Noteworthy News Articles on Mental Health Topics, January 17-20, 2007 Bill Cormier, Associated Press- 1/17/2007 Radio La Colifata -- whose name derives from Argentine slang for "colifa" or "crazy one" -- began 15 years ago to help patients communicate with their peers, to carry their voices beyond the hospital walls and to break down public misconceptions and prejudices about the mentally ill. Launched with taped segments sent to a local station, the four-hour program now goes live every Saturday. It can be heard across the Argentine capital, an area home to 10 million people. Via the Internet, it also is heard on more than 30 radio stations in Argentina and elsewhere in Latin America. And stations worldwide can download segments from the station's Web site, www.lacolifata.org. "This radio station has opened up a space for people to recover their dignity, to have their own say and to speak over the radio and find a new place in their community," said Radio La Colifata's founder, psychologist Alfredo Olivera. Veronica Rubens, a psychologist with no ties to the radio, lauded the idea. "Many of them are shut up inside the hospital and cannot go out. So this is a good way for people to express themselves and insert themselves into society." On a recent Saturday, dozens of patients wandered the grassy compound of drab buildings. Some mumbled and one shouted angrily. Some were disheveled and bandaged, others chain-smoked. At the radio command center -- a simple wooden table, a mixing board and microphones -- a patient wrote a neat list of a dozen programs that would air that day: news, sports, police reports, poetry, interviews. Guided by Olivera and his team, the patients began transmitting. On this day, patients swapped the microphone to discuss "happiness." For one patient it was friends, for another a new sports car or a succulent seafood dinner. The program is an eclectic mix and includes interviews, music, poetry and storytelling. The level of discourse on current events sometimes shows a logic and civility often absent from commercial radio shows. One outpatient, Julio, spent a year in the hospital and said the program keeps him sane. "For many on the inside, the walls are impenetrable barriers and the only way to get out is via the microphone," he said. "But people are listening and that surprised us all. Listeners have e-mailed back from Bolivia, Mexico, even Spain." Volunteers also participate, including two young women who played the drums. Many patients danced gleefully, and one man pulled a toy cap gun from his pocket as if to fire to the beat of a song. Fernando, another patient, said the program helps break the stereotype of the mentally ill. Olivera, who launched the radio show, requested that Fernando and the other patients not be fully identified to safeguard their privacy. "A person with psychiatric problems is still a person who thinks, a person who wants to live peacefully on the outside again," he said. "Yes, there are people who have been here 30 years or more with little possibility of recovery, but there are also many who are going through therapy in order to leave." `Dex' Abuse Up Among Teens, Researchers Say Sandra Boodman, Washington Post- 1/17/2007 Dextromethorphan, the active ingredient in many widely available non-prescription cough and cold remedies, has a nefarious use that some teenagers know well: as a cheap intoxicant that at high doses can induce euphoria and hallucinations. A recent study by researchers at the University of California at San Francisco School of Pharmacy and the California Poison Control System has found that the drug -- also known as "Dex," "Poor Man's PCP" and "Robo" (short for Robitussin, which in some formulations contains it) -- is increasingly popular among 15- and 16-year-olds looking to get high. Between 1999 and 2004, the poison-control system saw a tenfold jump in cases involving abuse of the drug. The most commonly abused product was Coricidin HBP Cough & Cold Tablets, according to the federally funded study, which appeared in the December issue of the Archives of Pediatric & Adolescent Medicine. In 1999, the researchers say, 48 cases of abuse were reported to the California poison system, compared with 478 in 2004. Sixty percent of the 1,382 calls during the six-year study involved boys. Most cases, researchers said, resulted in mild or moderate problems, while seven resulted in severe problems, including breathing difficulties that required intubation. Side effects: According to the authors, led by UCSF pharmacist Jodi Bryner, dextromethorphan abuse dates to the 1960s. In the last few years, the authors say, there has been a resurgence of abuse involving the drug, fueled in part by Web sites aimed at teenagers that promote it. Some adolescents, they write, mistakenly believe using cough medicines to get high is safe because the drugs are available without a prescription and are widely used. There is insufficient awareness, they write, that at high doses dextromethorphan can cause psychosis, agitation and seizures. Other worries: The cough-control drug can be especially dangerous when mixed with another widely used over-the-counter product -- the pain reliever acetaminophen, which also is found in many cough and cold products. At high doses, acetaminophen, the active ingredient in Tylenol, can cause liver problems, including life-threatening liver failure, which can develop hours later, after the symptoms of dextromethorphan abuse have cleared. Hypnotherapy for Weight Loss? Chris Woolston, Los Angeles Times- 1/17/2007 Hypnotherapists across the country are staking claim to the multibillion-dollar weight-loss industry. Through Web sites, newspaper classifieds, radio spots and local TV ads, they pitch waist-reducing therapy sessions and slimming CDs. Some even offer to hypnotize clients over the phone. The claims: The word "effortless" dominates ads for weight-loss hypnosis. Many practitioners claim that hypnosis can help people embrace exercise and healthy foods -- little or no willpower required. In a tone reminiscent of a revival preacher, L.A. hypnotherapist Michael Almaraz assures CD listeners that his words will "strengthen your determination and desire, giving you much more self-control than ever before." Others claim that clients can use brainpower to boost their metabolism and shed fat. "Healthy & Natural Weight Loss," a CD by L.A. hypnotherapist Monte Hueftle, lulls the listener with phrases such as, "I can sense my body burning more calories efficiently, naturally and safely." The reported results often border on the miraculous. According