Noteworthy News Articles on Mental Health Topics, February 1-10, 2008



Bipolar Explorer
Hilary MacGregor, Los Angeles Times- 2/1/2008

Manic Hollywood tales are never in short supply: crazy agents screaming into the phone, out-of-control actors driving drunk, starlets creating outre public spectacles or insomniac writers, holed up in hotel rooms for weeks, hammering out the perfect screenplay. This is not natural behavior, except in L.A., where it is almost expected.

The city provides the physical and emotional backdrop for a new book by Terri Cheney, a former entertainment lawyer who exposes the more clinical side of all that out-of-control energy. "Manic: A Memoir" chronicles Cheney's decades-long struggle to come to terms with and manage her bipolar disorder.

The book is not the first to give an autobiographical account of living bipolar. It joins the ranks of Kay Redfield Jamison's "An Unquiet Mind," Carrie Fisher's "Postcards From the Edge" and "The Big Awful" (two novels based on her life) and Andy Behrman's "Electroboy: A Memoir of Mania," to name a few. But set in a glamorous world saturated with money and celebrity, the book not only describes Cheney's individual struggle against this disease -- which afflicts 5.7 million adult Americans of every age, gender and social class -- it also provides an apt metaphor for the bizarre psychological terrain of Hollywood.

"Hollywood is an industry of extremes," said Cheney, whose clients included Michael Jackson and Quincy Jones. "It is feast or famine, euphoria or despair. Everything has got to be faster, bigger, more, and right now! In a way, you need to be manic to survive."

Therapists and psychiatrists around L.A. tend to share Cheney's view. "We are not talking about a town where being married and going to church every Sunday is highly valued," said Rebecca Roy, a therapist who estimates that 75% of her clients are musicians, actors, producers and writers, and advertises her practice with the slogan "Stay Sane in an Insane Industry." "L.A. is about reaching for the heights, for whatever is possible. That is kind of a manic view: the idea that there is always a carrot on a stick in front of you and if you can just gear yourself up for it you can get it. Millions and millions of people come here for that reason."

No one knows what percentage of people living in Los Angeles are bipolar, but studies have shown that there are very high rates of bipolar among people in the arts, which includes musicians, poets and writers.

"We don't know why this is the case, but there may be something about the gene for creativity that runs not only in those types of professions but in bipolar as well," said Dr. Lori Altshuler, the Julia S. Gouw Professor of Psychiatry and director of the UCLA Mood Disorders Research Program.

The up and down nature of Hollywood life, Cheney suggests, makes it easier for those who suffer to conceal their mental illness here. Bipolar may go undiagnosed in many communities, but in Hollywood, manic traits are not only overlooked, they are celebrated. (There are two types of bipolar: I and II. The difference is one of degree. Those with bipolar II experience hypomania, but not mania. In most cases, hypomania does not impair a person's daily functioning.)

Bipolar traits include increased energy and productivity, a decreased need for sleep -- many with bipolar need only three to four hours of sleep a night during a manic or hypomanic phase -- and increased self-esteem, talkativeness and sociability. "These are the types of traits most actors would like to have all the time," Altshuler said. "People who are hypomanic are the life of the party. They are magnetic, and the problem is, they don't want to be treated for hypomania because it feels so good."

Written in episodic chapters that mimic the ups and downs of bipolar depression -- hypomania, mania, depression -- Cheney's book is a gut-churning ride. At times the reader feels lost, discombobulated, but Cheney said the nonlinear structure was intentional.

"I wanted this book to mirror the disease, to give the reader a visceral experience," she writes in her preface. "It's truer to the way I think. When I look back, I rarely remember events in terms of date or sequence. Rather, I remember what emotional state I was in. Manic? Depressed? Suicidal? Euphoric? Life for me is defined not by time, but by mood."

On a recent evening, curled up in her writer's lair in a hidden canyon in Beverly Hills, the petite, red-haired Cheney came across as controlled and slightly fragile. It is hard to imagine her living the crazed sexual and suicidal episodes she describes in her book.

For Cheney, a correct diagnosis took seven years. She has endured multiple suicide attempts, nights in jail and even electroshock therapy in her struggle to reach what she calls "an uneasy truce with the disease."

Her view of L.A. is inseparable from the disease. During 16 years working as an entertainment lawyer, she often wondered if the agent or studio executive talking a mile-a-minute on the other end of the phone wasn't secretly manic, too. And when she sees stories of volatile young celebrities struggling with substance abuse problems, she suspects the undiagnosed symptoms of bipolar.

Britney Spears, for example, now hospitalized for the second time: "The relentless exuberance, the irreverence, the constant defiance of rules -- mania looks like fun on the outside, but it's not," Cheney said. "It's absolutely terrifying. You're swept up by forces you can neither control nor understand. To me, it looks as if bipolar disorder has swallowed her whole."

Doctors know there are very high rates of drug and alcohol abuse in people who are bipolar, many times higher than the general population rates. "They are trying to self-medicate," Altshuler said.

Experts say the list of celebrities with bipolar disorder -- some confirmed, some not -- is in the hundreds. Some actors, such as Carrie Fisher and Patty Duke, have come out publicly about their struggles.

Actress and activist Mariette Hartley, who has appeared in shows such as "Star Trek" and "The Incredible Hulk" over the course of her long career, called her decision to come out about the disease "wrenching." "Whether you are a famous actor, or a farmer in Iowa, this disease can be hidden from yourself," she said. "When the demons hit, they get you wherever you are."

