Sunday, August 28, 2011

I Have a Dream

There has been a lot of hoopla here in New England the last few days. A storm was coming that threatened to be a disaster. Indeed, there are areas that have seen disaster. People have lost homes, some have died, lots are under water, and tens of thousands are without power. Here in my little corner of New England it wasn't much of a disaster. My house still stands. A few branches are down. The last roses of the season have blown off. All in all, I'm thankful that me and my neighbors have escaped unharmed.

It nearly escaped me that today marks the 48th anniversary of Dr. Martin Luther King's "I Have a Dream" speech. It is a speech that I've listened to a lot recently. I've re-read many of Dr. King's speeches with an eye toward the narrative structures he creates for a paper I'm working on. His rhetoric was brilliant then in his time and remains brilliant now, in our times.

He offered up such a language of inclusion -- we are brothers. We are in this together. Together we will have a dream.

There is so much work to be done before we can share that dream. So much need for connection and togetherness. Take a look at the news and our current fascination with budgets and finances. We no longer care to help out our communities. We no longer care to help lift up those who need our help. We are slowly and completely turning our backs on our communities in preference of our selfish needs. The brotherhood,  community, and dream Dr. King spoke of are all becoming rapidly replaced with a singular self-interest in getting what we think we "deserve."

Interested in doing a little background reading on the overwhelming amount of rhetoric that stokes racial fear by the perpetuation of myths and falsehoods. Jeffery Ogbar presents an excellent analysis of just this in a recent article posted on the Root.

Some dream that is. Don't you think?

So today as millions of Americans reflect on Dr. King and the anniversary of his beautiful speech that envisioned all Americans having the same rights and opportunities to succeed and prosper, maybe his words will provoke more Americans to work to make his dream a reality. Because although there is an African-American president and people of color serving in Congress, there are still millions of Americans who barely subsist from day-to-day and conditions are getting worse thanks to Republicans who are more concerned with enriching the wealthy off the backs of the poor. 
Read more of this article here.

Take a minute an listen to the speech. Dream a little. See what happens. I think you'll be glad you did.

The View From Here: Churning Sky Edition

The Great Hurricane of 1938

So I recently acquired the Complete National Geographic Collection on DVD. That's right, at my finger tips I have access to over 1,400 issues, 200,000 photographs, and 8,000 articles. Everything the magazine has published since 1888. For those of you who know me, you might imagine that I've been squirreled away learning all sorts of interesting facts.

With the sounds of Hurricane Irene outside my window right now, I could think of nothing better to do (while I still have power) but to explore another storm that passed overhead 73 years ago. The New England Hurricane of 1938 made landfall as a category 3 hurricane on September 21 on Long Island and made its way through New England. It was estimated that some 682-800 people lost their lives, 57,000 homes were destroyed, and $41.1 billion dollars (2011 value) of damage was caused.

The April 1939 edition of National Geographic details the beginning of the storm. "Hordes of salps, strange soft-bodied creatures from far out to sea, swarmed into the harbor of Halifax, Nova Scotia, one September day, and brought an early "forecast" of New England's hurricane of September 21, 1938. When the brewing storm was still down near the Equator, some force associated with it already was pushing surface waters of the open ocean quietly in toward the North Atlantic coast, 3,000 miles away. Vast numbers of the salps, carried shorward by the influx of the waters, thus gave scientists in Canada an advance hint of what was going on."

Imagine that--the first hint of the storm to come came from fish observed in Canada. In this new world of supercomputer-powered forecasts, satellite tracking, and 24 hour news coverage I knew about the potential of Hurricane Irene last week. I've been preparing for the reality of Hurricane Irene since Friday. Today I can click on a helpful graphic provided  my my local newspaper and get predictions of hourly windspeeds. With all this advanced notice I knew to lash down everything outside that might go airborne, I knew to purchase enough food and supplies should the power go out, and I knew to charge my lap top, my wireless 4G card, and various battery backups around the house so I can do what whatever is required of me.

