Speaking in the Third Person, Removed From Reality

Almost from the moment he walked into my office, something bothered me about my 18-year-old patient, Mark, sent to see me by his parents after they found marijuana and steroids in his bedroom.

He was tall and muscular, with tousled, dirty-blonde hair, outfitted in a faded T-shirt emblazoned with the words "Sunset Strip," distressed jeans made to look threadbare at midthigh and along the edges of the pockets and a 70's retro leather choker with a few clay beads on it.

A shiny silver bolt pierced his left brow. He shook my hand and introduced himself with a smile, then sat down in the suede armchair opposite me, his legs outstretched, his ankles crossed.

"So tell me what's going on," I said.

"I'm in a serious jam, man," he said. "I think I need rehab to get my life back. You know?"

He didn't sound upset about it.

"What have you lost?" I asked him.

"Got two weeks?" He chuckled.

"I'm listening."

"I don't know if I ought to head to rehab or really go deep into analysis with you or what," he said. "Or maybe we just go the Prozac route."

"You think you're depressed?" I asked.

"Hard to say."

He shrugged. "I'm kind of like the quiet guy who goes to the gym, you know, keeps to himself, maybe hooks up with a girl here and there, but doesn't make a big deal of it. He's, like, sort of on the outside looking in, never letting anything get him too down."

Mark's lapse into the third person - "He's ... on the outside, looking in" - helped me realize what had disturbed me about him from the start.

He seemed fake, as if playing a role. He showed no anxiety or sadness or anger. He spoke in clichés. I'm in a ... jam. I need ... to get my life back. Got two weeks?

His hair looked intentionally messy. Everything about him, down to his carefully chosen, probably pricey, "worn out" clothing felt scripted.

I have treated several other teenagers this year who display a similar kind of profound detachment from self.

It is a kind of identity disorder I believe has its roots in a society that has drifted free from reality and is creating adolescents (and, I would venture, people of many ages) who are at most participant-observers in their own lives, with little genuine emotion - like actors playing themselves.

The signs and symptoms of this identity disorder are everywhere. Teenagers are embracing lies on a wholesale (and retail) scale.

They not only buy clothing made to look old when it is new, but they buy T-shirts emblazoned with logos from bars and bait shops and resorts they have never visited, and that sometimes don't exist at all.

More and more, they use illicit substances and alcohol to keep their genuine feelings at bay. They use steroids (and plastic surgery) to alter their appearances and athletic abilities. Their self-esteem floats ever higher, untethered even when their academic performance and family relationships and prospects for the future sink to new lows.

They pierce themselves and tattoo themselves and have sex more and earlier, in what I see as desperate efforts to anchor themselves to some sort of reality - the reality of the flesh.

If a teenager can feel a steel bolt through her tongue move whenever she speaks, at least she knows she inhabits her own body, even if she doubts her own soul.

If she can use low-cut jeans or a glimpse of thong underwear to attract glances from boys around her, at least she knows she occupies space and time at the center of their attention.

The soil for this detachment from self has been sown for decades, partly by psychiatry itself.

By not opposing vigorously enough the dangerous myth that psychoactive medications are a complete answer to depression and anxiety, we have allowed the idea to take root that we need not heed our emotions as evidence of life crises with real and crucial meaning, that we should turn off our inner voices and "listen to Prozac," instead.

The growth of technology has cleaved us from the reality of self, as well. We say that we are "going" places on the Internet without ever leaving the room.

In elaborate Internet-based games, people pay thousands of dollars to own "real estate" that isn't real at all.

We watch newscasters (who increasingly could double as models or comedians) report on terrible tragedies, then shift gears and joke about the weather or a baseball game. And we learn to mirror them, to respond to our own losses like channels we can change.

We can wage wars that kill tens of thousands of people with "smart" bombs. But we see little, if any, blood. And we can count the dead between episodes of our favorite sitcoms.

We sit still for a cloudy sense of whether our president was elected to his first term. Then the president in the television drama "West Wing" delivers a political statement about the war in Iraq, and people actually pay attention.

A senator appears as himself in the film "Traffic," in which Michael Douglas is the nation's drug czar. Unless Mr. Douglas really is ...

The trouble with all this is that the truth always wins. Reality will not be frustrated forever.

You have to pay back emotional debt, like the national debt, with interest. A crushing major depression lies in wait for Mark, if I fail to help him face whatever demons from the past drove him away from reality, to drugs.

Ever-increasing rates of substance abuse and attention-deficit disorder and depression lie in wait for adolescents emerging into adulthood. And, in not many decades, our nation's sense of itself will, inescapably, depend on theirs.

Lying Is Good For You
Lacey Rose, 10.24.05, 9:00 AM ET
http://www.forbes.com/2005/10/19/lying-dishonesty-psychology_cx_lr_comm05_1024lie.html

If I told you lying was good for you, you probably wouldn’t believe me. But trust me--I’m not lying.

Simply put, we lie because it works. When we do it well, we get what we want.

We lie to avoid awkwardness or punishment. We lie to maintain relationships and please others. And, of course, most of all we lie to please ourselves. Whether we’re embellishing our credentials or strengthening our stories, we often tell untruths to make ourselves appear and feel better.

What's more, we lie all the time. In 2002, Robert Feldman, a psychology professor at the University of Massachusetts at Amherst, conducted a study in which he secretly videotaped student’s conversations with strangers. After the fact, he had the students examine the videotapes and identify the untruths. On average, they claim to have told three lies per ten minutes of conversation.

And that number is likely far too low. First, we’re likely to underreport the number of lies we tell (we lie about lying, that is). And Feldman’s study only accounted for lies of the verbal variety, ignoring other deceptive behavior--misleading body language or facial expressions, for example.

In fact, we lie so readily that the dishonesty becomes automatic. Most of the time, we’re not even aware of the lies we tell, explains David Smith, director of the New England Institute at the University of New England and author of Why We Lie. He says we lie best when we don’t know we’re lying. “We don’t have the nervousness or broadcast the tell-tale signs of unease that the intentional liar can barely help,” he explains. “Self-deception is the handmaiden of deceit--in hiding the truth from ourselves, we’re able to hide it more fully from others.”

But why are we so dishonest so often? Isn’t honesty always the best policy? In fact, no. Nobody wants to hear that they look heavier or less attractive. In truth, we consider those who are too honest to be blunt, antisocial and even pathological. A recent study found that adolescents who are most popular with their peers were the ones that were the best at being deceptive.

And lying has proven psychological benefits. For instance, there’s scientific evidence showing that depressive people are more honest with themselves than nondepressive, or mentally healthy, people. When people recover from their depressions, they become less honest.

Strangely enough, despite the frequency with which we lie, we are pretty bad at it. Lying--at least the intentional kind--isn’t easy. “It takes more work to tell a lie than it does to tell the truth,” says Maureen O’Sullivan, professor of psychology at the University of San Francisco. “You have to not only make up something, but also watch me to make sure I’m believing you.”

But don't worry too much. People are easily fooled. “There is no Pinocchio’s nose,” explains Paul Ekman, professor emeritus of psychology at the University of California, San Francisco. “There’s no sign that is always present when someone lies and always absent when someone is truthful.” As a result, research shows that we’re only slightly better than chance level at detecting deception.

“Our default assumption is that people are telling the truth,” says Feldman. And often, we don’t actually want to hear the truth. If we hear what we want to hear, we accept it, true or not.

Take the example of evaluating a colleague’s work. When we ask a friend if we did a good job, we want the response to be yes, regardless of its legitimacy. Once we hear it, we’re unmotivated to probe further.

“So while we’d like to say we value honesty, we also value dishonesty,” says the University of New England’s Smith. After all, we’ve been taught the importance of lying from a very early age. The catch is, we don’t call it lying, we call it tact or social grace.

There is a great series of articles at:
http://www.forbes.com/technology/2005/10/18/communication-networks-language-cx_mn_de_comm05land.html

Scare Yourself Silly, but the Real Terrors Are at Your Feet

Just in time for Halloween, the usual yearly ritual of terror by headline is now playing itself out in medical offices everywhere. Last year it revolved around flu shots; a few years ago it was anthrax and smallpox; a few years before that it was the "flesh-eating bacteria"; and before that it was Ebola virus, and Lyme disease and so on back into the distant past. This year it's the avian flu.

"I was crossing Third Avenue yesterday and I was coughing so hard I had to stop and barely made it across," a patient told me last week. "I'm really scared I'm getting the avian flu."

I just looked at him. What could I say? He has smoked two packs of cigarettes a day for the last 50 years. He has coughed and wheezed and gasped his way across Third Avenue now for the last 10 years. His emphysema is not going to get any better, but it might stop getting worse if he were to stop smoking.

He made it clear long ago that this is not going to happen. When it comes to the whole cigarette/health question, his motto, apparently, is "What, me worry?"

But the avian flu - now there's a health scare a person can sink his teeth into. So scary and yet, somehow, so pleasantly distant. So thrilling, so chilling, and yet, at the same time, so not here, not now, not yet. All in all, a completely satisfying health care fear experience. Unlike his actual illness.

Scary movies give children nightmares. Scary health news gives adults the extraordinary ability to ignore the immediate in favor of the distant, to escape from the real (and the really scary) into a far easier kind of fear.

A few years ago, a young woman waited patiently to be seen in our office after hours. She was a patient of one of my colleagues, but she couldn't wait for their scheduled appointment; she needed to see someone right away.

"I'm worried I have Lyme disease," she said. "I have all the symptoms. I think I need to be treated."

"But you have AIDS," I said.

"I'm tired and weak and I have fevers and sweats. I've lost my appetite. I can't think straight. I'm losing so much weight!"

She had seen a TV news report on Lyme disease, and then she had checked the Internet. All her symptoms were right there.

"But you have AIDS," I said. "And you don't want to take meds. That's why you're feeling so bad."

"I'm really scared about Lyme disease," she said. "I really need to get treated."

"If you want to be scared, how about that untreated AIDS of yours?"

We looked at each other. It was an impasse. The fact that logic was on my side mattered not at all: evidently the real was just a little too real for her. How much better to find another illness to be scared of, obsess over, get treated for, get rid of.

Eventually she coerced my colleague into testing her for Lyme disease and treating her despite negative tests. Then she decided her symptoms might actually be due to a brain tumor, instead. And so it went, until she died of AIDS.

Of four patients I saw in a single hour last week, three announced how scared they were of the avian flu. I reassured them, but there was quite a bit I did not say, and here it is.

I did not say: If you want to be scared, then how about that drug habit of yours you think I don't know about? How about the fact that you are 100 pounds overweight and eat nothing but junk? How about the fact that in a few short months Medicaid is going to stop paying for your very expensive medications and no one knows how just high that Medicare Part D deductible and co-payment are going to be? I did not say: If you want something to be scared of, how about the drug-resistant Klebsiella that is all over this very hospital, an ordinary run-of-the-mill bacterial strain that has become so resistant to so many antibiotics that we've had to resurrect a few we stopped using 30 years ago because they were so toxic.

That Klebsiella is one scary germ. It's in hospitals all over the country, and by now it's probably killed a thousandfold more people than the avian flu.

But you don't hear much about our Klebsiella. Like our bad habits and our dismally insoluble health insurance tangles, our antibiotic-resistant bacteria are with us, right here, right now. Apparently they all lack the drama, the suspense, the titillating worst-case situations that energize our politicians and turn into a really newsworthy health care scare.

