The Compass of Pleasure

By David J. Linden

When we think of the qualities we seek in visionary leaders, we think of intelligence, creativity, wisdom and charisma, but also the drive to succeed, a hunger for innovation, a willingness to challenge established ideas and practices.

But, in fact, the psychological profile of a compelling leader — think of tech pioneers like Jeff Bezos, Larry Ellison, and Steve Jobs — is also that of the compulsive risk-taker, someone with a high degree of novelty-seeking behavior. In short, what we seek in leaders is often the same kind of personality type that is found in addicts, whether they are dependent on gambling, alcohol, sex or drugs.

From 'The Compass of Pleasure'

How can this be? We typically see addicts as weak-willed losers, and chief executives and entrepreneurs are people with discipline and fortitude. To understand this apparent contradiction, we need to look under the hood of the brain, and in particular at the functions that relate to pleasure and reward.

As a key motivator, pleasure is central to learning; if we did not find food, water and sex rewarding, we would not survive and have children. Pleasure evokes neural signals that converge on a small group of interconnected brain areas called the medial forebrain pleasure circuit — tiny clumps of neurons in which the neurotransmitter dopamine plays a crucial role.

This dopamine-using pleasure circuitry, refined over millenniums of evolution, can also be artificially activated by some, but not all, psychoactive substances that carry a risk for addiction, like cocaine, heroin, nicotine or alcohol. Our brain’s pleasure circuits are also hard-wired to be activated by unpredictable rewards: While a roulette wheel is spinning or horses are on the track, we get a pleasure buzz even if we don’t get a payout in the end. Uncertainty itself can be rewarding — clearly a useful attribute for high-risk, high-reward business ventures.

So why do some people become addicted to drugs, alcohol, gambling or sex while others can indulge in a moderate, noncompulsive manner? One hypothesis is that addicts feel those pleasures unusually strongly and are motivated to seek them more intently. It’s reasonable but wrong. Evidence from animal experiments and human brain scans indicates that the opposite is true: Addicts want their pleasures more but like them less.

We’re now starting to understand the biology behind the blunted pleasure of addicts. From studies comparing identical and fraternal twins, it is estimated that genetic factors account for 40 percent to 60 percent of the variation in the risk for addiction. But we are only in the early stages of understanding the role of genes in addiction; there is no one “addiction gene,” but it is likely that a large number of genes are involved in this complex trait.

Crucially, genetic variants that suppress dopamine signaling in the pleasure circuit substantially increase pleasure- and novelty-seeking behaviors — their bearers must seek high levels of stimulation to reach the same level of pleasure that others can achieve with more moderate indulgence. Those blunted dopamine receptor variants are associated with substantially increased risk of addiction to a range of substances and behaviors.

Is there a silver lining to the addictive personality? Some of our most revered historical figures were addicts — not only the obvious creative types like Charles Baudelaire (hashish and opium) and Aldous Huxley (alcohol and the nonaddictive hallucinogens mescaline and LSD), but also scientists like Sigmund Freud (cocaine) and warriors and statesmen from Alexander the Great and Winston Churchill (both known to be heavy drinkers) to Otto von Bismarck, the unifier of Germany, who typically drank two bottles of wine with lunch and topped them off with a little morphine in the evening.

Leaders in America rarely admit to addictions in public, but one recent example is Henry T. Nicholas III, a founder of Broadcom, a multibillion-dollar company that makes microchips for cellphones, game consoles, wireless headsets and other electronic devices. Starting with a $10,000 investment, Nicholas and his partners created a company that now has 9,000 employees and 5,100 patents. Along the way, he struggled with alcohol, cocaine and Ecstasy; he entered a rehab program in 2008. (He also successfully fought off criminal charges related to backdating stock options and drug distribution.)

The risk-taking, novelty-seeking and obsessive personality traits often found in addicts can be harnessed to make them very effective in the workplace. For many leaders, it’s not the case that they succeed in spite of their addiction; rather, the same brain wiring and chemistry that make them addicts also confer on them behavioral traits that serve them well.

So, when searching for your organization’s next leader, look for someone with an attenuated dopamine function: someone who is never satisfied with the status quo, someone who wants the feeling of success more than others — but likes it less.

David J. Linden is a professor of neuroscience at Johns Hopkins University School of Medicine in Baltimore and the author of “The Compass of Pleasure: How Our Brains Make Fatty Foods, Orgasm, Exercise, Marijuana, Generosity, Vodka, Learning, and Gambling Feel So Good.” He wrote this piece for the New York Times Syndicate.

