someone in England organizing a debate over whether high-risk adolescents should be treated with drugs. "He wanted to sign me up for the pro side, and I said absolutely not," he said. Now colleagues are watching the progression of his thinking, wondering where his drive for answers will ultimately take him. "It's funny, he seems to be coming full circle," said Dr. Barbara Cornblatt, the director of the Recognition and Prevention Program at Zucker Hillside Hospital in Glen Oaks, N.Y., and an early critic of preventive drug treatment. "I may be more optimistic about early treatment than he is at this point."



Patterns: Exploring Women's Health and Double Duty
Nicholas Bakalar, New York Times- 5/23/2006

For women, combining work and family may be a healthier choice than staying home, recent research in Britain suggests. The researchers studied 1,171 women born in 1946, interviewing them in each decade from their 20's on to collect information about their health, work, marriage and children. They then had the women report their state of health at 54. The study found that women who had taken on multiple roles as mothers, wives, and employees over those years were significantly healthier than those who had not.
      "Our question," said Anne McMunn, the lead author of the findings, "was whether women were working and having families because of their good health or whether their health was relatively good because of multiple role occupation." The answer, the study found, is that taking on extra roles was itself associated with good health, and that initial good health was not a predictor of taking on extra roles. Dr. McMunn is a senior research fellow in the department of epidemiology and public health at University College London.
     According to background information in the paper, which appears in the June issue of The Journal of Epidemiology and Community Health, it has been well known for some time that women who both work and maintain families are healthier than those who do not. But it had not been clear that that was not simply because healthier women were inclined to take on both work and other roles.
     The authors acknowledged the difficulty of generalizing beyond the specific group of British women included in the study. Examining other populations may produce different findings. Nevertheless, they concluded, "Our results suggest that good health is more likely to be the result, rather than the cause" of taking on work along with family and child-rearing obligations.



Subway Nightmare: Focus of Yet a Third Trial
Anemona Hartocollis, New York Times- 5/23/2006

What happened to Kendra Webdale seven years ago was a New Yorker's nightmare: She was pushed in front of a subway train by a mentally ill man who had stopped taking his antipsychotic medication. Ms. Webdale, a 32-year-old journalist and photographer, was killed instantly. Her assailant, Andrew Goldstein, now 36, was convicted of her murder in March 2000 and was sentenced to up to life in prison. Now he will be tried again.
     Last December, the state's highest court overturned his conviction, saying that Mr. Goldstein's constitutional right to confront witnesses against him at his trial had been violated. Yesterday, the United States Supreme Court declined to review that decision. A spokeswoman for Robert M. Morgenthau, the Manhattan district attorney, said prosecutors would retry Mr. Goldstein, who remains in custody. Ms. Webdale's sister, Kim, said through the family's lawyer that the family would attend every day of the new trial, as they had his two previous ones. "What Kim said, was, it's going to bring up memories, but we're prepared to go through it a third time if necessary," the lawyer, Jay Dankner, said. "The family will be there as they were the first two trials, and await the jury's verdict."
