9. Sleep and Learning…

April 28, 2015

On June 6, 2014, the lead article of the BBC News website reported on the role that sleep has in learning.  Basically, researchers in the U.S. and China, writing in the journal “Science”, by using advanced microscopy techniques, had demonstrated that mice undergoing training forged significantly more inter-neuronal connections if allowed to sleep, than did mice who were sleep-deprived.   Which raises a question I have had about our whole educational paradigm.

Even in my own neurophysiology courses in the early 1990’s, I learned that shifting items from very short-term memory to long-term memory actually involves the production of new proteins in the relevant parts of the brain.  As I recall, building up those proteins can take almost two weeks.  Why then, I wondered, have we developed an educational system that purports to pump several hours of new information into us every day, when that to which we are exposed in just the first hour won’t begin to be remembered until about 24 hours later, and when intense exposure cannot speed up the process of forming new proteins in the brain?

Regarding the role of sleep in learning, ironically I developed extremely severe insomnia in my first year in law school.  In what I would now characterize as a state of chronic panic over needing to learn fifty or sixty pages of densely compacted new information each evening, I would force myself to read on at a rapid pace despite my exhaustion.  Whereupon, in act of cortical rebellion, my brain did a strange thing.  I would discover that I had, without realizing it, been reading the same paragraph over and over again for an hour.  Redoubling my efforts and flogging my weary brain I would read on into the night and finally fall into bed at five in the morning, my head swimming with the stuff I had been reading.  My roommate would try to wake me for our 8 o’clock class, but to no avail.  I was nineteen, naive, and unable to interrupt what became a dismal daily cycle and lasted the whole winter of my first year in law school.  I barely scraped through in that eight o’clock course I never attended.  By luck, In June that final exam came last, and I had nearly a week to read my virgin Criminal Law text before I had to sit for the exam.

By the time I went to medical school, five years had passed, two of them in the Army in Germany.  I was married and had a daughter, and in the last half-year of pre-med, after the Army, I was able to figure out how to study.  Or, now that I think about it, was it merely that I got a good night’s sleep snuggled next to my wife every night?

Yet, especially in the first two years of medical school, the pedagogical strategy was still to give the proverbial, “drink of water from a fire hose”.  Some of the teachers used the same intimidation techniques I had met in law school. In the final two years, sleep deprivation was specifically accomplished by placing students on night-call for the Emergency Room, the delivery rooms, the medical wards and the Operating Room.  However, at least the book and classroom load was reduced in those “clinical” years.

During my internship and a year of surgical residency, once again the “teaching'” establishment employed sleep deprivation, in the form of a 36 hours on, 12-off daily schedule, with time off from Saturday at noon to Monday morning three weekends a month.  Moreover, with an annual salary of only $3,000, and with a wife and three kids to feed,  I had to use one of my weekday “off” nights and one Sunday a month to moonlight in the E.R. at another hospital.  At 30, I was able to survive on this regimen, but it could not possibly have been the most effective way to form useful and lasting knowledge.  In the intervening fifty years, some have also questioned whether sleep-deprived young doctors in training can think clearly and perform adequately on the wards, in performing surgeries and deliveries, and in responding to emergencies.

Why doesn’t the training and educational system conform more to the neurophysiology of how we actually learn and remember?  True, a limbic component (in the academic case both fear and the exhilaration of learning) is one way to accelerate and enhance memory formation, but at what expense?

It wasn’t until I returned to a three-year residency in psychiatry at the age of 56 that I encountered a “humane” teaching program, and that wasn’t because the medical establishment wished it so.  At the state hospital , the doctors, including residents, all belonged to the Union of American Physicians and Dentists, which subscribed to the eight-hour work day, (for which more than a dozen union factory workers died in the early 20th Century).  If the state wanted to put us on night call they would have had to pay us time and a half for anything over eight hours, and double time for holidays.  So it was cheaper for them to hire non-union contract doctors for night and weekend coverage and we residents only worked forty hours a week.  Another thing that had changed:  we were paid between $37K and 40K per year.  I was single and my kids were all grown up.  Given that I needed to spend nights and weekends hitting the books, it was a good thing I could live on the salary and  didn’t have to take on an additional moonlighting job.

The process of memory formation being what it is, why are medical schools and law schools organized around sleep-deprivation methods?  Is it that the training for these professions is also a rite of passage, a form of hazing that each initiate must learn to endure?  In both cases the student certainly learns that he or she can persevere through chronic and severe deprivation of proper rest, far beyond what one would otherwise have believed possible.  It is not dissimilar to what one learns about endurance on a physical level during military basic training, where techniques of bullying and intimidation are also famously employed, but in that case only for a period of eight to sixteen weeks.

