Noteworthy News Articles on Mental Health Topics, March 15-20, 2007 Virginia Heffernan, New York Times- 3/15/2007 Pseudoscientists don’t know yet whether drug-documentary addicts are hooked by the gruesomely thrilling scenes of tourniquets and needles, the photos of pre-Vicodin fifth graders or the promise of redemption through higher powers. But something definitely sets the brain reeling with manic questions: How could they fall so far? How could so many of us? Whom will addiction strike next, and will the culprit be the demon rum or the demon OxyContin? The American addiction story, as refined by Alcoholics Anonymous, tells of good folks turned bad — of men taking drinks and drinks taking men. No wonder we crave this story: It’s the master narrative of innocence and fall, complete with the possibility of deliverance. Nor is it any wonder that HBO has embraced the genre with its current authoritarian gusto. That channel’s “Addiction,” an anthology of short films by famous documentary filmmakers, has its premiere tonight. The blunt title holds promise. As a story, addiction to drugs and alcohol has a chilling and ritualistic arc. Typically, the variable is the drug. Some viewers go for the methamphetamine documentaries, with their slightly high-handed attitude toward the Midwest, their contested statistics and their focus on dental issues. Other viewers prefer the shadowy, stylish heroin ones, with the sexy, skinny kids and “Requiem for a Dream” fashion. When it comes to drug-addiction TV, I’m a garbagehead: I watch it all. But to my amazement, “Addiction” doesn’t quite hit the spot. Someone at HBO seems to have instructed the esteemed filmmakers — auteurs like Albert Maysles and D. A. Pennebaker, even — to deny ravenous viewers what they want. The film is bereft of feel-good scenes and drug-movie clichés. As such, the shorts can build a cumulative sense of deprivation. Don’t expect needles here, in other words, or ravaged street kids turning tricks, or spectacular scenes of delirium tremens. No one even gets high in “Addiction”; no fervid expression gives way to one of stoned beatitude. It’s enough to make you kind of mad: “Addiction” is holding out on us. And, surely, this is the point. The program is part of a solemn project, something that Sheila Nevins, the enterprising president of HBO Documentary Films, has called “didactic television.” It is also devised to be more accessible than past HBO projects, with some cable systems, including RCN in the New York City area, showing it free during its first four-day run. Intended to do more than entertain or alarm, then, “Addiction” is meant to sober people up. To that end, its message is this: Drug and alcohol addiction are diseases of the brain, and they can be treated, at least partly, with medicine. This straightforward message is remarkable for at least two reasons. First, it’s intrinsically controversial, since A.A. for a long time expected its participants to refrain entirely from drug use, even prescription pills. The model of addiction presented here — addiction as a brain disease — is somewhat at odds with the cognitive model used in classic 12-step programs. Second, it’s remarkable that so many top-notch filmmakers have consented to push someone else’s point so hard. It’s almost ominous. The sameness of the films in “Addiction” might aid its effectiveness as propaganda, but as art it’s monotone; it’s hard to believe it’s the collaborative work of so many otherwise individualistic artists. Evidently, filmmakers submitted film to HBO, which took over postproduction. As a result, each installment mixes vérité and to-the-camera interviews in precisely the same proportions; employs explanatory title cards and interviews with experts; showily defers to the experts, most of them M.D.’s and Ph.D.’s; refrains from using graphics, humor or archival photographs; and keeps sound bites short. An exception here is Barbara Kopple. Her short film “Steamfitters Local Union 638” is crisp tonic with lime. Unlike the other filmmakers, she has stuck to her interests and her aesthetic, making a film about a labor union that now actively supports its members who want treatment for addictions. The faces and voices of the union members, many of whom have been installing heating, ventilation and air-conditioning systems for decades, are like nobody else’s in “Addiction,” and indeed like those of few other people’s on television. “We were the hardest-working,” says one union lifer, remembering the ’60s, when he was drinking daily on the job. “We were the biggest drinkers.” He recalls how the members used to enable one another as drinkers, helping them lie to their wives and families and still be paid. Now the union uses the same infrastructure of loyalty to help people into detox and rehabilitation. Steamfitters like them — with mustaches and paunches like theirs — join them in meetings; there’s no interference from management or doctors. As rendered, this is an extremely effective, and good-natured, program. By presenting both addiction and recovery as community affairs, only “Steamfitters Local Union 638” has added something beyond the brain-scan science to these drug and alcohol stories. Still, as I detoxed from the sensationalism I had gotten from other films and had been hoping for in “Addiction,” I also came to appreciate other parts of the program. One was the short by Chris Hegedus and Mr. Pennebaker. In their story of two young addicts who try a new Methadone-like drug to treat their cravings for prescription pills, the melancholy Amanda caught my eye. She’s kind of a lazy oracle. As she’s driving to the clinic for the first time, contemplating the new drug that she’s hoping will relieve her dopesickness, she seems to speak for every kind of addict, as well as about the paradox of treating drug addiction with drugs. As Amanda says, “I hope it works as good as everybody says it does, so I don’t have to worry about feeling like this anymore.” Report: Binge Drinking Rises at Colleges Associated Press, 3/15/2007 Substance abuse on college campuses is nothing new, but it is taking a more extreme and dangerous form, with higher rates of frequent binge drinking and prescription drug abuse, and more negative consequences for students such as arrests and risky sexual behavior. That's the portrait painted by a new, comprehensive report tying together a range of recent research on college substance abuse, supplemented with some of its own new survey data. The report by The National Center on Addiction and Substance Abuse at Columbia University, argues substance abuse isn't an inevitable rite of passage for young adults. Rather, it argues a particular culture of excessive consumption has flourished on college campuses, and calls on educators to take bolder stands against students and alumni to combat it. ''If they make this a priority they can do something about it,'' said Joseph Califano, chairman and president of the center, who among other steps called on colleges and the NCAA to stop allowing alcohol advertising during high-profile events like the NCAA men's basketball tournament. The report, being released Thursday, relies largely on research that has already appeared in various forms, but assembles it to emphasize findings particular to college students. Among the highlights: -- The proportion of students who drink (about 68 percent) and binge drink (40 percent) has changed little since 1993. But there have been substantial increases in the number of students who binge drink frequently (take five drinks at a time, three or more times in two weeks), who drink 10 or more times a month, and who get drunk three or more times in a month. -- Though still used by far fewer students than alcohol, hundreds of thousands more students are abusing prescription drugs including Ritalin, Adderall and OxyContin than during the early 1990s. The proportion of students using marijuana daily has more than doubled to about 4 percent. -- Analyzing outside survey data, the Center calculated 23 percent of college students meet the medical criteria for substance abuse or dependence. That's about triple the proportion in the general population. Young adults in general have higher abuse rates, so a higher rate for college students is to be expected. But other research indicates that college students drink more than high school peers who don't go to college, said Henry Wechsler of the Harvard School of Public Health, who published similar findings in 2002. Both researchers involved in the report and outside experts say they have seen troubling changes in how students drink in recent years. ''The percentage of kids who drink and binge drink is essentially the same between 1993 and 2005, but the intensity of the drinking has dramatically changed,'' Califano said. ''There's an intensity to the consumption we see here that we don't see in the general population.'' At the University of Kentucky, longtime administrator Victor Hazard says he too has noticed a change, with more students drinking simply to get drunk. ''To the extent there is such a thing as a social drinker, it was more of a meet-and-greet type of environment in the earlier years when I was here,'' said Hazard, Kentucky's associate vice president for student affairs and dean of students. Now, he said, students are ''drinking to become intoxicated as fast as they possibly can.'' Carol Falkowski, director of research communications for the Hazelden Foundation, an addiction treatment and research group, said too many students are getting the message that excessive drinking is OK. ''It's getting more intense,'' she said. ''Drinking games that were happening in private parties or houses or bonfires 10 years ago are now happening in public venues. That to me reflects a sort of larger acceptance of extreme drinking.'' College administrators often say they know campus substance abuse is a problem but say there is little they can do. But the report's authors say it's a question of commitment. ''Things do work, it's just having the will and time and money to implement them,'' said Roger Vaughan, a Columbia biostatistician involved in the report. ''People need to step up and realize this is not a rite of passage, this is not something we should tolerate. If it keeps going, we're going to destroy our best and brightest.'' On the Net: http://www.casacolumbia.org Trying to Unlock the Secrets of Addiction Dennis