Noteworthy News Articles on Mental Health Topics, July 30- 31, 2007




Bill Improves Veteran Mental Health Care
Associated Press, 7/30/2007

WASHINGTON -- The House took steps Monday to improve counseling and care for the tens of thousands of military personnel returning from Iraq and Afghanistan with brain injuries and post traumatic stress disorder.

The bill, one of four veterans bills passed by the House, requires the Veterans Affairs Department to provide outreach and mental health services to veterans of the two campaigns. The VA secretary is also directed to contract with community mental health centers in areas not adequately served by the VA.

The VA in April reported that one-third of veterans of the two wars have sought VA health care since fiscal 2002, and that mental disorders comprised 37 percent of possible diagnoses among recent battlefield veterans.

It said that of 84,000 patients that received a diagnosis of possible mental disorder, almost half were provisionally diagnosed with PTSD.

That number could be low, said Veterans' Affairs Committee Chairman Bob Filner, D-Calif.

The bill, sponsored by Rep. Michael Michaud, D-Maine, also allows the VA secretary to make grants to conduct therapeutic workshop programs in such areas as music and the arts.

The bill provides grants for rural veterans service organizations to help transport veterans in remote areas, makes permanent a program to treat participants in Defense Department chemical and biological testing, expands counseling services for veterans emerging from prison who are at risk of homelessness, and provides housing assistance to very low-income veterans.

A second bill waives co-payment for veterans receiving hospice care at home or at acute-care facilities, and another assures that disabled veterans living temporarily with a family member are eligible for adaptive housing assistance.

The fourth bill extends pension benefits to World War II veterans of the U.S. Merchant Marine who were deprived of the benefits given most veterans after the war.

Merchant Marine veterans were ineligible for the GI Bill and other housing and health benefits, and it wasn't until 1988 that they received veterans status. The bill authorizes $485 million over five years to pay $1,000 a month to Merchant Marine veterans and surviving spouses.

According to one VA estimate, about 13,000 surviving mariners and 6,000 spouses would qualify for the benefit.

All four bills passed by voice vote and now go to the Senate.

The bills are H.R. 23 (Merchant Marines), H.R. 1315 (disabled housing), H.R. 2874 (health care improvement) and H.R. 2624 (hospice care).

On the Net: Congress: http://thomas.loc.gov/

The study by New Zealand's Medical Research Institute found that longtime pot smokers can develop symptoms of asthma and bronchitis, along with obstruction of the large airways and excessive lung inflation. The paper was released Tuesday ahead of its publication in the journal Thorax.

''The study shows that one cannabis joint causes a similar degree of lung damage as between 2.5 and five tobacco cigarettes,'' said lead author Sarah Aldington.

However, the researchers found that the progressive chronic lung disease emphysema, often associated with cigarette smoking, was uncommon among marijuana smokers. Only 1.3 percent of the long-term pot smokers were found to have signs of the disease compared to 16.3 percent of those who combined marijuana and tobacco, and 18.9 percent of those who only smoked tobacco.

Marijuana smokers had symptoms that included wheezing, coughing, chest tightness and phlegm -- all of which were associated with tobacco smokers, except chest tightness.

The study, which used lung function tests, high-resolution X-rays and questionnaires, also revealed that among marijuana smokers damage occurred to the small, fine airways which are important for taking in oxygen and removing waste gases. The extent of damage rose in proportion to the number of joints smoked.

Last week, another study published in The Lancet medical journal suggested that using marijuana may increase the likelihood of becoming psychotic, with even infrequent use potentially raising the overall small risk by up to 40 percent.

The three-year Thorax study involved 339 people in New Zealand, where pot smoking is fairly common. An estimated 160 million people use marijuana worldwide.

Participants were recruited into four groups based on smoking habits -- nonsmokers, tobacco-only smokers, tobacco and marijuana smokers, and marijuana-only smokers.

To qualify as a long-term marijuana user, participants had to have smoked a minimum of one joint a day for five years, said institute director Richard Beasley, who also participated in the study. Tobacco users had to have smoked a pack a day for one year.

