Noteworthy News Articles on Mental Health Topics, August 20-23, 2006



The Trouble When Jane Becomes Jack
Paul Vitello, New York Times- 8/20/2006

In the most recent season of the lesbian soap opera, “The L Word,” a new character named Moira announced to her friends that, through surgery and hormone therapy, she would soon be a new person named Max. Her news was not well received. “It just saddens me to see so many of our strong butch women giving up their womanhood to be a man,” one friend said. The sentiment was a tamer version of what many other women wrote on lesbian blogs and Web sites in the weeks after the episode was broadcast last spring. Many called for the Max character to be killed off next season. One suggested dispatching him “by testosterone overdose.”
      The reaction to the fictional character captured the bitter tension that can exist over gender reassignment. Among lesbians — the group from which most transgendered men emerge — the increasing number of women who are choosing to pursue life as a man can provoke a deep resentment and almost existential anxiety, raising questions of gender loyalty and political identity, as well as debates about who is and who isn’t, and who never was, a real woman.
     The conflict has raged at some women’s colleges and has been explored in academic articles, in magazines for lesbians and in alternative publications, with some — oversimplifying the issue for effect — headlined with the question, “Is Lesbianism Dead?” It has been a subtext of gay politics in San Francisco, the only city in the country that covers employees’ sex-change medical expenses. And it bubbles to the surface every summer at the Michigan Womyn’s Music Festival, a lesbian gathering to which only “women born as women and living as women” are invited — a ban on transgendered people of either sex.
     Barbara Price, a former festival producer, said the uneasiness has been “a big topic among lesbians for quite some time.” “There are many people who look at what these young women are doing, and say to themselves, ‘Hey, by turning yourselves into men, don’t you realize you’re going over to the other side?’ ” she said. “We thought we were all supposed to be in this together.”
     Beyond the political implications, the sense of loss is felt most keenly in personal relationships. “I am a lesbian because I am attracted to women, and not to men," said a 33-year-old woman who broke up with her partner of seven years, Sharon Caya, when Sharon became Shane. The woman, who asked to be identified only as Natasha, to protect family members who are unaware of her lifestyle, said that she was ultimately faced with the reality of her sexual orientation and identity. “I decided I couldn’t be in a romantic relationship with a man.”
     The transgender movement among men is at least as old as the pioneering surgery that turned George Jorgensen into Christine Jorgensen in 1952. Among women who wish to become men, though, the movement has gained momentum only in the last 10 years, in part because of increasingly sophisticated surgical options, the availability of the Internet’s instant support network, and the emotions raised by the 1999 movie “Boys Don’t Cry,” based on the true story of the murder of Brandon Teena, a young Nebraska woman who chose to live as a man.
     The word for the process is “to transition,” a modest verb for what in women usually means, at the minimum, a double mastectomy and heavy doses of hormones that change the shape of the face, deepen the voice, broaden the upper body, spur the growth of facial hair, and in some cases, trigger the onset of male pattern baldness. Politically and personally, the change has equally profound effects. Some lesbians view it as a kind of disloyalty bordering on gender treason.
     The Census Bureau does not try to count the number of transgendered people in the United States, and many who make the transition from one sex to another do not wish to be counted. A European study conducted 10 years ago, and often cited by the American Psychiatric Association, says full gender reassignment occurred in 1 in 11,000 men and 1 in 30,000 women, a ratio that would place the number of men who have become women nationally at only about 13,000 and women who have become men at about 5,000.Transgender advocates, however, say those statistics fail to reflect an increasing number of people, especially young people, who call themselves transgendered but resist some or all of the surgeries available, including, for women becoming men, the creation of a penis. Some delay or avoid surgeries because of expense. For women especially, the genital surgery is still risky. “There are tens of thousands of us, probably more than 100,000,” said Riki Wilchins, the executive director of GenderPAC, a lobbying group in Washington, citing the looser definition of being transgendered.
     Dr. Michael Brownstein, a surgeon in San Francisco, said he had performed more than 1,000 female-to-male surgeries in the last several years, and transgender advocates say there are a dozen surgeons specializing in the work in the United States. The numbers are slight, considering the estimated five million gay men and five million lesbian women in the United States. Still, coupled with a simultaneous trend among the young to reject sexual identity labels altogether, some lesbians fear that the ranks are growing of women who once called themselves lesbian but no longer do. “It’s as if the category of lesbian is just emptying out,” said Judith Halberstam, a gender theorist and professor of literature at the University of Southern California, San Diego, whose books include “Female Masculinity.”
     Leaders of some lesbian organizations dismiss the idea of a schism or contend that it has been resolved in the interest of common human rights goals among lesbians, gays, bisexuals and transgendered people. “The view in some lesbian corners that we are losing lesbians to transitioning is absurd,” said Kate Kendall, the executive director of the National Center for Lesbian Rights. “Given our history of oppression, all lesbians should encourage people to be themselves even if it means our lesbian sister is becoming our heterosexual-identified brother.”
     But in private conversations and in public forums like women’s colleges, the questions about how to frame the relationship among lesbians, former lesbians and young women who call themselves “gender queer” rather than lesbian at all, seem largely unresolved. “There is a general uneasiness about this whole thing, like ‘What are we losing here?’ ” said Diane Anderson-Minshall, the executive editor of Curve, a lesbian magazine. The issue stirs old insecurities about women being “not good enough,’’ she added.
     Koen Baum, a family therapist in San Francisco who is a transgendered man, said the anxiety some lesbians feel has complicated roots. Some, he said, believe that women who “pass” as men are in some ways embracing male privileges. Ben A. Barres, a professor of neurobiology at Stanford and a transgendered man, recently provided fodder for that view in an article in Nature and an interview with The New York Times. “It is very much harder for women to be successful, to get jobs, to get grants, especially big grants,” he told The Times.
     The idea of male privilege was also part of “The L Word” plot: When Max learns he is to be offered a job that he was rejected for as Moira, he promises that he will refuse it and tell off the would-be boss, but he later decides to take the job and say nothing. Mr. Baum said the anxiety also stems from fear over the loss of an ally in the struggle against sexism. “The question in the minds of many lesbian women is, ‘Is it still going to be you and me against sexism, you and me against the world?’ ” he said. There are also practical questions: What place should a transgendered man have in women’s spaces such as bathhouses, charter cruises, music festivals and, more tricky still, at women’s colleges, where some “transmen” taking testosterone are reportedly playing on school sports teams? Laura Cucullu, a freelance editor and recent graduate of Mills College in Oakland, Calif., phrased the question this way: “When do we kick you out? When you change your name to Bob? When you start taking hormones? When you grow a mustache? When you have a double mastectomy?”
     The fact that there is no apparent parallel imbroglio in the gay community toward men who become women is a subject of some speculation.“There is the sense that a transman is ‘betraying the team,’ joining the oppressor class and that sort of thing,” said Ken Zucker, a clinical psychologist and a specialist in gender research at the University of Toronto. Despite the tangled set of issues involved, the survival rate of lesbian couples seems higher than among gay couples when one partner changes gender, advocates say.
     After Susie Anderson-Minshall became Jacob several years ago, he and his partner of 15 years, Ms. Anderson-Minshall, the Curve editor, decided to marry. Their March 19 wedding was actually their second union. The first had been a partnership ceremony as lesbians; the second was as legally recognized husband and wife under the laws of the state of California, where they live.
     Other couples, like the former Sharon Caya and Natasha, found the transition much rougher. Sharon’s decision to become Shane coincided with Natasha becoming pregnant, having conceived with donor sperm. “When the baby came along, I wanted to become myself,” Mr. Caya said. “I wanted the baby to know me as I truly am.” She began taking testosterone about three years ago, then had “top surgery” — a double mastectomy — and is now a muscular 42-year-old of medium height with long sideburns and a goatee. For financial and practical reasons, Mr. Caya, the legal director of the Transgender Law Center in San Francisco, decided to forgo “bottom surgery,” which could cost as much as $100,000 and would involve two or three operations to graft on an ersatz penis. According to the standards of the European study, Shane Caya would not be counted as a transgendered person.
     Natasha, a financial manager in San Francisco, still cries when describing Sharon’s decision to become male. “You’re in love with a person, but there is something about gender that is so central to identity it can be overwhelming if the person changes,” she said. “When she told me what she wanted to do, I was completely blown away at first,” Natasha said. Then, “I thought to myself, ‘All right, we’re good lesbians. We should be able to figure this out.’ ”
     But after a month of struggling with the idea, Natasha said she could not make the adjustment. The breakup occurred when the child was 5 months old. The couple remain on friendly terms and share custody. And when Mr. Caya attended a lesbian organization’s lunch recently, he recalled, he was welcomed by a woman who said she was “pleased to see a man supporting us lesbians.” His reply, he said, was quick and to the point: “Of course I support lesbians,” he said. “I used to be one.”



