Noteworthy News Articles on Mental Health Topics, November 18-26, 2007
In Florida, Addicts Find an Oasis of Sobriety
Jane Gross, New York Times- 11/18/2007
DELRAY BEACH, Fla. — Whitney Tower, 56, a scion of the Whitney, Vanderbilt and Drexel fortunes, squandered his trust fund and sold family treasures to support a $1,000-a-day heroin habit before landing in a tough-love facility near here seven years ago and never leaving. “If I went back to New York I’d be dead in two weeks,” he said.
In some ways Mr. Tower, who spent three decades in and out of treatment, remains a creature of his pedigree. He favors foppish linen suits and drops names of the fast crowd he once ran with. But his social life these days is dinner at home with sober friends who have settled here in what experts consider the recovery capital of America. He is studying addiction counseling, and he works as an unpaid intern at a local drug treatment center.
Delray Beach, a funky outpost of sobriety between Fort Lauderdale and West Palm Beach, is the epicenter of the country’s largest and most vibrant recovery community, with scores of halfway houses, more than 5,000 people at 12-step meetings each week, recovery radio shows, a recovery motorcycle club and a coffeehouse that boasts its own therapy group.
Recovery communities are springing up outside the walls of rehab centers for alumni seeking the safety in numbers. The prototype community is in Minnesota, near the Hazelden clinic. But recovering substance abusers are also sinking roots in Arizona, Southern California and the Gold Coast of Florida — places with more sizzle and better weather. Lindsay Lohan spoke hopefully of finding eternal rehab in the Wasatch mountains of Utah, near Provo, where some graduates of her latest drug treatment center have moved.
Delray Beach is in a class by itself, experts say, because of its compact geography and critical mass of recovering addicts who cross paths daily in the shops and bistros along Atlantic Avenue. They fly beneath the radar of tourists oblivious to telltale signs of addiction, like unapologetic chain smoking. But they see one another everywhere: On the patio at Starbucks, reading the “Big Book,” the bible of Alcoholics Anonymous. At the Longhorn restaurant, pushing tables together for Friday night gatherings. At the Crossroads Club, the headquarters for 115 12-step meetings a week, where gossip is of romance between recovering addicts, overdoses, suicides and friends who have successfully moved back home. “This community is one big helping hand that is always open,” said Mike Devane, a new halfway house owner, who lost his job and family in New Jersey before coming south five years ago to get sober.
This society-within-a-society gets mixed reviews from addiction experts. A few find it insular and cultish. “Cutting off contact with the outside world, is that a sign of mental health?” asked Stanton Peele, a psychologist and author who challenges much conventional wisdom in the field. But many more experts note that a recovery community like Delray Beach may provide a promising environment for certain addicts. While such communities have not been studied, there is consensus that substance abuse is a chronic and relapsing disease, comparable to diabetes or high blood pressure. It thus requires permanent lifestyle changes that may be easier in a new environment. Relapse rates range from 90 percent, for short treatment programs with no follow-up care, to 40 percent when treatment is comprehensive and long-lasting.
And even then, new research shows that sustained addiction can lead to changes in the brain that make relapse all but inevitable, experts say. Success, for those entrenched addicts, is measured by longer and more productive periods of sobriety and shorter and less damaging periods of substance abuse.
A. Thomas McLellan, director of the Treatment Research Institute at the University of Pennsylvania, said the way to judge the wisdom of retreating to a bubble of sobriety like Delray Beach was to ask: “Where were they before? This may be their best available option.”
Harold Jonas, 52, kicked a heroin habit two decades ago in this beachfront city, far from his native Philadelphia, and decided to stay. He married a fellow addict, raised a family, earned a doctorate and opened a halfway house for substance abusers making the transition from residential care to independent living. Steadily, Dr. Jonas and his wife, Dawn, expanded their cottage industry. They organized an association of halfway house owners and opened KoffeeOkee, the coffeehouse-karaoke bar.
Mr. Devane was among 20 Delray Beach residents who gathered at the cafe one recent night for a weekly counseling session. One “normie” — their word for the 65,000 year-round town folk — wandered in unawares and was allowed to stay. First-timers sat at the periphery of the circle, avoiding eye contact with others. But Jeannie Saros, a onetime addict and now a therapist who sees private patients in a cottage behind KoffeeOkee, soon had everyone sharing closely guarded secrets. One admitted resuming a “sick relationship” with a drug-abusing lover. Another, although sober, said she continued to steal from friends. Mr. Devane, his voice a whisper, confessed to having been a bad father.
Many here have lost custody of their children. Among them is Jennifer Boeth Whipple, 53, a journalist who arrived in the clutches of alcoholism in 1998. Ms. Whipple said she “took to heart” — during her third effort at rehabilitation — “that some people have to change their lives completely to maintain sobriety.” So she stuck around, following a carefully phased program, known as the Florida Model, from residential treatment to a halfway house and a “recovery job” at Home Depot. Eventually she bought a condominium and worked for an art dealer.For six years, Ms. Whipple said, she “felt very safe here, surrounded by people who’d been through what I’d been through” — detoxing in the same roach-infested apartments, cycling through recovery centers familiar to New Yorkers, like Silver Hill or Four Winds. Then a year ago, “after I’d gotten my sea legs,” Ms. Whipple returned to New York City, where her son lives with his father. All is well, she said, except she is lonely. She talks to her friends often. “At times,” Ms. Whipple said, “Florida still beckons.”
It is difficult to count the recovery population here because only residential treatment beds are licensed by the state. As of Nov. 1, almost 3,500 people were being treated as in-patients in Palm Beach, Broward and Miami-Dade Counties in southeastern Florida, by far the largest concentration in the state. Halfway houses, by contrast, are unregulated. But Dr. Jonas said there were about 1,200 halfway house beds in this city alone. With rent averaging $175 a week, these businesses generate almost $11 million a year.
Low-wage jobs for people in recovery are plentiful in a tourist economy. Recovering addicts make smoothies at Ben and Jerry’s, and sell housewares at Crate and Barrel. Among the current worker bees are an executive chef and a professional baseball player, both busing tables. “Just about every business in town has at least one of us, whether they know it or not,” said Susan Miller, sober for 13 years and executive director of the Crossroads Club, command central for newcomers seeking meetings, housing, transportation — for those with too many D.W.I.’s to drive — and legal help.
Typically modest bungalows, halfway houses provide structure and supervision — curfews, random urine tests, the requirement that tenants have jobs and attend meetings. Still, unscrupulous owners prey on tenants by “flipping” the same bed, insisting on several months’ rent up front, then evicting someone for rules violations and re-renting the room. Some owners also put rule-breakers out on the curb, with no alternative housing, which can lead to crime and an outcry from neighborhood homeowners.
A movement to ban halfway houses in residential neighborhoods has so far been unsuccessful, with courts ruling that such restrictions violate the Americans with Disability Act. The association of halfway-house owners is trying self-regulation, and its members are required to find a placement for an evicted tenant, often at a discounted rate in a motel Dr. Jonas owns.
A bigger concern, said Detective Gary Martin in the Palm Beach County Sheriff’s Office, is drug overdoses — 218 in 2006 and 241 during the first nine months of 2007. “I consider close to one overdose every 36 hours a big problem,” Detective Martin said. The overdoses highlight the high risk of relapse. Indeed, even owners of halfway houses fall off the wagon, leaving tenants like Katrina W., 28, clean for a few months of a heroin and crack cocaine addition, suddenly in charge. One resident, testing Katrina’s limits, came home smoking crack and blew smoke in her face. Katrina got the resident out without incident and managed to hold on to her fragile sobriety.
