October 1, 2017

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First Words Attention Deficit Why bother with arguments when you can By Carina Chocano 11 dismiss the other point of view? The new rule is: The thing I care about is important. The thing you care about is a ‘‘distraction.’’

On Medicine Plumbers and Poisoners What we learn when two killers, By Siddhartha Mukherjee 14 heart disease and cancer, collide and reveal a common root.

The Ethicist Herd Immunity Should you spread the word about an By Kwame Anthony Appiah 18 unvaccinated child?

1100 2600 2400

Diagnosis Age Not a Factor She was 94, and all signs pointed to a By Lisa Sanders, M.D. 20 stroke. But when tests came back negative, the doctors had to explore more unusual possibilities.

Letter of ‘Shark Tank’ Trickle-down economics that works, By Jaime Lowe 24 Recommendation at least on TV.

Eat The Taste of Regret How you should — and should not — By Samin Nosrat 26 cook with garlic.

Talk Franklin Leonard The founder of ‘‘The Black List’’ wants Interview by Ana Marie Cox 62 to diversify the box office.

Behind the Cover Gail Bichler, design director: ‘‘Th is week’s cover story looks at what 6 Contributors 25 Tip happens when someone is found ‘not guilty by reason of insanity.’ Th e mentally ill who are 7 The Thread 58 Puzzles acquitted of a crime may spend more time involuntarily confi ned than those convicted. 13 New Sentences 60 Puzzles Hugo Alonso’s image of the closed door to a psychiatric ward evokes the weight of realizing 17 Poem (Puzzle answers on Page 54) you may walk through the hospital doors and never come out.’’ Artwork by Hugo Alonso. 18 Judge John Hodgman

Continued on Page 4 3 October 1, 2017 28 The Angler John McPhee’s radical structures. By Sam Anderson

‘They’ll Be Here Till What happens after a defendant is found not guilty by reason By Mac McClelland 34 They Die’ of insanity? Often the answer is involuntary confinement in a state psychiatric hospital — with no sure way of getting out.

Beyond Relief Managers rarely use their closers — often the most dominant By Bruce Schoenfeld 42 pitchers in baseball — for more than a few outs at the end of the game. Is that beginning to change?

How Fake News At the height of the 2016 election, exaggerated reports of By Caitlin Dickerson 46 Turned a Small Town a juvenile sex crime brought a media maelstrom to Twin Falls Upside Down — one the Idaho city still hasn’t recovered from.

‘There are a lot of people who feel like society is changing too quickly, like the community is changing too quickly.’

PAGE 46 Shoshone Falls in Twin Falls, Idaho. Photograph by Harris Mizrahi for The New York Times. York The New for Mizrahi Harris by Photograph Idaho. Falls, Twin in Shoshone Falls

4 Copyright © 2017 The New York Times

Contributors

Caitlin Dickerson ‘‘How Fake News Turned a Editor in Chief JAKE SILVERSTEIN Small Town Upside Down,’’ Deputy Editors JESSICA LUSTIG, Page 46 BILL WASIK Caitlin Dickerson is a national reporter for The Managing Editor ERIKA SOMMER Design Director GAIL BICHLER Times. She has covered changes in immigration Director of Photography KATHY RYAN policy and often profiles the lives of immigrants, Art Director MATT WILLEY including those without legal status. She is also Features Editor ILENA SILVERMAN a radio journalist and won a Peabody Award in Politics Editor CHARLES HOMANS 2016 for investigative reporting. This week, she Special Projects Editor CAITLIN ROPER writes about a city in Idaho convulsed by rumors Story Editors NITSUH ABEBE, surrounding a crime committed by juvenile MICHAEL BENOIST, SHEILA GLASER, refugees, which was elevated nationally as a CLAIRE GUTIERREZ, harbinger of dangers to come. ‘‘After reading LUKE MITCHELL, so many deconstructions of false narratives about DEAN ROBINSON, immigrants and refugees that influenced the WILLY STALEY, presidential election,’’ Dickerson says, ‘‘I wanted SASHA WEISS to see how those stories played out in individual Associate Editors JEANNIE CHOI, JAZMINE HUGHES Photographed by Kathy Ryan at Th e New York Times people’s lives, especially for those who were targeted. Chief National Correspondent MARK LEIBOVICH on Sept. 17, 2017, at 5:06 p.m. It turns out, they were horrifying.’’ Staff Writers SAM ANDERSON, EMILY BAZELON, Sam Anderson ‘‘Th e Angler,’’ Sam Anderson is a staff writer for the magazine. SUSAN DOMINUS, Page 28 He writes the magazine’s New Sentences column. MAUREEN DOWD, He last wrote about the marble quarries in NIKOLE HANNAH-JONES, northern Italy. JONATHAN MAHLER, WESLEY MORRIS, JENNA WORTHAM Mac McClelland ‘‘ ‘Th ey’ll Be Here Mac McClelland is a three-time National Magazine Writers at Large TAFFY BRODESSER-AKNER, Till Th ey Die,’ ’’ Award finalist and the author of “Irritable Page 34 C. J. CHIVERS, Hearts: A PTSD Love Story.” She last wrote for the PAMELA COLLOFF, magazine about the pop star Azis. NICHOLAS CONFESSORE, JIM RUTENBERG Siddhartha On Medicine, Siddhartha Mukherjee is a cancer physician and David Carr Fellow JOHN HERRMAN Mukherjee Page 14 scientist at Columbia University. His most recent Deputy Art Director BEN GRANDGENETT Digital Art Director RODRIGO DE BENITO SANZ book is “The Gene: An Intimate History.” This is his Special Projects Art Director DEB BISHOP debut On Medicine column. Deputy Photo Editor JESSICA DIMSON Associate Photo Editors STACEY BAKER, Bruce Schoenfeld ‘‘Beyond Relief,’’ Bruce Schoenfeld is a frequent contributor to the AMY KELLNER, Page 42 magazine and has covered baseball since CHRISTINE WALSH the early 1980s. He last wrote about a new tool Virtual Reality Editor JENNA PIROG to measure a player’s defensive contribution. Copy Chief ROB HOERBURGER Copy Editors HARVEY DICKSON, DANIEL FROMSON, Dear Reader: What If You Could MARGARET PREBULA, ANDREW WILLETT See Everyone Naked? Head of Research NANDI RODRIGO Research Editors ROBERT LIGUORI, Every week the magazine publishes the RENÉE MICHAEL, results of a study conducted online in June LIA MILLER, by The New York Times’s research-and STEVEN STERN, MARK VAN DE WALLE analytics department, refl ecting the opinions Production Chief ANICK PLEVEN 21% 30% 49% of 2,903 subscribers who chose to participate. Yes Maybe No Production Editors PATTY RUSH, This week’s question: If you could, would you HILARY SHANAHAN use X-ray specs? Editorial Assistant LIZ GERECITANO BRINN

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6 10.1.17 The Thread

Readers respond to the 9.17.2017 issue. and surgery. Sometimes, at 70, I exert rational control — except when I suc- RE: RT cumb. It’s no diff erent from the obses- Jim Rutenberg wrote about the new infor- sion with certain forms of exercise: Yes, mation war waged by Russia’s state-run they help in many ways, and more than media network. cosmetics, but an 85-year-old who is in good shape is still in no way a 25-, 45- or Jim Rutenberg’s seeming difficulty even 65-year-old in appearance. THE STORY, in conveying the essence of this story ON TWITTER The siren lure that once belonged to shows how tangled are the thickets of promises of weight loss with the right modern communication. When trust- The Cold War system has been transferred to anti-aging has never really gone ed sources of ‘‘truth’’ are undermined away, has it? beauty products for a certain set. None by intentionally placed untruths, and @RJMourinha of us want to disappear in plain sight, when ‘‘news’’ is purveyed by every Face- and we know that like it or not, more book poster, tweeter and tiny website, attractive (and generally younger) peo- it becomes very hard in the short term if there wasn’t already an audience for it.’’ ple are treated better. So while I know to fi nd truthful news accounts. And the There is only one solution to the problem there’s no fountain of youth, I keep my percentage of people and organizations of fake news: the development of criti- eyes peeled for the newest ideas. This with the time, persistence and skill to cal-reasoning skills among an educated was good at pointing out the change in ferret out the truth is not high — raising population that is grounded in individual tone and metaphor: It is now obviously the danger that attitudes will be formed, rights, freedom and tolerance and that lazy not to fi ght your own body! and actions taken, under the infl uence of can recognize authoritarian movements Cheryl Gajowski, Yorktown Heights, N.Y. agitprop. All of this presents a real-world based on bigotry and prejudice. Joker, Dr. No or similar ‘‘world villain’’ If we can all identify and understand dilemma: It is easier to destabilize and fake news, where it is coming from and disorient than it is to restabilize and the motivation for its existence, it will reorient, and that gives a gigantic head lose its eff ectiveness, and the audience start to the fomenters. for Alex Jones, Fox News, Breitbart, RT The most humbling, and troubling, ele- and others will wither away. ment in all of this to me? That our educa- One can only hope. tional system, despite routinely teaching dvepaul, New York, on nytimes.com the young about facts, their potential distortion, the uses of rhetorical devices The Russian strategy is likely to be suc- to skew and becloud and appropriate ana- cessful. Too few people are skeptical lytic ‘‘countermeasures,’’ has not succeed- enough to question what they hear and ed in equipping citizens with suffi cient read. Fox News and RT thrive in this commitment to the truth, nor the means environment. On the other hand, the to approach it. White House, the Pentagon and other Robert Moore, Seattle United States government agencies Ageism is rampant in many guises. But have not been models of accuracy and what about the store greeter who hails An amazing, well-written article. I’m par- truthfulness. No one in this country has me as I enter with ‘‘Hello, young lady’’? ticularly drawn to this sentence: ‘‘It’s hard less credibility than the president and his I’m obviously an old woman, 82 in Octo- to imagine Russia’s state-backed media spokespeople. As the article shows, RT ber. But this person thinks it a kindness getting any traction in the United States is as important to Russia as their armed to tell me I look young. And that over- forces. The Russians refer to misinforma- used phrase, ‘‘successful aging’’? What tion as a weapon, and they are probably is that, really? Eating blueberries, doing right. Putin has shown his intention to crossword puzzles, exercising, having an wield this weapon, and we have not yet active social life, staying trim? found a good defense. Who came up with the idea that we William A. Heidecker, Odenton, Md. ‘No one in can fail at aging? Just more pressure this country piled up on top of battling wrinkles. RE: FIRST WORDS has less Perhaps it is time for my generation, the Amanda Hess wrote about new branding in Silent Generation, older than Boomers, the old industry of anti-aging. credibility those of us lucky enough to still be alive, than the to speak up and join our voices to those So we will pay a high price to try to avoid president of astute observers like Amanda Hess. aging ‘‘naturally’’ but only use ‘‘natural’’ Judith Church Tydings, South Th omaston, Me. products. Or, for those who have the and his

inclination and money: Botox, implants spokespeople.’ Send your thoughts to [email protected]. Images. DreamPictures/Getty from Photograph McQuade. Mike by Illustration

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Member FDIC. © 2017 Northern Trust Corporation. First Words Why bother with good-faith arguments when you can dismiss the other point of view entirely? Th e new rule is: Th e thing I care about is important. Th e thing you care about is a ‘distraction.’ By Carina Chocano Attention Defi cit I recently stumbled across a quote, rendered in friendly block lettering and posted, naturally, on the internet: ‘‘Perhaps fi guring out what matters most matters most.’’ I couldn’t tell if it was meant to be inspirational or a joke. Funny as it sounds, it is a widespread, fervid belief that we are failing to concentrate on the things that actually matter. If only we could pay attention where attention must be paid! Instead, we fritter away our energy on frivolous distractions! Our inability to focus is framed as weakness, moral failure, neuropathology; as the byproduct of sugar, artifi cial colors, video games, loopy brain chemistry, social media. Distraction, we say, will be the death of us. This is the way the world ends — not with a bang but a ding. From your iPhone. ¶ Until recently, these distractions were easy to spot; you knew one when you saw one, and we all basically agreed on what mattered and what did not. Distractions were assumed to be external threats, random and dumb and always nagging at us: device notifi cations, blaring advertisements, pointless meetings, small talk. Without them, we assumed, we’d exist in an Arcadian state of

10.1.17 11 First Words natural concentration and absorption in the task at hand. Free us from our con- stant diversions, and we’d be forging, sowing, cobbling, real-estate-developing, brand-extending or whatever else, all in a state of blissful creative fl ow and perfect economic effi ciency. We’d enjoy quality time with children; we’d bask in the power of now, mindfully present and presently mindful. Every conversation would be deep, every interaction meaningful. But sometime around the 2016 elec- tion — as political discourse grew ever more heated and chaotic and factional — we found ourselves no longer able to agree on what, precisely, was distracting us from what. Groups began to predi- cate entire political identities on what was ‘‘important’’ versus what was a ‘‘dis- traction,’’ and ‘‘distraction’’ became a euphemism for everything outside the speaker’s own most fervent aims. For one person, following the Russia investigation is a distraction from the disabling of the E.P.A.; for the next, watching the E.P.A. is a distraction from legislation brewing in the House. Arguing about Confederate monuments is a distraction from health care; Trump’s tweets are a distraction from Trump’s executive orders. This goes in both directions: It has become a standard of political discussion to call every political asteroid shooting toward the White House — infi ghting, leaks, special counsels, Nazis — a ‘‘dis- traction’’ for the administration itself, for instance, an argument continues over By calling ploys, attention-grabbing tidbits meant which would, in some magical alternate whether ‘‘identity politics’’ — or what to draw focus from even shadier goings- universe, be working smoothly and effi - many of us call our basic rights — are a something a on. In this thinking, our politics are full ciently toward a coherent set of goals. This, distraction from ‘‘economic issues,’’ which distraction, not of chaos but of canny, fi ve-dimen- offi cially, is why Trump’s Strategic and are framed as more pressing. But even if you declare sional chess moves; the president posts Policy Forum disbanded after Charlottes- that argument was settled, what action strange things on Twitter and then ville: The protest resignations and political should be taken? In The New Yorker, a yourself smiles, knowing people will obsess over pressure on members had ‘‘become a dis- recent piece notes ‘‘skeptics suggest that squarely in his behavior while other gears grind away traction’’ from its goals of guiding policy. ‘folk politics’ — marches, protests, and the the white-hot beneath their notice. like — are a distraction from the challenges Calling something a distraction tells The magic of waving away a ‘‘distraction’’ of real change.’’ All issues are equal, but center of the us more about the person making the is that it lets you minimize and dismiss some issues are more equal than others, universe. accusation than about the thing itself. something without having to explain as are some ways of addressing them. When middle-school girls in shorts or why. The whole discussion is tabled, by Amid all this, ‘‘distraction’’ serves, tank tops are called ‘‘distracting’’ and sent fi at. It’s to trump everything, instantly. increasingly, as a way to brush off incon- home, we learn that people are happy to By calling something a distraction, you venient criticism and disagreement and make girls responsible for boys’ behavior. declare yourself — and the things you ride indignantly into the sunset on a Colin Kaepernick and Marshawn Lynch’s value — squarely in the white-hot center moral high horse, nose in the air, toward gestures of protest are ‘‘distracting’’ if of the universe, far away from all tangen- what really matters. It is a weapon used you resent being made aware of social tial concerns, without pausing to justify to nullify the other point of view — or injustice while getting choked up during that placement at all. even, sometimes, to suggest that the the national anthem, or if what you value Thus it gets harder to agree not just other point of view is being tricked. This most is the N.F.L.’s functioning smoothly about where attention must be paid but is another popular speculation: that all of as an entertainment business. Everything

even how it should be paid. On the left, these distractions we face are deliberate is a distraction now, depending on your Images via Getty Photos/UIG, Clouds: Geography

12 10.1.17 Photo illustration by Derek Brahney aims. In the weirdly denatured language us that advertising and propaganda, far Framing about engaging in good faith with reality. of the news media, August’s total solar from being the opposite of Renaissance It’s no longer a given that we do. It’s eclipse was notable in large part as a oil painting, were the logical extension of is power: a sign of the times that we can hardly potentially lethal distraction for drivers. it — its endgame. It determines agree on what constitutes a distraction Even the scandal-plagued C.E.O., forced Decades later, shortly after 9/11, Berg- what should and what constitutes stuff -that-matters. to step down from his post, has a way to er wrote about the hazards of mistaking It’s an even bigger, more garish sign of put the blame on our lack of focus: All the that ideology for reality. ‘‘Being a unique be paid the times that the debate itself is being accusations surrounding him have come superpower,’’ he wrote, ‘‘undermines the attention to conducted in bad faith. The way we use to distract, he might say, from the incred- military intelligence of strategy. To think and what the word ‘‘distraction’’ now seems like ible work his company is doing. These strategically, one has to imagine oneself the mirror image of the problem it wants terrible allegations, he suggests, are petty in the enemy’s place. If one cannot do shouldn’t. to name. It’s a word we use to dismiss and irrelevant — but because you’re all so this, it is impossible to foresee, to take everything besides what we want to obsessed with them, he’ll throw himself on by surprise, to outfl ank. Misinterpreting focus on, a habit that leaves us even more his sword, so as not to get in the way of an enemy can lead to defeat. This is how blinkered and blinded than the distracted the stuff that really matters. empires fall.’’ What he was recommend- person, who is at least open to chance. ing was empathy, sincerity and curiosity Our tug of war over what is important In 2007 — the year the fi rst iPhone arrived, — the ability to step into somebody else’s and what is irrelevant reveals something one year after the release of Facebook shoes, even if it’s only in the service of unsettling: a bent toward totalizing ideol- to the general public and the launch of defeating them. But in order to do this, we ogies and a seismic struggle over which Twitter — a group of magicians gathered must fi rst agree that the shoes exist, and one gets to lay claim — in our minds, at in Las Vegas to share their tricks with psy- that they are indeed shoes. He was talking least — to the center of the universe. chologists, philosophers and neuroscien- tists at a symposium called ‘‘The Magic of Consciousness.’’ Magicians, after all, had spent ages performing behavioral New Sentences By Nitsuh Abebe experiments on people, using the same techniques of misdirection that pick- ‘‘A Little Bit Like Fun,’’ though, pockets use to steal and parents use to ‘Well, isn’t this a little simply repeats the question quoted get toddlers to sit still for shots. Physical bit like fun?’ here — asking first about fun, then misdirection is a common trick — big, joy, then love. There are countless fl ashy gestures that draw your eye away situations in which someone might from something the magician is hiding. ask such a question, nearly all of them But psychological misdirection is sad. Is this person unsure what fun subtler and more effective, its effects on feels like and wondering, uncertainly, behavior more insidious. ‘‘The false solu- if present circumstances maybe tion,’’ for instance, encourages people vaguely resemble it? (We do this to believe they’ve figured out how a all the time with love, a thing we’re trick is done, at which point they stop differently capable of and cannot considering any alternative solutions. For nearly 50 years, the brothers much compare notes on outside of art, Other tricks use cognitive illusions like Ron and Russell Mael, recording which tends to exaggerate and make ‘‘choice blindness’’ (in which someone as Sparks, have crafted songs that everybody feel bad.) Is this a person is steered to defend a choice they didn’t scan almost like light verse. None whose standards have fallen low actually make) and ‘‘forcing’’ (in which of the impressionistic muddle of enough that the barest simulacrum people believe that they have free rock lyrics for them; their subjects, of fun is worth noting? Is the speaker choice in a decision that’s been care- scenarios and verbal conceits are trying to cajole someone else into fully managed all along). as clear and legible as limericks. admitting things are almost nice, like ‘‘Ways of Seeing,’’ the British art critic On their latest record, those a man trying to salvage a bad date? John Berger’s 1972 series on visual culture subjects turn often to the stasis and I can’t help hearing the question for the BBC, made the case that how we angst of late middle age. A song on a grand scale, like a more neurotic are directed to look at something deter- about living inconspicuously ends with version of the one Peggy Lee made mines what we see. Framing is import- the chant ‘‘live fast and die young, so memorable in ‘‘Is That All There Is?’’ ant, Berger suggests, because framing is too late for that’’; another is a spirited (It’s hard not to, when one of the power: It determines what matters and From ‘‘A Little Bit defense of unflashy, reliable classics, preceding tunes is about eulogies.) Like Fun,’’ a song by what doesn’t, what should be paid atten- the long-running titled ‘‘Missionary Position’’; another I imagine people surveying the lives tion to and what shouldn’t. It isn’t merely musical duo Sparks. simply lists things happening in the they’ve constructed, counting up all aesthetic; it’s ideological. ‘‘Ways of See- ‘‘Hippopotamus’’ world (coral bleaching, new sneakers, the things in them that approach being ing’’ later became a book and went on to (BMG, 2017) is, Taylor Swift) before gazing down satisfying, and thinking, hopefully, depending on how become one of the seminal postmodernist you count, their at a baby and envying her total lack wearily: This is . . . kind of approximately

Illustration by Kyle Hilton Kyle by Illustration critiques of Western aesthetics. It taught 23rd studio album. of awareness of any of it. not terrible, right? Right?

13 On Medicine By Siddhartha Mukherjee

Recently, I met a very unlucky man. What we learn when two killers, A fi nancial adviser in his mid-60s, he seemed chronically short of breath, and he had an odd habit of widening his eyes heart disease and cancer, collide and and raising his brows every time he fi n- ished a sentence. ‘‘I’ve had two potentially deadly can- reveal a common root. cers,’’ he told me. ‘‘Melanoma and lung cancer. They took the lung cancer out, and the melanoma was resected.’’ The brows lifted and dropped. ‘‘But it wasn’t either of the cancers that nearly killed me,’’ he continued, with what seemed to me an extraordinarily sanguine approach to his medical history. ‘‘It was a heart attack.’’ Months earlier, he had an acute bout of chest pain — a ripping feeling across his chest that arced down to his left arm. He was rushed to the hospital, where doctors discovered a near-complete blockage of one of his heart’s main arter- ies. By the time cardiologists relieved the block, there was a dying wedge of tissue in his heart; he never recovered normal heart function. If this man’s case had been present- ed to me a decade earlier, I would have thought of him as the victim of two unre- lated illnesses. Heart disease and cancer — Killer 1 and Killer 2 in the United States — inhabited parallel universes of medi- cine. Coronary heart disease, we were taught as medical residents, was typical- ly caused by the buildup in the arteries of plaque, made up mainly of cholesterol deposits. If the plaque ruptured, a clot formed around it, precipitating an acute blockage of blood fl ow — a ‘‘heart attack.’’ Cardiologists learned that they could prevent plaque accumulation by chang- ing diet or habits or by using cholester- ol-lowering drugs like Lipitor. Beyond prevention, the doctors could forcibly widen the arterial blockade or inject clot-busting drugs. The image of scales of lead clogging old pipes, and a Roto-Root- er, was hard to shake. Coronary artery disease, it seemed then, was mainly a plumbing problem, demanding a plumb- er’s toolbox of solutions (to be fair, there’s a cosmos of biology behind cholesterol metabolism and its link to heart disease). Cancer, by contrast, was an extermi- nator’s problem — a poisoner’s dilemma. Cancer-causing agents unleashed abnor- mal cellular proliferation by mutating genes involved in regulating growth. These cancer cells, occupying tissues and

spreading, demanded a cellular poison Images Getty photographs: Source

14 10.1.17 Photo illustration by Najeebah Al-Ghadban Next Week: On Technology, by John Herrman New!

