Noteworthy News Articles on Mental Health Topics, February 16-21, 2008
NYPD Arrests Man in Therapist Slaying Colleen Long & Adam Goldman, Associated Press- 2/16/2008 NEW YORK - A 39-year-old man with a history of mental problems was arrested Saturday in the vicious slaying of a psychologist attacked in her office with a meat cleaver, police said. David Tarloff of Queens was taken into custody in the morning after investigators matched him with three palm prints found at the bloody crime scene, said Police Commissioner Raymond Kelly. Tarloff made statements incriminating himself during a 25-minute interrogation, Kelly said. The questioning stopped when he asked for a lawyer, and it wasn't clear later Saturday whether he had an attorney. Murder and attempted murder charges are pending, Kelly said. Therapist Kathryn Faughey was slashed 15 times with the cleaver and a 9-inch knife in her Manhattan office Tuesday evening. A psychiatrist who worked in the building, Dr. Kent Shinbach, went to Faughey's aid and was badly injured. During questioning, Tarloff said he had gone to the office because Shinbach had him institutionalized in 1991. He said he planned to rob the psychiatrist and leave the country with his mother, who lives in a nursing home, but until recently had lived with him in an apartment in Queens. Kelly couldn't confirm whether Tarloff was ever Shinbach's patient, or whether he had met Faughey. It remained unclear why Tarloff would have attacked Faughey, police said. The breakthrough in the case came as friends, relatives and former patients attended a funeral for the slain therapist in Manhattan. "I hope this arrest provides some measure of solace at this terrible time for her husband and the rest of her family," Kelly said. Neighbors described Tarloff as a troubled, erratic, sometimes combative man who would occasionally wander the halls half-clothed, muttering to himself. He attended Syracuse University but did not graduate and was unemployed, neighbors said. Tarloff had been arrested about two weeks ago for punching a security guard in the face at St. John's Episcopal Hospital after he was asked to leave, Kelly said. It wasn't clear why he was at the hospital. Police matched his prints from the Feb. 1 arrest with three found on a roller suitcase left at the crime scene. The suitcase was filled with adult diapers and women's clothing and was left near the basement door where the killer escaped. A smaller bag was also found with rope, duct tape and knives not used in the attack, police said. Investigators established Tarloff's identity early Saturday and found his address on an application he had submitted in 2001 to the city's Taxi and Limousine Commission, which licenses cabdrivers. Police then moved swiftly to locate him. Detectives discovered him at his apartment, and he went voluntarily to the 19th Precinct near where the attack occurred, Kelly said. Kelly described his demeanor as "calm" but said Tarloff had cuts on his right hand. During the interrogation, Tarloff claimed he had been institutionalized or incarcerated 20 times -- a figure Kelly said didn't appear to be accurate. There was a whirl of police activity at the Queens apartment Saturday afternoon. Police barred nonresidents as officers came and went. Police searched Tarloff's apartment and were collecting possible evidence, Kelly said. One neighbor who has known the family for decades, Phyllis Zicherman, said that Tarloff had seemed down lately, but that she was stunned to hear he was a suspect. "He had problems, but he was never violent," she said. Sisters Betty and Margaret Feeney, who live below Tarloff, said they have known him his entire life. They described him as unstable but were shocked that he was accused in the slaying. "I know he's crazy and everything," said Betty, 72. "I don't think that he's capable of doing something like that -- of killing somebody. I really don't." She said that Tarloff would come around asking for money but that she would not give it to him. "I would keep out of the elevator if I saw him. I was scared of him. I wouldn't go near where he would be," she said. "He used to make terrible noise above us. We had an awful time with him. He was tramping back and forth all hours of the night." Investigators said the pudgy, balding, middle-aged killer arrived around 8 p.m. Tuesday, telling the doorman he had an appointment with Shinbach, then sat in the waiting room with another of Shinbach's patients until she went into his office around 8:30 p.m. Sometime after that, the killer entered Faughey's office and attacked her. Shinbach came to her aid but was assaulted, pinned behind a chair and robbed of $90. The killer then tried to attack Shinbach's patient, but she fended him off and he fled. Blood was splattered on the walls and pooled on the floor of Faughey's office and was found on the basement door, police said. Three witnesses, including Shinbach, picked Tarloff out of a lineup, Kelly said. Shinbach was taken to New York-Presbyterian Hospital/Weill Cornell Medical Center with slash wounds on his head, face and hands. Kelly said the psychiatrist was released Saturday. Schools Have Stepped Up Mental Health Intervention Jodi Cohen & Bonnie Rubin, Chicago Tribune- 2/17/2008 Since the shooting rampage at Virginia Tech last spring, colleges nationwide have tried to do a better job of detecting and treating students who exhibit volatile or potentially violent behavior, mental health experts said. "One thing that has happened around the country, there is a much lower threshold now for when a student is acting strangely to insist that they be evaluated," said Richard Kadison, Harvard University's chief of mental health services. Colleges are being more proactive in encouraging students to seek help. Some schools now have more stringent requirements in deciding when students must meet with a counselor. Others have beefed up their mental health staffs. "If we make mistakes," Kadison said, "let's make them on the side of being conservative and get students in for evaluations." Already lauded nationally for its strict counseling requirement for suicidal students, the University of Illinois counseling department expanded its reach after a gunman with a history of psychiatric problems killed 32 people and himself in April at Virginia Tech. "If a student starts yelling at a professor, we step in," said Paul Joffe, a counselor at the Urbana-Champaign campus. Steven Kazmierczak, identified as the gunman at Northern Illinois University last week, was a U. of I. student, but officials would not say whether he had received counseling at the school, citing health privacy laws. Law enforcement sources said he was taking medication for an anxiety disorder, and police said Friday he had recently stopped taking his medication. He reportedly spent time in a Chicago psychiatric treatment facility in the late 1990s. "What we try to do is engage directly with someone we are concerned about," Joffe said. "We are doing that more systematically than we had in the past." Faculty also have become more sensitive to students' writings, looking for possible violent tendencies, said William Riley, U. of I. dean of students. Northern Illinois' Web site includes a guide from the counseling department that suggests ways to recognize emotionally troubled students. Kazmierczak attended NIU as a graduate student before switching to the U. of I. Situations are divided into three levels, with