Thought Control and Halacha, Part 1

Several weeks ago I received an email asking about the intersection of psychology and halacha with regard to mandated and proscribed thought. How far does the Torah go in prohibiting certain thoughts, and is such a thing even possible? The following discussion is neither exhaustive nor halachic, but it presents the topic as it has occurred to me as I have thought about the question.

Categories of Thought

There are several levels of halachically categorized thought. 

On the most sustained level, there is belief, about which we have mitzvot such as the 1st dibrah (commandment, i.e., "I am the Eternal, your G-d...") and the Rambam's ikarim (Maimonedes' 13 principals of faith). (See also Ramchal's Daat Tevonot for a much longer discussion and the Shaar HaYichud VeHaemuna from the Tanya). Those fundamental mitzvot of faith point to the centrality of thought as a means of individuals' fulfilling a purpose of creation, Kevod Shamayim, and generally bringing about the universal, eschatological object of Yichud Hashem (the revelation of G-d's Unity), along the lines of "Umalah haaretz daat et Hashem." 

The Torah also relates halachically to certain attitudes such as the kavod and yir'ah (honor and awe) required toward parents, the ahava (love) required toward one's fellow and, in particular, converts, and the hatred that one is prohibited from harboring "in [his or her] heart." I refer to them as attitudes rather than feelings because they are more cognitive than the mitzvot of affect such as "vesamachata bechagecha" (rejoicing on the holiday) and mourning for a loved one or for the Temple. However, those two categories are alike in that while the mitzot in both are, in essence, internal and abstract, they are given behavioral parameters. For example, honoring one's parents involves doing things to help them and having awe means not doing things such as sitting in their seats. Similarly, having joy on the holidays entails eating meat and drinking wine.

A more delimited form of thought is remembering. In the context of mitzvot, this is operationalized as active recollection, or self-reminding, as opposed to the passive state of not having forgotten that pertains, for instance, to the validity of a witness' testimony. Examples of this include the 6 remembrances mentioned in the Torah and typically found in siddurim at the end of the Shacharit service. These include remembering: (a) the Exodus Egypt (Deut 6:3); (b) the incident of the golden calf (Deut 9:7); (c) the giving of the Torah at Sinai (Deut 4:9- 10); (d) the Sabbath (Exodus 20:8); (e) the attack of Amalek (Deut 25:17-19); and (f) Miriam's tzaraat (Deut 24:9, Numbers 12:10).

A, perhaps, more involved form of thought is referred to by chazal (the early rabbis) as hirhur, or contemplation. This involves actively considering a matter to the point that the endeavor takes on some of the behavioral properties of speech, with various ramifications. Thus, for example, there are opinions that hirhur is "ke'dibur" (serves as speech) in the context of learning Torah (with implications for reciting a blessing beforehand) counting the omer, and reciting the Shema, among others. This term is also applied to fantasizing about illicit acts, as will be discussed below. In the context of Shabbat, where discussion of mundane matters is prohibited, there is an explicit drasha (hermeneutical derivation) that permits mundane hirhur. 

Two forms of intent have relevance in the context of particular actions that they accompany. These are kavanah (mindfulness), and daat (consent). Kavanah is a form of intentionality that qualitatively shapes a person's fulfillment of a mitzvah. Certain mitzvot are more dependent on, or sensitive to, kavanah than others. Typically, action-based mitzvot can be fulfilled without the requisite kavanah, although doing so is less than ideal. (The particulars of this rule are the subject of lengthy halachic discussions that are beyond the present scope). Tefilah (prayer), on the other hand requires a certain minimal level of kavanah in order to have meaning. (See the first piece in Rav Haim Solovietchik's Chiddushei Rav Chaim al HaRambam). In addition, "negative" kavanah can prevent an act from constituting the fulfillment of a mitzvah in situations where the individual explicitly intends for it not to be. 

Musical Beat Enhances Visual Comprehension

New research finds a link between musical rhythm and visual processing, and offers a tantalizing clue to the art form’s origins.

By Tom Jacobs, Miller-McCune.com

The origins of music are, necessarily, speculative. Charles Darwin guessed it grew out of courtship rituals, which would explain the continuing popularity of love songs. But a more recent school of thought suggests it emerged to enhance group cooperation and synchronization.

