Noteworthy News Articles on Mental Health Topics, January 21-26, 2007

Amy Bloom, New York Times- 1/21/2007

If I were a snob, a liar, a drunk, a philanderer, an anti-Semite, a violent bully, a poseur and a menace to the vulnerable, I would want Linda Hopkins to write my biography. Masud Khan, an Anglo-Pakistani psychoanalyst notable in the 1960s and '70s, was all of those things. Hopkins, a psychologist and psychoanalyst, has written the story of his life with the kind of generous forgiveness, insistent evenhandedness, patient understanding and restrained judgment one might hope for in a very good analyst of a certain kind, or a wise, exceptionally forbearing and insightful mother. She sees his life as a tragedy, lived ''on a scale grand enough to match ... his favorite characters: Shakespeare's King Lear and Dostoyevsky's Prince Myshkin.'' Khan also identified with Dostoyevsky himself and was particularly pleased when one of his later girlfriends showed signs (briefly) of living up to the high benchmark of Anna Dostoyevsky's devotion (''so robust and militant in her loving regard for her husband's nobility of soul,'' as he put it).
      Hopkins describes Khan's Dostoyevsky delusion as she does his lies about being a Pakistani prince; his drunken rages; his sleeping with patients, with patients' wives and with the daughters of friends -- always more in sorrow than in anger, and with the reminder that Khan may well have suffered from a bipolar disorder. Hopkins faults the psychoanalytic community for not saving him in the face of what may have been illness and was indisputably bad behavior and poor judgment: ''His former analysands provided him with the care that should have been provided by an extended family or others from Khan's private life, but Khan had nobody to do that for him,'' she writes. Surprisingly, she does not ask, Why not? And she does not say, How selfish and unprofessional that he should put that burden on his patients.
     Most Americans don't know who Masud Khan was. Most psychotherapists don't know who Masud Khan was, unless they have studied the work of D. W. Winnicott, the great English pediatrician, child psychiatrist and psychoanalyst, who died in 1971. (If you ever went back to the playground after dark to retrieve your toddler's blankie, you have successfully incorporated Clare and Donald Winnicott's notion of the necessary ''transitional object''; if you have thought that it's just as important to learn how to say no in a firm, clear way as to say yes, you have absorbed Winnicott's concept of ''the good enough mother.'') Khan was one of Winnicott's disciples, co-author of some significant works and his editor -- as well as one of his patients.
     This seems like a bad idea to those of us who like our therapists from the old school: in their office, in their chair, not chatting on about their own private lives, not having sex with us, not socializing with us, not gossiping about other patients (which might be great, except for the possibility that they gossip about us too, or like the others better). But, as a number of writers, including Hopkins, have pointed out, Khan learned about boundary jumping from his elders. Anna Freud was analyzed by her own father. Melanie Klein analyzed her son, Eric, then handed him over to Winnicott for treatment, supervising that analysis and praising Winnicott for his skill in concealing all this from him. Winnicott himself, it turns out, interrupted Khan's sessions with his patients to chat and gossip -- sometimes about those patients.
     Masud Khan, born in the Punjab in 1924, came to Oxford to study Modern Greats. He became an analyst and then, after three attempts, a training analyst. He married not one but two beautiful ballerinas and, through his second wife, became friendly with Julie Andrews, Mike Nichols and the Redgraves. He was dashing and boldly self-promoting in a professional community in which those things were rare.
     Before his death in 1989, Khan wrote two very good and interesting books, ''The Privacy of the Self'' (1974) and ''Alienation in Perversions'' (1979); one interesting book, ''Hidden Selves'' (1983); and one disaster, ''The Long Wait'' (1988), in which the occasional insight breaks through a sea of rambling prose and anti-Semitic goofiness (''I was freeing myself of the rigid Yiddish shackles of the so-called psychoanalysis''). His warmth, intuition and maverick style helped some patients: a number spoke up on his behalf at the end of his life, when he was investigated and finally expelled by the British Psycho-Analytical Society, and spoke warmly of him in long interviews with Hopkins.
     Several women asserted that he had been a brilliant if unorthodox psychoanalyst, although some did remark that it had not been therapeutically helpful for Khan to have initiated sexual relationships with them. ''If I had been less ill, and he more sound, it might have been wonderful,'' one said. Hopkins, in her non-judgmental way, writes of this analysand only that it is ''easy to assume she must be in denial about the harm done to her by Khan, but it is perhaps more honest to grope with the possibility that there may be some validity to her subjective experience.''
     It seems to me that it is not only his patients but his admirers, including his biographer, who may be struggling with some denial about the harm done by an alcoholic married analyst who initiated sex with female patients, encouraged affairs between patients, threatened patients who terminated treatment and abandoned those who did not meet his own emotional needs.Khan began to fall apart in the early '70s, after his mother and Winnicott died within months of each other. And his spectacularly erratic behavior -- once, in a restaurant, he sent a piece of cake to an obese diner and shouted, ''So that you might die sooner!'' -- set the stage for what now seems his greatest legacy: a complete and long overdue change in the training and ethical standards for English psychoanalysts.
     Hopkins persuades me that Masud Khan was fascinating at a dinner party (unless there was too much wine), interesting as a thinker, given to the occasional brilliant intuitive flash, handsome as the devil and twice as charming. But she does not persuade me that English bigotry brought about his downfall (though as for whatever schadenfreude followed it, I certainly believe that there were some English psychoanalysts ''somewhat acutely alive to the existence of class distinctions,'' as P. G.Wodehouse put it). She does persuade me that this is a sad story of a talented man, that Khan's own emotional troubles made him at first gifted in treating difficult patients, and later, incapable of being anything else. As one former analysand wrote in 2000, ''somebody could write a tragicomic account of this.'' Hopkins's biography is thoughtful, thorough and insightful. But I never felt the tragedy she asserts, and only Bruce Jay Friedman or Iris Murdoch could have done justice to the other.

