The Washington Post National Weekly - February 28, 2016

Politics Can Trump be bumped from top? 4

World The latest threat of Zika 11

Entertainment Who wants a piece of celebrity? 17

5 Myths The placebo effect 23

ABCDE NATIONAL WEEKLY SUNDAY, FEBRUARY 28, 2016

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IN COLLABORATION WITH

THE MIND’S BIOLOGY Doctors are reaching past the symptoms of mental illness to fix the circuits that breed them PAGE 12

SUNDAY, FEBRUARY 28, 2016

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THE FIX

Who could be Trump’s VP? C HRIS C ILLIZZA

after seven years of President Obama’s very intentional government takeover of the U.S. economy,” Scott wrote of Trump in a very fan “Morning Joe” Tuesday morning, vorable opinion piece in USA Today in Januhost Mika Brzezinski threw out an inary. Under normal circumstances, the fact that teresting theory: Donald Trump and Scott’s company paid a $1.7 billion Medicare Marco Rubio are playing nice with one fraud penalty would be disqualifying. But this another — and savaging Ted Cruz — because a is Donald Trump we are talking about. backroom deal has been cut between the two to form a ticket with Trump as the presidential Sarah Palin: Stay with me . . . Trump loves nominee and the senator from Florida as the nothing more than sticking it to the GOP politsecond in command. ical class and the media punditry. And which I don’t think that deal has been cut. candidate in recent years is more disBut Brzezinski’s speculation did get liked by those two groups than the me to thinking about whom Trump former governor of Alaska? Answer: might pick as his vice president. (For No one. Palin’s populism is not all those of you who think such speculathat dissimilar to what Trump is tion is premature, yes, it sort of is.) pitching in this election. Picking PaBefore I go any further, let me lin is, um, not without risk. But throw out a caveat or two. First, vice Trump loves risks. presidential picks are very, very diffiCarly Fiorina: Fiorina disapcult to handicap. It is an intensely peared without a trace after several personal decision that is extremely strong debate performances last Rick Scott Sarah Palin Carly Fiorina Nikki Haley tightly held. It’s one of the last big seyear. But, on paper, she holds some crets in the modern era of politics. appeal to Trump. A successful busiSecond, the way you (or, more accurately, I) nesswoman who might be able to blunt his wrong the idea that Trump is simply the candithink about who a presidential nominee losses among women in a general election race date of angry white men. She’s in her early 40s, might pick as a vice president tends to depend against Hillary Clinton. Fiorina’s stewardship while Trump will be 70 on Election Day. She on the oldest and crustiest of conventional of HP might become an issue, but Trump, a endorsed Rubio in her state’s primary, so pickwisdom. You pick someone from a swing state man who somehow in this race has been able ing her could put to rest the idea that Trump is you need to win. Or you pick someone whose to slough off four bankruptcies, wouldn’t likevengeful and vindictive to anyone who crosses experience or skill set complements your own. ly be dissuaded by that baggage. him. It almost makes too much sense . . .

And so on and so forth. Of course, Trump has Businessman to be named later: Carl Rick Scott: The Florida governor is, yes, a broken every bit of conventional wisdom so Icahn? Jack Welch? Some other classy dealgovernor and, therefore, part of the political far in this race. So the idea that he will suddenmaker whom Trump has come into contact class that Trump loathes. But Scott, like ly start following the established rules of order with during his years in business? Picking Trump, has his roots in the private sector — in his vice presidential pick seems unlikely. someone who has never been involved in polimaking millions as a health-care executive beIn fact, it’s much easier to figure out who tics before would bolster Trump’s basic mesfore he ran for office in 2010. And Scott got Trump won’t pick than it is who he might. For sage that politicians don’t know what the hell into the governor’s mansion by beating the example, Trump isn’t going to choose Cruz as they are doing. It also might be slightly risky Florida Republican establishment at its own his vice presidential nominee. The Donald since, well, someone who has never run for or game — sort of like Trump has done in this seems to genuinely loathe the senator from been in office before wouldn’t have much of a race. Plus, don’t forget that Scott was an early Texas, as his Tuesday morning Twitter barrage clue about how the whole system works in the advocate of Trump’s message: “I think he is reveals for about the 1,000th time. event Trump actually got elected president. n capturing the frustration of many Americans BY

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I also don’t see Jeb Bush winding up on the Trump short list. Or Ben Carson.

So who might make that cut? Below a few thoughts as well as reasons for each. (These are in no particular order.)

Nikki Haley: The South Carolina governor probably makes the most conventional sense for Trump — or any of the rest of the likely Republican nominees. For Trump, Haley would help address lots of his weaknesses. She’s an Indian American woman who can help prove

This publication was prepared by editors at The Washington Post for printing and distribution by our partner publications across the country. All articles and columns have previously appeared in The Post or on washingtonpost.com and have been edited to fit this format. For questions or comments regarding content, please e-mail weekly@washpost.com. If you have a question about printing quality, wish to subscribe, or would like to place a hold on delivery, please contact your local newspaper’s circulation department. © 2016 The Washington Post / Year 2, No. 20

CONTENTS POLITICS THE NATION THE WORLD COVER STORY TECHNOLOGY BOOKS OPINION FIVE MYTHS

4 8 10 12 16 18 20 23

ON THE COVER In the struggle over the future of psychiatry, researchers are looking deep within the brain to understand mental illness and find new therapeutic tools. Illustration by DANIEL HERTZBERG for The Washington Post.

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POLITICS

Can Donald Trump be stopped?

JAE C. HONG/ASSOCIATED PRESS

He could be out of reach by March 15, and much rests on his competitors’ home states

BY D AN B ALZ AND P HILIP R UCKER

Houston

D

onald Trump has taken firm control of the race for the Republican presidential nomination with his third straight victory, in Nevada. To deny him that role, strategists say, his leading rivals must quickly change the trajectory of the race and then dig in for what could be a long battle that could go all the way to the GOP convention in Cleveland.

Strategists who have been through past nomination battles say that Sen. Marco Rubio (Fla.), Sen. Ted Cruz (Tex.) and Ohio Gov. John Kasich collectively have un-

til March 15 to turn the race away from the New York billionaire.

Each has a must-win test looming in his home state between now and then. But those victories alone might not be sufficient to block Trump’s path.

As for Trump, the front-runner hopes to suffocate his three main rivals in this week’s Super Tuesday contests, particularly in primaries across the Deep South, and to knock them off with wins in each of their home states. In his Las Vegas victory speech after the Nevada caucuses Tuesday night, Trump predicted he would secure the nomination in less than two months and taunted his top three opponents by trumpeting his high poll numbers in Florida,

Ohio and Texas.

Changing the dynamic, however, depends on whether any of them has a strategy to put Trump on the defensive. So far, Trump’s rivals have focused more on one another than on him, in hopes of becoming Trump’s last viable opponent. Many Republicans fear that strategy will only allow Trump to put a stranglehold on the nomination with continued victories in the coming weeks.

“The reality is that, until the field starts to narrow, it’s going to be very, very hard to take him out,” said Katie Packer, deputy campaign manager for Mitt Romney’s 2012 campaign and the leader of an anti-Trump super PAC. “I think people need to step up and

Republican presidential candidate Donald Trump arrives for a caucus night rally Tuesday in Las Vegas.

start taking on Trump. Frontrunners don’t just stumble. People trip them.”

After losing the Iowa caucuses to Cruz on Feb. 1, Trump has piled up victories in New Hampshire, South Carolina and Nevada. He heads into the Super Tuesday contests in 11 states with the anti-Trump vote still splintered among his rivals.

Given Trump’s string of successes, his rivals must demonstrate that they can beat him, not just finish ahead of each other.

“You have to win,” said Stuart Stevens, chief strategist for Romney in 2012. “Winning transforms a candidate, and losing transforms a candidate. You’re not the same person after you’ve won a bunch of

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POLITICS races, and you’re not the same after you’ve lost a bunch of races.”

Winning states does more than change perceptions. It’s the key to amassing delegates. From here forward, the campaign shifts from a battle for momentum to the trench warfare of gathering delegates.

Trump has taken hold of the delegate race in large part by winning all 50 that were at stake in South Carolina. The longer the field remains divided, the better Trump’s opportunities to maintain or enlarge that lead.

David Wasserman of the Cook Political Report updated his delegate charts Wednesday morning and concluded that Trump is on pace or slightly ahead of what he would need to win the 1,237 delegates needed to secure the nomination. Rubio and Cruz are behind their pace to achieve that.

Only about 5 percent of the total delegates have been awarded so far. But over the next three weeks, they will come in bunches, with 595 at stake Tuesday and 368 more through March 12.

At that point, the rules shift in what could be a game-changing fashion. Between now and March 14, delegates will be awarded proportionally. Starting March 15, states will be allowed to award delegates on a winner-take-all basis. On that day alone, Florida, Illinois, Missouri and Ohio, with a combined 292 delegates allocated in that way, are among the states or territories with contests.

“It’s important to take a deep breath here,” Rubio said Wednesday on “CBS This Morning.” “It’s not based on how many states you win — it’s based on how many delegates you picked up.” Looking ahead to the March calendar, Rubio said there were “plenty of states out there that — in the winnertake-all category — that if you win them, you more than catch up.”

Over time, Rubio intends to more aggressively draw a contrast with Trump and call him out for inaccuracies or shallow policies.

“We believe a majority of Republicans don’t want Trump to be the nominee and will vote for an alternative,” said Rubio communications director Alex Conant.

“As this becomes a two-person race, Marco will beat Trump head to head.”

Rep. Peter T. King (R-N.Y.), a Rubio supporter, said Rubio needs to limit Trump’s victories and ensure that Cruz, who came in third

JOSH EDELSON/AGENCE FRANCE-PRESSE VIA GETTY IMAGES

CHRIS KEANE/REUTERS

in South Carolina, is halted.

“He has to run the hardest campaign he can and stop Trump from sweeping” Super Tuesday, King said. “He has to make it as clear as possible that he’s now the only option, that Cruz is finished and hit a high-water mark in South Carolina. . . . Cruz had his chance and missed it.”

Jeff Roe, Cruz’s campaign manager, offered a counter view in a phone interview Wednesday. He argued that his candidate still has the best chance to defeat Trump, despite a loss in South Carolina.

“He’s won three in a row,” Roe said of Trump. “That’s not lost on me.” Still, he said that based on the campaign’s projections of states and demographics and possible support, “the road map through March 15th will not be smooth sailing for Donald. For those that are hysterically declaring the race over should take a breath and look at the remaining 46 states.”

At this point, however, none of Trump’s leading rivals sees any incentive to get out of the race. All can sketch a path to the nomination, however difficult, and until they are proven wrong, they will soldier on.

Mike DuHaime, who was chief

strategist for the presidential campaign of New Jersey Gov. Chris Christie, said he could imagine long-odds scenarios for Cruz, Rubio or Kasich and said the psychology of believing there is a path to victory, no matter what outsiders think, will keep the candidates going.

“I have been in those rooms,” DuHaime said. “As long as you believe there is a path and a chance, you keep going.”

A fifth Republican, retired neurosurgeon Ben Carson, also remains in the race but is not expected to be a major factor in the March contests.

Meanwhile, Trump’s insular campaign is quickly expanding into a national organization. Staffers are on the ground in states with Super Tuesday primaries and are building grass-roots networks there and in other states such as Florida. Campaign manager Corey Lewandowski said Trump has lined up a “crazy travel schedule” over the next couple of weeks and brushed off any suggestion that his boss was stoppable.

“We have a very strong candidate who is going to be competing in every state,” Lewandowski said. “I don’t expect anything. Our

ALEX SANZ/ASSOCIATED PRESS

Clockwise from left, Sen. Marco Rubio (Fla.), Sen. Ted Cruz (Tex.) and Ohio Gov. John Kasich face must-win contests in their respective home states if they wish to stop Trump from running away with the nomination.

KLMNO WEEKLY

goal is to play everywhere.”

But Republican strategist Phil Cox said the home-state tests are crucial for all three of Trump’s leading rivals. “If you are a candidate other than Trump, from the standpoint of both the national narrative and the actual number of delegates you need to win the nomination, anything less than a win in your home state is a fatal,” he said.