They're all just too real.

Beyond Human

Many of the fans milling into this year's postseason baseball games have been wearing authentic major league uniforms, with GUERRERO, say, or OSWALT, stitched on the back. True, society has traditionally encouraged kids to fantasize about what they'll be as adults. But most of the people I've seen in $200 regulation shirts are adults. What they're fantasizing about is an alternative adult identity for themselves.

Why do they do this? The literary critic Paul Fussell once speculated that wearers of "legible clothing" like T-shirts were merely losers trying to associate themselves with a success, whether it be a product (Valvoline) or an institution (The New York Review of Books). A conservative view held that dressing like a child meant shirking the responsibilities of adulthood. It was a subset of dressing like a slob. But these explanations do not cover the ballpark people or (to take a similar phenomenon) those weekend bicyclists in their expensive pretend-racer costumes, with European team logos and company trademarks. The message in their clothing is aimed not at others but at themselves. It is a do-it-yourself virtual reality.

Abandoning your own world for a made-up one is an ever larger part of adult life. For the futurist Ray Kurzweil, this is only the beginning. According to his new book "The Singularity Is Near," we are approaching the age of "full-immersion virtual-reality." Thanks to innovations in genetics, nanotechnology and robotics, you'll be able to design your own mental habitat. You'll be able to sleep with your favorite movie star - in your head. (It is not lost on Kurzweil that you can already do that, but he insists it will be really, really realistic.) Those same technologies will help us "overcome our genetic heritage," live longer and become smarter. We'll learn how brains operate and devise computers that function like them. Then the barrier between our minds and our computers will disappear. The part of our memory that is literally downloaded will grow until "the nonbiological portion of our intelligence will predominate."

But this raises questions: What will then be the point of unenhanced human beings? And what will become of our relations to one another? A willingness to run head-on at these moral-technological issues has made the French novelist Michel Houellebecq one of Europe's best-selling writers and arguably its most important. His "Elementary Particles" (2000), set in the year 2079, recounts the near-total extinction of ordinary human beings. His new novel, "The Possibility of an Island," due out in the United States next spring, describes the triumph of a cult that believes man was created by nondivine extraterrestrials and sees genetic engineering as a path to "immortality."

The novel cuts between a sex-obsessed comedian, Daniel1, and two of his enhanced clones, Daniel24 and Daniel25. It would not surprise Houellebecq that Kurzweil, like other technological optimists, should use sex to sell his utopia. For Houellebecq, the important line the cult crosses is not a scientific but an anthropological one. By making credible promises of longevity and sex, it manages to elevate materialism (more specifically, consumerism) into a religion. Daniel1's girlfriend, the editor of a magazine called Lolita, explains, "What we're trying to create is an artificial humanity, a frivolous one, that will never again be capable of seriousness or humor, that will spend its life in an ever more desperate quest for fun and sex - a generation of absolute kids."

But something gets left out of sex when it is idealized, marketed, venerated or souped up: other people. Regardless of whether your girlfriend can handle your sleeping (virtually) with Angelina Jolie, it is very likely you'll find the hard work of maintaining a relationship less rewarding when so many starlets beckon. Americans may be surprised that Houellebecq attributes the bon mot about masturbation being sex with someone you love not to Woody Allen but to either Keith Richards or Jacques Lacan. But whatever its source, the narrator Daniel25 views it as one of the more profound insights of our time.

Human interactions of all kinds, especially those that involve caring for others, appear less and less worth the trouble. Houellebecq is fascinated by young couples who have pets instead of children, and by the French heat wave of 2003, which killed thousands of senior citizens who were forgotten by their vacationing children and abandoned by their vacationing doctors. Daniel1 mocks the newspaper headline "Scenes Unworthy of a Modern Country." In his view, those scenes were proof that France was a modern country. "Only an authentically modern country," he insists, "was capable of treating old people like outright garbage."

If we treat our fellow humans this way, why should we expect posthumans to care for us any better? We shouldn't. In the novel, when an acolyte witnesses a murder that, if revealed, could derail the cult's DNA experiments, the chief geneticist orders her thrown from a cliff. He feels no shame, nor does the narrator see any reason why he should. "What he was trying to do," Daniel1 writes, "was to create a new species, and this species wouldn't have any more moral obligation toward humans than humans have toward lizards."

In his recent book, "Radical Evolution," Joel Garreau suggests a "Shakespeare test" to determine whether Prozac or cloning or full-immersion virtual reality robs us of our humanity: would the user of these innovations be recognizable to Shakespeare? Houellebecq suggests that the answer is tipping toward No. "Nothing was left now," Daniel25 notes, "of those literary and artistic works that humanity had been so proud of; the themes that gave rise to them had lost all relevance, their emotional power had evaporated."

Many Westerners looking to the future think they're about to attain the prize of a fantasy-filled high-tech life that lasts until a ripe old age. Houellebecq warns that second prize may be a fantasy-filled high-tech life that lasts forever.

Christopher Caldwell, a contributing writer, last wrote for the magazine about Turkey.

Parents Fret That Dialing Up Interferes With Growing Up

KATHERINE KELIHER, 9, of Lakeville, Minn., could sleep an extra hour every weekday morning if she wanted to. But she would rather get up early, sit down at her computer and spend that time trading instant messages with her best friends, five girls she will soon see at school.

"We just talk about, like, 'What are you going to do today?' and stuff like that," Katherine said.

Her mother, Judy Keliher, says she isn't looking to deprive Katherine of her messaging access. "For fourth graders this is critical," she said, understanding that video games, cellphones, iPods and other high-tech gear are just part of growing up in a digital world. But Ms. Keliher is concerned about the amount of time her children, including a son, Matthew, 14, spend there.

So she is asserting some control. She says she will allow only one computer in the house and limits Matthew's and Katherine's screen time each night. "I don't like them to be home and be lazy, not at the expense of doing other things that need to get done," said Ms. Keliher, 43, who is divorced and works full time as the manager of a hardware store. "I just put it into the whole scope of a healthy lifestyle."

In interviews and surveys many parents say that their children spend too much time in front of computers and on cellphones. Some parents worry that long, sedentary hours spent at a computer may lead to weight gain, or that an excess of instant and text messaging comes at the expense of learning face-to-face social skills. Some complain of having to compete for their childrens' attention more than ever.

A report on teenagers and technology released this summer by the Pew Internet and American Life Project found that teenagers' use of computers has increased significantly. More than half of teenage Internet users go online daily, up from 42 percent in 2000, the report said; 81 percent of those users play video games, up from 52 percent.

Instant messaging has become "the digital communication backbone of teens' daily lives," used by 75 percent of online teenagers, according to the Pew report. "Parents are really struggling with this," said David Walsh, the president of the National Institute on Media and the Family, a nonprofit educational organization in Minneapolis that began a program this year to help families reduce screen time and increase physical activity. "As the gadgets keep evolving, they keep consuming more and more of our kids' time. Our kids need a balanced diet of activity, and the problem is that it's getting out of balance. I don't think as a society we're dealing with it yet."

Technological advances have produced generational conflicts before, of course, whether the gadget was a rabbit-ear television set, a transistor radio or a personal computer. The young would find the latest thing exciting and freeing. Parents would worry that it was distracting and cramping academic and social development. So it goes today. Only now it is not a single high-tech wonder that concerns parents but a seemingly constant and ever-more-sophisticated tide of them.

As new technological devices beckon - Apple recently rolled out an iPod that can play video - young people are not necessarily shedding old media. A survey of 8- to 18-year-olds by the Kaiser Family Foundation this year found that the total amount of media content young people are exposed to each day has gone up by more than one hour over the past five years, to eight and a half hours.

But because they are multitasking, young people are packing that content into an average of six and a half hours a day, including three hours watching television, nearly two hours listening to music, more than an hour on the computer outside of homework (more than double the average of 27 minutes in 1999) and just under an hour playing video games.

Neither the Kaiser nor the Pew report found evidence of impending doom in all that exposure. The Pew report noted, for example, that despite their great affection for technology, teenagers still spent somewhat more time socializing with friends in person than on the telephone or through e-mail or instant and text messaging. And as teenagers get older, the report found, they tend to be less interested in diversions like online games and more inclined to use the Web for information.

"It's not something I think is a crisis," said Elizabeth Hartigan, the managing editor of L.A. Youth, a newspaper and Web site for high school students in Los Angeles. "Teen pregnancy is a crisis."

For a great number of young people, Ms. Hartigan said, high-tech gear was not an issue because their families can't afford much beyond a television set. Others are just not that interested. "Some kids get really into it, but some kids are obsessed with fashions or boyfriends or cars," she said.

Ariel Edwards-Levy, 16, a staff writer with L.A. Youth, agreed that computer use is "a sedentary activity, and if you let yourself be obsessive, it's an issue."

"But some parents don't understand that it's a different medium," she said. "It's mostly just a tool, and it can be used very well. The resources online are amazing. You can meet people and reconnect with people."

Many parents say they are limiting screen time, checking their children's Web-surfing histories and using filters to block objectionable material. Another strategy is to keep only one computer in the house and to place it in a common area, like the family room, better to monitor children's online habits.

Paula Hagan Bennett, a lawyer from the San Francisco Bay area, says she uses a variety of methods to manage how and when her four boys - ages 16, 14, 12 and 5 - are connected. For the two older boys that means controlling the use of their cellphones. "It's not for them to be chattering," said Ms. Bennett, 48, who insists that calls are for contacting parents, not friends, and should last no longer than three minutes.

For the 12-year-old it means limiting computer screen time and disabling the instant messaging function. He was unhappy about it, she said, and had no trouble reinstalling it when she wasn't looking. (Ms. Bennett prevailed.) But she said she views instant messaging as she does most cellphone conversations among young people.

"It's a waste of time," she said, "because most of the time they're talking about nothing." As for her 5-year-old, technology is not yet an issue, but Ms. Bennett said that in affluent Marin County, where she lives, she has seen young children watching "Barney and Friends" on portable DVD players in the backs of cars.

Linda Folsom, a media producer for the Walt Disney Company theme parks, decided to stick to a "motherly nag mode" rather than impose restrictions on her 14-year-old daughter, Alana, who "tends to be constantly on the I.M.," Ms. Folsom said.

While doing homework Alana will write a paragraph, respond to an instant message, then go back to her schoolwork, her mother said. "She says the I.M. is related to the project she's working on," Ms. Folsom said. "But if I hear giggling, I put in a comment: 'It doesn't sound like homework to me.' "

But Ms. Folsom, 46, and her husband, Scott, 57, a PTA leader in Los Angeles, said they had no reason to crack down on Alana because she earned good grades and behaved well. But they have insisted that she eat dinner with them and that she practice her clarinet and play soccer.

Alana sees her instant chatting as harmless. "It's just rambling," she said. And it is fun to be able to have a five-way chat with friends, she said. But she said she knows when it's time to type the message: "I'm doing homework. Leave me alone."

"If it starts controlling you rather than you controlling it, that's when you stop," Alana said.

Ms. Folsom said she felt that the technology was robbing her of her daughter's company more and more. There was a time, she said, when father, mother and child would listen to the same music in the car. "Now she plays the iPod, and she's in her own music world," Ms. Folsom said.

