Noteworthy News Articles on Mental Health Topics, June 15-21, 2006
That Wild Streak? Maybe It Runs in the Family
Amy Harmon, New York Times- 6/15/2006
Jason Dallas used to think of his daredevil streak — a love of backcountry skiing, mountain bikes and fast vehicles — as "a personality thing." Then he heard that scientists at the Fred Hutchinson Cancer Research Center in Seattle had linked risk-taking behavior in mice to a gene. Those without it pranced unprotected along a steel beam instead of huddling in safety like the other mice. Now Mr. Dallas, a chef in Seattle, is convinced he has a genetic predisposition for risk-taking, a conclusion the researchers say is not unwarranted, since they believe similar variations in human genes can explain why people perceive danger differently. "It's in your blood," Mr. Dallas said. "You hear people say that kind of thing, but now you know it really is."
A growing understanding of human genetics is prompting fresh consideration of how much control people have over who they are and how they act. The recent discoveries include genes that seem to influence whether an individual is fat, has a gift for dance or will be addicted to cigarettes. Pronouncements about the power of genes seem to be in the news almost daily, and are changing the way some Americans feel about themselves, their flaws and their talents, as well as the decisions they make.
For some people, the idea that they may not be entirely at fault for some of their less desirable qualities is liberating, conferring a scientifically backed reprieve from guilt and self-doubt. Others feel doomed by their own DNA, which seems less changeable than the more traditional culprits for personal failings, like a lack of discipline or bad childhoods. And many find it simply depressing to think that their accomplishments might not be the result of their own efforts. Parents, too, are rethinking their contributions. Perhaps they have not scarred their wayward children so much as given them bad genes. Maybe it was not their superior parenting skills that produced that Nobel laureate.
Whether a new emphasis on genes will breed tolerance or bigotry for inborn differences remains an open question. If a trait like being overweight comes to be seen as largely the result of genetic influence rather than lack of discipline, the social stigma connected to it could dissipate, for instance. Or fat people could start being viewed as genetically inferior.
Because tests for the genes that influence personality and behavioral traits are not yet commercially available, there is no way for most people to know which ones they have. And even if they could, the newly uncovered genes are thought merely to influence, not determine, their personalities. Biologists are also quick to emphasize the role environment plays in activating genetic dispositions that might otherwise never be expressed, or mitigating those that are. But that has not stopped people from acting on their assumptions.
Mr. Dallas's wife, Mari, for instance, convinced that her husband is in some sense hostage to his daredevil genes, has insisted he draw the line at certain activities. "If he had his choice, he would be getting a motorcycle," said Ms. Dallas, a pediatric oncologist. "I don't think that's such a good idea."
The public embrace of genetics may be driven as much by wishful thinking as scientific truth. In an age of uncertainty, biology can appear to provide a concrete answer for behavior that is difficult to explain. And the faith that genetics can illuminate the metaphysical aspects of being human is for some a logical extension of the growing hope that it can cure disease. "More and more stories about who we are and how we live are becoming molecular," said Paul Rabinow, an anthropologist at the University of California, Berkeley, who studies the interrelation of science and culture. "The older liberal worldview that it's all a question of willpower is still very present in America, but genetics has become a strong countercurrent."
That may be partly because the science has become more credible. Armed with the human genome sequence, along with a catalog of genetic variation in the human population, and tools that can inexpensively gauge any individual's genetic makeup, scientists can now pinpoint the genes associated with inherited traits. Developed to dissect the genetic basis for complex ailments like heart disease and cancer, the methods are now being applied to less pressing areas like the way genes may influence attention deficit disorder. While scientists have yet to demonstrate any genetic cause that directly affects such behavior, they have found plausible associations. And for many people, that is all that matters. "The scientific facts have changed," said Steven Pinker, a psychologist at Harvard who documented cultural resistance to the influence of genetics on behavior in his 2002 book "The Blank Slate." "We now have real evidence that some of the variation in personality is inherited," Dr. Pinker said, "and I think it may be affecting people's everyday choices."
Some people persist in believing in the power of the human spirit, but a growing number prefer to submit it to a DNA test. In the wake of the recent discovery that millions of people who carry a specific genetic variation are more likely to gain weight, Mike DeWolfe, a computer programmer who considers himself overweight, cannot help wondering if he is one of them. "I really would like to have a test, because it would help reduce my guilt over it," said Mr. DeWolfe, 38, of Victoria, British Columbia, noting he would also welcome a genetic treatment as an alternative to his constant dieting. "That would make a big difference."
There is nothing new about the idea that temperament and behavior are shaped by genetic endowment. Families have long clucked over a trademark stubborn streak showing up in a new generation, or crowed about inherited creative abilities. But as science begins to corroborate intuition, the public is reassessing where credit and responsibility lie for character traits that may be in part genetically preordained. "To summarize, want to live until a ripe old age? Have parents that live long," Joe Pickrell, a 23-year-old graduate genetics student wrote in a recent blog entry. "Think you're a friendly, peaceful guy 'cause your mom raised you right? Think again. Able to try drugs just a couple times and never get hooked because of your strong will? Nope." (Mr. Pickrell, of Chicago, punctuated each clause with a link to a recent scientific journal article describing the genetic component of life expectancy, aggression and susceptibility to drug addiction.)
Jacki Thorpe wondered for years why her older sister could quit smoking so easily, while her own numerous attempts have failed. After all, their upbringing had been virtually identical, and they had started smoking together when they were 12 and 14. Then she heard about a genetic variation that predisposes some people to nicotine addiction. "I have it," guessed Ms. Thorpe, 42, an administrative assistant in Whidbey Island, Wash. "My sister doesn't." Determined to fight her presumed genetic destiny, Ms. Thorpe has sworn to try quitting one more time this summer. A Stanford University student in a focus group on smoking and genetics was more accepting: "Let's say I'm still addicted to cigarettes 10 years from now," the student said in a telephone interview, asking that his name not be used because he has concealed his smoking habit from his family. "It might feel like it's not a total personal failure, just that certain things made it harder for me than other people. It kind of takes the weight off."
Friends and family members who worry about behavior that seems unhealthy or self-destructive sometimes suspect that blaming genes is an easy out. When Representative Patrick J. Kennedy, Democrat of Rhode Island, cited his family's history of addiction in admitting to a prescription drug addiction after he crashed his car near the Capitol last month, for instance, some scoffed. "Kennedy blames crash on 'car accident gene,' " read the headline on Antimatternews.com, a satirical blog, an allusion to the 1969 crash in which his father, Senator Edward M. Kennedy, was driving and a passenger was killed. Some bioethicists warn that the embrace of genetics as an explanation for troubling behavior threatens to let society off the hook, too. Taxing cigarettes, banning smoking in bars and not glamorizing it in movies is far more likely to lower smoking rates than drugs tailored to certain genotypes, these critics say.
Still, at Hazelden, an addiction-treatment center in Minnesota, teaching about genetics has become standard. Learning that roughly half the risk of alcohol addiction is associated with genes can remove a burden of guilt that otherwise serves as an obstacle to recovery, said Dr. Marvin D. Seppala, the center's chief medical officer. "They've driven drunk, and they have children, and they're saying, 'I can't believe I did this,' " Dr. Seppala said. "To learn they have a disease with a genetic component like other diseases really helps them understand these crazy sort of behaviors."
