Bodies in Motion, Clean and Sober
Paul Scott, New York Times- 10/12/2006

When Todd Crandell competes in the Ironman World Championship in Hawaii this month, it will mark his 12th Ironman in seven years. The remarkable is no longer remarkable, of course. Tens of thousands of people have completed one. But Mr. Crandell’s path to the starting line was unconventional. He first learned of the endurance showcase while smoking crack cocaine.
      Now sober, Mr. Crandell, 39, recalls how at 21 he watched television coverage of the triathlon (2.4-mile swim, 112-mile bicycle ride and 26.2-mile run) in awe while struggling with alcohol and cocaine addictions. In a memoir, “Racing For Recovery: From Addict to Ironman,” he describes his path of self-destruction as marked by drug dealing, arrests and living out of a Buick filled with gin and Mötley Crüe posters. Today he runs Racing for Recovery, a five-year-old foundation based in Sylvania, Ohio, that encourages people battling dependency to exercise as a way to create much-needed structure in their lives. More than 2,000 people have run in 5-kilometer races organized by the foundation around the country.
     Strenuous exercise has not been a part of traditional recovery programs like Alcoholics Anonymous or the Betty Ford Center, which emphasize abstinence above all else. But a few treatment centers, and former addicts like Mr. Crandell, are coming to see the value of road running and other fitness regimens in building confidence and managing stress for those battling alcohol and drugs. Mr. Crandell said he and other addicts he knows embrace regular conditioning as a way to help them stay sober and to pursue goals. And for those who are competitive, preparing for a race not only eats up time and distracts them from temptations, it also can help them establish goals and make clean-living new friends.
     Odyssey House, a treatment program in New York City, shares that view. On Sept. 23, 1,000 walkers and runners, many of them ex-addicts, participated in a 5-kilometer race organized by the program. It also now has 15 residents preparing for next month’s New York City Marathon. “We’re turning people who were heroin addicts, cocaine addicts, crack addicts into marathon runners,” said Peter Provet, the president of Odyssey House. “I really believe it’s a model for other treatment centers.”
     A new study seems to back up the idea that exercise can play a role in addiction recovery. Butler Hospital, affiliated with Brown University in Providence, R.I., recently completed a study that tracked 44 alcoholics and found that outpatient treatment and 12 weeks of aerobic conditioning increased the likelihood of their remaining sober. Research also has found that aerobic exercise improves symptoms of mild to moderate depression. Considering that depression is a risk factor for relapse for substance abusers, alleviating some of the disease’s burden may help addicts stay sober .Dr. Provet, a clinical psychologist, calls physical activity “the perfect antidote to addiction.” Ordinary hobbies don’t suffice, he said. “Knitting is good, but knitting does not address the negative breakdown of the human spirit and human body. Running does.”
     Odyssey House, with over 1,000 low-income patients in its nine centers, encourages clients to run. Activity counselors lead residents on group treks three to four times a week; athletic clothing and footwear are provided when needed. Nancy Waite-O’Brien, the vice president for clinical services at the Betty Ford Center in Rancho Mirage, Calif., said she thinks that helping addicts train for a race is a “terrific idea.” But helping patients accomplish their training goals is not always feasible for short-stay centers like Betty Ford, she said. Patients tend to stay three to four weeks at the Betty Ford Center compared with state-financed centers like Odyssey House, where patients reside an average of nine months to a year. The Betty Ford Center does not reject the benefits of exercise; it has a gym and offers some personal training, which the able-bodied can take advantage of, Dr. Waite-O’Brien said. But, she said: “Sometimes people are physically sick when they arrive. What we’re doing is mostly helping them get moving.”
     The Butler Hospital study suggests that incorporating exercise into recovery programs may be beneficial. Richard A. Brown, Butler’s director of addiction research, said their randomized controlled trial is in the final stages, but has already noted the impact that moderate exercise has had on previously sedentary alcoholics in outpatient treatment. The study used a control group, which was given only brief advice on the benefits of activity. The intervention group, though, received a weekly gym session, with instruction, on cardiovascular machines. The exercise group also attended discussions about overcoming barriers to activity, and were instructed to do two or three workouts on their own. Two months into the intervention, the group that participated in structured exercise sessions was two and a half times more likely to be abstinent from alcohol than those in the control group, according to preliminary results. Dr. Brown also reported that the more moderate exercise the alcoholics did, the higher the rates of their abstinence. “What we showed was when people are actively engaged in exercise they are doing better,” Dr. Brown said. “The question is how to keep them engaged.” After six months, Dr. Brown found, his charges ran into the same problem many of us do: their training dwindled.
     Jean Ferlesch, 54, who has been sober for two decades, wouldn’t dream of giving up her running and weight lifting routine. She recalls how the toil of exercise helped her manage emotions wrought by her divorce that at one time would have caused her to drink. “I started going to the gym and I was so sad and so angry,” she said. As she built up endurance, she imagined herself emotionally strong. “I ran through my pain.” Being able to persevere was novel, said Ms. Ferlesch, a store designer living in Brooklyn. “Years ago when something hurt, I would do anything to get away from that feeling,” she said. “It’s a more sophisticated understanding of pain now. I can sit with it and go through it, be it physical or emotional.”
     Other ex-addicts are drawn to competition for the exhilaration it offers. When Glen Caulkins, 53, of Dana Point, Calif., took up freestyle snowboarding four years after he kicked heroin, the intensity of his new sport felt familiar. Doing 60-foot aerial stunts was “the edge, and I was used to the edge,” said Mr. Caulkins, the owner of Glenhaven Sober Living Homes, a drug-free residence in San Clemente, Calif. He went on to become a three-time national snowboarding champion. “It was a fix for about 10 years,” said Mr. Caulkins, who now prefers inline skating and practicing yoga. Besides stimulation, Mr. Caulkins said, snowboarding gave him something far more mundane, a new social identity. “It gave me a whole group of friends who didn’t know my past,” he said.
     Exercise can also add structure to lives that once revolved around using. “When you’re drinking four, five, six hours a day, that in itself is an activity,” said Steve Vallender, 38, a recovering alcoholic and financial planner from Las Vegas who has set up a chapter of Racing for Recovery in his hometown. “I found myself with three, four hours of idle time every night and that’s when I started working out. Ex-addicts looking to reinvent themselves commonly look to the sport of triathlon, said Alan Ley, the coaching education manager for USA Triathlon. “We’ve got a lot of people in triathlon training who are trying to change old habits, whether they be related to drugs, alcohol or living a poor lifestyle,” he said. “It’s sort of like trading a negative addiction for a positive one.”
     Melissa Ellefson Huray, 33, a freelance writer and disc jockey in Duluth, Minn., sees her marathon training as a way to manage emotions, even if it can feel like a dependency. “I have a schedule and I do it six days a week,” said Ms. Huray, who was walking on a treadmill at 8:30 p.m. as she took part in a telephone interview. “I don’t like to deviate from my schedule,” she said. “If I didn’t run, I don’t think I would drink, but I might be on anxiety drugs or drugs for depression.” She added: “I have to be vigilant. I can never let my guard down with drinking or running.”
     Training consistently offers recovering addicts a way to regularly finish tasks. “There’s a mentality of, ‘Oh, someday I’ll do it,’ that alcohol perpetuates,” said Heidi Stone, 34, a mortgage broker and recovering alcoholic living in Brooklyn. But through weight lifting three times a week, she not only has arms strong enough to do a military push-up, but also a sense of accomplishment. And that, experts say, is crucial to an ex-addict’s growth. “Whether it is a 5K or a marathon, the closure of accomplishment is powerful,” Dr. Provet said. Racking up Ironman finishes is a way for Mr. Crandell to feel good but also to send a message to other addicts that they, too, can start over. He added: “There’s more to life than saying ‘I’m powerless over alcohol’ and ‘I’ve got to come to support-group meetings.’ ”