      Natalie Rea, a lawyer for the Legal Aid Society who represented Mr. Goldstein in his appeal, said she was gratified that the Supreme Court had declined to hear the district attorney's appeal. "Obviously, they agreed with us," that the case did not present any new issues for the highest court, she said.
     In the meantime, Mr. Dankner said yesterday, there have been developments in a civil lawsuit filed by Ms. Webdale's family in 2000 against seven hospitals and clinics that cared for Mr. Goldstein before Ms. Webdale's death. He said he had obtained records detailing Mr. Goldstein's treatment in the weeks before he pushed Ms. Webdale to her death on Jan. 3, 1999, off the N-line platform at 23rd Street. "We see numerous prior assaults," Mr. Dankner said. "He was striking out at nurses and psychiatrists. This guy was a walking time bomb."
     In their civil suit, the Webdale family contends that Mr. Goldstein was discharged from North General Hospital in Harlem because the state reimbursement for 21 days of treatment had expired and there was no financial incentive to keep him there. Instead of going to a community-based facility, as he was supposed to, the lawyer said, Mr. Goldstein went back to his apartment, and stopped taking his medication. "Andrew Goldstein fell between the cracks in this system that we call mental health care in New York State as it existed in 1998 and 1999," Mr. Dankner said.
     In the seven years since Ms. Webdale was killed, her mother, Patricia, who lives in Fredonia, in upstate New York, has gone through a transformation. Mrs. Webdale, who has five other children, has become an advocate for the mentally ill, and she lectures across the country on the need for better treatment. She pushed for what became known as Kendra's Law, passed by the State Legislature in 1999. It allows families of mentally ill people, their roommates and mental health workers to petition the courts to require outpatient treatment for people who otherwise might not take their medication or follow their treatment plans. In an interview last winter, after Mr. Goldstein's conviction was overturned, Ms. Webdale said that in seeking supervision of the mentally ill, she is trying to prevent others from being victimized as her daughter was. The jury deadlocked in Mr. Goldstein's first trial, forcing a mistrial.
     In his second trial, his lawyer argued that Mr. Goldstein pushed Ms. Webdale onto the tracks while suffering from a transient psychotic episode, perhaps made worse by his failure to take his medication. The prosecution said Mr. Goldstein knew what he was doing, and had a history of using his mental illness as an excuse for bad behavior.
     Last December, the Court of Appeals, the state's highest court, ruled that the psychiatrist who testified for the prosecution should not have been allowed to testify about what other people — including Mr. Goldstein's former landlady — had told her about him, unless those people were available to be cross-examined by the defense. The state court cited a 2004 Supreme Court decision, Crawford v. Washington, in saying that Mr. Goldstein had a constitutional right to confront such witnesses. The prosecution's contention that Mr. Goldstein "was sane when he killed Kendra Webdale was a strong one, but we cannot say it was so strong that no rational jury could have rejected it," Judge Robert S. Smith of the Court of Appeals said, writing for the majority.

