Excerpts from Must Read Books & Articles on Mental Health Topics
Articles- Part XXXVII

Me and My Girls
David Carr, New York Times Magazine- 7/20/2008

Where does a junkie’s time go? Mostly in 15-minute increments, like a bug-eyed Tarzan, swinging from hit to hit. For months on end in 1988, I sat inside a house in north Minneapolis, doing coke and listening to Tracy Chapman’s “Fast Car” and finding my own pathetic resonance in the lyrics. “Any place is better,” she sang. “Starting from zero, got nothing to lose.”
      After shooting or smoking a large dose, there would be the tweaking and a vigil at the front window, pulling up the corner of the blinds to look for the squads I was always convinced were on their way. All day. All night. A frantic kind of boring. End-stage addiction is mostly about waiting for the police, or someone, to come and bury you in your shame.
     After a while I noticed that the blinds on the upper duplex kitty-corner from the house were doing the same thing. The light would leak through a corner and disappear. I began to think of the rise and fall of their blinds and mine as a kind of Morse code, sent back and forth across the street in winking increments that said the same thing over and over. W-e a-r-e g-e-t-t-i-n-g h-i-g-h t-o-o. They rarely came out, and neither did I, so we never discussed our shared hobby.
     I was lonely, but not alone. The house belonged to Anna, my girlfriend and dope dealer, who had two kids of her own and newborn twins by me. One night, Anna was out somewhere, and I was there with the kids. I had a new pipe, clean screens, a fresh blowtorch and the kids were asleep. It was just me and Barley, a corgi mix I’d had since college. When I was alone and tweaking with Barley, I’d ask her random questions. Barley didn’t talk back per se, but I heard answers staring into her large brown eyes. Am I a lunatic? Yes. When am I going to cut this stuff out? Apparently never. Does God see me right now? Yes. God sees everything, including the blind.
Trapped in drug-induced paranoia, I began to think of the police as God’s emissaries, arriving not to seek vengeance but a cease-fire, a truce that would put me up against a wall of well-deserved consequences, and the noncombatants, the children, out of harm’s way. On this night — it was near the end — every hit sent out an alarm along my vibrating synapses. If the cops were coming — Any. Minute. Now. — I should be sitting out in front of the house. That way I could tell them that yes, there were drugs and paraphernalia in the house, but no guns. And there were four blameless children. They could put the bracelets on me, and, head bowed, I would solemnly lead them to the drugs, to the needles, to the pipes, to what was left of the money. And then some sweet-faced matrons would magically appear and scoop up those babies and take them to that safe, happy place. I had it all planned out.
     I took another hit, and Barley and I walked out and sat on the steps. My eyes, my heart, the veins in my forehead, pulsed against the stillness of the night. And then they came. Six unmarked cars riding in formation with lights off, no cherries, just like I pictured. It’s on. A mix of uniforms and plainclothes got out, and in the weak light of the street, I could see long guns held at 45-degree angles. I was oddly proud that I was on the steps, that I now stood between my children and the dark fruits of the life I had chosen. I had made the right move after endless wrong ones. And then they turned and went to the house across the street.
     Much yelling. “Facedown! Hug the carpet! No sudden movements!” A guy dropped out of the second-floor window in just gym shorts, but they were waiting. More yelling and then quiet. I went back inside the house and watched the rest of it play out through the corner of the blind. Their work done, the cops loaded several cuffed people into a van. I let go of the blind and got back down to business. It wasn’t my turn.
     Twenty years later, now sober and back for a look at my past, I sat outside that house on Oliver Avenue on a hot summer day in a rental car, staring long and hard to make sense of what had and had not happened there. The neighborhood had turned over from white to black, but it was pretty much the same. Nice lawns, lots of kids, no evidence of the mayhem that had gone on inside. Sitting there in a suit with a nice job in a city far away and those twins on their way to college, I almost would have thought I’d made it up. But I don’t think I did. While I sat there giving my past the once over, someone lifted up the corner of the blind in the living-room window. It was time to go.

