Noteworthy News Articles on Mental Health Topics, July 16-26, 2007 Britain's General Medical Council is examining claims that Dr. Andrew Wakefield failed to disclose his links to autism litigators and conducted the study without proper ethical approval. Wakefield denies any misconduct. Wakefield's study suggested that the combined measles-mumps-rubella (MMR) vaccine, which is administered throughout the world, could put children at risk of autism or bowel disease. The finding published in The Lancet medical journal in 1998, and the subsequent media coverage, led many parents to refuse to vaccinate their children. But the study was soon discredited, and 10 of its 13 authors have since renounced its conclusions. The Lancet also said it should not have published the study, saying Wakefield's links to litigation against the manufacturers of the MMR vaccine were a ''fatal conflict of interest.'' In addition to Wakefield, two other authors of the paper -- John Walker-Smith and Simon Murch -- are being investigated by the medical council. Numerous studies have concluded that there is no link between the MMR vaccine and autism or bowel disease. Wakefield suggested that vaccines be administered separately. The vast majority of the medical establishment supports the combined vaccine's use. ''It is one of the safest, best-studied vaccines,'' said Dr. Philip Minor, head of virology at Britain's National Institutes of Biological Standards and Control. Doctors warn that the MMR controversy has led many parents to underestimate the dangers of the diseases. Last April, for the first time in more than a decade, a 13-year-old boy died from measles in Britain. Wakefield stands accused of conducting operations on children -- including colonoscopies and lumbar punctures -- which were arguably unnecessary, of coordinating his research with lawyers for autism patients, and of taking blood from a group children at his son's birthday party -- paying them 5 pounds each for their contributions and later joking about the incident. The council said Wakefield could be barred from practicing in Britain if the allegations are proven. The hearings are expected to last through October. The number of measles cases surged as the proportion of vaccinated children in Britain fell below 80 percent, leading researchers to warn that the disease -- once all but wiped out -- could become endemic in Britain. Mounting concern over the disease even prompted the intervention by then Prime Minister Tony Blair, who lead a campaign to reassure concerned parents. Vaccination rates have since rebounded, but not to a level sufficient to protect the entire population from the diseases. Before Monday's hearing, parents gathered to show their support for Wakefield, holding signs, clapping and cheering as he walked in. The doctor and his wife posed for pictures while a few parents chanted: ''There's only one Andrew Wakefield,'' One shouted: ''It's a witch hunt.''
Chronic Fatigue No Longer Seen as ‘Yuppie Flu’
But the syndrome is now finally gaining some official respect. The Centers for Disease Control and Prevention, which in 1999 acknowledged that it had diverted millions of dollars allocated by Congress for chronic fatigue syndrome research to other programs, has released studies that linked the condition to genetic mutations and abnormalities in gene expression involved in key physiological processes. The centers have also sponsored a $6 million public awareness campaign about the illness. And last month, the C.D.C. released survey data suggesting that the prevalence of the syndrome is far higher than previously thought, although these findings have stirred controversy among patients and scientists. Some scientists and many patients remain highly critical of the C.D.C.’s record on chronic fatigue syndrome, or C.F.S. But nearly everyone now agrees that the syndrome is real. “People with C.F.S. are as sick and as functionally impaired as someone with AIDS, with breast cancer, with chronic obstructive pulmonary disease,” said Dr. William Reeves, the lead expert on the illness at the C.D.C., who helped expose the centers’ misuse of chronic fatigue financing. Chronic fatigue syndrome was first identified as a distinct entity in the 1980s. (A virtually identical illness had been identified in Britain three decades earlier and called myalgic encephalomyelitis.) The illness causes overwhelming fatigue, sleep disorders and other severe symptoms and afflicts more women than men. No consistent biomarkers have been identified and no treatments have been approved for addressing the underlying causes, although some medications provide symptomatic relief. Patients say the word “fatigue” does not begin to describe their condition. Donna Flowers of Los Gatos, Calif., a physical therapist and former professional figure skater, said the profound exhaustion was unlike anything she had ever experienced. “I slept for 12 to 14 hours a day but still felt sleep-deprived,” said Ms. Flowers, 51, who fell ill several years ago after a bout of mononucleosis. “I had what we call ‘brain fog.’ I couldn’t think straight, and I could barely read. I couldn’t get the energy to go out of the door. I thought I was doomed. I wanted to die.” Studies have shown that people with the syndrome experience abnormalities in the central and autonomic nervous systems, the immune system, cognitive functions, the stress response pathways and other major biological functions. Researchers believe the illness will ultimately prove to have multiple causes, including genetic predisposition and exposure to microbial agents, toxins and other physical and emotional traumas. Studies have linked the onset of chronic fatigue syndrome with an acute bout of Lyme disease, Q fever, Ross River virus, parvovirus, mononucleosis and other infectious diseases. “It’s unlikely that this big cluster of people who fit the symptoms all have the same triggers,” said Kimberly McCleary, president of the Chronic Fatigue and Immune Dysfunction Syndrome Association of America, the advocacy group in charge of the C.D.C.-sponsored awareness campaign. “You’re looking not just at apples and oranges but pineapples, hot dogs and skateboards, too.” Under the most widely used case definition, a diagnosis of chronic fatigue syndrome requires six months of unexplained fatigue as well as four of eight other persistent symptoms: impaired memory and concentration, sore throat, tender lymph nodes, muscle pain, joint pain, headaches, disturbed sleeping patterns and post-exercise malaise. The broadness of the definition has led to varying estimates of the syndrome’s prevalence. Based on previous surveys, the C.D.C. has estimated that more than a million Americans have the illness. Last month, however, the disease control centers reported that a randomized telephone survey in Georgia, using a less restrictive methodology to identify cases, found that about 1 in 40 adults ages 18 to 59 met the diagnostic criteria — an estimate 6 to 10 times higher than previously reported rates. However, many patients and researchers fear that the expanded prevalence rate could complicate the search for consistent findings across patient cohorts. These critics say the new figures are greatly inflated and include many people who are likely to be suffering not from chronic fatigue syndrome but from psychiatric illnesses. “There are many, many conditions that are psychological in nature that share symptoms with this illness but do not share much of the underlying biology,” said John Herd, 55, a former medical illustrator and a C.F.S. patient for two decades. Researchers and patient advocates have faulted other aspects of the C.D.C.’s research. Dr. Jonathan Kerr, a microbiologist and chronic fatigue expert at St. George’s University of London, said the C.D.C.’s gene expression findings last year were “rather meaningless” because they were not confirmed through more advanced