Noteworthy News Articles on Mental Health Topics, February 21-28, 2007 Ben Harder, Los Angeles Times- 2/21/2007 WHEN Murray Straus was raising his children in the 1950s and '60s, spanking was de rigueur in the American household. The Straus residence was no exception, with the father of two occasionally reacting to their misbehavior with a swat to the bottom. But times have changed, and so has Straus' perception of spanking. "If I knew then what I know now, I would not have spanked them at all," he says. "My research has convinced me that there should be no hitting — never, under any circumstances." Straus, co-director of the Family Research Laboratory at the University of New Hampshire, has long advocated doing away with spanking. And many psychologists and pediatricians also now say that parents should never strike a child. Assemblywoman Sally Lieber (D-Mountain View) has even promised to introduce a bill in the California Legislature that would make it illegal to hit those younger than 4. Frequent and impulsive spanking is clearly detrimental, researchers agree. Other kinds of physical punishment, including hitting children with objects, are harmful as well. "Corporal punishment has really serious side effects," says Alan Kazdin, a professor of psychology at Yale University and president-elect of the American Psychological Assn. "Children who are hit become more aggressive." Yet the mildest forms of spanking have not been proved harmful. "A family that hits once in a while? The research is equivocal about that," Kazdin says. What the research does show is that spanking is generally no more effective than nonphysical disciplinary techniques in instilling acceptable behavior, that its effects vary from culture to culture and that a greater frequency of spanking increases the risk of negative consequences. Although some researchers say it can play an occasional role in supporting more lenient forms of discipline, Kazdin argues that spanking should be avoided even if it is harmless. "It suppresses misbehavior momentarily. But you haven't really changed its probability of occurring," Kazdin says. "Physical punishment is not needed to change behavior. It's just not needed." Reasons not to spank Spanking can escalate toward physical abuse, potentially injuring the child, and can contribute to later emotional and behavioral problems, according to the American Academy of Pediatrics. It's also less effective than alternative disciplinary tactics, and it's a hard habit to break, the organization says. Studies have shown that people who were spanked as kids tend to spank as parents, perpetuating the cycle. During the last decade, a raft of studies showed that kids who get spanked are more likely than their peers to display behavioral and emotional problems later in life. The more frequently they're spanked, the more harmful the consequences tend to be. In a 1997 study in the Archives of Pediatric and Adolescent Medicine, for example, Straus and two colleagues found that 6- to 9-year-olds whose mothers spanked them at least weekly were more likely, two years later, to behave antisocially than were kids whose moms didn't spank. The researchers interviewed more than 800 mothers and asked how often their kids did antisocial things such as cheat, lie, bully, deliberately break objects or act disobediently at school. Taking into account the degree of antisocial behavior that each mother said her child displayed at the beginning of the study, Straus' team concluded that spanking probably contributed to increases in bad behavior seen during the study. Nevertheless, Straus notes, a "lucky majority" of kids who get spanked suffer no discernible harm. Another 1997 study also linked spanking to subsequent antisocial behavior, and it additionally found that children who were spanked at the beginning of the five-year study were more likely to be getting into fights at school by the end of the study. (An exception was African American kids, who were less likely to fight if they'd been spanked than if they hadn't. More on that in a bit.) Since then, other studies that have tracked kids over time have linked corporal punishment to higher rates of children later assaulting their parents and higher rates of boys assaulting their girlfriends years after they themselves were smacked. Spanking "gives the message that force is a justifiable method of solving conflicts," says Daphne Bugental, a psychologist at UC Santa Barbara. "The child is learning a lesson: If you run into a conflict, use power, use force." Adds Shari Barkin, a pediatrician at the Children's Hospital at Vanderbilt in Nashville: "It teaches children that when you're angry, you should hit people." Spanking also appears to have a detrimental effect on the brain. In 1999, Straus found after a two-year study that 2- to 9-year-olds who were spanked developed less rapidly, judging from cognitive tests, than other children. In a 2003 study, Bugental and her colleagues delved deeper, examining the effect of corporal punishment on brain chemistry in infants younger than 1. Those who were spanked frequently, they found, showed exaggerated spikes in the stress hormone cortisol when they were subjected to a novel situation, such as being in the presence of a stranger after their mother had left the room. "They were very easily frightened," Bugental says. "They tend to be more afraid of things generally." By contrast, she says, "in the children who had not been spanked, there was hardly a blip" in cortisol. Researchers haven't yet determined whether spanking has similar hormonal effects on older kids. Cortisol imbalances could potentially lead to impaired coping abilities, social and emotional problems and cognitive deficits, Bugental says. In support of spanking Spanking has its supporters, of course. A couple of swats to a child's behind has a well-deserved place in discipline when milder tactics fail, says Robert Larzelere, an Oklahoma State University psychologist who has been researching corporal punishment for more than a quarter of a century. Larzelere describes that circumscribed use of corporal punishment as "conditional spanking." "It's better, wherever possible, to offer verbal correction and explanation," he says. "But then back that up, first with nonphysical consequences, and then, if the child acts defiantly, with conditional spanking." For example, he says, if a child refuses to sit in a chair during a timeout, then a light spanking would emphasize the need to cooperate with that form of discipline. "If it's used as a backup for the timeout, then the next time, the child is more likely to cooperate with the timeout procedure," Larzelere says. Parents "can then phase out the spanking. "I think it's a minority of spanking that fits this conditional definition," he adds. "For all the usual ways that parents use spanking — combining the good, the bad and the ugly — its outcomes are neither better nor worse than any alternative." The effects of spanking may depend not only on how and when it's meted out but also on the cultural context. In a study published in Child Development in 2005, researchers at Duke University interviewed 336 pairs of mothers and children in six countries in Asia, Africa and Europe about discipline and behavior. They found that physical discipline seemed to have a stronger negative effect on children in countries where it was not the