Why Are There So Many Single Americans?
Kate Zernike, New York Times- 1/21/2007

The news that 51 percent of all women live without a spouse might be enough to make you invest in cat futures. But consider, too, the flip side: about half of all men find themselves in the same situation. As the number of people marrying has dropped off in the last 45 years, the marriage rate has declined equally for men and for women. The stereotype has been cemented in the popular culture: the hard-charging career girl who gets her comeuppance, either violently or dying a slow death by late-night memo and Chinese takeout. Think Sigourney Weaver in “Working Girl,” two enduring icons. In last year’s model, Meryl Streep in “The Devil Wears Prada” ends up single, if still singularly successful.
      But when it comes to marriage, the two Americas aren’t divided by gender. And it’s not the career girls on the losing end. It’s their less educated manicurists or housekeepers, women who might arguably be less able to live on their own. The emerging gulf is instead one of class — what demographers, sociologists and those who study the often depressing statistics about the wedded state call a “marriage gap” between the well-off and the less so.
     Statistics show that college educated women are more likely to marry than non-college educated women — although they marry, on average, two years later. In the past, less educated women often “married up.” In “Working Girl,” Melanie Griffith triumphs. Now, marriage has become more one of equals; when more highly educated men marry, it tends to be more highly educated women. Today, Harrison Ford and Sigourney Weaver would live happily ever after.
     Women with more education also are becoming less likely to divorce, or inclined to divorce, than those with less education. They are even less likely to be widowed all in all, less likely to end up alone. “Educated women used to have a difficult time,” said David Popenoe, co-director of the National Marriage Project at Rutgers University. “Now they’re the most desired.” In Princeton, where he lives, men used to marry “way down the line,” Mr. Popenoe said. No more The difference extends across race lines: black women are significantly less likely to marry than white women, but among blacks, women with a college education are more likely to marry than those who do not.
     Among women ages 25-34, 59 percent of college graduates are married, compared with 51 percent of non-college graduates, according to an analysis of the Census Bureau’s June 2006 Current Population Survey by Steven P. Martin, a sociologist at the University of Maryland. The same is true at older age groups: the difference is 75 percent to 62 percent for those ages 35-44, and 50 percent to 41 percent among those 65 and older. The difference is smaller between men and women. According to the census, 55 percent of men are married, down from 69.3 percent in 1960, and 51.5 percent of women are, down from 65.9 percent in 1960.
     The number of women living without a spouse is greater largely because women live longer, leaving them more likely to be widowed. Older men are also more likely to remarry. To control for these variables, consider 35-44 year olds. In 2005, according to the census, 66.2 percent of men in this age group were married, down from 88 percent in 1960; 67.2 percent of women were married, down from 87.4 percent.
     The marriage gap exists for men, too. But particularly at younger ages, it is not nearly as wide as it is among women. Commitment-averse men in their 20’s and 30’s, it turns out, look the same whether or not they have a college degree. In surveys and focus groups, they fit depressingly well into the old stereotypes: they fear marriage means a loss of liberty; they worry a wife will want to change them. They don’t trust women to tell the truth about past relationships, or they are waiting for the soul mate who hasn’t appeared. With the rising frequency of cohabitation, they can get sex without marriage, and they might lose their hard-earned money in a divorce, so what’s the rush? As a Marriage Project report concluded, with no biological or sociological clock ticking, “boys can remain boys indefinitely.” But that gap widens among older men. Among men ages 25 to 34, 50 percent of college graduates are married, compared to 47 percent of those who did not graduate from college. In older age brackets, there is a difference of 12 percentage points.
     The class gap happens in large part because, as Christopher Jencks, a professor of social policy at Harvard, said, “like marries like.” “If you wanted to predict the characteristics of who I would marry,” he said, “knowing my education, the strongest correlation you could observe is that someone who is educated is more likely to marry someone who is educated, and someone who is not educated is more likely to marry someone who is not educated.”
     Why have things changed so much for women who don’t have the choices that educated women have? While marriage used to be something you did before launching a life or career, now it is seen as something you do after you’re financially stable — when you can buy a house, say. The same is true for all classes. But the less educated may not get there. “Women are saying, ‘I’m not ready, I want to work for a while, the guys I hang around with don’t make enough money and they don’t want a commitment,’ ” Mr. Jencks said. “It’s the same thing a lot of African-American women in poor neighborhoods are saying. But there’s the difference that they’re having children.”
     Women of all education levels figure their earning power will flatten out after they have children, he said. “The longer you wait, the higher the level it flattens out at,” he said. “That’s a good argument to wait. For the less educated, there isn’t a steep increase in salary, so there’s less incentive to wait.” Maybe in the past, a man with little education nevertheless had a good-paying manufacturing job, with a health care and pension plan. He was a catch and represented stability.
     Today, it may be hyperbolic to talk about the emasculation of the blue-collar man. But it is not only liberals concerned with the wealth gap who are watching these national trends with alarm. Social and religious conservatives have called on society to do more to address economic strains faced by this class. “Marriage is more difficult today than it was in the past,” Mr. Popenoe said. “The people who excel in one area probably excel in that area, too. And people who are high school dropouts probably have a higher propensity to drop out of marriage.”
     The last 30 years have seen a huge shift in educated women’s attitudes about divorce. Mr. Martin, who has written about women and divorce, said that three decades ago, about 30 percent of women who had graduated from college said it should be harder to get a divorce. Now, about 65 percent say so, he said. But for less educated women and for men, the numbers have not changed; only 40 percent — a minority — say it should be harder to get a divorce. “The way we used to look at marriage was that if women were highly educated, they had higher earning power, they were more culturally liberal and people might have predicted less marriage among them,” Mr. Martin said. “What’s becoming more powerful is the idea that economic resources are conducive to stable marriages. Women who have more money or the potential for more money are married to men who have more stable income.”
     All this leads to a happiness gap, too. According to the Marriage Project, the percentage of spouses who rate their marriage as “very happy” has dropped among those without a college education, while it has risen or held steady among those better educated. The better educated husbands and wives tend to share intellectual interests and economic backgrounds, as well as ideas about the division of household roles. They also have more earning power. And as in so many other things, in marriage, money helps ease the way.

So, you think you're stressed? Get a load of this dream I had last week. In my waking hours, I thought I was getting along just fine, despite an abnormally heavy workload (lots of assignments -- including this article -- due at once) and the daily travails of a work-at-home mother of two.

