Rochester Post Bulletin: New law equalizes mental health insurance coverage

By Jeff Hansel
Post-Bulletin, Rochester MN



Insurance that covers 80 percent of the cost for an appendectomy might pay only 50 percent for mental-health care.

After a decades-long battle, that disparity is about to change.

The Paul Wellstone Mental Health and Addiction Equity Act used the $700 billion economic rescue package to gain enough votes. Along with financial rescue came federally mandated insurance equality for people with mental illness.

"Finally it's being recognized," said Pat Schwartzhoff of Rochester, who has experienced depression and talks at school assemblies about mental illness. The bill passed in October and was signed into law by Pres. George W. Bush.

The mental-health equality portion of the bill is just as significant for many people as the Americans with Disabilities Act, which in 1990 banned discrimination against people with disabilities.

Mental illness insurance coverage must now equal coverage for physical illness.

Minnesota's Sen. Paul Wellstone, who died in a 2002 plane crash, fought to pass such legislation, but the needed votes eluded him before his death.

"I am absolutely proud that it's named after my father," said the late senator's son, Dave Wellstone.

The younger Wellstone started working to get the bill passed right after the plane crash that killed his parents, sister and five others.

"We all know somebody with a mental illness or who suffers from addiction," Wellstone said. "This is going to be groundbreaking."

The bill doesn't require that mental health be covered. Instead, it simply requires that, if physical health is covered, that mental health is covered at the same level.

"If it's offered now, then it will have to be brought up to par with the physical illnesses," Wellstone said.

The bill lagged for many reasons, he said. For one, there's a lot of stigma related to mental illness.

"To be able to help leave that legacy that's now in law, it's kind of a way to make sense of things," Wellstone said.

Working for the bill helped him heal.

"When you lose your family, you try sometimes to make sense out of it, and try to have good things happen," Wellstone said.

Pat Schwartzhoff's husband Earl, 64, said he worked as a health-insurance company manager for more than 25 years, supervising, at one point, three states.

"If you have an appendectomy, with most insurance companies, the claim will be handled easily," he said. Not so with mental illness. Two sets of rules exist, one for mental and one for physical health.

"They will quiz you, for lack of a better word. It's like they question the diagnosis of your doctor and you have to jump through so many hoops," Schwartzhoff said.

The new national law takes effect in 2010.

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Laura redefines insanity ... and sheds some light on our modern world

My buddy Laura (or my close personal friend Laura, as I refer to her when I'm trying to bask in reflected glory) writes a fascinating blog about birds called "Laura's Birding Blog" and edits an equally fascinating but whimsical blog called "Twin Beaks" (actually, i think she writes that one, too, but I have learned NEVER to antagonize our local chickadees) when she's not writing books -- or instant messages to me.

This week I happened to share that when you tell IT urchins (the Information Technology students who work at the University where I do) that you have renamed "My Computer" to "Pete," it bewilders them.

Which prompted this thoughtful reply from Laura:

IT urchins are always bewildered. They expect the world to work exactly opposite of the definition of insanity--there is supposed to be a way of analyzing a problem and finding a solution. But computers don't work that way. My computer at work, when it turns on, either has a working cursor or doesn't--you can't predict which times it won't, and all you can do is turn it off and reboot it. And part of the time that works, and part of the time it doesn't. So to make it work one must do exactly the same thing over and over, hoping for a different result.

No wonder IT people are fragile and bewildered.

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The Orange County Register: Giant poodles save the day

The canine versions of Jimmy Stewart and Rita Hayworth help a Santa Ana psychologist work with children.
LORI BASHEDA
The Orange County Register


There I sat on psychologist Amy Stark’s couch with her sidekick Jim sitting practically on top of me. I had only known Jim for a couple of minutes and already his face was so close to mine.

I could smell his breath as he stared hard into my eyes.

Longingly? Wistfully? Sadly? I couldn’t tell.

I wondered what he was thinking. That I was clearly in need of some counseling? Or was he just wondering if I had a can of Purina in my purse?

Jim is a giant poodle.

Standard poodle is the correct name. But Jim is 4-feet tall from his enormous toe pads to his curly head. That’s only a foot shorter than I am. So to me, he’s a giant poodle.

Rita is not as tall as Jim, and more high strung, but she is friendly.

Rita is also a giant poodle.

•••

It was Rita who greeted me when I walked into Stark’s waiting room the other day in Santa Ana.

On the wall hung framed head shots of Jim and Rita with the title: “Employees of the Month.”

And behind the counter, standing on her hind legs, peering out from behind that little window that doctors offices have, was a rather serious Rita, her front paws resting on the counter like she was about to collect a co-pay.

She was taller than me and her head was the size of a human’s. I laughed nervously, but she just stared at me, all business.

Jim and Rita followed me into Stark’s office, which is really too cold a word for what I found. It was more like someone’s cozy living room with sofas and lots of stuffed animals.

“I want this to be a calm place, because we have to talk about some hard stuff here,” Stark says.

A PhD clinical psychologist, Stark gives court-ordered therapy in family reunification and child custody cases. Most of her patients are kids; kids who have been through the wringer and have an easier time trusting giant poodles than humans.

In Stark’s office, the kids let Rita lick their ears and invite Jim to rest his head in their lap.

“Some of these kids come and lay on Jim if they’ve had a hard day,” she says.

Jim tends to go to whoever in the room is upset. If a different person becomes upset, he moves to that person. Basically, Stark says, “if Jim sleeps through a session, we know we’re doing better.”

When Stark’s young patients use puppets to role play, giving her a window into what might be going on in their lives, Rita and Jim are an attentive audience.

“My dogs love to watch puppet shows,” Stark says. “They cock their heads and get really involved. Sometimes they march behind the chair to see the kid and then go back and sit down and watch.”

By the end of a day, they’re exhausted.

•••

At Stark’s home, Jim and Rita unwind on leather recliners in the den. Stark had to teach them to stop reclining because she was afraid they might hurt themselves.

Jim likes to watch TV. “Oh, he loves the Westminster dog show,” she says. “Every year, he watches the whole thing.”

He also likes dramas. But sometimes they upset him. Once, Jim got so worked up over some actors fighting on TV that his baby sitter (Stark was having a garden tour that day) had to turn the station to the gardening channel.

“I gotta say, sometimes I think Jim is not even a dog. It’s like Jim’s a person and Rita is his dog. Like Goofy and Pluto.”

The dogs spend a few weekends a year with a trainer to brush up on their manners so they’re in control at the office. They also get groomed twice a month; the Park Avenue cut. And Stark brushes their teeth twice a week. To keep them healthy, she feeds them Himalayan berry juice, cranberry extract and vitamin supplements with their Purina.

Stark’s first dog was a Boston terrier she got as a child. His name was Princie. “He was a snarly little thing,” she says. And that might explain why she now gravitates to the large dog.

The first dog she bought as an adult was a black standard Poodle she named Greta Garbo. Stark had Greta trained as a therapy dog and together they would visit hospitals and senior homes.

When Greta died seven years ago, Stark drove to Northern California to look over two new litters of giant poodle pups and returned to her home in Floral Park, an English Tudor with English fairy gardens, with Jim and Rita.

•••

Stark initially gave Jim a different name: Spencer, after Spencer Tracy. But he wouldn’t answer to Spencer. So she switched it to Jimmy Stewart. “Plus he’s tall and lanky and very likable like Jimmy Stewart,” she says.

Rita is named after Rita Hayworth. Once while walking Rita in Laguna Beach, a woman overheard Stark call Rita’s name: “Rita Hayworth, come back here!” she shouted. The woman told Stark she had actually been an old friend of Rita Hayworth’s and that her old friend would have been pleased.

As soon as Stark finishes her book about ballroom dancing (she competes at the bronze level), she plans to write a book about Jim and Rita.

“When you think about it, they hear a lot of stuff,” she says.

The book will be stories about them, the kids they’ve helped and the letters and notes they’ve received, some of which are taped to the back of Stark’s office door. “Jim Rocks,” reads one tribute, in crayon.

It won’t be Stark’s first book. She had a book published in 1992 called “Because I said so.” It was about people taking their childhood dynamics into their work lives and the problems that causes. After the book came out, Oprah had Stark on her couch for a show called “Bosses wives who drive secretaries insane.”

Maybe Oprah can have Stark on again.

The show can be called “Giant poodles save the day.”

Contact the writer: dramystark.com714-932-1705 or lbasheda@ocregister.com

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SFGate: Brain workout may help anxiety, study suggests

Charles Burress, Chronicle Staff Writer

Wednesday, December 17, 2008

Could Sudoku be a balm for anxious people?

