On inequality and disease.

On inequality and disease.

I should preface these remarks by stating that my political views qualify as “extremely liberal” in the United States.

I’m a well-trained economist – I completed all but the residency requirement for a masters at Northwestern – but I don’t give two shits about the “damage we’re doing to our economy,” except insofar as financial insecurity causes psychological harm to people in poverty.  Our economy should be slower, to combat climate change and inequality.

One of my big fears during this epidemic is that our current president will accidentally do something correctly and bolster his chances of reelection.  The damage that his first term has already caused to our environment and our judiciary will take generations to undo – imagine the harm he could cause with two.

And yet, in arguing that our response to the Covid-19 epidemic is misguided, I seem to be in agreement with our nation’s far right. 

As far as I can tell, the far right opposes the shutdown because they’re motivated by philosophies that increase inequality.  Many of them adore Ayn Rand’s “Who will stop me?” breed of capitalism, as though they should be free to go outside and cough on whomever they want.  They dislike the shutdown because they think our lives are less important than the stock market.

By way of contrast, I care about fairness.  I care about the well-being of children.  I care about our species’ future on this planet.  It’s fine by me if the stock market tanks!  But I’ve written previously about the lack of scientific justification for this shutdown, and I’m worried that this shutdown is, in and of itself, an unfair response.

#

Quarantine could have prevented this epidemic from spreading.  If we had acted in December, this coronavirus could have been contained.  But we did nothing until several months after the Covid-19 epidemic began in the United States. 

Then schools were closed: first for two weeks, then a month, then the entire year.

Stay-at-home orders were issued: first for two weeks, then extended to a month.  No data supports the efficacy of these orders – haphazard, partial attempts at social distancing, from which certain people, like my buddy doing construction for a new Amazon facility, have been exempted.  And no metrics were announced that might trigger an end to the shutdown.

Currently, the stay-at-home orders last until the end of April.  But, as we approach that date, what do people expect will be different?  In the United States, we still can’t conduct enough PCR tests – and even these tests yield sketchy data, because they might have false negative rates as high as 30%, and they’re only effective during the brief window of time — perhaps as short as one week — before a healthy patient clears the virus and becomes invisible to testing.

Based on research with other coronaviruses, we expect that people will be immune to reinfection for about a year, but we don’t know how many will have detectable levels of antibody in their blood.  As of this writing, there’s still no serum test.

#

In the United States, New York City has the largest concentration of risk – densely populated elderly people with constant exposure to unclean air. But even the New York Times has begun to print articles describing the folly of our response to Covid-19.

The Italian government is considering the dystopian policy of drawing people’s blood to determine if they’ll be eligible for a permit to leave their homes.  If you were worried about the injustice that the virus itself imposed on people who are elderly or immunocompromised, this is worse!

We can’t evaluate our response without tests.  Missteps by the CDC (which was gutted by the Trump administration) have left us blind to the progression of the epidemic.  And we can’t evaluate our response if we have nothing to compare it to – we will have to end the shutdown to see what happens next (with the option of resuming these safety measures if our test shows they were necessary).

We know, clearly, that the shutdown has been causing grievous harm.  Domestic violence is on the rise.  This is particularly horrible for women and children in poverty, trapped in close quarters with abusers.  The shutdown is creating conditions that increase the risk of drug addiction, suicide, and the murder of intimate partners.

We don’t know whether the shutdown is even helping us stop the Covid-19 epidemic.  And we still don’t know whether Covid-19 is scary enough to merit this response.  As of this writing, our data suggest that it isn’t.

Covid-19 is a rare breed, though: a communicable disease where increased wealth correlates with increased risk.

And so we’re taking extreme measures to produce a small benefit for the most privileged generation to ever walk the face of this Earth, at the cost of great harm to vulnerable populations.  This is why I feel dismayed.

Hopefully I can present some numbers simply enough to explain.

#

Many diseases are more likely to kill you if you’re poor.

Malaria kills between 400,000 and one million people every year.  The vast majority are extremely poor, and many are children – the World Health Organization estimates that a child dies of malaria every thirty seconds.

Wealth protects against malaria in two ways.  Wealthy people are less likely to live in parts of the world with a high prevalence of malaria (most of the deaths each year occur in Africa and India), and wealthy people can buy effective anti-malarial medications. 

I took prophylactic Malarone when I visited Ecuador and India.  Lo and behold, I did not get sick. 

I believe Malarone costs about a dollar per day.  I am very privileged.

HIV kills between 700,000 and one million people every year.  Again, the vast majority are poor.  HIV is primarily transmitted through intimate contact – exposure to blood, needle sharing, or sex – so this virus rarely spreads across social boundaries in stratified communities. 

