Noteworthy News Articles on Mental Health Topics, February 1-5, 2007



Sex Issues May Signal Other Health Risks
Associated Press, 2/1/2007

LONDON -- Doctors shouldn't shy away from asking patients about their sex lives, a new research paper advises. Researchers say problems in the bedroom can translate into serious medical conditions, and ignoring sexual dysfunction may mean missing early indicators for heart failure, depression or other ailments, according to a paper published in Friday's issue of The Lancet. ''Sex is a legitimate part of medicine, but it has largely been kept separate from the rest of medicine,'' said Dr. Rosemary Basson, the paper's lead author. Basson is based at the British Columbia Centre for Sexual Medicine in Vancouver.
      Basson and her co-author, Dr. Willibrord Weijmar Schultz of the University Medical Centre in Groningen, the Netherlands, examined numerous medical databases looking for sexual dysfunctions in combination with diseases such as heart failure, diabetes, depression, multiple sclerosis and Parkinson's. Many sexual problems were identified as possible red flags of underlying or imminent medical conditions. ''If a man comes in with erectile dysfunction, it can be the tip of the iceberg,'' said Dr. Andrew McCullough, a sexual health expert at New York University Medical Center who was not connected to the paper.
     Doctors are being increasingly advised to take the initiative to ask patients about their sex lives, including basic questions about who they have sex with, how frequently and if they engage in potentially risky behavior. ''People aren't going to volunteer that kind of information unless they're specifically asked,'' said Dr. Jonathan Zenilman, chief of the infectious diseases division at Johns Hopkins Bayview Medical Center, who was not involved with the research.
     What patients often fail to realize, physicians say, is that sexual dysfunctions are often a symptom of something more serious. For instance, men with erectile dysfunction, the most common sexual disorder in older men, are often at increased risk of heart disease. In one study of 132 men who had heart surgery, nearly half had a history of erectile dysfunction. That diagnosis preceded the heart surgery in nearly 60 percent of the men.
     In women, picking up on sex clues is more difficult. ''Women don't have as obvious a physical signal for sexual problems as men,'' said Basson. But a woman's lack of sexual desire reveals an underlying depression in up to 26 percent of cases. Taken together with other symptoms, sexual abnormalities in women could point to hormone conditions, kidney failure, diabetes, or other chronic diseases.
     By using sexual problems as early indicators of medical complications, doctors can capitalize on valuable lead time to treat their patients. ''The first manifestation of early diabetes could be erectile dysfunction,'' said Zenilman. ''It may not be what men want to hear, but if it's caught early enough, you can still do something about it.''
     In the case of depression, patients often go for years without being treated. If astute clinicians were able to make the connection between lack of sexual desire with psychiatric conditions such as depression or post-traumatic stress syndrome, patients could be offered treatment earlier, according to Zenilman. Yet while sexual problems can be an indicator of poor health, the prospect of better sex may persuade people to lead healthier lives. ''Sex can be used as a great carrot for people,'' said McCullough. ''People will be more willing to make lifestyle modifications to improve their health if they think they'll also get improved sex.''

Eating Disorders a Guy Thing Too, Study Finds
Denise Gellene, Los Angeles Times- 2/1/2007

Contrary to the long-held belief that anorexia and bulimia are female afflictions, the first national survey on eating disorders has found that one-quarter of adults with the conditions are men.
The study estimated that about 850,000 men had suffered from the disorders and, despite two decades of intense attention to the conditions, had gone largely undetected. "This is a very important finding," said Ruth Streigel-Moore, an eating disorders expert at Wesleyan University who was not connected with the study. "It suggests a need to move away from gender-based explanations."
     The researchers said the findings, which appear today in the journal Biological Psychiatry, indicated men are vulnerable to the same social pressures that lead some women to uncontrollably binge and purge on food and others to starve themselves. "Body image has become more important among men," said co-author Dr. Harrison G. Pope Jr., a professor of psychiatry at Harvard Medical School. "There's a large, silent population of men who might be quite ill."
     Overall, the survey found that 4.5% of adults, or 9.3 million people, have struggled with an eating disorder sometime in their lives. Anorexia accounted for 1.3 million of the cases, and bulimia 2.1 million. Binge eating, a disorder of frequent, uncontrollable periods of gorging, accounted for the largest number of cases, 5.9 million.
      The study, conducted by researchers at Harvard University Medical School, was based on information obtained from the National Comorbidity Survey Replication, a mental health survey of nearly 9,000 adults across the U.S. Funding for the study came from several sources, including the National Institutes of Health and pharmaceutical companies Eli Lilly & Co. and Johnson & Johnson, both of which sell drugs that are used as off-label treatments for eating disorders.
     The survey found the prevalence of eating disorders has been rising since World War II. The lifetime risk of 18-year-olds developing an eating disorder is twice that of their parents, according to the report.

Role of fast food
Researchers haven't pinpointed the cause of eating disorders but said heredity and the environment, including a societal obsession with thinness and the proliferation of calorie-laden fast food, are factors. People with anorexia are obsessed with their body weight and diet to the point that they become dangerously thin. Half of the people with the disorder binge on food and then purge by vomiting or using laxatives or diuretics. The other half restricts the food they eat and excessively exercises. The disorder is fatal in 10% of cases. People with bulimia eat a lot of food in a short amount of time and then try to prevent weight gain by vomiting or taking laxatives to get rid of the food. Bulimics also may exercise or use diuretics to keep off extra pounds, but they generally maintain a normal body weight. It also can be fatal.
     Dr. Walter H. Kaye, director of the eating disorders program at UC San Diego, who was not involved in the research, said that men with eating disorders may have escaped attention because they are less likely to seek psychological help in general and because the extent of their illnesses may not be as severe. "It could be that eating disorders are associated with women, so men may not even recognize eating disorders in themselves," he said.

