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How I Lost 47 Pounds Without Trying (very hard)

Seven weeks ago I weighed 239 lbs.  I am 6’1” tall, and I had just crossed over into clinically obese category.  My weight has ranged from 232 to 245 pounds for the last fifteen years or so.  During that time I have tried any number of diets with the usual erratic results and recidivism: I would lose the weight and add it back on in endless seesaw fashion with the resulting disappointment and loss of self-respect.

I never really thought of myself as obese until I obtained a copy of my medical record and one of the doctor’s notes referred to me as “sort of obese.”  That hit me right between the eyes.  I knew I was overweight, but obese was a word you used for fat people.  People with no self-control.  People with emotional problems.  People whose lives had spun out of control.  I was just a happy gourmand.  I just really liked food.

Okay, that’s not entirely honest.  I knew that I was a binge eater.  Eating was part of my coping mechanism to deal with anxiety.  I knew this because I often found myself not even realizing that I was eating, and sometimes couldn’t remember having eaten or what I had eaten.  I was just putting food in my mouth.  And I had grown comfortable with that leaden feeling in the center of my torso.  In a moment of horrible truth I realized that I wasn’t really even tasting my food most of the time; I was satisfying a craving.  But a craving for what, if I wasn’t tasting my food?  I was putting food in my mouth to make something go away, something that refused to go away, or that always came right back after the briefest recess.

There are several things I had learned along the way to my failures:

1.  If you don’t want to eat it, don’t bring it in the house.

2.  Your stomach and digestive system adapts to too much food, and adds capacity to accommodate increased craving. No matter what you ate, the rate of craving was a constant.

3.  The rate of weight loss was not rapid enough to provide quick and essential positive reinforcement.  Losing weight was like timing a caterpillar with a stopwatch.

4.  All paths lead to the kitchen.  Houses should be designed with the kitchen and pantry on the far side of the garage.  No matter what you’re doing or where you’re going, you always have to go through the kitchen.

5.  Losing weight requires way too many decisions.  Suddenly my hunger hits and I have to answer twenty questions before I can put any food in my mouth.  How many calories, how many carbs, how big a helping, etc.  I can’t make all those decisions when I am hungry.  I want to eat.  NOW.

That’s where I was seven weeks ago.  I called an old friend and he told me he had lost a lot of weight about a year ago and kept it off.  He said it was quick and the weight “just fell off.”  That’s what I needed, something where the weight would just “fall off”.  Something simple.  Not too many decisions.

Without my asking, my friend sent me a link to a video that had motivated him to get started.  The video lasted almost an hour.  It had nothing to sell.  There was no contact information, nothing to buy.  No books, pamphlets, or potions.  Just this Australian guy who decides to take 60 days traveling across the U.S. interviewing people about being fat.  And during his sojourn he carried a juicer in the back of his vehicle and he juiced only fruits and vegetables.  That’s it.  Honest.  That’s the whole story.

I have lost 47 pounds in six weeks.  Three bowling balls.  Oh, a couple other things.  Before I began, I had my wife photograph me from the side, almost naked.  I did not suck my belly in.  I wanted to be photographed in all my grossness.  I wanted to be disgusted.  And I was.  I printed out the photo.  It helped.  Using self-loathing to overcome self-loathing.

It took me about a week to figure out what vegetables and fruits to commingle.  I used a food processor because I didn’t have a juicer.  A juicer separates the juice from the pulp.  A food processor doesn’t.  So I drank a lot of very thick “juice” which was more pulp than anything else.   So I kept adding water to my concoctions because otherwise it was way too thick, almost beyond pouring.

Some of those really dark vegetables that are supposed to be so healthy for you taste unbelievably gross when reduced to mush.  Here’s a few suggestions that the video doesn’t include:

1.  Pears and bananas can mask the bad taste of almost anything.  After that, apples are best.  Mangos and raspberries have too delicate a flavor to mask anything.  They are better eaten and savored than processed.

2. Take a sharp knife and cut the stems of the dark leafy vegetables away from the leaves, and discard them.  Only juice the leaves.  The woody stems add a lot of bitterness to the taste.

3.  I would make up an 8-cup container of juice the night before and put it in the refrigerator.  I couldn’t bear to do all the processing when I was hungry the next morning, so I did my preparations the night before.  I covered the container tightly.  I didn’t want the nutrients to get away during the night (to wherever nutrients go when you’re not looking).

4.  I cheated.  About twice a week I would reward myself and eat an avocado, which I love.  About twice a week I would eat a package of a really tasty fruit like kiwi or raspberries or a couple handfuls of mixed nuts.  Even radishes if I craved something crunchy.

5.  I was never HUNGRY, but I was always hungry, if you know what I mean.  By the seventh week my menu was getting boring.

6.  My wife ate whatever she wanted whenever she wanted, and made no effort to make it easier for me.  I didn’t want her to.  I needed to know I could do this without trying to change the world around me.  It wasn’t a problem.  Sometimes her food looked really good, but I never wavered.  I guess it was just time.

I am doing a lot of thinking about what I’m going to do when I come off this diet.  The best I have come up with is that I am going to continue using the food processor, but I will eat one small meal each day in addition to my “juice.”  I will eat fish about twice a week, and incorporate beans into my diet, and about once a month I will treat myself to a steak dinner.  I get enough natural sugar from the fruit in my diet, so I have lost my taste for artificial sweets, and I have never been a carbonated beverage person.  I have been without coffee and alcohol for the last seven weeks, and I will add red wine back into my diet a few times a week.

I believe it will take me another six months of constant vigilance to maintain my minimalist eating habits.  The fat cells in your body never go away; they sit there empty, and like the plant in The Little Shop Of Horrors, plead with you for the rest of your life “Feed me Seymour, feed me!”

I began this journey  in the late third trimester of my “pregnancy” and I have worked my way backwards almost to the orgasm that began it all sometime in the distant and obscure past.  I don’t remember when the bad habits began, but I know this is where they have to end.

Here’s the link:  http://www.hulu.com/watch/289122

Feel free to send me any questions or comments you have.  I would be interested to know how it works out for you.

BOOK REVIEW: The Black Count by Tom Reiss

This is a fabulous  non-fiction narrative that rivals many of the best novels ever written.  Even the fact that it made the New York Times bestseller list and also won the Pulitzer Prize hardly does it justice.  Tom Reiss obviously spent many months, even years, doing very original research on at least two continents and as many languages.  But let’s begin at the beginning

If you have ever read the novel The Count of Monte Cristo by Alexandre Dumas, and you liked it, or like me, loved it, Reiss’ book is a must-read for you.  Dumas also wrote The Three Musketeers and The Man in the Iron Mask, as well as dozens of other fiction and non-fiction books and articles.  The Count of Monte Cristo is a story of revenge; the story of a man imprisoned for life on unknown charges as the result of a conspiracy of three enemies he didn’t know he had.  He is condemned to a medieval prison, whose castle walls are several feet thick.  He makes a daring and miraculous escape aided by another prisoner, an aging abbe, who reveals to him the location of great treasure.  The hero becomes fabulously wealthy and the rest of the book is about how he wreaks revenge on those who had condemned and then forgotten him.  The Hollywood movie version in my opinion ruined the story by changing the ending.

What I didn’t know is that the author of these sagas, Alexandre Dumas, was a mulatto, and his father, Alex Dumas was a very dark black man from the island of Haiti who intermarried with a white French woman.  Through the real story of this man, Reiss takes us on a global panoramic tour of the institution of slavery itself, with many surprises along the way.

Slavery of course, has been around since the beginning of man’s recorded history, and obviously predated that history.  All acquisition of property and power throughout the ages was through conquest, and the victor took all, including the vanquished as slaves.  Slavery was not racially tinged until the 18th century.  Before then, anyone anywhere was at risk of becoming a slave if a predator group won the battle.  For example, when Alexander the Great conquered Egypt, he made slaves of the Egyptians, but he also imported lots of white slaves from what are now eastern European nations populated by ethnic Slavs, which is where we got the word slave.  Christians during this time period thought slavery was fine as long as the slaves weren’t other Christians.  So making slaves of non-Christians and especially the Moors, was acceptable.    In time these ethnic Slavs, who became known as Mamelukes,  revolted against their Egyptian masters, and the Egyptians became their slaves–until Napoleon came along and drove off the Mamelukes. Read more..

