Pain, Suffering, and Self-Reliance

The Atlantic has a good piece titled, "Who Has a Right to Pain Relief?" about the relationship between how we treat complaints of physical pain and politics, especially the politics of social welfare. As Rebecca Davis O'Brien writes,

Physical pain is not merely a private struggle.  Pain is also a problem of representation and trust, of rights and responsibilities, and a source of tension between individual and community. Perhaps not surprisingly, efforts to manage it give rise to a chronic American condition:  an intimate, unknowable experience co-opted by special interests.  Pain, in short, is political.

Courts embraced a liberal, subjective standard of "real" pain, rejecting the notion that discomfort was a fact of life; those who in earlier years might have been dismissed as malingerers were now guaranteed treatment and protection. Medicare and Medicaid were born, and a "bureaucracy of relief" grew throughout the 1960s and 1970s.

[Princeton historian of medicine and public policy Keith] Wailoo dates the modern era of pain politics to Reagan, whose acolytes saw in the welfare state "a failed and overliberalized society taken in by subjective complaints of pain." The time had come, they urged, for a "conservative restoration founded on objective criteria for measuring true need." ...The pain of the fetus and the pain of the taxpayer mattered most; the addict's pain was suspect, the housewife's pain imagined, the disabled worker's pain symptomatic of a weak society, Wailoo writes.

The great irony...is that deregulation and government retreat allowed the pharmaceutical industry to expand, virtually unchecked, to meet the demand for analgesia--in turn creating new clinical criteria for pain, new opportunities for treatment, and new markets for drugs. The pendulum swing was extreme, abetted by a growing sentiment in the medical community that...a crisis of undertreated chronic pain was at hand.

 This led me to consider how much of the idea of pain is a cultural trope that gets manipulated in various ways but ultimately functions as a complaint against the order of things.  Specifically, how much of what O'Brien writes about reflects a conscious or unconscious understanding by the guardians of the order of things that the cultural trope of pain imperils the overriding cultural trope of self-reliance?  Medicalizing pain segregates the idea of pain from the idea of the self-reliant individual so that pain cannot function as a complaint against the trope of self-reliance.  Once medicalized, pain can no longer reveal the trope of self-reliance to be false or problematic because it is located in the biological leaving any potential cultural failure or problem undiagnosed.

The dominant cultural myth of self-reliance and those interested in its perpetuation cannot countenance the possibility that visible evidence exists demonstrating that the myth is in fact just that, a myth, and that the myth causes much suffering.  Hence, suffering must be considered either a medical (and hence pathological) condition separate from the culture or as a failure of will and constitution.  This is true of both liberal ("rejecting the notion that discomfort is a fact of life") and conservative positions ("the disabled worker's pain symptomatic of a weak society").  In this way, pain as a complaint against society is dismissed.  To those suffering, the message is two-fold:  you are physically defective or you are psychologically defective.  Either way, the suffering is your fault, a failure of the individual and not of society.  The order of things cannot, after all, bear any blame or the order of things might actually change.  Heaven forbid.

 

 

"Many tweets were accompanied by the sort of pictures that could be used to tar even staid black professionals as intimidating. Brown was a large eighteen-year-old—six feet four inches, according to his mother—and, in the image that circulated in the media immediately following the shooting, his size is highlighted. He flashes a peace symbol that, in conjunction with his imposing stature, could predictably be assailed as a gang sign."

Jelani Cobb identifies something that perhaps could be ameliorated by one simple step:  conversation.  The interactions between white persons and young black males is the performance of a fear drama.  Fear suffuses every aspect of practically every encounter.  Whites fear young black males and act apprehensive, worried, and defensive.  Young black males, internalizing the exquisite humiliation of their role, inhabit the part in varying ways that usually suffice to convince white persons of the accuracy of their culturally ingrained intuition.  This doesn't mean a young black male in inhabiting the part is doing anything wrong, simply that young black males often react to white persons within the context of the fear drama, having a dearth of culturally transmitted roles available to them and choosing how to act from among them.

What can be done to change things?  Perhaps white people could talk to black teenagers and young men as if they were just teenagers and young men.  Sitting at the bus stop?  Ask a black kid what school he goes to, whether he plays sports, what television shows he likes to watch, what the music is that he is listening to, etc.  Yup, you're a goofy cracker, but so what.  The distance separating black and white is one that can be bridged by simply normalizing the human interaction and the expectations between black and white.  Someone has got to start somewhere to make things better.  Why not make it you.

"A brave man will try to make the evil stop with him.  He shall keep the blow.  No man shall get it from him, and that is a sublime ambition."  Saul Bellow, Henderson the Rain King.

The Douchebaggery of Grammar and Usage Zealots

We have norms of grammar and usage for one purpose:  to make language universally intelligible to speakers of the same language.  The norms are largely arbitrary as can be seen by comparing the propriety of expressions across different languages.  For example, many tonal languages do not have plurals.  How can this be?  Seems unthinkable for an English-speaker, right?  Well, the billion plus speakers of tonal languages in Asia seem to do just fine.  Why?  Because their grammar and usage does not require making words plural due to the heavy reliance on context in their speech.  The point being that a norm in English is not universal, but is something that developed as the language itself developed and is not, as some might have you believe, sacrosanct (like the use of the second person plural just now and this run-on parenthetical fragment).