On the face of it, I am no
more qualified to take my own inventory than the addict with the fetid dreads who spare-changes people on the subway while singing “Stand by Me.” Ask him how he ended up sweating people for quarters, and he may have an answer, but he doesn’t really know and probably couldn’t bear it if he did.
     To be an addict is to be something of a cognitive acrobat. You spread versions of yourself around, giving each person the truth he or she needs — you need, actually — to keep them at a remove. Let’s stipulate that I do not have a good memory, having recklessly sautéed my brain in fistfuls of pharmaceutical spices. Beyond impairment, there may be no more unreliable narrator than an addict. Recovered or not, I am someone who used my mouth to constantly create one more opportunity to get high.
     Here is what I deserved: hepatitis C, federal prison time, H.I.V., a cold park bench, an early, addled death. Here is what I got: the smart, pretty wife, the three lovely children, the job that impresses. Here is what I remember about how That Guy became This Guy: not much. But my version of events is worth knowing, if for no other reason than I was there.
     I was born a middle kid in a family of seven children into a John Cheever novel set on the border of Hopkins and Minnetonka, suburbs on the western edge of Minneapolis. It was a suburban idyll where any mayhem was hidden in the rear rooms of large split-level houses. My home was a good one; my parents were kind; no one slipped me a Mickey, and if they had, I would have grabbed it with both hands and asked for another. It is baked into my nature.
     Let’s skip high school. I graduated and traveled out West, hopping a bus of the so-called Rainbow Family, and on the ensuing ride, they gifted me with peyote, a profound sense of life’s psychedelic possibilities and a tenacious case of the crabs. I came back to Minneapolis and took crummy jobs, including working at a hydraulic-tube assembly plant where my boss was a dwarf who took Dolly Parton’s breasts as his central religious icons. I eventually enrolled in two land-grant universities where I had many friends, very little money and what Pavlov called “the blind force of the subcortex.” I subsisted on Pop-Tarts and Mountain Dew, along with LSD, peyote, pot, mushrooms, mescaline, amphetamines, quaaludes, valium, opium, hash and liquor of all kinds. Total garbage head.
     On my 21st birthday, a dealer who dropped his money on Dom Pérignon at the fancy restaurant where I worked palmed me a cigarette tin and told me to open it in the bathroom. I did the powder inside and it was a Helen Keller hand-under-the-water moment. Lordy, I can finally see! My endorphins made a Proustian leap at this new opportunity, hugging it and feeling all its splendid corners. Every addict is formed in the crucible of the memory of that first hit. Even as the available endorphins attenuate, the memory is right there. By 1985, I tried freebasing coke and its more prosaic sibling, crack.
     “Crackhead” is an embarrassing line item to have on a résumé. If meth tweakers had not come along and made a grab for the crown — meth makes you crazy and toothless — crackheads would be at the bottom of the junkie org chart. In the beginning, smokable cocaine fills you with childlike wonder, a feeling that the carnival had come to town and chosen your cranium as the venue for its next show. There is only one thing that appeals after a hit of crack, and it is not a brisk walk around the block to clear one’s head. Most people who sample it get a sense of its lurid ambush and walk away.
     Many years later, my pal Donald sat in a cabin in Newport, Minn., staring into a video camera I had brought and recalling the crackhead version of me. “As good friends as we were, as much as I loved you, you weren’t you. I wasn’t talking to my friend David; I was talking to a wild man. You were a creature. I was afraid.”
     If the subject of careers or majors came up, I told people I was a journalist, with only that uttered noun as evidence. But then I caught a real, actual story for the local weekly and the fever to go with it. I was a dog on a meat bone when it came to stories; I could type — and sometimes write — as fast as the next guy, and I had an insatiable need to know more. My work got noticed, and some of the more unfortunate aspects of the guy who produced it were overlooked. I got jobs, nailed investigative targets and won a few awards.