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nytimes.com/newwashington On Medicine

— chemotherapy — that would spare nor- activation of certain immune cells. These Inflammation is an very high risk for coronary disease in a ran- mal cells and kill the malignant ones. activated immune cells infi ltrated blood immune response to domized study to determine the eff ects of injury. But its effects, Cardiologists and oncologists — plumb- vessels early in the course of coronary we are learning, can the inhibitor on heart disease and strokes. ers and poisoners — lived in diff erent disease and enabled plaques to grow and take many forms The results, published this August, medical realms. We spoke diff erent lan- rupture. ‘‘Bad’’ cholesterol was a necessary — some beneficial, are provocative: Despite no change in some harmful. guages, attended diff erent conferences, part of the equation — it was these lipid cholesterol levels, there was a demon- read diff erent specialty journals. If our deposits that may incite the immune cells, strable reduction in heart attacks, stroke paths intersected, we considered the they proposed — but it was not suffi cient. and cardiovascular death, particularly at crossing coincidental, the unavoidable If infl ammation triggers coronary dis- higher doses of the drug. But what caught convergence of two common age-related ease, might targeting it directly — beyond my attention was a separate analysis that illnesses on the same body. simply reducing cholesterol — decrease asked a seemingly unrelated question: I was a medical resident in Boston in the risk of heart attacks? Over the course Might the drug also reduce the risk of the early 2000s when I heard a theory that of a decade, Libby and Ridker found them- cancer? In a paper published in The Lan- would, in time, force these separate worlds selves focusing on a molecule involved in cet, Ridker and his colleagues found that to collide. Two cardiologists, Peter Libby infl ammation called interleukin-1 beta. By drug-treated patients had a drop in all Siddhartha and Paul Ridker, were thinking about the mid-2000s, they heard of a new drug — Mukherjee cancer mortality. More striking still was plaque formation in a diff erent way. Libby an interleukin-1-beta inhibitor — that was is a cancer physician, a stark decrease in the incidence of and and Ridker acknowledged the role of cho- used to treat exceedingly rare infl amma- scientist and Pulitzer deaths from lung cancer. Some element lesterol and lipids. But just as important tory diseases. In April 2011, Ridker’s team Prize-winning author. of infl ammation that drives plaque for- His most recent was another variable, seldom discussed: started enrolling 10,000 patients who car- book is “Th e Gene: An mation in coronary disease is also driv- infl ammation — the recruitment and ried signs of infl ammation and were at Intimate History.” ing cancer progression. It’s a study that Images Getty photographs: Source

16 10.1.17 Photo illustration by Najeebah Al-Ghadban Poem Selected by Terrance Hayes needs careful replication; the analysis was Some carry no labels. Some do, but the Ekphrastic poetry is generally in response to art, usually designed to suggest a hypothesis, not to writing is in a foreign language. paintings, and this poem’s opening gesture is ekphrastic. It even prove it. There are questions about drug ‘‘Infl ammation, an umbrella term, is compares the mother to Venus, to marble. But then it goes on to pricing and the risks of infections and low now being broken up into many diff erent treat the photograph as a sort of window, a portal wherein the blood counts. But if the benefi t holds up categories,’’ Sharma told me. Is it chronic mother jumps across space and time. Elegiac, yes, but the poem is in future trials, interleukin-1-beta inhi- or acute? Is there a ‘‘right’’ kind of infl am- ultimately celebratory. It celebrates fl irtatious refusals. Time bition could eventually rank among the mation that protects us from infections falls from the wrist of this mother. She is ‘‘nebulous perfection.’’ most eff ective prevention strategies in the and a ‘‘wrong’’ kind that precipitates dis- Jim Croce sings to her. She is eternally laughing. recent history of cancer. ease? Is it mediated ‘‘adaptive’’ immu- nity — the type of immunity involving Infl ammation at the nexus between can- B and T cells that adapts to infections? cer and heart disease? But of course, some Or ‘‘innate’’ immunity, the more ancient of you must be thinking, with an exasper- phalanx of immune responses that is pre- ated nod. You’ve had your third serving programmed to fi ght certain pathogens? of blueberries; you’ve drunk your green When doctors read trials like Ridker’s, tea. Wasn’t it obvious all the while? we generally ask two sets of questions. It isn’t so simple. An avalanche of stud- The fi rst might be loosely described as: Is ies has implicated infl ammation as a cen- it good science and good medicine? Was the tral player in many diseases — but there are concept proposed in the study proved by inconsistencies. Consider an infl ammatory the trial? Were the conclusions accurate, illness like lupus: The risk of most cancers the adverse eff ects acceptable? Cardiolo- (except some virally related cancers and gists and oncologists I spoke to agreed on lymphomas) in lupus patients is only the technical accuracy of the study. One of marginally higher. Rheumatoid arthritis them noted the modest benefi t for heart increases the risk of lymphomas — but disease; Ridker and Libby counter that oddly lowers the risk of breast cancer. the drug is at least as eff ective as some Last Photograph of My Mother Laughing Tuberculosis, an infl ammation-inducing cholesterol-reducing medicines. By Sasha Pimentel disease, appears to promote lung-cancer But there’s a second kind of inquiry risk, but in an animal study, eczema, weird- that’s harder to put a fi nger on, for it lives The one in the book after this, you’re in the Louvre, whiter ly, reduces the risk of skin cancer. Mean- in a nearly aesthetic realm. Does the study and colder than Venus. It will be winter, your hands while, an alternative-medicine industry illuminate something strange and wonder- daily peddles ‘‘anti-infl ammatory’’ diets ful about human physiology ? A trial might in veins, your lips tight as marble. But now, it is spring — but which of these reduce infl ammation, be ‘‘good’’— but is it, well, ‘‘beautiful’’? in Manila, Jim Croce’s voice is wrapping against or what types of infl ammation are aff ected, This study is: It links disparate arenas of remains far from known. medicine through a common pathologi- an aging purpling sky where a seam of your hair puff s ‘‘Infl ammation,’’ in short, is a concept in cal mechanism. It’s hard to know wheth- up—, nebulous perfection. You’ve placed your hand fl ux — ‘‘a wastebasket word,’’ as Padmanee er the illnesses in the man I met were on your hip in young, fl irtatious refusal. One wrist steels Sharma, an immuno-oncologist at M. D. driven by infl ammation, but Ridker and with a watch so big, it’s halfway to falling, and your arms are Anderson Cancer Center, told me. There Libby forced me to view his case — and a isn’t one infl ammation: Lupus, tubercu- thousand other cases I’d seen previously — plain and hairless enough to turn into a statue’s missing losis and infl uenza all cause ‘‘infl amma- under new clinical lights. I will never think limbs. Gallery mother, swing of my heart, tion,’’ but each might provoke diff erent about patients with cancer and coronary or overlapping wings of immune respons- disease in the same way. you’re standing above three black-haired sisters es. I asked James Allison, who pioneered There’s another twist of wonder, who as I look at you there, are dead. cancer immunotherapy, to defi ne ‘‘infl am- though. What are the chances that one mation,’’ and he paused, considering the molecule, sitting at one corner of the The investigative report says ‘‘dark sky, calm wind’’ defi nition. ‘‘It’s a response to injury, medi- immune response, acts as a switch for in Louisiana when Jim gazed out the plane’s window, ated by immunological cells. But there two utterly diff erent diseases? It must are dozens of cell types communicating be a quirk in our design, a barely visible morning sticky with haze. Your city aches in the corner. through even further dozens of signals.’’ chink in physiology that allows us to tar- And your mouth breaks so cleanly across the sky. We might imagine infl ammation, then, get infl ammation in a manner that doesn’t as a fuse box that you chance upon in a kill or maim but acts just so, disabling two new house. You are looking for the switch terrifying illnesses. It’s as if we had walked that turns the light on in the living room, into the basement of the new house, or one that turns the alarm off (just as found the fuse box, learned to read the we’re hoping to throw the switch that dis- coded language of the labels and — in the Terrance Hayes is the author of fi ve collections of poetry, most recently ‘‘How to ables cancer growth or plaque formation). partial darkness — pulled just one switch. Be Drawn,’’ which was a fi nalist for the National Book Award in 2015. His fourth collection, ‘‘Lighthead,’’ won the 2010 National Book Award. Sasha Pimentel is a But the circuitry baff les you. Some knobs And, miracle of miracles: Upstairs, only professor of poetry at the University of Texas at El Paso. Her second collection, ‘‘For are marked in crimson: Do Not Touch. the living-room lights went on. Want of Water: And Other Poems,’’ will be published this month from Beacon Press.

Illustration by R. O. Blechman 17 The Ethicist By Kwame Anthony Appiah

Having children can be scary. Parental the pathogen. Unfortunately the immunity love, like all love, makes you vulnerable, threshold for measles is very high, around Can I Spread because you can be profoundly threat- 92 to 94 percent. Fortunately, in most of ened by harm to someone else. Unlike the United States, we’re at that level. In most other loves, however, parental love 2000, the disease had eff ectively been The Word also involves overwhelming responsibil- eliminated here. But there are 10 million ity. Your young children are enormously cases a year outside the United States, dependent on you. In light of these inter- and travelers (especially unvaccinated About an secting conditions, it’s not surprising that ones) bring it back. The anti-vaccination parents can be panicked by the possibil- movement, meanwhile, appears to have ity that they will fail as caretakers. Such depressed vaccination rates in certain Unvaccinated panic has been promoted by activists who communities, as happened recently in spread untruths about the dangers of vac- Minnesota . So the virus reappears, and cines, especially the vaccine that protects outbreaks can happen. Child? against measles. (The anti-vaccination Given the combination of vulnerability movement was fueled by a discredited and responsibility I mentioned, one rea- study from 1998 that linked the measles son parents avoid vaccinations is some vaccine to autism.) I refer to untruths version of this thought: ‘‘If I decide to and not lies, because the anti-vaccination vaccinate my child and something bad movement is no doubt largely sincere. happens, my child will have suff ered at Sincerity, though, doesn’t make them true. my hands.’’ But if that’s a sensible thought, I’m pregnant with my fi rst child, and As you make clear, two benefi ts come so should this one be: ‘‘If I decide not to concern for my unborn baby has prompted from vaccination. First, a vaccinated child vaccinate my child and something bad me to ask my friends if their children is less likely to suff er serious harm from happens, my child will have suff ered at are vaccinated. One close friend, Y, has exposure to the relevant pathogen. Sec- my hands.’’ What’s important is whether two young (vaccinated) children, and ond, if enough children are inoculated, the likely results of vaccination are better lives near another friend, X. Both Y and everyone’s risk is reduced by the ‘‘herd than the alternative. And the answer, once I have suspected for some time that X immunity’’ you mention. That means that exposure to measles is a possibility, is yes. chose not to vaccinate her child, and we you can help protect all the kids in your Even if that weren’t true, there would be have been trying to work up the courage community, including those who (because a second reason for being vaccinated: If to ask her. With the new pregnancy as an they are immune-compromised or aller- we all did it, we would get herd immunity. excuse, the task fell to me. gic to the vaccine) can’t be vaccinated. At that point, someone who thought It turns out that X has indeed chosen When vaccination rates are high that there were even small risks associ- not to vaccinate . When telling me this, she enough, the disease disappears from the ated with vaccination might say, ‘‘Hey, also asked me to keep her answer private. population until it’s reintroduced from I’m going to avoid the risks of vaccina- While her choice is not one I would make, outside. The level where this happens is tion for my kids, because the disease is I am perhaps even more upset by her called the ‘‘herd-immunity threshold’’; very unlikely to reach them.’’ But that’s request that I conceal the information. and it varies depending on the effi cacy true only because other people are vac- Y and X’s children play together, and of the vaccine and the contagiousness of cinating. So someone who thinks this we have regular gatherings with many young children present. I feel that parents have a right to know whether they are exposing their children to unvaccinated Bonus Advice From Judge John Hodgman children, especially with anti-vaxxers on the rise and herd immunity declining. Kristen writes: I have recently embarked on a journey toward My frustration is compounded by the minimalism. As part of my new way of life, I asked my mother fact that X’s child attends a public school to stop buying me birthday gifts, holiday gifts or anything and as far as I know has no valid grounds else. I would also like to stop buying her as many gifts. I would (for instance, an immuno-compromised prefer to give and receive experiences (e.g., a mani-pedi). child) for exemption. She is very unhappy and says I’m ruining everything. To submit a query: I respect the privacy of others; however ———— Send an email to I don’t like being asked to be complicit This court is totally with you. We are not children, and if you’re ethicist@nytimes in placing others at risk. I feel a responsibility like me, you have more decorative gavels and hand-stitched .com; or send mail to The Ethicist, The to other parents of young children, ‘‘a hot dog is not a sandwich’’ pillows than you will ever need. New York Times especially parents of new babies who are But I cannot order your mother to cease expressing her Magazine, 620 not yet vaccinated. Do I respect X’s affection for you in the best way she knows how. Accept her Eighth Avenue, New request to keep the information secret? tributes with equanimity, and then at the holidays you York, N.Y. 10018. (Include a daytime can pay her back with all the old magazines and shoes and

phone number.) Name Withheld charging cables you are getting rid of. Hilton Kyle by Illustration

18 10.1.17 Illustration by Tomi Um way is a free rider, like the person who dark, though, you can tell Y what you’ve One of the However, the book seemed to be an old fi gures she doesn’t need to pay the bus learned. As far as the school goes, there and rare book that should have been fare because everybody else does. One may be no easy alternative to informing its anti-vaxxers’ checked. I bought the book at the low price. of the anti-vaxxers’ off enses is refusing to offi cials directly. Why not tell X that you’ll offenses Do I have an obligation to check the undertake their fair share of the burdens be checking on her? Because that would is refusing to going internet price myself, and if it is high, for something from which they benefi t. turn a request to tell the truth into a threat. pay the diff erence or return the book? And just to be clear about how great But some vigilance is warranted, espe- undertake those benefi ts are: In a typical year before cially now that anti-vaccination ‘‘science’’ their fair share Name Withheld the measles vaccine was available in the has a proponent in the White House. A of the burdens United States, the virus infected millions, recent study found that even a small You can tell yourself that you just did what sent tens of thousands to the hospital, increase in what’s diplomatically called for something anyone interested in the book would have gave encephalitis to at least a thousand vaccine hesitancy would have large pub- from which done. After all, your store is no worse off and killed hundreds. Given that measles lic-health consequences. Talk about scary. they benefit. than if a random customer had bought it. is a highly contagious disease that can But people who work for charitable busi- be fatal and that the risks of vaccination I volunteer at a used-book store whose nesses have an obligation to look after are minuscule, not vaccinating your chil- proceeds benefi t the local public library. their interests. If you thought the book was dren is wrong. X has done wrong, too, if Our books are donations and library underpriced, you should probably have she’s lying to her kid’s school — public discards, which we sell at very low prices. brought it up with the other staff members schools require vaccination unless there’s Occasionally an old or rare book comes and, if you still wanted it, paid the price a recognized medical reason not to or the in. We then check the internet to see who else that was set once its value was known. parents have a sincere religious objection. is selling that book and price it at the (Can’t imagine a religious objection? lower end of what others ask. Recently I Kwame Anthony Appiah teaches philosophy Many Christian Scientists believe that came across a book that was priced by at N.Y.U. He is the author of ‘‘Cosmopolitanism’’ and health problems should be dealt with by another volunteer at a normal low price. ‘‘Th e Honor Code: How Moral Revolutions Happen.’’ prayer, not medicine, and so some reject vaccination, even though the founder, Mary Baker Eddy, said that a Christian Scientist should be vaccinated ‘‘if the law demand’’ and then ‘‘appeal to gospel to save him from bad physical results.’’) To be sure, the direct risk of infection remains very small, and the main harm done by avoiding vaccination would occur only if more people did it. But it isn’t crazy to worry about the danger of contact with unvaccinated children; parents are entitled to know the status of the kids that their kids play with. Something like 3 percent of vaccinat- ed people can still get measles (though it’s very likely to be less serious than in the unvaccinated). And children aren’t normally vaccinated until they are 1, so older children with infant siblings need to be kept away from the virus, too. What about respecting X’s request that you keep her answer private? There’s an important norm here, but it doesn’t neces- sarily apply to information that other peo- ple are entitled to know. Besides, you and Y have conferred in your eff ort to fi nd out the truth; how are you supposed to respond when Y asks you what you learned? Tell X that she ought to inform Y about the situation and also tell the school the truth. Letting her do it shows that you acknowledge her request not to pass the information on yourself. Give her a few days. If she continues to leave Y in the Diagnosis By Lisa Sanders, M.D.

‘‘Mom?’’ the middle-aged man asked. He She was 94, and all signs pointed to recognized the voice, but the words were muff led and strange. I’ll be right over, he said into the phone. The 15-minute drive a stroke. But when tests came back from his small Connecticut town to his mother’s seemed to last forever. Had she had a stroke? She was 94, and though negative, the doctors had to explore she’d always been healthy, at her age, anything could happen. more unusual possibilities. He burst into her tidy brick home to fi nd her sitting in the living room, waiting. Her eyes were bright but scared, and her voice was just a whisper. He helped her to his car, then raced to the community hospital a couple of towns over. The doctors in the emergency room were also worried about a stroke. Her left eyelid hung lower across her eye than her right. She was seeing double, she told them. And the left side of her mouth and tongue felt strangely heavy, making it hard to speak. Initial blood tests came back normal; so did the CT scan of her brain. It wasn’t clear what was wrong with the patient, so she was transferred to nearby Yale New Haven Hospital. ↓ Not Looking Your Age Dr. Paul Sanmartin, a resident in the second year of his neurology training, met the patient early the next morning. He’d already heard about her from the overnight resident: a 94-year-old woman with the sudden onset of a droopy eye- lid, double vision and diffi culty speaking, probably due to a stroke. As he entered the room, he realized he wasn’t sure what 94 was supposed to look like, but this woman looked much younger. She did have a droopy left lid, but her eyes moved in what looked to him to be per- fect alignment, and her speech, though quiet, was clear. The patient’s story was also diff erent from what he expected. She had macular degeneration and had been getting shots in her left eye for more than a decade. Her last injection was nearly two weeks earlier, and she’d had double vision and the droopy eyelid on and off ever since. Did she have double vision now, the young doctor asked? She glanced around the room. Not just then, but it would come back, she was sure of it. Other than the macular degeneration, the woman had only high blood pressure, for which she faithfully took a pill each day. She lived alone, and until all this happened, drove

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Atlanta At Cancer Treatment Centers of America® (CTCA), treating cancer isn’t one thing we do, it’s the only thing we do. CTCA® is a national network of fi ve hospitals in the U.S. We combine advanced treatments and technologies with Chicago evidence-informed therapies for an integrative approach to cancer care to help reduce side eff ects and support quality Philadelphia of life during and after treatment. We bring precision cancer treatment to our patients for truly personalized care. If you or someone you love has cancer, call 855-587-5528 or visit cancercenter.com. Phoenix © 2016 Rising Tide Tulsa Diagnosis herself to all her appointments and volun- and the muscles they command, causing little raspy. By the time she got to 50, it teered at a local school for the disabled. the muscles to tire out quickly. was barely a whisper, as the muscles she Sanmartin was surprised. He’d dis- used to speak gave out. She probably did ↓ cussed this at length with the last attend- have MG, Nowak told his resident. Still, it Unrevealing Tests ing neurologist, who was just as certain wasn’t proof enough for him to treat her. The young doctor held up a finger, it wasn’t MG. That doctor argued that Each morning, when Nowak came to instructing the woman to follow it with although myasthenia often causes weak- see her, her exam was the same — sug- her eyes as he traced a large box in front ness in the muscles of the eyes and mouth gestive but not defi nitive. One day he of her face. Her eyes moved normally. — not unlike what this woman had — that wasn’t able to see the woman until late He asked her to stick her arms out ‘‘like weakness usually comes and goes. But afternoon. She was alert and engaged as chicken wings,’’ and he pushed down on this woman’s symptoms were consistent- always, but her words were slurred and them repeatedly, testing her strength. She ly present. Besides, the resident added, at nearly inaudible. Muscle weakening late seemed a little weaker on the second or 94, wasn’t she too old for that? in the day is a classic symptom of MG. third time. She felt weak all over, she told Age was not a factor, Nowak said. As The test results hadn’t come back yet and him. Not as strong as she used to be. the director of Yale’s myasthenia clinic, he probably wouldn’t for several more days, Sanmartin thought that the patient recently diagnosed the disease in a 98-year- so Nowak decided to try a diff erent test. probably had a stroke. Less likely, but old man. And although men tend to get the He would start her on a low dose of Mes- possible, she could have a small mass or disorder later than women — men were tinon, the drug used to reduce the muscle tumor. Myasthenia gravis (MG), an auto- more likely to get it in their 60s and women weakening of MG. If she responded, the immune disease that causes intermittent in their 20s and 30s — age alone can’t be diagnosis would be confi rmed. muscle weakness, was also possible but used to rule it out. In the meantime, the less likely at her age. She defi nitely needed team should send off the blood tests for ↓ an M.R.I. and also a scan called an M.R.A. MG because it usually took a week or more Successful Treatment to look at how the blood fl owed through for the results to come back. Sanmartin had the day off when the patient her brain. And she needed a swallowing started on the medicine. When he returned study because she said she was choking on Lisa Sanders, M.D., ↓ the next morning, he hurried to see her. her food at home. Whatever made it hard is a contributing writer A Tired Voice She was awake and smiled as he walked to talk could make it hard to swallow too. for the magazine Sanmartin watched the more experi- in. She greeted him, and he immediate- The M.R.A. was normal; so was the and the author of ‘‘Every enced doctor examine the woman. Nowak ly noticed the change in her voice. The Patient Tells a Story: M.R.I. There was no stroke, no brain Medical Mysteries and couldn’t fi nd any evidence of double nasal quality he heard before was gone. tumor. All the blood tests were com- the Art of Diagnosis.’’ vision. And the patient passed all the tests She spoke as if with a diff erent voice. She pletely normal. By Day 4 in the hospi- If you have a solved case he did to try to tire out the muscles of the could even drink water. Thin liquids like tal, the plan was to send her home. She to share with Dr. eyes and shoulders. Then Nowak asked that are the most challenging to swallow. Sanders, write her at would need a follow-up appointment Lisa.Sandersmd@ the patient to count to 50 out loud. At 29, When the test results fi nally came back with her eye doctor because the lid was gmail.com. her voice changed. It got quieter and a positive for MG, no one was surprised. still droopy, and with an ear, nose and They started her on a second medication. throat doctor because she complained The hope was that the dual approach of of diffi culty swallowing, even though she Mestinon for relief of the symptoms and had passed a swallowing test just that the second drug to help protect her from morning. He wasn’t sure what she had her wayward immune system would pre- but fi gured that they had ruled out the vent future attacks. possibilities that might kill her. And it did — at least for a while. But a That night at the hospital, though, she couple of months later, the woman had proved them wrong; she choked while a life-threatening fl are-up of her disease, eating dinner. She wasn’t going anywhere. an episode of weakness that left her inca- pable of breathing on her own. She was ↓ on a ventilator for nearly a week. And Circling Back strangely, like her fi rst episode of weak- When Sanmartin presented the patient ness, this terrible crisis came right after to Dr. Richard Nowak, the neurologist she got the injection to treat her macu- who took over the team as the attending lar degeneration. Was this some unusual physician, it still wasn’t clear what was reaction to a medicine she’d been taking wrong with her. But even before seeing for years? According to Nowak, no link the elderly woman, Nowak told the resi- between the medicine she took and MG dent, he already had a diagnosis in mind has been reported. But she’s unwilling to — he did think she had myasthenia gra- take that risk — or the eye medication vis. In this rare autoimmune disorder, the — again. And if her vision worsens, she body’s defense system mistakenly attacks told me with the cheerful determination the connections between the nerve fi bers of a survivor, she still has her other eye.