David Levy, a University of Washington professor who studies high-tech communications and quality of life, acknowledges that the young have become adept at managing multiple sources of information at once, but he questions whether the ability to multitask has curbed their "ability to focus on a single thing, the ability to be silent and still inside, basically the ability to be unplugged and content."

"That's true for the whole culture," he said. "Most adults have a hard time doing that, too. What we're losing is the contemplative dimension of life. For our sanity, we need to cultivate that."

Some parents seem to be getting that message. When the National Institute on Media and the Family went looking for a few hundred families in Minnesota and Iowa to participate in a research project this year that calls for reducing the amount of time third to fifth graders spend in front of a computer or television screen, 1,300 families signed up.

Ms. Keliher, a Lakeville school board member, is one of the participants. She thought the project would help 9-year-old Katherine "acknowledge the amount of time she spends on the screen."

But as parents try to monitor their children's habits, some said there is also a need to be realistic. "We as parents tend to overreact a little bit to this," Mr. Folsom said. "This is the virtual playground. It's part of growing up."

Bizarre and Infamous Join Scholarship in an Archive of Psychology

AKRON, Ohio - Just 45 minutes from the Rock and Roll Hall of Fame and Museum in Cleveland, half an hour from the Pro Football Hall of Fame in Canton and two blocks from the Inventors Hall of Fame in this city's downtown is an attraction like no other.

Where else but at the Archives of the History of American Psychology can visitors see the uniforms and billy clubs used in the Stanford Prison Experiment, in which students ended up acting the role of guards all too realistically; watch a home movie of Freud batting fruit out of a tree with his cane; or have the bumps on their heads measured to calculate their personalities and career prospects with a 1933 psychograph?

Forty years after its founding at the University of Akron as a national repository for scholars, the archives - psychology's attic - have amassed not only the papers of more than 740 psychologists, but also a dazzling array of their instruments, ephemera, photographs and films. Although it is a beacon to historians from around the world and the source of hundreds of scholarly articles and books, the archives remains virtually unknown to the public at large.

"Never heard of it," said the administrator of an office one floor up in the same building.

No sign on Main Street here indicates the presence of the archives in, unfittingly enough, the basement of the former Polsky department store, now a branch of the University of Akron. Not even the directory next to the elevators on the main floor lists it.

"Isn't it amazing, all this stuff down in a basement in Akron?" asked the archive director, Dr. David B. Baker, who is also a professor of psychology at the university.

Surrounded by century-old devices as arcane as they are beautiful, Dr. Baker described his twin mission to increase the visibility of the archives and the field it illuminates. The archive was named an affiliate of the Smithsonian Institution in 2003. In April, Roadway Express, the trucking company, announced that it was donating a large building next to the University of Akron to allow the archives to escape its basement hiding place and expand its public offerings.

"The field of psychology has mushroomed," he said. "It's getting more and more specialized. But we do have common roots. The place where we all meet is here, in our history."

He traced the roots of recent efforts to evaluate the level of consciousness of Terri Schiavo, the comatose Florida woman who died on March 31, to many of the antique instruments in the archives. Built more than a century ago of brass and glass, they were designed to measure perception and the discrimination of visual, audio and tactile stimuli. One instrument built around 1880, the chronoscope, could measure how long it took a person to react to a stimulus down to the hundredth of a second.

"Things like reaction time, which now seem deadly dull, were of the utmost importance," Dr. Baker said. "They were some of the very first scientific demonstrations of the ability to measure mind. That's what got people excited 100 years ago."

Testing was, in fact, the raison d'être of psychology until just after World War II, he noted, when psychologists were first permitted to offer clinical care in response to the needs of returning veterans.

Even the bizarre psychograph, Dr. Baker said, was predicated on a theory that remains a bedrock of modern research, that different regions of the brain have differing functions that can be measured and described. Although psychologists and neurologists of today measure those regions using magnetic resonant imaging, 19th-century phrenologists believed that those regions could be calculated from outside.

The device is one of three remaining in the United States. With its 1,954 parts housed in a walnut case, it sits in a corner of the reading room, its crown of calipers ready to measure every nook and node of the skull.

"You'll have to remove your glasses," John Bean, an undergraduate in psychology who works as an assistant at the archives, said as he put on latex gloves to place the sharp, heavy calipers on a visiting reporter's skull. In less than two minutes, it cranked out a kind of ticker tape giving a five-point rating, from "poor" to "excellent," on 28 personality variables like benevolence, suavity, caution, conscientiousness, acquisitiveness and conjugal love. The device automatically combined the variables to predict suitability for various professions, a process that Mr. Bean modernized with a computer spreadsheet.

"Do you want to see your results?" Dr. Baker asked. "Your highest score, you've got 70 percent on mechanic, followed by pugilist, at 60 percent. How did you do on journalist? Forty-five percent. You have a higher score as a zeppelin attendant."

Among the more than 1,000 instruments in the collection, a crown jewel is the simulated shock generator designed by Dr. Stanley Milgram. It was used in experiments in the early 1960's to investigate how far people would go to obey instructions from an authority figure. The participants were told that they were in a study on using electric shocks to penalize participants who failed a simple learning test. They were instructed to flick switches that would deliver steadily more intense shocks, from mild to dangerously severe. In fact, despite the convincing labels and knobs, the shocks were imaginary, and volunteers pretended to react in pain to the nonexistent shocks. Dr. Milgram found that nearly half of the real subjects followed orders to inflict pain that they were convinced was real. "It's probably one of the most important psychological experiments of the 20th century," Dr. Baker said. "It deals with a very fundamental question about the nature of good and evil. We like to believe that it would only be a very sick and evil person who would inflict torture on others. He showed us otherwise."

Standing 30 feet from the display, he demonstrated a more harmless test of conformity, conducted on visitors to the exhibition. A sign at the front entrance instructed visitors to step only on black tiles in a passageway with a floor of alternating black and white tiles. Sure enough, Dr. Baker watched as a family of visitors followed the instructions.

"They were like a group of ducklings there," he said. "That's what Milgram said, we're very compliant."

Similar conclusions were reached in the early 70's, when Dr. Philip G. Zimbardo of Stanford carried out his prison experiment in which students, told to act and dress as prison guards, quickly began mistreating other students dressed as prisoners. On display in addition to the guards' and prisoners' uniforms are fake cans of Chemical Mace and a cell door used in the experiment.

For all the interest generated by such displays, the primary draw to historians is a trove of psychologists' papers, the largest such collection in the world. Ronald F. Levant, president of the American Psychological Association, said the papers represented the field's "institutional memory."

Dr. Alexandra Rutherford, coordinator of one of only two graduate-level programs in the history of psychology, at York University in Toronto, said she and many of her students had often visited the archives.

"AHAP is a world-class resource for any historian of psychology or the social sciences," Dr. Rutherford said, adding that many articles published by psychology journals were based on research there.

"I can't tell you how many visits I've made, probably 25," said Ludy T. Benjamin Jr., professor of psychology at Texas A&M. "Probably 75 percent of what I've written in the last 30 years has come at least partially from that collection. Those are the best moments of my professional life, to be able to sit at one of those tables and read somebody else's mail. There's a real rush to that."

A bit of the frisson of discovery may be felt walking down Row 17 of the stacks, where the papers of Dr. Abraham Maslow, the humanistic psychologist, are in numbered boxes. Box M437, picked at random, had a folder marked "expression, spontaneity." Inside was a column of an undated article from The New Yorker torn from its surrounding page. The article, apparently addressing the question of why writers write, offered this dour answer, "All work and creative action is a way to snatch ourselves from the meaninglessness of transience."

Dr. Maslow would have none of it. In his angular, easily legible script, the psychologist famed for extolling the search for peak experiences had scribbled this typically Maslovian answer: "To objectify our subjective thought so as to be able to look at it and improve it toward perfection. To seek peak experiences."

Much as he knows that such papers offer profound insights into the history of psychology, Dr. Baker's passion for the peculiar and absurd in the equipment he guards is undeniable.

"It's a shame you won't be here on Friday," he said. "A U-Haul full of stuff from this place called the IQ Zoo is coming. They were the ones who worked with Skinner on a pigeon-guided missile. When a collection arrives, it's like Christmas morning. It's like, 'Oh my gosh, look at this stuff.' "

It was to make such "stuff" available that Dr. John A. Popplestone and the late Dr. Marion White McPherson, the married couple who taught psychology at the university, established the archives in 1965. Forced to teach a course on the history of psychology, Dr. Popplestone casually said to his wife one evening that the field would never amount to anything without a central archive.

He recalled her saying, "That's the best idea you've had in quite a while."

Diagnostic criteria for Self-defeating Personality Disorder

1. A pervasive pattern of self-defeating behavior, beginning by early adulthood and present in a variety of contexts. The person may often avoid or undermine pleasurable experiences, be drawn to situations or relationships in which he or she will suffer, and prevent others from helping him or her, as indicated by at least five of the following:

1. chooses people and situations that lead to disappointment, failure, or mistreatment even when better options are clearly available
2. rejects or renders ineffective the attempts of others to help him of her
3. following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that produces pain ( e.g., an accident)
4. incites angry or rejecting responses from others and then feels hurt, defeated, or humiliated (e.g., makes fun of spouse in public, provoking an angry retort, then feels devastated)
5. rejects opportunities for pleasure, or is reluctant to acknowledge enjoying himself or herself (despite having adequate social skills and the capacity for pleasure)
6. fails to accomplish tasks crucial to his or her personal objectives despite demonstrated ability to do so, e.g., helps fellow students write papers , but is unable to write his or her own
7. is uninterested in or rejects people who consistently treat him or her well, e.g., is unattracted to caring sexual partners
8. engages in excessive self-sacrifice that is unsolicited by the intended recipients of the sacrifice

2. The behaviors in A do not occur exclusively in response to, or in anticipation of , being physically, sexually, or psychologically abused.

3. The behaviors in A do not occur only when the person is depressed.

Note:For coding purposes, record: 301.90 Personality Disorder NOS (Self-defeating Personality Disorder).

Source: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Washington, DC, American Psychiatric Association, 1987. pp. 373-74.

December 19, 1999

NYtimes.com

WORD FOR WORD / Mental Disorders

Defining the Line Between Behavior That's Vexing and Certifiable

he United States is suffering from a veritable epidemic of mental illness, according to a report last week by the surgeon general, which asserted that "22 percent of the population has a diagnosable mental disorder."

But how is mental illness defined? The standard reference used by therapists for diagnosis and for assigning insurance-payment codes is the Diagnostic and Statistical Manual of the American Psychiatric Association.

The most recent edition, DSM-IV, which was issued in 1994, lists more than 300 kinds of mental disorders -- a far cry from the 22 illnesses identified in 1918 in the Statistical Manual for the Use of Institutions for the Insane, the precursor to the DSM.

Like its predecessors, DSM-IV provides standardized diagnoses for debilitating mental illnesses like psychoses, major depressions, anxieties, phobias and personality disorders. But critics contend that the manual contains large gray areas in which ordinary life-adjustment problems and vexing behaviors are classified as mental illnesses requiring clinical treatment.

	John Baer/Tri-Star Pictures
	An obsessive Jack Nicholson in "As Good as It Gets."

Here are some disorders found in those gray areas.

-- JOE SHARKEY

Therapists and the courts have always struggled to separate mental illness from bad behavior. For example, a good percentage of any prison's criminal population would seem to fit the criteria for Antisocial Personality Disorder (301.7):

1. Failure to conform to social norms with respect to lawful behaviors ...
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility ...