norm than in countries where it was practiced widely. Several other studies, including the 1997 one that found differences between African Americans and whites, suggest that cultural differences also influence the effect of spanking in the U.S. "Spanking may be detrimental in some families but not in others," says Eric Slade, a social scientist at the University of Maryland School of Medicine. In 2004, he and Lawrence Wissow, a pediatric and adolescent psychiatrist at Johns Hopkins University, found that white children who were spanked before the age of 2 were twice as likely as other white kids to have behavioral problems in school. But spanking didn't appear to lead to misbehavior in African American or Hispanic children, the researchers reported in the journal Pediatrics. "In minority cultural contexts, spanking could be more the norm and consequently less commonly perceived by the child as being harsh or unfair," Slade says. As long as spanking isn't perceived as unfair, he adds, "it could have a positive and constructive effect … and establish what the limits are on misbehavior." Too often, researchers lump all kinds of spanking or even all forms of corporal punishment together, Larzelere says. Whenever an analysis links "spanking" to detrimental effects, he says, "conclusions are inappropriately made about even the mildest form of spanking." But because researchers harbor ethical reservations about asking or even knowingly permitting parents to spank their children, few experiments have been conducted in which parents were given explicit instructions about how to use spanking to maintain discipline. "There will never be the gold-standard study," says Michael Regalado, a developmental-behavioral pediatrician at Cedars-Sinai Medical Center in Los Angeles. And researchers disagree in their interpretations of the few such experimental studies to date, which clinical psychologist Mark Roberts and his colleagues at Idaho State University conducted during the 1980s. In dealing with a few dozen rebellious children ages 2 to 6 — whose out-of-control behavior had driven their parents to seek professional assistance — the researchers asked some parents to spank kids who refused to stay on a timeout chair and taught others to briefly confine noncompliant children to their rooms. In several such experiments, each approach worked about as well as the other, and both worked better than alternatives such as physically restraining the child in the chair. Although spanking increased compliance with timeouts in those experiments, Roberts adds, it was accompanied by more crying. "Since spanking demonstrates aggressive behavior to children, I recommend sending children to their rooms instead of spanking them," Roberts says. Straus infers: "It didn't work any better, and it had an emotional cost." Larzelere offers the opposite perspective. Spanking, he says, was one of the "best ways to enforce cooperation with the timeout. Even these very difficult children learned to cooperate." Decline in popularity Even without a law in effect, the popularity of spanking has fallen considerably in recent decades, at least among parents of school-age children. "In 1975, we found that two-thirds of parents were hitting 13-year-olds" at least once a year, says Straus, who along with his colleagues has conducted a series of parent surveys. By 1995, that fraction had fallen to one-third. Moreover, in 1999, 52% of parents believed corporal punishment is sometimes necessary, compared with 94% in 1968. Last month, in Clinical Pediatrics, Vanderbilt's Barkin published survey results detailing about 2,100 parents' disciplinary practices with 2- to 11-year-olds. Parents today, she found, more often reported using enforced timeouts or removing kids' privileges than they did spanking. However, Straus says the prevalence of spanking among 2- to 4-year-olds has remained basically unchanged. As of 1995, 94% of them had been spanked at least once in their lives, according to surveyed parents. Children in that age range and younger would be covered by the proposed California ban. But even opponents of spanking have reservations about the proposed bill. Criminalizing spanking could make it more difficult to root out corporal punishment, they say, because the threat of the law could dissuade parents from seeking help to change their disciplinary habits. "It may drive spanking underground, and it definitely won't address the issues that parents need addressed to avoid spanking," Regalado says. "The bill should be framed to help parents who'd like help with their discipline practices." Parent training programs were expanded in Sweden after that country banned corporal punishment in 1979, and in some other European countries that followed Sweden's lead. "I'd like to see legislation in California and everywhere modeled on Sweden's," Straus says. "I'm not in favor of a law with criminal penalties," he says. The proposed California law "would do the very thing it wants parents not to do — use harsh punishment to correct misbehavior." As for maintaining discipline among Straus' progeny, no law is needed. His past use of spanking hasn't left his grown children with any apparent psychological wounds, he says, and neither of them spanks their own children. "They are among the lucky ones who have escaped the harmful effects," he says. "If you do it rarely, the probability of harmful side effects is low," he says. But, he contends, the possibility of harm from spanking "is never absent. Since other methods of correction and control work just as well, why put that child through even that small risk?" Verbal attacks can be more hurtful than physical ones Most experts warn parents against not only spanking but also yelling at or disparaging children. Although targeted verbal reprimands may be effective in immediately halting or reducing undesirable behaviors, frequent and indiscriminate reprimands become ineffective and reinforce undesired behavior, they say. Attacking a child's character is particularly counterproductive. Research on the subject is limited compared with that on corporal punishment, Robert Larzelere of Oklahoma State says, but verbal hostility may actually lead to more detrimental consequences for the child than does even physical abuse. A study seven years ago on post-traumatic stress disorder found that victims tended to have childhood memories of being often put down or ridiculed. As potentially harmful influences go, such verbal attacks ranked roughly on par with memories of being pushed and shoved, although lower than a history of sex abuse. In an earlier study of more than 3,000 parents and their children younger than 18, Murray Straus of the University of New Hampshire and his collaborators linked both verbal and physical aggression by parents to aggressive behavior, delinquency and interpersonal problems in the kids. The psychological abuse, in fact, was the more harmful of the two. The only difference, Straus says, is that verbally attacked kids tend to lash out at others with words, while kids subjected to corporal punishment use physical hostility. Those connections applied to both boys and girls, regardless of age. Researchers led by Michael Regalado of Cedars-Sinai Medical Center in L.A. found in a 2004 analysis of survey data that 67% of some 2,000 parents reported yelling "sometimes" or "often" at children age 19 to 35 