Mental Health & Behavior:

New York Times

January 26, 2006

For Therapy, a New Guide With a Touch of Personality
By BENEDICT CAREY
A new diagnostic manual tries to go beyond symptoms to the human complexity at the root of disorders.

Mastering the Geometry of the Jungle
By NICHOLAS BAKALAR
Members of isolated Amazon villages with no words in their language for any geometric shape except circles still understand many principles of geometry.

FINDINGS
A Shocker: Partisan Thought Is Unconscious
By BENEDICT CAREY
Neuroscientists have tracked what happens in the politically partisan brain when it tries to digest damning facts about favored candidates.

Cells That Read Minds
By SANDRA BLAKESLEE
Scientists plumb the secrets of mirror neurons, which allow the brain to perform its highest tasks. One mystery remains: What makes them so smart?

Psychotherapy on the Road to ... Where?
By BENEDICT CAREY
A field of aging leaders seeks new superstars and some direction.

Essay: When Teenagers Abuse Prescription Drugs, the Fault May Be the Doctor's

Movie Review | 'My Name Was Sabina Spielrein': Dear Carl and Sigmund . . .

Mental Health: Hurricane Takes a Further Toll: Suicides Up in New Orleans

Older Antipsychotics Are Found as Risky for Elderly as New Ones

Hooked on the Web: Help Is on the Way

Preventing Cancer: Is There a Link Between Stress and Cancer?

Experiment Gives Illusion of That Shrinking Feeling

Head of Psychotherapy Institute Resigns in Dispute With Founder

Cases: A Wedding, a Cold and a Trip to the Emergency Room

Q & A: Do Babies Dream?

Aetna to Pay for Program to Manage Depression

Cases: Speaking in the Third Person, Removed From Reality

Vital Signs: At Risk: Tie Between Obesity and Dementia Is Discovered

'Lincoln's Melancholy': Sadder and Wiser

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Ruth Marten

SIDE EFFECTS

This Is Your Brain on Schadenfreude
By JAMES GORMAN
Brain scans have clearly reached the level of sophistication required to identify states of mind described by complicated German words.

The Cute Factor
By NATALIE ANGIER
From pandas and penguins to King Kong, 2005 was the year of the adorable. Now scientists are discovering why cute is so appealing.

This Is Your Brain Under Hypnosis
By SANDRA BLAKESLEE
Hypnosis is receiving some new respect from neuroscientists as brain scans show how a suggestion can change the mechanism of perception.

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ESSAY
Scare Yourself Silly, but the Real Terrors Are at Your Feet
By ABIGAIL ZUGER, M.D.
Frightening health news lets people replace immediate dangers with more distant ones.

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Exploring Mental Illness and Battling with Her Own

New York Times

January 31, 2006

As a reporter for The New York Times in the 1940's and 50's she worked to remove the stigma of mental illness, even writing a revealing book that chronicled her own psychoanalysis.

Ms. Freeman's efforts recall a heady time in the history of psychiatry, when two competing groups, the followers of Sigmund Freud and those who favored physical manipulation of the brain, each believed it had found a "cure" for mental illness. We know more today, but all the answers are not in.

Ms. Freeman was born in 1916, the daughter of Lawrence Greenbaum, a prominent New York lawyer, and his wife, Sylvia. In 1940, after graduating from Bennington College, she became one of the few women on the reporting staff of The Times. Seven years later, she married William Freeman, an editor.

But Ms. Freeman had a troubled personal life. As she said in her 1951 book "Fight Against Fears," she was angry, unhappy and unable to sleep. She also had a series of ailments, including sinus headaches.

That Ms. Freeman turned to a psychoanalyst was not surprising. The teachings of Freud, who believed that emotional problems in adulthood resulted from unresolved childhood conflicts, were at the height of popularity then, and his solution was psychoanalysis — spending years revisiting one's life history with a trained therapist.

Still, Ms. Freeman's family and friends were displeased with her decision to go into analysis, responding, she said, with "skepticism, jeers and outright disapproval."

One acquaintance told her, "You're crazy if you go to a psychiatrist."

This type of response stemmed from the prevailing beliefs of the era, which viewed mental illness scornfully and its victims as deviants. Compounding this stereotype was the reliance on imposing state hospitals, like the one depicted in the 1948 Hollywood film "The Snake Pit," to house people with severe schizophrenia or depression.

In truth, many psychiatrists were trying to convert such institutions from overcrowded, custodial facilities to state-of-the-art medical centers. Believing that mental illness stemmed from organic problems within the brain, psychiatrists had devised a series of treatments, including electroshock therapy and lobotomy.

It was these advances that Ms. Freeman relentlessly publicized as The Times's reporter on mental health. Writing scores of articles like "Action Now Urged on Mental Cases" and "State Mental Care Entering New Era," she willingly blurred the roles of reporter and advocate.

But Ms. Freeman's heart lay in promoting psychoanalysis, which she believed had greatly improved her own condition, most likely a severe form of neurosis. By helping her confront her childhood conflicts, which included hating her mother, having sexual feelings for her father and envying her siblings, her analyst, she said, had cured her headaches and eased her psychological pain. Psychoanalysis, she wrote, "is part of today's struggle for survival."