Earlier studies have shown that smoking one joint results in three to five times more carbon monoxide and tar inhaled than smoking a cigarette of the same size. The New Zealand research also showed that the ''products of combustion'' in marijuana are very similar to tobacco, Beasley said.

Part of the reason for this is the way joints are smoked, with users often inhaling and holding the smoke in longer for a better hit. Marijuana joints typically do not have filters and they have shorter butts than cigarettes with a higher smoke temperature. Pot also is commonly smoked through various types of pipes.

Jeff Garrett, president of the Australia-New Zealand Thoracic Society, who was not involved in the study, said that although researchers found emphysema among marijuana smokers relatively rare, he emphasized that it does occur.

Hospital specialists also are seeing an increasing number of people with emphysema specifically related to marijuana smoking, he said.

Perhaps you didn’t lament this omission. Perhaps you thought that the motivations for sex were pretty obvious. Or maybe you never really wanted to know what was going on inside other people’s minds, in which case you should stop reading immediately.

For now, thanks to psychologists at the University of Texas at Austin, we can at last count the whys. After asking nearly 2,000 people why they’d had sex, the researchers have assembled and categorized a total of 237 reasons — everything from “I wanted to feel closer to God” to “I was drunk.” They even found a few people who claimed to have been motivated by the desire to have a child.

The researchers, Cindy M. Meston and David M. Buss, believe their list, published in the August issue of Archives of Sexual Behavior, is the most thorough taxonomy of sexual motivation ever compiled. This seems entirely plausible.

Who knew, for instance, that a headache had any erotic significance except as an excuse for saying no? But some respondents of both sexes explained that they’d had sex “to get rid of a headache.” It’s No. 173 on the list.

Others said they did it to “help me fall asleep,” “make my partner feel powerful,” “burn calories,” “return a favor,” “keep warm,” “hurt an enemy” or “change the topic of conversation.” The lamest may have been, “It seemed like good exercise,” although there is also this: “Someone dared me.”

Dr. Buss has studied mating strategies around the world — he’s the oft-cited author of “The Evolution of Desire” and other books — but even he did not expect to find such varied and Machiavellian reasons for sex. “I was truly astonished,” he said, “by this richness of sexual psychology.”

The researchers collected the data by first asking more than 400 people to list their reasons for having sex, and then asking more than 1,500 others to rate how important each reason was to them. Although it was a fairly homogenous sample of students at the University of Texas, nearly every one of the 237 reasons was rated by at least some people as their most important motive for having sex.

The best news is that both men and women ranked the same reason most often: “I was attracted to the person.”

The rest of the top 10 for each gender were also almost all the same, including “I wanted to express my love for the person,” “I was sexually aroused and wanted the release” and “It’s fun.”

No matter what the reason, men were more likely to cite it than women, with a couple of notable exceptions. Women were more likely to say they had sex because, “I wanted to express my love for the person” and “I realized I was in love.” This jibes with conventional wisdom about women emphasizing the emotional aspects of sex, although it might also reflect the female respondents’ reluctance to admit to less lofty motives.

The results contradicted another stereotype about women: their supposed tendency to use sex to gain status or resources.

“Our findings suggest that men do these things more than women,” Dr. Buss said, alluding to the respondents who said they’d had sex to get things, like a promotion, a raise or a favor. Men were much more likely than women to say they’d had sex to “boost my social status” or because the partner was famous or “usually ‘out of my league.’ ”

Dr. Buss said, “Although I knew that having sex has consequences for reputation, it surprised me that people, notably men, would be motivated to have sex solely for social status and reputation enhancement.”

But then, men were also more likely than women to say they’d had sex because “I was slumming.” Or simply because “the opportunity presented itself,” or “the person demanded that I have sex.”

If nothing else, the results seem to be a robust confirmation of the hypothesis in the old joke: How can a woman get a man to take off his clothes? Ask him.

To make sense of the 237 reasons, Dr. Buss and Dr. Meston created a taxonomy with four general categories:

¶Physical: “The person had beautiful eyes” or “a desirable body,” or “was good kisser” or “too physically attractive to resist.” Or “I wanted to achieve an orgasm.”

