Noteworthy News Articles on Mental Health Topics, August 12-27, 2007

Elderly Staying Sexually Active
Rob Stein, Washington Post- 8/22/2003

Many people maintain rich, active sex lives well into their 80s, according to the first detailed examination of sexuality among older Americans. The nationally representative survey of more than 3,000 U.S. adults ages 57 to 85 found that more than half to three-quarters of those questioned remain sexually active, with a significant proportion engaging in frequent and varied sexual behavior.
      Sexual problems do increase with age, and the rate of sexual activity fades somewhat, the survey found. But interest in sex remains high and the frequency remains surprisingly stable among the physically able who are lucky enough to still have partners. "There's a popular perception that older people aren't as interested in sex as younger people," said Stacy Tessler Lindau of the University of Chicago, who led the study, being published today in the New England Journal of Medicine. "Our study shows that's simply not true. Older people value sexuality as an important part of life." "This study paints a portrait of this aspect of older Americans' lives that suggests a previously uncharacterized vitality and interest in sexuality," agreed Georgeanne E. Patmios of the National Institute on Aging, the primary funder of the study. "This has not perhaps been fully appreciated."
     The survey found a close link between sex and health, with healthier people reporting the highest rates of sexual activity. In addition to supporting the well-known idea that illness can interfere with sex, that finding suggests that a healthy sex life may itself help keep people vibrant, the researchers said. "Individuals who remain sexually active gain the benefit of the physical exercise that comes with sex," Lindau said. "It's also possible the hormones -- the endorphins released by orgasms -- give a general sense of well-being that could be beneficial. The psychological benefits of being loved and cared for may also trickle over to physical health."
     Despite the intense focus on sex in popular culture, political sensitivities have severely limited funding for reliable, detailed studies of sexual activity among Americans of any age. Smaller, more limited studies have provided glimpses into the sex lives of the elderly, but no one had previously attempted an in-depth, nationally representative survey among this rapidly growing segment of the population. "We just don't know very much about sexuality in the later years," said Robert N. Butler, president of the International Longevity Center in New York, a nonprofit think tank. "There's been a tremendous amount of resistance to such studies. That's what makes this so terrific."
     For the study, researchers conducted face-to-face interviews with a randomly selected sample of 3,005 Americans from July 2005 to March 2006. "We found people to be grateful to have an opportunity to discuss these issues," said Lindau, noting that researchers achieved an unusually high 75 percent response rate from those they approached. "The topics we were asking about resonated with people. Many said they had never had a chance to talk to anyone about these issues, not even a spouse or their physicians."
     About 28 percent of men and about 14 percent of women said sex was very important, and about three-quarters of those with partners reported being sexually active, which is about equivalent to what previous research had found for people in their 40s and 50s. Being sexually active was defined as having had mutually voluntary sexual contact with another person within the past 12 months. "Our findings indicate that when it comes to sexual activity, older people are really just younger people later in life," Lindau said "There's no reason to believe they give up the basic human desire for love and intimacy and the kind of pleasure that comes from intimate relationships."
     The proportion of those having sex did decline somewhat with age. By ages 75 to 85, it was down to 39 percent of men and 17 percent of women. Among those who remained sexually active, frequency also fell somewhat with age. But even among the oldest age group, 54 percent of those who were sexually active reported having sex at least two to three times per month and 23 percent reported having sex once a week or more. "This just shows that the light doesn't go out. The flame doesn't go out," said Todd P. Semla, president of the American Geriatrics Society.
     The most common sexual activity was vaginal intercourse. But the survey found a significant proportion reported engaging in oral sex, both giving and receiving, as well as masturbation. Mirroring their younger counterparts, elderly men reported more sexual activity than women, but researchers said that was largely because women live longer than men, giving the surviving men more opportunities to have sex than women. "This doesn't necessarily mean that women aren't necessarily interested in intimacy and sexuality," Lindau said. "A substantial number of women say the reason they are not having sex is they don't have a partner."
     Among those who remained sexually active, nearly half reported at least one sexual problem. Forty-three percent of women reported a lack of sexual desire, 39 percent of women reported vaginal dryness, and 37 percent of men reported problems achieving an erection. Given the availability of new medical treatments such as Viagra, those findings indicate that the elderly would benefit from more frank and open discussions about sex with their doctors. "This should increase awareness among physicians to pay more attention to this," said John E. Morley, director of geriatrics at St. Louis University. "This is extraordinarily important, and we need to pay more attention to it."

