Social Issues – Page 2 – The Doctor Is In

A Life Not Long

July 30, 2006December 31, 2006 Dr Bob

I’ve been working on several posts, which had been taking longer than expected — especially a post on euthanasia, which is beginning to look like another multi-part series. I hope to start getting some of these up in the near future.

In the meantime, a link from Glenn Reynolds hooked into something I’ve been ruminating on in recent days: the endless pursuit of longer life.

Here’s the question I’ve been pondering: is it an absolute good to be continually striving for a longer life span? Such a question may seem a bit odd coming from a physician, whose mission it is to restore and maintain health and prolong life. But the article which Glenn linked to, describing the striking changes in health and longevity of our present age, seemingly presents this achievement as an absolute good, and thereby left me a tad uneasy–perhaps because I find myself increasingly ambivalent about this unceasing pursuit of longer life.

Of course, long life and good health have always been considered blessings, as indeed they are. But long life in particular seems to have become a goal unto itself–and from where I stand is most decidedly a mixed blessing.

Many of the most difficult health problems with which we battle, which drain our resources struggling to overcome, are largely a function of our longer life spans. Pick a problem: cancer, heart disease, dementia, crippling arthritis, stroke — all of these increase significantly with age, and can result in profound physical and mental disability. In many cases, we are living longer, but doing so restricted by physical or mental limitations which make such a longer life burdensome both to ourselves and to others. Is it a positive good to live to age 90, spending the last 10 or more years with dementia, not knowing who you are nor recognizing your own friends or family? Is it a positive good to be kept alive by aggressive medical therapy for heart failure or emphysema, yet barely able to function physically? Is it worthwhile undergoing highly toxic chemotherapy or disfiguring surgery to cure cancer, thereby sparing a life then severely impaired by the treatment which saved that life?

These questions, in some way, cut to the very heart of what it means to be human. Is our humanity enriched simply by living longer? Does longer life automatically imply more happiness–or are we simply adding years of pain, disability, unhappiness, burden? The breathlessness with which authors often speak of greater longevity, or the cure or solution to these intractable health problems, seems to imply a naive optimism, both from the standpoint of likely outcomes, and from the assumption that a vastly longer life will be a vastly better life. Ignored in such rosy projections are key elements of the human condition–those of moral fiber and spiritual health, those of character and spirit. For we who live longer in such an idyllic world may not live better: we may indeed live far worse. Should we somehow master these illnesses which cripple us in our old age, and thereby live beyond our years, will we then encounter new, even more frightening illnesses and disabilities? And what of the spirit? Will a man who lives longer thereby have a longer opportunity to do good, or rather to do evil? Will longevity increase our wisdom, or augment our depravity? Will we, like Dorian Gray, awake to find our ageless beauty but a shell for our monstrous souls?

Such ruminations bring to mind a friend, a good man who died young. Matt was a physician, a tall, lanky man with sharp bony features and deep, intense eyes. He was possessed of a brilliant mind, a superb physician, but left his mark on life not solely through medicine nor merely by intellect. A convert to Christianity as a young adult, Matt embraced his new faith with a passion and province rarely seen. His medical practice became a mission field. His flame burned so brightly it was uncomfortable to draw near: he was as likely to diagnose your festering spiritual condition as your daunting medical illness–and had no compunction about drilling to the core of what he perceived to be the root of the problem. Such men make you uneasy, for they sweep away the veneer of polite correction and diplomatic encouragement which we physicians are trained to deliver. Like some gifted surgeon of the soul, he cast sharp shadows rather than soft blurs, brandishing his brilliant insight on your now-naked condition. The polished conventions of medicine were never his strength–a characteristic which endeared him not at all to many in his profession. But his patients–those who could endure his honesty and strength of character–were passionate in their devotion to him, personally and professionally. For he was a man of extraordinary compassion and generosity, seeing countless patients at no charge, giving generously of his time and finances far beyond the modest means earned from his always-struggling practice.