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Julianne Malveaux

By Julianne Malveaux, NNPA Columnist
July 26, 2011

Amy Winehouse seemingly had everything to live for. An exceptionally talented songbird, a phenomenal writer, with two best-selling albums under her belt, she was also manic-depressive and amazingly troubled, living out her issues in the headlines. Every time she had an “episode”, a fight with a fan, an incoherent performance, you wanted to just scream at her “get help”. And while she had been in and out of rehab for her drug and alcohol addictions, apparently she didn’t get the help she needed for her mental illness.

Since I didn’t know Amy Winehouse personally, I probably have no business writing about her. But her death haunts me because she was so young, so talented. It also haunts me because we don’t talk enough about mental health and mental illness in the African American community, and yet we must.

The National Institute of Mental Health says that communities of color are underserved by our nation’s mental health system. Only one in three of the African Americans who needs mental health services is receiving them. We love to tell jokes about “crazy” people, but some of those crazy folks really need help. Yet we have a cultural bias against seeking it, thinking prayer, a good chat with a friend, or something else is a substitute for talk therapy or medication.

To be sure, the mental health system has biases as well. There is very little cross-cultural competency among psychiatrists and other mental health professionals. Some folks can’t see clearly enough to serve people of color, especially African Americans, and we are sometimes misdiagnosed by therapists who miss important cultural clues about us.

Mental illness still has a stigma attached to it. Some believe that it is a matter of will to simply feel better, when chemical imbalances often cause depression and other mental illnesses. Our national health care system, too, discriminates against those with mental illness, with health insurance coverage often providing only limited care for mental and dental issues, but more care for medical issues. Yet, it is clear that mental illness can be as debilitating as chronic physical illness. It often goes unaddressed, and yet it has significant societal consequences. When we have these instances of mass killings, do we actually think sane people commit them? How many lives could be saved if there were more adequate health care.

I am especially concerned about mental illness in this down economy, since so many of us are challenged with dealing with the results of unemployment and underemployment. The average unemployed person has not held a job for 40 weeks, or 10 months. Nearly a third of those who are unemployed have been looking for work for more than a year. While I do not suggest that very unemployed persona is mentally ill, I have talked to too many unemployed people who’ve lost their spark, their verve, their energy, and even the possibility of positive thinking. One wonders how effectively they can actually look for work when they are feeling down and downtrodden.

I’ve often suggested that entrepreneurship is the antidote for unemployment and write about those African Americans who were able, even in hard times, to both survive and thrive in a down economy. A recent conversation with an unemployed sister convinces me that much more must be written about the psychic costs of unemployment and underemployment and the impact that joblessness has on, among other things, self-esteem and mental health. How can we maintain healthy minds in a sick economy?

Much has been written about health disparities in the African American community. We know that we are more likely to be overweight, to experience diabetes and high blood pressure. We know that African American women are more likely than others to die of breast cancer. These are important facts, but it is equally importance for us to know that our community has been underserved and undertreated for mental illness. It is also important for us to understand, in this sick economy, that lots of people are hurting, that unemployment is not a personal issue but an economic one, and that sometimes it helps to talk about that which ails us in order to understand that we aren’t the only ones who are hurting.

The talented Amy Winehouse has, perhaps, found the peace that she sought all her life in her untimely death. Those who find treatment for mental illness can find peace without the alcohol and drugs to which Winehouse was addicted. We don’t do people with mental illness any favors by telling jokes about craziness and minimizing the real medical problems that are associated with mental illness.

A shout out, by the way, to Terrie Williams, who wrote courageously of her own battle with depression in her book, Black Pain (Simon and Shuster, 2008). In writing the book, she turned her pain into power and, in many ways, empowered many people to ask the right questions about mental illness.

Julianne Malveaux is President of Bennett College for Women and author of “Surviving and Thriving: 365 Facts in Black Economic History”.

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Our Two Cents – Perhaps the most positive and optimistic report in a long history of dour and dingy documents plopped out of the Oregon State Hospital this week –

Excellent! All fixed. Turns out bricks and mortar, charming lists, graphics and more gobbledegook faux-business lingo evoke good psychiatric care. Everyone go home – watch TV. Go home – watch TV.

Here’s the truth. We don’t believe in or expect miracles. There are still many people at OSH who should – by Federal law – be in far less restrictive quarters. Decades of mistreatment branded the OSH a dangerous place – not a safe place – for persons sick with mental illness. Good things seem to be happening after over 100 years of lies and abuse – but it will take more than PR fluff to change Oregon minds.