But I knew it was time to reassess when I woke, panting, from a nightmare in which:
· Out-of-town guests appeared unexpectedly in my home and needed a ride to the airport.
· Only I couldn't remember where the airport was.
· Nor could I find my purse.
· So I couldn't drive my car (no purse, no keys).
· And when I set out on foot to find the airport, I found it was raining baby frogs, which got caught in my hair and everywhere else.

The following morning, after shaking off those baby frogs, I followed two of my therapist's most enduringly useful tips. First, I smiled big and said, out loud, "Hello, anxiety!" Confronting my stress on friendly terms makes it less ominous, says my doctor, psychologist Joe Brown, who practices in the Hartford, Conn., area. Plus, the ritual is so goofy it takes the edge off.

Next, I made myself sit right down and get to work. Because, Dr. Brown helped me discover, procrastination is a huge source of my stress -- and stress-related behaviors such as cramming mini marshmallows into my maw by the fistful.

I'm feeling much better now, in part because most of that stress-inducing pressure to produce is behind me. Most of the work's done -- except this story. But while I initially viewed the piece as part of the problem, in fact it ended up helping me place my stress-reduction strategies in context.

In speaking with two stress-management gurus, I learned that there are three basic ways in which people try to beat back anxiety. They:
· mask it in ways that may ultimately be destructive (through use of illicit drugs or overuse of alcohol, smoking or overeating);
· distract themselves from it in ways (such as exercise or even prescription anti-anxiety drugs) that, while perhaps health-promoting in themselves, do little to fix the underlying stress-inducing problem;
· make some changes that actually tackle the stress problem at its root.

Though countless people resort to taking drugs, getting drunk, lighting up or pigging out to relieve their stress, you'd be hard-pressed to find an expert who supports covering up anxiety in these ways. Most therapists suggest a combination approach: figure out exactly what's causing you stress, change what can be changed, and devise a plan for coping with the inevitable remainder.

Jerilyn Ross, president and chief executive of the Ross Center for Anxiety and Related Disorders, located in the District, has been treating stressed-out people for a quarter of a century. Ross says a lot of stress derives from trying to meet expectations, real and imagined, external and self-imposed. The stress of managing all those expectations has been compounded in recent years by the difficulty of taking a real break from those pressures. Even on vacation, she notes, we take along our BlackBerrys and our laptops so that those who wish to impose their expectations on us can reach us at the beach.

Instead of blindly accepting all those expectations, Ross suggests taking a hard look at them to determine whether any can be scrapped. "Ask yourself, 'Who are you really doing it for?' " Ross advises. "If you're volunteering in school, serving as a Cub Scout leader and coaching the sports team and you're feeling overwhelmed, ask yourself, 'Am I doing this for my child? Am I really enjoying it?' " If so, she says, carry on. But if you're doing those things to prove to others -- or to yourself -- what a great, involved parent you are, then maybe you can ditch some of those activities.

Of course, not all stressful expectations are easily ditched: caring for an ailing parent or sick child, keeping up with the mortgage and navigating the ups and downs of a marriage are realities that must be dealt with. That's when you need some reliable stress-management strategies.

Harvey Oaklander, a licensed clinical psychologist and principal of the Center for Stress Management in Arlington and Fairfax, recommends confronting stressors you can't eliminate, acknowledging their sources and working to achieve a healthier balance in your life. "It's okay to be ambitious and to work hard," he says. "But sometimes the balance between internal focus and external focus gets lost." Adopting a self-interested (as opposed to selfish) stance can help you determine which of your activities and commitments are really important to you, he says; pruning away those that are less important should result in less stress.

How to do this? Ross suggests starting with a stress-management diary. "Note when you feel stressed. Where do you feel it? In your stomach? Your head? Note the time of day and the circumstance. Look at stress patterns." When you've got a sense of when and how your stress kicks in, ask yourself, 'What can I do to alleviate it?' Find something you like. Look at things that are easily accessible to you. Try a few different things and look at how you feel afterward."

What activities work best? "Anything that makes us get away from our thoughts of what we're doing all the time," Ross suggests. Ross's personal favorite? "I sit down at the piano." For others, she says, "meditation is wonderful. Dance, music. Clubs, hobbies, musical instruments. Sudoku puzzles. You're using your mind, but [the activity is] mindless in terms of everything else in your life -- unless it becomes a competition."

With stress-reduction tools, as with all things in life, moderation is key. If you find a cocktail relaxing at the end of a long day, that's fine, says Ross. "But two or three? Not so fine. You'll just get depressed," she says.

You can even overdo physical exercise. "A lot of people find if they do some exercise, they feel good, so they figure if they do more, they'll feel better. They end up working out two hours a day -- and stressing out over it," Ross notes.

Oaklander cautions against over-reliance on temporary fixes, whether alcohol or something else. People who turn to food for stress relief, for instance, "are comforting themselves with eating, not looking at themselves, not taking time out to think about what feels good in the long term versus the immediate gratification of eating," he says.

Even exercise and relaxation techniques, by themselves, "don't really solve the problem," he says. "Exercise is great temporarily, but doesn't get rid of the stress. Exercise addicts siphon off the feeling of being tense, which makes them feel euphoric. But after it wears off, if they haven't faced the stress, it's going to continue."

But don't ditch that treadmill. Oaklander says that working out has its place in his anti-stress prescription, which starts with staring the sources of your stress in the eye and taking active steps to minimize or eliminate them. Then he recommends what he calls "self-gardening techniques": getting enough rest, eating healthfully and, yes, getting some exercise. (Ross adds to the list: watch your caffeine intake, which can affect your anxiety level, and slow down on sugar, which can make you lethargic and less able to meet daily challenges.) "It's a matter of taking time out every day, to do nothing, if necessary," Oaklander says. "Just finding withdrawal time every day. You find balance that way."

For many, finding time for stress release might feel like just one more big expectation. Women, in particular, feel guilty about doing anything for themselves, Ross says. "The fact is that if people take time to build in stress-relieving activities, they'll be more productive at work, more loving at home." So, Ross insists, "give yourself permission" to take time to do whatever you need to do to feel better. "You have to schedule it like anything else. And don't just pencil it in -- pen it in. Make an appointment." For quick stress-reduction at work, Ross suggests that you "build in a 10-minute walk. And if you can't build in a 10-minute walk, you should find a new job."

