Noteworthy News Articles on Mental Health Topics, April 1-9, 2007

Some examples:
--In Minnesota's Twin Cities, meth-related emergency room visits dropped from 1,402 in 2005 to 251 in 2006, according to a recent report by the nonprofit Hazelden Foundation.
--In Montana, a new report from that state's attorney general noted that meth-related crime fell 53 percent in 2006, compared with the previous year. They also found that, while meth remains a big problem there, the overall rate of employees in Montana who tested positive for meth was down more than 70 percent from 2005 to last year.
--In the San Francisco Bay area, meth-related emergency room visits leveled off in 2006, after peaking the previous two years. Decline in meth use has been particularly notable among gay men, following efforts in their community to spread the word about the drug's ill effects, says John Newmeyer, who heads San Francisco's Haight-Ashbury Free Clinics. In addition to causing paranoid, aggressive behavior, meth is known for its harsh physical effects -- from sunken eyes and bone-thin frames to teeth that turn gray and deteriorate.
      Newmeyer believes such effects have helped change attitudes about meth for ''probably the same reasons we saw the decline 10 years ago with African-Americans and crack cocaine.'' ''It just became not the thing to do,'' says Newmeyer, who tracks his region's drug numbers for the federal government.
     The news isn't good everywhere -- especially on the East Coast, where meth became a problem more recently. South Florida has, for instance, continued to see a steady increase in meth-related deaths, from 77 in 2003 to 115 last year. It's also more of an urban problem than a rural one, with much of the meth coming from Mexico by way of Atlanta, says Jim Hall, executive director of the Up Front Drug Information Center in Miami. Others have noted surges in use in the Hispanic community -- and also the advent of strawberry and other flavored meth, aimed at renewing interest in the drug.
     Still, for much of the country, researchers say it appears this latest meth epidemic reached its peak in 2004 and 2005. Data from the federal government shows that the number of first-time meth users has steadily declined in recent years. And Quest Diagnostics Inc. -- a New Jersey company that maintains a national drug testing index based on millions of tests each year -- found that 16 out of every 10,000 drug tests in the general work force came back positive for meth in 2006. That compares with 26 in 2005 and 33 the year before that. While they still remain above the national average for overall positive tests for the amphetamine class of drugs, Idaho, Wyoming, New Mexico, Hawaii and Georgia saw the biggest drops in those positive tests, says Quest researcher Barry Sample.
     Some law enforcement officials also are starting to feel less overwhelmed by methamphetamine -- and, in some cases, seeing interest in the Mexican-made form of the drug decline. ''We expected a big switch (to Mexican meth) -- and for a while there was,'' says Eric Schober, a police lieutenant with the criminal intelligence unit in Portland, Ore. But in recent months, he says, he's seen the price of Mexican meth go up to more than $1,000 an ounce, compared with $600 to $700 in the state's meth heyday. He says the purity of that meth also has been cut from 90 percent to about 50 percent -- perhaps a sign of a dwindling supply. Meanwhile, he and others are seeing more interest in powder cocaine, which -- like meth -- is a dangerous stimulant.
     Lisa Madigan, the state attorney general in Illinois, isn't ready to declare victory in her state but says the significant reduction in meth lab seizures has been a positive first step. ''There's simply a difference in the impact that the mom-and-pop labs have -- in the cost to families and in cleaning them up,'' says Madigan, who has helped push drug stores to comply with pseudoephedrine limits in her state.
     In addition to those types of laws, many experts say state and community efforts aimed at curbing meth use also have been key. They include the Montana Meth Project, a public service campaign with stark, edgy ads that depict the horrors of meth. Some critics view the approach as one-dimensional. ''They see a dollar spent on prevention as a dollar not spent on enforcement. But it's all important,'' says Tom Siebel, the project's founder and main funder. The Montana attorney general's report credits the program with helping change attitudes about meth -- and cites a survey in which 93 percent of Montana students considered meth a ''great risk.''
     Elsewhere, residents are taking it upon themselves to fight meth, including in the Dodge Flower and Dodge Oak neighborhoods in Tucson, Ariz., where the theme is ''Meth Get Outta Dodge.'' They recently sponsored a workshop for the neighborhoods' many landlords to teach them how to do tenant background checks, legal property inspections and immediate evictions for criminal activity. ''We still have a meth problem; it hasn't cured it,'' says Barbara Lehmann, president of the Dodge Flower neighborhood association. ''But I do feel hopeful. I mean, I'm still living in the neighborhood, right?''
     On the Net: Montana Meth Project: http://www.montanameth.org/

