Mind: A Misguided Focus on Mental Illness in Gun Control Debate

The gunman, Adam Lanza, 20, has been described as a loner who was intelligent and socially awkward. And while no official diagnosis has been made public, armchair diagnosticians have been quick to assert that keeping guns from getting into the hands of people with mental illness would help solve the problem of gun homicides.

Arguing against stricter gun-control measures, Representative Mike Rogers, Republican of Michigan and a former F.B.I. agent, said, “What the more realistic discussion is, ‘How do we target people with mental illness who use firearms?’ ”

Robert A. Levy, chairman of the Cato Institute, told The New York Times: “To reduce the risk of multivictim violence, we would be better advised to focus on early detection and treatment of mental illness.”

But there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness.

This does not mean that mental illness is not a risk factor for violence. It is, but the risk is actually small. Only certain serious psychiatric illnesses are linked to an increased risk of violence.

One of the largest studies, the National Institute of Mental Health’s Epidemiologic Catchment Area study, which followed nearly 18,000 subjects, found that the lifetime prevalence of violence among people with serious mental illness — like schizophrenia and bipolar disorder — was 16 percent, compared with 7 percent among people without any mental disorder. Anxiety disorders, in contrast, do not seem to increase the risk at all.

Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself. In the National Institute of Mental Health’s E.C.A. study, for example, people with no mental disorder who abused alcohol or drugs were nearly seven times as likely as those without substance abuse to commit violent acts.

It’s possible that preventing people with schizophrenia, bipolar disorder and other serious mental illnesses from getting guns might decrease the risk of mass killings. Even the Supreme Court, which in 2008 strongly affirmed a broad right to bear arms, at the same time endorsed prohibitions on gun ownership “by felons and the mentally ill.”

But mass killings are very rare events, and because people with mental illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. Consider that between 2001 and 2010, there were nearly 120,000 gun-related homicides, according to the National Center for Health Statistics. Few were perpetrated by people with mental illness.

Perhaps more significant, we are not very good at predicting who is likely to be dangerous in the future. According to Dr. Michael Stone, professor of clinical psychiatry at Columbia and an expert on mass murderers, “Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.”

Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless.

Jeffery Swanson, a professor of psychiatry at Duke University and a leading expert in the epidemiology of violence, said in an e-mail, “Can we reliably predict violence?  ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.”

It would be even harder to predict a mass shooting, Dr. Swanson said, “You can profile the perpetrators after the fact and you’ll get a description of troubled young men, which also matches the description of thousands of other troubled young men who would never do something like this.”

Even if clinicians could predict violence perfectly, keeping guns from people with mental illness is easier said than done. Nearly five years after Congress enacted the National Instant Criminal Background Check System, only about half of the states have submitted more than a tiny proportion of their mental health records.

How effective are laws that prohibit people with mental illness from obtaining guns? According to Dr. Swanson’s recent research, these measures may prevent some violent crime. But, he added, “there are a lot of people who are undeterred by these laws.”

Adam Lanza was prohibited from purchasing a gun, because he was too young. Yet he managed to get his hands on guns — his mother’s — anyway. If we really want to stop young men like him from becoming mass murderers, and prevent the small amount of violence attributable to mental illness, we should invest our resources in better screening for, and treatment of, psychiatric illness in young people.

All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group. But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.

Read More..

Mind: A Misguided Focus on Mental Illness in Gun Control Debate

The gunman, Adam Lanza, 20, has been described as a loner who was intelligent and socially awkward. And while no official diagnosis has been made public, armchair diagnosticians have been quick to assert that keeping guns from getting into the hands of people with mental illness would help solve the problem of gun homicides.

Arguing against stricter gun-control measures, Representative Mike Rogers, Republican of Michigan and a former F.B.I. agent, said, “What the more realistic discussion is, ‘How do we target people with mental illness who use firearms?’ ”

Robert A. Levy, chairman of the Cato Institute, told The New York Times: “To reduce the risk of multivictim violence, we would be better advised to focus on early detection and treatment of mental illness.”

But there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness.

This does not mean that mental illness is not a risk factor for violence. It is, but the risk is actually small. Only certain serious psychiatric illnesses are linked to an increased risk of violence.

One of the largest studies, the National Institute of Mental Health’s Epidemiologic Catchment Area study, which followed nearly 18,000 subjects, found that the lifetime prevalence of violence among people with serious mental illness — like schizophrenia and bipolar disorder — was 16 percent, compared with 7 percent among people without any mental disorder. Anxiety disorders, in contrast, do not seem to increase the risk at all.

Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself. In the National Institute of Mental Health’s E.C.A. study, for example, people with no mental disorder who abused alcohol or drugs were nearly seven times as likely as those without substance abuse to commit violent acts.

It’s possible that preventing people with schizophrenia, bipolar disorder and other serious mental illnesses from getting guns might decrease the risk of mass killings. Even the Supreme Court, which in 2008 strongly affirmed a broad right to bear arms, at the same time endorsed prohibitions on gun ownership “by felons and the mentally ill.”

But mass killings are very rare events, and because people with mental illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. Consider that between 2001 and 2010, there were nearly 120,000 gun-related homicides, according to the National Center for Health Statistics. Few were perpetrated by people with mental illness.

Perhaps more significant, we are not very good at predicting who is likely to be dangerous in the future. According to Dr. Michael Stone, professor of clinical psychiatry at Columbia and an expert on mass murderers, “Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.”

Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless.

