Later On

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Archive for the ‘Medical’ Category

What happens when your doctor blames you for your own cancer?

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Monica Bhargava, a pulmonary/critical care physician in Oakland, California, writes in the Washington Post:

Not long ago, I was working in a busy teaching hospital’s intensive-care unit, poring over EKGs, examining X-rays and reviewing medication orders, when I received a phone call. Results were in for the lung biopsy of one of my patients, Ms. X. She had cancer.

The news shook me. Ms. X hugged us at the end of every visit. She had worked for decades as a seamstress and hoped to retire soon. A resident overheard my conversation. “Did your patient smoke?” she asked. “No,” I said. The trainee sighed and shook her head. “When a person who doesn’t smoke gets lung cancer — that’s just unacceptable.”

I was stunned by the implication — that a cancer diagnosis in a patient who used tobacco was acceptable. It is a tragedy when any patient develops lung cancer. They will undergo surgeries, toxic infusions and lonely nights in the hospital. Many will face crushing financial pressures and be forced to confront their mortality in unimaginable ways. Why would we mute our sympathy at this moment?

As a pulmonologist practicing in a disadvantaged community in Oakland, Calif., I screen patients for lung cancer every day. About half a million Americans alive today have been diagnosed with this disease at some point in their lives. Though treatments evolve, there’s an old standby that the medical establishment keeps dishing out to these patients: shame and blame.

The hard-working resident was just echoing what she had been taught in medical school. Her conclusion was drawn from American medicine’s hidden curriculum: the assumption that individual will is destiny and that patients who behave imperfectly can be blamed for their illness. At hospitals across the country, I’ve seen health-care providers use language that separates “deserving” from “undeserving” patients.

As a trainee at an academic medical center, I observed weekly conferences where the care plans of new cancer patients were determined by a large team of expert physicians. The words “lung cancer” — followed by “nonsmoker” — often elicited murmurs of sympathy. I wondered whether this sympathy would lead to longer and more meaningful clinic visits with the patient in question, and whether the opposite would be true for the Vietnam veteran who had smoked for 40 years. The tight link between tobacco and lung cancer has hardened into stigma, and the potential for care disparities is real.

There is little research measuring how physicians’ biased attitudes affect outcomes for smoking lung cancer patients, but a number of studies point to its likely negative impact. One questionnaire-based study revealed that physicians were less likely to offer advanced lung cancer treatments to patients who were smokers as compared with similar nonsmokers. Scientific reviews have shown that physicians who harbor biased attitudes toward their patients often ask fewer questions during visits, order fewer tests and offer suboptimal therapies. Over the past decade, I’ve seen hundreds of tobacco-using patients who were treated this way at some point in their care journey — their coughs ignored, their symptoms minimized, their stories unprobed.

The stigma goes far beyond the medical community. Lung cancer accounts for 25 percent of our nation’s cancer deaths but receives only 10 percent of cancer research dollars. Some in the field believe that donors give less to lung cancer research because of the perception that the disease is self-inflicted.Research and anecdotal data show that lung cancer patients receive less support from their friends and neighbors than those with other cancers, making their disease more difficult to bear. A 2004 study from the BMJ notes that some patients hid the illness because of stigma, at times resulting in worrisome financial consequences and increased emotional distress.

Smokers, in particular, are shamed more vocally than other patients who develop diseases with a strong behavioral correlate. When a well-known person dies of a heart attack, the obituary seldom notes their sedentary lifestyle or dietary choices. But when a brilliant former colleague, the late physician and writer Paul Kalanithi, was being treated for lung cancer, newspaper articles made it a point to mention that he didn’t smoke . He wasn’t one of those who had brought cancer on himself, the stories implied.

Stigma isn’t limited to lung cancer patients, of course. Our culture’s tendency to frame certain illnesses as character defects, as opposed to complex phenomena with genetic and psychosocial components, is widespread and carries serious consequences. The group that suffers most is the obese, a classification that applies to nearly 40 percent of American adults. Research shows that obese patients are more likely to be considered lazy or undisciplined by health-care providers; they are also viewed as more likely to disregard treatment recommendations and insufficiently committed to their health. These attitudes erode patient-doctor communication, and physicians tend to spend less time with patients who are obese. This means these patients have more limited interactions with the health-care system and miss many opportunities. For instance, data shows that morbidly obese women are often under-screened for cervical and colorectal cancer.

Those dealing with addiction and hepatitis C, a blood-borne virus often transmitted through sharing needles or other equipment to inject drugs, face a similar stigma. A high percentage of health-care professionals exhibit negative attitudes toward patients with substance use disorders, perceiving them as morally deficient or lacking self-control, and leading to reduced access to care. Some hepatitis C patients, fearing biased providers, avoid medical care altogether, leaving the latest curative treatments on the table. When I worked in a primary-care setting, a patient asked me to remove his hepatitis C diagnosis from my clinic note. “If someone sees that, they’re going to treat me differently,” he said. “You all can’t help it.”

