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    Held Involuntarily in a Psychiatric Hospital

    More from our inbox:The Debate Over Taxing TipsNonpartisan ElectionsSitting Still in SchoolAcadia Healthcare’s Park Royal hospital in Fort Myers, Fla., and Florida is among those that wrongly held some patients against their will.Michael Adno for The New York TimesTo the Editor:Re “Patients Held Against Will by Hospitals” (front page, Sept. 2):Thank you for your hard-hitting exposé of Acadia Healthcare, a chain of psychiatric hospitals, which revealed Acadia’s corrupt financial practices. The authors report on the toxic effects — including but not limited to driving people away from treatment — of these unscrupulous procedures.But even when hospitals have pure motives, inpatient psychiatric care — especially when it is involuntary — can be traumatizing, and may lead to an increased risk of suicide: In one meta-analysis, “the postdischarge suicide rate was approximately 100 times the global suicide rate during the first 3 months after discharge.”The key to helping people is funding community-based, evidence-based programs. For example, “Peer-run respites provide a voluntary alternative to an emergency department visit or inpatient hospitalization for people experiencing a psychiatric crisis,” as was noted in a recent article in Psychiatry Online.With so much evidence to support the benefits of community-based mental health care, I believe that a paradigm shift in the mental health system — away from hospitalization and toward community-based treatment, including peer support — is long overdue.Susan RogersCherry Hill, N.J.The writer is the director of the National Mental Health Consumers’ Self-Help Clearinghouse.To the Editor:The motivation for this atrocious behavior is cited in the first paragraph of the article, where it is noted that Acadia Healthcare’s stock price has more than doubled. This is an example of the perverse results of the use of private equity to finance health care. There are other such examples.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Medicaid Funding Would Expand Psychiatric Beds Under New Bill

    A Democrat and a Republican from New York will introduce the “Michelle Go Act,” named after a woman who was killed when a mentally ill homeless man pushed her in front of a subway train.As the nation faces a growing mental health crisis among people who are homeless, a bipartisan bill being introduced in Congress on Thursday may substantially increase the number of psychiatric beds covered by Medicaid.Proponents of the bill say that it will help address a severe shortage of psychiatric hospital beds and spur the construction of new beds and new facilities.The bill is sponsored by the unlikely-seeming New York City congressional duo of Dan Goldman, a liberal Democrat, and Nicole Malliotakis, a Republican Trump loyalist, along with Representatives Tony Cárdenas, Democrat of California, and Gus Bilirakis, a Florida Republican. Mr. Goldman is the lead author of the bill, the Michelle Go Act, named after the woman who was fatally pushed in front of a subway train in New York in 2022 by a man with schizophrenia, who had spent decades rotating from hospital to jail to street.Under current law, for people age 21 to 64, Medicaid covers stays in dedicated psychiatric hospitals only if they have 16 or fewer beds. The Michelle Go Act would raise the threshold to 36 beds.Mr. Goldman said in an interview that the legislation would “not only provide for significantly more beds for long-term mental health care but has the potential to increase the ability for those who cannot afford mental health care to get the treatment they need.”Mr. Goldman has said that he would have liked to remove the cap on hospital size altogether — one estimate put the cost at $33 billion over 10 years. But he said that the more modest measure was necessary to win support on both sides of the aisle.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Why Adult ADHD Is Hard to Diagnose

