HOW TO AVOID ALIMONY

Following the publication of my most recent blog in honor of Valentine’s day, my daughter/editor proposed a question which has been asked of me previously.  I am asked to divulge the secret to a long happy marriage.  Of course those terms are not necessarily synonymous, and my own marriage has certainly not always been happy; although, I would guess that it would register above average on the happiness meter.  The most encouraging thing for me is that it seems to get better as time goes by.

Marriage and Divorce in the “Good Ole Days”

In my day, lengthy marriages were the rule and divorce uncommon.  Divorced people were apt to be stigmatized. The women were referred to as “grass widows.” Men were often assumed to be philanderers.  In those times, most wives became stay-at-home mothers (housewives) who had been conditioned and trained to be just that.  Those few who had chosen a career were expected to give up their jobs as soon as they became pregnant.  Daycare centers were few and far between.  Consequently, a woman abandoned by her husband faced insurmountable obstacles to becoming self- supporting.

Men likewise faced financial hardship sufficient for them to eschew divorce.  This was during the days of alimony before the days of no-fault divorce, and adultery was the most common charge leveled by the complainant.  Awards could be punitive.  Divorces were often nasty, long, drawn out, and expensive.  Reputations suffered as the family’s dirty linen was made public.  At times, courtrooms were filled with spectators who had attended in hopes of hearing some salacious gossip.

Thus there were many pragmatic reasons to stay married and undoubtedly many men and women felt trapped in their marriages (quite a few of whom ended up in my office); however, there were also many more who were quite content with their marital relationships.  All of this raises the interesting question as to the ratio of happy versus unhappy relationships, both in those old days and now.  It could be argued that my contemporaries stayed together because they were stuck with each other or could it be that since the alternative was so distasteful that they were more diligent in finding ways to be compatible?

Although the divorce rate in the U.S. has been reported to be as high as 50%, there are some encouraging signs.  During the past decade this number has gone down some, and there appears to be a significant decline in the rate when the couples are married later in life.  As a matter of fact, there appears to be an inverse relationship between divorce and age beginning in the thirties.  Presumably this would indicate that maturity and/or life experiences might be an asset to a happy marriage.  That was not true for me as I was married at 22, and was as green, naïve and inexperienced as they come; although, I thought I was really cool.

Infidelity

As you might expect, infidelity is a frequent cause of marital discord.  I don’t believe this is only due to changing of societal sexual mores.  In my experience most problems of this sort occur in the workplace, which should not be surprising since women are now frequently side by side with men.  They may share in their accomplishments and failures much as happens in marriage, and may spend more time with a coworker than with a spouse.  Likewise, the coworker is likely to be more understanding of work stresses.  Those who work closely together are apt to see each other at their best, but may arrive home after a hard day tired and grumpy.   In addition the development of effective means of birth control lessened the risk of sexual liaisons.  Needless to say, fooling around can be a real downer for a marriage, and is not recommended.

Is an unhappy marriage better than divorce?

None of this should be construed to mean that I am unalterably opposed to divorce.  It can be very dangerous to live in a dysfunctional family environment.  The U.S Bureau of Justice reports that 6.5% of all murders in the US. are committed by spouses.  Obviously, family relationships are important factors that influence children in hundreds of ways, not only when witness to violent behaviors, but how they view those relationships affects their ability to express feelings, develop self-esteem, have healthy relationships and functional marriages of their own.

Although I have quarrels with some of Freud’s writings, I believe that he was right on with the concept of identification.  In simple terms the concept is basically “monkey see monkey do” and we often end up unconsciously adopting characteristics of others: usually our parents.  One of my former patients was a perfect example of this phenomenon.  This very sophisticated lady whom I had seen occasionally throughout the years had a great deal of animus toward her mother.  During one visit, she was discussing problems related to her daughter, and suddenly announced: “I have become my Mother,” an insight of which she had been blissfully unaware until that moment.  Many of us will have a similar experience and will end up unconsciously mimicking characteristics we found abhorrent in one of our parents.

All this brings to the fore a problem which has been vexing to me during my entire career.  Although I have rarely recommended divorce, I have always been troubled by the question of which is the more damaging to a child, divorce or growing up in a dysfunctional family.  The patients who focused on family as a cause for their problems seemed evenly split.  Some were angry that their parents had divorced while an equal number blamed them for staying together, so maybe it is one of those damned if you do damned if you don’t situations.

So, what’s the secret to a long, happy marriage?

I realize that up to now I have written little to answer Maggie’s question about how to stay happily married.   It is a simple question that deserves a complex answer.  The melding of two personalities into a functioning unit requires more than lust; although, that can certainly be helpful in the early stages.   In my early days as an academic, I was placed in charge of a family and couple’s therapy clinic where we made use of communications and systems theory in our treatment plans.  We have all had times when our messages have been misinterpreted, for example, the recipient thought we were being sarcastic (the words did not fit the music).  In other words, the tone or nonverbal message was inconsistent with the verbiage, a situation we called sending roses and feces in the same box.  This is only one example of the myriad ways in which communications can become garbled and result in a great deal of frustration.

Another characteristic of couples caught up in these systems is that they both are unaware of their part in the problem. It is as if they are swallowed up in their communications system and cannot see beyond its borders.  The therapist’s job is to become a meta communicator, that is to communicate to each of them about their communication system so that each can see the part they play in their problems.

The person who plays the part of meta communicator is not necessarily a therapist.  Barb and I have had therapy both together and separately, but the most insightful revelation for me came from one of my students who after a party said, “I can’t believe how you treat your wife.”   Initially, I thought: “Who, me?  The great communicator, insightful couple’s therapist, and kind considerate husband? The audacity of this pip-squeak!”

Then, I thought more about that observation and began to see our relationship in different terms.  With awareness, I was able to put forth some effort to improve our relationship, which was in need of some improvement at that time.  But old habits are hard to break and even after all these years I still relapse from time to time.

Of course people always bring their own unique personality characteristics to the relationship along with their needs, expectations (often unrealistic), and dreams.  In our case Barb and I probably fit into what I categorize as a complementary relationship.  Opposites often attract, and in our case (in addition to that swivel) Barb seemed to fill the void of my shyness with her outgoing personality, and sensitivity while I came across as an in charge, stoic person.  She must have felt that I could look after things and provide stability.