Still, she said, for actors or rock stars, one depends on the highs to perform, and as time goes by it becomes harder and harder to reach those highs. When that is not there, you plunge down. "Often, you are lost, if you do not have a life."

Even when the disease is diagnosed, many artists and performers are reluctant to be treated, because they fear treatment will extinguish their creative fire. For Cheney, who spent seven years on her memoir, writing became a form of salvation. In one chapter, she is arrested and jailed in Van Nuys. She was deeply ashamed, and for years could not return to the site of her humiliation. But after she wrote her story, it lost its power over her.

It's perhaps surprising that Cheney writes with humor, and even wonder, about this disease that has wreaked havoc with her life. In the end, she offers hope -- that the proper medication can be found, and that some semblance of a normal life can be lived. "It's an incredible time to be bipolar," she said, with only a touch of irony. "There is so much awareness. There are so many medications. There is so much unexpected compassion."

Testimony at Hearing Seals Fate of Virginia Psychiatrist
Sandra Boodman, Washington Post- 2/2/2008

The hearing was entering its 10th hour Thursday night when Arlington County psychiatrist Martin H. Stein learned that his 40-year career as a practicing physician was effectively over. The Virginia Board of Medicine denied Stein's petition to reinstate the license he surrendered six years ago for his treatment of 10 patients, among them a 4-year-old whose legs he bound with duct tape. The three-member panel found that Stein had harmed 17 other patients by over-prescribing sometimes dangerous combinations of drugs, diagnosing nonexistent conditions and engaging in unethical behavior with female patients.
      Stein, 67, who declared personal bankruptcy five years ago and has been sued more than 15 times since 1995, may reapply or appeal. But both are expensive, time-consuming processes with virtually no chance of success. "I know he's disappointed, as I was," his Richmond-based attorney, Michael Goodman, said yesterday, adding that his client has not decided how to proceed.
     Stein's marathon hearing in Richmond provided a revealing glimpse into the largely secret process involving the reinstatement of doctors disciplined for the most serious offenses. The toughest cases are those such as Stein's that hinge on competence and psychological factors rather than substance abuse, which can be treated and monitored through random drug tests. State medical boards, which are dominated by doctors, must balance the safety of the public with the rights of colleagues, who typically mount well-financed and aggressive efforts to get their licenses back. Last year, only two of the 12 doctors who petitioned the Virginia board for reinstatement were denied. "The questions we looked at during these hearings are, has a doctor learned his lesson, is he currently competent and are his problems fixable?" said former board chairman Joseph A. Leming. He called reinstatement hearings "profoundly intense."
     Stein, who has been receiving psychiatric disability benefits, told the board he is being treated for bipolar disorder, which he said was largely to blame for his many problems. The panel met in closed session for two hours with Stein's psychiatrist and other doctors to hear details of his treatment. The medical director of the Virginia Health Practitioners' Intervention Program, whose staff evaluated Stein, disagreed. Internist Patricia Pade, who argued against reinstatement, said his problems involve "characterological issues." Also known as personality disorders, such problems include narcissism and grandiosity.
     Julia Bennett, a lawyer representing the commonwealth, emphatically argued against reinstatement, saying that Stein failed to prove he was no longer a danger to public health and that there was no way to monitor him. "It doesn't matter what kind of safeguards you put in place," she said, noting that some of Stein's former patients called or wrote asking that he be permanently barred, though none attended the hearing. "I'm glad they did their job," said Robert Kratzke of Honolulu, an aerospace engineer who retired on disability at 47 after suffering permanent brain damage caused by Stein's overmedication. "He used his patients as guinea pigs." Kratzke's young son, who also was under Stein's care, spent a year in a mental hospital, and his wife died while taking massive doses of narcotics that the doctor prescribed for her back pain.
     Stein, who holds degrees from Harvard and Yale universities, was once listed among Washingtonian magazine's best therapists. He told the board he hoped to treat Iraq war veterans suffering from post-traumatic stress disorder at the Veterans Affairs hospital in Washington. Armed with a battered cardboard banker's box tied with twine and a laptop computer containing patient records, he alternately apologized for and defended his treatment. His rambling answers were sometimes hard to follow.
     Stein, a Georgetown resident, said that his marriage has suffered and that he was "humiliated" by a 2003 investigation of his case by The Washington Post. That story examined the impact of years of inaction by the medical board, hospitals, professional societies and other doctors. At times, panel members seemed sympathetic. But they appeared visibly shocked when Stein defended his failure to see a patient who had been mutilating herself. "I'm very comfortable with patients cutting themselves," Stein said, adding that he did not consider it a serious problem. Most doctors disagree; cutting can be permanently disfiguring or cause fatal injury.
     Stein, who billed a patient $200 an hour to go shopping with her, said he had taken remedial courses on proper boundaries and prescribing. He said he would accept any conditions in order to be able to contribute "some very special skills." Neurologist Sam Potolicchio, a professor of medicine at George Washington University, said he was willing to help monitor Stein, whom he called "a very astute neuropsychiatrist" who was sometimes "misled" by patients. But Donna Rostant, a Fairfax lawyer who represented 12 clients whose malpractice cases against Stein were resolved confidentially, told the panel that it was patients who were misled. "I saw the fallout from this," Rostant said. "It destroyed some lives."