laboratory techniques. Kristin Loomis, executive director of the HHV-6 Foundation, a research advocacy group for a form of herpes virus that has been linked to C.F.S., said studying subsets of patients with similar profiles was more likely to generate useful findings than Dr. Reeves’s population-based approach. Dr. Reeves responded that understanding of the disease and of some newer research technologies is still in its infancy, so methodological disagreements were to be expected. He defended the population-based approach as necessary for obtaining a broad picture and replicable results. “To me, this is the usual scientific dialogue,” he said. Dr. Joseph Montoya, a Stanford infectious disease specialist pursuing the kind of research favored by Ms. Loomis, caused a buzz last December when he reported remarkable improvement in 9 out of 12 patients given a powerful antiviral medication, valganciclovir. Dr. Montoya has just begun a randomized controlled trial of the drug, which is approved for other uses. Dr. Montoya said some cases of the syndrome were caused when an acute infection set off a recurrence of latent infections of Epstein Barr virus and HHV-6, two pathogens that most people are exposed to in childhood. Ms. Flowers, the former figure skater, had high levels of antibodies to both viruses and was one of Dr. Montoya’s initial C.F.S. patients. Six months after starting treatment, Ms. Flowers said, she was able to go snowboarding and take yoga and ballet classes. “Now I pace myself, but I’m probably 75 percent of normal,” she said. Many patients point to another problem with chronic fatigue syndrome: the name itself, which they say trivializes their condition and has discouraged researchers, drug companies and government agencies from taking it seriously. Many patients prefer the older British term, myalgic encephalomyelitis, which means “muscle pain with inflammation of the brain and spinal chord,” or a more generic term, myalgic encephalopathy. “You can change people’s attributions of the seriousness of the illness if you have a more medical-sounding name,” said Dr. Leonard Jason, a professor of community psychology at DePaul University in Chicago.
Josh White, Washington Post- 7/18/2007 The Army plans to begin a program today to educate every soldier about traumatic brain injury and post-traumatic stress disorder. The rare effort to break the perceived stigma within the military on mental health problems comes as increasingly more troops return from battle with serious but undiagnosed conditions. Senior Army leaders are using a "chain-teaching" method to reach all U.S. soldiers, including more than 150,000 who are facing combat in Afghanistan, within 90 days. Such a technique extends down the chain of command, with commanders educating their subordinates until individual soldiers are taught by their platoon leaders. Lt. Gen. James L. Campbell, director of the Army staff, said yesterday that the impetus is a growing recognition that brain injuries and mental trauma are real problems that affect soldiers, their families and the general readiness of the Army. But many soldiers have been reluctant to seek help because of a perceived stigma, he said, and others have fallen through the system's cracks and have been overlooked. "We want to try to educate our soldiers and our leaders . . . to be able to recognize the symptoms and then to be aware of the treatment options that are available," Campbell said. "There is a huge culture issue here, and it is this: that those leaders or soldiers who seek help could be perceived as being weak. And the whole thrust behind this program is that if you are in fact someone who needs help, that your desire to get that help is not perceived as a weakness but rather as a strength, as a personal courage to do it." Much of the training centers on a 35-page guide that will be used to show videos and slide shows and to answer questions. The material covers how to notice symptoms of hard-to-detect mild brain injuries such as concussions, as well as the warning signs of post-traumatic stress disorder. Army officials hope that the training will increase the number of reported cases of such problems as soldiers become more comfortable seeking help for nightmares, flashbacks and emotional withdrawal. That, however, will probably stretch Army resources; the service is already short about 270 mental health providers nationwide. There are about 200 mental health experts on the battlefield who help care for soldiers facing the daily threats of makeshift bombs, sniper fire and injury to comrades. "A marker of our success is if we get an increased referral rate," said Col. Elspeth C. Ritchie, the top psychiatry consultant to the Army surgeon general. "It's going to be a strain, and we're working as hard as we can." The training materials include video clips of roadside bomb explosions and dramatic re-creations of situations involving soldiers after they return from combat. The goal is to let soldiers know that apparently routine situations in the war can lead to mental health concerns later. Army officials said yesterday that the video and training materials were created in-house, at no additional cost to taxpayers. The Army has also developed a separate video for soldiers' families and materials for young children, and officials plan to post all of the materials at http:/ Julian Sher & Benedict Carey, New York Times- 7/19/2007 Experts have often wondered what proportion of men who download explicit sexual images of children also molest them. A new government study of convicted Internet offenders suggests that the number may be startlingly high: 85 percent of the offenders said they had committed acts of sexual abuse against minors, from inappropriate touching to rape. The study, which has not yet been published, is stirring a vehement debate among psychologists, law enforcement officers and prison officials, who cannot agree on how the findings should be presented or interpreted. The research, carried out by psychologists at the Federal Bureau of Prisons, is the first in-depth survey of such online offenders’ sexual behavior done by prison therapists who were actively performing treatment. Its findings have circulated privately among experts, who say they could have enormous implications for public safety and law enforcement. Traffic in online child pornography has exploded in recent years, and the new study, some experts say, should be made public as soon as possible, to identify men who claim to be “just looking at pictures” but could, in fact, be predators. Yet others say that the results, while significant, risk tarring some men unfairly. The findings, based on offenders serving prison time who volunteered for the study, do not necessarily apply to the large and diverse group of adults who have at some point downloaded child pornography, and whose behavior is far too variable to be captured by a single survey. Adding to the controversy, the prison bureau in April ordered the paper withdrawn from a peer-reviewed academic journal where it had been accepted for publication, apparently concerned that the results might be misinterpreted. A spokeswoman for the bureau said the agency was reviewing a study of child pornography offenders but declined to comment further. Ernie Allen, who leads the National Center for Missing and Exploited Children, which is mandated to coordinate the nation’s efforts to combat child pornography, said he was surprised that the full study had not been released. “This is the kind of research the public needs to know about,” Mr. Allen said. Others agreed that the report should be published but were more cautious about the findings. “The results could have tremendous implications for community safety and for individual liberties,” said Dr. Fred Berlin, founder of the Johns Hopkins Sexual Disorders Clinic. “If people we thought were not dangerous are more so, then we