What turns you on is what will turn you off

In my experience the qualities that attract couples to each other are the same ones they will come to complain about after a few years.  True to form I found that her emotional responses eventually became irritating to me and she began to complain that she felt ignored and put down by my apparent lack of feelings.  She hungered for conversation, but after a day listening to people and talking to people, I wanted solitude.

We eventually worked that out by scheduling 30 minutes after dinner to talk.  I learned to listen, and she found she didn’t need that much time after all, mostly just needed to be appreciated which I learned to do.  She likewise has learned totolerate my  foibles and we now roll along with only minor skirmishes.  I know she will be there for me and she knows I will do likewise for her.

As you have undoubtedly noticed I have no secrets for success in this marriage business.  I do have some hints that you could just as easily have learned from your Grandmother as follows:

• Be patient Rome wasn’t the only thing not built in a day.
• Listen, I mean with both ears.
• Sex may lessen the sting, but is not enough to solve the problem.
• When you think you can’t stand him/her see if you can’t find a little bit of something good.  Nobody is all bad.
• Don’t be sticky, you both need time away from each other occasionally.
• Trust, paranoia will tank your marriage, if your mate is screwing around there will be plenty of time to shoot him/her later.
• If you don’t “feel the love” mutual respect may well resurrect it.
• If there is abuse, get the hell out.
• Remember it often takes work to make it work, but when it succeeds it is well worth the effort.
• If things still don’t click, find a professional who sees couples. Individual therapy is not likely to be very helpful.  Dancing lessons without a partner don’t work very well.

Introduction

Another holiday season goes in the books…not the least of which are the check books.  Our family has developed a tradition of attending a movie on Christmas evening, that is, by those who have sufficiently recovered from the materialistic orgy of gift giving and gluttony.  Since wife and I no longer host the activities, I felt energetic enough to accompany the movie goers this year.  Of course I was counting on deferential treatment for this old patriarch, and was not disappointed, for I was deposited at the theater entrance while a grandson parked the car.  Fortunately, this provided just enough time for me to purchase tickets for the group.

The movie we had chosen was The Imitation Game, which provoked some painful memories for me.  For those unfamiliar with the story, it is about the person who was able to break the German code in World War II, and is credited with designing the precursor to modern computers.  As portrayed in the movie, the main character exhibited symptoms suggestive of a diagnosis of Asperger’s syndrome.  He was also homosexual, “outed” by British police, charged with “indecent behavior,” chose chemical castration in lieu of incarceration, and eventually committed suicide.

Bryan

The story reminded me of a major failure of mine as a psychiatrist many years ago.  Bryan (not his real name of course) was a freshman at the university where I was teaching.  His chief complaint was depression with rather typical symptoms such as: insomnia, loss of appetite, restricted interests, weight loss, the inability to experience pleasure, impaired concentration, and self-deprecation.  In those days, depression was characterized either as Reactive or Endogenous.  As the word suggests, the former title was reserved for those patients who had experienced trauma of some kind such as grief or other kind of loss, while the latter referred to those for whom no explanation could be found to explain their illness.

Initially Bryan’s depression seemed to be without cause and therefore endogenous.  As a matter of fact, it seemed that he should be sitting on top of the  world.  He was a very handsome young man with blond hair and muscular build.  He had been valedictorian of his class, the quarterback of his football team and the president of his high school class.  He soon confessed, however, that he had recently participated in a sexual encounter with another male student, which left him immersed in shame and guilt for he said he never wanted to be a “queer.” He did acknowledge that he had always been attracted to males, but had previously been able to suppress and ignore those feelings. However a few beers at a fraternity party had allowed him to act out impulsively with devastating results.

Bryan’s Call for Help

After a few visits with little change, he arrived one day, and announced that he was feeling much better, and had decided to quit school to look for work in his hometown.  I of course questioned such a drastic decision especially since in the face of depression judgment is often impaired.  He assured me that he was no longer depressed and felt much better since deciding to change the course of his life.  Several weeks passed until one day I received a call from his Mother who wanted to see me in person to talk about Bryan.   As promised, Bryan had quit school, and gone home but not to look for a job.  Shortly after his last visit with me, he had shot himself in the head.  Fortunately or unfortunately depending on one’s point of view he did not die and after several weeks in the hospital was placed in a nursing home.  Mother reported that he had suffered severe brain damage, and was in her words a “vegetable” with no hope of improvement.

The Pain of Hindsight

My thoughts went immediately to that last visit, and I realized my blunder in not decoding Bryan’s message.  For he was telling me that he had found a terrible solution to his problem, and I should have suspected that such a sudden cure from depression of this magnitude was extremely unlikely, and probably was what has been called by psychiatrists a “flight into health”.   Studies have shown that suicidal patients frequently send such coded messages prior to attempting to kill themselves.  They seem to be rolling the dice to see if anyone will notice, perhaps retaining a faint glimmer of hope that someone might still be able to rescue them from their torment.  I also theorized that his termination of our relationship was designed to release him from the promises he had made to me that he would not act out his suicidal thoughts.

Depression: What It Is and What It Isn’t. What Helps and What Doesn’t.

At the risk of digressing from my story, I feel the need to talk about depression and suicide.  It is unfortunate that the word depression is used to describe a group of very serious, often fatal illnesses, which are often confused with the transient feelings of sadness we all experience from time to time.  This leads to a great deal of misunderstanding by most people as to what we as psychiatrists mean by depression, and often leads to delay in treatment.  We use a number of adjectives such as: melancholic, bipolar, unipolar, major, etc. to differentiate different types of depression, but the one thing they all have in common is that the course of the afflicted person’s illness is beyond his/her control.

Consequently; advice such as, “go have some fun, don’t take yourself so seriously, stop worrying so much,” and my all time favorite “you need to trust more in God” are apt to worsen the situation.  Suggesting such remedies is much like advising a person with a broken arm to go lift weights.  The fact that the person is unable to do these simple things further depresses self-esteem which is already at a low ebb.