As neuroscientist Steven Brown put it, “Music is a powerful device for promoting group identity, cognition, coordination and catharsis.” All of which would come in handy when a party of prehistoric humans headed out in search of food or when one tribe was threatened by another.

Indirect support for this thesis is provided in a study just published in the journal Acta Psychologica. In it, a research team led by psychologist Nicolas Escoffier of the National University of Singapore provides evidence that a musical beat “both synchronizes and facilitates concurrent stimulus processing.”

Their research suggests rhythm (say, in the form of a drum beat, which continues to play a role in military rituals) helps you to quickly understand what it is you’re looking at. This could save your life if you spot a shape that could be either a lion or a rock, and its advantages multiply if you and your hunting partners come to such crucial realizations simultaneously.

Escoffier and his colleagues recruited 36 undergraduates (all of Chinese ancestry) to participate in a visual discrimination test. They were shown a series of photographs — half featuring faces, the other half houses — and instructed to indicate as quickly as possible (by pressing one of two buttons) whether an image was right side up or upside down.

They were told to ignore the music playing in the background, but those sounds were in fact the key to the experiment. For one-third of the test, the appearance of the images was synchronized with the beat. For another third, the images were shown out of sync with the music. The other third were shown in silence.

The results: The students responded faster when there was music playing, and still faster when the appearance of a new image matched the beat of the music. They were able to identify the direction of the faces more rapidly than that of the houses in all three conditions, but the same ratio held: Their swiftest reactions took place when the musical rhythm and the change in image were in sync. (The accuracy rate was around 95 percent for all three conditions; what varied was the speed of the realization.)

Why would hearing music affect visual processing? Escoffier and his colleagues suggest two possible processes. Auditory rhythms have been shown to enhance physiological arousal, which could lead to heightened attention. Alternatively, an insistent rhythm may trigger “changes in attention allocation policies,” alerting the brain to focus its limited resources on the matter at hand.

Either way, “musical rhythm appears to be a powerful modulator of human cognitive processes, enhancing their efficiency and allowing synchronization across a group of individuals,” they conclude. “Through this synchronization, individuals collectively experience their environment and are able to feel, think, and act as one.”

Thus the thrill of sitting in a concert hall and engaging in a mass brain-bond with Beethoven or Bono. To paraphrase George and Ira Gershwin: I got rhythm/And clear vision/We’re all in sync/Who could ask for anything more?

When Insurance Companies Go Cold Turkey on Rehab Coverage

Typical treatment for heroin addiction requires 90 days of inpatient care. Yet, insurance companies routinely claim that addicts seeking to get clean are "healthy" enough for shorter stays or outpatient treatment. When patients get dumped before they're ready, the results can be tragic.

Selfish Frumkeit

Daas Torah blog
Rav Wolbe, Alei Shur, vol. 2: On the narrow path to Truth in serving G‑d there is a major impediment which is called “frumkeit” (religiosity) – a term which has no clear and exact translation. “Frumkeit is the natural urge and instinct to become attached to the Creator. This instinct is also found amongst animals. Dovid said, “The lion cubs roar for their prey and ask G‑d for their food” (Tehilim 104:21). “He gives to the beast his food and to the young ravens who call to Him” (Tehilim 247:9). There is no necessity why these verses should be understood as metaphors [and therefore they will be read according to their literal meaning]. Animals have an instinctive feeling that there is someone who is concerned that they have food and this is the same instinct that works in man – but obviously at a higher level. This natural frumkeit helps us in serving G‑d. Without this natural assistance, serving G‑d would be much more difficult.

However this frumkeit, as in all instinctive urges that occur in man, is inherently egoistic and self-centered. Therefore frumkeit pushes man to do only that which is good for himself. Activities between people and actions which are done without ulterior motivations are not derived from frumkeit. One who bases his service of G-d entirely on frumkeit remains self-centered. Even if a person places many pious restrictions on himself – he will never become a kind person and he will never reach the level of being pure motivated. This is why it is necessary that we base our service of G-d on commonsense (da’as). (Study Sotah 22b lists 7 types of activities which it labels as foolish piety. Each one of them is a manifestation of frumkeit without commonsense). Commonsense has to direct our service of G-d. From the moment we desert commonsense and act only according to frumkeit, our Divine service becomes corrupted. This is true even for a person on the level of a Torah scholar. [...]

