Noteworthy News Articles on Mental Health Topics, January 10-16, 2007



U-M Researcher to Lead Autism Databank
Ann Rueter, Ann Arbor News- 1/10/2007

University of Michigan researcher Catherine Lord will lead an 11-university effort to create a major new tool in the search for causes and treatments for autism. A databank of DNA samples from 3,000 autism patients around the country should be complete in three years.

The project will receive $10 million for the first two years from the New York-based Simons Foundation, which aims to spend $100 million long-term to find a cure for autism.

"The Simons Foundation is hopeful the genetics will be just the beginning of a huge initiative,'' said Lord, an internationally known autism researcher and director of the U-M Autism and Communication Disorders Center.

Autism is a complex developmental disorder that affects one in every 200 children. Children and adults with autism suffer from a lack of normal brain development, as yet poorly understood, in areas linked to social interaction and communication.

With the DNA databank, researchers around the world will have the genetic data needed to identify subtypes of autism and develop possible drugs and other interventions, said Lord.

"Autism spectrum disorder,'' the official term, reflects the wide range of behaviors and severity in people who have autism. Yet scientists don't have a clear picture of how many subtypes may exist. The gene data could help greatly to identify and treat even newborns, similar to the way PKU, a genetic disorder that can cause mental retardation, is routinely detected and treated today, Lord said.

There hasn't been an adequate databank until now for the 90 percent of autism cases in families where no sibling or other family member has autism. A DNA databank focusing on families with two or more siblings with autism already exists, created several years ago by the group Cure Autism Now.

DNA samples for the databank will also be collected by scientists at universities including Yale, Harvard, Columbia, Emory, McGill, Boston University, Washington University, the University of Washington, the University of Illinois-Chicago and the University of California, Los Angeles.



As Drugs Destroy, New Families Take Shape
Dahleen Glanton, Chicago Tribune- 1/10/2007

CROSSVILLE, Tenn. -- Delta and Paul Cottrell thought they would be empty nesters by the time they reached their 60s. By then, they would have competed the toughest job of their lives--parenting--and a leisurely retirement would be just a few years away.

But methamphetamine has a way of altering lives, not just for those who abuse the drug but also for the relatives who step in to pick up the pieces when families fall apart. So Delta Cottrell, 56, and her 57-year-old husband, Paul, have settled into an unexpected life as parents of her 11- and 7-year-old grandchildren, adopted when Delta's stepdaughter from another marriage lost custody because of drugs.
"When this happens, your whole life is imposed upon, but it is by choice because there is no other way," said Paul Cottrell, a retired Air Force veteran who works as a construction site handyman. "I would not take anything for my children, but our new lifestyle means there is no time for me, and more of my hard-earned money is going toward things I had not planned for."

What happened in one home in rural Tennessee is being played out across the U.S. as methamphetamine makes its way across the country, breaking up families and creating an influx of abused and neglected children who have placed an unprecedented burden on state welfare systems.

In many cases, grandparents are viewed as the last hope for relieving foster care systems that are overflowing. And they are stepping out of retirement or forgoing it in record numbers to raise grandchildren whose parents are unable or unwilling to take responsibility.

More than 4.5 million children in the United States live with their grandparents, according to the 2000 census, a 30 percent increase from 1990. An additional 1.5 million children live with other relatives.

The increase in so-called grandfamilies, experts said, coincides with the rise in meth addiction, particularly in rural areas where social services are limited. In a recent study by Generations United, a grandparents advocacy group, 40 percent of child welfare workers reported an increase in meth-related placements.

In Montana, 57 percent of the foster care placements are related to meth, according to the study. In some areas of Iowa, meth is responsible for up to 80 percent of placements, and in Oregon, more than 71 percent. In Tennessee, the number of such cases rose to 700 children in 2004 from 400 in 2003.

"Because of meth and other problems, grandparents have become lifelines for so many hurt children," said Donna Butts, executive director of Generations United. But, she said, grandparents are not receiving the support they need.

Advocacy groups are lobbying Congress to change laws to make it easier for grandparents and other relatives to care for children, giving them the same rights as foster parents but easing some of the stringent requirements for state licensing. The federal government and many states, however, have been slow to grant financial help and decision-making rights to relatives who have no legal status in the child's life.

"In the foster care system, there are restraints on how many bathrooms you can have. You have to go through parenting classes, and there is oversight," Butts said. "Under current rules, a grandparent would have to ask the court if the child can travel outside the state or spend the night with friends. These rules are outdated."

Congress last year approved $145 million in matching grants to help local officials provide services to children affected by drugs. When Congress extended the USA Patriot Act, lawmakers included a provision restricting the sale of over-the-counter medications containing pseudoephedrine--a primary ingredient in meth. Thirty-nine states, including Illinois, already had taken that action, which has contributed to a decline in amateur meth labs and children affected by them.

But Mexican super-labs have taken their place, saturating the country with the highly addictive drug that has disproportionately affected young women, according to the Drug Enforcement Administration.

"When people are on meth, they don't think about feeding a child or changing a diaper. When they come down from a meth high, they crash and sleep for a long time, so you might have a 4-year-old trying to take care of a 2-year-old," said Joe Dunn, associate legislative director for the National Association of Counties lobbying group. "Some counties are spending over $1 million a year on child welfare because of meth."

When a child is removed from a meth-lab home, he often arrives at the grandparents' home with nothing. And he often suffers from medical problems.

This can cause a financial burden for grandparents, many of whom are on fixed incomes. Foster parents receive monthly assistance; grandparents, for the most part, receive little or no financial aid.

