31. Physical Attacks on Doctors

August 12, 2016

This item appeared in the on-line medical news magazine Medscape:

“Tony Lee Cason, a burly patient at Timberlawn Mental Health System in Dallas, Texas, was standing outside his room at 1 pm on June 30 when Ruth Anne MarDock, MD, rounded a hallway corner and met him face to face.

The 55-year-old Cason had just heard that he was being transferred to another facility, “which appeared to upset him,” according to a Dallas police report. Six feet tall and weighing 213 pounds, he “violently tackled” the petite Dr MarDock, some 8 inches shorter, and slammed her to the floor.

She struck her head, lost consciousness, and died 2 days later. Cason now faces manslaughter charges.

Things might have been different, however, had the state of Texas carried out its threat to shut down the 99-year-old hospital over safety issues involving not clinicians but patients.

Her death highlights the outsized threat of workplace violence directed against physicians, nurses, and other healthcare workers, who experience 50% of all job-related assaults, according to the US Bureau of Labor Statistics. The risk for violence is even higher for workers in inpatient psychiatric facilities, a number of studies have found.”

By the time I read the article there were already some eighty comments appended, to which I added my own, (which was deleted by Medscape editors). Some of the previous commenters had attested to the unsafe, understaffed conditions at the hospital. Many had offered prayers for the young doctor and her family. There were lamentations and condemnations. A couple partly blamed the doctor for not being more aware of her surroundings. One excoriated hospitals for not allowing physicians with concealed carry permits to take their guns into the hospital with them.

One or two letters advocated having doctors accompanied by bodyguards when seeing patients.

I worked as a unit psychiatrist on a locked forensic ward for a little over eight years. All of the patients were placed there for having committed crimes, and many of my patients had killed people while in a psychotic state, or while pretending to have been in a psychotic state. Three in particular were clearly malingering mental illness in order to escape murder charges. Yet they had been in the hospital for years – in some cases many years – and no one in that setting appeared to be particularly dangerous.

Generalizing from my own experience I would say that the people drawn to work in the state hospital were empathetic and kind. Some had never seen the kind of violence that I experienced during my training, working for a time in a county psychiatric emergency facility, where patients were brought in by the police raving and combative.

During my years at the state hospital I knew of only two violent and brutal attacks upon staff, one of them fatal. In one case close at hand, a young woman clinical social worker on my own team, ignoring my concerned advice, had a habit of taking patients into her office for interviews and assessments. The unit consisted of two long, intersecting hallways with a nurses’ station at the crossroads. Patient rooms, common rooms and various staff offices opened off the hallways. Staff offices were locked and there were small windows in the ultra-heavy doors.

We all carried alarm pens on our key rings. Flicking the pen’s trigger would set off the nearest of many sensors, sounding an alarm throughout the area and summoning staff to wherever a ceiling light was flashing red.

When a large male patient in the social worker’s office became angry and attacked her violently the screaming and commotion were heard. Staff rushed to her door and could see the attack, but their own door keys were specific, the only pass key belonged to the unit’s nursing supervisor who was on an errand elsewhere, and the only other pass keys were in the possession of security guards, who had to be phoned and come from some distance away.

By the time they got the door open, the social worker had had the crap beaten out of her. Her face was bruised and swollen and she had some cracked ribs but was still alive.

In the other attack, a male doctor was merely walking down the hall when a patient stepped up behind him and hit him in the back of the head with a chair. He fell dead.

The office assigned to me was a few feet outside of the locked doors of the ward and the door had no window. I could have escorted patients through the door of the unit and to my office, but I never once did so. Always a cautious person, in my early sixties I was even more so. There were a couple of “fishbowl” conference rooms with windows all around whose doors could be opened by any staff key. Whenever I needed to talk to a patient to take a history or do an evaluation, I would use one of those rooms. Someone had once advised me that it was best to avoid sitting in a way to block the door to a patient wanting to leave, or to sit with a patient between me and the door in case I ever needed to get out of the room in a hurry. So I usually followed that advice, and also sat with the conference table between me and the patient, which seemed natural and random, but was intentional.

When I walked on the ward it was natural to keep my keys (and the alarm pen) in my hand. What was perhaps less unobtrusive was that I always arranged my path to leave a few feet of space between me and any patients in the hall, and when passing a patient, always managed a glance back out of the corner of my eye to be sure they weren’t moving towards me.

In describing that vigilant behavior I am reminded of when I was a sixteen-year-old college student on the south side of Chicago. If I had to go somewhere after dark and was walking on a lonely street, if someone was approaching on my side of the street, I crossed over while they were still some distance away, prepared to turn and run if they also crossed over. I realize this may seem like hypervigilance and uses up some energy, but I call it “situational awareness” and accept the cost. Turns out I was about the only person I knew who, by the end of college, had never been mugged.

When considering their advantageous retirement benefits following my psych residency I interviewed at the psychiatry departments of several state prisons. At one prison that specialized in “mentally disordered offenders” – Charles Manson was one of the inmates – I became aware of an example of a more extreme strategy. As I was escorted to the interview office, whenever we encountered prisoners in the hall, they were ordered to stop, turn and face the wall until we had passed.

I mentioned it to the interviewer, who told me that when a prisoner attacked any of the custodial or treatment staff, the guards would take him into a room and beat him severely enough to put him in the hospital wing. When I appeared shocked, he informed me that as a consequence there were almost no attacks in the prison side of the mental health system: that serious and fatal attacks almost always happened in the state hospitals. “These people may be crazy, “ he explained, “but they’re not stupid.”

I am not advocating beatings, but it should be noted that they do fulfill all the requirements for an effective “behavioral psychological” approach to behavior modification. The sanctions are immediate, consistent and painful, the very opposite of the stimuli applied in the jurisprudence and mental health systems, which are long-delayed, inconsistent and trivial by comparison. Worse than merely ineffective, such sanctions actually encourage repetition of the undesirable behavior.

In the Dallas case, there seems to be a need to change the behavior of the assailant, the county, and the institution that is intentionally chronically understaffed.  (Hey! Somebody is deciding not to provide sufficient funding.)

With regard to the intentional understaffing, all that the article and most of the comments provided were hand-wringing and complaining, which will lead to no improvement whatsoever.

Large institutions, public and private, only respond to significant economic pain. They might also respond to immediate firing, fining or imprisonment of those in charge, if that were ever done. Given the recent examples of malfeasance in the VA Hospital system however, it is clear that will never happen.

In the case of this and many other complaints by physicians about those for whom they work as actual or virtual employees, individual physicians will never have sufficient power to prevail. The only possible solution is collective bargaining through labor organizations. Until physicians form and join unions, their compliant, benevolent and super-responsible nature will continue to assure their individual failures to achieve work conditions that match the performance standards of their profession.


29. What Has Storytelling to Do With Avoiding Physician Burnout

July 26, 2016

I thought I was done writing for the day, having participated in an on-line discussion about voice dubbing by singers for famous films of 20th Century, which I had triggered with a couple of stories about my early accidental discovery of Marni Nixon, “the ghostess with the moistest” in the world of studio vocalists.

Marni died yesterday at the age of 86, of breast cancer. Back when I was 75 and she was 80, I had looked up her web site and had shared a story with her via e-mail about discussion I had when I was in my late teens and she would have been under 25.  I had been discussing singers  with a then already well known TV music director and the father of a friend, both named Irv Kostal. On a weekend visit to their suburban Long Island home, I took along a children’s record to which my little brothers had been listening called, “The Mother Magoo Suite” — a play on Ravel’s “Mother Goose Suite” (Ma Mere L’Oye), and the then popular cartoon character, Mister Magoo.