John Weaver, Kasich’s chief strategist, agreed: “There’s no legitimate rationale. If you can’t win your home state in a primary, you can’t expect to move forward.”

The Texas primary comes first, on March 1 along with 10 other Super Tuesday primaries or caucuses. Polls show Cruz with a lead there, although Trump is uncomfortably close behind.

Cruz’s advisers and allies are confident he will carry the state and are hopeful he gets more than 50 percent of the vote, which would mean he wins all 155 delegates.

Rubio is racing to absorb Jeb Bush’s financial and political network in Florida and is expected to pick up endorsements from most officeholders. He is opening at least three campaign offices in Florida and on March 11, the day after a Miami debate, Rubio plans to crisscross the state holding fundraising events with former Bush supporters.

“Some folks are trying to decompress from having backed Jeb and Jeb suspending his campaign, but people are coming on board and recognize that Marco’s the candidate who can win this, who can unite the party and come out the last man standing,” said Rubio spokesman Alex Burgos.

One factor potentially working in Rubio’s favor: Florida is a “closed primary,” meaning only registered Republicans can vote.

Trump’s early victories have been fueled in part by independent voters crossing over to support him.

In Ohio, Kasich, as the sitting governor, enjoys the support of the state Republican Party as well as most GOP officeholders. He also has a relatively high jobapproval rating, which his team believes gives him an edge over Trump or any other challenger.

“We’ll do what we have to do to make sure that we do win,” Weaver said. “We’re very confident of it, but we’re not overconfident.”n

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POLITICS

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Bloomberg’s billion-dollar question

KEVIN LAMARQUE/REUTERS

The former New York mayor weighs a third-party run Michael Bloomberg would face long odds if he chose to launch an independent bid for the Oval Office.

BY

P AUL S CHWARTZMAN

I

n a wildly chaotic presidential election starring a tycoonturned-reality-television-star from New York and a socialist from Vermont, is there room for another billionaire from Manhattan’s East Side?

That is a central riddle facing former New York mayor Michael Bloomberg as he contemplates a third-partybidfortheWhiteHouse.

Donald Trump’s resounding victories in South Carolina on Saturday and in Nevada’s caucuses Tuesday have solidified his status as the Republicans’ front-runner.

On the Democratic side, Sen. Bernie Sanders’s unexpected surge — and landslide win in New Hampshire — have kept him in the race even as Hillary Clinton has regained some momentum after her narrow victory in Nevada.

What remains unknown is whether Bloomberg, 74, is willing to insert himself into a contest that remains unpredictable even as the field of candidates winnows.

Bloomberg went out of his way the other week to bemoan a campaign he described as a “race to the extremes,” with candidates exploiting Americans’ loss of faith in a political system that is “corrupt, gridlocked and broken.”

“That’s why you see the current

candidates out there doing well, and not the conventional ones,” Bloomberg told a gathering at a Manhattanbookparty,anapparent reference to Trump and Sanders.

Looming over the deliberations is the question of which party a Bloomberg candidacy would hurt more. With polls suggesting that Bloomberg would draw more Democratic than Republican voters, it makes little sense that Trump’s surge would prompt the former mayor to run.

That said, Bloomberg’s viability may be strengthened if Clinton is damaged by a drawn-out nomination process.

Bloomberg proved his capacity for defying naysayers 15 years ago, when he captured New York’s City Hall. But New York is not the United States, and it’s far from certain that swing-state voters would embrace a former Republican known for opposing guns, smoking and Big Gulp sodas.

Nor is it clear that a measured, sober-toned business executive could command an electorate that so far has rewarded unceasing bombast over pragmatism.

“You don’t solve problems by pointing fingers or making pie-inthe-sky promises,” Bloomberg told the gathering recently. “You solve them by bringing people together around common goals, promoting

innovation, demonstrating independence and recognizing that compromise is not a bad word.”

Bloomberg’s potential as a candidate is rooted in what the Gallup organization has identified as an ever-broadening swath of American voters who define themselves as independent and express dissatisfaction with both major political parties.

For those voters, familiar names such as Clinton and Jeb Bush may seem like more of the same; meanwhile,Sanders, Trump and Sen. Ted Cruz (R-Tex.) may be too extreme, creating opportunity for Bloomberg, a former Democrat who turned Republican before declaring himself unaffiliated in 2007.

“There is a broad constituency, and there will be a broader one still, given the polarization of this election,” said Douglas Schoen, Bloomberg’s pollster, who recently wrote a Wall Street Journal opinion piece titled, “Why Mike Bloomberg Can Win.” “He’d be the only one talking about bipartisan consensus and bipartisan decision-making and results-oriented policies,” Schoen said. “In a particularly unstable political situation like the one we’re in now, where there’s so much anger, it’s impossible to write off any credible candidate.”

Bloomberg would face daunting challenges, not the least of which would be prevailing in enough states to reach the 270 electoral college votes needed to win the presidency.

American voters have never elected a third-party candidate to the presidency. In 1992, when he faced President George H.W. Bush and then-Gov. Bill Clinton, Ross Perot managed to draw 19 percent of the popular vote. But he did not win a single state.

On a logistical level, Bloomberg’s campaign would need to quickly assemble an army to gather more than 900,000 signatures needed to qualify for the ballots in all 50 states, with a parade of rolling deadlines beginning this spring.

“Every state has a different process for getting on the ballot, and it’s implicitly designed to make it very difficult,” said Reed

Galen, a Republican strategist who advised Sen. John McCain’s 2008 presidential campaign. “Is it plausible for him to get on the ballot? Yes. Easy? No.” Perhaps more crucially, Bloomberg would need to sell himself to a public that is largely unaware of him. A Quinnipiac poll earlier this month found that 56 percent of American voters had not heard of Bloomberg, the owner of the media company that bears his name.

And a new poll this past week from the Associated Press showed even more dire numbers — that a majority of voters of both parties would not consider voting for him.

Ed Rollins, the Republican strategist who advised Perot in 1992, recalled that the Texas billionaire’s appearances on Larry King’s CNN talk show galvanized a massive effort to get him on ballots across the country.

Unlike the enthusiastic hordes propelling Trump and Sanders, the strategist said, Bloomberg “has noneofthat.Hehasabilliondollars, butthere’snotamovementforhim.”

“My sense is that people telling Bloomberg to run are his New York dinner companions who are not happy with their choices,” Rollins said. “That’s not a constituency or a movement.

“Arguably, he was a good manager of New York,” Rollins said.

“But the vast majority of Americans don’t care about New York.”

Bloomberg’s success in New York may have little bearing on how he would fare in a presidential race, the outcome of which is determined not by the popular vote but by the electoral college.

“What works in New York doesn’t necessarily work in the rest of the country,” said Stuart Rothenberg, the editor of a nonpartisan newsletter covering state and federal campaigns. “He’s the guy who’s known for being against guns and soft drinks. Is that going to play in Fairbanks, Alaska, or the suburbs of Indianapolis?”

Competing in a three-way race, Bloomberg’s progressive stances may not be problematic if he needs towinonlyapluralityagainstopponents such as Trump and Sanders.

But his success would depend on

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POLITICS independents remaining estranged from the two major parties by November — and on their willingness to expend their vote on a candidate whose viability is uncertain.

Despite claims of political independence, voters’ “partisanship runs pretty deep,” Rothenberg said. “There are people who say they’re independent who aren’t really independent. They don’t want to throw their vote away.”

Then there’s the question of which party a Bloomberg candidacy would damage more. A recent USA Today-Suffolk University poll showed Sanders in a close twoway contest against Trump but losing to the reality-television star if Bloomberg were on the ballot (Bloomberg placed third).

Ultimately, Bloomberg’s challenge would be to identify those states in which he could win a plurality and put together the necessary electoral votes, an analysis Rothenberg undertook this month in a column in Roll Call.

What Rothenberg concluded is that Bloomberg would have little chance in what Gallup and he have identified as the country’s 20 most conservative states, including Mississippi, Alabama, Louisiana, Oklahoma and South Carolina.

Bloomberg would also face imposing challenges in the country’s most left-leaning states, such as Oregon, Vermont, Massachusetts, Michigan and Maryland.

There’s little question, though, that Bloomberg’s candidacy would upend the current list of key swing states in the general election — states including Ohio, Iowa, New Hampshire, Florida, Colorado and Virginia.

Where Bloomberg could find success, Rothenberg said, is in states such as California, New York, Connecticut and New Jersey — all states that typically vote Democratic. Ohio is the only swing state on that list.

And with so many states probably out of reach, Bloomberg “would have to run the table” in those and other states. “That won’t be easy. My bottom line is I don’t see it.”

Trump’s and Sanders’s success may have made the art of political predictions risky, Rothenberg said, but the math isn’t adding up, “even for Michael Bloomberg with all his money.”

“When you look at the puzzle,” he said, “it’s, at the least, very, very difficult.”n

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CAMPAIGN ....2016 THE FIX

Debate winners, losers BY

C HRIS C ILLIZZA

T

he 10th Republican presidential debate is in the books. My best and worst from the night:

WINNERS

Marco Rubio: This was not only Rubio’s best debate performance, it was the best debate performance by any candidate in any debate so far in the 2016 election. Rubio, grasping the fact that if nothing changes in this race he — and everyone else — will lose to Donald Trump, hit Trump at every turn. He savaged Trump on using illegal immigrants to help build Trump Tower. He went after Trump for inheriting money. He hit Trump for his position on Israel and Palestine. And, most importantly, he rattled Trump during a backand-forth over Obamacare.

What Rubio’s stellar performance means is that the race between Thursday night and Tuesday — and March 15 and beyond — will be cast as a two-man showdown between Trump and Rubio. That’s the only chance Rubio has of winning. What I don’t know is whether the punches Rubio landed will do any lasting damage to Trump. Nothing else has — yet.

Mitt Romney: The 2012 Republican presidential nominee has been a low-profile figure in this race. No longer! First came this tweet: “Methinks the Donald doth protest too much. Show voters your back taxes, @realDonaldTrump. #WhatIsHeHiding.”

Sure, Romney came under a full-frontal assault from Trump during the debate. But questions over when Trump and the other candidates will release their taxes took up a considerable amount of debate time. That demonstrates that Romney is still able to drive conversation within the GOP. Crosstalk: There were times — lots of times — when two, three or even four candidates were trying to speak at the same time. This was crosstalk’s finest

hour in its unending march to make America great again.

Fruit salad: It’s delicious. And nutritious.

LOSERS

Ted Cruz: Cruz watched — and I do mean watched — as Rubio turned the race into a twoman contest between him and Trump. Cruz was strangely absent from the main back-and-

posed the thinness of Trump’s policy solutions especially on health care.

I am under no illusion — and no Republican operative or candidate should be either — that Rubio’s punches on Trump are guaranteed to slow the real estate billionaire’s momentum in advance of Tuesday’s primaries.

But, Trump didn’t escape this debate unscathed and, if he can be

DAVID J. PHILLIP/ASSOCIATED PRESS

Sen. Marco Rubio (R-Fla.) and Donald Trump traded fire over Trump’s business record in the debate at the University of Houston.

forths of the night. To the extent Cruz was able to get into a debate with Trump, he spent his time hitting the real estate mogul for making past donations to Democrats. Cast me as skeptical that that line of attack will work. Cruz also tried to make the electability case against Trump but found himself hoisted on his petard by The Donald, who noted that the senator’s polls aren’t in a great place. Cruz looked like the third wheel in this debate — a bad place to be with March 1 just days away.

Donald Trump: This wasn’t Trump’s worst debate. In fact, it might not even be in the bottom half of his performances. He generally counter-punched admirably — particularly against Cruz.

But Rubio got the better of Trump on several occasions; the senator from Florida found ways to embarrass and mock Trump, which is something no one in any previous debate has been able to do. Rubio also effectively ex-

cut, he was.

Ben Carson/John Kasich: You could be forgiven for having forgotten that either the retired neurosurgeon or the Ohio governor were part of this debate. Carson and Kasich got almost no questions, and the ones they did get they seemed unprepared to handle. Carson somehow made a fruit salad reference (see above) when asked about Supreme Court nominees. Kasich used every question to talk about how we all need to get along. Both men felt entirely ancillary to the proceedings — as though they were engaged in a different event than the one Trump, Rubio and Cruz were participating in.