    It’s one of the most common psychiatric disorders in adults. Yet there are no U.S. guidelines for diagnosing and treating patients beyond childhood.Just before Katie Marsh dropped out of college, she began to worry that she might have attention deficit hyperactivity disorder.“Boredom was like a burning sensation inside of me,” said Ms. Marsh, who is now 30 and lives in Portland, Ore. “I barely went to class. And when I did, I felt like I had a lot of pent-up energy. Like I had to just move around all the time.”So she asked for an A.D.H.D. evaluation — but the results, she was surprised to learn, were inconclusive. She never did return to school. And only after seeking help again four years later was she diagnosed by an A.D.H.D. specialist.“It was pretty frustrating,” she said.A.D.H.D. is one of the most common psychiatric disorders in adults. Yet many health care providers have uneven training on how to evaluate it, and there are no U.S. clinical practice guidelines for diagnosing and treating patients beyond childhood.Without clear rules, some providers, while well-intentioned, are just “making it up as they go along,” said Dr. David W. Goodman, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.This lack of clarity leaves providers and adult patients in a bind.“We desperately need something to help guide the field,” said Dr. Wendi Waits, a psychiatrist with Talkiatry, an online mental health company. “When everyone’s practicing somewhat differently, it makes it hard to know how best to approach it.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Canada Delays Plan to Offer Medically Assisted Death to the Mentally Ill

    A parliamentary panel concluded that there are not enough doctors, particularly psychiatrists, in the country to properly assess patients.Canada is postponing a plan to offer people suffering from mental illnesses the option of a medically assisted death, two cabinet ministers said on Monday.The announcement by Mark Holland, the health minister, and Arif Virani, the justice minister, came after a special parliamentary committee looking into the plan concluded that there are not enough doctors, particularly psychiatrists, in the country to assess patients with mental illnesses who want to end their lives and to help them do so.“The system needs to be ready, and we need to get it right,” Mr. Holland told reporters. “It’s clear from the conversations we’ve had that the system is not ready, and we need more time.”Neither minister offered any timeline for the latest extension. Following an earlier delay, the expansion had been scheduled to come into effect on March 17.Canada already offers medically assisted death to terminally and chronically ill people, but the plan to extend the program to people with mental illnesses has divided Canadians.Some critics say the plan is a consequence of the inability of Canada’s public health care system to offer adequate psychiatric care, which is chronically underfunded and facing demand that outstrips its availability.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber?  More

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    The Republican Alternatives to Trump

    More from our inbox:Whatever Happened to Civil Presidential Debates?Questions for HamasQuestions for IsraelAdvice for These Fraught TimesAntipsychotic Drugs and Weight GainThe presidential hopefuls seemed content to aim for second place behind former President Donald J. Trump and deliver digs at President Biden.Maansi Srivastava/The New York TimesTo the Editor:Re “If You’re Going to Win the Nomination, Here’s Step 1,” by Kristen Soltis Anderson (Opinion guest essay, Nov. 8):Ms. Anderson says that many Republicans are open to opponents of Donald Trump who can articulate a new direction for the party, but that those candidates are running out of time to make their case.Ms. Anderson mentions the former South Carolina governor Nikki Haley as a viable alternative to Mr. Trump. But in terms of good fiscal governance and foreign policy, I believe that Ms. Haley is even more misguided than Mr. Trump.For example, she has recommended ending the federal gas tax, enacting a new middle-class tax cut and extending the 2017 Trump administration tax cut. While such policies might attract some voters to Ms. Haley, they would greatly diminish the revenue needed to pay for essential services, not to mention blowing up the national debt.As for international affairs, she has recommended sending special forces to “take out the cartels” in Mexico. Imagine how Mexico and other countries might react to such an invasion.Serious Republicans don’t need to look far to find a better presidential candidate than Ms. Haley.Eric MurchisonVienna, Va.To the Editor:Ron DeSantis, Nikki Haley and the other G.O.P. candidates must know that the most likely path to a nomination for them is if Donald Trump is convicted or forced to drop out of the race. In that scenario, many Republican voters are likely to be very angry, and they will rally behind the candidate who can most compellingly channel their indignation. Anyone who