Why are doctors and nurses so judgy? In part, our culture of blame is an extension of American culture, which tends to hold the sick and impoverished personally responsible for their situations. We don’t feel comfortable invoking social structures, environments or even luck as powerful drivers of our fates. Physicians are also expected to be high-performing and deeply self-critical. This can easily spill over into our interactions with patients.

In my practice, I see how the culture of blame has altered the care that pulmonary patients receive. One lung cancer patient asked me if I felt less invested in his trajectory “because I smoked my way into this.” His fears were understandable. . .

Continue reading.

Written by LeisureGuy

20 January 2019 at 2:27 pm

What Life Is Like When Corn Is off the Table

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Sarah Zhang writes in the Atlantic:

When Christine Robinson was first diagnosed with a corn allergy 17 years ago, she remembers thinking, “No more popcorn, no more tacos. I can do this.”

Then she tried to put salt on her tomatoes. (Table salt has dextrose, a sugar derived from corn.) She tried drinking bottled iced tea. (It contains citric acid, which often comes from mold grown in corn-derived sugar.) She tried bottled water. (Added minerals in some brands can be processed with a corn derivative.) She ultimately gave up on supermarket meat (sprayed with lactic acid from fermented corn sugars), bagged salads (citric acid, again), fish (dipped in cornstarch or syrup before freezing), grains (cross-contaminated in processing facilities), fruits like apples and citrus (waxed with corn-derived chemicals), tomatoes (ripened with ethylene gas from corn), milk (added vitamins processed with corn derivatives). And that’s not even getting to all the processed foods made with high-fructose corn syrup, modified food starch, xanthan gum, artificial flavorings, corn alcohol, maltodextrin—all of which are or contain derivatives of corn.

“It’s such a useful plant,” Robinson says of corn. “It can be made into so very, very many things that are, from my perspective, trying to kill me.”

Read: Drowning in corn ]

Corn allergies are relatively rare, and ones as severe as Robinson’s are rarer still. (Many people unable to eat whole corn can still tolerate more processed corn derivatives.) But to live with a corn allergy is to understand very intimately how corn is everywhere. Most of the 14.6 billion bushels of corn grown in the U.S. are not destined to be eaten on the cob. Rather, as @SwiftOnSecurity observed in a viral corn thread, the plant is a raw source of useful starches that are ubiquitous in the supply chain.

It’s not just food. Robinson told me she is currently hoarding her favorite olive-oil soap, which she had been using for 17 years but recently went out of stock everywhere. (A number of soap ingredients, such as glycerin, can come from corn.) She’s been reading up on DIY soapmaking. A year ago, the brand of dish soap she liked was reformulated to include citric acid, so she had to give that up, too. And navigating the hospital with a corn allergy can be particularly harrowing. Corn can lurk in the hand sanitizer (made from corn ethanol), pills (made with corn starch as filler), and IV solutions (made with dextrose). A couple years ago, she went to see a specialist for a migraine, and her doctor insisted she get an IV that contained dextrose.

“And while in the midst of a migraine I had to argue with a doctor about the fact [that] I really could not have a dextrose IV,” she said. In the moment, she realized how absurd it was for her to be telling a world-class specialist to change her treatment.

Read: The allergens in natural beauty products ]

Because corn allergies are rare, many doctors are not familiar with the potential scope. Robinson said she was the first case her original doctor had ever seen in 38 years of practice, and he didn’t know to advise her against corn derivatives. Even official sources of medical information can be confusing, telling corn-allergy patients that they do not need to avoid cornstarch and high-fructose corn syrup. Misinformation abounds in the other direction, too, because corn allergies can be easy to misdiagnose and easy to self-diagnose incorrectly. All this means that corn-allergy sufferers encounter a good deal of skepticism. But Robert Wood, president of the American Academy of Allergy, Asthma & Immunology and a pediatric allergist at Johns Hopkins, told me that derivatives such as corn syrup can indeed cause problems for certain people.

People with corn allergies have naturally been finding one another on the Internet. A Facebook group called Corn Allergy & Intolerance (Maize, Zea Mays) now has nearly 8,500 members. Becca, a tech worker in Washington State, writes a fairly prominent blog called Corn Allergy Girl. (She asked I not use her last name because she doesn’t want her health status to affect her professional life.) The blog collates years of Becca’s research into corn allergies, as well as resources inherited from other, now-defunct corn-allergy blogs.

Members of the Facebook group have also forged ties with individual farms. Once a year, Robinson said, a farmer in California sends members of the group a big box of avocados that have not been exposed to corn-derived ethylene gas or waxes. “It’s a great month when you’re trying to get through all of them,” she said. For the rest of the time, she gets most of her food from a CSA with a local farm in Pennsylvania.

Becca, who writes Corn Allergy Girl, also gets a lot of her produce from local farms. The rest she grows. She goes to a specific butcher and meat processor who will custom-process whole animals for her without using lactic acid or citric acid. . . .

Continue reading.