Buffeted by fitness craze
Pope said the findings showed that men too had been buffeted by the fitness craze of recent years. "The cynical interpretation would be that all the industries that have preyed upon women have saturated the female market and are turning their attention to the other 50% of the population," he said.
     One of the key findings of the survey was the length of time that the disorders persisted. It found that bulimia and binge eating persisted for an average of eight years, while anorexia was far more transient, typically lasting for one year.
     Kaye, who is researching the genetic basis of eating disorders, said the finding about anorexia was puzzling. The medical community has long regarded anorexia as a chronic condition, he said. "I have been doing this for 25 years, and I know a number of people who have died and have been chronically ill for many years," he said. Jeanine Cogan, policy director of the Washington-based Eating Disorders Coalition, worried the finding might cause some to dismiss the severity of the disorder. "Anorexia is not just a passing phase," she said.
     Binge eating is not considered a life-threatening condition. Nearly 15% of people with binge-eating disorder are severely obese, which can lead to heart disease, diabetes and other serious health problems. More than half of binge eaters are women. As with anorexia and bulimia, binge eating is associated with mood disorders.
     Pope said that binge eating is not the same as eating too much. "These are people who sit down to have a couple potato chips and all of a sudden they can't stop eating, and they want something sweet, and they want something salty, and the next thing they know they are completely stuffing themselves," he said. "It is quite different from the munching you would do watching the Super Bowl."
     Binge-eating disorder isn't classified as an official medical diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the bible of the psychiatric profession. Dr. James I. Hudson, lead author of the report, said the latest findings argued that it should be included, which would allow patients to receive insurance reimbursement for treatment.

Study: Binging a Common Eating Disorder
Associated Press, 2/1/2007

BOSTON -- Frequent binge eating is the country's most common eating disorder, far outpacing the better-known diet problems of anorexia and bulimia, according to a national survey. Psychiatric researchers at Harvard University Medical School and its affiliate, McLean Psychiatric Hospital, have billed the study as the first national census of eating disorders. The results were published Thursday in the medical journal Biological Psychiatry.
      The survey found that 3.5 percent of women and 2 percent of men suffer from binge eating, defined as bouts of uncontrolled eating, well past the point of being full, that occur at least twice a week. The doctors diagnosed fewer than 1 percent of women and 0.3 percent of men with anorexia, a disorder where an exaggerated fear of weight gain causes undereating and malnourishment. The study determined that 1.5 percent of women and 0.5 percent of men had bulimia, characterized by the ''binge-purge'' syndrome of overeating followed by vomiting.
     McLean Hospital's Dr. Harrison Pope, an author of the study, said binge eaters face severe risk of obesity and related diseases like diabetes, heart disease, stroke and certain cancers. A binge eater, for instance, might eat a full dinner, then a quart of ice cream for dessert, followed by a bag of chips, without being able to stop, Pope said. ''It's a little bit analogous to something you hear from an alcoholic, when they might say, 'Well, I wanted to have one drink,' and they've had 12 drinks and they're passed out on the floor,'' he said in a conference call with reporters. ''Even though they feel full, even though they feel disgusting and guilty, they can't stop.''
     Dr. James I. Hudson, the study's lead author and a Harvard Medical School psychiatry professor, said binge eating deserves more recognition from health professionals. ''These results argue that binge eating is common. It's more common than both the other eating disorders combined and it's strongly associated with obesity,'' he said. ''Taken together, these findings suggest that this is an eating disorder and should be treated as such.''
     Funding for the study came from several sources, including the National Institutes of Health, Eli Lilly & Co. and the Robert Wood Johnson Foundation. Hudson said the research team interviewed more than 9,000 people nationwide from 2001 to 2003 about their eating habits and psychological backgrounds. The study probably underestimates the actual number of those with eating disorders, he said, because people are often ashamed to acknowledge their abnormal eating habits.
     The survey also found that people struggle longer with binge eating -- symptoms persist for an average of about eight years compared to less than two years for anorexic patients, who are often young and may recover as they mature. Bulimics suffer without cure for an average of roughly eight years, according to the study. Men and women between the ages of 18 and 29 were most likely to be diagnosed with an eating disorder, while people older than 60 had the lowest rates of eating problems. The doctors said all three illnesses usually coincided with mood disorders like depression and anxiety. A combination of the ''cultural barrage'' of images of rail-thin movie stars, ubiquitous fast-food advertising and genetic predisposition is usually the root of eating disorders, the study said.
     Dr. B. Timothy Walsh, director of the eating disorders research unit at the New York State Psychiatric Hospital at Columbia University Medical Center, said the study confirms a widespread belief that the population of binge eaters is growing. He said if binge eating is a cause of obesity, psychiatrists could give more effective treatment to many overweight people. ''Everyone has a sense, whether from a casual inspection of people on Broadway or an empirical study, that there are a lot of problems with binge eating and overeating,'' he said. ''The question is, is it a cause or a symptom?''
     On the Net: http://www.mclean.harvard.edu/

The Lady Regrets: Interview with Renee Richards
Joyce Wadler, New York Times- 2/1/2007

