Carrie Jackson, 65, has twice faced the torment of a child's mental illness.

She used Ohio's court system to declare both of her adult sons mentally incompetent to care for themselves. She is their legal guardian and is responsible for everything in their lives - their shelter, their food, their hygiene. Neither is capable of dealing with the simplest responsibility of modern life.

Car or health insurance? Forget it. Cable repairman? No way.

Her sons are mentally ill. Both have been diagnosed as schizophrenic.

Both have to take powerful antipsychotic drugs to get closer to a normal life. Jackson hopes she will always be able to persuade them to use the medications, but experience tells her she cannot completely trust that will happen.

Her heart goes out to several families involved in a slaying last month in Lakewood. The victim. The accused assailant. The families.

William Houston, 29, who told his family he had stopped taking medications for schizophrenia, strangled his friend and neighbor, Mussa Banna, 55, in the hallway of a Cove Avenue apartment building, police said. Houston is in jail on $500,000 bond, charged with murder. Houston's family said he believed his grandmother, who lived in the apartment building, was about to be sexually assaulted or had been. Houston was living with his grandmother but had no guardian.

Jackson understands such delusions. Her son, Tommie Anderson, 49, has been hospitalized four times as a mental patient. He once disappeared for 18 months, and she learned of his whereabouts only because Allentown, Pa., police told her his abandoned car would be junked unless it was claimed. Jackson gained guardianship over Tommie in Probate Court in Cleveland in 1992.

Last November, after Tommie had secretly stopped taking his antipsychotic medications, voices he hears told him to walk from their home on East 105th Street and Superior Avenue. Police found him on the grass along the East Shoreway at East 55th Street, a few feet from afternoon rush-hour traffic. The voices had told him to sit down and rest.

Tommie's 40-year-old brother, Anthony, has been hospitalized twice. Like Tommie, he had become a danger to himself and others. He repeatedly threatened his mother and his wife, sat in the dark in the bathroom for hours and hid in a closet, court documents show. Jackson gained guardianship over Anthony in 1997.

Interviews with Jackson, other families with schizophrenic children and medical and mental-health professionals show a similar pattern. Parents and friends are reluctant to take a loved one to probate court to have them declared incompetent.

"Families are afraid to do that," said Nancy Fitch of Chester Township. She said her 30-year-old son, Brandon, is schizophrenic and takes antipsychotic medication. He lives at home. Fitch has seen no need to seek guardianship.

Families don't want to upset the trust and bond created in therapy, she said. They believe medicated patients will be best cared for at home, she added. "And they don't want to make them angry."

Schizophrenia is a brain disease that will attack 1 percent of the world's population. Although it usually hits people in their late teens or early 20s, it can strike anyone at any time. All races, all economic or social classes of people are affected. In America, about 2 million people have schizophrenia each year.

Patients frequently have a combination of symptoms, including suffering delusions and hallucinations, hearing voices and seeing things. They are paranoid. They are severely unable to plan events in their lives. Their families sometimes think they're lazy.

Dr. Cristinel M. Coconcea, an assistant professor at Case Western Reserve University and director of the Schizophrenia and Psychotic Disorders Program at University Hospitals Health System, said research is contradictory on whether people with schizophrenia are prone to commit violent acts. He does not believe they are more violent than other mental patients.

"Schizophrenics are easy to deal with if they get to know you," said Coconcea, who has treated incarcerated patients. Part of the regimen is to build trust with the patient, which is difficult for a family that has taken the drastic step of seeking guardianship in probate court.

Coconcea, who has not treated William Houston, said people with schizophrenia have their own perceptions of reality. Of Houston, he said, "He must have been terrified to think that his grandmother was about to be raped or had been raped."

Under Ohio law, mental patients cannot be forced to take medications by family or friends. They can be medicated by force while under a court order in a hospital.

The court order ends at the hospital door, Coconcea said. He added that in his practice as a psychiatrist and professor, he sees only two or three cases a year in which court-ordered medication is delivered because the person is in immediate danger of harming himself or others.

Houston was being treated at a branch of Bridgeway Inc., a publicly funded agency that sees about 3,000 clients each year in Cuyahoga County. The Cuyahoga County Mental Health Board is conducting a routine investigation of Houston's care at Bridgeway.

Ralph Fee, Bridgeway executive director, declined to discuss Houston as a client, citing patient confidentiality.

However, he said, treatment is a combination of drugs, therapies and family support. "It's one of the four or five most devastating illnesses in the world.

"We're not sure what causes it," Fee said. "But with the advances in mental health care, we do much better now than we did five or 10 years ago."

Jackson wants Ohio law to be changed to allow mental health patients to be forced to take medication. Schizophrenic patients cannot make good decisions, families and medical experts say. That condition is a symptom of the disease.

"They say they have rights," declares Jackson. "Don't families have rights?"

Jackson has touched on an age-old debate among mental health professionals, patients and families.

"Nobody should be forced to take medications - or walk down the street straight or wear a red shirt," said Blair Young, of the Ohio chapter of the National Alliance for the Mentally Ill.

(Source: Cleveland Plain Dealer Newspaper - 2/9/03)

How meditation helps with anxiety and general health. Learn the technique of meditation and mindfulness meditation for stress-reduction program.

Once viewed as a somewhat suspect practice by many Westerners, meditation is becoming mainstream. The ancient discipline is increasingly being embraced within traditional medical circles as a powerful healing tool, and now new research may help explain why it works.

A University of Wisconsin, Madison, study, reported in the February 2003 issue of the journal Psychosomatic Medicine, shows that meditation not only has clear effects in areas of the brain focused on emotion, but it also may strengthen the ability of a person to ward off illness.

Researcher Richard J. Davidson, PhD, and colleagues measured brain electrical activity among 25 subjects before, immediately after, and four months following their participation in an eight-week training course in what's called mindfulness meditation. The stress-reduction program emphasizes awareness of sensations and thoughts during meditation, but students learn to avoid acting on their emotions. This type of meditation differs from the more commonly known form called transcendental meditation, which focuses solely on just one thing, such as a sensation or a phrase.

The group attended weekly classes and participated in a seven-hour retreat. Following the instruction, they were asked to practice mindfulness meditation for an hour a day, six days a week. A comparison group of 16 people received no instruction and did not meditate.

Measurement of brain electrical activity showed the meditation group had increased activation in the left, frontal region of their brains - an area linked to reduced anxiety and a positive emotional state.

To test immune function (the ability of a person to ward of illness), the meditators were given flu shots at the end of the eight-week training session, along with the non-meditators. Blood tests taken one and two months after the shots were given showed the meditation group had higher levels of protection than those who did not meditate, as measured by antibodies produced against the flu virus.

"To our knowledge this is the first demonstration of a reliable effect of meditation on immune function [within the body]," Davidson and colleagues write. "The observation that the magnitude of change in immune function was greater for those subjects showing the larger shift toward left-sided [brain] activation further supports [the study's] earlier associations."

Cardiologist Herbert Benson, MD, has spent the last 30 years studying the effects of meditation and is founder of the Mind/Body Medical Institute at Harvard Medical School's Beth Israel Deaconess Medical Center. He says that the study offers further evidence that meditation produces measurable benefits. But he rejects the idea that any one type of meditation or relaxation technique is inherently better than another.

"Any practice that can evoke the relaxation response is of benefit, be it meditation, yoga, breathing or repetitive prayer," Benson says. "There is no reason to believe that one is better than the other. The key is repetition, but the repetition can be a word, sound, mantra, prayer, breathing or movement."

Benson says stress management can benefit 60% to 90% of people who see doctors for illness. It is increasingly being added to traditional therapies for the treatment of patients with life-threatening illnesses like cancer and AIDS.

"The relaxation response helps decrease metabolism, lowers blood pressure and heart rate, and slows breathing and brain waves," he says. "Just about any condition that is either caused or made worse by stress can be helped with meditation."