¶Goal Attainment: “I wanted to even the score with a cheating partner” or “break up a rival’s relationship” or “make money” or “be popular.” Or “because of a bet.”

¶Emotional: “I wanted to communicate at a deeper level” or “lift my partner’s spirits” or “say ‘Thank you.’ ” Or just because “the person was intelligent.”

¶Insecurity: “I felt like it was my duty” or “I wanted to boost my self-esteem” or “It was the only way my partner would spend time with me.”

Having sex out of a sense of duty, Dr. Buss said, showed up in a separate study as being especially frequent among older women. But both sexes seem to practice a strategy that he calls mate-guarding, as illustrated in one of the reasons given by survey respondents: “I was afraid my partner would have an affair if I didn’t.”

That fear seems especially reasonable after you finish reading Dr. Buss’s paper and realize just how many reasons there are for infidelity. Some critics might complain that the list has some repetitions — it includes “I was curious about sex” as well as “I wanted to see what all the fuss was about” — but I’m more concerned about the reasons yet to be enumerated.

For instance, nowhere among the 237 reasons will you find the one attributed to the actress Joan Crawford: “I need sex for a clear complexion.” (The closest is “I thought it would make me feel healthy.”)Nor will you find anything about gathering rosebuds while ye may (the 17th-century exhortation to young virgins from Robert Herrick). Nor the similar hurry-before-we-die rationale (“The grave’s a fine and private place/ But none I think do there embrace”) from Andrew Marvell in “To His Coy Mistress.”

From even a cursory survey of literature or the modern mass market in sex fantasies, it seems clear that this new taxonomy may not be any more complete than the original periodic table of the elements.

When I mentioned Ms. Crawford’s complexion and the poets’ rationales to Dr. Buss, he promised to consider them and all other candidates for Reason 238.

You can nominate your own reasons at TierneyLab. You can also submit nominations for a brand new taxonomy: reasons for just saying “No way!” Somehow, though, I don’t think this list will be as long.

Who’s Minding the Mind?
Benedict Carey, New York Times- 7/31/2007

In a recent experiment, psychologists at Yale altered people’s judgments of a stranger by handing them a cup of coffee.

The study participants, college students, had no idea that their social instincts were being deliberately manipulated. On the way to the laboratory, they had bumped into a laboratory assistant, who was holding textbooks, a clipboard, papers and a cup of hot or iced coffee — and asked for a hand with the cup.

That was all it took: The students who held a cup of iced coffee rated a hypothetical person they later read about as being much colder, less social and more selfish than did their fellow students, who had momentarily held a cup of hot java.

Findings like this one, as improbable as they seem, have poured forth in psychological research over the last few years. New studies have found that people tidy up more thoroughly when there’s a faint tang of cleaning liquid in the air; they become more competitive if there’s a briefcase in sight, or more cooperative if they glimpse words like “dependable” and “support” — all without being aware of the change, or what prompted it.

Psychologists say that “priming” people in this way is not some form of hypnotism, or even subliminal seduction; rather, it’s a demonstration of how everyday sights, smells and sounds can selectively activate goals or motives that people already have.

More fundamentally, the new studies reveal a subconscious brain that is far more active, purposeful and independent than previously known. Goals, whether to eat, mate or devour an iced latte, are like neural software programs that can only be run one at a time, and the unconscious is perfectly capable of running the program it chooses.

The give and take between these unconscious choices and our rational, conscious aims can help explain some of the more mystifying realities of behavior, like how we can be generous one moment and petty the next, or act rudely at a dinner party when convinced we are emanating charm.

“When it comes to our behavior from moment to moment, the big question is, ‘What to do next?’ ” said John A. Bargh, a professor of psychology at Yale and a co-author, with Lawrence Williams, of the coffee study, which was presented at a recent psychology conference. “Well, we’re finding that we have these unconscious behavioral guidance systems that are continually furnishing suggestions through the day about what to do next, and the brain is considering and often acting on those, all before conscious awareness.”