As genetics comes to rival childhood experience as the favored lens through which to interpret behavior seen as deviant, parents who blamed themselves for their children's disorders are also finding some relief. Recent research has found that conditions like anorexia or autism, once thought to be largely psychological, are at least partly genetic. "You would wonder, 'What's wrong, what aren't we providing?' " said Kathy Ramsay, 55, a legal secretary in Sacramento who has had three daughters who suffered from anorexia. The new DNA paradigm, however, can come with a new guilt trip. "I passed it on to them," added Ms. Ramsay, whose daughter Heather volunteered for a genetic study of anorexia at the University of North Carolina after reading about the research in her local newspaper this year. "It was in me."
Some adults are more forgiving of parents' sins they now consider DNA-enabled. Others get angry, however irrationally, for being saddled with inferior genes. Tim McGrath, 45, said learning about the genetics of alcoholism had made him more determined not to follow the path of his father. Still, he is haunted that he has seen his own fate. "It's like this demon out there, lurking," said Mr. McGrath, a teacher in Chicago. "And without the proper vigilance, or whatever, it could strike."
By suggesting a genetic basis for behavior previously believed by some to be the result of character flaws, scientists and others say the discoveries could make for more understanding of human differences. Some overweight people, for instance, hope it will reduce the stigma associated with being fat. "Maybe it will help the rest of the world realize it's not lack of willpower, it's not stubbornness, it's not laziness," said Jane Perrotta, 52, a medical writer and contributor to the weight-loss blog The Skinny Daily Post. "It's the hand you're dealt," Ms. Perrotta said.
Others fear that when certain behaviors once ascribed to personal choice are seen as genetic, the next step will be not tolerance for difference, but support for intervention. On a "fat-acceptance" e-mail list, several members suggested recent research will lead only to new ways for them to lose weight through genetic alteration, rather than be accepted as they are. And when scientists caused fruit flies to pursue flies of the same sex by altering a gene last year, some gay-rights advocates worried it would lend credence to the notion that homosexuality could be "cured."
People could also find their genes being held against them. Already, some scientists suspect a specific gene plays a role in violent behavior, for instance, and a discussion has already begun over how people bearing such genes should be treated. "If we find a murder mutation, are we going to be more accepting of murderers, or are we going to lock them up even more tightly?" asked Jeffrey M. Friedman, director of the Starr Center for Human Genetics at Rockefeller University. "The more we find genes that play a role in determining all sorts of attributes, the more we're going to face these kinds of ethical issues."
Of course, for traits that are socially desirable, people may not be as eager to accept genetic explanations that seem to trivialize their skills or accomplishments. When scientists this year found two gene variations that appear at higher rates in professional dancers than in the general population, many dancers bristled at the news. In online message boards for the ballet magazine Pointe, several writers said success in dance was the result of hard work, passion and good mentors. "Being a dancer requires so much more than what's there in your body, an emotional strength," said Virginia Johnson, editor of Pointe and a former principal dancer with the Dance Theater of Harlem. She paused. "That genes can't really — well, I guess that's genetic, too, isn't it?"
Officials Seeking Source of Lethal Heroin Mixture
Kirk Johnson, New York Times- 6/15/2006
CHICAGO — The police and health authorities are struggling to track down the source of a doctored, intensely powerful heroin that has killed at least 130 people in and around Chicago and Detroit and sent hundreds more to hospitals in cities from St. Louis to Philadelphia.
In the labyrinthine and often paranoid world of illicit drugs, tales of killer heroin have come and gone before. But this time is different, law enforcement and health officials say. The pattern of cases is broader, involving many markets at once, suggesting, they say, a larger and more sophisticated distribution network. The additive has been traced to laboratories in Mexico, which has traditionally supplied much of the Midwest heroin, raising fears that other hybrid pharmaceutical street drugs might emerge. "The biggest new thing is the high mortality rate," said Dr. Carl Schmidt, the chief medical examiner for Wayne County, Mich., which includes Detroit and suburbs. The county has had more than 70 deaths since September related to the altered heroin mixture, Dr. Schmidt said, including those of three people found together in a car in April. The three were overcome so quickly that no one could get out to summon help.
The additive, called fentanyl, was developed as a commercial painkiller in the 1960's and surfaced as street-drug compound in the mid-80's on the West Coast, where it killed perhaps 100 people over as many as eight years. It made waves again in the early 90's in the New York metropolitan region, where it killed dozens of people who bought fentanyl-laced heroin under the street brand Tango and Cash. Fentanyl, which is 50 to 100 times more powerful than morphine, is not a contaminant or filler, drug experts say, but rather a deliberately introduced enhancement intended to improve the product. It kills by shutting down a victim's respiratory system when too much is taken, an easy mistake because of the potency.
Much has changed in the drug world since fentanyl first became a killer. In many parts of the country, the use of synthetic, laboratory-produced drugs like methamphetamine, or meth, has surged. A sharp increase in prescriptions for narcotics, depressants and stimulants has also contributed to an increase in drugs diverted for illicit use and has created drug users familiar with pharmaceuticals, according to a report this year by the National Drug Intelligence Center, a unit of the Justice Department. And a national crackdown on illegal drug laboratories in the United States has recently pushed more meth production to Mexico, where local police officers and federal Drug Enforcement Administration officials say they think Chicago's fentanyl was produced.
The Chicago police superintendent, Philip J. Cline, said in an interview that his officers working with the D.E.A. were looking for connections among clusters of overdose cases and then trying to track back from there through undercover purchases, arrests and laboratory tests to understand the pipeline. "Everybody is looking for a signature," Superintendent Cline said. "Is it the same here as in Philly? We're not sure on that yet." Superintendent Cline said city officials had been frustrated because warnings appeared to have partly backfired. Drug dealers were even seen waving the fliers the city distributed this year, advertising that they were selling the very thing the police were so worried about. "The biggest problem is that we have willing victims," he said.
One former heroin user, Justin Sorci, said the wave of deaths had given him a mission, to warn people he knows are still using. "The thinking of an addict is that 'I won't be the one,' " said Mr. Sorci, 27, who went on Wednesday morning to a mobile treatment van on the North Side of Chicago to receive the methadone tablets that blunt his craving for heroin. "People who are still out there — I'm warning them to be careful."
Fentanyl's re-emergence has revived old fears among some experts that underworld chemists could one day learn to manipulate opiate molecules to produce superdrugs of devastating malevolence — more addictive or corrosive to society than heroin, alcohol or cocaine at their worst. Others say the wave of deaths proves that such a formula has not been perfected, since the fentanyl makers are killing off their own customers. But people who study the market say more laboratory-produced drugs, of whatever quality, are probably inevitable because the process is cheaper than harvesting and transporting agricultural drugs and can be done anywhere. "It is becoming easier to manufacture mind-altering substances, and the Internet has spread that knowledge all over the world," said Martin Y. Iguchi, a professor of public health at the University of California, Los Angeles, who was running a drug treatment clinic in New Jersey when the Tango and Cash cases unfolded in the 90's. "That's got to have an impact longer term."
