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Eric Clapton walks alone into the light and sits down. Wearing a blue shirt and khaki pants, cradling an acoustic guitar, he starts picking Big Bill Broonzy's "Key to the Highway" for a rapt crowd of 6,800 at the Forum in Copenhagen. The rhythm of Clapton's left foot, thumping the floor, is strong and clear. So is his voice. Two days short of his fifty-sixth birthday, Clapton sings Broonzy's travelin' blues, cut in 1941, with the leathery authority of one who has been on the road almost as long.
The next two hours are a soulful roll with his five-piece band through Clapton's own life story: "Tears in Heaven," "Bell Bottom Blues" and "Layla"; the autumnal pop of his new album, Reptile, dedicated to his late uncle, Adrian Clapton. Then at the end, after a gleaming "Sunshine of Your Love," Clapton sits down again with the acoustic guitar and plays an unexpected blues: "Somewhere Over the Rainbow," from The Wizard of Oz. Swinging slightly behind the beat, Clapton digs into the song with juke-joint force. But there is an exhausted melancholy in his performance too, the sound of a man nearing the end of his highway.
"It was born on holiday," Clapton says the next day in his kingly hotel suite, still wearing those khaki slacks, this time with a 1970s-vintage Stevie Wonder T-shirt. On a recent trip to the Caribbean, Clapton – who never travels anywhere without a guitar – learned "Somewhere Over the Rainbow," purely "to test my musical intelligence." He kept fiddling with the tune in tour rehearsals: "The sound guys were going, 'What the fuck is this all about?' " But the song," Clapton says, "insisted itself into the show." As a youngster in Ripley, England, a village in the Surrey countryside outside London, Clapton went to the cinema with his uncle, usually on Adrian's dates with his future wife, Eric's Aunt Sylvia. "I was their chaperon," Eric recalls. "We would see movies like Gunfight at the O.K. Corral, High Society and Carousel. The music from that period was so powerful."
"As I get into my old age," he continues, "those songs are coming up. I may have to do another couple of albums to get these things out of my system – before I can lay down and rest." Clapton delivers that line with a laugh. But he means it. Clapton's current world tour, he says, is his last.
Now in his fourth decade of recording, Clapton enjoys a unique, continuing relevance. He is virtually alone among his classic-rock peers in terms of his work rate – Reptile is his fourth studio project in five years – and sales. Last year's Riding With the King, Clapton's record with longtime idol B.B. King, sold more than a million copies. Personally, Clapton declares, "I'm in a good space with my domestic life." He is expecting a child by his girlfriend of the last two years, Melia McEnery, a twenty-five-year-old graphic artist from Ohio.
Yet Clapton admits that as he was planning this tour, which began in England in February and ends on August 18th in Los Angeles, "I was musing that it might be the last time. Now I'm going, 'This is definitely the last time.' It's hard. It doesn't work for me anymore. I get indigestion. I get tired." He grins. "Just talking to you – I'll pay for this."
"I will leave the door open for a couple of projects, to play the odd theater," says the guitarist, who has two albums left in his Warner Bros. deal. "But I'd say this was near the end."
"Anyone I talk to about it goes, 'Oh, you'll never stop.' I won't, in truth. I will always want to express something. But," he insists, "I don't need to do it like this anymore."
"It's been ten years I've been doing this with Eric," says Clapton's rhythm guitarist, Andy Fairweather-Low, over coffee before showtime. "And I still haven't figured out why when he goes – he makes a screaming-guitar sound – it has that effect on you."
"I have one bit tonight that I do – I'll mull over what I'm going to do when it's my turn," says Fairweather-Low, a buoyant Welshman who sang with the 1960s group Amen Corner and made several fine solo LPs in the 1970s. "But Eric doesn't even think. Jump on him at any time, say 'Go!' and he'll take you to another level. Then if you say 'Once more,' he'll take you even higher."
"Jump on me," Fairweather-Low adds, "I'll freeze."
At the Forum with Fairweather-Low, bassist Nathan East, drummer Steve Gadd, keysman David Sancious and percussionist Paulinho Da Costa, Clapton plays with compact fire. In the 1970s, he could roll out diamond riffs for a quarter hour in a single blues like T-Bone Walker's "Stormy Monday." But tonight's high points include the precise shiver of Clapton's break in "River of Tears," from the 1998 album Pilgrim, and his gabba-gabba burst of wah-wah in the Reptile cover of J.J. Cale's "Travelin' Light." "I can't play long solos anymore without boring myself," Clapton contends. "I think it's important to say something powerful and keep it economical. That wasn't available to me as a younger player. I was motivated by ego. If I thought I was doing something good, I would do it all night." Backstage, Clapton is a man without any visible superstar pretensions. In the band lounge, he greets visitors warmly, fixes his own cappuccino and tries to coax band mates and crew members into table-soccer matches. (It's a tough sell; Clapton is an ace player.) The owlish spectacles he wears offstage, combined with his close-cropped hair and grayish beard, lend him a professorial air. But it suits his encyclopedic passion for music. During the opening set by guitarist Doyle Bramhall II and his band, Smokestack, Clapton cocks an ear at a quote in one of Bramhall's solos. "'Stone Free,'" Clapton says quickly, referring to the Jimi Hendrix song.
Clapton is "definitely a fan of music," says the Texas-born Bramhall, who contributed songs and guitar to Reptile and Riding With the King. "I grew up playing the blues. I know some obscure artists. I thought I would hip him to some: Louisiana stuff like Lightnin' Slim." Bramhall laughs at his audacity. Clapton "knew all about them: the artists, the other people who played on the records, the producers."
Clapton talks of his own career with a directness that reflects years of acute study. Asked whether there is any misconception about him as a musician that he would like to clear up before he retires, he simply says, "That I'm any good, really." Even in front of the most adoring audience, he goes on, "I'm just trying my best to sing in tune. I'm focusing with all my might to get the next note on the money."
But Clapton is not embarrassed by acclaim. "It was great support," he says of the legendary graffiti, CLAPTON IS GOD, that appeared in London during his 1965-66 tenure with bluesman John Mayall. "It was instrumental in giving me the confidence to push forward. When I left the Yardbirds, then John Mayall and Cream, these were all scary decisions to make. I could have stayed and cleaned up. But I used that support to say, I must be doing the right thing."
Clapton is fearless about assessing his earliest successes, how the immediate superstardom that came in the 1960s with Cream and Blind Faith both fed and masked his emotional insecurities. "I was so disappointed," he says of listening to the disc of unreleased jams that came with the recent reissue of the Blind Faith album. "At the time, I thought these were magnificent things we were doing, just jamming away. But I was a kid. The only personality I had was within my fingers. I could play it, but I couldn't say it. When we didn't have a song, I'd just think, 'Let's get stoned.' Which we did when we didn't know what we were doing."
Clapton looks back on his records from the mid-1970s – after his recovery from heroin addiction and as he sank into a drinking problem that lasted into the mid-1980s – with the same honesty. "My attitude was anti-guitar playing, and I thought I was doing the absolute right thing," he says. "A lot of it was wrapped up in my alcoholism. There was a denial in the way I was approaching those records: One in Every Crowd, Another Ticket, Backless. I got a lot of flak, and I wouldn't listen."
"Since I got sober, I've just been trying to develop . . ." – Clapton pauses, searching for the right phrase – "a career with dignity, records where I can say, 'I finished it, it's complete.' Whether or not it's up to the standard of the current thing, it's complete."
Eric Clapton was born on March 30th, 1945. His mother, Pat, was sixteen and unmarried; she left Eric in the care of her mother, Rose, and Rose's second husband, Jack, who raised Eric in Ripley. Pat later married a Canadian serviceman and had three more children, a boy and two girls. Clapton is still not certain who his own father was: "My father, I think, was Canadian," he says. "I'm not 100 percent sure." But in Pat's brother Adrian, Eric found a valuable paternal influence, one he celebrates in conversation as well as on Reptile.
The album title, Eric explains, is local Ripley slang, "a put-down, but only in a way that you would say to someone you really like." To Eric, Adrian was indeed a reptile, an endearing rogue who taught him much about the world.
"He was a rebel, a local James Dean," Eric says. An old photo in the Reptile CD booklet – a handsome, raffish Adrian with Sylvia at a British seaside resort – confirms Eric's description. Adrian was an engineer for a motor company. He was also an atheist and a science-fiction enthusiast ("He had all of the early Kurt Vonnegut books," Clapton notes). Adrian played the chromatic harmonica and introduced Eric to jazz and the swing music of Stan Kenton and Woody Herman. "I started getting to the blues from other people," Eric says. But "hearing that dance-band stuff – messages were coming through."
At fifteen, Clapton got his first guitar; by eighteen, he had dropped out of Kingston College of Art and was in the Yardbirds. Over time, the bond between uncle and nephew "got lost," in Clapton's words. When the guitarist stopped drinking, he broke off nearly all contact with Adrian. Eric deeply regrets that now.
"When I got sober," he says, "I had to re-evaluate all of the old people, places and things, see how dangerous they are to staying sober. My mother and uncle were big boozers. I deliberately removed myself. I became very anti-social and hardly spoke to him at all. For the last ten years of his life, I was not there." Adrian died in the spring of last year. Reptile did not start out as a memorial to Adrian. Clapton set a date to start recording, showed up, then realized, as he puts it, "that I didn't have an idea what I was there for." He took a break to visit his half sisters, who live in Canada, and spent a lot of time with them talking about Adrian: "I went, 'Of course, that's what's going on in me, and I'm not attending to it.'" Clapton had already been working on a country-blues shuffle, "Find Myself." "The chorus didn't make any sense," he says, "until I wrote the verses about my experiences with my uncle and the way I felt about him. I had the musicians, I had the studio time. Then I got the message: 'I need to sing about this area of my life.'"