Adding Method to Judging Mayhem
Adam Liptak, New York Times- 4/2/2007

There are, Dr. Michael H. Stone says, 22 varieties of killers, and he has ranked them in order of evil. The worst are your psychopathic torture-murderers, at least where torture is the primary motive. Near the other end, at No. 4, are those who killed in self-defense "but had been extremely provocative towards the victim."
     Dr. Stone, a professor of clinical psychiatry at Columbia, said had put the scale together based the biographies of hundreds of killers. "I have a very extensive spreadsheet," he said. Dr. Michael Welner, a clinical associate professor of psychiatry at New York University, has even greater and much more practical ambitions. He is at work on a "depravity scale" to aid juries in separating the worst of the worst from the really bad. It is based on an Internet survey that asks respondents to rank various acts in order of heinousness.
     I took the survey the other day, at www.depravityscale.org, but I found it hard and largely pointless to try to distinguish between, say, a contract killing and mailing anthrax. It feels odd to put degrees of depravity up for a vote, but Dr. Welner's work follows the erratic logic of death penalty jurisprudence. For ordinary crimes, we rely on legislatures to distinguish among blameworthy acts in criminal codes. Juries determine guilt. Judges decide sentences, often guided by sentencing laws.
But we ask more of juries in capital trials. They must decide whether convicted defendants deserve to die.
     In the second, sentencing phase of a capital trial, juries weigh aggravating factors against mitigating ones. The sum of that calculation equals life or death. Most states have long lists of possible aggravating factors, often including, for instance, killings committed during other felonies, torture and terrorism. But prosecutors are fond of relying on one aggravating factor in particular -- that the murder was heinous, atrocious or cruel. That is pretty vague, and that is where Dr. Weiner comes in. His aim is to use the objectivity of science to help jurors confronted with that phrase to sentence consistently.
     Dr. Welner said he had collected 17,000 responses to one part of the survey. He wants more before he rolls out his depravity scale for use in the courts, but he gave me a tentative idea of what people are saying. Almost everyone agrees that intending to inflict emotional trauma qualifies as depraved. But what racked up the biggest numbers as "especially depraved," he said, was "prolonging the duration of a victim's suffering." "The weakest supported item," Dr. Welner said, is an "extreme response to a trivial irritant." The survey gives road rage-as an example.
     The survey could also help lawyers in selecting juries. Women, Dr. Welner said, are more likely to think particular acts are especially depraved. Defense lawyers and prosecutors, perhaps because they are inured to depravity, tend the opposite way.
     Dr. Stone, who developed the 22-part taxonomy of evil, said his work was not meant for judges and juries. "I don't much care about the legal system," Dr. Stone said. "Welner is transfixed with the legal system. I'm not."
     The Supreme Court has never been particularly comfortable with vague phrases like "heinous, atrocious and cruel." Justices have repeatedly mused that all murders can be said to be depraved, and the court has sometimes struck down death sentences based on that factor. But in 1990 the court sustained an Arizona death sentence based on a finding that the murder had been committed "in an especially heinous, cruel or depraved manner." The court said the sentence passed muster because Arizona courts had defined the phrase narrowly.
     The list of what qualifies as depraved in Arizona, however, includes the senselessness of the crime, the helplessness of the victim, the apparent relishing of the murder, the age of the victim, "needless mutilation" (as opposed, one supposes, to the kind necessary to the murder), the fact that the victim had been kind to the killer, special bullets, "gratuitous violence" and "total disregard for human life." As Justice Harry A. Blackmun said in dissent in the 1990 case, "there would appear to be few first-degree murders the Arizona Supreme Court would not define as especially heinous or depraved."  Dr. Welner intends to bring some order. to this chaos, to sort out the mayem.
     Prof. Robert Blecker, an authority on the death penalty at New York Law School who sits on an advisory board assisting Dr. Welner, said the survey had the potential to focus attention on sadistic cruelty, which he said "is the essence of who deserves to die." But Professor Blecker also worried about how a numerical scale would be used in practice. "Would it remove the arbitrariness?" he asked. "Or merely give the illusion of objectivity?"
     The current system of capital sentencing, which the Supreme Court likes to call guided discretion, is not quite an oxymoron. But, as efforts to make scientific sense of it demonstrate, it is something like one.

Finding Hope in Knowing the Universal Capacity for Evil
Claudia Dreifus, New York Times- 4/3/2007