BEFORE Dr. Renée Richards had a sex-change operation, when she was an up-and-coming eye doctor and one of the top-ranked amateur tennis players in the East, she could be, by her own estimation, an arrogant fellow, tough and demanding. Talking with her three decades later, one still has the uneasy sense, at times, of that impatient male surgeon trapped in her body trying to break out.
      Not that Dr. Richards, 72 and still practicing, is ever anything but polite. She comes outside in the rain, in sneakers, warm-up pants and a red sweater, to greet her visitor, reining in her enthusiastic, 140-pound Bernese mountain dog. She’s had her assistant, Arleen Larzelere, 60, prepare lunch. She provides a tour of her cozy three-bedroom cottage in the hamlet of Kent Cliffs, in Putnam County, an hour north of New York City: the faded chintz armchairs, the walk-in closet where a mink shares space with a golf bag that bears her name.
     But as the conversation prompted by Dr. Richards’s new memoir, “No Way Renée,” runs to two hours, she grows restless. Dr. Richards is 6’2”, with the rangy body of a lifelong athlete, and in maturity, her angular bone structure seems to be pushing its way to the fore. And as she wearies of the interview, her body language seems to become more traditionally male, suggesting an athlete who is wearying of the game. “You’re writing this book all over again,” she grouses. And, later, on another subject, “I can explain, but I don’t think you’re going to be able to follow it.”
     Time to talk about, uh ... décor. Those antique tennis illustrations; the plaque marking your induction into the Eastern Tennis Hall of Fame in 2000. It appears, Dr. Richards, that there are no photos of you as a man. “I don’t like to have pictures of me as a guy in the dining room or living room,” says Dr. Richards, who was once Dr. Richard Raskind. “I threw away most of the pictures of Dick. In fact, pictures of Dick with a beard, I destroyed.” She leads the way to the bedroom, where there are photos of her as both a handsome young male Naval officer and a good-looking middle-aged woman. In one photo of herself, Renée stands with her father, who refused to acknowledge her sex change, even when she visited him in a skirt. He’s smiling at you, the reporter says. “Sure he’s smiling, you kidding?” Dr. Richards says. “The sun rose and set over me. Every clipping about me, Dick or Renée, he saved.”
     Dr. Richards never wanted to be a pioneer. But in 1976, while taking part in women’s amateur tennis competitions, she was revealed to have once been a man, setting off a media feeding frenzy. The next year, when the United States Tennis Association tried to prevent her from playing in the women’s events at the U.S. Open, Open, she went to court and won the right to play.
     “No Way Renée: The Second Half of My Notorious Life,” written with John Ames, deals with the long-term consequences of her surgery. Dr. Richards writes of life as a very young boy, when an older sister, “after pushing my penis into my body,” would say “Now you’re a little girl”; of their psychiatrist mother who occasionally dressed him in a slip. As an adult, there was off-and-on use of female hormones, which left Dr. Richard Raskind with breasts. He tried to compensate in the early years of his marriage by acting tough. “I swaggered like a macho man,” Dr. Richards writes, “but I jiggled when I did so.”
     The marriage, which produced a son, ended in divorce. Nor did Dr. Richards’s sex change bring her the great love affair with a man of which she dreamed, although there was affection and sex. Romance with a woman does not interest her. Though she has lived with Ms. Larzelere, her former office manager, for almost 25 years — she turns over her check each week and Ms. Larzelere handles the grocery shopping and cooking — their relationship is not romantic. Dr. Richards says there is a bond because both were scarred by their childhoods, Ms. Larzelere by an alcoholic father who beat her. Ms. Larzelere, a warm woman who is so insistent about being a caregiver that she calls the reporter three times with an offer to pick her up at the train station, explains it more simply. “I just take care of people,” she says, “that’s what I do.” Now divorced, Ms. Larzelere says she gave up on men in her mid-30s. Dr. Richards’s book also deals with the effects of her surgery on her son, Nick Raskind, now grown. Mr. Raskind was 3 years old at the time of the sex change, but was not told about it until he was 8. (When Dr. Richards saw her son during that period, she dressed as a man and wore a short gray wig.) Dr. Richards takes responsibility for her son’s problems: getting tossed out of prep schools; running away to Jamaica at 13. These days, Mr. Raskind is a New York City real estate broker specializing in lofts in the financial district, and Dr. Richards bunks at her son’s Park Avenue apartment when she works in Manhattan.
     Would Mr. Raskind be willing to talk about Dr. Richards? “If he thinks it would help him sell some lofts, he will,” she says. Mr. Raskind seems perfectly comfortable speaking about the woman who still considers herself his father — although he’s annoyed that his problems were always blamed on the sex change. He also refers to Dr. Richards as “he. Why? “Because I have a mother that’s a woman,” he says. “My father could have an elephant change — he could be a dromedary — and he’d still be my father.”
     He has no memory of being told about his father’s change. “For a kid, it was a non-event,” he says. “I was a pretty fat little kid and I used to get teased about being fat a lot. Then between the time I was 10 and 13, kids at school did know about it and I used to get teased about it. That was the driving force behind me getting into martial arts very seriously later in life.”
     Back to Dr. Richards, who is surprisingly conservative. She calls the 2004 decision of the International Olympic Committee, which allows transsexuals to compete, “a particularly stupid decision,” explaining that when she sued to play at the U.S. Open, she was 40. “I wasn’t going to overwhelm Chris Evert and Tracy Austin, who were 20 years old.” And while she believes same-sex couples should receive the same benefits as those who are married, her idea of marriage demands a man and a woman. “It’s like a female plug and an electrical outlet,” she says.
     In Ms. Larzelere, she seems to have a wife, she is told. “How many famous actresses have said, ‘I want a wife,’ ” Dr. Richards says. “Katharine Hepburn had somebody like Arleen who lived with her for the final 30 years.”
     In her book, Dr. Richards never writes that she regrets having had her surgery, yet she lists so many regrets relating to her sex change that it is like someone who returns again and again to the edge of a great pit, but refuses to leap in. Those feelings were also evident in past interviews. “In 1999, you told People—” the reporter begins. Dr. Richards interrupts. “—I told People what I was feeling, which I still feel: Better to be an intact man functioning with 100 percent capacity for everything than to be a transsexual woman who is an imperfect woman.”
     In the same interview, Dr. Richards talked about wishing for something that could have prevented the surgery. “What I said was if there were a drug, some voodoo, any kind of mind-altering magic remedy to keep the man intact, that would have been preferable, but there wasn’t,” Dr. Richards says. “The pressure to change into a woman was so strong that if I had not been able to do it, I might have been a suicide.” Does she regret having the surgery? “The answer is no.”
     Dr. Richards’s game is no longer tennis; her knees are shot. Her great passion now is golf. “I swing a golf club four times a week, every chance I get, ” she says. “I try to cram in what I didn’t have until starting 12 years ago. And I can’t do it. No matter how excellent an athlete I was, maybe it’s like having a sex change, it’s something I can’t undo: I can’t undo the fact I didn’t play golf when I was a kid.”

