Misdiagnosis/Murder

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Sigmund Freud lived from 1856 to 1939.  And, as we all know, from the science section of the New York Times and the psychology coverage in Time magazine and the introductory courses in psychology we took at community college, Freud has not only passed away, but he is dead, really, really dead.  He is not merely an iPhone 4s in the era of iPhone 5, he is Alexander Graham Bell, 12 years after Bell Atlantic decided they preferred to go by the name Verizon.  What in heaven’s name, in 2013, is a psychoanalyst?  And if one has been cloned from the DNA in the marrow of a fossil psychoanalyst’s bones, what, exactly, might a psychoanalyst think? 

Read on, if you must, for a word or two (or two thousand) of what a psychoanalyst might think, after years spent listening to the web of relatedness that emerges from patients on the couch, and in this particular essay, the encounters those patients have had with pedophilic and sadistic perversion, and, from this psychiatrist psychoanalyst, years also of listening to the vicissitudes of psychotic experience in persons with schizophrenia. 

I was a psychiatrist before I became a psychoanalyst, and continue to spend half of my week in a community mental health center performing explicitly psychiatric care. The widespread call, at the moment, for better mental health services in the wake of Sandy Hook school shooting of 20 first-graders leaves this psychiatrist psychoanalyst feeling deeply ambivalent, because of its potential to inaccurately identify a certain kind of illness sufferer as the problem.  Surely, the public mental health system in which I work is in need of better resources—the clinics where my agency treats 5000 outpatients lose money in the average month, which is made up only by the slim profit earned in the agency’s other programs that are slightly better remunerated (residential and day programs).  Some months the agency budget overall is in the red and some months it’s in the black.  My CEO bends the ear of the board about how the money-losing clinics are central to the agency’s mission and to the survival of the other, money-making services.  So far, he’s won that battle, but don’t ask him or me to predict our future 5 years out.  An enormous portion of those seeking mental health care in our country can’t access it. So I will be the last person ever to say spending more resources on mental health care would be a wrong turn for America.

But it shouldn’t be characterized as the single solution, or even the primary solution, to the Sandy Hooks in the headlines.  Wayne LaPierre of the NRA, at his recent press appearance, described the type of person who unloads a semi-automatic rifle on his mother and on an elementary school full of children and their teachers, as “so evil, so possessed by voices and driven by demons, that no sane person can ever possibly comprehend them.”

So, stop right there.

The illness with the most frequent presentation of “hearing voices” is schizophrenia, but my patients with chronic or periodic auditory hallucinations are not the individuals most likely to perpetrate our next Sandy Hook.  Many of my patients who hear voices raise their children and work full-time jobs as grocery clerks and medical records department directors.  When schizophrenia is disabling, it is just as likely or more likely that the disabling symptom is dearth of motivation or decline in cognition, which can and frequently do present relatively independent from any hallucinations, and are less responsive to the medications we have available.

Paranoia in schizophrenia is sometimes more dangerous.  It can be well-organized, persistent, and compelling to the individual.  But in schizophrenia, it more often than not remits with one of our current antipsychotic medications, and the majority of my patients with schizophrenia do take their medications, because the presence of such symptoms is distressing to the individual, and they seek relief from such distress.

Yet Christmas Day in the New York Times, psychiatrist Paul Steinberg wrote an op-ed pointing the finger almost exclusively at schizophrenia as the cause of mass killings.

When I hear of a Sandy Hook or an Aurora or a Name-the-next-eruption-of-mayhem in the news, it is not my patients with schizophrenia that come to mind, or that I worry about. 

In the other half of my life, away from the mental health center, I maintain an office where I conduct psychoanalysis and analytic psychotherapy.  And the parallel that comes to mind when I hear about shooters like Adam Lanza is to the pedophiles and sadists I have heard about fairly incessantly since I started out in practice. 

It is not the pedophiles and sadists themselves who come to lie on my couch and sit in the chair in my consulting room, of course.  It is their daughters and sons, sometimes their nieces and nephews, their grandchildren and neighbors’ children.  They are the living victims of perversion just as the children of Sandy Hook’s first grade are the dead victims of perversion, the difference being, in part, that it is a sexualized perversion rather than a violently sadistic one.

But the commonality lies in the type of brain and the type of sickness that makes the rape and murder of children possible. 

Paranoiacs and psychotics of the schizophrenic type, when untreated or when not responding to the medications they are taking, frequently become so chaotic in their behavior or so out of touch with reality that they come to the attention of other members of their families and communities and to the police.  They lack the filter for their thoughts and actions that would keep them out of trouble.  There is still a need in the current field of psychiatry for better drugs, which would help those with active psychosis that is chronic—despite available medications—to attain remission, and there is still a need for outpatient commitment laws, which would help families and psychiatrists compel treatment for certain patients who won’t take drugs that would work.  But neither of these will in fact eliminate the problem we have with mass murderers.

Many a mass murderer is more like the pedophile than he is to the schizophrenic  psychotic.  They both plot, which takes a high degree of intact reality-testing, and they elude detection while plotting, which is central to achieving their goals.

We shake our heads and say “crazy” when we hear of someone shooting a classroom full of first graders, and it stumps the capacities of our imagination to think of how a human being becomes capable of such evil. 

Well, think for a minute about the taboos in your own mind.  The taboos you take for granted being in your neighbor’s minds.  Those injunctions are not doors slammed shut because there’s nothing in the room behind them.  They are doors slammed shut to keep us away from what’s in the room behind them.  And under particular circumstances, when the mix of motivations is right, the mind opens one of those doors and walks into one of those rooms.  And what it finds there is not necessarily a rudimentary sketch.  The human mind that takes a simple desire to stack a taller tower of blocks and a desire to be big like daddy and makes of them, over time, an architect for the Chrysler building, can make from the rudimentary thoughts on the far side of the open door of taboo something equally elaborate.  It can make, for example, the Austrian father who imprisoned his daughter and several of the children born of his incestuous rape of her in a basement dungeon for years.  It can make the father of one of my patients, who deliberately waited until other family members were away from the house and then just as deliberately broke his son’s bones, often with a baseball bat, passing them off later as “accidents” from clumsy falls.  (My patient kept silent, until telling me years later, for fear of lethal blows where these bone-crunching ones had landed.)  And it can make Adam Lanza, who plotted to get a semi-automatic weapon, kill his mother, and in a blaze of self-imagined glory take out a classroom full of six- and seven-year-olds, the adults who got in the way of his reaching that goal, and, for good measure, himself. 