But drug treatment workers and addicts have a tool against overdoses that was not widely available in the past, an injectable medicine called naloxone or narcan that can reverse respiratory failure. The Chicago Recovery Alliance, a group that works to improve the health of intravenous drug users and runs the methadone van where Mr. Sorci stopped, pioneered the effort to get naloxone into the hands of the city's drug users in 1999. Baltimore, San Francisco and other cities now have anti-overdose programs using the medication, as well. The group's medical director, Dr. Sarz Maxwell, said she knew of at least five people in Chicago who had stopped breathing after using heroin-fentanyl and were saved by friends. "We even heard of a couple of complete strangers who found somebody, had naloxone and saved a life," Dr. Maxwell said.
One heroin user, Sean H., 20, who was visiting the treatment van and spoke only on the condition that his last name not be used, said a friend died six weeks ago from a fentanyl-related overdose. The man, 24, specifically sought out fentanyl, Sean said, and had just recovered from one overdose. His body was found on a train. Sean says he and his brother, who also uses heroin, are more careful now and always have naloxone on hand when they take drugs, though he thinks that none of the heroin they have taken has contained the additive. But the talk about the intensity of the fentanyl experience has intrigued him, he said. "From an addict's point of view," he said, "that intensity is what you want."
Painkiller Patch Abuse Blamed for Deaths
Associated Press, 6/16/2006
ST. LOUIS -- Justin Knox bit down on the bitter-tasting patch, instantly releasing three days' worth of a drug more powerful than morphine. He was dead before he even got to the hospital. The 22-year-old construction worker and addict was another victim in an apparent surge in U.S. overdoses blamed on abuse of the fentanyl patch, a prescription-only product that is intended for cancer patients and others with chronic pain and is designed to dispense the medicine slowly through the skin. ''I cannot tell you the amount of people I've seen and the creative ways they abuse this drug,'' said Dr. Scott Teitelbaum, director of the Florida Recovery Center in Gainesville, Fla. ''Fentanyl has been abused for years. But recently there has been an increase. I've seen more chewing, squeezing of the drug off the patch and shooting it up.''
Fentanyl, a synthetic narcotic, was introduced in the 1960s, but it was not until the early 1990s that it became available in patch form. Last year, the first generic versions of the patch hit the market. At least seven deaths in Indiana and four in South Carolina since 2005 have been blamed on abuse of the fentanyl patch, along with more than 100 deaths in Florida in 2004. About a week after Knox's death in Farmington, Mo., in March, a second man in the same county was prescribed the patch legally and died after injecting himself with the gel that he had scraped from it.
Emergency-room visits by people misusing fentanyl shot up nearly 14-fold to 8,000 nationwide between 2000 and 2004, according to the U.S. Department of Health and Human Services. The figures do not indicate how many of those ER visits were because of the patch. (In recent months, more than 100 deaths have been reported from Chicago and Detroit to Philadelphia among drug addicts who overdosed on heroin mixed with fentanyl. And federal drug agents believe fentanyl is being made in clandestine labs in Mexico and elsewhere.)
The first fentanyl patch was Duragesic, made by Johnson & Johnson. Sales more than tripled from 2000 to 2004, according to the Pacific Law Center in La Jolla, Calif. Worldwide sales were more than $2 billion in 2004, and half of that was in the U.S., according to the J&J's Web site. More than 5.7 million prescriptions were written in 2003 for the Duragesic patch, according to IMS Health. Mark Wolfe, spokesman for PriCari, the J&J unit that oversees Duragesic, said the product comes with strong ''black box'' warnings about the dangers of abusing Duragesic.
One theory is that addicts are turning to the fentanyl patch because of a government crackdown on abuse of another powerful prescription painkiller, OxyContin, or oxycodone. ''The abuse of oxycodone and the fear of litigation is enough to scare doctors from prescribing it. Duragesic is in vogue, as we've seen over the last year and a half and two years,'' said Dr. John Brandt, a chronic-pain specialist at the University of Florida.
In Missouri, the man accused of illegally selling the fentanyl patch to Knox has been charged with murder. ''The awareness is just not out there. I had never heard of this patch,'' said Knox's mother, Rose Marler. ''There's a new generation of drugs and people just need to be aware.''
On the Net:
Drug Abuse Warning Network: www.dawninfo.samhsa.gov
Drug Enforcement Administration: www.usdoj.gov/dea
Suicide-Risk Tests for Teens Debated
Shankar Vedantam, Washington Post- 6/17/2006
A growing number of U.S. schools are screening teenagers for suicidal tendencies or signs of mental illness, triggering a debate between those who seek to reduce the toll of youthful suicides and others who say the tests are unreliable and intrude on family privacy. The trend is being aggressively promoted by those who say screening can reduce the tragedy of the more than 1,700 suicides committed by children and adolescents each year in the United States. Many of the most passionate supporters have lost children to suicide -- among them Sen. Gordon Smith (R-Ore.), whose son Garrett died in 2003.
One screening program, TeenScreen, developed by Columbia University, has been administered to more than 150,000 children in 42 states and the District. The state of New York plans to start screening 400,000 children a year, and the federal government is directing tens of millions of dollars to expand screening nationwide.
Use of the psychological evaluations is growing even though there is little hard evidence that they prevent suicides. A panel of government experts concluded two years ago that the evidence to justify suicide screening was weak and that such programs, although well intentioned, had potential adverse consequences.
The growing use of screening has coincided with a rapid increase in the number of youngsters being prescribed powerful antipsychotic medications such as Risperdal and Zyprexa that have not been specifically approved for use by children. There was a fivefold increase in the use of these drugs in children between 1993 and 2002, according to one analysis published this month in the Archives of General Psychiatry, and a 73 percent increase in such prescriptions between 2001 and 2005, according to Medco, a firm that manages pharmacy benefits.
Proponents of screening say that it is no different than having health checkups or visiting a dentist, and that the potential benefits are incalculable. After Smith's son killed himself, the Republican bucked the objections of several conservative groups to push into a law an $82 million effort to expand programs such as TeenScreen. "Without any doubt, had TeenScreen been available to us as Garrett's parents, I am convinced we would have been empowered to save his life," Smith said in an interview. "Logic tells me the more you know, the more you are able to help."
Garrett Smith died one day shy of his 22nd birthday. He had seen a psychiatrist shortly before he committed suicide and was given a prescription for an antidepressant. Sen. Smith said the family did not know whether Garrett took the medication. Later, Smith said, several experts concluded that Garrett probably had bipolar disorder, also known as manic-depression. Antidepressants are not recommended for this condition, and Smith said his son had probably concealed his symptoms during his single visit with the psychiatrist. Still, he said, if the family had known that Garrett had bipolar disorder, they could have acted years earlier.
The controversy over screening has become emotional. Opponents say such programs have turned into fronts for the pharmaceutical industry to boost sales. Advocates, meanwhile, say those against screening are often driven by anti-psychiatry ideologies such as Scientology. "It is industrial psychology at its worst," said Michael D. Ostrolenk, a family therapist with the Eagle Forum, a conservative group founded by commentator Phyllis Schlafly. "We think it is inappropriate to turn state schools into laboratories for psychiatry." He added that the group is also concerned that screening violates family privacy.
But screening has wide support among both Republicans and Democrats. In 2004, President Bush signed into law the Garrett Lee Smith Memorial Act to boost funding for suicide screening, and the President's New Freedom Commission on Mental Health has been broadly supportive.