     During the day, I took the slipperiness of public officials personally — my moral dudgeon is freighted with irony in retrospect — and displayed significant promise as a reporter. But as time wore on, I combined a life of early promise as a writer with dark nights full of half-baked gangsters and full-blown addiction. I became a dealer for the creative community in Minneapolis, selling coke to colleagues, comedians and club kids. I was a frantic fan of the amazing Minneapolis music scene at the time — Soul Asylum, the Replacements, Prince — but the only thing I played with any regularity was drug-addled fool. I moved grams, eight balls, ounces, quarter pounds — no one trusted me with a kilo for more than a few minutes. Every day I would wake up to a catalog of my misbegotten life — jobs, money, girlfriends and family were all subject to the ineluctable entropy of the junkie lifestyle. There were signs early on that the center would not hold. In the mid-’80s, I was working on a running story about a suspect who had been accidentally shot dead while he was being taken into custody by the police department’s decoy unit. In the middle of the reporting, my phone rang, and one of the cops from the decoy unit was on the line. “You know, I’ve been asking around, and your life is not without blemish,” I remember him saying. “You better watch your step.” For weeks afterward, I would drive somewhere and see the van from the decoy unit in my rearview.
     Some of my running buddies went to prison, but I was more of a misdemeanant, spending hours — and every once in a while, days — in various county jails. I lived by this credo: moderation in all things, especially moderation. My duplicity around women was towering and chronic. I conned and manipulated myself into their beds and then treated them like human jewelry, something to be worn for effect. And when I was called to account, I sometimes responded with violence.
     One night in 1986, I was at a party for Phil, my longtime coke connection who was going away to federal prison. I met Anna, who had better coke than Phil and soon developed a fondness for me. She was selling serious amounts of coke and allowed me to pretend I was her partner. We were an appalling mix, metastasized by her unlimited supply. In less than a year, I lost my job, and she lost her business.
     It would have ended there, but on April 15, 1988, Anna had twin girls. My daughters. Our remaining friends had begged us, quite reasonably, to abort them. Pals began to boycott our house because it had become such a grim, near-scientific tableau of addiction’s progression. Eventually we both went to treatment, and our kids went into foster care. I sobered up; Anna did, too, until she didn’t; and I obtained physical custody of the twins, Erin and Meagan. As a power trio, we worked our way off welfare. I married somebody grand, we had a baby and professionally, one thing led to another, and I ended up working at The New York Times. I have lived most of the last two decades showered by those promises that recovery delivers, with luck, industry and fate guiding me to a life beyond all expectation.

The above text covers the first two pages of this nine page article. For the remainder, visit the archives of the New York Times at www.nytimes.com.

A Question of Resilience
Emily Brazelon, New York Times Magazine- 4/30/2006

In the spring of 1993, when I was an intern at The New Haven Advocate, a local weekly, I met two girls named La'Tanya and Tichelle. La'Tanya was 13, Tichelle was 11 and, along with their two younger sisters, they had recently returned from a year in foster care to live with their mother, Jean. (I have used middle names to protect the family's privacy.) I was supposed to spend an hour or two with them and write an article for the paper about families that reunite. But I liked the girls, and I decided I needed to interview them again — the joy of being an intern, after all, is that no one really cares when you finish your article. The next time I showed up, about a week later, a worried-looking woman was talking to the girls. She was a prosecutor who was about to try Jean's boyfriend, Earl Osborn, for sexually abusing La'Tanya and Tichelle over several years and their 7-year-old sister, Charnelle, for a shorter period. The girls were her chief witnesses.
      At the trial that May in a courtroom in New Haven, La'Tanya testified that Osborn started touching her when she was in kindergarten. She told her mother, and Jean put him out of the house. But somehow, though he wasn't violent, she couldn't make him stay out. She would later say that this was the greatest mistake of her life, but in court, she said as little as possible. During the next five years, Jean warned Osborn to keep away from her daughters. He didn't. When La'Tanya and Tichelle were about 10 and 8, Jean testified, she put a lock on the door of their bedroom. Osborn broke the lock three times. Jean would find him lying on top of the girls, rubbing against them and putting his hands down their pajamas, or next to them masturbating. She gave her daughters a stick to sleep with. But she never banished him from their home.
