What Science Says About Aging and Depression

DATE September 11, 2007 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Robert Reich, author of "Supercapitalism," on how big
deals online and at discount stores comes from low wages, minimal
benefits and other unseen prices
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross. We've been getting some great deals as
consumers: cheap prices at big discount stores, we can buy anything from
anywhere on the Internet, markets have become extraordinarily responsive to
our wishes as consumers and investors. But my guest, Robert Reich, points out
this has come at a big price. The flipside of cheap prices is unemployment,
low wages, minimal benefits and big box stores forcing out local businesses.
In Reich's new book, "Supercapitalism," he says that the gains we've made as
consumers and investors are offset by our losses as citizens.

Reich served as secretary of labor under President Clinton and is a professor
of public policy at the University of California at Berkeley. He's also a
commentator for the public radio program "Marketplace."

Robert Reich, welcome back to FRESH AIR. You write about how many of us
operate with a divided mind. For instance, we'll go shopping for the bargains
at Wal-Mart or, you know, wherever we're going to find the cheapest prices.
And at the same time we'll go home and complain that wages are low, people
don't have good health insurance benefits. And that's, you know, Wal-Mart is
an example of a company that keeps prices low at the expense of wages, at the
expense of good benefits. Would you talk a little bit about that divided mind
that you think we operate with as consumers?

Mr. ROBERT REICH: Well, I think we don't want to admit it to ourselves very
often. We have a citizen's side of our minds that says, `You know, I don't
like the fact that people at Wal-Mart are being paid $9 an hour. I don't like
the fact that my local bookstore--an independent bookstore just closed down
because of lack of business. I don't like the fact that our Main Streets are
being destroyed because everybody's using the Internet and ordering online or
going to big box retailers,' and on and on and on. I mean, we have citizen
values of all sorts.

But at exactly the same time, the consumer in us, or the investor in us, if
you're talking about my 401(k) plan, which I look at and I say, `Gee, I'm
going to move my money because I'm not getting very much out of that
investment.' The consumer and investor doesn't understand that in order to
maximize our benefits, get really great deals as consumers or investors, we
are pushing companies to do exactly what we don't want them to do in our
capacities as citizens. That is, depressed wages. Go offshore to get
lower-waged goods and services from a developing nation. Maybe even abrogate
human rights abroad, pollute the environment.

The two sides of our brain are almost at war, but we are very good at
maintaining that cognitive dissonance, compartmentalizing. Now, ideally,
democracy is a process whereby we, as a polity, as a community of citizens, we
address the things that we want in common that cannot be satisfied in the
market. But as our democracy becomes less and less effective, that whole
capacity to express ourselves as citizens disappears, and we become only
consumers and investors...

GROSS: What are some...

Mr. REICH: ...who are seeking the best deals.

GROSS: What are some of the systems that you feel have disappeared that used
to represent our shared values, our shared needs as citizens?

Mr. REICH: Well, first of all, Terry, let me just say I don't think there's
any going back to the what I'd call the not-quite golden age of the '50s, '60s
and '70s, but at least then we had a third of Americans in labor unions. The
bargaining that took place between unions and management in our big companies
set prevailing wages, even for nonunionized workers. We had regulatory
agencies. Now, granted, some of those did the bidding of many of the
companies that they regulated, but they also were charged with articulating
and responding to the public interest, and they did so.

We had local grass roots political organizations in our national parties, and
parties were much more effective in representing what it was that people at
the grass roots in towns and cities and states really wanted from their
politicians. We didn't have nearly the degree of lobbyists and money that has
flooded Washington, DC, over the last 30 years. And I could go on and on and
on.

I'm not saying that democracy 30 years ago was perfect, but because of all of
these systems and institutions and organizations--and I could go on with my
list--at least we had a crude approximation of the common good emerging. But
now we don't. We don't. You know, we're just individual citizens who are
mostly consumers and investors and we don't really know what to do as
citizens. I mean, we can write letters, we can, you know, we can elect--you
know, in the voting booths, we can elect who we want to elect. But our sense
of efficacy as citizens and the practice of citizenship is almost completely
gone.