I had been doing a lot of singing in college, and had heard on the record what I thought was an absolutely gorgeous voice. “Big Irv” scoffed gently at my offering, saying anybody could sound good using an echo chamber, and countered with a record of a woman singing German tone poems written in Arnold Schoenberg’s 12-tone scale. The woman was hitting intervals that were entirely unexpected to the western ear, and therefore practically impossible to sing. And she was dead on pitch every time.

But the voice was sounding familiar. When I checked the record jackets, both were sung by Marni Nixon. Who, a dozen years later, sang the lead for West Side Story, “ghosting” for Natalie Wood, under the musical direction of… the very same Irv Kostal!

On that day in Long Island, Mister Kostal had also not paid adequate attention, I thought, to the other voice I had thought he might enjoy, a recording with the 19-year-old ingénue singing the lead role, of “The Boyfriend”, a British musical that had just appeared on Broadway, and which voice, from the first note, had pierced my soul in the last row of the top balcony a few weeks earlier. But Big Irv said he had grown to detest the ‘20s flapper music he had spent years playing on the road in an itinerant dance band. In consequence, I thought at the time, didn’t really give a fair hearing to young Julie Andrews either.  Of course, later when he was the music director for Mary Poppins and Sound of Music and I loved teasing him about that on the few occasions we met over the following decades.

Well, you will not have guessed from the foregoing, but what captured my attention this morning were two seemingly unrelated articles: one in an on-line medical news journal about physician burnout and a suggested method to prevent it, and another from Science Daily about whether reading and viewing fiction is good for our mental health.

The connection, for me, was storytelling. Like the stories above, about Marni Nixon and Julie Andrews.

First, the anti-burnout article from the Cleveland clinic, to which my immediate reaction was that it reminded me of the joke about Irish fiddle tunes. To the question of how you tell all these nearly identical tunes apart, the answer is… by the title.

The Cleveland Clinic Neurological Institutes research suggests a way of, “rekindling physicians’ job satisfaction”, and calls it “relationship-centered communication”, a nebbish of a title that could mean anything or nothing.

Looking the phrase up on line I discovered that it is merely a new Title for an ancient tune.

One course that purports to teach this “new” idea offers these goals:

• Understand the importance and value of effective communication
• Build rapport and relationships with others
• Acknowledge communication barriers
• Recognize another’s perspectives and concerns­­
• Negotiate an agenda for an encounter
• Ask questions using skilled open-ended inquiry
• Elicit another’s story
• Listen reflectively and respond with empathy
• Collaborate on a plan that others can follow

Oh, c’mon, really? People who have graduated from medical school don’t know how to talk to a person? Well, I guess that if they don’t, and think that talking doctor to patient is different from talking person to person, the work would soon become lonely and boring.

Now that I think back, I came back to pre-med, medical school and medical practice with an unusual advantage. First, I had been advised by Dorothea Starbuck Miller, my undergraduate advisor at the University of Chicago, and later dean of the Biological Sciences, that I should stay and finish law school and not transfer back to pre-med, because testing had indicated that my aptitude for language and communication was somewhat higher than my aptitude for science.

Second, at the end of my first year after transferring from law school to pre-med, I had stayed in summer school to raise my inorganic chemistry grade and had run out of money in the Fall Quarter. So I took off the Winter Quarter to replenish my savings, not realizing that taking off any quarter but the summer one would void my draft deferment. As a result of which I was drafted into the Army in 1957.

They looked at my liberal arts degree, law school and pre-med, and instead of the medical corps I had hoped for, decided to make me a journalist.  About the only thing the Army didn’t know about me was that I had been the Editor in Chief of my high school paper, a two-page mimeographed bimonthly, so how they landed on ‘journalist’ is beyond my ability to imagine.

But they sent me for 16 weeks of training at the bar-none best, most efficient and effective school I ever attended, the Army Information School at Fort Slocum, New York. And I spent the following two years interviewing people in Germany and Holland, and composing short news stories about them. These stories and features were published every day on the wire services, hometown newspapers and the Stars and Stripes.  And this process of asking questions, listening to answers and composing a story, it could be said, I continued to do for the succeeding forty years in interviewing and listening to patients, and writing their histories into the charts.

Abstracted to simple terms, the common feature was that when I sat down with someone, whatever was going on with them was of vital importance to them and I was very curious to understand it in detail in order to figure out what was going on within the contexts of the relevant medical metaphors.

My impulse from the beginning was, from the first moments of the encounter, to find points of similarity between my own life and that of any new patient. I was a young father with three kids even when I first started practice, and later a fourth. I had endured many sleepless nights when my kids were babies. I had done dozens of summer and part-time jobs when I was a student, had been in the Army overseas, had been in the Merchant Marine. I played the guitar, sang folk songs and was a folk dancer. I spoke a little German and French. I was an amateur astronomer and ham radio operator. When I was a boy I helped my family build a house in which we later lived. I drank beer. My father was a recovering alcoholic who had died young when I was in medical school. I cannot remember a single patient with whom I was not within seconds able to identify, automatically and without any conscious effort, some common interest or experience, some place in the world we had both been, some aspect of work or family life, some hobby or interest.

These things helped me feel that I was spending my days with people I knew; with people who knew me, and when I made my notes I was writing stories about people who had shared stories with me that were vitally important to their lives. I assisted at surgery practically every day for the first three decades, so in addition to all that transpired between us, in addition to the more than a hundred babies I had delivered as an intern and palpating and listening to my patients’ exteriors, to their limbs and joints, I had had my hands on my patients’ lungs and hearts, their stomachs, livers and kidneys, their very brains. After each surgery I dictated a couple of pages of operative reports, each another little story about the patient.

The Cleveland Clinic can call that ‘relationship-centered communication’ if they like, and believe it is a new thing. I just thought I was being a doctor, hearing and retelling the patients’ stories.  But then, my own family doctor, the one I had known from birth, was William Carlos Williams, a famous writer and poet, although his patients didn’t know it at the time.

Which brings me to the Science Daily report on psychologist Keith Oatley’s article suggesting that reading fiction that stimulates the imagination somehow helps in the development of empathy.

Reading certain kinds of literary fiction simulates a social world, fostering understanding and empathy in the reader.

In studying neuroscience for three years, when I became a psychiatrist in the last decade of my medical career, I gradually developed what was for me a useful metaphor, that there is somewhere in the brain a function I called, “the storyteller”, that has to do with the establishment of reality.

For example, while on long road trips I have not infrequently awoken in a motel, where I usually leave a light on in the bathroom and the door cracked open, so that I will have enough light to orient myself if I awake in the dark. Actually, I do the same thing at home, so, after driving for 12 or 14 hours and going to bed exhausted, I had sometimes awakened a bit confused when the light is on the wrong side of the bed from home.  At which point my storyteller, probably in the frontal lobe somewhere, searches through some old and some new memories, examines what little sensory input there is, and then concludes, “I am Denis. I have been driving for several days. I am in a motel. The bathroom is over to the left.”

Which proves to be the case.

This is an example of what neuroscientists are coming to believe we all do in order to construct or “confabulate” what we think of as “reality”.

When we have disrupted the train of memory with drink or some trauma causing unconsciousness, the first thing we ask when we open our eyes is……

You got it… “Where am I?” We already remember who we are.

If we have experienced some sort of amnesia and we awake, we first want to know… “Who am I?” Because whenever we awaken, we first reconstruct reality by a process of telling ourselves a story about who and where we are, and whatever else we remember and is relevant, like, “Who is this in bed with me?!”