Much as we who are treating have a semantic problem in labeling, our patients have a problem in describing their symptoms for I don’t believe there are any words in the English language that can adequately describe the torment of the clinically depressed patient.  The more seriously depressed are often literally at a loss for words.  I have seen patients with histories of medical problems resulting in excruciating physical pain who tell me that it was nothing compared to the suffering endured by an episode of clinical depression.  No wonder that the CIA chose two psychologists to design a protocol for their “enhanced interrogation,” for depressed patients often describe their condition as torture.  Faced with such intolerable torment and hopelessness, it is not surprising that one might choose the only avenue left.

Indeed, the lack of hope in a depressed person is one of the risk factors for suicide.   Untreated clinical depression carries a mortality rate of nearly 20%, but is not often treated as a potentially fatal disease.

40,600 Suicides

Much has been written in the lay literature about suicide, but much more needs to be done.  Suicide is endemic throughout the world, and the incidence varies little in different parts of the world.  ¹The Center for disease control reports 40,600 suicides in 2012, but the actual incidence is certainly much higher as there are many incentives to deny the true cause of such deaths.

Suicide remains the 4^th leading cause of death among children and young adults, and the epidemic of suicides among returning veterans has finally gained some notice.  The loss of life is only part of the tragedy of suicide.  Families have a grief enhanced by questions such as: What could I have done, Why didn’t he tell me?  The grief and guilt are often laced with the anger of having been abandoned.   In my experience the pain suffered by parents of child suicides is by far the most intense.  As one parent told me several years after losing her child, you never get over it, you just learn to live with it.

When Was Homosexuality Demonized?

Anthropologists have reported that many so called primitive societies (that term may be one of those pot kettle things) were accepting of homosexual behavior and in some instances homosexuals were venerated.

John Boswell² and Scott Bidstrup³ allege it was not until the 12^th  Century that homosexuality came to be regarded as immoral, and subsequently was made illegal.  Bidstrup holds the Christian church responsible for those judgments, and sees them as the genesis for the homophobia which still persists to some degree.  It should be noted however that the Torah⁴  prescribes death as punishment for sex between two men or two women; although some scholars insist this was meant to apply  only to certain pagan practices. In the New Testament Romans 1”26-27 is frequently used as proof of the sinful and immoral nature of homosexuality but again others disagree with that interpretation.   There have always been disagreements amongst scholars and lay people alike regarding scriptural meanings, and nowhere is this more apparent than with the issue of homosexuality.  My own personal opinion is that these interpretations are strongly influenced by one’s political view as people of a more liberal bent generally appear to be more accepting.   There is ample evidence that homosexuality has always existed regardless of the culture, and its prohibitions, and its incidence does not vary a great deal.

Whenever I see on TV gay couples being married or hear of a gay pride parade, my thoughts often turn to Bryan.  I wonder if he had lived in a time when the homosexual label was less toxic, and he had not been conditioned to view it as repugnant and shameful, would he have lived to fulfill the promise that his life seemed to hold for him.

Homophobia in the Old Days

I must confess that I was a classic homophobe early on in my life.  Although, I did not approve of gay bashing which some thought was a fun way to spend a Saturday evening, awareness of its happening did not seem to bother me much in those days.  I recall that being called Queer was worse than sissy; although in my case I had no idea what the former meant.  Sex was a taboo subject in those days except between adolescent boys whose testosterone levels were heading for the stratosphere.  The “F” word was considered the most profane utterance of all, and would only be heard in secure facilities such as the boy’s locker room.   By high school awareness of male attraction to males came to the fore, and should one, heaven forbid, develop an erection in the post game shower, he became immediately suspect and would likely be shunned.  In those days a guy would likely receive more respect as an axe murderer than as a homosexual.  I imagine the same attitudes were still in place during Bryan’s time, and I picture him attempting to avoid any glances at his team mate’s anatomy.  Come to think of it, such behavior is not unique as can be witnessed by observing a group of men relieving themselves at a row of urinals.  Without exception, they will all be staring straight ahead as if there is something particularly interesting on the wall.  It is as if to look down at another man’s genitalia would signify a prurient interest.

After becoming a physician and later a psychiatrist I became aware of the multitude of serious problems facing the male homosexual.  For most the fear of discovery was always with them.  After all there were so called sodomy laws some of which remain on the books in a few jurisdictions; although generally no longer enforced.  There was widespread discrimination in hiring.  For those fortunate enough to have a job, outing could result in its loss.  Long term relationships were not common, since living with another man was sure to raise eyebrows.   Consequently; multiple sexual partners were common which put them at greater risk for venereal diseases.  As mentioned previously gay bashing was a popular sport among some homophobes, and was rarely prosecuted unless it resulted in death.  Some religious groups considered them evil and others saw them as simply disgusting.  Ridicule and denigration were not unusual.  The cruelest cut of all was for those who were ostracized by their family when their sexual identity was revealed.   At a time in their lives when they most needed love and support, they were recipients of rejection and shame.

There were a few openly gay people, but most chose to remain secretive for obvious reasons.  Bisexuals were able to maintain the charade of heterosexuality in most cases, marry and be seen as traditional family men.  Some with a more  fixed sexual identity would also marry as a means to cover their sexuality or as an attempt to “cure” themselves.  Needless to say such unions were rarely successful.  Some estimate the incidence of homosexuality to be as high as seven per cent, and since their lives were usually quite stressful the incidence of depression, and anxiety disorders was in my experience significantly higher than that seen in the population at large.  The result of which was that there were more patients with problems arising from their sexual identity than one might expect.

Homosexuality: Nature or Nurture?

During my more than fifty years in the practice of general medicine and psychiatry, the one thing all those patients had in common was their insistence that they had not chosen to be homosexual.  Almost without exception when I asked my homosexual patients when they had become aware of their sexual orientation, their response was that they had always known they were different.  They felt it was not a learned behavior, but something they were born with.  Since Freud appeared on the scene over one hundred years ago, there has been a running debate as to the roles played by early childhood experiences versus genetics in human development, (the so called “nature, nurture controversy”).  Nowhere has the debate been more strident than in the areas of sexual identity and sexual orientation.

