NYTimes
January 7, 2007
Happiness 101
By D.T. MAX
One Tuesday last fall I sat in on a positive-psychology class called the Science of Well-Being — essentially a class in how to make yourself happier — at George Mason University in Fairfax, Va. George Mason is a challenge for positive psychologists because it is one of the 15 unhappiest campuses in America, at least per The Princeton Review. Many students are married and already working and commute to school. It’s a place where you go to move your career forward, not to find yourself.
The class was taught by Todd Kashdan, a 32-year-old psychology professor whose area of research is “curiosity and well-being.” Kashdan bobbed around the room or sat, legs dangling, on his desk beneath a big PowerPoint slide that said “The Scientific Pursuit of Happiness” as he took the students, a few older than he, through the various building blocks of positive psychology: optimism, gratitude, mindfulness, hope, spirituality. Though the syllabus promised to “approach every topic in this class as scientists” and the assigned readings were academic, the classroom discussion was Oprah-ish. The students seemed intrigued by the research Kashdan presented mostly in relation to their own lives.
The focus of Kashdan’s class that day was the distinction between feeling good, which according to positive psychologists only creates a hunger for more pleasure — they call this syndrome the hedonic treadmill — and doing good, which can lead to lasting happiness. The students had been asked first to do something that gave them pleasure and then to perform an act of selfless kindness. They approached the first part of the assignment eagerly. One student recounted having sex with her boyfriend 30 feet underwater while scuba diving. Another said he “went to Coastal Flats and got hammered.” A third attended a Nascar race in North Carolina, smoked, drank and had sex. Some also watched favorite TV shows; others chatted with friends.
When it came time to talk about the second part of the assignment, the students were excited, too. The Nascar attendee, who was afraid of needles, gave blood. Another collected clothes from family members and donated them to a shelter for battered women. The boy who had gotten hammered bought a homeless person a 12-pack of “Natty Ice” at a 7-Eleven, wondering if it was the right thing to do. A fourth gave her waiter at Denny’s a $50 tip. At times, Kashdan, who ran the class in the nonjudgmental manner of a ’70s rap-session leader — he used the word “cool” a lot — would compliment them on their behavior and pull out a moral. In this case, as one student wrote in a summary she submitted to Kashdan, comparing “a day at the spa covered in really expensive French” stuff and “a day of community improvement covered in horse” manure, the smile on the community organizer’s face “beat out the smile on the masseur’s face any day.” That is, she had learned that doing good is good for you.
Though Kashdan brought up published studies that optimistic people live longer and that certain regions of the brains of positive people show more activity (“Have a very active left prefrontal lobe day,” he joked at one point), in class they didn’t spend a lot of time on clinical research. Absent were the rats with electrodes, data charts, syndromes and neuroses. The main experimental corpus seemed to be the students themselves, with Kashdan assuming the role of therapist, asserting that pleasure isn’t enough. True happiness comes with meaning, he said, and the students agreed.
I sat in on the course a few more times during the semester, and when Kashdan was done with pleasure versus selfless giving, he took up gratitude and forgiveness, close relationships and love, then spirituality and well-being and finally “meaning and purpose in life.” “I never use the word morality,” Kashdan said. Rather his goal was to show that “there are ways of living that research shows lead to better outcomes.”
More than 200 colleges and graduate schools in the United States offer classes like the one at George Mason. At the University of North Carolina at Chapel Hill, Barbara Fredrickson passes out notebooks with clouds on a powdery blue cover for each student. At the University of Wisconsin-Stevens Point, students pass out chocolates and handwritten notes to school custodians and secretaries. The introductory positive-psychology class at Harvard attracted 855 students last spring, making it the most popular class at the school. “I teach my class on two levels,” says Tal Ben-Shahar, the instructor. “It’s like a regular academic course. The second level is where they ask the question, How can I apply this to my life?” True, the course is known as a gut, but it is also significant that 23 percent of the students who commented on it in the undergraduate evaluation guide said that it had improved their lives. “It wasn’t until my senior year that I started thinking maybe law school wasn’t for me,” wrote one graduate, Elizabeth Peterson, in her biographical précis for the masters program in applied positive psychology at the University of Pennsylvania. She had decided to take the class on a whim. “I was pretty much hooked from there. I realized that what I loved the most was talking to people about their problems.”
Positive psychology brings the same attention to positive emotions (happiness, pleasure, well-being) that clinical psychology has always paid to the negative ones (depression, anger, resentment). Psychoanalysis once promised to turn acute human misery into ordinary suffering; positive psychology promises to take mild human pleasure and turn it into a profound state of well-being. “Under certain circumstances, people — they’re not desperate or in misery — they start to wonder what’s the best thing life can offer,” says Martin Seligman, one of the field’s founders, who heads the Positive Psychology Center at the University of Pennsylvania. Thus positive psychology is not only about maximizing personal happiness but also about embracing civic engagement and spiritual connectedness, hope and charity. “Aristotle taught us virtue isn’t virtue unless you choose it,” Seligman says.
Sitting in Kashdan’s classroom, you might wonder whether psychology had abandoned its proper territory or found a new one, and if a new one, whether it owed more to science or to Sunday school. Perhaps that was because the class reflected the discipline’s own tension between simplicity and complexity, “good tough science,” as Seligman calls it, and airier talk of values. With its emphasis on the self in the world, positive psychology is already an ethics seminar. Which is fitting, given that it has its roots in a Socratic dialogue of sorts. Seligman likes to tell the story of how his daughter Nikki, when she was 5, accused him of being a grouch. She reminded him that he had criticized her for being whiny and that she had worked hard to stop whining. If she could stop being whiny, he could stop being grumpy. He realized, he says, that she was right, that he was “a pessimist and depressive and someone of high critical intelligence” and that he needed to change. Seligman, who at 54 had just been elected president of the American Psychological Association and was renowned for his hard science — most of his research had been in depression — decided to put his considerable talents into finding out “what made life worth living.”
Though positive psychology is only beginning to be used as an educational tool in classrooms and secondary schools, in the nine years since Seligman’s epiphany it has taken a firm hold in academia. The field’s steering committee includes a number of psychologists and psychiatrists who have done highly regarded clinical work: Ed Diener of the University of Illinois at Urbana-Champaign, whose specialty is “subjective well-being”; Christopher Peterson at the University of Michigan, who has made a study of admired character traits around the world; George Vaillant, who has long headed a Harvard project tracking success and failure among the college’s graduates; and Mihaly Csikszentmihalyi of Claremont Graduate University, who has spent years studying “optimal functioning,” or the state of being intensely absorbed in a task, what he calls “flow.” Seligman’s book, “Authentic Happiness,” published in 2002, lays out the field’s fundamental principles and has been translated into nearly 20 languages. Last year’s annual positive-psychology summit in Washington attracted hundreds of academics working in the field or interested in doing so, as well as a children’s programming director, who was working to imbue her cartoons with positive psychology messages, and the Nobel Prize-winning economist Daniel Kahneman, who studies the relationship between economics and perceptions of happiness. In addition there were a lot of “life coaches,” independent consultants who hire themselves out to help clients achieve their life goals.
Despite its seemingly American emphasis on self-reliance and self-expression, positive psychology is also proving popular in England and the British Commonwealth. Nick Baylis, a psychologist at Cambridge University, helped found the Well-being Institute there last year and is consulting with Wellington College, a private boarding and day school, on how to apply positive psychology to its curriculum. The Geelong Grammar School, a prestigious boarding and day school in Australia, is planning to shape its curriculum around the precepts of positive psychology in 2008, and the government of Scotland has also been in touch with Seligman to see whether the discipline might help its citizens. “Our old nation has been renewed through our new Parliament, and if we can embrace this new science of positive psychology, we have the opportunity to create a new Enlightenment,” one government official announced.
Positive psychology is popular with educators because if happiness is something that can be learned, it can be taught. And because being happier seems to have positive long-term effects not just on well-being but also on health and life span. In one often-cited study, researchers at the University of Kentucky analyzed the essays novices born before 1917 wrote on entering the School Sisters of Notre Dame and correlated them to the nuns’ life spans. They found that 9 out of 10 of the most positive 25 percent of the nuns were still alive at 85, while only one-third of the least positive 25 percent were. Overall, their study showed positive emotions correlated to a 10-year increase in life span, greater even than the differential between smokers and nonsmokers. Another study, by Dacher Keltner, a psychology professor at U.C. Berkeley, correlated the smiles that the female graduates of Mills College in Oakland, Calif., displayed in two mid-20th-century yearbooks with life satisfaction and found that the bigger the smile, the more satisfying the marriage and the greater their well-being. Inspired by studies like these, positive psychologists have developed “interventions,” or practices, designed to maximize positive emotions and have tested them on thousands of people. One such intervention is to think every night about the good things that happened to you that day. Another is to make sure in any given day that you either work or play in a new area that draws on what positive psychologists call your “signature strengths” to create a sense of well-being. Gratitude visits — looking up someone who has taught or mentored you and thanking him or her — are important in positive psychology, too; this last intervention, studies show, gives the biggest increase in happiness of all.
In the first few weeks of the semester, Kashdan asked his students to keep a record of their thoughts and experiences. He then gave them “experiential assignments” to make them happier, working their emotions the way an athletic coach might work their muscles. One week they were to report on attempts to go into “flow.” “Sex, drugs and chocolate are all highly useful avenues for people to attain flow states,” Kashdan said. To enter flow, students were asked to do something that they were good at, be it writing, playing basketball or talking to their friends. According to positive psychology, your signature strengths play a special role in building your confidence and thus bringing you happiness. Seligman’s Web site, authentichappiness.org, has a 240-question test to help determine whether your gift is for creativity, bravery, love or something else. In class, one student recounted going into flow during a fistfight; another told of being at her father’s grave. A third talked about being with a friend watching TV and suddenly having a profound conversation. “We had so much love for each other,” the student remembered in class, “and suddenly we were crying.”
Several studies undertaken by positive psychologists have suggested that meditation enhances well-being, so another class assignment was to meditate for 15 minutes three days in a row, attend a free yoga class (Kashdan’s wife, a yoga instructor, arranged this with her studio), be mindful twice a day and report on the results. The mindfulness exercises — excercises in heightened awareness and openness to experience — are central to positive psychology and made a big impression, according to Kashdan: “Some said they just noticed for the first time how many types of trees there are on the way to campus.”
The following week, students were asked to watch “Before Sunrise” and “Before Sunset,” movies starring Ethan Hawke and Julie Delpy. In the former, the two fall in love through intense conversation during one long evening in Vienna and then part. The sequel catches up with them nine years later. The students had to write about the first time they fell in love. The next assignment was to pay a gratitude visit or write a gratitude letter. After that, the students were to exercise their curiosity by doing something “novel, complex, and uncertain . . . epistemic, sensory and social” — that is, they were to use their signature strengths to try something new. One student tasted a pomegranate for the first time; another went to a book reading by Carly Fiorina, the former C.E.O. of Hewlett-Packard. Finally, the students were asked to select one memory they would be willing to spend an eternity with, an intervention inspired by the Japanese movie “After Life.”
Kashdan’s enthusiasm — he is a passionate teacher — ate up class time, and so the students never got to other parts of the syllabus, among them optimism exercises and exercises that would make them better teammates. On the last week, students handed in their final papers, describing how they had tried to enhance their lives toward, in Kashdan’s words, “a specific, personally meaningful positive outcome” during the semester. There was no final exam; the students’ grades were based in large part on the paper and class participation.
In an era when psychology is seeking to become a hard science of fM.R.I.’s and evidence-based therapies, when, as Seligman says, “if it doesn’t plug into the wall, it’s not science,” positive psychology can seem like a retro endeavor with the appeal of a cure that fits on a recipe card. While this may make it particularly adaptable for use in the classroom, critics are often most disturbed by what they perceive as its prescriptive nature. “There is way too little evidence of stable, long-term benefits — and lack of harm — to justify large-scale incorporation of positive psychology programs into schools,” Julie Norem, chairwoman of the psychology department at Wellesley College in Massachusetts, said in an e-mail message. “It pays scant attention to individual differences.” For all that the open, 1960s-style classroom has fallen out of favor, it allowed a child to find his or her own way. In the words of the founder of the famous Summerhill school in England, a child should be free “to live his own life — not the life that his anxious parents think he should live, nor a life according to the purpose of the educator who thinks he knows best.” Children were treated as unique, which you might think would result in a more capable, independent adults. By comparison, positive psychology can seem as if it is laying out a road and asking the adherent to follow. “If I could wave my magic wand, there would be no positive psychology — there would be positive psychologists,” says Daniel Gilbert, a professor of psychology at Harvard, whose own work in the science of affective forecasting suggests that what we think will make us happy rarely does, or at least not for long. “I guess I just wish it didn’t look so much like a religion.”
Indeed, the sectlike feel of positive psychology can be hard to shake off when watching classes like Kashdan’s or even when reviewing the record of the field’s beginnings. When Seligman was first trying to establish the discipline, he and his colleagues invited 25 young psychologists to the Yucatán to discuss the positive side of life. They snorkeled and talked philosophy and then swam some more. They summarized their work and listened to others’ reactions. One evening, the group devoted itself to poetry and song. Seligman recited Ezra Pound’s “Immorality”; a colleague named Sonja Lyubomirsky read some of Prospero’s speeches from “The Tempest.” Seligman’s daughter Lara — Seligman educates his five younger children in part by traveling with them — recited a Delmore Schwartz poem, “I Am Cherry Alive.”
The talk under the palapas was not just about happiness but also about engagement. Participants contrasted the “hedonic treadmill” with “the meaningful life.” To find the qualities that gave life purpose, the team examined Western religions, Buddhism, Hinduism, Confucianism and Bushido as well as the mores of 70 nations. Over time, positive psychologists, led by Christopher Peterson, settled on 24 virtues — or character strengths, as they prefer to call them — including courage, modesty, spirituality and leadership. “The agenda comes from the world,” Seligman told me. “These are universals we’re after.”
The search for what unites humans in virtue was an ambitious effort to integrate psychology with those fields that have long sat alongside it: ethics, religion, philosophy. Before the retreat in Mexico, Seligman met with one of his former professors, the Harvard philosopher Robert Nozick. His book “The Examined Life,” written late in his career, looked at how questions of value might be related to everyday experience. It was Nozick who suggested a “taxonomy of character,” by which he meant, as Seligman put it, a list of “those abiding moral traits that everyone values.” Lyubomirsky remembers that many of the young scientists were uncomfortable doing so. “There was a lot of debate about it,” she said. “We were trained as hard scientists.” Seligman wasn’t so sure himself that he wanted virtue to be part of positive psychology either: he was wary of science becoming prescriptive, but Csikszentmihalyi was enthusiastic, Seligman recalled, and in the end Seligman agreed.
Two criticisms as troubling as the problem of positive psychology’s religiosity are 1) that it is not new — psychology always cared about happiness and 2) that the publicity about the field has gotten ahead of the science, which may be no good anyway. True, there have been attempts to marry psychology to ethics, to enlist it in the service of decoding what it means to be fully human, throughout its history. In the 1950s and ’60s, for instance, Abraham Maslow and Carl Rogers, among others, established humanistic psychology to focus on what gave meaning to life, looking at the very subjects positive psychologists now take as their own. But where Maslow and Rogers relied primarily on qualitative research for their theories, Seligman and his colleagues hope to establish positive psychology — and thus the nature of happiness itself — on firmer scientific ground. The idea that whatever science there is may not yet be first-class troubles Seligman, too. “I have the same worry they do. That’s what I do at 4 in the morning,” he says.
When Todd Kashdan asked his students at George Mason to tell him which they liked better, experiencing pleasure or doing good, he cautioned, “Don’t give me the Miss Universe answers.” But when I met the participants in the nation’s only master’s program in applied positive psychology, at the University of Pennsylvania, I felt the spirit of Gandhi was hovering over us. One woman wrote in her application essay, “My strange and energetic career has included activism for peace and justice; teaching safety and self-defense skills to 10,000 students.” She was also a founder of two nonprofit organizations and taught “Swedish massage and stress-reduction skills.” Another sold her Mercedes and was using her savings to pay for the course. A third left banking to find the meaning in life.
There were, in all, about 30 students in the master’s class at Penn on the Saturday in September I attended. MAPP, as the program is known, is organized around intensive days of class time, online work and conference calls. Seligman, who runs the program, says that he likes to invite others to lecture so he can learn what’s going on in the field, and so that day Barbara Fredrickson of the University of North Carolina was presenting her “broaden and build” theory, while Seligman sat at a little table nodding and taking notes. “It’s a neat design that allows humans and other organisms to grow and become more resourceful versions of themselves,” she told the class.
The first part of her theory stems from a series of experiments that she published in 2005 in which five groups of 20 people each watched short film clips. The clips were meant to elicit negative, positive or neutral emotions. The participants were given a sheet ruled with 20 blank lines and asked to write down what they were feeling. Those who had just had positive emotions induced were able to provide more ideas about what their responses would be than those with either negative or neutral ones.