months. An additional 24% admitted to yelling at least "rarely." Only 26% of the parents said they spanked kids sometimes or often. "More than a third of families feel like they're ineffective with discipline tactics," says Vanderbilt pediatrician Shari Barkin. Yelling, like spanking, is often a symptom of the resulting frustration, she says. "The yellers, they're the ones who feel most ineffective. They lost control." ADHD Drug Makers to Warn of Side Effects Associated Press, 2/21/2007 WASHINGTON (AP) -- Drugs prescribed to treat attention deficit hyperactivity disorder will include guides to alert patients and parents of the risks of mental and heart problems, including sudden death. The Food and Drug Administration said Wednesday that it directed the manufacturers of Ritalin, Adderall, Strattera and all other ADHD drugs to develop the guides. In May 2006, the agency told manufacturers to revise the labels of the drugs to reflect concerns about the cardiovascular and psychiatric problems. Draft versions of the guides posted on the FDA Web site include discussion of reports of increased blood pressure and heart rate in ADHD patients, as well as cases of sudden death in some who have heart problems and heart defects. In adult patients, the reported problems also include stroke and heart attack. The alerts also cover psychiatric problems, such as hearing voices, unfounded suspicions and manic behavior, of which there is a slightly increased risk in patients who take the drugs, the FDA said. The guides also tell patients and their parents of precautions they can take to guard against the risks. Wednesday's announcement came roughly a year after two panels of FDA advisers recommended that the drugs include such patient medication guides. The announcement covers 15 drugs, including extended-release, patch and chewable versions of some of them. Ritalin is manufactured by Novartis Pharmaceuticals Corp. and in generic form by other companies; Adderall is made by Shire Pharmaceuticals Inc.; Strattera by Eli Lilly & Co. ADHD affects an estimated 3 percent to seven percent of school-age children and four percent of adults, the FDA said. On the Net: Food and Drug Administration ADHD drug information: http://www.fda.gov/cder/drug/infopage/ADHD/default.htm FDA Approves ADHD Drug Vyvanse Associated Press, 2/23/2007 WASHINGTON -- A new amphetamine-based drug to treat attention deficit hyperactivity disorder won federal approval Friday. It's harder to abuse than older stimulants, the manufacturer says. The Food and Drug Administration approved Vyvanse, also known as lisdexamfetamine, agency spokeswoman Susan Cruzan said. The drug is made by Shire PLC. Shire hopes the drug will extend its lucrative ADHD franchise once its top-selling Adderall XR begins facing competition from lower-priced generic versions in 2009. Shire plans to move patients from the older to the newer drug at the time, company spokesman Matt Cabrey said this week. Shire said it tried to limit the drug's potential for misuse. It tested the drug on adults with a history of abusing stimulants to assess its ''likeability.'' Results suggest the drug delays the onset and limits the intensity of amphetamine-like effects, the company said. Vyvanse works by gradually releasing its active ingredient, d-amphetamine, after the drug has been swallowed and comes into contact with enzymes in the digestive tract. Unless it's swallowed, Vyvanse remains inactive. Shire believes that will curtail its potential for abuse by users who snort or inject crushed pills. Despite those measures, the Drug Enforcement Administration has proposed making Vyvanse a Schedule II drug, a class that includes cocaine, methadone, methamphetamine and other drugs with a high potential for abuse. Other ADHD medicines, including Adderall and Ritalin, also are Schedule II drugs. Vyvanse's label will bear a ''black-box'' warning, the government's strongest, Cruzan said. Details were not immediately available. The label of Adderall XR bears a warning because of safety concerns related to amphetamine abuse as well as the risk of sudden death in patients with heart defects. FDA approval of Vyvanse came the same week that the agency asked all manufacturers of ADHD drugs to warn patients and their parents of mental and heart problems associated with use of the medicines. Internet Addicts Re-Educated in China Ariana Eunjung Cha, Washington Post- 2/23/2007 Alarmed by a survey that found that nearly 14 percent of teens in China are vulnerable to becoming addicted to the Internet, the Chinese government has launched a nationwide campaign to stamp out what the Communist Youth League calls "a grave social problem" that threatens the nation. Few countries have been as effective historically in fighting drug and alcohol addiction as China, which has been lauded for its successes, as well as criticized for harsh techniques. Now the country is turning its attention to fighting another, supposed addiction -- one that has been blamed in the state-run media for a murder over virtual property earned in an online game, for a string of suicides and for the failure of youths in their studies. The Chinese government in recent months has joined South Korea, Thailand and Vietnam in taking measures to try to limit the time teens spend online. Beijing has passed regulations banning youths from Internet cafes and has implemented control programs that kick teens off networked games after five hours. China has also instituted broad efforts to control what its citizens can see on the Internet. The Communist government runs a massive program that limits Web access, censors sites and seeks to control online political dissent. In the Internet-addiction campaign, the government is helping to fund eight in-patient rehabilitation clinics. The clinic in Daxing, a suburb of Beijing, the capital, is the oldest and largest, with 60 patients on a normal day. Few of the patients, who range in age from 12 to 24, are here willingly. Most have been forced to come by their parents, who pay about $1,300 a month -- about 10 times the average salary in China -- for the treatment. Led by Tao Ran, a military researcher who built his career by treating heroin addicts, the clinic uses a tough-love approach that includes counseling, military discipline, drugs, hypnosis and mild electric shocks. The cases are similar, he said. In terms of withdrawal: "If you let someone go online and then he can't go online, you may see a physical reaction, just like someone coming off drugs." And in terms of resistance: "Today you go half an hour, and the next day you need 45 minutes. It's like starting with drinking one glass and then needing half a bottle to feel the same way." Among the milder cases are those of Yu Bo, 21, from Inner Mongolia, and Li Yanjiang, 15, from Hebei province. Both said that they used to spend four to five hours a week online and their daily lives weren't affected but that their parents wanted them to cut their computer usage to zero so they could study. A more serious case is that of He Fang, 22, a college student from the western region of Xinjiang. The business administration major said his grades tanked when he started playing online games several hours a night. The clinic "has mainly helped me change the way I think," he said. "It's not about getting away from pressure but facing it and dealing with it." Before Sun, the 