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Room for Debate: Trick-or-Treating for a Purpose

Written By Unknown on Jumat, 31 Oktober 2014 | 13.26

  • Andy Hinds

    The Beauty of Going Local

    Andy Hinds, blogger

    When families do Commuter Halloween, they miss a great opportunity for community bonding.

  • Sarah Werthan Buttenwieser

    Come Trick-or-Treat at My Big House

    Sarah Werthan Buttenwieser, blogger

    On Halloween, big houses should give plenty of candy to all trick-or-treat goers, no matter how old they are or where they live.

  • Nick Rogers

    A Give-and-Take Tradition

    Nick Rogers, historian

    The original threshold encounter on the eve of All Saints was for poor people to come to the door to pray for the recently departed in return for victuals and ale.

  • Imani Perry

    Halloween Can Build a Bridge Across Communities

    Imani Perry, Princeton University

    Children, if no one else, ought to have an opportunity to cross the tracks.

  • Samira Kawash

    The Problem with Candy Mania

    Samira Kawash, author, "Candy: A Century of Panic and Pleasure"

    Kids need to have more freedom to explore and make mistakes, more room to roam unsupervised and maybe even get in trouble.

  • Karen Karbo

    Let Halloween Be the Weird Holiday That It Is

    Karen Karbo, novelist and memoirist

    Trick-or-treat is basically a celebration of extortion and I see no reason to rehabilitate it into a noble community event.


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    Opinionator | The Stone: Dreamboat Vampires and Zombie Capitalists

    Written By Unknown on Senin, 27 Oktober 2014 | 13.26

    Photo Alexander Skarsgard, who played the vampire Eric Northman in "True Blood," left, and a zombie from "The Walking Dead."Credit Left, Lacey Terrell/HBO; Greg Nicotero/AMC

    If popularity on television and movie screens is any indication, a good number of the costumed ghouls knocking on our doors this October 31 will be the modern West's two preferred trespassers from the afterlife — vampires and zombies. At first blush, these nightmarish cousins couldn't be further apart. Vampires — which have been with us in their current form at least since the Industrial Revolution — are fast, sexy, cunning and imperishable. They are sleek nocturnal hunters, and even in the violence of the kill they can be depicted as elegant, like great cats. Zombies — not the Afro-Caribbean variety, controlled by a shaman, but the mindless, flesh-eating dead injected into American popular culture by the filmmaker George Romero with his 1968 film, "Night of the Living Dead" — are most often the opposite: slow, mindless, shambling, putrid excrescences in a state of perpetual decay. Vampires represent a kind of higher place on the food chain — one could at least imagine wanting to become a vampire; the current vogue of carnival-like zombie walks notwithstanding, we can safely assume that no one would want to become a zombie.

    The Stone is a forum for contemporary philosophers and other thinkers on issues both timely and timeless.

    Nevertheless, beyond their obvious differences lies a common core, one that stems from a universal ambivalence that humans, condemned to know they will die, share toward what Shakespeare called "the dark backward and abysm of time." On the one hand, the dead, while dear to us, lose their human aspect and in their physical existence take on the repulsive quality of decay; on the other, we yearn for and project something eternal, unchanging, an animate presence that we refuse to surrender to the degeneration of time.

    That humans live simultaneously real, physical lives and symbolic, meaningful existences means that they must die not once, but twice. As the French psychoanalyst Jacques Lacan wrote, it is possible in the human imagination for these two deaths, one symbolic and one real, to not entirely coincide. In such cases we enter a peculiar state, one he called "entre deux morts" — or between two deaths.

    Those whose symbolic selves die while their bodies still live attain a kind of extra-worldly beauty. Lacan identified Sophocles' great character Antigone with this state — condemned to death by Creon for having defied the state's law by burying her treasonous brother, she burns with a righteous splendor that puts to shame Creon's pathetic attachment to the state's laws.

    Those whose bodies die while their symbolic selves linger constitute an entirely different breed. Chained by a law or obligation to an animate state their bodies can no longer support, such beings become monstrous specters, condemned to walk the earth as embodiments of some insatiable hunger.

    It is not too difficult to see in these two archetypes our modern vampires and zombies, the former "radiating a sublime beauty," in Lacan's words, the latter monstrous excrescences driven on by a fundamental imbalance in the world of men.

    The image of the uncannily beautiful vampire has become familiar enough to cross over into teenage fantasies, starting with the popular TV show "Buffy the Vampire Slayer," and continuing with the hit series "The Vampire Diaries" and the "Twilight" book and movie phenomenon. In these, as well as in adult-oriented novels, movies and TV series — such as Anne Rice's "The Vampire Chronicles" and their film adaptations, and the series "True Blood" and "Dracula" — vampires and humans are sometimes difficult to distinguish from one another. Vampires are often "humanized" in these pop culture blockbusters. In the case of "True Blood," it's more the case that humanity is "vampirized"; that is, humans are represented as vampire-like monsters just as likely to prey on the vampires as the vampires are to prey on them.

    "True Blood" goes furthest in projecting a fantasy world in which vampires and humans may coexist, thanks in part to the mass-production of a synthetic blood substitute for vampire consumption. The availability of this nutritional product allows some vampires to "come out of the casket." Indeed, the show makes no attempt to hide that it is in part an allegory of conservative entrenchment in the face of the liberalization of sexual morality and the mainstreaming of gay life. As the billboard featured prominently in the credit sequence screams, "God hates fangs."

    Related
    More From The Stone

    Read previous contributions to this series.

    It is hardly surprising that vampires continue to evolve in ways that mirror psychosexual anxieties. As children of the romantic age of horror, they are bound to the compulsive cycle of sin and punishment that is characteristic of the tradition of gothic horror. Yet there is another dimension of the repressed that has marked the figure of the modern vampire since its Victorian incarnation in Bram Stoker's "Dracula": namely the economic repressed that Karl Marx remarked upon when he spoke of the monstrous face of capitalism as a vampire-like machine, "a circulating thing which gains its energy only by preying upon 'living labor.'"

    In fact, the Marxist identification of the vampire with the predatory practices of capital has proved to be as enduring as the undead monster himself. Among recent literary offerings, Seth Grahame-Smith takes the association of the vampire with blood-draining sociopolitical practices in the direction of traditional slavery in "Abraham Lincoln, Vampire Hunter" (2010), while Guillermo del Toro and Chuck Hogan refocus the lens to reveal the vampire monster in the figure of the cunning capitalist in the "Strain" trilogy and its TV spinoff. Remarkably, "The Strain" features "blood factories" dedicated to the "efficient extraction and packaging of human blood."

    While the vampire continues to haunt our modern imagination, it may fall to its less attractive brethren to claim the title of the perfect monster for the age of globalization, sometimes called the age of the post-human. In effect, the anonymous zombie crowds pack into one moving bundle everything monstrous and terrifying about a global economic machine that leaves nothing but lifeless bodies and undead remnants in its wake. In late capitalism, the German philosopher Niklas Luhmann once wrote, the scandal is not class exploitation but the uncountable masses of people who are born not even to be exploited, but just to die:

    If we look at the huge masses of starving people, deprived of all necessities for a decent human life, without access to any of the function systems, or if we consider all the human bodies, struggling to survive the next day, neither "exploitation" nor "suppression" — terms that refer… to stratification — are adequate descriptions. It is only by habit and by ideological distortion that we use these terms. But there is nothing to exploit in the favelas.

    "Human debris," Rush Limbaugh sneered at the Occupy Wall Street protesters, by which he meant to imply that they were simply unemployed; like zombies, they were bodies without a purpose.

    If the modern vampire may have functioned as an apt metaphor for the predatory practices of capital in colonial and post-colonial societies, today's zombie hordes may best express our anxieties about capitalism's apparently inevitable byproducts: the legions of mindless, soulless consumers who sustain its endless production, and the masses of "human debris" who are left to survive the ravages of its poisoned waste.

    Perhaps our fixation with images of the zombie apocalypse is ultimately tied to the conviction that there is no possible alternative to capitalism as a worldwide economic system, paired with the realization that the logical evolution of global capitalism leads to nothing but destruction. As the philosopher Slavoj Zizek has said of our love of films depicting cataclysms of Earth-threatening proportions, we have come to a time when "it's much easier to imagine the end of all life on Earth than a much more modest radical change in capitalism."

    So as the vampires and zombies creep out of our screens and up to our doorsteps on Halloween night, we should recall what one survivor says to the others in Romero's "Dawn of the Dead," as they stare out in terror at the advancing zombie hordes approaching the shopping mall where they have taken refuge: "They are us!"

    David Castillo is a professor and chairman of romance languages and literatures at the State University of New York at Buffalo. William Egginton is the Andrew W. Mellon Professor in the Humanities at the Johns Hopkins University. They are currently writing a book on the media and the crisis of reality.


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    Room for Debate: Keeping Up Appearances

    Written By Unknown on Kamis, 23 Oktober 2014 | 13.26

    Many thought Renee Zellweger was unrecognizable when she appeared at an event on Monday night. She's attributed her transformation to "living a different, happy, more fulfilling life." But others saw evidence of plastic surgery — the kind Joan Rivers frequently joked about — and questioned the drive for eternal youth.

    Has the use of plastic surgery gone too far? What does it mean (or take) to age gracefully, especially in the public eye?

    Read the Discussion »
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    Opinionator | The Conversation: What Would Edmund Burke Say?

