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!

The Disruption Gospel: A Bill of Goods

Every age has a theory of rising and falling, of growth and decay, of bloom and wilt: a theory of nature. Every age also has a theory about the past and the present, of what was and what is, a notion of time: a theory of history...Our era has disruption, which, despite its futurism, is atavistic. It’s a theory of history founded on a profound anxiety about financial collapse, an apocalyptic fear of global devastation, and shaky evidence.

Jill Lepore has a good piece in the New Yorker on the problematic assumption that innovation or ‘disruption’ is necessary and virtuous.  Her point that the evidence on which the problematic assumption lies is flimsy should confirm any thinking person’s suspicions that the intellectual drivel coming out of Silicon Valley is self-interested, demonstrably wrong, and socially dangerous.  In this regard, Lepore’s observation that the innovation ‘gospel’ is in a fact a secularized (or material) faith is apt.  Disruption for disruption’s sake makes no more rational sense than conservatism for conservatism’s sake.  The ideas of disruption or conservatism only make sense or are supportable when they are instrumentalities that increase or safeguard human flourishing.

Our experience in the world is just that:  experience.  Hence, any school of thought, ideology, philosophy, etc. that purports to have answers to the human condition must be judged pragmatically:  does the proposed action or rule increase or protect human flourishing?  If it does, then the action or rule should be adopted, regardless of whether the action or rule is intellectually consistent with an overarching school of thought, ideology, or philosophy, etc.  Belief is not betterment no matter how strong the belief.  Lepore succinctly and delightfully points out what the innovation gospel conflates, “[T]he world may not be getting better and better, but our devices are getting newer and newer.”  Just because someone in Silicon Valley says newer is better, does not make it so.

Lepore most discerning argument against disruption is the most damning:  disruption is a self-fulfilling and inherently circular prophecy.

When the financial-services industry disruptively innovated, it led to a global financial crisis.  Like the bursting of the dot-com bubble, the meltdown didn’t dim the fervor for disruption; instead, it fueled it, because these products of disruption contributed to the panic on which the theory of disruption lies...

It doesn’t explain change. It’s not a law of nature. It’s an artifact of history, an idea, forged in time; it’s the manufacture of a moment of upsetting and edgy uncertainty. Transfixed by change, it’s blind to continuity. It makes a very poor prophet.

Why would we accept a school of thought or an ideology that led to a crippling recession and continues to produce billionaires who claim to know the solutions to all of our problems so long as the solutions involve less regulation, less worker protection, less corporate taxation, less income redistribution, and more privatization of public goods?  For example, Facebook is entertaining, but hardly necessary.  If that is the case, why would anyone think the code writer behind the company would have anything particularly useful to say about public education?  Mark Zuckerberg has no education bona fides.  He is just a citizen and his voice should only count as much as any non-expert citizen.  And yet, his voice counts much more than the average citizen and his gospel is clear:  disrupt everything so long as the disruption is consistent with my vision of how the world works which is based the serendipitous conditions that led to me founding a successful multibillion dollar diversion.

This isn’t to say Mark Zuckerberg’s desire to improve public education is disingenuous, simply that it is dangerous, based as it is on the gospel of disruption, to which he subscribes.

Once more Lepore:

Innovation and disruption are ideas that originated in the arena of business but which have since been applied to arenas whose values and goals are remote from the values and goals of business.  People aren’t disk drives.  Public schools, colleges and universities, churches, museums, and many hospitals, all of which have been subject to disruptive innovation, have revenues and expenses and infrastructures, but they aren’t industries in the same way that manufacturers of hard-disk drives or trucks or drygoods are industries.

The disruption gospel celebrates failure, but is this appropriate for public education?  Do we continue to disrupt the education of our students in the hopes of finding a silver bullet that doesn’t exist?  And what do we do with the fodder of disruption, with the millions of students subject to the whims of billionaires and their policy-making lackeys?  What do we do with the students who fail?  How shall they wear this badge of honor  (“When a startup fails, that’s a success, since epidemic failure is a hallmark of disruptive innovation”)?  

Read Lepore and don’t drink the self-interested, disruption-flavored Kool Aid coming from Silicon Valley.  It is bad for jobs, schools, and the economy.

A Constant, Blinding Rage

I spend a fair amount of time on longform.org because it is a great resource for finding high quality, long form journalism.  One of the things that has been particularly rewarding lately has been reading the James Baldwin essays that the site has posted which have been thought-provoking and have led me to contemplate a number of things.  First, I consider myself a literate individual with a decent grasp of American history and literature.  However, reading James Baldwin has demonstrated that I am both less literate than I thought and have a more incomplete grasp of American history and literature than I previously supposed.  Second, reading Baldwin has demonstrated that despite having made some progress toward becoming a more egalitarian and less oppressive society, that progress has been depressingly small.  Third, reading James Baldwin often puts me in the mode of a spectator, simply observing the deftness and power of his language.  The man wrote with remarkable power, poignancy, and perception.   

