Wednesday, November 16, 2005


(Nov. 16) - The case files of mental illness are filled with half-baked theories and their drastic advocates. Wilhelm Fleiss, for example, believed that sexual hang-ups stemmed from irregularities in the nasal cavity and that a little judicious snipping could set everything straight. In 1895 he famously botched an operation on Sigmund Freud's patient Emma Eckstein, absent-mindedly leaving a yard of surgical gauze stuffed in her head and almost causing her to bleed to death.

Sound Portraits ProductionsHoward Dully, age 12, is shown before, during and after his transorbital lobotomy. Now 56, he has made a documentary about it.
Dr. Walter J. Freeman, a central figure in "My Lobotomy," a radio documentary that will be broadcast this afternoon on the National Public Radio program "All Things Considered," believed that the source of many mental disturbances was the thalamus, in which overabundant emotions tended to congregate. The solution, in his view, was simply to sever that part of the brain from the frontal lobes.
In the late 1930's, Dr. Freeman was one of the first Americans to perform a transorbital lobotomy, in which holes are drilled in the patient's head. In 1946 he devised a faster and more efficient procedure, the prefrontal, or "ice pick," lobotomy, in which a spike is driven beneath the lids of both eyes and then swirled around in a sort of eggbeater motion to scramble the neural connections. He had some positive results, as in the case of Ann Krubsack, who today says she believes that the operation greatly helped her schizophrenia, if not entirely curing it, and enabled her to raise a family and hold down a job she liked.
But because the procedure was used indiscriminately, Dr. Freeman had at least as many poor and even tragic results. He nevertheless became a champion of the operation and to publicize it gave virtuoso demonstrations in which he sometimes used a carpenter's mallet instead of a surgical hammer and sometimes wielded two hammers at once, cracking both eye sockets simultaneously. The whole process took less than 10 minutes.
The operation was originally intended as a last resort for intractable patients, especially those in mental institutions before the advent of drugs like Thorazine made such patients easier to manage. But Dr. Freeman eventually expanded his practice to include patients who suffered from nothing more than migraine or postpartum depression. All told he performed some 3,000 lobotomies, including some on children as young as 4 , whom he believed to be suffering from the early onset of schizophrenia.

Sound Portraits ProductionsDespite his ordeal, Dully describes himself as "at peace" today.
His most famous patient was President John F. Kennedy's sister Rosemary, whom he lobotomized in 1941 when she was 23 and who required full-time care until her death this year. In 1960, when the ice-pick procedure was already becoming obsolete, he lobotomized a crew-cut 12-year-old Californian named Howard Dully. If the purpose of a lobotomy is to deaden the patient's emotions, then that operation, too, was a failure. Today Mr. Dully, a huge, barrel-shaped 56-year-old, is warm, expansive and full of feeling. He has been married three times - twice happily - and has a grown-up son and a job he likes, driving a tour bus. Except for his family and a few close friends, no one knew he had been lobotomized, and on meeting him no one would ever guess it.
But a couple of years ago, feeling, as he puts it, as if some part of him were missing, Mr. Dully began to look into what had happened to him.
In the course of his research he crossed paths with Dave Isay, a producer of radio documentaries, who encouraged Mr. Dully to make a documentary of his own. A result was "My Lobotomy," a 22-minute piece that includes archival recordings of Dr. Freeman (he has one of those deep 1950's newsreel voices), as well as of his son, Frank, who talks about his father's "magnificent obsession," and an interview with Ellen Ionesco, the first patient to undergo the ice-pick procedure. The most compelling voice, though, is Mr. Dully's own gravelly rumble as he tries to come to terms with what amounts to a second-rate fairy tale. (The documentary had its premiere on Monday evening in an auditorium at Bellevue Hospital Center.)
He was lobotomized, it turns out, for no other reason than that he didn't get along with his stepmother, whose long list of complaints about him included sullenness, a reluctance to bathe and that he turned on the lights during daytime. Mr. Dully's father signed off on the procedure, without seeming to take much of an interest in it, and the most dramatic moment in the documentary comes when, after 40 years of silence on the subject, Mr. Dully asks him why. "I got manipulated pure and simple," the father says. "I was sold a bill of goods." But he quickly adds that "nobody is perfect" and that in any case he doesn't like to "dwell on negative ideas." "You shaped up pretty good," he says to his son.