A new study suggests that intellectually demanding challenges like crossword puzzles or chess may be more successful at keeping worry-prone people from worrying than supposedly relaxing pastimes like watching TV or shopping.

Contrary to theories that "as things get harder, anxious people fall apart, this suggests it's the opposite way around," said UC Berkeley psychologist Sonia Bishop, lead researcher on the study published online this week by Nature Neuroscience.

The study showed that anxious people performed just as well as others when facing tasks that demanded concentration, but they took more time than others to complete tasks that were easier, Bishop said.

Their slower response time to challenges not requiring full attention was accompanied by reduced blood flow to the prefrontal cortex, which serves as the brain's CEO in thinking, planning and active memory.

The study indicated that anxious individuals have a weakened ability to block out distractions and that they might benefit from mindfulness training, which often uses meditation and stress-reduction exercises to help increase one's awareness and focus.

"With some very popular therapies like mindfulness training, people aren't sure why they work," Bishop said. "This perhaps gives us a rationale for why they do."

The results also challenge another explanation for why anxious people face day-to-day problems in concentration and work-related cognitive function, Bishop said. It has been argued that the "fight or flight" response center of the brain, the amygdala, overreacts to threat-related stimuli in anxious people, thus playing a central role in undermining concentration. But the new study suggests that attention-focusing ability in such individuals is impaired even when the amygdala is not extra-active, and thus their difficulties with concentration may be determined by a different mechanism, she said.

The study consisted of simple letter-recognition tests given to 17 volunteers, ages 19 to 48, while blood flow to a section in the front of the brain called the dorsolateral prefrontal cortex was measured by magnetic resonance imaging. The volunteers, seven female and 10 male, were from Cambridge, England, where Bishop did research at the University of Cambridge before becoming an assistant professor at Berkeley in July.

The results were scored according to the difficulty of the tests, including the distraction level of extraneous elements, and correlated to the volunteers' degree of anxiety. Surveys indicate that nearly a fifth of U.S. adults suffer from one or more anxiety disorders in a given year, Bishop noted in the study, titled "Trait anxiety and impoverished prefrontal control of attention."

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Stuck: Cut, Then Run

By Anneli Rufus on December 14, 2008 in Stuck

One poignant thing about the holiday season is all those Ghosts of Christmas, Chanukah and Kwanzaa past: folks who were once essential features around your table or tree but now ... aren't.

Why are they no longer with you? Some are literally gone; they're deceased, and you miss them and mourn them and know you'll never get them back. Others have drifted away. From some friends and relatives, you've grown apart. Yet others ... well, you snipped those bonds for what seemed like good reasons at the time but now you wonder, as the years go by and the gaps around that table or tree increase: Was losing that once-loved one really worth it? What fight was it, what quirk, what offhand remark in the wrong place, at the wrong time?

Sometimes the answer is clear, the moral crime in neon lights, the wound irreparable. She stole my husband. He stole my job. They ridiculed me in front of my children. But other times (most times), when we choose to end a relationship - intimate or platonic or biological - it's because that person insulted us in some way that felt unforgivable. These scenarios are as subtle and diverse as we are. And the trail of burned bridges extending behind us represents one of the trickiest paradoxes in human life: Where do we draw the line between forgivable insults and unforgivable ones, between wounds that will and will not heal? We are told from infancy onward that forgiveness is divine. Yet we are also schooled to sustain sky-high self-esteem, to not abide those who deflate it. Sometimes it's hard to have both. Where do we draw the line between forgiveness and self-abasement, forgiveness and selling out our own souls? At what point can you reliably say that someone has gone too far?

Granted, most people end relationships in stages. They announce that they're upset, they explain why, and the alleged upsetter gets a chance to explain and potentially redeem him- or herself. This either works or not. But at least he or she had a chance. I, on the other hand, am a cut-and-runner. Gone without a trace. Vanishing act. Now you see me, now you don't. I never was the kind to stay and fight. Not that I'm proud ot this: When interpersonal matters reach a certain degree of unpleasantness, rather than talk it out I flee. I always vow to change: Next time, I tell myself. Next time.

But no. I've always been this way. I had a college friend who liked to mock me in public. No sooner would I vouchsafe Gwen a secret than she would announce it at a party in front of everyone.

Guess what, you guys? Gwen would declare, pointing at me. She went to the emergency room in the middle of the night because she thought she had leprosy!

One night at one of those parties I shouldered my backpack, turned and left. This is how it is with cut-and-runners. We reach a saturation point and silently, without warning, flee. Gwen was neither the first nor the last. Cut-and-running is a desperate act and only vaguely punitive. Escape elates one at first, a giggly euphoria as one spends a few days relishing the tingly relief of the survivor. Afterwards - sometimes years afterwards, and often at holidays - regret seeps in. We should have talked. We should have had it out. If for no other reason, then at least to have said: You've hurt me and here's how. A kind of horoscope - if for no other reason, then at least to maybe save others from being hurt somewhere down the road.

This is a core theme in Elizabeth Drummond's intelligently tender new novel An Accidental Light. Two of its main characters are adults long estranged from their parents; after a personal tragedy, each ponders the option of rebuilding those burnt bridges.

How late is too late?

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Thea Gilmore: Songs were Thea's way out of depression

THEA GILMORE

Before the release of Harpo’s Ghost, Thea had been diagnosed with depression. During this time Thea had split with her previous record label and (temporarily) with her long term partner. Prior to Liejacker, Thea was faced with further hard-times when she parted company with her manager of ten years standing, split with her “new” and biggest record label yet after one album - and, almost as if for good measure, gave birth to her first child.

Liejacker is the testament to that journey. It began with Thea still battling off the shadows from her illness, writing her darkest, starkest songs ever. Liejacker also sees Thea at her most direct, “where in the past I’ve probably been guilty of hiding a little bit, falling back on an image or a metaphor - this time I was trying to get to the bone, to just tell it like it is. The genesis of this record was very different from my previous albums. It’s the first album that I’ve really felt a deep burn to make.”

Even whilst making Harpo’s Ghost - perhaps as a reaction to that record’s harder, glossier sheen - Thea spent hours buying up reams of quirky acoustic instruments - old banjoes, harmoniums from India, dobro guitars: and these became the instruments on which the new songs found their home.

The next step was to practically barricade herself in her newly acquired home studio, “Well I say studio... it’s basically a tiny 9 foot square room in my house. I practically had to mount the mike stand on the desk to sing and when I recorded the guitars I’d have to be halfway out the door. But for all the recording oddities, I was making music that was gritty and genuine. The songs kept coming and coming and I was able to record them as they arrived. As a result, I think they have a much less self-conscious feel to them. They are entities in themselves, quite apart from me.”

Thea went beyond merely the writing stage to create musical parts and arrangements herself. Before playing them to producer Nigel Stonier and her team, “The new material was so personal, it told a new story and I wasn’t even sure at first whether I wanted the world to hear that story in quite such direct terms... but the words kept appearing.”

Some of them were positively harrowing; “And You Shall Know No Other God But Me” is a chilling account of the dependencies we all fall prey to at some time in our lives. “The Wrong Side” has a jaunty lope that masks a descent into self loathing and a sympathetic suggestion to her lover that he should jump ship for his own sake and, right at the core of them, “Black Letter”, which has to be the most pithy song about depression since Nick Drake wrote “Black Eyed Dog”.

Just around the corner were the redemptive “Breathe” with its triumphant air of self-acceptance, and “Dance In New York” an exultant ode to the power of longing and the deep need for solid ground. New York takes the role of the eternal lover, arms always open. And then there’s the ethereal “Old Soul”, the album’s first single. Thea wrote the song while 8 months pregnant, and says “I was determined not to turn to mother-mush after having my son. So many people just wait for the fluff to appear in your music as soon as you so much as whisper “pregnancy” and I never really could figure out why. But the concept of “Home” and what it really means to me is a recurring theme in my music, has been for a long time. When I had a child, I really understood what home meant to me. That very deep, primal instinctive warmth for another and the roots that bind you in this life and down every generation to come. That’s my home, and it is eternal.” The metaphysical search is there in the lyric for all to interpret.

And ultimately, there’s the bonding force that both pulls the album’s themes together and also closes the record. “The Lower Road” is an almost unbearably moving peaen to hard won victories, to endurance and forgiveness. It begins with a racist lynching, references the grim shadow of the war in Iraq and everyday domestic abuse, in amidst insisiting that “We will be rolling on”. Not exactly “You’re Beautiful” then. The song closes with perhaps Thea’s finest words yet:

“There’s no telling which way, boys,
This thing is gonna take hold
From the fruit on a poplar tree
To the bruise round a band of gold
From the blood in a far country
To the war of just growing old
We travel a lower road
It’s lonely and it is cold
But we will keep rolling on...”