I recall that as a child of seven or eight years I learned a similar lesson of great value:  that despite fatigue and the aching of my legs, I could actually persist in climbing a sizable mountain in Vermont, due to the encouragement and cajoling of the counselors at the farm camp I attended there.  Reaching the top of Mount Haystack, a couple miles from Wilmington, I stood amazed that I had been able to walk up it despite my certainty that it could not be done, at least not by my body.

In law, and much more so in medicine at a time when there still existed the principle of “continuity of care”, the work by its nature demanded that one perform it when it was needed, often in the middle of the night and for prolonged periods of time.  Those students who had never climbed Mount Haystack or had never been through military basic training, as I had, may have benefitted from the endurance aspects of medical training.  But certainly that particular lesson could have been learned within the space of a month or two at most, and did not have to last nearly a decade.

From time to time I have wondered if it were not a form of child abuse, being passed, as are the other kinds, from generation to generation, the abused becoming the abuser.  Or whether it was a selection process, weeding out all those who were not obsessive workaholics willing to sacrifice self and family on behalf of the afflicted.  Selecting those who somehow needed the opportunity to become rescuers of major proportions.  Selecting those who, throughout their careers, would allow themselves to be abused and exploited without rebelling or even complaining.

8. Can Police Shoot A fleeing Felon?

April 27, 2015

Today I’ve been watching the rioters in Baltimore on cable news, where the Crips, the Bloods, the Black Guerrilla Family and other gangs have announced they are “teaming up” to target white police officers.  As of the time of writing seven police officers have been injured in the riot.

I had been wondering how the inner-city black ‘inversion of values’, and the narrative pitting blacks against the police in Baltimore and other American cities, ever gained the momentum with which it now surges forward.  Where, for goodness sake, did people ever get the idea that it was alright to fight with police and to run from them?

Someone reminded me that until recently it was legal for police to shoot a fleeing felon, until the 1970’s he thought.  Actually it was 1985 when the SCOTUS handed down the decision in Tennessee vs. Garner that when an officer is pursuing a fleeing suspect, he or she may not use deadly force to prevent an escape unless, “the officer has probable cause to believe that the suspect poses a significant threat of harm or serious injury to the officer or others”.

This decision by the U.S. Supreme Court overturned the state law in Tennessee, which had said, “if, after notice of the intention to arrest the defendant, he should either flee or forcibly resist, the officer may use all the necessary means to effect the arrest.”

The Garner decision was based on the Fourth Amendment, and construed the killing of a fleeing suspect as a “seizure”, unconstitutional unless “reasonable”.    Because that case involved a ten-dollar purse-snatching, the court was saying that the harm caused by the arrest had to be proportional to the seriousness of the felony.

I believe the ultimate outcome has been an “unintended consequence” of a well-intentioned action: an example of (Eric) Severeid’s Law: “All Problems Are Created By Solutions.

Viewed in the light of hindsight, it seems to me that the ruling caused a paradigm shift in the social contest between cops and robbers.  Basically it said that; a) if the police don’t actually know the extent of your crime, or if it would not have warranted your death, and if b) you can escape from their custody and run away fast enough, you may arrange to, c) not get caught at all and get off scot-free.

Before long this came to include the idea that if you could fight your way out of custody and run… same result.  I suggest that this was a seismic shift in thinking, such that the crimes of committing violence against the police and fleeing from the police were utterly discounted, and the burden fell to the police to not only see and stop crime, but, further, to regularly engage in a violent physical contest with criminals in order to apprehend them.  In the underworld of crime, petty and grand, and eventually in the social narrative of the inner city subculture, the criminals and the police gradually attained equal stature and legitimacy.   To the point where now the criminals, if they are black, are considered to be inherently more legitimate than the police.

The new joke is, “A mother shouldn’t have to worry that her son will be shot every time he goes out to rob a store.”  The sad part is that in inner city neighborhoods it isn’t a joke.

In an e-mail discussion group in which I participate, one writer who clearly hates the police, recently posted a statement that within the past month alone, American police have killed more people that British police have killed since 1910.  I believe that is probably one of those stupid, made-up, wildly hyperbolic statistics that compares apples and oranges and ignores several key factors.  But now I wonder whether, by turning every inner city arrest into a fight and a chase, Tennessee vs. Garner may not have greatly increased the number of people killed during an attempted arrest.  Whereas the British cop still says, “Come along quietly, sir, ” and British people by and large do just that.  Not so long ago in Britain when a Bobby blew his whistle you could tell who was the criminal.  He was the only one running away from the whistle, whereas others were running towards it to offer help to the policeman.  Compare that to inner city communities in America, where whether out of fear or due to racial animus, no one helps the police.

Looking at it from the point of view of behavioral psychology and operant conditioning, perhaps in solving one problem, Tennessee vs Garner created a worse one.