GROSS: How do you think our power as consumers has changed? I mean, you
write a lot about the big box stores, the Wal-Mart kind of stores that have a
gazillion consumers around the world. So how does that change the way that
corporations see the power of consumers?

Mr. REICH: Well, the big change for consumers is we now have, through
technology a world of choice. Literally a world of choice. I mean, beginning
in the 1960s and '70s, container ships, cargo ships, satellite communications
technologies, new manufacturing techniques and technologies. And then
Wal-Mart and big box retailers, using information technologies to get low-cost
deals from all over the world increasingly using their market power, which
really is kind of the aggregated power of all their consumers, to negotiate
for terrific deals on behalf of their consumers. In all these ways, and now
even the Internet, we can shop for great deals. We consumers have choices, we
can comparison shop, we get a lot of information.

Contrast this with, again, 30 years ago. We had, what? In terms of the auto
industry. We had the big three. At the same time, the telephone
communications systems, 30 years ago, we had Ma Bell. Now we have a vast
array of competitors, including voice over the Internet, which is virtually
free. With banking and finance 30 years ago, 40 years ago, most of us had the
local bank, maybe two or three, maybe a savings and loan. Now there's an
infinite array. We can save our money, we can put it into all sorts of
places. We're inundated with requests to put our money to Merrill Lynch, or
put it to here and there, to the extent that we have any savings at all. Most
of us these days are deep in debt because we've been inundated by so many
credit cards. But as consumers we've never had it so good.

GROSS: But as consumers, we have all these choices now. How has that changed
our power as consumers to affect what corporations do?

Mr. REICH: Well, we certainly have the power as consumers to pressure
corporations to satisfy us. I mean, that's really what we do as consumers.
We get companies to satisfy us. Because if they don't satisfy us with great
deals, low prices, innovative products, good responses, we go elsewhere.
That's the Adam Smith free market operating, and we have never had a market
that is as efficient and as responsive to consumer discipline, and that really
is--I mean, look, every company is now far more intensely in competition with
every other company for consumer dollars than ever before.

And the same thing goes with investor dollars. Now 51 percent of American
households hold some shares of stock, mostly through their 401(k)s or
retirement plans, and investors have huge power. They can move their money
from place to place to place, and that puts great pressure on companies to
satisfy investors, because if they want to get any more capital out of capital
markets and they want to go back to the stock market for more capital, they've
got to show investors that they're a good deal.

GROSS: This relates to something else you say in the book about the nature of
investing and how it's changed the relationship of Wall Street and
corporations. Now that so many more people are invested through their
retirement funds or as individual investors and there are so many mutual funds
that control huge amounts of money, corporations and CEOs are under more
pressure than ever to cut costs and raise the price of shares. So how does
that fit into your theory of supercapitalism and how it's changing our lives
as consumers and as citizens?

Mr. REICH: Well, increasingly over the last 30 years, Wall Street has become
more efficient at aggregating investor desires for better deals, just like the
big box retailer Wal-Mart has become more efficient at aggregating consumer
desires for better deals. So Wall Street is putting greater and greater
pressure on companies to respond to investors and maximize shareholder
returns, just as the big box retailers is putting pressure on every producer
to generate more value for consumers.

Look back in the 1950s, '60s, even early 1970s, the Dow Jones industrial
average plodded along at maybe 500, 600, 700. Investors were relatively
docile. There wasn't all that much activity, not that much trading. People
put their money in the stock market and left it there. And there weren't even
that many people in the stock market. And now fast forward to the '80s and
'90s and the first decade of the 21st century, and you see the Dow is up at
12,000, beyond 12,000, an extraordinary multiple. We haven't seen this kind
of rise in the Dow over 30 years ever before. There was a kind of a big rise
in the 1920s, but nothing like we've seen over the past 30 years. And the
volume of trading is intense. We've got people, not professional Wall
Streeters but day traders, people who are sitting at home on their computers,
moving money around to get the best deal. Think of the pressure that puts an
any individual company to maximize shareholder returns for fear that if it
doesn't do so it's going to lose out and it won't be able to raise more
capital.

GROSS: So, again, you're saying, it's our concerns as investors that is in
part responsible for some of the extremes on Wall Street. The cost cutting,
the high salaries of CEOs.

Mr. REICH: I...

