Sunday, April 29, 2007
The New York Times
April 29, 2007
Parenting
Young, Gifted, and Not Getting Into Harvard
By MICHAEL WINERIP
ON a Sunday morning a few months back, I interviewed my final Harvard applicant of the year. After saying goodbye to the girl and watching her and her mother drive off, I headed to the beach at the end of our street for a run.
It was a spectacular winter day, bright, sunny and cold; the tide was out, the waves were high, and I had the beach to myself. As I ran, I thought the same thing I do after all these interviews: Another amazing kid who won’t get into Harvard.
That used to upset me. But I’ve changed.
Over the last decade, I’ve done perhaps 40 of these interviews, which are conducted by alumni across the country. They’re my only remaining link to my alma mater; I’ve never been back to a reunion or a football game, and my total donations since graduating in the 1970s do not add up to four figures.
No matter how glowing my recommendations, in all this time only one kid, a girl, got in, many years back. I do not tell this to the eager, well-groomed seniors who settle onto the couch in our den. They’re under too much pressure already. Better than anyone, they know the odds, particularly for a kid from a New York suburb.
By the time I meet them, they’re pros at working the system. Some have Googled me because they think knowing about me will improve their odds. After the interview, many send handwritten thank-you notes saying how much they enjoyed meeting me.
Maybe it’s true.
I used to be upset by these attempts to ingratiate. Since I’ve watched my own children go through similar torture, I find these gestures touching. Everyone’s trying so hard.
My reason for doing these interviews has shifted over time. When I started, my kids were young, and I thought it might give them a little advantage when they applied to Harvard. That has turned out not to be an issue. My oldest, now a college freshman, did not apply, nor will my twins, who are both high school juniors.
We are not snubbing Harvard. Even my oldest, who is my most academic son, did not quite have the class rank or the SATs. His SAT score was probably 100 points too low — though it was identical to the SAT score that got me in 35 years ago.
Why do I continue to interview? It’s very moving meeting all these bright young people who won’t get into Harvard. Recent news articles make it sound unbearably tragic. Several Ivies, including Harvard, rejected a record number of applicants this year.
Actually, meeting the soon-to-be rejected makes me hopeful about young people. They are far more accomplished than I was at their age and without a doubt will do superbly wherever they go.
Knowing me and seeing them is like witnessing some major evolutionary change take place in just 35 years, from the Neanderthal Harvard applicant of 1970 to today’s fully evolved Homo sapiens applicant.
There was the girl who, during summer vacation, left her house before 7 each morning to make a two-hour train ride to a major university, where she worked all day doing cutting-edge research for NASA on weightlessness in mice.
When I was in high school, my 10th-grade science project was on plant tropism — a shoebox with soil and bean sprouts bending toward the light.
These kids who don’t get into Harvard spend summers on schooners in Chesapeake Bay studying marine biology, building homes for the poor in Central America, touring Europe with all-star orchestras.
Summers, I dug trenches for my local sewer department during the day, and sold hot dogs at Fenway Park at night.
As I listen to them, I can visualize their parents, striving to teach excellence. One girl I interviewed described how her father made her watch the 2004 convention speeches by both President Bush and Senator John Kerry and then tell him which she liked better and why.
What kind of kid doesn’t get into Harvard? Well, there was the charming boy I interviewed with 1560 SATs. He did cancer research in the summer; played two instruments in three orchestras; and composed his own music. He redid the computer system for his student paper, loved to cook and was writing his own cookbook. One of his specialties was snapper poached in tea and served with noodle cake.
At his age, when I got hungry, I made myself peanut butter and jam on white bread and got into Harvard.
Some take 10 AP courses and get top scores of 5 on all of them.
I took one AP course and scored 3.
Of course, evolution is not the same as progress. These kids have an AP history textbook that has been specially created to match the content of the AP test, as well as review books and tutors for those tests. We had no AP textbook; many of our readings came from primary documents, and there was no Princeton Review then. I was never tutored in anything and walked into the SATs without having seen a sample SAT question.
As for my bean sprouts project, as bad it was, I did it alone. I interview kids who describe how their schools provide a statistician to analyze their science project data.
I see these kids — and watch my own applying to college — and as evolved as they are, I wouldn’t change places with them for anything. They’re under such pressure.
I used to say goodbye at my door, but since my own kids reached this age, I walk them out to their cars, where a parent waits. I always say the same thing to the mom or dad: “You’ve done a wonderful job — you should be very proud.” And I mean it.
But I’ve stopped feeling bad about the looming rejection. When my four were little, I used to hope a couple might go to Harvard. I pushed them, but by the end of middle school it was clear my twins, at least, were not made that way. They rebelled, and I had to learn to see who they were.
I came to understand that my own focus on Harvard was a matter of not sophistication but narrowness. I grew up in an unworldly blue-collar environment. Getting perfect grades and attending an elite college was one of the few ways up I could see.
My four have been raised in an upper-middle-class world. They look around and see lots of avenues to success. My wife’s two brothers struggled as students at mainstream colleges and both have made wonderful full lives, one as a salesman, the other as a builder. Each found his own best path. Each knows excellence.
That day, running on the beach, I was lost in my thoughts when a voice startled me. “Pops, hey, Pops!” It was Sammy, one of my twins, who’s probably heading for a good state school. He was in his wetsuit, surfing alone in the 30-degree weather, the only other person on the beach. “What a day!” he yelled, and his joy filled my heart.
E-mail: parenting@nytimes.com
April 29, 2007
Parenting
Young, Gifted, and Not Getting Into Harvard
By MICHAEL WINERIP
ON a Sunday morning a few months back, I interviewed my final Harvard applicant of the year. After saying goodbye to the girl and watching her and her mother drive off, I headed to the beach at the end of our street for a run.
It was a spectacular winter day, bright, sunny and cold; the tide was out, the waves were high, and I had the beach to myself. As I ran, I thought the same thing I do after all these interviews: Another amazing kid who won’t get into Harvard.
That used to upset me. But I’ve changed.
Over the last decade, I’ve done perhaps 40 of these interviews, which are conducted by alumni across the country. They’re my only remaining link to my alma mater; I’ve never been back to a reunion or a football game, and my total donations since graduating in the 1970s do not add up to four figures.
No matter how glowing my recommendations, in all this time only one kid, a girl, got in, many years back. I do not tell this to the eager, well-groomed seniors who settle onto the couch in our den. They’re under too much pressure already. Better than anyone, they know the odds, particularly for a kid from a New York suburb.
By the time I meet them, they’re pros at working the system. Some have Googled me because they think knowing about me will improve their odds. After the interview, many send handwritten thank-you notes saying how much they enjoyed meeting me.
Maybe it’s true.
I used to be upset by these attempts to ingratiate. Since I’ve watched my own children go through similar torture, I find these gestures touching. Everyone’s trying so hard.
My reason for doing these interviews has shifted over time. When I started, my kids were young, and I thought it might give them a little advantage when they applied to Harvard. That has turned out not to be an issue. My oldest, now a college freshman, did not apply, nor will my twins, who are both high school juniors.
We are not snubbing Harvard. Even my oldest, who is my most academic son, did not quite have the class rank or the SATs. His SAT score was probably 100 points too low — though it was identical to the SAT score that got me in 35 years ago.
Why do I continue to interview? It’s very moving meeting all these bright young people who won’t get into Harvard. Recent news articles make it sound unbearably tragic. Several Ivies, including Harvard, rejected a record number of applicants this year.
Actually, meeting the soon-to-be rejected makes me hopeful about young people. They are far more accomplished than I was at their age and without a doubt will do superbly wherever they go.
Knowing me and seeing them is like witnessing some major evolutionary change take place in just 35 years, from the Neanderthal Harvard applicant of 1970 to today’s fully evolved Homo sapiens applicant.
There was the girl who, during summer vacation, left her house before 7 each morning to make a two-hour train ride to a major university, where she worked all day doing cutting-edge research for NASA on weightlessness in mice.
When I was in high school, my 10th-grade science project was on plant tropism — a shoebox with soil and bean sprouts bending toward the light.
These kids who don’t get into Harvard spend summers on schooners in Chesapeake Bay studying marine biology, building homes for the poor in Central America, touring Europe with all-star orchestras.
Summers, I dug trenches for my local sewer department during the day, and sold hot dogs at Fenway Park at night.
