An Ethnic Map
In The
Conversation, David Brooks and Gail Collins talk between columns every
Wednesday.
David Brooks: On Tuesday I was on a panel with
Representative Xavier Becerra, the chairman of the House Democratic caucus, and
Janet Murguía, who is the head of the National Council of La Raza.
Gail Collins: David, you are always just coming back
from a panel. You fill me with awe, respect and a deep sense of exhaustion.
David: They both told very moving stories about their
family backgrounds — their parents working away without the benefit of much
education and then living to see their own children rise to positions of
national leadership.
Now both my parents have advanced degrees. Do you realize
what a burden that is for me in these circumstances? What kind of inspiring
stories am I supposed to tell? Watching my father trudge through the snow to
the annual convention of the Modern Language Association? Never knowing where
my next Philip Larkin poem was going to come from?
Gail: Too bad your parents went to school in the 20th
century. If you were a child with two advanced-degree parents now, you’d
probably have moving stories of being left home alone while they were waiting
tables on the overnight shift to pay back their student loans.
David: You have to go back three generations to get
to my immigrant forebears and unfortunately even my great-grandfather opened a
butcher shop and seems to have immediately made money hand over fist. I wonder
if there is a place to rent some wretchedness just to fill out the family lore?
I hope you’re not now going to top me with some awesome
story of suffering and overcoming great odds.
Gail: Well, I did grow up on the west side of
Cincinnati. Which was regarded as a severe social handicap by people on the
east side. Fortunately, I never noticed since nobody in my neighborhood ever
left the block.
David: Anyway, I was hoping we could talk about
immigration and immigration reform.
Gail: I have a sinking feeling this is going to be
one of those conversations where we fail to disagree, which is so much less
exciting. I don’t suppose you’d rather fight about Social Security again?
David: When I was a kid my grandfather drew me an
ethnic map of his neighborhood. Some buildings were dominated by Finns, some by
Norwegians, some by Germans. He made all sorts of ethnic distinctions that we
don’t think to make today. When immigration works, ethnicity drops from the
foreground to the background over time. It stops being a public destiny and
starts being a private source of meaning.
Others disagree, but I think the current wave of immigration
is going to end up working out like past waves, which is wonderful news for
this country.
Gail: Obviously I agree. However, it’d be a lot
easier for the newcomers to find the American dream if we could juice up the
economy with some infrastructure spending and improve early childhood
education. But that’s another economic fight, and I can tell you don’t want to
go down that road right now.
David: I do worry about immigration reform, though. I
think the proposal emerging in the Senate is a no-brainer. It increases
high-skill immigration. It brings people out of the shadows. It’s got to be
better than what we have. Is that your basic take?
Gail: Yes. Of course it took Mitt Romney getting
drubbed in the Latino and Asian communities to get Republicans interested in
the issue.
Ted Cruz talked to reporters after his vote
against advancing the Gun Bill Capitol Hill on April 11, 2013.
David: But I worry about the proposal’s prospects in
Congress. If this were still the same old Republican Party of Reagan, then
things would be fine. But the corporate wing is much weaker and the populist
wing is much stronger. The struggle within the party for control is now playing
out as a struggle over immigration policy. A few weeks ago I would have said
the bill had a 70 percent chance of passage. Now I’m down to 50.
Gail: It’s been a long time since I gave a 50 percent
chance to any piece of legislation larger than renaming a post office. I’d say
35 or 40 percent.
David: I must say I admire Marco Rubio’s role in all
this. He’s taken a bold position. He’s really staked his political future on
it. And he’s getting beaten up on the right. If he can hold the Gang of Eight
together and then add about six or seven Republican Senators, then this thing
has a chance.
Gail: On the other side of the picture, you have
Senator Ted Cruz of Texas, who is currently trying to take the credit for
destroying gun control while vowing to do the same thing to immigration reform.
Cruz is a great example of how the Tea Party affects the Republican senators.
Every six years during election season they’re in the right wing’s pocket.
Witness John McCain. In 2005, he sponsored a similar immigration bill. In 2010
he was running for re-nomination against a Tea Party type, and suddenly he’s
talking about illegal immigrants murdering people and running “complete the danged fence”
ads.
But once they’re safely re-elected they remember how much
they hate the Tea Party’s dogmatic craziness. Now McCain is back to the old
mavericky 2000 version. That’s partly because he doesn’t have an election
coming up. But I think he’s also been driven to the center by his loathing for
Ted Cruz. You don’t often see such a combination of irritating personality,
insane political convictions and total implacability in one so young.
So I think it’s very possible immigration reform will pass
the Senate handily, if only because so many people are eager to disappoint Cruz
and Company. But the real problem, on this as on so very many things, is the
House of Representatives.
David: The Republicans in the House will either kill
it amid turmoil and street-fighting, or else they will try to break it up into
a bunch of little bills. If that happens, maybe we can get to a conference
committee and the party leaderships can muscle it through.
Gail: Well, at least they’ll allow a conference
committee to happen. That’s more than the Republicans would do on the budget.
