A unique research project is tracking hundreds of people at risk for suicide, using data from smartphones and wearable biosensors to identify periods of high danger — and intervene.CAMBRIDGE, Mass. — In March, Katelin Cruz left her latest psychiatric hospitalization with a familiar mix of feelings. She was, on the one hand, relieved to leave the ward, where aides took away her shoelaces and sometimes followed her into the shower to ensure that she would not harm herself.But her life on the outside was as unsettled as ever, she said in an interview, with a stack of unpaid bills and no permanent home. It was easy to slide back into suicidal thoughts. For fragile patients, the weeks after discharge from a psychiatric facility are a notoriously difficult period, with a suicide rate around 15 times the national rate, according to one study.This time, however, Ms. Cruz, 29, left the hospital as part of a vast research project which attempts to use advances in artificial intelligence to do something that has eluded psychiatrists for centuries: to predict who is likely to attempt suicide and when that person is likely to attempt it, and then, to intervene.On her wrist, she wore a Fitbit programmed to track her sleep and physical activity. On her smartphone, an app was collecting data about her moods, her movement and her social interactions. Each device was providing a continuous stream of information to a team of researchers on the 12th floor of the William James Building, which houses Harvard’s psychology department.In the field of mental health, few new areas generate as much excitement as machine learning, which uses computer algorithms to better predict human behavior. There is, at the same time, exploding interest in biosensors that can track a person’s mood in real time, factoring in music choices, social media posts, facial expression and vocal expression.Matthew K. Nock, a Harvard psychologist who is one of the nation’s top suicide researchers, hopes to knit these technologies together into a kind of early-warning system that could be used when an at-risk patient is released from the hospital.He offers this example of how it could work: The sensor reports that a patient’s sleep is disturbed, she reports a low mood on questionnaires and GPS shows she is not leaving the house. But an accelerometer on her phone shows that she is moving around a lot, suggesting agitation. The algorithm flags the patient. A ping sounds on a dashboard. And, at just the right time, a clinician reaches out with a phone call or a message.There are plenty of reasons to doubt that an algorithm can ever achieve this level of accuracy. Suicide is such a rare event, even among those at highest risk, that any effort to predict it is bound to result in false positives, forcing interventions on people who may not need them. False negatives could thrust legal responsibility onto clinicians.Algorithms require granular, long-term data from a large number of people, and it’s nearly impossible to observe large numbers of people who die by suicide. Finally, the data needed for this kind of monitoring raises red flags about invading the privacy of some of society’s most vulnerable people.Dr. Nock is familiar with all these arguments but has persisted, in part out of sheer frustration. “With all due respect to people who’ve been doing this work for decades, for a century, we haven’t learned a great deal about how to identify people at risk and how to intervene,” he said. “The suicide rate now is the same it was literally 100 years ago. So just if we’re being honest, we’re not getting better.”The gray zoneSurvey questions popped up on an app Ms. Cruz was given by the researchers, one of several digital check-ins she receives each day.Kayana Szymczak for The New York TimesFor psychiatrists, few tasks are more nerve-racking than caring for patients they know to be at risk for suicide while they are at home and unsupervised.Dr. Karen L. Swartz, a professor of psychiatry at Johns Hopkins University, calls it “the gray zone.” She was fresh out of training when she first wrestled with this problem, caring for a prickly, intelligent woman who admitted she had suicidal thoughts, and even alluded to a plan, but dreaded the thought of being hospitalized.Dr. Swartz turned to the woman’s husband for advice. If you force her into the hospital, he said, she will fire you.So Dr. Swartz decided to take the risk, allowing the woman to remain at home, tweaking her medications and waiting. She spent the next weeks on tenterhooks, and, slowly, the patient improved. “It was one of those things where I just genuinely hoped I was right,” she said. It never gets easier, said Dr. Swartz, who now trains young psychiatrists: With experience, it only becomes clearer that suicidal thoughts can come and go without warning.“We are asked to predict something that is highly unpredictable,” she said.Increasingly, health care systems are turning to machine learning to make this call. Algorithms based on vast data sets — drawn from electronic medical records as well as scores of other factors — are used to assign patients a risk score, so that individuals at exceptionally high risk can be provided with extra attention.Algorithms have proven more accurate than traditional methods, which, according to a 2017 review of published research, had not improved in 50 years and were only slightly better than chance at predicting an outcome. These methods are already used in some clinical settings. Since 2017, the Department of Veterans Affairs has used an algorithm to flag the 0.1 percent of veterans at the highest risk for suicide, a few hundred patients in a population of six million.This approach has yielded some success. A study published last year in JAMA Network Open found that veterans enrolled in REACH VET, a program for at-risk patients, were 5 percent less likely to have a documented suicide attempt, and less likely to be admitted to a psychiatric facility or visit the emergency room. But the study found no significant change in the rate of suicide.The expectations that have built up around this research are so high that experts take pains to temper them. Michael Schoenbaum, a senior adviser at the National Institute of Mental Health, compared it to the excitement, 25 years ago, around the search for biological markers for mental illnesses — a case in which, he pointed out, “the optimists were wrong.”“We are waiting to see when and where and maybe even whether signals like that are valid and reliable,” he said. “The evidence so far, it’s exciting in the sense that any signal is promising. This is something that we couldn’t do before at all.” But, he warned, “we are looking for something we haven’t found yet.”And some of Dr. Nock’s colleagues say they doubt algorithmic predictions will ever be precise enough to intervene in the narrow window that precedes a suicide attempt.“It’s certainly not an easily solvable problem,” said Nick Allen, the director of the Center for Digital Mental Health at the University of Oregon, who helped develop EARS, an app that tracks mood based on factors like music choice, facial expression and the use of language.“It’s probably, in some senses, not a solvable problem, for the same reason that we have school shootings and the same reason that we can’t predict a lot of this kind of stuff,” Dr. Allen said. “You know, the math is just really daunting.”A fire hose of dataMatthew Nock, a professor of psychology at Harvard and a leading suicide researcher. “The suicide rate now is the same it was literally 100 years ago,” he said. “So just if we’re being honest, we’re not getting better.”Kayana Szymczak for The New York TimesOn an August afternoon in the William James building, a lanky data scientist named Adam Bear sat in front of a monitor in Dr. Nock’s lab, wearing flip-flops and baggy shorts, staring at the zigzagging graphs of a subject’s stress levels over the course of a week.When moods are mapped as data, patterns emerge, and it’s Mr. Bear’s job to look for them. He spent his summer poring through the days and hours of 571 subjects who, after seeking medical care for suicidal thoughts, agreed to be tracked continuously for six months. While they were being tracked, two died by suicide and between 50 and 100 made attempts.It is, Dr. Nock believes, the largest reservoir of information ever collected about the daily lives of people struggling with suicidal thoughts.The team is most interested in the days preceding suicide attempts, which would allow time for intervention. Already, some signs have emerged: Although suicidal urges often do not change in the period before an attempt, the ability to resist those urges does seem to diminish. Something simple — sleep deprivation — seems to contribute to that.Dr. Nock has been looking for ways to study these patients since 1994, when he had an experience that shocked him profoundly. During an undergraduate internship in the United Kingdom, he was assigned to a locked unit for violent and self-injurious patients. There, he saw things he had never encountered: Patients had cuts up and down their arms. One of them pulled out his own eyeball. A young man he befriended, who seemed to be improving, was later found in the Thames.Another shock came when he began to pepper the clinicians with questions about treating these patients and realized how little they knew: He recalls being told, “We give them some medicine, we talk to them and we hope they get better.”One reason, he concluded, was that it had never been possible to study a large number of people with suicidal ideation in the same way that we are able to observe patients with heart disease or tuberculosis. “Psychology hasn’t advanced as much as other sciences because we’ve been largely doing it wrong,” he said. “We haven’t gone out and found some behavior that is important in nature, and gone out and observed it.”But with the advent of phone-based apps and wearable sensors, he added, “we have data from so many different channels, and we have, increasingly, the ability to analyze those data, and observe people as they’re out living their lives.” One dilemma in designing the study was what to do when participants expressed a strong desire to hurt themselves. Dr. Nock decided they should intervene.“There’s a downside to this because you get fewer attempts and fewer suicides, because, scientifically, we’re now decreasing our likelihood of finding a signal,” he said. But, he added, “I keep coming back to the issue of, what if it was my child?”Interventions have become a routine part of life in the lab. If, in a routine questionnaire, a subject reports a strong desire to harm themselves, and it is between the hours of 9 a.m. and 9 p.m., they receive a call within 15 minutes from one of the researchers, who asks whether they have made an attempt.“We’re kind of this faceless person, so there’s less discomfort,” said Narise Ramlal, a research assistant in the lab. But Dr. Nock wonders — and hopes to test — whether digital interventions may prove to be more effective.“Many people don’t want a human to contact them when they’re a high risk,” he said. “Not to say that we’re going to replace humans with machines, but they can probably be a lot more efficient than we are now.”Telling the truth to a computerMs. Cruz said the app’s questions at first felt intrusive, then comforting. “It felt like I wasn’t being ignored,” she said. “To have somebody know how I feel, that takes some of the weight off.” Kayana Szymczak for The New York TimesIt was around 9 p.m., a few weeks into the six-month study, when the question popped up on Ms. Cruz’s phone: “Right now how strong is your desire to kill yourself?”Without stopping to think, she dragged her finger all the way to the end of the bar: 10. A few seconds later, she was asked to choose between two statements: “I am definitely not going to kill myself today” and “I am definitely going kill myself today.” She scrolled to the second.Fifteen minutes later, her phone rang. It was a member of the research team calling her. The woman called 911 and kept Ms. Cruz on the line until the police knocked on her door, and she passed out. Later, when she regained consciousness, a medical team was giving her a sternum rub, a painful procedure used to revive people after overdoses.Ms. Cruz has a pale, seraphic face and a fringe of dark curls. She had been studying for a nursing degree when a cascade of mental health crises sent her life swerving in a different direction. She maintains an A-student’s nerdy interest in science, joking that the rib cage on her T-shirt is “totally anatomically correct.”Right away, she had been intrigued by the trial, and she responded dutifully six times a day, when the apps on her phone surveyed her about her suicidal thoughts. The pings were intrusive, but also comforting. “It felt like I wasn’t being ignored,” she said. “To have somebody know how I feel, that takes some of the weight off.”On the night of her attempt, she was alone in a hotel room in Concord. She didn’t have enough money for another night there, and her possessions were mounded in trash bags on the floor. She was tired, she said, “of feeling like I had nobody and nothing.” Looking back, Ms. Cruz said she thought the technology — its anonymity and lack of judgment — made it easier to ask for help.“I think it’s almost easier to tell the truth to a computer,” she said.But many in the field are wary of the idea that technology can ever substitute for a clinician’s care. One reason is that patients in a crisis become skilled at deception, said Justin Melnick, 24, a doctoral student who survived a suicide attempt in 2019 and is now an advocate for people with mental illness.He recalled cutting short telephone conversations with his mother, the person best able to pull him off “the precipice,” and then switching his phone off. “And it was like, OK, that door has been closed,” he said. He described these evasions as “an act of defiance.” Why, he asked, would a person in that frame of mind agree to wear a sensor?In the end, he said, what helped him turn the corner was people — a support group, which met weekly in a circle of chairs for sessions of dialectical behavioral therapy, and a network of friends, family and clinicians who know him well enough to recognize his behavior. When that happens, he said, “we can generally ride that wave together.”Ms. Cruz does not have a network like that. Last month, as temperatures in Massachusetts were dipping into the 40s, she was living in a tent with her boyfriend, huddling together under a blanket for warmth. In the morning, they waited until McDonald’s opened so they could dry out their sweatshirts and shoes and charge their devices.She was faithful about taking her medications — five of them — but was scrambling to find a new therapist: The only one in her area who accepts Medicaid has an eight-month waiting list.Last week, as the six-month clinical trial came to an end, she filled out her final questionnaire with a twinge of sorrow. She would miss the $1 she received for each response. And she would miss the sense that someone was watching her, even if it was someone faceless, at a distance, through a device.“Honestly, it makes me feel a little bit safer to know that somebody cares enough to read that data every day, you know?” she said. “I’ll be kind of sad when it’s over.”If you are having thoughts of suicide, text the National Suicide Prevention Lifeline at 988 or go to SpeakingOfSuicide.com/resources for a list of additional resources.