Another part of the family curse has been an urge to aggrandize all things Sedgwick. Memoirists seem as common as suicides on the family tree. So John Sedgwick’s new book, “In My Blood,” runs the risk of seeming like a vanity project, though it proves to be legitimate and substantial.

Mr. Sedgwick wrote two novels and three nonfiction books before readying himself to tackle the family’s story. It’s clear from the articulate, insightful “In My Blood” that his literary credentials are at least as interesting as his genetic ones, and that he can take on any subject he chooses.

Many of his forebears have written primarily about their own lives. But “In My Blood” is about the whole Sedgwick pie; that term, by the way, describes the family’s unusual circular graveyard in Stockbridge, Mass. It is arranged so that children lie at the feet of their parents and generations form concentric circles.

Mr. Sedgwick says that the Pie has always been a source of ridicule and embarrassment, but that sounds like hereditary Sedgwick disingenuousness. Given the pride of pedigree that looms large in “In My Blood,” the fame of the family plot cannot be such a liability. And it’s one more reason the family warrants a book-length biography.

“In My Blood” has sent Mr. Sedgwick down a long trail of research, prompting him to study everything from early land dealings in Stockbridge between English settlers and Indians to the physiology of mental illness. Only occasionally does he strain for effect, as when he lies down on a bed in the family manse in Stockbridge and tries to imagine the loneliness of Pamela, Theodore Sedgwick’s long-suffering and ultimately despondent wife.

Pamela was the daughter of a Williams, of the Williams College Williamses. And it is to this ancestor that Mr. Sedgwick traces the family’s first amped-up signs of hypomania. That frenzied behavior would show up in Henry Dwight Sedgwick, known as Harry. He was a son of Pamela and Theodore’s, and his manic business dealings made him the first (but hardly the last) Sedgwick sent to the then-new McLean asylum for help.

Also in Harry’s generation was Catharine Maria Sedgwick, who became a successful 19th-century novelist and exemplified another family trait: self-absorption. “Beloved mother!” she wrote, upon the occasion of Pamela’s suicide. “The thought of what I suffered when you died thrills my soul!”

John Sedgwick shows his strength as a memoirist by taking a realistic measure of such outbursts. “What she suffered?” he asks. He then goes on to write insightfully about the near-pathological clinginess that kept Catharine unmarried but unshakably attached to another of her brothers, Robert, and a self-appointed keeper of the Sedgwick flame. “As nuns are said to be brides of Christ,” he writes, “she was a bride of the family.”

John Sedgwick is a great-great-grandson of Harry, and a grandson of Harry III, who was known as Babbo. Babbo alone wrote 38 books (and immortalized a childhood memory of looking up at the family seamstress but realizing that, for reasons of class, he ought to be looking down). Born in 1861 Babbo also lived through a pivotal period in the family’s fortunes, as the Sedgwicks’ regional predominance was suddenly eclipsed by the newly rich tycoons of the Gilded Age, some of whom built vast houses in nearby Lenox. Faced with a likely downward trajectory, some Sedgwicks found it opportune to marry up.

John’s father, R. Minturn Sedgwick, was known as Duke. His first marriage (John is a child of his second) was to Helen Peabody, daughter of the Rev. Endicott Peabody, who founded the Groton School. Future Sedgwicks would thus go to Groton whether it suited them or not, and John recalls the strange sensation of feeling that the faculty knew more about him than he knew about himself. He also recalls how dearly his otherwise distant father — a man who each morning did the Royal Canadian Mounties’ calisthenics to the tune of “Ol’ Man River” — cherished his old boarding-school blazer.

When John Sedgwick published his first novel in 2000, Publishers Weekly gratuitously noted, “F.Y.I.: Sedgwick’s family includes Warhol groupie Edie Sedgwick and actress Kyra Sedgwick.” But Kyra plays no role in “In My Blood,” and Edie’s famous meltdown is put in perspective. It was not an isolated event. Edie was one of three siblings who killed themselves and the surviving one, Saucie, called their father, Francis, a “filthy old creep” and said he had made a pass at her.

When Francis, the most loathsome Sedgwick in this book, met Andy Warhol, “the clash of cultures was so complete, there was no clash at all, for there was no possible point of contact,” John Sedgwick writes. “It was like two armies that have mistakenly massed for battles on different continents.”

“In My Blood” ultimately arrives at a delicate question: How do its author’s troubles, including a breakdown in 2000 (at the age of 46) and subsequent divorce, fit into the family’s big picture? Its answer is melodramatic. (“I was a Sedgwick, guilty as charged,” he writes. “I could never peer into my own soul and find nothing, for my soul is not entirely my own.”) But by and large, despite occasional overreaching, Mr. Sedgwick provides a clear, incisive view of a complicated family. He needn’t claim that “the Sedgwick story is the story of America” to make it feel that way.

State Report Describes Teen's Early Aggression
Maria Cramer, Boston Globe- 1/23/2007

In seventh grade, John Odgren had several explosive episodes, was verbally abusive, and at times became physically aggressive, his parents, specialists, and teachers said, according to a state hearing report. Odgren, who is accused of fatally stabbing a fellow student Friday at Lincoln-Sudbury Regional High School, did not understand the "effect of his behavior on others," according to a decision by the state Bureau of Special Education Appeals in 2003.

His parents had argued to the state agency that their son needed better services than he had received from the Wachusett Regional School District, which had placed him in an alternative school in Fitchburg. At that school, he was so miserable he came home and "often spent evenings wrapped in a blanket, crying," one of his parents testified. The state agreed that the placement was not appropriate and ordered Wachusett to pay for Odgren's attendance at a smaller program in Belmont that his parents had found.

The state report portrays a complex picture of Odgren, who has been charged with first-degree murder in the killing of 15-year-old James F. Alenson, a freshman at Lincoln-Sudbury. Odgren, 16, is depicted at age 12 as a highly intelligent but troubled preadolescent with poor social skills. He has a hyperactivity disorder and Asperger's disorder, a mild form of autism. Several specialists familiar with Asperger's have said that those with the condition are not more prone to violence than others.