Nightly, onstage, Clapton revisits specific, painful chapters of his past: in "Bell Bottom Blues" and "Layla," his desperate and, at the time, unrequited love for Pattie Boyd, ex-Beatle George Harrison's then-wife, whom Clapton eventually married in 1979; in "Tears in Heaven," the 1991 death of his first son, Conor, in a fall from a high-rise apartment window in New York. Clapton accepts that these songs are hits, that he is obligated to play them at every show. But it has not been easy.
He remembers going on tour in 1992, after "Tears in Heaven" went to Number Two. "I'd walk out, start playing that, and the applause . . . they would drown me out," he says. "I would get furious. Afterward, offstage, I would be inconsolable. I was feeling vulnerable and exposed – and they'd be chanting and yelling and whistling. I was raw and not able to make sense of it."
"I don't go back to that specific event when I perform the song now. I honor the way I was, try to reflect on it and do a good performance. It isn't difficult now. It's good fun." Clapton made Reptile with the same intention. Much of the record is given over to pure pleasure: covers of "Come Back Baby" by Ray Charles and Stevie Wonder's "I Ain't Gonna Stand for It," in which Clapton admits, with a wink, that he is "honoring my own taste." But Reptile commemorates the individualism Adrian passed on to his nephew. "That's why I had such a great love for him: You could not bat him off course," Eric says. After Adrian died, Eric learned that his uncle never begrudged Eric for being out of touch.
Adrian "never tried to contact me or ask for anything," Eric says. "And from what I've gathered, he wouldn't hear a word spoken about me in criticism. People would say, 'How come Eric hasn't been around to see you?' He'd say, 'Well, that's his business.' He'd stop 'em short. A wonderful man."
In the band lounge at the forum, after his second Copenhagen show, Clapton is talking about retirement again. "I've been retiring since I was seventeen," he exclaims cheerfully. "It was imminent. When I left the Yardbirds in 1965, it was over!"
"I think I've always been looking for the journey to end," he adds with more seriousness. "My life in music is eternal. But the notion of trying to fit into an industry that I no longer have any admiration for . . ." His voice trails off, not in disgust or weariness but sadness.
Clapton already knows what he wants to do on his last two Warner Bros. records. One will be a collaboration with the Impressions, who contributed backing vocals to Reptile. The other will be "soulful rock blues, like an old Tony Joe White record."
And he is clearly thinking about the end of the road. Asked what he would like to play as the final encore of his last-ever show, Clapton recoils in mock-horror. "God!" he exclaims. "What a leading question." He has an idea, though. "There's a great song that I discovered on a Nat "King" Cole trio album that I'm going to learn, 'For All We Know.'"
"The first verse goes, 'For all we know/We may never meet again.' I know this from the mortalities that have happened in my life. The real shock was my son. What I learned from that was that every moment is precious. Either one of us could walk out of this room, and I would never see you again, for one reason or another. We have to get the max out of every moment. So me doing a tour – it really is a good idea to think about it as, 'You and I may not do this again.'"
"People think it's a drama-queen attitude," he says. "It's a reality check. This is probably the last time, guys. So I'm going to try and give it my best shot."
"And I hope you can make it."
Eric Clapton Tour Dates:
Eric Clapton Tickets 9/16: Minneapolis – Xcel Energy Center
Eric Clapton Tickets 9/18: St. Louis – Savvis Center
Eric Clapton Tickets 9/20: Chicago – United Center
Eric Clapton Tickets 9/21: Grand Rapids MI – Van Andel Arena
Eric Clapton Tickets 9/23: Auburn Hills MI – Palace of Auburn Hills
Eric Clapton Tickets 9/24: Toronto – Air Canada Centre
Eric Clapton Tickets 9/26: Ottawa ON – Scotiabank Place
Eric Clapton Tickets 9/28: New York – Madison Square Garden
Eric Clapton Tickets 9/29: New York – Madison Square Garden
Eric Clapton Tickets 10/3: Boston – TD Banknorth Garden (Fleet Center)
Eric Clapton Tickets 10/6: Uncasville CT – Mohegan Sun Casino
Eric Clapton Tickets 10/7: Uncasville CT – Mohegan Sun Casino
Eric Clapton Tickets 10/9: Philadelphia – Wachovia Center
Eric Clapton Tickets 10/10: Washington DC – Verizon Center
Eric Clapton Tickets 10/12: Charlottesville VA – John Paul Jones Arena
Eric Clapton Tickets 10/14: Duluth GA – Gwinnett Center
Eric Clapton Tickets 10/15: Raleigh NC – RBC Center
Eric Clapton Tickets 10/17: Charlotte NC – Charlottte Bobcats Arena
Eric Clapton Tickets 10/18: Birmingham AL – Birmingham Jefferson Arena
Eric Clapton Tickets 10/20: Orlando – TD Waterhouse Centre
Eric Clapton Tickets 10/21: Jacksonville – Jacksonville Veterans Memorial Arena
Eric Clapton Tickets 10/23: Miami – American Airlines Arena
David Fricke
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Antony Starr worries that he's angered the producers of his Cinemax series "Banshee," or possibly the universe in general.
"If I'm honest it has crossed my mind that possibly I've done wrong to someone, I've pissed them off in some way," the New Zealand native said during a recent phone chat, "because the guys that I'm fighting just seem to get bigger and bigger. And every day I do a fight sequence I come out of it battered and bruised. So, you know, it's payback for some transgression either in this or a past life."
As Sheriff Lucas Hood in the action series, Starr squares off against increasingly larger foes, often getting beat to a pulp even if he comes out on top in the end. In the show's first season, Hood faced down a character known as The Albino in prison. This season's answer to that bruiser is Chayton Littlestone (Geno Segers), a member of the Kinaho tribe living next to the Amish outside of Banshee, Penn.
"That guy is huge! He is huge," exec producer Greg Yaitanes told me in a separate interview. "If you are a big human being you have a good shot at being on 'Banshee.'"
Littlestone and Hood battle in "The Warrior Class," airing at 9 p.m. Jan. 24 on Cinemax, when the sheriff attempts to question Littlestone's friend in connection with the murder a girl from the tribe. As you can see in the video preview above, Starr once again gets tossed about in the epic fight.
Exec producer, writer and creator Jonathan Tropper didn't sound too distressed about putting Starr in the line of fire when I spoke to him, telling me, "Some guys just look better bloody."
Not that Starr is complaining about the stunt work. He actually enjoys getting the crap beat out of him.
"Yeah, look, I'd be lying if I said I didn't. I do quite enjoy them—weirdly and maybe in a slightly masochistic way," he said. "What I love about them is not getting battered and bruised but I love the fact that the character goes in against all odds and sort of pits himself against ridiculous ogres of men. And it's the spirit that triumphs in the end."
Starr, who before "Banshee" had done mostly TV work in New Zealand, had never done much stunt work. He said the stunts are demanding but a challenge he enjoys. Part of the prep work for a season on "Banshee" includes a lot of physical training, he said, but nothing really prepares you for filming the fight scenes, which can take up to 25 hours to shoot.
"I mean, I'm not a huge guy. I'm about 180 pounds and I'm fighting guys that are like anywhere from 230 to 250. So it really is getting thrown around by big dudes and getting hit by them," he said. "Even when it's just play acting it does take its toll after a while. So it's pretty brutal."
Starr talked more about the toll of fight scenes, Lucas Hood's state of mind in Season 2, and his love life.
I read you were injured in Season 1.
Yeah, actually day one of shooting as an introductory gift, a welcoming gift I got six stitches in my lip from a fight sequence when the choreography just got slightly mixed up and someone's head went into my face at a time when it wasn't supposed to. And I wasn't ready for it and it just split my whole lip open. So that was day one. It was a welcome to "Banshee."
Do they carry on and just keep shooting?
We carried on. I think the schedule was pretty tight because that was the pilot episode. So we could have taken me off to hospital but we only had this location for one day so it was kind of over to me. They could take me off to the hospital or I could make the choice to keep shooting. So I kept shooting and then they took me at the end of the day. We shot another six hours and then they took me off and I got stitched up and went back to work the next day. Yeah, it was a lot of fun.
Always a challenge.
Always a challenge. I could do without that, if I'm honest. That's going a little too far because it was on my lip and I was doing a new American accent. So it was a bit of a hindrance; having a face full of meat that's exposed was kind of awful.
It looked good on camera though, right?
Oh my God. I think they spent so much time and energy at the end of the pilot episode just painting out my puffy lip. ... It was day one and that fight happened about halfway through the episode so everything after that fight sequence they could leave alone. But everything up to there had to be painted out. So it was quite a lot of work in post-production.
This season Lucas seems a little messed up. He's having these visions of Rabbit and panic attacks.
Yeah, I mean psychologically he's been messed up. I reckon since he got out I think there's been a lot of mental issues going on as a part of getting released and facing up to it to where he's at. But this season definitely if you look at what happened at the end of the first season he effectively committed suicide by swapping himself out for the boy. And then went unconscious, came back to consciousness and is still alive.