OSH gets a clean bill of health, Salem Statesman Journal, July 23, 2011

Improvements at the Oregon State Hospital are placing the hospital on track to rebound from its troubled history and become a world-class psychiatric facility, state-hired consultants said in a new report.

Kaufman Global, an Indiana-based consulting firm, said the Salem psychiatric facility “has taken great strides over the past seven months and is improving with each passing day.”

READ – Oregon State Hospital Excellence Report – by Kaufman Global

In a final report capping the $2 million consulting project, the OSH consultants said: “The picture that emerges is of an organization that has come a long way in a short time, and is now firmly on the path to improvement, headed toward excellence.”

The consulting report points to a dramatic turnaround in the workplace culture at the 128-year-old institution — long plagued by revolving-door leadership, turmoil and other chronic problems, including obsolete facilities, understaffing and high-profile cases of patient abuse.

“Hope is displacing despair, praise is offsetting criticism, and possibilities are supplanting impossibilities,” the report said.

With solid leadership, OSH now has the tools, talent and “playbook” necessary to evolve into a world-class organization, according to the consultants.

However, they also cautioned that it won’t be easy for the hospital to maintain the current momentum.

“The next phase in the project will present an equally large hurdle,” the report said. “Building on the foundations that have now been laid, but without the on-site presence and counsel of Kaufman Global, and — barring anything unforeseen — without the ‘burning platform’ provided by public controversy or leadership change, Oregon State Hospital will now be expected to continue its drive toward Hospital Excellence using internal resources and learned processes. In our experience, this is a critical juncture in the transformation of any organization.”

Hospital chief touts ‘lean’ tools

OSH Superintendent Greg Roberts, who took the hospital reins in September, links much of the hospital’s recent progress to the consulting team’s push for improvements based on “lean” tools and techniques.

Initially devised by Toyota, lean methodology widely is used in the private sector to streamline processes and cut waste.

It took time for the hospital’s work force to embrace lean techniques, Roberts told the Statesman Journal in an interview last week.

“We struggled a bit to figure out how the principles of lean methodology applied to a state psychiatric hospital,” he said.

The turning point came around February or March, Roberts said.

“There was a moment in time when it just clicked,” he said. “People got it, they understood it, they liked it, they valued it, all the way down to the unit level. From that point on, things really began to take off pretty quickly.”

Roberts touted the success of various projects spurred by lean methodology — from an accelerated hiring process for psychiatrists to streamlining how patient privileges are determined to pruning the number of hospital committees from more than two dozen to about six or seven.

In the wake of Kaufman Global’s departure, Roberts said, the hospital plans to create an in-house team to spearhead further improvements, applying methods instilled by the consultants.

“I think we’ve really accomplished a lot of significant things in a short period of time, but we have a lot more to do,” he said. “I think we should all be excited about what’s coming.”

New hospital nears completion

The reported turnaround comes as Oregon’s main mental hospital is entering the home stretch on a parallel improvement track: construction of a new 620-bed, $280 million replacement hospital.

In mid-August, more than 200 patients are scheduled to move into Trails, a three-story, 183,344-square-foot section of the new hospital.

Plans call for the entire facility, totaling 870,000 square feet, to become fully operational by the end of the year.

Gone are dozens of run-down, outdated hospital structures — stark symbols of decades of neglect. The old buildings were razed to clear the way for the new hospital, located south of Center Street NE on the sprawling OSH campus.

The first 104-bed section of the new hospital, called Harbors, opened in January.

By some accounts, Harbors got off to a rocky start.

Patients grumbled about irritating noise levels in the new building; staff vented about poor planning, patient outbursts and excessive reliance on mandated double shifts to plug staffing gaps.

Roberts said most of the early kinks in Harbors have been ironed out.

He envisions a much smoother start up in Trails: “First of all, we have the benefit of learning from the process of moving into Harbors to make the necessary changes for Trails. It’s all come together very well. In fact, the decision was made to move in one day because the preparation has been so thorough.”

Aug. 16 is the designated move-in date for 216 patients who are scheduled to occupy nine residential units in Trails.

These patients will leave behind cramped quarters within an outdated 1950s-era structure, called the “50 Building.”

In some areas of the obsolete building, as many as five patients are jammed into rooms designed for two.

Patient privacy and living conditions will markedly improve in Trails, which has one-person and two-person rooms, hospital officials said last week while leading a tour of the facility.

Trails is designed to provide patients with expanded treatment hours at centralized malls and offer them relaxing features, such as sensory rooms equipped with comfortable chairs and soft lighting.