O'Brien, Baltimore Sun- 3/16/2007 BALTIMORE — You might think reaching for that cup of coffee or that cigarette is a simple decision. But scientists think the way we act to satisfy cravings involves a little-understood automated response — one we have no control over — and researchers are using brain scans to unlock its secrets. "If there's an automated component to craving, we really want to understand how it works," said Elliot Stein, director of the neuro-imaging lab at the National Institute on Drug Abuse. In a basement lab at Johns Hopkins University, Stein and other researchers scan the brains of smokers, drug addicts and alcoholics with a functional magnetic resonance imaging machine to try to determine why the subjects have such a hard time kicking their habits. The scientists are part of a growing research movement that's using the imaging machine to unlock the brain's secrets. The technology was developed in the early 1990s by scientists who discovered they could track increased blood flow to different brain regions in real time. "We were trying to see changes in the brain as they were occurring, and not just look at brain structures," said Kenneth Kwong, a physicist at Harvard University and Massachusetts General Hospital who was instrumental in developing the imaging machine as a research tool. Work at the National Institute on Drug Abuse lab is infused by the belief that addiction is a brain disease. Stein said he was convinced that a key to helping those trying to overcome addiction lies in understanding the brain's response to conscious and subconscious cues. "There's a multiplicity of factors that are behind human behaviors. Why wouldn't there be a multiplicity of factors behind addiction and something like drug abuse?" Stein said. Stein and colleague Britta Hahn are studying how cues trigger cravings in addicts. Living With Autism: The Teenage View Virginia Heffernan, New York Times- 3/16/2007 Autism, an enigmatic disorder of the central nervous system, excites an unusual kind of curiosity. The curiosity, it should be said, includes no small part of outright identification. After all, the disorder’s signature behaviors — shrieking, retreating, acting obsessively or withdrawn — are familiar to many of us in extremis, or at least in adolescence. But very little in the popular literature is meant to engender empathy. Instead articles and documentaries on the subject whip up fear, and particularly fear in parents, because autism, which surfaces in early childhood, has no cure and no straightforward treatment. Leave it to MTV, then, not to address terrified parents, but voyeuristic teenagers. That channel’s impressive, long-running documentary series “True Life” has always eschewed the news-at-11 take on suffering — the alarmist angle — in favor of the first person. Tonight, with minimal voice-over, “True Life: I Have Autism” introduces viewers to Jeremy, Jonathan and Elijah, three high school students whose autism is now old hat to themselves and their families. No one cries when talking about it. Instead they plan new approaches, sigh as old problems resurface and laugh often. Jeremy can’t speak — that’s the hallmark of his autism; the condition manifests itself variously in the three boys. In childhood this meant that he couldn’t communicate, but later he and his mother developed a system with a written “keyboard” that allowed him to point to letters and spell words. It was a breakthrough. More recently, a Lightwriter — a keyboard that talks for you — has made this process more efficient. He’s finally able to strike up conversations with his classmates, who are receptive to his overtures. (It probably helps that he’s got MTV cameras with him.) His segment culminates in a birthday party he gives for himself, complete with presents and a houseful of friends. He retreats when the crowd threatens to overwhelm him, watching from a balcony. Without the Lightwriter, his retreats might be seen as evidence of unhappiness instead of canny self-regulation. But using the Lightwriter, he regularly explains to those around him, “Happy and nervous, so I need to relax,” and they get it. Whatever the official state of your central nervous system, the option of periodically withdrawing from a party with “happy and nervous” as a pretext seems like a great option. Jeremy concludes, “I must say this goes hands down as the best party I have ever been to.” Jonathan comes across quite differently. He’s a terrific portraitist, who regularly sells and shows his work, and who was profiled by The New York Times in 1992, when he was 14. His charcoal faces — part cartoon and part Expressionism — have even been compared to the work of Francis Bacon and Al Hirschfeld. Unlike Jeremy, Jonathan talks, but he’s less adept at heading off overwhelming emotions. Several times on camera he can be seen clenched and shrieking, seized by bouts of seemingly insurmountable frustration. These tantrums often happen within range of an easel; he looks more like an artist in the throes of concentration than he does like anything else. Elijah, whose version of autism is the milder form called Asperger’s syndrome, is considered the least impaired of the three, and indeed he speaks so freely that he performs as a stand-up comic. The suspense of his story is whether he’ll take the advice of a seasoned performer at a comedy conference and introduce references to his autism into his act. His parents seem uncertain about this suggestion: is it reductionist for Elijah to call himself simply “autistic”? While allowing their son, who has an engagingly mannered way of talking that he plays for laughs, to make up his own mind, they nonetheless take pains not to pressure him, and go so far as to scoff mildly at the idea that he tell audiences, “I’m autistic.” But Elijah, in an intriguing twist, finds the idea liberating. This scene could occur only on “True Life,” and it’s a small revelation in the canon of reporting on autism. Elijah knows that so-called normalcy is not within his reach; he likes the idea of autism being an asset, or at least being somehow put in the foreground. Talking about autism, he tells his surprised parents, is “helpful for probably a new routine — it’s something new, and I’d like to try it.” A new routine: there’s something elegant and hopeful in that phrase. One of his comedy coaches has proposed the lines: “My parents tell me I have autism. I tell them they have an attitude problem.” Elijah finds the suggestion funny, but like any self-respecting comic, he wants to refine it and make it his own. He works out some new material, only to get cold feet about it the next day. The coaches urge him to think it over, and he does, only to break it out confidently at showtime. It’s a hit. The documentary informs us that a joke or two about autism is now regularly part of Elijah’s routine. Gunman Had Pent-Up Hostility and a Résumé of Failures N.R. Kleinfield & Serge Kovaleski, New York Times- 3/16/2007 David R. Garvin’s first brush with New York City came at a time when his life was already drenched in personal and professional failure. It ended in May 2005 with a collapsed career in the production department of The Wall Street Journal. But he came back, months later, this time to make movies. Traveling in the dim light of obscurity that New York bestows on most of its citizens, he had a sensibility that was unremittingly dark. He gravitated toward the paranormal, to projects where the bizarre and abstruse — in one of his scripts, a metallic object inhabits a philosophy professor — converged into the far-fetched. Twice divorced at 42, he found refuge in a Bronx apartment with an old friend, an emergency medical technician, a man committed to saving lives. Then a woman drew him to live in Greenwich Village, where he liked to drop into the De Marco’s Pizzeria on West Houston Street to eat bowls of spaghetti. That was where he went Wednesday night, bent on a bloody errand. He had a beard glued to his face and a bag stuffed with ammunition and two guns, and he fired 15 rounds into the back of a restaurant worker, Alfredo Romero, presumably to avenge a grudge. Pursued by a pair of young auxiliary policemen, he killed them, too, before the police ended his life on Bleecker Street. Just like that, David Garvin entered one of his macabre projects for real. With his death, it is difficult to burrow into the motives and inner thinking that led to that explosion of violence. “He had no real violent inclinations,” said his brother Charles Garvin. But, he added: “He wasn’t a person to cross. If you crossed him, he was an action person. Obviously, we know that now.” When Mr. Garvin returned to the city from St. Louis in the fall of 2005, he arrived carrying an impressive-enough résumé that hid a tangle of dead ends. He was born in Missouri on Dec. 2, 1964, the police said. He went to Southeast Missouri State University in Cape Girardeau for about three years, majoring in marketing, before dropping out to join the Marine Corps Reserve. The police said he was with the Marines from 1986 to 1988, when he was given an unsatisfactory discharge. According to his Web page at Classmates.com, he enrolled at Webster University in Webster Groves, Mo., after leaving the Marines and received a bachelor’s degree in journalism. He claims to have worked at the Suburban Journals in St. Louis, but officials there said they had no record of his employment. The résumé on his personal Web site says that starting in 1986, he produced film shorts and corporate and promotional videos. It also says he started a video production program at Mohave Community College in Arizona and wrote a syndicated political column that circulated in Arizona, Nevada and California. Officials at Mohave confirmed that Mr. Garvin was a part-time associate faculty member from January 1995 until May 1999, but they said they had no video production program. They said their records indicated he taught “human relations, interpersonal relations and tile decorating.” It could not be confirmed whether he wrote a column. Along the way, he married twice. Court records show that he was divorced from his first wife, Laura Ann Roth, in July 1993. She would not talk about him yesterday other than to say that they had met in high school and that she had not seen him in more than a decade. Asked if she had had children with him, she said, “God, no.” He remarried and had two children, and