SAN FRANCISCO — At Philip G. Zimbardo’s town house here, the walls are covered with masks from Indonesia, Africa and the Pacific Northwest. Dr. Zimbardo, a social psychologist and the past president of the American Psychological Association, has made his reputation studying how people disguise the good and bad in themselves and under what conditions either is expressed.
      His Stanford Prison Experiment in 1971, known as the S.P.E. in social science textbooks, showed how anonymity, conformity and boredom can be used to induce sadistic behavior in otherwise wholesome students. More recently, Dr. Zimbardo, 74, has been studying how policy decisions and individual choices led to abuse at the Abu Ghraib prison in Iraq. The road that took him from Stanford to Abu Ghraib is described in his new book, “The Lucifer Effect: Understanding How Good People Turn Evil” (Random House). “I’ve always been curious about the psychology of the person behind the mask,” Dr. Zimbardo said as he displayed his collection. “When someone is anonymous, it opens the door to all kinds of antisocial behavior, as seen by the Ku Klux Klan.”
Q. For those who never studied it in their freshman psychology class, can you describe the Stanford Prison Experiment?
A. In the summer of 1971, we set up a mock prison on the Stanford University campus. We took 23 volunteers and randomly divided them into two groups. These were normal young men, students. We asked them to act as “prisoners” and “guards” might in a prison environment. The experiment was to run for two weeks. By the end of the first day, nothing much was happening. But on the second day, there was a prisoner rebellion. The guards came to me: “What do we do?” “It’s your prison,” I said, warning them against physical violence. The guards then quickly moved to psychological punishment, though there was physical abuse, too. In the ensuing days, the guards became ever more sadistic, denying the prisoners food, water and sleep, shooting them with fire-extinguisher spray, throwing their blankets into dirt, stripping them naked and dragging rebels across the yard. How bad did it get? The guards ordered the prisoners to simulate sodomy. Why? Because the guards were bored. Boredom is a powerful motive for evil. I have no idea how much worse things might have gotten.
Q. Why did you pull the plug on the experiment?
A. On the fifth night, my former graduate student Christina Maslach came by. She witnessed the guards putting bags over the prisoners’ heads, chain their legs and march them around. Chris ran out in tears. “I’m not sure I want to have anything more to do with you, if this is the sort of person you are,” she said. “It’s terrible what you’re doing to those boys.” I thought, “Oh my God, she’s right.”
Q. What’s the difference between your study and the ones performed at Yale in 1961? There, social psychologist Stanley Milgram ordered his subjects to give what they thought were painful and possibly lethal shocks to complete strangers. Most complied.
A. In a lot of ways, the studies are bookends in our understanding of evil. Milgram quantified the small steps that people take when they do evil. He showed that an authority can command people to do things they believe they’d never do. I wanted to take that further. Milgram’s study only looked at one aspect of behavior, obedience to authority, in short 50-minute takes. The S.P.E., because it was slated to go for two weeks, was almost like a forerunner of reality television. You could see behavior unfolding hour by hour, day by day. Here’s something that’s sort of funny. The first time I spoke publicly about the S.P.E., Stanley Milgram told me: “Your study is going to take all the ethical heat off of my back. People are now going to say yours is the most unethical study ever, and not mine.”
Q. From your book, I sense you feel some lingering guilt about organizing “the most unethical study” ever. Do you?
A. When I look back on it, I think, “Why didn’t you stop the cruelty earlier?” To stand back was contrary to my upbringing and nature. When I stood back as a noninterfering experimental scientist, I was, in a sense, as drawn into the power of the situation as any prisoners and guards.
Q. What was your reaction when you first saw those photographs from Abu Ghraib?
A. I was shocked. But not surprised. I immediately flashed on similar pictures from the S.P.E. What particularly bothered me was that the Pentagon blamed the whole thing on a “few bad apples.” I knew from our experiment, if you put good apples into a bad situation, you’ll get bad apples. That was why I was willing to be an expert witness for Sgt. Chip Frederick, who was ultimately sentenced to eight years for his role at Abu Ghraib. Frederick was the Army reservist who was put in charge of the night shift at Tier 1A, where detainees were abused. Frederick said, up front, “What I did was wrong, and I don’t understand why I did it.”
Q. Do you understand?
A. Yeah. The situation totally corrupted him. When his reserve unit was first assigned to guard Abu Ghraib, Frederick was exactly like one of our nice young men in the S.P.E. Three months later, he was exactly like one of our worst guards.
Q. Aren’t you absolving Sergeant Frederick of personal responsibility for his actions?
A. You had the C.I.A., civilian interrogators, military intelligence saying to the Army reservists, “Soften these detainees up for interrogation.” Those kinds of vague orders were the equivalent of my saying to the S.P.E. guards, “It’s your prison.” At Abu Ghraib, you didn’t have higher-ups saying, “You must do these terrible things.” The authorities, I believe, created an environment that gave guards permission to become abusive — plus one that gave them plausible deniability. Chip worked 40 days without a single break, 12-hour shifts. The place was overcrowded, filthy, dangerous, under constant bombardment. All of that will distort judgment, moral reasoning. The bottom line: If you’re going to have a secret interrogation center in the middle of a war zone, this is going to happen.
Q. You keep using this phrase “the situation” to describe the underlying cause of wrongdoing. What do you mean?
A. That human behavior is more influenced by things outside of us than inside. The “situation” is the external environment. The inner environment is genes, moral history, religious training. There are times when external circumstances can overwhelm us, and we do things we never thought. If you’re not aware that this can happen, you can be seduced by evil. We need inoculations against our own potential for evil. We have to acknowledge it. Then we can change it.
Q. So you disagree with Anne Frank, who wrote in her diary, “I still believe, in spite of everything, that people are truly good at heart?”
A. That’s not true. Some people can be made into monsters. And the people who abused, and killed her, were.