On the other hand, some behavior classified as mental illness seems to apply to quite functional, if annoying, people. How could Hollywood or Sunday morning television media-punditry thrive without personalities who exhibit the symptoms of Histrionic Personality Disorder (301.50)?

1. Is uncomfortable in situations in which he or she is not the center of attention.
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking in detail.
6. Shows self-dramatization, theatricality and exaggerated expression of emotion.
7. Is suggestible, i.e., easily influenced by others or circumstances.
8. Considers relationships to be more intimate than they really are.

Without doubt, psychiatric treatment is a life-saver for many deeply troubled children. But given the manual's broad definitions, many parents might question whether every adolescent is certifiable, at least on occasion. Consider the criteria for Oppositional Defiant Disorder (313.81):

1. Often loses temper.
2. Argues with adults.
3. Actively defies or refuses to comply with adults' requests or rules.
4. Deliberately annoys people.
5. Blames others for his or her mistakes or misbehavior.
6. Is touchy or easily annoyed by others.
7. Is spiteful or vindictive.

Clinicians treating severe drug and alcohol addiction work within a wide range of diagnostic categories. The following also qualify as "substance related disorders":

Caffeine Intoxication (305.90): Recent consumption of caffeine in excess of 259 mg (e.g. more than 2-3 cups of brewed coffee ...)
Nicotine Dependence Disorder (305.10): Tolerance to nicotine is manifested by the absence of nausea, dizziness and other characteristic symptoms ....
Nicotine Withdrawal Disorder 292.0: Abrupt cessation of nicotine use ((resulting in)) dysphoric or depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating; restlessness; decreased heart-rate; increased appetite.

Despite the comedy spin that Jack Nicholson put on it in the movie "As Good as It Gets," obsessive-compulsive disorder can be debilitating. But the D.S.M.'s diagnostic criteria also suggest that the fretful workaholic with that desktop Snoopy figurine collection may require treatment for Obsessive Compulsive Personality Disorder (301.4):

1. Preoccupied with details, rules, lists, order, organization or schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion . . .
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships . . .
4. Is over-conscientious, scrupulous, and inflexible about matters of morality, ethics or values (not accounted for by cultural or religious identification).
5. Is unable to discard worn out or worthless objects . . .

Many critics argue that the D.S.M. often reflects political and cultural biases. For example, homosexuality was listed as a mental illness as recently as 1968 in D.S.M.-II, which defined it as Sexual Deviation (302):

This category is for individuals whose sexual interests are directed primarily towards objects other than people of the opposite sex, toward sexual acts not usually associated with coitus...

The gay-rights movement ultimately pressured the American Psychiatric Association to eliminate homosexuality as a mental disorder in subsequent editions of the D.S.M. Cross-dressing males, however, are still categorized as mentally ill if they exhibit the signs of Transvestic Fetishism (302.3):

Over a period of at least 6 months in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.

The manual suggests that additional clinical research be devoted to treatment for those who suffer from the symptoms of Identity Problem (313.82):

Uncertainty about multiple issues relating to identity, such as long-term goals, career choice, friendship patterns, sexual orientation and behavior, moral values and group loyalties.

Other diagnoses shift with the cultural climate. The latest D.S.M., for example, eliminated one controversial diagnosis that was previously applied to women suffering depression, Self-Defeating Personality Disorder (301.90):

1. Chooses people and situations that lead to disappointment, failure or mistreatment . . .
2. Rejects or renders ineffective the attempts of others to help him or her.
3. Following positive personal events (e.g., a new achievement), responds with depression . . .
4. Incites angry or rejecting responses from others and then feels hurt, defeated or humiliated (e.g., makes fun of spouse in public . . .
5. Rejects opportunities for pleasure, or is reluctant to acknowledge enjoying himself or herself. . .
6. Fails to accomplish tasks crucial to his or her personal objectives. . .
7. Is uninterested in or rejects people who consistently treat him or her well . . .
8. Engages in excessive self-sacrifice . . .

The D.S.M. suggests that denial can be itself be a symptom of a disorder called Non-Compliance with Treatment (V15.81):

The reasons for noncompliance may include discomfort resulting from treatment (e.g., medication side-effects); expense of treatment; decisions based on personal value judgments or religious or cultural beliefs about the advantages and disadvantages of the proposed treatment; [and] maladaptive personality traits . . .

Dealing With Depression

Mental health has become a big topic at schools. Suicides and litigation have forced the issue. What students and parents must know

Posted August, 2004 - On the long list of worries that Mom and Dad have when a child goes to college—grades, homesickness, partying—there's a new issue gaining prominence: the apparent rise in mental illness on campus. More than 1,100 college students commit suicide each year, according to estimates by mental-health groups. And even when students aren't in acute distress, they're suffering in surprisingly large numbers. In a 2003 survey by the American College Health Association, more than 40 percent of students reported feeling "so depressed it was difficult to function" at least once during the year. Thirty percent identified themselves as suffering from an anxiety disorder or depression.

While there is debate over why the numbers seem to be rising, there's also concern that colleges aren't dealing with the problem adequately. In January 2004 the Crimson, Harvard's student newspaper, published a widely discussed five-part series which concluded that "an overwhelming majority" of Harvard undergraduates experience mental-health problems, and that the university's shortcomings in helping them were creating "a pervasive mental-health crisis" on the campus.

Given that kind of assessment, it's inevitable that mental-health issues are starting to filter into admissions conversations. One counselor at an East Coast private high school says that during the 2003-04 admissions cycle, officials from two colleges confided they were particularly focused on admitting a class that was "rock solid" emotionally—both to help prevent suicides and to reduce the toll on overbooked school therapists. MIT Admissions Dean Marilee Jones says she's looking to enroll "emotionally resilient" students. "If we think someone will crumble the first time they do poorly on a test, we're not going to admit them," she says. "So many kids are coming in, feeling the need to be perfect, and so many kids are medicated now. If you need a lot of phar-maceutical support to get through the day, you're not a good match for a place like MIT."

Since the admissions process requires students to appear flawless, many families avoid disclosing a child's history of emotional problems, especially before they get an acceptance letter. However, parents are starting to ask tough questions about just which kind of mental-health services they can expect from schools. Those inquiries become particularly acute at colleges that suffer high-profile student suicides.

At NYU, after four students fell to their death from buildings during the 2003-04 school year, the university took several steps to help students cope. Among them is a 24-hour "wellness" hot line; when talking on the phone doesn't seem to help, the hot line—with the student's acquiescence—will dispatch a counselor or the campus police to the student's residence.

In addition, families of all incoming NYU students are receiving letters asking for information on special needs, including whether a student is taking medication or seeing a therapist. The university's therapists now make weekly trips to residence halls for one-on-one appointments. By going to dorms, administrators hope, counselors will increase their visibility and make sessions more convenient.

NYU's door-to-door approach may be extreme, but it illustrates the range of support that colleges can offer. While nearly every school has a counseling office, almost half lack a full-fledged staff psychiatrist, according to Robert Gallagher, a University of Pittsburgh professor who conducts an annual survey of college counseling offices. That means it may be difficult for a student to receive prescription drugs to treat depression or anxiety, and that students with serious problems may be referred off campus for treatment. "Not only are the [on-campus] services more accessible, but the people providing the services are more familiar with college pressures," says Gallagher. And while some schools offer unlimited therapy for students, others restrict them to eight or 10 appointments a year. That may be fine for the average student, who often sees a counselor just once or twice to discuss homesickness, a bad grade or a relationship breakup. For those with more serious problems, such limits may mean rushed care.

Experts cite a mix of reasons that campus therapists' offices are so crowded. Harvard provost Steven Hyman, former director of the National Institute of Mental Health, says that until a few years ago teenagers with mental illness weren't as likely to get good treatment, leading many to stay home after finishing high school. "These kids very likely underperformed [academically] and may not have been able to attend college at all, let alone a challenging, selective institution," says Hyman. Today, with drugs and earlier intervention, many can. While Hyman thought the Crimson's examination of Harvard's health-care system was unfairly anecdotal and negative, he says he is pleased it's a topic of conversation on campus, because it signals a new openness about mental illness. Until recently, he says, "depression was so stigmatized, people were so ashamed they just toughed it out. As the stigma diminished, treatment became more acceptable, and now more students are coming forward."

But the cries for help appear to have other causes, too. The quest to get into a top college has grown so cutthroat for many that more students are emerging from it emotionally damaged. "Kids are burning out sooner and sooner," says Leigh Martin Lowe, director of college counseling at Roland Park Country School in Baltimore. "They're not being allowed to enjoy their teenage years, and many of them end up in college and they don't have the energy or stamina to really turn it on." At MIT, Jones, the admissions dean, gives preference to students who are "self-driven" (read: not being pushed by their parents), based on her belief that self-motivated students are better able to cope with failures. "Our culture has become insane—we're making people sick," Jones says.

The strategies used by MIT to deal with its troubled students are at the heart of a closely watched court case. In April 2000 MIT sophomore Elizabeth Shin of Livingston, N.J., fatally set herself on fire in her dorm room. The family is suing the school for $27 million, claiming that despite Shin's repeatedly telling MIT administrators, psychiatrists and dorm mates that she was suicidal, the school failed to place her under intensive psychiatric care, inform her family of her troubles or take adequate steps to prevent her death. "If a student is acting out because of drugs or alcohol, there's no hesitation to bring in the family," says David Deluca, the Shin family's attorney. "We've not gotten to the same point when it comes to mental-health care." (MIT has denied the allegations, saying it treated Shin adequately and kept the family informed.) If the Shin family prevails, other colleges may rethink how they communicate with parents about a student's problems.

For students with mental illness, college counselors and therapists say that fact should play some role in their college search. Andrea Rifkin, a college counselor in Santa Barbara, Calif., routinely asks her clients if they have any health issues or are taking medication. When the facts spill out, she asks: "Are you feeling healthy enough to go away to school?" Indeed, psychiatrists agree that students with serious mental illness are often best off attending a college where family is nearby. "It doesn't necessarily have to be near the parents' home—it might be near a brother, sister, aunt or uncle, somebody they can turn to and see on a regular basis," says Robert Hendren, chief of adolescent and child psychiatry at the University of California, Davis. Hendren says parents of students with particular conditions (such as bipolar disorder) can network through online support groups to get other parents' views on how well individual colleges deal with disabilities. Another tip: families should find a local therapist and arrange for prescription delivery to the child's school before he or she arrives.

There may also be benefits in choosing smaller schools. At Grinnell College in Iowa, where the student body numbers 1,350, two students committed suicide during spring 2003. Since then the administration has made therapists more accessible and created systems so anyone—faculty members, coaches, RAs—who sees a student flailing knows whom to call for help. While there's no proof that smaller colleges like Grinnell are better equipped to spot and treat students' emotional problems, there is evidence they have more resources. According to the University of Pittsburgh study, at colleges with 2,500 or fewer students, health centers had one counselor for every 818 students. At colleges with more than 15,000 students, the counselor-to-student ratio jumped to 1 to 2,426.

