In praise of tacit knowledge: lessons in listening part 2

For someone who lives by words, I have a surprising proclamation to make: we rely too much on language. Hear me out, because I know what it is to rely on language. Years of philosophical training encourage such reliance but ultimately reveal its limitations.

There are multiple ways of knowing, thinking, and communicating—sensation, emotion, movement, sound, shapes—and it is impossible to reduce all that is worth knowing to factual statements. In fact, most of what gets communicated even in speeches is conveyed at the level of gesture, posture, vocal tone, and so on. (Which is why email is notorious for sparking misunderstanding; it is too easy to misread...or, perhaps, too easy for the actual meaning to poke through the veil of words.) I was discussing this sort of thing recently with a very interesting woman from Wyoming whom I met at a cafe last week. 

I had been reading the New York Times and was annoyed by yet another article touting some quality that purportedly makes humans superior to other animals. I wondered aloud why we expend so much effort delineating difference rather than recognizing our kinship.* My accidental lunch companion, who works with horses for a living, responded by telling me about Buck, a Sundance Festival award-wining film about a cowboy named Buck Brannaman who “helps horses with people problems.” He learned natural horsemanship from Tom and Bill Dorrance and Ray Hunt, who inspired a new way of engaging with the animals. There's a brief trailer clip for the film at the link above that gives you an idea what all this is about, but at bottom it's about respecting the horse's tacit knowledge of the world.


As my Wyoming companion waxed poetic about these horsemen, it became clear that as much as she enjoyed visiting Manhattan—she had, in fact, grown up here and was back to help care for her 91-year old mother—she also felt alienated by an implicit dismissiveness toward the beauties of rural life and subtly demeaned by a contempt toward nature her urban counterparts didn't realize they had. That, perhaps, is the most difficult thing about contempt: it's a moral prejudice rather than a language statement we consciously believe.

It was only after we parted company that I re-discovered Verlyn Klinkenborg's New York Times column about the rural life. In honor of my lunch companion, then, as well as a more humble and open way of living, I’m going to quote an obituary Klinkenborg wrote in 1999:

There is no such thing as a horse whisperer. There never has been and never will be. The idea is an affront to the horse. You can talk and listen to horses all you want, and what you will learn, if you pay close attention, is that they live on open ground way beyond language and that language, no matter how you characterize it, is a poor trope for what horses understand about themselves and about humans. You need to practice only three things, patience, observation and humility, all of which were summed up in the life of an old man who died Tuesday in California, a man named Bill Dorrance.

Dorrance was 93, and until only a few months before his death he still rode and he still roped. He was one of a handful of men, including his brother Tom, who in separate ways have helped redefine relations between the horse and the human. Bill Dorrance saw that subtlety was nearly always a more effective tool than force, but he realized that subtlety was a hard tool to exercise if you believe, as most people do, that you are superior to the horse. There was no dominance in the way Dorrance rode, or in what he taught, only partnership. To the exalted horsemanship of the vaquero —the Spanish cowboy of 18th-century California—he brought an exalted humanity, whose highest expression is faith in the willingness of the horse.

....what you could learn from Dorrance was a manner of learning whose subject was nominally the horse but that extended itself in surprising directions to include dogs, cattle and people. If you learned it, you would know it was nothing to boast about.

There is no mysticism, no magic, in this, only the recognition of kinship with horses. Plenty of people have come across Bill Dorrance and borrowed an insight or two, and some have made a lot of money by popularizing what they seemed to think he knew. But what he knew will never be popular, nor did he ever make much money from it. You cannot sell modesty or undying curiosity. It is hard to put a price on accepting that everything you think you know about horses may change with the very next horse.

“You cannot sell modesty or undying curiosity.” You can’t buy them, either, and that’s actually good news. It means they are within the reach of every single one of us, if we are willing to practice.

It seems to me that our culture actively encourages us to mistrust others, to adopt a "moral prejudice" that is inimical to curiosity, let alone honesty, respect, compassion, love, and understanding. The pervasiveness of manipulation by the advertising industry, politicians, media moguls, and corporations demands we become more discerning, not less; the manipulation is blatant, so ubiquitous that it has become invisible. (The Union of Concerned Scientists says that the average American is exposed to three thousand ads each day.) Is this why we simply shut down, shut away, shut off? How do we protect ourselves from harm and yet remain open to one another? For starters, we need to be curious, and we need to listen.

Considering a recent kerfluffle on a New York Times comment thread, it seems to me that we get into trouble precisely because 1) we assume we already know what we need to know about a situation, and 2) we are quick to assume that others, in general, are ignorant. In the first instance we foreclose our own curiosity; in the second, our humility. We would do far better to assume that we have limited knowledge and others might have something to teach us, even in areas in which we have expertise. But the very same belligerent, self-satisfied incuriosity that dominates our public discourse —c.f. the comments beneath virtually any YouTube video clip— reinforces the notion that other people are uninformed or worse. I would argue that ideological intransigence is much more dangerous to democracy than simple lack of knowledge.  As long as our arrogance-cum-ignorance keeps us from questioning ourselves or others, all it will take is a comely face or the mere appearance of confidence to disguise intellectual and moral rot. 

________________

* Subject for another post. Here I'll simply note that the leading candidates (language, the ability to recognize oneself in a mirror, etc.) all fail the task, and that looking to define humanity by selecting one quality that appears to be unique seems to me to be a pretty muddle-headed way to prove superiority, which itself is a muddle-headed project.


Marriage equality comes to New York

New York just became the sixth (and most populous) state to grant marriage rights to gay couples. Now it seems that the only people who remain politically and economically disadvantaged are single renters, who contribute comparatively little to the wedding, childbearing/rearing, and mortgage industries. (In a nation of "consumers"—the preferred American descriptor for what other democracies call "citizens"—it is the size of one's economic footprint that matters, not one's ecological footprint.)[1]

It's a bit ironic that gay couples have fought so hard to enjoy the social legitimacy of a contractual relationship that has so often spelled hierarchy and inequality for the participants. (A recent New Yorker cartoon shows two men in a domestic scene, with the apron-wearing partner saying he wants equality in marriage.) Perhaps this is what really frightens religious homophobes: the possibility that gay marriage will undermine the structural inequality that the religious right believes proper for heterosexual relations. Heterosexuals should be so lucky!  I have gay friends who have been more happily married, and for more years, than many straight couples; I also have gay friends who feel ambivalent about the institution of marriage while still applauding New York's decision, given the socioeconomic realities of contemporary life. One gay friend wrote wistfully of the days when to be gay was to be an outsider, anti-bourgeois; I know several who view the desire of so many gay couples to have children as a mere ploy for social acceptance or, at best, a result of straight culture's brain-washing.

Although I do not have children myself and believe that dominant narratives should always be scrutinized, I think this particular view condemns with too broad a stroke. There are certainly wrong-headed motives for having children—to seek cultural legitimacy, personal validation, or unconditional love (any of which is sure to backfire when said children are born) — but there are generous motives, too.  Any sensitive, thoughtful person, gay or straight, could conceivably want to provide love and guidance to a vulnerable young human, and the world contains far too many unwanted children who desperately need to be adopted into loving homes. Rescuing such children from a life of feeling unwanted and alienated is a noble endeavor, and perhaps no one is better suited to the task than someone who has experienced such wounds and managed to learn, from examining their own suffering, how to strengthen others.