Many Diagnoses of Depression May Be Misguided, Study Says
Benedict Carey, New York Times- 4/3/2007

About one in four people who appear to be depressed are in fact struggling with the normal mental fallout from a recent emotional blow, like a ruptured marriage, the loss of a job or the collapse of an investment, a new study suggests. To avoid unnecessary diagnoses and stigma, the standard definition of depression should be redrawn to specifically exclude such cases, the authors argue. The study , appearing today in The Archives of General Psychiatry, is based on survey data from more than 8,000 Americans; it did not analyze the number of people who had been misdiagnosed.
      Psychiatrists and other doctors who take careful medical histories do so precisely to rule out such life blows, as well as the effects of physical illnesses, before making a diagnosis of depression. But the American Psychiatric Association’s diagnostic manual does not specifically exclude people experiencing deep but normal feelings of sadness, unless they are bereaved by the death of a loved one. And an increasing number of school districts and health clinics use simple depression checklists, which do not take context into account, the authors said. “Larger and larger numbers of people are reporting symptoms on these checklists, and there’s no way to know whether we’re finding normal sadness responses or real depression,” said Jerome C. Wakefield, a professor of social work at New York University and the study’s lead author. His co-authors were Mark F. Schmitz of Temple University, Allan V. Horwitz of Rutgers University, and Dr. Michael B. First, a psychiatrist at Columbia who edited the current version of the psychiatric association’s diagnostic manual.
     The study’s findings suggest that previous estimates of the number of Americans who suffer depression at least once during their lives — more than 30 million — are about 25 percent too high. Dr. Darrel Regier, director of research for the American Psychiatric Association, said, “I think the concern this study raises is real, and that we do need to be very careful not to overdiagnose a normal, homeostatic response to loss and call it a disorder.” But he added that depression checklists had in fact helped identify people in need of treatment.
     The researchers analyzed responses from 8,098 adults to survey questions posed between 1990 and 1992. The questions were based on diagnostic criteria for mood problems and asked people who reported a period of sadness if they remembered any event that might have caused it, like the death of a loved one or a divorce.
     The diagnostic manual makes a distinction between severe bereavement that precipitates lasting depression, which is rare, and normal grief, which looks like depression but usually loosens its hold in a few weeks or months. The researchers found 56 people in the survey who suffered this normal reaction after the death of someone close. Another 174 people struggled with normal levels of distress after a different kind of blow, like the breakup of a relationship or a lost job — a group that would qualify for a diagnosis of depression under the current definition.
     The investigators then compared the two groups’ answers to questions about nine kinds of depression symptoms, including a loss of appetite, sleeping problems and thoughts about suicide. The only significant difference, they found, was that those grieving a death were twice as likely as those digesting another kind of loss to have thoughts about death or suicide. “The profile you get for these two groups is so very, very close,” Dr. Wakefield said, that it does not justify the exclusion of one group and not the other in the depression diagnosis.
     The authors draw no conclusions about the study’s implications for treatment. Doctors often treat even normal grief reactions if patients are in some pain. But such patients should not be identified as having depression, the authors conclude.

Phone Therapy Plus Pills Lifts Depression
Jennifer Huget, Washington Post- 4/3/2007