FDA: Chantix May Pose Psychiatric Risks
Matthew Perrone, Associated Press- 2/2/2008

WASHINGTON -- Government regulators said Friday the connection between Pfizer's anti-smoking drug Chantix and serious psychiatric problems is "increasingly likely." The Food and Drug Administration said it has received reports of 37 suicides and more than 400 of suicidal behavior in connection with the drug. In November, the agency began investigating reports of depression, agitation and suicidal behavior among patients taking the popular twice-daily pill.
     The agency's announcement comes two weeks after Pfizer added stronger warnings to the drug. In doing so, the company stressed that a direct link between Chantix and the reported psychiatric problems has not been established, but could not be ruled out. Pfizer suggested that since nicotine withdrawal alone can cause mood swings and agitation, it may be impossible to determine if Chantix aggravates those behaviors.
     But FDA said it found evidence of Chantix patients who experienced psychiatric problems even though they were still smoking. "There are a number of compelling cases that look like they are the result of exposure to the drug itself and not other causes," said Bob Rappaport, a director at FDA's drug evaluation center. Some patients experienced the same psychiatric problems after they stopped using Chantix, he said, suggesting a negative reaction to withdrawal.
      In a public advisory released Friday, FDA said patients taking Chantix should tell their doctor about any history of mental illness. Patients and family members should watch for any changes in mood and behavior. "Chantix may cause worsening of current psychiatric illness even if it is currently under control," reads the statement. "It may also cause an old psychiatric illness to reoccur." FDA noted that patients with psychiatric problems were not included in the original studies used to test Chantix's safety.
     Approved in May 2006, Chantix, already prescribed 4 million times in the U.S., has been one of the few bright spots on Pfizer's balance sheet. For full-year 2007, the drug had sales of $883 million, helping offset lower sales of older drugs, such as the antidepressant Zoloft, which face generic competition. The tablets work by binding to nicotine receptors in the brain, reducing the symptoms of withdrawal. GlaxoSmithKline makes Zyban, the only other non-nicotine, anti-smoking drug for sale in the U.S. Part of the antidepressant drug class, Zyban includes warnings about increased suicidal behavior.

