“I do not respect an inconsistent critic.”

The renewed discussion of pseudonymity in my blog circles has again sparked my interest in the history of pseudonyms. Searching for writing on the subject, I quickly came across Carmela Ciuraru’s 2011 Nom de Plume: A (Secret) History of Pseudonyms. It’s not exactly what I was looking for – a history of pseudonym use by a variety of people writing publicly about politically charged subjects.* It focuses on a selection of 19th- and 20th-century literary authors who wrote under pseudonyms.

So far, I’ve only read the first chapter, about Anne, Charlotte, and Emily Brontë writing under the ‘nyms Acton, Currer, and Ellis Bell. I enjoyed it quite a lot. One bit stood out: Ciuraru describes the positive critical and public reception of Jane Eyre, and continues

There came an inevitable backlash – among other things, the novel was said to be coarse and immoral – but those reviews were drowned out by the praise. (Some critics wanted it both ways: The Economist declared the novel a triumph if written by a man, ‘odious’ if written by a woman.)

The same book!

Ciuraru includes some great quotes from Anne and Charlotte Brontë challenging this pernicious double standard, including Charlotte’s letter to the critic George Lewes, who insisted on evaluating her work based on her gender (“I wish all reviewers believed ‘Currer Bell’ to be a man. They would be more just to him”), stating that she would rather recede into obscurity than have to write always seeing her work through the lens of her perceived role and character as a woman. I also found online, from the introduction to the third edition of the Norton Jane Eyre, this response from Charlotte to the reviewer at the Economist and others of similar mind:

To such critics I would say – ‘to you I am neither Man nor Woman – I come to you as an Author only – it is the sole standard by which you have a right to judge me – the sole ground on which I accept your judgment’.

The sisters were perpetually fearful of being “outed” and left without the protection and freedom (social, psychological, and creative) afforded by their pseudonyms. If it weren’t for the pseudonymous Bell brothers, their voices would probably be lost to literature.

* As Ciuraru briefly describes (without references, unfortunately), the use of pseudonyms has spanned the centuries. Judging from Marcus Daniel’s Scandal & Civility: Journalism and the Birth of American Democracy, pseudonyms were widely used in the Revolutionary era in the US, and many appear in Harriet Ritvo’s The Animal Estate: The English and Other Creatures in the Victorian Age.

Neurosis and Human Growth: The Novel

I read Richard Yates’ 1961 novel Revolutionary Road



just after I posted about Karen Horney’s work. It was coincidence – a couple of people had mentioned it in other contexts – but it so powerfully illustrated Horney’s ideas that it seemed almost the novelization of her thought. (One of many, to be sure.)

Also coincidentally, the 2008 movie, in which I hadn’t been particularly interested prior to reading the book, happened to be on TV just after I’d finished it, so I watched that, too. It wasn’t bad. It has to be difficult to adapt such a psychological novel to film,* and I feared intrusive voiceovers. Fortunately, the movie relied on dialogue carefully selected from the book to convey the characters’ thoughts, although of course it couldn’t fully capture the novel’s richness. It also stayed true enough to the book, and didn’t try anything too gimmicky. On the other hand, if I hadn’t read the book first, I’m not sure if I would have found the film satisfying; it’s easy to read the internal dialogues from a book into a movie, especially when you’ve read it recently.

* This wasn’t really a problem with the character of April Wheeler, played by Kate Winslet. Since the novel isn’t told from her point of view, her thoughts and motives have to be ascertained from her words and actions even there.

#pharmaban

Something very interesting is happening at the British Medical Journal. Last year, the editors made the wise and principled decision to stop publishing studies funded by tobacco money. In the discussion that ensued, Richard Smith, former BMJ editor, asked: “So will the editors stop publishing research funded by the pharmaceutical industry, and if not why not?” (Adding snarkily: “Knowing the heavy financial dependence of journals on the pharmaceutical industry, I shall be looking for sophistry in the explanations.”)

In a surprising (in my view) move, the journal has decided to feature a debate on the subject, with Smith and Peter Gøtzsche arguing that pharma-sponsored studies should be banned and current BMJ Open editor and BMJ head of research Trish Groves arguing against such a ban.

The arguments for a ban are very strong – unassailable, really, particularly if you favor the tobacco-studies ban.* Smith and Gøtzsche open their argument:

The BMJ and its sibling journals have stopped publishing research funded by the tobacco industry for two main reasons: the research is corrupted and the companies publish their research to advance their commercial aims, oblivious of the harm they do.1 But these arguments apply even more strongly to research funded by the drug industry, and we suggest there is a better way to communicate the results of trials that would be safer for patients.

They go on to provide concrete evidence, of which there’s an overwhelming amount, of the corrupt and harmful nature of commercial drug and device research and publication. They also offer concrete suggestions for alternative means of developing and communicating clinical trials.

Groves’ response isn’t much of anything, as it doesn’t address the information provided in Smith and Gøtzsche’s statement or make a convincing case against a ban. In fact, even without acknowledging some of their evidence she admits some facts that help the case for the ban (“Only about one in 10 newly approved drugs substantially benefits patients”; “How much can we trust the evidence base for drugs in current use? It’s hard to tell, given the woeful legacy of widespread non-registration, non-publication, and selective reporting of clinical trials”). Most significantly, she doesn’t - because she can’t - successfully contest the similarities between pharma and the tobacco industry that form the basis of the argument for extending the ban.

