Mind: A Misguided Focus on Mental Illness in Gun Control Debate

The gunman, Adam Lanza, 20, has been described as a loner who was intelligent and socially awkward. And while no official diagnosis has been made public, armchair diagnosticians have been quick to assert that keeping guns from getting into the hands of people with mental illness would help solve the problem of gun homicides.

Arguing against stricter gun-control measures, Representative Mike Rogers, Republican of Michigan and a former F.B.I. agent, said, “What the more realistic discussion is, ‘How do we target people with mental illness who use firearms?’ ”

Robert A. Levy, chairman of the Cato Institute, told The New York Times: “To reduce the risk of multivictim violence, we would be better advised to focus on early detection and treatment of mental illness.”

But there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness.

This does not mean that mental illness is not a risk factor for violence. It is, but the risk is actually small. Only certain serious psychiatric illnesses are linked to an increased risk of violence.

One of the largest studies, the National Institute of Mental Health’s Epidemiologic Catchment Area study, which followed nearly 18,000 subjects, found that the lifetime prevalence of violence among people with serious mental illness — like schizophrenia and bipolar disorder — was 16 percent, compared with 7 percent among people without any mental disorder. Anxiety disorders, in contrast, do not seem to increase the risk at all.

Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself. In the National Institute of Mental Health’s E.C.A. study, for example, people with no mental disorder who abused alcohol or drugs were nearly seven times as likely as those without substance abuse to commit violent acts.

It’s possible that preventing people with schizophrenia, bipolar disorder and other serious mental illnesses from getting guns might decrease the risk of mass killings. Even the Supreme Court, which in 2008 strongly affirmed a broad right to bear arms, at the same time endorsed prohibitions on gun ownership “by felons and the mentally ill.”

But mass killings are very rare events, and because people with mental illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. Consider that between 2001 and 2010, there were nearly 120,000 gun-related homicides, according to the National Center for Health Statistics. Few were perpetrated by people with mental illness.

Perhaps more significant, we are not very good at predicting who is likely to be dangerous in the future. According to Dr. Michael Stone, professor of clinical psychiatry at Columbia and an expert on mass murderers, “Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.”

Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless.

Jeffery Swanson, a professor of psychiatry at Duke University and a leading expert in the epidemiology of violence, said in an e-mail, “Can we reliably predict violence?  ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.”

It would be even harder to predict a mass shooting, Dr. Swanson said, “You can profile the perpetrators after the fact and you’ll get a description of troubled young men, which also matches the description of thousands of other troubled young men who would never do something like this.”

Even if clinicians could predict violence perfectly, keeping guns from people with mental illness is easier said than done. Nearly five years after Congress enacted the National Instant Criminal Background Check System, only about half of the states have submitted more than a tiny proportion of their mental health records.

How effective are laws that prohibit people with mental illness from obtaining guns? According to Dr. Swanson’s recent research, these measures may prevent some violent crime. But, he added, “there are a lot of people who are undeterred by these laws.”

Adam Lanza was prohibited from purchasing a gun, because he was too young. Yet he managed to get his hands on guns — his mother’s — anyway. If we really want to stop young men like him from becoming mass murderers, and prevent the small amount of violence attributable to mental illness, we should invest our resources in better screening for, and treatment of, psychiatric illness in young people.

All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group. But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.

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Richard Engel of NBC Is Freed in Syria

Richard Engel, the chief foreign correspondent for NBC News, and three of his crew members were freed on Monday after five days in captivity in Syria, the news organization said on Tuesday.

The journalists were unharmed. The news organization released a short statement that said, “We are pleased to report they are safely out of the country.”

The identities of the kidnappers and their motives were unknown. But an article on the NBC News Web site quotes Mr. Engel as saying their captors “were talking openly about their loyalty to the government” of Syrian President Bashar al-Assad.

Their kidnapping once again highlights the perils of reporting from Syria, which is said by the Committee to Protect Journalists to be “the world’s most dangerous place for the press.”

NBC declined to specify the number of crew members that were with Mr. Engel. Two of the crew members, John Kooistra and Ghazi Balkiz, appeared with Mr. Engel on NBC’s “Today” show on Tuesday morning. A third, Aziz Akyavas, spoke at a news conference in Turkey. Mr. Akyavas said in an interview on the Turkish television channel NTV that a technician who traveled with the crew was still missing. NBC did not respond to a request for comment about that report.

Mr. Engel and the crew members covertly entered Syria several times this year to report on the insurgency that is fighting Mr. Assad there. Mr. Engel was last seen on television last Thursday in a taped report from Aleppo, Syria’s commercial capital, where he reported that “the Syrian regime appears to be cracking, but the rebels remain outgunned.”

In order to transmit their report in safety, Mr. Engel and his crew apparently crossed the border into Turkey. Their effort to cross back into the country on Thursday led to their capture.

About 15 men, Mr. Engel said on the “Today” show, “just literally jumped out of the trees and bushes” and “dragged us out of the car.” The kidnappers killed one of the rebels whom the crew had been traveling with, he said.

NBC’s Web site said there was “no claim of responsibility, no contact with the captors and no request for ransom during the time the crew was missing.”