Detox for the Camera. Doctor's Order!
Kara Jesella, New York Times- 2/3/2008

On the first episode of the VHF reality series "Celeb­rity Rehab With Dr. Drew," Jeff Conaway arrives for in-patient treatment at the Pasadena Recovery Center in California slumped over in the passenger seat of a car, caressing an open bottle of Dom Perignon. The actor, who starred in the television show "Taxi" and the movie "Grease," describes himself as "loaded," for which he blames people who, the night before, accused him of being an addict. "How dare they," Dr. Drew Pinsky says in a deadpan bit of gallows humor meant to lighten the mood.
      An easy rapport with television cameras and celebrity also-rans is not part of the job description for the typical doctor. But with his soap-opera looks and cool-dad aura, Dr. Pinsky, 49, has been famous in his own right for 25 years, all while navigating a precarious balance of professionalism and salaciousness. "I have a pretty keen ethical compass," Dr. Pinsky said by telephone from Pasadena, Calif., where he has a general medicine practice and is the medical director of the department of chemical dependency services at Las Encinas Hospital. "That's why I can walk this line."
     Some fans and fellow professionals say that with "Celebrity Rehab" he has careened over it. The show features low-wattage personalities, including the actress Brigitte Nielsen, an alumna of "The Surreal Life," and Jessica Sierra, a former "American Idol" contestant, undergoing detoxification treatments and group therapy under Dr. Pinsky's supervision. They can be seen throwing up, crying and having seizures on camera — images that are much grimmer than your average public-service announcement.
     Since the debut of "Celebrity Rehab" last month, Dr. Pinsky has been criticized by bloggers, recovering addicts, the news media and addiction specialists among others, who question his motivation for doing the show and challenge his confessional treatment methods, which seem to play to the television cameras. "I'm not confident that people who are patients, if you want to call them that, are in the best position to make decisions for themselves relative to such theatrics," said William C. Moyers, the executive director of the Center for Public Advocacy at Hazelden, a nonprofit rehabilitation and recovery center. The VH1 series, Mr. Moyers said, was "yet another example of the dumbing down and trivialization of a very serious chronic illness that robs people of their dignity and respect."
     From the time Dr. Pinsky emerged as a radio personality in 1982, he has mostly managed to stay above the fray. About that time, while still in medical school, acquaintances at the Los Angeles station KROQ persuaded him to join a late-night call-in radio show that was eventually titled "Loveline." On "Loveline," he advised callers on sex and relationships and also engaged in off-color banter with celebrities and such co-hosts as Adam Carona, whose raunchy comedy made Dr. Pinsky, with his studied paternalism, seem that more professional.
     By the time "Loveline" became a television show on MTV in 1996, Dr. Pinsky had become the Gen-X answer to Dr. Ruth Westheimer, with an AIDS era, pro­safe sex message. "You had Dr. Ruth encouraging people to have more sex," Dr. Pinsky said. "That was going to kill people."
     His work on "Loveline" led to other opportunities, including appearances in the. movie "Wild Hogs" and on the television show " Dawson's Creek." He remains a frequent magazine talking-head and talk-show guest, turning up recently on news and entertainment programs to speculate about the cause of Heath Ledger's death and the state of Britney Spears's mental health. "My goal was always to be part of pop culture and relevant to young people, to interact with the people they hold in high esteem," Dr. Pinsky said, "I have no social life except for the time I spend on the air with these people."
     But as the public has become fed up with the sad shenanigans of messed-up celebrities, so too have they wearied of the famous doctors they perceive to be trying to increase their own star power by association. Last month, Dr. Phil McGraw, the talk-show psychologist and one-man self-help franchise, visited Britney Spears after she was admitted to Cedars-Sinai Medical Center in Los Angles. Later, Dr. McGraw issued a statement about her mental health and announced plans for a show about the troubled star, leading to accusations that he was breaking medical codes of ethics in an attempt to increase his ratings. "I'm getting some of that backlash," Dr. Pinsky said.
     An advocacy group for recovering addicts, Faces and Voices of Recovery, began a letter writing campaign to VH1, criticizing "Celebrity Rehab." The entertainment Web site Hollywood.com chided Dr. Pinsky for being the best television doctor with ulterior motives. "People call it exploitative; I'm confused by that," said Dr. Pinsky. The celebrities on the show "know exactly what they're getting into and have allowed to resolve the problem, to help others," he added.
     Dr. Pinsky's longtime colleagues are quick to note that, unlike many media pundits who have just Ph.D.s, or have let their medical licenses lapse, Dr. Pinsky is a board-certified physician. "I was with the guy for 11 years," said Mr. Corolla, his former "Loveline" sidekick. "He would make the rounds at the hospital every day. I felt sorry for him because he would get lumped in with the Dr. Lauras and the Dr. Phils."
     Some fans worry that Dr. Pinsky is now taking advantage of celebrities on a channel known for turning bad behavior into hit programs, posting their concern on message boards on the VH1 Web site. "I have lost all respect for Dr. Drew," one fan wrote. "Dr. Drew should be ashamed to be part of this 'Survivor With Cigarettes' Show," Wrote another.
     Dr. Pinsky said he had concerns when a producer approached him with the idea for the show. "I thought it couldn't be done ethically; clinically," he said. He said he changed his mind when a colleague complained that there were no portrayals of rehab in the media he thought were authentic.
     Dr. Pinsky initially wanted to feature noncelebrities, then decided against it. "During the interview process, the regular people had no idea what they were getting into," he said. "They couldn't render consent. Celebrities understood. They got it."
     On the first episode of "Celebrity Rehab," Seth Binzer of the band Crazy Town, eagerly produced a crack pipe for the camera and then proceeded to smoke. "I've had cameras on me the last 10 years of my life," Mr. Binzer said in a telephone interview, adding that he has stayed sober since the show was filmed in August. "I'm comfortable around cameras."
     Dr. Pinsky declined to comment on the sobriety of his "Celebrity Rehab" patients while the show is still airing. "Some of that is part of the drama," Dr. Pinsky said. But he added that Mr. Binzer was not an anomaly. "All of them are significantly improved or actively engaged in recovery," Dr. Pinsky said. "I feel it was a transformative experience with them."
     Like many addicts, some of the "Celebrity Rehab" subjects have fallen off the wagon, including Ms. Sierra, the "American Idol" contestant, who was arrested for disorderly intoxication and obstruction of an officer. At the behest of Dr. Pinsky, a circuit judge in Tampa, Florida agreed to send Ms. Sierra to a private rehabilitation clinic, rather than to jail. But the judge also chastised both doctor and patient saying, "I don't want this to be some sort of stepping stone for her to have some sort of a career as a recovering addict."
     Mr. Binzer had no criticism for Dr. Pinsky, whom he cited as the reason he agreed to do the show. "I had done 'Loveline' a couple of times," Mr. Binzer said. "I already knew I love Drew and thought he was a good guy, light-hearted. For such a conservative doctor guy, he's still very hip. I've been in a lot of treatment centers, and this is the one that worked for me."

Addiction Remedy Is Being Misused
Fred Schulte & Doug Donovan, Baltimore Sun- 2/4/2008

In a report to federal regulators, the manufacturer of buprenorphine has provided the starkest evidence to date that misuse of the drug is growing in parts of the U.S. where it is most widely prescribed as an addiction treatment. Reckitt Benckiser Pharmaceuticals Inc. outlines problems such as a rise in the number of children sickened by accidentally ingesting the pills; an increase, in some areas, of people taking the drug to get high; and commonplace street sales in some cities.
     The U.S. Food and Drug Administration received the report Jan. 8. A spokesman for the agency said it is under review but declined to comment further. If federal officials conclude that abuse of the drug has become a problem, they can seek more controls over its distribution.
     The report linked misuse and illicit sales to the federally sanctioned practice of allowing doctors to prescribe large quantities of the drug for patients to take at home. "It was the patients in treatment for opioid abuse -- no doubt selling or trading their own supply of buprenorphine -- who were "seen .as major contributors to the street supply" the report stated.
     Federal officials didn't anticipate such abuses when they spent $26 million to develop the drug and help Reckitt Benckiser bring it to market. Congress considered buprenorphine, sold mainly in the U.S. as Suboxone, the centerpiece of its plan to broaden access to addiction treatment. The latest report parallels the findings of a series published in December in The Baltimore Sun, which revealed that while buprenorphine has been highly effective as an addiction treatment, misuse is increasing.
     Many specialists in addiction medicine believe that in the five years the drug has been on the Market, its benefits have outweighed problems.