For Fredrickson, this was evidence that positive emotions lead to broader thinking. The participants were also tested for what is called global-local-visual processing. When asked to look at a design on a computer of three squares arranged in a triangle, those who had watched happy-making film clips tended to see the broader pattern — i.e. the triangular pattern — while the angrier subjects saw only the squares. (The neutral ones saw some of each.)
This was only the first part of Fredrickson’s theory. But it could be that thinking broadly has no effect on happiness or well-being — it might even be a deficit. To show that broadening led to building, she then described an experiment she had undertaken on a group of employees at Compuware, a progressive information-technology firm in Detroit. With the company’s assistance, she followed two groups — one that was taught a loving-kindness meditation (a meditation in which the practitioner repeats phrases that cultivate a caring attitude toward all life) and one that was wait-listed for the meditation. After eight weeks, she compared the two groups’ responses to questions about well-being. Those who meditated reported higher mental resources than before; their mindfulness, freedom from illness and connectedness to others all increased. But interestingly, their sense of well-being hadn’t, at least not immediately. It dropped at first. “It’s like you started a gym membership and then you realize you have to go,” Fredrickson theorized. But once their sense of well-being increased, they retained their edge over those who only wanted to meditate even after the meditation program was over.
All this interested Seligman’s students, but what Fredrickson says always catches their attention most is a study Fredrickson did with a Brazilian workplace psychologist named Marcia Losada, who observed annual strategic-review meetings of employees through one-way mirrors. The data she collected showed that the most effective teams — the criteria were customer satisfaction, profitability and internal review — were the ones who had more positive meetings. There was even a number that corresponded to the minimum amount of positive to negative feedback necessary to encourage successful functioning. That number, Fredrickson told the class, was three positive comments to one negative comment. “The ratio lady,” one student called her.
With its emphasis on universals and practical applications, positive psychology fits these divided times: it preaches values without linking them to a particular value system and embraces spirituality without making you go to church. When positive psychology was introduced into the language-arts program at Strath Haven High School outside Philadelphia in 2003, the left-leaning parents welcomed it because the values were internationally accepted; all but the most conservative ones were reassured that there were values at all.
Seligman recently held a meeting with the leaders from the Lawrenceville School in New Jersey, the Episcopal Academy in Merion, Pa., the Riverdale Country School in the Bronx and the KIPP program, a national network of public charter schools, at which the educational leaders discussed introducing positive psychology into their schools. They are all looking to restore “wholeness” to the teenage years, to replace the supposed sense of certainty that the ’60s removed and that returned in the ’80s as a national political objective but that teachers are now too bogged down in the fundamentals to teach and adults, working longer and longer hours, are simply too busy to shore up at home. A follow-up meeting is scheduled for June, this time with a dozen schools; one item on the agenda is to add personal strengths and virtues to admissions criteria. (Educational Testing Service is exploring a test that students wouldn’t be able to fake.) “What this is about is building character,” Seligman says.
Currently, the biggest project on positive psychology’s drawing board is at the Geelong School. “As a school, we would like to know how to make all students more resilient, how to turn depressing thoughts into positive ones,” Charles Scudamore, the head of the project at what Seligman calls “Australia’s Eton,” wrote in an e-mail message. That there is a need for a curriculum to promote engagement and happiness among teenagers is obvious, and Geelong is the first school to give positive psychologists a chance to show that they can really change teaching. According to Scudamore, “When we adopt a positive-psychology approach, it will be seen and practiced in all that we do.” The Australians “have had a lot of depression in kids, that’s half the reason they want it,” said Ed Diener, the professor of psychology at the University of Illinois.
What the psychologists have in mind for Geelong is very much the sort of intervention Kashdan was teaching at George Mason. The draft proposal by which they secured Geelong’s support included gratitude exercises, exercises in the “three pathways of happiness,” “the four ways to promote savoring” and “the five ways to overcome” adversity. To teach savoring, the teacher would explain mindfulness and show the students how to taste their food more thoroughly and then instruct them to try “savoring with a friend.” The students would have journals to record their emotions, their “grudges and gratitudes.” They would mentor a younger student too. Scudamore says he hopes that even the teachers will feel “their well-being” and their teaching skills enhanced. Seligman and his family are scheduled to make a six-month visit. An American-trained positive-psychology instructor will be in residence to provide training and real-time feedback.
This endeavor outstrips the ongoing Strath Haven experiment. The effort there, financed by a $2.8 million grant from the U.S. Department of Education, is limited to the ninth-grade language-arts program. At the school last year, the positive psychologists interwove their teachings with the literature classes. The idea was to buffer the lessons from bleak books like “Lord of the Flies” and “Romeo and Juliet” with some reassuring thoughts — or at least a more positive framework for understanding human behavior than the classics offer. Thus, according to Mark Linkins, now coordinator of the Swarthmore school district’s curriculum, who helped teach the classes, the animalistic and murderous Jack in “Lord of the Flies” shows “what happens when someone is lacking in signature strengths.” And when reading “The Odyssey,” students were asked: “What are the signature strengths that Odysseus lived and breathed? What are the things he might have improved on to make things go better?” It is too soon to know the effect of these stratagems on the school’s students, since part of the protocol agreed to with the Department of Education requires that they be followed for four years. The results will be compared with a control group that received the standard curriculum. (For his part, Seligman home-schools the children he had with his second wife. He says he likes to balance the standard high-school fare he gives the older ones with “books in which notions of virtue and nobility do not end in humiliation and death,” like Harper Lee’s “To Kill a Mockingbird” and Arthur C. Clarke’s “Childhood’s End.”)
Not all positive psychologists are sure educational interventions are a good idea. Lyubormisky, for instance, turned down a similar request from the Compton school system in California. “I did not think the science was ready to be applied in that big a way,” she told me. Linkins acknowledges that happiness may come at the cost of a full understanding of literature and human complexity. But, he said, “it’s preferable to be happy than not, even if that means the potential for creative output is diminished.”
The question is, Can positive psychology actually fulfill its promise of making people happier? If positive emotions widen the sphere of what it is to be human, as positive psychology asserts, then positive psychology, at least as it is taught in the classroom, can seem to narrow it. If you are not optimistic, fake it. If you do not have friends, make some. I wondered what sort of student positive psychology would create. Was he or she more likely to be a future Nobel Peace Prize winner or J. P. (Gus) Godsey, the Virginia Beach stockbroker, dad and Craftsmen-tool enthusiast whom USA Weekend Magazine declared in 2003 “the happiest person in America” (“You are a blessed, happy person, Gus,” Martin Seligman commented in the article. “You’ve created many of your blessings on your own.”)
When I e-mailed various graduates of Penn’s first master’s class, I found that they continued to take positive psychology’s emphasis on the engaged life very seriously. One woman was using positive psychology to teach first-year medical students better patient-communication skills, citing Fredrickson’s optimal flourishing ratio as a benchmark. John Yeager, who has a doctorate in education and runs the Center for Character Excellence at the Culver Academies, a boarding school in Indiana, wants to “help teachers ‘broaden and build’ character strengths and positive emotions in children, young adults and themselves.”
Of course the master’s students were a self-selected group, willing to pay almost $40,000 for a degree with no clear career track. The students at George Mason, though they, too, had chosen the course, were perhaps more relevant to the question of what positive psychology can really teach. There I found a mixed response. They seemed remarkably sure that they had undergone an important experience but less sure what the nature of that experience had been. Had they saved the world or themselves? I spoke to Brandon Rasmussen, an easygoing student who seemed to me like a surfer dude washed up on some New Age shore. The class had energized him, and he had been a vigorous participant — earning an A. His final paper was about learning to really be with his friends, going into flow with them, something he had long had difficulty doing. “My personal satisfaction is the personal measure for me, and my personal satisfaction is great,” he explained. “I hate to say this, but really in the scheme of things we’re not going to change the war in Iraq.” Then he paused and thought how that sounded. “We can only fix the world one person at a time.”
Tuesday, January 09, 2007
Diabetics' unequal treatment in the workplace
NYTimes
December 26, 2006
Diabetics in the Workplace Confront a Tangle of Laws
By N. R. KLEINFIELD
John Steigauf spent more than a decade fiddling with the innards of those huge United Parcel Service trucks until an icy day two years ago when the company put him on leave from his mechanic's job. A supervisor escorted him off the premises.
His work was good. He hadn't socked the boss or embezzled money. It had to do with what was inside him: diabetes.
U.P.S. framed it as a safety issue: Mr. Steigauf's blood sugar might suddenly plummet while he tested a truck, causing him to slam into someone.
Mr. Steigauf considered it discrimination, a taint that diabetes can carry. ''I was regarded as a damaged piece of meat,'' he said. ''It was like, 'You're one of those, and we can't have one of those.' ''
With 21 million American diabetics, disputes like this have increasingly rippled through the workplace:
A mortgage loan officer in Oregon was denied permission to eat at her desk to stanch her sugar fluctuations, and eventually was fired.
A Sears lingerie saleswoman in Illinois with nerve damage in her leg quit after being told she could not cut through a stockroom to reach her department.
A worker at a candy company in Wisconsin was fired after asking where he could dispose of his insulin needles.
In each instance, diabetics contend that they are being blocked by their employers from the near-normal lives their doctors say are possible. But the companies say they are struggling, too, with confusion about whether diabetes is a legitimate disability and with concern about whether it is overly expensive, hazardous and disruptive to accommodate the illness.
The debate will probably intensify. The number of diabetics in America swelled by 80 percent in the past decade. Experts say the disease is on its way to becoming a conspicuous fact of life in the nation's labor force, raising all sorts of issues for workers and managers.
Even an outspoken advocate for diabetics like Fran Carpentier, a Type 1 diabetic and a senior editor at Parade magazine, understands the implications for business. ''Knowing what it's like to live with the disease hour by hour, day by day, I wonder if I owned my own company if I would hire someone with diabetes,'' she said. ''I'm being bluntly honest. And it kills me to say this.''
Doctors, though, say that with improved medications and methods of self-testing blood sugar, most diabetics can do almost any job if they properly manage their illness. Yet myths about the disease persist, advocates say, leading many companies to shun diabetic employees.
''It's not all about ignorance, but if I can get rid of ignorance, I can get rid of a lot of discrimination,'' said Shereen Arent, the director of legal advocacy for the American Diabetes Association.
Part of the confusion is a byproduct of the disease itself, a capricious illness of elevated, damaging levels of sugar in the blood. Type 1 is a malfunction of the immune system that usually appears in childhood, while the far more prevalent Type 2 is closely associated with obesity and inactivity. Many people with diabetes will face withering complications like blindness, amputations and heart disease. Others will not.
For some, particularly insulin users prone to the abnormal drops in blood sugar known as hypoglycemia, the illness can cause dizziness, fainting or muddled judgment. Doctors, however, say those constitute a tiny number of readily identifiable cases.
Nonetheless, the risk of plunging blood sugars has fueled a longstanding reluctance to employ diabetics in jobs like those of truck driver or police officer, if they are on insulin. Until this summer, the National Fire Protection Association cautioned against making it too easy for even non-insulin-dependent diabetics to become firefighters. Now the association recommends an individual assessment.
Federal law bars diabetics from joining the armed services and prevents diabetics on insulin from becoming commercial pilots.
Innumerable diabetics, though, are engaged in more mundane jobs uninvolved in matters of life and death. For these people, secretaries and factory workers and programmers, a ''reasonable accommodation,'' like permission to eat at one's desk or to be excused from fluctuating shifts, can make the difference in whether they can function.
When disputes can't be resolved, the cases often land in court or before the Equal Employment Opportunity Commission. The commission, which enforces the Americans With Disabilities Act of 1990, says diabetes-related complaints have been on the rise, one of the few conditions generally showing an increase in complaints. Diabetes accounts for nearly 5 percent of the 15,000 annual allegations that the commission gets under that act, trailing only back impairment, other orthopedic injuries and depression.
Often the courts are of scant help in bringing clarity. Mr. Steigauf has spent two years trying to thread his way through the disability discrimination law. The federal law can be fuzzy, for it mentions no illness or handicap by name but supplies a legal test under which plaintiffs must usually demonstrate that a ''major life activity,'' like walking or vision, is ''substantially limited.''
This is easy enough for anyone who has lost sight or a limb. But the restrictions of diabetes are often invisible. Diabetics thus can find themselves teetering on a balance beam, needing to prove they are disabled enough to fit under the law but not so impaired that they can't do a job.
Judges in nearly identical cases have ruled in completely opposite ways, leaving diabetics bewildered and businesses unsure what, if anything, they should do. While some courts, for example, have held that the eating restrictions diabetics face satisfy the substantial limitation, others have disagreed.
''Usually the battle is over that word, 'substantially,' '' said Craig A. Crispin, an Oregon employment lawyer. ''If you say the person is disabled because of the impact on eating, the other side will say: 'Hey, look, she's eating a sandwich. Where's the disability?' ''
Seeking Accommodations
The quarrels are as varied as working life: a musician rejected for a cruise ship's cabaret band, baggage handlers and plane cleaners fired by an airline, a blackjack dealer dismissed by a casino.
The American Diabetes Association fields about 100 calls a month about workplace tussles like these. Many of them revolve around accommodations, though the changes sought tend to be modest: predictable hours, a place to test blood, freedom to snack when sugars get unbalanced.
Companies often cite workplace safety as their paramount concern, though there is little hard evidence to suggest that diabetics are a risk.
In one case in 2002, ConAgra Foods withdrew a job offer to Rudy Rodriguez at a Texas baked bean plant after a physical suggested that his Type 2 diabetes was so out of control that he was a hazard. Mr. Rodriguez had performed fine as an interim laborer, but the examining doctor declared there was nowhere he could safely work ''outside of a padded room where he could even then fall and break his neck from dizziness or fainting.''
An appeals court found otherwise and held that ConAgra had violated the law. The case was settled, and Mr. Rodriguez now works for a printer.
''Some people who have a problem with hypoglycemia should not be doing public safety-type jobs,'' said John W. Griffin Jr., a lawyer from Texas with Type 2 diabetes who handles discrimination cases. ''But I guarantee you that that baked bean factory was not public safety.''
There has been other progress for diabetics: the San Antonio Police Department's barring of diabetics on insulin was struck down. Insulin-using diabetics in good control of their illness can get private pilot's licenses.
In the lingerie saleswoman's case, Sears agreed to a consent decree awarding the woman $150,000 and stipulating that the store train supervisors about disability discrimination.
Employers, however, prevail in a vast majority of cases (many are settled). It is hard even to get lawyers to pursue complaints since prejudice is tricky to prove. Establishing discrimination has become harder since 1999, when the Supreme Court held that if a disability can be corrected with medicine or things like prostheses, it is not necessarily protected. Advocates for the disabled say the ruling warped the intent of Congress.
Ruth Colker, a law professor at Ohio State University who studies disability discrimination, said that very few working people with diabetes now find themselves guarded by the law.
Judges, in fact, have deemed these diabetics not disabled: a Maine store manager who had trouble walking because of poor circulation, and a New York security guard without vision in one eye and declining vision in the other who had four episodes of hypoglycemia in two years.
In some instances, employers have said they took action against an employee because of diabetes, but the court still found that the worker was not disabled and threw out the case.
''There's not a remedy for every wrong,'' said David A. Copus, a lawyer who represents employers and specializes in disability issues. ''There are employers who don't like ugly people. They're not protected by the law.''
Mr. Copus said he was not unsympathetic. His father had diabetes; it was very debilitating.
Wary of bad outcomes, many diabetics conceal their illness on the job. Brian T. McMahon, a professor at Virginia Commonwealth University who studies workplace discrimination, said: ''You get to the question of whether or not to disclose you have diabetes. Most people opt not to, for they fear: Am I inviting more trouble?''
Figuring Employer Costs
There was a time, four or five decades ago, when you wouldn't find one diabetic on the entire floor of a factory. Now, Type 2 diabetics are commonplace. It is not only the ascendancy of the disease, but also the fact that a condition once considered a corollary to old age is striking people sooner, catching them long before retirement. And this comes as companies are already struggling to balance productivity in the workplace with soaring medical costs.
To understand the brutal math of diabetes, all a business has to do is consult the Web site diabetesatwork.org, set up by the government to furnish advice on addressing diabetes in the workplace. One of its tools is a calculator that uses rough assumptions to suggest what costs might be involved.
Businesses plug in the number of employees, the tally is multiplied by 8.2 percent (a slightly dated national prevalence rate for diabetes), then that figure is multiplied by $13,243, an estimate for yearly medical costs of a diabetic. Voilà: the price tag of diabetes. It is a burden more than five times that of workers without diabetes.
Ron Z. Goetzel, a vice president for Thomson Medstat, which analyzes health care costs for businesses, said that if absenteeism and productivity losses are added, diabetes ranks third among major conditions as an economic cost to employers, after heart disease and hypertension.
Companies have only started to reckon with this, and with the disease's ancillary concerns. Even if advocates say safety is rarely a factor, companies argue they cannot take chances with some types of workers, like school bus drivers or even pizza deliverers.