Little Benefit Seen in Antipsychotics Used in Alzheimer's
Shankar Vedantam, Washington Post- 10/12/2006

Antipsychotic drugs that are widely used to calm agitated patients with Alzheimer's disease help very few of them, and those modest benefits are canceled out by the frequent side effects, a comprehensive government-funded study has found. The surprising finding is expected to trigger a broad reevaluation of the widespread use of the drugs in patients with Alzheimer's and other forms of dementia. As many as a quarter of the Alzheimer's patients in nursing homes are prescribed the powerful drugs, even though they have never been formally approved for this purpose. "I wish I could say the odds are better," said Thomas R. Insel, director of the National Institute of Mental Health, which funded the $17 million study. "This paper says most people are not going to be any different on these drugs than they would on placebo." The researchers did not conclude that the drugs should never be used, and a minority of patients do benefit. But the study suggests that doctors would be well advised to prescribe the drugs sparingly and as a last resort, experts said.
      The study is the latest to produce sobering data on the newer, expensive antipsychotics such as Zyprexa, Risperdal and Seroquel, which are among the most widely prescribed drugs in the United States at an annual cost of about $10 billion. Another government-funded study recently showed that the drugs were no better than an older and much cheaper drug called perphenazine in the treatment of schizophrenia.
     Taken together, the government-sponsored clinical trials have highlighted two troublesome issues in the regulation and use of psychiatric medications in the United States. The schizophrenia study showed that the short-term trials that pharmaceutical companies sponsor to gain Food and Drug Administration approval have limited value in telling doctors how patients will fare overall, or whether newer drugs are worth their higher cost. The Alzheimer's study has revealed a different problem -- the extent to which physicians are prescribing and using medications in the absence of empirical data to guide them. None of the antipsychotic drugs is currently approved for Alzheimer's disease, and several short-term industry-sponsored clinical trials have failed to show a benefit. The FDA has required prominent "black box" warnings on the drugs' labels about side effects in elderly people following cases where the drugs were associated with strokes and death. "Clearly the drugs cannot be cost-effective, because there is nothing to choose between drugs and placebo," said Lon Schneider, the lead author of the new study published today in the New England Journal of Medicine. "Most patients are not benefiting."
     Insel, Schneider and Jason H.T. Karlawish, an Alzheimer's expert at the University of Pennsylvania who wrote a commentary about the new study, said it also underscores the desperate need to develop better treatments for Alzheimer's patients who are agitated or psychotic. About 5 million Americans suffer from dementias, including Alzheimer's, and large numbers of them experience periods of agitation and psychotic symptoms that are extremely debilitating for them, their caregivers and medical facilities. "You can't respond to agitation by saying 'Here is some olanzapine,' " said Karlawish, referring to the drug sold under the brand name Zyprexa. "The question is, why is there agitation?" Such symptoms could be the result of overstimulation, sleep deprivation, untreated pain, moving to a new environment or dehydration, the experts said.
     Like young children, patients with dementia can also be set off by a conversation that normal adults brush off or find routine. Karlawish suggested that this could be because dementias affect the frontal lobe of the brain, which plays an important role in judgment and self-control. "Any good parent knows there are effective and ineffective ways to respond to their 4-year-old," Karlawish said. Similarly, he said, "there are effective and non-effective ways to respond to someone with frontal-lobe damage."
     Clinicians and caregivers would do well to deal with such potential triggers of agitation before considering antipsychotic medication, Schneider agreed. The drugs might be useful in patients who continue to have agitation and breaks with reality despite such efforts, but Schneider cautioned that the drugs ought to be prescribed for limited periods and stopped if side effects emerge. Those effects include uncontrolled muscle movements, excessive sedation, worsened mental functioning and confusion.
     The manufacturers of the three drugs used in the study all said they do not recommend their products for Alzheimer's patients. Eli Lilly and Co. makes Zyprexa, AstraZeneca makes Seroquel, and Janssen Pharmaceutica makes Risperdal. The new study found that Risperdal and Zyprexa seemed to help Alzheimer's patients more than Seroquel, but those two medications also had more serious side effects.