Dark Days Follow Hard-Hitting Career in N.F.L.
Alan Schwarz, New York Times- 2/2/2007

“There’s something wrong with me,” said Mr. Johnson, 34, who spent 10 years in the National Football League as the Patriots’ middle linebacker. “There’s something wrong with my brain. And I know when it started.” Mr. Johnson’s decline began, he said, in August 2002, with a concussion he sustained in a preseason game against the New York Giants. He sustained another four days later during a practice, after Patriots Coach Bill Belichick went against the recommendation of the team’s trainer, Johnson said, and submitted him to regular on-field contact. Mr. Belichick and the Patriots’ head trainer at the time, Jim Whalen — each of whom remain in those positions — declined to comment on Mr. Johnson’s medical experience with the team or his allegations regarding their actions.
      Following his two concussions in August 2002, Mr. Johnson sat out the next two preseason games on the recommendation of a neurologist. After returning to play, Mr. Johnson sustained more concussions of varying severity over the next three seasons, each of them exacerbating the next, according to Mr. Johnson’s current neurologist, Dr. Robert Cantu. Dr. Cantu said that he was convinced Mr. Johnson’s cognitive impairment and depression “are related to his previous head injuries, as they are all rather classic postconcussion symptoms.” He added, “They are most likely permanent.”
     Asked for a prognosis of Mr. Johnson’s future, Dr. Cantu, the chief of neurosurgery and director of sports medicine at Emerson Hospital in Concord, Mass., said: “Ted already shows the mild cognitive impairment that is characteristic of early Alzheimer’s disease. The majority of those symptoms relentlessly progress over time. It could be that at the time he’s in his 50s, he could have severe Alzheimer’s symptoms.”
     Mr. Johnson is among a growing number of former players and their relatives who are questioning whether their serious health issues are related to injuries they sustained and the treatment they received as players. Mr. Johnson said he decided to go public with his story after reading in The New York Times two weeks ago about Andre Waters, the former Philadelphia Eagles player who committed suicide last November and was later determined to have had significant brain damage caused by football-related concussions. Mr. Johnson said he was not suicidal, but that the depression and cognitive problems he had developed since 2002 had worsened to the point that he now takes Adderall, a prescription amphetamine, at two to three times the dosage authorized by his doctors, who have been unaware of this abuse. When he runs out of these pills, Mr. Johnson said, he shuts himself inside his downtown apartment for days and communicates with no one until a new prescription becomes available. He said he was coming forward with his story so that his friends and family might better understand his situation, and also so that the National Football League might improve its handling of concussions.
     While the league’s guidelines regarding head injuries have been strengthened over the past decade, the N.F.L.’s record of allowing half of players who sustain concussions to return to the same game remains a subject of medical debate. “I am afraid of somebody else being the next Andre Waters,” said Mr. Johnson, who spent two weeks in February at a psychiatric hospital outside Boston with, he said, no appreciable results. “People are going to question me: ‘Are you a whistleblower, what are you doing this for?’ You can call it whatever you want about what happened to me. I didn’t know the long-term ramifications. You can say that my coach didn’t know the long-term, or else he wouldn’t have done it. It is going to be hard for me to believe that my trainer didn’t know the long-term ramifications, but I am doing this to protect the players from themselves.”
     The N.F.L. spokesman Greg Aiello said that the league had no knowledge of Johnson’s specific situation. Regarding the subject of player concussions in general, he said, “We are very concerned about the issue of concussions, and we are going to continue to look hard at it and do everything possible to protect the health of our players.” At a news conference yesterday in Miami, where the Super Bowl will be held Sunday, Gene Upshaw, the executive director of the National Football League Players Association, spoke in general terms about concussions in the N.F.L. “If a coach or anyone else is saying, ‘You don’t have a concussion, you get back in there,’ you don’t have to go, and you shouldn’t go,” Upshaw said, not speaking about the Johnson case specifically. “You know how you feel. That’s what we tried to do throughout the years, is take the coach out of the decision-making. It’s the medical people that have to decide.”
     Mr. Johnson, who has a 2-year-old daughter and a 1-year-old son, is currently in divorce proceedings with his wife, Jackie, a situation that he admitted was compounding his depression. He was arrested in July on domestic assault-and-battery charges, which were later dropped because his wife declined to testify. Mr. Johnson said that his concussive symptoms and drug addiction not only precipitated his marriage’s decline but began several years before it, specifically that preseason of 2002.
