Noteworthy News Articles on Mental Health Topics, December 7-14, 2007



Shutting the Door to Treatment
Lee Romney & Scott Gold, Los Angeles Times- 12/7/2007

ORLAND, CALIF. -- Torrie Gonzales stood at the stove, laughing with her boyfriend as she fried him some eggs on his 23rd birthday. Then she felt him press a flimsy blade against her neck. Struggling on the floor, she pried a paring knife from Reny Cabral's hand, leaving him curled up in a ball, sobbing and seemingly horrified."He said, 'I don't know what I'm doing. I'm so sorry,' " recalled Gonzales, now 25. Twice more he attacked her, choking her until she passed out, then performed mouth-to-mouth resuscitation to revive her. Finally, he raised his arms with a look of panic and walked into the orchard adjacent to his parents' modest rural home. A neighbor, hearing Gonzales' screams, dialed 911.
     In the days leading up to the Jan. 6 attack, Cabral had been exhibiting symptoms of an emerging psychotic illness. He was held, briefly, in a psychiatric facility. But once Glenn County sheriff's deputies responded to the 911 call, he lost any chance of being treated in the mental health system. He would now be dealt with as a criminal, with catastrophic consequences.
     As the availability of acute inpatient services has diminished, rising numbers of the mentally ill are ending up behind bars. About 350,000 of the country's 2.1 million inmates have been diagnosed with severe mental illness, said Dr. H. Richard Lamb, director of research for the Institute of Mental Health, Law, and Public Policy at USC's Keck School of Medicine. Some mentally ill people find themselves diagnosed and treated for the first time after being incarcerated. But jails and prisons -- never designed for therapeutic care -- often trigger deeper crises, Lamb said.
     What happened to Cabral provides a stark illustration of just how wrong things can go. Today, Cabral is not only facing criminal charges and struggling with mental illness; he is also paralyzed from the mid-chest down, unable to walk, to dial a phone or hold a pen.
      Arturo and Rosa Cabral immigrated to Orland in the late 1970s from the hills of Zacatecas in central Mexico. On the flat expanse of the northern Sacramento Valley, hard work was plentiful in orchards of almonds, olives and plums. In time, they forged their own business as landscapers and had three sons, who helped from the time they were young. None pitched in with as little complaint as Reny. "Conscientious," "always respectful," and "a cut above the outstanding" an array of elementary and high school teachers wrote of him in letters last spring to the Glenn County Superior Court. He ran track and played basketball, baseball and football, all while making the honor roll. Photographs show him beaming as prom king.
      At Butte College, he developed a passion for politics, trolling fraternity parties at Cal State Chico in 2004 to register new voters. At one such party, Cabral met Gonzales, a women's studies major with laser-sharp wit. The following summer they moved in together. "He was something different from everyone else who I met," Gonzales said. "He wasn't some drunk guy. That was refreshing."
     But by the fall of 2006, she recalled, he'd changed. "He would sit on the couch and just stare at nothing." He told her bizarre tales: that he worked for the FBI, that he'd been kidnapped and molested. He began using marijuana and alcohol in increasing quantities, Gonzales said, a common occurrence among people with emerging mental illness. On landscaping jobs, the old Reny would lift his mother in the air and twirl her around until both were breathless with laughter. The new Reny was removed. "His face was different. He talked to us differently," said Rosa Cabral. "But we didn't know what it was."
     On Jan. 3, Gonzales walked through the open door of the Chico apartment she shared with Cabral to find tufts of body hair on the living room floor. Meanwhile,in the city's expansive Bidwell Park, police watched as Cabral bolted naked through traffic, dragging a roll of saran wrap behind him. Nearby, officers found 5 gallons of kerosene and his oil-drenched clothes.
     A detached Cabral spoke of suicide to police and social workers and said he shaved his eyebrows for a "fresh start," records show. Police had him transported to a local emergency room, and from there he was sent to Butte County's 16-bed Psychiatric Health Facility on a 72-hour hold, police and county records show. There, he was tentatively diagnosed with psychotic and depressive disorders, records show, and prescribed Risperdal, an antipsychotic drug most commonly used to treat schizophrenia.
     Early chart entries described him as "suspicious" and "guarded." Entries at 2:45 a.m. and 6:15 a.m. found him restless. But by 7:30 a.m., the tone of the entries had changed: Cabral promised he would not hurt himself. "I do need some help though," he said. "I cannot do it on my own." When, at 9:30 a.m., he said he needed "to spend time with my family," the facility obliged. His diagnosis was changed to "major depressive disorder," and about 10:30 a.m. -- just 10 hours into his three-day hold -- Cabral was released.
     The Cabrals, Gonzales and Julie Nasr, a close family friend, were waiting for Reny upon his release. Gonzales said Cabral that evening told the family he had been instructed by God to "cleanse the household" on his birthday. She said he burst into tears and told her: "The loved one" to be sacrificed "is you." Nasr had already placed several unsuccessful calls to the psychiatric facility, begging them to take Cabral back. Now she and Reny's older brother, Art Jr., both called in a panic. But Cabral refused to return to the facility, and the family was reluctant to call police who might use force.
     Butte County Behavioral Health officials declined to comment on the case. But Lamb, the USC psychiatrist, noted that as the availability of community beds for those with acute mental illness has plummeted statewide, there has been "a tremendous amount of pressure to keep the length of stay down." Cabral's bizarre behavior, however, made the need for more extensive treatment obvious, he said. "We can say with 100% certainty that he needed the full 72 hours," Lamb said. "We can probably say with 90% certainty that he should have had the full 17 days" that mental health officials could have authorized. If Cabral had been held for 72 hours, he would have been hospitalized on the day of the attacks. The fact that Cabral was experiencing his first psychotic break, Lamb noted, would have greatly enhanced his chances of successful intervention had he gotten proper treatment.
     On the Saturday after his release, Gonzales and Cabral made plans. They would cook breakfast, then walk the family's corgi-basset hound mix. His worried parents went to work, arranging for Art Jr. to come to the house too. But when he overslept and didn't show up, Gonzales wasn't worried.
"I didn't have the possible inkling that he would hurt me," Gonzales said of Cabral. "I think we were all in denial because everything hit so quick. We were thinking of the Reny that was, the Reny that wouldn't hurt anyone."
     The deputies who brought Cabral to the Glenn County Jail in Willows had heard about his recent psychosis from Art Jr., sheriff's records show. The jail also received a faxed copy of the police report from neighboring Butte County outlining the park episode and psychiatric hold. Nasr's husband, a Chico pathologist, called to inform jail officials that Cabral had been prescribed antipsychotic medication and needed help. But Cabral did not receive it.
     The lone psychiatrist who contracts with the jail was on vacation, records show, so shortly after Cabral was booked on charges of attempted murder and domestic abuse, a jail nurse called Glenn County's Mental Health Department to ask for a clinical assessment. But when a social worker called the jail, a deputy told him Cabral seemed OK, county records show. "The jail staff will advise us of any further desired services in this case," the social worker wrote in a log of the exchange.