What it would have been like in 1938. No supercomputers. No satellites. No advanced warnings--except for the fish. Fish and our five senses. "There were ominous signs. People noticed that the air was unseasonably hot and muggy. Their ears felt queer, because the atmospheric pressure was decreasing.... A man who had seen hurricanes before warned his neighbors, but they only laughed at him. Far up in Vermont people noticed a smell of the seashore in the air."

The photo of the four women working at the phone company makes for an interesting view of what technology was. Despite the advent of computer telephone switching, mobile phones, and battery backups our links to the outside world remain just as tenuous as they were in 1938.

The 1939 edition of National Geographic went on noting that  "no one suspected then that this hurricane, forming so far away, would strike northward at New England, turn time backward a generation or more for seven million people overnight, and bring changes ranging from recasting shore lines to altering the courses of men's lives.... The hurricane was to demonstrate how a great, close-packed, highly industrialized modern civilization can be crippled almost in an hour when struck on its "Achilles hell" of electric light and power--and how human energy, Yankee ingenuity, and the New England conscience can rise to defeat disaster"

Like in 1938, we are still likely to be thrown back into another era of life should the power go out. My battery backups will eventually fail and I shall resort to candles for light and fire to cook (that propane fired camping stove has so many uses!). Similarly, like in 1938, we still will rely on Yankee ingenuity. Should Irene cut out our power, or blow apart pieces of our house, I wonder how I'll put my Yankee ingenuity to the test with the miles of duct tape I bought?

Again, technology has brought a new level of security, yet that security is just as frail as it was in 1938.

My last thought before I end comes from this part of the article. In discussing the hurricane, the author of the National Geographic article wrote "It was to destroy valued relics of New England's proud history, but it made that same history live with new vividness as people actually went back to candles for light, fireplaces for cooking, and even community barn-raising to replace storm flattened structures.

The barn-raising made me think of some articles I've read in the news over the last couple of days. It made me think of where our community and values are today, and where they were 73 years ago. Some of the republicans in Congress, led by house majority leader Eric Cantor, are attempting to pin disaster relief funds to their political goals. Cantor believes that disaster relief should only happen if it is accompanied by budget cuts elsewhere.

This sounds great on paper--especially if you are reading that paper somewhere where your roof hasn't been blown off. Tell that to the family in Virginia that had a tree crash through their roof and kill their 11 year old child. It wouldn't sound so great to them. Cutting the budget somewhere to pay for disaster relief sounds great if you have electricity to cook your food, or power to run your business. It doesn't sound all that great when you are eating cold canned beans, or unable to work because your business has been washed away by your ocean.

Community barn-raising. Yankee values. American values. Helping your neighbor out in times of need. Opening your heart, your home, and your wallet for those who are suffering and for those who are devastated. We've done this for generations in the United States. It is part of who we are.

Shame on Cantor for wanting us to become someone else--a people who lets our own neighbors suffer through disaster. A people who let our neighbors go hungry while we squabble of political ideologies.

Saturday, August 27, 2011

Remember When?

Do you remember when we were concerned about dreams, hopes, and being more than we thought we could be? Do you remember when our leaders tried to be heroes, and tried to be concerned with lifting more of us up, and tried to build paths for more of us to reach our dreams?

I woke up this morning and found myself particularly affected by little men and little women with very little dreams. I woke up this morning seeing such sad rhetoric of fear, of broken hope, and of the failure to dream.

A Tree's a Tree--Until It's Not

Presidential candidate Rick Santorum was recently asked why he thought marriages between people of the same sex would affect marriages between people of other sexes. Here is what he said:

Because it changes the definition of an intrinsic element of society in a way that minimizes what that bond means to society. Marriage is what marriage is. Marriage was around before government said what it was.
It’s like going out and saying, ‘That tree is a car.’ Well, the tree’s not a car. A tree’s a tree. Marriage is marriage. You can say that tree is something other than it is. It can redefine it. But it doesn’t change the essential nature of what marriage is. Marriage is a union between a man and a woman for the purposes of the benefit of both the man and the woman, a natural unitive according to nature, unitive, that is for the purposes of having and rearing children and for the benefit of both the man and the woman involved in that relationship.