has been seen as significantly anti-Trump will be out of the running.It is strategically savvy of them not to level any direct harsh criticism at Mr. Trump. If the time comes that Mr. Trump is forced out of the race, the last thing his competitors will do in that situation is suggest that the charges against him are anything other than politically motivated.William ShermanHuntington, N.Y.To the Editor:This guest essay suggested that the candidates explain why they are running against Donald Trump, which in fact was one of the questions asked during Wednesday’s debate. Perhaps the reason they have not yet done so convincingly is that they are not running “against” Mr. Trump.Several of them are likely running for vice president, and that would preclude discussing their differences.Carolyn BrossBloomingdale, N.J.Whatever Happened to Civil Presidential Debates? To the Editor:Re “From Substance to Shouting: The Demise of Political Debate in America” (Opinion video, nytimes.com, Nov. 7):Our view of politics has shifted dramatically from the days when presidential debates were respectful discussions of platforms and ideologies. I am a high school junior, and my classmates and I are worried about the future of the American presidency.Presidential debates, once characterized by thoughtful discussions, have transformed into heated contests where candidates pick one another apart in hopes of winning a few more percentage points. Genuine discourse is rare, and recap videos showcase the biggest insults or the funniest moments.How does it affect our country’s future when presidential candidates can’t engage in respectful discussion? What does it mean for American society when our ideology divides us completely? A president’s priority should be to represent the people and work toward the betterment of our nation. We cannot afford to lower this standard.As the future generation of voters and leaders, it falls on us young people to advocate a return to civil and meaningful discussion in our political debates. The strength of our democracy depends on it, and young voices need to be part of the solution.Maia DietzSan Jose, Calif.Questions for Hamas Ronen Bergman/The New York TimesTo the Editor:Re “Hamas’s Goal for Oct. 7: A Permanent State of War; Group’s Leaders Say Carnage Was Needed to Restore Focus on Palestinians” (front page, Nov. 9):After reading your interviews with Hamas leaders, one wonders:1. Are the Palestinian citizens of Gaza OK with a permanent state of war?2. Where is that permanent state of war supposed to lead?3. What cause was “slipping away”? Certainly not peace or a two-state solution; so what is left?4. If the cause and the policy of permanent war mean the destruction of Israel, are all those chanting “Free Palestine” or “From the river to the sea” supportive of that?Scott BenardeWest Palm Beach, Fla.Questions for IsraelTo the Editor:Israel’s stated war objective, repeated often by Prime Minister Benjamin Netanyahu, is to “destroy Hamas.” Hamas is a movement, a political-military organization with the backing of Iran and other entities.Might one ask what exactly does “destroy Hamas” look like? Is it every member of Hamas surrendering, or is it the death of the leadership, much of which does not even live in Gaza? How does one measure success when the stated aim is impossible to measure, let alone manage?I think that if we are paying for the arming of Israel — and make no mistake, we are — we are entitled to a straight answer.Geoffrey D. BatrouneyRye Brook, N.Y.Advice for These Fraught Times Photo illustration by The New York TimesTo the Editor:Re “How to Stay Sane in Brutalizing Times,” by David Brooks (column, Nov. 5):What amazing advice from Mr. Brooks on how people can stay sane in these perilous times. His emphasis on humility, prudence and caution is inspiring. I would add just one thing: self-compassion. Today public leaders need to be kind to themselves for the nearly impossible jobs they are often called on to do.Jerome T. MurphyCambridge, Mass.The writer is a retired Harvard professor and dean who taught courses on leadership.To the Editor:David Brooks reaches back thousands of years, integrating diverse cultures and quoting appropriate phrases from several authors, to emphasize the vast depth of his subject matter. Yet after all that, he does not cite the one that summarizes the entire concept: “Love one another. As I have loved you, so you must love one another.”Mary Ann McGinleyWilmette, Ill.Antipsychotic Drugs and Weight Gain Derek AbellaTo the Editor:Re “Psychiatric Drugs Add