Norms are useful to the extent that speakers and writers internalize them and generally abide by them when speaking and writing which makes expression more readily intelligible to listeners and readers (though it should be noted that even our notions of speech and understanding bear correcting as it has become well-known among interested neuroscience specialists that much speech and the understanding of speech actually involves anticipation and so the actual completed expression of a speaker is of less importance than would seem to be the case from a common sense perspective on how language works).  Likewise, expressions that deviate from the norm but cleave close enough to it to be readily intelligible to speaker and listener or writer and reader seem for all practical purposes to fulfill the function of linguistic expression regardless of existing norms.  "Ain't" would be such an expression.  Every competent American English speaker who hears it knows what the speaker means and it seems rather prudish and Victorian to publicly insist that one ought to instead say "isn't" when they are functional equivalents.  It doesn't matter what the history of the contraction is or frankly any other highbrow criticism of the contraction as lacking meaning because, by any reasonable definition of "meaning," "ain't" has it and it, the meaning that is, is clear.

Ludwig Wittgenstein summarized the problem with being priggish about grammar and usage succinctly:  “For a large class of cases of the employment of the word ‘meaning’—though not for all—can be explained in this way: the meaning of a word is its use in the language” (Philosophical Investigations 43).  Language is practical and is driven by how it is used, not by rules that are appended to it (and which, it must be said, are always appended to it after the fact - the edifice of language by necessity preexists the rules that are applied to it).  The notion that language requires policing is narcissistic, to say the least.  In the spirit of openness and honesty, I must admit that I am predisposed to this narcissism and struggle mightily not to be a grammar and usage zealot.  In any case, the problem is that if the goal is intelligibility and an expression is understood, then it is narcissistic and patronizing to insist that the speaker conform his or her speech not to intelligibility but to the norm that the pedant, as unofficial arbiter of all things language, informs them is the only way to express themselves intelligibly.  

It must be said that norms serve a purpose and there are situations in which adhering to them is necessary.  However, adhering to the norms in special cases is usually not necessary for intelligibility but rather is an issue of culturally transmitted norms of credibility.  Hence, when a lawyer writes a brief to an appellate court, she will avoid writing "ain't" because the accepted norms of legal writing deem such an expression to be improper and, given the insistence by those in the legal profession that the norms be adhered to, using the expression will diminish her credibility in the eyes of the readers of the brief despite the fact that "ain't" may have been otherwise perfectly intelligible to those same readers.  I believe that ad hoc and arbitrary norms in any specialized field should be abandoned in favor of common usage, but I also recognize that until the norms are abandoned one must conform to them if one hopes to maintain his or her credibility.  The same would be true of speech among any specialized cohort such as teenagers, chemists, or detectives.

Language is perpetually in tension:  pulled between the particular and the general.  This reflects the fact that language develops in response to local conditions but is also common to diverse populations and so the influence of one pulls at the other and vice versa.  Hence, we have phenomena such as the northern cities vowel shift, which is a geographically particular change in the way many persons in cities from Buffalo to Minneapolis pronounce certain vowel sounds.  It would be patently ridiculous to say speakers from this region are somehow speaking improperly in the same way it would be ridiculous to admonish all speakers of English from the 15th century or so onward for speaking improperly because they adopted the pronunciation of vowel sounds common after the great vowel shift and in some ways were speaking a debased English, an improper dialect if you will.  

The same can be said of grammar and usage - the particular influences the general and vice versa not because of some failure to abide by fixed and inviolate rules but rather because any human language is (and should be) subject to the vicissitudes of the experiences of its speakers.  Thus "hopefully" as commonly used may appear to some as daft or moronic or unintelligible, but for the vast majority of English speakers and readers, the term is immediately understood and perfectly functional.  While the pedants descry or laugh at the "malaproprism," the rest of us just use it.  And this is how it should be.

So speak to be understood and when you understand don't pontificate or act pompous about how another said it.  You are not Moses and words are not written in stone.

The Free Market Sucks. No Really, It Does.

"For-profit home health agencies are far costlier for Medicare than nonprofit agencies, according to a nationwide study published in the journal Health Affairs. Overall cost per patient was $1,215 higher at for-profits, with operating costs accounting for $752 of the difference and excess profits for $463. Yet the quality of care was actually worse at for-profit agencies, and more of their patients required repeat hospitalizations."

The study makes it clear that the "market" is more inefficient than Medicare and is frankly dangerous to the recipients of home health care from private agencies.  Why this should surprise anyone is beyond me.  The needs of a patient and the motives of for-profit home health agencies are obviously divergent, despite the failed attempts of states to regulate the conflict of interest out of existence.

In the words of the studies authors, "Letting for-profit companies into Medicare was a huge mistake that Congress needs to correct...  Our findings show once again that the free-market, private-sector managed care model has failed."

Of course no one will fix this because we definitely want to keep the government out of our Medicare.  They just screw everything up, you know.

Be Nice, Be Human (According to Science)

"The modern human behaviors of technological innovation, making art and rapid cultural exchange probably came at the same time that we developed a more co-operative temperament. If prehistoric people began living closer together and passing down new technologies, they'd have to be tolerant of each other. The key to our success is the ability to co-operate and get along and learn from one another."

Of course if we do not want to be successful, we can be selfish, violent, and antagonistic.  In other words, we could be Tea Partiers!  Further proof of the diminution in quality of life when we decide not to be tolerant and cooperative:  Wisconsin has a widening gap of life expectancy between whites and blacks in the U.S. while the gap in New York is shrinking substantially.  Also, "states in the northeast made considerably more progress than states in the west."  Isn't conservatism grand!