The debate over screening also turns on the scientific paradoxes of suicide. It is rare enough that it is difficult to study by conventional scientific trials, but common enough to claim the lives of more than 30,000 Americans each year -- far more than those who die by homicide. There were 1,737 suicides by children and adolescents in 2003, the last year for which national statistics are available. Among those younger than 20, the suicide rate is 2.14 per 100,000, a fraction of the 14.6 per 100,000 rate for those older than 50. But national surveys suggest that about 1 in 12 high school students tries to harm himself or herself each year with an eye to committing suicide.
Because suicide victims often turn out to have had mental disorders such as depression and bipolar disorder, David Shaffer of Columbia University, who developed the TeenScreen questionnaire, and other specialists say identifying and treating youngsters with such disorders may reduce the number of suicides. "If the only product of screening was to predict who is going to commit suicide, you could argue about its utility," he said. "But the risk factors for suicide are other treatable psychiatric disorders."
Laurie Flynn, national executive director for TeenScreen, the largest of several such programs nationwide, said annual physical exams are less likely than mental health checkups to reveal problems. Moreover, she said, suicide screening can reveal problems that parents may never detect. Flynn's daughter attempted suicide when she was 17. When the school phoned Flynn with the news, she said, her initial reaction was "You have the wrong number." Shaffer and Flynn said the goal is not to put children on medication but to alert parents to a problem, which they can then discuss with a pediatrician, a psychiatrist or a clergy member. Flynn said TeenScreen is supported by private donors and receives no money from the drug industry. (Much of the initial funding came from the late William J. Ruane, a former board member of The Washington Post Co.) Shaffer said the screening test he developed is now in the public domain and he does not profit from its use.
In New York state, where 70 to 80 children commit suicide each year, Sharon Carpinello, commissioner of the Office of Mental Health, said officials plan to spend more than $60 million to expand youth suicide prevention initiatives such as TeenScreen.
Although the argument that treating mental disorders would reduce suicides is intuitively appealing, the U.S. Preventive Services Task Force, a federal panel of independent experts, concluded in 2004 that there was insufficient evidence either for or against general physicians screening the public for suicide risk. Ned Calonge, chairman of the task force, established to assess the evidence for various disease-prevention strategies, said the panel would reach the same conclusion today. "Whether or not we like to admit it, there are no interventions that have no harms," said Calonge, who is also chief medical officer for the Colorado Department of Public Health and Environment. There is weak evidence that screening can distinguish people who will commit suicide from those who will not, he said. And screening inevitably leads to treating some people who do not need it. Such interventions have consequences beyond side effects from drugs or other treatments, he said. Unnecessary care drives up the cost of insurance, causing some people to lose coverage altogether. For every 1 percent increase in premiums in Colorado, Calonge calculated, 2,500 people lose their health insurance.
The same panel had concluded that there is sufficient evidence to recommend screening adults for depression. This is in part because a variety of medications have proved effective in treating adults. Only one drug, Prozac, has been proved effective in clinical trials for treating depression in children.
Steven E. Hyman, a former director of the National Institute of Mental Health and now provost at Harvard University, said he favors developing screening questionnaires and treatments for children to reduce the number of suicides, but he is skeptical that such tools currently exist. "By and large, brief diagnostic tests -- especially doing broad screening in children -- are not well validated, and one has to be concerned about missing real illness or, conversely, interpreting transient life troubles as a mental illness requiring intervention," Hyman said. "It doesn't mean ignorance is good," he added. "But if your instrument is poor, or you don't know how to intervene to prevent a condition like suicide, there is actually a risk of harm. Besides cost and intrusiveness, there is a risk of harm in terms of stigmatization, but also interventions that backfire."
Insanity Remains Focus in Yates' 2nd Trial
Associated Press. 6/18/2006
HOUSTON -- Andrea Yates often struggles with deep depression or hallucinations in the weeks around June 20, the date when she drowned her five children in their bathtub in 2001. During that period this year, Yates will be in court for her second murder trial. Jurors, who will be selected beginning Thursday, will hear largely the same evidence as in Yates' first trial, but they also will hear about her psychotic episodes since her 2002 conviction, which was overturned on appeal, defense attorney George Parnham said.
In 2004, for example, Yates was hospitalized in July after starving herself for up to six weeks, losing about 30 pounds, according to the University of Texas Medical Branch Hospitals' discharge records. She believed she saw ''babies yelling for help,'' the records show. ''We've got four years of mental health records to show she's still severely mentally ill,'' Parnham said.
Yates is again pleading innocent by reason of insanity. Parnham maintains that severe postpartum psychosis prevented her from knowing that it was wrong to drown her children, ages 6 months to 7 years. Prosecutors, however, insist that Yates does not meet Texas' legal definition of insanity: not knowing at the time that one's actions are wrong. They plan to present the same evidence showing how Yates killed the children after her husband left for work and before her mother-in-law arrived to help, and how Yates called 911 to report the crime. ''Everything I've seen has reaffirmed that she was sane at the time she killed her kids,'' prosecutor Kaylynn Williford said. ''What's at the crux of this case is: You can be mentally ill and know right from wrong and be held criminally responsible.''
If convicted, Yates could be imprisoned for life. Because the first jury rejected the death penalty, prosecutors cannot seek that penalty again without presenting new evidence. She has been in a state psychiatric hospital awaiting her retrial since she was released from prison earlier this year on $200,000 bail. Opening statements start June 26, and the trial is expected to last through the end of July. Yates' conviction was overturned last year by the state's 1st Court of Appeals, which said a prosecution witness' erroneous testimony could have influenced the jury's decision. That witness, Dr. Park Dietz, a psychiatrist who has been a consultant for the ''Law & Order'' television series, testified that one episode that aired before the Yates children were killed depicted a woman who drowned her children in a bathtub and was acquitted by reason of insanity. Yates frequently watched the series, according to other testimony, and a prosecutor -- not Dietz -- suggested her actions were inspired by that episode. After the jury found Yates guilty, attorneys in the case learned no such episode existed.
In preparation for the retrial, prosecutors have reviewed boxloads of evidence. ''That's what's kept me going,'' Williford said, pointing to one of the state's exhibits, a large board holding pictures of the youngsters: 6-month-old Mary in a baby carrier; 2-year-old Luke holding his baby sister; 3-year-old Paul wearing pajamas and a fireman's hat; 5-year-old John leaning against a tree; and 7-year-old Noah grinning from ear to ear. ''It's very emotionally draining and difficult to go through this again: reviewing the evidence, looking at the autopsy photos. It's hard as a human being; it's harder as a mother,'' Williford said. ''It's not any easier looking through those pictures five years later.''
Prosecutors will call Dietz to testify again, along with other witnesses from the first trial, Williford said. ''Basically, our case in chief will be the same,'' she said, declining to say what the state may do differently this time. For the defense, Parnham said he planned to call 40 to 50 witnesses, including the same doctors who previously testified about Yates' mental condition. He said jurors also will be told more about her stays at a psychiatric hospital shortly before the 2001 drownings. Andrea's then-husband, Russell Yates, testified for the defense in her first trial. Parnham said he planned to call Rusty Yates again but would approach him in a ''different'' way. He would not elaborate. Rusty Yates did not return calls seeking comment but has said he continues to stand by Andrea. He divorced her last year, and in March he remarried at the same church where the funeral for his children was held.