Patient Kathryn Gerke, housed on Ward 50I in the dreary 50 Building, said she looks forward to a fresh start in Trails.

“The whole situation at the Oregon State Hospital just has a sense of doom about it,” she said. “It’s depressing. If you come here with a depression diagnosis, it’s really not going to help you.”

In contrast, the new facility promises to “make that go away” because it will have “more of a care overtone to it,” Gerke said.

“I’m hopeful about it,” she said. “It’s a real hospital.”

Though many patients are eager to pack up and move to Trails, they also fret about adjusting to new routines.

The top patient concern, as revealed by a recent survey conducted by the hospital: Who’s going to be my roommate?

Progress amid federal scrutiny

A multitude of flaws and failings at OSH were spotlighted in January 2008, when the U.S. Department of Justice issued a scathing report that criticized nearly every facet of patient care and hospital conditions.

The Civil Rights Division of the agency called for the state to make sweeping improvements or risk being hit with a federal lawsuit that could place the hospital under court control.

In November, on the eve of the dedication of the new hospital, federal officials put the state on notice that they were expanding the investigation to examine how long patients stay at OSH and whether the state provides adequate community-based mental health programs and services for people coming out of the hospital and those at risk of being institutionalized.

Federal officials have not publicly commented on the current status of the investigation.

However, the U.S. DOJ’s top civil rights official, Thomas Perez, came to Salem recently to discuss Oregon’s approach to mental health care with Gov. John Kitzhaber.

“The primary focus of the meeting was community mental health,” Christine Miles, Kitzhaber’s press secretary, said last week in an email to the Statesman Journal that confirmed the meeting.

Kitzhaber’s private meeting with Perez at the Capitol marked a departure from the stance taken by former Gov. Ted Kulongoski, who snubbed a request by the feds for a high-level meeting.

In back-and-forth correspondence between state and federal lawyers, Oregon attorneys have touted concerted efforts to improve both the state hospital and the community mental health system.

The new consulting report could bolster the attorneys’ assertions about a new and improved OSH.

It describes how hospital workers vented frustration, anger and resentment, then rolled up their sleeves and got to work on reform-minded initiatives.

“From the beginning there has been no silver bullet capable of transforming the entire organization,” the report said. “Out of necessity, Oregon State Hospital was forced to attack every cultural issue head-on, concurrently, with all its energy.”

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Sam Adams, Mayor
Amanda Fritz, Commissioner
Portland City Hall

Dear Sam and Amanda:

Congratulations and thanks to you both for developing Portland’s Office of Equity, which we’re certain will be a success. Moving this Office from idea to reality took courage, determination and perseverance. We are confident the Office of Equity will be a thriving centerpiece of our city, signifying and building upon Portland’s commitment to diversity — and continuing weirdness.

We support you especially in recognizing persons with a diagnosis of mental illness or addiction as the most discriminated-against underclass in Portland, a group that has long needed the support and protection potently offered by an Office of Equity. We encourage the city to actively include people with lived experience of mental illness and/or addiction who are open about it and willing to identify in this way.

We recognize there are certain challenges in making sure people with mental illness and /or addiction have a voice in the Office of Equity. In order to support the new Office, we offer a few suggestions to welcome citizens with mental illness and /or addiction, and to accommodate them in accordance with the Americans With Disabilities Act.

Our barriers are invisible

With rare exception, people with mental illness and/or addiction have no associated physical or intellectual limitations. We can’t be distinguished by wheelchairs, gender preference, white canes, skin color or accent. Most of us, most of the time, look and act as normal (or as weird) as any other Portlander.

The only reliable way to tell a person has a mental illness or addiction is their own self-identification. That’s one of the reasons it’s important to populate the Office of Equity with people who have a mental illness and will say so.

Include us explicitly

The main difficulty with getting people with mental illness to participate in the Office of Equity is the same reason the Office of Equity exists in the first place: discrimination.

The message that you welcome us must compete with multiple daily messages that we’re NOT welcome, especially in City Hall.

In a single morning, it’s possible we could read an Oregonian article describing us collectively as “Portland’s mental illness problem”; overhear a reference to a deranged troublemaker being ejected from a public meeting; and lose a job or housing opportunity because of our diagnosis. Then, if we mention to our case manager or other professional that the Office of Equity might want input from people like us, we are likely to hear a variety of reasons it would not be in our best interests.

To counter these messages, it will be insufficient to make an announcement and toss out a welcome mat. It is necessary to let us know we’re included — explicitly, emphatically, and repeatedly.

