Noteworthy News Articles on Mental Health Topics, February 6-9, 2007 Guy Trebay, New York Times- 2/6/2007 While a vast majority of Americans spent Sunday on a sofa watching men shaped like large appliances move a football up and down a 360-foot field, 15,000 New Yorkers, who probably wouldn’t know a pump fake from a wishbone formation, spent the day ogling women shaped more or less like coat racks move dresses up and down 400 feet of runways in Bryant Park. You don’t often hear Super Bowl and Fashion Week mentioned in the same sentence, but there is a link between the two, and it involves body image. Skinny models became a hot-button topic when the global news media got hold of the public relations mess the industry stumbled into after two models in South America died of anorexia nervosa last year. Suddenly trade groups around the world started wringing their hands about eating disorders. The Spanish banned underweight models. The Italians decided that in the future (meaning probably not until 2008) models would have to be over age 16, have a license and a body mass index above 18.5 percent to gain employment. The French, maintaining they already had strong rules on the subject, predictably dismissed the issue. In this country, where polls drive most things, the industry response gained impetus from a Nielsen Company survey of 25,000 people in 45 countries, which found that 81 percent disapproved of “extreme thinness.” In short order, the modeling agencies that manage the most notoriously underweight women abruptly benched them. All of a sudden some of the most in-demand models — the Eastern European blonde giantess, the knock-kneed Russian beauty with the far-off expression, the multiply pierced beauty with the Olive Oyl limbs — disappeared. Just as suddenly, the picture every agency photographer was assigned to grab backstage at the shows was of a model sitting with a plate of food. Commendably, the Council of Fashion Designers of America convened a symposium on Monday morning to ventilate the issue and to put forward some recommendations for addressing the customs of a business that, far from showing much historical concern with the health and well-being of models, views them as commodities. No one who has spent any time around fashion is a stranger to the notion that models, like milk, have “use by” dates. No one has failed to hear tales of scouts who discover some beauty working in a doughnut shop, who dangle promises of wealth, fame and escape from the family pig farm (true story) and then hand her strict instructions to shed the excess cruller pounds. Curiously, the evidence of model shrinkage was there all along, easy to track. “In 1986, the standard size was 4 to 6,” Ivan Bart, the creative director of IMG models and arguably the most powerful agent in the business, said on Sunday at the Diane Von Furstenberg show, referring to standard sample sizes. “Then it was a solid 4. Then 2 to 4. Then zero.” Ms. Von Furstenberg, who is the president of the Council of Fashion Designers of America, also brought up dress size. “Models have always been skinny and tall, and that’s fine as long as they’re healthy,” she said. Scanning a room where 50 rangy but apparently well-nourished women hired for her show were lounging, she posed a question. “What size do you think my dresses are? A 6.” Perhaps that is so. But is the point that models in general have been encouraged to conform to unnatural shapes or that everyone has? “What about Hollywood?” asked the Canadian model Irina Lazareanu at the Luella Bartley show on Sunday. “What about ballet schools? What about gymnastics camps?” What about cheerleading clubs or racetracks, where jockeys have blithely been destroying their health for decades by abusing with laxatives and diuretics and emetics in the effort to make weight? What about gyms, and not just the steroid temples of extreme bodybuilding? “We shouldn’t look only at an industry that happens to be in the headlines during Fashion Week,” said Dr. Evelyn Attia, a director of the Eating Disorders Clinic at Columbia University Medical Center. This is far from the first time that models have been singled out, and not coincidentally moralized about, as potentially unhealthy and somehow inherently bad. Healthy or ill, their images are always reliably good for improving ratings and newsstand sales. “It’s hard, with obesity being so urgent a health issue for such a large population, not to encourage thinness,” Dr. Attia said. “But with it comes a vulnerability, probably for a small group, but an important group, with a mortality rate as high as that of any psychiatric disorder.” To the surprise of some, the most articulate speaker at the Council of Fashion Designers symposium was the model Natalia Vodianova, who talked about what food meant to her growing up poor in Russia and what it meant once she became one of the world’s most sought after models, had a child and gained 15 pounds. It happened that I visited a French Vogue shoot in Paris months after Ms. Vodianova gave birth to her first child and was as impressed as anyone else at how quickly she regained her gamin figure. At the time, I thought she must be genetically blessed. But of course she was starving herself because designers had complained that she no longer fitted the clothes. “You have to look at this as a cluster, with models as just one part,” said Dr. Cynthia M. Bulik, a professor of eating disorders at the University of North Carolina at Chapel Hill and a former president of the Academy for Eating Disorders, after Monday’s meeting, which she termed an anemic response to a major problem. “A number of industries are now making people reach weights in order to be effective in their jobs,” Dr. Bulik said. “The N.F.L. is beefing people up to unhealthy proportions. Modeling is chiseling people down.” A Small Part of the Brain, and Its Profound Effects Sandra Blakeslee, New York Times- 2/6/2007 The recent news about smoking was sensational: some people with damage to a prune-size slab of brain tissue called the insula were able to give up cigarettes instantly. Suppose scientists could figure out how to tweak the insula without damaging it. They might be able to create that famed and elusive free lunch — an effortless way to kick the cigarette habit. That dream, which may not be too far off, puts the insula in the spotlight. What is the insula and how could it possibly exert such profound effects on human behavior? According to neuroscientists who study it, the insula is a long-neglected brain region that has emerged as crucial to understanding what it feels like to be human. They say it is the wellspring of social emotions, things like lust and disgust, pride and humiliation, guilt and atonement. It helps give rise to moral intuition, empathy and the capacity to respond emotionally to music. Its anatomy and evolution shed light on the profound differences between humans and other animals. The insula also reads body states like hunger and craving and helps push people into reaching for the next sandwich, cigarette or line of cocaine. So insula research offers new ways