dignity

Grief Story: Daughter recalls her father’s death in the UK

R. Horton2 Comments

The following is the recollection of a woman in middle age reflecting on her father’s illness and death some years earlier. I’ve heard many people from the UK who express similar gratitude for the NHS.

Memory is not my strong point. I say that because, when someone is dying, memory can get fuzzy anyway and I will remember some things about my Dad’s dying and death clearly and some things less so.

I guess Dad’s illness became most obvious about a year before he died. I can’t remember whether I knew it was Myelodysplasia – MDS (a form of leukemia in which the bone marrow does not function normally and produces insufficient number of normal blood cells ). What I do remember is that he started to feel tired and listless and started to have regular blood transfusions, at first once a month, then once every two weeks and finally weekly (and it could have even been more often). This trek to the hospital for the transfusions was quite a burden for him and for Mum. I was living 200 miles away at the time so heard about it in our weekly phone calls. Mum would tell me how he was doing. It seemed at first that everything was under control and there was nothing really to worry about. Life went on.

I think the first time I began to realize that something was really wrong was when I went home for a visit and saw the weight Dad was losing and how his mood was really affected by the illness. He was irritable, not his usual cheerful self. Someone had come to visit, a neighbor who, if I remember right, was also going through some illness himself. I Despairremember Dad only being able to tolerate a very few minutes of the social interaction before he had to give his apologies and go back to bed because he was so tired. I think this was a shock to me. This had to be about 6 months in.

I tried to visit more often of course, but a life in another city and a busy job kept me from doing so. I would hear in more regular phone calls with Mum about Dad’s slow deterioration. I marvel at the fact that the intense regime of transfusions and the treatments associated with them were free to Dad – a function of the British National Health Service (NHS). Over their years of working Mum and Dad had contributed their National Insurance contributions and now the NHS was doing what is was supposed to do – support them in their hour of need. Unlike here in the US, my parents never had a moment of worry about having to pay for the treatment – a true blessing at a time when any extra worry would have been overwhelming.

I learned later that Mum really knew what was happening, despite downplaying the seriousness to us (adult) children. I also learned later from her that she had tried to talk to Dad about the inevitable end point that she knew was coming – his imminent death, but, either because of his fear or discomfort for both of them in talking about such a taboo subject, she couldn’t get him to talk to her until a few days before his death and then only briefly.   My heart aches for the lack of this conversation, and I tear up now imagining what more discussions could have meant to them both.

Over the months, I think I had been hearing the stress in Mum’s voice and came to see them more often. However, she never asked for help – a Northern British trait if ever there was one. The first time she did tell me she needed me to come was on the day of the General Election in May of 1997. I will never forget that day. I was volunteering for the Labour Party that day, taking numbers at the polling station. Mum and I talked and she finally told me that she feared the worst – would I come? I, of course, said yes. I stayed up to watch Michael Portillo lose his seat  and got on the earliest train home the next morning.

When I arrived at home, I remember the stress, grief and fear that I encountered in Mum. I also remember seeing Dad, in bed, so tired, exhausted and drained. And thin, stick thin. A shock to me after not seeing him for a few weeks. That afternoon, the doctor came (yes, a home visit – a rarity these days). Dad had also been tended to by the District Nurse (as a side note, my recollection was that he had been looked after by Macmillan Nurses – an amazing free service via the Macmillan Cancer Support charity in the UK. In later conversations with Mum for this article, she reminded me that although they had applied for this help, everything happened so fast in those last days that Dad died before she got their help).   All of us, the doctor, the nurse, myself and Mum sat outside in the garden on the afternoon of 2nd May. I remember that scene so very clearly. I remember the doctor telling us about Dad’s condition and how he had deteriorated. I remember asking the doctor directly “How long does he have? Days? Weeks? Months?” I remember the doctor telling us that we should prepare for Dad’s death in the next hours and days.   It’s hard to convey to those who haven’t experienced this kind of interaction what a profoundly awful, sad and gut-wrenching feeling is engendered by this information. I think that’s why I remember it so vividly still today, 17 years later. There is something good about knowing this though, of course. It gave us just a little time to prepare.

So, with that time, Mum and I contacted my brother and sister who made plans to come straight away. That night I told Mum I would spend the night with Dad to give her some rest. In hindsight I don’t really know whether I regret that decision or not. It was probably one of the most traumatic and harrowing times of my life. I won’t go into details here but suffice to say that Dad was hallucinating on morphine and coming in and out of rational thought. It was a powerful and devastating experience, for both of us.

On Saturday my sister made it in the morning. She spent some time with Dad and then Mum and us girls made it through the day. Dad was in bed, still gravely ill but hanging on. What I now believe is that he hung on determinedly and staved off death until my brother made it home in the late afternoon. What an amazing gift he gave us for us all to be together at this profound moment. All of us were downstairs a couple of hours after he arrived and I heard a noise upstairs. Mum and I went to check on Dad and sat with him a while. Then he died.   Once more, it’s hard to convey the gravity of this experience. I was so glad we were with him to hold his hand and let him know that he was loved as he journeyed out of this world.   Once his spirit was gone and his body remained, we all as a family spent time with him, in his own bed, sitting with him, drinking whiskey and sharing tears and memories. The doctor and funeral directors came later that night and he was truly gone, spiritually and physically. To be honest much of these activities are a blur to me now.