Antidepressants Can Have a Dark Side
Christopher Weber, Chicago Tribune- 2/5/2008

Despite recent bad publicity over withheld studies showing marginal results, the resume of America's arsenal of antidepressants is enviable: consort to celebrities, subject of best-selling books and tabloid headlines. They may be the most celebrated pills since Valium. Prozac, Zoloft, Paxil, Celexa and Lexapro, among others, have become both household words and medicine-cabinet staples. Known collectively as selective serotonin reuptake inhibitors, or SSRIs, these antidepressants are prescribed for anxiety, social phobia, obsessive-compulsive disorder and numerous conditions besides depression.
     SSRIs are now the most commonly prescribed of all medications in this country. The rate at which physicians prescribed SSRIs more than doubled between 1995 and 2004, according to the Centers for Disease Control and Prevention. SSRIs are considered the first line of defense in treating depression, an illness that afflicts more than 20 million Americans.
Given their wide circulation, SSRIs will have a profound impact on the nation's mental health in the decades to come. But whether their impact is for good or ill depends upon whom you ask.
      Most antidepressants boost the amounts of messenger chemicals, or neurotransmitters, circulating in the brain. SSRIs were the first to target the key neurotransmitter serotonin, with highly touted results. In a recent study funded by the National Institutes of Mental Health, SSRIs helped 67 percent of participants recover from serious depression. But as SSRIs have become more common, so has criticism of them, and in some cases, with good reason.
     Just last month, a report in The New England Journal of Medicine showed that the makers of drugs such as Prozac and Paxil didn't publish results of trials indicating that their products performed just modestly better than placebos, which have no actual pharmaceutical value. Too, some users, citing personal experience, have raised concerns about these medications.
     Rosie Meysenburg of Dallas and Sara Bostock of California met at a public hearing on SSRIs sponsored by the Food and Drug Administration. Both had strong reservations about the safety of SSRIs. Together, they created a Web site, SSRIstories.com, which catalogs more than 2,000 news stories detailing violent acts -- murders, suicides, school shootings -- by individuals taking SSRIs. Bostock described the site as "a layman's effort to do an epidemiological study." She added, "We're just saying these events are associated with antidepressants. They reflect some kind of pattern."
     Most physicians maintain that SSRIs are safe. "If an individual is able to tolerate and respond positively to the first several months of antidepressant treatment, there's no reason to suspect that being on an antidepressant long term will have deleterious effects," said Dr. William Gilmer, associate professor at Northwestern University and medical director of the Asher Center for the Study and Treatment of Depressive Disorders. "After several million people have taken these drugs for extended periods of time," Gilmer continued, "we would have seen evidence of negative long-term effects by now if they existed to any significant degree."
     Dr. Ronald Duman, professor of psychiatry and pharmacology at Yale University, agreed. "There is no evidence at the present time that there are long-term side effects 10 to 20 years after taking SSRI antidepressants," he said. In fact, SSRIs may help patients years after taking them. Gilmer pointed out that there is evidence that SSRIs and other antidepressants can have a "neuroprotective effect" by reversing the structural deterioration that normally occurs in a depressed person's brain.
     So will SSRIs continue to grow in popularity? The answer depends on science yet to be forged. "We don't need more SSRIs," Gilmer argued. "We need medications and alternatives that work by completely different mechanisms. We also need more information to help us identify which treatment will be most effective for any particular individual." Such information already is starting to accumulate. A year ago researchers pinpointed a gene for a brain-derived protein that affects a person's ability to benefit from SSRIs.
     As scientists come to better understand how SSRIs work, they hope a better understanding of depression will follow. "As we learn more about the actions of antidepressants," Yale's Duman explained, "the design of new medications will be more informed and should lead to novel classes of more effective and faster-acting antidepressants."
     Ironically, the insights generated by SSRIs might curtail their circulation. Instead of being prescribed widely, physicians might give them only to patients with certain forms of depression, say, or specific genetic profiles. In other words, SSRIs may become less like aspirin in the future and more like insulin -- an effective drug used in very specific circumstances. And that may be a real advance.



Science of the Orgasm
Regina Nuzzo, Los Angeles Times- 2/10/2008

As they seek to document and demystify one of life's great thrills, scientists have run across some real head-scratchers. How, for example, can they explain the fact that some men and women who are paralyzed and numb below the waist are able to have orgasms? How to explain the "orgasmic auras" that can descend at the onset of epileptic seizures -- sensations so pleasurable they prompt some patients to refuse antiseizure medication? And how on Earth to explain the case of the amputee who felt his orgasms centered in that missing foot?
     No one -- no sexologist, no neuroscientist -- really knows. For a subject with so many armchair experts, the human orgasm is remarkably mysterious. But today, a few scientists are making real progress -- in part because they're changing their focus. To uncover the orgasm's secrets, researchers are looking beyond the clitoris, vagina, penis and prostate, to the place behind the scenes where the true magic happens. They're examining the central nervous system: the network of electrical impulses that zip to and fro through the brain and spinal cord. In an orgasm orchestra, the genitalia may be the instruments, but the central nervous system is the conductor.
     Armed with new lab tools and fearless volunteers, scientists are getting first-ever glimpses of how the brain lights up (and, in places, shuts down) when the orgasmic fireworks go off. They're tracing nerves and finding new pathways for pleasure that help explain how people with shattered spinal cords can defy sexual expectations.
     A few labs are even tinkering with devices that could put patients directly in touch with their orgasmic abilities by letting them observe their sexual brain patterns and "train" themselves to find the elusive frisson, or (in something akin to the Orgasmatron in Woody Allen's 1973 movie "Sleeper") letting them zap a sweet spot in their spinal cord with toe-curling electrical pulses. "There's a tremendous amount we don't know about orgasms," says Barry R. Komisaruk, psychology professor at Rutgers University and coauthor of the 2006 book "The Science of Orgasm." "But we're on the verge of getting a lot of very important information and really understanding what to do with it."
     It's not just the pleasure principle driving this research, says Julia R. Heiman, director of the Kinsey Institute, a nonprofit organization at Indiana University. Sex is an important part of human relationships, she says, which in turn can affect psychological health. "An awful lot of illness, or treatments for illnesses, interfere with people's orgasms," she says, including multiple sclerosis, cancer, Parkinson's disease, depression and diabetes.
     Indeed, if surveys are to be believed, this most delightful of experiences is elusive for many. About 43% of women and 31% of men in the U.S. between ages 18 and 60 meet criteria for sexual dysfunctions, according to a 1999 report on the sexual behavior of more than 3,000 U.S. adults. Orgasm researchers hope their efforts will help some of these people -- eventually. For now, reports are more likely to include the words "parasympathetic nervous system" than "try this at home tonight."

A difficult subject
It has never been easy to study any aspect of sexuality, let alone one so erotically center-stage as an orgasm. "Almost everybody is interested in orgasms, but it is also very difficult to start this kind of work," especially in the U.S., says Dr. Gert Holstege, a neurologist at University of Groningen in the Netherlands. "The Victorian time is still not over." So it's not surprising that some of the most impressive discoveries in the field of orgasm science were stumbled upon by accident. For example, Viagra originally was a drug being tested for treatment of high blood pressure and heart disease. Other touted aids lack formal proof. No doubt most of the nostrums available from pharmacies or the Internet derive their power from the "oh-please-please-make-this-work" power of the placebo effect. And though sexologists as far back as Alfred Kinsey have tallied people's orgasmic habits in exquisite detail, only now are researchers beginning to understand how it all works.
      Orgasms are difficult to define, let alone reverse-engineer. A few blueprints, however, have already been sketched out. First, stimulating the genitals sends electrical impulses along three main paths -- the pelvic, hypogastric and pudendal nerves. Next, these titillating signals enter the spinal cord at the base of the spine and zip up to brain regions that respond to genital sensations. Then other parts of the brain leap into action. Some send signals back down to the body with certain instructions -- lubricate the vagina, stiffen the penis, pump blood harder, breathe faster.
The intensity builds to a crescendo, and just like a long-awaited sneeze, tension is released in an explosive rush. The heart rate doubles. In women, the uterus contracts rhythmically; in men, sperm-carrying semen is propelled out of the body. And somehow, by mechanisms not yet understood, the brain perceives all this activity as a darn good feeling.
      Such a signaling pathway would seem to rule out orgasms for anyone whose spinal cord is completely severed, because people with such injuries cannot feel the brush of a finger across the penis or clitoris. But about two decades ago, anecdotal evidence started accumulating to the contrary. This was as a bit of a surprise to the medical profession, which for decades had told patients with damaged spinal cords to give up hope of a sex life. Researchers began to investigate.
      One, Dr. Marca Sipski-Alexander, published studies in 2001 and 2006 reporting that about 50% of 45 men and 44% of 68 women -- all with varying locations and degrees of spinal cord injury -- had orgasms in the lab, with the help of adult videos and genital stimulation by hand or vibrator.
     The findings show that the normal genitals-to-spine-to-brain route for an orgasm is not the only one. The best explanation may be that a touch unperceived by the brain can still be doing its work, says Alexander, a rehabilitation medicine professor at the University of Alabama at Birmingham School of Medicine. Alexander thinks that an orgasm, like urination, is a reflex. Both functions can be controlled partly by willpower. But just as voiding your bladder doesn't require the say-so of your higher brain, she says, maybe orgasms don't either. Maybe all that's needed is some chit-chat between pelvis and spinal cord.
     Some studies, mostly in animals, support this line of thought. In the brain stem and spinal cord, researchers have found hard-wired programs -- clusters of cells acting as primitive mini-brains of sorts -- that produce rhythmic movement without any higher brain input. These so-called central pattern generators are what let mollusks swim, rats crawl, tadpoles breathe and perhaps human males thrust their pelvises and ejaculate. Rat studies suggest that females, too, have these muscle-contracting proto-brains. But orgasms are more than just muscular contractions. They feel good. So how do the brains of spinal-cord-injured people sense the pleasure? "I don't know. No one knows that yet," Alexander says.