found his way to Bullhead City, Ariz. He held bartending jobs, the police said, but his finances were a mess. According to court records, he and his second wife filed for bankruptcy twice. (More recently, he was sued by the Ford Motor Credit Company for defaulting on a loan of $18,764 on a used 2001 Ford Focus.) In 1998, he came to New York, later working on typeface styles as an information graphics coordinator for The Wall Street Journal. On the side, he drifted into the movie business. In 1999, he played a London cabdriver and served in a production capacity for the low-budget movie “Brothers,” about a group of British men behaving coarsely and conspicuously while on vacation. People who worked with him at The Journal knew of his screenwriting aspirations. He produced a short dark comedy called “Stand-Ups” about comedians. A member of The Journal’s art department appeared in it. Mr. Garvin was working at the paper when it was forced from its Lower Manhattan offices during the Sept. 11 attack. His department moved to South Brunswick, N.J., where he continued to work. On his résumé, Mr. Garvin lists that he won a Pulitzer Prize. The Journal did win a prize for its Sept. 11 coverage, and it gave everyone a copy of the certificate. He had his share of run-ins at the paper. “A lot of people didn’t get along with him,” said Virginia Cahill, who was an art director at The Journal. “He was quiet and unassuming, but seemed to have a lot of authority issues.” Ms. Cahill now works for The New York Times. Another person who worked with him at The Journal said that he was known to have a gun collection and would often go to shooting ranges and liked to hunt deer. According to this colleague, he began sending e-mail messages to his supervisor complaining that people sitting near him were out to get him. In one message, he suggested that he was actually going to harm two of them. This led to his firing in 2005. “Paranoia is too strong of a word,” Charles Garvin said, “but he started developing this fear that he was being followed. And he would spot strangers and believed that they wanted to do him harm. That started three or four years into working at The Wall Street Journal.” Management was troubled enough by his odd behavior, the former colleague said, that security was temporarily beefed up in South Brunswick. He left for the Midwest after losing his job, settling in St. Louis. In 2005, he began cobbling together a science fiction movie called “Ambient,” which he described on his Web site as a short experimental film in which a family farm is “transformed into a surrealist nightmare world.” Brent Jaimes, an independent filmmaker in St. Louis, said Mr. Garvin had approached him about helping with the project. He said Mr. Garvin had begun auditioning actors and had permission from the owner of an old barn in nearby Nashville, Ill., to burn it down for the movie. “What he was doing in this project that I thought was unique was that he was going to take two cameras and set them parallel to each other,” Mr. Jaimes said. “Each image would be parallel and overlapping.” In the fall of 2005, before the project was fully under way, Mr. Jaimes said, Mr. Garvin abruptly notified everyone involved that he was scrapping the film because he had to move to New York immediately. “We were about two weeks out from shooting and he said that he had an offer from a buddy with HBO,” Mr. Jaimes said. “He e-mailed me on a Thursday or Friday and said he had to be in New York City on Monday.” A spokesman for HBO said yesterday that the company had no record that Mr. Garvin had been an employee for the company. Once in New York, Mr. Garvin moved in with a friend named James Reichman, an emergency medical technician with the Fire Department who had a two-bedroom apartment in a six-story, off-white brick apartment building in the Pelham Parkway section of the Bronx. He continued to pursue his films. Mr. Garvin’s Web site lists various contemplated projects. One was a script titled “Object.” The object is undefined — a drawing of concepts on his Web site shows something that resembles two conjoined potatoes bearing horns and suggests something “somewhat machine-like (like a submarine or spaceship).” The plot is that the object possesses a philosophy professor and the two “cleave into the fabric of space-time to explore parallel lives.” Another project was “Elucidation,” which he described as a “modern spy drama.” The site summarized the plot: “A Senate campaign worker uncovers the involvement of a secretive organization whose ambitions have disturbing implications for government and society. The small group of otherwise unremarkable individuals glimpses the dawning of a new and chilling age.” His site also says that he created a pilot for a television show, something of a sinister offshoot of the Addams Family. Called “The Darklys,” it is described as being “a mix between David Lynch and Tim Burton” and deals with how “a family of old-world Goths move into their baroque mansion and try with comedic effect to assimilate into their conservative upper-class neighborhood.” One of the actresses who worked for him, Amanda Cooley Davis, said it became clear to her that he was an unstable person after they finished shooting “Stand-Ups,” in which she was the lead female, in 2004. Ms. Davis said she continued to receive e-mail messages from Mr. Garvin, many of them long, obsessive and volatile, which she saved in a file folder she marked “crazy.” “Of all the people I’ve known in my life, for anybody to go postal, this is the least surprising,” she said. Another actor in the movie, Frank Mollica, recalled how Mr. Garvin finally reacted when two men stepped out of a comedy club next to the set to smoke cigarettes and kept boisterously interrupting the shoot. “He was polite for a while, even though I could tell he was getting real steamed, and finally he couldn’t take it anymore,” Mr. Mollica said. “It was a lot of spinning around and wild punches before a bouncer from the club came out and broke it up.” Recently, the police said, Mr. Garvin had left the Bronx and was living with a woman in her apartment in a doorman building on Horatio Street. He had been working as a bartender at the Raccoon Lodge in TriBeCa. “He didn’t have charisma,” said Brian Barrow, a manager. “You could say that the guy was a little strange, but aren’t we all?” He liked De Marco’s. Anthony Ruffino, the restaurant owner, said that Mr. Garvin had patronized the place for months. He became friends with a cook, who was fired late last year. Yet Mr. Ruffino said Mr. Garvin had come in several times since the man had been dismissed and never seemed angry or vindictive. But on several occasions when he came to De Marco’s, the police said, Mr. Garvin was ejected for being disruptive. They also said that a relative whom they interviewed indicated that he had become increasingly paranoid, convinced that evil people “were out to get him.” The police said they were unaware of any psychiatric history, and Mr. Garvin had no criminal record. “He was a very loyal person to the people he loved,” his brother said. From the Bronx apartment he shared, however, the police said that they retrieved a .357 revolver that he had bought in Arizona several years ago, 100 rounds of ammunition, speed loaders, a wig, a false mustache and several knives. The police do not know for sure, but they surmised that the firing of the cook is what may have transformed Mr. Garvin into a murderer. Somewhere along the line, in any event, Mr. Garvin acquired two other guns, a 9-millimeter semiautomatic pistol and a .38-caliber Russian handgun, as well as the capacity to kill. He was carrying all those things with him when he entered the spaghetti house at 9:20 Wednesday night and asked for a menu. Gunman Saw Himself as Slow to Anger, E-Mail Says Serge Kovaleski & Sarah Kershaw, New York Times- 3/17/2007 David R. Garvin viewed himself as a peaceful man, one who could be pushed to the edge only by aggressive people he did not know. “I would never be any threat to you other than as a mouthy SOB. I don’t even spank my kids, OK?” Mr. Garvin wrote in a 2004 e-mail message to a woman who played the lead role in a short comedy that he wrote and directed. In the message, he said he was never violent toward individuals he knew, but noted, “I react poorly to aggressive strangers, especially those who purposely violate my personal space.” The emotional and psychological factors that caused Mr. Garvin to unleash a torrent of violence on Wednesday night in Greenwich Village remain difficult to comprehend, even though security videotapes documented much of his shooting spree with chilling detail. Yesterday, when a wake was held for one of Mr. Garvin’s victims, the police had little to add to the suggestion they made on Thursday: that Mr. Garvin was motivated, however irrationally, by the sense that he was avenging the firing of a friend who had worked at a restaurant on Houston Street. By the time Mr. Garvin was killed on Bleecker Street by the police, he had executed a bartender at a pizzeria and fatally shot two auxiliary police officers. Mr. Garvin, 42, had no criminal record and no formal history of psychiatric care, although relatives, including his brother, said they had seen some evidence of paranoid behavior. Investigators have pulled hard drives from two computers at the Bronx apartment where Mr. Garvin lived recently, seeking clues to what set off the violence. Flashes of anger emerge, however, in e-mail messages that he sent to Amanda Cooley Davis, 32, the actress who performed in his short comedy. They came as she was trying to fend off his romantic overtures, which she considered inappropriate. “So unless your a punk with a Bronx accent trying to intimidate me to impress your buddy, you don’t have any reason to fear me, goofball!” Mr. Garvin wrote in the same July 2004 e-mail message, which was accompanied by a doleful photograph he took of himself and began, “Dave apologizes with big puppy dog eyes.” During his rampage on Wednesday night, Mr. Garvin was carrying two guns; the authorities subsequently recovered a third firearm from his apartment. Yesterday, the police submitted all three weapons to the federal Bureau of Alcohol, Tobacco, Firearms and Explosives for tracing. Mayor Michael R. Bloomberg described two of the guns as illegal. A law enforcement official said Mr. Garvin bought the gun