Written by LeisureGuy

19 January 2019 at 4:41 pm

Todd Marinovich’s story: Read it from the point of view of memes interacting and competing

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Very interesting report by Michael Rosenberg in Sports Illustrated. Interesting in itself, but the meme interaction is obvious. It’s a memetic jungle out there.

Written by LeisureGuy

14 January 2019 at 4:06 pm

How ‘traditional masculinity’ hurts the men who believe in it most

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Just reading the title one things of John Wayne, Ernest Hemingway, Clint Eastwood, William Holden—that sort of masculinity. Monica Hesse writes in the Washington Post:

My grandfather is traditionally masculine in most senses of the word: He was a soldier, then a bait-shop owner, then a garbage collector; he rose before dawn most days of his life and I never heard him complain about it. He raised six good kids, he tells funny one-liners, he’s an expert fisherman. He once refused over-the-counter pain meds even while at death’s door.

I’ve been thinking about him lately, for reasons I’ll get to in a bit.

More than a decade ago, the American Psychological Association released a set of guidelines for treating women and girls: a document that addressed sexual violence and pay inequality, discussed how women disproportionately suffer from eating disorders and anxiety, and advised clinicians with female clients on how to be more sensitive and more effective. The APA has also, over the years, released guidelines for treating older folks, and racial and ethnic minorities, and members of the LGBT community.

What the largest psychological organization in the United States had never done was release guidelines for treating men.

Men were already perceived as the default, unneeding of individuated study. “Unless you’re in a men’s group, you’re probably not regularly reflecting on what it means to be male,” says Matt Englar-Carlson, who directs the Center for Boys and Men at California State University at Fullerton. “You’re probably just enacting it.”

Psychologists want to change that, though, and last week marked the release of the APA’s inaugural Guidelines for Psychological Practice With Boys and Men — developed over 13 years and using four decades of research. Men are 3.5 times more likely to die by suicide than women, for example. They have more academic challenges and receive harsher punishments in school settings. They’re the victims of 77 percent of homicides (and they commit 90 percent of them).

One cause for this consortium of maladies, the guidelines suggested? “Traditional masculinity” itself — the term refers to a Western concept of manliness that relies — and sometimes over-relies — on stoicism, dominance, aggression and competitiveness.

“Everybody has beliefs about how men should behave,” says Ronald Levant, who was the APA president when the guidelines were initially conceived, and who has worked on them ever since. “We found incredible evidence that the extent to which men strongly endorse those beliefs, it’s strongly associated with negative outcomes.” The more men cling to rigid views of masculinity, the more likely they are to be depressed, or disdainful, or lonely.

The guidelines are saying some men are sick, in other words. But are they saying some men are sick, like, we need to gently care for them with aspirin and a thermometer? Or are they saying some men are sick, like, we need to put them in Hannibal Lecter masks and keep them away from everyone else?

Levant was shocked this past week by how many people responded as if the guidelines were suggesting the latter — people who read the 30-page document as an indictment not of rigid, traditional masculinity but of all masculinity, and of men themselves.

Fox News host Laura Ingraham accused the APA of conflating masculinity with “Harvey Weinstein”-like behaviors.

In the conservative National Review magazine, writer David French also critiqued the study: “It is interesting that in a world that otherwise teaches boys and girls to ‘be yourself,’ that rule often applies to everyone but the ‘traditional’ male who has traditional male impulses and characteristics. Then, they’re a problem. Then, they’re often deemed toxic.”

My grandfather is traditionally masculine in most senses of the word: He was a soldier, then a bait-shop owner, then a garbage collector; he rose before dawn most days of his life and I never heard him complain about it. He raised six good kids, he tells funny one-liners, he’s an expert fisherman. He once refused over-the-counter pain meds even while at death’s door.

I’ve been thinking about him lately, for reasons I’ll get to in a bit.

More than a decade ago, the American Psychological Association released a set of guidelines for treating women and girls: a document that addressed sexual violence and pay inequality, discussed how women disproportionately suffer from eating disorders and anxiety, and advised clinicians with female clients on how to be more sensitive and more effective. The APA has also, over the years, released guidelines for treating older folks, and racial and ethnic minorities, and members of the LGBT community.

What the largest psychological organization in the United States had never done was release guidelines for treating men.

Men were already perceived as the default, unneeding of individuated study. “Unless you’re in a men’s group, you’re probably not regularly reflecting on what it means to be male,” says Matt Englar-Carlson, who directs the Center for Boys and Men at California State University at Fullerton. “You’re probably just enacting it.”

Psychologists want to change that, though, and last week marked the release of the APA’s inaugural Guidelines for Psychological Practice With Boys and Men — developed over 13 years and using four decades of research. Men are 3.5 times more likely to die by suicide than women, for example. They have more academic challenges and receive harsher punishments in school settings. They’re the victims of 77 percent of homicides (and they commit 90 percent of them).

One cause for this consortium of maladies, the guidelines suggested? “Traditional masculinity” itself — the term refers to a Western concept of manliness that relies — and sometimes over-relies — on stoicism, dominance, aggression and competitiveness.

“Everybody has beliefs about how men should behave,” says Ronald Levant, who was the APA president when the guidelines were initially conceived, and who has worked on them ever since. “We found incredible evidence that the extent to which men strongly endorse those beliefs, it’s strongly associated with negative outcomes.” The more men cling to rigid views of masculinity, the more likely they are to be depressed, or disdainful, or lonely.

The guidelines are saying some men are sick, in other words. But are they saying some men are sick, like, we need to gently care for them with aspirin and a thermometer? Or are they saying some men are sick, like, we need to put them in Hannibal Lecter masks and keep them away from everyone else?

Levant was shocked this past week by how many people responded as if the guidelines were suggesting the latter — people who read the 30-page document as an indictment not of rigid, traditional masculinity but of all masculinity, and of men themselves.

Fox News host Laura Ingraham accused the APA of conflating masculinity with “Harvey Weinstein”-like behaviors.

In the conservative National Review magazine, writer David French also critiqued the study: “It is interesting that in a world that otherwise teaches boys and girls to ‘be yourself,’ that rule often applies to everyone but the ‘traditional’ male who has traditional male impulses and characteristics. Then, they’re a problem. Then, they’re often deemed toxic.” . . .

Continue reading.

Written by LeisureGuy

13 January 2019 at 4:00 pm

Very interesting report on exercise: what it can do and what it can’t

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It’s a long read but it’s worthwhile. Vybarr Cregan-Reid reports on “Why exercise alone won’t save us” in the Guardian. A few selections from the report.

. . . Fitness crazes are like diets: if any of them worked, there wouldn’t be so many. CrossFit, the intensely physical, communal workout incorporating free weights, squats, pull-ups and so forth, is still less than 20 years old. Spin classes – vigorous group workouts on stationary bikes – have only been around for about 30. Aerobics was a craze about a decade before that, although many of its high-energy routines had already been around for a while. (The pastel horror of 1970s Jazzercise is probably best forgotten.) Before that, there was the jogging revolution, which began in the US in the early 1960s. The Joggers Manual, published in 1963 by the Oregon Heart Foundation, was a leaflet of about 200 words that sought to address the postwar panic about sedentary lifestyles by encouraging an accessible form of physical activity, explaining that “jogging is a bit more than a walk”. The jogging boom took a few years to get traction, hitting its stride in the mid- to late-80s, but it remains one of the most popular forms of exercise, now also in groups. . .

. . . Technological innovations have led to countless minor reductions of movement. To clean a rug in the 1940s, most people took it into their yard and whacked the bejeezus out of it for 20 minutes. Fast-forward a few decades and we can set robot vacuum cleaners to wander about our living rooms as we order up some shopping to be delivered, put on the dishwasher, cram a load into the washer-dryer, admire the self-cleaning oven, stack some machine-cut logs in the grate, pour a glass of milk from the frost-free fridge or thumb a capsule into the coffee maker. Each of these devices and behaviours is making it a bit more difficult for us to keep moving regularly throughout our day.

As we step through various innovations, we tend to think of the work that is no longer required as “saved”. Cleaning a rug once burned about 200 calories, while activating a robo-vac uses about 0.2 – an activity drop of a thousandfold, with nothing to replace it. Nobody, when they buy a labour-saving device, thinks: “How am I going to replace that movement I have saved?” . . .

. . . A 2015 report by the Academy of Medical Royal Colleges called Exercise – theMiracle Cure said that regular exercise can assist in the prevention of strokes, some cancers, depression, heart disease and dementia, reducing risk by at least 30%. With regular exercise, the risk of bowel cancer drops by 45%, and of osteoarthritis, high blood pressure and type 2 diabetes by a whopping 50%.

Exercise, in these terms, is not a fad, or an option, or an add-on to our busy lifestyles: it is keeping us alive. But before it can work for us, our whole approach needs to change. . .

. . . The health effects of being sedentary are as common and recognisable as they are serious. Anxiety, depression, heart disease, breast and colon cancer, type 2 diabetes, high blood pressure, obesity, osteoporosis, osteoarthritis and the leading cause of global disability, back pain, are all driven by sedentary behaviours.

For our bodies to function properly, they operate on the assumption that we will be burning calories throughout the day, and not in short bursts. It is clear that periods of sedentariness are bad for the human body, and some exercise is always going to be better than none; the issue is not really to do with the types of exercise, but with our approach to them and what we expect them to achieve. We know from the data that the human relationship with exercise is predominantly characterised as both optional and additional to an otherwise sedentary life, which itself causes a ton of problems. As long as physical activity is divorced from the real work of our lives, we will find reasons for not doing it.