Some Psychiatrists See 'Shopaholic' As a Diagnosis
Shankar Vedantam, Washington Post- 10/12/2006

Lucille Schenk bought $20,000 worth of jewelry a year ago, plunging herself into debt and despair. She knew something was wrong but couldn't help herself: For hours each day, she watched a jewelry channel and the Home Shopping Network, until the salespeople felt like family. She did most of her binge buying late at night. Often, after her purchases arrived, she returned them, knowing she could not afford them. Then she would see the same items on TV and buy them again. When Schenk finally sought help, New York psychologist April Lane Benson advised her to have a "conversation" with the jewelry before she made her next purchase, as a way to put some distance between herself and her compulsion. "I would say, 'You are so beautiful, I can't live without you; I love the way you sparkle,' " recalled Schenk, 62, in an interview. "The jewelry would say back, 'You need me. You look pretty when you wear me.' I would say, 'I do need you. I can't possibly think of being without you. But something has to change. I need to stop this. I can't afford a penny more.' "
      There may be more than 10 million people like Schenk in the United States, according to a study published this month in the American Journal of Psychiatry. They shop compulsively, buy things they do not need and often cannot afford, and place their work, their families and their mental health in jeopardy. The problem is widespread and serious enough that the American Psychiatric Association, which is updating its influential "bible" of mental disorders, is weighing whether to list compulsive buying as a disorder. That proposal is sure to stir a long-running debate about whether psychiatry is turning every troubling aspect of human behavior into a disease. Some researchers argue that categorizing binge buying as a medical problem takes the focus away from social factors such as the impact of advertising, easy credit and commercialization.
     Avis Mysyk, an anthropologist at Cape Breton University in Nova Scotia, said therapists should not be advised to "throw the person out of your office" but added: "One thing with the holistic perspective is we don't isolate the individual from the wider context, or just look at the wider context to the exclusion of the individual."
     There is no historical data to show whether the number of people affected is growing, but experts agree that the easy access to shopping provided by the Internet, 24-hour cable networks and malls has probably had an impact. Most people can use shopping networks and credit cards without losing control, experts note. But for people who cannot control themselves, as with addictions to alcohol or gambling, easy availability of the thing they crave aggravates the problem. Like other addicts, binge buyers usually want to stop but find they cannot.
     The new study in the American Journal of Psychiatry was conducted by a team led by Lorrin M. Koran, a psychiatrist at Stanford University. Besides the sheer number of people, Koran said what surprised him was that men were just as likely as women to be binge buyers. The study also found that compulsive buyers were likely to earn less than $50,000.