used in the shooting, a Ruger P-89 9-millimeter pistol, in 1998 at the Longhorn Trading Company in Bullhead, Ariz. He also bought another gun at the same shop in 2001, a Taurus .357-Magnum revolver, which the police found in his apartment, the official said. The trace of the second weapon he carried on Wednesday night, a Russian-made Imez .380-caliber pistol, which he did not fire during the rampage, had not been completed yesterday afternoon, the official said. Mayor Bloomberg, during his weekly appearance on WABC radio yesterday, used the shooting carried out by Mr. Garvin to highlight again the abundance of guns in the United States and in New York City itself, many of them illegal. “We have too many guns on our streets,” he said. “Let’s not walk away from the fact that this guy had two illegal guns, and 100 rounds of ammunition.” At De Marco’s Pizzeria on West Houston Street — where Mr. Garvin shot a restaurant worker, Alfredo Romero, in the back, firing 15 rounds — people are still puzzled by the events. Mr. Garvin was a regular patron of the pizzeria and had been ejected several times for unruly behavior, but no one could recall any overt acts of hostility between Mr. Garvin and Mr. Romero. Mr. Garvin apparently came into De Marco’s several times a week and would go through the same routine: He would pore over the menu slowly, but then order the same thing, spaghetti bolognese. Until his last moments, there had been numerous frustrations in Mr. Garvin’s life. He had been divorced twice, he filed for personal bankruptcy on two occasions and he had been fired from a job in information graphics at The Wall Street Journal after threatening a colleague. He wrote screenplays and tried directing and acting in films, but was unable to achieve any notable success in that field. Mr. Garvin served in the Marines from March 4, 1986, to Oct. 24, 1988; he worked as a field radio operator and his last rank was private. His career in the Marines ended when he was given an unsatisfactory discharge. Ms. Davis, the actress, came to view Mr. Garvin as unstable and began to store his messages in a file she named “Crazy,” in case, she said, she ever needed a restraining order. In the fall of 2003, Ms. Davis, who lives now in San Diego, was cast in the lead female role, Nadine, in Mr. Garvin’s film “Stand-Ups.” She said she was thrilled to land a paying job in a film, having earned a graduate degree only six months before. And while Mr. Garvin was “overly complimentary from the start,” she said, “I was either willfully naïve or didn’t listen to my gut about him.” She said Mr. Garvin wrote the role of Nadine as his “ideal woman.” When the two of them argued, he told her in e-mail messages: “Nadine wouldn’t treat me like that, Nadine wouldn’t behave so cavalierly toward me. Nadine would have been kind-hearted, Nadine would have spared my feelings.” Shortly before they stopped shooting the film, in the winter of 2004, Mr. Garvin wrote Ms. Davis a long e-mail note professing his romantic feelings for her and telling her that her relationship with her boyfriend at the time was doomed, she said. He insisted that she felt the same way toward him, she recalled. Ms. Davis wrote him back that it was not appropriate and that the feelings were not mutual. He became “a viper,” she said. “He wouldn’t accept that I didn’t feel the same way.” Meredith Strauss, 31, said in a telephone interview yesterday that she had been chosen by Mr. Garvin to play Nadine before Ms. Davis got the part. But, Ms. Strauss said, he changed his mind after she told him that she was married and was unable to accompany him and a friend to dinner one evening. Girls Will Be Boys The First Man-Made Man: The Story of Two Sex Changes and a Twentieth Century Medical Revolution. By Pagan Kennedy. Bloomsbury, 214 pp., $23.95 Mary Roach, New York Times Book Review- 3/18/2007 Michael Dillon wanted nothing more than to be invisible, to be one of the guys. Problem: he was born with a woman’s body. Everything he did toward realizing his humble dream — the cross-dressing, the hormones and surgeries and the chimera that resulted — pushed it further from his grasp. He went through life as the most visible sort of human being: a physical anomaly. He was the first person on record to undergo surgery (13 operations between 1946 and 1949) to change his gender. Pagan Kennedy, the author of “Black Livingstone” and other books, does for Dillon what he never succeeded in doing for himself. She makes us see him as an ordinary, sane Englishman, worthy of respect and acceptance. Her compassion and restraint are laudable. She had access to before-and-after close-up medical photographs of Dillon but omits them. Her description of the surgeries is brief and devoid of graphic detail. She resists the temptation to highlight the comically surreal nature of her material. If you read this book, you will not gawk or laugh at Michael Dillon. Dillon’s story, as Kennedy tells it, is itself a chimera: part biography, part medical history. Here the surgery is seamless, the hybrid better than the sum of its parts. “The First Man-Made Man” is oddly mesmerizing, as close to Shakespearean tragedy as you can come with the words “tube pedicle” and “mast of cartilage” in your book. It’s Romiette and Julio. Dillon fell in love but once in his life. In 1950, he met Roberta Cowell, the only woman who might understand and even love him. Cowell, born (and equipped) Robert Cowell, came to him for advice. Dillon, who became a doctor, had written an obscure book about hormones and transsexuality, which Cowell read. With Dillon’s help, Roberta Cowell could become Dillon’s modest fantasy: a woman to whom he could reveal his secret (“a semierect, mostly numb sexual organ that resembled a small party balloon”), and who might have him anyway. Alas, Roberta didn’t love Michael Dillon. She led him on, because, well, she needed him to remove her testicles. Owing to an obscure bit of British law, the physical mutilation of a man who would otherwise be fit for military service was then illegal. Later in the 1950s and through the 1960s, British men seeking sex-change surgery could travel to Continental Europe for the prerequisite amputation of their gonads — “castrated abroad,” the medical records would say, lending an aura of worldliness and class to the proceeding — but for Roberta this was not yet an option. The besotted Dillon risked not getting his medical license for Cowell: he performed the castration himself. For the actual construction of a vagina, he introduced Cowell to Harold Gillies, the maverick British surgeon who had recently engineered Dillon’s own transformation. Cowell’s genital makeover was another surgical first, predating by almost a year the hyper-publicized metamorphosis of Christine (née George) Jorgensen, in Copenhagen. Shortly after the operation, Dillon proposed marriage and Cowell promptly jilted him. You could see it coming. As a man, Cowell flew fighter planes and raced sports cars. As a woman, she wore “va-va-voom” peroxide wigs and high heels. It wasn’t so much Dillon’s anatomy that put her off, it was the prospect of a quiet life as a doctor’s wife. I’m afraid I jilted Dillon too. I wanted to stand by him through all 200 pages, but I fell hard for Dr. Gillies. It is no small feat to make a romance between the world’s first two transsexuals seem ho-hum, but Gillies almost manages. During World War I, he persuaded the British government to devote one wing of a military hospital to the cosmetic repair of burned and maimed soldiers — a subspecialty all but unknown at the time. “Gillies made up plastic surgery as he went along, smoking furiously, operating for a dozen hours a day, sketching noses on the backs of envelopes,” Kennedy writes. She describes him preparing for the world’s first male-to-female transsexual surgery: cigarette in hand, doing a dry run on a cadaver while Cowell sits nervously in the waiting room in a skirt and blond wig. It’s heady stuff. Gillies was altering not merely faces and bodies, but the very nature of surgery. For the first time, operations were being done not out of medical necessity, but for the patient’s emotional well-being. “If it gives real happiness,” Gillies reasoned, “that is the most that any surgeon or medicine can give.” Happiness eluded Michael Dillon. Isolated, depressed, hounded by the press, he traveled to India and, bizarrely, to a series of ever more remote Tibetan monasteries. He could not speak the language of his fellow novices, but with his shaved head and robes, he felt he fit in someplace. Sadly, he faced prejudice in the monasteries too, and his visa ran out before he was allowed to become a full-fledged monk. In 1962, he died impoverished near the border of Ladakh. He was 47, and had been trying to get back to the monastery where he’d felt at home. Dillon’s is the tragedy of a man born too soon. Church Sees Pastor's Excessive Sex Talk As Clue Stephanie Simonk, Los Angeles Times- 3/18/2007 DENVER -- They have had four months to reflect, and the senior staff of New Life Church can look back and see the warning signs. Not one suspected that their high-profile pastor, the Rev. Ted Haggard, secretly had been visiting a gay prostitute. But they see now that Haggard talked too much about sex, that he could be crudely suggestive, that he seemed to have a need to push boundaries. And that no one called him on any of it. "His loose discussions about sexuality might have seemed refreshingly raw and real, especially since church had always been so stuffy and prudish in the past," said Rob Brendle, associate pastor of the mega-church in Colorado Springs, Colo. "In retrospect, some of his comments and interactions - that at the time seemed edgy, but innocent enough - now seem questionable." A team of pastors assigned to investigate Haggard after he admitted in November to "sexual immorality" have concluded his behavior went beyond merely questionable. The board of overseers uncovered a pattern of troubling behavior - "everything from sordid conversation to overt suggestions to improper activities to improper relationships," the Rev. Larry Stockstill told the New Life congregation in a February report. Stockstill would not divulge details, but he and the other investigators concluded that Haggard - who is in therapy and preparing to leave Colorado Springs - suffered from "habitual, life-controlling problems." They called it "a matter of grace" that the pastor was caught in his "final relationship," with prostitute Mike Jones of Denver. Jones had come forward with allegations that Haggard had been paying him for sex regularly for three years and had used methamphetamine in his presence. After Jones produced voice-mail messages from Haggard, the pastor admitted he had visited the prostitute - only for a massage, he said - and said he had purchased drugs but never used them. He was permanently removed from the leadership of New Life and resigned the presidency of the National Association of Evangelicals, which represents 30 million Christians. Shortly after his confession, Haggard and his wife, Gayle, spent three weeks at a secular counseling program in Arizona. A member of the church's board of overseers, the Rev. Tim Ralph, told a reporter that Haggard emerged from the treatment convinced "he is completely heterosexual." Ever since, Haggard's friends and mentors have been disavowing that quote. "The true characterization is that Mr. Haggard had a weakness and he continues to work to strengthen himself," said the Rev. H.B. London, a member of the three-man team overseeing Haggard's spiritual recovery. Even the most ardent proponents of therapy to change same-sex attraction say it is a lifelong struggle, demanding constant vigilance and sacrifice - a price that they find reasonable to avoid relationships they consider sinful. "Ted will need years of accountability to demonstrate his victory over both actions and tendencies," Stockstill said in the report, which he read aloud to the New Life congregation. Haggard's associates say he is working diligently toward that goal. He follows a strict regimen of group therapy, family counseling and one-on-one sessions with spiritual advisers. He has agreed to restrictions on what he watches and reads to try to banish what he has called "repulsive and dark" desires. New Life will continue to pay Haggard's salary of roughly $130,000 through the end of 2007. In exchange, he has agreed not to talk to the media and to leave town. Haggard and his wife have five children, two still in school; he has told friends that he wants to move the family somewhere with a low cost of living, perhaps Iowa or Missouri. "Jesus is starting to put me back together," Haggard wrote in February in an e-mail sent to the 14,000 members of his former congregation. He and Gayle plan to take online courses in psychology, he said, "so we can work together serving others the rest of our lives." After months of feeling "paralyzed by shame," Haggard wrote he was starting to feel hope. "(As) God and people like you forgive me," he wrote, "the sun is starting to rise in my life." The congregation that Haggard founded in his basement -- after a vision he had while fasting on Pike's Peak -- is also reaching for renewal. Donations to the church, the largest in Colorado, have dropped about 8 percent in the months since the scandal broke. New Life took in $4.9 million from November through February, compared with $5.3 million in the same period a year earlier, Brendle said. The drop forced the church to lay off 44 of its 350 workers, among them pastoral staff, administrative assistants and child-care providers. Attendance at New Life is also down, roughly 15 percent, Brendle said. But those who have stuck with the church say they haven't seen the free-fall they feared. The interim senior pastor, Ross Parsley, is a familiar face at New Life and has a strong following. "I look around on Sunday mornings and I don't notice as many empty seats as I would have expected, given what we've been through," said Carol Groesbeck, who sings in the choir. "There's still the sense of loss, but there's also an optimism that things are going in the right direction," her husband, James, added. A "moral audit" of the senior staff uncovered one other example of unspecified sexual sin, Brendle said. The staff member involved - who led a ministry for young adults - resigned. The remaining leadership of the church has vowed to hold one another accountable for their words and actions, hoping to wipe out what London called "a culture of enabling" that fueled Haggard's indiscretions. As an example of Haggard's inappropriate remarks, Brendle cited the pastor's boast to a documentary filmmaker that "evangelicals have the best sex life of any other group." Did Human Behavior Evolve? Shankar Vedantam, Washington Post- 3/19/2007 When Emory University primatologist Frans de Waal read a news story that said Microsoft's chief executive, Steve Ballmer, had hurled a chair across the room on hearing an employee was going to work for rival Google, the scientist immediately made a connection with his own research: "When I see such behavior, I think of a chimpanzee." Another time, a researcher that de Waal knew told him that whenever she chatted with another scientist in the hallway, her boss would get upset. He would later drop by her office and tell her she ought to stay clear of that person. "He was constantly interfering whenever she had a contact with an important person," de Waal said. "Chimpanzees also divide and rule. You have an alpha male, and he will try to keep his supporters away from his rivals. His supporters are in trouble if they groom one of his rivals." Does such behavior make you laugh? Well, if de Waal and other scientists are right, you may have to address some of your mirth to that face in the mirror. Over the past two centuries, people have had to disabuse themselves about various ideologies asserting that humans are fundamentally different from other animals. Biologists have shown that our arms and legs and organs have long evolutionary histories. Beliefs about the uniqueness of human behavior might well be the last bastion of our superiority complex, but research by de Waal and many others suggests that even this redoubt may be crumbling. "I have done studies of reconciliation and coalition strategies in chimpanzees," de Waal said. "Business managers tell me that reminds them so much of what people do." The idea that human behavior -- not just our physical bodies -- may have long evolutionary antecedents raises complicated questions about human agency and about how much of what we do and think is hard-wired. It is one thing to say we have eyes because our ancestors had eyes, but should we also credit our evolutionary predecessors for our highly complex social and political arrangements? Scientists such as de Waal argue the research suggests that, much as people believe in the originality of their thoughts, a lot of human cognition probably takes place at an automatic level, guided by inborn tendencies. About the woman with the possessive boss, for example, de Waal said: "I am sure her boss is not consciously doing that. It just bothers him if she has a chat with a rival." Two recent studies from the world of birds give us a glimpse into how far back in evolutionary terms complex behaviors that we would normally associate with humans go. One of these behaviors has a nice altruistic aspect to it. The other, not so much. But more on the morality question later. Emily DuVal, a biologist at the Max Planck Institute for Ornithology in Germany, found that male lance-tailed manakins display the behavior seen at nightclubs, where a person plays "wingman" or "wingwoman" to help a friend impress a potential mate. In a study of 457 lance-tailed manakins in Panama, DuVal found repeated instances of two males performing a skilled dance for the benefit of a female bird who was watching. The group performance, however, helped only one of the birds -- the alpha male. If only one lance-tailed manakin got to mate, why did the other bird, the beta male, cooperate in the dancing ritual when he had nothing to gain? In a paper she published in the April issue of the American Naturalist, DuVal found there was evidence that good "wingbirds" were more likely than other birds to become alpha males themselves. What makes the behavior especially interesting is that one lance-tailed manakin might be helping another because some other bird will help the helper down the road. Such behavior suggests an intricate social system where investments pay off in the distant future. In another study, Jeffrey Hoover, an avian ecologist at the Illinois Natural History Survey in Champaign, found that cowbirds have a lot in common with gangsters. It all began, he says, when ecologists started removing the eggs of cowbirds from the nests of warblers. Cowbirds leave their eggs in the nests of dozens of other birds. It has long been a mystery why birds such as warblers allow the eggs to hatch and why the hosts then feed the young cowbirds -- sometimes at the expense of their own offspring. Hoover and colleague Scott Robinson found that when they removed cowbird eggs from the warbler nests, those nests mysteriously got trashed. Turns out that the cowbirds, much like members of the mob, were keeping a close eye on the nests in which they had laid their eggs. If anything bad happened to the eggs, the cowbirds would return and destroy the nest. Hoover found that, much like the way the mafia operates, the cowbirds begin with detailed surveillance of their potential targets. That is because if a cowbird lays an egg in a warbler's nest before the warbler has laid any eggs of her own, the warbler can simply fly somewhere else and establish a new nest, and the cowbird will not be able to retaliate. On the other hand, if the cowbird lays its egg after the warbler has finished laying all her eggs over a period of three to five days, the warbler's hatchlings will emerge sooner than the cowbird's and thereby gain a size advantage in grabbing all the available food. Hoover found that after monitoring a warbler's nest for a period, a cowbird will lay its egg in the nest right after the warbler has started laying its eggs. Cowbirds can lay 10 to 15 eggs at a time in different nests, and it appears that after laying each egg these birds then make the rounds to ensure that all the warbler hosts are toeing the line. Cowbird eggs often look very different from the eggs of the birds whose nests they parasitize, which is why scientists had wondered why the host birds simply did not chuck those eggs. In a paper Hoover published online in the Proceedings of the National Academy of Sciences, he found that warblers that accepted the cowbird eggs produced three offspring on average. "What