Dr. Robert Lichtenstein, a neurosurgeon who assisted Dr. Freeman in lobotomizing Mr. Dully, attended the Bellevue gathering, along with Ms. Krubsack and the relatives of some people who had been lobotomized, and he, too, had an upbeat view. After all these years, he said, he was pleased to meet Mr. Dully and to see that the procedure had had such a "positive outcome."
For his part, Mr. Dully cried a little but also grinned and said that the best part of the process was merely being able to talk about the operation with his father and say that he still loved him. Ever since the lobotomy he had felt like a freak, he says at the end of the documentary, but now he knows that the operation "didn't touch my soul." "For the first time I feel no shame," he adds. "I am, at last, at peace."
Jack El-Hai, who has written a well-regarded biography of Dr. Freeman, was also at the premiere, and afterward he said of him: "Was he a nut job? I don't think so. He knew more about brain anatomy than just about anyone, and I think he did care about what happened to his people. But he was stubborn, he was impervious to criticism, and he had a loner quality that in the long run caused both him and his patients great harm. I think of him as King Lear in medical garb."

Wednesday, November 09, 2005

Andrea Yates is Back in the News. Is she not guilty by reason on insanity?

DA: New trial for Andrea Yates
Plea bargain possible in child-drowning case

Wednesday, November 9, 2005; A Texas appeals court refused to reinstate Andrea Yates' conviction for drowning her children.

HOUSTON, Texas (AP) -- Texas' highest criminal court on Wednesday let stand a lower court ruling that threw out Andrea Yates' murder convictions for drowning her children in a bathtub in June 2001.
Harris County Assistant District Attorney Alan Curry said the case would be retried or a plea bargain considered.
Jurors rejected Yates insanity defense in 2002 and found her guilty of two capital murder charges for the deaths of three of her five children.

Curry said if the case goes back to trial, he is confident Yates would be convicted again. He said a plea bargain also may be discussed.
"Andrea Yates knew precisely what she was doing," Curry said. "She knew that it was wrong."
Yates' attorney, George Parnham told CNN that he hoped Yates belongs mental health facility, not behind bars.
"She has been told she will be retried," Parhnam said. "She doesn't want to go through this process. She is very concerned about it. The right thing needs to be done here."
The First Court of Appeals in Houston overturned Yates' 2002 convictions in January because of false testimony from forensic psychiatrist Park Dietz.
Curry asked the highest criminal court in Texas, based in Austin, to reconsider the lower court's ruling. He said the lower court wrongly applied the law when it overturned the convictions.

Another article:

Ruling gives Yates a chance for treatment, husband says
Woman to remain in prison after court overturns convictions