If the perverse potential murderer or child rapist were sufficiently conflicted, he might come into the mental health system for assistance, might commit his energies to subduing his urges rather than discharging them.  But there are an abundance of murderers and pedophiles more invested in their own perverse behavioral goals than they are in any behavioral goals that might be suggested by  a therapist doing their intake, were they to cross the door to a mental health clinic.

I cannot and would not argue that a psychotic person suffering from schizophrenia or bipolar mania never killed anyone—I’ve had any number of them remanded to my care over the years who did just that—or that one will never kill again.  We should commit ourselves to providing the very best resources we can to provide the most effective intervention we can for these serious and tragic illnesses, and the resources to continue the research into more effective treatments, because God knows, we need them.

But we need additionally, to make the technology of mass murder less accessible to the Adam Lanzas already living among us.  And not delude ourselves into thinking we can identify them with a background check.  Lists of identified “mental patients” are not very likely to capture the future mass murderers among us, and will very likely dissuade many of those who could use mental health intervention from seeking it.  The disorganized psychotic patients will end up on the list, and the perverse murder-plotters won’t.

We need to actively intervene in the bullying of our young, who are vulnerable to turning it back on themselves or back at others in an aggrandized retaliatory way—to reduce, if we can, the number of future Adam Lanzas we might help create. 

We need to educate the young about the scope of mental illnesses and make access to mental health care truly available to any who seek it.

And we should talk frankly about sadistic violence and perverse sexuality as possible and very undesirable outcomes of development, if we hope to raise whatever veils cover our understanding of ourselves and cover our understanding of the difficulties in the human condition. 

It may seem odd for a gay man to be urging the country to talk more about perversion, since it took many decades for psychoanalysis to stop telling the world that my kind were, ourselves, perverted.  But perhaps because I had a need to understand how this came to be, in the profession to which I was certain I had a calling, and to figure out how the perverted in my own life experience escaped being labeled as any such thing by anyone who knew them, I took more than an average interest in the subject.  And then the patients came, one after another, struggling to make sense of the perversion they had encountered in the persons in their own lives, and to understand the silence and secrecy surrounding that perversion.  In sum, it has taught me that comprehending the possibility of sadistic and pedophilic perversion matters, that open acknowledgement of these possibilities matters, that silence only magnifies and multiplies vulnerabilities and the numbers of the vulnerable.

Mass murderers, on the whole, orchestrate murder suicides that cannot be understood in terms of conventional psychology.  Some can be understood in terms of paranoid psychosis, but many can best be understood in terms of what lies beyond the doors of taboo, and its attractions for a certain kind of person who is susceptible to imagining that transcendence of vulnerability lies in the embrace of sadistic power—and nowhere else.  If we can acknowledge this sad possibility, perhaps we can guide a potential Adam Lanza or many potential Adam Lanzas toward an alternative path.  But we have to do it as a culture, and not only as individual psychotherapists meeting with patients in our offices.  Because the evolution of an Adam Lanza too often takes place with deep immersion in the ideas and institutions of the culture as a whole and no acquaintance  whatsoever with the possibilities of help through psychotherapy.

Finger on the Pulse

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I resolve periodically to never again read the “comments” section of anything posted on the internet. Too much exposure to the unbridled id of our culture can, after all, make it hard to get up and go to work in the morning.

And then I slip for some reason, and find myself scrolling through the 172 comments on some political post on Facebook. And I resolve all over again to resist that temptation.

There is the well-worn story about six men in a dark room with an elephant, each asked to describe the animal from the part he touches in his hands. Political commentary on the internet, more than anything else in life, makes me wonder what part of the elephant folks are touching. For my part, it’s hard to imagine that the underclass, the aged, and the disabled that I see every day are the same underclass, aged and disabled that generate such contempt from certain vociferous people on the right end of our political spectrum. Because in America, the “freeloaders” so hated by those who would promote not just the survival but in fact the unencumbered freedom of the fittest among us, are mostly just these--the underclass, the aged, and the disabled. From what I read, the moral narrative goes something like “Those people are lazy, short-sighted, or drug-addicted, and I shouldn’t have to pull their weight.”

Yes, there are people in America who are lazy, short-sighted, or drug-addicted, and who leech off a society to which they would better contribute. But where in the dark room does one sit and with what fingers does one feel the elephant in order to think most of the folks along the financial margins are there through a process of their own election? It baffles me. I guess it’s because the thing I have elected in life is treating the mentally ill (and occasionally addicted) poor that my sense of proportion is so different. I am shoulder-to-shoulder every day with exactly this part of our citizenry, and after twenty years I harbor no hatred of them nor of the system that tries to provide for their care. And when they are the object of contempt, I not only take a contrary view, but I’m truly confused. Just as Ronald Reagan’s “welfare queen” was an apocryphal anecdote told over and over until I guess he actually believed it himself, it seems to me that this “culture of freeloading” so many are fed up with is more myth than reality. Yes, our Social Security and Medicare systems are a demographic time bomb in need of reform if they are going to survive. But a plague of miscreants? I am too intimately acquainted with the true causes of disability to easily buy any story that the majority of folks in our social safety net are just too willfully lazy or self-destructive to get themselves out.