Jeffery Swanson, a professor of psychiatry at Duke University and a leading expert in the epidemiology of violence, said in an e-mail, “Can we reliably predict violence?  ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.”

It would be even harder to predict a mass shooting, Dr. Swanson said, “You can profile the perpetrators after the fact and you’ll get a description of troubled young men, which also matches the description of thousands of other troubled young men who would never do something like this.”

Even if clinicians could predict violence perfectly, keeping guns from people with mental illness is easier said than done. Nearly five years after Congress enacted the National Instant Criminal Background Check System, only about half of the states have submitted more than a tiny proportion of their mental health records.

How effective are laws that prohibit people with mental illness from obtaining guns? According to Dr. Swanson’s recent research, these measures may prevent some violent crime. But, he added, “there are a lot of people who are undeterred by these laws.”

Adam Lanza was prohibited from purchasing a gun, because he was too young. Yet he managed to get his hands on guns — his mother’s — anyway. If we really want to stop young men like him from becoming mass murderers, and prevent the small amount of violence attributable to mental illness, we should invest our resources in better screening for, and treatment of, psychiatric illness in young people.

All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group. But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.

Read More..

Advertising: Finding a Documentary Audience, for a Cause

DOCUMENTARY films are notoriously difficult to finance, with filmmakers often spending more time scrounging up money to make a film than actually producing it. Unlike big Hollywood films, where having the presence of a marquee name can attract dollars, documentary filmmakers often must try to explain how a niche idea can succeed at the box office.

The director and backers of “Girl Rising,” a documentary that is a cornerstone of a media campaign about educating girls around the world, hope to change that. To promote the new film, and demonstrate the impact that documentaries can have on audiences, they will rely on technologies often used by more traditional advertisers, including personalized ads for employees of companies viewing them online.

“If what you are after is engagement and connection to a cause,” said Richard E. Robbins, the director, “how you use the tools that are available to you is very different than if you are trying to market ‘Batman.’ ”

Money donated by consumers seeing the film will be funneled to a nonprofit group, 10x10, which will then distribute the funds to various nonprofits helping to educate girls.

Many documentary filmmakers have trouble quantifying the social and financial impact their films can have, Mr. Robbins said. And many are confronted with “a dearth of evidence to support the idea that documentary films affect change.”

But using highly targeted advertising can help filmmakers learn who is donating, how much they are donating, how much interest there is in a film and whether there is enough interest to warrant a screening in a city, he said. Having that information might also help persuade future investors to support documentaries connected to causes.

“Girl Rising,” which will be released in March, is being financed in part by 10x10, which supports educating girls around the world through film and social media advocacy.

Ads promoting “Girl Rising” will be shown to employees of 57 companies that the filmmakers selected in hopes they will support efforts to educate girls in developing countries. Those companies include Apple, Bank of America, Oracle, Goldman Sachs, Wal-Mart, Disney and Procter & Gamble.

“Those companies are deeply invested in vibrant economies overseas, healthy supply chains, diversity, attracting and retaining and identifying new employees, skilled employees,” said Holly Gordon, executive director at 10x10. “We thought that they would be advocates for these issues of gender diversity and global education.”

Employees at the companies will see ads on their computers at work, customized to use the company name. For example, an Oracle employee will see an ad that says “Oracle employees can change the world,” with a link to see a trailer for the film and donate to the cause.

A group of former ABC News journalists, known as the Documentary Group, and Vulcan Productions announced the creation of 10x10 and its media campaign at the United Nation’s first International Day of the Girl in October. Additional funds for organization came from Intel, the Ford Foundation, Google, the Nike Foundation, the Skoll Foundation and the Fledgling Fund.

“Girl Rising,” the first film backed by the group, features stories inspired by nine girls in countries like Haiti, Nepal, Sierra Leone, Uganda and Afghanistan. Some of the segments are narrated by celebrities like Meryl Streep, Selena Gomez and Kerry Washington.

Well-known writers from each of the countries, including Mona Eltahawy, an Egyptian-American author, and Edwidge Danticat of Haiti helped to write the stories of each of the girls to whom they were paired. Each story will be presented differently; some will be animated while others will be live action.

Chris Golec, the chief executive of Demandbase, the company behind the ads, said technology that aimed at the Internet addresses at the companies would be used to find the right users for each ad.

“Targeting people at work is four times more likely to drive engagement than somebody coming from a residential I.P. address,” said Mr. Golec, referring to the Internet addresses of home viewers. “If you personalize the ad with the company name that they work for you get a three times higher click through rate on the ad.”

Using such digital advertising also helps the filmmakers and producers in another way, said Mr. Robbins. “It’s infinitely more trackable, there’s so much more data,” he said. “We can measure conversion rates, who our audience is — its not just anonymous people buying tickets.”

Distribution of “Girl Rising” will be in phases, beginning in January at the Sundance Film Festival, where one chapter will be shown. It will make its official debut in March for International Women’s Day at an event in New York City, and with a smaller event in Los Angeles. CNN will show the film in June as part of the network’s new film division.

Organizers are also using technology to get viewers to book a screening of the film in the city of their choice. Supporters of 10x10 will receive an e-mail asking them to go to a Web site, Gathr.us, which will keep track of the number of screening requests from various cities.

Read More..

North Korean Satellite Most Likely Dead, Astronomers Say

The North Korean satellite launched into space last week is out of control and most likely dead, astronomers reported Monday. The apparent failure will not cause the spacecraft to fall quickly back to earth but represents a major setback in Pyongyang’s bid to portray the launching as a patriotic and technological success.