The call I received from another friend, a general surgeon, requesting an assist at his surgery, was an unsettling one: Matt had developed a growth in his left adrenal gland. His surgery went deftly, with much confidence that the lesion had been fully excised. The pathology proved otherwise: Matt had an extremely rare, highly aggressive form of adrenal cancer. Fewer than 100 cases had been reported worldwide, and there was no known successful treatment. Nevertheless, as much for his wife and two boys as for himself, he underwent highly toxic chemotherapy, which sapped his strength and left him enfeebled. In spite of this, the tumor grew rapidly, causing extreme pain and rapid deterioration, bulging like some loathsome demon seeking to burst forth from his frail body. I saw him regularly, although in retrospect not nearly often enough, and never heard him complain; his waning energies were spent with his family, and he never lost the intense flame of faith. Indeed, as his weakened body increasingly became no more than life support for his cancer, wasting him physically and leaving him pale and sallow, there grew in him a spirit so remarkable that one was drawn to him despite the natural repulsion of watching death’s demonic march.

Matt died at age 38, alert and joyful to the end. His funeral was a most remarkable event: at an age in life where most would be happy to have sufficient friends to bear one’s casket, his funeral service at a large church was filled to overflowing–thousands of friends, patients, and professional peers paying their respects in a ceremony far more celebration than mourning. There was an open time for testimony–and such a time it was, as one after another took to the lectern to speak through tears of how Matt had touched their lives; of services rendered, small and large, unknown before that day; of funny anecdotes and sad remembrances which left not one soul of that large crowd untouched or unmoved.

A journey such as his casts critical light on our mindless pursuit of life lived only to live long. In Matt’s short life he brought more good into the world, touched more people, changed more lives, than I could ever hope to do were I to live a century more. It boils down to purpose: mere years are no substitute for a life lived with passion, striving for some goal greater than self, with transcendent purpose multiplying and compounding each waking moment. This is a life well-lived, whether long or short, whether weakened or well.

Like all, I trust, I hope to live life long, and seek a journey lived in good health and sound mind. But even more–far more indeed–do I desire that those days yet remaining–be they long or short–be rich in purpose, wise in time spent, and graced by love.

Euthanasia Investigation in New Orleans

October 22, 2005December 25, 2015 Dr Bob

In the aftermath of hurricane Katrina, there were some scattered reports–in an admittedly questionable media source (a British tabloid)–of euthanasia of patients trapped in a New Orleans hospital. I discussed the initial media report here, and did a follow up post here which expanded on the questionable nature of the sources and some of the comments in response. In brief, there was widespread skepticism from some commenters on the veracity of this report, which was, in their opinion, pure urban legend–and I was castigated for lending credence to such an outrageous myth.

Apparently they never got the word to the Louisiana Attorney General.

CNN is now reporting that a very active investigation is currently underway of Memorial Hospital–where 45 patients were found dead–by the Attorney General’s office. This investigation to date has uncovered additional testimony that euthanasia was actively discussed and may well have been performed:

The Louisiana attorney general’s office is investigating allegations that mercy killings occurred and has requested that autopsies be performed on all 45 bodies taken from the hospital after the storm.Orleans Parish coroner Frank Minyard said investigators have told him they think euthanasia may have been committed.

“They thought someone was going around injecting people with some sort of lethal medication,” Minyard said.

A nurse manager, Fran Butler, is quoted as saying:

“My nurses wanted to know what was the plan? Did they say to put people out of their misery? Yes. … They wanted to know how to get them out of their misery,” she said.

Butler also told CNN that a doctor approached her at one point and discussed the subject of putting patients to sleep, and “made the comment to me on how she was totally against it and wouldn’t do it.”

Dr. Bryant King, a physician who was present at the hospital, was also interviewed by the AG’s office, and recounts his story:

But King said he is convinced the discussion of euthanasia was more than talk. He said another doctor came to him at 9 a.m. Thursday and recounted a conversation with a hospital administrator and a third doctor who suggested patients be put out of their misery.

King said that the second physician — who opposed mercy killing — told him that “this other [third] doctor said she’d be willing to do it.”

About three hours later, King said, the second-floor triage area where he was working was cleared of everyone except patients, a second hospital administrator and two doctors, including the physician who had first raised the question of mercy killing…

One of the physicians then produced a handful of syringes, King said.

“I don’t know what’s in the syringes. … The only thing I heard the physician say was, ‘I’m going to give you something to make you feel better,’ ” King said….

King said he decided he would have no part of what he believed was about to happen.

Time will tell how this investigation turns out–and it may ultimately be very difficult to prove what happened at Memorial Hospital, given the poor condition of the bodies and the difficulty in distinguishing therapeutic pain management and sedation versus the same drugs used in doses sufficient to kill. One suspects that those involved in such actions–if they occurred–will be loath to admit it–and likely would have been careful to avoid witnesses, if at all possible.