David: But I have to confess the prospects are
worrying. Usually a committed minority can destroy a complex compromise bill
fashioned by a broad majority. I wonder if some Democrats would actually prefer
to see Republicans kill it, knowing that it would essentially mean political
suicide for the opposing party for years to come.
Gail: Well, some Democrats certainly might
have that thought in the back of their mind, but most of them genuinely want to
get this done. No fair blaming the immigration bill’s peril on the party that’s
been solidly behind it from the beginning.
If immigration reform passes, it’ll be a big victory for
sanity — nobody really believes it’s healthy for a country to have millions and
millions of undocumented noncitizens living in the shadows. But it’ll also be a
sign that the Republican Party has gotten tired of letting the Tea Party push
it around. If the bill goes down, the Republicans’ failure will be about a
whole lot more than the fate of the Hispanic vote.
Deportees See Hope for Second Chance
in U.S.
Erik Garcia, center, and Victor Perez, right, who were
deported from the United States, waited in a long line for breakfast at a
Catholic charity in Tijuana that provides free meals to the poor and migrants,
many of them deportees stranded on the border, far from their hometowns
throughout Mexico.
By DAMIEN CAVE Published: May 8, 2013
TIJUANA, Mexico — Erik Garcia arrived at the metal gate of a
migrant shelter here, deported from Los Angeles just hours earlier. After 23
years in the United States illegally, he suddenly found himself separated from
the country where he had moved as a boy, and from his two teenage daughters,
both American citizens.
That same day, senators in Washington unveiled a surprise:
an immigration
bill that could allow deportees like him to return to the United States, a
stunning reversal of American policy after years of record-high deportations.
“Really?” said Mr. Garcia, 33, wiping his eyes when told of
the measure. “Are you sure?”
No previous Congressional effort to change immigration law
has offered such a broad, swift reprieve to people deported by the government.
The bill, introduced last month, would give a legal second chance to tens of
thousands of deportees without serious criminal records who have a child,
parent or spouse with a green card or American citizenship. Many deportees
brought to the United States before their 16th birthday would be eligible to
return as well.
Even in a bill overflowing with ambitious and controversial
proposals, the deportee measure is becoming one of the most contested elements
— a humanitarian necessity to some; to others, a shameful reward for
lawbreakers.
On Wednesday, an
amendment from Senator Jeff Sessions, the Alabama Republican who is among
the bill’s most vocal critics, sought to strip out the deportee reprieve. Other
opponents have welcomed it as a political godsend, calling it such an overreach
that it would make the entire immigration bill easier to defeat. But some
Democrats and immigrant rights groups have pledged to defend the deportee
return, characterizing it as an important step in righting a wrong.
“We have had four million people deported since 2002 and
close to two million since 2008,” said Angelica Salas, director of the
Coalition for Humane Immigrant Rights of Los Angeles. “This is the only way to
reunite families that have been destroyed by our outdated, broken and cruel
immigration policies.”
The Senate bill, one of the most sweeping bipartisan immigration
efforts in decades, would cut down on future deportations by giving millions of
immigrants in the United States provisional legal status. It could also reduce
illegal traffic heading north because, as Democrats involved in drafting the
legislation noted, many migrants crossing the border illegally are deportees
trying to return to their families.
But it is unclear who would get that winning ticket. Under
the legislation, there are obvious candidates who would qualify, some criminals
who clearly would not — and an ocean of people who may fall somewhere in
between.
An epic sorting process, if the bill passed, would be
especially visible here.
Roughly 70 percent of immigrants deported under President
Obama have been sent to Mexico, and Tijuana has received more than anywhere
else. More than 461,000 immigrants have been dropped off in this hilly
metropolis south of San Diego since 2008, flooding barrios and soup kitchens
and adding to insecurity as deportees both commit and fall victim to crime.
“The city doesn’t have the resources to care for them,” said
Tijuana’s mayor, Carlos Bustamante. “We’re suffering.”
Homes and flophouses here are now filled with former and
future immigrants like María Luisa Reyes, who left her tiny town in central
Mexico in 1989, at 20. Now she has three daughters in the United States whom
she has been trying to get back to since being deported two years ago.
“I was in the immigration office checking on my application
to get legal, and they told me I was denied and that I needed to be removed,”
she said. “They arrested me right there.”
“My youngest daughter is 7,” she added, in limbo at a
women’s shelter here. “When I call, she says, ‘Why, Mommy, why?'”
Mr. Garcia, 33, also tried to get legal. He said he arrived
in the United States when he was 10 and tried to adjust his status in 2007,
while working for one of California’s largest catering companies. But he lost
his job in a mass layoff in 2010, he said, and moved in with his sister. When
immigration officials sent him a letter with an appointment date, he said, he
never saw it. An order of removal followed, unbeknown to Mr. Garcia until last
month.
“The police stopped me and asked me for my ID,” he said,
sitting in an icy room in the shorts he wore at the time. “They checked it and
found a warrant from immigration.” He said he had no other crimes on his
record.