GROSS: You say people are spending a lot of money for CEOs because they
really believe the CEOs will cut costs and increase the shares because that's
what we're demanding as investors.

Mr. REICH: We as investors are rewarding ruthless CEOs, CEOs who, to use the
butcher metaphors of modern management, cut to the bone, get rid of the fat.
You know, who really deliver value in the short term. And that's basically
what the stock market is all about: making the market more efficient, getting
higher value, squeezing higher value out of companies and putting greater and
greater pressure on management to cut costs and provide higher profits. We
are putting companies under greater and greater and greater pressure to cut
costs, to generate value, to do everything they can to give us good deals, and
if we don't get the good deals, we're going to take our business elsewhere.

The irony is that the same intensifying competition that has forced companies
to provide better deals to consumers and investors at risk of losing consumers
and investors, has sloshed over into the political sphere and has made
democracy less effective. Because so many companies are in politics
protecting their turf, trying to outmaneuver their rivals. The reason we've
got, you know, 35, 40,000 lobbyists in Washington now as opposed to the 7,000
who were there when I first went to Washington in the 1970s is mostly because
companies are fighting each other. It's an arms race to outdo one another in
the political battleground just like they try to outdo one another in the
consumer and investor battleground.

GROSS: My guest is Robert Reich. His new book is called "Supercapitalism."
We'll talk more after a break. This is FRESH AIR.

(Announcements)

GROSS: My guest is Robert Reich. In his new book, "Supercapitalism," he
argues that the cheap prices and wide variety of choices that we have as
consumers have come at a price.

So what would you like to do to restore the balance that we have as citizens?
Because, you know, again the point of your book is that we have more power as
consumers, we have more choices as consumers, we have more options and power
as investors. But we've lost out as citizens. We have less input into the
democratic process. There are less agencies looking out for us, or less
powerful agencies looking out for us. So how would you like to restore our
balance as citizens in our democracy?

Mr. REICH: I want to get corporate money out of Washington, out of politics.
Easy to say, hard to do. The latest lobbying reform legislation coming
through the Democratic House of Representatives was a small mini-step in the
right direction. But, for example, there's a ban on lobbying for members of
Congress who are retired, lobbying your colleagues back in Congress of one
year. One year! Well, Terry, that has almost no consequence. I mean, you
want a ban that's five years. I mean, you want public financing of elections
so that our candidates, right now most the Democratic candidates for president
have said, `No, we're not going to take public financing because we don't want
to be limited. We don't want to be constrained. We can make more
money--raising more money by not taking public finance.' Well, you need more
public financing dollars so that candidates don't make that choice.

And even a more radical suggestion. Have a blind trust so that individual
members of Congress or individual candidates cannot know who's contributing to
them. If you want to contribute, sure you have a First Amendment right to
contribute, but you don't have a First Amendment right to have a seat at the
table when somebody you contribute to gets in. And if it's a blind trust so
that the individual candidates never know who is contributing to them, then
they're not going to give you an invitation to a seat at that table, based
upon your campaign contributions.

GROSS: You say you want laws and regulations that make our purchases and
investments a social choice as well as a personal one. What do you mean by
that?

Mr. REICH: There are social consequences to what we do as consumers and
investors. Some of those consequences may be global warming. You know, we're
very active as consumers and investors, and that activity encourages an
increase in our economic activity, and that increases pollution and global
warming. Some of those consequences have to do with widening inequality or
unstable jobs. And so on. Almost everything we do as consumers and investors
have some social consequence, but we are unable to respond to them as
consumers and investors because, after all, we want the best deals as
consumers and investors.

So we also want to, as citizens, have a vehicle for expressing our concerns
about these social consequences. That's what democracy is all about. That's
what it should be all about. I wish I believed that the corporate social
responsibility movement, the movement that says, in effect, we as consumers
and investors can influence the social trajectory of companies. We can,
through our consuming and investing decisions, make them better citizens. I
wish I believed that that were possible, but the evidence says no.

GROSS: Why don't you believe it's possible?