A new study in which patients receiving psychotherapy for depression improved without ever meeting their therapists face to face may encourage some psychologists to consider telecommuting. The research spotlights the changing role of the telephone in psychotherapy, its potential to extend help to reluctant or hard-to-reach patients and its limitations as a therapeutic tool.
      In the study of 393 patients diagnosed with depression and placed on antidepressant medications, most (77 percent) of those who also received periodic psychological counseling over the phone found their depression "much" or "very much" improved after 18 months, found Evette Ludman, senior research associate at the Group Health Center for Health Studies in Seattle, and colleagues. Of those who received medication without phone counseling, only 63 percent saw similar gains, according to the study, funded by the National Institute of Mental Health and published in the April issue of the Journal of Consulting and Clinical Psychology.
     The phone-therapy patients didn't initiate the calls; in a departure from usual practice, psychotherapists phoned them, after the patients' diagnoses by primary care physicians, to conduct eight half-hour talk therapy sessions for six months. The therapists then conducted shorter "booster" sessions every two months for up to a year. Researchers said they chose to test this care model because, in the United States, most depressed patients either don't seek psychotherapy after their diagnosis or cut short their therapy.
     Ludman's study did not isolate which component of the phone-therapy program -- counselors' reminders to patients to stay on their meds, for example, or patients' feeling that somebody out there cared -- should be credited with patients' improved mental health. Whatever it was, Ludman said, the key was that "the results were maintained over time" -- months after therapy stopped. "This is the holy grail of psychotherapy: Can you help people not only get better but stay better over time?"
     Ludman noted that the phone-therapy model used was similar to programs recently launched by pharmaceutical companies and insurers to support sick patients and ensure they follow prescribed treatments. "Telephone psychotherapy almost more resembles those programs than traditional therapy," she said, noting that "this program was about outreach to people who might not seek therapy themselves." Phone counseling, she said, is "a way to make sure people don't slip through the cracks" -- not necessarily better than face-to-face therapy but apparently better than no therapy at all. The findings were consistent with earlier research by Ludman, published in 2004 in the Journal of the American Medical Association.
     There are no good estimates on the number of therapists who counsel patients by phone; it's not a recognized subspecialty, and most who do it, do it as one aspect of their traditional practices. It's also a technique that the American Psychological Association has not completely assessed. The APA's most recent policy statement on the matter, issued in 1997, acknowledges that no formal phone-therapy standards have been set and urges practitioners to follow guidelines that govern traditional therapy.
     Non-uniform licensing laws complicate the picture. Some states require therapists to be licensed both in their own state and in the state where the patient receives counseling. Some states waive such rules to allow for short-term treatment of people moving from one state to another. Nor is the insurance environment friendly to phone therapy. Aspen, Colo., psychotherapist Martin Manosevitz noted that all insurers limit reimbursement to sessions that are conducted face to face. That means that except where a waiver is granted, patients generally must pay for phone therapy out-of-pocket, he said.
     Still, some psychologists say they are filling a need by picking up the phone. "Usually the combination of medications and talk therapy seems to be the most efficacious way to go" in treating patients with depression, said Wendell Cox, a Washington psychotherapist who conducts phone therapy with some patients. "This study seems to support that idea that some personal contact helps, even over the phone." Cox said he offers phone therapy only in cases in which he has a "well-established relationship with the patient." Otherwise, he said, "I don't think you can gauge mood, affect, body language, lots of stuff" that's important for a therapist to observe. In such cases, he said, "it's only slightly better than e-mail. It leaves too much to the imagination."
     Herman Lowe, a clinical psychologist and owner of BriefCounseling.com, a phone therapy service based in Newton, Mass., sees his service as "not a substitute for face-to-face therapy but as pre-therapy." Lowe's practice is aimed largely at "people in crisis who need to call for immediate help," he said. "We find there are a lot of people who would not go to [conventional] therapy," Lowe said. "Through BriefCounseling, their resistance is overcome, and they then seek [regular] therapy. We're helping people who would otherwise never get any professional help."
     Manosevitz said he started offering occasional phone therapy while practicing in Austin, where some of his patients' jobs required frequent travel. "I'd work with them over the phone," he said. "That gave me some limited confidence that this might work as I made the transition" from Austin to Aspen 7 1/2 years ago. "Most of my [Austin] patients continued working with me [by phone] until their [psychological] work was done." Since then, Manosevitz has frequently worked with high school students, continuing to counsel them by phone after they leave for college. Manosevitz said that, although he has found depression, anxiety and substance abuse to be highly treatable via phone therapy, other conditions aren't appropriately treated over the phone. "Patients who are not good candidates are those who are actively psychotic, suicidal, homicidal or highly impulsive," he said.
     In entering a phone-therapy relationship, Manosevitz added, therapist and patient should make sure the therapist has contact information for psychiatric hospitals, outpatient clinics and other facilities that a patient might need in a crisis. It's also important, he said, to schedule sessions for times when both doctor and patient can go uninterrupted and undisturbed by distractions. Finally, he said, both should be aware of potential compromises to confidentiality. "Both have to have an understanding that use of cell, mobile or cordless phones pose the risk that confidentiality might be pierced," he said.

Paul Watzlawick; Pioneering Stanford Family Therapist
Los Angeles Times, 4/6/2007

Paul Watzlawick, 85, a pioneering family therapist and communications theorist who believed people create their own suffering by trying to fix their emotional problems, died Saturday of cardiac arrest at his home in Palo Alto, according to colleagues.
     Born in Austria, Watzlawick gained fame for parting with Freudian psychoanalysis in favor of an approach to therapy that emphasized relationships over introspection. He trained at the C.G. Jung Institute in Zurich, Switzerland, and in 1960 joined the Mental Research Institute in Palo Alto.
     Watzlawick wrote 22 books, which were translated into 80 languages. Emotional health, he believed, hinged on abandoning the ego and achieving well-being through effective communication.
In such popular books as "The Situation Is Hopeless, but Not Serious" and "Change," Watzlawick playfully promotes his theory that the worst way to find happiness is to seek it.
      Watzlawick's research into the processes and principles of communication formed the foundation of the outward-looking therapeutic approach known as MRI Brief Therapy, which he developed with Mental Research Institute colleagues. In 1967, he joined the faculty in the Department of Psychiatry and Behavioral Sciences at Stanford University Medical Center and was a clinical professor emeritus at the time of his death.