to the Web site of Steve G. Jones, a hypnotherapist in Savannah, Ga., hypnosis can "increase metabolic rate by 76.9 percent without exercise" and "reduce 40-70 percent overall fat under skin." Bottom line: Dr. David Spiegel, medical director of the Stanford Center for Integrative Medicine in Stanford, Calif., believes in the therapeutic value of hypnosis. (As past president of the Society for Clinical and Experimental Hypnosis, he had better.) But even he says that the vast majority of weight-loss claims made by hypnotherapists are bunk. "It's a caricature of real hypnosis," Spiegel said. Real hypnotherapists use calming words and mental imagery to focus a client's attention. Hypnosis doesn't put people in a trance or force them do things against their will, but it can help people gain more control over their thoughts and emotions. When done properly, hypnosis can relieve stress, ease pain or help people quit smoking, Spiegel said. But no hypnotherapist can honestly promise dramatic weight loss. At best, Spiegel said, hypnosis might help someone shave off a few pounds by curbing stress-related food binges or sharpening a commitment to a healthy lifestyle. The most recently published study -- released nearly nine years ago by British researchers -- found modest benefits. Sixty obese patients received either dietary advice alone or advice combined with hypnotherapy geared toward reducing stress or curbing appetite. Three months later, all three groups had lost 2 percent to 3 percent of their body weight. After 18 months, only the stress-reduction group had maintained weight loss: about 8 pounds. The lack of hypnosis studies since the 1990s reflects a dearth of interest in the approach among weight-loss experts, said Daniel Kirschenbaum, director of the Center for Behavioral Medicine & Sport Psychology in Chicago. The overall record of hypnosis in scientific weight-loss studies has been "deeply unimpressive," he said. "Weight loss is not effortless. We have to get away from such nonsense." Spiegel believes that hypnosis can play a small but helpful part in a larger plan to lose weight. He recommends finding a psychiatrist or psychologist -- an MD or a PhD -- with experience in the technique. "Many people making weight-loss claims," he said, "learned hypnosis during a weekend seminar." Abstinence Works Melissa Healey, Los Angeles Times- 1/17/2007 A team of European researchers used magnetic resonance imaging to assess the brains of 15 alcohol-dependent and 10 healthy subjects and tracked the volume of two key brain chemicals that are indicators of cell health and activity. The subjects were given a battery of tests of cognitive function at the beginning and end of the study. As the 10 male and five female alcoholics embarked on a journey of sobriety, the team of radiologists plotted a remarkable story of comeback. In less than two months without alcohol consumption, the brain volume of alcoholic subjects increased, on average, 1.85 percent. Cerebellar choline levels - indicators of how well brain cells are able to relay messages - increased 20 percent. Levels of another brain chemical that indicates proper function of the brain cells went up 10 percent. The more dramatic those changes, the greater the improvement in a subject's performance on tests of cognitive function. The study is among the first to show where regeneration occurs most robustly in the early days of an alcoholic's recovery - in the brain's ventricles and in the white matter that helps brain cells and brain regions coordinate and communicate more smoothly with one another. By comparison, the brains of healthy subjects, who also were asked to abstain from alcohol during the study period - did not change. Dr. Andreas Bartsch of the University of Wurzburg, in Germany, says the study, when added to several that have shown similar resilience on the part of the brain under assault by alcohol, holds a hopeful message for drinkers beset by lapses of memory, motivation and judgment. "Abstinence pays off and enables the brain to regain some substance and perform better," Bartsch says. "The adult human brain, and particularly its white matter, seems to possess genuine capabilities for regrowth." The study is the latest and most detailed of a mounting body of research showing how alcohol - even heavy drinking that falls short of dependence - can impair cognition, and how abstinence can prompt at least a partial reversal of intellectual deficits. Those studies have established that alcoholism can cause significant loss of short-term memory skills and of higher-order functions such as reasoning, planning and prioritizing. In adults as well as adolescents, alcohol abuse was associated with changes in the brain - in particular in the prefrontal cortex, the seat of higher reasoning. The most well-documented alcohol-related impairments occur in a drinker's visual-spatial skills - those that allow us to drive, read a map and orient ourselves in three-dimensional space. A Stanford University study published in August found that although middle-age alcoholics who had been abstinent for as little as six months regained virtually all lost function on measures of abstraction, attention, memory, reaction time and verbal skills, the damage to their visual-spatial skills was not so easily undone. Studies have found that women are particularly vulnerable to the cognitive effects of alcoholism, and that smoking tobacco during recovery can significantly hamper the brain's process of self-repair. The length of a person's descent into alcoholism also is key, a point that Bartsch's study underscores. Bartsch says that among the 15 alcohol-dependent patients who participated in his study, the degree to which a subject showed return of lost brain volume and function correlated with the duration of their alcoholism. Those who had been dependent longest showed more modest, and in one case no, recovery, he says. That's why, he says, it's important for alcoholics to quit as soon as possible, before secondary medical or psychiatric disorders make recovery harder and cognitive deficits more difficult to reverse. To Clancy Imislund, a recovering alcoholic who is managing director of Los Angeles' Midnight Mission, research that details the comeback of cognitive function hits home but also misses a key point. "It's a funny thing: The brain of an alcoholic is really a dried-out brain," says Imislund, referring to research suggesting that alcohol cripples and kills brain cells, in part, by dehydrating them. "As the alcohol goes out of your system and the synapses get to working