“It’s tumbling and we haven’t picked up any transmissions,” said Jonathan McDowell, a Harvard astronomer who tracks global rocket launchings and space activity. “Those two things are most consistent with the satellite being entirely inactive at this point.”

North Korea’s state-run press, which was preoccupied on Monday with reporting on the somber one-year anniversary of the death of Kim Jong-il, the longtime leader, said nothing about the satellite’s dysfunction. It has been describing the satellite launch as a triumphal achievement of Mr. Kim’s successor, his son Kim Jong-un, done in the face of worldwide criticism and United Nations sanctions on the North’s ballistic missile program.

The satellite, said to be about the size of a washing machine, reportedly carries an onboard camera to observe the earth. That mission requires the spacecraft’s orbit to be rock-steady.

Dr. McDowell said the tumbling implies that onboard systems meant to control and stabilize the craft had failed.

He added that radio astronomers had picked up no signals from the satellite and that optical astronomers had observed it brightening and dimming as it slowly tumbled end over end.

“It’s clear that the rocket part of this mission worked very well for the North Koreans,” Dr. McDowell said in an interview. “They ended up in the right orbit. But the preponderance of the evidence suggests that the satellite failed either during the ascent or shortly afterwards.”

Read More..

Nickelodeon and PBS Pursue Preschool Apps Alongside TV Shows

In 2014, the preschool cable network Nick Jr. plans to introduce a television show featuring a little boy, his miniature pet dragon and a magic stick.

But the show, “Wallykazam,” will not be new to users of smartphones and tablets. Educational applications built around it will start appearing in app stores late next year, making “Wallykazam” Nickelodeon’s first major show to be introduced as a mobile product first, said Steve Youngwood, Nickelodeon’s executive vice president and general manager for digital media.

Driving the change, at Nickelodeon and other preschool television brands, are parents who are increasingly putting mobile devices into preschoolers’ hands and laps.

According to new research commissioned by Sesame Workshop, producer of PBS’s “Sesame Street,” mobile device ownership is booming as TV set ownership declines. Eighty-eight percent of the parents surveyed said they owned a television, down from 95 percent in 2010.

Twenty-one percent said their children first interacted with “Sesame Street” someplace other than television, with YouTube and PBS.org the top alternative sources. (PBS said separately that its free PBS Kids Video app, which has been downloaded 2.4 million times, reached 120 million streams of PBS Kids shows in November, surpassing 100 million for the first time.)

“On-air does still drive digital,” said Diana Polvere, Sesame Workshop’s vice president for market research, citing the 79 percent of viewers who still come to television first. But given the rapid changes, she said, Sesame’s research will now be conducted every six months instead of every two years.

Nickelodeon’s research, done in April and updated in October, shows striking growth in educational app use. In October, 27 percent of United States households with children ages 3 to 5 had an iPad, up from 22 percent in April. In those households, 40 percent of preschoolers used the iPad for educational apps, up from 27 percent in April.

The study also found that Apple device users were willing to pay 15 to 23 percent more for educational apps than for general apps.

“Parents want to feel good about what they are purchasing and downloading for their kids,” said Scott Chambers, Sesame Workshop’s senior vice president for digital worldwide distribution. Adding an educational element to an entertaining app, he said, “makes everybody feel better.”

Parents’ feelings aside, apps are strong educational tools, said Lesli Rotenberg, who oversees PBS’s children’s programming, including its more than two dozen apps.

While television “is somewhat of a passive experience” for children, she said, interactive apps give them immediate feedback and tailored experiences that become more difficult as they gain skills.

Though numerous producers are entering the app business, three of the top 10 paid educational apps in the iTunes store last week were Nickelodeon’s. They included the $1.99 Bubble Guppies: Animal School Day, already profitable six weeks after its introduction, Nickelodeon said. A Team Umizoomi math app was still in the top 10 after a year on the market.

Originally scheduled for August release, the Bubble Guppies app, filled with the same silly jokes as the show, was revised after focus group testing with preschoolers showed, among other things, that their small fingers had a hard time maneuvering a virtual latch and that the children wanted more control over their exploration.

“We were hearing kids say in testing: ‘I want to play with the dolphin. I want to play with the penguin,’ ” said Jordana Drell, Nickelodeon’s senior director of preschool games.

Nickelodeon’s educational apps normally take six to eight months to create and, even with lush graphics like the shimmery underwater background in Bubble Guppies, cost about half as much as a single episode of one of the company’s preschool shows, officials said.

The Bubble Guppies creators, Jonny Belt and Robert Scull, said they approached the app as they would a television episode, reading the 90-page game document aloud, technical material and all. “That really brings it to life, and you know what you’re getting,” Mr. Scull said.

A Nickelodeon rival, Disney Junior, has taken a less integrated approach to apps, developing television shows first and apps later to expand on the content, said Albert Cheng, executive vice president for digital media at the Disney/ABC Television Group.

The free Mickey Mouse Clubhouse Road Rally Appisode, released in May, is a repurposed version of an episode of the “Mickey Mouse Clubhouse” television program, reconfigured to be highly interactive.

It proved so popular that “we definitely feel there’s something here we want to invest in,” Mr. Cheng said.

Although the app had educational elements, it was not intended as such. The sprawling Walt Disney Company has published educational apps through other units, however.

Since releasing its first app three years ago, Sesame Workshop has added more than three dozen, including Elmo Loves 123s, which was introduced Dec. 10 and draws on new research for developers and parents that Sesame plans to release this week. App users, Mr. Chambers said, tend to come back regularly, a loyalty that executives have noted as they consider future expansion in the category.

