Noteworthy News Articles on Mental Health Topics, May 12-25, 2007

Still, Sergeant Padilla, 28, could not ward off memories of the people he had killed with a machine gun perched on his Bradley fighting vehicle. On April 1, according to the authorities and friends, he withdrew to the shadows of his Colorado Springs home, pressed the muzzle of his Glock pistol to his temple and squeezed the trigger.

Sergeant Padilla had been diagnosed with post-traumatic stress disorder at Fort Carson Army base here, where concerns over the treatment of returning soldiers struggling with the condition, compelled members of Congress last month to ask the Government Accountability Office to reassess the military’s mental health policies.

A letter signed by nine senators refers to “a number of upsetting allegations” at the base regarding a lack of treatment for soldiers with post-traumatic stress disorder and the stigmatization of those with the condition. On Monday, some of those senators’ staff members will visit Fort Carson to meet with soldiers, families and commanders, the fourth time this year Congressional staff members have traveled to the base.

The Army, reeling from fallout over its poor handling of outpatient soldiers at Walter Reed Army Medical Center, dispatched Brig. Gen. Michael S. Tucker to Colorado to speak with the base’s leaders and soldiers on Tuesday.

General Tucker, the deputy commander of Walter Reed, commended Fort Carson for its treatment of post-traumatic stress and said he viewed the Congressional visits as a means of highlighting the base’s programs that deal with the condition, said an Army spokesman, Paul Boyce.

But Veterans for America, an advocacy group that has lobbied the Army and Congress on behalf of returning soldiers, said the Army must do better, particularly at Fort Carson, where soldiers with the stress disorder have spoken of being punished by their commanders.

The base has 17,500 soldiers assigned to it, and about 26,000 of its soldiers have been deployed to Iraq since the war began.

“Fort Carson is overwhelmed with men and women coming home from Iraq with psychological injuries from war, and there are unit commanders here who don’t understand these medical conditions,” said Steve Robinson, director of veterans affairs for the group.

Col. John Cho, the base’s chief medical officer, said Fort Carson had treated 1,703 soldiers for post-traumatic stress disorder, or P.T.S.D., since 2003. Colonel Cho disputed the assertion that problems at Fort Carson were widespread. “We’re never going to fully eliminate the stigma associated with P.T.S.D., but the leadership at Carson has been fully supportive of getting soldiers they help they need,” he said.

The Army reports seven suicides of active duty soldiers at Fort Carson since 2004 but says it does not know if any were linked to the disorder. Sergeant Padilla was not included among the seven because he died after being discharged.

Most recently, Staff Sgt. Mark Alan Waltz, who was being treated for post-traumatic stress, was found dead in his living room on April 30. An autopsy of Sergeant Waltz, 40, is pending, but his wife, Renea, believes her husband died from a reaction to the antidepressants he was taking for stress and painkillers prescribed for a back injury. Ms. Waltz is also convinced that the psychological wounds he carried from battle played a part in his death.

Ms. Waltz said her husband was reluctant to seek treatment after returning from Iraq in 2004 because he thought a diagnosis of post-traumatic stress disorder would cost him his rank. She said the condition was eventually diagnosed and he was referred for treatment. Even then, she said, he was “picked out, scrutinized and messed with continually” by his commanding officers.

“It’s not right that our guys are going over to Iraq, doing their job, doing what they’re supposed to do, and they when they come back sick, they’re treated like garbage,” Ms. Waltz said.

Army officials at Fort Carson said Sergeant Waltz’s death was still under review and, citing privacy laws, would not comment further.

Mr. Robinson, of Veterans for America, said the group’s research indicated that since 2004, there had been at least six incidents in which Fort Carson soldiers with stress disorder have died, either from suicide or from accidents involving narcotics or medications.

In addition, the veterans group is investigating some 30 cases of Fort Carson soldiers with post-traumatic stress disorder, traumatic brain injury or personality disorders who have complained of mistreatment.

One case involves Specialist Alex Lotero, who returned from Iraq late last year suffering from anxiety attacks and nightmares after dozens of combat missions, including one in which his convoy was struck by a roadside bomb.

Specialist Lotero, a thick-muscled 20-year-old from Miami, said his superiors treated his diagnosis disdainfully, showering him with obscenities and accusing him of insubordination when he missed training for doctors’ appointments.

“They belittled my condition,” he said. “They told me I was broke, that I didn’t have anything left.”

Specialist Lotero eventually checked himself into nearby Cedar Springs Hospital for a few days and is waiting for his medical discharge request to be processed. He points to his forearm, draped in a tattoo of a machine-gun wielding, Vietnam-era soldier. The soldier’s face is ghoulish, his body gaunt and rotting. “This is how I feel right now,” he said.

In an interview, Maj. Gen. Gale S. Pollock, the acting Army surgeon general, said Fort Carson had taken “the bull by the horns” in combating the stigma associated with post-traumatic stress disorder.

General Pollock said the Army was developing initiatives to lessen that stigma and cited examples of officers publicly seeking treatment for combat stress as a means of encouraging their soldiers to follow suit.

“We have to reinforce it again and again,” she said. “I talk with patients, and many of them have looked at me through cheerful eyes and said, ‘You mean I’m not crazy?’ ”

Lt. Col. Laurel Anderson, a psychiatric nurse in charge of behavioral health at Fort Carson’s soldier readiness center, said the number of soldiers referred for mental health screenings had risen from about 12 percent of those seen at the center to 25 percent over the past year.

Colonel Anderson said soldiers sometimes refused her referrals to psychiatrists. “They don’t want anyone to know,” she said.

This year, Colonel Anderson began training officers to de-stigmatize post-traumatic stress disorder within their units. Another training session, this one for noncommissioned officers, is scheduled for Monday.

The Army is also considering sending a unit to Fort Carson and other bases to help soldiers navigate the administrative tangle of medical treatment. But Sergeant Padilla’s death showed that even when a soldier feels comfortable enough to seek treatment, that may not be enough.

Friends and family say Sergeant Padilla complained that antidepressants and painkillers were no substitute for talking with someone who understood what it was like to kill.

“He told me that the doctors weren’t helping him,” said his mother, Carmen Sierra, in a telephone interview from her home in Puerto Rico. “He told me that they couldn’t understand him, that he was still having those nightmares.”

A few months ago, Sergeant Padilla told his girlfriend, Mia Sagahon, that maybe it was time he start speaking with a doctor again. He never did.