Mr. REICH: I used to believe it, Terry, and I still think, at the margin,
that concerned consumers and concerned investors can have an influence, but
all of the stories have convinced me that we, in our capacities as consumer
and investors, simply want the best deals possible. We may be--you know, our
consciences may be pricked, but we know that if we refrain from a good deal
because we think of the social consequence, we have no assurance that anybody
else is going to follow our example, and therefore we kind of shrug our
shoulders and say, `Well, why should I?' Most of us as consumers and investors
would like to be more socially responsible, but without any assurance that
other consumers and investors are going to follow our lead, we won't be.
We're going to get the best deal. That's what the studies show.

Nothing is going to change in terms of the behavior of companies unless there
are rules and regulations that come out of our democracy requiring that they
change their behavior. They will play the game as ruthlessly and as tough as
they can to give us as consumers and investors the best possible deals we can
get, and that's what capitalism is all about. But the rules of that game have
got to be set by our democratic process.

GROSS: So what kind of new type of organizations or agencies do you envision?
Because, as you point out in your book, it's not like we're going to go back
to the way things were. The airline industry isn't going to be re-regulated.
Unions won't return in the form that they once were. So give us an example of
an organization or an agency that you think would be suited for the way
consuming and investing has changed?

Mr. REICH: Well, we don't have them yet. I mean, one of the suggestions in
the book is that on our tax forms we can just check off a little book that
says `I want $10,000 of my tax payments to go to the following not-for-profit
group,' and we can designate a group that represents us in our capacity as
citizens. And conservatives may have different groups than liberals, but at
least we are funding those groups with a direct write-off of our taxes. That
might go some way.

I also suggest in the book that we have what I call "shareholder protection."
Just as some states have what they call payroll, or paycheck protection laws.
Those paycheck protection laws are designed to make sure that union dues are
not used for political purposes. If some union member doesn't want his or her
dues to be used that way, well, why shouldn't we have a law that says, `Look,
I'm a shareholder in a big company and I don't want my money in that company
because I basically own a small percentage of that company by being a
shareholder. I don't want it used to support political activities I disagree
with in my capacity as a citizen. So you've got to check in with me if you
want to do that, and reimburse me my pro-writer's share of the company if I
don't like the politics that you are supporting in terms of my money, support,
you know, in a political action committee, for example.'

GROSS: Robert Reich is the author of the new book "Supercapitalism." He's a
professor of public policy at the University of California at Berkeley. He'll
be back in the second half of the show. I'm Terry Gross, and this is FRESH
AIR.

(Announcements)

GROSS: This is FRESH AIR. I'm Terry Gross back with Robert Reich. In his
new book, "Supercapitalism," he argues that the cheap prices and dynamic stock
market that we've become accustomed to have come at a price. What we've
gained as consumers is offset by what we've lost as citizens--like jobs, wages
and health insurance. Reich served as secretary of labor under President
Clinton and is now a professor of public policy at the University of
California at Berkeley. He's also a commentator on the public radio program
"Marketplace."

Your book isn't about having an agenda, but there are things that you
recommend to restore the balance between who we are as citizens and what our
demands are as consumers and investors. You'd like to see universal health
care. You'd like to see health care no longer be employee-based, and so many
companies are cutting benefits to cut costs. You'd like to see a higher
minimum wage. And at the same time--and this kind of surprises me--you oppose
penalizing companies who outsource. You'd like to abolish corporate income
tax. How come? I mean, you want to restore a balance between who we are as
citizens and the powers of corporations. Why do you want to make it easier
for corporations by abolishing corporate income tax and opposing any kind of
penalties for outsourcing?

Mr. REICH: Because I don't think corporations are people, and I think that
the sooner we give up that anthropomorphic fallacy, the better we will be able
to address the very fundamentally important job of restoring our democracy.
If we tax corporations thinking that they're people, or if we criminalize
corporations like Arthur Andersen assuming that they are people, we fall into
the trap--and it's a conceptual trap as well as a practical, legal trap--of
giving corporations the rights and the responsibilities of individuals. We
ultimately give them political rights because no taxation without
representation. No criminalization without representation. Corporations are
just pieces of paper.

GROSS: But corporations make, I mean, money. Why wouldn't their entities,
and there are laws governing entities, why wouldn't you want those entities
taxed?