“I’ve been trying to become a pastor,” he said. “Ever since
I applied for a green card, I’ve been praying for God to help me.”
A Senate aide involved in legislative negotiations said
deportees would not be granted an automatic right of return; they would have to
apply. Deportees would be ineligible if they had been expelled for criminal
reasons, or if they were convicted of a felony or at least three misdemeanors.
The waivers would be granted at the discretion of the secretary of homeland
security.
Immigration lawyers say that could mean approvals end up
being inconsistent, and even those who seem to qualify say they do not trust
the same authorities who had deported them to suddenly help them return.
“I’m hopeful, but I need to be ready for the possibility of
denial,” said Nancy Landa, 32, a graduate of Cal State Northridge who said she
was brought to the United States as a little girl but deported in 2009 because
her immigration lawyer had failed to file the proper paperwork. “I’m not too
confident that the process would actually work.”
A major complication could be repeat immigration offenses
and the range of prosecutions they have spawned, giving immigrants with nearly
identical immigration violations far different criminal records.
The crime of “illegal re-entry” for returning to the United
States after a deportation used to be reserved largely for violent criminals.
Now it is the nation’s most prosecuted federal felony, but not everyone caught
by immigration authorities is charged with it.
“It’s arbitrary. It depends on who picks you up, when, and
where they pick you up,” said David Leopold, general counsel for the American
Immigration Lawyers Association. “So who will become eligible or ineligible in
terms of illegal re-entry is really luck of the draw.”
Ms. Reyes appeared to be among the fortunate. In the last
six months, she says she has tried to cross the border four times, only to turn
back or be caught by the San Diego border patrol. Once, she said, she was
rescued on a mountain during a snowstorm after being held by men with guns and
black masks, who fled when they saw American agents. But for all of her many
attempts, she said, she had yet to be prosecuted for illegal re-entry.
Victor Pérez, though, a mechanic standing in the long line
at a free breakfast near the border fence, said he had been deported after
spending more than a year in an Arizona jail because he was caught crossing the
mountains outside Nogales, Ariz. It was his third immigration offense. He said
he was deported in 2005 because of a traffic stop, and again in 2008.
“It’s not fair, for me or for a lot of us” he said, looking
down the food line, where, volunteers say, 65 percent of the 1,100 people who
show up every day have been deported. “It’s not like I robbed anyone or hurt
anyone. I just wanted to work.”
If not for his immigration felony, Mr. Pérez, 28, would have
a better shot at getting back under the deportee provision. He arrived in the
United States when he was 13; his wife and two children are all American
citizens.
Wherever deportees gathered in Tijuana, similar if-only
stories emerged.
Uriel Leo Ramirez, 38, said he was deported after the police
knocked on his door because he was drunk and arguing with his wife. “My kids
are 8 and 5,” he said.
Guadalupe Jimenez Griffith, 44, said she was deported after
her sick (now deceased) husband used someone else’s Social Security card to get
Medicaid and welfare. All three of her children were born in the United States.
In this crowd, Mr. Garcia mostly kept to himself. He had
found a jacket to keep warm and was still mulling over his long-shot chance at
getting back to his family. If only the bill would pass, he thought. If only he
could hold on long enough. “What I’m worried about is the next two years,” he
said. “What happens now?”
Karla Zabludovsky and Elisabeth Malkin contributed
reporting from Mexico City.
Related
- Rubio
Disputes Report on Immigration Bill Costs (May 8, 2013)
- G.O.P.
Opponents Plan Immigration Bill Attack (May 7, 2013)
- Times
Topic: Immigration
and Emigration
The Fix the Debt Fix Is Still In
May 8, 2013, 12:04 pm
¶So, Bill
Clinton says that I’m right in the short run while Simpson-Bowles are right
in the long run; he’s half right. But what’s interesting is to see the Peterson
juggernaut still rolling along despite the enormous intellectual hit the cause
has received.
¶And there are some truly disturbing things
about the double standards still applied to Peterson-backed deficit scoldery.
¶Ezra Klein noted
a while back that reporters don’t think the usual rules about even trying
to seem neutral don’t apply when the deficit scolds are concerned, that
¶On this one issue, reporters are permitted
to openly cheer a particular set of highly controversial policy solutions.
¶Something a bit similar is taking place when
it comes to the role of colleges in nurturing the deficit scolds of tomorrow. Alec
MacGillis reports on the lavish rewards for college students participating
in It’s Up To Us, yet another tentacle of
the deficit-scold octopus, this time mobilizing the young. If you read the
front organization’s site, it seems to imply that universities — not just
individual student organizations — are involved, and my understanding is that
it looks that way at some of the schools too; in effect, political advocacy is
being masked as general public service, because of course promoting
Simpson-Bowles is the patriotic thing to do, right?
¶Austerity mania, it turns out, isn’t just a
disaster on intellectual and policy grounds; it has also turned into an ethical
morass.
