Noteworthy News Articles on Mental Health Topics, June 1-15, 2008
THE CROWD SOUNDS HAPPY
A Story of Love, Madness, and Baseball.
By Nicholas Dawidoff.
271 pp. Pantheon Books. $24.95.
Sam Stephenson, New York Times Bood Review- 6/1/2008
As a junior in high school in 1984 I studied Russell Baker’s Pulitzer Prize-winning 1982 memoir, “Growing Up,” in which he recounted his childhood after his father died when Baker was 5. He grew up in rural, Depression-era Virginia, without plumbing or electricity, and later in Baltimore. Baker demonstrated that ordinary tales told plainly could rise to the level of art, and the book stuck with me over the years, through the rise of the memoir industry, as a premier example of writing about boyhood.
Nicholas Dawidoff’s memoir, “The Crowd Sounds Happy,” is a successor to “Growing Up,” and it deserves as much attention. Dawidoff, at 45, is a generation younger than Baker (he was 19 when the 57-year-old Baker came out with his book in 1982), and his story is more complicated, involving not his father’s death but something perhaps more insidious, mental illness. The book grew out of Dawidoff’s New Yorker magazine article, “My Father’s Troubles,” published in 2000, and he expands the father-son focus into a beautiful portrait of a wounded family.
Dawidoff’s father earned degrees from Harvard and Yale, but not long after his marriage, he began talking to squirrels, claiming they instructed him to act violently toward his family. Dawidoff’s parents divorced in 1966, and Dawidoff, who was 3, settled with his mother and infant sister into a two-family home in New Haven. His duty-honoring mother, a schoolteacher, gave the children the bedrooms while she slept on a converted sofa in the living room. The kids made dreaded, often harrowing monthly visits to see their father in New York. Once, when “Nicky” was 6, he visited the Washington zoo with his father, who became enraged and took off, leaving Dawidoff no choice but to run after him. In restaurants his father would verbally abuse the waitresses and then make passes at them. He would also go into rages with eyes bulging, declaring that all the women in the family were whores, including Nicky’s beloved Aunt Susi. “Your father is supposed to protect you,” Dawidoff writes, “and mine was scaring the hell out of me.”
In passages often heartbreakingly honest, Dawidoff evokes the “unpredictable sources of harm” he felt at every turn. Some are fairly typical adolescent insecurities — fear of schoolyard bullies, shyness around girls, the shame of his clothing and his family’s duplex — and others are pure terror: a girl in his elementary school is kidnapped and her corpse is found in the woods.
Many pages pass without mention of his father, and throughout the book, Dawidoff beautifully blends in familiar details of a 1960s and ’70s youth — Space Food Sticks, the Hardy Boys, Top-Siders and Tretorn sneakers, Lacoste shirts, Farrah Fawcett-Majors. Though his mother rarely buys popular consumer items, not even a television, Dawidoff portrays these lacks with no cynicism, only pain. As he grows older he gradually realizes that no matter how bad he has it, the black residents of New Haven’s horrid, segregationist public housing projects have it worse.
Dawidoff’s safe haven was baseball. He was introduced to it by his aunt and uncle and a grandfather. His early baseball education came from books. He read and reread Ted Williams’s autobiography, finding solace in the man’s loner qualities, and he commiserated with Williams’s dysfunctional family. He also pored over Lawrence Ritter’s oral history masterpiece, “The Glory of Their Times.” Before he experienced live action as a fan or a player — Dawidoff eventually played on Harvard’s team — he learned that baseball had the narrative qualities of literature. “With the game’s system of making a tangible record of every substantive event, there was a stability and an order to baseball. ... It could be known,” he writes.
He became a Red Sox fanatic, his imagination ignited by the radio broadcasts. The announcer welcomed listeners to Fenway Park every night, “and right then,” Dawidoff says, “a part of me zoomed down the I-91 highway entrance ramp and lifted out of New Haven. ... As he introduced the players position by position — ‘Jim Rice left field, Fred Lynn center field’ — it was like having the cast of characters read aloud to you from the beginning of a Russian novel.”
Dawidoff’s grandfather Alexander Gerschenkron, a Harvard economist who was the subject of Dawidoff’s brilliant biography, “The Fly Swatter,” was a Russian immigrant. His major work argued that underdeveloped countries enjoyed opportunities that economic powers didn’t have; that “backward” countries could skip steps and “spurt” forward. In effect, Gerschenkron created economic theories to match the compassionate literary values of his heroes Tolstoy, Pushkin, Chekhov and Turgenev.
Dawidoff inherited his grandfather’s belief in the special possibilities for long sufferers. In an earlier book, “In the Country of Country,” he explored the working-class roots of the music of Ralph Stanley, Jimmie Rodgers, Patsy Cline and others.
The voice in “The Crowd Sounds Happy” is inquisitive and graceful while sparing no pain, and it makes one wish Dawidoff had a broader platform, like Russell Baker’s old New York Times column. Dawidoff writes, “When you are young there is the terrible inability to understand that it’s your deficits that will make others not only like you but feel close to you.” He learned this bit of wisdom, but I’m not sure many other adults have. If they did, then crowds might be happy.
The Science of Sarcasm (Not That You Care)
Dan Hurley, New York Times- 6/3/2008
There was nothing very interesting in Katherine P. Rankin’s study of sarcasm — at least, nothing worth your important time. All she did was use an M.R.I. to find the place in the brain where the ability to detect sarcasm resides. But then, you probably already knew it was in the right parahippocampal gyrus.
What you may not have realized is that perceiving sarcasm, the smirking put-down that buries its barb by stating the opposite, requires a nifty mental trick that lies at the heart of social relations: figuring out what others are thinking. Those who lose the ability, whether through a head injury or the frontotemporal dementias afflicting the patients in Dr. Rankin’s study, just do not get it when someone says during a hurricane, “Nice weather we’re having.” “A lot of the social cognition we take for granted and learn through childhood, the ability to appreciate that someone else is being ironic or sarcastic or angry — the so-called theory of mind that allows us to get inside someone else’s head — is characteristically lost very early in the course of frontotemporal dementia,” said Dr. Bradley F. Boeve, a behavioral neurologist at the Mayo Clinic in Rochester, Minn. “It’s very disturbing for family members, but neurologists haven’t had good tools for measuring it,” he went on. “That’s why I found this study by Kate Rankin and her group so fascinating.”