I suppose the reason for putting all of this down on paper is partly to remember that time and have a record so that it’s noted in this span of life when I can still recall some details. Another reason is to remark on my experience of how terminally ill people are supported and cared for in England. Mum will have her own experiences of the National Health Service treatment leading up to this final time. From what I remember it was supportive. My sister reminded me that it wasn’t all great and that sometimes Dad would be waiting on a trolley until he could get a place in a ward and that this experience made him determined to die at home. However, what I do clearly remember is the warmth, care, attention and dedication of the healthcare providers I encountered. And, what I also remember is that all of this amazing care was free at the point it was needed. No-one in this story had to have the additional stress of worrying about which treatments were covered by health insurance. No-one had to worry about co-pays or debt because of the treatment my Dad had to have. No-one had to have the additional stress of worrying about bankruptcy if things weren’t covered. I know the NHS has it’s problems – it did back then and it does now. But, even though problems exist, the fundamental principles of the NHS: that it meet the needs of everyone; that it be free at the point of delivery; that it be based on clinical need, not ability to pay substantially helped my family to experience leukemia diagnosis, treatment and ultimately death in the best and least stressful way possible. I hope you’re listening America.

 

When the hospital refuses to provide treatment

R. Horton

Few things are as horrifying as the idea that a hospital might refuse to treat you or a loved one at a time of crisis. This is so frightening, that many used the specter of “death panels” to terrify Americans from supporting the Affordable Care Act, which had no provision for such panels. All the same, we don’t get to go into hospitals demanding whatever treatments we think are appropriate. Doctors, other medical caregivers, and insurance companies all have a say over what treatments are acceptable for various conditions.

One of the most common issues before Hospital Ethics Committees is futility. In all the cases I experienced personally, a family member demanded treatment for loved ones that threedoctorsdoctors deemed inappropriate as they felt it offered no benefit to the patient. In most of these cases, the patient was either dying or already pronounced brain dead when the conflict arose, but other types of conflict over futility arise from time to time.

For a less grave example, consider people who get a cold or cough and go into the doctor demanding antibiotics to treat what is generally a viral infection. Some doctors might prescribe antibiotics just to appease their patients, but others will refuse on the grounds that the treatment offers no benefit to the patient while carrying both costs and some risks. (If you prefer an even more absurd example just to illustrate the point, imagine someone demanding cholesterol medicine to treat a broken arm.) This type treatment is futile because it will have no effect on the condition being treated.

Another kind of futility is both more common and more serious in its consequences. These cases often, though not always, involve infants on ventilators or elderly patients receiving artificial nutrition (feeding tubes) and hydration. In these cases, doctors and the family or other surrogates agree that the feeding tubes or ventilators are keeping the patient alive, but disagree on the value of doing so. In some cases, the patient may be suffering and medical providers feel the patient’s suffering makes it unconscionable to continue treatment. In other cases, the patient may be in a permanent state of unconsciousness or even be brain dead, and the healthcare providers feel the patient no longer exists as a person in any real sense. All the qualities associated with life (consciousness, will, pleasure) are already gone, so treatment has no use.

Few forces in the world are as powerful as the duty we feel to protect our children or to care for our parents or other loved ones. The one comfort we take in the face of such a devastating loss is that we “did everything we could.” When doctors tell us that doing “everything” is costly, painful, and of no value, it can be more than painful to accept. Complicating matters is that most of us have heard of miracle cases where people recovered despite dire prognoses. When told that no more than one in a million patients survive such a condition, family members often only hear that there is some chance of survival. It is a point of honor that they will “never give up” on their child or parent.

I’ve seen doctors handle futility with great skill and also with awkwardness. In one case, a man was convinced the hospital was abandoning his wife at the time she most needed care. The man felt the doctor was expressing the needs of the hospital rather than the needs of his wife. Once he was reassured that she would be cared for even in the absence of treatment, he felt much better about discontinuing treatment. In another case, the doctor made every effort to assure the parents of an infant that she and the entire staff would stay with them throughout the ordeal and do everything possible to reduce both the suffering of the child and the pain of the parents.

It is impossible, of course, to eliminate all disagreements and conflict, but I think doctors who are able to effectively communicate empathy and concern for the patient and the people who love the patient have greater success at avoiding battles with patients. We all want to know our experiences are recognized and validated. We all want to be heard. We also want the dignity of our loved ones to be promoted and protected, especially as they face death, which strips them of autonomy and self-respect. We want healthcare providers to recognize that we hold our dying loved ones in the highest regard even if they can no longer speak for themselves and show why they are worthy of such respect. When we fight for their lives, I think we are really fighting for their dignity and worth as a person. Doctors will do well to keep that in mind.

Patient Story: University Student Faces Surgery in Wuhan, China

R. Horton

I am hoping that Ethics Beyond Compliance can become a place for patients and caregivers to share their stories of medicine, medical research, illness, and loss. The following post is by a university student in Wuhan, China who had to undergo surgery and spend 12 days in the hospital (for less than $1,000). Here is her story.

Wuhan, China

In the end of May 2014, after few really spicy meals, I had dysentery. A few days later, things became worse, so I went to the eighth hospital of Wuhan, which specializes in anorectal diseases.

Knowing that I needed surgery, I felt very nervous and insecure. Then my dad asked one of our relatives, who is also a proctologist, about this hospital and the doctors here. My relative recommended a doctor for me. I went to see the doctor, and he agreed with the former doctor. At first he said he would perform surgery the day after but later told me he had some other business for the day after, so we had to do the operation that day, which was children’s day, 1st of June.