Concessions may seem small -- for example, granting a bank teller more frequent breaks -- but many employers contend that if rules bend for one person, then that breeds resentment among other employees. Co-workers cannot see the diabetes, and if an employer gives preferential treatment to a diabetic worker, it cannot legally tell other workers it is because of the diabetes. Companies feel that indulging all diabetics trivializes the meaning of disability and of fairness.
''It comes down to how many extra points do I give you,'' said William J. Kilberg, a Washington employment lawyer. ''Why is everybody a victim?''
He said too many people who are not disabled demand special favors. ''I mean, I wear eyeglasses,'' he said.
In addition to the threat of a suit under federal or state disability law, businesses must grapple with the Family and Medical Leave Act, which requires them to grant unpaid leave to ill workers. That can create scheduling difficulties.
''This whole area gets complicated, because the medical leave act can mean employees absent from the workplace for extended periods,'' said Stephen A. Bokat, general counsel for the United States Chamber of Commerce. ''That bothers employers even more than an employee needing a half-hour during the day to administer some insulin.''
Health care consultants urge companies to become proactive, try to use tools like wellness programs to forestall diabetes' claim on their workers and install disease management programs to improve existing cases. And many do. Companies dangle $100 incentives (though more often a mug or a T-shirt) if an employee submits to a health assessment or accepts a phone call from a health coach.
But getting participation is hard. And the economic worth of these undertakings to a business is difficult to gauge with a progressive disease like diabetes. Sometimes the evident benefits of in-house health programs are years down the road, when an employee a business invested in may well be working elsewhere.
When Safety Comes First
John Steigauf's fellow mechanics called him ''Flunky.'' The name caught on after Mr. Steigauf gave advice to a prickly supervisor, who thundered, ''I'm not going to let some flunky mechanic tell me how to do my job.'' Mr. Steigauf, 47, wanted it embroidered onto his uniform. Supervisors said forget it.
He joined United Parcel in Minneapolis in 1991, turning wrenches from the start. Five years ago, he learned that he had Type 2 diabetes. Though it often goes with being overweight, he had a wide receiver's build: 6-foot-2, 193 pounds. But his mother had diabetes.
He was put on pills and watched his diet, abandoning his cherished hot chocolate. Yet his blood sugar remained high. If it didn't drop, he would need insulin. That sent fear pumping through him.
U.P.S. requires mechanics, like its interstate drivers, to hold a commercial driver's license and to be cleared to drive out of state so they can road-test trucks. In reality, mechanics could go weeks without leaving the yard, but those were the rules. And at the time, federal officials did not grant interstate licenses to insulin-using diabetics.
They did dispense a few exemptions. But Mr. Steigauf, who started using insulin only in 2004, stood no chance. The requirement was to have driven safely while on insulin for three years.
So Mr. Steigauf tried starving himself, slicing off 30 pounds. It made him crabby, fatigued and so thin ''that if I stuck my tongue out, I looked like a zipper.''
His blood sugars did not budge. But after he took insulin, his diabetes settled down almost at once.
Later in 2004, he had to have a physical to renew his commercial license, a test he could no longer pass. Minnesota did not have the three-year rule, and since he had never had a hypoglycemic episode or other problems, Mr. Steigauf got an exemption to drive within the state. Given that he didn't even leave the county while road-testing trucks, he hoped that would be good enough.
It wasn't. For consistency, U.P.S. wanted all its mechanics to be certified to drive from state to state, whether they needed to or not. So Mr. Steigauf was sent home on disability, even though he felt fine.
Norman Black, a U.P.S. spokesman, said the company had always intended to find Mr. Steigauf another position. He said the company did not discriminate but was passionate about safety.
Studies tracking accident rates of diabetics are inconclusive; some indicate worse outcomes, others don't. But either way, Mr. Steigauf's direct supervisor at the time, Dan Welke, said he thought the company had gone too far, that somebody else could road-test the trucks repaired by Mr. Steigauf.
''It just seemed ridiculous,'' Mr. Welke said.
Mr. Steigauf also had trouble making sense of this. When his diabetes raged out of control, it had been all right to fix trucks. Now, with the illness under control, it wasn't.
When he spoke to someone in human resources, Mr. Steigauf said he was told that he would never come back. The notion that he was a human tinderbox punctuated his interactions. ''I'd be told that I could pull a tractor up to a fuel pump and pass out and the thing would explode,'' he said. ''I was like a grenade and was going to kill people.''
At home in Bloomington, Minn., where Mr. Steigauf's tidy ranch is bordered by a soupçon of lawn, he, his wife, Dawn, their twin daughters and their severely autistic son struggled on a weekly disability check of $431, about half his old pay.
To keep going, he did odd jobs. Friends at U.P.S. dug into their pockets. The family cut one another's hair and skipped sending Christmas cards.
Finally, Mr. Steigauf asked U.P.S. to excuse him from interstate driving as a ''reasonable accommodation'' under disability law. After all, he had left the state for U.P.S. only once in 13 years. Some of his colleagues, he found out, did not even have commercial driver's licenses.
But U.P.S. refused, saying he was not disabled under discrimination law, and thus not entitled to an accommodation.
So, in early 2005, he filed a complaint with the Equal Employment Opportunity Commission and waited, interned in his house, as if he had evaporated -- all the while collecting disability from a company that said he was not disabled.
After seven months, U.P.S. offered him a lower-paying job, fixing trailers. He could not touch an engine or drive. But he took it while he battled for his former position.
Then he had some luck. Federal officials changed their rules on interstate licenses and Mr. Steigauf qualified for a waiver, allowing him to return to his old job. He is expected to start within a month or so.
This fall, the E.E.O.C. concluded that he had been discriminated against and that U.P.S. owed him relief. U.P.S. said it would contest the decision.
Mr. Steigauf is still bitter, not toward U.P.S. itself, but toward the way he believes it treats diabetics. Even now, he feels singled out.
''I've had unloaders at work say to me, 'Are you that diabetic guy?' '' he said. ''I don't know what they mean. Nothing? Or, 'You shouldn't be working here'?''
To keep his exemption, he must obey a complicated protocol to show the Federal Motor Carrier Safety Administration that he remains fit. Every three months, he has to report how much he drives and his sugar levels. If he has an accident, even if someone rams his car while he's in a movie, he has two days to alert the government. He has seven days to let the government know if he has a new car or a new phone number.
''The exemption adds to the discrimination,'' he said one afternoon at home. ''It constantly reminds me that I'm different.''
His children skittered through the room.
''You become a show dog,'' he said. ''I fix engines. I don't want to be a show dog.''
December 26, 2006
Diabetics in the Workplace Confront a Tangle of Laws
By N. R. KLEINFIELD
John Steigauf spent more than a decade fiddling with the innards of those huge United Parcel Service trucks until an icy day two years ago when the company put him on leave from his mechanic's job. A supervisor escorted him off the premises.
His work was good. He hadn't socked the boss or embezzled money. It had to do with what was inside him: diabetes.
U.P.S. framed it as a safety issue: Mr. Steigauf's blood sugar might suddenly plummet while he tested a truck, causing him to slam into someone.
Mr. Steigauf considered it discrimination, a taint that diabetes can carry. ''I was regarded as a damaged piece of meat,'' he said. ''It was like, 'You're one of those, and we can't have one of those.' ''
With 21 million American diabetics, disputes like this have increasingly rippled through the workplace:
A mortgage loan officer in Oregon was denied permission to eat at her desk to stanch her sugar fluctuations, and eventually was fired.
A Sears lingerie saleswoman in Illinois with nerve damage in her leg quit after being told she could not cut through a stockroom to reach her department.
A worker at a candy company in Wisconsin was fired after asking where he could dispose of his insulin needles.
In each instance, diabetics contend that they are being blocked by their employers from the near-normal lives their doctors say are possible. But the companies say they are struggling, too, with confusion about whether diabetes is a legitimate disability and with concern about whether it is overly expensive, hazardous and disruptive to accommodate the illness.
The debate will probably intensify. The number of diabetics in America swelled by 80 percent in the past decade. Experts say the disease is on its way to becoming a conspicuous fact of life in the nation's labor force, raising all sorts of issues for workers and managers.
Even an outspoken advocate for diabetics like Fran Carpentier, a Type 1 diabetic and a senior editor at Parade magazine, understands the implications for business. ''Knowing what it's like to live with the disease hour by hour, day by day, I wonder if I owned my own company if I would hire someone with diabetes,'' she said. ''I'm being bluntly honest. And it kills me to say this.''
Doctors, though, say that with improved medications and methods of self-testing blood sugar, most diabetics can do almost any job if they properly manage their illness. Yet myths about the disease persist, advocates say, leading many companies to shun diabetic employees.
''It's not all about ignorance, but if I can get rid of ignorance, I can get rid of a lot of discrimination,'' said Shereen Arent, the director of legal advocacy for the American Diabetes Association.
Part of the confusion is a byproduct of the disease itself, a capricious illness of elevated, damaging levels of sugar in the blood. Type 1 is a malfunction of the immune system that usually appears in childhood, while the far more prevalent Type 2 is closely associated with obesity and inactivity. Many people with diabetes will face withering complications like blindness, amputations and heart disease. Others will not.
For some, particularly insulin users prone to the abnormal drops in blood sugar known as hypoglycemia, the illness can cause dizziness, fainting or muddled judgment. Doctors, however, say those constitute a tiny number of readily identifiable cases.
Nonetheless, the risk of plunging blood sugars has fueled a longstanding reluctance to employ diabetics in jobs like those of truck driver or police officer, if they are on insulin. Until this summer, the National Fire Protection Association cautioned against making it too easy for even non-insulin-dependent diabetics to become firefighters. Now the association recommends an individual assessment.
Federal law bars diabetics from joining the armed services and prevents diabetics on insulin from becoming commercial pilots.
Innumerable diabetics, though, are engaged in more mundane jobs uninvolved in matters of life and death. For these people, secretaries and factory workers and programmers, a ''reasonable accommodation,'' like permission to eat at one's desk or to be excused from fluctuating shifts, can make the difference in whether they can function.
When disputes can't be resolved, the cases often land in court or before the Equal Employment Opportunity Commission. The commission, which enforces the Americans With Disabilities Act of 1990, says diabetes-related complaints have been on the rise, one of the few conditions generally showing an increase in complaints. Diabetes accounts for nearly 5 percent of the 15,000 annual allegations that the commission gets under that act, trailing only back impairment, other orthopedic injuries and depression.
Often the courts are of scant help in bringing clarity. Mr. Steigauf has spent two years trying to thread his way through the disability discrimination law. The federal law can be fuzzy, for it mentions no illness or handicap by name but supplies a legal test under which plaintiffs must usually demonstrate that a ''major life activity,'' like walking or vision, is ''substantially limited.''
This is easy enough for anyone who has lost sight or a limb. But the restrictions of diabetes are often invisible. Diabetics thus can find themselves teetering on a balance beam, needing to prove they are disabled enough to fit under the law but not so impaired that they can't do a job.
Judges in nearly identical cases have ruled in completely opposite ways, leaving diabetics bewildered and businesses unsure what, if anything, they should do. While some courts, for example, have held that the eating restrictions diabetics face satisfy the substantial limitation, others have disagreed.
''Usually the battle is over that word, 'substantially,' '' said Craig A. Crispin, an Oregon employment lawyer. ''If you say the person is disabled because of the impact on eating, the other side will say: 'Hey, look, she's eating a sandwich. Where's the disability?' ''
Seeking Accommodations
The quarrels are as varied as working life: a musician rejected for a cruise ship's cabaret band, baggage handlers and plane cleaners fired by an airline, a blackjack dealer dismissed by a casino.
The American Diabetes Association fields about 100 calls a month about workplace tussles like these. Many of them revolve around accommodations, though the changes sought tend to be modest: predictable hours, a place to test blood, freedom to snack when sugars get unbalanced.
Companies often cite workplace safety as their paramount concern, though there is little hard evidence to suggest that diabetics are a risk.
In one case in 2002, ConAgra Foods withdrew a job offer to Rudy Rodriguez at a Texas baked bean plant after a physical suggested that his Type 2 diabetes was so out of control that he was a hazard. Mr. Rodriguez had performed fine as an interim laborer, but the examining doctor declared there was nowhere he could safely work ''outside of a padded room where he could even then fall and break his neck from dizziness or fainting.''
An appeals court found otherwise and held that ConAgra had violated the law. The case was settled, and Mr. Rodriguez now works for a printer.
''Some people who have a problem with hypoglycemia should not be doing public safety-type jobs,'' said John W. Griffin Jr., a lawyer from Texas with Type 2 diabetes who handles discrimination cases. ''But I guarantee you that that baked bean factory was not public safety.''
There has been other progress for diabetics: the San Antonio Police Department's barring of diabetics on insulin was struck down. Insulin-using diabetics in good control of their illness can get private pilot's licenses.
In the lingerie saleswoman's case, Sears agreed to a consent decree awarding the woman $150,000 and stipulating that the store train supervisors about disability discrimination.
Employers, however, prevail in a vast majority of cases (many are settled). It is hard even to get lawyers to pursue complaints since prejudice is tricky to prove. Establishing discrimination has become harder since 1999, when the Supreme Court held that if a disability can be corrected with medicine or things like prostheses, it is not necessarily protected. Advocates for the disabled say the ruling warped the intent of Congress.
Ruth Colker, a law professor at Ohio State University who studies disability discrimination, said that very few working people with diabetes now find themselves guarded by the law.
Judges, in fact, have deemed these diabetics not disabled: a Maine store manager who had trouble walking because of poor circulation, and a New York security guard without vision in one eye and declining vision in the other who had four episodes of hypoglycemia in two years.
In some instances, employers have said they took action against an employee because of diabetes, but the court still found that the worker was not disabled and threw out the case.
''There's not a remedy for every wrong,'' said David A. Copus, a lawyer who represents employers and specializes in disability issues. ''There are employers who don't like ugly people. They're not protected by the law.''
Mr. Copus said he was not unsympathetic. His father had diabetes; it was very debilitating.
Wary of bad outcomes, many diabetics conceal their illness on the job. Brian T. McMahon, a professor at Virginia Commonwealth University who studies workplace discrimination, said: ''You get to the question of whether or not to disclose you have diabetes. Most people opt not to, for they fear: Am I inviting more trouble?''
Figuring Employer Costs
There was a time, four or five decades ago, when you wouldn't find one diabetic on the entire floor of a factory. Now, Type 2 diabetics are commonplace. It is not only the ascendancy of the disease, but also the fact that a condition once considered a corollary to old age is striking people sooner, catching them long before retirement. And this comes as companies are already struggling to balance productivity in the workplace with soaring medical costs.
To understand the brutal math of diabetes, all a business has to do is consult the Web site diabetesatwork.org, set up by the government to furnish advice on addressing diabetes in the workplace. One of its tools is a calculator that uses rough assumptions to suggest what costs might be involved.
Businesses plug in the number of employees, the tally is multiplied by 8.2 percent (a slightly dated national prevalence rate for diabetes), then that figure is multiplied by $13,243, an estimate for yearly medical costs of a diabetic. Voilà: the price tag of diabetes. It is a burden more than five times that of workers without diabetes.
Ron Z. Goetzel, a vice president for Thomson Medstat, which analyzes health care costs for businesses, said that if absenteeism and productivity losses are added, diabetes ranks third among major conditions as an economic cost to employers, after heart disease and hypertension.
Companies have only started to reckon with this, and with the disease's ancillary concerns. Even if advocates say safety is rarely a factor, companies argue they cannot take chances with some types of workers, like school bus drivers or even pizza deliverers.
Concessions may seem small -- for example, granting a bank teller more frequent breaks -- but many employers contend that if rules bend for one person, then that breeds resentment among other employees. Co-workers cannot see the diabetes, and if an employer gives preferential treatment to a diabetic worker, it cannot legally tell other workers it is because of the diabetes. Companies feel that indulging all diabetics trivializes the meaning of disability and of fairness.
''It comes down to how many extra points do I give you,'' said William J. Kilberg, a Washington employment lawyer. ''Why is everybody a victim?''
He said too many people who are not disabled demand special favors. ''I mean, I wear eyeglasses,'' he said.
In addition to the threat of a suit under federal or state disability law, businesses must grapple with the Family and Medical Leave Act, which requires them to grant unpaid leave to ill workers. That can create scheduling difficulties.
''This whole area gets complicated, because the medical leave act can mean employees absent from the workplace for extended periods,'' said Stephen A. Bokat, general counsel for the United States Chamber of Commerce. ''That bothers employers even more than an employee needing a half-hour during the day to administer some insulin.''
Health care consultants urge companies to become proactive, try to use tools like wellness programs to forestall diabetes' claim on their workers and install disease management programs to improve existing cases. And many do. Companies dangle $100 incentives (though more often a mug or a T-shirt) if an employee submits to a health assessment or accepts a phone call from a health coach.
But getting participation is hard. And the economic worth of these undertakings to a business is difficult to gauge with a progressive disease like diabetes. Sometimes the evident benefits of in-house health programs are years down the road, when an employee a business invested in may well be working elsewhere.