Since 1985 have we had to hire mesomorphic applicants to be law enforcement officers, people ready, willing and able to engage in a fight with a felon?  Have we, of necessity,  hired people who spend their time in the gym and like being pumped up on adrenalin and testosterone?  Have we in turn encouraged criminals to at least try to make a fight of it and a run for it, with a guarantee of enhanced street credibility if they get away?   Have we thus increased the necessity for even police officers who might have been inclined to be respectful, gentle and calm, to reach for a taser or a gun in order to go home safely to their families at the end of the watch?  Have we put older, fatter, female or weaker cops in the position where they have to use a gun to come out of an encounter alive?

Have we made it a rite of passage for a every kid criminal to take on the cops and make a run for it?  Are they then almost righteously indignant when they are bested and caught?

7. Bork on Lawyers Studying the Constitution

April 20, 2015

In a discussion group in which I participate a discussant posted the following quote from Robert Bork, preeminent Constitutional scholar and defeated Supreme Court nominee.

“I don’t think the Constitution is studied almost anywhere, including law schools. In law schools, what they study is what the court said about the Constitution. They study the opinions. They don’t study the Constitution itself.”

In my college fraternity each applicant or “pledge”  receives a “pledge father” or mentor.  Mine was a mathematician named Gene Ferrari.  When I had been accepted into law school but before I graduated from college, Gene said he wanted me to meet and talk to his pledge father, Bob Bork, who was then mid-way through law school.  Gene said he though we’d hit it off.

He set it up and one day we sat down for a long talk.  I thought Bob was a little distant and preoccupied, but law school can do that to you and I didn’t hold it against him that he neither seemed all that friendly, nor did he seem as delighted to meet me as Gene thought he would be.  Bob didn’t live in the fraternity house and by the time I started in the law school he was graduating, so we never initiated the the friendship that Gene hoped we might.  Perhaps Bob detected that law school was my lawyer father’s idea and I wasn’t really that enthusiastic about it.  In retrospect I think my lack of passion about practicing law would probably have chilled his interest in our conversation.

Decades later, having quit law school after two years, and after eventually finishing a medical education,  I was sitting with my kids after a long day of seeing patients, listening with interest to the televised confirmations hearing for supreme court nominee Robert Bork, when it gradually dawned upon me that Robert Bork was Bob Bork!  Stunned, I tried in vain to remember precisely what we had talked about that day we met in 1953.

As for the quote, above, I think I understand what Bork means, having studied Constitutional Law in my second year before I quit. (I actually enjoyed studying law, but I had no interest in being a lawyer.  Just couldn’t see myself in practice.)

Legal education is pursued by the “case study” method.  A statute, if there is one, is read, then, pursuant to the principle of stare decisis:  the present case is governed by the older decisions,  a number of cases are studied in detail as to their precise findings, so as to see how the statute law has been exactly circumscribed and defined by the courts.  While the Constitution is merely a more powerful piece of legislation, because of its nature there is a wealth of information about the history and debate that went into its making, meaning it is possible to know a much larger than average amount about the “legislative intent”.  All of which would figure into the arguments in Constitutional case law, but which would not necessarily show up clearly in the end decisions.  If students focus only on the decisions of the court they may never understand what the various provisions of the Constitution were intended by its authors to accomplish.  As a “strict constructionist”, and one opposed to “creative interpretation” of the Constitution merely to offer convenience to some modern circumstance or current issue, Bob would have put much importance on the history and debate attending its writing, and not just in studying the raw decisions of Constitutional case law.  [Ed.  Now in 2020 the term employed is “originalism”.]

Democrats successfully blocked Robert Bork’s appointment in 1987.  Truth be known, as a registered Democrat turned Independent late in life, I think he was just too good for the job.

5. Borderline attachments…

April 16, 2015

This is just a story. Perhaps a parable. Names and key circumstances have been changed to protect the privacy of its characters.

More than twenty years ago, while I was in psychiatric residency training at a state hospital, I was assigned a patient, Livvy, with whom I would do long-term psychotherapy with the help and guidance of my supervisor, the ward psychiatrist.

He, my supervisor, had been a practicing child and adult psychiatrist during the more than thirty years since we had been college dormitory acquaintances in Chicago, whereas I had practiced family medicine, and later occupational medicine. Until we met again at a California State Hospital, we had had no idea that we lived and worked most of our lives within a few miles of one another in the Bay Area.

George is a really nice man, and reconnecting in the role of master and pupil was, I believe, as great a pleasure for him as it was for me. Therefore I believe that his choice of psychotherapy patients for me was with excellent intention. And I had the impression that while he would not have made that specific choice for a freshly-minted medical graduate, he was confident that at 59, I would not be psychologically damaged by taking on in psychotherapy a very difficult woman with a severe personality disorder.

I detected a slight crinkle of mischief in George’s eyes as he described my new patient, which I suspected was because she was immensely challenging and he was planning to have some fun watching me try to figure how to deal with her.

