Noteworthy News Articles on Mental Health Topics, January 20-26, 2008 Deep into this lucid history of the rise of psychoanalysis, George Makari cites a tribute an acolyte sent Freud for his 60th birthday in 1916. “Beware ... when the great God lets loose a thinker on this planet,” he wrote. “Then all things are at risk. It is as when a conflagration has broken out in a great city, and no man knows what is safe, or where it will end.” Makari doesn’t cite Freud’s somewhat morose response: “Only a funeral oration at the Central Cemetery is normally as beautiful and affectionate.” Faced with Freud’s tendency to play the heretic to the psychoanalytic orthodoxy he yet defined, followers and detractors alike may have wished their understanding of him carried the certainty of a eulogy. In “Revolution in Mind,” Makari argues that we’ve been blinded to the cultural reach of psychoanalysis by the magnitude of Freud’s stature and the magnetic pull or repulsion of his personality and theories. In Makari’s view, much contemporary discussion about the relevance of psychoanalysis is based on a false choice: “Freud as everlasting genius, or Freud as relic and fraud.” To Makari, the director of Cornell University’s Institute for the History of Psychiatry, this dichotomy is artificial. Instead, he argues, we should look to the rich, polyphonous context that gave birth to and was influenced by the analytic enterprise: “the culture of Kant; the assumptions of Geisteswissenschaft and a European classical education,” along with “evolutionary biology, positivism and Newtonian physics.” Rather than providing yet another biography of Freud, Makari maps out the Freud family tree with all its thorny branches, its disciples and dissenters. Even if psychoanalysis is increasingly overshadowed by neurobiology and cognitive psychology, Makari argues that the language of Freudianism remains the lingua franca for some of our most vexing questions: How can aspects of the mind be unknown to itself? How is it possible that another person can be more aware of our thoughts than we are? Assuming such knowledge is possible, how can it be deployed by a doctor to ease our pain and bolster the felicity of our engagement with the outside world? Makari’s book projects a pleasing orderliness onto a tangled tale. It opens in Paris in 1885, where the 29-year-old Freud traveled on a study grant, fleeing controversy in Vienna over his claims for the benefits of cocaine and hoping to galvanize a career that hadn’t yet gained traction. Makari admirably recovers neglected figures of the era, including Théodule Ribot, who rejected the spiritualist philosophy in vogue at the École Normale Supérieure and combined English empiricism with his own theories of heredity, thus laying the groundwork for la psychologie nouvelle, which classified psychology as science, not philosophy and would dominate Europe for decades. We also encounter Jean-Martin Charcot, Freud’s first mentor in Paris, who charted the stages of hysteria and proposed that the power of hypnosis depended upon the abnormal nervous condition of the hypnotized, not the magus-like potency of the hypnotizer. And Hippolyte Bernheim, a provincial doctor who diagnosed hysteria in Charcot and, discounting the notion that vulnerability to hypnosis indicated hereditary brain dysfunction, attributed the action of hypnosis to exaggerated human credulity. Freud deftly absorbed key concepts from these various rivals. He adopted Ribot’s scientific definition of psychology; sided with Bernheim, contra Charcot, that hypnotic susceptibility did not depend on degenerative heredity; and declared Bernheim right to have stressed the mind’s pervasive suggestibility. But then he twisted Bernheim’s message to argue that people are more susceptible to autosuggestion, that is, ideas they generate on their own, than to suggestion from without. This switch of focus laid the groundwork for a “model of warfare between desires and inner defenses,” Makari writes, an intrapsychic battleground that became a crucial subject of analysis. The battleground wasn’t just internal. By the time he left Paris, Freud had also excited an impressive array of powerful “lifelong enemies.” Time and again, Freud would settle on a position — the seduction theory, which posited that many neurotic women had been seduced by their fathers, or the proposition that all phobias have their roots in sexual dysfunction and anxiety neurosis — only to reverse or enlarge the theory just as his advocates began to canonize it. “When opposed,” Makari writes, “he would fight bitterly to hold his ground, and then after rebuffing a foe, he would quietly incorporate those aspects of the challenge he most admired into his ever expanding models.” From his base in Vienna, Freud sprouted offshoots across Europe. In Zurich, Carl Jung and Paul Eugen Bleuler compiled clinical data that buttressed aspects of psychoanalytic theory for which there had previously been no hard evidence. In Budapest, Sandor Ferenczi explored the dynamic between analyst and patient. In each instance, Freud took notice, collaborated with his colleagues — then moved on after a messy split that enabled him to co-opt the best of his rivals and break fresh ground. As Makari recounts, this process led to much debate over who was the “real” Freud. The squabbles continued long after Freud’s death, with one or another analytic school — Anna Freud, Melanie Klein, Wilhelm Reich — claiming to represent the gospel. The history of Freud and his followers is one of grand dueling over ideas — and spiteful bickering over territory. Makari’s writing is clear, but he does not always capture the vivid personalities of his subjects. For a history of a theory obsessed with showing how our higher thoughts reflect quirks of personal history and temperament, the book could have used a little more mud-stirring from the biographical streambed. Makari also smooths over the rapacious, even hysterical tenor of Freud’s Vienna — a city with a striking fixation on suicide, zipping to the stimuli of 600 coffeehouses, where the lustrous glamour of backstage life at the Imperial Theater tore public attention from the imploding political arena. A bit more sparkle, shriek and cigar smoke would have made Makari’s story more evocative. There are other omissions. Freud’s own mind was preoccupied with ancient cultures far from Mitteleuropa. He wrote to Stefan Zweig that he had read more archaeology than psychology, yet this foundational metaphor in Freud, where the exploration of the mind is likened to the excavation of ancient civilizations, is perplexingly absent here. Over the years, Makari writes, psychoanalysis created “the richest systematic description of inner experience that the Western world had produced.” It addressed “sex, love and