In a similar vein, there's a difference between those who yearn to spend their lives freely and openly with the person they love and those who seek to marry simply because it is expected, all their friends are doing it, or their parents are pressuring them. A case could be made that people who have long been deprived of a right are that much more appreciative of it—there is, in fact, evidence that granting marriage rights to gay couples, who divorce less than heterosexual couples, actually reduces the divorce rate among heterosexuals as well. (Not that we should make too much of statistics, for they tell only a small part of any story.) And it surprises many people to learn that there is a long history of gay marriage in other cultures and historical periods, dating from the ancient Greeks and continuing into the 18th century among Native American tribes [2]. To ignore this history, not to mention the equally long history of long-term heterosexual love, is to disdain those relationships that do endure, among humans as well as many other species.

Human motives are complex, however, and, often as not, confused and opaque even to the most introspective among us.  All I can say is that it is best to carefully consider why we want to marry or not marry, to have children or not, and to make sure that when we undertake actions that necessarily and profoundly affect another sentient being we consider the consequences with a rigor as robust as the passion we feel [3].  Here we can find inspiration in two poets, one 19th century German (Heinrich Heine) and one 20th century American (Dorothy Parker), who achieved crystalline clarity about what they wanted from marriage:

Die Heimkehr [4]
LXXII

Und bist du erst mein ehlich Weib,

Dann bist du zu beneiden,

Dann lebst du in lauter Zeitvertreib,

In lauter Pläsier und Freuden.

Und wenn du schiltst und wenn du tobst,

Ich werd es geduldig leiden;

Doch wenn du meine Verse nicht lobst,

Laß ich mich von dir scheiden.

*

If you shall be my faithful wife

Then fortune on you shines.

You'll live a gay and carefree life

Of leisurely pastimes.

And if you scold and if you rave

I'll abide it all with pleasure.

But if my poems you will not praise

Then let us split forever.

Fighting Words

Say my love is easy had,

Say I'm bitten raw with pride,

Say I am too often sad—

Still behold me at your side.

Say I'm neither brave nor young,

Say I woo and coddle care,

Say the devil touched my tongue—

Still you have my heart to wear.

But say my verses do not scan,

And I get me another man!

May we all find an appreciative audience, whether straight, gay, or ameobic.

_____________


Footnotes


[1] The economic impact of this decision was not lost on anyone: marriage (or, rather, weddings) are projected to add $142 million to the NYC economy and $184 million to NY state as a whole. Another angle that should not be overlooked: this is the first time gay marriage has passed in a state where one of the houses was controlled by Republicans. Back in 2009, when Democrats controlled the state house and senate, the gay marriage bill was roundly defeated (by 14 votes).  On Friday, the bill won by a four-vote margin (33 to 29). 

[2] That is, before Protestant Europeans dedicated themselves to imposing gender dimorphism on the "savages" who were otherwise living happily with each other and the rest of the natural world. So much for progress.  See, for example, Michael Bronski, A Queer History of the United States (2011), and Intimate Matters: A History of Sexuality in America, John d'Emilio and Estelle Freedman (1988, 1997). The latter book is a classic and was cited by Supreme Court Justice Anthony Kennedy when he struck down a Texas law criminalizing sodomy.

[3] This includes the decision to acquire a pet. Today I was walking down a Manhattan street and saw a young couple, probably in their twenties, stepping out of a souped-up black car to deposit a tiny, and I mean tiny, pit bull puppy on the sidewalk. I had the impression they wanted it to "do business" but the poor thing looked lost and very fragile. I asked how old it was as I stooped down to give it some affection and protect it from the stark sun, if not the heated pavement; the young man, thick arms crossed in front of his capacious chest, said "almost 4 weeks." I tried to suppress my horror and said that was awfully young. The man, this boy, really, mumbled, "it's ok, we have a book... we give it milk." I dared not ask what kind; images of chocolate and strawberry milk cartons popped into my head.

I pointed out that puppies need more than milk from their mother, and continued supporting this tender little fellow whose cerebellar development was so incomplete he could barely stand without wavering. Or maybe he was dehydrated: he tried to suckle my finger, and the boy gruffed, "no biting," to which I replied that he might be hot and thirsty. Hefty boy was unimpressed.

Puppies should not be taken from the mother before 8 weeks; 10 weeks is even better, and frankly, we don't know how much better it would be if we didn't make a habit of breaking up canine families at all.  (A famous wag once wrote that the only reason dogs hadn't yet acquired language is because we take them away from their families so young.) I really didn't know what to do; I tried gently admonishing this young guy and his girlfriend, but walked away wondering if I should have told them to report the person who sold or gave them such a young dog. This was a set-up for disaster, and these kids had absolutely no idea what they were doing. Sadly, I am certain their ignorance was learned: had they been wisely parented themselves, they could not have been so obtuse.


[4] It's exceedingly difficult to translate poetry well—to capture both the sense and the sensibility of it. I was delighted to find that Justin Erik Halldór Smith has met the challenge beautifully with his translation of this Heinrich Heine poem.

Since I first posted this, I have altered the essay in several ways. Most importantly, I had quoted a friend anonymously but without asking her permission, and I have removed the quote. I usually would not have been so careless, but two friends had expressed virtually the same thought, except that one wrote and the other spoke. I therefore quoted the written lines, which the other person could just as well have thought were his, but on principle I should have asked. I am normally punctilious about such issues, and I regret the error. I amended the passage, which in the end led me to reconsider and clarify what I was really trying to say anyway.

Our demand for drugs: the case of oxytocin

In the first two posts of this series, I outlined the current prescription drug crisis and the responses of physicians, the managed health sector (PHA) and the pharmaceutical industry (PhRMA). I believe these drug shortages reveal the unsustainability of certain healthcare industry practices as well as fundamental flaws in how we think about health, technology, and progress. To build the foundation for this argument, I will sketch brief case histories of three drugs over the next few posts, beginning here with oxytocin.

The January 2000 British Medical Journal report I referred to in Part 1 of this series noted that in October 1999, the Harvard-affiliated Brigham and Women’s Hospital abruptly found itself unable to procure oxytocin, which it used “in almost every one of its 10,000 annual deliveries.”  Speeding along in my first reading, I suddenly stopped short. Oxytocin was used in nearly every delivery?

As most of you know, oxytocin is administered to induce labor. The hormone actually serves many purposes; all of us produce it naturally, men as well as women, and it has been touted as “the social bonding factor.” It was discovered by accident in 1909 when Sir Henry Dale noticed that pituitary gland extract induced uterine contractions in a pregnant cat; as early as 1911 pituitary extract was being used to stimulate labor [1]. In 1953, oxytocin became the first peptide hormone to be synthesized in a lab. Both Dale, who discovered the hormone, and Vincent de Vigneaud, who synthesized it, went on to win Nobel Prizes.