Mr. Engel said on “Today” that the kidnappers had a plan to exchange the crew for several people being held by Syrian rebels. “We were told that they wanted to exchange us for four Iranian agents and two Lebanese people who are from the Amal movement,” he said.

But the crew members were freed when the captors “ran into a checkpoint manned by members of the Ahrar al-Sham brigade, a Syrian rebel group,” NBC’s Web site reported. “There was a confrontation and a firefight ensued. Two of the captors were killed, while an unknown number of others escaped.” The rebels then helped escort the crew to the border with Turkey.

“We are very happy to be back in Turkey,” Mr. Engel said, speaking in front of cameras at Cilvegozu border gate in southern Turkey. He added, “The last five days are the days that we want to forget.”

NBC tried to keep the crew’s disappearance a secret for several days while it sought to ascertain their whereabouts. Its television competitors and many other major news organizations, including The New York Times, refrained from reporting on the situation, in part out of concern that any reporting could worsen the danger for the crew. News outlets similarly refrained from publishing reports about a 2008 kidnapping in Afghanistan of David Rohde of The New York Times and a local reporter, Tahir Ludin. The two reporters escaped in June 2009 after seven months in captivity.

In the case of Mr. Engel, some Web sites reported speculation about his disappearance on Monday. NBC declined to comment until the crew members were safely out of Syria on Tuesday.

While none of the crew members suffered any physical injuries, there was “psychological pressure,” Mr. Akyavas told NTV. He said they were blindfolded, handcuffed, and “every now and then had guns pointed on our heads. It was not pleasant.”

In his comments on “Today” Mr. Engel said: “They made us choose which one of us would be shot first, and when we refused there were mock shootings. They pretended to shoot Ghazi several times.”

The crew members were also filmed for a video that showed them being held in a small, nondescript room.

Mr. Engel is perhaps the best-known foreign-based correspondent on television in the United States. Hop-scotching from Iraq to Afghanistan to Egypt and other countries in recent years, he has had more airtime than any other such correspondent at NBC, ABC or CBS. Thus the news of his kidnapping and safe release is likely to generate widespread interest from viewers.

Mr. Engel has worked for NBC since May 2003, two months into the Iraq war. He was promoted to chief foreign correspondent in 2008. At the time, the NBC News president Steve Capus said, “There aren’t enough superlatives to describe the work that Richard has done in some of the most dangerous places on earth for NBC News. His reporting, his expertise on the situation in the Middle East, his professionalism and his commitment to telling the story of what is happening there is unparalleled.”

The “NBC Nightly News” anchor Brian Williams has been among Mr. Engel’s most ardent fans. Without alluding to his disappearance, Mr. Williams brought up Mr. Engel while being interviewed onstage at a charity fund-raiser in New Jersey on Sunday night. “What I know about Richard Engel is, he’s fearless, but he’s not crazy,” Mr. Williams said. When Mr. Engel’s name came up, there was spontaneous applause from the crowd.

Brian Stelter reported from New York and Sebnem Arsu from Istanbul. Bill Carter contributed reporting from New York.

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Gérard Depardieu Says He Is Giving Up French Citizenship

PARIS — Gérard Depardieu, the famous French actor, will be French no more, so exasperated is he with French taxes and the French government, he declared in an angry open letter to France’s prime minister on Sunday.

Mr. Depardieu, who has been accused by France’s Socialist government of abandoning the country to avoid paying taxes, will be giving up his French citizenship and taking up residence over the border in Belgium, he wrote. Mr. Depardieu insisted that his move was not solely for tax reasons, but also because he felt the government believed that “success, creation, talent — difference, in fact — must be punished.”

Mr. Depardieu’s decision to leave France, where the Socialist government has created a 75 percent marginal tax rate for incomes above $1.3 million amid stagnating growth, rising unemployment and a contracting budget, has drawn reprobation from politicians of all ideological stripes, as well as the news media and a good number of ordinary citizens. Prime Minister Jean-Marc Ayrault has called the actor’s departure unpatriotic and “pathetic,” while the labor minister, Michel Sapin, deemed it the sign of a “form of personal degeneration.”

In his letter, published in the newspaper Le Journal du Dimanche, Mr. Depardieu said he had paid an 85 percent tax rate on his 2012 revenue and a total of 145 million euros, or $190 million, in taxes over his working life.

“I am neither to be pitied nor to be praised, but I refuse the word ‘pathetic,’ ” Mr. Depardieu wrote.

Mr. Depardieu, 63, who has been in almost 200 films and has won numerous awards, has drawn attention in recent years for his love of drink and several related episodes that caused him embarrassment.

“Who are you to judge me so, I ask you, Mr. Ayrault?” he wrote in his letter. “Despite my excesses, my appetite and my love of life, I am a free being, sir, and I will remain polite.”

On Friday, President François Hollande took up the subject, calling for “ethical behavior” by French taxpayers and suggesting that France may renegotiate its fiscal conventions with Belgium. He also joked that French residents of Néchin, the Belgian border village where Mr. Depardieu has bought a home, should not get too comfortable. Mr. Hollande noted that the mayor there is also a Socialist.