Illinois has been a leader in establishing so-called subsidized guardianship programs, which provide relatives the same rights as foster parents as well as financial support.

One of a dozen states to receive a waiver from the federal government to use Title 4 funds designated for foster children to provide subsidies for relatives, Illinois drastically reduced its foster care caseload between 1997 and 2002. Only 3.5 percent of the 6,820 children in the system during that time returned to state custody, with the majority finding permanent homes with grandparents or other relatives. In March, the U.S. Department of Health and Human Services ended the waiver program.
While alcohol and other drugs, including crack cocaine and heroin, devastate urban communities, U.S. Atty. Gen. Alberto Gonzales declared meth the most dangerous drug in America in terms of its damage to children.

People such as the Cottrells are on the front line of the battle to save them.

Ann, the stepdaughter raised by Delta Cottrell, started using drugs at age 13, developing an addiction that has cycled her in and out of jail for all of her adult life. When Ann's oldest son, Todd, was a year old, she left him with Delta one day and never returned. Delta raised him for two years, driving two school bus routes and working as a restaurant manager to support him. But when she went to court to get temporary custody, the child's father fought for full custody and won.

"To him, I was mom. And if grandparents had the rights they should have, my Todd would be here with me now," Delta said.

She and her husband adopted Todd's younger brother, Zachery, now 11, and Amber Rose, now 7, in 2003. The state removed Ann's parental rights and asked Delta to seek legal custody. Ann, now 32, signed them away to the Cottrells and is no longer part of their lives.

For the first four months, the Cottrells received no help from the state of Tennessee. Both children had medical problems and needed counseling. Zachery, who suffers from attention deficit disorder, takes five medications.

Both children are now enrolled in TennCare, the state's medical care program for children, and the Cottrells receive $9 a day to care for Amber Rose and $12 a day for Zachery.

They have built a comfortable life in a six-bedroom home that is bustling with energy. Two of the Cottrells' former foster children, 18-year-old Kendra and her 19-year-old sister, Dawn, have returned home. Dawn's 7-month-old daughter, Charlee, also lives there. A mentally challenged friend of the family, 21-year-old Sheena, recently moved in. There are also three dogs and a cat.

Days and evenings are full for the Cottrells. Delta, who underwent surgery in May for a brain aneurysm, said, "You do get tired sometimes and you realize why God gives children to young people.

"For me, the children I gave birth to are no different than the children I adopted. Children don't only come from the womb, they come from the heart."

Drugmakers Doing Better on Study Info
Associated Press, 1/11/2007

Drug companies are doing a much better job of supplying key information about research they are doing since medical journals started pressuring them to enter studies in a government registry. The federal registry, at www.clinicaltrials.gov, began operating in 2000 but saw little industry participation until late 2004. That was when the 11 members of the International Committee of Medical Journal Editors said they would publish only studies registered early on, in part to keep drug companies from suppressing the results of experiments that did not turn out the way they wanted. New England Journal of Medicine editor in chief Dr. Jeffrey Drazen and Dr. Deborah A. Zarin of the National Library of Medicine, which operates the registry, reported on its progress in an editorial in Thursday's issue of the journal.
      Only 8 percent of the 2,983 studies that drugmakers added to the registry last year failed to describe the outcomes being measured in the experiment, such as cholesterol levels or deaths. That was down from 26 percent of studies registered in the prior years. Meanwhile, none of the 2006 filings omitted the name of the treatment being tested, as did a small number of trials registered before 2006, Drazen and Zarin wrote. The pharmaceutical industry has sometimes withheld such information in the past, calling it commercially sensitive. ''Although more can be done, this improvement in registration quality is to be praised,'' Drazen and Zarin wrote.
     Previously, they reported in the journal that drugmakers were still leaving out key details in the period from May through October 2005 -- a month after the journals' new mandate took effect. At the time, they noted Pfizer Inc., the world's biggest drugmaker, was the worst at reporting names in its new listings, leaving out more than 6 percent. Last year, none of the 115 trials it registered left out the treatment or outcome being tested.
      On the Net: http://www.nejm.org
                         International Committee of Medical Journal Editors: http://www.icmje.org

Autistic Children's Future Concerns Parents
Jo Collins Mathis, Ann Arbor News- 1/14/2007

It's Tuesday afternoon at the Plymouth Road Rite-Aid, and Steve Tsai is busy pricing bottles of club soda. The work is monotonous, routine. Just what he likes. A shopper spots his blue vest and name tag and asks: "Do you sell catsup?'' Steve keeps walking, as if he hasn't heard the question. It's not that he's rude or deaf. Steve has autism, a brain disorder that affects communication, social interaction and imagination. That's why his mother Merling is right behind him. "What do you need, sir?'' she quietly asks the customer, before escorting him to the condiments shelf.
      When Steve was in school, Merling had her own job. Now, at the age of 60, her job is helping make sure Steve, 32, does his. In the morning, she accompanies him to his part-time job at the Ann Arbor District Library, where he carefully and quickly reshelves books. In the afternoons, she's with him at the Plymouth Mall drug store, where manager Paul Anderson says he's one of the best, hardest-working employees there. "A problem with autistic people is they look normal, so people expect them to behave in a normal way,'' said Merling Tsai. "But they don't. ... As a parent, you worry about them every day.''
     P.V. Roby of Ann Arbor, who has a 20-year-old developmentally disabled daughter, knows that worry well. Of particular concern to parents of those with autism and other developmental disabilities is how their adult children will function in society and what will happen to them when their parents can no longer look out for them. "We're all terrified,'' said Roby. "It takes a huge amount of work to make sure all the services are there, but after we die, then what happens?''
     Hoping to address that issue, a group of Washtenaw County parents of disabled children and adults has been meeting monthly for the past year. Members of Intentional Communities of Washtenaw hope to cut through the long waiting lists and high cost of community-based housing with new housing options for the disabled. They are also trying to meet their children's need for social connection and structure.
     Jill and Al Blixt of Ann Arbor are hoping Intentional Communities of Washtenaw will serve the needs of their son, Andrew, 23. "We're very lucky in the state of Michigan that there are services, and education and training for young adults until 26,'' said Jill Blixt. (Michigan is the only state that provides services until that age; most stop at 21.) "But what happens is that once they step out of program and are in their lives without the structure of daily social activities and training, they end up profoundly isolated. We're trying to create a nonprofit that would survive us, that would be run by other parents who understand, so we could leave this earth in peace knowing that the program's going to be there ... .''