Address our challenges

Many in our community have genuine contributions to make, but might never do so because of internal and external barriers. However, no two people with mental illness and/or addiction have the same set of challenges. Addressing them will take your best creative thinking on an ongoing basis.

One common barrier is that many of us live so far below the poverty line even a bus ticket is prohibitively expensive. Another barrier: some of us have specific fears about being in groups of people.

Surprisingly, both of these challenges could be eased the same way, by providing alternative ways to participate, such as attendance via the Internet or teleconference.

Choose your words

Often, well-meaning plans for persons with mental illness are couched in the language of waste management: “We need to get these people off the streets.” First, we are not “these people” (nor, for that matter, “the mentally ill”). Second, it’s axiomatic that “getting us off the streets” is primarily of benefit to so-called normal persons; if it does happen to benefit us, it’s usually accidental. Words matter. Treat us as individuals. Call us by name. When referring to us as a group, use People-First Language. Find more information at www.DisabilityIsNatural.com.

Ask us what we need.

The above suggestions are barely a start, so this final one is the most important: Ask us. This is key. It is the only way to know what we need, and thus the only way to find proper accommodations. This must be done, and not just once.

Amanda and Sam, thank you again for your work and expertise, and your assistance bringing our community to the table. We look forward to helping in any way we can, including any needed assistance in finding representative citizens with mental illness to help enrich the Office of Equity.

Sincerely,

Mental Health Association of Portland
www.mentalhealthportland.org
info@mentalhealthportland.org

Thomas A. Perez
Assistant Attorney General
Department of Justice
Civil Rights Division
Seattle, Washington

SENT BY EMAIL to usaor.civilrights@usdoj.gov

Dear Mr. Perez and colleagues,

Since 2003, the Mental Health Association of Portland (MHAP) has been Oregon’s only independent and impartial advocacy organization for persons with mental illness and addiction.

Independent means MHAP is entirely separate from any other group or mission; does not participate in closed-door meetings; and accepts no funding from corporate or governmental entities. Impartial means our actions are always public, transparent and without judgment. Advocacy means we speak up, speak out, and always speak the truth about mental illness and addiction. We refuse to be muzzled, no matter the cost — to our budget, or to others’ comfort.

A main focus of ours — now yours as well — has been tracking, documenting and publicizing officer-involved shootings in Portland. We appreciate your involvement, and we’d like to offer you some key pieces of information.

Your question: “Have the Portland police routinely and predictably harmed persons with mental illness?

Our answer, informed by years of close study, statistics and data compilation, is “Yes. Absolutely. And they continue to do so.”

According to our review of documents, since 1970 there have been 197 persons whom Portland police have: (1) shot and killed; (2) shot and wounded; (3) shot at; (4) beaten to death; or (5) lethally Tasered.

Out of these 197 cases, only one notable pattern emerged: most of the victims have been persons with active mental illness or addiction. All other demographics, such as race, followed expected statistical patterns for individuals who come into contact with police.

Note that we do not separate “persons with mental illness” from “persons with addiction.” Neither should you.

First, the distinction is often arbitrary, derived from an insurance company’s referral to psychiatric care on the one hand, or drug and alcohol treatment on the other.

Second, there is so much overlap between mental illness and addiction that trying to draw a boundary would be an absurd waste of time. Results of the Epidemiologic Catchment Area (ECA) Survey and the National Comorbidity Survey (NCS) show that in any given year, 42.7% of individuals addicted to drugs or alcohol also have a mental illness; up to 61% of people with a serious mental illness also have an addiction; and 14.7% of people with any sort of mental illness deal with addiction. Comorbidity is so prevalent that a seemingly obvious causal relationship is entirely obscure. The National Institute on Drug Abuse says mental illness may lead to drug abuse. Or that drug abuse may lead to mental illness. Or both. Or perhaps the two have a common cause.

The two are twined so tightly that attempting to talk about mental illness exclusive of addiction is like trying to talk about the Atlantic Ocean and mentioning only the salt.

In sum: We don’t accept a difference in value to the person, and we urge you in the strongest possible terms to expand your investigation to include persons affected by addiction.

As mentioned above, we have documented 197 cases of Portland police violence since 1970, most involving persons with mental illness and/or addiction. We do not think Portland is unique; in fact, we believe both the following statements are true of most U.S. cities:

1. The overwhelming majority of citizens shot by police are in crisis from active mental illness and/or untreated addiction.

2. The city’s police officers, overall, are well-trained, well-meaning, capable, well-equipped and willing to be helpful – and blindly convinced they are, always have been, and ever will be blameless. This thinking can be explained by confirmation bias. Even while their own actions go from shocking to egregious to unimaginable, the police are ever more steadfast in their own defense.