In the United States, HIV risk is concentrated among people living in our dying small towns, people without homes in inner cities, and people trapped inside the criminal justice system. 

It seems that these people are all easy to ignore.

Wealth will protect you even if you do contract HIV.  We’ve developed effective antiretroviral therapies.  If you (or your government) can pay for these pills, you can still have a long, full life while HIV positive.  About 60% of the people dying of HIV happen to have been born in Africa, though, and cannot afford antiretrovirals.

Even the myriad respiratory infections that plague our species – of which Covid-19 is but one example – are more likely to kill you if you’re poor.  The World Health Organization lists the top causes of death for people living in low-income versus high-income countries.  The death rate from respiratory infections is twice as high for people living in low income countries.

The second-highest cause of death among people in low-income countries is diarrhea.  Diarrhea kills between one million and two million people each year, including about 500,000 children under five years old.

These deaths would be easy to treat and even easier to prevent. 

Seriously, you can save these people’s lives with Gatorade!  (Among medical doctors, this is known as “oral rehydration therapy.”)  Or you could prevent them from getting sick in the first place by providing clean water to drink.

We could provide clean water to everyone – worldwide, every single person – for somewhere between ten billion and one hundred billion dollars.  Which might sound like a lot of money, but that is only one percent of the amount we’re spending on the Covid-19 stimulus bill in the United States.

We could do it.  We could save those millions of lives.  But we’re choosing to let those people die.

Because, you see, wealthy people rarely die of diarrhea.  Clean water is piped straight into our homes.  And if we do get sick – I have, when I’ve traveled – we can afford a few bottles of Gatorade.

Instead, wealthy people die of heart disease.  Stroke.  Alzheimer’s.  Cancer.

If you’re lucky enough to live past retirement age, your body will undergo immunosenescence.  This is unfortunate but unavoidable.  In old age, our immune systems stop protecting us from disease.

Age-related immunosenescence explains the high prevalence of cancer among elderly people.  All of our bodies develop cancerous cells all the time.  Usually, our immune systems kill these mutants before they have the chance to grow into tumors.

Age-related immunosenescence also explains why elderly people die from the adenoviruses and coronaviruses that cause common colds in children and pre-retirement-age adults.  Somebody with a functional immune system will get the sniffles, but if these viruses are set loose in a nursing home, they can cause systemic organ failure and death.

#

I haven’t seen this data presented yet – due to HIPAA protections, it can’t easily be collected – but Covid-19, on average, seems to kill wealthier people than influenza.

On a personal level, wealth will protect you from Covid-19.  We know that early treatment saves lives, which is a reason why Germany’s death rate is so low, and wealthy people are less likely to postpone going to the hospital.  Wealthy people can afford the Albuterol inhaler that might keep you out of the ICU. Wealthy people are less likely to experience the stresses, sleep loss, and discrimination that have caused disproportionate numbers of Black people in the United States to succumb to Covid-19.

But on a population level, wealth is correlated with increased risk.

Part of this wealth gap is due to age.  I’ve made a rough sketch of the risk of death versus age for both Covid-19 and seasonal influenza.  Currently we don’t have enough data to know exactly where these risk curves intersect, but it seems to be around retirement age.  If you’re younger than retirement age, seasonal influenza is more deadly.  If you’re older than retirement age, Covid-19 is more deadly.

In the United States, if you’re older than retirement age, you’re more likely to be wealthy.

Covid-19 is also more dangerous if you’re already sick.  A study of Covid-19 deaths found that 97% of the people killed were already sick with at least one serious medical condition.  The average person killed by Covid-19 had 2.7 other serious diseases.

Because these people were receiving expensive medical care, they were able to survive despite their other diseases.  Imagine what would have happened if these people had chanced to be born in low-income countries: they would already be dead. 

This is a tragedy: all over the world, millions of people die from preventable causes, just because they had the bad luck of being born in a low-income country rather than a rich one.

We don’t have data on this yet, but it’s likely that Covid-19 will have a much smaller impact in Africa than in Europe or the United States.

When my father was doing rounds in a hospital in Malawi, his students would sometimes say, “We admitted an elderly patient with …”  And then my father would go into the room.  The patient would be 50 years old.

Covid-19 is particularly dangerous for people in their 80s and 90s.  Great privilege has allowed so many people in Europe and the United States to live until they reached these high-risk ages.

#

Our efforts to “flatten the curve,” in addition to increasing many people’s risk of death (from domestic violence, suicide, and the lifelong health repercussions of even a few months of sedentary living), will save relatively few lives, even among our country’s at-risk population.

The hope is that we won’t exceed the capacity of our hospitals.  If someone’s condition deteriorates after a Covid-19 infection, they need invasive ventilation.