In the western hemisphere, there were large population centers located among the Mayans, the Aztecs, and the Incas.  One of the Incan cities had a larger population at the time than the European city of Lisbon, the capital of Portugal. Each of these south and central American civilizations had slave populations themselves.   When the Spanish conquistadors invaded they absorbed the existing slave populations and also made slaves of the former masters.   Those  who didn’t die of the white man’s diseases were turned into slaves and were sent to die in brutal, murderous silver and gold mines.  None of this was race related.

When other imperial explorers reached the islands of the Caribbean, they didn’t find precious metals as they had hoped, but instead found sugar cane, which they learned how to refine into sugar.  The sugar capital of the world became the island of Haiti, then known as Saint Domingue.  Growing sugar cane was labor intensive, and unlike in central and south America, there were no large concentrations of population that could easily be enslaved.  The African slave trade in the 18th century was largely concentrated around the sugar plantations of Saint Domingue.  There were few African women imported to Saint Domingue, and the men were treated so brutally they died quickly of starvation and beatings.  This rapid turnover further exacerbated the labor shortage, requiring more and more slaves.

Reiss traces how the imperial expansion into the western hemisphere took place concurrent with the philosophical movement of The Enlightenment with its special emphasis on liberty and individual rights.  The French were the first to attempt to come to grips with the contradictions between slavery and liberty.  The French were intrigued by the American experiment and the principles embodied in our Declaration of Independence and Constitution, and of course our revolution only came to a successful conclusion due to the assistance of the French navy.  As a matter of fact, the French involvement in our revolution drove their nation into bankruptcy, and precipitated food riots and their own Revolution.  The French Revolution championed the rights of man at the same time that it engaged in a Reign of Terror against its own citizens, sending thousands of innocent people to the guillotine.

The French resolved the slavery/liberty debate at first by declaring that any black man who made it to the shores of France proper was a free man, and the French sort of washed their hands, Pontius Pilate-like,  of what happened in the slave-holding colonies such as Saint Domingue.  Activists pressed the issue however, and within a short time freedom was being promised to slaves in the colonial territories, which of course enraged the plantation owners, who withdrew their support from the French Revolution.   This facilitated Napoleon’s rise to power, culminating in his naming himself emperor of France and ending the centuries-old monarchy.

Alex Dumas, the father of Alexandre, came to France as a young man and entered the military, and quickly distinguished himself.  For a while he actually outranked Napoleon, but in time came to report to him.  He was captured in what is today Italy, and spent several short years in a medieval prison, held without charges.  His prison experience broke his spirit and his health.  Napoleon meanwhile, in an effort to placate the very wealthy plantation owners of the French Caribbean colonies, rescinded many of the freedoms that the Revolution had instituted for blacks.

After many years of valiant service to the Revolution in which he devoutly believed, Alex Dumas found himself without a pension, without a home, and with no means of support.    Napoleon, who knew him well and personally, ignored his requests and his lieutenants ignored the requests and pleas of his widow after Alex died, still fairly young and impoverished.

This is broad brushing this delightful narrative, which holds many insights you’re not going to find in a history book.  Reiss approaches his topic without bias or political correctness, and what I came away with was that the lot of the common man of any race, color, or origin from time immemorial has been to serve as the cannon fodder of the ruling class of every nation, and that the golden rule prevailed:  he who had the gold ruled.

Reiss is quick to point out many of history’s ironies:

Napoleon and Alex Dumas fought against the Spanish in southern Italy.  This is the same Spain that was colonizing the central and southern Americas.  And that is how the South American tomato made it’s way to southern Italy, which of course made it famous. or was it the tomato that made Italian cuisine famous?

The French continued to refer to black and mixed race people in France as “Americans”, in America members of its Congress would not permit blacks into their presence except to serve refreshments or sweep up. Says Reiss: “But having enjoyed prestige as “Americans” during the[French] Revolution, black and mixed-race soldiers now found themselves denigrated as “Africans.”

The French helped us achieve the rights to life, liberty, and pursuit of happiness, and were also the first to give blacks freedom, at a time when  General George Washington said he didn’t think Virginians were ready for that step yet.   French  General Lafayette of Yorktown fame had to flee for his  life from his own Revolution.  He was captured by the Prussians and spent the next five years in prison.  His friend George Washington was powerless to help him because Prussia [parts of what is now Germany] and Austria at the time refused to recognize the new United States.

Miscegenation , or racial intermarriage, was common until it too was outlawed.  Haiti, the sugar capital of the world and probably the richest island on the planet, experienced the first successful major slave rebellion. The slaves fought 80,000 of Napoleon’s troops to a standstill; the French left, the plantations closed, and today Haiti is quite possibly the poorest island on the planet.  Today Haiti has experienced something of a brain drain as their best and brightest have abandoned her to seek their fortunes in the United States and elsewhere.

New post-revolutionary France decided to deflect attention away from their internal problems by invading most of their neighbors, which is how Napoleon and Alex Dumas came to know each other and fight almost literally side by side.  As always, the government attempted to finance their wars with debt, in the form of bonds backed by property–that had been seized from the Church.  These bonds were on pieces of paper called assignats, which were used as money,  and of course they printed more assignats than there was real estate collateral, which resulted in devaluing the assignats and creating massive inflation.  Eventually the floor under the assignats gave out–literally.  At the Paris printing house someone piled up too much of the worthless paper in one place and the floor of the building collapsed under the weight.  Their real-estate secured bonds were worthless.  Nothing familiar here, is there?

Reiss peppers his story with personal vignettes such as this description of one French revolutionary:  “. . . his main character flaw was that of so many French revolutionaries: a zeal for human rights so self-righteous that it translated into intolerance for the actual human beings around him.”  I’ve often thought the same of the purported champions of the war on poverty; their concerns are usually self-serving and they wouldn’t want to get too up close and personal with real poverty.  They preach humanity but don’t like poor people moving into their neighborhood.

Reiss weaves a wonderful and complex tapestry of events that spans the globe and leads to even more questions.  Life is never quite what it appears to be, and the more it seems to change the more it stays the same.  If you have strong opinions about modern race relations in the U.S., read Reiss’ book for a more global perspective.  Without our Constitution and limited government, there is nothing left but the governments guns, the moneyed powers behind the throne, and the ragtag mob.  Without individual freedom that cannot be voted away by any block of voters of any color for any reason, there is no freedom except by permission, and that is not freedom at all.

For author Alexandre Dumas, his novel The Count of Monte Cristo was the fantasy version of his father’s life.  Indeed part of the story begins in an obscure little village in Haiti (Saint Domingue) near the border with the Dominican Republic (Santo Domingo) called Monte Cristo.

Many parts of this biography of Alex Dumas, and his legendary fictional counterpart, the Count of Monte Cristo, read like a Kafkaesque novel.    Until we figure out a way to change human DNA, the possibility of a return to this world should never be dismissed lightly.  Liberty is and always will  be under siege.

The Cat and the Alligators: How Perception Becomes Reality

by on February 2, 2014
in Uncategorized

This post is not about a fable.  It’s real.  See for yourself:

http://www.youtube.com/embed/Duqvb-IRv9c

How does a 15-pound cat intimidate an alligator, that weighs up to 800 lbs.?  What is going on in that tiny cat brain?  What is going on in the alligator’s brain?  Obviously the cat has no comprehension of how hopeless his cause is, and how incredibly mismatched he is against the scaly leviathan.  He knows instinctively to avoid the snapping gator jaws, but he doesn’t flee.  Does he see the alligator as an outsized and ugly cat?  Or is he just instinctively being territorial and protecting his turf?  Would he be afraid of anything?

On the other hand, what about the alligator?  Is he so accustomed to prey desperately fleeing his approach that the cat, by virtue of his fearlessness and aggression must not be prey at all, but a new kind of competition in the food chain?  The alligators clearly seem to reevaluate their assessment of the cat and apparently reach the conclusion that anything that fearless constitutes a danger best left alone.  Apparently even in the rest of nature, the best defense against a bully is to stand up to him.

To me this video, while hilarious in its own right, is an excellent metaphor for life.  It has been said that one man with courage constitutes a majority.  There is physical courage, which for the purposes of this discussion we could attribute to this cat, and there is moral courage, the willingness to stand up and be heard when the outcome cannot be assured.  At the very least one risks ostracism from the group, loss of friendship,  love, approval, and resources.