New Drug Developed for Smoking Cessation
Jennifer Barrett, Newsweek- 5/29/2006

For years smokers trying to kick the habit have had three choices: taking an antidepressant like Zyban, switching to nicotine replacements like patches or gum, or going cold turkey. Now the Food and Drug Administration has approved another option. Pfizer's varenicline, marketed as Chantix, targets areas of the brain that are affected by nicotine, easing withdrawal symptoms and blocking the effects of inhaled cigarette smoke (so if a patient falters and lights up a cigarette, any pleasurable effects would be muted).
      The prescription-only drug could be available as early as the fall; its price has not yet been determined. The FDA recommends a 12-week course for the tablet, taken daily starting one week before the smoker's "quit date" target (potential side effects include nausea, headaches and constipation). In clinical trials, more than one in five smokers using Chantix remained smoke-free for at least one year--"a significant improvement over current medications; says Thomas J. Glynn, the American Cancer Society's director of international tobacco programs. While trial results aren't always duplicated in the real world, Glynn says that if smokers comply with the treatment, "we would expect success rates to be high." At the least, having another option may prompt more of the country's 44.5 million smokers to kick the habit.



ADHD Drugs Send Thousands to ERs
Associated Press, 5/24/2006

Accidental overdoses and side effects from attention deficit drugs likely send thousands of children and adults to emergency rooms, according to the first national estimates of the problem. Scientists at the U.S. Centers for Disease Control and Prevention estimated problems with the stimulant drugs drive nearly 3,100 people to ERs each year. Nearly two-thirds -- overdoses and accidental use -- could be prevented by parents locking the pills away, the researchers say. Other patients had side effects, including potential cardiac problems such as chest pain, stroke, high blood pressure and fast heart rate.
     Concerns over those effects have led some doctors to urge the Food and Drug Administration to require a ''black box,'' its most serious warning, on package inserts for drugs such as Ritalin, Concerta and Adderall. Yet even doctors advising the FDA don't agree on whether that's warranted.
     The issue was discussed in a series of letters in Thursday's New England Journal of Medicine, including some from doctors worried about the dangers of not treating attention deficit hyperactivity disorder. ''The numbers (of side effects) are puny compared to the numbers of stimulant prescriptions per year,'' said Dr. Tolga Taneli, a child and adolescent psychiatrist at University of Medicine and Dentistry of New Jersey in Newark. ''I'm not alarmed.''
      An estimated 3.3 million Americans who are 19 or younger and nearly 1.5 million ages 20 and older are taking ADHD medicines. Ritalin is made by Novartis Pharmaceuticals Corp. of East Hanover, N.J.; Concerta by Johnson & Johnson of New Brunswick, N.J., and Adderall by Shire US Inc. of Newport, Ky.
     Twenty-five deaths linked to ADHD drugs, 19 involving children, were reported to FDA from 1999 through 2003. Fifty-four other cases of serious heart problems, including heart attacks and strokes, were also reported. Some of the patients had prior heart problems. Still, there hasn't been a clear estimate of the scope of side effects. The CDC report, while not a rigorous scientific study, attempts to provide that by using a new hospital surveillance network.
     From August 2003 through December 2005, the researchers counted 188 ER visits for problems with the drugs at the 64 hospitals in the network, a representative sample of ERs monitored to spot drug side effects. Doctors linked use of stimulant ADHD drugs to 73 patients with side effects or allergic reactions. Another 115 accidentally swallowed ADHD pills, including a month-old baby, or took too much. ''These are cases where a young child took someone else's medication or they took too much of their own,'' CDC epidemiologist Dr. Adam Cohen said of the second group.
     Nearly 1 in 5 patients was admitted to the hospital, 1 in 5 needed stomach pumping or treatment with medicines, and 1 in 7 had cardiac symptoms. Sixteen percent of the side effects involved interaction with another drug. Besides cardiac problems, common symptoms included abdominal pain, rashes and spasms, pain or weakness in muscles, according to Cohen. No patients died. Extrapolating to all U.S. hospitals, the researchers estimated 3,075 ER visits occur each year.
     In another letter in the journal, the heads of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry wrote they are concerned a black box warning would discourage use of ADHD drugs, raising patients' risks of academic failure, substance abuse and other problems.
     This past February, an FDA drug safety advisory panel voted 8-7 for a black box warning. The next month, another FDA panel instead recommended data on cardiac and other risks go in a new ''highlights'' section the agency plans to add to the top of drug inserts.
     Dr. Marsha Rappley, pediatrics professor at Michigan State University, and two other doctors on the advisory panels believe the vote for a black box was premature. She said studies show the drugs raise blood pressure and pulse rates a bit, but it's unknown whether that would harm children taking them for years, and that cardiac risks may be higher for adults.
     Dr. Steven Nissen, cardiology chief at the Cleveland Clinic, who had pressed for a black box warning at the FDA panel meeting, said ADHD drugs are powerful stimulants and inherently risky. Nissen and other doctors say the drugs are being prescribed to some who don't need them. This week, the FDA said it is ''working diligently'' on ''labeling changes that we feel accurately reflect the available data and the advice of the committees.'' The agency declined interview requests
     On the Net: http://www.nejm.org
American and Academy of Pediatrics ADHD site: http://www.aap.org/healthtopics/adhd.cfm

Psychiatric Care Denied To Gunman, Attorney Says
Tom Jackson, Washington Post- 5/26/2006

