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Psychiatrist's Notes, Initial Therapy Session.

Patient: Buffalo.

History of Past 50 Years: Grim.

Prognosis for the New Millennium: Uncertain.

Symptoms: Patient suffers severe depression and absence of self-esteem; appears unable to change self-destructive behavior patterns. Though once optimistic, the effect of traumatic events beyond its control and repeated cycles of self-abuse have left it morose, conflicted and unable to set clear goals. Subject is the butt of jokes from healthier peers, which contributes to subject's self-loathing. Patient is prone to self-medicate with Canadian beer, keeping itself up until the wee hours.

Topics That Provoke Deep Anxiety: Steel, savings and loans, snowstorms, Super Bowls.

Pharmaceutical Treatment: Patient has spent huge sums on postmodern America's main anti-depressant drug, professional sports. Subject invested enormous resources into retaining its football team and tens of millions on a new arena for its hockey team.

These teams at best provide temporary mood elevation, and when losing, contribute to patient's depression. New or improved stadiums have effected little change in the patient's grim economic status. Yet sports teams are vital to patient's self-image and ability to attract national attention, given the lack of other attributes. Thus, patient feels obligated to retain them at virtually any cost.

Patient History: An alarming number of events outside patient's control have turned a once-healthy, vital subject into a world-weary, jaded shell of its former self. Only by understanding the severity of these circumstances can one appreciate patient's current condition.

The opening of the St. Lawrence Seaway virtually ended patient's use as a port and eroded its feelings of self-worth. The death of the steel industry broke its economic legs and caused patient to become lethargic and depressed.

Co-therapist Robert Shibley, professor at the University at Buffalo's School of Architecture and Planning: "(Patient) structured an economy around steel and transshipment, and they both collapsed."

Patient then embraced the banking industry as a savior but was rudely jilted by the savings-and-loan scandal of the '80s.

Other outside forces conspired against it. The invention of air conditioning opened the South for business and drained economic blood from the patient. Lame-brained "urban renewal" policy prompted the bulldozing of healthy neighborhoods and the building of high-rise public housing, the petri dish of crime and hopelessness. Development of the suburbs -- fed by federal highway and housing dollars -- led to the post-World War II exodus of the middle class, the city's lifeblood. Patient has yet to recover from these blows or devise other attributes to reinflate its self-esteem.

Self-Destructive Behavior: Patient's physical and psychological deterioration also is traceable to numerous self-inflicted wounds. Grasping at "solutions" that did more harm than good has killed patient's self-confidence and left it, at times, delusional.

Against all logic, patient decided 30 years ago to build a new University at Buffalo campus in the outer suburbs instead of downtown. A failure to extend the Metro Rail system beyond the city line undercut its usefulness and deepened the divide with its suburbs. Patient built highways that cut off its waterfront, sliced up its neighborhoods -- notably Humboldt Park, a middle-class black enclave -- and bisected its signature Frederick Law Olmsted park. It built a blob-like convention center that was obsolete the day it opened; now it needs another.

Patient remained lethargic as unchecked suburban sprawl gobbled farmland, sapped life from the city and made older suburbs undesirable. A political system driven by ego, patronage and party bosses limited patient's exposure to new ideas and fresh blood. Discrimination and the lack of suburban low-income housing and mass transit kept the poor, minorities and elderly in the inner city and bred blight, crime and segregation.

The history of bad decisions has left the patient consumed with self-doubt and uncertain where to turn.

Co-therapist Shibley: "The bad decisions fostered a belief that good decision-making is impossible, that whatever decision is made will be the wrong one. (Patient) needs to change that history, to decide not to act like a victim any longer."

Prognosis for Recovery: Uncertain. Some treatments are insufficient or unavailable. The anti-sprawl remedy that worked for Sun Belt cities -- annexing suburbs as they grew -- is virtually impossible in New York State. Patient imposes taxes that are too high to attract business. The local Chamber of Commerce has an identity crisis: Though patient is on the economic critical list, the Chamber -- called the Buffalo-Niagara Partnership -- acts more like a think tank than a new-business generator.

Fits of delusional thinking hinder recovery. The patient is engaged in a huge debate over a new bridge, in which neither choice is economically superior to the other. Meanwhile, its public schools decline and businesses and people keep leaving.

Hope for the Future: Patient shows fits of clearheadedness. It's repairing its world-class architecture, to draw tourists and remake its image. It's turning downtown into a theater-entertainment district. Planned conversion of a former department store to apartments for yuppies and empty-nesters could signal new life for other vacant downtown buildings. Neighborhoods of new housing are springing up in once-blighted areas of its East Side.

Continued growth of the cable company that owns the hockey team gives patient a healthy connection with a growing corporate power. The presence of a huge state university, the growing downtown medical corridor and the potential reuse of contaminated former industrial sites is encouraging.

There is talk of grand projects -- a new zoo, a remade downtown waterfront, a children's museum -- that could add to the quality of life and attract tourists. But a lack of corporate strength makes our weak, aging subject overly dependent on Mother Government; it remains largely unable to help itself.

Patient has yet to capitalize on its proximity to Canada, its abundance of fresh water and an enviable road/rail infrastructure.

Reality Testing: Patient focuses on weaknesses, yet ignores considerable quality-of-life strengths.

Patient has access to a variety of recreational pursuits -- skiing, boating, hiking. Other attributes include a lack of traffic congestion, an abundance of affordable housing and a variety of cultural offerings.

If patient could set aside feelings of worthlessness and develop a new leadership culture, there is hope for a slow, steady revival. It will never regain its vitality of a century ago, but it could become a reasonably well-adjusted, productive member of society.

Treatment Plan: Massive doses of anti-depressant drugs and prolonged therapy. Patient is urged to focus on its strengths, develop its waterfront and other self-affirming projects -- and call back in 10 years.