Israel Moves to Expand Settlements in East Jerusalem
Label: World
Rina Castelnuovo for The New York Times
From his home in East Jerusalem last year, Haj Ibrahim Ahmad Hawa looked at the separation barrier surrounding Jerusalem with the Israeli settlement of Maale Adumim in the background. More Photos »
JERUSALEM — As the United Nations General Assembly voted overwhelmingly to upgrade the Palestinians’ status Thursday night, Israel took steps toward building housing in a controversial area of East Jerusalem known as E1, where Jewish settlements have long been seen as the death knell for a two-state solution to the Israeli-Palestinian conflict.
A senior Israeli official, speaking on the condition of anonymity, said on Friday that the decision was made late Thursday night to move forward on “preliminary zoning and planning preparations” for housing units in E1, which would connect the large settlement of Maale Adumim to Jerusalem and therefore make it impossible to connect the Palestinian cities of Ramallah and Bethlehem to Palestinian neighborhoods of East Jerusalem. Israel also authorized the construction of 3,000 housing units in other parts of East Jerusalem and the West Bank, the official said.
The prime minister’s office refused to comment on whether the settlement expansion — first reported on Twitter by a reporter for the Israeli daily Haaretz — was punishment for the Palestinians’ success in upgrading its status from nonmember observer entity to nonmember observer state at the United Nations, but it was widely seen as such. The United States, one of only eight countries that stood with Israel in voting against the Palestinians’ upgrade, has for two decades vigorously opposed construction in E1, a 3,000-acre expanse of hilly parkland where a police station was opened in 2008.
In Washington, a State Department official criticized the move. “We reiterate our longstanding opposition to settlements and East Jerusalem construction,” he said. “We believe it is counterproductive and makes it harder to resume direct negotiations and achieve a two-state outcome.”
Hagit Ofran, who runs the Settlement Watch project of Peace Now, called E1 a “deal breaker for the two-state solution” and denounced the decision as “disastrous.”
“Instead of punishing the Palestinians, they are actually punishing Israel,” Ms. Ofran, who is Israeli, said in an interview. “Instead of taking advantage of this bid in the U.N. and calling for negotiations to get to a two-state solution, this government is choosing to take actions that might prevent the possibility of a two-state solution.”
But Dani Dayan, leader of Israel’s settler movement, welcomed the news, saying it was “a very important Israeli interest to develop E1.”
He described the two-state solution as “an existential threat to Israel” and said the E1 development was “beneficial for peace because a two-state solution is a prologue for another bloody confrontation.”
“The fear to develop the communities is not rational,” Mr. Dayan said. “The opposition to the settlements has become a kind of religious dogma for the West.”
Even Mr. Dayan, however, said he did not like the idea of expanding settlements “as a sort of retaliatory or punitive step.”
“Under the circumstances that we understand the government operates, I think it’s O.K.,” Mr. Dayan added. “We have a legal and a political and a moral right to build. It’s strategic for Jerusalem; to strengthen Jerusalem is the only horizon. We don’t see it as an obstacle to peace.”
AP survey: Bonds, Clemens likely miss in Hall vote
Label: LifestyleNEW YORK (AP) — Baseball's all-time home run king and the most decorated pitcher likely will be shut out of the Hall of Fame in January. A survey by The Associated Press shows that Barry Bonds and Roger Clemens, as well as slugger Sammy Sosa, don't have enough votes to get into Cooperstown.
With steroid scandals still very much on the minds of longtime members of the Baseball Writers' Association of America as they cast their ballots, the trio failed to muster even 50 percent support among the 112 voters contacted by the AP — nearly one-fifth of those eligible to choose.
Candidates need 75 percent for election
So Bonds, the only seven-time MVP, and Clemens, the only seven-time Cy Young Award winner, are likely to remain outside the Hall along with career hits leader Pete Rose, who was banned for betting on baseball as manager of the Cincinnati Reds.
"I'm not going to vote for anybody who has been tainted or associated with steroids," said MLB.com's Hal Bodley, the former baseball columnist for USA Today. "I'm just not going to do it. I might change down the road, but I just love the game too much. I have too much passion for the game and for what these people did to it."