Mr. REICH: Because ultimately the corporate income tax is paid by people,
it's not paid by the corporation. It's passed on, to mostly investors, to a
lesser extent to employees and consumers. The corporate income tax is a good
example of something that we assume is paid by the corporation because the
corporation, we assume, is something separate from its employees and its
shareholders. But, actually, that's not true. The corporation doesn't pay
the corporate income tax. The corporate income tax is passed on to investors
in the form of a slightly less return on their investments, and, to some
extent to employees, in the form of slightly lower wages. So let's get rid of
the corporate income tax. Let's stop indulging in that fiction. Similarly...

GROSS: Wait, wait, wait, wait.

Mr. REICH: Mm-hmm?

GROSS: So where's that tax money going to come from? You going to raise my
personal taxes instead? I mean...

Mr. REICH: No, no...

GROSS: If we need tax money to do the things we want as citizens, and if you
abolish the corporate tax, where does the money come from?

Mr. REICH: Well, my proposal is to charge--because they're really the owners
of corporations--individual shareholders, and instead of having a corporation
pay the corporate income tax, have the taxes paid on a pro rata basis in terms
of their proportional ownership of the corporation by individual shareholders
and withheld by the corporation, just as the corporation withholds employee
tax payments that are owed to the government.

It may sound like a symbolic effort, Terry, but it's not really symbolic. It
helps us understand that it's not the corporation that's paying. It's really
the shareholders, and in the principle of no taxation without representation,
companies should not be represented in Congress or in any other legal or
political process. It's shareholders who deserve to be represented as people
in their capacity as citizens and as shareholders. Let's get rid of the
fiction that a corporation is a person with its own political rights and its
own political duties.

GROSS: Well, you know, one of the things I thought you might suggest to kind
of help right the balance is that we consumers demand that corporations don't
outsource and take, you know, American jobs to other countries where the wages
are cheaper, but you oppose that.

Mr. REICH: Well, consumers--the consumer side of our brains wants the best
deals we possibly can get, and consumers would be appalled if they suddenly
could not get great deals from all over the world. I mean, the prices would
shoot upward, and the consumer sides of our brains would be in revolt.

No, my response in terms of balancing the citizen and the consumer there is to
have trade treaties that contain labor clauses, labor provisions, that say to
developing nations, `Look, your minimum wage has got to be, say, half of your
median wage, so that as you trade with the United States and as you get
richer, you create larger middle classes that eventually will buy our goods
and create stable democracies at the same time.' That's my answer. Now, I'm
not saying that that's necessarily the best answer, but at least we need to
address the trade-off and acknowledge that there is a trade-off.

GROSS: You know, I'm wondering how the subprime mortgage meltdown and its
impact on Wall Street fits in, if at all, to your theory of supercapitalism,
which is the subject of your new book.

Mr. REICH: It fits in quite directly. I mean, the real tragedy of the
subprime meltdown has been millions of families who face mortgage foreclosure
because they were sold a bill of goods. They were told by mortgage bankers
and lenders that they could repay these loans, zero interest, zero down. And
like any people who are hoodwinked by sellers--and this is, you know, the kind
of tough sales--strong-arm sales tactic go back in history--they ended up and
they may end up with nothing. The Federal Reserve board is concerned about
the major banks and the financial institutions, but the little guy, once
again, is left with very little protection.

We have a democracy now, sadly, that is very responsive to the biggest
players, the richest and largest institutions. If you're too big to fail,
then you will not fail. If you're a long-term capital management hedge fund,
you will be bailed out. But if you're just a normal, blue-collar,
middle-class poor person, you're not going to be bailed out. In fact, the
rules for personal bankruptcy have been made more difficult, and you're going
to find yourself, as so many people find themselves these days, on the short
end of the stick.

GROSS: Robert Reich is the author of the new book "Supercapitalism." He's a
professor of public policy at the University of California at Berkeley and a
commentator for the public radio program "Marketplace."

Coming up, diagnosing and treating depression in the elderly. We talk with
Dr. Charles Reynolds. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Dr. Charles Reynolds, director of a late-life mood
disorder research center at the University of Pittsburgh Medical
School, on depression in the elderly
TERRY GROSS, host:

Older people often suffer with undiagnosed and untreated depression. My
guest, Dr. Charles Reynolds, says depression should not be regarded as a
normal part of aging. Reynolds directs a research center for late-life mood
disorders that is funded by the National Institute of Mental Health. It's
based at the University of Pittsburgh Medical School, where he's a professor
of psychiatry, neurology and neuroscience. Among the things he's studied is
the use of antidepressants in people over 70.