No matter how low the institutional expectations for physical activity drop, more of us fail to meet them each year. A Public Health England survey last year found that people in England are becoming so inactive that 40% of those aged between 40 and 60 walk briskly for less than 10 minutes a month. The reasons are numerous, but they seem to be connected to our notion of exercise, and the difference between short bursts of running or cycling and low-level, sustained physical activity. If we go back to the beginnings of exercise, we can see why it is still so problematic for us today. . .

. . . If being fit promotes long life, you might expect being an elite athlete to help you reach a ripe old age. It doesn’t. Olympians buy themselves an extra 2.8 years on average, according to a 2012 study. Devoting your life to sport and exercise will buy you more time, but once you factor in the Olympians’ lifelong sustained attention to diet and healthy living, as well as tens of thousands of hours spent training, 2.8 years might not really seem sufficient recompense.

Instead, the fittest and healthiest people on the planet have never been to a gym. These people, who report high levels of wellbeing and live extraordinarily long lives, inhabit what have been called “blue zones” – areas where lifestyles lead to peculiar longevity. The term was coined by two demographers, Gianni Pes and Michel Poulain, who, while collecting data on clusters of centenarians on the island of Sardinia, identified places of especially high longevity on their map with a blue felt-tip pen. Because clusters of long-lived people are often found in geographically remote places (also including parts of Okinawa, Costa Rica and Greece), jackpot genes seem like a strong candidate to explain their longevity. But a famous study of Danish twins has concluded that a long life seems to be only “moderately heritable”. Over the years, many studies have looked at the lifestyles ofpeople in “blue zones” and found that a number of their customs and habits contribute to a long life (everything from a sense of belonging and purpose to not smoking, or eating a predominantly plant-based diet). In the list of contributory factors, there is a noticeable absence of exercise.

I travelled to Sardinia to meet Pes and find out more about his work. He has a vested interest in longevity. His great uncle was a supercentenarian (living beyond 110). The years that Pes is interested in finding out more about are the good ones, not those spent with 24-hour care in a nursing home (there are also none of these in Sardinia’s blue zones). A trial by a group of gerontologists based at Boston University reported that 10% of supercentenarians made it to the final three months of their lives without being troubled by major age-related diseases.

In my conversation with Pes, he repeatedly stressed that while diet and environment are important components of longevity, being sedentary is the enemy, and sustained, low-level activity is the key that research by him and others has uncovered: not the intense kinds of activity we tend to associate with exercise, but energy expended throughout the day. The supercentenarians he has worked with all walked several miles each day throughout their working lives. They never spent much time, if any, seated at desks. . .

. . . For those of us who can’t move to Sardinia and become a shepherd, a review published in the Lancet in 2016 found that “high levels of moderate-intensity physical activity (ie, about 60-75 min per day) seem to eliminate the increased risk of death associated with high sitting time”.

So even if we go to the gym on a Saturday morning, our absolute inactivity at other times can still be damaging to the body. Low and moderate activity for longer or sustained periods seems to produce the best results. It looks like excessive high-intensity activity (the kind we see in elite athletes) drives metabolism and cell turnover, and may even, when all factors are taken into account, accelerate the ageing process. . .

Written by LeisureGuy

11 January 2019 at 4:21 pm

The persistence of culture: Harsh Nazi Parenting Guidelines May Still Affect German Children of Today

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Memes evolve over time, but they are also surprisingly enduring over generations. Anne Kratzer writes in Scientific American:

In 1934 physician Johanna Haarer published The German Mother and Her First Child. Her advice guided child-rearing in the Third Reich. It ultimately sold some 1.2 million copies, almost half of them after the end of the war.

In that book, Haarer recommended that children be raised with as few attachments as possible. If a child cried, that was not the mother’s problem. Excessive tenderness was to be avoided at all cost.

Psychotherapists fear that this kind of upbringing led many children in Germany to develop attachment difficulties and that those problems might have been passed on to subsequent generations.

***

Renate Flens, a German woman in her 60s who suffers from depression, tells her psychotherapist that she wants to love her children but just can’t. She and the therapist soon realize that both Flens’s problems may be rooted in her frustration at being unable to allow others to get close to her. After lengthy conversations, they realize something else: a contributing factor may well be the child-rearing teachings of Johanna Haarer, a physician whose books were written during the Nazi era and aimed at raising children to serve the Führer. Flens (a pseudonym) was born after World War II, but Haarer’s books were still popular during her postwar childhood, where many households had a copy of The German Mother and Her First Child (Die deutsche Mutter und ihr erstes Kind)—a book that continued to be published for decades (ultimately cleansed of the most objectionable Nazi language). When asked, Flens recalled seeing one of Haarer’s books on her parents’ bookshelf.

Flens’s story, told to me by her therapist, illustrates an issue troubling a number of mental health experts in Germany: Haarer’s ideas may still be harming the emotional health of its citizens. One aspect was particularly pernicious: she urged mothers to ignore their babies’ emotional needs. Infants are hardwired to build an attachment with a primary care giver. The Nazis wanted children who were tough, unemotional and unempathetic and who had weak attachments to others, and they understood that withholding affection would support that goal. If an entire generation is brought up to avoid creating bonds with others, the experts ask, how can members of that generation avoid replicating that tendency in their own children and grandchildren?