For many years I was in the property management business, and in the early eighties I had the opportunity to take a bid tour of the World Trade Center complex in New York City.  During part of the tour we were traveling through seven or eight stories of underground corridors, walking the equivalent of several city blocks through bleak, isolated and empty concrete hallways with no doors or windows.  The contractor who was then responsible for the cleaning of the mammoth facility employed over a thousand cleaning staff, all members of New York unions, and some of those employees had served hard time in the federal penitentiary for murder one raps.  I asked our tour guide, a bright, energetic young female supervisor for the contractor then cleaning the facility if she wasn’t afraid for her physical safety at times.  What would she do if she happened to come across one of the “tough guys” on their staff in one of these isolated tunnels?  I will never forget her answer:  “The only supervisor who needs to be afraid is the supervisor who is afraid.”

Those who are truly fearless, or who give off the impression of being fearless, give pause to their opponents.  They are so certain of themselves and their ability to handle whatever happens that they cause their adversaries to doubt themselves.  This confidence, this certainty, can be in defiance of all the facts of reality and still carry the day.  Power is as power thinks.  I am speaking here more of the moral variety, the sense of the rightness of the ground we stand on, and the moral indignation that causes us to stand that ground against obviously hopeless odds.  I am not speaking of those with the pseudo-courage of shouting from the center of the pack, mocking the outliers who dare to challenge the conventional wisdom.  I am speaking of individuals who are willing to stand alone and speak alone because of their convictions.

How many of us in a classroom situation will wait to answer a question until we see other hands go up?  How many of us will be whistleblowers when we are witnesses of wrongdoing, gross incompetence, negligence,  or causing harm to others knowing we risk being severely penalized for doing so?  How many of us have worked hard all our lives in order to prove we are just as good as the others in the group whose approval we need?

Acceptance into the group is a lot like peeing in your pants.  At first it is warm and wet and vaguely reminiscent of the comforts of the womb from which we were forcefully expelled long ago.  In time it chafes and demands change.  Unattended to, we can become so inflamed we can no longer stand on our own.

So what am I afraid of?  What does it take to make me tremble?  What keeps me awake at night?  In a world consumed with social media, where we all seek the comforts and reinforcement of our groups, how many of us can still remember who we are as individuals, what our core values are?  More has been given to us than the cat or the alligator, so life demands more of us.  We need to know more than who we are; to stand alone we need to know why.  Are we a cat or an alligator?  You can’t always tell by who or what is around us.

The highest level of courage is to understand the odds, feel the fear, and do the right thing anyway.

It doesn’t happen too often.

BOOK REVIEW: The House of God by Samuel Shem

This book, originally published in 1978, became an almost instant cult classic.  The author Stephen Bergman (pen name Samuel Shem) was a Boomer  child of the fifties and sixties, and he wrote this, his first novel, when he was in residency at Oxford as a Rhodes scholar.  As far as I know he does not claim this, but it appears to me that the book is autobiographical to some degree.  The book is about a year as a medical intern in a Jewish hospital called The House of God.  It is funny, irreverent, occasionally salacious, and was frowned on by the medical establishment when it was first published.  

The book pulls the reader into the lives of the interns serving under intense, almost brutal conditions, and confronting what appears to be the very worst in life, its end and all the degrading things that happen to the human mind and body as they gradually shut down.  It is a revelation for the casual, non-medical reader to learn what  happens in the hospital to real people, the interns, members of the hospital hierarchy, and most of all the patients, most of whom are on the last part of the downhill slide. Read more..

The author doesn’t spare any of the gory details.  He discusses and describes in vivid technicolor many of the most unglamorous tasks undertaken by medical students and the attendant sights, sounds, and smells, work that may make you rethink your desire to go to medical school.  What was of the most interest to me however was what was happening to these young men and women as they struggled with the overwork, the authoritarianism of the hospital regime, and the realities of sickness, disease, and death.

The interns develop their own house rules and vocabulary, the first of which is that gomers don’t die.  A gomer (acronym for Get Out of My Emergency Room) applies to mostly elderly patients who have lost most or all of what makes them a human being.  They are existing and taking up space, but they have no awareness of what is going on around them.  As anyone who has spent time in a nursing home knows, their behavior can be humorous and tragic at the same time.  The patient load at The House of God was mostly gomers, and Rule #1 above means that gomers come in and out of hospitals like a revolving door, but they rarely die.  Their organs seem to function on auto-pilot.  It is mostly the younger patients who die in the hospital.  It’s hard to kill a gomer, and it’s impossible to cure or even save many of the young ones.

Even though this is fiction, there is a lot to be learned from this novel, and I am very glad I have read it.  I am amazed at how well known The House of God is, with over two million copies in print; I mentioned it to two middle-aged doctors just this week and they both immediately confessed to having read it many years ago, and they both broke into a grin when I mentioned the word gomer.

The hero among the interns was a fat black doctor who taught them that the goal of medical care was not to cure anyone, but to buff them and turf  them, which meant to make them look better, and then to transfer them out of the ward, either to another department (surgery, psychiatry, the morgue, or just back out onto the street).  When it came to treatment, they learned that less is better, and Rule # 13 was, heretically :  “The delivery of medical care is to do as much nothing as possible.”  It would appear this is a rule that modern medicine lost and is just now rediscovering–that there is a point of diminishing returns with continually prescribing more, and often unnecessary treatments.  Many of these do more harm than benefit.

The reader cringes at the descriptions of what the interns put the sick and dying through in the name of doing something, anything, even if it puts the patient through pointless, agonizing pain.  The concept of modern hospice, i.e. make the patient as comfortable as possible and let them ease into death, was incomprehensible and unacceptable.  You as the reader watch time and again the horrific prolonging of life out of “collective impotence and guilt” — of the interns and the families of the patients.  I cannot imagine anything being more graphic other than  being personally involved in such useless miscarriages of medicine.  I know that such things still happen, because I  remember the final weeks of my sister’s life when she was demented due to brain cancer and procedures for no known purpose were performed on her that obviously caused enormous stress and pain, because she shoved violently at the restraints that kept her bound to the bed.  She did not scream because apparently her brain was not able to transmit or translate the pain signals to other parts that controlled cognition and vocal ability.  It was modern medicine at its best and it was horrible to watch.  The author describes situations that make my sister’s situation pale in comparison, and the reader just prays for the damn interns to let this poor soul die.  And of course they can’t, because their code of ethics requires them to torment their subjects until there is nothing left of them.  That brings us to Rule #8  “”They can always hurt you more.”

I have to believe much of the medical information in the book is based on reality, and the novel is a fun way to explore how young men and women become doctors.  The reader also learns how normal, and sometimes even humble interns gradually evolve into the narcissistic god frame of mind that is partly responsible for the closed society that the medical fraternity has been.

The book is a good read and you will occasionally find yourself laughing out loud, and there will be times when you turn the pages in horrified anticipation of what is done next  in the name of medicine to the defenseless old or dying.

I will leave my readers with a very important question that remains unresolved in my mind:  How many patients have to die, on average, for one medical student to become a doctor?  Students, interns, and residents do practice on, and occasionally kill their patients, and very, very few of these become malpractice lawsuits.  What is the price in human lives and suffering for each apprentice to learn “to do no harm?”

BOOK REVIEW: Hospital Negligence: Legal and Administrative Issues by Arthur S. Shorr, FACHE

Edith Rodriguez entered Martin Luther King Hospital in Los Angeles on May 8, 2007 and was misdiagnosed as suffering from gallstones.  She returned the next day complaining of severe abdominal pain. The triage nurse refused to assess and prioritize her condition, and so Edith could not be placed in line to be examined by a physician.

In an effort at fairness, this could be understandable, don’t you think?  Lots of people use the ER for non-emergency purposes, because they are lonely, hypochondriacs, have mental issues;  or they use the ER as a substitute for seeing a doctor.

But not this time.  The hospital’s surveillance camera shows Edith lying on the floor “writhing and screaming in pain while the janitor mopped around her.” Other patients in the ER asked the nurse to help Edith Rodriguez, but these requests were ignored.  Someone called the police, but even they could not persuade the nurse to triage Mrs. Rodriguez, so the police decided to take her to a police facility where she could be treated.  Unfortunately before that was possible, Edith Rodriguez suffered a cardiac arrest secondary to a perforated colon, and died.

This happened less than five years ago, here in America.  The county settled with Edith’s family for $3 million.  Would you call this a malpractice litigation problem, or a malpractice problem? Read more..