better, if you stay sober for a while, it's been my experience they come back pretty well." But Imislund adds that, with abstinence, alcoholics must face the outside world again, and the challenge of doing so reinvigorates the brain - a dynamic that research, he acknowledges, may never capture. "When you straighten out, you get going again and you get some focus outside of yourself," Imislund says. Alcoholics, he adds, may "appear to be mentally retarded. They're not, they're just mentally self-obsessed. They need to be pulled out of themselves. And that's when your cognitive abilities return, I believe." In a commentary accompanying Bartsch's study, Yale University psychiatrist Graeme Mason wrote that physicians treating alcoholics in recovery could use the latest research to encourage those patients by holding out the prospect that abstinence will pay off with real gain in intellectual function. Starting Age Affects Drinking David Brown, Washington Post- 1/17/2007 People who start drinking alcohol at a young age are more likely to drink a lot when they get older - and to get into trouble with it. That has been known for a while and is not much of a surprise. A new study, however, sheds important light on one reason that early drinkers often become heavy - or dependent - older drinkers. It's because they are more likely to use alcohol as a "stress reducer" than do people who began drinking at an older age. Alcohol, it seems, becomes an overused tool for weathering the trials of adulthood if a person first uses it as a young teenager. Deborah A. Dawson, of the federal government's National Institute on Alcohol Abuse and Alcoholism, analyzed the responses of nearly 27,000 people in a nationally representative survey of Americans and their drinking habits. The respondents, average age 43, were asked when they started drinking, how much they drank now and whether they had experienced any of 12 stressful events in the previous year. The events include such things as death of a family member, financial crises, marital disruption and loss of a job. Regardless of when people started drinking, alcohol use increased with the number of stressful events a person experienced. People who started drinking at 14 or younger and reported six or more "stressors" in the previous year consumed an average of six drinks a day - five times the amount of similarly stressed people who started drinking at 18 or older. The early drinkers increased their alcohol intake 19 percent with each additional stressful event they suffered, compared with only 3 percent by the later-starting drinkers. The trend of youthful drinkers' growing into adults who rely on alcohol to cope was evident even when the scientists considered only events that heavy drinking was not likely to have caused - things such as the death or illness of a family member, a new living situation or a change in work hours. Help, I’m Surrounded by Jerks Stephanie Rosenbloom, New York Times- 1/18/2007 Certain mortals have the power to sink hearts and sour moods with lightning speed. The hysterical colleague. The meddlesome neighbor. The crazy in-law. The explosive boss. A mélange of cantankerous individuals, they are united by a single achievement: They make life miserable. You call them jerks, dolts and nitwits. Psychologists call them “difficult people.” In fact they are difficult in so many ways that they have been classified into species like the Complainer, the Whiner and the Sniper, to name but three. But in an age when no problem goes unacknowledged or unaddressed, living with such people is no longer the only choice. Instead, an industry of books and seminars has sprung up, not to help the difficult change their maddening ways, but to help the rest of us cope with them. Two decades ago there were only a handful of books offering advice on how to defang the dears. Today there are scores of seminars, workbooks and multimedia tools to help people co-exist with those they wish did not exist. In the spring, Career Press is to publish “151 Quick Ideas to Deal With Difficult People” by Carrie Mason-Draffen. But numerous resources are already on the market, including the succinctly titled “Since Strangling Isn’t an Option” by Sandra A. Crowe. Next month the Career and Professional Development Center at Duke Law School will for the first time offer a workshop called Dealing With Conflict and Difficult People. In September the negotiation program in Harvard Law School’s executive education series will present a seminar called Dealing With Difficult People and Difficult Situations. And the Graduate School, United States Department of Agriculture, which offers continuing education classes, has scheduled more than half a dozen seminars entitled Positive Approaches to Difficult People for this year. The lessons include common sense (talk it out and put yourself in their shoes), character by character tactical road maps and something that the victims of the difficult don’t want to hear: they might be the problem. Nan Harrison, the vice president of training resources and publication sales for CareerTrack, which every month presents more than 50 public “difficult people” seminars across the country, attributes the increased popularity of such workshops to a desire to improve workplace skills in a time of corporate downsizing and a more competitive job market. “I think the stakes have gotten higher for everyone,” she said. Other conflict-resolution specialists suggested an unexpected reason for the increasing interest: A post-9/11 desire to make peace, even if it is merely with the wet blanket in the adjoining cubicle. Whatever the reason, “difficult people” gurus are in demand. That is perhaps because everyone knows at least one person who can set the blood boiling. They can be found in corporate offices, on co-op boards, in church choirs and on university faculties. They are the office Cassandra who predicts doom for every project her team initiates, the intimidating boss for whom nothing is ever good enough and the unreasonable receptionist at the motor vehicles office. “They’re very disruptive, these people,” said Brook Zelcer, a tennis pro and an English teacher in Westwood, N.J. On the tennis court, Mr. Zelcer has been served up his share of overbearing and impatient parents. One stood out as truly difficult: The father who gave his wife play-by-plays of his daughter’s matches on his cellphone, disrupted games by shouting from the stand, encouraged his daughter to cheat during matches and drove her to tears. Mr. Zelcer tried to control the father, but all he got was a phone