The New Old Age Blog: Taking a Zen Approach to Caregiving

You try to help your elderly father. Irritated and defensive, he snaps at you instead of going along with your suggestion. And you think “this is so unfair” and feel a rising tide of anger.

How to handle situations like this, which arise often and create so much angst for caregivers?

Jennifer Block finds the answer in what she calls “contemplative caregiving” — the application of Buddhist principles to caregiving and the subject of a year-long course that starts at the San Francisco Zen Center in a few weeks.

This approach aims to cultivate compassion, both for older people and the people they depend on, said Ms. Block, 49, a Buddhist chaplain and the course’s lead instructor. She’s also the former director of education at the Zen Hospice project in San Francisco and founder of the Beyond Measure School for Contemplative Care, which is helping develop a new, Zen-inspired senior living community in the area.

I caught up with Ms. Block recently, and what follows is an edited transcript of our conversation.

Let’s start with your experience. Have you been a caregiver?

My experience in caregiving is as a professional providing spiritual care to individuals and families when they are facing and coping with aging and sickness and loss and dying, particularly in hospital and hospice settings.

What kinds of challenges have you witnessed?

People are for the most part unprepared for caregiving. They’re either untrained or unable to trust their own instincts. They lack confidence as well as knowledge. By confidence, I mean understanding and accepting that we don’t know all the answers – what to do, how to fix things.

This past weekend, I was on the phone with a woman who’d brought her mom to live near her in assisted living. The mom had been to the hospital the day before. My conversation with the daughter was about helping her see the truth that her mother needed more care and that was going to change the daughter’s responsibilities and her life. And also, her mother was frail, elderly, and coming nearer to death.

That’s hard, isn’t it?

Yes, because we live in a death-denying society. Also, we live in a fast-paced, demanding world that says don’t sit still — do something. But people receiving care often need most of all for us to spend time with them. When we do that, their mortality and our grief and our helplessness becomes closer to us and more apparent.

How can contemplative caregiving help?

We teach people to cultivate a relationship with aging, sickness and dying. To turn toward it rather than turning away, and to pay close attention. Most people don’t want to do this.

A person needs training to face what is difficult in oneself and in others. There are spiritual muscles we need to develop, just like we develop physical muscles in a gym. Also, the mind needs to be trained to be responsive instead of reactive.

What does that mean?

Here’s an example. Let’s say you’re trying to help your mother, and she says something off-putting to you like “you’ve always been terrible at keeping house. It’s no wonder you lost my pajamas.”

The first thing is to notice your experience. To become aware of that feeling, almost like being slapped emotionally. To notice your chest tightening.

Then I tell people to take a deep breath. And say something to themselves like “soften” to address that tightness. That’s how you can stay facing something uncomfortable rather than turning away.

If I were in this position, I might say something to myself like “hello unhappiness” or “hello suffering” or “hello aging” to tether myself.

The second step would be curiosity about that experience. Like, wow, where do I feel that anger that rose up in me, or that fear? Oh, it’s in my chest. I’m going to feel that, stay with it, investigate it.

Why is that important?

Because as we investigate something we come to understand it. And, paradoxically, when we pay attention to pain it changes. It softens. It moves. It lessens. It deepens. And we get to know it and learn not to be afraid of it or change it or fix it but just come alongside of it.

Over hours, days, months, years, the mind and heart come to know pain. And the response to pain is compassion — the wish for the alleviation of pain.

Let’s go back to what mother said about your housekeeping and the pajamas. Maybe you leave the room for five minutes so you can pay attention to your reaction and remember your training. Then, you can go back in and have a response rather than a reaction. Maybe something like “Mom, I think you’re right. I may not be the world’s best housekeeper. I’m sorry I lost your pajamas. It seems like you’re having a pretty strong response to that, and I’d like to know why it matters so much to you. What’s happening with you today?”

Are other skills important?

Another skill is to become aware of how much we receive as well as give in caregiving. Caregiving can be really gratifying. It’s an expression of our values and identity: the way we want the world to be. So, I try to teach people how this role benefits them. Such as learning what it’s like to be old. Or having a close, intimate relationship with an older parent for the first time in decades. It isn’t necessarily pleasant or easy. But the alternative is missing someone’s final chapter, and that can be a real loss.

What will you do in your course?