American teenagers are reporting severe levels of anxiety and depression. But when Connecticut moved to expand mental health services in schools, it ran into fierce opposition in one town.KILLINGLY, Conn. — One evening in March, a high school senior named Sydney Zicolella stood before the school board in this rural, blue-collar Connecticut town and described her psychiatric history, beginning in the sixth grade, when she was “by definition, clinically depressed.”Ms. Zicolella, 17, who wore her dark, curly hair pulled back, is the third of four children in a devout Christian family, and the editor of the newspaper at Killingly High School.Many students there were struggling, she told the board. She had seen kids “walked, carried and cradled out of counseling, hysterical, not wanting to go to the hospital, but also not wanting to be sad anymore.”It was not uncommon, she said, for friends to “disappear for months, only to find out that they had been at a mental health hospital right down the road to my house.” She urged the board to approve the placement of a mental health clinic in the school, part of a push by the state of Connecticut to dramatically expand access to care for teenagers.Convincing the board was a long shot, she knew that. Her own mother, Lisa, 49, who, by her own account, grew up in “the generation of toughing things out,” didn’t support the clinic.It wasn’t that Lisa entirely disapproved of therapy — when Sydney was in crisis, she scoured northeastern Connecticut in search of a therapist who would take her insurance — but she feared school-based therapists would end up advising teens on matters like gender identity or birth control, which she felt belonged firmly in the grip of parents.“I do personally believe there’s a lot of agendas out there,” Lisa said. “And children are very malleable.”This debate has divided Killingly, and its families, since January, when Robert J. Angeli, the superintendent of schools, presented a plan to open a state-funded mental health clinic in the high school.Legislation to expand Connecticut’s network of school-based clinics had sailed through the legislature, passing the House by a vote of 143 to 4. When Mr. Angeli presented the plan before the town’s Board of Education, though, it ran into a solid wall of resistance, mostly on the grounds that it infringed on the rights of parents.In March, Killingly’s board members rejected the plan by a vote of 6 to 3. After that, dozens of supporters of the clinic filed a complaint with Connecticut’s Board of Education, asking the state to “investigate and take corrective action.”Pledging allegiance before a Board of Education meeting last month in Killingly.Christopher Capozziello for The New York TimesSince then, Killingly’s school board meetings have become a battleground for competing views on mental health, exposing divisions that are both partisan and generational. Teenagers have picketed on the well-manicured town common, where petunias grow around a memorial to the Civil War dead, with signs reading “14.7 PERCENT HAVE MADE A SUICIDE PLAN” and “TALK TO YOUR CHILDREN ABOUT MENTAL HEALTH.”Standoffs like the one in Killingly are being watched apprehensively by mental health advocates. During the pandemic, the mental health of children shot to the top of the agenda for both political parties. School-based services, which studies suggest can significantly decrease suicidal behavior and substance abuse, have emerged as a first-line policy response.Over the last year, legislators in more than 30 states have considered an expansion of school-based services, according to Inseparable, a mental health policy group, and eight states, including Connecticut, have passed legislation to do so. Before the services reach students, though, they must be embraced by American communities.In Connecticut, which already has more than 100 school-based health clinics, Killingly is an outlier. But lawmakers and conservative activists have targeted mental health curriculum in several states, often taking aim at social and emotional learning programs, known as SEL, which train students to manage emotions and practice conflict resolution. Lawmakers in Indiana and Oklahoma have put forward bills that would limit the use of SEL in the classroom.A plan is rejectedOlivia McOsker, 17, a senior at Killingly High School, spoke during public comment at the Board of Education meeting in support of the clinic.Christopher Capozziello for The New York TimesOn the January evening when the superintendent introduced staff from Generations Family Health Center, the nonprofit health care group that was to provide services in the school, the visitors peered out of Zoom screens with cheery smiles.The plan was for licensed therapists from Generations to work in a space on the school’s third floor. Students could be referred by teachers or family members, or could come in themselves, and therapy sessions would be scheduled during school hours. Therapists would bill insurance based on a sliding fee scale, using federal funds if necessary, so there would be no cost to the school and little, if any, to the families.Then a chill entered the room as the board members began peppering them with questions. The visitors’ smiles faded.Would they advise students on birth control or abortion? (They wouldn’t give medical advice, but might discuss if it comes up.) If children were referred and didn’t want therapy, would they be forced to do it? (No.) Would students be seen by peers going into treatment, exposing them to ridicule and stigma? (Hopefully not.) Could they get therapy without their parents knowing about it?Conceivably, yes, was the answer. By law, clinicians in Connecticut can provide six sessions of mental health treatment to minors without parental consent under a narrow set of circumstances — if the minor sought treatment, it was deemed clinically necessary and if requiring parental notification would deter the minor from receiving it.This provision is used rarely; in the nearby town of Putnam, which has hosted a school-based mental health clinic for nine years, treating hundreds of students, no child has ever been treated without parental permission, said Michael Morrill, a Putnam school board member.But it was a major sticking point for Norm Ferron, one of the Killingly board members, who said the arrangement would “give a student a lot more access to counseling without seeking parental approval, and I’m not real keen on that.”Another board member, Jason Muscara, said he had already heard enough to make his mind up.“I am not going to make it easier for kids to go around their parents,” he said. “I don’t think we should be helping a kid to walk into a mental health facility in a school and say, ‘I’m thinking about an abortion, let’s talk about that,’ without the parents knowing, for up to six visits.”Chris Viens, a member of the Board of Education, supports the expanded mental health program. He said he expected a little pushback, but was shocked by the vehemence of the opposition.Christopher Capozziello for The New York TimesKillingly’s school board, swept up in the culture wars of the Trump era, has repeatedly cast itself as a bulwark against liberalism and government intrusion. Several of its members were elected in 2020, amid popular outrage over a decision to retire the school’s mascot, the Redmen, at the urging of a student group who said it was offensive. After the election, the new board voted 5 to 4 to reinstate the mascot.The proposed mental health clinic has reopened those divisions, this time around psychotherapy and the values it might instill.At one meeting, a school board member said that, years ago, a therapist had “meddled with my teenaged son’s mind, because at that age they are most vulnerable and they want someone to talk to.” A local man got up to say that “our modern-day psychology is rooted in occultism,” noting that Sigmund Freud used drugs while writing his thesis and Karl Jung channeled spirit guides.Their wariness has resonated with some people in this community.Gerry Golob, 33, a house painter, said his view of psychiatry was shaped when his mother was committed to a state mental hospital, where “they just drug people up.” Plenty of people in Killingly receive mental health treatment, he said — he called the town “a walking pharmaceutical clinic” — but he doesn’t want his children exposed to it. If a clinic were placed in the school, he said, “I would remove my kids instantly.”The vehemence of the opposition to the clinic has come as a shock to Chris Viens, 49, one of three board members who has supported the idea. He said he expected “a little bit of pushback” but “really wasn’t prepared for the idea that we were going to have this long, drawn-out experience.”“It almost seems like there’s a fear that something about their belief system is under attack,” Mr. Viens said in an interview, adding that he was offering his views as a citizen, rather than a board member. “They seem to think that they have to stop it here. It’s almost like this line you don’t cross.”The superintendent, Mr. Angeli, and other members of the school board declined to comment for this article. ‘Why are we treating this like it’s taboo?’Jen Simpson runs a salon in Killingly where she said she hears teenage clients speaking with sophistication about mental health, a subject that was “taboo” when she was their age. Christopher Capozziello for The New York TimesOn the night in March when the Board of Education voted down the mental health center, Ms. Zicolella was at work, at a Mexican restaurant in Dayville. A mother from the school came up to the cash register, told her about the vote and burst into tears.“It was crazy, it made such an outpouring of emotion,” Ms. Zicolella said.For Sydney and her close friends, mental health was a frank topic of discussion. Many of them had struggled after a series of deaths in the school community when they were seventh-graders, she said. In high school, she was diagnosed with depression and generalized anxiety disorder.“Knowing what is going on in your head — being able to call it something official — helps you cope with those things,” she said. By the time they were seniors, her classmates were open about their diagnoses and treatments. “We do consider it part of our identity,” she said.Jen Simpson, 28, said she listens to teenage customers who come in to her salon, BeautyHaus, and is startled by their sophisticated discussion of anxiety and trauma, a vocabulary she assumes they have picked up from social media.Tips for Parents to Help Their Struggling TeensCard 1 of 6Are you concerned for your teen?