to think about treating drug addiction, alcoholism, anxiety and eating disorders. Of course, so much about the brain remains to be discovered that the insula’s role may be a minor character in the play of the human mind. It is just now coming on stage. The activity of the insula in so many areas is something of a puzzle. “People have had a hard time conceptualizing what the insula does,” said Dr. Martin Paulus, a psychiatrist at the University of California, San Diego. If it does everything, what exactly is it that it does? For example, the insula “lights up” in brain scans when people crave drugs, feel pain, anticipate pain, empathize with others, listen to jokes, see disgust on someone’s face, are shunned in a social settings, listen to music, decide not to buy an item, see someone cheat and decide to punish them, and determine degrees of preference while eating chocolate. Damage to the insula can lead to apathy, loss of libido and an inability to tell fresh food from rotten. The bottom line, according to Dr. Paulus and others, is that mind and body are integrated in the insula. It provides unprecedented insight into the anatomy of human emotions. Of course, like every important brain structure, the insula — there are actually two, one on each side of the brain — does not act alone. It is part of multiple circuits. The insula itself is a sort of receiving zone that reads the physiological state of the entire body and then generates subjective feelings that can bring about actions, like eating, that keep the body in a state of internal balance. Information from the insula is relayed to other brain structures that appear to be involved in decision making, especially the anterior cingulate and prefrontal cortices. The insula was long ignored for two reasons, researchers said. First, because it is folded and tucked deep within the brain, scientists could not probe it with shallow electrodes. It took the invention of brain imaging techniques, such as functional magnetic resonance imaging, or fMRI, to watch it in action. Second, the insula was “assigned to the brain’s netherworld,” said John Allman, a neuroscientist at the California Institute of Technology. It was mistakenly defined as a primitive part of the brain involved only in functions like eating and sex. Ambitious scientists studied higher, more rational parts of the brain, he said. The insula emerged from darkness a decade ago when Antonio Damasio, a neuroscientist now at the University of Southern California, developed the so-called somatic marker hypothesis, the idea that rational thinking cannot be separated from feelings and emotions. The insula, he said, plays a starring role. Another neuroscientist, Arthur D. Craig at the Barrow Neurological Institute in Phoenix, went on to describe exactly the circuitry that connects the body to the insula. According to Dr. Craig, the insula receives information from receptors in the skin and internal organs. Such receptors are nerve cells that specialize in different senses. Thus there are receptors that detect heat, cold, itch, pain, taste, hunger, thirst, muscle ache, visceral sensations and so-called air hunger, the need to breathe. The sense of touch and the sense of the body’s position in space are routed to different brain regions, he said. All mammals have insulas that read their body condition, Dr. Craig said. Information about the status of the body’s tissues and organs is carried from the receptors along distinct spinal pathways, into the brain stem and up to the posterior insula in the higher brain or cortex. As such, all mammals have emotions, defined as sensations that provoke motivations. If an animal is hot, it seeks shade. If hungry, it looks for food. If hurt, it licks the wound. But animals are not thought to have subjective feelings in the way that humans do, Dr. Craig said. Humans, and to a lesser degree the great apes, have evolved two innovations to their insulas that take this system of reading body states to a new level. One involves circuitry, the other a brand new type of brain cell. In humans, information about the body’s state takes a slightly different route inside the brain, picking up even more signals from the gut, the heart, the lungs and other internal organs. Then the human brain takes an extra step, Dr. Craig said. The information on bodily sensations is further routed to the front part of the insula, especially on the right side, which has undergone a huge expansion in humans and apes. It is in the frontal insula, Dr. Craig said, that simple body states or sensations are recast as social emotions. A bad taste or smell is sensed in the frontal insula as disgust. A sensual touch from a loved one is transformed into delight. The frontal insula is where people sense love and hate, gratitude and resentment, self-confidence and embarrassment, trust and distrust, empathy and contempt, approval and disdain, pride and humiliation, truthfulness and deception, atonement and guilt. People who are better at reading these sensations — a quickened heart beat, a flushed face, slow breathing — score higher on psychological tests of empathy, researchers have found. The second major modification to the insula is a type of cell found in only humans, great apes, whales and possibly elephants, Dr. Allman said. Humans have by far the greatest number of these cells, which are called VENs, short for Von Economo neurons, named for the scientist who first described them in 1925. VENs are large cigar-shaped cells tapered at each end, and they are found exclusively in the frontal insula and anterior cingulate cortex. Exactly what VENs are doing within this critical circuit is not yet known, Dr. Allman said. But they are in the catbird seat for turning feelings and emotions into actions and intentions. The human insula, with its souped-up anatomy, is also important for processing events that have yet to happen, Dr. Paulus said. “When you decide to go outside on a cold day, your body gets ready before you hit the cold air,” he said. “It starts pumping blood to where you need it and adjusts your metabolism. Your insula tells you what it will feel like before you step outside.” The same goes for drug addicts. When an addict is confronted with sights, sounds, smells, situations or other stimuli associated with drug use, the insula is activated before using the drug. “If you give cocaine to an addict, you are affecting their brain’s reward system, but this is not what drives the person to keep using cocaine,” Dr. Paulus said. The craving is what gets people to use. For example, smokers enjoy whole-body effects, said Nasir Naqvi, a student at the University of Iowa Medical Scientist Training Program, who was the lead author of the recent article on smoking. It is not just nicotine binding to parts of the brain, he said, but sensations — heart rate, blood pressure, a tickle in the lungs, a taste in the mouth, the position of the hands, all the rituals. The insula’s importance makes it an ideal target for many kinds of treatment, Dr. Paulus said, including drugs and sophisticated biofeedback. But methods to quell insular