Which, of course, they sort of were.

The Shrieker: Who was this person? And why did she shriek before the candidates even finished what they were saying?

Was she pro-Rubio? Pro-Trump?

I have no idea. One thing I do know: She was anti-my-ears. n

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NATION

The agonizing wait for answers

BY M ARK M ICHAEL

G UARINO AND S . R OSENWALD Kalamazoo, Mich.

I

nvestigators say they are baffled. Neighbors are totally bewildered. All around this traumatized city, residents wonder whether they will ever learn why Jason Brian Dalton allegedly gunned down random strangers while picking up fares for Uber.

This past week, as police continued looking for clues into the Feb. 20 shootings, so did people close to him. One neighbor was puzzled to learn Dalton, 45, was driving for Uber and not working for Progressive Insurance anymore.

“He left every morning at 8 a.m. like he was going to work,” the neighbor said.

Where he was going, what he was enduring, what he was thinking — mass-shooting experts say these fragments will eventually coalesce into a motive that probably made sense to the killer, even though it’s incomprehensible to everyone else.

“In these cases, people typically don’t just snap and go berserk,” said James Alan Fox, a Northeastern University criminologist and author of several books on mass murders. “It may seem senseless, but there’s always a reason.”

For investigators, sorting that out takes time. For everyone else, the waiting is agonizing, a cruel ritual in the age of mass shootings. So far, all investigators have been able to offer is Dalton’s statement that he “took people’s lives.”

“This first thing I thought of was, why?” said Kalamazoo resident Lisa Stavish, 33. “Everyone I know is talking about it, but no one really knows anything.”

In some mass shootings, the reason is almost immediately apparent.

A married couple in San Bernardino, Calif., stockpiled bombs and ammunition for a shooting motivated by radical Islamist beliefs. In Colorado, a religious drifter with bitter beliefs about abortion is charged with killing three people at a Planned Parenthood clinic. Dylann Roof, who

CHELSEA PURGAHN/KALAMAZOO GAZETTE-MLIVE MEDIA GROUP VIA ASSOCIATED PRESS

The mass shooting in Kalamazoo, Mich., ended with the suspect in custody, but no clear motive had expressed his hatred of African Americans, stands accused of killing nine of them in a Charleston, S.C., church.

But most mass shootings aren’t that simple to unravel. Experts say they typically combine precipitating events that might seem like everyday problems — work, money, love — with undiagnosed or untreated mental health issues. Sometimes the idea for a mass shooting unfolds over months. Other times, it’s days.

“It’s not something he did spontaneously,” Fox said.

In many ways, Dalton fits the typical profile of a mass shooter — a white male with no criminal record, no psychological impairment known to those around him and the ability to legally purchase firearms.

What makes him different, Fox said, is that he “killed people in the wrong place at the wrong time.”

Meaning he targeted total strangers without a specific setting.

Most mass killers, even if they

target strangers, single out specific places for attacks. Students pick schools. Disgruntled workers pick their workplaces. Those making political statements choose symbolically important places.

Dalton’s setting was the entire city of Kalamazoo, making his motive more difficult to piece together.

J. Reid Meloy, a psychiatry professor at the University of California at San Diego who studies mass murderers, said investigators typically find “a mental state that is coming apart” and recent stressors causing difficultly in life.

“We think there’s an event that starts the clock,” he said. “But the predisposition to commit a mass murder has often been there for quite some time.”

What may have been Dalton’s event?

Working for Uber, as Dalton had been since late last month, is a clue that might indicate he needed extra money or that he couldn’t find a regular job. If he

A vigil Tuesday in Mattawan, Mich., honored victims of the mass shooting in Kalamazoo, Mich., on Feb. 20.

“People typically don’t just snap and go berserk.

It may seem senseless, but there’s always a reason.”

James Alan Fox, Northeastern University criminologist

had a grudge against Uber, killing strangers while picking up fares could make total sense to him.

But there’s also a danger in being too reductive.

Meloy said mass killers are often in a depressed and paranoid state, though there’s usually a kernel of truth that they feed on.

While stressing that he was not talking specifically about Dalton, Meloy said that in cases appearing to take place randomly, “the individual has placed victims into a pseudo community.”

One of the riders Dalton picked up said he began driving erratically after getting a phone call.

But it is not known whom the call was from and whether it somehow set him off.

Even if a motive is not readily apparent yet, Fox said, “clearly something was going on making him miserable and unhappy. And if he’s miserable and unhappy, then other people need to suffer, too.”

To Fox and other experts, it seems clear Dalton was quietly planning something. A local gunstore owner said Dalton came in Saturday, the day of the killings, to buy a vest for concealing handguns. And then there’s his alleged steely demeanor during the attacks, still picking up customers and reportedly switching vehicles.

“That reflects the calmness that is typical in mass killers,” Fox said, noting that many mass killers are seen smiling while shooting. “Because they plan their crime, if only in their head, it’s something comfortable to them. So they are calm and cool and the rest of us are totally caught by surprise.”

One characteristic Dalton does not share with other mass killers: He’s still alive.

Most mass shooters kill themselves or are killed by police. That leaves open the possibility that Dalton will eventually explain his actions to authorities or a courtappointed psychiatrist.

So far, he’s mum on that topic.

“From what detectives told me, he is unaffected, kind of monotone,” Kalamazoo Police Chief Jeff Hadley said. “Showed no emotion relative to the offense. It’s really just baffling.” n

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Changing how we think about race Mixed marriages are producing children who more frequently don’t identify as minorities

BY

J EFF G UO

F

or all the talk about immigrants refusing to embrace American ways — a defining controversy of this GOP presidential race — the evidence has been scant.

The National Academies of Sciences deflated most of the myths in a definitive report last year.

Today’s immigrants are more educated and better English speakers than their predecessors, and they are far less likely to commit a crime compared to the nativeborn. They are quickly becoming part of American communities.

In fact, new immigrants may be assimilating a lot faster than we thought. A new study this week from economists Brian Duncan, of the University of Colorado, and Stephen Trejo of the University of Texas at Austin finds that the descendents of immigrants from LatinAmerican and Asian countries quickly cease to identify as Hispanic or Asian on government surveys.

According to the authors, these are mostly children of interracial couples that aren’t writing down their diverse heritages.

Mixed marriages are increasingly common in America — Pew finds that about 26 percent of Hispanics marry a non-Hispanic these days, and 28 percent of Asians marry a non-Asian. To accommodate this trend, government surveys now allow you to check multiple boxes for your race and ethnicity.

But it turns out that many aren’t doing that.

The report from Duncan and Trejo has two major consequences. First, it casts some doubt on the government's projections of the future Hispanic and Asian populations. Famously, the Census Bureau has predicted that non-Hispanic whites will become outnumbered in America by as early as 2044. But as Pew has pointed out, these calculations don’t take into account trends in how the children of mixed marriages report their own race. A fair fraction of people with Asian or Hispanic heritage actually consider themselves exclusively white (or black).

By the second generation, only 93 percent of Latin American immigrants consider themselves Hispanic

DATA FOR PEOPLE FROM MEXICO, CUBA, EL SALVADOR, THE DOMINICAN REPUBLIC OR PUERTO RICO.

By the second generation, only 79 percent of Asian immigrants say they are even part Asian

SOURCE: DUNCAN AND TREJO (2016) WAPO.ST/WONKBLOG

Second, the report may cause us to reconsider what we think we know about Hispanics and Asians.

A lot of social science research relies on people to disclose their own racial and ethnic identities. If people who are part-Asian or partHispanic stop identifying that way, they, in a way, disappear from the statistics. What we think we know about Hispanics, for instance, may be wrong because a lot of people with Hispanic heritage don't consider themselves Hispanic.

Duncan and Trejo focused on the Current Population Survey, a monthly study of American households that supplies much of what we know about earnings and employment in America. For instance, the CPS is what helps the government calculate the unemployment rate, and it provides data for reports on, say, the racial wage gap.

The CPS contains a number of questions about heritage. People are asked for their race, their ethnicity, where they were born, and where their parents were born. Using this information, Duncan and Trejo analyzed how first- and second-generation immigrants from

certain countries self-identified.

They looked at four LatinAmerican nations (Mexico, Cuba, El Salvador, the Dominican Republic) plus Puerto Rico; they also looked at five Asian nations (China, India, Japan, Korea, and the Philippines).

Among the first-generation Latin-American immigrants — people born in one of those five places — 98.6 percent checked the “Hispanic” box. Likewise, 96.3 percent of the first-generation Asian immigrants identified as Asian.

It’s important to remember that the CPS allows people to check multiple boxes for race. You can be any combination of black, Asian, white, Native American and so forth. On top of that, the government also asks a separate question about whether you are Hispanic.

This means you can be white and Hispanic, black and Hispanic, even white-black-Asian triracial and Hispanic.

The point is that it’s easy for people to indicate complex heritages on the survey form. Yet, many who are multi-racial are not doing this.

They might have Hispanic grandparents but don’t consider themselves Hispanic.

They might have an Asian and a black parent but only consider themselves black.

Duncan and Trejo also have some data on the children of second-generation immigrants, where the trend continues. The CPS asks parents to provide racial information about their kids. Of the kids with at least one LatinAmerican grandparent, only 81.7 percent were marked down as Hispanic. Of the kids with at least one Asian grandparent, only 57.5 percent were marked down as Asian.

These statistics highlight an overlooked way that immigrants assimilate in America — by literally blending in and blending families with the native-born. “In a lot of ways, intermarriage is the most intimate kind of assimilation,” Trejo says.

But this phenomenon may also present problems for researchers looking to measure progress among minorities.

Duncan and Trejo have found that the second-generation LatinAmerican immigrants who refuse to call themselves Hispanic are more educated, on average, than their counterparts who embrace their Hispanic identity. It’s still unclear how big of a deal this is, but it seems that we have been underestimating the progress of Hispanic immigrants and their offspring because some of the more successful ones don’t mark themselves as “Hispanic” on government surveys.

A lot of this should have been obvious. Immigrants are everywhere in American public life.

Countless celebrities, including Frankie Muniz, Aubrey Plaza and Fergie, are second- or third-generation Hispanic. Latina Magazine has a whopping list of 109 stars “you never knew were Latino!”

These are some of the faces that we may want to recognize in any debate about immigration and assimilation in America. The irony is that some have blended in so well, we hardly recognize them as the children of immigrants anymore. n

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WORLD

Are they martyrs? Desperate? Crazy?

W ILLIAM B OOTH Ramallah, West Bank BY

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he Israelis are clear. They call it “terrorism.” Yet after five months of near-daily violence against Israelis, Palestinian society struggles with how to describe the wave of knife, gun and vehicular attacks targeting Israeli soldiers and civilians.

Is it an “uprising” or “upheaval” or “awakening” — or personal “despair”? Are the assailants “martyrs” or “victims” or both? Are the teens wielding kitchen knives “heroes” or “children” — and after they are shot and killed by Israeli soldiers during the attacks, should they be celebrated as “warriors” for the Palestinian cause or pitied as unstable individuals who “snapped”?

If Palestinians on the street are uncertain about what to call the ongoing violence, the Palestinian leadership appears paralyzed over word choices.

The aging, unpopular leaders of the Palestine Liberation Organization are careful to neither openly support nor oppose the attacks, adding to the aimless narrative of the current violence. Are the attacks helping the Palestinians get a state — or lose one?

The Palestinian political class is wary of offending the international community, which has universally condemned the attacks. At the same time, Palestinian officials are afraid of getting in front of their own people, who tell pollsters they support “armed struggle” and are tired of the old leadership, which has failed to win them a nation.

The words Palestinians use to describe the attacks are important. Language reveals meaning and intent, especially in conflict.

Israelis dismiss the Palestinian vagueness as weakness or guile.

Israeli officials say, “Look, the Palestinians cannot control their own children” — and say they are silent because they either fear their people or hope to gain some tactical advantage from the violence.