As I listen to them, I can visualize their parents, striving to teach excellence. One girl I interviewed described how her father made her watch the 2004 convention speeches by both President Bush and Senator John Kerry and then tell him which she liked better and why.
What kind of kid doesn’t get into Harvard? Well, there was the charming boy I interviewed with 1560 SATs. He did cancer research in the summer; played two instruments in three orchestras; and composed his own music. He redid the computer system for his student paper, loved to cook and was writing his own cookbook. One of his specialties was snapper poached in tea and served with noodle cake.
At his age, when I got hungry, I made myself peanut butter and jam on white bread and got into Harvard.
Some take 10 AP courses and get top scores of 5 on all of them.
I took one AP course and scored 3.
Of course, evolution is not the same as progress. These kids have an AP history textbook that has been specially created to match the content of the AP test, as well as review books and tutors for those tests. We had no AP textbook; many of our readings came from primary documents, and there was no Princeton Review then. I was never tutored in anything and walked into the SATs without having seen a sample SAT question.
As for my bean sprouts project, as bad it was, I did it alone. I interview kids who describe how their schools provide a statistician to analyze their science project data.
I see these kids — and watch my own applying to college — and as evolved as they are, I wouldn’t change places with them for anything. They’re under such pressure.
I used to say goodbye at my door, but since my own kids reached this age, I walk them out to their cars, where a parent waits. I always say the same thing to the mom or dad: “You’ve done a wonderful job — you should be very proud.” And I mean it.
But I’ve stopped feeling bad about the looming rejection. When my four were little, I used to hope a couple might go to Harvard. I pushed them, but by the end of middle school it was clear my twins, at least, were not made that way. They rebelled, and I had to learn to see who they were.
I came to understand that my own focus on Harvard was a matter of not sophistication but narrowness. I grew up in an unworldly blue-collar environment. Getting perfect grades and attending an elite college was one of the few ways up I could see.
My four have been raised in an upper-middle-class world. They look around and see lots of avenues to success. My wife’s two brothers struggled as students at mainstream colleges and both have made wonderful full lives, one as a salesman, the other as a builder. Each found his own best path. Each knows excellence.
That day, running on the beach, I was lost in my thoughts when a voice startled me. “Pops, hey, Pops!” It was Sammy, one of my twins, who’s probably heading for a good state school. He was in his wetsuit, surfing alone in the 30-degree weather, the only other person on the beach. “What a day!” he yelled, and his joy filled my heart.
E-mail: parenting@nytimes.com
The New York Times
April 24, 2007
Behavior
Understanding Empathy: Can You Feel My Pain?
By RICHARD A. FRIEDMAN, M.D.
“Can I ask you a question?” the young woman ventured. “Have you ever been depressed? Do you have any idea how bad it feels?”
The patient, a married woman in her late 20s, had been tearfully describing her symptoms of depression during a consultation when she suddenly popped this question.
How could I possibly understand or help her, she seemed to be asking, if I had not personally experienced her pain?
Her question caught me by surprise and made me pause. O.K., I’ll admit it. I’m a cheerful guy who’s never really tasted clinical depression. But along the way I think I’ve successfully treated many severely depressed patients.
Is shared experience really necessary for a physician to understand or treat a patient? I wonder. After all, who would argue that a cardiologist would be more competent if he had had his own heart attack, or an oncologist more effective if he had had a brush with cancer?
Of course, a patient might feel more comfortable with a physician who has had personal experience with his medical illness, but that alone wouldn’t guarantee understanding, much less good treatment.
Still, many patients want their doctor to be someone with whom they can identify, not just a technically competent professional who can alleviate their pain.
As a psychiatrist, I’ve met many patients who have made requests for a specific type of therapist: African-Americans who want a black psychiatrist, Orthodox Jews who insist on a Jewish psychotherapist, women who ask for a feminist therapist and so on.
Not long ago, a gay man in his 30s called me to ask for a referral to a gay therapist. He was adamant about seeing only a gay clinician. “I can’t take the chance of getting a homophobic shrink,” he said.
His assumption was that if a therapist shared his sexual orientation or ethnic group, there would be a kind of guaranteed basis for understanding or acceptance.
I did, in fact, refer him to an excellent colleague who happens to be gay, but the brief conversation left me troubled. All these patients who were searching for understanding had a misconception, I think, of what empathy is all about.
What is critical to understanding someone is not necessarily having had his or her experience; it is being able to imagine what it would be like to have it. Thus, I do not have to be black to empathize with the toxic effects of racial prejudice, or be a woman to know how I would feel about being denied promotion on the basis of sex.
Contrary to what many people believe, being empathic is not the same thing as being nice. In fact, empathy can sometimes be put to a very dark purpose.
When the Nazis were bombing Rotterdam in World War II, for example, they put sirens on the Stuka dive-bombers knowing full well that the sound would terrify and disorganize the Dutch. The Nazis imagined perfectly how the Dutch would feel and react. Fiendish, but the very essence of empathy.
In the right hands, empathy has tremendous positive therapeutic force and can narrow what looks like an unbridgeable gap between patients and therapists.
A few years back, I saw an elderly woman who had just lost her husband to cancer. “Oh, I hadn’t realized you were so young!” she exclaimed. “No offense, but maybe I need to see someone who’s a bit older.”
I asked her, “Are you worried that I can’t know what it feels like to lose someone you love and face life without him?”
True, I had never lost a partner, but it wasn’t hard to imagine her grief and anxiety about her future. That must have done the trick, because she stayed in treatment and never again mentioned my age.
Sometimes, though, patients should get exactly what they ask for in a therapist. One of my residents once saw a young woman from Africa who had survived hideous torture and rape and said that she didn’t think she could see a male therapist.
That struck me as entirely appropriate. Given her trauma, she simply could not have put her trust in a male therapist, no matter how empathic he might actually be.
What about patients whose demand for a particular therapist springs from nothing more than everyday prejudice? I remember a patient who once stormed into my office and demanded a white therapist to replace his therapist, who was black.
That’s a request I turned down, even knowing that this patient’s biased beliefs were an appropriate target for treatment. To do otherwise would have vindicated his prejudice and fundamentally compromised the therapy from the start.
In the end, empathy is what makes it possible for us to read each other. And it is the reason your doctor can understand your problem without actually having to live it.
Richard A. Friedman is director of the psychopharmacology clinic at the Weill Medical College of Cornell University.
April 24, 2007
Behavior
Understanding Empathy: Can You Feel My Pain?
By RICHARD A. FRIEDMAN, M.D.
“Can I ask you a question?” the young woman ventured. “Have you ever been depressed? Do you have any idea how bad it feels?”
The patient, a married woman in her late 20s, had been tearfully describing her symptoms of depression during a consultation when she suddenly popped this question.
How could I possibly understand or help her, she seemed to be asking, if I had not personally experienced her pain?
Her question caught me by surprise and made me pause. O.K., I’ll admit it. I’m a cheerful guy who’s never really tasted clinical depression. But along the way I think I’ve successfully treated many severely depressed patients.
Is shared experience really necessary for a physician to understand or treat a patient? I wonder. After all, who would argue that a cardiologist would be more competent if he had had his own heart attack, or an oncologist more effective if he had had a brush with cancer?
Of course, a patient might feel more comfortable with a physician who has had personal experience with his medical illness, but that alone wouldn’t guarantee understanding, much less good treatment.
Still, many patients want their doctor to be someone with whom they can identify, not just a technically competent professional who can alleviate their pain.
As a psychiatrist, I’ve met many patients who have made requests for a specific type of therapist: African-Americans who want a black psychiatrist, Orthodox Jews who insist on a Jewish psychotherapist, women who ask for a feminist therapist and so on.
Not long ago, a gay man in his 30s called me to ask for a referral to a gay therapist. He was adamant about seeing only a gay clinician. “I can’t take the chance of getting a homophobic shrink,” he said.
His assumption was that if a therapist shared his sexual orientation or ethnic group, there would be a kind of guaranteed basis for understanding or acceptance.
I did, in fact, refer him to an excellent colleague who happens to be gay, but the brief conversation left me troubled. All these patients who were searching for understanding had a misconception, I think, of what empathy is all about.
What is critical to understanding someone is not necessarily having had his or her experience; it is being able to imagine what it would be like to have it. Thus, I do not have to be black to empathize with the toxic effects of racial prejudice, or be a woman to know how I would feel about being denied promotion on the basis of sex.