When Safety Comes First
John Steigauf's fellow mechanics called him ''Flunky.'' The name caught on after Mr. Steigauf gave advice to a prickly supervisor, who thundered, ''I'm not going to let some flunky mechanic tell me how to do my job.'' Mr. Steigauf, 47, wanted it embroidered onto his uniform. Supervisors said forget it.
He joined United Parcel in Minneapolis in 1991, turning wrenches from the start. Five years ago, he learned that he had Type 2 diabetes. Though it often goes with being overweight, he had a wide receiver's build: 6-foot-2, 193 pounds. But his mother had diabetes.
He was put on pills and watched his diet, abandoning his cherished hot chocolate. Yet his blood sugar remained high. If it didn't drop, he would need insulin. That sent fear pumping through him.
U.P.S. requires mechanics, like its interstate drivers, to hold a commercial driver's license and to be cleared to drive out of state so they can road-test trucks. In reality, mechanics could go weeks without leaving the yard, but those were the rules. And at the time, federal officials did not grant interstate licenses to insulin-using diabetics.
They did dispense a few exemptions. But Mr. Steigauf, who started using insulin only in 2004, stood no chance. The requirement was to have driven safely while on insulin for three years.
So Mr. Steigauf tried starving himself, slicing off 30 pounds. It made him crabby, fatigued and so thin ''that if I stuck my tongue out, I looked like a zipper.''
His blood sugars did not budge. But after he took insulin, his diabetes settled down almost at once.
Later in 2004, he had to have a physical to renew his commercial license, a test he could no longer pass. Minnesota did not have the three-year rule, and since he had never had a hypoglycemic episode or other problems, Mr. Steigauf got an exemption to drive within the state. Given that he didn't even leave the county while road-testing trucks, he hoped that would be good enough.
It wasn't. For consistency, U.P.S. wanted all its mechanics to be certified to drive from state to state, whether they needed to or not. So Mr. Steigauf was sent home on disability, even though he felt fine.
Norman Black, a U.P.S. spokesman, said the company had always intended to find Mr. Steigauf another position. He said the company did not discriminate but was passionate about safety.
Studies tracking accident rates of diabetics are inconclusive; some indicate worse outcomes, others don't. But either way, Mr. Steigauf's direct supervisor at the time, Dan Welke, said he thought the company had gone too far, that somebody else could road-test the trucks repaired by Mr. Steigauf.
''It just seemed ridiculous,'' Mr. Welke said.
Mr. Steigauf also had trouble making sense of this. When his diabetes raged out of control, it had been all right to fix trucks. Now, with the illness under control, it wasn't.
When he spoke to someone in human resources, Mr. Steigauf said he was told that he would never come back. The notion that he was a human tinderbox punctuated his interactions. ''I'd be told that I could pull a tractor up to a fuel pump and pass out and the thing would explode,'' he said. ''I was like a grenade and was going to kill people.''
At home in Bloomington, Minn., where Mr. Steigauf's tidy ranch is bordered by a soupçon of lawn, he, his wife, Dawn, their twin daughters and their severely autistic son struggled on a weekly disability check of $431, about half his old pay.
To keep going, he did odd jobs. Friends at U.P.S. dug into their pockets. The family cut one another's hair and skipped sending Christmas cards.
Finally, Mr. Steigauf asked U.P.S. to excuse him from interstate driving as a ''reasonable accommodation'' under disability law. After all, he had left the state for U.P.S. only once in 13 years. Some of his colleagues, he found out, did not even have commercial driver's licenses.
But U.P.S. refused, saying he was not disabled under discrimination law, and thus not entitled to an accommodation.
So, in early 2005, he filed a complaint with the Equal Employment Opportunity Commission and waited, interned in his house, as if he had evaporated -- all the while collecting disability from a company that said he was not disabled.
After seven months, U.P.S. offered him a lower-paying job, fixing trailers. He could not touch an engine or drive. But he took it while he battled for his former position.
Then he had some luck. Federal officials changed their rules on interstate licenses and Mr. Steigauf qualified for a waiver, allowing him to return to his old job. He is expected to start within a month or so.
This fall, the E.E.O.C. concluded that he had been discriminated against and that U.P.S. owed him relief. U.P.S. said it would contest the decision.
Mr. Steigauf is still bitter, not toward U.P.S. itself, but toward the way he believes it treats diabetics. Even now, he feels singled out.
''I've had unloaders at work say to me, 'Are you that diabetic guy?' '' he said. ''I don't know what they mean. Nothing? Or, 'You shouldn't be working here'?''
To keep his exemption, he must obey a complicated protocol to show the Federal Motor Carrier Safety Administration that he remains fit. Every three months, he has to report how much he drives and his sugar levels. If he has an accident, even if someone rams his car while he's in a movie, he has two days to alert the government. He has seven days to let the government know if he has a new car or a new phone number.
''The exemption adds to the discrimination,'' he said one afternoon at home. ''It constantly reminds me that I'm different.''
His children skittered through the room.
''You become a show dog,'' he said. ''I fix engines. I don't want to be a show dog.''
Mental exercises
NYTimes
December 27, 2006
As Minds Age, What's Next? Brain Calisthenics
By PAM BELLUCK
Is there hope for your hippocampus, a new lease for your temporal lobe?
Science is not sure yet, but across the country, brain health programs are springing up, offering the possibility of a cognitive fountain of youth.
From ''brain gyms'' on the Internet to ''brain-healthy'' foods and activities at assisted living centers, the programs are aimed at baby boomers anxious about entering their golden years and at their parents trying to stave off memory loss or dementia.
''This is going to be one of the hottest topics in the next five years -- it's going to be huge,'' said Nancy Ceridwyn, co-director of special projects for the American Society on Aging. ''The challenge we have is it's going to be a lot like the anti-aging industry: how much science is there behind this?''
Dozens of studies are under way. Organizations like AARP are offering tips on brain health. And the Alzheimer's Association conducts hundreds of Maintain Your Brain workshops, many at corporations like Apple Computer and Lockheed Martin.
At least two health insurers are pushing brain health. MetLife is giving prospective clients a 61-page book it commissioned called ''Love Your Brain.'' Humana will provide, free or deeply discounted, $495 worth of brain fitness software to some four million older customers, and offers ''brain fitness camps'' with the software at computer stores and community colleges.
There are Web sites like HappyNeuron.com, which offers subscribers cranial calisthenics, and MyBrainTrainer.com, marketed to anyone who ''ever wished you could be a little quicker, a little sharper mentally.''
And Nintendo's Brain Age, a video game intended for baby boomers and their elders, features simple math, syllable-counting, word memory activities and the quick reading aloud of passages from the likes of Poe and Dickens, which ''gives your prefrontal cortex a workout,'' the instructions say.
''I just felt that, Hey, this is something I ought to do,'' said Roy Gustafson, 85, who tried it at a Nintendo promotion at his Redmond, Wash., retirement community. He quickly got top scores (his ''brain age'' was low 20's), and decided to quit while ahead. But almost daily, he plays the Sudoku games in the handheld device, saying, ''It keeps me alert.''
Whether the hopes for brain health programs are realistic is still largely unknown, scientists say.
Certainly most brain-healthy recommendations are not considered bad for people. They do not have the potential risks of drugs or herbal supplements. And things like physical exercise and Omega-3 fatty acids help the body, even if they do not end up bettering the mind.
''All of the things are good for you to do in general,'' Dr. Elizabeth Edgerly, a clinical psychologist with the Alzheimer's Association, said. ''Do I have concerns? Yes. We're very cautious. Is it going to mean you can remember where you left your car keys? We can't say that.''
Still, the appeal of the programs is strong.
Epoch Senior Living in Providence is among the many assisted living facilities with ''brain fitness centers.'' Surrounded by posters of Einstein, Rodin's ''Thinker,'' and ''Brain Facts'' (''one billion glial cells in the human brain''), residents spend an hour a day for eight weeks doing computer exercises involving recalling story details and distinguishing similar-sounding syllables.
David Horvitz, 92, an Epoch resident, said, ''It did improve my concentration, particularly when I read. Before, my mind would wander and I'd have to reread passages several times. It also seems to me that I'm remembering names a little bit better.''
Emeritus Assisted Living, a chain, started a brain health program for residents, their families, staff members and people in the community. So far, centers in Florida, Massachusetts and South Carolina offer ''brain-healthy'' foods like salmon and walnuts, activities like spelling bees and reminiscing games, prizes to staff members for recalling brain health trivia, and a ''brain health self-assessment'' questionnaire asking, among other things, if people play challenging board games, walk 10,000 steps a day, or eat flax seed three times a week.
The brain program at the Isle at Emerald Court in Tewksbury, Mass., an Emeritus facility, includes a five-day-a-week regimen of leg lifts and stretches on the burgundy jacquard lobby chairs, influenced Ray Decker to choose the center for his mother, Joan, 75, who is in the early stage of Alzheimer's.
''Those types of things may stimulate her brain and, despite her debilitating disease, she actually may come back a little,'' said Mr. Decker, 57, who plans to adopt brain-healthy activities. ''I think that this will keep my mother healthy for some time to come, actually extend her life in a mental and physical manner.''
While there is encouraging animal research, experts say human studies have generally relied on observations of people with healthier brains, but have not tested whether a particular behavior improves brain health. Perhaps people with healthier brains are more likely to do brain-stimulating activities, not the reverse.
''Right now,'' said Dr. Marilyn Albert, director of cognitive neuroscience at Johns Hopkins University, ''we can't say to somebody, 'We know that if you walk a mile every day for the next six months, your memory's going to be better.' We don't know that if you do certain kinds of puzzles it's going to have a benefit.''
In addition, few scientists believe brain health activities prevent dementia, only that they might delay it.
The strongest evidence suggests that cardiovascular exercise also probably helps the brain, by improving blood circulation, experts say.
''What's good for your heart's probably good for your head,'' said Dr. Lynda Anderson, chief of health care and aging studies at the federal Centers for Disease Control and Prevention, which last year received the first Congressional appropriation to study brain health.
Similarly, Dr. Albert said that heart-healthy foods were probably brain-healthy foods.
As for brain-training exercises, studies show improvement from them, though not necessarily in real-life activities, said Dr. David A. Loewenstein, professor of psychiatry and behavioral sciences at the University of Miami medical school.
In a National Institute on Aging study, people given at least 10 hours of training in memory, reasoning or processing speed showed improvement, which held five years later. People reported slightly less difficulty in everyday skills, like handling medication and making telephone calls, but most of those results were not significant, researchers reported.
Dr. Loewenstein, meanwhile, found that people with early Alzheimer's who were trained in real-life tasks like face-name recognition and balancing checkbooks improved significantly in those skills. People given computer memory and concentration games and crossword puzzles did not do as well on real-life tasks, although many thought they were improving, he said.
''Just because you're able to recall a story better after six weeks may not mean that it's had any demonstrable effect on everyday life,'' Dr. Loewenstein said.
Posit Science, a San Francisco company that makes the brain fitness software used by Epoch and Humana, said its own studies, some published, showed that its software improved memory and mental focus.
''We've seen more than 10 years of improvement,'' said Jeff Zimman, the company's chief executive. ''In processing speed, people who were on average 80 years old were performing like 30-year-olds in speed at those tasks.''
Posit, one of several making such software, hopes to adapt it for people with early Alzheimer's, AIDS-related dementia and schizophrenia. Mr. Zimman envisions other uses: corporations hoping to improve brains of older employees; sports enthusiasts and hobbyists honing, say, bird-watching skills.
Emeritus Assisted Living has partnered with Dr. Paul Nussbaum, a neuropsychologist advocating social, mental, spiritual, nutritional and physical ways to promote brain health, to make its 180 homes ''brain health centers for the community,'' said Chris Guay, a divisional director of operations. The Isle at Emerald Court hands out brain-shaped stress balls and plans to fly a brain flag out front. One administrator tried stimulating her brain by writing with her opposite hand (with barely legible results). The maintenance director wears a pedometer and gives them to visitors. An Emeritus center in Florida is lobbying grocery stores for brain-healthy food displays.
Mr. Guay said he hoped the program would attract ''more people to fill our buildings'' and ''help us retain employees.''
Some experts say even if there is little cognitive benefit, there may be psychic benefit to mental exercises.
''I feel my brain is better,'' said Dorothy Pereshluha, 84, a resident at Isle at Emerald Court, who had trouble finding her room and remembering names when she moved in.
Alice Babulicz, 75, a resident at Wartburg Assisted Living in Mount Vernon, N.Y., which uses brain fitness software, said she paid more attention in church and was so energized that ''now I can walk four or five blocks.''
And Marcia Mittleman, 88, who took Epoch's course twice, with graduation and a medal, said that psychologically, it ''filled a void.''
Asked if her cognitive function improved, she replied, ''Did it make me smarter? No.''
Suddenly, she scanned the room. ''Did anyone see my walker?''
December 27, 2006
As Minds Age, What's Next? Brain Calisthenics
By PAM BELLUCK
Is there hope for your hippocampus, a new lease for your temporal lobe?
Science is not sure yet, but across the country, brain health programs are springing up, offering the possibility of a cognitive fountain of youth.
From ''brain gyms'' on the Internet to ''brain-healthy'' foods and activities at assisted living centers, the programs are aimed at baby boomers anxious about entering their golden years and at their parents trying to stave off memory loss or dementia.
''This is going to be one of the hottest topics in the next five years -- it's going to be huge,'' said Nancy Ceridwyn, co-director of special projects for the American Society on Aging. ''The challenge we have is it's going to be a lot like the anti-aging industry: how much science is there behind this?''
Dozens of studies are under way. Organizations like AARP are offering tips on brain health. And the Alzheimer's Association conducts hundreds of Maintain Your Brain workshops, many at corporations like Apple Computer and Lockheed Martin.
At least two health insurers are pushing brain health. MetLife is giving prospective clients a 61-page book it commissioned called ''Love Your Brain.'' Humana will provide, free or deeply discounted, $495 worth of brain fitness software to some four million older customers, and offers ''brain fitness camps'' with the software at computer stores and community colleges.
There are Web sites like HappyNeuron.com, which offers subscribers cranial calisthenics, and MyBrainTrainer.com, marketed to anyone who ''ever wished you could be a little quicker, a little sharper mentally.''
And Nintendo's Brain Age, a video game intended for baby boomers and their elders, features simple math, syllable-counting, word memory activities and the quick reading aloud of passages from the likes of Poe and Dickens, which ''gives your prefrontal cortex a workout,'' the instructions say.
''I just felt that, Hey, this is something I ought to do,'' said Roy Gustafson, 85, who tried it at a Nintendo promotion at his Redmond, Wash., retirement community. He quickly got top scores (his ''brain age'' was low 20's), and decided to quit while ahead. But almost daily, he plays the Sudoku games in the handheld device, saying, ''It keeps me alert.''
Whether the hopes for brain health programs are realistic is still largely unknown, scientists say.
Certainly most brain-healthy recommendations are not considered bad for people. They do not have the potential risks of drugs or herbal supplements. And things like physical exercise and Omega-3 fatty acids help the body, even if they do not end up bettering the mind.
''All of the things are good for you to do in general,'' Dr. Elizabeth Edgerly, a clinical psychologist with the Alzheimer's Association, said. ''Do I have concerns? Yes. We're very cautious. Is it going to mean you can remember where you left your car keys? We can't say that.''
Still, the appeal of the programs is strong.
Epoch Senior Living in Providence is among the many assisted living facilities with ''brain fitness centers.'' Surrounded by posters of Einstein, Rodin's ''Thinker,'' and ''Brain Facts'' (''one billion glial cells in the human brain''), residents spend an hour a day for eight weeks doing computer exercises involving recalling story details and distinguishing similar-sounding syllables.
David Horvitz, 92, an Epoch resident, said, ''It did improve my concentration, particularly when I read. Before, my mind would wander and I'd have to reread passages several times. It also seems to me that I'm remembering names a little bit better.''
Emeritus Assisted Living, a chain, started a brain health program for residents, their families, staff members and people in the community. So far, centers in Florida, Massachusetts and South Carolina offer ''brain-healthy'' foods like salmon and walnuts, activities like spelling bees and reminiscing games, prizes to staff members for recalling brain health trivia, and a ''brain health self-assessment'' questionnaire asking, among other things, if people play challenging board games, walk 10,000 steps a day, or eat flax seed three times a week.
The brain program at the Isle at Emerald Court in Tewksbury, Mass., an Emeritus facility, includes a five-day-a-week regimen of leg lifts and stretches on the burgundy jacquard lobby chairs, influenced Ray Decker to choose the center for his mother, Joan, 75, who is in the early stage of Alzheimer's.
''Those types of things may stimulate her brain and, despite her debilitating disease, she actually may come back a little,'' said Mr. Decker, 57, who plans to adopt brain-healthy activities. ''I think that this will keep my mother healthy for some time to come, actually extend her life in a mental and physical manner.''
While there is encouraging animal research, experts say human studies have generally relied on observations of people with healthier brains, but have not tested whether a particular behavior improves brain health. Perhaps people with healthier brains are more likely to do brain-stimulating activities, not the reverse.
''Right now,'' said Dr. Marilyn Albert, director of cognitive neuroscience at Johns Hopkins University, ''we can't say to somebody, 'We know that if you walk a mile every day for the next six months, your memory's going to be better.' We don't know that if you do certain kinds of puzzles it's going to have a benefit.''