When we read a story or watch a movie, it is an active process, wherein we are taking in the information provided and simultaneously telling ourselves the story of what is going on? Contrary to our assumption, it isn’t the page or the screen that tells us what is going on, it is the brain’s storyteller making up a story consistent with the perceived visual and auditory sensations coming in through the sensory switching center, or thalamus.

Emeritus Professor Oatley concludes:

“What’s a piece of fiction, what’s a novel, what’s short story, what’s a play or movie or television series? It’s a piece of consciousness being passed from mind to mind. When you’re reading or watching a drama, you’re taking in a piece of consciousness that you make your own. That seems an exciting idea.”

If a particular person’s brain is capable of generating feelings, which some are not, a feeling may be elicited in the reader similar to the one experienced in the circumstances described by the writer. Oatley reports that experiments indicate that the level of these empathetic feelings can be enhanced by social experience, even one simulated by a writing or a film.

It seems to me that this may be because the brain developed long before any experience was possible beyond the limits of vision, hearing, or the other commonly understood senses. Therefore anything sensed is considered by the brain to be real and immediately and concurrently present. If we see a film about another culture, that culture becomes that much more real to us, and our limbic (emotional) system may regard it as more trusted and safe than strange and frightening.

By the same token, humans judge risk by their immediate experiences. But they do not distinguish between TV and real experience. Therefore in the presence of ever-increasing 24-hour world-wide coverage of mostly bad news we conclude that the world is becoming more dangerous, whereas according to Steven Pinker in, “The Better Angels of our Nature”, the world is safer now than it has ever been.

So if Oatley is right, we are just as likely to be affected by adverse images in books and movies as we are by favorable ones. In other words those who have been telling us that the content of TV can have a bad effect upon our beliefs and behaviors are right, and violence in the media begets violence in life.

Meanwhile by asking and listening and writing stories about people all day long, I have always felt bathed in intimacy with other humans during my work hours, and have not experienced the need to get away from work in order to assuage the pain of a lonely, depressed and exhausted inner child.


28. What is the Meaning of “A Well Regulated Militia” ?

July 23, 2016

“Felix, qui potuit rerum cognoscere causas.” — Virgil

Happy is he who knows the causes of things.

Some of my moments of clearest thinking seem to occur during my morning shower, which probably means that they occur during sleep and that I am remembering them during the hypnopompic moments I spend soaping and rinsing.

I went to bed late last night too tired to begin this essay, the thought of which has excited me ever since I began to discover the answer to the title question.   In the half hour before arising, between sleep and waking fully, I remember thinking that what underlies nearly all “gun control” sentiment and logic is ignorance: Ignorance about firearms themselves, ignorance of why the U.S. Constitution was set up above all other local, state and federal laws, ignorance of history more ancient than Lady Gaga or Burning Man, ignorance about the nature and causes of violence, ignorance about the depth or significance of the racial divide in America, ignorance about the nature of mental illness including the health care system that tries to address it, profound ignorance regarding what can and cannot be done about violence, and finally, ignorance of the English language, of which I was myself, in this particular instance, also possessed until a couple of days ago.

Knowing that the Supreme Court, (SCOTUS) had decided the issue of whether the Second Amendment conferred an individual right to keep and bear arms, I had always skimmed over the first clause: “A well regulated militia, (why is that comma there?) being necessary to the security of a free state, …”, and focused on the last, “…the right of the people to keep and bear Arms shall not be infringed.”

Although at 81 I am well beyond having to move my home in order to be near work, I do migrate annually between the locations of some of my kids and grandchildren, and they are sometimes uprooted for work and professional reasons, which is why, at the end of last summer, I found myself moving to a notoriously gun-unfriendly state, to a notoriously liberal college town and to a county with a sheriff who is manifestly unfriendly to the rights of gun owners, specifically in the area of concealed carry weapons permits. But that is a story for another time. The connection here is that I have recently begun joining the local ham radio club members at a weekly dinner and gab-fest, and this week a discussion of the Second Amendment arose. The fellow across from me, Jim, a fiftyish young man with a gray beard, raised the issue of the “well regulated militia” clause, with the implication that the Constitution meant gun owners should be well-vetted and trained members of a military force, and not just any Tom, Dick or Harry.

While passionate, the discussion was friendly. Over the next day or two, for the first time I was moved to learn more about that puzzling phrase, “well regulated”, which, truth be told, I had never really understood myself.

“Militia” I understand. History is clear that the colonists had long relied for their defense upon a quick gathering of ordinary citizens, expected to bring their then modern implements of warfare with them. That process, only slightly more formalized, carried the colony successfully through their Revolution against the king and his standing army.

A militia, therefore, had these features: An organization somewhat looser than an army, but with ranks and a chain of command, the officers of which might have a smattering of knowledge about tactics if not strategy, and a body of men who kept their military arms at home, used them for hunting and defense, practiced and competed with them, and brought them along when called to duty for a specific purpose or to meet a specific threat. In 1792 every able-bodied man between age 18 and 45 (the average life expectancy of a citizen in the 18th Century was 35 years) was designated a member of the militia.

The Swiss are famous for this militia approach to military service. When I was a boy in New Jersey during WW II a neighbor from Switzerland still had his bolt-action Vetterli rifle that I was allowed to handle very carefully on several occasions.

Nowadays the Swiss militiaman keeps the SIG SG 550 at home: a fully automatic assault rifle. At the conclusion of his active service he may purchase the weapon, which is then converted from fully automatic to semi-automatic (one trigger pull – one shot).

So what is a well regulated militia?

It turns out that our puzzlement over that phrase is caused by the fact that “well regulated” has not been in common usage for more than a hundred years. But it was in common usage in 1791 when the Second Amendment, along with the rest of the Bill of Rights, was adopted.

And it had a common meaning that virtually everyone at that time would have been able to enunciate.

Taken from the website of the Constitution Society: “The phrase “well-regulated” was in common use long before 1789, and remained so for a century thereafter. It referred to the quality or property of something being in proper working order. Something that was well-regulated was calibrated correctly, functioning as expected.”


Also see: http://www.lectlaw.com/files/gun01.htm

The Constitution Society also offers several quotes from the Oxford English Dictionary (O.E.D.) dating from the time of the adoption of the Second Amendment, which clarify its meaning and appear to support the “properly functioning” view of the term, as opposed to the “regulated by law” view favored by modern liberals.

1709: “If a liberal Education has formed in us well-regulated Appetites and worthy Inclinations.”

1714: “The practice of all well-regulated courts of justice in the world.”

1812: “The equation of time … is the adjustment of the difference of time as shown by a well-regulated clock and a true sun dial.”

[Ed. From their invention in 1656 until the 1930’s pendulum clocks, many models known as Regulator clocks, were the most precise timekeeping method in the world.]

1848: “A remissness for which I am sure every well-regulated person will blame the Mayor.”

1862: “It appeared to her well-regulated mind, like a clandestine proceeding.”

1894: “The newspaper, a never wanting adjunct to every well-regulated American embryo city.”

The Constitution Society finally argues: “Establishing government oversight of the people’s arms was not only not the intent in using the phrase in the 2nd amendment, it was precisely to render the government powerless to do so that the founders wrote it.”

Of course there are those who come to a different conclusion but I find the evidence of the O.E.D. persuasive.

To me, the syntax of the Second Amendment makes perfect sense just as it is, without embellishment or further specificity, if “well regulated” means “A properly functioning militia (of armed citizen soldiers) being necessary to the security of a free state”, as opposed to a standing army under the control of the federal government or a monarch.

I am grateful to my dinner companion for his level-headed question about the meaning of the clause, and comfortable with the understanding my search for an answer has produced.