Level 3 behaviors indicating students need emergency care. Those include homicidal or suicidal threats, the inability to communicate clearly and highly disruptive behavior. Faculty are urged to refer those students for counseling. Last week, a mental health task force of the American College Health Association convened in Baltimore to discuss prevention strategies, said Joy Himmel, who oversees health services at Penn State-Altoona. "If there's anything that's positive that comes from these tragedies it's the impetus to have people work together collaboratively," she said. An Illinois group, too, is studying whether more should be done. A campus security task force created after the Virginia Tech shooting sent a survey in January to about 180 colleges to gather data on mental health services. About 85 percent of schools responded, and the findings will be made public next month. The survey is intended to learn if there are any gaps in services, said Tom Green, spokesman for the Illinois Department of Human Services. Still, professionals caution against overzealousness that can increase stigma for those with mental disorders. For a student with a psychiatric disorder to be expelled, Himmel said, "it normally has to reach a pattern and severity of not responding to intervention." Whenever large numbers of young people live together, "there is more disruptive behavior that has nothing to do with mental illness," she said. "Students come in drunk at 4 a.m. and vomit on their roommate's bed. . . . We have to make sure we hold everyone to the same standards." ‘Have You Ever Been in Psychotherapy, Doctor?’ Richard A. Friedman, M.D., New York Times- 2/19/2008 A curious thing happened to one of my psychiatric residents not long ago. One of his patients caught him off guard with a challenging question: “Have you ever been in psychotherapy yourself? He was uncomfortable answering the question directly, so he spent some time trying to discover why it mattered to his patient. “He wanted to know if I knew what it felt like to be ill and helpless,” the resident said. It was an interesting question, and it made me wonder whether one could be a good therapist without having been in psychotherapy. If the answer was no, it would appear to be at odds with what we do in the rest of medical practice. After all, we don’t require neurologists to have a spinal tap or cardiac surgeons to have undergone bypass surgery before performing these medical procedures. But there is something special about psychotherapy, I think, that sets it apart. Of course, the doctor-patient relationship is important in any clinical encounter. But in therapy, the relationship is the very instrument of the treatment. If your cardiologist does not have the best bedside manner but effectively treats your hypertension, you might not be happy, but at least you are heading in the right medical direction. In contrast, if you do not have a rapport with your therapist, then the treatment is useless. To be any good, a cardiologist should be an expert in the use of his instrument, whether the stethoscope or the cardiac catheter. But how does this principle apply to psychotherapists? One way to think about it is that a therapist should not start exploring a patient’s mind without really knowing what is in his own. Therapists, just like their patients, bring their own life experiences into treatment, which influence their feelings about their patients — a process called countertransference. Therapists who do not understand their own countertransference run the risk not just of misunderstanding their patients, but of confusing their own hang-ups with those of their patients. Once a resident asked me to help him deal with a difficult patient, whom he actually dreaded seeing. It was easy to see why. The patient, a 35-year-old man, told me that my resident was incapable of understanding him and then angrily dismissed his therapist as inexperienced (right) and unfeeling (wrong). My resident turned out to have plenty of feeling that he did not know what to do with. He felt angry, humiliated and trapped. This patient, who felt disappointed and mistreated by the world, was simply giving the therapist a taste of his own narcissism. It did not help that this patient bore a striking resemblance to my resident’s older brother, whom he found critical and demeaning. The resident had never had therapy himself, but just realizing the origin of his negative feelings helped him deal with this difficult patient. Nowadays, most psychiatric residents finish their training without having had any personal psychotherapy. This is a departure from the past, when psychotherapy reigned supreme and a personal psychoanalysis was a rite of passage for trainees. The explosion of neuroscience, along with the pressure of market forces, has had a powerful effect on the training of young psychiatrists. Not all of it is good. Being a psychiatrist and psychopharmacologist, I could not be more thrilled with the promise of brain science. And there is no question that we have more effective biological treatments for the major psychiatric disorders than at any point in the past. But even as we have been swept off our feet by sexy neuroscience, my field is in danger of losing touch with the rich psychological life of patients, something that is reflected in the waning popularity of therapy during residency training. Does it really matter? After all, psychiatrists are too expensive and too few to treat the vast majority of patients who need psychotherapy. Psychiatrists of the future are more likely going to be consultants in the treatment of patients with the most serious mental illnesses like schizophrenia, mood disorders and complicated substance abuse. All true, but we are far from understanding the ultimate cause of most psychiatric disorders, despite the promise of brain science. We can effectively relieve symptoms and increase functioning, but we still have to help our patients live with illness. Psychiatrists who have had the humbling experience of therapy themselves know something of what it feels like to be a patient — the sense of frustration, anxiety and dependence it entails. As such, they can better understand the emotional reactions patients have to their illness — and to their doctors. I don’t know about you, but that sounds like the kind of psychiatrist I would want taking care of me. Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College. Midlife Suicide Rises, Puzzling Researchers Patricia Cohen, New York Times- 2/19/2008 Shannon Neal can instantly tell you the best night of her life: Tuesday, Dec. 23, 2003, the Hinsdale Academy debutante ball. Her father, Steven Neal, a 54-year-old political columnist for The Chicago Sun-Times, was in his tux, white gloves and tie. “My dad walked me down and took a little bow,” she said, and then the two of them goofed it up on the dance floor as they laughed and laughed. A few weeks later, Mr. Neal parked his car in his garage, turned on the motor and waited until carbon monoxide filled the enclosed space and took his breath, and his life, away. Later, his wife, Susan, would recall that he had just finished a new book, his seventh, and that “it took a lot out of him.” His medication was also taking a toll, putting him in the hospital overnight with worries about his heart. Still, those who knew him were blindsided. “If I had just 30 seconds with him now,” Ms. Neal said of her father, “I would want all these answers.” Mr. Neal is part of an unusually large increase in suicides among middle-aged Americans in recent years. Just why thousands of men and women have crossed the line between enduring life’s burdens and surrendering to them is a painful question for their loved ones. But for officials, it is a surprising and baffling public health mystery. A new five-year analysis of the nation’s death rates recently released by the federal Centers for Disease Control and Prevention found that the suicide rate among 45-to-54-year-olds increased nearly 20 percent from 1999 to 2004, the latest year studied, far outpacing changes in nearly every other age group. (All figures are adjusted for population.) For women 45 to 54, the rate leapt 31 percent. “That is certainly a break from trends of the past,” said Ann Haas, the research director of the American Foundation for Suicide Prevention. By contrast, the suicide rate for 15-to-19-year-olds increased less than 2 percent during that five-year period — and decreased among people 65 and older. The question is why. What happened in 1999 that caused the suicide rate to suddenly rise primarily for those in midlife? For health experts, it is like discovering the wreckage of a plane crash without finding the black box that recorded flight data just before the aircraft went down. Experts say that the poignancy of a young death and higher suicide rates among the very old in the past have drawn the vast majority of news attention and prevention resources. For example, $82 million was devoted to youth suicide prevention programs in 2004, after the 21-year-old son of Senator Gordon H. Smith, Republican of Oregon, killed himself. Suicide in middle age, by comparison, is often seen as coming at the end of a long downhill slide, a problem of alcoholics and addicts, society’s losers. “There’s a social-bias issue here,” said Dr. Eric C. Caine, co-director at the Center for the Study of Prevention of Suicide at the University of Rochester Medical Center, explaining why suicide in the middle years of life had not been extensively studied before. There is a “national support system for those under 19, and those 65 and older,” Dr. Caine added, but not for people in between, even though “the bulk of the burden from suicide is in the middle years of life.” Of the more than 32,000 people who committed suicide in 2004, 14,607 were 40 to 64 years old (6,906 of those were 45 to 54); 5,198 were over 65; 2,434 were under 21 years old. Complicating any analysis is the nature of suicide itself. It cannot be diagnosed through a simple X-ray or blood test. Official statistics include the method of suicide — a gun, for instance, or a drug overdose — but they do not say whether the victim was an addict or a first-time drug user. And although an unusual event might cause the suicide rate to spike, like in Thailand after Asia’s economic collapse in 1997, suicide much more frequently punctuates a long series of troubles — mental illness, substance abuse, unemployment, failed romances. Without a “psychological autopsy” into someone’s mental health, Dr. Caine said, “we’re kind of in the dark.” The lack of concrete research has given rise to all kinds of theories, including a sudden drop in the use of hormone-replacement therapy by menopausal women after health warnings in 2002, higher rates of depression among baby boomers or a simple statistical fluke. At the moment, the prime suspect is the skyrocketing use — and abuse — of prescription drugs. During the same five-year period included in the study, there was a staggering increase in the total number of drug overdoses, both intentional and accidental, like the one that recently killed the 28-year-old actor Heath Ledger. Illicit drugs also increase risky behaviors, C.D.C. officials point out, noting that users’ rates of suicide can be 15 to 25 times as great as the general population. Jeffrey Smith, a vigorous fisherman and hunter, began ordering prescription drugs like Ambien and Viagra over the Internet when he was in his late 40s and the prospect of growing older began to gnaw at him, said his daughter, Michelle Ray Smith, who appears on the television soap “Guiding Light.” Five days before his 50th birthday, he sat in his S.U.V. in Bloomfield Hills, Mich., letting carbon monoxide fill his car. Linda Cronin was 43 and working in a gym when she gulped down a lethal dose of prescription drugs in her Denver apartment in 2006, after battling eating disorders and depression for years. Looking at the puzzling 28.8 percent rise in the suicide rate among women ages 50 to 54, Andrew C. Leon, a professor of biostatistics in psychiatry at Cornell, suggested that a drop in the use of hormone replacement therapy after 2002 might be implicated. It may be that without the therapy, more women fell into depression, Dr. Leon said, but he cautioned this was just speculation. Despite the sharp rise in suicide among middle-aged women, the total number who died is still relatively small: 834 in the 50-to-54-year-old category in 2004. Over all, four of five people who commit suicide are men. (For men 45 to 54, the five-year rate increase was 15.6 percent.) Veterans are another vulnerable group. Some surveys show they account for one in five suicides, said Dr. Ira Katz, who oversees mental health programs at the Department of Veterans Affairs. That is why the agency joined the national toll-free suicide hot line last August. In the last five years, Dr. Katz said, the agency has noticed that the highest suicide rates have been among middle-aged men and women. Those most affected are not returning from Iraq or Afghanistan, he said, but those who served in Vietnam or right after, when the draft ended and the all-volunteer force began. “The current generation of older people seems to be at lesser risk for depression throughout their lifetimes” than the middle-aged, he said. That observation seems to match what Myrna M. Weissman, the chief of the department in Clinical-Genetic Epidemiology at New York State Psychiatric Institute, concluded was a susceptibility to depression among the affluent and healthy baby boom generation two decades ago, in a 1989 study published in The Journal of the American Medical Association. One possible reason she offered was the growing pressures of modern life, like the changing shape of families and more frequent moves away from friends and relatives that have frayed social support networks. More recently, reports of a study that spanned 80 countries found that around the world, middle-aged people were unhappier than those in any other age group, but that conclusion has been challenged by other research, which found that among Americans, middle age is the happiest time of life. Indeed, statistics can sometimes be as confusing as they are enlightening. Shifts in how deaths are tallied make it difficult to compare rates before and after 1999, C.D.C. officials said. Epidemiologists also emphasize that at least another five years of data on suicide are needed before any firm conclusions can be reached about a trend. The confusion over the evidence reflects the confusion and mystery at the heart of suicide itself. Ms. Cronin explained in a note that she had struggled with an inexplicable gloom that would leave her cowering tearfully in a closet as early as age 9. After attempting suicide before, she had checked into a residential treatment program not long before she died, but after a month, her