My question is not what is the magic dollar amount of appropriate compensation for Edith’s family, but how can something this barbaric happen?  Can refusing treatment to a patient writhing on the floor in pain be considered just a lapse in judgment?   Can healthcare practitioners become this fatigued, indifferent, or callous to their power of life and death over a suffering patient?  The obvious answer is yes, and not infrequently.  Edith Rodriguez’ case can be found on page 290 of Arthur Shorr’s book Hospital Negligence Legal and Administrative Issues.

If you are interested in a movie developed around this type of flagrant and catastrophic medical malfeasance, watch The Confession, starring Alec Baldwin, Amy Irving, and Ben Kingsley.  If you are interested in an exhaustive (but not exhausting) treatment of current patient care in American hospitals, and the efforts of the courts to establish accountability, read Arthur Shorr’s book.

As those of you who have been faithfully following the thread of this blog over the last few months know, I have been heavily engaged in a research project on the subject of medical malpractice.  Not, mind you, the subject of medical malpractice litigation, but the subject of malpractice itself.  The objective has been to get past the defensiveness, angry bombast, propagandizing, and frequent intellectual dishonesty of vested interests, and discover what is really going on in the arcane, veiled world of healthcare in America.  Admittedly there is a bias to what I report, and that bias is that I am very pro-patient.   I have been a patient  many times, and as I approach the geriatric years, I want to know what to expect, I want to better understand the mysterious inner workings of the healthcare universe and how to survive in it.  Statistically, all of us will spend more time in the hospital during the last year of our life than the total of all our prior hospitalizations combined.  This is even true of doctors and nurses.  We are all going to die, and about half  of us are going to die in a hospital.  Would you like to get better acquainted with the place now, while you are well?  Then take this journey with me through Arthur Shorr’s book.

The 5% Who Maim and Kill

If you have been reading my previous book reviews, you cannot possibly have any doubt that to enter the doors of a hospital in calm confidence that your best interests will be tended to competently and professionally is not only naïve, but to play the part of the fool.  No one disputes the Institute of Medicine’s conclusion that between 100,000-200,000 people are killed in hospitals every year due to preventable error, carelessness, negligence, whatever you want to call it.  What most people don’t know, as Arthur Shorr, the author of Hospital Negligence Legal and Administrative Issues reminds us, is that 5% of all physicians create 54% of all malpractice litigation.  (See National Practitioners Data Bank, 2001 Annual Report: www.npdb-hipdb.com/pubs/stats.2001HIPDB_Annual_Report.pdf )  The National Practitioner’s Data Bank is the central repository for all major physician disciplinary actions, loss of privileges, etc.

You say you didn’t know that such a fount of valuable information existed?    Ever wondered what your doctor’s  cumulative professional history looks like? Would you be interested in knowing if s/he made the honor roll of healthcare practitioners whose  competence is open to question?  Now that you are educating yourself about the very real perils of healthcare  in America that one day could conceivably impact your life or prematurely end it, would you like to take a peek at this repository of reportable events created by the federal HCQIA law?  Well, so sorry, but the same law says you and I  aren’t allowed to see it.  In what is apparently a flagrant and obsequious concession to physician and hospital political lobbies, we, the patient population, are not permitted to identify and avoid the 5%ers.  In the healthcare game, the patient is the patsy, the powerless constituent who continues to have sublime faith that the system is going to take care of him (us).

Clearly, in actual malpractice litigation is the part of the malpractice iceberg that shows above the surface; the vast majority of mistakes go undiscovered, are concealed from patients and their families, or for various reasons never make it to the courtroom.

Where and how do these 5% hide out?  What (and why) hospitals permit them to admit and treat patients within their institutions?  How are doctors screened, or in the argot of the medical world, credentialed and privileged?  How reliable and trustworthy a process is this?  Why is the profession so notoriously lax in disciplining its own members?  When you enter a hospital, it all appears vaguely chaotic, with all these people in uniform running here and there.  Who are they, what are they doing, and who’s in charge here?  How do you know if these people are doing what they are supposed to be doing, especially when it’s your turn?  Mistakes and even negligence are a frequent part of life, in every profession and occupation.  Mistakes and negligence kill 50,000 on the roads of America every year, yet we don’t bat an eye.  But when an accident happens, there is an investigation, there is accountability, there are consequences.  Depending on the circumstances and intent, when a driver kills someone, it may be called accidental death, or involuntary manslaughter, or vehicular homicide.  What happens when a doctor kills someone?  What is it called?  Oops?  (And dispose of the evidence?)

In other words, the issue is medical malpractice or institutional negligence  or both, and this does not mean mistakes, which are inevitable to all aspects of the human experience.  It is important for readers to appreciate that outcomes are not guaranteed, but this should not be confused with medical malpractice or institutional negligence. Malpractice in Shorr’s book means administrative negligence; in other words, outcomes (often catastrophic) that with customary professional care should not have happened.  And so Mr. Shorr wrote a 600+ page tome that takes us on a guided tour into the bowels of the hospital organization, explaining the interrelationships between all levels of the institution, including the responsibilities, conflicts, egos, frustrations, and humanity of all the players, from the governing body to the newest certified nursing assistant.  He elucidates the processes, regulations, policies, and system redundancies that must, or should, be in place to prevent disaster, and what happens when they fail.

Cooking Patients

Considering his subject material and the human carnage involved, the author is remarkably sanguine as he calmly marches through the records and elucidates what actions can and should be taken to improve patient safety.  Take for example his treatment of surgical fires.  I had never even heard of surgical fires, and perhaps, dear reader, you haven’t either.  These occur when something combustible, such as oxygen catches fire on, or even worse, inside the patient on the operating table.  The Joint Commission, the organization that develops minimum safety oriented community standards for hospitals issued a Sentinel event bulletin alerting hospitals to the issue of operating room fires.  Arthur Shorr lists the nine inexpensive  measures recommended by the Joint Commission to take so that a surgical fire never occurs.  Sometimes the fires occur because ointments or gels on the patients face have not fully dried yet, and when an electric tool is used to cauterize, it ignites the ointment.  The solution is very simple; either wait until the ointment thoroughly dries, or make sure you wipe excess ointment that may be hidden in the folds of an obese patient’s skin before you proceed.  Surgeons do not operate alone in the operating room.  They have nurses and assistants and anesthesiologists working with them.  How could all of these people not think of taking simple and necessary precautions to prevent a disaster?  Too often the answer is, they all defer to the surgeon, the commander-in-chief in the operating room.

When a surgical fire occurs, it is usually around the face and neck, and often part of the patient’s face can get severely burned, on the inside as well, including the mouth, airways, esophagus, etc.  The treatment of these burns often causes infections and other complications, leading sometimes to the death of the patient, and most certainly to grotesque scarring.  Imagine going into what you expect to be a routine surgery, and, as reported by MSNBC,  waking up in recovery with ‘your chin gone, your nose deformed, your mouth virtually melted—so damaged that after a dozen reconstructive surgeries, you still have difficulty eating, drinking, and breathing?’

If you are having difficulty imagining this, look at this.

How Many Does It Take?

Now that you’ve looked at some pictures, maybe, like me, you have a problem with comments such as from Karen Weiss, M.D., M.P.H., program director of the Safe Use Initiative in FDA’s Center for Drug Evaluation and Research, that ‘these fires are small in number compared to the millions of surgical procedures performed each year.’  How many is this small number of surgical burn victims?  The same article estimates 550-650 each year!  Entirely preventable except  that the others in the operating room are too intimidated by the surgeon to speak up when the situation is unsafe!  We know this number must be understated because there are many more surgical fires that go unreported or are covered over to preclude malpractice litigation.  As Arthur Shorr reflects, “Both plaintiff and defense attorneys should recognize that the theory of the surgeon as “captain of the ship” has given way to the concept of the surgical team in which everyone  in the operating room has a duty to maximize the patient’s safety.”

The sad plight of children shot and killed in our schools and malls recently has dominated the attention of the media.  So how is it that five or six hundred patients have been burned on the operating table, and it doesn’t even make the news?  And since this conservative estimate of the number of victims is so small, according to Weiss of the FDA, how many victims do there have to be before it deserves comparable outrage?  The MSNBC article quoted above downplays the severity of the situation, in my opinion, by noting that 500 incidents out of 50 million surgeries per year is not that big a deal (unless it’s you, or a member of your family, of course).  Well, let’s see, 89 million passengers fly out of Atlanta airport every year, so I guess if five or six hundred a year catch fire, are disfigured or killed getting off the ground, that’s not such a big deal, right?

Who Authorized this Doctor to Practice?