     In June 1991, after being tipped off that there might be a problem at home, a school social worker pulled La'Tanya out of her sixth-grade graduation party and asked if anyone was bothering her. La'Tanya shook her head no and then started to cry, and to talk. Jean lost custody of La'Tanya, Tichelle, Charnelle and their youngest sister, Chanté. That's when the girls lived in foster care, first with a family and then for several months with their grandmother. Osborn was arrested. In May 1993, on the strength of La'Tanya and Tichelle's testimony, a jury in New Haven convicted him of nine charges of sexual assault. Osborn was sentenced to 85 years in prison. The jury foreman was Jon Butler, a history professor, who is dean of the Yale Graduate School of Arts and Sciences. "The verdict hinged overwhelmingly on the credibility of the girls," he told me recently. "They were so good because they weren't so good. They weren't acting, this wasn't contrived, what happened had been deeply disturbing to them. They conveyed this with the kind of precision that made it completely believable."
     During the summer after the trial, I spent time with the girls, taking them to the playground and the pool. I wrote about them for The Advocate. Then I left, as interns do. I did stay in touch with La'Tanya and Tichelle, because I was worried about them and because I admired them. They took care of each other, and they were resourceful. "They're very appealing kids, and I don't think anyone expected that, considering what they've been up against," Cecilia Wiederhold, the prosecutor, said in my Advocate article.
     As the girls grew up, they kept exceeding my expectations. Study after study has shown that sexually-abused children — especially those who grow up in the sort of low-income, messy surroundings that the girls did — are more likely to develop a raft of emotional and health problems, including depression, post-traumatic stress disorder and suicidal thoughts. As adults, they are more likely to be unemployed, homeless, addicted to drugs or alcohol and alone. Now, at ages 26 and 24 respectively, La'Tanya and Tichelle are none of those things. La'Tanya works as a certified nursing assistant at St. Raphael's Hospital. She has her own apartment in a small town on the Connecticut shore. She is raising her two sons, who are 10 and 5. Tichelle is a computer operator for the city of Bridgeport. She lives with her 1-year-old son in the same apartment complex as La'Tanya. Both sisters graduated from high school and have their own cars.
     By middle-class standards, these accomplishments seem modest. But financial independence and stability are rare and hard-won for anyone in the poor black New Haven neighborhood where the sisters grew up. Jean raised her children on welfare and never learned to drive. La'Tanya and Tichelle's fathers have been almost entirely absent. On the blocks of row houses and vacant lots where they were raised, teenage mothers far outnumber married ones. Over the years, I've wondered what accounts for their relative success. Were La'Tanya and Tichelle different, and if so, why? Weren't their lives supposed to have fallen into chaos? How is it that some children show a certain resilience after experiencing a trauma and others do not?
     The everyday meaning of the word "resilience" extends to anything that bounces back. Estée Lauder makes Resilience Lift Eye Crème and Hanes makes Resilience Pantyhose. But in psychology, resilience has a specific meaning. It's the word for springing back from serious adversity, like abuse, war or natural disasters. You exhibit resilience (as opposed to plain competence) if you cope with terrible misfortune and live a relatively successful life as defined by mental health, success in school or at work or solid relationships. In studies of the long-term effects of physical and sexual child abuse, 20 to 40 percent of victims show few signs of behavioral or mental-health problems. And many of them don't appear damaged later in life. As Ann Masten, a resilience researcher, has written, resilient children have the benefit of "ordinary magic." When it comes to abuse victims, though, this finding is rarely trumpeted, for fear that saying abuse isn't always inevitably harmful is tantamount to saying it's not always bad.
