My Addicted Son
David Sheff, New York Times Magazine- 2/6/2005

One windy day in May 2002, my young children, Jasper and Daisy, who were 8 and 5, spent the morning cutting, pasting and coloring notes and welcome banners for their brother's homecoming. They had not seen Nick, who was arriving from college for the summer, in six months. In the afternoon, we all drove to the airport to pick him up.
     At home in Inverness, north of San Francisco, Nick, who was then 19, lugged his duffel bag and backpack into his old bedroom. He unpacked and emerged with his arms loaded with gifts. After dinner, he put the kids to bed, reading to them from ''The Witches,'' by Roald Dahl. We heard his voice -- voices -- from the next room: the boy narrator, all wonder and earnestness; wry and creaky Grandma; and the shrieking, haggy Grand High Witch. The performance was irresistible, and the children were riveted. Nick was a playful and affectionate big brother to Jasper and Daisy -- when he wasn't robbing them.
      Late that night, I heard the creaking of bending tree branches. I also heard Nick padding along the hallway, making tea in the kitchen, quietly strumming his guitar and playing Tom Waits, Bjork and Bollywood soundtracks. I worried about his insomnia, but pushed away my suspicions, instead reminding myself how far he had come since the previous school year, when he dropped out of Berkeley. This time, he had gone east to college and had made it through his freshman year. Given what we had been through, this felt miraculous. As far as we knew, he was coming up on his 150th day without methamphetamine.
      In the morning, Nick, in flannel pajama bottoms and a fraying woolen sweater, shuffled into the kitchen. His skin was rice-papery and gaunt, and his hair was like a field, with smashed-down sienna patches and sticking-up yellowed clumps, a disaster left over from when he tried to bleach it. Lacking the funds for Lady Clairol, his brilliant idea was to soak his head in a bowl of Clorox.
      Nick hovered over the kitchen counter, fussing with the stove-top espresso maker, filling it with water and coffee and setting it on a flame, and then sat down to a bowl of cereal with Jasper and Daisy. I stared hard at him. The giveaway was his body, vibrating like an idling car. His jaw gyrated and his eyes were darting opals. He made plans with the kids for after school and gave them hugs. When they were gone, I said, ''I know you're using again.'' He glared at me: ''What are you talking about? I'm not.'' His eyes fixed onto the floor. ''Then you won't mind being drug-tested.'' ''Whatever.''
      When Nick next emerged from his bedroom, head down, his backpack was slung over his back, and he held his electric guitar by the neck. He left the house, slamming the door behind him. Late that afternoon, Jasper and Daisy burst in, dashing from room to room, before finally stopping and, looking up at me, asking, ''Where's Nick?''
     N ick now claims that he was searching for methamphetamine for his entire life, and when he tried it for the first time, as he says, ''That was that.'' It would have been no easier to see him strung out on heroin or cocaine, but as every parent of a methamphetamine addict comes to learn, this drug has a unique, horrific quality. In an interview, Stephan Jenkins, the singer in the band Third Eye Blind, said that methamphetamine makes you feel ''bright and shiny.'' It also makes you paranoid, incoherent and both destructive and pathetically and relentlessly self-destructive. Then you will do unconscionable things in order to feel bright and shiny again. Nick had always been a sensitive, sagacious, joyful and exceptionally bright child, but on meth he became unrecognizable.
      Nick's mother and I were attentive, probably overly attentive -- part of the first wave of parents obsessed with our children in a self-conscious way. (Before us, people had kids. We parented.) Nick spent his first years on walks in his stroller and Snugli, playing in Berkeley parks and baby gyms and visiting zoos and aquariums.
      His mother and I divorced when he was 4. No child benefits from the bitterness and savagery of a divorce like ours. Like fallout from a dirty bomb, the collateral damage is widespread and enduring. Nick was hit hard. The effects lingered well after his mother and I settled on a joint-custody arrangement and, later, after we both remarried.
      As a kindergartner, when he wore tights, the other school children teased him: ''Only girls wear tights.'' Nick responded: ''Uh, uh, Superman wears tights.'' I was proud of his self-assuredness and individuality. Nick readily rebelled against conventional habit, mores and taste. Still, he could be susceptible to peer pressure. During the brief celebrity of Kris Kross, he wore backward clothes. At 11, he was hidden inside grungy flannel, shuffling around in Doc Martens. Hennaed bangs hung Cobain-like over his eyes.
     Throughout his youth, I talked to Nick ''early and often'' about drugs in ways now prescribed by the Partnership for a Drug-Free America. I watched for one organization's early warning signs of teenage alcoholism and drug abuse. (No. 15: ''Does your child volunteer to clean up after adult cocktail parties, but neglect other chores?'') Indeed, when he was 12, I discovered a vial of marijuana in his backpack. I met with his teacher, who said: ''It's normal. Most kids try it.'' Nick said that it was a mistake -- he had been influenced by a couple of thuggish boys at his new school -- and he promised that he would not use it again.
      In his early teens, Nick was into the hippest music and then grew bored with it. By the time his favorite artists, from Guns N' Roses to Beck to Eminem, had a hit record, Nick had discarded them in favor of the retro, the obscure, the ultra contemporary or plain bizarre, an eclectic list that included Coltrane, polka, the soundtrack from ''The Umbrellas of Cherbourg'' and, for a memorable period, samba, to which he would cha-cha through the living room. His heroes, including Holden Caulfield and Atticus Finch, were replaced by an assortment of misanthropes, addicts, drunks, depressives and suicides, role models like Burroughs, Bukowski, Cobain, Hemingway and Basquiat. Other children watched Disney and ''Star Wars,'' but Nick preferred Scorsese, David Lynch and Godard.
      At 14, when he was suspended from high school for a day for buying pot on campus, Nick and my wife and I met with the freshman dean. ''We view this as a mistake and an opportunity,'' he explained. Nick was forced to undergo a day at a drug-and-alcohol program but was given a second chance. A teacher took Nick under his wing, encouraging his interest in marine biology. He surfed with him and persuaded him to join the swimming and water-polo teams. Nick had two productive and, as far as I know, drug-free years. He showed promise as a student actor, artist and writer. For a series of columns in the school newspaper, he won the Ernest Hemingway Writing Award for high-school journalists, and he published a column in Newsweek.
      After his junior year, Nick attended a summer program in French at the American University of Paris. I now know that he spent most of his time emulating some of his drunken heroes, though he forgot the writing and painting part. His souvenir of his Parisian summer was an ulcer. What child has an ulcer at 16? Back at high school for his senior year, he was still an honor student, with a nearly perfect grade-point average. Even as he applied to and was accepted at a long list of colleges, one senior-class dean told me, half in jest, that Nick set a school record for tardiness and cutting classes. My wife and I consulted a therapist, and a school counselor reassured us: ''You're describing an adolescent. Nick's candor, unusual especially in boys, is a good sign. Keep talking it out with him, and he'll get through this.''
      His high-school graduation ceremony was held outdoors on the athletic field. With his hair freshly buzzed, Nick marched forward and accepted his diploma from the school head, kissing her cheek. He seemed elated. Maybe everything would be all right after all. Afterward, we invited his friends over for a barbecue. Later we learned that a boy in jeans and a sport coat had scored some celebratory sensimilla. Nick and his friends left our house for a grad-night bash that was held at a local recreation center, where he tried ecstasy for the first time.
      A few weeks later, my wife planned to take the kids to the beach. The fog had lifted, and I was with them in the driveway, helping to pack the car. Two county sheriff's patrol cars pulled up. When a pair of uniformed officers approached, I thought they needed directions, but they walked past me and headed for Nick. They handcuffed his wrists behind his back, pushed him into the back seat of one of the squad cars and drove away. Jasper, then 7, was the only one of us who responded appropriately. He wailed, inconsolable for an hour. The arrest was a result of Nick's failure to appear in court after being cited for marijuana possession, an infraction he ''forgot'' to tell me about. Still, I bailed him out, confident that the arrest would teach him a lesson. Any fear or remorse he felt was short-lived, however, blotted out by a new drug -- crystal methamphetamine.
     When I was a child, my parents implored me to stay away from drugs. I dismissed them, because they didn't know what they were talking about. They were -- still are -- teetotalers. I, on the other hand, knew about drugs, including methamphetamine. On a Berkeley evening in the early 1970's, my college roommate arrived home, yanked the thrift-shop mirror off the wall and set it upon a coffee table. He unfolded an origami packet and poured out its contents onto the mirror: a mound of crystalline powder. From his wallet he produced a single-edge razor, with which he chipped at the crystals, the steel tapping rhythmically on the glass. While arranging the powder in four parallel rails, he explained that Michael the Mechanic, our drug dealer, had been out of cocaine. In its place, he purchased crystal methamphetamine.
      I snorted the lines through a rolled-up dollar bill. The chemical burned my nasal passages, and my eyes watered. Whether the drug is sniffed, smoked, swallowed or injected, the body quickly absorbs methamphetamine. Once it reaches the circulatory system, it's a near-instant flume ride to the central nervous system. When it reached mine, I heard cacophonous music like a calliope and felt as if Roman candles had been lighted inside my skull. Methamphetamine triggers the brain's neurotransmitters, particularly dopamine, which spray like bullets from a gangster's tommy gun. The drug destroys the receptors and as a result may, over time, permanently reduce dopamine levels, sometimes leading to symptoms normally associated with Parkinson's disease like tremors and muscle twitches. Meth increases the heart rate and blood pressure and can cause irreversible damage to blood vessels in the brain, which can lead to strokes. It can also cause arrhythmia and cardiovascular collapse, possibly leading to death. But I felt fantastic -- supremely confident, euphoric.
      After methamphetamine triggers the release of neurotransmitters, it blocks their reuptake back into their storage pouches, much as cocaine and other stimulants do. Unlike cocaine, however, meth also blocks the enzymes that help to break down invasive drugs, so the released chemicals float freely until they wear off. Methamphetamine remains active for 10 to 12 hours, compared with 45 minutes for cocaine. When the dawn began to seep through the cracked window blinds, I felt bleak, depleted and agitated. I went to bed and eventually slept for a full day, blowing off school.
      I never touched methamphetamine again, but my roommate returned again and again to Michael the Mechanic's, and his meth run lasted for two weeks. Not long afterward, he moved away, and I lost touch with him. I later learned that after college, his life was defined by his drug abuse. There were voluntary and court-ordered rehabs, car crashes, a house that went up in flames when he fell asleep with a burning cigarette in his mouth, ambulance rides to emergency rooms after overdoses and accidents and incarcerations, both in hospitals and jails. He died on the eve of his 40th birthday.
      When I told Nick cautionary stories like this and warned him about crystal, I thought that I might have some credibility. I have heard drug counselors tell parents of my generation to lie to our children about our past drug use. Famous athletes show up at school assemblies or on television and tell kids, ''Man, don't do this stuff, I almost died,'' and yet there they stand, diamonds, gold, multimillion-dollar salaries and fame. The words: I barely survived. The message: I survived, thrived and you can, too. Kids see that their parents turned out all right in spite of the drugs. So maybe I should have lied, and maybe I'll try lying to Daisy and Jasper. Nick, however, knew the truth. I don't know how much it mattered. Part of me feels solely responsible -- if only his mother and I had stayed together; if only she and I had lived in the same city after the divorce and had a joint-custody arrangement that was easier on him; if only I had set stricter limits; if only I had been more consistent. And yet I also sense that Nick's course was determined by his first puff of pot and sip of wine and sealed with the first hit of speed the summer before he began college.
       When Nick's therapist said that college would straighten him out, I wanted to believe him. When change takes place gradually, it's difficult to comprehend its meaning. At what point is a child no longer experimenting, no longer a typical teenager, no longer going through a phase or a rite of passage? I am astounded -- no, appalled -- by my ability to deceive myself into believing that everything would turn out all right in spite of mounting evidence to the contrary.
      At the University of California at Berkeley, Nick almost immediately began dealing to pay for his escalating meth habit. After three months, he dropped out, claiming that he had to pull himself together. I encouraged him to check into a drug-rehabilitation facility, but he refused. (He was over 18, and I could not commit him.) He disappeared. When he finally called after a week, his voice trembled. It nonetheless brought a wave of relief -- he was alive. I drove to meet him in a weedy and garbage-strewn alleyway in San Rafael. My son, the svelte and muscular swimmer, water-polo player and surfer with an ebullient smile, was bruised, sallow, skin and bone, and his eyes were vacant black holes. Ill and rambling, he spent the next three days curled up in bed.
      I was bombarded with advice, much of it contradictory. I was advised to kick him out. I was advised not to let him out of my sight. One counselor warned, ''Don't come down too hard on him or his drug use will just go underground.'' One mother recommended a lockup school in Mexico, where she sent her daughter to live for two years. A police officer told me that I should send Nick to a boot camp where children, roused and shackled in the middle of the night, are taken by force.
      His mother and I decided that we had to do everything possible to get Nick into a drug-rehabilitation program, so we researched them, calling recommended facilities, inquiring about their success rates for treating meth addicts. These conversations provided my initial glimpse of what must be the most chaotic, flailing field of health care in America. I was quoted success rates in a range from 20 to 85 percent. An admitting nurse at a Northern California hospital insisted: ''The true number for meth addicts is in the single digits. Anyone who promises more is lying.'' But what else could we try? I used what was left of my waning influence -- the threat of kicking him out of the house and withdrawing all of my financial support -- to get him to commit himself into the Ohlhoff Recovery Program in San Francisco. It is a well-respected program, recommended by many of the experts in the Bay Area. A friend of a friend told me that the program turned around the life of her heroin-addicted son.
      Nick trembled when I dropped him off. Driving home afterward, I felt as if I would collapse from more emotion than I could handle. Incongruously, I felt as if I had betrayed him, though I did take some small consolation in the fact that I knew where he was; for the first time in a while, I slept through the night.
      For their initial week, patients were forbidden to use the telephone, but Nick managed to call, begging to come home. When I refused, he slammed down the receiver. His counselor reported that he was surly, depressed and belligerent, threatening to run away. But he made it through the first week, which consisted of morning walks, lectures, individual and group sessions with counselors, 12-step-program meetings and meditation and acupuncture. Family groups were added in the second week. My wife and I, other visiting parents and spouses or partners, along with our addicts, sat in worn couches and folding chairs, and a grandmotherly, whiskey-voiced (though sober for 20 years) counselor led us in conversation. ''Tell your parents what it means that they're here with you, Nick,'' she said. ''Whatever. It's fine.''
      By the fourth and final week, he seemed open and apologetic, claiming to be determined to take responsibility for the mess he'd made of his life. He said that he knew that he needed more time in treatment, and so we agreed to his request to move into the transitional residential program. He did, and then three days later he bolted. At some point, parents may become inured to a child's self-destruction, but I never did. I called the police and hospital emergency rooms. I didn't hear anything for a week. When he finally called, I told him that he had two choices as far as I was concerned: another try at rehab or the streets. He maintained that it was unnecessary -- he would stop on his own -- but I told him that it wasn't negotiable. He listlessly agreed to try again.
     I called another recommended program, this one at the St. Helena Hospital Center for Behavioral Health, improbably located in the Napa Valley wine country. Many families drain every penny, mortgaging their homes and bankrupting their college funds and retirement accounts, trying successive drug-rehab programs. My insurance and his mother's paid most of the costs of these programs. Without this coverage, I'm not sure what we would have done. By then I was no longer sanguine about rehabilitation, but in spite of our experience and the questionable success rates, there seemed to be nothing more effective for meth addiction.
      Patients in the St. Helena program keep journals. In Nick's, he wrote one day: ''How the hell did I get here? It doesn't seem that long ago that I was on the water-polo team. I was an editor of the school newspaper, acting in the spring play, obsessing about which girls I liked, talking Marx and Dostoevsky with my classmates. The kids in my class will be starting their junior years of college. This isn't so much sad as baffling. It all seemed so positive and harmless, until it wasn't.''
      By the time he completed the fourth week, Nick once again seemed determined to stay away from drugs. He applied to a number of small liberal-arts schools on the East Coast. His transcripts were still good enough for him to be accepted at the colleges to which he applied, and he selected Hampshire, located in a former apple orchard in Western Massachusetts. In August, my wife and I flew east with him for freshman orientation. At the welcoming picnic, Karen and I surveyed the incoming freshmen for potential drug dealers. We probably would have seen this on most campuses, but we were not reassured when we noticed a number of students wearing T-shirts decorated with marijuana leaves, portraits of Bob Marley smoking a spliff and logos for the Church of LSD.
      In spite of his protestations and maybe (though I'm not sure) his good intentions and in spite of his room in substance-free housing, Nick didn't stand a chance. He tried for a few weeks. When he stopped returning my phone calls, I assumed that he had relapsed. I asked a friend, who was visiting Amherst, to stop by to check on him. He found Nick holed up in his room. He was obviously high. I later learned that not only had Nick relapsed, but he had supplemented methamphetamine with heroin and morphine, because, he explained, at the time meth was scarce in Western Massachusetts. ''Everyone told me not to try it, you know?'' Nick later said about heroin. ''They were like, 'Whatever you do, stay away from dope.' I wish I'd got the same warning about meth. By the time I got around to doing heroin, I really didn't see what the big deal was.''
      I prepared to follow through on my threat and stop paying his tuition unless he returned to rehab, but I called a health counselor, who advised patience, saying that often ''relapse is part of recovery.'' A few days later, Nick called and told me that he would stop using. He went to 12-step program meetings and, he claimed, suffered the detox and early meth withdrawal that is characterized by insuperable depression and acute anxiety -- a drawn-out agony. He kept in close touch and got through the year, doing well in some writing and history classes, newly in love with a girl who drove him to Narcotics Anonymous meetings and eager to see Jasper and Daisy. His homecoming was marked by trepidation, but also promise, which is why it was so devastating when we discovered the truth.
      When Nick left, I sunk into a wretched and sickeningly familiar malaise, alternating with a debilitating panic. One morning, Jasper came into the kitchen, holding a satin box, a gift from a friend upon his return from China, in which he kept his savings of $8. Jasper looked perplexed. ''I think Nick took my money,'' he said. How do you explain to an 8-year-old why his beloved big brother steals from him?
      After a week, I succumbed to my desperation and went to try to find him. I drove over the Golden Gate Bridge from Marin County to San Francisco, to the Haight, where I knew he often hung out. The neighborhood, in spite of some gentrification, retains its 1960's-era funkiness. Kids -- tattooed, pierced, track-marked, stoned -- loiter in doorways. Of course I didn't find him. After another few weeks, he called, collect: ''Hey, Pop, it's me.'' I asked if he would meet me. No matter how unrealistic, I retained a sliver of hope that I could get through to him. That's not quite accurate. I knew I couldn't, but at least I could put my fingertips on his cheek.
      For our meeting, Nick chose Steps of Rome, a cafe on Columbus Avenue in North Beach, our neighborhood after his mother and I divorced. In those days, Nick played in Washington Square Park opposite the Cathedral of Saints Peter and Paul, down the hill from our Russian Hill flat. We would eat early dinner at Vanessi's, an Italian restaurant now gone. The waiters, when they saw Nick, then towheaded, with a gap between his front teeth, would lift him up and set him on telephone books stacked on a stool at the counter. Nick was little enough so that after dinner, when he got sleepy, I could carry him home, his tiny arms wrapped around my neck.
      Since reason and love, the forces I had come to rely on, had betrayed me, I was in uncharted territory as I sat at a corner table nervously waiting for him. Steps of Rome was deserted, other than a couple of waiters folding napkins at the bar. I ordered coffee, racking my brain for the one thing I could say that I hadn't thought of that could get through to him. Drug-and-alcohol counselors, most of them former addicts, tell fathers like me it's not our fault. They preach ''the Three C's'': ''You didn't cause it, you can't control it, and you can't cure it.'' But who among us doesn't believe that we could have done something differently that would have helped? ''It hurts so bad to think I cannot save him, protect him, keep him out of harm's way, shield him from pain,'' wrote Thomas Lynch, the undertaker, poet and essayist, about his son, a drug addict and an alcoholic. ''What good are fathers if not for these things?'' I waited until it was more than half an hour past our meeting time, recognizing the mounting, suffocating worry and also the bitterness and anger. I had been waiting for Nick for years. At night, past his curfew, I waited for the car's grinding engine when it pulled into the driveway and went silent, the slamming door, footsteps and the front door opening with a click, despite his attempt at stealth. Our dog would yelp a halfhearted bark. When Nick was late, I always assumed catastrophe.
      After 45 minutes waiting at Steps of Rome, I decided that he wasn't coming -- what had I expected? -- and left the cafe. Still, I walked around the block, returned again, peered into the cafe and then trudged around the block again. Another half-hour later, I was ready to go home, really, maybe, when I saw him. Walking down the street, looking down, his gangly arms limp at his sides, he looked more than ever like a ghostly, hollow Egon Schiele self-portrait, debauched and emaciated. I returned his hug, my arms wrapping around his vaporous spine, and kissed his cheek. We embraced like that and sat down at a table by the window. He couldn't look me in the eye. No apologies for being late. He asked how I was, how were the little kids? He folded and unfolded a soda straw and rocked anxiously in his chair; his fingers trembled, and he clenched his jaw and ground his teeth. He pre-empted any questions, saying: ''I'm doing. Great. I'm doing what I need to be doing, being responsible for myself for the first time in my life.'' I asked if he was ready to kick, to return to the living, to which he said, ''Don't start.'' When I said that Jasper and Daisy missed him, he cut me off. ''I can't deal with that. Don't guilt-trip me.'' Nick drank down his coffee, held onto his stomach. I watched him rise and leave.
      Through Nick's drug addiction, I learned that parents can bear almost anything. Every time we reach a point where we feel as if we can't bear any more, we do. Things had descended in a way that I never could have imagined, and I shocked myself with my ability to rationalize and tolerate things that were once unthinkable. He's just experimenting. Going through a stage. It's only marijuana. He gets high only on weekends. At least he's not using heroin. He would never resort to needles. At least he's alive.
      A fortnight later, Nick wrote an e-mail message to his mother and asked for help. After they talked, he agreed to meet with a friend of our family who took him to her home in upstate New York, where he could detox. He slept for 20 or more hours a day for a week and began to work with a therapist who specialized in drug addiction. After six or so weeks, he seemed stronger and somewhat less desolate. His mother helped him move into an apartment in Brooklyn, and he got a job. When he finally called, he told me that he would never again use methamphetamine, though he made no such vows about marijuana and alcohol. With this news, I braced myself for the next disaster. A new U.C.L.A. study confirms that I had reason to expect one: recovering meth addicts who stay off alcohol and marijuana are significantly less likely to relapse.
      Two or so months later, the phone rang at 5 on a Sunday morning. Every parent of a drug-addicted child recoils at a ringing telephone at that hour. I was informed that Nick was in a hospital emergency room in Brooklyn after an overdose. He was in critical condition and on life support. After two hours, the doctor called to tell me that his vital signs had leveled off. Still later, he called to say that Nick was no longer on the critical list. From his hospital bed, when he was coherent enough to talk, Nick sounded desperate. He asked to go into another program, said it was his only chance.
      So without reluctance this time, Nick returned to rehab. After six or so months, he moved to Santa Monica near his mother. He lived in a sober-living home, attended meetings regularly and began working with a sponsor. He had several jobs, including one at a drug-and-alcohol rehabilitation program in Malibu. Last April, after celebrating his second year sober, he relapsed again, disappearing for two weeks. His sponsor, who had become a close friend of Nick's, assured me: ''Nick won't stay out long. He's not having any fun.'' Of course I hoped that he was right, but I was no less worried than I was other times he had disappeared -- worried that he could overdose or otherwise cause irreparable damage.
      But he didn't. He returned and withdrew on his own, helped by his sponsor and other friends. He was ashamed -- mortified -- that he slipped. He redoubled his efforts. Ten months later, of course, I am relieved (once again) and hopeful (once again). Nick is working and writing a children's book and articles and movie reviews for an online magazine. He is biking and swimming. He seems emphatically committed to his sobriety, but I have learned to check my optimism.
      We recently visited Nick. His eyes were clear, his body strong and his laugh easy and honest. At night, he read to Jasper and Daisy, picking up ''The Witches'' where he left off nearly three years before. Soon thereafter, a letter arrived for Jasper, who is now 11. Nick wrote: ''I'm looking for a way to say I'm sorry more than with just the meaninglessness of those two words. I also know that this money can never replace all that I stole from you in terms of the fear and worry and craziness that I brought to your young life. The truth is, I don't know how to say I'm sorry. I love you, but that has never changed. I care about you, but I always have. I'm proud of you, but none of that makes it any better. I guess what I can offer you is this: As you're growing up, whenever you need me -- to talk or just whatever -- I'll be able to be there for you now. That is something that I could never promise you before. I will be here for you. I will live, and build a life, and be someone that you can depend on. I hope that means more than this stupid note and these eight dollar bills.''

Growing Meth Use on Navajo Land Brings Call for Tribal Action
Joseph Kolb, New York Times- 2/7/2005

WINDOW ROCK, Ariz. - With no law on the books to criminalize the sale, possession or manufacture of methamphetamine on the Navajo reservation here, the largest reservation in the country, officials are fearing an explosion of the drug's use. "We've seen more than a 100 percent increase in meth on the reservation in the past five years," said Greg Adair, a 26-year officer with the Navajo Nation police.
      Under pressure from local and federal law enforcement officials, the Navajo Nation Tribal Council raised the issue of criminalizing methamphetamine during its summer meeting last year but was told that it needed to include other controlled substances. The matter was on the agenda for the winter meeting last month, but the optimism of public health and law enforcement officials was dashed when the session ended without the measure being passed. By the time the measure came up for consideration, only 42 of the 88 tribal council representatives were still in attendance, 3 short of a quorum. Larry Anderson, a council delegate from Fort Defiance, Ariz., and a co-sponsor of the legislation to criminalize the drug, said a special session would be planned to address the measure.
      The bill, which was introduced by Hope MacDonald-LoneTree, chairwoman of the Navajo Nation's Public Safety Committee, would bring tribal laws in line with state and federal statutes. The bill makes the possession or sale of a controlled substance, including methamphetamine, punishable with up to a year in tribal jail and a $5,000 fine. "Right now we don't have anything to charge the person we find with meth unless we go to the feds," said Greg Secatero, a criminal investigator with the Navajo Nation police.
      Paul Charlton, the United States attorney in Phoenix, said that under current procedures, when a tribal law enforcement officer finds a small amount of methamphetamine on a suspect, the drug is confiscated and an F.B.I. agent from Flagstaff is called. The substance is sent to a crime laboratory for identification, a process that one Navajo Police officer said can take a month. If tests show it is methamphetamine, the F.B.I. will issue an arrest warrant. Some police officials believe the process is not worth the effort for small amounts. Mr. Adair said that his officers have become "creative" and arrested people on other offenses, but that the cases are frequently dismissed in tribal court. "Kids and young adults say, 'Hey, I can get away with this,' and the drugs spread through the communities like wildfire," Mr. Adair said. One officer said he recently had to free someone who had 14 ounces of methamphetamine until the federal process took effect. "The legal system has fueled the meth epidemic," Mr. Adair said.
      Mr. Adair suspects the problem began proliferating on the reservation about five years ago. He said it was not until the government hospital in Tuba City begin to test victims and look for signs of methamphetamine abuse did they realize the problem was progressing. "We still don't have a handle on the exact amount of violent cases unless the suspect is tested for meth," Mr. Adair said. Mr. Adair said one incident that stuck in his mind involved the death of a 19-year-old girl four years ago. The girl was stabbed 43 times by her boyfriend, who was said to have been a methamphetamine user, Mr. Adair said. "That murder has always haunted us," he said.

For the Worst of Us, the Diagnosis May Be 'Evil'
Benedict Carey, New York Times- 2/8/2005

Predatory killers often do far more than commit murder. Some have lured their victims into homemade chambers for prolonged torture. Others have exotic tastes - for vivisection, sexual humiliation, burning. Many perform their grisly rituals as much for pleasure as for any other reason.
Among themselves, a few forensic scientists have taken to thinking of these people as not merely disturbed but evil. Evil in that their deliberate, habitual savagery defies any psychological explanation or attempt at treatment.
      Most psychiatrists assiduously avoid the word evil, contending that its use would precipitate a dangerous slide from clinical to moral judgment that could put people on death row unnecessarily and obscure the understanding of violent criminals. Still, many career forensic examiners say their work forces them to reflect on the concept of evil, and some acknowledge they can find no other term for certain individuals they have evaluated.
      In an effort to standardize what makes a crime particularly heinous, a group at New York University has been developing what it calls a depravity scale, which rates the horror of an act by the sum of its grim details. And a prominent personality expert at Columbia University has published a 22-level hierarchy of evil behavior, derived from detailed biographies of more than 500 violent criminals. He is now working on a book urging the profession not to shrink from thinking in terms of evil when appraising certain offenders, even if the E-word cannot be used as part of an official examination or diagnosis. "We are talking about people who commit breathtaking acts, who do so repeatedly, who know what they're doing, and are doing it in peacetime" under no threat to themselves, said Dr. Michael Stone, the Columbia psychiatrist, who has examined several hundred killers at Mid-Hudson Psychiatric Center in New Hampton, N.Y., and others at Creedmoor Psychiatric Center in Queens, where he consults and teaches. "We know from experience who these people are, and how they behave," and it is time, he said, to give their behavior "the proper appellation."
      Western religious leaders, evolutionary theorists and psychological researchers agree that almost all human beings have the capacity to commit brutal acts, even when they are not directly threatened. In Dr. Stanley Milgram's famous electroshock experiments in the 1960's, participants delivered what they thought were punishing electric jolts to a fellow citizen, merely because they were encouraged to do so by an authority figure as part of a learning experiment. In the real world, the grim images coming out of Iraq -- the beheadings by Iraqi insurgents and the Abu Ghraib tortures, complete with preening guards -- suggest how much further people can go when they feel justified.
      In Nazi prisoner camps, as during purges in Kosovo and Cambodia, historians found that clerks, teachers, bureaucrats and other normally peaceable citizens committed some of the gruesome violence, apparently swept along in the kind of collective thoughtlessness that the philosopher Hannah Arendt described as the banality of evil.
      "Evil is endemic, it's constant, it is a potential in all of us. Just about everyone has committed evil acts," said Dr. Robert I. Simon, a clinical professor of psychiatry at Georgetown Medical School and the author of "Bad Men Do What Good Men Dream." Dr. Simon considers the notion of evil to be of no use to forensic psychiatry, in part because evil is ultimately in the eye of the beholder, shaped by political and cultural as well as religious values. The terrorists on Sept. 11 thought that they were serving God, he argues; those who kill people at abortion clinics also claim to be doing so. If the issue is history's most transcendent savages, on the other hand, most people agree that Hitler and Pol Pot would qualify. "When you start talking about evil, psychiatrists don't know anything more about it than anyone else," Dr. Simon said. "Our opinions might carry more weight, under the patina or authority of the profession, but the point is, you can call someone evil and so can I. So what? What does it add?"
      Dr. Stone argues that one possible benefit of including a consideration of evil may be a more clear-eyed appreciation of who should be removed from society and not allowed back. He is not an advocate of the death penalty, he said. And his interest in evil began long before President Bush began using the word to describe terrorists or hostile regimes. Dr. Stone's hierarchy of evil is topped by the names of many infamous criminals who were executed or locked up for good: Theodore R. Bundy, the former law school student convicted of killing two young women in Florida and linked to dozens of other killings in the 1970's; John Wayne Gacy of Illinois, the convicted killer who strangled more than 30 boys and buried them under his house; and Ian Brady who, with his girlfriend, Myra Hindley, tortured and killed children in England in a rampage in the 1960's known as the moors murders.
      But another killer on the hierarchy is Albert Fentress, a former schoolteacher in Poughkeepsie, N.Y., examined by Dr. Stone, who killed and cannibalized a teenager, in 1979. Mr. Fentress petitioned to be released from a state mental hospital, and in 1999 a jury agreed that he was ready; he later withdrew the petition, when prosecutors announced that a new witness would testify against him. At a hearing in 2001, Dr. Stone argued against Mr. Fentress's release, and the idea that the killer might be considered ready to make his way back into society still makes the psychiatrist's eyes widen.
      Researchers have found that some people who commit violent crimes are much more likely than others to kill or maim again, and one way they measure this potential is with a structured examination called the psychopathy checklist. As part of an extensive, in-depth interview, a trained examiner rates the offender on a 20-item personality test. The items include glibness and superficial charm, grandiose self-worth, pathological lying, proneness to boredom and emotional vacuity. The subjects earn zero points if the description is not applicable, two points if it is highly applicable, and one if it is somewhat or sometimes true.
      The psychologist who devised the checklist, Dr. Robert Hare, a professor emeritus at the University of British Columbia in Vancouver, said that average total scores varied from below five in the general population to the low 20's in prison populations, to a range of 30 to 40 - highly psychopathic - in predatory killers. In a series of studies, criminologists have found that people who score in the high range are two to four times as likely as other prisoners to commit another crime when released. More than 90 percent of the men and a few women at the top of Dr. Stone's hierarchy qualify as psychopaths.
      In recent years, neuroscientists have found evidence that psychopathy scores reflect physical differences in brain function. Last April, Canadian and American researchers reported in a brain-imaging study that psychopaths processed certain abstract words -- grace, future, power, for example -- differently from nonpsychopaths. In addition, preliminary findings from new imaging research have revealed apparent oddities in the way psychopaths mentally process certain photographs, like graphic depictions of accident scenes, said Dr. Kent Kiehl, an assistant clinical professor of psychiatry at Yale, a lead author on both studies.
      No one knows how significant these differences are, or whether they are a result of genetic or social factors. Broken homes and childhood trauma are common among brutal killers; so is malignant narcissism, a personality type characterized not only by grandiosity but by fantasies of unlimited power and success, a deep sense of entitlement, and a need for excessive admiration.
      "There is a group we call lethal predators, who are psychopathic, sadistic, and sane, and people have said this is approaching a measure of evil, and with good reason," Dr. Hare said. "What I would say is that there are some people for whom evil acts -- what we would consider evil acts -- are no big deal. And I agree with Michael Stone that the circumstances and context are less important than who they are."
      Checklists, scales, and other psychological exams are not blood tests, however, and their use in support of a concept as loaded as evil could backfire, many psychiatrists say. Not all violent predators are psychopaths, for one thing, nor are most psychopaths violent criminals. And to suggest that psychopathy or some other profile is a reliable measure of evil, they say, would be irresponsible and ultimately jeopardize the credibility of the profession.
      In the 1980's and 1990's, a psychiatrist in Dallas earned the name Dr. Death by testifying in court, in a wide variety of cases, that he was certain that defendants would commit more crimes in the future -- though often, he had not examined them. Many were sentenced to death. "I agree that some people cannot be rehabilitated, but the risk in using the word evil is that it may mean one thing to one psychiatrist, and something else to another, and then we're in trouble, " said Dr. Saul Faerstein, a forensic psychiatrist in Beverly Hills. "I don't know that we want psychiatrists as gatekeepers, making life-and-death judgments in some cases, based on a concept that is not medical."
      Even if it is used judiciously, other experts say, the concept of evil is powerful enough that it could obscure the mental troubles and intellectual quirks that motivate brutal killers, and sometimes allow them to avoid detection. Mr. Bundy, the serial killer, was reportedly very romantic, attentive and affectionate with his own girlfriends, while he referred to his victims as "cargo" and "damaged goods," Dr. Simon noted. Mr. Gacy, a gracious and successful businessman, reportedly created a clown figure to lift the spirits of ailing children. "He was a very normal, very functional guy in many respects," said Dr. Richard Rappaport, a forensic psychiatrist based in La Costa, Calif., who examined Mr. Gacy before his trial. Dr. Rappaport said he received holiday cards from Mr. Gacy every year before he was executed.
      "I think the main reason it's better to avoid the term evil, at least in the courtroom, is that for many it evokes a personalized Satan, the idea that there is supernatural causation for misconduct," said Dr. Park Dietz, a forensic psychiatrist in Newport Beach, Calif., who examined the convicted serial murderer Jeffrey Dahmer, as well as Lyle and Erik Menendez, who were convicted of murdering their parents in Beverly Hills. "This could only conceal a subtle important truth about many of these people, such as the high rate of personality disorders," Dr. Dietz said. He added: "The fact is that there aren't many in whom I couldn't find some redeeming attributes and some humanity. As far as we can tell, the causes of their behavior are biological, psychological and social, and do not so far demonstrably include the work of Lucifer."
      The doctors who argue that evil has a place in forensics are well aware of these risks, but say that in some cases they are worth taking. They say it is possible -- necessary, in fact, to understand many predatory killers -- to hold inside one's head many disparate dimensions: that the person in question may be narcissistic, perhaps abused by a parent, or even charming, affectionate and intelligent, but also in some sense evil. While the term may not be appropriate for use in a courtroom or a clinical diagnosis, they say, it is an element of human nature that should not be ignored.
      Dr. Angela Hegarty, director of psychiatry at Creedmoor who works with Dr. Stone, said she was skeptical of using the concept of evil but realized that in her work she found herself thinking and talking about it all the time. In 11 years as a forensic examiner, in this country and in Europe, she said, she counts four violent criminals who were so vicious, sadistic and selfish that no other word could describe them. One was a man who gruesomely murdered his own wife and young children and who showed more annoyance than remorse, more self-pity than concern for anyone else affected by the murders. On one occasion when Dr. Hegarty saw him, he was extremely upset -- beside himself -- because a staff attendant at the facility where he lived was late in arriving with a video, delaying the start of the movie. The man became abusive, she said: he insisted on punctuality.

Just when I had started to relax it happened again. In the past I worried a lot about being pessimistic because a variety of research suggested that optimists had better health odds. I didn't see much of a chance for change. I hadn't been able to stick to exercise or eating lots of vegetables or keeping my desk neat and organized, so I was pretty pessimistic about becoming optimistic.
      On one score, however, I figured I had an edge. Other research hinted that an active mind could help fend off Alzheimer's disease. I have an active mind -- distracted perhaps, hard to corral, kind of sour, but certainly active. I tend to hop back and forth from one interest to another -- chess, boat building, guitar, the intricacies of miso soup. Each interest has a literature to master, problems to solve, a new way of thinking to explore. I thought all this thinking would help keep my mind sharp.
      Well, maybe not. Dr. Robert S. Wilson of Rush University Medical Center in Chicago and several colleagues reported in the January issue of Neurology that there was a clear correlation between a proneness to distress and the likelihood of developing Alzheimer's. He didn't propose any causal relationship. But when a scientist says it's just a correlation, I always imagine George Costanza saying to Jerry Seinfeld, "Not that there's anything wrong with that."
      George's character, by the way, is a nice example of pessimism, and worry. Larry David, the star of "Curb Your Enthusiasm," helped invent George, based on his own personality. Both George and Mr. David illustrated that there was at least one benefit to looking on the dark side. Expecting the worst can make for a lot of laughs.
      What Dr. Wilson studied was not pessimism but distress proneness, which is not exactly worry, but something like it. The study involved about 1,000 people studied over six years. Even correcting for other factors like genes known to increase susceptibility to Alzheimer's, it turned out that those likely to be distressed were more likely to develop the disease than the others.
      The effect was less strong in African-Americans than in whites. Dr. Wilson noted that "African-Americans have been disproportionately exposed to social conditions considered to be stressful" but said this did not explain the differences. Nor did he find any significant racial differences in general emotional states or proneness to distress.
      After reading the report, I had to admit that the numbers were sound. And even though I had stopped worrying about being pessimistic, I knew which group I would be in if I were part of the study. So now I was distressed about my proneness to distress, worried about being worried, which made me worried about being worried about being -- you get the idea.
      When I encounter research like this I wonder, Why are they doing this to me again? I know, of course, that the actual goal of Dr. Wilson is to understand a really awful disease. And in the long run, the more that is known about Alzheimer's the better, for both prevention and treatment. But what about the distressed among us? Should we relax, calm down, take it easy? Probably, but what are the odds?
      Science may offer some hope. The reign of the gene continues to become stronger and stronger. Many observers find this development unfortunate. If genetic determinism takes over our view of life, people may be tempted to forgo policies for social improvement. They may be tempted to ignore the fact that genes always interact with environment. For me, however, and other pessimists and worriers, there is, I have to say, a bright side. If I am predestined, by the precepts of a new genetic Calvinism, to worry, then I don't need to worry because there's nothing I can do.
      My genes have done a few good things for me. My cholesterol stays within tolerable limits. I don't gain weight easily. Despite lack of exercise and regular consumption of potato chips, I am in generally good health. On the downside, I've never been a fast runner and I tend to see the glass as half empty. But, then, if personality is as heavily influenced by genes as body type, there's nothing I can do about it. This doesn't mean I'll stop worrying. It just means I can stop worrying about worrying. I don't know whether this is Calvinism or Zen, but what it suggests is that I may be able to relax after all, to just sit back and enjoy my sense of impending doom.

Focus Narrows in Search for Autism's Cause
Sandra Blakeslee, New York Times- 2/8/2005

There comes a point in every great mystery when a confusing set of clues begins to narrow. For scientists who study autism, that moment may be near, thanks to a combination of new tools for examining brain anatomy and of old-fashioned keen observation. Within the last year, several laboratories have reported finding important new clues about the mysterious syndrome that derails normal childhood brain development. For the first time, they say, a coherent picture is emerging.
      In autism, subtle brain abnormalities are present from birth. Infants and toddlers move their bodies differently. From 6 months to 2 years, their heads grow much too fast. Parts of their brain have too many connections, while other parts are underconnected. Moreover, their brains show signs of chronic inflammation in the same areas that show excessive growth. The inflammation appears to last a lifetime. "Autism is still a confusing disorder, but one thing is now clear," said Dr. Pat R. Levitt, a neuroscientist who is the director of the Kennedy Center for Research on Human Development at Vanderbilt University in Nashville. "There is a specific disruption of circuitry in brain development. We can really dig in and begin to explain the splintered brains of autistic children."
      To that end, Dr. Levitt and two dozen leading brain researchers held a three-day "autism summit" in Malibu, Calif., sponsored by the Cure Autism Now Foundation, to discuss this emerging view and to plan collaborative studies. The meeting ended Sunday. "Up to now, there was no theory to link one anatomical study to the next," said Dr. William T. Greenough of the University of Illinois, an expert on brain development. "We now have a theoretical framework that can generate predictions to test."
      People with autism have great difficulty with social interaction. Some cannot speak. Many are clumsy. A common trait is obsessive attention to certain details. Symptoms can be severe to mild. Diagnoses of the disorder have increased in recent years, although no one knows why. One child in 166 born today may fall on the autism spectrum.
      Researchers agree that an unknown number of genes interact with unidentified environmental factors to produce the disorder. The new clues focus on brain development and circuitry, and especially on the brain's white matter. White matter contains fibers that connect neurons in separate areas of the brain, whereas gray matter contains the neurons themselves. "You can think of this distinction as analogous to that between cables, or white matter, and circuit boards, or gray matter, inside a computer," said Dr. Matthew Belmonte, an autism researcher at the University of Cambridge in England. "Even though each individual circuit board may be intact, if the cables are disrupted then the computer can't function."
      Using a new technique called morphometric analysis, in which post-mortem brain tissue is divided into tiny parcels and examined, Dr. Martha Herbert, a pediatric neurologist at Harvard Medical School, found an anomaly in the white matter of autistic brains -- it is asymmetrical. In autism, white matter grows normally until 9 months, Dr. Herbert said. Then it goes haywire. By 2 years, excessive white matter is found in the frontal lobes, the cerebellum and association areas, where higher-order processing occurs. The right side of the brain, the nonverbal hemisphere, is especially encased in white matter. The two sides of the brain are poorly connected. Moreover, small functional regions in each hemisphere tend to be prematurely insulated by excess white matter.
      Another clue was reported last year by Dr. Eric Courchesne, a neuroscientist at the University of California, San Diego. Using a simple tape measure, he found that newborns who later developed autism had smaller head circumferences than average. From 1 to 2 months of age, their brains suddenly begin to grow rapidly. Another spurt occurs between 6 months and 2 years, giving rise to exceptionally large heads. At age 3, one child could wear his father's baseball cap, Dr. Courchesne said. The rate of brain growth gradually slows from 2 to 4 years, reaching a peak a year later. A 5-year-old with autism has the same size brain as a normal 13-year-old. But by midadolescence, when normally developing children catch up, the autistic child's brain is again comparatively smaller.
     Dr. Ruth Carper, who works with Dr. Courchesne, went on to show that the frontal lobes, the slowest and latest brain region to develop, have the biggest size increase of all. But the nerve cells in this region, which is responsible for social reasoning and decision making, are actually much smaller than normal and "underpowered," Dr. Carper said.
      A third clue, from the laboratory of Dr. Marcel A. Just, a neuroscientist at Carnegie Mellon University in Pittsburgh, reaffirms the odd circuitry in autism. In a study published in November, he found that people with autism remembered letters of the alphabet in a part of the brain that ordinarily processes shapes. That is, the subjects used a basic sensory region to deal with higher-level concepts. "Autism results from a failure of various parts of the brain to work together," Dr. Just said. "Distinct brain areas work independently. People with autism are good at details but bad at conceiving the whole." Local networks are overconnected, he said. Long-range networks are underconnected.
      Skewed brain wiring could explain a fourth clue: clumsiness. Dr. Philip Teitelbaum, an expert on human movement patterns at the University of Florida, studies how babies with autism learn to roll over, sit up, crawl and walk. By looking at videotapes of their early months, before their disorders are diagnosed, he finds that autistic children use unusual strategies for locomotion. It is as if the parts of their brains that control movements are not properly connected.
      A fifth clue, also reported in November, may turn out to be a major piece of the puzzle. Dr. Carlos Pardo-Villamizar, an assistant professor of neurology and pathology at Johns Hopkins, studied the brain tissue of 11 people with autism who died at ages 5 to 44. He found a pattern of inflammation in the same regions that appear to have excess white matter. The brain has an innate immune system separate from the body's immune system, Dr. Pardo said. A sentinel cell type, called microglia, is always on the lookout for trouble. When activated, the cells elicit inflammation and growth factors. Another cell type, astroglia, helps pattern the brain in fetal development and is later involved in synaptic activity. The astroglia were also elevated in the 11 brains. Dr. Pardo then examined spinal fluid in six living children with autism. He found evidence of activated microglia, hence inflammation, along with astroglia. It is not yet clear whether the inflammation is protective or destructive, Dr. Pardo said. In either case, inflammation is most marked in the same areas highlighted in all the other studies showing the same abnormal circuitry.
      Other researchers have begun studies to find out whether genes involved in innate immunity and prenatal wiring are involved in the disorder. A crucial question is why does the brain grow rapidly and then stop growing, Dr. Courchesne said. What accounts for the timing of the defect? Dr. Herbert and others wonder whether the white matter is really larger. "We don't know what is inside those enlarged areas," she said. "It could be more axons, more white matter, or more glial cells and astrocytes." Dr. Robert Miller, a white matter expert at Case Western Reserve University School of Medicine in Cleveland, said he planned to examine white matter from autistic brains to see what gives them their "odd architecture" and perhaps discover the cause of the overgrowth. Studies are under way to dissect the white matter in greater detail.
      While these new clues are exciting, they do not lead to immediate treatments. Parents should not, for example, rush to give their autistic children anti-inflammatory medications at this time, Dr. Pardo said, because the link between autism and inflammation is still preliminary, and in any case, the drugs do not affect the type of inflammation particular to the brain. On the other hand, once autism is diagnosed, often around age 2 or 3, when the frontal lobes fail to activate properly, therapies might focus on activating multiple brain areas at the same time. This would not cure the disorder, Dr. Herbert said, but could theoretically lead to improvement. Meanwhile, other clues remain elusive. "Parents will tell you that when their child spikes a high fever, the child becomes lucid and communicative," said Dr. Levitt, of Vanderbilt. "A fever is a neuroinflammatory response. That suggests the circuit defects could be reversible. We just don't know."