Noteworthy News Articles on Mental Health Topics, October 23-31, 2007

An Active, Purposeful Machine That Comes Out at Night to Play
Benedict Carey, New York Times- 10/23/2007

The task looks as simple as a “Sesame Street” exercise. Study pairs of Easter eggs on a computer screen and memorize how the computer has arranged them: the aqua egg over the rainbow one, the paisley over the coral one — and there are just six eggs in all. Most people can study these pairs for about 20 minutes and ace a test on them, even a day later. But they’re much less accurate in choosing between two eggs that have not been directly compared: Aqua trumped rainbow but does that mean it trumps paisley? It’s hazy. It’s hazy, that is, until you sleep on it.
      In a study published in May, researchers at Harvard and McGill Universities reported that participants who slept after playing this game scored significantly higher on a retest than those who did not sleep. While asleep they apparently figured out what they didn’t while awake: the structure of the simple hierarchy that linked the pairs, paisley over aqua over rainbow, and so on. “We think what’s happening during sleep is that you open the aperture of memory and are able to see this bigger picture,” said the study’s senior author, Matthew Walker, a neuroscientist who is now at the University of California, Berkeley. He added that many such insights occurred “only when you enter this wonder-world of sleep.”
     Scientists have been trying to determine why people need sleep for more than 100 years. They have not learned much more than what every new parent quickly finds out: sleep loss makes you more reckless, more emotionally fragile, less able to concentrate and almost certainly more vulnerable to infection. They know, too, that some people get by on as few as three hours a night, even less, and that there are hearty souls who have stayed up for more than week without significant health problems.
     Now, a small group of neuroscientists is arguing that at least one vital function of sleep is bound up with learning and memory. A cascade of new findings, in animals and humans, suggest that sleep plays a critical role in flagging and storing important memories, both intellectual and physical, and perhaps in seeing subtle connections that were invisible during waking — a new way to solve a math or Easter egg problem, even an unseen pattern causing stress in a marriage.
     The theory is controversial, and some scientists insist that it’s still far from clear whether the sleeping brain can do anything with memories that the waking brain doesn’t also do, in moments of quiet contemplation. Yet the new research underscores a vast transformation in the way scientists have come to understand the sleeping brain. Once seen as a blank screen, a metaphor for death, it has emerged as an active, purposeful machine, a secretive intelligence that comes out at night to play — and to work — during periods of dreaming and during the netherworld chasms known as deep sleep. “To do science you have to have an idea, and for years no one had one; they saw sleep as nothing but an annihilation of consciousness,” said Dr. J. Allan Hobson, a psychiatry professor at Harvard. “Now we know different, and we’ve got some very good ideas about what’s going on.”
     The evidence was there all along. Infants make sucking motions when asleep, and their closed eyelids quiver, as if the eyeballs beneath had a life of their own. But it wasn’t until the early 1950s, in a lab at the University of Chicago, that scientists recorded and identified what was happening. Eugene Aserinsky, then a graduate student in physiology, reportedly was monitoring sleep and waking in his 8-year-old son, using electronic leads stuck to the boy’s head, connected to a brain-wave detecting machine. He had attached two leads to the boy’s eyelids as well, so he could tell whether his son woke up. One night he noticed percolating wave patterns that showed the boy had awoken. But he hadn’t.
     Dr. Aserinsky confirmed the activity in others, and in 1953 he and his adviser, Nathaniel Kleitman, published the finding in a now-famous paper in Science. They later called the odd, unconscious state rapid eye movement, or REM, sleep. “This was really the beginning of modern sleep research, though you wouldn’t have known it at the time,” said Dr. William Dement, then a medical student in Dr. Kleitman’s lab and now a professor of psychiatry and sleep medicine at Stanford University. “It took years for people to realize what we had.”
     Dr. Dement, infatuated with Freud’s theories about dreams, quickly threw himself into the study of REM. He found that it was universal and occurred periodically through the night, alternating with other states. He gave them names: Stages 3 and 4, or deep sleep, when electrical waves roll as slow as mid-ocean swells; Stage 2, an intermediate stage between REM and deep sleep; and Stage 1, light sleep. He also confirmed the link between REM and dreaming, and for a time hopes for sleep research — and money for it — soared.
     Yet Drs. Dement, Hobson and others found in their studies scant evidence to confirm that dreams were the disguised, forbidden wishes described by Freud. They found instead a tangle of apparent anxieties, fantasy and vivid, often nonsensical replays of events that showed few verifiable patterns or measurable function. They had hit a wall, and sleep research, like its nocturnal subjects, dropped from REM excitement back into a void. “You had this great excitement, basically followed by 40 years of nothing; it was just horrible,” said Robert Stickgold, a cognitive neuroscientist at Harvard. “Just a period of darkness.”
     The sun came up in 1994, in Rehovot, Israel. There, a research team led by Avi Karni found that depriving people of REM sleep undermined memory of patterns they had learned the day before, while depriving them of deep sleep did not. This result raised more questions than it answered — Were the participants simply sleepy, or stressed? Why just REM? What was the purpose of the other sleep states? — but it was an invitation to researchers interested in sleep. “I called Karni immediately, and he sent me all his protocols, everything,” Dr. Stickgold said. Others called, too. The field was waking up, and now turning its focus to a long-neglected area: learning and memory.
     Since then the study findings have come almost too fast to digest, and they suggest that the sleeping brain works on learned information the way a change sorter does on coins. It seems first to distill the day’s memories before separating them — vocabulary, historical facts and dimes here; cello scales, jump shots and quarters over there. It then bundles them into readable chunks, at different times of the night. In effect, the stages of sleep seem to be specialized to handle specific types of information, the studies suggest.
     On a recent Monday afternoon in Dr. Stickgold’s lab at Beth Israel Deaconess Medical Center in Boston, a postdoctoral student, Matthew Tucker, was running a study of the effect of naps on memorized words. In a neighboring room, a Boston University student was cramming on a list of 48 word-pairs; in another, a stubbly University of Massachusetts student had finished studying and was reclining for a nap, his face covered with electrode patches, like leeches sprouting antenna. “College students are always ready for nap; we have no problems there,” Dr. Tucker was saying, as he moved back and forth, checking his watch, timing one student’s nap and the other’s study period. He sat down for a moment. “We are finding that if a person takes a nap that contains slow-wave sleep — deep sleep — that performance on declarative memory tasks, which require the memorization of fact-based information like word-pairs, is enhanced compared to a person who doesn’t take a nap,” Dr. Tucker said.
     Previous studies of nocturnal sleep have found the same thing. Memory of learned facts, whether they are names, places, numbers or Farsi verbs, seems to benefit in part from deep sleep. Healthy sleepers usually fall into deep sleep about 20 minutes or so after head meets pillow. They might spend an hour or more in those lolling depths early in the night, and typically less time later on. When cramming on facts, in short, it may be wiser to crash early at night and arise early, than to burn the candle until 2 a.m., the research suggests.