They had lived in this muddy town of 6,000 people, a hub at the center of scores of much smaller and more remote native villages in the Yukon-Kuskokwim Delta of southwest Alaska. Their parents taught them to hunt for geese and seals and to fish for pike and herring and salmon. They taught them to speak their native Yupik and to cut wood for steam baths each night, even as one son played electric guitar and the family surfed the Internet.

“Sit,” said Evon Waska, the father, directing two visitors to a freshly finished wooden bench in his living room. Mr. Waska had placed it like a pew before a makeshift memorial of cards and photographs of the dead. “Sit with us.”

“When I was heartbroken,” he said, “I put my sorrow into making that bench.”

In grieving for the older son, William George Kinzy, 34, who died on March 8, and his half-brother, Evon David Waska Jr., 20, who shot himself on April 15, Mr. Waska and his wife, Dora, are suffering a cruel concentration of the kind of loss that so many others in communities like theirs confront.

“Rural Alaska has some of the highest rates in the world for suicide,” said Ron Perkins, who came to Alaska three decades ago to work for the federal government’s health program for Native Alaskans and now is executive director of the Alaska Injury Prevention Center, a nonprofit organization. “I remember talking once to an elder in a village outside Kotzebue. He said, ‘I was 20 years old before I first heard of a suicide, and then it was a white man in Kotzebue.’ Now, if a native kid is 10 and hasn’t heard of a suicide, it’s rare.”

The suicide rate among Native Alaskans was three times that of nonnative Alaska residents and five times the national rate from 2003 to 2006, according to a study Mr. Perkins helped conduct.

Contrasts are also striking in the ages of those committing suicide. Nationwide, people 80 and over and those in their 40s are most likely to kill themselves. Among Alaska natives, the 20-to-29 age group had the most suicides, 39 percent of the total, while that age group ranked seventh nationwide.

Natives ages 10 to 19 make up just 20 percent of the state population in that age group, but accounted for 61 percent of its suicides.

The suicide rates for natives declined somewhat in 2005 and 2006, but Mr. Perkins said it was too soon to know whether that reflected a pattern. Roughly 80 percent of all Alaska suicide victims are male.

Suicide among natives is commonly linked with depression and mental illness, which often goes untreated in rural areas, as well as with alcoholism and cultural and economic stress. Many native families are reluctant to discuss suicide, adding to the challenge, Mr. Perkins said.

Native death rates over all are about 50 percent higher than for nonnatives, according to data compiled by the Institute of Social and Economic Research at the University of Alaska Anchorage. Natives are increasingly moving to urban areas from rural villages and native families are increasingly led by a single parent. Women are more likely than men to move to cities to find work.

“They’ve lost their culture, they don’t have a way to support their family, and then what we see is a lot of alcohol and drug use, particularly alcohol,” said Diane Casto, the section manager for prevention and early intervention for the state’s division of behavioral health. “There’s such a feeling of hopelessness, particularly for young men.”

Christian missionaries, followed by government bureaucracy and modern technology, have long since transformed villages on the tundra into places where seal meat is hung out to dry in the shadow of steeples, public schools and satellite dishes. Many natives still hunt and fish for staples even as the outside culture promotes materialism. Experts say young people often have frayed connections to the old ways but poor preparation for living in a modern world.

“How do you move out, how do you move on?” said Yvonne Kinegak, an intake supervisor for the Bethel branch of the state’s Office of Children’s Services. “We see healthier people when they’re more connected to their culture.”

Bonnie Bradbury, who teaches Sunday school at United Pentecostal Church in Bethel, where her husband is the pastor, said that deaths among natives, many of whom in the delta are Russian Orthodox, are repeatedly memorialized through feasts at various anniversaries. Evon David Waska Jr. killed himself as his family was preparing for a feast on the 40th day after his half-brother died.

“They think, well, if they don’t think much of me now, maybe they will when I’m dead,” Ms. Bradbury said, echoing a common view.

Mr. Perkins, who conducted the suicide study, acknowledged that perception but said he knew of no way to confirm it. Misperceptions about native suicides are common, he said, including the belief that more people kill themselves during the dark Alaskan winters.

“We found that suicides occurred all during the year,” he said, noting that December, one of the darkest months, had one of the lowest suicide rates.

Alcohol or drugs were a factor in nearly three-fourths of the suicides among natives, the same as for nonnatives. And while about two-thirds of all suicides were from gunshot wounds, natives were twice as likely to hang themselves as were nonnatives, even though gun ownership is high among natives.

Mr. Perkins said that efforts were being made to help people maintain their connection to native culture and language, but that some groups less likely to speak their native language, like the Aleuts, had relatively low suicide rates.

“They’re past that cultural transition,” he said.

Researchers Examine Crystal Meth Effects
Associated Press, 5/15/2007

HONOLULU -- University of Hawaii researchers are looking into the brains of crystal methamphetamine users to find out the consequences of drug use on newborns, children, adults and former users. The researchers will explore the chemistry, physiology and structure of drug users' brains through the magnetic resonance imagining system at Queen's Medical Center.

''It really affects their ability to function,'' said Dr. Linda Chang, a university researcher and co-director of the Neuroscience and Imagine Research Program at Queen's Medical Center.

The researchers have received about $15 million from the National Institutes of Health, and they expect another $15 million in other grants.

Scientists already know that crystal meth, also called ice, causes swelling, inflammation and less organized nerve fibers. Studies have also shown that children of women who used ice during pregnancy had a smaller brain structure.

The new study for which participants are being recruited will focus on how drugs change the brain during different stages of life.

While abnormalities in the brains of crystal meth users improve with treatment, adults still suffer consequences even after they stop abusing the drug, said Chang, who will work with psychiatry professors Helenna Nakama and Daniel Alicata on the research.

''We see loss of nerve cells in the brain, inflammation and addictive elements. It takes a long time for the brain to heal, at least a year or two before we see improvement,'' she said.

The research will also evaluate symptoms of ice users in treatment.

''There seems to be a strong relationship between depression and cravings for drugs,'' Chang said.

Other planned studies will look at 75 adolescents who used meth or are still using it, and 75 teens who do not use drugs. Another analysis will evaluate children ages 3 or 4 who were exposed to ice before birth.