While several wealthy French citizens have reportedly departed for other fiscal shores since Mr. Hollande’s election in May, Sunday brought the unanticipated return to France of the writer Michel Houellebecq, who had been living in Ireland, where tax rates are relatively low.

“The major reason is that I want to speak my language, once again, in everyday life,” Mr. Houellebecq wrote in an e-mail to Agence France-Presse, insisting that taxes and politics had little to do with his repatriation.

Mr. Depardieu, too, will be able to speak his native tongue in his new home. Though many Belgians speak Flemish, Mr. Depardieu’s neighbors in Néchin speak French.

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49ers withstand comeback, top Patriots 41-34

FOXBOROUGH, Mass. (AP) — LaMichael James awaited the kickoff, determined to regain the momentum for the 49ers after they quickly lost all of a 28-point lead.

"We need a boost," he said. "That's what I was thinking. I was thinking I got to take it to the house."

He didn't get all the way there, but close enough to set up the decisive touchdown — going 62 yards before Colin Kaepernick's 38-yard pass to Michael Crabtree with 6:25 left — that helped San Francisco reach the playoffs with a 41-34 win over the New England Patriots on Sunday night.

"We faced adversity," James said. "Nobody flinched."

Now the 49ers have at least a wild-card berth with a 10-3-1 record, knowing a win against division rival Seattle (9-5) next Sunday clinches the AFC West title.

The Patriots (10-4) already had locked up first place in the AFC East with a chance to improve their chances for a first-round bye. They began the day in second place in the race for the two byes but fell behind the Denver Broncos (11-3). The Houston Texans (12-2) hold the top spot.

"We haven't thought about that yet," Tom Brady said. "What's in our control is winning football games."

Doing that on Sunday night seemed almost impossible after the 49ers rolled to a 31-3 lead on Kaepernick's 27-yard touchdown pass to Crabtree five minutes into the third quarter. Only one team in NFL history had won a regular-season game after trailing by 28 — a 38-35 win by the 49ers over the New Orleans Saints on Dec. 7, 1980.

But with 25 minutes left and Brady at quarterback, the 49ers weren't comfortable.

"Tom is a good quarterback and we knew some adversity was going to come and they were going to make plays sooner or later," linebacker NaVorro Bowman said.

They did — time after time — until they had tied the score at 31 on Danny Woodhead's second touchdown, a 1-yard run with 6:43 remaining.

Woodhead began the comeback with a 6-yard touchdown run, Brady scored on a 1-yard sneak on the first play of the fourth quarter and then threw a 5-yard touchdown pass to Aaron Hernandez less than three minutes later. And when Woodhead scored again, the Patriots had their fourth touchdown in 14 minutes, 16 seconds.

But two plays later — James' kickoff return and Crabtree's catch — the 49ers were back on top. And this time they stayed there.

David Akers made it 41-31 with a 28-yard field goal with 1:56 to go, Stephen Gostkowski kicked a 41-yarder for New England with 38 seconds remaining and San Francisco sealed the win when Delanie Walker caught the onside kick.

"We just spotted them 28 points," Brady said. "We fought hard, but you can't play poorly against a good team and expect to win. We can't miss plays that we have opportunities with."

For Kaepernick, a second-year pro starting just his fifth game, it was a chance to remain calm even as the big lead disappeared. He finished with 14 completions in 25 attempts for 216 yards and a career-high four touchdowns.

"This is my 17th year of football," he said. "I've been playing since I was eight years old. So, to me, I am going to go out there and I'm going to throw to the guy who is open and you try to keep football simple so your mind can be clear when you're on the field."

It was clear enough for him to throw a short pass to Crabtree then watch him race by cornerback Kyle Arrington for the go-ahead touchdown. That gave the team that had allowed the fewest points this season enough to beat the team that had scored the most.

"We can win a shootout," said Crabtree, who had 107 yards receiving. "Whatever it takes, that's our motto. ... We feel like we can do anything, sky's the limit."

New England, which had won seven straight games, lost for the first time at home in December in 21 games. The Patriots also had won 21 in a row in the second half of the schedule before San Francisco somehow regrouped late in a game it seemingly had clinched long before.

The 49ers forced four turnovers, matching the number of giveaways the Patriots had at home all season.

"I don't think they faced a physical defense like us all season," said San Francisco cornerback Carlos Rogers, who intercepted Brady midway through the first quarter and ran 53 yards to the Patriots 5.

The 49ers were leading 7-0 at the time on Kaepernick's 24-yard touchdown pass to former Patriot Randy Moss. Gostkowski's 32-yard field goal made it 7-3, but San Francisco scored on Kaepernick's 34-yard pass to Walker and David Akers' 20-yard field goal for a 17-3 lead at intermission.

"Everything" went wrong in the first half, Patriots wide receiver Wes Welker said. "A lot of bad football."

Frank Gore then recovered Kaepernick's fumble and ran 9 yards for a touchdown. Two plays later, Aldon Smith intercepted Brady's pass and Kaepernick struck on the next play with his 27-yard pass to Crabtree for a 31-3 lead with 10:21 remaining in the third quarter.

Still plenty of time for Brady.

"I had a feeling we'd be able to come back," he said.