What is Rick actually saying here when he says a tree is a tree and a marriage is a marriage? He is suggesting that there is a single definition of marriage that has been consistently used in the history of humanity. Any student of history (or psychology, or science, or a student of any other subject, really) would easily reject this statement. There are no absolute meanings, and there are no static social institutions that have kept the same purpose for all of recorded (and unrecorded) civilization.

Santorum makes a stupid argument. He makes an argument that is intellectually and morally bankrupt.

Interested in the history of marriage? You might want to check out this link, or this one, or even this one.  You might also be interested in E.J. Graff's book "What is Marriage for: The Strange Social History of Our Most Intimate Institution."

A few highlights:

While in many (but not all) parts of the modern world marriage is a personal decision between two people, for much of recorded history marriage has been an arranged affair. We married not for love, not for companionship, but for family bonds. We married because our families arranged for us to do so, and we did so to build businesses, alliances, and economic security. There was little--if any--room for love or affection.

Did you know that during the Protestant revolution Martin Luther totally rejected the religious underpinnings of marriage? He declared that marriage is "a worldly thing... that belongs to the realm of government. The Puritans, who found there way here to the coast of New England, felt similarly. They asserted (and passed an Act of parliament) that "marriage [is] to be no sacrament." That was the beginning of our modern day secular marriages.

Check out the links above to learn more.

My point here is that a tree isn't always a tree. They evolve, change, and adapt to the environment in which they are living. What Santorum is really saying is that he values one particular understanding of marriage. It is an understand that is adapted to his values, his morals, and his way of seeing the world. The meaning of the word, and the institution, reflects the values of the meaning maker and the zeitgeist of the times.

It's just silly to engage in meaningless banter about a tree always being a tree, and a marriage always being a marriage, when the recorded history of humanity shows that what we consider a marriage has changed over time.

So here is my question: what are your morals and values? Why do you value one sort of marriage over another? Why is that important to you? How does it reflect the world you want to be in? How does it reflect the world that you want to create?

Wednesday, August 24, 2011

Complaints About Insurance

There has been a lot of talk in the media over the last few years about health insurance companies. Some perspectives offer up health insurance companies as the savior of our bloated health care industry. The insurance companies help hold down costs, innovate cost-saving measures, and drive quality. The news from other quarters suggested that the bloated corporate structures of these very same companies restrain innovation, ration care, and divert money from patient care.

The news also gives doctors a similar treatment. We can simultaneously read articles deriding one hospital that chargers $80 for a tablet of acetaminophen while another article talks about the shortage of primary care doctors driven, in part, because the field doesn't pay enough for them to be able to afford their own medical education. 

I've recently had an experience with an insurance company that really just frosted me. I could rant for some time about what happened. Suffice it to say, sending a claim to this particular insurance company is a bit like throwing a nano-particle into the ocean and hoping to retrieve the particle again ten years later by catching it in a coffee filter. The company engaged in a game of lost-and found with the billing forms. When they reappeared they were diverted to an outside processing company which promised to pay me faster if I accepted less money. When I declined the billing forms were lost again, only to be found after several angry phone calls from myself and my patient.

The final straw was when the patient complained to their employer about the low quality of the health insurance. The company brought the concerns back to the insurance company, which in turn called me asking if I'd be willing to become a provider in their network. I was offered a contracted rate that was significantly below any other insurance company in the area along with an 'array' of benefits including a coupon for discount diet products from a national diet company chain.

That just really frosted me. The lost forms, the promise of 'expidited' payment in return for accepting less than half my normal fee, and then there is the coupon. Really?

So please accept into consideration my experience with this particular health insurance company. It is part of the puzzle of health care reform. It's an important part. I offer you the letter that I sent to this nameless insurance company so you can learn a little bit more of my experience of dealing with insurance.