need to know that and we should treat them that way. But if we’re wrong, then their liberties aren’t going to be fairly addressed.” Everyone agrees that researchers need to learn more about online consumers of illegal child images. The volume of material seized from computers appears to be doubling each year — the National Center collected more than eight million images of explicit child pornography in the last five years — and Attorney General Alberto R. Gonzales made child protection a national priority in 2006. Those who are arrested on charges of possession or distribution of child pornography generally receive lighter sentences and shorter parole periods than sexual abusers. They do not fit any criminal stereotype; recent arrests have included politicians, police officers, teachers and businessmen. “It’s crucial to understand the sexual history of all these offenders, because sometimes the crime they were arrested for is the tip of the iceberg, and does not reflect their real patterns and interests,” said Jill S. Levenson, an assistant professor of human services at Lynn University in Boca Raton, Fla., and head of the ethics committee of the Association for the Treatment of Sexual Abusers. Previous studies, based on surveys of criminal records, estimated that 30 percent to 40 percent of those arrested for possessing child pornography also had molested children. The psychologists who conducted the new study, Andres E. Hernandez and Michael L. Bourke, focused on 155 male inmates who had volunteered to be treated at the Federal Correctional Institution in Butner, N.C., according to a draft of the paper obtained by The New York Times from outside experts who want the study published. The Butner clinic is the only residential program devoted to the treatment of sexual offenders in the federal prison system. The inmates in the study were all serving sentences for possession or distribution of child pornography. About every six months as part of an 18-month treatment program, they filled out a record of their sexual history, including a “victims list” tallying their previous victims of abuse. Therapists encouraged the men to be honest as part of their treatment, and the sexual histories were anonymous, according to the paper. The psychologists compared these confessions with the men’s criminal sexual histories at the time of sentencing. More than 85 percent admitted to abusing at least one child, they found, compared with 26 percent who were known to have committed any “hands on” offenses at sentencing. The researchers also counted many more total victims: 1,777, a more than 20-fold increase from the 75 identified when the men were sentenced. Dr. Hernandez and Dr. Bourke concluded in the paper that “many Internet child pornography offenders may be undetected child molesters.” But they also cautioned that offenders who volunteer for treatment may differ in their behavior from those who do not seek treatment. They submitted the paper to The Journal of Family Violence, a widely read peer-reviewed publication in the field, and it was accepted. But in a letter obtained by The Times, dated April 3, Judi Garrett, an official of the Bureau of Prisons, requested that the editors of the journal withdraw the study, because it did not meet “agency approval.” Editors at The Journal of Family Violence did not respond to phone or e-mail messages asking about the withdrawal. Dr. Hernandez mentioned the research briefly during testimony before a Senate committee last year. But the bureau blocked Dr. Hernandez and Dr. Bourke from attending some law enforcement conferences to speak about the findings, said two prosecutors who did not want to be identified because they have a continuing work relationship with the bureau. “We believe it unwise to generalize from limited observations gained in treatment or in records review to the broader population of persons who engage in such behavior,” a bureau official wrote to the organizers of a recent law enforcement conference, in a letter dated May 2 and given to The Times by an expert who is hoping the study will be published. Some prosecutors say they could use the study to argue for stiffer sentences. While some outside researchers agreed that the risk of over-generalizing the study’s results was real, almost all the experts interviewed also said that the study should still be made public. Dr. Peter Collins, who leads the Forensic Psychiatry Unit of the Ontario Provincial Police, called the findings “cutting-edge stuff.” “We’re really on the cusp of learning more about these individuals and studies should be encouraged, not quashed,” Dr. Collins said. Understanding the relationship between looking at child pornography and sexually assaulting children is central to developing effective treatment, psychologists say. It is not at all clear when, or in whom, the viewing spurs action or activates a latent, unconscious desire; or whether such images have little or no effect on the offender’s subsequent behavior. But the relationship probably varies widely. “My concern is about sensationalism, about the way something like this is handled in the media,” said Michael Miner, an associate professor in the department of family medicine at the University of Minnesota who treats sex offenders. “The public perception is that all of these guys will re-offend, and we know that just isn’t true.” At least some men convicted of sexual abuse say that child pornography from the Internet fueled their urges. In a recent interview, one convicted pedophile serving a 14-year sentence in a Canadian federal prison said that looking at images online certainly gave him no release from his desires — exactly the opposite. “Because there is no way I can look at a picture of a child on a video screen and not get turned on by that and want to do something about it,” he said. “I knew that in my mind. I knew that in my heart. I didn’t want it to happen, but it was going to happen.” How many offenders does he speak for? The study may help answer that question, some say. “The penalties we seek, the vigor with which we prosecute — the very importance we give to child pornography cases — all of these things are affected by what we know about the offenders,” said Leura G. Canary, the United States attorney for Middle Alabama who also leads the Attorney General’s Working Group on Child Exploitation and Obscenity. “And right now we know very little.”
In announcing the unorthodox sentence, Judge James P. Jones of United States District Court indicated that he was troubled by his inability to send the executives to prison. But he noted that federal prosecutors had not produced evidence as part of recent plea deals to show that the officials were aware of wrongdoing at the drug’s maker, Purdue Pharma of Stamford, Conn. The sentences announced by Judge Jones came at the end of a lengthy and highly emotional hearing at a small brick courthouse in this town in far western Virginia. Parents of teenagers and young adults who died from overdoses while trying to get high from OxyContin arrived here from as far away as Florida, Massachusetts and California. Given the opportunity to speak, they both memorialized their lost children and lambasted Purdue Pharma and its executives, saying they bore a responsibility for those deaths. They also urged Judge Jones to throw out the plea agreements and send the executives to jail. “Our children were not drug addicts, they were typical teenagers,” said Teresa Ashcraft, who said that her son Robert died of an overdose at age 19. “We have been given a life sentence due to their lies and greed.” Another women held up a jar that she said contained the ashes of the dead son. OxyContin, which is a long-acting time-release form of the narcotic oxycodone, is used to treat serious pain. Several reports have suggested that Purdue may have helped fuel widespread abuse of the drug by aggressively promoting it to