(CNN) -- The husband of Andrea Yates, who admitted she drowned the couple's five children, said a Texas appellate court's decision to throw out her murder convictions gives prosecutors a chance to seek treatment for his wife's mental illness.
Russell Yates made the comments Thursday evening in an exclusive interview on CNN's "Larry King Live."
"If they drop charges against her, then she'd go to a mental hospital and then the doctors would decide when she's well enough to go home," Yates said. "They've treated her like a serial killer, and my feeling all along has been it's a waste of the taxpayers' money to prosecute her."
But a spokesman for the Harris County District Attorney's Office said prosecutors will ask the appellate court to reconsider its ruling striking down Andrea Yates' convictions, and, if that fails, they will appeal the ruling to the Texas Court of Criminal Appeals.
Yates' attorneys said that despite the ruling, they will not seek her release from the prison psychiatric ward immediately.
"She is in the very best possible place, all things considered, at this time and in this place under these circumstances," said George Parnham, her lead attorney.
Parnham said his client was "surprised and not unpleased" by Thursday's ruling.
Case specifics
In June 2001, Yates drowned her children -- Mary, 6 months; Noah, 7; John, 5; Paul, 3; and Luke, 2 -- in the bathtub of her Houston-area home. The charges did not include the deaths of Paul and Luke. In March 2002, a jury convicted her of capital murder for the deaths of the other three.
She had a well-documented history of postpartum depression, and her attorneys argued that she suffered from postpartum psychosis, but the jury rejected her plea of not guilty by reason of insanity.
The difference between a verdict of guilty and one of not guilty by reason of insanity in the Yates trial hinged on one key issue: whether Yates knew what she was doing when she drowned the children was wrong.
Both the defense and prosecution agreed Yates is mentally ill, but prosecutors convinced the jury that she knew her actions were wrong.
Under Texas law, defendants can be declared not guilty by reason of insanity only if it is determined they did not know right from wrong at the time of the crime.
Thursday, the Texas 1st Court of Appeals overturned the convictions and ordered a new trial. That court found that an expert prosecution witness, Dr. Park Dietz, provided false testimony that "could have affected the judgment of the jury."
Dietz, who worked as consultant for NBC's "Law and Order" program, testified that there was an episode dealing with a woman suffering from postpartum depression who drowned her children in a bathtub and was found to have been insane.
Yates, now 40, apparently was a fan of the show and watched it regularly.
Dietz suggested that Yates might have been inspired to kill her children because of that specific episode. But on appeal, the defense said it contacted the producers of the show, who said such an episode was never aired.
"We conclude that there is a reasonable likelihood that Dr. Dietz's false testimony could have affected the judgment of the jury," the appeals court found. "We further conclude that Dr. Dietz's false testimony affected the substantial rights of the appellant."
Imperfect memory
The appeals court ruling found that Dietz did not intentionally lie and the prosecution did not knowingly use false testimony.
Dietz released a statement Thursday evening saying that he learned a week after his testimony, while the trial was still under way, "that my recall of a particular episode might be mistaken." He said sent a letter informing attorneys in the case about the mistake and offered to return to Houston to correct the error.
"Unfortunately, neither of the parties introduced this letter into the record, so the judges were unaware of what had happened," he said in his statement. "I made an honest mistake and took immediate steps to correct it."
Dietz said that as a consultant for "Law & Order," he has "read, discussed or watched" more than 200 shows, as well "as most episodes of other crime dramas aired for the last 20 years."
"My spontaneous recall about particular shows is admittedly imperfect," he said.
Dietz also said that at the time of his testimony, he did not know that another witness had testified that Yates watched the show -- disputing the idea that his testimony was somehow designed to show she premeditated the crime.
"At no time have I ever believed or told anyone that I thought 'Law & Order' or any other television show gave Andrea Yates the idea to kill her children," he said. "I believe, and testified, that she killed her children because of a psychotic mental illness. Evidence I relied on that tended to show she knew it was wrong included Mrs. Yates recorded statements, including my own interviews."
Retrial possible
Parnham said Dietz's testimony was critical to the prosecution's argument that Yates knew what she was doing was wrong.
"Only one mental health expert testified that Andrea knew that what she was doing was wrong, and that was the celebrated Park Dietz," Parnham said. "Every other mental health expert ... testified that she was either incapable of knowing what she was doing was wrong or did not know what she was doing was wrong."
Now that a retrial is possible, Parnham emphasized that a verdict of not guilty by reason of insanity "does not mean that an individual is released."
"I am certain that there are circumstances in her future that can be addressed that would be outside four walls of razor wire," he said. "I don't believe that Andrea will ever be in a position to be free of any type of mental health assistance."
Rusty Yates told King that he was "extremely surprised" by the court's favorable ruling.
"This court has really come under fire lately, because they've habitually ruled against the defendants and in favor of the state," he said. "They're very tough."
Yates stood by his wife throughout the trial, but last July, he filed for divorce.
"I forgive her for what she's done, and in many respects have never blamed her, she's hurt me tremendously through her actions," he said. "It's kind of a place I can't go back to."

Monday, November 07, 2005

SUICIDE + Asperger's Syndrome

Report: Teen left suicidal messages on Web site before rampage
19-year-old vowed 'to hurt those that have hurt me'

Tuesday, November 1, 2005; ALISO VIEJO, California (AP) -- A 19-year-old man who authorities say killed two neighbors then himself posted suicidal messages on a Web site before the rampage, according to a report published Tuesday.
William Freund posted an Internet message October 16 that threatened a "Terror Campaign to hurt those that have hurt me," the Los Angeles Times reported. In the same message, he said, "My future ended some time ago."
The messages were posted on, a site used by people with Asperger's syndrome, an autism-like neurological disorder marked by poor social skills and communication problems. He wrote on the site that he was diagnosed at age 16, but the Times reported that details of his medical treatment were unavailable.
The founder of the Web site, George Mason University student Alexander Plank, said volunteer monitors were concerned about the messages and tried unsuccessfully to find Freund's parents. After seeing news accounts of the shootings, Plank contacted police.
"We're looking into his mental health at the time of the shooting," said Orange County sheriff's spokesman Jim Amormino.
On Saturday, Freund, who lived with his parents in the upscale community of Aliso Viejo, donned a dark cape and a paintball mask. Armed with a shotgun, he drove to a nearby neighbor's house and shot to death Christina Smith, 22, and her father, Vernon Smith, 45.
After the gun apparently jammed when trying to shoot another neighbor, he walked home and killed himself.
On the Web site, Freund wrote that he had purchased a 12-gauge shotgun for defense, and that his health was deteriorating because of a new medication. "I feel like I need to kill myself," he wrote.
On October 19, he asked for references to a mental hospital and said he needed counseling and training in social skills. He also wrote that he wished he had some friends -- emphasizing it with 75 exclamation points.
Some of the messages remained on the site Tuesday morning.