Pounds. Some See Solution in Ozempic” (front page, Nov. 6):Like other clinical psychiatrists, I use a simple, low-tech solution for my patients who gain weight on their antipsychotic drugs. In consultation with our patients, we find another antipsychotic, one that doesn’t cause weight gain. There are many to choose from.Together with our patients, we look for the most effective drug with the least side effects, at the lowest possible dose. To be on the safe side, we weigh our patients at each visit to guard against weight gain.Of course, this requires continuing follow-up visits with our patients, to form a trusting relationship and a common goal of healing. But with a new patient it’s essential to provide such close attention.Some might object that such frequent office visits for follow-up care are too expensive. But compared with the monthly cost of Ozempic, good care is a bargain.Alice FellerBerkeley, Calif. More

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    An Anti-Obesity Drug and Cultural Stigmas

    More from our inbox:Seeking More Insight Into Republican VotersScandal at Liberty UniversityFree Analysis? Alice Rosati/Trunk ArchiveTo the Editor:Re “Ozempic Can’t Fix What Our Culture Has Broken,” by Tressie McMillan Cottom (column, Oct. 15):By “broken” in the headline, the column implies that we still perpetuate a cultural bias against obese people.Yes, we do stigmatize fat people. I’m fat. What’s also broken, though, is our habit of blaming society for failing to accept us, and medical institutions for failing to fix us, before we take an honest look at our own choices contributing to becoming unhealthy in the first place.Clearly obesity is an epidemic with complex environmental, economic and genetic factors. But for most, physical activity and healthy eating are still nature’s best prevention and remedy. Unlike Ozempic, they’re not a sexy quick fix. They’re work.Maybe healthy eating and activity are just too simple. But viewing ourselves first as victims of unfair systems is also not the answer.Society will always judge. Institutions will always be profit-driven. Blaming is easy. Honest self-assessment and changing habits are hard.Leslie DunnCarmel, Calif.To the Editor:Tressie McMillan Cottom’s fine column covers almost all the issues that I, as a slightly overweight but not obese woman, have with the new weight-loss drugs.But one issue needs to be addressed: What will we think about and how will we treat people (women) who choose not to take this drug, for whatever reason? Maybe it’s because it’s too expensive; maybe because it’s a commitment to a lifetime of taking the drug; maybe it’s just, amazingly, because they are comfortable in their rounded, plush bodies, and don’t desire to change them. Will they face even more opprobrium for that choice than they already do?I’ve spent the last 66 years (and counting) being told that my body isn’t “right,” by doctors, family and society. I’ve just finally come to terms with the fact that I’m stuck in it, and I’m lucky to be able to wake up every morning and get out of bed. Isn’t that enough?Naomi Weisberg SiegelPittsburghTo the Editor:While I agree with the author on many points, one point she didn’t address effectively is that Ozempic and other weight-loss drugs help cover up a main culprit that is causing our obesity: the U.S. food industry and “ultraprocessed foods.”Up until about the 1980s the U.S. didn’t have such a serious obesity problem. Then sugar began being added to everything, along with other things not found in any garden or kitchen.Dr. McMillan Cottom points out that people can be obese and be healthy, but that is not true of most obese people. Ozempic was created because of rampant diabetes in the U.S., the risk of which is increased by eating ultraprocessed foods.Our food industry is killing us with slow deaths from chronic diseases.Deborah JerardMontpelier, Vt.The writer is a pediatrician.Seeking More Insight Into Republican VotersWhy These 11 Republican Voters Like Trump But Might Bail on HimThe group discusses what it would take for a candidate other than Trump to win their vote.To the Editor:Re “Could These Republican Voters Abandon Trump?” (“America in Focus” series, Opinion, Oct. 22):This piece was disturbing but unenlightening about why voters support Donald Trump.Focus groups are supposed to probe for deeper understanding of participants’ views, yet your moderator accepted answers without delving into how participants reached those views.For example, when Cristian said about Donald Trump that “he does get things