Contrary to what many people believe, being empathic is not the same thing as being nice. In fact, empathy can sometimes be put to a very dark purpose.
When the Nazis were bombing Rotterdam in World War II, for example, they put sirens on the Stuka dive-bombers knowing full well that the sound would terrify and disorganize the Dutch. The Nazis imagined perfectly how the Dutch would feel and react. Fiendish, but the very essence of empathy.
In the right hands, empathy has tremendous positive therapeutic force and can narrow what looks like an unbridgeable gap between patients and therapists.
A few years back, I saw an elderly woman who had just lost her husband to cancer. “Oh, I hadn’t realized you were so young!” she exclaimed. “No offense, but maybe I need to see someone who’s a bit older.”
I asked her, “Are you worried that I can’t know what it feels like to lose someone you love and face life without him?”
True, I had never lost a partner, but it wasn’t hard to imagine her grief and anxiety about her future. That must have done the trick, because she stayed in treatment and never again mentioned my age.
Sometimes, though, patients should get exactly what they ask for in a therapist. One of my residents once saw a young woman from Africa who had survived hideous torture and rape and said that she didn’t think she could see a male therapist.
That struck me as entirely appropriate. Given her trauma, she simply could not have put her trust in a male therapist, no matter how empathic he might actually be.
What about patients whose demand for a particular therapist springs from nothing more than everyday prejudice? I remember a patient who once stormed into my office and demanded a white therapist to replace his therapist, who was black.
That’s a request I turned down, even knowing that this patient’s biased beliefs were an appropriate target for treatment. To do otherwise would have vindicated his prejudice and fundamentally compromised the therapy from the start.
In the end, empathy is what makes it possible for us to read each other. And it is the reason your doctor can understand your problem without actually having to live it.
Richard A. Friedman is director of the psychopharmacology clinic at the Weill Medical College of Cornell University.
Saturday, April 28, 2007
The New York Times
April 22, 2007
The Nation
When the Group Is Wise
By BENEDICT CAREY
Correction Appended
SEUNG-HUI CHO seemed indifferent to every small act of human kindness, any effort to connect.
According to classmates of Mr. Cho, the Virginia Tech killer, one student made several attempts to speak to him, even after reading his frightening writings. Mr. Cho’s suitemates, and some teachers, too, made an effort to engage him. And there were undoubtedly others. Maybe they signaled their openness with a slight nod, a friendly widening of the eyes.
Those acts of genuine decency failed to prevent Mr. Cho’s rampage on Monday. But the tragedy in Blacksburg, Va., illustrates how human social groups, whether in classrooms, boardrooms or dormitories, are in fact exquisitely sensitive to a threat in their midst, and act in ways both conscious and unconscious to test how dangerous it is. Take a step back, and the peer group can be seen as a single organism that recoils from a threat, then sends out feelers, in the form of overtures from its members, to gauge whether danger is imminent or might be reduced.
The Blacksburg case suggests just how this process typically works, and highlights its strengths as well as its limits in preventing a crisis.
After this shooting (and most school and workplace rampages, big and small), forensic experts quickly and properly cautioned that no profile of a rampage killer exists. Most predatory killers score very highly on the most rigorously tested measure to predict violence, the so-called psychopathy checklist; but many who do not commit crimes also score high.
Yet out in the world, no one uses questionnaires or diagnostic manuals to check out a stranger or an acquaintance. People read the other person’s body language, tone of voice; they read between the lines of what is said. They absorb most of this information instantly, unconsciously, and often accurately, studies suggest. And they sometimes get the creeps — for reasons they might not be able to explain right away.
The evidence that this happened over the months and years before the shooting in Blacksburg is now abundant. After hearing Mr. Cho read one of his sinister poems in a creative-writing class, dozens of his classmates did not show up the next time the class met, so as to avoid the young man, according to the teacher. This is what most human social groups do, when they collectively register a threat: they move away, socially and often literally.
The thousands of years that early humans lived in small, fragile kin groups helped shape their instinct for social distancing, anthropologists say. A person who steals, who lies or who incites fights is a direct threat not only to those lured into confrontations but also to the coherence and ultimate survival of the group itself.
“Social stigma is rooted in part in a concern for social predictability,” said Robert Kurzban, a psychologist at the University of Pennsylvania. “One thing that’s crucial in groups, particularly small groups, is cooperation, and if someone is unpredictable, they don’t cooperate or coordinate well and represent a group threat. So people look out for such individuals.”
To guard against a real threat, this instinct is naturally conservative. It flags as potentially threatening many people who aren’t, as millions of people living with mental illness have experienced firsthand.
In some ancient societies and religious communities, the rules that guided how to manage a person thought to be dangerous were very explicit, said David Sloan Wilson, an evolutionary biologist at the State University of New York at Binghamton and the author of “Evolution for Everyone.” Bad gossip, followed by a rebuke, then ostracism. Each stage sets in motion more isolation. This escalating discipline protects the community but is also intended to bring about a change of heart in the outcast.
Finally, if such a change isn’t forthcoming, there is expulsion. “For some nomadic cultures, it was as simple as saying, ‘O.K., you go this way, we’re going that way,’ ” Dr. Wilson said.
Modern societies are — blessedly, for most people — far more tolerant. Their justice systems are less likely to be swayed by hearsay, or claims of possession and superstition. People perceived as threatening have some civil rights, and as the Virginia Tech case showed, the authorities are limited in what they can do if a person of interest hasn’t actually made threats or attacks.
Still, the peer group is tracking the person carefully and, deliberately or not, doing its own tests for a threat.
For some 20 years, Lawrence Palinkas, a professor of social work at the University of Southern California, has studied the social networks that form like crystals among work teams who spend the winter together in scientific missions in Antarctica. The groups, which range in size from a dozen people to nearly 200, very often have at least one outcast. That person may be simply unlucky, picked on by influential people central to the group. But often the person helps define the identities of those who make up the group’s core.
“It’s a stable situation, because in a way that isolated person helps define a group; people look at him and can say, ‘I’m not like him, someone who doesn’t fit in,’ ” Dr. Palinkas said.
It often happens, Dr. Palinkas has found, that another group member makes an investment and helps reel the outcast back in. But this is much more likely to succeed when the main group is a cohesive one, like a team or work crew with a tightly bound inner core, Dr. Palinkas said. “If it’s a group that is split into factions, diffuse, not well integrated, then it is very hard to integrate the isolates,” he said.
Large college campuses tend to be tolerant, fluid, self-enclosed societies, where almost anyone can find a niche. The peer group around Mr. Cho, even as he avoided direct eye contact, seemed to be extending a tentacle now and then, to see if the young man was ready to find his own place. The student who tried to talk to Mr. Cho in English class, Ross Alameddine, made several attempts.
Mr. Cho ignored every one, and many more from others who were less patient.
Debate will undoubtedly continue about what could have, or should have, been done by university officials, campus police officers or the Virginia mental health system. Teachers will have their say, as will administrators.
But it is clear from interviews that many of Mr. Cho’s peers knew in their guts the danger the young man presented. They sent up alarms, even while watching him. They kept their distance, as a natural protective instinct.
And through the spirit of people like Mr. Alameddine, who would become one of the random shooting victims, they continued to send out feelers: small human invitations that, in the shadow of what was to come, now look very large indeed.
April 22, 2007
The Nation
When the Group Is Wise
By BENEDICT CAREY
Correction Appended
SEUNG-HUI CHO seemed indifferent to every small act of human kindness, any effort to connect.
According to classmates of Mr. Cho, the Virginia Tech killer, one student made several attempts to speak to him, even after reading his frightening writings. Mr. Cho’s suitemates, and some teachers, too, made an effort to engage him. And there were undoubtedly others. Maybe they signaled their openness with a slight nod, a friendly widening of the eyes.
Those acts of genuine decency failed to prevent Mr. Cho’s rampage on Monday. But the tragedy in Blacksburg, Va., illustrates how human social groups, whether in classrooms, boardrooms or dormitories, are in fact exquisitely sensitive to a threat in their midst, and act in ways both conscious and unconscious to test how dangerous it is. Take a step back, and the peer group can be seen as a single organism that recoils from a threat, then sends out feelers, in the form of overtures from its members, to gauge whether danger is imminent or might be reduced.
The Blacksburg case suggests just how this process typically works, and highlights its strengths as well as its limits in preventing a crisis.