They gave me an enema first, and then had me do a lot of tests such as blood test, allergy test and so on. Later, a nurse came in and gave me a tranquilizer to prepare for the operation. Then another nurse came in to lead me to the operation room. I signed some paper for anesthesia. After a while, there was an angry nurse for the operation who, I guess, frowned on my skirt. I said “sorry,” but she kept frowning on me, which made me very upset and a little bit angry. During the preparation, I asked the angry nurse why she seemed so unhappy, and she said it was just work, nothing else. Then she tried to give me injection. But somehow she had no luck. She gave me three injections in the wrong place, which hurt me a lot. I tried to calm her and said, “It’s okay, don’t be nervous,” but the truth is deep down I felt I could not bear one more try. My hands were very swollen. Finally, the fourth went okay. During the injection a man gave me anesthesia. I could not feel my legs, and then the doctor came and asked me to kneel on my front.

I could not tell what was going on there, but I could hear what they said. The angry nurse checked my wound and said, “Ew, that’s big wound.” Then the doctor said he didn’t expect such a big one either. And he said he would show me my files later, but I said “No, thank you.” Somehow another nurse came in, made some comments and flirted with the doctor. Then another doctor in, also judged my wound, and said something that was not very nice. I swallowed it all in. I felt so assaulted and humiliated, but I could not do anything. Finally, it was over. They used the bed to send me back to my room.

I guess it’s because of the anesthesia that I still could not feel much. Only tired, exhausted. After having some fluid, I fell asleep. I remember around 3 o’clock, I was awoken by severe pain. I could not even cry loud, but somehow my aunt heard me. She woke up the caregiver, whom we hired that day. The caregiver came and helped me to pee; I felt like peeing but owing to the anesthesia and the pain, I found it difficult. After three painful hours, I finally did it. With the help of two painkillers the caregiver gave me, I fell asleep again.

Every time I woke up, I was in great pain. Still I had four more days of injections. The younger nurse tried to give me an injection but she failed and asked an elder nurse; however, the elder nurse gave me even more pain. Then there came a middle-aged nurse who smiled a lot at me even though she felt nervous while giving me the injection. I think she is the first nurse I met in the hospital who made me feel comfortable.

My dad checked on me from time to time, told me the doctor asked for more money for this operation because of my large wound. I checked the bills and found mistakes. I told one nurse, and she said she would check on it but later, and then I got no response.

I spent 12 days in the hospital, and the whole operation cost me 5,618 RMB ($905.00) not including the caregiver.

Horton’s Taxonomy of Racial Prejudice

R. Horton1 Comment

It seems we keep having people make racist remarks and then proclaim, defensively, that they are not racists. Some people are so hostile that their claims of innocence are both laughable and infuriating, but others seem genuinely bemused by the accusation that they are racist. It doesn’t seem possible that anyone could be so clueless, their critics think, that their attitudes would not be obvious to them. In other cases, people strive with everything they have against being racist, only to find to their dismay and horror that they have unconscious racial biases.

In order to sort things out, I think we need to recognize a few categories of racism:

1. Overt racial hostility. In this category we have white supremacists (or other kinds of supremacists, even, depending on your location and circumstances). People in this category believe other races are inferior and will not apologize for saying so. We can renounce them, but we aren’t likely to shame them, as they are quite self-righteous in their belief in their own superiority (leaving their latent fears and anxieties aside for the moment).

2. Racial Prejudice. Some people say they don’t hate anyone or want anyone harmed, but they just happen to believe it is a brute fact that people from different races are different and have different abilities and preferences. People in this category can be the most confounding, as they might say things that are outlandish to the rest of us and then become extremely offended that anyone could possibly accuse them of racism. “I don’t hate such and such people, but they sure hate hard work. God love ‘em.”

3. Racial insensitivity. Sometimes people genuinely don’t mean any harm at all but have no idea how their comments may hurt others. Assuming a person of a particular race enjoys a certain kind of music, dance, food, or whatever may seem completely reasonable to you while it reduces that person to a broad stereotype. Even if the person does happen to like that music or food, he or she may resent you making any assumptions about their taste based merely on race or ethnicity.

4. Racial privilege. A member of my family once said he couldn’t understand why certain groups were always complaining about police harassment. He mentioned that he had many experiences with the police and he had always been treated with respect and courtesy. It didn’t occur to him that his skin color, sexual orientation, and socioeconomic class had anything to do with his treatment. That certain groups are targeted for mistreatment seemed inconceivable to him because he never had to experience what others endure regularly. This is the nature of racial privilege. (Yes, many kinds of privilege exist, but they aren’t relevant to this discussion.)

5. Unconscious and undesired racial bias. Finally, we all have biases without realizing it. When people take psychological tests (you can take one here) to see what biases they have, they may be chagrined to find they are biased against others without wanting to, but some of us are even surprised to find we hold implicit biases against our own social groups. Even those who are aware of no bias whatsoever find that some biases are so deeply entrenched that they are difficult to detect. Ironically, those with the least ill feelings toward other races are, in my experience, more aware of implicit bias. Confront an obvious racist about overt racial attitudes, and he or she will often declare, loudly, that he or she is completely indifferent to race. In my experience, those who are most committed to ending racial prejudice are the ones who are also most willing to examine their own implicit biases. Such is life.

Is there a wrong way to grieve?

R. Horton6 Comments

Over the past few months, I’ve written of several philosophers of the ancient past who taught that grief should not overwhelm us before themselves becoming overwhelmed by grief. Stoic philosophers taught that we should understand that death is nothing to fear or mourn, if only we can have the proper understanding, but the emotion of grief trumps rational explanations every time. I would conclude, then, that we should not attempt to suppress or diminish our grief but should let it unfold naturally and grieve for as long as necessary. Criticizing the grief of others seems counterproductive at best.

But this left me wondering whether there is a wrong way to grieve. What obligations can the bereaved have to others? Obligations to the dead? Does grief suspend normal obligations?