And I’m sure those who so vehemently argued the absurdity of this story will belly up to the bar and confess they may have overreacted just a bit–but I’m not holding my breath waiting.

Update 10-27-2005: CNN is reporting that dozens of subpoenas have been issued to find out what happened at Memorial:

The subpoenas were served on employees of all levels at Memorial Medical Center, which is owned by Tenet Healthcare, because “cooperation, lately, has not been as good as I had hoped,” Foti said.

The subpoenas require that people appear before investigators for questioning.

“Some people were not coming forward. We learned Tenet sent out a letter that had a chilling effect,” Foti said. “We had no choice but to issue these subpoenas.”

“They [Tenet] seem to be in a position of protecting themselves, while we are just trying to get to the facts of what happened at the hospital,” the attorney general said.

Stay tuned–this may begin to get very interesting…

The Engine of Shame – Pt II

October 19, 2005December 9, 2012 Dr Bob

In my previous post on guilt and shame, I discussed their nature and differences, their impact on personal and social life, and their instrumentality in much of our individual unhappiness and communal dysfunction. If indeed shame is the common thread of the human condition–fraught as it is with pain, suffering, and evil–it must be mastered and overcome if we are to bring a measure of joy to life and peace to our spirits and our social interactions.

Shame is the most private of personal emotions, thriving in the dark, secluded lairs of our souls. It is the secret never told, the fears never revealed, the dread of exposure and abandonment, our harshest judge and most merciless prosecutor. Yet like the Wizard of Oz, the man behind the curtain is far less intimidating than his booming voice in our subconscious mind.

The power of shame is the secret; its antidotes, transparency and grace. Shame thrives in the dark recesses of the mind, where its accusations are amplified by repetition without external reference. Shame becomes self-verifying, as each new negative thought or emotion reinforces the theme that we are rejected and without worth. It is only by allowing the light of openness, trust, and honesty that this vicious cycle may be broken.

The barriers to this liberating openness are fear and mistrust: fear that revelation of our darkest selves will lead to rejection, pain and humiliation; and lack of trust that the sharing of such darkness will be used against us to our detriment. This fear and mistrust lock us into a self-imposed prison from which there is seemingly no escape. Our only recourse becomes the adaptive but destructive defenses of withdrawal, self-attack, avoidance, or aggression.

The most dangerous type of infections in medicine are those occurring in a closed space. As the bacteria grow, they generate increasing pressure which drive deadly toxins into the bloodstream. Only by uncovering and draining the abscess can the infection be treated and health restored. And so it is with shame: we must take that which is most painful, most toxic, and release it, lest we become even more emotionally and spiritually sick.

So just how do we go about such a process? It is not something to be done lightly, as the world remains a dangerous place, and there are many who cannot bear such disclosure–and who may indeed use it against us. It is for this reason–this reasonable fear (amplified many times over in the echoes of our inner chambers of shame)–that many will not take this step until life circumstances become so difficult or painful that they have no other choice. Hence you will find this process first in the alcoholic at his bottom, at the therapist for intractable depression, at the counselor after divorce, in the prodigal son re-seeking fellowship in a grace-based church or small group.

But we need not wait for such disasters before beginning the process of addressing shame. There are a number of principles to begin the journey from shame to sanity and peace. Here are a few which come to mind:

Sharing of shortcomings with trusted friends: First and foremost, we must be willing to open the door, to begin sharing something of our inner selves with others. This involves finding someone trusted, someone who is a good listener and not quick to judgment. It means taking some risks, as many people may be unwilling–or unable–to be safe harbors for our vulnerabilities, failures, and shortcomings. Test the waters by sharing some small issues with others who seem trustworthy–or perhaps even better, by being open to others who may be willing to share their pain in some small way with you. Nothing builds the trust of others quite like your own vulnerability: it signals a willingness to establish a relationship based on true intimacy. We all put our best foot forward, expending great energy at maintaining our masks. But at the same time, we all hunger for the intimacy of being truly open with another.
Learn to listen: Our isolation begins to lessen when we hear our story repeated by others. As we begin to hear the bits and pieces of our own experiences, failures, and struggles in the lives of others, the uniqueness–and the shame–of our own experiences begins to lessen. We develop compassion for the struggles of others–and thereby become willing to accept our own shortcomings. Becoming mutually vulnerable is the essence of true, intimate relationships–and to achieve this we must be willing both to share our own weaknesses and to accept those of others.
Honesty: Deceit and shame go hand-in-hand–dishonesty with self and others is a requisite for the maintenance of the autocracy of shame. Dishonesty becomes habitual, making life far more complicated and difficult than one based on openness and truth. The main driving force for deceit is fear: fear of discovery, of condemnation, of judgment, of rejection. In reality, the consequences of honesty about our failures and shortcomings–particularly with those we trust and with whom we reciprocate acceptance–is far less onerous that of sustaining the fragile edifice of a life of lies.
The importance of forgiveness: When you begin to make yourself open to others, trusting them, you will sooner or later get hurt–perhaps intentionally, more likely inadvertently. Count on it, it’s a sure bet. Once it happens, you then have some choices: you can withdraw, no longer exposing yourself to the pain, or strike back, or carry a resentment. These approaches are proven shame-builders: they do little or nothing to visit revenge on our offenders, but rather replay the injury over and over (re-SENT-ment: to experience–to feel–again), reinforcing our loneliness and worthlessness. Forgiveness allows you to move on. It may mean taking the risk of confronting the one who has hurt you–a terrifying thought for a shame-based person–but such courage pays off in restored relationships at best, or maintaining your dignity at worst. Courage is not acting without fear, it is acting in spite of fear–and is the best antidote to fear, as reality is virtually never as bad as the scenarios our fearful minds fabricate. Bear the pain, reconcile where possible, and move on from there.
Other-orientation: We are designed to give, but have been programmed to receive. We try to fill our inner emptiness by getting: material stuff, the attention and admiration of others, pleasure, the oblivion of drugs or alcohol, food, sex, success, achievements in work or society. None of it works–the emptiness remains, as we are not worth something because we have something. We become worth something when we give–when our actions and efforts are helping others, improving their lives, giving them joy, help, comfort, support. This is why someone like Mother Theresa experienced a richness in life unmatched by endless hosts of wealthy, famous celebrities or business billionaires. We nod, agreeing that this is so–but no one wants to walk her path: we lack her faith, and her calling. But we don’t need to move to Calcutta to start down the same path: we can begin in small ways, one little act at a time. Make an effort to help someone out each day, somebody who doesn’t deserve it, perhaps someone you don’t like or would rather avoid. Do it when you’re too busy, or self-absorbed, or too tired. Do it willfully, not grudgingly. Don’t do it with any expectation of return. Try it–and watch miracles begin to happen, in your life and those around you.
Grace and mercy: Grace is receiving what we do not deserve; mercy is not receiving what we do deserve. Shame tells us we deserve nothing good, that we are tried, convicted, and condemned both by ourselves and by others. Grace trumps shame by not waiting until we are worthy, or worthwhile, or “fixed”, but by accepting us right where we are, just as we are. It must be experienced–it cannot be appropriated by logic, reason, will or effort. It is, indeed, anti-logical. It starts when you tell a friend a painful, dark secret–and hear that he has done far worse. It begins with terror at relating humiliating events, and ends with laughter and perspective about those same events. It arrives when you tell of hurting another, and receive not condemnation but understanding and guidance on repairing the damage and restoring relationships. And it shatters the gloom like shafts of light through broken clouds when the God whom you have driven away and abandoned–a God in whom you have lost all hope and confidence–instead wraps His arms around you in tears of joy at your return. When you have experienced such grace, your life will never be the same again.
The role of faith: People struggling with guilt and shame often turn to religion for answers and relief. This is not invariably a wise decision: religion can be of enormous benefit in overcoming these liabilities–but can also greatly exacerbate them. Guilt and shame are the golden hooks of toxic religion and religious cults, and even mainstream religious denominations which have a highly legalistic emphasis can cause far more harm than good. Cults and toxic religion lure the wounded by offering “unconditional love”–which later proves very conditional indeed. You are accepted only when you rigorously follow the rules–which may be arbitrary, capricious, or even unspoken–and interaction with “unbelievers” outside the sect is severely restricted, leading to isolation, ritualism, and depersonalization–and severe rejection should you choose to leave. Becoming enmeshed with such groups, driven by shame, is highly detrimental and a recipe for personal and emotional disaster. But true grace-based faith and spirituality can transform shame into service, guilt into gratitude. It finds the balance between a God who is just and One who is merciful. It is a place where love accepts us with all our imperfections and shortcomings–yet desires their removal that we may live with more joy and purpose, not hiding our flaws but using our own brokenness to restore, heal, and lift up others.