     According to Patriots medical records that Mr. Johnson shared with The Times, the only notable concussion in his career to that point happened when he played at the University of Colorado in 1993. Against the Giants on Aug. 10, 2002, those records indicate, he sustained a “head injury” — the word concussion was not used — and despite the clearing of symptoms after several minutes on the sideline, he did not return to the game. Mr. Johnson said that four days later, when full-contact practice resumed, Mr. Whalen issued him a red jersey, the standard signal to all other players that he was not supposed to be hit in any way. About an hour into the practice, Mr. Johnson said, before a set of high-impact running drills, an assistant trainer came out on the field with a standard blue jersey. When he asked for an explanation, Mr. Johnson said, the assistant told him that he was following Mr. Whalen’s instructions. Mr. Johnson, whose relationship with Mr. Belichick had already been strained by a contract dispute, said he interpreted the scene as Mr. Belichick’s testing his desire to play, and that he might be cut and lose his $1.1 million salary — N.F.L. contracts are not guaranteed — if he did not follow orders. “I’m sitting there going, ‘God, do I put this thing on?’ ” Mr. Johnson said. “I put the blue on. I was scared for my job.” Regarding the intimidation he felt at that moment, Mr. Johnson added, “This kind of thing happens all the time in football. That day it was Bill Belichick and Ted Johnson. But it happens all the time.”
     Several Patriots teammates said they did not recall this incident but invariably testified to the believability of Mr. Johnson, the team captain in 1998 and 2003. Said one former teammate, who insisted on anonymity because he still plays with the Patriots under Mr. Belichick, “If Ted tells you something’s going on, something’s going on.”
     Mr. Johnson said that the first play called after he put the blue jersey on, known as “ace-ice,” called for one act from him, the middle linebacker: to sprint four yards headlong into the onrushing blocking back. After that collision, Mr. Johnson said, a warm sensation overtook his body, he saw stars, and he felt disoriented as the other players appeared to be moving in slow motion. He never lost consciousness, though, and after several seconds regained his composure and continued to practice “in a bit of a fog” while trying to avoid contact. He said he did not mention anything to anyone until after practice, when he angrily approached Mr. Whalen, the head trainer. “I said, ‘Just so you know, I got another concussion,’ ” Johnson said. “You could see the blood, like, leave his face. And he was like, ‘All right, all right, well, we’re going to get you in to see a neurologist.’ ”
     Dr. Lee H. Schwamm, the neurologist at Massachusetts General Hospital who examined Mr. Johnson, concluded in a memo on Aug. 19, 2002, that Mr. Johnson had sustained a second concussion in that practice. Dr. Schwamm also wrote that, after speaking with Mr. Whalen, that Mr. Whalen “was on the sidelines when he sustained the concussion during the game and assessed him frequently at the sideline,” and that “he has kept Mr. Johnson out of contact since that time.” Mr. Johnson said that the next day he spoke with Mr. Belichick about the incident but that they only glossed over it. “He was vaguely acknowledging that he was aware of what happened,” Mr. Johnson said, “and he wanted to just kind of let me know that he knew.”
     Mr. Johnson missed the next two preseason games, played in the final one, and then, believing he was still going to be left off the active roster for the opening game against Pittsburgh, angrily left camp for two days before returning and meeting with Mr. Belichick and confronting him privately about the blue-jersey incident. “It’s as clear as a bell — ‘I had to see if you could play,’ ” Mr. Johnson recalled Mr. Belichick saying. Minutes later, Mr. Johnson said, Mr. Belichick admitted he had made a mistake by making him wear the blue jersey. “It was a real kind of admittance, but it was only him and I in the room,” Mr. Johnson said.
     Mr. Johnson sat out the season opener but played the following Sunday against the New York Jets, a game in which Mr. Johnson said he could not remember line formations and was caught out of position because he could not concentrate. After sitting out the next game against Kansas City, Mr. Johnson played against San Diego and had the same problem. He learned how to manage the disorientation and played the rest of the season but said that, “from that point on, I was getting a lot of these, what I call mini-concussions.” Mr. Johnson added that he did not report these to his trainer or coaches for fear he would be seen as weak.