An alternate route
Rutgers University's Komisaruk and retired Rutgers professor Beverly Whipple, coauthor of "The Science of Orgasm" and "The G Spot and Other Discoveries About Human Sexuality," believe they do know. But they don't think an orgasm is a reflex. Through studies of spinal-cord-injured women, they've found evidence of what appears to be a new orgasmic pathway, one that bypasses the spine completely.
     The proposed detour makes use of a vast highway of nerves called the vagus nerve network. Like the vagabonds for which they were named, vagus nerves wander throughout the body. They start at the base of the brain, slide down the neck (but not the spinal cord) and stretch to all the major organs, and (at least in female rats) to the uterus and cervix. If vagus nerves reach human pelvises, genital signals could hopscotch over the spinal cord and still reach the brain.
     Animal experiments support the idea. Female rats with intact vagus nerves but snipped genital nerves (cutting off their signals to the spinal cord) still respond to vaginal stimulation in their normal, albeit rodent-like, fashion: enlarged pupils, rapt attention and a tendency to ignore painful stimuli applied to their paws. But when the vagus nerves in the pelvises are also severed, all these sexual responses stop.
     To investigate further, in a 2004 study, Komisaruk and Whipple worked with four women with shattered spinal cords. Each stimulated her cervix with a phallus while the researchers used fMRI scanning to measure brain activity. Despite their severed spinal cords, all women reported feeling the touch of the stimulator, Whipple says. The sensation at the cervix was reaching the brain. What's more, in the fMRI scans their brains lighted up in an area where vagus nerve signals are processed. And three of the volunteers experienced an orgasm.
     Komisaruk and Whipple have compared these brain images with those of women who are able to have orgasms by thought alone (who thus provide a clean brain image of a person reaching climax). They found that orgasms elicit strong activity in the nucleus accumbens, the reward center, which also lights up in response to nicotine, chocolate, cocaine and music; in the cerebellum, which helps coordinate muscle tension; and parts of the hypothalamus, which releases oxytocin, the trust and social-bonding hormone.
     Intriguingly, areas of the cortex that respond to pain also responded during orgasm. "Perhaps it's related to the fact that people often have pained expressions at the time of orgasm," Komisaruk says. The amygdala, the brain's emotional center, and the hippocampus, which deals with memory, light up too. This helps explain a medical mystery: When epileptic seizures start in these areas, the electrical frenzy can triggers euphoric feelings called orgasmic auras. Most patients find the experience displeasing. But in one published case, a 51-year-old woman said her auras were so pleasant she wouldn't consider antiepileptic drugs or surgery.

Role of inactive regions
Holstege's group has also studied the sexually stimulated brain, and his findings suggest that orgasms are not just about how the brain lights up but also about where it shuts off. In the late 1990s, his team recruited volunteers plus their sexual partners, who would stimulate them in the lab. To measure brain activity, the researchers used PET scanners, which require obsessive attention to timing. The stimulators were asked to induce an orgasm in their receivers within a two-minute window, with an eight-minute advance warning. (Couples were told to practice at home first.)
     Results from men and women were fairly similar, says Janniko R. Georgiadis, a neuroscientist at the University of Groningen and a study coauthor. There were several regions of activation, but the most striking result, Georgiadis says, was how certain regions in the front of the brain shut down during orgasm, especially one just behind the left eyeball. Researchers have long noticed that damage to this area -- the lateral orbitofrontal cortex -- can leave people with wildly antisocial and impulsive tendencies, including hypersexuality. Shutdowns in the brain's prefrontal cortex appears crucial, Georgiadis adds. "It's the seat of reason and behavioral control. But when you have an orgasm, you lose control."
     Regions called the temporal lobes also showed damped activity. In fact, the less activity these regions showed, the more sexually aroused the women felt. These deactivations might explain the appeal of autoerotic asphyxiation, the researchers say. Depriving a brain of blood during sex not only provides a dangerous thrill but also shuts down key brain regions, leading to addictive orgasmic euphorias.

Unsticking the brain
Back in New Jersey, Komisaruk is trying to apply some of this new brain knowledge. He is studying two extremes: women who complain of constant sexual arousal and find no relief in orgasms and those who can never have an orgasm. He hopes to reveal where their brains are "stuck" and help them alter their brain patterns.
     The setup is simple: Women lying in an MRI scanner watch a computer display of their brain activity. Scans of women with persistent genital arousal disorder reveal unusually high activation in regions that respond to genital stimulation. It shows, Komisaruk says, that the women's complaints are real. Their brain thinks the genitals are constantly being stimulated.
     Komisaruk is coaching them to use neuro-feedback -- mental strategies such as counting or imagery -- to alter their brain activity. If they see those genital brain regions cooling seconds after their mental exercises, they can refine their techniques and eventually do it without the scanner, whenever these brain areas again slip into hyperdrive.
     Fire rather than ice might be the trick for anorgasmic women, whom Komisaruk plans to study next. For some women, clitoral stimulation might travel along the spinal cord but then is somehow blocked so they don't travel to the brain regions they need to. "We want to see if there's a blockage somewhere and if that blockage is susceptible to a change in mental activity," he says. Anorgasmic women might practice in a lab with a vibrator, trying to mimic other women's successful brain patterns.
     The brain is surprisingly plastic, Komisaruk says. Witness the curious case -- described by UC San Diego neuroscientist Dr. V.S. Ramachandran -- of the man who had orgasms in his phantom foot. When the man's foot was amputated, cells in the "foot" part of the brain were suddenly deprived of stimulation. They died, leaving prime cerebral real estate vacant. Then, like an opportunistic roommate, a neighboring region in the man's brain likely sent sprouts to commandeer the vacated landscape. That region? One that processes input from penis and vulva.
The result: The man felt foot-sized orgasms in a foot he no longer had. Nothing quite so drastic is expected to occur with a bit of orgasmic neural training in the lab, Komisaruk says. But the anecdote points out that the brain is indeed capable of some very imaginative tricks.