A Place to Go When a Child Really Refuses Food
Ellen Barry, New York Times- 8/23/2007

Some years ago, a couple came to Ramasamy Manikam with a disturbing problem. Their 8-year-old daughter, who had suffered a brain injury, refused to eat despite countless hours of pleading and bribery. One thing worked: If they left the room, she would fling the food to the floor, get down from her chair, crawl into it and eat. Dr. Manikam, a clinical psychologist who has been treating feeding disorders for 19 years, listens to such stories with a gentle neutrality. He remembers the girl’s mother weeping as she explained what this strange ritual was doing to their family; if she or her husband ventured into the room, even enough to cast a shadow, the girl would stop eating, so they would wait, frozen, outside. The three of them — mother, father and child — were trapped in a “real triad problem,” he said, but “they were really good people, for all that.”
      There are only nine programs in the country designed to treat young children who will not eat. Dr. Manikam runs one of them, in a ward at St. Mary’s Hospital for Children in Bayside, Queens, that can house six inpatients. Inside a row of small rooms at the Center for Pediatric Feeding Disorders, therapists do the slow, careful work of breaking down children’s resistance to eating. They act as detectives, tracing the behavior backward to the experience that may have shaped it.
     Underlying the work is the notion that eating is a learned behavior, not an instinctive one. Babies fed by tube after birth may never learn to associate the sensation of hunger with the act of eating; babies who do not move to solid food by the age of 8 months may not learn to breathe, chew and swallow without choking. When those learning opportunities are missed, children can develop a deep anxiety that defies logic, something that Dr. Manikam compares to a fear of flying. He has spent a career trying to break down that fear, most often in children with disabilities who become accustomed to tube-feeding early in life. “I am a firm believer that learning never ends,” he said. “If you are living, you can learn.”
     There was, years ago, the case of an 11-year-old boy with Asperger’s syndrome. The boy had a high I.Q.; he could play the trombone and deliver a lecture on sharks “better than Jacques Cousteau,” Dr. Manikam recalls. But he was stick-thin. He barely ate and survived by hiding in a closet and inserting a feeding tube in his abdominal incision, something he desperately wanted to keep secret. The boy’s mother, depressed and anxious, had given in to his wishes.
     Dr. Manikam, then treating patients at the Kennedy Krieger Institute in Baltimore, managed the 11-year-old’s case for two months. At first he just built a relationship: He invited the boy to lecture medical students about sharks, which flattered the boy deeply. Ultimately, the doctor appealed to the boy’s ego, asking him to teach younger children about the importance of nutrition. The task required the boy to eat on videotape, something he willingly did. Without treatment, Dr. Manikam said, “he would have starved.”
     More typical are babies and toddlers who spent their early months in the hospital. Dr. Manikam recalled a 9-month-old brought from South America who would bottle-feed only under a bizarre set of circumstances. She had to be held over an adult’s shoulder, on the edge of sleep, and fed by a second adult from behind, with the sound of a vacuum cleaner in the background. The baby had lived in a neonatal intensive-care unit whose nurses had noticed that she seemed to eat more when the cleaning crews were in the area; her frantic parents made a recording and carried it around with them. “Actually, they might have shaped the child to it,” Dr. Manikam said. “I cannot verify that the child made the association.”
     With the baby, as with the 11-year-old, Dr. Manikam and his colleagues used “deconditioning,” a behavioral psychology technique that aims to extinguish a conditioned response. Therapists began by playing the sound of the vacuum cleaner, then altering it slightly until the baby’s window of acceptance grew larger. This took six weeks.