By 1998, about 16% of labors were induced, by oxytocin, an additional 16% that began naturally were augmented with oxytocin, and the drug was also used post-partum to prevent hemorrhage [1]. Oxytocin use peaked in the late ‘90s and early 2000’s before greater caution set in, as much from an increasing cultural preference in the West for ‘natural’ childbirth as from evidence that exogenous oxytocin could have adverse effects on the infant [2].

The BMJ noted that Brigham and Women’s Hospital did not find that the oxytocin shortage compromised care or the results of labor and delivery. Why, then, was it used in almost every delivery in the Boston hospital? Perhaps self-selection was involved: BWH is a renowned, high-tech hospital that likely draws more women with high-risk pregnancies (or women who are anxious about their pregnancies, or who are technologically inclined). A medical article published in 1999 sheds some light on the attitude of physicians at this time:

In an ideal world, all pregnancies would go to term, and labor would begin spontaneously. In reality, it is often best to deliver the infant before the onset of natural labor... In the past decade, our knowledge of the mechanisms of labor has increased tremendously. In addition, the ability to detect and manage antepartum maternal and fetal complications has greatly improved. As a result, labor can be induced in an increasingly rational and successful manner.

The authors clearly have a strong conception of what an “ideal world” looks like and the kinds of “rational management” that can lead us there. These ideas deserve consideration, but for now, let me just note that last April, a study conducted by Iraqi physicians from 2004 to 2006 concluded that acupuncture largely eliminated the need for oxytocin in women who had undergone ceasarean deliveries [3]. (Persistent shortages of oxytocin had compelled physicians to seek alternatives.)

Along the same lines, a 2004 paper published in Hospital Pharmacy evaluated the results of an antibiotic shortage on patient outcomes and costs and found that the alternative antibiotics they substituted for piperacillin/tazobactam (P/T) reduced the average hospital length of stay by about one day and slightly reduced costs, without adverse effects on patients. This is not to say that drug shortages never have ill effects—they increase the risk of errors, for one thing—but this question has not been formally addressed in most cases. Given that experts consider only about two to four dozen compounds to be the core of our pharmacopia, with the remainder being "me-too" drugs, it is possible that lack of a particular drug poses a problem less because of the drug's unique characteristics than because of the structural consequences of the scarcity (secondary shortages, time spent locating alternatives, etc.).

The oxytocin story does raise other questions, however. How much of our reliance on drugs is necessary, or even beneficial, to our long-term health? And how much does the availability of a drug create our "need" for it? How different is our desire to control events like labor and delivery from our desire to control events like erections? (Have Viagra and Cialis ever been scarce?) And how does the desire for control shade into the wish to enhance abilities like pitching a fast ball, or concentrating in school, or simply feeling happier? Where does treating illness cross over into self-improvement or simply extend our strong cultural tendency to want to dominate nature, subdue our bodies, control our wayward physiology?

The next post will concern the curious case of colchicine.

 

Footnotes

[1] http://pubs.acs.org/cen/coverstory/83/8325/8325oxytocin.html

[2] See, for example, Oscarsson, ME et al., Outcome in obstetric care related to oxytocin use. A population-based study.  Acta Obstet Gynecol Scand. 2006;85(9):1094-8.

[3] http://reliefweb.int/node/352976

Observations on the 19th c. Japanese response to natural disasters

One of the themes of this still-new blog is the revelatory potential of perspectives brought by history, other cultures, and other disciplines. Julian Sands' beautiful essay in this week's London Review of Books explores Japan's present-day reaction to March's triple disaster (earthquake-tsunami-nuclear reactor meltdown) through a 19th century Japanese lens. I was so struck by the inversion of our present-day values that I wanted to share it with you; excerpts are below but the whole can be found through the link above. 

On 11 November 1855, a massive earthquake and tsunami destroyed most of Japan's capital city, Edo, the precursor of modern Tokyo. Roughly 7000 people were reported dead or injured, and the numbers rose in the days that followed. There were no newspapers published in the city—the shogun's government forbade public comment on anything directly concerning the regime—but by the end of the year hundreds of woodblock broadsheets had appeared with stories and interpretations of the disaster. Among the surviving broadsheets one type stands out: colour woodblock prints depicting the earthquake as a catfish.

 

Since the 17th century, folklore had associated catfish with earthquakes. It was said that a giant catfish lay under a stone at the Kashima shrine... The god of the shrine had the duty of holding the catfish down. When he neglected his job, the catfish would wake up and shake, causing earthquakes. The god of Kashima seems to have been peculiarly negligent around this time: an earthquake destroyed the castle in the city of Odawara in 1853, another struck near the imperial shrine of Ise in the summer of 1854, and two tsunamis caused thousands of deaths along the Pacific coast that autumn. These events occurred soon after the arrival of American gunships under Commodore Perry forced the shogunate to open its ports to trade, rocking a dynastic system that had maintained stability in Japan for 250 years. It is not surprising that many in Edo believed the gods had chosen this time to overturn the existing world and start things anew....

I have been showing these pictures to students for years, interested in what they tell us about the period, but until the earthquake and tsunami that struck Japan on 11 March it had never occurred to me just how remarkable and strange to modern sensibilities this outburst of satirical humour in the face of disaster was.

The example reproduced here, ‘Mr Moneybags Launches Forth His Ship of Treasure’, employs a common motif: the suffering of elite merchants and the delight of working men. The man at the top is a wealthy miser: with the encouragement of a catfish, he is vomiting gold coins. Three men wearing the blue leggings, jackets and cloth headbands of craftsmen and builders scramble for the fallen money. The catfish lectures the miser: ‘Sir, you suffer now because you oppressed those beneath you in ordinary times. It would be well for you to change your ways and practise charity and virtue.’ Meanwhile, one of the labourers tells his mates: ‘Don’t be greedy. If you save too much and an earthquake comes you’ll regret it: better to go and spend it at the temporary brothels and keep it circulating.’ Destruction of property naturally hurt the haves more than the have-nots, and construction workers in particular stood to profit from the city’s rebuilding. Indeed, just as many occupations seem to have profited as suffered in the aftermath of the earthquake.

Another print depicted two groups of people standing on either side of a catfish, one labelled ‘those who laugh’ (a carpenter, a plasterer, a lumber merchant, a roofer, a blacksmith, a prostitute, a physician and a street-food vendor) and the other ‘those who weep’ (a teahouse proprietor, a seller of eels, a seller of luxury goods, a diamond dealer, an import merchant, musicians and entertainers). A city made entirely of wood, paper and clay could be rebuilt in a matter of weeks, and reconstruction provided work at good wages to a large segment of the urban population...

Although Japan’s disaster-prone capital lies on a major faultline and tremors are frequent, fire was by far the more common source of destruction in the 19th century. A conflagration that turned several blocks to ashes occurred in Edo on average every five or six years... Since there was a seasonal rhythm to these events and the gap between them was short, Edo’s citizens learned to flee, then return and rebuild. They kept their belongings light and portable and lived in houses that were easily dismantled. In 1880, a fire swept through Kanda’s city centre, destroying 16 blocks of dense tenements and displacing 5986 people. The mayor reported that, fortunately, it had occurred during the day, so there were no deaths or injuries. With a population well prepared for disaster, destruction of property even on this scale was accommodated within the management of the city.