Here’s the reality I know: One of my patients with schizophrenia, I’ll call him William, told me yesterday that he’d had a really good Christmas. About a year ago he got out of the state mental hospital on conditional release after several months’ detention, after getting arrested for some illegal behavior while in a grossly psychotic state of mind. What brought on this episode? Maybe he had stopped his meds, or maybe not. Any number of individuals with schizophrenia have a major break despite taking their meds, and despite the efforts of their doctors to catch the first signs of the episode in time to ward it off. When he improved again and came to live in a residential program, he tried for months to contact his girlfriend of 15 years, who is also someone with chronic mental illness who lives most of the time in one supervised housing program or another. When he first tried to locate her, after falling out of contact for a year, he found that she had moved, and no one at her residential program could tell him where. Finally, Christmas came, and he tried calling her mother’s house on Christmas Eve. Ordinarily, her mother doesn’t answer the phone if it’s from a number she doesn’t recognize, but on Christmas Eve his girlfriend was there visiting and picked up the phone. Since he’s found his girlfriend again, he’s been taking three buses every Saturday to the other side of the county so he can meet her at a McDonald’s for lunch.

Certainly, William is by any standard a person who lives on the margins of our society, and depends on Social Security and expensive psychiatric interventions to keep hide and hair together. But largely, his lot in life is not one he chose. One percent of every population in every culture on the planet will develop schizophrenia, so truly, there but for the grace of God go you, my friend, or your children, or your children’s children. And somehow, I think William’s commitment to his girlfriend, although they live without the benefit of marriage (since marriage would bring them an immediate decrease in benefits), is a bit more tried and true than the commitment Newt Gingrich has demonstrated to any of his three wives.

William’s story is not just a heart-warming anecdote I pull out, as antidote to the apocryphal Reagan story about his “welfare queen.” William is typical of the disabled folks I treat. Just like he’s typical, more or less, of the patients I see who have less profound mental illness, but still don’t work because of another condition, like their severe obstructive lung disease or arthritic knees or advanced age or frequent dialysis. Our agency runs a vocational program for anyone who’s willing and able-bodied and financially eligible, and I have seen dozens of markedly impaired individuals make their way gradually off disability and into the job market, with sufficient time, assistance, coaching, and encouragement. And enough of my attention, which, as it turns out, is costly. Rehabilitation of the mentally ill is expensive.

It seems as though there ought to be some lesson to be taken from the fact that I, who walk daily with the folks who are carried in our social safety net, do not harbor the contempt for them that one finds on the airwaves of talk radio and in the comment sections of online media. I pay taxes, too. And trust me, it’s not a matter of a knowing wink between me and the folks who enable me to keep my cushy gig sucking the teat of government largess. There’s got to be an easier bureaucratic job than the one I have battling schizophrenia with funding through Medicare and Medicaid. Schizophrenia is mostly the shits, and navigating Medicare and Medicaid is an exquisite torture for any soul.

I do not consider myself a Christian, but I definitely read once that the King shall answer and say to them, “Truly I say to you, inasmuch as you have done it to one of the least of these my brothers, you have done it to me.” Seems a little at odds with the narrative that the least among us are the worst among us, but then I guess I just don’t really get Christianity. At least not right-of-center Christianity.

So there you have it-—my part of the elephant. The lesson I take from the life I’ve seen is that it is important to speak out against the caricature that the poor and disabled are shiftless, and that caring for them is an erosion of moral justice. If your part of the elephant is truly different, I'm all ears. But Reagan’s “welfare queen” was always just a mythical creature, and I, for my part, will both model and advocate for charity and compassion in place of meanness and self-concern, for William, and for all of the Williams I know (which number in the thousands) probably until my last day on Earth. (After which, from what I hear, I’m off to burn in hell. But there's always that "what have you done to the least of these, my brothers" card...)

The Devil in the Details

"But good people, heroic people, are led into temptation by their very goodness — by the illusion, common to those who have done important deeds, that they have higher responsibilities than the ordinary run of humankind. It’s precisely in the service to these supposed higher responsibilities that they often let more basic ones slip away." –Ross Douthat, The Devil and Joe Paterno, The New York Times, Nov. 13, 2011 http://www.nytimes.com/2011/11/13/opinion/sunday/douthat-the-devil-and-joe-paterno.html

After reading a column like the one Mr. Douthat wrote for today’s paper, I am left wondering if his failings are intellectual, psychological, or both. Since Anna Freud published The Ego and the Mechanisms of Defense in 1937, professional and amateur psychologists alike have had no excuse not to be aquainted with the concept of identification with the aggressor, the role it plays in individual moments of psychic conflict, or how for some it becomes the basis for pervasive aspects of character.

It can be difficult for anyone, when faced with the immolation of a victim by an aggressor, to take up identification with the vulnerable party and not identify with the powerful abuser. This is a human frailty in a moment of stress, and it might make us understand the psychic fortitude it would have taken for Mike McQueary and Joe Paterno to go directly to legal authorities and report a crime where a crime had been committed. We should not, however, engage in the ongoing idealization that Douthat evidences when confronted with the unsalutary effects of this psychic operation as it played out in these men’s behavior. No, it is not in service to higher responsibilities that a usually-moral individual fails the test of siding with a helpless innocent human being who is being violated; it is in fact an identification with the wrong party that leads to this behavior.

When such a pattern of identification is habitual it is evident in sociopathic behavior, and in individuals with such character, actual generosity and sacrifice are rarely seen.

When such a pattern of identification is aberrant, we might understand that it occurred in particular circumstances, where the identification with the aggressor was already strong for other reasons, as it was with McQeary and Paterno and their colleague Sandusky. Such an indentification with the wrong party, morally, might be out of character for an individual. What it is not, as Douthat lamely offers, is in any way a product of heroism, or superior moral character. That idea is an insult to all the individuals who would have made the right choice and called the police.