I should quote a couple of sentences, because I found them telling. Groves asserts that “The drug and tobacco industries, notwithstanding the inescapable fact that both are out to make money, have very different aims.” This of course isn’t so. The first part of the sentence tells the important story. Corporations in both industries are out to make money, and the drugmakers’ history of behavior and the harms they’ve caused show clearly the dominance of this orientation.**

The argument that drug companies (or agribusiness or food manufacturers or the fossil fuels industry) specialize in products related to human needs and therefore should be treated more generously than the tobacco industry, looked at from another angle, is actually quite perverse. The extensive evidence that pharma engages in the same damaging practices as corporations in all industries is reason to argue that for-profit companies should not be involved in medicine. The interest in making money is so rarely coincidental with public health needs, and so often opposed to them, that it’s plainly naïve to think that such a system is ideal or even acceptable. Our health is far too important to be entrusted to a system in which commercial motives play a role.

This issue of trust is central. It’s not that drugmakers are less trustworthy than corporations in other industries – they’re all equally untrustworthy. But people have to trust in medicine to a greater extent than they do in other realms. People don’t have the time or resources or expertise to evaluate thoroughly every piece of advice or prescription given or device used on them or their children. They have to trust to a great degree in government agencies and regulators, doctors, medical organizations, scientists, universities, patients’ advocacy groups, and, yes, medical journals to have their interests – and the interests of scientific medicine - at heart.

Currently, that trust is misplaced. I’ve been arguing for years that corporations have no place in medicine (or anywhere else, for that matter, but especially in medicine). But even those who disagree with that position can surely recognize that the fact that these corporations are making and selling drugs that are going to be prescribed to people means that others involved in medicine have not a responsibility to be more trusting but a heightened responsibility to put in place strong safeguards to protect people.

Right now, drugmakers pay billions in criminal fines for actions resulting in widespread suffering, death, and waste; meanwhile, they’re allowed not only to participate in the system but to wield enormous influence. Pharma involvement with medical publishing is clear and demonstrated,*** and it harms not only medical science and real human beings but the journals themselves. Groves asks:

[A]re we editors afraid or unable to extend the ban to pharmaceutical research because our journals receive advertising, reprint, and some sponsorship income from the drug industry (www.bmj.com/about-bmj)? No; that’s not the reason. As Fiona Godlee, the BMJ’s editor in chief, said in her response to Richard Smith’s challenge, ‘If these efforts do not soon bring about a necessary sea change in the way industry funded trials are performed, the BMJ may well decide to stop publishing them. Whether an editor would survive such a decision is a question I may have to test’.

Journals can continue to support (“encourage,” “welcome,”…) wider reforms and efforts to increase transparency, but they shouldn’t hang around waiting for those reforms to take or have effect. Like the tobacco ban, a ban on pharma-sponsored studies, which could be revised or loosened in response to any other reforms enacted in the future, is an action that journals can take right now to defend and support medicine, science, and public health. It wouldn’t only be an effective act but a display of integrity that could potentially inspire other organizations to stop talking about hypothetical reforms and to take similar concrete steps.

IMPORTANT: If you’re on Twitter (which I’m not) you can “Join the authors live…to debate the issue on 21 January, 1200-1230 GMT at #pharmaban.

* The parallel isn’t strictly necessary to the case for banning pharma-funded studies. Even if, for some reason, you rejected the ban on publishing tobacco-funded studies, you could still accept the pharma ban on the basis of the evidence in this case alone. The most consistent position, of course, is to refuse to publish research funded by for-profit corporations or their agents in any industry.

** While the tobacco industry makes harmful products, Groves argues, “[t]he drug industry makes and sells products aimed at improving health.” As a commenter points out, this “could read ‘“marketed as” improving health’, as tobacco once was” [my emphasis – SC]. It’s astounding and very suggestive that a medical journal editor could publicly state something this ingenuous. The drug industry makes and sells products aimed at making money. Groves goes on to quote Gro Harlem Brundtland from 1999: “A cigarette is the only consumer product which when used as directed kills its consumer.” “Whatever your concerns about the drug industry and the safety of drugs,” she insists, “you’d be hard pushed to make the same allegation.” But this is utterly bizarre: Smith and Gøtzsche provide clear evidence of pharma products used as directed killing large numbers of people in the very piece to which she’s responding.

*** One of Groves’ more casual remarks is symptomatic of how far the pharma-corrupted perspective has penetrated medical science. She offers some suggestions for potential reforms from Garattini and Chalmers – none of which involves the journal directly – that would need drug company cooperation. She then explains why such reforms might be agreed to: “More openness could help to transform the drug industry’s image and performance, they say, and perhaps in return governments could extend patent time.” The notion, expressed by a medical journal editor, that governments should offer corporations that have been acting like criminal organizations for decades anything – much less extended patents! – “in return” for abiding by basic standards of scientific integrity, decency, and legality reveals the depth of the problem.

A blowfly goes into a bar...

Read the article for the punchline (how I love puns).

Karen Horney and Stalin’s institutionalized neurosis

Karen Horney’s Neurosis and Human Growth



is one of those rare books capable of fundamentally transforming your understanding of the world. Horney’s work is also sadly underappreciated today,* even more so than Erich Fromm’s – added to the reflexive dismissal of anyone or anything connected to Freud (even of those like Horney who themselves came out against the most problematic aspects of Freud’s arguments, at a time when it was professionally difficult to do so) there’s the fact that she was a woman.

But the undeniable light her work can shed not just on individual psychology but on culture and politics has been appreciated by some. Recently, I ran across “Memoir of a Stalin Biographer” by Robert C. Tucker, published in 1982. As the essay’s title suggests, Tucker is best known for his three-volume biography of Stalin, of which two volumes were completed before his death in 2010. In this piece, he describes how reading Neurosis and Human Growth while living and working in Stalinist Russia led him to conceive the hypothesis that Stalin was an example of a neurotic personality, institutionalized in the political system. He offers a nice summary of Horney’s arguments (which, of course, doesn’t begin to do justice to the richness and nuance of the book):

Horney's subject was the ‘neurotic character structure’. To summarize the core of her argument, a person who experiences ‘basic anxiety’ resulting from adverse emotional circumstances in early life may seek and find a rock of inner security by forming an idealized self-image. Its content will depend upon the direction the child takes in relations with others -- moving against, toward, or away from them. For example, one whose tendency is to move against others may idealize himself as a great warrior, while one whose tendency is to move toward others may imagine himself as saintlike.