After this shooting (and most school and workplace rampages, big and small), forensic experts quickly and properly cautioned that no profile of a rampage killer exists. Most predatory killers score very highly on the most rigorously tested measure to predict violence, the so-called psychopathy checklist; but many who do not commit crimes also score high.
Yet out in the world, no one uses questionnaires or diagnostic manuals to check out a stranger or an acquaintance. People read the other person’s body language, tone of voice; they read between the lines of what is said. They absorb most of this information instantly, unconsciously, and often accurately, studies suggest. And they sometimes get the creeps — for reasons they might not be able to explain right away.
The evidence that this happened over the months and years before the shooting in Blacksburg is now abundant. After hearing Mr. Cho read one of his sinister poems in a creative-writing class, dozens of his classmates did not show up the next time the class met, so as to avoid the young man, according to the teacher. This is what most human social groups do, when they collectively register a threat: they move away, socially and often literally.
The thousands of years that early humans lived in small, fragile kin groups helped shape their instinct for social distancing, anthropologists say. A person who steals, who lies or who incites fights is a direct threat not only to those lured into confrontations but also to the coherence and ultimate survival of the group itself.
“Social stigma is rooted in part in a concern for social predictability,” said Robert Kurzban, a psychologist at the University of Pennsylvania. “One thing that’s crucial in groups, particularly small groups, is cooperation, and if someone is unpredictable, they don’t cooperate or coordinate well and represent a group threat. So people look out for such individuals.”
To guard against a real threat, this instinct is naturally conservative. It flags as potentially threatening many people who aren’t, as millions of people living with mental illness have experienced firsthand.
In some ancient societies and religious communities, the rules that guided how to manage a person thought to be dangerous were very explicit, said David Sloan Wilson, an evolutionary biologist at the State University of New York at Binghamton and the author of “Evolution for Everyone.” Bad gossip, followed by a rebuke, then ostracism. Each stage sets in motion more isolation. This escalating discipline protects the community but is also intended to bring about a change of heart in the outcast.
Finally, if such a change isn’t forthcoming, there is expulsion. “For some nomadic cultures, it was as simple as saying, ‘O.K., you go this way, we’re going that way,’ ” Dr. Wilson said.
Modern societies are — blessedly, for most people — far more tolerant. Their justice systems are less likely to be swayed by hearsay, or claims of possession and superstition. People perceived as threatening have some civil rights, and as the Virginia Tech case showed, the authorities are limited in what they can do if a person of interest hasn’t actually made threats or attacks.
Still, the peer group is tracking the person carefully and, deliberately or not, doing its own tests for a threat.
For some 20 years, Lawrence Palinkas, a professor of social work at the University of Southern California, has studied the social networks that form like crystals among work teams who spend the winter together in scientific missions in Antarctica. The groups, which range in size from a dozen people to nearly 200, very often have at least one outcast. That person may be simply unlucky, picked on by influential people central to the group. But often the person helps define the identities of those who make up the group’s core.
“It’s a stable situation, because in a way that isolated person helps define a group; people look at him and can say, ‘I’m not like him, someone who doesn’t fit in,’ ” Dr. Palinkas said.
It often happens, Dr. Palinkas has found, that another group member makes an investment and helps reel the outcast back in. But this is much more likely to succeed when the main group is a cohesive one, like a team or work crew with a tightly bound inner core, Dr. Palinkas said. “If it’s a group that is split into factions, diffuse, not well integrated, then it is very hard to integrate the isolates,” he said.
Large college campuses tend to be tolerant, fluid, self-enclosed societies, where almost anyone can find a niche. The peer group around Mr. Cho, even as he avoided direct eye contact, seemed to be extending a tentacle now and then, to see if the young man was ready to find his own place. The student who tried to talk to Mr. Cho in English class, Ross Alameddine, made several attempts.
Mr. Cho ignored every one, and many more from others who were less patient.
Debate will undoubtedly continue about what could have, or should have, been done by university officials, campus police officers or the Virginia mental health system. Teachers will have their say, as will administrators.
But it is clear from interviews that many of Mr. Cho’s peers knew in their guts the danger the young man presented. They sent up alarms, even while watching him. They kept their distance, as a natural protective instinct.
And through the spirit of people like Mr. Alameddine, who would become one of the random shooting victims, they continued to send out feelers: small human invitations that, in the shadow of what was to come, now look very large indeed.
Thursday, April 26, 2007
The New York Times
April 22, 2007
Life’s Work
Sharing Practical Truths, in Child-Size Measures
By LISA BELKIN
I RECENTLY had a chance to speak to a cafeteria full of high school girls at the Lincoln School in Providence, R.I. Each had been asked to invite a woman she admires, and most brought their moms, making it the first time I spoke to an audience of mothers and daughters.
As I talked about life and work, and how some days the balancing act doesn’t go very well, the mothers nodded knowingly while the students were polite, but looked confused.
The evening resonates for me as companies across the country prepare to participate in Take Our Children to Work Day on Thursday. At some offices, there will be just a handful of children, sitting by their parents’ side, watching them go through a quasitypical day. At others, there will be thousands, and they will participate in elaborate programs paid out of the corporate budget.
I wonder how many of these parents, however, have thought about exactly what they want their sons and daughters to learn about work.
After my talk at the Lincoln School, mothers came up to tell me that this was the first time they had ever thought to talk to their girls about the challenges of combining work and parenting. Do any of us think to have those talks?
When we talk to our children about sex, about alcohol and drugs, or about the dangers of the Internet, we give them limitations and warnings. But when it comes to the subject of work, we tell them that they can be whatever they aspire to be; that they should aim high, work hard and dream big.
What we rarely do is tell them how hard some days are. Or that along the road, they might have to compromise, or detour, or backtrack. To warn them would be to discourage them. Or so our thinking goes.
The morning after my speech I met with smaller groups of students in workshops, where I heard that many of them had learned quite a lot about their mothers during their rides home the night before.
One girl heard for the first time how her mother was still wistful over her choice not to go to medical school after she’d learned she was pregnant. Another mother described a recent itch to get back into the work force after a few years of being away, and the unfamiliar frustration of being seen by employers as too old.
How many of you, I asked, were regularly told by your mothers that you can be whatever you want to be? Every girl in the room raised her hand. Then I asked: “How many of your mothers have worked full time for most of your lives?” In each of two workshops, with about 25 girls each, only one or two hands went up.
The message: Do as I say, not as I have been able to do.
We are telling our children only half the truth. We are doing this to both boys and girls — as it happens, the Lincoln School is girls only — and we are leaving them ill-prepared.
Of course we want to tell them that they can achieve all they can envision. But we also need to tell them that those visions may change color and scope along the way. Of course we want to tell them that hard work will pave their way. But we must also warn them that sometimes it won’t be enough, and that they will have to choose, because the whole of work and the whole of life rarely fit neatly into every working day.
There is the risk that this will discourage them, but the alternative, I think, is worse. Thinking that we could do it all, then crashing headlong into the wall of “but not at the same time” is part of the reason that so many women have left the work force in frustration in recent years.
Thinking that hard work will get them anywhere is what led so many to believe that re-entry would be much easier than it is proving to be.
IN her new book, “The Feminine Mistake,” Leslie Bennetts writes about the destructive assumption that women can leave their jobs without financial risk. Unprepared for the imperfections of the workplace and the “second shift” at home, they assume that their inability to balance is their own failure. So they leave, trusting that their husbands will stay alive and faithful, and that the workplace will remain eager for their return.
Will an understanding that Mom regularly drops the ball give them permission to do so, too? Will frank talk about the bad days provide inoculation against them? Will eyes open to the faults of an inflexible workplace make them more likely to insist on change?
Maybe not. But as parents we must hope that there are more answers for them than there were for us, just as we had more than our mothers. And the only way to find those answers is to teach our children — early and often — how to ask the questions.
This column about the intersection of jobs and personal lives appears every other week. E-mail: Belkin@nytimes.com.
April 22, 2007
Life’s Work
Sharing Practical Truths, in Child-Size Measures
By LISA BELKIN
I RECENTLY had a chance to speak to a cafeteria full of high school girls at the Lincoln School in Providence, R.I. Each had been asked to invite a woman she admires, and most brought their moms, making it the first time I spoke to an audience of mothers and daughters.