Freud’s formulation of the genesis of homosexuality was that normal psychosexual development was inhibited when a child grew up in a household where the mother was simultaneously seductive, but cold and rejecting, while the father was emotionally distant and uninvolved.  His views were widely accepted, but there were critics who insisted that these psychodynamics could not be elicited in many cases.  During the last half of the 20^th century there developed more interest in brain function as it relates to mental disorders, personality development etc.  This new field of neuroendocrinology with its high tech methods of studying brain function called into question many of Freud’s theories, and resulted in the development of many medications which have been lifesaving for many.  One eminent psychiatrist went so far as to declare the talking therapies obsolete, and many training programs deemphasized the teaching of the various psychotherapies.  It is true that there have been amazing progress in understanding how our brains function.  The discovery of DNA and mapping of the human genome have opened new exciting vistas for the study of human behavior and its problems.

Call me old fashioned (which of course I am), but I remain convinced that the hand that offers the pill is also important.   Man’s ability to form mutually dependent relationships was an important factor in the survival of the species.  I am convinced that the computer which gathers a patient’s history although accurate is not as effective as a concerned human being.   Brain scans may allow us to visualize certain feelings, but doesn’t show much empathy.  Recently, I have been heartened to read pleas for more psychotherapy training for psychiatry residents in some journals.  I am hopeful this may be a prelude to a return to a more equal swing of that nature-nurture pendulum.  Among the population at large, the distinction of the classic debate is important.  The major question  as whether homosexuality is predetermined or developmental remains unanswered.  Gay rights activists hold that homosexuality is merely a normal variation in one’s psychological makeup which is no more in their control than is the color of their skin; therefore genetically determined.  Others consider it to be immoral, while some of the more zealous religious groups still consider it a sin.  Regardless of etiology, there is general consensus in the psychiatric community that one’s sexual proclivities are not subject to change.  There are some who claim success in their efforts to change a person’s sexual orientation, but others refute these reports and suggest they are only teaching their subjects to repress their urges.

Hope for the Future?

Since Bryan’s day there have been remarkable changes in our society’s attitudes towards homosexuality; although that is not to say that discrimination and homophobia has been banished.  The enlightenment had its origins when the gay community organized and attached themselves to the coat tails of the civil rights movement of the sixties.  The political boldness of this group contributed to and was enhanced by several well known public figures who “came out of the closet” and reported they felt liberated by their decision.  I vividly recall the hallabaloo in the press when Billy Jean King announced to the world that she was a lesbian.  This was in marked contrast to the recent outing of Anderson Cooper which hardly caused a whimper.  There was as expected a backlash in those early days of the movement, and one of my other vague memories of those times is of a gay man who was tied to a fence pot and beaten to death by two rednecks.

In 1972 my own professional organization, The American Psychiatric Association, in an apparent response to political pressure deleted homosexuality from the list of mental disorders in ⁶DSM III (The Diagnostic and Statistical Manual of Mental Illness).  They resolved their ambivalence about causation by adding the term “Homosexual dysphoria” referring to mood problems associated with homosexuality.  The response of the membership was mixed with some praising the leadership and others expressing concerns that the organization was abandoning scientific principles for political correctness, and that the new term was simply an attempt at fence straddling.

The march towards gay rights was slowed by the aides epidemic, which was originally called the gay disease.  One prominent TV evangelist went so far as to label the disease as God’s punishment of gays for their sins, and equated it to the story of Sodom and Gomorrah.  Although less evident discrimination is not hard to find even though examples are less obvious.  One such case was brought to my attention shortly before my recent retirement.  The patient was a young man who  was angry, depressed and  anxious.  He was employed in a factory where he told me he had received awards for his productivity;  however that was to change after it became known that he was homosexual.  He was continually harassed teased and belittled.  His work bench was sabotaged.  He was routinely addressed as faggot or queer, and was shunned in the lunch room.  He decided to take his problem to the human services department where he received only token acknowledgment, and later heard his supervisor refer to him as a “fag trouble maker”.   He sought legal redress for the discrimination in which he thought his employer was complicit.  This accomplished little other than to deplete his savings with legal fees.  With the abusive behaviors unchecked they escalated until the stress became intolerable and he quit his job.  His employer refused to okay his application for unemployment compensation.

In spite of such incidents, which are hopefully isolated, there are hopeful signs that things are changing for the better.  The gay community has become organized and is no longer powerless.  There is a new openness regarding sexual identity, and fewer reasons to remain in the shadows.  In recent years I have noted that my patients are rarely apologetic for their sexuality, and in most cases have accepted it.  With this newfound openness, there appears to be more long term relationships.  Polls show that in the past few years there has been a demonstrable increase in the acceptance of gay marriages, and a relaxation by some courts on the bans against gay parenthood.  The most hopeful sign for the future; however, is the fact that homophobia appears to have been drastically reduced among young people.

It has pleased me to witness more dramatic changes in attitudes in the past 50 years than have occurred in the previous several hundred.  They come too late for Bryan; however they may be life saving for others.  That is important as the world is in great need of their sensitivity and creativity.

¹Centers for Disease Control and Prevention; Fatal injury Report 2012

²Boswell, John; The church and the homosexual an historical perspective

³Bidstrup,Scott; Saint Aelred the Queer

⁴Leviticus 20:13

⁵Romans 1:26-27

⁶The diagnostic status of homosexuality in DSM III: a reformulation perspective; Amerrican Journal of Psychiatry: Volume 138 issue 2 February 1981 pp. 210-215

Preface: This article is intended to provide a straight-forward, unedited view of my perception of the treatment of minorities as a young white boy growing up in the Midwest. In that vein, I use the derogatory terms for minorities that were commonly used in those days as a literary device to illustrate how far we have come while acknowledging we have a long way to go in our quest to fulfill Martin Luther King, Jr.’s vision that a person be judged by the content of his character rather than the color of his skin.

Introduction:

In my last blog, I mentioned that my childhood was a kinder gentler time.  As I re-read that sentence, it dawned on me that for many people that time was neither kind nor gentle.