activity must be approached carefully, he said. People might lose the craving to smoke, drink alcohol or take other drugs, but they could simultaneously lose interest in sex, food and work. As clinicians explore the possibilities, Dr. Craig is thinking about the insula in grander terms. For example, lesions in the frontal insula can wipe out the ability to appreciate the emotional content of music. It may also be involved in the human sense of the progress of time, since it can create an anticipatory signal of how people may feel as opposed to how they feel now. Intensely emotional moments can affect our sense of time. It may stand still, and that may be happening in the insula, a crossroads of time and desire. About That Mean Streak of Yours: Psychiatry Can Do Only So Much Richard Friedman, M.D., New York Times- 2/6/2007 When have you ever heard of a therapist telling a patient that he is mean or bad? Probably never. It’s not fashionable in our therapy-friendly nation, where people who behave obnoxiously are assumed to have a treatable psychiatric problem until proven otherwise. Nothing in the human experience is beyond the power of psychiatry to diagnose or fix, it seems. But even for me, an optimist and a proponent of therapy, things have gotten a little out of hand. Not long ago, one of my psychiatric residents called in distress about a patient who was demanding a different therapist. “This guy is in my office shouting at me and telling me how bad I am,” the resident said. Sure enough, the patient in question was very hostile and demeaning in talking about this young doctor. Jabbing his finger in the air, he told me how unsympathetic my resident was and how rude the staff at the front desk had been. “This kid doesn’t know the first thing about treating patients,” he said with derision. He clearly meant to hurt and humiliate his new doctor in front of a supervisor. I listened for a while to his litany of complaints and found it easy to understand why people didn’t like him. “It’s no surprise to me that people aren’t nice to you if this is a sample of how you behave in the world,” I said to him. This remark did not go over well. “I’m basically a nice guy who has a terrible problem with anxiety,” the patient said resentfully. He in fact did have a major psychiatric disorder; he had been struggling with obsessive-compulsive disorder for the last decade but had shown a pretty good response to antidepressant medication. There was something else about him, however, that could not be neatly explained by psychiatry: he was simply mean-spirited. At this point, most therapists might go in search of a cause for the patient’s behavior. Was there something in this patient’s life experience that might explain his nastiness? Not really. Life had not been too unkind to him; he’d suffered no major deprivation or trauma, and he had had all the benefits of an upper-middle-class upbringing. Many of my colleagues would argue that he could have a personality disorder, a category that is broad enough to encompass nearly every variety of human misbehavior. Of course, everyone has personality traits, but when they cause major problems in relationships and work, they cross the line into disorder. On the other hand, maybe he was mean by nature, a concept that may sound heretical coming from a psychiatrist because it seems dangerously close to rendering a moral judgment on a patient’s soul, something doctors should doubtless leave to theologians and philosophers. But if some people turn out happy and good despite a lifetime of withering hardships, why can’t some people be mean or bad for no discernible reason? There can be a relationship between nastiness and mental illness, and many therapists assume that when patients are mentally ill and mean, the illness is probably the cause of the ill temper. But human meanness is far more common than all the mental illness in the population combined, so the contribution of mental illness to this essential human trait must be very small indeed. Don’t get me wrong. There is plenty of undesirable human behavior that falls well within the rightful domain of psychiatry to understand and treat. But must we turn everything we don’t like about our fellow humans into a form of psychopathology? Not long ago, we had a patient in the hospital who was psychotic and frightening to the staff. After several weeks, his psychosis cleared beautifully with antipsychotic medication, and we all thought he was ready for discharge. Then early one morning, he used the pay phone to call one of my female residents at home, threatening her and talking in a sexually provocative way. When I confronted him, it was quickly obvious that he was no longer psychotic or manic. In fact, he was cheeky and unrepentant about his behavior. And he left no doubt in my mind that psychiatry had done all it could for him. He said it better than all the clinicians who had treated him on the inpatient unit: “I’m not crazy now, but I guess I’ve never been a nice guy.” To put it another way, some mentally ill patients can be mean or bad just like anyone else, and this is not a problem for psychiatry to fix. In Rigorous Test, Talk Therapy Works for Panic Disorder Benedict Carey, New York Times- 2/6/2007 The field of psychoanalysis has struggled with a disabling internal conflict in recent years: whether to subject the therapy to rigorous testing, like the process through which new drugs are approved, or to insist that the insights it provides are self-evident and cannot be put under a microscope. Eric Nagourney, New York Times- 2/6/2007 Most people at risk for any number of alcohol-related problems may not even qualify for a diagnosis of alcohol dependence, the researchers suggest in the February issue of Alcoholism: Clinical and Experimental Research. “Even though alcohol dependence is an important issue, in fact other forms of excessive drinking, especially binge drinking, are more prevalent,” said one of the authors, Jim Roeber, a New Mexico Department of Health epidemiologist. The researchers, led by Sandra Woerle of the National Institute of Justice, surveyed more than 4,700 residents of New Mexico. Respondents were asked about how often they drank, how much they drank and whether they had ever driven while impaired. While only 1.8 percent of those surveyed appeared to have an alcohol dependence problem, the study found, more than 16 percent took part in at least one kind of excessive drinking. Most of those were binge drinkers. By some estimates, heavy drinking leads to 75,000 deaths a year in the United States. It plays a role in a variety of health problems, as well as accidents and violence. The results of the study raise questions about the best way to reduce the public health problems associated with alcohol abuse. People with alcohol dependencies are usually treated individually. But if most of the threat comes from people who are not dependent, the study said, it may be more effective to focus on deterrents like increasing alcohol taxes, raising the drinking age and training waiters and bartenders. “It seems illogical to expend a