What happens when schooling ends?
The Washtenaw Intermediate School District provides vocational and life skills training for moderately to severely impaired young adults 18 to 26. Some students go out as a group to job sites, and some begin jobs they'll keep for years after they graduate. John Williams, who has taught all ages of special education for 30 years, particularly enjoys his group of 15 young adults, who seem equally happy to spend the day with him. Williams frequently reminds his students' parents that they must prepare for the inevitable, always tearful, graduation day. "Every September or October (after graduation), I'll get a call from a parent who says, 'John, I don't know what to do with him,''' he said. "I'm kind of like, 'That's what I've been telling you the last six years: We gotta get prepared for this.' They need any reason to get up in the morning.''
      Steve Tsai's father is Luke Y. Tsai, professor of psychiatry and pediatrics at the University of Michigan Medical School. He is a leading autism specialist in the area, and one of just a few psychiatrists in the state who specialize in autism. Although he did not choose his specialty because of his son, he believes his career path was the right one.
      Tsai said that because the autistic are slow learners and have trouble interacting with people, they have a hard time securing employment. If they're put in the right job with good training, possibly in a field such as computer programming, they can do well.
     Michigan Ability Partners, an agency that offers many services including job development and job coaching for people with disabilities, has placed clients in libraries, book stores, movie theaters and restaurants. Pam Byrnes, MAP's vocational services director, said clients are usually good, dependable workers who stay for years. The job becomes important to the client because it's part of his or her identity. "Usually, it's not that they need the money,'' said Byrnes. "They'll have other benefits.''
      Rite Aid Manager Paul Anderson had been at the store just four months when Steve Tsai was hired there 15 years ago. "He's become a tremendous employee,'' said Anderson. "I've found that just because someone is handicapped doesn't mean that they can't do a job. Everyone, no matter who you are, is good at something.''

Creating solutions
Andrew Blixt was born prematurely at 11/2 pounds when his mother developed severe toxemia. When he was 2, he was diagnosed with cerebral palsy, which is his prime disability. Later, it became obvious he had a few of the autistic characteristics. Andrew loves attending WISD's young adult program but, like his parents, worries about the future. "He's just beginning to comprehend that it's going to be over, and that panics him,'' said his mother. "School has been a structure in his life since he was 21/2.''
     When school's not in session, Andrew's parents work hard to give him a life away from his video games, at which he excels. For years, they've hired U-M and EMU students to be his tutors and mentors and have looked for appropriate summer programs. "We sign him up for everything that's available that would be safe for him where he wouldn't feel totally overwhelmed,'' she said of summer vacations. "He's aware enough that he is disabled, so that makes him shut down more when he's in competition with others.'' She said she and her husband constantly ask themselves one question: "How do we help him find him something to do either work-wise or volunteer-wise that feeds his soul, that gives him a sense of purpose?'' "My husband and I have been entrepreneurs for a long time, and we look at each other and say, 'What can we dream up that he can do with others so he has the social context, that would be sustainable?' So there's a lot to create here. All across the country, we're having to invent what happens to our children after we leave.'' She said her older son, David, is married with a new baby. "We've told him that, while we know he would take Andrew in to live with his family, that might not be the best thing for either one of them,'' she said.
      Jill Blixt said that despite the challenges, many gifts come from having a child with special needs. "One of the gifts is that every success is a triumph,'' she said. "For example, my mother died recently and Andrew went on his computer and wrote his own eulogy and he got up in front of everybody and read it to them. He stood there straight and tall and he read. And that was a triumph. My niece read hers, too. And that was great. But you have this appreciation of every success that frankly I didn't have at that level with my older son growing up.''
     York Township resident John Madakacherry's 24-year-old son, John, was diagnosed with autism at age 3. Like other parents of autistic adults, he and his wife, Mary Mathai, worry about what John will do when he turns 26. Madakacherry is so concerned about what the future holds that he plans to retire from General Motors at the age of 62, the same year his son turns 26. "Then I can focus full time on him.'' Madakacherry said after his retirement, he'll probably take his son to the Saline Recreation Center for exercise and find a place he can work, not necessarily for pay. He's good at cleaning and lawn work, but because he lacks common sense and doesn't understand social norms, must be supervised, Madakacherry said.
     Autism is one of the toughest disabilities to deal with because of the slew of problems that accompany it, Madakacherry said. For instance, he and his wife can never leave John alone because he has enough intelligence and curiosity to get into problems, but lacks the common sense to get out of them. "We've traveled all over the world with him,'' he said, "and he requires careful management.''
     Steve Tsai also travels often with his parents, which he enjoys despite his lack of social skills. At an airport once, Steve was reading USA Today when a fellow traveler asked, "Are these your papers?'' When Steve ignored him, the man turned to his daughter and said, "He doesn't speak English.'' Then he reconsidered. "But he was reading USA Today,'' he said, confused. Merling said all that's required is that others treat her son and all people with autism with respect and understanding. "Just treat them as normal people,'' she said. "Have a little patience when communicating with them. And compassion.''

