Coping with life’s everyday fears

Drawing lessons from trauma, author offers parents advice on a child’s anxieties, large and small.

By Cathy Shufro

It was 3 a.m. on a summer night in 2004 when the sound of a pager awoke psychoanalyst Steven R. Marans, M.S.W., Ph.D. The New Haven police were summoning him to a home where three children had witnessed a murder. Along with colleagues in the city’s Child Development-Community Policing Program (which Marans founded with the late Donald J. Cohen, M.D. ’66, in 1991), Marans invited the children to draw pictures and to talk about any aspects of the event they wished to discuss.

As a nationally known expert on children facing severe trauma, Marans spends much of his time helping children and those who care for them to cope with major upheavals—domestic violence, school shootings, the 9/11 attacks and such natural disasters as Hurricane Katrina. Since 2000 he has also directed the National Center for Children Exposed to Violence, a federal program based on Yale’s partnership with the New Haven police.

Now Marans, professor of child psychiatry and psychiatry at the Yale Child Study Center and in the department of psychiatry, has applied his insights to writing a guide for parents that explores the day-to-day challenges of growing up. In his first book for a general audience, Listening to Fear: Helping Kids Cope, From Nightmares to the Nightly News, Marans suggests that children’s reactions to stress have a common source. Whether the stressor is as extreme as witnessing a murder or as ordinary as coping with teasing, the common source is fear.

Marans, who has been trained in both child and adult psychoanalysis, shows in his book how fear enters into everyday events with a description of a supermarket tantrum by his toddler son (now a college student). For the child, fear played a role—perhaps he feared his lack of competence when his father had to lift him to reach a container of sour cream. Most likely the child also scared himself with his outburst. But the incident stirred Marans’ own fears: loss of control, loss of his self-image as someone skilled in understanding children—and loss of face as he imagined onlookers judging him a bad parent. Those fears Marans could explain rationally.

Marans says that children’s fears also evoke their parents’ suppressed fears, fears that stem from the normal course of development and from their own childhood experiences. “We desperately want to wave the proverbial magic wand and wave our children’s feelings away, not only because we don’t like to see our children unhappy but also because it stirs up our own feelings—feelings that we’re reminded of by our kids’ experiences,” said Marans.

Drawing on clinical research and his own experience, Marans said all people share five fundamental fears: loss of life (of loved ones and of oneself); loss of the love of others and for ourselves; bodily harm; losing control of our feelings, impulses or thoughts; and losing the assumed predictability of daily life. By distinguishing our own fears from our child’s, Marans said, we become better parents. We need to listen, not only to words but also to behavior, which may be the child’s only means of expressing distress.

“My interest in extreme situations is an extension of the concern that I always have: how we use our understanding of human behavior and human development as a way of illuminating people’s experience,” said Marans during an interview at the Child Study Center. “What I hope the book does is remind us that the worst of our fears, fears that can reach overwhelming or dramatic proportions, are elaborations of the basic fears and anxieties that are part of who we are as human beings. Discovering that there is, in fact, sense to what we feel and how we act can be tremendously reassuring.”

Bookshelf is a column in Yale Medicine focusing on matters related to books and authors at the School of Medicine. Send ideas to Cathy Shufro at cathy.shufro@yale.edu.

Book notes

Smoking 101: An Overview for Teens
by Margaret O. Hyde and John F. Setaro, M.D., HS ’86, FW ’92, associate professor of medicine (cardiology) (Twenty-First Century Books) This book provides information that will help teenagers considering whether to try cigarettes. For teens who already smoke, the authors describe programs and techniques for quitting and list websites of organizations that can help.

On Call: A Doctor’s Days and Nights in Residency
by Emily R. Transue, M.D. (St. Martin’s Press) While a resident at the University of Washington, Transue, Yale College Class of 1992, wrote about her patients as a way to guard against burnout and share her experiences with friends and family. This collection of stories conveys the atmosphere of overwork, exhaustion and insecurity in which a resident works, as well as Transue’s compassion for her patients.

Mortal Secrets: Truth and Lies in the Age of AIDS
by Robert Klitzman, M.D. ’85, and Ronald Bayer, Ph.D. (The Johns Hopkins University Press) The authors provide a portrait of moral, social and psychological decision making by drawing on interviews and testimonies from more than 70 gay men and women, intravenous drug users, sex workers, bisexual men and heterosexual men and women. For those who are HIV-positive, decisions about disclosure of their diagnosis make them confront intimate questions about truth, lies, sex and trust.