disproportionate share of resources on individual treatment rather than on community-based preventive strategies,” the study concluded. Psychiatrist to Suspend Practice; Denies Wrongdoing Liz Kowalczyk, Boston Globe- 2/8/2007 Dr. Kayoko Kifuji, the psychiatrist who treated Rebecca Riley in the months before the Hull girl died from an overdose of prescription drugs, agreed yesterday to immediately stop treating patients while the state investigates her role in the case. The Board of Registration in Medicine accepted Kifuji's voluntary agreement to cease the practice of medicine at its meeting yesterday, a day after Riley's parents pleaded not guilty to murder charges for allegedly giving her excessive amounts of the drug Kifuji prescribed for the 4-year-old. The agreement does not detail any specific allegations against Kifuji, who works at Tufts-New England Medical Center. But the board said in a statement that such agreements "are one tool available to the Board to ensure the safety of the public during the pendency of an investigation." Nancy Achin Audesse, the board's executive director, said after the meeting: "Clearly this case and the attention it has garnered is very frightening to patients and to the public, and it raises a lot of questions. A voluntary agreement gives us time to gather information and decide what we need to do next." Tufts-NEMC issued a statement yesterday saying that Kifuji is on a paid leave of absence, but that hospital executives could not comment further on the case, because of concern about medical confidentiality of the child. The agreement is considered a disciplinary action that will appear on Kifuji's record as a physician. But she states in the document that "nothing contained in this agreement shall be construed as an admission or acknowledgment by me as to wrongdoing." The doctor's lawyer said yesterday that she did nothing wrong. "Dr. Kifuji's diagnosis of Rebecca, her prescribing of medication, and the care provided was 100 percent appropriate under the circumstances," said attorney J.W. Carney Jr. "Dr. Kifuji agreed to a voluntary suspension from practice so that she can have the opportunity to present all of the facts to the board staff in a calm and professional setting, rather than the frenzy of an emergency hearing." When asked whether he expected the Plymouth district attorney to pursue criminal charges against his client, Carney said that Kifuji "provided first-class medical care to her patient and did absolutely nothing wrong medically, never mind anything that was in violation of the law." Kifuji began treating Riley in August 2004 and diagnosed her with attention deficit hyperactivity disorder and bipolar disorder. She prescribed medications, including clonidine, a blood pressure drug for adults that is also sometimes given to children to reduce aggressiveness and help them sleep. Prosecutors allege that Riley's parents, Michael and Carolyn Riley, intentionally killed their daughter in December by giving her an overdose of clonidine. In a State Police affidavit filed Feb. 5 in Hingham court, investigators said they interviewed Kifuji twice about the care she provided to Rebecca Riley. She told police she saw the girl in her office sometimes every two weeks and other times every two months. Carolyn Riley had told investigators that the doctor had said the parents could give Rebecca an extra half-tablet of clonidine at night if she couldn't sleep. But Kifuji emphatically denied that, according to the affidavit. "No! Never!" she is reported as saying. Kifuji told police that Carolyn Riley called her in the early fall, saying she had lost an entire bottle of clonidine, so she reauthorized the medication. Rebecca's mother called her 10 days later, the affidavit quoted Kifuji as saying, stating that water had gotten into the new bottle and ruined the pills. At that point, Kifuji said, she authorized an additional 10-day supply and required all future prescriptions to be filled every 10 days to prevent more accidents. Yesterday Carney defended his client's handling of the situation. "It appeared to Dr. Kifuji that she had no reason to disbelieve the mother's account of losing or wetting the medication," he said. In a second interview with investigators, the doctor said that Carolyn Riley told her in October 2005 that she had gradually increased her daughter's nighttime dose of clonidine to 2 1/2 tablets from two tablets, according to the affidavit. Kifuji told investigators that she was shocked by the statement and explained to Carolyn Riley that an increased dose of the potent drug could kill Rebecca. She said she told her that if she went outside prescribed doses again, she would report her to the Department of Social Services. Web Child Porn Was `Worst Kind' of Abuse Brian Bergstein, Associated Press- 2/8/2007 The numbers behind an international child pornography bust announced Wednesday were disturbing: Nearly 2,400 suspects from 77 countries allegedly paid to view videos depicting sexual abuse online. But the nature of Internet traffic makes it unsurprising that people would figure they could hide so much hideous material, experts say. Finding and stamping out such content "is needle-in-a-haystack work," said Carole Theriault, a security consultant with Sophos PLC in London. Austrian authorities said an employee of a Vienna-based Internet file-hosting service alerted his nation's Interior Ministry last July that he had noticed the pornographic material during a routine scan. U.S. Says Autism Rate About 1 in 150 Associated Press, 2/8/2007 ATLANTA -- About one in 150 American children has autism, U.S. health officials said Thursday, calling the troubling disorder an urgent public health concern that is more common than they had thought. The new numbers are based on the largest, most convincing study done so far in the United States, and trump previous estimates that placed the prevalence at 1 in 166. The difference means roughly 50,000 more children and young adults may have autism and related disorders than was previously thought -- a total nationwide of more than half a million people. Advocates said the study provides a sad new understanding of autism's burden on society, and should fuel efforts to get the government to spend hundreds of millions of additional dollars for autism research and services. ''This data today show we're going to need more early intervention services and more therapists, and we're going to need federal and state legislators to stand up for these families,'' said Alison Singer, spokeswoman for Autism Speaks, the nation's largest organization advocating services for autistic children. The study by the U.S. Centers for Disease Control and Prevention was based on 2002 data from 14 states. It calculated an average autism rate 6.6 per 1,000, compared to an estimate last year of 5.5 in 1,000. ''Autism is more common than we believed,'' said Catherine Rice, a CDC behavioral scientist who was the study's lead author. The research was based on 2002 data from all or part of 14 states. It involved an intense review of medical and school records for children