There was–the story goes–a holy man, who sat by the side of the road praying and meditating. As he watched and prayed, the broken of the world passed by–the crippled, the lame, the ragged poor, the sick, the blind. In his prayer, with broken heart, he asked God, “How could such a good and loving Creator see such things and do nothing about them?”

There was a long period of silence with no answer. Then, in a soft voice, God replied: “I did do something about them: I made you.”

Our shame, our brokenness, brings us great pain and wreaks much destruction in our lives. Yet it is by this very means that God equips us to be His hands, His heart, His voice, His compassion. In such can be found a purpose in life unmatched by anything else we might wish for or desire. Such are the ways of the God of endless surprise and limitless grace.

The Engine of Shame – Pt I

October 12, 2005December 9, 2012 Dr Bob

A wise friend–a man who helped me emerge from a period of considerable difficulty in my life–once taught me a simple lesson. In less than a minute, he handed me a gift which I have spent years only beginning to understand, integrating it into my life with agonizing slowness. It is a lesson which intellect cannot grasp or resolve, which faith only begins to illuminate–a simple principle which I believe lies close to the root of the human condition.

My friend taught me a simple distinction: the difference between guilt and shame.

While you no doubt think I am devolving into the linguistic morass of terminal psychobabble, I ask you to stick with me for a few moments. What you may discover is a key to understanding religion, terrorism, social ills such as crime and violence–and why the jerk in the next cubicle pushes your buttons so often. On the other hand, if you’re among those who believe guilt and shame are simply the tools of religion and society to restrict your freedom–that as a perfectly liberated postmodern person you are beyond all that–well, you are probably wasting your time reading this. But most of us recognize the influence of guilt and shame in our lives–even while trying not to focus on them, as they are uncomfortable emotional topics, best avoided if possible.

There is a tendency to conflate guilt and shame, merging them into a single human response to bad behavior or personal shortcomings. Yet they are quite different. Guilt is about behavior, shame about being. Allow me to expand on this a bit.

Guilt is an emotional–or some would say spiritual– human response to behavior or actions which violate a respected set of rules. The rules violated may be internal or external, and may be based either in reality and truth or distortion and error. The rules which may engender guilt must be respected: that is, they must originate from a valid source of authority–parents, elders, religion, law–or have been internalized into one’s personal mores or conscience from one or more such sources. Rules which are not respected pose no difficulty: I feel no guilt at not becoming a suicide martyr for Allah, since I do not respect (i.e. recognize as valid) the rules which promote such behavior. The response to violating respected rules is at its heart based on fear: fear of punishment by God or man, fear of rejection, or fear of ostracization from friends, family, or society.

Since guilt is an uncomfortable emotional state, we generally make efforts to avoid or mitigate it if possible. There are a number of means by which this can be accomplished, with greater or lesser efficacy. We may of course, practice avoidance of the behavior which induces the guilt. If the rules are legitimate and based on worthwhile principles, this is obviously a beneficial approach: if you don’t steal things, you won’t go to jail for burglary. But avoidance may prove destructive if the rules are based on error. For example, if your parents or religion have taught you that all sexual activity is wrong or evil, this can prove a huge impediment to physical intimacy and relationships in marriage.

Guilt may also be mitigated–especially when it is chronic and recurring–by changing the rules. You may leave a religion which is highly legalistic for another less so–or for none at all; you may change your situation or environment to one where the rules can be ignored and not enforced; you may seek counseling to correct perceptions about sexuality or other destructive interpersonal biases or beliefs. Or you may simple practice denial–justifying your behavior through the creation of new internal or social rules, while avoiding or rationalizing the inevitable consequences of your still-errant behavior.

So guilt may be addressed by modifying behavior or changing belief systems, through choice or denial. What then about shame?

Shame–the very word makes us uneasy, striking deeply into the core of our being. For shame is not about what we do, but about who we are. It speaks to a deep sense of unworthiness, rejection, inadequacy, and isolation. It says we are not OK, that what we truly are must be hidden. And this we do with all the energy at our disposal, throwing up an impenetrable wall to keep others out at all costs. For the essence of shame is relational–it says that if you really knew what I was like, you would be repulsed and thus reject me. The resulting isolation–real or perceived–is a devastating threat, engendering a pain so profound it approaches unbearable.