To Be Married Means to Be Outnumbered
Sam Roberts, New York Times- 10/15/2006

Married couples, whose numbers have been declining for decades as a proportion of American households, have finally slipped into a minority, according to an analysis of new census figures by The New York Times. The American Community Survey, released this month by the Census Bureau, found that 49.7 percent, or 55.2 million, of the nation’s 111.1 million households in 2005 were made up of married couples — with and without children — just shy of a majority and down from more than 52 percent five years earlier.
      The numbers by no means suggests marriage is dead or necessarily that a tipping point has been reached. The total number of married couples is higher than ever, and most Americans eventually marry. But marriage has been facing more competition. A growing number of adults are spending more of their lives single or living unmarried with partners, and the potential social and economic implications are profound. “It just changes the social weight of marriage in the economy, in the work force, in sales of homes and rentals, and who manufacturers advertise to,” said Stephanie Coontz, director of public education for the Council on Contemporary Families, a nonprofit research group. “It certainly challenges the way we set up our work policies.”
     While the number of single young adults and elderly widows are both growing, Professor Coontz said, “we have an anachronistic view as to what extent you can use marriage to organize the distribution and redistribution of benefits.” Couples decide to live together for many reasons, but real estate can be as compelling as romance. “Owning three toothbrushes and finding that they are always at the wrong house when you are getting ready to go to bed wears on you,” said Amanda Hawn, a 28-year-old writer who set up housekeeping near San Francisco with her boyfriend, Nate Larsen, a real estate analyst, after shuttling between his apartment and one she shared with a friend. “Moving in together has simplified life,” Ms. Hawn said.
     The census survey estimated that 5.2 million couples, a little more than 5 percent of households, were unmarried opposite-sex partners. An additional 413,000 households were male couples, and 363,000 were female couples. In all, nearly one in 10 couples were unmarried. (One in 20 households consisted of people living alone). And the numbers of unmarried couples are growing. Since 2000, those identifying themselves as unmarried opposite-sex couples rose by about 14 percent, male couples by 24 percent and female couples by 12 percent.
     Matt Foreman, executive director of the National Gay and Lesbian Task Force, said gay couples were undercounted because many gay people were reluctant to disclose their sexual orientation. But he said that inhibition seemed to be fading. “I would say the increase is due to people feeling more comfortable disclosing that they are gay or lesbian and living with a partner,” he said. The survey did not ask about sexual orientation, but its questionnaire was designed to distinguish partners from roommates. A partner was defined as “an adult who is unrelated to the householder, but shares living quarters and has a close personal relationship with the householder.”
     Some of the biggest gains in unmarried couples were recorded in unexpected places. In the rural Midwest, the number of households made up of male partners rose 77 percent since 2000. The survey revealed wide disparities in household composition by place. The proportion of married couples ranged from more than 69 percent in Utah County, Utah, which includes Provo, to 26 percent in Manhattan, which has a smaller share of married couples than almost anyplace in the country. But Manhattan registered a 1.2 percent increase in married couples since 2000, in contrast to the rest of New York City and many other places. Among counties, the highest proportion of unmarried opposite-sex partners was in Mendocino, Calif., where they made up nearly 11 percent of all households.
     The highest share of male couples was in San Francisco, where, according to the census, they accounted for nearly 2 percent of all households. In Manhattan, they made up 1 percent of households. Hampshire County, Mass., home to Northampton, had the highest proportion of female couples, at 1.7 percent. Some of the highest numbers of unmarried couples were recorded in the South, which as defined by the census, has the largest population of any region.
     David Blankenhorn, president of the marriage advocacy group the Institute for American Values, said married couples had become a minority largely because of the growing number of households made up of people who planned to marry or who used to be married. Steve Watters, the director of young adults for Focus on the Family, a conservative Christian group, said that the trend of fewer married couples was more a reflection of delaying marriage than rejection of it. “It does show that a lot of people are experimenting with alternatives before they get there,” Mr. Watters said. “The biggest concern is that those who still aspire to marriage are going to find fewer models. They’re also finding they’ve gotten so good at being single it’s hard to be at one with another person.”
     But Pamela J. Smock, a researcher at the University of Michigan Population Studies Center, said her research — unaffiliated with the Census Bureau — found that the desire for strong family bonds, and especially marriage, was constant. “Even cohabiting young adults tell us that they are doing so because it would be unwise to marry without first living together in a society marked by high levels of divorce,” Ms. Smock said. A number of couples interviewed agreed that cohabiting was akin to taking a test drive and, given the scarcity of affordable apartments and homes, also a matter of convenience. Some said that pregnancy was the only thing that would prompt them to make a legal commitment soon. Others said they never intended to marry. A few of those couples said they were inspired by solidarity with gay and lesbian couples who cannot legally marry in most states.
     Jennifer Lynch, a 28-year-old stage manager in New York, said she had lived on the Lower East Side with her boyfriend, who is 37 and divorced, for most of the five years they have been a couple. “Cohabitating is our choice, and we have no intention to be married,” Ms. Lynch said. “There is little difference between what we do and what married people do. We love each other, exist together, all of our decisions are based upon each other. Everyone we care about knows this.” If anything, she added, “not having the false security of wedding rings makes us work even a little harder.”
     With more competition from other ways of living, the proportion of married couples has been shrinking for decades. In 1930, they accounted for about 84 percent of households. By 1990 the proportion of married couples had declined to about 56 percent. Married couples have not been a majority of households headed by adults younger than 25 since the 1970’s, but among those aged 25 to 34 the proportion slipped below 50 percent for the first time within the past five years. (Among Americans aged 35 to 64, married couples still make up a majority of all households.) “It’s partially fueled by women in the work force; they don’t necessarily have to marry to be economically secure,” said Andrew A. Beveridge, a demographer at Queens College of the City University of New York, who conducted the census analysis for The New York Times. “You used to get married to have sex. Now one of the major reasons to get married is to have children, and the attractiveness of having children has declined for many people because of the cost.”
     William H. Frey, a demographer at the Brookings Institution, attributed the accelerated trend to the lifestyles of baby boomers. “It’s the legacy of the boomers that have finally caused this tipping point,” Dr. Frey said. “Certainly later generations have followed in boomer footsteps, with high levels of living together before marriage, and more flexible lifestyles. But the boomers were the trailblazers, once again, rebelling against a norm their parents epitomized. “This would seem to close the book on the Ozzie and Harriet era that characterized much of the last century,” he said.