The report, giving an overall description, said that Odgren became aggressive at times when confused or ordered to do work, but did not offer details other than to say he was suspended three times for physical aggression within a two-month period at Caldwell Alternative School in Fitchburg. His parents, at the same time, were expressing concern for his physical and emotional safety at Caldwell, whose principal declined to comment.

The report made one mention of him having "explosive episodes" in fall 2002 in Wachusett's special education program, but did not detail those. Wachusett school officials declined to comment about Odgren, citing student confidentiality. Odgren's lawyer, Jonathan Shapiro, also declined to comment. A pseudonym was used to describe Odgren in the state agency's report on the case; a source with knowledge of the decision confirmed that the boy described in the report was Odgren.

Lincoln Waterhouse, Wachusett's special education coordinator, was directly involved with Odgren's case in 2002 and 2003. He declined to comment about Odgren during a brief telephone interview. Waterhouse, according to the state report, selected the Caldwell school for Odgren and testified that he thought the placement provided enough support to help the boy succeed.

"My heart goes out to everybody involved," he said of the stabbing.

Odgren, according to the state report, was diagnosed with depression and Attention Deficit Hyperactivity Disorder in 2000 and later placed in a special education program at a Wachusett elementary school. In 2002, in the sixth grade, he was diagnosed with Asperger's. His parents complained that he needed training in social skills, according to the state report, but never received it.

Shortly after beginning seventh grade in a Wachusett school, his performance deteriorated, according to the report, and the school system placed him at Caldwell Alternative School in Fitchburg for students in grades 7 to 12. The school serves students with emotional and behavioral problems and learning disabilities

But he floundered at Caldwell, where the other students "teased, used foul and aggressive language, and were rude and disrespectful to each other and to the teacher," according to the report. Odgren's behavior grew more troubling, resulting in the suspensions and his failing three subjects.

In March 2003, his parents took him out of Caldwell and placed him at Pathways Academy in a special education program at McLean Hospital in Belmont for students ages 12 and 13. There, his behavior dramatically improved, the report stated.

Odgren told his parents the program was "like heaven." His father testified that after about six weeks at Pathways, Odgren "demonstrated spontaneous empathy for the first time."

It is unknown whether Odgren went directly from Pathways to Lincoln-Sudbury and whether school officials were made aware of the state report that described a history of physical aggression. Beginning this school year, he was a sophomore at Lincoln-Sudbury enrolled in Great Opportunities, a program for students with significant emotional and/or psychiatric disabilities. Lincoln-Sudbury officials have said they had no knowledge of any violent behavior involving Odgren.

John M. Ritchie, Lincoln-Sudbury regional's principal and superintendent, told reporters yesterday that the school's security policy and how it applies to Great Opportunities would probably be reviewed. "We can't explain everything at once when we're in the middle of still grieving," Ritchie said.

According to the state's report, Odgren needed to be in an educational environment where he would not be threatened and would "be free from peers who tease, bully, or have behaviorally based disorders."

In the days after the stabbing, Lincoln-Sudbury students told reporters that Odgren had been teased by schoolmates for wearing a trench coat in the halls like the killers in Columbine High School. Police have not said why Odgren allegedly stabbed Alenson, who was described as shy and sweet, in a boy's bathroom.

Odgren's mother , Dorothy, a nurse at a Worcester clinic, is a fierce advocate for her son, said Kathryn Mattison, a Princeton child and family therapist. Dorothy Odgren is a fixture at area conferences on Asperger's, she said, adding that she met Dorothy Odgren when she was a school nurse at Princeton's Thomas Prince Elementary School, which Mattison's children attended.

"She's a model parent in terms of trying to understand her son," Mattison said. "I'm putting myself in their position. What would I have done differently? I don't think I would have done anything differently."

Yesterday, students, police, grief counselors, and parents gathered at the high school for the first time since the slaying. The students broke into spontaneous applause in the school auditorium, showing love for the school, Ritchie said. But the mood of the day was somber, Ritchie said.

School officials kept accessible the spot in the hallway where Alenson bled after the stabbing. Officials didn't want the hallway to be a "taboo zone," and school staff was stationed in the area to comfort students or accompany them into the restroom where Alenson was stabbed if they needed to see it.

Amnesiacs May Be Cut Off From Past and Future Alike
Benedict Carey, New York Times- 1/23/2007

In the movies amnesia is bizarre, and thrilling. The star is usually a former assassin or government agent whose future depends on retrieving the bloody, jigsaw fragments that restore identity and explain the past.

Yet in the real world, people with amnesia live in a mental universe at least as strange as fiction: new research suggests that they are marooned in the present, as helpless at imagining future experiences as they are at retrieving old ones.

The new Proceedings of the National Academy of Sciences, is the first rigorous test of how brain-injured people with amnesia mentally inhabit imaginary scenes. The results suggest that to the brain, remembered experience and imagined experience are reflections from the same mirror, rich inner worlds animated by almost identical neural networks.

The findings provide a glimpse into what it might mean to truly live in the moment. And they feed a continuing debate about memory. Some researchers say that the brain region central to forming new memories — the hippocampus, a sliver of tissue deep in the brain where the day’s memories are registered — is not necessary for retrieving those experiences, once they have been consolidated elsewhere in the brain.

Others, including the authors of the new study, contend that the hippocampus in fact provides the stage on which inner mental dramas are set. Without its help only the props remain — loose facts, people’s names, snippets from favorite songs: the players without the play.

“The study suggests that these patients have fragments, the brick and mortar to create new scenarios, but their descriptions lack coherence because they don’t have the scaffolding the hippocampus provides,” said Morris Moscovitch, a neuroscientist at the University of Toronto, who was not involved in the study. “The other interpretation is they don’t have enough brick and mortar to put it all together.”

The researchers, led by Eleanor Maguire and Demis Hassabis of University College London, instructed five men with severe hippocampus injuries to imagine themselves in familiar scenes, like a museum, a pub and a beach. People with this type of injury, often from oxygen deprivation due to a heart attack, can seem in conversation to be as mentally adept as the next person — until it becomes clear they have forgotten comments made only moments before.

The men, urged to fill out the scenes with imagined detail, described what they could. The researchers analyzed transcripts of their answers, carefully scoring each one for personal touches: projected emotions, sensations and actions. They found that compared with similar descriptions produced by adults without brain injuries, the five men’s imagined scenes were flat, barren of personal dimension.