     About 40 hours after Cabral's arrest, deputies noticed urine seeping from under his cell door, according to county officials. They found him naked, drinking copious amounts of water and vomiting. In his distorted mind, Cabral would later recall in an interview, he was transforming into the DC Comics hero Aquaman so he could travel down the drain "to be with my mom."
     When deputies entered to move him to the jail's "safety" cell, he began throwing toilet water.Willows Police Officer Jason Dahl, who responded to a call for backup, deployed his Taser, delivering seven 5-second shocks to Cabral's chest, police records show. Writhing, Cabral splashed more urine and fecal matter from the toilet. Dahl reloaded and zapped again, then reached for his pepper spray. "I emptied the entire 4-ounce bottle . . . on Cabral," he wrote that morning in a document later filed in court.
     Finally subdued at 3:50 a.m., Cabral was placed in a safety cell lined with a thin layer of hard rubber. Paranoia raging, he believed he would be raped if he didn't escape, he recalled, and so rammed his head against the wall. In checks through a slit in the door every 15 minutes, deputies noted his posture. The last entry to record him standing was at 4:31 a.m. "Laying on floor," "Laying on stomach breathing," "Laying on stomach," subsequent entries in a jail log note. At 5:45 a.m., breakfast was pushed through the opening. Cabral did not rise. Cabral claims he yelled for help steadily. "If they did answer, they said to 'get up,' " he said.
     The first log entry to note Cabral's distress was at 10:11 a.m.: "Laying on stomach/yelling." At 11:10 a.m.: "alleges paralysis -- 'broken neck.' " Without entering the cell to investigate, the deputy left a voicemail for a nurse, records show. At noon, as Cabral pleaded for help, they served him lunch. No one opened the door until the jail nurse arrived at 1:09 p.m. -- more than eight hours after Cabral was last reported standing.
     Willows' tiny Glenn Medical Center concluded Cabral was quadriplegic. Three more hours passed before he was taken to Enloe Medical Center in Chico and given medication to reduce spinal cord swelling, according to a legal claim Cabral filed against Glenn County. The county rejected the claim, and Cabral's civil attorney said he is now preparing to file a lawsuit.
     His paralysis might have been mitigated by more prompt treatment: Steroids to reduce swelling must generally be given within eight hours of trauma, said Dr. Geoffrey Manley, chief of neurotrauma at San Francisco General Hospital and Medical Center. "Time is critical for the nervous system," he said. Cabral emerged from surgery "a C6 complete quadriplegic," Dr. Jeffrey Mimbs wrote in a document submitted to the criminal court. He could elevate his arms and flex his elbows, but could not use his hands.
     Because of the civil claim alleging negligence, malpractice, battery and civil rights violations, county officials have declined to discuss details of Cabral's stay at the jail. But Glenn County Sheriff Larry Jones conceded that his staff -- whom he notes are "not mental health clinicians" -- are increasingly overwhelmed by inmates in psychiatric crisis.
     Just two weeks after Cabral broke his neck in the safety cell, officers repeatedly used a Taser on a mentally ill inmate who was dipping his shredded articles of clothing in toilet water and eating them, according to a Sheriff's Department document. Unlike Butte County, Glenn County has no psychiatric facility, instead leasing beds in Yuba City for $600 a day. Jones has declined to send inmates there because the facility insists that guarding officers check their weapons at the door -- a requirement that Jones said would leave his officers "emasculated."
     A recent Glenn County Grand Jury report, while not mentioning Cabral's case specifically, acknowledges inadequate inmate mental health care, spreading blame among the jail, the county Mental Health Department and the hospital, citing several cases in which mentally ill inmates did not receive any care.
     For the Cabrals, it has been a year of pain and adjustment. "Before this, I maybe saw my dad cry once," Art Jr. said. "Now it's a regular occurrence." Dozens of friends, relatives and former teachers have packed Cabral's court hearings along with longtime landscaping customers who have pitched in to defray legal costs, shouldered primarily by the Nasrs.
     At a March arraignment held at the physical rehabilitation center where Cabral was recovering, he was released on his own recognizance pending trial.After six months at a Chico nursing home, Cabral returned this month to his parents' now heavily mortgaged home, equipped with ramps and climate control financed by a $65,000 loan. His position must be frequently adjusted to relieve pressure. Tight gloves compress his hands at night to create a claw-like reflex that may help him perform simple tasks.
     Cabral is taking a dose of Risperdal that quiets his mind, leaving him with a slight slur of speech and a gentle insight into his schizophrenia diagnosis. "It's something I'm committed to do -- to stay on the medication," Cabral said from his bed one evening. He longs to be at work with his parents, hearing "the rustle of the leaves, the wind in the trees." But along with a maddening desire for independence has come reflection. "You know," he told Nasr one night as she read aloud to him from Ray Bradbury's "Fahrenheit 451," "I'm looking forward to what my life as a quadriplegic will bring me. I think it will be a more intellectual life than I would have otherwise had -- now that I don't have my body."
     His relationship with Gonzales has taken new shape, punctuated by Best Friends Forever bracelets. In May, she returned for her first visit since moving to her parents' home in Riverside to grieve and rebuild. Both were nervous. But the hug came naturally. For days, Gonzales sat by Cabral's side, feeding him, stroking his arm, playing Uno. At night, amid the inhale and exhale of the leg pressurizing machine, they cried and talked -- about the shattered romance and Cabral's looming criminal charges.
     Twenty-seven California counties have mental health courts for adults whose crimes are linked to illness, offering flexible treatment and a reduced or nonexistent criminal record. Glenn County is not among them. Prosecutors there continue to press their case, even as community members have pleaded for leniency. Gonzales' early statements to law enforcement form the backbone of the prosecution's case, despite her desire to see the charges dropped.
     Conviction on triple attempted murder charges could mean many years in a state prison system in which care of the mentally -- and medically -- ill has been deemed so poor as to be unconstitutional. It could also jeopardize Cabral's chances of accessing public housing for the disabled, and frighten off potential employers. Cabral's other option -- a mental health defense of not guilty by reason of insanity -- raises the specter of indefinite institutionalization in the state mental hospital system, which is under federal oversight for a history of poor patient care.
     Cabral's defense attorney, Dennis Latimer, first sought to leave the mental health issue out altogether, arguing that Cabral's attempts at resuscitation and Gonzales' superficial injuries indicated no intent to kill. But Cabral's actions are hard to explain without context. On Aug. 25, Cabral and his family once again entered a Glenn County courtroom. Inside, Cabral softly entered his plea: Not guilty by reason of insanity. Latimer hopes prosecutors -- or a jury -- will see fit to reduce the charges. "Do you understand that this could mean a lifetime in a state mental hospital?" the judge asked Cabral. "Yes," he answered, as his mother wept.