Author Shorr divides his time equally between the top and the bottom of the hospital hierarchy, but always his focus is on patient safety.  It is obvious he knows from 40+ years of personal experience where the land mines are.  He gives a superb and constructive critique of the credentialing process, which is how hospital governing boards decide whether to grant hospital privileges to a physician after evaluating his performance record.  He points out the turf wars and ego conflicts that can (and do) occur between the administrator and the powerful, leading figures in the medical hierarchy of the hospital.  The CEO, in the incredibly delicate position of having  nondelegable accountability for whatever occurs in the institution,  also knows that if and when he challenges or countermands the medical leadership, those who recommend clinical practice privileges to the governing body, he places himself at the risk of jeopardizing his own employment and career.  How do you exercise principled leadership in such a situation?  Shorr points out the powerful personal incentives for administrators to avoid confrontation with the medical staff leadership and stick to issues with less personal risks such as the politics of  hospital systems, finance, equipment purchases, etc. and not to push issues that could create unpleasant blowback from the medical hierarchy.  Everyone likes to stay employed.

The Administrator’s Catch-22

The catch-22 for the CEO/administrator is that when malpractice occurs in his hospital by a member of the medical staff, the buck stops with the administrator if the credentialing process was compromised when that negligent physician was screened and accepted.  In other words, if a doctor’s professional history gives reason to doubt his competency and he is credentialed and granted practice privileges at the hospital anyway and then later is found guilty of malpractice, the CEO/administrator and the governing body have a serious problem.  The hospital may likely share liability for negligent credentialing and privilege granting.

Shorr focuses on not only ineffective credentialing and weak peer reviews, but he turns his laser on the opposite: sham peer review; the removal from the medical staff of otherwise qualified clinicians for political or economic reasons.  The most dramatic example might be of powerful physicians basically ganging up on a whistle blower in their midst and maliciously driving him/her out of the hospital:  “One of the most profound unintended consequences of HCQIA (a 1986 law designed to improve accountability of physicians)  is the emergence of “sham peer review,” the willful misapplication of HCQIA’s intended  protections refocused to persecute, punish, and otherwise penalize competent physicians.  This cynical and abusive practice is often employed by politically powerful physicians or groups of physicians to advance their own economic, social, or political agendas in the hospital setting.”  It’s hardly a quantum intellectual leap to go from understanding the existence of sham peer review to a profession that tightly closes ranks around its members and resists efforts at transparency, a threat to their control.

Registered Nurses as the Patient’s Advocate

My favorite part of Hospital Negligence is the section on nursing.  Nurses spend by far the most time in actual patient contact, and it is the nurses who generally define a patient’s experience during a hospital stay.  It is obvious that author Shorr has a special empathy for the nursing constituency.  He emphasizes their unique responsibility as patient advocate:  “Registered nurses are the full-time guardians of the patient, and function as patient advocates as defined by the American Nurses Association (ANA) Code of Ethics and most state licensure laws.  Their role as patient advocates should be recognized in their job descriptions as well.  It is understood that although the nurse will principally discharge physician orders consistent with their professional assessment of patients, professional nurses are also expected to utilize their independent  professional assessment and evaluation skills, and communicate relevant observations and concerns to the physician in a timely manner.”

The ANA Code of Ethics, in application, means that a registered nurse will advocate for the patient, even in the face of incompetent or compromised physician oversight.  This puts the registered nurse in the same precarious employment position as the hospital administrator.  If she advocates for the patient, she may open herself up to retaliation from those higher up on the food chain, but if her failure to act courageously results in harm to the patient, she exposes her hospital to liability and probably the termination of her employment.  I have to wonder how many of either hospital administrators or nurses would pass that test?  In my experience, survival instincts trump all other considerations, including violations of the training manual.  As Shorr points out “The administration must continuously reinforce senior management’s commitment to support nursing advocacy”—but how many of them will do that in actual practice?  To his credit, Shorr gives practical examples of how a nurse can question without seeming to challenge authority.

Following a sub-theme of protecting the patients from the very human natures of their caretakers, Shorr gives examples of patient chart notes appropriately done, but no one reads them, and hospital or nursing home records that are falsified by nursing staff, attesting to their having timely turned their patients to prevent pressure sores, when the patient in question had been transferred or even died, or the individual  who falsified the record was not even at work on the days or shifts indicated on the turning logs.  This would be almost funny were it not for the fact that patients needlessly die because of such negligence.  Shorr says:  “Although turning the patients is highly effective, the unreliability of nursing assistants coupled with inconsistent supervisory follow up can place patients at risk.”

Shorr maintains that while physician negligence is by far the most expensive per case in human suffering, death, and malpractice litigation, the mistakes of nurses and other caregiving hospital staff are greater in number, but generally cost far less per incident.

The New Healthcare–a Different Paradigm

The lesson for the patient:  “Until the 1970s the relationship between doctors and patients was highly paternalistic, based upon the premise that “the doctor knows best.”  Today, the concept of patient rights is based on the principle that patients are self-reliant and should exercise the greatest degree of influence possible on the decisions that impact their health and well-being.  Thus, this principle has re-defined the relationship between the patient and the caregivers.  It is the hospital’s responsibility to ensure that this dynamic is respected.”

To which I would add that it is our individual responsibility as patients to insist on this, or find better  caretakers as soon as the opportunity presents itself.  The paternalistic (and sometimes narcissistic) physician model who dictates rather than invites patient participation is being replaced by a new patient activism aided and abetted by the Information Age.  Our becoming a more-aware consumer of healthcare will raise the bar for our providers, as they realize they have a better educated, more observant and involved patient.  Some of them will become better doctors because of us.  That’s good for everybody.

The 5-percenters?  I can’t help wondering, of the five or six hundred people who are victims of surgical fires each year, what happens to the sloppy surgeons who wreck their lives or kill them? Presumably we only know about these five or six hundred cases each year because the doctors are  sued.  Are they still practicing medicine?  Was there disciplinary action?  Even a slap on the wrist?  How would we even know?  I have to ask you, my reader, if you or one of your children needed surgery, and you saw pictures like these of what your intended surgeon had done to one of his/her previous patients, would it influence your decision to have him operate on you or your child?  Would you be inclined to blow it off with an “Aw shucks, everybody has a bad day?  He deserves another chance.”  How would you feel if you knew, not only that he withheld this information from you, but that his entire profession conspired to prevent it from becoming known in order to protect him, a member of the Hippocratic brotherhood?  With improved and accessible performance metrics and much greater transparency,  dangerous physicians should be encouraged to  find something more suitable to do for a living.

Who Should Read This Book?

Who should read this book?  I did, but I am researching the subject.  But I found myself enjoying it, and I learned a lot.  I feel slightly less like a potential victim, and slightly more empowered knowing how a hospital is organized, the relationships, the conflicts, the dangers, the pressure points.  Just as with prior books where I have learned to pay attention to such things as whether or not my doctors or nurses wash their hands (most don’t), Shorr’s book has helped me learn what I have a right to expect in the hospital, and when I have the right to object or insist, strenuously if necessary.  This book has contributed to my self-confidence when I am in a very intimidating hospital environment where you are vulnerable both mentally and physically, are unceremoniously pushed, pulled, and poked, and I am less inclined to passivity the more I learn.  I think it will be a little bit harder for a careless provider to bluff or blast their way past me.

Besides everybody like me, patients or might-be-patients-someday, who else should read this book?  The first thing that comes to mind is every single Congressman and all their staff assistants.  It is the staff assistants who write healthcare legislation, and no one should be permitted to do that without reading this book first.  If this book has an ideology, it is patient safety.  If the staff aides are only concerned about satisfying their lobbyist campaign donors, they might conclude that this book would be of little practical value to them.  This, in my opinion, would be a mistake.  Health, and healthcare, are the great equalizers of us all.  Sooner or later, with very few exceptions, we are all going to need a hospital, and no matter which side of the ideological aisle we hail from, when that day comes, we are going to be better prepared if we have read Arthur Shorr’s book.  There should be a copy of this book in every Congressional office.

Graduate students enrolled or majoring in hospital administration should read this book, and learn about hospital accountability from someone who knows it from the inside out.

Key hospital administrative, nursing, and physician staffs should read this as a reminder of why they chose their respective professions to begin with, and who have a greater interest in raising the bar of their profession than they do in evading the plaintiff’s bar.  By paying more attention to the former, they can minimize danger from the latter.

Defense attorneys:  This book creates a clear picture of the standards and expectations against which your client will be measured.