In the three months before he fatally shot two Fairfax County police officers, Michael W. Kennedy and his parents tried numerous times to get him immediate psychiatric help, their attorney said. Four times, Kennedy was sent home without getting help, and two mental health facilities told them not to bother coming in at all. On one occasion, Kennedy, 18, who by this time claimed he was talking to God and was threatening suicide, was voluntarily admitted to a mental health facility in Rockville. But after several hours, he left of his own accord and carjacked a vehicle to return home to Fairfax. "This young man was crying out for help," said Richard F. MacDowell Jr., the attorney for Brian and Margaret Kennedy, Michael Kennedy's parents. "On at least five occasions, they sought mental health services and were turned away. I can't think of another case that would be this compelling as to how ineffective our mental health system has become."
     Michael Kennedy's last contact with mental health professionals occurred May 4, four days before he carried seven loaded guns to the Sully District police station and opened fire, MacDowell said. Kennedy fatally shot Detective Vicky O. Armel and Officer Michael E. Garbarino before being shot to death by other officers.
      MacDowell spoke on behalf of Kennedy's parents to express their frustration at a system that seemed unable or unwilling to help their son. MacDowell said Kennedy's mental condition was never diagnosed, except for "a generalized diagnosis of depression and then anxiety at the end. This was somebody who was obviously deeply troubled." Despite Kennedy's mental problems, the parents did not remove their guns from their home because the weapons were kept in locked containers, MacDowell said. The Kennedys did not expect their son to break into them. Police could not verify the family's version of events, because the Kennedys have not met with authorities in the investigation of the killings. MacDowell said he could not comment on the reasons for that.
     Beginning in February, Kennedy was evaluated twice at the Woodburn Center for Community Mental Health in Annandale and twice at Prince William Hospital in Manassas but was turned away all four times, MacDowell said. He was not given any medication or a plan for treatment. Officials at those facilities said they could not discuss individual cases because of privacy laws. Woodburn is part of the Fairfax-Falls Church Community Services Board, with mental health professionals available 24 hours a day to evaluate people and, if necessary, recommend that they be hospitalized, even involuntarily. Prince William Hospital has its own psychiatric inpatient ward.
     Experts said the refusal to treat Kennedy is far from surprising. "Particularly here in Northern Virginia, it's so hard to get somebody in when they need psychiatric care," said Mary Zdanowicz, executive director of the Treatment Advocacy Center in Arlington. She said the definition of who must be given immediate treatment -- a person who is in "imminent danger" of harming himself or others or is incapable of caring for himself -- is usually interpreted too strictly, often because facilities don't have room for anyone but the most obviously dangerous people.
     Northern Virginia has lost about one-third of its private psychiatric beds in the past three years and more than half of its beds -- a decrease from 402 to 196 -- since 1990, Zdanowicz said. The one state mental hospital in the region, Northern Virginia Mental Health Institute in Fairfax, is "always full," Zdanowicz said. "The people that desperately need care aren't getting help."
     Kennedy's family knew he needed help and had him seeing a private therapist early this year, MacDowell said. But on Feb. 13, while home alone, the teenager shot the family dog. Kennedy told police and friends that he had been suicidal that day, then decided against killing himself but accidentally fired a gun and hit the dog. MacDowell said police took Kennedy to the Woodburn center that day. After an evaluation, "they determined he was not in need of future services. They had been told that he was seeing a therapist" and advised that was sufficient, MacDowell said.
     Kennedy returned to Woodburn with his parents on Easter Sunday, April 16, after he told them "he's got to be seen by somebody," MacDowell said. After a lengthy evaluation, MacDowell said Kennedy was told: "You're too smart to be here. You don't need to be here. Just go home. Here are four sleeping pills. Go see your private doctor." The Kennedy family was not satisfied and returned to Woodburn the next day. MacDowell said a crisis intervention team met with Kennedy, determined that his family had insurance and found a bed for him at Potomac Ridge Behavioral Health Center in Rockville. He was voluntarily admitted the next day, April 18, but broke out a window later that evening and left. He told friends that he didn't like the way he was being treated. He then stole a car and drove back to Fairfax. Euphia Hsu Smith, a spokeswoman for Potomac Ridge, said she could not discuss the specifics of Kennedy's case because of privacy laws. But she noted that "because we're a health-care facility, we're not a detention facility. We're not set up for detention, especially if someone is here voluntarily."
     On April 24, MacDowell said, Kennedy's mother again tried to get her son help. She called Inova Fairfax and Dominion hospitals, both with limited numbers of psychiatric beds, and was told that there was no room, MacDowell said. She then contacted Prince William Hospital, which said that Kennedy should be brought to the emergency room. "He's talking about cutting himself, he's suicidal and God talks to him," MacDowell said of Kennedy. "They say he's fine and give him 10 milligrams of Ambien," a sleeping pill, MacDowell said. Donna Ballou, a spokeswoman for Prince William Hospital, said the hospital disagrees with MacDowell's claims but could not be more specific because of privacy laws.
     By early May, Kennedy was talking about aliens, MacDowell said. Margaret Kennedy called Prince William Hospital on May 4 and took him back to the emergency room, in tears, MacDowell said. MacDowell said the staff thought Kennedy was claiming mental problems to evade criminal charges. "The diagnosis is anxiety," MacDowell said. "And they let him go." "It's astonishing," MacDowell said, "how the system has deteriorated to the point that a clearly troubled individual, such as Michael Kennedy, cannot receive inpatient services. Our mental health system in Virginia is essentially broken when the severely ill cannot receive vital and necessary services."