IN 2011, a group of American high-tech executives and
angel investors traveled to North Africa as part of an innovative State
Department economic development program. Local entrepreneurs flocked to
workshops in Tunisia, Morocco and Algeria, where the Americans judged their
business proposals and encouraged them to open start-ups. The initiative
embodied the “economic statecraft” at the heart of Secretary Hillary Rodham
Clinton’s vision for American foreign policy.
But the program turned out to be so poorly financed that
it had no prize for the winners. Embarrassed delegates cobbled one together: an
internship at a start-up incubator in Detroit.
Today, the Middle East is an economic powder keg. About
60 percent of the Arab world’s population is under the age of 30; millions of
jobs are needed or already high unemployment levels will explode.
The Obama administration’s efforts in the region should
be more economic than military. “The United States government has done a
terrible job of focusing on economic issues in the Middle East,” Thomas R.
Nides, a former deputy secretary of state, told me recently. “You have huge
youth unemployment and no hope.”
This argument is hardly new. “To succeed, the Arab
political awakening must also be an economic awakening,” Mrs. Clinton said,
more than a year ago. “Economic policy is foreign policy,” her successor, John
Kerry, said this week.
Last month he asked Congress to approve the creation of a
$580 million “incentive fund” that would reward countries in the Middle East
and North Africa for enacting reforms that foster market-based economies,
democratic norms, independent courts and civil societies. But Mrs. Clinton’s
proposal for a similar fund received scant support last year from a Congress
that was understandably focused on domestic issues. With the sequester now in
effect, Mr. Kerry’s request could suffer the same fate.
After Iraq and Afghanistan, it’s no longer politically
feasible to sponsor vast development initiatives with little regard for whether
they create self-sustaining growth for the region. We must find innovative ways
to conduct economic statecraft in an age of austerity. The incentive fund — a
small fraction of the $1.2 trillion Washington has spent in Iraq and
Afghanistan — is a good start.
Some countries in the region have had success
implementing, on their own, the kinds of reforms the fund would encourage. Over
the past decade, Turkey has carried out a harsh International Monetary Fund
economic reform program, opened its economy and attracted foreign investment as
part of its effort to join the European Union. Today, few Turkish business
owners care if the country is part of the union. In 2011, Turkey boasted a
faster growing economy than any other European nation.
And in the West Bank, the economic and security reforms
of Salam Fayyad, who recently resigned as prime minister of the Palestinian
Authority, deserve much praise.
Mr. Kerry should also focus aid in areas where viable
markets and partners exist. Tareq Maayah, a Palestinian engineer who runs a
West Bank high-tech firm, said $100,000 from the United States Agency for
International Development helped his firm gain a tryout with Hewlett-Packard.
Today, his company writes software for Cisco, Hewlett-Packard and
Alcatel-Lucent, with no government assistance.
Ahmed El Alfi, an Egyptian-American Silicon Valley
venture capital investor, said American officials could “do a lot more” at
little cost. Mr. Alfi, who began a high-tech incubator in Cairo, said Egyptian
start-ups clamor for access to American investors. “Have a weekly call for
companies from the region doing 10-minute presentations to American companies,”
he suggested.
Finally, Mr. Kerry should emphasize to American companies
that investment opportunities exist in the region, particularly in
infrastructure, energy and aviation. Chinese firms exported an estimated $150
billion to the Middle East and North Africa in 2011, twice as much as American
firms.
Of course, some countries in the region are too unstable
for American private investment. But in others, public-private initiatives that
foster trade, investment and job creation with little taxpayer funding could be
expanded. The high-tech entrepreneurship delegations started by Mrs. Clinton
should be increased and properly funded. Wealthy Persian Gulf countries should
be asked to finance a regional bank for small and medium-size enterprises.
Perhaps most important, we should stop thinking we can
transform societies overnight. Even if the United States perfectly executes its
policies and programs, they alone will not stabilize countries. We need viable
local partners. Nations must transform themselves.
We should scale back our ambitions and concentrate on
long-term economics. By trying to do fewer things over longer periods, we will
achieve more.
David Rohde, a columnist for Reuters and The Atlantic and
a former New York Times reporter, is the author of “Beyond War: Reimagining
American Influence in a New Middle East.”
A version of this op-ed appeared in print on May 8, 2013,
on page A27 of the New York edition with the headline: Start-Up Diplomacy.
Q&A - Eating Locally on the Road
by EMILY BRENNAN Published: May 8, 2013
Sarah Elton is a regular at the farmers’ market near her
home in Toronto. She religiously checks labels and menus to make sure her food
hasn’t traveled far before arriving on her plate. Yet, while traveling to
organic farms in India, China and even food-obsessed France to research her new
book, “Consumed: Food for
a Finite Planet,” she found that her locavore ways were not always
sustainable.
“You’d think it
would be so easy to eat fresh, local, organic food from scratch,” she said.
“But it was surprisingly hard to eat the same quality foods that I choose to
eat at home.”
Below are edited excerpts from a conversation with Ms.
Elton on the strategies she developed for finding local food on the road.