Temptation and Fidelity: Research on Protecting Relationshps

New York Times
Why do some men and women cheat on their partners while others resist the temptation?

To find the answer, a growing body of research is focusing on the science of commitment. Scientists are studying everything from the biological factors that seem to influence marital stability to a person’s psychological response after flirting with a stranger.

Their findings suggest that while some people may be naturally more resistant to temptation, men and women can also train themselves to protect their relationships and raise their feelings of commitment.
Read more...

Inside the Mind of a Pedophile

By Michael Cochran & Meghan Cole, Neuroanthropology.net

Most people imagine pedophiles as ugly old men dressed in trench coats, hiding in the bushes, waiting to snatch young children off the street. However, recent television shows, such as To Catch a Predator, have exposed pedophiles as local neighbors, trusted friends, clergy, babysitters, teachers, and even family members.

Conceptions about pedophiles have been changing rapidly, and pedophilia has recently become a topic of increased awareness and concern. Not only do television shows expose pedophiles, but there are new sexual offender disclosure laws, websites that track convicted sexual offenders, and more investigations of pedophilia, especially after the sex abuse scandal in the Catholic Church. Yet children still remain vulnerable to sexual offenders regardless of their public façade.

The increasing attention on pedophilia has caused many Americans to question what this disorder entails, its characteristics, and what type of treatment should be sought for abusers. What is pedophilia? Do people choose to be pedophiles or are they born that way? This post will address these questions.

Pedophilia

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines pedophiliaas recurrent sexually arousing fantasies, impulsive desires, or behaviors involving sexual acts with a child and that occur over a period of at least six months. In most cases, the pedophile is at least sixteen years of age and at least five years older than the child. Those who suffer from pedophilia have a compulsion to abuse young children.

Categorizing Pedophiles

Pedophiles can be classified in several ways. Pedophilia can be characterized as either exclusive or non-exclusive. Exclusive pedophiles are attracted only to children. They show no interest in sexual partners who are not prepubescent children. This desire prolongs even when they are not in the presence of children. Non-exclusive pedophiles are attracted to both adults and children. A large percentage of male pedophiles are homosexual or bisexual in orientation to children, meaning they are attracted to male children or both male and female children (Schiffer, 2008).

Many people assume that only males are pedophiles. However, case studies on pedophilia have demonstrated that female pedophilia does exist (Chow, 2002). Although this is a rare phenomenon, females who meet the DSM-IV criteria for pedophiles display similar cognitive distortions to that of males, such as irrational thoughts. Some differences, however, do exist among males and females. Females who exhibit pedophilia tend to suffer from psychiatric disorders or substance abuse problems. Also, there is a higher correlation between sexual abuses as a child with females compared to males.

What Causes Pedophilia?

The etiology of pedophilia can be attributed to both biological and environmental factors. Case studies indicate that cerebral dysfunction may be a contributing or dominant factor of pedophilia (Scott, 1984), including problems with self-control, extreme urges, and cognitive distortions. Many experts also believe that disorders for sexual preferences emerge from childhood experiences during critical periods in human development (DiChristina, 2009). In many cases, child sex abusers suffer from traumatic experiences during their childhood.

More specifically, pedophiles tend to also have been molested as children. As children, they lacked the ability to control the situation. By sexually assaulting children, pedophiles attempt to re-live the trauma they experienced and they learn how to master it. A complete role reversal gives them the upper hand and prevents them from being victimized. Overall, through the impact of cerebral dysfunction and traumatic development, the sexual urges and desires for children can become ingrained within a person’s nervous system.

Role of the Brain

There is significant evidence that indicate structural abnormalities in the brains of pedophiles (Schiffer, 2008). Abnormalities occur when the brain is developing and can be on-set through certain experiences, such as sexual abuse as a child. Abnormalities in the brains of pedophiles may result in compulsion, poor judgment, and repetitive thoughts.