general practitioners not skilled in either pain treatment or in recognizing drug abuse. The company has denied such a connection. Among those who testified at the hearing were some patients who told about the pain relief they received from OxyContin. This bucolic town is not far from the spine of the Appalachian Mountains and Kentucky and Tennessee, where abuse of OxyContin exploded in early 2000, just a few years after it was first sold. Both addicts and young experimenters quickly discovered that a pill needed only to be chewed or crushed before ingesting to release large doses of oxycodone, which produced a heroinlike high. In May, a holding company affiliated with Purdue Pharma pleaded guilty to a felony charge that it had fraudulently claimed to doctors and patients that OxyContin would cause less abuse and addiction than competing short-acting narcotics like Percocet and Vicodin. The Food and Drug Administration had allowed the company to claim only that it “believed” that the drug, because it was long-acting, might be less prone to abuse. To settle that charge, Purdue Frederick, the holding company, agreed to pay $600 million in fines and other payments, and the executives agreed to pay $34.5 million in fines. In accepting that deal, Judge Jones put the company on five years’ probation. In a statement issued Friday, Purdue Pharma said that “Judge Jones’s acceptance of the settlement concludes this matter and we welcome its resolution.” That ruling, however, does not mean the end of legal problems for Purdue Pharma, which is owned by the Sackler family, known for its contributions to institutions like the Metropolitan Museum of Art in New York. A number of insurers had lawsuits against it seeking compensation for what they say were unnecessary prescriptions for OxyContin, a very expensive drug, that were written because of the company’s false marketing claims. Defense lawyers for the three executives involved — Michael Friedman, the company’s president until recently; Howard R. Udell, its top lawyer; and Dr. Paul D. Goldenheim, its former medical director — all urged Judge Jones not to put their clients on probation. The executives had pleaded guilty to misdemeanor charges of misbranding, a crime that does not require prosecutors to show that they knew about wrongdoing or intended to defraud anyone. And defense lawyers said their only crime was heading Purdue Pharma at time when others were committing crimes. They also described their clients in glowing terms. For example, Mary Jo White, a former United States attorney in New York who represented Mr. Udell, described the lawyer as the “moral compass” of Purdue Pharma. Had he known about wrongdoing, Ms. White said, he “would have done everything in his power to stop it.” Judge Jones appeared unmoved by such arguments. And while he said a lack of jail time was the “most difficult” part of accepting the plea agreements, he added that his hands were legally tied because prosecutors had not provided him with evidence on which to act. Still, he appeared to be sending out a message by placing the executives on three years of probation and ordering them to perform 400 hours of service in a drug abuse or drug treatment program. “As we have heard today, prescription drug abuse is rampant in all parts of this country,” Judge Jones said. At an earlier outdoor rally Friday attended by about 50 people, including many of those who would later testify at the hearing, there was ample testimony to that problem. Assembled around a bandstand where speakers stood to castigate Purdue Pharma as a “corporate drug pusher” were photographs of teenagers and young adults at parties, family trips or graduation ceremonies. The legend over one young man’s photograph read “One Pill Killed.”
Associated Press, 7/22/2007 MINNEAPOLIS -- Kelli Smith was nervous as she walked into the Philadelphia treatment center, seeking help at last for her anorexia. Looking around at the other patients, she was struck by how young they seemed. ''I just kind of looked around and I thought, 'Oh, where is someone my age?''' recalls Smith. At age 31, she found herself face-to-face with teenagers and 20-somethings. Eating disorders such as anorexia and bulimia have long been considered diseases of the young, but experts say in recent years more women have been seeking help in their 30s, 40s, 50s, and older. Some treatment centers are creating special programs for these more mature patients. Most of the women in this age group who seek treatment have had the problem for years, said Dr. Donald McAlpine, director of an eating disorders clinic at Mayo Clinic in Rochester, Minn. ''The epidemiology is pretty clear that anorexia and bulimia both peak in the late teens, early 20s,'' yet ''a lot of (patients) continue to be symptomatic right on through to middle life.'' People who study eating disorders suggest several reasons there might be more women over 30 seeking treatment for what is typically a young woman's problem: growing public awareness, social pressure to be thin and an aging group of baby boomers. National statistics on eating disorders are hard to come by, but data from some treatment centers suggest a steady increase. In the Minneapolis suburb of St. Louis Park, Park Nicollet Health Services' Eating Disorders Institute saw 43 patients ages 38 and older in 2003 -- about 9 percent of its total patients. For the first six months of this year, the institute has treated nearly 500 patients 38 and older, about 35 percent of its total. The Renfrew Center, a network of treatment centers in the eastern U.S., said about 20 percent of the 522 patients treated at its Philadelphia center in 2005 were 30 or older. In 2006, about 13 percent of the 600 patients were in that age group. ''Whatever this is -- if it's an increased awareness, if it's a response to being in midlife -- those numbers are staggering,'' said Carol Tappen, director of operations for the Eating Disorders Institute. Women over 30 who seek treatment tend to fall into three categories, said Holly Grishkat, who directs outpatient programs at Renfrew. Some have had an eating disorder for years. Others had a disorder in remission that resurfaced because of new stress in life, such as a divorce or loss of a parent. A third group, the smallest of the three, includes women who develop an eating disorder late in life. Of Renfrew's patients over age 30 in 2005, about 60 percent first suffered from an eating disorder at 18 or younger. Nearly 20 percent said they were 30 or older when they first encountered the problem. While body image is an issue for any age group, women over 30 are dealing with problems that teens don't have, such as work, divorce, stepchildren and aging parents. ''It's not about wanting to be the cheerleader or being the homecoming queen,'' said Tappen. ''It's much bigger than that.'' They also are dealing with an aging process, or childbirth, that changes the way they look. ''One day, (a woman) wakes up and the kids are gone and she has a sense that nobody really needs her. She looks in the mirror and she says, 'My body is shot,''' said Tappen. ''This woman says, 'You know, that's it. I'm going on a diet.''' Tappen said the aging of the huge baby boomer population may be one reason the Eating Disorders Institute has seen more older patients. Not only are there now more people in this group, but this population has traditionally been image-conscious, she said. ''Baby boomers have always cared about how they looked, what they wear,'' she said. ''I think a lot of eating disorders years ago went undiagnosed because it was the thing to do.'' The Eating Disorders Institute is building a new facility, set to open in 2009, that will offer a treatment track for mature patients. Grishkat, of The Renfrew Center, encourages older women to seek age-specific treatment programs. Some may be embarrassed to get help alongside very young women. Also, some older women may take on maternal roles for younger girls when they should be focusing on themselves, she said. ''It's not a lost cause at 30, 40, 50 years old,'' she said. ''You can still get better. In some sense, the older women do better in recovery than younger women. They tend to be more motivated.'' For Smith, motherhood was a motivator. When she entered treatment, she was told she might have internal damage that could affect her ability to have children. Now 39 and out of treatment, she and her husband are parents to a 2-year-old boy and live in New Jersey. She says she's in recovery, and her primary goal these days is to be healthy. ''There's no question I put on weight because I wanted to have a baby,'' she said. ''And I stay healthy right now for my baby.'' On the Net:
Tim Murphy, New York Times- 7/24/2007 For most of the 100 or so sleepy-eyed people boarding the U.S. Airways shuttle to Logan Airport in Boston from La Guardia in New York on a recent hazy Saturday morning, the 35-minute flight could not have been a bigger nonevent. But that was not the case for about 20 passengers clustered nervously near the gate. Many clutched puzzle books and bags of sour candy as though they held talismans. Some made nervous jokes, others sobbed quietly. “I have pills with me just in case of an emergency,” said a teenage girl who planned to distract herself on the flight with celebrity magazines. Mariasol Flouty, a 44-year-old software developer from White Plains, held fast to her Sudoku book. “I had plane-crash nightmares,” she confessed. “I woke up very tense.” No one was more terrified than Beth Brenner, a 45-year-old mother of two teenagers from Somers, N. Y. “I was hysterical last night,” she said, “but my son said, ‘You’re going to be O.K.’ ” Ms. Brenner was crying quietly on the shoulder of a counselor and staying close to her designated seatmate, Richard Bracken, a retired pilot who had flown for American Airlines for 30 years. “I’m trying to be a father figure here,” Mr. Bracken said. Several studies have found that up to 40 percent of people have some degree of anxiety about flying, said Dr. Lucas van Gerwen, an aviation psychologist and professional pilot in the Netherlands and an organizer of an international fear-of-flying conference, sponsored by the International Civil Aviation Organization, that took place in early June in Montreal. According to the National Institute of Mental Health, the percentage of Americans who have a fear of flying so intense that it qualifies as a phobia or anxiety disorder and keeps them off airplanes is closer to 6.5 percent. Those most paralyzed by their flying fear — called aviophobia — sometimes turn to programs like the one at Westchester County Airport in New York, run for 10 years by the Anxiety and Phobia Treatment Center at White Plains Hospital. The program culminates with the graduation flight to Logan from La Guardia. “We have people who haven’t flown for 5, 10, 15 years,” said Dr. Martin Seif, a psychologist in Greenwich, Conn., who created the program, called Freedom to Fly. He himself used to be so scared of flying, he said, that he once arrived late at a conference in Atlanta because he insisted on taking a train, which got stuck in the snow. People who suffer from phobias inhabit a world apart. “Anxiety is an altered state of consciousness,” Dr. Seif said. An anxiety or panic attack is often acutely physical, marked by sweating, numbness in the hands and feet, and a pounding heart, leading sufferers to think they are having a heart attack. In such an episode, “the images in your mind feel like they can really happen,” Dr. Seif said. Exposure-therapy programs like Dr. Seif’s, in which participants face their fear in small doses by meeting at an airport and boarding a stationary plane several times before taking an actual flight, have declined since the World Trade Center attacks of Sept. 11, 2001, as airport security has tightened, said several fear-of-flying experts. As a result, virtual-reality programs — high-tech simulations of the flight experience involving a helmet with built-in audiovisual components — have replaced many more traditional treatment programs like Dr. Seif’s. According to Dr. Barbara Rothbaum of Emory University in Atlanta, who has studied virtual-reality treatments for fear of flying, the success rate is comparable. Dr. Seif said his program’s success rate, defined as those who take the flight to Boston and back, was at least 90 percent. That is comparable to the success rate for similar programs, according to Jerilyn Ross, president and chief executive of the Anxiety Disorders Association of America. The Sept. 11 attacks also shifted the equation for aviophobes in more subtle ways. With polls immediately after the attacks showing a spike in people who said they were anxious about or unwilling to fly, true aviophobes “grabbed that as a reason for not flying anymore at all,” Dr. van Gerwen said. In fact, when prodded by Dr. Seif during the program’s first session in mid-April, many participants conceded that their phobia was driven not by a rational fear of crashing but by their own anxiety, easily whipped into a frenzy by factors like a plane’s height, its enclosed atmosphere and wind turbulence, which can feel hazardous even to hardy fliers. Together, Dr. Seif said, they would learn to “stay in the situation and out-bluff anxiety. For the next five Mondays, group members practiced just that. They passed through airport security and met in one of the staff classrooms, where the program began with an outpouring of personal One man, a tall, broad-shouldered 37-year-old finance executive for an airline, divulged that he had not flown in 20 years, since having had a panic attack on board a flight after the death of his grandmother. He was among several in the group to link the onset of their phobia to a major life change. That factor, Dr. Seif said, along with a genetic predisposition to anxiety disorders, appears to be a major contributor to a fear of flying. Twice, the group was visited by Mr. Bracken, the veteran pilot, who patiently dispelled a wild array of fears. “When I’m up there, I feel like the wings and tail are going to rip off,” one man said. Mr. Bracken detailed the protections woven into building, maintaining and inspecting aircraft. He explained that turbulence was what occurred when, say, a plane hit a ripple of air left in the wake of another jet, and assured his listeners that radar kept planes miles away from truly dangerous weather. Most group members found the explanations calming. Not Ms. Brenner. Told that the chance of a multiple engine failure was next to none, she insisted, “But what would you do if they did?” Dr. Seif replied, “That’s like asking what if you’re driving down the highway and your brakes go, your airbag’s not working and you’re approaching a big brick wall.” The last half-hour of every session was spent aboard a stationary jet. The first time, many group members said their anxiety levels were high, raised by the enclosed space and the smell of the cabin. “I feel like I’m going to throw up,” Ms. Brenner said. But by the week before the actual flight, when airport staff members added another layer of reality by starting the plane’s engine, even she was relatively at ease. That changed the next Saturday when the group members took their seats in the front of the plane to Boston. Tension filled the cabin. One young woman bolted from her seat, unpersuaded by entreaties to stay from Dr. Seif and others. Once the flight was in the air, most participants coped well, as Dr. Seif had predicted they would, busying themselves with their magazines and puzzles or organizing an e-mail list so the group could stay in touch. Ms. Brenner did not fare as well. She was nearly catatonic throughout the flight, clutching Mr. Bracken’s arm on one side and on the other, that of Cecilia Gschwind, 39, a homemaker