Please note that we can often prevent people’s condition from deteriorating by giving them Albuterol inhalers.  And these used to be so cheap!  In the early 2000s, you could buy an inhaler for about five dollars.  But pharmaceutical companies were allowed to re-patent these and the price has soared to nearly four hundred dollars.

Many news reports have included sensational numbers about how many people in their 30s and 40s have gone to the hospital for Covid-19.  These reports rarely mention that many of these hospitalizations could be prevented with a five dollar inhaler.

But we’re allowing drug companies to charge people four hundred dollars a pop for these now, which puts them out of reach for many people.

When I caught what I assume to be Covid-19, I took an inhaler.  I am very privileged.

Some young people can’t afford an inhaler, and many elderly people develop symptoms too severe to be treated with Albuterol, so they need care in an ICU.

But the benefit of this shutdown is simply the difference between how many people would die if we did nothing, compared to how many people will die now. 

In a recent essay, I gave an estimate for how many people would die if we’d done nothing.  New data suggests that my estimate was too low – the numbers out of Italy (where they did nothing until it was probably too late) suggest that around 80,000 people might have died in the United States.  Hospitals would have been overwhelmed, and some people whose condition required invasive ventilation would have been denied that treatment.

Even with the shutdown, though, we’re doing a crappy job.  Our numbers are pretty much guaranteed to be worse than Germany’s, which has a more equitable health care system overall and is testing enough people to track the spread of the disease and treat people early.  With this shutdown, all we’re hoping for is that the severe cases will be spread enough in time that everyone whose condition deteriorates to the point of needing invasive ventilation can have it.

Maybe.  The shutdown is so slapdash that hospitals in certain high-risk areas, like New York City, will still be overwhelmed.

Assuming that our efforts to flatten the curve succeed – and neglecting all the other risks of this strategy – we’ll be able to provide ventilation to everyone.  But there will still be a lot of deaths.  The shutdown will not have helped those people.  The shutdown is only beneficial for the small number who would be treated in one scenario, would not be treated in another, and who actually benefit from the treatment.

The Lancet reported that in the initial wave of the Covid-19 epidemic, 97% of patients receiving invasive ventilation died.  Later on, the death rate among people receiving ventilation was still over 80%

So we’d actually be saving only a fifth of the people who would have to be triaged if we’d exceeded our hospitals’ capacity to provide care.  This could be as few as 10,000 at-risk people.

Their lives matter, too.  Many of us have a friend or relative whose life was cut short by this. But something that we have to accept is that we all die.  Our world would be horrible if people could live forever.  Due to immunosenescence, it becomes increasingly difficult to keep people alive after they reach their 70s or 80s.

And the priorities of elderly people are different from mine.  I care deeply about the well-being of children and our planet’s future.  That’s why I write a column for our local newspaper discussing ways to ameliorate our personal contribution to climate change.  That’s why my family lives the way we do.

These priorities may be quite different from what’s in the short-term best interests of an 80-year-old.

Schools are closed.  Children are suffering.  Domestic violence is on the rise.  All to protect a few thousand people who have experienced such exceptional privilege that they are now at high risk of dying from Covid-19.

Our national response to Covid-19 is being directed by a 79-year-old doctor.  I haven’t gotten to vote in the presidential primary yet, but if I get to vote at all, I’ll be allowed to choose whomever I prefer from a selection of a 77-year-old white man or a 78-year-old white man.  Then comes the presidential election, where there’ll be an additional 73-year-old white man to choose from.

It makes me wonder, what would our national response be like if we were facing a crisis as risky as Covid-19, but where elderly people were safe and children were most at risk?

And then I stop wondering.  Because we are facing a crisis like that. 

It’s climate change.

And we have done nothing.

On attentiveness and names.

On attentiveness and names.

When a scientist first discovers a function for a gene, that scientist gets to name it.  Sometimes these names seem reasonable enough: I worked with a hematologist who did a study to identify proteins involved in apoptosis, which means roughly “programmed cell death” or “cellular suicide,” and so each gene wound up named “Requiem 3”, “Requiem 4,” etc.

Fruit fly geneticists tend to give their discoveries more creative names than other scientists.  There’s the gene “cheap date” – if a fruit fly is missing that gene, it will – ha ha – be unable to process ethanol and  so quickly passes out.  Another genetic mutation produced male flies that would court either males or females, and so this was known for over a decade as “fruity,” until another scientist decided that universal courtship could be less offensively described by the term “fruitless,” because clearly any mating-like activity that does not lead to progeny is a waste of time.

Yup, some gene names were bad.  One person’s idea of a joke might seem to somebody else like a mean-spirited reference to the wider world’s power dynamics.

Other gene names were bad not out of malice, but because humor at the expense of a fruit fly doesn’t make as many people laugh when a human child is dying. 