Sobriety is the tightrope addicts walk, even years into recovery. Claire Condon arrived here at age 19, a six-foot beauty withered to 100 pounds by heroin. But in Delray Beach she got sober, got a modeling job, a “normie” boyfriend, a condominium and two dogs. Then, a year ago, at age 27, everything unraveled. Ms. Condon battled depression, smoked marijuana to take the edge off her misery, then upgraded to cocaine and OxyContin. She text messaged friends from recovery, urging them to stay away. “I didn’t want to be a tornado in their lives,” she said. “But every time they heard someone died, they thought it was me.” Ms. Condon resumed treatment, however, and returned to her regular meetings at the Crossroads Club. Back at Square 1, she still hopes to leave here one day. She misses the mountains and the seasons of Connecticut. “That’s my goal,” Ms. Condon said. “But what pulls on my heart is the people here, the connections I made at a time of desperation.”
Denial Makes the World Go Round
Benedict Carey, New York Times- 11/20/2007
For years she hid the credit card bills from her husband: The $2,500 embroidered coat from Neiman Marcus. The $900 beaded scarf from Blake in Chicago. A $600 pair of Dries van Noten boots. All beautiful items, and all perfectly affordable if she had been a hedge fund manager or a Google executive. Friends at first dropped hints to go easy or rechannel her creative instincts. Her mother grew concerned enough to ask pointed questions. But sales clerks kept calling with early tips on the coming season’s fashions, and the seasons kept changing. “It got so bad I would sit up suddenly at night and wonder if I was going to slip up and this whole thing would explode,” said the secretive shopper, Katharine Farrington, 46, a freelance film writer living in Washington, who is now free of debt. “I don’t know how I could have been in denial about it for so long. I guess I was optimistic I could pay, and that I wasn’t hurting anyone. “Well, of course that wasn’t true.”
Everyone is in denial about something; just try denying it and watch friends make a list. For Freud, denial was a defense against external realities that threaten the ego, and many psychologists today would argue that it can be a protective defense in the face of unbearable news, like a cancer diagnosis.
In the modern vernacular, to say someone is “in denial” is to deliver a savage combination punch: one shot to the belly for the cheating or drinking or bad behavior, and another slap to the head for the cowardly self-deception of pretending it’s not a problem. Yet recent studies from fields as diverse as psychology and anthropology suggest that the ability to look the other way, while potentially destructive, is also critically important to forming and nourishing close relationships. The psychological tricks that people use to ignore a festering problem in their own households are the same ones that they need to live with everyday human dishonesty and betrayal, their own and others’. And it is these highly evolved abilities, research suggests, that provide the foundation for that most disarming of all human invitations, forgiveness.
In this emerging view, social scientists see denial on a broader spectrum — from benign inattention to passive acknowledgment to full-blown, willful blindness — on the part of couples, social groups and organizations, as well as individuals. Seeing denial in this way, some scientists argue, helps clarify when it is wise to manage a difficult person or personal situation, and when it threatens to become a kind of infectious silent trance that can make hypocrites of otherwise forthright people.
“The closer you look, the more clearly you see that denial is part of the uneasy bargain we strike to be social creatures,” said Michael McCullough, a psychologist at the University of Miami and the author of the coming book “Beyond Revenge: The Evolution of the Forgiveness Instinct.” “We really do want to be moral people, but the fact is that we cut corners to get individual advantage, and we rely on the room that denial gives us to get by, to wiggle out of speeding tickets, and to forgive others for doing the same.”
The capacity for denial appears to have evolved in part to offset early humans’ hypersensitivity to violations of trust. In small kin groups, identifying liars and two-faced cheats was a matter of survival. A few bad rumors could mean a loss of status or even expulsion from the group, a death sentence.
In a series of recent studies, a team of researchers led by Peter H. Kim of the University of Southern California and Donald L. Ferrin of the University of Buffalo, now at Singapore Management University, had groups of business students rate the trustworthiness of a job applicant after learning that the person had committed an infraction at a previous job. Participants watched a film of a job interview in which the applicant was confronted with the problem and either denied or apologized for it.
If the infraction was described as a mistake and the applicant apologized, viewers gave him the benefit of the doubt and said they would trust him with job responsibilities. But if the infraction was described as fraud and the person apologized, viewers’ trust evaporated — and even having evidence that he had been cleared of misconduct did not entirely restore that trust. “We concluded there is this skewed incentive system,” Dr. Kim said. “If you are guilty of an integrity-based violation and you apologize, that hurts you more than if you are dishonest and deny it.”
The system is skewed precisely because the people we rely on and value are imperfect, like everyone else, and not nearly as moral or trustworthy as they expect others to be. If evidence of this weren’t abundant enough in everyday life, it came through sharply in a recent study led by Dan Ariely, a behavioral economist at the Massachusetts Institute of Technology.
Dr. Ariely and two colleagues, Nina Mazar and On Amir, had 326 students take a multiple-choice general knowledge test, promising them payment for every correct answer. The students were instructed to transfer their answers, for the official tally, onto a form with color-in bubbles for each numbered question. But some of the students had the opportunity to cheat: they received bubble sheets with the correct answers seemingly inadvertently shaded in gray. Compared with the others, they changed about 20 percent of their answers, and a follow-up study demonstrated that they were unaware of the magnitude of their dishonesty.“What we concluded is that good people can be dishonest up to the level where conscience kicks in,” said Dr. Ariely, author of the book “Predictably Irrational: The Hidden Force that Shape Our Decisions,” due out next year. “That essentially you can fool the conscience a little bit and make small transgressions without waking it up. It all goes under the radar because you are not paying that much attention.”
It is a mistake to underestimate the power of simple attention. People can be acutely aware of what they pay attention to and remarkably blind to what they do not, psychologists have found. In real life, to be sure, casual denials of bad behavior require more than simple mental gymnastics, but inattention is a basic first ingredient. The second ingredient, or second level, is passive acknowledgment, when infractions are too persistent to go unnoticed. People have adapted a multitude of ways to handle such problems indirectly. A raised eyebrow, a half smile or a nod can signal both “I saw that” and “I’ll let this one pass.” The acknowledgment is passive for good reasons: an open confrontation, with a loved one or oneself, risks a major rupture or life change that could be more dire than the offense. And more often than is assumed, a subtle gesture can be enough of a warning to trigger a change in behavior, even one’s own.
In an effort to calculate exactly how often people overlook or punish infractions within their peer groups, a team of anthropologists from New Mexico and Vancouver ran a simulation of a game to measure levels of cooperation. In this one-on-one game, players decide whether to contribute to a shared investment pool, and they can cut off their partner if they believe that player’s contributions are too meager. The researchers found that once players had an established relationship of trust based on many interactions — once, in effect, the two joined the same clique — they were willing to overlook four or five selfish violations in a row without cutting a friend off. They cut strangers off after a single violation.
Using a computer program, the anthropologists ran out the simulation over many generations, in effect speeding up the tape of evolution for this society of players. And the rate of overlooking trust violations held up; that is, this pattern of forgiving behavior defined stable groups that maximized the survival and evolutionary fitness of the individuals. “There are lots of way to think about this,” said the lead author, Daniel J. Hruschka of the Santa Fe Institute, a research group that focuses on complex systems. “One is that you’re moving and you really need help, but your friend doesn’t return your call. Well, maybe he’s out of town, and it’s not a defection at all. The ability to overlook or forgive is a way to overcome these vicissitudes of everyday life.”
Nowhere do people use denial skills to greater effect than with a spouse or partner. In a series of studies, Sandra Murray of the University of Buffalo and John Holmes of the University of Waterloo in Ontario have shown that people often idealize their partners, overestimating their strengths and playing down their flaws. This typically involves a blend of denial and touch-up work — seeing jealousy as passion, for instance, or stubbornness as a strong sense of right and wrong. But the studies have found that partners who idealize each other in this way are more likely to stay together and to report being satisfied in the relationship than those who do not. “The evidence suggests that if you see the other person in this idealized way, and treat them accordingly, they begin to see themselves that way, too,” Dr. Murray said. “It draws out these more positive behaviors.”