Like the rest of the world, I don’t know what caused Spc. Ivan Lopez to go on a shooting rampage at Ft. Hood. He certainly had experienced a great deal of stress in his life and had good reason to experience problems with mental health. According to a CNN article by Ray Sanchez, Lopez’s father said the recent deaths of his mother and grandmother, medical treatment, and changes related to transfer of military installations “surely affected his condition.” Grief often becomes unmanageable when it is combined with other complications, obstacles, and challenges. We do well not to ignore the impact of grief on those around us. We are part of a community, and the health of the community deals in part on how well we respond to grief.

For an example from fiction, I’m reminded of “A Rose for Emily” by William Faulkner. Emily has much to grieve for: When she loses her father, she loses a loved one but also status, wealth, predictability, and honor. She responds by simply refusing to acknowledge her loss. In the beginning she denies that her father is even dead. Eventually, she relents and permits him to be buried, but continues her life as if nothing has changed. Her neighbors go along out of pity, not respect. As you probably remember, Emily eventually takes a lover from out of town, kills him, and sleeps with his body for the rest of her life.

Emily’s neighbors had tried to offer condolences to her when her father died, but she denied his death. After his death, the neighbors reacted to her with a mix of compassion, respect, suspicion, and disgust, but they also lacked the will to intervene as Emily continually pushed them away. They left Emily with her privacy and, as much as possible, a little dignity, which only led her to more extreme and destructive measures.

If I say that Emily grieved unethically, you may say that grieving wasn’t the core problem; rather, she was refusing to accept change. But grief is always a reaction to change, and all change is annihilation. The bereaved will often say the whole world changed, and that is exactly what has happened. Emily’s world changed, but she refused to accept either her father’s death or her change in fortune. By killing her lover, she tried to preserve a moment forever. Emily’s response to grief was understandable but not excusable. Then again, perhaps her neighbors did not respond ethically to Emily’s grief. The neighbors did reach out to Emily, even with follow-up visits, but failed to intervene more forcefully. Are they obligated to take matters into their own hands?

I recently had the opportunity to hear author Cheryl Strayed speak on her latest book, Wild, which is about Strayed’s own response to her mother’s death. Strayed is a talented and courageous writer and proficient speaker. As she talked about her grief journey, she only lost her composure once. She said that after her mother’s death she became the kind of daughter her mother would not have wanted her to be. She described her adultery, promiscuity, and substance abuse through tears that evaporated as she moved on to discuss how she began to manage her grief more positively (ethically?).

I ask whether there is an ethical way to grieve. We can see that people, overcome by grief, behave in ways that are certainly unethical in most contexts, but we may have such compassion for the bereaved that we soften our judgment of them. “What she did was wrong,” we may say, “But I can see why she did it. I might have reacted the same way.” But this may be true anytime someone acts unethically. In the exact same situation, I may have acted as Bernie Madoff acted. In fact, we have all acted in unethical ways. We had our reasons (grief, exhaustion, addiction, depression, or whatever), but our actions were unethical.

So what helps people behave more ethically? Jean-Paul Sartre, the famous Existentialist philosopher, says that with each of our actions we choose “the good.” He doesn’t mean we always make good choices, but given our options, we choose the one we thought was best, which means we write our ethical values for public view by the actions we choose. In this environment, other people become our hell. Nothing is more damaging to us than being trapped by the others’ perceptions of us.

When we choose an action, we are choosing the one that seems best to us at the time. The problem is that some of us have run out of good ideas for what to do. We often explain ourselves, rightly, by saying, “I didn’t know what to do!” If we had more ideas, we would have more choices and could make better decisions. Sartre claimed we have absolute freedom, but really we can increase our freedom by increasing the number of actions we have in our consciousness. Sartre saw others as our judge, jury, and executioner, but they can also become our community.

It is Sartre’s companion and lover who had a broader vision for existentialist ethics. Simone de Beauvoir was able to see the positive importance of others in our lives. Beauvoir declares “freedom can be achieved only through the freedom of others.” If we want to be free, we must seek our freedom through the freedom of our community, and our freedom grows out of our love. Beauvoir says, “If we do not love life on our own account and through others, it is futile to seek to justify it in any way.” Without valuing others, our life truly loses meaning, and we will lose all hope.

When I was in China, I once thanked someone for helping me with a problem, and she responded, beautifully, “When we help each other, we are free.” Indeed, it is the only way for us to become free. And it is the only way for us to have more good ideas of what we can do.

Why I hate Steak and BJ Day

R. Horton12 Comments

On March 14, I learned of a new holiday known as Steak and BJ Day. Known as a humorous response to Valentine’s Day, the idea behind Steak and BJ Day is that women get all the attention on Valentine’s Day (men spend about twice as much as women) and there should be day for men to get what they enjoy, which is, obvious to the creators and celebrants of this day, steaks and blow jobs. It’s just a joke. It’s all in fun. If you don’t like it, don’t participate.

Many women seem to feel this is a fair way to compensate men for being so generous on Valentine’s Day, apparently having no qualms describing their romantic relationships as blatant prostitution. (“After all the trouble he went to for Valentine’s Day, I owe him something. Teehee.”) If people want to live their lives exchanging gifts for sexual favors and cooking services, I have no problem with it, so long as everyone knows what is going on and feels comfortable commodifying relationships. I have a different problem with this holiday.