The origins of shame are varied, and not fully understood. We seem to be programmed to interpret certain words and behavior by others–especially parents and siblings in childhood–as not simply critical of our behavior, but a statement of our worth. This is an especially powerful force coming from parents, under whose authority and supervision we are molded into social beings. While this may be especially pronounced in dysfunctional or abusive homes–alcoholism, sexual abuse, and mental illness come to mind–it occurs even in well-functioning family units, and with speech and actions which are not intended as critical or demeaning, but which are interpreted as such. The soil of the soul seems fertile ground to bring forth a tainted crop of shame, even from the seemingly benign bruises of normal human interactions and relationships.

From the Judeo-Christian perspective, this propensity toward shame is understood as rooted in the spiritually-inherited rupture of our relationship with God, manifesting itself in an extreme self-centeredness and self-focus, which acts as a toxic filter letting in the destructive while keeping out the good. Having been born into a state of remoteness from God–perceived at a spiritual level as rejection by Him, though in fact just the opposite–we are acutely sensitized to rejection by others: it fits the mold perfectly. Thus every real or perceived hurt, criticism, or rejection simply confirms that we are rejected, worthless, and of no value. Our self-centered mindset insures that even events not focused on our self-value are interpreted in ways that affirm our sense of shame–hence the child that blames herself for her father’s drinking and abusiveness.

While shame lives deep below the surface–a monstrous child kept hidden from public view–its manifestations are legion, and its ability to percolate to the surface and alter our lives and behavior is formidable. The pain of shame requires response, no less than a hand on a hot stove, and it may be triggered by many means: by concerns about physical size, strength, skill, or ability; by issues of dependency or independence; by competition with others; by worries about personal attractiveness and sexuality; or when dealing with matters of personal closeness and intimacy. Thus triggered, an outward manifestation is inevitable, and will generally fall into one of four general responses:

Withdrawal — perhaps the most natural response to pain, we retreat from its source to avoid the risk of exposing our vulnerability. Hence we steer clear of people or circumstances which may trigger shame, withdrawing into a nominally safer–but profoundly lonely–world. This response may range in manifestation from shyness up to deep, pathologic depression or psychosis.
Attack Self — The loneliness of withdrawal and isolation is itself a deeply uncomfortable state, and often raises the profound terror of abandonment. To avoid such painful estrangement, many will resort to demeaning and depreciating themselves, thereby becoming subservient to others more powerful, resulting in a condition of dependency. While this may lessen the pain of isolation and abandonment, it further exacerbates the underlying shame by reinforcing one’s worthlessness and inferiority. The relationships so formed are not those of equals, and therefore satisfy the need for true intimacy poorly. Such responses range from obsequiousness and self-demeaning deference to others, to depression, and all the way to masochism, self-mutilation, and suicide.
Avoidance — If the shame cannot be eliminated, the feelings most surely can: shame is soluble in alcohol, can be freebased, and its pain assuaged as well by a host of other self-destructive behaviors. One’s choice of drug–chemical or behavioral–is influenced by genetics, neurochemistry, and environment, but all have the common goal of emotional oblivion. Eating disorders, obsessive-compulsive behavior, behavioral addictions to work, computers, gambling, or sex can divert the mind and stimulate sufficient endorphins to make the pain go away–at least for the moment. But the drugs and behaviors only worsen the underlying sense of failure and inadequacy, and lead to fractured and destroyed relationships, loneliness, and sometimes physical illness and death.
Attack Others — Rage and anger are common responses to shame, as we seek to defend our threatened worth by destroying the antagonist–or at least diminishing their worth, through sarcasm, criticism, gossip, physical, verbal or sexual abuse, or violence. But as with other coping mechanisms for shame, the outcome is invariably destroyed relationships, and adverse consequences, both legal and personal.

Thus the engine of shame drives a host of behaviors which are both personally destructive and socially disruptive. If you scratch the surface of nearly any dysfunctional personal or social problem–alcoholism and drug abuse, obesity, school violence, inner city crime and teen pregnancy–even international terrorism–you will find at its dark heart the issue of shame. It is, at the very least, a common thread among such societal and personal liabilities, if not a central driving force.

So it behooves us to get a handle on this matter of shame, uncomfortable though it may be. Our responses to its provocations are major causes of personal agony and social crisis. But like a schoolyard bully, once confronted face-to-face, the tyranny of shame can be broken through courage and openness, and the strength of numbers. On these thoughts I will be reflecting in a subsequent essay.