Sources:

• Psychosomatic Medicine, February 2003
• Herbert Benson, MD, president, Mind/Body Institute, Beth Israel Deaconess Medical Center

next: Natural Panic Attack Treatments
~ anxiety-panic library articles
~ all anxiety disorders articles

Descent into darkness

Descent into darkness
By Louise Kiernan
Chicago Tribune
February 16, 2003

First of two parts

The mothers are searching for their daughters.

They are always searching for their daughters, even though their daughters have been dead for more than a year now.

At a march on the lakefront, the two women share a hug and a murmured joke, heads close, hands woven together. On the telephone, they whisper so they won't wake napping grandchildren.

In a meeting of mental health experts at a dingy medical library, they trade a quick wave across the room. They explain who they are.

"I'm Carol Blocker and I lost my daughter through postpartum psychosis."

"I'm Joan Mudd and I lost my daughter to postpartum depression four weeks after Carol's daughter, Melanie, took her life."

Carol Blocker reaches for a discarded napkin to wipe her eyes. Joan Mudd pushes past the crack in her voice.

The two mothers aren't friends so much as allies. They want the same answers. They want to know why their daughters, after giving birth to the children they desperately wanted and desperately wanted to love, became mentally ill and took their own lives. They want to make sure that no one else's daughter dies.

In obvious ways, they are different. Carol is black, petite and precise, with hands that reach out unconsciously to smooth wrinkles and brush away crumbs. Joan is white, tall and blond, with a raucous laugh and the frame of the model she once was. But they are also alike, in their anger and determination and the pain in their eyes sharp as hooks.

Even their apartments are similar, airy, high-rise perches cluttered with evidence they have gathered in their struggle to understand: videotapes, pamphlets, articles from medical journals. A worn handout on how to deal with someone who is depressed, a laminated eulogy, a plastic bag with 12 bottles of pills and, everywhere, photographs.

Look at Jennifer Mudd Houghtaling in her wedding dress, her gloved arms flung wide in joy. Look at Melanie Stokes, her pregnant belly bursting bare from beneath a red scarf wrapped around her chest.

Look at Melanie at 20, a homecoming queen waving from a car, flowers tucked into the crook of her arm. Look at Jennifer at 12, sitting on a raft in a lake, a sheet of dark hair hanging to her shoulders, arms wrapped tight around her knees.

Look, because you can't help but look, for a portent of what will happen. Look for a shadow, for the sadness lurking at the corner of a mouth.

Look for some hint that Jennifer Mudd Houghtaling, less than three months after delivering her first child, will stand in front of an elevated train, hands raised above her head and wait for it to kill her.

Look for the sign that Melanie Stokes will write six suicide notes, including one to a hotel clerk and one to God but not one to her infant daughter, line them up neatly on a nightstand and drop from a 12th-floor window.

There is no hint. There is no sign.

The college student waves. The bouquet blooms.

The girl smiles. The sun shines.

Rare cluster of tragedy

Melanie Stokes was the first to die, on June 11, 2001.

Over the next five weeks, three more new mothers in Chicago followed her.

On June 18, the day before her daughter's first birthday, Amy Garvey went missing from her home in Algonquin. Her body was found floating in Lake Michigan two days later.

On July 7, Jennifer Mudd Houghtaling slipped out of her mother's Gold Coast apartment and walked to the "L" station to kill herself.

Ariceli Erivas Sandoval disappeared on July 17, five days after she gave birth to quadruplets, and drowned herself in Lake Michigan. A blue sign reading "It's a Boy!" was found on the floor of her car.

This cluster of apparent suicides was rare, the flash of attention it drew even rarer. What people know about mental illness among new mothers they know mostly from women who kill their children, like Andrea Yates, who drowned her five children in Houston nine days after Melanie Stokes committed suicide. In these cases, the horror of the deed often clouds the horror of the illness.

Most women who suffer postpartum mood disorders do not kill their children or themselves. They just suffer. And, with time and treatment, they get better.

---

Postpartum depression, some experts say, is the most common yet most frequently undiagnosed complication of pregnancy, affecting somewhere from 10 to 20 percent of women who give birth, or almost half a million women every year.

Postpartum psychosis, which usually involves hallucinations and delusions, is a much rarer condition but so severe that the woman is at risk of hurting herself and her baby.

The deaths of Melanie Stokes and Jennifer Mudd Houghtaling may have been unusual but they convey larger truths about postpartum mood disorders. These illnesses are often diagnosed late or not at all. Treatment, if it's available, may be a matter of guesswork. People can get sick and sicker with the speed and unpredictability of an avalanche.

The volatility of these postpartum disorders is one way they differ from mental illnesses that strike at other times of life, some experts believe. Another is the context in which they occur, during the period of extraordinary physical, mental and emotional stress involved in caring for a newborn.

No one keeps track of how many new mothers in the United States kill themselves. But suicide may be more common than people believe. When officials in Great Britain examined the records of all women who died, from 1997 to 1, within a year of giving birth, they found that suicide was the leading cause of death, accounting for an estimated 25 percent of the 303 deaths related to childbearing. Almost all the women died violently.

"This is the real shock," says Margaret Oates, a perinatal psychiatrist involved in the study. "It's an indication of the profound level of mental illness. This was not a cry for help. This was an intention to die."

Melanie Stokes and Jennifer Mudd Houghtaling took different paths toward death. But, as they deteriorated, their families felt the same confusion about what was happening. They experienced the same frustration with medical care that, at times, seemed inadequate and uncaring. Ultimately, they felt the same despair.

Lifetime of anticipation

Sommer Skyy Stokes was delivered to her mother on Feb. 23, 2001, after 19 hours of labor and almost a lifetime of anticipation.

Melanie didn't give birth until she was 40 but she had named her daughter before she was 14, for her favorite season.

Even as a freshman in high school, when the other girls talked about the careers they dreamed of, Melanie unabashedly declared she wanted to become a wife and mother.

After Melanie was admitted to Spelman College in Atlanta, she decided that, someday, Sommer would go to Spelman, too. Once, out shopping, she saw an antique pink feeding bowl and bought it for her daughter-to-be.

It seemed for a painfully long time, though, that Melanie would be granted every wish in life except the one she wanted most of all.

The daughter of an insurance agent and a teacher, Melanie grew up within an extended family that nurtured ideals of education, equality and achievement. At 3, Melanie went with her grandmother to Washington, D.C., to hear Dr. Martin Luther King Jr. speak. She and her younger brother, Eric, graduated from private schools in Chicago to attend two of the nation's most prestigious historically black colleges.

She was so beautiful that one friend used to joke it took a strong constitution to stand next to her. Her sense of self-possession was such that she once delivered a plate of home-baked cookies to a neighborhood drug dealer with the request that he please cut down on the trade in front of her home.

Every aspect of her life was polished into perfection. Pajamas pressed and starched at the dry cleaners. Dinner, even takeout, eaten on the good china. No event went unmarked. When Melanie planted a tree in her yard, she hosted a party, complete with a poetry reading.

Melanie's first marriage broke up after four years, in part because the couple couldn't have children, friends and family say. Not long after, she met a urology resident at a conference sponsored by the pharmaceutical company where she worked as a district sales manager.

Sam Stokes saw Melanie across the room and decided he was looking at the woman who would become his wife. They were married within the year, in a small ceremony on Thanksgiving Day, at one of Melanie's favorite places, Garfield Park Conservatory.

For almost three years, Melanie and Sam tried to have children. Melanie took fertility drugs but nothing happened.

As time wore on, she became more reconciled to the idea that she might not be able to have a child. She decided she would be content in her role as "Mimi" to Andy, Sam's son by a previous relationship, and perhaps adopt.

A few days after she decided to give up her attempts to conceive, Melanie realized she might be pregnant. She bought a home-pregnancy test at a Wal-Mart in Springfield, where she was traveling for work. She was so excited that she performed the test in the store's bathroom.