Mentally Ill Inmate Dies in Isolation
Jeff Gerritt, Detroit Free Press- 8/20/2006

Timothy Joe Souders lived a hard life and, on Aug. 6, died an even harder death in a segregated prison cell in Jackson, MI. Souders, 21, spent most of his last four days naked, without physician or psychiatric care, his arms and legs bound to a steel bed in four-point restraints. He was in a bare, all-steel isolation cell about the size of a walk-in closet. He went to the cell Aug. 2 because of unruly behavior. He lay in urine -- "agitated, disoriented, psychotic" -- as the cell felt close to 106 degrees at times, according to a report written by a federal monitor assigned to scrutinize medical care for Jackson prisons. Souders was found dead on his bed around 4 p.m., two hours after staff had removed his shackles. The death of the severely mentally ill inmate is a glaring example of a troubled state prison health care system, riddled with misdiagnoses, delayed or denied treatment and inadequate accommodations for people with disabilities.
     The Jackson prison complex, including the Southern Michigan Correctional Facility where Souders died, has been under federal oversight for more than 20 years. Corrections officials are investigating the death. Autopsy results might not be available for two or three weeks.
     The Michigan Attorney General's Office, which represents the Department of Corrections, disputed the account by the federal monitor, whose report this week brought Souders' death to light. "The governor's office is very concerned about the issue of prisoner health care," Liz Boyd, spokeswoman for Gov. Jennifer Granholm, said Saturday. "We want to make sure that prisoners are getting appropriate health care and that taxpayer dollars are being spent wisely. Be assured, the issue of prisoner health care will be reviewed and, if changes are warranted, changes will be made."
     The Corrections Department had issued a heat alert the day Souders went into isolation. Such alerts are issued when the combined temperature and humidity index reaches 90 degrees. Alerts are supposed to trigger actions to ensure that inmates have adequate water and ventilation.
     Dr. Robert Cohen, the court-appointed monitor, uncovered Souders' death during a visit to the Jackson medical complex on Aug. 8-10. Disturbed by what he found, he issued a special report to U.S. District Judge Richard Enslen in Kalamazoo, who is enforcing federal oversight of the facilities. "Although the circumstances of Mr. S.' death overwhelmed my visit ... there are a number of additional continuing serious deficiencies in the medical program which require immediate attention, some of which may have contributed to the abject failure to provide Mr. S. with medical care," Cohen wrote. "There is a critical shortage of medical staff" at the Jackson facilities "and serious medical staff shortages throughout the medical program. This is an emergency situation which has gone on for too long and is having an extremely adverse effect on patient care." Souders' death was "predictable and preventible," Cohen wrote, "a terrible, unnecessary tragedy."
     Souders was serving a sentence of 1 to 4 years for resisting arrest, assault and destroying police property. Because he was taking medications for multiple medical conditions -- including manic-depression, psychosis and hypertension -- he was at high risk for heat-related injury or death, Cohen wrote. Still, a physician did not see him from the time he was restrained until he died. He was seen and monitored by nurses, however, Department of Corrections spokesman Russ Marlan said. Mental health staff at the Southern Michigan Correctional Facility tried to transfer Souders to Huron Valley Center in Ypsilanti, a psychiatric hospital for prisoners, but he wasn't moved, Marlan said. At least one person involved in the transfer has been removed, Marlan said. The department is reviewing policies on prisoner restraint.