Aftermath of the Storm

September 4, 2005December 25, 2015 Dr Bob

Like most Americans, I have watched with morbid fascination and horror the tragedy of immense proportions unfolding in the Gulf states and New Orleans. Partially distracted by the need to prepare for a large family get-together this weekend, the repeated images of this disaster nevertheless have been haunting and thought-provoking, in ways I have not yet clearly delineated nor had time to thoroughly digest. It is disturbing–deeply disturbing–in many more ways than I can easily ennumerate. The frames flash through my mind like some silent movie, with fast flickering images painting a grainy impression of a tragic story:

–The hyperventilatory commentary of Geraldo Rivera on the day before the storm, and his bedfellows in the TV media, hyping yet another storm with faux dread but thinly-guised glee at an impending Big Story, salvation from a slow news cycle and the increasingly-repulsive Cindy Sheehan. Like a broken clock–right twice a day–after countless storms, this time they predicted rightly;

–The spectacle of a major American city under mandatory evacuation: when you evacuate your city, where do you go? Where will you put these tens of thousands of refugees?

–The premature glee that New Orleans had been spared–yet again–while tens of thousands suffered and died in nearby, less-newsworthy Mississippi;

–The worrisome news that levies had failed, while still not comprehending the magnitude of those seemingly small breeches;

–The growing news of violence and anarchy–not merely looting (a given, sadly), but murder, and rape, and riots, shooting at rescuers and holding hostages;

–The disgusting spectacle of those first responders–not the emergency workers or National Guard, who were heroic but overwhelmed–but rather the moral shuttlecocks (mostly on the left and among our “friends” in Europe and Kuwait) who immediately blamed the President, or global warming, or unsigned treaties, or Allah, or racism, as responsible for this vast natural disaster and its brutal consequences–have you fools no fear of God? How will you stand when such a disaster is visited on you?

–The constant drumbeat of media pundits demanding to know “Where are the Feds?”–as if the American Ship of State can be turned on a dime to immediately compensate for decades of local corruption and incompetence, or the lost gamble of dikes designed to fail under someone elses’s watch, or the hubris of believing dirt walls and a little concrete can resist the awesome power of nature in storm and river;

–The American spirit–generous and compassionate, despite the harping and selfishness of its most vocal–and nefarious–citizens. Their generosity will far exceed anything this country–or the world–has ever seen when this crisis is over. This will happen despite the ignoble and disgraceful conduct of many in the disaster areas–and those in the public eye-who compounded the evils of nature with personal depravity. This is American grace, and you will behold it in an abundance not seen in the world’s history. It will be underreported by the media, but those who care to look will stand amazed.

I am grateful for some things in this tragedy, however. I am thankful for the unspoken heroism of those who stayed behind to help the sick, the elderly, the young, and the disabled, risking and sometimes losing their lives in this effort, whose story will never be fully told. I am thankful that no moronic televangelist has intoned righteously how this storm was the judgment of God on the wickedness of a city. I am thankful that the vacuous “compassion” of the mouthpieces on the left–those who hunger only for power, and use the poor for their own political and personal gain–has been shown, once again, to be the hollow deceit it has always been; perhaps a few more will see through their cynical charade. I am thankful for those in our miltary and National Guard–already under the heavy load of war, who will give of themselves far more than should be asked of anyone–and do so honorably and willingly.

And I am grateful for a wake-up call.

We have done some simple home preparedness for emergencies, partly in preparation for Y2K, partly for earthquakes which frequent the Pacific Northwest. But I now know it is wholly inadequte, and plan to promptly address the many deficiencies of our emergency planning. The disaster in New Orleans will not happen here–but a catastrophic earthquake, or mass casualty terroroism attack very well may–at any time. There will be breakdown in all major services–police, fire, medical, utilities, social. Food and water will likely be scarce if available at all. And help will be a very long time coming–if ever. A few things which come to mind which need to be addressed:

A well-stocked emergency medical kit, with bandages, IV fluids, antibiotics, splints, and other short term medical supplies;
A substantial supply of bottled water, and water purification items, such as bleach and filters;
A one-month extra supply of critical prescription medications, rotated to maintain potency;
Non-perishable canned and dried food for at least several weeks–the more the better;
Tarps, plywood, and simple repair supplies to fix roof leaks, broken windows, etc.
Candles and kerosene lamps;
A portable cooking or camp stove, matches, fire-starters;
Batteries, flashlights, battery-powered radios;
Ropes, axes, hunting knives;
A home generator to maintain critical electrical appliances or short-term PC or TV use;
A large gasoline container, filled, for emergency auto use;

There are, no doubt, other things which will come to mind.