    Written By Unknown on Rabu, 22 Oktober 2014 | 13.26

    In The Conversation, David Brooks and Gail Collins talk between columns every Wednesday.

    David Brooks: Gail, as you know I have a policy of teaching at colleges I couldn't have gotten into, and as a result I find myself teaching at Yale.

    Gail Collins: I didn't go to Yale either. But I spent the '70s living in New Haven. Does that count for anything?

    David: I just got out of a class in which we discussed Edmund Burke's "Reflections on the Revolution in France." As you may know, this book changed my life. I began reading it as a big lefty and I loathed Burke. But over the years, I came to see wisdom in it. Have there been big books like that for you, which had a pivotal effect on your thinking?

    Gail: When I was in high school, I decided I needed to read the work of a great mind on the subject of politics. I picked Dwight D. Eisenhower's "Mandate for Change" because at the time I believed that all presidents were deep thinkers.

    Carried that sucker around for six months. Read every page. There wasn't much philosophy, but I did learn that if we lost Vietnam we would forgo an important source of tin.

    I believe this had a crippling effect on my ability to appreciate genuine political philosophy when it was thrust upon me in later life. And I want to say how impressed I am that after reading "Reflections on the Revolution in France" and not liking it, your response was to read it again.

    David: Burke is famous for his belief in gradual change. He didn't believe in revolutionary change because he thought that society was too complicated to be planned through reason and remade according to that plan. My students were divided on this. Some saw wisdom in this modesty, pointing to failed efforts to remake societies, ranging from the war in Iraq to the Russian revolution. Others pointed out that most systems are constructed by those in power for those in power. If you don't have radical change, you just allow entrenched privilege to stay in power forever.

    Did you ever go through a revolutionary phase? Are you still in one?

    Gail: When I was in college and graduate school I hung around with a lot of people who believed that revolution was both necessary and inevitable. That was less because I agreed than because I felt they were much nicer than the folks who believed things were just peachy the way they were.

    David: Burke is known as the founder of conservatism, but his thought sits oddly these days with the Republican Party and those who call themselves conservative. The party has become much more populist, supporting term limits and political outsiders over those who have been educated by experience. Most call for pretty radical change to the welfare state. It's the Democrats who fight to preserve the current structures of Social Security, Medicare and food stamps. It's the Democrats who have been running ads through this election campaign accusing their opponents of being a bunch of wild-eyed radicals. Are Democrats now the conservators of tradition?

    Gail: The difference between the two parties is about empty places versus crowded places. You have heard me say this before – it's my long-standing theory, which takes the place of a political philosophy.

    People who perceive the world as a crowded place believe that government has a very important role to play. They see it in action every day – enforcing the law, directing traffic, removing garbage and providing clean water. They're also likely to witness the inequality of the world and they want government to at least make the divisions less painful.

    The current crop of Republicans, especially the Tea Party types, see the world as an empty place, where people can take care of themselves and government exists only to levy taxes and get in their way. Given the fact that the country is becoming increasingly crowded, I don't think you can define that as a message of change.

    David: I do think Republicans are seen as the party of change this election. My sense is that in state after state, polls are swinging their way. The peculiarities of each candidate matter a bit less and the national tide is mattering a bit more. I'd now guess that the G.O.P. will pick up seven or eight Senate seats. It's just hard to be a Democrat in a red state or a Republican in a blue state. Do you have a different read on the trends?

    Gail: I suspect you may be right about the outcome. The Democrats are in trouble in states where a large number of people either live in empty places or tell themselves they do. There's a lot of delusion in this game – we've all seen the guy who lives on Social Security and depends on Medicare for his visits to the doctor, yelling that he wants government off his back.

    David: I'm not sure either party has an agenda.

    Gail: You don't think announcing that terrorists are infecting themselves with Ebola and crossing the Mexican border is an agenda?

    David: As you know I've been depressed by the vacuousness of the campaign.

    Gail: Me too. Another one of my theories is that politics is at its worst when the country is almost evenly divided and each party thinks it can win if it just avoids saying anything.

    David: But people do believe that things are pretty seriously off track, and so of course they are going to register some protest. Peter Wehner had a piece on the Commentary website that nicely sketched out how much the fundamentals favor the party out of power. It was called "America's Anxious Mood and What It Means for Republicans."

    Wehner pointed to the drop in median household income, the fact that income inequality is nearing its highest levels in 100 years, the fact that the poverty rate has stood at 15 percent for three consecutive years (the first time that has happened since the mid-1960s), the fact that a record number of people are now on food stamps and the fact that only a quarter of people think the country is on the right track.

    I sort of agree that Republican proposals on what to do about all this are less than, er, fully developed, and have not been fully explained. But isn't it an indictment of the Obama administration that it has made so little progress even on, say, reducing the poverty rate?

    Gail: Well, Obama did run on the argument that our biggest problem was too much partisanship in Washington, and that he'd cure that by being less partisan. So I guess you could blame him for the fact that that definitely did not work.

    I give Obama credit for the fact that we've gotten out of the recession, which never would have happened if the Republicans had their way. I guess I blame him for not actually being the kind of great communicator we needed to explain that the keys to reducing inequality lie in more government spending and higher taxes on the wealthy.

    David: Wehner also points out that two-thirds of Americans think it is harder to reach the American dream, and three-quarters think it will be harder for their children and grandchildren to succeed. Of course they're going to favor the party out of power in such conditions.

    Gail: Yes, and we may just keep switching parties without ever resolving anything.

    David: All of this may be reason for some sort of radical change — maybe a Rand Paul type change or an Elizabeth Warren type change.

    Gail: Ah, Rand Paul. What this country needs is a libertarian who believes the government has no right to control anything except women's reproductive systems.

    David: If I was 25 I wonder if I'd be a radical libertarian or even a Marxist on the ground that a country that has been on the wrong track for so long needs a sharp kick in the pants.

    Gail: This is possible. I'd say a 25-year-old who reads a lot of political philosophy is capable of anything.

    David: But I'm sticking to my Burkean roots. Change should be steady, constant and slow. Society has structural problems, but they have to be reformed by working with existing materials, not sweeping them away in a vain hope for instant transformation. My only fear is that if I keep thinking this way I'll end up voting for Hillary Clinton, who will be the most conservative candidate from the party of the status quo.

    Gail: Tee-hee.

    David: That can't be right.

    Gail: No, but I'm sure Hillary will be happy to accept your vote anyway.


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    Room for Debate: Who Needs Football?

    The recent scandal in which a New Jersey high school cancelled its football season after seven varsity players were charged with hazing and sexually assaulting younger players, has led to more scrutiny about football and youth sports.

    Have competitive teenage athletics gotten out of hand? Should high schools eliminate their sports teams?

    Read the Discussion »
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    Opinionator | The Stone: The Reign of ‘Terror’

    Written By Unknown on Senin, 20 Oktober 2014 | 13.26

    The Stone is a forum for contemporary philosophers and other thinkers on issues both timely and timeless.

    When President Barack Obama spoke to the public in September about his decision to use American military force against the Islamic State in Iraq and Syria he used familiar language. ISIS (or ISIL as the White House and others refer to the group), the president said, "is a terrorist organization, pure and simple. And it has no vision other than the slaughter of all who stand in its way." The man picked to manage Obama's strategy, General John R. Allen, wrote in the publication Defense One that "the Islamic State is an entity beyond the pale of humanity and it must be eradicated."

    The powerful rhetoric centered on the word "terrorism" makes it difficult to speak intelligently about its real sources.

    It is undeniable that many of the tactics being used by ISIS — executions of civilians and well publicized beheadings of hostages — do violate accepted standards of conduct in conflict (detailed in an evolving legal and philosophical code known as just war theory.) And understandably, those moved by language of the sort used by the president and his staff are in no mood to consider softer tactics like negotiation with ISIS, nor to ponder the complex causes contributing to its rise. Obama's stated policy of removing the "cancer" threatening the established political order in the Middle East is already underway, and is facing little resistance.

    This is merely the latest example of a powerful rhetoric centered on the word "terrorism" that has shaped — and continues to shape — popular conceptions about contemporary political conflicts, making it difficult to speak intelligently about their real sources.

    If individuals and groups are portrayed as irrational, barbaric, and beyond the pale of negotiation and compromise, as this rhetoric would have it, then asking why they resort to terrorism is viewed as pointless, needlessly accommodating, or, at best, mere pathological curiosity. Those normally inclined to ask "Why?" are in danger of being labeled "soft" on terrorism, while the more militant use the "terrorist" label to blur the distinction between critical examination and appeasement.

    *

    Part of the success of this rhetoric traces to the fact that there is no consensus about the meaning of "terrorism." While it is typically understood to mean politically motivated violence directed against civilians, the Federal Bureau of Investigation and the Department of Defense, for example, describe terrorism as the unlawful use of violence to achieve political goals by coercing governments or societies. The State Department cites a legal definition of "terrorism" as "premeditated, politically motivated violence perpetrated against noncombatant targets by sub-national groups or clandestine agents." It adds: "The term 'noncombatant' is interpreted to include, in addition to civilians, military personnel who at the time of the incident are unarmed or not on duty." Thus, by means of linguistic gerrymander, members of uniformed government military forces acting under government authorization are incapable of committing acts of terrorism no matter how many civilians are ground up in the process.