Nationwide, the health and social costs of drug abuse and mental illness are ''almost unfathomable,'' said Dr. Mark Mitchell, chief executive officer of the Kahi Mohala psychiatric hospital.

Between 28 percent and 30 percent of the population has a mental illness or an addictive disorder, he said.

''We are experiencing significantly greater proportions of people with co-occurring disorders,'' he said.

Suspended Sentence for Woman Pretending to Be Psychologist
John Ellement & Andrew Ryan, Boston Globe- 5/15/2007

Louise Wightman stood yesterday and spoke in a calm voice just moments after cold torrents of anger were directed at her by a former patient and the parents of patients she treated while professing, falsely, to be a licensed psychologist.

"I am sorry for any harm I've done," Wightman said. "I really am. I know what pain is and I wouldn't want to cause anybody pain. I'm really sorry."

Despite pleas from victims that she be imprisoned, Suffolk Superior Court Judge Nancy Staffier Holtz instead imposed a six-month sentence, suspended for five years, for her convictions on May 4 of larceny, filing false healthcare claims, and posing as a psychologist.

The judge said she was swayed by the emotional testimony of the victims who appeared in court yesterday, but she said she also was influenced by more than 60 letters written on Wightman's behalf by "people from all walks of life," includ ing former patients.

Speaking from the bench, the judge also stressed that Wightman's trial and sentence had drawn heavy media coverage "because of what she did in a former life."

Wightman was known professionally as Princess Cheyenne when she worked as a stripper in Boston's Combat Zone in the 1970s and 1980s.

But the judge said the 47-year-old woman's exotic dancing career was not a factor in the criminal case.

Assistant Attorney General David Andrews, who prosecuted the case, had asked Staffier Holtz to send Wightman to prison for 2 1/2 years, saying she preyed on parents and children who sought what they thought was professional help from a licensed psychologist, who operated on the South Shore from 1998 to 2005.

But her lawyer, Katie Cook Rayburn, argued that the death last May 16 of Wightman's teenage daughter in a car crash and the loss of her business that has led to the foreclosure of her Hull home is punishment enough. She also said that Wightman admits she may have harmed some patients, but helped many more.

In court, some of those victims took the stand and delivered victim impact statements, including Kenneth Maydoney, Sr., who said he brought his depressed daughter to Wightman, spent $2,000 in fees, and broke off contact quickly enough so his daughter got the professional help she needed.

"Louise Wightman delayed my daughter's recovery for her own financial gain," said Maydoney, who asked that Wightman serve nine years in prison.

Joyce Rossi said her daughter sought treatment for an eating disorder from Wightman, but ended up worse off because Wightman did not know what she was doing.

"It's unconscionable to take a shortcut in the practice of medicine," Rossi said. "She crossed all the boundaries, moral, professional and ethical."

Wightman practiced psychology when she treated young people for eating disorders and other issues in clinics in Hingham and Norwell. During trial, she testified that she never purported to be a licensed psychologist when she treated hundreds of patients, many under 18, at a practice called South Shore Psychology Associates.

Massachusetts law requires psychologists to have a doctoral degree in psychology from a program recognized by the state and to be licensed with the state Division of Professional Licensure.

Wightman acknowledged, however, that she advertised as having a doctorate in psychology, despite withdrawing from the Massachusetts School of Professional Psychology after completing five years of course work without earning a degree.

Wightman, who has a master's degree in counseling psychology from Lesley University, told the jury she dropped out of the doctoral program when a dean, whom she did not identify, confronted her about her career as a stripper. She said she got a diploma over the Internet.

Infants' Mental Health Studied
Lindsey Tanner, Associated Press- 5/15/2007

"We used to say it was like it burned his eyes to look at you," said his mother, Tamie Day of Antelope, Calif. "It was like a physically painful thing for him. It wasn't just that he wasn't looking at us; he was purposefully looking away."

Day suspected her son might have autism. She enrolled him in a study, published in April, that found that babies like Jacob are indeed at high risk for autism if they do not respond to their names by 12 months of age.

At 18 months, he was formally diagnosed with autism, about a year earlier than usual. Before he turned 2, Jacob began daily intensive behavior treatment designed to help him lead a more normal life.

He is part of a growing field in psychiatry called infant mental health. Doctors and scientists are increasingly looking for early signs in babies of autism, attention deficit disorder and other mental problems that just a generation ago, scarcely anyone thought could appear in children so young.

Some scientists even believe that intensive treatment in some susceptible babies can actually prevent autism, attention deficit disorder and other problems.

An influential Institute of Medicine report in 2000 helped energize this idea. The report emphasized the plasticity of babies' brains. It also explained how interacting with babies can change their brain wiring.

"We used to say `nature vs. nurture,' but now people really think it's `nature through nurture,'" said the University of Chicago's Dr. Lawrence Gray.

In April, researchers from the federal Centers for Disease Control and Prevention and the Interdisciplinary Council on Developmental and Learning Disorders presented a report emphasizing earlier diagnosis and treatment.

The report said that about 17 percent of U.S. children have a developmental disability such as autism, mental retardation and attention deficit-hyperactivity disorder, but that fewer than half are diagnosed before starting school.

The authors say warning signs include failure to:

focus on sights and sounds by 2 months.

initiate joyful behavior with parents by 4 months.

exchange smiles and sounds with parents by 8 to 9 months.

take a parent's hand to find a toy and point to objects by 12 to 16 months.

Last year, the American Academy of Pediatrics recommended that pediatricians routinely evaluate children for developmental problems such as autism starting in infancy, and begin testing at 9 months, rather than wait until young child "misses a major milestone such as walking or talking."

The largest U.S. study of childhood autism found earlier this year that about 1 in 152 have the disorder, with the highest rate -- 1 in 94 children -- found in New Jersey.

Madeleine Goldfarb, a Livingston mother of a 13-year-old autistic son, said a crisis looms as children with autism approach adulthood without specialized services and with aging parents. A recent study found less than 13 percent of people with autism in New Jersey attend day programs and 89 percent live at home.

''We are woefully, woefully unprepared,'' Goldfarb said, lobbying senators to support creating a task force on adult autism.

Autism is a complex disorder usually not diagnosed in children until after age 3. It's characterized by a range of behaviors, including difficulty in expressing needs and an inability to socialize. Its cause is unknown.

The bills would establish a statewide autism registry, restructure a state research and treatment council, train teachers in autism awareness, instruct physicians in early detection, create the task force on adult autism and provide more money for research and treatment.

