This is a great winter seafood stew adapted from a much richer recipe by Mark Peel, executive chef of Campanile Restaurant in Los Angeles. It’s easy to make and easy to serve.

Each week this series will present recipes around a particular type of produce or a pantry item. This is food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and a pleasure to eat.

1/2 pound kale, collards or other greens, stemmed and washed in two or three changes of water

2 tablespoons extra virgin olive oil

4 pounds medium-sized clams or mussels (or use a mixture of the two), purged

1 large shallot, finely chopped

3 large garlic cloves, sliced

1/2 cup dry white wine

A few sprigs each parsley and thyme

Salt and freshly ground pepper

1 15-ounce can white beans, drained and rinsed

1 cup chicken stock

1 tablespoon chopped fresh parsley

1. Bring a large pot of water to a boil. Fill a bowl with ice water. When the water in the pot comes to a boil, salt generously and add the greens. Cook for one to three minutes (depending on the type of green) until just tender. Transfer to the ice water. Allow to cool for a few minutes, then drain, squeeze dry and chop. Set aside.

2. Cook the clams or mussels in batches. In a large, lidded pan over medium heat, combine 1 tablespoon of the shallots, one garlic clove, the wine, parsley and thyme sprigs and half the clams or mussels. Bring to a boil, cover and cook about four minutes until they just open. Remove from the pan using tongs, and place in a bowl. Repeat with the remaining clams or mussels. When the seafood is cool enough to handle, remove from the shells, holding the shells over the bowl to catch their juice. Rinse briefly in case there is any lingering sand. Cut the clams in half if they’re large. Strain the liquid in the pan through a cheesecloth-lined strainer into a small bowl, and set aside.

3. Return the pan to medium heat, and add 1 tablespoon of olive oil. Add the remaining shallots and garlic and salt to taste. Cook gently for three to four minutes until the shallots are tender. Add the remaining tablespoon of olive oil and the chopped blanched greens. Cook, stirring over medium heat, for five minutes. Slowly pour the strained seafood juice into the pan, then add the beans and chicken stock. Bring to a simmer. Simmer five to 10 minutes. The greens should be very tender. Stir in the seafood, add several twists of the pepper mill, taste and adjust salt. Heat through and serve.

Yield: Serves four to six.

Advance preparation: You could make this through step 2 several hours ahead of serving and refrigerate the cooked seafood. Shortly before serving proceed with step 3.

Martha Rose Shulman can be reached at martha-rose-shulman.com.

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For years, a prevailing theory has been that one of the chief villains in Alzheimer’s disease has no real function other than as a waste product that the brain never properly disposed of.

COMMON VILLAIN Bacteria being attacked by beta amyloid, in this image enlarged 18,500 times.

The material, a protein called beta amyloid, or A-beta, piles up into tough plaques that destroy signals between nerves. When that happens, people lose their memory, their personality changes and they stop recognizing friends and family.

But now researchers at Harvard suggest that the protein has a real and unexpected function — it may be part of the brain’s normal defenses against invading bacteria and other microbes.

Other Alzheimer’s researchers say the findings, reported in the current issue of the journal PLoS One, are intriguing, though it is not clear whether they will lead to new ways of preventing or treating the disease.

The new hypothesis got its start late one Friday evening in the summer of 2007 in a laboratory at Harvard Medical School. The lead researcher, Rudolph E. Tanzi, a neurology professor who is also director of the genetics and aging unit at Massachusetts General Hospital, said he had been looking at a list of genes that seemed to be associated with Alzheimer’s disease.

To his surprise, many looked just like genes associated with the so-called innate immune system, a set of proteins the body uses to fight infections. The system is particularly important in the brain, because antibodies cannot get through the blood-brain barrier, the membrane that protects the brain. When the brain is infected, it relies on the innate immune system to protect it.

That evening, after the lab’s usual end-of-the-week beer hour, Dr. Tanzi wandered into the office of a junior faculty member, Robert D. Moir, and mentioned what he had seen. As Dr. Tanzi recalled, Dr. Moir turned to him and said, “Yeah, well, look at this.”

He handed Dr. Tanzi a spreadsheet. It was a comparison of A-beta and a well-known protein of the innate immune system, LL-37. The likenesses were uncanny.

Among other things, the two proteins had similar structures. And like A-beta, LL-37 tends to clump into hard little balls.

In rodents, the protein that corresponds to LL-37 protects against brain infections. People who make low levels of LL-37 are at increased risk of serious infections and have higher levels of atherosclerotic plaques, arterial growths that impede blood flow.

The scientists could hardly wait to see if A-beta, like LL-37, killed microbes. They mixed A-beta with microbes that LL-37 is known to kill — listeria, staphylococcus, pseudomonas. It killed 8 out of 12.

“We did the assays exactly as they have been done for years,” Dr. Tanzi said. “And A-beta was as potent or, in some cases, more potent than LL-37.”

Then the investigators exposed the yeast Candida albicans, a major cause of meningitis, to tissue from the hippocampal regions of brains from people who had died of Alzheimer’s and from people of the same age who did not have dementia when they died.

Brain samples from Alzheimer’s patients were 24 percent more active in killing the bacteria. But if the samples were first treated with an antibody that blocked A-beta, they were no better than brain tissue from nondemented people in killing the yeast.

The innate immune system is also set in motion by traumatic brain injuries and strokes and by atherosclerosis that causes reduced blood flow to the brain, Dr. Tanzi noted.

And the system is spurred by inflammation. It is known that patients with Alzheimer’s disease have inflamed brains, but it has not been clear whether A-beta accumulation was a cause or an effect of the inflammation. Perhaps, Dr. Tanzi said, A-beta levels rise as a result of the innate immune system’s response to inflammation; it may be a way the brain responds to a perceived infection.

But does that mean Alzheimer’s disease is caused by an overly exuberant brain response to an infection?

That’s one possible reason, along with responses to injuries and inflammation and the effects of genes that cause A-beta levels to be higher than normal, Dr. Tanzi said. However, some researchers say that all the pieces of the A-beta innate immune systems hypothesis are not in place.

Dr. Norman Relkin, director of the memory disorders program at NewYork-Presbyterian/Weill Cornell hospital, said that although the idea was “unquestionably fascinating,” the evidence for it was “a bit tenuous.”

As for the link with infections, Dr. Steven T. DeKosky, an Alzheimer’s researcher who is vice president and dean of the University of Virginia School of Medicine, noted that scientists have long looked for evidence linking infections to Alzheimer’s and have come up mostly empty-handed.

But if Dr. Tanzi is correct about A-beta being part of the innate immune system, that would raise questions about the search for treatments to eliminate the protein from the brain.

“It means you don’t want to hit A-beta with a sledgehammer,” Dr. Tanzi said. “It says what we need is the equivalent of a statin for the brain so you can dial it down but not turn it off.” (Dr. Tanzi is a co-founder of two companies, Prana Biotechnology and Neurogenetic Pharmaceutical, that are trying to dial down A-beta.)

Dr. Relkin said that even if A-beta were not part of the innate immune system, it might not be a good idea to remove it all, along with the hard balls of plaque it makes in the brain.

In the past, Dr. Relkin said, scientists assumed “that the pathology was the plaque.” Now, he likens removing plaque to digging up bullets at the Gettysburg battlefield.

The more bullets in an area, the more intense the fighting was. But “digging up bullets will not change the outcome of the battle,” he said. “Most of us don’t believe that removing plaque from the brain is the end-all.”

But other scientists not connected with the discovery said they were impressed by the new findings.

“It changes our thinking about Alzheimer’s disease,” said Dr. Eliezer Masliah, who heads the experimental neuropathology laboratory at the University of California, San Diego. “I don’t think we ever thought about that possibility for A-beta.”

Dr. Masliah is intrigued by the idea that aggregates of A-beta may be killing bacteria and brain cells by the same mechanism. He noted that Dr. Tanzi had a track record of coming up with unusual ideas about Alzheimer’s disease that later turn out to be correct.

“I think he’s onto something important,” Dr. Masliah said.

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An unusual study done in 49 remote Hutterite farming colonies in western Canada has provided the surest proof yet that giving flu shots to schoolchildren protects a whole community from the disease.

Although previous studies have demonstrated what scientists call “herd immunity,” none have been so incontrovertible, because they were done in less isolated places with more sources of flu passing through. Also, only one other study, done 42 years ago, was able to immunize over 80 percent of a community’s children, as this one did. Success repeated in many separate communities with very high vaccination rates implies that the shots themselves — rather than luck, viral mutations, hand-washing or any other factor — were the crucial protective element.

The study, done by scientists from several Canadian universities and St. Jude’s Children’s Research Hospital in Tennessee, was paid for by the governments of Canada and the United States. It was published online Tuesday by the The Journal of the American Medical Association.

“This is quite a definitive study, and it took a Herculean effort,” said Dr. Carolyn B. Bridges, an expert in influenza epidemiology at the Centers for Disease Control and Prevention. “My hat’s off to them.”

Dr. Anthony S. Fauci, director of the National Institute for Allergy and Infectious Diseases, which supported the project, called it “a really nice study” and added that, even though it was done with seasonal flu shots in the 2008-2009 winter, its results validated the American government’s decision to vaccinate children first during the recent swine flu pandemic.

“Not only was that clearly needed to protect the kids, but they probably wound up protecting the older people too,” he said.

To do his unique study, the lead investigator, Dr. Mark Loeb of McMaster University in Ontario, made “literally hundreds of calls” to 187 different Hutterite communities in Alberta, Saskatchewan and Manitoba, asking them to join.

Like the Mennonites and the Amish, the Hutterites are descended from a 16th century Swiss Protestant sect. They believe in adult baptism, refuse military service, speak a German dialect and dress in homemade black jackets and long skirts.

“People from different groups can be identified by the size of the polka dots on their bonnets,” Dr. Loeb said.

Although they frown on television and radio, Hutterites drive cars and modern tractors. More important from a medical point of view, they live in communities of up to 160 people, own everything jointly, attend their own schools, eat in one dining hall and have little contact with the outside world.

Each community governs itself, but, in Dr. Loeb’s words, “after one very with-it Alberta bishop recognized the study’s benefit to the rest of the world and backed it,” almost 50 communities voted to participate.

Hutterites have no religious objections to Western medicine, that very “with-it” bishop, John K. Stahl, 76, said in a telephone interview. While deliberately cut off, they perform acts of generosity — for example, many donate blood frequently.

Some do not vaccinate their children, but not for religious reasons. “Some families are herb-minded rather than drug-minded,” Bishop Stahl explained.

In 25 of the colonies that joined, all children ages 3 to 15 got flu shots in late 2008; in 24 others, they got hepatitis A vaccine instead. (Hepatitis was not studied, but to keep the investigators from knowing which colonies got flu vaccine, they had to offer placebo shots, and hepatitis shots do some good while sterile water injections do not.)

By last June, more than 10 percent of all the adults and children in colonies that got the placebo had had laboratory-confirmed seasonal flu. Less than 5 percent of those in the colonies that got flu shots had.

There was a 60 percent “protective effect” for the whole community, the study concluded. It implies, Dr. Bridges said, that giving flu shots only to schoolchildren would protect the elderly just as well as giving flu shots to the elderly themselves. (Aged immune systems do not make antibodies to the vaccine very well.)

The C.D.C. would never recommend that, she cautioned, “because you still should vaccinate high-risk people.”

The previous landmark study in this field was done in 1968 in Tecumseh, Mich., by Dr. Arnold S. Monto, a flu expert still teaching at the University of Michigan School of Public Health.

Tecumseh, a town of 7,500, had long been part of a larger study similar to the well-known Framingham, Mass., heart study, when the 1968 Hong Kong flu broke out in Asia. Flu shots were then relatively rare, and Dr. Monto drove to Indianapolis to get hundreds of doses from Eli Lilly. His team vaccinated over 85 percent of Tecumseh’s students. (Almost none refused, he said, but high schoolers were not universally diligent about getting their parental permission slips signed.)

When flu season was over, Tecumseh had had only a third as many flu cases as nearby Adrian, Mich., which got no shots. There were far fewer cases of flu in all age groups, not just children.

Dr. Monto called Dr. Loeb’s study “very interesting.” Its persuasive power, he said, was that its results were consistent across many communities more isolated than Tecumseh ever was, sorted at random into placebo and vaccine groups and studied without the investigators being subconsciously biased by knowing which got placebo.

He was one of the experts Canada consulted about Dr. Loeb’s grant request, he said, “and I’m glad I told them this is a wonderful opportunity.”

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A unit of Johnson & Johnson, just months after saying it was phasing out an artificial hip implant because of slowing sales, has warned doctors that the device appears to have a high early failure rate in some patients.

A rendering of metallic debris caused by an improperly implanted hip, as shown in instructional material about the proper positioning of a hip socket, sent from DePuy to doctors.

The action by the company, DePuy Orthopaedics, follows more than two years of reports that the hip implant, which is known as the ASR, was failing in patients only a few years after implant, requiring costly and painful replacement operations.

Some orthopedic experts have voiced dismay in recent interviews that DePuy had not halted sales of the device earlier. And some specialists said that they believed the device had a design flaw that made it difficult to implant properly, a claim disputed by DePuy officials, who had said the product had no safety problems. The director of an implant database in Australia, Dr. Stephen Graves, said the data had shown for some time that the ASR had been failing early at a significantly higher rate than some competitors’ devices. In December, DePuy voluntarily withdrew the ASR from the Australian market.

DePuy, of Warsaw, Ind., also announced late last year that it planned to phase out sales of the product worldwide by the end of 2010.

“It is way too late,” Dr. Graves said.

While the ASR is not widely used in the United States, DePuy officials said recently that it had been implanted in thousands of patients worldwide.

In a letter dated March 6, DePuy told doctors that recently analyzed data from Australia suggested that the ASR had a higher-than-expected failure rate when used in traditional hip replacement on certain types of patients. The letter said that the data shows that the risk is highest for patients of small stature, a group that typically includes women, and patients with weak bones.

Asked Tuesday by a reporter why the company was issuing the advisory now, even as it was winding down sales of the device, DePuy said in a statement that it believed that “this is new and important information surgeons who continue to use ASR should have to inform their clinical decision making.”

The ASR, one of several hip models sold by DePuy, belongs to a category of devices known as metal-on-metal implants.

Such implants are under increasing scrutiny because they can generate large amounts of metallic debris as they wear. The debris can cause severe inflammatory responses in some patients, damaging muscles and other soft tissues, requiring a follow-up operation to replace the device soon after implant — instead of the 15 or more years artificial hips are supposed to last.

Just last month, in an interview, DePuy officials defended the ASR’s track record, saying its performance equaled that of competing devices. Those officials also said that the company was phasing out sales of the ASR for commercial reasons, not because of any safety issues.

“With declining sales of this particular product in its market segment, we are focusing on newer technologies,” Sally Hunter, DePuy’s worldwide vice president for regulatory affairs, said last month.

DePuy sells the ASR for use in hip “resurfacing,” a popular alternative to traditional replacement. The company also separately markets an ASR component — its hip socket, or cup — for use in traditional hip replacement. DePuy’s March 6 alert deals with that the ASR’s failure rate in traditional replacements.

While the ASR resurfacing system has been used abroad, the Food and Drug Administration has not approved it for sale in the United States. In 2005, however, the F.D.A. cleared the ASR cup for use in traditional hip replacement. The device was cleared through a regulatory pathway that did not require it to undergo clinical trials.

Since the beginning of 2008, the F.D.A. has received about 300 complaints on the ASR involving patients in the United States who received it. A review of those reports indicates that a vast majority of those patients underwent an operation to have the device replaced soon after getting it.

The number of such complaints typically understates a product’s problem, however, because many doctors and hospitals never bother to file reports with the F.D.A.

Andrew W. Lehren contributed reporting.

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WASHINGTON — To bolster the case for a far-reaching overhaul of the health care system, the Obama administration is seizing on a new analysis by Goldman Sachs, the New York investment bank, recommending that investors buy shares in two big insurance companies, the UnitedHealth Group and Cigna, because insurance rates are up sharply and competition is down.

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White House officials on Saturday said that the Goldman Sachs analysis would be a “centerpiece” of their closing argument in the push for major health care legislation. The president and Democratic Congressional leaders are hoping to win passage of the legislation before the Easter recess. Republicans remain fiercely opposed to the bill.

The Goldman Sachs analysis shows that while insurers can be aggressive in raising prices, they also walk away from clients because competition in the industry is so weak, the White House said. And officials will point to a finding that rate increases ran as high as 50 percent, with most in “the low- to mid-teens” — far higher than overall inflation.

The analysis could be a powerful weapon for the White House because it offers evidence that an overhaul of the health care system is needed not only to help cover the millions of uninsured but to prevent soaring health care expenses from undermining the coverage that the majority of Americans already have through employers.

Republicans, however, could also point to the analysis as bolstering their contention that Democrats should be focused more on controlling costs and less on broadly expanding coverage to the uninsured.

The research brief is largely based on a recent conference call with Steve Lewis, an industry expert with Willis, a major insurance broker.

In the call, Mr. Lewis noted that “price competition is down from a year ago” and explained that his clients — mostly midsize employers seeking to buy health coverage for their employees — were facing a tough market, in which insurance carriers are increasingly willing to abandon existing customers to improve their profit margins.

“We feel this is the most challenging environment for us and our clients in my 20 years in the business,” Mr. Lewis said, according to a transcript included in the Goldman brief. “Not only is price competition down from a year ago,” he added, “but trend or (health care) inflation is also up and appears to be rising. The incumbent carriers seem more willing than ever to walk away from existing business resulting in some carrier changes.”

The report also indicated that employers are reducing benefit levels, in some cases by adding deductibles for prescription drug coverage in addition to co-payments, and raising other out-of-pocket costs for employees as a way of lowering the cost of insurance without increasing annual premiums and employee contributions to them.

Kathleen Sebelius, the secretary of health and human services, is expected to discuss the Goldman analysis on two Sunday television talk shows, “Meet the Press” on NBC and “This Week” on ABC.

In his call with Goldman, Mr. Lewis said beneficiaries were feeling the brunt of the changes to existing policies. “Visually to employees, they’re fairly significant,” he said.

But the report also sounded cautionary notes that the administration will probably not want to highlight.

Asked by Goldman analysts about the effort to pass major health care legislation, Mr. Lewis said many employers experiencing increases in their insurance costs were nonetheless apprehensive about the president’s proposal.

“They’re very mixed in their reaction, quite candidly consistent with what we’re seeing in the polling numbers by party lines,” Mr. Lewis said. “I think most people would acknowledge that there’s a need for health care reform; employers continue to be very frustrated. So when they look at what the Obama administration and the Democratic majority state as their goals to increase access and lower cost and rail at what may be termed oligopolistic behavior of carriers in certain markets, I think employers really buy in to that message and have much of that frustration and anger at our lack of solutions.”

And yet, he said, there is little enthusiastic support from employers for the Democrats’ proposals.

“Many of them still view the legislation and the partisanship coming out of Washington as possibly the medicine worse than the disease,” he said. “So many employer groups that we’re talking to feel like it would be a shame to lose an opportunity to do something with respect to health care reform. But many are starting to feel like maybe nothing is better than something in this current environment.”

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Too tired for sex? You are not alone.

About one in every four Americans married or living with someone say they are so sleep-deprived that they are often too tired to have sex, according to a new study by the National Sleep Foundation. Lack of sleep also keeps many people from work and family functions, the report said.

The study, based on a random sampling of 1,007 adults ages 25 to 60, focused on differences in sleep habits among ethnic groups — but the responses on tiredness and sex were about the same across the board.

Whites were the most likely — at a rate of about 1 in 10 — to have received a diagnosis of insomnia. Blacks were the most likely to have sleep apnea, about one in seven.

Hispanics were most likely to be kept up at night worrying about work, money, relationships and health problems, with about three in every eight losing sleep over such concerns.

Asian-Americans slept the best of all, with five of every six saying they got a good night’s sleep at least a few nights a week. They were also less likely than members of other groups to watch television or drink alcohol before going to bed, and less likely to share a bed with a spouse or partner, said Dr. Barbara Phillips, a sleep clinician and member of the sleep foundation’s board. She added that “what we do in the hour before bedtime is important.”

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To help average Americans do something to fight AIDS, tuberculosis and malaria, several foundations and travel companies, in cooperation with the United Nations, are starting a campaign to allow travelers to donate $2 every time they pay for a flight, a rental car or a hotel room.

The campaign, called MassiveGood, is asking users of various travel Web sites, including Travelocity, to click a box to donate an extra $2 when they pay.

The management consultants McKinsey & Company estimated that the plan could bring in $600 million to $1 billion a year within four years, said Dr. Jorge Bermudez, executive secretary of Unitaid, the international charity that is to receive the donations.

Unitaid, founded in 2006, receives about $350 million a year through small taxes on airline tickets in France, Chile and South Korea, a carbon tax in Norway and donations from Britain and Brazil. It then channels the money through other groups — including Unicef, the William J. Clinton Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria — to pay for drugs for children with AIDS, drugs for adults with drug-resistant AIDS or tuberculosis, and mosquito nets to prevent malaria.

The United Nations secretary general, Ban Ki-Moon, and former President Bill Clinton last week announced the plan, which has been endorsed by several European governments. The United States government does not contribute to Unitaid, but the AIDS and malaria programs started by the Bush administration give money to many of the same recipients.

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Old Gus sat on his customary bar stool in the corner, tossing down the bourbon and tossing out the barbs.

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“I can tell you one thing,” he announced, as I recall. “Back in my day, you didn’t have young kids going around talking to shrinks, yakking about their fee-ee-ee-lings, getting all doped up on medications.

“Back in my day, kids were kids! We worked out our problems on our own. We didn’t go crying to some stranger with a whole bunch of initials after his name.”

Gus was ridiculing a conversation a fellow therapist and I were having about a 13-year-old she was treating for depression and acute anxiety. I didn’t rise to his bait, but it wasn’t because I had no interest in defending my profession. Rather, as with the college guys at the other end of the bar lamenting yet another epic collapse by their beloved Jets (this was before the team got good), it was that I’d heard the complaint so often it had become tiresome.

Not that Gus was entirely wrong. A greater percentage of young Americans than ever receive treatment — talk therapy, medication or both — for psychological disorders, and the number is steadily rising.

But when I think about what life was like in my day (I’m in my mid-50s, and Gus is probably 20 years older), I’m not so sure this is a bad trend.

One of my most vivid and least cheerful childhood memories is how discouraged I felt when it dawned on me that most of my peers could sit down for an hour or so at a time and plow through homework assignments without fidgeting, getting out of their chairs, pacing the floor or succumbing to the distractions of their rooms.

Nor was environment the determining factor; I found it difficult to sit still and concentrate in the classroom, glued to my desk, with an assignment right in front of me and the teacher hovering over me. It was never a matter of resenting the work or not knowing how to do it. To my reckoning, it was just physically impossible to be still and focus on a task for more than a few minutes at a time.

With this as a part of my past, the first time I read the criteria for attention deficit hyperactivity disorder — “often fails to give close attention to details or makes careless mistakes in schoolwork … fails to finish schoolwork, chores or duties” and so on — my only surprise was that they didn’t include “Prefers G.I. Joe or flipping through baseball cards to civics lessons and pop quizzes.”

In short, I was an A.D.H.D. kid, lacking only a diagnosis. And now that I know that the condition was a result of my body’s inherent inability to manage the flow of neurotransmitting chemicals like dopamine and serotonin, all of my parents’ heated entreaties to “buckle down” and “pay attention to what’s in front of you” were about as useful as telling a nearsighted child to see clearly without glasses.

As I grew into adulthood, I was left with a string of unanswerable but concentric questions: Could medication have helped me to concentrate on my schoolwork? If so, would I then have been a more industrious student? And if I had been a more industrious student, could I have developed more of a passion for reading and for learning? And if I had developed that passion, would I be a happier, better, more productive human being? If, and if, and if … I’ll never know.

And while my own life is dogged by the possibility of unfulfilled possibility — what might have been had I been treated — what really haunts me is the memory of full-blown tragedy in the lives of some of my childhood friends.

I think of a pretty but perpetually sullen girl named Maureen, her body scarred for life by an abusive mother who (as Gus would say) was not above giving her daughter what for. Or a tall, lanky guy named Dave, a star athlete with Hollywood looks who stunned us all by putting a gun to his head and taking his life.

To their horrific stories, I could add the countless quotidian ones of seemingly normal, everyday kids who endured overbearing siblings or bullying classmates, who didn’t get included in the secret, invited to the prom or chosen for the volleyball team, whose father one morning just up and left the family because he got a better offer from another woman. Those who just couldn’t work out their problems on their own (Gus again). Who knows how much more bearable their lives might have been if they had received the proper intervention?

It was only much later in life that I began to appreciate the many insidious ways in which psychological well-being can be altered by things outside a child’s command.

Most children exercise very little power over the decisions that affect their lives. They don’t decide who their parents are, where their family will live, where they will attend school, when they will reach puberty, who will or will not befriend them. They have limited control over their athletic skills, their looks, their wit, or whether, in the great Serengeti that is their schoolyard, they will be predator or prey. They are as much the subject of their story as its author.

At toxic moments, the insights to be gained from a professional who takes this stuff seriously (and in some instances the medications that can bring calm to chaos) are eminently useful to the child who is looking for a narrow path through some very difficult years.

Of course, there will always be critics. “Look at me,” Gus declaimed as my friend and I wound down our conversation.

“My old man was a drunk, and I didn’t turn out too bad,” he told us proudly, one word slurring into the next.

Erik Kolbell, a psychotherapist in New York, is the author of a book of essays, “The God of Second Chances.”

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