Melanie approached her pregnancy in the same thoughtful and methodical manner she did everything else. She made lists of the activities she hoped to share with her child someday (Tuesday would be shopping day). At her baby shower, Melanie insisted that no one buy her gifts. All she wanted from her friends was for each of them to write her a piece of parenting advice.

Although she had always dreamed of having a daughter, Melanie didn't find out the sex of her baby, so it was a surprise when after a long and hard labor, her husband and then her mother called out, "It's a girl!" At that moment, the culmination of everything she had wished for, Melanie was too worn out to manage much more than a weak smile.

---

Two days later, she and Sam brought Sommer home to their red-brick townhouse near the lakefront on the South Side. They bought it because Melanie's mother, who is divorced from her father, lived in a condominium just across 32nd Street. The couple planned to move soon to Georgia, where Sam was going to start a urology practice with an old friend, but wanted to keep the townhouse for visits.

Melanie had been home about a week when her best friend from college, Dana Reed Wise, called from Indiana to see how she was doing. Melanie, usually effervescent, spoke in a monotone.

"I'm fine," Wise remembers her saying. "I'm just tired."

Then, in a voice so quiet it was almost a whisper, she said, "I don't think I like this."

"You don't like what?" Dana asked her.

"Being a mother."

Chronicle of despair

In the brown kraft paper journal her father gave her, Melanie tried to explain what happened.

"One day I wake up pacing then increasingly tired, then disturbed enough to go outside then I feel the thump in my head," she wrote in small, tight handwriting across the bottom of a page.

"My whole life becoming altered."

That was how it must have felt to her, like a blow, like something that jumped out at her from the dark. But, to almost everyone else, the encroachment of her mental illness was so stealthy that they did not see the shadow creeping over Melanie until she was almost engulfed.

She kept changing Sommer's formula, insisting each one made her cry too much. When a friend asked to see the nursery, Melanie refused, saying it wasn't neat enough. She stopped writing thank-you notes.

Sometimes, when Sam was paged at 2 or 3 a.m., he awoke to find Melanie already up, sitting on the edge of the bed, even though Sommer was asleep. Once, when the baby fell off the sofa where she had been sleeping and began screaming, Sam ran to comfort her, while Melanie looked on, seemingly unconcerned.

Sam thought Melanie was just having a hard time adjusting to motherhood. Her aunts Vera Anderson and Grace Alexander, who were helping her with Sommer, decided she had a touch of the "baby blues."

At first, it can be hard to distinguish the normal stress of new motherhood from a mild case of the blues or a more serious mood disorder.

People often don't know what to expect from parenthood. They aren't sure if what they feel is normal. Some of the classic symptoms of depression--lack of sleep, appetite or sex drive--are common experiences for someone trying to care for a newborn.

If women do feel unhappy or anxious they may be reluctant to tell anyone. Everyone is telling them that motherhood should be the most joyful experience of their lives. They worry that someone will try to take away their baby.

During the first week or so after delivery, many women experience the baby blues and find they are unusually weepy, irritable and sensitive. The blues usually resolve themselves within a few weeks.

Carol suspected something wasn't quite right with her daughter but she didn't know what. She urged her to see a doctor but Melanie insisted on waiting for her six-week checkup with her obstetrician.

There wasn't much Carol could do. Women in the United States are not routinely screened for symptoms of a postpartum mood disorder as they are, for example, in Great Britain.

They usually don't see their obstetricians for six weeks after they give birth, and may not see them again for a year after that, a gap that Richard Silver, chairman of the Obstetrics and Gynecology Department at Evanston Northwestern Hospital, calls "an absolute void in care."

The doctor women do see during the early months of motherhood--their child's pediatrician--often is not trained to recognize symptoms. And many women are afraid to confide in their child's doctor.

By the beginning of April, Carol became worried enough about Melanie that she didn't like to leave her alone. So she brought her daughter and five-week-old granddaughter with her the night that report cards were distributed at Healy Elementary School, where she taught 4th grade.

There they sat, in Carol's classroom, and Melanie just couldn't seem to hold the baby right.

She rocked her. She switched her from side to side. She put her down in the Moses basket, and when she started crying, she picked her back up. She put her back down. Melanie's eyes were vacant.

After that, she started to slip fast. Melanie told her mother the neighbors kept their blinds closed because they knew she was a bad mother and didn't want to look at her. She decided that Sommer hated her.

By the time Melanie went to see her obstetrician on April 6, her mother and aunts were caring for Sommer. Finally, at Melanie's checkup, with her mother by her side, the doctor asked her how she felt.

"Hopeless," she answered.

---

'No good to myself'

Later that afternoon, Melanie stood with her husband in their immaculate townhouse, which she had decorated in her confident, colorful style--a trio of giant tin giraffes in the bedroom and silk curtains the shade of saffron in the kitchen.

Her voice was as flat as her surroundings were vibrant.

She needed Sam to drive her to the emergency room, she said, because her obstetrician thought she should be evaluated by a psychiatrist for postpartum depression.

Sam didn't know what to say.

His wife was beautiful. She was smart. She had a husband who loved her. A successful career. A comfortable home. Enough money to buy almost anything she wanted to buy and go almost anywhere she wanted to go. On top of everything else, she had the daughter she had dreamed of since childhood.

How could she be depressed?

Sam didn't understand what was happening. As he and his wife left for the hospital in silence, they headed into a world that would offer Melanie and the people who loved her little in the way of answers.

The causes of postpartum mood disorders remain unknown, but recently, some experts have come to believe that the dramatic physiological changes that occur with birth and its aftermath may play a role in their onset.

During pregnancy, a woman's estrogen and progesterone levels skyrocket, then plummet to pre-pregnancy levels within a few days of giving birth. Other hormones, including oxytocin, which is known to trigger maternal behavior in some mammals, and cortisol, which is released in times of stress, also change dramatically during pregnancy and afterward.

Hormones act upon the brain in ways that can influence mood and behavior. Some researchers think that in women who may already be vulnerable for some reason--because of a prior bout of mental illness, for example, or stressful life events--these biological shifts may trigger psychiatric illness.

Melanie came back home from the emergency room at Michael Reese Hospital that evening. The emergency room doctor didn't think she was sick enough to admit, hospital records show, and referred her to a psychiatrist.

Whatever strength Melanie had mustered to maintain control evaporated. Over the weekend, she became more agitated and upset. She couldn't stop pacing. Early Sunday morning, Sam awoke to find Melanie gone. He went outside and found her walking back from the lakefront in the dark.

Later that morning, they returned to the emergency room at Michael Reese and Melanie was admitted to the psychiatric unit.

By the time Melanie got help, she was so sick she needed to be hospitalized. Most women with postpartum mood disorders can be treated as outpatients, with a combination of medication, therapy and social support.

Drugs work in about 60 to 70 percent of cases, but they can be tricky to administer. Finding the right mix of medications and doses can be a matter of trial and error. Some medications produce serious side effects; most don't take full effect for weeks.

At the hospital, Melanie told a social worker that she had become increasingly anxious about parenting, her medical records show. She thought that she should do that as well as she had done everything else in her life. She couldn't tell anyone how desperate she felt. Finally, she said, she couldn't function anymore.

"I can't care for myself or my child feeling like this," she said. At the hospital, doctors placed Melanie on antidepressant and antipsychotic drugs, as well as a nutritional supplement, because she wasn't eating.

No one used the word "psychosis," her family says. But depression didn't seem to describe the distant, agitated woman who sat in the hospital room, stony-faced and fiddling with her hair.

"How can I explain to anybody how something has literally come inside my body," Melanie wrote in her journal. "(T)ook away my tears, joy, ability to eat, drive, function at work, take care of my family. ... I'm just a useless piece of rotting flesh. No good to anyone. No good to myself."

From her 10th-floor condominium, Carol Blocker could see Melanie's hospital room.