We’ll teach the principles of contemplative care and discuss them. We’ll have homework, such as ‘Bring me three examples of someone you were caring for who was caring toward you in return.’ That’s one way of practicing attention. And people will train in meditation.

We’ll also explore our own relationship to aging, sickness, dying and loss. We’ll tell our stories: this is the situation I was in, this is where I felt myself shut down, this was the edge of my comfort or knowledge. And we’ll teach principles from Buddhism. Equanimity. Compassion. Deep inner connectedness.

What can people do on their own?

Mindfulness training is offered in almost every city. That’s one of the core components of this approach.

I think every caregiver needs to have their own caregiver — a therapist or a colleague or a friend, someone who is there for them and with whom they can unburden themselves. I think of caregiving as drawing water from a well. We need to make sure that we have whatever nurtures us, whatever supplies that well. And often, that’s connecting with others.

Are other groups doing this kind of work?

In New York City, the New York Zen Center for Contemplative Care educates the public and professionals about contemplative care. And in New Mexico, the Upaya Zen Center does similar work, much of it centered around death and dying.

People who want to read about this might want to look at a new book of essays, “The Arts of Contemplative Care: Pioneering Voices in Buddhist Chaplaincy and Pastoral Work” (Wisdom Publications, 2012).

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DealBook: Wells Fargo Profit Jumps 24% in Quarter, Driven by Mortgage Gains

8:46 a.m. | Updated

Wells Fargo reported $5.1 billion in profit for the fourth quarter on Friday, a 24 percent increase, driven by the bank’s lucrative mortgage business.

Seizing on low-interest rates that have spurred a flurry of refinancing activity, the bank again notched record profits. For the last 12 quarters, profits at the bank have increased.

In this latest quarter, Wells Fargo, based in San Francisco, reported earnings of 91 cents a share, which exceeded analysts’ expectations. Ahead of the report, analysts polled by Thomson Reuters estimated that the bank would report earnings of 89 a share.

Wells Fargo, unlike many of its rivals, has been able to steadily increase its revenue. The first bank to release fourth-quarter earnings, Wells Fargo reported $21.95 billion in revenue in the fourth quarter, up 7 percent from a year earlier.

Much of the revenue gains stemmed from the bank’s consumer lending business, as borrowers jumped on record low interest rates to refinance their mortgages. Wells Fargo, which dominates the market as the nation’s largest mortgage lender, notched $125 billion in mortgage originations, up from $120 billion in the fourth quarter of 2011. Refinancing applications accounted for nearly 75 percent of that total.

The big profit in the group came from the extra money that Wells Fargo makes bundling the mortgages into bonds and selling them to the government. In the fourth quarter, the bank reported $2.8 billion of so-called net gains on its mortgages activities, up 51 percent from the previous year.

Under the tenure of its chief executive, John G. Stumpf, Wells Fargo has aggressively expanded into the mortgage market, a strategy that might help the bank surpass its rivals in profits, notably JPMorgan Chase.

Wells Fargo’s net interest margin, a closely watched profit metric that measures the difference between the interest the bank collects and the interest it pays on its own borrowings, was down slightly to 3.56 percent, from 3.89 percent a year earlier.

Profit in the community banking division, which spans Wells Fargo’s retail branches and mortgage business, increased 14 percent to $2.9 billion.

The bank successfully courted more cash from depositors, adding $72 billion in total core checking and savings deposits than a year earlier.

“The company’s underlying results were driven by solid loan growth, improved credit quality, and continued success in improving efficiency,” Wells Fargo’s chief financial officer, Tim Sloan, said in a statement.

The bank has benefited from sweeping federal stimulus initiatives that have buoyed the mortgage business. The Treasury Department has helped spur Americans to refinance their mortgages.

Wells Fargo is the reigning titan in the mortgage industry, generating roughly a third of all the mortgages across the United States. Mortgage originations continued to climb, up 4 percent to $125 billion.

Adding to its mortgage-related profit, Wells Fargo reported a $926 million profit from its servicing business, in which the bank collects payments from homeowners. That’s up roughly 6 percent from a year earlier.

Alongside the consumer loan business, Wells Fargo had gains in its wealth management business, a particular focus for the bank to defray the impact of federal regulations that dragged down profits elsewhere.

Still, Wells Fargo’s profit from residential mortgages could wane this year if the Federal Reserve halts its extensive bond buying spree.