Faced with the high odor of real perfidy, people unwilling to risk a break skew their perception of reality much more purposefully. One common way to do this is to recast clear moral breaches as foul-ups, stumbles or lapses in competence — because those are more tolerable, said Dr. Kim, of U.S.C. In effect, Dr. Kim said, people “reframe the ethical violation as a competence violation.” She wasn’t cheating on him — she strayed. He didn’t hide the losses in the subprime mortgage unit for years — he miscalculated.
This active recasting of events, built on the same smaller-bore psychological tools of inattention and passive acknowledgment, is the point at which relationship repair can begin to shade into willful self-deception of the kind that takes on a life of its own. Everyone knows what this looks like: You can’t talk about the affair, and you can’t talk about not talking about it. Soon, you can’t talk about any subject that’s remotely related to it.
And the unstated social expectations out in the world often reinforce the conspiracy, no matter its source, said Eviatar Zerubavel, a sociologist at Rutgers and the author of “The Elephant in the Room: Silence and Denial in Everyday Life.” “Tact, decorum, politeness, taboo — they all limit what can be said in social domains,” he said. “I have never seen tact and taboo discussed in the same context, but one is just a hard version of the other, and it’s not clear where people draw the line between their private concerns and these social limits.”
In short, social mores often work to shrink the space in which a conspiracy of silence can be broken: not at work, not out here in public, not around the dinner table, not here. It takes an outside crisis to break the denial, and no one needs a psychological study to know how that ends. In Ms. Farrington’s case, the event was a move out of the country for her husband’s job. Unable to earn much money from her own work, she kept buying but had no way to cover the credit card payments. “Basically,” she said, “I had to fess up. It was terrible, but I fessed up to my husband, I fessed up to my mother and to another friend who was getting the bills while I was away. This whole web of intrigue, and in the end it just had to crash.” She now hunts for better bargains on eBay.
Addiction: Lowering Nicotine Levels May Help Cut Smoking
Eric Nagourney, New York Times- 11/20/2007
Smokers who were given nicotine-reduced cigarettes for five weeks and then allowed to return to their regular brands ended up smoking less, according to the authors of a small study. The study suggested that if the government required tobacco companies to lower the nicotine levels in cigarettes, more people might be able to quit and fewer might become addicted in the first place. The companies already make cigarettes marketed as low tar and low nicotine. But they do so, the researchers say, not by lowering the amount of nicotine but by engineering the cigarette so that, in theory at least, less nicotine and tar is inhaled.
“Because there is plenty of nicotine available in the tobacco of commercial low-yield cigarettes, it is easy for the smoker to alter puff rate and/or smoking intensity,” says the study, in the November issue of Cancer Epidemiology, Biomarkers and Prevention. The study was led by Dr. Neal L. Benowitz of the University of California, San Francisco.
By contrast, the cigarettes used in the study contained less nicotine. Twenty volunteers were given the cigarettes for four weeks, with the amount of nicotine in them dropping each week. Then the volunteers were told they could return to their own brands. The researchers were mostly interested in seeing whether the smokers compensated for the reduced nicotine by smoking more or changing their style of smoking. They found that unlike with commercial low-yield cigarettes, this was not the case.
'I Had To Go To The Casino'
Christine Dempsey, Hartford Courant- 11/20/2007
MANCHESTER — - Charlene Darby's voice broke as she talked about her gambling addiction in a mostly empty courtroom Monday, a room lacking the family members who usually shed a tear for the relative being sent to prison. The 59-year-old stole at least $45,000 last year from an East Hartford Dunkin' Donuts shop — the store says it was $60,000 — to pay for her frequent casino visits and purchases of instant lottery scratch tickets. "I just could not stop myself," Darby said in Superior Court in Manchester. "When I took the money the first time, nobody noticed. It seemed so easy. ... It was like a drug. I was addicted. I had to go to the casino."
Judge Eliot Prescott sentenced Darby, of Manchester, to one year in prison, although he noted she is likely to be paroled in the "very near future" because she has served more than half of her sentence in pre-trial detention. Darby, who was unable to raise bail, pleaded guilty to first-degree larceny Aug. 15; she was arrested March 12. Charges of third-degree forgery were not prosecuted. Her full sentence is 10 years, suspended after one year, followed by three years of probation. Under a plea deal, Prescott could have sentenced her to as much as five years.
Prescott said Darby seems to have low self-esteem, perhaps because of a difficult childhood and a lack of supportive family members.
Earlier, Cynthia Barlow, her public defender, told the judge that Darby was abused as a teenager and tried to kill herself. Barlow also said Darby, who is white, was disowned by her family when she married an African American man. Still, at York Correctional Institution, where she has a job chopping vegetables, "she's kind of been adopted" by younger female inmates as a mother figure, Barlow said.
Prescott said he was torn between punishing Darby for a serious crime and saving her prison bed "for people who present a real danger to society." Another factor in his decision was a pre-sentencing investigation that showed she didn't fully cooperate with probation officials attempting to document her background. That information helps the judge decide what a convicted person's sentence should be. Darby explained to the judge: "I've been incarcerated since March. I just gave up. I told them, 'Do whatever you want.' "
Prescott said he is concerned she may give up again and fail to carry out her vow to repay her former employer once she's released from prison. But probation officials will be watching, he said. He ordered her to pay back the $45,000 at a rate she can handle financially. She also plans to attend Gamblers Anonymous meetings, Barlow said.
According to police, Darby pocketed 27 deposits between May 1 and Nov. 8 of 2006 for a total of $45,084.71. The amounts she stole ranged from $799.17 to $2,338.62. She got away with it for seven months because she was a trusted employee of six years and because she handed in to the store's accountant false deposit statements. Darby gave the store's owner accurate deposit slips, but the two hadn't been comparing deposit information, the warrant says, and the accountant was too busy to compare his deposit logs to the bank statements.
Many Treatments Can Ease Chronic Pain
Jane Brody, New York Times- 11/20/2007
There is one undeniable fact about chronic pain: More often than not, it is untreated or undertreated. In a survey last year by the American Pain Society, only 55 percent of all patients with noncancer-related pain and fewer than 40 percent with severe pain said their pain was under control. But it does not have to be this way. There are myriad treatments — drugs, devices and alternative techniques — that can greatly ease persistent pain, if not eliminate it.
Chronic pain is second only to respiratory infections as a reason patients seek medical care. Yet because physicians often do not take a patient’s pain seriously or treat it adequately, nearly half of chronic-pain patients have changed doctors at least once, and more than a quarter have changed doctors at least three times.
In an ideal world, every such patient would be treated by a pain specialist familiar with the techniques for alleviating pain. But “very few patients with chronic disabling pain have access to a pain specialist,” a team of experts wrote in a supplement to Practical Pain Management in September. As a result, most patients have to rely on primary care physicians for pain treatment, obliging them to learn as much as they can about treatment approaches and to persist in their search for relief.
Medications
Most chronic pain patients end up taking a cocktail of pills that complement one another. These are three categories of drugs useful for treating chronic pain:
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If the pain is not severe, nonsteroidal anti-inflammatory drugs, Nsaids for short, are often tried first. Some, like ibuprofen and naproxen, are sold over the counter. Others, like diclofenac (Voltaren) and celecoxib (Celebrex), are available by prescription. All have risks, especially to the heart and gastrointestinal tract, and may be inappropriate for those prone to a heart attack, stroke or ulcers. Nsaids must not be combined with one another or any aspirinlike drug, but they can be used safely with acetaminophen (Tylenol).
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Several classes of drugs originally marketed for other uses are now part of the pain control armamentarium — antidepressants, especially the S.N.R.I.’s like venlafaxine (Effexor) and duloxetine (Cymbalta); antiepileptics like gabapentin (Neurontin) and pregabalin (Lyrica); and muscle relaxants like baclofen (Lioresal) and dantrolene sodium (Dantrium). These are often used in combination with specific pain-relieving drugs.