    When violent political groups like ISIS are labeled as irrational and barbaric, asking why they resort to terrorism becomes pointless.

    Even when a definition is agreed upon, the rhetoric of "terror" is applied both selectively and inconsistently. In the mainstream American media, the "terrorist" label is usually reserved for those opposed to the policies of the U.S. and its allies. By contrast, some acts of violence that constitute terrorism under most definitions are not identified as such — for instance, the massacre of over 2000 Palestinian civilians in the Beirut refugee camps in 1982 or the killings of more than 3000 civilians in Nicaragua by "contra" rebels during the 1980s, or the genocide that took the lives of at least a half million Rwandans in 1994. At the opposite end of the spectrum, some actions that do not qualify as terrorism are labeled as such — that would include attacks by Hamas, Hezbollah or ISIS, for instance, against uniformed soldiers on duty.

    Historically, the rhetoric of terror has been used by those in power not only to sway public opinion, but to direct attention away their own acts of terror. Yet, to the fair-minded, the attempt by governments to justify bombardment of residential districts, schools and hospitals in the name of fighting terrorism is outright hypocrisy. Government forces have long provided outstanding examples of politically-motivated violence against civilians, the very thing they allegedly oppose. Claims about not "targeting" civilians ring hollow when it is quite obvious that high-tech explosives are aimed at buildings known to contain civilians.

    If what is insidious about terrorism is its callous disregard for civilian lives in pursuit of political goals, why is there not an uproar about state terrorism? Why do so many reserve their venom for people whose destructive capacity pales in comparison with those who command tanks, artillery and warplanes?

    It is easy to lose sight of inconsistencies in wartime hostilities. Instead, the emotional impact of language tends to triumph at the expense of accuracy and fairness. By effectively placing designated individuals or groups outside the norms of acceptable social and political behavior, the rhetoric of "terror" has had these effects:

    1) It erases any incentive the public might have to understand the nature and origins of their grievances so that the possible legitimacy of their demands will not be raised.

    2) It deflects attention away from one's own policies that might have contributed to their grievances.

    3) It repudiates any calls for negotiation.

    4) It obliterates the distinction between national liberation movements and fringe fanatics (for example, during the 1990s, the "terrorist" label was applied to Nelson Mandela and Timothy McVeigh alike);

    5) It paves the way for the use of force by making it easier for a government to exploit the fears of its citizens and ignore objections to the manner in which it responds to terrorist violence.

    This is not just a strategy of the United States government. For decades, Israeli leaders have used such language in their attempt to discredit Palestinian nationalism and deflect attention away from their own policies in the occupied territories. In the 1986 book "Terrorism: How the West Can Win," Benjamin Netanyahu, the book's editor, who is now Israel's prime minister, encouraged pre-emptive strikes "to weaken and destroy the terrorist's ability to consistently launch attacks," even at the "risk of civilian casualties." Addressing the origins of terrorism, he surmised that "the root cause of terrorism lies not in grievances but in a disposition toward unbridled violence" traceable to "a worldview that asserts that certain ideological and religious goals justify, indeed demand, the shedding of all moral inhibitions." Other contributors to the volume voiced similar sentiments in portraying the terrorist as a carrier of "oppression and enslavement," having "no moral sense," "a perfect nihilist," and whose elimination is the only rational means for the West to "win."

    Related
    More From The Stone

    Read previous contributions to this series.

    More careful assessments were made by scholars like Robert Pape of the University of Chicago, who has stressed that foreign military interventions and nationalism are the primary causes of terrorist violence. In his book "Dying to Win: The Strategic Logic of Suicide Terrorism," Pape argued that desires for national self-determination and an end to military occupation were at the root of nearly every instance of suicide terrorism from 1980 to 2003, and that while religion was used a tool for recruiting and procuring aid from abroad, it was rarely the cause. While some took issue with Pape's analysis, he at least employed a more dispassionate, analytical approach in attempting to understand this form of violence.

    *

    Obviously, to point out the causes and objectives of particular terrorist actions is to imply nothing about their legitimacy — that is an independent matter — nor is it any endorsement of a particular method for dealing with the problem of terrorist violence. Yet, to ignore these causes and objectives is to undermine attempts to deal intelligently with terrorism, since it leaves untouched its motivating factors, and paves the way for blind reactions of the sort that are likely to exacerbate rather than resolve the problem.

    To put it bluntly, by stifling inquiry into causes, the rhetoric of "terror" actually increases the likelihood of terrorism. First, it magnifies the effect of terrorist actions by heightening the fear among the target population. If we demonize the terrorists, if we portray them as evil, irrational beings devoid of a moral sense, we amplify the fear and alarm generated by terrorist incidents, even when this is one of the political objectives of the perpetrators. In addition, stricter security measures often appear on the home front, including enhanced surveillance and an increasing militarization of local police.

    Second, those who succumb to the rhetoric contribute to the cycle of revenge and retaliation by endorsing military actions that grievously harm the populations among whom terrorists live. The consequence is that civilians, those least protected, become the principle victims of "retaliation" or "counterterrorism."

    Having been desensitized by language, the willingness to risk civilian casualties becomes increasingly widespread. For example, according to a CBS/New York Times poll of 1216 Americans published on September 16, 2001, nearly 60 percent of those polled supported the use of military force against terrorists even if "many thousands of innocent civilians may be killed," an echo of the view taken by Netanyahu in his book.

    Third, a violent response is likely to stiffen the resolve of those from whose ranks terrorists have emerged, leading them to regard their foes as people who cannot be reasoned with, as people who, because they avail themselves so readily of the rhetoric of "terror," know only the language of force. As long as groups perceive themselves to be victims of intolerable injustices and view their oppressors as unwilling to arrive at an acceptable compromise, they are likely to answer violence with more violence. Their reaction might be strategic, if directed against civilians to achieve a particular political objective, but, with the oppression unabated, it increasingly becomes the retaliatory violence of despair and revenge.

    In "1984," George Orwell described doublethink as "the power of holding two contradictory beliefs in one's mind simultaneously, and accepting both of them," and portrayed it as a device for destroying the capacity for critical thinking, for controlling populations, and for perpetuating the political status quo. Something like doublethink is occurring as the rhetoric of terror continues to immerse us in a nightmare of skewed reason and perpetual warfare. In condemning terrorism, we think of it as something to be eliminated at all costs. Yet, in sanctioning the use of modern weaponry to achieve this end, regardless of its impact upon civilian populations, we are effectively advocating the very thing we condemn, and this is closer to doublethink than we should ever wish to be.

    Tomis Kapitan is a professor emeritus at Northern Illinois University. He is the author of papers in metaphysics, the philosophy of language and international ethics, and the co-author of "The Israeli-Palestinian Conflict: Philosophical Essays on Self-Determination, Terrorism, and the One-State Solution."


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    Opinionator | Draft: What Union Soldiers Thought About the Civil War

    Written By Unknown on Minggu, 19 Oktober 2014 | 13.25

    Disunion follows the Civil War as it unfolded.

    Several years ago, a thick sheaf of Civil War letters was discovered in an old barn in upstate New York. Most were sent by a Union soldier, Charles Freeman Biddlecom, to his wife, the former Esther Lapham. Now edited and published by Katherine M. Aldridge, who owns the barn, they provide a remarkably candid window into the outlook of an ordinary infantryman. They also caution us against exaggerating the affinity of common soldiers for the great causes — the Union and emancipation — that we now hold in such high regard.

    Today we often remember Union soldiers as principled, articulate and ready to sacrifice their lives for something larger. The historians James McPherson and Chandra Manning each have written influential recent volumes articulating soldiers' views: McPherson's Union soldiers were "intensely aware of the issues at stake and passionately concerned about them"; they knew that they were playing roles in a transcendently important struggle, on which the future of the American nation would pivot. Likewise, the "commitment to emancipation" among Manning's Union soldiers deepened and intensified as the war progressed. For them, "ideals like liberty, equality, and self-government" were not empty abstractions but core principles worth fighting to uphold.

    The filmmaker Ken Burns spearheaded this heroic reassessment with his widely watched public television series on the Civil War in the early 1990s. Most memorably, Burns used the emotionally charged letter to "My very dear Sarah" from a Rhode Island infantryman, Sullivan Ballou, written in July 1861 just before the battle of Bull Run. Much as Ballou wanted to return to his loved ones unharmed and to see his sons grow to "honorable manhood," he gave ultimate priority to his country. He and his generation owed a great debt to "those who went before us through the blood and sufferings of the Revolution." He was "willing — perfectly willing — to lay down all my joys in this life, to help maintain this Government, and to pay that debt." Untold millions of television viewers, alerted that Ballou's iconic letter was his last, have listened intently to its dramatic rereading, complete with stringed instruments in the background, tugging at our heartstrings.

    Ballou's noble and stoic valedictory makes for splendid theater, but the messy realities of war swept into the Army countless men whose commitment to big causes was far more muddled and erratic – men like Charles Biddlecom, who lived as a farmer in Macedon, N.Y., just east of Rochester.

    On the face of it, Biddlecom might have been a promising candidate for Burns's honor roll. He was educated, he wrote vivid prose, he was older than the average (born in 1832) and he came from a region where slavery was deplored and enthusiasm for reform was widespread. So one might expect Biddlecom to have embraced the Union cause for all the right reasons. But in his letters, we find that he saw no purpose in the war and considered himself a helpless pawn in an enormous kill-or-be-killed chess match.