In the movie Female Perversions, Tilda Swinton plays Eve Stevens, one of two sisters struggling with the effects of growing up in the milieu of their parents’ marriage. In a pivotal scene, Eve is talking with her sister, Maddie (played by Amy Madigan), about events of a particular day in their childhood, which have come up recurrently in her dreams. As she asks her sister about her own memories of that day, she describes the first details as she remembers them: The girls were swimming in a backyard pool while their parents played cards with another couple at a poolside table. Their father got enraged and tipped the table over, causing playing cards to end up in the pool. Later that evening, they witnessed their mother coming out to the living room in her robe to try to soothe their father’s hurt pride. When Eve relates the next events that occurred, she makes a factual mistake, and then corrects herself: Their father struck their mother as she approached him in his chair, and she fell to the floor. Eve says, “And then I went to her;” but stops herself. “No,” she admits to herself and to her sister, “I went to him.” For Eve, her original moment of siding with her aggressive father gives her an important avenue into understanding the way in which this identification became generalized and has plagued her throughout her life.

A number of individuals at Penn State need to ask themselves why they came to the aid of Jerry Sandusky and not the boy he was raping in the shower. I am sure they might find layers of rationalization and denial along with their core identification with the offending party. It is an error we all might fall prone to under the right circumstances of psychological vulnerability. What it would not ever be is a product of too much heroism and its effect on our view of daily events.

Mr. Douthat is free to live in a world where powerful institutions that have his sympathy are deemed to be worthy of moral authority. For the life of me, what I can’t understand is how he contrives to consider himself an intellect worth listening to when he lives in a world that is also doggedly pre-Freudian.

Am I religious? Should anyone care?

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Wherever you go, I will go; And wherever you lodge, I will lodge; Your people shall be my people, and your God, shall be my God. (The Book of Ruth, 1:16)

My husband and I recently bought our first house together. Now, more than ever, we are each other’s family. I not only lodge where he lodges, I pay a mortgage where he pays a mortgage. Our decorating decisions have taken on increased significance in this, our third actual residence together, because having bought the house, there are intimations of permanence where there were once intimations of transience. No longer is there a landlord in our midst whose ultimate ownership of the property might attenuate our ownership of the particulars, down to the size and color of the pillows on the couches. I suppose it is some kind of acknowledgement that we are a mixed-faith couple that the crucifix he bought in Croatia for his late mother and the menorah on our kitchen window sill has each found its place in our home. His people have become my people—a fact never more in evidence than it was last weekend when we flew to Wisconsin to attend the wedding of his youngest cousin, and my 10-year-old son reunited instantly after a year's absence with Jack, his 10-year-old second cousin on my husband’s side. But is my husband’s God, my God, too? One of the reasons I identify with Judaism instead of Christianity is because it leaves room for skepticism about the existence of an afterlife, and it does not consider such skepticism to be the very definition of “lacking in faith.” My sense is that my husband is not a skeptic on this subject, and retains much more identification with the Christian faith in which we both were reared. Whatever disparity there is between us, however, it is not one that causes us consternation.

On the other hand, I hear from my sister that a source of consternation to my 92-year-old Roman Catholic mother is that she might die and go to purgatory. It’s not that she can’t accept that the Almighty might think she has some faults in need of purging—her own righteousness is not a necessary part of her religious views—but instead the prospect that she will need the prayers of the living to help her get to heaven. She fears she’s not inculcated enough of this view in any of the living she’ll leave behind for us to spend the requisite time praying, after her death, for her admission into paradise.

Of this I am fairly confident: The God image that comes to my husband’s mind when he looks on whatever religious symbol he encounters in our home or out in the world is more similar to my image of God than it is to that of my mother, with whom he nominally shares a Christian faith. And this is true even though I identify with the Reconstructionist movement in Judaism most because it holds that God is not supernatural, and puts forth the fairly radical idea that religious traditions as we know them represent not God’s attempt to communicate His nature to man, but instead man’s attempt to articulate the nature of God for ourselves, and therefore that all religious precepts about God are more or less anthropomorphic, and only tenuously Divine. How can I say that my husband’s image of God is more like mine than it is like my mother’s? In the terms of normal discourse on the subject, his view is more like hers: God is supernatural, personal, and intends His own revelation. Furthermore, He created us as individuals for personal immortality. None of this do I share. But it is exactly this normal religious discourse—which would lump my husband with my mother as believers, in contrast to me, in the company of mere humanists—that I would have change.

It has long seemed exceedingly curious to me that so many teachers and leaders who claim for themselves the title of “religious” relentlessly draw a line of distinction between the faithful and the non-believing, when what seems to me much more compelling is the distinction between those who see God principally as strict, jealous, vengeful, and unforgiving and those who believe that any God worth the name must certainly be at least as loving and forgiving as we are at our best. Whether the latter group believes such a God is real or is a fiction, they seem to me to behave more in concert with each other than they do with those who believe in the other, darker God.

Sitting at that family wedding last weekend and listening once again to the familiar Pauline text from 1 Corinthians on the nature of love (Love is patient, love is kind; It does not envy, it does not boast, it is not proud; It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs; Love does not delight in evil but rejoices with the truth; It always protects, always trusts, always hopes, always perseveres) I reflected again on its inspired and wise description of mature and sustaining love. In this letter, Paul attributes anthropomorphic characteristics to God, for sure, and yet seems to think of God as being like us in our best moments, and to see us as created in His image, if only we could refine ourselves into our best selves, not our worst selves.

If my mother’s anxieties prove to be well-founded, it would mean on the other hand that God is a stickler for a game that is played according to arcane rules: She can be admitted to paradise only if enough entreaties come from the living for God to allow it; Mere good will, mere loving intentions would not move Him. It seems to be an image of an omnipotent but capricious Ruler, a “gotcha” God, not at all in keeping with the mature loving attitudes Paul exhorts us to emulate in 1 Corinthians.

It is not to trivialize my mother’s concerns about possible eternal deprivation that I point out that she could take a view of God that made Him even more imperious and peremptory: The news every week is full of reports of religious persons who believe piety demands that the righteous undertake immediate and harsh punishment—in this life, not leaving it to the hereafter—for offenses to Godly ways, from adultery all the way down to the lesser offense (as most of the planet’s population would see it) of dating a boy outside one’s own sect. But even the horrific reality of honor killings committed in the name of the Deity does little to sway the normal discourse about who gets to wear the mantle of faith and piety. What would it take for the dominant contrast drawn in discussions of faith to switch from belief and non-belief to the contrasting outcomes between equating Divinity with vengeance and equating Divinity with love?