Dr. Bargh added: “Sometimes those goals are in line with our conscious intentions and purposes, and sometimes they’re not.”

Priming the Unconscious
The idea of subliminal influence has a mixed reputation among scientists because of a history of advertising hype and apparent fraud. In 1957, an ad man named James Vicary claimed to have increased sales of Coca-Cola and popcorn at a movie theater in Fort Lee, N.J., by secretly flashing the words “Eat popcorn” and “Drink Coke” during the film, too quickly to be consciously noticed. But advertisers and regulators doubted his story from the beginning, and in a 1962 interview, Mr. Vicary acknowledged that he had trumped up the findings to gain attention for his business.

Later studies of products promising subliminal improvement, for things like memory and self-esteem, found no effect.

Some scientists also caution against overstating the implications of the latest research on priming unconscious goals. The new research “doesn’t prove that consciousness never does anything,” wrote Roy Baumeister, a professor of psychology at Florida State University, in an e-mail message. “It’s rather like showing you can hot-wire a car to start the ignition without keys. That’s important and potentially useful information, but it doesn’t prove that keys don’t exist or that keys are useless.”

Yet he and most in the field now agree that the evidence for psychological hot-wiring has become overwhelming. In one 2004 experiment, psychologists led by Aaron Kay, then at Stanford University and now at the University of Waterloo, had students take part in a one-on-one investment game with another, unseen player.

Half the students played while sitting at a large table, at the other end of which was a briefcase and a black leather portfolio. These students were far stingier with their money than the others, who played in an identical room, but with a backpack on the table instead.

The mere presence of the briefcase, noticed but not consciously registered, generated business-related associations and expectations, the authors argue, leading the brain to run the most appropriate goal program: compete. The students had no sense of whether they had acted selfishly or generously.

In another experiment, published in 2005, Dutch psychologists had undergraduates sit in a cubicle and fill out a questionnaire. Hidden in the room was a bucket of water with a splash of citrus-scented cleaning fluid, giving off a faint odor. After completing the questionnaire, the young men and women had a snack, a crumbly biscuit provided by laboratory staff members.

The researchers covertly filmed the snack time and found that these students cleared away crumbs three times more often than a comparison group, who had taken the same questionnaire in a room with no cleaning scent. “That is a very big effect, and they really had no idea they were doing it,” said Henk Aarts, a psychologist at Utrecht University and the senior author of the study.

The Same Brain Circuits
The real-world evidence for these unconscious effects is clear to anyone who has ever run out to the car to avoid the rain and ended up driving too fast, or rushed off to pick up dry cleaning and returned with wine and cigarettes — but no pressed slacks.

The brain appears to use the very same neural circuits to execute an unconscious act as it does a conscious one. In a study that appeared in the journal Science in May, a team of English and French neuroscientists performed brain imaging on 18 men and women who were playing a computer game for money. The players held a handgrip and were told that the tighter they squeezed when an image of money flashed on the screen, the more of the loot they could keep.

As expected, the players squeezed harder when the image of a British pound flashed by than when the image of a penny did — regardless of whether they consciously perceived the pictures, many of which flew by subliminally. But the circuits activated in their brains were similar as well: an area called the ventral pallidum was particularly active whenever the participants responded.

“This area is located in what used to be called the reptilian brain, well below the conscious areas of the brain,” said the study’s senior author, Chris Frith, a professor in neuropsychology at University College London who wrote the book “Making Up The Mind: How the Brain Creates our Mental World.”

The results suggest a “bottom-up” decision-making process, in which the ventral pallidum is part of a circuit that first weighs the reward and decides, then interacts with the higher-level, conscious regions later, if at all, Dr. Frith said.

Scientists have spent years trying to pinpoint the exact neural regions that support conscious awareness, so far in vain. But there’s little doubt it involves the prefrontal cortex, the thin outer layer of brain tissue behind the forehead, and experiments like this one show that it can be one of the last neural areas to know when a decision is made.