Emerging from the home studio with her new store of songs, Thea chose to leave the performances untouched - and that’s how many of them appear on the final record. Hence many of the original vocals remain, hence the groove on ‘The Wrong Side “ comes from a cutlery drawer, grill pan and a chimney hood rather than orthodox drums and.hence any guitar solos on the record are by Thea herself.

But having brought the material into her favourite studio, the Loft in Liverpool, and for good measure adding a couple of new tunes to the pot, Thea then called upon some of her favourite kindred spirits. Erin McKeown added vocals to ‘Dance In New York”, and Waterboy Steve Wickham was invited to play fiddle on “The Lower Road.” Zuton-in-chief Dave McCabe duetted on “Old Soul” and unearthed magical, hitherto unheard soft tones to his bluesy voice. Thea was then left with the task of finishing “The Lower Road”, whose narrative is told in several different voices: she delivered “Liejacker”s last trump card by inviting the legendary Joan Baez - a long term fan with whom she has toured the US - to duet on the song. “Joan Baez practically invented my job some forty odd years ago - I can’t think of anyone else on the planet with the voice, the presence and the standing to carry this off.” Not only was Joan pleased to be asked, but she fell in love with the song and has recorded it now for her own forthcoming album.

So Liejacker, born of the darkest beginnings, ends with positives abounding. The mood remains stark and acoustic, with celloes, dulcimers and ukeleles adding colour here, texture there. “Old Soul”, chosen as the first single sets the record in motion with its quest for the truest of truths - and “The Lower Road” closes it. The album is thus framed by guest appearances with an arena filling indie rocker and an iconic folk singer/activist: but while the compliment paid implicitly by their involvement is indicative of the esteem in which Thea Gilmore is held, the songs and the story of Liejacker are solely the work of one pen and one voice, Thea Gilmore. According to Mojo she remains “the most coherent and literate of singer/songwriters”. Liejacker is a beautiful piece of work that will only enhance the evolving legend.

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Ventura County Reporter : Uncomfortably numb

Mental health, illness and wellness in Ventura County

By James Scolari 12/11/2008

Last week my aunt found herself crying in a restaurant for no reason that she could discern, and found that she couldn’t stop. She was with her husband of nearly four decades, a man whom she loves, and their life is good — they raised four daughters, all of whom have more kids than I can count, every one of them well and whole and hale. The bills are paid; by nearly any measure she is blessed, and yet there she sat, in the Olive Garden, unable to stop crying. As I loaned a sympathetic ear to her malaise, I couldn’t help but hear the strains of Pink Floyd, of Roger Waters singing from the landmark album Dark Side Of the Moon:

The lunatic is on the grass
The lunatic is on the grass
Remembering games and daisy chains and laughs
Got to keep the loonies on the path.

It’s not that I minimized or failed to understand her distress; in point of fact, I understood her too well — even if impromptu, irrational tears strike me as, well, a little nuts, though it feels as if it’s more about the age than about her life.

If there was an age that could broker nameless malaise without tangible source, it would be this one.

People often refer to others of good sense or emotional stability as being “well-adjusted,” which connotes a subtext that looks, upon examination, rather dire. Adjusted to what, I wonder — to the generalized, de rigeur madness of a world that evolved more in service of commerce, power and busy-ness than humanity? Fearing that might construe an intuitive leap into a logical abyss, I consulted an expert.

“The term ‘well-adjusted’ suggests a stable personality that can dynamically adjust to life’s vagaries,” offers Matthew Bennett, Psy.D., of the Ventana Center for Psychotherapy. “It’s not an easy thing to build a self — it’s a vastly more difficult endeavor than most realize. The structure of a personality must be flexible and consistent and sustainable, in the face of what are the often-extreme demands of an unpredictable world and its inhabitants. While most of us seem to manage it,” he concludes, “we do so with more difficulty than is apparent to the casual eye.”

Read the full article ....

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Minnesota Spokesman-Recorder: Penetrating the isolation of mental illness

by Susan Budig


Minnesota Spokesman-Recorder

Reaching those who need help requires dispelling old prejudices

Like a lot of kids, Ramon gave his folks trouble. And like any earnest parent, Lanice Palmer-Cole tried various methods to rein him in. She thought she knew her son well, although he was “different.” Palmer-Cole says, “He was a deep, deep thinker.” She felt hopeful that her son would grow up to be a productive member of society.

But then a significant thing happened to this Detroit family and “Ramon lost his mind,” Palmer-Cole tells us in a confessional voice, speaking for the first time in public as she narrates the story of her mentally ill son.

Last Thursday evening, December 4, while most people were hunkered down in their homes, a couple dozen concerned citizens braved the bitter cold to gather at United Church of God and Christ in St. Paul. They came to hear the stories of those grappling with mental illness and to network with one another as webs were woven in an effort to catch those individuals, especially those within communities of color, who too often fall through the cracks.

Read the full article ....

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Financial Post: Margaret Trudeau to write about struggle with mental illness

Paul Gessell, The Ottawa Citizen Published: Wednesday, December 10, 2008

Mike Carroccetto, The Ottawa Citizen

OTTAWA - Margaret Trudeau is writing a memoir, to be published in the fall of 2010, detailing her many years struggling with bipolar depression.

News of the forthcoming book was announced Wednesday by Ms. Trudeau's Toronto-based publisher, HarperCollins Canada.

"The memoir, intended to guide and inspire others suffering from mental illness, will also describe in some detail how the Canadian medical system helped her and where it fell short," according to a statement from HarperCollins.

Iris Tupholme, vice president, publisher and editor-in-chief of HarperCollins, says the former wife of the late Pierre Trudeau will be offering "a very honest, very candid account" of her battle with a mental illness that affected her and those close to her.

"This is a brave and compassionate book - one that will remain an important part of the Canadian consciousness for years to come," Ms. Tupholme says. Ms. Trudeau, while the prime minister's wife in the 1970s, publicly acknowledged that she had sought psychiatric treatment for "severe emotional stress," but not until 2006 did she publicly describe herself as suffering from bipolar disorder. She has since lent her name and profile to educating the public about mental illness. Her efforts have been recognized. She won the 2008 Lectureship Award from the College of Family Physicians of Canada. She sits on the University of British Columbia's Mental Health Institute Executive Advisory Board and will receive the 2009 Humanitarian Award from the Society of Biological Psychiatry in May 2009.

Ms. Trudeau, 60, has written two other autobiographical books, both of a kiss-and-tell nature. Beyond Reason and Consequences dealt with her rocky marriage to Mr. Trudeau, the initial years after their 1977 separation and various romantic adventures after leaving 24 Sussex. The Trudeaus had three sons, Justin (currently a Montreal MP), Alexandre (a Montreal film-maker) and Michel (who was killed in an avalanche in British Columbia in 1998).

After divorcing Pierre in 1984, Margaret married Ottawa businessman Fried Kemper. They had two children, Kyle and Alicia. That marriage also faltered. Ms. Trudeau now lives in Montreal.

While still in Ottawa, Ms. Trudeau volunteered with various charitable organizations and frequently appeared in gossip columns.

In an interview in 2007, she said she wanted to help others who "feel so helpless they consider suicide because they don't think there's any way they're going to get off the (bipolar) roller-coaster."

There are, in fact, ways to get off that roller-coaster, she said.

"You can get off if there is good treatment and medical science has come a long way in the last 10 or 15 years to create drugs and therapies that really help you to achieve balance."

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FOXNews: Japan Princess' Mental Depression Improving, After 5-Year Absence From Public Eye

TOKYO —
Japan's reclusive and troubled Crown Princess Masako said Tuesday that her health is improving and she is feeling more able to take part in social activities.

Her father-in-law, Emperor Akihito, is also suffering from stress and inflammation of the stomach, the Imperial Household Agency said Tuesday. Akihito, who turns 75 later this month, had surgery for prostate cancer in 2003.

Masako, who married Crown Prince Naruhito in 1993, has skipped much of her duties in the last five years, mostly because of stress-related symptoms and mental depression.

"My performance still is not at its best, but I'm beginning to feel I'm now able to do more things, little by little," she said in a statement for her 45th birthday on Tuesday.

Royal doctors said Masako has made "steady progress" over the last two years, and is starting to resume public appearances, including welcoming Spanish King Juan Carlos and his wife, Queen Sofia, last month — her first participation in an official event in five years.

But they warned she remains unstable and needs rest.

"The biggest reason for her condition is that she has unpredictable ups and downs in her physical and mental condition," the doctors said in a statement Tuesday.