But when the Patriots tied it, a poor job by the kickoff team proved costly.

"I did as much as I could to help the team win," James said.

It was just enough.

NOTES: The 49ers allowed 520 yards after entering the game second in the NFL in fewest yards allowed, 275.5 per game. ... Welker had five catches, giving him 100 and making him the first player in NFL history with that many in five seasons. ... Gore led all rushers with 83 yards on 21 carries. ... Brady was 36 for a career-high 65 for 443 yards, one touchdown and two interceptions.

___

Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL

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The New Old Age Blog: In the Middle: Why Elderly Couples Fight

George and Gracie (let’s call them that because using their real names would make them even unhappier than they already appear to be) are in their 80s and have been married for more than 65 years. Until recently they seemed to ride the waves that are inevitable in any marriage that spans nearly seven decades; through good and bad, they were partners and best friends.

But lately — ever since her hospitalization and his fall — they have been arguing more bitterly than usual (“Do you have to make such a mess in the kitchen?”), criticizing each other (“Why haven’t you dealt with the insurance company yet?”), withdrawing from each other, and generally making each other more miserable, more often than ever before.

This kind of degenerative relationship is not uncommon among the elderly in even the happiest marriages, marriage therapists and geriatricians said. But that is small comfort to either the couple in the middle of the maelstrom, or the children who care for them, as evidenced by a number of postings on caregiver blogs. As some of the children have wondered there: “Why can’t we all just get along?”

Therapists and others who work with the elderly said the first step to addressing the problem is understanding where it came from.

“A key question is whether the marital bickering is part of a lifelong marital style or a change,” said Dr. Linda Waite, director of the Center on Demography and Economics of Aging at NORC/University of Chicago. Is it new behavior – or just new to the grown children who are suddenly so deeply enmeshed in their parents’ lives that they are only now noticing that something is amiss?

How much of the problem is really just the marriage style? “Some couples like to fight and argue – it keeps their adrenaline going,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and author of “Overwhelmed: Coping With Life’s Ups and Downs.”

Sometimes the best judges of whether there is a problem are outsiders, said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine. Pay attention if someone says, “‘Gee, Mom seems more argumentative or withdrawn than the last time I saw her,’” Dr. Dale advised.

If the tone or severity of the marital tensions seem new, then it is important to find out why. The causes could be mental or physical, doctors say.

On the mental front, increased anger and fighting could be one of the first signs of mild cognitive impairment, a precursor of dementia or Alzheimer’s, in one or both of the spouses, said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program and an associate professor in the department of psychiatry and behavioral sciences.

Dr. Dale concurs: “There is good evidence that the earliest signs of cognitive impairment are often emotional changes” — anger, anxiety, depression — “rather than cognitive ones” — memory, abstract thought.

But these early signs of cognitive decline can be so subtle that neither the spouses themselves, or their grown children, recognize them for what they are, Dr. Gwyther said. So husband and wife blame each other for the changes and allow feelings of hurt and resentment to grow.

Withdrawing from activities that used to give them pleasure can be a telltale sign of mild cognitive impairment – and can trigger anger and arguments.

“In one couple, the husband just didn’t want to participate in the holidays — the wife got angry and said he was being lazy and stubborn,” said Dr. Gwyther. But the truth was that his cognitive decline made all the activity overwhelming, and he didn’t want anyone to know that he was anxious about not remembering everyone’s names and embarrassing himself.

Suspicion and paranoia can also accompany mild cognitive decline and precipitate distrust and hurtful accusations. Dr. Gwyther recalled another woman who “called her daughter frantic because she said her husband dropped her at her chemo appointment, went to park the car, and didn’t return to get her.” The woman couldn’t imagine that her husband could possibly have lost his sense of time and direction, Dr. Gwyther added. She took it personally, complaining to her daughter that “your father doesn’t seem to care any more.”

Dr. Dale told of a spouse who accused her mate of infidelity because “she was convinced that when he was out grocery shopping he was really having an affair.”

Hoarding, an early symptom of mild cognitive impairment, can also create tension in a marriage. (For new treatments, see this recent post by my colleague Paula Span.)

When one couple came to a counseling session with Dr. Norman Abeles, emeritus professor of psychology and former director of psychological clinic at Michigan State University, the hoarding spouse finally said she did it because she thought that they would run out of money, “even though there was enough money to go around.” Dr. Abeles said that incident led to her diagnosis of mild cognitive impairment.

Adding to the confusion, mild cognitive impairment, or M.C.I., comes and goes. “There are good days and bad days, good hours and bad hours,” said Dr. Gwyther. “Alzheimer’s and dementia don’t start on Tuesday — it’s a slow insidious onset.” But the diagnosis is becoming more common: The Institute for Dementia Research and Prevention predicts that 1 in 6 women, and 1 in 10 men, who live past the age of 55 will develop dementia in their lifetime.

“Spouses find it difficult to know when their partner with M.C.I. is acting differently, usually badly, due to the advancing illness or due to ‘willful’ personality issues,” said Dr. Dale, citing a 2007 study in the journal Family Relations exploring the problems this can create for couples.