Not only that, he's got a second chance to take care of the people that he loves. And I think part of the post-traumatic stress disorder that I believe he came back with—part that is the hallucinations and visions and really struggling to cope with what's happened to him. So internally everything's sort of tipped on its head and externally everything's positioned very precariously on the edge. So it's definitely an interesting spot to be in to start the second season.
Do you feel that he's become more thoughtful and caring?
Yeah, yeah, yeah, definitely.
Is he tired of the violence?
Absolutely. Look, I think Lucas when he first got out of prison was all about himself and getting back what was his. And then through the course of Season 1—at the base of it all Lucas wants to be a part of a family and part of a community—like he has the same basic human needs that we all have. And without realizing it he has created that for himself in the deputies and the people in the town. And they come to his aid at the end of Season 1.
In Season 2 there's that realization not only does he have a daughter and a need to protect her, but also he has a responsibility in some way, shape, form to that community that went to bat for him. A lot of what's going on in Season 2 is about looking at other people and realizing that it's not all about him.
Does that realization make him weaker, or I mean more vulnerable?
I don't think it makes him weaker at all. It definitely makes him more vulnerable because when it's just you then you can be physically hurt, but they can't emotionally screw with you in the same way as when you actually love others. And getting to others is a great way to impact him. Rabbit is still at large and at completely unknown quantities. So it's all about protection and taking care of those you love.
He still loves Ana, or Carrie now.
But so much happens that makes me want to ask you, is there a woman that Lucas won't go to bed with?
Ha, ha, ha. I don't know. I think that's a part of it. I think Season 1 was like getting out of prison and that's part and parcel of a man getting out of prison. I self-diagnose the character as having antisocial personality disorder, part of which is promiscuity. So I've always looked at it from a character point of view and a story point of view.
And I think that settles down toward the end of Season 1, but in Season 2 it's still there. He's still human. He's still a man. He has needs and some of those needs can be met by getting entangled with the opposite sex. But inevitably that's not really what the heart of the character is about. That's just the distraction on top that makes him temporarily feel [better]. It's escapism, you know?
He strikes up a relationship this season with somebody from the office.
Yeah, I think with it being he can never be together with Ana, closing the door in that sense opens the door in another sense. It makes him very much free and available to really pursue other romantic avenues with his heart rather than just from a fleshy point of view.
Whenever we do these scenes—the sex scenes or anything like that—there's always a psychology involved. And whilst people might turn up and take it at face value and think that it's superficial and shallow, if you actually look at the scenes and dissect them there's always a lot of story and character going on. So at its heart Lucas is really looking for connection and, yeah, Season 2 entertains that notion.
Well now, I wasn't even talking about sex scenes there.
[Laughs.] Oh no, I know. I figured I'd just throw it in for you.
With Deputy Kelly (Trieste Kelly Dunn), he seems to genuinely care. Does that further his growth in your eyes?
Yeah, absolutely. The show's all about a broken human becoming whole again from his point of view. So it's really the way that we sort of heal ourselves and move forward and grow is true connection with other people. And there's no stronger connection than with an intimate other. So inevitably he's gonna be looking for that and that's something that's gonna be an ongoing [subject].
There's a great line from Job (Hoon Lee) this season. He tells Lucas that people who get close to him get burned or killed. I can't remember exactly what it is, but I loved the line and I'm wondering if you feel Lucas believes that, too? Or do you think he he has a romantic notion that he can change all that?
Both. I think that is a truth. I think it's about not being able to escape your past and having your past coming back to haunt you. But I also think he believes and has to believe that you can achieve more, that you can be more, that you can get rid of the monkey on your back and move forward and become something more than what you are.
And he really wants to get to know Deva, his daughter.
Yeah, I think having that new responsibility of being a father and wanting more—that works hand-in-hand with wanting more out of life and wanting to be there for her and develop in that sense as well.
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SAMJ: South African Medical Journal
versión On-line ISSN 2078-5135
versión impresa ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.100 no.10 Cape Town oct. 2010
Mental health advocacy - lessons from HIV activism
It is encouraging that since 1994 the South African government has worked hard to create legislation and policy that place equality, human rights and justice at the centre. This is the case for health, education, social development and the legal system. However, it is a depressing reality that in many (if not most) cases, those charged with implementing the transformative changes in society have failed due to a host of reasons. Lack of skills coupled with unwillingness to consult with those working at the coalface has resulted again and again in poor planning, inappropriate interventions and a waste of valuable resources. Nowhere is this truer than for the provision of psychiatric and mental health services for our communities.
Two papers in this edition of the SAMJ address this issue and provide data from KwaZulu-Natal to substantiate claims that in that province good legislation has not translated into good practice as far as psychiatric service provision is concerned. Ramlall and colleagues1 outline some of the progressive changes enshrined in the Mental Health Care Act (2002), including the introduction of the 72-hour observation period at designated general hospitals and the appointment of Mental Health Review Boards (MHRBs). The former development, as these authors explain, was intended to increase access to mental health care, avoid unnecessary and stigmatising admission to psychiatric hospitals, and improve medical care for those with acute psychiatric disorders. The MHRBs were intended as 'ombud-sbodies' that would safeguard the interests and rights of individuals treated under the Act. Burns2 draws attention to the fact that the South African government has committed itself on the international stage to the principles of equality, non-discrimination and human rights for those with disabilities, including mental disorders (through signing and ratifying the United Nations Convention on the Rights of Persons with Disabilities and its Optional Protocol). On paper, therefore, South Africa scores high on its public commitments to improving the lives of those with mental illnesses. But from these two reports we learn that psychiatric and mental health services in the most populous province are in a sad state, and that the law and policy makers have not moved 'beyond mere rhetoric'2 to ensure transformation. In fact, the mental health services are characterised by inequitable funding and resource allocation, shortages of mental health facilities and professionals, almost non-existent tertiary psychiatric services and a lack of proper planning, provisioning, training and support at general hospitals to enable them to perform their mandated functions in terms of the MHCA (2002).
Those working in the mental health field often bemoan their sorry lot by referring to themselves in terms such as the 'poor cousins' or the 'soft under-belly' of the health services. In using such language they are correct, as psychiatric disorders and mental health care are usually not high on the list of priorities for politicians, health planners and funders. As Burns2 acknowledges, our country is faced with innumerable social and public health challenges that require attention and rightly consume the lion's share of budgets. However, it is not enough for those who care about mental health just to complain and bemoan their lot. History has shown that the mere wringing of hands does not bring about change. More is required. We are very fortunate in South Africa, because we have an excellent recent example of what kind of action firstly draws attention to a public health crisis and secondly brings about a tangible response that is felt on the ground. That example is the HIV/AIDS pandemic.
During the 1990s it was increasingly clear that HIV was having a massive impact on the social and economic life of South Africa. Internationally, many countries with a lesser burden of HIV/AIDS were rapidly implementing preventive and treatment strategies with apparently good outcomes. As we well know, the South African government did not respond timeously or appropriately. Then in the past decade we have witnessed a change of attitude that has resulted in unprecedented efforts to meet this crisis head-on. Why did this transformation happen? What brought about the change of heart? Like mental illness, HIV and AIDS are highly stigmatised conditions. As in the case of mental illness there is too often a veil of secrecy and shame around affected individuals and their families. And, as with people living with HIV/AIDS, those with mental disorders have too often been victims of social alienation, victimisation and abuse. So, what can advocates of mental health service transformation learn from the extraordinary success of the HIV/AIDS advocacy movement?
The first lesson is that any successful advocacy movement must, at its core, be represented and driven by 'user activists' - that is, individuals living with HIV, mental illness, etc. The Treatment Action Campaign (TAC) was founded and spearheaded by a group of HIV-positive individuals who were no longer prepared to be passive victims of an unjust system. TAC is now 'the world's most effective AIDS group', 3 has 16 000 members, and was nominated in 2004 for the Nobel Peace Prize. A number of countries in Europe and Australasia have strong user-led mental health advocacy movements that are starting to bring about change. South Africa, like many developing nations, does not have such an advocacy movement. This is a key limitation to effecting transformation in our mental health services.
Secondly, the highly successful HIV campaigns in South Africa and elsewhere have recruited champions to help raise the profile of their cause. Bono (of the Irish superstar band U2) is a regular star attraction at the Global Economic Forum, talking about poverty and HIV/AIDS, and has his own global campaign focused on HIV in Africa called 'Red'. Annie Lennox, another famous rock star, talks about HIV every time she gets on stage. Ex-US vice-president Al Gore is a major asset for the climate change advocacy movement, while glamorous actress Angelina Jolie is arguably the public face of the causes adopted by the UN High Commission for Refugees. As Thrall and colleagues4 explain, 'The trick for any cause, then, is to get and maintain public attention long enough to influence policy outcomes.' In the UK, a nationally organised mental health anti-stigma campaign ('Time to Change') recently recruited boxing legend Frank Bruno as a spokesman - Bruno was diagnosed with bipolar disorder in a much-publicised psychiatric hospital admission in 2003. Given the very high prevalence of mental illness in the population, it should not be an insurmountable challenge to find similar celebrity 'users' in South Africa to help focus public attention on mental health needs in our country.