     REM sleep, the bulk of which comes later in the night, seems important for pattern recognition — for learning grammar, for example, or to bird-watch, or play chess. In one 2003 study, Sara Mednick, then at Harvard and now at the University of California, San Diego, led a team that had 73 people come into the lab at 9 a.m. and learn to discriminate between a variety of textured patterns. Some of the participants then took a nap of about an hour at 2 p.m. and the others did not. When retested at 7 p.m. the rested group did slightly better. When tested again the next morning, after everyone had slept the night, the napping group scored much higher. The naps included both REM and deep sleep. “We think that a nap that contains both these states does about the same for memory consolidation as a night’s sleep,” when it comes to pattern recognition learning, Dr. Mednick said.
     Not that Stage 2 is an empty corridor between destinations. In series of experiments that he began in the early 1990s, Dr. Carlyle Smith of Trent University in Canada has found a strong association between the amount of Stage 2 sleep a person gets and the improvement in learning motor tasks. Mastering a guitar, a hockey stick or a keyboard are all motor tasks. Musicians, among others, have sensed this for ages. A piece that frustrates the fingers during evening practice often flows in the morning. But only in recent years has the science caught up and given their instincts a practical shape.
     For instance, Dr. Smith said that people typically got most of their Stage 2 sleep in the second half of the night. “The implication of this is that if you are preparing for a performance, a music recital, say, or skating performance, it’s better to stay up late than get up really early,” he said in an interview. “These coaches that have athletes or other performers up at 5 o’clock in the morning, I think that’s just crazy.”
     For all these nighttime fireworks, memory researchers have yet to work out a complete picture of how all the pieces fit together. Each has a theory, but they differ: Dr. Smith focuses on Stage 2, others on deep sleep, still others on REM or a combination of REM and deep sleep. And no one knows how individual differences, between night owls and early birds, for instance, affect nighttime learning.
     In addition, said Jerome Siegel, a professor of psychiatry at the University of California, Los Angeles, millions of people have taken drugs that suppress REM without reporting serious memory problems. “I wouldn’t rule out the possibility that sleep contributes to learning and memory consolidation, but the claim is that it’s essential, that it’s doing something the waking brain won’t, and the research hasn’t shown that,” Dr. Siegel said. Even the college all-nighter provides evidence that some consolidation occurs during waking, he said. “College students know that the best way to learn stuff isn’t to stay up all night because it’s going to impair your judgment,” Dr. Siegel said, “but it doesn’t matter how good your judgment is if the information isn’t in there. And students know from experience that a lot of it is.”
     One reason some neuroscientists are confident that the sleeping brain is actively working on the day’s streaming video of information is because they have seen it with their own eyes — or heard it, at least. In his lab at the Massachusetts Institute of Technology, Matthew Wilson has been studying rats and mice wearing what look like Carmen Miranda hats. These are ultralight implants through which researchers thread hairlike wires to record the activity of single cells deep in the brain, in the left and right hippocampus, where the day’s memories are recorded. Past research has shown that the hippocampus is spatially sensitive: it seems literally to pair the firing of individual neurons with locations outside the body. These systems are thought to function in similar ways in humans and rodents.
     Computers record the cells’ firing in real time and can broadcast it over speakers. “I would listen to this background music of the brain sometime when the animals were asleep, and I started hearing this section that sounded very much like the pattern when the animals were in the maze,” Dr. Wilson said in an interview. “I recognized the firing pattern.” The maze route is an important memory for these animals; it’s about all they know. In a paper published last December, Dr. Wilson and Daoyun Ji reported that in sleeping animals they had recorded chatter in neurons in the visual center of the neocortex, followed by an apparent response in the hippocampus — and not just any response, but a replay of the activity in the hippocampus that occurred during a maze task.
     Dr. Wilson thinks of this as a kind of off-line conversation between the neocortex, which is involved in conscious learning during waking, and the hippocampus. “What we notice is that the light goes on in the neocortex a fraction of a second before it goes on in the hippocampus, as if the cortex is asking for information,” he said. He said that this process was probably similar to what goes on when people take a moment to reflect, without distractions, sifting through the experiences of the day, also flagging important details, replaying events. “The question is not whether this is an essential process; it is,” Dr. Wilson said. “The question is whether there is something going on during this process that is unique to sleep"
     Subimal Datta, a neuroscientist across the river at Boston University School of Medicine, thinks so. In his studies of animals, he has documented that during sleep the brain is awash in a chemical bath unlike any during waking. Levels of inhibitory transmitters increase sharply, and levels of many activating messengers drop, or shut down entirely. Even before REM is detectable, Dr. Datta said, a small pocket of cells in the brainstem spurs a surge in glutamate — an activating chemical — which leads to protein synthesis and other changes that support long-term memory storage. “During waking we have a thousand things happening at once, the library is filling up, and we can’t possibly process it all,” Dr. Datta said. While awake the brain is also gathering lots of valuable information subconsciously, he said, without the person’s ever being aware of it. “It’s during sleep that we have this special condition to clear away this overload, and these REM processes then help store what’s important,” Dr. Datta said. In the jargon of the field, the “signal to noise ratio” becomes much stronger. The neural trace of the trivia has weakened, and crucial details are replayed and reinforced.
     Dreams still defy scientific measurement but they, too, have a place in the evolving theory of sleep-dependent learning. It is likely during REM, some scientists argue, that the brain proceeds to mix, match and juggle the memory traces it has preserved, looking for hidden connections that help make sense of the world. Life experience is cut up and reordered, sifted and shuffled again. This process could account for the cockeyed, disjointed scenes that occur during dreams: the kaleidoscope of distilled experience is being turned.
     It also might account for that golden gift often attributed to a night’s sleep: inspiration. To hear some people tell it, a night’s sleep changed their world. It was reportedly during sleep that the Russian scientist Dmitri Mendeleev’s periodic table of the elements tumbled into place. Friedrich August Kekule, a 19th-century chemist, said he worked out the chemical structure of the benzine ring — an important discovery — when he dreamed of a snake biting its tail. Athletes, including the golfer Jack Nicklaus, have also talked about insight coming during sleep. Slight corrections in technique are revealed; sand traps are averted; mountains move.
     “It does make sense these insights come during REM,” Dr. Walker said. “I mean, what better time to play out all these different scenarios and solutions and ideas than in dreams, where there are no consequences?” The problem, he and others say, is how to study it. That, most neuroscientists agree, will take some very creative thinking — both of the daytime and nighttime kind.