From ‘Troubled’ to ‘Killer,’ Despite Many Efforts
Eric Konigsberg, New York Times- 12/8/2007

OMAHA— “As the twig is bent, so grows the tree.” A sign bearing these severe but hopeful words marks the entrance to Cooper Village, a residential treatment facility for teenagers along the rural northern edge of Omaha. Robert A. Hawkins, as a ward of the State of Nebraska, received extensive care at Cooper — private psychotherapy, family therapy, drug counseling — from 2003 to 2005. It was his longest stop in a five-year journey through a maze of juvenile-services programs that began when he was 13 and was charged with making homicidal threats toward his stepmother.
     On Wednesday, just a few miles away, Mr. Hawkins, 19, took a semiautomatic assault rifle into the largest mall in the state and opened fire, killing eight people before turning the gun on himself. It was the deadliest attack in Nebraska since Charles Starkweather killed 10 people here in 1957-58. “I’ve just snapped,” Mr. Hawkins wrote in one of two suicide notes the police released on Friday.
     But his actions did not come without warning signs; nor were these signals ignored. The rampage appears to be not so much a case of a young man slipping through the cracks, as a tragedy in which measured vigilance ended up not being enough. “We all cared about this child,” said Sandra K. Markley, a deputy county attorney who represented the state in a juvenile case involving Mr. Hawkins and played a role in determining his course of treatment. “I’ve been reviewing his file, and, of course, there is a lot of second-guessing. But there were no indications that he was harmful in this way.”
      That is the point state officials have emphasized. Todd Landry, the director of children and family programs for the Department of Health and Human Services, said at a press conference Thursday that “all appropriate services were provided when needed and as long as needed.” The state estimates it spent more than $265,000 on Mr. Hawkins’s care. “He was in good facilities,” Ms. Markley said. “He had good supervision. It didn’t all go perfectly, of course. But we deal with a lot of troubled children, and, as far as we could tell, he was no more troubled than many of them.”
     But even with the intervention, said Denis McCarville, who runs Cooper Village, the state failed Mr. Hawkins. “If this were a physical health issue — if he had leukemia — you would not say that as much as possible had been done,” Mr. McCarville said. “This was not pursued. As you can see, there continued to be issues.”
     In a suicide note to his family, Mr. Hawkins described himself as “a constant disappointment,” apologized for “what I’ve put you through” and wrote that he did not want anyone to miss him. “Just remember the good times we had together,” he wrote. “I love you mommy. I love you dad.” The note went on to express his love for several others, closing with “P.S. I’m really sorry.”
     His was hardly an idyllic childhood. Mr. Hawkins’s parents divorced when he was 3. Officials said that from that point, he lived with his father, Ronald Hawkins, who was in the Air Force, and his mother had little involvement in his life. Both parents remarried and eventually divorced again. A juvenile petition filed in 2002 listed Mr. Hawkins’s father’s address but stated that his mother’s whereabouts were unknown.
     In May that year, after Mr. Hawkins threatened to kill his stepmother, he was admitted to the Piney Ridge Center in Waynesville, Mo. Court records show that by that September, he had been hospitalized twice for psychiatric problems, and doctors had diagnosed attention-deficit disorder, oppositional defiant disorder, a mood disorder and “parent/child relational problems.” When his military health insurance ran out, the elder Mr. Hawkins applied for his son to become a ward of the state. The boy moved in and out of foster care, in and out of school — last year, he eventually dropped out of high school — and through residential facilities, including Cooper Village. “The circumstances of being out of his home from the age of 13 until whenever — that was obviously hard on him,” Ms. Markley said. “But we felt that he had to be removed from his home for the sake of his stepmother’s safety. His father was dealing with a very difficult child.” She added: “But his father tried very hard. He participated in the family therapy sessions.”
     In 2003, while in foster care, Mr. Hawkins was charged with third-degree assault after a fight at Papillion-LaVista High School. In March 2005, he was charged with possession of marijuana with intent to distribute. Later that year, he was ordered to complete a chemical dependency program that included attending one Alcoholics Anonymous or Narcotics Anonymous meeting a week. “At the end, marijuana was one of the big issues for him,” Ms. Markley said.
     Dennis Marks, the Sarpy County public defender who once represented Mr. Hawkins, said Mr. Hawkins had been “making progress” through his treatment. “There were a lot of services provided,” Mr. Marks said. “But it’s up to the individual after that.” He cited one of Mr. Hawkins’s caseworkers, Angie Pick, as “excellent.”
     But by August 2006, the state had terminated its custody of Mr. Hawkins, saying “the child is nonamenable to further services.” Officials said he had refused to participate in drug treatment. Although he was 18 by then, the age of majority in Nebraska is 19, and the termination, officials said, was based more on exasperation than evidence that Mr. Hawkins was rehabilitated. Mr. McCarville, the director of Cooper Village, said that decision was regrettable. “The state could have ordered him to continue treatment,” he said. “Instead, the state made the decision to terminate. Even for a youth that received over $265,000 worth of treatment, you can’t say, ‘Well that’s enough.’”
     For many of those who had tried to help Mr. Hawkins, it was jarring on Friday to see three photographs of him taken from a store surveillance video. The pictures show that he walked in, left and returned six minutes later, ready to kill, said Officer Bill Dropinski, a spokesman for the Omaha Police Department, which released the images. In the first photograph, Mr. Hawkins appears to be unarmed as he enters the Von Maur department store in a black sweatshirt and sneakers. In the second picture, he again enters the store, this time apparently with a weapon tucked under his right arm. In the third photo, he is outside the store’s third-floor elevator with the rifle raised, taking aim. Investigators are studying the rest of the surveillance tape. “We want to get some idea of how to stop this, if it were to unfortunately ever happen again,” Officer Dropinski said. “Was there anyone who could have possibly stopped him?