The proposals, pushed by Assembly Speaker Joseph Roberts Jr., D-Camden, were approved in March by the Assembly. The approval by the Senate health committee on Monday means they can now be considered by the full Senate.

''With our increased understanding of the spectrum of autism disorders comes the increased responsibility of providing a support system for families and individuals living with autism in the Garden State,'' said bill sponsor Sen. Loretta Weinberg, D-Bergen.

She said the task force on adult autism will focus on job training and placement, housing and long-term care.

''While New Jersey has done a lot to help children with autism, many times the support dries up when those children transition into adulthood,'' Weinberg said. ''In some of the most severe cases of autism, individuals need structured support for their entire lives.''

This Is Your Life (and How You Tell It)
Benedict Carey, New York Times- 5/22/2007

For more than a century, researchers have been trying to work out the raw ingredients that account for personality, the sweetness and neuroses that make Anna Anna, the sluggishness and sensitivity that make Andrew Andrew. They have largely ignored the first-person explanation — the life story that people themselves tell about who they are, and why.

Stories are stories, after all. The attractive stranger at the airport bar hears one version, the parole officer another, and the P.T.A. board gets something entirely different. Moreover, the tone, the lessons, even the facts in a life story can all shift in the changing light of a person’s mood, its major notes turning minor, its depths appearing shallow.

Yet in the past decade or so a handful of psychologists have argued that the quicksilver elements of personal narrative belong in any three-dimensional picture of personality. And a burst of new findings are now helping them make the case. Generous, civic-minded adults from diverse backgrounds tell life stories with very similar and telling features, studies find; so likewise do people who have overcome mental distress through psychotherapy.

Every American may be working on a screenplay, but we are also continually updating a treatment of our own life — and the way in which we visualize each scene not only shapes how we think about ourselves, but how we behave, new studies find. By better understanding how life stories are built, this work suggests, people may be able to alter their own narrative, in small ways and perhaps large ones.

“When we first started studying life stories, people thought it was just idle curiosity — stories, isn’t that cool?” said Dan P. McAdams, a professor of psychology at Northwestern and author of the 2006 book, “The Redemptive Self.” “Well, we find that these narratives guide behavior in every moment, and frame not only how we see the past but how we see ourselves in the future.”

Researchers have found that the human brain has a natural affinity for narrative construction. People tend to remember facts more accurately if they encounter them in a story rather than in a list, studies find; and they rate legal arguments as more convincing when built into narrative tales rather than on legal precedent.

YouTube routines notwithstanding, most people do not begin to see themselves in the midst of a tale with a beginning, middle and eventual end until they are teenagers. “Younger kids see themselves in terms of broad, stable traits: ‘I like baseball but not soccer,’ ” said Kate McLean, a psychologist at the University of Toronto in Mississauga. “This meaning-making capability — to talk about growth, to explain what something says about who I am — develops across adolescence.”

Psychologists know what life stories look like when they are fully hatched, at least for some Americans. Over the years, Dr. McAdams and others have interviewed hundreds of men and women, most in their 30s and older.

During a standard life-story interview, people describe phases of their lives as if they were outlining chapters, from the sandlot years through adolescence and middle age. They also describe several crucial scenes in detail, including high points (the graduation speech, complete with verbal drum roll); low points (the college nervous breakdown, complete with the list of witnesses); and turning points. The entire two-hour session is recorded and transcribed.

In analyzing the texts, the researchers found strong correlations between the content of people’s current lives and the stories they tell. Those with mood problems have many good memories, but these scenes are usually tainted by some dark detail. The pride of college graduation is spoiled when a friend makes a cutting remark. The wedding party was wonderful until the best man collapsed from drink. A note of disappointment seems to close each narrative phrase.

By contrast, so-called generative adults — those who score highly on tests measuring civic-mindedness, and who are likely to be energetic and involved — tend to see many of the events in their life in the reverse order, as linked by themes of redemption. They flunked sixth grade but met a wonderful counselor and made honor roll in seventh. They were laid low by divorce, only to meet a wonderful new partner. Often, too, they say they felt singled out from very early in life — protected, even as others nearby suffered.

In broad outline, the researchers report, such tales express distinctly American cultural narratives, of emancipation or atonement, of Horatio Alger advancement, of epiphany and second chances. Depending on the person, the story itself might be nuanced or simplistic, powerfully dramatic or cloyingly pious. But the point is that the narrative themes are, as much as any other trait, driving factors in people’s behavior, the researchers say.

“We find that when it comes to the big choices people make — should I marry this person? should I take this job? should I move across the country? — they draw on these stories implicitly, whether they know they are working from them or not,” Dr. McAdams said.

Any life story is by definition a retrospective reconstruction, at least in part an outgrowth of native temperament. Yet the research so far suggests that people’s life stories are neither rigid nor wildly variable, but rather change gradually over time, in close tandem with meaningful life events.

Jonathan Adler, a researcher at Northwestern, has found that people’s accounts of their experiences in psychotherapy provide clues about the nature of their recovery. In a recent study presented at the annual meeting of the Society for Personality and Social Psychology in January, Mr. Adler reported on 180 adults from the Chicago area who had recently completed a course of talk therapy. They sought treatment for things like depression, anxiety, marital problems and fear of flying, and spent months to years in therapy.

At some level, talk therapy has always been an exercise in replaying and reinterpreting each person’s unique life story. Yet Mr. Adler found that in fact those former patients who scored highest on measures of well-being — who had recovered, by standard measures — told very similar tales about their experiences.

They described their problem, whether depression or an eating disorder, as coming on suddenly, as if out of nowhere. They characterized their difficulty as if it were an outside enemy, often giving it a name (the black dog, the walk of shame). And eventually they conquered it.

“The story is one of victorious battle: ‘I ended therapy because I could overcome this on my own,’ ” Mr. Adler said. Those in the study who scored lower on measures of psychological well-being were more likely to see their moods and behavior problems as a part of their own character, rather than as a villain to be defeated. To them, therapy was part of a continuing adaptation, not a decisive battle.

The findings suggest that psychotherapy, when it is effective, gives people who are feeling helpless a sense of their own power, in effect altering their life story even as they work to disarm their own demons, Mr. Adler said.