22 10.1.17 Illustration by Andreas Samuelsson Music and the Brain Taught by Professor Aniruddh D. Patel TIME TUFTS UNIVERSITY ED O T FF I E LECTURE TITLES IM R L 70% 1. Music: Culture, Biology, or Both? 2. Seeking an Evolutionary Theory of Music 1 O 1 off R R 3. Testing Theories of Music’s Origins D E E B R O 4. Music, Language, and Emotional Expression BY OCT 5. Brain Sources of Music’s Emotional Power 6. Musical Building Blocks: Pitch and Timbre 7. Consonance, Dissonance, and Musical Scales 8. Arousing Expectations: Melody and Harmony 9. The Complexities of Musical Rhythm 10. Perceiving and Moving to a Rhythmic Beat 11. Nature, Nurture, and Musical Brains 12. Cognitive Benefi ts of Musical Training 13. The Development of Human Music Cognition 14. Disorders of Music Cognition 15. Neurological Eff ects of Hearing Music 16. Neurological Eff ects of Making Music 17. Are We the Only Musical Species? 18. Music: A Neuroscientifi c Perspective Are Humans Wired for Music? Music and the Brain Course no. 1181 | 18 lectures (30 minutes/lecture) Are we born with our sense of music? What gives mere tones such a powerful effect on our emotions? Why does music with a beat give us the urge to move and dance? How and why did musical behavior originate? SAVE UP TO $160 Music is intimately woven into the fabric of our lives, yet we still ponder these deeply puzzling and provoking questions. In the last 20 years, researchers have come closer to solving these riddles DVD $219.95 NOW $59.95 thanks to cognitive neuroscience, which integrates the study of human Video Download $199.95 NOW $39.95 mental processes with the study of the brain. Join neuroscientist and CD $149.95 NOW $39.95 Professor of Psychology Aniruddh Patel of Tufts University as he Audio Download $99.95 NOW $19.95 probes one of the mind’s most profound mysteries. Professor Patel +$10 Shipping & Processing (DVD & CD only) has been lauded by scientists and musicians alike for his work in this and Lifetime Satisfaction Guarantee groundbreaking field. Covering the latest research findings—from the Priority Code: 151437 origins of music’s emotional powers to the deficits involved in amusia— you will think about music and your brain in a new way. For over 25 years, The Great Courses has brought the world’s foremost educators to millions who want to go deeper into Off er expires 10/11/17 the subjects that matter most. No exams. No homework. Just a world of knowledge available anytime, anywhere. THEGREATCOURSES.COM/7NYM Download or stream to your laptop or PC, or use our free apps for iPad, iPhone, Android, Kindle Fire, or Roku. Over 1-800-832-2412 600 courses available at www.TheGreatCourses.com. Letter of Recommendation ‘Shark Tank’ By Jaime Lowe

When I was 10 or so, my mom took me He handed it to me. I was mesmerized, A show that capitalism. The premise of the tank is to a Fourth of July barbecue so we could enchanted. I held the small wooden reimagines that small-business owners get an audi- capitalism as it celebrate America in our traditional fam- pole and watched the sacred symbol of ought to be. ence with investors — the ‘‘sharks,’’ a ily way — at her Howard Zinn-reading America burn. It was the mid-’80s, and crew of millionaires and billionaires that grad-student friend’s apartment, where Ronald Reagan was a hated capitalist pig includes Mark Cuban, Daymond John most of the other guests were aspiring in our household. and Lori Greiner, the ‘‘queen of QVC’’ — screenwriters. The America we celebrat- Something happened in the interven- in the hope of provoking a bidding war ed was one that encouraged protest and ing 30 years, because today, my favorite for a stake in the company. Sometimes strived for justice, peace and equality. TV show is ‘‘Shark Tank.’’ I think President the sharks dismiss the ideas outright, and My lasting memory of the party came Reagan would have loved it, too, for it is they often do so cruelly, but in a satisfy- after dark, after the fi reworks, after the trickle-down economics if trickle-down ing, detailed way. You start to feel as if hot dogs, when the host brought out economics actually worked, a Potem- you could write your own business plan

a tiny American fl ag and set fi re to it. kin village dedicated to the wonders of after watching a few episodes. Images. via Getty Images. Diamond: ryasick/iStock, Library/Getty Photo Shark: Science

24 10.1.17 Photo illustration by Matt Dorfman Finding an episode of ‘‘Shark Tank’’ is The miracle of The America I read about was founded my opinion, to value me. I wanted to be easy; it’s basically always on. Reruns air ‘Shark Tank’ on slavery, misogyny and genocidal bru- taken seriously. I think most kids feel on CNBC fi ve nights a week, sometimes tality. Even when its elites proceed with this way, dismissed outright for being in seven-hour blocks. Watch enough epi- is that it the best intentions, the inequities of the small. In the tank, no one is dismissed sodes, and the segments begin to reveal recasts a brutal system recreate themselves generation — the sharks start every segment with a similar rhythm; seeing the pitch pro- economic after generation. Any meritocratic veneer furrowed brows, ready to take notes and cess repeated so many times in rapid is belied by the way capital wends its way hear out pitches, no matter how prepos- succession, a viewer develops a sort of system in its through our world. For example, venture terous. They begin the process with a omniscience, that mixture of intimacy best light. capitalists tend to be white men, and they clean slate every time. Somewhere deep and superiority that is unique to reality tend to invest in white men with software down, I want all these deals to work, I TV. By Hour 2, I fi nd myself thinking that that destroys middle-class jobs, while want the enthusiasm that sharks feel to Lori is crazy for not investing in a perfect sometimes reaping ungodly returns for be genuine and I want the contestants to QVC product or that Mark is a moron their investors. And in this way, wealth walk away with business plans ready to for passing up a product that could eas- begets wealth — except on ‘‘Shark Tank,’’ be set into motion. Even if ‘‘Shark Tank’’ ily pair with his sports empire. Still, the where we witness a comforting, inclusive is propaganda — the selling and market- outcomes hardly matter to me — I can form of capitalism in action. ing of the American dream — the fantasy play couch shark just as easily as I can I was so politically assertive as a kid feels real. I get to imagine the country as play couch entrepreneur. because I wanted someone to respect it could be but never really was. The miracle of ‘‘Shark Tank’’ is that it recasts a brutal economic system in its best light. The show dramatizes a roman- tic vision of our economy, depicting it Tip By Malia Wollan increased tolerance within a few months. as a bootstrap meritocracy. Most of the True novices might want to begin with people appearing onstage are regular How to Eat one of the gentler chemical compounds, folks applying for patents and tinker- Spicy Food whose eff ects are shorter-lived, found in ing with plastic molds in their garages, cinnamon, ginger, black pepper, mint or dreaming of the sorts of modestly prof- wasabi and build up to the fi ery capsai- itable businesses that no real venture cin in chiles. If you need more incentive capitalist would ever touch. They sell to start down this path, consider that special brooms or gluten-free frosting studies suggest that capsaicinoids have or inventions like the Squatty Potty — a anti cancer, anti-infl ammatory and anti- stool that claims to induce the ‘‘best poop oxidant properties. They also aid in diges- of your life.’’ On a recent segment, two tion and reduce cholesterol levels. potential entrepreneurs walked in with ‘‘Add the spice to a dish you already a live llama and pitched a GPS security like,’’ Dalton says. Take a mouthful. If it gadget called the Guard Llama. The prop hurts, wait two and a half to fi ve min- llama pooped in the middle of negotia- utes for the receptors in your mouth to tions. Still, they got a deal. desensitize before taking another bite. Part of the show’s appeal is that it’s Don’t overdo it, and keep a dairy prod- an equal-opportunity forum — you uct nearby in case you do; molecules in don’t have to know a Silicon Valley V.C. ‘‘It’s helpful to think of spiciness as some- milk attract and dissolve capsaicin. Put or even a banker to get your audience thing other than painful,’’ says Pamela the food toward the back of your throat, with the sharks. This is, to put it lightly, Dalton, an olfactory researcher at Monell where people tend to fi nd the mucous not at all how the actual venture-capital Chemical Senses Center in Philadelphia. membrane less sensitive. ‘‘Don’t get it world works. For a year, I worked for a The burn of spicy food is not a taste; it’s a on your lips,’’ Dalton says. company founded by the daughter of a result of chemical compounds triggering It might take you a while to genuine- venture capitalist who notoriously and an innate averse reaction in the central ly enjoy spiciness. In chile-eating cul- proudly boasted about his nepotism. nervous system. At Monell, researchers tures like Mexico’s and India’s, children During my job interview with him, he use the word ‘‘mouthfeel’’ to describe that start eating capsaicin-containing foods made his habit of investing in his chil- post-chile tongue-on-fi re sensation. between the ages of 3 and 5, but what dren’s companies clear. It was a savvy Practice a benign masochism: By scientists call the ‘‘hedonic shift’’ from business strategy, he said, because his repeatedly exposing your nerves to disliking to liking occurs later, between children were smart and he could get spices, you reassure your brain that 5 and 9. It might help to think of capsaicin in on the ground floor. Why not trust these are desired encounters, not threats. as a recreational drug. Relax and let the those closest to you? ‘‘We tend to like things that we experi- plant compounds expand your ability to This conversation confi rmed for me ence over and over,’’ Dalton says. Psy- experience food in a new way. ‘‘You have everything I was taught when I was Jaime Lowe chologists call this phenomenon ‘‘the to be willing to give up control,’’ Dalton is the author of young — that American capitalism was ‘‘Mental,’’ out Oct. 3 mere-exposure eff ect.’’ If you eat spicy says. ‘‘Trust that your mouth is not going a fallacy built on the concept of equality. from Blue Rider Press. food at least once a week, you’ll notice an to burn for the next year.’’

Illustration by Radio 25 Eat By Samin Nosrat The Taste of Regret How you should — and should not — cook with garlic.

A few years ago, at the end of a lovely bully in the kitchen. With every fl edgling Flavorful and when he insisted that he had a special long afternoon spent browsing used relationship, I’m anxiously aware that the fragrant: garlic touch with garlic bread, I stepped aside bread with herbs bookstores, my date and I unexpectedly simple act of cooking alongside my new and Parmesan. and let him proceed. ended up in my kitchen, famished. There paramour can unleash havoc. He roughly chopped the garlic. I wasn’t much food around, but I managed Let me be clear: I don’t consider watched him struggle to mix it into cold to dig up some leftovers and the makings being a skilled cook a prerequisite to unsalted butter, and then smear it clum- for garlic bread. I’d been dreading this romance. And while I found many things sily onto to the bread. I knew the heat of occasion, our fi rst time cooking together. about this gentleman endearing, his the oven wouldn’t be suffi cient to cook

Friends have warned me that I can be a culinary prowess wasn’t on the list. But that garlic through. Afraid of bruising Wilson. Amy stylist: Prop Ruggiero. stylist: Maggie Food

26 10.1.17 Photograph by Gentl and Hyers Comment: nytimes.com/magazine his ego, I kept quiet. But my eyes grew for a few minutes, or until the garlic is We’d take it 3 tablespoons chopped parsley, wide at the thought of having to eat raw tender . Just as it starts to take on a golden plus ½ cup parsley leaves chunks of garlic. On a date. All I could hue and release a savory aroma, remove it to the table and 2 tablespoons chopped chives, think about was the time I made a similar from the heat, or add a little water, stock let it cool just plus ½ cup chives cut into 1-inch pieces mistake a dozen years before. or chopped tomato to prevent browning. 2 tablespoons chopped basil, enough so that plus 20 basil leaves Very early in my culinary career, If your garlic does brown, throw it out and while helping another cook prepare the start over. Browned garlic is burned gar- we could tear Heaping ⅓ cup fi nely grated Parmesan (about ¾ ounce) staff meal, I stirred some chopped raw lic, and its acrid fl avor will seep through- into and devour garlic and herbs into a bowl of leftover out an otherwise perfect dish. it one chewy, Freshly ground black pepper lentils. The atonement for this sin was Bloom garlic for Alfredo, puttanesca or 1 1-pound loaf rustic country bread so extreme that I’ve never repeated it: any pasta you can imagine. To add garlic heavenly piece Extra-virgin olive oil After being chastised, I spent the next 20 into a pan of cooked greens or onions, at a time. minutes fi shing out the minuscule piec- clear away a little space in the center of Note: You can prepare, wrap and refrigerate the loaf up to one day ahead. Bring to room es of garlic. ‘‘The last thing you want is the pan by pushing the food to the edge. temperature before baking. for someone to bite on a piece of raw Add a little oil, and continue as above, garlic,’’ the other cook said, without stirring the garlic into the rest of the veg- 1. Arrange a rack in the center of your oven, explaining what to do instead. etables just before it starts to brown. and preheat to 400. Over time, I fi gured it out by watching My date didn’t employ either method. 2. Bloom half the garlic: Thinly slice 7 of more experienced cooks. There are two Instead, he broiled the butter-smeared the cloves. Melt 2 tablespoons butter in proper ways to use garlic: pounding and bread, yielding distinct pieces of garlic a small saucepan over medium-low heat, blooming. Neither involves a press, which that were raw and burned all at once. and add garlic. Cook, stirring and swirling is little more than a torture device for a He was pleased with his eff ort, so I did constantly, 7 to 8 minutes, or until the garlic beloved ingredient, smushing it up into my best to feign enjoyment. But the is aromatic and tender. Do not allow it to take on any color. (If you sense it starting watery squiggles of inconsistent size that garlic left behind a terrible taste of fi re to brown, remove the pan from heat, and will never cook evenly or vanish into a and regret in my mouth. And in his too. add a few drops of water.) Pour garlic vinaigrette. If you have one, throw it away! With tears in his eyes, he dumped me and butter into a heatproof bowl, and set Instead, pound raw garlic into a paste the next time I saw him — the chemistry aside to cool to room temperature. that can dissolve into food. Like an just wasn’t there. I didn’t resist. Still, the 3. Very roughly chop remaining garlic, then intoxicatingly perfumed woman who rejection burned like each bite of that place in the bowl of a mortar. Add a generous left a party before you arrived, it’ll leave stale bread covered in raw garlic. pinch of salt, and pound to a very fine paste. behind only a faint rumor of its pres- In the wake of a failed relationship, I’m ence. Pound garlic for mayonnaise, vin- often fl ooded with if-onlys. This time was 4. Place the cooled garlic butter in the bowl of a food processor along with the garlic aigrettes, marinades, kebabs and herb no exception. If only I had trusted my paste, chopped parsley, chopped chives and butter. For several cloves, use a mortar intuition, if only I had spoken up, if only chopped basil. Pulse until everything is very and pestle. For one or two, turn your knife I had insisted on making the garlic bread, finely chopped, stopping to scrape down the on its side and squish the garlic with the I would have shown him how to put both sides of the bowl with a spatula as needed. blade. In either case, a preliminary rough techniques in practice and make a gar- Add remaining butter, Parmesan and black pepper. Pulse to combine, again stopping to chop and a generous pinch of salt will lic butter rich with herbs and Parmesan. scrape down the sides of the bowl with help expedite the proc ess. Keep going Then we’d score the loaf into thick slices a spatula. Taste, and add salt as needed. until it’s as smooth as toothpaste. and slather each with the butter, wrap it Cover your perfect paste with a little with foil and slip it into the oven. When 5. Deeply score the loaf of bread in 1-inch olive oil to keep it from turning an unap- the crust turned mahogany and a savory slices, but don’t cut all the way through. Use an offset spatula or butter knife to generously pealing greenish gray. Add it, without steam piped from the loaf, we’d pull it spread garlic butter on one side of each slice, much delay, to a sauce or a dish while from the oven and stuff each slot with a as far down as you can reach. remembering two things: fi rst, that you’re salad of fresh herbs. Then we’d take it to now adding salt along with the garlic, so the table and let it cool just enough so 6. Wrap the bread in aluminum foil, and place hold back on salting your food until after that we could tear into and devour it one on a baking sheet. Bake on the center rack for 10 minutes, rotate the loaf 180 degrees and you taste it with the garlic. And second, chewy, heavenly piece at a time. bake 10 minutes more. Unwrap the loaf, return that the fl avor of raw garlic grows more The romance wouldn’t have lasted it to the baking sheet and bake for 12 to 15 intense with the passage of time — your much longer, but it would have been minutes, or until the crust is brown and crisp. aioli will be more garlicky tomorrow. You so much more delicious. Remove from the oven, and let cool slightly. can always add more, so add it gradually. 7. Meanwhile, in a medium bowl, combine To cook with garlic, sizzle but don’t Herbed Garlic Bread the parsley leaves and chive pieces. Tear brown it before adding it to food — this Time: 1 hour the basil leaves into the bowl in 1-inch is blooming, and it will tame garlic’s raw pieces. Add a pinch of salt, and dress lightly fi re, leaving it fragrant and fl avorful. To 14 large cloves garlic with a few drops of olive oil. Stuff herb salad into the bread crevices, and serve the bloom, gently heat a tablespoon or two of 10 tablespoons unsalted butter, at room loaf immediately. butter or oil in a pan over low heat, then temperature add minced or sliced garlic. Swirl and stir Salt Serves 8 to 10.

27 THE ANGLER

John McPhee’s radical structures.

By Sam Anderson Photograph by Andrea Modica

28

1999, McPhee won a Pulitzer Prize for his 700-page McPhee embraces this tradition. In his preface geology collection, ‘‘Annals of the Former World,’’ to ‘‘Annals of the Former World,’’ he calls writ- W which explains for the general reader how all of ing ‘‘masochistic, mind-fracturing self-enslaved North America came to exist. (‘‘At any location labor.’’ (The fi rst time I read this, I put a large star on earth, as the rock record goes down into time in the margin.) In ‘‘Draft No. 4,’’ McPhee writes of and out into earlier geographies it touches upon his ‘‘inability to get going until 5 in the afternoon’’ hen you call John McPhee on the phone, he is tens of hundreds of stories, wherein the face of the and his ‘‘animal sense of being hunted.’’ And yet instantly John McPhee. McPhee is now 86 years earth often changed, changed utterly, and changed this doubt, he writes, ‘‘is a part of the picture — old, and each of those years seems to be fi led away again, like the face of a crackling fi re.’’) He has now important and inescapable.’’ inside of him, loaded with information, ready to published 30 books, all of which are still in print Much of the struggle, for McPhee, has to do access. I was calling to arrange a visit to Princeton, — a series of idiosyncratic tributes to the world with structure. ‘‘Structure has preoccupied me N.J., where McPhee lives and teaches writing. He that, in aggregate, form a world unto themselves. in every project,’’ he writes, which is as true as was going to give me driving directions. He asked McPhee describes himself as ‘‘shy to the point saying that Ahab, on his nautical adventures, where I was coming from. I told him the name of of dread.’’ He is allergic to publicity. Not one of was preoccupied by a certain whale. McPhee is my town, about 100 miles away. his book jackets has ever carried an author photo. obsessed with structure. He sweats and frets over ‘‘I’ve been there,’’ McPhee said, with the mild He got word that he won the Pulitzer while he the arrangement of a composition before he can surprise of someone who has just found a $5 bill was in the middle of teaching a class, during a begin writing. He seems to pour a whole novel’s in a coat pocket. He proceeded to tell me a story break, and he returned and taught the whole sec- worth of creative energy just into settling which of the time he had a picnic at the top of our local ond half without mentioning it to his students bits will follow which other bits. mountain, with a small party that included the — they learned about it only afterward, when the The payoff of that labor is enormous. Structure, wife of Alger Hiss, the former United States offi - hall outside was crowded with photographers, in McPhee’s writing, carries as much meaning cial who, at the height of McCarthyism, was dis- reporters and people waiting to congratulate him. as the words themselves. What a more ordinary graced by allegations of spying for the Russians. For McPhee’s 80th birthday, friends, family and writer might say directly, McPhee will express The picnic party rode to the top, McPhee said, colleagues arranged a big tribute to his life and through the white space between chapters or an on the incline railway, an old-timey conveyance work. But McPhee found out about the plan short- odd juxtaposition of sentences. It is like Morse that has been out of operation for nearly 40 years, ly beforehand and squashed it by refusing to go. code: a message communicated by gaps. and which now marks the landscape only as a Bill Bradley, the former basketball star and United The fi rst time I read ‘‘The Pine Barrens,’’ ruin: abandoned tracks running up a scar on the States senator who was the subject of McPhee’s McPhee’s 1968 novella-length portrait of an mountain’s face, giant gears rusting in the old fi rst book, ‘‘A Sense of Where You Are,’’ was one ecologically odd region of southern New Jer- powerhouse at the top. Hikers stop and gawk of the organizers. ‘‘You can’t celebrate somebody sey where forests of dwarf pine trees grow out and wonder what the thing was like. who doesn’t want to be celebrated,’’ he told me. of sandy soil, its opening paragraph struck me ‘‘It was amazing,’’ McPhee said. ‘‘A railroad cre- As I spoke to people about McPhee — editors, as unnecessarily dull. I wanted razzle-dazzle, ated by the Otis Elevator Company. An incline of students, friends, colleagues — I got the sense jokes, aphorisms, fi reworks displays. I wanted 60-something percent.’’ that they had all been waiting, respectfully, for Joan Didion (‘‘We tell ourselves stories in order Then he started giving me directions — 87, decades for the chance to gush about him in pub- to live’’) or Hunter S. Thompson (‘‘We were some- 287, Route 1 — until eventually I admitted that lic. McPhee has profi led hundreds but never been where around Barstow on the edge of the des- I was probably just going to follow the direc- profi led. Almost everyone expressed surprise ert when the drugs began to take hold’’) or Tom tions on my phone. McPhee kept going for a that he had agreed to such a thing. His focus has Wolfe (‘‘Hernia, hernia, hernia, hernia, hernia, few seconds, suggesting another road or two, generally been outward; he writes, as he likes to hernia, hernia, hernia, hernia, hernia, hernia, but fi nally he gave up. put it, about ‘‘real people in the real world.’’ In hernia, hernia, HERNia; hernia, HERNia . . . ’’). ‘‘Well,’’ he said. ‘‘The machine will be telling recent years, however, his writing has become McPhee, I thought, had wasted his chance. you what to do.’’ more personal: He has written essays about his The opening paragraph of ‘‘The Pine Barrens’’ As soon as we said goodbye, I checked mother and father, his childhood, his grandchil- reads like an information board on top of a scenic McPhee’s facts. The incline railway was, indeed, dren. McPhee’s new book, ‘‘Draft No. 4,’’ takes us lookout. ‘‘From the fi re tower on Bear Swamp designed by the Otis Elevator Company, with about as deep into his singular mind as we are Hill, in Washington Township, Burlington Coun- an average incline of 65 percent — in its heyday, likely to get. It is about the writing process itself. ty, New Jersey, the view usually extends about it was one of the steepest railways of its kind on twelve miles. To the north, forest land reaches to earth. These were things I had not known about Every book about writing addresses, in one the horizon. The trees are mainly oaks and pines, a structure that is visible from my house, that way or another, the diffi culty of writing. Not and the pines predominate. Occasionally, there I look at every day of my life. just the technical problems (eliminating clutter, are long, dark, serrated stands of Atlantic white McPhee has built a career on such small deto- composing transitions) but the great existen- cedars. . . . ’’ This goes on for several pages, at nations of knowledge. His mind is pure curiosi- tial agony and heebie-jeebies and humiliation which point I imagine some readers wandering ty: It aspires to fl ow into every last corner of the involved — the inability to start, to fi nish, or to off for a walk in an actual forest. world, especially the places most of us overlook. progress in the middle. This is one of the genre’s Why start there? McPhee can do razzle-daz- Literature has always sought transcendence great comforts: learning that you are not alone zle. Almost immediately after that hiking-guide in purportedly trivial subjects — ‘‘a world in in your suff ering. William Zinsser: ‘‘It was hard of an opening, ‘‘The Pine Barrens’’ unleashes all a grain of sand,’’ as Blake put it — but few have and lonely, and the words seldom just fl owed.’’ kinds of color and legend and bizarre characters, ever pushed the impulse further than McPhee. Annie Dillard: ‘‘I do not so much write a book including a deep-woods cranberry farmer who He once wrote an entire book about oranges, as sit up with it, as with a dying friend.’’ Anne invites McPhee into his shack while eating a pork called, simply, ‘‘Oranges’’ — the literary cousin of Lamott: ‘‘Your mind has become a frog brain that chop in his underwear. ‘‘Come in. Come in. Come Duchamp’s urinal mounted in an art museum. In scientists have saturated with caff eine.’’ on the hell in,’’ he shouts.