In 1972, Dr. John Fryer risked his career to tell his colleagues that gay people were not mentally ill. His act sent ripples through the legal, medical and justice systems.On the second day of the annual convention of the American Psychiatric Association in 1972, something extraordinary happened.While the assembled psychiatrists, mostly white men in dark suits, settled into rows of chairs in the Danish Room at the Adolphus Hotel in Dallas, a disguised figure had been smuggled through the back corridors. At the last minute, he stepped through a side curtain and took his place at the front of the room.There was an intake of breath in the audience. The man’s appearance was grotesque. His face was covered by a rubber Nixon mask, and he was wearing a garish, oversized tuxedo and a curly fright wig. But the outlandishness of his outfit diminished in importance once he began to speak.“I am a homosexual,” he began. “I am a psychiatrist.”For the next 10 minutes, Henry Anonymous, M.D. — this is what he had asked to be called — described the secret world of gay psychiatrists. Officially, they did not exist; homosexuality was categorized as a mental illness, so acknowledging it would result in the revocation of one’s medical license, and the loss of a career. In 42 states, sodomy was a crime.The reality was that there were plenty of gay people in the A.P.A., psychiatry’s most influential professional body, the masked doctor explained. But they lived in hiding, concealing every trace of their private life from their colleagues.“All of us have something to lose,” he said. “We may not be under consideration for a professorship; the analyst down the street may stop referring us his overflow; our supervisor may ask us to take a leave of absence.”This was the trade-off that had formed the basis of the masked man’s life. But the cost was too high. That’s what he had come to tell them.“We are taking an even bigger risk, however, in not living fully our humanity,” he said. “This is the greatest loss, our honest humanity.”He took his seat to a standing ovation.Dr. Fryer’s speechListen to Dr. Fryer deliver his remarks in their entirety as “Dr. Henry Anonymous,” May 2, 1972.The 10-minute speech, delivered 50 years ago Monday, was a tipping point in the history of gay rights. The following year, the A.P.A. announced that it would reverse its nearly century-old position, declaring that homosexuality was not a mental disorder.It is rare for psychiatrists to transform the culture that surrounds them, but that is what happened in 1973.By removing the diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., psychiatry removed the legal basis for a wide range of discriminatory practices: for denying gay people the right to employment, citizenship, housing and the custody of children; for excluding them from the clergy and the military and the institution of marriage. The long process of rolling back those practices could begin.When referred to psychiatrists, gay people would no longer be sent to be “cured” — injected with hormones, subjected to aversion therapy or pored over by analysts — but instead told that, from the point of view of science, there was nothing intrinsically wrong with them.The Great ReadMore fascinating tales you can’t help but read all the way to the end.One hundred years ago, the British spy Cruxy O’Connor was caught in what appears to be the I.R.A.’s only authorized attack on American soil.​​Here’s how Viola Davis drew on a life of private hardship to become one of the greatest actors of her generation.The tale is oft-repeated: A lover of Shakespeare released dozens of European starlings in New York City as an ode to the Bard, starting a North American invasion. Crucial parts of the story are not true.After delivering his speech, the man in the mask, John Ercel Fryer, 34, flew from Dallas to his home in Philadelphia, noting in his journal just how terrifying and profound the experience had been.“The day has passed, it has come and gone and I am still alive. For the first time I have identified with a force that is akin to my selfhood,” he wrote, in excerpts included in “Cured,” a 2018 documentary.Still — he didn’t tell his mother he had done it. He didn’t tell his sister. He didn’t tell his closest childhood friend. He barely told anybody for 20 years.‘What the hell is going on here?’Dr. Fryer in an undated yearbook photo from Transylvania University, where he was pre-med.Transylvania UniversityDr. Fryer, circa 1990, when he was a professor at Temple University.Historical Society of PennsylvaniaDr. Fryer, who died in 2003 at the age of 65, stood out for his size (he was 6-foot-4 and 300 pounds), for his flashing intelligence, and for the fact that he was obviously gay.Betty Lollis, a friend from Winchester, Ky., recalled him as the round-faced boy who was led into her second-grade class, dressed by his mother in a sailor suit. He was a prodigy, she said, and also “just a boy the boys laughed at or teased.”Decades later, Ms. Lollis said, some of their classmates apologized to Dr. Fryer for the way they had treated him. “These people that were painful for him were also all he had,” she said. “Those are his dearest friends.”He sailed through his classes, enrolling in college at 15 and medical school at 19. But again and again, his path was blocked when supervisors learned he was gay.The most crushing of these setbacks occurred in 1964. He had relocated to the freer atmosphere of the East Coast, and was a few months into a residency at the University of Pennsylvania when he let his guard down, telling a family friend at dinner that he was gay.The young man immediately reported this to his father, who reported it to the department chairman at Penn, Dr. Fryer said in a 2002 interview with the Journal of Gay and Lesbian Psychiatry. The department chairman called Dr. Fryer into his office and said: “You can either resign or I’ll fire you.”It took years of humiliating assignments at a state-run psychiatric hospital, the only institution that accepted him, for Dr. Fryer to complete his residency. After that he faced a long, uncertain path to tenure. For these reasons, coming out had little appeal, he said in a 2001 interview for “This American Life,” much of which has not been published until now.“It was a way, if you came out as gay, to not have any power,” he said. “And I wanted to be powerful. So being a straight, closeted physician enabled me to have power.”In 1970, Frank Kameny, an astronomer who had been dismissed from the military because he was gay, led a small group of gay rights activists to protest the A.P.A.’s annual convention, demanding that the diagnosis be declassified.Dr. Fryer was a full-fledged member of the “Gay P.A.,” a group of closeted A.P.A. members. who gathered in secret on the edges of the association, and he watched with distaste as the protesters stormed into panel discussions and heckled the speakers. “I was embarrassed by it, and I wished that they would shut up,” he said.But the following year, Barbara Gittings, one of the activists, approached Dr. Fryer to ask for his help.Younger, more progressive leaders were rising through the ranks of the A.P.A., and the activists sensed an opening. They had an idea: Instead of picketing, they could shake things up by confronting the psychiatrists with one of their own, a gay psychiatrist. If only they could find someone who would agree to do it.Ms. Gittings, left, at a “Gay, Proud and Healthy” display at the Dallas convention in 1972.Kay Tobin/Manuscripts and Archives Division, The New York Public Library“My first reaction was: No way,” Dr. Fryer recalled. “I had no security, and I did not want to do anything to jeopardize the possibility that I could get a faculty position somewhere. There was no way at that point that I was going to do that as an open thing.”Over the months that followed, though, Ms. Gittings kept calling. She updated Dr. Fryer as she approached a dozen of his gay colleagues and each said no, the risk was too great.Their refusals bothered Dr. Fryer. And Ms. Gittings, as he put it, kept “upping the ante.” What if she paid his way to Dallas? What if he wore a disguise, so that no one knew it was him?“She planted in my mind the possibility that I could do something,” he said. “And that I could do something that would be helpful without ruining my career.”Dr. Fryer’s lover at the time was a drama student, and the two threw themselves into the project of devising a disguise that would conceal his identity: a vastly oversized tuxedo, a rubber mask melted to distort its features, and a wig with a low hairline opposite to his own.Stepping onto the stage that day, Dr. Fryer said, “I felt a great freedom, a great sense of freedom.”There was pride, too, that he was the only one of his colleagues who dared.“To do that thing, to be willing to do that thing, when none of my colleagues in the Gay P.A. would be wiling to do it, openly or otherwise,” he said. “They were all in the audience. They were clapping.”The sight of Dr. Fryer had a powerful emotional effect on the psychiatrists gathered in the room, said Dr. Saul Levin, who in 2013 became the first openly gay man to serve as the A.P.A.’s chief executive and medical director.“It obviously really shook them,” he said. “Here was this huge audience for the time, seeing someone come out in a very weird costume. It made them a little disoriented — what the hell is going on here? And then this person comes out with such an eloquent speech.”Dr. Fryer was giddy as he left the stage, so exhilarated that, before returning to Philadelphia, he splurged on a manual harpsichord, which he wryly described as “among the least wise choices of my life.”As he returned to his hotel room to change out of his disguise, he passed the chairman of the psychiatry department at the University of Pennsylvania, who had fired him from his residency. Neither man showed any sign of recognition.‘It was over for me’Dr. Fryer in his Germantown home with one of his Doberman pinschers, circa 1975.Harry Adamson, via Historical Society of PennsylvaniaDr. Fryer returned to the rambling, Victorian house where he lived in Germantown with his Doberman pinschers and the medical students he took in as boarders.He remained himself — by turns generous and overbearing, charismatic and acerbic, switching on his Kentucky accent when it suited him.He still didn’t have tenure, and his career path was as tenuous as ever. In 1973, the A.P.A. voted to declassify homosexuality. And Dr. Fryer lost another job, this one at Friends Hospital.Again, an administrator called him into his office. “If you were gay and not flamboyant, we would keep you,” Dr. Fryer recalled him saying. “If you were flamboyant and not gay, we would keep you. But since you are both gay and flamboyant, we cannot keep you.”Dr. Fryer watched as his colleagues got promoted and won tenure. The Gay P.A. faded, as a new, more activist generation stepped forward as an open force within psychiatry, forming the Association of Gay and Lesbian Psychiatrists. But Dr. Fryer took no part in it.“I ran away again,” he said. “I didn’t go to the meetings. It was like I just sort of disappeared.” It was as if, he said, “I had done my thing and it was over for me.”Every now and then, he would tell someone about what he had done.Dr. Karen Kelly, 67, who rented a room from Dr. Fryer as a medical student, said he told her over dinner some time in the late 1970s, and never mentioned it again.Ms. Lollis, 85, said she and Dr. Fryer confided in one another later in life, sometimes speaking on the phone several times a week. But she didn’t find out that he was Dr. Anonymous until 2002, when he sent her the episode of “This American Life” that described the speech.