27. Generalists vs. Specialists

July 19, 2016

Two articles have come to my attention that may be more closely related than at first they seem.

The first was the article by Maria Popova about Buckminster Fuller on synergistic thinking:


In which Fuller is very critical of specialist education and thinking.

And the second was a seemingly lighter piece by Sheilamary Koch —

http://exclusive.multibriefs.com/content/for-children-to-be-independent-thinkers-we-must-teach-autonomy/education — which begins:

“When I asked junior high students to look back on their school career and describe the assignment that stood out most for them, most named activities where they were in the driver’s seat. They claimed having the opportunity to take responsibility for their learning motivated them to achieve their best.”

For me, the “Aha!” moment came 30 years ago when I was reading a passage from Marshall McLuhan’s, “The Medium is the Message”. In it the celebrated Canadian professor of communication theory spent a few pages talking about the difference between generalists and specialists.

At the time I was practicing Family Medicine, which had then only recently changed its name from General Practice. I was acutely aware of both the value and the limitation of medical specialization, and had just survived the urgent swerve of the late 1960’s that sought to elevate specialization at the expense of the medical privileges of the general practitioner.

Whereas G.P.’s had, for example, until then performed appendectomies, tonsillectomies, other simple surgeries and had delivered most of the babies born in the United States, there was a powerful political movement, led by the university hospitals that did most of the specialist training and had by that time produced an over-abundance of surgeons, to restrict all but certified specialists from doing even the simplest hands-on procedures.

This movement had purely economic roots, but was clothed in the medical pseudo-logic that it was for the good of patients. Of all the private and public funding available for medical school teaching, overgrown departments of surgery, internal medicine, and obstetrics and gynecology were already consuming lion’s share and were hungry for the rest.

It wasn’t until the Robert Wood Johnson Foundation threw its weight into the struggle that the specialty departments were forced to acknowledge that an ever-growing surplus of surgeons and internists had created a scarcity of G.P.’s and a serious maldistribution of medical services, particularly in rural and inner city areas.

Ironically but not unexpectedly, the solution from medical academia in 1969 was to create yet another official board Certified specialty, the twentieth, called Family Practice, requiring three years of residency training beyond medical school. However, instead of creating Departments of Family Practice equal in stature to the departments of Surgery or Obstetrics and Gynecology, many of the medical schools designated “Divisions” of family practice, within the administrative and budgetary control of the already existing Departments of Internal Medicine. By which they funneled newly available funds designated by federal and private sources solely for family practice training, into an established administrative structure designed to support a specialty that had constituted part of the problem, not part of the solution. Devious buggers.

For the first couple of years after its creation, those of us already in practice were allowed to sit for the exam based upon our experience and independent study, and without the residency training, which I did in 1972, becoming board Certified in Family Practice.  Again ironically, it was the first of three medical specialties in which I became Board Certified. In addition to those three, there were two others in which I became eligible to sit for the exams, but chose not to do because of matters of timing and money. In those two cases I was about to transition into another field, or to retire from practice altogether.

You see the irony: that if a person successfully pursues five medical specialties, is he or she better described as a serial specialist, or rather, a generalist with areas of deeper interest?

I had not thought about that (too damned busy you see) until I ran across the passages from McLuhan, where he described a generalist as one who looks up at what exists and sees it as an environment. But as he or she learns more about it, organizes it and reduces parts of its amorphous complexity into a meaningful story or metaphor, those parts become an artifact of his or her construction. An example would be the beguiling mystery of life reduced to medicine’s story of, “how the body works”. After savoring that for a bit, the generalist again gazes up at what remains: the unexplained, unreduced environment, and begins to think about it, organize it and perceive it as another coherent story or metaphor. Which again becomes an artifact of the mind.

And so the generalist begins to gaze at what remains….. and so on.

As I understood him, McLuhan was saying that the generalist is repeatedly curious about and fascinated by that which he or she does not understand.

The truth is I can’t remember what he said about specialists. Other than that they are moved to learn everything there is to know about one narrow topic.

Thinking in terms suggested by the Popova and Koch articles and using the language of Eric Berne’s Transactional Analysis, whereas the generalist is driven primarily by a natural Child’s unrestrained curiosity about everything, the specialist more resembles the Adapted Child, trying to meet and match the expectations of parents and teachers by learning and repeating everything they seek to teach. Is what governs specialists a fear of being caught not knowing?

But perhaps I am being unfair. Perhaps both apply the same energy. curiosity and intensity, but the difference is in the direction of gaze: that the generalist is looking upward and outward at everything that is, and the specialist merely happens to be looking down and into the depths of a particular phenomenon.

I do remember clearly that in medicine, as a Family Physician it often fell to me to keep in mind the whole picture, and the patient as a whole person, and therefore to use the consultations of the specialists regarding a particular organ or body part within that larger context, to which some specialists were somewhat oblivious. (Others were obviously generalists who happened to be practicing a specialty.)  Clearly both skills are necessary, but the management decisions of the generalist, made in conjunction with the person who is ill, are better.

If Popova’s Fuller is right, that it is a good thing to keep the generalist within each child alive and well, so that there are enough of us that are able to cross-connect information, it seems to me that Koch’s story about science teacher Monserrat Alverado provides useful guidance: encourage independence of study at a much earlier age.  [Ed.  In 2019 I learned from my grandson who paid an extened visit to their schools,  that this constitutes the core of a new, extremely successful, educational practice in Finland.]


26. Dallas – 2016

July 8, 2016

Being retired, I can watch marathon news coverage when I decide to.  This morning, the day after the Dallas shootings, I awoke to learn that five police officers have died so far, and that six others and two civilians were shot by from one to four shooters, one of whom was killed in a standoff.  Police took him out in a parking garage with the “disrupter” charge of a bomb-destroying robot.

