Thursday, March 25, 2010

I moved my blog over to Here's the link:

Wednesday, February 17, 2010

Sober Up and Grow Up: Time to Get to Work Americans

I encountered a couple expressions of opinion lately that annoyed me enough to want to write. My rather crazily busy lifestyle of late has made this a rare thing (though I am profoundly grateful a job plays into the activity level). Generally, I avoid most of the media because popular news sources often fail to provide relevant information in a cogent manner, instead opting for bombastic carnival barking (to borrow a phrase from Cornell West). But the the most popular opinion among those barkers was represented by a patient I worked with, and then was reiterated by a CNN poll result released today. I must say something.

My patient was a man who required constant care due to extreme chemical withdrawal symptoms. When questioned by staff in an effort to assess his mental status, he responded immediately that the president of the United States was Obama and used a descriptive phrase involving misplaced genitals. The suffering patient struggled to remember where and when he was, but was immediately able to pull up not only accurate information from the brutally punished neural networks of his brain, but his opinion about said leader! This man had some powerful feelings about Obama.

Obama is the kind of leader who inspires strong feelings for many reasons. CNN is reporting that 52% of Americans currently believe Obama does not deserve a second term. The fevered pitch ringing out from the Republican party (you remember those guys- the neigh sayers to affordable health insurance, healthy economies, ethical wars, truth) seems to have caught on as a national anthem.

It's been twelve months- gosh darn it- why isn't our ailing economy, idiotic (at best)health care system, and military misadventures fixed?! Sure Obama told us these problems were all decades, in fact generations in the making, and that we would have to work hard and creatively together over years to fix them, but somehow millions of American feel betrayed anyway. They don't remember the call to duty and responsibility Obama rang out over the microphones. They only remember the word "hope."

Unfortunately for Obama, and therefore for the rest of us, when many Americans heard the word "hope," they likely associated it with religious ideas. Hope being hope in a miracle, which can only be bestowed by a god and fixes everything for us mere mortals without any effort on our part other than a plea. Time to grow up. This is not how sustained good happens in the world, and it is not how sustained good happens in our lives.

Perhaps I found the negative comments of my patient so poignant because he had, through his choices, developed a life that required huge efforts to save. He was taking a lot out of our system and had taken a lot out of the people closest to him. The mental obsession and physical decay of addiction is horrendous. I have compared overcoming addiction to taking on a grizzly bear. Those who overcome and live meaningful, good lives frequently find the strength to do so by devoting time daily to helping other people. Healing for addicts generally involves addressing the harm they've caused, and work to balance the cosmic scales. Healing is found through compassionate deeds.

My patient may have had a good amount of work in front of him to balance those cosmic scales. The speed and certainty with which he launched a personal insult at Obama, a leader who is gaunt and gray with constant exertion, was astonishing. It is very easy to criticize and insult our leaders, it is quite another matter to get involved politically, read up on history and current events,and engage intelligently with our fellow citizens towards finding solutions to our national and local problems.

To debate and question public policy is fair, necessary and good for our country. But that is not what has been happening in Washington, and I do not believe that we have taken up the work necessary on local levels, either. If our country is to heal and grow strong again, it will be a result of a dance between national and local efforts. Change starts and is sustained by our apparently humble community projects.

No perfect political leader is going to be dropped from the heavens to fulfill our "hopes" for the relief of suffering by enacting the miracles of God. The arch of human history cannot be contained in a ninety minute movie with a punchy, simple resolution. Obama, himself, warned us about reality repeatedly while campaigning and now as our president.

Time to sober up, folks, and start working in our own lives to balance the scales. Obama is not the miracle worker millions expected and he's not the uppity Black(I shutter even writing the term- but there is a strongly racist tenor to the criticisms of Obama) millions of others secretly consider him. He is the same intelligent, flexible, hardworking man we elected to the presidency a little over a year ago. If we expected too much of him, then there is evidence he overestimated our sophistication as citizens, as well. In the clear-eyed moment of the next morning, we see that there are no easy and instant solutions to our national problems.