     They took a similar approach with the brain-injured girl who would only eat off the floor: Therapists hid in the house and observed her while she ate alone, then played with her on the floor when her parents were not around, to “neutralize the battle of wills.” The therapists became “positive agents,” new figures in her life, and very slowly they added food to the play. Four months later, she was eating at a table.
     Years ago, many of these children would have received diagnoses like colic or failure to thrive. The notion of a feeding disorder is a relatively new one, and only 15 percent of families coming to St. Mary’s are reimbursed by insurance for the cost of treatment, said Burton Grebin, the hospital’s president and chief executive.
     Dr. Grebin is working to convince the State Health Department that the demand for these services merits Medicaid reimbursement: Dr. Manikam estimates that one in four children has some kind of feeding disorder, and that severe problems occur in 3 percent to 10 percent of the population, a percentage that continues to rise as neonatal medicine improves.
     It is clear, at any rate, that families are looking for help: The wait for treatment at the Center for Pediatric Feeding Disorders is 16 to 18 months. Marilyn Villalona was so excited when her son, John, 12, got a spot there that she quit her job as a receptionist in a dentist’s office to accompany him full time. She was watching on a recent morning while he sat with a therapist, gazing down into a bowl of steak and mashed potatoes.
     For 10 years, Ms. Villalona has been preparing liquid food for her son. He was born with Hirschsprung’s disease, a disorder of the colon, which required the insertion of a colostomy bag from infancy to age 2. Although he was physically able to eat from that age onward, every attempt met with gagging, coughing and anxiety, which was particularly upsetting because he also suffers from congenital heart disease. Throughout his childhood, he would join the family around the table at restaurants, watching as his two younger sisters ate, Ms. Villalona said.
     This is John’s second month as a patient at the center, and his mother has watched, mesmerized, as the therapist nudged him toward solid food, doling out rewards (in John’s case, the reward is Pokemon or Yu-Gi-Oh trading cards) in exchange for an agreed number of bites. He comes for three 20-minute sessions a day, with each session’s result entered in a spreadsheet. Ms. Villalona was sitting in an observation room, watching over a video link, when he ate his first mouthful of mashed potatoes. “I cried, honestly, I cried, it was so touching for me,” said Ms. Villalona, who lives with her husband, a cabdriver, in the Bronx. “I was like, ‘Oh, my God.’ ”
     The worst, said a feeding therapist, Rosie Johnston, was the broccoli day. Though John was never able to explain why, “he was so afraid of what broccoli was going to do to him,” Ms. Johnston said. She coated the broccoli in ranch dressing and repeated their old mantra: It is your job to eat, just as it is my job to help you eat. It was the only day John wept. But he ate the broccoli.
     Watching the sessions can be both exhilarating and difficult for parents, said Kristin Bruno, the program’s deputy director. “They want their child to succeed,” Ms. Bruno said. “But they also wonder why they couldn’t have done it themselves.” Indeed, Ms. Villalona was asking herself questions as she watched her son take his first bite of steak. Can she start cooking one meal for her family, instead of two? Can she go back to work? And, more painfully, could this have happened 10 years ago? These will take time to answer. But she beamed as she recalled a family picnic, when John was given a hot dog, like all the other children. The adults looked worried when they saw him holding it, and shocked when they saw him take a bite. “He was laughing,” Ms. Villalona said. “He said, ‘I can eat now.’ ”