The third factor contributing to the success of the HIV campaign in South Africa is that of evidence. Methodologically water-tight research yielding important data on epidemiology, natural history, biological processes, treatment response and health services functioning has been (and continues to be) critical in shaping policy around HIV/AIDS prevention, detection and treatment.5 To this end, the Lancet published a series on global mental health in 2007 that presented in a coherent manner the overwhelming evidence for a significant 'treatment gap' between mental health needs and services, especially within low-and middle-income countries. Subsequently, international advocacy groups such as the Movement for Global Mental Health (www.globalmentalhealth.org/) have used these publications and the evidence they present as a powerful weapon supporting their cause. In South Africa there has until quite recently been a relative paucity of good data that both describe the extent of the burden of disease attributable to mental disorders and document the deficiencies in mental health service provision. Now, however, the evidence is beginning to accumulate. The two papers published in the SAMJ this month add to this evidence-base by reporting data obtained at the levels of both health systems organisation2 and actual service provider experience.1
The problems that beset the provision of psychiatric and mental health care in KwaZulu-Natal are likely to be generic across all provinces. These problems are not going to go away in a hurry, especially in a context where poverty, infectious diseases and noncommunicable diseases give rise to a massive burden of ill-health and disability. The mental health community - both professional and lay - needs to take a leaf out of the HIV/AIDS advocacy movement's book and mobilise itself into a high-profile, populist force to be reckoned with. Mental illness and its service-related needs must be thrust into the public eye as a major issue which, if ignored, will threaten the well-being of society in all its facets - social, economic and political. Sitting and waiting for the government to experience a spontaneous change of heart will, as we know from sorry experience, lead to nothing.
Jonathan K Burns
Department of Psychiatry
Nelson R Mandela School of Medicine
University of KwaZulu-Natal
1. Ramlall S, Chipps J, Mars M. Impact of the South African Mental Health Care Act No. 17 of 2002 on regional and district hospitals designated for mental health care in KwaZulu-Natal. S Afr Med J 2010;100:667-670. [ Links ]
2. Burns JK. Mental health services funding and development in KwaZulu-Natal province: A tale of inequity and neglect. S Afr Med J 2010;100:662-666. [ Links ]
3. Rosenberg T. For people with AIDS: a government with two faces. New York Times, 30 August 2006. http://www.nytimes.com/2006/08/30/opinion/30wed4.html (accessed 2 August 2010). [ Links ]
4. Thrall T, Lollio-Fakhreddine J, Berent J, et al. Star power: Celebrity advocacy and the evolution of the public sphere. International Journal of Press/Politics 2008; 13:362-385. [ Links ]
5. Joint Statement by Centre for Infectious Disease Epidemiology and Research; School of Public Health and Family Medicine, University of Cape Town; Médecins sans Frontières; Treatment Action Campaign (8 July 2010). HIV incidence in South Africa: what is really happening? http://www.tac.org.za/community/node/2904 (accessed 2 August 2010). [ Links ]
Corresponding author: J K Burns (firstname.lastname@example.com)


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Saturday, December 1, 2018 3:00 PM - 3:00 PM
Quiet Valley Living Historical Farm
Gather around a bonfire while you wait for your lantern-lit visit to the 1800s led by guides in period clothing. Enjoy watching an enacted scene where a Victorian family is busy working on Christmas preparations. While you are there you can peek at their Christmas Putz, a homemade nativity and village scene that was a custom the Moravians began and was soon enthusiastically adopted by the Pennsylvania Germans.
Afterwards, it's on to the living Nativity located in the barnyard which includes the farm animals and offers a glimpse at the foundation of this special holiday. Then off to a simple log cabin where folks will enjoy another family's Christmas joy. Christmas caroling in the one-room schoolhouse gets quite exuberant as the musicians and school marm lead the singing of favorite seasonal tunes. At the original farmhouse, the Belschnikel, a traditional Pennsylvania German character who made his rounds in the Christmas season, will appear in the cellar kitchen to remind children that it's not too late to be good!
The tour caps off in the Engel Education Building with complimentary refreshments and don't forget to visit the Gift Shop which is stocked with items handcrafted by Quiet Valley's heritage craftspeople. It is the perfect place to find unique, local gifts at reasonable prices. Old Time Christmas is sure to become a favorite holiday tradition for many years to come.
Quiet Valley Living Historical Farm
345 Quiet Valley Road
Stroudsburg, PA 18360


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A group of about thirty guests and residents of Nitzana sing "Shalom Aleichem" together under the rising full desert moon. We are 8 and 18 and 40 and 60. We are men and women from Tel Aviv suburbs and Paris and development towns in Northern Israel and Moscow and Washington D.C.
A global (eco-)village
The world alters as you near Nitzana. You will see military drills and camels, and road signs to remote communities. As far as the eye can see – there is you, there is sand, and a parched sky. Which leaves ample space for you to dream.
Indeed, that is how the place was born.
Nitzana is an educational eco-village in Israel's Negev, about 30 minutes beyond the last signs of civilization (Aroma and McDonald's), and just before the Egyptian border. It was imagined by late Labor party visionary Lova Aryeh Eliav, and built by The Jewish Agency for Israel. Eliav wanted Nitzana to become a "school to teach respect for humanity and its place in developing the arid wilderness," and truly – it is.
Today it is administered by The Agency and the Negev Regional Council, and headed by a compact, ageless man appropriately named David Palmach, a true blue (and white) cowboy who began as Eliav's right-hand-man close to two decades ago. And like any desert cowboy worth his sand in these parts, he makes perfect mint tea.
A strange looking tube-like structure at the village's edge is a sun-powered 'desert cooler,' one of several installations in Nitzana's solar park, a small outdoor science museum about green energy which is visited by about 10,000 kids every year.
But the thing about Nitzana is who lives there.
The dwellers at Nitzana are incredibly tranquil, particularly since most of them are between the ages of 14 and 24. Where their counterparts in cities are often wild, these transplants to the wilderness crackle with positive, open energy, disturbing no one or nothing but the Universe, in the T.S. Elliot sense.
They are a living mosaic who in their very being answer the question of "why Israel." In the Herzl sense.
Nitzana is: Students at the post-high school service learning program (Derech Eretz), kids from Israel's periphery who spend six months learning and volunteering instead of warming their mothers' couch during the time between high school and IDF service. They return home sunburned, independent, empowered, and with a strong sense of communal responsibility.
Nitzana is: Participants of an Aliyah program called MIR, young people from the Former Soviet Union learning Hebrew and getting acclimated to their new country and culture with the help of a well-trained staff. It defies logic how people used to negative temperatures can love the desert, almost instantly.
Nitzana is: Other students, on a Masa Israel Journey program called Desert Challenge, a semester or two of Hebrew study and sport-instructor training in cooperation with the famed Wingate Institute. Swimming, working out, learning physiology, and hiking, many students fall in love with Israel (or an Israeli) and come to stay; others go back to their countries of origin as excellent ambassadors for Israel and Judaism… and in perfect shape.
Nitzana is: A few dozen Eritrean refugees, boys between the ages of 14 - 18. They walked across Sinai, often brutally abused on the way, to seek human rights and refuge in Israel. A boarding school at Nitzana provides these unaccompanied minors with supervision and vision – several years of being held by kind, professional arms – and an education.
Nitzana is: Some two dozen kids doing a year of service before being conscripted to the Israel Defense Forces (IDF). These are Israel's elite; demand for a volunteer year at Nitzana is in the hundreds, of whom the top few percent are chosen. These volunteers (called "shinshinim" in the Hebrew slang) guide school children at the solar park and guests at Nitzana's hostel, act as big brothers and sisters to the Eritrean kids, tend arid crops, and generally behave as if the future is in their own personal hands, which I most certainly hope it is.
All of these young people take their meals together in a big dining room. There is total decorum. Every time.
Whispering Sands
A recent acquaintance, Tel Aviv attorney Gideon Fisher, remarked that he had thought the pioneer era was over, that his parents' post-Auschwitz generation had suffered and done the work of nation building so our kids' generation would not have to. A highly respected, successful professional with extensive international ties, Fisher was sure that Israel had finally arrived as a full-fledged Western country without the need for constant remaking. He found himself corrected on his visit to Nitzana, where the pioneer spirit is something, as he put it, "you can feel between your toes."
On second thought, we mused together, perhaps constant re-invention is simply who we are, as Israelis, and as Jews. Perhaps it makes us who we are. I am reminded of Shimon Peres's mandate to be forever dissatisfied, like his mentor, David Ben-Gurion, another man of the desert.
The Silicon Coast of Herzliya and the sands of Nitzana bear the very same DNA, after all.
If you will it…
Back in Jerusalem, Nitzana is a mirage. But it is living proof that dreams are real, if you give them air, sunlight, and respect.


text: Say Yes to the Desk Posted on June 4, 2014When you think of working at a desk in your home, the office usually comes to mind. But desks these days are breaking away from a defined home office space and have made a big splash as a functional space in the kitchen. "Desks in the kitchen are not a new idea, but in the… more


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Home > Public Services > Elder Law Fair
Each spring, the Center for Elder Law & Justice http://www.elderjusticeny.org/ partners with several community groups and presents the Elder Law Fair. The program was first presented in 2001 and is well-attended, providing hundreds of seniors the opportunity to take advantage of free seminars and events designed especially for senior citizens, family members, caregivers, case managers, and other professionals in the field of aging and long-term care. Participants attend seminars that provide accurate and detailed information on law-related topics such as long-term care planning, wills, trusts and estate planning, and Medicaid/Medicare issues.


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Kevin Buenafe has not received any gifts yet
Hi Kevin,
This website is pretty confusing to me. Thanks for the reply. Please contact me at either my email (email@example.com) or cell phone 206-601-8157 (voice or text).
Sounds great to hit it around. I should be able to play this afternoon after you get off work. We may be hiking in the mtns earlier in the day.