Though she was reportedly feeling better mentally, the Imperial Household Agency said Masako canceled meetings Tuesday with the Emperor and the Empress, as well as palace officials, because of a fever and sore throat associated with a cold.

Speculation about Masako's health has become a staple of the Japanese media. Some tabloid magazines and newspapers have criticized her for lavish dinners and shopping outings while missing her official duties.

Although Masako has been seen on nationally televised news shows attending family events at her 7-year-old daughter Aiko's school, she has skipped formal events that are standard fare for Japanese royalty, such as greeting guests, attending charities and making overseas trips.

Public expectations for Masako, a former diplomat and Harvard graduate, were high from the moment she became engaged to Naruhito, with many hoping she would be a role model for the modern Japanese woman.

The couple's failure to have a son has put a great deal of pressure on the princess as only sons can inherit the country's Chrysanthemum Throne. Masako had a miscarriage before giving birth to Aiko.

Rigid and insular palace life is also believed to have contributed to her mental illness.

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Science Daily: Depression Treatment: Mindfulness-based Cognitive Therapy As Effective As Anti-depressant Medication, Study Suggests

ScienceDaily (2008-12-02) -- Research shows for the first time that a group-based psychological treatment, Mindfulness Based Cognitive Therapy, could be a viable alternative to prescription drugs for people suffering from long-term depression. In this study, MBCT proved as effective as maintenance anti-depressants in preventing a relapse and more effective in enhancing peoples' quality of life. The study also showed MBCT to be as cost-effective as prescription drugs in helping people with a history of depression stay well in the longer-term.

Read the full article ...

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Santa Barbara Independent: Tender Hearts, Tender Times

Goleta Church Helps the Grieving Through the Holidays
By Elena Gray-Blanc

Sunday, December 7, 2008

For most, the holiday season is one of cheer. For others, most notably those who have suffered a loss — be it the death of a loved one, a divorce, or other trauma — Christmas, Hanukkah, the New Year, and all the attending merriment can be insult added to injury, a constant and contrasting reminder of grief.

Reverend Erika Hewitt, minister at Live Oak Unitarian Universalist Congregation in Goleta, has set out to provide a comforting, open, and pressure-free environment for anyone in the community who might be grieving, and is holding a “Tender Hearts, Tender Times” service on Sunday, December 14.

“Sometimes,” Hewitt said in a recent phone conversation, “the merriness gets forced down our throats… That first Christmas [after a loss], people lose their bearings. They don’t know how it’s ‘supposed’ to be. [Live Oak] is creating space to acknowledge that.” And what makes Rev. Hewitt’s service so special is that it is just and only that — an acknowledgement of trouble and grief, without any pressure to share a story or emote. “I don’t ask questions,” she said. “And we’re not going to go around the circle and talk about it.”

Read the complete article ...

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Science Daily: Depression Treatment: Mindfulness-based Cognitive Therapy As Effective As Anti-depressant Medication, Study Suggests

Depression Treatment: Mindfulness-based Cognitive Therapy As Effective As Anti-depressant Medication, Study Suggests

ScienceDaily (2008-11-30) -- Research shows for the first time that a group-based psychological treatment, Mindfulness Based Cognitive Therapy, could be a viable alternative to prescription drugs for people suffering from long-term depression. In this study, MBCT proved as effective as maintenance anti-depressants in preventing a relapse and more effective in enhancing peoples' quality of life. The study also showed MBCT to be as cost-effective as prescription drugs in helping people with a history of depression stay well in the longer-term. ... read full article

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Reuters UK: Sick leave for mental illness linked to early death

By Amy Norton

NEW YORK (Reuters Health) - People who need to take time off from work for a mental health problem may live shorter lives than those in better psychiatric health, a new study suggests.

Researchers found that among nearly 20,000 French workers they followed, those who'd taken at least 1 week's sick leave for a mental health disorder had a higher death rate over 14 years.

At the outset, 41 percent of the workers -- all public utility employees -- had taken at least 1 week's sick leave over the past 3 years. Those who'd taken time off specifically for depression or other mental health disorders were one quarter to one third more likely to die over the study period than workers with no mental-health absences.

"Basically the message is that workers with medically certified absences for mental diagnoses should be considered a population at a higher risk of fatal disease," lead researcher Dr. Jane E. Ferrie, of the University College London in the UK, told Reuters Health.

She stressed, however, that the findings point to a relatively higher death rate in this group as a whole -- and that does not mean that any one person with a mental health disorder has an unusually high risk of early death.

When studies observe large populations over time to look for patterns, the results cannot be used to "infer risk at the level of the individual," Ferrie explained.

The findings, published in the Journal of Epidemiology and Community Health, are based on 19,235 public utility employees (5271 female) who were part of long-range health study. The researchers used employment records to verify any medically certified work absences the employees had between 1990 and 1992. (French law requires workers to get a medical certificate from their doctors for each day of sick leave.)

Between 1993 and 2007, there were 902 deaths among the study participants. Those who'd taken 7 days or more off from work for a mental health disorder had a higher risk of death, even when their age and type of job were taken into account.

With the exception of extreme cases, mental health problems do not, in themselves, kill people, Ferrie pointed out. Instead, she explained, poor mental health is often connected to poor physical health.

On one hand, physical conditions may lead to depression or other mental health problems, Ferrie noted. On the other, psychiatric conditions may directly impair physical health, possibly by affecting the nervous and hormonal systems.

SOURCE: Journal of Epidemiology and Community Health, November 25, 2008.

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globeandmail.com: Psychiatry: A specialty relegated to the basement

CAROLYN ABRAHAM
November 24, 2008 at 8:52 PM EST

Jai Shah could have been any sort of doctor he wished. Even before he graduated with honours from the University of Toronto's medical school, the 30-year-old Edmonton native had earned a master's degree in international health policy from the London School of Economics, published papers and worked for the Canadian Institutes of Health Research.

Praise follows him wherever he goes. Except for last fall – when he decided to specialize in psychiatry.

“A psychiatrist?” some of his supervisors said, “But you're smart! … You're taking the easy way out … Your patients will make your life hell … Your patients will make you depressed … What a waste of talent!”

Dr. Shah knew mentally ill people battle both their disorders and the social stigma their conditions carry. But it surprised him that psychiatrists confront a certain stigma, too.


“I'm sure the feedback has discouraged some young doctors from choosing this as their career,” said Dr. Shah, now at the Harvard Longwood Psychiatry Residency Training Program in Boston.

In fact, Susan Abbey, who heads the U of T first-year residency program in psychiatry, said the disparaging comments are “ubiquitous.”

“I don't think there's one of our incoming residents who hasn't been exposed to negative comments from family or friends or academic supervisors,” Dr. Abbey said.

Just as lawyers can face a barrage of bottom-feeder jokes, psychiatrists, both in film and real life, have long been seen as doctors of a lesser science. Even their own physician colleagues can view their patients as difficult and time-consuming. The negativity, experts say, is contributing to a national shortage of psychiatrists and shoddy care for mentally ill people.

Across the country, Canadians are unable to see a psychiatrist when they need one. A survey from the B.C.-based Fraser Institute released last month suggests the national median waiting time for psychiatric care this year is 18.6 weeks, longer than for any physical treatment.

A Canadian Psychiatric Association survey has found that even in emergency cases – where the CPA recommends a patient be admitted for acute care within 24 hours due to a “high degree of risk to self or others” – delays in some regions range from 57 hours to nearly five days.

“It's the patients who doubly suffer from the stigma,” Dr. Shah said. “First, from the social perception of their illness and then, on top of it all, from the shortage of treaters, and the gaps in care reflect the stigma within the medical profession and that contributes [to the social perception]… so it's a vicious circle.”

Studies suggest these attitudes take a toll on medicine's front lines: Mentally ill people have a tougher time finding a family doctor, are more likely to need urgent medical care and less likely to receive life-saving treatments. They're also more likely to die of conditions such as heart attacks, strokes and cancer.

At the same time, funding for mental-health research and psychiatric services has paled compared with monies doled out for physical ailments. Mental illness, meanwhile, is the No. 1 cause of disabilities in Canada and accounts for 20 per cent of all hospital admissions.

The inequities are so apparent that the Mental Health Commission of Canada has made it a top priority to fight stigma among health-care professionals, and this year the Canadian Medical Association, which represents the country's doctors, has launched a campaign to combat the stigma within its ranks.

“Doctors will be inclined to see mental illness differently than other medical illnesses … it's not like a broken bone, you don't see it clearly,” said CMA president Dr. Robert Ouellet. “We feel mental illness has not received its fair share of attention.”