Dear (Health Insurance Company Provider Relations Specialist),
I received your voice mail yesterday. This is actually the second phone call I've gotten from (health insurance company) in the past two weeks--both have asked me if I was interested in becoming a contracted provider with (health insurance company).
In 2010 I declined a contract with (health insurance company) because I found the reimbursement rate for contracted psychologists to be unreasonably low. The quoted figure, $70 per 90806 service, is lower than any other insurance company that I am contracted with. In addition it is less than half my standard fee. 
To put the reimbursement rate that (health insurance company) offers contracted psychologists in context, I pay more than that rate to my hair stylist for a haircut, I pay more money to a licensed massage therapist for a massage, and I pay more money for that for an oil change and regular service at my automobile dealer. I pay close to that amount to fill up my moderate sized vehicle with gas. A reimbursement rate  of $70 isn't sufficient to keep the lights on in my office, let alone compensate me for the significant investment I've made in my education or the significant amount of skills I provide my patients.
Additionally, I've encountered nothing but difficulty with out-of-network business I have had with (insurance company). Billing forms are lost and misdirected by your company, I've encountered scores of unhelpful, knowledgeable, and  rude provider relations representatives, and received constant requests to receive a lower rate of reimbursement in return for "speedy" response to my billing invoices.
The most recent contract I've received from (insurance company) last week came with a list of "discounts" offered to contracted providers. I found that particularly insulting. I'm not interested in receiving coupons for diet centers, discount eye glasses, or any other services. I'm interested in being reasonably compensated for my time, experience, and training. I'm interested in having my billing forms processed promptly and my concerns addressed rapidly. 
I again decline becoming a contracted provider with (health insurance company). It simply does not make good business sense for me to enter into a contract with your company.
Dr. Jason Evan Mihalko

Thursday, August 18, 2011

Existential Therapy Meets the Irreverent Psychologist

Imagine the following two stories which are basically true.

The patient asked, "What happens if my plane breaks up over the ocean and crashes?"

"Well then I suppose you'll die," responded the irreverent psychologist.

"Well now that's comforting. Aren't you supposed to say something comforting, something to make me feel better. I feel that we've lost a little safety here."

"You'd feel even less safe if your plane breaks up over the ocean and your last thought before you died is that I lied."

"Thanks a whole hell of a lot, Doc."


I was in Palm Springs getting ready to venture out into the desert  to look at the early spring flowers that were blanketing the landscape. I distinctly remember looking into the mirror. That lump on my forehead. I can't really pretend like it's not there anymore. I can't really explain it away by saying that it's just the natural contour of my head. I can't explain it away by saying that I'm just a lumpy sort of guy.

I know what a lump means. It doesn't mean something good. I know what it means when people avoid thinking about their lumps: they are avoiding something that is too scary to contemplate. They are avoiding something that is too unimaginable. They are avoiding death.

I couldn't avoid it. I couldn't be that person.

I returned from the desert and made an appointment with my doctor. "Hmmm. It's a lump," he said. "Great help you are doctor," I responded. X-Rays, CAT scans, MRIs, and bone scans followed.

For one full week I sat with my lump. I sat with my fear of death. I was not yet even done with my doctorate and I might have bone cancer. I  might have brain cancer. I might be dead before I finished my doctorate.

I head back to the doctor to talk about my head. "Not cancer," he said. "Stop shaking."

I'll save you from the medical gibberish, but I had a bizarre condition most commonly seen in cats. I needed to see a neurosurgeon. I needed to have a portion of my cranium removed and replaced with titanium. I would be just fine, though a little more thick headed. I was hoping I could attach notes to my head with a magnet but apparently that doesn't work. I know this because I tired. Twice.

Viktor Frankl, Irv Yalom, and a raft of others have taught me that we should not avoid thinking about death.  In fact, that we should think about the finite amount of time we have every now and again. When we turn off our defenses and tools of avoidance we become closely connected with a single unalterable fact: we all have the same destination and that destination is death.

On a good day I don't find this destination particularly sad or scary. I find it liberating. I find it enlivening.