In addition, few scientists believe brain health activities prevent dementia, only that they might delay it.
The strongest evidence suggests that cardiovascular exercise also probably helps the brain, by improving blood circulation, experts say.
''What's good for your heart's probably good for your head,'' said Dr. Lynda Anderson, chief of health care and aging studies at the federal Centers for Disease Control and Prevention, which last year received the first Congressional appropriation to study brain health.
Similarly, Dr. Albert said that heart-healthy foods were probably brain-healthy foods.
As for brain-training exercises, studies show improvement from them, though not necessarily in real-life activities, said Dr. David A. Loewenstein, professor of psychiatry and behavioral sciences at the University of Miami medical school.
In a National Institute on Aging study, people given at least 10 hours of training in memory, reasoning or processing speed showed improvement, which held five years later. People reported slightly less difficulty in everyday skills, like handling medication and making telephone calls, but most of those results were not significant, researchers reported.
Dr. Loewenstein, meanwhile, found that people with early Alzheimer's who were trained in real-life tasks like face-name recognition and balancing checkbooks improved significantly in those skills. People given computer memory and concentration games and crossword puzzles did not do as well on real-life tasks, although many thought they were improving, he said.
''Just because you're able to recall a story better after six weeks may not mean that it's had any demonstrable effect on everyday life,'' Dr. Loewenstein said.
Posit Science, a San Francisco company that makes the brain fitness software used by Epoch and Humana, said its own studies, some published, showed that its software improved memory and mental focus.
''We've seen more than 10 years of improvement,'' said Jeff Zimman, the company's chief executive. ''In processing speed, people who were on average 80 years old were performing like 30-year-olds in speed at those tasks.''
Posit, one of several making such software, hopes to adapt it for people with early Alzheimer's, AIDS-related dementia and schizophrenia. Mr. Zimman envisions other uses: corporations hoping to improve brains of older employees; sports enthusiasts and hobbyists honing, say, bird-watching skills.
Emeritus Assisted Living has partnered with Dr. Paul Nussbaum, a neuropsychologist advocating social, mental, spiritual, nutritional and physical ways to promote brain health, to make its 180 homes ''brain health centers for the community,'' said Chris Guay, a divisional director of operations. The Isle at Emerald Court hands out brain-shaped stress balls and plans to fly a brain flag out front. One administrator tried stimulating her brain by writing with her opposite hand (with barely legible results). The maintenance director wears a pedometer and gives them to visitors. An Emeritus center in Florida is lobbying grocery stores for brain-healthy food displays.
Mr. Guay said he hoped the program would attract ''more people to fill our buildings'' and ''help us retain employees.''
Some experts say even if there is little cognitive benefit, there may be psychic benefit to mental exercises.
''I feel my brain is better,'' said Dorothy Pereshluha, 84, a resident at Isle at Emerald Court, who had trouble finding her room and remembering names when she moved in.
Alice Babulicz, 75, a resident at Wartburg Assisted Living in Mount Vernon, N.Y., which uses brain fitness software, said she paid more attention in church and was so energized that ''now I can walk four or five blocks.''
And Marcia Mittleman, 88, who took Epoch's course twice, with graduation and a medal, said that psychologically, it ''filled a void.''
Asked if her cognitive function improved, she replied, ''Did it make me smarter? No.''
Suddenly, she scanned the room. ''Did anyone see my walker?''
Tuesday, January 02, 2007
Body weight exercises
The Best Exercise You're Not Doing
By Alwyn Cosgrove, Men's Health
Men's Health
As a trainer, I've witnessed some amazing things in the gym, most of which involved 300-pound powerlifters moving weight equal to that of a small SUV. (There was also the adult-film star I trained who had an orgasm every time she did hanging leg raises, but that's another story.)
The most impressive feat I've ever seen, though, came courtesy of a 160-pound guy named Steve Cotter. Steve's a martial artist, and one day he did a dozen single-leg squats while holding an 88-pound kettlebell in each hand. If that doesn't sound particularly jaw-dropping, try doing one—without any weights.
And there lies an important point: Despite the plethora of gym equipment available, some of the greatest exercises remain the ones you can do with just your body weight—for instance, the single-arm pullup and the handstand pushup. Or the lower-body version, the best movement to build leg strength and improve athletic performance: the full-range, rock-bottom, single-leg squat.
So, while you may not be the strongest guy in the gym, you can still turn heads by banging out a set of single-leg squats. And the attention is just a side benefit. Master this one exercise and you'll see gains in strength, speed and balance. You'll squat more weight, jump higher and discover athletic ability you never had before. The best part: You can do it all without setting foot in a gym.
Test Your Best
To determine your training plan, do as many single-leg squats as you can. If you aren't able to perform at least two repetitions flawlessly, note the spot during your descent at which you can't control your speed of movement. This is your "breaking point"—and you'll need to know it to complete the routine. Once you've finished the test, proceed to the workout here that most closely matches your maximum effort.
Single-Leg Squat
Stand on a bench or box that's about knee height. Hold your arms in front of you and flex your right ankle so your toes are higher than your heel. Keeping your torso as upright as possible, bend your left knee and slowly lower your body until your right heel lightly touches the floor. Pause for 1 second, then push yourself up. That's one repetition.
YOUR BEST EFFORT: 0 TO 1 REPS
THE PROBLEM: Individually, your legs aren't strong enough to support your body weight through the entire range of motion.
THE FIX: A two-pronged attack using "negatives" and "partials," both of which help you challenge your weak spots and lower your breaking point. Do this workout once every 4 days until you can perform at least two single-leg squats with perfect form.
Step 1: Negative Squat
Stand on your left leg, facing away from a bench. Holding your arms and your right leg in the air in front of you, slowly lower your body until your butt is slightly higher than your breaking point. (Ideally, this should take 5 to 7 seconds.) Sit, then stand up using both legs. That's one repetition. Do six reps with your left leg, then six more with your right. Complete a set. Rest for 2 to 3 minutes and move on to step 2.
Step 2: Partial Squat
Stand on a bench holding a pair of 5-pound dumbbells. As you perform a single-leg squat, simultaneously lift the dumbbells in front of you to shoulder height. (This helps counterbalance your body, making the movement easier.) Again, lower your body until you're just above your breaking point, then pause for 2 seconds before pushing yourself back up. Do 10 repetitions with each leg, pausing for 10 seconds instead of 2 on the last rep with each.
YOUR BEST EFFORT: 2 TO 5 REPS
THE PROBLEM: Because you can't adjust the weight you're using, as you can with free weights, your muscles give out quickly — and that limits the total number of repetitions you can perform, a key factor in increasing strength.
THE FIX: A technique called escalating density training, or EDT. Popularized by Charles Staley, author of Muscle Logic, this method helps you slow the onset of fatigue, so you can complete more total repetitions than usual. Instead of doing as many reps as you can in each set, you'll do more sets of fewer repetitions. In addition, you'll further increase the challenge to your legs by adding two other single-leg exercises: the Bulgarian split squat and the high stepup.
Step 1: Determine your starting point
Take the number of single-leg squats you can complete with perfect form and divide it by two. That's how many repetitions you'll do each set. (If your best effort is three, round down to one.) Perform the four-week EDT routine below once every four days, doing the number of sets indicated and resting after each for the prescribed amount of time.
Step 2: Bulgarian Split Squat
Stand with a bench about 2 feet behind you and place the instep of your right foot on the bench. Keeping your torso upright, lower your body until your left thigh is parallel to the floor. Your left lower leg should remain perpendicular to the floor. Pause, then push yourself back to the starting position as quickly as you can. Do 12 to 15 repetitions, then repeat, this time with your left foot resting on the bench and your right foot in front. After you've worked both legs, immediately (without resting) complete step 3.
Step 3: High Stepup
Stand facing a bench or step that's about knee height. Lift your left foot and place it firmly on the bench, push down with your left heel, and push your body upward until your left leg is straight and your right foot hangs off the bench. Lower yourself back down. That's one rep. Do 12 to 15, then do the same number of reps with your right leg.
YOUR BEST EFFORT: 6 TO 9 REPS
THE PROBLEM: You have poor endurance.
THE FIX: Training your muscles to resist fatigue. Perform the following routine once every 4 days for 5 weeks.
Step 1
Do as many single-leg squats as you can, then rest for 60 seconds
Step 2
Repeat until you've completed twice the number of reps you achieved in your first set.
So, if you do seven reps in your first set, you'll do as many sets as needed to complete 14 reps. For each subsequent workout, this will be your repetition goal.
Step 3
Each workout, try to reach your repetition goal in fewer sets. For instance, if you need five sets in your first workout, aim for your goal in four sets in your next session. After five weeks, repeat the entire process. But in order to keep improving, do the exercise while holding dumbbells at your sides.
By Alwyn Cosgrove, Men's Health
Men's Health
As a trainer, I've witnessed some amazing things in the gym, most of which involved 300-pound powerlifters moving weight equal to that of a small SUV. (There was also the adult-film star I trained who had an orgasm every time she did hanging leg raises, but that's another story.)
The most impressive feat I've ever seen, though, came courtesy of a 160-pound guy named Steve Cotter. Steve's a martial artist, and one day he did a dozen single-leg squats while holding an 88-pound kettlebell in each hand. If that doesn't sound particularly jaw-dropping, try doing one—without any weights.
And there lies an important point: Despite the plethora of gym equipment available, some of the greatest exercises remain the ones you can do with just your body weight—for instance, the single-arm pullup and the handstand pushup. Or the lower-body version, the best movement to build leg strength and improve athletic performance: the full-range, rock-bottom, single-leg squat.
So, while you may not be the strongest guy in the gym, you can still turn heads by banging out a set of single-leg squats. And the attention is just a side benefit. Master this one exercise and you'll see gains in strength, speed and balance. You'll squat more weight, jump higher and discover athletic ability you never had before. The best part: You can do it all without setting foot in a gym.
Test Your Best
To determine your training plan, do as many single-leg squats as you can. If you aren't able to perform at least two repetitions flawlessly, note the spot during your descent at which you can't control your speed of movement. This is your "breaking point"—and you'll need to know it to complete the routine. Once you've finished the test, proceed to the workout here that most closely matches your maximum effort.
Single-Leg Squat
Stand on a bench or box that's about knee height. Hold your arms in front of you and flex your right ankle so your toes are higher than your heel. Keeping your torso as upright as possible, bend your left knee and slowly lower your body until your right heel lightly touches the floor. Pause for 1 second, then push yourself up. That's one repetition.
YOUR BEST EFFORT: 0 TO 1 REPS
THE PROBLEM: Individually, your legs aren't strong enough to support your body weight through the entire range of motion.
THE FIX: A two-pronged attack using "negatives" and "partials," both of which help you challenge your weak spots and lower your breaking point. Do this workout once every 4 days until you can perform at least two single-leg squats with perfect form.
Step 1: Negative Squat
Stand on your left leg, facing away from a bench. Holding your arms and your right leg in the air in front of you, slowly lower your body until your butt is slightly higher than your breaking point. (Ideally, this should take 5 to 7 seconds.) Sit, then stand up using both legs. That's one repetition. Do six reps with your left leg, then six more with your right. Complete a set. Rest for 2 to 3 minutes and move on to step 2.
Step 2: Partial Squat
Stand on a bench holding a pair of 5-pound dumbbells. As you perform a single-leg squat, simultaneously lift the dumbbells in front of you to shoulder height. (This helps counterbalance your body, making the movement easier.) Again, lower your body until you're just above your breaking point, then pause for 2 seconds before pushing yourself back up. Do 10 repetitions with each leg, pausing for 10 seconds instead of 2 on the last rep with each.
YOUR BEST EFFORT: 2 TO 5 REPS
THE PROBLEM: Because you can't adjust the weight you're using, as you can with free weights, your muscles give out quickly — and that limits the total number of repetitions you can perform, a key factor in increasing strength.
THE FIX: A technique called escalating density training, or EDT. Popularized by Charles Staley, author of Muscle Logic, this method helps you slow the onset of fatigue, so you can complete more total repetitions than usual. Instead of doing as many reps as you can in each set, you'll do more sets of fewer repetitions. In addition, you'll further increase the challenge to your legs by adding two other single-leg exercises: the Bulgarian split squat and the high stepup.
Step 1: Determine your starting point
Take the number of single-leg squats you can complete with perfect form and divide it by two. That's how many repetitions you'll do each set. (If your best effort is three, round down to one.) Perform the four-week EDT routine below once every four days, doing the number of sets indicated and resting after each for the prescribed amount of time.
Step 2: Bulgarian Split Squat
Stand with a bench about 2 feet behind you and place the instep of your right foot on the bench. Keeping your torso upright, lower your body until your left thigh is parallel to the floor. Your left lower leg should remain perpendicular to the floor. Pause, then push yourself back to the starting position as quickly as you can. Do 12 to 15 repetitions, then repeat, this time with your left foot resting on the bench and your right foot in front. After you've worked both legs, immediately (without resting) complete step 3.
Step 3: High Stepup
Stand facing a bench or step that's about knee height. Lift your left foot and place it firmly on the bench, push down with your left heel, and push your body upward until your left leg is straight and your right foot hangs off the bench. Lower yourself back down. That's one rep. Do 12 to 15, then do the same number of reps with your right leg.
YOUR BEST EFFORT: 6 TO 9 REPS
THE PROBLEM: You have poor endurance.
THE FIX: Training your muscles to resist fatigue. Perform the following routine once every 4 days for 5 weeks.
Step 1
Do as many single-leg squats as you can, then rest for 60 seconds
Step 2
Repeat until you've completed twice the number of reps you achieved in your first set.
So, if you do seven reps in your first set, you'll do as many sets as needed to complete 14 reps. For each subsequent workout, this will be your repetition goal.
Step 3
Each workout, try to reach your repetition goal in fewer sets. For instance, if you need five sets in your first workout, aim for your goal in four sets in your next session. After five weeks, repeat the entire process. But in order to keep improving, do the exercise while holding dumbbells at your sides.
Monday, December 25, 2006
DeBakey's surgery
NYTimes
December 25, 2006
The Doctor’s World
The Man on the Table Devised the Surgery
By LAWRENCE K. ALTMAN
In late afternoon last Dec. 31, Dr. Michael E. DeBakey, then 97, was alone at home in Houston in his study preparing a lecture when a sharp pain ripped through his upper chest and between his shoulder blades, then moved into his neck.
Dr. DeBakey, one of the most influential heart surgeons in history, assumed his heart would stop in a few seconds.
“It never occurred to me to call 911 or my physician,” Dr. DeBakey said, adding: “As foolish as it may appear, you are, in a sense, a prisoner of the pain, which was intolerable. You’re thinking, What could I do to relieve myself of it. If it becomes intense enough, you’re perfectly willing to accept cardiac arrest as a possible way of getting rid of the pain.”
But when his heart kept beating, Dr. DeBakey suspected that he was not having a heart attack. As he sat alone, he decided that a ballooning had probably weakened the aorta, the main artery leading from the heart, and that the inner lining of the artery had torn, known as a dissecting aortic aneurysm.
No one in the world was more qualified to make that diagnosis than Dr. DeBakey because, as a younger man, he devised the operation to repair such torn aortas, a condition virtually always fatal. The operation has been performed at least 10,000 times around the world and is among the most demanding for surgeons and patients.
Over the past 60 years, Dr. DeBakey has changed the way heart surgery is performed. He was one of the first to perform coronary bypass operations. He trained generations of surgeons at the Baylor College of Medicine; operated on more than 60,000 patients; and in 1996 was summoned to Moscow by Boris Yeltsin, then the president of Russia, to aid in his quintuple heart bypass operation.
Now Dr. DeBakey is making history in a different way — as a patient. He was released from Methodist Hospital in Houston in September and is back at work. At 98, he is the oldest survivor of his own operation, proving that a healthy man of his age could endure it.
“He’s probably right out there at the cutting edge of a whole generation of people in their 90s who are going to survive” after such medical ordeals, one of his doctors, Dr. James L. Pool, said.
But beyond the medical advances, Dr. DeBakey’s story is emblematic of the difficulties that often accompany care at the end of life. It is a story of debates over how far to go in treating someone so old, late-night disputes among specialists about what the patient would want, and risky decisions that, while still being argued over, clearly saved Dr. DeBakey’s life.
It is also a story of Dr. DeBakey himself, a strong-willed pioneer who at one point was willing to die, concedes he was at times in denial about how sick he was and is now plowing into life with as much zest and verve as ever.
But Dr. DeBakey’s rescue almost never happened.
He refused to be admitted to a hospital until late January. As his health deteriorated and he became unresponsive in the hospital in early February, his surgical partner of 40 years, Dr. George P. Noon, decided an operation was the only way to save his life. But the hospital’s anesthesiologists refused to put Dr. DeBakey to sleep because such an operation had never been performed on someone his age and in his condition. Also, they said Dr. DeBakey had signed a directive that forbade surgery.