A 'lack of ... responsibility'
In response to Cohen's letter to the judge, the Attorney General's Office, which represents the Corrections Department, questioned some of Cohen's findings. The office pointed out in an e-mail to Cohen that the day Souders died, a nearby cell was only 83 degrees, with 58% humidity, which wouldn't produce a heat index of 106. Shortly after 10 on the morning he died, Souders, 5-foot-8 and 235 pounds, was able to walk to the shower outside the cell, Marlan said. He was returned to the cell, placed in restraints and covered with a blanket, the Attorney General's Office noted. He was released from the restraints just before 2 p.m. By 3:58 p.m., according to the Attorney General's Office, he was "found to be unresponsive and without pulse and respiration" on the bed.
      "It's a tragic example of what we've been trying to illustrate to the court, and to the department, for a long, long time," said Patricia Streeter of Ann Arbor, an attorney for prisoners in what is known as the Hadix case, which triggered the federal oversight. "There's a lack of leadership and responsibility. The doctors are overworked. The Jackson facilities have become essentially a hospital, and they're still treated like a prison with average, healthy people."
     The Corrections Department has been under a federal consent decree in the Hadix case since 1985 to improve medical care and other conditions at Jackson prisons. The decree covered a range of issues, including sanitation, fire protection, crowding, medical care, access to courts, mental health care and prisoner safety.

A hard and desperate life
Souders of Adrian had bipolar disorder, among other conditions, according to court records. Over the last three years, he supported himself with Social Security checks, odd jobs and Dumpster diving. Attempts to reach a family member Thursday and Friday were unsuccessful. Souders' prison sentence stems from convictions for resisting arrest, destruction of police property and assault. In March 2005, after stealing two paintball guns from a Meijer store, he walked with a stolen knife toward a police officer. "Go ahead and kill me," he told the officer, who stunned him with a Taser. Souders told a probation officer that he wanted police to put him out of his misery. While in an isolation cell in the Lenawee County Jail on those charges, he tried to hang himself with a noose made with fabric from jail coveralls. He was charged with malicious destruction of police property. This was on top of a record of five misdemeanors, including possession of marijuana. Souders started his sentence Nov. 1 and was transferred to Jackson on March 2. While locked up, he received seven misconduct reports, including two for fighting.
      In response to Souders' death, Cohen called an emergency meeting Wednesday with prison administrators, resulting in some of the Department of Corrections review. Cohen's investigation could take weeks and will include a review of tapes, incident reports and medical records.
     Critics say the Legislature, governor and correction officials have failed to properly oversee the $190 million a year the state spends on prison medical care, including the state's $70-million contract with Correctional Medical Services Inc. "Responsibility is so dispersed between state agencies, a private contractor, line staff and administrators," said Sandra Bailiff Girard, executive director of Prison Legal Services of Michigan. "No one is held responsible -- so there's little incentive to follow the rules.



On the Web, Pedophiles Extend Their Reach
Kurt Eichenwald, New York Times- 8/21/2006