Hey Kevin,
I'm a 56 yr old 4.0 guy in Santa Fe for the month of October. I play singles/doubles men/mixed. Interested in getting together with individuals or groups to play. I'm retired so available anytime of day really.
I tried sending a message to the group, but have to wait for a 'friend request' to do so. I played with the website and found this way to contact you...
My cell phone is 206-601-8157. Can call and/or text.
© 2019 Created by Mark / The Mayor. Powered by


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I'm being watched, closely and with a sense of longing.
I fiddle with my wedding ring, trying to douse an old flame before it rekindles.
It's super tough, because I remember our time together.
How could I forget?
So much laughter. So much carefree fun. So much passion.
I'd be lying if I didn't admit to thinking about those days.
I'd be dishonest if I refused to admit there were times — especially when engulfed in the responsibilities of family and work — that I've longed for time travel to back then.
All those years ago, it was, as Sir Jim Cuddy sang, bad timing that's all.
I had things on the go and there were some serious strings attached.
I couldn't commit to the work our relationship required.
We drifted apart.
But now, many years later, I'm being presented with this chance to pick up where we left off.
I'm tempted.
Sorry if you think less of me.
I'm human.
Maybe we could just spend an hour or two together.
Or maybe this could become a weekly escape from it all — a reprieve from work deadlines, getting receipts together for taxes, depressing world news and carting the kids around.
Aaaah, the kids.
What would they think?
What would my wife think?
I don't even want to go there.
Maybe no one would find out, although being discreet was always impossible for us.
Oh, maybe I should just go for it.
No! No! No!
I can't take this risk. It's not worth it.
A stream of memories starts flowing and I can't stop the flood.
Dancing fast and slow, and madly off in all directions.
Singing "The Foggy Dew" aloud.
Dreaming about what was possible.
Three pools form at these thoughts.
One is filling with the past.
One is raging with temptation.
One is overflowing with guilt.
I've got to bail and get the heck out of here.
I came to get something for my kids, but now I leave feeling weak and guilty.
But I just can't give in.
There's no way I can play Gwyneth, my fiddle, the instrument I've been trying to master since Chrétien was in power, right now.
Other, bigger, priorities are calling and I can't justify pausing for a few tunes.
Wait …
What did you think I was talking about?
Try infiddelity.
Steve O'Bartlett is an editor with TC Media. He dives into the Deep End every Monday to escape reality and plan for St. Patrick's Day. Reach him at firstname.lastname@example.com.


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I only play because it's something to do and I honestly perfer Tides over this monstrosity but yeah. Anyhow they put out another new hero to keep the gimics going but I found this one so familliar I figured I'd let you guys know.
http://www.leagueoflegends.com/news/new ... son-reaper
Sounds like a certain blood mage we all know = /
I guess some old habbits die hard. (Referring to the rumor that they basically stole most of the abilities and character ideas for dota )


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NEW YORK (Reuters) - U.S. stocks rose on Friday as Dow component Hewlett-Packard surged on strong results and comments from Fed officials allayed fears that the central bank would curtail its stimulus measures.
Federal Reserve Chairman Ben Bernanke downplayed worries that the Fed has fueled asset bubbles that could hurt the economy in a private meeting with bond dealers and investors earlier this month, Bloomberg reported on Friday.
Bernanke's view helped ease fears that the central bank may end its easy money policies. Minutes from the Federal Reserve's January meeting hit markets on Wednesday as investors interpreted divergent opinions on the benefit of stimulus as a sign the measures may be halted sooner than thought.
"They are in uncharted territory with divergent views," said Jack Ablin, chief investment officer at BMO Private Bank in Chicago. "I could see some pretty heated opinions on what the ultimate outcome is, so I do believe there is dissension."
Hewlett-Packard Co
The Dow Jones industrial average <.dji> gained 119.95 points, or 0.86 percent, to 14,000.57 at the close. The Standard & Poor's 500 Index <.spx> rose 13.18 points, or 0.88 percent, to 1,515.60. The Nasdaq Composite Index <.ixic> added 30.33 points, or 0.97 percent, to end at 3,161.82.
With Bernanke's reported comments much on their minds in Friday's session, investors will want the Fed chairman to reiterate his remarks publicly when he speaks before the Senate Banking Committee on Tuesday. That would echo comments made by two top Fed officials on Friday.
Boston Fed President Eric Rosengren and Fed Governor Jerome Powell both defended the U.S. central bank's asset-buying program, arguing that the policy helps the U.S. economy.
The S&P 500 shed 1.9 percent over the previous two sessions, its worst two-day drop since early November, following the release of the Fed's minutes on Wednesday. The selloff marked the end of seven back-to-back weeks of gains for stocks.
For the week, the S&P 500 slipped 0.3 percent and the Nasdaq lost nearly 1 percent. Only the Dow ended the week with a gain - up just 0.1 percent.
HP's results come near the end of a relatively strong earnings season in which 70 percent of S&P 500 companies beat analysts' expectations, compared with a 62 percent average since 1994 and 65 percent over the past four quarters, according to Thomson Reuters data.
"Overall, the earnings supports were better than expected in this cycle," said Peter Jankovskis, co-chief investment officer at OakBrook Investments LLC in Lisle, Illinois. "We may see the market rising during the month of March."
Fourth-quarter earnings for S&P 500 companies are estimated to have risen 6 percent, according to the data, above a 1.9 percent forecast at the start of the earnings season.
But with only a handful of companies left to report earnings, investors are looking ahead to the possibility of hefty automatic budget cuts that could happen on March 1.
A large option investor appeared to be adjusting a bearish view on the SPDR S&P 500 Trust fund
"An institutional investor appears to be rolling down and increasing in size a defensive hedge timed to match the March 1 deadline for the sequester," said Henry Schwartz, president of options analytics firm Trade Alert.
The trader sold 132,000 $149 to $150 weekly put spreads for 22 cents as shares of the exchange-traded fund had traded near $151.14 on Friday morning. The transaction entailed the sale of $150 weekly puts to buy the $149 weekly puts. In addition, the investor purchased another 42,000 $149 weekly puts, which increases the size of the hedge to 174,000 contracts.
"It is likely this large position protects an existing underlying long position in a portfolio," Schwartz said.
In another political risk factor, Italians go to the polls this weekend in an election that could threaten reforms in the indebted country. Silvio Berlusconi's resurgence has thrown the vote wide open, with deep uncertainty over whether the poll can produce the strong government the country needs.
Inconclusive Greek elections last year sparked a protracted selloff and a period of uncertainty in markets.
In the tech sector, Marvell Technology Group Ltd
Texas Instruments Inc
The PHLX semiconductor index <.sox> gained 2.1 percent.
"Dividends growing are another way the market's level is justified, if not especially attractive at these levels," said Rex Macey, chief investment officer of Wilmington Trust in Atlanta, who manages about $20 billion in assets.
On the downside, Abercrombie & Fitch dropped 4.5 percent to $46.86 after the youth-oriented clothing retailer reported a drop in fourth-quarter comparable sales, even as its latest quarterly earnings topped estimates.
Insurer American International Group Inc posted fourth-quarter results that beat analysts' expectations. AIG's stock advanced 3.1 percent to $38.45.
About three stocks rose for every one that fell on both the New York Stock Exchange and Nasdaq.
Around 5.8 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, below the 20-day moving average of around 6.51 billion shares.
(Additional Reporting by Ryan Vlastelica and Doris Frankel; Editing by Kenneth Barry and Jan Paschal)
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San Francisco Concerts This Week
No shows found based on your search criteria. However, you may be interested in these popular shows in SF Bay Area: Spamalot is the best deal at 50 percent off. Spamalot is selling for as low as $19.
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However, you may be interested in these popular shows in SF Bay Area:
House of Joy
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This action-adventure romance at Cal Shakes outdoor amphitheatre proves paradise isn't all it's cracked up to be.
Broadway Princess Party
ConcertEast Bay
Featuring Broadway's original Cinderella, Belle, Anastasia, and Jasmine, "Broadway Princess Party" will delight Disney fans young and old.
Anything Goes
MusicalSouth Bay
Cole Porter's Delightful, Delicious, and De-Lovely "Anything Goes" comes to Hillbarn Theatre!
Sister Act
MusicalSouth Bay
This sparkling musical brings the sisterhood to Broadway by the Bay!
MusicalNorth Bay
Marin Shakespeare Company's first ever musical theatre production is a zany performance of epic proportions and riotous nonsense.
The 39 Steps
PlaySouth Bay
TheatreWorks' acclaimed hit comedy "The 39 Steps" returns in a hilarious, high-speed spoof of Alfred Hitchcock's silver-screen classic.
San Francisco Concerts This Week per Ticket Price
Average discount for San Francisco Concerts This Week is 40%. Some shows offer lotteries and rush tickets. Rush tickets can be accessed via the TodayTix app.


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Make An Appointment Online
Problem with your car? Time for your next scheduled maintenance? Request an appointment with our Service Department by completing the form below or call us at 949.891.CARS (2277). We will confirm your appointment with you by Phone and/or E-mail within 12 hours of receiving your request.


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Breakups & Divorce Support Group
Just broke up with someone or in the midst of a difficult divorce? Breaking up is difficult no matter what the circumstances are. They say that time heals all wounds, but sometimes a listening ear or a hug can work wonders for the heart. Whether you need a place to vent, someone to hold you to No Contact, or need advice about what to do, we're here to help.