done,” the moderator could have asked for specifics. It would have been an interesting answer because Mr. Trump actually got very little done.The most glaring omission was Mr. Trump’s false claims of a stolen 2020 election. Do participants agree with Mr. Trump? Where do they get their news? Does this issue even matter to them?We have known for months that Mr. Trump maintains strong voter support. We might have gotten some insight into why had the moderators asked more clarifying questions.Ann LaubachAustin, TexasTo the Editor:First, I will applaud both Kristen Soltis Anderson for her skilled questions and moderation, as well as Patrick Healy and the Times Opinion team for sticking with your amazing series, most recently “Could These Republican Voters Abandon Trump?” Fascinating stuff.But just like the infamous CNN town hall with Donald Trump, it leaves an urgent set of questions. Mainly these:1. What about the criminal cases against Mr. Trump?2. What about climate change and the green agenda?Without understanding in depth these 11 Republicans on these topics, I just don’t see how I can evaluate. Of course, I recognize that these individuals have most likely completely dismissed these entire areas of thought. Nonetheless, to understand the situation in my country, I need to see what rationales they are using to do that.George OdellNewburyport, Mass.Scandal at Liberty University Julia Rendleman for The New York TimesTo the Editor:Re “The Worst Scandal in American Higher Education,” by David French (column, Oct. 23):Thank you to Mr. French for bringing the truly appalling behavior of Liberty “University” officials to our attention. Yet while he reports that the $37.5 million fine Liberty might face would be “unprecedented,” I can’t help but wonder why the Department of Education wouldn’t strip Liberty of its accreditation altogether, making it ineligible to receive federal money.Such a move is long overdue, and not just because Liberty has lied about campus crime and pressured victims of sexual assault to stay quiet. Liberty, and a host of other Christian institutions, are not colleges in the critical sense. These are places where answers precede questions, where intellectual exploration is hemmed in by theological dogma, and where basic tenets of academic freedom are treated as optional.Why should taxpayers be funding education at such places at all?Steven ConnYellow Springs, OhioThe writer is a professor of history at Miami University.Free Analysis?James AlbonTo the Editor:“How Do You Charge a Friend for a Professional Favor?” (Business, nytimes.com, Oct. 21): Another favor-asking situation that commonly occurs is asking physicians, be they friends or a recent acquaintance at a social event, for free medical opinions or even advice. The many ways of handling those situations would warrant an entire New York Times article.There is another common experience that occurs when one is introduced to someone as a psychiatrist, psychoanalyst or therapist in nonprofessional settings.Such introductions often evoke the question, “Are you analyzing me?” To which I almost always respond, “Not if you’re not paying me.” And we move on.Jack DrescherNew YorkThe writer, a psychiatrist and psychoanalyst, is past president of the Group for Advancement of Psychiatry. More

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    Does Therapy Culture Help or Hurt Us?

    More from our inbox:Trump Pardoning Himself? An ‘Appalling Idea’Trump’s WeightImproving Access to E-BooksGraphicaArtis/Getty ImagesTo the Editor: Re “Hey, America, Grow Up!” by David Brooks (column, Aug. 11), about how an emphasis on trauma makes adults immature:As a psychiatrist, I feel that Mr. Brooks makes several valid points regarding trauma but fails ultimately to thread the needle.A good psychiatrist or therapist identifies the real trauma in a patient’s past — typically from events in childhood at the hands of parents or other family members — while simultaneously discouraging the kind of victim mind-set that displaces past pain onto present-day scapegoats.The goal is to illuminate the real trauma, which requires re-evaluating what is often an idealized remembrance of one’s upbringing, so that the patient can stop projecting malice onto anyone and instead regain a sense of agency. As the saying goes, those who forget the past are condemned to repeat it.If we fail as a culture to acknowledge the well-established long-term consequences, both physical and psychological, of legitimate trauma, we will wind up creating more people who identify as victims, not