Q. What’s your first step for eating
locally somewhere?
A. Before I leave, I search online for
restaurant and agritourism suggestions. If I’m going somewhere in North
America, I read message boards like Chowhound or the food critics of
alternative weeklies. Googling the name of the town and “local food” brings up
a lot of interesting blogs. And Wikipedia almost always mentions where a city’s
farmers’ markets are.
Many government sites now offer agritourism
opportunities. Quebec has maps for a
cheese trail and a food trail.
Dig In Vermont has incredible maps for
cheeses, wineries, farms and restaurants. Oregon’s
site is similar, and even has tips for picking and foraging.
Q. What if you’re going abroad?
A. Try searching for “slow food” and the
name of the city to find Slow Food chapters; that’s how I found many
restaurants in Beijing. And now many young expat Americans have food blogs.
With this one blog called Barcelona Food Girl, we basically stalked her restaurant
picks.
Q. How do you figure out what’s locally
grown on a restaurant’s menu?
A. Epicurious.com
has a map for the United States that tells you what’s in season in that
state. But that won’t tell you if the restaurant’s cabbage came from the farm
down the road or across the country. If it’s a nice restaurant, I ask, “Is
there anything that’s fresh that just came in?” The waiter should know. At a
mom-and-pop place, I look for items made from scratch, which might not be
local, but at least you know it’s not from a can. If nothing looks promising, I
order the eggs, because you know it’s at least going to be an egg. Though at
this one diner, I bit into my spinach omelet, and it was frozen in the inside.
At some point you have to relinquish and go with the flow. ¶And when you don’t speak the language, you
relinquish completely.
Q. Any strategies for buying from farmers’
markets and local stores?
A. Keep a collapsible cooler bag and a cold
pack in your car, so if you pass by a farmers’ market or a boutique-y food
place, you can get that lettuce or egg salad, put it in your cooler, and you
don’t have to worry about food safety.
Q. Do you cook a lot when you’re on the
road?
¶A. A bit, if we’re renting an
apartment for a couple of days. But if we’re doing a road trip, traveling from
hotel to hotel, we don’t cook so much as compose a meal, do a nice picnic of
salads and cheeses. We bought this Japanese portable picnic table, which,
folded, is about the size of a large briefcase. We keep that in the trunk and
set it up on the hotel’s patio or even next to the bed at night. I bring
tableware to make it feel like a holiday: a tablecloth, hard plastic plates,
cutlery, condiments, a tea towel for drying the dishes in the bathroom. And
hotels always have wineglasses, so you don’t have to worry about bringing that.
Psychiatry’s Guide Is Out of Touch
With Science, Experts Say
Just weeks before the long-awaited publication of a new
edition of the so-called bible of mental disorders, the federal government’s
most prominent psychiatric expert has said the book suffers from a scientific
“lack of validity.”
The expert, Dr. Thomas R. Insel, director of the National
Institute of Mental Health, said in an interview Monday that his goal was to
reshape the direction of psychiatric research to focus on biology,genetics and
neuroscience so that scientists can define disorders by their causes, rather
than their symptoms.
While the Diagnostic and Statistical Manual of Mental
Disorders, or D.S.M., is the best tool now available for clinicians treating
patients and should not be tossed out, he said, it does not reflect the
complexity of many disorders, and its way of categorizing mental illnesses
should not guide research.
“As long as the research community takes the D.S.M. to be
a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that
everything has to match D.S.M. criteria, but you know what? Biology never read
that book.”
The revision, known as the D.S.M.-5, is the first major
reissue since 1994. It has stirred unprecedented questioning from the public,
patient groups and, most fundamentally, senior figures in psychiatry who have
challenged not only decisions about specific diagnoses but the scientific basis
of the entire enterprise. Basic research into the biology of mental disorders
and treatment has stalled, they say, confounded by the labyrinth of the brain.
Decades of spending on neuroscience have taught
scientists mostly what they do not know, undermining some of their most
elemental assumptions. Genetic glitches that appear to increase the risk of schizophrenia
in one person may predispose others toautism-like
symptoms, or bipolar
disorder. The mechanisms of the field’s most commonly used drugs — antidepressants
like Prozac, and
antipsychosis medications like Zyprexa — have revealed nothing about the causes
of those disorders. And major drugmakers have scaled back psychiatric drug
development, having virtually no new biological “targets” to shoot for.
Dr. Insel is one of a growing number of scientists who
think that the field needs an entirely new paradigm for understanding mental
disorders, though neither he nor anyone else knows exactly what it will look
like.
Even the chairman of the task force
making revisions to the D.S.M., Dr. David J. Kupfer, a professor of psychiatry
at the University of Pittsburgh, said the new manual was faced with doing the
best it could with the scientific evidence available.
“The problem that we’ve had in dealing with the data that
we’ve had over the five to 10 years since we began the revision process of
D.S.M.-5 is a failure of our neuroscience and biology to give us the level of
diagnostic criteria, a level of sensitivity and specificity that we would be
able to introduce into the diagnostic manual,” Dr. Kupfer said.