Stabbing Spree Recalls Violent Outbursts of the Past
Sam Roberts, New York Times- 6/18/2006
What else might have prompted a 20-year-old Boston man, his condition diagnosed earlier as "limited but not mentally ill," to embark on a 13-hour stabbing spree that injured four random victims in Manhattan last week? The attacks that the Boston man, Kenny Alexis, is accused of committing bore none of the earmarks of a serial killer. Nor of a circumstantial succession of crimes, like the robbery that leads to a kidnapping and a car theft. Nor of the mob mentality that fuels a binge of teenage wilding.
Rather, the attacks evoked past paroxysms of violence that appeared to have been triggered by the most innocent gesture — visible or spoken, genuine or imagined — and that generally ended just as abruptly when a suspect was captured or killed. "Sometimes, extreme acts of violence seem to come out of nowhere," said Jack Levin, a criminologist and director of the Brudnick Center on Violence at Northeastern University in Boston. He said the attackers were almost always quickly caught. "Their crimes are so disorganized and ineffectual that they never run up a large body count," he said. "In a frenzied state, they go from victim to victim without any cooling-off period. The entire rampage is held together by their lack of mental health, and little more."
Last week's stabbings fit the pattern of other multiple attacks that, because of their apparent randomness and short duration, briefly gripped the public's imagination. In January 2005, Jesse Nettles, 58, stabbed five strangers, including a man pushing his two children in a stroller in Times Square, during a two-day rampage in Manhattan. Mr. Nettles, who was homeless, pleaded guilty to assault charges and was sentenced to 30 years in prison. In 1974, he had killed a man at the Port Authority bus terminal. On an afternoon in May 2004, Jose Rodriguez-DeJesus, 29, used a 13-inch kitchen knife to stab three people in Greeley Square, just south of Herald Square in Manhattan, before being shot by the police. He is now serving a 25-year sentence. Mr. Rodriguez-DeJesus had served 30 months in a Massachusetts prison for stabbing an uncle and was committed in 2000 for a psychiatric evaluation but was not found to be insane. He was described as distraught and volatile, and a relative said he "was into violence; he liked talking about killing."
In some cases, bizarre behavior came seemingly without warning. Ronald J. Popadich, 39, of Garfield, N.J., was arrested in 2002 for injuring 18 people whom he tried to run down with a car on Feb. 12, and 7 more people two days later in a second hit-and-run spree in Midtown. One pedestrian died. In between the attacks, the police said, he shot a cabdriver in the East Village. The police said that Mr. Popadich told them later he wanted to kill as many people as he could. Two days before the first attacks, he had shot a woman who had refused his sexual advances. She later died. In 1996, John Royster, 22, a drifter with a minor criminal record, was charged in an eight-day rampage that included the murder of a woman outside her dry-cleaning shop on Park Avenue, a sexual attack on a woman in Central Park and a vicious attack on a woman who was jogging. At his sentencing two years later, he said, "It should be apparent to anyone with common sense that I'm mentally disturbed." Defense lawyers said the spree began when Mr. Royster was spurned by a tourist with whom he had had a brief affair.
While they declined to elaborate on specifics of the latest case, several criminologists said it did not seem atypical. "It's probably the end result of a series of disappointments or stresses this guy has had over the past several years," said N. G. Berrill, a forensic psychologist who teaches at John Jay College of Criminal Justice of the City University of New York. "He could be mentally ill. He feels angry that a girl just dropped him, or he didn't get a job, or his parents kicked him out of the house," Dr. Berrill continued. "This is more like, 'I'm going to take my little knife and show people how angry I am.' "
On June 8, Mr. Alexis was released on bail in Boston after a court hearing on vandalism charges. Last Tuesday afternoon, the police said, he was stopped for fare-beating at a subway station near the Port Authority bus terminal in Midtown. He was issued a summons after officers found that he was not wanted on any outstanding warrants. At 3:41 p.m., the authorities say, Mr. Alexis stabbed a 21-year-old tourist from Texas on a southbound C train in Harlem, saying later that the man was in his way. About 12 hours later, the police said, Mr. Alexis stabbed a 30-year-old Brooklyn man on a subway platform at Rockefeller Center after the victim refused to give up his cellphone. Then Mr. Alexis stabbed two students from Montreal, one 22 years old and the other 25, who were standing on a traffic island in Times Square, after he unsuccessfully tried to engage the two women in conversation, the police said. He was arrested after witnesses to the last attack followed the assailant to a McDonald's in Times Square and called the police. All four victims were recovering. "In all likelihood," Professor Levin said of the attacker, "he sought revenge for his miseries, not against any particular individual, but against an entire group of people — all New Yorkers, all Americans, all of humankind."
Another criminologist at Northeastern, James Alan Fox, said that sometimes there was method to the madness. "Most people who go on crime sprees like this don't necessarily attack randomly," he said. "It may look random — they may not be targets they know — but certain kinds of targets. Those are people who 'just snap,' but who have a longstanding grudge. "The more random the event, the more likely it's a case of mental illness where the person is delusional in some way," Professor Fox said. "Alexis is a homeless man. There's a good possibility he is suffering from some undiagnosed mental disorders that play into his decision to attack and his decision whom to attack. Then, there's no pattern to victims except unfortunately for them being in the wrong place at the wrong time." The rampage ends, Professor Fox said, "when he is caught, killed, or the voices stop talking to him."
When the moon set Tuesday morning, it was almost full. But Police Commissioner Raymond W. Kelly did not resort to folklore to explain the string of stabbings that began in the city's subways. "When you get four and a half million people a day into the system," Mr. Kelly said, "every once in a while a really bizarre thing can happen."
Getting Older Along With the Bluebird of Happiness
Eric Nagourney, New York Times- 6/20/2006
Researchers who surveyed younger and older adults found that both believe that, as a general rule, happiness declines with age. But when it came to their own experience, the older adults described themselves as happier than the younger people did. The study, led by Heather P. Lacey of the Veterans Affairs Ann Arbor Healthcare System and the University of Michigan, appears in The Journal of Happiness Studies.
The researchers asked 540 people, one group ages 21 to 40 and the other over 60, to assess their current state of happiness. They were also asked, depending on their age, to recall or predict how happy they were at 30 and again at 70. Most said that with age came decreasing happiness. But the findings from this study, as well as others that the researchers cited, suggested that there was little evidence to support that.
"Beliefs about aging are important," the researchers write. "If younger adults mispredict old age as miserable, they may make risky decisions, not worrying about preserving themselves for what they predict will be an unhappy future. "Conversely, exaggerating the joys of youth may lead to unwarranted nostalgia in older adults, interfering with their appreciation of current joys," they wrote.
Measuring happiness can be a tricky business. Despite popular belief, most older people describe themselves as happy. (Other studies have shown that even very sick people often report surprising levels of happiness.) "One possibility is, of course, that they are really happier," Dr. Lacey said. But it may also be that by the time people are older, they are better equipped to deal with adversity, perhaps because they have more perspective.
Finding New Passion After the Pain of Infidelity
Keith Ablow, M.D., New York Times- 6/20/2006
About two years ago, a man named Mitch phoned me asking for counseling to cope with his impending divorce from his wife of more than 20 years, the mother of his three children. "I'm going to need some serious support to get through this," he said. "I haven't slept more than two hours the last six nights. It came completely out of the blue. I can't believe this is happening to me."