Creatures of Habit
Nicholas Kulish, New York Times Book Review- 8/26/2007
THE KING OF METHLEHEM
By Mark Lindquist.
235 pp. Simon & Schuster. $23.
LEAVING DIRTY JERSEY
A Crystal Meth Memoir.
By James Salant.
342 pp. Simon Spotlight Entertainment/Simon & Schuster. $21.

     Whether on the local news or the latest episode of “CSI,” meth is the drug of the moment. Last summer’s big-budget “Miami Vice” visited a meth-addled trailer park as well as the high seas of the sexier cocaine trade, and November brought the country’s first National Methamphetamine The methamphetamine cook has laid claim to a permanent place in criminal lore — the cross-pollination of the killer next door and the garage-based entrepreneur makes him a peculiarly American character. The novelist and drug-crime prosecutor Mark Lindquist introduces us to a chef among cooks in his uneven novel “The King of Methlehem.” Of his 13 aliases, Howard Schultz is the one to which Lindquist’s kingpin is most attached, perhaps because he wishes he could move meth on the same scale that the chairman of Starbucks can push caffeine.
      Howard’s operation is like a grotesque criminal carnival, from his password-stealing A.T.M. to his staff of garbage-combing identity thieves. Like Howard, Lindquist is best sifting through the grit and the gear of the home labs, with the blenders and pancake griddles, drain opener and coffee filters, rock salt and lithium batteries used to elevate garden-variety cold tablets into the powerful, addictive stimulant. For all of the knowledge on display, however, the book could benefit from a little more nuance.
     “We’ve cried wolf too many times — about pot and heroin, for example — and now people are understandably slow to accept that we really do have a drug that’s like putting your brain in a frying pan,” the novel’s prosecutor, Mike Lawson, earnestly tells a television reporter. For a real-life prosecutor like Lindquist, who deplores the devastation it has visited upon many communities, the drug can begin to rise beyond social problem to the level of evil scourge. But that view can also make it awfully hard to create three-dimensional characters.
     Lindquist needs to inhabit his junkies more, the way the noir master Jim Thompson embraced even his most loathsome creations — without condoning their actions or trying to apologize for them. Instead Lindquist seems determined to keep them unsympathetic. Lest Howard’s wild schemes and devious tricks win a few readers over, the author makes him a pedophile as well.
     The users in the book can’t even spell one-syllable words correctly. A hard-nosed detective named Wyatt James feels compelled to lecture an addict that one quashes rather than squashes a warrant. Perhaps if Wyatt weren’t such a stickler for vocabulary it would have registered that the criminal mastermind with whom he is said to be obsessed — his “white whale,” Howard — has dropped in on Wyatt’s on-and-off girlfriend at the coffee shop where she works. In what feels like an outright lapse, Wyatt not only doesn’t rush her into protective custody but barely notices when she informs him of the meth-psycho’s visit, responding, “Hey, hey, relax, don’t worry about it.”
     It might help Lindquist temper his view of the criminals he prosecutes if he read the new memoir by James Salant, “Leaving Dirty Jersey.” Salant came from a good home in Princeton with loving parents but ended up a drug user and dealer. In one of the worst (but perhaps most common) unintended consequences of rehab, his stint at a facility in California called Get Straight for Life introduces him to harder-core users who get him hooked on meth.
     He testifies to the drug’s overwhelming strength. Salant had been using heroin, cocaine and LSD before he went to rehab, but when a former nurse injects him with meth for the first time, he writes, “it felt even better than I’d expected, but at the same time the intensity of it caught me by surprise — like swimming in a rough ocean, enjoying it, and then all of a sudden you get taken under, crushed and tumbled, and you realize that you can’t surface until it lets you.”
     Though the exact veracity of Salant’s tale would be difficult to determine (he explains in an author’s note that the work “derives primarily from my memory”), it at least has none of the macho posturing of James Frey’s “Million Little Pieces.” Salant goes out of his way to remind the reader that he is only posing as a tough guy among violent, paranoid cons. He makes his mark by telling his tale plainly and well; there’s no self-aggrandizing.
     While there is plenty of sex and violence, Salant shines in less lurid moments, like his painful conversations with Megan, the 9-year-old daughter of a fellow junkie, and in small details, as when, riding in a rental car with his visiting parents, he observes that it has been months since he’s “driven in a single car whose check-engine light was off.”
     Salant’s territory is the users and dealers, not the backyard cooks. In fact, homemade meth is in sharp decline, thanks to stepped-up law enforcement and legislation cutting off access to legal precursor ingredients. Like big multinationals in other industries, enormous labs in Mexico and Asia have picked up the slack. The demand, Salant shows us, remains. Someone will fill the need.