The rush to apps is changing the development process for PBS, which will no longer develop television-only shows, Ms. Rotenberg said. PBS’s newest property, “Daniel Tiger’s Neighborhood,” came out as an app — already the company’s third best-selling — the day of the television premiere in September.

Ms. Rotenberg said her team had “sent away” a number of producers who came to PBS with ideas for television shows with no thought-out mobile component, telling them, “ ‘Come back when you have a plan.’ ”

Read More..

The New Old Age Blog: In the Middle: Why Elderly Couples Fight

George and Gracie (let’s call them that because using their real names would make them even unhappier than they already appear to be) are in their 80s and have been married for more than 65 years. Until recently they seemed to ride the waves that are inevitable in any marriage that spans nearly seven decades; through good and bad, they were partners and best friends.

But lately — ever since her hospitalization and his fall — they have been arguing more bitterly than usual (“Do you have to make such a mess in the kitchen?”), criticizing each other (“Why haven’t you dealt with the insurance company yet?”), withdrawing from each other, and generally making each other more miserable, more often than ever before.

This kind of degenerative relationship is not uncommon among the elderly in even the happiest marriages, marriage therapists and geriatricians said. But that is small comfort to either the couple in the middle of the maelstrom, or the children who care for them, as evidenced by a number of postings on caregiver blogs. As some of the children have wondered there: “Why can’t we all just get along?”

Therapists and others who work with the elderly said the first step to addressing the problem is understanding where it came from.

“A key question is whether the marital bickering is part of a lifelong marital style or a change,” said Dr. Linda Waite, director of the Center on Demography and Economics of Aging at NORC/University of Chicago. Is it new behavior – or just new to the grown children who are suddenly so deeply enmeshed in their parents’ lives that they are only now noticing that something is amiss?

How much of the problem is really just the marriage style? “Some couples like to fight and argue – it keeps their adrenaline going,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and author of “Overwhelmed: Coping With Life’s Ups and Downs.”

Sometimes the best judges of whether there is a problem are outsiders, said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine. Pay attention if someone says, “‘Gee, Mom seems more argumentative or withdrawn than the last time I saw her,’” Dr. Dale advised.

If the tone or severity of the marital tensions seem new, then it is important to find out why. The causes could be mental or physical, doctors say.

On the mental front, increased anger and fighting could be one of the first signs of mild cognitive impairment, a precursor of dementia or Alzheimer’s, in one or both of the spouses, said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program and an associate professor in the department of psychiatry and behavioral sciences.

Dr. Dale concurs: “There is good evidence that the earliest signs of cognitive impairment are often emotional changes” — anger, anxiety, depression — “rather than cognitive ones” — memory, abstract thought.

But these early signs of cognitive decline can be so subtle that neither the spouses themselves, or their grown children, recognize them for what they are, Dr. Gwyther said. So husband and wife blame each other for the changes and allow feelings of hurt and resentment to grow.

Withdrawing from activities that used to give them pleasure can be a telltale sign of mild cognitive impairment – and can trigger anger and arguments.

“In one couple, the husband just didn’t want to participate in the holidays — the wife got angry and said he was being lazy and stubborn,” said Dr. Gwyther. But the truth was that his cognitive decline made all the activity overwhelming, and he didn’t want anyone to know that he was anxious about not remembering everyone’s names and embarrassing himself.

Suspicion and paranoia can also accompany mild cognitive decline and precipitate distrust and hurtful accusations. Dr. Gwyther recalled another woman who “called her daughter frantic because she said her husband dropped her at her chemo appointment, went to park the car, and didn’t return to get her.” The woman couldn’t imagine that her husband could possibly have lost his sense of time and direction, Dr. Gwyther added. She took it personally, complaining to her daughter that “your father doesn’t seem to care any more.”

Dr. Dale told of a spouse who accused her mate of infidelity because “she was convinced that when he was out grocery shopping he was really having an affair.”

Hoarding, an early symptom of mild cognitive impairment, can also create tension in a marriage. (For new treatments, see this recent post by my colleague Paula Span.)

When one couple came to a counseling session with Dr. Norman Abeles, emeritus professor of psychology and former director of psychological clinic at Michigan State University, the hoarding spouse finally said she did it because she thought that they would run out of money, “even though there was enough money to go around.” Dr. Abeles said that incident led to her diagnosis of mild cognitive impairment.

Adding to the confusion, mild cognitive impairment, or M.C.I., comes and goes. “There are good days and bad days, good hours and bad hours,” said Dr. Gwyther. “Alzheimer’s and dementia don’t start on Tuesday — it’s a slow insidious onset.” But the diagnosis is becoming more common: The Institute for Dementia Research and Prevention predicts that 1 in 6 women, and 1 in 10 men, who live past the age of 55 will develop dementia in their lifetime.

“Spouses find it difficult to know when their partner with M.C.I. is acting differently, usually badly, due to the advancing illness or due to ‘willful’ personality issues,” said Dr. Dale, citing a 2007 study in the journal Family Relations exploring the problems this can create for couples.

Blaming is often easier than understanding. Another of Dr. Gwyther’s patients was furious at her husband for not filing their taxes. “He’s a C.P.A.,” she said. “How could we owe back taxes?” It did not occur to her that he might be unable to handle that task — and was too frightened about his deteriorating mental focus to let her know.