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By far the most important class of drugs for moderate to severe chronic pain are the opioids: morphine and morphinelike drugs. Patients often reject them for fear of becoming addicted, a rare event when they are used to treat pain. Doctors often avoid prescribing them for fear of addicting patients, being duped by drug abusers or being raided by the Justice Department. Pain societies have established clear-cut guidelines to help doctors avoid such risks, including ways to identify patients who could become addicted.
Many patients and physicians do not know the difference between physical dependence on a drug (withdrawal symptoms result if the drug is abruptly stopped) and addiction (loss of control over drug use, cravings and continued use despite harm). As with other medications, like steroids and antidepressants, patients have to be gradually weaned from opioids to avoid withdrawal symptoms.
For patients with chronic, continuous pain, using a slowly released opioid like oxycodone (Oxycontin), morphine or fentanyl (administered through a skin patch or lozenge on a stick) is preferred. These drugs minimize or eliminate the hills and valleys of pain and reduce the medication patients need. The usual side effects — sedation, nausea, confusion — soon disappear except for constipation, which can be treated. Pain specialists also recommend that patients taking slow-release opioids have on hand a fast-acting one like Percocet (oxycodone with acetaminophen) to treat breakthrough pain.
Methadone, a synthetic opioid, is another option for managing chronic pain, especially neuropathic pain, but it has to be taken several times a day. It is metabolized in the liver, along with other drugs that can affect blood levels of methadone.
Other Remedies
Some patients in chronic pain use a technique called TENS, for transcutaneous electrical nerve stimulation, in which pulses of low-intensity electric current are applied to the skin. The theory is that the pulses transmit signals to the brain that compete with the pain signals. Unlike drugs, TENS has no side effects or interaction with drugs, and it can be used at home.
Acupuncture, another increasingly popular treatment for persistent as well as intermittent pain, is thought to work by increasing the release of endorphins, chemicals that block pain signals from reaching the brain. It may be effective in relieving headaches, facial and low back pain, and pain caused by shingles, arthritis and spastic colon.
Guided imagery, meditation, relaxation therapy and hypnosis or hypnotherapy are often useful adjuncts to pain treatment, because they can reduce stress and take one’s mind off the pain. Likewise, cognitive behavioral (“talk”) therapy can help patients think and behave differently with respect to their pain. Other options include massage and hydrotherapy, the use of hot or cold water to reduce inflammation and promote healing.
Many chronic pain patients can benefit from physical therapy and exercises to strengthen weak supporting muscles and relax tight joints (which for the last two years has helped me control sciatic pain), or occupational therapy to learn new ways of moving, sitting and lying down to reduce irritation of or dependence on painful body parts.
Finally, a mental adjustment may be necessary to improve the quality of life of chronic pain patients, who have to accept that they may always have some degree of pain. Chronic pain tends not to go away, and changes may have to be made both at work and at play. The goals should be to reduce pain to an acceptable level and to learn how not to make it worse.
For Further Information
AMERICAN CHRONIC PAIN ASSOCIATION E-mail: ACPA@pacbell.net; Web site: www.theacpa.org. P.O. Box 850, Rocklin, Calif., 95677-0850; (916) 632-0922 or (800) 533-3231.
AMERICAN PAIN FOUNDATION info@painfoundation.org; www.painfoundation.org. 201 North Charles Street, Suite 710, Baltimore, Md., 21201-4111; (888) 615-7246.
NATIONAL FOUNDATION FOR THE TREATMENT OF PAIN Pain@cwo.com; www.paincare.org. P.O. Box 70045, Houston, Tex., 77270; (713) 862-9332.
American Therapists Cool To Video Game Use
Alix Boyle, Hartford Courant- 11/22/2007
The use of video games to treat anxiety has been approved in Great Britain, but experts here warn that while they may help certain specific phobias or mild depression, a video game is no substitute for a therapist. In Great Britain, the game "FearFighter" was given the seal of approval to treat panic attacks, mild depression and phobias by a group of mental-health professionals.
The game had proved effective in small-scale studies, and it was endorsed partly because about 90 percent of people with mild depression never see a therapist, and patients routinely wait six months or more for mental-health services in Britain's National Health Service. "It could be helpful for people who have agoraphobia or social phobia who wouldn't otherwise be able to get out of the house to get treatment," said Dr. Karen Steinberg, a clinical psychologist and assistant professor of psychiatry at the University of Connecticut.
Research shows that the therapeutic alliance, the relationship between the doctor and patient, is an active ingredient in therapy, often adding to the effectiveness of the treatment. "By using a game instead of a therapist, you're saying the relationship doesn't matter," Steinberg said. "A computer could ask these same questions, such as when does the person have symptoms of anxiety and how long it's been going on, but the therapist's expressions of warmth and positive regard, those are things that are hard for a computer to do."
"FearFighter" is based on some of the principles in cognitive behavior therapy, Steinberg said. Patients are asked by the computer program to identify the situations that set off their panic attacks, for example, and then given instructions on how to cope with their fears. A person can learn to do these things without a therapist, Steinberg said.
After the patient answers questions rating the severity of their fears and how well they adjust to their situation at work and in social settings, the computer presents scenarios so that patients can face their fears long enough to get used to them. This is known as exposure therapy. But what about missing more serious mental illness or even suicide? Only a live human can assess those risks, Steinberg said.
Although he has not seen "FearFighter" specifically, Dr. David Tolin, an anxiety expert at Hartford's Institute for Living, sees promise in using computer games to treat phobias. Say, for example, the patient is afraid of flying on an airplane. "Flying on a real airplane can get awfully expensive, and you can't get off the plane if you become anxious in the middle of the flight, but we can use virtual reality technology to facilitate exposure to flying on an airplane, seeing the sights and hearing sounds in a much more feasible manner," Tolin said. "The patient faces their fears in a controlled manner, when those fears are not easy to face in real life."
In Tolin's office, some patients are treated with virtual reality games in which they are seated in a chair and given goggles to wear. Within the goggles are small screens with images that re-create various frightening scenarios, including airplane travel.
Chicago psychiatrist Dr. Alexander Obolosky said that in places like Britain a computer program might make sense for mild depression or specific anxieties. "But if you have a person with a more serious anxiety disorder, using a game will waste precious time in doing things that are not helpful," said Obolosky, who is also an assistant professor of psychiatry at Northwestern University medical school. "If patients are not evaluated appropriately they can even commit suicide. It can compound the problem."
Obolosky would like to see video games prescribed after an evaluation by a psychiatrist to rule out more serious issues such as bipolar disorder. He further points out that using a video game instead of interpersonal therapy could be enabling patients to avoid their problems altogether. "People who are suffering from mental illness are very embarrassed. It is a stigma," Obolosky said. "We are only playing into it because they don't want to see a real person and establish a real relationship. We're telling them, 'It's not that bad, go play on the computer.'"
Although video games may play a continuing role in mental health treatment, more study is needed, experts say. For a lot of patients with no health insurance or who live in a remote location, it may be useful to consider an alternative. Any therapy may be better than no therapy. "Computer-assisted therapy can help many people with anxiety-related disorders, but that's not to say it's as good as you can get with a therapist," said Tolin. "Ultimately, we are going to need research on how receiving treatment from a computer compares to receiving treatment from a therapist."
Europe Fears That Meth Foothold Is Expanding
Nicholas Kulish, New York Times- 11/23/2007
JESENIK, Czech Republic — The methamphetamine epidemic is not just a scourge of the American heartland. It has a powerful foothold here in the heart of Central Europe. Home meth labs are sprouting up all over the country to produce this cheap, potent drug using the pseudoephedrine found in common cold medications.
In 2000, the Czech police raided 19 cooking facilities. By last year that number had grown to 416 — in a country of just 10.2 million people.
The appetite for methamphetamine in the Czech drug scene grew out of the strange ingenuity fostered among users once cut off by the Iron Curtain from imported highs. Now the consumption of this strongly addictive, often injected stimulant appears to be spreading from the Czech Republic to the rest of Europe.