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The Independent: Nervous breakdown: Happy survivors

Anyone can have a nervous breakdown – high-flyers included. But it doesn't have to mean the end of a contented life, says Sophie Morris


Out the other side: Emma Mansfield's bipolar condition makes her prone to frenetic activity and slumps

At 25, Emma Mansfield was a poster girl for successful young women. She lived in Bristol and loved her job as a producer of natural history programmes, which allowed her to travel all over the world. She had also met and fallen for a wonderful new boyfriend. She was in the pink, you might say, so the last thing she was expecting was to be dragged down into the deep blue storm of a nervous breakdown. "It was like somebody had pulled a rug out from under me," she remembers, eight years, another nervous breakdown and spells of clinical depression, psychosis and time in hospital later. "I didn't know what the hell was happening to me. I'd feel like I was being sucked down in this vortex, like in Harry Potter where the death-eaters suck out your soul."

The term "nervous breakdown" is neither medical nor scientific, but a shorthand for someone who can no longer cope in their normal life, explains Phillip Hodson, of the British Association for Counselling and Psychotherapy (BACP). "It describes someone who has gone through the tipping point. They have gone from stress and distress, to an over-stressed situation. It's the difference between, 'I'm very uncomfortable but I'm managing' to 'I'm so unhappy and fraught that I'm not functioning.'" Not functioning might manifest itself in strange behaviour such as stepping out in front of buses, flaring up at other people, having suicidal thoughts or going into states such as a trance, catatonia or gibbering."

Mansfield's breakdown unravelled over a few days. "I looked around me," she says, now 33, "and thought, I'm living in a city I don't know. I don't know many people. I don't go walking or riding any more. I don't have mates I can go for a cup of tea with or down to the pub with. This isn't very balanced. I had a dream I was being asphyxiated and made a decision that I had to deal with it."

A diagnosis of clinical depression followed and she suffered suicidal thoughts for a week. After undergoing a lot of therapy and a year on antidepressants, Mansfield realised her tale fitted the notorious pattern of too much, too soon, too quickly. "I was an extremely high flyer at a young age," she admits. "I think it all caught up with me. I came out of education and thought, well, life should be easy now. Actually, it's not. Life becomes even more challenging and complex."

Although Mansfield sought help early on, many sufferers of nervous breakdowns feel too ashamed to admit they are experiencing difficulties. Mental illness has a stigma, and admitting to one can be tantamount to scoring one's reputation with an indelible black mark. When well known personalities admit to struggling, the subject is demystified. More useful than clarifying a confusing topic, though, is the message that it is OK to have a breakdown, and that you can recover. It is not a life sentence.

Stephen Fry has spoken openly about his breakdown, a painfully public collapse when he walked out of a play in 1995 and disappeared for weeks. In Stephen Fry: The Secret Life of the Manic Depressive, he interviewed other sufferers including Carrie Fisher, Richard Dreyfuss, Robbie Williams and Jo Brand.

More recently, Alastair Campbell revisited his own breakdown of 1986, in the BBC programme Cracking Up. One interviewee was Ruby Wax, another of the few brave enough to speak out about depression and anxiety.

Why did Fry tip over when he was in a successful play? Mansfield was similarly flying high when crisis struck. She now believes the comfort of a loving relationship provided her with the space to confront issues she hadn't worked through, which presented themselves as depression. She comes from a supportive family and had suffered none of the physical, emotional or sexual abuse that often leads to mental illness, though she had sought counselling at university. "I always knew there were things I needed to work out," she explains, "such as taking everything very much to heart. I was open, but also quite vulnerable."

"Experiencing a nervous breakdown was terrifying – especially because I didn't know what had caused it. My breakdown was physical, emotional and psychological, it was as though my mind went into an enormous spin while my body, particularly my nervous system, was coping to process the incredible sensory and physical assault which accompanied the experience. I felt extremely anxious and fearful. I couldn't eat. I couldn't think. I was confused, disoriented and hyperventilating. I lost a lot of weight."

Mansfield confronted her deteriorating situation head on, switching her job and busy lifestyle for the countryside and a new job. First, though, she went to recuperate at her family home in Essex.

Eight long months there made her even more determined to move on with her life. "I knew I had to get to grips with my mental state and focus on what I wanted next."

She chose Cornwall as the place she could best "get to grips" with her state of mind. It was familiar from childhood family holidays. "The sea and the fresh air were what I needed more than anything."

Cornwall suited her. She had found Bristol isolating and overwhelming and she missed the sense of community and belonging of living in a small town or village. She found a job as an arts administrator at the Eden Project, and threw herself into the role. She discovered she was far more creative than a television career had allowed her to realise, but her dedication proved too much, leading to a second breakdown in the spring of 2006, much more serious than the first.

"It was a complete and utter nervous collapse," she recalls. "I couldn't eat or sleep for four or five days." She was admitted to hospital for five days and sedated, giving her space to calm down. "It is terrifying when you lose your mind. You think you know who you are and what you're doing, and all of a sudden your mind goes into spin drive. I experienced paranoia and psychosis."

"Psychosis," explains Phillip Hodson, "is where you may not be responsible for your actions. The obvious psychoses are things such as schizophrenia, mania and bipolar disorder."

In May, 32-year-old barrister Mark Saunders was shot dead by police after firing his shotgun from his Chelsea home. Last June, a Spanish insurance executive, Alberto Izaga, plunged into such a psychotic meltdown that he battered his two-year-old daughter to death. It is possible that both men were experiencing episodes of psychosis as part of a nervous breakdown.

Campbell entered a psychosis after a period of heavy drinking, where he thought he was being tested on his actions, and saw everything as part of this test. He was arrested and admitted to hospital, where he was heavily medicated. The episode left him depressed, but he rebuilt his life. He is proof that a nervous breakdown is a heavy burden, but not a life sentence.

Despite her experience of mental illness and knowledge of counselling and therapy, both as a patient and student, Mansfield had not seen her own burn-out coming. "I think I'd had enough," she says, as if she did nothing more but collapse on the sofa. It is her bipolar condition that makes her prone to frenetic activity – mania – followed by depressive slumps. "I'm very driven and self-disciplined," she observes, "so sometimes I don't realise how much energy I put into things until I need to go and lie down for two weeks."

One such exhausting undertaking is Mansfield's new book, The Little Book of the Mind, a touching and informative encyclopaedia of mental illness, which attacks the stigma around diseases of the mind. It follows The Little Book of Cornwall, about her adopted county.

Mansfield advises anyone who thinks they might be experiencing some sort of mental illness to visit their GP and get the six free therapy sessions on offer, though she admits that most problems take much, much longer to resolve.

Mansfield thinks herself lucky, because she found the resilience to fight her illnesses. She has left the Eden Project and works with young people, coaching them to write for the local newspaper, runs several choirs and arranges music. She can walk her dog in the fresh air whenever the mood takes her. "It all depends," she says, "on whether you think you can change your life."

'The Little Book of the Mind' is published by Lovely Little Books, £6.99. Available in Waterstone's

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Ambigamy: Thanksgrieving: Cheer up 'cause it's downhill from here (a musical op-ed)

By Jeremy Sherman, Ph.D. on November 25, 2008 in Ambigamy

When we're down, people sometimes try to cheer us up with reminders that other people are much worse off than we are. Comparing misfortune to good effect also applies to our future selves. We should all cheer up because compared to who we'll be in our declining years we're doing great. Along with AARP cards, one perk senior citizens get is the occasional amusement of consoling some youngster who is distressed to be growing so old. I wrote this song after just such an experience, me at 51 consoling a 36 year old who was distressed about aging.

Enjoying the happiness we get depends upon our ability to manage our interpretation of wellbeing as either a complement to, or substitute for future happiness. If my happiness today is a complement to happiness tomorrow--if it sets up an expectation that I'll be happy then because I'm happy now-then unhappiness tomorrow will be disappointing. If my happiness today is a substitute for happiness tomorrow--if it sets up an expectation that I might not be happy tomorrow then I won't be as disappointed. Happy today I like to remind myself that when I'm old I'll be able to look back and say, "I had my turn."

Buddha is often interpreted as saying that you should work to have no expectations, which, to me makes no sense. Expectations are absolutely essential to life. It's all about expectation management. So here's my Thanksgrieving gift (see last years at loving ingratitude) an uplifting ditty for us, the temporarily-abled.

Here I sing it and play a seven-string fretless bass solo along with my four piece virtual jazz combo: http://www.mindreadersdictionary.com/downhillfromhere.mp3

Downhill from here

Sure your things are sagging
You can see you're in decline
A glimpse into the mirror shows
The ravages of time

Just remember that compared to now
the future's looking sour
And looking back in decades
this will have been the finer hour.

At the rate that things are going
yes our future looks austere
Cheer up ‘cause it's downhill from here.