and gives the clearest picture yet of how common autism is in some parts of the country, CDC officials said. The results suggest 560,000 children and young adults have the condition. However, the study population is not demographically representative of the nation as a whole, so officials cautioned against using the results as a national average. The study doesn't include some of the most populous states like California, Texas and Florida. Also, the study does not answer whether autism has recently been on the rise -- a controversial topic, driven in part by the contention of some parents and advocates that it is linked to a vaccine preservative. The best scientific studies have not borne out that claim. ''We can't make conclusions about trends yet,'' because the study's database is too new, Rice said. Autism is a complex disorder usually not diagnosed in children until after age 3. It is characterized by a range of behaviors, including difficulty in expressing needs and inability to socialize. The cause is not known. Scientists have been revising how common they think the disorder is. Past lower estimates were based on smaller studies. The study released Thursday is one of the first scientific papers to come out of a more authoritative way of measuring it. ''This is a more accurate rate because of the methods they used,'' said Dr. Eric Hollander, an autism expert at New York's Mount Sinai School of Medicine. The study involved 2002 data from parts or all of 14 states -- Alabama, Arizona, Arkansas, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, Pennsylvania, South Carolina, Utah, West Virginia and Wisconsin. Researchers looked specifically at children who were 8 years old because most autistic kids are diagnosed by that age. The researchers checked health records in each area and school records when available, looking for children who met diagnostic criteria for autism. They used those numbers to calculate a prevalence rate for each study area. Included were autism-linked conditions like Asperger disorder, which some experts say might partly account for the higher rate. Dr. Fred Volkmar, director of the Child Study Center at Yale University, said the educational records researchers relied on in some states may be misleading. Sometimes, if a child has problems that seem like autism, parents will push for an autism label to get additional educational services, he said. Rates varied dramatically among states, in some cases. The rate was 3.3 per 1,000 in the northeastern Alabama study area and 10.6 per 1,000 in the Newark, N.J., metro area. Researchers say they don't know why the rate was so high in New Jersey. They think the Alabama rate was low partly because of limited access to special education records. The study was not an effort to find the cause of autism, still a point of debate. While many advocacy groups blame the vaccine preservative thimerosal, scientists are putting more focus on possible genetic causes, according to a recent Stanford University study. The weights of male athletes are widely publicized by college teams, but 35 years after passage of the gender-equity legislation known as Title IX, and 25 seasons after the National Collegiate Athletic Association began sponsoring women’s basketball, the weights of amateur female athletes are almost never published, in basketball or any other sport. Even as women are embracing their size and power, projecting the notion that a wide body can be a fit body, the idea of weighing female athletes is under vigorous debate. Some colleges weigh their basketball players regularly to guard against rapid weight loss or gain. Some weigh them infrequently, others not at all. “It’s a sensitivity about eating disorders,” said Jody Conradt, the Hall of Fame coach who has led the Texas Longhorns for three decades. “We’re dealing with a population that is vulnerable because it’s a Type A personality, driven, the people that want to be perfectionists.” Female athletes still face the same enormous societal pressures that other women face to remain thin and to possess a body type that many find unrealistic, especially for sports. Some experts believe athletes feel even greater pressure, given the assumption — also debatable — that they can improve performance by lowering their weight and percentage of body fat. Thus, many become vulnerable to what is called the female athlete triad: eating disorders, interrupted menstruation and osteoporosis. The N.C.A.A. recommends that women not be weighed on a regular basis, said Dr. Ron A. Thompson, a psychologist and eating-disorder therapist in Bloomington, Ind., who consults with the collegiate association. He said he opposed making weights public and the practice of weighing female athletes. Lining athletes up for weigh-ins is a form of “public degradation,” Thompson said. “Weighing doesn’t accomplish anything, and it can cause undue anxiety and even trigger unhealthy weight-loss practices,” Thompson wrote in an e-mail message. The touchy issue of weight received prominent attention recently when the professional tennis star Serena Williams faced questions about supposedly being out of shape before the Australian Open. After she won the tournament, she faced criticism for appearing to weigh more than a listed 135 pounds. Williams has led an “in-your-face redefinition of what a strong woman should look like,” said Donna Lopiano, executive director of the Women’s Sports Foundation. Basketball and tennis courts provide an oasis of freedom for female athletes, she said, although she added that “90 percent of their lives is not lived in that oasis” and that women’s sports have “been burdened by a stereotypical view of women.” Thompson said he tried to assist female athletes, not by focusing on their weight, but on their eating and how it is related to their emotions. Many teams have nutritionists and psychologists available. The trend in college is moving away from weighing athletes, Lopiano said. But colleges are left to make their own decisions. The female basketball players at top-ranked Duke are weighed once a week, Coach Gail Goestenkors said; they are not given a target weight, but are monitored to guard against quick weight gain, she said. Ohio State’s players are also weighed regularly, Coach Jim Foster said, adding, “It’s a medical issue; putting your head in the sand is not an attractive alternative.” At Tennessee, players are neither weighed nor measured for body-fat percentage, said Jenny Moshak, the university’s assistant athletic director for sports medicine. Instead, players are monitored for performance in such areas as speed, flexibility, vertical jump and weight lifting. “Far more detrimental things occur when you try to micromanage body shape and size,” Moshak said. At Texas, players are weighed and tested for lean mass two or three times a year, but always privately by sports-science experts. Coaches of women’s teams are not permitted to weigh players, set target weights or initiate a conversation about weight. Some Oklahoma players are weighed up to twice a week during preseason, the strength coach Tim Overman