Working to move beyond the mortgage crisis woes that have dogged the bank, Wells Fargo has been brokering deals with federal regulators. Wells Fargo was one of 10 banks that signed onto an $8.5 billion settlement this week with the Comptroller of the Currency and the Federal Reserve over claims that shoddy foreclosure practices may have led to the wrongful eviction of homeowners.

The sweeping federal pact ends a deeply flawed review of millions of loans in foreclosure that was mandated by federal regulators in 2011. The review, which was ended this week, began in November 2011 amid mounting public fury that bank employees were churning through hundreds of foreclosure filings without reviewing them for accuracy.

In addition to the settlement, the bank set aside $1.2 billion to prevent foreclosures.

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Way of the World: Economists, Consensus and Healthy Debates

SAN DIEGO — This is a tough time for experts. Empowered by the Internet and embittered by the sour economy, many people doubt the wisdom of expert elites. Journalism sometimes casts further doubt by seeking polarized positions that can draw an attention-grabbing debate, or by taking refuge in he-said-she-said accounts to avoid the harder job of figuring out who’s right.

Now one tribe of specialists — economists — is striking back. Concerned that the great unwashed have come to see all economic proposals as being equally valid, the University of Chicago Booth School of Business has led an effort to figure out what economists agree on, where they diverge and how certain they are about their views.

To do that, the Booth school called on reputable economists to join its panel of experts. Each week, the panelists are asked whether they agree or disagree with a particular economic idea.

“Among practicing economists, it is understood that the media and the political process paints economists as more divided than they are,” Anil K. Kashyap, a professor of economics and finance at the University of Chicago and a leader of the project, explained. “It is more sensational and maybe makes for better reading to have point-counterpoint. It seemed reasonable to provide some context. There’s a lot more settled issues than most people have a sense of.”

Dr. Kashyap cited as an example the gold standard, the monetary system in which the standard economic unit of account is a fixed weight of gold. “The gold standard is an insane idea,” he said. “I don’t know of any reputable economist who thinks it is a wise idea, but it got a lot of real political traction.”

Of the Booth panelists, 93 percent disagreed that the gold standard could improve price stability or employment.

But that is an extreme example. A paper presented this week at the annual gathering of the American Economic Association investigated the survey results in greater detail. “Based on our analysis, we conclude that there is close to full consensus among these panel members when the past economic literature on the question is large,” the authors of the paper, Roger Gordon and Gordon B. Dahl of the University of California, San Diego, wrote. “When past evidence is less extensive, differences in opinions do show up.”

But the authors did not find an ideological bias in those disagreements: “There are certainly some idiosyncratic views expressed, but we found no evidence of different camps.”

Economists, these results suggest, seek to objectively establish the truth and have a widely agreed on body of knowledge about how the economy works. In an age when it can be hard to write the word “facts” without reflexively reaching for quotation marks, that is of some comfort. But this picture of consensus among experts comes with a few caveats.

One was articulated by Paul Krugman, a Nobel Prize laureate and New York Times columnist who was at the American Economic Association meeting. Mr. Krugman accepted the idea that economists share a wide body of agreed, objective and nonideological knowledge. But he argued that when it comes to one subset of issues — business-cycle macroeconomics, or how policy should respond to booms and busts — economists are both divided and biased. That matters, Mr. Krugman rightly pointed out, because outside the academy these are among the economic issues ordinary mortals care about, and fight about, the most.

The second caveat is that consensus may be more fleeting, and therefore less valuable, than the economic high priesthood might like to think. To his credit, Dr. Kashyap revealed two issues on which the economic conventional wisdom, and his own views, have changed since the financial crisis of 2008.

One is currency controls: “Having watched all this hot money flow into these markets, I am much more sympathetic to the desire to slow things down,” he said.

The second is whether central bankers should try to pop asset bubbles, an idea toward which Dr. Kashyap has softened. “I don’t think the conventional wisdom was very good on this and I was firmly in the consensus,” he said.

These shifts suggest that it is worth looking more closely at one clear subgroup among the economists in the University of California study. Dr. Gordon and Dr. Dahl searched for, and failed to detect, ideological bias or even the subtler influence of the very distinct intellectual traditions of top U.S. universities.

But they did pick up a clear difference between men and women. “Women,” they write, “tend to be more cautious in taking a stance.” For women making their way in the 21st-century world of work, that reticence is mostly a handicap — a willingness to admit to uncertainty is one reason women are paid less and can find it difficult to break through the glass ceiling.