Israeli Prime Minister Benjamin Netanyahu recently offered his own explanation: The Palestinians are stabbing Israelis because they celebrate a “culture of death.”

ILIA YEFIMOVICH/GETTY IMAGES

Palestinians wrestle with how to label the attackers in the wave of violence against Israelis The Palestinians blame the almost 50-year military occupation of their home, which they condemn as 21st-century apartheid.

Interviews by The Washington Post with Palestinians and their leaders reveal deep divides over language, in Arabic and English.

Since the beginning of October, Palestinians have killed 28 Israelis and four others, including an American. More than 160 Palestinians have been killed — 111 during attacks and 50 in clashes with Israeli forces.

Palestinians often decline to describe the stabbings and shootings as “attacks.” Instead, they call them “acts” or “incidents” or “operations,” though the word “operation” implies militant organization and direction from above, which they deny.

Mohammad Shtayyeh, a government minister and director of the Palestinian Economic Council for Development and Reconstruction, said: “We’re not sending people out with knives. We’re not

throwing our children into the fields to die.”

“We are encouraging resistance in a peaceful way,” he said.

When asked what he would call the spate of violence, Shtayyeh blamed “certain personal initiatives.”

And what of the Israeli targets — who are they?

Palestinians and their media use the default terms “settlers” and “occupiers” to describe Jewish victims in the occupied West Bank, home to 400,000 Jewish settlers.

They struggle, though, to explain how a Jewish mother of six stabbed to death in her kitchen is the same value target as an Israeli soldier with a gun at a checkpoint.

Al-Quds University sits on the outskirts of Ramallah, where the first assailant in this wave of attacks attended school. Muhannad Halabi, 19, slashed at an ultraOrthodox couple with a baby stroller in Jerusalem’s Old City, killing the father and a rabbi who came to his aid. He was fatally shot

Relatives mourn Hadar Cohen on Feb. 4 in Ehud, Israel. Cohen was killed by three Palestinians at the Damascus Gate in Jerusalem.

by police.

Young people milled in the courtyards between classes on a recent day. Abdul Ayad, 20, a law student, said: “These acts should be politically directed, but they’re not. They are individual attacks. I don’t see any politics. I see rage.

The death of the young is a waste.

He tries to knife an Israeli and he is shot. I understand it, but what is the point?”

In conversations, many Palestinians stress that the assailants are “children,” though most are older teens and young adults — the same age as Israeli soldiers.

Are their acts “heroic” or “courageous,” to be celebrated with waving flags and mass funerals, as Jibril Rajoub, former chief of Palestinian security forces and president of the Palestinian Football Association, said on Palestinian TV? Asked how he would describe the violence, Rajoub said in an interview with The Post: “Do you wantmetocallitterrorismortocall them martyrs? They were victims.”

“I promise you, behind every one of these there was a personal act by a settler or a soldier, either to him or to his mother or father.

There is a reason,” Rajoub said.

Some Palestinian officials have told Western diplomats and journalists that they believe at least some of the attackers have “snapped” from the pressure of living stunted lives under occupation.

Where this is going, nobody knows. But the signs are troubling.

The most recent public opinion poll by the respected Palestinian Center for Policy and Survey Research, conducted in December, found that two-thirds of the public are demanding that Abbas resign, two-thirds support the current wave of stabbings, and half believe the current confrontations will escalate into an armed intifada.

The survey found that members of the “Oslo generation,” people between the ages of 18 and 22 who were born at the dawn of the nowfailed “peace process” and who do not recall the past intifadas, are the most supportive of the ongoing violence — and are no longer believers in a two-state solution. n

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The Zika epidemic’s scary new turn N ICK M IROFF Turbo, Colombia BY

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he Zika epidemic flaring across the Americas has produced several hot spots with large numbers of cases. But there is no place quite like Turbo.

The mosquito-borne virus has spread rapidly here and across lowland Colombia, but the city is unusual for the subsequent outbreak of a rare, debilitating disorder known as Guillain-Barre syndrome, whose precise link to the virus remains unclear. Before Zika’s arrival in Turbo, a mostly Afro-Colombian town of 60,000 set amid vast banana plantations on the country’s north coast, doctors typically saw one case of Guillain-Barre a year, if that.

In the past seven weeks, there have been at least five, all of them severe. Three patients have died.

One is fighting for his life in an intensive care unit. The fifth, a 10-year-old girl, hasn’t been able to move her legs in a week.

The deaths, and the aggressiveness of the Guillain-Barre cases here, are among the first signs of a strange and worrisome pattern that is challenging the way doctors in Colombia and across Latin America are preparing for the spread of Zika.

Much of the global attention to the virus has zeroed in on a suspected link to microcephaly, a congenital defect that leaves babies with undersized heads and varying degrees of nerve damage. Brazilian officials say they may have hundreds or thousands of such cases related to Zika. But the photos of worried mothers and distressed infants may have given many people the impression that the virus poses no major risk to anyone else.

That is not true, and certainly not here in Turbo, where rank sewage-filled canals line the streets and more and more people are arriving at the crowded emergency room with bloodshot eyes and itchy, red pockmarks, the telltale signs of Zika. Something about the virus — and researchers still don’t know what it is — ap-

DANIA MAXWELL FOR THE WASHINGTON POST

In a Colombian city, the virus appears to be behind an uptick in a rare, debilitating disorder pears to significantly increase the incidence of Guillain-Barre.

The first resident here to get it was 41-year-old Eliana Uribe. She called in sick to her cousin’s dress shop one morning in mid-January, not long after missing several days of work with a strange rash and sore joints. Something was wrong with her feet, she said.

A few hours later, when Uribe tried to walk, she collapsed. Her legs felt “like rags.” The illness was creeping toward her torso.

Uribe’s family carried her to the emergency room. German Gomez, the internist at the small public hospital, thought it might be Guillain-Barre. But he wasn’t sure.

“I’d been here 15 months and hadn’t seen a single case,” he said.

Two days later, Uribe lost control of her tongue and facial muscles. She fell short of breath. Doctors rushed her to a bigger hospital.

Uribe died Feb. 2, her brain swamped in fluid — “severe hydrocephaly,” doctors told her family.

The day after Uribe’s death, another Turbo resident, Edelberto Padilla, 51, also died with GuillainBarre, at a different hospital. He had the symptoms of Zika, too.

The Colombian government has confirmed three fatalities with Guillain-Barre, including two of the Turbo patients, blaming the deaths on Zika.

The U.S. Centers for Disease Control and Prevention (CDC) has confirmed two cases of GuillainBarre related to Zika in the United States, presumably among the more than 80 travelers infected by the virus who have returned to the country. Another Guillain-Barre case was reported in Puerto Rico.

The normal prevalence rate for Guillain-Barre is one or two cases per 100,000 people, said Kenneth Gorson, a professor of neurology at Tufts University in Boston, who is one of the leading U.S. authorities on the disorder, named for the two French neurologists who discovered it exactly 100 years ago.

At its most basic level, Guillain-

Wilfrido Molinares, whose daughter is being treated for Guillain-Barre, skirts the edge of a sewage canal in Turbo, Colombia. The mosquitoes that spread the Zika virus breed in stagnant water.

Barre is what happens when a patient’s immune system fights off an infection and then goes haywire, as antibodies turn against the body’s own nervous system, Gorson said. They attack nerve cells, apparently mistaking them for a virus. In some instances,the antibodies strip away the membrane that protects nerve endings, leaving the body’s muscles unable to communicate with the brain.

Adults and children appear to be equally at risk of developing Guillain-Barre, but patients who already have health problems or compromised immune systems are less able to recover from it.

One study in the Netherlands found a death rate of 1 in 20, “but that is with high-level care,” Gorson said. About one-quarter of patients need breathing assistance.

In the rural areas of Latin America where Zika is spreading, highlevel care is often unavailable.

Wait times at public hospitals, especially those swamped by Zika patients, can discourage patients from seeking care. Those with aggressive Guillain-Barre need complicated blood transfusions or a treatment known as immunoglobulin therapy to wash out the harmful antibodies. But the treatments can cost more than $10,000, and patients may need several rounds.

“We are seeing a spike everywhere that we are seeing the Zika virus,” said Tarun Dua, a neurologist at the World Health Organization. What’s unclear is whether Zika is causing Guillain-Barre or whether it is”cross-reacting” with antibodies from other widespread mosquito-borne viruses such as dengue or chikungunya.

Another major problem: There is no widely available, quick test for Zika, and the virus remains in an infected patient’s blood only for about a week. So it’s difficult to test for Zika in patients hospitalized with Guillain-Barre symptoms.

“The hypothesis is that Zika may be a more efficient trigger of Guillain-Barre, but we can’t say that at the moment,” said Anthony Costello, director of maternal, child and adolescent development at WHO. “The detective work is starting, but it takes time.” n

deep peek into the brain

BY AMY ELLIS NUTT

S

he relaxed in the recliner, her eyes closed, her hands resting lightly in her lap. The psychiatrist’s assistant made small talk while pushing the woman’s hair this way and that, dabbing her head with spots of paste before attaching the 19 electrodes to her scalp.

As the test started, her anxiety ticked up. And that’s when it began: the sensation of being locked in a vise. First, she couldn’t move. Then she was shrinking, collapsing in on herself like some human black hole.

It was a classic panic attack — captured in vivid color on the computer screen that psychiatrist Hasan Asif was watching.

“It’s going to be okay,” he said, his voice quiet and soothing. “Just stay with it.”

The images playing out in front of him were entirely unexpected; this clearly wasn’t a resting state for his patient. With each surge of anxiety, a splotch of red bloomed on the computer screen. Excessive activity of high-energy brain waves near the top of her head indicated hyper-arousal and stress. Decreased activity in the front of her brain, where emotions are managed, showed she couldn’t summon the resources to keep calm.

“This was your brain as you were sitting there trying to relax,” Asif explained afterward, rerunning the sequence for the woman, who for many of her 37 years had struggled against crushing waves of dread. “Look at what just happened. This was the area of your brain that started firing. . . . It’s right there on the screen.”

For the 51-year-old psychiatrist, the episode last year in his Bronxville, N.Y., practice was yet another piece of evidence that he was on the right track, burrowing past his patient’s symptoms to probe the structures in her brain that

PHOTOS BY YANA PASKOVA FOR THE WASHINGTON POST

New technology is allowing researchers to seek a biological understanding of mental illness, but it has created some controversy

The brain looks different in those who struggle with mental illness.

However, this does not necessarily mean all mental disorders originate in the brain.

produced them. Individually, all the tools he employshavebeenusedbefore,butrarely,ifever, together. It’s an approach that parallels some of the most cutting-edge research in the field.

Scientists have long known that the most forward part of the brain is the seat of higher cognition. But only in recent years have they been able to link certain mental disorders with specific brain circuits, the connections between neurons that are responsible for every one of our thoughts, emotions and actions.

Asif’s tools enable him to more precisely diagnose his patients’ problems and, ultimately, to treat them.

Neuroscience’s inroads have emboldened a small but growing number of clinicians and researchers to reject diagnostic protocols on which mental health practitioners have relied for years — the cataloguing of symptoms such as sadness, fatigue, loss of appetite — and

Marris Szeliga, a patient and employee of psychiatrist Hasan Asif, is fitted with an EEG cap that will allow him to analyze her brain-wave activity.

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volunteer work that clients perform for charities. “What has led to a real confusion or distress in their lives, and how these things come up, that’s when you get a real idea of how and why something upset them. . . . You look at things through their eyes and say, yes, this person has gone through the wringer.”

instead focus on finding biological clues associated with these symptoms in a blood test, a brain image or a saliva sample.

These are the biomarkers, the concrete measurements of mental illness, that many think will move the mental health profession into the 21st century. For Asif, some of the tools being used in the search are already yielding practical results, such as sending a patient’s cheek swab for DNA analysis to help determine which psychotropic medication will be most effective and best tolerated.

This new, if controversial, approach to mental illness got a boost in 2013 when the director of the National Institute of Mental Health announced that the government, the largest funder of mental health research in the world, would drastically shift its priorities. Research based solely on the Diagnostic and Statistical Manual of Mental Disorders, the chief tool of mental health professionals, would no longer be funded. The reason, Thomas Insel said, was “its lack of validity.”