At first blush, the two conversations — taking place almost simultaneously in different corners of the Internet — might have seemed unremarkable, even humdrum. In April, with summer fast approaching, both groups of online friends chatted about jobs at children’s camps. Did anyone, one man asked, know of girls’ camps willing to hire adult males as counselors? Meanwhile, elsewhere in cyberspace, the second group celebrated the news that one of their own had been offered a job leading a boys’ cabin at a sleep-away camp. But participants in the conversation did not focus on the work. “Hope you see some naked boys in your cabin,” a man calling himself PPC responded. “And good luck while restraining yourself from doing anything.” The two groups were made up of self-proclaimed pedophiles — one attracted to under-age girls, the other to boys. Their dialogue runs at all hours in an array of chat rooms, bulletin boards and Web sites set up for adults attracted to children.
     But it is no longer just chatter in the ether. What started online almost two decades ago as a means of swapping child pornography has transformed in recent years into a more complex and diversified community that uses the virtual world to advance its interests in the real one. Today, pedophiles go online to seek tips for getting near children — at camps, through foster care, at community gatherings and at countless other events. They swap stories about day-to-day encounters with minors. And they make use of technology to help take their arguments to others, like sharing online a printable booklet to be distributed to children that extols the benefits of sex with adults.
      The community’s online infrastructure is surprisingly elaborate. There are Internet radio stations run by and for pedophiles; a putative charity that raised money to send Eastern European children to a camp where they were apparently visited by pedophiles; and an online jewelry company that markets pendants proclaiming the wearer as being sexually attracted to children, allowing anyone in the know to recognize them. These were the findings of a four-month effort by The New York Times to learn about the pedophiles’ online world by delving into their Internet communications. In recent months, new concerns have emerged about whether the ubiquitous nature of broadband technology, instant message communications and digital imagery is presenting new and poorly understood risks to children. Already, there have been many Congressional hearings on the topic, as well as efforts to write comprehensive legislation to address the issue. But most of those efforts have focused on examining particular instances of harm to children. There have been few, if any, recent attempts to examine the pedophiles themselves, based on their own words to one another, to gain a better recognition of the nature of potential problems.
     Last week, that world attracted new attention after reports that John M. Karr, who was arrested last Wednesday as a suspect in the 1996 murder of JonBenet Ramsey, apparently used Internet discussion sites intensively in efforts to communicate with children, sometimes about sex. In e-mail messages to a journalism professor that investigators believe were written by Mr. Karr, statements about children seemed to echo the online dialogue among pedophiles. “Sometimes little girls are closer to me than with their parents or any other person in their lives,’’ the e-mail messages say. “I can only say that I can relate very well to children and the way they think and feel.’’
     The recent conversations among pedophiles that were examined by The Times took place in virtual rooms in Internet Relay Chat, a text-based system allowing for real-time communications; on message boards on Usenet, which has postings by topic; and on Web sites catering to pedophiles. In this online community, pedophiles view themselves as the vanguard of a nascent movement seeking legalization of child pornography and the loosening of age-of-consent laws. They portray themselves as battling for children’s rights to engage in sex with adults, a fight they liken to the civil rights movement. And while their effort has brought little success, they celebrated online in May when a small group of men in the Netherlands formed a pedophile political party, and they rejoiced again last month when a Dutch court upheld the party’s right to exist.
     The conversations themselves are not illegal. And, given the fantasy world that the Internet can be, it is difficult to prove the truth of personal statements, or to demonstrate direct connections between online commentary and real-world actions. Nor can the number of participants in these conversations, taking place around the Internet, be reliably ascertained. But the existence of this community is significant and troubling, experts said, because it reinforces beliefs that, when acted upon, are criminal. Repeatedly in these conversations, pedophiles said the discussions had helped them accept their attractions and had even allowed them to have sex with a child without guilt.
      Indeed, law enforcement officials say that the refrain of justification from online conversations is frequently voiced by adults arrested for molestation, raising concern that such conversations may lower pedophiles’ willingness to resist their temptation. “It is rationalization that allows them to avoid admitting that their desires are harmful and illegal,” said Bill Walsh, a former commander of the Crimes Against Children Unit for the Dallas Police Department, who founded the most prominent annual national conference on the issue. “That can allow them to take that final step and cross over from fantasy into real-world offenses.”
     Still, in their conversations, some pedophiles often maintain that the discussion sites are little more than support groups. They condemn violent child rapists and lament that they are often equated with such criminals. Many see themselves as spiritually connected to children and say that sexual contact is irrelevant. Yet the pedophiles consistently return to discussions justifying sex with minors and child pornography.
     Many of these adults described concepts of children that veered into the fantastical — for example, at times depicting themselves as victims of predatory minors. A little girl in a skirt reveals her underwear by doing a cartwheel; a boy in a bathing suit sits on a bench with his legs spread apart; a child playfully jumps on a man’s back — all of these ordinary events were portrayed as sexual come-ons. “It really is like going through the rabbit hole, with this entire alternative reality,” said Philip Jenkins, a professor of religious studies at Pennsylvania State University who wrote “Beyond Tolerance,” a groundbreaking 2001 book about Internet child pornography.
     The conversations also demonstrated technological acumen, with frequent discussions about ways to ensure online anonymity and to encrypt images. That underscores a challenge faced by the authorities who hope to combat online child exploitation with technology. For example, in June, Internet service providers announced plans for an alliance that will use new technologies to locate child pornography traders. Pedophiles were undaunted. Within hours of the announcement, their discussion rooms were filled with advice on how to continue swapping illegal images while avoiding detection — months before the new technologies were to be in full operation.

Portraits of Pedophilia
In a sense, the creation of the pedophiles’ online community was a ripple effect from the success of government efforts to crack down on them. Washington’s efforts in the late 1970’s to stamp out child pornography by declaring it illegal were enormously effective, closing off traditional outlets for illicit images. But the Internet soon presented an alternative. In the early 1980’s, through postings on bulletin board systems, pedophiles went online to swap illegal images. From there, they could easily converse with others like themselves, and they found theirs to be a community of diverse backgrounds.
      In the conversations observed by The Times, the pedophiles often discussed their personal lives. Their individual jobs were described as being a disc jockey at parties (“a high concentration of gorgeous” children, a man claiming to hold the job said); a pediatric nurse (“lots of looking but no touching”); a piano teacher (“I could tell you stories that would make you ...well... I’ll be good”); an employee at a water theme park (“bathing suits upon bathing suits!!!!!”); and a pediatrician specializing in gynecology (“No need to add anything more, I feel”).The most frequent job mentioned, however, was schoolteacher. A number of self-described teachers shared detailed observations about children in their classes, including events they considered sexual, like a second-grade boy holding his crotch during class. The man relating that story held up that action as an expression of sexuality; he was not dissuaded when another participant in the conversation suggested that the boy might have just needed to go to the bathroom.
     Some pedophiles revealed that they gained access to children through their own families. Some discussed how they married to be close to the children from their wives’ previous marriages. Pedophiles who said they were fathers described moments involving their own children, such as a man who told of watching his sons change for swimming in a locker room, complete with details about the older boy’s genitals and emerging pubic hair. Others insisted they would never feel any interest in their own children, but commented on the benefits presented by parenthood. “I have a daughter and have never been attracted to her,” a man with the screen name of jonboy wrote. But, he added, “I did find her friends very attractive.”
     Pedophiles chafe at suggestions that such comments reflect risks to minors. They point out, correctly, that family members and friends — not strangers — are the most frequent perpetrators of child sexual abuse. They never note, however, that the minors mentioned in their online discussions are most frequently those they know well, like relatives and children of friends.