JAPS

I was 11 years old when the Japanese attacked Pearl Harbor.  Like most people, I was caught up in the patriotic fervor of the day.  We were taught that this “sneak attack” was characteristic of these “sneaky little slant-eyed devils.”  We applauded the imprisonment of all people of Japanese descent, even if they were American citizens. Preservation of national security and the suspicion that these Japanese Americans couldn’t be trusted, was the rationale used to effectively imprison American citizens without being charged with a crime.  Of course the word “prison” was not used and this completely unconstitutional act was justified by saying they would be interned only for the duration of the war.  Most of these people lived in California, and there was concern that if Japan invaded the West Coast many Japanese Americans would be involved in sabotage.  A large percentage of these “detained citizens” were farmers who owned some of the best farmland in the country. When the war ended, they found themselves homeless because their farms had been sold for back taxes.

JEWS

The war in Europe had been going on for some time, but there was little note of the persecution of Jews by Hitler.  Anti-semitism was rife in the U.S., and I can recall overhearing conversations where adults blamed the Depression (and poverty in general) on “those New York Jews.” Consequently, when a ship full of German Jews appeared on the East Coast, they were denied asylum and turned away, eventually returning to Europe to await their fate.

COLOREDS

African Americans were drafted into the military in large numbers, but usually assigned to non-combatant roles.  It was not until 1948 that Harry Truman issued an executive order to desegregate the military.  A number of years later, I happened to be reading a story in The Reader’s Digest that was written by the first African American man granted a commission in the Navy.  He recounted the bigotry that still existed when he was commissioned, but made mention of one person who had been supportive.  I am proud to say that person was one of my cousins, Travis Van Horn.

Higher paying jobs were denied to African-Americans.  They were excluded from most factory work and if they were hired it would be to do the “dirty work” or to clean the premises.  They were denied membership in most trade unions so that only positions as laborers were all that were available to them.  For example if working on a construction job, a black man would be mixing the mortar and carrying the bricks while a white guy would be laying them.  These factors contributed to higher unemployment among blacks and more poverty in black neighborhoods, but the average white person would explain the cause to be laziness.  Black women’s job opportunities were largely limited to domestic help, or cleaning of offices or motels.

WASPs

In my position as a WASP (White Anglo Saxon Protestant) in a middle class neighborhood, I didn’t have much contact with black kids.  There were a few in our schools, but most attended schools in black neighborhoods. No black family would ever dare move into a white neighborhood.  Statements meant to deny racism such as “I have nothing against niggers, but I wouldn’t want one to move in next door or my daughter to marry one” were common.

Higher paying jobs were denied to African-Americans.  They were excluded from most factory work and if they were hired it would be to do the “dirty work” or to clean the premises.  They were denied membership in most trade unions so that only positions as laborers were all that were available to them.  For example if working on a construction job, a black man would be mixing the mortar and carrying the bricks while a white guy would be laying them.  These factors contributed to higher unemployment among blacks and more poverty in black neighborhoods, but the average white person would explain the cause to be laziness.  Black women’s job opportunities were largely limited to domestic help, or cleaning of offices or hotels.

Generally I believe that even here in a small town in the Midwest it was commonly held that black people were intellectually inferior, oversexed and smelled badly. They were not required to go to the back of the bus, they did so because they “knew their place.”    During my childhood, there were still occasional reports of lynching in the South.  Although such murders were generally disparaged, I don’t recall a huge public outcry, but then kids don’t pay much attention to the news.

The Bubble of Bigotry

Even though I was immersed in a culture of bigotry, I was mostly oblivious to it.  Yes, I had wondered why the black kids all chose to sit in the balcony at the movies, and I was aware that the local skating rink was open to blacks only on Monday nights.  I knew that a nearby ice cream store was closed on Monday nights, but never made the connection.  There were two side by side swimming pools in our town presumably to make us feel that we were doing well by satisfying the separate but equal mantra.  The schools were integrated in theory.  There were no separate water fountains or rest rooms, but a quarterback on the football team would have been unthinkable.

The first time I can recall feeling much empathy for African Americans occurred while I was a teenager working at my father’s service station.  A black family pulled into the station to get gasoline.  Their license plate indicated they were from a neighboring state.  As I was filling the tank, the father crossed the street to a nearby restaurant, knocked on the back door, and returned with food for his family.  It suddenly dawned on me how demeaning this must be for a person to be excluded from even entering this dumpy little restaurant, let alone not being allowed to feed his family there.   Until then, I had not noticed that black folks did not eat in our restaurants.

Equal Opportunity Bigotry

Our prejudices were not limited to African Americans, we were equal opportunity bigots.  Words* such as WOP, dago, kraut, heinie, hun, chink, jap, nip, Pollock, towel head, kike, frog, and nigger were all part of our everyday vocabulary. There were many jokes about “dumb Pollocks” and “Irish drunks.” We were tolerant of other religions, but only barely.  Discrimination against Catholics and Jews was more subtle than it was for people who had a different skin color, and the non-WASPs reciprocated by keeping a superficial but cordial relationship with us. Many families were fragmented by interfaith marriages. After all it was the Jews who murdered Jesus, and the Pope was felt by many to be a dictator intent on world domination, in some cases even considered the devil incarnate. Indeed, even marriages between people of the same religion, such as Catholicism, but different cultures (Italian or Irish) were considered controversial.

Western movies were a favorite amongst us kids and cowboys and Indians was a favorite game.  As in the movies, the ones who got to be cowboys were the good guys and the Indians were ruthless savages.  No one bothered to tell us how they had been displaced from their lands, persecuted and ethnically cleansed.  Nor did we learn anything about their customs.  Here in the land of the free they were not permitted to practice their own religion or even speak their own language.  We of course were blissfully ignorant of all this.

*Etymology of Slurs

WOP = a term used to describe Italian immigrants and stood for With Out Papers

Dago = is thought to be from the Spanish term Diego and was a slur used to describe Italians.

Heinie= term referred to Germans, in which the origin is probably the German colloquial word Heini, which is loosely translated as idiot or moron.

Nips= shortened for the Japanese word for Japan, which is Nippon

Kike = several theories on this etymology of this Jewish slur. Some say it originated at Ellis Island when Jewish people who didn’t write English refused to sign with an X because it represented the Christian cross so they would sign with a circle. Keikl is the Yiddish word for circle.