Bad Heroin Sparks a Series of Overdoses
Associated Press- 5/27/2006

DETROIT -- Larry, a 53-year-old heroin addict, has two cardinal rules: Never shoot up alone, and shoot up only one person at a time. If one overdoses, ''you need someone there to bring you back,'' he said. Larry, who asked that his last name not be used because of his habit, recited his rules after hearing that a mixture of heroin and a powerful painkiller has been killing users who believe they are taking heroin alone.
     Officials from Philadelphia to Chicago have reported deaths from the drug, called fentanyl and considered 80 times more powerful than morphine. In the Detroit area -- the apparent hub of the problem with more than 100 confirmed cases since last fall and as many as 41 possible deaths in the past eight days -- officials from the national Centers for Disease Control and Prevention are investigating and community organizations are scrambling to get the word out to users.
     The CDC says it has no national statistics on fentanyl deaths. But individual reports from a scattering of states indicate the drug mixture is widespread. Philadelphia has had 20 confirmed deaths from heroin mixed with fentanyl since April 17, and test results are pending in eight suspected cases, the city health department said. In New Jersey, where officials first raised the alarm about the drug in April, there have been about 10 confirmed fentanyl deaths and 10 to 20 suspected cases since last month, according to the state's poison control center. In Chicago, 30 people died from fentanyl or fentanyl-laced heroin from September 2005 to March 2006, said Christopher Hoyt, a spokesman for the U.S. Drug Enforcement Administration in that city. In addition, 23 suspected cases were reported in April and May. ''This is a huge, huge problem,'' said Stephen Marcus, medical director of the New Jersey Poison Control Center.
     In Wayne County, which includes Detroit, Medical Examiner Carl J. Schmidt said he began noticing a rise in fentanyl-related deaths in September. In total, medical examiners found 63 people who died in Wayne County with fentanyl in their blood last year. From the beginning of 2006 to mid-April, there were 70 such cases. County officials did not begin treating fentanyl as a crisis until last week, when the number of overdoses began to soar. ''Sometimes divining what the role of fentanyl is in an individual's death is more an art than a science,'' Schmidt said, noting that drug users often have multiple substances in their blood. Still, it was clear something was amiss when 12 people died of overdoses May 18-19, Schmidt said. In total, there have been 41 drug-related deaths since May 18, said Teresa Blossom, a spokeswoman for the Detroit-Wayne County Community Mental Health Agency. The county of 2 million typically sees two to three drug deaths a day. The drug kills by inhibiting respiration, Schmidt said. ''It literally suppresses your natural impulse to breathe,'' he said.
     Before the recent surge, Wayne County saw 20 to 30 fentanyl deaths a year, Schmidt said. Those cases tended to be severely ill people with legitimate prescriptions who committed suicide or people who had stolen the drug, he said. The fentanyl behind the current problem appears to be manufactured illegally and mixed with heroin long before it gets to the user, Schmidt said. In one case, three people found dead in a car last month took fentanyl not with heroin but with cocaine. Schmidt said he fears that could indicate a new trend.
     Organizations that run needle exchanges and other health programs for drug users are trying to spread the word. Officials emphasize there is help for people who have overdosed if they get to an emergency room immediately. But to some drug users, the warnings are an advertisement. ''When they hear about people OD'ing somewhere, they want to go there'' to get the more potent drugs, said Larry, the Detroit heroin user.
     Like Larry, 37-year-old Latonja said she would do her best to stay away from the tainted heroin by sticking to dealers she knows. However, she acknowledged it may be difficult, because users can never know for sure what they're buying. ''We're not analyzers when we're trying to shoot our dope,'' said Latonja, of Detroit, who also asked that her last name not be used. ''We're like, 'OK, it's time to get happy.'''