    Biddlecom first enlisted in May 1861, as a volunteer in the 28th New York Infantry. Suspecting that the "fuss" soon would be over, he wanted to rout the "southern whelps." But his health deteriorated, and he was discharged before he saw combat.

    Two years later, however, in the summer of 1863, Biddlecom was called back. The war had grown to proportions unimaginable in 1861. He and many other "poor forsaken conscripts" were assigned to rebuild the depleted ranks of the 147th New York, which had been decimated on the first day at Gettysburg. The re-formed regiment was stationed in a dismal part of Northern Virginia, already scarred by three years of warfare.

    As the army went into winter quarters, Biddlecom was sickened by dysentery, afflicted by lice and miserably lonesome and homesick. He and three other men lived in a "little dog kennel," about four feet high. In his darker moments he predicted cynically that the war would grind on inconclusively for 20 years, because "Lincoln and his miserable crew" could never bring it to a successful finish. Biddlecom also second-guessed the decision to go to war in the first place. Much as he hated slaveholders, he mused that it might have been "better in the end to have let the South go out peaceably and tried her hand at making a nation."

    Biddlecom longed to go home to rejoin his family. Some men, he observed, had been discharged who were "not a bit more disabled than I am," and he vowed to follow their example. By spring, as the prospect of renewed fighting came closer, the trickle of deserters fleeing into the nearby mountains from the 147th increased. Most nights two or three men quietly absconded to join the euphemistic "Blue Ridge Corps," and Biddlecom predicted that the regiment stood to lose 150 men. In some ways he sympathized with the deserters — he agreed that no conscript should have to serve longer than nine months — but he could not see himself "sneaking off."

    In early May 1864, Biddlecom and his regiment were thrown across the Rapidan River into the terrifying caldron of Ulysses S. Grant's Overland Campaign. Ten days of fighting in the Wilderness and at Spotsylvania left his division "terribly cut up," with half his own company killed or wounded, and others missing. By early June, barely 100 of the 550 men in his regiment who had started the campaign remained fit for duty.

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    Biddlecom initially hoped that Grant could bring the war to a prompt end, but six weeks of inconclusive bloodletting rekindled his cynicism. He dismissed as "bosh" all talk about "great Union victories." Reports about the "pluck and courage" of the Union Army were "the worst kind of exaggeration." The Army was "worn out, discouraged, [and] demoralized." He admonished his wife, Esther, to reject "newspaper hokum" that depicted ordinary soldiers as patriotic. Men would fight to preserve their reputations, but "as for men fighting from pure love of country, I think them as few as white blackbirds."

    What motivated Biddlecom to continue fighting? Certainly not the high ideals depicted McPherson or Manning. It was in part personal. Convinced that he was the "black sheep" of his family and that most of his kinfolk "never gave me credit for being much of a man," he carried a chip on his shoulder. He wanted to make it clear that he was "not an absolute failure in all things." He was determined not to disgrace his parents or stigmatize his sons by "showing cowardice." But, he insisted, he was neither a "Union Saver" nor a "freedom shrieker." He rejected all high-flown rationalizations for the war effort — "to hell with the devilish twaddle about freedom."

    As late as August 1864, Biddlecom believed that the men in the Army would vote "four to one" against Lincoln. He resolved to support the president's opponent, George B. McClellan, on grounds that wasting "more blood and treasure in this war will be productive of more evil to the white race than it will be of good to the black race." He was content to allow slavery to "die a peaceful death," even if it required 50 or 100 years.

    As Union prospects brightened and the election approached, however, Biddlecom reversed himself and spurned the "copperhead ticket." Suddenly, the soldier who was no "freedom shrieker" embraced the war "for freedom, [and] for equal rights." On Election Day in November he sounded entirely unlike his old self, as he pontificated that the contest would decide "the future of American civilization." It pitted "Lincoln and the universal rights of man" against "McClellan and another compromise with the Devil." He heralded the outcome for affirming that "freedom shall extend over the whole nation." The "greatest nation of Earth" would not bow down to "traitors in arms."

    So Biddlecom's pithy letters convey a mixed message. Until the autumn of 1864, he disdained all ideological rationalizations for the Union war effort. But he also was a team player, and his team appears to have broken strongly toward Lincoln. The army, he decided, was "a very good school for hot heads such as I was." Home influences may also have played a role — after all, the men in his regiment came from one of the most intensely Republican regions in the country.

    The patriotic prose that Charles Biddlecom penned in November 1864 would have delighted Ken Burns. But we dare not forget the long and circuitous journey that finally landed him among the charmed circle of those Union soldiers whose ideas square with modern sensibilities.

    Follow Disunion at twitter.com/NYTcivilwar or join us on Facebook.


    Sources: Katherine M. Aldridge, ed., "No Freedom Shrieker: The Civil War Letters of Union Soldier Charles Biddlecom"; James McPherson, "For Cause and Comrades: Why Men Fought in the Civil War"; Chandra Manning, "When This Cruel War Was Over: Soldiers, Slavery, and the Civil War."


    Daniel W. Crofts, a professor emeritus of history at The College of New Jersey, is completing a new book, entitled "Lincoln's Other Thirteenth Amendment: Rewriting the Constitution to Conciliate the Slave South."


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    Opinionator | Couch: Why Doctors Need Stories

    Couch is a series about psychotherapy.

    A FEW weeks ago, I received an email from the Danish psychiatrist Per Bech that had an unexpected attachment: a story about a patient. I have been writing a book about antidepressants — how well they work and how we know. Dr. Bech is an innovator in clinical psychometrics, the science of measuring change in conditions like depression. Generally, he forwards material about statistics.

    Now he had shared a recently published case vignette. It concerned a man hospitalized at age 30 in 1954 for what today we call severe panic attacks. The treatment, which included "narcoanalysis" (interviewing aided by a "truth serum"), afforded no relief. On discharge, the man turned to alcohol. Later, when sober again, he endured increasing phobias, depression and social isolation.

    Four decades later, in 1995, suicidal thoughts brought this anxious man back into the psychiatric system, at age 70. For the first time, he was put on an antidepressant, Zoloft. Six weeks out, both the panic attacks and the depression were gone. He resumed work, entered into a social life and remained well for the next 19 years — until his death.

    If the narrative was striking, so was its inclusion in a medical journal. In the past 20 years, clinical vignettes have lost their standing. For a variety of reasons, including a heightened awareness of medical error and a focus on cost cutting, we have entered an era in which a narrow, demanding version of evidence-based medicine prevails. As a writer who likes to tell stories, I've been made painfully aware of the shift. The inclusion of a single anecdote in a research overview can lead to a reprimand, for reliance on storytelling.

    My own view is that we need storytelling in medicine, need it for any number of reasons.

    Repeatedly, I have been surprised by the impact that even lightly sketched case histories can have on readers. In my book "Listening to Prozac," I wrote about personality and how it might change on medication. "Should You Leave?" concerned theories of intimacy. Readers, however, often used the books for a different purpose: identifying depression. Regularly, I received — and still receive — phone calls: "My husband is just like — " one or another figure from a clinical example. For a decade and more, public health campaigns had circulated symptom lists meant to get people to recognize mood disorders, and still there remained a role for narrative to complete the job.

    Other readers wrote to say that they'd recognized themselves. Seeing that they were not alone gave them hope. Encouragement is another benefit of case description, familiar to us in this age of memoir.

    But vignettes can do more than illustrate and reassure. They convey what doctors see and hear, and those reports can set a research agenda.

    Consider my experience prescribing Prozac. When it was introduced, certain of my patients, as they recovered from their depression or obsessionality, made note of personality effects. These patients said that, in responding to treatment, they had become "myself at last" or "better than baseline" — often, less socially withdrawn. I presented these examples first in essays for psychiatrists and then in my book, where I surrounded the narrative material with accounts of research. (Findings in cell biology, animal ethology and personality theory suggested that such antidepressants, which altered the way the brain handled serotonin, might increase assertiveness.)

    My loosely buttressed descriptions — and colleagues' similar observations — led in time to controlled trials that confirmed the "better than well" phenomenon. (One study of depressed patients found that Paxil drastically decreased their "neuroticism," or emotional instability. Patients who became "better than well" appeared to gain extra protection from further bouts of mood disorder.) But doctors had not waited for controlled trials. In advance, the better-than-well hypothesis had served as a tentative fact. Treating depression, colleagues looked out for personality change, even aimed for it. Because clinical observations often do pan out, they serve as low-level evidence — especially if they jibe with what basic science suggests is likely.

    To be sure, this approach, giving weight to the combination of doctors' experience and biological plausibility, stands somewhat in conflict with the principles of evidence-based medicine. The movement's manifesto, published in the Journal of the American Medical Association in 1992, proclaimed a new era that would see near-exclusive reliance on systematic clinical research — the direct assessment of treatments in patients. But even the manifesto conceded that less formal expertise would remain important in areas of practice that had not been subject to high-level testing.

    THAT concession covers much of the territory. Making decisions about prescribing, often I exhaust the guidance that trials can give — and then I consult experts who tell me about this case and that outcome. Practicing psychotherapy, I employ methods that will never be subject to formal assessment. Among my teachers I number colleagues I know only through their descriptions of patient encounters. One psychoanalyst, Hellmuth Kaiser, imparted his wisdom through a fictional case portrayed in a stage play. I follow his precepts daily, hourly.