So what do we know at this point?
        The police were protecting a peaceful protest organized by “I’m going to keep blowing shit up because Jesus told me to,” pastor, Jeff Hood.    (During an interview on the street this morning, Hood talked about last night as if it were all about him.  He reminded me of other piss-ant, narcissistic, apocalyptic cult leaders.)
        He organized the protest using social media, along with followers of the habitually belligerent “black lives matter” hate-group.  This is the movement that jumps the gun every time police kill a black man during an arrest, assuming from the fact of the shooting alone that the cause was racial animus on the part of the police, and that the killing was wanton, and unnecessary to protect the lives and safety of officers.
        That movement gave us the infamous, “Hands up!  Don’t shoot!” slogan that came out of Ferguson, and was later clearly shown to have originated in a lie told by the partner-in-crime of the criminal who was shot after attacking a police officer in his patrol car and trying to take his gun.  A criminal who did not have his hands up, and who was again rushing at the officer when shot.
        Even though the lie was contested from the beginning, it was immediately believed and accepted without any confirmation by many politicians, from the local level right up to Attorney General Holder and the President of the United States, Barack Obama.   Neither of whom ever backed away from their racist assumptions even after the lie was revealed in Grand Jury testimony.
        And what led to the massacre of police officers in Dallas?   Protests by Black Lives Matter over unrelated shootings in Louisiana and Minnesota, after cell phone video footage surfaced on the internet alleging to show what were called “unnecessary”shootings of two armed black men.
        In one case, while two officers struggled on the ground with a man who was reported to have drawn a gun on a bystander while selling something on the sidewalk, one (or both) of the officers fatally shot the man struggling beneath
        In the other case, the video started rolling immediately AFTER a man, also known to be armed, and sitting in the passenger seat of a car, had been fatally shot by an officer standing at the passenger window with his gun drawn.
        Just because some people lack the imagination to envision circumstances that would justify the officers’ actions doesn’t mean that the shootings were not justified.  And of course, just because the shooters were police officers doesn’t mean that the use of lethal force was justified.
        In the first situation, for a man pinned to the ground and known to be armed with a pistol to continue to struggle may be enough to justify the use of lethal force.  The intensity of the struggle may be the determining factor.   In a struggle violent enough that it may have knocked both body cams askew or out of commission, it might well have been impossible for the officers to be sure the man was not reaching for, or had not already reached, a pistol he had pulled on bystanders only minutes earlier.  Moreover, as far as we know, they didn’t even know where his gun was concealed… in a pocket or his waistband.  With the gun concealed, unless his hands were up, away from his body, and splayed open, they could just as easily have been an inch from his gun…. and a split-second away from the death or injury; of the officers.  The video clearly shows a struggle on-going.  On the other hand, if the man was only wriggling a bit due to the discomfort of being pinned down, and if his hands were plainly visible or restrained, it may be there was no cause for officers to fear for their lives and shoot him.
        In that case we have a man who had armed himself, had brandished his weapon at others, and who then struggled with police trying to arrest him.  THAT’S ALL WE KNOW RIGHT NOW!  [Subsequently, several TV talking heads referred to the man’s firearm was “legal” because Louisiana is an “open carry” state, but this is not true if the firearm was concealed in his waistband or pocket.  Whether it was concealed when the police confronted him has never beed discussed.]
        In St. Paul the only information the public has right now is what is seen on the video of the man dying, and what his girlfriend who took the video has said.  Philando Castile appears to have been shot by police while sitting in the passenger seat of a car.
        The only version we have of what happened in the minutes preceding the shooting comes from HIS COMPANION, Lavish “Diamond” Reynolds.  IF EVERYTHING SHE SAYS is true, the shooting seems to have been have been unjustified, but there are several incongruous elements about the story that would cause a prudent person to want more details before deciding.
  1. The car having been stopped for a busted taillight, according to Reynolds, Castile, the passenger, not the driver, is asked to produce his driver’s (?) license.
  2. Reynolds says the Castile tells police he has a permit to carry a concealed weapon and is carrying a pistol.
  3. Reynolds says the Castile then complies with an instruction to produce his license, telling the officer he is reaching for his wallet, not his pistol.
  4. As he reaches, Reynolds says, the officer fatally shoots the passenger through his right arm and into the chest.
        The video shows Castile slump over as Reynolds begins recording on her cell phone.  We don’t hear or see exactly what happened just before.
        As a person who has had concealed weapons permits and who has had some law enforcement training there are a couple of things that strike me as strange about this sequence of events, and, for me, calls the story as it stands into question.
  1. Why would a police officer, apprehensive enough to have his gun drawn and aimed at a man in a car, having been informed that the man is armed, instruct a man, or agree to allow a man, to reach into a back pants pocket for a license.
  2. Why would a man, just having informed the police about a legally concealed weapon, reach into his pocket even if ordered to produce his license, while an officer had a gun pointed at him? 

In a similar traffic stop, wherein in the end I was not cited, my registration and my legal handgun were both in the glove compartment.  Keeping my hands on the wheel and informing the officer there was a pistol in the glove compartment, I asked that another officer retrieve my registration, which he did.  After he had secured the weapon, I got out my driver’s license.

        Lavish Diamond’s story may be true and accurate, but it is certainly not safe or prudent to assume so,  even when to make such an assumption would have little or no consequence.
        [Looking at her heartrending, yet flagrantly anti-white racist Facebook rant just now, I saw her reveal what seems to me may have been the cause of this tragic event. The way she described it, instead of announcing that he was armed while his hands were in the air, it is possible he announced it to the officer just as he was complying with the instruction to produce his license, and was reaching for a fat wallet in his right-hand back pocket.  There may have been a coincidence of two tragic factors here, that together resulted in the shooting.  If the officer had been forewarned that the man was legally armed, he would likely have had him exit the car and would have secured the gun before proceeding with the production of a license. Castile, by all accounts a law-abiding, working and family man with a legal permit to carry concealed, may have been trying to comply with the advice given to all who hold concealed weapon permits, which is to advise the officer that he is armed.  Perhaps he was a bit flustered by the circumstances and being afraid not to comply immediately, didn’t keep enough separation between informing the officer about the gun and reaching for his wallet.  If they were simultaneous, to the officer his words could have sounded more like a threat than a statement of fact. It is also not clear from Lavish Reynolds’ account whether he was reaching for his wallet to show the officer his license to carry concealed, or for a driver’s license that the officer probably had no reason to see and may not have asked for.]
        When the consequences of assuming that these shootings were motivated by racial animus and utter disregard for black life are to encourage an outraged and very likely violent reaction from the black community, for outsiders to jump to a  conclusion of police racism within hours of the incidents as did Jesse Jackson and Barack Obama, is nothing short of anti-white-cop race-hustling.
        Here is the text of Obama’s statement:

All Americans should be deeply troubled by the fatal shootings of Alton Sterling in Baton Rouge, Louisiana and Philando Castile in Falcon Heights, Minnesota. We’ve seen such tragedies far too many times, and our hearts go out to the families and communities who’ve suffered such a painful loss.

Although I am constrained in commenting on the particular facts of these cases, I am encouraged that the U.S. Department of Justice has opened a civil rights investigation in Baton Rouge, and I have full confidence in their professionalism and their ability to conduct a thoughtful, thorough, and fair inquiry.

[Ed. This statement, and the pattern of instantly sending in the DOJ to investigate incidents where black men are shot by police, clearly implies the generalization that the ability of local departments to investigate racial incidents is tainted by racism to the point of incompetence.]

But regardless of the outcome of such investigations, what’s clear is that these fatal shootings are not isolated incidents. They are symptomatic of the broader challenges within our criminal justice system, the racial disparities that appear across the system year after year, and the resulting lack of trust that exists between law enforcement and too many of the communities they serve.

[Ed. This paragraph by Obama can only be interpreted to pre-judge the facts of this and all other police shootings of black people.]

To admit we’ve got a serious problem in no way contradicts our respect and appreciation for the vast majority of police officers who put their lives on the line to protect us every single day.

[Ed. Despite this empty and self-serving disclaimer, Obama’s paragraph does precisely what he says it does not do.]

It is to say that, as a nation, we can and must do better to institute the best practices that reduce the appearance or reality of racial bias in law enforcement.

That’s why, two years ago, I set up a Task Force on 21st Century Policing that convened police officers, community leaders, and activists. Together, they came up with detailed recommendations on how to improve community policing. So even as officials continue to look into this week’s tragic shootings, we also need communities to address the underlying fissures that lead to these incidents, and to implement those ideas that can make a difference. That’s how we’ll keep our communities safe. And that’s how we can start restoring confidence that all people in this great nation are equal before the law.

[Ed.  Unfortunately this is just the usual political bullshit, as indicated by the fact that even though nearly all the federal inquiries were dropped, neither Obama nor his DOJ have ever once announced that as a result of their investigation they have found the police shootings justified, while local and state tribunals have often found the officers not guilty of any wrongdoing].

In the meantime, all Americans should recognize the anger, frustration, and grief that so many Americans are feeling — feelings that are being expressed in peaceful protests and vigils. Michelle and I share those feelings. Rather than fall into a predictable pattern of division and political posturing, let’s reflect on what we can do better. Let’s come together as a nation, and keep faith with one another, in order to ensure a future where all of our children know that their lives matter.