30 10.1.17 Why not start there? I didn’t discover the answer until the book’s end, some 150 pages later. ‘‘The Pine Barrens’’ leads you right back where it started, to the fi re tower on Bear Swamp Hill — except now the view of that spreading forest is charged with sinister context. McPhee stands there, this time, with a city planner, who fantasizes aloud about a thrill- ing future in which the Pine Barrens will be paved over, replaced not only with a city but also with the largest airport in the world. Supersonic jets will whisk people away to everywhere else on earth. The region, in other words, is under threat, and McPhee, by introducing us to its creatures and lore, has made us care. When I reached the fi nal sentence — ‘‘At the rate of a few hundred yards or even a mile or so each year, the perimeter of the pines contracts’’ — I turned immediately back to that long open- ing passage, the encyclopedic panorama of trees. What had seemed dry was now poignant and rich with meaning. In fact, the qualities I had objected to — the quietness, the numbing distance, the John McPhee with his daughters Jenny, left, sense of taking inventory — had actually, slyly, and Martha in Ontario in the 1970s. been the point. The very large quietness of the Pine Barrens, which took such patience and focus to appreciate, was exactly what was under attack. Our modern minds, too, had been paved, and McPhee was peeling that pavement back. It hit It was all about technique. In the same spirit that This inscrutable pictogram turned out to be me like the end of a great work of fi ction. The a medical student, in gross anatomy, would learn the structure of a 1973 New Yorker essay called razzle-dazzle, I realized, had been there all along what a spleen is and what it does, we would learn ‘‘Travels in Georgia,’’ in which McPhee describes — it was just suppressed, and there was no way how stuff works in a piece of writing.’’ a long road trip with ecologists who, among other to feel it until you fi nished the book. Much of that stuff , of course, was structure. things, eat roadkill. (‘‘Weasel,’’ in the diagram, One of Remnick’s enduring memories is of refers to the time McPhee ate one.) The piece is ‘‘Draft No. 4’’ is essentially McPhee’s writing watching Professor McPhee sketch out elaborate one of McPhee’s early magazine masterpieces, its course at Princeton, which he has been teaching shapes on the chalkboard. One looked like a nau- language lovely (‘‘The darkness in there was so since 1975. This imposes a rigid structure on his tilus shell, with thick dots marking points along rich it felt warm,’’ he writes of a swamp) and its life. During a semester when he teaches, McPhee its swirl. Each of these dots was labeled: ‘‘Turtle,’’ characters almost unbelievably vivid. (‘‘She had does no writing at all. When he is writing, he does ‘‘Stream Channelization,’’ ‘‘Weasel.’’ Down the a frog in each hand and saw another frog, so she not teach. He thinks of this as ‘‘crop rotation’’ side of the chart it said, simply, ‘‘ATLANTA.’’ An put one frog into her mouth while she caught and insists that the alternation gives him more arrow next to the words ‘‘Rattlesnake, Muskrat, the third.’’) Like much of McPhee’s work, it sits at energy for writing than he would otherwise have. etc.’’ suggested that the swirl was meant to be some thrilling intersection of short story, essay, McPhee’s students come to his offi ce frequently, read counterclockwise. documentary, fi eld research and epic poem. for editing sessions, and as they sit in the hallway ‘‘Draft No. 4’’ is full of such diagrams. McPhee waiting for their appointments, they have time creates them for everything he writes. Some of to study a poster outside his door. McPhee refers the shapes make almost no sense — they look like to it as ‘‘a portrait of the writer at work.’’ It is a the late-stage wall sketches of a hermit stuck in a print in the style of Hieronymus Bosch of sin- Turtle cave. Others are radically simple. ‘‘Draft No. 4’’ ners, in the afterlife, being elaborately tortured begins, for instance, with an alphabetical fraction: A Stream in the nude — a woman with a sword in her back, T Channelization a small crowd sitting in a vat of liquid pouring L ABC out of a giant nose, someone riding a platypus. A The poster is so old that its color has faded. N D David Remnick, the editor of The New Yorker, T A where McPhee has been a staff writer for more Weasel than 50 years, took McPhee’s class in 1981. ‘‘There Rattlesnake, This is the structure of ‘‘Encounters With the was no fancy discussion of inspiration,’’ he told Muskrat, Archdruid’’ (1971), possibly my favorite McPhee etc. me. ‘‘You were in the room with a craftsman of book. After years of writing traditional profi les, the art, rather than a scholar or critic — to the McPhee was bored of the form, so he decided to point where I remember him passing around write a quadruple portrait: one character (D) as the weird mechanical pencils he used to use. revealed through separate interactions with three

Photograph from John McPhee The New York Times Magazine 31 other characters (A, B and C). He came up with the structure fi rst, then spent months trying to come up with the right people. He fi nally set- tled on the pugnacious conservationist David Brower, and set him against three unapologetic developers. After this, McPhee was tempted to experiment even further. ‘‘I began to think of a sequence of six profi les,’’ he writes, ‘‘in which a seventh party would appear in a minor way in the fi rst, appear again in greater dimension in the second, grow further in the third, and further in the fourth, fi fth and sixth, always in subordinate ratio to the principal fi gure in each piece until becoming the central fi gure in the seventh and fi nal profi le. However, I backed away from this chimerical construction.’’ I asked McPhee why he is so obsessed with structure. He told me it was because his high school English teacher, Olive McKee, made him outline all of his papers before he wrote them. But lots of people, I said, had to outline papers in school. Not many ended up devoting the meat of their adult lives to scribbling byzantine dia- grams all over the place. Perhaps there was a deeper psychological cause — something about McPhee with his granddaughter Isobel at childhood, maps, his father, anatomy? his Pennsylvania fishing spot in 1998. ‘‘Not consciously,’’ McPhee said, cheerfully. ‘‘But that doesn’t mean you’re not right.’’

John McPhee lives, and has almost always lived, in Princeton. I met him there in a large parking lot on McPhee was born in 1931. His father was idealized abstractions of plans and maps relate the edge of campus, next to a lacrosse fi eld, where the university’s sports doctor, and as a boy to the fertile mess of the actual world. The camp’s he stood waiting next to his blue minivan. He wore McPhee galloped after him to practices and infi rmary is now offi cially named after McPhee’s an L.L. Bean button-down shirt with khaki pants games. By age 8, he was running onto the fi eld father. McPhee’s own name still sits in the rafters, and New Balance sneakers. The top half of his face alongside Princeton’s football team, wearing a an honor for having been the second-most-accom- held glasses, the bottom a short white beard that custom-made miniature jersey. He played bas- plished camper in 1940, when he was 9. McPhee fi rst grew, unintentionally, during a canoe ketball in the old university gym, down the hall On the center console of McPhee’s minivan trip in the 1970s and has not shaved off since. He from his father’s offi ce; when the building was was a 10-CD set of ‘‘Lolita,’’ read by Jeremy Irons. is soft-spoken, easy and reserved. Although locked, he knew which windows to climb in. The entire back of the van was occupied by a McPhee possesses intimidating stores of knowl- McPhee was small and scrappy, and he played bicycle, standing upright. McPhee drove me by edge — he told me, as we walked around campus, just about every sport that involved a ball. To the house where both Aaron Burrs lived — the the various geological formations that produced this day, he serves as a faculty fellow of men’s father, who was Princeton’s second president, the stone used in the buildings — he seems to go lacrosse, observing Princeton’s practices and and the son, who shot Alexander Hamilton. out of his way to be unintimidating. Whenever we standing on the sidelines during games. We passed, many times, the Firestone Library. stepped outside, he put on a fl oppy hat. Every summer growing up, McPhee went to (‘‘Interesting structure,’’ McPhee said. ‘‘Most of McPhee proceeded to show me every inch a camp in Vermont called Keewaydin, where his it is underground.’’) We saw his childhood home, of Princeton, campus and city, narrating as we father was the camp doctor. One of his grand- tucked into leafy streets named after trees. Every- went. I’m not sure I’ve ever seen anyone so thor- sons goes there today. (‘‘I have 200 grandchil- thing was incredibly green. It was a great year oughly identifi ed with a place. His memories are dren,’’ McPhee told me; the number is actually for foliage, McPhee said, because of all the rain. archaeological, many layers deep. Not 30 seconds 10.) McPhee speaks of Keewaydin as paradise, and He pointed to a house with columns. into our orienting drive, we passed the empty lot his time there established many of the preoccupa- ‘‘See it?’’ he said. ‘‘Einstein.’’ where he used to play tackle football as a child, tions of his life and work: canoeing, fi shing, hiking. We followed Einstein’s walk to work, which and where, at age 10, he fi rst tasted alcohol. (‘‘One ‘‘I once made a list of all the pieces I had written in included a stroll down two rows of mighty syca- thing it wasn’t was unpleasant,’’ he wrote recent- maybe 20 or 30 years, and then put a check mark mores, between which the great man would ly.) The lot is no longer empty; it is occupied by beside each one whose subject related to things I pause, occasionally, to watch local boys play- a new house, boxy and modern. I asked McPhee had been interested in before I went to college,’’ ing football. Those local boys included John if he felt any animosity toward the structure for he writes in ‘‘Draft No 4.’’ ‘‘I checked off more than McPhee. We stepped into the old basketball stomping out his memories. 90 percent.’’ Keewaydin put McPhee into deep gym, where his father worked and where Bill ‘‘No,’’ he said. ‘‘I’ve had a lot of stomping contact with the American land, and introduced Bradley played, and also into the new gym, a grounds stomped out.’’ him to the challenge of navigation — how the vast arcing space that looks like a blockbuster

32 10.1.17 Photograph by Laura McPhee sci-fi set. ‘‘This is a hell of an interesting struc- a code. To fi nd the structure of a piece, McPhee about the species, now and again making ture,’’ McPhee said, with admiration. makes an index card for each of his codes, sets comparisons and asking him questions — McPhee is a homebody who incessantly them on a large table and arranges and rearranges did he remember the sand sharks off Sias roams. He inherited Princeton and its Ivy League the cards until the sequence seems right. Then he Point? the rainbows of Ripton? the bull- resources as a kind of birthright, but he comes works back through his mass of assembled data, head he gutted beside Stony Brook that at the place from an odd angle: He was not the labeling each piece with the relevant code. On the fl ipped out of his hand and, completely son of a banker or a politician or some glamorous computer, a program called ‘‘Structur’’ arranges gutless, swam away? — to which I expected alumnus but of the sports doctor. His view of the these scraps into organized batches, and McPhee no answers, and got none. university is practical, hands-on — it is, to him, then works sequentially, batch by batch, convert- like a big intellectual hardware store from which ing all of it into prose. (In the old days, McPhee It is a touching scene of laconic masculine he can pull geologists and historians and avia- would manually type out his notes, photocopy love — emotion expressed not directly but tors and basketball players, as needed, to teach them, cut up everything with scissors, and sort through the medium of shared wilderness him something. He is able to run off to Alaska it all into coded envelopes. His fi rst computer, he activities. After which McPhee does something or Maine or Switzerland or Keewaydin because says, was ‘‘a fi ve-thousand-dollar pair of scissors.’’) structurally magical. There is a section break, he always knows where he is coming back to. Every writer does some version of this: gath- some white space, and then a paragraph of fi sh ‘‘I grew up in the middle of town,’’ McPhee ering, assessing, sorting, writing. But McPhee facts that, in the context of his father’s impend- said. ‘‘It’s all here.’’ takes it to an almost-superhuman extreme. ‘‘If ing death, reads like a prose poem: McPhee took me to his offi ce in the geology this sounds mechanical,’’ McPhee writes of his With those minutely oscillating fi ns, a pick- building, in a fake medieval turret that, before method, ‘‘its eff ect was absolutely the reverse. erel treads water in much the way that a he moved in, was crowded with paint cans. Now If the contents of the seventh folder were before hummingbird treads air. If the pickerel its walls are full of maps: the Pacifi c Ocean fl oor, me, the contents of twenty-nine other folders bursts forth to go after prey, it returns to United States drainage, all the world’s volcanoes. were out of sight. Every organizational aspect the place it started from, with or without On the carpet in the corner of the room, a box was behind me. The procedure eliminated the prey. If a pickerel swirls for your fl y and sat stuff ed with dozens more, from the center of nearly all distraction and concentrated just misses, it goes back to the exact spot from which protruded, almost shyly, a folded map of the material I had to deal with in a given day which it struck. You can return half an hour Guayaquil, Ecuador. His enormous dictionary, or week. It painted me into a corner, yes, but later and it will be there. You can return at open to the letter P, sat on top of a minifridge. in doing so it freed me to write.’’ the end of the day and it will be there. You Multiple shelves were loaded with books pub- can go back next year and it will be there. lished by former students, above which stood McPhee’s next book, ‘‘The Patch,’’ will be a col- framed photos of McPhee’s wife, Yolanda, and lection of previously uncollected work reaching McPhee’s great theme has always been con- his four daughters. all the way back to his fi rst magazine job, starting servation, in the widest possible sense of the McPhee sat down at his computer and in the late 1950s, when he wrote celebrity pro- word: the endless tension between presence clicked around. Green text appeared on a black fi les for Time magazine — often without actual- and absence, staying and leaving, existence and screen. That was all: green text. No icons, rulers, ly meeting the celebrity. (‘‘He looked like a big the void. It is, of course, a losing battle. Our or scrollbars. basset hound who had just eaten W. C. Fields,’’ fathers will die. The Pine Barrens will contract. McPhee began to type in command lines. he wrote about Jackie Gleason.) If that sounds Civilization will continue to invade the vast wil- x coded.* straightforward, McPhee has decided to make it derness of Alaska. The course of the Mississippi dir coded.* not so. He has turned it into another structural River once roamed erratically ‘‘like a pianist x coded-10.tff challenge. ‘‘The Patch’’ will gather fragments of playing with one hand,’’ but humans put a stop x coded-16.tff the old work, arranged by McPhee into a pattern to that. Developers want to mine mountains, Up came portions of his book ‘‘The Founding that pleases him, out of order, like patches in pave islands and turn the Grand Canyon into a Fish.’’ He typed in further commands, and hunks a quilt. (‘‘I’m still trying to get my head around lake. North America, in McPhee’s telling, is the of green text went blinking around: a complete it,’’ Alex Star, McPhee’s current editor at Farrar, product of nearly infi nite vanished worlds, with inventory of his published articles; his 1990 book, Straus and Giroux, told me.) species and climates and mountain chains and ‘‘Looking for a Ship.’’ The title piece of ‘‘The Patch’’ is a short essay oceans all lost in the chasms of deep time — so I felt as if I were in a computer museum, that McPhee wrote about the death of his father. far gone that even the most brilliant geologists watching the curator take his favorite oddity It is, in its way, as revealing as anything he has ever are unable to extrapolate all the way back to for a spin. McPhee has never used a traditional written. Fishing, McPhee writes, was his father’s their original bubbling source. word processor in his life. He is one of the world’s ‘‘best way of being close.’’ In the essay, he fi nds Everything, for McPhee, is annals of a former few remaining users of a program called Kedit, himself alone in a hospital room with his father, world. Even his own work, he is fully aware, which he writes about, at great length, in ‘‘Draft who has suff ered a debilitating stroke. McPhee will disappear. ‘‘The fact is that everything I’ve No. 4.’’ Kedit was created in the 1980s and then doesn’t know what to do, and so he begins, spon- written is very soon going to be absolutely tailored, by a friendly Princeton programmer, to taneously, to talk about fi sh, particularly a species nothing — and I mean nothing,’’ he told The fi t McPhee’s elaborate writing process. that he had recently been out catching in New Paris Review in 2010. ‘‘It’s not about whether The process is hellacious. McPhee gathers Hampshire: the aggressively ravenous pickerel. little kids are reading your work when you’re every single scrap of reporting on a given proj- ‘‘Pickerel that have been found in the stomachs 100 years dead or something, that’s ridiculous! ect — every interview, description, stray thought of pickerel,’’ McPhee writes, ‘‘have in turn con- What’s 100 years? Nothing.’’ and research tidbit — and types all of it into his tained pickerel in their stomachs.’’ And yet McPhee’s work is not melancholy, computer. He studies that data and comes up macabre, sad or defeatist. It is full of life. Learn- with organizing categories: themes, set pieces, I went on in this manner, impulsively ing, for him, is a way of loving the world, savoring characters and so on. Each category is assigned blurting out everything I could think of it, before it’s gone. In the (Continued on Page 55)

The New York Times Magazine 33

WHAT HAPPENS AFTER A DEFENDANT IS FOUND NOT GUILTY BY REASON OF INSANITY? OFTEN THE ANSWER IS INVOLUNTARY CONFINEMENT IN A STATE PSYCHIATRIC HOSPITAL —

WITH NO SURE WAY OF GETTING OUT.

BY MAC MCCLELLAND

35 say, he ran track and fi eld in the Special Olym- convicted of a crime — people who have been pics, competing in Minnesota, Colorado, Ger- found not guilty by reason of insanity or who many and London. When I asked what charge, have been arrested but found incompetent to exactly, led to his arrest, he lowered his voice stand trial — are involuntarily confi ned to psy- and said: ‘‘rape.’’ His mother added that a kid- chiatric hospitals. Even a contributor to the study napping count was ‘‘tacked on.’’ concedes that no one knows the exact number. In 1996, when James was 20, the police While seemingly every conceivable data point responded to a frantic 911 call near the house in America’s prison system is meticulously com- where he lived with his mother. At the scene, the piled, not much is known about the confi nement offi cers found a woman bloodied and in distress. of ‘‘forensic’’ patients, people committed to psy- She said that James had lured her inside for a chiatric hospitals by the criminal-justice system. housekeeping interview — and that he’d been No federal agency is charged with monitoring screaming when he started ripping her clothes them. No national registry or organization tracks off and beating her. The cops later picked him how long they have been incarcerated or why. up at his grandmother’s house, a few miles away. In 1992, the Supreme Court ruled, in Foucha D At the police station, James signed a statement v. Louisiana, that a forensic patient must be both saying he understood his rights. He waived the mentally ill and dangerous in order to be hospital- right to representation. He signed a confession. ized against his will. But in practice, ‘‘states have espite Ann’s determination to betray no emotion, (He and his mother now claim that the confes- ignored Foucha to a pretty substantial degree,’’ a drop of sweat rolled down her temple as a guard sion was coerced and that he is innocent.) When says W. Lawrence Fitch, a consultant to the painstakingly examined her lunch items. That doctors subsequently evaluated him, they found National Association of State Mental Health Pro- Sunday morning, she had taken two buses, two him so unstable that they ruled him incompetent gram Directors and former director of forensic trains and a shuttle to get from her home to the to stand trial. He was remanded to a hospital for services for Maryland’s Mental Hygiene Adminis- New York state psychiatric facility where her son several months, then sent back to jail, where he tration. ‘‘People are kept not because their danger- is confi ned. Frustrated, she pushed back a little, regressed again, then sent back to the hospital ousness is because of mental illness. People stay but just a little, when the guard took away two for several more months, stabilized once again, in too long, and for the wrong reasons.’’ sealed bottles of fruit-fl avored water, a special then sent back to jail, where in preparation for Michael Bien, a lawyer who helped bring a treat that Ann had made an extra stop to buy. his trial, he was returned to the hospital to be successful lawsuit against the California prison She watched as he held them up to examine them evaluated for mental illness. Doctors diagnosed system on behalf of prisoners with psychiatric and concluded that they must contain caff eine borderline-personality disorder, his mother says illnesses, concurs. ‘‘Under constitutional law, — which is not allowed — because they did not — which enabled him to plead ‘‘not responsible they’re supposed to be incarcerated only if read, ‘‘Does not contain caff eine.’’ by reason of insanity.’’ they’re getting treatment, and only if the treat- ‘‘They’re testing you,’’ she said to her son, James says that he understood the plea he ment is likely to restore sanity,’’ he says. ‘‘You James, after she was fi nally cleared, metal- took. In the abstract sense, he did. But the spe- can’t just punish someone for having mental ill- detected and led upstairs to the visiting room, cifi cs of it were as mysterious to him and his ness. But that’s happening.’’ a spare, linoleum-fl oored space inside the hos- family as they are to most people. Before he was In the visiting room in New York that Sun- pital’s high-security building. Ann, who asked arrested, James and his mother were set to move day, as the hours went by, families came and that her nickname and her son’s middle name to Georgia, where they had relatives, and where went. Ann settled in. On James’s birthday, she be used to protect their privacy, usually comes Ann had friends and a job lined up. After his plea brings a party: relatives, presents, a cake. And to see James three times a week. Obstacles like deal, Ann says, she ‘‘put everything on hold,’’ for almost every week, on every visiting day, she these are routine. James, a middle-aged white what she thought would be a few years. and James try to make a life here together at man with thinning hair and a thickening waist- Instead, James, now in his 40s, has been in the hospital — because it now seems possible line, listened to her complaints in a routine way, the hospital for almost two decades. This isn’t that he could die there. too, glancing up from the newspaper his mother because he was sentenced to 20 years, or to 25. had brought, the two of them sitting at a table, He was not sentenced at all; he is technically, THE INSANITY DEFENSE has been part of the Amer- the same arch in their brown eyebrows, eating legally, not responsible. The court believes ican judicial system from its founding, carried homemade coleslaw and sandwiches. They’ve beyond a reasonable doubt that he committed over from our English forebears. British law has been doing this a long time. the act he was accused of, a prerequisite for the long refl ected the moral sense that society has a At some point in the next fi ve hours — while state to accept an insanity plea. The plea does duty not to punish people who can’t comprehend the three of us ate lunch, and dessert, and later not, however, prescribe or limit the duration or control their crimes. But the insanity defense snacks between rounds of Bananagrams and of his stay. The laws that govern the practice of has always sat uneasily with the public, which Kings in the Corner — James said to me, ‘‘I committing people who are acquitted because tends to regard it as a means to escape justice. In shouldn’t have taken the plea.’’ of mental illness dictate that they be hospital- the United States, such sentiments reached fever By the time of the arrest that would lead to ized until they’re deemed safe to release to the pitch in 1981, when a 25-year-old named John James’s confi nement here, he had already been public, no matter how long that takes. Hinckley Jr., hoping to win Jodie Foster’s heart, hospitalized multiple times for threatening to James’s insanity acquittal placed him in an tried to assassinate President Reagan and instead kill himself. His problems stemmed, he said, obscure, multibillion-dollar segment of domes- shot James Brady, the White House press secre- from being sexually abused by his stepfather. tic detention. According to a 2017 study con- tary. Hinckley was found not guilty by reason of But he had held down jobs — at a pizza shop, ducted by the National Association of State insanity (N.G.R.I., as it is frequently abbreviated) banquet setup in hotels — and after an intellec- Mental Health Program Directors, more than and sent to St. Elizabeths Hospital in Washington. tual disability was diagnosed, he and his mother 10,000 mentally ill Americans who haven’t been The country was outraged. Dan Quayle, then a

36 10.1.17 senator from Indiana, called the verdict ‘‘deca- act in accordance with the law, but most defi ne prison, inmates know they’re leaving. Once you dent’’ and said the insanity defense ‘‘pampered it, post-Hinckley, as only the fi rst of these. At the check into the hospital, it’s hard to check out.’’ criminals.’’ His Senate colleague Strom Thur- trial of James Holmes, who killed 12 people and Though forensic detentions get little atten- mond equated it to a free ride. injured 70 in a movie theater in Aurora, Colo., tion, they can range from ethically question- In fact, despite its reputation as a ‘‘get out of one psychiatrist testifi ed that he was mentally ill able to fl agrantly unconstitutional and illegal. jail free’’ card, the insanity defense has never but that he knew right from wrong and should In 1983, a national study found that N.G.R.I. been an easy way out — or easy to get. After a be considered ‘‘sane.’’ Another testifi ed that he patients often lost their freedom for twice as defendant is charged, the defendant, her lawyer was mentally ill and incapable of reason (and, long as those actually convicted of the same or a judge can request evaluation by a psychia- by extension, guilt). All four who examined him off ense. A study of N.G.R.I. patients in seven trist. A defendant may be found incompetent to agreed that he had some form of schizophrenia. states between 1976 and 1985 found that in four stand trial and committed for rehabilitation if Jurors rejected his insanity plea. of those states, they were confi ned for less time she isn’t stable enough or intellectually capable And when an N.G.R.I. defense does succeed, than people who were found guilty, and that of participating in the proceedings. If she is reha- it tends to resemble a conviction more than an in three, they were confi ned for longer. Scant bilitated, she may be tried; if she cannot be, she acquittal. N.G.R.I. patients can wind up with lon- research, conducted decades ago, seems to con- may languish in a psychiatric hospital for years ger, not shorter, periods of incarceration, as they stitute the most recent survey of the fate of the or decades. But mental illness is not exculpatory are pulled into a mental-health system that can be country’s forensic commitments. in itself: A defendant may be found mentally ill harder to leave than prison. In 1983, the Supreme ‘‘There’s not been a lot done,’’ Fitch says. and still competent enough to stand trial. At that Court ruled, in Jones v. the United States, that The federal government doesn’t collect data on point, the district attorney may off er an insanity it wasn’t a violation of due process to commit forensic patients’ lengths of stay, crimes or treat- plea — some 90 percent of N.G.R.I. verdicts are N.G.R.I. defendants automatically and indefi nite- ment. In some cases, neither do the state or local plea deals. If the district attorney doesn’t off er a ly, for the safety of the public. (Michael Jones, departments in charge of their custody. In 2015, plea, or the defendant doesn’t take it, the case who was a paranoid schizophrenic, had been I began collecting, via request or the Freedom goes to trial. The defendant may still choose hospitalized since 1975, after pleading N.G.R.I. of Information Act, all individual length-of-stay insanity as a defense, but then her case will be to petty larceny for trying to steal a jacket.) In data by legal status that existed in each state and decided by a jury. almost all states, N.G.R.I. means automatic com- Washington. Colorado, Wyoming, Arkansas, Mis- souri, California, Maine, New Hampshire, Ken- tucky, Wisconsin, Delaware, New Jersey, Ohio and South Carolina said they simply didn’t have ‘YOU CAN’T JUST that information. Alabama may or may not: In response to repeated queries, it ‘‘decided not to release forensic data,’’ and hospital reports are PUNISH SOMEONE excluded from its public-records law. Many of the above states have reported legal FOR HAVING status and average lengths of stay. In 2014, Fitch, on behalf of the National Association of State MENTAL ILLNESS. Mental Health Program Directors, estimated, based on states’ self-reported average lengths BUT THAT’S of stay, that the national average for all N.G.R.I.s was around fi ve to seven years. He says he fi nds HAPPENING.’ that ‘‘horrendous,’’ given that civil commitments with the same diagnoses as forensic commit- ments can get out in under 30 days. There is no accepted body of research to suggest that If N.G.R.I. was always diffi cult to get, it mitment to a psychiatric facility. In most states, lengthy institutionalization leads to better treat- became even harder after Hinckley. With the like New York, there is no limit to the duration ment outcomes. On the contrary, says Mar- Insanity Defense Reform Act of 1984, Congress of that commitment. In the states that do have thagem Whitlock, an assistant commissioner restricted the judicial defi nition of ‘‘insanity’’ to limits, like California, the limits are based on in Tennessee’s Department of Mental Health only the most severe cases. Some states — Idaho, the maximum prison sentence for the off ense, and Substance Abuse Services, ‘‘The deeper Utah, Kansas and Montana — have eliminated a model that belies the idea of hospitalization as penetration into the system usually means more the defense altogether. In trials in which it is treatment rather than punishment. As Suzanna complications for the individual.’’ There are, as attempted, doctors may disagree, and jurors Gee, an attorney with Disability Rights California Fitch acknowledges, ‘‘people who don’t respond are often infl uenced by emotional consider- (a protection and advocacy agency with counter- to treatment or who refuse treatment.’’ But, he ations. Today, only an estimated one-120th of parts in every state), points out, the law allows argues, ‘‘it should almost never be necessary to 1 percent of contested felony cases end in a two-year extensions as patients approach a ‘‘top hospitalize people that long.’’ successful N.G.R.I. defense — that is, the pros- date,’’ the limit set on their confi nement. And so, According to the state records collected ecutor disputes the insanity defense, the case she says, ‘‘it can be extended in perpetuity.’’ for this article, in 2015, Florida had 24 N.G.R.I. goes to trial and the jury fi nds the defendant James’s mother, Ann, now knows the predic- patients who had been hospitalized for longer not guilty by reason of insanity. In addition, ament of forensic confi nement well. At some than 15 years. Texas had 27. Connecticut had 40, the legal standards for ‘‘insanity’’ vary among point during James’s stay at the state hospital, and Georgia had 43. New York and Washington states; some defi ne it as a defendant’s inability she became an advocate for mentally ill off end- had around 60 apiece. That’s six of the 28 states to know the crime was wrong or the inability to ers. ‘‘It’s like a roach motel,’’ she says. ‘‘At least in from which such data can be extrapolated, along