Justifications Online
In the pedophiles’ world view, not all sexual abuse is abuse. There is widespread condemnation and hatred of adults who engage in forcible rape of children. But otherwise, acts of molestation are often celebrated as demonstrations of love. “My daughter and I have a healthy close relationship,” a person with the screen name Sonali posted. “We have been in a ‘consensual sexual relationship’ almost two months now.” The daughter, Sonali wrote, is 10. Whatever guilt Sonali felt for the relationship was eased by the postings of other pedophiles. “I am so happy to find this site,” Sonali wrote. “I thought having a sexual attraction to my daughter was bad. I now do not feel guilty or conflicted.”
      In that, Sonali was demonstrating what experts said is the most dangerous element of the pedophile Internet community: its justification of illegal acts. Experts described the pedophiles’ online worldview as reflective of “neutralization,” a psychological rationalization used by groups that deviate from societal norms. In essence, the groups deem potentially injurious acts and beliefs harmless. That is accomplished in part by denying that a victim is injured, condemning critics and appealing to higher loyalties — in this case, an ostensible struggle for the sexual freedom of children.
     Pedophiles see themselves as part of a social movement to gain acceptance of their attractions. The effort has a number of tenets: that pedophiles are beneficial to minors, that children are psychologically capable of consenting and that therapists manipulate the young into believing they are harmed by such encounters. “Every human being, no matter the age, should be allowed to have consenting mutual sexual relations with anyone they wish,” a man calling himself Venn wrote. “All age of consent laws must, and forever, be abolished.”
     Those same types of comments online are now turning up in court. For example, a man known by the screen name Brother Peteticus is among those who have argued online for legalizing sex with children. In real life, he is Phillip J. Distasio of Rocky River, Ohio, who was arrested last year on charges of raping two autistic boys who were his students. In court this month, Mr. Distasio, 34, portrayed himself as following the dictates of his own religion, and made arguments frequently expressed by the online community. “I’ve been a pedophile for 20 years,” Mr. Distasio said at the pretrial hearing. “The only reason I’m charged with rape is that no one believes a child can consent to sex. The role of my ministry is to get these cases out of the courtrooms.”
     In the days that followed, some pedophiles supported that position online, agreeing with Mr. Distasio that mentally handicapped, prepubescent boys could consent to sex with their teacher.That same logic is applied by the pedophiles to child pornography, which many of them said should be legalized. “Where is the problem?” from child pornography, a pedophile who used the screen name Writer said in an online posting. “Once again, the underlying issue is the repressive belief that sex is intrinsically sinful.”
     In making these arguments, pedophiles often demonize parents and other adults as cruel, unloving people who exert authoritarian control over children and stand in the way of minors’ sexual freedom. “Anti-pedophiles are NOT about protecting children,” a man who called himself Christopher wrote. “They are usually the ones who are beating (they call it spanking) or emotionally neglecting their children.” But their arguments often seem contradictory. While maintaining that they can be trusted with children, some pedophiles said they would not allow minors in their lives to be with other adults attracted to children. “I guess coming from the inside, I know a bunch of the bad stuff that can happen,” one man wrote.
     Many pedophile sites conduct surveys to learn about the attitudes of their contributors. While none of these surveys are scientifically valid, they do reflect the thinking of some people who traffic in these sites. And not surprisingly, a large number of the surveys are about sex. For example, on one site, pedophiles were asked if they would “have full intercourse with a little girl.” Seventy-four members responded. Only 17 replied no. The same number said that they might. The largest group — over 54 percent — said that they would. Some attached comments to their survey response. One man provided descriptions of the acts he would repeatedly perform on an 8-year-old to prepare her. The words — too graphic to be printed here — raised no criticism on the site.
     But in other discussions, pedophiles cautioned that some comments were too dangerous. When one man described in lurid terms his fantasies about molesting an infant girl, the response was quick. “This is best not discussed,” a man calling himself garvy wrote, adding that someday, pedophiles would need evidence proving that they cared only about children’s best interests. “Such posts,” garvy concluded, “will be very damaging to the Cause.”