Faggots

The problems of the aforementioned folks, pale in comparison to that of the so called “sexual deviant.”  This term is very telling for it might be defined as any kind of sexual activity which deviates from the “norm,” which was in actuality often interpreted as any type of sexual activity other than that performed in the missionary position.  Prescribed punishments for these deviants was codified in so called sodomy laws and varied from two to 10 years in prison depending on the state.   Consequently, homosexuals attempted to satisfy their needs in secret.

Men living together would surely raise questions so they would secretly “cruise” to find willing partners.  Parks and public restrooms were the places where they could meet, and engage in clandestine sexual activity.  These areas became labeled as public nuisances.

Homophobia was rampant, fueled by misinformation equating homosexuality with pedophilia, bestiality and all other manner of criminal behavior.  Gay men were not only at risk of contracting venereal diseases, but also becoming the object of a “gay bashing party” which could be administered either by redneck homophobes or police.  In some cases, arrest and resultant exposure could have caused even more devastating results.

Some had married in an attempt to hide their homosexuality or in the mistaken belief that they could change their sexual orientation.  Exposure could literally destroy their lives.  The stress of living under such a cloud took a toll and suicide rates among gays were higher than in the general population.

Did the Rampant Poverty of the Depression Encourage Bigotry?

In a previous blog I had mentioned that I was “a child of The Depression.” My own family suffered through that period along with millions of others.  I’ve often wondered if the struggle for basic needs led to more prejudice and bigotry as all people struggled for the scraps to survive. Or, did it just allow more people who might have disagreed with unfair treatment of minorities to ignore it due to their instinct for self-preservation? As in the Maslow’s hierarchy of needs, it is difficult for one to aspire to self-actualization and championing a cause for others when scrambling each day to feed his family?

My father had been unemployed, and had lost our home to foreclosure.  I was not aware of my family’s financial woes and had no idea that we were poor.  It never occurred to me to question our frequent moves, or why our parents sometimes insisted we eat before they came to the table.  Occasionally there was “surplus” food available at the local “relief office,” and I do recall Dad coming home one time with a gigantic cloth sack of rice.  Subsequently we daily ate every kind of rice dish imaginable long enough that to this day I have an aversion to rice.

As I’ve grown older, I see this as a credit to phenomenal selfless parenting I was afforded. My parent’s ability to sacrifice in order to make me feel safe and secure during a time of extreme poverty is something at which I marvel today. Hence, I didn’t grow up feeling like a victim or insecure.

My father’s friends congregated most nights at our house to discuss their successes and failures at finding work.   I recall lying on the floor listening to their conversations as they discussed strategies or rumors of where a day’s labor might be available amid speculation as to whether they had enough gasoline to get there and back. In retrospect, my father’s home brew was probably the real attraction.  One of those nights comes to mind which I choose to relate in spite of the risk of offending the sensitivities of any SPCA or PETA members who may be reading this.  Dad had received a live rooster in return for some work he had done for a farmer, and when the guys assembled in our cellar for one of the brews, dad decided to offer the rooster a sample.  He gobbled it quickly and was given a refill.  The poor rooster was immediately tipsy and began to stagger around the room, lift his head and attempt to crow.  If he had a hangover, it would have been short lived for he would be in a pot with some drop dumplings the following day.

For many there were no fond memories of those times.  The basics of food and shelter were not available to all.  There were essentially no social safety nets.  In retrospect, it amazes me that there was not more civil unrest or even revolution in the face of such ubiquitous suffering.  I suppose hope stayed alive partially due to Roosevelt’s programs and reassurances that things would improve.  He was a public relations genius and I recall how everyone who could get near a radio would tune in to his “fireside chats.”

The Hobo

The Great Depression spawned a new type of homeless person who came to be called the hobo.   Homeless people were not permitted to sleep in parks or other public places.  There were vagrancy laws which made it illegal to be destitute; consequently many unemployed homeless men kept on the move.  It seems they were much like Forrest Gump who started running and just didn’t stop.  They sometimes hopped freight trains or rode the rails, but could often be seen walking along the highways. Theirs was a rather solitary existence; although through the years they had developed a subculture, and would share with each other the whereabouts of likely places to get free food and other logistical information.  For example they would learn which towns were tolerant of begging and which jails to avoid.   At times there might be chance meetings under a railroad bridge or other secluded spot where several might stay for a few days until rousted out by the authorities.  Their routes of travel tended to follow the seasons much as do migrating birds, and they would rarely be seen in our area when cold weather set in.  Since my grandparents’ farm was located on a well traveled state route they were subject to frequent visits.  The hobo or tramp as they were sometimes called would offer to do work for food.  Grandma would thank him for offering, decline his help, and bring a plate of food out on the back porch for him.  The transaction was mutually beneficial as his hunger was satiated as was her need to do her Christian duty.

After The Great Depression

By the early fo1940s, things were beginning to improve for most families thanks to the war effort.  In short order a decade of massive unemployment morphed into a labor shortage as factories were converted to produce planes, tanks, guns, and ammunitions.  The draft was in full swing, and out of desperation, women were hired to work in the factories.  It has been said that nothing unites a people like a common enemy.  That was certainly the case during WWII, for our hatred focused on those terrible people, the Japs and the Germans.  It seemed as if generations of ethnic strife was put aside in order to deal with a common threat.

My family, as did many others, soon moved to the big city where they both found work in an airplane factory.  My brother was drafted into the army at 18 and a few months later found himself in the Battle of the Bulge. My parents would cringe whenever they saw a Western Union telegraph delivery person in the neighborhood for fear that he would be heading to our house with the dreaded message which began: “We regret to inform you…”

As the months passed, many blue stars hanging in front windows were replaced with gold ones.  At a time when over 60 million people were being killed, not to mention 6 million Jews, it is ludicrous to say this was a kinder and gentler time. However, it does seem in the face of this worldwide catastrophe, people did seem to be more caring.