     This continued through the 2003 season, Mr. Johnson said, as he noticed himself feeling increasingly more unfocused, irritable and depressed. Teammates noticed as well, said Willie McGinest, a fellow linebacker who now plays for the Cleveland Browns. “He was always an upbeat, positive guy,” Mr. McGinest said. “After the last few concussions, you could tell he was off at times.” Playing poorly, Mr. Johnson lost his starting job.
     In the week before the 2004 Super Bowl, Mr. Johnson said, a friend who supplied amphetamines to several major league baseball pitchers gave him some Adderall pills to cure his lethargy and increase his concentration. “It was the best I had felt in the longest time,” Mr. Johnson said. “The old Ted was back.” After playing only sparingly in that Super Bowl, Mr. Johnson began taking larger and larger doses before and throughout the 2004 season, when he regained his starting position at middle linebacker and helped the Patriots win their second consecutive Super Bowl.
     The better mood did not last long, he said. The minor concussions — euphemized as “dings” in N.F.L. lingo — that he regularly sustained in practice and in games hurt more than the Adderall could help. The thought of violently tackling a player, he said, “made me physically ill.” “For the first time in my life,” he said, “I was scared of going out there and putting my head in there.”
     Mr. Johnson retired before the 2005 season and briefly worked as a football analyst for WBZ-TV in Boston. But he said his malaise and cognitive problems were only getting worse, and in his attempt to regain some sort of balance, he wound up taking large amounts of antidepressants along with increasing amounts of Adderall, creating a dangerous up-and-down cycle that he realized required professional attention. Last February, he spent two weeks at McLean Hospital, a psychiatric institution in suburban Belmont, Mass. Mr. Johnson said he felt no better after that experience, and he quickly resumed the Adderall abuse that continues today. He has moved out of his former house during his divorce proceedings and lives in a two-bedroom apartment downtown, which after three months contains dozens of half-open moving boxes. “Welcome to the glamorous life of a former N.F.L. player,” he said. A half-hour later, he stepped into his Range Rover and drove to his local CVS to pick up another bottle of Adderall. The 72 pills of 30 milligrams each are supposed to last nine days, but he knows he will blow through them in four or five.
     One of his most maddening frustrations, Mr. Johnson said, is that no tests — from M.R.I.’s to other scans of his brain — have confirmed his condition, causing some people in his life to suspect that he is wallowing in retirement blues. “That’s ridiculous,” he said, “because I always treated football as a steppingstone for the rest of my life. I used to have incredible drive and ambition. I want to get my M.B.A. But I can’t even let myself have a job right now. I don’t trust myself.”
     Dr. Cantu, his neurosurgeon, said he was convinced that Mr. Johnson’s condition was primarily caused by successive concussions sustained over short periods of time. He said that M.R.I.’s of Mr. Johnson’s brain were clear, but that “the vast majority of individuals with postconcussion syndrome, including depression, cognitive impairment, all the symptoms that Ted has, have normal M.R.I.’s.” The most conclusive method to assess this type of brain damage, Dr. Cantu said, was to examine parts of the brain microscopically for tears and tangles, but such a test is done almost exclusively post-mortem. It was this type of examination that was conducted by a neuropathologist at the University of Pittsburgh, Dr. Bennet Omalu, on the brain of Mr. Waters after his suicide, revealing a condition that Dr. Omalu described as that of an 85-year-old with Alzheimer’s disease. “The type of changes that Andre Waters reportedly had most likely Ted has as well,” Dr. Cantu said.
     Experts in the field of athletic head trauma have grown increasingly confident through studies and anecdotal evidence that repeated concussions, particularly those sustained only days apart, are particularly dangerous. Dr. David Hovda, a professor of neurosurgery and director of the Brain Injury Research Center at U.C.L.A., said, “Repeated concussions — it doesn’t matter the severity — have affects that are more than additive, and that last longer.”
     Sitting in his apartment this week, Mr. Johnson said that he had not considered a lawsuit against Mr. Belichick, any Patriots personnel or the N.F.L. He said that his sole motivation was to raise awareness of the dangers that football players can face regarding concussions. Asked who was to blame for his condition — Mr. Belichick, Mr. Whalen, himself or the entire culture of the N.F.L. — Mr. Johnson thought for 30 seconds and said he could not decide.
     Several hours later, he was riding in an elevator up to a consultation with Dr. Cantu. As the door opened on the seventh floor, a middle-aged man walked out and smiled warmly at Mr. Johnson. “We missed you this year,” he said. “Thanks, man,” Mr. Johnson said with a grin and a nod. Later, Mr. Johnson said something else went through his troubled mind at that moment. “I miss me, too,” he said.