I asked: "She didn't give you any hint your relationship was in trouble? Is this the first time she brought up divorce?" "She isn't the one who wants it," he said. "I am. She says she'll do anything to stay together." "It doesn't sound like you're completely comfortable calling it quits, either," I ventured. "I caught her cheating," he said. "I'm not about to stand for that."
Mitch's wife had taken a rare weekend away with girlfriends and bumped into an old college flame. Over the weekend, they were physically intimate. Shortly after she returned home, Mitch found an instant message she had sent the man from her cellphone, telling him how alive he had made her feel.
My job is to help people make sense of their life stories, including the toughest chapters. To do so, I have to help them embrace the truth about their personal histories and understand the facts about human emotions and relationships. In my experience talking with people coping with infidelity, I have found that learning that their spouses have been unfaithful creates so much anger, jealousy and fear that deep and sustaining connections can be obscured, leading them to further damage or utterly abandon marriages that often have more potential than ever to be intimate and passionate.
In his first session in my office, Mitch described how he had found his wife's incriminating message and how much it had caused him to suffer. But I believed that his suffering, as intense and understandable as it was, was not necessarily more powerful than his continuing capacity to be loving toward his wife, despite his pain.
"Do you remember the kind of romantic energy you and your wife had at the beginning of your marriage?" I asked.
"Well, sure," he said. "We were phenomenal together."
"Has it been different the last few years?" I asked.
"The last few?" he asked. "How about the last 10? But that doesn't give her the right to go out and do whatever she wants."
"Did you ever ask her whether she missed that kind of passion?" I asked. "Did you ever tell her that you did?"
"Well, no. That's not the kind of thing we would ever talk about."
"You could now," I said.
"Now? Why now, of all times?" he asked.
"Because she started the discussion."
"By cheating?"
"That, and getting caught," I said. "I'm not saying she unconsciously orchestrated this moment. But I'm telling you there's a critical moment at hand. And it could be the beginning of the best part of your marriage."
In working with couples who have chosen to write new chapters of their marriages, rather than final ones, I have found they often include themes beyond how to renew sexual passion. Husbands and wives end up discussing their fears of aging and mortality (fears that often lead to infidelity), the deficits in their self-esteem, the ways that focusing on parenting their children may have led them to neglect each other, hurtful patterns of infidelity in their own parents' relationships and many others.
Mitch wasn't immediately convinced that he wanted to try. "I don't know if I can do it," he said.
"You understand it's a luxury that you're here talking about your pain right now?" I asked him.
"How do you figure?" he asked.
"Well, how much time would we spend talking about your wife's cheating if you found out today that she had cancer?"
He didn't respond.
"Would you help her with that, despite what's gone on?" I asked. "Would you do the right thing for the mother of your kids?"
He looked at me incredulously. "Of course I would."
"Then do the right thing for her now."
Mitch did. He started a new chapter of his marriage by asking his wife to coffee and telling her he needed to hear three things to reconsider the divorce.
"I know," she said, "that I apologize, that I know what I've put you through, and that it won't happen again. I've told you all that a million——"
He interrupted. "Not even close," he said. "I want you to tell me why you think you felt the need to cheat. I want you to tell me a romantic fantasy of yours that you've never told anyone. And I want you to tell me what changes we need to make in our marriage for you to be able to honestly recommend it to our daughter when she's ready." Those three questions could be asked only by someone beginning a new journey. When Mitch's wife took the time and the risk to answer them honestly, that journey began in earnest. And it has truly never ended.
Iraq War May Add Stress for Past Vets
Donna St. George, Washington Post- 6/20/2006
More than 30 years after their war ended, thousands of Vietnam veterans are seeking help for post-traumatic stress disorder, and experts say one reason appears to be harrowing images of combat in Iraq. Figures from the Department of Veterans Affairs show that PTSD disability-compensation cases have nearly doubled since 2000, to an all-time high of more than 260,000. The biggest bulge has come since 2003, when war started in Iraq.
Experts say that, although several factors may be at work in the burgeoning caseload, many veterans of past wars reexperience their own trauma as they watch televised images of U.S. troops in combat and read each new accounting of the dead. "It so directly parallels what happened to Vietnam veterans," said Raymond M. Scurfield of the University of Southern Mississippi's Gulf Coast campus, who worked with the disorder at VA for more than 20 years and has written two books on the subject. "The war has to be triggering their issues. They're almost the same issues." At VA, officials said the Iraq war is probably a contributing factor in the rise in cases, although they said they have conducted no formal studies.
PTSD researcher John P. Wilson, who oversaw a small recent survey of 70 veterans -- nearly all from Vietnam -- at Cleveland State University, said 57 percent reported flashbacks after watching reports about the war on television, and almost 46 percent said their sleep was disrupted. Nearly 44 percent said they had fallen into a depression since the war began, and nearly 30 percent said they had sought counseling since combat started in Iraq. "Clearly the current Iraq war, and their exposure to it, created significantly increased distress for them," said Wilson, who has done extensive research on Vietnam veterans since the 1970s. "We found very high levels of intensification of their symptoms. . . . It's like a fever that has gone from 99 to 104." Vietnam veterans are the vast majority of VA's PTSD disability cases -- more than 73 percent. Veterans of more recent wars -- Iraq, Afghanistan and the 1991 Persian Gulf War -- together made up less than 8 percent in 2005.
VA officials said other reasons for the surge in cases may include a lessening of the stigma associated with PTSD and the aging of the Vietnam generation -- explanations that veterans groups also suggest. PTSD is better understood than it once was, said Paul Sullivan, director of programs for the group Veterans for America. "The veterans are more willing to accept a diagnosis of PTSD," he said, "and the VA is more willing to make it." In addition, as Vietnam veterans near retirement age, "they have more time to think, instead of focusing on making a living all the time, and for some this is not necessarily a good thing," said Rick Weidman, executive director for policy and government affairs at Vietnam Veterans of America.
Max Cleland, a former U.S. senator from Georgia and onetime head of the VA who was left a triple amputee by the Vietnam War, said the convergence of age and the Iraq war has created problems for many of his fellow veterans -- as well as for himself. "As we Vietnam veterans get older, we are more vulnerable," he said. When the war started in 2003, he said, "it was like going back in time -- it was like 1968 again." Now he goes for therapy at Walter Reed Army Medical Center and is wary of news from Iraq. "I don't read a newspaper," he said. "I don't watch television. It's all a trigger. . . . This war has triggered me, and it has triggered Vietnam veterans all over America."
PTSD has become a volatile topic lately, with some skeptics questioning whether the rise in claims is driven by overdiagnosis or by financial motives. A report last week from the Institute of Medicine, part of the National Academies, concluded that "PTSD is a well characterized medical disorder" for which "all veterans deployed to a war zone are at risk."
VA's growing PTSD caseload became an issue last August, when the agency announced a new review of 72,000 PTSD compensation cases, expressing concerns about errors and a lack of evidence. That probe was dropped after a sample of 2,100 cases turned up no instances of fraud.
Still, some experts are not convinced that the Iraq war has driven up the caseload. "I'm skeptical that it accounts for a broad swath of this phenomenon," said psychiatrist Sally Satel, a resident scholar at the American Enterprise Institute. "These men have had deaths in their families, they had all kinds of tragedies over 30 years that surely affected them emotionally but they coped with." Although a small percentage of veterans might be deeply affected, she said, she doubts "they have become chronically disabled because of it."