Finally, I submit that it is not solely he job of police departments to somehow “get” the black community to love and respect them.  As a once young man who repeatedly yearned after women who were ever unattainable, I further submit that it is a practical impossibility to “get” someone to like you.  Moreover, it is the job of the parents of black children to raise them to respect and appreciate the police.  I have heard black fathers for whom I have great respect, say how difficult it is for them to have “the talk” with their sons, when they first warn them to be very careful when encountering the police, lest they be killed on some flimsy excuse because they are black.  And these are the fathers of black children who have fathers, not the 65% in the inner cities who do not.

But it had better be possible for black kids to learn to trust and respect the police, even if they do so warily and with great care.  If it is not impossible, then Dallas may have been what some feared (and some may have hoped) after the first fusillade, the opening salvo in a race war, wherein the only choice left is to pick a side.
What I learned in four decades of medical practice was that all I could do was my part.  I couldn’t do the patient’s part.  Eventually I learned that if I was working harder than the patient, it was a sign that something was wrong and it wasn’t going to work.  The police need to do their part, but only their part.  The rest has to be done by the fathers and mothers, but mostly the fathers, in the community the police are trying to serve.
Again, it had better be possible.

25. Fourth of July 2016

July 3, 2016

Independence Day

This morning I watched an Animal Planet channel documentary about three or four families living in the far northeast corner of Alaska.   They are among fewer than a dozen individuals who have had permission to build cabins on National Forest Reserve land. No more permits have been issued since the 1980’s and when these folks and their kids die, or within 100 years of the issuance, whichever is sooner, no one will be able to occupy the small cabins they have hand-built from logs.

One couple raised two daughters in their tiny dwelling, and the husband and wife still go there all winter to hunt game upon which to subsist, and trap furs for  a bit of income, now that the girls are grown.

One man has wintered alone in his cabin for 40 years and says with absolute certainty that he is the only human alive who knows the 200 square miles of mountains and woods in which he runs his trap lines. A third youngish couple is thinking about having a baby next year.

All spoke of the absolute freedom they experience. All mention that the price of that freedom has been their utter separation from other people they love.

The families move around from year to year among three or four cabins they have built, in order to allow the game and fur animals to replenish their populations sufficient to support the human predators who hunt and trap them.

The man living alone lost many of his supplies this winter when a bear broke into his cabin while he was away. This winter has been so cold that there has been no game whatsoever. Instead of a couple of hundred martin in his traps he has had none. Instead of a moose and a caribou to sustain him he has subsisted upon grouse, squirrel and rabbits and has not been able to maintain his weight. In the middle of the documentary, sad and discouraged, he gave up for the year and went back to the city to get a job.

The woodsmen and women all talked about how they loved the utter freedom of their lives, which caused me to reflect that freedom is only absolute when there is literally no one else around, and that all other circumstances necessarily make that freedom conditioned upon and relative to the needs of others. Freedom declines in some inverse mathematical relationship to the density of the population. And this sets up another inverse relationship between the desire of some people to control others, and the desire of others to retain as much freedom as is possible for all members of the community. It is this latter struggle within which most of us live out our lives.

I think the stories of individuals in the wilderness somehow made it more clear to me this morning that I have made a choice to live among other people, and to endure the inevitable disagreements about how to accomplish that.









24. What Americans Can Learn From BREXIT…

June 23, 2016

Watching the News at Two in the Morning

CNN and Fox News appear not to have figured out the significance of what just happened in Great Britain.  They have their clueless second-stringers doing the marathon coverage of the vote wherein that nation just opted out of the European Union, an act that most likely derives from growing  resistance against globalization of the economy and abandonment of national sovereignty.

It seems to me that what has happened is that somehow ordinary people understand something about which the experts remain steadfastly in denial, or about which they wish us to remain ignorant, which is that globalization only benefits international corporations and banking institutions, and inevitably does so at the expense of the workers in the more industrious and productive parts of the world.

In 1982, when I first heard the pitch for achieving a “balance of trade” for the U.S., meaning that we had to sell as many goods and services overseas as we bought from overseas, after a brief befuddlement, it quickly became clear to me that there were only two possible ways that, say, a native of Equatorial Guinea, a nation with a president whose family steals 96% of his nation’s oil profits, could afford to buy an American-made product.  Either his government had, with wholly uncharacteristic generosity, to increase his income to that of an American worker, or our government had to reduce the income of an American factory worker to that of an unskilled Guinean laborer.   Workers in the Equatorial Guinean kleptocracy are so poor that after a heavy rainstorm, dock workers in the oil ports rush to take the opportunity for a bath in the roadside ditches that fill with water.   Whereas, over the years, our government has been purchased by corporations and by the wealthy, the final nail in that particular coffin being Citizens United v FEC, which held that corporations were people and campaign contributions were “speech” and therefore protected by the First Amendment. A disastrous piece of unreality.

While the increased temperature of international trade would benefit the owners, executives and stockholders of corporations that do business internationally, it would necessarily cripple and impoverish what Robert Reich and many other economic analysts have called the main driving engine of First World economies, the well-paid manufacturing middle class of those industrialized nations.

Nevertheless, it was, of course, that fatal second option that was intended from the time in the early 1980s when the “balance of trade deficit” was first mentioned, to lower the pay of the American worker to that of a third world worker.  That is well under way and the result we now see was entirely predictable, but never mentioned out loud.  On the contrary, the term itself, by using the term “trade deficit” was chosen to imply that there was something wrong that needed to be corrected, which, I argue, was untrue in the first place.

As a corollary to the aim of destroying the working middle class in, for instance, America, England and Germany, it was also advantageous to arrange the free flow of immigration, flooding richer, more productive nations with unskilled laborers who were linguistically, culturally and politically disadvantaged and, lacking all power, willing to work for third-world wages.  It was important that these folks should flood in and overwhelm both the economy and the organizational structure of the labor force, undermining their unions and the collective bargaining process by which American workers had previously been able to insist upon a fair portion of the wealth of which they were the primary creators.

The fundamental institution upon which the economic health of nations depended was national sovereignty:  the absolute control of a nation over its laws and its borders.  Therefore, corporations, interested primarily, or more accurately solely, in their own net profits, bought governments and set them to the task of destroying the key aspects of national sovereignty, protective trade agreements and tariffs, and careful, planned management of immigration.  To the latter end, sovereign national boundaries were first attacked semantically.  The enforcement of national boundaries was disparaged and called racist, cruel and inhumane, while at the same time American borders were studiously neglected by bought-and-paid-for Democrats and Republicans.

Example:  (Too numerous to count, but here is one…) Last year I heard some interviews with ranchers on the Mexican border who had been told that day by bewildered border patrol members that, without explanation, they had been ordered to stop making arrests.  A week later, I heard Obama say he was pleased to announce that the number of people crossing the border illegally had been significantly reduced.  The single piece of evidence to which he pointed with pride?  The number of arrests was down!

In Europe the Globalists constructed the European Union, an economic and political entity that obliterated the internal sovereign borders of its constituent nations while at the same time carefully avoiding constructing any functioning borders around its external perimeter.  While trade and travel were facilitated, at the same time it effectively destroyed any economic protection of the more industrious nations from the profligacy of socialist regimes like Italy, Spain and Greece.  At the same time it allowed a flood of unregulated immigration from inside and outside the EU, of the victims of profligate or even evil regimes, as well as the unregulated entry of the ideologically hostile and vindictive, which actively sabotaged and undercut the productive workers of the more industrious northern nations.