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Biketoberfest Daytona Beach
Any DSr's attend this event or Bikeweek in Daytona?
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If you're going to start a sexual relationship with a relative, might not want to do it in Utah. They really don't take kindly to that whole incest thing in Utah. A father-daughter pair were arrested on third-degree incest charges after they began a sexual relationship even though the woman was over 21 years old when the romance started. Now they could spend five years in prison.
The woman reportedly had been put up for adoption when she was a child -- unclear at what age exactly -- and only met her biological father for the first time when she was 21 and he was 52. A year later, they began a sexual relationship.
Because both of them knew about their biological connection, they were arrested, even though they are consenting adults. Utah has tightened its incest laws -- even eliminating artificial insemination as a possible defense. So if you happen to meet your sperm donor years later and think he's a hunk, you are totally out of luck.
I don't understand the whole incest attraction, but it's nothing new. Nor is it solely the province of the depraved, uneducated, or mentally ill. One of my favorite authors, Anais Nin, wrote extensively of her affair with her father. Author Kathryn Harrison wrote about the same thing. Neither was arrested.
I can definitely see the law coming down hard on incest when an adult takes advantage of a child -- that's rape. But two consenting adults is much more of a gray area. Obviously, the woman has some kind of daddy issues, but lots of women do. And the guy sounds like a real loser, but lots of men are. Should these two serve time because the object of their dysfunction is their close relative?
There is the increased chance of cognitive disorders in a child when parents are closely related. But what of parents who test positive for some disorder that almost surely will be passed down to their offspring if they procreate? No one arrests them. Besides, people don't have to have kids.
Just putting it out there for debate. I think the whole idea is pretty skeevy myself. But people who kill people with cars usually spend less time in prison.
On the whole, I think it's a good idea to keep incest illegal because in the vast majority of cases, incest is going to be a one-sided manipulative act perpetrated by the adult with more power. Not to mention that it's a big world, surely fathers and daughters can find someone else to date.
Do you think that incest between consenting adults should be harshly punished?
Image via SLR Jester/Flickr


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January, 2010
by Steven E. Hyman, M.D.Provost, Harvard UniversityProfessor of Neurobiology, Harvard Medical School
Since its formation in 1992, the Dana Alliance for Brain Initiatives has sought to keep the public informed about cutting-edge research in neuroscience. Given the large and growing number of people afflicted with brain disorders, public understanding of the research becomes more crucial each year. Among the important findings of the past year presented in this, the sixteenth in the Alliance's annual progress reports on brain research, I want to highlight promising outcomes in the genetics of neuropsychiatric disorders. I do this not only because of the significance of the results, but also because they arrive after years of frustration.
Neuroscientists face daunting challenges in attempting to understand the processes that go awry in the brain to cause autism, schizophrenia, bipolar disorder, obsessive-compulsive disorder, depression and other neuropsychiatric disorders. The difficulty derives in part from the fact that these disorders affect the highlevel integrated functioning of the human brain, impairing complex domains such as social cognition, control of behavior and mood regulation. Consequently, it has been very difficult to model these disorders convincingly in animals. In addition, rather than exhibiting readily identifiable pathology such as cell death, the symptoms of neuropsychiatric disorders often reflect abnormal activity in brain circuits. In psychiatry, for example, the science has matured to the point that depression is no longer seen in excessively simplistic terms as the deficiency of one or two neurotransmitters; rather, it is viewed as the result of regulatory mechanisms in the brain gone awry.
Non-invasive neuroimaging provides some assistance, by enabling researchers to observe the brain at work while performing tasks that might help distinguish between health and disorder or probe specific impairments in conditions such as autism or schizophrenia. With imaging, it has been possible to study, for example, how people with autism process social information and to study how the impairment of "working memory," which is the ability to hold information "online" to guide thought and behavior, affects people with schizophrenia. A more recent development, deep brain stimulation (DBS), described in this report, promises to give us new information on the workings and possible infirmities of brain circuits that regulate mood and aspects of cognition. By delivering electrical current through fine electrodes implanted deep in the brain, DBS can activate or inhibit specific brain circuits and thus regulate mood or diminish unwanted, intrusive thoughts (obsessions). The combination of results from neuroimaging and DBS has given us exciting new hypotheses about the circuits that regulate mood in the brain and those that might malfunction, for example, to cause depression or obsessive-compulsive disorders. Nonetheless, these are only pieces in an extraordinarily complex puzzle.
Scientists have long hoped that the identification of the precise genetic variations that contribute to neuropsychiatric disorders would provide tools that neurobiologists could use to decipher the disease processes. Though finding such genes has proved difficult (for reasons that I will describe below), nevertheless, after years of frustration, results reported during the last year have begun to identify genes involved in autism and, with a bit less certainty, in schizophrenia and bipolar disorder.
An important distinction is also relevant to this research: the distinction between genetics and epigenetics, both of which produced significant new findings in psychiatric research in 2009. Briefly, epigenetics is the study of how the action of genes may change once an organism's underlying DNA blueprint is laid down. Here's what that means: DNA, the genetic material, is bound inside the nucleus of the cell by a large diversity of proteins. If uncoiled, DNA molecules would stretch far beyond the boundaries of individual cells, but they do not, because they are held in coiled and folded conformations by histones and other proteins. As a kind of spool for the DNA, histones are the most important in holding its structure. If a gene is to be expressed— that is, to be read out to produce either an RNA or a protein product—it must be accessible to the transcriptional machinery that does the reading, and histones help make that possible, too. We have long known that both DNA and histones undergo chemical modification (e.g., by adding or removing methyl groups or other chemical groups) and that these modifications make it more or less likely that a nearby gene will be expressed. The modification of DNA and histones is what is meant by epigenetic regulation of the genome.
Most of the attention paid to epigenetics was focused on early development. Every cell in our bodies begins with the same genome,but some become liver cells; others become one of many thousands of different types of neurons; and still others take on the humble but necessary task of making fingernails. The stable patterns of gene expression that give rise to the myriad cell types of the body are in great part the result of epigenetic modifications within cells. A surprise that crystallized in the recent past is that epigenetic regulation can be induced by stress, other types of life experience and both therapeutic and abused drugs. The implications of these discoveries are now a matter of very exciting research, and one possibility is that epigenetic mechanisms may provide new avenues for designing treatments.
Genetics provides tools for biological investigation in many ways. At the simplest level, a version of a gene that predisposes to a disease, such as autism, can be compared with a different version of the same gene that does not. If that particular genetic variant strongly influences the symptoms of autism (i.e., the variant's degree of "penetrance"), researchers might insert it into a mouse genome to observe its effect on brain development, brain function and behavior in the engineered mice.
Despite the substantial influence of genes, attempts to identify the variants that confer risk of neuropsychiatric illness have proved frustrating for the last two decades. This is largely because the concept of heritability that we investigate is an aggregate measure—it lumps together the totality of the effects of genetic influence. If we "look under the hood," we find that a very large number of different genes affecting brain function can contribute to specific disorders, and that, in different families, an individual might have symptoms of schizophrenia as a result of different combinations of genes. This scientifically messy situation, which is described as "genetic complexity," is typical of most common human illnesses. Harmful mutations that act alone to cause a serious illness tend to decrease reproductive fitness, and thus they often get weeded out of the gene pool. As a result, disorders caused by a single harmful high-penetrance mutation tend to be rare. If, instead, illness is caused by the interaction of a large number of gene variants that are not harmful, except in unlucky combinations, the risk-conferring gene variants will remain in the population. This is described as the "common disease, common variant" hypothesis. Alternatively, disorders that appear genetically complex can result from diverse high-penetrance mutations, each individually rare, acting in different extended families. Thus, for example, a disorder causing vision loss, retinitis pigmentosa, is a single-gene disorder in each extended family, but there are a very large number of individual mutations that lead to retinal degeneration, ultimately by converging molecular mechanisms.
Modern genomic technologies have begun to solve the genetics of diseases resulting from both types of complexity, but the common neuropsychiatric disorders exhibit one further level of difficulty to geneticists. Unlike most other complex diseases, such as type 2 diabetes mellitus or inflammatory bowel disease, no objective medical tests exist to narrow the study populations of neuropsychiatric disorders. Geneticists—indeed, all scientists studying these disorders—must therefore rely on clinical observation, with all its inherent imprecision, to make diagnoses.
After years of taking one step forward and one step back, research efforts in 2009 yielded notable progress in the search for genetic variants that contribute to autism and promising results for those involved in schizophrenia and bipolar disorder. I readily confess that this work is far from complete and, in most cases, still some distance from providing the tools that neurobiologists need to interrogate the brain. However, the sense of progress and promise is palpableand exciting.
The Human Genome Project and other large-scale efforts in genomics have provided new information and technologies relevant to understanding disease risk. Although I am not a human geneticist, I have long been concerned with the question of how to exploit the high heritability of neuropsychiatric disorders to provide tools for neurobiology. A decade ago, when I was director of the National Institute of Mental Health (NIMH), the reality of genetic complexity and the challenges it posed were coming squarely into view. Traditional linkage studies, based on markers taken from lowresolution maps of the genome, were not yielding reproducible results. The question was how to spend federal resources in a way that would maximize the possibility of long-term success. I began programs to collect and store DNA samples and extensive phenotype information from large numbers of individuals and families affected by schizophrenia, bipolar disorder, early onset depression and later, in collaboration with family groups, autism. I also instituted a "sharing policy" so that these resources could be available broadly to researchers as the technologies improved. The sharing policy was not initially popular with the entire community of investigators, but it is now widely accepted. As the psychiatric research community matured, it was widely recognized that pooling of samples would be necessary to generate studies large enough to yield reproducible results. Not surprisingly, many of the recent successes have come from large international collaborations.