death; childhood, parenting and family; cruelty, fear, jealousy, envy and hate; identity, conscience and character; desire and mourning.” Yet rather than the integrated, universal system Freud envisioned, his insights seem more a cabinet of curiosities, not unlike the antiquities displayed on his desk. Paradoxically, Makari’s attempts to demythologize Freud only underscore his incurable dominance. In a movement that splintered in as many directions as the far-flung harbors to which refugee analysts fled, Freud still remains the most vivid unifying agent. “A man had come to represent a history,” Makari writes, “and as a symbol he would live on.” Still, this book confronts us with Freud’s virtuosity as a cannibalizing theoretician, his savage efficacy as a tactician — and his irreducible brilliance as a bestower of names: Oedipus complex, dream-work. In the end, it may still be those initial revelations, when Freud was a rebel without a movement, that ignite the imagination and speak the language of our midnight visions: of sexual and murderous fantasies hidden from the fantasizers; of archetypal family structures; of slips of tongue and deed that betray true desire; of endlessly metastasizing guilt. Freud’s own mythological stature derives in part from the way he gave us a timeless language in which to mythologize ourselves. Sheryl Futrell, New York Times- 1/21/2008 The man emerged from the night’s anonymity to sit at the counter, across from the stainless steel grill and the stacks of white plates. He wore a blue jacket appropriate for the January cold, but his left hand was covered with writing of some kind. And, ever so softly, he was talking to himself. It was 3:20 on the second morning of a new year indistinguishable still from the difficult one just past, in a 24-hour chain restaurant on Highway 41 called the Huddle House, where pie and respite are served to the hungry and solitary. The tired waitress, Patsy Schirmer, pulling a rare overnight, approached the customer and asked: "What can I get for you?" The man accepted this open-ended question in terms of food only, muttering an order of scrambled eggs and grits and requesting water, with lemon. He ate everything on his plate, continuing his private conversation all the while. He paid his bill, left no tip, and slipped back behind night’s curtain. A woman walked in 20 minutes later, carrying leaflets. Her name was Sheryl Futrell and she had been searching for weeks for her disoriented son, an Iraq-Afghanistan war veteran named Gary Chronister. Here is his photograph, she said — and you know the rest. Soon the waitress was wailing, "Oh my God, he was just here." Soon the mother was making frantic telephone calls, searching for a flashlight to beam into the brush out back, bouncing between sorrow and joy. "Yes, my son always orders scrambled eggs. Yes, he always asks for lemon with his water. Yes, he is so off his meds that he would be talking to himself." She has arranged search parties, talked with dozens of shop owners, handed out hundreds of fliers, and festooned intersections with sad little signs that bear his photograph. “Missing Gary Chronister,” the signs say. “Confused & Unable to Call Home.” In searching the surrounding woods of this prospering county just northwest of Atlanta, she has come upon homeless veterans in lean-tos, living lives of invisibility. But the longer her son remains missing, the more complex his story becomes. Last week the sheriff’s office in Cherokee County, to the immediate north, issued a warrant for his arrest on charges that he molested a young girl last summer. Dr. Futrell says it is untrue, unfair — un-Gary. She also maintains that he is not on the run. For one thing, she and the child’s mother both say that investigators told everyone months ago that there were too many inconsistencies to prosecute a case. For another, Mr. Chronister was living in Bibb County, 100 miles to the south: if he was on the run, why would he run toward his pursuers? “Because my son has disappeared, and is talking to himself, then he’s guilty,” Dr. Futrell says. “He’s not running; he’s walking.” Or so the sightings say. Here he is, walking near the Circle K convenience store on Highway 41, a big smile on his face. And here he is, at a stoplight on Wade Green Road, trying to cross the street but not making it, walking out a few feet and then back, out and back, head bowed, smiling. The smile, his mother says, voice breaking, “seems to be a hallmark of my son.” Dr. Futrell returned recently to the Huddle House, driving up in her son’s pickup that she hopes he might recognize from the road. Stacks of “Missing Gary Chronister” signs, each one adorned with a small American flag, sat in its bed. She is 53, stout and tired, with a ready smile conveying disbelief at what her life has become. A school psychologist by profession, now a manhunter by circumstance. That is why she chose a back booth: she wanted to see everyone and everything. Her ever-ringing cellphone rang again before she could take a bite of her meal. “This is Gary’s mom,” she answered, hopeful, then not. “No, no, that wouldn’t be Gary ... I so appreciate you calling, though. Thank you so much. Keep your eyes open, sweetie.” Dr. Futrell said her son has a great intellect, a mild case of Tourette’s syndrome and a sense of right and wrong so rigid that he sometimes struggles through the grays of life. He is also a loner. Asked if he ever had a girlfriend, his mother said with a note of reluctance, “Not really.” After earning a bachelor’s degree in English in 1998 from the University of Tennessee, he enrolled in a seminary in Kentucky to pursue “full-time Christian service,” his mother said. But things didn’t work out there, and he had a lot of outstanding college loans. So, several weeks before 9/11, he joined the Army. Over the next three years he spent several months in Afghanistan and several in Iraq, helping to erect guard towers, install light fixtures and build memorials for dead soldiers. Although he saw no combat he came home different, his mother said, with the only telltale sign a check mark on a military document, next to the words “personality change.” Mr. Chronister disappeared many days into his bedroom, which he kept boot-camp spotless. He had trouble holding jobs. Then came his first psychotic break, in which he quietly disengaged from reality. Tests revealed an unspecified brain injury. Was it from being beaten up when he was 16? Was it from something that happened in the military? After several go-rounds with the Department of Veterans Affairs, Mr. Chronister finally received medication that seemed to work, but only for a while. “This is the first day of my healing,” he wrote in his journal on Nov. 8. Within two days, he was gone. Now the police are looking for Gary Chronister, up, down and around Highway 41. And so, still, is his mother, who hasn’t forgotten one of their last conversations. He had said he was having trouble again controlling the thoughts, and she answered, “Son, I’m here.”