Plaintiff attorneys who screen potential clients, to appreciate where the community standards and the bar of accountability  are set in order to assess whether the client’s situation is actually worthy of legal pursuit. Shorr makes it clear that there are no guarantees for outcomes in the practice of medicine or patient care services.  As such, the author makes it clear that less than desirable outcomes aren’t necessarily worthy of lawsuit, and draws a clear line between medical and ministered cases of negligence and bad outcomes.

Anyone involved in the education of future generations of hospital administrators should have this book as a resource.

Patient safety advocates of every stripe need to read this book.  Hospital Negligence Legal and Administrative Issues is an invaluable  desktop encyclopedia of patient safety case law.

Why am I promoting Arthur Shorr’s book?  Because nothing in this world moves unless someone or something is pushing it.  If we want our hospitals to become safer places, we have to participate at some level.  This book is a great combination of academic excellence without being afflicted with ivory tower isolation.  It is reality-based, not rhetoric.  This man obviously didn’t spend his many years of hospital administration hiding in some corner office.  He knows hospitals where it really counts most–at the intersection of the hospital and the patient.

You can reach the author through his website here.

 

 

 

The Allure of a Label (part 1)

Humans are tribal.  We tend to form groups with common interests.  Each of us experiences a life-long tension between our desire to individuate and our desire to belong.  We may form or join a group, and eventually the group will get a name, a label, to distinguish it from other groups.  Thus is born the concept of us versus them. Read more..

We are born into some groups.  Religion, nationality, family, ethnic or racial groups are examples of these.  Our families are given to us, but we choose our friends.  At different times during our lives we may identify more strongly with groups we have joined by choice than those we are in as an accident of birth.  We may abandon family ties, or change religions, or become citizens of a different country.  Such conversions usually include some rite of passage, some ceremony publicly indicating that we are now a part of this group, and have severed our relationship with that group.  There may be a baptism, or a taking of an oath, or even a marking of our body in some way.  We publicly take on the name or label of our group, and we usually want the world to know of our new means of self-identification.

Over many years or generations, our long-standing association with a certain group may become a matter of great pride to us, a time-honored tradition.  We may no longer even know why our ancestors originally joined this group, but our own membership has been integrated into our  sense of self.  For some, the question of why you are a Catholic or a Democrat or Republican may seem incomprehensible, like why is there a moon in the sky?  It just is.  There doesn’t need to be an explanation.   Our membership is marked by certain traditions, rituals, ceremonies, festivals, and of course, friends.  Over time the why of our membership becomes less relevant.

As the traditions and creeds of acceptable behavior and thinking for members of the group become entrenched, they are treated as behavioral norms, and breaches of those norms are considered deviations and their practitioners deviant.  Deviants are treated differently, ranging from reduced status to outright eviction from the group.  In every religion for example, there are the orthodox devout and there are the cafeteria believers, those who pick and choose which of the rules and beliefs they will actually adhere to.  Most groups will tolerate deviant behavior, particularly if the group continues to receive financial support from the slackers.  What cannot be tolerated is assimilation or loss of group identity, any weakening of the us versus them.  Demonizing the enemy builds cohesion in the home tribe.

Sports Brands

In time all groups degenerate into power struggles, and joining a group allows us to participate in the power struggle either directly or vicariously.  Take for example our fondness for identifying with certain professional sports teams.    We may root for the Baltimore Boas because they have an incredible pitcher and a powerful batting line-up.  But if over the years those special players get traded to other teams, our loyalties do not follow the players, but generally remain with the local team.  And if, God forbid, the owner of the Baltimore Boas uproots the entire team and relocates them to Baton Rouge, we will abandon our beloved Boas and switch loyalties to the new replacement Baltimore Pythons.  So what exactly are we doing here?  We have not attached to a coach, or the players, or any specific group of players.  We have attached to a label.  To a brand.  We exult with their triumphs, and we share the agony of their defeats, and we will argue endlessly and passionately about what they could have or should have done.  We belong.  We are a part of things.  This is our team.  As individuals, we are faceless fans; in the aggregate we fill their stadiums.

Political Brands

We identify with political and religious labels in much the same way.  For example, am I a Democrat or a Republican?  Suppose for example I see myself as a Democrat.  What exactly does that label mean to me?  Does it mean I espouse every plank in this year’s national or local election?  Maybe, maybe not.  Perhaps I believe a woman should have the right to her own body, but I am fiscally conservative and do not agree with bailouts of the big banks, or of our nation’s myriad undeclared wars and projection of force on people who want to self-govern.  Or vice versa.

A hundred fifty years ago, the Democratic Party politically controlled the South, creating and implementing Jim Crow racist laws to maintain white supremacy in post-Reconstruction.  The Democrats were the conservatives of the era, in the sense that their intent was to preserve the status quo power structure, the aristocracy of the slave-holding South.  The Republican Party as we know it today was formed in reaction to this.  At their first convention in 1880, they stated:  “Resolved:  That in view of the necessity of battling for the first principles of Republican government, and against the schemes of aristocracy [the slave-holding South] . . . . we will . . .  be known as Republicans.”

Over the following century, the Democratic Party did an about-face and became the major political force behind the Civil Rights movement.  Would a 1960s Democrat have been proud to call himself an 1870s Democrat?  Probably not.  By the 1960s the parties had flip-flopped and the Republicans had become the conservatives.  Eventually the Democrats lost political control of the South.  The labels changed meaning.  For some Democrats, nothing ever changed.  They were cafeteria Democrats.  They approved of some things their party stood for, and disapproved of other things.  But they were still Democrats.

The same of course is true of Republicans.  They may see themselves as fiscally conservative, but social liberals.  They don’t care if you are gay or not, but they don’t think their government should recklessly forge ahead with more and more debt.  They may strongly disagree with certain elements of their party platform, but to get their team elected they will have to put up with disagreeable content in their party’s platform.  And of course those wanting to lead the parade have no choice but to pander to all significant subgroups.  After the election is over, let the infighting and the scrambling for positions in the power structure begin.  Again, the group will tolerate dissidence, particularly if the financial support of the group continues.  Leadership of groups comes at a price, and clarity of purpose (other than winning), transparency and integrity are the first values to be sacrificed.  The benefit for members is that they get to belong.  Our team.  Our triumphs and our defeats.   Our iconic leaders.  As individuals we are faceless voters; in the aggregate we put leaders into power.

Labels and Group Warfare (Part 2)

Sometimes one group finds it useful to appropriate the label used by another group and adopt it as their own.  Those who called themselves liberals 200 years ago most likely would today identify with the label classical liberals or libertarian to better distinguish themselves from the progressives who arrogated the label of liberal to their cause.  Why is the label so important?  Because folks buy labels.  Once a brand is established and trusted, it becomes invaluable. 

Very broadly speaking, Democrats became known as the party of the poor and minorities.  Republicans became known as the party of the business-rich (not to be confused with Hollywood-rich) and the financially savvy.   For perhaps the majority of voters, once these identifications become fixed in their minds, little or no further research is necessary.  These instant mental associations do not need to be accurate to be effective precisely because they serve as a shortcut for thinking and make decision-making easier.  From the point of their acceptance  on, the only reinforcement that labels need is brief but frequently repeated sound bites in the media.  As with sports, the names may change and even the entire team can be transformed or relocated, but it is still our team.  We are loyal to our brands. Read more..

Because of the blurring of boundaries when using labels, we are often unsure who we should hate.  During periods of intense competition for control over resources, we find our leaders fanning the flames of our differences, because assimilation usually means loss, defeat.  Republicans don’t want their membership showing interest in or empathy for some of the Democratic Party’s platform. (And of course, vice versa.) There can be no weakness, because we have a winner-takes-all system.  The rank-and-file then behaves much like sports fans, learning to hate people they don’t know, people with families like themselves.  There is too much at stake, or so it seems at the moment.  Politics is group warfare, and the grandstanding of the candidates has little to do with the maneuvering for the levers of power in the back rooms of the State.  The power they seek is to control resources confiscated by taxation and regulation of the producers, to be redeployed to the fulfillment of the winners’ personal vision of a better world and rewarding the pillars of their personal power structure.

Racial Brands

When I was growing up, white people called black people colored.  It wasn’t terribly important because in my neighborhood we were friends and we were all just people.  Well, somewhere along the line colored people became blacks.  I never really understood this because a lot of my colored friends were not very black.  They were just not white.  It didn’t matter.  We were friends, we went to the same church, and I thought a couple of the girls were hot.  But our new abbreviated labels made it clear we had been de-peopled.  Dehumanized.  It became easier to know who to hate.  Black versus white.  Us versus them.