Dr. Rankin, a neuropsychologist and assistant professor in the Memory and Aging Center at the University of California, San Francisco, used an innovative test developed in 2002, the Awareness of Social Inference Test, or Tasit. It incorporates videotaped examples of exchanges in which a person’s words seem straightforward enough on paper, but are delivered in a sarcastic style so ridiculously obvious to the able-brained that they seem lifted from a sitcom. “I was testing people’s ability to detect sarcasm based entirely on paralinguistic cues, the manner of expression,” Dr. Rankin said.
In one videotaped exchange, a man walks into the room of a colleague named Ruth to tell her that he cannot take a class of hers that he had previously promised to take. “Don’t be silly, you shouldn’t feel bad about it,” she replies, hitting the kind of high and low registers of a voice usually reserved for talking to toddlers. “I know you’re busy — it probably wasn’t fair to expect you to squeeze it in,” she says, her lips curled in derision.
Although people with mild Alzheimer’s disease perceived the sarcasm as well as anyone, it went over the heads of many of those with semantic dementia, a progressive brain disease in which people forget words and their meanings. “You would think that because they lose language, they would pay close attention to the paralinguistic elements of the communication,” Dr. Rankin said.
To her surprise, though, the magnetic resonance scans revealed that the part of the brain lost among those who failed to perceive sarcasm was not in the left hemisphere of the brain, which specializes in language and social interactions, but in a part of the right hemisphere previously identified as important only to detecting contextual background changes in visual tests. “The right parahippocampal gyrus must be involved in detecting more than just visual context — it perceives social context as well,” Dr. Rankin said.
The discovery fits with an increasingly nuanced view of the right hemisphere’s role, said Dr. Anjan Chatterjee, an associate professor in the Center for Cognitive Neuroscience at the University of Pennsylvania. “The left hemisphere does language in the narrow sense, understanding of individual words and sentences,” Dr. Chatterjee said. “But it’s now thought that the appreciation of humor and language that is not literal, puns and jokes, requires the right hemisphere.”
Dr. Boeve, at the Mayo Clinic, said that beyond the curiosity factor of mapping the cognitive tasks of the brain’s ridges and furrows, the study offered hope that a test like Tasit could help in the diagnosis of frontotemporal dementia. “These people normally do perfectly well on traditional neuropsychological tests early in the course of their disease,” he said. “The family will say the person has changed dramatically, but even neurologists will often just shrug them off as having a midlife crisis.” Short of giving such a test, he said, the best way to diagnose such problems is by talking with family members about how the person has changed over time.
After a presentation of her findings at the American Academy of Neurology’s annual meeting in April, Dr. Rankin was asked whether even those with intact brains might have differences in brain areas that explain how well they pick up on sarcasm. “We all have strengths and weaknesses in our cognitive abilities, including our ability to detect social cues,” she said. “There may be volume-based differences in certain regions that explain variations in all sorts of cognitive abilities.”
So is it possible that Jon Stewart, who wields sarcasm like a machete on “The Daily Show,” has an unusually large right parahippocampal gyrus? “His is probably just normal,” Dr. Rankin said. “The right parahippocampal gyrus is involved in detecting sarcasm, not being sarcastic.” But, she quickly added, “I bet Jon Stewart has a huge right frontal lobe; that’s where the sense of humor is detected on M.R.I.” A spokesman for Mr. Stewart said he would have no comment — not that a big-shot television star like Jon Stewart would care about the size of his neuroanatomy.
Soldiers' Recovery From Stress Complicated
Ann Tyson, Washington Post- 6/3/2008
FORT BENNING, Ga. -- Army Sgt. Jonathan Strickland sits in his room at noon with the blinds drawn, seeking the sleep that has eluded him since he was knocked out by the blast of a Baghdad car bomb. Like many of the wounded soldiers living in the newly built "warrior transition" barracks here, the soft-spoken 25-year-old suffers from post-traumatic stress disorder. But even as Strickland and his comrades struggle with nightmares, anxiety and flashbacks from their wartime experiences, the sounds of gunfire have followed them here, just outside their windows.
Across the street from their assigned housing, about 200 yards away, are some of the Army infantry's main firing ranges, and day and night, several days each week, barrages from rifles and machine guns echo around Strickland's building. The noise makes the wounded cringe, startle in their formations, and stay awake and on edge, according to several soldiers interviewed at the barracks last month. The gunfire recently sent one soldier to the emergency room with an anxiety attack, they said. "You hear a lot of shots, it puts you in a defensive mode," said Strickland, who spent a year with an infantry platoon in Baghdad and has since received a diagnosis of PTSD from the military. He now takes medicine for anxiety and insomnia. "My heart starts racing and I get all excited and irritable," he said, adding that the adrenaline surge "puts me back in that mind frame that I am actually there."
Soldiers interviewed said complaints to medical personnel at Fort Benning's Martin Army Community Hospital and officers in their chain of command have brought no relief, prompting one soldier's father to contact The Washington Post. Fort Benning officials said that they were unaware of specific complaints but that decisions about housing and treatment for soldiers with PTSD depend on the severity of each case. They said day and night training must continue as new soldiers arrive and the Army grows. "Fort Benning is a training unit, so there is gunfire around us all the time," said Elaine Kelley, a behavioral health supervisor at the base hospital. If a soldier had a severe problem, it would have been identified, she said. Lt. Col. Sean Mulcahey, who recently took command of the Warrior Transition Battalion, where wounded soldiers are assigned, said: "No soldier has talked with me about the ranges." If it is an issue, "we will address it," he said, stressing that the battalion's mission is "getting those soldiers to heal."