It has taken far longer than I could have imagined to get to where we are now, and the NIMH DNA resources have proven important but far too small on their own. As I have described, it is clear that multiple pathways lead to illnesses such as autism and schizophrenia; some individuals are at risk because of an unlucky combination of a very large number of common genetic variants, and others may have rare harmful mutations. Perhaps not surprisingly, the discovery of common variants has led to a new controversy: since each variant has such a small individual influence, one can reasonably ask whether the results of whole-genome association studies can really inform biology. I believe that there will be a large biological payoff, but that it will require very clever scientists, including computer scientists, to show us how all this information comes together.
If the genetic clues converge on a limited number of pathways that can illuminate the biology of the illness, clues to treatment developments will follow. Unfortunately, there are no guarantees that this will happen. The discovery of rare high-penetrance mutations may initially be more useful to neurobiologists, because such mutations are more likely to produce substantial biological effects. Already researchers have produced genetic mouse models with human mutations that cause autism or disorders that include symptoms of autism, such as Rett syndrome. I do not want to over-promise on the rate of progress, but I think that, after decades of effort, we will have a new and important window into the biology of neuropsychiatric disorders. This will be complemented by new understandings of the role of epigenetics and by new avenues of research on the brain.
One such avenue described in this report brought good news to scientists pursuing treatments for disorders that do not respond to pharmacological therapies: encouraging results from deep brain stimulation (DBS) studies. DBS involves neurosurgery to implant thin electrodes deep in the brain, attaching them to a device implanted under the collarbone that delivers a steady electrical current to the neurons the electrodes are touching. Developed in the late 1980s and 1990s, DBS is now widely used to treat symptoms of treatment-resistant Parkinson's disease and is approved by the FDA on a limited basis for obsessive-compulsive disorder, as well as some movement disorders. New studies are showing that some patients with depression who had not responded to medication, psychotherapy and electroconvulsive therapy (shock treatment) have experienced longlasting improvements with this therapy.
Beyond the value of genetics for psychiatric research, genetic advances in 2009 continued to improve the outlook for new therapies for diseases, such as multiple sclerosis, in which multiple genes are implicated. Certain populations, especially those of Northern European stock, are more susceptible to MS, but environmental pressures such as a virus may be needed as a catalyst. Once scientists are able to determine which genes are interacting with which environmental factors, new treatments will become possible. In 2009, scientists using a genome database identified several specific genes, all genes in the immune system, that contribute to susceptibility to MS.
Equally noteworthy in 2009 were findings about molecular processes providing insight into normal brain function. Among these, scientists studying the molecules involved in memory succeeded in selectively removing fearful memories in rats by using a protein, CREB, to identify the specific neurons carrying the memory, and then destroying those neurons. Other research explored enhancing memories by increasing the expression of an enzyme, PKM zeta, which helps turn short-term memories into long-term memories.
Against the backdrop of debilitating disorders and those that threaten people's very identity, it is easy to forget that, for most people, the risk is that harm to the brain will come in the form of disabling brain or nervous system injury, by stroke, accidents such as car crashes and chronic disease. In the search for effective therapies and treatments for injury and disease, scientists have begun delving into the mystery of neuroprotection—the methods by which neurons protect themselves against injury. In 2009 scientists added several chemicals to the small list of known neuroprotectors. Sex hormones, especially estrogen, figure heavily in the reduction of neuron loss with aging, while vitamin D helps to minimize cognitive decline.
But it was genetics that took center stage in the advancement of neuroscience in 2009. Genes dictate how our brains develop, what diseases we may be susceptible to and even how well our neurons will survive into old age. Mutations and variants, which scientists are now able to identify through the use of the Humane Genome Project, hold clues to treating psychiatric illnesses, such as Parkinson's, and to unlocking cures for diseases such as multiple sclerosis. In combination with the discoveries of the molecules that govern brain function, genetics promises to propel neuroscientists to greater understanding about how the brain works, and how we can both heal it and improve its function.
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This story first appeared in UC Davis Magazine, Volume 29 · Number 4 · Summer 2012
At a UC Davis outpost in the Pacific Northwest, wildlife veterinarians work to heal an ocean.
EASTSOUND, Wash. — "Watch out for the otter scat," warns UC Davis wildlife veterinarian Joe Gaydos, as he points to several tidy pink-crustacean-tinged piles on a dock. A glance over the edge of the dock reveals a world of anemones and algae swaying in the incoming tide. And overhead, a pair of courting bald eagles circles above the cedars in a gray February sky.
These stunning views — on shore, under water and in the air — offer glimpses of the expansive "laboratory" of the SeaDoc Society, an outpost of the UC Davis Wildlife Health Center on Orcas Island, the largest of Washington state's San Juan Islands. Through science and education, SeaDoc is working to protect the health of marine wildlife and their ecosystems 700 miles north of Davis in the Salish Sea. One of the world's largest inland seas, it covers more than 10,500 square miles, encompassing Washington's Puget Sound, the Strait of Juan de Fuca and the San Juan Islands, as well as British Columbia's Gulf Islands and the Strait of Georgia.
"The Salish Sea is one of the most amazing places on Earth and people who live here want to pass on a healthy ecosystem to future generations," says Gaydos. "SeaDoc's work is to make sure there will still be amazing wildlife, abundant fish and shellfish to eat and clean water for people and for wildlife far into the future."
The waters and shores of the Salish Sea are the shared home of 37 species of mammals, 172 species of birds, 247 species of fish, more than 3,000 species of invertebrates and nearly 6 million people. This lush ecosystem includes killer whales, bald eagles, Pacific salmon, abalone, crabs and clams. Indeed, the species count is one example of SeaDoc's work here — a report that Gaydos co-authored in 2011 included the first compilation of birds and mammals that depend on the Salish Sea.
But a growing number of those species are in decline — another SeaDoc finding. Since 2002, SeaDoc has tracked the overall number of wildlife species that are listed as threatened or endangered in the Salish Sea; from 2008 to 2011, that number nearly doubled, from 64 to 113.
A powerful partnership
How and why the UC Davis Wildlife Health Center established the SeaDoc Society so far from campus is a testament to the center's reputation as well as a local couple's commitment to restoring the health of the Salish Sea.
In the late 1990s, philanthropists Ron and Kathy McDowell of the San Juan Islands began looking for an institutional partner with the right credentials — high-caliber academics and a good history of working on ecosystem-level problems — to study and enhance the health of the Salish Sea. Impressed with the School of Veterinary Medicine's talented faculty and its Wildlife Health Center's applied, problem-solving approach to conservation and health, the McDowells considered the school a perfect partner for developing a new program — one that would apply the veterinarian's patient-oriented skills, not on individual animals, but on the whole ecosystem.
Then-Dean Bennie Osburn reasoned that if the veterinary school could run programs in Africa, it certainly could run one in Washington state. Osburn tapped the Wildlife Health Center for the program. Veterinarian Kirsten Gilardi was named director; Gaydos, a veterinarian specializing in medical microbiology and wildlife diseases then working at the University of Georgia, was brought on as regional director and chief scientist.
Gilardi and Gaydos quickly established what today has evolved into a unique marine ecosystem health program — one that combines new research into critical questions about the management of the Salish Sea, science translation that ensures that the information is getting into the hands of policymakers and the public, and the close involvement of citizens providing input and support. The SeaDoc Society recently celebrated its 10th birthday, and in this short time has become a key player in marine conservation in the Salish Sea.
"To me, the most interesting thing about SeaDoc is the fact that it's a private/public partnership," says Gary Davis, chair of SeaDoc's board of directors and a former senior scientist with the National Park Service. "It's a small group of citizens interested in collectively doing something to improve the environment. It's a powerful combination when supported by an institution like the University of California, particularly the Wildlife Health Center and the School of Veterinary Medicine. It means you can do things in a different way."
With just five employees at the Orcas Island headquarters, and a shoestring annual budget of about $500,000, SeaDoc depends on citizens' involvement, Gilardi says. "SeaDoc is largely funded by private gifts and most of our donors are local, so they feel incredibly connected to — and partly and rightfully responsible for — the success of SeaDoc's work in the Salish Sea," she says. "It's what makes SeaDoc unique: the university working hand-in-hand with concerned citizens to get essential science done that conserves wildlife and helps to heal the ocean."
One Sea, One Health
Even the name of the Salish Sea reflects the work of the SeaDoc Society. Formerly known as Puget Sound and Georgia Basin, the inland sea was renamed by the U.S. and Canada in 2010 in honor of the Coast Salish, the people who have inhabited the region for millennia.
"SeaDoc really pushed for adopting the new name 'Salish Sea' because it drives home the concept that this is a whole ecosystem, regardless of political boundaries," says Gaydos.
Since international borders are invisible to fish and other wildlife, the SeaDoc Society recognized that healing Washington's inland waters was going to require an approach that "treated" the inland waters as a whole entity, rather than as a sum of parts, much as a veterinarian approaches an individual patient.
This holistic view of the marine region, and the people and animals that live in it in a connected interdependence, is in keeping with the Wildlife Health Center's focus on One Health, a philosophy that recognizes that the health of the environment is essential for the health of wildlife, domestic animals and people — and vice versa.