is interesting is the female cowbirds are running this mafia-like racket," Hoover said. "People often think of males as being violent . . . . The male cowbirds play little or no role in this." All of this raises interesting questions. If a human playing wingman or wingwoman for a roommate is doing what the lance-tailed manakin has done for thousands of years, how much conscious thought is actually necessary for such behavior? And could the Tony Sopranos of this world plead not guilty by virtue of evolution? Frans de Waal argues that there is a difference between cowbirds and human gangsters. A Tony Soprano knows what he is doing and understands the consequences. "The birds may not even know what reproduction is," he said. "They are not thinking, 'If I trash the nest, next time they will be careful.' " Or . . . are they? Proposals for Mental Health Parity Pit a Father’s Pragmatism Against a Son’s Passion Robert Pear, New York Times- 3/19/2007 WASHINGTON— It’s Kennedy versus Kennedy as two members of Congress from the same family face off over competing versions of legislation that would require many health insurance companies and employers to provide more generous benefits to people with mental illness. Representative Patrick J. Kennedy, Democrat of Rhode Island and chief sponsor of the House bill, has criticized as inadequate the Senate bill introduced by his father, Senator Edward M. Kennedy, Democrat of Massachusetts. Representative Kennedy is trying to mobilize mental health advocates to lobby for what he describes as “the stronger of the two bills, the House bill.” Both bills seek to end discrimination against people with mental disorders by requiring insurers and employers to provide equivalent coverage, or parity, for mental and physical illnesses. That would be a huge change. For decades, insurers have charged higher co-payments and set stricter limits on coverage of mental health services. For example, insurers often refuse to cover more than 20 visits a year to a psychotherapist. And a patient may have to pay 20 percent of the cost for visiting a cancer specialist, but 40 percent or more for a mental health specialist. The differences between the Kennedys’ bills reflect different views about what is possible and what is politically feasible. Senator Kennedy said he was taking a pragmatic approach and had made a number of compromises to win the support of business and insurance groups. These compromises, he said, greatly increased the chances that a bill would become law, protecting millions of Americans in group health plans. Insurers and employers had opposed similar proposals in the past, saying the plans would drive up costs. This year, however, Senator Kennedy invited employers and insurers to help write the legislation, along with mental health groups, and they have endorsed the bill that he introduced with Senator Pete V. Domenici, Republican of New Mexico. The bill was recently approved in a Senate committee by a vote of 18 to 3. The younger Kennedy approaches the issue with the passion of a man who has been treated for depression and drug dependence. He has advocated parity legislation since 2001, but he said his commitment increased when he became “the public face of alcoholism and addiction” last year after a car crash on Capitol Hill. With a new Democratic majority, Congress appears likely to pass some version of the legislation. President Bush has endorsed the principle of mental health parity, though not a specific bill. Nearly 60 percent of all House members have expressed support for the House bill, which provides more protections to patients but is not backed by insurers or employers. “The House bill is everything that we did not like in previous mental health parity bills,” said E. Neil Trautwein, a vice president of the National Retail Federation, a trade group. Speaking to mental health advocates this month, Representative Kennedy declared: “We can’t cut any deals with insurance companies. We need to strengthen the Senate bill.” America’s Health Insurance Plans, which represents 1,300 insurers, and the American Benefits Council, a trade group mostly of Fortune 500 companies, strongly prefer the Senate version. The American Psychiatric Association supports both bills, describing them as different approaches to the same goal. Mental Health America, an advocacy group for patients, also supports both bills. But Ralph J. Ibson, the chief lobbyist for Mental Health America, said, “The House bill has greater protections and is therefore a stronger bill.” The House bill is named for Paul Wellstone, the senator from Minnesota who championed similar legislation before he died in a plane crash in 2002. Jeff Blodgett, executive director of Wellstone Action, a nonprofit group that is continuing the Democratic senator’s work, said, “The Senate bill is a step forward, but the House version is true to Paul Wellstone’s vision.” On behalf of the senator’s sons, David and Mark Wellstone, Mr. Blodgett said, he asked the Senate sponsors not to put the Wellstone name on the Senate bill at this time. One of the biggest differences between the House and Senate bills is that the House version defines the “minimum scope of coverage.” Under the House bill, if a group health plan provides any mental health benefits, then it must cover the same wide range of mental illnesses and addiction disorders covered by the health plan with the largest enrollment of federal employees. By contrast, the Senate bill does not specify what mental conditions or diagnoses must be covered. James A. Klein, president of the American Benefits Council, said he liked the Senate bill because it “does not mandate the specific benefits that a plan must cover.” But Patrick Kennedy said that was a weakness of his father’s bill. “Congress is covered, under the Federal Employees Health Benefits Program, for the treatment of mental illnesses as defined by the medical community,” Representative Kennedy said in an interview. “If it’s good enough for members of Congress, it should be good enough for the American public. The Senate bill leaves the definition up to whatever is negotiated between the insurer and the employer.” Representative Kennedy said he feared that some insurers would refuse to cover drug and alcohol abuse, eating disorders, or post-traumatic stress disorder. A patient’s ability to get treatment at an affordable price often depends on state law. The National Conference of State Legislatures says that 42 states have some type of parity law. The House bill says that federal law will not override “any state law that provides greater consumer protections, benefits,” rights or remedies. The Senate bill, by contrast, would “supersede any provision of state law” that establishes standards different from the federal standards for cost-sharing and treatment limits. Karen M. Ignagni, president of America’s Health Insurance Plans, praised this provision of the Senate bill, saying it would help “achieve consistency on how parity is defined” in different states. But Senators Christopher J. Dodd, Democrat of Connecticut, and Bernard Sanders, independent of Vermont, expressed concern that the Senate bill could interfere with laws in their states. Senator Kennedy said he was confident that he and his son could resolve their differences. “We will find ways of working together,” he said. Tracing the Cigarette’s Path From Sexy to Deadly Howard Markel, M.D., New York Times- 3/20/2007 For many Americans, the tobacco industry’s disingenuousness became a matter of public record during a Congressional hearing on April 14, 1994. There, under the withering glare of Representative Henry A. Waxman, Democrat of California, appeared the chief executives of the seven largest American tobacco companies. Each executive raised his right hand and solemnly swore to tell the whole truth about his business. In sequential testimony, each one stated that he did not believe tobacco was a health risk and that his company had taken no steps to manipulate the levels of nicotine in its cigarettes. Thirty years after the famous surgeon general’s report declaring cigarette smoking a health hazard, the tobacco executives, it seemed, were among the few who believed otherwise. But it was not always that way. Allan M. Brandt, a medical historian at Harvard, insists that recognizing the dangers of cigarettes resulted from an intellectual process that took the better part of the 20th century. He describes this fascinating story in his new book, “The Cigarette Century: The Rise, Fall and Deadly Persistence of the Product that Defined America” (Basic Books). In contrast to the symbol of death and disease it is today, from the early 1900s to the 1960s the cigarette was a cultural icon of sophistication, glamour and sexual allure — a highly prized commodity for one out of two Americans. Many advertising campaigns from the 1930s through the 1950s extolled the healthy virtues of cigarettes. Full-color magazine ads depicted kindly doctors clad in white coats proudly lighting up or puffing away, with slogans like “More doctors smoke Camels than any other cigarette.” Early in the 20th century, opposition to cigarettes took a moral rather than a health-conscious tone, especially for women who wanted to smoke, although even then many doctors were concerned that smoking was a health risk. The 1930s were a period when many Americans began smoking and the most significant health effects had not yet developed. As a result, the scientific studies of the era often failed to find clear evidence of serious pathology and had the perverse effect of exonerating the cigarette. The years after World War II, however, were a time of major breakthroughs in epidemiological thought. In 1947, Richard Doll and A. Bradford Hill of the British Medical Research Council created a sophisticated statistical technique to document the association between rising rates of lung cancer and increasing numbers of smokers. The prominent surgeon Evarts A. Graham and a medical student, Ernst L. Wynder, published a landmark article in 1950 comparing the incidence of lung cancer in their nonsmoking and smoking patients at Barnes Hospital in St. Louis. They concluded that “cigarette smoking, over a long period, is at least one important factor in the striking increase in bronchogenic cancer.” Predictably, the tobacco companies — and their expert surrogates — derided these and other studies