“This has long been a question among analysts and attachment researchers but ignored by the general public,” says Klaus Grossmann, a leading researcher in mother-child attachment, now retired from the University of Regensburg. The evidence that Haarer’s teachings are still affecting people today is not definitive. Nevertheless, it is supported by studies of mother-child interactions in Germany, by other research into attachment and by therapists’ anecdotal reports.

HAARER’S TEACHINGS

Haarer was a pulmonologist, who, despite having no pediatric training, was touted as a child-rearing expert by the Nazis (the National Socialists). The recommendations from herbook, originally published in 1934, were incorporated into a Reich mothers training program designed to inculcate in all German women the proper rules of infant care. As of April 1943, at least three million German women had gone through this program. In addition, the book was accorded nearly biblical status in nursery schools and child care centers.

Although children need sensitive physical and emotional contact to build attachments and thrive, Haarer recommended that such care be kept to a minimum, even when carrying a child. This stance is clearly illustrated in the pictures in her books: mothers hold their children so as to have as little contact as possible.

Haarer viewed children, especially babies, as nuisances whose wills needed to be broken. “The child is to be fed, bathed, and dried off; apart from that left completely alone,” she counseled. . She recommended that children be isolated for 24 hours after the birth; instead of using “insipid-distorted ‘children’s language,’” the mother should speak to her child only in “sensible German”; and if the child cries, let him cry.

Sleep time was no exception. In The German Mother and Her First Child, Haarer wrote, “It is best if the child is in his own room, where he can be left alone.” If the child starts to cry, it is best to ignore him: “Whatever you do, do not pick the child up from his bed, carry him around, cradle him, stroke him, hold him on your lap, or even nurse him.” Otherwise, “the child will quickly understand that all he needs to do is cry in order to attract a sympathetic soul and become the object of caring. Within a short time, he will demand this service as a right, leave you no peace until he is carried again, cradled, or stroked—and with that a tiny but implacable house tyrant is formed!”

Before publishing The German Mother and Her First Child, which ended up selling 1.2 million copies, Haarer had written articles about infant care. Later titles included Mother, Tell Me about Adolf Hitler!(Mutter, erzähl von Adolf Hitler), a fairy-tale-style book that propagated anti-Semitism and anti-Communism in language a child could understand, and another child-rearing manual, Our Little Children (Unsere kleinen Kinder). Haarer was imprisoned for a time after Germany’s defeat in 1945 and lost her license to practice medicine. According to two of her daughters, she nonetheless remained an enthusiastic Nazi. She died in 1988.

MODERN CONSEQUENCES

There are many reasons to think that Haarer’s influence persisted long after the war and continues to affect the emotional health of Germans today even though parents no longer rely on her books. Researchers, physicians and psychologists speculate that attachment and emotional deficits may contribute to an array of phenomena of modern life, including the low birth rate, the many people who live alone or are separated, and the widespread phenomena of burnout, depression and emotional illnesses in general. Of course, the causes of these personal and societal issues are many and varied. But the stories of people such as Renate Flens lend credence to the idea that Haarer’s lessons could play a role.

As Flens’s therapist notes, after a time patients may disclose their disgust at their own body and admit to following strict eating rules or to being unable to enter into close relationships—which are all consistent with the outcome of Haarer’s child-rearing regimen. Psychotherapist Hartmut Radebold, formerly at the University of Kassel, tells of a patient who came to him with serious relational and identity problems. One day this man found a thick book at home in which his mother had noted all kinds of information about his first year of life: weight, height, frequency of bowel movements—but not a single word about feelings.

In the laboratory, Grossman, who retired in 2003, continually observed scenes such as this: A baby cries. The mother rushes . . .

Continue reading. There’s much more.

Written by LeisureGuy

9 January 2019 at 3:45 pm

The Priest of Abu Ghraib

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The Smiethsonian has a long and thoughtful article that is very much worth reading. It’s by Jennifer Percy and it begins:

Joshua Casteel was 24 years old when he learned he would be sent to Iraq as an interrogator with the 202nd Military Intelligence Battalion. This was his first deployment. It was June 2004, and the war in Iraq had been going on for a little more than a year. Casteel packed a copy of the Book of Common Prayer and didn’t stop reading until he saw the lights of Baghdad in the desert below. From Ali Al Salem Air Base, outside Kuwait City, he took a military bus overnight to Baghdad International Airport. Out his window he saw oil fires, roadside weddings, sand that went on forever.

The next day, he suited up in body armor, strapped on his M-16, and took a heavily armored three-vehicle convoy 20 miles outside Baghdad to Abu Ghraib prison. On the way, he was thinking about Pope John Paul II, who wrote about suffering, human dignity and the nature of personhood and its relationship to the divine. Then the commander asked about newcomers: “Who has never done this before?” Casteel raised his hand. The commander explained that they didn’t fire warning shots. “If you move your selector level from ‘safe’ to ‘semi’ automatic, you shoot to kill,” he said.