Informing policy
SeaDoc's success in translating science is evident in the growing number of policymakers who seek its help. Groups like the Northwest Indian Fisheries Commission, the Washington governor's office, Washington State Legislature and the Washington Department of Fish and Wildlife regularly ask SeaDoc to provide the current state of science on a particular issue so that a sound management or policy decision can be made.
As Gaydos says, "Science is great because it gives us the facts that help us make good decisions and inspire people to want to care — to want to save a place."
For more than eight years, SeaDoc has hosted a winter lecture series. Gaydos, who was hired as a translational scientist, gives an average of two professional presentations a month. He also sits on a number of science panels, including the Puget Sound Partnership Science Panel, which is charged with restoring Puget Sound by 2020. Martha Kongsgaard, chair of the Puget Sound Partnership, says "SeaDoc plays a unique role in not only producing essential science, but, as importantly, in integrating that science into environmental policy."
Gaydos and his collaborators conduct research on how disease impacts wildlife populations. In addition, using privately donated funds, SeaDoc awards competitive grants to scientists to focus on the marine ecosystem or on the threatened and endangered species that live in it. Those species include the following:
River otters Those telltale signs of otters on the dock provide evidence for a scientific study on how the predators, which eat up to 15–20 percent of their body weight in food every day, could affect salmon and rockfish populations.
Northern (pinto) abalone A number of funded studies looked at why the population of this native mollusk had not recovered, but rather declined, since Washington and British Columbia banned their recreational harvest in the 1990s. One project examined genetics, another looked at hatchery release techniques, a third studied interactions of pinto abalone with other species, and a fourth explored whether aggregating animals left in the wild helps them breed.
The results: the discovery of a subspecies that improved hatchery breeding, and a finding that hatchery young are less likely to become merely crab bait if placing in the sea is delayed until they grow to about 1 inch in diameter. These and other scientific discoveries formed the foundation for what is now an active statewide recovery program.
Western grebe A bird so aquatic that it can't even walk on land and builds floating nests, the Western grebe has declined by 95 percent over the past several decades in the Salish Sea. Although once there were flocks of 3,000 to 5,000 in Bellingham Bay, Gaydos and his colleagues now get excited when they see 50. Gaydos and collaborators have improved a surgical procedure to allow scientists to implant transmitters in these birds to track their migratory patterns and better understand their decline.
Killer whales Three distinct types of killer whales, or orcas (Orcinus orca), live in the Salish Sea. The most commonly encountered are the fish-eating "resident" orcas. These whales are salmon eaters, preferring Chinook, as shown in recent studies. Less commonly seen are the marine mammal-eating "transient" killer whales. Occasionally, "offshore" killer whales are spotted in the Salish Sea and are thought to be fish and shark-eaters. All three ecotypes of killer whales are state and federally listed as endangered.
Killer whales from the Salish Sea are some of the most contaminated marine mammals in the world, and pollutants are considered a factor in causing the decline of the southern resident population. The Salish Sea has very high levels of legacy PCBs, chemicals once widely used in manufacturing electrical equipment and a variety other products. SeaDoc has ensured critical research to look at contaminants in salmon and how they affect the killer whales that eat them. SeaDoc has also conducted research examining the role of disease in the declining killer whale population.
On the other hand, one species that is doing well is the harbor seal, and its story is a testament to what can be done when species-appropriate action is taken. In 1972, following studies that had shown a precipitous decline in the harbor seal population, the U.S. passed the Marine Mammal Protection Act, which has enabled the Salish Sea's population of harbor seals to bounce back and stabilize, from about 2,000 to around 12,000 animals. The Salish Sea population is now one of the most dense harbor seal populations found anywhere in the world. Stories like this can move the public to advocate for measures that will give other species a chance.
Far-reaching impacts
SeaDoc's ability to assess the ocean's ills, diagnose ecosystem health ailments and propose solutions or cures for them has resonated well beyond the Salish Sea. The group also sponsors research along the California and Baja California coasts and coordinates a West Coast program to clean up derelict fishing gear, which kills marine life.
That's not to say there aren't frustrations for the SeaDoc team. "Sometimes it does get hard. You get frustrated that recovery isn't moving fast enough or worried that we're not raising more money," Gaydos says, "because we know the amount of work that still has to be done.
"But one good part of my job is that I get to see all the good work that is happening — on salmon and killer whale recovery, on restoring estuaries. So, we're making progress, and a lot of people really do recognize the importance of SeaDoc's work. That's hugely gratifying."


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In the Pipeline: Ducks' Kerdiles Moves to Centerby Staff Writer / Anaheim Ducks
Nicolas Kerdiles can score. Of that, there is little doubt.
As a freshman for the University of Wisconsin in 2012-13, the Anaheim Ducks' second-round draft pick in 2012 (No. 36) collected 33 points -- 11 goals, 22 assists -- in 32 games, making him the first Badger since Joe Pavelski to average more than a point per game as a rookie.
The Badgers heated up down the stretch as Kerdiles continued to pour in the points. At season's end, the Irvine, Calif., native scored multiple points in all five Western Collegiate Hockey Association (WCHA) playoff games, earning himself Final Five MVP honors and his Badgers the Broadmoor Trophy as conference champions.
Now, four games into his sophomore season, Kerdiles is riding a 16-game point streak dating back to Feb. 24. He scores in wins – Kerdiles had two assists in the season-opening 5-2 victory against Northern Michigan -- and he scores in losses, assisting in a 7-3 defeat to Boston University in the team's most recent outing. He has five points in four games, which is tied for the team lead.
"I think my role on the team is to produce every game, and this just shows that I am," Kerdiles told NHL.com. "But I think being consistent is one of my roles also, and it's good for my confidence to consistently be putting up points."
Asked what he thought of Kerdiles' point streak, Wisconsin coach Mike Eaves echoed his player's sentiment.
"Nic expects that of himself," Eaves said. "We've got other players on the team that are in the same boat. It's part of their skill set. They should be on the score sheet every night."
And Eaves should know: The longtime Wisconsin coach and former player scored in 21 straight games in 1977-78, which is still a Badgers record.
When the Anaheim Ducks drafted Kerdiles -- a hometown kid who grew up 20 minutes from Honda Center -- the organization knew they were getting a player with natural gifts. Kerdiles possesses skating ability, a power forward's frame, vision on the ice and a scoring touch. So while a point-per-game collegiate career is an encouraging sign, it's not necessarily a surprising one.
Nor is it enough, according to Anaheim's Director of Player Development Todd Marchant, to pencil Kerdiles into the Ducks roster in the future.
"I think if you look across the board at the NHL teams, certain fourth-line guys if you look back at their college stats or junior stats, they were all point producers," Marchant said. "What I tell my young players is, no matter what you do offensively, that's a bonus, that's great, but you have to be well-rounded."
Kerdiles knows this too. After proving as a freshman that he could score on a consistent basis, the 19-year-old is hoping to spend this season bringing that same consistency to all parts of his game.
It started this summer. In addition to Ducks' rookie camp and his obligations at the United States junior evaluation camp, Kerdiles focused on his physique, his faceoffs and his one-timers. All three are critical to the transition he made from wing to second-line center – and special-teams mainstay – this season.
"There's a lot of responsibility that the center has [in our system]," Eaves said. "We've just found that to give a young freshman that responsibility is little overwhelming. Putting Nic in the middle [this season] is based on his growth and understanding of what we want to get done."
Eaves noted that current NHL centers Pavelski and Derek Stepan also played on the wing for at least their first semester at Wisconsin, so Kerdiles, who played center prior to college, finds himself in good company.
As his team's pivot, Kerdiles will often be the only forward in his team's zone and will need the physicality to match his new defensive mindset.
"I think that's a necessity when you're trying to make that jump to the next level," said Kerdiles, who officially checks in at 6-foot-1, 200 pounds. "You've eventually got to be a certain weight, you've gotta feel comfortable on your skates and playing against big, strong men."
For Marchant, developing physically is one of the major advantages of the college hockey route.
"The unfortunate thing for a college hockey player is they can't come to training camp," Marchant said. "That's the negative. But the positive is [college] gives you the chance to develop physically. They have a lot of time to do the off-ice training and get developed physically."
When he wasn't in the weight room, Kerdiles was shooting pucks. He stuck around Madison and took summer courses, and he and a teammate would hit the rink each morning before class. He shot around 150 pucks each morning, mostly one-timers he will deploy from his position on the weak side of the Badgers' power play.
Kerdiles told NHL.com that along with a quicker and more effective release, his development on the defensive side will be key to his and his team's success this season.
"As a centerman, you're usually back in the defensive zone and you're using a little more energy being down there defensively," Kerdiles said. "The defensive responsibilities are a little different because college is a big step up and the guys are that much better. So getting into that defensive zone mentally, staying on the right side of my guy and having good body position with him."
Well-rounded forward play, which includes a heavy dose of defense, is something Marchant thinks is key to success in the NHL.
"Coaches in the NHL, if you're good defensively, they'll find a way to get you in the lineup and get you ice time," Marchant said. "I don't care whether you score 50 goals. I want you to be a good defensive player as well. That alone will get you into more conversations."
For now at least, the only conversation Kerdiles is worried about is the one surrounding the NCAA title. It's why Kerdiles came to Wisconsin, where the Badgers entered the campaign ranked in the top three of multiple preseason polls based on the strong finish of players like Kerdiles a season ago.
"I think that my success translates to how well the team does," Kerdiles said. "I think we have the team to go out and win a national championship and if go out there and do what we're supposed to do, we have that opportunity."


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