These abnormalities in the brains of pedophiles are caused by early neurodevelopmental perturbations (Schiffer, 2008). The use of functional magnetic resonance imaging (fMRIs) and positron emission tomography scans (PET) has revealed that the abnormalities of pedophiles exhibit appear in the frontal and central regions of the brain. In particular, there is a decreased volume of gray brain matter in the central striatum. As a result, the nucleus accumbens, orbital frontal cortex, and the cerebellum are all affected (Schiffer, 2008).

These areas of the brain play an important role in addictive behavior. The accumbens is the central mediator of reward signaling and expectation. The striatum and orbito frontal cortex control this reward system. As a result, this contributes to the etiology of pedophilia because a reward deficiency complication disturbs the neurotransmission of dopamine involved in compulsive and addictive behaviors.

Due to the frontotemporal dysfunctions, pedophilia shares neural characteristics with psychiatric disorders that fall in the range of the obsessive-compulsive (OC) spectrum. These impulsive disorders include pathological gambling, kleptomania, and even Tourettes syndrome. While some debate this claim (Schiffer et al., 2007), there is substantial evidence for the existence of physiological and genetic overlaps. In particular, studies have shown that alterations in the frontostriatal circuitry are a major abnormality leading to obsessive-compulsive behavior. Pedophiles tend to act inappropriately and exhibit poor judgment because they lack the ability to control their impulses.

These structural alterations underlie the antisocial behaviors exhibited by someone with pedophilia. Pedophiles are burdened with repetitive thoughts and urges. Consequently, they seek to fulfill these desires through behavior that is socially unacceptable and at times, even illegal. Most pedophiles express shame and guilt after partaking in their immoral behavior because their neurological dysfunctions deal strictly with urges and not emotions (Schiffer et al., 2007).

Is There a Cure?

Pedophilia, like many types of disturbances or diseases, does not have a complete cure. The sexual urges associated with pedophilia may never permanently disappear, and a person’s sexual preference and orientation can be difficult to completely re-orient. At present, treatment primarily focuses on preventing further offenses rather than changing sexual orientation.

Yuli Grebchenko, MD, has done extensive research on pedophiles. He noted that pedophilia is a life-long disorder and stated that, “It needs lifelong treatment” (Lamberg, 2005). Recent studies have demonstrated that psychotherapy and pharmacotherapy can be combined to bring about the most effective treatment to someone suffering from pedophilia (Kersebaum, 2007).

Therapy includes discussing traumatic events, especially those from the childhood of an abuser. Therapy also seeks to help patients identify situations that may tempt them to engage in harmful behaviors toward children. During therapeutic treatment, therapists may try to correct a patient’s cognitive disorder, which may include misperceptions that the child enjoyed the abuse.

The three standard pharmacotherapy treatments for pedophilia are selective serotonin reuptake inhibitors (SSRI), luteinizing hormone-releasing hormone (LHRH), and leuprolide acetate (LA) (Briken, 2003). These pharmacotherapy treatments target certain hormones and chemicals in the body, but have varying side effects. SSRIs are effective in less severe cases and patients often experience only sexual side effects (Kraus, 2007). In more serious cases, LA can reduce testosterone to extremely low levels along with pedophilic urges. While LA treatment is somewhat dangerous, it has been found to be very effective (Schober, 2005). The newest treatment drug, LHRH, reduces neural responsiveness to visual sexual stimuli and has very little side effects (Briken, 2003).

Today’s World

Most people are in denial that pedophilia exists in their community or home. Pedophiles, however, will go to great lengths to continue their compulsive behavior. They will volunteer in church youth groups, coach youth athletic teams, and find other ways to associate with potential victims. Many times, they place themselves in positions where they can easily meet children.

The Internet has become a common hunting ground to prey on children. Today more and more kids are using Facebook accounts. While Facebook acts as a social network to help link people together, the ability to create a profile displaying one’s personal information may indirectly be helping pedophiles find their next victim. Pedophiles can then befriend children and manipulate, trap, and lure their victims into a false sense of trust. Some pedophiles may pretend they are someone else, such as a classmate. Others develop friendship with children and then arrange meeting times and places so they can act upon and fulfill their sexual desires (Deirmenjian, 2009).