The creators of the D.S.M. in the 1960s and ’70s “were
real heroes at the time,” said Dr. Steven E. Hyman, a psychiatrist and
neuroscientist at the Broad Institute and a former director at the National
Institute of Mental Health. “They chose a model in which all psychiatric
illnesses were represented as categories discontinuous with ‘normal.’ But this
is totally wrong in a way they couldn’t have imagined. So in fact what they
produced was an absolute scientific nightmare. Many people who get one
diagnosis get five diagnoses, but they don’t have five diseases — they have one
underlying condition.”
Dr. Hyman, Dr. Insel and other experts said they hoped
that the science of psychiatry would follow the direction of cancer research,
which is moving from classifying tumors by where they occur in the body to
characterizing them by their genetic and molecular signatures.
About two years ago, to spur a move in that direction,
Dr. Insel started a federal project called Research Domain Criteria, or RDoC,
which he highlighted in a blog post last
week.Dr. Insel said in the blog that the National Institute of Mental
Health would be “reorienting its research away from D.S.M. categories” because
“patients with mental disorders deserve better.” His commentary has created
ripples throughout the mental
health community.
Dr. Insel said in the interview that his motivation was
not to disparage the D.S.M. as a clinical tool, but to encourage researchers
and especially outside reviewers who screen proposals for financing from his
agency to disregard its categories and investigate the biological underpinnings
of disorders instead. He said he had heard from scientists whose proposals to
study processes common to depression,
schizophrenia and psychosis were
rejected by grant reviewers because they cut across D.S.M. disease categories.
“They didn’t get it,” Dr. Insel said of the reviewers.
“What we’re trying to do with RDoC is say actually this is a fresh way to think
about it.” He added that he hoped researchers would also participate in
projects funded through the Obama administration’s new brain initiative.
Dr. Michael First, a psychiatry professor at Columbia who
edited the last edition of the manual, said, “RDoC is clearly the way of the
future,” although it would take years to get results that could apply to
patients. In the meantime, he said, “RDoC can’t do what the D.S.M. does. The
D.S.M. is what clinicians use. Patients will always come into offices with
symptoms.”
For at least a decade, Dr. First and others said,
patients will continue to be diagnosed with D.S.M. categories as a guide, and
insurance companies will reimburse with such diagnoses in mind.
Dr. Jeffrey Lieberman, the chairman of the psychiatry
department at Columbia and president-elect of the American
Psychiatric Association, which publishes the D.S.M., said that the new
edition’s refinements were “based on research in the last 20 years that will
improve the utility of this guide for practitioners, and improve, however
incrementally, the care patients receive.”
He added: “The last thing we want to do is be defensive
or apologetic about the state of our field. But at the same time, we’re not
satisfied with it either. There’s nothing we’d like better than to have more
scientific progress.”
ASK AN EXPERT - By THE NEW YORK TIMES Published: May 8, 2013
More than 100 readers submitted
questions about aging and yoga toDr. Loren Fishman, a back-pain
and rehabilitative medicine specialist who has long incorporated yoga into
patient care. In 1972, before applying to medical school, he studied yoga with
B.K.S. Iyengar for a year in Pune, India. Dr. Fishman is medical director of Manhattan Physical
Medicine and Rehabilitation in New York City, an assistant clinical
professor at Columbia Medical School and an associate editor of the journal
Topics in Geriatric Rehabilitation. He is also an author of eight books,
including “Yoga
for Osteoporosis: the Complete Guide.”
Here is part one of his responses. More from Dr. Fishman
will be posted next week, but because of the volume, not all questions may be
answered. New questions are no longer being accepted.
INTRODUCTION
Is yoga good for the aging population? My answer is yes.
A couple of years ago I ran into my yoga teacher, B.K.S. Iyengar, at a
conference in India. Though he was over 90 years old, he was capable of
traveling to China and giving a three-day workshop consisting of classes that
lasted for many hours each day. When he saw me he rose gracefully from his
chair and greeted me by name, though we hadn’t seen each other for more than 20
years. I think Mr. Iyengar is an example of what yoga can do for an aging human.
To me he seemed like a man 30 years younger. And, in a way, beyond age.
AGING AND YOGA
Q. Are there any aspects to yoga practice that the
over-50 practitioner should give up if she/he is healthy and otherwise feeling
well? How about after 70? What poses cause the most injuries, and which might
help protect or rehabilitate common yoga-associated injuries? — Elizabeth,
Lenox, Mass.
A. Yes, there are things you may need to
give up in your yoga practice as you get older. People age differently, and yet
there are characteristic aspects to aging. Chronic conditions are cumulative.
With osteoporosis you can doforward
bends to as far as your hips will carry you without pushing, keeping your back
slightly arched if possible, and preventing it from slouching forward no matter
what. As my fellow yoga devotee Leslie Kaminoff has rightly noted, this
avoidance of forward bending too can be carried to phobic extremes: good
posture and sensible bending and lifting is an antidote to osteoporotic
fractures; flexibility, coordination, balance and strength are the best
prevention of hip fractures. Standing poses like the tree, the warrior trilogy,
and half-moon promote these positive traits and are among the last poses one
should give up as one ages.