Every night, she stood at the window with a flashlight. She flicked it on and off so her daughter would know she was there.

---

Groping for an explanation

In a matter of seven weeks, Melanie was admitted three times to the psychiatric units of three different hospitals. Each stay followed the same pattern.

She deteriorated, then, as her discharge date approached, she seemed to get better. When she went home, whatever progress she had made disappeared.

Her family ricocheted from hope to despair to frustration. Carol says she once chased a doctor down a hallway, trying to get some sort of explanation for what was happening to her daughter. Melanie's aunts assured themselves after each hospitalization that this time she seemed better. Sam told himself to be patient.

After she was discharged from Michael Reese following a five-day stay, Melanie stopped eating again. At meals, she daintily wiped her mouth with a napkin after each bite. Afterward, her aunt Grace would find the crumpled napkins full of food in the trash.

When Carol took her back to a hospital, this time to the University of Illinois at Chicago Medical Center, Melanie told the doctors she hadn't eaten for a week.

She wanted to eat, she said, but she couldn't swallow.

She was admitted overnight for dehydration and released the next morning for a scheduled appointment with a psychiatrist. The psychiatrist changed her medication and decided to start her on electroconvulsive therapy (ECT), more commonly known as shock treatment.

Once considered violent and inhumane, ECT has quietly regained popularity among many psychiatrists as a safe and effective treatment for severe depression and psychosis. In ECT, electricity is used to cause a short, controlled seizure in the brain while the patient sleeps under general anesthesia.

No one knows exactly why these seizures may relieve the symptoms of mental illness but they often do. Typically, someone will undergo five to 12 sessions of ECT over two or three weeks.

From the start, Melanie hated the treatments. She said it felt as though her brain were on fire. When she came home from the first ECT, she crawled into bed, exhausted.

Her aunts Vera and Grace crept upstairs to check on her. She was curled up in a ball, so small and thin she barely made a lump beneath the blankets.

Then, after her second treatment, Melanie came back to herself.

She started talking and laughing. In the recovery room, she drank half a dozen glasses of orange juice and ate packets of cookies and crackers from the vending machine, consuming more in three hours, Sam thought, than she probably had in the previous three weeks.

Because ECT can affect short-term memory, Melanie didn't know where she was or what had happened to her.

"I have a baby?" she kept asking Sam. "I have a baby?"

After three hours or so, she slipped back into her silence. There was little improvement after her third treatment and when it came time for her fourth session, she refused.

"It's killing me," she told her husband.

By Mother's Day, she was back on a psychiatric ward, at UIC.

Before she was a mother herself, Melanie had once celebrated Mother's Day by buying flowerpots for the children in her neighborhood and helping them decorate the containers for their mothers.

This time, she sat on her hospital bed, blank-faced, when Carol brought Sommer to see her. In the nine days she had been hospitalized, she had never asked her mother about Sommer and now she had to be told to take her into her arms.

Melanie had resumed the ECT treatments and started another combination of medications. But her weight continued to drop. At 5 feet 6 inches tall, she now weighed 100 pounds. Whenever anyone asked her how she felt, she said she thought she would never get better.

---

She thought God was punishing her and, in her journal, made a list of her sins in an attempt to figure out why. She had lied once as a child about being kicked in the head. She had thrown a dissected frog at someone in high school.

"Hurt people who were trying to be kind," she wrote.

Every night, Melanie's father, Walter Blocker, sat with her in her room. He massaged her feet, whispering to her as if she were still an infant.

You'll get better, he told her. This will end.

You'll get better. It's all right.

Trying to be a mom

Melanie spent 19 days at the University of Illinois at Chicago Medical Center. The day after she was released, she asked her neighbor for a gun.

It's for Sam, she said. He likes to hunt and I'm thinking about buying him a gun for his birthday. The neighbor demurred, then called Sam at work. Sam told him that he had never gone hunting a day in his life. Not long after that, she visited her aunt Grace, who lives on the 22nd floor of a high-rise, and sat for hours, looking out her windows. After her mother learned that she had been wandering near the lake again, she told Melanie that the doctors were concerned about her blood pressure and took her back to the hospital.

UIC was full and sent her to Lutheran General Hospital in Park Ridge. When she arrived on May 27, she had already been through four different combinations of anti-psychotic, anti-anxiety and anti-depressant drugs, as well as the electroconvulsive therapy.

Twice, Melanie had stopped the ECT treatment and she refused to start up again at Lutheran General. At the hospital, she was suspected of spitting out her medication at least once.

She wanted to get out and, her mother thought, was trying to fool people to do it. At one point, her records show, she described her mood as "calm," even though she sat with her hands clenched. When she was asked what she needed to get back to her old self, she answered, "Organization."

To that end, she drew up a timetable of her plans to integrate herself into Sommer's life. When she was released after five days, she took it with her.

Almost every day, Melanie visited her daughter, who was staying with one of her aunts, Joyce Oates. Melanie always plucked at Sommer's clothes or fussed with her hair, tics that never quite masked the fact that she rarely held or cuddled her.

Her family could see that her smiles were forced and her arms stiff. Sometimes, the only physical attention she could give Sommer was to clip her fingernails.

If Melanie ever had thoughts of hurting her daughter, she didn't tell anyone, but her aunt Joyce was concerned enough that she didn't leave Melanie alone with the baby.

On June 6, five days after Melanie came home from the hospital, she told Joyce she wanted to learn her daughter's bedtime routine. She watched as her aunt fed and bathed Sommer.

Joyce lay the baby's nightgown on the bed and asked Melanie to put it on her. Melanie picked it up and stared at it. Then, she put the nightgown back on the bed.

"I can't do it," Joyce remembers her saying.

She turned around and went back to the living room.

It was the last time her daughter saw her.

Goodbyes to all

Melanie tried to say goodbye.

Early the next morning, she called her mother and told her she had been a good parent. Her father got a telephone call, too, while he was shaving. She said she loved him.

For Sam, there was a note tucked under a corner of a photo album she placed on the kitchen table.

---

He had walked in from a Thursday staff meeting at Cook County Hospital, expecting to pick up Melanie. They had planned a day out together. It wasn't until he had made half a dozen telephone calls and two trips to the lakefront to look for her that he saw the note.

"Sam, I adore you, Sommer and Andy, Mel."

Puzzlement dawned into panic. Her family contacted police and with her friends scattered around the city to search her favorite spots: the Osaka Garden in Jackson Park, Bloomingdale's, the Garfield Park Conservatory.

A neighbor later told the family she saw Melanie getting into a cab. After that, she vanished, a thin woman in an orange peacoat, sweat shirt and jeans.  

Melanie's last stop

The woman who arrived at the Days Inn across from Lincoln Park late Saturday night was neatly dressed and clean, polite almost to a fault.

Her bag had been lost or stolen on the train, she said, and she didn't have any identification on her. But she did have cash. Could she book a room?

Tim Anderson, the front desk supervisor, was sympathetic but skeptical. He told her he couldn't allow someone to pay cash without photo identification. But she was welcome to wait there until she heard from the lost-and-found.

So, Melanie spent most of Sunday in the hotel's cramped lobby, little more than an alcove with two armchairs and a sliding-glass door. Occasionally, she chatted with Anderson. She asked him where she could get something to eat and he directed her to a coffee shop around the corner. Later, she bought a chicken quesadilla from the restaurant next door and he let her eat in the break room.

From time to time, she left the hotel. At some point, she went to the Dominick's at Fullerton and Sheffield Avenues, where an employee in the cafe later would find a blank card with a photograph of Melanie and Sam enclosed.

Melanie's family had turned to the local newspapers and television stations asking for help in finding her. Her photograph was in the Sunday newspapers in the convenience store across the hotel lobby. No one recognized her.

She didn't strike Anderson as someone who was hiding or homeless, but something about her just didn't seem right.