Your Child’s Disorder May Be Yours, Too
Benedict Carey, New York Times- 12/9/2007

By age 2 it was clear that the boy had a sensibility all his own, affectionate and distant at the same time, often more focused on patterns and objects than the people around him. He was neither naturally social like his mother, nor an early and gifted reader like his father. Quirky, curious, exuberant, he would leap up and dance across the floor after solving a problem or winning a game, duck walking like an N.F.L. receiver posing for a highlight film.
      Yet after Phil and Susan Schwarz received a diagnosis for their son, Jeremy, of high functioning autism, they began to think carefully about their own behaviors and histories. Mr. Schwarz, a software developer in Framingham, Mass., found in his son’s diagnosis a new language to understand his own life. His sensitivities when growing up to loud noises and bright light, his own diffidence through school, his parents’ and grandparents’ special intellectual skills — all echoed through his and Jeremy’s behavior, like some ancient rhythm. His son’s diagnosis, Mr. Schwarz said, “provided a frame in which a whole bunch of seemingly unrelated aspects of my own life growing up fit together for the first time.”
     Researchers have long known that many psychiatric disorders and developmental problems run in families. Children born to parents with bipolar disorder, in which moods cycle between euphoria and depression, run about eight times the normal risk for developing a mood problem. Those born to parents with depression run three times the usual risk. Attention and developmental disorders like autism also have a genetic component.
     As more youngsters than ever receive diagnoses of disorders — the number has tripled since the early 1990s, to more than six million — many parents have come to recognize that their own behavior is symptomatic of those disorders, sometimes in a major, but more commonly, in a minor way. In effect, the diagnosis may spread from the child to other family members, forcing each to confront family frustrations and idiosyncrasies that they might prefer to have left unacknowledged. “It happens very frequently, with all sorts of disorders, from attention-deficit difficulties to mood problems like bipolar disorder,” said Dr. Gregory Fritz, a child psychiatrist and academic director of Bradley Hospital in Providence, R.I., the largest child-psychiatry hospital in the country. “Sometimes it’s a real surprise, because the child is the first one in the family ever to get a thorough evaluation and history. The parents are there, and they begin to see the pattern.”
     But diagnosing an adult through his or her child has its risks, psychiatrists say. In an act of solidarity, parents may exaggerate similarities between their thinking and behavior and their son’s or daughter’s. Families desperate to find a diagnosis for a troubled child are also prone to adopt a vague label — bipolar disorder, say, which is not well understood in young children — and attribute all variety of difficulties to it, when the real source may be elsewhere.
     But psychological experts say traces of a disorder in the family tree are very often real, and the stickier issue is what to do once they surface. Depending on the family, for instance, one parent may not want to shoulder the responsibility for having “passed on” the behavior problem, they say. “The adult may have spent a lifetime compensating for the problem, as well, and is still struggling with it and would rather not be identified that way,” said Dania Jekel, executive director of the Asperger’s Association of New England.
     Openness can nonetheless have its benefits, say parents who have chosen to accept their contribution to a child’s diagnosis. Self-examination, for instance, may lead to an appropriate diagnosis for the adult.
     Norine Eaton, 51, of Williamsville, N.Y., reared two boys who were diagnosed with attention deficit disorders. “The younger one was literally climbing out second-floor windows, climbing bookcases, onto counters,” she said. “Nothing was safe in the house. It was insanity.” After the boy and his brother each received a diagnosis of attention deficit disorder, Ms. Eaton sought treatment at the Center for Children and Families at the State University at Buffalo, where she now works. She soon began thinking about her own behavior, past and present. She had long had difficulty focusing on even simple jobs, like paying bills on time and remembering and keeping appointments.
     She decided to have one of her sons’ psychologists evaluate her for attention problems. The symptoms of attention deficit disorder, which some scientists now see as a temporary delay in the maturing of the brain, can last through adulthood, but it almost always shows up first in childhood. To make a proper diagnosis, doctors like to see some evidence of a problem in childhood — evidence that can be hard to come by. “In my case, I went to school here in Buffalo, and I dug through some boxes and found reports going back to elementary school,” Ms. Eaton said. “Sure enough, they said things like, ‘Disorganized,’ and ‘Has trouble paying attention.’”
     She now takes a stimulant medication, she said, that helps her focus enough to compensate for the problem, by making calendars, notes to herself, and responding to invitations and messages on time. Once it’s out in the open, knowledge of a parent’s diagnosis or behavioral tendencies can ease strained relations in a family, especially if the previously unappreciated disability contributed to the rupture.
     John Halpern, 76, a retired physicist living in Massachusetts, began to review his own life not long after hearing a radio interview with an expert on Asperger’s syndrome. He immediately recognized himself as a textbook case, he said, and decided to call his daughter, whom he hadn’t spoken to in 10 years. He wanted to apologize, he said, “for my inadequacy as both a father and a husband to her mother.” But as soon as he started explaining, he said, his daughter cut him off. “That’s Asperger’s,” she told him. “She knew,” he said. “She had been looking into it herself, wondering if in fact I had it.” Mr. Halpern said that over several calls they shared feelings and agreed “to work on our new relationship and see how far we can take it.” The two now talk regularly, at least once a week, he said.
     Children made miserable by a psychiatric or developmental disorder may not always want company; but they often long for evidence that they aren’t the only ones putting a burden on the family, some psychiatrists say. Having a parent with the same quirks who can talk about it eases the guilt a child may feel. The child has a fellow traveler, and in some families maybe more. “When we got reports that our son was not interacting in school, that he was very quiet, slouching, unusual — we said, ‘Well, that’s us; our family is like that,’” said Susan Shanfield, 54, a social worker living in Newton, Mass.
     After her son’s difficulties were diagnosed as a learning deficit, a neuro-lingual disorder, she quickly identified some of the same traits in herself. “It was very therapeutic for me,” she said. “I had known I was different from an early age, and now I had a definition that could at least explain some of that. I also told my father, a man now in his 80s, and he was very moved by it.” He has since talked openly about painful memories from growing up, and during his time raising his own family, that were all but off-limits before, she said, and become more tolerant of his own past mistakes and others’.
     It can alter the present, too, if parent and child have enough common ground. Mr. Schwarz, the software developer in Framingham, said he became in some ways like a translator for his son, who’s now 16. “I think there are a lot of parents of kids with these diagnoses who have at least a little bit of the traits their kids have,” Mr. Schwarz said. “But because of the stigma this society places on anything associated with disability, they’re inhibited from embracing that part of themselves and fully leveraging it to help their kids.”