The trickiest task faces parents whose children seem 100 percent healthy when they leave for college. Donna Satow of New York had sent two children to college by the time her third, Jed, went off to the University of Arizona. In 1998, as a sophomore, he committed suicide. Today Satow and her husband run the Jed Foundation, which helps colleges develop strategies for dealing with student depression. She'd like all colleges to screen incoming students for depression, the same way they make sure they've had all their immunizations. Satow advises parents of every student to become informed about mental-health services at their child's school. "You don't ask, 'What kind of support do you have in case my youngster gets in trouble?' " But in a world where families agonize over finding the cushiest dorm room and the perfect meal plan, it's a question that deserves to be asked.

WHAT SEEMS TO BE THE PROBLEM?
BY JOHN FETTO
American Demographics, Apr 1, 2002

In the days and weeks following Sept. 11, many Americans sought the aid of psychotherapists to help them cope with the tragedy. Little did they know that by helping themselves, they were also helping to reduce the stigma associated with psychotherapy. According to this month's exclusive American Demographics survey, conducted by market research firm Market Facts, 1 in 7 Americans (14 percent) say they are more accepting of psychotherapy today than they were prior to Sept. 11. But even so, many people still have negative perceptions of Dr. Freud and his colleagues, which suggests it may be some time before the shroud is entirely lifted from the leather couch.

Admittedly, most personal problems do not require the assistance of a professional. But 16 percent of respondents to our nationally representative telephone survey of 1,000 Americans confessed to having sought the advice of a psychotherapist or a comparable professional counselor at some point in their lives.

Perhaps not surprisingly, Baby Boomers — the “me” generation — are the most likely to have seen a therapist. In fact, nearly a quarter of 45- to 54- year-olds (23 percent) have sought professional help compared with 13 percent of 18- to 34-year-olds and 13 percent of adults age 55 and older. A greater share of Westerners (21 percent) — as their Hollywood reputation suggests — have been to see a shrink. Only 16 percent of Midwesterners, 15 percent of Southerners and 12 percent of people in the Northeast admit to making a self-help visit.

Interestingly, income is not a predicting factor for psychotherapy treatment, but education is. Fully a quarter of Americans with a postgraduate degree have been to a therapist, compared with 17 percent of college grads and just 12 percent of those with a high school diploma or less. Noted psychologist and author Dr. Joyce Brothers, explains: “With greater education, you're aware that you don't have to be mentally ill to get support. If you sense there's something wrong, you're going to find someone who can help you, regardless of how much you make. If money is an issue, you find a cheaper therapist.”

Overall, Americans tend to see therapy as a good thing, but there is still a handful who remain skeptical. When asked how they would feel if they found out someone they knew was in psychotherapy, almost half (49 percent) of respondents say the news would evoke a positive feeling, but 1 in 10 say their reaction would be decidedly negative. Thirty-eight percent remain ambivalent. Or so they say. But consider this: Nearly 1 in 5 Americans (19 percent) believe that psychotherapy is primarily “for people with serious psychological disorders,” while another 13 percent think it's “a waste of time” and an additional 3 percent say that psychotherapy is essentially “for the rich and famous.”

Regardless of what they say, more people would likely be in therapy today were it not for the perceived cost. A third of respondents (32 percent) admit that they have avoided therapy in the past or will not seek the advice of a therapist in the future because they don't think they can afford the counseling. This perception is especially high in the Midwest and the West, where 37 percent of residents in both regions say cost is one factor keeping them from the therapist's couch, compared with only 29 percent of Northeasterners and 27 percent of those in the South who say the same.

But fees are certainly not the only obstacle. Many Americans still fear the social ramifications they could face if others found out. This reason is cited by 15 percent of respondents as a factor which either has or will inhibit them from seeing a psychotherapist. Ironically, typically fearless Gen Ys are most afraid of being judged. Almost a third (29 percent) of 18- to 24-year-olds, compared with half as many adults age 25 and older, shun therapy for fear of being found out.

“Young people are more concerned with what others think because they're still in their developmental years and seek approval from others,” says Dr. Brothers. “They don't want anything on their record, like therapy, that might keep them from advancing later in life.”

LEND AN EAR

With whom have you spoken in the past when dealing with a personal problem?
MEN WOMEN
Friend or family member
68% 82%
Religious/spiritual leader
24% 28%
Psychotherapist
13% 18%
Source: American Demographics/Market Facts


SUPPORT GROUP

Women are significantly more accepting of those in therapy than men. More men say that word of someone they know seeing a therapist would carry a negative connotation.
IF YOU FOUND OUT SOMEONE YOU KNEW WAS SEEING A PSYCHOTHERAPIST, WOULD THAT NEWS CARRY IN YOUR MIND…

MEN WOMEN
A very positive connotation
17% 35%
A somewhat positive connotation
23% 21%
Total: positive connotation
40% 57%
A somewhat negative connotation
10% 4%
A very negative connotation
2% 3%
Total: negative connotation
12% 7%
Neither a positive nor negative connotation
43% 34%

Source: American Demographics/Market Facts

The Tug of the Newfangled Slot Machines

May 9, 2004
By GARY RIVLIN
nytimes.com

When Anthony Baerlocher makes his monthly visit to the
Atlantis Casino Resort in Reno, Nev., he always starts with
a ritual he calls ''taking inventory,'' walking several
laps around the casino's sprawling 32,000-square-foot
gambling floor and noting which machines sit unloved,
vainly burping out their come-hither sounds, and which
machines have captured players' attention. The Atlantis is
home to more than 1,400 slot machines, but so vivid is the
mental snapshot that Baerlocher, 35, carries in his head
that he immediately registers the presence of a new machine
on the floor. Although Baerlocher is a trained
mathematician, his interest is far from academic. He is the
chief game designer for the country's largest maker of slot
machines, International Game Technology of Reno. At the
first sign of a new slot machine from a competitor, he goes
into action. ''Give me 30 minutes and $60,'' he says, ''and
I can tell you pretty much anything you want to know about
another company's machine.''

At 8 p.m. on a warm midsummer's night, Baerlocher watched a
woman dressed in green polyester pants and a
yellow-and-white-striped short-sleeved top play a slot
machine he designed called ''The Price Is Right.'' At
first, the woman's body language was noncommittal: she
stood half-turned from the game, as if no more than mildly
curious about the outcome of her wager. ''Price'' is what
slot pros call ''a cherry dribbler,'' a machine that
dispenses lots of small payouts while it nibbles at your
stash rather than biting off large chunks of it. ''You want
to give the newbie lots of positive reinforcement -- to
keep 'em playing,'' Baerlocher told me. As if on cue, the
woman hit a couple of small jackpots and took a seat.
''Gotcha,'' Baerlocher said softly under his breath.

Baerlocher also watched players nearby at another machine
he designed for I.G.T., ''Wheel of Fortune.'' I.G.T. is to
the slot industry as Microsoft is to computer software, and
no product contributes more to I.G.T.'s bottom line than
what industry insiders simply call ''Wheel.'' How big is
it? In its 14-year lifetime, ''Madden N.F.L. Football,''
from Electronic Arts, has made roughly $1 billion, making
it one of the most successful home video games ever
produced. ''Wheel of Fortune,'' by contrast, takes in more
than a billion dollars each year.

As in the televised game show, there is an actual wheel,
which spins whenever a player reaches the bonus round, on
average once in every 42 plays. The presence of the wheel
allows the slot machine to employ one of the most powerful
feints in the slot designer's arsenal: the near miss. When
a contestant spins the wheel on the game show and it stops
one or two spots past the $1,000 mark -- that's a near
miss. The slot machine version of ''Wheel,'' like many of
I.G.T.'s most popular slots, is designed to produce these
near misses, lots of them: though the wheel is divided into
22 pie slices of equal size, the odds are weighted so that
a player is likely to land on some wedges far more often
than on others.

After a couple of minutes, an older woman, dressed in a
sparkly pink sweatsuit ensemble, reached the bonus round.
She groaned when the wheel nudged past the ''250 times
bet'' wedge and landed on ''10 times bet.'' Her male
companion cried out, ''Honey, you were so close!''
Baerlocher's starchy mien melted away, revealing an amused
smile. ''You can see it on their faces every time,'' he
said. ''They feel they came soooo close. They're ready to
try it again, because next time they're going to get it.''

Baerlocher shook his head and laughed in a way that
suggested he never gets bored witnessing this moment. He is
among a cadre of people inside I.G.T.'s giant slots factory
who study addiction -- though unlike their counterparts in
academia, of course, he and his colleagues work on the
promotion side of things. He is so devoted to the slot
machine that he has one in the front room of his town
house, in the hills above Reno, and a second one downstairs
in his den. We lingered another minute or so, long enough
to watch the lady in pink slip another $20 into the
machine, confident that this time the wheel wouldn't make
those extra couple of clicks.


Nearly 40 million Americans played a slot machine in 2003,
according to an annual survey of casino gambling conducted
by Harrah's Entertainment. Every day in the United States,
slot machines take in, on average, more than $1 billion in
wagers. Most of that money will be paid back to players,
but so great is the ''hold'' from slot machines that
collectively the games gross more annually than McDonald's,
Wendy's, Burger King and Starbucks combined. All told,
North American casinos took in $30 billion from slots in
2003 -- an amount that dwarfs the $9 billion in tickets
sold in North American movie theaters that year.
Pornography, the country's second most lucrative form of
adult entertainment, doesn't come close, either: experts
estimate that Americans spend at most $10 billion a year on
live sex shows, phone sex and porn in various media from
cable to DVD to video and the Internet. Is it any wonder
that Baerlocher's boss, Joe Kaminkow, I.G.T.'s head of
design and product development, likes to say that he's in
the business of creating ''beautiful vaults''?

Although it has frequently been controversial -- Fiorello
La Guardia and Earl Warren are among those who have made
headlines crusading against it -- the slot machine has
traditionally enjoyed little status in the world of casino
gambling. Slots were where the wives of the high rollers
sat, killing time with buckets of coins. But revenues from
the games have grown exponentially over the past few
decades, according to Bill Eadington, director of the
Institute for the Study of Gambling and Commercial Gaming
at the University of Nevada, Reno, and now the slot machine
is the undisputed king of the casino. Craps, blackjack and
roulette -- which once defined organized gambling -- are
going the way of tuxedos and diamonds inside the modern-day
casino, where the standard dress these days tends toward
polyester and athletic wear. Accounting for more than $7
out of every $10 of gambling revenues in casinos across the
United States, the once lowly slot machine is the top
earner even in glitzy palaces along the Las Vegas strip.

Not only have slots been capturing an expanding share of
business on gambling floors across the country -- grabbing
an ever greater ''share of wallet,'' as industry insiders
put it; they have also played a crucial role in expanding
the footprint of casino gambling in the United States.
Where casinos were legal in just 2 states at the end of the
1980's, today they are legal in more than 30 -- a trend
that the slot machine, so easy to learn to play and
seemingly harmless, has no doubt helped fuel. ''It's the
slot machine that drives the industry today,'' says Frank
J. Fahrenkopf Jr., head of the American Gaming Association.
While craps, roulette and baccarat are outlawed in roughly
half the states that permit casino gambling, slot machines
are widely viewed as a politically palatable solution for
elected officials seeking to raise revenues -- the casino
equivalent, critics say, of a gateway drug. And the trend
is far from exhausted: Maryland, Massachusetts, Ohio,
Pennsylvania, Alabama and Kentucky are among the states
that have recently considered installing slots at
racetracks to generate needed tax revenue.