Before Anderson left for the day, he says, he told his replacement not to allow her to check in unless she produced some identification. But just after 5:30 p.m., her bill shows, Melanie paid $113.76 for a room, in cash. She checked in under the name Mary Hall.

She was given Room 1206, on the top floor of the hotel. From her window, she could see the Lincoln Park Zoo, which was her father's favorite place to spend his birthday, walking with Melanie.

Just before 6 the next morning, a cyclist riding by the hotel saw a woman perched on a window ledge and ran inside to tell the clerk.

Within minutes, firefighters were in Melanie's room, trying to talk her back inside. She sat on the other side of a window, her back straight and pressed against the glass.

Paramedic Deborah Alvarez tried to reassure her. This woman, she thought, looks as frightened as a child. Melanie answered but the glass blocked her voice. Alvarez never heard what she said.

After about 20 minutes, a firefighter approached the window. Melanie turned a little, as if she were going to try to pull herself up. Then, she turned back, put her hands at her side and dropped from the ledge.

Gasps and screams rose from the small crowd that had gathered across the street. One of Melanie's shoes fell off and bumped against the building.

Alvarez raced for the elevator, hoping against hope. When she ran outside, she saw that Melanie's body had already been covered.

In her room, the bed was made. On the radiator cover was a copy of the Chicago Sun-Times. The front-page headline was about her.

On a night stand next to the digital clock sat a neat stack of notes, written on hotel stationery, with a pen laid perfectly straight in the middle.

Melanie wrote a note to her parents. It said, in part, "Please let Sommer know how much I loved her during the pregnancy."

She wrote a note to her husband, telling him to continue with their plans to move to Georgia and thanking him for loving her in "such a generous, sweet way."

---

She wrote a note to Tim Anderson, the employee who let her sit in the lobby.

"I am so sorry to have used your kindness in this way," it said. "You really are a fabulous clerk--very good at what you do. Tell your boss this was not your fault."

She wrote a note to herself.

"Everyone going along with normal happy lives. I wish I was normal again."

In her apartment on Chicago's Gold Coast, Joan Mudd read about Melanie's death in the newspaper. She tore out the article and tucked it into a drawer. She didn't want her daughter Jennifer to see it.

----------

WHERE TO FIND HELP

Postpartum Support International, Illinois chapter: (847) 205-4455, www.postpartum.net

Depression After Delivery: (800) 944-4773, www.depressionafterdelivery.com

Jennifer Mudd Houghtaling Intervention Program for Postpartum Depression at Evanston Northwestern Healthcare, 24-hour toll-free hot line: (866) ENH-MOMS

Pregnancy and Postpartum Mood & Anxiety Disorder Program at Alexian Brothers Hospital Network, Elk Grove Village: (847) 981-3594 or (847) 956-5142 for Spanish speakers Perinatal Mental Health Program, Advocate Good Samaritan Hospital, Downers Grove: (630) 275-4436

next: Forced ECT
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

Men with body-image anxiety are embarrassed when attention is called to their physiques.

More men falling prey to anxiety over bodies

Traditionally men have been off the hook when it comes to anxiety about body image, and a blatant double standard has existed.

Several years ago, for example, actor John Goodman was voted one of the sexiest men in America, even though he was 75 pounds overweight on the sitcom "Roseanne." It's hard to imagine an overweight woman earning the same status.

This double standard is wrong, and things are beginning to change, but in a surprising way. No, women are not giving us men a taste of our own medicine and criticizing us for our love handles, potbellies and scrawny arms, and demanding that we shape up and meet some mythical and unattainable Arnold Schwarzenegger standard.

Men bashing themselves

The change in attitude is happening among men. Recent research revealed that men are beginning to victimize themselves with body-image anxiety. We don't like how we look, and we get embarrassed and anxious when attention is called to our physiques.

Men apparently are paying attention to those magazines and TV commercials with buff guys showing off sculpted midsections and bulging biceps, and they are drawing unfavorable comparisons with the soft, frumpy bodies staring back at them in the mirror.

Moreover, the socio-economic success of the individual male doesn't necessarily shield him from anxiety, the way it did in the past.

I believe this is a significant finding. On the one hand, I like it. What's good for the goose is good for the gander, and now that we are experiencing what women have had to put up with for decades, perhaps something good can come out of this for our society.

On the other hand, I fear that our entire society, with men now joining women, is headed toward a slippery slope. The greater the body-image anxiety, the more vulnerable we are and the more likely we are to do irrational things to compensate.

On the wrong track

Crash diets are one example, and the number of men signing on to the foolish yo-yo dieting circuit is increasing dramatically.

Of course, crash diets not only don't fix the situation, they make it worse; crash dieters always end up fatter in the long run.

Ironically, the fatter we get, the thinner we think we need to be and the less attainable the standard we set. Traditionally, women have led the charge. Here's an example:

As the average American woman has gained many pounds progressively during the past five decades, Miss America, the ideal female figure, has shrunk by more than 30 pounds, and winners seem to keep getting taller and thinner. Cover girls and runway models are frightfully thin, and teenagers try to emulate their looks through starvation, bulimia, metabolic enhancers and laxatives.

Although men generally have resisted this dangerous trend, there is evidence that we are beginning to move in the same insane direction; a no-win, highly destructive situation to be sure.

The answer?

Men and women must unite in an effort to be more self-accepting and more accepting of others. With this as a starting point, perhaps we can begin moving toward improved health, successful long-range weight management and a friendlier relationship with our bodies.

About the author: Bryant Stamford has a doctorate in exercise physiology and is director of the Health Promotion and Wellness Center at the University of Louisville. Feb. 2003

next: Panic Disorders in Men
~ anxiety-panic library articles
~ all anxiety disorders articles

Does genetics play a role in ADHD and can ADHD be inherited? There are now several dozen case studies showing that ADHD does run in families.

When a child is diagnosed with ADHD, it often pays to look at the adults in the family, too. ADHD sometimes runs in families, and parents or grandparents may also have it.

When Michele Novotni was pregnant with her son, Jarryd, she might have guessed that he would become a child with attention deficit hyperactivity disorder (ADHD). After all, while in the womb, he was so active. Before he was 2 years old, he was diagnosed with ADHD, and he began taking medication for the disorder at age 5.

As Jarryd's family began dealing with the challenges of his ADHD, Novotni contemplated whether her father might also be afflicted with the same disorder, even though it had never been diagnosed. "We didn't know why my father had never worked up to his potential," says Novotni, PhD, a clinical psychologist in Wayne, Pa.

Before long, Novotni's father was, in fact, diagnosed with ADHD at the age of 65. He has been treated with a combination of strategies, including medication and personal coaching, and "it has made a huge difference in his life," she says.

Among Novotni's relatives, the family tree of ADHD doesn't stop there. One of her sisters has ADHD. So do several of her nephews.

ADHD Running in Families

The familial nature of ADHD isn't uncommon. With increasing frequency, child and adult psychologists and psychiatrists are encountering families with multiple ADHD cases. More than 20 studies now confirm that the tendency to develop ADHD can be inherited, often affecting not only parents and their children, but also cousins, uncles, and aunts in the same extended family.

For example, when one child in a family has ADHD, a sibling will also have the disorder 20% to 25% of the time, says geneticist Susan Smalley, PhD, co-director of the Center for Neurobehavioral Genetics at the David Geffen School of Medicine at UCLA (www.adhd.ucla.edu). About 15% to 40% of children with ADHD will have at least one parent with the same condition.

The prevalence of ADHD within families is particularly striking in studies of twins. Identical twins share all of their genes, and when one sibling has the disorder, his or her twin will have the condition 70% to 80% of the time. With non-identical or fraternal twins, ADHD occurs in both siblings in 30% to 40% of cases.