    I have long felt isolated in this position, embracing stories, which is why I warm to the possibility that the vignette is making a comeback. This summer, Oxford University Press began publishing a journal devoted to case reports. And this month, in an unusual move, the New England Journal of Medicine, the field's bellwether, opened an issue with a case history involving a troubled mother, daughter and grandson. The contributors write: "Data are important, of course, but numbers sometimes imply an order to what is happening that can be misleading. Stories are better at capturing a different type of 'big picture.' "

    Stories capture small pictures, too. I'm thinking of the anxious older man given Zoloft. That narrative has power. As Dr. Bech and his co-author, Lone Lindberg, point out, spontaneous recovery from panic and depression late in life is rare. (Even those who put great stock in placebo pills don't imagine that they do much for conditions that are severe and chronic.) The degree of transformation in the Danish patient is impressive. So is the length of observation. No formal research can offer a 40-year lead-in or a 19-year follow-up. Few studies report on both symptoms and social progress. Research reduces information about many people; vignette retains the texture of life in one of its forms.

    How far should stories inform practice? Faced with an elderly patient who was anxious, withdrawn and never medicated, a well-read doctor might weigh many potential sources of guidance, this vignette among them. Often the knowledge that informs clinical decisions emerges, like a pointillist image, from the coalescence of scattered information.

    HERE is where I want to venture a radical statement about the worth of anecdote. Beyond its roles as illustration, affirmation, hypothesis-builder and low-level guidance for practice, storytelling can act as a modest counterbalance to a straitened understanding of evidence.

    Take psychotherapy. Most of the research into its efficacy concerns cognitive behavioral therapy, or C.B.T., the treatment that teaches patients to moderate their habitual maladaptive thoughts. The reasons for this concentration are historical and temperamental. C.B.T. is rooted in a branch of psychology devoted to research, and the school of therapy attracts students who favor the practical and systematic over the spontaneous and poetic. There are no trials of existential psychotherapy.

    But where the comparison has been made — primarily in the treatment of depression — C.B.T. does not outperform alternative approaches. (The alternatives tested are mostly distant derivatives of psychoanalysis.) And detailed research suggests that where C.B.T. works, specific techniques are not the reason. Studies of the components of therapy find that it is factors common to all schools, like the practitioner's commitment and the alliance with the patient, that do the job.

    If we weigh "evidence" by the pound or the page, we risk moving toward a monoculture of C.B.T., a result I would consider unfortunate, since there are many ways to influence people for the better. Here's where case description shines. We hear the existential psychoanalyst Leston Havens describe his use of imitative statements, exclamations by the therapist that seem to come from within the patient: "What is one supposed to do?" For me, Dr. Havens's approach — sitting beside the patient metaphorically and looking outward, hand-crafting interventions on the spot — carries what I call psychological plausibility. The vignette corresponds to a convincing account of how people change.

    It has been my hope that, while we wait for conclusive science, stories will preserve diversity in our theories of mind. For 17 years, starting in the 1980s, I ran a psychotherapy seminar for psychiatry residents. As readings, I assigned only case vignettes, trusting that one or another would speak to each trainee.

    My recent reading of outcome trials of antidepressants has strengthened my suspicion that the line between research and storytelling can be fuzzy. In psychiatry — and the same is true throughout medicine — randomized trials are rarely large enough to provide guidance on their own. Statisticians amalgamate many studies through a technique called meta-analysis. The first step of the process, deciding which data to include, colors the findings. On occasion, the design of a meta-analysis stacks the deck for or against a treatment. The resulting charts are polemical. Effectively, the numbers are narrative.

    Because so little evidence stands on its own, incorporating research results into clinical practice requires discernment. Thoughtful doctors consider data, accompanying narrative, plausibility and, yes, clinical anecdote in their decision making. To put the same matter differently, evidence-based medicine, properly enacted, is judgment-based medicine in which randomized trials, carefully assessed, are given their due.

    I don't think that psychiatry — or, again, medicine in general — need be apologetic about this state of affairs. Our substantial formal findings require integration. The danger is in pretending otherwise. It would be unfortunate if psychiatry moved fully — prematurely — to squeeze the art out of its science. And it would be unfortunate if we marginalized the case vignette. We need storytelling, to set us in the clinical moment, remind us of the variety of human experience and enrich our judgment.

    Peter D. Kramer, a clinical professor of psychiatry at Brown University, is the author of several books, including "Against Depression" and "Listening to Prozac."

    A version of this article appears in print on 10/19/2014, on page SR1 of the National edition with the headline: Why Doctors Need Stories.


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    Opinionator | Fixes: Treating Depression Before It Becomes Postpartum

    Written By Unknown on Jumat, 17 Oktober 2014 | 13.25

    Fixes looks at solutions to social problems and why they work.

    Shortly after the birth of her daughter, Andrea became severely depressed. She was 17 at the time and she didn't fully understand what she was going through; she just felt like a failure. "I felt like I didn't want to be alive," she recalls. "I felt like I didn't deserve to be alive. I felt like a bad person and a bad mother, and I was never going to get any better."

    Postpartum depressions are often assumed to be associated with hormonal changes in women. In fact, only a small fraction of them are hormonally based.

    When her baby persisted in crying, she felt her frustration mount quickly. "I was hitting a boiling point," she says. "I was at a point where I didn't want to deal with anything. Sometimes I would just let her cry — but then I would feel very bad afterwards."

    Depression is the most common health problem women face. In the United States, outside of obstetrics, it is the leading cause of hospitalizations among women ages 15 to 44. It's estimated that 20 percent to 25 percent of women will experience depression during their lifetimes, and about one in seven will experience postpartum depression. For low-income women, the rates are about twice as high. As my colleague Tina Rosenberg has reported, the World Health Organization ranks depression as the most burdensome of all health conditions affecting women (as measured by lost years of productive life).

    Postpartum depressions are often assumed to be associated with hormonal changes in women. In fact, only a small fraction of them are hormonally based, said Cindy-Lee Dennis, a professor at the University of Toronto and a senior scientist at Women's College Research Institute, who holds a Canada Research Chair in Perinatal Community Health.

    The misconception is itself a major obstacle, she adds. Postpartum depression is often not an isolated form of depression; nor is it typical. "We now consider depression to be a chronic condition," Dennis says. "It reoccurs in approximately 30 to 50 percent of individuals. And a significant proportion of postpartum depression starts during the pregnancy but is not detected or treated to remission. We need to identify symptoms as early as possible, ideally long before birth."

    The major predictors include previous incidents of depression, as well as a woman's past and current life stresses, like childhood trauma or abuse, conflicts with a partner or family members, lack of social support or coping skills, and poverty.

    Only about 20 percent to 30 percent of women who experience postpartum depression in the United States get proper treatment, and for low-income mothers, the rate is considerably lower, says Robert T. Ammerman, a professor of pediatrics at Cincinnati Children's Hospital Medical Center who is the scientific director of Every Child Succeeds, a home visiting program for vulnerable first-time mothers.

    The consequences for both mother and child can be devastating. If left untreated, postpartum depression can develop into severe clinical depression. In addition to feeling listless, anxious, guilty, lonely and frequently suicidal, mothers who are clinically depressed in pregnancy are three to four times more likely to have a premature delivery or deliver a low-birth-weight baby (both predictors of serious developmental and medical problems for the child) and, just as urgent, less likely to form healthy attachments with their children. Their children are more likely to have attention deficits, difficulties controlling their emotions and behavior, language delays and lower I.Q.s — and they are themselves at increased risk of becoming depressed later in life (PDF).

    "We have this idea that during motherhood struggling with emotional issues is normal," Ammerman says. "The message that a lot of moms hear from families and friends and even professionals who may not know much about perinatal depression is 'be tough and fight your way through it' — and they don't seek help."

    Ammerman says that while it's true that many mothers have or develop depression, it's not a normal or typical response to the challenges of parenting. There are effective treatments. They include medication as well as a range of therapies – like cognitive behavioral therapy (C.B.T.), which helps people learn how to counter negative thoughts and their associated emotions, and interpersonal psychotherapy (I.P.T.), which focuses on improving the quality of personal relationships and the satisfaction that is gained from them. About a third of women who get treated for chronic or recurrent depression achieve remission, and more than half see an improvement in their symptoms.

    Today, several states, including Illinois, New Jersey, West Virginia and Washington, have initiated mandatory screening for perinatal depression (something that is done nationally in Australia). But inadequate screening is only part of the problem. Cost and access barriers and stigmatization – and an overall lack of awareness among health professionals – are what prevent most mothers who need help from getting it. Many primary care doctors fail to recognize when their patients are depressed. And when they do, they often don't know how to provide the most effective treatments. They also can't ensure that patients will follow up with mental health professionals (many of whom do not accept Medicaid). And communication between doctors is notoriously problematic.

    "When people are referred to mental health professionals from primary care settings, the vast majority of the referral slips go into the garbage," says Katherine L. Wisner, director of the Asher Center for the Study and Treatment of Depressive Disorders at Northwestern University.

    Given the scope of the problem, new outreach and treatment models are urgently needed. The three that I'm highlighting today are in early stages of development, but they are noteworthy because they demonstrate promise and illustrate pathways for potentially broader system changes.