Under Army rules, commanders of warrior transition units are supposed to enforce "quiet hours." Officials said the location of the barracks for wounded soldiers, along with a $1.2 million Soldier and Family Assistance Center, was chosen for its proximity to central facilities such as the hospital. About 350 soldiers are assigned to the battalion -- including 176 who live in the barracks near the ranges -- where they stay an average of eight months, Mulcahey said. An estimated 10 to 15 percent of the soldiers have PTSD, he said. The soldiers are part of a growing group of an estimated 150,000 combat veterans of the wars in Iraq and Afghanistan who have PTSD symptoms. The mental disorder has been diagnosed in nearly 40,000 of them.
PTSD symptoms include flashbacks and anxiety, and noises such as fireworks or a car backfiring can make sufferers feel as though they are back in combat. Health experts say that housing soldiers near a firing range subjects them to a continual trigger for PTSD. "It would definitely traumatize them," said Harold McRae, a psychotherapist in Columbus, Ga., who counsels dozens of soldiers with PTSD who are at Fort Benning. "It would be like you having a major car wreck on the interstate" and then living in a home overlooking the freeway, he said. "Every time you hear a wreck or the brakes lock up, you are traumatized."
Fort Benning, which covers more than 180,000 acres, is one of the Army's main training bases, with 67 live-fire ranges. The base has thousands of housing and barracks units. "There is no excuse" for the housing situation, said Paul Ragan, an associate professor of psychology at Vanderbilt University, who treats veterans with PTSD. "Charitably put, it's very untherapeutic." Brig. Gen. Gary Cheek, director of the Army's Warrior Care and Transition Office, which oversees 12,000 wounded soldiers, said: "I can see how that would be a problem. It's something we haven't considered" but should. "We have alternatives for housing the soldiers who have issues" with the ranges, he said, adding that the barracks for wounded troops at Fort Benning are an interim facility.
The gunfire "makes me crazy," said a soldier who lives in the barracks and has PTSD and traumatic brain injury from a roadside explosion in Iraq. "It makes me jump and I get flashbacks." He spoke on the condition of anonymity for fear of retribution from the Army. "It . . . freaks me out," said Sgt. Jonathon Redding, 27, of Little Rock. He said the gunfire has required him to increase his sleep medication. "I was under the impression I would get help here," he said. Instead, he said, he "got considerably worse."
Soldiers living at the barracks say their rooms are in good condition and have recently been outfitted with flat-screen TVs, laptop computers and free Internet service. They say that their rooms are inspected frequently for cleanliness and that even soap scum on a sink or sunflower seeds left on a counter are noted in records. But the soldiers said they have received no explanation for why they must live so close to the firing ranges, even though they said at least one soldier raised the question at a town hall meeting with battalion leaders several weeks ago.
'It Just Kind of Drains You'
Rolling through Iraqi towns with his artillery unit during the 2003 invasion, Redding saw and smelled the charred corpses of Iraqis he helped kill. "You can never forget that," he said, sitting in his room at Fort Benning last month.
When he returned home in August 2003, the Army did not screen him for behavioral health problems, he said. Redding began "self-medicating" -- which is common for PTSD sufferers -- drinking several fifths of Southern Comfort a week. His weight dropped 30 pounds, to 135, in two months, and he grew withdrawn, sleepless and depressed.
According to Pentagon data, up to 15 percent of returning U.S. troops now show signs of PTSD, and the total number who receive diagnoses of chronic PTSD rose by nearly 50 percent last year.
Redding went home and joined the Arkansas National Guard. With help from a civilian doctor who gave him medicine for insomnia and anxiety, he limited his drinking and took a part-time job carrying caskets at the funerals of fallen soldiers. "I did about 90 funerals, I loved it," he said. But Redding was informed in September that he would be mobilized with a military police unit bound for Iraq. At Camp Shelby, Miss., where he went for training in January, gunfire and artillery practice caused him to "freeze up," he said. He asked his civilian doctor for a prescription, but the company medic told him it was for a "non-deployable" medication, so if he was planning to deploy, his family would have to fill it and mail it to him -- skirting the rules.
Redding took the prescription through proper channels and was sent to a behavioral health expert, who determined he had PTSD and depression. The expert advised that he not deploy and that he go to a community health organization at home in Arkansas. Instead, in February, Redding was sent to Fort Benning, where he awaits orders to leave. "I went from a bad situation to a worse situation," he said. "In formations, they would be shooting and I would just be cringing. . . . I'd want to see where it's coming from."
Redding complained to his doctor about his housing. "She said it didn't make any sense," he said. He said his psychologist at the base hospital called the location "stupid." His chain of command said they would "look into it," he said. But he still waits for relief from the constant gunfire. "It just kind of drains you," he said.
'Near-Constant Fear'
The 29-year-old Army specialist palmed the wheel of his 2003 Cadillac on the way to his psychotherapy appointment in downtown Columbus, just outside Fort Benning. He reached into the leather armrest, filled with bottles of prescription medicine: tranquilizers, antidepressants, pills to calm anxiety. He popped a couple of tablets in his mouth and turned into the clinic parking lot.
Spec. Keith, who spoke on the condition that only his first name be used in order to protect his privacy, has what he calls "daymares" -- flashbacks caused by chronic PTSD that has left him paranoid. "Anytime I see a U-Haul truck pull up, in my mind I think it might be a car bomb," he said.
Last July, Keith was nearly killed in Iraq when insurgents fired 107mm rockets, hitting his tent. Shrapnel shredded his uniform, narrowly missing him. He soon began suffering headaches, dizziness and nausea. Doctors told him his ailments would go away, but they "only got worse," he said. In November, he arrived at Fort Benning, where the live ammunition reminds him of the attack. "I have a hard time sleeping at night when they do night firing," Keith said. "For a moment I think something bad is going to happen, then I try to sit back and realize that it is a firing range." Keith lives in "near-constant fear of being shot or killed," said an Army evaluation written by a doctor at Fort Benning in April. Two weeks ago, the Army released him, so he loaded his car, pills close at hand, and drove away.