If you notice your ability
To jump and skip is slipping
And much of your agility
Is going, don't be trippin'

Compared to 20 years from now
You're agile and you're well
Viewed from future wheelchairs
Today you're a gazelle.

At the rate that things are going
Yes, our future looks austere
Cheer up ‘cause it's downhill from here.

I'm a forward thinking pessimist
It makes my days much brighter
Tomorrow will be heavier
today is therefore lighter

Life's decline is certain
Of what's left this time's the best
Enjoy it now it's bound to be
much better than the rest

If the crowd is suffocating you
in the rat race to success
and your edge is always slipping
and you cannot take the stress

Just remember that the pile of product's
only getting deeper
And your grandkid's competition
will certainly be steeper.

At the rate that things are going
our futures looks austere
Cheer up ‘cause it's downhill from here.

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ABC News: Florida Teen Live-Streams His Own Suicide

Abraham Biggs, 19, Was Egged On by Fellow Bloggers, Cops Say
By EMILY FRIEDMAN

Nov. 21, 2008 —

A Florida teenager who used a webcam to live-stream his suicide Wednesday was reportedly encouraged by other people on the Web site, authorities told ABCNews.com.

"People were egging him on and saying things like 'go ahead and do it, faggot,' said Wendy Crane, an investigator at the Broward County Medical Examiner's office.

Abraham Biggs, 19, of Pembroke Pines, Fla., had been blogging on an online body-building message board and had linked to his page on Justin.tv, a live video streaming Web site, where the camera rolled as he overdosed on prescription pills, according to Crane.

Biggs, who had reportedly been discussing his suicide on the forums, also posted a suicide note on a body-building forum, which has since been taken down, in which he wrote, "I hate myself and I hate living."

"I have let everyone down and I feel as though I will never change or never improve," Biggs wrote in the posting. "I am in love with a girl and I know that I am not good enough for her. I have come to believe that my life has all been meaningless. I keep trying and I keep failing. I have thought about and attempted suicide many times in the past."

The video and blog postings have since been removed from the sites, but Crane, who has seen both, said that at first viewers thought the suicide was a hoax.

"The bloggers said that Biggs had threatened to kill himself before and had faked it, so at first they didn't believe him," said Crane. "Gradually, as you read the blog further into the day the bloggers start commenting on how Biggs isn't moving."

Crane said comments on the thread included an exchange about whether the image of Biggs' motionless body was a still photograph or a video, and eventually resulted in one of the site's visitors calling the police, who tracked down the teen through his computer IP address.

According to Wired magazine, online viewers watching the video ranged from "OMG" -- Internet slang for oh my god -- and LOL -- an abbreviation for laughing out loud.

Blog Posts

On a blog where Biggs wrote about his suicidal thoughts, which has since been removed, commenters wrote, "hahaha hahahahha hahahahahah ahhaha." Wired reported that someone else wrote: "Instant Darwinism ..." to which a fellow commenter wrote: "f**king a nicely put." Others called the teen a "coward," "faggot" and a "dick."

In the Web stream, Crane said viewers saw a piece of a door frame -- which had splintered from the police kicking in the teen's bedroom door -- hit Biggs, who is curled up on his bed and facing away from the camera.

"Then you see a police officer go in and check on him, and then the EMS pronounced him dead," said Crane.

Biggs was pronounced dead at 3:30 p.m. Nov. 19 -- about 12 hours after he had begun blogging about his suicide.

The official cause of death was suicide combined with drug toxicity. Crane said that benzodiazepines and opiates were found near the body, but a blood toxicology to quantify just how much Biggs consumed is still under way.

Crane said that at least one of the prescription drugs was in Biggs' name.

Michael Seibel, the CEO of Justin.tv, posted a blog entry on the site titled "A Moment of Silence."

"Justin.tv staff would like to take a moment to recognize and reflect upon the tragedy that occurred within our community today," wrote Seibel. "We respect the privacy of the broadcaster and his family during this challenging time."

Reached by telephone, Biggs' father, Abraham Biggs Sr., told ABCNews.com that he was shocked to learn of his son's death.

"He was a good kid. Everyone knows him," said Biggs. "We live together and everything was fine -- I'm so surprised."

Biggs' father was not home at the time of his son's suicide, and the father told ABCNews.com that he was not aware that his son used Justin.tv.

Biggs had struggled with depression, according to his father, and had been prescribed medication for bipolar disorder. Benzodiazepine is commonly prescribed as a sleep aid or an anti-anxiety medication.

Even so, Biggs had been "doing better," according to his father and had been attending daily classes at Broward College, where he was pursing a career as a paramedic.

Internet Provides Outlet to Suffer in Public

"I am upset that Justin.tv streamed this live," said Biggs. "I have not seen it, and I do not intend to look at it.

"There seems to be a lack of control as to what people put out on the Internet," he said. "There's a lot of garbage out there that should not be, and unfortunately, this was allowed to happen."

David Griner, a social media strategist for Luckie & Company, said that while public deaths are not new, online chatrooms provide an especially accessible forum for those debating suicide.

"The social Web tends to create a sideshow atmosphere, like public executions in the 1700s," said Griner. "The anonymity and lack of personal connection bring out the worst in people."

Griner points out that there have been several other online suicides, and some have been faked as well.

In February 2008 a girl who identified herself only as "90 Day Jane" wrote an anonymous blog chronicling the days leading up to her death. The blog turned out to be a hoax, and "Jane" later described it as an "art project."

The United Kingdom had an online suicide in March 2007, when 42-year-old Kevin Whitrick hanged himself while others watched. According to the BBC, some onlookers tried to stop him while others urged him on.

"The explosion of high-speed Internet access in the past few years has made it so that almost anyone can broadcast a live video in front of a global audience," said Griner. "It's impossible for sites like Justin.tv to monitor everything that's going on, so that puts the burden on the community to help stop bad things from happening."

Griner believes that those who encourage suicidal people are simply a sad reality of an unrestricted World Wide Web. Even so, some potential suicides are prevented on the Internet as well.

"You'll always have the morbid jerks who yell 'Jump!' when someone's on a rooftop, and you'll always have people threatening suicide in a public venue," said Griner. "And while it's easy to focus on the abundance of bloodthirsty trolls online, the bright side is that the Internet also gives more decent people the opportunity to intervene and try to save a life."

"Most times, they just need someone to talk to, and the Internet is the only forum they have."

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ABC 7 News : Family outraged, distraught over teen's cyber suicide

The family of a college student who killed himself live on the Internet say they're horrified his life ended before a virtual audience, and infuriated that viewers of the live webcam or operators of the Web site that hosted it didn't act sooner to save him. Only after police arrived to find Abraham Biggs dead in his father's bed did the Web feed stop Wednesday - 12 hours after the 19-year-old Broward College student first declared on a Web site that he hated himself and planned to die.

"It didn't have to be," said the victim's sister, Rosalind Bigg. "They got hits, they got viewers, nothing happened for hours."

Biggs announced his plans to kill himself over a Web site for bodybuilders, authorities said. He posted a link from there to Justin.tv, a site that allows users to broadcast live videos from their webcams.

A computer user who claimed to have watched said that after swallowing some pills, Biggs went to sleep and appeared to be breathing for a few hours while others cracked jokes.

Some members of his virtual audience encouraged him to do it, others tried to talk him out of it, and some discussed whether he was taking a dose big enough to kill himself, said Wendy Crane, an investigator with the Broward County medical examiner's office.

Some users told investigators they did not take him seriously because he had threatened suicide on the site before.

Eventually, someone notified the moderator of the bodybuilding site, who traced Biggs' location and called police, Crane said. The drama unfolded live on Justin.tv, which allows viewers to post comments alongside the video images.

As police entered the room, the audience's reaction was filled with Internet shorthand: "OMFG," one wrote, meaning "Oh, my God." Others, either not knowing what they were seeing, or not caring, wrote "lol," which means "laughing out loud," and "hahahah."

His father, Abraham Biggs Sr., told The Miami Herald he didn't want to watch the video.

"We were very good friends," he said. "It's wrong that it was allowed to happen."

An autopsy concluded Biggs died from a combination of opiates and benzodiazepine, which his family said was prescribed for his bipolar disorder.

"Abe, i still wish this was all a joke," a friend wrote on the teenager's MySpace page, which he described himself as a goodhearted guy who would always be available for his pals, no matter what time of day.

In a statement, Justin.tv CEO Michael Seibel said: "We regret that this has occurred and want to respect the privacy of the broadcaster and his family during this time."

It is unclear how many people watched it happen. The Web site would not say how many people were watching the broadcast. The site as a whole had 672,000 unique visitors in October, according to Nielsen.