Lawmakers Weigh Parental Notification Changes
Anita Kumar, Washington Post- 2/10/2008

RICHMOND -- After last spring's shooting at Virginia Tech, the extent of the confusion over federal privacy laws at college campuses became obvious. Can schools contact parents with concerns about their adult children? Should they? What can they say?
      State lawmakers are considering several proposals that would require officials at Virginia's public colleges and universities to notify a parent if a student is deemed a danger to himself or others, something that did not happen in the case of Virginia Tech shooter Seung Hui Cho. "It's critically important that parents be brought in," said Del. Robert B. Bell (R-Charlottesville), who introduced one of the bills.
     But officials at some schools are worried that the proposals will have serious negative consequences, including discouraging students from seeking needed mental health treatment and placing the burden of responsibility on colleges. "This law is a mistake,'' said Jeff Pollard, director of counseling and psychological services at George Mason University. "It will put people at risk."
     Bell said his bill, which has been combined with similar proposals, tries to balance privacy rights with safety concerns while providing the guidelines schools asked for after the Virginia Tech shootings. The bill has been modified to address concerns that it would have forced schools to contact abusive parents and so as not to hold colleges liable for what happens after parents are notified.
     Kirsten Nelson, director of communications and government relations at the State Council of Higher Education for Virginia, said the bill should not apply to students who are feeling down because they are feuding with their roommate or have a broken relationship, but rather carefully written to address students who are an "imminent danger to themselves or another person." "It's important to us that the bill be narrow, limited,'' she said.
     The House passed the bill Thursday and sent it to the Senate. Gov. Timothy M. Kaine (D) said he wants to see details of the bill before making a decision. He is unsure whether notification should be mandatory. "It should have been done already,'' said William Kim, whose 21-year-old son, Daniel, a Virginia Tech senior, killed himself in December. Kim said he was never told of his son's problems, even after at least one student at another college contacted Virginia Tech to say that Daniel had bought a gun and was talking about killing himself. "How did they think this wasn't necessary?" Kim said schools, including Virginia Tech, should have changed their policies after Cho shot and killed 32 people and himself in April. After the shooting, many of the victims' families questioned why Cho's parents were not told that he had been ordered to get mental health treatment.
     A panel appointed by Kaine found that concerns about privacy restrictions led to communication problems among school officials, some of whom mistakenly believed that education or medical laws prevented them from sharing information. Lawmakers and education experts said school officials often mistakenly think that the Family Educational Rights and Privacy Act prevents them from sharing information with parents and others. The law, enacted in 1974 to protect student education records, does not prevent schools from calling parents, or others, if students are a danger to themselves or others. "There is nothing that prohibits a school from calling parents and saying, 'We're nervous about your child,' " Kaine said. "The notion that privacy laws mean that 'I can't call a parent' -- it's absurd. It's ridiculous." Pollard, of GMU, said the school provides mental health counseling for about 10 percent of its 30,000 students. Once or twice a month, he said, school officials contact parents, police or a hospital because of concerns about a student.
     Congress also is considering a bill that would call on school officials to contact parents if a student is considered suicidal or has threatened to attack someone. It was passed by the Senate last year and is awaiting action by the House. In Virginia, other proposals being considered during the 60-day legislative session require a government employee who is providing mental health treatment to an underage person to notify a parent within five days. That bill has passed the House of Delegates and has been sent to the Senate for consideration.
     "Parents are part of the solution. We need to ensure they have the express right to be involved when their children are having serious mental issues,'' said Del. L. Scott Lingamfelter (R-Prince William), who sponsored the bill. Del. Joseph D. Morrissey (D-Richmond) voted for the bill but questioned the "chilling effect" the proposal might have on students who might not want to seek treatment if their parents are notified.

But just as all the neighbors — on the wall —
Are drawing a long breath to shout “Hurray!”
The strangest whim has seized me ... After all
I think I will not hang myself today.

     Finally, doctors who have spent their lives studying suicide say that it is, almost always, a complex combination of factors — the stars aligning, darkly — that leads to the act. In his forensic analyses of suicides, Dr. Maris tries to evaluate biological factors, like drug metabolism, as well as family history, sleep habits, personality, and what was happening in the person’s life. Did a spouse threaten to leave? Did a person get fired? Did a best friend just die? “In that context, then, you have to ask what the drug contributed,” Dr. Maris said. “And often the person is taking more than one medication.”
      Perhaps the only thing all parties agree on is that better data is needed. In a paper in The Journal of the American Medical Association last year, the psychiatrists Dr. Donald Klein of Columbia University and Dr. Charles O’Brien of the University of Pennsylvania argued that the best way to study the risk of rare side effects was to establish large, linked databases of patients, including medical records and prescription histories. Such a system could be created in the United States in a short time, they wrote, but “the possibility has received almost no public discussion or legislative attention.” And until it does, doctors, regulators and patients alike will have their theories — that the drugs do pose a serious risk; or that the dangers are being exaggerated — and likely see in the limited evidence some confirmation.
     Not unlike the tormented souls themselves who are pondering a final exit. In his classic study, “The Savage God,” the English poet and critic A. Alvarez, a failed suicide himself, wrote that suicide is “a closed world with its own irresistible logic. ... Once a man decides to take his own life he enters a shut-off, impregnable but wholly convincing world where every detail fits and each incidence reinforces his decision.”