A gene that produces a somewhat spiky-shaped protein was named after Sonic Hedgehog.  It seemed funny at the time!  See?  The protein is spiky, the video game character has spiky hair, and … get it?  You get it, right?

 Okay, so this Sonic Hedgehog protein doesn’t look all that much like Sonic the Hedgehog.  But spend enough time staring at something like protein crystal structures and you’ll experience pareidolia, like seeing animal shapes in irregularly dappled plaster ceilings, or anthropomorphic gods amongst the twinklings of the stars.

Well, the Sonic Hedgehog protein establishes a concentration gradient that allows cells to recognize their spatial position in a developing body.  If a human fetus comes to term despite having a mutation in the Sonic Hedgehog gene (genetic abnormalities will often result in a miscarriage, but not always), the resulting child will have severe brain defects.

And then a doctor has to explain, “Your baby is suffering because of a Sonic Hedgehog mutation.”

And so, in 2006, geneticists capitulated to medical doctors. No more fanciful names for genes that might lie at the root of human health problems … which, because humans and fruit flies are actually pretty similar, means most genes.  Patients would now be told about a mutation in the SHH gene instead of Sonic Hedgehog, or a mutation in the LFNG gene instead of Lunatic Fringe.

Words have power, after all.


Some people are more attentive to their environments than others.  During evolutionary time, this trait was obviously good for humanity.  If your tribe is traveling through a hostile environment, it helps to have somebody around who is paying attention to the world.  A friend who’s primed to notice encroaching threats like a hungry lion about to leap out and attack.  Maybe we should take a different path.  Which, yeah, that sounds like a good idea.

Other people are particularly inattentive to their surroundings, so it’s easy for them to ignore the world and focus instead on one single problem.  During evolutionary time, this trait was surely good for humanity, too.  It’s helpful to have somebody on the lookout for threats that might eat you, obviously.  But it’s also helpful to have somebody who might discover a way of using dried grass to weave baskets.  A way of cooking mud into pottery that could carry or store water.

Image by Herb Roe on Wikimedia Commons.

Neurodiversity is a virtue in and of itself.  Over the millennia, the world has offered our species many challenges.  Populations that were sufficiently diverse that some members were good at each of a variety of tasks were most likely to flourish.  A cooperative species like termites or Homo sapiens benefits from specialization among its members.

Left to our their own devices, people would naturally fall asleep and wake up at different times.  Some brains are primed to work best in the early morning; others work best late at night.  And that’s good.  It reduces the amount of time that a tribe would be susceptible to attack, everyone asleep.

But in the modern world, we occasionally forget to feel grateful for the diversity that allowed our species to thrive.  The high school students whose brains are primed for late-night thinking drag themselves through morning classes like zombies.  They’ll be midway through first period before the sun rises.  Their teachers glance derisively at their slumped and scruffy forms and call them lazy.


Eventually, humans invented language.  Much later, we invented writing.  Much, much later, we invented the printing press, and then written words became so widely accessible that most humans could benefit from learning how to read.

Of course, reading is easier for people who are inattentive to their environment.

If I had been born earlier in human evolution, I totally would have been lion bait.  When I’m reading a book, or am deep in thought, the rest of the world melts away.  When I’m typing at home, K or the kids sometimes shout my name several times before I even realize that I’m being spoken to. 

People like me, or this kid at a library, totally would’ve been lion bait.

Luckily for me, I wasn’t born way back then.  Instead I was born into a world where inattentive people – the people best able to block out the world and instead focus on their own thoughts – are the most likely to find academic success.  People like me become medical doctors.  Then we get to name the world’s various conditions and maladies.

And so, when it came time to categorize the sort of person who is especially attentive to the world, people like me (who obviously thought that our way of being is the best way to be) referred to those others as having an attention deficit disorder.

Identifying those people’s awareness of their environs might sound like a virtue; instead, we castigated those people’s difficulty at ignoring the world.

I’ve never read the Percy Jackson books, but I’m glad that they exist, if only for passages like this (from The Lightning Thief):

“And the ADHD – you’re impulsive, can’t sit still in the classroom.  That’s your battlefield reflexes.  In a real fight, they’d keep you alive.  As for the attention problems, that’s because you see too much, Percy, not too little.”


Childhood trauma can cause symptoms that medical doctors term “attention deficit disorder.”  Which makes sense – if you’ve gone through an experience where your environs were threatening, you should learn to be more aware of your environment.  It should become more difficult to ignore a world that has proven itself to be dangerous.

Even for somebody with my type of brain, it’s going to be easier to sit outside and read a book when there’s a squirrel nearby than if there’s a prowling grizzly fifteen meters away.

Some children have to learn early on that daddy’s sometimes a grizzly.  And if it can happen to him, why not other grown-ups, too?  Best to stay on high alert around the teacher.  She’s trying to get you absorbed in these number tables … but what if that’s a trap?