Mental resilience relies in part on exactly this kind of autobiographical storytelling, moment to moment, when navigating life’s stings and sorrows. To better understand how stories are built in real time, researchers have recently studied how people recall vivid scenes from recent memory. They find that one important factor is the perspective people take when they revisit the scene — whether in the first person, or in the third person, as if they were watching themselves in a movie.

In a 2005 study reported in the journal Psychological Science, researchers at Columbia University measured how student participants reacted to a bad memory, whether an argument or failed exam, when it was recalled in the third person. They tested levels of conscious and unconscious hostility after the recollections, using both standard questionnaires and students’ essays. The investigators found that the third-person scenes were significantly less upsetting, compared with bad memories recalled in the first person.

“What our experiment showed is that this shift in perspective, having this distance from yourself, allows you to relive the experience and focus on why you’re feeling upset,” instead of being immersed in it, said Ethan Kross, the study’s lead author. The emotional content of the memory is still felt, he said, but its sting is blunted as the brain frames its meaning, as it builds the story.

Taken together, these findings suggest a kind of give and take between life stories and individual memories, between the larger screenplay and the individual scenes. The way people replay and recast memories, day by day, deepens and reshapes their larger life story. And as it evolves, that larger story in turn colors the interpretation of the scenes.

Nic Weststrate, 23, a student living in Toronto, said he was able to reinterpret many of his most painful memories with more compassion after having come out as a gay man. He was very hard on himself, for instance, when at age 20 he misjudged a relationship with a friend who turned out to be straight.

He now sees the end of that relationship as both a painful lesson and part of a larger narrative. “I really had no meaningful story for my life then,” he said, “and I think if I had been open about being gay I might not have put myself in that position, and he probably wouldn’t have either.”

After coming out, he said: “I saw that there were other possibilities. I would be presenting myself openly to a gay audience, and just having a coherent story about who I am made a big difference. It affects how you see the past, but it also really affects your future.”

Psychologists have shown just how interpretations of memories can alter future behavior. In an experiment published in 2005, researchers had college students who described themselves as socially awkward in high school recall one of their most embarrassing moments. Half of the students reimagined the humiliation in the first person, and the other half pictured it in the third person.

Two clear differences emerged. Those who replayed the scene in the third person rated themselves as having changed significantly since high school — much more so than the first-person group did. The third-person perspective allowed people to reflect on the meaning of their social miscues, the authors suggest, and thus to perceive more psychological growth.

And their behavior changed, too. After completing the psychological questionnaires, each study participant spent time in a waiting room with another student, someone the research subject thought was taking part in the study. In fact the person was working for the research team, and secretly recorded the conversation between the pair, if any. This double agent had no idea which study participants had just relived a high school horror, and which had viewed theirs as a movie scene.

The recordings showed that members of the third-person group were much more sociable than the others. “They were more likely to initiate a conversation, after having perceived themselves as more changed,” said Lisa Libby, the lead author and a psychologist at Ohio State University. She added, “We think that feeling you have changed frees you up to behave as if you have; you think, ‘Wow, I’ve really made some progress’ and it gives you some real momentum.”

Dr. Libby and others have found that projecting future actions in the third person may also affect what people later do, as well. In another study, students who pictured themselves voting for president in the 2004 election, from a third-person perspective, were more likely to actually go to the polls than those imagining themselves casting votes in the first person.

The implications of these results for self-improvement, whether sticking to a diet or finishing a degree or a novel, are still unknown. Likewise, experts say, it is unclear whether such scene-making is more functional for some people, and some memories, than for others. And no one yet knows how fundamental personality factors, like neuroticism or extraversion, shape the content of life stories or their component scenes.

But the new research is giving narrative psychologists something they did not have before: a coherent story to tell. Seeing oneself as acting in a movie or a play is not merely fantasy or indulgence; it is fundamental to how people work out who it is they are, and may become.

“The idea that whoever appeared onstage would play not me but a character was central to imagining how to make the narrative: I would need to see myself from outside,” the writer Joan Didion has said of “The Year of Magical Thinking,” her autobiographical play about mourning the death of her husband and her daughter. “I would need to locate the dissonance between the person I thought I was and the person other people saw.”

Idaho Rampage Opens Mental Health Debate
Associated Press, 5/22/2007

MOSCOW, Idaho -- As the bullet-pocked Latah County Courthouse reopened Tuesday following a shooting rampage that left four people dead, authorities defended their response to the shooter's cryptic warning that he wanted to kill lots of people.

Jason Hamilton had recently told a mental health professional he would take a large number of people with him if he were to commit suicide. This weekend, he killed his wife, a deputy and a church sexton before taking his own life.

His comment -- later recanted -- may have raised a red flag but was not specific enough to allow authorities to have him involuntarily committed to a mental hospital in Idaho and many other states, police and mental health professionals say.

''Any time you live in a society where people have freedoms, it's very difficult to restrict their movements,'' said Sheriff Wayne Rausch, whose communications office and patrol cars were riddled with bullet holes. ''It's very difficult to take specific actions against them unless they actually break the law.''

Most mental health treatment in Idaho is voluntary.

''We can't make someone receive treatment,'' said Tom Shanahan, a state Health and Welfare spokesman. ''Unless a court commits a person to our care, treatment is voluntary.''

But others want involuntary commitment laws changed. Hamilton had been evaluated for involuntary confinement, but a judge had not yet made the final decision that he was dangerous enough to send him to a mental hospital.

Hamilton's statement that he would take people with him, while not naming a specific individual, ''nevertheless is an expression of danger to other people,'' Jonathan Stanley, assistant director of the Treatment Advocacy Center in Arlington, Va.

He predicted that more tragedies like the one in Moscow last weekend will happen until improvements are made in involuntary commitment laws to make it easier to get people quickly into mental health treatment programs.

''As tragic as this is for the families, this is just the tip of the iceberg,'' he said.

Because privacy laws prohibit disclosure of mental health records, circumstances surrounding Hamilton's journey through Idaho's mental health system, or whether mental illness was diagnosed, remained vague.

What is clear is that Hamilton, 36, who had a history of violence, was placed in protective custody on a court-ordered 72-hour mental health hold after a failed suicide attempt in February, said David Duke, Moscow assistant police chief.

Hamilton had received two mental health evaluations and had appeared in a Latah County courtroom May 15, but was released on the condition that he get mental health counseling and not possess any weapons, Duke said. A judge continued the hearing for a month, a common practice, to allow Hamilton to seek counseling in nearby Pullman, Wash.