It was no joke. Michelle had swallowed an entire bottle of Ambien and didn't wake until she had been checked into a nearby hospital in the Bronx. She spent two days there. She then was transferred to a psychiatric unit in Manhattan -- one young Latina among approximately 2 million in the United States who have attempted suicide. Latinas ages 12 to 17 are the largest minority group of girls in the country, and growing. They are more likely to try to take their lives than any other racial or ethnic group their age. Twenty-five percent say they've thought about suicide, according to the Centers for Disease Control and Prevention, and about 15 percent attempt it, compared with approximately 10 percent of white and black teen girls. Other studies put the proportion of attempters at 20 percent -- slightly less than the fraction who smoke cigarettes. In most cases, a girl swallows pills at home, according to Luis Zayas, a psychologist and professor of social work at Washington University in St. Louis. Zayas is in the middle of a five-year study of more than 150 young Latina girls who have attempted suicide. He says cutting is also finding a following among Latinas. The physical pain of cutting helps to mask their emotional pain, says Carolina Hausman, a social worker who assists Zayas. "These adolescents have intense emotions and no tools to process them," she adds. "Their body has to be calmed down somehow. They talk about seeing blood go down their wrist as a release." Suicide attempts can spread like a virus, from girlfriend to girlfriend. Michelle -- whose last name, like some others in this article, has been withheld to protect her privacy -- says she knew of two girls who had made attempts before she did. A friend of one girl Hausman works with not only told the girl how to cut herself but advised her to minimize the pain by putting Vaseline on the area. Zayas and other experts suggest that suicide attempts like these are more a cry for help than evidence of a will to die. Were these girls living in the countries they or their parents were born in -- where they might enjoy strong ties to relatives, communities and familiar customs -- there's a good chance they wouldn't feel a need to act out, Zayas says. But here they struggle with feelings of powerlessness and frustration, torn between an American popular culture that encourages them to be sexy and assertive, and family expectations that they be modest and submissive. Add to that the isolation they may feel in school and you get some pretty depressed teenagers, Zayas says. They rarely seek help partly because they and their parents are suspicious of mental health services and believe in keeping family troubles in the family. "Crossing the border," Zayas says, "can be hazardous to Latinas' health. Until we understand the cultural conflict, we will not be able to prevent this." Jocelyn Garay's parents, who fled the war in El Salvador in the early 1980s, always demanded a lot of their bubbly, dark-haired daughter: that she excel in school, help out with housework, be attentive to her younger sister and attend church. Her father, who, true to Hispanic custom, considered himself the boss of the family, had a hard time understanding why she wanted to do anything else. He considered some common teen social activities to be unnecessary, even dangerous. She says he forbade her from going to sleepovers at her friends' houses until she was 18. He said no when she asked to try out for the cheerleading team. He opposed dance lessons and put her in taekwondo instead, wanting her to learn to defend herself in what seemed to him (though not to his daughter, who was born here) a strange land. The high school senior in Northern Virginia says has never tried to kill herself. But she has thought about it. Washington psychologist Lillian Comas-Diaz, who counsels immigrants, says parents often don't understand that for many adolescents here, social success inspires motivation and academic success. What parents do know is that by moving to the United States they left behind the relatives, friends and neighbors who would have watched out for their daughter. They may be more rigid than they would have been back home -- and meanwhile their daughter is hearing from her non-Latino friends, "Think about yourself and what you want. Forget your parents." The daughter, then, tries to be dutiful at home and to fit in at school, what Comas-Diaz calls being "of the divided heart." The phrase describes Jocelyn in middle school and early high school. She spent much of that time being angry both at her father for having what she considered unrealistically high academic expectations and at herself for failing to meet them. She joined a Hispanic gang in seventh grade and alienated her white friends. In the spring of ninth grade, her father finally let go of his opposition to cheerleading and she made the team, only to be chastised by her Hispanic friends as being "whitewashed." "I don't want to live anymore," she remembers telling her younger sister. "If I'm not comfortable at home or school, what's the point?" "Don't do it," she recalls her sister saying. "Please, don't leave me alone." Jocelyn never acted on her thoughts. Her mother has an intuitive sense of the pull between family and classmates, Jocelyn says, and helped her navigate her father's demands. Last year, Jocelyn joined a Girl Scout troop, where she found encouraging adults and new, upbeat friends. She now considers her father her biggest champion and her mom her closest friend. Hispanics have the highest unmarried birth rate in the country, according to the CDC, and experts say many youths who have attempted suicide have witnessed a parade of boyfriends move in and out of their homes. Abuse is not infrequent and can contribute to feelings of worthlessness, as Yadasmarie knows. Yadasmarie, 17, is a blond, blue-eyed Puerto Rican living in New York. She has never met her father, who she says is in prison, and rarely sees her mother anymore. In her early years, she lived with her mother, her mother's children by another man and her mother's boyfriend. Her mother and the boyfriend fought regularly, she says. The boyfriend would occasionally turn on Yadasmarie; once, when he caught her biting her nails, he punished her by putting her hand on the hot burner of the kitchen stove. She got along well with her mom's next boyfriend, whom she called "Dad," and when Mom decided to leave that man a year ago, Yadasmarie insisted on staying with him. The man's father was bothered that Yadasmarie was living with his unmarried son, though. "It