This accommodation was possible because the city’s light physical infrastructure was matched by a strong and enduring social infrastructure. The people of Edo policed themselves and fielded their own fire brigades. The wealthy property owners who had the most to lose from lawlessness and property damage paid directly for these services, which were provided by their tenants and employees, and established town residents provided alms to the poor until houses were rebuilt. Although this charity was in theory voluntary, the need to maintain neighbours’ respect (and keep their custom) made it effectively obligatory. After major disasters such as the earthquake of 1855, registers were compiled in each neighbourhood listing the names of donors and amounts given, making the contributions a matter of public record. Kitahara Itoko, Japan’s leading historian of disasters and the author of a social history of the 1855 quake, has found that the donations corresponded closely to the wealth of each household, with the city’s wealthiest merchant houses, like the Mitsui dry goods business, contributing more than a thousand gold pieces, while smaller shops contributed as little as a few coppers. The shogun’s government made a practice of rewarding almsgivers after disasters, but the same fixed amount was doled out to everyone on the register, so that the compensation was little more than a token to the wealthy but could be double the amount of the original donation in the case of a poor household.

The working man gathering Mr Moneybags’s treasure implicitly referred to a physiological theory of cycles in nature, of destruction followed by renewal. Like typhoon-season floods and dry-season fires, earthquakes and tsunamis were understood as corrections of temporary imbalances in the vital force perpetually flowing through the world (known in Japanese as ki and in Chinese as qi). Periodic eruptions of natural violence released pent-up force and kept both nature and human society healthy by renewing them. In a study of the catfish prints, Gregory Smits has shown that Confucian philosophers as well as ordinary people believed that the economy followed the same principles. Just as ki flowed continuously in nature, money should be kept moving in the economy too, not allowed to stagnate and foster greed. For this reason, many people viewed capital accumulation distrustfully. Nature, they believed, censured it. 

It would be a mistake to presume that these Japanese fatalistically accepted natural destruction. Other contemporary accounts reveal that Edoites mourned the loss of family and friends, that they commemorated their deaths solemnly and sought solace in religion. But the relief of having survived, the outpouring of private and public charity, the break from everyday life and its duties, the levelling effect of the shared crisis, and the economic activity and opportunities in the reconstruction that followed, gave a positive tone to many of the catfish prints, prompting Kitahara to coin the term ‘disaster utopia’ to describe the world they depict. Of course, the condition was temporary, and neither alms nor higher wages were sufficient to cause a fundamental change in the poverty of the masses in the city’s tenements. Nevertheless, since everyone suffered together, and practically everyone contributed alms to relieve that suffering, common folk could believe that nature – in the form of the trickster catfish – had indeed instigated a healthy social renewal, and that these were bright times. Many of the prints plainly celebrate the present: using a formulaic phrase containing equal measures of irony and genuine hope, they call it ‘this blessed age’.

[VL comment: this is quite a contrast to the world of "disaster capitalism," in which wealthy developers swoop in to buy up, rebuild, and profit from areas that have been decimated by disasters, leaving the original residents permanently displaced.  It is also noteworthy that private charity, strongly local, was enforced by a system of complete transparency that itself depended on a strong social fabric. Our atomized American culture is comparatively ill-equipped to care for the dispossessed.]

Why aren’t the Japanese celebrating today? If the Fukushima nuclear plant can be brought under control, post-disaster reconstruction, at least in the long term, holds out the possibility of social and economic renewal. Assistance is flowing into the tsunami-affected region, voluntarism is flourishing and there is talk of this being an opportunity to revitalise the country, evoking notions of economic stagnation and flow that Japanese would have readily understood 150 years ago. Yet a wide gulf separates the Japan of the mid-19th century from the Japan of the present. In its slow unfolding and the inequality of its social effects, March’s triple disaster may bear more resemblance to a premodern famine than to the earthquake-tsunami that destroyed the capital in 1855. No one ever welcomed a famine because of its potential for enabling renewal. The drawn-out disaster gradually exposed and exacerbated class and regional disparities. The tsunami also brought to the surface deep structural problems: the depopulation of rural areas and the advanced age of their inhabitants (the median age of tsunami victims was reportedly around 70); the economic fragility of Japanese farming, which depends on government subsidies and tight import restrictions; and the fragility of the food system, vulnerable as it is to the invisible threat of contamination.

...In Tokyo one of my former neighbours, a woman in her sixties, writes of ‘trains running on reduced schedules, blackouts and calls to save energy, shops half dark, heat off in the house – why, we lived this way just a little while ago. I can only hope this will be the turning point away from mass production and mass consumption, towards a sustainable society.’ For people like her, who remember the days before Japan’s economic take-off, the hope is that this disaster will lead to a reduced dependence on heavy technological infrastructure.

It is remarkable that a country so seismically active and vulnerable, and which had developed the art of light infrastructure, should have embraced nuclear power. Japan began building heavy in the 1870s, soon after the modern state that replaced the shogunate chose to join the international economic and military competition led by the Western imperial powers. The country’s first model factory, a silk filature built under French guidance, and its first planned commercial district, the main avenue of Ginza in central Tokyo, were both constructed from brick in 1872. A massive earthquake in central Honshu in 1891 damaged iron bridges and toppled brick buildings, sparking debate over the appropriateness of Western technology to Japan, and the possible superiority of the lightweight, flexible structures that carpenters had built there for centuries (Gregory Clancey’s brilliant book Earthquake Nation explores the cultural politics of this debate). The debate would continue into the era of nuclear power. Today, Tokyo’s skyscrapers are built with flexible frames, designed to sway in earthquakes. Yet nowhere have architects been able to match the light and quickly constructed urban fabric that Japanese artisans had perfected before modernisation.

Sands goes on to discuss changes wrought by nuclear power technology, the quintessential heavy infrastructure, in 20th century Japan, and he makes the case that the traditionally robust social network is inseparable from the light physical infrastructure that characterized 19th century city life. As various "slow" movements spring up here in the West—slow food, slow gardening, slow art, slow fashion, slow blogging (my neologism for my lengthy posts, perhaps not inappropriately close to "slogging")—I keep thinking that as human beings we long for the kinds of connections that really need to be forged face-to-face, slowly building trust and interdependence over time... in other words, locally. I am grateful for the internet, for the phone, for being able to communicate with dear friends who live far away and 'meet' new friends through comments on this and other blogs. But there is still something irreplaceable about inviting someone over for tea and pastries warm from the oven, about making music together, about having long conversations curled up on a cozy couch, that goes well beyond the advantage of not getting a sore ear from the telephone. Even suffering together through a disaster can be a bonding experience, if all members of a given community share a sense of responsibility.


Given the increasingly inescapable effects of climate change, we need to think about the consequences of our own "heavy infrastructure" for the social fabric of our communities as well as their ability to rebuild.