Shields’ Textbook of Glaucoma
edited by R. Rand Allingham, M.D., Karim F. Damji, M.D., Sharon F. Freedman, M.D., Sayoko E. Moroi, M.D., Ph.D., George Shafranov, M.D., associate professor of ophthalmology and visual science, and M. Bruce Shields, M.D., the Marvin L. Sears Professor of Ophthalmology and Visual Science (Lippincott Williams & Wilkins) Readers will find updated information on the cellular and molecular biology of the eye, molecular genetics of glaucoma and congenital and developmental glaucomas. The book also describes management of glaucoma and approaches to treatment. Each chapter includes summaries of key points.

Psychological Aspects of Reconstructive and Cosmetic Plastic Surgery: Clinical, Empirical and Ethical Perspectives
edited by David B. Sarwer, Ph.D., Thomas Pruzinsky, Ph.D., Thomas F. Cash, Ph.D., Robert M. Goldwyn, M.D., John A. Persing, M.D., professor of surgery (plastic) and neurosurgery, and Linton A. Whitaker, M.D. (Lippincott Williams & Wilkins) This volume examines the relationships among physical appearance, body image and psychosocial functioning. The authors detail the psychological implications of specific disfigurements and of reconstructive procedures, and discuss bioethical, professional and legal issues.

The Flavor Point Diet: The Delicious, Breakthrough Plan to Turn Off Your Hunger and Lose the Weight for Good
by David L. Katz, M.D., M.P.H. ’93, associate clinical professor of public health, and Catherine S. Katz, Ph.D. (Rodale Books) This book introduces readers to the Flavor Point Diet and provides menu plans and recipes. By combining foods selected by flavor, the regimen “tricks the brain into being satisfied all day.”

Globalization, Women, and Health in the 21st Century
by Ilona S. Kickbusch, Ph.D., former professor of public health, Kari A. Hartwig, Dr.P.H., assistant clinical professor of public health, and Justin M. List, M.Div. ’04 (Palgrave Macmillan) This book explores the complex set of interdependencies among gender, health and globalization.

The Psychotherapist’s Own Psychotherapy: Patient and Clinician Perspectives
edited by Jesse D. Geller, Ph.D., associate clinical professor of psychiatry, John C. Norcross, Ph.D., and David E. Orlinsky, Ph.D. (Oxford University Press) The first-person narratives, clinical wisdom and research findings gathered in this book offer guidance for providing effective treatments to patients who are also therapists.

Medical Complications During Pregnancy, 6th ed.
edited by Gerard N. Burrow, M.D. ’58, HS ’66, the David Paige Smith Professor Emeritus of Medicine and dean emeritus, Thomas P. Duffy, M.D., professor of medicine (hematology), and Joshua A. Copel, M.D., FW ’85, professor of obstetrics, gynecology and reproductive sciences and of pediatrics (W.B. Saunders) This reference book presents multidisciplinary coverage of the full spectrum of complications associated with pregnancy. Postpartum depression and bioethics are two of the topics covered.

Foundations of Anesthesia: Basic Science and Clinical Practice, 2nd ed.
edited by Hugh C. Hemmings Jr., Ph.D. ’86, M.D. ’87, and Philip M. Hopkins, M.D. (Elsevier) International experts provide complete coverage of basic and clinical science in anesthesiology, emphasizing the principles and clinical applications of molecular and cell biology, physiology, pharmacology and physics and measurement.

Maimonides
by Sherwin B. Nuland, M.D. ’55, HS ’61 (Schocken Books) Maimonides was a physician, a Torah scholar, a community leader and a philosopher who attempted to reconcile scientific knowledge with faith in God. He was a Jew living in a Muslim world, a rationalist living in a time of superstition. Nuland gives us a portrait of Maimonides that makes his life, his times and his thought accessible to the general reader.

Get Hired! How to Land the Ideal Federal Job and Negotiate a Top Salary
by Lily Whiteman, M.P.H. ’90 (FPMI Solutions) This book, based on the experiences of people who found federal jobs, provides tips for breaking into the federal job market—from entry-level to executive positions. The author provides strategies for finding domestic and overseas openings, lists the latest federal jobs websites and offers tips for mastering online applications.