Arthritis will respond to yoga. Supta padangusthasana is as
safe and as good as a pose gets, and will help with safe forward bending, too,
by lengthening the hamstrings and stretching the hips’ capsule. We will come to
many more suggestions and caveats in the questions and answers that follow.
Q. For fit people without specific health issues in
middle age who already practice yoga, it would be nice to have knowledge about
and access to a series of poses appropriate for this age group, which can be
arranged into routines of various difficulties to form the core of a yoga
class. Also targeting areas, like the lower back, with specific poses for this
age group would be helpful. We can then take this knowledge to and practice it
with our local yoga community. Thanks. — David, Maine
Q. Which yoga styles are best if you’re starting at age
50? — LOL, Ithaca
Q. I am 61. Very inflexible, have a history of low back
and neck pain that are currently minor. I get regular exercise at a gym and I
hike in the mountains several times a week. What is the best way to get
introduced to yoga? — Burrito’s, Westbrook, Maine
A. Besides these readers, Big Bird from NYC
and SH and Pinotman from Chicago wrote in wanting to know the best place and
the best way to begin or resume yoga when you are over 50. The absolute best
way is to find out what your liabilities are, and this is an individual matter,
requiring a medical visit or summary. The next step is an appointment with an
experienced and smart yoga teacher, one on one. Group classes are an artifact
of urban economics: the teacher cannot afford to live in the city in which she
teaches any other way. But chronic conditions are cumulative, by definition:
when you’re older you need the individual attention that yoga has traditionally
offered.
I believe the teachings of B.K.S. Iyengar are the most
anatomically sophisticated and therapeutically oriented, but there are many
other good types of yoga. You’ll need a resourceful and sensitive person to get
you started, and to introduce you to an appropriate yoga practice that you can
do every day. Then, after a month or two or three, you should go back to that
person for a reassessment and suggestions about how to progress to the next
step. Yoga, practiced consistently, does good things to your temperament and
perceptions.
Q. Any age-related additional risk factors with respect
to the vertebral artery during shoulder stand and plow poses? — JPT, Ohio
Q. I am 55 and began yoga two months ago. I go every
other day, but I still have problems with the balance poses. I did not have
these issues in my youth. Is it typical to have more balance issues as you get
older? — AJT, Madison
A. Most arteries become more brittle, and
are more easily injured, just as the skin gets more delicate with age. Shoulder
stand, plow, and poses like the gate should be trimmed back from their extremes
for safety after the age of 70. The vertebral artery actually figures in
nourishing a number of neurological structures critical to good balance and
coordination, so it is worth our care. Our sense of balance can also be
degraded with age decreased sensitivity to changes in direction and momentum in
the semicircular canals(offshoots of our hearing apparatus that detect changes
in speed and direction of movement), decreased proprioception (lowered
awareness of position and relative location) in the joints and in one's feet,
and less acute vision. These are the three determinants of balance: the inner
ears, proprioception and vision.
Do the precarious poses against or very close to a wall.
The wall is a wonderful, supportive teacher.
BACK PAIN AND SCIATICA
Q. I am 48, in good shape cardiovascular-wise (runner),
and decided to try yoga recently. All went well initially but of late I have
had considerable back pain both when sitting and lying flat. Could I have an
injury? If it’s just sore muscles, will it eventually get better if I keep
doing it? — MB, Ohio
A. First, much back pain is discovered in
yoga class but really has its origins elsewhere. Second, yoga can cause back
pain, and then, as always, the question is: what is the diagnosis? Pain is a
symptom, not a disease. Without a diagnosis you’re left to guess about proper
treatment, for the same pain can have causes so different that treatments are
diametrically opposite.
One way to decide if it’s sore muscles or a neurological
injury is if the pain goes down one or both legs or radiates. Does anything
tingle, is some part of your leg numb? If so, it’s nerve pain, indicating an
injury that merits further inquiry. If not, it’s probably a muscle spasm or
strain, and stretching should make it feel better. I say probably because
someone could also have a spinal fracture, facet arthritis, spondylolysis or
other problem. The bottom line is that you need a diagnosis before yoga or
anything else can be used rationally to help.
Q. I have sciatica and a herniated disc so bad I want to
cry. I’m on prescription pain killers but I’d rather be better, not drugged up.
Will yoga help sciatica? — Linda, Oklahoma
A. Sciatica — nerve pain that goes down the
leg along the course of the sciatic nerve — can be helped with yoga, but it
must be done with extreme care. A herniated disc responds to extension, and may
be worsened by flexion; spinal stenosis improves with flexion, and is
exacerbated by extension — yet both can cause sciatica, and the same exact
distribution of numbness, weakness and pain. And about 5 percent of the time,
the treatments reverse: extension helps stenosis, flexion is good for herniated
discs. So start tentatively, be sensitive to the changes you feel, and progress
slowly.