17-year-old, who is from the city of Cangzhou, checked into the clinic about a month ago, he said, he was sometimes online playing games for 15 hours nonstop. "My life was not routine - day and night I was messed up," he said. Since he's been there, Sun said, he's decided to finish high school, attend college and then work at a private company. With the help of a counselor, he's mapped out a life plan from now until he's 84. The most serious cases are housed on the third floor. Most have been addicted to the Internet for five or more years, Tao said, are severely depressed and refuse counseling. One sliced his wrists but survived. These teens are under 24-hour supervision. Tao said he believes 70 percent of the teens, after one to three months of treatment, will go home and lead normal lives, but he's less optimistic about the third-floor patients. "Their souls are gone to the online world," he said. Mentally Ill Finding Support in Church Bonnie Miller Rubin, Chicago Tribune- 2/23/2007 When Pat Doyle was growing up with a mother who suffered from bipolar disorder, she remembers how she longed to share her pain with someone at her parish. "I had this deep prayer life and yet I couldn't talk to anyone at church about what was going on at home," said the Carol Stream woman, who was raised Roman Catholic. "Sometimes, I couldn't help but wonder if God had forgotten about us." In times of trouble, people often have turned to their faith for guidance and comfort. But those with mental illness and their families often felt excluded. At best, spiritual leaders lacked the tools to deal with the disease. At worst, clergy saw the condition as a sign of sin or moral failing, admonishing those who suffer to just "pray harder." However, many denominations are now recognizing the key role that religion can play in recovery and are reaching out to the mentally ill in unprecedented ways, experts say. The National Council of Churches USA has produced a documentary called "Shadow Voices: Finding Hope in Mental Illness," which has aired on ABC-TV stations nationwide. The Religious Action Center of Reform Judaism spoke out against insurance discrimination during the High Holidays, and Pope Benedict XVI used World Day of the Sick to focus on the disease. That message "was the catalyst for renewed Catholic outreach," said Connie Rakitan, chair of the Chicago Archdiocesan Commission on Mental Illness. Pathways to Promise, a national interfaith organization that promotes understanding for the mentally ill, is using a $90,000 grant from the American Psychiatric Foundation to launch an anti-stigma campaign aimed at some 26,000 U.S. churches and synagogues. The goal of the new campaign is to chip away at misperceptions by providing support and resources. "We're just emerging from a time when people feared this disease because they didn't understand it," said Rev. Bob Dell of Sandwich in DeKalb County. Dell, who has a 49-year-old son with schizoaffective disorder, has channeled his energy into Pathways to Promise after retiring from parish ministry with United Church of Christ. "But every time a Mike Wallace comes out about his depression, the door opens just a little wider--and that goes for religious communities as well," Dell said. Another sign of collaboration: The National Alliance on Mental Illness, or NAMI, last year took over the FaithNet Web site, an online network that addresses spiritual matters during difficult times, increasing subscribers sevenfold. "It's a very nice fit in the NAMI family," said spokesman Bob Carolla. "For people who are searching and struggling, it's one point of access to start down the path to recovery." Doyle wishes she had this kind of help in the late 1960s when her mother's unpredictable mood swings began. "Why couldn't I have seen a support group or been able to put her on a prayer list?" asked Doyle, who now attends a Missouri Synod Lutheran church. "I needed some cue that someone else understood what I was going through. What I wanted was help from the church instead of silence." Now, though, there is more understanding--in the pews as well as in the pulpit--that mental illness is a disease of the brain, not the soul. Said Rakitan: "In our parents' generation, there was so much misunderstanding. But now we have a more accurate grasp on the illness and what causes it. And people who struggle are just more visible, which is also forcing the issue." Psychiatrist Carl Bell, president of the Chicago Community Mental Health Council, told the story of a woman who had been managing quite well on medication but threw herself down a flight of stairs after her pastor urged her to stop taking antidepressants. "The good reverend had been talking with God, who said she had been cursed due to her sin," Bell said. "Of course, this fit exactly with her depressive symptoms." Though challenges persist, Bell said he is encouraged by the shift to a more open-minded climate. Bell, who is African-American, traces the change in black churches to the surgeon general's first report on mental illness in 1999 ("It helped that it came from a black guy," Dr. David Satcher) and says it is continuing with a recent paper by the National Alliance on Mental Illness specifically addressing the challenges facing African-American congregations. For spiritual leaders to better meet the mental health needs of their flock, Bell said, it will take "enlightened ministers and congregations who say `Cut it out' in terms of demonizing mental illness." "That is the right word because that's exactly what many clergy do," he said. Such understanding will come only with increased education and training, both in seminaries and beyond. One ambitious local effort encompasses more than two dozen congregations, including two mosques, in west Cook and DuPage Counties. Monthly workshops are designed to help "raise the confidence level" of clergy dealing with these disorders, said Jeanne Laird, community ministry coordinator at Advocate Good Samaritan Hospital in Downers Grove, a partner in the program. Carolla, for one, welcomes the dialogue--not just as the National Alliance on Mental Illness spokesman, but also as a devout Catholic with bipolar disorder. "Could I have gotten better without medication? Absolutely not," Carolla said. "But there's no question that, for those of us who live with mental illness, at some point, you get around to talking about a spiritual dimension. ... And when recovery finally does come, it can feel like a rebirth and, frankly, like a resurrection." Help for coping - Faithnet: www.faithnet.nami.org - Pathways to Promise: www.pathways2promise.org - Mental Health Ministries: www.mentalhealthministries.net - Mobilizing diverse faith communities: www.mentalhealthandfaith.org - Mental Illness Ministries (Catholic Archdiocese of Chicago): www.miministry.org Painkiller Patch Abuse Rises Susan Oppat, Ann Arbor News- 2/24/2007 A Willis man found lying in a parking lot Friday admitted he chewed two patches of fentanyl in an attempt to get high -- a move police say nearly killed him. State Police Trooper Greg Morenko said the man told him a friend also had eaten patches of the same highly potent painkiller a few weeks ago and died. Across the nation, cases of deaths linked to ingesting fentanyl patches have occurred in several states since 2005, prompting the Federal Drug Administration to issue a warning about the