Fahrenkopf is reportedly paid in seven figures to praise
all things casino, but he can't seem to help taking a poke
at the slot machine. He views the transition from table
games to slots as symptomatic of the dumbing down of
American life. Playing craps means learning a complex set
of rules. Blackjack may be easy to learn, but it still
requires skill and concentration, and it's not uncommon for
the novice player to feel stupid in front of strangers. ''I
don't know if it's the education system, or maybe it's that
we as a society have gotten intellectually lazy,'' says
Fahrenkopf, who headed the Republican National Committee
under Ronald Reagan. ''But people would rather just sit
there and push a button.'' When I asked one elderly man to
explain the allure of playing slots, he replied, ''I don't
have to think.''

Slot machines are in fact for those well into the second
half of life. Manufacturers design games primarily for
women over 55 with lots of time and disposable income, and
casinos near retirement communities in and around places
like Phoenix and San Diego operate small fleets of jitneys
that shuttle back and forth to assisted-living centers. As
a come-on, one casino advertises free oxygen-tank refills
for its players, and heart defibrillators are increasingly
becoming standard equipment inside casinos. If a good
portion of the younger set today is hooked on video games,
it seems that the over-60 crowd has its own similarly
hypnotic fixation. ''For older people, it's a safe
environment,'' Baerlocher says. ''There are cameras and
security guards everywhere. You can go to one place and
shop and eat and be in a crowd even if you don't know
anybody.'' As one old Las Vegas hand put it, the country's
casinos are now providing ''day care for the elderly.''


The archetypal slot machine was invented in 1899 by Charles
Fey, a German immigrant, in San Francisco. But most
modern-day slot machines bear little resemblance to the
familiar one-armed bandit with its three reels spinning
behind a pane of glass and mechanically
click-click-clicking into position with each pull of a
lever. Today's slot machines feature well-choreographed
illusions designed to hide a fundamental truth: at heart
they're really nothing more than computers whose chips
randomly cycle through hundreds of thousands of numbers
every second. A player's fate is determined almost the
instant play begins. But to simply display a long string of
numbers on a computer screen, along with an accounting of
the money won or lost, would hardly prove entrancing.

That said, the computer chip at a slot machine's core does
account in part for the exploding popularity of slots -- it
means flexibility for game designers. The physical size of
the spinning reels in most of yesterday's mechanical
machines typically limited them to 22 stops and just over
10,000 possible combinations. Computer technology lets game
makers weight the reels so that winning big occurs as
infrequently as, say, one in 46 million plays (the odds of
hitting the big multimillion-dollar jackpot on ''Wheel of
Fortune''). The increased odds make possible today's huge
jackpots, which reach into the millions of dollars on some
machines. You can double your wager on a hand of blackjack
or win 35 times your bet on a single spin of the roulette
wheel, but only the slot machine gives you the hope of
turning a few dollars into a seven- or eight-figure payoff.


Still, to maintain a sense of suspense in games that are
over the moment they start, to increase what Baerlocher and
his fellow game designers call ''time on device,'' I.G.T.
spends $120 million each year and employs more than 800
designers, graphic artists, script writers and video
engineers to find ways to surround the unromantic chips
with a colorful matrix of sounds, chrome, garishly-painted
glass and video effects, which include the soothing images
of famous people, from Bob Denver (the actor who played
Gilligan on ''Gilligan's Island'') to Elizabeth Taylor,
many of whom receive hundreds of thousands, if not
millions, of dollars to lend their identities to the
machines. The traditional pull-handle, if it exists at all,
is nothing more than a vestigial limb; most players now
press a button to start the reels, often virtual, spinning.
Many slot machines don't even pay out coins but issue
''credits'' on a paper receipt to be redeemed at the
cashier's cage. Slot makers have found that their customers
don't miss handling money -- coins are heavy and dirty,
after all -- and stereo speakers can project the simulated
yet satisfying ping and clink of cascading cash. ''We
basically mixed several recordings of quarters falling on a
metal tray and then fattened up the sound with the sound of
falling dollars,'' says Bill Hecht, I.G.T.'s top audio
engineer, when describing one of the audio files he
programs into a machine.

Founded in 1981, I.G.T. dominated the expanding casino slot
machine industry until the mid-90's, when video slot
machines suddenly appeared. WMS Gaming, based in Illinois,
was the first company to cash in on these new machines in
the United States. (The marriage of slot machines and video
games was first consummated in Australia.) Their popularity
took I.G.T. by surprise. Bob Bittman, who was then the
company's chief designer, confesses that by 1999 he and his
fellow executives were anxious. The company's stock had
fallen precipitously, and Bittman recognized that he was
hardly the one to turn things around. ''I wasn't left-brain
enough -- or do I mean right brain?'' says Bittman, who
remains on I.G.T.'s board. That's when the company decided
to hire a talented young game designer, Joe Kaminkow, to
lead them into this jazzed-up new world.

Kaminkow began college thinking he would someday work as a
TV weatherman, but soon his ambitions veered toward game
making. He was a co-founder of a pinball-design firm in his
20's, and after he and his partner sold the company to
Sega, the video-game giant, Kaminkow spent the next seven
years overseeing that company's U.S.-based pinball
operations.

Kaminkow knew virtually nothing about slot machines when he
took the reins of I.G.T.'s design and product-development
division. Yet five years later, the company has reasserted
its supremacy in the slot machine industry. The majority of
I.G.T.'s most popular games -- ''The Munsters,'' for
example, or ''The Price Is Right'' -- now feature virtual
reels spinning on video monitors, touch screens and, in the
bonus rounds, video clips. The company has been so
profitable during Kaminkow's tenure that if you bought
$10,000 worth of stock in I.G.T. and Microsoft in the month
of his arrival, January 1999, the I.G.T. shares would be
worth more than $70,000 today and the Microsoft shares
about $6,000. ''I'm not worthy of being mentioned in the
same paragraph as Joe Kaminkow,'' says Brooke Dunn, who had
been Kaminkow's equivalent at Shuffle Master, a Las
Vegas-based company that made a short-term foray into the
slots business. Jerald Seelig, general manager of A.C. Coin
and Slot, which occasionally creates machines in tandem
with I.G.T., says, ''History will certainly show he's one
of the guys who changed the industry forever.''

I was granted my first hour with the man Brooke Dunn calls
the industry's god in the winter of 2003. Kaminkow is on
the short side, a stocky fellow with a wolfish grin who
tends to sport a grizzled, haven't-shaved-in-a-day facial
growth. Despite the near-freezing temperatures outside, he
was dressed in jeans and a bright short-sleeved shirt that
you might wear to a summer barbecue with friends. Through
most of the interview, he leaned back in his chair and
propped his Nikes up on a table. He wore a red baseball cap
on his head. When I told him I wanted to explore the world
of casino slots from inside his design unit, he didn't need
convincing. From Kaminkow's point of view, it seemed high
time someone followed him around with a tape recorder.
''You're very lucky,'' he said. ''You're going to get a
million-dollar lesson. You'll be going to Joe U.''

Kaminkow's spacious office is drenched in pop culture. On
the walls hang assorted pictures of Kaminkow in the company
of any number of B-list stars: Scotty from ''Star Trek,''
Bob Denver and Cassandra Peterson, who, as Elvira, has been
featured on a couple of I.G.T. slot machines. His bookshelf
includes a pair of collector's editions Monkees videos,
several volumes of ''The Addams Family'' TV show and all
five ''Rocky'' films. Behind his desk hangs a framed blowup
of a photo signed by ''Sopranos'' cast members that, he
said, ''cost a small fortune.''

One wall in the office was hidden by a set of metal blinds
that Kaminkow showily snapped open partway through our
first meeting. ''This is our battle plan,'' he said. There
were maybe 100 note cards, each printed with an idea for a
game: ''Twinkies.'' ''Dilbert.'' ''That Girl.'' ''Cops and
Donuts.'' ''Beverly Hillbillies 3.'' Not too long ago a
big-time slots maker might introduce a dozen new games at
Global Gaming Expo, the annual gambling trade show held
each fall in Las Vegas. That, however, was before the
arrival of Joe Kaminkow, a time he refers to as
''pre-Joe.'' By his fourth show, in fall 2002, I.G.T.
unveiled 82 games at the expo, and Kaminkow, ignoring the
moans from his staff, promised that the company would
release 150 games a year later. (Often two years can pass
between inspiration and a spot in a casino, thanks to the
complications of designing a slot machine and to the
onerous approval process imposed by a multitude of
jurisdictions.) ''G2E,'' as everyone inside I.G.T. refers
to it, is the gambling industry's equivalent of Fashion
Week in Paris. And while employees work long weeks in the
run-up to G2E, the atmosphere at I.G.T. resembles that of
an Internet start-up at the height of the bubble: video and
pinball games are scattered in hallways throughout the
design building, and Kaminkow had a slush machine and a
popcorn maker put in the communal kitchen.

Included in last year's G2E lineup were two games that
represented such high-stakes gambles for I.G.T. that
Kaminkow at first alluded to them only cryptically as ''the
big kahunas.'' Kahuna 1 turned out to be a ''Star Wars''
game -- and a coup of the first order. ''Baseball and 'Star
Wars,''' Bob Bittman says, ''have long been the two
untouchables'' in the world of themed slot machines. But
Kaminkow had signed deals with George Lucas for ''Star
Wars'' pinball and video games before, and after four years
of lobbying he apparently wore down the director-producer.
''George said, 'I recognize and understand that my audience
has matured,''' Kaminkow told me. '''They're spending time
in Las Vegas and in other casinos and on riverboats.''' The
question, though, is whether this game targeting a younger
demographic will justify the millions I.G.T. has spent on
what Baerlocher calls the ''most expensive title we've ever
done.'' I.G.T. says it does not know when the game will
appear in casinos.

Big Kahuna 2 was ''Drew Carey's Big Balls of Cash,'' and it
also represented a considerable risk. Typically, Kaminkow
engages the services of a celebrity sure to provide an air
of comfortable nostalgia -- for instance, Dick Clark (who
holds the company record for most games, at seven) or Robin
Leach, from ''Lifestyles of the Rich and Famous.'' Drew
Carey is not only more expensive; his image is also far
more provocative. When I.G.T. flew Carey to Reno for a day
of taping at the company's state-of-the-art film studio,
his caustic wit was a constant. Encouraged to improvise,
Carey read only occasionally from the prepared script;
instead, the comedian ad-libbed most of his own lines:
''Ohhhhhh, I'm so sorry. I guess that means another walk to
the A.T.M.'' ''Don't give up, we want to build another wing
on the casino.'' ''Why don't you go get another old lady so
I can take her Social Security check, too?'' ''Step right
up -- we need another sucker.''


Among the first things Kaminkow did when he arrived in Reno
in 1999 was spend as much time in the local casinos as he
could learning more about the games he was now responsible
for designing. ''I'd feed a twenty into a machine, and it'd
be gone in two minutes,'' he recalls. The word he uses to
describe the experience is not suitable for a family
newspaper. The problem, he decided, wasn't the vanishing
$20 -- taking people's money, after all, is the whole
purpose of these beautiful vaults -- but the speed with
which it disappeared. He instructed his mathematicians to
design most of I.G.T.'s new video games so that the typical
player would get at least 15 or 20 minutes on a machine
before needing to reach into her purse for another bill. He
also wanted games that paid more frequent, smaller payouts.