What is the supposed importance of confessing belief in God? Could any God at least as loving and mature as the best among us really care? Why would He need it? And if the way we live our lives and treat our fellow man and make our moral decisions were otherwise identical to our belief-confessing neighbor, why would any but a self-preoccupied and most unloving God be hung up on us believing in His existence? Many of the doctrinaire would have us believe that it is faith that makes us moral, and secular existence that makes for amorality or immorality, but evidence is generally to the contrary—there are bad deeds issuing from the believing and non-believing in equal proportion. When the pope decries the secular West, why does the normal media discourse grant him the presumption that he represents piety more than our more liberal, tolerant Christian leaders? It seems to me that we abandon some depth of meaningful discourse when we implicitly accept that a punitive and intolerant view of human sexuality is more “religious” or represents a position of faith more than more tolerant ones. The Catholic hierarchy can say the pope speaks for 1.3 billion believers, and therefore represents the perspective of Catholic faith, except that on the morality of contraception, he clearly doesn’t speak for Catholic believers, since the vast majority disagree with him. The same goes for our habitual equation of Islam with Islamic “fundamentalists.” The very word gives them some presumptive right that is not logically theirs.

What does it matter if false distinctions are commonplace and other, more apt distinctions are lost? I think there is important value to be found in drawing the distinction between a mature spirituality and its immature opposite, for a lot of reasons. One is the evil perpetrated in the world in the name of certainty about a jealous, angry, vengeful, punishing and unforgiving God. Would that we could agree to name and to criticize these evils without having to accede to being the straw man the “true believers” would have us be, namely, an impious lot, who have no regard for Divinity or for morality. The flip side would be the ability to advance peace and human cooperation by positively preaching tolerance and the importance of entertaining sufficient doubt that we can defer damnation and punishment to the Deity, instead of taking them into our own hands. We could advocate addressing conflict in terms of competing interests and an explicit secular and religious consensus about the dignity and rights of the human person, and explicitly advocate that there is sufficient doubt about Divine imperatives for us to leave them out of our plan of action. Philosophers disagree about whether it makes rational sense to believe the human person is sacred if one does not posit the existence of God (see http://opinionator.blogs.nytimes.com/2011/07/17/the-sacred-and-the-humane/), but rational or not, what is empirically true is that atheists are just as likely to value human rights as are believers.

I personally find it hard to imagine that if there is a God, He is less forgiving and loving of my fellow man than I am. That He is less appreciative or capable of comprehending mutuality than the best of us humans. By mutuality, I refer to an idea technically described in psychoanalytic theory, but I think one fairly easily understood by anyone capable of the trait, which is regard for another with empathy and mutual trust, although we fully know they are themselves and are neither a part of us nor in fact just like us—only enough like us for us to know they should be treated as we would like to be treated.

Would most of those who, unlike me, believe that God is personal and that there is individual immortality after death, actually cast their lot with the man who seeks the “honor killing” of his own teenage daughter for dating a boy from another faith, rather than with me? Am I really the one closer to their idea of an enemy of the kingdom of God? If I am not, then let’s begin to change our discourse about faith so we can discuss the distinctions we actually believe are most important, instead of the often-specious demarcation between who is religious and who is secular. Am I a religious humanist or a secular humanist? It is a distinction truly in the eye of the beholder. If a God who is not supernatural is no God at all to you, then you’d say I am secular. It’s an issue of semantics to me, because I believe in my God, who isn’t a God who cares. To you it may be more than semantic. But if you care, have you asked yourself exactly why that is? And is it possible that we could start a discourse that unites us, you and me, against the influence on our world of the darker view of God, the God of our basest anthropomorphic projections, the God who is gratified by suffering and appeased by destruction? I am optimistic and hopeful that we can. We just need to find the words, and more than occasionally the gall to speak them.

Voir Dire: My Day In Court

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When I reported for jury duty this morning, I was fairly certain of the stakes. Last night I’d been surprised that my high summons number didn’t give me a pass on even having to show up, but once I listened to the pre-recorded message from the clerk’s office and adjusted to the news that my presence was actually required, I thought my day at court would play out predictably. I thought the commitment would surely be just for today, and that any chance of being placed on a jury was remote. My one previous experience of being brought into the courtroom for voir dire had ended predictably, with the judge sending me back to wait with the jury pool on the basis of my being a physician, and the case involving physician testimony about injuries to the plaintiff in an accident.

So I wasn’t prepared to feel anything when my number was among those called in a group to go to a courtroom upstairs for jury selection. The defendant looked relaxed—-too relaxed, as though this was just one more spin round the dance floor for him—-sitting next to his attorney at the table. The defense counsel and the state’s attorney were both decades younger than me, as I expected. The judge made mention of the fact that he had been called out of retirement to help clear up the court’s docket, and he looked the part: gaunt, white-haired, his voice a little tremulous. The defendant was charged with theft of a car, unauthorized use of a car, and resisting arrest.

I had just enough prior experience to expect the first question posed by the judge: Had any of the prospective jurors been convicted of a crime, been the victim of a crime, or had family members that were convicted of a crime or were victims of a crime? More than half the jury pool stood. As it turned out, my summons number was at the low end of the group that had been called, and I was first to approach the bench. The attorneys and the defendant all leaned in close to listen to my exchange with the judge.
“State your juror number, your name, and your reason for standing,” the judge instructed us.
“Juror 481," I said, and I gave my name. "I stood because I have been the victim of a crime.”
“Can you tell us, Dr. Hoffman, what that was, and approximately when?”
How does he know I am a doctor? Oh, right, they asked for my profession on the jury questionnaire.
“I was forced off the road and robbed at gunpoint when I was 18. And my car has been stolen three times in Baltimore City since I moved here in 1987.”
“From your residence?”
“Two times from outside my residence. Once from the doctor’s parking lot at the hospital.”
“Anything else?”