danger of misusing the patches. Fentanyl, a synthetic narcotic, was introduced in the 1960s, but didn't become available in patch form until the early 1990s. According to the FDA, the skin patches administer a painkiller over the course of up to 72 hours, but abusers extract the gel and ingest it to get a day's worth of narcotics in a single dose. On Friday, Morenko said he responded to the Willis Market at about noon to find a man lying next to a car in the parking lot. The trooper said the man was "as blue as my shirt," could not be roused and was taking a breath only every 20 seconds. Paramedics from Huron Valley Ambulance adminitered a dose of Narcan, which counteracts the effects of opiates, and the man awoke, Morenko said. The man's name was not released. Morenko said the man told him the last thing he remembered was chewing two patches of fentanyl, which he did despite the fact that it killed a friend a few weeks earlier. Doctors told police the man came within about five minutes of death himself. "It's the modern way of dying," Washtenaw County Medical Examiner Bader Cassin said of fentanyl overdoses. Most local fentanyl deaths have resulted from the painkiller being mixed with heroin, Cassin said. But recently, Cassin said, fentanyl patches have been found at the scene of fatal overdoses. The patches had been "disrupted," or torn apart, but Cassin said he could not confirm that they had been chewed. In some cases, Cassin said he suspects the patches were chewed. In other cases, overdose victims have had a number of fentanyl patchess attached to their bodies. The Medical Examiner's Office has not tracked the number of fentanyl-related deaths locally, but likely will begin to monitor that figure since it appears to be increasing, Cassin said. Fentanyl depresses the respiratory system by working on the brain stem, and a person revived after a fentanyl overdose could have brain damage, Cassin said. Police in Ann Arbor, Pittsfield Township and Ypsilanti said they had not seen any overdose cases involving fentanyl patches. Morenko said he wanted to discuss Friday's case "to let the public know it's not a good idea." Mentally Ill Children to Get Help at Home Stephen Smith, Boston Globe- 2/24/2007 A federal judge has accepted the state's plan to fix its system of care for poor mentally ill children, with Massachusetts authorities promising comprehensive services at youngsters' homes, rather than stranding them in institutions or ignoring them altogether. US District Judge Michael A. Ponsor ruled late Thursday that the state's proposal offered the best hope for children in desperate need of treatment for psychiatric and emotional conditions and would end years of legal wrangling. "If implemented and successful, the plan will represent a new day for this population of underserved, disabled children," the judge wrote in his nine-page opinion. "It holds the potential to be an enormous step forward." Massachusetts had endured withering criticism from Ponsor in an earlier ruling for keeping children too long in psychiatric wards, group homes, and foster care, rather than providing services in their homes. Advocates even coined a term for such patients, "stuck kids." It is estimated that 15,000 Massachusetts children whose care is paid for by the government could be affected by the decision, at a cost to the state of up to $459 million, according to Ponsor's ruling. Some provisions of the reform plan must be implemented as soon as the end of this year, and it needs to be fully in effect by June 2009. Brigitte Walsh, a spokeswoman for the state Executive Office of Health and Human Services, said last night that Massachusetts officials are examining Ponsor's decision and would have no further comment until their review is complete. Advocates hailed the ruling as a crucial turning point in the state's often-sullied history of guaranteeing uniform, coordinated services for poor children suffering from conditions that range from attention deficit disorder to schizophrenia. "It's going to make a tremendous difference," said Lisa Lambert, assistant director of the Parent/Professional Advocacy League, an association representing about 4,000 families with mentally ill children. "There has been a real focus up until now on a crisis response. This will be much more of a response at an earlier time, and it's definitely the way we really need to go." The judge's ruling appeared to be a Solomonic decision. A year ago, Ponsor sided with the eight families who brought the case, ruling that the state had illegally forced thousands of mentally ill children "to endure unnecessary confinement in residential facilities." But on Thursday, he adopted the state's plan for fixing the system, rather than the more expansive plan proposed by children's advocates. In effect, the judge said to state authorities: You will have no one but yourselves to blame if you don't like the way the new system turns out. Ponsor said that he embraced the state's plan "as a practical matter." "There is some force in being able to say to defendants: You have endorsed this plan, now implement it; prove to the court that it will work," Ponsor wrote. Thursday's ruling entitles children to extensive services where they live. That means there will be specialists to help manage their care and crisis teams available during severe bouts of mental illness. And instead of having the care of a child overseen by a number of sometimes-conflicting specialists, each child will be assigned to a single case manager. "You get one person who's in charge of the show," said Steven J. Schwartz, executive director of the Center for Public Representation, the nonprofit law firm that handled the case for the families. "All of these services are delivered in the community and either literally in the home or on the playground or at the school." The litigation was known as the Rosie D. case, named for the lead plaintiff, who remains unidentified. After Ponsor's January 2006 ruling siding with the families, representatives of the state and the families attempted to reach an agreement on how to repair the mental health system. When they failed, Ponsor ordered each side to submit a plan. The proposal from the families, Schwartz said, was more detailed and advocated more extensive care for children and their families, including specific services after school and training for parents. The heart of the state's 35-page plan is the substantial expansion of home-based services and the creation of crisis teams capable of intervening in the community. Additionally, the state vows it will do a better job of letting poor families know that mental health services exist and perform more rigorous assessment of children to make sure all youngsters who need help receive appropriate care. The financial implications of the ruling for the cash-strapped state remained murky last night. The cost quoted by Ponsor was the figure state lawyers used, and Schwartz described it as an amount "intended to impress the court." He suggested it might have been overstated, failing, for example, to take into account substantial savings by eliminating expensive hospital stays. Walsh, the state spokeswoman, said health agency authorities had no comment on the plan's economic implications. David Matteodo, leader of a trade organization of mental health hospitals, agreed that offering more services at home is