Cho Had a Severe Anxiety Disorder
Brigid Schulte & Tim Craig, Washington Post- 8/27/2007

Fairfax Countyb school officials determined that Seung Hui Cho suffered from an anxiety disorder so severe that they put him in special education and devised a plan to help, according to sources familiar with his history, but Virginia Tech was never told of the problem.

The disorder made Cho unable to speak in social settings and was deemed an emotional disability, the sources said. When he stopped getting the help that Fairfax was providing, Cho became even more isolated and suffered severe ridicule during his four years at Virginia Tech, experts suggested. In his senior year, Cho killed 32 students and faculty members and himself in the deadliest shooting by an individual in U.S. history.

The condition, called selective mutism, is a symptom of a larger social anxiety disorder. It prompted the Fairfax school system to develop a detailed special education plan to help ease Cho's fears so he might begin to talk more openly, the sources said.

Part of his individualized program in Fairfax excused Cho from participating in class discussions, according to the sources, who spoke on condition of anonymity because of the confidentiality of Cho's records. Another part of the plan called for private therapy to resolve his underlying anxiety. The therapy and special provisions were "apparently effective," the sources said.

But once Cho left the safe and highly structured high school setting that had created a cocoon of support, officials at Virginia Tech were never told of his condition and never addressed the issue, the sources said. Since the April 16 shootings, stories have emerged from Cho's teachers and classmates at Virginia Tech. They say it was common for professors to call on Cho and for him to remain silent. The teachers would become angry, and students would taunt him. The severely isolated Cho began to refer to himself as "?". All of this would have worsened his deep-seated anxiety, experts said.

"Think of the image of the little kid at the end of the diving board, just frozen. They can't move no matter how much we tell them to jump," said Robert Schum, a clinical psychologist and expert in selective mutism. "In a classroom, they feel threatened. They're trapped. And the more people push, the more it exacerbates the anxiety."

Professors and school administrators at Virginia Tech could not have known of Cho's emotional disability -- Fairfax officials were forbidden from telling them. Federal privacy and disability laws prohibit high schools from sharing with colleges private information such as a student's special education coding or disability, according to high school and college guidance and admissions officials. Those laws also prohibit colleges from asking for such information.

The only way Virginia Tech officials would have known about Cho's anxiety and selective mutism would have been if Cho or his parents told them about it and asked for accommodations to help him, as he had received in Fairfax. Cho's disability was first reported in the Wall Street Journal and will be explored further when a panel appointed by Gov. Timothy M. Kaine (D) releases an investigative report about the shootings.

Although the only way college officials could have known about Cho's problem would have been from Cho, experts said that asking for help is an almost impossible task for someone with selective mutism.

"Children with selective mutism don't want to be the center of attention. They don't like to sit on Santa's lap. They don't like their photo taken on picture day. They don't want kids to sing to them at their birthday celebration. They just want to be left alone," Schum said. "So when you put the responsibility on them and ask them to draw attention to themselves by asking for help . . . that's really tough."

Cho's parents, although cooperative with Fairfax school officials, might not have fully understood what was wrong and that their son needed help in college as well. As recently as last summer, Cho's mother had sought out members of One Mind Church in Woodbridge to purge him of what the pastor there called the "demonic power" possessing him.

Cho's family said he was always a quiet, reserved child. After he emigrated with his parents from South Korea when he was 8, a great-aunt in Korea said the boy's mother told her he had autism. "We knew something was wrong," the aunt, Kim Yang Soon, said in April.

Classmates from Stone Middle School in Centreville remember some students making fun of Cho and his silence.

"He never tried to say anything," former classmate Sam Linton said. "Even when the teachers called roll, he wouldn't say 'Present' or raise his hand. He just looked straight ahead. Someone else would have to say 'Seung's here.' "

By the time Cho entered Westfield High School in Chantilly, classmate Chris Davids remembers an uncomfortable sophomore English class. Students were taking turns reading aloud from works of Shakespeare. When it was Cho's turn, he sat in silence. The teacher began to cajole him. Silence. Students began to snicker. The teacher became angry. Silence. She threatened him with an F. Finally, Cho began to read in a strange mumble.