History stands naked, clothed only by our imagination. So a historical novel has a particularly difficult task: breathing life into a story without losing it in a maze of research. In his keenly detailed new book, the Canadian writer Greg Hollingshead offers the pleasures of this sort of undertaking, despite eventually losing his balance under the weight of the past.
      “Bedlam” begins in 1797 with a jolt: in the bedroom of a real (if minor) historical woman surprised by the unexpected arrival of her naked husband, James Tilly Matthews, an escapee from a London madhouse who is soon back within its walls. After this wrenching, lunatic scene, the novel details, in three different narrative voices, a prolonged struggle both to release him and to discover the possibly political reason for his incarceration. Interspersed are the emotional letters husband and wife write to each other and one touching note from their son. There are accounts of visits by foreign doctors and interviews before deciding boards, as well as entreaties to some of the famous men of the age. Early on, however, we realize that Matthews’s release is unlikely, even if, as he writes, his hope is “like a precious plate,” always “springing from the shelf to smash again.”
     “Bedlam” is filled with rewarding descriptions of a bygone era (men, for example, smile with “battle of Waterloo teeth” stolen from dead soldiers), but the best passages illuminate the madhouse and its patients. A first visit shows wood figures of beggars “painted and shellacked, the paint rubbed away by the strokings of visitors at their noses, nipples and crotches.” Within, one meets Mary Creed, who “stole a patient’s wooden leg and mounted it in an attempt to hatch it like an egg to a limb of flesh and blood, and when she failed to effect that miracle blamed it on the misery of her sex and hanged herself with a strip of her blanket-gown.” The madness of James Tilly Matthews features the delusion of a “gang” working on a mind-controlling “Air-Loom,” a fantasy nearly as complex as the actual London politics of the era and apparently taken directly from Matthews’s real-life engravings.
     As with all copiously researched fiction, Hollingshead’s novel is best served when he shows not merely a dungeon of pitiables and grotesques but also inmates whose infirmity reflects the novel’s wider themes — men like Richard Pocock, “whose conviction it is that as soon as he thinks of something, it’s destroyed” and who stands in his cell with his eyes closed, trying to undo the damage, repeating, “I never thought of America, nor Jersey, nor Spain, nor Portugal, nor Plymouth Dock” and so on.
     “Bedlam” has no end of gorgeous writing. Ostentatious language is always a danger when using narrators from the distant past, but Hollingshead’s descriptions stand tastefully back from such overexuberance: a land crab becomes “a rat in armor,” a keeper at the madhouse is an albino with “a cherry-pit-and-porridge complexion”; the sun is “a solar disk the color of soot-streaked copper.” Cruel Dr. Haslam, the master of the hospital, touches on one of the novel’s nerves when he considers “how you can think of yourself as a certain sort of person yet watch yourself behave as quite another,” noticing the way you tell yourself it is “only the small, private price you must pay awhile longer yet if you would achieve such-and-such worthy end.”
     Hollingshead’s elegant, heartfelt writing and smart research almost make up for the novel’s oddly static feeling. The author seems too in love with the past to be willing to take liberties with it. In a less rigorously fact-based madhouse, an inmate’s wife might disguise herself as a charwoman to visit her husband; the madman himself might be as visionary as William Blake; the doctor who treats him might even break through the stone walls to let in some light. But in a history-bound novel like “Bedlam” (as Hollingshead’s acknowledgments confirm), the characters can do none of these things — because they didn’t do them in real life. Haslam, Matthews and his wife, true to the real people who inspired them, remain glued in history, unable to change. Instead of following them through an inventive plot, one must simply watch them endure time’s passage; instead of feeling a mounting suspense, one merely waits for Matthews to tell the complex secret of his detainment.
     Lesser writers of historical fiction often stoop to melodrama. Hollingshead, happily, does not, though he does resemble the headstrong theatrical producer who buys the costumes first and then is forced to find actors to fit them. But while his storytelling may not be the reason to read “Bedlam,” his love of language — so carefully unearthing and framing a long-lost time — certainly is.

Midlife Crisis and Men
Josh Fischman, Los Angeles Times- 10/16/2006

Minding your health is not a young man's game. Muscles work smoothly in the teen years, joints flex easily in the 20s. It seems like men can eat what they want, drink what they desire, and the pounds melt away as quickly as they put them on. They can work 16-hour days, party until 3 a.m., and get up the next day and do it again. (Give or take a few bad hangovers, of course.) Life is a river, flowing to them effortlessly and endlessly.

Then sometime in the middle decades — perhaps as men hit their mid-30s and approach 40, or sometimes 50 — the river changes. It no longer flows quite so smoothly, quite so fast. Knees give out during a squash game. Hair gives out, well, every time a comb runs through it. And men begin to think that, beyond the next bend, the end of the river waits. They can't see it yet, but they know that it's there. This, for many men, marks a turning point, not just physically but in the mind as well.

"You realize half of your life is over," says screenwriter Bruce McKenna, 44, who just moved from Los Angeles to Santa Fe, N.M. "I found myself thinking seriously about what to do with the rest of it. I hit 42, 43, and I was more worried about my kids, about them growing up" — his children are 13, 11 and 8 — "about wanting to spend more time with them. I worried about working myself to an unhealthy degree, and I worried about finances. So I decided to leave L.A. Not only is Santa Fe cheaper, but L.A. is just not an easy town to be middle-aged in. In my business, you're old if you're 30."

Health, like so much else for men in midlife, is in flux, and men like McKenna are reacting to it. Bodies and mind-sets are changing. Physically, men pack on more pounds around the middle during these years, and report more chronic, nagging illnesses. At the same time, men increase their efforts to improve their well-being. Use of vitamins goes up, as does moderate and vigorous exercise, according to one of the largest studies ever done of middle age: a survey of 7,000 people called Midlife Development in the United States. The health portion of that survey was published in 2004 as a book, "How Healthy Are We?"