Gradually and unconsciously, if the anxiety-causing conditions do not change, the child moves from self-idealizing to adopting the idealized image as his real identity. Then the energies available for growth toward self-realization are invested in the quest to prove the idealized self in action. Horney calls this the ‘search for glory’.

Because the idealized self is absolute -- free of the faults, blemishes, and limitations that go with being human -- it can't be actualized. Hence, the individual begins to feel estranged from, and to accuse, hate, and condemn, the fallible, merely human ‘empirical self’ that he proves to be in practice. The drive to enact the idealized self is, however, compulsive, with extreme pain of anxiety and self-condemnation as the price of failure.

Consequently, the by now inwardly conflicted individual develops a system of unconscious defenses against the experience of failure. These include repression of the disparity between the idealized and empirical selves; various forms of rationalization; the seeking of affirmation of the idealized self by significant others; and the projection upon still others -- who can realistically be condemned and combated -- of both the repressed faults and the self- hatred that they arouse.

Repressed self-hatred is then experienced as hatred of others. The particular others on whom it is projected are likely to be those who have incurred the neurotic person's vindictive animosity by somehow failing to affirm him as the idealized self that he mistakenly takes himself to be. A ‘need for vindictive triumph’ is, therefore, a regular ingredient, according to Horney, of the search for glory, especially in those who have a tendency to move against others in a drive toward mastery.

Tucker continues:

When I was reading and rereading this book, my work consisted in directing a translation bureau operated cooperatively by the British, American, and Canadian embassies. It produced a daily bulletin of complete or condensed translations into English of articles selected by me from eight Soviet daily papers, and separate translations of articles selected from periodicals ranging from the Central Committee's monthly Kommunist to Soviet journals on history, law, philosophy and the arts. Because my Russian wife, Eugenia, whom I had married in 1946, was not given an exit visa to enable her to accompany me back home, I was, so to speak, serving an indefinite sentence in Moscow.

What would one day be called the ‘cult of personality’, with Stalin as the centerpiece, was at its zenith. Unlike Orwell's Big Brother, Stalin really existed. But he was a recluse and hardly ever appeared in public save for the parades in Red Square twice a year, May Day and November 7. Nevertheless, a heroic portrait of him, usually in generalissimo's uniform, appeared almost daily on the front pages of Soviet newspapers, and in a myriad other ways he symbolically figured in Soviet public life as an object of reverential tribute.

Two years earlier, in 1949, the cult of Stalin had reached a climax in the celebration of his 70th birthday. This amounted to what can only be described as his virtual deification….

One Saturday afternoon in 1951 I had been browsing in the Academy of Sciences bookstore and was walking down Gorky Street toward the U.S. Embassy on Mokhovaya. In full view below was Red Square and, off to its right, the Kremlin. It may have crossed my mind that Stalin was at work there. Suddenly the thought occurred to me: What if the idealized image of Stalin appearing day by day in the party-controlled, party-supervised Soviet press was an idealized self in Horney's sense?

If so, Stalin must be a neurotic personality as portrayed in her book, except that he possessed an unprecedented plenitude of political power. In that case, his personality cult must reflect his own monstrously inflated vision of himself as the greatest genius of Russian and world history. It must be an institutionalization of his neurotic character structure.

So this Kremlin recluse, this ruler who was so reticent about himself, must be spilling out his innermost thoughts about himself in millions of newspapers and journals published in Russia. He must be the most self-revealed disturbed person of all time. To find out what was most important about him there would be no need to get him onto a couch; one could do it by reading Pravda, while rereading Horney! I began to do just that, and in the process grew more convinced of my hypothesis….

As Tucker goes on to describe, he tried to be conscientious about respecting the uniqueness of the subject rather than simply trying to illustrate a conceptual framework: “Instead of dealing in such abstract categories from a book of psychology,…I was now using that book as guidance in a biographer's effort to portray his subject as an individual.”** (I haven’t yet read the biography, so I can’t attest to how successful he was.) This is perfectly in keeping with Horney’s own views; she regarded her categories and types as useful heuristics that shouldn’t be imposed on individuals but used to guide the understanding of their psychology as it came to appear from the evidence in each case.

This doesn’t mean, though, that Horney’s concepts don’t have great applicability for understanding cultural and political dynamics and how individuals are formed in conditions of oppression. They’re potentially extremely useful for understanding political cultures and social movements as long as glib extrapolations and identifications aren’t made between individual psychology and cultures, institutions, and systems. Horney wasn’t a revolutionary, but her ideas have revolutionary possibilities.

* A telling illustration of how dismal the situation is: last year, the head of the Karen Horney Clinic, Henry Paul, published a book entitled When Kids Need Meds.

** It’s noteworthy that in his discussion of how his loathing for Stalin grew in proportion to his knowledge of the man and his actions, he emphasizes Stalin’s use of torture (called by the euphemism “physical pressure”):

Khrushchev testifies in the secret report that on January 20, 1939, Stalin dispatched a coded telegram to high party and police officials throughout the country saying that ‘physical pressure should still be used obligatorily as an exception applicable to known and obstinate enemies of the people, as a method both justifiable and appropriate’. This is amply documented by other sources. ‘Physical pressure’ meant torture. Stalin was determined that those labeled enemies must be tortured. If, as I believe, the worst of human vices is cruelty, this man may have been the most vicious individual ever to wield power. Certainly he was one of them.