said. During the season, they are weighed and tested for percentage of body fat about once a month, Overman said, adding that too much attention paid to weight loss during the season can lead to calorie deficiency and fatigue. Courtney Paris’s father weighed more than 330 pounds when he was in the N.F.L. He was cut by the 49ers in 1991 when he failed to make their weight limitation of 325 pounds. Overman said he wanted Courtney Paris to lose about 15 pounds, from 240 to 225, so that she could lessen the stress on her body while extending her stamina and the length of her career. Paris, a 19-year-old sophomore, said she did not generally care if people asked about her weight, saying, “It’s not like I can hide who I am.” She said she was proud and glad to be in game shape, but “being in shape and being conditioned well are things I really have to work on.” Yet, it is not universally believed that lowering the weight and percentage of body fat of fit athletes will enhance their performance, said Thompson. Some studies indicate improvement, while others do not, he said. If Paris lost weight, “she might not be as strong or she might be distracted by trying to maintain the weight loss and might not perform as well,” said Thompson, an Oklahoma graduate who said he did not know Paris. Perhaps never have so many influential centers played on so many commanding teams in one season. Alison Bales, a 6-7 center for Duke, leads the nation in shot blocking, while 6-9 Allyssa DeHaan of Michigan State is second. Sylvia Fowles of Louisiana State, is 6-6 and anchors the country’s top defense; 6-5 Jessica Davenport of Ohio State can play in the post and beyond the 3-point line; and 6-4 Candace Parker of Tennessee can play any position and has transformed the dunk from a novelty shot to a statement of authority. “There are more centers of different types across the country than I’ve ever seen,” said Sherri Coale, Oklahoma’s coach. “You have graceful, powerful, fundamental, thick, long — all shapes and sizes. To me, that’s the greatest evolution in that position.” And there is no more dominant center than Paris, who averages 23 points and 16 rebounds a game. Last season as a freshman she became the first collegiate player, man or woman, to collect at least 700 points, 500 rebounds and 100 blocked shots in a season. “She’s a female Shaquille O’Neal,” said Kim Mulkey, who coached Baylor to the 2005 national championship. Kurt Budke, the Oklahoma State coach, said, “She’s the best player in the country.” Because Paris has soft hands and a ravenous anticipation for rebounding, nearly 25 percent of her points have resulted from offensive rebounds — often from her own misses. “She’s got much better hands than Terrell Owens,” said Foster, the Ohio State coach. “She’s not going to lead the league in passes dropped.” Paris represents the evolution of a position that has grown more essential as players have become more skilled in the post and comfortable with their size. Female players today have professional role models in the Women’s National Basketball Association, undergo sport-specific weight training, practice regularly against male scout teams and wear baggy uniforms that allow them to be less self-conscious than athletes like volleyball players, gymnasts and swimmers who participate in more revealing outfits. “We’re women who are not apologizing for being bigger and being different or for being athletic,” Paris said. “It’s more acceptable in society. For my generation, it’s really not a big deal.” Her twin sister, Ashley, a center-forward at Oklahoma, said that their mother, who is 6-1, told of slouching as a girl, and of buying shoes that were too small, in an effort not to stand out. The difference today, at least in basketball, is that big women are more secure in being and playing big, said Goestenkors, the Duke coach. She said that Bales, the Blue Devils’ center, proudly wore three-inch heels, which made her 6-10, while the team was in Cancún, Mexico, in December. Bales said a photograph of her in heels on Duke’s Web site had elicited several grateful messages from tall girls or their parents. “Before, tall girls were all soft and finesse and didn’t want contact,” Goestenkors said. “Now it’s strong, physical, bring on the contact. Courtney epitomizes that.” Growing up in Piedmont, Calif., Courtney Paris developed her skills against four older brothers, who ranged from 6-4 to 6-8. “Courtney and Ashley had an opportunity to see their father, who was big and winning championships, and have seen their brothers go off and play ball,” Bubba Paris said in a telephone interview. “In their mind, being big is good; it benefits you.” That was evident Sunday when Oklahoma overcame an early deficit against Oklahoma State by inserting Ashley Paris in the high post to pass to her sister in the low post. Courtney scored 41 points, 2 below her career high, and grabbed 19 rebounds in a 78-63 victory. “I think people have fallen away from the stereotype that big means slow and tall means clumsy,” Ashley said. Amaechi, Former Player in N.B.A., Says He’s Gay Liz Robbins, New York Times- 2/8/2007 In an announcement made yesterday in advance of a forthcoming book, the former journeyman center John Amaechi became the first N.B.A. player to acknowledge that he is gay. The news, first reported by Outsports.com on Tuesday, caused a small ripple in the N.B.A. world. Amaechi, in a book to be published next week by ESPN Books, “Man in the Middle,” wrote about his reluctance to disclose his sexuality in the homophobic culture of sports. The New York Times received a proof of the book. Amaechi’s publicist, Howard Bragman, told The Associated Press yesterday, “He is coming out of the closet as a gay man.” Amaechi, 36, said he has never defined himself as a basketball player. He acknowledges another definition, one that he did his best to hide alongside teammates and opponents in the N.B.A. “Coming out threatens to expose the homoerotic components of what they prefer to think of as simply male bonding,” Amaechi wrote. “And it generally is. It’s not so much that there’s a repressed homosexuality at play (except for a small minority), only that there’s a tremendous fear that the behavior might be labeled as such. Or, as I heard the anti-gay epithets pour forth that gay men in the locker room would somehow violate this sacred space by sexualizing it.” Bragman is the publicist for the W.N.B.A. star Sheryl Swoopes, who came out in October 2005, and the golfer Rosie Jones, who came out in March 2004. Swoopes and Jones were still competing when they came out. Five male professional athletes have come out after their careers ended: David Kopay wrote a best-selling book after he retired from the N.F.L. in 1972 and Esera Tuaolo wrote a book in 2002 when he retired from the N.F.L. The others were Roy Simmons, a former N.F.L. offensive lineman; and the former major league outfielders Glenn Burke and Billy Bean. N.B.A. Commissioner David Stern told The A.P.: “We have a very diverse league. The question at the N.B.A. is always, ‘Have you got game?’ That’s it, end of inquiry.” Amaechi said he was careful never to express interest in any teammate or opponent, so as not to ruin the “social fabric of any team” or, as he wrote, risk his career. Amaechi, who was raised in England, was traveling in Europe yesterday and was not available for comment, Bragman said. Amaechi lives in Manchester, England. After playing at Penn State, Amaechi joined the Cleveland Cavaliers as an undrafted free agent for the 1995-96 season. He then played in Europe for three years and returned to the N.B.A. in 1999 to play for the Orlando Magic for two seasons. He wrote he felt betrayed by Orlando the summer after he turned down a $17 million offer from the Los Angeles Lakers. The Magic did not re-sign him. He went instead to the Utah Jazz, where he played his final game in the 2002-3 season. It was in Salt Lake City where, he wrote, he started to be more comfortable with his sexuality in a community that had a large gay population. But Amaechi wrote that he had a contentious relationship with the Utah coach, Jerry Sloan. “I learned that great coaches do not make great human beings, though,” wrote the 6-foot-10 Amaechi, who averaged 6.3 points and 2.6 rebounds in 16.4 minutes a game during his five N.B.A. seasons. He wrote that Jazz owner Larry Miller “made his antipathy to gay people clear.” Amaechi, who was traded from Utah to Houston in 2003 but never played for the Rockets, wrote that he felt he had “been sent packing because Sloan couldn’t comprehend me, especially my sexuality.” Sloan issued a statement yesterday that said: “John is 1 of 117 players I have coached in the past 19 seasons, and it has always been my philosophy that my job is to make sure Jazz players perform to the maximum of their abilities on the floor. As far as his personal life is concerned, I wish John the best and have no further comment.” By the fall of 2004, Amaechi was an inactive player on the Rockets’ roster and was a throw-in when the Knicks exchanged Clarence Weatherspoon for Moochie Norris. Amaechi never played for the Knicks, but he wrote that when he was in New York during road trips, he frequented a gay club. He said: “All it would have taken was a single anonymous cellphone call from inside Splash to Page Six and I would have been toast. I was hiding, but in plain sight.” He had become tired of hiding, though. “Every year had been more and more of a struggle,” he wrote. “This was not my life. I was never a basketball player; I just happened to be really good at it for a while.” Massachusetts DSS Seeking Medical Experts Maria Cramer, Boston Globe- 2/9/2007 The state's top social services official yesterday defended how his agency handled the case of 4-year-old poisoning victim Rebecca Riley, saying that she "did not fall through the cracks." But Harry Spence, commissioner of the Department of Social Services, said his department needs more medical expertise to help social workers review the diagnoses and drugs prescribed by doctors treating children overseen by the agency. JudyAnn Bigby, secretary of Health and Human Services, said she would appoint an independent physician in the next few days to be on call to help DSS, until the agency develops a medical review system. "I will assure you that if we get additional medical personnel, our capacity to assess the medical quality of children will improve," Spence said. "My hope would be that as a result, lives that otherwise might be lost could be saved." Investigators continue to examine the death of Rebecca, whose parents have been charged with first-degree murder by allegedly giving her an intentional overdose of a drug prescribed for hyperactivity. Last summer, DSS investigated a therapist's concerns that Riley and her 6-year-old sister and 11-year-old brother were overmedicated. The agency was assured by doctors for all the children and their mother, Carolyn Riley, that the family was receiving proper medication and decided not to seek an independent medical review, Spence said. "The department . . . did not drop that inquiry, but completed that inquiry with assurances from medical experts that the care was appropriate and sufficient," he said, disputing the headline on a story in yesterday's Globe that reported that the agency sought an independent review of the family's medical treatment only after Rebecca was found dead Dec. 13 in Hull. Spence said that review, conducted by Children's Hospital Boston, found the amount of medication the children had been prescribed was not appropriate. Dr. Kayoko Kifuji, the psychiatrist who diagnosed Rebecca and prescribed drugs for attention deficit and bipolar disorders, agreed Wednesday to stop treating patients while the state investigates her role in the case. "Children's certainly raised questions about the medication, the propriety of the amounts, and the administration of the medication," he said in a telephone interview. He declined to be more specific about the hospital's recommendations. A spokesman for Children's Hospital also declined to comment. Spence said his agency, which had been involved with the Riley children since December 2002, is still examining how it handled Rebecca's case, but that so far it appeared his workers did not fail the girl. "We have certainly not found a terrible failure," he said at a press conference at the agency's headquarters in South Boston. "This child did not fall through the cracks." DSS was concerned, Spence said, about Michael Riley, Rebecca's father, being near the couple's children even after a judge decided last summer that he could be around the children unsupervised following allegations of sexual abuse of his 13-year-old stepdaughter. Last October, Carolyn Riley agreed to seek a restraining order after her husband allegedly grabbed their 11-year-old son by the neck and slammed his head against the back window of a pickup truck. She allowed the restraining order to lapse, but told DSS officials during a Nov. 10 meeting that she was renewing it and that Michael Riley would not be moving back in with the family. Agency workers tried to visit with the family, but Carolyn Riley failed to return their calls, so on Dec. 12, DSS officials decided to arrange a surprise visit soon afterward. Rebecca was found dead the next day on the floor of her parents' bedroom. Immediately afterward, the agency sought the independent review of the children's medication and diagnoses. Spence said he contacted three psychiatrists to ask them to consider treating the surviving Riley children. They all refused, he said. "Our interpretation of their explanation was that there was a reluctance to engage in second-guessing of fellow professionals," Spence told the Globe. Their refusals underscore the difficulty DSS generally faces trying to find physicians willing to provide an independent medical opinion, Spence said. The agency had been working to establish a panel of medical specialists following the controversy over Haleigh Poutre, now 12, who was beaten into a coma in 2005 and from whom DSS almost prematurely withdrew life support. But DSS found that many doctors were unwilling to participate, worried about possible