Study: Anxiety Avoidance May Cause Problems Later
Ann Arbor News, 12/10/2007

People who block out unpleasant memories or issues may enjoy short-term gains but emotionally detaching themselves causes long-term consequences, according to a University of Michigan psychology researcher.
      Robin Edelstein, a assistant psychology professor, and her colleagues studied victims of sexual abuse 15 years after their cases went to trial to see how many were still willing to talk about what happened to them and whether such victims tend to block out such memories.
     About 80 per­cent brought up the crimes when asked if they'd ever been a sexual abuse victim, but 20 percent avoided mentioning the painful memory. She found that people who were victims at a younger age and those whose crimes were less severe were less likely to talk about what happened to them.
     Edelstein says research shows people who block out or avoid painful memories, people who are detached and more avoid-ant, are less happy in relationships. "While avoiding things can be a helpful short-term strategy, not paying attention to certain things for extended periods of time might be bad for your mental health with consequences for your physical health. All the effort to avoid anxiety actually creates more anxiety later," Edelstein said. People with a healthy support system have friends or family they can talk with about difficult issues, Edelstein said. The healthiest solution is to deal with an issue, take action and move on, she said.

Emergency Antidote, Direct to Addicts
Dan Hurley, New York Times- 12/11/2007

Among the growing numbers of researchers and public health officials advocating a daring new strategy to put an injectable antidote for heroin overdoses directly into the hands of addicts, few have the credibility of Mark Kinzly. After 11 years as an addict, Mr. Kinzly cleaned up, began working with needle exchange programs and became a research associate at the Yale School of Public Health. Then came the relapse and the overdose that nearly killed him. “We were watching TV — I think it was the Red Sox beating the Yankees,” Mr. Kinzly, 47, recalled of the evening in 2005 when he passed out in a colleague’s apartment. “Because of our work he knew what to do. He dialed 911 and then injected the naloxone.”
     Taken in high enough doses, heroin and other opioids suppress the brain’s regulation of breathing and other life-sustaining functions. Naloxone is a chemical that blocks the brain-cell receptors otherwise activated by heroin, acting in minutes to restore normal breathing. Since its approval by the Food and Drug Administration in 1971, naloxone has become a standard treatment for overdoses, used almost exclusively by emergency medical workers. But it has lately become a tool for state and cities struggling to reduce stubbornly high death rates among opiate users. By distributing the drug and syringes to addicts and training them and their partners in preventing, recognizing and treating overdoses, the programs take credit for reversing more than 1,000 overdoses. “From a public health perspective, it’s a no-brainer,” said Dan O’Connell, director of the H.I.V. prevention division in the New York State Health Department, which supports 20 naloxone programs, all but one in New York City. “For someone who is experiencing an overdose, naloxone can be the difference between life and death.”
     But federal drug officials say distributing naloxone directly to addicts may do more harm than good. “It is not based on good scientific data,” said Dr. Bertha Madras, deputy director for demand reduction at the White House Office of National Drug Control Policy. “It’s based on what some people would consider the right thing to do. But the studies supporting it are so sparse it’s painful.”
     She pointed to a survey in 2003 of addicts in San Francisco. published in The Journal of Urban Health, in which 35 percent said they might feel comfortable using more heroin if they had naloxone on hand, and 62 percent said they might also feel less inclined to call 911. “These were their attitudes,” Dr. Madras said. “I’m taking the stand that in the absence of scientific evidence we don’t engage in policies that would bring more harm than benefit.” Similar concerns were expressed by Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment, a federal agency that finances treatment programs. “Our position is that naloxone should be administered by licensed health care professionals,” Dr. Clark said.
     Nevertheless, the direct-to-addicts model has spread rapidly since Chicago introduced it in the late 1990s. Baltimore, New York and San Francisco soon adopted the model, and Boston, Philadelphia, Connecticut, Minnesota, New Mexico, Rhode Island and Wisconsin have more recently joined the trend. “The program here has been extremely successful,” said Richard W. Matens, assistant commissioner of health for chronic disease prevention in Baltimore. Overdose deaths there in 2005 were at their lowest level in more than a decade, and Mr. Matens gives at least some credit to the naloxone distribution.
     The worrisome findings of the San Francisco survey have not been borne out by more recent studies of actual programs that include training in prevention and treatment. A study in 2005 of San Francisco’s pilot program found that of 20 overdoses witnessed by trained addicts, 19 victims received CPR or naloxone from the trainee, and all 20 survived. Knowledge about managing overdoses increased, and heroin use decreased. “Research has shown none of the concerns about naloxone distribution to be true,” said Dr. Sandro Galea, a researcher at the University of Michigan who has written two studies of programs in New York. “It probably is one of the few interventions that truly can reduce the deaths from opioids overdoses.”
     R. Herbert Kleber, who had Dr. Madras’s position in the White House under President George H. W. Bush and now directs the Columbia University substance abuse division, said although he wished the evidence supporting naloxone distribution were stronger, “In terms of lives saved, it’s probably the kind of intervention where there’s a likelihood of more good than harm.”
     In New York City, the 863 overdose deaths in 2005 made up the fourth leading cause of death among people younger than 65, according to Dr. Thomas R. Frieden, commissioner of health and mental hygiene. “We want people off drugs,” he said. “But until they get off, we’d like them to stay alive. That means not getting H.I.V. and not dying of overdose.”
     Existing programs focus on reaching urban heroin addicts, but naloxone is equally effective at reversing overdoses from other opioids like OxyContin and methadone. With overdose death rates from such drugs increasing sharply, officials in Wilkes County, N.C., are working on a program to dispense a naloxone nasal spray to users leaving hospital emergency rooms, detoxification centers and jails. The program, Project Lazarus, received approval from the state medical board in November. “Lazarus, biblically speaking, is one who was raised from the dead, and that is essentially what naloxone does for these people,” said the director of the program, the Rev. Fred Brason II.
     Dr. Sharon Stancliff, medical director of the Harm Reduction Coalition, which operates naloxone distribution and training in New York and San Francisco, conceded that the scientific case was not ironclad. “Right now,” Dr. Stancliff said, “we’re at the point where we know it’s safe. We’re not seeing any bad outcomes. “And we know it’s feasible. We’re just beginning to get really good evidence that it’s associated with a significant reduction in overdose deaths.”
     Mark Kinzly, who is back in recovery after relapsing in 2005, says he has all the evidence he needs. “This weekend I will go see my 9-year-old son play Pop Warner football,” he said. “I am extremely grateful that the medication was available, and as a result I get to raise my child.”

An Ancient Medicine (Enjoy in Moderation)
Natalie Angier, New York Times- 12/11/2007