As the hospital’s ethics committee debated in a late-night emergency meeting on the 12th floor of Methodist Hospital, Dr. DeBakey’s wife, Katrin, barged in to demand that the operation begin immediately.
In the end, the ethics committee approved the operation; an anesthesiology colleague of Dr. DeBakey’s, who now works at a different hospital, agreed to put him to sleep; and the seven-hour operation began shortly before midnight on Feb. 9. “It is a miracle,” Dr. DeBakey said as he sat eating dinner in a Houston restaurant recently. “I really should not be here.”
The costs of Dr. DeBakey’s care easily exceeded $1 million. Methodist Hospital and his doctors say they have not charged Dr. DeBakey. His hospitalizations were under pseudonyms to help protect his privacy, which could make collecting insurance difficult. Methodist Hospital declined to say what the costs were or discuss the case further. Dr. DeBakey says he thinks the hospital should not have been secretive about his illness.
Dr. DeBakey’s doctors acknowledge that he got an unusually high level of care. But they said that they always tried to abide by a family’s wishes and that they would perform the procedure on any patient regardless of age, if the patient’s overall health was otherwise good.
Dr. DeBakey agreed to talk, and permitted his doctors to talk, because of a professional relationship of decades with this reporter, who is also a physician, and because he wanted to set the record straight for the public about what happened and explain how a man nearly 100 years old could survive.
A Preliminary Diagnosis
As Dr. DeBakey lay on the couch alone that night, last New Year’s Eve, he reasoned that a heart attack was unlikely because periodic checkups had never indicated he was at risk. An aortic dissection was more likely because of the pain, even though there was no hint of that problem in a routine echocardiogram a few weeks earlier.
Mrs. DeBakey and their daughter, Olga, had left for the beach in Galveston, but turned back because of heavy traffic. They arrived home to find Dr. DeBakey lying on the couch. Not wanting to alarm them, he lied and said he had fallen asleep and awakened with a pulled muscle.
“I did not want Katrin to be aware of my self-diagnosis because, in a sense, I would be telling her that I am going to die soon,” he said.
An anxious Mrs. DeBakey called two of her husband’s colleagues: Dr. Mohammed Attar, his longtime physician, and Dr. Matthias Loebe, who was covering for Dr. Noon. They came to the house quickly and became concerned because Dr. DeBakey had been in excellent health. After listening to him give a more frank account of his pain, they shared his suspicion of an aortic dissection.
Dr. DeBakey and his doctors agreed that for a firm diagnosis he would need a CT scan and other imaging tests, but he delayed them until Jan. 3.
The tests showed that Dr. DeBakey had a type 2 dissecting aortic aneurysm, according to a standard classification system he himself devised years earlier. Rarely did anyone survive that without surgery.
Still, Dr. DeBakey says that he refused admission to Methodist Hospital, in part because he did not want to be confined and he “was hopeful that this was not as bad as I first thought.” He feared the operation that he had developed to treat this condition might, at his age, leave him mentally or physically crippled. “I’d rather die,” he said.
Over the years, he had performed anatomically perfect operations on some patients who nevertheless died or survived with major complications. “I was trying to avoid all that,” he said.
Instead, he gambled on long odds that his damaged aorta would heal on its own. He chose to receive care at home. For more than three weeks, doctors made frequent house calls to make sure his blood pressure was low enough to prevent the aorta from rupturing. Around the clock, nurses monitored his food and drink. Periodically, he went to Methodist Hospital for imaging tests to measure the aneurysm’s size.
On Jan. 6, he insisted on giving the lecture he had been preparing on New Year’s Eve to the Academy of Medicine, Engineering and Science of Texas, of which he is a founding member. The audience in Houston included Nobel Prize winners and Senator Kay Bailey Hutchison.
Mrs. DeBakey stationed people around the podium to catch her husband if he slumped. Dr. DeBakey looked gray and spoke softly, but finished without incident. Then he listened to another lecture — which, by coincidence, was about the lethal dangers of dissecting aneurysms.
Dr. DeBakey, a master politician, said he could not pass up a chance to chat with the senator. He attended the academy luncheon and then went home.
In providing the extraordinary home care, the doctors were respecting the wishes of Dr. DeBakey and their actions reflected their awe of his power.
“People are very scared of him around here,” said Dr. Loebe, the heart surgeon who came to Dr. DeBakey’s home on New Year’s Eve. “He is the authority. It is very difficult to stand up and tell him what to do.”
But as time went on, the doctors could not adequately control Dr. DeBakey’s blood pressure. His nutrition was poor. He became short of breath. His kidneys failed. Fluid collected in the pericardial sac covering his heart, suggesting the aneurysm was leaking.
Dr. DeBakey now says that he was in denial. He did not admit to himself that he was getting worse. But on Jan. 23, he yielded and was admitted to the hospital.
Tests showed that the aneurysm was enlarging dangerously; the diameter increased to 6.6 centimeters on Jan. 28, up from 5.2 centimeters on Jan. 3. Dr. Noon said that when he and other doctors showed Dr. DeBakey the scans and recommended surgery, Dr. DeBakey said he would re-evaluate the situation in a few days.
By Feb. 9, with the aneurysm up to 7.5 centimeters and Dr. DeBakey unresponsive and near death, a decision had to be made.
“If we didn’t operate on him that day that was it, he was gone for sure,” Dr. Noon said.
At that point, Dr. DeBakey was unable to speak for himself. The surgeons gathered and decided they should proceed, despite the dangers. “We were doing what we thought was right,” Dr. Noon said, adding that “nothing made him a hopeless candidate for the operation except for being 97.” All family members agreed to the operation.
Dr. Bobby R. Alford, one of Dr. DeBakey’s physicians and a successor as chancellor of Baylor College of Medicine, said the doctors had qualms. “We could have walked away,” he said.
He and Dr. Noon discussed the decision several times. “We recognized the condemnation that could occur,” Dr. Alford said. “The whole surgical world would come down on us for doing something stupid, which it might have seemed to people who were not there.”
Surgery would be enormously risky and unlikely to offer clear-cut results — either a full recovery or death, Dr. Noon and his colleagues told Mrs. DeBakey, Olga, sons from a first marriage, and Dr. DeBakey’s sisters, Lois and Selma. The doctors said Dr. DeBakey might develop new ailments and need dialysis and a tracheostomy to help his breathing. They said the family’s decision could inflict prolonged suffering for all involved.
Olga and she “prayed a lot,” said Mrs. DeBakey, who is from Germany. “We had a healer in Europe who advised us that he will come through it. That helped us.”
Then things got more complicated.
A Refusal to Treat
At that point the Methodist Hospital anesthesiologists adamantly refused to accept Dr. DeBakey as a patient. They cited a standard form he had signed directing that he not be resuscitated if his heart stopped and a note in the chart saying he did not want surgery for the aortic dissection and aneurysm. They were concerned about his age and precarious physical condition.
Dr. Alford, the 72-year-old chancellor, said he was stunned by the refusal, an action he had never seen or heard about in his career.
Dr. Noon said none of the anesthesiologists had been involved in Dr. DeBakey’s care, yet they made a decision based on grapevine information without reading his medical records. So he insisted that the anesthesiologists state their objections directly to the DeBakey family.
Mrs. DeBakey said the anesthesiologists feared that Dr. DeBakey would die on the operating table and did not want to become known as the doctors who killed him. Dr. Joseph J. Naples, the hospital’s chief anesthesiologist, did not return repeated telephone calls to his office for comment.
Around 7 p.m., Mrs. DeBakey called Dr. Salwa A. Shenaq, an anesthesiologist friend who had worked with Dr. DeBakey for 22 years at Methodist Hospital and who now works at the nearby Michael E. DeBakey Veterans Affairs Medical Center.
Dr. Shenaq rushed from home. When she arrived, she said, Dr. Naples told her that he and his staff would not administer anesthesia to Dr. DeBakey. She said that a medical staff officer, whom she declined to name, warned her that she could be charged with assault if she touched Dr. DeBakey. The officer also told Dr. Shenaq that she could not give Dr. DeBakey anesthesia because she did not have Methodist Hospital privileges. She made it clear that she did, she said.
Administrators, lawyers and doctors discussed the situation, in particular the ambiguities of Dr. DeBakey’s wishes. Yes, Dr. Pool had written on his chart that Dr. DeBakey said he did not want surgery for a dissection. But Dr. Noon and the family thought the note in the chart no longer applied because Dr. DeBakey’s condition had so deteriorated and his only hope was his own procedure.
“They were going back and forth,” Dr. Shenaq said. “One time, they told me go ahead. Then, no, we cannot go ahead.”
To fulfill its legal responsibilities, Methodist Hospital summoned members of its ethics committee, who arrived in an hour. They met with Dr. DeBakey’s doctors in a private dining room a few yards from Dr. DeBakey’s room, according to five of his doctors who were present.
Their patient was a man who had always been in command. Now an unresponsive Dr. DeBakey had no control over his own destiny.
The ethics committee representatives wanted to follow Texas law, which, in part, requires assurance that doctors respect patient and family wishes.
Each of Dr. DeBakey’s doctors had worked with him for more than 20 years. One, Dr. Pool, said they felt they knew Dr. DeBakey well enough to answer another crucial question from the ethics committee: As his physicians, what did they believe he would choose for himself in such a dire circumstance if he had the ability to make that decision?
Dr. Noon said that Dr. DeBakey had told him it was time for nature to take its course, but also told him that the doctors had “to do what we need to do.” Members of Dr. DeBakey’s medical team said they interpreted the statements differently. Some thought he meant that they should do watchful waiting, acting only if conditions warranted; others thought it meant he wanted to die.
The question was whether the operation would counter Dr. DeBakey’s wishes expressed in his signed “do not resuscitate” order. Some said that everything Dr. DeBakey did was for his family. And the family wanted the operation.
After the committee members had met for an hour, Mrs. DeBakey could stand it no longer. She charged into the room.
“My husband’s going to die before we even get a chance to do anything — let’s get to work,” she said she told them.
The discussion ended. The majority ruled in a consensus without a formal vote. No minutes were kept, the doctors said.
“Boy, when that meeting was over, it was single focus — the best operation, the best post-operative care, the best recovery we could give him,” Dr. Pool said.
The Operation
As the ethics committee meeting ended about 11 p.m. on Feb. 9, the doctors rushed to start Dr. DeBakey’s anesthesia.
The operation was to last seven hours.
For part of that time, Dr. DeBakey’s body was cooled to protect his brain and other organs. His heart was stilled while a heart-lung bypass machine pumped oxygen-rich blood through his body. The surgeons replaced the damaged portion of Dr. DeBakey’s aorta with a six- to eight-inch graft made of Dacron, similar to material used in shirts. The graft was the type that Dr. DeBakey devised in the 1950s.
Afterward, Dr. DeBakey was taken to an intensive care unit.
Some doctors were waiting for Dr. DeBakey to die during the operation or soon thereafter, Dr. Noon said. “But he just got better.”
As feared, however, his recovery was stormy.
Surgeons had to cut separate holes into the trachea in his neck and stomach to help him breathe and eat. He needed dialysis because of kidney failure. He was on a mechanical ventilator for about six weeks because he was too weak to breathe on his own. He developed infections. His blood pressure often fell too low when aides lifted him to a sitting position. Muscle weakness left him unable to stand.
For a month, Dr. DeBakey was in the windowless intensive care unit, sometimes delirious, sometimes unresponsive, depending in part on his medications. The doctors were concerned that he had suffered severe, permanent brain damage. To allow him to tell day from night and lift his spirits, the hospital converted a private suite into an intensive care unit.
Some help came from unexpected places. On Sunday, April 2, Dr. William W. Lunn, the team’s lung specialist, took his oldest daughter, Elizabeth, 8, with him when he made rounds at the hospital and told her that a patient was feeling blue. While waiting, Elizabeth drew a cheery picture of a rainbow, butterflies, trees and grass and asked her father to give it to the patient. He did.
“You should have seen Dr. DeBakey’s eyes brighten,” Dr. Lunn said. Dr. DeBakey asked to see Elizabeth, held her hand and thanked her.
“At that point, I knew he was going to be O.K.,” Dr. Lunn said.
Dr. DeBakey was discharged on May 16. But on June 2, he was back in the hospital.
“He actually scared us because his blood pressure and heart rate were too high, he was gasping for breath” and he had fluid in his lungs, Dr. Lunn said.
But once the blood pressure was controlled with medicine, Dr. DeBakey began to recover well.
The Aftermath
At times, Dr. DeBakey says he played possum with the medical team, pretending to be asleep when he was listening to conversations.
On Aug. 21, when Dr. Loebe asked Dr. DeBakey to wake up, and he did not, Dr. Loebe announced that he had found an old roller pump that Dr. DeBakey devised in the 1930s to transfuse blood. Dr. DeBakey immediately opened his eyes. Then he gave the doctors a short lecture about how he had improved it over existing pumps.
As he recovered and Dr. DeBakey learned what had happened, he told his doctors he was happy they had operated on him. The doctors say they were relieved because they had feared he regretted their decision.
“If they hadn’t done it, I’d be dead,” he said.
The doctors and family had rolled the dice and won.
Dr. DeBakey does not remember signing an order saying not to resuscitate him and now thinks the doctors did the right thing. Doctors, he said, should be able to make decisions in such cases, without committees.
Throughout, Dr. DeBakey’s mental recovery was far ahead of his physical response.
When Dr. DeBakey first became aware of his post-operative condition, he said he “felt limp as a rag” and feared he was a quadriplegic. Kenneth Miller and other physical therapists have helped Dr. DeBakey strengthen his withered muscles.
“There were times where he needed a good bit of encouragement to participate,” Mr. Miller said. “But once he saw the progress, he was fully committed to what we were doing.”
Now he walks increasingly long distances without support. But his main means of locomotion is a motorized scooter. He races it around corridors, sometimes trailed by quick-stepping doctors of all ages.
Dr. DeBakey said he hoped to regain the stamina to resume traveling, though not at his former pace.
Dr. William L. Winters Jr., a cardiologist on Dr. DeBakey’s team, said: “I am impressed with what the body and mind can do when they work together. He absolutely has the desire to get back to where he was before. I think he’ll come close.”
Already, Dr. DeBakey is back working nearly a full day.
“I feel very good,” he said Friday. “I’m getting back into the swing of things.”
December 25, 2006
The Doctor’s World
The Man on the Table Devised the Surgery
By LAWRENCE K. ALTMAN
In late afternoon last Dec. 31, Dr. Michael E. DeBakey, then 97, was alone at home in Houston in his study preparing a lecture when a sharp pain ripped through his upper chest and between his shoulder blades, then moved into his neck.
Dr. DeBakey, one of the most influential heart surgeons in history, assumed his heart would stop in a few seconds.
“It never occurred to me to call 911 or my physician,” Dr. DeBakey said, adding: “As foolish as it may appear, you are, in a sense, a prisoner of the pain, which was intolerable. You’re thinking, What could I do to relieve myself of it. If it becomes intense enough, you’re perfectly willing to accept cardiac arrest as a possible way of getting rid of the pain.”
But when his heart kept beating, Dr. DeBakey suspected that he was not having a heart attack. As he sat alone, he decided that a ballooning had probably weakened the aorta, the main artery leading from the heart, and that the inner lining of the artery had torn, known as a dissecting aortic aneurysm.
No one in the world was more qualified to make that diagnosis than Dr. DeBakey because, as a younger man, he devised the operation to repair such torn aortas, a condition virtually always fatal. The operation has been performed at least 10,000 times around the world and is among the most demanding for surgeons and patients.
Over the past 60 years, Dr. DeBakey has changed the way heart surgery is performed. He was one of the first to perform coronary bypass operations. He trained generations of surgeons at the Baylor College of Medicine; operated on more than 60,000 patients; and in 1996 was summoned to Moscow by Boris Yeltsin, then the president of Russia, to aid in his quintuple heart bypass operation.
Now Dr. DeBakey is making history in a different way — as a patient. He was released from Methodist Hospital in Houston in September and is back at work. At 98, he is the oldest survivor of his own operation, proving that a healthy man of his age could endure it.
“He’s probably right out there at the cutting edge of a whole generation of people in their 90s who are going to survive” after such medical ordeals, one of his doctors, Dr. James L. Pool, said.
But beyond the medical advances, Dr. DeBakey’s story is emblematic of the difficulties that often accompany care at the end of life. It is a story of debates over how far to go in treating someone so old, late-night disputes among specialists about what the patient would want, and risky decisions that, while still being argued over, clearly saved Dr. DeBakey’s life.
It is also a story of Dr. DeBakey himself, a strong-willed pioneer who at one point was willing to die, concedes he was at times in denial about how sick he was and is now plowing into life with as much zest and verve as ever.
But Dr. DeBakey’s rescue almost never happened.
He refused to be admitted to a hospital until late January. As his health deteriorated and he became unresponsive in the hospital in early February, his surgical partner of 40 years, Dr. George P. Noon, decided an operation was the only way to save his life. But the hospital’s anesthesiologists refused to put Dr. DeBakey to sleep because such an operation had never been performed on someone his age and in his condition. Also, they said Dr. DeBakey had signed a directive that forbade surgery.