insurance ran out. Her parents had offered to continue the payments, but her sister, Kelly Gifford, said Ms. Cronin did not want to burden them. Ms. Gifford added, “I think she just got sick of trying to get better.” Gunman’s Use of Antidepressant Renew Debate Over Side Effects Benedict Carey, New York Times- 2/19/2008 Steven P. Kazmierczak stopped taking Prozac before he shot to death five Northern Illinois University students and himself, his girlfriend said Sunday in a remark likely to fuel the debate over the risks and benefits of drug treatment for emotional problems. Over the years, the antidepressant Prozac and its cousins, including Paxil and Zoloft, have been linked to suicide and violence in hundreds of patients. Tens of millions of people have taken them, and doctors say it is almost impossible to tell whether the spasms of violence stem in part from drug reactions or the underlying illnesses. “It’s a real chicken-and-egg sort of situation,” said Dr. Jane E. Garland, director of the Mood and Anxiety Disorders Clinic at BC Children’s Hospital in Vancouver, British Columbia. Dr. Garland said some people could and did become agitated and unpredictable in response to the drugs, usually just after starting to take them or soon after stopping. “But it’s hard to make a case for a withdrawal reaction here, because Prozac comes out of the system gradually,” she said. The girlfriend, Jessica Baty, said in an interview on CNN that Mr. Kazmierczak took Prozac to battle anxiety and compulsive behavior but that it “made him feel like a zombie and lazy.” She said that in the days leading up to the shooting he was not behaving erratically, as university officials had suggested. Much of the debate over the side effects of antidepressants focuses on erratic behavior like the cautious college student who stabs herself or the good husband and father who buys a gun and shoots himself. The drug labels warn about agitation and severe restlessness, and display a prominent caution that the medications increase the risk of suicidal thinking and behavior in some children and young adults. Psychiatrists said Monday that stopping an antidepressant could cause effects like lightheadedness, nausea and agitation as the brain adjusted. Among the most commonly prescribed drugs, Prozac is the least likely to cause withdrawal effects because it stays in the system longest, the doctors said. “A small dose of Prozac is what you might use to block withdrawal symptoms when you take a patient off one of the other drugs,” said Dr. Donald Klein, an emeritus professor of psychiatry at Columbia who has consulted with drug companies. Sara Bostock, of Atherton, Calif., whose daughter committed suicide shortly after taking Paxil, acknowledged that the interaction between drug effects and underlying emotional distress was hard to untangle. Ms. Bostock wrote in an e-mail message, “As an observer and suicide survivor, my main wish is that medical professionals, regulatory authorities and other scientists will examine closely the entire medical and treatment history of the perpetrators of these violent incidents in which innocent people are victims.” She is a founder of ssristories.com, a Web site that has tallied 2,000 news reports of violent acts in which people were thought to be taking antidepressants or had recently stopped them. “If it weren’t for us, many of these stories would be lost to oblivion forever,” Ms. Bostock said. Psychiatrists say the debate on such side effects, particularly suicide in the last four years, has driven many patients from drugs that could help save their lives. The psychiatrists emphasize that patients should be closely monitored for changes in behavior when starting or tapering off a medication. Advocates on both sides agree that catalogs of violent acts are not enough and that news reports are incomplete. Only more thorough investigation and careful tracking of drug side effects, they say, will clarify the links between drug treatment and violent behavior. Dr. Michael Stone, a professor of clinical psychiatry at Columbia, maintains a database of 1,000 violent crimes, including mass murders, going back decades. In many cases the accused had stopped taking drugs for schizophrenia, Dr. Stone said. “I only have a handful of cases,” he added, “where the person was on an antidepressant.” Father Tells of Slaying Suspect’s Long Ordeal Eric Konigsberg & Ann Farmer, New York Times- 2/20/2008 On Saturday, shortly after the police arrested David Tarloff, he was permitted to talk on the phone with his father. “Dad, they say I killed some lady,” he said, according to his father, Leonard Tarloff. “What are they talking about?” Then, Mr. Tarloff said in an interview on Tuesday, his son asked for things he had always requested during his numerous visits to the city’s psychiatric wards: a pile of quarters so he could call his parents, and a bag of potato chips. For father and son, it was the latest and most wrenching turn in an ordeal that began in 1991, a long struggle in which Leonard Tarloff repeatedly found himself working to get his son treatment for mental illness . On Tuesday, David Tarloff, 39, remained at Bellevue Hospital Center, where he was under evaluation after his arrest in the killing of a psychologist, Kathryn Faughey, on the Upper East Side last week. The police said that after repeatedly stabbing Dr. Faughey, he then slashed and seriously wounded Dr. Kent D. Shinbach, a psychiatrist working in the same suite. Dr. Shinbach played a role in Mr. Tarloff’s diagnosis of schizophrenia 17 years ago and was his principal target, the police said. Mr. Tarloff told the police that he had sought out Dr. Shinbach to rob him and then intended to leave the country or go to Hawaii with his ailing mother, Beatrice, who has been living in a series of nursing homes since 2003. Leonard Tarloff surmised that his son might have planned to kidnap Dr. Shinbach to get access to Beatrice Tarloff. “I think maybe he thought, ‘If I have a psychiatrist with me, they’ll let me see my mother,’ ” Mr. Tarloff said. Leonard and Beatrice Tarloff are divorced. In the interview on Tuesday, David Tarloff’s father and his brother, Robert, described his sudden and precipitous descent into illness and their own dealings with a mental health system that, in general, prohibits patients from being hospitalized against their will unless they have been proven to be dangerous to themselves or to others. Leonard Tarloff, an executive for an international transportation company in Queens, and Robert Tarloff, a special-education teacher who is married with three children, recalled David as handsome, smart and happy when he was growing up in Corona, Queens. His troubles surfaced after he enrolled at Syracuse University. “He came back home and he was changed,” his father said. He was moody, and at first Leonard Tarloff suspected he had a drug problem. “All of a sudden, he became catatonic,” he added. “He couldn’t talk.” He said his son would see things and believed that people were looking at him and were against him. He could not hold a job for longer than a day; he also attended St. John’s University and the University of Miami, but left both times before one semester was through. He would walk the streets picking up cigarette butts, and his father said he had obsessions. “There were times when he would take showers 15 or 20 times in a day,” Leonard Tarloff said. It caused the younger man’s mother to worry that the water would flood the apartment below. If his son said something mean, Mr. Tarloff said, “later he would say, ‘I’m sorry.’ ” He added, “But he’d have to say ‘sorry’ in a particular way. He’d call back 20 times or more to say it right so that it would go away.” In 1991, when David Tarloff was 22, his behavior was troublesome enough that his father, on the advice of a personal physician, took him to see Dr. Shinbach. The doctor, Leonard Tarloff said, diagnosed “acute paranoid schizophrenia.” His parents obtained a court order to have him involuntarily committed. He was taken to Gracie Square Hospital in Manhattan and kept for 40 days, the limit under Leonard Tarloff’s insurance coverage. David Tarloff was evaluated and committed more than a dozen times after that, family members said. Over the years, he was put on a handful of drugs used to treat schizophrenic or bipolar patients: lithium, Depakote, Haldol, Seroquel and Zyprexa. Several times, he was treated at NewYork Presbyterian/Weill Cornell Medical Center on the Upper East Side. Therapies included shock treatment. The typical pattern, his father said, involved his son taking his medication long enough to become stabilized, at which point, over the family’s protest, the hospitals would release him. “He’d feel better and then say to himself, ‘I feel good. There’s nothing wrong,’ and stop taking his medications.” At one point, the family invoked Kendra’s Law, passed by the State Legislature after a young woman, Kendra Webdale, was pushed to her death on the subway tracks in 1999 by a man who had stopped taking his antipsychotic medication. The law allows family members and others to seek a court order forcing someone to undergo outpatient psychiatric treatment, even if he or she does not meet the standard for involuntary hospitalization. Leonard Tarloff said, however, that even this approach failed, as his son was able to frequently avoid those assigned to monitor him. “They’d come to get him and ring the bell,” he said. “When he didn’t answer, they went away.” David Tarloff’s behavior deteriorated even more after his mother entered a nursing home. Three times, she was transferred to another nursing home after workers at the nursing homes became uncomfortable with her son’s constant hounding. “He felt they weren’t caring for her correctly,” Mr. Tarloff said. Last June, the police took David Tarloff to Elmhurst Hospital Center after he threatened to kill everyone at the Midway Nursing Home in Queens. After a stay at Elmhurst, he managed to avoid being sent to a voluntary program at the Creedmoor Psychiatric Center, according to his father. Instead, he went to Baltimore to try to see his brother. Then he returned. A spokesman from Elmhurst said he could not comment because of confidentiality rules. “He called me and says he’s on Staten Island and in a taxi and the cabdriver can’t find me,” Mr. Tarloff said. When his father met the taxi, he recalled: “He looked completely crazy. He said, ‘Dad, I love you. Let’s go get a Coke.’ ” But his father would soon call the police, saying his son had stopped taking his medication and was acting violently. He was taken to Staten Island University Hospital, where he stayed until November. On Feb. 1, David Tarloff was arrested at St. John’s Episcopal Hospital in Far Rockaway, Queens, where his mother had been transferred. “He was laying in bed next to his mother,” Leonard Tarloff said. “The guard says, ‘You can’t do that. It’s the I.C.U.’ He got into a fight with the guard.” His brother said David and their mother were close. “He comforted her and she comforted him,” he said, but added, “She did call the police on him when he was acting terribly at home.” After David Tarloff was examined by a doctor at St. John’s, who determined that he did not need to be kept there, the police took him to the 101st Precinct station house, Leonard Tarloff said. He said that he frantically tried to get his son committed. He said he tried to get a social worker at Staten Island University Hospital to call the authorities and explain just how sick his son was, but was told that the hospital could not release any information on his condition because of confidentiality rules. David Tarloff was released by a judge the day after his arrest. Leonard Tarloff visited his son at Bellevue on Tuesday. “He didn’t really say anything,” he said. “He didn’t talk about the situation. He’s in a fog. He’s very lethargic.” He speculated that his son was being heavily medicated. “We’ve done everything we could have thought of,” Leonard Tarloff said. “My son’s life was over 20 years ago when this first struck.” A Home Remedy for Juvenile Offenders Leslie Kaufman, New York Times- 2/20/2008 When Jacob Rivera, 15, was resentenced in May on an assault conviction, he felt he had received a “blessing.” Only months earlier he had been sentenced to a year in state custody, and he had already spent weeks bouncing between a juvenile detention center in the Bronx and a residential treatment campus upstate. Two of his older siblings had spent time in those facilities and, he said, had “come out a mess.” He could see his future. But the court gave him a second chance because his case had not been properly reviewed for inclusion in a new alternative sentencing program, which the city started in February 2007. The program, called the Juvenile Justice Initiative, sends medium-risk offenders back to their families and provides intensive therapy. The city says that in just a year, it has seen significant success for the juveniles enrolled, as well as cost savings from the reduced use of residential treatment centers. Under the program, Jacob went back home on probation, and he and his family were assigned a counselor, Eddy Lee, who visited the two-bedroom Bronx apartment that the teenager shares with his mother, Michelle Rivera, her husband, a younger brother and other relatives. Within weeks, the situation improved as Mr. Lee provided intensive counseling to the family, with the aim of defusing what had become an increasingly angry relationship between Jacob and his mother. Instead of screaming at Jacob when he refused to comply with her curfew, Ms. Rivera called Mr. Lee. Over time, Mr. Lee persuaded her to agree to be less strict if her son would agree to be more forthcoming about his whereabouts, and more responsible. Soon Jacob started meeting curfew and began passing his court-ordered drug tests and staying in school. If he continues on this course, he will end his probation in July, Mr. Lee said. By the standards of juvenile justice, Jacob is a resounding success. And he is not alone. The city said that in the year since the program began, fewer than 35 percent of the 275 youths who have been through it have been rearrested or violated probation. State studies found that more than 80 percent of male juvenile offenders who had served time in correctional facilities were rearrested within three years of their release, usually on more serious charges. While in-home services mean that hundreds of teenagers with criminal records are returned to their communities, city officials say it is a trade they are willing to make. “It’s an uphill battle,” says Ronald E. Richter, the city’s family services coordinator. “These young people and their families present complex challenges.” But whether the children go to residential correctional facilities or not, they come back to the community eventually anyway, Mr. Richter