Even while the US government installed, funded, trained, and supported governments who systematically tortured presumed “enemies,” Tucker could still assume the reference to torture would be seen by a US readership as an indication of extreme cruelty and viciousness naturally to be greeted with the utmost contempt.

Near the other vultures

From Virginia:

Town manager Chris Lawrence tells The Roanoke Times that more efficient methods are being considered for the vultures' return next year.

The town could apply for a federal permit to kill one vulture. The remains would be hung near the other vultures.

Lawrence says the vultures would disperse because they don't like to be around their own dead.

I have no idea whether any of the claims in this story is true. The attitudes are important.

Winter fog

Review of Cracked by James Davies

So I’ve now read James Davies’ Cracked: The Unhappy Truth about Psychiatry



While I’d read the Amazon sample and the chapter available at Salon, I was wary of the book because of some of Davies’ writing about suffering that I’d found online. I’d read several similar books, and didn’t want to waste my time on one contrasting biopsychiatry with some “positive” Christian vision. My concerns were eased sufficiently by Davies’ response to a review of the book by Andrew Solomon for me to take the time to read it.*

Cracked covers a lot of the same territory as other recent books critical of biopsychiatry and corporate psychopharmacology. In fact, Davies, a British anthropologist and psychotherapist, interviews several of the authors whose works I’ve discussed here - Irving Kirsch, Joanna Moncrieff, Pat Bracken, Ethan Watters,… - as well as some other interesting people (e.g., Paula Kaplan, who describes her opposition to the insertion of Masochistic Personality Disorder in the DSM-III). He also talks to the heads of the DSM-III and –IV task forces, Robert Spitzer and Allen Frances; former president of the APA and director of NIMH, Herbert Pardes; and Sue Bailey, current president of the Royal College of Psychiatrists; among others.

The interviews are probably the book’s best contribution. Davies asks the right questions, and receives some shockingly candid answers. He does a good job of recreating his own stunned reactions to the admissions of some of the top figures in psychiatry about the scientific vacuum at the center of the model. I knew about this going in, and even about the extent to which it’s acknowledged, but I was still taken aback when reading some of their statements.

I think this is why I’d probably now recommend this book first to people who haven’t yet read much or anything on the subject. Biopsychiatry’s basic premises are so widely accepted that when we’re first confronted with the overwhelming evidence against them we’re incredulous. “The chemical imbalance thing isn’t true?! Surely you mean it’s just part of the story…” After the reality has sunk in, though, it becomes easy to forget how new and strange and dubious this all sounds to those who haven’t seen the evidence. So Davies’ narrative inclusion of his own surprise and disbelief as he gradually discovers the reality about biopsychiatry could help people to be more open to learning about it.

Most shocking, of course, is how little biopsychiatry and psychopharmacology have to do with science, and how they in fact use the language and appearance of science to hide what’s really going on. The creation of diagnoses through voting and consensus and in response to corporate or social pressure, the secrecy, the manipulation of research, the suppression of data, the constant claims of future scientific vindication, the ignoring and spinning of unwelcome findings, the arguments from authority and popularity,… - none of this has anything to do with science, except to provide an example of what science is not. Ben Goldacre suggests that his arguments about the corruption of medicine by pharmaceutical corporations are general and not specific to any specialty, meaning that in theory it’s all redeemable through reforms. But biopsychiatry is special. There’s no scientific core to corrupt – as Davies’ and so many other works show, and as so many of the field’s leaders admit, it’s fraudulent at its very heart.

Cracked is, like several other books I’ve talked about here, primarily a critical work about biopsychiatry and psychopharmacology. And of all of the books and articles I’ve mentioned, it provides the best overview, synthesizing the other arguments and evidence within a general framework (another reason to recommend it to someone new to the topic). But, like so many others, Davies also devotes some of the book to the social and historical meaning of the rise of biopsychiatry and to advocating constructive paths beyond it.

As I’ve said, I don’t think this is necessary or that writers should feel obliged to provide it. In this case, though, despite the wariness I mentioned above, I was hoping for it. Since Davies is an anthropologist, I thought anthropological insights – about people in the field/industry itself and about its relation to the rest of the culture - would be the book’s most original and distinguishing feature. As it turned out, if I hadn’t known of his profession before I read it, I’d never have guessed it from the content. Though the discussion was interesting and my worst fears weren’t realized, it offered little beyond what others have said elsewhere.

The better aspects are found in the more critical portions. When it came to alternatives, though, the section was fairly disappointing. Davies’ general take, like that of several of his interviewees, is that (bio)psychiatry had filled the void left by the destruction – intentional or otherwise - of older social, especially religious, myths about the world, well being, and suffering. While this is true in one sense, his presentation suffers from two significant flaws. First, he mentions but then proceeds to ignore an entire tradition of secular political-humanist-liberation thought. He seems to be influenced by Jung (and some other strange choices), but where’s Erich Fromm? Where’s Ignacio Martín-Baro? Karen Horney? Albert Camus? Where are the anarchist, socialist, feminist, existentialist, anticolonial, environmental, and animal liberation thinkers who’ve written about these questions?

This picture of traditional-myths-versus-modern-pseudoscience gives the impression that our choices are pretty narrowly circumscribed,** which in turn can lead to fearfulness about rejecting the traditional myths. And Davies steers very close to the idea that psychological arguments are to be respected and valued not on the basis of their correspondence with reality but according to their presumed individual or social usefulness - not “is it true?” but “Does it help someone feel better and/or lead to positive individual or social action?” This is an argument I roundly reject, in this as in all other areas.