We expect your findings and conclusions will be similar to ours. We expect, too, you will find yourselves in the same unfortunate position. Like us, you have neither the powers, authority or capacity to make changes that would cure mental illness and addiction, nor even to provide reasonable medical relief. No one does, which means this is a problem with no solution.

Unless, that is, society can achieve one thing: equal justice for all.

Our community has never had it. We’re counting on you to make a start.

In closing, we are happy to talk with you further, but as we mentioned, we do not attend private meetings. Our interest is public. Also, we represent persons with significant communications barriers; to meet privately would exclude the persons we represent. If you wish to meet, it would need to be in a public place that is safe for our friends. We would also need equipment to video record the meeting, in order to share it with friends who were not able to be present.

Good luck with your investigation. We hope we have helped enlarge your understanding of the problem. Let us know if we can assist further.

Sincerely,

Mental Health Association of Portland
www.mentalhealthportland.org
info@mentalhealthportland.org

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From the Oregonian, July 23, 2011

In Northwest Portland, two neighborhoods lie within the same confines of Old Town-Chinatown.

Drug use and dealing in front of the store pushing Anthem Records out of Old Town into Northeast Portland. Owner Jon Klote said he relocated because he believes the crime issues in Old Town scare off customers.

The other is described by Old Town residents and business owners as a much darker place. A place, say the owners of Hamburger Mary’s restaurant, where drug deals happen in the middle of the day and crack-cocaine smoking takes place on the street outside the restaurant’s windows.

It’s where they reopened the iconic restaurant 10 months ago after a decade-long hiatus — and where they might have to leave if the situation doesn’t improve.

“If we can’t get help, then we’re not going to be able to stay here,” said Frank Saenz, Hamburger Mary’s assistant general manager. “You can’t get customer loyalty with a crack dealer standing outside.”

Crime is nothing new for Old Town, the Northwest Portland neighborhood of businesses, low-cost housing and numerous social service organizations between the Pearl District and the Willamette River. Nearly four months ago, the city pledged to step up police patrols and hire a new assistant district attorney.

But several Old Town business owners say police, the city and 9-1-1 dispatchers have not done enough to keep the neighborhood safe. And crime in the area is taking its toll, pushing a record store to move out.

When they began scouting locations for their restaurant, Hamburger Mary’s owners Ian Cooke and Emily Quick knew something about the reputation of Old Town, but Cooke said the development commission told them that the neighborhood would improve.

During the past five years, the commission has injected $20.5 million worth of development projects and grants into the downtown waterfront Urban Renewal Area, most of which includes Old Town-Chinatown.

Hamburger Mary's, a Portland institution, came back to Portland 10 months ago and set up shop at 19 N.W. Fifth Ave. But transients take refuge in the entryway as soon as the lights are out in the restaurant.

“I think we’ve gotten past the point that the Old Town-Chinatown neighborhood is floundering,” Englander said.

He says the neighborhood is not a hard sell to business owners.

“I think the Old Town-Chinatown neighborhood is selling itself,” Englander said. “I think people see this as a particularly unique part of the central city. It’s very different from the downtown employment and retail core.”

But Cooke said he felt the neighborhood’s issues were downplayed by the commission and that other city agencies aren’t providing the support to keep businesses there. Saenz estimated that Hamburger Mary’s staff members have called 9-1-1 twice a week since the restaurant reopened, but Cooke said dispatchers tell them to call a nonemergency number, which often results in slow or no police response.

“We’re being shuffled around by those services,” Cooke said. “Nonemergency will tell us that no one is coming out because there are other issues at hand. If you’re going to bring businesses in, how are you going to protect those businesses?”

Employee threatened

Recently, a woman wielding a knife threatened a Hamburger Mary’s employee. No one was injured, but Cooke worries about his employees’ safety and even reduced weekend hours of operation.

Central Precinct Capt. Sara Westbrook said she spoke to Hamburger Mary’s staffers recently and said she believes they don’t understand how the emergency response system works.

“Hamburger Mary’s is frustrated, I get it,” she said. “But if the suspect is not there right now, then that’s going to be downgraded to a lower level of response; it doesn’t mean we’re not going to come.”

Cooke said he’s seen more foot patrols near the business since the conversation with Westbrook, but he worries it’s temporary.

Mike Boyer, crime prevention specialist with the Office of Neighborhood Involvement, said city and county officials recently met with six area businesses. City officials said they would look into the 9-1-1 calls that Hamburger Mary’s has made to ensure proper action was taken by dispatchers.