As I talked about life and work, and how some days the balancing act doesn’t go very well, the mothers nodded knowingly while the students were polite, but looked confused.
The evening resonates for me as companies across the country prepare to participate in Take Our Children to Work Day on Thursday. At some offices, there will be just a handful of children, sitting by their parents’ side, watching them go through a quasitypical day. At others, there will be thousands, and they will participate in elaborate programs paid out of the corporate budget.
I wonder how many of these parents, however, have thought about exactly what they want their sons and daughters to learn about work.
After my talk at the Lincoln School, mothers came up to tell me that this was the first time they had ever thought to talk to their girls about the challenges of combining work and parenting. Do any of us think to have those talks?
When we talk to our children about sex, about alcohol and drugs, or about the dangers of the Internet, we give them limitations and warnings. But when it comes to the subject of work, we tell them that they can be whatever they aspire to be; that they should aim high, work hard and dream big.
What we rarely do is tell them how hard some days are. Or that along the road, they might have to compromise, or detour, or backtrack. To warn them would be to discourage them. Or so our thinking goes.
The morning after my speech I met with smaller groups of students in workshops, where I heard that many of them had learned quite a lot about their mothers during their rides home the night before.
One girl heard for the first time how her mother was still wistful over her choice not to go to medical school after she’d learned she was pregnant. Another mother described a recent itch to get back into the work force after a few years of being away, and the unfamiliar frustration of being seen by employers as too old.
How many of you, I asked, were regularly told by your mothers that you can be whatever you want to be? Every girl in the room raised her hand. Then I asked: “How many of your mothers have worked full time for most of your lives?” In each of two workshops, with about 25 girls each, only one or two hands went up.
The message: Do as I say, not as I have been able to do.
We are telling our children only half the truth. We are doing this to both boys and girls — as it happens, the Lincoln School is girls only — and we are leaving them ill-prepared.
Of course we want to tell them that they can achieve all they can envision. But we also need to tell them that those visions may change color and scope along the way. Of course we want to tell them that hard work will pave their way. But we must also warn them that sometimes it won’t be enough, and that they will have to choose, because the whole of work and the whole of life rarely fit neatly into every working day.
There is the risk that this will discourage them, but the alternative, I think, is worse. Thinking that we could do it all, then crashing headlong into the wall of “but not at the same time” is part of the reason that so many women have left the work force in frustration in recent years.
Thinking that hard work will get them anywhere is what led so many to believe that re-entry would be much easier than it is proving to be.
IN her new book, “The Feminine Mistake,” Leslie Bennetts writes about the destructive assumption that women can leave their jobs without financial risk. Unprepared for the imperfections of the workplace and the “second shift” at home, they assume that their inability to balance is their own failure. So they leave, trusting that their husbands will stay alive and faithful, and that the workplace will remain eager for their return.
Will an understanding that Mom regularly drops the ball give them permission to do so, too? Will frank talk about the bad days provide inoculation against them? Will eyes open to the faults of an inflexible workplace make them more likely to insist on change?
Maybe not. But as parents we must hope that there are more answers for them than there were for us, just as we had more than our mothers. And the only way to find those answers is to teach our children — early and often — how to ask the questions.
This column about the intersection of jobs and personal lives appears every other week. E-mail: Belkin@nytimes.com.
Thursday, April 19, 2007
The New York Times
April 19, 2007
Laws Limit Options When a Student Is Mentally Ill
By TAMAR LEWIN
Federal privacy and antidiscrimination laws restrict how universities can deal with students who have mental health problems.
For the most part, universities cannot tell parents about their children’s problems without the student’s consent. They cannot release any information in a student’s medical record without consent. And they cannot put students on involuntary medical leave, just because they develop a serious mental illness.
Nor is knowing when to worry about student behavior, and what action to take, always so clear.
“They can’t really kick someone out because they’re writing papers about weird topics, even if they seem withdrawn and hostile,” said Dr. Richard Kadison, chief of mental health services at Harvard University. “Most state laws are pretty clear: you can only bring students to hospitals if there is imminent risk to themselves or someone else, so universities are in a bit of a bind that way.”
But, he said, some schools do mandate limited amounts of treatment in certain circumstances.
“At the University of Missouri, if someone makes a suicide attempt, they mandate four counseling sessions, for example,” said Dr. Kadison, an author of “College of the Overwhelmed: The Campus Mental Health Crisis and What To Do About It.”
Universities can find themselves in a double bind. On the one hand, they may be liable if they fail to prevent a suicide or murder. After the death in 2000 of Elizabeth H. Shin, a student at the Massachusetts Institute of Technology who had written several suicide notes and used the university counseling service before setting herself on fire, the Massachusetts Superior Court allowed her parents, who had not been told of her deterioration, to sue administrators for $27.7 million. The case was settled for an undisclosed amount.
On the other hand, universities may be held liable if they do take action to remove a potentially suicidal student. In August, the City University of New York agreed to pay $65,000 to a student who sued after being barred from her dormitory room at Hunter College because she was hospitalized after a suicide attempt.
Also last year, George Washington University reached a confidential settlement in a case charging that it had violated antidiscrimination laws by suspending Jordan Nott, a student who had sought hospitalization for depression.
“This is a very, very difficult and gray area, when you take action to remove the student from the campus environment, versus when you encourage the student to use the resources available on campus,” said Ada Meloy, director of legal and regulatory affairs at the American Council on Education. “In an emergency, you can share certain information, but it’s not clear what’s an emergency.”
Ms. Meloy estimated that situations complicated enough to involve a university’s lawyers arise, on average, about twice a semester at large universities.
While shootings like the one at Virginia Tech are extremely rare, suicides, threats and serious mental-health problems are not. Last year, the American College Health Association’s National College Health Assessment, covering nearly 95,000 students at 117 campuses, found that 9 percent of students had seriously considered suicide in the previous year, and 1 in 100 had attempted it.
So mental health experts emphasize that, whatever a college’s concerns about liability, the goal of campus policies should be to maximize the likelihood that those who need mental-health treatment will get it.
“What we really need to do is encourage students to seek mental health treatment if they need it, to remove any barriers to their getting help, destigmatize it, and make it safe, so they know there won’t be negative consequences,” said Karen Bower, a lawyer at the Bazelon Center for Mental Health Law in Washington, who represented Mr. Nott.
With the Virginia Tech killings, many universities are planning to remind faculty members of their protocols. “We’re actually going to go ahead and have the counseling service here do a session for all our instructors and faculty on what to look for, what the procedures are, and what the counseling center can do,” said Shannon Miller, chairwoman of the English department at Temple University.
At Harvard, Dr. Kadison said, dormitory resident assistants watch for signs of trouble, and are usually the first to become aware of worrisome behavior — and to call a dean.
“The dean might insist that they get an evaluation to make sure they’re healthy enough to live in a dorm,” he said. “If it’s not thought that they’re in any immediate danger, they can take or not take the recommendation.”
Last month, Virginia passed a law, the first in the nation, prohibiting public colleges and universities from expelling or punishing students solely for attempting suicide or seeking mental-health treatment for suicidal thoughts.
“In one sense, the new law doesn’t cover new territory, because discrimination against people with mental health problems is already prohibited,” said Dana L. Fleming, a lawyer in Manchester, N.H., who is an expert on education law. “But in another sense, it’s ground-breaking since it’s the first time we’ve seen states focus on student suicides and come up with some code of conduct for schools.”
College counseling services nationwide are seeing more use.
“We’re seeing more students in our service consistently every year,” said Alejandro Martinez, director for counseling and psychological services at Stanford University, which sees about 10 percent of the student body each year. “Certainly more students are experiencing mental illness, including depression.
“But there’s also been a cultural shift,” Mr. Martinez said, “in that more students are willing to get help.”
College officials say that a growing number of students arrive on campus with a history of mental-health problems and a prescription for psychotropic drugs. But screening for such problems would be illegal, admissions officers say.
“We’re restricted by the disabilities act from asking,” said Rick Shaw, Stanford’s admissions director. “We do ask a question, as most institutions do, about whether a student has been suspended or expelled from school, and if they have been, we ask them to write an explanation of it.”
Federal laws also restrict what universities can reveal. Generally, the Family Educational Rights and Privacy Act, Ferpa, passed in 1974, makes it illegal to disclose a student’s records to family members without the student’s authorization.
“Colleges can disclose a student’s private records if they believe there’s a health and safety emergency, but that health and safety exception hasn’t been much tested in the courts, so it’s left to be figured out case by case,” Ms. Fleming said.
And the Health Insurance Portability and Accountability Act prohibits the release of medical records. “The interaction of all these laws does not make things easy,” she said.
April 19, 2007
Laws Limit Options When a Student Is Mentally Ill
By TAMAR LEWIN
Federal privacy and antidiscrimination laws restrict how universities can deal with students who have mental health problems.
For the most part, universities cannot tell parents about their children’s problems without the student’s consent. They cannot release any information in a student’s medical record without consent. And they cannot put students on involuntary medical leave, just because they develop a serious mental illness.
Nor is knowing when to worry about student behavior, and what action to take, always so clear.
“They can’t really kick someone out because they’re writing papers about weird topics, even if they seem withdrawn and hostile,” said Dr. Richard Kadison, chief of mental health services at Harvard University. “Most state laws are pretty clear: you can only bring students to hospitals if there is imminent risk to themselves or someone else, so universities are in a bit of a bind that way.”
But, he said, some schools do mandate limited amounts of treatment in certain circumstances.
“At the University of Missouri, if someone makes a suicide attempt, they mandate four counseling sessions, for example,” said Dr. Kadison, an author of “College of the Overwhelmed: The Campus Mental Health Crisis and What To Do About It.”
Universities can find themselves in a double bind. On the one hand, they may be liable if they fail to prevent a suicide or murder. After the death in 2000 of Elizabeth H. Shin, a student at the Massachusetts Institute of Technology who had written several suicide notes and used the university counseling service before setting herself on fire, the Massachusetts Superior Court allowed her parents, who had not been told of her deterioration, to sue administrators for $27.7 million. The case was settled for an undisclosed amount.
On the other hand, universities may be held liable if they do take action to remove a potentially suicidal student. In August, the City University of New York agreed to pay $65,000 to a student who sued after being barred from her dormitory room at Hunter College because she was hospitalized after a suicide attempt.
Also last year, George Washington University reached a confidential settlement in a case charging that it had violated antidiscrimination laws by suspending Jordan Nott, a student who had sought hospitalization for depression.
“This is a very, very difficult and gray area, when you take action to remove the student from the campus environment, versus when you encourage the student to use the resources available on campus,” said Ada Meloy, director of legal and regulatory affairs at the American Council on Education. “In an emergency, you can share certain information, but it’s not clear what’s an emergency.”
Ms. Meloy estimated that situations complicated enough to involve a university’s lawyers arise, on average, about twice a semester at large universities.
While shootings like the one at Virginia Tech are extremely rare, suicides, threats and serious mental-health problems are not. Last year, the American College Health Association’s National College Health Assessment, covering nearly 95,000 students at 117 campuses, found that 9 percent of students had seriously considered suicide in the previous year, and 1 in 100 had attempted it.
So mental health experts emphasize that, whatever a college’s concerns about liability, the goal of campus policies should be to maximize the likelihood that those who need mental-health treatment will get it.
“What we really need to do is encourage students to seek mental health treatment if they need it, to remove any barriers to their getting help, destigmatize it, and make it safe, so they know there won’t be negative consequences,” said Karen Bower, a lawyer at the Bazelon Center for Mental Health Law in Washington, who represented Mr. Nott.
With the Virginia Tech killings, many universities are planning to remind faculty members of their protocols. “We’re actually going to go ahead and have the counseling service here do a session for all our instructors and faculty on what to look for, what the procedures are, and what the counseling center can do,” said Shannon Miller, chairwoman of the English department at Temple University.
At Harvard, Dr. Kadison said, dormitory resident assistants watch for signs of trouble, and are usually the first to become aware of worrisome behavior — and to call a dean.
“The dean might insist that they get an evaluation to make sure they’re healthy enough to live in a dorm,” he said. “If it’s not thought that they’re in any immediate danger, they can take or not take the recommendation.”
Last month, Virginia passed a law, the first in the nation, prohibiting public colleges and universities from expelling or punishing students solely for attempting suicide or seeking mental-health treatment for suicidal thoughts.
“In one sense, the new law doesn’t cover new territory, because discrimination against people with mental health problems is already prohibited,” said Dana L. Fleming, a lawyer in Manchester, N.H., who is an expert on education law. “But in another sense, it’s ground-breaking since it’s the first time we’ve seen states focus on student suicides and come up with some code of conduct for schools.”
College counseling services nationwide are seeing more use.
“We’re seeing more students in our service consistently every year,” said Alejandro Martinez, director for counseling and psychological services at Stanford University, which sees about 10 percent of the student body each year. “Certainly more students are experiencing mental illness, including depression.
“But there’s also been a cultural shift,” Mr. Martinez said, “in that more students are willing to get help.”
College officials say that a growing number of students arrive on campus with a history of mental-health problems and a prescription for psychotropic drugs. But screening for such problems would be illegal, admissions officers say.
“We’re restricted by the disabilities act from asking,” said Rick Shaw, Stanford’s admissions director. “We do ask a question, as most institutions do, about whether a student has been suspended or expelled from school, and if they have been, we ask them to write an explanation of it.”
Federal laws also restrict what universities can reveal. Generally, the Family Educational Rights and Privacy Act, Ferpa, passed in 1974, makes it illegal to disclose a student’s records to family members without the student’s authorization.
“Colleges can disclose a student’s private records if they believe there’s a health and safety emergency, but that health and safety exception hasn’t been much tested in the courts, so it’s left to be figured out case by case,” Ms. Fleming said.
And the Health Insurance Portability and Accountability Act prohibits the release of medical records. “The interaction of all these laws does not make things easy,” she said.
Saturday, April 14, 2007
The New York Times
April 13, 2007
Editorial Observer
Kurt Vonnegut
By VERLYN KLINKENBORG
If you read Kurt Vonnegut when you were young — read all there was of him, book after book as fast as you could the way so many of us did — you probably set him aside long ago. That’s the way it goes with writers we love when we’re young. It’s almost as though their books absorbed some part of our DNA while we were reading them, and rereading them means revisiting a version of ourselves we may no longer remember or trust.
Not that Vonnegut is mainly for the young. I’m sure there are plenty of people who think he is entirely unsuitable for readers under the age of disillusionment. But the time to read Vonnegut is just when you begin to suspect that the world is not what it appears to be. He is the indispensable footnote to everything everyone is trying to teach you, the footnote that pulls the rug out from under the established truths being so firmly avowed in the body of the text.
He is not only entertaining, he is electrocuting. You read him with enormous pleasure because he makes your hair stand on end. He says not only what no one is saying, but also what — as a mild young person — you know it is forbidden to say. No one nourishes the skepticism of the young like Vonnegut. In his world, decency is likelier to be rooted in skepticism than it is in the ardor of faith.
So you get older, and it’s been 20 or 30 years since you last read “Player Piano” or “Cat’s Cradle” or “Slaughterhouse-Five.” Vonnegut is not, now, somehow serious enough. You’ve entered that time of life when every hard truth has to be qualified by the sense of what you stand to lose. “It’s not that simple,” you find yourself saying a lot, and the train of thought that unfolds in your mind as you speak those words reeks of desperation.
And yet, somehow, the world seems more and more to have been written by Vonnegut and your life is now the footnote. Perhaps it is time to go back and revisit that earlier self, the one who seemed, for a while, so interwoven in the pages of those old paperbacks.
April 13, 2007
Editorial Observer
Kurt Vonnegut
By VERLYN KLINKENBORG
If you read Kurt Vonnegut when you were young — read all there was of him, book after book as fast as you could the way so many of us did — you probably set him aside long ago. That’s the way it goes with writers we love when we’re young. It’s almost as though their books absorbed some part of our DNA while we were reading them, and rereading them means revisiting a version of ourselves we may no longer remember or trust.
Not that Vonnegut is mainly for the young. I’m sure there are plenty of people who think he is entirely unsuitable for readers under the age of disillusionment. But the time to read Vonnegut is just when you begin to suspect that the world is not what it appears to be. He is the indispensable footnote to everything everyone is trying to teach you, the footnote that pulls the rug out from under the established truths being so firmly avowed in the body of the text.
He is not only entertaining, he is electrocuting. You read him with enormous pleasure because he makes your hair stand on end. He says not only what no one is saying, but also what — as a mild young person — you know it is forbidden to say. No one nourishes the skepticism of the young like Vonnegut. In his world, decency is likelier to be rooted in skepticism than it is in the ardor of faith.