Following the cessation of hostilities it was not long until anger began to emerge.  The civil rights movement changed laws but I am afraid not many attitudes.  Recently I sense a backlash.  For example things like preferential treatment legislated for minority groups leads to resentment on the people who feel they are being punished for the sins of their fathers.  If history is any judge then these feelings will also fester and conflict will continue as always.

Self-identification is an interesting concept. There are some identifiers we can’t avoid, such as skin color or gender. There are other identifiers we choose, such as religious affiliation or being a member of a fraternity or sorority. It appears humans have always found ways to group themselves to be part of a smaller community versus embracing the idea that we are all part of the human race. We all want to be heard. We all want to be understood. To be loved. To be happy.

It reminds me of a story my daughter tells about her son who attended a Summer Bible Camp with a neighbor. Little did she know the zealous nature of the camp until her six-year-old son told her how each day before lunch, the preacher would call for true Christians to come to the front to be saved. In addition to being saved, they would get a prize from the toy box and a snack. Simon refused to go to the front of the room to be saved by the preacher. His neighbor pleaded with him, “Don’t you want to be saved, Simon? Don’t you want to be a Christian?” to which Simon responded, “I just want to be Simon.”

Ferguson

Now we are once again experiencing violent demonstrations, and there is little sign of true reconciliation.

The frustrations and injustices suffered by the citizens of Ferguson are undoubtedly well founded. They are reminiscent of the riots of 1992 in Los Angeles.  This was precipitated by the beating of a black man by police officers from the LAPD, which was recorded on video tape. His name was Rodney King and his tearful statement was perhaps the most eloquent and wise question of all when he said “Can we all just get along?”   Of course there has been progress in the area of black white relations, and the “N” word has supplanted the “F” word as the most profane of utterances.  But as my grandfather once said, “Just because you don’t say it, don’t mean you don’t think it.”

Like everyone else, I have been following the nearly continuous news briefs on the Ebola epidemic, and feel compelled to express some of my concerns. I have been watching the NIH guy who seems to be on the cable news channels at all hours.  I will give him credit for endurance, but I must confess that I am a bit skeptical of some of his pronouncements.  I get the feeling that his job is to reassure, and that the powers-that-be are more worried about panic amongst the populous than the spread of a virus with a 60% mortality rate.  Contrarian that I am, I can’t help wondering if a bit of low grade panic might be indicated.  As of this writing, the second case of Ebola has been contracted inside the United States.

Let the Blame Game Begin

As has become standard operating procedure, we can now let the blame games begin. The nurses blame the CDC.  The CDC blames the nurses and the hospitals.  The hospitals are quick to retaliate and join the nurses in blaming the CDC.   All this is done using polite terms but the inference is clear.   Predictably, it did not take long for the loudest and most vocal of all blamers to enter the fray—oh yes, the politicians saw this as an opportunity to make hay.   They blamed everyone except themselves.  It seems lost on them that they were the ones who cut the budgets of both the NIH and CDC, or that the position of Surgeon General had been vacant for over a year because they had refused to confirm his appointment, allegedly due to pressure from the National Rifle Association.  Perhaps he was not confirmed because he was opposed to people shooting people.

But do not fear our fearless leaders have already mounted their white horses and are getting ready to convene multiple congressional inquiries. I am sure this will solve the problem in short order.   They are now well rested from their vacation and will be full of vim and vigor.  They will be able to prance and preen, adopt expressions of concern only occasionally glancing at the TV monitors to see if they are being seen back home.  They will give opening statements as to how this issue is much too important to politicize it, prior to launching into a diatribe as to why the opposing party is responsible.  Yes indeed, it is true as someone said, we have the best government that money can buy.

Experts in Incompetence?

I am not convinced that all of the reassurances offered by our experts are justified.   Initially we were told that an infected person was not communicable until symptoms such as fever occurred.  Later that was modified from impossible to “very unlikely.”  We were also told that because this was not an airborne virus, it could only be contracted by direct contact with an infected person’s body fluids.  They did of course include saliva in the list of body fluids that could harbor the virus, and I was reminded of a friend who usually violates my space during a conversation and I find myself recipient of significant amounts of his spittle.  I guess this is not what they meant by “airborne.”

History of the Containment of Viruses before Vaccines

Although I am by no means a virologist or expert in communicable diseases, I was, an eon or so ago, a family doctor in the days before there were vaccines for many of the viral diseases.   Quarantine was our only weapon to prevent measles or chickenpox from infecting an entire school.  Nearly all adults had developed immunity to most of the childhood viruses because they were so prevalent that nearly everyone had been   infected during childhood. For anyone else, even minimal contact guaranteed infection. They all had incubation periods that were quite predictable, as does Ebola.  One of the difficulties in preventing the spread of viruses was the fact that the children were often infectious before they exhibited symptoms. However, tiny lesions inside the mouth called Koplik spots could often be seen a couple of days prior to development of the rash from Measles.   A testament to the success of measles vaccinations is that during a recent outbreak of measles in Southern  California (due to misguided information to parents who refused to have their children vaccinated) there were few pediatricians or family physicians who  had ever seen a measles rash let alone Koplik spots.

The incubation period for Ebola, as for all such viral illnesses, is the time it takes for the virus to replicate itself until there are sufficient numbers to cause symptoms. During that entire time, there are viruses present in the body and I find it difficult to believe that the number of organisms necessary to infect another person is exactly the same as that which will cause a fever.  We were taught in medical school to never use the terms never or always as there are always exceptions.  With this in mind, the idea that one is safe until full blown illness develops seems questionable.

Since there is no definitive treatment for Ebola, it has become necessary to revert to some of the tried and true methods of the past which were used to limit the spread of infectious diseases. Before antibiotics or vaccinations, local health departments were responsible for case finding and initiating quarantines.  It was not unusual to see a card in a window announcing that the family was under quarantine for some of the more serious illnesses, such as scarlet fever.  It was mandated that such illnesses be reported to the local health department whose job it was to monitor the patients, and their contacts.  This was especially true for venereal diseases, and although this could be embarrassing for the afflicted patient, the public’s health trumped privacy or personal embarrassment.  As a matter of fact it was routine policy for a serologic test for syphilis to be done on everyone admitted to a hospital.  Positive results would be reported, even though it was not convenient for an infected person to have his or her spouse notified.