In her case summary, referring to her earlier history, I had written the following: “Livvy’s behavior on the ward has been characteristically borderline, with self-cutting, obsessive exercise, rages, splitting, turbulent relationships, food-binging and melodramatic and histrionic displays of emotion, mostly anger and pathos. She has had months at a time of one-to-one therapy with Doctors X, Y and other staff, often characterized by shouting and crying that could be heard all over the ward.”

Before she became my patient I had seen Livvy around the ward, an athletic-looking young woman with shoulder-length light brown hair, not tall, with a level, dark-eyed, appraising gaze. Passing me in the halls she may have nodded in acknowledgement, full lips not smiling perhaps, but with a confident expression on her freckled face, a face that I learned could grow red and contorted during outbursts of anger.

When the professional staff got wind that I was to begin psychotherapy with her they begged me to reconsider, saying that her histrionics made it impossible to work in any nearby office or space. As they predicted, after a few quiet minutes of preliminary questions during our first meeting, which I had purposely scheduled to take place in a glass, “fishbowl” meeting room next to the nurses’ station, Livvy began to rant and rave, shouting and gesticulating in a most intimidating and frightening way. Feeling myself become flushed, frightened, angry and defensive, I sat back, closed the chart and, when she paused, said, “When you shout and accuse, it scares me and I’m unable to think clearly. I have a professional responsibility to think clearly when I‘m working with you and I can’t do that if I’m busy being scared. Moreover, this is a job for me. I’m paid to help you as best I can, but no one pays me enough to be screamed and shouted at, so I’m going to stop now and try again in two days at the same hour. I will work with you as long as we are talking. Every time you scream and shout we will stop.”

Staff who knew her well told me that by angering her I had assured she would never be back for another session with me. I told them, “Oh, she’ll be back. She’s a Borderline, and what Borderlines want is to hang on — and fight!” Livvy showed up two days later, on time. We worked together for the next year and she never again raised her voice or was belligerent or intimidating towards me.

Borderline Personality Disorder is one of a group of what are called Attachment Deficit disorders, thought to be related to a lack of intimate connection, usually with the mother, during the first few months of life. Sometimes the mom is distant, disinterested, drunk or psychotic. Sometimes the baby is so angry and demanding that the mom is afraid to be around it. The result is as if the baby’s unmet need to be loved is fused with a rage generated by its persistent or recurring sense of being neglected and abandoned. I think rage must predominate over fear because for an infant, not to be tended could literally lead to death, and it must feel as though it is being annihilated by its own mother. Subsequently in a Borderline’s life, important attachments are fused with the need to express that inchoate rage.

When babies are very, very young they don’t actually realize that the mother that picks them up in the morning is the same person that put them down the night before. If the mother is neglectful or hurtful one day, and guiltily over-solicitous the next, the baby may literally develop the idea that there is a Good Mom and A Bad Mom. Later in life this may lead the child to think of people to whom she is very close as good and wonderful; until some need or desire is thwarted, after which they are seen as utterly traitorous and bad: a pattern of perception called, “splitting”. Best friends can become worst enemies with a single, sometimes seemingly trivial act. For a Borderline, there are no grays, with good and bad traits, virtues and failings, existing in the same person.

It is very difficult for anyone to have a friendly or loving relationship with a Borderline. Or a parental, supervisory or therapeutic relationship. Any perceived slight, oversight or betrayal is likely to trigger an explosive disruption.   One of the things a Borderline fears most is abandonment. They soon learn that in any relationship abandonment is a likely outcome. It is as if some Borderlines are intentionally provocative, as if it might be better to get the betrayal and abandonment over with. At the same time they are endlessly manipulative, in an effort to control the relationship and the other person in it.

Here was the odd thing about Livvy’s nine-year stay at the state hospital: she had merely been convicted of shoplifting laxatives, twice from the same supermarket. The first instance of shoplifting was treated as a misdemeanor, carrying less than a one-year sentence. The second instance is a felony, punishable by up to more than a year in prison. Livvy somehow managed to convince her lawyer that because she had once been diagnosed as bulimic, she should plead Not Guilty by Reason of Insanity (the eating disorder), in order to be sent to the state hospital rather than to prison.

In California, a person sentenced to confinement in a mental institution under Penal Code Section 1026 maybe released if restored to sanity, or after being confined for the length of the longest prison sentence for the crime. Livvy would almost certainly have been sentenced to a far shorter term in prison than the eventual length of her confinement to the state hospital. Moreover, when she had been released conditionally a couple of years into her commitment, she managed to get her self returned to the hospital within just a few weeks.

I had been puzzled by her calm indifference to the paradoxical duration of her confinement until one day in a session when it hit me.