Steak and BJ Day is based on a crude masculine stereotype that is inoffensive to men who live for their next steak and treat of oral sexual gratification. All men are supposed to want this. Any man who doesn’t love and know how to prepare steak, in fact, should turn in his man card, according to this web site.  Again, it is just a joke. If you don’t love steak, you are just a girl. Hilarious. I mean, who would want to be a girl? It isn’t meant to offend anyone. Any man who objects to this stereotype is himself at risk of being told he is too sensitive or not a “real man” or a “typical man.” People who are less kind will tell him he is a sissy, wimp, girl, or any number of nastier anti-gay slurs.

So, men who don’t want these things should turn in their man cards (see this site for an uproariously funny rendition of this ). “Turn in your man card” is the functional equivalent of “you throw like a girl.” As much as people insist this is all just a joke, the consequences of masculine stereotypes are severe. Children who fail to express their gender in expected ways are more likely to be bullied and abused and suffer from depression and PTSD (see a study on the risk here). You may have heard what happened to a boy who liked My Little Pony. Further, anti-gay attacks are typically in reaction not to sexual activity but to perceived non-conformity to gender stereotypes (a 1982 study by Joseph Harry found that “effeminate” men are twice as likely to be victims of gay bashing than gender conforming men), which means gay-bashing victims include many heterosexuals or children with no obvious sexual orientation or identity at all.

This bias against unmanly men is nothing new. Through an essay by Elizabeth V. Spelman, I found a passage in Plato‘s Republic describing what kinds of men would be inappropriate for a decent society:

We will not then allow our charges, whom we expect to prove good men, being men, to play the parts of women and imitate a woman young or old wrangling with her husband, defying heaven, loudly boasting, fortunate in her own conceit, or involved in misfortune and possessed by grief and lamentation—still less a woman that is sick, in love, or in labor.

People sometimes want to credit Plato with an early form of feminism, because he felt women should be trained in the mode of men. Like many today, he felt it was quite admirable for women to strive to “achieve” masculine traits. Men being the highest form of human perfection, Plato thought it made sense for women to strive for the masculine ideal. The man who would follow the lead of women, however, would be lowering himself below his station and be pathetic at best. His view persists as we encourage girls in sports, mathematics, and leadership, but forbid boys from nurturing, crying, creativity, and careers related to care and empathy. It seems odd to me that eating meat is considered particularly masculine, but vegetarian men are portrayed as being the least manly of all. The hatred and devaluation of “feminine” men is an extension of the oppression of women. Feminist philosopher Jean Grimshaw points out that the conception of a feminine ideal depends on “the sort of polarization between ‘masculine’ and ‘feminine’ which has itself been so closely related to the subordination of women.”

The hatred of “effeminate” men is an extension of the devaluing of the feminine, but it leads to violence and oppression of both men and women. In order to be free, we must assign equal value to all human activities and emotional dispositions. Leadership and assertiveness have their value, but we will not last long in a society devoid of nurturing, care, and concern. Another feminist philosopher, Genevieve Lloyd, puts it this way:

If the full range of human activities–both the nurturing tasks traditionally associated with the private domain and the activities which have hitherto occupied public space–were freely available to all, the exploration of sexual difference would be less fraught with the dangers of perpetuating norms and stereotypes that mutilated men and women alike.

I added the emphasis on the word “mutilated,” because I am grateful to her for using such strong language to describe accurately what sexist stereotypes have done to us. I often hear women struggle to describe how sexism hurts men. Some say it discourages men from working hard or from caring for others, but they miss the fact that sexism destroys men from the inside out. Very few men escape childhood without having their masculinity questioned and challenged. And too many men have responded violently to a woman who has taunted them with, “If you were a real man, you’d . . . !” The constant demand that a boy or man prove his resilience, indifference to pain and fear, and lack of compassion rends men from their humanity. Those who resist are often trampled under foot and left with depression, addiction, anxiety, and self-loathing. Too often, it ends in self-destruction through addiction, isolation, or suicide.

You may be thinking I take things a little too seriously. No one would kill himself over Steak and BJ Day. I agree, but I am asking you to consider the good of masculine stereotypes, and I tell you they serve no purpose and provide no benefit. The cumulative effect of such stereotypes is to prevent men from being whole and to destroy those who are uninterested or unable to fulfill the social expectations such stereotypes are designed to enforce.

For the love of humanity, please free us all.

See also: Why I Hate Valentine’s Day

You shouldn’t have to go to jail for mental health treatment

R. Horton

Last week I tweeted a link to a Texas Observer article by Emily DePrang about sexual assaults in Harris County jails. DePrang had written about two Bureau of Justice Statistics studies that showed the Harris County Jail on Baker Street had sexual assaults that are higher than national averages.

One survey reported rates of sexual victimization as reported by inmates, and found that inmates reported higher than average rates of victimization from other inmates. The other survey was based on official reports of sexual violence in jails and also reported higher than average rates for the Baker Street jail. DePrang did not discuss, in her short post, all the statistical and methodological limitations of the studies in question.

To my surprise, Alan Bernstein, the director for public affairs at the sheriff’s office tweeted me, saying he hoped someone would fact-check DePrang’s article as it had many mistakes, so I asked him what the mistakes were, and he sent me a list of items he felt were misleading. Later, the Texas Observer agreed to publish his response to the article (his published response was slightly different from what he sent me).

For the most part, his response pointed out the limitations of the study. Also, he noted that only one of four jails in Harris County had a higher incidence of sexual assault, and he also noted that jail had a high percentage of inmates who are under treatment for mental illness. In his note to me, Bernstein asked, “Is touching a clothed inmate’s thigh sexual violence? Maybe so. But this is one of the actions considered sexual victimization in the study.” I will just say that I consider any unwanted touching of my upper thigh over or under clothing to be sexual assault, even if the “violence” seems minor.