"You know exactly what I mean. You know that I hope that if your plane is crashing apart, your final moments are filled with connection, and presence, and knowledge. That is the best we can do. That is the only thing we can do. We're all heading full tilt to that destination of death. How are you going to get there? Hasn't that been exactly what our work together has been about?"

How are you going to get there?

Friday, August 12, 2011

Summer Sunset

If you turn up the sound and listen closely you can hear all the sounds of summer--including one very annoying mosquito which also makes a cameo appearance toward the end.

Wednesday, August 10, 2011

Riotous community

What is society? What is the common thing that binds us all together. When I'm feeling in an idealistic mood, I think the common bond we all share is a mutual self interest--and deep desire to care for others and be cared for by others. Help the neighbor out across the street when his car is stuck in snow. Be helped by the other neighbor when you are trying to open your door with just one too many bags of groceries.

Isn't that part of what makes us human? We cooperate. We care for others. We are cared for by others. We are united by our community, by our shared needs for food, shelter, protection, and companionship.

Others, of course, don't see this as the common bond that we share. I was reminded of that when I became acquainted with the FM dial in my car. I had forgotten to bring my MP3 player this morning and was left to my own devices for amusement during my morning commute.

On this particular morning, the conservative program that I tuned into was discussing the riots in the UK. They played this audio of this clip several times:

The host took particular offense to this young women's comments. I took offense to her comments. Not for the same reason as the host. I thought she was just ignorant. However, I'm not willing to accept political analysis from an intoxicated person on the street. There are clearly more astute observers who could shed more light on this subject.

I should also remind myself not to take political observations from radio hosts. This host compared our current situation in the US with the riots going on in the UK. Saying we are just days away from such riots, he stoked up his listening audience saying that the unemployed and various other "lazy" Americans are sitting on the couch expecting to be taken care of by hard working people's tax dollars. The host criticized the idea of taxing companies and millionaires to "redistribute" wealth and take care of those "lazy" Americans. Why should someone who works hard to create a business give away their money to take care of lazy people on a couch?

Why should we? That's an honest question. Why should we tax those with a lot to pay for services that those without resources need? Why should we tax those with a lot of resources at a higher rate to build roads, airports, seaports, and schools?

As I wrote at the beginning of this post, I think that caring for each other--and being cared for--is an essential part of our humanity. Why wouldn't it be in our best interests for each of us to pitch in our fair share--to offer the best health care, the best schools, the best infrastructure---the best opportunity--so that all of us have the opportunity to succeed. That's my vision of my country. My vision is a place where we are all working together to build something greater than any one of us can do on our own. My vision is a place where those who are fortunate are willing and able to help those who are not.

I got to thinking about what values the host might have underlying his statements. I don't know for sure, but I'm guessing they are much different than mine. I'm guessing those host, along with many of his callers, believes that we get what we earn. We earn our money through the work we do--and those wages are ours. We can spent them as we wish. On ourselves. On our families. On our needs.

I do agree with that. I don't begrudge anyone enjoying the fruits of their labor. I do, however, thing that many forget the importance of making the choice to help another--the importance of making the choice to help out our common good.

I wish that we as a country--as a society--would hold onto the very old idea of noblesse oblige. Where is it that we began to lose the notion that with nobility, wealth, and power come responsibilities and obligations? When is it that we began to lose our moral economy in which privilege was balanced out with a duty and responsibility to those without that privilege?

I see the value of noblesse oblige disappearing all over the place. It was missing in the dialogue on this talk show. It's missing when I hear political candidates talk on both the right and the left. On the right we have the mindless droning of the GOP chanting mine mine mine mine mine. On the left we have an equally mindless droning of give give give give give. Both sides fail at discussing anything resembling a value. What is the value behind the Tea Party? Why do they find their ideas important? Can they hear the values that the Democrats have under their policies? Can the democrats identify and speak to those values? Can the Democrats hear and speak to the values of the GOP?