Blaming is often easier than understanding. Another of Dr. Gwyther’s patients was furious at her husband for not filing their taxes. “He’s a C.P.A.,” she said. “How could we owe back taxes?” It did not occur to her that he might be unable to handle that task — and was too frightened about his deteriorating mental focus to let her know.

But as harmful as mental decline can be for a marriage, it is just part of the equation. Physical ailments – even those that seem completely unrelated to marital relations – “can upset the equilibrium of the marriage,” according to a study in The Canadian Medical Association Journal.

“Most men get angry at what’s happened to them when they get ill, women get angry and scared when he’s not what he used to be — so they fight,” said Dr. Schlossberg.

Chronic illnesses, like diabetes, arthritis and heart disease, can have a strong negative effect on mood, said Dr. Waite, who will soon be publishing a study on the subject. Diabetes is so often accompanied by depression that Dr. Waite said “one of my colleagues argues that that it is even part of the disease.”

And ailments can have an effect on a couple’s sex life — which can compound the marital problems, doctors said.

“Diabetes brings on neuropathy,” said Dr. Waite. “That means touching and feeling in sex is not as rewarding.” Without the pleasures of affectionate touching — whether a passing hug at the sink or more — tensions can build. That’s why, if a couple is having problems with sex, they are more likely to have problems in the relationship — and vice versa, according to a 2007 New England Journal of Medicine study of sex and health among older adults.

Other changes in circumstances — retirement, shifting roles, the loss of autonomy, disparities in health and abilities — can wreak havoc. Losing independence can feel like losing oneself — and if you don’t know who you are any more, how can you know how to relate to your spouse?

“Fighting may come from a misguided notion that you can regain power by asserting it over your spouse,” said Dr. Schlossberg, whose observations are echoed in a 1984 study in The Canadian Journal of Medicine. “It doesn’t work, it’s false power – but they’ll try anything.”

The sheer exhaustion that can come from being the caregiving spouse is also bound to “make them stressed and angry,” said Dr. Waite. Not to mention guilty and resentful — never a prescription for happy marital relations.

“Part of the trap for the caregiver is the idea that you have to do it all, and the guilt you feel when you cannot live up to it,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc. Not surprisingly, resentment can soon follow, Dr. Herz added, because it is hard to admit to anyone that, “‘this is too much for me.’”

What can outside caregivers — children or other loved ones — do about these golden marriages on the rocks? Should they intervene — or butt out? And can marital therapy help — or is it too late to change?

Share your thoughts and experiences — and on Tuesday we will try to provide some advice from experts.

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Bucks Blog: The Over-The-Wall Portfolio for Excess Cash

Carl Richards is a financial planner in Park City, Utah, and is the director of investor education at the BAM Alliance. His book, “The Behavior Gap,” was published this year. His sketches are archived on the Bucks blog.

If you’re an entrepreneur, you’ll spend years pouring everything — time, money, passion — into your businesses with the hope that someday it will pay off. If things go well, you’ll wake up one morning and find yourself with excess time, energy and, of course, cash.

Great! But now you have to figure out what do with that cash, and this is when things can get dangerous, fast.

Most entrepreneurs get twitchy at the thought of idle money. They’re used to taking big chances and are comfortable with risk. So, there’s a temptation to assume the same approach to controlled risk when investing outside their business.

One of the smartest guys I know runs an incredibly successful company but provided a textbook example of this approach. As the business matured and started throwing off excess cash, he began thinking about what to do with it. He invested in some pretty strange ventures. He backed a doctor with a new toothbrush design, a car wash and a company that made kayak paddles.

He knew nothing about any of these businesses. Not surprisingly, he lost that money.

Instead of sticking to what he knew to make money and protecting the profits, he made the classic mistake of thinking he could do more. He took risks with money that he promised himself he would never lose.

It’s like what Warren E. Buffett said about the super-smart and incredibly wealthy founders of Long-Term Capital Management, who ended up doing something really dumb: “To make money they didn’t need, they risked what they did have and did need, and that’s foolish.”

Don’t be foolish. If you’re fortunate to have enough money to last for a good long while, the game can, and should, change. Of course you can still focus on growing your business. Or, if you’re a serial entrepreneur, you can build the next one. But at the same time, you can start building a portfolio to protect your future.

One thing I have heard over and over when interviewing successful entrepreneurs is the idea of what I call the Over-the-Wall Portfolio. Of course, the entrepreneurs didn’t call it that. They often referred to it as the safe money or the money they promised their spouse they’d never lose.

Whatever you call it, the concept is pretty simple: You take the excess cash your business generates, or the lump sum from the sale of a business, and throw it over the wall into stable (and probably boring) investments.

Then you forget about it.

The allocation of an Over-the-Wall Portfolio will vary, but here are a few general guidelines to consider:

• Boring. Remember: excitement comes from being an entrepreneur (or the movies), not your over-the-wall money.
• Liquid. If something goes wrong, you want to be able to get to the money.
• Diversified. You can get rich by putting all your eggs in one basket, but you stay wealthy by being diversified.
• Passive. The Over-the-Wall Portfolio can’t depend on you for day-to-day management. You’re too busy with your business and having a life. The last thing you should be doing at night is logging into your day-trading account.