“He just didn’t share it with anyone,” she said. “Not his mother, not his sister.”Circa 1970. Dr. Fryer was a musician and a choirmaster of his local church for 30 years.Historical Society of PennsylvaniaAt Temple University with colleagues around 1975.Historical Society of PennsylvaniaDr. Fryer would eventually get tenure at Temple University, where he built a specialty in bereavement and helped pioneer the hospice movement. After teaching all day and having dinner, he would often see patients until 11 p.m., Dr. Kelly recalled. He sat with many of his patients while they were dying.He threw big parties, and sometimes his famous friends, like the anthropologist Margaret Mead or the writer Gail Sheehy, would show up. He wore dashikis. Traveling for conferences, “he’d end up in a tiki restaurant with my cousins, dancing with the hula dancer,” Dr. Kelly said.But a sense of resentment clung to him, said Dr. David Scasta, who got to know Dr. Fryer as a medical resident at Temple University and interviewed him about his life in 2002.He felt isolated from the gay community, said Dr. Scasta, a past president of the Association of Gay and Lesbian Psychiatrists. He never had a long-term relationship. And he always felt that his career was not what it could have been.“There was always a sense of sadness at not being fully accepted,” he said. “John always felt he was on the fringe.”Decades would pass before historians of gay rights fully understood the significance of the Dr. Anonymous speech, that it had “a Stonewall riots kind of importance,” Dr. Scasta added. In that case, too, the surge of forward motion was driven by unlikely people.“It’s not always the law-abiding, nice people who did it, it’s the ones who are on the periphery who can make change,” he said.On Monday, the 50th anniversary of the Dr. Anonymous speech will be celebrated with speeches and proclamations in Philadelphia, which has declared May 2 John Fryer Day.Public celebration of his act had already begun in the years before Dr. Fryer’s death, and in 2001 he remarked on it caustically, saying he “sort of was trundled out as an exhibit every time someone wanted an exhibit.”At the time, though, it was secrecy that gave his act its power, he said.“As this person who was in disguise, I could say whatever I wanted,” he said, adding, “I did this one isolated event, which changed my life, which helped change the culture in my profession, and I disappeared.”

As the White House pleads with Republicans in Congress for emergency aid to fight the coronavirus, the federal government said that a fund established to reimburse doctors for care for uninsured Covid patients was no longer accepting claims for testing and treatment “due to lack of sufficient funds.”Some U.S. health care providers are informing uninsured people they can no longer be tested for the virus free of charge, and will have to pay for the service.Quest Diagnostics, which operates one of the largest networks of testing sites and laboratories in the United States, last week began to notify clients that the reimbursement was no longer available, Kimberly B. Gorode, a spokesperson for the chain, said on Sunday.Patients “are being told they can’t get it for free,” she said. Uninsured people will now have to pay $125 to be tested at Quest Diagnostics, while other testing services may charge up to $195.Customers enrolled in a private insurance plan, or covered by Medicare or Medicaid, are not affected, she said.The federal Covid uninsured program was established in 2020 to pay the medical bills of coronavirus patients who lack health coverage. Early this year, during the Omicron wave, the program allowed leading laboratories to perform 500,000 tests a month free of charge to uninsured individuals, according to the American Clinical Laboratory Association.In 2021, the program spent $130 million to reimburse providers for testing, treating and vaccinating uninsured people.Around 31.2 million Americans are uninsured, according to federal data in 2020. Uninsured people were more likely to be people of color or from low-income families.The White House recently requested $22.5 billion in emergency Covid aid, but Republicans in Congress have said they will not approve another aid package unless the White House finds another way to source the funds and lawmakers were still struggling to break through the impasse. An initial deal to use about $7 billion in state government coronavirus aid to help pay for a smaller, $15.6 billion package collapsed earlier this month when rank-and-file House Democrats and governors objected to clawing back that money.On Wednesday, the federal Heath Resources and Services Administration stopped accepting claims for testing and treatment for uninsured patients. On April 6, the agency will stop reimbursing providers for vaccinating uninsured people.Top federal health officials reiterated their concerns on Wednesday about the impact of stalled funding amid the spread of BA.2, a highly transmissible Omicron subvariant accounting for about 35 percent of new U.S. cases and a form of the virus similar to the version that swept through the nation this winter.Xavier Becerra, the health and human services secretary, warned last week that reimbursements for testing were ending.“Continued execution requires continued support from Congress,” he said, referring to President Biden’s recently released Covid response plan. “And at this stage, our resources are depleted.”Pharmacies operate 20,000 testing sites across the country, and, until this month, many have used federal emergency funds to provide tests and vaccinations to uninsured Americans.“This places health care providers in an extremely tenuous position,” the National Association of Chain Drug Stores wrote in a recent letter to the White House and congressional leaders.Cutting off funding “could create extreme confusion at the pharmacy counter,” the letter said, and “could result in the tragedy of increasing disparities in access to critically needed care and patients forgoing care.”The American Hospital Association urged Congress to release relief funds, describing the uninsured program as one of the services “essential to our country’s ability to respond to Covid-19.”In some cases, county, state or other federal programs may provide an alterative for uninsured people.

The latest edition of the DSM-5, sometimes known as “psychiatry’s bible,” includes a controversial new diagnosis: prolonged grief disorder.After more than a decade of argument, psychiatry’s most powerful body in the United States added a new disorder this week to its diagnostic manual: prolonged grief.The decision marks an end to a long debate within the field of mental health, steering researchers and clinicians to view intense grief as a target for medical treatment, at a moment when many Americans are overwhelmed by loss.The new diagnosis, prolonged grief disorder, was designed to apply to a narrow slice of the population who are incapacitated, pining and ruminating a year after a loss, and unable to return to previous activities.Its inclusion in the Diagnostic and Statistical Manual of Mental Disorders means that clinicians can now bill insurance companies for treating people for the condition.It will most likely open a stream of funding for research into treatments — naltrexone, a drug used to help treat addiction, is currently in clinical trials as a form of grief therapy — and set off a competition for approval of medicines by the Food and Drug Administration.Since the 1990s, a number of researchers have argued that intense forms of grief should be classified as a mental illness, saying that society tends to accept the suffering of bereaved people as natural and that it fails to steer them toward treatment that could help.A diagnosis, they hope, will allow clinicians to aid a part of the population that has, throughout history, withdrawn into isolation after terrible losses.“They were the widows who wore black for the rest of their lives, who withdrew from social contacts and lived the rest of their lives in memory of the husband or wife who they had lost,” said Dr. Paul S. Appelbaum, who is chair of the steering committee overseeing revisions to the fifth edition of the D.S.M.“They were the parents who never got over it, and that was how we talked about them,” he said. “Colloquially, we would say they never got over the loss of that child.”Throughout that time, critics of the idea have argued vigorously against categorizing grief as a mental disorder, saying that the designation risks pathologizing a fundamental aspect of the human experience.They warn that there will be false positives — grieving people told by doctors that they have mental illnesses when they are actually emerging, slowly but naturally, from their losses.And they fear grief will be seen as a growth market by drug companies that will try to persuade the public that they need medical treatment to emerge from mourning.“I completely, utterly disagree that grief is a mental illness,” said Joanne Cacciatore, an associate professor of social work at Arizona State University who has published widely on grief, and who operates the Selah Carefarm, a retreat for bereaved people.“When someone who is a quote-unquote expert tells us we are disordered and we are feeling very vulnerable and feeling overwhelmed, we no longer trust ourselves and our emotions,” Dr. Cacciatore said. “To me, that is an incredibly dangerous move, and short sighted.”“I completely, utterly disagree that grief is a mental illness,” said Joanne Cacciatore, an associate professor of social work at Arizona State University who operates the Selah Carefarm, a retreat for bereaved people.Adriana Zehbrauskas for The New York Times‘We don’t worry about grief’The origins of the new diagnosis can be traced back to the 1990s, when Holly G. Prigerson, a psychiatric epidemiologist, was studying a group of patients in late life, gathering data on the effectiveness of depression treatment.She noticed something odd: In many cases, patients were responding well to antidepressant medications, but their grief, as measured by a standard inventory of questions, was unaffected, remaining stubbornly high. When she pointed this out to psychiatrists on the team, they showed little interest.“Grief is normal,” she recalls being told. “We’re psychiatrists, and we don’t worry about grief. We worry about depression and anxiety.” Her response was, “Well, how do you know that’s not a problem?”Dr. Prigerson set about gathering data. Many symptoms of intense grief, like “yearning and pining and craving,” were distinct from depression, she concluded, and predicted bad outcomes like high blood pressure and suicidal ideation.Her research showed that for most people, symptoms of grief peaked in the six months after the death. A group of outliers — she estimates it at 4 percent of bereaved individuals — remained “stuck and miserable,” she said, and would continue to struggle with mood, functioning and sleep over the long term.“You’re not getting another soul mate and you’re kind of eking out your days,” she said.In 2010, when the American Psychiatric Association proposed expanding the definition of depression to include grieving people, it provoked a backlash, feeding into a broader critique that mental health professionals were overdiagnosing and overmedicating patients.“You’ve got to understand that clinicians want diagnoses so they can categorize people coming through the door and get reimbursement,” said Jerome C. Wakefield, a professor of social work at New York University. “That is a huge pressure on the D.S.M.”Still, researchers kept working on grief, increasingly viewing it as distinct from depression and more closely related to stress disorders, like post-traumatic stress disorder. Among them was Dr. M. Katherine Shear, a psychiatry professor at Columbia University, who developed a 16-week program of psychotherapy that draws heavily on exposure techniques used for victims of trauma.By 2016, data from clinical trials showed that Dr. Shear’s therapy had good results for patients suffering from intense grief, and that it outperformed antidepressants and other depression therapies. Those findings bolstered the argument for including the new diagnosis in the manual, said Dr. Appelbaum, who is chair of the committee in charge of revisions to the manual.In 2019, Dr. Appelbaum convened a group that included Dr. Shear, of Columbia, and Dr. Prigerson, now a professor at Weill Cornell Medical College, to agree on criteria that would distinguish normal grief from the disorder.The most sensitive question of all was this: How long is prolonged?Though both teams of researchers felt that they could identify the disorder six months after a bereavement, the A.P.A. “begged and pleaded” to define the syndrome more conservatively — a year after death — to avoid a public backlash, Dr. Prigerson said.