Strickland, who says he is lucky if he can get four hours of sleep a night, said the sounds from the firing ranges return him to the sweltering August night in Baghdad when the bomb threw him to the ground. He came home from Iraq in March 2005 and PTSD was diagnosed. But when his unit was called up to serve in Iraq late last year, his superiors encouraged him to go. The "commander told me if I got back on the deployable list, I'd get my promotion," said Strickland, whose wife is expecting their second child. "I was trying to look after my family and get more pay."
He was ultimately pulled from the deployment and sent to Fort Benning, where he awaits paperwork to allow him to return to Arkansas. In the meantime, he looks out the window of his third-floor room onto firing ranges where recruits blast at targets. "We've been there, we've fought in it, we've lost friends there," Strickland said, his mind in a distant war zone. "I'm not going to get any better in this environment."
Researchers Fail to Reveal Full Drug Pay
Gardiner Harris & Benedict Carey, New York Times- 8/8/2008
A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators.
By failing to report income, the psychiatrist, Dr. Joseph Biederman, and a colleague in the psychiatry department at Harvard Medical School, Dr. Timothy E. Wilens, may have violated federal and university research rules designed to police potential conflicts of interest, according to Senator Charles E. Grassley, Republican of Iowa. Some of their research is financed by government grants.
Like Dr. Biederman, Dr. Wilens belatedly reported earning at least $1.6 million from 2000 to 2007, and another Harvard colleague, Dr. Thomas Spencer, reported earning at least $1 million after being pressed by Mr. Grassley’s investigators. But even these amended disclosures may understate the researchers’ outside income because some entries contradict payment information from drug makers, Mr. Grassley found.
In one example, Dr. Biederman reported no income from Johnson & Johnson for 2001 in a disclosure report filed with the university. When asked to check again, he said he received $3,500. But Johnson & Johnson told Mr. Grassley that it paid him $58,169 in 2001, Mr. Grassley found. The Harvard group’s consulting arrangements with drug makers were already controversial because of the researchers’ advocacy of unapproved uses of psychiatric medicines in children.
In an e-mailed statement, Dr. Biederman said, “My interests are solely in the advancement of medical treatment through rigorous and objective study,” and he said he took conflict-of-interest policies “very seriously.” Drs. Wilens and Spencer said in emailed statements that they thought they had complied with conflict-of-interest rules.
John Burklow, a spokesman for the National Institutes of Health, said: “If there have been violations of N.I.H. policy — and if research integrity has been compromised — we will take all the appropriate action within our power to hold those responsible accountable. This would be completely unacceptable behavior, and N.I.H. will not tolerate it.”
The federal grants received by Drs. Biederman and Wilens were administered by Massachusetts General Hospital, which in 2005 won $287 million in such grants. The health institutes could place restrictions on the hospital’s grants or even suspend them altogether.
Alyssa Kneller, a Harvard spokeswoman, said in an emailed statement: “The information released by Senator Grassley suggests that, in certain instances, each doctor may have failed to disclose outside income from pharmaceutical companies and other entities that should have been disclosed.” Ms. Kneller said the doctors had been referred to a university conflict committee for review. Mr. Grassley sent letters on Wednesday to Harvard and the health institutes outlining his investigators’ findings, and he placed the letters along with his comments in The Congressional Record.
Dr. Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children. The Grassley investigation did not address research quality.
Doctors have known for years that antipsychotic drugs, sometimes called major tranquilizers, can quickly subdue children. But youngsters appear to be especially susceptible to the weight gain and metabolic problems caused by the drugs, and it is far from clear that the medications improve children’s lives over time, experts say.
In the last 25 years, drug and device makers have displaced the federal government as the primary source of research financing, and industry support is vital to many university research programs. But as corporate research executives recruit the brightest scientists, their brethren in marketing departments have discovered that some of these same scientists can be terrific pitchmen.
To protect research integrity, the National Institutes of Health require researchers to report to universities earnings of $10,000 or more per year, for instance, in consulting money from makers of drugs also studied by the researchers in federally financed trials. Universities manage financial conflicts by requiring that the money be disclosed to research subjects, among other measures. The health institutes last year awarded more than $23 billion in grants to more than 325,000 researchers at over 3,000 universities, and auditing the potential conflicts of each grantee would be impossible, health institutes officials have long insisted. So the government relies on universities.
Universities ask professors to report their conflicts but do almost nothing to verify the accuracy of these voluntary disclosures. “It’s really been an honor system thing,” said Dr. Robert Alpern, dean of YaleSchool of Medicine. “If somebody tells us that a pharmaceutical company pays them $80,000 a year, I don’t even know how to check on that.” Some states have laws requiring drug makers to disclose payments made to doctors, and Mr. Grassley and others have sponsored legislation to create a national registry. Lawmakers have been concerned in recent years about the use of unapproved medications in children and the influence of industry money.
Mr. Grassley asked Harvard for the three researchers’ financial disclosure reports from 2000 through 2007 and asked some drug makers to list payments made to them. “Basically, these forms were a mess,” Mr. Grassley said in comments he entered into The Congressional Record on Wednesday. “Over the last seven years, it looked like they had taken a couple hundred thousand dollars.”
Prompted by Mr. Grassley’s interest, Harvard asked the researchers to re-examine their disclosure reports. In the new disclosures, the trio’s outside consulting income jumped but was still contradicted by reports sent to Mr. Grassley from some of the companies. In some cases, the income seems to have put the researchers in violation of university and federal rules.
In 2000, for instance, Dr. Biederman received a grant from the National Institutes of Health to study in children Strattera, an Eli Lilly drug for attention deficit disorder. Dr. Biederman reported to Harvard that he received less than $10,000 from Lilly that year, but the company told Mr. Grassley that it paid Dr. Biederman more than $14,000 in 2000, Mr. Grassley’s letter stated. At the time, Harvard forbade professors from conducting clinical trials if they received payments over $10,000 from the company whose product was being studied, and federal rules required such conflicts to be managed.