Hamburger Mary’s, a Portland institution, came back to Portland 10 months ago and set up shop at 19 N.W. Fifth Ave. But transients take refuge in the entryway as soon as the lights are out in the restaurant, and employees have to shoo them away the next morning.

“There are obvious issues with the (9-1-1) system,” Boyer said. But he added that he’s pursuing other ideas that could cut down on crime, including updating a trespass agreement for Hamburger Mary’s that would allow police to arrest people for being on the restaurant’s property without permission.

He would also ask the Salvation Army Female Emergency Shelter next door to Hamburger Mary’s to place staffers outside the shelter to police residents.

But Salvation Army Maj. Don Gilger said that won’t happen.

“Once they step on the street, they’re not under my control,” Gilger said. “To say that it’s a dangerous area is a correct statement. It’s not any more dangerous because we’re there.”

Westbrook estimated that Old Town has “more resources per square foot than I suspect any other area of the city has.”

She said the Central Precinct has several patrols that no other precinct has, including a mounted patrol, street crimes unit and a walking patrol that works overtime hours.

“What’s here is scary”

But the police presence hasn’t been able to deter crime enough for Jon Klote to stay in the neighborhood. He recently relocated his record store, Anthem Records, from Old Town to Northeast Flanders Street and 28th Avenue.

“People who come to Old Town are usually lost while looking for Voodoo Doughnuts. What’s here is scary things for people like that,” Klote said. “It’s not worthwhile to do business here.”

During the two years he operated in Old Town, Klote said, he regularly slapped crack out of people’s hands and cleaned up urine and feces in the doorway.

“A lot of people, I think they want to see things work in Old Town,” Klote said. “It’s just that it’s very volatile because there is no oversight” for the people staying at the shelters.

Cooke and others don’t blame the shelters for the neighborhood’s issues, but they say the organizations and city have an obligation to make sure the neighborhood is safe.

“We need support,” Cooke said. “We’re not here to ruffle feathers, we’re here to make a change. The only way change happens is with support, and we’ve done everything we can; we’re running on empty.”

“We cannot accept this. We cannot accept the neighborhood the way it is.”

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By Christopher Faille, Forbes.com
Jul. 19 2011

Among the public, scholars and within the medical profession, a backlash has developed against the widespread use of psychoactive drugs. This backlash will help define the biotech and pharmaceutical industries in the coming years, because it means over time a shift in opportunities and capital away from a search for the next psychiatric blockbuster toward solutions to more tractable human troubles that arise outside of the central nervous system.

Eli Lilly’s (NYSE: LLY) Prozac is perhaps still the most cited instance of a real or alleged psychopharmacological breakthrough. It is an anti-depressant, the result of laboratory research conducted in the 1970s, approved for sale in the U.S. by the FDA in 1986. By 1990, it was not only the most widely prescribed anti-depressant in the U.S., it merited a Newsweek cover story.

The corporate history of another much touted drug, Adderall, is more complicated. Adderall, a stimulant used to treat both ADHD and narcolepsy, and for various off-label purposes, was once exclusively associated with Shire Pharmaceutical (NASDAQ: SHPGY). Shire no longer produces the instant release (IR) form of the drug. It sold those rights years ago to Dura Pharmaceuticals, which was in turn acquired by Teva Pharmaceuticals Industries Ltd. (NASDAQ: TEVA).

Last year, Basic Books published The Emperor’s New Drugs, by Irving Kirsch. Kirsch is himself no outsider to the world he is critiquing here. He has spent decades in the discipline of psychology since receiving a Ph.D. therein, in 1973, and has been at work on the subject of this book since 1998, when he and Guy Sapirstein co-wrote a meta-analysis of the effects of antidepressant medicines that they rather jauntily called “Listening to Prozac but Hearing Placebo.”

In The Emperor’s New Drugs, Kirsch says that he and Sapirstein were “cautious in our interpretation of the data” back in 1998. They were, despite that title, too kind to the hypothesis that the drugs under examination actually did have therapeutic value that a placebo could not duplicate. Since then, though, “the process of addressing the objections of my critics has steadily driven me to a set of much more far-reaching conclusions.”

“In the long run,” he now believes, “psychotherapy is both cheaper and more effective” than chemical therapies, “even for very serious levels of depression.”