Ms. Freeman and her analyst saw unexplored childhood and adult fears as the cause of mental illness — even of psychotic conditions like schizophrenia. As she wrote, fear had "incited the anger, the hatred, the guilt" and thus "split me into pieces."

Not surprisingly, perhaps, this emphasis on fear had great currency during the cold war, leading former mental patients to start "Fight Against Fear" clubs across the nation.

From our modern perspective, viewing fear as the cause of most mental illnesses seems quite outdated. Even Freud had intended that only neurotics, as opposed to people with more severe diseases, explore their childhood conflicts.

Moreover, recent studies have demonstrated that disorders like schizophrenia have a genetic basis and result from chemical abnormalities in the brain.

While lobotomy has been abandoned, electroshock therapy is still used to treat depression. And over the last 50 years, scientists have developed numerous effective medications to treat psychosis and other symptoms of mental illness.

Meanwhile, the grand claims made by Ms. Freeman and others for psychoanalysis have been challenged. Researchers argue that the effectiveness of psychoanalysis, like other medical interventions, needs further validation through studies.

Lucy Freeman wanted to hear none of this. According to her niece, Dale Schroedel, she remained "absolutely devoted and committed to Freud even when he became archaic."

Many therapists still agree with Ms. Freeman. Analysis, and its less intensive cousin, psychotherapy, remain a cornerstone of psychiatric practice.

Ms. Freeman eventually wrote 78 books, many of them addressing the connection of emotions and health.

In so doing, she further fought the stigma that plagued her and others suffering from mental illness. "By saving them," she wrote, "in some way I also saved myself."

Barron H. Lerner teaches medicine and public health at Columbia University.

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The results of two new studies underscore the quandary that faces women taking antidepressants who are pregnant or plan to be.

In one, researchers report that pregnancy, contrary to widespread belief, provides no protection against emotional or psychiatric problems, suggesting that stopping antidepressants may be dangerous for both mother and child.

The other study confirms previous research showing that 30 percent of pregnant women who take antidepressants have babies who exhibit symptoms of drug withdrawal.

The first study, published last week in The Journal of the American Medical Association, found that women with major depression who stopped their medication relapsed more than two and a half times as often as women who continued to take antidepressants.

Dr. Lee S. Cohen, the lead author on the study and a psychiatrist at Massachusetts General Hospital, emphasized that this was an observational study of women who were already taking the drugs, and not a randomized trial.

Two of the authors have consulted for pharmaceutical companies that make antidepressants or have accepted research money from them.

The researchers found that 68 percent of 207 women who discontinued their medicine relapsed into depression while they were pregnant, but only 26 percent of those who continued their medicine through at least 16 weeks of gestation had a relapse.

According to the authors, these rates of relapse are similar to those of depressed women who are not pregnant and stop their medicine. Being pregnant, in other words, apparently provided no protection.

The second paper, published yesterday in The Archives of Pediatrics & Adolescent Medicine, reported that newborns exposed in the womb to Prozac and similar antidepressants, called selective serotonin reuptake inhibitors or S.S.R.I.'s, could develop neonatal abstinence syndrome.

This condition creates a physically uncomfortable withdrawal period of about 48 hours and can bring on crying, tremors, sleep problems and gastrointestinal disturbances, among other symptoms.

Israeli researchers tracked 60 infants exposed to S.S.R.I.'s during gestation, and found that 18 of them suffered the syndrome. None of a matched group of 60 infants whose mothers had not taken S.S.R.I.'s had the problem. The women had been taking various drugs, including Prozac, Zoloft, Paxil and Celexa.

The withdrawal usually does not require treatment and appears to have no immediate negative consequences, the researchers said. But, they wrote, "The long-term effects of in utero exposure to S.S.R.I.'s have not been demonstrated clearly."

The researchers acknowledged that their sample size was small and that they depended on mothers to report their own use of the drugs.

Yet stopping the medication also presents problems for mother and child, said Dr. Margaret G. Spinelli, an assistant professor of clinical psychiatry at Columbia, who was not involved in either study. One concern about depression in pregnancy is adverse outcomes to the baby, she said.

"Depressed mothers don't eat properly, they don't tend to their prenatal care and they're more likely to be smoking," Dr. Spinelli said. "Many physicians just stop the medicine without even thinking. We have to be aware of these things."

Dr. Gil Klinger, the lead author of the Israeli study and a neonatologist at Tel Aviv University, agreed. "Pregnant women should not stop treatment because depression during pregnancy has its own risks," he wrote in an e-mail message. "However, it should be kept in mind that prolonged S.S.R.I. exposure has at least a short-term effect on the newborn."

Dr. Cohen of Massachusetts General also stressed weighing the risks and said that the data helped to refine the risk-benefit decision of doctors and patients. "Hopefully those decisions can now be made in a more informed fashion so that we worry not just about the risks of exposure to antidepressants but also about risks to the patient from depression if they stop their medicine," he said.

"My hope is that it will be less of a reflex to stop the medicine and more a collaborative decision that weighs all the risks," he added.

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