Dr. Reynolds, welcome to FRESH AIR. You know, there are so many reasons to
be depressed if you're very old. There's declining health; that's probably
not going to improve. Maybe you've lost a spouse. You've probably lost
friends. You're facing more decline as you get older, and you know that
that's just going to be followed by death. So you'd maybe say that depression
is a natural and even almost sensible state to be in given what you're facing.
What would you say to that?

Dr. CHARLES REYNOLDS: What's really, I think, surprising, Terry, is how many
older people are resilient to clinical depression. Despite the losses that
accompany old age, perhaps bereavement or changes in health status that make
one more dependent or frail, most people don't in fact develop the symptoms
and signs of clinical depression; rather they're able to copy actively with
the challenges of old age. Perhaps two in 10 people do, however, become
clinical depressed, and it's important that they be identified and offered
appropriate treatment.

GROSS: Now, I was once told by a doctor, by an internist, that
antidepressants aren't as effective in the elderly as they are with other
people. And that also antidepressants won't be as effective if an older
person's depression seems to be situational--like the loss of a spouse or like
facing, you know, chronic health problems. Do you think that doctor was
correct?

Dr. REYNOLDS: The data really do suggest otherwise, and let me tell you what
I mean. Clinical trials involving the use of antidepressant medications have
matured in the last 10 to 20 years, and what we've shown, in essence, that
situational depression, such as depression following bereavement, in fact is
quite responsive to antidepressant medication and allows the person who is
bereaved to be in a better position for doing the work of grief. It removes
one of the barriers to doing appropriate grief work and to adjusting to life,
say, without the spouse.

GROSS: Do you find that a lot of elderly people are resistant to even talking
to a psychiatrist because they grew up in a time when psychiatry was
considered, you know, for the mentally ill, and the word mentally ill was such
a stigmatized word, you know? I've known older people who will look at you
and say, `I'm not crazy, therefore I don't need to see a psychiatrist and I
certainly don't need any medication.'

Dr. REYNOLDS: I do think that is the case. The older generation of
Americans, I think, have a very different personal model of what depression
is. And we should say that depression doesn't mean that you're crazy. It's a
treatable medical illness.

At the same time, I think many older Americans may take the view that
depression may somehow represent a moral failing or a character, a logic flaw
rather than an illness like diabetes or hypertension, which can be diagnosed
and treated. You see that attitude expressed as well in preferences: if one
is to have treatment at all, to be treated in the primary care setting rather
than being referred out to a mental health specialist.

My own view happens to be that it's very appropriate for most older Americans
living with depression to be treated in the primary care setting. Depression
treatment is often a very straightforward medical undertaking. Geriatric
mental health specialists like myself can be called in as consultants, or we
can offer an opinion on a particularly difficult-to-manage situation.

GROSS: When you do talk therapy, as I assume you do with some older patients
who you see...

Dr. REYNOLDS: Correct. Yes.

GROSS: ...can you give us a sense of what therapy is like, like what topics
you'd bring up and especially if somebody's older and their memory isn't as
good as it used to be, maybe they even have a little bit of dementia. I mean,
how does talk therapy work when your mind isn't want it used to be?

Dr. REYNOLDS: Talk therapy is actually very helpful for older people with
depression. I think it's important to emphasize that all of these therapies
are relatively brief. They're very active. The patient is not lying on a
couch, as you might think of in terms of traditional psychoanalysis. Rather,
the patient and the therapist are actively engaged in one form of problem
solving or another.

Take interpersonal psychotherapy as an example. Here we're very often dealing
with issues related to bereavement, such as the loss of a spouse or
transitions in major social roles, such as can be seen in the wake of
retirement.