Penicillin and Subsequent Antibiotics

In the 1940s penicillin was developed, which revolutionized the treatment of many bacterial infections.  Other antibiotics soon followed, which were effective in treatment of some of the diseases in which penicillin was not.

Penicillin became the treatment of choice for everything in John Q. Public’s mind, and he wanted a shot of it for every conceivable problem including but not limited to snotty noses, ingrown toenails, and common colds. I recall several instances where patients left my office in a huff after I refused to give them penicillin.  Consequently, penicillin and subsequently developed antibiotics were misused, and given even for viral infections for which they were not effective.  Farmers even now feed antibiotics to their livestock to promote growth so we all may be unwittingly ingesting small amounts of these drugs.  There was also the problem of compliance. Often, people would take their medication long enough for symptoms to disappear before all the offending pathogen could be destroyed.  These factors conspired to result in the development of resistance to the drugs in the case of many bacteria. Now hospitals struggle with trying to rid themselves of MRSA and C-Diff for example, and it is said that 20% of all admissions will develop some kind of infection while hospitalized.  Tuberculosis, which had been all but wiped out is now making a comeback—this time in a form which does not respond to available medications.  It seems we consistently underestimate the versatility and tenacity of those little buggers.   They are too small for us to see, yet they continue to adapt and ultimately outsmart us.

Other Viruses: AIDS and Our Response

Viruses such as flu, AIDS, or Ebola to name a few are a different story. They are not affected by antibiotics; although the so called cocktail of meds has been effective in altering the course of AIDS.  Both AIDS and Ebola originated in Africa, and are transmitted to humans through body fluids.  The vector for aids is thought to be subhuman primates (monkey family) and for Ebola, bats.  Both diseases were thought to be contracted by using their respective vectors for food.

The story of HIV is particularly poignant for there was much misinformation, and discrimination. Since AIDS was thought to have been brought to this country by a world traveling airline attendant, who was apparently quite promiscuous.  He is postulated to have infected many other gay men and initiated the epidemic.*  Consequently, fear was coupled with homophobia, and AIDS patients were subject to discrimination both socially and  in the workplace.  This mistreatment and discrimination was the subject of a Tom Hanks movie in 1993 entitled Philadelphia for which he was nominated for an academy award. As the disease spread through the homosexual community, some TV evangelists preached that this was God’s punishment for the sin of homosexuality.

Ryan White was a 13-year-old hemophiliac who contracted AIDS in the early 1980s from a drug transfusion.  Ryan was the first hemophiliac to contract AIDS, which considered a “homosexual disease” at the time. Due to fear of contagion and the fact that the spread of the disease still wasn’t understood, Ryan White’s middle school expelled him. He and his family were shunned.  The case received international attention as the Indiana teenager fought to be allowed to returned to school. “It was really bad. People were really cruel, people said that he had to be gay, that he had to have done something bad or wrong, or he wouldn’t have had it. It was God’s punishment, we heard the God’s punishment a lot. That somehow, some way he had done something he shouldn’t have done or he wouldn’t have gotten AIDS,” said Ryan White’s mother recounting the early days of his diagnosis at ryanwhite.com.

Soon there was a backlash from saner sections of populous, but as is usually the case, the pendulum swung too far in the laudable direction of preserving privacy.

My Experience with the AIDS Backlash

During the early days of the AIDS epidemic, I was called upon to serve on a panel to discuss the problem.  At the time, the medical community was still learning about the virus and how it spread. I had the temerity to suggest that it might be a good idea to use some of the case finding techniques that had been helpful in the past, by adopting procedures to allow health department workers to find those who had been sexually involved with the identified patient.

The rest of the panel jumped on me with a vengeance for even suggesting that we violate an AIDS patient’s privacy by reporting their illness to an agency.  Their reasoning was that even if the agency honored confidentiality agreements, the contact person would know.  I can’t help but wonder if this refusal to use time honored public health measures didn’t contribute to the rapid spread of the disease.  According to the CDC, there are now 1,100,000 people in the  United States who are  HIV positive 20% of whom are women.  40,000 of these people die each year; although admittedly not all die from AIDS alone.  Many are drug users who use dirty needles and some are prostitutes.   In any event those numbers suggest to me that the AIDS epidemic is not over.

Back to Ebola: We Did Know about It and Chose to Ignore It.

Nearly 20 years ago, Laurie Garrett authored a book titled:  The Coming Plague, newly emerging diseases in a world out of balance. One of the chapters was a history of the 1970s Ebola epidemic, and the heroic virologists who were involved in its study.  It was self contained largely because it affected very rural villages at great distances from each other in Africa.  In many of the villages there was over a 90 percent mortality rate.  It was felt that had it affected areas more densely populated, the effects would have been much more devastating.  The investigators realized this organism had not disappeared from the planet and was likely, even surely, to appear again. But the complacency about which Garrett warned in her book set in, and here we are woefully unprepared.  Could a vaccine have been developed?  Who knows?  What is obvious is that there could be little money to develop treatment for a disease when no one had it.  There was also the problem that it was an African disease, and there has always seemed to be some reticence to spend resources on those folks.  Yes, it appears the world is still out of balance.

Will we learn anything from this episode? I am not optimistic.  Ms. Garrett outlined all of the conditions necessary to virtually guarantee an eventual worldwide pandemic and we do little to change that course or to prepare for what will most probably come.  There have been many other lessons never learned.  Bubonic plague is said to have killed nearly 40 percent of all Europeans.  The flu pandemic of 1917-18 killed 50 million people.  There have been major epidemics recorded throughout history.  Not long ago, we were told that bioterrorism was something we must guard against.  Anthrax, which so far has been susceptible to some antibiotic,s was a suspected weapon.  I take little comfort in the knowledge that no longer are any antibiotics manufactured in the United States.  But, not to worry, I am sure that the countries where they are manufactured would be happy to give us the highest priority in getting us what we need in the event of an epidemic whether man made or naturally occurring.

I imagine that there will be books written about all the major screw ups in our attempts to deal with the current crisis.   The question to be answered is what have we learned?