"We begin seeing our bodies start to deteriorate, and that's just a reality we have to cope with," says David Almeida, a psychologist at Pennsylvania State University and one of the study investigators.

But men at midlife actually seem well prepared to cope. Men in their 40s seem better able to "recalibrate" than do men in their 20s, says Almeida. They feel they can make adjustments and change for the better. They reach out to others more, and are less focused on themselves. In fact, men in midlife report fewer daily stresses than do women or younger men, according to the midlife development study.

The "midlife crisis" so often portrayed in the media — a period of emotional tumult and strain, when men get divorced, buy a red Corvette, sleep with women half their age and get hair and pectoral implants — is actually quite rare, researchers say. Instead, most men in their 40s are people like McKenna, adjusting to a changing situation with sensitivity and good judgment. "The midlife crisis notion is pretty much a dead duck," says Michael Kimmel, a sociologist at the State University of New York at Stony Brook and author of the book "Manhood in America." "It's a myth."

It certainly seems like a myth to Los Angeles resident Marty Sokol, 38, who produces reality shows for MTV and owns Club Chico, a nightspot in Montebello. "When you're in your 20s, you think a lot about what other people think of you. Now what's really important to me are my responsibilities to myself, to my employees, and to my community."

Sokol says he does a lot of things now that he wouldn't have dreamed about a decade ago. He meditates every day. He eats a healthful breakfast: granola, yogurt, flax and things high in antioxidants. "In my 20s that would more likely to have been an Egg McMuffin." He also exercises three times a week at a local gym, focusing on stretching more than strength-building.

For Thomas Henderson, 44, a former lab technician at the University of North Dakota in Grand Forks, family and fitness came together.

"Yeah, I started feeling a few more twinges, maybe some arthritis, maybe carpal tunnel coming on … You start to wonder if these are harbingers of bigger problems," he says. "So I decided to start swimming." His two kids were in the Boy Scouts "and doing a lot of water activities. To supervise them, I needed to swim better myself. I started last year, and I was really a floundering beginner. Now I'm up to 1,000 yards a session, three or four times a week." He's still got a bit of a belly, "the ol' Buddha," but he doesn't obsess about it.

Henderson also made some other changes. He went back to school, starting a doctoral program in microbiology. Working in other people's labs, he was dependent on their ability to get grants. "But with a PhD I could get my own money for research, or a teaching position." That sense of flexibility and independence is important to him as he goes forward in life, he says, and it's important for his family.

This doesn't mean that every man at midlife is Mr. Maturity. "We probably all know someone who bought the little red sports car, dumped his wife, and all that," says Sam Cochran, a clinical psychologist at the University of Iowa and editor of the scientific journal Psychology of Men & Masculinity. "I just don't think there are that many of them." He does admit that when he goes to the gym "I see guys who are middle-aged and driving themselves too hard. They get kind of obsessive with the machines…. It's like they're trying to stop all the aging."

Adds McKenna: "One of the most terrifying things about getting older is fearing the loss of sexual potency. And all these magazines, like GQ, FM and Playboy, play off that fear." The glorification of youth, and linking it to celebrity and success, can give aging men the heebie-jeebies. "I have this one friend, a wealthy, powerful guy, and he's started driving a Ferrari, going to a lot of Vegas strip shows, and he's in the gym every morning at 6:30. I think he's kind of a joke."

But it's the minority who are driven to extremes by these worries. Only 10% of men are swirling in midlife turmoil, according to an estimate by psychologist Orville Brim, director of the midlife development study. The rest are following the river, trying to stay out of the rocks and enjoying the ride.

Cocaine May Diminish Brain Regions That Motivate
Jamie Talan, Newsday- 10/16/2006

People who abuse cocaine may be damaging brain regions that motivate people to work harder for greater monetary rewards, and may extend to other nondrug rewards such as food, according to a new study. It could also make recovery from addiction more difficult.
     "The problems in the brain's reward-processing area and the control of behavior could explain
why people have such a hard time stopping," said Rita Gold stein, a scientist at Brookhaven National Laboratory on Long Island, N.Y, and lead investigator in the study. She and her colleagues have identified disruptions in the brain's prefrontal cortex, the area that governs thinking, planning and behavior.
     When addicts were asked to complete a number of computerdriven tests--a correct response would lead to rewards totaling $50--brain scans showed that the amount of money they could make had no impact on their response. Volunteers with no history of drug use performed better if they knew the reward was higher.
     In other words, one of the most powerful rewards that drive human behavior--money--didn't seem to register a normal brain response, said Goldstein, who presented the latest findings during the Society for Neuroscience annual meeting in Atlanta this week "The drug overpowers the brain regions that respond to nondrug rewards like money," said Goldstein, who says the ability to seek other rewards like food and sex may also be compromised by the changes to this region. Goldstein and her colleagues also asked people in the study 16 addicts and 13 healthy volunteers, how much they value money. Goldstein said more than half of the cocaine addicts said that $10 was just as good as $1,000, compared with two of the 13 healthy volunteers.