Then black people became persons of color.  As Americans we were in search of better, more politically correct labels.  In trying to mitigate prejudice, we became more focused than ever on differences.  Our labels reflected and exacerbated those differences.

At one time, people who came to this country wanted to become, and be called, Americans.  What was important was not where they came from, or where they had been, but what they had become.  This was the New World, and they were thrilled to begin a new life.  The world changed on us again, and today we are distancing ourselves from our homogeneity and resurrecting and re-emphasizing our cultural differences.  People of color have now become African-Americans.  Perhaps this is because some people came here to become free, and others came here to be slaves.   That would certainly have an impact on my attitude.

But the fact is, today none of us regardless of color are free.   There are growing limits on our autonomy and our lives become increasingly circumscribed by the intrusions of the State.  In New York City as of this date, it is illegal to donate food to homeless shelters because the government does not have the manpower to monitor the salt, fat, and nutrition content of the donated food.  Read about it here http://newyork.cbslocal.com/2012/03/19/bloomberg-strikes-again-nyc-bans-food-donations-to-the-homeless/.   Are there really people who  imagine such micromanagement as being part of the founding fathers’ vision for freedom? The sad truth is, yes there are—a lot of them.  And obviously they have the power to turn their opinions and whims  into law.  One has to wonder, are they really concerned about the nutrition of hungry people, or are they simply trying to starve undesirables out of their city?

Do we want to be perceived and judged as individuals or as members of our group?  Is being a hyphenated American a good thing, or simply one more sign of our fractured society?  If you haven’t traveled much, you may be unaware that prejudices of one group against another are everywhere.   There is no place on this planet that is prejudice-free.  This is just what groups do.  Us versus them.  So by hyphenating ourselves, emphasizing our group-ness, are we celebrating our differences or deepening the divide already between us?  Are our labels the herald of our rise or the stigmata of our fall?  As individuals we might like each other; in the aggregate we can demonize and hate each other.  Divided we fall, while the ascendant State continues to metastasize.

The American Brand

Americans are a group.  What does it mean to be an American today?  What do we stand for?  How would a European watching our elections answer that question?  I used to think being an American had something to do with our Constitution, but today that document seems to change in meaning daily, if not hourly when Congress is in session.  Is there any philosophical bedrock to this racial and ethnic medley called America?  Some few people came here because they were tired of groups, but most came here because they were tired of their group being told what to do by another group.  America meant freedom from harassment from other groups who didn’t approve of your group.  For me, the meaning of the Constitution was simple.  In the words of Erwin Griswold, one-time Dean of Harvard Law School in a speech to Northwestern University Law School in 1960:  “The right to be let alone is the underlying principle of the Constitution’s Bill of Rights.”  America was an experiment in upholding the rights of the individual.  America was not about your freedom to conform, but your freedom not to conform.

Our politicians from both sides see that Constitution as a rubber document.  Yes, some of them pay lip service to a strict construction of the founders’ intent, but those philosophical pretensions evaporate as soon as they get their shot at winning a prize for their group.  The Constitution was formed to protect the smallest minority in the world—the minority of the individual.  If you protect the individual, including those individuals we don’t like and don’t agree with, then you have defanged the power of groups.  Individuals need protection from groups.  When we lose sight of that one fact, we have opened Pandora’s box to endless possibilities for injustice and evil.

 

Labels and Ultimate Truth (Part 3)

Our country was founded more than anything else on the premise of basic individual freedoms, including freedom  of religion, which also had to include freedom from religion, for those so inclined.  Most of those who came to this country were fleeing religious persecution; they were refugees from the moral certainty of their persecutors.  As American educator and historian Arthur Schlesinger stated:  “Those who are convinced they have a monopoly on The Truth  always feel that they are only saving the world when they slaughter the heretics.”  Read more..

Believer is a label.  So is the word heretic.  One indicates belonging and conformity.  The other describes a non-conformist, a deviant from some orthodoxy.  The word heretic has persisted in infamy throughout history, the cause of some of the worst crimes of man against his fellow man.  Groups get very upset when someone deviates from ultimate truth.  In every instance throughout history, the oppressors believed that in their case circumstances justified their behavior.

Among our early forebears, it took almost no time at all for the oppressed to become the oppressors.  Let’s revisit a bit of Americana we may have forgotten.  The Massachusetts Bay Colony was formed by a business that was strongly influenced by Puritan theologians.  About 20,000 folks from England emigrated to this central part of what we now call New England.  In short order the Puritans came to blows with the local Indians because they did not understand their culture.  The leaders of the colony had to pass an examination about their religious beliefs before they could take office.  (Anything sound remotely familiar here, folks?)

One member of their community, a guy named Roger Williams, was banished (excommunicated) on the grounds of sedition and heresy (non-conformity), and the religion-dominated General Court of the Massachusetts Bay Colony accused Roger of “diverse, new, and dangerous opinions.”  In the dead of winter, the sheriff came to pick up Roger (the Church using the police powers of the State).  Roger escaped by hiking through a blizzard 105 miles to an Indian tribe where he was given refuge.  Imagine!  A Christian given refuge by the heathens from his fellow Christians.  Roger and a few of his buddies obtained land from the Indians and called their tiny settlement Providence.  The very next year they decided that in their settlement, government would be restricted to “civil things.”  Unknown to them, they had established the first settlement in modern history with religious liberty and separation of church and state.

But wait.  The story gets even better (and worse).  About four years later the first law was passed to make slavery legal in the English colonies.  And no, it wasn’t in the South.  It was the very same religion-dominated Massachusetts Bay Colony that had made Roger Williams run for his life.  Eleven years after their infamous law was passed, Roger Williams and a colleague spearheaded the passing of a law banning slavery in their new province of Rhode Island.  The pernicious influence of the Massachusetts Bay colony prevailed however, and Roger Williams’s law was ignored and became a dead document.  Seventeen years after his death Newport, Rhode Island entered the African slave trade and remained the leading slave trading center all the way up to the American Revolution.

In one case, persecution was theology motivated, in the other case it was economically motivated.  It never really matters.  When a group wants  something, they will always find the means to justify it.  When a group succeeds in uniting with the police power of the State, minorities will suffer.  Labels are a big part of the propaganda campaigns in advance of misdeeds by isolating the target, portraying them as a threat to the greater community, an instrument of Satan or a danger to society.

Labels become a higher priority in an adversarial or judgmental context.  We know someone or something should be condemned, if only we can get the label right.  What exactly is an atheist?  Indeed, what is a believer?  In what kind of god or God?  Do you believe in an anthropomorphic God, one with human-like characteristics?  Is your God male or female?  Or do you believe in a more ancient model, a pantheistic god, a god who cannot be separated from the universe, that God and the Universe are one and the same?  Or do you subscribe to an Eastern model of God, an infinite force that is everywhere at once?  Or do you simply not know, but in talking about “God” infer something beyond human reference?  There is a continuum between your literalist, fundamentalist believer at one extreme who believes in a personal God who hears and answers every prayer and another believer at the opposite extreme who believes in God as some manifestation of quantum  physics, some indefinable energy field or force stripped of human characteristics–or believers not at all, at least not in any traditional sense.  All of the world’s belief systems fit on that continuum somewhere.  And the vast majority of them have mystical components to their spiritual lives that include good and bad spirits and ultimate rewards.  Even many atheists have churches and services, rituals, liturgies and prayers.

How complicated life can be, when all we want is your basic “us versus them” so it can be clear who has truth and who is sadly in error.  Continuums of any kind have no place in our group orthodoxy, because they introduce uncertainty and ambiguity.  It is the insistence on certainty and final truth that makes any group dangerous to their fellow travelers, whether they are believers of the religious or secular stripe.  Let any group of such believers get their hands on unchallenged power of the State, and we can be sure that whatever is left of the Constitution would be eviscerated overnight.  The primary differences in our political parties today is only which parts of our lives they most want to control.  They have no interest in the individual.  Control of groups is the source of their power.  The laws that are passed and enforced by the State’s monopoly on power are nothing more than the codification of the cultural beliefs of the majority.  As always, behavior considered deviant by that group will be punished.  You are either in or in trouble.

When we feel compelled to impose our sense of superiority or moral rightness on those around us, it is humbling to reflect that it was the Christian world that plunged us into warfare that eliminated 100 million of us during the 20th century.  America is the most religious Christian nation on earth, and we have soldiers in over 170 countries, doing what exactly, other than maintaining our military-industrial complex and doing what empires do?