Whether it is carried by the flow of Czech workers migrating within the European Union or simply is gaining appeal as a half-price alternative to cocaine is unclear. But the number of countries in Europe reporting seizures of methamphetamine more than doubled between 2000 and 2005, to 25 from 11, according to the United Nations Office on Drugs and Crime.
Use of methamphetamine remains for now far behind heroin and the Continent’s swiftly growing cocaine habit. Though the quantity seized rose fourfold over the same period to 300 pounds, that is a small amount compared with the 11,300 pounds seized in the United States. But the concern is that the European growth lays the groundwork — in demand, production and distribution — that could lead to an explosion in use.
The sudden growth of the drug in the United States and its expansion from a regional issue to a national one serves as a warning, said an expert at the United Nations drug office. “It must be feared that something similar could happen in Europe,” said the expert, Thomas Pietschmann, a main author of the annual United Nations World Drug Report.
Czech legislators and law enforcement officials are trying to crack down on the local, small-time producers who, according to police officials, are preparing enough methamphetamine for the entire Czech market. But the experience in the United States has shown that once the demand is clear, it can be filled by the tidal flows of the global drug market. Though the United States has made significant headway in the fight against small meth producers with tighter restrictions on the sales of the medications used in its production, enormous labs in Mexico and Asia continue to supply American users.
The challenge is “to stop the methamphetamine market while it’s in its infancy,” Mr. Pietschmann said. “Once it’s established it’s really far more difficult.” Mr. Pietschmann said that in addition to the Czech Republic’s exporting the drug to neighboring countries, the Baltic states were producing it for northern countries, including Sweden and Finland; he has even heard about two labs discovered in Vienna, where his office is based. “It’s dangerous because it’s so easy to produce,” Mr. Pietschmann said.
A meth cook in the tiny Czech town of Jesenik, not far from the Polish border, said he once sent several batches of the drug — known locally by an old trade name, Pervitin — to friends in England who went there for work. “They wanted to escape from Jesenik, to escape Pervitin, but when they got there they asked me to send it,” said the cook, who covered his face and refused to give his name out of fear of prosecution.
In his crude laboratory, the world outside was cut off with makeshift blackout curtains, old rugs and worn blankets hung over windows. The cook tended with painstaking care to the bubbling red stew that he said would yield more than an ounce of homemade methamphetamine. Though that batch alone — which could produce hundreds of doses — would be worth, based on average street prices, around $1,800, he was so short on cash he could not even make calls on his prepaid cellphone because it was out of credits. He said that he did not sell his output, but used it or shared with friends.
The national police here say that such tight circles of users are the norm, and the decentralization is part of the difficulty in shutting down operations. “If one of them is seized, three mushroom up somewhere else,” said Bretislav Brejcha, head of the methodology and prevention group at the national drug headquarters for the police.
In the decades when what was then Czechoslovakia was under Communist rule, addicts largely had to produce their own highs by concentrating medications. These drugs were produced by small, tight-knit rings of users, known as squads, for their own consumption rather than for distribution and sale. Meth came on the scene here in the early 1970s, and it and other drugs boomed with the end of Communism and opening of the country in 1989.
Of the roughly 30,000 “problem drug users” identified by the Czech government, 20,000 use Pervitin — Pervitin was the trade name of the drug when the Nazi military gave it to its soldiers and pilots to counter fatigue. Among problem users, 90 percent are injecting the drug with needles — known in the United States as slamming — rather than snorting or smoking it. More than a third of intravenous drug users in the Czech Republic have hepatitis C, although their H.I.V. infection rate remains contained, below 1 percent.
According to the United Nations drug office, the Czech Republic has high levels of cannabis use, the highest for ecstasy, and “by far” the worst methamphetamine abuse in Europe. That may have been encouraged by the accessibility of the main ingredient. The town of Roztoky, just outside of Prague, had one of the world’s largest ephedrine factories until 2002. According to the Czech police, that was the year the factory began to shut down its production of the chemical. Not coincidentally, they say, it was the first year the number of seized labs really jumped, nearly quadrupling from 28 the previous year to 104. The police said that up to that point, larger, more organized rings were getting ephedrine from the factory and producing the drug in quantity for street sales. Now, the production system has reverted to the squads of the Communist days and is reaching smaller, out-of-the-way places.
The Parliament is working on legislation to give pharmacists discretion over the quantity of cold medication containing pseudoephedrine (used to produce the drug when pure ephedrine is not available) that any individual customer can buy. Others say a national registry listing all sales of precursor drugs should be mandatory. “A solution where a pharmacy will be deciding without a national registry is not going to solve the problem,” Mr. Brejcha said. The meth cook in Jesenik agreed with that point. “There will be pharmacists who consider 100 boxes a proper amount,” said the man, who admitted to using the drug for over a decade but to cooking it for only two and a half years.
A short distance from the Polish border, Jesenik is among the most isolated corners in the entire Czech Republic. There are no highways, and even a small November snowfall in the mountains makes switchbacks on the sharply curving roads dangerous. Unlike many small rural communities, the inhabitants do not have deep roots here. Ethnic Germans, once the main population, were expelled after World War II. The industries from the Communist period largely disappeared after the Velvet Revolution toppled that government. “Young and educated people are away,” said Jiri Stana, the deputy mayor. “There is no work for them. Who is clever enough is in Prague.”
The local government keeps no statistics on the number of methamphetamine users, but the head of a small, overstretched drug clinic near the bus station in this town of 12,500 said employees had given out over 17,000 clean needles in just the first 10 months of the year. “In bigger towns, the situation is really anonymous,” said the clinic’s director, Josef Vondrka, 31, who is himself a former user. “Here it’s much more personal. To go to a pharmacy and ask for syringes immediately ends anonymity.”
In his black hoodie and large black boots he would not look out of place at a hard-core punk show. But the boots, he said, were protection for when he stepped on used needles. At the center, clients can shower, wash their clothes, have a cup of coffee and receive counseling. The center also provides H.I.V. tests.
Lenka, a 23-year-old user who refused to give her last name, said that on a recent morning she knocked on the doors of five neighbors — all of whom use meth — and could not find anyone who could give her a clean needle. “Many people don’t start snorting like they used to,” she said. “Many people start with needles.” Though she has been using for six years, Lenka said she refused to cook the drug herself. “If you start it can get really dangerous,” she said, “because you never stop.” The local meth cook agreed. “When people ask me to show them how to do it, I tell everyone, ‘I will not show you,’” said the man, as he added more iodine into his batch. “Don’t do it. When you learn to cook then you will die.” “I think I will die because of this,” he said, keeping watch on the thermometer buried in the thick red mixture.
Suit Over a Woman’s Suicide at an Elite Private Hospital
Alison Leigh Cowan, New York Times- 11/23/2007
NEW CANAAN, Conn.—Silver Hill Hospital was familiar to Ruth A. Farrell as a place of refuge, one she had sought more than a dozen times when life seemed too hard to bear. Only this time, Ms. Farrell, a 41-year-old librarian from Westport with few relatives or close friends, never made it home safely. What the hospital papers delicately describe as her last “discharge date,” Jan. 28, 2002, was the day she left the hospital in a body bag.
Depressed and addicted to painkillers, Ms. Farrell had checked herself into the acute-care ward at Silver Hill the previous week. Records show she told the staff she was feeling better the day she died and even asked the dietitian for less garlic in her orzo, showing that she was looking ahead. But by nightfall, Ms. Farrell had made other plans. The orderly who had been checking on her every 15 minutes found her suspended from a bathroom door, eight feet from the nurses’ station. Black Spandex pants were tied around her neck. A suicide note was in the trash.
Now Silver Hill — a 76-year-old nonprofit hospital specializing in psychiatric disorders and substance abuse — is being sued by the executor of Ms. Farrell’s estate, himself a former patient with whom she maintained a close relationship despite warnings by her doctor that she should stay away from him. The suit accuses the hospital and a psychiatrist there, Dr. Ellyn Shander, of wrongful death by failing to protect a troubled woman from herself.