But there’s at least one other thing on the list: a gun, and the training to use it.

I have long believed that the Second Amendment guaranteed an individual’s right to keep and bear arms–it is hard to imagine any other intent when it was implemented, in a society where a firearm was a necessity of life for hunting, protection against man and beast, and the final recourse against tyranny. Yet I have long been ambivalent about guns, having seen the devastation and tragedy they have caused in poor neighborhoods and through careless use in homes and around children. And I have long been wary of gun zealots. I had basic weapon training in the military–but medical providers didn’t get much. I have had no desire to own a personal firearm, and never expected I would. My wife would never approve, anyway, so the point was moot.

But life is full of surprises.

While watching the anarchy in New Orleans, my wife turned to me a said, “I want to get a gun.” She expected my usual skepticism about her over-the-top paranoia. But she was serious, and I was shocked–I had always assumed she would never want a gun around. After first checking to make sure she wasn’t angry with me (she wasn’t), I responded, “So do I.” Her shock matched mine: we had both assumed the other would never agree to such an idea. I was, in fact, a bit startled at my own response–but there was at that moment no doubt about my conviction–nor is there now.

The thin veneer of civilization is easily cracked–perhaps more easily in our current age than in decades past. Katrina has demonstrated clearly that mere provision of needs during emergencies–food, clothing, water–is not sufficient: nursing homes and hospitals were under seige in New Orleans by armed gangs without conscience, and the normal restraint of law enforcement, once neutralized and overwhelmed by disaster, will bring forth the hideous beast of man at his basest. It may well become necessary to protect oneself and family in such a setting.

Such a decision is not without moral qualms: as a Christian, could I kill another man? In just warfare, no doubt–but personally, to protect possessions only, the act would seem dubious. But to protect one’s self and family–and the provisions necessary to sustain their lives–might well warrant such an act, extreme though it be, and be therefore morally justifiable. One hopes that the deterence would be sufficient that such a moral choice would be unnecessary; without such deterence, there would be no choices available.

So we will proceed in our preparations. Advice will be sought on appropriate weapon or weapons, safety and training undertaken, safe and secure storage obtained.

And may God spare us the need to ever use such a weapon.

The Children Whom Reason Scorns

December 5, 2004December 9, 2012 Dr Bob

In the years following the Great War, a sense of doom and panic settled over Germany. Long concerned about a declining birth rate, the country faced the loss of 2 million of its fine young men in the war, the crushing burden of an economy devastated by war and the Great Depression, further compounded by the economic body blow of reparations and the loss of the German colonies imposed by the Treaty of Versailles. Many worried that the Nordic race itself was threatened with extinction.

The burgeoning new sciences of psychology, genetics, and medicine provided a glimmer of hope in this darkness. An intense fascination developed with strengthening and improving the nation through Volksgesundheit–public health. Many physicians and scientists promoted “racial hygiene” – better known today as eugenics. The Germans were hardly alone in this interest – 26 states in the U.S. had forced sterilization laws for criminals and the mentally ill during this period; Ohio debated legalized euthanasia in the 20’s; and even Oliver Wendall Holmes, in Buck v. Bell, famously upheld forced sterilization with the quote: “Three generations of imbeciles are enough!” But Germany’s dire circumstances and its robust scientific and university resources proved a most fertile ground for this philosophy.

These novel ideas percolated rapidly through the social and educational systems steeped in Hegelian deterministic philosophy and social Darwinism. Long lines formed to view exhibits on heredity and genetics, and scientific research, conferences, and publication on topics of race and eugenics were legion. The emphasis was often on the great burden which the chronically ill and mentally and physically deformed placed on a struggling society striving to achieve its historical destiny. In a high school biology textbook – pictured above – a muscular German youth bears two such societal misfits on a barbell, with the exhortation, “You Are Sharing the Load!–a hereditarily-ill person costs 50,000 Reichsmarks by the time they reach 60.” Math textbooks tested students on how many new housing units could be built with the money saved by elimination of long-term care needs. Parents often chose euthanasia for their disabled offspring, rather than face the societal scorn and ostracization of raising a mentally or physically impaired child. This widespread public endorsement and pseudo-scientific support for eugenics set the stage for its wholesale adoption — with horrific consequences — when the Nazi party took power.
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