The New York Times Magazine 37 with the District of Columbia. In those states — whom the police responded to near his house which exclude thousands of N.G.R.I. patients saying that James sexually assaulted her, beat her — a signifi cant portion of N.G.R.I. patients had unconscious, then threw her down the basement been hospitalized more than two years. Nearly stairs. She told the police that when she came to, 1,000 had been hospitalized for fi ve to 15 years. naked, she realized she was locked in. This, you More than 400 had been in for longer than 15. Of might presume, was the basis for the rape and these, more than 100 had been in longer than 25 kidnapping charges that James said put him in years and at least 60 for more than 30. And those the state hospital. numbers don’t present the whole picture, either: ‘‘Well,’’ Arcidiacono clarifi ed when I contacted Many factors, like hospital transfers or conver- him, ‘‘there were two cases, actually.’’ sion to civil commitment, can start the clock over Two months earlier, James had been arrested or obscure patients’ histories. In many cases, Gee based on another woman’s statement, taken at says, when patients reach out to Disability Rights the emergency room, that she was pinned by California to advocate on their behalf, ‘‘if they’d her throat and raped in an empty fi eld. (In his not pled N.G.R.I. and just gone to prison, they statement, James said she had agreed to have might have gotten out earlier.’’ sex with him in exchange for crack, and that Which is not to say there aren’t protocols for he didn’t actually intend to make good on his release. Most states do have a formal review promise.) Charges were fi led, and James was process to judge whether N.G.R.I.s no longer fi t released to his mother’s custody — Arcidiacono commitment criteria: They are no longer men- says there’s no record of why, but it could have tally ill or are no longer dangerous as a result of been because James hadn’t been indicted yet. their mental illness. Some states review cases on a When James pleaded N.G.R.I. to the subsequent schedule — every year, say, or in the case of New attack, the charges from the fi rst incident were Hampshire, every fi ve years. In others, patients lumped together with the new ones: in total, (or their lawyers) have to request the review. second-degree kidnapping, second-degree Doctors can recommend patients for discharge assault, second-degree aggravated sexual abuse, at any time. Patients’ lawyers can also fi le writs fi rst-degree sexual abuse, fi rst-degree rape and of habeas corpus or petitions for restoration of third-degree robbery. sanity to have their cases heard in court. ‘‘You can see in his case,’’ Arcidiacono said, At the psychiatric facility where James is a ‘‘that they were serious charges.’’ patient, as at every New York state hospital, Like most district attorneys, Arcidiacono has cases are reviewed every two years or so, in a substantial discretion when an N.G.R.I. patient joint process by the hospital and the Offi ce of comes up for review. Any time a hospital wants Mental Health (O.M.H.) in Albany. In 2002, when to release or transfer an N.G.R.I. patient, his offi ce the hospital and O.M.H. review declared James can demand a hearing. In contesting transfer or unfi t for release, James requested that the court release, Arcidiacono can compel the patient to be appoint him an independent evaluator and grant examined by a doctor he selects. Even if that doc- him a hearing. tor agrees that the patient is ready to leave, the That doctor found that he wasn’t danger- district attorney can still contest the release. Arci- ous and was ready to be transferred. The judge diacono has done this and won. If a patient does agreed and ordered it. win release or transfer (in New York, a forensic But James didn’t leave. patient is almost always transferred to a civil, less ‘‘Even the mechanisms for getting out,’’ says secure facility for another unspecifi ed amount Pat McConahay, communications director for of time before release), the district attorney can Disability Rights California, ‘‘are not really mech- appeal, as in James’s case. When you’re dealing anisms for getting out.’’ not with facts but with opinions, Arcidiacono told me, ‘‘reasonable people can diff er.’’ JAMES’S ALMOST-TRANSFER 15 years ago fell under He went on to explain: ‘‘There are two con- the jurisdiction of Guy Arcidiacono, now 61, the siderations here. What is good for the defen- district attorney in charge of the Suff olk Coun- dant, and also, the safety of the public. And ty Forensic Psychiatric Litigation Unit, who has that’s the difficult part of these cases, balancing handled 130 N.G.R.I. cases over 25 years. After the those two interests.’’ judge approved James for transfer, Arcidiacono All this adds up to a diffi cult path to freedom and the Suff olk County district attorney’s offi ce, for some N.G.R.I.s. In most states, as in New York, joined by the New York State attorney general’s the courts have fi nal review over forensic releases offi ce, which represents the hospital, appealed and transfers, and judges have the prerogative to have the transfer order overturned. Under to side with the prosecution regardless of what another judge, it was. doctors advise. Cas Shearin, director of investiga- James’s police fi les are terrible to read. There tions and monitoring at Disability Rights North was never a trial, but the allegations are disturb- Carolina, recalls a 1988 case in which, during ing. They include a statement by the woman an alcohol-related psychotic break, a man shot

38 10.1.17 Photograph by Ilona Szwarc for The New York Times four strangers he thought were demons. ‘‘Year after year after year, his treating doctors went to the judge and said, ‘He’s ready to be released.’ ’’ The hospital where he was committed gave him increasing leave privileges, including reporting to a full-time job and visiting a girlfriend with whom he had children. After 21 years of incarcer- ation and seven psychologists and psychiatrists testifying that he was no longer mentally ill and posed no threat to the public, he was released — though the judge still ordered that he submit to random drug tests for a year. Politics, says Joel Dvoskin, a former New York State Offi ce of Mental Health forensic director, can determine if ‘‘you’re going to stay locked up for a really long time, regardless of whether it’s safe to let you go.’’ Elected judges, fearing bad publicity, may be loath to release an off ender into the community. As Ira Burnim, legal direc- tor of the Bazelon Center for Mental Health Law, a national advocacy organization based in Washington, explains the situation: ‘‘You have a mechanism to confi ne, for the protection of the public, these individuals when they’re mentally ill and dangerous, and the further you stray from that, the less it’s legally justifi ed.’’ John Hinckley Jr. became a famous example. Last September, Hinckley was released from St. Elizabeths Hospital in Washington, 35 years after being found not guilty. It had been two decades since his doctors declared his mental illnesses in full remission, which should have provided the basis for his release. ‘‘That anyone can justify keeping him in the hospital’’ for so long, Fitch says, ‘‘is just nuts.’’ The question, according to Dvoskin, ‘‘becomes one of risk tolerance. America has become — to an extreme level that’s almost impossible to exaggerate — a risk-intolerant society.’’ Fears of people with mental illness persist, even though, according to the best estimates, only 4 percent of violent acts in the United States are uniquely attributable to serious mental illness. One study has found that those with mental illness are actu- ally less likely to be seriously violent than the general population. (In addition, some N.G.R.I.s have been acquitted of nonviolent crimes, like public-order off enses, traffi c off enses and prostitution.) Even if a mentally ill person has

HOUSTON committed a crime, says Chris Slobogin, HERCZOG director of the criminal-justice program AT NAPA STATE at Vanderbilt University Law School, ‘‘it HOSPITAL doesn’t mean they’re going to do it again,’’ ON JULY 27. especially because their encounter with the forensic psychiatric system means they’ve received treatment. ‘‘This is a group of people that are incredibly stigmatized and misunder- stood in terms of how dangerous they are.’’ Recidivism for N.G.R.I.s is relatively low. Whereas, nationally, recidivism for released prisoners is above 60 percent, ‘‘people who are

The New York Times Magazine 39 found N.G.R.I. tend to go back out into the com- and received the minimum sentence, he would to fi le any writs or petitions for release. That num- munity, and they tend to do really, really well,’’ be out before his 50th birthday. His ‘‘top date,’’ ber has nothing to do with what he thinks of his Fitch says. The arrest rate for people in Maryland according to his hospital paperwork, is Dec. 31, mental state but with comments his fi rst social on conditional release, a kind of mental-health 2600 — 587 years after he was admitted. worker at Napa made: that because of what he parole from the hospital, is less than half the Houston doesn’t dispute that he did what he did, he can’t possibly be let go for a long time. arrest rate of the general population in the state. did, but he does dispute the basis for his contin- (When reached for comment about whether this ‘‘If you provide treatment of illness and provide ued detention. ‘‘What are they rehabilitating?’’ was a plausible conversation, a spokesman for the the supports they need, then they don’t reoff end,’’ he asked me that day, shaking his legs up and hospital said, ‘‘A patient with a determinate sen- Fitch says. As a 2016 study of N.G.R.I. recidivism down when the caff eine from a Mountain Dew tence length of life for a high-profi le crime might in Connecticut — which has a post-release super- Code Red kicked in, his blue eyes wide behind end up staying in the hospital for many years. It is vision program, too — also concluded: ‘‘The vast wire glasses. He held his hand up, ticking the reasonable and therapeutic for a treatment team majority of individuals are not rearrested.’’ points off on his fi ngers. ‘‘Not a pattern of violent to discuss these realities with patients.’’) It is not sober data analysis, however, that behavior, since I have no record of violent behav- Houston’s sister Savannah says that she gets it sticks in the public’s mind — or infl uences judges’ ior before my crime. Is it my insanity? Because — the urge to confi ne forever someone who did rulings. Hearing that a man in Nebraska whose the treatment for my disease is medication, and something horrifi c. Savannah was home the night most recent diagnosis was ‘‘cannabis abuse, I’m medicated and stable now.’’ And he is — her brother killed their father. Only 17 at the time, unspecifi ed’’ had been in the hospital for 37 years high-functioning as you please. Before we began she ‘‘had to walk past them to get the phone’’ to may evoke less sympathy or outrage when you talking about his incarceration, he kept trying call 911. When she ran to her room to dial, Hous- learn that he killed six people, three of them chil- to engage me in a debate about feminist theory. ton followed her, still holding a knife, but stopped dren. Two of his victims he raped. One of them When he calls, Houston sometimes apol- HOUSTON when she shut the door on him. ‘‘Part of me was dead when he did it. The other one, who was ogizes for not having much to say about HERCZOG thinks he should still have to pay in some way, WITH HIS alive for the assault, was 10. his life — what would he have to say? — in FATHER, whether he was in his right mind or not,’’ she ‘‘It’s not an easy population to represent,’’ Bien limbo as it is. He would love to have a girl- MARK. says. ‘‘It’s hard though, too, because it is ‘not says. ‘‘No one likes these people.’’ friend, his fi rst, but it seems unlikely to hap- guilty.’ I have to remind myself of that a lot. I think pen at the hospital. (‘‘You know, I came here that’s because I was there. I saw it happen.’’ But, ON NOV. 21, 2011, after months of having delusions for the women,’’ he joked once.) He spends a she went on, ‘‘it’s my brother, and obviously I don’t about aliens, conspiracies and poison, Houston portion of his unnumbered, many-numbered want him to spend his whole life there, because Herczog, then 21, partly decapitated his father, days arguing with staff about how many pack- even seeing what he has to eat makes me want Mark. Six days earlier, Mark Herczog had written ets of sweetener he’s allowed to use at a time. to cry. Being there just deteriorates him more a letter to God (‘‘God — Help!’’) asking him to save (Patients are restricted to two at lunch; he likes and breaks his spirit. He realizes what he did and his newly unrecognizable son. After Houston was his tea quite sweet.) His schedule consists of where he is, and he’s depressed.’’ arrested in the bloodied family kitchen, he told shuff ling from group activity to group activity Not everyone in the family is so sympathetic, the police: ‘‘The look in his eyes! I had to!’’ in a beige uniform, between feedings of institu- says Houston’s half sister, Cameron McDowell, I heard about the murder from my mother. tional food three times a day, mind-numbing TV 43. ‘‘We have some family members who just hate Houston is my distant cousin, though I had never in the background, no internet or cellphones. him and will never forgive him. It was just such an met him or his immediate family . During his trial, Houston’s plan is to wait until he has been hos- awful thing. And I wish Dad were here every day. as psychiatrists testifi ed about a psychotic break pitalized for at least fi ve years before he bothers I can’t even imagine what he went through that related to an onset of schizophrenia, his family — night — oh, God, it was so awful.’’ But, she says, my family — prayed that he would be found not ‘‘he’s gone. And we have Houston now. We have guilty by reason of insanity and sent somewhere to support him. This is going to sound strange, for treatment. Charged with fi rst-degree mur- but I’ve not once been mad at him. I really, truly, der, Houston was facing 25 years to life. When passionately believe that it’s not the person that he was found N.G.R.I. and sent to nearby Napa commits the crime. It’s the illness.’’ State Hospital, it was a relief. At the same time, she understands why peo- It wasn’t until he was inside that any of us real- ple are afraid. Cameron’s own husband isn’t yet ized, from the mounting anxiety in his phone comfortable with the idea of Houston’s hanging calls, the rules and restrictions that governed the around their two young kids; though he loves possibility of his getting out. Houston, he’s ‘‘a little bit freaked.’’ ‘‘I hope my Houston has now been in the hospital for four husband will change his mind when Houston years. In 2015, I visited him there for the fi rst time. gets out,’’ she says. She, too, worries about what After passing through a prison fence and four will happen after his release, though for entirely locked doors, I sat with him in an all-beige room. diff erent reasons. ‘‘Is he going to be so institu- Schizoaff ective disorder is the current diagnosis, tionalized that he won’t know how to live? That’s and he is stable on medication, though he has what breaks my heart for him.’’ periods of deep hopelessness. He struggles with Like Houston’s sisters, the judicial and med- what he has done; at the beginning of his incar- ical systems struggle to fi nd a balance between ceration, when, pharmacologically stabilized for the blamelessness of N.G.R.I. patients and the the fi rst time, he was suddenly lucid, he couldn’t gravity of many of their crimes. The rights of do anything but lie in bed and cry. But he also the patient are always weighed against the pub- struggles with the uncertainty of how long his lic good, a standard that may include a more confi nement will last. Had he been convicted or less explicit desire for retribution. Those

40 10.1.17 From the family of Houston Herczog who provide treatment for forensic patients, about his own reactions to his patients in his point included Emotional Management, Sub- says Michael Norko, professor of psychiatry at 2014 memoir, ‘‘Behind the Gates of Gomor- stance Recovery, Current Issues in Mental Health, Yale and director of forensic services for the rah: A Year With the Criminally Insane.’’ He Self-Esteem, Fitness/Easy Exercise, Leisure Skills/ Connecticut Department of Mental Health and describes being in the hallway with a group of Computer, Fitness/Weight Lifting, Discharge Plan- Addiction Services, ‘‘still have to answer to a them heading to lunch as being ‘‘engulfed in a ning, Wellness Recovery Action Plan, Coping Skills/ court, or to the board, or to the court of public wave of hungry psychopaths.’’ When one of his Fitness, Leisure Skills/Journal and Conditional opinion. Every facility has people in it who have patients tells him a story about his childhood, Release Prep. He says they watch a lot of videos. I so violated a community, a community that is so he writes, ‘‘I didn’t like thinking that some of once talked to a fellow patient of Houston’s on the angry, so hurt, that they’re basically pariahs.’’ He the men even had childhoods.’’ Asked in court phone who said he was heading to a class where recalls one patient who shot a police offi cer; at about a patient’s diagnosis, he gave the admit- the day’s lesson was learning to make cheesecake. hearings for his release, a crowd of uniformed ting diagnosis — bipolar disorder, manic with ‘‘Cheesecake!’’ he said. ‘‘Imagine that.’’ cops repeatedly showed up and stood silent- psychotic features — though he writes that he State forensic hospitals vary widely in size ly, facing the review panel. The question of a knew he wasn’t currently mentally ill. But he — anywhere from just one ward to 1,500 beds patient’s hospitalization can be ‘‘reduced to peo- did think he was dangerous. When I asked him — and they also vary in the activities and treat- ple’s grief, people’s anger, people’s fear — and about this, he said: ‘‘The point is they’re sup- ments they off er. Public psychiatric hospitals the complexity of the patient’s rights and their posed to be dangerous because they’re men- across the country may be accredited by an recovery, all of those complexities get overshad- tally ill, but if they get better and they’re still independent nonprofi t called the Joint Com- owed very quickly.’’ When I asked Norko what dangerous, what do you do?’’ He is well aware mission. But it doesn’t require, for a start, the happened to the patient who shot the offi cer, he of the import of expert testimony in retention use of evidence-based therapies. One-on-one said, ‘‘Well — well, eventually, he died.’’ decisions. ‘‘Most of the time,’’ he said, ‘‘judges psychotherapy can be hard to get. (Houston Because diagnoses and treatment assessments take our opinion on it. began receiving such therapy only after his cannot predict future behavior, the standards ‘‘I look for the safety of the community,’’ he mother spent two years asking for it, his family for involuntary confi nement — degree of men- went on. ‘‘I live here. Sometimes you just have says. Napa declined to comment, citing privacy tal illness and dangerousness — are necessarily to say something for everybody’s best interest, laws.) State mental-health agencies may not be subjective. Emotions and prejudice easily come regardless of whether they’re mentally ill or not.’’ required to report what kind of care hospitals are ‘EVERYBODY EXCEPT FOR PEOPLE WHO TAKE THE CONSTITUTION SERIOUSLY AND PEOPLE WHO ARE IN THE HOSPITAL ARE HAPPY THE PATIENTS ARE THERE.’

into play, even from experts. A 2003 study in The Of patients who ‘‘just never quite get better,’’ giving, unless something goes so wrong that it American Journal of Forensic Psychology, for in doctors’ estimations, Seager said: ‘‘Oh, they’ll attracts the attention of federal authorities. (Many example, showed that doctors are more likely be here till they die.’’ do, however, voluntarily participate in national to fi nd minorities incompetent to stand trial data-collection systems.) and more likely to diagnose psychotic disor- NAPA STATE HOSPITAL’S VAST, drought-dry campus The American archetype of bad mental-health ders in African-Americans. At Napa, I spoke is roamed by a pack of screeching peacocks. At practices is the movie ‘‘One Flew Over the with a patient, a friend of Houston’s, who plead- 1,255 beds, it is one of the largest state psychi- Cuckoo’s Nest’’: doped-up patients locked away ed N.G.R.I. to a murder charge and had been atric hospitals in the country. For most of his from society to suff er and, ultimately, to per- hospitalized for nearly 20 years. When he was time there, Houston has been on what’s called ish. Some advocates argue that the conditions granted a hearing in which, according to court a discharge unit, with one to three roommates, at psychiatric institutions aren’t always much transcripts, multiple clinicians recommended where it’s possible to get privileges like walk- better. Until recently, Oregon State Hospital, his release, one doctor dissented — a doctor ing to the visitors’ center alone. After a bout of where ‘‘Cuckoo’s Nest’’ was fi lmed, may in ways with whom he had had an ugly dispute and who, suicidal thoughts, he was moved, indefi nitely, have been worse. another doctor testifi ed, wasn’t objective. The to a locked unit where all activities and access In 2006, The Oregonian won a Pulitzer Prize patient’s release was denied. to the courtyard are supervised. for its exposé of the institution. It reported that Stephen Seager, a 67-year-old psychiatrist Houston’s treatment consists of up to 20 hours there was a male staff member who worked on who was at Napa for five years, writes openly of group classes a week. His schedule at one one ward for only a year (Continued on Page 56)

The New York Times Magazine 41

Beyond Relief

Managers rarely use their closers — often the most dominant pitchers in baseball — for more than a few outs at the end of the game. Is that beginning to change?