Thursday, November 03, 2005

Post Traumatic Stress....The Good News

The Effects of Trauma Do Not Have to Last a Lifetime(

Most people will experience a trauma at some point in their lives, and as a result, some will experience debilitating symptoms that interfere with daily life. The good news is that psychological interventions are effective in preventing many long-term effects.
Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, such as terrorist attacks, motor vehicle accidents, rape, physical and sexual abuse, and other crimes, or military combat.
Those suffering from PTSD can have trouble functioning in their jobs or personal relationships. Children can be traumatized and have difficulty in school, become isolated from others and develop phobias. Many people with PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects that remind them of the trauma. PTSD is diagnosed when symptoms last more than one month.
Psychologist Roxane Silver has studied the effects of the 9/11/01 terrorist attacks on New York City and Washington, D.C. Her research focused on the immediate and long-term responses to the attacks and found that the severity of exposure to the event, rather than the degree of loss, predicted the level of distress among people. For example, people who reported seeing the planes smash into the trade center buildings experienced more PTSD symptoms than average, but people who experienced financial losses because of the attacks did not. Other studies have shown that simply watching traumatic events on TV can be traumatic to some, especially those individuals who had pre-existing mental or physical health difficulties or had a greater exposure to the attacks.
The good news is, research has shown that psychological interventions can help prevent these long-term, chronic psychological consequences.
In general, cognitive-behavioral therapies (CBT) (which strive to help traumatized individuals understand and manage the anxiety and fear they are experiencing) have proven very effective in producing significant reductions in PTSD symptoms (generally 60-80%) in several civilian populations, especially rape survivors. Even combat veterans who have experienced PTSD after chronic, repeated exposure to horrific events experience moderate benefits from CBT (though, not surprisingly, this kind of repeated trauma is harder to treat).
Research also suggests that brief, specialized interventions may effectively prevent PTSD in some subgroups of trauma patients. Psychologist E. B. Foa and colleagues have developed brief cognitive-behavioral treatments (lasting four to five sessions) that include, (1) education, (2) various forms of relaxation therapy, (3) in vivo exposure (repeated confrontations with the actual traumatic stressor and with situations that evoke trauma-related fears), and (4) cognitive restructuring (techniques for replacing catastrophic, self-defeating thought patterns with more adaptive, self-reassuring statements). If used within a few weeks of exposure to traumas, this brief form of therapy often prevents PTSD in survivors of both sexual and nonsexual assaults. R. A. Bryant’s research found that cognitive-behavioral treatment is also effective in preventing the occurrence of PTSD in survivors of motor vehicle and industrial accidents. In addition to targeted, brief interventions, some trauma survivors may benefit from ongoing counseling or treatment, according to Bryant, and candidates for such treatment include survivors with a history of previous traumatization (e.g., survivors of the current trauma who have a history of childhood physical or sexual abuse) or those who have preexisting mental health problems.
Trauma disorders are a common and costly problem in the United States. An estimated 5.2 million American adults ages 18 to 54, or approximately 3.6 percent of people in this age group in a given year, have PTSD. In 1990, anxiety disorders cost the U.S. an estimated $46.6 billion. Untreated PTSD from any trauma is unlikely to disappear and can contribute to chronic pain, depression, drug and alcohol abuse and sleep problems that impede a person’s ability to work and interact with others.
According to psychologist R.C. Kessler’s findings from The National Cormorbidity Survey Report (NCS) that examined over 8,000 individuals between the ages of 15 to 54, almost 8 % of adult Americans will experience PTSD at some point in their lives, with women (10.4%) twice as likely to be victims as men (5%).
Practical Application
The challenge for the mental health community is to learn how best to help people who are suffering from ill effects of traumatic events. Within the past decade, a number of programs have been created to bring appropriately trained mental health services to trauma victims. Examples include:
The American Psychological Association developed its Disaster Response Network (DRN) in response to the need for mental health professionals to be onsite with emergency workers to assist with the psychological care of trauma victims. Over 1,500 psychologist volunteers provide free, onsite mental health services to disaster survivors and the relief workers who assist them. The APA has worked with the American Red Cross, the Federal Emergency Management Agency (FEMA), state emergency management teams and other relief groups on every major disaster our country has experienced and many smaller disasters since 1992.
Under the auspices of The National Association of State Mental Health Program Directors (NASMHPD) 15 state departments of mental health have initiated formal efforts to better address the needs of persons exposed to trauma with state-wide trauma initiatives and resources. Now “tool kits” have been developed to better help trauma victims.
The University of South Dakota developed the Disaster Mental Health Institute (DMHI) in 1993. Psychologist Gerad Jacobs, Ph.D., helped create the Institute in response to his involvement in helping airline crash victims in the 1989 Sioux City airline crash. The DMHI is designed to bring together practice and research in disaster mental health and help prepare psychologists to deliver mental health services during emergencies and their aftermath. Furthermore, educational opportunities exist for students to learn how to serve their communities in times of disaster. This undergraduate program includes working with the American Red Cross Disaster Service.
Pacific Graduate College and Stanford University recently created the National Center on Disaster Psychology and Terrorism, which trains doctoral students to help victims of catastrophic events.
Cited Research
Blanchard, E.B., Hickling, E.J., Barton, K.A., Taylor, A.E., Loos, W.R., & Jones-Alexander, J. (1996). One-year prospective follow-up of motor vehicle accident victims. Behaviour Research and Therapy, Vol. 34, No. 10, pp. 775-786.
Bryant, R.A., Sackville, T., Dang, S.T., Moulds, M.L., & Guthrie, R. (1999). Treating Acute Stress Disorder: An evaluation of cognitive behavior therapy and supportive counseling techniques. American Journal of Psychiatry, Vol. 156, No. 11, pp. 1780-1786.
Bryant, R.A., Harvey, A.G., Dang, S.T., Sackville, T., & Basten, C. (1998). Treatment of Acute Stress Disorder: A comparison of cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, Vol. 66, No. 5, pp. 862-866.
Frueh, B. C., Cusack, K.J., Hiers, T. G., Monogan, S., Cousins, V. C., & Cavenaugh, S. D. (2001). The South Carolina Trauma Initiative. Psychiatric Services, Vol. 52, pp. 129-146.
Foa, E.B., Hearst-Ikeda, D.E., & Perry, K. J. (1995). Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. Journal of Consulting and Clinical Psychology, Vol. 63, No. 6, pp. 948-955.
Foa, E. B., Dancu, C.V., Hembreee, E. A., Jaycox, L. H., Meadows, E. A., & Street, G. P. (1999). A Comparison of Exposure Therapy, Stress Inoculation Training and their Combination for Reducing Posttraumatic Stress Disorder in Female Assault Victims. Journal of Consulting and Clinical Psychology, Vol. 67, pp. 194-200.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R Psychiatric Disorders in the United States. Archives of General Psychiatry, Vol. 51, pp. 8-19.
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B., (1995). Post-traumatic Stress Disorder in the National Comorbidity Survey. Archives of General Psychiatry, Vol. 52, pp. 1048-1060.
King, L.A., King, D.W., Fairbank, J.A., Keane, T.M., and Adams, G.A. (1998). Resilience-Recovery Factors in Post-Traumatic Stress Disorder Among Female and Male Vietnam Veterans: Hardiness, Postwar Social Support and Additional Stress Life Events. Journal of Personality and Social Psychology, Vol. 74, pp. 420-434.
Narrow WE, Rae DS, Regier DA. NIMH epidemiology note: prevalence of anxiety disorders. One-year prevalence best estimates calculated from ECA and NCS data. Population estimates based on U.S. Census estimated residential population age 18 to 54 on July 1, 1998. Unpublished.
Silver, R.C., Holman, A., McIntosh, D.N., Poulin, M., and Gilrivas, V. (2002). Nationwide Longitudinal Study of Psychological Responses to September 11. Journal of the American Medical Association, Vol. 228, pp. 1235-1244.
Zoellner, L.A., Fitzgibbons, L. A., & Foa, E. B., (2001). Cognitive-Behavioral Approaches to PTSD. In J. P. Wilson, M. J. Friedman, & J. D. Lindy (Eds.), Treating Psychological Trauma and PTSD (pp. 159-182). New York: Guilford
Additional Sources
American Psychological Association’s disaster information
A National Center for PTSD Fact Sheet, by Eve B. Carlson, Ph.D. and Josef Ruzek, Ph.D.:
National Institute of Mental Health Web site on PTSD:
Jon D. Elhai, Ph.D., Assistant Professor, Disaster Mental Health Institute, The University of South Dakota: