Well: Getting the Right Addiction Treatment

“Treatment is not a prerequisite to surviving addiction.” This bold statement opens the treatment chapter in a helpful new book, “Now What? An Insider’s Guide to Addiction and Recovery,” by William Cope Moyers, a man who nonetheless needed “four intense treatment experiences over five years” before he broke free of alcohol and drugs.

As the son of Judith and Bill Moyers, successful parents who watched helplessly during a 15-year pursuit of oblivion through alcohol and drugs, William Moyers said his near-fatal battle with addiction demonstrates that this “illness of the mind, body and spirit” has no respect for status or opportunity.

“My parents raised me to become anything I wanted, but when it came to this chronic incurable illness, I couldn’t get on top of it by myself,” he said in an interview.

He finally emerged from his drug-induced nadir when he gave up “trying to do it my way” and instead listened to professional therapists and assumed responsibility for his behavior. For the last “18 years and four months, one day at a time,” he said, he has lived drug-free.

“Treatment is not the end, it’s the beginning,” he said. “My problem was not drinking or drugs. My problem was learning how to live life without drinking or drugs.”

Mr. Moyers acknowledges that treatment is not a magic bullet. Even after a monthlong stay at a highly reputable treatment center like Hazelden in Center City, Minn., where Mr. Moyers is a vice president of public affairs and community relations, the probability of remaining sober and clean a year later is only about 55 percent.

“Be wary of any program that claims a 100 percent success rate,” Mr. Moyers warned. “There is no such thing.”

“Treatment works to make recovery possible. But recovery is also possible without treatment,” Mr. Moyers said. “There’s no one-size-fits-all approach. What I needed and what worked for me isn’t necessarily what you or your loved one require.”

As with many smokers who must make multiple attempts to quit before finally overcoming an addiction to nicotine, people hooked on alcohol or drugs often must try and try again.

Nor does treatment have as good a chance at succeeding if it is forced upon a person who is not ready to recover. “Treatment does work, but only if the person wants it to,” Mr. Moyers said.

Routes to Success

For those who need a structured program, Mr. Moyers described what to consider to maximize the chances of overcoming addiction to alcohol or drugs.

Most important is to get a thorough assessment before deciding where to go for help. Do you or your loved one meet the criteria for substance dependence? Are there “co-occurring mental illnesses, traumatic or physical disabilities, socioeconomic influences, cultural issues, or family dynamics” that may be complicating the addiction and that can sabotage treatment success?

While most reputable treatment centers do a full assessment before admitting someone, it is important to know if the center or clinic provides the services of professionals who can address any underlying issues revealed by the assessment. For example, if needed, is a psychiatrist or other medical doctor available who could provide therapy and prescribe medication?

Is there a social worker on staff to address challenging family, occupational or other living problems? If a recovering addict goes home to the same problems that precipitated the dependence on alcohol or drugs, the chances of remaining sober or drug-free are greatly reduced.

Is there a program for family members who can participate with the addict in learning the essentials of recovery and how to prepare for the return home once treatment ends?

Finally, does the program offer aftercare and follow-up services? Addiction is now recognized to be a chronic illness that lurks indefinitely within an addict in recovery. As with other chronic ailments, like diabetes or hypertension, lasting control requires hard work and diligence. One slip need not result in a return to abuse, and a good program will help addicts who have completed treatment cope effectively with future challenges to their recovery.

How Families Can Help

“Addiction is a family illness,” Mr. Moyers wrote. Families suffer when someone they love descends into the purgatory of addiction. But contrary to the belief that families should cut off contact with addicts and allow them to reach “rock-bottom” before they can begin recovery, Mr. Moyers said that the bottom is sometimes death.

“It is a dangerous, though popular, misconception that a sick addict can only quit using and start to get well when he ‘hits bottom,’ that is, reaches a point at which he is desperate enough to willingly accept help,” Mr. Moyers wrote.

Rather, he urged families to remain engaged, to keep open the lines of communication and regularly remind the addict of their love and willingness to help if and when help is wanted. But, he added, families must also set firm boundaries — no money, no car, nothing that can be quickly converted into the substance of abuse.

Whether or not the addict ever gets well, Mr. Moyers said, “families have to take care of themselves. They can’t let the addict walk over their lives.”

Sometimes families or friends of an addict decide to do an intervention, confronting the addict with what they see happening and urging the person to seek help, often providing possible therapeutic contacts.

“An intervention can be the key that interrupts the process and enables the addict to recognize the extent of their illness and the need to take responsibility for their behavior,”Mr. Moyers said.

But for an intervention to work, Mr. Moyers said, “the sick person should not be belittled or demeaned.” He also cautioned families to “avoid threats.” He noted that the mind of “the desperate, fearful addict” is subsumed by drugs and alcohol that strip it of logic, empathy and understanding. It “can’t process your threat any better than it can a tearful, emotional plea.”

Resource Network

Mr. Moyer’s book lists nearly two dozen sources of help for addicts and their families. Among them:

Alcoholics Anonymous World Services www.aa.org;

Narcotics Anonymous World Services www.na.org;

Substance Abuse and Mental Health Services Administration treatment finder www.samhsa.gov/treatment/;

Al-Anon Family Groups www.Al-anon.alateen.org;

Nar-Anon Family Groups www.nar-anon.org;

Co-Dependents Anonymous World Fellowship www.coda.org.

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This is the second of two articles on addiction treatment. The first can be found here.

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Media Decoder Blog: NPR Campaign Seeks the Quirky Listener

Are you a sky diving algebra teacher? A Sudoku-playing barista? NPR has a new ad campaign aimed at you.

The pilot campaign, in four cities, is intended to bring new listeners to local public radio stations, and in turn NPR’s national programs, by matching a show to even the quirkiest interests.

The three-month campaign, financed with a $750,000 grant from the Ford Foundation and developed by Baltimore agency Planit, includes billboards, as well as television spots, social media outreach and rail, print and digital ads aimed at adults 25 to 54, with at least some college education. Ads point to a Web site, interestingradio.com, where visitors can take a poll, discover shows and click through to a live stream from a local station.

The ads will run in the Dallas/Fort Worth, San Diego, Indianapolis and Orlando, Fla., markets, chosen because they offer geographic diversity, as well as stations that are strong and growing, said Emma Carrasco, who joined NPR two months ago as chief marketing officer, a new position.

The campaign comes as listenership for “Morning Edition” and “All Things Considered” — NPR’s two top programs and the radio news programs that reach the most people nationwide each week — declined from spring 2011 to spring 2012, the last period for which national ratings are available.

Year-to-year, the cumulative weekday audience for “Morning Edition” declined 5 percent to 12.3 million listeners a week, from 13 million, NPR officials said, citing Arbitron ratings figures, while “All Things Considered” was off 4 percent, to 11.8 million weekly listeners, compared with 12.3 million in spring 2011.

Preliminary fall 2012 estimates showed year-to-year audience increases for those two shows, NPR said, but the figures were for major markets only.

Local public radio stations have undertaken similar efforts in recent years. WQXR’s modest 2011 “Obeythoven” campaign used TV spots to get audiences thinking about New York City classical music radio in a new way. Chicago’s WBEZ this month began a cheeky campaign called “2032 Membership Drive” encouraging audiences to procreate and raise a new generation of listeners.

If NPR’s new ads are deemed successful, NPR will seek additional funds to expand them to more markets, Ms. Carrasco said.

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Michigan, Kansas go down as run continues

There goes another one, and another one.

No. 3 Michigan, fifth-ranked Kansas and No. 11 Louisville all lost on Saturday, continuing a perilous stretch for the Top 25.

The Wolverines became the third top-three team to fall this week when Ben Brust hit a tiebreaking 3-pointer with less than 40 seconds left in overtime, leading Wisconsin to a 65-62 victory. Brust also tied the game at the end of regulation with a heave from just inside halfcourt.

That's just the way it has gone lately for the top of the poll.

No. 2 Florida lost at Arkansas on Tuesday night, and No. 1 Indiana dropped a 74-72 decision at Illinois on Thursday. This should be the sixth straight week with a different No. 1 in The Associated Press' Top 25, which would be the second-longest streak since the first AP poll in 1949.

The Jayhawks have dropped three straight games for the first time in eight years after they lost 72-66 at Oklahoma.

"It hasn't been a good week for us by any stretch, but let's be real," Kansas coach Bill Self said. "We were ranked No. 2 in the country seven days ago, and you don't go from being a good team to a bad team overnight.

"We've had a couple of bad outings, but we're still a good team."

The current string of No. 1 swapping is the longest since 1994, when Arkansas, North Carolina, Kansas, UCLA and Duke alternated at the top seven straight weeks — the longest streak since Saint Louis debuted as No. 1 in the initial AP poll.

But it isn't just the teams at the top that are having trouble. Top 25 teams all over the country are getting knocked off by unranked opponents.

According to STATS LLC, Top 25 teams lost to unranked teams 36 times from Jan. 17 to Feb. 6 this season, most in at least 17 years.

Louisville lost 104-101 in five overtimes at No. 25 Notre Dame on Saturday night. It was the longest regular-season game in Big East history.

The Irish trailed by eight with 46 seconds left in regulation.

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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

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Boeing 787 Completes Test Flight

A Boeing 787 test plane flew for more than two hours on Saturday to gather information about the problems with the batteries that led to a worldwide grounding of the new jets more than three weeks ago.

The flight was the first since the Federal Aviation Administration gave Boeing permission on Thursday to conduct in-flight tests. Federal investigators and the company are trying to determine what caused one of the new lithium-ion batteries to catch fire and how to fix the problems.

The plane took off from Boeing Field in Seattle heading mostly east and then looped around to the south before flying back past the airport to the west. It covered about 900 miles and landed at 2:51 p.m. Pacific time.

Marc R. Birtel, a Boeing spokesman, said the flight was conducted to monitor the performance of the plane’s batteries. He said the crew, which included 13 pilots and test personnel, said the flight was uneventful.

He said special equipment let the crew check status messages involving the batteries and their chargers, as well as data about battery temperature and voltage.

FlightAware, an aviation data provider, said the jet reached 36,000 feet. Its speed ranged from 435 to 626 miles per hour.

All 50 of the 787s delivered so far were grounded after a battery on one of the jets caught fire at a Boston airport on Jan. 7 and another made an emergency landing in Japan with smoke coming from the battery.

The new 787s are the most technically advanced commercial airplanes, and Boeing has a lot riding on their success. Half of the planes’ structural parts are made of lightweight carbon composites to save fuel.

Boeing also decided to switch from conventional nickel cadmium batteries to the lighter lithium-ion ones. But they are more volatile, and federal investigators said Thursday that Boeing had underestimated the risks.

The F.A.A. has set strict operating conditions on the test flights. The flights are expected to resume early this week, Mr. Birtel said.

Battery experts have said it could take weeks for Boeing to fix the problems.

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India Executes Man Tied to 2001 Attack on Parliament

MUMBAI - India on Saturday on Saturday hanged a man who was convicted of an attack on India’s Parliament in 2001 that killed nine people.

The hanging of Afzal Guru, a 43-year-old militant with the group Jaish-e-Mohammad, comes more than a decade after the Dec. 13, 2001, suicide attack on India’s parliament in which five gunmen opened fire, killing nine people, including security officials and one journalist. The execution drew protests from human rights groups concerned about the growing use of capital punishment in such cases.

Mr. Guru was convicted of conspiracy in the plot and sentenced to death by a special court in 2002. In 2004, the Supreme Court of India upheld the call for death sentence.

After the execution, clashes broke out in Mr. Guru’s hometown of Sopore, and police and paramilitary units were called to the scene to restore order.Days before the execution, President Pranab Mukherjee had rejected a mercy plea by Mr. Guru’s wife, according to reports from the Press Trust of India, paving the way for Mr. Guru’s hanging in the Tihar Jail complex, officials said.

Mr. Guru was originally from Sopore, in the northern part of the Kashmir. The clashes following his execution came despite the fact that in the hours following the hanging the Kashmir valley was placed under strict curfew in the anticipation of trouble from separatist leaders, according to reports. Authorities in the Srinagar asked citizens to remain indoors. They also closed the national highway for one day.

Omar Abdullah, the Jammu and Kashmir chief minister, appealed for peace and calm.

“I understand there is certain degree of angst and there are some people who would like to take advantage of the situation,” Mr. Abdullah said. “I appeal to the people to allow us to get through this with peace and not to restore to violent protests.”

Congress Party officials said that the execution was a sign that India would not tolerate acts of terror.

“We have sent a message to the world that we cannot tolerate terrorism at any cost. Anybody committing any acts of terror will be punished,” said Rashid Alvi, a Congress Party spokesman. “People of our country and government have zero tolerance for terrorism.”

But the opposition Bharatiya Janta Party criticized the government’s delay in carrying out the execution.

“The attack on the Indian Parliament happened in 2001, that is 12 years ago, which was an attack on India,” said Ravi Shankar Prasad, the Bharatiya Janta Party spokesman.

On Nov. 21, 2012, India hanged Ajmal Kasab, the sole surviving gunman from the November 2008 terror attacks in Mumbai, ending an eight-year moratorium on the death penalty and drawing criticism from rights groups, which they reiterated Saturday.

“The hanging of Afzal Guru, following closely behind the hanging of Ajmal Kasab in November, shows a very worrying trend by the Indian government,” said Meenakshi Ganguly, South Asia director for Human Rights Watch. “Human Rights Watch opposes the death penalty in all circumstances as an inherently irreversible, inhumane punishment.”

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Northeast storm disrupts travel for sports teams

Several professional and college sports teams were forced to rearrange their travel plans as a massive storm swept through the Northeast, dumping a few feet of snow in some areas.

The NBA's New York Knicks were stuck in Minnesota after playing the Timberwolves on Friday night, hoping to try to fly home sometime Saturday. The San Antonio Spurs were also staying overnight in Detroit after seeing their 11-game winning streak fall to the Pistons, awaiting word on when they might be able to fly to New York for their game Sunday night at Brooklyn.

"We can't get there tonight — we know that," Spurs coach Gregg Popovich said. "So we're going to stay here tonight and try to get there (Saturday). Hopefully, we will be able to get there, but at this point, we don't know."

Airlines canceled more than 5,300 flights through Saturday, and New York City's three major airports and Boston's Logan Airport closed.

The Brooklyn Nets planned to take a train home instead of flying from Washington D.C. after losing to the Wizards on Friday night.

Knicks coach Mike Woodson said before a 100-94 victory that his team initially planned to fly home after the game, but the flight had already been postponed. New York is scheduled to play the Los Angeles Clippers at Madison Square Garden on Sunday.

The NHL's Boston Bruins pushed back the start of Saturday's game against the Tampa Bay Lightning by six hours because of the blizzard. The game originally slated for 1 p.m. was rescheduled for 7 p.m., but Boston was expected to be one of the cities hit hardest by the storm.

The storm had dumped more than 2 feet of snow on New England by early Saturday and knocked out power to 650,000 customers. The National Weather Service said up to 3 feet of snow is expected in Boston, threatening the city's 2003 record of 27.6 inches.

The Bruins and Lightning each already had road games scheduled for Sunday night.

The New Jersey Devils were still scheduled to host the Pittsburgh Penguins at 1 p.m., while the New York Islanders were slated to play at home against the Buffalo Sabres at 7 p.m.

Two Ivy League men's college basketball games that were scheduled for Saturday night were moved back to Sunday because of treacherous travel conditions.

Dartmouth will play at Cornell at noon on Sunday in Ithaca, N.Y., and Harvard will visit Columbia at 2 p.m. Sunday in New York. Dartmouth played at Columbia on Friday night, and Harvard played at Cornell. Two other Ivy League games were still scheduled to be played Saturday night, with Yale visiting Princeton and Brown playing at Pennsylvania.

Aqueduct also called off Saturday's card because of the storm. The track and Belmont Park were expected to remain open for wagering on out-of-town races, with racing scheduled to resume Sunday.

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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John E. Karlin, 1918-2013: John E. Karlin, Who Led the Way to All-Digit Dialing, Dies at 94

Courtesy of Alcatel-Lucent USA

John E. Karlin, a researcher at Bell Labs, studied ways to make the telephone easier to use.

A generation ago, when the poetry of PEnnsylvania and BUtterfield was about to give way to telephone numbers in unpoetic strings, a critical question arose: Would people be able to remember all seven digits long enough to dial them?

And when, not long afterward, the dial gave way to push buttons, new questions arose: round buttons, or square? How big should they be? Most crucially, how should they be arrayed? In a circle? A rectangle? An arc?

For decades after World War II, these questions were studied by a group of social scientists and engineers in New Jersey led by one man, a Bell Labs industrial psychologist named John E. Karlin.

By all accounts a modest man despite his variegated accomplishments (he had a doctorate in mathematical psychology, was trained in electrical engineering and had been a professional violinist), Mr. Karlin, who died on Jan. 28, at 94, was virtually unknown to the general public.

But his research, along with that of his subordinates, quietly yet emphatically defined the experience of using the telephone in the mid-20th century and afterward, from ushering in all-digit dialing to casting the shape of the keypad on touch-tone phones. And that keypad, in turn, would inform the design of a spate of other everyday objects.

It is not so much that Mr. Karlin trained midcentury Americans how to use the telephone. It is, rather, that by studying the psychological capabilities and limitations of ordinary people, he trained the telephone, then a rapidly proliferating but still fairly novel technology, to assume optimal form for use by midcentury Americans.

“He was the one who introduced the notion that behavioral sciences could answer some questions about telephone design,” Ed Israelski, an engineer who worked under Mr. Karlin at Bell Labs in the 1970s, said in a telephone interview on Wednesday.

In 2013, the 50th anniversary of the introduction of the touch-tone phone, the answers to those questions remain palpable at the press of a button. The rectangular design of the keypad, the shape of its buttons and the position of the numbers — with “1-2-3” on the top row instead of the bottom, as on a calculator — all sprang from empirical research conducted or overseen by Mr. Karlin.

The legacy of that research now extends far beyond the telephone: the keypad design Mr. Karlin shepherded into being has become the international standard on objects as diverse as A.T.M.’s, gas pumps, door locks, vending machines and medical equipment.

Mr. Karlin, associated from 1945 until his retirement in 1977 with Bell Labs, headquartered in Murray Hill, N.J., was widely considered the father of human-factors engineering in American industry.

A branch of industrial psychology that combines experimentation, engineering and product design, human-factors engineering is concerned with easing the awkward, often ill-considered marriage between man and machine. In seeking to design and improve technology based on what its users are mentally capable of, the discipline is the cognitive counterpart of ergonomics.

“Human-factors studies are different from market research and other kinds of studies in that we observe people’s behavior and record it, systematically and without bias,” Mr. Israelski said. “The hallmark of human-factors studies is they involve the actual observation of people doing things.”

Among the issues Mr. Karlin examined as the head of Bell Labs’ Human Factors Engineering department — the first department of its kind at an American company — were the optimal length for a phone cord (a study that involved gentle, successful sabotage) and the means by which rotary calls could be made efficiently after the numbers were moved from inside the finger holes, where they had nestled companionably for years, to the rim outside the dial.

John Elias Karlin was born in Johannesburg on Feb. 28, 1918, and reared nearby in Germiston, where his parents owned a grocery store and tearoom.

He earned a bachelor’s degree in philosophy, psychology and music, and a master’s degree in psychology, both from the University of Cape Town. Throughout his studies he was a violinist in the Cape Town Symphony Orchestra and the Cape Town String Quartet.

Moving to the United States, Mr. Karlin earned a Ph.D. from the University of Chicago in 1942. Afterward, he became a research associate at Harvard; he also studied electrical engineering there and at the Massachusetts Institute of Technology.

At Harvard, Mr. Karlin did research for the United States military on problems in psychoacoustics that were vital to the war effort — studying the ways, for instance, in which a bomber’s engine noise might distract its crew from their duties.

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Tunisians Prepare for Burial of Slain Opposition Leader

TUNIS — In a country quieted by the largest labor strike in decades, thousands of people started to gather early Friday for the funeral of Chokri Belaid, a leading opposition figure assassinated by unknown gunmen two days ago. 

The killing of Mr. Belaid, a human rights activist who had been a harsh critic of the ruling Islamist-led party, has led to fears that polarization and growing political violence will imperil Tunisia’s transition, often held up as a model in the region.

“We are steadfast, like mountains,” mourners chanted in the Jebel Jalloud neighborhood, where they gathered the rain in preparing to march to the city’s largest cemetery.  “We do not fear assassination.”

A steady stream of supporters also traveled to Mr. Belaid’s home, where a circle of flowers and other mementos marked the spot where he was killed, raising fears of a broader conflagration.

  “I’m afraid the country will descend into chaos,” said Nuzha ben Yayha, a mourner who came to pay her respects.

The country’s labor federation called the first general strike in more than three decades for Friday to coincide with the burial, adding to a combustible mix of passions just two years after the overthrow of President Zine el Abidine Ben Ali in early 2011 signaled the beginning of the Arab revolts sweeping the region.

The official TAP news agency said the national Army had been ordered to “secure” Mr. Belaid’s funeral “and ensure the protection of participants” while the trade union federation had called for a “peaceful” general strike “in order not to serve the objectives of Tunisia’s enemies who had planned Chokri Belaid’s assassination.”

The embassy of France, the former colonial power, said on its Web site that it would close its schools in the capital on Friday and Saturday for fear of renewed outbursts of violence.

On Thursday, protesters clashed with riot police officers in several cities. In Tunis, shuttered stores, tear gas and running street battles recreated the atmosphere of that uprising against former President Ben Ali but with none of the hope. Instead, many worried about a growing instability following the killing.

Adding to the uncertainties, Tunisia’s governing Islamist-led party on Thursday rejected a proposal by the prime minister to form a national unity government.

The announcement by the party, Ennahda, revealed growing strains within a movement that has promoted its blend of Islamist politics and pluralism as a model for the region. As it rejected the proposal by the prime minister, Hamadi Jebali, a member of Ennahda, the group also publicly rebuked one of its most senior leaders and rejected his efforts to calm the political crisis.

“The prime minister did not ask the opinion of his party,” Abdelhamid Jelassi, Ennahda’s vice president, said in a statement reported on the party’s Web site that rejected the proposal to replace the government with technocrats not affiliated with any party. “We in Ennahda believe Tunisia needs a political government now. We will continue discussions with other parties about forming a coalition government.”

The troubles in Tunisia unsettled the region and endangered a country that was credited with avoiding the chaos plaguing some its neighbors. In the same way some had held up Tunisia’s transition as an example, politicians in the region studied Mr. Belaid’s assassination and saw a broader warning.

Mr. Belaid’s death was seen as a blow to the country’s turbulent transition, raising the possibility that the political violence in Tunisia had reached a dangerous new level.

In the southern mining city of Gafsa, riots broke out and the police fired tear gas at demonstrators who threw stones, a local radio station reported. The city is known as a powerful base of support for Mr. Belaid, who was a fierce advocate for the miners.

A regional headquarters of Ennahda was burned down in the town of Siliana, according to local news media, one of more than a dozen party offices attacked by protesters in the last two days.

In one of the most disturbing aspects of the situation, Mr. Belaid had himself warned just before his death about Tunisia’s troubling turn toward violence and called for a national dialogue to combat it. He took special aim at Ennahda, accusing the Islamist group of turning a blind eye to crimes perpetrated by hard-line Islamists known as Salafis, including attacking Sufi shrines and liquor stores.

There have been no arrests in the killing, and no suspect has been identified. The governing party has condemned the assassination. Anxiety about the assassination reverberated in Egypt, where political feuds have been eclipsed by street clashes between protesters and the riot police. Security officials said plainclothes guards had been assigned to guard the homes of prominent opponents of Egypt’s Islamist-dominated government. The worries were amplified because of a fatwa issued by a hard-line Egyptian cleric saying that opponents of President Mohamed Morsi should be killed. The fatwa specifically mentioned Mohamed ElBaradei, a former United Nations diplomat and leader of Egypt’s largest secular-leaning opposition bloc, which led him to request the protection.

“Regime silent as another fatwa gives license to kill opposition in the name of Islam,” Mr. ElBaradei wrote in a Twitter message. “Religion yet again used and abused.”

On Thursday, Mr. Morsi addressed the issue in a speech, saying that political violence “has become one of the most important challenges that face the Arab Spring revolutions.”

In what seemed to be a direct challenge to religious hard-liners — as well as an attempt to avoid the criticism directed at Ennahda — he condemned those “who claim to speak for religion” and who “permit killing based on political differences.”

“This is terrorism itself,” he said.

Kareem Fahim reported from Tunis, David D. Kirkpatrick from Antakya, Turkey, and Alan Cowell from Paris. Monica Marks contributed reporting from Tunis, and Rick Gladstone from New York.

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