In trying to separate the signal from noise, though, what interested me most was not the definition of sexual violence or even the limitations of the study but the fact that the jail had so many inmates on medications. The Houston Chronicle quoted Sheriff Adrian Garcia saying, “The Harris County Jail has been referred to as the largest psychiatric facility in the state of Texas” and “More than 2,000 inmates … are on psychotropic medications on a daily basis.” And in Bernstein’s response, posted on the Texas Observer site, he said:

That building houses the jail system’s inmates with acute mental illness. In fact the statistician who worked on the 2011 study tells us that two-thirds of the surveyed inmates in the so-called “high” rate building had “psychological stress disorders.” We don’t know how that was determined, and we would never allege that people with mental illness fabricate allegations more often than anyone else.

I’m not sure what “acute” means in this context, but I suspect anyone on medication is assumed to have an acute mental illness. Given the number of prescriptions written for antidepressants and anti-anxiety medications these days, I suspect a fairly high percentage of the general population is acutely mentally ill, according to these assumptions. Even someone being treated for mild depression, though, will experience unpleasant side-effects if doses are missed, as they are likely to be missed inside a jail. We should be concerned both about lack of treatment for mental health and the over-prescription of  drugs for depression and anxiety. Withdrawal sometimes leads to aggressive behavior and could account for some problems. On the other hand, mental illness is also stigmatized, and those receiving treatment may become targets for abuse at the hands of other inmates.

Fortunately, I found more information on treatment of the mentally ill in Harris Country jails in excellent article by DePrang titled “Barred Care.” According to the article, the jail “treats more psychiatric patients than all 10 of Texas’ state-run public mental hospitals combined.” And why is that? Because no one else is treating those patients. Again from the article: “Harris County has one of the most underfunded public mental health systems in a state that consistently ranks last, or almost last, in per capita mental health spending.” Some people get so desperate for relief, that they break the law just so they can go to jail and get treatment.

The program in the jail is commendable. The funding priorities of our state government are not. In 2003, the Texas legislature slashed funding for mental health services in Texas. According to DePrang’s article, “In Harris County, the number of law enforcement calls about people in psychiatric crisis jumped from fewer than 11,000 in 2003 to more than 27,000 in 2012.” So, the Harris County jail has a high number of mentally ill as a result of deliberate action of our state’s lawmakers. This should make us all angry. Cutting funding for mental health services only to force the mentally ill into jails is cruel and expensive. No matter what sends people to jail, many will never really recover from the stigma and the trauma of the experience.

What should be done? We should lobby our lawmakers to restore funding for mental health services in Texas. We should stop blaming the mentally ill for their problems. We should resist the temptation to treat even minor difficulties with powerful and addicting drugs. We should insist that Texas expand Medicaid as part of the Affordable Care Act (this would cost the state nothing) so that people can receive basic medical care and avoid crisis.

In short, we should learn to heal each other. The person with a mental health crisis tomorrow could be you.

The Proper Way to Grieve for a Child: Cicero’s Example

R. Horton1 Comment
Epictetus stated he would embrace death before...
Epictetus stated he would embrace death before shaving. (Photo credit: Wikipedia)

In advising us on how to respond when we encounter someone who has lost a child or suffered an equally calamitous loss, the stoic philosopher, Epictetus said, “Don’t reduce yourself to his level, and certainly do not moan with him. Do not moan inwardly either.”  These negative emotions are dangerous to us and to others, so we must be sure to keep them in check.

This sounds harsh, but Epictetus also advises us not to beat ourselves up when we do give over to grief. He says, “Some who is perfectly instructed will place blame neither on others nor on himself.” Epictetus assures us that death is not to be feared, and our terror of it comes from within, but blaming ourselves for our feelings is also pointless.

Scottish philosopher David Hume, reflecting on the nature of tragedy in art, makes a comment about the best way to comfort a parent who has lost a child. Hume says, “Who could ever think of it as a good expedient for comforting an afflicted parent, to exaggerate, with all the force of elocution, the irreparable loss which was met with by the death of a favorite child?” I’m sure Hume is right that we shouldn’t exaggerate the loss, but I would also advise against minimizing the loss in any way, which is what Cicero’s friend, Servius Sulpicius Rufus,  did after the death of Cicero’s daughter, Tullia.

David Hume
David Hume (Photo credit: Wikipedia)

Sulpicius said, “If you have become the poorer by the frail spirit of one poor girl, are you agitated thus violently? If she had not died now, she would yet have had to die a few years hence, for she was mortal born.” Sulpicius sounds harsh in this instance, but this is actually offered only after he introduced the topic, saying, “If I had been at home, I should not have failed to be at your side, and should have made my sorrow plain to you face to face. That kind of consolation involves much distress and pain, because the relations and friends, whose part it is to offer it, are themselves overcome by an equal sorrow.” If he had been available, he would have comforted Cicero and perhaps avoided the need for such harsh and critical words later, apparently.

Cicero, Kopiezeichnung einer Büste aus London ...
Cicero, Kopiezeichnung einer Büste aus London (Herzog Wellington) (Photo credit: Wikipedia)

Cicero expressed his gratitude for the comforting words laced with recrimination, but also acknowledged their ineffectiveness, saying, “For I think it a disgrace that I should not bear my loss as you – a man of such wisdom – think it should be borne. But at times I am taken by surprise and scarcely offer any resistance to my grief, because those consolations fail me.”