Every year, the average American adult drinks the equivalent of 38 six-packs of beer, a dozen bottles of wine and two quarts of distilled spirits like gin, rum, single malt Scotch, or vodka that aspires to single malt status through the addition of flavors normally associated with yogurt or bubble bath.
     We are by no means the most bibulous people: according to the World Health Organization, 39 other nations outdrink us, a list topped by Luxembourg, where residents manage to ingest roughly 284 bottles of beer and 88 bottles of wine annually, no doubt to salve the indignation of explaining that their country isn’t part of Belgium.
     Yet even though we Americans drink less than some others, we can hold our own, especially now that the peak ethanol season is under way. Liquor sales in December, according to hospitality trade groups, are usually a good 50 percent higher than in other months, and that’s hardly a surprise. December is a time of multicreedal spirituality and festivities, and alcohol has been a fixture of celebration and religious ritual since humans first learned to play and pray. December is also cold, dark and miserable, a meteorological migraine begging for home remediation, and alcohol is perhaps humanity’s oldest medicine.
     Moreover, December is a time for family, and a taste for alcohol, it seems, is all in the family, the extended phylogenetic family of primates and other animals that make fruit a centerpiece of their diet. Nothing broadcasts the presence of ripe, digestible fruit as effectively as the aroma of fermentation. We’re frugivores at our core. “As far back as we can look, humans have had a love affair with fermented beverages,” said Patrick McGovern, an archaeological chemist at the University of Pennsylvania. “And it’s not just humans. From fruit flies to elephants, if you give them a source of alcohol and sugar, they love it.”
     Humans may have an added reason to be drawn to alcohol. Throughout antiquity, available water was likely to be polluted with cholera and other dangerous microbes, and the tavern may well have been the safest watering hole in town. Not only is alcohol a mild antiseptic, but the process of brewing alcoholic beverages often requires that the liquid be boiled or subjected to similarly sterilizing treatments. “It’s possible that people who drank fermented beverages tended to live longer and reproduce more” than did their teetotaling peers, Dr. McGovern said, “which may partly explain why people have a proclivity to drink alcohol.”
     Dr. McGovern and other archaeologists have unearthed extensive evidence of the antiquity and ubiquity of alcoholic beverages. One of the oldest known recipes, inscribed on a Sumerian clay tablet that dates back nearly 4,000 years, is for beer. Chemical traces inside 9,000-year-old pottery from northern China indicate that the citizens of Jiahu made a wine from rice, grapes, hawthorn and honey, a varietal recently brought back to life by the intrepid palates at Dogfish Head brewery in Delaware. Last month, Dr. McGovern, John S. Henderson of Cornell University and colleagues reported evidence in The Proceedings of the National Academy of Sciences that the earliest known chocolate drink, made from the cacao plant in Honduras 1,400 years ago, was probably a fermented beverage, with an alcohol content similar to beer, a discovery that brings to mind the classic Onion T-shirt: “I’m like a chocoholic but for booze.”
     Researchers caution, however, that if we humans are congenitally inclined to drink, we are designed to do so only in moderation. We are not, in other words, Syrian hamsters, the popular pet rodents that also are a favorite of alcohol researchers. Syrian hamsters are the Andy Capp of the animal kingdom. “They’ll drink alcohol whenever offered the option,” said Howard B. Moss, associate director for clinical and translational research at the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md. “You give them a bottle of water and a bottle of alcohol, they’ll always choose the alcohol over the water.”
     Researchers have traced this avidity to the hamster’s natural habits. The animals gather fruit all summer and save it for later by burying it underground, where the fruit ferments. “That’s how the hamsters find their cache of last summer’s goodies when it’s the middle of winter,” Dr. Moss said. “They’ve developed a preference for the taste and smell of fruit that’s turned.” They’ve also developed the necessary equipment to metabolize high doses of alcohol. “A hamster’s liver is five times the size of a human liver in comparison to the other abdominal organs,” Dr. Moss said. “It’s all liver in there.”
     Behind the hamster dance is the ancient chemical legerdemain of fermentation, which by its most general definition means extracting energy from sugar without using oxygen. There are many ways to do this: our muscle cells ferment when operating anaerobically, say, while lifting weights. The fermentation that yields ethanol, the type of alcohol we drink, is the work of yeast cells, which will latch onto any suitable sugar source and start feasting. As they break down the sugary chains, the yeast enzymes generate two key byproducts: carbon dioxide, which can be used to puff up bread dough, and ethanol. Alcohol, then, is nothing more than fungal scat.