Intervention for Multi-Problem Families
Paul Raeburn, New York Times Magazine- 5/28/2006

Three years ago, Mary Beth Towell, a counselor in Canton, Ohio, was assigned to a family in a crumbling neighborhood of dilapidated houses, drug dealers and gangs. Even in that tough neighborhood, this family stood out as desperate. In a single month, child-protective services fielded more than 30 calls from teachers, police officers and others demanding that the children be removed. The mother had bipolar disorder and was a heavy marijuana user. The children's father no longer lived in the home. Two of the girls, 15 and 10, and a boy, 11, were violent and suicidal. They threatened one another with knives and fought viciously. (The remaining child, a 14-year-old girl, was somehow O.K.)
      Few families in such bad shape survive intact. The children may be sent to residential treatment centers or juvenile corrections facilities. "These programs generate high recidivism rates," says Bart Lubow, director of the program for high-risk young people at the Annie E. Casey Foundation in Baltimore. And they can cost at least $50,000 a year per child. "That would be O.K. if you were getting a reasonable return on your investment," Lubow says. "But the outcomes are very poor."
     Stark County in Ohio is trying something different. Towell was part of a team using an innovative antiviolence program called multisystemic therapy, or MST. Developed over the last 30 years by Scott Henggeler, a clinical psychologist and a professor of psychiatry at the Medical University of South Carolina, it is based on the assumptions that families should remain together and that all of the causes of antisocial behavior should be attacked at once.
     Taking his cues from family therapy as well as from social ecology, which emphasizes that behavior is shaped by multiple aspects of the environment, Henggeler studies the ecosystem composed by family, neighborhood, schools, peer groups and the broader community. Instead of removing children from that ecosystem, he tries to change it: solve the drug problems and the legal problems, get kids away from delinquent peers and encourage academic success.
     A central idea is to focus on the parents. "We want the therapist to build the competency of the parents, because the parents are going to be there after the therapist leaves," he says. If the parents can't handle the job, he might ask an uncle, aunt or grandparent to fill in.
     MST therapists like Towell have small caseloads — four to six families at a time. They visit the families every day, if necessary, and are always on call. If the police grab a child at 2 a.m., the therapist can help sort things out. Because of this intensive effort, MST isn't cheap. It typically lasts four to five months and costs between $5,000 to $7,500 per child. To make it cost-effective, it is directed at kids at high risk of expensive out-of-home placements. If enough of them can be kept at home, the program can pay for itself — and even save communities money.
     MST is one of only a handful of "evidence based" programs that have been shown to be effective for violent children. In a recent 14-year evaluation, kids who had been through MST programs had 54 percent fewer arrests and spent 57 percent fewer days in jail. "These programs have a higher success rate than what else is out there," Henggeler says. The single most important piece of the treatment is getting children away from deviant peers.
     While the program has become more popular in recent years, it is still relatively small. Edward Latessa, head of the division of criminal justice at the University of Cincinnati, contends that MST is one of the best programs for delinquent kids, but he adds that it isn't for everyone. "The problem with MST is it's a difficult model to implement," he says. "It requires a caregiver that's really committed. It's not easy, so some agencies give up." With such concerns in mind, Henggeler has set up a private company called MST Services to help communities develop programs, train therapists and make sure they stick with the program. Meanwhile, he is extending MST-style programs to other arenas, like the treatment of sexual offenders and abused or maltreated kids.
     Towell had surprisingly good luck with the Canton family. She discovered that the children liked to draw, and she helped them join art classes. There they met the sort of other kids she wanted them to associate with. With pressure from Towell, the mother cleaned herself up and made the commitment to turn things around. It wasn't easy, but it worked. "She was willing to do whatever it took," Towell says. "That's when we have the most successful cases."