"That snickering turned to full-out laughing," Davids said. "There were several comments made, such as 'Go Back to ESL' -- English as a Second Language class -- 'Learn how to read,' or 'Go back to China.' "

Not long after that incident, Fairfax school officials realized that Cho was not merely painfully shy. Nor was he being recalcitrant or passive-aggressive. He was literally too paralyzed to speak. They put him in special education and devised a number of accommodations to help him, sources said. School officials said Cho would no longer be required to answer teachers' questions or participate in classroom discussions. Davids said that he does not recall Cho ever being called on after that incident.

Cho was also given speech therapy. His parents were encouraged to put him in private counseling, which they did. School officials suggested that Cho join school clubs. He joined the band, where students soon began referring to him derisively as "trombone boy." He also joined the science club.

Davids, another member of the science club, said that although Cho came to many of the club's meetings and hung out, he never spoke. "The teacher who was the sponsor for the club would ask him if he wanted to participate in whatever we were doing, then leave him alone," Davids said. "If he wanted to participate, he would come over and do so; otherwise, he would just sit at a desk and stare at the desk."

Although most students are given special education services because their disability makes it more difficult for them to do well academically, that is generally not the case with selective mutism, Schum said. Indeed, classmates remember Cho as intelligent and capable of getting good grades.

Fairfax school officials would not speak about Cho directly, citing privacy laws. They said, however, that a team of psychologists had studied selective mutism in detail, worked with several children and felt it had made "significant progress" with the students.

Ellie Barnes, director of student services for the Fairfax schools, said the best treatment for the disorder includes private counseling to unearth the emotional issues or anxiety that is causing it. The county complements that with "desensitization therapy," exposing children to their phobia in small increments "so they can understand the irrationalization of that phobia."

But none of that care and level of detail was transferred to Virginia Tech.

Richard Crowley, coordinator of guidance services for Fairfax, said high schools generally send transcripts to colleges with only a student's courses, grades and test scores. Race, sex, religion and even the number of times a student has been suspended are considered optional pieces of information that a student can choose to disclose. The only way college officials could tell if a student had been in special education would be by looking at the classes the student took. Basic Skills is a fairly common special education class."We don't send anything that has to do with special education," Crowley said. "If the parent, who has the authority, wants us to disclose to colleges that the student was in a special-ed program, we can do that and send whatever records they want. But that doesn't happen very often."

The reason, explained Barmak Nassirian, with the American Association of Collegiate Registrars and Admissions Officers, is that in the competitive admissions process, students don't want to be at a disadvantage. As recently as 2003, parental pressure caused the College Board to stop flagging SAT scores for students who had been given special education accommodations while taking the test.

Moreover, many colleges say they don't want to know because of the potential liability. "In soliciting a student's history of psychiatric treatment or diagnoses by treating physicians, you basically open a Pandora's box," Nassirian said. "Even if you should decide, for reasons that have nothing to do with medical circumstances, not to accept a student, you most certainly will have a case that will be litigated."

For students who are accepted and disclose their disability, most colleges and universities have services to provide appropriate accommodations, said Andrew Flagel, dean of admissions at George Mason University.

Schum said selective mutism, which can be treated successfully, had never been associated with violent behavior. Most of the children, teens and young adults who suffer from the disorder -- about 1 percent of the U.S. population -- are simply born that way. They come from families where anxieties tend to run high.

One technique Schum said he has found particularly effective in helping children overcome their mutism is videotaping. Children can be videotaped reading aloud at home and then can take the tape to their teacher to be graded. Or the student can be videotaped giving a show-and-tell presentation to share with the class.

So Schum was not at all surprised when the world finally heard Cho speak in a setting of his choosing, on the strange and violent tape he sent to NBC News. "He was not autistic. He clearly had the capability of talking to people," Schum said. "We saw that on the video."