Don’t Talk Write ep 8 with Loraine Mponela

Interview with poet and activist Loraine Mponela.

I was not born a sad poet — Get a copy:
UK
https://www.amazon.co.uk/dp/B0BHL4R1JL/
US
https://www.amazon.com/dp/B0BHL4R1JL/

Socials: @LoraineMponela

Website: https://www.noaudienceloraine.co.uk

YouTube: https://www.youtube.com/@lorainempone…

Poem: You Tried to Keep Your Head Up (for James Byrd)

You lived a life that made your family proud,
But the weak-minded hated the colour of your skin.
You lived a life that made your family proud,
But fuelled master race fantasies for neighbour kids.

You trusted the boys who claimed supremacy.
To be generous and relieve your heavy burden.
You trusted the boys who claimed supremacy
as they brought your death and your ascent began.

You tried to keep your head up,
as those bastards laughed through your screams.
You tried to keep your head up,
with pain and blood in free flowing streams.

You were the only man there
as you were tortured by these boys.
You were the only man there,
Your body drug through gravel like a toy.

You lived gently and kept your head up,
And you died in excruciating pain.
You lived gently and kept your head up,
So we must ensure white supremacy never rises again.

Other works inspired by the murder of James Byrd, Jr.

 

How to Become Homeless

People use the phrase “homeless people” as if it refers to a type of person instead of a type of circumstance. People without access to shelter are sometimes born into a homeless situation, but they are not “born that way” in the same way that tall people are born with genes for height.

If you spend any time at all talking to people without homes, you will quickly realize you are much closer to being homeless than you are likely to want to admit. I honestly believe this is why so many people avoid those conversations at all costs.

I suppose we are most affected by stories that relate closely to our own lives. At least, I know that is true for me, so I will never forget meeting a homeless man who taught at the same college as I. He was highly educated and had been living quite comfortably until a medical emergency left him in a coma for some time. He wasn’t expected to live, much less come out of the coma and leave the hospital, but sometimes medical miracles do happen.

When this man got out of the hospital, he found that his sister and nephews, thinking he was dying, had emptied all the money from all his accounts and gone on a cross-country spending spree. The money could not be retrieved, and prosecuting the thieves would mean sending his own family to jail. As he told me he couldn’t bring himself to file charges, tears rolled down his cheeks. He was still teaching classes while trying to hide the fact that he was homeless from his students and employer.

I spoke to hundreds of people who were in crisis, and I would say that the most common causes of their homelessness were medical emergencies that resulted in job and/or income loss, failed businesses or theft of businesses funds by unscrupulous business partners, failed romantic relationships, mental illness, grief, domestic abuse, and, yes, addiction. This last one (addiction) should simply fall under illness, but I recognize that many people believe that addiction is a personal choice, and this belief enables them to blame homelessness on the victims of depression, grief, or other factors that lead to addiction. No one chooses to become an addict and lose everything.

Another category deserves a separate post, really, and that is young people who are thrown out of their family homes for being different, usually for being LGBT+. These young people are extremely vulnerable to exploitation and abuse, including murder.

I suppose some people are wealthy enough to be insulated from the risk of homelessness, but many people I spoke to had lost all the things you have and take for granted. They had homes, cars, businesses, and all that goes with those things, including pride, self-worth, dignity and comfort. Many of the people I met were able to maintain their feelings of pride, dignity, and self-worth despite seemingly every part of their families, their society, and their government trying to take those away from them. I was and remain in awe of the people who have managed to fight their way back from the brink without being destroyed by their situation.

Many aren’t able to overcome the odds, and each death is a failure of society to look out for every member. Immanuel Kant famously said that if we will heartlessness to those who are victims of misfortune, we are willing indifference to our own suffering when our time comes. No one gets out of this world alive, so your time is coming. Have you acted in ways that make you worthy of compassion and respect?

Photo by Chris John on Pexels.com

Exit Strategy (#poem)

“… come out of the wardrobe, cross the line of the rainbow and be who you want to be!” Dona Onete

After encouraging him to explore his “other side,”

She said, “If you leave me, I will tell about this,

And you will never see your children again.”keeping promises.jpg

And so it began—a desperate life locked

In a wardrobe guarded by a severe overseer.

Each tentative act of self-expression

Quashed in a confused melee of frustration.

He lived an inauthentic life of duplicity under duress,

With progeny held for ransom in

An unending act of passive aggression.

He lives behind a mask—

A promise keeper and provider—

As a pillar of the community,

A propagator of traditional value.