Biggs was not the first person to commit suicide with a webcam rolling. But the drawn-out drama - and the reaction of those watching - was seen as an extreme example of young people's penchant for sharing intimate details about themselves over the Internet.

Montana Miller, an assistant professor of popular culture at Bowling Green State University in Ohio, said Biggs' very public suicide was not shocking, given the way teenagers chronicle every facet of their lives on sites like Facebook and MySpace.

"If it's not recorded or documented then it doesn't even seem worthwhile," she said. "For today's generation it might seem, 'What's the point of doing it if everyone isn't going to see it?'"

She likened Biggs' death to other public ways of committing suicide, like jumping off a bridge.

Crane said she knows of a case in which a Florida man shot himself in the head in front of an online audience, though she didn't know how much viewers saw. In Britain last year, a man hanged himself while chatting online.

Miami lawyer William Hill said there is probably nothing that could be done legally to those who watched and did not act. As for whether the Web site could be held liable, Hill said there doesn't seem to be much of a case for negligence.

"There could conceivably be some liability if they knew this was happening and they had some ability to intervene and didn't take action," said Hill, who does business litigation and has represented a number of Internet-based clients. But "I think it would be a stretch."

Condolences poured into Biggs' MySpace page, where the mostly unsmiling teen is seen posing in a series of pictures with various young women. On the bodybuilding Web site, Biggs used the screen name CandyJunkie. His Justin.tv alias was "feels_like_ecstacy."

Bigg described her brother as an outgoing person who struck up conversations with Starbucks baristas and enjoyed taking his young nieces to Chuck E. Cheese. He was health-conscious and exercised but was not a bodybuilder, she said.

"This is very, very sudden and unexpected for us," the sister said. "It boggles the mind. We don't understand."

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Anger in the Age of Entitlement: Emotional Abuse (Overcoming Victim Identity)

By Steven Stosny in Anger in the Age of Entitlement

In terms of your health, happiness, and deepest values, one of the worst things that can happen is to live with a resentful, angry, or emotionally abusive partner. The worst thing you can develop, in terms of your health, happiness, and deepest values, is an identity as a victim.

Victim identity destroys personal power and undermines the sense of self. It makes you falsely identify with "damage" done to you or with bad things that have happened to you. The cry I hear over and over again from those who live with resentful, angry, or emotionally abusive partners is, "I don't like the person I've become."

Once emotional abuse occurs in a relationship, it becomes necessary not only to stop the abuse but to overcome victim identity through a strong identification with your inherent strengths, talents, skills, power, and appreciation of the self as a unique, ever-growing, competent, and compassionate person. This is accomplished through an emphasis on healing, growth, and empowerment, not by reviewing checklists of behaviors that qualify you as a victim or by reading lengthy descriptions of the resentful, angry, or abusive behavior and attitudes of your partner.

Detailed descriptions of your possible symptoms or of your partner's angry, abusive behavior are not only unnecessary for your recovery, they can cause harm by encouraging victim identity. If you live with an abusive person, you know better than any self-help author or advocate that your relationship has put thorns in your heart. You don't need a description of the thorns to know how much they hurt. You need to learn how to take them out and heal the wounds in ways that prevent scarring.

Perhaps the most insidious thorn in the heart that comes from living with a resentful, angry, or emotionally abusive partner is the feeling that you cannot be well until your partner changes. This understandable but tragic assumption is the first thorn you must remove from your heart. You deserve to heal and grow, whether or not your partner does.

Although a sense of fairness and justice tells you that your abusive partner ought to be the one to make changes, your pain tells you that you need to become the fully alive person you are meant to be. (Pain is not a punishment; it motivates behavior that heals, improves, and protects.) This means that you have to remove the focus from your partner and put it squarely on you. Renewed compassion for yourself will lead directly to a deeper compassion for your resentful, angry, or abusive partner. With that compassion you will demand meaningful, lasting change, for you will appreciate the enormous harm he does to himself when he hurts you. One of two things is likely to result from your reclamation of self and your compassionate demands on your abusive partner. You may be able to stop walking on eggshells and step into a deeper relationship with a more compassionate, loving partner. But if he chooses not to do the hard work of breaking abusive habits, for his sake, for the sake of your children, and for your own sake, you will no longer tolerate his resentful, angry, or abusive behavior. From your core value, you will stop walking on eggshells, one way or the other.

As you experience the enormous depth of your core value, the last thing you will want to do is identify with being a victim, or a survivor, for that matter. You want to outgrow walking on eggshells, not simply survive it, and you do that only by realizing your fullest value as a person.

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In Practice: Chicken and Egg

By Peter D. Kramer in In Practice

Does depression cause brain differences, or do brain differences cause depression? A scientist whose past research pointed to the latter conclusion has just published findings that reverse the direction.

The prevailing contemporary model for depression suggests that in vulnerable people, repeated stress gives rise to adverse changes in the brain; depression is itself a stressor. The primary evidence for this hypothesis comes from rodent studies, where early deprivation and later mild stress cause what look like mood changes - and shrinkage in areas of the brain that correspond to our hippocampus and prefrontal cortex. Human studies have tended to be correlational: patients who have suffered more days of mood disorder have more differences in brain volume. These findings are ambiguous. Perhaps a person with a small hippocampus is more prone to depression.

Evidence for the second theory, in which small hippocampal size creates vulnerability, came from the laboratory of the German psychiatrist , Thomas Frodl. He found that over the course of a year, chronic depression did not predict hippocampal change, but small hippocampal size predicted chronicity of depression. That's what makes a new study particularly intriguing. Looking now at a three-year interval, Frodl has found that depression does lead to loss of volume in critical regions of the brain.

The study contrasted 38 patients hospitalized for depression with 30 matched controls and used MRI scans coded by new software technology that distinguishes changes throughout the brain, not just in areas pre-selected by researchers. Over the next three years, the patients, and not the controls, showed a "decline in gray matter density" in the hippocampus, prefrontal cortex, and elsewhere. There was no part of the brain where the depressed patients showed increased volume or density. Patients whose mood disorder had remitted showed less volume decline. Overall, Frodl concluded, this prospective study in humans supports the findings from animal models in which stress and depression-like disorders cause brain change.

In the just-published study, antidepressants did not have a separate effect - it was getting better that conferred some protection. But the month before, in September, Frodl contributed an analysis showing that in some patients who took antidepressants for the whole of three years "hippocampal volumes increased significantly." A critical interactive factor may have been hippocampal size at the start of treatment. (It should be said that this study had a high attrition rate; its conclusions are necessarily speculative.) In the September paper, Frodl concluded that "a relatively small hippocampal volume may be a vulnerability factor for a bad treatment response in major depression."

Both may be true: depression attacks the hippocampus, and a small hippocampus impairs resilience. In Against Depression, I wrote that the evidence favored this combined hypothesis - so the theory is not new. But Frodl's current research does point to movement in the field toward the conclusion that depression or stress in the presence of depression injures the brain. That model suggests a need for vigorous early intervention and extended treatment. Recovery seems to offer some protection. Although the evidence is hardly clear-cut, long-term antidepressant use may as well.

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Quirky Little Things: Imposter!

By Jesse Bering, Ph.D. in Quirky Little Things

I don't know what it says about me that as a thirteen-year-old boy my favourite television show was The Golden Girls, but like many fans I was saddened earlier this year to learn of the death of Estelle Getty, who played the sassy Sicilian octogenarian Sophia Petrillo in this long-lived series. Given her obvious talent and inimitable delivery on screen, you might be surprised that Estelle Getty felt like a fraud as an actress. Here's what she said in a 1988 interview with Entertainment Tonight:

"I'm awed every day of my life. I think, this is Bea Arthur, this is Betty White. This is a big hit #1 show in the country. I'm afraid. I live with fear as a constant companion. Can I do this week after week? Am I good enough? Will I be able to pull it off this week? Will I be able to fool them again? And every day I'm a little scared. And every Friday I'm scared out of my wits. I keep thinking, I can't believe I'm in this. Wait till they find out I can't do it."

Now, I've never been on an '80s television series, nor has my name been stitched into the fabric of popular culture as a beloved character actress, but I have a pretty good sense of what Estelle Getty is talking about here. Years ago I interviewed for a position on the faculty of psychology at Harvard University. My selection committee comprised Steven Pinker, Susan Carey, and Elizabeth Spelke and in terms of stature in the field of psychological science, Pinker is something like the equivalent of Bea Arthur and Carey is a good analogy for Betty White. (Comparing Spelke to Rue McClanahan requires a bit more shoehorning, but you get the idea.) One of the reasons I botched the interview was because I couldn't get over the fact that I'd actually pulled this much off. I mean, come on, these are all-star celebrity researchers, bona fide superheroes of psychology who'd achieved posterity. And I'm a third-rate academic from Ohio who'd cavalierly graduated at the bottom of his high school class, earned a PhD from a university most people have never heard of, and who'd been toiling away in obscurity at the University of Arkansas as an assistant professor. Like Estelle Getty at her initial casting call, I felt like a charlatan, a ruse, a fake at Harvard. An impostor. Actually, I suspect I was, since in the end they didn't offer me the post.