fewer.Christopher BaileyKirkland, Wash.To the Editor:One thing David Brooks’s good column leaves untouched is how much resistance to the hyperinflation of “trauma” there has been among psychotherapists themselves.In 1967, Anna Freud, Sigmund Freud’s daughter, wrote that the concept had become so “carelessly used” that its “blurring” could lead to “abandonment and loss of a valuable concept.” In 1978, psychiatrist Henry Krystal, an Auschwitz survivor and founder of contemporary trauma theory, said flatly that the use of the term “has become so loose that it has become virtually useless.”Of course, “trauma culture” has a life of its own, independent of psychiatric or psychological knowledge. And no small number of therapists have fully cashed in from Trauma, Inc., which is, indeed, big business.But my sense is that, even in the culture at large, “trauma” hype may have run its course. What follows may be greater “maturity,” as Mr. Brooks and many others would hope, or it may be just the next form of mishegoss.Henry GreenspanAnn Arbor, Mich.The writer is an emeritus psychologist at the University of Michigan.To the Editor:Wouldn’t it be nice if David Brooks’s ideas about how people should “throw off some of the tenets of the therapeutic culture” and “weave their stable selves through the commitments to and attachments with others” in order to build a culture of maturity were realistic?But try telling that to people who have grown up in poverty, who have never had adequate health insurance or medical care, who grew up in families rife with violence and abuse, who live in communities with chronic gun violence, and who have to drop out of high school to give birth to a baby.What can you weave in there? And who can you attach to when your life and the lives of those around you are a mess, and you live in a world that you have little hope of escaping?Debra KuppersmithDobbs Ferry, N.Y.The writer is a psychoanalyst.To the Editor:David Brooks made some excellent observations about our country’s growing narcissism. But he missed a key prescription for change: helping Americans develop a sense of purpose.This starts with treating challenges as temporary setbacks and harnessing our talents and efforts in the service of something bigger than ourselves. We need to lose the “me” and find the “we.”Studies show that people who feel a sense of purpose in their lives — through family, friends, work or community — are overall more resilient and report a greater sense of well-being. This message feels especially urgent for adolescent girls in America who are experiencing record levels of isolation, depression and suicidal thoughts.Until Americans commit to a purpose-driven mind-set, we will continue to wallow in our current obsession with victimization and search out cheap ways to validate our self-worth.Suzanne ChazinChappaqua, N.Y.Trump Pardoning Himself? An ‘Appalling Idea’Haiyun Jiang for The New York TimesTo the Editor: It has become commonplace to suggest that one difference between a state and a federal conviction of Donald Trump is that Mr. Trump could not pardon himself from a state conviction if he is elected president, implying that he could pardon his own federal offenses. It’s long past time to stop giving this appalling discussion of self-pardons any air.A president pardoning himself for his own crimes is the very definition of unchecked power. Revolutionaries called it tyranny, which in this context is a better word. The idea that our executive has so much power that the rule of law does not apply to him because he could forgive himself betrays what the Revolutionary War was about.The Constitution separated the powers of the government into three branches. It empowers Congress with the legislative power and the courts with the judicial power. The idea that a president could make himself immune from both other branches — in the furtherance of a crime — is inexcusable.Mr. Trump has floated this idea before and some allies are resurrecting it again. It’s born in the brevity of the Constitution’s pardon power. But it flouts both the rule of law and the separation of powers essential to the Constitution. We should be outraged.Andrew J. KennedyMonroeville, Pa.The writer is a lawyer.Trump’s WeightTo the Editor: Re “Trump Is Booked at Jail in Atlanta in Election Case” (front page, Aug. 25):Donald Trump weighs only 215 pounds? Forget the mug shot T-shirts; his campaign should be selling whatever brand of scale he’s using.Alan RutkowskiVictoria, British ColumbiaImproving Access to E-BooksAnn Johansson for The New