Around the country, many veterans dwell on the similarities between the wars in Vietnam and Iraq: guerrilla tactics, deadly explosives, fallen comrades, divisive politics. The way they see it, "Iraq is Vietnam without water," Weidman said. "We have people who have symptoms that they haven't had in a long time," said Randy Barnes, 65, who works in the Kansas City offices of Vietnam Veterans of America. For some, "the nightmares and flashbacks have been very hard to deal with," he said. Group therapy sessions are "much more crowded," he said, "with Vietnam veterans particularly, but now also with the Iraq and Afghanistan veterans."
Barnes served as a combat medic in Vietnam from 1968 to 1969 and went into treatment only in the late 1990s. By the time the Iraq war started, he said, he felt steadier -- but then his symptoms ramped up again. "Depending on what I saw or heard that day or read, I would have night problems -- nightmares, night sweats," he said. Sometimes, he said, he would roll out of bed and wake up crawling on the floor, "seeking safety, I guess."
A study published in February by VA experts showed that veterans under VA care experienced notable mental distress after the war started and as it intensified. While younger veterans, ages 18 to 44, showed the greatest reactions to the war, "Vietnam era VA patients reported particularly high levels" of distress consistently, the study reported. Powerful images of war have revived combat trauma in the past. "Traumatized people overreact to things that remind them of their original trauma," said Scurfield, the PTSD expert in Mississippi. When the movie "Saving Private Ryan" was released, World War II veterans sought mental health help in great numbers, said Wilson of Cleveland State. "It rekindled it all," he said.
The Silent Treatment
Ronald Pies, M.D., Boston Globe- 6/20/2006
The young man had not said a word to anyone for over a year. As he sat in my office, gazing at the floor, I turned helplessly to the patient's case manager and translator. She dutifully transformed my questions into the patient's native language, Cambodian: How are you feeling? Are you having any bad thoughts these days? How is your appetite? Hearing any noises in your head? But the patient returned her questions with still more silence.
As physicians trained in ``differential diagnosis," psychiatrists earn their keep by helping solve medical mysteries like this one. But I was stumped. Normally, we try to pin down the diagnosis by beginning with a detailed interview and mental status examination. We may then obtain MRI images of the brain, check the patient's blood for biochemical abnormalities, hold discussions with family members, or have the patient complete various pen-and-paper tests. But in this case, these approaches proved to be dead ends. Besides his inability to cooperate with an interview, my patient had no family in the vicinity that we knew about. So far as we were able to tell, many of them had been left behind, or killed, in Cambodia.
This was, after all, the late 1980s. A decade earlier, Cambodia had been seized by one of the most ruthless dictators of modern times, Pol Pot. Under his Khmer Rouge henchmen, nearly two million people -- fully a fifth of the population -- were murdered in the infamous ``killing fields." My patient had managed to escape to this country as a teenager in the late 1970s. Had he been brutalized by the Khmer Rouge? Was this related in some way to his mutism?
We are just beginning to understand the clinical aftermath of physical and psychological trauma, usually called PTSD, for post-traumatic stress disorder. Two of my colleagues -- David Spiegel and Etzel Cardena -- have described trauma as ``the experience of being made into an object." Whether the trauma is sexual assault or mutilation at the hands of the Khmer Rouge, the feeling of overwhelming helplessness is usually present. Spiegel has also described a syndrome called ``traumatic dissociation," in which the abused individual may defensively split off parts of her consciousness or personality. This may lead to periods in which the patient describes ``feeling unreal" or ``floating outside my body." In severe cases, traumatic dissociation may lead to a personality so fragmented that it fits the pattern described in famous works like ``The Three Faces of Eve." This condition used to be known as multiple personality disorder but is now called ``dissociative identity disorder. Indeed, as Spiegel has noted, the problem for severely traumatized patients does not lie in having more than one personality but in having less than one. The shattered pieces of personality that survive simply can't sustain complete and satisfying human relationships. My patient did not show the sort of flamboyant ``Jekyll and Hyde" alterations seen in Hollywood versions of multiple personality. Still, I wondered whether his mutism might be a delayed reaction to trauma he had suffered in Cambodia. I never found out for sure, but to this day, I believe this was the case.
Often, as a psychotherapist, half your job is just sitting quietly and respectfully in the presence of the patient's silence. And this I tried to do, month after month, with my mysteriously silent patient and his case manager. At times, if my patient's body language or facial expression changed, I might venture a question, or offer a supportive comment like, ``Coming in to see me must be very hard for you," or, ``It must be very lonely for you at times." And, sometimes, I would just sit.
Silence is a hard thing for most doctors to manage, and I'm no exception: The temptation to say or do something -- anything! -- is often enormous. But traumas take time to heal, and that time needs to be suffused with trust, safety, and empathy. Sometimes, even when you aren't quite sure what you're doing for the patient, those ingredients eventually work their way into the psychic wound. And sometimes you just catch a lucky break.
One morning, about a year after our treatment began, having rushed to work in rather casual attire, I found my patient and his case manager already sitting in my office. As I sat down, I noticed the patient staring intensely at my feet. Though his eyes were, as usual, directed toward the floor, I noticed a softening at the corners of his mouth, as if some granite rock face were about to give way. Suddenly, my patient broke out into a toothy grin. ``Doctor need new shoes!" he exclaimed loudly, pointing at my scuffed Hush Puppies. My patient was not only getting better, he was giving me good advice.
Medication for Stuttering? Experts Study Potential
Jeremy Mainer, Chicago Tribune- 6/20/2006
As a 62-year-old grandmother who has dealt with a severe stutter all her life, Sue Payne was skeptical when a friend told her last year about a study of a new drug that might relieve her speech problem. "I just laughed when I heard about it," said Payne, a special-education counselor from Austin, Texas, who laughs at the memory even now. "I thought, `Gee whiz, I'd like to try that just to see what it's like.'" But six months of taking two experimental pills each morning made a believer of Payne, who said she speaks with fewer staccato pauses between words than before. Her improvement has come as many experts are taking the promise of medication for stuttering more seriously.
Treatments for stuttering still lag behind scientists' changing understanding of the disorder, which affects about 3 million Americans. Since the 1950s, when Freudian therapists blamed the problem on overbearing parents, researchers have recognized the role of biological factors such as genetics and the development of language centers in the brain.
Still, until recently, scientists struggled to find drugs to attack the disorder at its biological roots. Dr. Gerald Maguire, a psychiatrist and stuttering specialist at the University of California at Irvine, said his studies over the last decade on drugs for stuttering ran into resistance within his own field. "When we started this research, it was kind of heretical to suggest there was something wrong with the brains of people who stutter," Maguire said.
In the 1990s researchers identified the first medications that seemed to improve some stuttering symptoms. Drugs such as risperidone and olanzapine, first developed to treat schizophrenia, work by blocking activity of the chemical messenger dopamine, which may be elevated for schizophrenics and people who stutter. One beneficiary of olanzapine is Maguire, who has stuttered as long as he can remember. Maguire said he learned at an early age to be a class clown, because his disorder seemed to disappear when he imitated the voices of cartoon characters such as Donald Duck or Elmer Fudd. He said taking the anti-psychotic drugs that came into use in the 1990s made his speech feel natural for the first time. "I lived every single waking moment thinking about my speech and monitoring my speech," Maguire said. "Now the words just come out."