laudable. But he cautioned that the reform plan should not be regarded as a panacea, saying that some conditions are so severe they will continue to need hospital services. "I do think this is going to help -- I don't want to be negative," said Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems. But, he said, "the problems are so severe, not only with the kids but with their families, that it's probably not going to solve everything." Was Repressed Memory a 19th-Century Creation? Shankar Vedantam, Washington Post- 2/26/2007 There is a pain -- so utter / It swallows substance up / Then covers the Abyss with Trance / So Memory can step around -- across. . . Emily Dickinson wrote those lovely words sometime in the middle of the 19th century, probably after a love affair broke her heart. Over the next century and a half, that same idea found its way into countless books, plays and movies -- when a memory becomes too painful to bear, the mind finds a way to seal it off, to "step around, across." But when researchers recently mounted an exhaustive effort to find examples of trauma-related amnesia in literary works before the 19th century, they drew a blank. If repressed memories are one way the brain deals with painful memories, why would there be no literary examples of the phenomenon that are more than 200 years old? In an unusual study, a group of psychiatrists and literary scholars, led by Harrison Pope of Harvard Medical School, recently argued that the psychiatric disorder known as dissociative amnesia (often called "repressed memory") is a "culture-bound syndrome" -- a creation of Western culture sometime in the 19th century. Pope pointed out that Shakespeare and Homer and other pre-19th century writers have numerous examples of characters who suffer from other psychiatric disorders -- the disjointed thinking that we call schizophrenia, for example, or the persistent sadness that marks depression. Because art draws its inspiration from life, Pope says, this shows that disorders such as schizophrenia and depression have been around forever. In the opening lines of "The Merchant of Venice," for example, Antonio vividly describes what it feels like to be depressed: " In sooth, I know not why I am so sad / It wearies me; you say it wearies you / But how I caught it, found it, or came by it / What stuff 'tis made of, whereof it is born / I am to learn." Pope said a wide search of literary texts in European languages, Arabic, Sanskrit and Chinese has produced no convincing example of a character created before the year 1800 who suffered a traumatic event, repressed the memory and later recovered it. The scientists recently published their findings in the journal Psychological Medicine. The researchers are offering $1,000 to anyone who can produce a convincing example that would disprove their theory. (To send a suggestion, go to biopsychlab.com and click on "Repression Challenge.") Pope said many intriguing examples have come in, but none has been exactly right. Besides, he says, if dissociative amnesia has its origins in actual brain functioning, there ought to be many examples of it -- just as there are countless examples of characters who have epileptic seizures. In "Shakuntala," a play written in ancient India, a king falls in love with a woman. After a curse, the king forgets about his love. But his amnesia, which eventually reverses itself, was not triggered by a traumatic event. Examples of trauma-related amnesia proliferated in 19th-century Western literature, said Michael Parker, a professor of English at the U.S. Naval Academy and one of Harrison's co-authors. One of the best examples was in Charles Dickens's "A Tale of Two Cities," published in 1859, in which Dr. Manette is horrifyingly imprisoned in the Bastille but has no memory of the trauma until revelations in the plot cause him to recall some of what happened. Movies and television have produced ever more such tales; a recent "Masterpiece Theatre" production of "Jane Eyre," for example, showed her suffering amnesia after finding out on her wedding day that the man she was about to wed was already married. Interestingly, Charlotte Bronte's 1847 novel has no reference to such amnesia -- the television version invented it. "What that illustrates is repressed memory is such a wonderful dramatic device," Pope said. "Film is such a perfect vehicle for someone to have a flashback that grows back into a memory. . . . Maybe Hollywood to some extent has kept this concept in the foreground." Pope's literary-based study offers an unusual take on the controversy over repressed memory. Over the past two decades, large numbers of people have come forward to say that they abruptly recovered memories of traumatic childhood events, especially sexual abuse. Some of these memories have been proved false. One implication of Pope's paper, said Richard McNally, a professor of psychology at Harvard who studies reactions to trauma, is that therapists should focus their attention on treating patients for the symptoms they are displaying -- depression or post-traumatic stress disorder, for example -- with tools such as psychotherapy and medication, rather than assuming that hidden memories are the source of their emotional problems. Pope and McNally emphasized that a culture-bound syndrome was no less "real" than a biological brain disorder -- the suffering of patients in both cases can be identical. Indeed, many experts argue that all psychiatric disorders, including schizophrenia and depression, have cultural aspects. For one thing, the ways people express emotional suffering is informed by the cultures they come from. But given there are no laboratory tests or brain scans to diagnose schizophrenia or depression -- doctors make those diagnoses based on clinical impressions and criteria agreed upon by consensus -- one critic of Pope's study argued that it had the effect of belittling dissociative amnesia when it was no less scientific than other psychiatric disorders. Matthew Erdelyi, an experimental psychologist at Brooklyn College argued that his own experiments show that human memory is indeed malleable, and that people's ability to recall distant events can decline or improve with time. "I think it is patronizing," he said of the paper. "What is the claim of the article? You can't find repressed memories in historical articles. But that does not argue to the proper therapy for repressed memory." Erdelyi said the paper illustrates the enduring tension between modern psychiatry, which emphasizes the treatment of patients' symptoms, and Sigmund Freud's psychoanalytic approach, which emphasizes the exploration of past events as a way to resolve patients' problems. Freud himself worked with patients to recover memories of trauma. But by 1895, Erdelyi said, Freud had modified his idea after he realized that most people were not suffering from a single trauma. "He started to emphasize insight," Erdelyi said. "The insight was not, 'Oh my God, my father raped me!' but that there is a pattern to my problems. The task of therapy is not to recover a particular point of memory, but to connect the points and to see a pattern in what makes you depressed." Experts Admit There's a Lot They Don't Know About Sex Orlando Sentinel, 2/26/2007 ORLANDO, FLA. — To get an idea of how much remains unknown about a subject that affects most people's lives, check out the