as mere statistical arguments or anecdotes rather than definitions of causality. Dr. Brandt, who has exhaustively combed through the tobacco companies’ internal memorandums and research documents, amply demonstrates that Big Tobacco understood many of the health risks of their products long before the 1964 surgeon general’s report. He also describes the concerted disinformation campaigns these companies waged for more than half a century — simultaneously obfuscating scientific evidence and spreading the belief that since everyone knew cigarettes were dangerous at some level, smoking was essentially an issue of personal choice and responsibility rather than a corporate one. In the 1980s, scientists established the revolutionary concept that nicotine is extremely addictive. The tobacco companies publicly rejected such claims, even as they took advantage of cigarettes’ addictive potential by routinely spiking them with extra nicotine to make it harder to quit smoking. And their marketing memorandums document advertising campaigns aimed at youngsters to hook whole new generations of smokers. In 2004, Dr. Brandt was recruited by the Department of Justice to serve as its star expert witness in the federal racketeering case against Big Tobacco and to counter the gaggle of witnesses recruited by the industry. According to their own testimony, most of the 29 historians testifying on behalf of Big Tobacco did not even consult the industry’s internal research or communications. Instead, these experts focused primarily on a small group of skeptics of the dangers of cigarettes during the 1950s, many of whom had or would eventually have ties to the tobacco industry. “I was appalled by what the tobacco expert witnesses had written,” Dr. Brandt said in a recent interview. “By asking narrow questions and responding to them with narrow research, they provided precisely the cover the industry sought.” Apparently, the judge, Gladys Kessler of Federal District Court for the District of Columbia, agreed. Last August, she concluded that the tobacco industry had engaged in a 40-year conspiracy to defraud smokers about tobacco’s health dangers. Her opinion cited Dr. Brandt’s testimony more than 100 times. Dr. Brandt acknowledges that there are pitfalls in combining scholarship with battle against the deadly pandemic of cigarette smoking, but he says he sees little alternative. “If one of us occasionally crosses the boundary between analysis and advocacy, so be it,” he said. “The stakes are high, and there is much work to be done.” Scientist Finds the Beginnings of Morality in Primate Behavior Nicholas Wade, New York Times- 3/20/2007 Some animals are surprisingly sensitive to the plight of others. Chimpanzees, who cannot swim, have drowned in zoo moats trying to save others. Given the chance to get food by pulling a chain that would also deliver an electric shock to a companion, rhesus monkeys will starve themselves for several days. Biologists argue that these and other social behaviors are the precursors of human morality. They further believe that if morality grew out of behavioral rules shaped by evolution, it is for biologists, not philosophers or theologians, to say what these rules are. Moral philosophers do not take very seriously the biologists’ bid to annex their subject, but they find much of interest in what the biologists say and have started an academic conversation with them. The original call to battle was sounded by the biologist Edward O. Wilson more than 30 years ago, when he suggested in his 1975 book “Sociobiology” that “the time has come for ethics to be removed temporarily from the hands of the philosophers and biologicized.” He may have jumped the gun about the time having come, but in the intervening decades biologists have made considerable progress. Last year Marc Hauser, an evolutionary biologist at Harvard, proposed in his book “Moral Minds” that the brain has a genetically shaped mechanism for acquiring moral rules, a universal moral grammar similar to the neural machinery for learning language. In another recent book, “Primates and Philosophers,” the primatologist Frans de Waal defends against philosopher critics his view that the roots of morality can be seen in the social behavior of monkeys and apes. Dr. de Waal, who is director of the Living Links Center at Emory University, argues that all social animals have had to constrain or alter their behavior in various ways for group living to be worthwhile. These constraints, evident in monkeys and even more so in chimpanzees, are part of human inheritance, too, and in his view form the set of behaviors from which human morality has been shaped. Many philosophers find it hard to think of animals as moral beings, and indeed Dr. de Waal does not contend that even chimpanzees possess morality. But he argues that human morality would be impossible without certain emotional building blocks that are clearly at work in chimp and monkey societies. Dr. de Waal’s views are based on years of observing nonhuman primates, starting with work on aggression in the 1960s. He noticed then that after fights between two combatants, other chimpanzees would console the loser. But he was waylaid in battles with psychologists over imputing emotional states to animals, and it took him 20 years to come back to the subject. He found that consolation was universal among the great apes but generally absent from monkeys — among macaques, mothers will not even reassure an injured infant. To console another, Dr. de Waal argues, requires empathy and a level of self-awareness that only apes and humans seem to possess. And consideration of empathy quickly led him to explore the conditions for morality. Though human morality may end in notions of rights and justice and fine ethical distinctions, it begins, Dr. de Waal says, in concern for others and the understanding of social rules as to how they should be treated. At this lower level, primatologists have shown, there is what they consider to be a sizable overlap between the behavior of people and other social primates. Social living requires empathy, which is especially evident in chimpanzees, as well as ways of bringing internal hostilities to an end. Every species of ape and monkey has its own protocol for reconciliation after fights, Dr. de Waal has found. If two males fail to make up, female chimpanzees will often bring the rivals together, as if sensing that discord makes their community worse off and more vulnerable to attack by neighbors. Or they will head off a fight by taking stones out of the males’ hands. Dr. de Waal believes that these actions are undertaken for the greater good of the community, as distinct from person-to-person relationships, and are a significant precursor of morality in human societies. Macaques and chimpanzees have a sense of social order and rules of expected behavior, mostly to do with the hierarchical natures of their societies, in which each member knows its own place. Young rhesus monkeys learn quickly how to behave, and occasionally get a finger or toe bitten off as punishment. Other primates also have a sense of reciprocity and fairness. They remember who did them favors and who did them wrong. Chimps are more likely to share food with those who have groomed them. Capuchin monkeys show their displeasure if given a smaller reward than a partner receives for performing the same task, like a piece of cucumber instead of a grape. These four kinds of behavior — empathy, the ability to learn and follow social rules, reciprocity and peacemaking — are the basis of sociality. Dr. de Waal sees human morality as having grown out of primate sociality, but with two extra levels of sophistication. People enforce their society’s moral codes much more rigorously with rewards, punishments and reputation building. They also apply a degree of judgment and reason, for which there are no parallels in animals. Religion can be seen as another special ingredient of human societies, though one that emerged thousands of years after morality, in Dr. de Waal’s view. There are clear precursors of morality in nonhuman primates, but no precursors of religion. So it seems reasonable to assume that as humans evolved away from chimps, morality emerged first, followed by religion. “I look at religions as recent additions,” he said. “Their function may have to do with social life, and enforcement of rules and giving a narrative to them, which is what religions really do.” As Dr. de Waal sees it, human morality may be severely limited by having evolved as a way of banding together against adversaries, with moral restraints being observed only toward the in group, not toward outsiders. “The profound irony is that our noblest achievement — morality — has evolutionary ties to our basest behavior — warfare,” he writes. “The sense of community required by the former was provided by the latter.” Dr. de Waal has faced down many critics in evolutionary biology and psychology in developing his views. The evolutionary biologist George Williams dismissed morality as merely an accidental byproduct of evolution, and psychologists objected to attributing any emotional state to animals. Dr. de Waal convinced his colleagues over many years that the ban on inferring emotional states was an unreasonable restriction, given the expected evolutionary continuity between humans and other primates. His latest audience is moral philosophers, many of whom are interested in his work and that of other biologists. “In departments of philosophy, an increasing number of people are influenced by what they have to say,” said Gilbert Harman, a Princeton University philosopher. Dr. Philip Kitcher, a philosopher at Columbia University, likes Dr. de Waal’s empirical approach. “I have no doubt there are patterns of behavior we share with our primate relatives that are relevant to our ethical decisions,” he said. “Philosophers have always been beguiled by the dream of a system of ethics which is complete and finished, like mathematics. I don’t think it’s like that at all.” But human ethics are considerably more complicated than the sympathy Dr. de Waal has described in chimps. “Sympathy is the raw material out of which a more complicated set of ethics may get fashioned,” he said. “In the actual world, we are confronted with different people who might be targets of our sympathy. And the business of ethics is deciding who to help and why and