Teen's Cell Phone Use Related to Depression
Denise Gellene, Los Angeles Times- 5/28/2006

The teen obsession with yakking, text messaging and ring tone swapping on their cell phones might mean more than a whopping phone bill. For the most crazed, it's a sign of unhappiness and anxiety, according to a new medical study. A survey of 575 high school students in South Korea found that that the top third of users -- students who used their phones more than 90 times a day -- frequently did so because they were unhappy or bored. They scored significantly on tests measuring depression and anxiety compared to students who used their phones a more sedate 70 times daily.
     The study, presented at a meeting of the American Psychiatric Association in Toronto last week, was among the first to explore the emotional significance of teens' cell phone habits as the device becomes more entrenched in today's youth culture. Two of every five people in the U.S. from ages 8 to 18 own a cell phone, according to a recent survey. Students in grades seven through 12 spend an average of an hour a day on their cell phones -- about the same amount of time they devote to homework.
     Some earlier studies involving college students have suggested a link between heavy cell phone use and depression. Other research has shown that students incorporate cell phones into their personal identities.
     For teens, cell phones were not just objects or communications tools. They were portals for being in touch with other people -- extensions of themselves " said Christina Wasson an anthropologist at University of North Texas who has studied cell phone use.
      Dr. Jee Hyan Ha, lead author of the latest report, said heavy cell phone users involved in his study weren't clinically depressed. Rather, Ha said, the students probably were suffering from some serious cases of teen angst. The youths may have been unhappy because of a problem in their lives or anxious about their social status. "They are trying to make themselves feel better by reaching out to others," he said.
     Ha, a psychiatrist at Yongin Mental Hospital in South Korea, surveyed students attending a technical high school in that country about their cell phone habits and attitudes. Most of the participants were boys, and their average age was 15. The heaviest users were communicating with their phones on average about every 10 minutes during waking hours. The majority of their usage was in text messages. They continually, checked their phones for messages and often became irritated when people didn't call them right back.
     Based on the popularity of the devices in South Korea, where three-quarters of residents have cell phones, Ha expected to find students had become addicted to their phones. "I thought that there would be some kind of craving, but that is not what I saw," he said. Instead, Ha found that cell phone use appeared linked to self-esteem. Students in the highest third of users scored significantly worse on scales measuring depression, anxiety and "alexithymia," or the ability to express emotion, compared to students in the bottom third of cell phone users.
     Ha used a psychological test to measure the mental state of the students. In the test, a score of 21 marked a clinical depression. The heaviest cell phone users scored 12, well below that point, while the lighter users came in at 7. The heavy users also showed in the tests that they struggled more with self-identity issues versus the lighter users. Although cell phone use in South Korea is higher than in the U.S., Ha said he believed the findings applied to American teens.
     James Katz, a professor of communications at Rutgers University, said Ha's findings were not surprising. "A central concern for teenagers is being in touch with friends and drawing boundaries about who's in and who's out," he said. "People who are anxious and depressed are concerned about whether they are in or out and naturally often look at their cell phones to see if they've gotten answers to the text messages they sent out."
     Dr. Mark DeAntonio, a clinical professor of child and adolescent 'psychiatry at UCLA, said it was difficult to assess the South Korean study because its statistical measures were not widely used in the U.S. However, he said the general point of the study was worth noting. For anxious teens, text messaging can become a substitute for face-to-face communication, DeAntonio said. "You want to be sure that you are not reinforcing social isolation," DeAntonio said.
     Dr. Bruce Spring, assistant professor of Keck School of Medicine at the University of Southern California, said that in some cases, light or no use of a cell phone might actually be a more serious warning sign. "Teens who are really anxious and depressed won't be sending messages or making
calls," he said.