International Society for the Study of Women's Sexual Health. Scientists, gynecologists, therapists and hundreds of other experts who gathered for the society's sixth annual meeting are still trying to figure out which hormones and neurotransmitters make sexual arousal possible, where in the brain orgasm takes place and which nerves control the genital organs. "Now we're sticking needles into different parts of the brain," said Dr. Irwin Goldstein, a Boston urologist who founded the group. "Whatever pharmaceuticals are proven to help most likely will work in the central nervous system." Clinicians, frustrated by the slow pace of sexual science, want effective treatments for patients brave enough to seek help. "I think it's progress that we can spend two hours in this performance-driven society admitting that maybe we don't know what we're talking about," said Ellen Laan of the University of Amsterdam. Michael Sand, a sexologist who works in Germany, agreed. "We don't understand normative, healthy sexuality well enough to make judgments about what's dysfunctional." Study: Psychologist Shortage Hurts Military Hartford Courant, 2/27/2007 U.S. military servicemen and women aren't getting the mental health care they need because of a shortage of uniformed behavioral health professionals and limited resources for families and children, according to a report from the American Psychological Association. About 40 percent of the active-duty licensed clinical psychologist jobs in the Army and Navy are vacant and there are similar shortages for social workers and psychiatrists across the entire military, the report issued Sunday said. "Appropriate mental health services are not often readily accessible" because of long waiting lists, limited clinic hours and a poor referral process, the report said. "Unrestricted access to high-quality mental health care should be made available to every active duty service member and his or her family members." The preliminary report, conducted by a presidential task force, recommends that the military improve hiring practices, clinical services, community outreach, and training to provide better care. Aside from institutional weaknesses in offering psychiatric services, the quality of care is affected by the perceived "stigma" of treatment, the report found. More than three out of 10 soldiers met the criteria for a "mental disorder," but far less than half of those in need sought help, according to the task force. In Connecticut, state agencies and the National Guard are scrambling to launch a program in March that will provide troops and their families free mental health counseling. Rare No More, Autism Sheds More of Its Mystery Roy Grinker, Washington Post- 2/27/2007 When my daughter Isabel's autism was diagnosed in 1994, when she was 2 1/2 , I knew little about the condition. Autism was a strange word to most people. "You mean like Dustin Hoffman in 'Rain Man'?" people would ask. "You mean she's artistic?" Back then, autism was considered a rare disorder, occurring in only about three in every 10,000 live births. Little more than a decade later, autism has become a "major public health concern," according to Marshalyn Yeargin-Allsopp, chief of the developmental disabilities branch of the Centers for Disease Control and Prevention. The results of a CDC survey released this month suggest that about one in every 150 children in the United States has some form of autism. Those numbers don't reflect an epidemic, as some reports have suggested, or even mean that the incidence of autism has necessarily increased. Instead, we are defining autism and measuring its prevalence differently than we did in the past. Isabel's story illustrates that evolution. The years since Isabel's diagnosis show a rapid change in our awareness of the disorder. In 1993, the state of Maryland (where we live) told the U.S. Department of Education that the state's public schools had provided special education services during the 1992-93 academic year to just 28 children between the ages of 6 and 21 with autism. By the time Isabel was diagnosed, Maryland's public schools claimed to have served 300 people in the same age group with autism in 1993-94 (still a small number, but an enormous increase over the previous year). And by 2003 there were more than 4,084 children ages 3 to 22 who had been given the official coding for autism in the Maryland public school systems, a rate of 1 in 183 children. Isabel was no longer alone. Like most of the illnesses psychiatrists treat, you cannot see autism under a microscope or discover it through a lab test. The only evidence we have is the individual's behavior. And until 1980, when the criteria we're familiar with today were first standardized in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III), there was little agreement about what was and was not autism. Even now, there is an element of subjectivity in each diagnosis. What's more, many psychiatric diagnoses come and go -- and hence rates of diagnoses go up and down and change rapidly. Several million Americans have been diagnosed with depression, for example. But many of them would not have received that diagnosis just 50 years ago. The increase does not mean that depression is more common today than in the past, but only that our way of defining depression has changed. Half a century ago, the term was used to describe only debilitating depressions that required long-term hospitalization. The shift in how we view autism is also part of a set of broader shifts taking place in society. The growth of child psychiatry after World War II, the rise of advocacy organizations, greater public sensitivity to children's educational problems and changes in public policies (the establishment, for example, of autism as a special-education code after the 1991 Individuals with Disabilities Education Act, or IDEA) have together changed the way autism is diagnosed and defined. As a society, we have also become more aware of children's behavioral and learning differences at earlier and earlier ages and more comfortable with diagnosis, medication and psychiatric labels. Under the rubric of autism we now find a multitude of emotional and cognitive problems -- problems that used to be given other diagnostic labels or were even considered within the range of the normal. And these days, researchers use reliable diagnostic tools to provide more accurate statistical counts of disease rates in a community, rather than basing their counts on reports of already known cases. As a result, there are more people with a diagnosis of autism now than at any time in history. And it's a better time than ever to be autistic. More Awareness, Research What was our school supposed to do in the early '90s with Isabel, who was just one of a few hundred kids in the whole state labeled with autism? The key word here is "labeled," because there were certainly thousands of people in Maryland with autism at the time. So where were they? The answer is that many of the kids were in school; they just didn't have the label. That category had been introduced only in the 1991-92 academic year -- and then as an optional category. A diagnostic label really does influence the way we view someone. If Isabel's condition had been diagnosed as schizophrenia, as might have happened in the 1950s and '60s, a psychologist might have recommended that she be sent to a