College Town Party Paper Glorifies Heavy-Drinking Life
Alan Zagier, Associated Press- 10/25/2007

COLUMBIA, MO. - Ah, college life. All-night study sessions in the library. Professors challenging the conventional wisdom. Snowball battles on the quad. Get real.
     For students at the University of Missouri-Columbia, college is all about casual sex, meddling parents, foul-mouthed friendships and partying until you puke -- that is, if you believe, the portrayal in The Booze News, a new weekly newspaper that glorifies the wonders of heavy drinking.
     The publication's founders, a pair of University of Illinois graduates, call The Booze News (motto: "Today's News ... Under the Influence") an over-the-top satire modeled after The Onion, the popular parody newspaper started by college students in Madison, Wis., that has since gone global.
     But some Missouri students and local business owners aren't laughing. Several downtown business owners have thrown out the free paper, which has published seven issues, afraid of offending customer sensibilities. Even some campus fraternity houses deem the material too edgy for members. "The paper is not for 8-year olds," said co-founder Atish Doshi, a 2004 Illinois graduate from suburban Detroit. "It's about being immature college kids. That's what makes it successful. We don't take ourselves seriously."
    Success has come quickly for Doshi and Derek Chin, who said they started the paper three years ago "as a complete joke." The Booze News can now be found at Illinois State, Indiana, Iowa and the University of Wisconsin-Madison, along with Missouri and Illinois. Doshi, who works in Chicago with a full-time staff of six, said he expects to expand to another dozen campuses in the next year. "I would love to be at as many schools as possible," Doshi said. "There will always be college students." The paper's Web site boasts that its writers, editors and advertising sales crew members "are drunk at least four hours a day, six days a week" but assures readers that "we are not obnoxious drunks."