when.” Many philosophers believe that conscious reasoning plays a large part in governing human ethical behavior and are therefore unwilling to let everything proceed from emotions, like sympathy, which may be evident in chimpanzees. The impartial element of morality comes from a capacity to reason, writes Peter Singer, a moral philosopher at Princeton, in “Primates and Philosophers.” He says, “Reason is like an escalator — once we step on it, we cannot get off until we have gone where it takes us.” That was the view of Immanuel Kant, Dr. Singer noted, who believed morality must be based on reason, whereas the Scottish philosopher David Hume, followed by Dr. de Waal, argued that moral judgments proceed from the emotions. But biologists like Dr. de Waal believe reason is generally brought to bear only after a moral decision has been reached. They argue that morality evolved at a time when people lived in small foraging societies and often had to make instant life-or-death decisions, with no time for conscious evaluation of moral choices. The reasoning came afterward as a post hoc justification. “Human behavior derives above all from fast, automated, emotional judgments, and only secondarily from slower conscious processes,” Dr. de Waal writes. However much we may celebrate rationality, emotions are our compass, probably because they have been shaped by evolution, in Dr. de Waal’s view. For example, he says: “People object to moral solutions that involve hands-on harm to one another. This may be because hands-on violence has been subject to natural selection whereas utilitarian deliberations have not.” Philosophers have another reason biologists cannot, in their view, reach to the heart of morality, and that is that biological analyses cannot cross the gap between “is” and “ought,” between the description of some behavior and the issue of why it is right or wrong. “You can identify some value we hold, and tell an evolutionary story about why we hold it, but there is always that radically different question of whether we ought to hold it,” said Sharon Street, a moral philosopher at New York University. “That’s not to discount the importance of what biologists are doing, but it does show why centuries of moral philosophy are incredibly relevant, too.” Biologists are allowed an even smaller piece of the action by Jesse Prinz, a philosopher at the University of North Carolina. He believes morality developed after human evolution was finished and that moral sentiments are shaped by culture, not genetics. “It would be a fallacy to assume a single true morality could be identified by what we do instinctively, rather than by what we ought to do,” he said. “One of the principles that might guide a single true morality might be recognition of equal dignity for all human beings, and that seems to be unprecedented in the animal world.” Dr. de Waal does not accept the philosophers’ view that biologists cannot step from “is” to “ought.” “I’m not sure how realistic the distinction is,” he said. “Animals do have ‘oughts.’ If a juvenile is in a fight, the mother must get up and defend her. Or in food sharing, animals do put pressure on each other, which is the first kind of ‘ought’ situation.” Dr. de Waal’s definition of morality is more down to earth than Dr. Prinz’s. Morality, he writes, is “a sense of right and wrong that is born out of groupwide systems of conflict management based on shared values.” The building blocks of morality are not nice or good behaviors but rather mental and social capacities for constructing societies “in which shared values constrain individual behavior through a system of approval and disapproval.” By this definition chimpanzees in his view do possess some of the behavioral capacities built in our moral systems. “Morality is as firmly grounded in neurobiology as anything else we do or are,” Dr. de Waal wrote in his 1996 book “Good Natured.” Biologists ignored this possibility for many years, believing that because natural selection was cruel and pitiless it could only produce people with the same qualities. But this is a fallacy, in Dr. de Waal’s view. Natural selection favors organisms that survive and reproduce, by whatever means. And it has provided people, he writes in “Primates and Philosophers,” with “a compass for life’s choices that takes the interests of the entire community into account, which is the essence of human morality.” Seeds of Compassion, Buried but Not Gone Salin A. Dahlben, M.D., New York Times- 3/20/2007 Michael was 16 years old when his life changed. How much worse could it become? Mental retardation had allowed him only one great pleasure — his bicycle — and even that was taken away when he was hit by a truck while riding. The resulting head injury caused multiple behavioral changes. Once sweet and soft-spoken, he became disruptive and violent. No community environment could manage his repeated bouts of agitation, lack of control and aggression. I first examined Michael in the mid-1980s, when he was a 30-year-old patient in a maximum-security hospital for the criminally insane (though there were no criminal charges against him). He would stay in his room all day long for weeks on end, uncommunicative, with periods of extremely hostile behavior toward anyone who came nearby. Psychotropic medications worked to decrease his agitation. But they blunted his emotional expression and caused restlessness, muscle stiffness and tremors, along with even more distressing side effects that he was unable to express at the time: dry mouth, blurred vision, constipation and urinary retention. Those symptoms, unknown to anyone, made his uncontrollable behavior even worse. I moved on to another hospital, leaving Michael behind — until two years ago. Under a court order mandating the removal of noncriminal patients from prisons, he had been transferred to a difficult-to-manage unit in a state institution. From there, he went on to an intermediate-care unit. That was where we met again. His condition did not appear to have changed. He stayed in bed for weeks, except for abrupt trips to the nursing station, where he yelled, screamed and banged his fists on the wall. Moved to see him again, and frustrated that nothing had improved, I began an obsessive quest to help him. In search of clues, I pored over his 36 years of medical records — treatment plans, medications that worked or did not work, behavioral plans, risk reviews — and read every single note in his chart. I juggled with court-approved medications and interventions, and struggled with justifying medications not considered or not approved. Six months ago, at age 52, well groomed and well dressed, Michael started going out to the mall and on trips, and attending meetings and programs. He underwent hernia surgery without incident, and became eager to approach anyone who paid some attention to him and had the time to talk. About a month ago, I experienced a personal loss, the end of a long-term relationship. I was devastated, but I maintained my usual demeanor and activities, making every effort to keep my emotions from my patients. It was difficult, but I thought I was succeeding. One morning, as I entered the ward, Michael was standing by the door. He walked over to me and pushed his right hand onto my left shoulder, forcing me to stop. As he stared straight into my eyes, my heart started beating fast. What would he do? Suddenly, any fear subsided, and I felt calm. For in his perplexed, piercing blue eyes, I found the most compassionate look. “Dr. D., Dr. D., you been sad for days now,” he said. “You gonna be all right. You gonna be all right.” Salin A. Dahlben is a clinical assistant professor of psychiatry at Harvard University and Tufts University.
Schizophrenia Study Offers Clue Newsday, 3/20/2007 MELVILLE, N.Y. — A team of Long Island scientists has scanned the entire human genome for evidence of genes that play a role in schizophrenia and has discovered a hot spot near two genes that regulate the immune system. Dr. Anil Malhotra and Todd Lencz of the Zucker Hillside Hospital campus of the Feinstein Institute for Medical Research in Glen Oaks, N.Y., found that certain markers within these genes were more common in patients with schizophrenia than in those without a history of the mental illness. Their study will appear today in the journal Molecular Psychiatry. A small group of scientists has long proposed that infectious agents might play a role in schizophrenia. A finding supported by multiple studies is that toxoplasma, a cat parasite, is two times more common among patients than normal volunteers. One percent of the population suffers from schizophrenia, a serious mental illness that can cause hallucinations, delusions, apathy, dulled emotion and cognitive problems. The Hillside study looked at genes from 178 chronic schizophrenia patients and 144 volunteers. For computer analysis, they put the DNA from each individual onto a gene chip that has 500,000 markers, numbers along the entire stretch of the human genome. When they found markers overrepresented in the patient population studied, they looked for genes at or near the marker. The two closest genes they identified are both involved with immune function and are activated when the body is responding to an infection. The genes are on the male Y chromosome and the female X chromosome, although the genes don't have a specific sex-linked role, Malhotra said. Some of the markers were seen in as many as 30% of the schizophrenia patients, compared with 10% of healthy controls. The scientists studied another group of 71 schizophrenia patients, and the markers pointed to the same two genes. "There are a number of common and rare polymorphisms [varieties] that are overrepresented in patients with schizophrenia," Malhotra said. He suspects that cytokines, substances produced by the immune system, might play a role as a genetic switch that puts certain people at risk. "It's interesting work," said Dr. Robert Yolken, a professor of pediatrics and director of the Stanley Laboratory of Developmental Neurovirology at Johns Hopkins University School of Medicine. "It fits with the prediction that Dr. [E.] Fuller Torrey and I made that genes discovered in schizophrenia will be associated with an immune response. "It would make sense that some of the genes are determinants of the response to infection."
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