We might also be dealing with interpersonal conflicts. Let's suppose an older
person with depression is becoming increasingly frail or dependent up on a
caregiver, and that relationship is become somewhat conflictual. One of the
important focuses of IPT, interpersonal therapy, in a situation like that is
to help improve communication with the caregiver in order to lower the amount
of tension or stress that's in that relationship. Not infrequently we'll also
invite the caregiver or significant other in the patient's family to join
briefly in the therapy in order to help clarify the situation or to improve
communication.

GROSS: Now, I know while you were doing your residency at the the University
of Pittsburgh one of your grandparents committed suicide at the age of 89, and
I understand that that helped lead you to study geriatric psychiatry. What
happened? What do you know about why your grandparent committed suicide?

Dr. REYNOLDS: Yeah, this was my grandfather, Mr. Charlie, as he was called.
I'm actually named for him. He was a very successful Mississippi farmer. He
raised cotton. He was a--really a great guy, very vital and, as far as I
know, had never experienced any depression in his life until he reached very
old age, and in his mid- to late-80s, Mr. Charlie, as he was called, suffered
a stroke. He also developed a very painful case of herpes, which is common in
older people who are frail or whose immune systems are compromised.

And my speculation, Terry, is that in the wake of these medical insults, which
were very disabling for him, so that he couldn't really practice farming
anymore, I think he came to feel that his life was pointless. He became
pessimistic and hopeless, and, as is the class with many older Americans
living in the rural parts of our country, he had relatively limited access to
medical care. Certainly he had virtually no access to mental health specialty
care.

So I think he made the decision that he had no more, in a sense, windmills to
tilt at and he had a gun in his house and, as is the case with many older men
who die by suicide, he shot himself in the head. I found out about that after
the fact and, as your question suggested, it had really a profound impact on
me, both as his grandson but also as a budding young psychiatrist at that
point. And so for the last really 25 years, this has been the focus of a lot
of the scientific and clinical work that I've done, and I think we've made a
lot of progress to trying to prevent the sort of thing that happened to my
grandfather.

GROSS: Did people in your family feel that if they had intervened in some way
that they might have prevented him from killing himself?

Dr. REYNOLDS: Oh yes. I think this is always, Terry, the emotional legacy
of suicide within a family. You always have to ask yourself if it was
preventable. And yet the science, I think, tells us two things here that are
very important to take note of. A lot of suicide in old age is preventable
because it's the product of depression, which is a treatable illness. My
colleagues and I have shown that if you appropriately treat depression in old
age, you greatly lower or reduce the amount of suicidal ideation. At the same
time, it's important to remember that mental illnesses, like other illnesses,
are sometimes fatal. They can be terminal, and it's not possible in fact to
prevent all cases of suicide, even under the best of circumstances.

GROSS: My guest is Dr. Charles Reynolds. He directs the Intervention
Research Center for Late-Life Mood Disorders at the the University of
Pittsburgh School of Medicine. We'll talk more after a break. This is FRESH
AIR.

(Announcements)

GROSS: My guest is Dr. Charles Reynolds. He directs the Center for
Late-Life Mood Disorders and specializes in the diagnosis and treatment of
geriatric depression.

Let me raise a question--and this gets to an issue that I think a lot of
people talk about with people that they're comfortable with. You know there
is--a lot of people feel now that we are able to be kept alive medically past
the point where anybody would really want to be alive. In other words, that
through surgeries and drugs and other therapies, you could be incredibly
frail, in a lot of pain, you know, with no hope of any real improvement and
that like, earlier, people would die of like heart attacks and strokes and
stuff, and now, you know, thank goodness there's medicine that can enable you
to survive things that would have killed you, but you're surviving at a very
old age in a very frail, compromised state and in a very unhappy state. And,
I mean, people are living in ways that they just never did before. I'm sorry
for stammering here, but it's a very uncomfortable subject to discuss, but
there's just a lot of people who say, `If I get to that point, I don't want to
live that way.'

Dr. REYNOLDS: I'm glad that you asked the question, because it's a
conversation that we need to have as a nation, isn't it? As well as within
our own families and with our primary care physicians. The fastest-growing
segment of the population in the US is actually people above the age of 85.
That is to say, the frail elderly. We're now learning a good deal more about
how to help the elderly age successfully so that the period of functional
morbidity that you describe so well in your question to me...

GROSS: What does functional morbidity mean?