“We think that what the hippocampus provides is a scaffold for experience and imagination, and that scaffold is spatial,” Dr. Maguire said. The brain’s record of physical space, she said, appears to be necessary to infuse a scene with rich personal dimension.

Other researchers said the dulling of imagination could reflect a more fundamental dynamic. The brain may naturally draw on previous experiences to inform imaginary scenes, said Peter J. Bayley, a neuroscientist at the University of California, San Diego. If so, the only such memories accessible to the men might have been childhood scenes, consolidated over the years outside the hippocampus, which would not likely provide rich detail to outfit, say, an imaginary pub.

“The differences between the two groups may reflect the difficulty the patients are having retrieving information from the recent past,” Dr. Bayley said. He and other researchers have previously reported on patients with hippocampus damage who can recall childhood memories in the same kind of detail almost everyone else does.

The distinctions the brain makes between loose facts and the richer, wraparound ambience of an experience are important to understanding memory, because people with healthy brain function tend to recall the gist of experience, whereas those with hippocampus damage can often recollect discrete facts with more accuracy. The difference is partly reflected in the study participants’ words.

When asked to envision an open-air market, one brain-injured man said: “I see people, very many people. Most of all ... um ... not many men, all I see are young ladies. And basically they are all in a hurry.”

A participant without brain injury responded: “Right, so on either side of me I’ve got stalls and it’s noisy. We have a person on my right who is selling fruit and veg, and they’re telling us that bananas are on special offer this week, and they’re shouting about that.”

In an essay published this month in the journal Nature, two Harvard researchers, Daniel L. Schacter and Donna Rose Addis, contend that this ability to richly imagine scenes, whether entirely dependent on the hippocampus or not, is perhaps the most promising frontier for memory research.

“For almost 100 years, memory has been the object of experimental studies that have focused almost exclusively on its role in preserving and recovering the past,” they wrote. “We think it’s time to try to understand some of memory’s errors by looking to the future.”

''The quitting is like a light switch that went off,'' said Dr. Antoine Bechara of the University of Southern California, who scanned the brains of 69 smokers and ex-smokers to pinpoint the region involved. ''This is very striking.'' Clearly brain damage isn't a treatment option for people struggling to kick the habit.

But the finding, reported in Friday's edition of the journal Science, does point scientists toward new ways to develop anti-smoking aids by targeting this little-known brain region called the insula. And it sparked excitement among addiction specialists who expect the insula to play a key role in other addictions, too.

''It's a fantastic paper, it's a fantastic finding,'' said Dr. Nora Volkow, director of the National Institute on Drug Abuse and a longtime investigator of the brain's addiction pathways.

''What this study shows unequivocally is the insula is a key structure in the brain for perceiving the urges to take the drug,'' urges that are ''the backbone of the addiction,'' Volkow added.

Why? The insula appears to be where the brain turns physical reactions into feelings, such as feeling anxious when your heart speeds up. When those reactions are caused by a particular substance, the insula may act like sort of a headquarters for cravings.

Some 44 million Americans smoke, and the government says more than 400,000 a year die of smoking-related illnesses. Declines in smoking have slowed in recent years, making it unlikely that the nation will reach a public health goal of reducing the rate to 12 percent by 2010.

Nicotine is one of the most addictive substances known, and it's common for smokers to suffer repeated relapses when they try to quit. So imagine Bechara's surprise at hearing a patient he code-named ''Nathan'' note nonchalantly that ''my body forgot the urge to smoke'' right after his stroke.

At the time, Bechara was at the University of Iowa studying the effects of certain types of brain damage after strokes or other injury. While Nathan was hospitalized, stroke specialists sent his information to that brain registry. He was 38, had smoked since 14, said he enjoyed it and had had no intention to quit. But his last puff was the night before his stroke. His surprised wife said he never even asked for a smoke while in the hospital.

It's not unusual for a health scare to prompt an attempt at quitting. ''That's the quitting that's not as interesting,'' Bechara said. Instead, Nathan experienced what Bechara calls a ''disruption of smoking addiction,'' and he wanted to know why.

Bechara and colleagues culled their brain-damage registry for 69 patients who had smoked regularly before their injuries. Nineteen, including Nathan, had damage to the insula. Thirteen of the insula-damaged patients had quit smoking, 12 of them super-easily: They quit within a day of the brain injury, and reported neither smoking nor even feeling the urge since then.

Of the remaining 50 patients with damage in other brain regions, 19 quit smoking but only four met the broken-addiction criteria.

If Bechara's findings are validated, they suggest that developing drugs that target the insula might help smokers quit. There are nicotine receptors in the insula, meaning it should be possible to create a nicotine-specific drug, Bechara said -- albeit years from now.

More immediately, NIDA's Volkow wants to try a different experiment: Scientists can temporarily alter function of certain brain regions with pulses of magnetic energy, called ''transcranial magnetic stimulation.'' She wants to see if it's possible to focus such magnetic pulses on the insula, and thus verify its role.

Other neurologic functions are known to be involved with addiction, too, such as the brain's ''reward'' or pleasure pathways. The insula discovery doesn't contradict that work, but adds another layer to how addiction grips the brain, Bechara said.