Wednesday, January 13, 2010

What makes a good teacher makes a good human

I enjoyed "What Makes a Great Teacher," an article in this month's The Atlantic magazine last night. It reported on findings by Teach for America that were collected, analyzed and implemented in order to be used to maximize the efficacy of its new teachers. If selected (a huge "if" because there are far fewer positions than applicants) new grads join the program and work in low-income school districts for two years. The data set on these teachers' performance as correlated with student performance outstrips any collected elsewhere. The findings have been used to improve their own teacher preparation and, incidentally or otherwise, also appear to have informed the new standards being used by the Obama administration to improve the nation's schools.

What they have found is great teachers get great results from their students independent of available resources. As long as these people have a room, light, something to write on and children to teach, the test subject competence of the students tends to go up, way up. (Incidentally, the article reported a backlash against these new standards by the national teacher's union. Lovers of education may need to contend with some educators when improvement is on the line).

The question then becomes, "What makes a great teacher?" There are several answers, one central being what researchers termed "grit." Those individuals who have the internal resources to overcome difficulties in their own lives tended to inspire the same in their students. These were the teachers who engaged in a constant and recursive cycle of self-improvement. When contacted by researchers to be observed, they often reported their classrooms were a mess because they had torn up their curriculum and were trying something new. They wanted to do better and were acutely aware when one or more students weren't understanding the lessons.

These teachers contacted the parents and made themselves available. They were always prepared for class and did not make excuses for themselves or their students. They believed in their own possibilities through self-improvement and believed the same of their students. One analysis found grade school students in low-income communities who were given the opportunity to be taught by these kinds of teachers would perform as well as students in wealthy suburbs by high school.

In contrast, one interviewed teacher cited the poor conditions of the communities, homes and schools as reason for poor student performance. This teacher also had very poorly performing students- worse after a year with her. Perhaps those who make excuses for their students may be making excuses for their own lack of efficacy.

I argue that the attributes of the excellent teachers are the attributes of all effective people. Hard work, "grit," and a belief that things can and will be better are the central concepts behind the best of American culture. The very best of who we are as a culture and country lies in the beliefs in limitless possibilities as per our ability and willingness to work towards these possibilities.

The problems that face our nation and our globe are problems of matter, of form. They are problems of written law, cast off waste, in short, human behavior. And human behavior can be changed over time and through perseverance.

What most people need is leadership, to be shown how to do this. Not ever person fights their way out of a difficult situation depending almost entirely on internal resources. These people are exceptional and uncommon. However, all people can learn and all people can change. We do not need every person to lead, we need a few and then country, community and family to be savvy enough to identify these people and follow their lead.

The last year in our national politics has been a sobering moment for those of us drunk from the possibilities made visible by last year's election. We had our blissful moment of inspiration. The moment we have now calls for the very thing the successful teachers from Teach for America demonstrated, GRIT. If we want to have an exceptional country created by what is exceptional in us all we have to downshift into low gear and trudge forward through the mire of corruption, callousness, and ambivalence. Time to get to work.

Wednesday, November 11, 2009

What Have You Done To Yourself?

I work with alcoholics and opiate addicts who are in active physical withdrawal from their drugs. Night after night they are brought onto my unit on stretchers, in wheelchairs or on the arms of concerned family and friends. Often these people look and smell aweful, unbathed, unhealthy, and unhappy. My first task, once they get in, is to take their vital signs. I watch them through the corner of my eye, trying to be unobtrusive in their terrible moment, while the blood pressure cuff inflates. I wonder again and again, “What have you done to yourself?”

This is a question all of us need to answer and not to each other first, but to ourselves. Dr. Michael Stein wrote presciently in The Addict: One Patient, One Doctor, One Year of his experiences as a practicing internist. In his practice he treats people with maladies ranging from hypertension to diabetes to opiate addiction.

In his considerations, Dr. Stein put forward the idea that the most significant gains in overall health for people in the twenty first century will not be a result of science and hygiene, as in the previous centuries, but in lifestyle choices. The CDC reports on their website that two thirds of Americans are over weight or obese. It is not just the heroine addicts who resist making necessary lifestyle changes in the face of life endangering consequences.