The most recent essay I read is “From the American Scene: The Harlem Ghetto: Winter 1948.”  In it, Baldwin tackles a number of issues involving the experience of being a “Negro” in America.  Toward the end he makes a couple of observations that are worth repeating because they are accurate and powerful.  He writes that “oppression – the social and political optimists to the contrary – does not imbue a people with wisdom or insight or sweet charity:  it breeds in them instead a constant, blinding rage.”  He is, of course, speaking of the African American experience.   As noted above, it is peculiar that I considered myself literate when I was exposed to no such perspective.  I carried an enormous amount of passion when I was young for justice and equality and would rage against the excesses and inequities of the farce known as Reagonomics; nevertheless, the experience that stirred my passion was not “oppression” of the sort Baldwin describes in the essay.  While Reagonomics undoubtedly sanctioned inequity and excess, my complaint in truth was one of quantitative degree.  I looked like the very opponents with whom I argued.  I debated Paul Ryan (yes, that Paul Ryan) in AP History class and realistically the only difference between myself and Paul was and is familial wealth.  Redistribute a bit here and there, luck out a bit here and there, and our positions could be flip-flopped.  My arguments were of a vertical sort, addressing the unfair quantitative differences separating people.  There was in me no “constant, blinding rage.”  I could not conceive of such a thing.  Despite my youthful radicalism, I was at base optimistic.  Things would be better if only we just shared the wealth more equitably.  Unfortunately, redistribution is not the answer to oppression (witness the blinding rage stirred by the image of the “black welfare queen”). 

I retain a sort of optimism, though one measured and realistic, tempered as it has been by time and experience.  One such experience adding nuance to my perspective has been greater exposure persons of African American descent, among others.  Coupled with reading Baldwin (and other African American writers), this exposure has opened a window on a part of the American experience to which I had previously been blind.  I was always against and horrified by racism.  Nevertheless, I could only grasp racism as an intellectual concept, as a category that was like class, which could be ameliorated through quantitative means. 

My son is completing second grade and many of his classmates and friends are African American.  They are, like all of his classmates, funny, delightful, mischievous, ornery, regular, goofy, serious, brilliant, difficult, easy, etc.  In short, they are regular kids.  However, I fear that my son’s classmates and friends will be, if they have not already been, subject to the oppression about which Baldwin writes.  Perhaps it will not come in the form of abject poverty and overt discrimination.  It will however, come in some form, be it traffic stops that happen simply because they are black and driving or the palpable discomfort many white people will express simply because they are young and black or the condescension of those who will assume that their achievements were not wholly “earned” because they are black and must have gotten some affirmative action or something or the razor’s edge they stand on as adolescents between freedom and incarceration for doing things that would just be stupid things if they were melanin-challenged and living in a suburb.  Oppression, I fear, will come.  In this respect, I wonder how far we have come, if at all from Baldwin who, in 1948 wrote,

I can conceive of no Negro native to this country who has not, by the age of puberty, been irreparably scarred by the conditions of his life.  All over Harlem, Negro boys and girls are growing into stunted maturity, trying desperately to find a place to stand, and the wonder is not that so many are ruined but that so many survive.

I look at the boys and girls with whom my son goes to school and I am furious that any single one of them has been or will be irreparably scarred by the conditions of his or her life.  I am furious that I went 40 years before I began to understand in a visceral way that being “black” is not a class category or even a race (as the term is ordinarily understood) but instead is a category of power(lessness).  I am grateful to have encountered James Baldwin on longform.org, but I am furious that I did not encounter him sooner as a mandatory part of my education.  I think every person would do well to read Baldwin and allow his words to percolate and sink in, to consider whether the world about which Baldwin wrote is so different from our own, to consider whether she has been complicit in perpetuating the power differential that causes oppression, to consider whether there is something he can do to change the power differential, to consider whether we want to live in a country where persons deemed “black” are irreparably scarred by the conditions of their lives, to consider how she can fight oppression so that hope and possibility and ordinary striving can “replace constant, blinding rage.”  I leave you with these words from Ta-Nehesi Coates and Lyndon Johnson:

“Negro poverty is not white poverty,” President Johnson said in his historic civil-rights speech.

Many of its causes and many of its cures are the same. But there are differences—deep, corrosive, obstinate differences—radiating painful roots into the community and into the family, and the nature of the individual. These differences are not racial differences. They are solely and simply the consequence of ancient brutality, past injustice, and present prejudice.

We invoke the words of Jefferson and Lincoln because they say something about our legacy and our traditions. We do this because we recognize our links to the past—at least when they flatter us. But black history does not flatter American democracy; it chastens it.