     Over the last several decades, a small group of researchers has tried to understand how a minority of maltreated children exceed expectations. The grandfather of resilience theory is Norman Garmezy, who by the 1960's had begun asking why some children of schizophrenics fared better than others. In the 1970's, Ann Masten joined Garmezy at the University of Minnesota, and the two, along with others, started a project spanning more than two decades. They looked at a child's personality, among other things, imagining resilience as a function of temperament, will or intelligence. While children of average intelligence or above were more likely to exhibit resilience, the researchers noted that good relationships with adults can exert an effect that is as powerful, if not more, in mitigating the effects of adversity.
     In recent years, biological science has proposed a new paradigm. The latest research shows that resilience can best be understood as an interplay between particular genes and environment — GxE, in the lingo of the field. Researchers are discovering that a particular variation of a gene can help promote resilience in the people who have it, acting as a buffer against the ruinous effects of adversity. In the absence of an adverse environment, however, the gene doesn't express itself in this way. It drops out of the psychological picture. "We now have well-replicated findings showing that genes play a major role in influencing people's responses to adverse environments," says Sir Michael Rutter, a leading British psychiatrist and longtime resilience expert. "But the genes don't do anything much on their own."
     Rutter opened a GxE research center because he was frustrated that most psychiatric studies tracked the effects either of genes or of environment rather than looking at them in tandem. Despite a few initial successes, like the discovery of the gene that causes Down syndrome, most searches for genes that fully explain psychiatric outcomes — "the alcoholism gene," "the schizophrenic gene" — have failed. Meanwhile, in the field of medicine, it's increasingly common to consider external factors when studying the effects of genes. "With heart disease and cancer, genetic researchers have always known to include factors like smoking and exercise," says Terrie Moffitt, who is on the faculty of Rutter's research center at the Institute of Psychiatry in London and of the University of Wisconsin. "We wanted to do the same thing for the study of behavior."
     The breakthrough moment for GxE came in 2003, when Moffitt and her husband and co-investigator, Avshalom Caspi, published a paper in Science that discussed the relationship between the gene, 5-HTT, and childhood maltreatment in causing depression. Scientists have determined that 5-HTT is critical for the regulation of serotonin to the brain. Proper regulation of serotonin helps promote well-being and protects against depression in response to trauma or stress. In humans, each 5-HTT gene has two alleles, and each allele occurs in either a short or a long version. Scientists are still figuring out how the short allele affects serotonin delivery, but it seems that people with at least one short 5-HTT allele are more prone to depression. And since depression is associated with unemployment, struggling relationships, poor health and substance abuse, the short allele could contribute to a life going awry.
     About one-third of the white population have two copies of the protective long allele. About one-half have one long allele and one short one. And about 17 percent have two short alleles. (African-Americans are less likely to have a short allele; Asians are more likely.) In their 2003 study, Caspi and Moffitt looked at 847 New Zealand adults and found a link between having at least one short 5-HTT allele and elevated rates of depression for people who had been mistreated as children or experienced several "life stresses" — defined as major setbacks with jobs, housing, relationships, health and money. Having two short alleles made it highly likely that people who had been mistreated or exposed to unhinging stress would suffer depression. One short allele posed a moderate risk of depression in these circumstances. Two long alleles, on the other hand, gave their carriers a good chance of bouncing back under negative circumstances. In other words, as a group, children with two risky alleles lost out badly when their environments failed them, children with one risky allele were at some risk and children with good resilience alleles often carried a shield. The risky variation of the gene doesn't confer vulnerability, though, if an individual who carries it never experiences abuse or serious stress — in other words, it's not a "depression gene" in any general sense. It seems that only under dire circumstances — abuse, the strife of war, chronic stress — is the gene triggered. Eventually scientists hope to understand more about other genes that most likely play a role like 5-HTT's.

The above text covers the first two pages of this six page article. For the remainder, visit the archives of the New York Times at www.nytimes.com.