“You aren’t here because you cant leave, Livvy; you got yourself into this hospital  because no matter what you do here, the staff can’t leave you!”

While in the hospital, Livvy’s abandonment fears were assuaged and her relationships, for the first time, were stabilized on her terms. No matter what she might do, and no matter how much they might want to, the people around her simply had to stay and make the best of it.

I wish I could say that with that insight Livvy’s life changed and that she lived happily ever after, but that didn’t happen.

We did good enough work together over the following seven months that she was able to leave the hospital on a second “conditional release” to be followed as an out-patient by her county’s mental health clinic. At her request, my supervisor and the hospital director arranged for her to be able to make the hundred-mile trip back to the hospital about twice a month to continue therapy with me, which she did for about another year. At my suggestion she got a beautiful black and white dog with an intelligent face and soft fur, someone, I had thought, who would provide unconditional love and would never willingly leave her.

The following Christmastime she saved up the medications prescribed by the county clinic doctors and took an overdose, but was discovered before she died. She was in a coma and on a respirator for a week, and when I saw her weeks afterwards she had a tracheostomy scar. We talked for another few months, including about suicide, and then she decided she didn’t need to come back any more. She seemed like she was in a peaceful state of mind, and the fact that she was able to calmly end that phase of her relationship with me was, I thought, a sign of improved relationship health.

Livvy was, at that time, an attractive college graduate in her mid thirties. She continued to give me the impression, via occasional letters and e-mail, that she was doing well enough. I responded to each with friendly, supportive, professional encouragements, among which, I suppose, there were occasional insights that might have been useful to her. But at the next Christmas she took her life, again with saved medications, this time taking enough that she would not be found alive.

Six months later Livvy’s mother came to see me. She thanked me for working with her daughter, and she brought me a banker’s box full of Livvy’s writings from the time she was a small child until she had grown up and left home. She said she hoped they might reveal something that might help me help a future patient like her. When I was finished with the box of writings, she said I needn’t return them.

The box sat in my office for more than a month, but eventually I made time and read every one of the hundreds of writings, as much as anything to honor the hopes and feelings of a parent whose child was of about the age as my own daughters.   Livvy’s mother’s hope, I judged, was that her daughter’s life, despite its brief, turbulent course, might thereby have had meaning and value.

As it happened, although there was great poignancy in reading the writings of a little girl dead too soon, I didn’t find any clear warning signs or antecedents of her disorder among them. Still, by being willing to sit and talk to me rather than act out her rage, Livvy had already given me many deep insights into the workings of her fatal illness.

I kept the banker’s box for a while, then took its contents to a shredding service.

Oh, … you’re worrying about the dog. Livvy arranged for the dog to be safe before she killed herself. Some may have felt relief at her death, or mixed feelings of loss and deliverance, but of course the dog simply missed her terribly.

4. All the power…

April 7, 2015


Recently a friend contributed the above reference to an article by Gilens and Page in which they concluded that which we all know instinctively to be the case: “Multivariate analysis indicates that economic elites and organized groups representing business interests have substantial independent impacts on U.S. government policy, while average citizens and mass-based interest groups have little or no independent influence.”

This discussion reminded me of a Constitutional insight I once had.  I was at the time thinking about the nature of power.  It seemed to me that there were basically two kinds of power operating in any sovereign state: political power and physical power.  Political power, in the form of statutes, laws, ordinances and rules, works when honest citizens voluntarily comply with them.   Physical power is that which the government employs when people refuse to obey the laws, or when foreign enemies attack the sovereignty.

While the 15th, 19th and 26th Amendments make it illegal to discriminate in voting laws on the basis of race, sex and age, there is no individual right to vote in the federal Constitution.  The individual right to vote is given to the people through the laws of each state.  The individual right to vote is a principle that forces the more or less equal distribution of the political power of the state among all of its citizens.  The paper by Gilens and Page offers evidence, that equal distribution of political is greatly modified by the degree to which various people or groups may have access to and influence or control over the representatives whose votes create the laws and public policy which govern us. And that it is also modified by those who have control over the media that shape voter opinion.

However, the Constitution does provide another balancing mechanism, because the Second Amendment guarantees the continued distribution of physical power by the individualn right to keep and bear arms.  A right, the framers said, that came not from the sovereign, but from God or nature.  The framers understood that the when the people were no longer willing to be bound by the king’s edicts, the power of the monarchy thenceforth depended entirely upon the king having armed troops and the people having no way to defend themselves against pikes, swords pistols and muskets.  The framers of the US Constitution had seen an armed colonial populace defeat the king’s army with squirrel rifles.  Various members of my family at that time owned some iron mines and foundries in northern New Jersey, and southern New York, and made some of the cannon and shot that augmented the authority of those hunting rifles, but it was the practiced skill and marksmanship of the individual farmers and shopkeepers that stopped the British army.  It was the equal distribution among the people of the physical power to resist tyranny.