A leader is born in shame,

As he passes judgment on

His fellow sinners and wanderers,

He builds influence and takes on followers

Until his identity cracks,

And the anti-depressants fail

Along with his attempted suicide.

From hospital, he reads the headlines.

Everyone knows his name.

His warden and manipulator is now moot,

So he lifts himself off the pillow

And squares his shoulders

Before facing the inevitable question:

“If you were so miserable,

Why didn’t you leave?”

In US, Illness is Financial Anxiety

In August 2016, I moved from Texas to the northwest of England. Last summer, I while walking in the local park I slipped on a stepping stone and sprained my ankle. As the pain pulsed through my body and my ankle began to swell, I began to wonder whether I needed an ambulance, an x-ray, or possibly even surgery.

I did not think about the cost of an ambulance or whether my insurance might refuse to pay for it, the cost of an x-ray if needed, the price of surgery, or even co-pays for medication or any possible treatments. I was worried only about my condition and getting better.

I enjoy hiking, cycling, dirt bike riding and other sports with risk of injury, so I’m not unaccustomed to dealing with the occasional injury. With similar injuries in the United States, though, I always thought immediately of the cost. Mind you, I was never uninsured, but even with insurance proved by the college where I taught, a shattered tibial plateau in 2001 that required two surgeries and months of physical therapy left me with surmountable but daunting bills long after I had recovered. Since 2001, prices have risen dramatically along with higher deductibles, narrower networks, and higher copays for treatment.

In the United States, illness or injury means an immediate calculation of costs and threats to financial security even for working people securely in the middle class. For others, the situation is much worse. Of course, long-term illness or injury can throw middle-class workers out of work, which means they will lose their insurance, unless they can afford COBRA payments to maintain their insurance for a limited time after employment. In my experience, COBRA payments are much higher than people expect or are able to pay.

As a student in medical humanities, I read many narratives of illness. They all focused on suffering from the condition, facing mortality, finding or making meaning in the face of prolonged pain, but not so much about what truly horrifies Americans when they fall ill. Illness or injury should be a time to focus on healing, if possible, or confronting or preparing for prolonged pain in the case of a chronic condition, or to prepare for death in the case of terminal illnesses. It should not be a time to worry about financial ruin for oneself and one’s family.

The study of medical ethics offers many opportunities to contemplate challenging philosophical problems with rich and varied intellectual interest. However, access to healthcare is by far the most pressing problem in the United States. Anyone concerned about illness, suffering, and medicine must assume the obligation to relieve the suffering created by unaffordable healthcare.

 

 

Payment as Coercion: Researchers Versus Research Participants

In the world of medical research, ethicists say it is unethical to pay a substantial amount of money to research participants. If you give a hefty sum for participation, people might sign up for risky research that they would otherwise avoid, so they can only receive minimal compensation for their time. Large payments exploit them and violate their autonomy by removing their ability to refuse participation. Of course, people with little money and few resources will sign up for risky experiments, anyway, because they need the money, even if the sum is paltry. Poverty reduces one’s autonomy and makes one ripe for exploitation, unfortunately.

The other way to look at it, of course, is that individuals are participating in research that may yield lucrative products, may cause unpleasant or harmful side effects, and may be quite inconvenient, indeed. For loaning their bodies to this unpredictable, but likely profitable, enterprise, it might make sense to compensate them more generously for their time and willingness to risk their own health. After all, it is common for workers who engage in other types of risky work to be compensated above normal pay scale. So, I say the industries should compensate their research participants in ways that are commensurate with the risk and inconvenience they are accepting.

Finally, if payment is coercive for research participants, surely it is coercive for researchers as well. Even workers with six-figure salaries can be exploited and manipulated with large sums of money and other favors. Without large payments, doctors and researchers might well be doing the work they are doing, but surely large payments (much larger than any research participant ever gets) must compel them to conduct their research in ways they would not in the absence of such large payments. We might say they have, in effect, had their autonomy stripped from them through coercive payments.

And so it goes.

How to Support a Mourning Man

When Olympian gymnast John Orozco made it onto the US Olympics team after recovering from an Achilles tendon injury and, more importantly, the loss of his mother, he wept openly with a mixture of joy and profound grief. We can’t know whether he was trying to suppress his tears, but they flowed freely and he made no apology for them. I was moved by his emotion, of course, but also grateful that he appeared to weep unabashedly and free from shame.

