The Three Keys to Change

That's been studied over and over and over again. The dean of the nation's most famous medical school said so with confidence. But following the conference, when I searched through the archives of the leading scientific journals, I came across something strange. Something that just didn't fit. In 1993, Dr. Dean Ornish, a professor of medicine at the University of California at San Francisco, convinced the Mutual of Omaha insurance company to pay for an unusual experiment. The researchers recruited 194 patients who suffered from severely clogged arteries and could have bypass grafts or angioplasties covered by their insurance plans. Instead they signed up for a trial. The staffers helped them quit smoking and switch to an extreme vegetarian diet that derived fewer than 10 percent of its calories from fat. In places like Omaha, they shifted from steaks and fries to brown rice and greens. The patients got together for group conversations twice a week, and they also took classes in meditation, relaxation, yoga, and aerobic exercise, which became parts of their daily routines.

The program lasted for only a year. After that, they were on their own. But three years from the start, the study found, 77 percent of the patients had stuck with these lifestyle changes--and safely avoided the need for heart surgery. They had halted--or, in many cases, reversed--the progress of their disease.

If the medical establishment was resigned to the supposed fact that only one out of every ten people can change, even in a crisis, then how did Dr. Ornish's team inspire and motivate nearly eight out of ten of its heart patients to accomplish and sustain such dramatic transformations?

In 2002 the Justice Department published a study that tracked 272,111 inmates after they were released from state prisons in fifteen states. This was the largest study of criminal recidivism ever conducted in the United States. The results were alarming: 30 percent of former inmates were rearrested within six months, and 67.5 percent of them were rearrested within three years. Most of the repeat offenders were felons.

Psychologists and criminologists have come to share the belief that most criminals can't change their lives. Although a movement to "rehabilitate" offenders gained momentum in the sixties and seventies, the idea has since largely been abandoned. Now the experts believe that many criminals can't change because they're "psychopaths"--they're unlike the rest of humanity because they aren't burdened by conscience. They don't have any empathy for others. They're concerned only for themselves. In a word, they're ruthless.

Psychopaths make up about 1 percent of the overall population, but they're thought to be the norm in prisons. A large number of convicts have been put through "The Hare," the standard test for psychopathy, created by Dr. Robert Hare, a professor at the University of British Columbia, who has been an influential adviser to the Federal Bureau of Investigation. The average score for male inmates in North America is "moderately psychopathic." The experts admit that they really don't know what causes psychopathy. They assume that some people are simply born that way. They also believe that psychopaths can't change to be like the rest of us. This conclusion is powerful and convincing, but if you've lived for a while in San Francisco, you've probably come across a strange exception.

On the waterfront, taking up an entire city block in an enviable location between the Bay Bridge and the Giants' baseball stadium, there's what looks like a luxury condominium complex. The Delancey Street Foundation is actually a residence where criminals live and work together. Most of them have been labeled as "psychopaths." They typically move to Delancey after committing felonies and having serious problems with addiction--to heroin or alcohol, most commonly. Judges send them to Delancey from the state prisons, where they belonged to gangs and perpetrated violence. They're usually the third generation of their families who have known only poverty, crime, and drug addiction. They've never led lawful lives or even understood the values and ideals of lawful society.

They live at Delancey, five hundred of them, blacks and Latinos together with self- proclaimed neo- Nazis, along with only one professional staffer, Dr. Mimi Silbert, who earned PhDs in psychology and criminology before cofounding the program thirty- five years ago. Aside from Silbert, who's sixty- three and stands four feet, eleven and weighs about ninety- five pounds, the felons run the place themselves, without guards or supervisors of any kind.