The Catholic Church frowns upon certain sexual behavior. Yet, priests were recently discovered to have engaged in sexual behavior with children. A great deal of hypocrisy surrounds the sex abuse scandal in the Catholic Church. Over the course of the past two decades, the Church has struggled with confronting sex crimes committed by Catholic priests and religious orders against children. In many cases, the clergy suffered from pedophilia. These priests sexually abused minors, primarily male altar servers, and exerted power over these boys.

The children who fell victim to the clergy were easily accessible, vulnerable, and unthreatening. These priests who engaged in sexual behavior with youth should be held responsible for their actions. The Church should come forward and acknowledge this type of inappropriate behavior. They should take the proper steps to correct this type behavior and have their pedophilic priests seek treatment for their disorder.

Conclusion

Pedophilia is a complex disorder with many underlying factors. These range from dysfunctions in the development of the brain to particular traumatic experiences, such as sexual abuse or rape as a child. Despite no cure for pedophilia, measures can be taken to help people with this disorder control their urges and behavior. Society needs to be more aware of this disorder and its prevalence in everyday life. So while not all people who engage with children are pedophiles, the prominence of pedophiles across many facets of life is much greater than we think.

Works Cited

Briken, P. “Pharmacotherapy of Paraphilias with Long-Acting Agonists of Luteinizing Hormone-Releasing Hormone.” Journal of Clinical Psychiatry 64.8 (2003): 890-7.

Chow, Eva W. C. “Clinical Characteristics and Treatment Response to SSRI in a Female Pedophile.” Archives of Sexual Behavior 31.2 (2002): 211-5.

Deirmenjian, JM. “Pedophilia on the Internet.” Journal of Forensic Sciences, 47.5 (2002): 1090-1092.

DiChristina, Mariette. “Abnormal Attraction.” Scientific American Mind, 20.3 (2009): 76-81.

Kersebaum, Sabine. “Correcting Pedophilia.” Scientific American Mind 18.1 (2007): 62-.

Kraus, C. “Selective Serotonine Reuptake Inhibitors (SSRI) in the Treatment of Paraphilia – A Retrospective Study.” Fortschritte Der Neurologie Psychiatrie 75.6 (2007): 351-6.

Lamberg, Lynne. “Researchers Seek Roots of Pedophilia.” JAMA, the Journal of the American Medical Association, 294.5 (2005): 546.

Schiffer, Boris. “Reduced Neuronal Responsiveness to Visual Sexual Stimuli in a Pedophile Treated with a Long-Acting LH-RH Agonist.” 6.3 (2009): 892-4.

Schiffer, Boris. “Brain Response to Visual Sexual Stimuli in Homosexual Pedophiles.” Journal of Psychiatry and Neuroscience 33.1 (2008): 23.

Schiffer, Boris et al. “Structural Brain Abnormalities in the Frontostriatal System and Cerebellum in Pedophilia.” Journal of psychiatric research 41.9 (2007): 753-62.

Scott, Monte, James Cole, Stephen McKay, Kenneth Liggett, and Charles Golden. “Neuropsychological Performance of Sexual Assaulters and Pedophiles.” Journal of Forensic Sciences, 29.4 (1984): 1114.

Schober, Justine M. “{L}Euprolide Acetate Suppresses Pedophilic Urges and Arousability.” Archives of Sexual Behavior 34.6 (2005): 691-705. Web.

Fighting Over Mental Health Parity

New York Times-

A huge fight has erupted over rules issued by the Obama administration to enforce a 2008 law that requires equal insurance coverage for the treatment of mental and physical illnesses.

The fight offers a taste of the coming battle over rules to remake the health care system under legislation pushed through Congress by President Obama.

Insurance companies and employer groups are lobbying the White House to delay and rework the rules on “mental health parity.” Insurers and many employers supported the 2008 law, but they say the rules go far beyond the intent of Congress and would cripple their cost-control techniques while raising out-of-pocket costs for some patients.