As the hospital’s ethics committee debated in a late-night emergency meeting on the 12th floor of Methodist Hospital, Dr. DeBakey’s wife, Katrin, barged in to demand that the operation begin immediately.
In the end, the ethics committee approved the operation; an anesthesiology colleague of Dr. DeBakey’s, who now works at a different hospital, agreed to put him to sleep; and the seven-hour operation began shortly before midnight on Feb. 9. “It is a miracle,” Dr. DeBakey said as he sat eating dinner in a Houston restaurant recently. “I really should not be here.”
The costs of Dr. DeBakey’s care easily exceeded $1 million. Methodist Hospital and his doctors say they have not charged Dr. DeBakey. His hospitalizations were under pseudonyms to help protect his privacy, which could make collecting insurance difficult. Methodist Hospital declined to say what the costs were or discuss the case further. Dr. DeBakey says he thinks the hospital should not have been secretive about his illness.
Dr. DeBakey’s doctors acknowledge that he got an unusually high level of care. But they said that they always tried to abide by a family’s wishes and that they would perform the procedure on any patient regardless of age, if the patient’s overall health was otherwise good.
Dr. DeBakey agreed to talk, and permitted his doctors to talk, because of a professional relationship of decades with this reporter, who is also a physician, and because he wanted to set the record straight for the public about what happened and explain how a man nearly 100 years old could survive.
A Preliminary Diagnosis
As Dr. DeBakey lay on the couch alone that night, last New Year’s Eve, he reasoned that a heart attack was unlikely because periodic checkups had never indicated he was at risk. An aortic dissection was more likely because of the pain, even though there was no hint of that problem in a routine echocardiogram a few weeks earlier.
Mrs. DeBakey and their daughter, Olga, had left for the beach in Galveston, but turned back because of heavy traffic. They arrived home to find Dr. DeBakey lying on the couch. Not wanting to alarm them, he lied and said he had fallen asleep and awakened with a pulled muscle.
“I did not want Katrin to be aware of my self-diagnosis because, in a sense, I would be telling her that I am going to die soon,” he said.
An anxious Mrs. DeBakey called two of her husband’s colleagues: Dr. Mohammed Attar, his longtime physician, and Dr. Matthias Loebe, who was covering for Dr. Noon. They came to the house quickly and became concerned because Dr. DeBakey had been in excellent health. After listening to him give a more frank account of his pain, they shared his suspicion of an aortic dissection.
Dr. DeBakey and his doctors agreed that for a firm diagnosis he would need a CT scan and other imaging tests, but he delayed them until Jan. 3.
The tests showed that Dr. DeBakey had a type 2 dissecting aortic aneurysm, according to a standard classification system he himself devised years earlier. Rarely did anyone survive that without surgery.
Still, Dr. DeBakey says that he refused admission to Methodist Hospital, in part because he did not want to be confined and he “was hopeful that this was not as bad as I first thought.” He feared the operation that he had developed to treat this condition might, at his age, leave him mentally or physically crippled. “I’d rather die,” he said.
Over the years, he had performed anatomically perfect operations on some patients who nevertheless died or survived with major complications. “I was trying to avoid all that,” he said.
Instead, he gambled on long odds that his damaged aorta would heal on its own. He chose to receive care at home. For more than three weeks, doctors made frequent house calls to make sure his blood pressure was low enough to prevent the aorta from rupturing. Around the clock, nurses monitored his food and drink. Periodically, he went to Methodist Hospital for imaging tests to measure the aneurysm’s size.
On Jan. 6, he insisted on giving the lecture he had been preparing on New Year’s Eve to the Academy of Medicine, Engineering and Science of Texas, of which he is a founding member. The audience in Houston included Nobel Prize winners and Senator Kay Bailey Hutchison.
Mrs. DeBakey stationed people around the podium to catch her husband if he slumped. Dr. DeBakey looked gray and spoke softly, but finished without incident. Then he listened to another lecture — which, by coincidence, was about the lethal dangers of dissecting aneurysms.
Dr. DeBakey, a master politician, said he could not pass up a chance to chat with the senator. He attended the academy luncheon and then went home.
In providing the extraordinary home care, the doctors were respecting the wishes of Dr. DeBakey and their actions reflected their awe of his power.
“People are very scared of him around here,” said Dr. Loebe, the heart surgeon who came to Dr. DeBakey’s home on New Year’s Eve. “He is the authority. It is very difficult to stand up and tell him what to do.”
But as time went on, the doctors could not adequately control Dr. DeBakey’s blood pressure. His nutrition was poor. He became short of breath. His kidneys failed. Fluid collected in the pericardial sac covering his heart, suggesting the aneurysm was leaking.
Dr. DeBakey now says that he was in denial. He did not admit to himself that he was getting worse. But on Jan. 23, he yielded and was admitted to the hospital.
Tests showed that the aneurysm was enlarging dangerously; the diameter increased to 6.6 centimeters on Jan. 28, up from 5.2 centimeters on Jan. 3. Dr. Noon said that when he and other doctors showed Dr. DeBakey the scans and recommended surgery, Dr. DeBakey said he would re-evaluate the situation in a few days.
By Feb. 9, with the aneurysm up to 7.5 centimeters and Dr. DeBakey unresponsive and near death, a decision had to be made.
“If we didn’t operate on him that day that was it, he was gone for sure,” Dr. Noon said.
At that point, Dr. DeBakey was unable to speak for himself. The surgeons gathered and decided they should proceed, despite the dangers. “We were doing what we thought was right,” Dr. Noon said, adding that “nothing made him a hopeless candidate for the operation except for being 97.” All family members agreed to the operation.
Dr. Bobby R. Alford, one of Dr. DeBakey’s physicians and a successor as chancellor of Baylor College of Medicine, said the doctors had qualms. “We could have walked away,” he said.
He and Dr. Noon discussed the decision several times. “We recognized the condemnation that could occur,” Dr. Alford said. “The whole surgical world would come down on us for doing something stupid, which it might have seemed to people who were not there.”
Surgery would be enormously risky and unlikely to offer clear-cut results — either a full recovery or death, Dr. Noon and his colleagues told Mrs. DeBakey, Olga, sons from a first marriage, and Dr. DeBakey’s sisters, Lois and Selma. The doctors said Dr. DeBakey might develop new ailments and need dialysis and a tracheostomy to help his breathing. They said the family’s decision could inflict prolonged suffering for all involved.
Olga and she “prayed a lot,” said Mrs. DeBakey, who is from Germany. “We had a healer in Europe who advised us that he will come through it. That helped us.”
Then things got more complicated.
A Refusal to Treat
At that point the Methodist Hospital anesthesiologists adamantly refused to accept Dr. DeBakey as a patient. They cited a standard form he had signed directing that he not be resuscitated if his heart stopped and a note in the chart saying he did not want surgery for the aortic dissection and aneurysm. They were concerned about his age and precarious physical condition.
Dr. Alford, the 72-year-old chancellor, said he was stunned by the refusal, an action he had never seen or heard about in his career.
Dr. Noon said none of the anesthesiologists had been involved in Dr. DeBakey’s care, yet they made a decision based on grapevine information without reading his medical records. So he insisted that the anesthesiologists state their objections directly to the DeBakey family.
Mrs. DeBakey said the anesthesiologists feared that Dr. DeBakey would die on the operating table and did not want to become known as the doctors who killed him. Dr. Joseph J. Naples, the hospital’s chief anesthesiologist, did not return repeated telephone calls to his office for comment.
Around 7 p.m., Mrs. DeBakey called Dr. Salwa A. Shenaq, an anesthesiologist friend who had worked with Dr. DeBakey for 22 years at Methodist Hospital and who now works at the nearby Michael E. DeBakey Veterans Affairs Medical Center.
Dr. Shenaq rushed from home. When she arrived, she said, Dr. Naples told her that he and his staff would not administer anesthesia to Dr. DeBakey. She said that a medical staff officer, whom she declined to name, warned her that she could be charged with assault if she touched Dr. DeBakey. The officer also told Dr. Shenaq that she could not give Dr. DeBakey anesthesia because she did not have Methodist Hospital privileges. She made it clear that she did, she said.
Administrators, lawyers and doctors discussed the situation, in particular the ambiguities of Dr. DeBakey’s wishes. Yes, Dr. Pool had written on his chart that Dr. DeBakey said he did not want surgery for a dissection. But Dr. Noon and the family thought the note in the chart no longer applied because Dr. DeBakey’s condition had so deteriorated and his only hope was his own procedure.
“They were going back and forth,” Dr. Shenaq said. “One time, they told me go ahead. Then, no, we cannot go ahead.”
To fulfill its legal responsibilities, Methodist Hospital summoned members of its ethics committee, who arrived in an hour. They met with Dr. DeBakey’s doctors in a private dining room a few yards from Dr. DeBakey’s room, according to five of his doctors who were present.
Their patient was a man who had always been in command. Now an unresponsive Dr. DeBakey had no control over his own destiny.
The ethics committee representatives wanted to follow Texas law, which, in part, requires assurance that doctors respect patient and family wishes.
Each of Dr. DeBakey’s doctors had worked with him for more than 20 years. One, Dr. Pool, said they felt they knew Dr. DeBakey well enough to answer another crucial question from the ethics committee: As his physicians, what did they believe he would choose for himself in such a dire circumstance if he had the ability to make that decision?
Dr. Noon said that Dr. DeBakey had told him it was time for nature to take its course, but also told him that the doctors had “to do what we need to do.” Members of Dr. DeBakey’s medical team said they interpreted the statements differently. Some thought he meant that they should do watchful waiting, acting only if conditions warranted; others thought it meant he wanted to die.
The question was whether the operation would counter Dr. DeBakey’s wishes expressed in his signed “do not resuscitate” order. Some said that everything Dr. DeBakey did was for his family. And the family wanted the operation.
After the committee members had met for an hour, Mrs. DeBakey could stand it no longer. She charged into the room.
“My husband’s going to die before we even get a chance to do anything — let’s get to work,” she said she told them.
The discussion ended. The majority ruled in a consensus without a formal vote. No minutes were kept, the doctors said.
“Boy, when that meeting was over, it was single focus — the best operation, the best post-operative care, the best recovery we could give him,” Dr. Pool said.
The Operation
As the ethics committee meeting ended about 11 p.m. on Feb. 9, the doctors rushed to start Dr. DeBakey’s anesthesia.
The operation was to last seven hours.
For part of that time, Dr. DeBakey’s body was cooled to protect his brain and other organs. His heart was stilled while a heart-lung bypass machine pumped oxygen-rich blood through his body. The surgeons replaced the damaged portion of Dr. DeBakey’s aorta with a six- to eight-inch graft made of Dacron, similar to material used in shirts. The graft was the type that Dr. DeBakey devised in the 1950s.
Afterward, Dr. DeBakey was taken to an intensive care unit.
Some doctors were waiting for Dr. DeBakey to die during the operation or soon thereafter, Dr. Noon said. “But he just got better.”
As feared, however, his recovery was stormy.
Surgeons had to cut separate holes into the trachea in his neck and stomach to help him breathe and eat. He needed dialysis because of kidney failure. He was on a mechanical ventilator for about six weeks because he was too weak to breathe on his own. He developed infections. His blood pressure often fell too low when aides lifted him to a sitting position. Muscle weakness left him unable to stand.
For a month, Dr. DeBakey was in the windowless intensive care unit, sometimes delirious, sometimes unresponsive, depending in part on his medications. The doctors were concerned that he had suffered severe, permanent brain damage. To allow him to tell day from night and lift his spirits, the hospital converted a private suite into an intensive care unit.
Some help came from unexpected places. On Sunday, April 2, Dr. William W. Lunn, the team’s lung specialist, took his oldest daughter, Elizabeth, 8, with him when he made rounds at the hospital and told her that a patient was feeling blue. While waiting, Elizabeth drew a cheery picture of a rainbow, butterflies, trees and grass and asked her father to give it to the patient. He did.
“You should have seen Dr. DeBakey’s eyes brighten,” Dr. Lunn said. Dr. DeBakey asked to see Elizabeth, held her hand and thanked her.
“At that point, I knew he was going to be O.K.,” Dr. Lunn said.
Dr. DeBakey was discharged on May 16. But on June 2, he was back in the hospital.
“He actually scared us because his blood pressure and heart rate were too high, he was gasping for breath” and he had fluid in his lungs, Dr. Lunn said.
But once the blood pressure was controlled with medicine, Dr. DeBakey began to recover well.
The Aftermath
At times, Dr. DeBakey says he played possum with the medical team, pretending to be asleep when he was listening to conversations.
On Aug. 21, when Dr. Loebe asked Dr. DeBakey to wake up, and he did not, Dr. Loebe announced that he had found an old roller pump that Dr. DeBakey devised in the 1930s to transfuse blood. Dr. DeBakey immediately opened his eyes. Then he gave the doctors a short lecture about how he had improved it over existing pumps.
As he recovered and Dr. DeBakey learned what had happened, he told his doctors he was happy they had operated on him. The doctors say they were relieved because they had feared he regretted their decision.
“If they hadn’t done it, I’d be dead,” he said.
The doctors and family had rolled the dice and won.
Dr. DeBakey does not remember signing an order saying not to resuscitate him and now thinks the doctors did the right thing. Doctors, he said, should be able to make decisions in such cases, without committees.
Throughout, Dr. DeBakey’s mental recovery was far ahead of his physical response.
When Dr. DeBakey first became aware of his post-operative condition, he said he “felt limp as a rag” and feared he was a quadriplegic. Kenneth Miller and other physical therapists have helped Dr. DeBakey strengthen his withered muscles.
“There were times where he needed a good bit of encouragement to participate,” Mr. Miller said. “But once he saw the progress, he was fully committed to what we were doing.”
Now he walks increasingly long distances without support. But his main means of locomotion is a motorized scooter. He races it around corridors, sometimes trailed by quick-stepping doctors of all ages.
Dr. DeBakey said he hoped to regain the stamina to resume traveling, though not at his former pace.
Dr. William L. Winters Jr., a cardiologist on Dr. DeBakey’s team, said: “I am impressed with what the body and mind can do when they work together. He absolutely has the desire to get back to where he was before. I think he’ll come close.”
Already, Dr. DeBakey is back working nearly a full day.
“I feel very good,” he said Friday. “I’m getting back into the swing of things.”
Thursday, December 21, 2006
Embracing room clutter
NYTimes
December 21, 2006
Saying Yes to Mess
By PENELOPE GREEN
IT is a truism of American life that we’re too darn messy, or we think we are, and we feel really bad about it. Our desks and dining room tables are awash with paper; our closets are bursting with clothes and sports equipment and old files; our laundry areas boil; our basements and garages seethe. And so do our partners — or our parents, if we happen to be teenagers.
This is why sales of home-organizing products, like accordion files and labelmakers and plastic tubs, keep going up and up, from $5.9 billion last year to a projected $7.6 billion by 2009, as do the revenues of companies that make closet organizing systems, an industry that is pulling in $3 billion a year, according to Closets magazine.
This is why January is now Get Organized Month, thanks also to the efforts of the National Association of Professional Organizers, whose 4,000 clutter-busting members will be poised, clipboards and trash bags at the ready, to minister to the 10,000 clutter victims the association estimates will be calling for its members’ services just after the new year.
But contrarian voices can be heard in the wilderness. An anti-anticlutter movement is afoot, one that says yes to mess and urges you to embrace your disorder. Studies are piling up that show that messy desks are the vivid signatures of people with creative, limber minds (who reap higher salaries than those with neat “office landscapes”) and that messy closet owners are probably better parents and nicer and cooler than their tidier counterparts. It’s a movement that confirms what you have known, deep down, all along: really neat people are not avatars of the good life; they are humorless and inflexible prigs, and have way too much time on their hands.
“It’s chasing an illusion to think that any organization — be it a family unit or a corporation — can be completely rid of disorder on any consistent basis,” said Jerrold Pollak, a neuropsychologist at Seacoast Mental Health Center in Portsmouth, N.H., whose work involves helping people tolerate the inherent disorder in their lives. “And if it could, should it be? Total organization is a futile attempt to deny and control the unpredictability of life. I live in a world of total clutter, advising on cases where you’d think from all the paper it’s the F.B.I. files on the Unabomber,” when, in fact, he said, it’s only “a person with a stiff neck.”
“My wife has threatened divorce over all the piles,” continued Dr. Pollack, who has an office at home, too. “If we had kids the health department would have to be alerted. But what can I do?”
Stop feeling bad, say the mess apologists. There are more urgent things to worry about. Irwin Kula is a rabbi based in Manhattan and author of “Yearnings: Embracing the Sacred Messiness of Life,” which was published by Hyperion in September. “Order can be profane and life-diminishing,” he said the other day. “It’s a flippant remark, but if you’ve never had a messy kitchen, you’ve probably never had a home-cooked meal. Real life is very messy, but we need to have models about how that messiness works.”
His favorite example? His 15-year-old daughter Talia’s bedroom, a picture of utter disorder — and individuality, he said.