call from the man insisting he loved his child. “That’s one of the reasons I quit coaching,” Mr. Zelcer said. “I couldn’t deal with these people.” For Ann Rothman, a Manhattan real estate agent, her difficult person is a know-it-all friend who simply cannot be pleased. “She’s a superior human being, and she comes from a superior area — Berkeley, Calif.,” Ms. Rothman said. “She has told me many times that there are only two places to get good food. One of them is Berkeley, and one of them is France. And France is only second to Berkeley.” Difficult people are not harmless. The impact of slowing productivity or creating unhappy customers and vendors is immeasurable, unknowable and often a company’s biggest cost, said Ms. Harrison of CareerTrack, paraphrasing W. Edwards Deming, a management consultant. Yet, some scholars say, the problem is not the difficult people themselves. It is you. “There’s a good quote from the Talmud,” said Bruce Elvin, an associate dean and the director of the Career and Professional Development Center at Duke Law School. “ ‘We do not see the world as it is. We see the world as we are.’ That really in my view sums this topic up.” He and others say that rather than seeing the office curmudgeon or the post office nitpicker as the sum of their most wretched behavior, it is better to think of them as full people, even to empathize with them, if only to maintain some sense of control. Easier said than done. But psychologists say people exhibit difficult behavior because they have a need that is not being met. Understanding that need — a colleague may be snappish, for instance, because his personal life is in turmoil — helps take the sting out of his or her actions, they say. “Some people really are bad people,” said Mark I. Rosen, a social scientist at Brandeis and the author of “Thank You for Being Such a Pain: Spiritual Guidance for Dealing With Difficult People,” “but I don’t think the percentage is as high as people think it is.” Instead, he said, “most people fall into the category of incompetent or oblivious.” Several authors think it is useful to characterize infuriating people into types and prescribe ways to deal with them, as Robert M. Bramson did in 1981 in “Coping With Difficult People,” one of the first popular books on the topic. Its overarching lesson is to find a way to communicate with these people because they are not going away. Dr. Bramson lists seven difficult behavior types: Hostile-Aggressives, Complainers, Silent and Unresponsives, Super-Agreeables, Know-It-All Experts, Negativists and Indecisives. These authors say that after categorizing the difficult behavior, you can take steps to rein it in. For example, Dr. Rick Brinkman, a seminar leader and an author of “Dealing With People You Can’t Stand: How to Bring Out the Best in People at Their Worst,” calls one category Whiners. These people rattle off an endless loop of complaints and must be coaxed into problem solving. He suggests listening to them and letting them vent. Chances are, he said, their complaints will be vague and exaggerated. When they begin to repeat their gripes, summarize for them what they have said. Then begin asking specific questions. “You have to keep asking them what they think they should do,” Dr. Brinkman said, to press for resolutions. You might finally say something outrageous, like “What if we were to kill everyone in the other department?” The literature on difficult people often focuses on the workplace, but business scholars say that neither your department nor “the other department” has a corner on the difficult people market. Rather, as Richard Freedman, the distinguished service professor of management at the Leonard N. Stern School of Business of New York University, put it, “Difficult people are distributed evenly throughout society.” “How many mother-in-law stories have you heard?” he asked. “It’s not disproportionate in the workplace, but often what it is, is that the stakes are so big for people. Career is at the center of people’s lives.” Workplaces are competitive environments comprising individuals with disparate styles of working and communicating. With so many temperaments thrown together, every office is a powder keg. For instance, there are those who think they are powerless, that their ideas go unheard or are dismissed and who believe they are not valued, feelings that can turn into chronically difficult behavior. In the end, the specialists say, we cannot control other people, only our response to them. Then again, we can always let nature take its course. “Having somebody who is really difficult can actually be good for the workplace,” said Jo-Ellen Pozner, a researcher in the Kellogg School of Management at Northwestern. “If everyone really hates this one person, it becomes the basis of social bonding for the rest of the group.” Nicotine Boost Was Deliberate, Study Says Stephen Smith, Boston Globe- 1/18/2007 Data supplied by tobacco companies strongly suggest that in recent years manufacturers deliberately boosted nicotine levels in cigarettes to more effectively hook smokers, Harvard researchers conclude in a study being released today. The companies increasingly used tobacco richer in nicotine and made design changes to give smokers more puffs per cigarette, according to the analysis from the Harvard School of Public Health. The report expands on a landmark Massachusetts Department of Public Health study issued last August showing that the amount of nicotine that could be inhaled from cigarettes increased an average of 10 percent from 1998 through 2004. The Harvard researchers, who corroborated the basic findings of the state study, wanted to determine why cigarettes were delivering more nicotine. The state report did not address causes . "Industry says it's changed," said Greg Connolly, an author of the Harvard study and former director of the state health agency's Tobacco Control Program. "Yeah, they've changed -- maybe for the worse." Philip Morris, the biggest US tobacco maker, released a statement last night challenging the Harvard study. The company said that nicotine levels of its top-selling Marlboro product have fluctuated, but that the rates in 1997 and 2006 were identical. The Harvard study, which was begun several months ago, did not include 2006 data. The two other leading cigarette makers, Lorillard Tobacco Co. and R.J. Reynolds Tobacco Co., did not return phone calls yesterday seeking comment on the study. The Harvard study relies on information supplied by the industry. A 1996 state law required cigarette makers to test the nicotine that