The current ballot was announced this week and Bonds, Clemens and Sosa were on it for the first time. Votes will be cast throughout the month and results will be released Jan. 9.
Among voters who expressed an opinion, Bonds received 45 percent support, Clemens 43 percent and Sosa 18 percent. To gain election, Bonds and Clemens would need more than 80 percent support among the voters not surveyed and Sosa would need to get more than 85 percent.
"No one would dare say that Bonds, a seven-time National League MVP with 762 home runs, isn't a Hall of Famer," Thom Loverro, a columnist for The Washington Examiner, wrote in a column that explained his decision. "Nor would anyone say that Clemens, with 354 career victories, 4,672 strikeouts and seven Cy Young Awards, shouldn't be enshrined in Cooperstown. The same goes for Sosa, who finished with 609 career home runs, including 243 of them from 1998 through 2001.
"Except they cheated — all of them. And this Hall of Fame is not just about numbers. Three of the six criteria for election to Cooperstown are sportsmanship, integrity and character. Bonds, Sosa and Clemens fail on all three counts."
The Denver Post's Troy Renck doesn't plan to vote for them, either.
"I understand that everyone has their opinion on this issue and I respect those," he said in a telephone interview. "For me personally, having coached kids for the last decade and talked to them about doing things a certain way, I would feel very uncomfortable voting for anyone that is a known cheater."
San Francisco Chronicle columnist Bruce Jenkins took the opposite view.
"The Hall of Fame's 'character' clause should be stricken immediately, because it's far too late to turn Cooperstown into a church," he wrote in an email. "Whether it was gambling (rampant in the early 20th century), scuffing the baseballs, corking bats, amphetamines or steroids, players have been cheating like crazy forever. It's an integral, if unsavory, part of the culture. I've always had the same criteria: which players were the best performers of their particular era — so absolutely, I'll vote for Bonds, Clemens and Sosa."
Bonds and Clemens gained far more support than Sosa in the survey.
"I will definitely vote for Bonds and Clemens. I still need to consider Sosa's resume," ESPN.com's Jim Caple said. "Steroid use has nothing to do with my vote. Steroids were not banned during the majority of their careers when they achieved the vast majority of their accomplishments. All we can go by is what they did on the field. If Gaylord Perry is in the Hall for violating a rule that was in place 40 years before his career began, how can you justify withholding a vote from someone for a rule that wasn't in effect? (And personally, I would rather face a pitcher on PEDs than a spitballer)."
Hall voters are BBWAA members who have been with the organization for 10 consecutive years at any point. About 8-10 percent of the approximately 600 Hall of Fame voters are employees of the AP or freelance writers who work for the AP, the BBWAA said.
Bonds has denied knowingly using steroids. A positive test was introduced as evidence during his criminal trial last year, when he was convicted of obstruction of justice by a jury that failed to reach a verdict on charges he made false statements to a grand jury when he denied knowing using performance-enhancing drugs.
Clemens has repeatedly denied drug use and was acquitted this year on charges he lied to Congress when he said he didn't take steroids or human growth hormone.
Sosa was among the 104 positive tests in baseball's 2003 anonymous survey, The New York Times reported in 2009. He told a congressional committee in 2005 that he never took illegal performance-enhancing drugs.
Bonds and Clemens fared far better in the survey than Mark McGwire did when a sample of voters were questioned by the AP before his first appearance on the ballot in December 2006. The slugger with 583 home runs received 24 percent support in the survey and 23.5 percent in the BBWAA ballot.
Since then, McGwire's support has never topped 24 percent and dropped to 19.5 percent of the 573 votes cast last January.
Rafael Palmeiro, who topped 3,000 hits and 500 home runs, was suspended for 10 days in 2005 following a positive test for Stanozolol — he said he didn't know what caused it. He received 12.5 percent in January.
Several voters said their decisions were for this vote only and they planned to reassess their position each year. Some said that they wouldn't consider voting for Bonds, Clemens or Sosa this year because they didn't want them to have the additional honor of being elected on their first ballot.