Reconceiving the Gene: Seymour Benzer’s Adventures in Phage Genetics
by the late Frederic L. Holmes, Ph.D., the Avalon Professor of the History of Medicine and chair of the Section of the History of Medicine, and edited by William C. Summers, M.D., Ph.D., professor of therapeutic radiology and of molecular biophysics and biochemistry (Yale University Press) More than any other individual, biologist Seymour Benzer is considered to have led geneticists from the classical gene into the molecular age. Drawing on Benzer’s record of his experiments, correspondence and published sources, this book reconstructs how the former physicist initiated his work in phage biology and achieved his landmark investigation.

Nuclear Cardiology, the Basics: How to Set Up and Maintain a Laboratory
by Frans J.Th. Wackers, M.D., Ph.D., professor of diagnostic radiology and medicine, Wendy Bruni, and Barry L. Zaret, M.D., the Robert W. Berliner Professor of Medicine and professor of diagnostic radiology (Humana Press) This guide offers a concise, action-oriented plan for solving the many practical and technical problems involved in establishing and running a nuclear cardiology lab. The authors answer basic questions about purchasing equipment and determining space requirements.

Rewards for Kids! Ready-to-Use Charts & Activities for Positive Parenting
by Virginia M. Shiller, Ph.D., lecturer in the Child Study Center, and Meg F. Schneider (Magination Press) This book shows how to motivate children to improve their behavior and fulfill their responsibilities, using a variety of child-friendly sticker charts and other tools. The authors teach parents positive techniques for helping children to overcome such common behavior problems as bedtime procrastination and fighting with siblings.

The descriptions are based on information from the publishers.

Send notices of new books by alumni and faculty to Cheryl Violante, Yale Medicine, P.O. Box 7612, New Haven, CT 06519-0612, or via e-mail to cheryl.violante@yale.edu.

In circulation

Consortium seeks to boost minority presence in health information professions

A senior at Hill Regional Career Magnet High School in New Haven, Jordon Thomas was impressed when he first set foot in the Cushing/ Whitney Medical Library last summer. “I didn’t know there were so many resources that were right in front of me,” said Thomas, who attended a science program sponsored by the School of Medicine.

Thomas is just the type of student that Charles J. Greenberg, M.L.S., M.Ed., coordinator of medical library curriculum and research support, would like to attract to the health sciences information professions: a college-bound minority student who might consider becoming a medical librarian or health information specialist. (As it turns out, Thomas, who is African-American, plans to be a pharmacist.) Greenberg is the project coordinator for a newly formed consortium of eight university medical libraries that is trying to interest minority students in careers in medical librarianship. Nancy K. Roderer, M.L.S., former director (1992-1999) of Yale’s medical library and now director of the William H. Welch Medical Library at Johns Hopkins, is the principal investigator. Funded with a three-year, $640,000 matching grant from the federal Institute of Museum and Library Services, the group comprises Yale, Georgetown University, Houston Academy of Medicine, Howard University, the University of Colorado at Denver, Johns Hopkins University, the University of Tennessee and Washington University in St. Louis. Currently, 9 percent of medical librarians are members of minority groups.

The effort to interest minority students is part of a broader attempt to recruit health care professionals who reflect the ethnic and racial diversity of their patients. “Health care providers are very concerned with cultural competence,” said Greenberg. “We want to become part of that mosaic of health careers.” The medical librarianship project is just in the planning stage, but libraries in the group plan to sponsor tours, internships and other outreach programs.

The group’s task in part is to replace the image of a dowdy librarian with a more up-to-date view of a computer-savvy “information specialist.”

Yale’s medical library has been “at the forefront of the university’s partnerships with the New Haven public schools,” said Claudia R. Merson, director of public school partnerships at the Office of New Haven and State Affairs. For instance, Yale medical librarians taught Internet skills to Career High School teachers and administrators in the mid-1990s. “This is another opportunity,” said Merson. “There’s been so much exposure to health professions, but librarianship has not been one of them. It’s new and exciting, and it looks like it’s going to be cool.”

The project’s website is http://www.bioinfo-career.org/.