Scenes From a Marriage, Revealed by a Son
A. O. Scott, New York Times- 10/18/2006

The lives of Mike and Mina Block, in outline, seem so typical as to be almost indistinguishable from those of countless other Americans of their generation. Born in the early 1920’s, they were married in 1947, after Mike returned from combat in World War II. The couple settled in Port Washington, in suburban Long Island, and made their contribution to the postwar baby boom: three children, one of whom, Doug, the youngest and the only son, grew up to be a documentary filmmaker. His parents’ 54-year marriage (Mina died in 2002) is the subject of “51 Birch Street,” one of the most moving and fascinating documentaries I’ve seen this year.
      Curiously enough, what makes this movie so engrossing is the sheer ordinariness of the lives it surveys. Unlike some other recent memoir films — “Capturing the Friedmans,” for example, or “Tarnation” — “51 Birch Street” does not explore terrible secrets or extreme dysfunction. Instead Mr. Block explores more subtle forms of repression, secrecy and denial, and confirms what the best novelists know: that marriage, among the most common of human arrangements, is also among the most complex and mysterious.
     “Aren’t you glad we got married?” Mrs. Block says into her son’s camera, as he records one of his parents’ anniversary parties. “You’d better be.” And so he is. But it is less clear that Mike and Mina are quite as grateful, and it is the intimation of their lingering, buried frustration that propels the filmmaker into a sometimes uncomfortable investigation of their shared past.
     He was initially drawn into making this movie — one he says, via voice-over, that he never imagined he’d make — by events that followed his mother’s sudden death from pneumonia. A few months later his father revealed that he had re-established contact with Kitty Duffy, who had been his secretary nearly 30 years earlier and who would shortly become his second wife. In his early 80’s, the elder Mr. Block seemed determined to make a fresh start, selling the house on Birch Street and setting out for Florida.
     Did his marriage to Kitty represent the rekindling of an old flame? This question appears at first to be the central enigma of “51 Birch Street,” but as Mr. Block delves into his mother’s diaries and starts interviewing some of her friends, a more complicated picture of his parents’ marriage begins to emerge. At the same time, a window opens onto the history of the postwar American middle class, as its placid suburban idyll is buffeted by the cultural upheavals of the 60’s and 70’s: feminism, psychotherapy, drugs, the sexual revolution. And the puzzle of Mike and Mina’s marriage — its shadows, its silences — nudges their son into contemplation of his own.
     It also leads to consultation with a psychologist and a rabbi, both of whom respond to Mr. Block’s confusion with the boilerplate of their respective professions, returning the Block family history to the plane of the general. Which may be helpful from a therapeutic or an ethical standpoint, but for the movie audience, what makes “51 Birch Street” so gripping is its particularity. Everyone in it seems so familiar that by the end you can’t quite believe that you have known them for less than 90 minutes. Mr. Block has put his parents’ life, and his own, into this film with such warmth and candor that it may take more than one viewing to recognize it as a work of art.

The Rev. Anthony Mercieca told The Associated Press in a telephone interview that he was naked with Foley in a sauna, and was quoted in other interviews saying he also fondled him. Mercieca told the AP that the encounters weren't sexual, a distinction abuse experts found disturbing.

''The priest is very focused on the legalities here and I think it's important for the rest of us to see the enormous power differential between these two,'' said David Finkelhor, director of the Crimes Against Children Research Center at the University of New Hampshire.

''There is a tremendous abuse of authority and position involved in these activities whether or not they constitute child molestation.''

Foley, 52, resigned from Congress last month after his sexually explicit computer messages to young male pages were released. His lawyer has said that Foley was an alcoholic, gay and had been molested as a youth by a clergyman.

The Archdiocese of Miami confirmed Friday that Mercieca, 69, is the person Foley said abused him as a teen. In phone interviews, the priest, who is retired and lives on the Maltese island of Gozo, has given details about his encounters with Foley four decades ago.

The priest told the Sarasota (Fla.) Herald-Tribune that he and Foley ''loved each other like brothers'' and that although he taught Foley ''some wrong things'' related to sex, Mercieca insisted their interactions were innocent.

''It was just fondling,'' he told WPTV of West Palm Beach, Fla.

From the perspective of people who have worked with abusers and their victims, that thinking is typical of a molester. Offenders, who are sexually immature, commonly view their involvement with their victims as normal and are baffled when others see things differently.

''This is the same type of rationalization that I've heard time and time again from priests who have been grooming or setting a young boy up for molestation,'' said the Rev. Thomas Doyle, a canon lawyer turned victim advocate.

The Herald-Tribune reported that Mercieca said he could not clearly remember one encounter ''that might have gone too far'' because he had been taking tranquilizers and drinking at the time.

''It's common that offenders will block out major pieces of the events. I personally believe that it's also part of the denial process, where they just don't, frankly, want to remember,'' said the Rev. Stephen J. Rossetti, president of Saint Luke Institute, which provides psychological counseling to Catholic priests who suffer from a variety of troubles, including sexual attraction to children. ''Those are typical kinds of statements of offenders who are not in recovery.''

Abusers assume that because a young person seems to be enthusiastic around them, that any boundary crossing or sexual activity is OK, Finkelhor said. And if no penetration occurs, molesters convince themselves that the interaction does not hurt the youth, he said.

Mercieca's ''basic approach is, 'You're trying to take something good and trying to turn it into something evil,''' said Peter Isely, a clinical social worker who counsels abuse victims and a leader of the Survivors Network of those Abused by Priests.