This bottom-up order makes sense from an evolutionary perspective. The subcortical areas of the brain evolved first and would have had to help individuals fight, flee and scavenge well before conscious, distinctly human layers were added later in evolutionary history. In this sense, Dr. Bargh argues, unconscious goals can be seen as open-ended, adaptive agents acting on behalf of the broad, genetically encoded aims — automatic survival systems.

In several studies, researchers have also shown that, once covertly activated, an unconscious goal persists with the same determination that is evident in our conscious pursuits. Study participants primed to be cooperative are assiduous in their teamwork, for instance, helping others and sharing resources in games that last 20 minutes or longer. Ditto for those set up to be aggressive.

This may help explain how someone can show up at a party in good spirits and then for some unknown reason — the host’s loafers? the family portrait on the wall? some political comment? — turn a little sour, without realizing the change until later, when a friend remarks on it. “I was rude? Really? When?”

Mark Schaller, a psychologist at the University of British Columbia, in Vancouver, has done research showing that when self-protective instincts are primed — simply by turning down the lights in a room, for instance — white people who are normally tolerant become unconsciously more likely to detect hostility in the faces of black men with neutral expressions.

“Sometimes nonconscious effects can be bigger in sheer magnitude than conscious ones,” Dr. Schaller said, “because we can’t moderate stuff we don’t have conscious access to, and the goal stays active.”

Until it is satisfied, that is, when the program is subsequently suppressed, research suggests. In one 2006 study, for instance, researchers had Northwestern University undergraduates recall an unethical deed from their past, like betraying a friend, or a virtuous one, like returning lost property. Afterward, the students had their choice of a gift, an antiseptic wipe or a pencil; and those who had recalled bad behavior were twice as likely as the others to take the wipe. They had been primed to psychologically “cleanse” their consciences.

Once their hands were wiped, the students became less likely to agree to volunteer their time to help with a graduate school project. Their hands were clean: the unconscious goal had been satisfied and now was being suppressed, the findings suggest.

What You Don’t Know
Using subtle cues for self-improvement is something like trying to tickle yourself, Dr. Bargh said: priming doesn’t work if you’re aware of it. Manipulating others, while possible, is dicey. “We know that as soon as people feel they’re being manipulated, they do the opposite; it backfires,” he said.

And researchers do not yet know how or when, exactly, unconscious drives may suddenly become conscious; or under which circumstances people are able to override hidden urges by force of will. Millions have quit smoking, for instance, and uncounted numbers have resisted darker urges to misbehave that they don’t even fully understand.

Yet the new research on priming makes it clear that we are not alone in our own consciousness. We have company, an invisible partner who has strong reactions about the world that don’t always agree with our own, but whose instincts, these studies clearly show, are at least as likely to be helpful, and attentive to others, as they are to be disruptive.

One morning, as I arrived on our inpatient unit, I nearly froze in my tracks. Our overnight admission stood in the hallway, looking disheveled and sporting a dense 5 o’clock shadow. He had the vacant look of someone whose spirit had been snuffed out like a cold candle. Our overnight admission was Mike.

It turned out that he had been struggling with a ferocious bout of depression for several weeks. Even those who had been with him recently in the E.R. were shocked at his appearance; he looked as if his blood had been drained and replaced with skim milk. I resolved immediately that I would be the one to bring him back from the Land of the Unliving.

Before you can put some folks back together, as one of my supervisors liked to say, they need to fall apart. Mike certainly qualified on that score. He spent most of his time curled up in a ball, sleeping on his cot. He had the usual symptoms of major depression: low self-esteem, loss of pleasure in most activities, thoughts of suicide and a tremendous sense of guilt. The precipitating causes were not clear, and Mike seemed humiliated at our efforts to delve into them. He, too, saw himself as a sort of “top gun,” and he had been ignominiously shot down.

I treated Mike with two robust antidepressant regimens over the course of about two months. I saw him twice weekly in individual psychotherapy and made sure he attended group therapy three days a week. Yet nothing seemed to budge his depression. His lethargy and somnolence seemed almost contagious, and our staff clearly felt uncomfortable working with Mike. He was a disconcerting reminder of our own vulnerability to depression, to what Winston Churchill used to call “The Black Dog.” I no longer wanted to meet Mike’s gaze in the hallway for fear he would catch the look of failure in my eyes.