could be inhaled from their products, and the state ordered the use of machines that simulate a typical smoker's puffing. State regulations also require cigarette companies to provide other information to the Department of Public Health related to the delivery of nicotine, a substance that makes smoking more addictive and pleasurable. The state required companies to provide measures of nicotine concentration in tobacco, the number of puffs yielded by each cigarette, and the design of the filter. The Harvard researchers used a sophisticated statistical analysis to examine data from the companies covering 1997 through 2005, two years more than the earlier state study. Like the Department of Public Health report, the Harvard study found that levels of inhalable nicotine during that period increased regardless of whether the cigarettes were menthol, full flavor, light, or ultralight. The researchers used the company data to review possible causes for the increase and concluded that the single most important factor in the increased rates of inhalable nicotine was the amount of nicotine in the tobacco chosen for the cigarettes. "It was systematic, it was pervasive, it involved all the manufacturers, and it was by design," said Dr. Howard Koh, an associate dean at the Harvard School of Public Health and an author of the study. Another author said that the likelihood that the nicotine increase happened by chance was less than 1 in 1,000. The study also said that the company data showed an increase in the number of puffs per cigarette, which the researchers said was probably due to a design change, but they could not determine the mechanism for that increase. One activist expressed no doubt about what caused the changes . "The tobacco industry is clearly looking to addict people quickly and to keep them heavily addicted by making it really, really hard for them to quit," said Diane Pickles, executive director of the advocacy group Tobacco Free Massachusetts, which was not involved with the study. The Harvard researchers, as well as antismoking forces, said the study offers compelling evidence that the federal government should regulate tobacco much the way pharmaceuticals are controlled by the US Food and Drug Administration. Senator Edward M. Kennedy is reviving long-stalled legislation that would give the FDA extensive authority over the sale, distribution, and advertising of tobacco products. A spokeswoman for Kennedy said last night that the senator intends to introduce the legislation in the next couple of weeks and conduct hearings shortly thereafter. "Congress has been an accomplice in the travesty because of the success of the tobacco lobby in blocking real reform," Kennedy, a Massachusetts Democrat, said in a statement. The Harvard researchers included a broader range of data than the state report in their search for the underlying cause of increases in inhalable tobacco. State officials said that in order to release their report as quickly as possible and to keep it accessible, they chose to limit the scope of their August study. "We tried to do as simple an analysis as we possibly could," said Tom Land, a research analyst in the state's Tobacco Control Program. "We wanted as many people as possible to understand it." In reports such as those generated by Harvard and the state, researchers look for trends while acknowledging that figures can fluctuate year to year. For instance, the Harvard researchers present data showing that inhalable nicotine in Marlboro brands generally trended upward from 1997 through 2005, although levels declined slightly in the last two years covered in the study. In its statement, Philip Morris said, "There are random variations in cigarette nicotine yields, both upwards and downwards, and those variations are not consistent in either direction across reporting years." Connolly and state health officials dispute that assertion, saying that their research shows a consistent upward trend. The company also said, "Philip Morris USA agrees with the authors that cigarettes are addictive and harmful." The Harvard researchers do not speculate in the study on how companies might have chosen tobacco with higher nicotine content, but veterans of the war on tobacco suggested possibilities. They pointed, for example, to US government documents showing that in the 1980s one company, Brown & Williamson, bred tobacco in Brazil with twice the nicotine content of its standard product. Matt Myers, head of the Campaign for Tobacco-Free Kids, said that companies can also manipulate nicotine levels by choosing parts of the tobacco plant known to have high concentrations of the addictive ingredient. "The evidence is clear that the tobacco companies are capable of and do carefully regulate the level of nicotine in their products," Myers said. "The consistent increase over a period of years can't happen by accident." On the Net: Expert Ties NFL Ex-Player’s Suicide to Brain Damage Alan Schwarz, New York Times- 1/18/2007 Since the former National Football League player Andre Waters killed himself in November, an explanation for his suicide has remained a mystery. But after examining remains of Mr. Waters’s brain, a neuropathologist in Pittsburgh is claiming that Mr. Waters had sustained brain damage from playing football and he says that led to his depression and ultimate death. The neuropathologist, Dr. Bennet Omalu of the University of Pittsburgh, a leading expert in forensic pathology, determined that Mr. Waters’s brain tissue had degenerated into that of an 85-year-old man with similar characteristics as those of early-stage Alzheimer’s victims. Dr. Omalu said he believed that the damage was either caused or drastically expedited by successive concussions Mr. Waters, 44, had sustained playing football. In a telephone interview, Dr. Omalu said that brain trauma “is the significant contributory factor” to Mr. Waters’s brain damage, “no matter how you look at it, distort it, bend it. It’s the significant forensic factor given the global scenario.” He added that although he planned further investigation, the depression that family members recalled Mr. Waters exhibiting in his final years was almost certainly exacerbated, if not caused, by the state of his brain — and that if he had lived, within 10 or 15 years “Andre Waters would have been fully incapacitated.” Dr. Omalu’s claims of Mr. Waters’s brain deterioration — which have not been corroborated or reviewed — add to the mounting scientific debate over whether victims of multiple concussions, and specifically longtime N.F.L. players who may or may not know their full history of brain trauma, are at heightened risk of depression, dementia and suicide as early as midlife. The N.F.L. declined to comment on Mr. Waters’s case specifically. A member of the league’s mild traumatic brain injury committee, Dr. Andrew Tucker, said that the N.F.L. was beginning a study of retired players later this year to examine the more general issue of football concussions and subsequent depression. “The picture is not really complete until we have the opportunity to look at the same group of people over time,” said Dr. Tucker, also team physician of the Baltimore Ravens. The Waters discovery began solely on the hunch of Chris Nowinski, a former Harvard football player and professional wrestler whose repeated concussions ended his career, left him with severe migraines and depression, and compelled him to expose the effects of contact-sport brain trauma. After hearing of the suicide, Mr. Nowinski phoned Mr. Waters’s sister Sandra Pinkney with a ghoulish request: to borrow the remains of her brother’s brain. The condition that Mr. Nowinski suspected might be found in Mr. Waters’s brain cannot be revealed by a scan of a living person; brain tissue must be examined under a microscope. “You don’t usually get brains to examine of 44-year-old ex-football players who likely had depression and who have committed suicide,” Mr. Nowinski said. “It’s extremely rare.” As Ms. Pinkney listened to Mr. Nowinski explain his rationale, she realized that the request was less creepy than credible. Her family wondered why Mr. Waters, a hard-hitting N.F.L. safety from 1984 to 1995 known as a generally gregarious and giving man, spiraled down to the point of killing himself. Ms. Pinkney signed the release forms in mid-December, allowing Mr. Nowinski to have four pieces of Mr. Waters’s brain shipped overnight in formaldehyde from the Hillsborough County, Fla., medical examiner’s office to Dr. Omalu in Pittsburgh for examination. He chose Dr. Omalu both for his expertise in the field of neuropathology and for his rare experience in the football industry. Because he was coincidentally situated in Pittsburgh, he had examined the brains of two former Pittsburgh Steelers players who were discovered to have had postconcussive brain dysfunction: Mike Webster, who became homeless and cognitively impaired before dying of heart failure in 2002; and Terry Long, who committed suicide in 2005. Mr. Nowinski, a former World Wrestling Entertainment star working in Boston as a pharmaceutical consultant, and the Waters family have spent the last six weeks becoming unlikely friends and allies. Each wants to sound an alarm to athletes and their families that repeated concussions can, some 20 years after the fact, have devastating consequences if left unrecognized and untreated — a stance already taken in some scientific journals. “The young kids need to understand; the parents need to be taught,” said Kwana Pittman, 31, Mr. Waters’s niece and an administrator at the water company near her home in Pahokee, Fla. “I just want there to be more teaching and for them to take the proper steps as far as treating them. “Don’t send them back out on these fields. They boost it up in their heads that, you know, ‘You tough, you tough.’ ” Mr. Nowinski was one of those tough kids. As an all-Ivy League defensive tackle at Harvard in the late 1990s, he sustained two concussions, though like many athletes he did not report them to his coaches because he neither understood their severity nor wanted to appear weak. As a professional wrestler he sustained four more, forcing him to retire in 2004. After he developed severe migraines and depression, he wanted to learn more about concussions and their effects. That research resulted in a book published last year, “Head Games: Football’s Concussion Crisis,” in which he detailed both public misunderstanding of concussions as well as what he called “the N.F.L.’s tobacco-industry-like refusal to acknowledge the depths of the problem.” Football’s machismo has long euphemized concussions as bell-ringers or dings, but what also alarmed Mr. Nowinski, 28, was that studies conducted by the N.F.L. on the effects of concussions in players “went against just about every study on sports concussions published in the last 20 years.” Studies of more than 2,500 former N.F.L. players by the Center for the Study of Retired Athletes, based at the University of North Carolina, found that cognitive impairment, Alzheimer’s-like symptoms and depression rose proportionately with the number of concussions they had sustained. That information, combined with the revelations that Mr. Webster and Mr. Long suffered from mental impairment before their deaths, compelled Mr. Nowinski to promote awareness of brain trauma’s latent effects. Then, while at work on Nov. 20, he read on Sports Illustrated’s Web site, si.com, that Mr. Waters had shot himself in the head in his home in Tampa, Fla., early that morning. He read appraisals that Mr. Waters, who retired in 1995 and had spent many years as an assistant coach at several small colleges — including Fort Valley (Ga.) State last fall — had been an outwardly happy person despite his disappointment at not landing a coaching job in the N.F.L. Remembering Mr. Waters’s reputation as one of football’s hardest-hitting defensive players while with the Philadelphia Eagles, and knowing what he did about the psychological effects of concussions, Mr. Nowinski searched the Internet for any such history Mr. Waters might have had. It was striking, Mr. Nowinski said. Asked in 1994 by The Philadelphia Inquirer to count his career concussions, Mr. Waters replied, “I think I lost count at 15.” He later added: “I just wouldn’t say anything. I’d sniff some smelling salts, then go back in there.” Mr. Nowinski also found a note in the Inquirer in 1991 about how Mr. Waters had been hospitalized after sustaining a concussion in a game against Tampa Bay and experiencing a seizure-like episode on the team plane that was later diagnosed as body cramps; Mr. Waters played the next week. Because of Dr. Omalu’s experience on the Webster and Long cases, Mr. Nowinski wanted him to examine the remaining pieces of Mr. Waters’s brain — each about the size of a small plum — for signs of chronic traumatic encephalopathy, the tangled threads of abnormal proteins that have been found to cause cognitive and intellectual dysfunction, including major depression. Mr. Nowinski tracked down the local medical examiner responsible for Mr. Waters’s body, Dr. Leszek Chrostowski, who via e-mail initially doubted that concussions and suicide could be related. Mr. Nowinski forwarded the Center for the Study of Retired Athletes’ studies and other materials, and after several weeks of back-and-forth was told that the few remains of Mr. Waters’s brain — which because Waters had committed suicide had been preserved for procedural forensic purposes before the burial — would be released only with his family’s permission. Mr. Nowinski said his call to Mr. Waters’s mother, Willie Ola Perry, was “the most difficult cold-call I’ve ever been a part of.” When Mr. Waters’s sister Tracy Lane returned Mr. Nowinski’s message, he told her, “I think there’s an outside chance that there might be more to the story.” “I explained who I was, what I’ve been doing, and told her about Terry Long — and said there’s a long shot that this is a similar case,” Mr. Nowinski said. Ms. Lane and another sister, Sandra Pinkney, researched Mr. Nowinski’s background, his expertise and experience with concussions, and decided to trust his desire to help other players. “I said, ‘You know what, the only reason I’m doing this is because you were a victim,’ ” said Ms. Pittman, Mr. Waters’s niece. “I feel like when people have been through things that similar or same as another person, they can relate and their heart is in it more. Because they can feel what this other person is going through.” Three weeks later, on Jan. 4, Dr. Omalu’s tests revealed that Mr. Waters’s brain resembled that of an octogenarian Alzheimer’s patient. Nowinski said he felt a dual rush — of sadness and success. “Certainly a very large part of me was saddened,” he said. “I can only imagine with that much physical damage in your brain, what that must have felt like for him.” Then again, Mr. Nowinski does have an inkling. “I have maybe a small window of understanding that other people don’t, just because I have certain bad days that when I know my brain doesn’t work as well as it does on other days — and I can tell,” he said. “But I know and I understand, and that helps me deal with it because I know it’ll probably be fine tomorrow. I don’t know what I would do if I didn’t know.” When informed of the Waters findings, Dr. Julian Bailes, medical director for the Center for the Study of Retired Athletes and the chairman of the department of neurosurgery at West Virginia University, said, “Unfortunately, I’m not shocked.” In a survey of more than 2,500 former players, the Center for the Study of Retired Athletes found that those who had sustained three or more concussions were three times more likely to experience “significant memory problems” and five times more likely to develop earlier onset of Alzheimer’s disease. A new study, to be published later this year, finds a similar relationship between sustaining three or more concussions and clinical depression. Dr. Bailes and other experts have claimed the N.F.L. has minimized the risks of brain trauma at all levels of football by allowing players who sustain a concussion in games — like Jets wide receiver Laveranues Coles last month — to return to play the same day if they appear to have recovered. The N.F.L.’s mild traumatic brain injury committee has published several papers in the journal Neurosurgery defending that practice and unveiling its research that players from 1996 through 2001 who sustained three or more concussions “did not demonstrate evidence of neurocognitive decline.” A primary criticism of these papers has been that the N.F.L. studied only active players, not retirees who had reached middle age. Dr. Mark Lovell, another member of the league’s committee, responded that a study using long-term testing and monitoring of the same players from relative youth to adulthood was necessary to properly assess the issue. “We want to apply scientific rigor to this issue to make sure that we’re really getting at the underlying cause of what’s happening,” Dr. Lovell said. “You cannot tell that from a survey.” Dr. Kevin Guskiewicz is the director of the Center for the Study of Retired Athletes and a member of U.N.C.’s department of exercise and sport science. He defended his organization’s research: “I think that some of the folks within the N.F.L. have chosen to ignore some of these earlier findings, and I question how many more, be it a large study like ours, or single-case studies like Terry Long, Mike Webster, whomever it may be, it will take for them to wake up.” The N.F.L. players’ association, which helps finance the Center for the Study of Retired Athletes, did not return a phone call seeking comment on the Waters findings. But Merril Hoge, a former Pittsburgh Steelers running back and current ESPN analyst whose career was ended by severe concussions, said that all players — from retirees to active players to those in youth leagues — need better education about the risks of brain trauma. “We understand, as players, the ramifications and dangers of paralysis for one reason — we see a person in a wheelchair and can identify with that visually,” said Mr. Hoge, 41, who played on the Steelers with Mr. Webster and Mr. Long. “When somebody has had brain trauma to a level that they do not function normally, we don’t see that. We don’t witness a person walking around lost or drooling or confused, because they can’t be out in society.” Clearly, not all players with long concussion histories have met gruesome ends — the star quarterbacks Steve Young and Troy Aikman, for example, were forced to retire early after successive brain trauma and have not publicly acknowledged any problems. But the experiences of Mr. Hoge, Al Toon (the former Jets receiver who considered suicide after repeated concussions) and the unnamed retired players interviewed by the Center for the Study of Retired Athletes suggest that others have not sidestepped a collision with football’s less glorified legacy. “We always had the question of why — why did my uncle do this?” said Ms. Pittman, Mr. Waters’s niece. “Chris told me to trust him with all these tests on the brain, that we could find out more and help other people. And he kept his word.” Army Officer Warns of Mental Health Woes Associated Press, 1/19/2007 WASHINGTON -- Mental health screening isn't consistent for U.S. troops returning from war, and if they don't say they need help they often don't get it, the Army's top medical officer said Friday. ''If an individual checks nothing, I have no mental health issues, they're not necessarily being sent to mental health counseling,'' said Army Surgeon General Kevin Kiley, speaking at a hearing on military medical readiness before the House Defense Appropriations Subcommittee. It