Certain drugs can narrow a person’s perception of the world.  They act like blinders, chemicals like nicotine, ritalin, and amphetamines, both un-methylated (sold under the trade name Adderall) and methylated (a CH3 group attached to the amine moiety of Adderall will slow its degradation by CYP2D6 enzymes in the liver, increasing the duration of its effects).

Note to non-chemists: the methylated analogue of Adderall goes by several names, including “ice,” “shard,” and “crystal meth.”  Perhaps you’ve heard of it — this compound played a key role in the television show Breaking Bad.  And it’s very similar to the stuff prescribed to eight year olds.  Feel free to glance at the chemical structures, below.

In poetry class last week, a man who has cycled in and out of jail several times during the few years I’ve taught there – who I’d said “hello” to on the outside just a few weeks earlier when he rode his bicycle past the high school runners and me – plonked himself down in the squeaky plastic hair next to mine.

I groaned.

“I know, I know,” he said.  “But I might be out on Monday.”

“What happened?”

“Failed a urine screen.  But I was doing good.  Out for six months, and they were screening me like all the time, I only failed three of them.”

“With … ?”

“Meth,” he said, nodding.  “But I wasn’t hitting it bad, this time.  I know I look like I lost some weight, dropped from 230 down to 205, but that’s just cause it was hard getting enough to eat.  Wasn’t like last time.  I don’t know if you remember, like, just how gaunt my whole face looked when they brought me in.  But, man, it’s just … as soon as I step outside this place, my anxiety shoots through the roof … “

This is apparently a common phenomenon.  When we incarcerate people, we carve away so much of their experience of the world.  Inside the jail, there is a set routine.  Somebody is often barking orders, telling people exactly what to do.  There aren’t even many colors to be distracted by, just the white-painted concrete walls, the faded orange of inmate scrubs, the dull tan CO shirts and dark brown pants.

The world in there is bleak, which means there are very few choices to make.  Will you sit and try to listen to the TV?  (The screen is visible from three or four of the twelve cells, but not from the others.)  Try, against all odds, to read a book?  Or add your shouting voice to the din, trying to have a conversation (there’s no weather, so instead the fall-back topic is speculating what’s going to be served for dinner)?

After spending time locked up, a person’s ability to navigate the wider world atrophies, the same as your leg would if you spent months with it bundled up in a cast.

And these are people whom we should be helping to learn how to navigate the world better.

“ … so I vape a lot, outside.  I step out of this place, that’s the first thing I do, suck down a cigarette.  And, every now and then … “

He feels physically pained, being so attentive to his surroundings.  And so he doses himself with chemicals that let him ignore the world as well as I can.

And, yes.  He grew up with an abusive stepfather.  This led to his acting squirrelly in school.  And so, at ten years old, medical doctors began dosing him with powerful stimulants.

Meanwhile, our man dutifully internalized the thought that he had a personal failing.  The doctors referred to his hyper-vigilance as an attention deficit disorder.


Words have power.

We can’t know now, after all the hurt we’ve piled on him, but think: where might our man be if he’d learned to think of his attentiveness as a virtue?

On reading poems from Donika Kelly’s ‘Bestiary’ in jail.

On reading poems from Donika Kelly’s ‘Bestiary’ in jail.

This post briefly touches on sexual assault and child abuse.

Many of the men in jail have struggled with interpersonal relationships.

After reading Bruce Weigl’s “The Impossible,” a poem about being sexually assaulted as a child, somebody stayed after class to ask if there were resources to help somebody recover from that sort of experience.  The next week, he brought a two-page account of his own abuse.

After reading Ai’s “Child Beater,” many men proffered their own horror stories.  Sometimes they offered excuses for their parents: “My mom, she had me when she was thirteen, I guess what you’d call it now would be ‘statutory rape.’  So she didn’t know what to do with us.  But there were plenty of times, I’d be mouthing off, she’d tie my arms to rafters in the basement with an extension cord, and … “

Seriously, you don’t need to hear the rest of that story.  Nor the conversation (we’ve read “Child Beater” about once a year) when the men discussed which objects they’d been hit with.  They appraised concussions and trauma with the nuance of oenophiles.

Consider this gorgeous poem by Mouse:

 

THAT CAT

– Mouse

 

We had this cat

Small gray and frantic

Always knocking over my mother’s lamps

 

Me and my sister can’t sit on my mother’s furniture

But that cat can

My mother would whoop my ass for her lamps

Knocked over and broken

 

One day my mom bought me a dollar sign belt

Made of leather and metal

I put that belt to use every time I

Got my own ass whooped

 

We humans evolved to hunt.  By nature, we are a rather violent species.  But these cycles – people’s crummy childhoods; institutional violence during schooling and incarceration – amplify aggression.  Our world “nurtures” many into malice.