Mr. Grassley said these discrepancies demonstrated profound flaws in the oversight of researchers’ financial conflicts and the need for a national registry. But the disclosures may also cloud the work of one of the most prominent group of child psychiatrists in the world. In the past decade, Dr. Biederman and his colleagues have promoted the aggressive diagnosis and drug treatment of childhood bipolar disorder, a mood problem once thought confined to adults. They have maintained that the disorder was underdiagnosed in children and could be treated with antipsychotic drugs, medications invented to treat schizophrenia.
Other researchers have made similar assertions. As a result, pediatric bipolar diagnoses and antipsychotic drug use in children have soared. Some 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including 20,500 under 6 years of age, according to Medco Health Solutions, a pharmacy benefit manager.
Few psychiatrists today doubt that bipolar disorder can strike in the early teenage years, or that many of the children being given the diagnosis are deeply distressed. “I consider Dr. Biederman a true visionary in recognizing this illness in children,” said Susan Resko, director of the Child and Adolescent Bipolar Foundation, “and he’s not only saved many lives but restored hope to thousands of families across the country.” Longtime critics of the group see its influence differently. “They have given the Harvard imprimatur to this commercial experimentation on children,” said Vera Sharav, president and founder of the Alliance for Human Research Protection, a patient advocacy group.
Many researchers strongly disagree over what bipolar looks like in youngsters, and some now fear the definition has been expanded unnecessarily, due in part to the Harvard group. The group published the results of a string of drug trials from 2001 to 2006, but the studies were so small and loosely designed that they were largely inconclusive, experts say. In some studies testing antipsychotic drugs, the group defined improvement as a decline of 30 percent or more on a scale called the Young Mania Rating Scale — well below the 50 percent change that most researchers now use as the standard.
Controlling for bias is especially important in such work, given that the scale is subjective, and raters often depend on reports from parents and children, several top psychiatrists said. More broadly, they said, revelations of undisclosed payments from drug makers to leading researchers are especially damaging for psychiatry. “The price we pay for these kinds of revelations is credibility, and we just can’t afford to lose any more of that in this field,” said Dr. E. Fuller Torrey, executive director of the Stanley Medical Research Institute, which finances psychiatric studies. “In the area of child psychiatry in particular, we know much less than we should, and we desperately need research that is not influenced by industry money.”
Traffic Taking a Toll on Psychic Health, Experts Say
Christopher Goffard, Los Angeles Times- 6/8/2008
As society hurtles forward in an age of instant messaging and one-click shopping, motorists paradoxically find themselves moored between bumpers for hours a day, with a psychic toll that experts are still trying to tally. Dr. Laura Pinegar, a Long Beach psychologist who treats depression and panic disorders, hears a growing number of complaints about traffic anxiety in her practice.
"If you're stuck in traffic, there's a feeling of being out of control," she said. "You can be at a dead standstill on the freeway, but amped up from the day, thinking, 'I gotta get home. I gotta get the kids. What if I don't get to day care before it closes?' "
In several studies on commuter stress, UC Irvine psychologists Raymond Novaco and Daniel Stokols made a surprising finding. Though they hypothesized that long commutes would be more stressful for hard-charging, Type A personalities than for mellow Type Bs, it turned out that the opposite was true. The reasons: The hard-chargers exercised more control over their lives. They had picked homes they liked and jobs that absorbed them. In traffic, they thought about work. The mellow drivers, on the other hand, thought about being trapped in traffic.
According to one study, women with long-distance commutes who drive alone are in the demographic group that suffers the greatest commuting stress. Pinegar said she has had some success in encouraging drivers to think of their commute as a buffer zone between work and home. "Especially mothers with large families," she said. "They think, 'This is my time to mellow out, maybe listen to the radio, get books on tape.' "
How gridlock makes us feel depends on what we tell ourselves about the experience, says Ronald Nathan, a psychologist in Albany, N.Y., who has treated both perpetrators and victims of road rage. "Some people say, 'Great, I can kick back and listen to some music,' " Nathan said, but others feel like life is passing them by. "We can start to over-generalize by saying, 'My life is worthless. All I am is somebody who gets into a piece of metal and goes from one place to another.' "
For Leon James, a professor of psychology at the University of Hawaii, a lifetime's academic pursuit began 25 years ago when his wife told him his driving scared her. She pointed out that he switched lanes before he looked, took curves too fast and raged against other drivers. The rebuke stung his pride but got him thinking -- and led to his pioneering role in the small academic field of the psychology of driving. He began by asking his students to carry voice recorders to monitor their responses on the road, and learned that they were no strangers to rage -- particularly when cut off, tailgated or stuck behind slow cars in the fast lane. James said studies have found little correlation between motorists' personalities inside and outside of the car. Road rage can overtake those who are models of agreeability at home or at the office.
"People tell me, 'I'm amazed at myself. I'm not an aggressive person. I'm not this way. Why do I feel this way?' " James said. He has concluded that asphalt aggression is not an anger-management problem but one of socialization -- people absorb their driving mores in the back seat at an early age, watching grown-ups curse, pound the steering wheel and cut each other off. Even as kids learn self-control on the playground, he said, they are taught the opposite on the road. "What we need is traffic emotions education starting in kindergarten," he said. "You can't just act the way you want."
Debt: Enough to Make You Sick
Jeannine Aversa, Associated Press, 6/9/2008
WASHINGTON - The stress from deepening debt is becoming a major pain in the neck —and the back and the head and the stomach— for millions of Americans. When people are dealing with mountains of debt, they're much more likely to report health problems, too, according to an Associated Press-AOL Health poll. And not just little stuff; this means ulcers, severe depression, even heart attacks.
Although most people appear to be managing their debts all right, perhaps 10 million to 16 million are "suffering terribly due to their debts, and their health is likely to be negatively impacted," says Paul J. Lavrakas, a research psychologist and AP consultant who analyzed the results of the survey. Those are people who reported high levels of debt stress and suffered from at least three stress-related illnesses, he says.