looks bad," he told Yadasmarie's mother, who then insisted that she live with this "grandfather" and his wife. "Dad" was told not to contact her. A year ago, Yadasmarie cut her right arm with a razor blade. She is now in therapy and living with the "grandparents." She rarely sees her mother and wishes she could move back with her "dad." "I'm basically by myself right now," she says. A Latina's relationship with her mother is the single biggest factor in whether that girl copes well with stress, according to a study published by Fordham University's Graduate School of Social Service. "It's not just being loved, but knowing they're loved," says Edgardo Menvielle, a psychiatrist at Washington's Children's Hospital who also works at the Cliniqua de Pueblo in Adams Morgan. Zayas can spot the difference quickly by listening to a girl talk. "It's the difference between 'My mother doesn't understand' and 'My mother is old-fashioned but she listens.' " Some Latina mothers -- exhausted by fighting with boyfriends, raising children and working several jobs, or burdened by their own emotional problems -- have trouble showing mother love. Paula, a petite high school senior with curly black hair and a big smile, says her mother used to be that way. The two of them immigrated to New York from Ecuador four years ago, in part to escape Paula's violent father. Paula's relationship with her mother was strained after their arrival, and she believed her aunt, whose home they moved into, resented her presence. Paula knew no English as she started high school. At home, she was expected to keep her aunt's house clean, wash the dishes and do the laundry. Overwhelmed early one evening that first year, she sought out a bottle of high-dose Motrin, a painkiller, and took one pill. This past September, it was two pills. She was looking at the bottle, wondering whether to take more, when a good friend called and she told him what she was doing. The friend came over, took her to the emergency room and stayed with her until her mom arrived. Therapists see this pattern frequently: A girl chooses something a parent wouldn't notice -- a pill or two, a light scratch with a sharp instrument. The next time it's two or three pills or a deeper cut, then more. With each attempt, the girl is more likely to die, which is why early intervention is critical, though not foolproof. Paula found a counselor early. Her mother and aunt made efforts to talk to her more. Her boyfriend, currently a student at Montgomery Community College, started visiting more often and has plans to move to New York in June. Yet like the other girls, Paula remains very aware of her own vulnerabilities. Social worker Hausman, herself a Latina, worries about girls like Paula who come from lower-income homes. She wonders about their mental health long-term, given the continuing conflict in their families and lack of outside resources. Their schools and neighborhoods need preventive mental health services more attuned to Hispanic culture, she says -- starting with parenting classes. "In middle- and upper-class families, success is expected," she says. "If a child's mental health interferes with success, it tends to be noticed earlier. Low-income parents don't expect anything of their girls. Every middle-class mother tells me she wants her daughter to be a professional at 24, married with three children. These mothers want their girls to do the laundry."
If 21st-century parenthood is not scary enough, “Growing Up Online,” a documentary to be broadcast on the “Frontline” program on most PBS stations on Tuesday night, uses those real-life stories to ask an increasingly important question: What does it mean to be part of the first generation coming of age steeped in a virtual world seemingly outside parental control? The documentary touches on the much discussed fear of online sexual predators, as well as concerns about the ease of cut-and-paste plagiarism, using the Internet. It also examines how notions of privacy and the meaning of friendships change when a computer button can ferry your words and your images to strangers. “It’s one of those societal shifts that’s happening so quickly there’s not a lot of good data on what this means for our kids’ brains or hearts,” said Rachel Dretzin, the writer of “Online.” Her documentary credits include “Failure to Protect,” a series about Maine’s child welfare system, and “Hillary’s Class,” about the 1969 Wellesley College graduating class that included the future Senator Hillary Rodham Clinton. (Ms. Dretzin has also produced a 15-minute video on middle-aged sexuality for nytimes.com. Ms. Dretzin co-produced and directed “Online” with John Maggio, whose documentary work includes “Ten Days That Unexpectedly Changed America: Einstein’s Letter,” part of a series on the History Channel. “We came out of it feeling, you find what you’re looking for online,” Mr. Maggio said of making the film, adding that parents had a distorted fear of the online boogeyman. “If you’re basically a grounded kid, you’re going to be fine,” he said. “We need to teach people good citizenship, a sense of morality, right and wrong, that transfer to the Internet.” Mr. Maggio and Ms. Dretzin, who are parents, maintain that for most young people, being online is no disaster and can be a source of creativity and information. In any case, there is no going back. “Growing Up Online” estimates that more than 90 percent of teenagers use the Internet. The film begins with a look inside some homes and classrooms in Morris County in northern New Jersey. There affluent youths have their own computers, and the ones who live in housing projects crowd around computers at community centers. In each group some youngsters play war games, tweak their personal profiles, pose for racy photographs. In one home a 7-year-old, Kurt, goes to the Club Penguin Web site (clubpenguin.com) to socialize, while upstairs his 13-year-old brother, Clay, picks the last name Calamity to freshen his MySpace profile. Such behavior on its own is benign, but from a parent’s perspective, it opens the children to an unknown world. “It’s really hard to control what our kids are doing online,” says Anne Collier, a writer who provides online safety information for parents. “What we have here is really kind of the new Wild West. Nobody is really in charge.” This is a virtual Wild West, though, conducted through cellphones, MySpace and Facebook. “I have had, like, relationships with guys online, but, like, in school or in public, we’re not actually friends,” says a 16-year-old identified as Sara. She has an eating disorder and visits sites that celebrate anorexia. Sara’s parents knew nothing of her eating disorder until after her interview with “Frontline.” Similarly, Greg Bukata, a teenager who lives in Chatham, N.J., reveals