The best part of this strategy? It lets you get back to doing what you do best — running your business. But you get the added comfort of knowing that if your business fails, you’ll be O.K.

Eventually, my entrepreneur friend recognized his problem. One day, he told me, “Carl, I finally figured it out. My job is to stay focused on my business and make money. And with the money I make, I have to be sure I never lose any of it.”

I couldn’t have said it better myself.

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Egypt Votes on Constitution; Muslim Brotherhood Expects Approval

Lynsey Addario for The New York Times

A polling site in Cairo on Saturday. Lines were long as a referendum on an Islamist-backed charter got off to an orderly start. More Photos »

CAIRO — Millions of Egyptians voted peacefully on Saturday in a referendum on an Islamist-backed draft constitution, hoping that the results would end three weeks of violence, division and distrust between the Islamists and their opponents over the ground rules of Egypt’s promised democracy.

The Muslim Brotherhood, the main Islamist group aligned with President Mohamed Morsi, predicted a big win for ratification. In the districts that voted Saturday, including the opposition strongholds of Cairo and Alexandria, about 57 percent of voters approved the new constitution, according to preliminary tallies by state news media early Sunday morning.

Half of the country will vote next Saturday, in predominantly rural areas that are expected to heavily favor the charter. The relatively narrow margin of victory for the charter so far, combined with low turnout — 33 percent, according to the unofficial tallies, down from 41 percent in a referendum on a temporary constitution last year — seemed likely to embolden the non-Islamist opposition that has called for Mr. Morsi to scrap the charter and convene a new constitutional assembly.

A spokesman for the main coalition opposing the charter said that it had found widespread irregularities in voting and that its leaders would speak later on Sunday. In Cairo, the biggest city, about 56 percent voted no, according to an unofficial tally by the Muslim Brotherhood.

Regardless of the results, the orderly balloting and long lines marked yet another turning point for Egypt’s nearly two-year-old revolution. After three weeks of clashes and threats of a boycott, millions of voters appeared for the moment to pull back from the brink of civil discord and reaffirm their trust in the ballot box, spending hours in long lines to vote in the sixth national election since the ouster of Hosni Mubarak 22 months ago.

It remained to be seen if the losing side would accept the results, or how long the peace might last. Many who voted yes said they were doing so to end the chaos of the transition rather than to endorse the text of the charter. Despite opposition warnings of chaos, the streets of the capital were free of major protests for the first time in weeks.

And if the constitution is approved by the margins his supporters predict, the smooth vote could fortify Mr. Morsi’s power and legitimacy.

Military officers guarded polling places, and there were few reports of violence. Egyptian state media reported nine injuries in clashes around the Nile Delta town of Dakahleya, and that unknown assailants threw Molotov cocktails near the headquarters of a liberal party that had been part of the opposition under Mr. Mubarak.

As they waited in line to vote, neighbors continued to spar over the contentious process that produced the charter. Some said that it had been unfairly steamrolled by Egypt’s new Islamist leaders over the objections of other parties and the Coptic Christian Church, and that as a result the new charter failed to protect fundamental rights.

Others blamed the Islamists’ opponents for refusing to negotiate, in an effort to undermine democracy because they could not win at the ballot box. Many expressed discontent with political leaders on both sides.

“Neither group can accept its opposition,” said Ahmed Ibrahim, 40, a government clerk waiting to vote in a middle-class neighborhood in the Nasr City area of Cairo. Whatever the outcome, he said, “one group in their hearts will feel wronged, and the other group will gloat over their victory, and so the wounds will remain.”

The referendum once promised to be a day when Egyptians realized the visions of democracy, pluralism and national unity that defined the 18-day revolt against Mr. Mubarak. But then came nearly two years of chaotic political transition in which Islamists, liberals, leftists, the military and the courts all jockeyed for power over an ever-shifting timetable.

The document that Egyptians voted on was a rushed revision of the old Mubarak charter, pushed through an Islamist-dominated assembly in an all-night session, after Christian and secular representatives quit in protest. Many international experts faulted the charter as a missed opportunity, stuffed with broad statements about Egyptian identity but riddled with loopholes regarding the protection of rights.

Mayy El Sheikh and Mai Ayyad contributed reporting.

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Griffin not playing for Redskins

CLEVELAND (AP) — Redskins rookie quarterback Robert Griffin III will not play against the Browns.

Griffin, who sprained his right knee last week against Baltimore, is inactive for Sunday's game. Rookie Kirk Cousins will make his first career start and veteran Rex Grossman will be his backup. Grossman has been inactive for every other game this season.

The Redskins announced that Griffin would not start late Saturday night, ending days of speculation about whether the dynamic QB would play after taking a scary hit in the closing minutes of regulation against the Ravens.

Griffin sustained a mild sprain of the lateral collateral ligament. He was limited in practice all week, but as of Friday it appeared he might play.

Cousins came off the bench last week when Griffin got hurt and threw a late touchdown pass and ran for a 2-point conversion.

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Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL

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Dr. William F. House, Inventor of Cochlear Implant, Dies

Dr. William F. House, a medical researcher who braved skepticism to invent the cochlear implant, an electronic device considered to be the first to restore a human sense, died on Dec. 7 at his home in Aurora, Ore. He was 89.