—Cathy Shufro



Carlton		Folkman



El-Hai		Mutombo

On campus

Emergency care in the wake of Katrina

If there was a good news story about Hurricane Katrina, it was the medical response to the disaster, said Paul K. Carlton Jr., M.D., director of the Office of Homeland Security of the Texas A&M University System Health Science Center. Speaking at the Yale New Haven International Congress on Disaster Medicine and Emergency Management in September, Carlton described how emergency “surge” hospitals mobilized to handle thousands of patients in Baton Rouge.

“Your worst nightmare is to lose an entire medical network, and that is what happened in Katrina,” said Carlton, a proponent of the surge concept, in which hospitals expand facilities or open new ones in emergencies. Within days, he said, health and disaster teams had set up four surge hospitals in Baton Rouge, including one at a former Kmart store that had been closed for 10 years. “It was filthy,” Carlton said. Crews found portable air-conditioning units, got power to the building, bought portable toilets and converted the big-box store into a 1,000-bed hospital.

Driving the medical teams, Carlton said, was a basic principle: “We will not break trust with our patients.”

—John Curtis

Bright future for a roller-coaster compound?

In 1998, Endostatin, a protein that inhibits blood vessel growth, was touted as a silver bullet for cancer after tests in mice showed it killed tumors by cutting off their blood supply. But six years later, the future looked bleak: Fortune magazine said the angiogenesis inhibitor “failed dramatically” in clinical trials, and EntreMed, a Maryland biotech company, abandoned the drug in 2004 after flirting with bankruptcy.

But Endostatin is not dead yet, according to its creator, Judah Folkman, M.D., who spoke at Yale in October. Folkman, a Harvard researcher, said both reports exaggerated the reality. His work led to FDA approval in 2004 of another angiogenesis drug, Avastin, which is expected to reach $6 billion in sales and may become the largest-selling anticancer drug in history.

Three weeks before Folkman’s Yale talk, China approved an Endostatin product developed and tested by the Chinese biotech company Medgenn. A trial involving 493 late-stage lung cancer patients showed that its Endostar drug was effective, doubling survival time from three to six months when combined with chemotherapy. Folkman hopes the Chinese findings will revive the future of Endostatin in the American market. “It’s had a tough life,” he said, “but it’s been resuscitated.”

—Michael Fitzsousa

A pioneering lobotomist’s mixed legacy

When he began his biography of Walter J. Freeman, M.D., a Yale College graduate who pioneered lobotomy in the United States, journalist Jack El-Hai expected he would be writing about “a monster.”

The truth was more complicated, said El-Hai, author of The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness, speaking at a master’s tea at Yale in November. Psychiatrists embraced the crude surgery that severed neural pathways between the frontal lobes and the thalamus, El-Hai argued, because until the advent of Thorazine in 1954 they had few effective treatments for psychiatric illnesses. “They were willing to try something experimental, something desperate. ... because at least it held out some hope,” said El-Hai.

From 1936 to 1967 roughly 40,000 patients underwent lobotomies nationwide, for conditions ranging from depression to schizophrenia. Freeman did 3,400 of them, including one on a sister of John F. Kennedy. Some patients felt better, some became disabled and 2 percent died.

Freeman, El-Hai noted, “was one of the few advocates of a biological orientation for psychiatry. That is his most positive legacy today, if you can find one.”

—Cathy Shufro

NBA star makes a giant impact in his African homeland

As he walked through campus last September, Dikembe Mutombo, all-star center for the Houston Rockets, cut a somewhat startling figure. With an impeccably tailored deep-blue suit draped over his 7-foot, 2-inch frame, Mutombo towered over his hosts like a grade-school teacher minding charges on a field trip.

He came to Yale at the invitation of Anup Patel, a second-year medical student who had heard of the Dikembe Mutombo Foundation’s humanitarian work in Mutombo’s native Democratic Republic of Congo (DRC). Mutombo contributed $10 million for the construction of a 300-bed hospital in the capital of Kinshasa, which will open in June to provide care to the city’s poorest residents and to train its health professionals. Yale and the foundation are considering a partnership that would provide opportunities for medical students to travel to the DRC for clinical clerkships.

“I grew up poor and I never forgot where I came from,” said Mutombo, in an address at Battell Chapel. ”If I was going to do something that will carry my legacy, I wanted to make sure it was very good, that it will stop the suffering, that it will help the people that don’t have a chance to go on a plane to go to South Africa or Europe to get treatment.”

—Peter Farley


			Originally published in Yale Medicine, Spring 2006. Copyright © 2006 Yale University School of Medicine. All rights reserved.