the tricks he employs to wriggle out of his father’s attempts to monitor his computer use. “I’d go on my way and do what I wanted, and he’d think I’d be researching monkeys or something,” Greg says. He also says that he can’t remember the last time he read a book. Recently, he adds, he took five minutes to read an online condensed version of “Romeo and Juliet.” At Chatham High School, Michael LaSusa, a co-principal, concedes that the classroom must compete with the flash of cyberspace. “We have to be interactive because they’re accustomed to sitting in front of a screen and they’ve got five windows up and they’re talking to three people at the same time,” Mr. LaSusa says. The younger generation regards online not as a separate place “but as just a sort of continuation of their existence,” says Danah Boyd, a fellow at the Berkman Center for Internet and Society at Harvard Law School. “Cyberspace mirrors and magnifies offline behaviors, scaling up both the good and the bad,” Ms. Boyd said in an e-mail message. “On one hand, this is terrifying. On the other, it provides a great opportunity for parents, educators, social workers and other concerned professionals to understand and reach out to youth at an entirely new level.” “Growing Up” shows one young woman with body piercings using the Internet to find the popularity and acceptance that have eluded her elsewhere, but it also shows the Halligan family of Essex Junction, Vt., confronting the very worst. Their son, Ryan, 13, killed himself in October 2003 after enduring online bullying. After his son’s death, John Halligan logged on to Ryan’s computer to discover that he had been caught in a smear campaign of rumors about his sexuality. A popular girl at school flirted with him, using instant messaging, and then announced that the flirtation was a joke, Mr. Halligan learned. And Ryan had made an online friend with whom he visited a Web site that discusses the best suicide methods. “The computer and the Internet were not the cause of my son’s suicide, but they helped,” Mr. Halligan says. “I believe they helped amplify and accelerate the hurt and pain that he was trying to deal with that started in person, in the real world.” By the end of “Online,” Greg Bukata, for one, has quit the Internet, if only temporarily. He is seen graduating from Chatham High School, with plans to attend the United States Coast Guard Academy, where Internet use is prohibited for several weeks. “It’ll be hard, but I need to disconnect,” he says. “I need to just pull the plug on this Internet life for a little bit and see what it’s like.” ABC Drama Takes on Science and Parents Edward Wyatt, New York Times- 1/23/2008 LOS ANGELES — A new legal drama making its debut this month on ABC is stepping into a subject that is the source of heated debate among some parents — the relationship between autism and childhood vaccines — and seemingly coming down on the side that has been all but dismissed by prominent scientific organizations. The drama, “Eli Stone,” scheduled to be broadcast at 10 p.m. on Jan. 31, centers on a lawyer who begins having visions that cause him to question his life’s work defending large corporations, including a pharmaceutical company that makes vaccines. The title character of “Eli Stone,” adopting the message of his visions to fight for the little guy, takes his first case: suing his former client on behalf of the mother of an autistic child who believes a mercury-based preservative in a vaccine caused her son’s autism. For the last decade some parents and advocates for autistic children have championed the theory that a mercury-based vaccine preservative called thimerosal, developed in the late 1920s and used in many childhood vaccines until about seven years ago, is a primary cause of autism in young children. Autism often is diagnosed in children between their first and fourth years, during the time that many children begin receiving regular rounds of vaccinations. But reams of scientific studies by the leading American health authorities have failed to establish a causal link between the preservative and autism. Since the preservative was largely removed from childhood vaccines in 2001, autism rates have not declined. While police and legal dramas often use ripped-from-the-headlines topics as the basis of episodes, rarely do broadcast networks allow themselves to stray into the middle of heated debates that contain such emotional touchstones for large segments of their audience, if only because another big segment of a network’s audience is likely to be on the other side of the debate. With “Eli Stone,” however, neither ABC nor its ABC Studios production unit has expressed any qualms about the story, according to Greg Berlanti, a co-creator and an executive producer of the series, who said he believed that the script showed both sides of the argument. “I think they wanted us to do our homework about all of it, which we did,” he said. But the script also takes several liberties that could leave viewers believing that the debate over thimerosal — which in the program’s script is given the fictional name mercuritol — is far from scientifically settled. Through a spokeswoman, ABC declined to offer an executive to discuss the show. The issue is a potentially delicate one for ABC. Eli Lilly & Company, which developed thimerosal, and the two companies that now make the bulk of childhood vaccines used in the United States, GlaxoSmithKline and Sanofi-Aventis, spent an estimated $138 million for advertising on ABC last year, according to Nielsen Monitor-Plus, though little to none of it was spent advertising vaccines. Representatives of all three companies expressed dismay about the series, of which they said they were unaware until called by a reporter. Nancy Pekarek, a spokeswoman for GlaxoSmithKline, said the episode raised public-health concerns. “If parents watching this fictional series make that incorrect conclusion about a link” between vaccines and autism “and as a result choose not to vaccinate their own children, the consequences could be devastating,” she said. Doctors have previously expressed fears that the popularity of the antivaccine movement could have adverse effects. In Britain a widely publicized — and since discredited — research paper published in 1998 started a scare over the safety of the vaccine for measles, mumps and rubella, drawing a potential link to autism. Though the premise of the research did not concern thimerosal, vaccination rates plunged in Britain. Over the next two to six years, outbreaks of measles soared in Britain and Ireland, causing at least three deaths and hundreds of children to be hospitalized. Among the organizations that have studied possible links between autism and the preservative in vaccines are the Centers for Disease Control