Workaholics Now Seen As Addicts
Frank Bentayou, Newhouse News Service- 10/27/2007

Watch workaholics when they're off the job, and a big truth plays out before your eyes: Keeping ever available is a mixed blessing. For those addicted to their jobs, devices such as the Black Berry transcend mere tool status. They're prime enablers.
      Not that there aren't endless ways for workaholics to sneak out' of real life and into their jobs. Bryan Robinson, a retired University of North Carolina psychology professor and author, said he used to step away from family beach outings to jot down notes for his research -- on addiction. In time, he realized that he, too, was an addict -- a work junkie. So he did what you might expect. He became one of the world's authorities on the unnatural and unhealthful attraction to work He calls it "the best-dressed addiction."
     In this age of ever-present electronic connectivity, it's easy to become hooked. Robinson's latest book, "Chained to the Desk," available Nov. 5 in paperback from New York University Press, makes the point emphatically. "We have such easy links be­tween job and home," he said, that career can easily overpower family life.
     Social scientists like Robinson and Richard Boyatzis, a psychologist at Case Western Reserve University and also an academic researcher and popular author, think the world should better understand workaholism. It's a pathology. It hurts those afflicted, as well as their families, friends and colleagues. It does no service to the organizations they work for, whether government, corporation or Parent Teacher Association. Politicians and corporate executives boastfully call themselves workaholics to suggest devotion to con­stituents and shareholders. Robinson says his internationally acclaimed addiction studies led him to quite a different sense of this "obsessive focus on work," as he calls it. It has dark consequences. Another author and student of workaholism, Diane Fasell, links work obsession to sleep disorders, heart attacks and strokes.
     A California nonprofit, Workaholics Anonymous, modeled after the organization aimed at alcohol addiction, has its own 12-step process for coping, relying heavily on "a higher power," its Web site (www.workaholics-anonymous.org) indicates organizations don't benefit from workaholics. Boyatzis, who explored the topic for his 2005 book, "Resident Leadership," studied how the chronic stress of many managers pushes them into a spiraling syndrome of long hours, frantic effort and increasing incompetence.
     A consequence, Boyatzis found, is a neurological breakdown that keeps them from learning, from observing well, from performing the jobs that addict them. "The cycle fools a lot of people," he said. "They become like gamblers; they do it even though they know they're losing." In short, there's a growing awareness that workaholism is a disease infecting highly motivated people. It deserves treatment, not applause.
     But wait. Can we really consider a commitment to hard work a disease? "It's much more complicated than that," Robinson said in a phone conversation from his office in Asheville, N.C. "Workaholism is certainly more a pathology than a benefit to people."
     Commitment to work can still be a virtue -- and a ben­efit -- if it stands in balance with the rest of one's life. Workaholics' business addiction can be a health destroyer. It may generate stress, unhealthy eating habits, weariness from lack of sleep and too much nervous time in the office. Undue attention to career often interferes with the family lives of the afflicted. Spouses and children may suffer neglect, even emotional abuse.
     Ironic though it may seem, workaholics often don't do all that well at their jobs, even though they sacrifice personal lives to its demands. "They expect too much from others, interfere with their duties and worry themselves to distraction," Robinson said. Still, the notion that workaholism is admirable "permeates our culture," he said. When he began his studies of uncommonly fierce involvement in jobs and careers, "no one had really looked at it from the standpoint that it might be a detriment. Most thought it was a good thing."
     What he found was that workaholics are victims, as are addicts to alcohol, drugs, gambling. "It creates problems with productivity, including absenteeism and low morale among fellow workers. Workaholics have trouble delegating. They look over people's shoulders. They suffer burnout." Those managers think that "they just need to work harder, and they can get more done." But it's not true. "You need a coach," Boyatzis said. "It can be a friend, a colleague, a spouse. Probably best a therapist" who can convincingly identify the spiraling nature of stress and workaholism and bring the sufferer back to reality.

12 signs of workaholism:
* Rarely delegating or asking for help.
* Showing impatience at others' work.
* Doing two, three or more tasks at the same time.
* Biting off more than one an chew.
* Feeling guilty, lost when not at work.
* Focusing on results, not the task.
* Focusing on planning, ignoring the here and now
* Continuing to work after others quit.
* Imposing pressure-filled deadlines.
* Seldom relaxing.
* Attending more to work than to relationships.
* Lacking hobbies, social interests.

7 signs of optimal performers:
In his most recent book, "Chained to the Desk," psychologist Bryan Robinson lists these features of "optimal performers in the workplace." They add up to seven qualities of those who do not manifest workaholism but have a healthy sense of the role of work in their lives:
* Good collaborators and delegators.
* Socially involved.
* Enjoy the process as well as the outcome of work.
* Motivated by their own needs and creative contributions.
* Wok beyond the goal toward a more whole picture.
* Take creative risks beyond usual bounds.
* Self-correct and learn from mistakes.


Larry David and Schizophrenia
Jacob Ward, The New Yorker- 10/29/2007

In 2004, David Roberts, a second-year clinical-psychology student at the University of North Carolina at Chapel Hill, had a summer job teaching social skills to a group of schizophrenic patients at a state hospital. He had a particularly unresponsive group ("Many patients are flattened by their meds," he explained recently) and tried in vain to interest them in role-playing everyday social situations, offering the patients rewards of points and tokens in return for not giving in to their urges to wander around, respond to phantom voices, or otherwise become disruptive—a traditional system of behavioral therapy.
      During a break one day, Roberts, watching television in the hospital's lounge, noticed that a change had come over his patients, who generally seemed immune to basic social signals. "They were laughing at the ironic commercials," he said. "They were laughing at 'Friends.' They were laughing at all the places I was laughing." Many showed a fluency in the kinds of social communication that Roberts had been struggling to teach them in therapy. "We watched a scene from 'Monk' where Tony Shalhoub won't shake hands with anyone for fear of germs, and walks away awkwardly. I asked a man who'd been an inpatient for ten years, and who was generally blank, what had happened, and he shook his head and gave me a wry grin. Unspoken communication is huge for someone like that."
     So Roberts began showing TV clips during therapy sessions. Soon he had narrowed his selections down to one show: television's purest expression of social dysfunction, "Curb Your Enthusiasm." Roberts considers Larry David to be the perfect proxy for a schizophrenic person. "On his way into his dentist's office, he holds the door open for a woman, and, as a result, she's seen first," he said. "He stews, he fumes, he explodes. He's breaking the social rules that folks with schizophrenia often break" He went on, "Or the one where Ted Danson and Mary Steenburgen invite Larry and his wife to a concert: the night arrives, they don't call, Larry assumes they don't like him, then it turns out he got the date wrong. It's a classic example of a major social cognitive error—jumping to conclusions—that schizophrenic patients are prone to." As the patients watched David flub situation after situation, they laughed, and they willingly discussed with Roberts how they might behave in the same circumstances. "That bald man made a mountain out of a molehill!" one woman called out during a session.
     Roberts and his U.N.C. adviser, David Penn, began to formalize these findings, mapping out a teachable technique called Social Cognition and Interaction Training. They tested SCIT in four preliminary studies, and in post-training evaluations patients showed significant improvement in deciphering social situations. The technique has attracted attention—practitioners in Germany, Portugal, and China are now watching TV with their patients—and this fall Penn and a third researcher are conducting a randomized control trial funded by the National Institute of Mental Health.
     Larry David has been replaced, however. When no one at "Curb Your Enthusiasm" responded to a request for permission to use clips from the show, Roberts and Penn hired actors to film their own cringe-worthy situations. For instance, on a split screen, Suzanne calls her co-worker Heidi at home and invites her to dinner. "How did you get my number?" Heidi asks, and Suzanne, oblivious to Heidi's discomfort, explains that ifs in the employee directory.
     "Friday—I'm sorry, I already have plans," Heidi says. There's a long, horrible pause as Suzanne's face falls, and she begins backing off from the invitation—just as Heidi reconsiders and says that she has some time free on Saturday.
     "No, I'm sorry," Suzanne says. "I didn't mean to interrupt you." Angry and embarrassed, she hangs up the phone. Roberts said that when his patients watched this bit they slapped their foreheads and winced. "They were, like, 'Oh, man, I do that all the time!"
     Larry David, reached on the telephone in California, said that he hadn't realized how deeply the awkwardness on his show would affect people. "It just deals with how you're supposed to behave," he said. "A lot of the time, it's just me expressing myself freely. I knew that my own mental health was problematic, but should I be worried? I mean, I blowup, too! Is this something undiagnosed? Do I need to see a clinical psychologist?"

Doctors Push Autism Screening
Lindsey Tanner, Associated Press- 10/28/2007

CHICAGO - The country's leading pediatricians group is making its strongest push yet to have all children screened for autism twice by age 2, warning of symptoms such as babies who don't babble at 9 months and 1-year-olds who don't point to toys. The advice is meant to help both parents and doctors spot autism sooner. There is no cure for the disorder, but experts say that early therapy can lessen its severity.
      Symptoms to watch for and the call for early screening come in two new reports. They are being released by the American Academy of Pediatrics on Monday at its annual meeting in San Francisco and will appear in the November issue of the journal Pediatrics and on the group's Web site - www.aap.org. The reports list numerous warning signs, such as a 4-month-old not smiling at the sound of Mom or Dad's voice, or the loss of language or social skills at any age. Experts say one in 150 U.S. children have the troubling developmental disorder. "Parents come into your office now saying 'I'm worried about autism.' Ten years ago, they didn't know what it was," said Dr. Chris Johnson of the University of Texas Health Science Center in San Antonio. She co-authored the reports.
     The academy's renewed effort reflects growing awareness since its first autism guidelines in 2001. A 2006 policy statement urged autism screening for all children at their regular doctor visits at age 18 months and 24 months. The authors caution that not all children who display a few of these symptoms are autistic and they said parents shouldn't overreact to quirky behavior.
     Just because a child likes to line up toy cars or has temper tantrums "doesn't mean you need to have concern, if they're also interacting socially and also pretending with toys and communicating well," said co-author Dr. Scott Myers, a neurodevelopmental pediatrician in Danville, Pa. "With awareness comes concern when there doesn't always need to be," he said. "These resources will help educate the reader as to which things you really need to be concerned about."
     Another educational tool, a Web site offers dozens of video clips of autistic kids contrasted with unaffected children's behavior. That Web site — www.autismspeaks.org — is sponsored by two nonprofit advocacy groups: Autism Speaks and First Signs. They hope the site will promote early diagnosis and treatment to help children with autism lead more normal lives.
     The two new reports say children with suspected autism should start treatment even before a formal diagnosis. They also warn parents about the special diets and alternative treatments endorsed by celebrities, saying there's no proof those work Recommended treatment should include at least 25 hours a week of intensive behavior-based therapy, including educational activities and speech therapy, according to the reports. They list several specific approaches that have been shown to help. For very young children, therapy typically involves fun activities, such as bouncing balls back and forth or sharing toys to develop social skills; there is repeated praise for eye contact and other behavior autistic children often avoid.
     Mary Grace Mauney, an 18­year-old high school senior from Lilburn, Ga., has a mild form of autism that wasn't diagnosed until she was 9. As a young girl, she didn't smile, spoke in a very formal manner and began to repeat the last word or syllable of her sentences. She was prone to intense tantrums, but only outside school. There, she excelled and was in gifted classes. "I took her to a therapist and they said she was just very sensitive and very intense and very creative," said her mother, Maureen, 54. Pediatricians should send such children for "early intervention as soon as you even think there's a problem," Johnson said.
     Dr. Dirk Steinert, who treats children and adults at Columbia St. Mary's clinic in suburban Milwaukee, said the push for early autism screening is important — but that it's tough to squeeze it into a child's regular wellness checkup. Some pediatricians have tried scheduling a visit just to check for developmental problems, when children are 21/2. The problem is that insurance doesn't always cover these extra visits, Steinert said.

How to Figure Out When Therapy Is Over
Richard A. Friedman, M.D., New York Times- 10/30/2007

If you think it’s hard to end a relationship with a lover or spouse, try breaking up with your psychotherapist.

A writer friend of mine recently tried and found it surprisingly difficult. Several months after landing a book contract, she realized she was in trouble.

“I was completely paralyzed and couldn’t write,” she said, as I recall. “I had to do something right away, so I decided to get myself into psychotherapy.”

What began with a simple case of writer’s block turned into seven years of intensive therapy.

Over all, she found the therapy very helpful. She finished a second novel and felt that her relationship with her husband was stronger. When she broached the topic of ending treatment, her therapist strongly resisted, which upset the patient. “Why do I need therapy,” she wanted to know, “if I’m feeling good?”

Millions of Americans are in psychotherapy, and my friend’s experience brings up two related, perplexing questions. How do you know when you are healthy enough to say goodbye to your therapist? And how should a therapist handle it?

With rare exceptions, the ultimate aim of all good psychotherapists is, well, to make themselves obsolete. After all, whatever drove you to therapy in the first place — depression, anxiety, relationship problems, you name it — the common goal of treatment is to feel and function better independent of your therapist.

To put it bluntly, good therapy is supposed to come to an end.

But when? And how is the patient to know? Is the criterion for termination “cure” or is it just feeling well enough to be able to call it a day and live with the inevitable limitations and problems we all have?

The term “cure,” I think, is illusory — even undesirable — because there will always be problems to repair. Having no problems is an unrealistic goal. It’s more important for patients to be able to deal with their problems and to handle adversity when it inevitably arises.

Still, even when patients feel that they have accomplished something important in therapy and feel “good enough,” it is not always easy to say goodbye to a therapist.

Not long ago, I evaluated a successful lawyer who had been in psychotherapy for nine years. He had entered therapy, he told me, because he lacked a sense of direction and had no intimate relationships. But for six or seven years, he had felt that he and his therapist were just wasting their time. Therapy had become a routine, like going to the gym.

“It’s not that anything bad has happened,” he said. “It’s that nothing is happening.”

This was no longer psychotherapy, but an expensive form of chatting. So why did he stay with it? In part, I think, because therapy is essentially an unequal relationship. Patients tend to be dependent on their therapists. Even if the therapy is problematic or unsatisfying, that might be preferable to giving it up altogether or starting all over again with an unknown therapist.

Beyond that, patients often become stuck in therapy for the very reason that they started it. For example, a dependent patient cannot leave his therapist; a masochistic patient suffers silently in treatment with a withholding therapist; a narcissistic patient eager to be liked fears challenging his therapist, and so on.

Of course, you may ask why therapists in such cases do not call a timeout and question whether the treatment is stalled or isn’t working. I can think of several reasons.

To start with, therapists are generally an enthusiastic bunch who can always identify new issues for you to work on. Then, of course, there is an unspoken motive: therapists have an inherent financial interest in keeping their patients in treatment.

And therapists have unmet emotional needs just like everyone else, which certain patients satisfy. Therapists may find some patients so interesting, exciting or fun that they have a hard time letting go of them.

So the best way to answer the question, “Am I done with therapy?” is to confront it head on. Periodically take stock of your progress and ask your therapist for direct feedback.

How close are you to reaching your goals? How much better do you feel? Are your relationships and work more satisfying? You can even ask close friends or your partner whether they see any change.

If you think you are better and are contemplating ending treatment but the therapist disagrees, it is time for an independent consultation. Indeed, after a consultation, my writer friend terminated her therapy and has no regrets about it.

The lawyer finally mustered the courage to tell his therapist that although he enjoyed talking with her, he really felt that the time had come to stop. To his surprise, she agreed.

If, unlike those two, you still cannot decide to stay or leave, consider an experiment. Take a break from therapy for a few months and see what life is like without it.

That way, you’ll have a chance to gauge the effects of therapy without actually being in it (and paying for it). Remember, you can always go back.

Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.

His diagnosis was burnout — dysthymia, to use the clinical term. There was no need for medication, but I could benefit from psychotherapy, to deal with my repressed feelings as the child of a suicide.

Skeptical at first — this analytical stuff is not science! — I gradually began to appreciate the parallels between his discipline and mine.

In science and in psychotherapy, one approaches a problem from different angles, observes, hypothesizes, discards theories and begins to draw conclusions. When the evidence from various directions converges on a point, that point becomes a discovery, a new “truth.”

After four years of therapy, all seemed well. But three years later, I suddenly began to feel profoundly depressed and returned to therapy.

“Let’s try an antidepressant, and I bet you’ll come out of it,” my psychiatrist said. Medication loomed large. I had never taken more than aspirin, not even for childbirth. But as the depression deepened, I capitulated, using antidepressants in various combinations and at increasing doses.

While I was in this psychic hell, unable to eat or sleep, an odd e-mail message arrived from a colleague and friend, a Nobel Prize-winning scientist. He questioned my contributions to a collaborative discovery that had won me recognition. In my irrational fog, I assumed that all my scientific work was fraudulent and that my friend had found me out.

This psychosis was the scariest aspect of my depression. I did not realize that my colleague had nominated me to an esteemed scientific academy and was checking his facts. My paranoia deepened, my depression worsened, and as a last resort I was admitted to a psychiatric hospital.

There, I was stripped of all independence, a right valued even in my stupor. The staff took belongings like tweezers (no “sharps” allowed, not even blunt ones) and vitamins (no drugs, not even food supplements). I was bereft and frightened. But then the staff embraced and cared for me. I felt cradled, held like a baby.

Yet the depression persisted, and I became a candidate for the dreaded shock therapy. I was repeatedly strapped to a table and zapped, but almost immediately began to recover from the incapacitating despair that had shut down my life.

I suffered three relapses; none was as severe as the first, but only cutting-edge psychopharmacology and talk therapy kept me from rehospitalization. Nevertheless, each relapse pushed me into a dark void, in which setting the dinner table, let alone preparing the meal, seemed overwhelming.

The episodes put me back in touch with my father’s death, and although suicide seemed like an alternative to my hopelessness, it was not an option. I had too much to live for.

Then came a turning point. My psychiatrist had been struck by the sudden onset of a first major depression in midlife. He insisted on a blood workup. The results showed an endocrine condition called hyperparathyroidism, which causes elevated levels of blood calcium and parathyroid hormone. He pointed out a potential link to depression, prompting me to check the data.

When I did, sure enough, I grasped that there might indeed be a significant connection. Four years after my hospitalization for depression, I had surgery to control the parathyroid problem, followed by a second operation two years later. Plotting the data, I realized that when my calcium and hormone levels returned to normal, so did the moods. That was three years ago.

I wonder whether my father also suffered from hyperparathyroidism. I also wonder whether doctors might routinely explore a physical basis for the sudden, unexplained onset of emotional pain.

Of course, I may not be permanently cured of depression. My time in the abyss opened a place whose door will always remain ajar. But one thing’s for sure: I’ll keep monitoring my moods — and collecting the data.

Marlene Belfort is director of genetics at the Wadsworth Center laboratory of the New York State Health Department.

Scientists Note Brain's Reaction to Fear
Associated Press, 10/30/2007

WASHINGTON -- Science is getting a grip on people's fears. As Americans revel in all things scary on Halloween, scientists say they now know better what's going on inside our brains when a spook jumps out and scares us. Knowing how fear rules the brain should lead to treatments for a major medical problem: When irrational fears go haywire.

''We're making a lot of progress,'' said University of Michigan psychology professor Stephen Maren. ''We're taking all of what we learned from the basic studies of animals and bringing that into the clinical practices that help people. Things are starting to come together in a very important way.''

About 40 million Americans suffer from anxiety disorders, according to the National Institute of Mental Health. A Harvard Medical School study estimated the annual cost to the U.S. economy in 1999 at roughly $42 billion.

Fear is a basic primal emotion that is key to evolutionary survival. It's one we share with animals. Genetics plays a big role in the development of overwhelming -- and needless -- fear, psychologists say. But so do traumatic events.

''Fear is a funny thing,'' said Ted Abel, a fear researcher at the University of Pennsylvania. ''One needs enough of it, but not too much of it.''

Armi Rowe, a Connecticut freelance writer and mother, said she used to be ''one of those rational types who are usually calm under pressure.'' She was someone who would downhill ski the treacherous black diamond trails of snowy mountains. Then one day, in the midst of coping with a couple of serious illnesses in her family, she felt fear closing in on her while driving alone. The crushing pain on her chest felt like a heart attack. She called 911.

''I was literally frozen with fear,'' she said. It was an anxiety attack. The first of many.

The first sign she would get would be sweaty palms and then a numbness in the pit of the stomach and queasiness. Eventually it escalated until she felt as if she was being attacked by a wild animal.