A Web of Deception
The booklet — recently circulated through a Web site for pedophiles — had been written, it said, “for any boy who is old enough to be able to read it.” Called “Straight Talk for Boys,” it is an 18-page discussion of sex, particularly between children and adults, from the pedophiles’ viewpoint. Such encounters are depicted as harmless, even beneficial. The document criticizes parents and therapists. And it encourages boys to wear Speedo bathing suits and shower naked in public places.
      But it repeatedly returns to one message: boys should never tell about sex with adults. “Older boys and men may be frightened about getting caught having sex play with you, because they can be put in jail,” it says. “So you have to think of ways to ‘signal’ your interest in another person without openly saying what you want,” adding that “nobody else can know about what you agree to do.”
     The booklet comes with instructions, advising pedophiles on how to distribute it. “The best and safest way is to leave quantities of the booklet in places where boys in the 8 to 14 range can find them, and where adults will not discover them too quickly,” the instructions read. “Obviously, you don’t want to be observed placing the booklets in your chosen locations.”
     The booklet reflects how pedophiles can use the Internet to advance their interests in the real world. Like many of those efforts, this one involved deception: the booklet does not reveal, for example, that it has been written and distributed by men who are sexually attracted to children, but instead portrays itself as objective fact.
     Using deception to gain access to children is a recurring theme. For example, on a site for adults attracted to boys, someone calling himself Vespucci asked in June whether a single man could become a foster father. The respondents cautioned Vespucci to disguise his pedophilia. “You better have a darned good excuse why you never married, such as your fiancée died in a car wreck,” replied a man calling himself simply “d.” “I highly recommend you date women for several years and keep at least a couple of those relationships going for at least a couple of months. Around the women, make a point of being nice to children.” The deception would be worthwhile, d wrote. “It will help out in the reference-check dept. when you apply.”
     Pointers on ways to get close to children were frequent topics. One man posted an Internet “help wanted” advertisement from a single mother seeking an overnight baby sitter for her 4-year-old daughter; another recommended shopping at weekend estate sales, since plenty of bored minors showed up accompanying inattentive parents. Some participants in these conversations claimed to have established charitable efforts that put them in contact with children. For example, an organization called BL Charity said it was seeking money to send Eastern European children to camp. The charity’s site, which recently closed, showed scores of images of children at camp and in their homes, supposedly taken by the men running the site. The effort was organized by pedophiles; BL is the online term for “boy-lover.” It eventually shut down, largely from a lack of money, according to a posting from the site’s operators. After the site closed, further details of BL Charity could not be learned. Not every organization and effort of the pedophiles is directly tied to trying to reach children. For example, pedophiles have created Internet radio stations for the purpose of providing support for one another and encouraging their perceived social movement.
     It is not known how many such stations exist, nor the size of the audience. The most prominent station appears to be Sure Quality Radio, which on its home page proclaims, “From all levels of society you will find us, not as predators but as human beings, loving and caring for boys or girls or both.” The site has a program schedule and an online store selling mainstream music and movies featuring children. People who work with Sure Quality Radio did not respond to questions e-mailed to them from The Times, although one person with the online name of boystory replied by saying he was immediately severing all ties with the station.
     There are also online podcasts, recorded talk shows of 60 to 90 minutes featuring discussions among pedophiles. The discussions, as described online, deal with topics like “benefits of age difference in sexual relationships”; “failure of sex offender registries”; “children’s sexual autonomy, practices and consequences” and “the misrepresentation of pedophilia in the news media.”
     With the chat rooms, radio stations and other organizations, pedophiles’ views are continually reinforced. But some realize that this online echo chamber can warp reality. For example, a man calling himself AtosW reported to fellow pedophiles that he had been chatting on a game site frequented by boys. A conversation began about the Dutch pedophile party, AtosW said, and the minors reacted with threats of violence. AtosW was perplexed. “Why are posters THAT young so angry about it?” he asked. “It is after all THEIR rights that they are pushing for.” A man calling himself Ritter responded. “Your post is a typical example of what happens when you spend too much time in the online BL community,” he wrote. “Believe it or not, most young children are NOT anxious to have sex with adult men.”

Hope for Patients With Long Histories of Unexplained Symptoms
Dan Hurley, New York Times- 8/22/2006

People with a long history of medically unexplained symptoms — aches, pains, fatigue, dizziness and other complaints for which doctors can find no physical cause — might finally find relief. Two new studies by researchers who specialize in the baffling condition called somatization syndrome, estimated to affect up to 3 percent of adults, suggest that the quest for a physical explanation may take on a destructive life of its own. Instead, those with the syndrome should focus on practical strategies to regain normal function and relieve symptoms, the researchers say.
      One study, by German scientists, sought to explain why the doctors’ reassurances were generally ineffective with such patients. The researchers played taped comments by a doctor about a hypothetical patient for two groups of participants, people who had the syndrome and people who did not. Those with somatization syndrome were three times as likely to believe incorrectly that in the course of the comments the doctor had said the symptom had a worrisome physical cause. The findings, in the August issue of the online journal Public Library of Science Medicine, offer at least a partial explanation for why patients often go from doctor to doctor and take test after test in a fruitless search for answers: repeated reassurances are simply not being understood.
     A second study, by New Jersey researchers, provides the first published evidence of an effective clinical treatment. The study, in the July 24 issue of The Archives of Internal Medicine, found that patients benefited from 10 sessions of cognitive behavioral therapy specifically organized to help relieve their stress and increase emotional awareness and to get them to become more socially active and think differently about their symptoms. “For patients who have these symptoms, their lives are about going to doctors, being physically incapacitated and worrying about it,” said the lead author of the study, Dr. Lesley A. Allen, associate professor of psychiatry at the University of Medicine and Dentistry of New Jersey. “They stop their dance classes and don’t go to work and don’t spend as much time throwing the ball with their kids,” Dr. Allen said. “Our treatment emphasizes changing their behaviors, trying to change the focus of their lives from worrying about their symptoms to re-engaging in activities they’ve been avoiding.”
     The 84-patient study, compared the behavior therapy with the standard treatment. In that approach, primary care doctors avoid telling patients that the symptoms are “all in their head” or trying to dismiss them by sending them for unnecessary tests or to specialists. Rather, doctors examine the parts of the body of concern to the patient, convey that nothing appears to be seriously wrong, treat underlying anxiety or depression and schedule regular return visits. Dr. Allen, whose book on the new treatment is due out in October, treats patients at the university’s facility for medically unexplained symptoms, one of the few such centers in the country.
     Dr. Arthur J. Barsky, a psychiatrist at Harvard, called the findings very helpful. In 2004, Dr. Barsky published a study showing that cognitive behavior therapy was similarly helpful in treating hypochondriasis, a related disorder in which patients are sure they have a specific illness although no evidence can be found. “We’re starting to gather evidence that with these approaches, people really can cope better and feel better,” Dr. Barsky said.