In the context of the present discussion I think it may be no accident that two of the billionaire elite who have already co-opted the political power of our nation, Michael Bloomberg and George Soros, are now spending hundreds of  millions bankrolling the movement to disarm Americans.  Having used their money to consolidate the political power in their own hands, they now seek to unbalance the physical power and concentrate it in the hands of a government they have already purchased.

Lest anyone think that small arms are not significant as against the full might of a military force of about 1.5 million, even assuming that members of our military would all do the government’s bidding against their own family members and neighbors, consider the lessons of the past few decades, and remember that there are enough guns (mostly long guns) in the U.S. to arm nearly 300 million persons, more than the number of all of the adult men and women in the country.

I certainly hope that it does not come to armed conflict to defend and reclaim the political power for the benefit of the general citizenry, but if it were to happen, reason tells us the citizenry would win… unless universal background checks are transformed (as they are fully intended to do), into universal registration of firearms.  Which has typically led, in many examples in past and recent history, to confiscation of weapons and disarming of the public.  During hurricane Katrina, an assistant chief of police ordered his officers to confiscate any firearms they found in private hands. In Australia, firearm registration was soon followed by firearm confiscation. Not long ago Connecticut and New York passed Bloomberg sponsored laws that mandated the confiscation of previously legal firearms no longer “approved” by the state.  This is not a paranoid idea. This is history and it is a real danger.

The Bloomberg sponsored “universal background check” law that passed via a ballot initiative in Washington State last Fall is an example.  Misrepresented in a media blitz throughout the summer as merely a reasonable extension of background checks to all firearm transfers, the law is actually a de facto ban on any private transfer of firearms, even, say, between father and son.  Unlike the majority of voters, I actually read the full text of the law when I voted last year in Washington.  It specifies that in private sales the “police chief” has to write a letter certifying that the recipient is eligible and qualified to own a firearm.  Superficially this may not sound unreasonable, unless it is realized that no police chief has the means to ascertain whether a potential recipient is mentally healthy,  safe or suitable, and therefore no police chief can write such a letter making the positive assertion required by the new law.  Normally a background check can only result in the statement by police authorities that the purchaser has no record of arrest, nor has any condition been reported which disqualifies him or her from legally owning a firearm.

Also missed by most in the Washington law is the fact that the burden of proof regarding  the legal qualification to purchase a firearm has been shifted from the government to the citizen.  It is as if anyone accused of a crime would have to prove his or her innocence, rather than it being incumbent upon the government to prove him or her guilty of the charges.  Before I can receive a deer rifle from my son, or even borrow one from him for a day of hunting, I have to find a way to convince a police chief that I am sane, safe and suitable.

This reminds me of the requirement in one California county in which I had a license to carry concealed, that in my annual renewal letter I had to explain why I “needed” to carry a concealed weapon.   “Proof of need” was not a requirement under state law, and each year I declined to offer it, explaining that there was virtually no way to argue that one “needed” to carry a gun without sounding nuts.

The new Washington law, by the way, noes not solve the actual problem regarding the gaping holes in the mental health reporting system that allows guns to fall into the hands of the unfit.  A total nut-bag in California who has never been hospitalized and is therefore unreported, can pass the background check and buy a gun.  Even if he was hospitalized and reported to the California DOJ, they still don’t report it to the US DOJ’s National Instant Criminal Background Check System (NICS), and he can drive to a bordering state where he can legally be sold a firearm.

If the fight to protect the distribution of political power via the individual vote has been lost through the corruption of campaign finance laws, the tax code and others, the fight to protect the distribution of physical power, via the right to keep and bear arms, is still being waged against billionaire elitists who seek to wrest physical power from the hands of good citizens. The vanguard of this fight is the National Rifle Association (NRA), of which I first became a member at the age of seven in 1941.  Although it has been preeminent in firearm safety training since 1871, and although I have never seen it publish an untruth or false argument, it is, of course for that very reason, much maligned by the minions of the billionaire elites who seek to disarm America.

3. Comment on the Indiana “religious freedom” act…

April 2, 2015

In an e-mail discussion forum a friend made the following comment about the Indiana act:

“As I read the actual text of the law the media has done an absolutely abysmal job of accurately reporting and covering this thing.  The act only applies to government agencies and specifically excludes applicability to private companies.  It doesn’t even touch on interactions between a customer and a company.  There is nothing in this law that makes it easier (or more difficult) for a private company to discriminate against their customers or anyone else. There’s really nothing in the act to get worked up over other than the mere fact that it is pointless and represents needless pandering to religious conservatives.”
       I am not a lawyer,  but while I certainly agree that the Act in question has been poorly reported in the media, I think that my friend may have misread the law when he made the following three statement: “(1) The act only applies to government agencies and specifically excludes applicability to private companies.  (2) It doesn’t even touch on interactions between a customer and a company.  (3) There is nothing in this law that makes it easier (or more difficult) for a private company to discriminate against their (sic) customers or anyone else.”
       The examples often cited in the media are that a florist might decline to provide flowers for a homosexual wedding, or a baker to provide the wedding cake, on the basis that homosexuality was an offense to his or her religious beliefs.
       If either a civil action were brought, or a criminal complaint filed against the business, it would be on the basis of ordinances or laws against discrimination by those providing goods or services to the public.  Such laws can only forbid discrimination on the basis of a class defined by “protected” features, such as sex, age, race, religion, etc.  Not very long ago, homosexuality had not been a protected class or status, but whenever a government entity made it “protected” by law or executive order, etc., Section 8(a) in this law, (which affects prior laws retrospectively), would apply, placing upon the government (even though not a party to the civil suit), the burden of proof that “application of the burden (upon the religious beliefs of) the person: (1) is in furtherance of a compelling governmental interest; and (2) is the least restrictive means of furthering that compelling governmental interest.”
       For an example of laws regarding equal treatment by entities offering goods or services to the public, take a look at the British laws described at:
        In the case of the Indiana law, the requirement for the government to meet that burden of proof, on pain of several painful penalties for failing to do  so, would be triggered under Section 10 (a):  “If a court or other tribunal in which a violation of this chapter is asserted in conformity with section 9 of this chapter determines that: (1) the person’s (Ed. e.g. the florist’s or baker’s) exercise of religion has been substantially burdened, or is likely to be substantially burdened”
       In a final irony, the law says, “Sec. 5. As used in this chapter, “exercise of religion” includes any exercise of religion,whether or not compelled by, or central to, a system of religious belief.”  Which sounds to me like if the florist or baker merely SAY that giving service would violate their understanding of the religion in which they claim a belief, no law may compel them to provide it.
       Because of the vague and ambiguous definition of religion I think the Indiana law would fail a court challenge, but taking it through all the appeals could take years.  Alternatively, the prospect of having the state or other jurisdiction coming in to prove a “compelling government interest” and “least restrictive means” would have a chilling effect upon the passage of any laws and ordinances for which a religious nexus could be found or invented.
       To recapitulate regarding your statements above:  (1) the act pertains to laws that directly regulate the behavior or private companies and businesses;  (2)  It provides an affirmative defense (an exception to the anti-discriminationo law) for businesses, when civil suits or criminal complaints are filed by their customers;  (3) It greatly strengthens the defense of businesses against charges of illegal discrimination, thereby making it easier/possible for the business to discriminate.
       That’s what I understand the Act to say, but I am willing to listen to other opinions.
       My friend was kind enough to provide a copy of the Indiana Act for reference.
AN ACT to amend the Indiana Code concerning civil procedure.
Be it enacted by the General Assembly of the State of Indiana:
Chapter 9. Religious Freedom Restoration
Sec. 1. This chapter applies to all governmental entity statutes, ordinances, resolutions, executive or administrative orders, regulations, customs, and usages, including the implementation or application thereof, regardless of whether they were enacted, adopted, or initiated before, on, or after July 1, 2015.
Sec. 2. A governmental entity statute, ordinance, resolution, executive or administrative order, regulation, custom, or usage may not be construed to be exempt from the application of this chapter unless a state statute expressly exempts the statute, ordinance, resolution, executive or administrative order, regulation, custom, or usage from the application of this chapter by citation to this chapter.
Sec. 3. (a) The following definitions apply throughout this section: (1) “Establishment Clause” refers to the part of the First Amendment of the Constitution of the United States or the Constitution of the State of Indiana prohibiting laws respecting the establishment of religion. (2) “Granting”, used with respect to government funding, benefits, or exemptions, does not include the denial of government funding, benefits, or exemptions. (b) This chapter may not be construed to affect, interpret, or in any way address the Establishment Clause. (c) Granting government funding, benefits, or exemptions, to the extent permissible under the Establishment Clause, does not constitute a violation of this chapter.
Sec. 4. As used in this chapter, “demonstrates”means meets the burdens of going forward with the evidence and of persuasion.
Sec. 5. As used in this chapter, “exercise of religion” includes any exercise of religion,whether or not compelled by, or central to, a system of religious belief.
Sec. 6. As used in this chapter, “governmental entity” includes the whole or any part of a branch, department, agency, instrumentality, official, or other individual or entity acting under color of law of any of the following: (1) State government. (2) A political subdivision (as defined in IC 36-1-2-13). (3) An instrumentality of a governmental entity described in subdivision(1) or (2), including a state educational institution, a body politic, a body corporate and politic, or any other similar entity established by law.
Sec. 7. As used in this chapter, “person” includes the following: (1) An individual. (2) An organization, a religious society, a church, a body of communicants, or a group organized and operated primarily for religious purposes. (3) A partnership, a limited liability company, a corporation, a company, a firm, a society, a joint-stock company, an unincorporated association, or another entity that: (A) may sue and be sued; and (B) exercises practices that are compelled or limited by a system of religious belief held by: (i) an individual; or (ii) the individuals; who have control and substantial ownership of the entity, regardless of whether the entity is organized and operated for profit or nonprofit purposes.
Sec. 8. (a) Except as provided in subsection (b), a governmental entity may not substantially burden a person’s exercise of religion, even if the burden results from a rule of general applicability. (b) A governmental entity may substantially burden a person’s exercise of religion only if the governmental entity demonstrates that application of the burden to the person: (1) is in furtherance of compelling governmental interest; and (2) is the least restrictive means of furthering that compelling governmental interest.
Sec. 9. A person whose exercise of religion has been substantially burdened, or is likely to be substantially burdened, by a violation of this chapter may assert the violation or impending violation as a claim or defense in a judicial or administrative proceeding, regardless of whether the state or any other governmental entity is a party to the proceeding. If the relevant governmental entity is not a party to the proceeding, the governmental entity has an unconditional right to intervene in order to respond to the person’s invocation of this chapter.
Sec. 10. (a) If a court or other tribunal in which a violation of this chapter is asserted in conformity with section 9 of this chapter determines that: (1) the person’s exercise of religion has been substantially burdened, or is likely to be substantially burdened; and (2) the governmental entity imposing the burden has not demonstrated that application of the burden to the person: (A) is in furtherance of a compelling governmental interest; and (B) is the least restrictive means of furthering that compelling governmental interest; the court or other tribunal shall allow a defense against any party and shall grant appropriate relief against the governmental entity. (b) Relief against the governmental entity may include any of the following: (1) Declaratory relief or an injunction or mandate that prevents, restrains, corrects, or abates the violation of this chapter. (2) Compensatory damages. (c) In the appropriate case,the court or other tribunal also may award all or part of the costs of litigation, including reasonable attorney’s fees, to a person that prevails against the governmental entity under this chapter.
Sec. 11. This chapter is not intended to, and shall not be construed or interpreted to, create a claim or private cause of action against any private employer by any applicant, employee, or former employee.