Moscow Police Chief Daniel Weaver said the recent shootings of a University of Idaho student and at Virginia Tech show how difficult it is to know when a mentally ill person could become violent.

''To blame professionals for that is in error,'' he said. ''Unfortunately, we have some folks that turn to the dark side and do things that are abhorrent to us and illegal and harm society.''

For Drug Makers, a Downside to Full Disclosure
Barry Meier, New York Times- 5/23/2007

State of New York over the antidepressant medication Paxil, the company agreed to take an unusual step: publicly disclosing the results of its clinical trials for Paxil and other drugs.

The company, which was criticized at the time for failing to publicize all pediatric trials of Paxil, not just the positive ones, made good on its promise. The first posting on a new Web site was about 65 studies involving its popular diabetes drug, Avandia.

This week, GlaxoSmithKline learned what that greater disclosure could mean.

A cardiologist at the Cleveland Clinic, Dr. Steven Nissen, stumbled onto the Glaxo Web site while researching Avandia last April. He and a colleague quickly analyzed the data, and on Monday, The New England Journal of Medicine released its finding that Avandia posed a heightened cardiac risk.

“It was a treasure trove,” Dr. Nissen said about the Web site.

GlaxoSmithKline has disputed the journal’s interpretation. Officials with the Food and Drug Administration said they were reviewing whether to take any action on Avandia.

Whatever the drug’s fate, the episode is likely to fuel efforts by some medical experts, including Dr. Nissen, to persuade lawmakers to require makers of drugs and medical devices to disclose study results publicly. Currently, producers are not required to do so, but Congress is considering legislating a requirement.

Many companies besides GlaxoSmithKline already post results from some studies or trials on their Web sites, or one operated by the Pharmaceutical Research and Manufacturers Association, a trade group in Washington.

Dr. Bruce M. Psaty, a cardiologist at the University of Washington, said that having such information can play a critical role, as the case of Avandia suggests, in spotting signals of a drug’s possible dangers.

Other experts have argued that the relative efficacy or cost of competing drugs can be compared only when all study results, rather simply those that a company chooses to publicize, are available.

Studies have found that the vast majority of drug and medical device studies are never published in medical journals.

“The more information, the better,” Dr. Psaty said.

Dr. Ronald L. Krall, chief medical officer for Glaxo, said his company sharply disputed the methodology of Dr. Nissen’s study, and a top F.D.A. official said that the agency had previously informed doctors about Avandia’s heart risks.

Dr. Krall said his company was aware when it created its database of study results a few years ago that it might lead to controversy. Other scientists might look at its data or choose to analyze it differently than company officials did, he said.

“We are committed to the principle of transparency,” Dr. Krall added. “But we knew that when starting this, by putting the data in the public, many things could happen, some of which could be trouble.”

Some experts also believe that releasing the results of hundreds of studies involving drugs or medical devices might create confusion and anxiety for patients who are typically not well prepared to understand the studies or to put them in context.

“I would be very concerned about wholesale posting of thousands of clinical trials leading to mass confusion,” said Dr. Steven Galson, the director for the Center for Drug Evaluation and Research at the F.D.A.

Roughly a decade ago, some experts raised concerns that doctors were not getting the full picture about a drug’s risks and benefits because they tended to hear or read about only those trials in which the medication showed a benefit.

Companies and researchers typically did not seek publication of studies that showed that a drug had little benefit or might even cause harm. In some cases, trials that were started and stopped before completion were not disclosed.

As a result, outside researchers could not learn what trials of a drug had been performed so they could put findings in context or compare studies of competing drugs.

That issue caught the public’s attention after it was disclosed that Glaxo had not publicized trials of Paxil in children in which the drug showed little, if any, benefit. The company was subsequently sued by Eliot Spitzer, who was then the attorney general and who is now the governor of New York. The drug maker, as part of the lawsuit’s settlement, created a public Web site for trial results. Glaxo was by no means the only drug company that came under scrutiny. In late 2004, a group of leading medical journals, including The New England Journal of Medicine, said that they would no longer publish articles about study results unless producers publicly registered the tests on Web sites like ClinicalTrials.gov, which is run by the National Library of Medicine.

As a result, the number of drug trials registered on that site has sharply increased, said Dr. Deborah Zarin, its director. (Currently, drug manufacturers are required to register trials of new drugs for serious or life-threatening conditions).

But even before the recent Avandia episode, advocates for greater study transparency like Dr. Nissen were pushing lawmakers to take the next step by requiring that producers of drugs and makers of devices not only register trials but also publicly disclose study findings.

“It is critical, but this raises the question of how many other drug safety issues are out there,” Dr. Nissen said. Recently, the Senate passed an F.D.A.-related bill that would set up a process for developing a mechanism that experts expect would result in a government-run database where companies and others would post the results of clinical trials. The House is currently considering a bill that has somewhat different provisions.

Dr. Alan Goldhammer, a senior executive at the Pharmaceutical Research and Manufacturers Association, said the organization supported the disclosure provision in the Senate bill that had passed.

He said the group, however, was concerned that some states may be trying to get ahead of the federal government on the issue; for instance, Maine recently passed a bill that mandates the release of study findings.

“We want to make sure it is done in a reasonable way,” Dr. Goldhammer said.

Recently, a report issued by the Institute of Medicine, a part of the National Academy of Sciences, recommended that the F.D.A. release all summaries of study data it had collected in the process of approving new drugs as well as all post-marketing studies of those products.

The F.D.A. rejected the first recommendation as overly burdensome and Dr. Galson, the director of the F.D.A.’s drug evaluation and research, said that the agency already released much of this information. “It is not that we are philosophically opposed to it, but the work would be enormous,” he said.

Even those supporting mandatory results disclosure acknowledge that finding uniform ways to disclose complex scientific information would prove difficult and time-consuming. For example, Dr. Zarin of ClinicalTrials.gov said that reviewing a study’s results to make sure that it was free of any biases interjected by researchers involved in a study or by its sponsor was a major undertaking.

Then, there is also the question of who the audience for such information should be — scientists, consumers or both?

Dr. Zarin said that there had been significant discussion among experts over the last year about that issue. Most have agreed that data is best understood by experts, a view that might not prove popular with patients.

Dr. Krall of Glaxo agreed, saying the drug maker had considered providing summaries of its studies for patients, but then dropped the efforts after deciding it would require making subjective decisions about trial results.