That finding is supported by medical research that has linked chronic stress to a wide range of ailments. And the current tough economic times and rising costs of living seem to be leading to increasing debt stress, 14 percent higher this year than in 2004, according to an index tied to the AP-AOL survey.
Among the people reporting high debt stress in the new poll:
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27 percent had ulcers or digestive tract problems, compared with 8 percent of those with low levels of debt stress.
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44 percent had migraines or other headaches, compared with 15 percent.
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29 percent suffered severe anxiety, compared with 4 percent.
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23 percent had severe depression, compared with 4 percent.
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6 percent reported heart attacks, double the rate for those with low debt stress.
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More than half, 51 percent, had muscle tension, including pain in the lower back. That compared with 31 percent of those with low levels of debt stress.
People who reported high stress also were much more likely to have trouble concentrating and sleeping and were more prone to getting upset for no good reason.
It isn't known for certain whether such stress is causing health problems, says Lavrakas, who while at Ohio State University in the late 1990s helped to develop an index to measure the extent to which people are stressed from financial debts. But medical research suggests that most of the symptoms reported in this poll are indeed typical of chronic stress. The body reacts with a "fight-or-flight" response, releasing adrenaline and the stress hormone cortisol. If the body stays in this high gear too long, those chemicals can wreak physical havoc in numerous systems—everything from a rise in blood pressure and heart rate to problem with memory, mood, digestion, even the immune system.
And no, stress doesn't cause stomach ulcers —most are caused by bacteria—but stress can worsen the pain.
Suicide Rate High in Violent Death Data
Nicholas Bakalar, New York Times- 6/10/2008
More than half of all violent deaths are suicides, a quarter are homicides and the typical victim is an African-American man in his 20s. In 2003, the Centers for Disease Control and Prevention began operating the National Violent Death Reporting System, a data collection program with 17 participating states. The 2005 report includes data from 16 of them.
Gathering data on violent death is difficult, for several reasons. Reports are not always complete, data about homicides are usually not available until after prosecutions are finished, and a single death can be classified differently depending on who is doing the classifying. An “unintentional death” in a police report, for example, can appear as “homicide” on a medical examiner’s report and “undetermined” on a death certificate. Finally, the accuracy of the figures depends on state health departments, medical examiners and police departments sharing their data quickly and accurately with the national reporting system.
Debra L. Karch, a behavioral scientist at the C.D.C. and the lead author of the report, said three major factors were common in violence of all kinds: intimate partner relationships, substance abuse and mental disturbances. “These are things we could focus on in an attempt to prevent violent deaths,” she said.
The 2005 data, the latest available, were published in April in the Morbidity and Mortality Weekly Report. The states included are Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia and Wisconsin.
Gay Unions Shed Light on Gender in Marriage
Tara Parker-Pope, New York Times- 6/10/2008
A growing body of evidence shows that same-sex couples have a great deal to teach everyone else about marriage and relationships. Most studies show surprisingly few differences between committed gay couples and committed straight couples, but the differences that do emerge have shed light on the kinds of conflicts that can endanger heterosexual relationships. The findings offer hope that some of the most vexing problems are not necessarily entrenched in deep-rooted biological differences between men and women. And that, in turn, offers hope that the problems can be solved.
Next week, California will begin issuing marriage licenses to same-sex couples, reigniting the national debate over gay marriage. But relationship researchers say it also presents an opportunity to study the effects of marriage on the quality of all relationships. “When I look at what’s happening in California, I think there’s a lot to be learned to explore how human beings relate to one another,” said Sondra E. Solomon, an associate professor of psychology at the University of Vermont. “How people care for each other, how they share responsibility, power and authority — those are the key issues in relationships.”
The stereotype for same-sex relationships is that they do not last. But that may be due, in large part, to the lack of legal and social recognition given to same-sex couples. Studies of dissolution rates vary widely.
After Vermont legalized same-sex civil unions in 2000, researchers surveyed nearly 1,000 couples, including same-sex couples and their heterosexual married siblings. The focus was on how the relationships were affected by common causes of marital strife like housework, sex and money. Notably, same-sex relationships, whether between men or women, were far more egalitarian than heterosexual ones. In heterosexual couples, women did far more of the housework; men were more likely to have the financial responsibility; and men were more likely to initiate sex, while women were more likely to refuse it or to start a conversation about problems in the relationship. With same-sex couples, of course, none of these dichotomies were possible, and the partners tended to share the burdens far more equally.
While the gay and lesbian couples had about the same rate of conflict as the heterosexual ones, they appeared to have more relationship satisfaction, suggesting that the inequality of opposite-sex relationships can take a toll. “Heterosexual married women live with a lot of anger about having to do the tasks not only in the house but in the relationship,” said Esther D. Rothblum, a professor of women’s studies at San Diego State University. “That’s very different than what same-sex couples and heterosexual men live with.”
Other studies show that what couples argue about is far less important than how they argue. The egalitarian nature of same-sex relationships appears to spill over into how those couples resolve conflict. One well-known study used mathematical modeling to decipher the interactions between committed gay couples. The results, published in two 2003 articles in The Journal of Homosexuality, showed that when same-sex couples argued, they tended to fight more fairly than heterosexual couples, making fewer verbal attacks and more of an effort to defuse the confrontation.
Controlling and hostile emotional tactics, like belligerence and domineering, were less common among gay couples. Same-sex couples were also less likely to develop an elevated heartbeat and adrenaline surges during arguments. And straight couples were more likely to stay physically agitated after a conflict. “When they got into these really negative interactions, gay and lesbian couples were able to do things like use humor and affection that enabled them to step back from the ledge and continue to talk about the problem instead of just exploding,” said Robert W. Levenson, a professor of psychology at the University of California, Berkeley.
The findings suggest that heterosexual couples need to work harder to seek perspective. The ability to see the other person’s point of view appears to be more automatic in same-sex couples, but research shows that heterosexuals who can relate to their partner’s concerns and who are skilled at defusing arguments also have stronger relationships.