“I have to say that they were kind of politically smart about that,” she added. The concern was that the public was “going to be outraged, because everyone feels because they still feel some grief — even if it’s their grandmother at six months, they are still missing them,” she said. “It just seems like you’re pathologizing love.”Measured at the year mark, she said, the criteria should apply to around 4 percent of bereaved people.The new diagnosis, published this week in the manual’s revised edition, is a breakthrough for those who have argued, for years, that intensely grieving people need tailored treatment.“It’s kind of like the bar mitzvah of diagnoses,” said Dr. Kenneth S. Kendler, a professor of psychiatry at Virginia Commonwealth University who has played an important role in the last three editions of the diagnostic manual.“It’s sort of an official blessing in the world,” he said. “If we were on the planetary committee of the American Astronomical Society deciding what is a planet or not — this one’s in, and Pluto we kicked out.”If the diagnosis comes into common use, it is likely to popularize Dr. Shear’s treatment and also give rise to a range of new ones, including drug treatments and online interventions.Dr. Shear said it was difficult to predict what treatments would emerge.“I don’t really have any idea, because I don’t know when the last time there was a really brand-new diagnosis,” she said.She added, “I really am in favor of anything that helps people, honestly.”Dr. M. Katherine Shear, a psychiatry professor at Columbia University and a founding director of the Center for Prolonged Grief, has been studying the condition since 1995.Yana Paskova for The New York TimesA loop of griefAmy Cuzzola-Kern, 54, said Dr. Shear’s treatment helped her break out of a terrible loop.Three years earlier, her brother had died suddenly in his sleep of a heart attack. Ms. Cuzzola-Kern found herself compulsively replaying the days and hours leading up to his death, wondering whether she should have noticed he was unwell or nudged him to go to the emergency room.She had withdrawn from social life and had trouble sleeping through the night. Though she had begun a course of antidepressants and seen two therapists, nothing seemed to be working.“I was in such a state of protest — this can’t be, this is a dream,” she said. “I felt like I was living in a suspended reality.”She entered Dr. Shear’s 16-session program, called prolonged grief disorder therapy. In sessions with a therapist, she would narrate her recollection of the day that she learned her brother had died — a painful process, but one that gradually drained the horror out of the memory. By the end, she said, she had accepted the fact of his death.The diagnosis, she said, mattered only because it was a gateway to the proper treatment.“Am I ashamed or embarrassed? Do I feel pathological? No,” she said. “I needed professional help.”Yet, others interviewed said they were wary of any expectation that grief should lift in a particular period of time.“We would never put a time frame around when someone should or shouldn’t feel that they have moved forward,” said Catrina Clemens, who oversees the victim services department of Mothers Against Drunk Driving, which provides services to bereaved relatives and friends. The organization encourages bereaved people to seek mental health care, but has no role in diagnosis, said a spokesperson.Filipp Brunshteyn, whose 3-year-old daughter died after an automobile accident in 2016, said grieving people could be set back by the message that their response was dysfunctional.“Anything we inject into this journey that says, ‘that’s not normal,’ that could cause more harm than good,” he said. “You are already dealing with someone very vulnerable, and they need validation.”To set a year as a point for diagnosis is “arbitrary and kind of cruel,” said Ann Hood, whose memoir, “Comfort: A Journey Through Grief,” describes the death of her 5-year-old daughter from a strep infection. Her own experience, she said, was “full of peaks and valleys and surprises.”The first time Ms. Hood walked into her daughter Grace’s room after her death, she saw a pair of ballet tights lying in a tangle on the floor where the little girl had dropped them. She screamed. “Not the kind of scream that comes from fright,” she later wrote, “but the kind that comes from the deepest grief imaginable.”She slammed the door, left the room untouched and eventually turned off the heat to that part of the house. At the one-year mark, a well-meaning friend told her it was time to clear out the room — “nothing worse than a shrine,” he told her — but she ignored him.Then one morning, three years after Grace’s death, Ms. Hood woke up and returned to the room. She sorted her daughter’s clothes and toys into plastic bins, emptied the bureau and closet and lined up her little shoes at the top of the stairs.To this day, she is not sure how she got from one point to the other. “All of a sudden, you look up,” she said, “and a few years have gone by, and you’re back in the world.”

Climate Change Enters the Therapy RoomTen years ago, when psychologists proposed that a wide range of people would suffer anxiety and grief over climate, the idea was seen as a fringe neurosis. But that sSkepticism about that idea is gone.Feb. 6, 2022, 5:00 a.m. ETAlina Black, a mother of two in Portland, Ore., sought a therapist who specialized in climate anxiety to address her mounting panics. “I feel like I have developed a phobia to my way of life,” she said.Credit…Mason Trinca for The New York TimesPORTLAND, Ore. — It would hit Alina Black in the snack aisle at Trader Joe’s, a wave of guilt and shame that made her skin crawl.Something as simple as nuts. They came wrapped in plastic, often in layers of it, that she imagined leaving her house and traveling to a landfill, where it would remain through her lifetime and the lifetime of her children.She longed, really longed, to make less of a mark on the earth. But she had also had a baby in diapers, and a full-time job, and a 5-year-old who wanted snacks. At the age of 37, these conflicting forces were slowly closing on her, like a set of jaws.In the early-morning hours, after nursing the baby, she would slip down a rabbit hole, scrolling through news reports of droughts, fires, mass extinction. Then she would stare into the dark.It was for this reason that, around six months ago, she searched “climate anxiety” and pulled up the name of Thomas J. Doherty, a Portland psychologist who specializes in climate.A decade ago, Dr. Doherty and a colleague, Susan Clayton, a professor of psychology at the University of Wooster, published a paper proposing a new idea. They argued that climate change would have a powerful psychological impact — not just on the people bearing the brunt of it, but on people following it through news and research. At the time, the notion was seen as speculative.That skepticism is fading. Eco-anxiety, a concept introduced by young activists, has entered a mainstream vocabulary. And professional organizations are hurrying to catch up, exploring approaches to treating anxiety that is both existential and, many would argue, rational.Though there is little empirical data on effective treatments, the field is expanding swiftly. The Climate Psychology Alliance provides an online directory of climate-aware therapists; the Good Grief Network, a peer support network modeled on 12-step addiction programs, has spawned more than 50 groups; professional certification programs in climate psychology have begun to appear.As for Dr. Doherty, so many people now come to him for this problem that he has built an entire practice around them: an 18-year-old student who sometimes experiences panic attacks so severe that she can’t get out of bed; a 69-year-old glacial geologist who is sometimes overwhelmed with sadness when he looks at his grandchildren; a man in his 50s who erupts in frustration over his friends’ consumption choices, unable to tolerate their chatter about vacations in Tuscany.The field’s emergence has met resistance, for various reasons. Therapists have long been trained to keep their own views out of their practices. And many leaders in mental health maintain that anxiety over climate change is no different, clinically, from anxiety caused by other societal threats, like terrorism or school shootings. Some climate activists, meanwhile, are leery of viewing anxiety over climate as dysfunctional thinking — to be soothed or, worse, cured.But Ms. Black was not interested in theoretical arguments; she needed help right away.She was no Greta Thunberg type, but a busy, sleep-deprived working mom. Two years of wildfires and heat waves in Portland had stirred up something sleeping inside her, a compulsion to prepare for disaster. She found herself up at night, pricing out water purification systems. For her birthday, she asked for a generator.She understands how privileged she is; she describes her anxiety as a “luxury problem.” But still: The plastic toys in the bathtub made her anxious. The disposable diapers made her anxious. She began to ask herself, what is the relationship between the diapers and the wildfires?“I feel like I have developed a phobia to my way of life,” she said.An Idea on the Edge Spreads OutThomas Doherty in Portland, Ore. He specializes in distress related to climate disaster, or ecopsychology, which was, as he put it, a “woo-woo area” until recently.Mason Trinca for The New York TimesLast fall, Ms. Black logged on for her first meeting with Dr. Doherty, who sat, on video, in front of a large, glossy photograph of evergreens.At 56, he is one of the most visible authorities on climate in psychotherapy, and he hosts a podcast, “Climate Change and Happiness.” In his clinical practice, he reaches beyond standard treatments for anxiety, like cognitive behavioral therapy, to more obscure ones, like existential therapy, conceived to help people fight off despair, and ecotherapy, which explores the client’s relationship to the natural world.He did not take the usual route to psychology; after graduating from Columbia University, he hitchhiked across the country to work on fishing boats in Alaska, then as a whitewater rafting guide — “the whole Jack London thing” — and as a Greenpeace fund-raiser. Entering graduate school in his 30s, he fell in naturally with the discipline of “ecopsychology.”At the time, ecopsychology was, as he put it, a “woo-woo area,” with colleagues delving into shamanic rituals and Jungian deep ecology. Dr. Doherty had a more conventional focus, on the physiological effects of anxiety. But he had picked up on an idea that was, at that time, novel: that people could be affected by environmental decay even if they were not physically caught in a disaster.Recent research has left little doubt that this is happening. A 10-country survey of 10,000 people aged 16 to 25 published last month in The Lancet found startling rates of pessimism. Forty-five percent of respondents said worry about climate negatively affected their daily life. Three-quarters said they believed “the future is frightening,” and 56 percent said “humanity is doomed.”The blow to young people’s confidence appears to be more profound than with previous threats, such as nuclear war, Dr. Clayton said. “We’ve definitely faced big problems before, but climate change is described as an existential threat,” she said. “It undermines people’s sense of security in a basic way.”Caitlin Ecklund, 37, a Portland therapist who finished graduate school in 2016, said that nothing in her training — in subjects like buried trauma, family systems, cultural competence and attachment theory — had prepared her to help the young women who began coming to her describing hopelessness and grief over climate. She looks back on those first interactions as “misses.”