from Harrison, N.Y. “Why does it feel like we’re not going up?” Ms. Brenner asked as the plane made its unmistakable ascent. Halfway to Boston, when asked how she was doing, she said, “I’m having a hard time focusing.” Dr. Seif demanded that she talk with him to distract herself. He was only half-successful. At Logan, with an hour or so to kill before the flight home, the participants were giddy and celebratory. Many spoke of their plans to fly again within the next few months. One woman, who had not flown in 10 years, said she was finally ready to take her children to Disney World. She lamented the places she had not flown in her 20s but said, “I think my 30s will be good.” Ms. Brenner, however, slipped away from the group and took a train back to New York, calling Dr. Seif to let him know. “O.K., goodbye, see you Monday,” he said curtly into a cellphone. He was softer, though, when the group reconvened Monday for a final session, and he told Ms. Brenner she did the right thing. “It was such a trauma that you needed time to heal,” he said. For her part, Ms. Brenner said she was not ashamed of herself for running — just frustrated. “I thought I was going to feel this huge rush of relief and accomplishment after the flight,” she said. “But I didn’t. I thought, ‘This is not helping.’ I was so unhappy.” Ms. Brenner is not making any immediate plans to fly again. “I’m going to try to figure out why it’s as bad as it is for me,” she said. “I don’t think it’s about the planes.” Some of her problem was her psychosis. Most of it was her mother, who was her legal guardian, appointed by a court to monitor her medications. But the mother was also convinced that psychiatric medications were poison; the patient would go home on weekend passes and return with all her pills in bottles and without a shred of sanity. This continued for months. Her mother brought a notebook listing side effects to each visit. She said the medication caused seizures, diabetes and heart disease, though the studies at the time showed none of these side effects associated with the drug we were giving. We thought she was sadistic, intent on standing between her daughter and independence. She thought we were evil experimentalists. The patient herself dreaded controversy and wished, wistfully, to please everyone. Finally, we petitioned to remove the mother as guardian. It was controversial, against nature, to question a family member’s competency or guidance. When we met before a judge, both sides were filled with strong emotion. But we were also filled with strong data. I remember looking at the mother across the courtroom while testifying about the hazardous nature of her beliefs and their effects on the patient’s mental state and future. Her size had changed. When she visited the hospital, something vibratory and angry about her made her seem to swell, so that neither her daughter nor I could look her in the eye. From the secure height of the witness box, though, she seemed to be shrinking — an ineffectual old woman, laboring under false beliefs, growing smaller as these beliefs were exposed one by one. The judge listened without expression and took the case under consideration. We had no doubt about the power of our presentation. Within a week he had ruled in our favor. The new guardian did not oppose our antipsychotic drug, and the patient flourished. It was like time-lapse photography: in what seemed like only a day, she smiled, spoke, became lucid, joined a day program, began overnights in a residential house and was discharged. We were full of public satisfaction, and private righteousness. Some aspects of psychiatry are clear-cut; they can be counted on. There might be no proof of the existence of Freud’s ego and id. But antipsychotic medications treat psychosis — this can be proven — and the patient’s life was going to be better for taking them. It was, too. For a while, she sent happy, mostly intelligible letters from her residential house. The letters became holiday cards, and eventually, in the fullness of her world, they stopped. Someone else told me, years later, that she had developed diabetes and required insulin. The research by that time was clear: there was no doubt whatsoever of an association between her antipsychotic and diabetes and other metabolic problems. The studies had been confirmed again and again. Kierkegaard wrote that we understand backward but live forward. Politicians say — using a tense so passive that it slinks out of the room before it can be noticed — “Mistakes were made.” The facts we had then were incomplete, even if we didn’t know it at the time. We were right but we were wrong, innocent but at fault, acting in good faith with bad results. The ground beneath professional feet should grow firmer over time — one ought to feel more certain of what one knows. But the more I know, the more I am afraid. Pointing to the high number of tobacco-related deaths among former addicts, the state’s Office of Alcoholism and Substance Abuse Service said that by July 24 of next year, all facilities treating drug or alcohol addiction would have to have programs in place to encourage clients to stop smoking. Under the plan, all treatment centers would have to be smoke-free, and staff members would also have to abide by the ban. Treatment for nicotine addiction, including drugs to relieve cravings, would have to be offered to all patients, and provided free to those without insurance. Patients who refuse to quit smoking could still be treated for other addictions, but they would not be allowed to smoke at the treatment centers. New Jersey has required residential addiction programs to treat nicotine addiction and be smoke-free since 2001, but officials in New York say it would be the first state to require smoking cessation efforts in outpatient programs, which account for two-thirds of the 1,100 treatment programs in the state. Programs in New York that failed to comply with the smoking regulations could lose state certification and would have to stop treating clients. The new requirements, if adopted after public review, would affect 110,000 clients on any given day. They could prove to be a significant hurdle for recovering addicts, who as a group tend to be committed and heavy smokers. Officials estimate that up to 92 percent of drug and alcohol rehabilitation clients in the state smoke, compared with 19 percent of the general population. For a long time, common wisdom held that it would be too hard for patients addicted to drugs or alcohol to stop smoking while they are fighting a dependency on drugs like heroin or cocaine, which can pose a more immediate threat to their health. But state officials say a deeper understanding about addiction triggers and the dangers of tobacco has changed the consensus on the best way to treat users. “It was thought that treating the tobacco dependence would put unfair pressure on the patient working toward recovery,” Karen M. Carpenter-Palumbo, the commissioner of the substance abuse agency, said in a written statement. “We now know that’s not true. Including tobacco dependence while treating other addictions actually leads to higher recovery success rates. We need to focus on the overall wellness of our patients and not ignore this deadly addiction.” Still, this approach is not undisputed in the scientific community. At least one recent study from a researcher at the University of Minnesota found that recovery rates are lower if patients are weaned off cigarettes while they are trying to break free of alcohol or drugs like heroin, scientists said. Dr. Richard Hurt, the director of the Nicotine Dependence Center at the Mayo Clinic in Rochester, Minn., however, said most studies showed that treating nicotine addiction along with others had no effect on treatment effectiveness. Still, he said, there may be some concern that “if you try and incorporate tobacco dependency treatment you somehow