Players who have appeared in 10 seasons and have been retired for five years are eligible for consideration by a six-member BBWAA screening committee, and a player goes on the ballot if he is supported by at least two screening committee members. A player remains on the ballot for up to 15 elections as long as he gets 5 percent of the votes every year.
Ballots must be submitted to the BBWAA by Dec. 31. Inductions will take place July 28.
Voters were contacted by telephone and email from Wednesday to Friday.
Craig Biggio, Mike Piazza and Curt Schilling also are among the 24 first-time eligibles, and Jack Morris, Jeff Bagwell and Tim Raines are the top holdover candidates.
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AP Sports Writers Janie McCauley, Noah Trister and Ben Walker contributed to this report.
Hockey Coaches Defy Doctors on Concussions, Study Finds
Label: Health
Despite several years of intensive research, coverage and discussion about the dangers of concussions, the idea of playing through head injuries is so deeply rooted in hockey culture that two university teams kept concussed players on the ice even though they were taking part in a major concussion study.
The study, which was published Friday in a series of articles in the journal Neurosurgical Focus, was conducted during the 2011-12 hockey season by researchers from the University of Western Ontario, the University of Montreal, Harvard and other institutions.
“This culture is entrenched at all levels of hockey, from peewee to university,” said Dr. Paul S. Echlin, a concussion specialist and researcher in Burlington, Ontario, and the lead author of the study. “Concussion is a significant public health issue that requires a generational shift. As with smoking or seat belts, it doesn’t just happen overnight — it takes a massive effort and collective movement.”
The study is believed to be among the most comprehensive analyses of concussions in hockey, which has a rate of head trauma approaching that of football. Researchers followed two Canadian university teams — a men’s team and a women’s team — and scanned every player’s brain before and after the season. Players who sustained head injuries also received scans at three intervals after the injuries, with researchers using advanced magnetic resonance imaging techniques.
The teams were not named in the study, in which an independent specialist physician was present at each game and was empowered to pull any player off the ice for examination if a potential concussion was observed.
The men’s team, with 25 players and an average age of 22, played a 28-game regular season and a 3-game postseason. The women’s team, with 20 players and an average age of 20, played 24 regular-season games and no playoff games. Over the course of the season, there were five observed or self-reported concussions on the men’s team and six on the women’s team.
Researchers noted several instances of coaches, trainers and players avoiding examinations, ignoring medical advice or otherwise obstructing the study, even though the players had signed consent forms to participate and university ethics officials had given institutional consent.
“Unless something is broken, I want them out playing,” one coach said, according to the study.
In one incident, a neurologist observing the men’s team pulled a defenseman during the first period of a game after the player took two hits and was skating slowly. During the intermission the player reported dizziness and was advised to sit out, but the coach suggested he play the second period and “skate it off.” The defenseman stumbled through the rest of the game.
“At the end of the third period, I spoke with the player and the trainer and said that he should not play until he was formally evaluated and underwent the formal return-to-play protocol,” the neurologist said, as reported in the study. “I was dismayed to see that he played the next evening.”
After the team returned from its trip, the neurologist questioned the trainer about overruling his advice and placing the defenseman at risk.
“The trainer responded that he and the player did not understand the decision and that most of the team did not trust the neurologist,” according to the study. “He requested that the physician no longer be used to cover any more games.”
In another episode, a physician observer assessed a minor concussion in a female player and recommended that she miss the next night’s game. Even though the coach’s own playing career had ended because of concussions, she overrode the medical advice and inserted the player the next evening.
According to the report, the coach refused to speak to another physician observer on the second evening. The trainer was reluctant to press the issue with the coach because, the trainer said, the coach did not want the study to interfere with the team.
A Hospital War Reflects a Tightening Bind for Doctors Nationwide
Label: Business
For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.
But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.
Today, Boise is a medical battleground.
A little more than half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center.
Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit. In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.
Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe increasing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.
In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint.
Federal and state officials have also joined the fray. In one of a handful of similar cases, the Federal Trade Commission and the Idaho attorney general are investigating whether St. Luke’s has become too powerful in Boise, using its newfound leverage to stifle competition.