One of the most common stereotypes in heterosexual marriages is the “demand-withdraw” interaction, in which the woman tends to be unhappy and to make demands for change, while the man reacts by withdrawing from the conflict. But some surprising new research shows that same-sex couples also exhibit the pattern, contradicting the notion that the behavior is rooted in gender, according to an abstract presented at the 2006 meeting of the Association for Psychological Science by Sarah R. Holley, a psychology researcher at Berkeley. Dr. Levenson says this is good news for all couples. “Like everybody else, I thought this was male behavior and female behavior, but it’s not,” he said. “That means there is a lot more hope that you can do something about it.”
Study: Marijuana Potency Increases in 2007
Associated Press, 6/12/2008
WASHINGTON -- Marijuana potency increased last year to the highest level in more than 30 years, posing greater health risks to people who may view the drug as harmless, according to a report released Thursday by the White House. The latest analysis from the University of Mississippi's Potency Monitoring Project tracked the average amount of THC, the psychoactive ingredient in marijuana, in samples seized by law enforcement agencies from 1975 through 2007. It found that the average amount of THC reached 9.6 percent in 2007, compared with 8.75 percent the previous year. The 9.6 percent level represents more than a doubling of marijuana potency since 1983, when it averaged just under 4 percent.
''Today's report makes it more important than ever that we get past outdated, anachronistic views of marijuana,'' said John Walters, director of the White House Office of National Drug Control Policy. He cited baby boomer parents who might have misguided notions that the drug contains the weaker potency levels of the 1970s. ''Marijuana potency has grown steeply over the past decade, with serious implications in particular for young people,'' Walters said. He cited the risk of psychological, cognitive and respiratory problems, and the potential for users to become dependent on drugs such as cocaine and heroin.
While the drug's potency may be rising, marijuana users generally adjust to the level of potency and smoke it accordingly, said Dr. Mitch Earleywine, who teaches psychology at the State University of New York in Albany and serves as an adviser for marijuana advocacy groups. ''Stronger cannabis leads to less inhaled smoke,'' he said.
The White House office attributed the increases in marijuana potency to sophisticated growing techniques that drug traffickers are using at sites in the United States and Canada.
A report from the office last month found that a teenager who has been depressed in the past year was more than twice as likely to have used marijuana than teenagers who have not reported being depressed -- 25 percent compared with 12 percent. The study said marijuana use increased the risk of developing mental disorders by 40 percent. ''The increases in marijuana potency are of concern since they increase the likelihood of acute toxicity, including mental impairment,'' said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which funded the University of Mississippi study. ''Particularly worrisome is the possibility that the more potent THC might be more effective at triggering the changes in the brain that can lead to addiction,'' Volkow said.
But there's no data showing that a higher potency in marijuana leads to more addiction, Earleywine said, and marijuana's withdrawal symptoms are mild at best. ''Mild irritability, craving for marijuana and decreased appetite -- I mean those are laughable when you talk about withdrawal from a drug. Caffeine is worse.''
The project analyzed data on 62,797 cannabis samples, 1,302 hashish samples, and 468 hash oil samples obtained primarily from seizures by law enforcement agencies in 48 states since 1975.
On the Net: White House Office of National Drug Control Policy: http://www.whitehousedrugpolicy.gov
Legal Drugs Kill Far More Than Illegal, Florida Says
Damien Cave, New York Times- 6/14/2008
MIAMI — From “Scarface” to “Miami Vice,” Florida’s drug problem has been portrayed as the story of a single narcotic: cocaine. But for Floridians, prescription drugs are increasingly a far more lethal habit. An analysis of autopsies in 2007 released this week by the Florida Medical Examiners Commission found that the rate of deaths caused by prescription drugs was three times the rate of deaths caused by all illicit drugs combined.
Law enforcement officials said that the shift toward prescription-drug abuse, which began here about eight years ago, showed no sign of letting up and that the state must do more to control it. “You have health care providers involved, you have doctor shoppers, and then there are crimes like robbing drug shipments,” said Jeff Beasley, a drug intelligence inspector for the Florida Department of Law Enforcement, which co-sponsored the study. “There is a multitude of ways to get these drugs, and that’s what makes things complicated.”
The report’s findings track with similar studies by the federal Drug Enforcement Administration, which has found that roughly seven million Americans are abusing prescription drugs. If accurate, that would be an increase of 80 percent in six years and more than the total abusing cocaine, heroin, hallucinogens, Ecstasy and inhalants.
The Florida report analyzed 168,900 deaths statewide. Cocaine, heroin and all methamphetamines caused 989 deaths, it found, while legal opioids — strong painkillers in brand-name drugs like Vicodin and OxyContin — caused 2,328. Drugs with benzodiazepine, mainly depressants like Valium and Xanax, led to 743 deaths. Alcohol was the most commonly occurring drug, appearing in the bodies of 4,179 of the dead and judged the cause of death of 466 — fewer than cocaine (843) but more than methamphetamine (25) and marijuana (0).
The study also found that while the number of people who died with heroin in their bodies increased 14 percent in 2007, to 110, deaths related to the opioid oxycodone increased 36 percent, to 1,253. Florida scrutinizes drug-related deaths more closely than do other states, and so there is little basis for comparison with them.
It has also witnessed several highly publicized cases in recent years that have highlighted the problem. Only last year, an accidental prescription drug overdose killed Anna Nicole Smith in Broward County. Still, the state has lagged in enforcement. Thirty-eight other states have approved prescription drug monitoring programs that track sales. Florida lawmakers have repeatedly considered similar legislation, but privacy concerns have kept it from passing.
As a result, federal, state and local law enforcement officials say, Florida has become a source of prescription drugs that are illegally sold across the country. “The monitoring plan is our priority effort, but that is not enough,” William H. Janes, the Florida director of drug control, said in a statement accompanying the study. He said Florida was also looking at ways to curb illegal Internet sales and to encourage doctors and pharmacists to identify potential abusers.