On top of being unnecessary (because reality-based alternatives exist!) and just plain wrongheaded, the instrumental attitude toward myth and falsehood undermines the critique of biopsychiatry at the center of the book. The same arguments with which Davies responds to those who would criticize him for calling people’s attention to the placebo mechanism of so-called antidepressants or to the pseudoscientific nature of biopsychiatry more generally could be turned against him: If it helps people, why shouldn’t they accept it? Furthermore, it provides ammunition for the stupid argument about how we need to continue to prop up biopsychiatry because its collapse would usher in a relativistic chaos in which any understanding of psychological distress – even other harmful, oppressive, reactionary ones – would have to be considered valid.

Despite these issues, though, Cracked as a whole is very worthwhile, and, like I said, I would put it at the top of the list for people interested in but not yet familiar with scientific (and social) criticism of biopsychiatry. It’s a good general, synthetic book, and very readable without being oversimplified. His personalized narrative should make the arguments more approachable, and the interview portions make it all the more interesting. At the end of the book, Davies describes asking Peter Breggin about how positive change will come about:

‘I think we need braver journalists and authors, dissident psychiatrists and psychologists’, answered Breggin. ‘This has got to be an educational movement, a political movement we need grassroots disillusionment among professionals, among consumers, and the sciences. From this we can only hope there will be manifested new kinds of organizations, research, and journals’.

Could this be the route to reform, then – a reliance on us? From everything I have learned from my encounters, I have to say as inadequate as this solution feels, it may well offer the most hope in the coming years.

I couldn’t agree more, and this work is a solid contribution to that project.

* He writes:

Stranger still is Solomon’s statement that I believe people, with respect to suffering, ‘should do more of it’. This is another example of Solomon misrepresenting my position: in my clinical experience many forms of suffering that are currently dismissed as medical disease are not disease at all. Rather are they often a call to change; the organism’s protest against inhospitable social or psychological conditions. Therefore, rather than turning to anesthetics as a first response there is often value in working through our suffering productively – trying to discern what it is seeking to communicate so that we can work to put things right. There is nothing in this view that either glamourizes or masochistically encourages suffering. I merely argue what my clinical experience has taught me; that it is oftentimes better to face ones suffering and work through it productively than have recourse to anesthetics.

** To be sure, as described in the note above, Davies does emphasize “working through our suffering productively,” individually and collectively, but he doesn’t discuss any larger frameworks through which this reality-based and constructive work can be understood.

“Miscarriage of Medicine”: ACLU and MergerWatch report on Catholic hospitals’ interference with medicine

The ACLU and the MergerWatch Project have released a short, informative report about Catholic hospitals and hospital systems* and their terrible effects on women’s health care.

From the introduction:

All across the country, an ever-increasing number of acute-care hospitals are Catholic- sponsored or are affiliated with a Catholic health system, with one in nine beds now in one of these facilities. Many of the largest health care systems in the country are Catholic-sponsored and they are expanding rapidly, in part by acquiring non-Catholic hospitals. In some states, such as Washington, one quarter or more of the hospitals are Catholic-sponsored or -affiliated, and entire geographic regions have no other choice for hospital care.

Religious restrictions govern care at Catholic-sponsored facilities. At these hospitals, health professionals are prohibited from providing vital health services or honoring patients’ health care decisions when they conflict with Catholic teaching. Often at these facilities health professionals may not even provide their patients with counseling and referrals for services prohibited on religious grounds. As a result, when it comes to reproductive health care, hospitals operating under these religious rules can provide care that falls short of expected standards of care. Historically secular hospitals or hospitals founded by other religious faiths are often required to adopt some or all of the Catholic restrictions when they affiliate with or are acquired by Catholic hospitals.

This report looks at the increasing number of acute-care hospitals that are Catholic-sponsored or -affiliated and the expansion of Catholic-sponsored health systems in the United States between 2001 and 2011.1 Indeed, 10 of the 25 largest health systems are Catholic-sponsored, with combined gross patient revenue of $213.7 billion. The report discusses the threat this growth poses to patient access to reproductive health services, including information and referrals. It further shows the degree to which these institutions rely on tax dollars, even as they limit medical care based on religious doctrine. At the same time, data also indicate that, despite their claims of service to the poor, Catholic-sponsored and -affiliated facilities actually provide only an average amount of charity care and report a lower percentage of gross patient revenue from Medicaid than any other type of hospital.2

In short, this report reveals how Catholic hospitals have left far behind their humble beginnings as facilities established by orders of nuns and brothers to serve the faithful and the poor. They have organized into large systems that behave like businesses — aggressively expanding to capture greater market share — but rely on public funding and use religious doctrine to compromise women’s health care. We make recommendations about how to ensure Catholic restrictions do not interfere with patients’ rights and protect access to comprehensive reproductive health care.

Even if you don’t have time to read the whole thing, you should at least skim the sample of items from the Ethical and Religious Directives in Appendix A. For example,

44. A Catholic health care institution should provide prenatal, obstetric, and postnatal services for mothers and their children [sic] in a manner consonant with its mission.

One would think a healthcare institution’s mission would be to provide these services.

On assisted dying:

60. Euthanasia is an action or omission that of itself or by intention causes death in order to alleviate suffering. Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way. Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that they can live with dignity until the time of natural death.

61. Patients should be kept as free of pain as possible so that they may die comfortably and with dignity, and in the place where they wish to die. Since a person has the right to prepare for his or her death while fully conscious, he or she should not be deprived of consciousness without a compelling reason. Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person’s life so long as the intent is not to hasten death. Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering. [my emphasis]

This seems inconsistent with recent statements from Francis. Why aren't poor and marginalized people simply helped to appreciate the Christian understanding of redemptive suffering? Problem solved.

* The report also shows the rapid growth of for-profit hospitals, which also poses a threat, if of a different sort. For-profit and healthcare shouldn’t be connected in any way.