So you get older, and it’s been 20 or 30 years since you last read “Player Piano” or “Cat’s Cradle” or “Slaughterhouse-Five.” Vonnegut is not, now, somehow serious enough. You’ve entered that time of life when every hard truth has to be qualified by the sense of what you stand to lose. “It’s not that simple,” you find yourself saying a lot, and the train of thought that unfolds in your mind as you speak those words reeks of desperation.
And yet, somehow, the world seems more and more to have been written by Vonnegut and your life is now the footnote. Perhaps it is time to go back and revisit that earlier self, the one who seemed, for a while, so interwoven in the pages of those old paperbacks.
Wednesday, April 11, 2007
The New York Times
April 11, 2007
Op-Ed Contributor
When the Cure Is Not Worth the Cost
By MAIA SZALAVITZ
ON its face, providing equal coverage for mental and physical illnesses sounds like a good idea, something only a managed-care bean counter could oppose. To that end, Representatives Jim Ramstad, Republican of Minnesota, and Patrick Kennedy, Democrat of Rhode Island, have introduced the Paul Wellstone Mental Health and Addiction Equity Act.
Named for the senator who was long an advocate for mental health “parity,” it would require that private insurers pay for as much treatment for mental illnesses and addiction as they do for physical illnesses.
Senators Ted Kennedy, Democrat of Massachusetts, and Pete Domenici, Republican of New Mexico, have introduced a similar bill in the Senate. President Bush has said he will sign the legislation if it passes.
Unfortunately, this change would not be as benign as it appears. Unless mental health parity is tied to evidence-based treatment and positive outcomes, generous benefits may become a profit bonanza for providers that does little to help patients.
Thanks to research by the National Institutes of Health and academic scientists during the last three decades, we now have proven treatments for depression, addiction and other mental disorders. But all too often clinicians do not use them.
Without financial incentives to provide treatments that are known to work, many mental health professionals stick with what they know, or pick up on the latest fad, or even introduce their own untested innovations — which in turn are spread by testimonials and credulous news media coverage.
Take the well-known approach featured on the cable TV reality show “Intervention” aimed at getting addicts and alcoholics into treatment. Here, the family and sometimes the employer gather with a counselor, confront the addict and threaten to shun him or fire him if he doesn’t enter a rehabilitation center. A 1999 study compared this style of intervention — which can backfire and lead to broken families — to a less confrontational approach known as “community reinforcement and family training,” which is aimed at helping the family nurture the addict’s own motivation.
More than twice as many families succeeded in getting their loved ones into treatment (64 percent) with the gentler approach than with standard intervention (30 percent). But no reality shows push the less dramatic method, and it is difficult to find clinicians who use it.
Similarly, one of the most common approaches to alcoholism treatment involves having counselors and fellow alcoholics confront patients and force them to identify themselves as alcoholics. But research finds that the more a counselor confronts, the more a patient drinks and the more likely he is to drop out of treatment. And no association between accepting the label “alcoholic” and quitting drinking has been found. Counselor empathy — not confrontation — is connected with recovery.
According to a review by the Institute of Medicine in 2006, only 10.5 percent of alcoholics received “care consistent with scientific knowledge” of the disorder; similarly, 43 percent of children in psychiatric hospitals are given antipsychotic medication despite not suffering from psychosis. Tough boot camps for troubled teenagers — which have been proven to be ineffective and potentially harmful — thrive, while “multisystemic family therapy,” which effectively treats teenagers at home, is available only through the juvenile justice system.
Even in general medicine, research is sometimes slow to be translated into practice — but mental health care is often entirely disconnected from evidence. Some therapists argue that the human mind is too complex and variable to allow for standardized treatments. But shouldn’t they at least start with approaches known to work for the largest number of patients?
If we want to provide genuine help for the 33 million Americans with mental health and drug problems, giving more no-strings-attached money to providers via insurance mandates is not the answer. It is dangerous to blindly bolster useless and even harmful treatments while failing to support proven therapies. Coverage must be tied to outcomes and evidence. And payment should be dependent, at least in part, on health improvements, not just services received. We need parity in evidence-based treatment, not just in coverage.
Maia Szalavitz, the co-author of “The Boy Who Was Raised as a Dog: And Other Stories From a Child Psychiatrist’s Notebook,” is a senior fellow at Stats, a media watchdog group.
April 11, 2007
Op-Ed Contributor
When the Cure Is Not Worth the Cost
By MAIA SZALAVITZ
ON its face, providing equal coverage for mental and physical illnesses sounds like a good idea, something only a managed-care bean counter could oppose. To that end, Representatives Jim Ramstad, Republican of Minnesota, and Patrick Kennedy, Democrat of Rhode Island, have introduced the Paul Wellstone Mental Health and Addiction Equity Act.
Named for the senator who was long an advocate for mental health “parity,” it would require that private insurers pay for as much treatment for mental illnesses and addiction as they do for physical illnesses.
Senators Ted Kennedy, Democrat of Massachusetts, and Pete Domenici, Republican of New Mexico, have introduced a similar bill in the Senate. President Bush has said he will sign the legislation if it passes.
Unfortunately, this change would not be as benign as it appears. Unless mental health parity is tied to evidence-based treatment and positive outcomes, generous benefits may become a profit bonanza for providers that does little to help patients.
Thanks to research by the National Institutes of Health and academic scientists during the last three decades, we now have proven treatments for depression, addiction and other mental disorders. But all too often clinicians do not use them.
Without financial incentives to provide treatments that are known to work, many mental health professionals stick with what they know, or pick up on the latest fad, or even introduce their own untested innovations — which in turn are spread by testimonials and credulous news media coverage.
Take the well-known approach featured on the cable TV reality show “Intervention” aimed at getting addicts and alcoholics into treatment. Here, the family and sometimes the employer gather with a counselor, confront the addict and threaten to shun him or fire him if he doesn’t enter a rehabilitation center. A 1999 study compared this style of intervention — which can backfire and lead to broken families — to a less confrontational approach known as “community reinforcement and family training,” which is aimed at helping the family nurture the addict’s own motivation.
More than twice as many families succeeded in getting their loved ones into treatment (64 percent) with the gentler approach than with standard intervention (30 percent). But no reality shows push the less dramatic method, and it is difficult to find clinicians who use it.
Similarly, one of the most common approaches to alcoholism treatment involves having counselors and fellow alcoholics confront patients and force them to identify themselves as alcoholics. But research finds that the more a counselor confronts, the more a patient drinks and the more likely he is to drop out of treatment. And no association between accepting the label “alcoholic” and quitting drinking has been found. Counselor empathy — not confrontation — is connected with recovery.
According to a review by the Institute of Medicine in 2006, only 10.5 percent of alcoholics received “care consistent with scientific knowledge” of the disorder; similarly, 43 percent of children in psychiatric hospitals are given antipsychotic medication despite not suffering from psychosis. Tough boot camps for troubled teenagers — which have been proven to be ineffective and potentially harmful — thrive, while “multisystemic family therapy,” which effectively treats teenagers at home, is available only through the juvenile justice system.
Even in general medicine, research is sometimes slow to be translated into practice — but mental health care is often entirely disconnected from evidence. Some therapists argue that the human mind is too complex and variable to allow for standardized treatments. But shouldn’t they at least start with approaches known to work for the largest number of patients?
If we want to provide genuine help for the 33 million Americans with mental health and drug problems, giving more no-strings-attached money to providers via insurance mandates is not the answer. It is dangerous to blindly bolster useless and even harmful treatments while failing to support proven therapies. Coverage must be tied to outcomes and evidence. And payment should be dependent, at least in part, on health improvements, not just services received. We need parity in evidence-based treatment, not just in coverage.
Maia Szalavitz, the co-author of “The Boy Who Was Raised as a Dog: And Other Stories From a Child Psychiatrist’s Notebook,” is a senior fellow at Stats, a media watchdog group.
Thursday, April 05, 2007
The New York Times
April 4, 2007
Op-Ed Contributor
The Rich Are More Oblivious Than You and Me
By RICHARD CONNIFF
Old Lyme, Conn.