“Climate stuff is really scary, so I went more toward soothing or normalizing,” said Ms. Ecklund, who is part of a group of therapists convened by Dr. Dougherty to discuss approaches to climate. It has meant, she said, “deconstructing some of that formal old-school counseling that has implicitly made things people’s individual problems.”‘Obviously, it would be nice to be happy’Caroline Wiese, 18, of New York City experienced “multiday panic episodes” over climate data, which interfered with her schoolwork.Calla Kessler for The New York TimesMany of Dr. Doherty’s clients sought him out after finding it difficult to discuss climate with a previous therapist.Caroline Wiese, 18, described her previous therapist as “a typical New Yorker who likes to follow politics and would read The New York Times, but also really didn’t know what a Keeling Curve was,” referring to the daily record of carbon dioxide concentration.Ms. Wiese had little interest in “Freudian B.S.” She sought out Dr. Doherty for help with a concrete problem: The data she was reading was sending her into “multiday panic episodes” that interfered with her schoolwork.In their sessions, she has worked to carefully manage what she reads, something she says she needs to sustain herself for a lifetime of work on climate. “Obviously, it would be nice to be happy,” she said, “but my goal is to more to just be able to function.”Frank Granshaw, 69, a retired professor of geology, wanted help hanging on to what he calls “realistic hope.”He recalls a morning, years ago, when his granddaughter crawled into his lap and fell asleep, and he found himself overwhelmed with emotion, considering the changes that would occur in her lifetime. These feelings, he said, are simply easier to unpack with a psychologist who is well versed on climate. “I appreciate the fact that he is dealing with emotions that are tied into physical events,” he said.As for Ms. Black, she had never quite accepted her previous therapist’s vague reassurances. Once she made an appointment Dr. Doherty, she counted the days. She had a wild hope that he would say something that would simply cause the weight to lift.That didn’t happen. Much their first session was devoted to her doomscrolling, especially during the nighttime hours. It felt like a baby step.“Do I need to read this 10th article about the climate summit?” she practiced asking herself. “Probably not.”Frank Granshaw, a retired glacial geologist in Portland, sees a psychologist who is well versed on the climate. Mason Trinca for The New York TimesA Knot Loosens: ‘There Will Be Good Days’Several sessions came and went before something really happened.Ms. Black remembers going into an appointment feeling distraught. She had been listening to radio coverage of the Intergovernmental Panel on Climate Change meeting in Glasgow and heard a scientist interviewed. What she perceived in his voice was flat resignation.That summer, Portland had been trapped under a high-pressure system known as a “heat dome,” sending temperatures to 116 degrees. Looking at her own children, terrible images flashed through her head, like a field of fire. She wondered aloud: Were they doomed?Dr. Doherty listened quietly. Then he told her, choosing his words carefully, that the rate of climate change suggested by the data was not as swift as what she was envisioning.“In the future, even with worst-case scenarios, there will be good days,” he told her, according to his notes. “Disasters will happen in certain places. But, around the world, there will be good days. Your children will also have good days.”At this, Ms. Black began to cry.She is a contained person — she tends to deflect frightening thoughts with dark humor — so this was unusual. She recalled the exchange later as a threshold moment, the point when the knot in her chest began to loosen.“I really trust that when I hear information from him, it’s coming from a deep well of knowledge,” she said. “And that gives me a lot of peace.”Dr. Doherty recalled the conversation as “cathartic in a basic way.” It was not unusual, in his practice; many clients harbor dark fears about the future and have no way to express them. “It is a terrible place to be,” he said.A big part of his practice is helping people manage guilt over consumption: He takes a critical view of the notion of a climate footprint, a construct he says was created by corporations in order to shift the burden to individuals.Ms. Black still tears up remembering a moment when Dr. Doherty told her, “In the future, even with worst-case scenarios, there will be good days.” The conversation was “cathartic in a basic way,” Dr. Doherty recalled.Mason Trinca for The New York TimesHe uses elements of cognitive behavioral therapy, like training clients to manage their news intake and look critically at their assumptions.He also draws on logotherapy, or existential therapy, a field founded by Viktor E. Frankl, who survived German concentration camps and then wrote “Man’s Search for Meaning,” which described how prisoners in Auschwitz were able to live fulfilling lives.“I joke, you know it’s bad when you’ve got to bring out the Viktor Frankl,” he said. “But it’s true. It is exactly right. It is of that scale. It is that consolation: that ultimately I make meaning, even in a meaningless world.”At times, over the last few months, Ms. Black could feel some of the stress easing.On weekends, she practices walking in the woods with her family without allowing her mind to flicker to the future. Her conversations with Dr. Doherty, she said, had “opened up my aperture to the idea that it’s not really on us as individuals to solve.”Sometimes, though, she’s not sure that relief is what she wants. Following the news about the climate feels like an obligation, a burden she is meant to carry, at least until she is confident that elected officials are taking action.Her goal is not to be released from her fears about the warming planet, or paralyzed by them, but something in between: She compares it to someone with a fear of flying, who learns to manage their fear well enough to fly.“On a very personal level,” she said, “the small victory is not thinking about this all the time.”

The number of people who try suicide has risen steadily in the U.S. But despite gains in health coverage, nearly half are not getting mental health treatment.Suicide attempts in the United States showed a “substantial and alarming increase” over the last decade, but one number remained the same, a new study has found: Year in and year out, about 40 percent of people who had recently tried suicide said they were not receiving mental health services.The study, published in JAMA Psychiatry on Wednesday, traces a rise in the incidence of suicide attempts, defined as “self-reported attempts to kill one’s self in the last 12 months,” from 2008 to 2019. During that period, the incidence rose to 564 in every 100,000 adults from 481.The researchers drew on data from 484,732 responses to the federal government’s annual National Survey on Drug Use and Health, which includes people who lack insurance and have little contact with the health care system. Because the data is self-reported, it could reflect faulty or inexact recollections.They found the largest increase in suicide attempts among women; young adults between 18 and 25; unmarried people; people with less education; and people who regularly use substances like alcohol or cannabis. Only one group, adults 50 to 64 years old, saw a significant decrease in suicide attempts during that time.Among the major findings was that there was no significant change in the use of mental health services by people who had tried suicide, despite the passage of the Affordable Care Act in 2010 and receding stigma around mental health care.Over the 11-year period, a steady rate of about 40 percent of people who tried suicide in the previous year said they were not receiving mental health care, said Greg Rhee, an assistant professor of psychiatry at the Yale School of Medicine and one of the authors of the study.The Affordable Care Act, which took effect fully in 2014, required all health plans to cover mental health and substance abuse services, and also sharply reduced the number of uninsured people in the U.S. In 2008, 43.8 million Americans, or 14.7 percent of the population, were uninsured, according to the Centers for Disease Control and Prevention. By 2020, the total uninsured had fallen to 28 million, or 8.6 percent of the population, the Census Bureau reported.Still, many respondents to the survey in the new report said the cost of mental health care was prohibitive; others said they were uncertain where to go for treatment or had no transportation.“It is a huge public health problem,” Dr. Rhee said. “We know that mental health care in the U.S. is really fragmented and complicated, and we also know not everybody has equal access to mental health care. So, it’s somewhat not surprising.”Since people who try suicide have a higher likelihood of making another attempt in the next six months compared with the general population, the barriers to treatment are particularly troubling, he said.“That is our idea of hope,” he said. “That is the goal of the medical structure. We want to provide health care to people who attempt suicidal behavior.”Suicide is one of the top 10 leading causes of death in the United States, with a yearly death toll that has risen 60 percent in recent decades, to 48,344 in 2018 from 29,180 in 1999. During that period, the rate of suicide in the population increased by 35 percent, dipping for the first time, by 2 percent, in 2019, according to the C.D.C.This has happened despite significant advances in brain science and the development of promising interventions using cognitive behavioral therapy, attachment-based family therapy and dialectical behavioral therapy, said Dr. Christine Moutier, the chief medical officer for the American Foundation for Suicide Prevention.“One would argue, why haven’t the rates been going down?” she said. “Until 2018, it’s very clear that those have yet to be made accessible to the general population.”The study suggests that overall, people who attempt suicide face especially high barriers to access, since the U.S. population as a whole is using mental health services at a higher level than ever before, with recent research suggesting that one in four Americans was receiving some care, Dr. Moutier said.“This is not a new finding, from that standpoint, but it is terribly concerning,” said Dr. Moutier, who was not involved in the study.The population of people who have tried suicide is distinct, demographically, from those who have died by suicide: While women make up a majority of suicide attempts, more than three-quarters of those who die by suicide are men, the data shows, among other reasons because men are more likely to use guns.People who survive a suicide attempt often do well afterward, said Dr. Paul Nestadt, an assistant professor of psychology at Johns Hopkins who has researched the epidemiology of suicide.He cited a 1978 study of 515 people who had tried suicide at the Golden Gate Bridge in San Francisco; after following up with the survivors for 26 years, researchers found 94 percent of them were alive or had died of natural causes, and only 4.9 percent had died by suicide subsequently.Dr. Nestadt, who was not involved in the study, said the new data points, once again, to the scarcity of psychiatric beds or mental health professionals who take insurance, factors that have prevented medical science from bringing down the country’s suicide rates.“The bottom line is, our treatments really work, that’s one of the things that always surprises medical students doing psychiatry rotations,” he said. “But people have to be able to access care. When they can’t, they’re left with less choices.”