My colleagues and I discuss back pain more fully on our
Web site, Sciatica.org. I have
poses — many of them modified for those in pain or unable to do the full pose —
in a book I wrote with Carol Ardman, “Yoga for Back Pain.”
There are chapters on herniated disc, spinal stenosis, and how to tell the
difference between the two. Yoga with physical therapy is an excellent choice
for someone with either a herniated disc or spinal stenosis. But first, the
diagnosis.
Q. I had disk surgery in the 1990s and sciatica has
returned. I have tried interventions to avoid additional surgery. I was told,
however, to stop yoga and continue with Pilates on the reformer. I stretch my
hamstrings and do a few poses daily after a hot shower. I walk a lot but want
to maintain my upper body strength. What are your thoughts? Thanks. — RNC71, DC
Q. Can yoga help in dealing with sciatic pain? Are there
particular poses that can relieve sciatica? — Henry Rabinowitz, San Francisco
Q. I have sciatica and a herniated disc also. I used to
practice yoga years ago on a daily basis until my back started to bother me. I
cannot do any forward or backward bends at all. I miss the yoga postures and
how limber it made me feel. Is there any yoga postures that people with back
problems can do? — Cate, New York
A. To RNC71, if sciatica has returned after
an initial surgery, I would not confine myself to Pilates on the reformer.
Pilates is good for the healthy, and there are people who describe themselves
as Pilates therapists, applying and modifying Pilates practices to form a
healing regimen. Still, I have not encountered the type of rigorous scientific
work, nor the long of therapeutic benefit that you find in yoga. Instead of
Pilates, I would do gentle yoga, restorative yoga, lift weights while lying
down on your back (taking all weight off the discs) and continue walking a lot.
Henry Rabinowitz — along with others like Shulumu in
Colombia and Linda in Oklahoma — get the same advice: first find the cause of
your sciatica, then consider the suggestions given above to RNC71.
Unfortunately, Cate in NY, who also has sciatica and a
herniated disk, cannot do either forward or backward bends. But she can do
sideways poses like vasisthasana (side plank), which we have shown with M.R.I.s
to reduce stenosis and herniated discs. Also, she may be pushing too hard; she
should consider trying the poses that used to make her feel good — but only 10
percent of the way — until she feels stronger. Start back bends very slowly.
Self-pacing is a critical part of any self-discipline, and applies to all parts
of yoga, from beginning to end.
Q. At a healthy 61, I took up Iyengar yoga last year with an experienced teacher and felt better and limber than I had in my whole life. Six months later, I experienced low back pain and sciatica. I have a L4-5 and L5 - S1 disk bulge. I had physical therapy and two epidural steroid injections. The pain and numbness is only marginally better and has kept me from yoga, which I miss greatly. I don’t think I overdid yoga. My doctors think I will recover slowly. Is there remedial yoga for sciatica, and what is the best way to get back to yoga once I am better? — DGR, Ann Arbor
A. DGR, with bulging discs, is inhibited from back bends
by a yoga-phobic physician. But back bends will very likely help. Find one of
the excellent Iyengar teachers in Ann Arbor and you will likely benefit from
the locust, the bridge and the camel, among others. Again, progress slowly.
JOINT PAIN AND METABOLISM
Q. I am 58 and a breast cancer survivor. I have been
doing vinyasa yoga for about five years. In the last two years, I have had
problems with my sacroliliac joint and I understand this may be the result of
too much flexibility in the hip joint. In addition, I am interested in whether
yoga can slow the metabolism. I would greatly appreciate advice on protecting
the sacroiliac and whether the metabolism issue is a myth. Thanks. — MR New
York, Port Washington, N.Y.
A. Both MR and a yoga teacher in Boston
asked about sacroiliac joint pain. For those with this problem, I describe some
unusual but easy versions of difficult poses, like the two-armed support in
peacock, in the new edition of “Yoga for Back Pain,” which I wrote with Carol
Ardman. Also helpful is the eagle, the cow and “leaning” as described in an
earlier book, “Low Back Pain.”
Several people, including MR, have asked whether yoga
slows metabolism. Yes, it does. It lowers blood pressure and reduces atrial
fibrillation and in general calms things down. But that does not mean yoga
cannot be used to trim your weight. Yoga does it differently, by stretching the
organ, the stomach, which will then send turn-off signals to the appetite
centers in the brain. Poses like the warrior III, the twisted janu sirsasana,
and parivrtta parsvakonasana, done 10 to 20 minutes before a meal, will
probably work. This requires a small amount of self-discipline, but then again,
so does just about anything that succeeds.
More answers will be posted on Booming next week.
Previous Ask an Expert columns can be found
here.
Booming: Living Through the Middle Ages offers news and
commentary about baby boomers, anchored by Michael
Winerip. You can follow Booming via RSS here or
visitnytimes.com/booming. You can
reach us by e-mail at booming@nytimes.com.