Cicero had also been writing consolations for himself, and he felt himself the inventor of this type of self-help. He said, “Why, I have done what no one has done before, tried to console myself by writing a book.” (This is quoted by Han Baltussen in the Nov. 2009 issue of Mortality in an essay titled, “A grief observed: Cicero on remembering Tullia.”) Unfortunately, Cicero’s Consolations have not survived the passage of time, so we can only infer what they may have said. In a letter to Titus Pomponius Atticus, Cicero remarked that he wrote in order to heal, but his writing also kept him out of public view, preserving the privacy of his grief and avoiding a vulgar display of emotion.

Cicero also took his turn in consoling others, Baltussen notes, “In the examples where Cicero aims at consoling others, we find a subtle approach, developing, as it were, a ‘philosophy of empathy,’ in which he consciously or unconsciously takes personal and political aspects into account. He shows great sensibility in narrowing or widening the emotional gap between him and the consolee.” Cicero noted that one task as consoler was to establish that he needed consolation himself, as he was grieving for his friend’s loss. I think this goes a little beyond mere empathy. Cicero actually feels his own sorrow upon hearing of the sorrow of a dear friend. He understands the friend’s pain because it is a magnified form of his own pain.

I personally feel that Cicero’s struggle with his grief highlights a social failure to deal with grief constructively. Can we not manage to express and process grief openly without fear of censure from friends and counselors? Since the time of Cicero, we have developed grief therapy, expressions of support for the bereaved, and paid lip service to the process of healing. Yet, we still criticize those who can’t “get it together” within a short time. Sadness is seen as weakness, especially for men, and we do not tolerate prolonged grieving. Cicero was lucky to have friends and the ability to spend time grieving and writing his consolations. Men with less power would have had no option but to keep working without respite.

Grief
Grief (Photo credit: tombellart)

As for me, I don’t know the best way to console others, but I’ve thought a little about what kinds of consolations have helped me in the past, and these are the things that I appreciate. First, recognize that my pain is of such a magnitude that it obscures the horizon, and I can’t see beyond it. Second, do acknowledge the enormous value of the life I have lost. Third, do remind me that the person I lost had life filled with wonder, love, accomplishments, and happiness. Fourth, remind me also that this person is in a state of peace with no more struggle, pain, or discontentment. Finally, and perhaps most importantly, assure me that I am not alone in the world, my grief is justified, and that a future is possible.

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Grief and the problem of meaning making

R. Horton
Kurt_Vonnegut_at_CWRU
Kurt_Vonnegut_at_CWRU (Photo credit: david_terrar)

I’ve been reading Kurt Vonnegut again. It is a bad habit I started as a teenager. When I began reading Vonnegut, I was a classic example of a depressed teenager, or at least that was how I saw myself.

Looking back, I realized I had many reasons to be sad. Extremely sad, even. A friend had died in a motorcycle accident when a car pulled in front of him in our own neighborhood, and then my uncle, who was 25 years old, died in a fire that consumed the mobile home he was living in. Of course, a few other bad things happened, too, and the world just seemed a little crazy to me, not fair at all.

My confusion was confounded by the fact that I would often hear family members ask one another, “Do you think someone is trying to tell you something?” They searched each devastating event for a message from God. If something bad happened, it was because we had done something wrong. At church, I learned that all the pain, all the trials, and all the trauma was part of God’s plan, even if no mortal could make heads nor tails out of the plan. I hadn’t read Kierkegaard yet, but I was told to take a “leap of faith,” and then I was thrown off a cliff of faith.

Søren Kierkegaard (Copenhague)
Søren Kierkegaard (Copenhague) (Photo credit: dalbera)

So, around that time, I read about Kurt Vonnegut’s unlucky sister. In the prologue to Slapstick, he told of how while his sister, Alice, was dying of cancer, her husband, who was to take care of their children after her death, died on “the only train in American railroading history to hurl itself off an open drawbridge.” It was bad luck—bad enough to make you feel a little depressed.

But Vonnegut always made me feel better about things. He said, “Since Alice had never received any religious instruction, and since she had led a blameless life, she never thought of her awful luck as being anything but accidents in a very busy place.” Although I have received prodigious religious instruction and led a life full of blame, that one line has gotten me though many dark moments.

Over the years, I’ve heard many people tell me that bad things were part of some tortuous plan by some deity or other, I’ve heard that children are only on earth as a “loan” from God, and I’ve heard that God won’t give us more than we can handle. It seems to me that people routinely get more than they can handle. Many people die from stress-related illness or suicide, brought about by despair and a massive inability to cope with life’s tribulations.

Ah, but the people who didn’t survive just didn’t have enough faith to get by. The message I got from this was: “Be strong—or God may kill you.” If I had no faith in the purely accidental nature of bad luck that I learned from the Vonneguts, I am not sure I could have survived my life, which really only has the normal amount of sorrow and trauma. I haven’t been spectacularly unlucky, even by first-world standards.

Thanks to some of the interpretations I have heard of the meaning of traumatic events, I get a little nervous when anyone starts talking about making meaning of suffering. I’m quite happy to believe that suffering is just one of the vagaries of an existence fraught with peril. According to a paper by psychologist Robert Neimeyer and his coauthors, people have an intense need to “make meaning” after an extreme event disrupts their life narrative. Through a process of making meaning, individuals are able to restore a coherent narrative of their lives.

Part of the problem, it seems, is that most people believe the world has a certain moral order, and that people who are good will be rewarded with positive outcomes. So, when bad things happen, we will surely ask, “Why me?” This is a question Alice Vonnegut never asked herself, according to her brother, anyway. The horrible luck she had did not interrupt her narrative because her narrative was one of randomness and accidental events.