Dr. David C. Pate, chief executive of St. Luke’s, denied the assertions by St. Alphonsus that the hospital’s acquisitions had limited patient choice or always resulted in higher prices. In some cases, Dr. Pate said, services that had been underpriced were raised to reflect market value. St. Luke’s, he argued, is simply embracing the new model of health care, which he predicted would lead over the long term to lower overall costs as fewer unnecessary tests and procedures were performed.
Regulators expressed some skepticism about the results, for patients, of rapid consolidation, although the trend is still too new to know for sure. “We’re seeing a lot more consolidation than we did 10 years ago,” said Jeffrey Perry, an assistant director in the F.T.C.’s Bureau of Competition. “Historically, what we’ve seen with the consolidation in the health care industry is that prices go up, but quality does not improve.”
A Drive to Consolidate
An array of new economic realities, from reduced Medicare reimbursements to higher technology costs, is driving consolidation in health care and transforming the practice of medicine in Boise and other communities large and small. In one manifestation of the trend, hospitals, private equity firms and even health insurance companies are acquiring physician practices at a rapid rate.
Today, about 39 percent of doctors nationwide are independent, down from 57 percent in 2000, according to estimates by Accenture, a consulting firm.
Many policy experts have praised the shift away from independent medical practices as a way of making health care less fragmented and expensive. Systems that employ doctors, modeled after well-known organizations like Kaiser Permanente, are better positioned to coordinate patient care and to find ways to deliver improved services at lower costs, these advocates say. Indeed, consolidation is encouraged by some aspects of the Obama administration’s health care law.
“If you’re going to be paid for value, for performance, you’ve got to perform together,” said Dr. Ricardo Martinez, chief medical officer for North Highland, an Atlanta-based consultant that works with hospitals.
The recent trend is reminiscent of the consolidation that swept the industry in the 1990s in response to the creation of health maintenance organizations, or H.M.O.’s — but there is one major difference. Then, hospitals had difficulty managing the practices, contending that doctors did not work as hard when they were employees as they had as private operators. This time, hospitals are writing contracts more in their own favor.
Sony sells over half a million PlayStation 3 consoles over Black Friday week
Label: TechnologyBoth Microsoft (MSFT) and Nintendo (NTDOY) had a big week of console sales during Black Friday’s week of shopping madness in the U.S. So how did Sony (SNE) do in comparison? Sony Computer Entertainment of America president and CEO Jack Tretton announced on Thursday that the company sold 525,000 PlayStation 3 consoles and 160,000 PS Vita handhelds during the Black Friday week. Overall PlayStation sales of hardware, software and accessories are up 9% over the same period last year. Tretton was also happy to reveal that subscriptions to its PlayStation Plus grew 259% since last year with customer satisfaction flying high at 95% after Sony added the Instant Game Collection to the service earlier this year.
Sony’s PlayStation 3 and PS Vita sales were largely bolstered by $ 199.99 bundles packaged with free games that the company pushed to retails on Black Friday. The sell-out of the bundles within minutes at retailers such as Amazon (AMZN) is a good indicator that there is huge demand for a sub-$ 200 PlayStation 3. Currently, the lowest-priced PS3 is a second-gen 160GB slim model with an MSRP of $ 249.99. The redesigned third-gen PS3s start at $ 269.99 with a 250GB hard drive.
In terms of which home console did the best over Black Friday, it looks like the Xbox 360′s 750,000 consoles took first place, while Sony came in second with 525,000 PS3s and Nintendo came in third with 400,000 Wii U systems.
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Benghazi Violence Beyond Control of Militias
Label: World
Esam Omran Al-Fetori/Reuters
Libyan police officers carried the body of Faraj Mohammed el-Drissi, the Benghazi security director, after he was gunned down last week.
BENGHAZI, Libya — The killing was not a shock here, in the city where Libyans started their quest to shake off dictatorship and now struggle, nearly two years later, to douse the simmering violence that is a legacy of the revolt.
One evening last week, a car screeched down a residential street. Three men stepped out and with startling ease gunned down Faraj Mohammed el-Drissi, the man whose job it was to ensure this city’s security.