But as harmful as mental decline can be for a marriage, it is just part of the equation. Physical ailments – even those that seem completely unrelated to marital relations – “can upset the equilibrium of the marriage,” according to a study in The Canadian Medical Association Journal.

“Most men get angry at what’s happened to them when they get ill, women get angry and scared when he’s not what he used to be — so they fight,” said Dr. Schlossberg.

Chronic illnesses, like diabetes, arthritis and heart disease, can have a strong negative effect on mood, said Dr. Waite, who will soon be publishing a study on the subject. Diabetes is so often accompanied by depression that Dr. Waite said “one of my colleagues argues that that it is even part of the disease.”

And ailments can have an effect on a couple’s sex life — which can compound the marital problems, doctors said.

“Diabetes brings on neuropathy,” said Dr. Waite. “That means touching and feeling in sex is not as rewarding.” Without the pleasures of affectionate touching — whether a passing hug at the sink or more — tensions can build. That’s why, if a couple is having problems with sex, they are more likely to have problems in the relationship — and vice versa, according to a 2007 New England Journal of Medicine study of sex and health among older adults.

Other changes in circumstances — retirement, shifting roles, the loss of autonomy, disparities in health and abilities — can wreak havoc. Losing independence can feel like losing oneself — and if you don’t know who you are any more, how can you know how to relate to your spouse?

“Fighting may come from a misguided notion that you can regain power by asserting it over your spouse,” said Dr. Schlossberg, whose observations are echoed in a 1984 study in The Canadian Journal of Medicine. “It doesn’t work, it’s false power – but they’ll try anything.”

The sheer exhaustion that can come from being the caregiving spouse is also bound to “make them stressed and angry,” said Dr. Waite. Not to mention guilty and resentful — never a prescription for happy marital relations.

“Part of the trap for the caregiver is the idea that you have to do it all, and the guilt you feel when you cannot live up to it,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc. Not surprisingly, resentment can soon follow, Dr. Herz added, because it is hard to admit to anyone that, “‘this is too much for me.’”

What can outside caregivers — children or other loved ones — do about these golden marriages on the rocks? Should they intervene — or butt out? And can marital therapy help — or is it too late to change?

Share your thoughts and experiences — and on Tuesday we will try to provide some advice from experts.

Read More..

The New Old Age Blog: In the Middle: Why Elderly Couples Fight

George and Gracie (let’s call them that because using their real names would make them even unhappier than they already appear to be) are in their 80s and have been married for more than 65 years. Until recently they seemed to ride the waves that are inevitable in any marriage that spans nearly seven decades; through good and bad, they were partners and best friends.

But lately — ever since her hospitalization and his fall — they have been arguing more bitterly than usual (“Do you have to make such a mess in the kitchen?”), criticizing each other (“Why haven’t you dealt with the insurance company yet?”), withdrawing from each other, and generally making each other more miserable, more often than ever before.

This kind of degenerative relationship is not uncommon among the elderly in even the happiest marriages, marriage therapists and geriatricians said. But that is small comfort to either the couple in the middle of the maelstrom, or the children who care for them, as evidenced by a number of postings on caregiver blogs. As some of the children have wondered there: “Why can’t we all just get along?”

Therapists and others who work with the elderly said the first step to addressing the problem is understanding where it came from.

“A key question is whether the marital bickering is part of a lifelong marital style or a change,” said Dr. Linda Waite, director of the Center on Demography and Economics of Aging at NORC/University of Chicago. Is it new behavior – or just new to the grown children who are suddenly so deeply enmeshed in their parents’ lives that they are only now noticing that something is amiss?

How much of the problem is really just the marriage style? “Some couples like to fight and argue – it keeps their adrenaline going,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and author of “Overwhelmed: Coping With Life’s Ups and Downs.”

Sometimes the best judges of whether there is a problem are outsiders, said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine. Pay attention if someone says, “‘Gee, Mom seems more argumentative or withdrawn than the last time I saw her,’” Dr. Dale advised.

If the tone or severity of the marital tensions seem new, then it is important to find out why. The causes could be mental or physical, doctors say.

On the mental front, increased anger and fighting could be one of the first signs of mild cognitive impairment, a precursor of dementia or Alzheimer’s, in one or both of the spouses, said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program and an associate professor in the department of psychiatry and behavioral sciences.

Dr. Dale concurs: “There is good evidence that the earliest signs of cognitive impairment are often emotional changes” — anger, anxiety, depression — “rather than cognitive ones” — memory, abstract thought.

But these early signs of cognitive decline can be so subtle that neither the spouses themselves, or their grown children, recognize them for what they are, Dr. Gwyther said. So husband and wife blame each other for the changes and allow feelings of hurt and resentment to grow.

Withdrawing from activities that used to give them pleasure can be a telltale sign of mild cognitive impairment – and can trigger anger and arguments.

“In one couple, the husband just didn’t want to participate in the holidays — the wife got angry and said he was being lazy and stubborn,” said Dr. Gwyther. But the truth was that his cognitive decline made all the activity overwhelming, and he didn’t want anyone to know that he was anxious about not remembering everyone’s names and embarrassing himself.

Suspicion and paranoia can also accompany mild cognitive decline and precipitate distrust and hurtful accusations. Dr. Gwyther recalled another woman who “called her daughter frantic because she said her husband dropped her at her chemo appointment, went to park the car, and didn’t return to get her.” The woman couldn’t imagine that her husband could possibly have lost his sense of time and direction, Dr. Gwyther added. She took it personally, complaining to her daughter that “your father doesn’t seem to care any more.”