ADHD Drugs to Have Stronger Warning
Associated Press, 8/22/2006

WASHINGTON -- The Food and Drug Administration on Monday announced changes to the labels for Dexedrine, an amphetamine used to treat attention-deficit hyperactivity disorder and narcolepsy, to warn of possible heart problems it may cause. There have been reports of sudden death caused by stimulant treatment in children and adolescents with serious heart problems, the FDA said. The new warning labels will reflect that information.
      Earlier this month, Dexedrine manufacturer GlaxoSmithKline advised health care professionals of changes to the drug's labeling. ''Sudden deaths, strokes and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD,'' the company warned. The new labels also warn that pre-existing psychotic disorders, such as bipolar illness, may be exacerbated. The advisory also said that new psychiatric symptoms, such as hallucinations or delusional thinking, may emerge.
     On the Net:
Food and Drug Administration: http://www.fda.gov/cder/
GlaxoSmithKline: http://www.gsk.com/

Online Poker Causing Epidemic of Gambling on Campus
Bella English, Boston Globe- 8/22/2006

Mike Zakarian is president of the student government at Emmanuel College and co-captain of the baseball team. He hopes to go to graduate school in education. But he's also a whiz at online poker. He's so good that, at age 21, he won $12,000 and a seat at the World Series of Poker in Las Vegas, where last month he took home $15,500 more.
      Zakarian started playing Texas Hold 'Em with friends in high school, and moved on to Internet poker in college. He'd win $50 here, $100 there, and lose only occasionally, he says. His first big score came at the end of his sophomore year: He put down $40 to enter an online tournament, and won $4,000. His earnings have helped pay his tuition and afforded him nice vacations. But Zakarian hasn't always been cavalier about the game. ``There were times when I could feel myself inside losing control," he says, ``and I left it for a couple of months until I felt better. I just didn't want to get caught up in it and lose everything I'd won."
     Zakarian was among five Bostonians, none older than 31, who participated in the 2006 World Series of Poker -- sponsored by PokerStars.com, a site popular with young players -- after they won online tournaments. Two of the 10 players who made it to the final table were recent college graduates, and they took home about $2 million each.
     How are college students getting so good at a game that once was the dominion of older men? The answer lies online, in the 2,500 Internet-based casinos that lure teenagers with offers of free tuition and other prizes. It is creating what some call an epidemic of gambling -- and debt -- on campuses everywhere.
      Online gambling has spread through high school and college campuses, ensnaring young men who hope to beat the odds. Sometimes they do. More often they don't. Greg Hogan, who was president of his class at Lehigh University, robbed a bank last December to pay a $5,000 debt amassed in online poker. Hogan, 20, will serve at least 22 months in prison. ``I can tell you it is a problem," says Laurajane Fitzsimons , an addiction specialist with the counseling center at the University of Massachusetts at Dartmouth. ``College is a time when students have freedom from their parents and access to credit cards and money, but they don't really understand the ramifications of gambling." Even those who don't cut classes to sit in front of their computer, she says, report that gambling is on their mind ``all the time," making it difficult for them to focus on school work. The college has trained resident advisers to look out for students holed up in their rooms. At freshman orientation, officials discuss the dangers of alcohol, drugs -- and gambling.
     The Massachusetts Council on Gambling held a program last spring with the state Department of Public Health about gambling on campuses, and it attracted administrators from 40 schools. ``A lot of them are starting to realize they need to have policies around it like alcohol and drugs," says council spokeswoman Margot Cahoon.
     The appeal of online gambling on campus is obvious: It's just a click away. There's no group to organize, no snacks to serve, no drinks to pour. You don't have to get dressed. You don't have to make small talk. You don't have to go home, because you're already there. Online casinos lure new players by allowing them to practice with ``play money" and then ``giving" them real money to get started. ``Come grab your $888 Welcome Bonus today!" promotes one company in an unsolicited e-mail sent out nationwide. Says another: ``Complete with . . . state-of-the-art graphics, a knowledgeable and helpful 24/7 phone and live chat support team, fast payouts and a payout rate of over 97%." It also offers $300 free, ``just for trying our casino." What they don't mention is people like the recent Harvard graduate who gambled away $35,000 online.

Stress Taking Toll on Japanese Workers
Associated Press, 8/22/2006

TOKYO -- Japanese office workers, particularly those in their 30s, are increasingly stressed and struck by mental health problems, partly because of grueling corporate competition, a new study shows. More than 61 percent of 218 leading Japanese companies surveyed by a local think-tank said that employees with mental health problems have steadily increased over the past few years.
      A report by the Mental Health Research Institute of the Japan Productivity Center for Socio-Economic Development said nearly 75 percent of the survey's respondents reported having employees who take leaves lasting longer than one month, up from 67 percent in 2004. Sixty-one percent of the polled companies said employees in their 30s constituted the largest group with mental health problems, a sharp increase from 41.8 percent in 2002 and 49.3 percent in 2004, according to the biennial survey released last month. Analysts cited by the study said harsher competition among colleagues due to performance-based pay systems, as well as decreasing communication and mutual support, were the most likely causes.
     Many companies underwent a major overhaul to boost efficiency and profitability in the 1990s, when corporate Japan struggled to survive a decade-long economic slump. Firms slashed work forces, stopped routine hiring of college graduates and shifted to merit-based pay systems. ''As the traditional, seniority-based pay system has been largely replaced with performance-based pay and achievement systems ... colleagues have become rivals,'' institute analyst Kotaro Kusunoki said Tuesday. ''Office workers are also under enormous pressure because of demanding responsibility compared to little room for discretion given,'' he added. A larger number of companies are trying to address the problems, Kusunoki said. The institute distributed questionnaires to 2,150 listed companies in April for the survey, and 218 of them responded with valid responses. No margin of error was provided.