In the Land of Bold Beauty, a Trusted Mirror Cracks
Larry Rohter, New York Times- 1/14/2007

As king of carnival, the corpulent Rei Momo is supposed to embody all the jollity, carnality and excess associated with that most Brazilian of bacchanals. So when the event’s reigning monarch has gastric bypass surgery, sheds 150 pounds and starts an exercise program, you begin to wonder what’s going on. And when six young women die of anorexia in quick succession — two in the last two weeks — the wonder turns to bewilderment. Brazil may well be the most body-conscious society in the world, but that body has always been Brazil’s confident own — not a North American or European one.
      For women here that has meant having a little more flesh, distributed differently to emphasize the bottom over the top, the contours of a guitar rather than an hourglass, and most certainly not a twig. Anorexia, though long associated with wealthier industrialized countries, was an affliction all but unheard-of here. But that was before the incursions of the Barbie aesthetic, celebrity models, satellite television and medical makeovers made it clear just how far some imported notions of beauty, desirability and health have encroached on Brazilian ideals once considered inviolate.
     By “ ‘upgrading’ to international standards of beauty,” said Mary del Priore, a historian and co-author of “The History of Private Life in Brazil,” the country is abandoning its traditional belief that “plumpness is a sign of beauty and thinness is to be dreaded.” The contradictory result, she added, is that “today it’s the rich in Brazil who are thin and the poor who are fat.”
     A generation ago, the ideal type here was Martha Rocha, a Miss Brazil from the mid-1950s. She finished second in the Miss Universe competition supposedly because her body was a bit too generous in the hips, buttocks and thighs, but since those characteristics were so highly valued here, as suggested by cartoons and the popularity of the semi-pornographic drawings of Carlos Zéfiro that circulated, it was the rest of the world whose taste was questioned. Even the famous “girl from Ipanema,” immortalized in the bossa nova song written in 1962, illustrated the cultural differences that prevailed then: only in the English lyrics is she “tall and tan and young and lovely.” In the original Portuguese version, the emphasis is on “the sweet swing” of her hips and backside as she walks, a sway described as “more than a poem, the most beautiful thing I have ever seen.”
     Today, in sharp contrast, the epitome of beauty is Gisele Bündchen, the top model whose enormous international success has inspired the thousands of Brazilian girls who dream of emulating her to enroll in modeling schools and competitions. But very little about Ms. Bündchen’s body — tall and blond, rangy yet busty — connects her to her homeland and its traditional self-image. “Hers is a globalized beauty that has nothing to do with the Brazilian biotype,” said Joana de Vilhena Novaes, author of “The Intolerable Weight of Ugliness: On Women and Their Bodies” and a psychologist here. “She has very little in the way of hips, thighs or fanny. She’s a Barbie,” one whose parents are of German descent.
     Dr. Novaes and others have noted that during the 1960s and 70s, Brazilian girls played with a locally made doll named Susi, who, reflecting the national aesthetic, was darker and fleshier than her counterparts abroad. But in the 1970s, Barbie arrived, and by the mid-1980s, production of Susi dolls had ceased, though it has resumed in recent years in a sort of backlash. Yet until recently no one here would ever have talked with admiration about having an hourglass figure like Barbie’s, let alone the coat-hanger physiques of the international runways. Instead, the ideal was what is known as “um corpo de violão,” or “guitar-shaped body”; that is, like Susi’s, thicker in the waist, hips and fanny.
     One indication of how rapidly values are changing can be gleaned from a government study released in November, just after the first in the cluster of anorexia deaths, that of Ana Carolina Reston, a 21-year-old model. According to the survey, the percentage of the population taking appetite-suppressants more than doubled between 2001 and 2005, making Brazil the world champion in the consumption of diet pills. “The reasons are purely aesthetic, not medical, especially for women,” who account for at least 80 percent of the market, said Dr. Elisaldo de Araújo Carlini, a professor at the Federal University of São Paulo who is the author of the study. “They want to get thin no matter what, all because of images from north of the Equator. It is a cruel cultural imposition on the Brazilian woman.”
     Women in countries around the world are subject to such pressures, of course. But Brazilians argue that the situation here is more extreme: this is, after all, a tropical country in which, much more than the United States, Europe or Japan, people live their lives outdoors, often, for comfort’s sake, in skimpy clothes showcasing the body’s glories or defects. A result is a culture of vanity that seems to know no boundaries. This summer, the newest rage, according to local news reports, is liposuction on the toes, and there have also been accounts of a boom in plastic surgery among women 80 and older. Men are not immune. President Luiz Inácio Lula da Silva is reported to have recently had cosmetic work done on his teeth, and even the chief of an Indian tribe in the Amazon had plastic surgery because, as he guilelessly put it, “I was finding myself ugly and I wanted to be good-looking again.”
     But most of the complaints about the tyranny of the culture of beauty here come from women. Each year follows the same pattern: Enrollment at gyms, here called “academies,” declines as cool weather arrives and then rises in the final quarter of the year, as women try to prepare their bodies to look good on the beaches during the Southern Hemisphere summer vacation season, which runs from just before Christmas until carnival, about two months later.
     But Brazilian eating habits don’t make the process easy. If the emblematic American meal consists of fried chicken, corn on the cob and apple pie, its Brazilian equivalent is more like this: rice and beans, potatoes, pasta, bread, salad and a slice of meat sprinkled with farofa, or ground and toasted yucca flour. The Brazilian diet is much higher in carbohydrates and lower in protein than is recommended, said Claudia Carahyba, a nutritionist in São Paulo whose clients include modeling agencies that want to break their girls of such bad habits. “That is especially true of the poor,” she said. “Since protein costs more, they trade that for more carbohydrates like yucca, which are cheaper and make you feel full.”
     In fact, the new paradigm has been slower to penetrate poorer regions like the Amazon and the northeast, where hunger is still widespread and the idea of “fartura,” or cornucopian abundance, is especially valued. There, men in particular are proud to show off wives and children whose bodies are more rounded, as a sign that they are good providers. “To be fat used to be considered wonderful in Brazil, because it showed that you eat very well, which is important to Brazilians,” said Roberto da Matta, an anthropologist and newspaper columnist who is a leading social commentator. “That you have three meals a day and eat meat and beans, calmly, at a table with friends and relatives, means that someone is taking good care of you.”
     Experts also agree that Brazilian men, whatever their class or race, have been much slower to accept slenderness as a gauge of feminine beauty. When they are looking for a sexual partner, Brazilian men are consistent and clear in saying that they prefer women who are fleshy in the rear — “popozuda” is the wonderfully euphonious slang term used here — and have pronounced curves. In the past, that standard was so firmly established that some Brazilian women resorted to breast reduction or buttock augmentation surgery, sometimes even transferring their own tissue from top to bottom.
     But as the international standard has taken hold, tastes are changing. “Those huge breasts you see in the United States, like in Playboy, were always considered ridiculous in Brazil,” said Ivo Pitanguy, the country’s most renowned plastic surgeon. “But there is now more of a tendency than before to want breasts that are a bit larger — not to make them huge, mind you, but more proportional as part of a body that is more svelte and more athletic.”
     Though such globalized standards of beauty originated in rich, mostly white neighborhoods, they are gradually being spread to the rest of Brazil and across racial lines by the actresses and models who live here and perform in popular telenovelas. Exercise academies can be found in slum areas, and newspapers noted that the most recent anorexia victim was a dark-skinned teenager from a working-class suburb of Rio who dreamed of becoming a model. In fact, all six women who died of anorexia lived either in Rio de Janeiro or in São Paulo, the country’s most cosmopolitan states and centers of the Brazilian fashion industry. The death that followed Ms. Reston’s was of a 21-year-old fashion student. There was also a 23-year-old student and office worker who had a home page on the Web and gave English lessons.
     Ms. del Priore, the historian, pointed to other fundamental changes, which she said have led to a rebellion against machismo and the patriarchal structure that she believes persists here. “This abrupt shift is a feminine decision that reflects changing roles” as women move out of the home and into the workplace, she said. “Men are still resisting and clearly prefer the rounder, fleshier type. But women want to be free and powerful, and one way to reject submission is to adopt these international standards that have nothing to do with Brazilian society.”

The Mentally Ill, Behind Bars
Bernard Harcourt, New York Times- 1/15/2007

Last August, a prison inmate in Jackson, Mich. — someone the authorities described as “floridly psychotic” — died in his segregation cell, naked, shackled to a concrete slab, lying in his own urine, scheduled for a mental health transfer that never happened. Last month in Florida, the head of the state’s social services department resigned abruptly after having been fined $80,000 and is facing criminal contempt charges for failing to transfer severely mentally ill jail inmates to state hospitals. Ten days ago, the Supreme Court agreed to determine when mentally ill death row inmates should be considered so deranged that their execution would be constitutionally impermissible. The case involves a 48-year-old Navy veteran who is a diagnosed schizophrenic. In the decade leading up to the crime he was hospitalized 14 times for severe mental illness. According to a study released by the Justice Department in September, 56 percent of jail inmates in state prisons and 64 percent of inmates across the country reported mental health problems within the past year.
      Though troubling, none of this should come as a surprise. Over the past 40 years, the United States dismantled a colossal mental health complex and rebuilt — bed by bed — an enormous prison. During the 20th century we exhibited a schizophrenic relationship to deviance. After more than 50 years of stability, federal and state prison populations skyrocketed from under 200,000 persons in 1970 to more than 1.3 million in 2002. That year, our imprisonment rate rose above 600 inmates per 100,000 adults. With the inclusion of an additional 700,000 inmates in jail, we now incarcerate more than two million people — resulting in the highest incarceration number and rate in the world, five times that of Britain and 12 times that of Japan.
     What few people realize, though, is that in the 1940s and ’50s we institutionalized people at even higher rates — only it was in mental hospitals and asylums. Simply put, when the data on state and county mental hospitalization rates are combined with the data on prison rates for 1928 through 2000, the imprisonment revolution of the late 20th century barely reaches the level we experienced at mid-century. Our current culture of control is by no means new. There were many more kinds of mental institutions at mid-century, ones for “mental defectives and epileptics” and the mentally retarded, psychiatric wards in veterans hospitals, as well as “psychopathic” and private mental hospitals. If we include residents of those facilities, from 1935 to 1963 the United States consistently institutionalized at rates well above 700 per 100,000 adults — with highs of 778 in 1939 and 786 in 1955. It should be clear why there is such a large proportion of mentally ill persons in our prisons: individuals who used to be tracked for mental health treatment are now getting a one-way ticket to jail.
     Of course, there are important demographic differences between the two populations. In 1937, women represented 48 percent of residents in state mental hospitals. In contrast, new prison admissions have consistently been 95 percent male. Also, the mental health patients from the 1930s to the 1960s were older and whiter than prison inmates of the 1990s. We have before us a number of troubling questions: Why did we diagnose deviance in such radically different ways over the course of the 20th century? Do we need to be imprisoning at such high rates, or were we right, 50 years ago, to hospitalize instead? Why were so many women hospitalized? Why have they been replaced by young black men? Have both prisons and mental hospitals included large numbers of unnecessarily incarcerated individuals? Whatever the answers, the pendulum has swung too far — possibly off its hinges.
     It would be naïve, today, to address any of these questions without also considering the impact of imprisonment on crime. One of the most reliable studies estimates that the increased prison population over the 1990s accounted for about a third of the overall drop in crime that decade. However, prisons are not the only institutions that seem to have this effect. In a recent study, I demonstrated that the rate of institutionalization — including mental hospitals — was a far better predictor of serious violent crime from 1926 to 2000 than just prison populations. The data reveal a robust negative relationship between overall institutionalization (prisons and asylums) and homicide. Preliminary findings based on state-level panel data confirm these results.
     The effect on crime may not depend on whether the institution is a mental hospital or a prison. Even from a crime-fighting perspective, then, it is time to rethink our prison and mental health policies. A lot more work must be done before proposing answers to those troubling questions. But the first step is to realize that we have been wildly erratic in our approach to deviance, mental health and the prison.
     Bernard E. Harcourt, a professor of law and criminology at the University of Chicago, is the author of “Against Prediction: Profiling, Policing and Punishing in an Actuarial Age.”

Link Seen Between Sleep, Depression
Ann Reuter, Ann Arbor News- 1/15/2007

Waking to the dawn's early light, taking a siesta, going to bed with the chickens. Quaint customs not remotely relevant or practical today, right? Delve into how humans have evolved over millennia, though, and you'll find it's not easy or desirable to override natural mechanisms in the body that guide patterns of rest and activity. The body heeds a 24-hour cycle called circadian rhythm, which guides us to be awake by day and then sink at night into extended slumber.
     Scientists are finding that circadian rhythms are often weak and easily thrown out of kilter in depressed people. Getting the cycle normal again can be an effective way to treat depression, believes sleep physiologist Roseanne Armitage, who heads a small, busy group of University of Michigan researchers at the U-M Sleep and Chronophysiology Laboratory. The researchers are on a mission to find out how depression, which affects an estimated 18 million Americans each year, and the body's sleep-regulating mechanisms are entwined.

Tuning in to the body clock
The natural circadian cycle is messed up in many people with insomnia. They fall asleep only to wake in the wee hours and toss and turn. They often make the problem worse by having irregular bedtimes, drinking too much caffeine and worrying about not being able to sleep. Sleeping in after a fitful night may only make things worse.
     Todd Arnedt, a researcher at the center, has tested several behavioral tools that help poor sleepers. Currently, he's studying sleep problems in recovering alcoholics. He intervenes with practical strategies -- two weeks of restricting one's time in bed to six hours, for instance -- "to reset the brains about how to sleep." Getting less than eight hours of sleep for a time is effective, because deep, restorative slow-brainwave sleep comes after sleep deprivation.
     The lab will move this spring to a custom-designed sleep research facility at the Rachel Upjohn Building, the new home of the U-M Depression Center at the East Ann Arbor Health Center northeast of Ann Arbor. The facility will have six beds instead of the present four and two time-isolation units where subjects in studies will have extended stays. It will allow researchers to do advanced circadian rhythm research. At their present quarters off Plymouth Road, Armitage and colleagues for several years have been actively studying how the body clock develops, starting in infancy, and how it changes in adolescence and in menopause. Among the recent and current research projects are:
• A study that shows warning signs of disturbed sleep occur even before puberty's onset in adolescents at risk for depression.
• Another that looks at male-female differences in sleep disturbance: What works to strengthen the body's sleep clock may be quite different in men vs. women.
• A study of currently depressed adults to see if a cognitive behavioral intervention can improve their sleep and also alleviate their depression.

Kids and depression
Work in the lab on depression and sleep issues in adolescents is yielding some surprises. For one thing, Armitage says, "long before the onset of puberty, there are clear sex differences." It's commonly thought that depression happens most frequently in women between adolescence and menopause because female hormones play a key role.
     Armitage's research shows that even before puberty, depressed girls have a weak circadian clock. They are not as responsive as others to changes in light. If the other cues that keep us on a 24-hour day are absent, wake-sleep patterns can become erratic. "So it's not just hormones," Armitage says. Then, when the hormonal changes of puberty hit, these girls' body docks get weaker still.
     In one experiment, the center compared brain-wave data in girls at puberty who had depressed mothers and girls at puberty with nondepressed mothers. The researchers found they could identify girls at puberty whose brain-wave patterns showed they were at risk of developing depression. In a follow-up, they found that half the girls in the high-risk group had developed symptoms in their mid-teens.
     Girls in a current study, who are at heightened risk of getting depression, get intense light exposure three times a day. "We get them to get up and move more," says Armitage: playing basketball, walking the dog, walking to a friend's house all help them expend energy and pump up their circadian rhythm. The point is to get these preteens, and at-risk adults as well, attuned to the natural rhythms that govern healthful periods of activity and rest.
     Armitage doesn't see the interventions her lab develops as alternatives to antidepressant drugs. "I'm all for correcting the underlying physiology of depression," she says. But if people take anti-depressant medications but don't have their sleep problems addressed, they won't likely put their depression behind them, she and Arnedt say.



Drug Helps Hypochondriacs Calm Their Fears of Illness
Washington Post, 1/15/2007

Now, a real pill for your unreal illness. Scientists report that the anti-depressant Paxil helped hypochondriacs be less fearful about getting sick. In the first controlled study that compared a group of hypochondriacs given the drug with a group that got psychological talk therapy and another group that received sugar pills, the medication significantly reduced people's fears about imaginary illnesses.
     Before the trial, one, 40-year-old, who said he had fears starting at age 10 that he was going to die in his sleep, rated his certainty that he was suffering from a serious illness as an 8 on a scale of 1 to 10. After six weeks on Paxil, his fear level dropped to a 4 -- an improvement that led him to continue the medication after the. trial.
     According to the standard manual of mental disorders, hypochondriasis is a potentially serious condition that can prompt people to go doctor shopping, abuse sick time at work and become complete invalids.

In December, a Kane County judge ruled the law constitutional but ordered the teen's name off the list, pending appeal.

States take different tacks
To date, 36 states have passed laws requiring juvenile sex offenders to register as adults with authorities, and many are starting to require those lists be made public at some point, according to the National Center for Juvenile Justice. But the laws vary greatly in scope, and some face court challenges.

Some states allow juveniles to petition to stay off the lists. Others have enacted "Romeo and Juliet" laws exempting teens who engage in consensual sex. Three states passed laws creating a hearing process by which juveniles are placed on public lists.

A new federal law called the Adam Walsh Act could spur even more change, as states try to fall in line with the law or face grant reductions.

Illinois' law, passed unanimously in 2005, is broader than the federal law, and its stricter elements would remain under federal statute. The Illinois law requires juveniles who commit any sex offense at any age to register for the public registry when they turn 17. It does not allow for cases of teen consensual sex to be excluded.

"Illinois went so far to the extreme when it made it mandatory," said Betsy Clarke, president of the Springfield-based Juvenile Justice Initiative. "They took all discretion away from the judges, from the prosecutors, from everyone involved."

Opponents say juveniles cannot be held to the same standards as adult sex offenders because they are not afforded jury trials. They point to national studies that find juveniles could benefit from treatment.

Contrary to popular public opinion, juvenile sex offenders are actually less likely to re-offend than adults or other non-sexual juvenile offenders, said Dr. Mark Chaffin, pediatrics professor at the University of Oklahoma and co-director of the National Center on the Sexual Behavior of Youth. Researchers place juvenile sex offender recidivism at somewhere between 5 and 15 percent, he said.

Curiosity and opportunity, the idea of "wanting to know what sex is like," drives many juvenile sex offenders, Chaffin said.

"It's not the same kind of deviant sexual attraction pattern as with adults," Chaffin said.

Victim advocates caution that those numbers don't account for the large number of sexual crimes, especially those among children, which aren't reported.

More cases may go to trial
A major concern among victim advocates and juvenile-justice leaders is that youth offenders, fearful of the public lists, will take their cases to trial, and more young victims will have to testify.

Faced with having to register publicly, juveniles may not agree to treatment and rehabilitation, they argue.

Legislators last summer used Tegeler's case in Kane County to highlight the need for scaling back the state's new law and passed a bill giving judges discretion over which juvenile offenders get on the public list.

But in July, Gov. Rod Blagojevich vetoed the bill, writing that he could not "condone leniency towards sex offenders." State Rep. Annazette Collins (D-10th), who proposed the bill, is still pushing for change.

Yet victim advocates say striking the right balance between community protection and juvenile privacy remains is no easy task.

"If the victim is a victim of a sex crime, it doesn't matter to them what the age of the offender is," said Lyn Schollett, general counsel to the Illinois Coalition Against Sexual Assault.



51% of Women Are Now Living Without Spouse
Sam Roberts, New York Times- 1/16/2007