    The first is a collaborative care model called DAWN being pioneered at two urban obstetrics and gynecology (ob-gyn) clinics that are part of the University of Washington system. The innovation here is that mental health care is being integrated directly into ob-gyn care. Why is this such an important idea? About a third of women in the country see their ob-gyn physicians for their primary care, explains Wayne Katon, vice chair of the department of psychiatry and behavioral sciences at the University of Washington School of Medicine. When depression screening and treatment are handled in the same place as primary care, it's more likely that women will get effective help.

    Through the DAWN program, when a woman comes in for care, she is screened for depression using a standard questionnaire known as PHQ-9. If her score indicates a likelihood of major depression, she is assigned a care manager who is trained to educate her about depression, explore real or perceived barriers in her life and motivate her to pursue treatment.

    It's important that treatments are designed to fit with a patient's preferences. "They're given the choice to start with a form of therapy or an antidepressant," Katon says. "Some say, 'I'm pregnant, I'd rather not be on medication.' Some want to take medication." They can also choose in-person visits or telephone consultations. Physician-supervised care managers follow up regularly for a year, tracking patients' progress. If their symptoms persist, they adjust or increase the intensity of treatment.

    In two studies published this year, women experienced significant improvements in depressive symptoms. The gains were particularly notable among women who were uninsured or received public insurance, such as Medicaid. "The women were more satisfied with the care they got and the ob-gyn doctors were more satisfied because their patients got better," Katon adds.

    The second model was developed by Every Child Succeeds, a home visiting program for vulnerable first-time mothers based out of the Cincinnati Children's Hospital Medical Center. In recent years, as I have reported in this column, home visiting programs have spread across the country as a result of a $1.5 billion appropriation in the Affordable Care Act. This summer, a study of families served by the Nurse-Family Partnership found, remarkably, that the mothers and children assisted by the program had significantly lower death rates over a 20-year period.

    But home visiting programs have one notable limitation. As recent research indicates, when mothers are clinically depressed, they don't benefit as much from the visits. "A mother who is depressed has very little to give her child," said Judith B. Van Ginkel, the founder of Every Child Succeeds, which has worked with 22,000 families. "We found that half of the mothers we were working with were depressed, and three-quarters had witnessed or been victims of violence."

    With the leadership of Robert Ammerman and others, Every Child Succeeds has developed a program called Moving Beyond Depression, to train therapists to deliver C.B.T. in conjunction with home visitation.

    Related
    More From Fixes

    Read previous contributions to this series.

    This is how Andrea was able to receive treatment. Shortly after her home visits started, Andrea, who lives just north of Cincinnati and works in a call center, was asked to fill out a questionnaire. (I have changed her name.) She learned that she was depressed. "I had been in denial," she said. For months, conflicts with her mother had been getting worse. Her mother suffered from mental illness and depression, had used drugs, and had long counted on, and expected, Andrea to take care of her.

    But now Andrea needed every ounce of her strength to care for her baby, and her mother reacted angrily. Over 15 sessions, the therapist helped Andrea develop strategies to manage her feelings and interact with her mother — rather than being thrown repeatedly to anger, negative thoughts and guilt.

    Last year, results from a clinical trial funded by the National Institute of Mental Health showed that mothers receiving Moving Beyond Depression's in-home C.B.T. model experienced subtantial improvements in depressive symptoms and decreased diagnosis of major depressive disorder following treatment relative to a control group. The model has spread to several states, including Connecticut, Massachusetts, Kentucky and Kansas, and has been used to assist 600 mothers.

    The third model grows out of Cindy-Lee Dennis's research in Canada, and is important because it illustrates the potential of treating women through interventions over the phone. It thus reduces one of the biggest barriers low-income or rural women face in accessing treatment: transportation to and from treatment and scheduling appointments.

    In one clinical trial, 700 women in the first two weeks after giving birth, who had been identified as being at a high risk of postpartum depression, were given telephone-based peer support from other mothers — volunteers from the community who had previously experienced and recovered from self-reported postpartum depression (and received four hours of training).

    "We created a support network for the mothers early in the postpartum period," Dennis explains. "It cut the risk of depression by 50 percent." On average, each mother received just eight contacts — calls or messages, and the calls averaged 14 minutes. Over 80 percent of the mothers said they would recommend this support to a friend.

    In another clinical trial conducted by Dennis, trained nurses provided interpersonal psychotherapy (I.P.T.) over the phone to 240 clinically depressed mothers across Canada. The calls were scheduled at the mothers' convenience. The results have not been published yet, but Dennis says the treatment was highly effective. Treatment compliance rates were greater than 85 percent. Dennis is currently working with health officials to pilot test the model in New York City.

    "We underestimate very simple interventions," she says. "We have this huge bias that face to face is the most effective way to provide care. But we have to be innovative about how we offer help to women."

    Andrea, who is now 19, remains grateful for the help she received. "I can actually focus on my daughter and be with her the way I want to be with her, and teach her things," she says. "I feel like now that I've been through the program — and distanced myself from people I needed to — I can focus on what I need to focus on rather than everybody else's problems. There's more out there than just being depressed."

    Join Fixes on Facebook and follow updates on twitter.com/nytimesfixes. To receive e-mail alerts for Fixes columns, sign up here.

    David Bornstein is the author of "How to Change the World," which has been published in 20 languages, and "The Price of a Dream: The Story of the Grameen Bank," and is co-author of "Social Entrepreneurship: What Everyone Needs to Know." He is a co-founder of the Solutions Journalism Network, which supports rigorous reporting about responses to social problems.


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    Room for Debate: Freezing Plans for Motherhood and Staying on the Job

    Written By Unknown on Kamis, 16 Oktober 2014 | 13.25

    Facebook and Apple have announced that they will cover up to $20,000 of the cost of egg freezing for female employees who want to delay motherhood. Some welcome the move, others see it as a way to get women to put off having children.

    Should doctors encourage young women to use the procedure more routinely? Do companies send the wrong message by offering this coverage?

    Read the Discussion »
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    Taking Note: In North Carolina, ISIS Is the New Wedge Issue

    Written By Unknown on Rabu, 15 Oktober 2014 | 13.25

    CHARLOTTE, N.C. — When political ads are reduced to criticizing a lawmaker's absence from a few congressional committee meetings, it's usually a pretty good sign that they're running out of material. In the case of Thom Tillis, the Republican who is running for the Senate from North Carolina, it's actually something more ludicrous.

    Mr. Tillis, who has struggled for an advantage against the Democratic incumbent, Senator Kay Hagan, has decided to use the cudgel of the Islamic State to make Ms. Hagan look weak. He is now running television ads here accusing her of missing several Armed Services Committee hearings, including one in February where global threats were discussed. (Though virtually no one, including most Republicans, were particularly concerned about the Islamic State back then.)

    In September, the ad says, she missed a hearing to attend a cocktail fundraiser. "While ISIS grew, Obama did nothing," the narrator says. "Senator Hagan did cocktails. To change policy, change your senator."

    Set aside for a moment the basic hypocrisy of the ad, since all candidates, including Mr. Tillis, miss legislative business in order to raise money. (Mr. Tillis, the speaker of the state House, has frequently been absent for crucial votes while campaigning, according to the Associated Press.)

    What's truly misleading about the ad is the notion that attendance at committee meetings actually has some effect on national security, or that any individual senator can be considered responsible for missing the rise of the Islamic State. Obviously senators should show up for work, but the real problem is that few of them really want to work when they're there. Leaders of both parties in the Senate and the House have been pressured by their members not to allow a vote on President Obama's bombing of the militant group, afraid of sticking their heads up on a controversial issue before the November election.

    What's really going on here is an attempt by Mr. Tillis to change the subject from Ms. Hagan's effective attacks on him for the cuts he has made to education and women's health services, and his leadership in trying to suppress the votes of minorities and other Democratic-leaning voters through a very strict voter ID measure.

    Capitalizing on fears of a looming national security threat is an old and often successful Republican tactic. For George W. Bush and Dick Cheney, it was al Qaeda; for their successors, it is the Islamic State, which is being waved like a red blanket in several other races as well.

    Its usefulness is one of the reasons why the National Republican Senatorial Committee announced yesterday that it would spend another $6 million on ads for Mr. Tillis in the last three weeks of the campaign, more than doubling its current spending. This race is already the most expensive in the nation — $59 million has been spent so far by the two campaigns and outside groups — but Mr. Tillis has not been able to establish a lead. The most favorable poll for him shows the race tied, though others have Ms. Hagan a few points ahead.

    But if several million dollars more can make Ms. Hagan appear to be responsible for the rise of the Islamic State, those numbers may start to change.


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    Taking Note: Medical Racism

    Written By Unknown on Selasa, 14 Oktober 2014 | 13.25

    Photo André Holland in the Cinemax series, "The Knick." Credit Mary Cybulski/Cinemax

    The worst racial atrocities that took place in the Jim Crow South were carried out by the medical establishment, not by night riders cloaked in sheets. Indeed, many more African-Americans were killed by racist medical policies than by all the lynch mobs that ever existed. Until the late 1960s, the American Medical Association tacitly endorsed rules that denied membership to black physicians in the South, thus depressing their numbers in specialties such as surgery and ensuring that black patients would continue to receive dangerously substandard care — or no care at all.