     Ah, but how that scat can sing. An alcohol molecule consists of a knob of hydrogen and oxygen linked to a carbon-based stalk, and that telltale knob, that hydroxyl group, allows the molecule to mix easily with water. “The hydroxyl group makes alcohol go to any cell in the body that has water,” said Samir Zakhari, director of the division of metabolism and health effects at the alcohol institute, “which means alcohol goes to every tissue in the body.”
     The brain is particularly well lubricated, and alcohol happily mingles therein, to noteworthy, crazy-quilt effect. It stimulates the secretion of dopamine, the neurochemical associated with the brain’s reward system. It stifles the brain’s excitatory circuits and excites the brain’s dampening circuits. It alters the membranes of neurons and the trafficking of important ions like calcium and sodium across neuronal borders. It stimulates like cocaine and it depresses like valium. It makes the shy voluble, the graceful clumsy and the operator of a motorized vehicle very dangerous. As always, the dose makes the poison, so as you savor the season, take it one small sip at a time.

Data Sought on Veterans' Suicide
Associated Press, 12/12/2007

WASHINGTON -- The parents of an Iraq war veteran who committed suicide and members of Congress on Wednesday questioned why there's not a comprehensive tracking system of suicide among Iraq and Afghanistan veterans. Mike Bowman, of Forreston, Ill., said his son, Spc. Timothy Bowman, 23, is a member of the ''unknown fallen'' not counted in statistics. His son, a member of the Illinois National Guard, took his own life in 2005 eight months after returning from war. Bowman said he considers his son a ''KBA'' -- killed because of action. ''If the veteran suicide rate is not classified as an epidemic that needs immediate and drastic attention, then the American fighting soldier needs someone in Washington who thinks it is,'' Bowman said. Bowman was one of several witnesses who testified before the House Veterans' Affairs Committee on the issue.
      Rep. Bob Filner, the committee chairman, questioned why the comprehensive tracking wasn't already being done. ''They don't want to know this, it looks to me,'' said Filner, D-Calif. ''This could be tracked.'' Dr. Ira Katz, the VA's deputy chief patient care service officer for mental health at the Department of Veterans Affairs, defended the work being done by his agency to tackle the issue, including implementing a suicide prevention hotline. ''We have a major suicide prevention program, the most comprehensive in the nation,'' Katz said. Katz questioned why Filner was focusing on the number of suicides instead of looking at treatment programs implemented to help prevent suicide.
     Awareness of suicide among Iraq and Afghanistan veterans was heightened earlier this year when the Army said its suicide rate in 2006 rose to 17.3 per 100,000 troops -- the highest level in 26 years of record-keeping.
     The Department of Veterans Affairs tracks the number of Iraq and Afghanistan veterans who commit suicide, but only if they have been discharged from the military. The Pentagon tracks the number of suicides in Iraq and Afghanistan. For an earlier story, a Pentagon spokeswoman told The Associated Press the military does not keep track of whether active duty troops who took their own lives served in Iraq or Afghanistan. In an e-mail on Wednesday, the same spokeswoman, Cynthia Smith, said, ''We track all suicides, I just don't have combat service information readily available.'' At least 152 troops have committed suicide in Iraq and Afghanistan, according to the Defense Manpower Data Center, which tracks casualties for the Pentagon.
     On Oct. 31, the AP reported that preliminary research from the Department of Veterans Affairs had found that from the start of the war in Afghanistan on Oct. 7, 2001, and the end of 2005, 283 troops who served in the wars who had been discharged from the military had committed suicide. On Wednesday, Katz said the VA's number had been changed to 144 because some of the veterans counted were actually in the active military and not discharged on the day they committed suicide. Smith said that the military's suicide rate is still lower than that of the general population.
     After leaving the military, however, veterans appear to be at greater risk for suicide than those who didn't serve. Earlier this year, researchers at Portland State University in Oregon found male veterans were twice as likely to commit suicide as their civilian counterparts. In a report last May, the VA Inspector General said VA officials estimate 1,000 suicides per year among veterans receiving care within the agency and as many as 5,000 per year among all veterans.
     ''When decision makers do no have reliable data, we must rely on anecdotal evidence,'' said Rep. Steve Buyer, R-Ind. ''While these may help inform us, it does not help us to develop strategies to diminish the risk and prevent incidents of suicide.''