I hesitated. Only the group at the bench could hear what I was telling the judge. I had raised my right hand and sworn that I would tell the truth. Did that mean that it had to be the whole truth? Or would merely some of the truth do? I thought of other crimes I’d been the victim of: burglary, twice. Chased through Baltimore's Mt. Vernon Square by a gang of rock-throwing homophobic teenagers, who my companion and I managed to outrun, in my early 30s. Minor assault, a few times, but mostly by mentally ill patients, in care settings. The crimes against me as a child? Not for polite company. Did I continue to elaborate?

No, I did not.

“Those are probably the salient instances, your honor.”
“And do you believe that those experiences will affect your ability to be fair and impartial in hearing this case.”
“No, I do not, your honor.”
“Good,” he said. “You may return to your seat.”

I turned from the bench, and as I sat down among the prospective jurors again, I realized I was welling up with tears. The attention of the courtroom had shifted to juror number 483, at the bench. I put my face in my hands, and wondered at my response to the interaction that had just transpired. I stifled anything like a gasp.

I have often advised trainees in my profession to be prepared for never-ending surprise. Just when you think you’ve seen it all, you’ll see something for which you feel utterly unprepared. You think you’ve seen death in all its forms in front of your eyes, and then you’re bowled over by the miscarriage of a second-trimester fetus in the moments between your helping the patient onto the ER exam table and your return with a bag of saline to start an i.v. You think you’re hardened to the grim possibilities in life and then a seventy-year-old great-grandmother who’s caring for her small great-grandchildren because their mother is a prostitute and their grandmother died of AIDS confesses to you that she herself is shooting heroin into her veins every day.

Even so, I was not prepared for the utterly new dimension for me in today’s voir dire. To stand in front of a judge, to whom I have sworn to speak the truth, and to say “I have been a victim.” And, equally the truth, “I do not think this marks me with a defect in judgment, or fairness, or impartiality.” And then to hear his response: “Good.” No attempt on his part to argue the opposite—-because he did not believe the opposite. True, he was probably gratified that I didn’t try to use the events to wiggle out of jury service, but I do not think, nevertheless, that he believed the opposite.

“Good.” That single word of acknowledgment and affirmation from some old gentleman with the mantle of legal authority resting on his shoulders packed more punch than I could have anticipated.

The contrast to what I have experienced for a lifetime, not only that someone’s criminal act was actually leading to a criminal prosecution, but also the contrast to the usual supposition that I could not be trusted to know if in fact I was a victim, the supposition that if I have been a victim I am too biased to take part in any discussion of the appropriate response to such events, the supposition that someone besides me is whole enough to make sober judgments where I am clouded and irrational, took my breath away.

After the rest of the questions were asked and answered, after three quarters of the prospective jurors left for reasons of conflict or stated bias or wives about to deliver babies at home, I approached the bench first, as my summons number would dictate. The state had no objection to my being seated on the jury. The defense attorney, earning his keep, used a peremptory challenge to thank me for my service and send me home. But I, lowly prospective juror, almost negligible in my importance to this process, left with something I had never experienced before in my life: a whiff of actual justice, rendered to me by a judge in a court of law in the jurisdiction in which I have resided for most of the past 20 years. No one knew it but me, but it was to me that it mattered most. Even a whiff of justice, it turns out, could make me grateful for my day in court.

You have met the gaywad, and the gaywad is me

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Occasionally, I think for a moment that I ought to be less of a curmudgeon. Just momentarily. And then I revert to type.

I suppose I will always see too much wrong with the world to ever truly lighten up about it. I suspect that there’s a self-reinforcing cycle at work here: Because I can tolerate acknowledging and listening to what is painful and unjust in life with compassion and with clear, sober vision, I work successfully in the eye of a human storm of illness, misery, trauma, neglect, and loss. And working in the eye of such a storm, I am never far enough from the painful and damaging aspects of life that I can be carefree about the dangers concealed around life’s every bend.

I had fresh occasion to think about this the other day as I got back on the freeway after dropping my son at camp for the day, and tuned in for a couple of minutes to the morning show banter on a popular local FM station. It happened to be the day after Judge Vaughn Walker issued his heartening ruling in the Proposition 8 case, and I had stayed up late to read it in its entirety. The juxtaposition of Walker’s thoughts with the ribbing going on among the twenty-something jocks on the staff at my son’s camp and the repartee of radio personalities was like driving down the highway on a pleasant day and catching a sudden whiff of road-killed skunk: visceral, impressive, timeless.

So here’s my curmudgeonly gripe for the day: I do not wish to lighten up about the generations that follow mine--the one that coaches at my son’s sports camp, for instance--who use the terms “gay,” or “gaywad” and the like, as terms of derision for what is weak, lame, dorky, or otherwise undesirable. And I don’t want to give media personalities a pass when they use the term “retard” to characterize what’s foolish or gauche--even if it’s a term I used myself as a child--and when they engage in sexist rants about women, or men, or vent their spleen about the idiosyncratic ways of recent immigrants. Oh, I know the defense…it’s just joking, not serious; “gaywad” really isn’t about gay people.

I learned from Erik Erikson years ago that a normal part of identity consolidation during development is the forceful rejection of alternate identities; that 8-year-old girls and 8-year-old boys think all things about the opposite sex are disgusting for reasons that are developmentally necessary for gender consolidation, and are ultimately benign, in their place. But I have gradually come to a firmer and firmer conclusion that spiritually we all need to grow--and those who conceive of themselves as spiritual leaders ought to lead us--beyond the collective expression of our 8-year-old selves. There are many objects of scorn that we deride (joking or not) as hated and inferior “others” which qualitatively are in fact merely “other”—not deserving of hate and not in any demonstrable way inferior to or less deserving than anyone else. The luxury of deriding them is a regressive pleasure, and I realize it is possible to be too uptight about this, just as it’s possible to be too uptight about poop and dirt. But I’d like to make the case that not being censorious enough about it, not aspiring sufficiently to an ideal of transcending it, carries the potential for needless harm and sometimes tragic harm. Which is why I think it’s more incumbent on spiritual leaders than say, handball partners in the locker room, to call forth from us our better angels rather than to demagogue our pre-adolescent hobgoblins.