In those days before managed care, we could keep patients on our unit for eight weeks or even more. But after a couple of months, Mike signed out of our unit, against medical advice. He was not suicidal, and there was no legal justification to keep him. I sulked around the unit for days afterward, wondering how I could have let him down so miserably.

A few weeks later, I ran into him outside the medical center. He looked as if he had just come back from a vacation in Tahiti. “Ron!” he yelled, “Great to see you! Hey, you won’t believe it! I saw this private psychiatrist and he figured out my problem. I had atypical depression. He put me on this fancy medication called an MAOI. I hate giving up wine and cheese, but I feel like a million bucks!”

As I tried to work up a smile, I wished nothing more than to sink into the sidewalk. Atypical depression — how could I have missed it? I had actually written a paper with one of my supervisors on this very diagnosis. Atypically depressed patients often show a different clinical picture from those with “classical” major depression. They often oversleep and overeat, for example. (Indeed, Mike had not lost weight before his admission.) And instead of feeling more depressed in the morning, as is common in major depression, atypically depressed patients tend to “crash” in the evening.

Furthermore, as Mike’s private psychiatrist clearly knew, patients with atypical depression often respond better to MAOIs (monoamine oxidase inhibitors) than to standard antidepressants.

Why had I not prescribed an MAOI? Perhaps, on some level, I was afraid of exposing Mike to a medication I knew to be potentially lethal, if proper precautions weren’t taken. But the explanation doesn’t hold much water. After all, that very medication helped give Mike back his life.

I think something else may have been at work: a phenomenon that Dr. Jerome Groopman identifies in his new book, “How Doctors Think.”

Dr. Groopman observes that V.I.P. or celebrity patients sometimes short-circuit the physician’s normal diagnostic thinking. For example, these patients may be spared the doctor’s usual tests and procedures. As our “top gun,” Mike was just such a patient to me. Even as I entertained grandiose fantasies about curing him, my unconscious may have steered me away from doing everything I could to help him get better.

“The importance of this study is that it contradicts what has been the accepted wisdom for many decades,” said Dr. Joseph R. DiFranza, the lead author, “which is that people had to smoke at least five cigarettes a day over a long period of time to risk becoming addicted to nicotine. Now, we know that children can be addicted very quickly.” Dr. DiFranza is a professor of family medicine at the University of Massachusetts.

The researchers recruited 1,246 sixth-grade volunteers in public schools in Massachusetts, interviewing them 11 times over a four-year period. They also took saliva samples to determine blood levels of nicotine and link them to addictive behavior. At some time during the four years almost a third of the children puffed on a cigarette, more than 17 percent inhaled, and about 7.5 percent used tobacco daily.

Since inhaling is required for sufficient drug delivery to cause dependence, the researchers limited their analysis, published in the July issue of The Archives of Pediatrics and Adolescent Medicine, to the 217 inhalers in the group. Their average age when they first inhaled was 12.8 years. Of these, almost 60 percent had lost some control over their smoking, and 38 percent developed tobacco dependence as defined by the widely used diagnostic manual published by the World Health Organization.

In the 10 percent of children who were most susceptible, cravings began within two days of the first inhalation, and saliva analysis showed that being dependent did not require high blood levels of nicotine throughout the day. In some cases dependence could be diagnosed as early as 13 days after the first smoking episode.

For most inhalers, daily smoking was not required to cause withdrawal symptoms. More than 70 percent had cravings that were difficult to control before they were smoking every day. The biochemical analyses confirmed this: the symptoms of dependence began mostly at the lowest levels of nicotine intake.

“We know very little about the natural history of dependence,” said Denise B. Kandel, a professor of sociomedical sciences at Columbia and a widely published addiction researcher who was not involved in the study. “This is really the first study that addresses the issue. Its strength is that DiFranza has followed a community sample of adolescents and interviewed them every three months, which is very difficult to do.