“One day I’m standing in front of the door,” he said, “and it’s out of control and my wife, Dana, is freaking out, and suddenly I see in all the piles the dress she wore to her first dance and an earring she wore to her bat mitzvah. She’s so trusting her journal is wide open on the floor, and there are photo-booth pictures of her friends strewn everywhere. I said, ‘Omigod, her cup overflows!’ And we started to laugh.”
The room was an invitation, he said, to search for a deeper meaning under the scurf.
Last week David H. Freedman, another amiable mess analyst (and science journalist), stood bemused in front of the heathery tweed collapsible storage boxes with clear panels ($29.99) at the Container Store in Natick, Mass., and suggested that the main thing most people’s closets are brimming with is unused organizing equipment. “This is another wonderful trend,” Mr. Freedman said dryly, referring to the clear panels. “We’re going to lose the ability to put clutter away. Inside your storage box, you’d better be organized.”
Mr. Freedman is co-author, with Eric Abrahamson, of “A Perfect Mess: The Hidden Benefits of Disorder,” out in two weeks from Little, Brown & Company. The book is a meandering, engaging tour of beneficial mess and the systems and individuals reaping those benefits, like Gov. Arnold Schwarzenegger, whose mess-for-success tips include never making a daily schedule.
As a corollary, the book’s authors examine the high cost of neatness — measured in shame, mostly, and family fights, as well as wasted dollars — and generally have a fine time tipping over orthodoxies and poking fun at clutter busters and their ilk, and at the self-help tips they live or die by. They wonder: Why is it better to pack more activities into one day? By whose standards are procrastinators less effective than their well-scheduled peers? Why should children have to do chores to earn back their possessions if they leave them on the floor, as many professional organizers suggest?
In their book Mr. Freedman and Mr. Abrahamson describe the properties of mess in loving terms. Mess has resonance, they write, which means it can vibrate beyond its own confines and connect to the larger world. It was the overall scumminess of Alexander Fleming’s laboratory that led to his discovery of penicillin, from a moldy bloom in a petri dish he had forgotten on his desk.
Mess is robust and adaptable, like Mr. Schwarzenegger’s open calendar, as opposed to brittle, like a parent’s rigid schedule that doesn’t allow for a small child’s wool-gathering or balkiness. Mess is complete, in that it embraces all sorts of random elements. Mess tells a story: you can learn a lot about people from their detritus, whereas neat — well, neat is a closed book. Neat has no narrative and no personality (as any cover of Real Simple magazine will demonstrate). Mess is also natural, as Mr. Freedman and Mr. Abrahamson point out, and a real time-saver. “It takes extra effort to neaten up a system,” they write. “Things don’t generally neaten themselves.”
Indeed, the most valuable dividend of living with mess may be time. Mr. Freedman, who has three children and a hard-working spouse, Laurie Tobey-Freedman, a preschool special-needs coordinator, is studying Mandarin in his precious spare moments. Perusing a four-door stainless steel shoe cabinet ($149) at the Container Store, and imagining gussying up a shoe collection, he shook his head and said, “I don’t get the appeal of this, which may be a huge defect on my part in terms of higher forms of entertainment.”
The success of the Container Store notwithstanding, there is indeed something messy — and not in a good way — about so many organizing options. “When I think about this urge to organize, it reminds me of how it was when Americans began to take more and more control of their weight: they got fatter,” said Marian Salzman, chief marketing officer of J. Walter Thompson and co-author, with Ira Matathia, of “Next Now: Trends for the Future,” which is about to be published by Palgrave Macmillan. “I never gained weight until I went on a diet,” she said, adding that she has a room in which she hides a treadmill and, now, two bags of organizing supplies.
“I got sick of looking at them so I bought plastic tubs and stuffed the bags in the tubs and put the tubs in the room.” Right now, she said, “we are emotionally overloaded, and so what this is about is that we are getting better and better at living superficially.”
“Superficial is the new intimate,” Ms. Salzman said, gaining steam, “and these boxes, these organizing supplies, are the containers for all our superficial selves. ‘I will be a neater mom, a hipper mom, a mom that gets more done.’ Do I sound cynical?”
Nah.
In the semiotics of mess, desks may be the richest texts. Messy-desk research borrows from cognitive ergonomics, a field of study dealing with how a work environment supports productivity. Consider that desks, our work landscapes, are stand-ins for our brains, and so the piles we array on them are “cognitive artifacts,” or data cues, of our thoughts as we work.
To a professional organizer brandishing colored files and stackable trays, cluttered horizontal surfaces are a horror; to cognitive psychologists like Jay Brand, who works in the Ideation Group of Haworth Inc., the huge office furniture company, their peaks and valleys glow with intellectual intent and showcase a mind whirring away: sorting, linking, producing. (By extension, a clean desk can be seen as a dormant area, an indication that no thought or work is being undertaken.)
His studies and others, like a survey conducted last year by Ajilon Professional Staffing, in Saddle Brook, N.J., which linked messy desks to higher salaries (and neat ones to salaries under $35,000), answer Einstein’s oft-quoted remark, “If a cluttered desk is a sign of a cluttered mind, of what, then, is an empty desk?”
Don Springer, 61, is an information technology project manager and the winner of the Type O-No! contest sponsored by Dymo, the labelmaker manufacturer, in October. The contest offered $5,000 worth of clutter management — for the tools (the boxes, the bins and the systems, as well as a labelmaker) and the services of a professional organizer — to the best example of a “clutter nightmare,” as expressed by contestants in a photograph and a 100-word essay. “Type O-Nos,” reads a definition on the Dymo Web site, are “outlaws on the tidy trail, clutter criminals twice over.”
Mr. Springer, who in a phone interview spoke softly, precisely and with great humor, professed deep shame over the contents of what he calls his oh-by-the-way room, a library/junk room that his wife would like cleaned to make a nursery for a new grandchild. With a full-time job and membership in various clubs and organizations, and a desire to spend his free time seeing a movie with his wife instead of “expending the emotional energy it would take to sort through all the stuff,” Mr. Springer said, he is unable to prune the piles to his wife’s satisfaction. “There are emotional treasures buried in there, and I don’t want to part with them,” he said.
So, why bother?
“Because I love my wife and I want to make her happy,” he said.
According to a small survey that Mr. Freedman and Mr. Abrahamson conducted for their book — 160 adults representing a cross section of genders, races and incomes, Mr. Freedman said — of those who had split up with a partner, one in 12 had done so over a struggle involving one partner’s idea of mess. Happy partnerships turn out not necessarily to be those in which products from Staples figure largely. Mr. Freedman and his wife, for example, have been married for over two decades, and live in an offhandedly messy house with a violently messy basement — the latter area, where their three children hang out, decorated (though that’s not quite the right word) in a pre-1990s Tompkins Square Park lean-to style.
The room’s chaos is an example of one of Mr. Freedman and Mr. Abrahamson’s mess strategies, which is to create a mess-free DMZ (in this case, the basement stairs) and acknowledge areas of complementary mess. Cherish your mess management strategies, suggested Mr. Freedman, speaking approvingly of the pile builders and the under-the-bed stuffers; of those who let their messes wax and wane — the cyclers, he called them; and those who create satellite messes (in storage units off-site). “Most people don’t realize their own efficiency or effectiveness,” he said with a grin.
It’s also nice to remember, as Mr. Freedman pointed out, that almost anything looks pretty neat if it’s shuffled into a pile.
December 21, 2006
Saying Yes to Mess
By PENELOPE GREEN
IT is a truism of American life that we’re too darn messy, or we think we are, and we feel really bad about it. Our desks and dining room tables are awash with paper; our closets are bursting with clothes and sports equipment and old files; our laundry areas boil; our basements and garages seethe. And so do our partners — or our parents, if we happen to be teenagers.
This is why sales of home-organizing products, like accordion files and labelmakers and plastic tubs, keep going up and up, from $5.9 billion last year to a projected $7.6 billion by 2009, as do the revenues of companies that make closet organizing systems, an industry that is pulling in $3 billion a year, according to Closets magazine.
This is why January is now Get Organized Month, thanks also to the efforts of the National Association of Professional Organizers, whose 4,000 clutter-busting members will be poised, clipboards and trash bags at the ready, to minister to the 10,000 clutter victims the association estimates will be calling for its members’ services just after the new year.
But contrarian voices can be heard in the wilderness. An anti-anticlutter movement is afoot, one that says yes to mess and urges you to embrace your disorder. Studies are piling up that show that messy desks are the vivid signatures of people with creative, limber minds (who reap higher salaries than those with neat “office landscapes”) and that messy closet owners are probably better parents and nicer and cooler than their tidier counterparts. It’s a movement that confirms what you have known, deep down, all along: really neat people are not avatars of the good life; they are humorless and inflexible prigs, and have way too much time on their hands.
“It’s chasing an illusion to think that any organization — be it a family unit or a corporation — can be completely rid of disorder on any consistent basis,” said Jerrold Pollak, a neuropsychologist at Seacoast Mental Health Center in Portsmouth, N.H., whose work involves helping people tolerate the inherent disorder in their lives. “And if it could, should it be? Total organization is a futile attempt to deny and control the unpredictability of life. I live in a world of total clutter, advising on cases where you’d think from all the paper it’s the F.B.I. files on the Unabomber,” when, in fact, he said, it’s only “a person with a stiff neck.”
“My wife has threatened divorce over all the piles,” continued Dr. Pollack, who has an office at home, too. “If we had kids the health department would have to be alerted. But what can I do?”
Stop feeling bad, say the mess apologists. There are more urgent things to worry about. Irwin Kula is a rabbi based in Manhattan and author of “Yearnings: Embracing the Sacred Messiness of Life,” which was published by Hyperion in September. “Order can be profane and life-diminishing,” he said the other day. “It’s a flippant remark, but if you’ve never had a messy kitchen, you’ve probably never had a home-cooked meal. Real life is very messy, but we need to have models about how that messiness works.”
His favorite example? His 15-year-old daughter Talia’s bedroom, a picture of utter disorder — and individuality, he said.
“One day I’m standing in front of the door,” he said, “and it’s out of control and my wife, Dana, is freaking out, and suddenly I see in all the piles the dress she wore to her first dance and an earring she wore to her bat mitzvah. She’s so trusting her journal is wide open on the floor, and there are photo-booth pictures of her friends strewn everywhere. I said, ‘Omigod, her cup overflows!’ And we started to laugh.”
The room was an invitation, he said, to search for a deeper meaning under the scurf.
Last week David H. Freedman, another amiable mess analyst (and science journalist), stood bemused in front of the heathery tweed collapsible storage boxes with clear panels ($29.99) at the Container Store in Natick, Mass., and suggested that the main thing most people’s closets are brimming with is unused organizing equipment. “This is another wonderful trend,” Mr. Freedman said dryly, referring to the clear panels. “We’re going to lose the ability to put clutter away. Inside your storage box, you’d better be organized.”
Mr. Freedman is co-author, with Eric Abrahamson, of “A Perfect Mess: The Hidden Benefits of Disorder,” out in two weeks from Little, Brown & Company. The book is a meandering, engaging tour of beneficial mess and the systems and individuals reaping those benefits, like Gov. Arnold Schwarzenegger, whose mess-for-success tips include never making a daily schedule.
As a corollary, the book’s authors examine the high cost of neatness — measured in shame, mostly, and family fights, as well as wasted dollars — and generally have a fine time tipping over orthodoxies and poking fun at clutter busters and their ilk, and at the self-help tips they live or die by. They wonder: Why is it better to pack more activities into one day? By whose standards are procrastinators less effective than their well-scheduled peers? Why should children have to do chores to earn back their possessions if they leave them on the floor, as many professional organizers suggest?
In their book Mr. Freedman and Mr. Abrahamson describe the properties of mess in loving terms. Mess has resonance, they write, which means it can vibrate beyond its own confines and connect to the larger world. It was the overall scumminess of Alexander Fleming’s laboratory that led to his discovery of penicillin, from a moldy bloom in a petri dish he had forgotten on his desk.
Mess is robust and adaptable, like Mr. Schwarzenegger’s open calendar, as opposed to brittle, like a parent’s rigid schedule that doesn’t allow for a small child’s wool-gathering or balkiness. Mess is complete, in that it embraces all sorts of random elements. Mess tells a story: you can learn a lot about people from their detritus, whereas neat — well, neat is a closed book. Neat has no narrative and no personality (as any cover of Real Simple magazine will demonstrate). Mess is also natural, as Mr. Freedman and Mr. Abrahamson point out, and a real time-saver. “It takes extra effort to neaten up a system,” they write. “Things don’t generally neaten themselves.”
Indeed, the most valuable dividend of living with mess may be time. Mr. Freedman, who has three children and a hard-working spouse, Laurie Tobey-Freedman, a preschool special-needs coordinator, is studying Mandarin in his precious spare moments. Perusing a four-door stainless steel shoe cabinet ($149) at the Container Store, and imagining gussying up a shoe collection, he shook his head and said, “I don’t get the appeal of this, which may be a huge defect on my part in terms of higher forms of entertainment.”
The success of the Container Store notwithstanding, there is indeed something messy — and not in a good way — about so many organizing options. “When I think about this urge to organize, it reminds me of how it was when Americans began to take more and more control of their weight: they got fatter,” said Marian Salzman, chief marketing officer of J. Walter Thompson and co-author, with Ira Matathia, of “Next Now: Trends for the Future,” which is about to be published by Palgrave Macmillan. “I never gained weight until I went on a diet,” she said, adding that she has a room in which she hides a treadmill and, now, two bags of organizing supplies.
“I got sick of looking at them so I bought plastic tubs and stuffed the bags in the tubs and put the tubs in the room.” Right now, she said, “we are emotionally overloaded, and so what this is about is that we are getting better and better at living superficially.”
“Superficial is the new intimate,” Ms. Salzman said, gaining steam, “and these boxes, these organizing supplies, are the containers for all our superficial selves. ‘I will be a neater mom, a hipper mom, a mom that gets more done.’ Do I sound cynical?”
Nah.
In the semiotics of mess, desks may be the richest texts. Messy-desk research borrows from cognitive ergonomics, a field of study dealing with how a work environment supports productivity. Consider that desks, our work landscapes, are stand-ins for our brains, and so the piles we array on them are “cognitive artifacts,” or data cues, of our thoughts as we work.
To a professional organizer brandishing colored files and stackable trays, cluttered horizontal surfaces are a horror; to cognitive psychologists like Jay Brand, who works in the Ideation Group of Haworth Inc., the huge office furniture company, their peaks and valleys glow with intellectual intent and showcase a mind whirring away: sorting, linking, producing. (By extension, a clean desk can be seen as a dormant area, an indication that no thought or work is being undertaken.)
His studies and others, like a survey conducted last year by Ajilon Professional Staffing, in Saddle Brook, N.J., which linked messy desks to higher salaries (and neat ones to salaries under $35,000), answer Einstein’s oft-quoted remark, “If a cluttered desk is a sign of a cluttered mind, of what, then, is an empty desk?”
Don Springer, 61, is an information technology project manager and the winner of the Type O-No! contest sponsored by Dymo, the labelmaker manufacturer, in October. The contest offered $5,000 worth of clutter management — for the tools (the boxes, the bins and the systems, as well as a labelmaker) and the services of a professional organizer — to the best example of a “clutter nightmare,” as expressed by contestants in a photograph and a 100-word essay. “Type O-Nos,” reads a definition on the Dymo Web site, are “outlaws on the tidy trail, clutter criminals twice over.”
Mr. Springer, who in a phone interview spoke softly, precisely and with great humor, professed deep shame over the contents of what he calls his oh-by-the-way room, a library/junk room that his wife would like cleaned to make a nursery for a new grandchild. With a full-time job and membership in various clubs and organizations, and a desire to spend his free time seeing a movie with his wife instead of “expending the emotional energy it would take to sort through all the stuff,” Mr. Springer said, he is unable to prune the piles to his wife’s satisfaction. “There are emotional treasures buried in there, and I don’t want to part with them,” he said.
So, why bother?
“Because I love my wife and I want to make her happy,” he said.
According to a small survey that Mr. Freedman and Mr. Abrahamson conducted for their book — 160 adults representing a cross section of genders, races and incomes, Mr. Freedman said — of those who had split up with a partner, one in 12 had done so over a struggle involving one partner’s idea of mess. Happy partnerships turn out not necessarily to be those in which products from Staples figure largely. Mr. Freedman and his wife, for example, have been married for over two decades, and live in an offhandedly messy house with a violently messy basement — the latter area, where their three children hang out, decorated (though that’s not quite the right word) in a pre-1990s Tompkins Square Park lean-to style.
The room’s chaos is an example of one of Mr. Freedman and Mr. Abrahamson’s mess strategies, which is to create a mess-free DMZ (in this case, the basement stairs) and acknowledge areas of complementary mess. Cherish your mess management strategies, suggested Mr. Freedman, speaking approvingly of the pile builders and the under-the-bed stuffers; of those who let their messes wax and wane — the cyclers, he called them; and those who create satellite messes (in storage units off-site). “Most people don’t realize their own efficiency or effectiveness,” he said with a grin.
It’s also nice to remember, as Mr. Freedman pointed out, that almost anything looks pretty neat if it’s shuffled into a pile.
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