It doesn't appear so. I don't really blame the politicians. They are only giving us what we want. I blame us--all of us. I blame us for forgetting that it's important to talk about ideas. It's important to talk about values. It's important to listen to the other, and it's important for the other to listen to you.

What do you think? More importantly, what do you value?
The community chest, by the way, dates back to at least 1913. I'm sure the roots of it go back much further. The first known community fund was founded in my hometown of Cleveland Ohio in 1913. Money was collected from businesses and workers and distributed to community projects--people who were in need were taken care of by people who had means. These community chest organizations quickly multiplied through the great depression. By 1948 there were more than 1,000 community chests in the country. Several name changes later, the community chest because "The United Way."

Sunday, August 7, 2011

Nepalese Night

A river of stars flows over the Mardi Khola Valley in the Himalaya, as seen in a recently submitted long-exposure picture taken in Nepal. The dense stellar band is the plane of our home galaxy, the Milky Way. This picture if from Anton Jankovoy. You can check out more of his images here.

Friday, August 5, 2011

Shave and a Haircut

So the most interesting part of this one is how different he looks with each change. How does what you think about him change?

Trim from Petey Boy on Vimeo.

Patient Suicide Part Three: Fully Present

This is part of an ongoing story about a patient suicide. Click here for Patient Suicide Part One: The Phone Call, here for Patient Suicide Part Two: 30 Minutes to Think, here for Patient Suicide Part Three: Fully Present, here for Patient Suicide Part Four: What's a Life Worth, here for Patient Suicide Part Five: Treat People Like They Matter, here for Patient Suicide Part Six--Leftovers, here for Patient Suicide: Part Seven--Training Monkeys/Herding Cats, and here for Patient Suicide: Part Eight--On Scarves and Lessons Learned

It was a couple of days after I got the phone call that my patient had died that a patient managed to see right through me. It was unnerving and of course, her observation was right.
"What just happened? You looked so very sad. I've never seen that before. I've never seen such deep sadness in your eyes."
I felt like I might as well have been nude. What else was there to do but respond truthfully?
"You are right. I got distracted thinking about something that happened recently was very sad. Thank you for noticing it--and noticing me. I'm sorry that I got lost for a moment and wasn't able to be there for you."
She was the only one who saw me like that. That is, she is the only one who saw me like that and mentioned noticing the sadness in my eyes. At the moment my client noticed me drifting into my own fantasy world, I was thinking about how my patient had killed herself and wondering what she experienced. I felt so very sad I couldn't be there with her.

I have some trepidation sharing this particular part of my experience. It seems almost too personal. It seems even a little dangerous. In my first draft of this part of the story I wrote something that was essentially true, but also essentially a lie. I wrote what I think a therapist is supposed to think. I wrote that I wished that I could be there so I could have saved my client. I wrote that I wished I could have been there so I could have done something.

Of course, in a way, that is true. I do wish that I could have saved her. I do wish that I could have done something. Given the opportunity I would have done anything in my power to alter this outcome. I couldn't. I have no special power to go back in time. I have no special power that allows me to alter history. This woman is dead and no fantasy can change that.

I remember the hours I spent sitting with this client. I remember exactly how she looked when she was scared and overwhelmed. I remember how her shoulders would gently roll forward. I remember how she would rock every so slightly forward and back. I remember how she would clasp her hands together and wring them. I remember her mouth moving silently speaking things that could could not be spoken. I remember how Maggie the therapy dog would gently come to her in these moments. She'd nudge her with a paw, lay her head on her foot, or crawl up in her lap and gently lick the tears off her face.

Most of all, I remember her ice blue eyes. I remember how she would eventually look up at me. She would look right into my eyes and silent beg for what she could never find: relief, comfort, and an end to her pain. She would beg me for what I could never give.

It's that image that haunts me. It's the thought of her having that experience alone in her last moments of life that is almost too unbearable for me to stand. It is my one enduring wish that I could have been with her in that last moment looking right back into her eyes, always steady, always sure. It is my wish that I could have done the only thing I ever can really do for another--offer a sense of comfort and relief by being fully present.