I know I have spent my life especially attuned to the phenomena of scapegoating and stereotyping. I have never readily identified with the pleasure in generalizing about women and men, husbands and wives, breeders and homos, Latinos and Jews and WASPs, lawyers and doctors and construction workers. I realize that the attraction is there. I just found it much more likely, for example when visiting the U.S. Holocaust Museum for the first time, that I’d identify with the position of Jews as targets of Nazi propaganda: There but for the grace of God, I thought, go I. The Nazis had their following, and Pat Robertson has his.

I think that especially those who purport to guide us to our higher selves should chastise us for the derision we heap on someone, anyone, whose principal transgression is being unlike us. It’s sometimes the opposite sex, sometimes another ethnicity, sometimes a different cultural group. (If you lack the imagination to think of the particulars, you can always rent Oliver Stone’s film version of Eric Bogosian’s Talk Radio for a compelling litany.) But too often the purported spokespersons for spiritual enlightenment, the ones who demand and get attention from the media for their supposed representation of righteousness, are those most entrenched in demonizing those outside their own little group.

When these demagogues engage in labeling my set of sensitivities as “political correctness,” my limbic system is kicked into overdrive. It’s in that moment I’m most able to comprehend outbreaks of civil war. I frequently think, but never actually say, that when armed conflict breaks out between threatened white people in America and the brown and black people they see as the enemy, or between those who want a Christian theocracy and the infidels and nonbelievers who resist, I have no doubt that I will take up arms, and whose side it will be for. But in the interest of avoiding a recurrence of civil war, and promoting civil accord, I truly wish that those who self-identify as spiritual leaders of every stripe would embrace the wisdom in guiding us toward the light--which is to say, away from the regressive pleasure we take in deriding the people unlike us as inferior, wrong, ridiculous, and--more than anything else--as a danger and a threat to us and our security.

This was the most welcome aspect for me of Judge Vaughn Walker’s decision in Prop 8: He spoke directly about the lack of evidence for the often-repeated assertion that marriage for gay men and lesbians will undermine marriage for heterosexual couples. He puts this fantasy squarely where it belongs—in the realm of imaginary goblins. It is an assertion that belongs alongside the idea that fighting next to black men will demoralize white troops, that admitting women to the study of medicine will destroy confidence in the healing power of the profession, that the afflicted and the damaged should be hidden away from public view in asylums in remote small towns. He clearly articulates that this particular religious dictum is not the basis for distinctions in law. I would go one step further, and say what was beyond Judge Walker’s task in deciding this case, which is that this kind of religious thinking is lacking a mature psychology, and therefore a mature spirituality. It is religion far too ill-acquainted with the better angels of the human spirit. All of us would be better off if CNN, when they went to find spokespersons for people of religious faith, made it their practice to quote less regressive religious thinkers. This would be contrary to their own instinct to find conflict and drama in current events, but sometimes there’s virtue in less conflict, and more conciliation.

There is the famous Martin Niemoller quote that starts, “First they came for the communists, and I didn’t speak up, because I wasn’t a communist. And then they came for the Jews, and I didn’t speak up, because I wasn’t a Jew….” I happen to be of the opinion that Niemoller’s warning is one we need to hear in every time, and every place, as long as there is a human condition. The grownups need to chide the children for their uncivil impulses. In the words of Paul in 1 Corinthians: "When I was a child, I spoke like a child, I thought like a child, I reasoned like a child. When I became a man, I gave up childish ways." It is no coincidence that this line comes in the middle of a discourse on the nature of love. While it is cited most often at weddings, and therefore has become associated with romantic love, I think it would be a breath of fresh air to hear it cited as a guide for civic life. The planet urgently needs us all to love our neighbor. The idea that “he who is not like me must be derided in the interest of my security” is childish. Understandable, and childish.

I sometimes wonder--has Pat Robertson (or James Dobson or Cardinal George) actually read his own New Testament? If he did, he didn't hear it saying what I heard it say.

The Real Men Who Eat Quiche

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I have no desire to have the pope rise (or is it fall?) to the status of personal pet peeve. I am not his constituency, and he is not my leader. I could agree to live and let live. To the extent that he chooses to make the cultural forces of "the secular West" his enemy, and by decree, the enemy of his church, he is free to do so, and I will be one who agrees to wear the label of "secular Westerner."

My attention, however, is drawn to him and his pronouncements at those moments when he is making of secular Westerners a straw man, which it turns out he does quite inveterately.

In just his latest international outing, in Portugal, he said that "politicians, intellectuals, and communications professionals" profess and promote "a monocultural ideal, with disdain for the religious and contemplative dimension of life." So one has to be an atheist and unreflective to value the separation of church and state, or religious tolerance in the public sphere? while interreligious violence continues frequently to be the story they are reporting?

After writing recently about the Catholic Church and its ongoing sexual abuse scandal, I found myself fortunate to have a larger readership and to elicit more comment than my writing has ever previously enjoyed. To my surprise, my post was liberally copied and posted to other blogs, regional newspapers, and special interest websites. Among the comments were any number based in assertions that the Catholic Church continually puts out to the world--Rome's talking points, you might say--which unfortunately convey the distortions about secular people and those outside the Catholic Church that this pope has enunciated for the past several decades.

It seems important for a number of reasons to push back against what is not in fact a matter of divergent belief or values but rather simply untrue in these assertions. Untruth repeated over many years and never challenged becomes accepted as common knowledge or as consensus, when other points of view have the virtue of greater basis in the facts.