Not many men can do the same. I have been honored and fortunate to be in the presence of men crying on a regular basis. As a volunteer facilitator for a grief support group, I see men seeking support after the loss of their children, spouses, or other loved ones. Although a few manage to suppress their tears, most of the men weep, and almost all of them apologize for crying like a child. Fortunately, other men who have experienced a traumatic loss are quick to offer a reassuring, “Don’t worry, I’ve spent many hours crying my eyes out, too” or something similar.

It is disappointing, though, to learn how many men do not feel comfortable crying in front of their own families and partners. I hear stories of men crying in the middle of the night or in cars, closets, and bathrooms. Some men schedule time to let their tears flow as they try to put on a brave, unemotional face for the world.

I wish I could say their efforts were unwarranted, but too many men have been criticized for their tears. One distraught father who lost his son to suicide told me people at the funeral told him to “pull himself together” for his family. Other men tell of supporting their wives through extended fits of wailing only to receive a cold shoulder when they break down. Often, I hear laments along these lines. “I know I’m a strong person. I have to be strong. But this is too much. Is there nowhere I can get support?”

It is commonly held, even by some therapists, that men naturally grieve differently from women. Allegedly, men process their emotions through actions rather than emotional purging. Men may bury themselves in work, start organizations in the name of the deceased, build monuments, or fight for legal changes to prevent future deaths. Of course, many men do this, and so do women, but this does not mean that men’s biology prevents them from accessing their tears. Men and women both grieve through actions and tears.

If anything prevents men from grieving openly, it is social prohibition, not biology. Whether you are a man or a woman, please know that most men are capable of crying, need to cry, and should not be ashamed of their grief or their tears. If you need to support a man in mourning, please let him cry. If you are a man in mourning, please follow the example of John Orozco and cry without shame or apology. You are not crying like a baby; you are crying like a man.

Stop infantilizing old people, please

As I write this, I am 55 years old. Like most people my age, I like to think I am a “young 55” or that I look good “for my age.” As I get older, I think I have become a little more patient, more accepting, less doctrinaire, and, yes, sadder and wiser. However, I have not become more adorable, precious, charming, or sweet.

Although I am not yet extremely old, I’ve already noticed that younger people I hardly know sometimes refer to me as “sweetheart” or “sweetie.” This seems to be a particular problem in healthcare settings. Some call it “elderspeak,” which is characterized by treating older people more as children than as fully functioning adults (I personally feel this demeaning language is often inappropriate for children as well, but I will take one thing at a time). For some reason, when people talk to older patients, they tend to slow their speech, raise the volume, and sing their sentences. In addition, every statement seems to become a question and second person pronouns are replaced with first-person plural pronouns ( e.g., “you” becomes “we”). You can read more about this phenomenon here.  At a time when nursing home workers are sharing explicit photos and videos of older adults on social media, complaining about “sweetheart” seems almost quaint, but both the diminutive terms and the more extreme demeaning media rob patients of their dignity and personhood.

Other people seem to think they are honoring older adults by treating them as mascots. Many videos on social media feature adults who are “adorable” or “precious” dancing, singing, or doing other activities they have no doubt done for their entire lives. The videos are presented with the exact same attitude behind videos of kittens, puppies, and babies. Samuel Johnson once said, “A woman’s preaching is like a dog’s walking on his hind legs. It is not done well; but you are surprised to find it done at all.” Videos of the elderly seem to take the same attitude: it is amazing that older people might still do the things they love. If they make the attempt to engage in the activities that make them happy, the are “so cute.”

The consequence of assuming adults become children once again in later life can have serious consequences. For instance, healthcare providers often ignore the sexual health of older patients. As this article states, “prevailing misconceptions among healthcare providers regarding a lack of sexual activity in older adults contribute to making elders an extremely vulnerable population.” The result of this ignorance, is that STD rates among the elderly are increasing at an alarming rate. Although about 80 percent of adults aged 50 to 90 years old are sexually active, they are infrequently screened for STDs.

I am more concerned, though, about the basic harm of a society that treats its elders as mascots for amusement. As we age we lose the respect of our fellow beings and we lose our status as persons. For the most part, younger people don’t mean any harm, even if they are doing harm; they are acting out of ignorance. That being the case, I am here to help. The following are things you should know about your elders:

  1. They have and talk about sex. In a movie, it is always easy to get a good laugh by having an old person, especially an old woman, make any kind of statement that indicates she knows what sex is. Apparently, many young people believe that when you hit a certain age you become an innocent and naïve virgin, completely unaware of how people reproduce.
  2. They curse. This is related to the first point, but it slightly different. If you curse now, you will probably curse in 10 or 30 years. At what point do you think it should become funny or cute? Old people have the same right to words that everyone else has. Language is a human right.
  3. They still know how to do things. It isn’t amazing that someone who has danced since he was seven still likes to cut the rug when he is 80. Our abilities may diminish over time (some do and some don’t), but we don’t suddenly forget everything we’ve learned over a lifetime.
  4. They are still rational and intelligent. I realize we all suffer some cognitive decline as we age and some are affected by diseases that accelerate or accentuate that decline, but young people also suffer brain injury, disease, and other limitations on cognitive ability. Age is not a sufficient reason to believe someone is stupid.
  5. They’ve won the battles you are fighting. Somehow, your elders have survived. If you can manage the same, you should be honored, as you should honor them now. Any old person can tell you it isn’t easy growing old. Someone who has survived had the wits and strength to overcome many adversities. They could teach you a thing or two.
  6. They are persons. Here, I am using the word “persons” in a philosophical sense of someone who bears human dignity and value. It does not diminish as you age. If anyone has value, you do.

In case you haven’t seen any of the videos I described above, here is an example:
[youtube https://www.youtube.com/watch?v=R7Br3-5L6hM]

Reid Ewing and the Failure of Autonomy in Bioethics

Reid Ewing of Modern Family fame recently wrote publicly about his struggle with body dysmorphia in a personal essay on the Huffington Post. Ewing revealed that his dysmorphia led him to seek and receive several surgeries. He feels his surgeons should have recognized his mental illness and refused to perform surgery. He wrote, “Of the four doctors who worked on me, not one had mental health screenings in place for their patients, except for asking if I had a history of depression.”

The principle of autonomy is by far the most discussed principle of bioethics. Discussions typically focus on the rights of patients to refuse treatments, not to seek them. On either side, the issues can be thorny. If a depressed and suicidal patient refuses life-prolonging treatment, is it ethical to respect the patient’s autonomy or should mental health services be provided first? As in Ewing’s case, the ethical problem arises from the claim that the decision is driven by mental illness and not reason. If someone is mentally ill, they are not fully autonomous agents as they are not fully rational.

This is a problem with autonomy in general. Our ideas of autonomy come largely from Immanuel Kant, who claimed that all rational beings, operating under full autonomy, would choose the same universal moral laws. If someone thinks it is okay to kill or lie, the person is either not johnny-automatic-gloved-hand-with-scalpel-800pxrational or lacks a good will. How do we determine whether someone is rational? Usually, most of us assume people who agree with our decisions are rational and those who do not are not rational. If they are not rational, they are not autonomous, so it is ethical to intervene to care for and protect them.

Earlier this year, a woman named Jewel Shuping claimed a psychologist helped her blind herself. She says she has always suffered from Body Integrity Identity Disorder (although able-bodied, she identified as a person with a disability). Most doctors, understandably, refuse to help people damage their healthy bodies to become disabled, which can lead clients to desperate measures to destroy limbs or other body parts, sometimes possibly endangering others.

Jewel Shuping never named the psychologist who may have helped her, so it is impossible to check the story. It is possible to imagine, however, that some doctors would help someone with BIID in the hopes of preventing further damage to themselves or others. Shuping says she feels she should be living as a blind person, and she appreciates the help she received to become blind. In contrast, Ewing feels he should have undergone a mental health screening before he was able to obtain his surgery and that his wishes should not have been respected.

Plastic surgeons are often vilified as greedy and unscrupulous doctors who will destroy clients’ self-esteem only to profit from their self-loathing. On the other hand, these same plastic surgeons are hailed as heroes when they are able to restore beauty to someone who has been disfigured in an accident or by disease. Unfortunately, we do not have bright lines to separate needless surgery to enhance someone’s self image and restorative surgery to spare someone from a life of social isolation and shame. Some would argue the decision should not be up to the doctors in the first place but should be left in the autonomous hands of clients.

Many have similarly argued that doctors should refuse gender confirmation surgery to transgender men and women. As with BIID, many assume that transgender individuals are mentally ill and should see a mental health professional, not a surgeon. Transgender activists (and I) argue that transgender individuals need empowerment to live as the gender that best fits what they actually are. If surgery helps them along that path, they should have access.

All this leaves us with the question of when to respect autonomy and when to take the role of caregiver, which may involve a degree of paternalism (or maternalism for that matter). Is it more important for doctors who ensure the patient’s rights to seek whatever treatment they see fit, or is it more important to provide a caring and guiding hand to resolve underlying mental health issues before offering any treatment at all?