The complaint, and other episodes recounted in lawsuits and police reports over the last decade, are peeling back the veil on life inside one of the country’s more prominent psychiatric institutions and raising questions about how far a psychiatric hospital has to go to ensure its patients’ safety.
Tucked away on 45 acres that include tennis courts and walking trails, Silver Hill has long had a following among celebrities like Mariah Carey and Billy Joel — along with a well-heeled crowd who find the countrylike setting a welcome place to regain control of their overstressed lives. Originally known as the Silver Hill Inn in the days when patients dressed for dinner, the institution has typically attracted those with Champagne tastes — or at a minimum, good insurance. Costs are usually more than $1,000 a day, and patients are often expected to put up hefty deposits. “Charity care,” or what the hospital volunteers in services, is well under 1 percent of revenue in most years, according to annual reports.
Citing patient confidentiality, a hospital spokeswoman declined to comment on the suicide or any other aspect of the hospital’s operations or history. A lawyer for the company, Catherine S. Nietzel, went only slightly further. “As unfortunate as this is, and it’s tragic, it’s horrible, sometimes these awful things happen despite our best efforts to do everything right,” Ms. Nietzel said. “It’s with great regret that Silver Hill is aware that sometimes bad things happen to its patients, despite its best efforts.”
But Victoria de Toledo, a Stamford lawyer who has twice sued the hospital, saw the situation differently. Speaking generally, she said, “It’s heartbreaking when someone goes in because they need help at a place like Silver Hill, and they come out worse than when they went in.” In one case, Ms. de Toledo represented a patient who settled a civil case after accusing a hospital employee with a long criminal record of sexually assaulting her while she slept. And in a case settled for an undisclosed amount in August, she was the lawyer for a man who had his ear partly bitten off by another patient in 2003.
Silver Hill is aggressively fighting the suit filed by Ms. Farrell’s estate in Stamford Superior Court, which is scheduled to go to trial next week. Turning the tables, lawyers for the hospital and Dr. Shander have countersued the executor of Ms. Farrell’s estate, David L. Kervick, charging him with contributing to her death. Mr. Kervick, who is 60, met Ms. Farrell in early 2001 when they were both patients at Silver Hill. Months later, Ms. Farrell named Mr. Kervick, a New Jersey lawyer whose license has been suspended twice because of problems related to substance abuse, her executor. She also directed that Mr. Kervick inherit half her estate — recently valued at about $500,000 — giving the other half to her church in Ridgefield, where she lived. Besides questioning Mr. Kervick’s motives, lawyers for the hospital and the psychiatrist contend that Mr. Kervick knew, or should have known, that Ms. Farrell was suicidal, and that he treated her abusively and undermined her psychiatric care. “Yes, she tried to commit suicide numerous times,” Nancy Monaco, a lawyer for Dr. Shander, said at a hearing this June. “And they stopped her every time except this one.” Among the personal effects the police found in her room was a note dated Jan. 28 that began, “Dear David,” referred to a worrisome phone call and drifted into an outburst that said, in part: “I WANT TO DIE, DIE, DIE. I’M ALREADY DEAD.” In depositions, Mr. Kervick has said he had no knowledge of a phone call that might have sent Ms. Farrell over the edge, and that he never asked her to make him either executor of her estate or a beneficiary.
Though Ms. Farrell had little in common with the celebrities who passed through Silver Hill, she was one of the regulars. One of Mr. Kervick’s lawyers, Paul Pacifico, argued that with her 17 previous stays, the hospital should have known that her problems were dire, especially since she had tried to hang herself a few years earlier in the same room. Her emotional problems ran deep. Named after a grandmother who committed suicide, Ruth Anne Marie Farrell began cutting herself while she was at Weston High School, where she graduated in 1978. At Bates College, she continued harming herself and was sent home, spending more than a year at a psychiatric hospital.
Acquaintances who declined to be identified because they did not want to become involved in the suit said her adult life revolved around her work at the Westport Public Library. She also volunteered at a soup kitchen in Westport and baked bread that the First Congregational Church in Ridgefield presented to new residents. But life was difficult for Ms. Farrell. Dale Rosenberger, a former pastor at her church, said she took keen interest in his sermons, but had trouble making eye contact and would sometimes flee if greeted too heartily.
Those who knew her said she carried the psychological scars of a dismal childhood. Depositions given by Mr. Kervick and briefs filed by Dr. Shander’s lawyers refer to years of sexual abuse suffered at the hands of her father, MacLennan Farrell, who died in 1997. An editor at several magazines ranging from The Saturday Evening Post to Gallery, a racy men’s magazine, Mr. Farrell handled such writers as P. G. Wodehouse, and wrote a few book reviews for The New York Times.
Meeting Mr. Kervick initially buoyed Ms. Farrell’s spirits, according to notes she made. They visited each other’s homes and shared holidays. Mr. Kervick testified that they were never intimate, although a recent court ruling referred to him as the “boyfriend.” Notes in the medical files show that Ms. Farrell’s psychiatrist and another therapist fretted about Mr. Kervick’s influence and urged her to drop him. And entries in a journal Ms. Farrell kept describe a miserable Christmas she shared with Mr. Kervick at his home in Westfield, N.J., weeks before she killed herself. She told the hospital’s medical staff how he used drugs in her presence on that occasion and tied her to a bed and forced her to watch pornography. But Mr. Kervick’s lawyer, Mr. Pacifico, dismissed the accusations that were leveled by Ms. Farrell, someone who he said had “personality disorders.” “What she told her therapist does not mean it’s accurate,” he said.
In the months before the trial, lawyers for the hospital and for Dr. Shander fought to obtain Mr. Kervick’s psychiatric records in an effort to shed light on his relationship with Ms. Farrell. Judge Thomas L. Nadeau acknowledged that some records might be relevant, although he displayed concern that the information might be used to smear Mr. Kervick. “What jury would want to give money to the beneficiary of an estate who is then portrayed as a bad guy, even if his bad-guyness didn’t impact her conduct?” he asked.
Neal P. Rogan, a Westport lawyer who once defended a man charged with abetting his wife’s suicide, though not involved in this case, said the judge’s concern was legitimate. “If the jury actually followed the law,” he said, Mr. Kervick would win his case because “even if you might not like the fact that he’s the one in the will, they’re the ones charged with her care.”
Psychiatrists with expertise in suicide say any institution that accepts troubled, high-risk patients will encounter situations that are difficult to control. “The problem is people can receive excellent care in a facility and still manage to commit suicide,” said Dr. Peter M. Marzuk, a professor of psychiatry at Weill Cornell Medical College. “Suicide can occur when a patient may not be watched every minute. But at some point, to transition a patient from the hospital to a community, you have to relax the level of vigilance. So, there’s no foolproof way to prevent suicide, even in the best psychiatric hospitals.” In the case of Ruth Farrell, said her former pastor, Mr. Rosenberger, with all of the emotional burdens she endured, “I had no idea how she lasted as long as she did.”
Freud Is Widely Taught at Universities, Except in the Psychology Department
Patricia Cohen, New York Times- 11/25/2007
Psychoanalysis
and its ideas about the unconscious mind have spread to every nook and cranny of the culture from Salinger to “South Park,” from Fellini to foreign policy. Yet if you want to learn about psychoanalysis at the nation’s top universities, one of the last places to look may be the psychology department.
A new report by the American Psychoanalytic Association has found that while psychoanalysis — or what purports to be psychoanalysis — is alive and well in literature, film, history and just about every other subject in the humanities, psychology departments and textbooks treat it as “desiccated and dead,” a historical artifact instead of “an ongoing movement and a living, evolving process.”