If you ask people in jail why they’re in, almost everybody will say that they were busted for drugs or alcohol.  But if you look at bookings, or hear from somebody what sort of case he’s fighting, about half the time it’s domestic violence.

So we’ve been reading poems from Donika Kelly’s Bestiary, a charming volume that uses abundant animal imagery to elucidate human relationships.  The men need a safe space to discuss love and romance.  Obviously, a dingy classroom inside a jail is not the ideal place, but this is what we’ve got.

image (5)

Kelly’s “Bower” opens with:

 

Consider the bowerbird and his obsession

of blue,

 

… then catalogs some of the strange objects that a male bowerbird might use to construct his pleasure dome.  They are artists, meticulously arraying flowers, berries, beetles, even colorful bits of plastic, striving to create an arch sufficiently beautiful that a visiting female will feel inclined to mate.

Among tropical birds with female mate choice, most males will remain celibate.  They try to woo each visitor, but fail.  Usually one single male – he of the most impressive aerial gymnastics (among manakins) or he of the most impressive bower – will be chosen by every female in an area.  Because the males don’t actually raise their young (their contribution ends after the ten or twenty seconds needed to copulate), any given male will have more than enough time for everyone who wants him.

Every male bowerbird devotes his life to the craft, but most of their creations will be deemed insufficiently beautiful.

 

And

how the female finds him,

lacking.  All that blue for nothing.

best

I love the irony of this ending.  This bird’s bower has failed.  The bits of blue that he collected were not sufficient to rouse anyone’s interest in him as a mate.

But life will generally seem pointless if we focus only on goals.  Most bowerbirds won’t mate; Sisyphus will never get that boulder up; you and I will die.    This poem is heartbreaking unless we imagine that the bowerbird takes some pleasure in the very act of creation.

(The natural world is not known for its kindness, but in this case it probably is – because every male bowerbird feels compelled to build these structures, it’s likely that their artistic endeavors feed their brains with dopamine.)

Indeed, most poems that we humans write will go unread.  Even for published poets, it’s probably rare that their words woo a future mate.  But even if Kelly’s own creation did not bring her love (and, based on what little I know about the publishing industry, it almost certainly did not bring her great fortune), it’s clear that all that effort was not for naught.

She made something beautiful.  Sometimes, that alone has to be enough.

At another class, we read Kelly’s “What Gay Porn Has Done for Me.”

Thanks to the internet, many people learn about sexuality from pornography.  One flaw with this “education” is that even when the female actors mime pleasure, they do so while gazing outward.

 

Kelly writes:

 

Call it comfort, or truth, how they look,

not at the camera, as women do,

but at one another.

 

In generic heterosexual pornography, there is a distance.  There is no “relationship” shown between the actors – they’re not even looking at one another.  Instead, the female actor is expected to gaze at a camera, and the (likely male) consumer is gazing at a computer or telephone screen to make some simulacrum of eye contact.

 

Each body is a body on display,

and one I am meant to see and desire.

 

Generic heterosexual pornography seems to objectify the actors much more than gay pornography because the focus is on a performer’s body more than the romantic acts depicted.  Because so much of this pornography is consumed by a homophobic audience, male bodies are depicted minimally – usually only a single organ within the frame – which prevents couples from being shown.

The pleasure offered isn’t quite voyeurism, pretending to watch another pair make love.  It’s fantasy, the chance to imagine being the bearer of the male genitalia.  But this fantasy, independent a fantasy of conversation and mutual seduction, makes others’ bodies seem a thing to be used, not a carriage for the partner’s personality.

 

I am learning

 

what to do with my face,

and I come on anything I like.

 

To desire, and to be desired, need not be degrading for anyone involved.  This is a hard lesson to square with the sort of “sex education” that I received in school, which was sufficiently Christian that sex was presented as both desirable and bad.  If a person thinks that he or she is wicked for wanting, it’ll be hard to discuss what each person wants.

There’s no way to pretend “I’m a good person who just got carried away!” if you make a sober, premeditated, consensual decision to do something bad.

Of course, sexuality isn’t bad.  But many people still posture as thought it is.  When these people feel (totally natural!) desire, they’re forced to create dangerous situations that might excuse their subsequent behavior.

Which, because of those excuse-enabling contortions, often winds up being bad.

image (6)

On clarity, Matthew Zapruder’s “Why Poetry,” and reading Bruce Weigl.

On clarity, Matthew Zapruder’s “Why Poetry,” and reading Bruce Weigl.

Some people approach poems as though they are puzzles.  My high school English teachers implied that poems are full of symbols that we must decode.  Which simply isn’t true.