One of Ewing’s complaints is that he was offered plastic surgery on demand with no screening at all. The process for people seeking gender confirmation surgery, by contrast, is arduous. Before surgery, transgender people go through counseling and live as their true gender for an extended period of time. At the far end of the spectrum, people with BIID rarely find doctors willing to help them destroy parts of their bodies and resort to self-harm. These three cases are not the same, but make similar demands on the distinctions between respect for autonomy and a commitment to compassionate care.

It seems reasonable to accept Ewing’s claim that mental health screenings should be a part of body modification surgery, especially when someone has no obvious flaws that need to be repaired. In all these cases (dysmorphia, gender identity, and BIID), mental health support is necessary. In each case, patients describe depression, emotional turmoil, and, too often, thoughts or attempts of suicide. Mental health care does not require a violation of autonomy, but it may help a person’s autonomous decisions to form more clearly from deliberation and not desperation.

 

The Problem with Telling Boys to Never Hit Girls

First, I should clarify that I do not think it is acceptable for boys to hit girls, but the admonishment to “never hit a girl” has two problems. 1. It gives tacit permission to hit other boys. 2. It tells boys they have no right to complain when someone hits them. Under this one maxim, boys are certified as aggressors and negated as victims of violence.

If parents and teachers simply told boys not to hit, it would go against everything masculinity represents, unfortunately, in our culture. Fathers would worry that their sons would never toughen up, “grow a pair,” or be able to attract mates. Surely, they say, if boys don’t enter the rough and tumble world of male aggression they will all grow up to be homosexual. Rather, they really mean they will grow up to be “feminine” (I use the quotation marks to show that I do not believe any particular traits are feminine or masculine, but these words are used in stereotypical fashion), which is the real fear. Misogynists assume feminine boys are gay without understanding the difference between orientation and identity or the simple human spectrum of personality traits. It is misogyny that drives the rage against non-conforming boys. It is hatred of who they are more that what they do.

To avoid recriminations, boys with take and give punches and other forms of violence on a regular basis as practice for adulthood. The boy who grows up in this environment isn’t shamed for being violent. Rather, he is shamed when he is passive. If you are a boy who has been told he must never hit girls, when someone hits you, the aggressor has done nothing wrong. In fact, if you don’t hit back, you have done something wrong. You are lacking. Violence is an obligation of masculinity.

If you fail to stand your ground, you will be reprimanded for letting some bully push you around. You will likely be put in self-defense classes. You will likely be told you must toughen up and learn to take care of yourself. While a girl in your position might be given the opportunity to learn self-defense, her status as victim protects her from similar shaming. Violence may be an option of femininity, but it is not an obligation. Boys are denied the status of victim. Boys are told they can only be bullied if they don’t stand up for themselves.

And if a girl hits a boy, the boy is in a double bind. The shame of being hurt by a girl is far greater than the shame of being hurt by a boy, but the opportunity of self-defense or retaliation is taken away. The boy will face shaming such as: “How could you let that happen? She’s just a girl. Don’t hit her! She’s just a girl. Be a man! Just walk it off!” We wonder how adult men become victims of domestic violence, but this pattern is carried into adulthood. The man who is physically assaulted by a woman is rarely recognized as the victim he is. A woman half his size (of course, not every man is married to a woman half his size) couldn’t possibly hurt him. Surely, a grown man can take care of himself? If he strikes back, he earns the label of abuser for himself. His explanations are unlikely to be believed.

In addition to teaching boys that they are acceptable victims of male-on-male violence and that aggression against other boys is expected, it does little to protect the physical integrity of girls and women. Some time back, a video PSA against domestic violence went viral. The video shows boys standing in front of a passive girl as a man off-camera tells them to touch her and caress her. The boys do not hesitate to touch her until the man tells them to to hit her. All the boys refuse, inspiring tears and celebrations around the world. At the end of the video, a boy is told to kiss her. He asks only, “On the mouth or the cheek?” The message, it would seem, is that girls, passive and beautiful beings that they are, should never be hit but should also never have agency over their bodies. They boys say they are against violence, but they appear to have no concept of consent. They are willing to touch her body without her invitation but with the approval of an adult male. Before venturing a kiss, the boy asks the man, not the girl, how to proceed. I find the message of the PSA disturbing.

We could instead teach boys and girls to respect the bodies of all others. Sure, teach the children self-defense techniques but teach them also that aggression is an assault on the bodily integrity of another. Furthermore, this aggression can come in the form of a slap, a kick, or a kiss. We can teach children to respect all bodies and that touching others requires consent, and we can begin by showing respect for the bodies of children. It is not all right to hit girls because it is not all right to hit people. And, as the video below shows, it is not all right to hit animals, either.