Inside I.G.T. they call it ''Joe's $20 test.'' One of the
first games released on Kaminkow's watch was based on the
old television sitcom ''I Dream of Jeannie.'' It was
Kaminkow who pioneered slots based on old TV shows; he
chose ''Jeannie'' as his first, he says, because ''every
woman wanted to be Jeannie'' (played by Barbara Eden), and
every man wanted -- paraphrasing Kaminkow -- to get to know
Eden's character intimately. The ''Jeannie'' machine, which
made its debut in 2000, included the show's big-band theme
song, Eden's voice (on small payouts you sometimes hear her
say, ''I can do so much more for thee, master'') and reel
icons tied to the show: a bejeweled thin-necked bottle, a
space capsule splashing into water and so on. And when you
have lined up the symbols just right, you enter a bonus
round that includes a spinning wheel and a short clip from
the show that lasts maybe 10 seconds. ''For your $20, you
should at least get to see a little of Jeannie,'' Kaminkow
says with a wink.

Over the years, Kaminkow has handed down a long list of
edicts that I.G.T. designers call ''Joe's rules.'' Early
on, for example, the sidekick he brought with him from Sega
overheard an older man complain to his companion that he
had left his reading glasses in the room and couldn't see
well enough to play. Kaminkow declared that henceforth the
lettering on all I.G.T. machines would be large enough so
that pretty much everyone but the legally blind could play.
Sometimes he would reach the bonus round in a game but win
no money, so that became another of Joe's rules: no zonks;
players who experience the fanfare of a bonus round receive
at the very least a consolation payout. He also dictated
that whenever a bonus round offered players a choice, the
machine would reveal the values of the options not
selected. ''You want the player to have the feeling, 'I
almost picked that one; I'll get it next time,''' says
Randy Mead, a game designer at I.G.T. The games also
include periodic free spins and other gimmicks designed, as
Mead puts it, ''to give players time for a small break --
to light a cigarette, order a drink, to stand and
stretch.''

''Joe brought this way of thinking, Look, we've got to wow
them,'' says Dave Forshey, a graphic designer who arrived
at I.G.T. shortly before Kaminkow. ''It's not just push the
red button and watch the wheels spin. Make people want to
sit there. Use sight and sound and everything at our
disposal to get people's juices going.'' Before Kaminkow's
arrival, I.G.T.'s games weren't quiet -- hardly -- but they
didn't take full advantage of the power of special effects
like ''smart sounds'' -- bright bursts of music. So
Kaminkow decreed that every action, every spin of the
wheel, every outcome, would have its own unique sound. The
typical slot machine featured maybe 15 ''sound events''
when Kaminkow first arrived at I.G.T.; now that average is
closer to 400. And the deeper a player gets into a game,
the quicker and usually louder the music.

''I'm not sure players even notice,'' says Bill Hecht,
I.G.T.'s top sound designer, ''but the effect is to get
them more excited.'' Every time the reels spin on
''Jeannie,'' a player hears a few seconds of the show's
theme song, and Hecht even orchestrated a bossa nova
rendition heard only when someone reaches the bonus round.
''Something for the regular players to look forward to,''
he says. ''We want to get your heart rate going a little.''


It wasn't Kaminkow who devised what are called multiline
games -- multicoin games that allow you to win on 1, 15 or
25 lines, assuming you wager enough coins. (Picture an
enlarged tic tac toe board that lets you win in any number
of crazy zigzag ways.) But under his stewardship, I.G.T.
has taken full advantage of whatever design changes have
allowed penny and nickel games to earn like dollar
machines. ''It used to be that the goal of casinos was to
move their nickel players to quarters, the quarter players
to dollars, the dollar players to five dollars,''
Baerlocher says. ''Now they don't bother, because we've
figured out how to get nickel and even penny machines to
play like dollar machines.'' How? By offering jackpots in
the hundreds of thousands, if not millions, of dollars. A
penny machine like I.G.T.'s ''Beverly Hillbillies'' can be
played for a penny a spin, but in most jurisdictions you're
eligible for the big prize, which starts at $200,000, only
if you wager the maximum bet per spin of $2.50. The odds of
winning that big jackpot may be in the tens of millions to
one, but there's a 100 percent chance you'll be kicking
yourself for eternity if you see five Beverly Hillbillies
line up on the machine's reels after you bet less than the
maximum needed to win. ''The truth is, nowadays you can
lose more money faster on a nickel slot machine than at a
$10 blackjack table,'' says Nigel Turner, a scientist at
the Center for Addiction and Mental Health in Toronto. The
true brilliance of the industry's emphasis on nickel and
penny machines is perhaps best seen by comparing how much
of ''the handle,'' or the total amount wagered, they pay
out compared with dollar machines. The average nickel
machine pays back to winners somewhere between 88 and 92
percent of the money wagered, Baerlocher says, compared
with the roughly 95 percent that dollar machines pay out.

Early on, Kaminkow's secretary, Pam Foster, told him, ''The
way you spend money, you'd better be good.'' Apparently all
the millions he spent have paid off. By the time I first
visited I.G.T., in 2002, the company had a 70 percent share
of the domestic slot market, and Kaminkow no longer saw
himself as competing against Bally, WMS Gaming and the
Australian-based Aristocrat so much as competing for the
attention of the tens of millions of Americans who had yet
to discover the magic of his slot machines. Although the
number of men who are playing the slots is increasing, they
tend to be on the far side of 60, and women in their late
50's still represent the slot machine's most trustworthy
devotees. So Kaminkow is devoting a sizable portion of his
time to what he benignly calls ''expanding his market.'' To
appeal to a younger, male cohort, he signed licensing deals
with the people behind ''South Park'' and ''Austin Powers''
(with mixed results) and then negotiated the even bigger
deals with Drew Carey and George Lucas for ''Star Wars.''
At the same time, he has been pursuing the potential of the
Latino market by designing a line of games that lets
gamblers play in Spanish with the push of a button. ''I
want my competitors to cry when they see my new games,'' he
says. ''I want them unable to get out of bed because they
realize, Damn, they've done what we didn't even think
possible.''

The makers of slot machines may rely on the lure of
life-changing jackpots to attract customers, but the
machines' ability to hook so deeply into a player's
cerebral cortex derives from one of the more powerful human
feedback mechanisms, a phenomenon behavioral scientists
call infrequent random reinforcement, or ''intermittent
reward.'' Children whose parents consistently shower them
with love and attention tend to take that devotion for
granted. Those who know they'll never be rewarded by their
parents stop trying after a while. But those who are
rewarded only intermittently -- in the fashion of a slot
machine -- will often pursue positive outcomes with a
persistent tenacity. ''That hard-wiring that nature gave us
didn't anticipate electronic gaming devices,'' says Howard
Shaffer, director of the division on addictions at Harvard
Medical School and perhaps the country's foremost authority
on gambling disorders.

''The slot machine is brilliantly designed from a
behavioral psychology perspective,'' says Nancy Petry, a
professor of psychiatry at the University of Connecticut
School of Medicine. ''The people who are making these
machines are using all the behavioral techniques to
increase the probability that the behavior of gambling will
reoccur.'' She refers to intermittent reward and
''second-order conditioning'' -- the lights and sounds that
go off when a player wins, for example, or the two cherries
in a row that convinces people they're getting closer.

''No other form of gambling manipulates the human mind as
beautifully as these machines,'' concludes Petry, who has
studied gambling treatments since 1998. ''I think that's
why that's the most popular form of gambling with which
people get into trouble.''

Anti-gambling activists refer to slots as ''the crack
cocaine of gambling.'' Though gambling's loudest critics
tend to be alarmists, the crack analogy may be apt. Just as
crack addicts have frequently seemed to self-destruct much
faster than those abusing powdered cocaine, there is
abundant, albeit still largely anecdotal, evidence
suggesting that the same is true of today's computer-driven
slot machines -- video-based slots especially. Where social
workers once found that the woes of a typical problem
gambler tended to mount gradually -- with a period of 20 or
more years commonly passing between a first wager and a
bottoming-out event like bankruptcy, divorce or even
suicide -- addiction cycles of a few years are, if not
typical, commonplace among slots players.

''Treatment folks are definitely identifying people who are
experiencing what we call 'telescoping' -- a shortening of
the period of time that it takes for someone to get into
trouble,'' says Rachel Volberg, president of the National
Council on Problem Gambling and the author of ''When the
Chips Are Down: Problem Gambling in America.'' Volberg, who
runs Gemini Research, an organization that specializes in
gambling-related investigations, says it remains to be seen
whether the problem lies in ''something special about these
machines or in the people who prefer playing them.'' Female
slots players in particular, Petry says, ''tend to
experience this telescoping phenomenon -- and we know from
research that women are quicker to seek treatment.''

Gambling counselors regularly encounter people like Ricky
Brumfield, a working-class Phoenix woman who won $3,700 the
first time she ever touched a slot machine -- a day that
turned out to be the unluckiest of her life. That was in
1997, when Brumfield, then 43, traveled to Las Vegas to
help a friend celebrate the Fourth of July. Within nine
months, she had hocked her jewelry and gone through
$100,000 in cash and credit-card debt. She only stopped,
she confesses, because the Sheriff's Department arrested
her on child-abuse charges for leaving her two young kids
locked in a car in a casino parking lot while she played
the slots inside. ''I knew it was really wrong to do that,
but the urge to go into the casino was stronger than my
instincts as a mother,'' Brumfield says. She had only
recently had back surgery, but she found that when she
played, she never felt pain. ''I think the dopamine and
serotonin levels, when they kicked in -- that blocked off
the pain,'' says Brumfield, who now works for the Arizona
Council on Compulsive Gambling. ''You feel hypnotized by
the machine. You don't think of anything else.'' Near the
end, the hold the machines had over her, she says, was akin
to that of an unfaithful lover. She would fall into a
jealous rage when a favorite machine paid a jackpot to
another, less devoted player.

''Slot machines have a different impact on the brain than
other forms of gambling,'' Howard Shaffer says. Unlike
table games, which are played in groups, slots are played
in isolation, and therefore they lack the same safeguards
social situations provide. ''And because the video form is
faster than the mechanical form, they hold the potential to
behave in the fashion of psychostimulants, like cocaine or
amphetamines. They energize and de-energize the brain in
more rapid cycles. The faster on, faster off, the greater
the risk.'' Colleagues of Shaffer have compared the brain
scans of people high on cocaine with those of people while
gambling: similar neurocircuitry is lighted up in both sets
of images.

Shaffer predicts that in time electronic games will
''protect players.'' Just as the car industry implemented
basic technologies like seat belts to save lives, he
expects the gambling industry (which finances many of his
studies) to eventually employ strategies to interrupt
people when they play too fast. As Bill Eadington, the
University of Nevada, Reno, professor and a consultant to
Indian tribes, governments and casinos around the world,
puts it, ''I worry that we're burning out players too
fast.''

The typical slots player initiates a new game every six
seconds. That works out to 10 games per minute, 600 per
hour. If the average player bets $2 a spin, that player is
wagering roughly $1,200 every hour. Slot designers have
experimented with machines that play even faster, but the
industry standard remains a six-second cycle. ''It wouldn't
be much fun if we took your money any faster than that,''
Kaminkow told me with a slight shrug of his shoulder,
suggesting that just how fast people play is entirely up to
him.