Billy_Collins_Poet_at_San_Diego_State_UniversityIn Billy Collins’s “Introduction to Poetry,” he exhorts his students to enjoy the experience of reading a poem, of feeling each sound leave the mouth and spill outward into the world.  His students balk.  That’s not how they were taught to read poetry!  Instead, Collins writes,

 all they want to do

is tie the poem to a chair with rope

and torture a confession out of it.

 

They begin beating it with a hose

to find out what it really means.

#

Matthew-Zapruder-Why-PoetryMatthew Zapruder began writing Why Poetry to explain the difference between the idea of symbolism taught in high school – a one-to-one mapping between words on the page and the author’s veiled intent, a parlor trick like the parallels between James Joyce’s Ulysses and Homer’s Odyssey – and actual symbolism employed by regular ol’ human poets.  In Zapruder’s words:

If what we mean by “symbol” is a word or phrase that has some specific, hidden, secret meaning, then we don’t really find those very often in poetry.  The idea that we do is inimical to a true experience of reading it.

When language in poetry becomes resonant, and charged with meaning, it achieves a symbolic status.

Zapruder is saddened that readers think writers would intentionally hide the meaning of their words.  Let alone that writers might actually do it.

Clarity for me in poetry is a kind of generosity, a willingness to be together with the reader in the same place of uncertainty, striving for understanding.  To give the impression that something important is happening but that the mere reader cannot, without some kind of special, esoteric knowledge, have access to it strikes me as deeply ungenerous, even cruel.

#

Our poetry classes in the jail have had high turnover recently.  New Leaf New Life previously ran a “recovery dorm” inside the jail.  The dorm was a miserable little space – an underground concrete room with a shower, a toilet, twelve bunks, and two tables for eating, no exterior windows, just a view of central booking and the elevator – but people chose to live in there, sometimes for years, to have a modicum of autonomy and access to volunteer programming.  Things like our poetry class, AA meetings, a weekly game night.

We were able to work with the same group of people for long stretches of time.  We could provide a full curriculum and work on revising our own writing.  Everyone who wrote for the recent Monster House Press publication was incarcerated in this dorm.

Since this program was canceled (replaced with court-mandated rehab), we’ve been teaching poetry classes only for general population, for people in one of the rowdier cell blocks.  One week, our class was totally derailed by a group of roughnecks extolling the gang control they’d imposed on the block.  Other weeks people come just to grab a pencil and a few sheets of paper, then promptly ask if the guards can come and take them back.  Or, when their block was on lockdown every day for weeks, pushy dudes who didn’t want to read or write would fill the sign-up sheet just for the chance to stretch their legs on the walk down the hallway to our classroom.

Some weeks class falls flat.

I don’t blame them for signing up.  I’ve never lived inside a jail, but it sounds like the pits.  I’d sign up for programs I didn’t care about, too, just to break up the monotony of days.

Still, some weeks we get lucky and have a room full of (unlucky) dudes who really want to read and write.

Since we’ve been seeing so many new people, we’ve been reading poetry by Bruce Weigl several times each year.  Weigl writes powerful narrative poems that deal with trauma and violence.  We begin with “The Impossible,” which opens:

Winter’s last rain and a light I don’t recognize

through the trees and I come back in my mind

to the man who made me suck his cock

when I was seven, in sunlight, between boxcars.

 

I thought I could leave him standing there

in the years, half smile on his lips …

This is a hard poem for guys in jail to read.  It’s a hard poem for anybody to read, but in our classes, particularly, whomever is reading it out loud first might stop at the third line.

AR-160539927The opening is perfect, though.  As with Proust’s mind flooding when he stumbles over a pair of uneven paving stones, or hears a long-forgotten tone, or smells tea and cake exactly like his aunt used to eat, Weigl’s memories swell unbidden when he glimpses light shining through tree leaves in a particular way.  Once, when I was seven, there was just this light … and … and …

He thought he could forget his trauma.  Thought he could “leave him standing there / in the years.”  He was wrong.

Many people who have survived abuse try to forget and move on.  But the memories can fester.  After class one week, a man lingered, asking a guard “Can I … can I talk for him a minute …” and, when the guard nodded, said to me, “Like, something happened to me … kinda like that poem we were talking about … do you … do you think there’s a way I could get some help with that?”

#

spotlight.jpgIn Tom McCarthy’s film Spotlight, a character finally agrees to be interviewed about the priest who raped him.  He is asked how he coped.  He turns out an arm riddled with needle tracks.

Most men in jail suffered disproportionately before they were locked up.  Many began taking drugs in lieu of the psychiatric care they needed but couldn’t afford; now they are addicted.  And behind bars.  Beneath fluorescent lights for nineteen hours a day.  Somehow they are expected to heal there, inside the jail, with even fewer resources before.