Maguire is helping conduct a study of a new compound called pagoclone, the drug that Payne credits with improving her speech. Although the medication's precise mode of action is unclear, scientists know it inhibits a neurotransmitter called GABA, quieting the cacophony of brain signals thought to play a role in stuttering. The drug's maker, Massachusetts-based Indevus Pharmaceuticals Inc., says its study found that more than half of 88 adult patients who received the drug showed improvement in their speech after two months. The results are preliminary and have not yet been published in a peer-reviewed journal. Experts say none of the drugs under study will cure stuttering. Many patients still may benefit most from traditional behavioral therapy, said Kristin Chmela, a speech pathologist based in Long Grove.
One promising new technique called the Lidcombe program involves training parents to give their young children constructive feedback on their speech. A study published last year in the British Medical Journal found that preschool children on the program reduced their stuttering by 77 percent after nine months. "For many people, medication may be the right choice," Chmela said. "But if you have a child with a mild problem, that may not be the right choice. As we advance in research, we should get more and more options."
A Legacy of the Storm: Depression and Suicide
Susan Saulny, New York Times- 6/21/2006
NEW ORLEANS— Sgt. Ben Glaudi, the commander of the Police Department's Mobile Crisis Unit here, spends much of each workday on this city's flood-ravaged streets trying to persuade people not to kill themselves. Last Tuesday in the French Quarter, Sergeant Glaudi's small staff was challenged by a man who strode straight into the roaring currents of the Mississippi River, hoping to drown. As the water threatened to suck him under, the man used the last of his strength to fight the rescuers, refusing to be saved. "He said he'd lost everything and didn't want to live anymore," Sergeant Glaudi said. The man was counseled by the crisis unit after being pulled from the river against his will. Others have not been so lucky.
"These things come at me fast and furious," Sergeant Glaudi said. "People are just not able to handle the situation here."
New Orleans is experiencing what appears to be a near epidemic of depression and post-traumatic stress disorders, one that mental health experts say is of an intensity rarely seen in this country. It is contributing to a suicide rate that state and local officials describe as close to triple what it was before Hurricane Katrina struck and the levees broke 10 months ago. Compounding the challenge, the local mental health system has suffered a near total collapse, heaping a great deal of the work to be done with emotionally disturbed residents onto the Police Department and people like Sergeant Glaudi, who has sharp crisis management skills but no medical background. He says his unit handles 150 to 180 such distress calls a month.
Dr. Jeffrey Rouse, the deputy New Orleans coroner dealing with psychiatric cases, said the suicide rate in the city was less than nine a year per 100,000 residents before the storm and increased to an annualized rate of more than 26 per 100,000 in the four months afterward, to the end of 2005. While there have been 12 deaths officially classified as suicides so far this year, Dr. Rouse and Dr. Kathleen Crapanzano, director of the Louisiana Office of Mental Health, said the real number was almost certainly far higher, with many self-inflicted deaths remaining officially unclassified or wrongly described as accidents. Charles G. Curie, the administrator of the federal Substance Abuse and Mental Health Services Administration, said the scope of the disaster that the hurricane inflicted had been "unprecedented," and added, "We've had great concerns about the level of substance abuse and mental health needs being at levels we had not seen before."
This is a city where thousands of people are living amid ruins that stretch for miles on end, where the vibrancy of life can be found only along the slivers of land next to the Mississippi. Garbage is piled up, the crime rate has soared, and as of Tuesday the National Guard and the state police were back in the city, patrolling streets that the Police Department has admitted it cannot handle on its own. The reminders of death are everywhere, and the emotional toll is now becoming clear.
Gina Barbe rode out the storm at her mother's house near Lake Pontchartrain, and says she has been crying almost every day since. "I thought I could weather the storm, and I did — it's the aftermath that's killing me," said Ms. Barbe, who worked in tourism sales before the disaster. "When I'm driving through the city, I have to pull to the side of the street and sob. I can't drive around this city without crying."
Many people who are not at serious risk of suicide are nonetheless seeing their lives eroded by low-grade but persistent feelings of sadness, hopelessness and stress-related illnesses, doctors and researchers say. All this goes beyond the effects of 9/11 and the Oklahoma City bombing, Mr. Curie said. Beyond those of Hurricanes Andrew, Hugo and Ivan. "We've been engaged much longer and with much more intensity in this disaster than in previous disasters," he said.
At the end of each day, Sergeant Glaudi returns to his own wrecked neighborhood and sleeps in a government-issued trailer outside what used to be home. "You ride around and all you see is debris, debris, debris," he said. And that is a major part of the problem, experts agree: the people of New Orleans are traumatized again every time they look around. "This is a trauma that didn't last 24 hours, then go away," said Dr. Crapanzano, the Louisiana mental health official. "It goes on and on." "If I could do anything," said Dr. Howard J. Osofsky, the chairman of the psychiatry department at Louisiana State University, "it would be to have a quicker pace of recovery for the community at large. The mental health needs are related to this."
The state estimates that the city has lost more than half its psychiatrists, social workers, psychologists and other mental health workers, many of whom relocated after the storm. And according to the Louisiana Hospital Association, there are little more than 60 hospital beds for psychiatric patients in the seven hospitals that remain open here. Because of a lack of mental heath clinics and related services, severely disturbed patients end up in hospital emergency rooms, where they often languish. Many poorer patients were dependent on a large public institution, Charity Hospital, but it has been closed since the storm despite the protests of many medical professionals who say the building is in good condition. Big Charity, as the locals called it, had room for 100 psychiatric patients and could have used more capacity. "When you don't have a place to send that wandering schizophrenic directing traffic, guess what? Law enforcement is going to wind up taking care of that," said Dr. Rouse, the deputy coroner. "When the Police Department is forced to do the job of the mental health system, it's a lose-lose situation for everyone." "When the family comes to see me at the coroner's office," he added, "it's a defeat. The state has a moral obligation to reinstitute this care."
Sergeant Glaudi and others said some people struggling with emotional issues had no prior history of mental illness or depression. The symptoms cut across economic and racial lines; life in New Orleans is difficult and inconvenient for everyone.
Susan Howell, a political scientist at the University of New Orleans, conducted a recent study with researchers from Louisiana State to see how people were coping with everyday life in the city and neighboring Jefferson Parish. Ms. Howell managed a similar survey in 2003. "The symptoms of depression have, at minimum, doubled since Katrina," she said. "These are classic post-trauma symptoms. People can't sleep, they're irritable, feeling that everything's an effort and sad." The new survey was conducted in March and April, and canvassed 470 respondents who were living in houses or apartments. Since they were not living in government-issued trailers, it is likely that they were among the more fortunate.
Jennifer Lindsley, a gallery owner, also feels the sting of missing her friends.
"When you can't get ahold of people you used to know, it leaves you feeling kind of empty," Ms. Lindsley said. "When you try to explain it to people in other cities, they say: 'The whole world is over it, so you've got to get over it. Sorry that happened, but too bad. Move on.' " Some people have decided to leave solely because of the mood of the city. "I'm really aware of the air of mild depression that pervades this entire area," said Gayle Falgoust, a retired teacher. "I'm leaving after this month. I worry about living with this level of depression all the time. I worry that it might affect my health. I know the move will improve my mood."
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