Mr. Drissi, who had been on the job since October, was among roughly three dozen public servants killed over the last year and a half, including army officers, security agents, officials from the deposed government and the United States ambassador, J. Christopher Stevens. In all the cases, no one has been convicted, and in many, no one has even been questioned. That is unlikely to change anytime soon.
Since Col. Muammar el-Qaddafi was killed more than a year ago, Benghazi has in many ways regained its balance, as residents build long-delayed additions to their homes and policemen direct traffic on some streets. But Mr. Drissi’s killing made it hard to ignore a darker rhythm — one that revolves around killing with impunity. The government is still weaker than the country’s militias, and neither is willing, or able to act.
“It is impossible for members of a brigade to arrest another,” said Wanis al-Sharif, the top Interior Ministry official in eastern Libya. “And it would be impossible that I give the order to arrest someone in a militia. Impossible.”
The violence was thrown into sharp relief after the September attack on the United States intelligence and diplomatic villas. Libyan and American officials accused militants associated with Libya’s ubiquitous militias, and specifically, members of Ansar al-Shariah.
“The killing of the ambassador brought back the true reality of this insecure state,” said Ali Tarhouni, a former Libyan finance minister who leads a new political party. “It was a major setback, to this city and its psyche.”
Justice itself is a dangerous notion here and throughout Libya, where a feeble government lacks the power to protect citizens or to confront criminal suspects. It barely has the means to arm its police force, let alone rein in or integrate the militias or confront former rebel fighters suspected of killings.
“Some had to do with personal grudges,” said Judge Jamal Bennor, who serves as Benghazi’s justice coordinator. But most were like the killing of Mr. Drissi. “This was a political assassination,” he said.
Adding to the feeling of lawlessness are the revelations that foreign intelligence services, like the C.I.A., are active around the country without answering to anyone, people here said. Every day, an American drone circles Benghazi, unsettling and annoying residents. Police officers share Kalashnikovs. The courts are toothless. Libyan and American investigators, faced with Benghazi’s insecurity, are forced to interview witnesses hundreds of miles away, in the capital, Tripoli.
And so the government is forced to reckon with the militias, who by virtue of their abundant weapons hold the city’s real power. Men like Wissam bin Hamid, 35, who before the revolution owned an automobile workshop, is now the leader of an umbrella group of former rebel fighters. Some groups, like Mr. Hamid’s, operate with the government’s blessing, while others are called rogue. The distinctions often seem arbitrary, but either way, the militias are effectively a law unto themselves.
Mr. Hamid and others insist that they are loyal to the state. Leading political figures said they respected Mr. Hamid but had concerns about many of the other militia leaders, among them hard-line Islamists.
The militias are called on for crucial tasks, including safeguarding elections. Mr. Hamid’s militia, a branch of a group called Libya Shield, has been called on to enforce order hundreds of miles away from Benghazi, in towns beyond the government’s reach. The militia has also worked with American officials: they escorted intelligence officers and diplomats away from the besieged villas on Sept. 11, and later, provided protection for American investigators visiting the city in search of evidence in the attack, Mr. Hamid said.
Steelers QB Roethlisberger testing hurt shoulder
Label: LifestylePITTSBURGH (AP) — Ben Roethlisberger doesn't sound like a guy who plans on playing against the Baltimore Ravens on Sunday.
The injured Pittsburgh Steelers quarterback said Thursday he's still in significant pain from the sprained right shoulder and dislocated ribs that have forced him to sit out Pittsburgh's last two games.
Roethlisberger said "there's always a chance" he could play against the Ravens but isn't sure his injured arm will cooperate. When asked if the issue is pain or arm strength, Roethlisberger said "both."
The Steelers (6-5) are 0-2 since Roethlisberger left in the third quarter of a 16-13 overtime win against Kansas City on Nov. 12. It's unlikely Pittsburgh can catch the Ravens (9-2) even with a win this week, but Roethlisberger said that won't affect the team's decision on whether to rest him another week or not.