''There's a trick to panic attack,'' said David Carbonell, a Chicago psychologist specializing in treating anxiety disorders. ''You're experiencing this powerful discomfort but you're getting tricked into treating it like danger.''

These days, thanks to counseling, self-study, calming exercises and introspection, Rowe knows how to stop or at least minimize those attacks early on.

Scientists figure they can improve that fear-dampening process by learning how fear runs through the brain and body.

The fear hot spot is the amygdala, an almond-shaped part of the deep brain.

The amygdala isn't responsible for all of people's fear response, but it's like the burglar alarm that connects to everything else, said New York University psychology and neural science professor Elizabeth Phelps.

Emory University psychiatry and psychology professor Michael Davis found that a certain chemical reaction in the amygdala is crucial in the way mice and people learn to overcome fear. When that reaction is deactivated in mice, they never learn to counter their fears.

Scientists found D-cycloserine, a drug already used to fight hard-to-treat tuberculosis, strengthens that good chemical reaction in mice. Working in combination with therapy, it seems to do the same in people. It was first shown effective with people who have a fear of heights. It also worked in tests with other types of fear, and it's now being studied in survivors of the World Trade Center attacks and the Iraq war.

The work is promising, but Michigan's Maren cautions that therapy will still be needed: ''You're not going to be able to take a pill and make these things go away.''

When it comes to ruling the brain, fear often is king, scientists say.

''Fear is the most powerful emotion,'' said University of California Los Angeles psychology professor Michael Fanselow.

People recognize fear in other humans faster than other emotions, according to a new study being published next month. Research appearing in the journal Emotion involved volunteers who were bombarded with pictures of faces showing fear, happiness and no expression. They quickly recognized and reacted to the faces of fear -- even when it was turned upside down.

''We think we have some built-in shortcuts of the brain that serve the role that helps us detect anything that could be threatening,'' said study author Vanderbilt University psychology professor David Zald.

Other studies have shown that just by being very afraid, other bodily functions change. One study found that very frightened people can withstand more pain than those not experiencing fear. Another found that experiencing fear or merely perceiving it in others improved people's attention and brain skills.

To help overcome overwhelming fear, psychologist Carbonell, author of the ''Panic Attacks Workbook,'' has his patients distinguish between a real threat and merely a perceived one. They practice fear attacks and their response to them. He even has them fill out questionnaires in the middle of a fear attack, which changes their thinking and causes reduces their anxiety.

That's important because the normal response for dealing with a real threat is either flee or fight, Carbonell said. But if the threat is not real, the best way to deal with fear is just the opposite: ''Wait it out and chill.''

On the Net:
David Carbonell's tips on how deal with anxiety problems: http://www.anxietycoach.com/steps.htm

Study Tracks Suicide Rate in V.A. Care
Benedict Carey, New York Times- 10/31/2007

Veterans receiving treatment for depression are no more likely to take their own lives than are civilian patients, a large Department of Veterans Affairs study published yesterday found.

The study, a joint effort with the University of Michigan that included detailed records from more than 800,000 veterans, is the largest and most comprehensive in this group of patients and the first to include troops returning from Iraq and Afghanistan.

It found 1,683 suicides in all, a rate of less than one-quarter of 1 percent — far lower than some past estimates. But experts cautioned against applying the findings too widely, because most former servicemen and women with mental problems do not seek treatment in the Veterans Affairs system.

In contrast to most studies of nonveterans, which have found that the risk of suicide generally goes up with age, the rate was highest among those ages 18 to 44, dropped about 20 percent for those ages 45 to 64 and then rose again after that.

Paradoxically, those who had post-traumatic stress symptoms as well as depression were at significantly lower risk of suicide than those without trauma symptoms, the study found. Veterans being treated for both conditions were 20 percent less likely to commit suicide than those who were treated for depression alone. People suffering from two conditions are usually considered to be at higher risk for harm than those with one.

“It may be that those being treated for P.T.S.D. have more access to services, more psychotherapy visits, just more mental health services in general,” said the study’s senior author, Dr. Marcia Valenstein of the University of Michigan and the veterans agency.

Dr. Valenstein added that the veterans being treated for post-traumatic stress were more likely than the others to receive income supplements from the government to cover the disability, which could also help account for the difference.

The Veterans Affairs and Defense Departments have been investigating suicide risk closely since a study of combat troops in 2003 found high rates of suicide. In another recent study, Oregon researchers found that veterans were about twice as likely to kill themselves as were people who had not served in the military.

The new analysis, published online in The American Journal of Public Health, focused only on those veterans who sought treatment for depression in the government’s health care system, and suggested that they might be different in some ways from others in treatment.

“This is an important study and adds a lot to what we know about this population,” said Mark Kaplan, a professor of community health at Portland State University in Oregon.

In the new study, a research team evaluated records for 807,694 veterans being treated in the V.A. system from April 1999 to September 2004. The group included men and women who had served in Vietnam, the Persian Gulf war, Iraq and Afghanistan, though the researchers did not do separate analysis for each.

The study did not evaluate the methods used in the suicides. The Oregon study, led by Dr. Kaplan and published last summer, found that more than 80 percent of veterans’ suicides were committed with a gun. The rate in nonveterans was 55 percent.