What does this mean for the current health care debate? Work on the legislation that could change the way Americans access the health care system is under profound scrutiny perhaps as I write this. Our democratically-elected congress is literally pulling together new law that could make it possible for all American families to enjoy the security hundreds of millions of people in other modern democracies have in knowing health care is accessible and affordable to them. Let’s pray fairness reigns out over the bullies of industry this time.

But the possibility of these remarkable changes will not answer my question. Americans deserve excellent health care at affordable prices. However, health cannot be purchased. How we choose to live is the first and most necessary step towards good health. No legislator or doctor can hand that to us. It is something we must choose and then work towards every day.

Friday, November 6, 2009

An Educated Guess: Hasan Knew Difference Between Right and Wrong (He just didn't care)

The details of Maj. Nidal Malik Hasan's life, accused shooter at yesterday's Fort Hood horror, are few and far between. There is, what I feel, an explanatory tone to what details have been given and some of the commentary offered on network and cable TV. Some of this tone concerns me.

The New York Times is reporting from multiple sources Hasan is an American born of immigrant parents from Palestine, a Muslim, army-educated psychiatrist, and, in the latter capacity, second-hand witness to the horrors of war. It was reported he was to be deployed to a combat zone later this month, and that he told a cousin he did not want to go. He was also reported in the NYT as being a vocal critic of the Iraq and Afghanistan wars and was acutely aware of the brutality some soldiers experienced in these wars through his work treating Post Traumatic Stress Disorder, PTSD, a severe and persistent anxiety disorder, in returning soldiers.

The entire episode is a horror beyond my abilities to describe and the surviving victims will be the appropriate tellers of the story. I simply want to point out the emphasis given by some commentators of Hasan's exposure to second-hand trauma through his treatment of soldiers, and the implication this could have been partly to blame for his outrageous behavior, may be misleading.

I would be surprised if hearing the horrors of war from fellow soldiers didn't negatively impact Hasan. But it is the way in which it effected him that singles Hasan out from other mental health professionals, soldiers, and people in general.

In my work, I have had opportunity to do forensic interviewing with mental health professionals and am trained in the field myself. I have seen a therapist so effected by years spent listening to children recount their stories of abuse and neglect that this woman literally cried the entire time I spoke with her. A coworker happened across this therapist's garage sale around the same time and mentioned how the poor woman began crying in a casual conversation. This is an understandable secondary PTSD reaction in a therapist.

I worked on a case through the juvenile court system as a child advocate that became so upsetting to me I literally had an anxiety reaction to the sight of the social worker on the case. She had the same reaction to the sight of me, and we snickered sadly at how upset we must be to have such a reaction.

Some people in the helping profession who are experiencing what is called Compassion Fatigue, or "burnout," may have difficulty with personal relationships, develop compulsions and even commit suicide at least partly as a result of bearing too much witness to the agony of others. The line that connects these varied negative responses is one that did not intersect with Hasan's deeds yesterday. Burned out helpers generally cause harm to themselves. Of course, people closest to them may suffer, as is typical when a loved one is having a difficult time. But for Hasan to take aggressive action against the very people he was trusted to heal is completely out of bounds and has a different rationale entirely, I suspect.

Hasan's behavior points much more toward anti-social personality disorder or perhaps narcissistic personality disorder than it does a severe anxiety disorder. It certainly sounds in the reports that he was scared as hell of being deployed into a combat zone where he could not control the violence. So why would he walk in and do so much violence, likely aware he would be hurt or killed in the process? My guess is that it wasn't violence this man feared, but not being able to decide who does what violence to whom.

In short, he may have simply wanted control. Where this level of need for control exists, I believe, there cannot be empathy, as well. And empathy for the lives of more than forty people should be an easy thing for a psychiatrist to feel no matter how many horror stories he heard or negative comments he may have gotten from ignorant people about his heritage as a Muslim or Arab.