One of the pervasive refrains coming out of this pope and his apologists is that those who deviate from the church's "truth" are advocates or representatives of relativism, when this is not the case. There are among us the most serious of ethical thinkers. We are in fact mostly more Aristotelian ethicists while the pope is a more Platonic ethicist. We think that virtue lies in avoiding two dangers, relativism at one end and absolutism on the other. In Aristotle's Nicomachean Ethics, virtue lies in the Golden Mean, between two less desirable extremes, deficiency and excess. For Plato, virtue lies in the pursuit of ideal form, which lies in another world, and which the world we know can only approximate in a very imprecise way (Plato's exact simile was that this world only roughly approximates ideal forms in the way shadows cast on the wall of a cave by figures in front of a fire only roughly resemble the figures that cast them.) The pope is more of an ethical Platonist in that he thinks what God demands morally, instead of any pragmatic balancing, is adherence to what might be envisioned as the ideal.

To an absolutist, anyone who doesn't agree with him is a dangerous relativist, and the hierarchy indulges frequently in drawing a caricature of those who don't share their view as proponents of "anything goes." The accusation that those who disagree with the pope think that morally "anything goes" is not at all intellectually honest; we are mostly not libertines or anarchists, we are just some variety of ethical Aristotelian where he is an ethical Platonist. We think there are dangers in the elevation of the absolute to a sacred position and the disregard, or at least the de-emphasis, of the pragmatic good. We think condoms used in the service of saving life in the midst of an AIDS epidemic easily trump an ideal of all sexual acts being open to procreation, and we think the elevation of that ideal over the actual sum of its effects in the world here and now is an example of cruelty born of absolutism.

Natural law theory of the Scholastic period claimed to carry the mantle of Aristotle while in fact building mostly on Platonism, with the assertion that God's intended purpose for man--the other-worldly ideal that Plato said was projected dimly onto our current worldly existence--could be ascertained rationally from the evidence available to us--a sort of approachable limit, to use an analogy from calculus that helps unify Plato's conception of the world as dimly lit with a religious quest for moral certainty. Plato exerts a great deal of pull on Christians, who are attuned to the scriptural words of Jesus about his Father's otherworldly house where he was going to prepare a room for them. Yet even ethicists more sympathetic to Plato than to Aristotle would question whether new evidence is allowed to change, over time, our conclusions about the laws nature reveals. Is modern psychology allowed to have a say about man's transit on this Earth, or are we locked into what Thomas Aquinas knew in 1274? The Catholic Church, unlike fundamentalist Protestantism, at least allows that God's revelation to man is ongoing, rather than privileged to the words of holy scripture. But the two are similar in raising a cry of heresy or relativism when anyone attempts to stretch the outlines of tradition to accommodate new conclusions about the rightful purpose of man. The differences between an Aristotelian approach to ethics and a Platonic or Scholastically-adapted Platonic one should not be minimized. The conception of the good lying in the middle between extremes is in fact opposite to a concept of the good lying in an ideal that exists at a far limit. What it is not is an assertion that "anything goes."

It is ironic that the charge of relativism should come up in the midst of a discussion about the church and the scandal of sexual abuse. It takes a fairly tin ear not to hear that the more absolute moral censure of pedophile priests is coming from the church's critics, who are less willing than the hierarchy or the Congregation for the Doctrine of the Faith to balance an old priest's desire to "die with the dignity of his priesthood" against the cry of his victims for justice or even for significant consequences. Perhaps the hierarchy is truly surprised to find itself in a struggle for the upper hand against critics who take it to task for it's moral failures while maintaining a tolerant attitude themselves toward some things Rome ever since Aquinas has seen as outside of natural law. But the argument put forth that the critics of the church's response to the sexual abuse crisis are ultimately looking to score points for their permissive and indulgent world view because this pope has castigated them for the last three decades is an astonishing bit of sophistry that is fairly insulting to the victims of clerical abuse. Just maybe, they're actually ticked off about the way the effects of the abuse have been persistently and pervasively minimized. Blaming their critics for being relativists is so habitual for this church leadership, it doesn't matter how poorly their canard fits the situation at hand.

While the pope makes of secular Westerners a straw man, he mostly makes of homosexuals a bogey man. His assertion that children raised by a gay couple would be subject to a "great violence" because "their condition of dependency would be used to place them in an environment that is not conducive to their full human development" is supported only by tautological arguments (gay parents cannot promote full development because only heterosexual couples can promote full development). After meeting privately with newly elected Pope Benedict XVI in 2005, Cardinal Alfonso López Trujillo, at that time President of the Pontifical Council for the Family, said of gay couples, "In these unions there are no promises for the partners or for the children, no stability, nothing before society or God, but they demand all the benefits of authentic marriage." This fervent derision is unfortunately impervious to actual evidence. Turn on the light, open the closet doors, look under the bed--homosexuals are still the bogey man because Benedict and his friends say we are.

Meanwhile, the general public for the most part decides, once they actually know gay people, that gay people are frighteningly...well, a lot like them. Justice Lewis Powell joined the majority of the United States Supreme Court and provided the swing vote in the 1986 Bowers vs. Hardwick decision, in which Justice Byron White, writing for the majority, stated that any claim that a right for homosexuals to engage in consensual adult sex in the privacy of their own homes is implicit in the concept of ordered liberty is, "at best, facetious." Four years later, retired from the court, Powell described his vote in that case as "probably a mistake." What religion did he get in the short intervening span? It may or may not have been the experience that converts so many to the view that homosexuals are deserving of equality, which is first-hand experience with particular individuals who are gay.

I harbor some degree of utopian fantasy (I am not deluded into thinking it's anything else) that the pope could not maintain his perspective and say the things he does if he actually came to know me, the life I live, and the work that I do. At a formative age, I really took to heart Thomas Merton's writings about contemplation as the way to give action depth, and action as a means of giving expression to contemplation. My ideas about God and church changed, but I hardly became materialistic or pursued a life lacking in meaning or in hope, as the pope would have us believe about secular people. And in my chosen line of work I have learned, sadly, a great deal about environments not conducive to children's full development--they exist in such abundance that one does not need to go looking for them where they don't exist. There is enough true evil and horror in the world, one does not need to populate it with fictional bogey men. But alas, to Benedict, a straw man and a bogey man are what I remain.