First published in 1952, the manual has changed over the years. Yet its categorization of mental illnesses is based nearly entirely on symptoms either reported by the patient or observed by the clinician. New funding, Insel said, would be based on the premise that “men-

Asif and visiting neuroscientist Aza Mantashashvili analyze the brain-wave activity of Szeliga as she undergoes an EEG.

tal disorders are biological disorders involving brain circuits.” Research into diagnosis and treatments such as talk therapy would be relegated to the bottom rung of the research ladder.

Insel later softened his criticism of the DSM. But the battle had been joined, and with millions of lives and billions of dollars at stake, the fight over the future of psychiatry was on.

“There are two camps: the very biologically oriented and the patient-oriented,” said Moira Rynn, director of child and adolescent psychiatry at the New York State Psychiatric Institute.

Rynn, who is both a clinician and a researcher, describes herself as “in the middle” of this tug-of-war. She’s worried, she says, that “we’re going to lose a generation of researchers” who think that identifying the influences of a patient’s environment, relationships and access to care is just as important as finding the biological markers of their illness.

Other skeptics of Insel’s approach say it is impossible to understand mental illness solely by trying to understand the brain.

“The main thing is looking at what people say about their lives,” said Richard Shulman, a Hartford, Conn., clinical psychologist and one of the founders of Volunteers in Psychotherapy, a nonprofit that provides affordable psychotherapy to the community in exchange for

FROM THE TIME OF THE ANCIENT GREEKS, medical practitioners have searched for biomarkers for physical illnesses. Hippocrates tasted patients’ urine for sweetness (he is thought to have been the first to diagnose diabetes mellitus), smelled their breath for signs of kidney and liver disease, and assessed the stickiness of their sweat. More recently, doctors relied on patients’ complaints about the severity of their chest pains in order to diagnose a heart attack. Today, they measure cardiac enzymes in the bloodstream.

“Cancer treatment doesn’t treat the symptoms of cancer. You don’t want the swelling to go down or the pain to disappear; you want to get rid of the cancer,” said Kenneth Kaitin, director of the Tufts University Center for the Study of Drug Development. “But that’s what we’re doing in psychiatry,” treating the symptoms of mental disorders — the sadness or the restlessness or the hallucinations — not the causes.

What is known is that the brain looks different in those who struggle with mental illness.

This does not necessarily mean all mental disorders originate in the brain. Post-traumatic stress disorder, for instance, occurs because of emotionally scarring experiences, but those experiences change the brain and the brain’s responses to the environment.

Nearly every day, researchers report findings about genetic or cellular associations with mental illness. But despite years of searching, no one has identified a single biological cause for any mental illness, proved that a chemical imbalance in the brain is at the root of any mental disorder, or positively shown that any medication corrects such a chemical imbalance.

“There’s been an intense search for biomarkers for the last 40 years, and so far we’ve come up empty,” said psychiatrist Allen Frances, a professor emeritus at the Duke University School of Medicine. “It’s been oversold. The decade of the brain came up empty. It should teach us to be humbler.”

The leading drugs for depression — the selective serotonin reuptake inhibitors, or SSRIs — are designed to ease symptoms by boosting serotonin, one of the brain’s pleasure chemicals. But it’s not known whether that corrects an imbalance, because there’s no way to directly measure a person’s neurochemical levels. Experts also can’t explain why antidepressants work only 40 percent of the time or why, when they do, it takes weeks for most patients to feel the effects since the levels are boosted almost immediately.

The chief complaint about today’s psychiatric medications is the same one cited by those frustrated by the lack of progress on Alzheimer’s: They don’t treat the disease, just the continues on next page

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from previous page

symptoms, and they don’t even do that very well.

Rather than targeting brain chemistry to reduce symptoms, people such as Insel want to focus on brain circuitry. Their efforts have been bolstered by advances in technology and imaging that now allow scientists not only to see deeper into the brain, but also to study single brain cells to determine which circuits and neurons underlie specific mental and emotional states. Many of these advances come from fields asdisparateasphysicsandelectricalengineering — as well as the new field of optogenetics, which uses light to manipulate neurons.

In the past, brain imaging allowed scientists to identify which groups of neurons were active when, say, a lab mouse was aggressive, but not whether the neurons were causing the aggressive behavior. Then a few years ago, researchers at the California Institute of Technology injected into the hypothalamus of a mouse a modified gene that made certain cells sensitive to light.

They then inserted a hair-thin fiber-optic thread into the mouse’s skull and delivered bursts of light into those cells to activate them.

The mouse became aggressive. When the researchers turned the light off, the activity in those specific hypothalamic cells ceased, and the mouse returned to a calm, normal state.

Because the technique is too invasive for people, researchers are now looking at nanotechnology and even magnets as a way to switch cells on and off in humans. Connecting specific symptoms with specific groups of neurons, and then manipulating those cells, would represent a watershed moment.

HASAN ASIF, WHO WAS BORN AND RAISED IN PAKISTAN, is a board-certified psychiatrist who first trained as a psychoanalyst.

When he came to the United States in 1990 for post-graduate training at New York Medical College in Valhalla, he was swept up in the biological psychiatry movement. He opened a private practice in New York and eventually spent tens of thousands of dollars outfitting his office with new neurological tools. On his walls are colorful microscopic close-ups of neurons, and on his bookcase and tables are replicas of Greek and Egyptian antiquities once collected by Freud.

Asif evolved into a “neurotherapist,” someone who first tries to understand a patient’s brain circuitry, then combines that with both psychological and physiological information to create a treatment plan. While a traditional psychotherapist might begin sessions by asking patients about their thoughts, feelings and problems, Asif has them fill out a color-coded form that matches statements about their thoughts and feelings with the parts of the brain most likely involved. Then his patients undergo a quantitative electroencephalograph, or qEEG. The EEG, which has been around for more than 90 years, is a map of the brain’s electrical activity and reflects a patient’s emotional and cognitive states. The qEEG compares that information, in real time, to a digital database of hundreds of EEGs of healthy subjects. A pa-

Neurofeedback therapy The goal of this treatment is for the patient to consciously alter brain-wave activity in reaction to visual and auditory stimuli.

Chronic depression

Normal

ALPHA WAVES

Low activity

High activity

An electroencephalogram is produced by 19 electrodes attached to the scalp. The two-dimensional image of a patient’s brain indicates areas of higher-than-average brain-wave activity (red) and lower-than-average activity (blue). Above, are images of brain-wave activity in two people, one with chronic depression and one without. The excessive alpha waves in the left frontal lobe of the depressed person suppress positive emotions.

SOURCES: ZOE SIMMONS, STAFF REPORTS THE WASHINGTON POST

tient’s brain map will pulse with red or blue if it is either overactive or underactive, compared with the norm.

Patient treatment plans might include psychotherapy and medication as well as neurofeedback, a technique in which patients are trained to increase or decrease brain-wave activity in the parts of the brain related to their complaints. Another tool is transcranial magnetic stimulation, a noninvasive method of delivering pulses of energy to the head, which has been approved by the Food and Drug Administration for the treatment of depression. But almost always, Asif begins with a qEEG. It acts as a kind of map, helping him to identify a patient’s troublesome brain circuits, which he then targets with his various therapeutic techniques.

Tina Raymond, 61, says her treatment produced almost immediate results. In 2006, Raymond was robbed and beaten inside her storefront office in Mount Vernon, N.Y., where she designed seasonal displays for department stores. She saw several doctors, including Asif, for memory loss and PTSD from the attack, and she eventually recovered. Then, in May 2014, just as Asif was ramping up his neurotherapy practice, Raymond returned, complaining of feelings of worthlessness.

“Iwashittingalull,anemotionallull,”shesaid.

“I was depressed. Getting out of bed was harder than usual. I’m a pretty upbeat person in general,

“He said, ‘Just give me nine days, and I’ll pull you out of this.’

From that moment, I thought, thank God, someone’s going to help me.”

A patient of psychiatrist Hasan Asif

so for depression to hit me . . . was distressing.”

Raymond filled out the color-coded form and scored the statements on a scale of 0 to 10, with 10 being the highest.

“I feel unfocused, tired, and bored”: 7.

“I have difficulty planning and organizing”: 9.

“I worry a lot, and have difficulty stopping repetitive negative thoughts and actions”: 6.

Asif next wired Raymond for a qEEG. The most striking image was a red blotch on the right side of her brain map, indicating too much slowwavedeltaactivityinthetemplearea.It’sapartof the brain that plays a role in mood regulation and motivation, and it wasn’t firing properly or communicating well with the left side of her brain.

Asif now had his target areas. He would use neurofeedback, employing a video-aided reward system, to retrain Raymond’s brain.

Neurofeedback is a descendant of biofeedback, which uses medical instruments, such as a blood pressure cuff, to monitor body functions and relay the information to patients who then try to alter their physical responses. Neurofeedbackhashadapopular,ifcontroversial,commercial application as a kind of relaxation therapy, but recently psychiatry has studied it in combination with real-time brain imaging. In 2013, for example, a team at Yale University found that neurofeedback used with functional MRI, another brain imaging technology, substantially reduced depression and anxiety in patients.

For some neurofeedback sessions, Asif plays a pleasant nature movie during which the patient’s brain-wave activity is automatically compared every half-second to the goal. If the two are in sync, the patient’s brain is “rewarded” by the movie’s continuation. If they are not, the movie stops. Which means that in one 50-minute session, Raymond’s brain experienced 6,000 chances to be “rewarded” for learning how to reduce the delta-wave activity in the right hemisphere and re-establish its normal firing pattern. Her concentration kept the video — she substituted a 1992 comedy by Italian director Lina Wertmüller for the nature film — playing without interruption.

If all this seems mysterious, scientists say it is no more inexplicable than children learning on their own how to play a video game or ride a bicycle. Our brains simply figure things out because that’s what they were built to do. For patients, the sense of control over their own treatment, of helping to heal themselves, is often exhilarating.

After those five sessions, Raymond felt her depression lift. Those overactive delta waves nearly disappeared, and her improving mood matched her brain map, evident by the diagnostic form she filled in before each session. Soon the 9’s and 7’s she had recorded before her first session were manageable 2’s and 3’s. She felt better in the same amount of time it takes for most psychiatric medications to begin working, and she experienced no side effects, except for the goop in her hair after each session.

Asif, she said,“put my pieces back together.”

ANOTHER OF ASIF’S PATIENTS, WHO asked that she not be identified, said she began

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COVER STORY

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Mental biomarkers New psychiatric methods visualize the nervous system and its activities, monitoring the physiological dynamics of mental health.

Gathering data 1 Questionnaire Every visit, patients fill out a form to describe their thoughts and feelings. The statements on the form are coded to match areas of the brain where those thoughts and feelings arise.

NEURODIAGNOSTICS Rate your thoughts and feelings today on a scale from 0 to 10.

Tired and bored 7 3 1 1 Trouble organizing 9 7 6 4

Unable to sit still 0 0 0 0

Nervous, tense, restless 1 3 1 1

Aches and pains 0 0 0 0

Frequent panic 1 2 1 1

Trouble verbalizing 3 2 2 3

Angry/impulsive 2 3 4 4 Pessimistic/sensitive 5 6 3 4 Numb/no emotions 5 5 5 4

Negative attitude 3 5 6 6

Spacey and confused 4 3 1 1

Excessive worrying 6 5 5 5 Difficulty with change 5 6 6 6

Brain activity Breathing rate

Cravings 6 4 4 5

Lack of motivation 9 7 5 4

Memory problems 4 3 2 4

2 Quantitative EEG A cap studded with 19 electrodes measures activity in various lobes of the brain, first in a resting state and then in reaction to a series of prompts by the psychiatrist.

Heart rate

3 Autonomic data Skin conductivity

A respirator belt and sensors attached to three fingers measure several functions unconsciously controlled by the peripheral nervous system: breathing rate, heart rate and skin conductivity (perspiration).

Sources: Zoe Simmons, staff reports PATTERSON CLARK/THE WASHINGTON POST

treatment for major depression in January 2014 when she lost weight, became paranoid about eating and isolated herself.