Advocates for patients generally support the rules, saying they will eliminate many forms of insurance discrimination against people with mental illness. The rules are also supported by the American Medical Association, the American Psychiatric Association and House Democrats, most notably Representative Patrick J. Kennedy of Rhode Island.

The goal of the law is to abolish discriminatory insurance practices frequently applied to coverage for the treatment of mental health disorders and substance abuse. Under the law, insurers cannot set higher co-payments and deductibles or stricter limits on mental health benefits than they set for the treatment of physical illnesses like cancer and diabetes. For decades, such disparities have been common.

Insurers and employers agree that the law prohibits them from setting numerical limits on hospital inpatient days and outpatient visits for mental health services if they do not impose such limits on other types of medical care.

But insurers say the Obama administration went overboard when it tried to regulate “nonquantitative treatment limits.” These include the techniques used by insurers to manage care, the criteria for selection of health care providers and the rates at which they are paid.

The Blue Cross and Blue Shield Association, Aetna and other insurers have urged the federal government to drop this aspect of the rules. The purpose of the law was to ensure parity in benefits for patients, not “parity in provider reimbursement,” said Justine Handelman, executive director of the Blue Cross and Blue Shield Association.

But Carol A. McDaid, a lobbyist for a coalition of mental health advocates, said, “Patients are not getting access to mental health care because many insurers are not paying enough to cover the cost of services.”

This may have three consequences for patients and their families, advocates say. Patients may be unable to find mental health experts in their health plan’s network of providers. If they go outside the network, they typically pay more. And if they cannot afford it, they may not receive treatment at all.

The American Psychiatric Association said that nonquantitative treatment limits, though less visible than limits on the number of doctor visits or hospital days, could be more insidious.

Dr. James H. Scully Jr., chief executive of the association, said some insurers had tried to “circumvent the law” by “imposing new requirements for prior authorization and the submission of treatment plans for mental health services where there were no comparable requirements on the medical-surgical side.”

Insurers strenuously object to one provision of the rules that requires them to maintain a single deductible for all medical and mental health services combined. This is a significant departure from the industry’s current practice of separate deductibles.

As a result of the change, insurers say, many mental health patients will face higher out-of-pocket costs because the combined deductible will almost surely be higher than the current one for mental health services alone.

But in a letter to the administration last week, leading House Democrats said Mr. Obama was right to prohibit separate deductibles. The law, they said, was adopted to end such inappropriate distinctions between medical and mental health care services.

A number of companies like Aetna, Magellan Health Services and ValueOptions specialize in managing mental health benefits.

In issuing the new rules, the Obama administration praised the work of such companies, saying they increased the use of mental health care while holding down costs.

But Pamela B. Greenberg, president of the Association for Behavioral Health and Wellness, which represents these companies, said the new rules would “hamstring” their ability to use the tools that have proved effective in managing mental health benefits.

In a suit over the rules, Magellan and other companies said the concept of nonquantitative limits was “boundless and ill defined” and would reach virtually every policy and procedure used to manage mental health benefits.

One premise of the law is that mental illnesses often have a biological basis and can be treated as effectively as many physical ailments. But insurers say it is impossible to use the same techniques in managing the treatment of colon cancer and schizophrenia, or heart failure and major depression.

Being Six and Schizophrenic

 

LA Times
It's been a rough week. A few days ago, at UCLA's Resnick Neuropsychiatric Hospital, 6-year-old Jani toppled a food cart and was confined to her room. She slammed her head against the floor, opening a bloody cut that sent her into hysterics. Later, she kicked the hospital therapy dog.


Jani normally likes animals. But most of her animal friends -- cats, rats, dogs and birds -- are phantoms that only she can see. January Schofield has schizophrenia. Potent psychiatric drugs -- in doses that would stagger most adults -- seem to skip off her. She is among the rarest of the rare: a child seemingly born mentally ill.


She suffers from delusions, hallucinations and paroxysms of rage so severe that not even her parents feel safe. She's threatened to climb into an oven. She's kicked and tried to bite her little brother. "I'm Jani, and I have a cat named Emily 54," she says, by way of introduction. "And I'm Saturn-the-Rat's baby sitter."