is estimated that about 17 percent of returning warfighters have post-traumatic stress disorder or severe anxiety and depression, compared with about 6 percent or 7 percent of the general population, Kiley said. Studies show some troops fear being stigmatized if they acknowledge they have problems such as nightmares, hyper vigilance or anxiety. Or, some want to spend time with their families instead of getting mental health help. To help catch them, Navy Surgeon General Donald Arthur said some of the mental health screening has been delayed a couple of months so that troops can first spend time with their families. Kiley said the amount of face-to-face counseling of returning troops is increasing, and those who seek help are getting it. In recent years, the military has implemented programs that encourage troops to seek mental help if they need it. Subcommittee Chairman John Murtha, D-Pa., asked if shortening deployment lengths could help. Many troops spend more than a year deployed in a war zone. Arthur said deployment length and the effect it has on a soldier's health is under review, but the consensus is that the effect varies with the intensity of the deployment. ''If you are on the front lines going door to door in Fallujah ... perhaps three months is an appropriate time,'' Arthur said. ''If you are in Kuwait or Djibouti as many of our folks are, then perhaps a year is all right, so we're trying to tailor those deployment lengths to the length of the threat.'' Charles Marmar, chief of staff for mental health at the San Francisco VA Medical Center, recommended that federal money be used to develop a brain screening that would help identify when a returning soldier potentially has mental health issues. After the hearing, Murtha said he supports that recommendation. While things have improved, it will be a long time before the stigma in the military associated with seeking mental health help goes away, said Murtha, a decorated Vietnam war veteran and retired Marine colonel. For troops today, ''unless you want to be helped, they aren't going to get help is what it amounts to,'' Murtha said. The story opens once upon a time not long ago when two Italians, a giddy, gregarious husband and wife, arrive at the foundling home in the company of a corrupt adoption broker, simply called Madam (Maria Kuznetsova). Bursting confidently out of her snug clothes, her eyes twinkling with malice and greed, Madam arranges for foreigners to adopt Russian children, including the ones here. The husband and wife have come for Vanya, a little Italian to call their own (hence the film’s title). But first there are papers to sign, bureaucratic channels to cross, personalities to meet, a world to discover, perils to note, jokes and toasts and scenes to be made, and the careful creation of an engrossingly dramatic reason for us to keep watching. That dramatic hook arrives in the person of a weeping woman, a Russian mother who has come to reclaim the son she once abandoned. But the child is long gone, having been adopted by a foreign family or, more terrifyingly, by an organ purveyor. After spilling her tears, she takes a cue from one of the great sacrificial victims of Russian literature and leaps under a train. The news gets back to the institution, where the children start buzzing fearfully, worried that their own mothers may try to come back to fetch them, only to end up dead. Among the most concerned is Vanya, whose anxiety inspires a ferocious, heroic quest, one that takes him far from the home and into a kingdom dangerously alive with ogres and witches. These are not real ogres and witches, naturally, though they loom just as menacingly as any fairy-tale fiend. Among the scariest is Madam, who keeps a close watch on her future sales while aided and abetted by Sery (Sasha Syrotkin), an all-purpose lackey who drives her S.U.V. and occasionally checks under her hood. Madam more or less runs the home, stingily paying off the old rummy who serves as its headmaster (Yuri Itskov). He seems to drink most of that money away; more careless than cruel, he has neither the head nor the heart really to run the place. That leaves the children to fend for themselves, which they do with all the cunning and invention of Fagin’s little troupe, led by a charismatic teenage boy, Kolyan (Denis Moiseenko). As a microcosm of contemporary Russia, the institution couldn’t be bleaker or feel more harshly true. Nestled in the warmth from its roaring furnace, Kolyan runs the home like a general or a mob boss, divvying up the work and collecting the earnings. One young teenager, Irka (Olga Shuvalova), turns tricks, climbing in and out of the cabs of passing trucks; the boys, including Vanya, pump gas and wash car windows and headlights at a local gas station. Much of the money goes into a chest, but some of it goes for shoes and supplies. The paradox of these children’s lives is that while some of their futures are dependent on the rapacious capitalism embodied by Madam, they survive as a collective, as a shadow of the Soviet past. The film’s director, Mr. Kravchuk, throws a beautiful, somewhat gauzy light over this world that gently softens its harder angles. There is something slightly magical about the lighting, almost as if this were a fantasy land from which Vanya might actually make an escape. This sense of unreality, of magical thinking and wishing, carries the story and Vanya through a remarkable journey. He leaps over hurdles like a stag, this child. He runs and fights and schemes and, during a ferocious eruption of pity and terror near the end of the story, he just about breaks your heart into pieces. There’s a touch of directorial sadism at work here, I think. But the last shot of a child’s face lighted up with hope also seems to me like something out of a film by Roberto Rossellini, which is very high praise indeed. “The Italian” is rated PG-13 (Parents strongly cautioned.) These children go through it all, including violence and prostitution, though few of their perils are rendered graphically. THE ITALIAN Directed by Andrei Kravchuk; written (in Russian, with English subtitles) by Andrei Romanov; director of photography, Alexander Burov; edited by Tamara Lipartiya; music by Alexander Kneiffel; production designer, Vladimir Svetozarov; produced by Vladimir Husid and Vladimir Bogoyavlensky; released by Sony Pictures Classics. Running time: 99 minutes. WITH: Kolya Spiridonov (Vanya), Denis Moiseenko (Kolyan), Sasha Syrotkin (Sery), Olga Shuvalova (Irka), Dima Zemlyanko (Anton), Maria Kuznetsova (Madam) and Yuri Itskov (Headmaster). |