A jury found Harvard chemist Charles Lieber guilty of lying to the federal government about his participation in China’s Thousand Talents recruitment program.BOSTON — Charles Lieber, one of the country’s top research chemists, sat miserably in a chair at the Harvard Police Department, trying to explain to two F.B.I. agents why he had agreed to partner with a lesser-known Chinese university in a relationship that had soured and landed him in trouble with the U.S. government.The university had money to spend — “that’s one of the things China uses to try to seduce people,” Dr. Lieber said in the interrogation, clips of which were shown in court. But money wasn’t the reason, he said. By training young scientists in the use of technology he had pioneered, he hoped to burnish his credentials with the committee that decides the ultimate scientific honor.“This is embarrassing,” he said. “Every scientist wants to win a Nobel Prize.”On Tuesday, after deliberating for two hours and 45 minutes, a federal jury found Dr. Lieber guilty of two counts of making false statements to the U.S. government about whether he participated in Thousand Talents Plan, a program designed by the Chinese government to attract foreign-educated scientists to China. They also found him guilty of failing to declare income earned in China and failing to report a Chinese bank account. Though it is not illegal to participate in Chinese recruitment programs, scientists are required to disclose their participation to the U.S. government, which also funds their research and may view it as a conflict of interest. Dr. Lieber’s conviction is a victory for the China Initiative, an effort launched in 2018, under the Trump administration, to root out scientists suspected of sharing sensitive information with China. Of several dozen cases opened against academic researchers, most, like the case against Dr. Lieber, do not allege espionage or intellectual property theft, but failure to disclose Chinese funding, and the effort has been criticized for prosecutorial overreach. It suffered a series of setbacks over the summer, with half a dozen cases dismissed and the first case to reach the trial stage, against the researcher Anming Hu, ending in acquittal. Dr. Lieber’s trial was watched closely in scientific circles, as an indicator of whether the Justice Department will proceed with prosecutions of other researchers. Peter Zeidenberg, a Washington, D.C. lawyer who represents around a dozen researchers who are under investigation, said Dr. Lieber’s case stands out because he was specifically asked about his participation in the Chinese program, and denied it.“The reason people like Lieber lie is because they are afraid,” he said. “It’s really sad. They are afraid to answer truthfully, ‘Are you a member of the talent program?’ I’m sure in the Red Scare, people said they were not a member of the Communist Party. ”The department of chemistry and chemical biology at Harvard, where Dr. Lieber was chair. He is on leave from the university.Katherine Taylor/ReutersIn closing arguments on Tuesday, Dr. Lieber’s lawyer, Marc Mukasey, said the government had inadequate proof of wrongdoing and risked silencing a pioneering researcher. “Isn’t it troubling that nobody in this courtroom has explained what the Thousand Talents Plan is and who is in it?” he said. “Isn’t it troubling that Dr. Lieber’s work was all public, was for the benefit of the world, yet he is facing criminal charges for it?”He added, “No villains, no victims, no one got robbed, no one got rich, but over a few seconds of conversation — Special Agent Mousseau called it a blip on the radar — the world’s greatest nonscientist is facing multiple felonies.”Among the researchers prosecuted as part of the China Initiative, Dr. Lieber is by far the most prominent, chosen as chairman of Harvard’s chemistry and chemical biology department and seen by some as a potential Nobel Prize winner. Since 2008, prosecutors said, his laboratory at Harvard had received research grants totaling $18 million from the Department of Defense and the National Institutes of Health.At issue in this case was a joint venture that Dr. Lieber launched in 2011 with the Wuhan University of Technology, where one of his former students had taken a post. Outside employment is standard for high-level researchers, who often contract with private sector firms or universities overseas for part of the academic year. A three-year contract emailed to Dr. Lieber in 2012, and displayed to the jury by prosecutors, identified him as a “One Thousand Talent High Level Foreign Expert,” entitling him to $50,000 a month, plus about $150,000 in living expenses and more than $1.5 million for a laboratory, which they called the WUT-Harvard Joint Nano Key Laboratory.In 2018, as the China Initiative got underway, investigators from the Department of Defense and the National Institutes of Health approached Dr. Lieber to ask if he had taken part in the Thousand Talents programs. Over the week-long trial, jurors heard from a series of witnesses who said that in both instances, Dr. Lieber had denied participating. They also watched video clips from an F.B.I. interrogation, conducted on Jan. 28, 2020, the morning Dr. Lieber was arrested at 6:30 a.m. at his office at Harvard. After initially asking for a lawyer, Dr. Lieber went on to answer the agents’ questions for about three hours, acknowledging at several points that he had misled investigators.At first, he denied receiving income from the Wuhan university or participating in the Chinese recruitment program. Then the agents produced a series of documents, including contracts from 2011 and 2012, and Dr. Lieber examined them, remarking at one point, “I should pay more attention to what I’m signing.”“That’s pretty damning,” he said. “Now that you bring it up, yes, I do remember.”He went on to offer detail about his financial arrangements with the Wuhan university: A portion of his salary was deposited in a Chinese bank account and the remainder — an amount he estimated as between $50,000 and $100,000 — was paid in $100 bills, which he carried home in his luggage.“They would give me a package, a brown thing with some Chinese characters on it, I would throw it in my bag,” he said. After returning home, he said, “I didn’t declare it, and that’s illegal.”He acknowledged, as well, that he “wasn’t completely transparent by any stretch of the imagination” when approached by investigators from the Department of Defense in 2018, and that he was aware he might face charges.“I was scared of being arrested, like I am now,” he added.As the jury prepared to deliberate, Jason Casey, an assistant U.S. attorney, reminded jurors of Dr. Lieber’s demeanor in the F.B.I. interview and urged them to “use your common sense.” “It’s not that the defendant has no memory of events prior to 2015,” he said. “It’s that he does not want to remember. He does not want to remember that he participated in the Thousand Talents program. He does not want to remember that he took bags of cash on an airplane and never reported them to the I.R.S.”‘Scaring the scientific community’Dr. Lieber in 2002. He studies nanotechnologies and has pursued commercial nanotechnology projects outside of his work at Harvard. He was considered a contender for a Nobel Prize in chemistry.Volker Steger/Science SourceDr. Lieber’s arrest was one of the first signals that federal authorities were investigating scientists who had received funding from Chinese sources, and it sent shock waves through academic circles. It was followed, in January of 2021, by the arrest of Gang Chen, a professor of mechanical engineering at the Massachusetts Institute of Technology, on suspicion of hiding affiliations with Chinese government institutions in order to secure $19 million in U.S. federal grants.Brian Timko, who worked under Dr. Lieber as a graduate student and now heads his own laboratory at Tufts University, said he believed China Initiative had strayed from its original focus on espionage toward disclosure violations that, a few years ago, “would have been handled at the university level.” “I think these cases are about scaring the scientific community,” he said. Dr. Timko, who attended stretches of the week-long trial, said he was troubled by the way Dr. Lieber’s work had been “twisted” by prosecutors. He said Dr. Lieber had invented electronic chips so small and flexible that they could be injected into parts of the human body, like the brain or the retina. Eventually, he said, the technology could lead to breakthroughs in bioelectronic medicine, like restoring sight to blind people or movement to paralyzed limbs.“Charlie spent his whole career trying to help the world, and a handful of individuals who don’t even understand how science works tore the whole thing down,” he said. “And that is just not fair.”This year, the Justice Department has dropped cases against five researchers accused of hiding ties to the Chinese military, and one case, which reached the trial stage, ended in acquittal.Stefani Reynolds for The New York TimesWitnesses over the last week painted Dr. Lieber as a demanding, sometimes impatient academic star, who struggled to manage his relationship with his partners in Wuhan, and complained that Harvard was not acting vigorously to defend him. “I definitely do not have a good taste” about “many ‘friends’ in China,” Dr. Lieber wrote in an email to a Chinese colleague at another institution. “These people want to use me, so we will not let that happen, versus me using them. But we’ll be ever so polite in the mean time.”He expressed alarm, in 2018, when investigators Department of Defense and the National Institutes of Health began asking about his participation in the Thousand Talents plan. “They are threatening not only to end my funding (which supports much of my research) but also force me to pay back the last three plus years they supported much of my work,” he wrote to a Chinese colleague, adding, “perhaps someone (Chinese) who does not like me brought this to attention of N.I.H.?”In his conversation with the F.B.I. agents on the day of his arrest, Dr. Lieber was reflective about the role of international funding in the lives of researchers, saying that relationships with foreign partners were never as straightforward as they seemed at first.“Early on, if someone said, ‘We’ll give you this title and we’ll pay your travel to and from,’ you don’t think anything about it,” he explained, “but partners “always want something from you.”“A lot of countries, money is what they have in excess,” he said. He added, “that’s one of the things China uses to seduce people.”He tried to impress on the two special agents that a different motive, the desire for acclaim, had brought him to partner with Wuhan and train scientists there. “I was younger and stupid,” he said. “I want to be recognized for what I’ve done. Everyone wants to be recognized.” He offered a comparison he had given his son, a high school wrestler. The Nobel Prize is “kind of like an Olympic gold medal — it’s very, very rare,” he said.A prize he had won recently was more like a bronze medal, he said with a self-deprecating laugh. “That probably is the underlying reason I did this,” he said.