Child Psychiatrist Is Accused of Molesting 3 Former Patients
Jesse McKinley, New York Times- 4/7/2007

SAN FRANCISCO— A prominent child psychiatrist who treated generations of troubled youth and preached sex education on public television was arrested Thursday night, accused of sexually abusing three patients. The psychiatrist, Dr. William H. Ayres, was taken into custody at his home in San Mateo, Calif., after a lengthy police investigation prompted by a civil suit over sexual abuse. Dr. Ayres, 75, was charged with 14 felony counts of lewd and lascivious conduct with a child under the age of 14 and accused of molesting his patients during psychiatric sessions, according to the criminal complaint.
      The three unidentified male patients, now ages 21, 25 and 26, were 9- to 12-year-old boys when the alleged abuse occurred from 1991 to 1996. The San Mateo County district attorney’s office said it was also aware of nearly two dozen other men who said they had also been molested by Dr. Ayres, but whose cases had exceeded the statute of limitations. At a hearing on Friday, the prosecutor, Melissa R. McKowan, called the charges “a gross violation of trust.”
     Dr. Ayres appeared in court in an orange jumpsuit but did not speak. Vincent O’Malley, a defense lawyer, called the charges unfounded and successfully argued for a lower bail of $250,000, from $1.5 million. “They’re crazy,” Mr. O’Malley said. “He’s an innocent man.” Dr. Ayres is in poor health, Mr. O’Malley added.
     A onetime president of the American Academy of Child and Adolescent Psychiatry, Dr. Ayres is a well-respected member of the community in San Mateo, a suburb about 20 miles south of San Francisco. In 2002, the San Mateo County Board of Supervisors honored Dr. Ayres for his work with abused and neglected children; the juvenile justice system regularly referred patients to him.
     Capt. Mike Callagy, a spokesman for the San Mateo Police Department, said the criminal investigation began in 2002 after a man said he had been repeatedly sexually abused by Dr. Ayres in the late 1970s. That investigation, however, was abandoned after a Supreme Court decision, Stogner v. California, limited the amount of time that prosecutors have to pursue criminal charges in old sexual abuse cases. The man, who was unidentified, then filed a civil suit, which was settled out of court in 2005. The police said that suit, however, had led to more former patients contacting the police about later incidents involving Dr. Ayres, including the three whose accusations are the basis of Thursday’s charges. The Medical Board of California said it had no disciplinary actions on file about Dr. Ayres. The San Mateo Police Department said it investigated an abuse claim by a former patient in 1987, but determined it to unfounded.
     The police also received claims of abuse dating to the late 1960s, when Dr. Ayres was a writer and narrator of “Time of Your Life,” a sex education series locally broadcast on public television. The series, aimed at fourth through sixth graders, was criticized at the time by some parents as being too explicit and undermining parental authority. In a 1969 interview with The New York Times, Dr. Ayres defended the program. “For many years, kids have been coming into my office knowing some of ‘the facts of life,’ but with many facts left out,” he said. “They wind up being bewildered, with a great many concerns and anxieties from their lack of knowledge.”
     During a 2004 deposition for the civil suit, Dr. Ayres denied molesting anyone but said that he would occasionally conduct physical examinations of his young patients if they complained of pain, explaining that psychiatrists are, by definition, doctors. Such examinations, he said, also put young patients more at ease to talk. “I say, ‘Well, you know, your stomach feels fine,’ ” Dr. Ayres said, adding that by “paying attention to it, they frequently then will talk about what they’re miserable about.” An arraignment is set for Wednesday. A message left at a number listed for Dr. Ayres in San Mateo brought no response. Each charge carries a sentence of up to eight years if convicted.

Psychoactive Herb Raising Concerns
Damian Guevara, Newhouse News Service- 4/8/2007

A Mexican plant with the power to send smokers on a psychedelic ride has appeared on the radar of police and prosecutors, some of whom say it should be banned. Lawmakers in Louisiana, Missouri,, Tennessee, Oklahoma and Delaware already have outlawed Salvia divinorum, a perennial herb in the mint family that is related to common garden sage.
     Salvia divinorum and its extracts are not controlled substances in the United States, but the Federal Drug Agency lists the herb as a "drug of concern." A Ohio's Lorain County Drug Task Force raised conerns in February about the drug's availability after agents found the herb for sale at a cellular phone store in Lorain. Police came upon the plant while cracking down on counterfeit name-brand shoes, jeans, shirts and other clothing, task force head Capt. Dennis Cavanaugh said. The one-, two- and three-gram packages were for sale in plain view.
     Although police could not confiscate the packages, agents have been tracking the herb's availability and purchased some to turn it over to a lab for testing, Cavanaugh said. Police rarely come across the drug, but the state's Bureau of Criminal Investigation and Identification recently put out an alert because of the polant's hallucinogenic properties, which Cavanaugh called disconcerting. "It's something we feel should be outlawed," Cavanaugh said. "It should not be available to kids."
     Medicine - men with the Mazatec Indian tribe of the Sierra Madre mountains in Oaxaca, Mexico, have historically used Salvia divinorum in divination rituals and healing. Since the advent of the Internet in the mid-1990s, the plant's reputation as a psychoactive drug has spread beyond Oaxaca state. Leaves and extracts can be found for sale online. Some shops that peddle counterculture products, including exotic glass smoking pipes, carry packaged Salvia divinorum.
     A one-gram package sold under the name Holy Smoke could be had for $25 at a Lorrain Avenue pager and pipe store in Cleveland. Users describe a psychedelic trip when the dried leaves are smoked or chewed. Those who share their Salvia divinorum experiences on the Internet describe distorted perception of light, space and time with varying intensity. The plant and its active property, salvinorin A, have been the focus of intense scientific research in recent years. Salvinorin A's unusual interaction with brain receptors could assist in the development of medicines for mood disorders, said Dr. John Mieyal, professor and vice chairman of pharmacology at Case Western Reserve University. Salvinorin A's qualities also could one day lead to development of a nonaddictive painkiller, said Thomas E. Prisinzano, an assistant professor of medicinal and natural products chemistry at the University of Iowa.
     Salvia divinorum made national news last year after a Delaware mother blamed the suicide of her son on his constant use of the drug. Some' studies of salvinorin A show it causes depression in rats, but no study shows a correlation between use and depression in humans, Prisinzano said. The Mazartee Indians who have used it for generations do not exhibit signs of addiction, Prisinzano said.
The debate over the scientific merits of a plant versus the potential for abuse and economic exploitation takes place any time medicines are discovered from the folk use of plants, Mieyal said.
"It's an energetic barrier between the U.S. Food and Drug Administration law enforcement and the scientific community. This will always exist and we need to find the appropriate balance," he said
At least seven others states have bills in place that could lead to bans.
     Lorain County Prosecutor Dennis Will said Ohio prosecutors recently raised the issue of criminalizing the plant after concerns about its growing use in the Cincinnati area. It's likely Lorain drug agents found the packaged Salvia in cell phone stores because that type of shop caters to youth culture, Will said.