and Prevention, the Food and Drug Administration, the Institute of Medicine, the World Health Organization and the American Academy of Pediatrics. Each of them has largely dismissed the idea that thimerosal causes or contributes to autism, and five major studies have found no link. Since 2001, no vaccine routinely administered to children in the United States had more than half a microgram of mercury, about the amount found in an infant’s daily supply of breast milk. But plenty of parents, as well as groups like SafeMinds, continue to say that a link exists. “We feel it is still an open question,” said Theresa Wrangham, president of SafeMinds, a nonprofit parent organization. Their position has been supported in recent years by some members of Congress and by public advocates including Robert F. Kennedy Jr. The initial episode of "Eli Stone" posits that the child received a flu vaccine containing the preservative; in recent years vaccine makers have produced new versions of the flu vaccine for children that do not contain the mercury-based preservative. “Is there proof that mercuritol causes autism?,” Eli Stone says to the jury in summing up his lawsuit against the vaccine maker. “Yes,” he says. “Is that proof direct or incontrovertible proof? No. But ask yourself if you’ve ever believed in anything or anyone without absolute proof.” The script also draws a parallel with research linking smoking and cancer, saying three decades passed between the first lawsuit charging a connection and the first jury award against a tobacco company. After the dramatic courtroom revelation that the chief executive of the vaccine maker did not allow his daughter’s pediatrician to give her the company’s vaccine, the jury in “Eli Stone” awards the mother $5.2 million. (In each episode Eli Stone takes on a different cause; in other episodes sent to television reviewers for preview, he wages court battles against a pesticide maker and a priest.) In the last two years Mr. Berlanti, who created “Eli Stone” with Marc Guggenheim, has become a major contributor to ABC’s primetime lineup. He also is an executive producer of “Brother & Sisters” and “Dirty Sexy Money.” Mr. Guggenheim is a lawyer who has worked on several law-related series, including “The Practice” and “Law & Order.” In interviews both men said they did not have any personal ties to the subject of autism and childhood vaccines. Mr. Guggenheim, who has two young children, said he had questioned his pediatrician about the number of vaccines his children were receiving. “I haven’t vaccinated them as aggressively as I could,” he said. Both of the producers also said that they wanted “Eli Stone” to provoke conversation. “A lot of TV these days is not talking about the same things that the nightly news is talking about,” Mr. Berlanti said. “As a show, we want to keep the conversation going after people turn off the television.” F.D.A. Requiring Suicide Studies in Drug Trials Gardiner Harris, New York Times- 1/24/2008 After decades of inattention to the possible psychiatric side effects of experimental medicines, the Food and Drug Administration is now requiring drug makers to study closely whether patients become suicidal during clinical trials. The new rules represent one of the most profound changes of the past 16 years to regulations governing drug development. But since the F.D.A.’s oversight of experimental medicines is done in secret, the agency’s shift has not been announced publicly. The drug industry, however, is keenly aware of the change. Makers of drugs to treat obesity, urinary incontinence, epilepsy, smoking cessation, depression and many other conditions are being asked for the first time by the drug agency to put a comprehensive suicide assessment into their clinical trials. In recent months, the agency has sent letters — it would not say how many — to drug makers requiring that they use such a scale. Merck, Sanofi-Aventis and Eli Lilly are all using a detailed suicide assessment in clinical trials being conducted now. The seeds for the new federal effort were planted four years ago with the discovery that antidepressants may cause some children and teenagers to become suicidal. Top agency officials at first discounted the finding but commissioned researchers from Columbia University’s department of psychiatry, led by Kelly L. Posner, to reanalyze the drugs’ clinical trials. This work caused the drug agency and its experts to view the risk as real. Then it received an application for rimonabant, a much-heralded obesity drug developed by the French drug giant, Sanofi-Aventis. As agency medical reviewers pored over the drug’s clinical trial data, they discovered hints that it could cause psychiatric problems, too. Unsettled by their experience with antidepressants, agency reviewers again mandated the use of Dr. Posner’s system. The assessment found that the drug doubled the risks of suicidal symptoms. In June, an F.D.A. advisory committee voted unanimously that the agency reject rimonabant because of its psychiatric effects, and Sanofi-Aventis withdrew the application although the drug is sold in Europe. Just this month, the results of a trial of Merck’s obesity drug, taranabant, were published showing similar psychiatric problems. Meanwhile, fears have grown that drugs used to treat epilepsy, seizures and mood disorders may have similar effects. An extensive examination of these medicines by the drug agency should be completed this year. Suddenly, agency officials realized that multiple classes of medicines might cause dangerous psychiatric problems. “Clearly we were somewhat surprised when this signal emerged in the pediatric antidepressant data,” said Dr. Thomas P. Laughren, director of the drug agency’s division of psychiatry products. “So various groups within F.D.A. are now looking at suicidality more broadly as a possible adverse event.” The drug agency’s concerns are consistent with a growing body of research confirming that behavior is heavily influenced not only by genes but also by seemingly innocuous changes in body chemistry. Drugs not reaching the brain were once thought to be largely free of mental effects. “One lesson from pharmacology is that you can see effects on emotion and cognition without the drug entering the brain if a drug leads to peripheral changes in” other chemicals that enter the brain, said Dr. Thomas R. Insel, director of the National Institute of Mental Health. Some critics say that the agency’s new-found focus on psychiatric side effects is long overdue. “The list of drugs that causes psychiatric problems is a very long one,” said Dr. Sidney M. Wolfe, director of Public Citizen’s health research group. Medicines to treat acne, hypertension, high cholesterol, swelling, heartburn, pain, bacterial infections and insomnia can all cause psychiatric problems, effects that were discovered in most cases after the drugs were approved and used in millions of patients. Some drugs cause depression so often that doctors prescribe antidepressants prophylactically with them. Among medicines still for sale, the F.D.A. has determined that the drugs’ benefits outweigh their psychiatric risks. Still, the agency now wants to uncover such problems more reliably and before approval. There are two reasons that the F.D.A. for years was inattentive to the psychiatric effects of new medicines. First, distinguishing between mental problems that spring from a disease and those that result from its treatment is often difficult. For antidepressants, many researchers suggested that suicidal behaviors resulted because, as patients’ depression lifted, they suddenly had the energy to carry out previous suicidal thoughts. Second, drug side effects are often first identified in clinical trials when multiple doctors treating hundreds of patients record similar problems in trial notes. But terms to describe depression or suicidal thoughts can vary widely, making them hard to discern. “The whole spectrum of suicidal thoughts, ideation and attempts is much more difficult to define and study than” other drug problems, said Dr. Eric Colman, deputy director of the drug agency’s division of metabolic and endocrine products. Indeed, the agency’s initial review of the effects of antidepressants in children was plagued by inconsistent and erroneous observations by investigators. A 10-year-old boy who tried to hang himself was listed only as having a “personality disorder,” an overdose of 11 tablets was called a “medication error” and a girl who slapped herself in the face was labeled as having attempted suicide. Dr. Posner’s team spent months reclassifying these events as either a suicidal symptom or not. The team created a detailed questionnaire called the Columbia Suicide Severity Rating Scale, now adopted by the drug agency as an often mandatory test to be used in clinical trials. The last time one medicine’s side effect led the F.D.A. to broadly re-examine its drug approval process was in 1992, when it discovered that Seldane, a popular antihistamine, could cause dangerous heart arrhythmias. Tests revealed other drugs that could affect heart rhythms, and the agency soon mandated that nearly all experimental medicines be tested for heart rhythm effects. Unlike the Seldane example, however, not every experimental drug program must use the new suicidal symptoms scale. Drug officials said that they looked at a drug’s molecular structure and its effects in animals before deciding whether to insist on the new test. “That’s where it gets tricky,” said Dr. Colman. “It’s difficult to say where you draw the line.” But Dr. Posner said in an interview that so many companies and academic research programs were adopting the suicide questionnaire that she was having trouble keeping up with the demand for its use. The questionnaire has been translated into 80 languages, and Dr. Posner has trained scores of teams of investigators from around the world on how to use it. On Jan. 4 she lectured a group of investigators at Yale. Benjamin A. Toll, an assistant professor in the university’s department of psychiatry, was in the audience and said he planned to use the Columbia questionnaire in a trial almost immediately. “It’s much more detailed than what we were doing before,” Dr. Toll said. “We used to ask, ‘Are you feeling down? Are you feeling sad?’ ” Dr. Colman said that the new questionnaire, while important, would not end the uncertainty around suicidal symptoms. “If a drug makes people depressed but doesn’t make them suicidal, what do you conclude?” he asked. “There will always be some degree of uncertainty.”
The homemade clip is time-stamped Jan. 18 and shows Ms. Winehouse, with her recent blond hairdo, in her London apartment, using a glass pipe to smoke what The Sun says is crack. And it was no surprise because she has been a very public wreck. Performers thrive on attention, and sometimes admit that it’s an addiction; now, the Internet enables that addiction all too easily. The unintended consequence is that we can now watch stars self-destruct in real time. Images of Ms. Winehouse looking intoxicated, disheveled, half-dressed and wild-eyed are all over the tabloids and the Internet. She has appeared to be drunk onstage, barely able to get through a song, and after a lamentable concert in Britain she canceled her fall tour there, stating, “I can’t give it my all onstage without my Blake” — her husband, Blake Fielder-Civil, who is in jail for perverting the cause of justice after a bar brawl. The glass-pipe video surfaced just as Ms. Winehouse — who was arrested and fined for marijuana possession in Norway in October — was seeking a visa to perform on the Grammy telecast Feb. 10. Ms. Winehouse is not the first, nor likely the last, celebrity to show a self-destructive streak. In gloating tabloid coverage she’s usually paired nowadays with Britney Spears, whose bizarre behavior — shaving her head, smashing a car window — has been documented just as thoroughly. But Ms. Spears’s songs have been chipper, impersonal exercises in pop flirtation, up until “Piece of Me,” a song on her 2007 album, “Blackout,” that taunts scandal watchers and paparazzi (joining a mini-tradition of resentful celebrity songs like Michael Jackson’s “Tabloid Junkie”). Ms. Winehouse, who writes her own lyrics, has been far more self-conscious from the start. She is no naïf; “Back to Black” is her second album, and she attended the BRIT school, a performing-arts high school in London that counts other British hitmakers like Lily Allen among its alumni. Ms. Winehouse has often sung about harmful appetites, not just in “Rehab” but in “Addicted” (about a freeloading pot smoker) and in “Back to Black,” in which she sings, “You love blow and I love puff/And life is like a pipe.” Back when the album was released, it sounded as if she already had some wry perspective. She didn’t have to get any more “real” than that. Rock history is punctuated with sad stories: suicides like Kurt Cobain, Nick Drake and Ian Curtis, and the excess-induced deaths of Janis Joplin, Jimi Hendrix, Gram Parsons, Sid Vicious and Jerry Garcia. Yet there have also been countless tales of abuse, bottoming out and survival, from the Rolling Stones to Metallica. What made “Rehab” amusing when it appeared was that Ms. Winehouse was mocking what had become such a standard celebrity way station. Addiction might start with experiments by performers so young they feel invulnerable; it might seem to be, at first, a way to ease the stress of a peculiar job. It might be a way to act out the old Romantic image of the artist as daredevil. And there’s no shortage of temptation