THE other day at a Los Angeles race track, a comedian named Eddie Griffin took a meeting with a concrete barrier and left a borrowed bright-red $1.5 million Ferrari Enzo looking like bad origami. Just to be clear, this was a different bright-red $1.5 million Ferrari Enzo from the one a Swedish businessman crumpled up and threw away last year on the Pacific Coast Highway. I mention this only because it’s easy to get confused by the vast and highly repetitious category “Rich and Famous People Acting Like Total Idiots.” Mr. Griffin walked away uninjured, and everybody offered wise counsel about how this wasn’t really such a bad day after all.
So what exactly constitutes a bad day in this rarefied little world? Did the casino owner Steve Wynn cross the mark when he put his elbow through a Picasso he was about to sell for $139 million? Did Mel (“I Own Malibu”) Gibson sense bad-day emanations when he started on a bigoted tirade while seated drunk in the back of a sheriff’s car? And if dumb stuff like this comes so easy to these people, how is it that they’re the ones with all the money?
Modern science has the answer, with a little help from the poet Hilaire Belloc.
Let’s begin with what I call the “Cookie Monster Experiment,” devised to test the hypothesis that power makes people stupid and insensitive — or, as the scientists at the University of California at Berkeley put it, “disinhibited.”
Researchers led by the psychologist Dacher Keltner took groups of three ordinary volunteers and randomly put one of them in charge. Each trio had a half-hour to work through a boring social survey. Then a researcher came in and left a plateful of precisely five cookies. Care to guess which volunteer typically grabbed an extra cookie? The volunteer who had randomly been assigned the power role was also more likely to eat it with his mouth open, spew crumbs on partners and get cookie detritus on his face and on the table.
It reminded the researchers of powerful people they had known in real life. One of them, for instance, had attended meetings with a magazine mogul who ate raw onions and slugged vodka from the bottle, but failed to share these amuse-bouches with his guests. Another had been through an oral exam for his doctorate at which one faculty member not only picked his ear wax, but held it up to dandle lovingly in the light.
As stupid behaviors go, none of this is in a class with slamming somebody else’s Ferrari into a concrete wall. But science advances by tiny steps.
The researchers went on to theorize that getting power causes people to focus so keenly on the potential rewards, like money, sex, public acclaim or an extra chocolate-chip cookie — not necessarily in that order, or frankly, any order at all, but preferably all at once — that they become oblivious to the people around them.
Indeed, the people around them may abet this process, since they are often subordinates intent on keeping the boss happy. So for the boss, it starts to look like a world in which the traffic lights are always green (and damn the pedestrians). Professor Keltner and his fellow researchers describe it as an instance of “approach/inhibition theory” in action: As power increases, it fires up the behavioral approach system and shuts down behavioral inhibition.
And thus the Fast Forward Personality is born and put on the path to the concrete barrier.
The corollary is that as the rich and powerful increasingly focus on potential rewards, powerless types notice the likely costs and become more inhibited. I happen to know the feeling because I once had my own Los Angeles Ferrari experience. It was a bright-red F355 Spider (and with a mere $150,000 sticker price, not exactly top shelf), which I rented for a television documentary about rich people. It came with a $10,000 deductible, and the first time I drove it into a Bel-Air estate, the low-slung front end hit the apron of the driveway with a horrible grating sound that caused my soul to shrink. I proceeded up the driveway at five miles an hour, and everyone in sight turned away thinking, “Rental.”
The bottom line: Without power, people tend to play it safe. Given power, even you and I would soon end up living large and acting like idiots. So pity the rich — and protect yourself. This is where Hilaire Belloc comes in.
He once wrote a poem about a Lord Finchley, who “tried to mend the Electric Light/Himself. It struck him dead: And serve him right!” Belloc wasn’t tiresomely suggesting that the gentry all deserve a first-hand acquaintance with the third rail, as it were, but merely that they would be smart to depend on hired help. In social psychology terms, disinhibited Fast Forward types need ordinary cautious mortals to remind them that the traffic lights do in fact occasionally turn yellow or even, sometimes, red.
So, Eddie Griffin: next time you borrow a pal’s car, borrow his driver, too. The world will be a safer place for the rest of us.
Richard Conniff is the author of “The Natural History of the Rich.”
April 4, 2007
Op-Ed Contributor
The Rich Are More Oblivious Than You and Me
By RICHARD CONNIFF
Old Lyme, Conn.
THE other day at a Los Angeles race track, a comedian named Eddie Griffin took a meeting with a concrete barrier and left a borrowed bright-red $1.5 million Ferrari Enzo looking like bad origami. Just to be clear, this was a different bright-red $1.5 million Ferrari Enzo from the one a Swedish businessman crumpled up and threw away last year on the Pacific Coast Highway. I mention this only because it’s easy to get confused by the vast and highly repetitious category “Rich and Famous People Acting Like Total Idiots.” Mr. Griffin walked away uninjured, and everybody offered wise counsel about how this wasn’t really such a bad day after all.
So what exactly constitutes a bad day in this rarefied little world? Did the casino owner Steve Wynn cross the mark when he put his elbow through a Picasso he was about to sell for $139 million? Did Mel (“I Own Malibu”) Gibson sense bad-day emanations when he started on a bigoted tirade while seated drunk in the back of a sheriff’s car? And if dumb stuff like this comes so easy to these people, how is it that they’re the ones with all the money?
Modern science has the answer, with a little help from the poet Hilaire Belloc.
Let’s begin with what I call the “Cookie Monster Experiment,” devised to test the hypothesis that power makes people stupid and insensitive — or, as the scientists at the University of California at Berkeley put it, “disinhibited.”
Researchers led by the psychologist Dacher Keltner took groups of three ordinary volunteers and randomly put one of them in charge. Each trio had a half-hour to work through a boring social survey. Then a researcher came in and left a plateful of precisely five cookies. Care to guess which volunteer typically grabbed an extra cookie? The volunteer who had randomly been assigned the power role was also more likely to eat it with his mouth open, spew crumbs on partners and get cookie detritus on his face and on the table.
It reminded the researchers of powerful people they had known in real life. One of them, for instance, had attended meetings with a magazine mogul who ate raw onions and slugged vodka from the bottle, but failed to share these amuse-bouches with his guests. Another had been through an oral exam for his doctorate at which one faculty member not only picked his ear wax, but held it up to dandle lovingly in the light.
As stupid behaviors go, none of this is in a class with slamming somebody else’s Ferrari into a concrete wall. But science advances by tiny steps.
The researchers went on to theorize that getting power causes people to focus so keenly on the potential rewards, like money, sex, public acclaim or an extra chocolate-chip cookie — not necessarily in that order, or frankly, any order at all, but preferably all at once — that they become oblivious to the people around them.
Indeed, the people around them may abet this process, since they are often subordinates intent on keeping the boss happy. So for the boss, it starts to look like a world in which the traffic lights are always green (and damn the pedestrians). Professor Keltner and his fellow researchers describe it as an instance of “approach/inhibition theory” in action: As power increases, it fires up the behavioral approach system and shuts down behavioral inhibition.
And thus the Fast Forward Personality is born and put on the path to the concrete barrier.
The corollary is that as the rich and powerful increasingly focus on potential rewards, powerless types notice the likely costs and become more inhibited. I happen to know the feeling because I once had my own Los Angeles Ferrari experience. It was a bright-red F355 Spider (and with a mere $150,000 sticker price, not exactly top shelf), which I rented for a television documentary about rich people. It came with a $10,000 deductible, and the first time I drove it into a Bel-Air estate, the low-slung front end hit the apron of the driveway with a horrible grating sound that caused my soul to shrink. I proceeded up the driveway at five miles an hour, and everyone in sight turned away thinking, “Rental.”
The bottom line: Without power, people tend to play it safe. Given power, even you and I would soon end up living large and acting like idiots. So pity the rich — and protect yourself. This is where Hilaire Belloc comes in.
He once wrote a poem about a Lord Finchley, who “tried to mend the Electric Light/Himself. It struck him dead: And serve him right!” Belloc wasn’t tiresomely suggesting that the gentry all deserve a first-hand acquaintance with the third rail, as it were, but merely that they would be smart to depend on hired help. In social psychology terms, disinhibited Fast Forward types need ordinary cautious mortals to remind them that the traffic lights do in fact occasionally turn yellow or even, sometimes, red.
So, Eddie Griffin: next time you borrow a pal’s car, borrow his driver, too. The world will be a safer place for the rest of us.
Richard Conniff is the author of “The Natural History of the Rich.”