If I am correct, a desire to control so powerful that it entirely supersedes a person's natural ability to empathize with other people may have a lot to do with serious mental health problems and emotional limitations Hasan developed over a lifetime. These mental health problems, notably, a personality disorder, are distinct from other mental health problems in several ways and very importantly here, because someone with anti-social or narcissistic tendencies knows the difference between right and wrong (unlike people suffering from something like a psychotic stress response). They just don't care what they are doing is considered wrong, because they believe they are unique, separate from others, and not rightly subject to the rules the rest of us live by.

The distinction between knowing the difference between right and wrong and not for this surviving gunmen will become very important when he stands trial. It could become that of life from death. I doubt anyone will afford him any more control when it comes to those matters.

Sunday, November 1, 2009

A Threadbare Representational Government

Ms. Scozzafava’s withdrawal from a congressional race in up-state New York apparently under the pressure put upon her campaign by outside support of a puppet candidate, Mr. Hoffman of the "Conservative Party," may be another death rattle for our representational government. However painful to acknowledge, it is not only the Neo Cons who are working towards the end of any legitimacy to our government. Even our faulty news sources have inadvertently brought us word from all corners of corruption this week.

But starting with the Neo Cons, The New York Times reported this morning that, despite local Republican anger over manipulation of their electoral process, the Neo Con movement moved in aggressively against Scozzafava's moderate views on gay marriage and abortion rights. Perhaps directed by their relationship with "God" or perhaps out of pure ambition, mental giants like Sarah Palin and our own Tim Pawlenty, put their support strongly behind Hoffman. Hoffman recently demonstrated in an interview with the local newspaper, Watertown Daily Times, his unequivocal ignorance of issues in a district he does not live in, but which he apparently believes he is the fittest representative. But why should someone need knowledge of a people or an earnest desire to represent their best interests when you have the will of God on your side?

It is clear that having a competent, moderate African American man in the White House with his equally competent and moderate African American wife has literally driven the Conservative movement (and by that I mean the Conservative White Movement) completely off their rocker. They are running on fear with hair sticking straight out and hands flapping over their screaming heads. Truly ridiculous. But the very degraded state of our economy, financial institutions and every system that supports a strong citizenry, including education and health systems, leaves us very vulnerable. Fanatics are given an ear during desperate times. In fact, in the U.S., fanatics have been given an ear in flush times, as well.

Then there was the leak of information about congress people being investigated on potential ethics violations including several Dems last week. I cringe at the potential involvement of such people as Maxine Waters (D-CA) in ethics violations, but fully support an outing of any and all shady dealings. She has been a strong advocate for economic fairness for all citizens. We need to make sure she hasn't been using her position to advocate for her husband's business interests in a federally-bailed out bank. If this is simply an investigation into unfounded accusations, lets hear who those accusations came from. Any under-handed players potentially involved in this "leak" by political competitors to the Dems may be discouraged by the reactions of Dem supporters.

I say, "Lets have it!" The time for truth is nigh. We need to know, just tell us the truth, who exactly is our representational government representing at this point? Is it the small groups of wealthy folks who control the vast majority of wealth and easily manipulate our government to get that wealth out of the grocery and heating budgets of our citizenry when their business ventures collapse? Is it the angry, White, conservative Christians who consider themselves the foot soldiers of Christ as they work to pummel with their negativity and rage the people they consider less human than themselves? Do these groups overlap? Maybe, maybe not. What they have in common is a deep sense of entitlement to legal, cultural and/or economic resources at the expense of others.

My point is this, competent, moderate folks of all kinds need to stay very active right now. This is a vulnerable time for our nation and our people. Voices of reason need to continue putting pressure on our representatives to act in our interests. We want easily afforded health care, strong investment in our infrastructure, and the acknowledgment and support of all families including those that include a same sex couple. All of these are moderate positions that seek only fair and respectful treatment of our people.

Friday, October 9, 2009

Nobel Peace Prizes for All of Us!

In a rather breathtakingly unexpected manner, the Nobel Peace Prize was delivered this morning to our sitting President, Barack Obama. Wow. What could have motivated a body to shift from honoring individual accomplishments to honoring the possibility of future accomplishments? That is what many of us are wondering right now. I have an idea.