mental institution or assigned her to a class or school for mentally disturbed children. If she had been diagnosed as mentally retarded, as so many autistic people were and still are, she would have been placed in classes for cognitively challenged kids. Today, pediatricians, mental health-care practitioners, speech and occupational therapists and educators are providing therapy to children with autism at earlier ages than ever, and they are discovering how to use safe and effective medicines to ameliorate some of their symptoms. Federal, state and local agencies have mobilized to manage the heavy public health burden of autism. Special-education programs are expanding; new money is pouring out of the National Institutes of Health into autism research; and donors are contributing millions of dollars to advocacy organizations, private schools and research foundations. Between 2003 and 2004, the number of grant applications to the National Alliance for Autism Research, which was then the leading private foundation for autism research, doubled. The increased awareness, and the new, higher, more accurate rates, mean that a newly diagnosed child is no longer a mystery. And this is true no matter where you are -- in a suburb of Washington or in Seoul, Cape Town or New Delhi. Parents all over the world are beginning to break through the walls of stigma that had made them hide their children from public view. They are asking for the public assistance they deserve, and where it is absent they are demanding it. Plenty of Progress I trace the beginning of my knowledge about autism and Isabel's identity back to that beautiful spring day in 1994 when a short, slightly overweight, affable child psychiatrist at Johns Hopkins told my wife and me that "Isabel has enough features of autism to be called PDD-NOS, Pervasive Developmental Disorder Not Otherwise Specified. It means that she's not severely autistic." By that time we had already been worried about Isabel for more than six months. The discussion of her diagnosis was really just having someone we could trust tell us what we knew all along, even if we hadn't admitted it to ourselves. Isabel was our first child, and so we didn't really have a standard for comparison. In her first two years, she had seemed like any other child, and at 12 months she had begun to make some of the sounds that seemed like the beginnings of words. We thought she was fine. But when I look at our home movies today, I see that she never tried to communicate with us; in none of the videos of Isabel between 18 and 24 months does she say a single word. At 25 months old, she made only fleeting eye contact. She began flapping her hands and arms occasionally and didn't respond to her name consistently. She spoke little and couldn't even tell us if she was hungry. We were at a point where we demanded clarity from doctors. A valid diagnosis of what was wrong with Isabel was more satisfying than devastating. It gave us a framework for understanding Isabel and a road map for the future. Today, my teenage daughter is mainstreamed into a high school classroom for part of the day. Numerous tests have shown that she has above-average intelligence. She plays cello in the school orchestra. Just last week, I showed her two magazine articles about my new book on autism, in which I talk about how far she has come -- farther than my wife and I, or our doctors, ever expected. "What do these articles say?" I asked. "They say I'm doing great," Isabel replied. Indeed, she is. Tantalized by the Hint of a Cure for Autism Abigail Zuger, M.D., New York Times- 2/27/2007 Strange Son Two Mothers, Two Sons and the Quest to Unlock the Hidden World of Autism. By Portia Iversen. 397 pages. Riverhead, $24.95. If lightning strikes once, then why not again? This irrational logic will tempt the victims of any senseless tragedy to believe in miracles, or so Portia Iversen assures us by way of explaining her long, determined slog toward a miracle of her own. Whether she actually found one or not, readers will have to decide for themselves. Larry Gordon & Louis Sahagun, Los Angeles Times- 2/27/2007 No wonder YouTube is so popular. All the effort to boost children's self-esteem may have backfired and produced a generation of college students who are more narcissistic and self-centered than their Gen-X predecessors, according to a comprehensive new study. And the Internet, with all its MySpace and YouTube braggadocio, is letting that self-regard blossom even more, said the analysis by five psychologists. In the study being released today, the authors warn that a rising ego rush could bring personal and social problems for Gen Y. People with an inflated sense of self tend to have less interest in emotionally intimate bonds and can lash out when rejected or insulted. "That makes me very, very worried," said Jean Twenge, the San Diego State associate professor who is lead author of the report. "I'm concerned we are heading to a society where people are going to treat each other badly, either on the street or in relationships." Twenge and her colleagues examined the responses of 16,475 college students nationwide who completed an evaluation called the Narcissistic Personality Inventory between 1982 and 2006. The standardized inventory, known as the NPI, asks for responses to such statements as "If I ruled the world, it would be a better place," "I think I am a special person" and "I can live my life any way I want to." The researchers describe their study as the largest ever of its type and say students' NPI scores have risen steadily since the current test was introduced in 1982. By 2006, they said, two-thirds of the students had above-average scores, 30 percent more than in 1982. Twenge stressed that she and her co-authors are not suggesting that more students today have a pathological narcissistic personality disorder that needs psychiatric treatment. Still, traits of narcissism have increased significantly, said Twenge, author of "Generation Me: Why Today's Young Americans Are More Confident, Assertive, Entitled - and More Miserable Than Ever Before." Some of the rise in narcissistic attitudes was probably caused by the self-esteem programs that many elementary schools adopted 20 years ago, the study suggests. It noted that nursery schools began to have children sing songs that proclaim: "I am special, I am special. Look at me." Those youngsters are now adolescents obsessed with websites, such as MySpace and YouTube that "permit self-promotion far beyond that allowed by traditional media," the report said. Other trends in American culture such as permissive parenting, increased materialism and the fascination with celebrities and reality TV shows may also heighten self-regard, said study co-author W. Keith Campbell, psychology professor at the University of Georgia. "It's part of a whole cultural system," he said. Although some analysts say today's young people show an increased commitment to volunteer work, Twenge say that may simply reflect high school requirements and the pressure of college admissions. The new report follows a study released by UCLA last month which found that nearly three-quarters of the freshmen it surveyed thought it was important to be "very well-off financially." That compared with 62.5 percent who said the same in 1980 and 42 percent in 1966.
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