    This subject is rarely discussed in film or on television. The director Steven Soderbergh deserves praise for taking it up in "The Knick," an absorbing, visually lush medical drama on Cinemax set in New York City at the turn of the 20th century. The show centers on the self-obsessed, drug-addicted Dr. Thackery — compellingly played by Clive Owen — who leads a surgical team at the Knickerbocker, a hospital whose wards are awash in the immigrant poor. Known to his comrades as Thack, the junkie surgeon plans to carve his way to immortality, one bloody patient at a time, while lecturing to the rapt audience of doctors who crowd in to view his handiwork in the operating theater.

    A racist, he is repulsed when a wealthy hospital patron forces him to accept the services of a talented black surgeon, Dr. Algernon Edwards — André Holland — even though Edwards has trained abroad and mastered techniques that his white betters have yet to learn.

    Edwards is initially sidelined in menial tasks like suturing wounds on the bodies of the poor, but even they are unhappy with him. When he closes the wound on a white adolescent, her mother leans in to ask, "Must you touch her so much?" This was the toxic premise of segregation: that blackness was a source of contamination from which whites had to be shielded at all costs.

    Segregation forces Edwards into a seedy boardinghouse in a bad section of town. He also sets up a rogue clinic in the hospital basement, where he pioneers new surgical techniques while secretly treating black patients who can't be admitted to the hospital proper. This fictional basement in "The Knick" serves as an homage to the very real cellars, furnace rooms and ramshackle annexes where black patients were often kept in white Southern hospitals — if they were admitted at all.

    Critics who wonder about the real-world antecedents of the Dr. Edwards character should look to Dr. Charles Drew (1904-1950). A towering figure in medical history, Dr. Drew helped to make blood banks possible by developing efficient ways to process and store vast amounts of blood plasma. He began his career in the 1930s when surgical residencies at white hospitals in New York — even those that treated black patients — were officially closed to black physicians. Charming and urbane, Dr. Drew wrangled what a contemporary later described as a "bootleg" residency at Columbia-Presbyterian Medical Center, thanks to a white doctor who took an interest in him. The fact that he was light-skinned enough to be mistaken for white was clearly an asset; it made it easier for him to find acceptance with white colleagues and patients.

    As a scientist, Dr. Drew knew that black blood and white blood were biochemically identical. He reacted with outrage when the federal government placated racists by insisting that blood banks serving the military in World War II be segregated by race. He condemned medical bigotry in all its forms and attacked the American Medical Association for tacitly approving discriminatory policies that excluded Southern black physicians from the organization. The fictional Dr. Edwards, in other words, is Drew-like indeed.

    "The Knick" winds up its first season later this week and has been renewed for a second, again featuring the handsome and combustible Dr. Edwards as he struggles to find his footing in early 20th-century medicine.


    13.25 | 0 komentar | Read More

    Taking Note: The Candidate Who Wants More Pollution in Iowa

    Photo Joni Ernst at a rally on Oct. 13 in Cedar Rapids, Iowa.Credit David Greedy/Getty Images

    Iowa voted for Barack Obama in the last two presidential elections, but now it is seriously considering electing a United States Senate candidate with a hard-right proposal that is truly radical: abolishing the Environmental Protection Agency. That candidate, Joni Ernst, now a Republican state senator, is ahead in the polls by a few points, despite taking a position that would severely degrade the quality of life in Iowa and every other agribusiness state.

    At a debate in Davenport on Saturday, Ms. Ernst came under fire from her Democratic opponent, Representative Bruce Braley, for her plan to eliminate the nation's environmental guardian. "You're saying you don't want anyone making sure the air we breathe is clean and the water we drink is pure," he said.

    Ms. Ernst first made this proposal during the state's Republican primary, when she pandered for Tea Party support by also promising to eliminate the Internal Revenue Service and the Department of Education. But now she is stuck with it, and made a feeble attempt to justify the plan at the debate by saying the E.P.A. has overreached.

    "I do believe our states know best how to protect their natural resources," Ms. Ernst said. "I believe this can be done at the state level, rather than at a national level with the federal E.P.A."

    Turning any number of big things over to the states, of course, has become a familiar Republican substitute for actually thinking about policy. For one thing, it's cost-free: none of these agencies or big programs are really going to be eliminated, so you can sound like you're swinging a big wrecking ball without ever having to be responsible for the damage. But if environmental enforcement really were turned over to the states, it would be a huge gift for the business interests (like the Kochs) who are backing Ms. Ernst and other likeminded candidates, allowing them to determine air and water policy.

    Iowa's regulators, for example, have done a terrible job of keeping the state's rivers clean, allowing so much agricultural runoff (fertilizer and livestock waste) that utilities have had to apologize to their customers for all the disinfectant poured into public water supplies. The power of the state's agribusiness lobby is enormous, and it generally gets more of what it wants out of Des Moines than of Washington. Ms. Ernst's plan would give that lobby far more influence.

    Earlier this year, when the E.P.A. proposed to beef up the Clean Water Act by extending it to more streams and wetlands that flow into big rivers, Ms. Ernst saw an opportunity and attacked Mr. Braley for supporting a huge intrusion into the lives of farmers. (Mr. Braley generally agrees with the E.P.A., but has proposed far too many exemptions for agriculture.) She even claimed farmers would need permission from the federal government to plant a tree under the plan, which the E.P.A. said is flat wrong.

    But the details don't really matter to Ms. Ernst. She wants Iowans to fear the federal government more than they fear what's coming out of their faucet, and she's getting her wish.


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    Taking Note: McConnell and Grimes Debate: United in Vagueness

    LEXINGTON, Ky. – Political campaigns aren't generally associated with specificity or truth-telling and political debates are no different. But at Monday night's debate in Lexington, both Senator Mitch McConnell and his Democratic challenger, Alison Lundergan Grimes, the Kentucky Secretary of State, reached absurd heights in the art of weasel-wording.

    Ms. Grimes knew the question was coming, since she's fielded it several times in the last few days. The host of the debate, Bill Goodman, asked Ms. Grimes for whom she'd voted in the 2012 presidential election. I'll take a wild guess here that Ms. Grimes, a Democrat who was a member of the Kentucky delegation to the Democratic National Convention two years ago, went for the Democrat: Barack Obama.

    But she refused to say — because she's petrified of being linked with the president, who is deeply unpopular in Kentucky. Instead, she took umbrage on the grounds that the Kentucky constitution guarantees ballot box secrecy. She actually made the preposterous claim that by ducking the question she was standing on constitutional principle.

    Mr. McConnell then made her look foolish by freely sharing his votes in the 2008 and 2012 presidential contests, as well as in the 2010 Senate race, when he voted for Trey Grayson, who lost to Rand Paul, the Tea Party darling.

    Mr. McConnell, who's been in Washington long enough —30 years — to know how to speak without communicating any information, had plenty of opportunity to show off his considerable obfuscation skills.

    Is the minimum wage a living wage, Mr. Goodman asked Mr. McConnell. "It's an entry-level wage," said Mr. McConnell, hardly an answer.

    Is climate change real? Before he could plead that he was "not a scientist," Mr. Goodman pointed out that although the senator was not an economist, he was willing to share his opinions on the economy. In a tight spot, Mr. McConnell said: "There are a bunch of scientists who feel there is a problem and maybe we can do something about it."

    Lest he be accused of siding with environmentalists, he added the caveat that scientists in the 1970s thought we were moving toward an ice age, and closed by declaring that his job, as United States Senator from Kentucky, was to fight for coal jobs in the state.

    Mr. McConnell approached Ms. Grimes's "ballot box secrecy"-level of absurdity when Mr. Goodman asked him if "Obamacare and Kynect" had been "a boon or bane" for the state. The difficulty for Mr. McConnell is that the Affordable Care Act is politically toxic in Kentucky, while Kynect — which is the state's health insurance program created under the Affordable Care Act — is a runaway success.

    Mr. McConnell's attempt to separate the two made no sense. The Affordable Care Act should be "pulled out root and branch." As for Kynect, that's just "a website. It was paid for by a grant. The website can continue."

    Seeking clarity, Mr. Goodman asked if Mr. McConnell would support the continuation of Kynect. "Yeah, I think it's fine to have a website, yeah," said the senator.

    That's like saying that Google should cease to exist but that Google.com should live on.


    13.25 | 0 komentar | Read More

    Room for Debate: Hitting 'Restart' With Cuba

    Written By Unknown on Senin, 13 Oktober 2014 | 13.26

    U.S. foreign policy is always facing new challenges, but in one area it has remained practically static for more than 50 years: Cuba is still considered a rogue state sponsor of terrorism and remains isolated under an economic embargo. In an editorial, The Times urged the Obama administration to take advantage of shifting domestic politics and changing policies on the island to establish diplomatic relations. The hope is that normalization would help bring democratic change in Cuba and stem a new flow of migrants making the dangerous voyage to reach American soil.

    Should the U.S. lift the embargo and establish diplomatic relations with the Cuban government?

    Read the Discussion »
    13.26 | 0 komentar | Read More

    Opinionator | Fixes: In This World Cup, the Goal Is a Better Life

    Written By Unknown on Sabtu, 11 Oktober 2014 | 13.26

    Photo Volunteers and Street Soccer USA alumni played during a league match at Brooklyn Bridge Park on Oct. 1.Credit Byron Smith for The New York Times

    Fixes looks at solutions to social problems and why they work.