Technophilia in the opposition to healthcare reform and environmentalism

Paul Krugman posted an interesting tidbit on his blog at the New York Times today, titled "American Superiority Complex." In part, he writes:

Aaron Carroll has a very good takedown of an op-ed article by Senator Ron Johnson, who basically exploits his infant daughter’s medical experience to make an incoherent attack on the Affordable Care Act. His daughter received excellent treatment, and he asserts that she wouldn’t have received that kind of treatment under universal health insurance, because …. well, he doesn’t explain. [...]


But what struck me about the whole piece was the assumption that modern medicine in general is something only we lucky free-market Americans have, while in Europe they’re still using leeches or something. In other words, it’s part of the superiority complex you often encounter in U.S. politics; people just know that we’re the best, and won’t believe you when you tell them that actually they have the Internet, cell phones, and antibiotics in Europe too.

But what strikes me, looking at the original piece by Senator Johnson, is that he valorizes specifically the technological aspects of Western medicine—it was a complex surgery that saved his daughter, and he refers later specifically to joint replacements, cataract surgery, and radiation, all technology-intensive procedures. He closes his piece talking about innovation, choice, and competition, all concepts that seem curiously placed in a mini-manifesto about healthcare. After all, how many patients complain their doctor isn't innovative or competitive enough or doesn't order enough tests? 

Virtually everyone I know wants medical care from doctors who pay attention to them, who perform the lost art of the physical exam, who spend more than 4 minutes half-listening, half-reading a chart while they scribble a prescription for the next test. This time-crunched scenario, by the way, is the very situation that has driven up healthcare costs in the first place.  It is far more “efficient” (another phrase often bandied about in these discussions) for both patient and physician to spend time together creating a thorough history, getting to know the patient’s life circumstances, personality, etc., than for the doctor to order a battery of tests relatively blind to that crucial information. Some things just take time and care; listening is one such activity, and properly reading tests is another.* Lack of time and lack of simple, low- (or really no-)tech checks and balances are responsible for most medical mistakes, misdiagnoses, and subsequent malpractice suits.**

Back to Senator Johnson and the arguments promulgated by the current crop of anti-healthcare-reformers, who apparently not only want healthcare not to be available to everyone, but also want it to be expensive, technology-driven, and less efficient. Leaving aside for a moment the deep problems with the tests themselves (false positives, false negatives, false reliance on tests as "objective", lab companies saving money by not recalibrating equipment frequently enough, not having an actual pathologist examine the specimens, etc.), this is a really screwy set-up. The only ones sure to benefit from it are the companies that make the equipment, read the labs, and make the drugs.

In fairness, I do not think it is all about greed (though it would be interesting to learn  how much money the anti-healthcare-reform politicians receive not just in donations from Big Pharma and Big Insurance, but from their own investments in these huge industries). I think science and technology, like divinity, provide a sense of magic and mystery that speaks to the human need to feel awe. They  also, again like religion, promise that there might be, after all, a way for us to exert some control over the vicissitudes of life.


This is a dangerous myth, however, and it is costing us dearly. 

It operates not just in healthcare, where we spend the vast majority of resources on the first and last six months of life, desperate to hold onto continued existence at any cost, never questioning whether the quantity of days spent technically alive should take precedence over the quality of the life thus endured or forced upon the unwitting. Technophilia is also an impediment to the environmental movement, because much of the public discourse is based on the assumption that the environment is endlessly plastic (!), amenable to our technological control, and thus we can "out-invent" and "out-compete" our way in developing "innovative new technologies" to battle rising sea levels, rising temperatures, etc. But this idea that Nature is to be controlled or conquered for our benefit is at the very root of our problems.  And there is little if any talk of developing technologies to reduce the amount of pollution that is dumped into the air, land and sea—only technologies to minimize the climate change effects of that pollution. This, too, is very odd, since if we cannot bring ourselves to alter an industrial process so that it is cleaner, it seems like outright megalomania to think we could send up some enormous swath of material to deflect sunlight or patch the ozone layer (all the while dumping more toxins into the atmosphere). There is a strange hatred of change toward the much cleaner technologies and processes already available, and a preference for far-fetched fantasy.

Does anyone else find this curious?


__________________


*Inter-rater and  intra-rater variability in interpreting  images such as chest X-rays and mammograms are shockingly high; see Jerome Groopman's excellent treatment of this issue in How Doctors Think. 


** Cf. Atul Gawande, The Checklist Manifesto.

What two dogs in the aftermath of the tsunami can teach us about ethics

The video I mentioned last week, showing the touching loyalty of one dog for her companion injured by the Japanese tsunami, apparently went viral. It's not surprising that people all over the world were moved to watch: the tender interaction between the two dogs is so utterly uncomplicated by any form of ego. They are emotionally in tune; there is no need for verbal language. They depict an ideal we humans have to work hard to achieve in our relationships.

I was reminded of other videos I've seen recently about animal relationships, especially inter-species friendships. Tara the elephant and Bella the dog; the joyful, affectionate reunion between Christian the lion and the men who rescued him years after they'd released him back to the wild; the zoo-caged gorilla who tenderly rescued the human child who'd fallen into the cage and brought him to the zookeepers. There are actually a plethora of such stories, which nevertheless are always reported as if they are singular, even miraculous, events. Perhaps we are only projecting the unlikelihood of our own involvement if we find a fellow creature in need, particularly if they are of another class, race, or species.

Considering these inter-species encounters, I'm struck by how uncomplicated they are by human-style egoism. Rather, they are emotionally "real": powerful, direct, profound, immanent. These animals do not waste time calculating which species is more intelligent.  They do not waffle over whether other species are sentient, lord their species-specific abilities over others, or shrug their shoulders when disaster strikes someone not of their tribe. They do not wonder, in self-justification, whether others feels pain. They do not set out to utterly destroy other species.

Only human animals are so disconnected from their place in the world that they regularly make the mistake of thinking they are above it. It is a holdover from the Judeo-Christian notion that man has dominion over nature, which has provided twisted justification for marking all non-human species as Other, as Object, paving the way to excluding them from the Kantian imperative to treat others as ends in themselves. 

In fact, I'd go so far as to say that ethical behavior is rooted in our animal natures, not our capacity to reason. Aristotle wrote of the similarities between humans and dolphins over two and half thousand years ago: both take pleasure in exercising their skills, both display curiosity, bravery, and purposefulness. Nietzsche picked up this idea a century ago:

The beginnings of justice, as of prudence, moderation, bravery—in short, of all that we designate as the Socratic virtues—are animal...

To empathize, to share joy or sorrow, to connect... these do not require verbal language—they require sensitivity, presence, memory of one's own experiences, the inclination to pay attention and to risk trusting.  Considering the range of inhumane responses and behaviors on display every day, it would seem we should look to nonhumans to learn how to live.

Preliminary thoughts about character, national and individual

It is natural that the recent disaster in Japan should turn our thoughts toward the possibility that our own homes might be vulnerable to similar upheavals. We vainly attempt to calculate the most likely disaster scenario, imagine for a few seconds what heroic actions we might take, what route we might use to escape, what neighbor we might rescue along the way (or not). And in a few days, most of us will have successfully buried these anxious-omnipotent fantasies, reassuring ourselves that we're exceptional or that technology will save us or that there's nothing we can do anyway.  Denial, grandiosity, fatalism.