The cause was metastatic melanoma, his daughter, Karen House, said.

Dr. House pushed against conventional thinking throughout his career. Over the objections of some, he introduced the surgical microscope to ear surgery. Tackling a form of vertigo that doctors had believed was psychosomatic, he developed a surgical procedure that enabled the first American in space to travel to the moon. Peering at the bones of the inner ear, he found enrapturing beauty.

Even after his ear-implant device had largely been supplanted by more sophisticated, and more expensive, devices, Dr. House remained convinced of his own version’s utility and advocated that it be used to help the world’s poor.

Today, more than 200,000 people in the world have inner-ear implants, a third of them in the United States. A majority of young deaf children receive them, and most people with the implants learn to understand speech with no visual help.

Hearing aids amplify sound to help the hearing-impaired. But many deaf people cannot hear at all because sound cannot be transmitted to their brains, however much it is amplified. This is because the delicate hair cells that line the cochlea, the liquid-filled spiral cavity of the inner ear, are damaged. When healthy, these hairs — more than 15,000 altogether — translate mechanical vibrations produced by sound into electrical signals and deliver them to the auditory nerve.

Dr. House’s cochlear implant electronically translated sound into mechanical vibrations. His initial device, implanted in 1961, was eventually rejected by the body. But after refining its materials, he created a long-lasting version and implanted it in 1969.

More than a decade would pass before the Food and Drug Administration approved the cochlear implant, but when it did, in 1984, Mark Novitch, the agency’s deputy commissioner, said, “For the first time a device can, to a degree, replace an organ of the human senses.”

One of Dr. House’s early implant patients, from an experimental trial, wrote to him in 1981 saying, “I no longer live in a world of soundless movement and voiceless faces.”

But for 27 years, Dr. House had faced stern opposition while he was developing the device. Doctors and scientists said it would not work, or not work very well, calling it a cruel hoax on people desperate to hear. Some said he was motivated by the prospect of financial gain. Some criticized him for experimenting on human subjects. Some advocates for the deaf said the device deprived its users of the dignity of their deafness without fully integrating them into the hearing world.

Even when the American Academy of Ophthalmology and Otolaryngology endorsed implants in 1977, it specifically denounced Dr. House’s version. It recommended more complicated versions, which were then under development and later became the standard.

But his work is broadly viewed as having sped the development of implants and enlarged understanding of the inner ear. Jack Urban, an aerospace engineer, helped develop the surgical microscope as well as mechanical and electronic aspects of the House implant.

Karl White, founding director of the National Center for Hearing Assessment and Management, said in an interview that it would have taken a decade longer to invent the cochlear implant without Dr. House’s contributions. He called him “a giant in the field.”

After embracing the use of the microscope in ear surgery, Dr. House developed procedures — radical for their time — for removing tumors from the back portion of the brain without causing facial paralysis; they cut the death rate from the surgery to less than 1 percent from 40 percent.

He also developed the first surgical treatment for Meniere’s disease, which involves debilitating vertigo and had been viewed as a psychosomatic condition. His procedure cured the astronaut Alan B. Shepard Jr. of the disease, clearing him to command the Apollo 14 mission to the moon in 1971. In 1961, Shepard had become the first American launched into space.

In presenting Dr. House with an award in 1995, the American Academy of Otolaryngology-Head and Neck Surgery Foundation said, “He has developed more new concepts in otology than almost any other single person in history.”

William Fouts House was born in Kansas City, Mo., on Dec. 1, 1923. When he was 3 his family moved to Whittier, Calif., where he grew up on a ranch. He did pre-dental studies at Whittier College and the University of Southern California, and earned a doctorate in dentistry at the University of California, Berkeley. After serving his required two years in the Navy — and filling the requisite 300 cavities a month — he went back to U.S.C. to pursue an interest in oral surgery. He earned his medical degree in 1953. After a residency at Los Angeles County Hospital, he joined the Los Angeles Foundation of Otology, a nonprofit research institution founded by his brother, Howard. Today it is called the House Research Institute.

Many at the time thought ear surgery was a declining field because of the effectiveness of antibiotics in dealing with ear maladies. But Dr. House saw antibiotics as enabling more sophisticated surgery by diminishing the threat of infection.

When his brother returned from West Germany with a surgical microscope, Dr. House saw its potential and adopted it for ear surgery; he is credited with introducing the device to the field. But again there was resistance. As Dr. House wrote in his memoir, “The Struggles of a Medical Innovator: Cochlear Implants and Other Ear Surgeries” (2011), some eye doctors initially criticized his use of a microscope in surgery as reckless and unnecessary for a surgeon with good eyesight.

Dr. House also used the microscope as a research tool. One night a week he would take one to a morgue for use in dissecting ears to gain insights that might lead to new surgical procedures. His initial reaction, he said, was how beautiful the bones seemed; he compared the experience to one’s first view of the Grand Canyon. His wife, the former June Stendhal, a nurse, often helped.

She died in 2008 after 64 years of marriage. In addition to his daughter, Dr. House is survived by a son, David; three grandchildren; and two great-grandchildren.