Smith hopes to make that truth widely known. When people read about “inner voices,” they may think of those commanding a disturbed patient to commit a violent act. But auditory hallucination is common. In one survey, 39 percent of healthy volunteers said they had heard their own thoughts aloud. Another survey found that 13 percent of widows and widowers heard their lost spouse’s voice. In surveys of healthy people, 3 percent or more report a history of vivid auditory hallucination; most do not think the experience calls for treatment.

With the advent of scanners that can track brain activity, neuroscience has taken a new interest in hallucinations. A recent study shows that schizophrenic patients who hear voices activate a language-related region in the right brain when reading, while people who do not hear voices use the left. The researchers suggest that because the “wrong” side of the brain helps process words, hallucinators may generate inner speech that is not attributed to the self. This conclusion is speculative, but the study shows the sort of findings researchers expect — glitches in the biology of producing and interpreting language. Other investigators have had some success treating these hallucinations by applying magnetic fields to specific parts of the brain.

Smith begins his exploration of the neurobiology of hearing with a clever description of what happens, from the vocal chords of the speaker to the neural networks of the hearer, when a wife tells her husband, “I want a divorce.” Smith concludes that hallucinated speech might implicate a range of brain areas controlling such functions as perception, emotion and attention. To try to understand what it’s like to experience auditory hallucination, he dons a headset that plays tapes simulating inner voices and later tests out a “sensory deprivation” flotation chamber. (Neither method succeeds.) He also attends an annual meeting of the Hearing Voices Network, a British organization within a broader movement advocating “liberation, not cure” for psychotic and well-adjusted hallucinators alike.

But Smith’s strongest interest is in hallucination as inspiration. He provides a fascinating account. Generations of religious figures have understood voices as divine. Muhammad heard the Archangel Gabriel order: “Recite!” St. Augustine and John Bunyan (of “The Pilgrim’s Progress”) turned to Scripture at the urging of voices. But with the advent of modernity, inspiration moved away from the aural. In the 16th century, Teresa of Ãvila received divine “locutions” that arrived without sound and argued that nuns with more vivid visitations might be best understood as suffering from mental illness — a position Smith suggests was a way of heading off the Inquisitors.

After St. Teresa, poets either celebrated the loss of “aurality” as a triumph of Christ over the oracles or mourned a loss of direct inspiration. Smith traces the debate, from Milton to Blake to A. E. Housman. Does the muse still speak? Smith tracks down one “automatic writer,” a poet named Sarah Arvio, but she denies that the “voices” she speaks of are auditory hallucinations.

Ultimately, Smith remains agnostic about whether voices convey special wisdom, though he makes a case for taking a nonjudgmental posture toward those who hear them. The association of voice-hearing with religious inspiration cuts two ways. Smith cites the anthropologist Tanya Luhrmann, who found that sensory hallucinations buttressed the faith of a group of evangelical Christians she interviewed, half of whom heard voices. But a doubter might argue that historically religion has benefited from the impulse to assign value to inexplicable phenomena — experiences now better seen through the lens of science. Smith sets (but does not explore) a provocative challenge: Had antipsychotic medication been available, would Moses have dismissed Yahweh’s demands at the burning bush “as his dopamine system playing tricks on him?”

Issues of faith complicate the question impossibly. Presumably a deity who wants to communicate will use convincing means. If the bush is consumed, if the hallucination is treatable, Moses may be right to ignore the sign. Besides, Smith has argued convincingly that we don’t know how biblical experience corresponds to voice-hearing today.