But it is worthwhile considering the hard truth that there is no place on earth that can guarantee our safety from some form of disaster—earthquake or flood, drought or famine, hurricane or tropical storm—and it's only going to get worse. Not just because we're now subject to socio-economic catastrophes with global reach (financial meltdowns, endless wars, dwindling resources) or the ravages of human greed on a grand scale (corporate pollution, misinformation promulgated for political or commercial gain). As Bill McKibben argues in Eaarth, we have created a planet that is increasingly inhospitable to life, a planet profoundly changed from the one many of us were born on. Sometimes human society itself seems inhospitable to life: abuses of power, abuses of privilege, abuses of one another....all of which are usually intimately related to the afore-mentioned financial meltdowns, wars, dwindling resources. And, while I’m delineating kinds of suffering, I might as well mention illness, which afflicts us as individuals yet can have profound consequences for people around us (and which also can result from natural disasters as well as acts of evil).

Seneca summed it up: "What need is there to weep over parts of life? The whole of it calls for tears." 

But if denial and grandiosity aren't viable options, neither is fatalism.

I’ve argued in this blog recently that we have to address problems at the level of scale at which they occur: our global environmental crisis, for example, requires coordinated responses among countries and corporations and not just individuals using less plastic. But there are, of course, appropriate responses that can take place only at the individual level. If you find yourself injured, for example: 1) you could deny it (a frequent response—at a public hospital we frequently see patients who’ve let a tumor get so large it becomes much harder to deal with, though that’s usually for lack of money rather than pushing the problem away from consciousness); 2) you could "push through the pain" (and likely injure yourself further); 3) you could collapse into a helpless heap and make everyone else around you cater to your needs; or 4) you could learn what you can about the injury and the circumstances leading to it and tend to the injured part until it heals, being particularly careful in the future to not make the same mistake.

I’m thinking response #4 reflects the healthiest approach, the one most likely to prevent further problems. But it requires knowing how to recognize an injury, having had a prior experience of being cared for and healing (thus knowing what it is to take care of the body), having a certain amout of hope and creativity in utilizing available resources, and a lot of patience, determination, and capacity for self-reflection. In a word: character.

One of the striking things about reports coming from Japan is that they regularly mention how calm and cooperative the displaced have been. The New York Times today reported:

Many Japanese have endured the privations with a similar mood of quiet stoicism, and the strong sense of community that still prevails in these northern rural areas. Even the hardest-hit areas have remained orderly and friendly, and crimes like looting are largely unheard of.

Without making too many generalizations about different cultures, I think many could agree that such communitarianism is comparatively weak in the U.S.  We live with a surfeit of information but a lack of integrity; all we seem to talk about is how to make more information available to more people (internet for everyone!), while few explore ways to enable individuals to make good use of that information. Analytic skills and understanding how to participate in a civil conversation can be shockingly absent even among professional groups.

We are, I believe, suffering the consequences of two powerful ideas combined into a distinctive political ethos: the central tenet of liberalism, which prioritizes process over substance (see Stanley Fish's provocative essay in the Times about this), and a central tenet of capitalism, which values competition.

We now habitually confuse means and ends, and our conceptions of goodness have grown dangerously thin. All that matters is winning the game, whatever the game happens to be at the moment. Is the game SAT scores? Let's teach to the test. Is the game about getting a degree? Let's plagiarize and cheat our way through school. Is the game winning an election? Let's lie about our opponent and stir up fear. Is the game about being popular? Let's talk about bipartisanship and hope no one has the audacity to remind us of the actual problems that aren't even up for discussion. Better yet, let's talk about "winning the future" and “out-educating the world” and hope no one asks what that even means.

I submit that a host of our ills reflect bad character, and that our contemporary process-oriented, competitive ethos has eroded certain conditions essential to human flourishing.  Over the course of future posts, I want to explore the notion that ethical behavior begins with attaining mastery of a practice, trade, or art—playing the piano, laying bricks, cutting hair, tending bar, raising chickens, designing gardens. I believe that through these ordinary social practices, which put us repeatedly and directly in touch with the effects of our actions, we develop a range of virtues that are necessary for our own happiness, the success of our relationships, and the health of the earth: humility, attentiveness,  self-discipline, circumspection, perseverance, sensitivity, taste, patience, perspective, connectedness... virtues that cannot arise either from the top-down application of abstract moral principles or from the practice of white-collar jobs whose express purpose is to manipulate people or money.

To be continued...

Responses to disaster: optimism as a form of resistance

Dominique Browning has done it again, with a moving post on the Japanese tsunami.

In this case, however, I was equally struck by some of the comments in response to her blog. A few responders seemed eager to cheer up Ms. Browning, who wrote of her anguish and anxiety over this catastrophe. Though I can appreciate caring individuals not wanting a friend, even a virtual one, to fall into the slough of despond, I think there is a tendency among us to be quick to "console" by urging a pollyanna-ish cheeriness. The Brits keep a stiff upper lip; we want to keep smiling. Maybe the French shrug (who knows?).

Although we do need to somehow maintain resilience in the face of catastrophes, whether natural or man-made, acute or chronic, it seems to be a strange American affliction to insist on being positive all the time. In fact, given the real world we live in, and the thorny challenges we face, it seems downright delusional. At the very least, it is inauthentic, responding to an intellectual construct of the world as opposed to the way it really is (and we know how well that works in personal relationships).

But there are consequences well beyond one's individual psyche, and this is where I find my real objection: the "stay positive" mantra isolates the sensitive among us, condemning them to shame and persecution for their realism and insight, when we should really promoting collective action and seriousness of purpose. Changes of behavior at the individual level, though important, cannot tackle political, economic, or social problems, because they exist at a different level of scale.* I cannot help but think that the Pollyannas are actually the most cynical of all, and that they are trying to fortify themselves and everyone else from falling into the black despair that otherwise is a perfectly justifiable response to so much of our self-inflicted human misery.

I am reminded of this passage from C. S. Lewis' Abolition of Man:

For every one pupil who needs to be guarded from a weak excess of sensibility there are three who need to be awakened from the slumber of cold vulgarity. The task of the modern educator is not to cut down jungles but to irrigate deserts. [...] By starving the sensibility of our pupils we only make them easier prey to the propagandist when he comes. For famished nature will be avenged and a hard heart is no infallible protection against a soft head.

Nor, I might add, is a soft head any use against hard problems. We need soft hearts, hard heads.

Barbara Ehrenreich, among others, has made a compelling argument that our relentless commitment to unrealistic optimism sowed the seeds for the banking crisis—and that an insistence on being cheerful actually leads toward a lonely focus inward and to political apathy.

So let's get serious about understanding the challenges we face, raise the level of discourse in this country, and act together to exert change. And when sensitive, intelligent people look at what's happening in various corners of the earth and express their despair, let's listen and let them irrigate our spiritual deserts.