Casteel stood 6-foot-1 and weighed 240 pounds. He was a blond, blue-eyed evangelical Christian from Cedar Rapids, Iowa. The deployment came six weeks after the revelation of prisoner torture and abuse at Abu Ghraib shocked the world. An Army intelligence officer and a patriot who’d long dreamed of serving his country in uniform, Casteel also had doubts about the morality of the so-called war on terror. Two weeks before he got his assignment letter from the Army, he was accepted to seminary school. He chose Iraq.

His mother, Kristi Casteel, could never picture her son as an interrogator. “He just wasn’t cruel to anyone,” she told me. She worried the job would change him. Casteel tried to rationalize. “Better that they have someone like me in the interrogation room,” he told her, “than someone who doesn’t care about the Geneva Conventions, or just wants to drop bombs.”

Abu Ghraib was already a prison before the Americans arrived, where Saddam Hussein incarcerated, tortured and executed Iraqi dissidents. When Saddam’s regime collapsed, the Americans took the place over and replaced Saddam’s portrait with a banner that read “America is the friend of all Iraqi people.” There was hardly any vegetation, just expanses of dirt and mud between buildings. “At the prison’s edge is a teetering skyline—minaret, palm trees, the mosaic dome of a mosque, rooftops,” Casteel wrote home to his parents. “At sunset I can hear the calls to prayer from the south and from the east. At times it may even appear as if in a round, like choirs of a cathedral, one folded atop the other. But always a few hours after the sun has fallen there is the intermittent echo of small-arms fire, the howling of dogs.” The complex, which now also housed a U.S. military base, had a chapel, a couple of cafeterias, an entertainment shed. When Casteel got to his sleeping quarters, everything was covered in ash. Outside, he saw a plume of smoke from a giant trash pile. The pit burned 24 hours a day, seven days a week. Sometimes the smoke blew right through Casteel’s sleeping quarters.

Casteel was told that the military’s top priority, above even the search for Osama bin Laden, was to hunt down Abu Musab al-Zarqawi, the leader of Al Qaeda in Iraq, and nicknamed the “Sheik of the Slaughterers.” Casteel’s job would be to interrogate prisoners to learn more about Zarqawi’s chief lieutenant, a man named Omar Hussein Hadid, whose army of insurgents had killed 95 Americans with rocket-propelled grenades and crude bombs during the Battle of Fallujah.

For the first week Casteel sat in on interrogations. There were six booths on each side of a long hallway; down the center was a two-way mirror that didn’t always work well, and when it didn’t, the prisoners watched you watch them. The rooms held little beyond plastic chairs, cheap tables, maybe zip ties on the chair legs. Sometimes a steel hook was attached to the floor. Every now and then prisoners were led to a more comfortable room, to confuse them, make them relax. The goal was to make them slip up. Sometimes Casteel saw men kept naked. Sometimes they were handcuffed to chairs.

During lessons, Casteel’s supervisors explained how to use fabricated stories and charges of homosexuality to shame the prisoners and manipulate them. The commanders were clear about who they were dealing with, Casteel remembered.

“These men,” they said, “are the agents of Satan, gentlemen.”

* * *

I met Casteel in 2009, when we were both graduate students in the writing program at the University of Iowa. We took a class together on the art of memoir, and on the side, Casteel told me, he took courses in philosophy and theology. I was surprised when I learned he had been an interrogator at Abu Ghraib prison. He wasn’t like any soldier I had ever met. He loved to sing solos from Les Misérables and gave frequent sermons at local churches. I often saw him in a corduroy blazer, books piled under one arm.

A few years later, I contacted Casteel’s mother, Kristi, because I wished I had gotten to know him better. She invited me to her home in Cedar Rapids and gave me access to a Dropbox account containing Joshua’s many writings and files. The folders had titles like “Heidegger and the Mystery of Pain,” “Flesh and Finitude,” “Heidegger and Sartre on God and Bodies,” “Technologies of Humanness” and “The Rhetoric of Pain.”

Kristi said, “Joshua had a complexity about his life.”

There were folders for academic papers, diary entries, plays—Casteel got a dual master’s degree in playwriting and nonfiction writing—and many jotted-off musings. A small publisher, Essay Press, had put out a short book by Casteel in 2008 titled Letters from Abu Ghraib, composed of selected emails he wrote to friends and family during his six-month deployment. And there were a lot of unfinished projects, including a memoir called No Graven Images.

Peeking into Casteel’s files felt a little like having a conversation with him, even if it was one-sided. But there was so much I still wished to know. Casteel often made difficult and even contradictory choices, which to many people who knew him seemed incomprehensible. He was constantly trying to make sense of how his Christianity fit with the war and his time in Iraq. For him, questioning this paradox at the heart of his life was analogous to figuring out the mystery of Christ. “If Jesus is anything,” Casteel wrote in the introduction to his unfinished memoir, “he is incomprehensible. This is my story of wrestling with that incomprehensibility.”