Dr. Dale told of a spouse who accused her mate of infidelity because “she was convinced that when he was out grocery shopping he was really having an affair.”

Hoarding, an early symptom of mild cognitive impairment, can also create tension in a marriage. (For new treatments, see this recent post by my colleague Paula Span.)

When one couple came to a counseling session with Dr. Norman Abeles, emeritus professor of psychology and former director of psychological clinic at Michigan State University, the hoarding spouse finally said she did it because she thought that they would run out of money, “even though there was enough money to go around.” Dr. Abeles said that incident led to her diagnosis of mild cognitive impairment.

Adding to the confusion, mild cognitive impairment, or M.C.I., comes and goes. “There are good days and bad days, good hours and bad hours,” said Dr. Gwyther. “Alzheimer’s and dementia don’t start on Tuesday — it’s a slow insidious onset.” But the diagnosis is becoming more common: The Institute for Dementia Research and Prevention predicts that 1 in 6 women, and 1 in 10 men, who live past the age of 55 will develop dementia in their lifetime.

“Spouses find it difficult to know when their partner with M.C.I. is acting differently, usually badly, due to the advancing illness or due to ‘willful’ personality issues,” said Dr. Dale, citing a 2007 study in the journal Family Relations exploring the problems this can create for couples.

Blaming is often easier than understanding. Another of Dr. Gwyther’s patients was furious at her husband for not filing their taxes. “He’s a C.P.A.,” she said. “How could we owe back taxes?” It did not occur to her that he might be unable to handle that task — and was too frightened about his deteriorating mental focus to let her know.

But as harmful as mental decline can be for a marriage, it is just part of the equation. Physical ailments – even those that seem completely unrelated to marital relations – “can upset the equilibrium of the marriage,” according to a study in The Canadian Medical Association Journal.

“Most men get angry at what’s happened to them when they get ill, women get angry and scared when he’s not what he used to be — so they fight,” said Dr. Schlossberg.

Chronic illnesses, like diabetes, arthritis and heart disease, can have a strong negative effect on mood, said Dr. Waite, who will soon be publishing a study on the subject. Diabetes is so often accompanied by depression that Dr. Waite said “one of my colleagues argues that that it is even part of the disease.”

And ailments can have an effect on a couple’s sex life — which can compound the marital problems, doctors said.

“Diabetes brings on neuropathy,” said Dr. Waite. “That means touching and feeling in sex is not as rewarding.” Without the pleasures of affectionate touching — whether a passing hug at the sink or more — tensions can build. That’s why, if a couple is having problems with sex, they are more likely to have problems in the relationship — and vice versa, according to a 2007 New England Journal of Medicine study of sex and health among older adults.

Other changes in circumstances — retirement, shifting roles, the loss of autonomy, disparities in health and abilities — can wreak havoc. Losing independence can feel like losing oneself — and if you don’t know who you are any more, how can you know how to relate to your spouse?

“Fighting may come from a misguided notion that you can regain power by asserting it over your spouse,” said Dr. Schlossberg, whose observations are echoed in a 1984 study in The Canadian Journal of Medicine. “It doesn’t work, it’s false power – but they’ll try anything.”

The sheer exhaustion that can come from being the caregiving spouse is also bound to “make them stressed and angry,” said Dr. Waite. Not to mention guilty and resentful — never a prescription for happy marital relations.

“Part of the trap for the caregiver is the idea that you have to do it all, and the guilt you feel when you cannot live up to it,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc. Not surprisingly, resentment can soon follow, Dr. Herz added, because it is hard to admit to anyone that, “‘this is too much for me.’”

What can outside caregivers — children or other loved ones — do about these golden marriages on the rocks? Should they intervene — or butt out? And can marital therapy help — or is it too late to change?

Share your thoughts and experiences — and on Tuesday we will try to provide some advice from experts.

Read More..

La Comay of ‘SuperXclusivo’ Stirs Anger Over Comments on Man’s Death

It’s been a bad few months for puppets in the media.

WAPA-TV

La Comay, left, with Hector Travieso, co-hosts of “SuperXclusivo,” a Spanish-language program shown in some United States markets.

WAPA-TV

Jose E. Ramos, president of WAPA Television, said the network tried to use La Comay to keep the officials attuned to issues.

In October, Big Bird was dragged into the presidential debate over PBS funds and in November, Kevin Clash, the puppeteer behind Elmo, left Sesame Street after allegations that he had sex with minors.

The latest puppet scandal involves a gossipy, big-haired crone puppet in Puerto Rico, known as La Comay, who has become one of the most controversial media figures on the island — and one of the most watched. On a recent show, the puppet commented on the murder of a 32-year-old publicist by pointing out that the victim was in an area frequented by prostitutes and wondered whether he was “asking for this.”

The reaction was swift. A Facebook page calling for a boycott of La Comay has drawn more than 72,000 signatures, and prominent advertisers like Walmart and AT&T withdrew their ads from “SuperXclusivo,” the program that features her.

The outrage was in part because of fears over a growing crime wave on the island and a reaction to La Comay, a puppet version of the television program “TMZ” with gossipy segments about celebrities, politics and crime.

La Comay (roughly translated as “the godmother”) was created by Antulio Kobbo Santarrosa, a former comedian and television personality. Since 1999 the show has been broadcast on WAPA Television, an independent Puerto Rican network owned by the private equity firm InterMedia. Before WAPA, Mr. Santarrosa had shows with similar characters on other networks including Telemundo.