An Alliance of Opposites

One thing that has made this deception possible has been a coincidence of the goals of two very unlikely bedfellows. While the economic Right has wished to globalize trade and commerce because by so doing it could operate in an interstitial environment free of sovereign taxes rules and controls, the politically progressive Left has long sought the abolition of national sovereignty in pursuit of the fairy-tale of what has become known as “transnationalism”, a main proponent of which is Harold Hongju Koh, Obama’s appointee as legal advisor to the State Department.


Politically, a generation raised on the Disneyesque view that cute little bears and tigers are our friends and that world peace is just around the corner, has come to believe that the only impediment to global governance is entrenched nationalism. They seek to remove the idea of national sovereignty first by denigrating it and pointing to its every flaw, and next by grafting or superimposing a more encompassing, and later a global government on the world.  This transnational structure is founded on the idea of “international norms”, which, however, are determined by consensus among groups of “experts”, none of whom are elected by the citizens of the countries they purport to represent and for whom they claim to speak.

This dream is only possible, however, if one ignores the valuable and protective benefits conferred by smaller and more manageable sovereign political units. The European Union has been an effort to replace national sovereignty and its increasingly obvious flaws have been studiously ignored.

Until tonight.

Tonight the pissed-off workers of Great Britain voted to leave the European Union, a vote that will bring down the Prime Minister’s government, and that may encourage other productive countries to vote to restore their national sovereignty and defend themselves against further exploitation by international corporations and globalist politicians who can’t see that at this point in time and with our current level of organizational efficiency, the whole globalization idea is a fairy-tale: a form of social science fiction, encouraged by the multinational corporations that want to exploit it.

Everyone seems to understand that the rich have grossly increased their wealth in the past decade, and that the working middle class has suffered greatly.  One can only hope that everyone will figure out that this is how it happened.

Tonight was very exciting, suggesting to me for the first time that those who are calling for a halt to the madness of free trade and the unregulated invasion called “illegal immigration”, may actually prevail in America in November.  It will depend to some extent upon how well Americans have observed and understood the recent “refugee” disaster in Europe, a lesson that was apparently not lost on British voters Thursday.


23. Is “Gun Violence” a Loaded Term?

June 17, 2016

Why do They Avoid All the Issues Other than Guns?

I sit at my keyboard today not to convince those who support the Bloomberg/Clinton/Obama-liberal advocacy of gun control, but to clarify my own objection to what I consider to be an intentional diversion from the true nature of religious, racial, ideological and drug-related gang violence as manifested by the Orlando massacre, the San Bernardino shooting, and the daily reign of death and terror on the streets of Chicago.

To me it has seemed clearer by the month, especially during the past year or so, that there exists, at least in inner city black communities a profound racial animus, and a contempt for white language, culture, values, and laws, as well as for law enforcement and institutions for the administration of criminal justice.

I frequently ask myself why Liberal America, right up to and including the half-black-half-white man who sits in the White House. Is so insistent upon avoiding awareness of the truly causal factors of violence, to the extent that they repeatedly drag out the red herring issue of what they call “gun-violence”, implying in the face of all evidence to the contrary that the cause of rampage killings and gang shootings is the “availability” of guns.  By guns they mean, at various times, handguns, semi-automatic rifles, pistols, or rifles that look like machine-guns even when they do not operate like them; or guns that can be reloaded by the simple insertion of a new magazine.

All of these firearms are available because the Founders wrote into the Constitution that the people have the right to keep and bear arms. Which they thought was so important to our on-going independence, freedom, security and stability that they put in the form of our strongest and most immutable law.

Inner City Violence

I don’t believe that all liberal-progressive, Muslim and black people want America weakened both internally and externally, though that which is expressed by the crowds in the street in Ferguson, Baltimore, New York and Chicago, and the language and policies emerging from the White House certainly suggests that conclusion. But I do think that political and community leaders are totally at a loss regarding how to deal with racial and ideological anger, or with the problem of preventing the mentally ill from obtaining weapons without intruding upon the privacy of their health records.   Identified leaders of inner-city communities have shown they have no idea how to broach the subject of the absence of fathers from 66% of the homes in which black children are being raised, or how that and teen motherhood create both poverty, and a moral void for children that is readily filled by the purveyors of the gang and drug culture, eager to place their criminal value system into the minds of new recruits.

The White House and city administrations, education, church and community leaders have largely been silent regarding the often reported observation that in the social structure of urban schools, whereas white kids tend to look up to high-achievers, black students tend to despise black high-achievers, (except in certain sports), in proportion to their achievement. The most obvious indicator of achievement in school being manner of speech, if a black kid speaks standard English, he is disparaged by his own race for his betrayal.  The inability to speak or understand rudimentary standard English, and to do simple arithmetic is obviously a major bar to obtaining most ordinary jobs. Which plays right into the agenda of the real leadership of the inner city, the drug gangs, given that it provides them with entry-level employees who have had no where else to go.

It is these kids who, as long as they can hold a pistol sideways in emulation of their Hollywood anti-heroes, account for 96% of urban murders.

The liberal political leadership of our major cities colludes in the production of this homicide statistic by shedding crocodile tears from time to time and clamoring for “more gun control”, but at the same ranting against such enforcement programs as, “Stop and Frisk”, the very program that had made a major dent in the homicide rate in New York.

What is worse, city leaderships seek more gun control (at the expense of the rights of a hundred and ten million, mostly white, law abiding gun owners), while at the same time they pander to mobs who systematically demonize the police agencies seeking to enforce the overabundance of gun laws (>6,000 of them) already on the books.

Rampage Violence

The following quote is a condensed version of something posted on an internet discussion site regarding the June 2016 shooting rampage in Orlando.

“I am not a father, but I mourn as Fathers’ Day nears, for:

“How does a father control his grief and rage, when a son or daughter will not be coming to share his day, or any future days…?

“How does a father act to protect his children from bigotry and violence?

“How does a father explain why it is so easy for anyone with a hate-filled heart to obtain a weapon of mass destruction?

“Fathers, mothers, children– take a step back, and then a giant leap forward:

“Banish all forms of discrimination, intolerance, indifference, and yes–

“Ban assault rifles.”

Well, I am a father with grown children.  I feel a powerful empathy for the fathers of whom the writer speaks.

I hadn’t followed the news of the tragedy in Orlando very closely, but I had picked up a few scraps of information from the TV being on while I was working around the house.  From the beginning, the case resembles the San Bernardino massacre, in which an assault rifle was used, widely trumpeted to have been, “legally acquired”, a code phrase in the language of the anti-gun movement that implies that existing laws were not plentiful or strong enough to prevent the tragedy.

But the FBI, whom I personally heard initiate the claim of “legally acquired” in that case, was quickly proven to be wrong.  The obtaining of the weapons used in San Bernardino was already entirely illegal under three separate federal and California laws.  First:  they were purchased by a friend for the two shooters, who themselves could not have bought them.  This is called a “straw purchase” and is a federal felony.  Second:  So-called assault rifles are already illegal in California, and one defining characteristic of such a weapon is the push-button release of the magazine.  After purchasing rifles requiring a tool to remove its fixed magazine, they were illegally modified to add a push-button release. Third: Magazines holding more than ten bullets are illegal in California, but the shooters obtained higher capacity magazines illegally, and used them in the crime.

What the San Bernardino case suggests is that what is lacking is NOT a sufficient number of laws, it is the enforcement of existing laws.   The enactment of more laws will surely infringe the Constitutional rights of the law-abiding, who will voluntarily comply.   New laws, no matter how restrictive, will not, if past events teach us anything, significantly hamper Islamic terrorists, who believe that the secular laws of any nation are blasphemous objects of contempt.