Changes at the Vatican: more political opportunity

I’m as surprised as anyone that I’m posting about the Pope again, but the developments are significant enough to warrant some comment.

A couple of weeks ago, I wrote about Francis’ remarks about global capitalism and their political significance. I welcomed the statements as providing a political opportunity for social justice movements, particularly in the Americas. (I wasn’t surprised to learn recently that he’d met with liberation theologian Gustavo Gutiérrez back in September.)

At the time, I wrote that my position didn’t entail an end to criticism or skepticism, linking to this article at RH Reality Check and this report from Democracy Now!. Both discussed the church’s continuing anti-woman policies. Conservative US bishops have been a powerful force both in fighting reproductive rights and in suppressing progressive movements within the church, including the Leadership Conference of Women Religious. To a significant extent, Francis has continued his predecessor’s support for these bishops and their priorities.

This week, though, he’s made some changes that could have a meaningful impact for progressive Catholic movements and for reproductive rights. Most importantly, he replaced conservative Cardinal Raymond Burke with “ideological moderate”* Cardinal Donald Wuerl on the Congregation for Bishops. “Cardinal Burke still serves as the prefect of the Vatican’s highest canonical court, but analysts say his removal from the Congregation for Bishops will sharply reduce his influence, especially over personnel changes in American churches,” Jim Yardley and Jason Horowitz report.

Once again, responding positively is not a matter of celebrating Francis, the institution of the papacy, Catholicism, or religion, but of appreciating the ways these moves alter the political landscape, both symbolically and concretely. They open possibilities for women and progressive movements within the church and in society more generally. This is especially true since the conservative bishops, under a more supportive pope, argued that the uppity progressive nuns should submit unquestioningly to papal authority. They’ve boxed themselves into that corner, and now any opposition to Francis’ agenda is revealed as hypocrisy. Authoritarianism is unforgiving that way.

* “Father [Thomas J.] Reese noted that Cardinal Burke had been a leader of American bishops arguing that Catholic politicians who support abortion rights should be barred from receiving communion, while Cardinal Wuerl had taken an opposite tack.”

It concerns me...

...how much Scandal resembles The Borgias.

Well, not the resemblance itself so much as the lack of attention to it.

A secular animal liberation movement compelled to respect Christianity? I don’t think so.

Atheists are increasingly coming to respect and recognize the need for religion. For social justice movements, religion is part of the solution.

This is the theme, implicit and often explicit, of so many New York Times articles about interactions between atheists and religious people. It’s interesting because I don’t believe or suspect that it’s at all conscious, but the pattern is so clear that there has to be something behind it. A recent piece, “Scholars Explore Christian Perspectives on Animal Rights” by Mark Oppenheimer, is a case in point. The tagline reads: “As Christians ask how their faith requires them to treat animals, they may force animal rights activists, a mostly secular lot, to reconsider their views on Christians.”

Oppenheimer argues that these days animal welfare is “a lively topic among Christians in the United States and England.” He writes specifically about two religious men, David Clough and Charles Camosy, who’ve both written books about animal rights (more accurately animal welfare) from a Christian perspective. Clough’s argument is basically that humans and other animals are all “created by God, reconciled to God in Jesus Christ and will be redeemed by God in the new creation”: “‘Good theology ought to recognize one fundamental separation…between God and all God has created. We belong with dogs and cats and hedgehogs and trees and rocks.” In his book, Camosy “links his concern for animals to his beliefs on abortion, arguing that the Catholic ethics of respect for life and care for the vulnerable should make us reconsider how we treat animals.”

Oppenheimer argues, without citation, that the animal rights movement has historically been secular. As is standard for this type of article, he offers one sole reason for the rejection of religious perspectives: “some secular animal-rights activists were suspicious of Christianity, concurring with Peter Singer’s claim, in his 1975 classic, ‘Animal Liberation’, that Christian teaching about man’s dominion had been an impediment to animal rights.”

He acknowledges the truth of this assessment, and the negative response to Camosy’s and Clough’s arguments in other Christian circles. But he contends that the history of some religious involvement in animal welfare campaigns and these more recent theological initiatives should lead, and in fact are leading, secular activists to a reevaluation of religion. Of course, Oppenheimer focuses on Singer. And of course Singer obliges with exactly the sort of accommodationist pap the Times loves.

For several years, Professor Singer and Dr. Camosy have been in frequent communication, and last year Dr. Camosy wrote a book about his fellow ethicist, ‘Peter Singer and Christian Ethics: Beyond Polarization’. Last month, the two men spoke together in Maryland, at the national headquarters of the Humane Society of the United States. As a result of their conversations, Professor Singer says he has become somewhat more charitable toward Christianity.

‘I think Charlie’s helped me to see that that’s overly negative’, Professor Singer said, referring to his depiction of Christianity in ‘Animal Liberation’. ‘It’s not that the negative statements’ — giving humans permission to use and abuse animals — ‘aren’t there, because they are, and were made by major figures from Augustine to Aquinas and so on. But there is another side to it, and other Christians have different interpretations of man’s dominion’.

It’s settled, then. Professor Singer has spoken.* And since the only secular justification for rejecting Christian arguments is the negative content of some (in this case, the majority) of those beliefs, the existence of some positive beliefs should lead the movement to a greater opening to faith. (These articles like to conflate atheists’ ideas about faith-religion with our attitudes toward people. So, Oppenheimer can write that their books and arguments “may force animal rights activists, a mostly secular lot, to reconsider their views on Christians,” as though this were about dislike of Christians rather than an evaluation of religious ideas about ethical relationships with other animals.)

This is nonsense. I’m going to summarize the good reasons atheist animal liberation activists should continue to reject religion and any role for it in the movement. I’ve discussed several of these in more detail in the past and will talk more about others in the future, but here’s a sketch.