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Follow Will Graves at www.twitter.com/WillGravesAP
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Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL
Clearing the Fog Around Personality Disorders
Label: Health
For years they have lived as orphans and outliers, a colony of misfit characters on their own island: the bizarre one and the needy one, the untrusting and the crooked, the grandiose and the cowardly.
Their customs and rituals are as captivating as any tribe’s, and at least as mystifying. Every mental anthropologist who has visited their world seems to walk away with a different story, a new model to explain those strange behaviors.
This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.
Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes are fairly well represented on the self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, avoidant personality disorder, as well as dependent and histrionic personalities.
But when full-blown, the disorders are difficult to characterize and treat, and doctors seldom do careful evaluations, missing or downplaying behavior patterns that underlie problems like depression and anxiety in millions of people.
The new proposal — part of the psychiatric association’s effort of many years to update its influential diagnostic manual — is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it’s allowed in at all.
Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force updating the manual, would not speculate on which way the vote might go: “All I can say is that personality disorders were one of the first things we tackled, but that doesn’t make it the easiest.”
The entire exercise has forced psychiatrists to confront one of the field’s most elementary, yet still unresolved, questions: What, exactly, is a personality problem?
Habits of Thought
It wasn’t supposed to be this difficult.
Personality problems aren’t exactly new or hidden. They play out in Greek mythology, from Narcissus to the sadistic Ares. They percolate through biblical stories of madmen, compulsives and charismatics. They are writ large across the 20th century, with its rogues’ gallery of vainglorious, murderous dictators.
Yet it turns out that producing precise, lasting definitions of extreme behavior patterns is exhausting work. It took more than a decade of observing patients before the German psychiatrist Emil Kraepelin could draw a clear line between psychotic disorders, like schizophrenia, and mood problems, like depression or bipolar disorder.
Likewise, Freud spent years formulating his theories on the origins of neurotic syndromes. And Freudian analysts were largely the ones who, in the early decades of the last century, described people with the sort of “confounded identities” that are now considered personality disorders.
Their problems were not periodic symptoms, like moodiness or panic attacks, but issues rooted in longstanding habits of thought and feeling — in who they were.
“These therapists saw people coming into treatment who looked well put-together on the surface but on the couch became very disorganized, very impaired,” said Mark F. Lenzenweger, a professor of psychology at the State University of New York at Binghamton. “They had problems that were neither psychotic nor neurotic. They represented something else altogether.”
Several prototypes soon began to emerge. “A pedantic sense of order is typical of the compulsive character,” wrote the Freudian analyst Wilhelm Reich in his 1933 book, “Character Analysis,” a groundbreaking text. “In both big and small things, he lives his life according to a preconceived, irrevocable pattern.”
Others coalesced too, most recognizable as extreme forms of everyday types: the narcissist, with his fragile, grandiose self-approval; the dependent, with her smothering clinginess; the histrionic, always in the thick of some drama, desperate to be the center of attention.
In the late 1970s, Ted Millon, scientific director of the Institute for Advanced Studies in Personology and Psychopathology, pulled together the bulk of the work on personality disorders, most of it descriptive, and turned it into a set of 10 standardized types for the American Psychiatric Association’s third diagnostic manual. Published in 1980, it is a best seller among mental health workers worldwide.
These diagnostic criteria held up well for years and led to improved treatments for some people, like those with borderline personality disorder. Borderline is characterized by an extreme neediness and urges to harm oneself, often including thoughts of suicide. Many who seek help for depression also turn out to have borderline patterns, making their mood problems resistant to the usual therapies, like antidepressant drugs.
Today there are several approaches that can relieve borderline symptoms and one that, in numerous studies, has reduced hospitalizations and helped aid recovery: dialectical behavior therapy.
This progress notwithstanding, many in the field began to argue that the diagnostic catalog needed a rewrite. For one thing, some of the categories overlapped, and troubled people often got two or more personality diagnoses. “Personality Disorder-Not Otherwise Specified,” a catchall label meaning little more than “this person has problems” became the most common of the diagnoses.
It’s a murky area, and in recent years many therapists didn’t have the time or training to evaluate personality on top of everything else. The assessment interviews can last hours, and treatments for most of the disorders involve longer-term, specialized talk therapy.