In Photos, Patients Explore Their World
Paul Schwartzman, Washington Post- 2/3/2007

The black-and-white photographs capture moments in the life of a psychiatric ward: a man vanishing through the door at the end of a long, drab hallway; a dark, empty gymnasium strafed by shafts of perforated sunlight; a winding black metal staircase that appears to lead nowhere. The photographers know their subject well. They are residents of St. Elizabeths Hospital in Southeast Washington, all of them sent there for committing crimes after being found not guilty by reason of insanity.
      Kevin McCain, 50, has been a patient since 1976, filling his days with a routine of phone calls to his mother, classes and Alcoholics Anonymous meetings. On Fridays, he gets to participate in something a bit different -- a photography workshop with five other residents and a volunteer who coordinates afternoons of taking pictures and talking about their work. The sessions, McCain said, are a welcome relief from what he finds himself seeing on television in the common area of his ward, images of war and crime and devastation. "It gives me a chance to see pictures that are more pleasant," he said in a telephone interview.
     A high point, McCain said, is when the group's photographs are exhibited, as they are until Feb. 9 at the Church of the Pilgrims, 22nd and P streets NW, in Dupont Circle. Seeing their work on a wall, encased in handsome black frames, makes the patients feel proud and exhilarated. "It was like spring had sprung," McCain said.
     The photography workshop is part of the yearly Lens, Pens, Brushes & Friends program that St. Elizabeths sponsors. Another group of patients is studying painting. Their work is on exhibit at Mocha Hut, 13th and U streets NW. Other patients explore poetry. Ed Washington, who recently retired as a St. Elizabeths social worker, conceived of the program eight years ago as a way to encourage patients to forge relationships and exercise their imaginations. The 20 residents in the program are men who range in age from their 30 to 60 and suffer from schizophrenia. Their crimes, he said, run the gamut, including attempted murder, attempted rape, arson and assault. "Here's a group of people who really have talents and aspirations just like anyone else, and they need to be recognized," Washington said. "One of the best ways to open the doors is through engagement in the arts."
     Kate DeCiccio, an artist, has spent more than a year volunteering with the men every Friday for several hours. She has come to know their personal and family histories, what medication they're taking, their fears and their aspirations. She also has seen them grow as artists. Herb Settles, a patient in his mid-60s, started out producing a substantial volume of work, showing up at their Friday sessions with 20 or 30 drawings that he made in his room. The question DeCiccio faced was, "How do I slow Herb down?" She encouraged him to paint, and he produced colorful, intricate works, filled with faces and fish, representations of images he has seen in his dreams. "Herb has developed a style," she said. "He's an artist. He fills his day producing and producing. He has come up with a style and an aesthetic."
     Maureen Jais-Mick, development director for the Green Door, a local organization that treats schizophrenics, coordinates the photography program. She supplies the men with cameras, teaches them about lighting, takes them on shooting expeditions and develops their pictures. "Everybody benefits from being creative," she said. "It's way cooler to be a photographer than a patient. If there are a couple of hours a week and they're thinking about photography and how the lighting is hitting something, I think that's wonderful."
     The subject of the men's photography is somewhat limited because they are confined to maximum and minimum security wards. Their mission over the past year was to photograph the inside of their residence at the John Howard Pavilion. While outsiders may view the building as a dreary, the patients see it as their home, defined by spare, familiar simplicity. A coat rack is the subject of one photograph. An oven is captured in another. Two barber chairs are the focus of a third. "They don't seem to have any difficulty finding the beauty," Jais-Mick said. "Because they have such a limited universe, they have to look at things more carefully." One of his pictures, "Man's Best Friend," captures a postage stamp of a dog resting on a grainy plywood board. Another is of a small action figure that a hospital psychiatrist keeps in his office. "Psychotropic Man" is the title of that image.
     Robert "22x" Smith, 62, a patient since 1999, chose an empty hallway as a subject. The hallways hold significance for him, he said, because they lead to other parts of the hospital, and, ultimately, the outside world. Recently, he said, he took a self-portrait and sent it home to his mother, who hung it on a wall where she keeps dozens of other pictures of her children and grandchildren. "She liked it," he said. "I'm well on my way to recovery."

Kids' Suicides Rise, CDC Report Finds
Associated Press, 2/5/2007

CHICAGO -- New government figures show a surprising increase in youth suicides after a decade of decline, and some mental health experts think a drop in use of antidepressant drugs may be to blame. Suicides climbed 18 percent from 2003 to 2004 for Americans under age 20, from 1,737 to 1,985 deaths. Most suicides occurred in older teens, according to the data -- the most current to date from the federal Centers for Disease Control and Prevention. By contrast, the suicide rate among 15- to 19-year-olds fell in previous years, from about 11 per 100,000 in 1990 to 7.3 per 100,000 in 2003. Suicides were the only cause of death that increased for children through age 19 from 2003-04, according to a CDC report released Monday.

''This is very disturbing news,'' said Dr. David Fassler, a University of Vermont psychiatry professor. He noted that the increase coincided with regulatory action by the U.S. Food and Drug Administration that led to a black box warning on prescription packages cautioning that antidepressants could cause suicidal behavior in children. Fassler testified at FDA hearings on antidepressants during 2003 and 2004 and urged caution about implementing black box warnings. The agency ordered the warnings in October 2004 and they began to appear on drug labels about six months later.
      Psychologist David Shern, president of Mental Health America, called the new data ''a disturbing reversal of progress.'' Other research has linked certain antidepressants with decreasing suicide rates, Shern said, adding, ''We must therefore wonder if the FDA's actions and the subsequent decrease in access to these antidepressants in fact have caused an increase in youth suicide.'' The advocacy group receives funding from makers of antidepressants, government agencies and private donations. The suicide data are in a report on vital statistics published in February's Pediatrics.
     Antidepressant use among children decreased during the same time period. Data from Verispan show 3 million antidepressant prescriptions were written for kids through age 12 in 2004, down 6.8 percent from 2003. Among 13- to 19-year-olds, the number dropped less than 1 percent to 8.11 million in 2004. Steeper declines in both age groups occurred in 2005, according to the prescription tracking firm. The suicide data are preliminary and don't show whether suicides might have been concentrated in one region or among one gender or ethnic group, said the CDC's Dr. Alexander Crosby. ''It's something that we want to look a little bit closer into,'' Crosby said. ''It's probably too early to say'' if declining use of antidepressants had anything to do with it, he said, The CDC is expected to issue a more thorough report on the data in a month or two.
     The data are concerning, but it's too soon to know if they're anything more than a statistical blip, said Dr. John March, a Duke University psychiatry professor. He led landmark National Institute of Mental Health research linking antidepressant use with an increased risk for suicidal behavior, but also showing that getting psychotherapy at the same time canceled out that risk.
     Some mental health experts believe suicide prevention programs and effective use of treatment including drugs and therapy contributed to the decline in suicides that occurred in the 1990s. Funding cuts for school-based suicide prevention programs might have contributed to the apparent rise noted in the new CDC report, said Emory University psychologist Nadine Kaslow. But the rise might not indicate a nationwide trend and needs to be investigated, she said. ''It's definitely concerning'' but will need to be followed to see whether increases occurred in subsequent years, Kaslow said.
     On the Net:
Pediatrics: http://www.pediatrics.org
CDC: http://www.cdc.gov

The girl is now recovering, but her story is only one of many. Which is why Kearney-Cooke, who's been treating girls and women with eating disorders for 25 years, sees the current ''skinny-model'' debate sweeping the fashion industry as a positive step -- one that may eventually help lead to a healthier body image for young girls.