Of Gay Sheep, Modern Science and Bad Publicity
John Schwartz, New York Times- 1/25/2007

Charles Roselli set out to discover what makes some sheep gay. Then the news media and the blogosphere got hold of the story. Dr. Roselli, a researcher at the Oregon Health and Science University, has searched for the past five years for physiological factors that might explain why about 8 percent of rams seek sex exclusively with other rams instead of ewes. The goal, he says, is to understand the fundamental mechanisms of sexual orientation in sheep. Other researchers might some day build on his findings to seek ways to determine which rams are likeliest to breed, he said. But since last fall, when People for the Ethical Treatment of Animals started a campaign against the research, it has drawn a torrent of outrage from animal rights activists, gay advocates and ordinary citizens around the world — all of it based, Dr. Roselli and colleagues say, on a bizarre misinterpretation of what the work is about.
     The story of the gay sheep became a textbook example of the distortion and vituperation that can result when science meets the global news cycle. The news media storm reached its zenith last month, when The Sunday Times in London published an article under the headline “Science Told: Hands Off Gay Sheep.” It asserted, incorrectly, that Dr. Roselli had worked successfully to “cure” homosexual rams with hormone treatments, and added that “critics fear” that the research “could pave the way for breeding out homosexuality in humans.” Martina Navratilova, the tennis star who is both openly gay and a PETA ally, wrote in an open letter that the research “can only be surmised as an attempt to develop a prenatal treatment” for sexual conditions.
     The controversy spilled into the blog world, with attacks on Dr. Roselli, his university and Oregon State University, which is also involved in the research. PETA began an e-mail campaign that the universities say resulted in 20,000 protests, some with language like “you are a worthless animal killer and you should be shot,” “I hope you burn in hell” and “please, die."  The news coverage, which has been heaviest in England and Australia, focused on smirk and titillation — and, of course, puns. Headlines included “Ewe Turn for Gay Rams on Hormones” and “He’s Just Not That Into Ewe.”
     In recent weeks, the tide has begun to turn, with Dr. Roselli and Jim Newman, an Oregon Health and Science publicist, saying they have been working to correct the record in print and online. The university has sent responses to senders of each PETA-generated e-mail message. Dr. Roselli, whose research is supported by the National Institutes of Health and is published in leading scientific journals, insists that he is as repulsed as his critics by the thought of sexual eugenics in humans. He said human sexuality was a complex phenomenon that could not be reduced to interactions of brain structure and hormones.
     On blogs where attacks have appeared, the researchers point out that many of the accusations, like The Sunday Times’s assertion that the scientists implant devices in the brains of the sheep, are simply false. The researchers acknowledge that the sheep are killed in the course of the research so their brain structure can be analyzed, but they say they follow animal welfare guidelines to prevent suffering.
     Dr. Roselli and Mr. Newman persuaded some prominent bloggers, including Andrew Sullivan, who writes an online column for Time, to correct postings that had uncritically quoted The Sunday Times’s article. They also found an ally in the blog world: a scientist who writes under the pseudonym emptypockets and has taken up Dr. Roselli’s cause. The blogger, who spoke on the condition of anonymity because he said a public stand could hurt his career, said he had been cheered by the number of bloggers who dropped their opposition when presented with the facts.
     Ms. Navratilova, who also received a response from the university, said she remained unconvinced. “The more we play God or try to improve on Mother Nature, the more damage we are doing with all kinds of experiments that either have already turned or will turn into nightmares,” she wrote in an e-mail reply to a reporter’s query. “How in the world could straight or gay sheep help humanity?”
     In an interview, Shalin Gala, a PETA representative working on the sheep campaign, said controlling or altering sexual orientation was a “natural implication” of the work of Dr. Roselli and his colleagues. Mr. Gala, who asked that he be identified as openly gay, cited the news release for a 2004 paper in the journal Endocrinology that showed differences in brain structure between homosexual and heterosexual sheep. The release quoted Dr. Roselli as saying that the research “also has broader implications for understanding the development and control of sexual motivation and mate selection across mammalian species, including humans.”
     Mr. Newman, who wrote the release, said the word “control” was used in the scientific sense of understanding the body’s internal controls, not in the sense of trying to control sexual orientation. “It’s discouraging that PETA can pick one word, try to add weight to it or shift its meaning to suggest that you are doing something that you clearly are not,” he said.
     Dr. Roselli said that merely mentioning possible human implications of basic research was wildly different from intending to carry the work over to humans. Mentioning human implications, he said, is “in the nature of the way we write our grants” and talk to reporters. Scientists who do basic research find themselves in a bind, he said, adding, “We have been forced to draw connections in a way that we can justify our research.” As for whether the deaths of the sheep are justified, he said, “why would you pick on a guy who’s killing maybe 18 sheep a year, when there’s maybe four million killed for food and clothing in this country?”
     Paul Root Wolpe, a professor of psychiatry at the University of Pennsylvania and a senior fellow at the university’s Center for Bioethics, said that although he supported Dr. Roselli’s research, “I’m not sure I would let him off the hook quite as easily as he wants to be let off the hook.” By discussing the human implications of the research, even in a somewhat careful way, Dr. Roselli “opened the door” to the reaction, Dr. Wolpe said, and “he has to take responsibility for the public response.” If the mechanisms underlying sexual orientation can be discovered and manipulated, Dr. Wolpe continued, then the argument that sexual orientation is based in biology and is immutable “evaporates.” The prospect of parents’ eventually being able to choose not to have children who would become gay is a real concern for the future, Dr. Wolpe said. But he added, “This concern is best addressed by trying to change public perceptions of homosexuality rather than stop basic science on sexuality.”



In Clue to Addiction, a Brain Injury Halts Smoking
Benedict Carey, New York Times- 1/26/2007