The Parent-Child Connection

ADHD is the most common behavioral disorder diagnosed in children, and overall it affects up to 7.5% of school-age youngsters, according to a recent Mayo Clinic report. But though ADHD is often perceived as a childhood condition, it also occurs in about 2% to 6% of adults. Although by definition ADHD is a disorder that always begins in childhood, many adults with the condition may never have been diagnosed while growing up.

"Often, when we do assessments of children, a parent will say, 'That sounds a lot like me,'" says Novotni, author of Adult ADHD: A Reader Friendly Guide and president of the Attention Deficit Disorder Association (www.add.org). "Or the parent might say, 'So that's why it took me three times longer than other students to study for tests.'"

But while genetics clearly have an important role in ADHD, it is not the only influence. Environmental factors are players in the equation as well, such as smoking or alcohol use by a mother during pregnancy, and extremely low birth weight of the newborn, which could delay the development of the baby's brain and put him at risk for ADHD. Toxins in the environment and dietary factors might also be pieces of the puzzle in some cases, but they need to be better studied.

According to Smalley, ADHD is the result of a blending of factors. "ADHD is always caused by a combination of a genetic predisposition to get ADHD, and then the kind of environmental factors that interact with that genetic predisposition."

Family Challenges

Families with multiple members with ADHD face special challenges in coping with the condition. A parent with ADHD may find it challenging to maintain self-control while dealing with a difficult child because of the parent's own emotional difficulties, says Arthur Robin, PhD, professor of psychiatry and behavioral neurosciences at Wayne State University School of Medicine in Detroit. "Parents may have a harder time inhibiting their own emotions and thinking things through before they act," he says. "The child's rashness and impulsiveness may evoke a reaction from the parent, creating an escalating and explosive situation."

Though hyperactive behavior and impulsivity are common characteristics in children with ADHD, the symptoms often change as these youngsters grow into adults. A study at Massachusetts General Hospital concluded that adults with the condition often are restless, easily distracted, have difficulty following directions, and frequently lose items -- but may not be hyperactive or impulsive like their own ADHD children.

---

---

---

When both a parent and his or her child have ADHD, treating the parent's disorder may be important in order for progress to be made in managing the child's disorder. After all, say ADHD experts, effective parenting of an ADHD youngster may require remembering to give the child his medications and implementing firm structure in his life. But an ADHD parent may need to be treated himself to become that kind of skillful parent.

"For example, when both a father and his child have ADHD, it's harder for the dad to deal consistently, calmly, and effectively when the child is acting out," says Robin. "It's also more difficult for the child to learn to behave appropriately because consistent consequences may not be imposed upon him by his father. But when the parent is calm, highly nurturing, and provides a structure, the ADHD child will probably do better."

In an ADHD household, the parent without ADHD may be facing challenges of his or her own. "A mother and wife without the disorder may feel like she has two children -- not only her child with ADHD, but also her husband who may seem like another child at times because of his ADHD -- and she has to care for both of them," says Robin, author of ADHD in Adolescence. "She's usually the family member who is most stressed out and most likely to be depressed."

Getting Treatment for ADHD

More than a dozen drugs -- most often, agents such as Ritalin and Adderall (an amphetamine product) -- are used to treat children with ADHD and are frequently prescribed for adults with the disorder as well. "Everyone's response to medication is different, but each of the medications seems to work in many individuals irregardless of age," says Novotni. Another drug, Strattera, was approved by the FDA in November 2002 and is the first ADHD medication proven clinically effective in adults.

In addition to taking a drug for their ADHD, adults may find that establishing routines or strategies for themselves can help them become better parents. These approaches may include making, posting, and frequently referring to lists of their day's activities and tasks, learning time management skills, and setting up a self-reward program when they meet their own goals.

Like their children with ADHD, adults with the disorder may benefit from psychotherapy as well, working on the emotional components of the disease. "When someone at age 40 learns that he has ADHD, he could react with sadness because he may not have accomplished all the things he otherwise might have in life," says Robin. "Or he may be angry at people who never figured out early in his life that he had this problem. Sometimes these adults are in denial. They need support and help in rebuilding their damaged self-esteem."

Understanding the Genetics of ADHD

In their studies of the familial nature of ADHD, most scientists believe that many genes -- perhaps 5, 10 or more -- are involved in the development of ADHD. One cluster of genes may cause one form of ADHD, says Smalley, and another cluster may cause another form. Once researchers have a clearer understanding of these genetic patterns, doctors may be able to use genetic testing very early in a child's life to identify whether he or she has a high risk of developing the disorder.

"We'll be able to diagnose better, and move toward better medications that can target the specific genetic problem in a particular child," says Smalley. At the same time, parents can be taught skills early on to deal effectively with their children, as well as utilize computer-based programs that may help improve a child's attention span.

SOURCES: Michele Novotni, PhD, president, Attention Deficit Disorder Association, Wayne, Pa. - Susan Smalley, PhD, co-director, Center for Neurobehavioral Genetics, David Geffen School of Medicine, UCLA - Arthur L. Robin, PhD, professor of psychiatry, Wayne State University, Detroit.

---

---

next: ADHD: Dealing with the Legal and Insurance System
~ adhd library articles
~ all add/adhd articles

African Americans and Hispanics victimized by discrimination and who experience racial disrespect develop stresses associated with racism.

You know about the dangers of smoking, obesity, fatty foods, unprotected sex, and environmental pollutants. Now chalk up another health hazard to that ever-growing list: Racism.

Racism plays a key role in the development of illness -- and countering it should be considered a public health issue, says a psychiatrist in the latest issue of the British Medical Journal. "Considering racism as a cause of ill health is an important step in developing the research agenda and response from health services," writes Kwame McKenzie, MD, a psychiatrist at Royal Free and University College Medical School in London.

Despite general agreement that racism is wrong, he says there is little evidence of concerted initiatives to decrease its prevalence.

The health effects of racism are well documented. One British study of 4,800 people finds that those who felt victimized by discrimination and forms of racism were twice as likely to develop psychotic episodes in the next three years. Meanwhile, a group of Harvard researchers documented that a mere 1% increase in incidences of racial disrespect translates to an increase in 350 deaths per 100,000 African Americans.

How? Being on the receiving end of overt or subtle racism creates intense and constant stress, say some experts, which boosts the risk of depression, anxiety and anger -- factors that can lead to or aggravate heart disease. Some research also suggests racism can also manifest itself in respiratory and other physical problems.

"We know that black folks are at higher risk of hypertension, but in childhood, there are no differences between black and white blood pressure rates," says Camara P. Jones, MD, MPH, PhD, research director of Social Determinants of Health for the CDC and a leading specialist on the health impact of racism. "By the time you get into the 25-44 year-old group, you start to see changes. We have evidence that in white folks, blood pressure is dropping at night, but not in black people."

Her theory on one reason: "There's a kind of stress, like you're gunning your cardiovascular engine constantly if you're black that results from dealing with people who are underestimating you, limiting your options," she says. "It results from little things like going to a store and if there are two people at the counter -- one black and one white -- the white person will be first approached. If you have stress from other sources, like a bad marriage, it's not something you think about constantly. But the stresses associated with racism are chronic and unrelenting."

In surveys she conducted, she finds that whites rarely think about their race in the course of a day. "But 22% of blacks surveyed said they constantly think about their race, and 50% said they think of race at least once a day -- they are constantly reminded of their blackness," she says. "That has a profound effect on health."

In addition to stress, numerous studies show that racial and ethnic minorities tend to receive lower-quality healthcare than whites -- even when insurance status, income, age, and severity of conditions are comparable, according to a recent report by the National Academies' Institute of Medicine (IOM). And in reviewing 81 studies comparing cardiac care received by black and white patients, the Henry J. Kaiser Family Foundation and the American College of Cardiology Foundation report that 68 -- a full 84% -- indicated that race played a role in the type of care received, with blacks getting inferior treatment.