First, and most generally, faith as a basis for ethics is fundamentally a problem. As I’ve argued, whatever the content of any specific faith beliefs, faith as an epistemic approach is inherently authoritarian and conservative.

Second, respecting or accepting as valid ethical justifications those religious beliefs we find relatively palatable means respecting and accepting as valid any or all religious beliefs. As I suggested in the past with regard specifically to this movement,

Respecting any faith-belief as a foundation for ethics, and celebrating faith as a motivation for ethics generally, of course bolsters the power of any faith-based ethics, including those we wouldn’t find even superficially ‘defensible’. And in this case the people who hold similar faith-beliefs which they see as justifying their cruel exploitation of nonhuman animals are far more numerous and far more powerful. If atheists/epists avoid aggressively criticizing the faith basis of ethical positions that are closer to ours in practice, we have no foundation for challenging the people who understand ‘dominion’ to mean cruel exploitation. We also have no foundation for challenging faith-beliefs that aren’t religious. Respecting any faith beliefs disarms you against all of them.

Third, suggesting that the animal rights movement embrace religion is politically regressive. It happens that I was reading Bob Torres’ Making a Killing when I saw Oppenheimer’s piece. Torres describes how after 9-11 “Many activists argued that we as a movement, needed to reach outward and rightward to draw in Christian conservatives, neoconservatives, and others from the Right who would be receptive to our message.” He was even warned about his open atheism being off-putting to these potential recruits. “The hope,” he suggests, “was that the ‘new blood’ would invigorate the movement and help to make it mainstream, yet no one seemed to consider the fact that this new blood was often happy to uphold exploitative and oppressive ideological positions on a variety of other issues.”

Torres particularly condemns the embrace of rightwing figures like Matthew Scully and Pat Buchanan by the large organizations in the animal rights movement. PETA gave a “Progress Award” to Buchanan, for agreeing with Matthew Scully about “compassionate conservatism” also applying to nonhuman animals. He makes clear that those who stand against oppression do the cause of liberation no favors by allying with “conservatives who have promoted policies that marginalize, exploit, and denigrate humans”: “Together, Buchanan and Scully promote a disastrous agenda for equality, regardless of what they think about animals.”

And in the case of one of the religious positions described in Oppenheimer’s article, oppressive beliefs about humans are linked to beliefs about animal welfare. David Clough, explicitly connects his animal welfare position to his views on women’s reproductive rights.** I’m annoyed that accommodationists expect animal rights activists to welcome these religious perspectives, especially as the movement is predominantly made up of women, many of them feminists. How condescending of Oppenheimer to suggest that some Christians’ “different interpretations of man’s dominion” should lead us to set aside our struggles against human oppression and ally with them.

In light of this, I’m more than a little disturbed that the person responsible for religious outreach at HSUS (Christine Gutleben) would declare that “Absolutely, Christianity is part of the solution,” and unhappy that HSUS even has such a position. As Torres points out, pandering to these people and beliefs unavoidably moves these organizations in a conservative direction, and away from an awareness of how different systems of oppression work together.

Fourth, religious justifications for animal rights or welfare don’t connect reasonably or consistently to a course of action – they’re compatible with many different personal or social actions. The people Oppenheimer describes as bringing an important new voice to the movement appear to hold similar and relatively conservative ideas about human-animal relations, but even they don’t seem to agree on the most ethical path. Clough doesn’t believe that humans should eat meat (the article doesn’t describe him as a vegan). But how this position is derived from the beliefs that animals are “created by God, reconciled to God in Jesus Christ and will be redeemed by God in the new creation” and that “We belong with dogs and cats and hedgehogs and trees and rocks” is unclear. In what practical ethical sense do animals belong with trees and rocks, and by what path does this lead to his decision not to kill and consume them? How does this categorization contribute anything to a theory of animal liberation?

Camosy, who bases his views on “the Catholic ethics of respect for life and care for the vulnerable,” argues that meat eating is OK (because permitted in Catholicism) but factory farming is unacceptable since animals should be treated “kindly” and not “suffer needlessly.” He isn’t a vegetarian: he “has given up meat — though he still eats fish, ‘half because Jesus Christ ate fish, and half because I am too weak to give up my grandmother’s tuna spaghetti sauce’.” As these examples show, even when Christians share similar welfarist interpretations, the connection between abstract belief and action is tenuous and unreliable.

Fifth, as I’ve described in the past, religious beliefs are alienating, which is of special concern when we’re discussing questions like animal rights or ecology.

Sixth, religious justifications for ethics are gratuitous and self-serving. They’re also divisive.

Seventh, most significantly, and at the root of many of the previous issues, religious arguments are false. You would think that being false would so obviously and immediately disqualify an argument from consideration as a basis for ethics or activism that it wouldn’t even require discussion. But it’s a sign of the deleterious effects of religious privilege in our culture that if you slap the faith label on any argument people think it has to be taken seriously. Their relation to reality pushed aside, religious beliefs are debated in terms of their so-called usefulness and their superficial desirability.

How authoritarian and condescending this idea is. It amounts to an acceptance of faith as a cultural practice. Even worse, it means taking advantage of that authoritarian cultural practice to promote the movement.*** Generally, it’s madness. Never in human history have false beliefs been a sound or positive basis for activism and social change relative to beliefs based in reality, and they never will be. Falsehoods have no place in a movement that seeks to overturn false supremacist beliefs and find ways to treat others ethically in reality. The duty to believe according to the evidence which we have to answer to in all aspects of our lives calls especially urgently when we’re seeking to overcome oppression and killing and develop ethical relationships with others: the tendency to cling to bogus claims from traditional or New Age religion or secular philosophy to justify oppression is very strong and every effort needs to be made to fight it.