“There is not a uniform view about how to interpret results,” he said. “It is quite problematic to go that next step.”

“There are so many of them,” said Mr. Kim, secretary general of the Korea Association for Suicide Prevention, a private counseling group working to decrease the number of suicides, which nearly doubled from 6,440 in 2000 to 12,047 in 2005, the last year for which government figures are available.

One of the recent Internet suicide pacts involved two women who died of carbon monoxide poisoning in a one-room apartment south of Seoul.

In another, five young men and women who made a pact over the Internet and had failed in two previous suicide attempts drove to a seaside motel to discuss more effective methods. There, one member of the group had a change of heart and slipped out to call the police.

Figures released by the Organization for Economic Cooperation and Development show that South Korea’s suicide rate stood at 18.7 per 100,000 people in 2002 — up from 10.2 in 1985. In 2002, Japan’s rate was the same as South Korea’s, but the rate in the United States was 10.2 per 100,000.

Experts attribute the increase to the stresses of rapid modernization and the degradation of rural life, but they are also concerned that the Internet is contributing to the jump. South Korea has one of the world’s highest rates of broadband access and, as in Japan in recent years, the Internet has become a lethally efficient means of bringing together people with suicide on their minds.

In hardly more than a generation, South Korea has transformed itself from an agrarian society into an extremely competitive, technologically advanced economy where the pressure to succeed at school and work is intense.

Meanwhile, the traditional support base, the family, is under pressure: divorce rates are at a record high. And guarantees of lifetime employment evaporated with the Asian financial crisis in the 1990s.

In 2005, in the first rally of its kind, hundreds of high school students demonstrated in central Seoul, shouting, “We aren’t study machines!” They gathered to mourn 15 students from around the country who had killed themselves, apparently because of the intense pressure to succeed.

The government does not compile figures on how many suicides may have been inspired or aided by the Internet. But in an analysis of 191 group suicides reported in the news media from June 1998 to May 2006, Kim Jung-jin, a sociologist at Korea Nazarene University, found that nearly a third of the cases involved people who had formed suicide pacts through Internet chat sites.

In Korea, the Internet has been implicated not only for helping people get together to die, but also for widely sharing individuals’ suicidal thoughts.

One well-known actress, Jeong Da-bin, 27, posted her thoughts on her Web site a day before killing herself on Feb. 10.

Under the title “The End,” she wrote: “For no reason at all, I am going crazy with anger. Then, as if lightening had struck, all becomes quiet.

“Then the Lord comes to me. The Lord says I will be O.K. YES, I WILL BE O.K.”

Counseling centers in Seoul said calls for help jumped in the days after her death.

Notes like Ms. Jeong’s — or ones that call for help in dying — are not difficult to find on Internet bulletin boards in Korea.

“I really want to kill myself,” said a Yahoo Korea Web posting in April by an anonymous teenager who complained of bullying at school and his parents’ pressure to improve his grades. “I only have 30,000 won,” or about $32, he wrote, adding: “Can anyone sell me a suicide drug? I don’t want a painful death like jumping from a high place.”

In March a 28-year-old man who ran a suicide-related blog called “Trip to Heaven” was arrested on a charge of selling potassium cyanide to a 15-year-old boy he met via the Internet. The boy used the poison to kill himself.

Since 2005, Web portals, acting under pressure from civic groups, have banned words like suicide and death from the names of blogs. If a user keys in “suicide,” search engines display links to counseling centers at the top of their search results.

Also in 2005, the Korea Internet Safety Commission, a government watchdog on cyberspace, ordered the removal of 566 blogs, chat groups and Web postings that encouraged suicide, up sharply from 93 cases a year earlier. The figure declined to 147 in 2006 and rose again to 161 in the first four months of this year.

The government is taking or discussing other measures to impede suicide as well. Since nearly 40 percent of South Koreans who kill themselves do so by drinking pesticides or jumping, the government is considering making pesticides less toxic and is installing more barriers on rooftops and bridges.

The Seoul subway system began erecting glass walls on platforms after 95 people, some wearing black plastic bags over their heads, threw themselves in front of subway trains in 2003, according to transit officials. Doors in the glass wall open only when trains pull into the station.

Kim Hee-joo’s counseling group discovers an average of 100 suicide-related Web sites each month and asks portals to delete them. A few are serious enough that the staff alerts the police to possible violations of laws against assisting suicide or trading in hazardous substances.

“People used to use blog names like ‘Let’s Die Together,’ ” said Mr. Kim. “Now they’re more careful. Once they’ve met each other they shut down the site and switch to e-mail and cellphones. You need a lot of searching and hunches and luck to track down these people.”

Recently Mr. Kim’s team discovered a blog called “Life Is Tough,” described by its creator as a meeting place for people contemplating suicide. The site attracted several people who left their cellphone numbers and e-mail addresses to link up with others who wanted to “take the trip together.”

The police are now searching for the blog’s creator, who could face charges of aiding suicide, a crime punishable by up to 10 years in prison on conviction.

“People are social animals,” said Jason Lee, director of the Metropolitan Mental Health Center in Seoul. “Some apparently want a companion even when committing suicide.”

Study: Cut Nicotine in Cigarettes
Associated Press, 5/24/2007

WASHINGTON -- The Food and Drug Administration should regulate tobacco and develop a plan to reduce nicotine levels in cigarettes, the Institute of Medicine urged Thursday.

Its report calls on Congress and the president to give FDA the authority to enforce standards for nicotine reduction and to regulate companies' claims that their products reduce exposure or risk.

''We propose aggressive steps to end the tobacco problem -- that is, to reduce tobacco use so substantially that it is no longer a significant public health problem. This report offers a blueprint for putting the nation on a course for achieving that goal over the next two decades,'' said Richard J. Bonnie, director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia School of Law. Bonnie was chairman of the committee that prepared the report.

''Unfortunately, cigarettes are one of the most dangerous consumer products ever marketed,'' Bonnie said at a briefing.

The report notes that cigarettes are unique in that they contain carcinogens and other dangerous toxins and would be banned under federal law if these statutes did not expressly exempt tobacco.

A bill currently before Congress would give FDA authority to regulate tobacco, but the head of the agency has expressed skepticism.