For the benefit of the community as a whole, though, more female economists may be needed. The quest for objective economic knowledge is surely a good thing, as is the Booth effort to map what economists agree on and where they diverge. But given how profoundly and unexpectedly the world economy collapsed in 2008, maybe a little more womanly humility about that conventional wisdom would be a good thing, too.

Chrystia Freeland is editor of Thomson Reuters Digital.

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NFL player Junior Seau had brain disease CTE

Junior Seau, one of the NFL's best and fiercest players for nearly two decades, had a degenerative brain disease when he committed suicide last May, the National Institutes of Health told The Associated Press on Thursday.

Results of an NIH study of Seau's brain revealed abnormalities consistent with chronic traumatic encephalopathy (CTE).

"The brain was independently evaluated by multiple experts, in a blind fashion," said Dr. Russell Lonser, who oversaw the study. "We had the opportunity to get multiple experts involved in a way they wouldn't be able to directly identify his tissue even if they knew he was one of the individuals studied."

The NIH, based in Bethesda, Md., conducted a study of three unidentified brains, one of which was Seau's. It said the findings on Seau were similar to autopsies of people "with exposure to repetitive head injuries."

Seau's family requested the analysis of his brain.

Seau was a star linebacker for 20 NFL seasons with San Diego, Miami and New England before retiring in 2009. He died of a self-inflicted shotgun wound.

He joins a list of several dozen football players who had CTE. Boston University's center for study of the disease reported last month that 34 former pro players and nine who played only college football suffered from CTE.

"I was not surprised after learning a little about CTE that he had it," Seau's 23-year-old son Tyler said. "He did play so many years at that level. I was more just kind of angry I didn't do something more and have the awareness to help him more, and now it is too late.

"I don't think any of us were aware of the side effects that could be going on with head trauma until he passed away. We didn't know his behavior was from head trauma."

That behavior, according to Tyler Seau and Junior's ex-wife Gina, included wild mood swings, irrationality, forgetfulness, insomnia and depression.

"He emotionally detached himself and would kind of 'go away' for a little bit," Tyler Seau said. "And then the depression and things like that. It started to progressively get worse."

He hid it well in public, they said. But not when he was with family or close friends.

"We appreciate the Seau family's cooperation with the National Institutes of Health," the league said in an email to the AP. "The finding underscores the recognized need for additional research to accelerate a fuller understanding of CTE.

"The NFL, both directly and in partnership with the NIH, Centers for Disease Control and other leading organizations, is committed to supporting a wide range of independent medical and scientific research that will both address CTE and promote the long-term health and safety of athletes at all levels."

NFL teams have given a $30 million research grant to the NIH.

The NFL faces lawsuits by thousands of former players who say the league withheld information on the harmful effects concussions. According to an AP review of 175 lawsuits, 3,818 players have filed suit. At least 26 Hall of Famer members are among the players who have done so.

Seau is not the first former NFL player who killed himself, then was found to have CTE. Dave Duerson and Ray Easterling are others.

Duerson, a former Chicago Bears defensive back, left a note asking for his brain to be studied for signs of trauma before shooting himself. His family filed a wrongful death suit against the NFL, claiming the league didn't do enough to prevent or treat the concussions that severely damaged his brain.

Easterling played safety for the Falcons in the 1970s. After his career, he suffered from dementia, depression and insomnia, according to his wife, Mary Ann. He committed suicide last April.

Mary Ann Easterling is among the plaintiffs who have sued the NFL.

"It was important to us to get to the bottom of this, the truth," Gina Seau said, "and now that it has been conclusively determined from every expert that he had obviously had it, CTE, we just hope it is taken more seriously.

"You can't deny it exists, and it is hard to deny there is a link between head trauma and CTE. There's such strong evidence correlating head trauma and collisions and CTE."

Tyler Seau played football through high school and for two years in college. He says he has no symptoms of any brain trauma.

Gina Seau's son Jake, now a high school junior, played football for two seasons, but has switched to lacrosse and has been recruited to play at Duke.

"Lacrosse is really his sport and what he is passionate about," she said. "He is a good football player and probably could continue. But especially now watching what his dad went through, he says, 'Why would I risk lacrosse for football?'