Perhaps we would do better to substitute a future-oriented thought experiment. Imagine that years hence a person hears a voice that can be traced to a misfiring brain circuit that is easily reregulated by the application of a magnet. Will that message have special standing, above the same idea arrived at in more ordinary fashion? Individuals might answer the question differently, just as Smith’s tortured father and his more accepting grandfather responded to voice-hearing in different ways. But it seems likely that a society with such medical capacities would move further down the trail blazed by St. Teresa, toward neurological and away from mystical understandings of the voices in our heads.

The researchers studied 293 patients with bipolar disease at 15 medical centers nationwide. They randomly assigned one group of 163 people to one of three kinds of psychotherapy (cognitive behavioral therapy, interpersonal and social rhythm therapy, or family therapy) consisting of up to 30 50-minute sessions over nine months.

A second group of 130 patients was assigned to “collaborative care,” three sessions over six weeks designed to offer a brief version of the most common psychological and behavioral strategies shown to be beneficial in bipolar illness. The participants, whose average age was 40, were followed for one year, and all were also being treated with mood-stabilizing medicines.

Cognitive behavioral therapy focuses on challenging and controlling negative thoughts. In interpersonal and social rhythm therapy, patients concentrate on stabilizing daily routines and resolving interpersonal problems. Family therapy engages family members to help solve problems related to the illness, like failing to take medication properly, and to reduce the number of negative family interactions.

Therapists at each of the 15 medical centers received brief training in the therapies they administered.

“The study included real-world patients experiencing the early phases of a depressive episode,” said David J. Miklowitz, the study’s lead author and a professor of psychology and psychiatry at the University of Colorado. “And the therapists who delivered the treatment were trained by experts in the field with low-intensity training, which is typical of what’s available in real-life practice.”

Recovery rates after one year were a combined average of 64 percent for the intensive therapy groups, but only 52 percent for those who had brief therapy. In any given month, the researchers calculated, a patient undergoing longer-term therapy was more than one and a half times as likely to be well as one who had short-term treatment. Family therapy was slightly more effective than interpersonal or cognitive behavioral therapy, but the differences among the types of intensive treatment were not statistically significant.

“This is a monumental study,” said Myrna M. Weissman, a professor of psychiatry at Columbia who was not involved in the work. “There are no pharmaceutical companies willing to pay for research in psychotherapy, so we don’t have many clinical trials.” But, she added: “Psychosocial treatment for bipolar illness is not an alternative to medication. It’s a supplement.”

The authors, one of whom has received grant support and consulting fees from several pharmaceutical companies, found that the median time to recovery for the patients in long-term therapy was 169 days, compared with 279 days for those who received the brief treatment.

The cost of long-term therapy is high, and insurance companies are reluctant to cover it. But according to Dr. Weissman, the cost of not covering it could be higher. “It isn’t just the cost of the therapy. It’s the long-term cost. Bipolar illness has devastating effects on families as well as on the patients themselves.”


Alzheimer's 'Fingerprint' May Aid Diagnosis
Amanda Vogt, Chicago Tribune- 4/9/2007

Until recently, in order to make a definitive diagnosis of Alzheimer's disease, the patient had to be dead. But the recent discovery of a biological fingerprint for the neurodegenerative disease has made postmortem diagnosis a thing of the past. Early diagnosis opens the possibility of earlier intervention to preserve memory.

Cornell researchers have discovered 23 protein markers in cerebrospinal fluid that provide a comprehensive diagnostic tool for Alzheimer's. Although currently in the research phase, doctors believe this "fingerprint" will lead to development of a blood or urine test capable of diagnosing a little understood disease that afflicts some 4.5 million Americans.

To date, the disease has been diagnosed based on a patient's age, behavior, symptoms and by PET scans of the brain revealing the plaques and tangles typical of Alzheimer's, according to Dr. Norman Relkin, associate professor of clinical neurology and neuroscience at Weill Cornell Medical College. In the past, researchers were able to identify individual protein markers shared by Alzheimer's patients, but single markers have proved poor predictors of the disease, Relkin said.

"The sum is greater than the parts. If you take away one or two markers, the accuracy of predicting the disease goes down," Relkin said. He and Dr. Kelvin Lee, associate professor of chemical and biomolecular engineering at Cornell University, are responsible for isolating the Alzheimer proteins.

"Ten years ago most doctors believed Alzheimer's could not be diagnosed," Relkin said. "Today we're moving closer to an objective method of identifying Alzheimer's" before its devastating effects are irreversible. In addition, a biomarker-based test will be far more affordable and accessible than the current PET scan diagnostic tool, which is still not definitive, he said.

The current research trend will soon make it possible to screen patients at risk for the disease like physicians do for diabetes and cholesterol, said Maria Carrillo, director of medical and scientific relations for the Alzheimer's Association. "Early identification of the disease, before patients begin to experience symptoms, particularly memory loss, is really important. We hope we will soon be able to develop drugs that slow down the progression of the disease before it's too late to bring back those memories. Once they're gone, they're gone."