* Consider recent events in the Arab world: after decades of abuses of power, wars, economic sanctions, and diplomatic efforts to influence the regimes, it finally took hundreds of thousands of people acting together, marching on the streets of Egypt for a month, risking life, limb, and freedom, to get rid of one measly dictator. That's the power of collective action. Speaking of which, I am inspired by Bill McKibben's creative leadership of global efforts over at 350.org to promote serious political action to address climate change.

Reactive Democrats

I was dismayed to be asked to vote on the next bumper sticker slogan for the Democratic Senatorial Campaign Committee. First, I don't have a car and thus no need for a bumper sticker. Second, when I had a car, I still had no need for bumper stickers.

But that's all beside the point. Here are the top five slogans offered up by (one assumes) Democrats:

1. We've got your back, Barack

2. Had enough tea? Repeal Republicans 2012!

3. GOP: not my cup of tea

4. No tea for me, please, I prefer progress.

5. GOPuleeeeeez

#1 has the virtue of rhyme and rhythm, but most liberals I know are kinda disappointed that ol' Barack hasn't shown much back the past two years, even right after the election, when he had abundant popular support.

#s 2-4 are all about the Tea Party, more specifically, standing against it. But the Tea Party is about populism. (At least the parts that aren't directly funded by Koch Industries.) With all that has been going on in Wisconsin—not to mention Egypt, Libya, etc.—don't we want to take that populism and run with it? The current crop of Republicans isn't promoting any policies that are going to help the "other 98%" of us who aren't mega-rich. Why not give voice to the legitimate gripes of the tea party, thereby diminishing their need to maintain paranoid psychological defenses by fixating on birth certificates, death panels, etc.?

#5 I found amusing, but I'm certain that the the GOP would read it as, "GOP, Please!" Too easy for them to appropriate that one.

Instead of just reacting to our perceived opponents and taking an adversarial stance, why don't we start standing up for things like, I dunno, fairness (the justice system)? shared responsibility (corporations can't pollute and run)? respect toward one another (support for early education that is rigorous and assumes the kids will one day be thinking, feeling citizens of a democracy)? sensitivity toward other species, the environment (global warming; this can even be couched in religious terms of stewardship)? job creation (green industries)? not wasting money on corporate subsidies (Big Ag, ethanol, the oil industry)?

"Liberté, egalité, fraternité" is already taken, but it's the right idea for a slogan.

Is democratic discourse even possible when healthcare professionals behave like this?

Faith in democracy rarely survives a scroll through a blog's public comments section.

To wit: Yale psychologist Rebecca Puhl, PhD wrote a blog entry on Medscape (a site for health professionals) entitled, "Harsh Comments During the Holiday Season" in response to Alastair Macaulay's New York Times review of the NYC Ballet's new production of The Nutcracker. Macaulay had criticized a male and female dancer for their lackluster performance. Here is the offending paragraph, which was, by the way, embedded within an otherwise glowing review of the opening night performance:

"This didn’t feel, however, like an opening night. Jenifer Ringer, as the Sugar Plum Fairy, looked as if she’d eaten one sugar plum too many; and Jared Angle, as the Cavalier, seems to have been sampling half the Sweet realm. They’re among the few City Ballet principals who dance like adults, but without adult depth or complexity. Ashley Bouder (Dewdrop) has the brilliance they lack, but also a greater and more tough-grained hardness."

Because Medscape requires a subscription, here is Dr. Puhl’s response to the Macaulay review:

Many people enjoy the holiday ritual of attending the Nutcracker ballet this time of year, and a couple of weeks ago a review of George Balanchine’s “The Nutcracker” at the New York City Ballet appeared in the New York Times. In part of his review, the writer Alastair Macaulay criticized the body weight of Jenifer Ringer, cast as the Sugar Plum Fairy, who according to Macaulay, “looked as if she’d eaten one sugarplum too many.”

These comments spurred considerable media attention, including a televised interview with the ballet dancer Ms. Ringer herself, who has battled with anorexia and overeating.

If a dancer doesn’t conform to the strict (and often unhealthy) ideals of thinness expected in ballet, does it reduce the quality of the performance? Are these expectations appropriate, or just reinforcing stigma? Ms. Ringer is a talented ballerina performing in a prestigious ballet production – her high profile role and the quality of her dancing speak to those talents.

This criticism sends yet another concerning message to young girls, who may face terrible pressures, negative body image, eating disorders, and other potential health problems in order to conform to excessively thin body types that have become the norm in the ballet world. Is this really necessary? Instead of instilling shame, stigma and harmful health messages on girls and women who love to dance, let's embrace and applaud them regardless of what size of tutu they wear.

Dr. Puhl, whose research specialty is weight bias, seems to have been overly sensitized by her occupation. She grand jetéd to the conclusion that Macaulay was insulting the female dancer's weight (she was apparently unconcerned about the male dancer), launched an attack on the "strict and unhealthy ideals of thinness" expected in ballet (forgetting that professional dancers have to be healthy enough to jump, twirl and kick most of their waking hours), and conflated “girls and women who love to dance” with NYC Ballet prima ballerinas who are called to somewhat higher standards.

Dr. Puhl seems to not understand ballet or criticism; the issue is not whether Ms. Ringer is talented, but how she performed on a particular night in a particular role. The real surprise of the blog, though, was the harshness, vindictiveness, simple-mindedness, and ignorance displayed by so many of the blog’s commenters—healthcare professionals, no less!—who leapt onto the eating disorders bandwagon without having bothered to check the original review. Some suggested ballet should be forced to change its standards and be boycotted until it does; many commenters searched for still photos of the female dancer in question and concluded that she was perfectly lovely and thin (it never occurred to them that one cannot evaluate a dancer or dance performance by looking at still shots). There were numerous ad hominem attacks on the critic, and some gratuitous gay-bashing. (A few comments, one of which suggested torture and death for the critic, were so inflammatory they were later removed by the blog’s editor.) The solid majority of commenters were able to see the issue only through the restricted lens of eating disorders, and a startling number evinced no understanding of the role of a critic.

What concerns me most, however, is not the clear ignorance of the healthcare-blogging public in matters of art. It is the ignorance of how to read critically, to analyze an argument. It is the fact that the people entrusted with our care (doctors, nurses, pharmacists, psychotherapists) seem so disinclined to question assumptions or check their sources or even control their hostility. This does not bode well for democracy. Eating disorders are evidently a hot-button issue, but are they any more volatile than, say, taxes? education? the environment? social security? Democracy works only if the citizenry is educated and committed to acting responsibly and honestly. There are many ways to cheat the system, as we have seen over and over again. But when the system is so weakened from within, what recourse do we have?

Lest my gentle readers think that I am over-reacting, I will now provide a glimpse of the comments.

The Data

I spent a considerable amount of time reading through all 195 comments and categorizing them to get a clearer picture of the state of this particular hive mind. Five comments were so off-topic or hard to decipher that I had to discard them. Otherwise, the breakdown was as follows.