"I didn't have to have a discussion with him after we saw what Junior went through."

Her 12-year-old son, Hunter, has shown no interest in playing football.

"That's fine with me," she said.

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Institute of Medicine Studying Concussions in Young Athletes

The Institute of Medicine, a federally financed research group, has started a 15-month investigation into sports-related concussions sustained by young athletes.

An ad hoc committee of scientists, which held its first meeting Monday, “will conduct a study on sports-related concussions in youth, from elementary school through young adulthood, including military personnel and their dependents,” according to the Web site of the institute, part of the National Academies of Science.

The committee will look at the causes of concussions and the “relationships to hits to the head or body during sports, and the effectiveness of protective devices and equipment.”

The committee will also review screening, diagnosis, treatment and long-term consequences of concussions and head hits.  

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Wall Street Flattens Out

Stocks rose ever so slightly on Wall Street on Thursday as stronger-than-expected exports in China, the world’s second-biggest economy, raised hopes for a more robust recovery in the global economy this year.

The Standard & Poor’s 500-stock index added 0.2 percent, the Dow Jones industrial average rose 0.1 percent and the Nasdaq composite index was flat in morning trading.

Data showed China’s export growth rebounded sharply to a seven-month high in December, a strong finish to the year after seven straight quarters of slowdown, even as demand from Europe and the United States remained subdued.

Ford shares gained 3.2 percent after it doubled its first-quarter dividend to 10 cents a share, despite a recent drop in market share.

Adding to the bullish sentiment, Spanish benchmark government bond yields fell below 5 percent to a 10-month low on the back of a strong bond auction that raised more than the targeted amount. European stock markets were mostly higher after the European Central Bank kept benchmark interest rates steady.

“The market’s more positive and it owes a lot of that to the Chinese economic data,” said Art Hogan, managing director of Lazard Capital Markets in New York, adding that the success of the Spanish auction was also of note.

Shares of the upscale jeweler Tiffany dropped 6 percent after it said earnings for the year through Jan. 31 will be at the lower end of its forecast.

Molycorp shares dropped 20 percent after the company said revenue and cash flow would be lower than expected this year due to lower rare-earth prices.

Nokia shares jumped 14 percent on Wall Street after the Finnish handset maker said its fourth-quarter results were better than expected and that the mobile phone business achieved underlying profitability.

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In Old Taliban Strongholds, Qualms About What Lies Ahead

LOY BAGH, Afghanistan — The battle against the Taliban in Helmand Province was so fierce two years ago that farmers here say there were some fields where virtually every ear of corn had a bullet in it.

Now it is peaceful enough that safety concerns were an afterthought during this year’s harvest. In districts of Helmand like Marja and Nad Ali that used to be Taliban strongholds, life has been transformed by the American troop surge that brought in tens of thousands of Marines three years ago. Over several recent days, a reporter was able to drive securely to places that in the past had been perilous without a military escort, and many of the roads were better paved, too.

So why, then, was it so difficult to find an optimist in Helmand Province?

In conversations with dozens of tribal elders, farmers, teachers and provincial officials, three factors loomed large: dissatisfaction with the Afghan government, the imminent departure of Western troops and recognition that the Taliban are likely to return. Few expressed much faith in the ability of the Afghan government and security forces to maintain the security gains won by the huge American and British military effort here.

Although some people said they believed that areas near the provincial capital would remain secure, beyond that there was little confidence, and many voiced worries that much of the province would drift back under Taliban control after the NATO combat mission ends in 2014.

Even now, with at least 6,500 Marines still in Helmand after a peak of 21,000 troops last year in Helmand and neighboring Nimroz Provinces, local people say the Taliban have begun “creeping back.” Residents report that threats from nearby militant commanders have increased, and that the Taliban are sending in radical mullahs to preach jihad in the mosques and woo the young and unemployed to their cause.

As fearful as residents may be of a resurgent Taliban, they are also angry at the government for what they see as widespread corruption and hypocrisy. Some of that anger focuses on bribery connected with government services, and some on policies relating to the opium trade, which still thrives here. Helmand is the supplier of more than 40 percent of the world’s opium, according to United Nations statistics, and the poppy crop is still the most profitable one by far. Even farmers who are willing to grow other crops are angry at officials who have eradicated poppy but failed to provide enough help with alternatives. Farmers say some of those same officials profit from the drug trade they profess to be fighting.