liability and not having access to records on the DSS children, Spence said. Some doctors also fret over becoming involved in the controversy that usually swirls around DSS cases, he said. But the agency will continue trying to put together the panel and rely on the state-appointed physician as a stopgap measure, he said. "It just gives us as an opportunity to have an independent assessment of what otherwise we are totally dependent on," he said, "which is the judgment of the doctors who are actually providing the treatment." House Speaker Salvatore F. DiMasi said yesterday that two committees are investigating the prescription of psychotropic drugs to children. "The death of a child is always a tragedy, but the facts that have emerged so far surrounding the senseless death of Rebecca Riley are particularly gut-wrenching," he said in a statement. On his first "Ask the Governor" call-in program on WTKK radio yesterday, Governor Deval Patrick called Rebecca's death "a terrible, terrible case." But he said that DSS manages other tough cases well and that "I want to be careful not to attack the whole agency."
The number of accidental drug overdose deaths rose from 11,155 in 1999 to 19,838 in 2004, according to the Centers for Disease Control and Prevention. The report was based on death certificates, which do not clearly detail which drugs played the greatest role. But CDC researchers said they believe sedatives and prescription painkillers like Vicodin and OxyContin were the chief cause of the increase. OxyContin has been blamed for hundreds of deaths across the country in recent years, becoming such a scourge in Appalachia that it is known as ''hillbilly heroin.'' Deaths from falls climbed between 1999 and 2004 at a more modest rate, from 13,162 to 18,807, the CDC said. Motor vehicle crashes accounted for 40,965 fatalities in 1999 and 43,432 in 2004. The South had one of the lowest fatal drug overdose rates in the nation in 1999, but it doubled by 2004. The South now ties the West for having the highest rate -- about 8 per 100,000 population. ''This is the first study really to describe the large relative increases in poisoning mortality rates in rural states. Historically, the drug issue has been seen as an urban problem,'' said Dr. Len Paulozzi, a CDC epidemiologist. The federal report, issued this week, noted that accidental drug overdoses remain most common in men and in people 35 to 54. But the most dramatic increases in death rates were for white females, young adults and Southerners Other findings: -- The death rates for men remained roughly twice the rate for women, but the female rate doubled from 1999 to 2004 while the male rate increased by 47 percent. -- The rate for white women rose more dramatically than for any other gender group, to 5 deaths per 100,000 population. -- The rate of overdose deaths among teens and young adults, ages 15 to 24, is less than half that of the 35-to-54 group. But it rose much more dramatically, climbing 113 percent in the study years, to 5.3 deaths per 100,000 population. About 50 percent of the deaths in 2004 were attributed to narcotics and hallucinogens, a category that includes heroin, cocaine and prescription painkillers like Vicodin and OxyContin. Earlier research suggests that deaths from illegal drugs appear to be holding steady. ''There is a misperception that because a drug is a prescription medicine, it's safe to use for non-medical reasons. And clearly that is not true,'' said Dr. Anne Marie McKenzie-Brown, a pain medicine expert at Atlanta's Emory Crawford Long Hospital.
This being a farce, Salvador’s strait-laced machismo is comically undermined at every turn. His attempt to hypnotize a woman with a dangling pocket watch backfires, and he puts himself into a trance in which he spouts his inner feelings. Eventually he is shown changing into a dress and waltzing with another man at a posh transvestite club. Among the Freudian disciples chipping away at Salvador’s complacency, the most extreme is his brother-in-law and best friend, León (Alex Brendemühl), also a psychiatrist, whose studies with the master have turned him into an emotional hypochondriac. Everyone, including himself, León believes, is sick, sick, sick. He reels off a textbook’s worth of kinks to describe his recently discovered, hopelessly twisted, inner nature. If, as he acknowledges sadly, the unconscious mind holds the ultimate truth of human identity, the truth will not set you free; it’s a whole new can of worms. Trooping through this 2004 Spanish movie are the psychiatrists’ wives, competitive sisters who are both daughters of Dr. Mira (Juanjo Puigcorbé), the pompous chief of staff in the hospital where both men practice. We soon realize that Salvador’s prim, frigid wife, Olivia (Núria Prims), and León’s voluptuous spouse, Alma (Leonor Watling), would probably be much happier if each had married the other’s husband. The farce springs into action when León, seized by a panic brought on by a mysterious visitor to his home, flees for his life, and Alma beseeches Salvador to help her find him and unravel the mystery. There are intimations that León’s disappearance may be connected to the concealment of embarrassing revelations about the sex life of the Spanish king. Clues to León’s distress are found in his thesis: a detailed journal of his psychoanalytic sessions with four women he is treating for Freud-defined “hysteria,” a diagnosis the movie ridicules as a tool used by husbands to control their wives. The search for these patients takes Alma and Salvador to an elegant brothel, a transvestite club and the back room of a barn. This is the kind of farce in which people hide behind doors to overhear withering descriptions of their bedtime activities and genitalia. The cigar dangling conspicuously from the lips of Dr. Mira is definitely more than a cigar. If “Unconscious” consistently overplays its hand, its fusion of a Sherlock Holmes-style detective story (Alma is the master sleuth, and Salvador her Dr. Watson) with a delirious bedroom farce in the spirit of early Pedro Almodóvar is frequently very funny. The dizzy, erotic euphoria of post-Franco Spanish cinema may have subsided somewhat, but it can still produce movies like “Unconscious,” which simultaneously sends up and celebrates Freudian philosophy. The film, acted so broadly that it plays somewhat like a silent movie with spoken dialogue, is framed by bogus silent newsreels describing the latest inventions and fads of 1913 and introduces scenes with zany chapter titles. It is paced so breathlessly that it keeps you panting to keep up with each new plot twist. Yet with its elegant settings and richly saturated color, it has the opulence of a costume drama. Eventually Freud himself appears, surrounded by fawning admirers, to discourse on his new book, “Totem and Taboo.” Even when “Unconscious” loses its head, it remains bracingly literate. “Unconscious” is rated R (Under 17 requires accompanying parent or adult guardian). It has sexual situations, nudity and clinical sexual language. UNCONSCIOUS
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