By Bruce Schoenfeld

Photograph by Philip Montgomery

43 On they came, one after another, making the least called it into question. Miller pitched a total Dennis Eckersley recorded 45, 33 and 48 saves walk from the bullpen to the pitcher’s mound. It of 19⅓ innings last October, including multiple for an Oakland A’s team that won three pennants was the fi rst night of the American League play- innings in nine of the Indians’ 10 victories. Three in succession. Two years later, Eckersley saved 51 off s, one year ago this week, and the Baltimore times he entered a game in the fi fth. He was as games and was named the A.L.’s Most Valuable Orioles’ starting pitcher hadn’t lasted through the responsible as anyone for getting his team into Player. He did it by pitching primarily in the ninth fi fth inning. Six relief pitchers followed as a 2-2 the 10th inning of the seventh game of the World inning, and almost never when his team trailed. stalemate with the Toronto Blue Jays stretched Series. Yet he earned just a single save. Within fi ve years, every team in baseball had such toward midnight. By the end, Buck Showalter, the Roberts’s Dodgers have their own standout relief a closer. ‘‘The dynamic of the game changed,’’ says Orioles’ manager, had put every available pitcher pitcher: Kenley Jansen, who allows an average of far Clint Hurdle, who manages the Pittsburgh Pirates. into the game except his best one: Zach Britton, less than one base runner for each inning he works ‘‘It became all about getting the last three outs.’’ the league’s leader in saves that season. and has converted 39 of 40 save opportunities this To Jansen, closing is a discrete position on a Britton is a closer, the pitcher charged with pro- year. His earned-run average is 1.25. Most aston- team’s roster, as diff erent from pitching earlier in tecting a lead at the end of a game. Showalter had ishing, he has struck out 102 batters and walked the game as third base is from shortstop. Among used him all season in the way that nearly every big- seven. By any measure, he ranks among baseball’s the current generation of pitchers, such thinking league manager deploys his closer, which is almost best pitchers. Yet since 2013, when he became the has become an article of faith. ‘‘Every reliever in always to start the ninth inning and only with a Dodgers’ closer, Jansen has rarely pitched in any- this room wants to be the closer,’’ the Los Angeles lead of three runs or fewer, a situation in which a thing but save situations. ‘‘People start depending Angels’ Huston Street told me before a game this pitcher can earn a save. This was a one-game play- on their role,’’ Roberts said. ‘‘But to not be able to year. Only closers, Street explained, can count on off between the A.L.’s two wild-card teams — a loss employ your reliever in a big spot, where it could having a direct eff ect on whether the team wins meant elimination. But Showalter didn’t change make the diff erence in a game —’’ He went on to or loses. Street has closed since he pitched at the his tactics. In the bottom of the 11th, the Blue Jays add, ‘‘We haven’t done that with Kenley yet.’’ University of Texas. Working for four major-league broke the tie with a tow- When I spoke with Roberts, it was July, and teams over 13 years, he has amassed 324 saves. ering home run off one the Dodgers were in the midst of what would be His job, as he perceives it, is to get three ninth-in- Opening pages: of Baltimore’s least reli- a 43-7 run, the best 50-game stretch by any team ning outs before allowing the tying run. Whatev- Kenley Jansen, the Dodgers’ closer. able pitchers, a starter in more than a century, and had a commanding er happens along the way isn’t his concern. ‘‘If a who rarely worked in lead in the National League West. But unexpect- seventh-inning guy gives up one run, that’s a bad relief. That the Orioles’ edly, they veered wildly off course at the end outing,’’ Street says. ‘‘If an eighth-inning guy gives season ended without Britton’s ever entering the of August. The most dominant team in memory up one run, that’s a bad outing. A closer gives up game struck baseball players, commentators and became the most enigmatic, losing 16 out of 17 one run with a two-run lead, that’s a great outing. fans as inexplicable, bordering on absurd. games. It was the worst spell of baseball that any It’s a diff erent mind-set. And that’s how closers For years, analytically adept observers have been good team had ever played. Night after night, the need to be wired.’’ asking why a manager would limit one of his best Dodgers lost. And night after night, with only a Jansen believes that the last three outs of a pitchers to a couple of dozen pitches every two or handful of exceptions, Jansen sat. For the two game are the toughest to get, and he takes pride three games, and no more than 70 innings a year. weeks starting Sept. 2, he pitched a total of just in getting them. ‘‘The batters are locked in,’’ he Top relievers should be used, they argue, as often 3⅓ innings. He was healthy and throwing as well explained. ‘‘They know it’s their last chance. That’s as possible during those infl ection points when as ever. But the Dodgers weren’t getting leads, true in any game, but especially a close one.’’ In the game’s outcome hangs in the balance. Man- so there were none to protect. That left Jansen, some ways, though, closing is easier than pitching agers have resisted. It isn’t always easy to identify one of their most important players, with no role earlier. Coming in to start the ninth means nobody an infl ection point, for one thing. And giving your beyond watching his teammates lose. is on base. Sometimes Jansen faces the best hitters best reliever the lead with one inning to go is seen Still, Jansen resists the idea of pitching in any in the opposing lineup, but just as often he faces as the culmination of a plan. ‘‘He puts in a closer,” inning but the ninth, and occasionally for an out the worst. Across baseball, closers have been able says Trevor Hoff man, who saved 601 games over or two in the eighth to go with it. ‘‘You want to to throw a scoreless ninth inning nearly 90 percent an 18-year major-league career, ‘‘and basically says, win,’’ he said. ‘‘But you’re also playing for your of the time. That sounds impressive until you learn ‘My work is done.’ ’’ Most closers, who are paid legacy.’’ It hasn’t escaped his attention that the that the success rate of an average reliever who far better than other relievers, also aren’t keen to honors Major League Baseball bestows on its comes into the game at the start of any inning is expand their duties. They’re baseball’s equivalent best relievers are named after pitchers who rank only about 5 percent less. And because closers of fi ghter pilots. Giving up the chance to earn a save second and fi rst in career saves. ‘‘It’s the Trevor don’t pitch to anyone twice in a game, by the time is a sacrifi ce that few are eager to make. Hoff man Award in the National League and the a batter has started to adapt to the sudden move- One afternoon this summer, I asked Dave Rob- Mariano Rivera Award in the American League,’’ ment of Jansen’s cut fastball, his signature pitch, erts, who manages the Los Angeles Dodgers, about he said. ‘‘There’s a reason for that. Those were that batter is typically headed back to the bench. Showalter’s decision not to use Britton. Roberts is guys who got people out in the ninth inning.’’ Jansen stands 6-foot-5 and weighs 275 preternaturally polite, yet he couldn’t help rolling Jansen won the Hoff man award last season; pounds. His cut fastball travels between 93 his eyes. During his two seasons’ managing the Zach Britton won the Rivera. ‘‘Both of us close,’’ and 96 miles an hour, but because Jansen takes Dodgers, he has come to believe that a team’s most Jansen pointed out. ‘‘And this year, I’m pretty sure such a long stride, it looks faster to a hitter. He eff ective relief pitcher should be used not just to that two closers are going to win it again. It has exudes the physicality of someone who should fi nish games but whenever he can have a decisive never not been that way. And it isn’t changing be yanking trees out of the ground for a living, infl uence on them. ‘‘You can make a strong, strong anytime soon.’’ or at least playing rugby. Yet often, his entire case to pitch your best reliever in a nonsave situa- body of work in an evening consists of about 10 tion,’’ he said. ‘‘I’m moving toward that.’’ Top relief pitchers used to be called fi remen, a pitches. With a week left in the season, Jansen The kind of pitcher he meant was Cleveland’s designation that required the nimbleness such a had appeared in 62 of his team’s 153 games but Andrew Miller, whose performance during last name implies. They came to the rescue when trou- had pitched just 65 innings. Though he’s per- year’s playoff s appeared to have altered conven- ble arose, occasionally as early as the fourth inning. ceived as, and paid like, the fi nest pitcher on tional wisdom about closers inside baseball, or at Beginning in 1988, a converted starter named the staff besides Clayton Kershaw, a perennial

44 10.1.17 All-Star, seven of his teammates had spent more isn’t on the line. It’s the same distance between Roberts was using the media to communicate time than he had on the mound. the mound and the plate, the same hitters in the with his player. He understood that Jansen had The Dodgers are one of baseball’s most ana- opposing lineup — why can’t they just throw the pitched when he wasn’t comfortable, and Rob- lytically savvy organizations. Andrew Friedman, ball the same way? The reason, several explained, erts wanted him to know that he appreciated it. the team’s president of operations, came from is that they’re accustomed to having that slim In terms of getting the Dodgers ready to win in Tampa Bay, where his staff of statisticians helped margin for error as their motivation. They need the postseason, there might be nothing more the underfunded Rays reach the 2008 World the adrenaline rush to perform. A couple of times important he could do. Series. Before that, he worked at a hedge fund. during the Dodgers’ losing streak, Roberts called Farhan Zaidi, who serves as general manager, is an on Jansen when the Dodgers were behind, just The Dodgers have suff ered only 13 losing sea- M.I.T. graduate with an economics doctorate from so he wouldn’t go too long without pitching in sons since moving to Los Angeles six decades Berkeley. The number-crunching has made it all a game. Jansen still looked like the same intimi- ago. They’ve also won the last fi ve division titles. the way down to the fi eld. ‘‘We know the stats,’’ says dating presence on the mound, but his pitching Yet nearly every other team in the majors, 24 of Yasmani Grandal, the Dodgers’ catcher. He told seemed to lack conviction. ‘‘When Kenley isn’t in the 29, has played in a World Series since the last me that using a closer in what baseball has come a save situation, his attention wanders,’’ Grandal time the Dodgers did, in 1988. to call a high-leverage situation is worth ‘‘an extra says. ‘‘The score of the game will tell you a lot about This year, their early dominance ratcheted up seven or eight wins a season.’’ Because of that, and the intensity that he’s going to have that day.’’ the pressure on Roberts to at least get them to with the lesson of Miller to draw on, you’d expect In late August, I caught a game in Pittsburgh, another one. The theatrically bad baseball that to see Jansen inserted into a variety of situations in hoping to see Jansen pitch. It was a Monday night, followed left Dodgers fans craving the reassur- the playoff s, which begin the fi rst week of October. the crowd was sparse and the innings piled up in ance of a strong fi nish. Through it all, Roberts has Except that, every time Jansen enters a game, he desultory fashion. The Dodgers led 5-3 with one managed with the long arc of the season in mind. still assumes that he will pitch until the last out. out in the eighth when, as often happens in base- Within fi ve years, he believes, every team will be On that point, he’s intransigent. If Rob- using its bullpen diff erently. The era that erts wants to bring him in earlier during began with Eckersley will be over. But right this year’s playoff s, he insists he’ll rise to now, Roberts has a closer whose confi dence that challenge. ‘‘But I want to go all the To Jansen, he can’t aff ord to shake. way,’’ Jansen says. ‘‘Why not? You’re the one of By the time they played the San Francisco closer, right? You’re the best, right? Let’s baseball’s Giants on Sept. 12, the Dodgers had lost 11 say I come in the seventh and do the job, premier in a row, the most since they left Brooklyn and in the ninth they blow it. And they’re relievers, in 1957. That evening, Kershaw carried a closing is going be, ‘Oh, I used my closer in the sev- 4-2 lead through the sixth. The drumbeat a discrete enth.’ ’’ Jansen crunched his expressive position, of nearly three weeks of failure had imparted face into a scowl. ‘‘I hate that idea,’’ he said. as different the urgency of the postseason to a game that, from in actual terms, remained close to meaning- Jansen didn’t even become a pitcher pitching less. It was very unlikely that second-place until 2009, four years into his professional earlier in Arizona would make up nine games over career. Signed as a 17-year-old catcher out the game the last two weeks, so the Dodgers were of Willemstad, Curacao, he rose to Class as third going to win their division regardless of AAA, one step below the majors. But he base is that night’s outcome. Nevertheless, after the couldn’t hit. His arm was the attraction; from Giants put a runner on base in the bottom scouts gathered to see him throw out run- shortstop. of the eighth, Roberts called for Jansen. It ners from his knees. He was having a hard was the fi rst time he had pitched before the time, says Charlie Hough, the former big ninth inning since July 23, the occasion of leaguer who now serves as the Dodgers’ his only blown save all season. senior adviser for player development. ‘‘But a lot ball, events suddenly became urgent. I looked for Jansen ended that threat. He returned in the of us felt we couldn’t let that arm go to waste.’’ Jansen, but he remained in the bullpen even after ninth and struck out the fi rst batter before the next In July 2009, Jansen was asked to return to Class a run scored and the Pirates loaded the bases. three singled, loading the bases and putting the A, a substantial demotion, and learn to pitch. His He didn’t take the mound until the 10th inning, potential winning run on fi rst. Jansen, who was father suff ered a stroke when Jansen was 11, and after Pittsburgh tied the game. Jansen allowed a covered in perspiration, had allowed as many as his parents were on the verge of losing their home. soft single but escaped without giving up a run. three hits in a game only twice since April. He Jansen felt uneasy about starting over, but he had In the 12th inning, with Jansen long gone, the seemed unsettled. But I also couldn’t help recalling little choice. ‘‘‘I’m struggling hitting,’’ he recalls Dodgers won. Roberts hadn’t made the bold what Huston Street stressed to me, that nothing thinking, ‘‘and now they want me to be a pitcher?’’ move, using Jansen in the eighth. But he hadn’t should matter for a closer other than getting that Under the tutelage of Hough, who won 216 waited until the Dodgers had a lead either. He’d third out before a winning run scores. With the games in the majors, however, Jansen’s rise was taken an incremental step. bases loaded, Jansen struck out the next two Giants swift. He made his debut for the Dodgers in 2010. The analytics are clear and prescriptive, but to end the game. In his second appearance, he fi nished a game for the psychology of managing a closer is more On this night, the traditional role of a closer Kershaw. ‘‘One-two-three, with two punches,’’ nuanced. In his offi ce afterward, with camer- and the game’s infl ection point coalesced into a he said, using ballplayer slang for strikeouts. ‘‘It as crowded around, Roberts made a point of single half-inning, and the league’s best reliever taught me that I could pitch in the big leagues, praising Jansen for his willingness to work the did his job. Those three singles amounted to but also that I could close in the big leagues. And 10th against the middle of the Pirates’ order. nothing, it turned out. The losing streak was now here I am. A closer.’’ ‘‘For Kenley to come in and take the ball in a over, and Jansen had another save. He slapped It is almost a point of pride with closers that tie game says a lot about his unselfi shness,’’ he his hand against his chest in celebration. It was they have a hard time pitching when the game said. Like every manager since Connie Mack, his 37th, as he surely knew, in 38 tries.

The New York Times Magazine 45 HOW FAKE NEWS

TURNED A SMALL

TOWN UPSIDE DOWN

AT THE HEIGHT OF THE 2016 ELECTION, EXAGGERATED REPORTS OF A JUVENILE SEX CRIME BROUGHT A MEDIA MAELSTROM TO TWIN FALLS — ONE THE IDAHO CITY STILL HASN’T RECOVERED FROM.

BY CAITLIN DICKERSON

PHOTOGRAPHS BY HARRIS MIZRAHI

Main Avenue East in Twin Falls, Idaho. 47 to the mayor and to his colleague at the paper known, were still unclear to Brown, but he was who covers crime. He pieced together that 12 skeptical of what he was reading. For one thing, days earlier, three children had been discovered he knew from his own previous reporting that partly clothed inside a shared laundry room at no Syrians had been resettled in Twin Falls after the apartment complex where they lived. There all. He woke up early on Monday to get a head were two boys, a 7-year-old and a 10-year-old, start on clarifying things as much as possible in and a 5-year-old girl. The 7-year-old boy was order to write a follow-up article. Before he got accused of attempting some kind of sex act with into the offi ce, a friend texted him, telling him ON A TUESDAY the 5-year-old, and the 10-year-old had used a to check the Drudge Report. At the top, a head- cellphone borrowed from his older brother to line screamed: ‘‘REPORT: Syrian ‘Refugees’ Rape record it. The girl was American and, like most Little Girl at Knifepoint in Idaho.’’ people in Twin Falls, white. The boys were refu- gees; Brown wasn’t sure from where. In his article about the meeting, Brown seems to anticipate AS THE ONLY that the police chief’s inability to elaborate was not going to sit well with the people whose tes- city of any size for 100 miles in any direction, timony he had just watched. Twin Falls serves as a modest hub within south- morning in June 2016, Nathan Brown, a reporter That weekend, Brown was on his way to see ern Idaho’s vast agricultural sprawl. Its popu- for The Times-News, the local paper in Twin Falls, a movie when he received a Facebook message lation of about 45,000 nearly doubles each day Idaho, strolled into the offi ce and cleared off a spot from Jim Dalos Jr., a 52-year-old known to Twin as people travel there to work, primarily in the for his coff ee cup amid the documents and note- Falls journalists and police as Scanner Man. thriving agribusinesses. But its bucolic rhythms books piled on his desk. Brown, 32, started his Dalos is disabled; he works six hours a week as still allow for children to play outside unattend- career at a paper in upstate New York, where he a dishwasher at a pizzeria but spends most of ed and make driving a meditative experience. grew up, and looks the part of a local reporter, clad his time in his apartment, sitting in a reclining Surrounding the city and sprinkled among its in a fresh oxford and khakis that tend to become chair and drinking Diet Pepsi out of a 52-ounce tidy tract neighborhoods, potatoes, alfalfa, sugar disheveled over the course of his long days. His plastic mug, voraciously consuming news. He beets and corn grow in fi elds. Half a million fi rst order of business was an article about a City reads the local paper, old issues of which litter dairy cows in the area produce three-quarters Council meeting from the night before, which he his living-room fl oor, and keeps the television of the state’s milk supply. Because of its location, hadn’t attended. Brown pulled up a recording of blaring — usually Fox News. He got his nick- Twin Falls is home to major food processors like the proceedings and began punching out notes name because he constantly monitors an old Chobani Yogurt, Clif Bar and Glanbia Nutrition- for his weekly article. Because most governing police scanner, a gift he received as a teenager als, a dairy company. All have large facilities in in Twin Falls is done by a city manager, these from his father, and often calls in tips to the town and have helped to push down the unem- meetings tend to deal with trivial subjects like media based on what he hears. He also happens ployment rate to just under 3 percent, below the lawn-watering and potholes, but Brown could tell to live at the apartment complex, Fawnbrook, national average. The wealth of easy-to-fi nd low- immediately that this one was diff erent. where the laundry-room incident occurred. skilled jobs made Twin Falls attractive as a place ‘‘We have been made aware of a situation,’’ Dalos told Brown that he had seen the police for resettling refugees, and they began arriving said the fi rst speaker, an older man with a scrag- around Fawnbrook and that the victim’s mother in the 1980s, at that time mostly from Cambodia gly white beard who had hobbled up to the lec- told him that the boys had been arrested. He also and the former Yugoslavia. Nearly 2,500 refugees tern. ‘‘An alleged assault of a minor child and pointed Brown to a couple of Facebook groups have moved to the town over the years. we can’t get any information on it. Apparently, that were created in response to the crime. Brown Most Twin Falls residents are churchgoing, and it’s been indicated that the perpetrators were scrolled through them on his cellphone and saw about half of those are Mormons. Locally owned foreign Muslim youth that conducted this — links fl ying back and forth with articles that said stores and restaurants are generally closed on I guess it was a rape.’’ Brown recognized the that the little girl had been gang raped at knife Sundays, and the city has not voted for a Dem- man as Terry Edwards. About a year earlier, after point, that the perpetrators were Syrian refugees ocratic presidential candidate since Franklin The Times-News reported that Syrian refugees and that their fathers had celebrated with them Delano Roosevelt in 1936. Liberals often regis- would very likely be resettled in Twin Falls, afterward by giving them high fi ves. The stories ter as Republicans just to have an opportunity Edwards joined a movement to shut the reset- also claimed that the City Council and the police to participate in the electoral process, by voting tlement program down. The group circulated a department were conspiring to bury the crime. in the primaries. If a Republican is going to win petition to put the proposal before voters. They Over the weekend, Brown plowed through his regardless, the thinking goes, they would at least failed to get enough signatures to force a ref- daily packs of cigarettes as he watched hundreds, like to play a role in deciding which one prevails. erendum, but Brown was struck by how much then thousands, of people joining the groups. The same qualities that bind the townspeople support around town the movement attracted. Their panic appeared to be piqued by a mass together can, in turn, be alienating to newcom- In bars after work, he began to overhear conver- shooting, the deadliest in American history, that ers. The refugee community has begun to expe- sations about the dangers of Islam. One night, had just occurred at Pulse nightclub in Orlan- rience this eff ect as its demographic makeup has he heard a man joke about dousing the entrance do. The perpetrator had declared allegiance to changed. Over the past decade and a half, as con- to the local mosque with pig’s blood. ISIS. The commenters also posted stories that fl ict spread across North Africa and the Middle After he fi nished watching the video, Brown claimed refugees were responsible for a rash of East, Twin Falls started to resettle larger numbers called the police chief, Craig Kingsbury, to get rapes in Europe and that a similar phenomenon of refugees with darker skin who follow an unfa- more information about the case. Kingsbury said in the United States was imminent. ‘‘My girl is miliar religion — two things that make it diffi cult that he couldn’t discuss it and that the police blond and blue-eyed,’’ one woman wrote. ‘‘I am to blend into a town that is 80 percent white. reports were sealed because minors were extremely worried about her safety.’’ On a national scale, an ascendant network involved. Brown made a couple phone calls: The details of the Fawnbrook case, as it became of anti-Muslim activists and provocateurs has

48 10.1.17 Photographs by Harris Mizrahi for The New York Times exploited the fears brought on by these changes, of the actual sexual component to it.’’ fi lled until there was standing room only, and fi nding a platform and a receptive audience online. Two weeks after the incident, the boys were television news crews appeared from Boise and The narrative they espouse — on blogs with names charged with lewd and lascivious behavior other nearby cities. When it came time for public like Jihad Watch — is that America, currently 1 per- against a minor. (The 14-year-old who lent his comments, one man got up and praised the city’s cent Muslim, is in the midst of an Islamic invasion. cellphone to the boys was initially charged with handling of the case, followed by more than a Central to the worldview of these bloggers, some the same crime. He was not present in the laun- dozen others who laid into the council members. of whom have celebrity-size social-media follow- dry room, and his charge was eventually reduced Terry Edwards handed each of them a small copy ings, is that Muslims have a propensity toward sex- to make him an accessory.) In Idaho, this statute of the Constitution and told them to do their jobs. ual violence. They seize on any news item that bol- applies to physical contact ‘‘done with the intent A woman named Vicky Davis, her hair in a satiny sters this notion. Perhaps their biggest touchstone of arousing, appealing to, or gratifying the lust or white bob, stood up and proclaimed that Islam is an incident that took place in Cologne, Germany, passions or sexual desires of such person, such had declared jihad on America. on New Year’s Eve in 2015. Mobs of men, many minor child, or third party.’’ Paredez said that ‘‘They are not compatible with our culture,’’ she of them asylum seekers from the Middle East, the cellphone video made clear what specifi cally said. ‘‘They hate us. They don’t want to be Ameri- pick-pocketed and groped more than a thousand had happened between the children, but that he cans. They don’t want to assimilate. What do you women in and around a train station. The German couldn’t show it to the reporters who asked him need to see? What more proof do you need?’’ police acknowledged the incident had taken place about it, because doing so would have constituted This was a highly unusual meeting, but Brown only under pressure, as the women’s stories began criminal distribution of child pornography. He wasn’t exactly surprised. Several months earlier, to leak out through the media. This established, for called most of the details that he read about the when the anti-refugee activists began to organize, these activists, the contours of a narrative that they case on the internet ‘‘100 percent false, like not he started reading up to try to better understand believe has been repeating itself. The Fawnbrook even close to being accurate.’’ (The family of the their views. He picked up a book by Ann Coulter incident quickly drew their interest. accused declined to comment.) and began to follow the anti-refugee blogs. At the What happened in Twin Falls was sadly some- As more time passed without a solid account meeting, he felt as if he were hearing all that he what commonplace but not in the way the activists of what happened inside the laundry room, lurid had read being repeated aloud by his neighbors. believed. The local Police Department investigates rumors continued to surface online and came to Kingsbury, the police chief, read from a state- ment while fumbling with a thicket of microphones piled onto the lectern by visiting reporters. In between exasperat- ed breaths, he explained why he could not disclose the details of the incident but said that he could address some of the mis- information that was spreading online. There was no evidence of a knife, he said, or of any celebration afterward or of a cov- er-up, and no Syrians were involved: The boys were from Sudan and Iraq. ‘‘I’m a kid who grew up in Idaho,’’ he said. ‘‘Law enforcement takes these types of allega- tions very seriously. However, we can’t act on them within an hour. It’s not like a crime show.’’ He told the audience that the boys had been arrested, to applause. But online, Kingsbury’s words only infl amed the activists more. Just after midnight, someone posted his work email address on Jihad Watch, along with those of the council members and the mayor. A commenter on another website called The Muslim Issue posted NATHAN BROWN, JIM DALOS JR., the phone numbers and email addresses WHO COVERS POLITICS FOR THE LOCAL THE ‘‘SCANNER MAN’’ WHO CALLS IN TIPS NEWSPAPER, THE TIMES-NEWS. TO LOCAL MEDIA. for the town’s government offi cials, the head of the refugee-resettlement center and some administrators at the college, sex crimes on a weekly basis, and in about half a dominate conversations in grocery stores and which runs the refugee resettlement program. dozen of those that proceed to court each year, the at school events. And while the City Council From there, the information spread to more victims and the accused are both minors. ‘‘If it’s members did not have control over the case, blogs and to the comments sections of far-right younger kids, it’s them being curious,’’ J. R. Pare- the bloggers who wrote about it placed much news outlets with massive audiences. dez, the lead investigator on the case, explained of the blame on them. By 9 the next morning, messages were to me. Some children who act out sexually have On the Monday when Twin Falls was the top pouring into the inbox of the mayor of Twin been victimized themselves, he said, while others story on Drudge, the City Council held another Falls, Shawn Barigar, nearly every minute. Bari- have been exposed to explicit material at home or weekly meeting. Normally only a handful of peo- gar grew up in a neighboring town and went at school or, as is more common recently, on their ple attend, and Brown is one of the few report- to work in Boise as a television news anchor cellphones. ‘‘As they start to get older, there’s more ers among them. But that night, the auditorium before moving back to start a family. His even