''This is such a waste of young people's energy,'' the Cincinnati-based psychologist says of the ever-intensifying obsession with being thin, an affliction she's seen in girls as young as 5 or 6. ''Teenagers should be figuring out who they are, how they feel about Iraq, about abortion. Instead, the question 'Who am I?' has been replaced by, 'How do I look?'''

With Fashion Week currently in full swing in New York, the debate over thin models is on the front burner. The Council of Fashion of Designers of America recently issued voluntary guidelines to curb the use of overly thin models. Officials in Madrid set a minimum body-mass index, and Milan tightened restrictions. Efforts gained urgency after 21-year-old Brazilian model Ana Carolina Reston died of anorexia in November, at 88 pounds.

Surely, models have always been thin -- Twiggy was a phenomenon in the '60s for her waifish looks. But recent years have seen a trend toward the emaciated, with younger models displaying protruding hip bones, sallow skin, and stick-like legs with knees wider than the thighs.

''A lot of models today, you're just worried for them,'' says Suze Yalof Schwartz, executive editor-at-large for Glamour Magazine. ''They look so vulnerable.'' (She notes, however, that some models are naturally skinny.) In the '90s, she points out, the sample size used by designers was 5 feet 9 inches or taller and a size 6 to 8; now, it's the same height, but a size 0 to 2.

And it isn't just models embracing the trend. Hollywood actresses, now often canvases for hot designers, are getting thinner and thinner too -- a development that likely impacts young women far more than the goings-on in the elite fashion world.

''It amazes me,'' says Janice Min, editor of the celebrity magazine US Weekly. ''The whole world has shrunk!'' Among the many stars with no discernible body fat: Ellen Pompeo of the ABC hit ''Grey's Anatomy,'' and Keira Knightley of ''Pirates of the Caribbean.'' The once more substantial Angelina Jolie (remember her buff Lara Croft?) has gone for the more skeletal look. One result of all this: if you have the slightest tummy, the world now thinks the stork is around the corner. As Min puts it, ''If they can't see a clavicle, they think you're pregnant!''

And if they really are expecting, there's a whole other pressure: ''To be super-thin until just before your baby comes, and two minutes after,'' says Rita Freedman, a psychologist in Harrison, N.Y. who treats women with body-image disorders.

Freedman is skeptical that efforts to get healthier-looking models on the runway will have any impact on ordinary people. ''My experience is that things aren't getting better, they're getting worse,'' she says. ''It's distressing,'' she says, ''but as a professional, do I think this will have a long-term ripple effect? I doubt it.''

Min notes that at least it's a step. ''For once, an establishment has set forth that there is something wrong with this,'' she says. ''Things may not change completely, but women may look and say, 'maybe there's something wrong with THEM, and not me.'''

That's the message of an ad campaign from Dove, the beauty products company. Its ''Campaign for Real Beauty,'' launched in 2004, featured a one-minute video, hugely popular on YouTube late last year, of a nice-looking woman in her early 20s with uneven skin. She gradually transforms -- through hairstyling, makeup and extensive photo-shopping -- into a billboard goddess. ''No wonder our perception of beauty is distorted,'' the filmmakers note at the end.

Kathy O'Brien, Dove marketing director, says the campaign was created after a study commissioned by the company found that only 2 percent of thousands of women surveyed worldwide described themselves as beautiful. ''Our mission is to make more people feel beautiful,'' says O'Brien. She adds that the company, whose parent is Unilever, has seen a steady increase in market share since the campaign began, though she doesn't give numbers. Another much-noted element of Dove's advertising: print and billboard ads last summer featuring ''real women,'' of all shapes and sizes, posing in their underwear.

Tyra Banks, former supermodel and current TV host, didn't pose in her underwear last week, but she came close: She opened an episode of ''The Tyra Banks Show'' in the same bathing suit that had just brought her a heavy dose of Internet grief, with paparazzi photos showing her looking heavier than usual. Banks used the incident to rebuke her critics. ''I have one thing to say to you,'' she said, her defiant tone suddenly turning into a teary shriek. ''Kiss my fat ...'' The audience leaped to its feet.

Drama aside, there was undeniable truth to Banks' assertion that, given the names she'd been called -- ''America's Next Top Waddle,'' for example -- she'd probably be ''starving myself right now'' if she had lower self-esteem, something she seems not to lack.

All that sounds familiar to Kearney-Cooke, the Cincinnati psychologist. Some of her younger patients have expressed a desire to look like the notoriously skinny Olsen twins -- one of whom, Mary-Kate, herself underwent treatment in 2004 for an eating disorder. ''They tell me, 'I'll be popular if I can look like that,''' says Kearney-Cooke.

''Our country needs to take this seriously,'' she says, with a hopeful nod to both the current fashion debate and initiatives like the Dove campaign. ''We need to widen the spectrum of beauty, so that these people can feel that they're in that spectrum, too.''

Early Drinking Leads to Later Abuse
David Brown, Washington Post- 2/5/2007

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's been known for a while and is not a surprise.

A new study, however, sheds 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, including the death of a family member, financial crises and marital disruption.

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% with each additional stressful event, compared with only 3% 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 — such as the death or illness of a family member or a change in work hours.

The study is published in the January issue of Alcoholism: Clinical and Experimental Research.