The Other College Binge: Overeating
Steve Hartsoe, Associated Press- 8/22/2006

DURHAM, N.C. -- Sunny Dawson ran 2 miles every other day when she started her freshman year at the University of Southern California. But the lure of the cafeteria near her dorm became too much to resist. "Everyone I know went crazy, `Oh my God, pizza. Oh my God, ice cream,"' she said. Dawson soon stopped running and "started piling up the food in the cafeteria." By Christmas break, the 5-foot-10 student from Haleiwa, Hawaii, had gained 10 pounds. "I realized I don't have to be a victim of this and started making better choices," she said. "I ate a lot of salads and cut out sodas altogether. By spring break I was normal again. I was stoked."
      As high school graduates start college this month and next, universities are offering a range of tools to help them avoid Dawson's mistake. While experts say the "Freshman 15" is usually only 5 to 7 pounds, it's a common experience for many college newcomers faced with the unlimited cafeteria food, late-night pizza binges and snacking that come with irregular student schedules. "The patterns and the habits that students get into in the first two to three months of school are what tends to carry them through the rest of their time on campus," said Jen Ketterly, nutrition and fitness coordinator for campus health services at the University of North Carolina at Chapel Hill.
      At nearby Duke University, the private college of about 6,000 undergraduates offers an interactive nutrition workshop for freshmen with eating problems. It includes tips for quick, healthy meals in the dorm, and how to eat the right way in an all-you-can eat dining hall. "A lot of kids really don't have a clue of what they're not supposed to eat and what constitutes a healthy diet," said Jenny Favret, the nutrition manager at Duke's Eating Disorders Program.
     The problem isn't always weight gain: Some new students lose weight because they're no longer getting three meals a day from Mom and Dad. "Oftentimes students have a very difficult schedule. They don't have enough time to eat properly so they eat a lot of snacks," said Joshua Solano, 20, of Florida, who will be a junior at Duke this year. "I actually lost a little weight from my irregular eating habits."
     Campus cafeterias have improved their menus over the years and now offer more healthy choices, such as salad bars, said Kim Dude, director of the Wellness Resource Center at the University of Missouri-Columbia. "Then the issue is how to educate students on how to make the right choice," she said. At Missouri, students are trained to make presentations to their peers at residence halls, fraternities and sororities on eating healthy, handling stress, exercising and generally leading a healthy lifestyle, Dude said.
     Social pressures often intensify at college, where students have more opportunities for comparison because they spend so much time together, officials at several schools said. The super-fit bodies that saturate TV shows and commercials can exacerbate such problems. At Southern Cal, there are seminars for freshmen taught by USC professors that deal with messages that can lead to damaging self-images. One such class--"Impossible Bodies: Plastic Surgery as a New Social Problem"--explores the relationship between viewing plastic surgery reality shows to dissatisfaction over a particular body part. Dawson, a 19-year-old business major entering her sophomore year, will lead a program for about 65 of her fellow dorm residents--mostly freshmen--on making healthy living choices. It will include exercising together and tips on healthy eating, she said. "A lot of freshmen," she said, "just don't know what they're getting into right now."

Conviction Of Pain Doctor Overturned
Jerry Markon, Washington Post- 8/23/2006

A federal appeals court threw out the conviction of William E. Hurwitz yesterday, granting the prominent former Northern Virginia pain-management doctor a new trial because jurors were not allowed to consider whether he prescribed drugs in good faith. The decision again galvanized the national debate that the Hurwitz case had come to symbolize: whether fully licensed doctors prescribing legal medication to patients in chronic pain should be subject to prosecution if their patients abuse or sell the drugs. Patient advocate groups strongly supported Hurwitz and expressed concern that his conviction would have a chilling effect on pain doctors.
      The Richmond-based U.S. Court of Appeals for the 4th Circuit acknowledged that prosecutors presented "powerful" evidence at Hurwitz's trial that was "strongly indicative of a doctor acting outside the bounds of accepted medical practice." Hurwitz was convicted in December 2004 of running a drug conspiracy from his McLean office, causing the death of one patient and seriously injuring two others. But a three-judge panel concluded that U.S. District Judge Leonard D. Wexler improperly told jurors that they could not consider whether Hurwitz acted in "good faith" when he prescribed large amounts of OxyContin and other painkillers -- in one instance, 1,600 pills a day. "We cannot say that no reasonable juror could have concluded that Hurwitz's conduct fell within an objectively-defined good-faith standard," the judges wrote, adding that Hurwitz presented evidence that he ran a legitimate medical practice and believed that his prescriptions were "medically proper."
     Patient and medical advocates hailed the decision. "It's about time that courts start to realize that these are doctors, not drug dealers," said Kathryn Serkes, a spokeswoman for the Arizona-based Association of American Physicians and Surgeons.
     The ruling sends the case back to U.S. District Court in Alexandria for another trial. Hurwitz's attorney, Marvin D. Miller, said the "good faith" argument ran to the core of Hurwitz's defense because "he believed what he was doing was helping patients with their pain." "My colleagues on the other side overreached in this case and tried to exert federal control over the practice of medicine," Miller added. James Rybicki, a spokesman for U.S. Attorney Chuck Rosenberg, said prosecutors are reviewing the decision and "studying our options on how to proceed." The government could appeal to the entire 4th Circuit or the U.S. Supreme Court.
     Hurwitz was perhaps the most prominent physician targeted in a federal crackdown on the abuse of OxyContin and other painkillers. His conviction capped a three-year investigation into doctors, pharmacists and patients suspected of selling potent narcotics and fueling an epidemic that ravaged Appalachia and triggered other crimes. Prosecutors portrayed Hurwitz as a common drug dealer whose waiting room was filled with sleeping and incoherent patients with track marks on their arms. More than 20 former patients of Hurwitz's testified at the trial; most had been convicted of drug crimes. Defense attorneys portrayed Hurwitz as a caring and courageous doctor who put his patients' welfare above his own. Jurors convicted Hurwitz on 50 counts of a 62-count indictment, including conspiracy to distribute controlled substances. They acquitted him on nine counts and deadlocked on three. Hurwitz was sentenced to 25 years in prison.