The implant Dr. House invented used a single channel to deliver information to the hearing system, as opposed to the multiple channels of competing models. The 3M Company, the original licensee of the House implant, sold its rights to another company, the Cochlear Corporation, in 1989. Cochlear later abandoned his design in favor of the multichannel version.

But Dr. House continued to fight for his single-electrode approach, saying it was far cheaper, and offered voluminous material as evidence of its efficacy. He had hoped to resume production of it and make it available to the poor around the world.

Neither the institute nor Dr. House made any money on the implant. He never sought a patent on any of his inventions, he said, because he did not want to restrict other researchers. A nephew, Dr. John House, the current president of the House institute, said his uncle had made the deal to license it to the 3M Company not for profit but simply to get it built by a reputable manufacturer.

Reflecting on his business decisions in his memoir, Dr. House acknowledged, “I might be a little richer today.”

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As Gold Is Spirited Out of Afghanistan, Officials Wonder Why

Zalmai for The New York Times

A Kabul jewelry shop. Officials are concerned about gold being flown out of Afghanistan.

KABUL, Afghanistan — Packed into hand luggage and tucked into jacket pockets, roughly hewed bars of gold are being flown out of Kabul with increasing regularity, confounding Afghan and American officials who fear money launderers have found a new way to spirit funds from the country.

Most of the gold is being carried on commercial flights destined for Dubai, according to airport security reports and officials. The amounts carried by single couriers are often heavy enough that passengers flying from Kabul to the Persian Gulf emirate would be well advised to heed warnings about the danger of bags falling from overhead compartments. One courier, for instance, carried nearly 60 pounds of gold bars, each about the size of an iPhone, aboard an early morning flight in mid-October, according to an airport security report. The load was worth more than $1.5 million.

The gold is fully declared and legal to fly. Some, if not most, is legitimately being sent by gold dealers seeking to have old and damaged jewelry refashioned into new pieces by skilled craftsmen in the Persian Gulf, said Afghan officials and gold dealers.

But gold dealers in Kabul and current and former Kabul airport officials say there has been a surge in shipments since early summer. The talk of a growing exodus of gold from Afghanistan has been spreading among the business community here, and in recent weeks has caught the attention of Afghan and American officials. The officials are now puzzling over the origin of the gold — very little is mined in Afghanistan, although larger mines are planned — and why so much appears to be heading for Dubai.

“We are investigating it, and if we find this is a way of laundering money, we will intervene,” said Noorullah Delawari, the governor of Afghanistan’s central bank. Yet he acknowledged that there were more questions than answers at this point. “I don’t know where so much gold would come from, unless you can tell me something about it,” he said in an interview. Or, as a European official who tracks the Afghan economy put it, “new mysteries abound” as the war appears to be drawing to a close.

Figuring out what precisely is happening in the Afghan economy remains as confounding as ever. Nearly 90 percent of the financial activity takes place outside formal banks. Written contracts are the exception, receipts are rare and statistics are often unreliable. Money laundering is commonplace, say Western and Afghan officials.

As a result, with the gold, “right now you’re stuck in that situation we usually are: is there something bad going on here or is this just the Afghan way of commerce?” said a senior American official who tracks illicit financial networks.

There is reason to be suspicious: the gold shipments track with the far larger problem of cash smuggling. For years, flights have left Kabul almost every day carrying thick wads of bank notes — dollars, euros, Norwegian kroner, Saudi Arabian riyals and other currencies — stuffed into suitcases, packed into boxes and shrink-wrapped onto pallets. At one point, cash was even being hidden in food trays aboard now-defunct Pamir Airways flights to Dubai.

Last year alone, Afghanistan’s central bank says, roughly $4.5 billion in cash was spirited out through the airport. Efforts to stanch the flow have had limited impact, and concerns about money laundering persist, according to a report released last week by the United States Special Inspector General for Afghanistan Reconstruction.

The unimpeded “bulk cash flows raise the risk of money laundering and bulk cash smuggling — tools often used to finance terrorist, narcotics and other illicit operations,” the report said. The cash, and now the gold, is most often taken to Dubai, where officials are known for asking few questions. Many wealthy Afghans park their money and families in the emirate, and gold dealers say more middle-class Afghans are sending money and gold — seen as a safeguard against economic ruin — to Dubai as talk of a postwar economic collapse grows louder.

But given Dubai’s reputation as a haven for laundered money, an Afghan official said that the “obvious suspicion” is that at least some of the apparent growth in gold shipments to Dubai is tied to the myriad illicit activities — opium smuggling, corruption, Taliban taxation schemes — that have come to define Afghanistan’s economy.

There are also indications that Iran could be dipping into the Afghan gold trade. It is already buying up dollars and euros here to circumvent American and European sanctions, and it may be using gold for the same purpose.

Yahya, a dealer in Kabul, said other gold traders were helping Iran buy the precious metal here. Payment was being made in oil or with Iranian rials, which readily circulate in western Afghanistan. The Afghan dealers are then taking it to Dubai, where the gold is sold for dollars. The money is then moved to China, where it was used to buy needed goods or simply funneled back to Iran, said Yahya, who like many Afghans uses a single name.

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