She locks her fingers in front of her chest and flexes her wrists furiously, a tic that surfaces when she's anxious.


She announces that she wants to be a veterinarian.


"I'm empathetic with rats," she says.


Asked what "empathetic" means, she smiles confidently. "It means you like rats."


The doctors have been trying a new antipsychotic medication, called Moban. Jani knows she is sick and that people want to help her.


"Is the Moban working?" her mother asks Jani during a visit.


"No. I have more friends."


Susan Schofield looks crestfallen.


She and her husband, Michael Schofield, have brought French fries. Jani takes a bite, runs around the room and circles back for another bite.


"You want the rats and cats to go away, don't you?" Susan asks, trying to make eye contact with her daughter.


Jani stuffs a French fry into her mouth.


"No," she says. "They're cool. Rats are cool."


--

About 1% of adults have schizophrenia; most become ill in their late teens or 20s. Approximately one in 10 will commit suicide.


Doctors and other mental health experts don't fully understand the disease, which has no cure. Jani's extreme early onset has left them almost helpless. The rate of onset in children 13 and under is about one in 30,000 to 50,000. In a national study of 110 children, only one was diagnosed as young as age 6.


"Child-onset schizophrenia is 20 to 30 times more severe than adult-onset schizophrenia," says Dr. Nitin Gogtay, a neurologist at the National Institute of Mental Health who helps direct the children's study, the largest such study in the world on the illness.


"Ninety-five percent of the time they are awake these kids are actively hallucinating," Gogtay says. "I don't think I've seen anything more devastating in all of medicine."


For Jani's parents, the most pressing issue is where Jani should live. She has been on the UCLA psych ward -- where she was placed during an emergency -- since Jan. 16. The ward is not designed for long-term care.


Jani can't return to her family's apartment in Valencia. Last fall, she tried to jump out of a second-story window.


Her parents -- Michael, a college English instructor, and Susan, a former radio traffic reporter -- must decide how to provide as much stability as possible for their daughter while also trying to protect their 18-month-old son.


"If Jani was 16, there would be resources," Michael says. "But very few hospitals, private or public, will take a 6-year-old."


Born Aug. 8, 2002, Jani was different from the start, sleeping fitfully for only about four hours a day. Most infants sleep 14 to 16 hours a day. Only constant, high-energy stimulation kept Jani from screaming.


"For the first 18 months, we would take her to malls, play areas, IKEA, anywhere we could find crowds," says Michael, 33. "It was impossible to overstimulate her. We would leave at 8 in the morning and be gone for 14 hours. We could not come home until Jani had been worn out enough so that she would sleep a couple of hours."


When Jani turned 3, her tantrums escalated. She lasted three weeks in one preschool and one week in another. She demanded to be called by different names; Rainbow one day, Blue-eyed Tree Frog the next. Make-believe friends filled her days -- mostly rats and cats and, sometimes, little girls.


She threw her shoes at people when angry and tried to push the car out of gear while Michael was driving. The usual disciplinary strategies parents use to teach their young children proper behavior -- time-outs, rules, positive rewards -- failed time and again for the Schofields.


"She would go into these rages where she would scream, hit, kick, scratch and bite. She could say, 'Mommy, I love you,' and seconds later switch into being really violent," Michael says.


Kindergarten lasted one week.


The Schofields consulted doctors and heard myriad opinions: bipolar disorder, attention-deficit hyperactivity disorder, ineffective parenting. No one considered schizophrenia.


In December 2007, they were referred to Dr. Linda Woodall, a psychiatrist in Glendale. Jani's medical records for the following year depict a doctor searching for effective medications while her patient slid further into a world stalked by rats and cats.


July 8, 2008: Claps hands, hops (tic-like); food can't touch; strips clothes off if she thinks they have a spot. Wants order and perfection in play, toys, stories.


Nov. 11, 2008: Talking to a "bird named 34" on her hand. Drawing on her clothes and body with permanent marker. Screaming at school and in the waiting room.


Jan. 7, 2009: Patient is psychotic; talking to rats naming them the days of the week . . . I believe it would be in the best interests of January and her family to have her placed in residential treatment. 


Continued...