said, and the program “helps parents learn how to supervise and manage their adolescents so that they act responsibly instead of engaging in dangerous behaviors.” Every year, hundreds of children in the city under 16 are found guilty of crimes ranging from graffiti to assault. They are tried and sentenced in the family courts; more serious crimes like murder are usually sent to the criminal courts. Until the Juvenile Justice Initiative, family court judges had few options for dealing with youngsters convicted of less-serious crimes. They could place them on probation and hope for the best, or send them to upstate residential centers. The decision would typically depend as much on the gravity of the crime as on the stability of the child’s family. Judges are more likely to send a child into state custody if the home situation is complicated or unsafe. “We were locking up way too many children, ” said Leslie Abbey, who runs the program for the city’s Administration for Children’s Services. “It was relied on too heavily, and it wasn’t working.” The problem with incarceration, as juvenile justice reformers saw it, was that it could make behavior worse by introducing teenagers to even more hardened youths. Some states and other counties in New York, including Westchester, have been experimenting for years with intensive in-home and in-community therapy for children who have significant criminal records but are not psychopathic. The basic idea is to reach and help borderline youths at a moment of crisis, and turn them away from a more serious criminal path. By treating them in the context of their families and environments rather than in isolation, officials found that recidivism was usually less than half that of residential correction programs. The city says that it hopes its program will be as successful, but that it will take many years before it can be sure. Still, at roughly $17,000 per child, such in-home therapy programs cost a fraction of the annual expense of keeping a child in secure detention, which can be $140,000 to $200,000. In fact, the financial incentive is such that both the city and state are rapidly moving away from residential detention. Gladys Carrión, the commissioner of the state’s Office of Children and Family Services, recently announced that she would close six nonsecure facilities, a cut that will save the state $16 million a year. The elimination of detention beds puts more pressure on the city to succeed. It is a tough order, but Qadriyyah Razzaaq, for one, is a believer. Ms. Razzaaq has been caring for John Whittington, 15, the son of a cousin, since he was 5. But last year, Ms. Razzaaq, a home health aide with her own children to care for and a job that often requires her to work 12 hours a day, was ready to give up on John, who was getting into ever more serious trouble. First, on a dare, he set a fire in a school toilet, she said. Then he began running with gangs, and his graffiti appeared in hallways in his apartment building. Finally, she said, he robbed someone of an iPod. When he was arrested for the iPod theft, she didn’t even go to detention to get him. “I was so angry,” she recalled. “I thought, ‘I am going to leave him there and teach him a lesson.’ ” When Ms. Razzaaq heard about the Juvenile Justice Initiative, she was not optimistic. “He had already been in counseling,” she said, “I didn’t believe it would help.” But to her amazement, the therapy at home made a difference. The counselors told her that John had been keeping secrets from her because he was afraid she would abandon him, the way his mother had. She spent more time with him alone, something he seemed to crave. His behavior improved. John will still fail the seventh grade for a third time at the end of the school year, but so far he has not violated probation. At home, Ms. Razzaaq has a new level of trust. “We have little problems, but we speak about it first,” she said. “He doesn’t wait to be caught. “I know his future is so much better than it would have been if he had gone upstate.” Anger Makes for a Deadly Bed Partner Patrick Kampert, Chicago Tribune- 2/20/2008 Going to bed while mad at your spouse could mean fewer mornings left in your lifetime. That's because a University of Michigan study led by professor emeritus Ernest Harburg has shown that ignoring the timeworn advice of not going to bed angry makes you twice as likely to die younger. Harburg studied four types of couples: ones in which the wife suppressed her anger while the husband expressed his, couples where the wife expresses anger and the husband suppresses, couples where both spouses express anger, and couples where both spouses suppress anger. The spouses who both suppressed their anger died in double the numbers of the couples who got things out in the open in a constructive way. "There are good fights and there are bad fights," Harburg cautioned. "A good fight is: 'What's the problem and let's solve it.' It's the solving of the problem that makes the stress go away." In a bad fight, though, one spouse is being attacked unfairly and doesn't say anything. Instead, he or she suppresses it, stews about it and replays it in his or her mind. "Your anger," Harburg said, "continues in your body and influences and affects your blood pressure and the respiratory system." When Yvette Gideon of Evanston married Rodger Sonneborn 22 years ago, his grandparents gave them the don't-go-to-bed-mad advice. Gideon said she and her husband's biggest adjustments came in dealing with extended families: Sonneborn's kin are numerous, while Gideon had none in the U.S. because her parents emigrated from Switzerland. "I remember being newly married and saying, 'I don't want to be an appendage of your parents. We're a family as a couple without kids.'" It helps, Gideon said, that both she and her husband are outgoing. "It's hard to suppress some stuff when you want to get it out," she said with a laugh. Sonneborn, she said, has helped her become less blunt. And don't forget the role of humor to defuse a situation, she added. "He would say, 'I'm always falling over your shoes.' So, as a joke, I would line up a bunch of shoes." Creating peace University of Michigan professor Ernest Harburg says most couples have never been taught how to come to a consensus. At 81, he offers four tips for living longer and reaching compromises: * Learn to listen. * Don't interrupt. * Restate what you're hearing the other person saying. * Then try to resolve the problem. Doctors: Prozac, Violence Rarely Linked Jeremy Manier, Chicago Tribune- 2/20/2008 In the wake of Steven Kazmierczak's murderous shooting spree at Northern Illinois University, law-enforcement officials noted he had begun to behave erratically after he recently stopped taking psychiatric medication. That fact might seem to offer a tidy explanation for his rampage, or at least some insight into his troubled mind. But psychiatrists say suspending a patient's use of antidepressants -- Prozac, in Kazmierczak's case -- is rarely linked to violence toward others. When used under a therapist's supervision, they stress, such medication can help people overcome depression and other mental ailments. And while the source of Kazmierczak's state of mind remains a mystery, experts said it's unlikely that halting his Prozac therapy would have led directly to his shooting plot. At the same time, psychiatrists say, his case may help reinforce a key lesson: Stopping antidepressant