''He literally describes this 12- or 13-year old child as if they're equals in age and in personality and characteristic, as if there's absolutely no power differential,'' Isely said.

''This is what makes these offenders so dangerous.''

States have different legal definitions of what constitutes child molestation, but many consider inappropriate touching a criminal offense. Mike Edmondson, a spokesman for the state attorney's office in West Palm Beach, Fla., said law enforcement action is over in Mercieca's case unless other alleged victims come forward, because Foley says he doesn't want to prosecute.

From a clinical perspective, Mercieca's description of his actions indicates abuse occurred, Rossetti said.

''The things he's talking about are very sexually charged and they are sexual abuse,'' Rossetti said. ''For an adult male to be with a young male naked in a bathtub or a shower would clearly be a major boundary violation in most cases -- and also traumatic.''



Kool-Aid, Craziness and Utopian Yearning
Stephen Holden, New York Times- 10/20/2006

The scariest thing about “Jonestown: The Life and Death of Peoples Temple” is that so many of the followers of Jim Jones, the demented demagogue who led them to commit mass suicide, appear to have been intelligent, idealistic, life-loving people. On Nov. 18, 1978, more than 900 of them died after drinking poisoned Kool-Aid in what this documentary, directed by Stanley Nelson, calls “the largest mass suicide in modern history.”

Two of the five Jonestown residents who resisted Mr. Jones’s call and escaped into the jungles of Guyana after their loved ones died in their arms offer moment-by-moment accounts of this orgy of self-annihilation. The movie includes an audiotape of Mr. Jones urging them to “die with a degree of dignity” rather than “lie down in tears and agony.”

Death, he argued, was not that big a deal; it was just crossing a line. He heralded communal self-destruction as “an act of revolutionary suicide protesting the conditions of an inhumane world.”

This is a movie to make you shudder. How many of us are so desperate for a charismatic leader claiming to have the answers that we will surrender our basic instincts for survival, along with our reason? This film paints a portrait of Mr. Jones, who died with his flock in Guyana, as a man with two faces. The appealing one was that of a trained Pentecostal minister, an idealist with polished oratorical skills. Growing up poor in Indiana, Mr. Jones was sensitive to the plight of African-Americans, and preached racial equality. His son Jim Jones Jr., who appears in the film, boasts of being the first black child adopted by a Caucasian in the state of Indiana.

Especially for Mr. Jones’s poor black followers, the interracial, self-sufficient community he established in Guyana, and before that in San Francisco and in the Redwood Valley of Northern California in the mid-1960’s, promised utopia. In exchange for their life savings, church members happy to work 20 hours a day for the cause were provided comfortable accommodations and given allowances. The documentary has clips of euphoric Peoples Temple celebrations in all three locations.

The other Jim Jones wears the scowl of a paranoid sadist. As a child, this Jim Jones (whose father was an unemployed alcoholic) conducted funerals for dead animals. A social outcast among whites, he found community in the Pentecostal church and preached on the revival circuit. Years later, he performed bogus faith healings.

Declaring that everyone in the community except himself was homosexual, he verbally coerced men and women into having sex with him and afterward told them he did it for them. At the same time, he discouraged liaisons among Temple members, asserting that sexual relationships were selfish and took away from the focus of the church.

One New Year’s Eve in California, he rehearsed the coming mass suicide by passing out punch to 126 people, then telling them they had just drunk poison and would die together as one. When nothing happened, he said it was a loyalty test.

After the church moved from the Redwood Valley to San Francisco, Mr. Jones became a political force whose support helped elect George Moscone the city’s mayor in 1975. But as the church grew in numbers and influence, Mr. Jones’s paranoia deepened. The night in 1977 that New West magazine went to press with an exposé of Peoples Temple based on defectors’ accounts, Mr. Jones fled for Jonestown, which was already under construction.

Some embraced it as a heaven on earth. But Mr. Jones also set up a speaker system through which he broadcast his paranoid ravings 24 hours a day. Before long, anyone who expressed a wish to leave was considered a traitor.

The end came suddenly, right after Leo Ryan, a California congressman, arrived in Jonestown on Nov. 17, 1978, to investigate complaints from constituents whose relatives had moved there. When Mr. Jones learned that several residents wanted to return with him to the United States, chaos erupted. As Representative Ryan’s plane was about to leave, he was one of five people who were killed on the airstrip. The mass suicide followed the next day.

In hindsight, it may be convenient to view Jonestown as the most tragic manifestation of 1960’s utopianism run amok, and to imagine that in today’s tougher, more cynical social climate, it couldn’t happen. But as this powerful, minutely documented film reveals, the tragedy wasn’t caused by the failure of the Peoples Temple to realize its goals. In many ways, it was succeeding as a self-sufficient community.

Rather, the horror of Jonestown was caused by people’s willingness to surrender their reason to a madman who was also a charismatic manipulator. And that can happen anytime and anywhere.

JONESTOWN: The Life and Death of Peoples Temple
Produced and directed by Stanley Nelson; written by Noland Walker and Marcia Smith, based on a story by Ms. Smith; director of photography, Michael Chin; edited by Lewis Erskine; music by Tom Phillips; released by Seventh Art Releasing. At the Quad Cinema, 34 West 13th Street, Greenwich Village. Running time: 85 minutes. This film is not rated.