Dr. REYNOLDS: Prolonged inability to engage in the activities of daily
living...

GROSS: Mm-hmm.

Dr. REYNOLDS: ...that give one meaning and a sense of pleasure in life, so
that that period of dependency on others, increasingly, we think will be
decreased. And I think that's important to keep that perspective in mind as
we go forward together as a nation, as a developed economy with an increasing
number of elderly people. That said, it's very important for all of us to
have discussions with family members, caregivers, ministers, physicians, about
what our core values and preferences are, about the extent of treatment and
support that we want at the end of life. So often we don't have those
conversations. They aren't reflected in living wills, for example And yet, if
we do have those conversations with significant others and with our
physicians, I think the chances are that we'll have a greater sense of control
at the end of life and prevent the kind of scenario that you described.

GROSS: Of course, you know, living wills never say, `I have a gun and at a
certain point, let me use it.' Do you know what I mean? And without sounding
cold, I'm wondering if there was anybody in your family who said about your
grandfather after he killed himself, `God bless him. He knew what he wanted.
He got to a point where he no longer wanted to live. He had a gun. He made a
rational choice, and, you know, who can argue with it? Maybe he knew what his
limits were and, by his standards, he did the right thing.'

Dr. REYNOLDS: You know, I think that's a very understandable point of view,
and I struggle with that myself. And at times I think, Terry, I've comforted
myself as a grandson with that point of view. You know, at the same time,
though, the science tell us something that may be slightly different from that
interpretation, and that is that if you provide appropriate clinical
management or treatment to an elder living with depression or with emotional
or spiritual or psychological pain, very often their desire to end their lives
may actually go away, and they may decide that it's worth sticking around for
a little bit longer.

GROSS: What advice would you have for people who have an elderly parent or
grandparent or spouse who they really feel is depressed and could benefit from
by kind of psychiatric help, but the person who is depressed doesn't
comprehend that they're depressed and they refuse to do anything about it, to
see anybody about it, and, in fact, even accept it as an insult that somebody
would think that they are depressed and that they need help.

Dr. REYNOLDS: Your question is so very important because, as you've just
said, many older people simply don't, or won't recognize clinical depression
in themselves. Also, it's very difficult to be the family member or caregiver
of an older person with depression. Depression is almost like a contagious
illness, and many of the caregivers of our depressed patients are themselves
suffering from mild forms of depression.

There's some practical things that a family member or caregiver can do. First
of all, it may be better not to use the D word, the depression word, which may
be so stigmatized for older Americans that it represents an absolute barrier
to help seeking. Instead of depression, they hear "crazy." So it may actually
be better to use terms that are out of the everyday vocabulary or experience
of an older depressed person. Perhaps they're tired day in and day out or not
enjoying most of their usual activities. Maybe they're worried. Maybe
they're not sleeping well. So a family member can talk to the older person in
terms of their actual lived experience of depression. Under those
circumstances it's often possible to persuade an older family member to get
help.

Now, the help may be from a trusted professional. Perhaps that is going to be
a minister or a priest or a rabbi. Maybe it's going to be a primary care doc
with whom they've worked for many years. The important point is that they're
beginning to get help from some appropriate source, and then, if the primary
care doc, for example, feels that he or she needs a second opinion, they can
call in a mental health specialist to give that opinion about managing a
tricky situation, for example.

GROSS: Dr. Reynolds, thank you so much for talking with us.

Dr. REYNOLDS: My pleasure. Great interview, Terry. Thank you.

GROSS: Dr. Charles Reynolds is a professor of psychiatry and neurology at
the University of Pittsburgh School of Medicine, where he directs the
Intervention Research Center for Late-Life Mood Disorders.

I'm Terry Gross. We're closing with a track featuring keyboard player Joe
Zawinul. He died of cancer today at the age of 75. Through his work playing
electric piano on the Miles Davis albums "In a Silent Way" and "Bitches Brew"
and by founding the band Weather Report, he became a leading figure in jazz
fusion. Before playing with Miles, he spent nine years with Cannonball
Adderley. This is Adderley and Zawinul's 1966 hit "Mercy, Mercy, Mercy,"
which was composed by Zawinul.

(Soundbite of "Mercy, Mercy, Mercy")
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