Also last year, Crown Publishing came out with a book on much the same subject by journalist Robert Whitaker. Whitaker’s tone in Anatomy of an Epidemic (2010) is angrier than Kirsch’s. While Kirsch focuses on the good that psychoactive drugs seem to do, and finds that only the patient’s confidence in the healing power of the pills actually does that good, Whitaker focuses on the harm that he contends such pills do.

He believes that the rush to prescribe pills is behind the fact that the “number of disabled mentally ill has risen dramatically since 1955, and during the last two decades, a period when the prescribing of psychiatric medicines has exploded, the number of adults and children disabled by mental illness has risen at a mind-boggling rate.”

In June, Marcia Angel reviewed both Kirsch and Whitaker in The New York Review of Books – so sympathetically that she must be considered a member of the same choir – and she is no stranger or philistine, but the former editor in chief of the New England Journal of Medicine.

Meanwhile, the drug companies themselves have been dropping or reducing research into fields that once looked promising. Daniel Cressy, writing about this in Nature last month, was mournful in tone: “Many people affected by mental illness are facing a bleak future as drug companies abandon research into the area and other providers fail to take up the slack,” he says.

My own suspicion is that his tone is misdirected. For those for whom the future is bleak, it is bleak because the critics are right, and the drugs really don’t do anything valuable, which is to say the bleakness arises because the research program has continued in a misguided direction for far too long.

But even if the pull-back Cressy notes is just a response to the change in cultural climate, it would mean development of improved treatments of diabetes or multiple sclerosis has just become an easier ‘sell’ on every level than further research on depression or schizophrenia, as the human mind stubbornly remains a Black Box.

If you want an investment play on diabetes you might look at Amylin (NASDAQ: AMLN). If you want a play on MS, consider Mylan (NYSE: MYL). Either way: psychopharma is looking like an idea whose time has passed.

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From the Portland Skanner, July 22, 2011

Aaron Campbell

Federal officials this morning announced they’re carving out the first three weeks of August for public testimony on their civil rights investigation of the Portland Police.

To request an individual meeting, the bureau invites people to contact the U.S. Attorney’s local Civil Rights Hotline at either 503-471-5577 or by email at usaor.civilrights@usdoj.gov.

You can also contact officials in the investigation at community.portland@usdoj.gov or 1-877-218-5228.

In a statement released Friday morning, U.S. Attorney for Oregon Dwight Holton confirmed the bureau plans individual interviews with members of the public, as well as telephone and written testimony submitted via email.

“Any individual that has specific and recent information they would like to share with the Department about their personal interaction with PPB officers may request an individual meeting at one of three locations in downtown, the outer east-side, or north Portland,” the statement says.

“Throughout the course of the investigation, the Justice Department will seek to determine whether there are systemic violations of the Constitution or federal law by officers of the PPB,” the statement continued.

“The Justice Department will consider all relevant information, particularly the efforts that Portland has undertaken to ensure compliance with federal law.”

Investigations are underway on state and local law enforcement agencies in New York, Ohio, New Jersey, Pennsylvania, the District of Columbia, Louisiana and California.

A similar investigation of the Austin Police Department was closed in May with officials announcing no civil rights violations were found; a civil rights probe of hiring practices by the Greensboro, N.C. Police and Fire Departments was also closed earlier this year.

In June of this year, the U.S. Justice Department announced its “civil investigation” to determine whether the Portland Police Bureau has engaged in a pattern or practice of use of force which amounts to a violation of civil rights.

The Jan. 29, 2010, police shooting of Aaron Campbell, above, an unarmed man in a mental health crisis, prompted local leaders to demand a federal investigation.

Community organizations including the Urban League of Portland, the African American Alliance, the Albina Ministerial Alliance, as well as then-Police Commissioner Dan Saltzman, U.S. Sen. Ron Wyden and Rep. Earl Blumenauer together called for a “pattern and practice” investigation by the Civil Rights Division in February 2010.

It was eventually referred to the DOJ Special Litigation Section for review.

Last month federal officials announced there would be no criminal charges against police officers involved in the Campbell shooting because, they said, they could not examine individual cases.

The next day federal officials announced the civil probe, which is a joint effort by the Department of Justice’s Civil Rights Division, Special Litigation Section and the U.S. Attorney’s Office for the District of Oregon.

The bureau says space and time are limited for the interviews, so information “from any individual” is welcomed through the email and the toll free number.

READ – Assistant Attorney General Thomas E. Perez of the Civil Rights Division Speaks at the Portland, Oregon, Police Bureau Press Conference, June 8, 2011
READ – U.S. Attorney’s Office and Civil Rights Division Announce Three Community Interview Sessions Regarding Portland Police Bureau Investigation, July 22, 2011

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