“He looked at me, and I’ll never forget it, he said, ‘Just give me nine days, and I’ll pull you out of this.’ From that moment, I thought, thank God, someone’s going to help me.”

Five times a week, she underwent transcranial magnetic stimulation, which delivers bursts of energy designed to stimulate the underactive area of the brain thought to be involved in depression. The progress was virtually immediate.

“As the treatments went on, I’d put a ring on or makeup. Then I noticed I started to cook. I hadn’t done my laundry in months and did it,” she said, and after two weeks she was significantly better.

“It was like being reborn,” she said.

Asif says that a person’s mental makeup is a kind of hierarchy, with personality on top, which is created by brain states that arise from circuits firing in a certain pattern below. With psychotherapy, you tweak the brain from the top down, dealing first with a patient’s personality and temperament. But with neurofeedback, combined with qEEG, he said, he tweaks his patients from the bottom up, identifying the brain areas involved and then retraining those circuits to fire differently, resulting in changed moods or mental outlooks.

“When they are shown the cause of their

suffering in their brain circuits and body function,” Asif said, “it gives them immense power in having control over things.”

Because he is a full-time clinician, Asif has done little formal research, although he has been published in Neuroconnections, the journal of the International Society for Neurofeedback & Research.

Insel, who stepped down from NIMH last year, supports the direction clinicians such as Asif are taking. But he cautions that this is still “the beginning of a long road” and that “rigorous studies are required to establish evidence” for biological tests of mental illness.

“The field needs biomarkers and cognitive tools to define more specific diagnostic groups and to predict an individual’s response to treatment,” Insel said. “We call that precision medicine. It sure beats trial and error.” n

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BY

TECHNOLOGY

F REDRICK K UNKLE

L

aser pointers: It’s all fun and games until you put someone’s eye out or crash an airplane.

But laser strikes on aircraft keep happening, and pilots are sounding ever more dire warnings that something must be done to raise awareness of the potential dangers.

One of the latest incidents targeted Pope Francis’s aircraft. As the pontiff’s jetliner made its descent into Mexico City this month, the cockpit crew was hit by a laser strike. None of the crew or passengers aboard the Alitalia flight were injured. The aircraft, an Airbus A330 en route from Havana, Cuba, landed safely. Other nearby aircraft at the time of the Feb. 12 incident saw laser flashes, too, the Italian airline said.

Two days later, a New Yorkbound Virgin Atlantic Airways flight from London’s Heathrow airport turned back after a laser strike. No one was injured, but a spokeswoman said that the flight’s first officer went to a hospital for a precautionary checkup. The flight was grounded overnight, and its passengers were put up in hotels. Passengers proceeded on their way the next day and the airline said it was working with authorities to track the source of the laser strike.

“It’s dangerous and it compromises the safety of the pilots and the passengers they’re carrying,” said Capt. Rick Dominguez, who flies Boeing 767s for a major airline and is executive administrator for the Air Line Pilots Association, International.

Many people think of lasers as a thread of brilliant light, usually in colors of red or green. But by the time a laser’s light reaches an aircraft several thousand feet away, the beam has expanded enough to bathe the cockpit in blinding light.

“If the pilots happen to be looking towards the laser, you can have a startle effect or a dazzle effect,” Dominguez said. “You can have temporary blindness. If they’re extremely unlucky, they can actually look at the laser at the exact right time and sustain retina damage. And that, of course, could be catastrophic.”

Yet Dominguez, whose group represents about 52,000 pilots in Canada and the United States,

It’s all fun and games until you crash an airplane ISTOCKPHOTO

said this has been happening “every week if not every day.”

That’s a lot of potential catastrophes for something that’s been a beloved plaything of office blowhards and house cats since at least the 1990s. But the laser pointer has become a potential menace as advances in technology transformed the dinky little PowerPoint companion into handheld monsters. Yet they’re still marketed as toys for “Star Wars” enthusiasts and others who fancy themselves swashbucklers with a light beam. As usual, the law has been trying to keep up with technology.

Let’s visit the website Wicked Lasers, for example. The Seoulbased firm markets its Krypton green laser as the “world’s most powerful green handheld laser.”

The laser, with 900-plus milliwatts, goes for a cool $999.95, according to the firm’s website.

To its credit, the Wicked Lasers company website carries an advisory urging people not to point them at aircraft, and it warns that doing so is a felony in the United

States. But the disclaimer is tucked away in an obscure spot on the site and in such itty-bitty print that you’d be forgiven for thinking that you must have been zapped in the eyes and missed it.

Meanwhile, at BigLasers.com, you can pick up a GX Green Laser System with at least 500 milliwatts for $379.95 or a GX3 with at least 100 milliwatts for $89.95.

Yet the Food and Drug Administration and the American Academy of Ophthalmology say that anything over 5 milliwatts is potentially dangerous to the eye, and that higher-power lasers should not be available to the general public.

Emails to both companies seeking comment weren’t immediately returned.

Lots of people have raised concerns about what this new generation of powerful handheld lasers can do on the ground, too.

Rahul N. Khurana, an ophthalmologist and spokesman for the American Academy of Ophthalmology, said lasers have been used

Laser pointers are becoming an increasing threat to pilots

at sporting events to target players, and they’ve shown up in children’s hands as playthings, not always to happy effect. The right burst of light from a powerful laser can scorch a hole in the retina, he said.

“I think a lot of people have a romanticized view of what a laser is,” Khurana said. “They can be quite dangerous.”

The more powerful the laser, the more likely it is to be potentially harmful. Most handheld pointers for office demos are less than 5 milliwatts, and a grocery scanner is powered by a laser with 3 milliwatts. Those over 5 milliwatts are considered more hazardous and regulated more closely. The problem is that the standards and labeling used by manufacturers can vary widely, Khurana said.

The FDA, which has regulatory authority over the devices in the United States, says those ranging from 5 milliwatts to 500 milliwatts — considered Class IIIb lasers — can be immediately hazardous to the skin or the eye when targeted directly. A laser over 500 milliwatts — considered Class IV — can be immediately hazardous even when the light is reflected, the FDA says.

Both class IIIb and IV lasers are supposed to be available only to certain people or organizations, such as academic institutions for research purposes, and only if the manufacturer requests and receives approval to do so, an FDA spokeswoman said. The agency also has authority to inspect the manufacturers and oversee them in other ways, and it can work with U.S. Customs and Border Protection to detain or seize illegal laser products entering the United States.

But that’s small consolation to the pilot who has ever been hit with a single laser strike while trying to maneuver a giant airship loaded with people.

The Federal Aviation Administration, which began tracking laser strikes in 2005, reported 3,894 in 2014, up 37 percent from 2,837 in 2010. The agency has also documented at least 35 instances since 2013 when pilots needed medical attention, federal officials said.

Shining a laser into a cockpit has been a federal crime since February 2012. The penalties include up to five years in prison and fines of up to $250,000.

“The problem is, of course, enforcement,” Dominguez said.

“How do you catch them?” n

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$35,000 for a lock of John Lennon’s tresses? It’s just another sale in the world of professional hair collection.

SNIPS OF FAME BY

J ESSICA C ONTRERA

T

he haircut was like any other. John Lennon was preparing for his role as Gripweed in the film “How I Won the War.” The performance was unmemorable. So too was the coif. But last weekend, nearly 50 years after it was chopped from his head, Lennon’s lock of hair sold for $35,000.

The clipping garnered triple the amount Dallas auctioneers expected it to sell for. And not because some crazed Lennon fangirl really wanted the lock for her “Hey Arnold!”-like shrine. The hair was in high demand by professional hair collectors — because that is an actual business. From George Washington to Justin Bieber, tresses of the famous are bought, sold and showboated across the country.

This lock of Lennon’s wasn’t even the first to go commercial. In 2007, a longer strand sold for $48,000. An unknown bidder purchased it along with a book Lennon signed for the Beatles’ personal hairdresser. Saturday’s strand went to Paul Fraser, a collector in the United Kingdom who has an enormous inventory of art, antiques, stamps and coins. Fraser believes in investing in irreplaceable objects, bucking the “throwaway culture” of today.

“We live in an age where few products will see next year, never mind the next century. Your new iPad may cost a fair amount, but it won’t survive for long before it is outdated and replaced with the latest gadget,” Fraser once wrote about his love of collecting. “However, a piece of art has immutable quality. It’s a real, tangible object,

$48,000 In 2007, a longer strand of Lennon’s sold for $48,000, purchased by an unknown bidder.

that someone has crafted by hand.”

No one has crafted these hairs by hand. They have, of course, grown out of real people’s heads, only to be sliced off and squirreled away by opportunistic hairdressers, morticians or zealous fans.

Lennon’s bandmate Ringo Starr once had his hair quickly chopped by an 18-year-old girl with a pair of nail scissors at a D.C. charity ball.

Fraser doesn’t own the Ringo hair, but he does own a half-inch strand from Beatle Paul McCartney. He also claims he owns hairs from President John Adams, Napoleon Bonaparte, Marilyn Monroe, John Steinbeck, Michael Jackson, Katherine Hepburn, Charles Dickens, Elizabeth Taylor, President John F. Kennedy and Bieber.

They’re all for sale online: 399 euros (about $444) per individual

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strand. Want a whole jar of Bieber’s trimmings? Fraser’s price tag is 35,000 euros ($38,964).

That’s a pretty sweet deal, depending on whom you’re comparing Bieber’s mane with. In 2007, hairs from the revolutionary icon Ernesto “Che” Guevara sold for $119,500 along with sets of his fingerprints and photographs.

The highest price on a swath of hair alone came from Elvis Presley.

It sold for $115,000 in 2002.

The pursuit of famous hairs combines two great pastimes of the human psyche: collection and celebrity obsession.

Most people have felt the rush of collecting something, be it stamps and baseball cards, or something much weirder like belly button fluff or traffic cones. The thrill of the hunt and the satisfaction that comes when you find something you’ve been looking for is understandably addicting.

Collections and celebrity love mix easily. Fans collect autographs, film and TV memorabilia, magazines, et cetera. The longerlasting the subject’s fame, the more valuable the object.

“We’re in the Kleenex phase of fame,” cultural historian Leo Braudy told Psychology Today in 1995.

“We see so much of people, and in all branches of the media. We blow our nose on every new star that happens to come along and then dispose of them.”

Braudy said that 20 years ago, way before the advent of social media. Today, big names come and go even faster. And tangible objects like autographs are rarer as young people opt to ask for selfies instead.

So to own a genuine artifact from a widely recognized cultural figure — even if it’s hair — is highly attractive to many people.

“People are interested in owning a piece of history and a piece of famous people,” collector John Reznikoff told CBS. Reznikoff is best known for owning locks of Abraham Lincoln’s hair that are said to have little bits of brain on them from his assassination.

But the newer hair in Reznikoff’s collection may serve as a cautionary tale. Those whose locks might be worth something one day might want to be careful when selecting their stylist. In 2005, it was discovered that Reznikoff purchased the hair of Neil Armstrong, who was still alive. The astronaut had no idea, and the barber earned $3,000 in the deal. n

KATHERINE LEE/THE WASHINGTON POST

ENTERTAINMENT

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BOOKS

How Elizabeth Taylor played herself N ON-FICTION

E ELIZABETH TAYLOR A Private Life for Public Consumption

By Ellis Cashmore Bloomsbury. 432 pp.

Paperback, $25.95

l

REVIEWED BY

N ATHAN S MITH

lizabeth Taylor often reminded us that she was alive despite many close encounters with death.

Like her title character in “Cat on a Hot Tin Roof,” she was a woman with nine lives.

In “Elizabeth Taylor: A Private Life for Public Consumption,” Ellis Cashmore adeptly unpacks the actress’s complex mythology, arguing that Taylor was the first modern “celebrity” as we know the term. Because her private life was inextricably linked to her public image, Cashmore asserts that Taylor “played” Elizabeth Taylor more than she played any character from her film career.

The book begins at Taylor’s birth as a modern celebrity: the scandal that erupted when she “stole” Eddie Fisher from Debbie Reynolds. As the public backlash against Taylor’s marriage grew (and then abated when she divorced Fisher and met Richard Burton), she became the first star to break free from the image constructed by the MGM studio and just be herself.