make the treatment of the other substances less important.” He said few in the treatment community would dispute that addicts tend to be particularly heavy smokers and that they are more likely to die of smoking-related illnesses than anything else. A study he conducted of alcoholics who had been in treatment found 30 percent died of alcohol-related illness but 50 percent died of tobacco-related diseases. “It is a very progressive step that New York is taking,” he said, “and it brings attention to the substance that is most likely to cause the death of the patient. I don’t know of any other state that has.” As part of this plan, the state’s Department of Health has already agreed to spend $8 million, with $4 million allocated to train staff members on smoking cessation programs and $4 million for nicotine replacement devices like patches. Despite that financial backing, providers expressed concerns about how hard such a program would be to carry out. John J. Coppola, the executive director of the Alcoholism and Substance Abuse Providers of New York State, said the the proposed rules were “pretty stringent.” He said that while providers did not disagree about the impact of smoking on client health, they were worried about enforcing such a policy, especially since so many clients and staff members are heavy smokers. “There will be a whole need to incorporate a while new set of protocols,” he said, “and we are expecting a lot of technical and other kinds of support from the state to make this work.” Jonathan Foulds, the director of the Tobacco Dependence Program at the University of Medicine and Dentistry of New Jersey’s School of Public Health, agreed that the success of the program very much depended on follow-through. He said that when New Jersey first mandated that all addicts in residential programs be treated for smoking in 2001, it was “way ahead of the game.” But, he said, in recent years, with the changes in administration in Trenton, priorities have changed and there has been less enforcement. He said that when he did a follow-up survey in 2006 he found that many treatment facilities were not “tobacco-free.” The cause, after extended illness, was kidney and heart failure, said a friend and spokeswoman, Gayle Rosellini. Dr. Ellis (he had a doctorate but not a medical degree) called his approach rational emotive behavior therapy, or R.E.B.T. Developed in the 1950s, it challenged the deliberate, slow-moving methodology of Sigmund Freud, the prevailing psychotherapeutic treatment at the time. Where the Freudians maintained that a painstaking exploration of childhood experience was critical to understanding neurosis and curing it, Dr. Ellis believed in short-term therapy that called on patients to focus on what was happening in their lives at the moment and to take immediate action to change their behavior. “Neurosis,” he said, was “just a high-class word for whining.” “The trouble with most therapy is that it helps you to feel better,” he said in a 2004 article in The New York Times. “But you don’t get better. You have to back it up with action, action, action.” If his ideas broke with conventions, so did his manner of imparting them. Irreverent, charismatic, he was called the Lenny Bruce of psychotherapy. In popular Friday evening seminars that ran for decades, he counseled, prodded, provoked and entertained groups of 100 or more students, psychologists and others looking for answers, often lacing his comments with obscenities for effect. His basic message was that all people are born with a talent “for crooked thinking,” or distortions of perception that sabotage their innate desire for happiness. But he recognized that people also had the capacity to change themselves. The role of therapists, Dr. Ellis argued, is to intervene directly, using strategies and homework exercises to help patients first learn to accept themselves as they are (unconditional self-acceptance, he called it) and then to retrain themselves to avoid destructive emotions — to “establish new ways of being and behaving,” as he put it. His methods, along with those of Dr. Aaron T. Beck, a psychiatrist who was working independently, provided the basis for what is known as cognitive behavior therapy. A form of talk therapy, it has been shown to be at least as effective as drugs for many people in treating anxiety, depression, obsessive-compulsive disorder and other conditions. His admirers credited Dr. Ellis with adapting the “talking cure,” the dominant therapy in extended Freudian sessions, to a pragmatic, stop-complaining-and-get-on-with-your-life form of guidance later popularized by television personalities like Dr. Phil. Dr. Ellis had such an impact that in a 1982 survey, clinical psychologists ranked him ahead of Freud when asked to name the figure who had exerted the greatest influence on their field. (They placed him second behind Carl Rogers, the founder of humanistic psychology.) His reputation grew even more in the next two decades. In 1955, however, when Dr. Ellis introduced his approach, most of the psychological and psychiatric establishment scorned it. His critics said he misunderstood the nature and force of emotions. Classical Freudians also took offense at Dr. Ellis’s critical observations about psychoanalysis and its founder. Dr. Ellis contended that Freud “really knew very little about sex” and that his view of the Oedipus complex, as suggesting a universal law of human disturbance, was “foolish.” A sexual liberationist, Dr. Ellis collaborated with Dr. Alfred C. Kinsey in his taboo-breaking research on sexual behavior, and his writings about sex drew complaints from members of the American Psychological Association. As a base for his work he established the Institute for Rational Living, now the Albert Ellis Institute, in a townhouse on East 65th Street in Manhattan. He lived there on the top floor. The article in The Times described Dr. Ellis at 90, hard of hearing and recovering from abdominal surgery, coming downstairs one day in the spring of 2004 to lead one of his Friday sessions, just as he had for 30 years. “Do you know why your family is trying to control you?” he asked a volunteer who had joined him in front of the audience. “Because they are out of their minds!” he said, inserting an unprintable adjective. Another participant recalled the murder of her sister years ago by a drug dealer. “Why can’t you understand that some people are crazy and violent and do all kinds of terrible things?” Dr. Ellis declared. “Until you accept it, you’re going to be angry, angry, angry.” Some critics complained that his seminars were more stand-up comedy than serious lecture. Still, despite his iconoclasm, or perhaps because of it, rational emotive behavior therapy became one of the most popular systems of psychotherapy in the 1970s and ’80s. In 1985, the American Psychological Association presented Dr. Ellis with its award for “distinguished professional contributions.” Dr. Ellis was the author or co-author of more than 75 books, many of them best sellers. Among them were “A Guide to Successful Marriage,” “Overcoming Procrastination,” “How to Live With a Neurotic,” “The Art of Erotic Seduction,” “Sex Without Guilt,” “A Guide to Rational Living,” and “How to Stubbornly Refuse to Make Yourself Miserable About Anything — Yes, Anything.” He often went back to his own life experiences to help explain his positive frame of thinking. Albert Ellis was born on Sept. 27, 1913, in Pittsburgh, the oldest of three children. As a child, he wrote, he had a kidney disorder that turned him from sports to books. His parents moved to the Bronx and separated when he was 11. He once wrote that he had limited but amiable contacts with his father, a traveling salesman, and that his mother, an amateur actress, was not interested in domestic life. He maintained that the experience had left no scars. “I took my father’s absence and my mother’s