"We all know that African Americans, Hispanics, and other ethic minority groups live sicker and die younger -- but this occurs even when we control for social class and income," says H. Jack Geiger, MD, ScD, of the City University of New York Medical School, who helped research the IOM report and other studies examining how racism impacts health outcomes. "People of color have a variety of disadvantages, including lack of access to care, lower income, less insurance. But if you take two people with the condition who have the same income and insurance, the minority is less likely to get the same treatment."

Who's to blame? Doctors get their share, says Geiger. "It's not that they practice overt racism; it usually happens without awareness," he says. "And that's one reason why most physicians are very reluctant to recognize this in themselves or their peers." There also other factors that influence medical care, such as a greater mistrust of the medical community among minorities, as well as communication problems between physicians and their cultural different patients.

The solution? "Health services and individuals should monitor prescriptions and medical interventions to see whether or not there are differential patterns by race," suggests Jones. "Physicians should actively guard against making assumptions about their patients, and connect with each patient by identifying something that they have in common with that patient. And researchers need to shift their focus from individual-level risk factors, like physical inactivity, to societal-level risk factors like neighborhood safety and resource constraints that lead to physical inactivity."

Sources:

• British Medical Journal, Jan. 11, 2003
• Camara P. Jones, MD, MPH, PhD, research director Social Determinants of Health, CDC
• H. Jack Geiger, MD, ScD, department of Community Health and Social Medicine, City University of New York Medical School, The Sophie Davis School of Biomedical Education, New York
• National Academies' Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, March 20, 2002
• Why the Difference?, a report by the Henry J. Kaiser Family Foundation and the American College of Cardiology Foundation, October 2002.

Ritalin is the most commonly prescribed medication for ADHD. This ADHD treatment has helped thousands of people control their symptoms. But because Ritalin is a stimulant like cocaine, it may cause undesirable changes in the brain over time. Ritalin also has the potential for abuse.

A report in the latest issue of Pediatrics concludes that children treated with Ritalin are not more likely to abuse drugs as adults. A New York Times rundown of the report notes that Ritalin is "chemically similar to cocaine." Just how similar?

Both cocaine and methylphenidate, the generic name for Ritalin, are stimulants that target the dopamine system, which helps control the brain's functioning during pleasurable experiences. The two drugs block the ability of neurons to reabsorb dopamine, thus flooding the brain with a surplus of the joy-inducing neurotransmitter. According to animal studies, Ritalin and cocaine act so much alike that they even compete for the same binding sites on neurons.

Why, then, aren't the 4 million to 6 million kids who take Ritalin daily acting more like the Studio 54 crowd, circa 1977? One important difference is that Ritalin, administered as directed, acts much more slowly than cocaine. Nora Volkow, a senior scientist at Brookhaven National Laboratory who has done extensive research on methylphenidate, found in a 2001 study that Ritalin takes upward of an hour to raise dopamine levels; cocaine, a mere seconds. The exact reason why the uptake speed matters is unknown, but it seems to account for the different effects.

Note, however, that not all Ritalin users swallow their pills. Recreational users frequently crush their supply into fine powder for nasal delivery or, in extreme cases, melt it into an injectible solution. These administration methods increase the uptake speed, and users report that the high is not too terribly different from a cocaine buzz. The exact nature of the experience depends on each person's unique brain chemistry; those who naturally lack an adequate amount of dopamine, such as people diagnosed with Attention Deficit Hyperactivity Disorder, may feel less giddy than a non-sufferer. And about half of Ritalin users who don't have ADHD won't enjoy the kick, which can be comparable to ingesting one (or six) too many espressos.

Sources: New York Times, University of Utah Genetic Science Learning Center, Slate

---

---

next: Pediatric Ritalin Use May Affect Developing Brain
~ adhd library articles
~ all add/adhd articles

Genetic Link to Common Mental Disorder Found in Mice

A genetic abnormality may help explain why some people are more prone to feelings of anxiety and aggression than others. Researchers say they've discovered a gene in mice that regulates levels of a chemical responsible for controlling anxiety, impulsive violence, and depression in humans.

Researchers say the gene, Pet-1, is active only in serotonin nerve cells in the brain. Serotonin is a chemical messenger that allows cells to communicate with each other in the brain and spinal cord.

When this gene was eliminated in laboratory mice, the researchers found that the mice displayed more aggression and anxiety.

The findings appear in the Jan. 23 issue of the journal Neuron.

Defective serotonin cells have been linked to anxiety and depression in humans. In fact, antidepressant drugs such as Prozac (Fluoxetine) and work by increasing serotonin levels.

But researchers say that until now, it was unknown whether a genetic defect causes these serotonin cells to malfunction.

This study suggests that Pet-1 is required for normal development of serotonin cells. Mice who didn't have this gene failed to develop enough serotonin cells in the fetus, and those that were produced were defective.

"This leads to very low serotonin levels throughout the developing brain, which in turn results in altered behavior in adults," says researcher Evan Deneris, PhD, neuroscientist at Case Western Reserve University in Cleveland, in a news release. This is the first gene shown to affect adult emotional behavior through specific control of serotonin nerve cells in the fetus, he says.

Researchers conducted anxiety and aggression tests on the mice lacking the Pet-1 gene and compared their behavior with normal mice. In an aggression test that measures a mouse's response to an intruder mouse entering its territory, the defective mice attacked the intruders much more quickly and more often than the normal mice.

For the anxiety test, the researchers measured the amount of time a mouse would stay in an open, unprotected area of a test chamber compared with a closed, protected area. Researchers say normal mice will enter and explore unprotected areas, but the mice lacking Pet-1 avoided this area entirely, which indicates abnormal anxiety-like behavior.

Deneris says if further research shows that Pet-1 is associated with excessive anxiety or violent activity in humans, then tests to detect the abnormal version of the gene might be useful for identifying people who may be at risk for these abnormal behaviors.

Source: Neuron, Jan. 23, 2003 - News release, Case Western Reserve University, Cleveland.

next: Anxiety and Depression After A Heart Attack
~ anxiety-panic library articles
~ all anxiety disorders articles

Anxiety and panic can be very troubling for a teenager and it's important for parents to seek professional help.

Dealing with Anxiety

Quite often even health professionals have difficulty distinguishing between depression and anxiety in an adolescent. Like depression, anxiety in young people can be a disabling disorder, interfering with school, interpersonal relationships, and nearly every other aspect of their lives. Some individuals also have physical symptoms along with the psychological ones.

Everybody has experienced anxiety from time to time. Sometimes it has a clear cause: examinations, a job interview, the first time behind the wheel of a car, the first attempt at sexual intercourse. Though this type of anxiety can be quite disruptive, it is transitory and disappears in short order.

But the unpleasant feelings associated with anxiety can also have no apparent cause and can become a chronic condition. This anxiety can be associated with a sense of danger or impending doom, even though there is no obvious justification for this feeling. As one pediatrician has said, "Fear is when you look up, see a 450-pound weight about to fall on your head, and feel discomfort. With anxiety, you feel the discomfort but you don't know the cause."

Anxiety (specifically, separation anxiety) sometimes occurs in younger children. But more serious problems with anxiety often begin in late adolescence or early adulthood and can take many forms. A common type is the so-called "panic disorder," often consisting of episodes of panic attacks (intense fearfulness) and physical symptoms such as heart palpitations, excessive sweating or cold, clammy hands, dizziness or light-headedness, trembling, tingling of the skin, muscle tension, flushes or chills, diarrhea, nausea, and a fear of dying. Hyperventilation is another common indication of this and other types of serious anxiety.

These adolescents also might experience agoraphobia -- another form of panic disorder characterized by an irrational fear of leaving familiar surroundings such as home. Thus they may be afraid to go to school because of a fear of crowds, feeling much more secure just staying in their room. The mere thought of venturing out into the world can cause many of the same physical symptoms described above. Panic attacks and agoraphobia can even occur together.