The trial of Charles Lieber offers a peek inside the world of big-money, big-prestige science as the U.S. cracked down on Chinese funding.BOSTON — Charles Lieber, one of the country’s top research chemists, sat at the Harvard Police Department, trying to explain to two F.B.I. agents why he had agreed to partner with a lesser-known Chinese university in a relationship that had soured and landed him in trouble with the U.S. government.The university had money to spend — “that’s one of the things China uses to try to seduce people,” Dr. Lieber said in the interrogation, clips of which were shown in court. He described returning from several visits to China carrying tens of thousands of dollars in cash, wrapped in “a package, a brown thing with some Chinese characters on it.”But money wasn’t why he had become involved, he said. By training young scientists in the use of technology he had pioneered, he hoped to burnish his credentials with the committee that decides the ultimate scientific honor.“This is embarrassing,” he said. “Every scientist wants to win a Nobel Prize.”The trial of Dr. Lieber, which is expected to conclude this week, has offered a glimpse inside the big-money, big-prestige world of elite science as the U.S. government began the China Initiative, an effort to root out scientists suspected of sharing sensitive information with China.Like many of the government’s cases against researchers, the one against Dr. Lieber does not bring charges of espionage or intellectual property theft but something narrower: a failure to disclose Chinese funding that could be viewed as a conflict of interest by the U.S. government, which also funds their research.Dr. Lieber is accused of lying to the government on two occasions about whether he participated in China’s Thousand Talents Plan, an effort to attract foreign-educated scientists to China; of failing to declare income earned in China on his tax returns; and of failing to declare a Chinese bank account. Though participating in the Chinese recruitment program is not a crime, making false statements to government agencies about it is.The trial comes as the China Initiative, which began under the Trump administration in 2018, has experienced a series of setbacks. In July, the Justice Department dropped cases against five researchers accused of hiding ties to the Chinese military, and in September, the one against a researcher, Anming Hu, the first prosecution to reach the trial stage, ended in an acquittal.The verdict in Dr. Lieber’s case is being watched in scientific circles as an indicator of whether the Justice Department will proceed with the prosecutions of other researchers.The department of chemistry and chemical biology at Harvard, where Dr. Lieber was chair. He is on leave from the university.Katherine Taylor/ReutersDr. Lieber’s lawyer, Marc Mukasey, argued in court that the government could not prove the false statements charges because the two interviews in question, in 2018 and 2019, were neither taped nor precisely transcribed.“That day almost two years ago when the F.B.I. raided Charlie’s home and office, they turned off one of the leading lights in the world of science,” he said in an opening statement, referring to Dr. Lieber’s 2020 arrest.A guilty verdict requires “proof beyond a reasonable doubt, and the government simply doesn’t have it,” he added. “If there was a Nobel Prize for inventing something out of nothing, the government’s case would win.”Conviction on a false statement charge could bring a sentence of up to five years in prison.Among the researchers under federal prosecution as part of the China Initiative, Dr. Lieber is by far the most prominent. Celebrated in the world of chemistry, he served as chair of Harvard’s department of chemistry and chemical biology and was seen by many in the field as a potential Nobel winner.Every morning, a handful of Dr. Lieber’s colleagues have filed into the gallery in Boston’s federal courthouse to listen to testimony.Adam Cohen, a professor of chemistry, chemical biology and physics, who attended last week, called him “one of the best and most impactful chemists alive.”Brian Timko, who worked under Dr. Lieber as a graduate student and now heads his own laboratory at Tufts University, said Dr. Leiber had invented electronic chips so small and flexible that they could be injected into parts of the human body, like the brain or the retina.Eventually, he said, the technology could lead to breakthroughs in bioelectronic medicine, like restoring sight to blind people or movement to paralyzed limbs.“I was especially devastated this week just by the way all of Charlie’s accomplishments, his altruistic accomplishments, were twisted,” Dr. Timko said. “Charlie spent his whole career trying to help the world, and a handful of individuals who don’t even understand how science works tore the whole thing down. And that is just not fair.”Mr. Mukasey, Dr. Lieber’s lawyer, tried during the trial to shift the focus toward the importance of Dr. Lieber’s work, asking one government witness to read aloud the paragraph of his curriculum vitae that lists 23 prizes he has won, among them the Welch Award in Chemistry, the John Gamble Kirkwood Award and the Von Hippel Award.‘These people want to use me’Dr. Lieber in 2002. He studies nanotechnologies and has pursued commercial nanotechnology projects outside of his work at Harvard. He was considered a contender for a Nobel Prize in chemistry.Volker Steger/Science SourceIt is standard for high-level academic researchers to enter into contracts with outside employers, either consulting with private-sector firms or maintaining affiliations at universities in other countries.In 2011, Dr. Lieber started a joint venture with Wuhan University, where one of his former students had taken a post.A three-year contract emailed to Dr. Lieber in 2012, and displayed to the jury by prosecutors, made him a “One Thousand Talent High Level Foreign Expert,” entitling him to $50,000 a month, plus about $150,000 in living expenses and more than $1.5 million for a laboratory, which they called the WUT-Harvard Joint Nano Key Laboratory.Mr. Mukasey has argued that the document proves nothing about payments or Dr. Lieber’s status, comparing it to a congratulatory letter from Publishers Clearing House.Dr. Lieber, who has been on paid administrative leave from Harvard since his arrest in 2020, told the F.B.I. that he received a smaller amount, with between $50,000 and $100,000 paid in cash and another portion deposited into a bank account in China, which at one time contained about $200,000, but which he said he had never touched.Emails read at trial trace the deterioration of Dr. Lieber’s relationship with his colleagues in Wuhan. In one email, Dr. Lieber complained to a colleague that his partners there were pressuring him to credit their grants in his published work.He was also upset when Wuhan University nominated him as a member the Chinese Academy of Sciences, but he was not elected, an outcome he described in an email as “an insult to me and all that I’ve done for Chinese scientists.” (He was elected later, in 2015.)“I definitely do not have a good taste” about “many ‘friends’ in China,” Dr. Lieber wrote in an email to a Chinese colleague at another institution. “These people want to use me, so we will not let that happen, versus me using them. But we’ll be ever so polite in the mean time.”To make things worse, Harvard administrators had discovered that the Wuhan institution was using the Harvard’s name on its nanotechnology laboratory without permission.By 2018, the Wuhan arrangement had become a serious problem for Dr. Lieber. Investigators from the Department of Defense and the National Institutes of Health approached Dr. Lieber to ask if he had participated in the Thousand Talents program.“They are threatening not only to end my funding (which supports much of my research) but also force me to pay back the last three plus years they supported much of my work,” he wrote to a Chinese colleague, adding, “perhaps someone (Chinese) who does not like me brought this to attention of N.I.H.?”Since 2008, Dr. Lieber’s lab had received research grants totaling $18 million from the Department of Defense and the National Institutes of Health, court documents show.This year, the Justice Department has dropped cases against five researchers accused of hiding ties to the Chinese military, and one case, which reached the trial stage, ended in acquittal.Stefani Reynolds for The New York TimesDr. Lieber had said little to investigators until 6:30 a.m. on Jan. 28, 2020, when two F.B.I. agents arrested and handcuffed him at his office in Cambridge.After initially asking for a lawyer, he went on to answer the agents’ questions for about three hours.At first, according to a video clip shown in court, he suggested the charges may have been based on a mix-up, because he had written a paper with a former student who “had Thousand Talents funding, which is a big no-no.”He also told them he had never received payment from Wuhan University aside from travel expenses and had not qualified for the Thousand Talents grant because it required spending extended time in China.Then the agents produced a series of documents, including contracts from 2011 and 2012, and Dr. Lieber examined them, remarking at one point, “I should pay more attention to what I’m signing.”“That’s pretty damning,” he said. “Now that you bring it up, yes, I do remember.”He went on to offer detail about his financial arrangements with Wuhan University: A portion of his salary was deposited in a Chinese bank account and the remainder was paid in $100 bills, which he carried home in his luggage.He said his involvement with the university had ended by 2016 but acknowledged he had not been forthcoming when approached by the Defense Department two years later.“I was scared of being arrested, like I am now,” he said.At moments in the interview, Dr. Lieber was reflective about the role of international funding in the lives of researchers, saying that relationships with foreign partners were never as straightforward as they seemed at first.“Early on, if someone said, ‘We’ll give you this title and we’ll pay your travel to and from,’ you don’t think anything about it,” he explained, “but partners “always want something from you.”“A lot of countries, money is what they have in excess,” he said.He tried to impress on the two special agents that a different motive, the desire for acclaim, had brought him to partner with Wuhan and train scientists there. “I was younger and stupid,” he said. “I want to be recognized for what I’ve done. Everyone wants to be recognized.” He offered a comparison he had given his son, a high school wrestler. The Nobel Prize is “kind of like an Olympic gold medal — it’s very, very rare,” he said.A prize he had won recently was more like a bronze medal, he said with a self-deprecating laugh. “That probably is the underlying reason I did this,” he said.