Finally, the argument that religious arguments have something valuable to contribute that commands the respect of atheist-secular activists assumes compelling secular arguments are inexistent or insufficient. As I’ve argued previously, respect for faith-based arguments “carries the implicit suggestion that powerful and convincing ethical arguments for ethical relationships with our fellow animals can’t be found outside of faith. It’s a backhanded rejection of the…humanist tradition of ethics and social justice activism….”

Times’ writers like to imply, for some reason, that secular arguments about ethics and animal liberation, like secular and atheist positions in general, have been widely covered and discussed. Nothing could be further from the truth. Though attention is occasionally paid to specific issues and the coverage is sometimes fair (for example, Jedediah Purdy’s “Open the Slaughterhouses,”**** (April 9, 2013) and the positive review of The Ghosts in Our Machine), the arguments and theory of animal liberation aren’t featured.

In fact, the Times magazine last year hosted a contest called “Defending Your Dinner,” calling on people to make their best arguments for carnism. It wasn’t structured as a debate, because, as organizer Ariel Kaminer claimed, “In recent years, vegetarians — and to an even greater degree vegans, their hard-core inner circle — have dominated the discussion about the ethics of eating.” It seems impossible that anyone could take such a claim seriously, especially in a magazine full of recipes for animals and their secretions, spreads of clothing made from their bodies, and advertisements for animal consumption. Kaminer offered that “those who forswear meat have made the case that what we eat is a crucial ethical decision.” Indeed they have, but not generally in the Times. If you look at the links provided to show how vegetarians and vegans have “dominated the discussion,” you’ll see that they haven’t. In fact, among the recent articles under the “veganism” link is “Why I’m Not a Vegan” (May 21, 2013) by Mark Bittman, one of the judges on the all-male contest panel. (See also this and this and this.)

The claim that vegetarians and “to an even greater degree” vegans have dominated the discussion about the ethics of eating – in the Times, the media, or the broader culture – is about as congruent with reality as the claim that atheists have dominated the discussion about religion and belief. The secular arguments for veganism and ending the oppression of other animals have long been marginalized and the movement caricatured, while carnism has been presented as the normal way of things. Contests promoting carnism contribute to this marginalization.

But the secular justifications for veganism and the abolition of animal exploitation are absolutely sufficient to make the case. That you don’t see them in the Times doesn’t mean they don’t exist. I’ve listed some books about animal rights and social justice here (to which I’ll have to add Animals & Women and Making a Killing), and posted about several of these individual themes, so I won’t elaborate on the arguments in detail. In short, though,…

Science (biology, ethology, ecology, neuroscience) has demolished the false beliefs, both religious and secular, that form the basis of speciesism, and thus removed the justification for denying other animals equal moral consideration. We’re an animal species, and all of our capacities are evolved animal capacities. Neither our species itself nor any particular characteristic makes of us a distinct category apart from other animals, allowing us to deny them equal moral consideration and giving us license to use or kill them at our wish. There’s no reasoned basis for denying beings equal moral treatment solely on the basis of their species, any more than there’s a reasoned basis for denying humans equal moral treatment solely on the basis of their gender or “race” or religion.

The evidence of animal suffering and the denial of their interests in human systems of exploitation is overwhelming. The oppression of nonhuman animals is deeply connected – in practice and ideas – to the oppression of humans. From a solely human-oriented perspective, participating in this system is harmful to us – forcing us to extremes of psychological denial, contortions, and bad faith; interfering with our compassionate and caring impulses; alienating us from other animals, from the rest of nature, and from ourselves; leading us to harm our environment; holding back science and existential understanding;…

Supremacist arguments are unfounded. No individual, group, or society has the right to oppress or exploit others for their own (perceived) ends. We don’t have the right to treat other beings capable of suffering and pleasure as things or property. We don’t have the right to enslave or kill others. These are all widely accepted positions concerning humans, and the need for solidarity amongst movements fighting human oppression is increasingly understood. The extension of these basic insights to our relationships with the other animals with whom we share so much is only logical and just.

All of these arguments have been developed in numerous books and articles by scholars and activists, and can be appreciated by anyone who fairly and reasonably considers the evidence. The New York Times would do well to present them fairly – and in much more detail, of course – to their readers. Only then can a real public conversation begin. And only after engaging in this conversation could anyone rationally attempt to declare the validity of or need for openness to religious arguments.

* I assume an invitation from the Harvard Humanists will soon be forthcoming. :)

** The argument is stupid in any case. The analogue to a human fetus isn’t an animal but an animal fetus; the analogue to a pregnant human is a pregnant animal.

*** This is especially grotesque when it comes to science advocacy movements.

**** Of course, given that ag gag laws affect not just animal rights or welfare activists and corporate whistleblowers but also journalists, you could suggest that the Times’ coverage is relatively muted.

Capitalism and medicine don’t mix: an illustration

Actually, just about any of my posts here related to health illustrates that principle. But this example is particularly good. Johnson & Johnson are paying their lawyers to fight to keep clinical trial data on Risperdal hidden from the public.

According to Law360 (where I can’t read the full stories), “Plaintiffs in a cluster of product liability lawsuits…told a Pennsylvania judge on Tuesday that documents detailing the medication’s risks were too vital to the public interest to remain under seal as part of court proceedings.”

Johnson & Johnson disagrees.

98%

In happy academic union news, graduate workers at New York University have voted overwhelmingly (620 to 10) for union representation, and the administration has agreed to negotiate in good faith.

News sources are reporting that this makes NYU's (again) the “only" graduate assistants' union recognized by a private university in the US. I prefer to think of it as the first.

Solid analysis of Venezuelan municipal elections

From Tamara Pearson at Venezuelanalysis.