Bertrand Russell once said:   “Dogmatism and skepticism are both, in a sense, absolute philosophies; one is certain of knowing, the other of not knowing.  What philosophy should dissipate is certainty, whether of knowledge or of ignorance.”  Every group believes their group will be different.  As a matter of fact, they’re certain of it!

The only sure  protection in any society is to enshrine and protect the rights of the individual. Otherwise life is like entering a prison where the only safety lies in quickly being accepted and protected by members of one group from the predations of opposing groups.  The government, as the warden of our society, has little interest in the individual, because what can one person offer the warden that he cannot get in greater abundance from the group?  Is it any wonder then that our Constitution has been under assault almost from the day it was written?

 

Gender Identity as a Label (Part 4)

It is beyond me why gay marriage is the subject of serious national debate.  It is controversy over a group right.  There would be no reason for government to be involved in this debate if we understood individual rights.  Leave people alone and let them do what they want to do.  In the last twenty years there has been a 1000 percent growth in the number of cohabiting heterosexual couples who have chosen not to seek state recognition of their relationship.  They see no particular benefit to involving the government in their bedroom.  Of those others who did get married, almost half of them seek ways to get out of it.  Every benefit the state can provide by licensing marriage can also be achieved through contract.  I think the worst thing that can happen to the gay community is to get what they are pushing for—greater involvement of the state in their private affairs!  Sometimes group thinking leads us to places we regret when we get there.

 If the gays are looking for enhanced legitimacy through state recognition, the results will be threefold:  1) a group that approves of them, with or without the state; 2) a group that disapproves of them, with or without the state; and 3) those that have no opinion about other people’s sex lives because they are too busy living their own.  I don’t think you have to solve everyone else’s problem in order to solve your own.  But then I think slavery would have eventually disappeared without sacrificing 700,000 soldiers in the Civil War. Read more..

At one point in my life I had occasion to ask a therapist friend of mine if she had an opinion about what determines the sexual orientation of a male.  She told me all boys in a normal upbringing are in love with their mothers.  Unlike girls, however, boys have to separate from their mothers.  At about ten or twelve years of age boys begin to compete with their fathers for the affections of their mother.  This is a competition the boy needs to lose, because when he does, he will begin to imitate his father (or male figure in the household) and this is when he begins to develop his male gender behaviors.

I do not know if this is still considered clinically correct.  I gave it no further thought until my son got to that age, and his class at school began to discuss homosexuality.  Over the next few months my son peppered me with questions about how he could tell if he was gay or not, and I didn’t really know what to tell him.  I tried out several theories on him, but they didn’t satisfy him because he kept asking.  One day we were in a tearing hurry running through a major airport because we were late to meet someone at Baggage Claim, and my son asked me for the umpteenth time how he could tell if he was gay.  In total exasperation, I stopped dead in my tracks, looked at him, and said “Jonathan, I don’t know, okay?  Maybe if you see some guy and you get this overwhelming urge to f_ _ k him in the a _ _, you know you’re gay.”  No offense is intended to my gay readers, but that is what I said.  And for whatever reason, it was the answer that satisfied my son.  He busted out laughing (maybe at his dad rather than the answer) and that was the end of it.

During that period of time when the issue was not resolved, I spent some time pondering my son’s question.  I really didn’t know how to answer him.  And I probably still don’t.  But I do believe that gender identity is also on a continuum, and that everyone, both male and female, is somewhere on that continuum between very heterosexual and very homosexual at the extremes.  It’s not a black or white issue for many men and women.  My son’s question was an honest one, and he didn’t need to be bludgeoned with an answer.  With no preconceived notions about gender identity, his question was a totally innocent one, having no cause to find himself at either extreme end of a gender continuum of say, 1 to 10.  This particular journey of self-discovery was just beginning for him.  There was no need to urge him to engage in stereotypical macho behaviors to convince himself or some audience of his masculinity or to make him feel guilty about honest inquiry.   I saw my son as an individual, not a potential member of some class of society.

 

Beware the State (Part 5)

Groups are a mask  for power seeking.  Nature abhors a vacuum, and a group can know no rest until a leader vanquishes all other comers.  Then groups compete with other groups, and groups align themselves in larger and larger packs, until finally nation states emerge.  At every level there is a struggle for power and dominance.  It becomes even harder to maintain power than it is to achieve it.  The vanquished go underground to live and fight another day.   I am forever reminded of the comment of Russell Baker, NY Times columnist, who wrote:  “What I despise the most about all minorities is their implied assumption that if the tables were turned, they would be different.”   Or as Eric Hoffer put it, “It is doubtful if the oppressed ever fight for freedom.  They fight for pride and for power.—power to oppress others.  The oppressed want above all to imitate their oppressors; they want to retaliate.”

The strong will prey on the weak.  Government is given a monopoly on the use of force to protect us from those who would harm.  Unfortunately government has always done more harm to its citizens than those others who supposedly threatened.  With a monopoly on guns, government has always found irresistible the temptation to use that power to solidify their position by eliminating their competition.  Read more..

The question has always been how to govern without letting the beast of power out of its cage?  Democracy is not enough, because any majority can and usually will turn on the minority for all the usual reasons.  Majority rule only makes sense if legal restraints are placed on the majority; that some things cannot be decided by majority rule, because some rights are inalienable and not subject to a vote.  The Constitution was the founding fathers best effort to limit the ability of our government to harm us.  Let’s be clear:  what is a government?  A group, that is all, some group of people like you and me with very bright ideas about how to make the world better for you and me, better than we can do on our own.  Of this they are quite certain.  So certain, in fact that they find it necessary to make their notions into laws as acts of coercion.  Every road to tyranny has been built with intentions for the greater good.  Every tyrant has demanded sacrifice for better tomorrows.

Today our national government passes 600-700 new laws every year to define and better refine the wonderful world they are making for us, or the better to protect us from our own foolish longings.  Every citizen in this country breaks laws every day, and should the government so choose, every single one of us could spend time in what is already the world’s largest prison system.  This is the price we pay for a century or more of steadily chipping away at the Constitution’s protections of individual rights.  Why have we done this?  Because over and over again, individual rights got in the way of something a group wanted, and each small victory for a group imposed a burden on others, who sought protection in groups of their own.

Since the State is nothing more than the conflict of groups, do you want to limit the power of those groups to interfere with your life, or would you give those groups free rein?  My experience is that those who are in favor of ever-expanding power of government are the same ones who are confident of final victory for their vision, with themselves experiencing the satisfaction of imposing the vision of their group  on those less enlightened.  There is a word for that:  tyranny.  No tyrant stands alone.  He has the support of groups, each of whom plays the odds as they jockey for advantage in competition with all other groups.  At best, the individual is only a footnote in the annals of history.

Emotional Response to Labels

Look at this list of labels.  What are your associations with each?  What emotions do you experience as you look at each item?  You are experiencing the power of labels, the power of branding, both positive and negative.

 

Drug addict                 Sex molester              Alcoholic

Ex-convict                   Mentally ill                 Tea Party member

Prostitute                     Atheist                         Occupy Wall Street

Televangelist               Lawyer                        Factory worker

Jew                                  Catholic                       Jehovah’s Witness

Social worker              Teacher                       Union organizer

Rich-celebrity            Rich-business           Rich-doctor

Liberal                          Conservative              Socialist

Gay                                 Straight                         Bi-sexual

 

Each label above brings a vivid emotional message to someone’s mind, and that message doesn’t have to have any basis in fact or reality.  Most likely it has to do with identification with one group or another and hostility to the perceived opposite.  Social media is powerful because we find strength in groups.  It is a rare person who is willing and able to think alone and stand alone for any length of time.

Groups use labels to narrow the field of who we are willing to learn from.  Judgment becomes pre-judgment.  Pre-judgment becomes prejudice.  Thinking is no longer required.  We know who the enemy is.  We know who to hate or fear.  The door to civil discourse and scientific inquiry quietly closes.  The individual is helpless.  Power to the people!

Which people?

The group with the control of the most resources; the group with the most access to the coercive machinery of the government; the group with access and control of propaganda, including media and state-sponsored education.  Power is ephemeral.  No group provides eternal safe harbor.  The only enduring legacy of groups is endless struggle for power.  What an irony that America became a magnet for freedom lovers from all over the world because of its Constitutional protection of individual rights, and then became an empire corrupted and mired in group warfare.

 

 

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