“Before the surge, the government in Helmand did not control even a single district,” said Hajji Atiqullah, a leader of the powerful Barakzai tribe in the Nawa district of central Helmand. “They had a presence in the district centers, a very small area, but the Marines cleared many districts, and they expanded the presence of the central government.”

Afghan forces now control his district, he said, but will not be able to hold it unless “the foreigners manage to get rid of corruption in the Afghan government, in the districts and the province levels.”

Local elders fear that many farmers, especially those impoverished by the government’s strict poppy eradication policies, will return to opium cultivation and look to the Taliban or other criminals for protection because the government has not offered them a satisfactory substitute livelihood.

“Before the Marines launched this big offensive, Marja was the center of the opium trade,” said Ahmad Shah, the chairman of the Marja development shura, a group of elders that works with the government to try to bring change here. “Millions and millions of Pakistani rupees were being traded every day in the bazaar. People were so rich that in some years a farmer could afford to buy a car.

“We were part of the eradication efforts by the government, and if they had provided the farmer with compensation, we could have justified our act. But the government failed to provide compensation, and unless it does so, the people will turn against us or join the insurgency and be against development, as they were during the Taliban.”

Part of the government’s rationale for poppy eradication was to starve militants of the opium profits that have been important to their finances. As opium cultivation was pushed away from the centers of the American troop surge, the Taliban made new allies by providing protection for farmers who moved their poppy cultivation to outlying deserts. Over the past few years, militants and opium farmers have increasingly found common cause.

A largely British-financed alternative crop program made significant headway at first in persuading farmers to switch crops, but few farmers could do as well as they had with opium.

Habib Zahori contributed reporting from Kabul, Afghanistan.

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Lawyers in Ohio football rape case want trial moved

(Reuters) – Attorneys for two Ohio teenage football players accused of raping a 16-year-old student have asked that the trial be moved because potential witnesses are afraid to come forward in defense of the boys, one of the lawyers said on Monday.

Walter Madison, the attorney for one of the accused rapists, Ma’lik Richmon, said social media efforts to bring the alleged rape into the national spotlight have led to an atmosphere of intimidation and coercion.

“This has a chilling effect on witnesses who could come forward to be part of this process so my client can get a fair and full proceeding,” he told Reuters. “So, we’re left without the opportunity to make our case. That’s pretty serious.”

Richmond and Trenton Mays, both 16 and members of the Steubenville High School football team, are charged with raping a 16-year-old fellow student at a party last August.

The two students are set to be tried as juveniles in February in Steubenville, a city of 19,000 about 40 miles west of Pittsburgh.

Madison said his client’s mother has had to change her cell phone number multiple times due to threats and harassment.

Last week, the online activist group Anonymous made public a picture allegedly of the rape victim, being carried by her wrists and ankles by two young men, and of a video that showed several other young men joking about an alleged assault.

Madison said that Richmond is not seen in the video.

A county sheriff under fire for how he has handled the high school rape investigation faced down a crowd of protestors on Saturday and said no new charges will be brought against anyone involved in the case.

Activists say there had been a cover-up by local officials to protect the integrity of the high school’s football program.

Meanwhile, a petition to the White House calling for the two rape suspects to be tried as adults reached 25,000 signatures Monday, the threshold required to receive a response from the Obama Administration.

Moving the case to the adult court system would allow for a jury trial and a more severe penalty, the petition says.

“This is a serious offense and this needs to be an example for everyone that this type of behavior should not, and will not be tolerated in our society,” it says.

The petition, created December 25, more than doubled its number of supporters overnight. It had 11,000 signatures on Sunday.

It was submitted to the White House through its online petition website, We The People. Now that it has the required 25,000 signatures, the Obama Administration will give an official statement at some point in the future. The petition has no legal impact.

(Editing by Paul Thomasch and Andrew Hay)

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Judgment day for Bonds, Clemens, Sosa at Hall

NEW YORK (AP) — Judgment day has arrived for Barry Bonds, Roger Clemens and Sammy Sosa to find out their Hall of Fame fates.

With the cloud of steroids shrouding many candidacies, baseball writers may fail for the only the second time in more than four decades to elect anyone to the Hall.

About 600 people are eligible to vote in the BBWAA election, all members of the organization for 10 consecutive years at any point. Results were to be announced at 2 p.m. EST Wednesday, with the focus on first-time eligibles that include Bonds, baseball's only seven-time Most Valuable Player, and Clemens, the only seven-time Cy Young Award winner.