“On the other hand,” she continued, “his definition of dependence is based on single symptoms, which may be open to question.”

The definition of tobacco addiction is controversial, but the scientists used widely accepted criteria to diagnose dependence and a well-validated questionnaire to determine the extent to which smokers had allowed the habit to dictate their behavior.

The researchers write that it may seem implausible that intermittent smoking could provide relief from withdrawal symptoms. But in fact a single dose of nicotine has effects on the brain that can last as long as a month, and the nicotine obtained from just one or two puffs on a cigarette will occupy half of the brain’s nicotinic receptors, the molecules specifically sought by nicotine in tobacco addiction.

The authors acknowledge that some of their data is retrospective and comes from self-reports, which can be unreliable, and that it is not possible to draw conclusions about other populations from their sample. In addition, they did not consider the roles of puberty, alcohol and other drug use. But the study has considerable strengths in measuring frequency and duration of smoking and in collecting exposure data by biochemical analysis as well as by repeated interviews.

“People used to think that long-term heavy use caused addiction,” Dr. DiFranza said. “Now, we know it’s the other way around: addiction is what causes long-term heavy use.”

He told the court he wanted to apologize to his parents, who were sitting in the front row, and only wished his victims had come to court as well so he could tell them, “I really am sorry for the things I did.” He and his lawyer attributed the crime spree in part to personal troubles, including learning disabilities, childhood sexual abuse and the revelation at age 14 that he had been adopted as a baby.

“I keep hearing from the prosecutor that I’m a wild animal,” Mr. Komisarjevsky (pronounced ko-mi-sor-JEFF-ski) told state officials during a presentencing investigation, according to a transcript of the sentencing hearing. “I’m not.”

Saying “it’s very apparent that you have a loving family that has done as much as they can to support you,” Judge Bentivegna nonetheless concluded that Mr. Komisarjevsky was a “cold, calculating predator,” and sentenced him to nine years in prison, followed by six on parole.

But in a move state officials now acknowledge was not made according to proper procedures, Mr. Komisarjevsky was paroled in April 2007. He now could face the death penalty for a brutal home invasion in Cheshire, the very town where he grew up in a storied and prominent family of Russian descent. What appears to have begun as a mirror image of Mr. Komisarjevsky’s earlier burglaries took a gruesome turn: He and another career criminal he met in a Hartford halfway house, Steven J. Hayes, 44, are accused of murdering Jennifer Hawke-Petit, 48, and her daughters, Hayley, 17, and Michaela, 11; sexually assaulting the mother and Michaela; severely beating the father, Dr. William A. Petit Jr., 50; and setting the house on fire.

Gov. M. Jodi Rell has ordered a “top to bottom” review of the criminal justice system to see where it failed, but equally perplexing is the transformation of Mr. Komisarjevsky, who was adopted at 14 days old by a couple who believed they could not have children of their own. The grandson of a famous Russian theatrical director and a pioneering modern dancer who once owned vast tracts of land not far from the Petits, he was home-schooled along with his sister, Naomi, in a pre-Revolutionary landmark that is known around town as the Merriman Cook house.

“This was a kid in and out of trouble,” Christopher Komisarjevsky, an uncle, said in an interview. “He was estranged from the family. A lot of what you’re asking is information that we just don’t know.”

A former neighbor who insisted on anonymity said the only mischief he could recall Joshua’s stirring up as a child in the 1980s was when he and his friends scuffed the clay tennis court behind his grandparents’ home with their tricycles.

But the 2002 court transcript quotes his defense lawyer, William T. Gerace, as saying that Mr. Komisarjevsky suffered from attention deficit disorder and the learning disabilities dyslexia and dysgraphia as a child, and suffered eight concussions along the way that affected his personality.

Mr. Gerace also told the judge his client was sexually abused “at several different points in his life,” starting at the hands of foster children his parents had taken in. Health officials at Elmcrest, a psychiatric hospital, tried at one point to put Mr. Komisarjevsky on antidepressants, but his parents balked, suggesting their son “deal with it on a spiritual level” and sent him to “a faith program” instead, according to the transcript.