The study, which is to appear in the June 2008 issue of psychiatry’s flagship journal, The American Journal of Psychiatry, is the latest evidence of the field’s existential crisis. For decades now, critics engaged in the Freud Wars have pummeled the good doctor’s theories for being sexist, fraudulent, unscientific, or just plain wrong. In their eyes, psychoanalysis belongs with discarded practices like leeching. But to beleaguered psychoanalysts who have lost ground to other forms of therapy that promise quicker results through cheaper and easier methods, the report underscores pressing questions about the relevance of their field and whether it will survive as a practice.
Given how psychoanalytic ideas have shaped the culture, the issue reverberates far beyond the tiny cluster of psychoanalysts. They worry that the gradual disappearance of psychoanalytic theory from psychology curriculums means that those ideas are bound to be applied incorrectly as new advances are neglected.
These worries led the psychoanalytic association to create a task force to increase undergraduates’ exposure to psychoanalytic ideas as both a theory and therapy. The effort includes this new study, a computer-based analysis of course descriptions at 150 public and private institutions that are highly ranked in U.S. News and World Report’s college survey. It found that of the 1,175 courses that referenced psychoanalysis, more than 86 percent were offered outside psychology departments.
The study has some shortcomings — course descriptions are not comprehensive and there are no comparative surveys from previous years. Still, it roughly maps out where psychoanalytic ideas — which once dominated the field and from which all psychodynamic therapy springs — have found a home. And it is not, for the most part, in psychology departments.
Alice Eagly, the chairwoman of the psychology department at Northwestern University, explained why: Psychoanalysis is “not the mainstream anymore” and so “we give it less weight.” The primary reason it became marginalized, Ms. Eagly, said, is that while most disciplines in psychology began putting greater emphasis on testing the validity of their approaches scientifically, “psychoanalysts haven’t developed the same evidence-based grounding.” As a result, most psychology departments don’t pay as much attention to psychoanalysis. At the same time, wondrous advances, in neuroscience, for instance, have attracted new students and resources, further squeezing out psychoanalysis. Outside the university setting, the refusal of most insurance firms to pay for extended psychoanalytic therapy has limited its reach. Scott Lilienfeld, a professor in the psychology department at Emory University, said, “I don’t think psychoanalysis is going to survive unless there is more of an appreciation for empirical rigor and testing.”
The humanities and social sciences have welcomed psychoanalysis without caveats. But the report complains of the wide gulf between the academic’s and the psychoanalyst’s approach and vocabulary, which has made their respective applications of Freud’s theories virtually unrecognizable to each other.
Scholars in the liberal arts have tended to use Freud as a springboard to examine issues and ideas never dreamt of in his philosophy — like gender studies, post-colonial studies, French postmodernism, Queer theory and so on. “American clinical psychoanalysis, and analysis as represented in academe, are at risk to become two ships that pass in the night,” the report said. As an example, the report points to a course on psychoanalysis and colonialism, two terms most clinically based analysts would never have imagined in a single sentence. “I honestly couldn’t understand what they’re talking about,” said Prudence Gourguechon, the psychoanalytic association’s incoming president, referring to those kinds of courses.
To Mr. Lilienfeld, much of postmodern theorizing has harmed psychoanalysis, saying it has “rendered claims even more fuzzy and more difficult to assess.” But Mark Edmundson, a professor of English at the University of Virginia and the author of “The Death of Sigmund Freud,” said, “Freud to me is a writer comparable to Montaigne and Samuel Johnson and Schopenhauer and Nietzsche, writers who take on the really big questions of love, justice, good government and death.” Scholars in the humanities, he said, use Freud “skeptically and provisionally and don’t think of him as scientist at all, but as an interpreter.”
Neither the split between the humanities and science, nor the warnings of the demise of psychoanalysis are as serious as they are often made out to be, said Jonathan Lear, a trained psychoanalyst and a philosopher who works on integrating the two fields at the University of Chicago. Wanting to measure the effectiveness of psychoanalysis is natural, he said, but figuring out how to do so is not simple. “Some of the most important things in human life are just not measurable,” he said, like happiness or genuine religious feeling. Freud, though, is particularly useful for gaining insights into questions of human existence. “There will be the discovery of problems that the standard ways don’t address,” he said, and then “there will be a swing back to Freud.”
Talk of Suicide Tough, But Vital to Hear
Susan Berger, Chicago Tribune- 11/26/2007
It's Ken Meyers' second presentation of the morning, on a mission born of unspeakable tragedy. The 15-year-olds, about 80 of them, file in the room at Glenbrook South High School, talking and laughing. Meyers warns the students they may feel uncomfortable. They may even want to leave the room.
He reaches for the enlarged photo perched on an easel. She is beautiful, this young girl. She is on a beach, the sun hitting her. She is smiling. He tells the group her name is Elyssa. He asks them to think of her as their best friend.
The students quickly learn that on the morning of Feb. 11, 2004, Elyssa Meyers, a 16-year-old sophomore at New Trier High School, hanged herself in her Northfield home. They learn too that she had suffered from depression.
After Elyssa's death, her uncle and mother, Ken and Joanne Meyers, began volunteering at Links-North Shore Youth Health Service, telling their story to others. But they broke away in June 2006 to form Elyssa's Mission with close family friends. The private, non-profit organization set out to teach teens about the warning signs of depression and suicide.
Now, their brutally honest message has earned a spot on the curriculum of several middle and high schools on the North Shore. And with the latest statistics verifying a disturbing increase in suicide among teenage girls, experts said, the program is sorely needed.
A study released in September by the federal Centers for Disease Control and Prevention showed that after a steady decline for 14 years, the suicide rate rose 8 percent for girls and young women ages 10 to 24 from 2003 to 2004. Among girls 10 to 14, the rate increased 75.9 percent.
"The increase is a great concern for us," said Keri Lubell, behavioral scientist in the CDC's injury center. "Especially because...there are several groups, like [10-to 14-year-old girls], where the rate increased much more markedly."
The study also found a 32 percent increase in suicide among girls 15 to 19 and a 9 percent increase in boys ages 15 to 19.
"We need to be looking at broad suicide-prevention measures that can help us stop suicidal behavior long before it causes a fatality," Lubell said.
Four months after Elyssa's death, Erika Neuckranz, 14, an 8th grader at Washburne Middle School in Winnetka, committed suicide after a yearlong struggle with depression.
Hearing about that and several other teen suicides on the North Shore reinforced the need to talk openly about depression and suicide and provided the impetus to launch their mission, the Meyerses said.
"Our message is to destigmatize suicide," Joanne Meyers said. "And to let people know that depression can kill."
Turning point
"Erika and Elyssa's death were a turning point in this community," said Tom Golebiewski, head of social work at New Trier High School. "There is a deep stigma attached to mental illness that is still pervasive in our society. The work of Elyssa's Mission and Erika's Lighthouse [a group that also addresses depression issues] has become an active force to courageously, actively address these issues."
Golebiewski said it is important to realize that other psychological issues such as drug and alcohol abuse and self-mutilation often mask depression. Eating issues, harassment and bullying are often warning signs.
Elyssa's Mission instructors have reached about 7,000 students at schools including Glenbrook South, New Trier, Loyola Academy in Wilmette, Deer Path Middle School in Lake Forest, Caruso Middle School in Deerfield and Choir Academy in Chicago.
The group now plans to take its message to parents, with suicide-awareness classes beginning at Glenbrook South in Glenview.
"Our goal now is to establish more of an alliance or relationship with schools, to maximize our impact," Ken Meyers said. "Not just to teach and leave, but to work with the parents, teachers, social workers and health workers."
At Loyola Academy, Elyssa's Mission was presented for its second year. Debra Larrea, guidance counselor, said students pay close attention.
"I am amazed by the number of young junior boys, athletic boys, who come in after and tell me that they are depressed," Larrea said.
Ken Meyers said he clearly remembers a program last year at Niles West High School in Skokie.
"One girl sat through the whole thing holding her girlfriend's hand," Meyers said. "Afterward, the school social worker told me they were holding hands because one of the girls had the same warning signs we were talking about. The counselor said we saved her life."