Regardless of what narrative one tells regarding the moral order of the universe, many people do see their own moral or spiritual growth as a result of suffering. Indeed, when we meet young people who are self-satisfied and callous, we often think that they will grow as they meet with grief and loss, and that growth will bring wisdom. It is good to know that our loss can make us better people, but I can’t think of a time when I would not give up my personal growth in order to have a loved one restored.

It seems somehow wrong, ethically wrong, to look toward loss as an opportunity for growth, but we do not seem quite so bothered by looking backward to a loss as a catalyst for growth. Herein lies some of my discomfort with focusing too clumsily on making meaning—it almost implies approaching loss by asking, “What can I get out of this?” Alternatively, it invites people to celebrate what they gained from loss. This, in itself, can create moral distress.

To be sure, psychologists such as Robert Neimeyer emphasize accompanying the grief-stricken on their own journey without guiding them down any particular path. People will, naturally, have to determine what their loss means and also what meaning they assign to life after their loss. If they fail to find any meaning, they may lose their lives all together.

In the quest for meaning, though, I hope we can accept that we live in a world full of hazards, and they do not affect us in any rational order. It turns out that some really awful people live rather charmed lives, and the purest and most compassionate people in the world suffer, though not always.

If we have the strength, we put one foot in front of another one more time. And, maybe, once again.

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Tea Party and the “Mask of Anarchy”

R. Horton1 Comment
Percy Bysshe Shelley, by Alfred Clint (died 18...
Percy Bysshe Shelley, by Alfred Clint (died 1883). See source website for additional information. This set of images was gathered by User:Dcoetzee from the National Portrait Gallery, London website using a special tool. All images in this batch have been confirmed as author died before 1939 according to the official death date listed by the NPG. (Photo credit: Wikipedia)

I don’t think I’m the only one to notice that Percy Bysshe Shelley‘s “Mask of Anarchy” seems amazingly relevant to current efforts to suppress the voices and will of workers around the world. So, I’ve taken the poem almost verbatim, made a few textual changes, and changed the names of the politicians to the names of Tea Party members and others in the Republican party. For more info on the poem, see The Guardian‘s partial explication.

Here is my take:

As I lay asleep in Houston, Texas
I heard a voice declare war on us,
And with great power it led me
To walk in visions of Poetry.
I met Murder as the widows began crying—

He had a mask like Paul Ryan—
Very smooth he looked, yet grim;
Seven blood-hounds followed him:
All were fat in the savage crew,

For one by one, and two by two,
He tossed them human hearts to chew
Which from his wide cloak he drew.
Next came Fraud, and he had on,

Like John Boehner, an ermined gown;

Official portrait of United States House Speak...
Official portrait of United States House Speaker (R-Ohio). (Photo credit: Wikipedia)

His big tears, for he wept well,
Turned to mill-stones as they fell.
And the little children, who

Believed him to be true,
Thinking every tear a gem,
Had their brains knocked out by them.
Clothed with the Bible, as with light,
And the shadows of the night.

Like Perry, next, Hypocrisy
On a crocodile rode by.
And many more Destructions played
In this ghastly masquerade,
All disguised, even to the eyes,

Like Bishops, lawyers, peers, and spies.
Last came Anarchy : he rode
On a white horse, splashed with blood;
He was pale even to the lips,
Like Death in the Apocalypse.

And he wore a kingly crown;
And in his grasp a sceptre shone;
On his brow this mark I saw—
‘I AM CRUZ, GOD, KING, AND LAW!’

With a pace stately and fast,
Over Texas land he passed,
Trampling to a mire of blood
The adoring multitude.

And with a mighty troop around
With their trampling shook the ground,
Waving each a bloody sword,
For the service of their Lord.

And with glorious triumph they
Rode through Texas proud and gay,
Drunk as with intoxication
Of wine of wanton destruction.

And each dweller, panic-stricken,
Felt his heart with terror sicken
Hearing the tempestuous cry
Of the triumph of Anarchy.

For from pomp to meet him came,
Clothed in arms like blood and flame,
The hired murderers, who did sing
‘Thou art God, and Law, and King.

‘We have waited weak and lone
For thy coming, Mighty One!
Our purses are empty, our swords are cold,
Give us glory, and blood, and gold.’

And Anarchy, the Skeleton,
Bowed and grinned to every one,
As well as if his education
Had cost billions to the nation.

When one fled past, a maniac maid,
And her name was Hope, she said:
But she looked more like Despair,
And she cried out in the air:

‘My father Time is weak and gray
With waiting for a Change this day;
So long as Anarchy rages on still,
The world awaits a reborn will!

‘He has had child after child,
And the dust of death is piled
Over every one but me—
Misery, oh, Misery!’

Then she lay down in the street,
Right before the horses feet,
Expecting, with a patient eye,
Murder, Fraud, and Anarchy.

And the prostrate multitude
Looked—and ankle-deep in blood,
Hope, that maiden most serene,
Was walking with a quiet mien:

To an accent unwithstood,—
As if her heart cried out aloud:
‘People of conscience, heirs of Glory,
Heroes of unwritten story,

‘Rise like Lions after slumber
In unvanquishable number.
Shake your chains to earth like dew
Which in sleep had fallen on you—

You are many—they are few.
‘What is Freedom?—you can tell
That which slavery is, too well—
For its very name has grown
To an echo of your own.

But change rose as a two-headed monster
Each head struggling to devour the other
But Hope nourishes the stricken half
And leaves Gold with a dark epitaph

“Let not this monster rise again.
Squelch the greed that lies within.”
We are not, as impostors say,
A shadow soon to pass away.

We ‘Rise like Lions after slumber
In unvanquishable number—
Shake our chains to earth like dew
We are many—they are few.’

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