I asked Kaminkow if he ever worried that the potent mix of
TV, technology and the prodigious talents of his creative
people will produce machines that are too powerful. ''What
kind of question is that?'' he replied. In his natural
state, Kaminkow is a breezy and sarcastic jokester who
revels in politically incorrect jokes. But he suddenly
sounded as if he were addressing a Rotary Club. ''I take
responsible gaming very seriously,'' he said. ''We're not
an alcohol, we're not a drug.'' He is in the entertainment
business, he added, a ''maker of small little movies'' that
bring a touch of joy and laughter to the lives of the
elderly and others.

''I'm not looking for people who say, 'I spent my milk
money,''' he said. ''I think people need to be very
responsible in their gaming habits. I know I am.''


The million-plus-square-foot facility that houses I.G.T.'s
Reno operations sits in the Sierra foothills south of
downtown. Workers use bicycles and golf carts to get around
a complex that is larger than the Reno airport. Roughly
1,600 employees staff the nine assembly lines that I.G.T.
operates for two shifts a day, five days a week. The
warehouse where parts are stored evokes the government
warehouse in the final scene from ''Raiders of the Lost
Ark.'' Maybe most impressive of all is what the company
calls its finished goods area: hundreds of gleaming
machines are stacked in row after row of shelves that reach
several stories high.

''My job is basically to keep feeding the beast,'' Kaminkow
likes to say, and toward that end he summoned a group of
his top designers to his office in the fall of 2002 to
discuss a game he was then calling ''Mega Money Ball.'' He
loved the idea of a lottery-themed game that gave the
illusion of costing just a penny to play, and he needed a
big name to ensure that it was a hit. The group considered
some of the company's regulars, like Dick Clark and Regis
Philbin, who was already under contract with I.G.T. for two
games, and also Max Baer Jr. (Jethro), who had three games,
with several more on the way. Eventually Kaminkow decided
they needed a comedian. Dennis Miller (too angry) and Jerry
Seinfeld (too expensive) were among the names bandied about
before Kaminkow suddenly bellowed, ''Nancy!'' The name that
had just crossed his mind was Drew Carey; Kaminkow was so
excited that he ignored the group and yelled for Nancy
King, who runs the company's licensing program.

Negotiations with a celebrity's people sometimes stretch
over months (''Let's just say a lot of C celebrities think
they're A's,'' King says), but Carey proved easier than
most. ''I thought, Oh, it'd be fun to be involved in the
making of a slot machine,'' Carey says, adding that he
asked himself if it would hurt his chances of ever doing
movies, a goal of his, and concluded that it would not.
''That's almost all the thought I put into it,'' he says.
It helped, of course, that his was a multigame deal that
several people inside the company confirmed is worth in the
millions even before annual royalties are figured.

Every slot machine starts with Kaminkow. ''Has Joe told you
his prima donna rule?'' several people had asked by the
time Kaminkow shared it with me (and then repeated on
successive visits). ''I tell people I've got my
one-prima-donna rule: there's room for only one prima donna
here, and I've already got the job,'' he says. But when
work began on the machine, the design team had received
little direction from the boss beyond a broad-brush mandate
to create an interesting lotterylike game that took full
advantage of Carey's talents. ''We get this pile of
vagueness,'' Baerlocher says, ''that we have to start
making into a game.'' A core group of about a dozen people
-- including Baerlocher and a junior mathematician, a
couple of computer programmers and assorted artists and
other creative types -- were assigned what was now being
called ''Big Balls of Cash.'' They all read Carey's book
''Dirty Jokes and Beer'' and then sat down to brainstorm.
''Basically we throw a lot of stuff at the wall and see
what sticks,'' says Randy Mead, the game designer charged
with coordinating the multitude of moving parts that would
become the Carey machine. ''So many of our gam es are based
on older themes that are perfect for our audience,'' Mead
explains. ''They're the same graphics, the same songs, the
same voices that those ladies really desire.'' The Carey
machine, though, offered a chance to work on ''something
much edgier and fun.''

Given the size of Carey's contract, ''Big Balls'' had to be
an important machine, important enough to slap a wholly
visible wheel on it. From almost the beginning, Kaminkow's
crew understood that the main bonus round would mimic those
commercial-like TV spots in which numbered Ping-Pong balls
are used to pick a winning lottery number. They dressed
Carey in a tuxedo and filmed him standing beside a
beautiful model in a low-cut dress. Given this premise and
the elaborate staging, a spinning wheel would seem
superfluous -- except that in the world of slot machine
design, spinning wheels are never superfluous. Baerlocher
likes to recount the time a man lined up the three ''Wheel
of Fortune'' symbols on a $1 machine. Bells rang, lights
flashed and the machine locked up, as it is programmed to
do whenever anyone hits the big jackpot. ''The casino host
comes over -- 'Congratulations, sir, you've won the big
jackpot. We're going to get people here to verify it.' And
he was like, 'Don't I get to spin the wheel?' He had just
won over a million dollars, but all he wanted to do is spin
the wheel.''

There are two basic elements to any slot machine,
Baerlocher says -- the art and the math: ''The art is used
to attract a player. That's our lure to get them to sit
down and play. That's when the game math takes over.'' The
math, he says, gives a game its personality. Baerlocher
decided that ''Big Balls'' couldn't be a cherry dribbler,
because it offered so bountiful a top prize, but he didn't
want it to be as tight as a game called ''Megabucks,''
which was already in casinos and which rarely rewarded
players with any money unless it was bestowing multiple
millions of dollars on some lucky soul. The Carey game, the
creators decided, would pay some small and medium jackpots,
but with nothing like the frequency of machines aimed at
the neophyte gambler. ''Our thinking was that people don't
want to come to a machine advertising a multimillion bonus
and walk away with a $20 or $40 win,'' Baerlocher says. The
other big question confronting the design team was how
often to initiate the bonus. Baerlocher was aiming for a
bonus that would kick in once during every 10 to 15 minutes
of play, but Kaminkow was pushing for something that would
hit more often. ''That's Joe,'' Baerlocher says. ''He wants
a machine that pays a ton of small pays, lots of
medium-size plays and a huge jackpot. In other words, he
wants us to do the impossible.''

Apparently Baerlocher accomplished just that. ''Big Balls
of Cash'' was a huge hit at last year's G2E, along with
''Star Wars'' and ''Elizabeth Taylor Dazzling Diamonds''
(described in I.G.T.'s press materials as an ''exciting new
merchandise-dispensing game'' that allows you to wear home
your winnings). I.G.T.'s designers killed many of Carey's
more candid wisecracks so as not to anger its most
important customers -- the casino executives who will
decide the machine's fate -- but there remained an
undeniable bite to the machine just the same. The company
took 150 new games to G2E, but there was often a wait to
play one of the two ''Big Balls'' machines. They were
''gaffed'' -- rigged -- to go immediately to the bonus
round, and over the three-day show it provided endless
laughs for the slots floor directors looking for new stuff.
''You've got a real winner here,'' person after person told
Kaminkow, who hovered around his two big kahunas and
''Dazzling Diamonds'' like a proud father. (''Big Balls''
is expected to make its debut in casinos at the end of this
year or early in 2005.)


Most of the people I met inside I.G.T. told me they never
played slot machines on their own time. Anthony Baerlocher
turned out to be the exception rather than the rule.
Kaminkow's wife, Kim, says she plays only ''when Joe hands
me $20 and tells me I'm supposed to play some new
machine.'' Even one corporate P.R. staff member couldn't
resist shaking her head in disbelief as she described
scenes of people lining up to play a new machine. ''It was
unfathomable to me,'' she told me. When I asked one I.G.T.
artist if he ever plays, he acted as if I had insulted him.
''Slots are for losers,'' he spat, and then, coming to his
senses, begged me to consider that an off-the-record
comment. ''Big Balls of Cash'' was designed to hold roughly
10 cents for every dollar played, but saying the obvious
inside I.G.T. -- that the very math of the slot machine
makes it a loser's game -- would not be a very good career
move.

Every so often during my time inside I.G.T. someone let me
into a locked showroom just off the building's main lobby.
Inside, I would find myriad machines clamoring for my
attention. They were in what slot designers describe as
''attract mode.'' A ''Dick Clark's New Year's Rockin' Eve''
kept announcing, ''It's a cold one in Times Square
tonight.'' A voice that sounded vaguely like Yosemite Sam
asked: ''Do you want to be rich? Oil rich?'' A familiar
voice from my TV past cried out, ''Come on down!'' Applause
emanated from a machine in the corner, and I heard Frank
Sinatra's voice: ''Thank you, ladies and gentlemen.''

On my first visit to the showroom, I jumped from game to
game, but on my second visit I stuck with a single game,
''The Price Is Right,'' which Baerlocher designed expressly
for the uninitiated. The showroom machine had 8,000 credits
on it -- $400. It wasn't my money, so I played the maximum
of $2.25 per spin. The machine constantly emitted noises:
clapping sounds, little bright chimes, the occasional
yodel. The show's theme song never stopped, driving me
batty, until finally I hit a bonus -- suddenly that theme
song turned sweet. Slot designers call it a ''rolling
sound'': the more credits you win, the longer the song
plays. At first I seemed to be winning, gathering credits
on every second or third spin. But after about 15 minutes,
I was down nearly 7,000 credits. I was winning the virtual
equivalent of 15 or 20 nickels every time I scored -- but I
was spending more than twice that with every spin. After 45
minutes, I was down below 5,000 credits. If I were playing
for real money, I would have lost more than $150.

Playing free credits is nothing like playing with your own
money, of course, so at 2 a.m. one sleepless night I
slipped a 20-dollar bill into a ''Jeannie'' machine in the
Sands casino in Reno. That bought me a full 25 minutes on
the machine and one brief bonus glimpse of Jeannie. I'm
pretty much the age of those Kaminkow is targeting with his
newer machines -- and in fact I grew up dreaming of Jeannie
-- but it's hard to imagine being seduced by any celebrity
he might trot out, even Neil Young or Lou Reed.

My brief crack at slots left me feeling somewhere between
stupid and glum. At that hour there were no cheery tourists
in brightly-patterned shirts amid the chirping of the
slots, no sunny smiles on the faces of elderly women happy
for a few hours out on the town. Several machines down from
me an older man sat slumped in his chair. His T-shirt was
riding up his overabundant belly, but he didn't seem to
care. He stared at the video screen in front of him in a
toddler-staring-at-television kind of way. Other players
around me were dressed in sweatsuits and slippers, and
there was even a woman in curlers. The hairstyles were
generally what you would expect if a fire alarm forced
people out of bed in the middle of the night. It wasn't
pleasure I saw on their faces so much as determination.

The scene called to mind an evening one year earlier when I
spent time with several undercover cops who work for
Colorado's division of gambling. Walking the casinos of
Black Hawk and Central City, a pair of side-by-side
mountain towns with dozens of casinos, we came across a
woman who had just won $5,000 playing a dollar slot
machine. The people at the Isle of Capri Casino had trotted
out a photographer and an oversize poster-board check, but
the woman wasn't smiling. In fact, she looked sad. ''I'll
tell you,'' said Michael Lask, one of the undercover
officers, ''she probably lost $10,000 to win that $5,000.
And she knows that next week she'll be giving that $5,000
right back.'' For the most part, the only smiling faces I
saw while delving into the realm of slot machines were on
the faces of I.G.T.'s designers, unless you count the
players posing on the oversize pictures that hang in the
atrium of the company's entrance.

Gary Rivlin covers Silicon Valley for The New York Times.
He is the author of ''The Plot to Get Bill Gates.''