therapy suddenly can be risky if patients do not follow a doctor's instructions and don't report any negative effects. About one-fifth of people who halt a course of Prozac-like drugs report symptoms associated with a condition known as discontinuation syndrome, which can include abdominal pain, dizziness, crying spells, irritability and even a sensation similar to an electrical shock in the patient's arms or legs. Kazmierczak's former girlfriend, Jessica Baty, told CNN on Sunday that he had stopped taking Prozac because "he said it made him feel like a zombie." One crucial detail left unanswered is whether Kazmierczak stopped the medication under the advice of a doctor or if he did it on his own. Several experts said that because of discontinuation syndrome, they advise patients who stop to do so gradually and to call if they experience worrisome symptoms. With most patients, that's enough to forestall any serious adverse effects. "Your body has to adjust to being off the medication," said Dr. Joan Anzia, an associate professor of psychiatry at Northwestern University's Feinberg School of Medicine. "Some people are more sensitive to it than others." For some people, stopping antidepressants abruptly may leave them briefly worse off than they were before they took the medication. That's because of the effect that Prozac and similar drugs have on serotonin, a chemical messenger in the brain that plays a key role in depression, obsessive-compulsive disorder and other psychological conditions. Serotonin carries signals among brain cells that affect mood, appetite and sexuality, among other brain functions. Although the biological roots of depression are a source of controversy, some research suggests it may stem in part from low levels of serotonin. The Prozac class of antidepressants -- also called SSRIs -- works by producing a surplus of serotonin in the brain. The excess serotonin can ease anxiety, curb unwanted impulses and relieve depression. It can also lead to diverse side effects, including the "zombie"-like lack of motivation that Kazmierczak's former girlfriend described. But other patients experience virtually the opposite problem in the form of akathisia, a state of extreme restlessness. The added serotonin may also change how some brain cells function, by decreasing their normal response to the chemical. That may worsen the effects of low serotonin levels when patients abruptly stop taking antidepressants. "The issue is how fast you reduce the serotonin activity," said Dr. William Scheftner, chair of psychiatry at Rush University Medical Center. "If the drug dosage is lowered gradually you have the opportunity to make adjustments." It's rare for patients who are stopping antidepressants to report severe psychological effects, but such reports do exist. Last month, doctors from Stanford University published a case study of a woman who began having symptoms of delusion within days of halting her Prozac therapy. The patient imagined hearing her son's voice even though he wasn't there, had uncontrollable crying spells and at one point said, "I am Jesus." In one other case of multiple homicides, the Columbine school shootings, assailant Eric Harris had been taking the antidepressant Luvox before the murders. Harris claimed on a videotaped message that he stopped taking the pills in order to let his anger grow without the restraint of the medication. It's true that antidepressants such as Prozac can reduce impulsive aggression in patients who are prone to such problems, said Dr. Emil Coccaro, chair of psychiatry at the University of Chicago Medical Center. For such patients, going off the drug may lead to loss of impulse control and more aggressiveness, he said. Yet Coccaro noted that the NIU murders did not appear to be a case of impulsive killings. Kazmierczak planned the spree in advance, and apparently sent goodbye messages and phone calls the night before the murders. "That looks like premeditated behavior," Coccaro said. "He didn't just snap." In addition, unlike Zoloft and other similar medications that disperse from the body rapidly once patients stop taking them, Prozac persists in the body for weeks. That can cushion the sudden effects of going off the drug, experts said. Patients who take Prozac in low doses -- about 25 milligrams per day or less -- tend to have the fewest side effects when stopping the drug, said Anzia of Northwestern. Kazmierczak's dosage level is unclear. The idea that Prozac itself leads patients to violence has gained little scientific support. In 2004, the U.S. Food and Drug Administration required drug companies to put a warning label on antidepressants such as Prozac, stating that the drugs may provoke suicidal thoughts in young adults. That move was controversial, and a study last year by University of Illinois at Chicago researcher Robert Gibbons showed that suicide rates among young adults have increased as antidepressant use declined. Many experts point to such studies as evidence that whatever the risks of antidepressants, they are outweighed by the drugs' effectiveness at preventing suicide by treating patients' depression. For now, the public information about Kazmierczak's psychological history remains incomplete, making it nearly impossible to guess what mental problems may have affected his behavior. But experts said it may be significant that Kazmierczak's former girlfriend said he cut himself as a teenager. Cutting can be a sign of serious psychological problems, Coccaro said, and that history of trouble is at least as important as the medication that Kazmierczak took. "It's hard to believe this just appeared from nowhere," Coccaro said. A Traditional Therapy Finds Modern Uses Camille Sweeney, New York Times- 2/21/2008 Quitting cigarettes had always been agony for Michele Fenzl, a 55-year-old computer operator from Denver. Pregnancy got her to stop for a while. But in 35 years of smoking a pack a day, nothing else gave her a reprieve. Until ear seeds. Last June, her acupuncturist, Karen Kurtak of the Frontier Medical Institute, started affixing tiny black seeds of a Vaccaria plant to specific points on her ears, to quell cravings between twice-weekly sessions with needles. It is hard to say which aspect of her multipronged program helped Ms. Fenzl stop smoking, but she attributes her success to the seeds taped onto her ears that she calls “life savers.” Long part of traditional Chinese medicine, “auricular therapy,” as it is called, entails stimulating key points of the outer ear (corresponding to body parts and functions) with seeds or needles as in traditional acupuncture. The practice is now increasingly being used nationwide to treat an array of ailments. Ear seeds have long been used stateside for addiction treatment. But today, with the growing demand for alternative therapies, there has been an increase in the practice of using ear seeds (or their metallurgic equivalents, acubeads and ear magnets) for health issues from anxiety to pain to insomnia. “They are used for people in situations of trauma, for example in the aftermaths of 9/11, Katrina, the California wildfires,” said Cynthia Neipris, an acupuncturist in New York and the director of outreach and community education for the Pacific College of Oriental Medicine, which trains students to use ear seeds. “And, because the seeds are worn home, it’s an added plus because it involves the patient in their own healing process.” It is not