Some local police departments have taken a more novel approach. In Broward County on May 31, deputies completed a “drug takeback” in which $5 Wal-Mart, CVS or Walgreens gift cards were distributed to 150 people who cleaned out their medicine cabinets and turned in unused drugs in an effort to keep them out of young people’s hands. “The abuse has reached epidemic proportions,” said Lisa McElhaney, a sergeant in the pharmaceutical drug diversion unit of the Broward County Sheriff’s Office. “It’s just explosive.”
Science Wonders: What Does Gay Look Like?
Regina Nuzzo, Los Angeles Times- 6/15/2008
Last month, Sen. John McCain dropped by “Saturday Night Live,” drawing laughs from his promise, if elected president, to fight expensive federal projects -- such as, he spoofed, a Department of Defense device to "jam gaydar." That was a joke. But some scientists are, in a way, working on gaydar, the supposed ability to discern whether a person is homosexual by reading subtle cues from their appearance. Just don't refer to it that way. The preferred term is "sexual orientation correlates."
These scientists are searching for innate traits that might not appear to be related to sexual orientation or even to standard clichés. So measuring a subject's shoe size is permissible; asking about ownership of Barbra Streisand albums would be cheating. Some inborn traits might be expected if homosexuality is -- as most scientists believe -- rooted in biology, and they might provide clues about the biological origins of sexual orientation.
Finding and solidifying these links isn't easy. Studies contradict each other, and some promising paths don't pan out. (A link between male homosexuality and finger lengths isn't holding up, and a claim that gays have distinctive fingerprint ridge patterns is largely discredited.) Scientists don't always agree on how to interpret the results, and more progress has been made with regard to men than to women.
Big brothers. Study after study -- including one of 87,000 British men published last year -- has found that gay men have more older brothers than straight men do. Only big brothers count. Lesbians don't show such patterns.
The numbers: Each older brother will increase a man's chances of being gay by 33%, says Ray Blanchard of the University of Toronto, an expert on the "big-brother effect." That's not as dramatic as it might sound. A man's chance of being gay is pretty low to begin with -- perhaps as low as 2% (lowered from 10% by researchers in the early 1990s). So having one older brother ups the chance to only about 2.6%.
What it might mean: Psychological influences are probably not at work, because the pattern holds even for gay men who weren’t raised with their older brothers. Instead, the mother's womb might be key. After giving birth to a boy, her immune system might create antibodies to foreign, male proteins in her bloodstream. Subsequent sons in the womb could be exposed to these "anti-boy" antibodies, which might affect sexual development in the brain. Accordingly, you'd expect the percentage of gay men in a society to vary depending on demographic differences in family size: One study calculated that a one-child-per-family law would reduce male homosexuality by about 29% from current levels.
* Left hand vs. right hand. The hand you use to sign your name might have something to do with what gender you are drawn to.
The numbers: More lefties -- or at least more somewhat-ambidextrous folks -- crop up in the gay population than among straight people, several studies have shown. An analysis of more than 23,000 men and women from North America and Europe in 2000 found that being non-right-handed seems to increase a man's chances of being gay by about 34%, and a woman's by about 90%.
What it might mean: One guess is that different-than-normal levels of testosterone in the womb -- widely theorized to play a role in determining eventual sexual orientation -- could nudge a fetus toward brain organization that favors left-handedness as well as same-sex attraction. Another theory is that development of a fetus might be disturbed by factors such as a mother's illness, steering the fetus into being less than strictly right-handed -- and, in some cases, less than strictly heterosexual. It's a politically sticky idea, says Qazi Rahman of Queen Mary-University of London. "It's essentially saying that homosexual preference . . . is some kind of biological error," he says. (It might tick off the left-handed folks too.)
* Hair whorl. How does your hair grow? This might reflect your sexual orientation.
The numbers: A 2004 study of nearly 500 men -- 272 on Delaware's Rehoboth Beach, popular with gay men, 200 on a beach without that reputation -- found that hair on the heads of men on the gay beach was 3.5 times more likely to grow in a counterclockwise direction. (Scalp hair typically resembles a clockwise-rotating typhoon.)
What it might mean: One theory is that a single gene might influence hair-whorl direction, left-right brain organization and, somehow, sexual orientation. Exactly how it would do all this, however, is anyone's guess. The study, although intriguing, suffers from a lack of scientific rigor. The author walked around while on vacation, collecting hair-whorl observations on men from a discreet distance. He didn't know anyone's sexual orientation for sure, and didn't objectively examine any scalps up close. Rahman's group is attempting to replicate the results in the lab.
* Penis size. If exposure to testosterone in the womb influences sexual orientation, scientists reckon that straight and gay people would differ in body parts strongly affected by testosterone, such as the penis.
The numbers: Anthony Bogaert of Brock University in Ontario and his colleagues re-analyzed data on 5,000 gay and straight men from sexologist Alfred Kinsey's famous files, collected from the 1930s to the 1960s. The results, published in 1999, showed that gay men had longer, thicker penises than did straight men: on average, about 6.5 inches long and 4.95 inches around when erect, versus 6.1 inches long and 4.8 inches around for straight men.
What it might mean: Scientists don't really know. One guess is that gay men could have been exposed to an odd mix of hormones in the womb. Testosterone levels might peak early, causing enhanced penis growth, then drop off later in pregnancy -- leading to some feminine characteristics.
There's one catch: Kinsey asked his subjects to measure themselves at home and mail a postcard recording their dimensions. It is within the realm of imagination that not every man reported the perfect truth. If everyone lied, the essence of the results wouldn't change. It's a problem only if gay men were more factually creative than straight men.
Bogaert says that all the measures -- length and circumference, erect and flaccid -- seem to plausibly line up, which probably wouldn't be the case if the men had tacked on a vanity half-inch or so. Also, a smaller, 1960s study (in which a physician did the measuring) backs up the findings. As to whether gay or straight men are more likely to exaggerate about penis size, "It would be an interesting master's thesis project," Bogaert muses. However, the next frontier in this kind of research seems to lie elsewhere -- with subtle differences in how gay and straight brains navigate new cities, respond to erotic movies and react to the scent of sweat and urine.
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