“SuperXclusivo” is broadcast on the island but also on the mainland in states with large Puerto Rican populations like New York and Florida. On the hourlong show, La Comay frequently asks viewers to call her show with crime tips, which producers investigate. “We tried to use her to bring out issues that other mediums would not touch,” said Jose E. Ramos, the president of WAPA.

In the last Puerto Rican race for governor, two of the candidates visited the show the night before the election, Mr. Ramos said. “People will report incidents and things that happen on the island to La Comay instead of going to the police and going to the newspapers,” he said.

“She ensures that the police and the government cover the main issues and are on top of the issues, and she does it in a way that is very entertaining, that’s what offends some people,” Mr. Ramos said.

In an e-mail, Mr. Santarrosa said: “We respect our audience and it was never my intention to offend anyone with the information we presented, which had already been presented in other media.” The comments were similar to the ones made by La Comay on her show in the days after the controversy where she tried to apologize to the audience.

The uproar began when, on Dec. 4, “SuperXclusivo” featured a segment on the publicist José Enrique Gómez Saladín, whose disappearance had been extensively covered by local media. On Nov. 29, according to published reports, Mr. Gomez Saladín attended a meeting in San Juan and then called his wife to tell her he was on his way home.

Instead, Mr. Gomez Saladín’s body was found four days later. He had been doused with gasoline, burned and then bludgeoned to death. The case is being handled by the United States Attorney’s Office in Puerto Rico. Four people were arrested on Dec. 4 in connection with the crime. They have been charged on two counts, carjacking resulting in murder and bank fraud. A preliminary hearing is set for Wednesday. The crime, which came less than two weeks after the shooting death of the boxer Hector Camacho, rattled the island.

After the news of the murder, residents began a social media protest for peace called “Todos Somos José Enrique” (We are all José Enrique).

Details of what happened that night remain unclear, with some reports saying Mr. Gomez Saladín had been a victim of a carjacking. But in her Dec. 4 segment, La Comay raised another issue: Mr. Gomez Saladín was on Padial Street in Caguas, a town near San Juan. The street, La Comay said, is “a center of male and female prostitution.”

Couching her statements with the phrase “apparently and allegedly,” La Comay asked, “Was this man, José Enrique, asking for this?” Of the four suspects in the case she asked, “Was he friends with these people? Did he used to be a client of these people?” At the end of her remarks she called for Puerto Rico to reinstate the death penalty.

The remarks created protests against the puppet, her show and the network.

“We didn’t know that this was going to explode the way it did,” said Carlos Rivera, an unemployed I.T. specialist from Puerto Rico who created the Facebook page calling for the boycott of La Comay by advertisers and viewers.

Mr. Ramos of WAPA said the boycotts have not hurt the show’s ratings. “If anything they have increased,” he said. “People want to see what’s going on.”

Read More..

Egypt Votes on Constitution; Muslim Brotherhood Expects Approval

Lynsey Addario for The New York Times

A polling site in Cairo on Saturday. Lines were long as a referendum on an Islamist-backed charter got off to an orderly start. More Photos »

CAIRO — Millions of Egyptians voted peacefully on Saturday in a referendum on an Islamist-backed draft constitution, hoping that the results would end three weeks of violence, division and distrust between the Islamists and their opponents over the ground rules of Egypt’s promised democracy.

The Muslim Brotherhood, the main Islamist group aligned with President Mohamed Morsi, predicted a big win for ratification. In the districts that voted Saturday, including the opposition strongholds of Cairo and Alexandria, about 57 percent of voters approved the new constitution, according to preliminary tallies by state news media early Sunday morning.

Half of the country will vote next Saturday, in predominantly rural areas that are expected to heavily favor the charter. The relatively narrow margin of victory for the charter so far, combined with low turnout — 33 percent, according to the unofficial tallies, down from 41 percent in a referendum on a temporary constitution last year — seemed likely to embolden the non-Islamist opposition that has called for Mr. Morsi to scrap the charter and convene a new constitutional assembly.

A spokesman for the main coalition opposing the charter said that it had found widespread irregularities in voting and that its leaders would speak later on Sunday. In Cairo, the biggest city, about 56 percent voted no, according to an unofficial tally by the Muslim Brotherhood.

Regardless of the results, the orderly balloting and long lines marked yet another turning point for Egypt’s nearly two-year-old revolution. After three weeks of clashes and threats of a boycott, millions of voters appeared for the moment to pull back from the brink of civil discord and reaffirm their trust in the ballot box, spending hours in long lines to vote in the sixth national election since the ouster of Hosni Mubarak 22 months ago.

It remained to be seen if the losing side would accept the results, or how long the peace might last. Many who voted yes said they were doing so to end the chaos of the transition rather than to endorse the text of the charter. Despite opposition warnings of chaos, the streets of the capital were free of major protests for the first time in weeks.

And if the constitution is approved by the margins his supporters predict, the smooth vote could fortify Mr. Morsi’s power and legitimacy.

Military officers guarded polling places, and there were few reports of violence. Egyptian state media reported nine injuries in clashes around the Nile Delta town of Dakahleya, and that unknown assailants threw Molotov cocktails near the headquarters of a liberal party that had been part of the opposition under Mr. Mubarak.

As they waited in line to vote, neighbors continued to spar over the contentious process that produced the charter. Some said that it had been unfairly steamrolled by Egypt’s new Islamist leaders over the objections of other parties and the Coptic Christian Church, and that as a result the new charter failed to protect fundamental rights.