Agree with Dr. Puhl’s post (“supporters”): 157. (= 80.5% of total comments) Of the 157, there were 59 calm supporters who wrote nothing harsher than “I looked at Ms. Ringer’s photos and she’s not fat” or “The reviewer’s comments are probably fair within the ballet workday, but are appalling in the healthy context. Maybe ballet should die a lovely death.” (Well, ok, that last comment isn’t terribly calm, but wait until we get to the hostile categories.) There were 8 autobiographical supporters who relayed personal or familial experience with eating disorders. 9 supporters were markedly ignorant about ballet (e.g., “the name Sugar Plum Fairy suggests a full-figured woman anyway”), 16 were markedly ignorant about the nature and purpose of reviews (“I doubt if the critic could have performed the piece as well as she did.”). The comments in this category were striking for their reliance on homilies: there seems to be something about adopting the position of criticizing someone else for their criticism that pushes one toward banality. Below are excerpts from comments in this category:

“ ...people who criticize others are trying to compensate for their own shortcomings...”

“... Abe Lincoln once said it is better to remain silent and thought a fool than to speak up and remove all doubt.”

“... I hope her parents taught her the old saying, ‘I'm made of rubber, You're made of glue, Whatever you say bounces off me and sticks on you!’”

“...do not judge and be kind to one another”

“...let him who is without sin cast the first stone”

“...As for the critic I would offer Proverb 14:23 All hard work (ballet dancer) bring a profit but mere talk (critic) leads only to poverty.”

“...as the old saying goes ‘no one has ever erected a statue or named a hospital in honor of a critic.’"

“...The Bible has great wisdom – ‘Be slow to anger.’ Let me add Be very slow to criticize.”

“...the most critical are those who have nothing to write home about themselves”

Seven commenters (the objectifers) seemed to be trying to use science to tamp down the emotional quotient: they wanted to make the question about whether the dancer had a “normal” BMI (body mass index) or not. Early on, one poster rightfully pointed out that normal BMI ranges are not applicable to professional athletes, but that didn’t stop four subsequent commenters from continuing to speculate about Ringer's BMI based on her photographs (!).

Now we get to the hostile categories (63 total, or 32% of total comments): 10 were angry toward the critic (e.g., “I’m seeing red!” “shame on this chauvinistic creep”), 12 were nasty toward the critic (from “he’s insane, he should have his nuts cracked” to calls for him to be fired, physically punished, or assassinated), 23 employed ad hominem attacks and speculations (he must have eating issues; he is sadistic and misogynistic, jealous, envious, soul-sick; “This old fool needs a new hairdo. When I did a Google search and saw his photo I thought what a jerk!”), and 3 homophobic comments assumed any dance critic must be gay and proceeded to conflate homosexual with pedophilic, sometimes with unintended self-contradiction: “...Since most skinny formless women are under age 13, the men/women attracted to that look are closet child abusers. In fact, it is my understanding that unwanted sexual advances is one of the risks for young women who go into ballet and female gymnastics.” (If the problem is pedophilic homosexuality, one wonders where all the sexual advances toward women come from.) 11 posts were angry-dismissive toward other commenters, and 2 were angry-oppositional (e.g., “Maybe Jenifer Ringer and all the other whiners should take a trip over to namby pamby land and get a dose of self-confidence. They should also realize no one wants to watch a Sugar Plum Fairy shake like a bowl-full of jelly...” Um, wouldn't that require a trip away from namby-pamby land?).

One post from a hospice nurse was in a category of its own: an over-reaction that was both wierdly morose and poignant:

This article and your message have upset me. My dream has always been to go to the ballet in a big city instead of watching on TV. But now in this terrible recession, I have started to walk and talk with my money. Too many in my family are unemployed or underemployed. From now on I will not watch ballet on TV and I will put aside my dream. Anyway, there are better things in my life now, like our first grand daughter and first grand son. I will give them my time, bake cookies, buy books published here in the USA. I did not go shopping after Christmas this year. I think we all need to use our assets to change what is so wrong in this world. We do not need goods made in foreign countries. We do not need to see dancers kill themselves in order to be accepted into dance companies. I do not approve of the way girls and women are treated in the fine arts and entertainment world. Never have. Now I have a good reason to not even watch The Nutcracker on TV ever again.

Among the mere 22 (11%) who voiced non-hostile disagreement were 6 who accepted Dr. Puhl’s premise but thought that obesity is a bigger problem to worry about than anorexic dancers. One of these thought we should be just as concerned about males with eating disorders.

Out of all 195 posts, only 16 (8%) expressed polite, thoughtful disagreement with Dr. Puhl’s premise. Comment #93 summed up the situation nicely: “it seems many commenting here are not fans of ballet and don’t understand critics...” Some urged an attitude of respect toward professional critics (“Ballet is art...those who spend a lifetime studying an art form are likely to have opinions based on some substance....”). Comment #49 (mine) took a step back and referred to the original review, which I was prompted to read only after finding flaw with Dr. Puhl’s reasoning:

Before we all form a cavalry on our high horses, let's look at the quote in context, near the end of an overall glowing review of this new production of the Nutcracker: 

"This didn’t feel, however, like an opening night. Jenifer Ringer, as the Sugar Plum Fairy, looked as if she’d eaten one sugar plum too many; and Jared Angle, as the Cavalier, seems to have been sampling half the Sweet realm. They’re among the few City Ballet principals who dance like adults, but without adult depth or complexity. Ashley Bouder (Dewdrop) has the brilliance they lack, but also a greater and more tough-grained hardness." 

The core criticism—about both Ringer AND a male dancer (which no one seems to be comparably up in arms about)—is about their dancing. The critic thinks they lack depth, complexity, brilliance, lapidary hardness.

To me, the reference to sampling sweets is not a veiled reference to corpulence but to a sense of a post-prandial somnolence, a soporific or even lazy quality in their dancing that he felt did not equal the technique and artistic imagination of the other dancers in that particular production, on that particular evening. It is akin to saying a few dancers in a ballet about a bacchanal looked like they'd had one too many glasses of wine. You wouldn't interpret that as a comment on their personal alcoholism—you would assume, rightly, that it was a reflection on how they danced.

Four comments applauded this “rational viewpoint” (thank you, #51, 123, 174 and 175), but the vast majority of the subsequent 146 kept riding their high horses. #186 expressed the same wonderment I felt when returning to the blog a couple days later and seeing how little influence my “rational viewpoint” had exerted:

Wow, I have to say that as a veterinarian, I am truly amazed (appalled) at the level of professionalism (what professionalism???) demonstrated by my human doctor counterparts on this particular blog. Amongst professionals in my chosen field, there is a level of respect, tolerance, and courtesy when engaged in professional blogs, even when opinions differ. Perhaps this is why so many of my clients tell me that they wish I could be their personal physician instead of their MD.

I hope to examine, in future posts, other situations in which respectful discourse seems compromised and to understand why this happens. Perhaps by understanding the categories we might fall into, we’ll be better able to recognize the pitfalls and avoid them ourselves.

* * * * *

P.S. Macaulay himself responded to general media brouhaha here. ("Judging the bodies in ballet.") His account of the whole kerfluffle, as well as the requirements of ballet and of reviewing, is worth reading; some of the NYT reader comments, apparently, were also "obscene and abusive."