For what experts say is probably the first time, more American women are living without a husband than with one, according to a New York Times analysis of census results. In 2005, 51 percent of women said they were living without a spouse, up from 35 percent in 1950 and 49 percent in 2000. Coupled with the fact that in 2005 married couples became a minority of all American households for the first time, the trend could ultimately shape social and workplace policies, including the ways government and employers distribute benefits.
     Several factors are driving the statistical shift. At one end of the age spectrum, women are marrying later or living with unmarried partners more often and for longer periods. At the other end, women are living longer as widows and, after a divorce, are more likely than men to delay remarriage, sometimes delighting in their newfound freedom.
     In addition, marriage rates among black women remain low. Only about 30 percent of black women are living with a spouse, according to the Census Bureau, compared with about 49 percent of Hispanic women, 55 percent of non-Hispanic white women and more than 60 percent of Asian women. In a relatively small number of cases, the living arrangement is temporary, because the husbands are working out of town, are in the military or are institutionalized. But while most women eventually marry, the larger trend is unmistakable.
      “This is yet another of the inexorable signs that there is no going back to a world where we can assume that marriage is the main institution that organizes people’s lives,” said Prof. Stephanie Coontz, director of public education for the Council on Contemporary Families, a nonprofit research group. “Most of these women will marry, or have married. But on average, Americans now spend half their adult lives outside marriage.” Professor Coontz said this was probably unprecedented with the possible exception of major wartime mobilizations and when black couples were separated during slavery.
      William H. Frey, a demographer with the Brookings Institution, a research group in Washington, described the shift as “a clear tipping point, reflecting the culmination of post-1960 trends associated with greater independence and more flexible lifestyles for women.” “For better or worse, women are less dependent on men or the institution of marriage,” Dr. Frey said. “Younger women understand this better, and are preparing to live longer parts of their lives alone or with nonmarried partners. For many older boomer and senior women, the institution of marriage did not hold the promise they might have hoped for, growing up in an ‘Ozzie and Harriet’ era.”
     Emily Zuzik, a 32-year-old musician and model who lives in the East Village of Manhattan, said she was not surprised by the trend. “A lot of my friends are divorced or single or living alone,” Ms. Zuzik said. “I know a lot of people in their 30s who have roommates.” Ms. Zuzik has lived with a boyfriend twice, once in California where the couple registered as domestic partners to qualify for his health insurance plan. “I don’t plan to live with anyone else again until I am married,” she said, “and I may opt to keep a place of my own even then.”
      Linda Barth, a 56-year-old magazine editor in Houston who has never married, said, “I used to divide my women friends into single friends and married friends. Now that doesn’t seem to be an issue.”
     Sheila Jamison, who also lives in the East Village and works for a media company, is 45 and single. She says her family believes she would have had a better chance of finding a husband had she attended a historically black college instead of Duke. “Considering all the weddings I attended in the ’80s that have ended so very, very badly, I consider myself straight up lucky,” Ms. Jamison said. “I have not sworn off marriage, but if I do wed, it will be to have a companion with whom I can travel and play parlor games in my old age.”
     Carol Crenshaw, 57, of Roswell, Ga., was divorced in 2005 after 33 years and says she is in no hurry to marry again. “I’m in a place in my life where I’m comfortable,” said Ms. Crenshaw, who has two grown sons. “I can do what I want, when I want, with whom I want. I was a wife and a mother. I don’t feel like I need to do that again.”
     Similarly, Shelley Fidler, 59, a public policy adviser at a law firm, has sworn off marriage. She moved from rural Virginia to the vibrant Adams Morgan neighborhood of Washington, D.C., when her 30-year marriage ended. “The benefits were completely unforeseen for me,” Ms. Fidler said, “the free time, the amount of time I get to spend with friends, the time I have alone, which I value tremendously, the flexibility in terms of work, travel and cultural events.”
      Among the more than 117 million women over the age of 15, according to the marital status category in the Census Bureau’s latest American Community Survey, 63 million are married. Of those, 3.1 million are legally separated and 2.4 million said their husbands were not living at home for one reason or another. That brings the number of American women actually living with a spouse to 57.5 million, compared with the 59.9 million who are single or whose husbands were not living at home when the survey was taken in 2005. Some of those situations, which the census identifies as “spouse absent” and “other,” are temporary, and, of course, even some people who describe themselves as separated eventually reunite with their spouses.
      Over all, a larger share of men are married and living with their spouse — about 53 percent compared with 49 percent among women. “Since women continue to outlive men, they have reached the nonmarital tipping point — more nonmarried than married,” Dr. Frey said. “This suggests that most girls growing up today can look forward to spending more of their lives outside of a traditional marriage.” Pamela J. Smock, a researcher at the University of Michigan Population Studies Center, agreed, saying that “changing patterns of courtship, marriage, and that we are living longer lives all play a role.” “Men also remarry more quickly than women after a divorce,” Ms. Smock added, “and both are increasingly likely to cohabit rather than remarry after a divorce.”
     The proportion of married people, especially among younger age groups, has been declining for decades. Between 1950 and 2000, the share of women 15-to-24 who were married plummeted to 16 percent, from 42 percent. Among 25-to-34-year-olds, the proportion dropped to 58 percent, from 82 percent. “Although we can help people ‘do’ marriage better, it is simply delusional to construct social policy or make personal life decisions on the basis that you can count on people spending most of their adult lives in marriage,” said Professor Coontz, the author of “Marriage, a History: How Love Conquered Marriage.”
      Besse Gardner, 24, said she and her boyfriend met as college freshmen and started living together last April “for all the wrong reasons” — they found a great apartment on the beach in Los Angeles. “We do not see living together as an end or even for the rest of our lives — it’s just fun right now,” Ms. Gardner said. “My roommate is someone I’d be thrilled to marry one day, but it just doesn’t make sense right now.”
     Ms. Crenshaw said that some of the women in her support group for divorced women were miserable, but that she was surprised how happy she was to be single again. “That’s not how I grew up,” she said. “That’s not how society thinks. It’s a marriage culture.”
     Elissa B. Terris, 59, of Marietta, Ga., divorced in 2005 after being married for 34 years and raising a daughter, who is now an adult. “A gentleman asked me to marry him and I said no,” she recalled. “I told him, ‘I’m just beginning to fly again, I’m just beginning to be me. Don’t take that away.’ ” “Marriage kind of aged me because there weren’t options,” Ms. Terris said. “There was only one way to go. Now I have choices. One night I slept on the other side of the bed, and I thought, I like this side.” She said she was returning to college to get a master’s degree (her former husband “didn’t want me to do that because I was more educated than he was”), had taken photography classes and was auditioning for a play. “Once you go through something you think will kill you and it doesn’t,” she said, “every day is like a present.”