Psychiatry was failing the sort of patients that no other field could possibly help, many experts said.
“The diagnoses simply weren’t being used very much, and there was a real need to make the whole system much more accessible,” Dr. Lenzenweger said.
Resisting Simplification
It was easier said than done.
The most central, memorable, and knowable element of any person — personality — still defies any consensus.
A team of experts appointed by the psychiatric association has worked for more than five years to find some unifying system of diagnosis for personality problems.
The panel proposed a system based in part on a failure to “develop a coherent sense of self or identity.” Not good enough, some psychiatric theorists said.
Later, the experts tied elements of the disorders to distortions in basic traits.
This article has been revised to reflect the following correction:
Correction: November 29, 2012
An earlier version of this article misstated the number of traits included in the proposed criteria for narcissistic personality disorder. The final proposal relies on two personality traits, not four.
U.S. Growth Revised Up, but Year-End Slowdown Is Feared
Label: Business
Even as the government said that the United States economy grew faster than first estimated in the third quarter, economists warned that the rate of expansion could slow sharply before the end of the year as worries mount about the fiscal impasse in Washington.
Nam Y. Huh/Associated Press
An employee on the assembly line this month at Generac Power Systems in Whitewater, Wis., a maker of residential generators.
The Commerce Department said Thursday that gross domestic product expanded at an annual rate of 2.7 percent in the three months ended Sept. 30, well above the 2 percent estimate it initially made in late October. But the revision was driven by increased inventory accumulation and a jump in federal spending — factors unlikely to be repeated in the current fourth quarter, economists said.
What’s more, the revised figures show spending by businesses on equipment and software declined by 2.7 percent in the third quarter, the first decrease since the end of the recession in mid-2009 and a sign of just how cautious many companies have become amid the uncertainty in Washington and slowing growth in Asia and Europe.
“It’s a nice headline number,” said Nigel Gault, chief U.S. economist at IHS Global Insight, of the 2.7 percent rate, “but it exaggerates the underlying momentum in the economy. Sustainable improvements in growth are not driven by inventories.”
The two biggest growth areas in the third quarter — inventory growth and federal spending — “are likely to be minuses in the fourth quarter,” he said. Mr. Gault expects the annual rate to sink to 1 percent this quarter, hurt by a fiscal stalemate in Washington as well as the aftereffects of Hurricane Sandy.
To be sure, there were signs of optimism in Thursday’s data. Residential fixed investment rose 14.2 percent, a sign that the housing recovery is gaining steam. Indeed, a separate report Thursday from the National Association of Realtors showed pending home sales rose to a two-and-a-half-year high.
And not all economists took a pessimistic view. “The economy certainly hasn’t taken off, but it’s nowhere close to a stall,” said David Kelly, chief global strategist for JPMorgan Funds. “The economy is still underperforming its full potential, but once we get past the ‘fiscal cliff’ uncertainty, we could see stronger growth next year.”
The new estimate of growth represents a substantial increase in the level of the second quarter, when the economy grew at a rate of just 1.3 percent. It also marks the fastest rate of expansion since the fourth quarter of 2011, when the economy grew at a 4.1 percent annual pace.
This was the second of the government’s three estimates of quarterly growth. The final figure is scheduled for Dec. 20.
“Over all, it was a disappointing report,” said Michelle Meyer, senior United States economist with Bank of America Merrill Lynch. The accumulation of inventories went from subtracting 0.1 percentage points from the initial estimate to adding 0.8 percentage points, she said.
“A lot of that inventory build was unintentional, which suggests a downside risk for the fourth quarter,” she said. “Businesses had expected stronger sales and consumer spending and were caught off guard."
Ms. Meyer said she expected the economy to grow by 1 percent in the fourth quarter and 1 percent in the first quarter of 2013, well below the level needed to bring down the unemployment rate, which stood at 7.9 percent in October.
On Thursday, the government also reported that first-time unemployment claims dropped by 23,000 to 393,000 last week. But Ms. Meyer cautioned that these figures were much more volatile than usual because of the Thanksgiving holiday as well as Hurricane Sandy.
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