2. About this old doc…

April 2, 2015

When I evaluate any assertions or opinions I always consider the source.  Therefore let me offer you a brief outline of my own history.

  • I attended law school for two years before returning to college for some pre-med courses.
  • In the middle of which I was drafted and spent two years as an Army news writer, with my stories published daily in Stars and Stripes, by AP UPI, the German wire service DPA, and many hometown newspapers.
  • Following the completion of pre-med courses I attended medical school.
  • After which I served an internship and two years of surgical residency,
  • Before entering practice as a Family Physician.
  • Having practiced for 17 years as a family doc, and needing a job with regular hours in order to be a responsible single father, I became a regional medical director for a large airline, serving for 11 years in a very busy company clinic.
  • Taking early retirement from the airline, and with my kids grown and flown, I completed a three year residency training program in psychiatry,
  • Then worked at a state hospital as a Forensic and Addiction psychiatrist for several years until a second retirement in 2000.
  • I am the parent of two sons and two daughters, successful in their various careers.
  • Though conservatives think I am a lefty and liberals think I am to the right of Genghis Kahn,  I am an Independent voter and on most issues will fall somewhere in between.
  • In a way, this blog represents a return to journalism, from which I have never actually strayed very far.

Hope that gives you enough to “consider the source.”


1. An auspicious beginning…

April 1, 2015

Somewhere around 1968, when I finally had a paying job and lived in San Francisco near Lake Merced, I bought a boat  in which to teach my kids to sail.  The boat was a wooden sloop called a Thistle, open-topped so that the beauty of her varnished ribs, planks and thwarts shone warmly in the sun.  Launched on April First, I painted APRIL FOOL on the transom and sailed her on many weekends, slicing back and forth on that little lake, swept as it was by winds straight off the ocean.

In seeking to teach, of course, I learned many things of value.

For several years I’ve been writing every day on various medical and non-medical discussion sites.   Of course I like it when people tell me they like my ideas and the way I express them, and it’s a pain when some others hate my stuff, but as I see it the only way to be a writer is to write and let the chips fall where they may:  put it out there and let people take it or leave it.  My intent is to help, perhaps amuse, and to clarify complicated matters, to apply my experience as a physician and former journalist to the day’s events.  But my part of the job ends with the writing, and it will be the reader who decides whether it is helpful or annoying.  In theory, a web “log” or journal may be a good vehicle for achieving that purpose. I suppose we’ll see about that.

Thanks for dropping by.  More soon.