Cashmore encourages us to measure Taylor’s transforming stardom from this significant moment in Hollywood history. He demonstrates that as Taylor’s public image became increasingly interpreted through her film roles — the sensual Maggie in “Cat on a Hot Tin Roof,” the call-girl in “BUtterfield 8,” the seductress of “Cleopatra” — she changed cultural attitudes and studio policy in the 1950s and 1960s, and she continued to shape the trajectory of celebrity culture in the forthcoming decades.

Much of the book’s strength lies is how Cashmore accentuates other aspects of Taylor’s complex stardom, including her large appetites — both real and figurative. Taylor delighted in her many pleasures, with a voracious desire for men, jewelry and food (later, alcohol and prescription pills). Since Taylor is often remembered solely for her glamour and celebrity status, Cashmore’s consideration of her other attributes offers a more com-

GLASSHOUSE IMAGES/ALAMY STOCK PHOTO

Elizabeth Taylor on the set of the movie “Suddenly, Last Summer” in 1959.

plex picture of this too-often sanitized screen star.

“A Private Life” has the broader thesis that Taylor’s life is a template for the celebrity as a brand. Taylor literally bottled her stardom and sold it as “White Diamonds” perfume,pointingthewayforanynumber of famous performers — from Taylor Swift to Kim Kardashian — who commodify their status into sellable products, making it avail-

able to a legion of fans.

“A Public Life” successfully straddles the line between academic text and popular biography.

But sometimes Cashmore, a sociologist, strains to marry rigorous scholarship with Hollywood tales; the narrative is undermined by superfluous asides about his sources. This wordiness can have a disorienting effect, especially for the non-academic reader.

Still, “A Private Life” offers a rich and illuminating reassessment, invigorating the somewhat lackluster discourse about the iconic movie star. Although there are at least 10 biographies of Elizabeth Taylor, Cashmore’s lively study provides a compelling interpretation and bridges the many gaps between Taylor’s impact on the American zeitgeist and her alluring, infamous life. n

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BOOKS

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A financial thriller inspired by Madoff

Mysteries of light through the ages

F ICTION

N ON-FICTION

H

l

REVIEWED BY

M AUREEN C ORRIGAN

ow did he sleep at night?

That’s probably the second most asked question about Bernie Madoff in the wake of his exposure, in 2008, as a master Ponzi scheme artist. (The most asked question surely would be: How exactly did he get away with it for so long?)

Madoff, who’s serving his 150-year sentence in federal prison for bilking billions of dollars from investors — a sizable swath of which were Jewish charitable organizations and the elderly — has been mostly mum on the subject of his conscience, although he did tell Politico in 2014: “There’s nothing for me to change from. It’s not like I ever considered myself a bad person. I made a horrible mistake and I’m sorry.”

Madoff’s meager words of contrition seem positively self-flagellating when compared to the selfjustifications of the financial villain at the center of Peter Steiner’s thriller, “The Capitalist.” St. John Larrimer is an investment banker modeled on Madoff who escapes into lavish exile in the French Antilles when his pyramid scheme collapses. Despite the fact that he’s left a multitude of clients and friends in financial ruin, Larrimer reasons that his thievery serves a higher purpose: “In separating the gullible from their money, St. John believed that he played a crucial role in the capitalist system, performing a kind of radical surgery on the failing economy. . . . By exploiting weaknesses within the system, St. John helped it excise these weaknesses and make the necessary corrections, just as one might have a tumor excised from one’s body so the body can rehabilitate itself and grow stronger.”

In “The Capitalist,” Steiner’s recurring hero, retired CIA operative Louis Morgon, faces off against Larrimer. Though he’s left the agency and moved to France, Morgon never relaxes for very long. In this fifth novel of the series, it’s Morgon’s companion, Pauline, who

pulls him into the hunt for Larrimer when her brother, a money manager in New York, commits suicide after he’s been ruined by Larrimer’s machinations. With the (sometimes unrequested) assistance of a Russian crime boss and Larrimer’s personal assistant, Morgon jerryrigs a lure to coax Larrimer out of hiding.

The greatest strength of “The Capitalist” lies in the ingenuity of its construction. The story opens in a sweatshop in Lahore, Pakistan, where a 16-year-old garment worker almost dies in a fire that kills some of her co-workers. In the chapters that follow, Steiner draws a sooty line of responsibility that stretches from the corrupt Pakistani fire inspector to the owner of the sweatshop to Larrimer, who wears some of those designer duds made at the factory. In turn, “The Capitalist” also does a splendid job of tracing the trickle-down effects of Larrimer’s reckless manipulation of “financial instruments.”

The novel’s best asset, however, is also the source of its biggest flaw.

Steiner, known to many for his New Yorker cartoons, has a distinctive wide-focus mode of storytelling; here, it slows the book’s respiration rate down to that of a houseplant. Morgon doesn’t fully enter into the action until almost halfway through the novel — and even then Steiner keeps dutifully checking on all the other far-flung characters who’ve been affected by the sweatshop fire or by Larrimer’s financial finagling or both.

The result is a thriller that’s technically accomplished and informed, but dull.

Morgon knows better than to ask the question, “How did he sleep at night?” He’s been around long enough to know that for St. John Larrimer — as well as for his real-life counterpart, Bernie Madoff — the answer most certainly is: “Like a baby.” n Corrigan, who is the book critic for the NPR program, Fresh Air, teaches at Georgetown University.

O THE CAPITALIST

By Peter Steiner Thomas Dunne. 294 pp. $25.99

LIGHT A Radiant History From Creation to the Quantum Age

By Bruce Watson Bloomsbury. 282 pp. $27

l

REVIEWED BY

A LAN L IGHTMAN

ne evening during Isaac Newton’s years as a student at Cambridge, alone in his room lit by candlelight,the budding scientist stuck a needle in his eye to test the nature of vision. If he wiggled the needle, he saw colored circles. If he held the needle still, the circles disappeared. When he took the needle out of his eye and looked at a dark wall, the circles reappeared for a few moments, “a motion of spirits.”

Bruce Watson’s new book, a sweeping cultural and scientific history of our understanding of light, is filled with such vivid and charming scenes. With his trademark good storytelling and wide reading, Watson takes us on a delightful journey from the earliest creation myths to Chinese ideas of the duality of light and darkness to 10th-century Islamic scientist Ibn al-Haytham’s construction of a light-refraction apparatus to Newton’s work with prisms to Scottish physicist James Clerk Maxwell and his mathematical theory of electromagnetic light waves to Einstein’s work on the quantum nature of light. In fact, Watson’s book feels like one long story of human history, with fairly detailed explanations of evolving scientific ideas alternating with intimate glimpses of daily life in various eras alternating with portraits of the scientists making the discoveries.

Watson’s enthusiasm for his subjects is infectious. In the introduction to his new book about light, Watson writes that he aims to “reconcile the battles between science and humanities, between religion and doubt, between mathematics and metaphor.” He succeeds, as much as one can with such marching orders.

In ancient times, there was great confusion about whether light originated in the eye (with a light beam emerging from the eye and illuminating objects) or, instead, originated in sources outside the human body, such as fire.

The same with color. Was it an intrinsic property of objects or of

the light striking those objects?

Such controversies seem preposterous to us now, with our modern comprehension of nature, but Watson succeeds in peeling back the centuries and conveying the mentality of an earlier world.

Another historical debate about light has been whether it is wavelike, as are water waves, or particlelike, as are baseballs thrown out of a pitching machine. Watson explains the evidence for both views.

A few quibbles. Many of the scientific explanations would be clearer with illustrations. More serious, Watson should have checked his science with physicists. His explanations of the photoelectric effect, black body radiation, Maxwell’s work predicting electromagnetic waves and other topics suffer from misunderstandings, and he commits some real bloopers, such as saying that forces obeying the inverse square law weaken “exponentially with distance.”

If the book has a climax, it is in one of the final chapters, titled “Einstein and the Quanta, Particle, and Wave,” where Watson celebrates the ultimate enigma of light — that it acts both like waves, simultaneously spread over an extended region of space, and particles, each located at only one point of space at a time. Such seemingly mutually exclusive descriptions violate our human experience with the world. That enigma reaches far beyond light.

It applies to all of reality at the tiny scale of the atom. Above all else, modern physics has shown us that what we humans perceive with our limited bodies, and all of our notions based on those perceptions, are an illusion, an approximation of a strange cosmos we can touch only with our instruments and equations. n Lightman, a physicist and novelist, is professor of the practice of the humanities at MIT. His two latest books are “The Accidental Universe” and “Screening Room.”

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OPINIONS

‘To Kill a Mockingbird’ offers lessons in empathy MICHAEL GERSON is a nationally syndicated columnist who appears twice weekly in The Post.

At a time when politics has veered toward division and exclusion, it is somehow fitting that Harper Lee, the apostle of empathy, made her exit.

After the success of her first novel, “To Kill a Mockingbird,” Lee chose to live a quiet life in a quiet South Alabama town, involved in the local Methodist Church, doing laundry at the XL Laundromat, occasionally going to Atlantic City to play the slots. But in all the years since the book’s publication in 1960, people (like me) have found reading it a momentous event in their lives. From her tranquil hometown, Lee must have known that her novel — required in English class, found tattered in a used bookstore, reclaimed from a box in the basement — was causing lightning, and earthquakes, and pealing church bells.

Abraham Lincoln called Harriet Beecher Stowe, the author of “Uncle Tom’s Cabin,” the “little woman who wrote the book that started this great war.”

While not responsible for starting it, Lee was the little woman who made the values of the civil rights movement — particularly a feeling for the godawful unfairness of segregation — real for millions.

“To Kill a Mockingbird” is occasionally mischaracterized as children’s literature. It is an adult story — dealing with pathetic loneliness, an accusation of rape, the strangely sexual content of bigotry, a complete failure of justice — told from the perspective of a child. And Lee gave us the reason for this device.

When one child in the story, Dill, cries and retches after seeing injustice in the courtroom, Dolphus Raymond (the outcast father of mixed-race children) says: “Things haven’t caught up with that one’s instinct yet. Let him get a little older and he won’t get sick and cry. Maybe things’ll strike him as being — not quite right, say, but he won’t cry, not when he gets a few years

on him.” Lee wanted her readers to see injustice as if they were seeing it for the first time, before rationalizations and hardness form.

Lee was too good a novelist — possessing a keen eye for hypocrisy and cruelty — to have a rosy view of humanity. The Cunninghams are dirty and liceridden. The Ewells are bigoted, welfare-dependent and fully capable of child murder. You get the sense that Lee is not nearly as naive as Atticus Finch, who does, in one large case, see good where there is only evil.

But it is Lee’s point that human beings often improve on closer, more sympathetic inspection. Scout finds that the

CHIP SOMODEVILLA/GETTY IMAGES

Harper Lee, author of “To Kill a Mockingbird,” made the values of the civil rights movement real for millions of people.

family cook, Calpurnia, is not really “tyrannical,” and that Raymond is not actually a drunkard, and that Aunt Alexandra has loyalty and steadiness beneath her “boarding school manners” and that Boo Radley is not a “malevolent phantom” but a guardian angel. The nasty old racist Mrs. Dubose — facing death without the crutch of morphine — is, to Atticus, the “bravest person I ever knew.”

Real courage, he says, “is when you know you are licked before you begin but you begin anyway and you see it through no matter what.”

All these cases are illustrations of the central, familiar moral insight of the book. “If you can learn a simple trick, Scout,” Atticus advises his daughter, “you’ll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of

But it is Lee’s point that human beings often improve on closer, more sympathetic inspection.

view . . . until you climb into his skin and walk around in it.”

For Lee, this point demands more than observation. By actively treating people as individuals, they can respond with unexpected virtue. In the book, Walter Cunningham is part of a lynch mob. When Scout causes Cunningham to recall that he is a father, he walks away from violence. Men and women can be better than the mob, when they remember their hidden dignity, their secret honor. Lee defends the possibility of the awakened conscience.