No matter what form the anxiety takes, however, these teenagers may have difficulty falling or staying asleep. They may also have trouble concentrating, and they can be quite irritable. Anxiety can manifest itself as chest pain, headaches, or abdominal pain too, and affect teenagers of any age.

No one knows exactly how prevalent anxiety disorders are among adolescents. But as with depression, anxiety can be provoked by factors ranging from the modern stresses on families to the breakup of the family unit. If a teenager's family has been split by divorce, or if there are serious economic pressures in the household, anxiety may be one way in which he will react. If he feels overwhelming pressure to get excellent grades to gain admission to the college that Dad attended, he may be experiencing genuine panic relative to his schoolwork.

Some adolescent anxiety is associated with growing up, leaving home, and separating from mother and father. The challenge of being independent is too much for some teenagers to bear, and they may panic at the mere thought of it.

As with depression, you shouldn't ignore adolescent anxiety. If your teenager appears to have a persistent anxiety disorder, a pediatrician should evaluate him. The doctor should begin by conducting a complete physical exam, since many medical problems can produce states that mimic anxiety disorders. Once the doctor rules out medical disorders, he or she should look closely at what may be causing the anxiety or the panic attacks. What are the stresses in the youngster's life? Are there problems with peers or the family that could be disturbing to him?

Counseling is often very effective for these young people, helping them deal with and ease their anxiety. Also, if there's a way you can change your youngster's environment to help relieve the stress in his life, you should make a strong effort to do just that.

Doctors sometimes prescribe short-term drug therapy as well. Your family's pediatrician might recommend that your youngster take an antianxiety medication or even an antidepressant drug. But your teenager should never take any medication that hasn't been prescribed specifically for him.

Source: American Academy of Pediatrics, 2003

next: Chronic Illness May Affect a Child's Social Development
~ anxiety-panic library articles
~ all anxiety disorders articles

My teacher responded to a poem a student had written about his suicide attempt. The room fell silent. Everyone else in the room was Black but her. "I mean, I didn't think they had serious problems," she added.

Sitting there in the classroom, I thought that had to be the most ignorant comment I had ever heard in my life. Now that slavery was abolished, the Civil Rights movement over and some African-Americans upwardly mobile, everything was alright? Blacks did not have any more problems? Wrong!

I found my teacher's statement absolutely offensive. But later, realized I had never thought about suicide among African-American teenagers either. Even though I had considered suicide myself, I didn't think that other Black kids did.

I Thought Suicide Was a White Thing

Like my teacher, I guess I thought suicide was more of a problem with White teens. Teen suicides talked about in the media were always White. If Blacks of any age were committing suicide, I had never heard about it in the news or on TV. Suicide never came up in a conversation with my friends, and my parents never talked about it.

My teacher's ignorance as well as my own led me to do further research on Blacks and suicide. I now know suicide is a real problem in the Black community and that I'm not the only Black teen who has ever thought about it.

My teacher and I weren't totally wrong to see suicide as a problem for White teens more than for Black teens. Until recently, White teens committed suicide at a much higher rate than Black teens, according to reports. But over the last 20 years, the rate of Black teen suicide has increased dramatically.

Paying More Attention to Suicide in the Black Teen Community

According to the Centers for Disease Control, in 1980, the suicide rate for Whites aged 10-19 was 157% greater than that of Blacks. However, by 1995 there was only a 42% difference. Although Whites are still more likely to commit suicide than blacks, the suicide rate for all African-Americans doubled between 1980 and 1996.

These statistics startled me. I wondered why there was such a dramatic increase in Black suicides. Dr. Juliet Glinski, of the Montefiore Medical Center, suggests that medical officials may be identifying suicide as a cause of death more frequently because education about suicide is more a part of their training than it used to be.

"Is there an increase among Black teenagers or in fact are we paying more attention to the problem?" said Alan Ross, executive director of the Samaritans of New York, a suicide prevention organization. "When you pay more attention to a problem, you become more aware of the number of people suffering from it," he says.

Possible Causes of the Increased Rate of Black Teen Suicide 

Black Teens Get Depressed, Too

It's also possible that there are simply more Black teens committing suicide than in the past. But what could be making more Black people end their lives? For some, the same reasons as White people, such as depression, social isolation and hopelessness.

According to the Centers for Disease Control, the most common reasons given for attempted suicides by teen suicide survivors were a conflict with a boyfriend or girlfriend, an argument with parents and school problems. And gay teens of all backgrounds have a much higher rate of suicide because they often feel conflicted about or ashamed of their sexuality.

"Certainly the warning signs of suicide and the risk factors that touch all teenagers would be there for Black teenagers," said Ross.

When it comes to the motivations to commit suicide, Ross said, "there is no difference between us." Just like White teens, Black teens have had exposure to conflicts and sexual identity issues.

Depression and Isolation a Cause of Black Teen Suicide

Is there anything that might account for the dramatic increase in suicides among African-Americans? Donna H. Barnes, one of the founders of the National Organization for People of Color Against Suicide, notes that depression, which often goes undiagnosed, is on the increase among African-Americans.

This might be because, says Barnes, "Blacks are being taken away from the traditional Black community and moving into White communities. Blacks feel isolated."

Barnes mentions that since the Civil Rights movement produced advances in law and equality, there are more opportunities available to Blacks than there used to be. Because of this, though, when they fail they may begin to blame themselves instead of the system. This can lead to depression and suicide.

---

Possible Causes of the Increased Rate of Black Teen Suicide

(Continued from page 1.)

Poverty and Low Self-Esteem

Poor African-Americans can also be affected by hopelessness and social isolation. Some community leaders have pointed to a lack of decent jobs and positive role models for young Black men in poor communities. They note that poverty and low self-esteem, together with easy access to drugs and guns, can lead to suicide as well.

Kenya Napper Bello, a counselor in Atlanta, told The Washington Post that the young Black men she counsels said they feel isolated from social institutions-such as family, church and school-that could help them.

Guys with Guns Die Most

Males do have a higher rate of suicide than females. Among people of all backgrounds, four males kill themselves for every female who kills herself. Of the 2,103 Blacks of all ages who committed suicide in 1997, Black males accounted for 1,764 of the completed suicides while only 339 were Black females. But more females, of all backgrounds, try to kill themselves; there are three female suicide attempts for every male attempt.

Males are more likely to actually kill themselves because they have greater access to firearms. Gun-related suicides accounted for 72% of suicides among Black males in 1997.

Because women and girls tend to use less effective ways to commit suicide such as slitting wrists and consuming pills, they are more likely to be found alive and taken to the hospital for treatment.

He Didn't Look Like the Suicide Type

I had thought about suicide before. I realized that the day my teacher made her ignorant comment. The student who had read his poem to the class (I'll call him Jai) did not look like the type that would want to end his life. He was popular and attractive. Out of all people, he would not have been the person I expected to weave this tale of horror.

Why did he want to die? "I wasn't happy with myself," he said. He survived his suicide attempt, though, and was sent to a mental institution for teenagers. The institution was crowded, depressing and suffocating.

"It was filled with hopelessness and despair," said Jai. The institution was filled with Black teenagers like himself, which surprised him.

I Didn't Feel Alone

After Jai read his poem, other students in the room also admitted to at least thinking about suicide. Suddenly, I didn't feel alone. We discussed why we had thought about suicide. Family problems and pressures from school were the most common reasons.

After our discussion, an eerie silence passed through the entire room, then we changed the subject. We never talked about it again. It was an eye opener for me. I did not know how widespread the problem was until that day.

"Everyone feels suicidal at one point in their life," said Ross. "We have to be responsive and supportive, not accusatory but understanding, and not blame the people for having a hard time. The more accepting we are, the more we help people before they feel more suicidal."

The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week.

Or for a crisis center in your area, visit the National Suicide Prevention Lifeline.

© 2002 by Youth Communication

next: U.S. Surgeon General Says Minorities Face Larger Hurdles Toward Mental Health Care Than Whites
~ depression library articles
~ all articles on depression