The New York Times Magazine 49 keel and the air of sophistication he picked up and Islamism, all of it backed by big-business of the few interviews with the victim’s family, while living in a comparatively big city have interests and establishment politicians. Bannon but his account of the crime off ered little more made him popular politically. He is left of the latched onto the Fawnbrook case and used his information than others’ had — and far more town on many social issues, which has made infl uence to expand its reach. During the weeks inaccuracies, according to the police and the some of his constituents suspicious of him. But leading up to his appointment in August 2016 to county prosecutor. He described what took most of the people who contacted him that lead Donald J. Trump’s campaign for president, place as a ‘‘horrifi c gang rape’’ and wrote graph- summer were from other states and even other Twin Falls was a daily topic of discussion on Ban- ic details about the incident, which the Twin countries. Some people demanded that the city non’s national radio show, where he called it ‘‘the Falls Police say are untrue. On Breitbart radio, pay for a new car and apartment for the victim beating heart’’ of all that the coming presidential Stranahan openly wondered whether Barigar, and her family. Others said that local offi cials’ election was about. He sent his lead investigative the mayor, was ‘‘a big, you know, Shariah sup- attempts to correct inaccurate details about the reporter, Lee Stranahan, to the town to investi- porter.’’ And he suggested repeatedly that mass incident were veiled eff orts to suggest that no gate the case, boasting to his audience that Stra- rapes by refugees had occurred in Europe and crime had occurred at all, in order to protect the nahan was a ‘‘pit bull’’ of a reporter. ‘‘We’re going were inevitably coming to the United States. refugees. Others accused him of being a ‘‘global- to let him off the chain,’’ he said. ‘‘If you want to wait until your country turns ist,’’ a word that has taken on many defi nitions Then 50, Stranahan was relatively new to jour- into France or Cologne, Germany. If you want but in this case meant he was part of a vast, nalism. He had spent a few decades as a televi- to wait, you can wait,’’ he warned the audience. arcane conspiracy. They believed that establish- sion producer and a graphic illustrator in Los ‘‘But if you want to watch it and stop it now, ment politicians wanted to turn red states like Angeles, and on the side he shot erotic photog- you’ve got a chance to do it in November.’’ Idaho blue by starting wars and then importing raphy, which is how he met his wife. Stranahan’s Stranahan says his Breitbart editors sent him refugees from those war zones as cheap labor transition into journalism began during the tele- to Twin Falls to report on the ‘‘Muslim takeover’’ who would not only displace American workers vision writers’ strike of 2007 and 2008. To keep of the town. (Breitbart denies this and says it’s but also reliably vote Democratic. himself entertained, he created parody political ‘‘absurd.’’) But he soon became enamored of a Many of the people who wrote to the mayor advertisements and posted them on YouTube. grander theory about what was happening in had a much simpler goal: to unleash their hatred One of the fi rst was a satirical Rudy Giuliani ad, southern Idaho: globalism. He wrote that local of Islam. One message, with the subject line ‘‘Mus- asking Republican primary voters to support businesses received government kickbacks for lims,’’ said that refugees were committing rapes him because he had taken good care of his mis- employing foreigners instead of Americans. and hit-and-runs and urinating on women and that tress, off ering her private security courtesy of (Stranahan did not cite any evidence of this, and the mayor was guilty of treason. ‘‘It’s out of the bag, the N.Y.P.D., whereas Mitt Romney ‘‘didn’t even it is untrue, according to the state Department [expletive],’’ it read. ‘‘We will and are holding you bother’’ to take on a paramour. Stranahan says of Labor.) And he often referred to a Syrian ref- responsible for any and all crimes committed by that within weeks, the videos led to invitations to ugee crisis, though no Syrians were ever reset- these quote refugees. No courts. No police. Just appear on CNN and to meet with a vice president tled there. Then, to bring the story full circle, us. You will answer to us in the darkness of night.’’ at NBC and to a job off er, which he accepted, he claimed these Muslim refugees were being The next day, Camille Barigar, the mayor’s writing political comedy for The Huffi ngton Post. used to replace American workers and that the wife, arrived in her offi ce at the college, where In college, Stranahan was a libertarian and government, big business and law enforcement she ran the performing-arts center, and started even attended Ayn Rand’s funeral. But when were either conspiring to conceal the sexual-as- listening to her voice mail. In a calm, measured he moved to California, he became a liberal, sault case or intentionally looking the other way, voice, a man who sounded as if he was reading vehemently opposing the Iraq war and the in order to keep the machine turning. from a script went on for nearly four minutes. presidency of George W. Bush. He voted for ‘‘Bottom line, this is bad for business,’’ he ‘‘I wonder, Miss Barigar, if your residence was Barack Obama in 2008. Two years later, Stra- told me in an interview last winter, explaining posted online and your whereabouts identifi ed, nahan interviewed Andrew Breitbart, a fellow his interpretation of the city offi cials’ rationale: how you would feel if half a dozen Muslim men Huffi ngton Post alumnus, for an article he was ‘‘ ‘I’m not really going to look into this too deeply raped and sodomized you, Miss Barigar, and writing about Jon Stewart’s Rally to Restore because if I fi nd out the truth, if I discover what when you tried to scream, broke every tooth in Sanity and/or Fear. They spoke for more than actually happened, if I fi gure out the truth, it’s your mouth,’’ he said. ‘‘And then I wonder how three hours, bonding over their shared love of not really good for business.’ ’’ Stranahan believed you’d feel if, when you went to the Twin Falls Depeche Mode. Eventually, Breitbart became that Chobani, a Greek-yogurt company, was at the Police Department, they told you to run along, Stranahan’s mentor, converted him to conser- center of the scheme. Breitbart had been covering that this is simply cultural diversity.’’ vatism and off ered him a job. In 2011, Breitbart the company for months, ever since the owner, The caller said that life was ‘‘becoming dif- took Stranahan to the Conservative Political Hamdi Ulukaya, a Turkish-born businessman, fi cult’’ in the United States, just as it had in Action Conference and introduced him to made a speech at the World Economic Forum England. He referenced Jo Cox, a British mem- Michele Bachmann, who, in Stranahan’s recol- at Davos encouraging other chief executives to ber of Parliament who spoke out in support of lection, convinced him that she had uncovered pledge fi nancial and political support to refugees. refugees and later ‘‘met with opposition in the disturbing details about Islam that no one in the While he was in town, Stranahan embed- form of a bullet to the head.’’ establishment was willing to talk about. Strana- ded with critics of the refugee program. They ‘‘She’s dead now,’’ he said. ‘‘They’ve buried her.’’ han says this conversation was the genesis of his drove him to some of his interviews and to the concerns about the religion. yogurt factory to shoot drone footage. Strana- Stranahan arrived in Idaho in August, after han doesn’t get around well on his own in part THE TWINS FALLS covering the national party conventions. The because he has been mostly blind in one eye sealed nature of the case prevented any jour- since grade school, when a neighborhood kid story aligned perfectly with the ideology that nalist from an exhaustive examination, and the threw a rock at him, shattering his right optic Stephen Bannon, then the head of Breitbart accused and the victim’s families refused to nerve. Rather than a round pupil, his is jag- News, had been developing for years, about the speak to the mainstream media. But Stranahan ged-edged, and so large that it nearly covers havoc brought on by unchecked immigration thrived in the void of facts. He was granted one his iris. He shuff les when he walks because of

50 10.1.17 Photographs by Harris Mizrahi for The New York Times SHAWN BARIGAR, CAMILLE BARIGAR, LEE STRANAHAN, THE MAYOR OF TWIN FALLS. THE MAYOR’S WIFE, WHO WORKS AT THE A FORMER INVESTIGATIVE REPORTER FOR LOCAL COLLEGE. BREITBART NEWS. neuropathic foot pain from diabetes, which he but is the fi rst known Russian attempt to spark a online have been debunked. Still, many of the regulates by eating a ketogenic diet, usually one demonstration on American soil. outlets that covered Twin Falls made only minor meal a day, consisting entirely of protein and The phone and email attacks continued tweaks to their stories or did nothing at all. fat. In Twin Falls, he subsisted most days on through the fall and spiked each time a new Many of the falsehoods that were written about blackened chicken from Popeyes. conspiracy theory was posted online. One coun- the Fawnbrook case still appear at the top of a During the three months he was in Twin cil member told me that she gained 15 pounds Google search of the city. Falls, City Council members refused his inter- from the stress. At night, Shawn Barigar would The most transparent course-correction view requests, leaving him stuck inside an echo lie down with his iPad and spend hours reading resulted from a lawsuit against Alex Jones, the chamber with the activists, which he amplifi ed stories that called him a crook, a liar or an ISIS publisher of InfoWars, for its misleading stories online. When I was in Twin Falls, I found myself sympathizer. He had to shut down his Twitter about Chobani. After initially vowing to fi ght the empathizing: These same activists refused to account after someone accused him of having yogurt company in court, Jones retracted several speak with me. One of the most outspoken been convicted of sexual assault. Before he stories and issued an apology in order to make a among them is a woman named Julie DeWolfe, could debunk the myth, the post had spread, lawsuit go away. Stranahan said that his editors who lives atop a grassy hill 20 minutes outside leaving untold numbers of constituents under forced him off the Twin Falls story during the fall town and who spent signifi cant time with Stra- the impression that he was a rapist. He stopped and suggested that they had done so under threat nahan. When I went there to ask for an inter- sleeping and struggled to focus at work or to be from Chobani. (Breitbart denies this.) view, she came outside with several barking present with his family. He and his wife say they Stranahan and I spoke a handful of times over dogs and told me to leave. ‘‘The company you bickered all summer. the course of the last year, each time for several work for is not trustworthy,’’ she said. ‘‘It was like being in a hole,’’ he told me, his hours. Talking with him feels like being inside As the summer came to a close, The Times- eyes welling up with tears. ‘‘It was all-consuming.’’ one of his conspiracy theories. When you ask him News was bombarded with threatening phone a question, he begins to answer and then imme- calls and email from all over. After it received diately swerves in a diff erent direction, bouncing a threat that was deemed credible enough to STRANAHAN NOW WORKS like a pinball between topics that barely connect engage the F.B.I., the editor of the paper told to one another — from the Fawnbrook case to Brown and the other reporters to conduct their out of a trendy shared workspace in Washing- clitorectomies and stoning, then Syrian refugees, interviews outside the offi ce and ordered the ton, across the street from the White House. He then a prominent Wahhabi cleric — and seems entire staff to walk in pairs when going out to their quit his job at Breitbart, which he said was being to increase in velocity as he ricochets off them. cars. For months, the reporters covered protests mismanaged in Bannon’s absence, to host a drive- It’s an exhausting exercise, but also a fascinat- around town, which were widely hyped on social time FM radio show with Sputnik, a state-run ing one. He seems perpetually on the precipice media but, for the most part, sparsely attended. Russian news outlet. He told me that he jumped of pulling the argument together, sparking just At least once the Police Department deployed at the chance to transition to a Kremlin-funded enough curiosity that you let him keep going. plainclothes officers into the crowds, with outfi t and, knowing that it would be controversial, Stranahan uses this talent most eff ectively in his instructions to look after the journalists. Later, it spoke to every media outlet that inquired about work, painting himself as a champion of people turned out that fake Facebook accounts linked to it, in order to draw even more people to his work. who are understandably uninformed about other the Russian government helped to spread stories He expressed no contrition about the report- cultures and religions based on their own expe- about Twin Falls and even organized one of the ing he did in Twin Falls, though many of the riences. ‘‘It’s just easy to brand these people as rallies there. The event was also poorly attended conclusions that he drew on the radio and a bunch of Islamophobic, (Continued on Page 54)

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For full T&C’s see www.hotterusa.com. *exclusions may apply Twin Falls disagree over whether Islamic teachings con- Answers to puzzles of 9.24.17 (Continued from Page 51) fl ict with American social norms. ‘‘I can’t take the leap,’’ Shawn told me, ‘‘that because you are STATE LINES racist yokels,’’ he told me, with a hint of disgust Muslim therefore you are reading the Quran ver- OPENERA GATEWAY ARSON in his voice. ‘‘I just don’t like it.’’ batim, and you’re going to go out and do genital POS EDAS ONSTAGE NEWDO CATCHME I FYOUCAN CLA I R Stranahan struck me as passionate about his mutilation.’’ Camille said she supported the local ICET JAMA TIKI SHAMUS stories; not about their veracity but about the resettlement program but thought that her hus- THRACE BR I S ONEMOTIME freedom he and the critics of refugee resettle- band’s unwillingness to even consider cultural dif- ROTOR S I C S PARE PAI R MOAN ATT I RE MI X ment should have to speculate as they wanted ferences or acknowledge any nuance was naïve. MAANDPAKE TT L E TDBANK without being belittled by the fact-mongering ‘‘I think we’ve got to be careful,’’ she said. ‘‘And I ESME OLES OLDE EDGE mainstream. When I reached him by phone this don’t want to be afraid to talk about it entirely or, ATE I LL OOPS MI CHAELS LETSKEEPTHISINHOUSE June, he told me he was planning to travel back like, sound racist.’’ It is precisely this discomfort WI THMAYO RONI REP EWE to Idaho for more reporting on Fawnbrook, now that provides an opening for people like Strana- AV I A SEAL BOER ENOL that he was no longer constrained by his editors han to dominate the conversation. RENTAL EVERYTHINGSOK MSG DOUB L E A L TA AGED at Breitbart. He told me that he believed that he Part of the reason a fear of Islam has persist- MO A N A Z I N O B E Y S had uncovered another dimension of his globalist ed in Twin Falls is because the local leadership HITORMISS SKIM ISHALL theory related to Chobani’s participation in the refused to defuse it, according to Matt Chris- INADAY EERO LADS ENYA CELEB OHTOBE INENGLAND federal school-lunch program. He felt compelled tensen, 36, the editor of The Times-News. While KR I L L S I TUATE BEE L I NE to follow up on the earlier coverage, because he Brown wrote articles that sorted out the truth STALE STEERED TRESSED was frustrated that Alex Jones and others were about the Fawnbrook case, Christensen was pub- forced to retract their stories and apologize under lishing commentary that castigated the people KENKEN pressure. ‘‘I don’t like people getting shut up like who were spreading falsehoods. He told me that that,’’ he said. ‘‘Even if their stories have problems, he had closed-door meetings with city offi cials, I don’t like journalists getting shut down.’’ in which he asked them to write guest editorials I started to ask why anyone should be allowed doing the same, but none of them did. Chris- to publish false information for the express pur- tensen suspected that they were afraid of one of pose of angering their audience and pushing the most reliable political dangers in the region, them further away from those with whom they the same force that leads would-be Democrats disagree, but Stranahan cut me off . ‘‘Hey, I’m there to register as Republicans: being outfl anked walking into the White House right now,’’ he said. on the right is the quickest way to lose your job. He had just arrived for a press briefi ng with the ‘‘Behind closed doors, they would all tell you DIAGRAMLESS SK I president’s spokesman. ‘‘Let me call you back.’’ they were pro-refugee, and we wanted them to LIENS step forward and make that declaration in a public IDEST This April, the boys accused in the Fawnbrook arena, and it just never really happened,’’ he told GMC S E P T A L OU case admitted guilt — the juvenile court equiv- me. ‘‘That was frustrating to us especially at the MACHU P RMAN POU T Y ATRAP SOUND OTTER alent to pleading guilty — and were sentenced beginning because it really felt like the newspaper COARS E AMT S PURNS in June. The judge prohibited city offi cials from was out there all alone.’’ He continued: ‘‘There RELAXED S IMPSON commenting on the outcome of the trial, but were days where we felt like, Godammit, what IDEM RAYE SWE AR TO GA S C A P S juvenile-justice experts told me that the boys are we doing here? We write a story and it’s going SPIRIT FIE HOTOIL would most likely be placed on probation and to reach 50,000 people. Breitbart writes a story SOLOS E FRON CE L LO required to attend mandatory therapy to correct and it’s going to reach 2, 3, 4, 5, 10 million people. SUDSY PR IMO KR I LL TEE EASED SOY their behavior. Even in Idaho, a state with tough What kind of a voice do we have in this debate?’’ EMOT E sentencing requirements, the law bars anyone The refugee resettlement center received SPURS under 10 from being jailed and only allows it in a dramatic increase in donations from local STY extreme cases for anyone under 12. residents during the last year. But those in the Late one Monday night in June I received a town who support the program have often been HEX NUTS BOXING MATCH phone call from Dalos, the Scanner Man. He drowned out by the relatively smaller, but louder, T asked if I had heard about the ‘‘fi reworks fl ying group of activists who oppose it. Brown said E R around Twin Falls.’’ The news of the boys’ fate he expected to see an anti-Shariah bill intro- A K O R had somehow reached the public. ‘‘The suspects duced in the State Legislature when the next B C C U T I S D M N didn’t go to jail or nothing,’’ he said, adding that session starts in 2018. Bills like this, which try N I E A people in town were ‘‘irate.’’ Facebook posts about to bar Islamic law from being used in American L N E E S A D R D the story were again fl ooding his feed. ‘‘They’re courts, have been introduced in the past two P N T E S blaming it on Muslim law,’’ he said. One of the years in Boise but never passed. He speculated I E R E articles circulating, from a site called Bare Naked that the momentum of the past year could force Islam, included a photograph of the judge in the a diff erent outcome. ‘‘There are a lot of people Answers to puzzle on Page 58 case with a large red arrow pointing toward his who feel like society is changing too quickly, head, next to the caption ‘‘Corrupt Judge.’’ Anoth- like the community is changing too quickly,’’ SPELLING BEE er article published the judge’s home address and he told me. ‘‘And who view other people not Volleyball (3 points). Also: Above, alloy, ballboy, phone number, inciting another fl ood of harass- like them or who don’t speak their language as baobab, bellboy, bobble, bobby, booboo, booby, ment, a year after the initial onslaught. a threat or a sign that their culture is going to evolve, lobby, lovable (or loveable), lovely, loyal, loyally, volley. If you found other legitimate dictionary Shawn and Camille Barigar’s bickering has be weakened. And they want to do what they words in the beehive, feel free to include them subsided, but they have discovered that they can to stop that.’’ in your score.

54 10.1.17 McPhee McPhee, of course, takes his fi shing extremely trip down. How, he wondered, had I gotten to (Continued from Page 33) seriously. He keeps a journal in which he records Princeton? What route did I take? What roads every possible relevant detail: not only every catch did I drive? He was curious to know how my grand cosmology of John McPhee, all the earth’s but also its gender and weight, as well as the hours phone had solved the problem of orientation, facts touch one another — all its regions, creatures he spent fi shing that day, water temperature and how its machine directions had diff ered from and eras. Its absences and presences. Fish, trucks, the current in the river. There is a category called his human directions. atoms, bears, whiskey, grass, rocks, lacrosse, ‘‘AWOLs’’ — the ones that got away. McPhee even Unfortunately, I told him, I had no idea. weird prehistoric oysters, grandchildren and Pan- records data about his friends. I had hardly been paying attention. I just trusted gea. Every part of time touches every other part ‘‘If I say, ‘Gee, how did I do three years ago the computer, followed its instructions turn of time. You just have to fi nd the right structure. when we were shad fi shing?’ ’’ Frazier said, ‘‘he by turn and spent my time daydreaming about can tell me how many fi sh I caught.’’ this and that. For now, on the head of the pin that is our cur- ‘‘He knows how many cubic gallons of water This answer did not satisfy John McPhee. rent moment, we have our little lives. Every are going over the rocks on a given day,’’ Remnick He wanted to know the roads I took. Didn’t other day, McPhee rides his bicycle 15 miles. said. (McPhee, asked about this, gently corrected I remember anything? Every spring, he teaches. Twice a year, he goes him: It is cubic feet per second, not cubic gallons.) I told him I remembered passing a water fi shing with three of his New Yorker colleagues: McPhee recently did months of strenuous tower. At some point, there was maybe a res- Ian Frazier, Mark Singer and Remnick. The rehab to recover from a shoulder injury so he ervoir. I searched my memory. There had been friendship runs deep. When I asked Singer would be ready to cast when fi shing season came. a sign that said ‘‘Fog Area,’’ after which every- what kind of fi sherman McPhee is, he started When it came, he was ready. thing got foggy immediately, as if the sign had describing the sight of his friend on the river ‘‘He went up to Canada and caught seven summoned the fog. I remembered, on the radio, — ‘‘He gets out there in a little canoe and sets salmon,’’ Frazier said. ‘‘Well, that’s how you catch a D.J. named Clay Pigeon saying that scientists up below a rapids, he’s got the fl y rod in his left seven salmon.’’ had successfully encoded a 19th-century fi lm hand, he’ll paddle to sort of maneuver around’’ of a running horse into a living cell. At some — and the description got more and more wist- As I prepared to leave Princeton, I stacked my point I hit traffi c, and my phone rerouted me ful until, fi nally, it turned into a pure declaration John McPhee books on the passenger seat of onto back roads. I remembered a very old stone of love. ‘‘You just sort of see him in silhouette,’’ my car, and there were so many of them that house, the Johnson & Johnson headquarters, Singer said, ‘‘and it’s just — ’’ He paused, took the car thought it was a person and frantical- a park called ‘‘Sourland.’’ a breath and was silent for a moment, and then ly beeped at me to buckle the seatbelt. Before Based on those scraps of information, McPhee he actually put his hand over his heart. ‘‘You McPhee said goodbye, he started to give me was able to reverse-engineer my route. know,’’ he said, ‘‘you just want to tell this guy driving directions. Then he remembered ‘‘Very interesting,’’ he said. ‘‘That’s not the way how much you love him.’’ about my phone. This reminded him of my I would have told you to go.’’