Obama has been under relentless, brutal attack by the religious and political right of our country for years (the attacks intensifying even since inauguration), buoyed by the millions of Americans whose opinions they mirror. Maybe the Peace Prize is being used by a progressive, liberal European body as a kind of friendly helping hand. When a person is embattled within the confines of their highly conflictual family of origin, sometimes higher functioning extended family members seek to help out by giving him or her a pep talk, some encouragement as this person must face again and again the challenges that go to the bone.

This Nobel Peace Prize may be akin to a pep talk or encouraging hand on the back for Obama and the rest of us who have supported his efforts to take the United State, like a backwards family where bullies run the show supported by followers of weaker wills but motivated entirely by fear, and make it a nation where respect for the basic dignity of human life is expressed through excellent health care, education systems, and public and private works.

I write again: the challenges that our nation is facing right now go down to the very bones of who we are and how we envision ourselves as a people, as a nation, as an expanded form of family. We are laid bare by our struggles over health care and the seemingly impossible choices to be made in Iraq and Afghanistan. Our people have been bullied by an unseeing industrial elite for decades, perhaps longer. The idea of personal responsibility has been used to club us over the head with exploding costs and reduced quality in our health care, our higher education, and ever-shrinking real wages.

The reality for young families is and has been one of a profoundly diminished quality of life set starkly against the dreams and expectations we developed as children that ours would be a country where an education and work ethic would interface with a basically equitable economy to create stability for our families and hope for our future. But these hopes have been repeatedly dashed by the realities of our profoundly uneven economic playing field. This system has been promoted and protected by people who appear to have utter disregard for basic human dignity. These people are not interested in an equitable, free market system where the best of the best win out. They apparently believe in the use of advantage to manipulate markets and political bodies to protect their vested interest in mediocre performance with outrageous returns.

Many of our political "leaders" have represented the interests of these elite few like dogs chasing a trail of fleshy bits left behind for reward by their masters. Through these dogs, unchecked corporate interests have been allowed open access to our government bodies including military. And millions of us have yelled, protested, read, voted, and written about the injustices. We have used our non-violent, legal forms of protest for years apparently to little avail.

And then Obama showed up on our political scene and he campaigned on exactly what we had lost- hope. Through him we began to allow ourselves to hope that our government could represent the best interests of all of us. We began to imagine, for the first time in a long time, justice for the people who have worked and toiled and benefited the larger system for years.

For us political wonks, we began to imagine a government led by people intelligent enough to recognize that there are environmental, political, economic, and military challenges to our nation right now that are so deep and so wide as to require us to dramatically alter our public and private sector behaviors. Even the very lifestyles of individual families need to significantly change if they are to be a part of the solutions.

With most of our hopes focused on the economic and political dynamics of the immediate family of our nation, Obama surprised many when he put forward an agenda for worldwide nuclear disarmament to the U.N. A world free of nuclear weapons. A world family no longer in any danger of blowing itself up. Over the entirety of my life, that dark, looming possibility of human annihilation has always been. The idea of it not being there anymore, the anvil hanging above our heads plucked and permanently removed as a threat, fills my heart with joy.

Yes, Obama has inspired hope. He is a kind and sane person within the profoundly dysfunctional American family. Forward-thinking people from our extended world family have offered through this Nobel Peace Prize award a kind of "atta boy" to Obama and all of us supporters inside and outside the government.

It feels like they're telling us, yes, you are on the right path. It is no easy thing to transform the dysfunctional meta-human relationships of economies and governments. It is no small hope to hope we can improve the quality of life for our citizens from being far below the quality of life for citizens in other developed nations, to being something comparable. And as far as the rest of the world is concerned, it is no small hope that our international policies are fueled not from power lust, but from a deep, intelligent desire for peace, prosperity and justice for the extended family of our world citizens.

These are our hopes, the hopes of millions of Americans. And perhaps it was in acknowledgment not only of Obama's efforts and dreams, but of our hopes that this Nobel Peace Prize was awarded.