York TimesTo the Editor: Re “What Does It Mean to Own a Book?” (Business, Aug. 13):I would like to thank David Streitfeld for his piece shining a light on the innovative and visionary work done by Brewster Kahle and the Internet Archive. In the discussion about the complexity of providing digital access, the work of our nation’s libraries and nonprofits like the Digital Public Library of America that support them should not be overlooked.Public libraries across the country offered access to over a billion digital e-books and half a billion digital audiobooks in fiscal year 2021. They circulated 460 million digital items and spent nearly $600 million to provide that access. And these numbers continue to grow.Mr. Streitfeld rightly points out that many titles are increasingly expensive for libraries to acquire, especially those from the “big five” publishers, which only offer licenses that are limited to a certain number of loans or length of time. However, the Digital Public Library of America works with hundreds of midsize and independent publishers to offer more reasonable terms including, for example, a perpetual one-user-at-a-time license that functions much like library ownership of a print book.Right now, legislators in several states are working with librarians to draft legislation that would enshrine the rights of libraries to acquire digital content on reasonable terms.Libraries need our support to ensure that as the transition into a digital world continues, access to knowledge becomes more and not less accessible.John S. BrackenChicagoThe writer is the executive director of the nonprofit Digital Public Library of America. More

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    Warren Boroson, Who Surveyed Psychiatrists on Goldwater, Dies at 88

    The defeated Republican presidential candidate sued Mr. Boroson and the magazine he worked for, saying it had libeled him for suggesting that he was mentally unfit for the presidency.Warren Boroson, a journalist who conducted a survey of psychiatrists that declared the 1964 Republican presidential nominee, Barry M. Goldwater, mentally unfit to be president — provoking a libel suit from the candidate and prompting a psychiatric association to muzzle its members from ever diagnosing a public figure from afar — died on March 12 at his home in Woodstock, N.Y. He was 88.The cause was complications of chronic obstructive pulmonary disease and heart ailments, his wife, Rebecca Boroson, said.Mr. Goldwater sued for $2 million, and Mr. Boroson, who had been the 29-year-old managing editor of the iconoclastic magazine Fact when he initiated the survey for it, feared a judgment against him would commit him to a lifetime of indentured servitude to that Arizona senator.A federal jury in New York found in favor of Mr. Goldwater, awarding damages of $75,000. But the verdict, which was upheld by the U.S. Supreme Court, put most of the blame on editing by others, largely absolving Mr. Boroson, who had to pay only a token 33 cents.Ethical questions raised by the survey, though, have roiled the psychiatric profession to this day.In 1973, the American Psychiatric Association adopted the so-called Goldwater rule, declaring that it was unethical for its members “to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.” Only one board member, Professor Alan A. Stone of Harvard Law School, voted against the rule, calling it “a denial of free speech and of every psychiatrist’s God-given right to make a fool of himself or herself.”Since then, some psychiatrists have defied the rule when asked by journalists and others to comment about the emotional and mental state of public figures, including foreign officials, terrorists and, in particular, Donald J. Trump, both as a candidate and as president. Some have resigned from the association rather than be bound by the rule.In 1964, the Fact survey led to Mr. Boroson’s resignation from the magazine. He had suggested polling psychiatrists to Fact’s publisher, Ralph Ginzburg, but quit before the article appeared, in September 1964, because, he said, his draft had been rewritten and sensationalized.Mr. Boroson had apparently agreed that Mr. Goldwater was “out of his mind” and feared for America’s safety if he were ever entrusted with the nation’s nuclear trigger, according to a book by Dr. John Martin-Joy, “Diagnosing From a Distance: Debates Over Libel Law, Media, and Psychiatric Ethics from Barry Goldwater to Donald Trump” (2020).Dr. Martin-Joy, a Cambridge, Mass., psychiatrist, said that Mr. Boroson had conducted “serious research into the best current thinking on how to prevent a recurrence of fascism,” and that his original draft represented “at least an effort to explain a complex psychological idea to the general public.”