in a musician’s work environment of bars, clubs, late nights and party people. Rock stars weren’t the first musicians to drink or drug themselves to death. What’s different, in the 21st century, is that we can watch the breakdowns almost as they happen. One day there’s a grainy video of Ms. Winehouse spreading across the Internet. Now the video has been given to the British police for investigation while Ms. Winehouse, black-haired and neatly made up, is photographed professionally on the way to a doctor visit. In the ’60s and ’70s there were occasional photos of Janis Joplin hoisting a bottle of Southern Comfort, and word-of-mouth about many bands’ backstage excesses or drunken exploits, but those were occasional glimpses and dispatches. Rockers dosed themselves, mostly, behind closed doors. Now digital video and photography, coupled with the Internet, can add up to near-constant surveillance. It’s voluntary for people who post daily photos on their Facebook pages, perhaps less so for celebrities trailed by paparazzi. There’s an entire industry in celebrity scandal, much of it remarkably callous. In their times the deaths of Jim Morrison and Kurt Cobain were sudden and shocking, leaving them a legacy as handsome rock martyrs. Now paparazzi and cyberazzi would be posting frequent updates, turning trouble into spectacle, and bloggers would be mocking "fat Jim" and "krazy Kurt" as they struggled, vying to see who could be more cruelly iconoclastic. But they were pre-Internet stars. Now, there’s a sleazy symbiosis that connects instantaneous worldwide visibility, publicity, marketing and narcissism. Attention addicts can get their fix with a few mouse clicks. Why, for instance, was Ms. Winehouse letting someone shoot video, in a private setting, of her puffing that pipe in the first place? Maybe it’s some version of “keepin’ it real,” the fallacy that insists art must be autobiographical to be worthwhile, as if art were documentation rather than storytelling. Maybe it’s obliviousness, although, since the camera followed her around, she was likely to know it was there. Maybe she mistakenly trusted that whoever made the video would resist another temptation: the potential profit to be made providing it to a tabloid. Perhaps Ms. Winehouse misunderstood what should be clear in the age of the Internet: Everything recorded can be duplicated and distributed. And possibly the video was, in its own bleary way, a kind of performance. She is keeping her audience informed if not exactly entertained. Mostly, however, she’s just supplying material for the sphere of celebrity interaction that only wants to see idols torn down. Her fans — those of us who believe she has more superb songs yet to write — would prefer she grow less visible and considerably more boring. Maybe it will have to wait until she wins or loses at the Grammys. But she would do well to disappear for a while, into rehab or private recovery, and then to hole up in a recording studio and work up some new songs. (She definitely has enough ups and downs to write about, realistically or not.) In the era of total exposure Ms. Winehouse would serve herself and her listeners best by working behind closed doors.
Virginia is among the five states with the country's toughest standards for involuntary commitment. Supporters said the proposed change would improve the ability of community health practitioners to treat mentally ill people. Under state law, people can be committed against their will only if they pose an "imminent danger to self or others." The law does not define "imminent danger," and the standard is applied differently by magistrates and special justices from county to county. The proposal approved by lawmakers on the Courts of Justice Committee would allow a magistrate or special justice to commit someone to treatment if there is "a substantial likelihood" that the person would cause "serious physical harm to himself or herself" in the near future or could "suffer serious harm due to substantial deterioration." The action mirrors recommendations by Gov. Timothy M. Kaine (D) and the state Supreme Court. Although there were minor disagreements over wording, the bill received bipartisan support. It will be scrutinized by the Appropriations Committee before a floor vote. Also Friday, a Senate subcommittee took up more than a dozen bills, including ones that would change the commitment standard, that will probably be voted on next week. "This is a massive overhaul," said Del. David B. Albo (R-Fairfax), chairman of the Courts of Justice Committee, which unanimously approved the measure, alluding to the increased power the state would be given to get people into treatment. He said, though, that no single law will be able to catch everyone who needs help. "No standard solves every problem," he said. Democratic leaders said the new law would make the process of assessing mental health more efficient and comprehensive. "We're trying to provide more clarity" to the standard, said Del. Brian J. Moran (Alexandria), chairman of the House Democratic Caucus. "We're providing additional explanation, which will serve to broaden the law's application." The system has come under scrutiny since 32 people were killed April 16 at Virginia Tech by a gunman with a history of psychiatric problems. The House bill follows recommendations of the independent commission that investigated the shootings by Seung Hui Cho, who killed himself after the rampage. But advocates for people with mental illness wondered whether the proposed laws are as vague as the originals. At a Senate hearing on a nearly identical bill Friday, opponents raised concerns that the language in the bills could be open to interpretation. And they said they feared that too many people will be brought in for hearings. "It's a massive deprivation of civil liberty, and it should only be done in limited circumstances," said Colleen Miller, executive director of the Virginia Office for Protection and Advocacy, an independent agency that focuses on people with disabilities. The action was the first of many votes expected on mental health issues during the 60-day General Assembly session. Also Friday, delegates considered legislation that would tighten the rules that govern how mental health officials monitor people in outpatient treatment. There is often confusion over how a person ordered by a court to receive services should be monitored. In Cho's case, there was confusion over who was to monitor him after he was ordered into treatment in December 2005. As a result, he never received it. The commission recommended that guidelines such as listing the consequences of not complying be adopted. The Courts of Justice Committee is scheduled to vote on that measure Monday.
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