Right now, the world of adults seems increasingly like Lee’s Maycomb, with a tiny religious minority stigmatized and targeted for exclusion, and another minority accused of being criminals and rapists, demonstrating the strangely sexual content of bigotry. And though we know it is not quite right, there are few who can manage tears.

Once again — maybe always — there is a great drama in what Lee called “the secret courts of men’s hearts.” Let us hope with Lee that people are better than the mob and capable of imagining the lives of strangers.

And whatever the outcome, Atticus — more real than any living politician — urges us to see it through. n

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OPINIONS

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TOM TOLES

Our absurd expectations of women DEBORAH TANNEN is a linguistics professor at Georgetown University.

Now we know that Gloria Steinem and Madeleine Albright don’t actually think that anyone should vote for Hillary Clinton simply because she’s a woman. Does that mean we can forget about Clinton’s gender? I don’t think so. But the question we face is subtler, more complicated and harder to address than “Do I vote for her because she’s a woman?” Rather, it’s “Can I be sure I’m judging this candidate accurately, given the double bind that confronts all women in positions of authority?”

A double bind is far worse than a straightforward damned-if-youdo, damned-if-you-don’t dilemma. It requires you to obey two mutually exclusive commands: Anything you do to fulfill one violates the other.

Women running for office, as with all women in authority, are subject to these two demands: Be a good leader! Be a good woman!

While the qualities expected of a good leader (be forceful, confident and, at times, angry) are similar to those we expect of a good man, they are the opposite of what we expect of a good woman (be gentle, selfdeprecating and emotional, but not angry). Hence the double bind: If a candidate — or manager — talks or acts in ways expected of women, she risks being seen as underconfident or even incompetent. But if she talks or

acts in ways expected of leaders, she is likely to be seen as too aggressive and will be subject to innumerable other negative judgments — and epithets — that apply only to women.

An example: Anyone who seeks public office, especially the highest one, must be ambitious, yet that word is rarely applied to male candidates because it goes without saying. And ambition is admirable in a man, but unacceptable — in fact, downright scary — in a woman.

Google “Bernie Sanders ambitious,” and you get headlines about the candidate’s “ambitious plans.” With Donald Trump, you find references to his “ambitious deportation plan” and “ambitious real estate developments.” When the word is used to describe Trump, it’s positive, as in “Trump is proud and ambitious, and he

strives to excel.”

But pair the word with Hillary Clinton, and a search spews headlines accusing her of “naked ambition,” “unbridled ambition,” “ruthless ambitions” — even of being “pathologically ambitious.”

The satirical website the Onion exposed the absurdity of demonizing a candidate for this requisite quality: “Hillary Clinton Is Too Ambitious to Be the First Female President.”

Robin Lakoff, the linguist who first identified the double bind as it applies to women in her 1975 book “Language and Woman’s Place,” has pointed out that it accounts for the persistent impressions of Clinton as inauthentic and untrustworthy.

We develop these impressions, Lakoff notes, when people don’t talk and act as we think they should, given who they are and what we know about them. In Clinton’s case, she explains, they come precisely from the fact that she has characteristics, such as toughness, that we require of a candidate but that just don’t feel right in a woman.

The trickiest thing about the double bind is that it operates imperceptibly. “It has nothing to do with gender,” I heard recently.

“It’s just that she’s shrill.” When is the last time you heard a man called shrill? “She should stop

shouting,” another critic advised.

How is a candidate to be heard over the din of a cheering crowd without shouting? Both these comments came from women.

Surprising? No. Women are just as likely, if not more likely, to react this way. After all, it’s from peers that girls learn to play down their power lest they be ostracized for being “bossy.”

This helps answer the question that Steinem and Albright brought into focus: Why aren’t more young women flocking to support the first woman with a serious shot at the presidency?

The double bind lowers its boom on women in positions of authority, so those who haven’t yet risen to such positions have not yet felt its full weight. They may well believe (as I did when I was young) that when the time comes, they’ll be judged fairly, based on their qualifications.

They probably have not yet experienced the truism that to get equal consideration, a woman has to be better than her male counterparts.

Voters of all ages must ask whether the lens through which they view Clinton is being clouded by these invisible yet ubiquitous forces. To make sure they’re seeing clearly, they need to understand — and correct for — the double bind. n

SUNDAY, FEBRUARY 28, 2016

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OPINIONS

RUTH MARCUS is a columnist for The Post, specializing in American politics and domestic policy.

The judicial wars threaten to engulf us in ceaseless cycles of partisan warfare and recriminations. Herewith, two modest (read: unlikely) proposals to try to mitigate the damage, one involving the chief justice, the other the president.

To begin with, though, a stipulation and a sense of the stakes involved.

The stipulation is that no one in this Almost Thirty Years’ War — Robert Bork was nominated in 1987 — comes with clean hands. The situational ethics of the capital are never more evident than when it comes to confirmation battles.

Republicans wave around quotes from Chuck Schumer and Joe Biden on stalling Republican Supreme Court nominees.

Democrats respond with reams of Mitch McConnell pronouncements on the importance of deferring to presidential prerogative. Would Democrats eagerly usher through a high-court nominee in the seventh year of a Republican presidency?

Of course not, although Democrats might be less blatant about trumpeting their plans for blockage, and Senate Republicans’ stance — don’t even bother, Mr. President —

takes things a significant and appalling notch further. The latest news, that Republicans will not hold hearings or even meet with a nominee, regardless of qualifications, is unprecedented in its disrespect for the constitutional process.

As to the stakes: Failing to act on a nominee would not affect just the current court term. It would, for all practical purposes, leave the court at less than full strength during the following term as well.

The new president will not be sworn in until Jan. 20, 2017. Even if the vacancy is at the top of his or her agenda, a nomination could not practicably be forthcoming until the following month. And even assuming a normally functioning Senate, the new justice would be lucky to be in place for the last arguments of the term, in April. (Elena Kagan’s confirmation

WEEKLY

BY BAGLEY FOR THE SALT LAKE TRIBUNE

BY STANTIS FOR THE CHICAGO TRIBUNE

How to halt the judicial wars

KLMNO

proceedings took 87 days; Sonia Sotomayor’s, 66; Samuel Alito’s, 82.)

Meantime, the absence of a ninth justice for two terms is no minor impediment, despite what Republicans say. Last term, 19 cases — 26 percent of the court’s docket — were decided by a vote of 5 to 4. The previous year’s number was 10, or 14 percent of the caseload. The year before, 23 cases, or 29 percent. These are some of the most important on the court’s docket.

Which brings me to Chief Justice John G. Roberts Jr. Sure, he won’t be inclined to insert himself into this political mess.

Still, he should. It would not only be appropriate for Roberts to speak out about the harm posed by a lengthy and contested vacancy, it would be in line with his previous statements on the problem of vacancies in lower courts and the politicization of nominations.

“When you have a sharply political, divisive hearing process, it increases the danger that whoever comes out of it will be viewed in those terms,” Roberts said this month, before Justice Antonin Scalia’s death. “. . . It’s natural for some member of the public to think, well, you must be identified in a particular way as a result of that

process. And that’s just not how — we don’t work as Democrats or Republicans.”

There’s also a way — albeit even less likely — for President Obama to reduce the political temperature. He could take the advice proffered by a lawyer who would later become his White House counsel, Robert F. Bauer, and ask that his nominee pledge to serve a limited term.

Term limits for justices are a good idea that will never happen because of the obstacles to amending the Constitution (and serious constitutional impediments to imposing such limits legislatively). Bauer’s intriguing idea is to achieve these limits through practice rather than dictate.

Perhaps the offer of a nominee to serve a reasonable term of years — Bauer tossed out the notion of 15, quoting a 1983 memo by Roberts — would dislodge the gridlock and pave the way for a more orderly, less acrimonious future.

A president willingly ceding power and influence is as antithetical to the politician’s instinct as a justice thrusting himself into a raging political battle is to the judicial temperament. But something must be done. Crazy times call for crazy suggestions. n

SUNDAY, FEBRUARY 28, 2016

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KLMNO WEEKLY

FIVE MYTHS

Placebos BY

J O M ARCHANT

I once interviewed a woman who’d fractured her spine. For months, she was laid up, barely able to walk. Finally, her doctor recommend­ ed an experimental treatment. She agreed to try it; afterward, her pain melted away. A decade later, she’s still playing golf. In truth, she didn’t get the experimental spine treatment. She was given a placebo.

The “placebo effect” is a phenomenon in medicine whereby patients feel better without the use of drugs. Although scientists have been studying placebos for decades, there are still a lot of misconceptions about how and why they work. Here are the most common.

1

The placebo effect is all in the mind.

A significant proportion of patients feel better after taking placebos, but many scientists claim that this improvement is totally mental.

In reality, placebo treatments can cause measurable, biological changes similar to those triggered by drugs. Studies show that depressed patients on placebos experience increased activity in their prefrontal cortex, which eases their symptoms.

Other research has shown that in patients with Parkinson’s disease, placebos trigger a flood of the neurotransmitter dopamine, just as their drugs do. And taking a placebo painkiller dampens painrelated activity in the brain and spinal cord and causes the release of pain-relieving endorphins.

2

Placebos work only if patients think they’re real.

Physicians and researchers have questioned the ethics of placebo use, suggesting that it requires doctors to willfully deceive their patients.

Over the past few years, however, scientists have found that this isn’t true. Honest placebos work, too. In one trial, patients with irritable bowel syndrome were told that they were taking a placebo, yet they still experienced significant relief

from their symptoms compared with patients who got no treatment. Researchers have found the same effect for depression, migraines and ADHD. There are several possible explanations. Some research shows that patients learn to associate taking a pill with a particular physiological response, so when they subsequently take a placebo, their bodies automatically mimic that response — a phenomenon known as conditioning. There’s also evidence that simply being cared for in a trial — even if patients know that a treatment is fake — eases anxiety and helps them feel that their conditions will improve.

3

Neurotic, suggestible people are more likely to respond to placebos.

The belief that placebo responders are pliable, suggestible souls who simply wish to “please the investigator” persists today.

Recent studies, however, suggest that anyone can respond to a placebo. Crucial factors include patients’ attitudes toward a particular treatment, their previous experiences (whether, for example, they’ve responded well to a particular drug) and the information they’re given about a treatment. Genes also play a role.

About a quarter of the variation does seem to depend on

CHRISTOPHER STEVENSON/CORBIS/GETTY IMAGES

personality. It’s not neurotic people who see benefits, but rather those who are optimistic, altruistic, resilient and straightforward. Scientists think this is because these personality types tend to be more engaged with their treatment and have more positive expectations for it.

Neurotic and hostile people are least likely to respond.

4

You have to take a placebo to get a placebo effect.

It’s true that placebos won’t shrink a tumor, cure an infection or replace insulin in someone with diabetes. But many “real” medical treatments — particularly those that modify symptoms like pain, fatigue, nausea or depression — rely on the placebo effect. Common opioid painkillers such as Tramadol are about a third less effective if we don’t know we’re taking them, for example. In a study that followed 459 migraine attacks, the placebo effect accounted for 60 percent of the benefit of the painkiller Maxalt.

Meanwhile, in mild to moderate cases of depression, the placebo effect is thought to account for almost all of the benefits of the drugs patients take.

5

Drugs are always more effective than placebos.

An oft-cited 2001 analysis

compared patients given placebos with those given no treatment in 130 trials. The researchers found little evidence that the placebos had powerful clinical effects.

But that analysis lumped many different conditions together.

And it incorporated trials in which the drugs being tested didn’t work. A rigorous, more recent study of 152 trials found that placebo effects are often about the same as drug effects.

Of course, when patients take an active drug, they benefit from both the drug and the placebo effect. But medication can also do harm; 16,000 Americans die from overdoses of prescription painkillers each year, for example. And in some cases, patients might do better taking a placebo.

What’s more, neuroscientists are finding that beliefs and expectations about treatment influence the brain in ways drugs don’t. This goes beyond easing symptoms to influence how patients cope with those symptoms. While drug effects last only as long as patients keep popping pills, these changes rely on their inner resources, which they can access at any time. n Marchant is a science journalist and the author of “Cure: A Journey Into the Science of Mind Over Body.”

SUNDAY, FEBRUARY 28, 2016

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