Dr. Andrew von Eschenbach said that if the FDA reduced nicotine levels in cigarettes, people would change their smoking habits to maintain current levels of the addictive drug.

''We could find ourselves in the conundrum of having made a decision about nicotine only to have made the public health radically worse. And that is not the position FDA is in; we approve products that enhance health, not destroy it,'' von Eschenbach said in an AP interview in March.

Cigarette maker Philip Morris USA has been supporting the legislation that would give FDA power to regulate the industry.

''FDA regulation creates a uniform set of federal standards for the manufacture and marketing of all tobacco products,'' Michael E. Szymanczyk, chairman and chief executive officer of Philip Morris USA, said earlier this year.

In addition to requiring a cut in nicotine the institute -- a branch of the National Academy of Sciences -- called for higher taxes on tobacco, nationwide indoor smoking bans and other steps to reduce smoking.

Also on Thursday, the American Academy of Pediatrics called for the elimination of smoking from movies accessible to children and young people.

Cigarette smoking is largely a 20th century development, the report noted. Prior to that Americans consumed tobacco primarily as chewing tobacco or cigars.

In 1900 adults smoked approximately 54 cigarettes per year, the report said. By 1963 per capita consumption had risen to 4,345 cigarettes per year.

The report said that while smoking in the United States has declined by more than 50 percent since 1964, tobacco use still claims about 440,000 lives every year and secondhand smoke causes another 50,000 deaths annually. Smoking-related health costs are estimated to be $89 billion a year.

Other recommendations of the report include:

-- Dedicating $15 to $20 per capita annually of the proceeds from higher taxes or other resources to fund tobacco control efforts in each state.

-- Requiring all health insurance plans to provide smoking cessation program benefits.

-- Licensing retail outlets that sell tobacco products.

-- Launching additional efforts aimed at curbing youth interest in smoking and access to tobacco, including bans on online sales of tobacco products and direct-to-consumer shipments.

-- Limiting tobacco advertising and promotional displays to text-only, black-and-white formats.

-- Requiring new, large pictorial warnings on the harmful effects of smoking -- similar to those required in Canada -- on all cigarette packs and cartons.

The National Academy of Sciences is an independent organization chartered by Congress to advise the government on scientific matters. The report was sponsored by the American Legacy Foundation, the anti-smoking organization established in 1999 as part of the settlement between state attorneys general and the tobacco industry.

On the Net:
Institute of Medicine: http://www.iom.edu
American Legacy Foundation: http://www.americanlegacy.org

Va. House to Review Psychiatric Care Gaps
Tim Craig & Chris Jenkins, Washington Post- 5/25/2007

RICHMOND, -- The Virginia House of Delegates will hold hearings this summer to consider solutions to problems in the mental health system exposed after Seung Hui Cho's shooting rampage atVirginia Tech.

The hearings in the Health, Welfare and Institutions Committee are the first step in what lawmakers say will be a flurry of potential legislative reforms to the mental health system after Cho killed 32 students and faculty members and then himself April 16.

Del. Phillip A. Hamilton (R-Newport News), the committee's chairman, said legislators want to review state funding of mental health services and the laws governing privacy, emergency custody orders and involuntary and voluntary commitments. The committee also plans to hear from private providers of mental health services and solicit suggestions from the public.

"We have to get a plan to make sure the system and processes don't break down again, so similar circumstances don't occur," Hamilton said.

He said the hearings, the first of which will be held June 18, will lay the groundwork for what could be a contentious debate in the General Assembly next year on mental health treatment and funding.

Although he has commissioned a separate investigation, Gov. Timothy M. Kaine (D) said Thursday he welcomes the legislative review.

"We are working toward the same goal," said Delacey Skinner, Kaine's communications director. "We all want to make sure we address any flaws or loopholes in the system that need to be addressed."

Cho's case underscores some of those flaws, officials have said. He was referred to the New River Valley Community Services Board in 2005 after Virginia Tech police said he had harassed two female students.

The board, the government mental health agency that serves Blacksburg, determined that Cho was "mentally ill and in need of hospitalization," according to court papers.

A day later, on Dec. 14, 2005, Paul M. Barnett, a special judge hearing Cho's case, decided that Cho was an imminent danger to himself as a result of mental illness and ordered him into involuntary outpatient treatment.

But three law enforcement sources familiar with Cho's medical records have said that Cho never received treatment. There was no follow-up from the community services board or the courts.

State law says that community services boards are responsible for setting up a treatment plan for mentally ill people released into the community for outpatient care. But Les Saltzberg, executive director of the New River Valley Community Services Board, said his agency did not create a treatment plan for Cho because the special justice did not tell the board of his order.
Saltzberg, who took over at New River last year, said a board representative used to be present for commitment hearings to help with treatment plans, but a lack of funding and resources stopped the practice several years ago.

Joe Painter, who said he presided over 15,000 mental health commitment hearings while serving as a special justice in Blacksburg from 1989 to 2000, dismissed as "naive" Saltzberg's contention that the board didn't know about Cho.

"The law requires them to set up the specific course of treatment," Painter said. "I want to know when and why they unlearned the law."

At a meeting today, Saltzberg said he and Barnett will seek to improve communication between the court and the agency.

"We're going to work with the special justice to figure out what the best way is to do this," Saltzberg said in an interview Thursday. "Based on our mutual cooperation, we'll figure out a way to make sure that nobody gets lost."

Hamilton said the legislative hearings will focus heavily on the role of community services boards.

But because the committee doesn't have subpoena power, Hamilton said it won't delve too deeply into the case of Cho, whose records are protected under privacy laws.

He said he will leave specific questions about Cho to the eight-member Tech Review Panel, which Kaine created to study the shooting and the state's response.

That review has been hampered by state and federal privacy laws that prevent Virginia Tech and providers of mental health services from releasing Cho's medical and academic records.

Cho's parents, as the executors of his estate, might be able to authorize the release of some records, but officials say they are out of the country.

Retired State Police superintendent W. Gerald Massengill, chairman of the review panel, said the committee might have to seek a court order to get the information.

"We will do whatever we have to do to get those records, and if that means a court order, subpoena, whatever, then certainly we have to look at that," Massengill said.

Massengill said panel members are debating how far into Cho's past they need to go to get a better understanding of his illness.

"At the very least, we have to know what happened since his issues were identified at Virginia Tech in 2005," Massengill said.

"I would think to really get at these root causes, we may want to go back much farther than that."