    On Oct. 19, soccer players from 46 countries will gather in Santiago, Chile, for eight days of matches. There will be parades, flags, tens of thousands of cheering spectators, dignitaries, plenty of TV cameras — even groupies.

    Unlike the World Cup that concluded in Brazil in July, this tournament takes place every year in a different city. It includes both men and women. Games are 14 minutes long. And all the players are homeless.

    Soccer is good for kids. It builds discipline, perseverance, trust, confidence and teamwork. Children need these things — but homeless adults need them even more.

    "Football is a very simple game about inclusion," said Mel Young, the president of the Homeless World Cup. Young, a Scot, was a publisher of newspapers sold by the homeless. He and Harald Schmied, a publisher from Austria, came up with the idea at a street paper convention in 2001. "Normally, our people are isolated, have very low self-esteem, very low self-respect," Young said. "They are by necessity very selfish, thinking only about how will I get to tomorrow? How will I sleep? What will I eat?

    "But they have to turn up to be part of a team. They have to pass balls to each other. There are coaches, they provide each other some support. As soon as you start playing football, you forget you're homeless."

    The Homeless World Cup is not just for the 500 people who will play in Santiago. The international competition has given rise to soccer programs for homeless adults in countries around the world, with their own national tournaments. (Children compete in a different tournament, the Street Child World Cup.) In the United States, the tournament's partner is Street Soccer USA, founded in 2004 in Charlotte, N.C., by Lawrence Cann, a college soccer player who now lives in New York.

    Street Soccer USA now has teams in 16 cities. In New York City, the program works with about 40 participants at any one time, Cann said. They practice or play three times a week.

    As in other countries, the program tries to help participants on and off the soccer pitch. As a group, players do volunteer projects or go to job fairs. Individually, they get connected to drug treatments, immigration lawyers, mentors, job coaches and G.E.D. tutors. Christopher Lodgson, who started playing while he was homeless in 2009, said that when he was just out of the shelter — a dangerous time, as many people fall back in — his support system was built around Street Soccer. "I'm talking about daily phone calls, in-person visits, meetings over coffee," he said.

    Coaches — many of whom are alumni of the program — meet with participants weekly to set and work on three-month, six-month and one-year goals. "Everyone wants employment and housing," Cann said. "We back it down to little steps, so people have the feeling of accomplishing stuff toward their goal. A three-month goal may be I need to get my college credits together I've accumulated and apply. Or get my security license back for a security job." No progress means no play.

    Photo Dennis Diaz in Brooklyn on Oct. 1.Credit Byron Smith for The New York Times

    Two years ago, Dennis Diaz was just out of prison, living in a shelter on Wards Island. He found out about Street Soccer through the Doe Fund's much-copied transitional work program, Ready, Willing and Able. Although he had never played soccer in his life, he was intrigued. The first day he was nervous, and left practice hurting — "I fell a lot," he said. But he was hooked. "I was going through a lot of stress, and it blocked everything away," he said.

    He turned out to be good enough to make Street Soccer's national team, and went to the Homeless World Cup in Poznan, Poland, last year.

    I met Diaz last week at a Street Soccer match in Brooklyn Bridge Park. He is short, 24 years old, with long black hair he gathered in a ponytail for the game. He now has an apartment in Brooklyn and a job as a security guard at the Doe Fund. He's planning to study to become a paramedic.

    One of the men who helped and inspired him, Diaz said, was Donnie Nicholson, who volunteers with Street Soccer and was filling in at the game last week as a coach and player. Nicholson is now a photographer and database manager, a man in his late 30s who exudes confidence. In 2010, however, trying to kick a cocaine addiction and change his life, he got on a bus in his native Texas and came to New York, knowing no one.

    He hadn't kicked a ball in 10 years when he saw the banners for Street Soccer at his Wards Island shelter. "I was out of shape from drugs and cigarettes, coughing, bad knees, bad legs, bad ankles," he said. But he had dreamed as a kid of playing in the World Cup. "I found out about the Homeless World Cup," he said. "And after the first night of practice, I said, 'Wouldn't that be nice.'" Over the next three years, he said, he didn't miss more than two weeks of practice — and he did play in the Homeless World Cup, in Mexico City.

    Photo Donnie Nicholson at a practice in Brooklyn on Oct. 1.Credit Byron Smith for The New York Times

    How did soccer help him? "It was a way to occupy my time, to not acknowledge the thirst for drugs," he said. "It was a way to meet new people. New York is a scary place for a newbie. But I knew soccer as a language since I was 6 years old. As I gained trust, I could ask people, 'Any ideas about what I can do with my day? Any ideas about where I could stay?' " One team member connected him to a landlord in the Rockaways who rented him an apartment — where he still lives.

    The Homeless World Cup has a budget of about $700,000. With that, it gets players to the host city, which then takes over all expenses — and cities compete to host. It also raises money to help national programs in some poor countries.

    More important, it's a framework for the national and local programs all over the world. In Minneapolis, Hani Haybe runs a program whose players are largely girls from Somalia. Daniel Copto, an addictions counselor who had emigrated from Mexico to Toronto, came across Canada's Street Soccer program and began coaching. He saw the program's impact on his clients, and decided to move his family back to Mexico to establish Street Soccer there. Copto lived off his savings from 2006 until 2009, when Fundación Telmex adopted the program. Last year, it worked with 26,600 homeless or otherwise marginalized people across Mexico.

    All over the world, people tell stories of how Street Soccer changed their lives. But how representative are these stories?

    The programs are very difficult to evaluate formally. Well-designed studies are expensive, following up with homeless people is challenging and you need a long time to be able to say anything conclusive. So the Homeless World Cup and Street Soccer programs usually interview players to ask how the program affects them.

    Related
    More From Fixes

    Read previous contributions to this series.

    The Homeless World Cup used to ask participants (PDF, tables on Page 16) six months out whether they had found housing or a job, or gotten sober. Between one-third and one-half reported improving their housing, getting a job or continuing their education — not necessarily the same group each time, so the people who report improving their lives in some way is considerably higher. They stopped the surveys in 2008 because the numbers were so consistent, Young said.

    Street Soccer USA also surveys participants: Jon Welty Peachey, an assistant professor at the University of Illinois, conducts periodic surveys of participants six months after they leave the program. He said that around two out of three make big changes in their lives.

    This isn't very reliable evidence. There's no control group — so people might have improved their lives without the soccer programs. Diaz, for example, was already in Ready, Willing and Able. There's selection bias: It's easier to track down successful people than unsuccessful ones for follow-ups, and the programs themselves most likely attract the people most committed to change. The data is self-reported, and interviewers, like journalists, tend to get a lot of the clichés participants think they should say.

    And six months is not forever, particularly with the homeless. "We know particularly well with a lot of people we work with that it's three steps forward, two steps back," Young said. "Lives are chaotic."

    We romanticize sports, and their effects. Yes, sports can raise self-esteem. But as any parent knows, playing soccer might have the opposite effect on a kid who's not very good. One fascinating study details the observations of a researcher who served as a coach for a team in Britain and went with them to the Homeless World Cup in Graz, Austria. Many of the men had gotten involved because of the lure of the overseas trip. Once there, however, they were repeatedly humiliated on the field — just one more thing to fail at. Many drank heavily throughout the tournament, "culminating in a 30-hour-long drinking binge" when the matches ended.

    Street Soccer USA found its national competition had the same problems. Welty Peachey said that the organization changed the rules a bit to try to emphasize achievements other than victory on the field. Referees, for example, now award players green cards for acts of sportsmanship. In a tie, the team with the most green cards wins.

    Photo The group prepared for the match in Brooklyn.Credit Byron Smith for The New York Times

    The Street Soccer team at the match I attended last week consisted almost entirely of volunteers and program alumni. The regular team members had been temporarily banned from play; a group of them had ganged up on and teased another team member. "We thought it would be good to make a strong statement," Cann wrote in an email. No doubt — but it does illustrate the difficulties of working with the homeless.

    That the evidence is weak, of course, doesn't mean the program is. To the contrary — it's probably very effective. One of soccer's advantages over more traditional programs for the homeless is that you don't have to drag people onto the soccer pitch. "Soccer got my attention," said Lodgson, who is now working as an accountant — one of his jobs is to manage Street Soccer's finances — and planning to get an M.B.A. "When you're in these homeless shelters, one of the things you hate the most is down time. You're just sitting there." Homeless people often have serious problems such as addiction, trauma and mental illness. Soccer isn't enough to solve them. But it keeps people coming back again and again — and as long as they keep coming back, they can keep getting other help.

    There's another way soccer is unique — not for the participants, but for the rest of us. How else do you get the great cities of the world to compete to bring in homeless people? How else could you encourage people in cafes to stand and applaud when a group of the homeless passes by? The Homeless World Cup and Street Soccer humanize a group that is often dehumanized, and therefore forgotten. "People who see the pictures say they didn't know the players were homeless," Young said. "That's the idea."

    Join Fixes on Facebook and follow updates on twitter.com/nytimesfixes. To receive e-mail alerts for Fixes columns, sign up here.

    Tina Rosenberg won a Pulitzer Prize for her book "The Haunted Land: Facing Europe's Ghosts After Communism." She is a former editorial writer for The Times and the author, most recently, of "Join the Club: How Peer Pressure Can Transform the World" and the World War II spy story e-book "D for Deception."


    13.26 | 0 komentar | Read More
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