Scientists studying stroke patients are reporting today that an injury to a specific part of the brain, near the ear, can instantly and permanently break a smoking habit. People with the injury who stopped smoking found that their bodies, as one man put it, “forgot the urge to smoke.” The finding, which appears in the journal Science, is based on a small study. But experts say it is likely to alter the course of addiction research, pointing researchers toward new ideas for treatment.
      While no one is suggesting brain injury as a solution for addiction, the finding suggests that therapies might focus on the insula, a prune-size region under the frontal lobes that is thought to register gut feelings and is apparently a critical part of the network that sustains addictive behavior. Previous research on addicts focused on regions of the cortex involved in thinking and decision making. But while those regions are involved in maintaining habits, the new study suggests that they are not as central as the insula is.
     The study did not examine dependence on alcohol, cocaine or other substances. Yet smoking is at least as hard to quit as any other habit, and it probably involves the same brain circuits, experts said. Most smokers who manage to quit do so only after repeated attempts, and the craving for cigarettes usually lasts for years, if not a lifetime. “This is the first time we’ve shown anything like this, that damage to a specific brain area could remove the problem of addiction entirely,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which financed the study, along with the National Institute of Neurological Disorders and Stroke. “It’s absolutely mind-boggling.”
     Others cautioned that scientists still knew little about the widely distributed neural networks involved in sustaining habits. “One has to be careful not to extrapolate too much based on brain injuries to what’s going on in all addictive behavior, in healthy brains,” said Dr. Martin Paulus, a psychiatric researcher at the University of California, San Diego, and the San Diego V.A. Medical Center. Still, Dr. Paulus said, the study “opens up a whole new way to think about addiction.”
     The researchers, from the University of Iowa and the University of Southern California, examined 32 former smokers, all of whom had suffered a brain injury. The men and women were lucid enough to answer a battery of questions about their habits, and to rate how hard it was to quit and the strength of their subsequent urges to smoke. They all had smoked at least five cigarettes a day for two years or more, and 16 of them said they had quit with ease, losing their cravings entirely.
     The researchers performed M.R.I. scans on all of the patients’ brains to specify the location and extent of each injury. They found that the 16 who had quit easily were far more likely to have an injury to their insula than to any other area. The researchers found no association between a diminished urge to smoke and injuries to other regions of the brain, including tissue surrounding the insula. “There’s a whole neural circuit critical to maintaining addiction, but if you knock out this one area, it appears to wipe out the behavior,” said Dr. Antoine Bechara, a senior author of the new paper, who is a neuroscientist at the Brain and Creativity Institute at U.S.C. His co-authors were Dr. Hanna Damasio, also of U.S.C., and Nasir Naqvi and David Rudrauf of the University of Iowa.
     The patients’ desire to eat, by contrast, was intact. This suggests, the authors wrote, that the insula is critical for behaviors whose bodily effects become pleasurable because they are learned, like cigarette smoking.
     The insula, for years a wallflower of brain anatomy, has emerged as a region of interest based in part on recent work by Dr. Antonio Damasio, a neurologist and director of the Brain and Creativity Institute. The insula has widely distributed connections, both in the thinking cortex above, and down below in subcortical areas, like the brain stem, that maintain heart rate, blood pressure and body temperature, the body’s primal survival systems.
     Based on his studies and others’, Dr. Damasio argues that the insula, in effect, maps these signals from the body’s physical plant, and integrates them so the conscious brain can interpret them as a coherent emotion. The system works from the bottom up. First, the body senses cues in the outside world, and responds. The heart rate might elevate at the sight of a stranger’s angry face, for example; other muscles might relax in response to a pleasant whiff of smoke.
     All of this happens instantaneously and unconsciously, Dr. Damasio said — until the insula integrates the information and makes it readable to the conscious regions of the brain. “In a sense it’s not surprising that the insula is an important part of this circuit maintaining addiction, because we realized some years ago that it was going to be a critical platform for emotions,” Dr. Damasio said in a telephone interview. “It is on this platform that we first anticipate pain and pleasure, not just smoking but eating chocolate, drinking a glass of wine, all of it.” This explains why cravings are so physical, and so hard to shake, he said: they have taken hold in the visceral reaches of the body well before they are even conscious.
     Other researchers have found that the insula is activated in unpleasant circumstances, like a bad smell or the anticipation of a painful shock, or even in shoppers when they see a price that seems too high. Damage to the insula is associated with slight impairment of some social function.
     While antismoking treatments based on the new findings are still a long way off, the authors suggest that therapies that replicate some of the physical sensations of the habit, like inhalers, could be useful. And at least two previous studies suggest that people can reduce the sensation of pain by learning to modulate the activity in an area of their brain. In experiments, healthy volunteers watched real-time M.R.I. images of a cortical region linked strongly to pain sensation and learned to moderate that neural activity, reducing the pain they felt from a heated instrument pressed to their palms. The same kind of technique could be tried with addicts watching images of their insulas. “The question is, Can you learn to deactivate the insula?” Dr. Volkow said. “Now, everybody’s going to be looking at the insula.”

Seattle Suicides Alarm Office Workers
Associated Press, 1/26/2007

SEATTLE -- A bridge over Seattle is becoming hazardous to the mental health of the dot-com employees and other office workers below, who keep seeing people jump to their deaths from the span. Thirty-nine people over the past decade have committed suicide off the 155-foot-high Aurora Bridge -- eight in 2006 alone -- and counselors are regularly brought in to help office workers deal with the shock of seeing the leap or the bloody aftermath. At least one woman, Sarah Edwards, drives on the left side of the street near her office ever since a body landed on the hood of a co-worker's car. City and state officials, meanwhile, are adding suicide-prevention signs and telephones in hopes of reducing the death toll.
      The ''suicide bridge,'' as the half-mile span has been occasionally called since it was built in 1931, carries as many as 45,000 vehicles a day on one of the main north-south highways through Seattle, passing over a narrow channel connecting Lake Washington and Lake Union. Some jumpers hit the water; others land on the pavement or other solid ground. Either way, they almost always die. (One person is said to have survived after landing in the water.)
     The neighborhood beneath the bridge used to be docks and warehouses, and the suicides went largely unnoticed. But during the technology boom of the past two decades, it morphed into a trendy area full of office buildings, shops and restaurants, and the bodies began to fall where people could see them. ''They end up in our parking lot,'' said Katie Scharer, one of Edwards' co-workers at Cutter & Buck, a sportswear company based in the Adobe complex. ''Nobody's ever totally used to it.''
     Grief counselors regularly go to Cutter & Buck, paying a visit as recently as a month ago. A few weeks ago, officials installed six emergency phones and 18 signs that read, ''Suicidal?'' and give the number of a 24-hour crisis line in bold yellow type. ''Any time you can interrupt a suicide thought process, you have a good chance of success, at least temporarily,'' said L.J. Eddy, head of the police hostage negotiation team. But as for other possible solutions, transportation officials said installing nets or raising the sides of the bridge could interfere with safety inspections -- which are made with a big bucket lowered over the railing -- and could catch the wind, making the span dangerously unstable. Moreover, any plans would need to go through a special public approval process because the bridge is a national historic landmark.
     Seattle's other major bridges -- the Ship Canal Bridge that carries Interstate 5 and the West Seattle Bridge -- see few suicides because they are closed to pedestrians. The city does not even want to talk about preventing people from walking on the Aurora Bridge, which is a pedestrian link between two densely populated hilltops. But the state has considered moving the pedestrian walkway to an enclosed structure below the span.