Study: Teens Turn to Prescription Drugs
Ofelia Casillas, Chicago Tribune- 12/12/2007

Though fewer 8th, 10th and 12th graders across the country report illicit drug use, those who do are increasingly turning to prescription drugs, according to a University of Michigan study released Tuesday at the White House. The use of OxyContin, first measured by the researchers in 2002, was slightly higher this year for all three grades. At least one in every 20 high school seniors has tried the narcotic in the past year, researchers found.
     Wilson Compton, division director at the National Institute on Drug Abuse, said he was troubled by the finding.

Campaign on Childhood Mental Illness Succeeds at Being Provocative
Joanne Kaufman, New York Times- 12/14/2007

"We have your son. We will make sure he will no longer be able to care for himself or interact socially as long as he lives." So reads one of the six “ransom notes” that make up a provocative public service campaign introduced this week by the New York University Child Study Center to raise awareness of what Dr. Harold S. Koplewicz, the center’s founder and director, called “the silent public health epidemic of children’s mental illness.” Produced pro bono by BBDO, an Omnicom agency that worked on two previous campaigns for the Child Study Center, the campaign features scrawled and typed communiqués as well as simulations of classic ransom notes, composed of words clipped from a newspaper.
      In addition to autism, there are ominous threats concerning depression, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, Asperger’s syndrome and bulimia. The campaign’s overarching theme is that 12 million children “are held hostage by a psychiatric disorder.” The public service announcements began running this week in New York magazine and Newsweek as well as on kiosks, billboards and construction sites around New York City. “Children’s mental disorders are truly the last great public health problem that has been left unaddressed,” said Dr. Koplewicz, adding: “It’s like with AIDS. Everyone needs to be concerned and informed.”
     In some quarters, however, the campaign has raised hackles as much as awareness. The Autistic Self Advocacy Network, a national grass-roots organization of children and adults, is circulating a petition asking the Child Study Center to end the campaign. Kristina Chew, founder of the blog Autism Vox, which has a link to the petition, says that “the reaction has been mostly outrage from parents of special-needs children, autistic adults, teachers, disability rights advocates and mental health professionals.”
     “It’s rallied them around one issue, and these aren’t people who normally agree about treating autism,” said Ms. Chew, who lives in Bernards Township, N.J., and has a 10-year-old son with autism. She says her blog attracts 3,000 to 4,000 visitors a day; traffic is up a third since the campaign was introduced, she said. “It emphasizes a lot of negative aspects,” she said. “To say that autism or bulimia has kidnapped a child suggests that these conditions are part of a criminal element. I’m not saying it’s easy to have an autistic child, but it could be framed in a more positive way.”
     Vicki Forman, an adjunct professor of creative writing at the University of Southern California whose 7-year-old son is blind and nonverbal, learned about the campaign on Ms. Chew’s blog and said it made her distraught. “The idea of an autistic person being held hostage is a very disturbing and backward image,” she said. “Rather than promote public awareness, this reinforces stereotypes — that there is something damaged about the autistic person, something in need of a repair.”
     According to Dr. Koplewicz, the campaign was inspired by filmed conversations of parents and children talking about life with a psychiatric disorder. “These families felt their children were trapped by their disorders,” he said. John Osborn, the president and chief executive of BBDO New York, said the effort was intended to increase the sense of urgency about the diseases and encourage conversation. “It’s tricky because there are a lot of messages in the air, particularly at holiday time. That makes it a challenge to cut through the clutter.”
     BBDO’s earlier ads for the Child Study Center — which included images of a child running happily through a sprinkler and a drawing of a child caught in a maze — “were wonderful, but they didn’t get this kind of attention from anyone,” Dr. Koplewicz said. “They were too pleasant and innocuous. That’s the reason we decided to go along with BBDO.”
     He was further emboldened, he said, by the reaction of focus groups of women whose children have the disorders mentioned in the ads. “Everyone who participated felt the ads were informative,” he said. “While we knew the campaign was edgy and we knew it would be harsh and upsetting, the facts of mental illness are even more upsetting. “I am disappointed. I thought the people we’d be arguing with are the people who believe psychiatric illness doesn’t exist” or those who believe children are being overmedicated, he said. “I thought we’d be fighting ignorance. I didn’t think we’d be fighting adult patients or the parents of patients whose feelings have been hurt.”
     Susan Etlinger of San Francisco is one such parent, but she maintains that hers is “not the P.C. outcry of an offended parent.” “It’s a legitimate claim that children with disabilities are vulnerable enough as it is,” said Ms. Etlinger, whose 4-year-old son has mild autism. “I think we need to take special care that they’re not further stigmatized. This campaign characterizes them as a series of symptoms rather than as the unique people they are.”
     Bennett L. Leventhal, a professor of psychiatry at the University of Illinois Medical Center in Chicago, said he understood the parents’ dismay. “We live in a world where people are still defensive about having a psychiatric illness or having a child with psychiatric illnesses,” he said. “But I think it’s a very bold campaign. I think the ads speak to the point that these are real diseases and if you don’t do something they can consume your child.”
     Dr. Koplewicz said he had not considered jettisoning the campaign, but there was some discussion about dropping its two most controversial components: the autism and Asperger’s ads. He decided to retain the ads after conferring with colleagues whose attitude, he said, “was that some people would be upset but that we should stick with it and ride out the storm.” “We’re going to see how it goes in New York,” Dr. Koplewicz said. “If it goes well, we’re going to go to four other cities."