“I think he, with Ginzburg, was important in trying to push forward the frontiers of free speech on behalf of public understanding of the mental health of public figures,” Dr. Martin-Joy said. “However, the job they actually did was imperfect.”Senator Barry Goldwater and his wife, Peggy, arriving at the federal courthouse in New York in 1968 to testify in his libel suit against Fact magazine.Associated PressMr. Goldwater, who had lost the election in a landslide to the incumbent, President Lyndon B. Johnson, filed suit in 1965.“It was clearly felt by the court that this met the definition of actual malice, that Ginzburg had creatively edited responses from psychiatrists and that they were departing from what they knew to be facts,” Dr. Martin-Joy said. “I think they undermined their own case.”Dr. Jacob M. Appel, director of ethics education at the Icahn School of Medicine at Mt. Sinai in Manhattan, said that “Boroson’s work in the 1960s had the unintended consequence of muzzling psychiatrists like me today.” Mr. Boroson recalled in interviews and unpublished notes that his fears about Mr. Goldwater’s fitness were piqued when he read that the candidate had suffered two nervous breakdowns — stressful conditions that were later said to have been overstated.“I said to Ginzburg, ‘Why don’t we ask a few psychiatrists whether a nervous breakdown incapacitates someone for public office?’” Mr. Boroson recalled. “Ginzburg immediately replied: ‘Let’s ask every psychiatrist in the country.’ So we did.”Fact reached out to all 12,356 members on the American Psychiatric Association’s mailing list, asking them, “Do you believe Barry Goldwater is psychologically fit to serve as president of the United States?” Of the 2,417 who responded, 657 answered “Yes,” and 1,189 replied “No.” The rest said they didn’t know enough about the senator’s psyche to make a determination.Mr. Boroson wrote that the magazine’s 41 pages of excerpted responses constituted “the most intensive character analysis ever made of a living human being.”The cover article, titled “The Man and the Menace,” was derived from Mr. Boroson’s draft, which was apparently rewritten by Mr. Ginzburg’s friend, David Bar-Illan, an Israeli pianist and editor.“In anger I resigned from Fact,” Mr. Boroson wrote in his notes. “And insisted that my name not be listed as the author of the Bar-Illan article.” The article appeared under Mr. Ginzburg’s byline.An appeals court concluded that Mr. Ginzburg had “deleted most of Boroson’s references to the authoritarian personality and reached the conclusion, which Boroson had not expressed, that Senator Goldwater was suffering from paranoia and was mentally ill.”Time magazine wrote that the published version depicted Mr. Goldwater as “as a paranoiac, a latent homosexual and a latter-day Hitler.”The Supreme Court upheld the jury award: punitive damages of $25,000 against Mr. Ginzburg and $50,000 against the magazine, and $1 in compensatory damages divided among the three defendants, including Mr. Boroson. Justices Hugo L. Black and William O. Douglas dissented, citing First Amendment protections.Warren Gilbert Boroson was born on Jan. 22, 1935, in Manhattan. His mother, Cecelia (Wersan) Boroson, was an office manager. His father, Henry, was a teacher.Warren attended Memorial High School in West Nyack, N.Y., and graduated summa cum laude with a bachelor’s degree in English from Columbia University in 1957.In addition to his wife, Rebecca (Kaplan) Boroson, a retired journalist, he is survived by his sons, Bram and Matthew, and his brother, Dr. Hugh Boroson. In 1968, four years after the Goldwater survey, Mr. Ginzburg sought to conduct a similar survey of psychiatrists regarding President Johnson’s mental health. If he succeeded, the results were apparently never published.  Mr. Boroson later wrote for local newspapers and magazines, including Mr. Ginzburg’s Avant Garde, under pen names. (Fact, a quarterly, was published from January 1964 to August 1967.) He was the author of more than 20 books, including self-help financial guides. He also taught music, finance and journalism at colleges.“What did I learn from the experience?,” he wrote in his reflective notes about the Goldwater case. “Not much. I regret not proposing to write a book about Trump when he first became famous: Trump: In Relentless Pursuit of Selfishness.” More