But what Estelle and I describe is a psychological experience known as the impostor phenomenon (IP), defined by Georgia State University psychologists Joe Langford and Pauline Clance as, "believing that one's accomplishments came about not through genuine ability, but as a result of having been lucky, having worked harder than others, or having manipulated other people's impressions." Here are some more basic facts about IP:

• Impostors attribute their successes to attributes unrelated to the actual talent required for their success, such as personal charm or attractiveness. Some people who experience IP are especially prone to 'chameleon-type' behaviours, modifying their attitudes and actions in ways that foster approval from onlookers. (I inherited from my salesman father a rather chronic but often disingenuous smile, which seems to have a mind of its own.)

• Although early research suggested women are more likely than men to feel like impostors given the lower expectations of success for the former, subsequent studies revealed no difference between the sexes. However, IP appears to express itself differently in men and women. Women tend to be less "playful" (doing things just for fun) and less sociable. Female impostors are also usually extra cautious and averse to risks, whereas men who experience IP tend to score high in impulsivity, express a strong need for change and a low need for order. (Suffice it to say that I've bought and sold 7 houses over the past 4 years and I haven't balanced my check book since 1994.)

• People who experience IP don't simply have low self-esteem in general, but only negative feelings about the self in relation to their particular area of success. And introverts - who are often shy, anxious and lacking in confidence - are more likely than extroverts to feel like phonies, presumably because they're less expressive and more prone to keeping their 'private self' hidden from others. (You may think you know me....)

• When impostors do fail, their reaction displays a stereotypical pattern: they withdraw from the task, blame themselves for the failure, and experience anxiety and shame. Impostors often need to come across as smart or intelligent in front of an audience; women impostors view intelligence as a fixed entity (either one's clever or not, no room for argument) rather than a malleable quality.

• An impostor's sense of worth and importance is unusually dependent on others' feedback. (This one reminds me of 17th century Baroque painter Caravaggio, a bad-tempered genius who allegedly once tore up one of his masterpieces at a slight word of criticism.) Langford and Clance say that impostors "have a strong need to protect themselves from narcissistic injury."

• Impostors often resort to self-deprecation and avoid the attention of others. (Have I told you yet how much I dislike myself? In any event, I hope you're not reading this.)

Estelle Getty wasn't an impostor, of course. She was a brilliant, Emmy-Award winning actress. I suspect deep down I'm not entirely a phony either, though if were to begin talking about my successes I'd just turn my own stomach with nauseating lines of braggadocio, and if there's anything I can't stand more than an impostor, it's a braggart. Ugh, it's a no-win situation for us impostors, isn't it.

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Beliefnet.com: 10 Ways to Transform Toxic Thoughts

If you've ever felt the way anger or fear can electrify the atmosphere in a room, you'll know what Sandra Ingerman means by 'toxic thoughts.' The author, a family therapist and shaman practitioner, believes our thoughts and emotions transmit an invisible but palpable energy that can affect our mental and physical well-being. 'Psychic punches,' she writes, are as real as physical violence.

Click here for ten simple ways to protect yourself from negative thoughts and learn to radiate positive energy.


Text by Sandra Ingerman, adapted from her book, 'How to Heal Toxic Thoughts: Simple Tools for Personal Transformation'"

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Time: Defending Nebraska's Child Abandonment Law

By Karen Ball / Lincoln

Nebraska never wanted the attention that came with the heart-wrenching reports of sobbing children at hospitals and desperate parents leaving kids, little ones and unruly teenagers alike, under the state's new "safe haven" law. "We were being ridiculed every day," says state Sen. Dianna Schimek of Lincoln, "but I have no apologies because something good will come of this. We uncovered something that we need to address. And it's not just Nebraska — it's widespread."

The Nebraska Legislature's Judiciary Committee met in a special session Monday to begin rewriting a law that has resulted in an epidemic of abandoned children — some parents driving from Florida, Arizona and Georgia to leave off their problem kids. Most states allow a parent to leave an infant at a fire station or hospital without fear of prosecution, but because Nebraska's law did not define "child," 34 kids have been dropped off at Omaha hospitals since September. None were infants. The rest of America was stunned. But, as the special session proceeded, some legislators defended the intent of the law.

While Gov. Dave Heineman is pushing to limit a rewritten law to newborns of 72 hours, some lawmakers argue the abandonments have exposed an urgent need to fix gaping holes in state mental health services, which they claim fail to assist families with little resources to help problem children. Sen. Annette Dubas introduced an alternate bill that would retain "safe haven" for parents with kids age one to 15 through June 2009, so that the Legislature could address the broader issues come January. "Do not forget those struggling families," she urged her colleagues.

Some lawmakers were angered at what they see as a callous response from Heineman's administration — that state welfare agents appear to be accusing parents of too easily abdicating responsibility. "It's been very disturbing, how judgmental you've been," Sen. Amanda McGill scolded the state's Health and Human Services chief, Todd Landry. "You've had plenty of time to make these judgmental statements to the press" but not to return phone calls from desperate parents, she said. Landry argued that the state offers many lifelines, that services are available. "So all a parent has to do is call a hotline?" Sen. Steve Lathrop asked skeptically. "What is the harm," he asked repeatedly, of allowing distraught parents to bring older kids in?

But the voices that appear to have won the day were those of the abandoned. "I'll be good — I'll be good, I promise," one child begged as the mother walked away, Ann Schaumacher of Immanuel Hospital in Omaha told the Judiciary Committee. "It is not the right place for relinquishment to occur," Schaumacher said of the emergency room abandonments. Some hardened adolescents show no emotion at all, she recalled. An older teen was left by a mother who simply said, "I can't do it anymore." "These children will never be the same, and that's the tragedy of this law," said Schaumacher, who, like most hospital representatives, argues that the law should be limited to newborns and infants.

Near the end of a four-hour-plus hearing, Lyman "Scott" Wostrel gave a grown man's choked testimony of the experience of abandonment. His mother gave him up at 14, he said, in urging lawmakers to limit the law to newborns. "It doesn't matter what a person says. The action speaks — I don't love you. Any kid can figure that out," he said.

At the end of the work day, the Judiciary Committee voted to send a measure to the floor of the full unicameral legislature on Tuesday and Wednesday that amended the governor's bill to extend the law to children as old as 30 days. (Some legislators wanted the limit to be as much as a year or more.) Chairman Brad Ashford said he expected vigorous debate and further amendments. A 24-hour cooling off period will then go in effect before a final vote comes Friday.

Even though Governor Heineman is likely to have the law pared back to apply only to infancy, the broader issue of childhood mental illness did have its hearing. A majority of the kids abandoned had a history of mental illness — 90% of the parents or guardians had sought state services for them before. Many had at least one parent in jail. One big hole in the safety net, said Dr. Jane Theobald, an Omaha psychiatrist and representative for the Nebraska Psychiatric Association, is that there are simply not enough facilities for troubled youngsters. A teenager who attempts suicide might stay at a general medical hospital for days, waiting for an opening in a mental health facility that may or may not come. "I've sent kids out of state or four hours away for a bed. That's typical, not the exception."

Lawmakers sympathetic to the parents and guardians of older, troubled children note that Omaha is, after all, home to the original Boys Town of Father Flanagan fame. In the city, there's a statue of one young boy carrying another on his back, with the words chiseled underneath, "He ain't heavy, Father, he's m' brother." During the Great Depression, parents would scrape together bus fare and hang a sign, "Take Me to Boys Town,' around their child's neck. Tysheema Brown, the Atlanta woman who drove 1,000 miles to Omaha to drop off her 12-year-old son, had been taken to Boys Town herself as a teenager. She had tried to get a spot for him in a similar Georgia institution for six months and failed. On that long drive she reportedly told her son what was happening; she reasoned later he would not hate her because she believes she is sparing him from a jail cell.

Father Steven Boes, president of Boys Town, didn't bother to attend Monday's hearing because he thinks little can be done on the big issues of mental health. He says he'll be back in Lincoln in January "to strike while the iron is hot" when legislators are scheduled to debate privatizing behavioral services for troubled adolescents. Meanwhile, Boes had good news for Tysheema Brown. The priest said he's working with Georgia alumni to get her housing and find her son a spot, hopefully in Omaha.

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