neglect in stride,” he wrote, “and even felt good about being allowed so much autonomy and independence.” He did well in school, skipped grades, won writing contests and, he said, was pleased with his accomplishments. But at 19 he was painfully shy and eager to change his behavior. In one exercise he staked out a bench in a park near his home, determined to talk to every woman who sat there alone. In one month, he said, he approached 130 women. “Thirty walked away immediately,” he said in the Times article. “I talked with the other 100, for the first time in my life, no matter how anxious I was. Nobody vomited and ran away. Nobody called the cops.” Though he got only one date as a result, his shyness disappeared, he said. He similarly overcame a fear of speaking in public by making himself do just that, over and over. He became an accomplished public speaker. Dr. Ellis studied accounting at City College during the Depression and took up some entrepreneurial schemes after graduating. In one, he paired used men’s jackets and pants of similar colors and sold them as suits. He wrote fiction but found no publishers. He had read a good deal about sex and set up a bureau in which he counseled couples. His first marriage, to Karyl Corper, an actress, in 1938, ended in annulment. His second, in 1956, to Rhoda Winter, a dancer, ended in divorce. For 37 years, from 1966 to 2003, he lived with a companion, Janet L. Wolfe, a psychologist who had been executive director of the institute. More recently he married Debbie Joffe-Ellis, a psychologist and former assistant, who survives him. After receiving a doctorate in clinical psychology from Columbia in 1947, Dr. Ellis spent several years undergoing classical psychoanalysis while using its techniques in his job at a state mental hygiene clinic in New Jersey. He quit in 1950 to begin a private practice specializing in sex and marriage therapy and soon started drifting from Freudian orthodoxy, finding it, he said, a waste of time. He turned to Greek, Roman and modern philosophers and considered his own experience. Out of this came rational emotive behavioral therapy, which he decided would focus not on excavating childhood but on confronting the irrational thoughts that lead to self-destructive feelings and behavior. He founded his Manhattan institute in 1959. “I was hated by practically all psychologists and psychiatrists,” he recalled. They thought his approach was “superficial and stupid,” he said, and “they resented that I said therapy doesn’t have to take years.” In 2005, Dr. Ellis sued the institute after it removed him from its board and canceled his Friday seminars. He and his supporters claimed that the institute had fallen into the hands of psychologists who were moving it away from his revolutionary therapy techniques. The board said it had acted out of economic necessity, asserting that payouts to Dr. Ellis for medical and other expenses were jeopardizing the institute’s tax-exempt status. Dr. Ellis was by then hard of hearing and required daily nursing care. Some board members said they were uncomfortable with his confrontational style and eccentricities and saw him as a liability. In January 2006, a State Supreme Court judge ruled that the board had been wrong in ousting Dr. Ellis without proper notice and reinstated him. But his friend Ms. Rosellini said Dr. Ellis’s relations with the board had remained strained afterward. Despite his failing health, Dr. Ellis maintained a demanding schedule late into his life. “I’ll retire when I’m dead,” he said at 90. “While I’m alive, I want to keep doing what I want to do. See people. Give workshops. Write and preach the gospel according to St. Albert.” The new review suggests that even infrequent use could raise the small but real risk of this serious mental illness by 40 percent. Doctors have long suspected a connection and say the latest findings underline the need to highlight marijuana's long-term risks. The research, paid for by the British Health Department, is being published Friday in medical journal The Lancet. "The available evidence now suggests that cannabis is not as harmless as many people think," said Dr. Stanley Zammit, one of the study's authors and a lecturer in the department of psychological medicine at Cardiff University. The researchers said they couldn't prove that marijuana use itself increases the risk of psychosis, a category of several disorders with schizophrenia being the most commonly known. There could be something else about marijuana users, "like their tendency to use other drugs or certain personality traits, that could be causing the psychoses," Zammit said. Marijuana is the most frequently used illegal substance in many countries, including the United Kingdom and the United States. About 20 percent of young adults report using it at least once a week, according to government statistics. Zammit and colleagues from the University of Bristol, Imperial College and Cambridge University examined 35 studies that tracked tens of thousands of people for periods ranging from one year to 27 years to examine the effect of marijuana on mental health. They looked for psychotic illnesses as well as cognitive disorders including delusions and hallucinations, bipolar disorder, depression, anxiety, neuroses and suicidal tendencies. They found that people who used marijuana had roughly a 40 percent higher chance of developing a psychotic disorder later in life. The overall risk remains very low. For example, Zammit said the risk of developing schizophrenia for most people is less than 1 percent. The prevalence of schizophrenia is believed to be about five in 1,000 people. But because of the drug's wide popularity, the researchers estimate that about 800 new cases of psychosis could be prevented by reducing marijuana use. The scientists found a more disturbing outlook for "heavy users" of pot, those who used it daily or weekly: Their risk for psychosis jumped to a range of 50 percent to 200 percent.One doctor noted that people with a history of mental illness in their families could be at higher risk. For them, marijuana use "could unmask the underlying schizophrenia," said Dr. Deepak Cyril D'Souza, an associate professor of psychiatry at Yale University, who was not involved in the study. Dr. Wilson Compton, a senior scientist at the National Institute on Drug Abuse in Washington, called the study persuasive. "The strongest case is that there are consistencies across all of the studies," and that the link was seen only with psychoses _ not anxiety, depression or other mental health problems, he said. Scientists cannot rule out that pre-existing conditions could have led to both marijuana use and later psychoses, he added. Scientists think it is biologically possible that marijuana could cause psychoses because it interrupts important neurotransmitters such as dopamine. That can interfere with the brain's communication systems. Some experts say governments should now work to dispel the misconception that marijuana is a benign drug. "We've reached the end of the road with these kinds of studies," said Dr. Robin Murray of King's College, who had no role in the Lancet study. "Experts are now agreed on the connection between cannabis and psychoses. What we need now is for 14-year-olds to know it." In the U.K., the government will soon reconsider how marijuana should be classified in its hierarchy of drugs. In 2004, it was downgraded and penalties for possession were reduced. Many expect marijuana will be bumped up to a class "B" category, with offenses likely to lead to arrests or longer jail sentences. Two of the authors of the study were invited experts on the Advisory Council on the Misuse of Drugs Cannabis Review in 2005. Several authors reported being paid to attend drug company-sponsored meetings related to marijuana, and one received consulting fees from companies that make antipsychotic medications. |