The New York Times Magazine 55 N.G.R.I. its executive director between 2007 hospital expenditures. This means politicians, for alternatives to indef- (Continued from Page 41) and 2010, Claude Edward Foulk, is less room for others who might be initely institutionalizing N.G.R.I.s. now serving 248 years in prison seeking psychiatric care, while at After 45 years of studying the issue in the late ’80s but still managed to for sexually molesting children.) the same time, states have cut bil- and fi ling lawsuits on behalf of sexually abuse six female patients; Before Roberts came to Oregon, lions from mental health, leaving patients, Michael Perlin, an emer- there was a wrongful-death suit in he was the person New Jersey sent even scantier outpatient systems. itus professor at New York Law 2003; a rape lawsuit in 1995 that to take over ‘‘problematic’’ hospi- In Hawaii, as a 2015 Samhsa report School and an expert on mental-dis- accused the hospital of what The tals that had ‘‘a serious negative notes, ‘‘There is no voluntary ability law, thinks he knows why: Oregonian described as a ‘‘long- incident or series of negative inci- admission to the [state psychiat- ‘‘Everybody except for people who standing pattern of sex abuse,’’ dents.’’ He revamped three there, ric] facility because of the volume take the Constitution seriously and some of it by a staff member who, one of them twice. of admissions from the court sys- people who are in the hospital are the paper reported, had nearly More than 10 years into its tem.’’ The same lack of services that happy the patients are there. Pros- been fi red the year before, ‘‘after he transformation, Oregon State has contributes to people’s reaching a ecutors, police, they’re glad they’re and several other staff asphyxiated come a long way. But, Roberts mental-health crisis that ends in not going anywhere. I believe that a patient while restraining him for acknowledges, it still has a long arrest also keeps people institu- the disability rights community has refusing to take off his shoe.’’ way to go. Among the hospital’s tionalized longer afterward. never gotten substantially involved The problems weren’t unique 937 forensic patients, there were Whitlock, of Tennessee’s men- in the issue because some of the to Oregon: Nebraska state psychi- 1,908 incidences of seclusion and tal-health department, says that people have been charged with very atric hospitals settled two major restraint in 2014. And while Rob- there are N.G.R.I. patients whom horrifi c crimes.’’ lawsuits, one in 1996 and another erts’s reforms included securing her state’s hospitals are trying to dis- As he put it: ‘‘This is an area that in 2006, which claimed that staff timely releases for patients — charge but for whom they ‘‘just can’t everybody kind of wishes would members and patients raped and between 2012 and 2015, the hospital fi nd a provider.’’ Under her lead, go away.’’ sexually assaulted female patients; discharged 90 percent of its ‘‘guilty Tennessee, more than any other two lawsuits have been brought except insanity’’ (Oregon’s N.G.R.I.) state, has been trying not to com- Nearly two decades into James’s against Massachusetts in the last patients with ‘‘top dates’’ early — mit forensic patients to begin with. confinement, it remains unclear if 10 years by families of forensic it still has several patients who’ve Since 1974, it has done its pretrial he will ever be considered fit for patients who were subjected to ille- been in for more than 15 years, who competency evaluations on an out- release. He says that currently his gal restraining methods, one whose it acknowledges long ago ceased patient basis, no insignifi cant matter entire medication regimen con- condition declined and another to be dangerous. Staff recently dis- given that elsewhere these can take sists of ‘‘fish oil twice a day, calci- who died. Napa had more than charged one patient who had been six months or longer. In 2009, the um, vitamin D and two Kool-Aids 4,000 reported patient-on-patient in for more than 30. state also started doing post-N.G.R.I. and prune juice and Metamucil.’’ or patient-on-staff assaults in 2014; Unfortunately, there aren’t a lot evaluations to see if N.G.R.I.s even In the 2004 appellate court over- in 2010, a staff member was killed. of other places for forensic patients needed hospitalization, also on an turning of his transfer, the hos- Today Oregon State Hospital still to go. When the push to deinstitu- outpatient basis. ‘‘We did not think pital doctor testifying in favor of has the towering 1883 brick face of tionalize psychiatric patients began there was a need to spend 60 or 90 his continued retention pointed the ‘‘Cuckoo’’ era, but inside, it’s in the 1970s, many inpatient facili- days in the hospital to determine if out that there was no medication all sparkling new facilities, yoga ties were shut down or downsized N.G.R.I.s fi t the involuntary-com- for his diagnosis of antisocial props and a physical-therapy pool in favor of community integration mitment standard,’’ Whitlock says. personality disorder — just ther- — thanks, in part, to a state senator, and outpatient services, which ‘‘Once you get someone into the apy, to which he was resistant. Peter Courtney. On a 2004 tour of never adequately materialized hospital, it’s hard to get the court The hospital forensic committee the hospital, Courtney was aston- because of a lack of funding. But to take them back out. We could said that they believed James ished to learn of 3,600 badly cor- institutions have remained the probably determine it in a day.’’ was insufficiently willing to take roded cans of cremains in an out- preferred repository for forensic Now only 55 percent of Tennessee’s responsibility for his actions. One building, still unclaimed. Around patients, who fi ll an increasing N.G.R.I.s are committed. Their typ- of his doctors called him ‘‘sexually the same time, after the death of yet share of the remaining 42,000 ical length of stay ranges between preoccupied’’; the appellate court another patient, the Justice Depart- state psychiatric hospital beds. In seven months and 4.5 years, and concluded that ‘‘the disorder will ment became involved. Oregon Pennsylvania, the proportion of they get out, on average, in about continue to cause him to be dan- State is now the fi rst state psychi- forensic patients increased by 379 two. The state’s new initiative gerous at least until such time as atric hospital in the nation to use percent between 1988 and 2008. adds to the body of evidence that he decides he wants to change and ‘‘collaborative problem solving,’’ In California, some 90 percent of less hospitalization doesn’t lead to begins working seriously with his instead of, say, automatic ‘‘seclu- approximately 7,000 state-hospital higher crime rates. Since Tennessee treatment providers.’’ sion and restraint’’ of patients who patients are now forensic. Nation- stopped automatically committing The court-appointed psychia- start to become diffi cult. Courtney wide, nearly one-third of ‘‘consum- N.G.R.I.s, says Jeff Feix, the state’s trist at the hearing two years ear- pushed funding for the reforms ers’’ in state hospitals in 2007 were director of forensic services, ‘‘the lier, when James was ordered for through Oregon’s State Legislature forensic, and that number is ‘‘rap- recidivism rate we have is no dif- transfer, said quite the opposite. and brought in a new superinten- idly expanding,’’ according to the ferent than it was before.’’ In his opinion, James ‘‘acknowl- dent, Greg Roberts. federal Substance Abuse and Men- Despite the clinical benefi ts and edged the wrongfulness of his ‘‘Very often when you fi nd seri- tal Health Services Administration cost savings — in 2015, according actions, and although he does not ous problems, the problem is one (Samhsa). In the last 10 years, foren- to a Samhsa report, the average show much remorse or regret for of three things: leadership, leader- sic patients’ costs jumped to $4.25 annual cost of one forensic patient, his actions as a result of limited ship or leadership,’’ Roberts says. (A billion from $2.5 billion; forensic nationwide, was $341,614 — Tennes- insight, he certainly realizes that notable problem of leadership was patients now account for 43.9 see’s model is still unusual. There what he did was wrong and against found at Napa: The man who was percent of total state psychiatric is no outcry, from the public or the law.’’ He said that James ‘‘has

56 10.1.17 benefi ted from [the state psychi- are injustices that are imposed atric facility] as much as he will on individuals,’’ Appelbaum says. benefi t, and at this point he could ‘‘But I also see at a 30,000-foot be transferred to a civil hospital, level why the system works that where he will continue to benefi t way, and recognize perhaps the from the structured environment paradox that if it didn’t work that and continue to receive individu- way, we might lose the insanity al treatment, hoping that he will defense altogether, or at the very eventually gain further insight.’’ But least have an even more restrictive in its appeal at that time, as in every system that we have to deal with.’’ review since, the hospital success- For many, Appelbaum says, an fully petitioned to retain him. N.G.R.I. verdict is still superior to a How much James’s perceived conviction. ‘‘It exempts them from dangerousness is due to his illness a formal fi nding of guilt, which can and how much to his extended be important later in their lives. It hospitalization can be diffi cult to enables them to serve their time of untangle. During a phone call last confi nement in what is generally a year, he confessed that lately he’d much better and safer environment been ‘‘going through a lot of crap.’’ than an overcrowded state prison.’’ He was referring to recent fi ghts While one way to look at indefi nite on the ward. The 2004 appeal notes confi nement is as an unbearable that he was assaulted twice in 2002 uncertainty, another is that it off ers and ‘‘got into an altercation with hope: ‘‘Compared to a life without another patient’’ that year; all of the the possibility of parole, you know, incidents read as demerits against maybe that’s better.’’ him. Such disputes are not uncom- Yet for the insanity defense to mon for patients with personality live up to the moral imperative it disorders, says Norko, the Yale was designed to embody — excul- professor and clinician. A hospital pating those with diminished is generally ‘‘not a good place for responsibility for their acts — bet- them,’’ he says. ‘‘Clinically you try ter mechanisms for evaluating very hard not to hospitalize peo- release will need to be adopted, ple who have personality disorders. Slobogin says. In an attempt, in They can’t quite seem to ever get part, to protect N.G.R.I.s’ consti- it right. To them it looks like: ‘The tutional rights to be released when staff want me to do this, they want they don’t fi t commitment crite- me to do that, they keep changing ria, the American Bar Association the rules,’ and they don’t under- recently revised its criminal-justice stand the rules, and they get into mental-health standards, which arguments, they get into fi ghts. It’s were adopted in 1986. The associ- all part of their personality disor- ation recommended that forensic der, which in itself isn’t necessar- patients be detained only if there ily all that dangerous, but it’s kind is clear and convincing evidence of hard to move somebody along — a standard that, if it had to be when their record is dotted with quantifi ed, means about 75 percent all of these altercations.’’ certainty — that they’re mentally Perhaps the most cleareyed ill and dangerous; the current legal view of the compromises inherent burden of proof in most jurisdic- in N.G.R.I. commitments comes tions is a ‘‘preponderance of the from Paul Appelbaum, profes- evidence,’’ or 51 percent certainty. sor and director of the division ‘‘It’s immoral to deprive someone of law, ethics and psychiatry at of liberty because you’re mad at Columbia University. Appelbaum them for being found N.G.R.I.,’’ says acknowledges that some N.G.R.I.s Slobogin, who was on the task force. are ‘‘unnecessarily detained for a ‘‘Under our new standards, after a longer period than what seems year you have to have very strong to be warranted by their mental proof of dangerousness, or you can’t disorder and its impact on their detain them.’’ But the standards are likelihood of being violent in the just recommendations, and some future.’’ But, he says, such exagger- states didn’t even follow the ones ated concerns about public safety from the ’80s. Slobogin concedes may be necessary to the survival that in many jurisdictions, they may of the insanity defense. ‘‘There have no impact at all. Puzzles SPELLING BEE DOUBLE OR NOTHING BOXING MATCH By Frank Longo By Patrick Berry By Thinh Van Duc Lai

How many common words of 5 or more letters can Each space in this crossword will contain either Place numbers from 1 to 9 in the grid so that each you spell using the letters in the hive? Every answer two letters or no letters. Words read across or down outlined region contains consecutive numbers, and so must use the center letter at least once. Letters may as usual, but may skip one or more spaces. that the sum of numbers in every 3x3 area is the same. be reused in a word. At least one word will use all 7 The grid has 16 overlapping 3x3 areas. Solving hint: letters. Proper names and hyphenated words are not ACROSS When 3x3 areas overlap, the sum of the numbers in allowed. Score 1 point for each answer, and 3 points 1. Utterly foolish, as a plan 5. Guys’ partners 6. Muscle- their unshared squares must be equal. In the example, for a word that uses all 7 letters. to-bone connector 7. Talked with a sore throat the total of each 3x3 area is 42. 8. Actor Richard of “Primal Fear” 9. Unlikely to collapse Rating: 6 = good; 11 = excellent; 16 = genius Ex. DOWN 1. Auto repair shop 2. What savings bonds earn 3. Spiny bur found in Florida grass 4. Frequent co-star of > Jeanette MacDonald in old musicals (2 wds.) A 1234 Y B 5

O 6

V E 7

L 8

9

Our list of words, worth 19 points, appears with last week’s answers.

1 K 2 W 3 I 4 U 5 O 6 C 7 T 8 A 9 Y 10 V 11 D 12 G 13 P 14 N 15 J 16 Q 17 X 18 K 19 M 20 H 21 E 22 S

ACROSTIC 23 A 24 B 25 L 26 C 27 U 28 G 29 Y 30 T 31 P 32 W 33 X 34 N 35 H 36 A 37 D 38 I 39 M 40 G 41 E 42 T By Emily Cox & Henry Rathvon 43 B 44 O 45 K 46 W 47 S 48 F 49 Q 50 N 51 L 52 H 53 A 54 C 55 G 56 D 57 R 58 B 59 V 60 K 61 F 62 O 63 I

Guess the words defined below and 64 T 65 W 66 E 67 A 68 X 69 S 70 L 71 J 72 P 73 B 74 M 75 G 76 R 77 H 78 D 79 Q 80 O 81 X 82 S 83 A 84 U 85 N write them over their numbered dashes. Then transfer each letter to 86 E 87 T 88 C 89 M 90 K 91 O 92 R 93 Q 94 F 95 B 96 P 97 X 98 W 99 I 100 V 101 T 102 H 103 U 104 K 105 C the correspondingly numbered square in the pattern. Black squares indicate 106 S 107 E 108 Q 109 W 110 Y 111 M 112 X 113 F 114 L 115 G 116 V 117 J 118 K 119 R 120 C 121 P 122 W 123 B 124 I 125 H 126 O 127 D word endings. The filled pattern will contain a quotation reading from left 128 U 129 N 130 F 131 A 132 J 133 G 134 S 135 Y 136 V 137 X 138 E 139 M 140 W 141 P 142 B 143 L 144 Q 145 I 146 C 147 K 148 R 149 S to right. The first letters of the guessed words will form an acrostic giving the 150 O 151 M 152 E 153 T 154 F 155 W 156 V 157 P 158 Q 159 Y 160 L 161 N 162 M 163 R 164 C 165 X author’s name and the title of the work.

A. Way of thinking about things H. Fine for a mess N. Tourist locale just east of the Los T. Compound derived from the Angeles County Museum of Art pigment Prussian blue ______23 53 8 131 67 36 83 (2 wds.) 20 52 77 35 125 102 ______B. Home city in “Moneyball” ______87 101 7 30 153 64 42 I. Stick in one’s craw ______14 34 129 161 85 50 U. Poem that starts “I think that I shall 142 95 58 24 43 123 73 ______O. “What a noble mind is here never see …” C. Star-studded display (2 wds.) 3 99 145 38 63 124 o’erthrown!” speaker ______103 84 4 27 128 ______J. Bad sign for a raconteur ______54 146 164 88 105 6 26 120 62 44 150 126 91 5 80 V. Second-largest moon of Uranus D. Things guinea pigs lack ______P. Red Sox Nation, e.g. (2 wds.) ______132 117 15 71 136 116 59 100 156 10 ______78 37 11 56 127 K. Put aboard a ship by force 157 31 141 121 13 96 72 W. Expression not easily interpreted E. It’s measured from E to F (2 wds.) (2 wds.) ______Q. Antediluvian ______90 1 45 147 118 18 60 104 ______138 107 152 86 66 21 41 ______109 122 32 155 46 65 140 98 2 158 108 79 16 144 93 49 F. Flowing very gradually L. Sunroof or heated seats, maybe X. Stuff in bowling balls and R. Bean, nut, noodle ______skateboard wheels 130 48 154 113 61 94 160 143 114 25 70 51 ______G. “Never interrupt your enemy when 163 92 148 119 57 76 137 112 165 17 68 97 81 33 M. Great turbulence in the social order he is making a ____” (Napoleon) S. Aquiline : eagle :: struthious : ____ Y. Finder of whales and shipwrecks ______12 40 115 133 28 55 75 111 74 139 151 162 19 89 39 22 82 149 47 69 106 134 29 110 159 9 135

58 Allie & Katie Buryk's Story It took the two of us, 29-year-old twins, eight years to find out what was wrong. Our symptoms started slowly. At first, there was the difficulty climbing stairs. Our leg muscles were weak and we had trouble standing from a sitting position without using our hands. We couldn’t squat. Sometimes our legs would just give out and we would fall. And our speech changed, words came tumbling out and sometimes people didn’t understand us. Finally, genome sequencing informed us that we had Late Onset Tay Sachs. And now here it is two years later, with Allie (left) & Katie Buryk. no treatment and no cure. Our bodies don’t produce enough of an enzyme which, right now, has no replacement. Infants who develop symptoms early usually die by age 2. Juveniles with symptoms pass away in their teens. So we guess we’re lucky to be alive. That’s how it feels sometimes. But we know the disease will continue and in our futures are wheelchairs, difficulty swallowing, cognitive decline and perhaps mental illness. We have decided to go public and raise money, awareness and mount a search for a cure. Sure it’s for us but perhaps more importantly, it is for infants and kids who aren’t as lucky as we are. And it’s for their families who embark on this difficult and sad journey. UPDATE... Many generous people have helped us and we’ve been able to fund four grants. One of them allows researchers to develop a Late Onset Registry and Repository to help future clinical trials. Another created tools for researchers to further explore and test the efficacy of potential therapies. We also funded a study by the National Institutes of Health using wearable devices to collect patient data on walking (and falling) that will be important for future clinical trials. And finally, the last grant allows researchers to test if drugs already approved by the FDA for other diseases could help our diseases. In addition, our good friend, Peggy Furth, made a significant donation to the Mayo Clinic which was used to create the Mayo Clinic Lysosomal Initiative. The premier health institution in this coun- try, if not the world, will be looking for a cure.

We need to continue the search. Whatever your contribution, it will help fuel our quest to make a difference in our lives and those of so many others. It gives us hope. To Donate National Tay-Sachs & Allied Mayo Clinic Diseases Association Department of Development Katie & Allie Buryk Fund Lysosomal Disease Initiative 2001 Beacon St Suite 204 Boston, MA 02135 200 First Street SW 1-800-90-NTSAD Rochester, MN 55905 http://bit.ly/2jr7EG9 Phone: 800-297-1185

Come meet our mom, Alexis Buryk, at the Individualizing Medicine Conference & Lysosomal Disease Symposium. Rochester MN. October 9-11, 2017. [email protected]. #cimcon17. Puzzles Edited by Will Shortz

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THAT’S ONE WAY TO PUT IT 21 22 23 By Robert Fisher 24 25 26 ACROSS 55 D.C. lobby for 110 Who “can’t buy 27 28 29 30 31 1 Draw in seniors you love” in an 8 Tight garment 57 Locale for two of Elton John hit 32 33 34 35 36 14 Come before the Quad Cities 113 “There, there” 21 Stingy sorts 58 Egyptian cobra 114 Tax increase 37 38 39 40 41 42 22 Blogger’s pick 61 Lying 120 Cheers in un for a pic 66 Heat, as to estadio 43 44 45 46 47 48 49 50 soften metal 121 Canon camera 23 Utility worker 51 52 53 54 55 56 57 58 59 60 24 Falling down 67 “u r hilarious!” 122 Take off quickly 26 Mean 68 How scallops are 123 “If I ____ penny 61 62 63 64 65 for every …” 27 Very: Ger. often prepared 124 Some W.S.J. topics 66 67 68 28 Earth goddess 69 French horticulturist after 128 Summer Olympics 29 G.P.A. killers whom a variety host after Barcelona 69 70 71 72 73 74 75 76 77 30 “Sprechen ____ of fruit is named 130 Dead Deutsch?” 78 79 80 81 82 83 84 85 86 72 Cause of insomnia, 133 Custom-fi ts 31 Robert of maybe 134 Took off quickly “The Sopranos” 87 88 89 90 91 92 93 74 Design detail 135 Pasta recipe phrase 32 Speeding ticket 77 Google ____ 136 Show contempt for 94 95 96 97 98 37 Prep for the 78 Run too far or runway, maybe 137 At the scene lift too much 138 99 100 101 102 103 104 40 Ball ____ “We should avoid 81 Go over in doing that” 41 Besmirch blackjack 105 106 107 108 109 110 111 112 113 42 Emotionally 84 In working order DOWN demanding 114 115 116 117 118 119 87 Layoff 1 New Testament 43 Climbing Mount 94 Old sitcom book 120 121 122 123 124 125 126 127 Everest, e.g. character who was 2 Pilgrims’ pronoun 45 Be Kind to Editors 229 years old 3 Radio host John 128 129 130 131 132 and Writers Mo. 95 Utah’s ____ Canyon 4 Life in the big city, [for real!] 133 134 135 96 Get 29-Across to some 48 Notable features 97 Railway off shoot 5 of Stockholm Bee: Prefi x 136 137 138

and Amsterdam 98 “So that’s it!” 6 Dance with a kick 10/1/17 51 It “exists when one 99 Florae and faunae 7 John Irving protagonist goes against 101 Down 13 Five-point 18 Charlotte ____, 62 Mother-of-pearl 93 Pinstriper portrayed by one’s conscience,” 103 Mariners Virgin Islands Robin Williams rugby play 63 Out in court 99 Store blowout per Pope Francis 105 TWA competitor 19 Very last part 8 Wine holders 14 Stripes mismatch, 64 Boost the 100 Suffi x with brew 52 Fire places 108 Classic Jag 20 Pep horsepower of 9 Spermatozoa traditionally 102 Underbrush targets 25 André ____, 1947 65 Dish served clearer 15 Amazon, e.g. Literature Nobelist with chopsticks Puzzles Online: Today’s puzzle and more 10 Dance-party 104 Occasionally than 9,000 past puzzles, nytimes.com/crosswords enthusiast 16 Oklahoma City- 30 Narrow waterway in a bowl 105 W.W. II shipping ($39.95 a year). For the daily puzzle commentary: 11 Wooden to-Tulsa dir. 33 Part of an 69 Florida beach city, worries informally nytimes.com/wordplay. 12 Worries no end 17 Develops (from) accusation in Clue 106 Oman’s leader, e.g. 34 70 Like the head of a Laker named to 107 Antarctic penguin the Basketball Hall tennis racket 109 Offi cially prohibit of Fame in 2016 71 Lowly worker 111 Lamb, e.g. 35 Small anatomical 73 Bit of wind KENKEN container 112 It goes up to 75 Those, in Tijuana about 1700 Fill the grid with digits so as not to repeat a digit in any row or column, and so that the digits within each 36 Landing post-E.T.A. 76 Complaining fi sh? 115 Aquarium fi sh heavily outlined box will produce the target number shown, by using addition, subtraction, multiplication 37 12 cc, maybe 79 “Hots” 116 Swelter or division, as indicated in the box. A 5x5 grid will use the digits 1–5. A 7x7 grid will use 1–7. 38 Country star 80 “Creme sandwich” Church introduced 117 Holiday 39 Alternative to a over a century ago celebrations name: Abbr. 82 Animal depicted in 118 Holy Roman 44 Draw, as a scene Edwin Landseer’s emperor called 46 Ratcheting wheel “The Monarch of “the Great” mechanism the Glen” 119 Country rocker 47 Adjust with 83 Work, work, work Steve Photoshop, maybe 85 Air-conditioner fi g. 125 One of the Ivies 49 Japanese drama 86 Entrap 126 Not conned by 50 Knocks over 88 Army NCO 127 Let stand, 53 Even 89 Alien autopsies, editorially 54 Trauma reminder crop circles and 129 Neither’s partner 56 School support the like 130 U.N. observer grps. 90 Liquid-____ since ’74 58 Corona, for one 91 Pet food with a 131 Day-in-and-day- 59 Repeated cry at a paw-print logo out pattern dance class 92 Where to accent 132 D.C. summer 60 Most profs “Laotian” setting KenKen® is a registered trademark of Nextoy, LLC. © 2017 www.KENKEN.com. All rights reserved.

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recouping investments, people think Franklin that there should be as many white characters as possible. But there’s tons of counterevidence to that claim. ‘‘Coming Leonard Wants to America’’ did $160 million foreign in the ’80s. Even ‘‘Big Momma’s House 2’’ made $68 million foreign in 2006. Every- To Diversify where in the world you have people pro- jecting themselves onto black athletes; hip-hop is arguably the most important The Box Office cultural form of the last 30 years around the world. And with gender: Before, let’s say, ‘‘The Hunger Games,’’ there Interview by Ana Marie Cox was an assumption that female-driven action movies do not work. In the last 10 years, we’ve certainly seen a number of female-driven action movies make hundreds of millions, if not a billion dollars at the box offi ce. ‘‘Titanic’’ is, in many ways, a female-driven action movie! Is there a fi lm that you have been proved You graduated from Harvard and wrong about? I remember being pitched worked in politics, then management ‘‘Slumdog Millionaire’’ and thinking, consulting, then Hollywood. What is Good luck. the through line with those jobs? It Do you worry that the increase in fi lms has probably been advocacy for people with diverse casting will give people whose stories have historically been a false sense of ‘‘wokeness’’? Well, it excluded or overlooked. I had pretty depends on how they internalize that much every advantage growing up — my experience, right? If they’re patting father’s a doctor, my mom was a teacher themselves on the back and saying, — but when you grow up a black nerd ‘‘I saw ‘Moonlight,’ therefore, like, I’ve in the Deep South while Steve Urkel is accomplished something,’’ no. If you see on television, you learn to identify with ‘‘Moonlight’’ and your experience with the those on the outside. black queer community changes or you Are you still a nerd? Oh, yeah, very much can recognize their common humanity so. People get confused because of the better because of ‘‘Moonlight,’’ then hair. yeah, I think it’s a good thing. After all this, you created ‘‘The Black We’re at a time in our culture when the List,’’ an annual anonymous survey of project of writing characters who are Hollywood executives about the year’s not like you is held up to really high most well loved but unproduced screen- scrutiny. The cliché is to write what plays. You’ve said one reason executives you know, right? I think that should be make movies without much attention amended to ‘‘write what you’ve rigorously to diversity is that their own lives and researched.’’ I’m never going to begrudge backgrounds are themselves not very a writer the opportunity to write and diverse. It’s important that people who create a story however they so choose. are in this system recognize that there At the same time, I think it’s important is a viable, profi table business in mak- to recognize that television and fi lm are ing fi lms that are representative of the a high-resource art form and that they are diversity that exists in the country and also a business. I don’t believe that a white Age: 38 Leonard created His Top 5 Films for the world. The assumptions that Holly- ‘‘The Black List,’’ Understanding the man can’t write about a black woman, or Occupation: a survey of Trump Era: wood makes about what is commercially Founder and C.E.O. a black woman can’t write about an Asian Hollywood’s most 1. ‘‘Dr. Strangelove’’ viable aren’t always accurate. of ‘‘The Black List’’ man, but I think that the people who are popular unproduced (1964) How so? Conventional wisdom has said Hometown: screenplays, 2. ‘‘Being There’’ doing that have an extraordinary respon- for years that you can’t make movies Columbus, Ga. in 2005. He is an (1979) sibility to make sure that those stories are with black people and expect those associate member 3. ‘‘In the Loop’’ being presented in as authentic a light movies to be commercially success- of the Academy (2009) as possible. You have to do research, and of Motion Picture 4. ‘‘Four Lions’’ ful abroad, so as the foreign box offi ce Arts and Sciences. (2010) that should really be the burden that art-

becomes more and more important to 5. ‘‘Bulworth’’ (1998) ists carry: to do it right, not to not do it. and edited. has been condensed Interview

62 10.1.17 Photograph by Jessica Chou Sleep better tonight.

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