Others blamed the Islamists’ opponents for refusing to negotiate, in an effort to undermine democracy because they could not win at the ballot box. Many expressed discontent with political leaders on both sides.

“Neither group can accept its opposition,” said Ahmed Ibrahim, 40, a government clerk waiting to vote in a middle-class neighborhood in the Nasr City area of Cairo. Whatever the outcome, he said, “one group in their hearts will feel wronged, and the other group will gloat over their victory, and so the wounds will remain.”

The referendum once promised to be a day when Egyptians realized the visions of democracy, pluralism and national unity that defined the 18-day revolt against Mr. Mubarak. But then came nearly two years of chaotic political transition in which Islamists, liberals, leftists, the military and the courts all jockeyed for power over an ever-shifting timetable.

The document that Egyptians voted on was a rushed revision of the old Mubarak charter, pushed through an Islamist-dominated assembly in an all-night session, after Christian and secular representatives quit in protest. Many international experts faulted the charter as a missed opportunity, stuffed with broad statements about Egyptian identity but riddled with loopholes regarding the protection of rights.

Mayy El Sheikh and Mai Ayyad contributed reporting.

Read More..

Bobby Kotick of Activision, Drawing Praise and Wrath

J. Emilio Flores for The New York Times

Bobby Kotick, chief executive of Activision Blizzard, with images of characters from the Skylanders series, one of the company’s successful franchises.

PEOPLE who love video games love to hate Bobby Kotick.

Mr. Kotick, the C.E.O. of Activision Blizzard, the world’s largest video game publisher, inspired a stocky, auburn-haired character named Money Sack, who, in a game created by a competitor and a former employee, wields a wide grin and an automatic weapon. In another video, Mr. Kotick pops up from behind a fortified wall, and in a husky, ominous voice says he’ll set the price of his biggest game, Call of Duty, to “your soul” — a dig at its cost. Then fiery lasers shoot out of his eyes, wreaking havoc on an apocalyptic fantasy world. In several online photographs he is depicted as the Devil, with red horns against a Hades-like background.

On this particular Sunday, it’s those Photoshopped horns that really irk Mr. Kotick. He is seated at a corner table in the cavernous breakfast room of the Pierre hotel, across the street from Central Park, shaking a leg nervously and whispering in a conspiratorial hush.

“Think about what it’s like for my dating life when the first picture that comes up is me as the Devil,” says Mr. Kotick, who is recently divorced. “You see all this chatter and you realize that they game the search results. These super-sophisticated 19-year-olds are smarter than our expensive P.R. firm.” (His publicist, Steven Rubenstein, shrugs sheepishly.)

Mr. Kotick, 49, has reason to be annoyed. Not since the music industry’s heyday has there been a business with such a wide disparity between the popularity of its products and its customers’ perception of the chief executive who made those products possible. Video games are among the most successful segments in the entertainment industry, and the disdain heaped on Mr. Kotick in video game blogs is second only to the admiration for him on Wall Street.

He bought the company that is now Activision in 1990, when it was nearly bankrupt and when analysts dismissed video games as fads. But in his 22 years as C.E.O. he has built Activision into a company with a stock market value of $12.7 billion, almost three times that of its top rival, Electronic Arts.

Mr. Kotick isn’t the most technology-driven executive. (He still prefers a BlackBerry.) And he doesn’t get into the weeds of creative storytelling; he leaves that to the studios Activision has acquired. But like David Geffen, who never played a musical instrument well but signed Bob Dylan, Joni Mitchell and the Eagles, Mr. Kotick has a knack for identifying hit after blockbuster hit. He wakes up each day thinking about those hits — some would say obsessing about them — and how Activision can lavish games like Call of Duty, Diablo and World of Warcraft with ever more bells and whistles to keep customers happy and ensure that the next release is a big success, too.

The latest edition of Activision’s biggest game, the shoot’em-up megahit Call of Duty: Black Ops II, was released Nov. 13 and had sales of $500 million in its first 24 hours and more than $1 billion in the first 15 days. That fell short of some analysts’ expectations but was nevertheless more than the total domestic box-office revenue of “Avatar,” the highest-grossing movie of all time.

BUT expensive, immersive games now face a challenge as free online games from companies like Zynga and Rovio compete for users’ attention. Retail sales of video games in the United States totaled $7.5 billion from January to October, down 26 percent from the same period in 2011, according to the NPD Group.

In response, Activision is doubling down on a handful of games with high margins. The strategy is to have customers pay $60 or more to traverse for hundreds of hours through story lines with orchestral soundtracks and realistic, hologram-like heroes and heroines. With each new version “we need more resources, more time, and our development schedule has to get longer,” Mr. Kotick says. “How do you make the games better each year?”

Developers of Call of Duty took the risky step of bringing the mostly historical war series into the not-so-distant future of 2025. David S. Goyer, co-writer of the story for “The Dark Knight Rises,” was a co-writer on the story for the latest Call of Duty. Trent Reznor, the Nine Inch Nails singer who won an Oscar for the soundtrack of “The Social Network,” did the theme song. Oliver L. North served as an adviser for the game, which features a virtual David H. Petraeus, the former Central Intelligence Agency director.

The Activision strategy relies heavily on the holiday season. “This is a nail-biting time for us,” said Brian G. Kelly, Mr. Kotick’s longtime business partner, who is co-chairman of the Activision Blizzard board.

In the three months ended Sept. 30, Activision exceeded analysts’ expectations and increased its earnings by 53 percent, to $226 million, or 20 cents a share, even as video game console sales declined slightly.

Read More..