Since 1965, the only years the writers didn't elect a candidate were when Yogi Berra topped the 1971 vote by appearing on 67 percent of the ballots cast and when Phil Niekro headed the 1996 ballot at 68 percent. Both were chosen the following years when they achieved the 75 percent necessary for election.

"It really would be a shame, especially since the other people going in this year are not among the living, which will make for a rather strange ceremony," said the San Francisco Chronicle's Susan Slusser, president of the Baseball Writers' Association of America.

Three inductees were chosen last month by the 16-member panel considering individuals from the era before integration in 1946: Yankees owner Jacob Ruppert, umpire Hank O'Day and barehanded catcher Deacon White. They will be enshrined during a ceremony at Cooperstown on July 28.

Also on the ballot for the first time are Sosa and Mike Piazza, power hitters whose statistics have been questioned because of the Steroids Era, and Craig Biggio, 20th on the career list with 3,060 hits — all for the Houston Astros. Curt Schilling, 11-2 with a 2.23 ERA in postseason play, is another ballot rookie.

The Hall was prepared to hold a news conference Thursday with any electees. Or to not have one.

Biggio wasn't sure whether the controversy over this year's ballot would keep all candidates out.

"All I know is that for this organization I did everything they ever asked me to do and I'm proud about it, so hopefully, the writers feel strongly, they liked what they saw, and we'll see what happens," Biggio said on Nov. 28, the day the ballot was announced.

Jane Forbes Clark, the Hall's chairman, said last year she was not troubled by voters weighing how to evaluate players in the era of performance-enhancing drugs.

"I think the museum is very comfortable with the decisions that the baseball writers make," she said. "And so it's not a bad debate by any means."

Bonds has denied knowingly using performance-enhancing drugs and was convicted of one count of obstruction of justice for giving an evasive answer in 2003 to a grand jury investigating PEDs. Clemens was acquitted of perjury charges stemming from congressional testimony during which he denied using PEDs.

Sosa, who finished with 609 home runs, was among those who tested positive in MLB's 2003 anonymous survey, The New York Times reported in 2009. He told a congressional committee in 2005 that he never took illegal performance-enhancing drugs.

The BBWAA election rules say "voting shall be based upon the player's record, playing ability, integrity, sportsmanship, character, and contributions to the team(s) on which the player played."

"Steroid or HGH use is cheating, plain and simple," ESPN.com's Wallace Matthews wrote. "And by definition, cheaters lack integrity, sportsmanship and character. Strike one, strike two, strike three."

Several holdovers from last year remain on the 37-player ballot, with top candidates including Jack Morris (67 percent), Jeff Bagwell (56 percent), Lee Smith (51 percent) and Tim Raines (49 percent).

When The Associated Press surveyed 112 eligible voters in late November, Bonds received 45 percent support among voters who expressed an opinion, Clemens 43 percent and Sosa 18 percent. The Baseball Think Factory website compiled votes by writers who made their opinions public and with 159 ballots had everyone falling short. Biggio was at 69 percent, followed by Morris (63), Bagwell (61), Raines (61), Piazza (60), Bonds (43) and Clemens (43).

Morris finished second last year when Barry Larkin was elected and is in his 14th and next-to-last year of eligibility. He could become the player with the highest-percentage of the vote who is not in the Hall, a mark currently held by Gil Hodges at 63 percent in 1983.

Several players who fell just short in the BBWAA balloting later were elected by either the Veterans Committee or Old-Timers' Committee: Nellie Fox (74.7 percent on the 1985 BBWAA ballot), Jim Bunning (74.2 percent in 1988), Orlando Cepeda (73.6 percent in 1994) and Frank Chance (72.5 percent in 1945).

Ace of three World Series winners, Morris finished with 254 victories and was the winningest pitcher of the 1980s. His 3.90 ERA, however, is higher than that of any Hall of Famer. Morris will be joined on next year's ballot by Greg Maddux and Tom Glavine, both 300-game winners.

If no one is elected this year, there could be a logjam in 2014. Voters may select up to 10 players.

The only certainty is the Hall is pleased with the writers' process.