Just recently, Liz DeSimon, a youth ministry counselor with St. Peter Damian Catholic Church in Bartlett contacted Elyssa's Mission to arrange a communitywide presentation in January. There have been nine teen suicides in the Bartlett-South Elgin area in the last 18 months.
"The kids have come to me and asked what to do, who will be next," DeSimon said. "There is confusion and anxiety. We want the parents to know the warning signs and to help the kids heal."
Ken Meyers has learned a lot since he first started the program. In the beginning, students would ask how Elyssa killed herself.
"I wouldn't tell. I would gloss over it," Meyers said. "Part of it was about me and protecting my family.
"But when you realize the impact you have with others, it gives you the confidence. Now when they ask, I tell them," he said.
One of the Mission teachers is Jeanne Malnati, a clinical social worker. Her daughter was one of Elyssa's best friends. She knew of Elyssa's problems and, in retrospect, wishes she had done more.
In her freshman year of high school, Elyssa was struggling with depression and had spent part of the year at a private school but returned to New Trier.
"I was working at New Trier and walking in the hall and heard this loud, wonderful 'Mrs. Malnati! I'm baaaack!' And it was like this new kid with a new beginning. I was so happy for her.
"But the next time I saw her, she was slumped in the fetal position in a chair in the social worker's office. That was the last time I saw Elyssa," she said.
Victim of bullying
Malnati, like the other Mission teachers, doesn't mince words. Elyssa had been the subject of bullying at New Trier. One student came to see Malnati, sobbing. He had been paid $10 to tell Elyssa that everyone hated her.
"The bullying stories about Elyssa are heartbreaking," she said. "But telling the stories to the kids -- they get it."
The mission's Web site is http://www.elyssasmission.org . The Centers for Disease Control's Injury Center also recommends a national suicide-prevention lifeline that links to local crisis centers as well as other resources at 800-273-TALK.
For Mentally Ill Young Adults, a Safe Haven
Martha Groves, Los Angeles Times- 11/26/2007
It's not at all typical for a 27-year-old man to enlist Buster the Bunny and Peter the Penguin to facilitate conversations with his mother. But Jan Kyas can tell his plush go-betweens things he finds it hard to say directly to people. His mother, Jirina Kyas, has embraced this communion; she talks to them as well when speaking right to her son doesn't work.
A former high school percussionist and Santa Monica College graduate, the young man learned as an adult that he suffers from Asperger's syndrome, a form of autism characterized by difficulties with social and communication skills, and the often attendant depression and anxiety. He carries the stuffed animals in his backpack.
Kyas has no qualms about trotting out his inanimate menagerie when he visits Daniel's Place, a Santa Monica support center for mentally ill young adults and their families. Other participants don't bat an eye in the center's group room, the walls of which are plastered with their original drawings.
After all, these are people who all have their own ways of coping. Sometimes it's growing a dramatically spiked mohawk. Sometimes it's singing the oldies on a karaoke machine. Sometimes, amazingly, it's using humor. Despite enduring frightening psychotic breaks and the vagaries of medication, the participants at Daniel's Place saw fit to dub a furry white mascot "Bipolar Bear."
Founded in 1998, Daniel's Place, on Ocean Park Boulevard near the Santa Monica Airport, is a program of Step Up on Second, a nationally recognized Santa Monica recovery center for individuals middle age or older who have chronic mental illness.
Daniel's Place provides support, education and information about available services to adults 18 to 30 and their families. It also connects families as they struggle with issues related to mental illness, primarily bipolar disorder, major depression and schizophrenic disorders. The program has served hundreds of young adults and has 79 active cases, said Emily James, team leader and program director.
Many of the young people referred to the center are experiencing their first episodes of mental illness. Their families, meanwhile, are suddenly having to grapple with their children's bewildering behavior.
For many of the young adults, Daniel's Place is a home away from home -- or the closest thing to a home that they have. They can play and listen to music, take cooking classes, use a computer and chat.
"Daniel's Place gives young adults a safe place in which to understand the implications of having a mental illness while pursuing recovery, wellness and their goals," said Robin Kay, acting chief deputy director of the Los Angeles County Department of Mental Health.
Daniel's Place was initially funded by Arthur Greenberg, a founding partner of the Los Angeles law firm Greenberg Glusker, and his wife, Audrey. The program is named for their son Daniel, who was born in 1959. He attended Harvard School for Boys, acted, played football and graduated from Princeton.
While in college, Daniel had his first psychotic break. Thanks to treatment and medication, he was able to finish school. He then spent several years at Step Up on Second, first as a client and then as a caseworker and outreach worker.
But Daniel continued to struggle with his illness, and it ultimately led to his suicide in 1997. "He touched the lives of many other people isolated by their illness and got them connected to Step Up," said Tod Lipka, chief executive and president of Step Up on Second.
Susan Dempsay, the retired executive director of Step Up on Second, encouraged the Greenbergs to provide the seed money for a separate program for young people. Her son, Mark Klemperer, 47, had known Daniel Greenberg in elementary school. Klemperer, the son of actor Werner Klemperer and the grandson of composer-conductor Otto Klemperer, suffered a mental break in high school and, Dempsay said, has been homeless many times since. "Daniel's Place was, I have to say, a first in Los Angeles and almost a first in the country," Dempsay said. "People were not paying attention to this young group."
Matt Lord, 28, said he feels that Daniel's Place helped save his life. While at the University of Florida, he started slipping into depression. "When I was awake, I seemed alone even when I was with people," Lord said. "My life was narrated by thoughts that weren't mine."
He drifted in and out of mental hospitals and lived in a rough "board and care" home. Eventually, he was diagnosed with schizoaffective disorder (a condition with characteristics of both schizophrenia and a mood disorder) and bipolar disorder. A county caseworker referred him to Daniel's Place.
"Another guy in my peer group talked about the TV talking to him," said Lord, who sports long dark hair and a goatee. "It opened the gate. I had that too. It was a supportive network." Lord now takes several medications to manage his illness and works as an assistant at the center.
"It's a cozy, safe environment," he said. "It bursts with hope and understanding."
That has been the case for Jan Kyas and his mother. They first sought the center's help in 2005 after Jan (pronounced Yahn) had a bad reaction to an antidepressant and spent every night walking around the house because he could not sleep. Fearful of his erratic behavior, his mother hid all the kitchen knives.
Since beginning sessions at the center, Jan has felt comfortable and accepted, Jirina Kyas said. She and other mothers have formed a support group. A Buddhist chanting group started by Clare Lowenau, whose daughter has schizoaffective disorder, helped Jan open up to the point that he now sings and leads discussions of fiction and poetry.
Whenever Jirina Kyas has trouble communicating with her son, Buster the Bunny comes out. "Hey, Buster, can you tell Jan that I need to talk to him?" she told the slightly worn stuffed animal as she held it on her lap one recent afternoon in the group room. Jirina Kyas said Jan carries the animals everywhere. "They keep us company when we watch TV, lined up on top of the sofa," she said. "They eat lunch with us."
Daniel's Place has had a profound effect on her and her son. When he decided to attend Santa Monica College, she joined him. She is now a research scholar at UCLA, where she has studied play therapy, among other subjects.
The center's success stories have won attention. Los Angeles County recently provided a $125,000 grant that will be used to expand the center's hours and services. Further expanding its mission, Daniel's Place is slated to open its first permanent supportive housing next fall. The $2.4-million project will transform a vacant motel on Santa Monica Boulevard into Daniel's Village, with eight units for mentally ill young people.
"We know for people with mental illness that permanent supportive housing is the answer," Lipka said. "Daniel's Village will provide the opportunity to get that needed support early on, as well as develop independent living skills such as shopping, budgeting money and paying bills."
Getting a diagnosis of mental illness does not doom a young adult to a lifelong struggle, Lipka said. Daniel's Place, he said, is about "encouraging the person to take over the management of their illness. You can lead a life of self-sufficiency."
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