* * *

Casteel was born into a family of evangelists and raised in Cedar Rapids. His father was an ordained minister with River of Life Ministries, and both of his parents worked as Christian marriage therapists. Joshua was the youngest child of three, and the only boy. For years Casteel soaked up the ecstasy of Pentecostalism, spoke in tongues, attended miracles. On Sundays, he listened to sermons, Scriptures, hymns, and learned about the fight between good and evil.

He was a kid driven by questions of meaning and significance. He lived with what people now like to call “intentionality.” He told his mother he wanted to give himself up to a higher cause—either his country, or God, or both. He even told his mother that his calling might include the ultimate sacrifice. He covered his bedroom walls with cutouts from Army brochures and Marine recruiters, the American flag and the U.S. Constitution, and a large wooden cross.

He attended his first presidential caucus events at age 7, and in high school became president of the local chapter of the Young Republicans. In his parents’ garage he would hold press conferences in a White House built from cardboard, wearing a suit and clip-on tie, his hair parted like Ronald Reagan’s. He got his first gun at 11, during the Gulf War—a 22-caliber rifle with a long-range scope. Rush Limbaugh was a constant presence. So was Billy Graham and Ralph Reed, then head of the Christian Coalition. “On the one hand,” Casteel wrote in his memoir, “the political banter of our ‘fundamentalist’ Christian household hovered around familiar conservative themes: family values, small government, private enterprise (Dad was an entrepreneur). But also always present was what Thomas Friedman refers to as the invisible fist behind the invisible hand in the economy: strong national defense.”

Casteel was consumed by feelings of loyalty to America and believed in America as a “Shining City on a Hill.” His father had been a captain in the Army, and his grandfather had fought in World War II, Korea and Vietnam. At his grandfather’s funeral, Joshua placed an old West Point badge in his casket.

One summer, at Bible camp, when Casteel was 14 years old, a man named Steve, a self-declared prophet, had a revelation that Casteel was destined to be a powerful and historically significant man. When Steve was kicked out of the ministry for false prophecy, Casteel asked the camp pastor whether the prophecy was still worth anything. “It doesn’t mean it wasn’t true,” the pastor said. “God can speak through a false prophet.”

* * *

Kristi Casteel describes her son as a happy and affectionate child, obedient as they come. The two forged a close and trusting relationship right from the beginning. One day when Casteel was 3 years old she found him sobbing uncontrollably. He brought her outside. “It’s really bad,” he said. “A little worm is dead.” The worm had dried out in the sun. Casteel dug a tiny grave and buried it. “Jesus loves the little wormies,” he told his mother. “All the little wormies of the world.” As a teenager he made small but symbolic acts in the name of God. He torched his collection of unholy CDs. He anointed the high school doorways and baseball dugouts with oil from the Christian bookstore. He blew a shofar from centerfield.

His mother said he could sometimes get lonely, staying home on weekends rather than partying or socializing with other teenagers. He didn’t drink or do drugs. Some of his friends took to calling him “Mama’s Boy.” Other classmates thought he was gay because many of his friends were girls, because he acted in school plays and musicals, because he had a hormone imbalance called gynecomastia that gave him breasts. For years, until he had surgery, he was teased in the locker room, and refused to take off his shirt to swim or change backstage during school plays.

He and his mother talked about everything—faith, friendships, girls, dreams, disappointments, fears, philosophy, theology, art, literature, music. “We were very much alike in many ways, and just naturally connected on a deep level,” Kristi told me. Joshua was never as close to his father, Everett, who didn’t share his son’s temperament or interests. (In 2010, Everett Casteel died from complications related to a brain tumor.) With his mother, Joshua was always sweet. He gave her a tiny crystal swan, a ragged cotton bunny (she collected bunnies), a pink chiffon blouse, a large print of an angel that he thought looked like her, and a framed poem he wrote about her and the meaning of her name. Casteel was always praying to Mary, the mother of God. For Kristi, it made sense. “We identified with Mary and Jesus—it just seemed to naturally evolve,” she says. “People mentioned his likeness to Christ again and again.”

Kristi had always worried that God would take her son. She had gone into his bedroom at night when he was a few weeks old and heard God talking: Give him back to me. You need to let him go. She tried to make sense of it. She later thought of the story of Isaac, when Abraham raised a knife above his son’s head to prove his faith in God.

“Whenever that fear entered my mind,” she told me, “I reminded myself that all of our children are on loan to us, and I shouldn’t live in fear of something I couldn’t know would happen.”

* * *

Casteel never forgot Steve’s prophecy, and a month after he turned 17 he enlisted as an Army reservist in Iowa City under the delayed entry program, in part to help his chances of getting accepted to West Point. That summer, between junior and senior year of high school, . . .

Continue reading. There’s a lot more.

Written by LeisureGuy

9 January 2019 at 3:13 pm

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