What little is known of the Orlando shooter at the time of this writing includes the fact that he was a radical Islamic man who was also a violent spousal abuser.  Mateen was suspected by some of being bipolar, but his history of being a rule-breaker and trouble-maker during his school days also raised the possibility that he was exhibiting a significant degree of sociopathy, especially given his murderous finale. He is the second member in as many years, of a tiny Florida mosque, who has undertaken a terrorist act.  The first had become a suicide bomber in Syria in 2014.  Omar Mateen’s father is an Afghani who is reported to have been an angry and vocal supporter of the Taliban, both before coming to the U.S. and since.   Omar Mateen himself, is thought to have been a regular attendee at the gay nightclub and is believed to have connected there with gay men.  One theory is that he may have suffered from the conflict between his sexual proclivities and his religion, which is homicidally intolerant of homosexuality.

Mateen had been taken into custody twice by the FBI because of his own ideological rants, but was found to have “committed no crime for which he could be charged.”

It appears that in this case we are again the victims of the fairness of our own culture, not of an insufficiency of laws.  As a wife-beater misdemeanant, Omar Mateen would have been prevented by federal and Florida law from purchasing a firearm.  The implication of the snippet of an interview of his ex-wife that I heard was that her family helped her get away from him after he became violent, but whether they notified the police was a question not asked in that interview. Later it was revealed that she may have known a great deal about his intentions and his actions but did not contact authorities.

As for the FBI, when they could find no proof of law breaking, they had to let him go.  Our laws protect those not found guilty in a court of law.  We don’t think it’s fair to take away the rights and freedoms of people not convicted of wrongdoing.  Wrong thinking is not a crime.

Unfortunately, the quoted writer’s recommendation that we “banish” all forms of discrimination and intolerance …and even indifference, is decidedly unAmerican.  We can ban some kinds of discriminatory acts that we define as illegal…e.g. discrimination on racial or religious grounds, in housing or employment.  But we can’t ban beliefs, feelings or speech that is intolerant or discriminatory.  We cannot ban even these behaviors with regard to people’s voluntary associations with one another.

This past year I read the entire Koran, word-for word, specifically looking for any expression or tolerance or peaceful coexistence with non-Muslims.  But I found the Koran unremittingly and violently intolerant of every belief but Islam as Mohammed defined it.  Nonetheless, many would be horrified if it were suggested to banish Muslims from the country.  Some find abhorrent the idea of stopping Muslims or immigrants from certain countries from entering the U.S. even temporarily while better vetting processes are established…(i.e. a processes that would have prevented Mateen’s Taliban-supporting father from coming here.)

In terms of prevention of ideological violence, the major disconnect, it seems to me, has been between it being well known that a person is mentally ill and/or ideologically dangerous, and that concern being communicated to the people who maintain the “no-buy” list for firearms.  Again, fairness and concern for privacy play a major role.  As in the case of the German Wings pilot who crashed a planeload of people into a mountain,  many people knew he was dangerously ill and suicidal, but extreme German privacy laws and privacy concerns prevented that information from flowing to licensing authorities.

If we are to enhance prevention of these horrible crimes without trampling on the Constitutional rights of, say, Muslims, or of one hundred and ten million law-abiding American gun owners, knowledge of relevant mental illness and ideological extremism must be communicated, immediately, consistently and quickly, to the authorities who can do something about it.

On Father’s Day I’ll be thinking not only of my own children, but of the fathers who have not been as lucky as I have been, to have their kids still with them for a lifetime.

Congress and the CDC

 In the wake of the Orlando rampage, the on-line medical news service, Medscape, reported that the American Medical Association (AMA) had resolved to recommend to the U.S. Congress that it lift a ban it had imposed upon the Center for Disease Control (CDC) to study “Gun Violence” as a public health issue. The AMA, true to my experience of it across four decades of medical practice, once again got it wrong. The Congress had never banned the CDC from doing research into violence, nor even violence involving guns. What it had forbidden was that the CDC should use public funds to “advocate or promote” gun control, which it feared the agency was more likely to do after the appointment of Obama’s candidate for Surgeon General, who had already agreed a priori with the President’s pre-judgment that guns caused violence and that banning them was the solution.

As far as the proposed CDC research is concerned, it risks guaranteed contamination by the political agenda of people who, before any study is undertaken, take the position that guns are the cause of violence.  This is foreshadowed by the very attachment of one word to the other in the proposed subject title:  GUN VIOLENCE.

The significance of this might be more easily seen in this example.  As a factor, Black race alone is actually four times more powerful a predictor of violence than is gun ownership alone.  So what if one were to propose that the CDC study BLACK VIOLENCE?   See the bias inherent in the wording of the question?  Do you notice that many avoid mentioning ISLAMIC VIOLENCE?  Oh, dear, not very PC in the current White House.  Our Surgeon General reportedly agrees that Islam is incidental and guns are causal.

People who for whatever reason would like to see the nation rid of guns, simply always draft laws into which that agenda is woven.  Then they characterize those laws as “reasonable restrictions” and those who oppose them as, ‘gun nuts’.  To such people the political end justifies the dishonesty of the means.  It would be distraction from achieving any scientific understanding of the problem of violence if we allow that political faction control over the CDC research process.


22. Families of Slain Sue Aurora Theater

May 11, 2016

In the news today is a story about a civil suit brought by the families of the killed and wounded against Century 16 theaters, claiming that the theater should have provided more security.

The theater responds that James Holmes was a madman, an ‘evil genius’, who was hell-bent upon destruction, that his arrival was unpredictable and that he was unstoppable.

Two important clues mitigates against that theory.  1) Holmes was wearing body armor and was heavily armed.  2) And when he was confronted at his vehicle by police, he surrendered immediately and without resistance.   From these facts, as a former forensic psychiatrist, I infer that he was very concerned about getting hurt.  Just guessing,  I’d say that like most people who act like bullies, he was himself a cowardly person.  My speculation is that there is a good chance he would have folded immediately if taken under fire.  And of course he might or would have stopped shooting if wounded or killed.

In 2012 the population of Colorado was 5,192,000.  At that time the number of concealed weapons permits existing in the state was 139,560, meaning that as many as 2.7% of Colorado’s citizens habitually go armed.  In a theater reported to have contained 400  patrons, statistically speaking, there would have been, on average, 10.68 armed patrons, had the management of the theater not reduced that number to zero by posting “No Guns” signage prohibiting law-abiding citizens from entering the theater armed.

With everyone in the theater crouching to flee, except the shooter who remained upright, it would have been likely that some of the armed patrons could immediately have returned fire, either hitting the shooter or causing him to stop shooting and flee.  This is not at all unlikely, and in fact is exactly what has happened in some previous active-shooting situations.  One that comes to mind is a shooting in a southern church where the shooter was immediately shot and killed by a young woman congregant who was armed.

In the Gabby Gifford shooting, an armed Safeway patron had emerged from the store and, having heard the shooting and screaming, was standing concealed, having drawn a bead on a man with a gun standing in the parking lot.  The man with the gun was not aiming it at anyone, and turned out to be someone who had taken the gun from the shooter.  The armed patron very wisely had waited until the situation became clear before opening fire, and in the end, holstered his weapon without shooting.

Century 16, as its management argues, may not reasonably have been expected to provide armed protection to its patrons, but in this case, if earlier news reports were right about the sign banning firearms, and its “no guns” policy,  it may have consciously and intentionally adopted a policy that prevented patrons from protecting themselves.  It will be interesting to see whether the courts consider that argument.

There is one further speculative argument.  It has been argued hypothetically that a rampage shooter might intentionally select a “No Guns” area, in which case that policy actually exposes patrons to a slightly nigher risk of harm even when it doesn’t actually  happen.