Efforts to reach Mr. Komisarjevsky’s parents, Benedict, an electrical contractor, and Judé, by telephone at their home Monday were unsuccessful. In a statement last week, they said, “We cannot understand what would have made something like this happen.”

Mrs. Komisarjevsky said at the sentencing hearing that she did not want her son to have antidepressants because she feared he wanted to overdose; her husband said he was proud that Joshua had admitted to his misdeeds on arrest.

“We have stood by our son for all these years and we do love him and care about him and consider him as our true son even though he was adopted,” the elder Mr. Komisarjevsky told the judge. “It’s a privilege to have him as a son since then and to walk all the trials and tribulations that we have experienced.”

One turning point appears to have come in 1995, when Joshua was 14, according to the transcript. That year, his step-grandfather, John Chamberlain, with whom he was close, died. He was a celebrated newsman and syndicated writer who had married Benedict’s mother, Ernestine Stodelle, the dancer, after her first husband, Theodore Komisarjevsky, died in 1954. Also when Joshua was 14, he learned he had been adopted, and it was then, he told the authorities before his 2002 sentencing, that he first broke into a house.It grew into a habit. Arrest warrants show a series of mostly petty burglaries in Bristol, Burlington, Cheshire and Farmington: He stole flatware, china and a medical bag with a stethoscope from one house; a crystal vase and cigarette case from another; $40 from one purse and $20 from another. He typically broke in through a back screen door or back window, using night-vision equipment, a knife, latex gloves and a green Army backpack, the documents show.

Once, at a state trooper’s house protected by a dog, he took boots, uniform shirts, a sweater and some other items, totaling $624, from a locker in the cellar.

“The warrants kept coming and coming,” Mr. Gerace, his former defense lawyer, recalled of the earlier burglaries in an interview on Monday. “He covered a lot of territory.”

George A. Montowski, whose home in Bristol was burglarized in July 2001 while he and his wife were away on vacation but their 19-year-old was home, said in an interview Monday that the incident “made us feel violated,” recalling the fear of it happening “while my son was sleeping downstairs.”

Another burglary victim, according to the prosecutor’s comments at the 2002 sentencing hearing, said, “Someone like him shouldn’t be out on the streets.”

But Mr. Gerace described his former client as “a shy, withdrawn, quiet polite kid” who was “very, very contrite,” saying he was having trouble squaring the young man he knew with the heinous crimes against the Petit family.

“His pregnant girlfriend would come to court like clockwork,” Mr. Gerace said. “She was very worried about him not being able to see the baby if he did time.”

In fact the baby, Jayda, was born in March 2002, while Mr. Komisarjevsky was behind bars; he pleaded guilty that September to 12 burglaries, having already been convicted of a similar string in Meriden. The former girlfriend, Jennifer Norton, Jayda’s mother, did not return repeated telephone calls in recent days.

The prosecutor in the 2002 cases, Ronald Dearstyne, told the judge that in 15 years of prosecuting burglaries, he could not recall a perpetrator who “had planned it out to this degree.” Beyond the $25,369 in goods Mr. Komisarjevsky’s victims reported stolen, Mr. Dearstyne said, there was “a cost that cannot be quantified, and that’s the emotional trauma suffered by these people.”

“These people are just like us: They’re family people, they go to work, they come home,” he added, in a chilling precursor to the current case, which has spread fear across the middle-class suburbs of this state. “If we can’t go home at night and feel safe in our own home and then go to bed at night and sleep in our own home and feel safe, then where can we feel safe, judge?”

Mr. Dearstyne declined through a secretary to discuss the case Monday.

Judge Bentivegna agreed that the crimes were serious, leaving homeowners feeling violated and vulnerable, and told Mr. Komisarjevsky that between the five previous convictions in Meriden and the dozen in Bristol, “it’s fair to characterize your course of conduct as predatory.” With the sentence of nine years in prison followed by six on parole, he instructed the defendant, “If you can’t change your life around” in the next 15 years, “there’s really no hope for you.”