known precisely how ear seeds work nor has enough research been done to prove which ailments they help relieve. But licensed acupuncturists as well as doctors from world-class hospitals recommend them. Dr. P. Grace Harrell, an anesthesiologist and an acupuncturist at Massachusetts General Hospital in Boston who uses seeds and acubeads to help treat back pain, suggests they may stimulate activity in the brain. But that is a guess. “We don’t know exactly what the ear seeds do,” she said. “What I do know is that more people are wearing them. I have patients coming in and asking for the seeds.” Staff acupuncturists at rehabilitation centers like Promises Treatment Center in Malibu, Calif., have long recommended ear seeds to help alleviate “physiological symptoms associated with addiction,” said Donna Markus, the executive director. They have been useful for anxiety and depression as well, she said. Do the conspicuous seeds draw unwanted attention? “No one has ever commented on them,” said Laura Soncrant, 32, who wears the seeds because of her insomnia. She said that pressing on them throughout the day has improved her sleep to the point that she can’t live without them now. “Since I wear them between acupuncture sessions, and my sessions are once every two weeks, there are even those days when the seeds have fallen off and I want to go to the acupuncturist just for them.” When Addicted Son Hurts, Father Feels His Own Pain Janet Maslin, New York Times- 2/21/2008 Addiction is a compulsion to do the same thing over and over, despite knowing that the outcome will almost certainly be the same. Addiction memoirs often illustrate this same definition of insanity. They follow the same arc, voice the same helplessness and arrive at the same set of conclusions. Yet the genre itself remains so addictive that readers keep hoping to discover something new. There are reasons to hope that David Sheff’s “Beautiful Boy” will be exceptional. For one thing, it is one of the rare books selected for sale by Starbucks; somebody thinks it is riveting enough to capture the interest of a caffeinated clientele. For another, its subject is methamphetamine addiction, which exerts such body-snatching effects on those who succumb to it. A cycle of madness and decline prompted by crystal meth goes well beyond the horrors of garden-variety substance abuse. What’s more, “Beautiful Boy” is heightened by a medical emergency that befell Mr. Sheff as well as the drama surrounding his son Nic Sheff. In the midst of weathering the grief and worry that came with watching Nic deteriorate, the senior Mr. Sheff suffered a brain hemorrhage. Did the son’s addiction and recidivism contribute to the father’s health crisis? In the words of one of the many therapists who drift through this book, often to frustratingly little effect for the Sheffs, “Well, it sure didn’t help.” This story’s emphasis depends on which Sheff is telling it. Nic has written his own book, “Tweak: Growing Up on Methamphetamines” (Ginee Seo Books/Atheneum Books for Young Readers, an imprint of Simon & Schuster). It is being published concurrently with “Beautiful Boy,” though it’s not a Starbucks book selection. Nic’s version is rougher, slangier and more in keeping with his literary tastes, which favor Baudelaire, Rimbaud, Camus and Bukowski. “Somehow the idea of being this drug-fueled, outsider artist has always been really appealing to me,” Nic writes in “Tweak” while detailing the hard drugs, street life and criminal activity about which his father could only guess. The older Mr. Sheff approaches the family story more conventionally, with more of the baby boom parent’s standard narcissism. As a father he is inclined to place himself tearfully at the center of Nic’s troubles. “People outside can vilify me,” he writes. “They can criticize me. They can blame me. Nic can. But nothing they can say or do is worse than what I do to myself every day. ‘You didn’t cause it.’ I do not believe it.” So he traces Nic’s unhappiness back to his own divorce — and to his own drug use, which he once regarded as a relatively harmless recreation. Now he is mortified that he ever found Hunter S. Thompson funny and that he tried father-son marijuana smoking as a way of bonding with Nic. In their overlapping accounts, which share many painful details (Nic stole from both of his trusting, younger half siblings), the trouble escalates with sad inevitability. According to “Beautiful Boy,” the father saw early signs of his son’s problems but was easily assuaged by the boy’s excuses. And there were few useful guidelines that the father could follow. (“Is your child suddenly volunteering to clean up after cocktail parties but forgetting his other chores?” asked one list of warning signs on which the father tried to rely.) By the time the police appeared to take Nic away in handcuffs, the father realized how much he had managed to ignore — and how irreversible Nic’s problems might be. “When I am alone,” the father writes, “I weep in a way that I have not wept since I was a young boy.” He is driven to this misery by realizing how insidiously meth addiction affects brain chemistry, how rarely it is successfully treated and how maddeningly close Nic comes to recovery, staying clean for long periods before abruptly relapsing. The reportorial side of “Beautiful Boy” explores the likelihood of a cure and comes up with little reason for hope. “There’s never going to be a drug that will make you check the peephole before you answer the door, so if it’s your dealer you won’t answer it,” one researcher tells the father. The preliminary version of “Beautiful Boy” was a tough 2005 article in The New York Times Magazine, “My Addicted Son.” In expanding it into a book Mr. Sheff added some of the warm, fuzzy dailiness of family life to an otherwise stark portrait (both “Beautiful Boy” and “Tweak” describe rituals like carpooling), and, inevitably, he lost some certitude. The article ended with the hope that Nic might finally have outrun his demons; the book ends on a less resolute but perhaps more realistic note. Among Mr. Sheff’s conclusions: Nic might have benefited from being forced into rehab when his parents were still legally able to compel him to go, if only to keep him substance-free during a critical phase of adolescent development. It also ends with the demonstrably true idea that it is therapeutic both to read and to write stories like the Sheffs’. On the long, crowded shelf of addiction memoirs “Beautiful Boy” is more notable for sturdiness and sense than for new insight. Even when paired with “Tweak” for a two-faceted look at the same events, it is not unprecedented. (“From Binge to Blackout: A Mother and Son Struggle With Teen Drinking,” about the drastically different perspectives of Chris Volkmann and her son Toren, remains a particularly visceral parent-child cautionary tale.) And on the subjects of parental worry, guilt and mourning, the singer Judy Collins wrote “Sanity & Grace” with exemplary wisdom. Compared with these more specialized books, “Beautiful Boy” has the advantage only when it comes to Starbucks-generated prominence. “Beautiful Boy” does illustrate how the most clichéd insights into addiction can also be the most accurate. Nothing here is more succinct than what Nic’s little brother says when he tries to explain addiction. “It’s like in cartoons when some character has a devil on one shoulder,” the boy says, “and an angel on the other.” |