"While the BBWAA does the actual voting, it only does so at the request of the Hall of Fame," said the Los Angeles Times' Bill Shaikin, the organization's past president. "If the Hall of Fame is troubled, certainly the Hall could make alternate arrangements."

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Gaps Seen in Therapy for Suicidal Teenagers

Most adolescents who plan or attempt suicide have already received at least some mental health treatment, raising questions about the effectiveness of current approaches to helping troubled youths, according to the largest in-depth analysis to date of suicidal behaviors in American teenagers.

The study, in the journal JAMA Psychiatry, found that 55 percent of suicidal teenagers had received some therapy before they thought about suicide, planned it or tried to kill themselves, contradicting the widely held belief that suicide is due in part to a lack of access to treatment.

The findings, based on interviews with a nationwide sample of more than 6,000 teenagers and at least one parent of each, linked suicidal behavior to complex combinations of mood disorders like depression and behavior problems like attention-deficit and eating disorders, as well as alcohol and drug abuse.

The study found that about one in eight teenagers had persistent suicidal thoughts at some point, and that about a third of those who had suicidal thoughts had made an attempt, usually within a year of having the idea.

Previous studies have had similar findings, based on smaller, regional samples. But the new study is the first to suggest, in a large nationwide sample, that access to treatment does not make a big difference.

The study suggests that effective treatment for severely suicidal teenagers must address not just mood disorders, but also behavior problems that can lead to impulsive acts, experts said. According to the Centers for Disease Control and Prevention, 1,386 people between the ages of 13 and 18 committed suicide in 2010, the latest year for which numbers are available.

“I think one of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide,” said Dr. David Brent, a professor of psychiatry at the University of Pittsburgh, who was not involved in the study. “We simply do not have empirically validated treatments for recurrent suicidal behavior.”

The report said nothing about whether the therapies given were state of the art or carefully done, said Matt Nock, a professor of psychology at Harvard and the lead author, and it is possible that some of the treatments prevented suicide attempts. “But it’s telling us we’ve got a long way to go to do this right,” Dr. Nock said. His co-authors included Ronald C. Kessler of Harvard and researchers from Boston University and Children’s Hospital Boston.

Margaret McConnell, a consultant in Alexandria, Va., said her daughter Alice, who killed herself in 2006 at the age of 17, was getting treatment at the time. “I think there might have been some carelessness in the way the treatment was done,” Ms. McConnell said, “and I was trusting a 17-year-old to manage her own medication. We found out after we lost her that she wasn’t taking it regularly.”

In the study, researchers surveyed 6,483 adolescents from the ages of 13 to 18 and found that 9 percent of male teenagers and 15 percent of female teenagers experienced some stretch of having persistent suicidal thoughts. Among girls, 5 percent made suicide plans and 6 percent made at least one attempt (some were unplanned).

Among boys, 3 percent made plans and 2 percent carried out attempts, which tended to be more lethal than girls’ attempts.

(Suicidal thinking or behavior was virtually unheard-of before age 10.)

Over all, about one-third of teenagers with persistent suicidal thoughts went on to make an attempt to take their own lives.

Almost all of the suicidal adolescents in the study qualified for some psychiatric diagnosis, whether depression, phobias or generalized anxiety disorder. Those with an added behavior problem — attention-deficit disorder, substance abuse, explosive anger — were more likely to act on thoughts of self-harm, the study found.

Doctors have tested a range of therapies to prevent or reduce recurrent suicidal behaviors, with mixed success. Medications can ease depression, but in some cases they can increase suicidal thinking. Talk therapy can contain some behavior problems, but not all.

One approach, called dialectical behavior therapy, has proved effective in reducing hospitalizations and suicide attempts in, among others, people with borderline personality disorder, who are highly prone to self-harm.

But suicidal teenagers who have a mixture of mood and behavior issues are difficult to reach. In one 2011 study, researchers at George Mason University reduced suicide attempts, hospitalizations, drinking and drug use among suicidal adolescent substance abusers. The study found that a combination of intensive treatments — talk therapy for mood problems, family-based therapy for behavior issues and patient-led reduction in drug use — was more effective than regular therapies.

“But that’s just one study, and it’s small,” said Dr. Brent of the University of Pittsburgh. “We can treat components of the overall problem, but that’s about all.”

Ms. McConnell said that her daughter’s depression had seemed mild and that there was no warning that she would take her life. “I think therapy does help a lot of people, if it’s handled right,” she said.

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