“The world needs to know,” we tell them.  “Write about that.”

They balk.  “I can’t write about this shit.”  It cuts too deep, the pain’s too raw … and they feel ashamed.  Our society has a tendency to blame victims.  In an interview with Blast Furnace, Weigl says that his father “was shocked that it had happened because I didn’t tell him at that time.  He said, ‘Why didn’t you tell me?’  I said, ‘Because you would’ve beaten my ass for letting it happen,’ and he knows he would have, too.  That would’ve been his response, Why did you let someone do this to you?

#

But Weigl wrote openly of his trauma, and his words help others come to terms with abuse.  It must feel nauseating to re-live certain experiences in order to write them down – but that act of generosity could save someone else.  And in “The Impossible,” Weigl teaches us how to write about the things that seem impossible to write about.  The poem ends,

Say it clearly and you make it beautiful, no matter what.

On addiction, crime, Buddhism, and exorcism.

On addiction, crime, Buddhism, and exorcism.

2014-01-31demon001In Jason Shiga’s Demon, the protagonist attempts to commit suicide.  Again and again.  Death never seems to take – each time, he wakes intact and offs himself again.

Eventually, the character realizes that he is cursed … or, rather, that he is a curse.  Whenever his current body dies, his spirit takes possession of the next available shell.  Each individual body can be snuffed, but every time that happens, his wants and desires leap into a new home.

*

We incarcerate drug dealers.  But we make little effort to change the world enough to staunch demand.  People’s lives are still broken.  Impoverished, addicted, they’ll buy.  When one dealer is locked up, the job leaps to someone else.

*

Child molesters receive less sympathy than anyone else in jail or prison.  When somebody wants to complain about sentencing, he’ll say “I’m looking at seven years, and that cho-mo got out in two!”  When gangs inside want to look tough, they find friendless child molesters and murder them – these murders might go unpunished.  Many child molesters spend their time in solitary for their own protection, but solitary confinement is itself a form of torture.

Child molesters were often abused as children.  In Joanna Conners’s I Will Find You, she realizes that her rapist was probably re-enacting abuses that he had experienced in prison.

The demon leaps from one shell to the next.

*

During a university commencement address, J.K. Rowling said that “There is an expiry date on blaming your parents for steering you in the wrong direction; the moment you are old enough to take the wheel, responsibility lies with you.”  Perhaps this is helpful for privileged college graduates to hear, but this attitude ignores how brains work.  When we have a thought, the synapses that allowed that thought grow stronger.  We become better at doing things that we’ve already done.

Bad parenting makes certain choices come easier than others.  And then, each time a bad choice is made, it becomes easier to make again.  After a long history of bad choices, it’s difficult to do anything else.  But the initial mistakes were made by a child.  Then these mistakes perpetuated themselves.

We as a society could have helped that child’s parents more – we did not.  We could have helped the child more, perhaps through education, or nutrition, or providing stable work for the parents – we did not.  We could have helped the young adult more, perhaps, at this point, through rehabilitative jails – we did not.

After all our failures to intervene, we must accept some responsibility for the ensuing criminality.

If buying in to the illusion of agency helps you get your work done, go for it.  I too believe in free will.  But we have no idea what it feels like inside someone else’s brain.  If born into someone else’s circumstances, with that person’s genetics, prenatal nutrition, and entire lifetime of experiences, would you have steered to a better course?

*

51ZgODW8D+L._SX330_BO1,204,203,200_.jpgIn ancient Tibetan Buddhist mythology, crimes and addiction are the province of demons.  A person has been possessed – the demon is influencing choices.

This perspective does not deny free will to the afflicted.  It simply implies – correctly – that some decisions will be easier to make than others.  This idea was tested in an experiment asking right-handed people to touch a button near the center of a computer screen.  Study subjects were not told which hand to use, and most used their right.  After a powerful magnetic pulse, people could still chose either hand to touch the button … but pressing it with the left hand suddenly seemed easier, and so that’s what many people did.

Addiction makes choosing not to use drugs more difficult.  Either option is available, but the demon is constantly pushing toward one.

*

In most mythologies, a demon can be exorcised.  In Jason Shiga’s Demon, the protagonist can die permanently only if his body is killed at a time when the nearest available Homo sapiens shell is already possessed.

Existence, for this demon, is a form of torment.  A villain was thrilled to find Shiga’s protagonist … not to do him harm, but as a chance to end the cycle.

*

Some demons might never leave the body.  The brain is plastic, but synaptic connections reflect its entire history.  Even after years clean, addiction lingers.

In Buddhist mythology, even demons that cannot be exorcised can be distracted.  Apparently demons love to guard treasure.  It’s a beautiful image – the demon is still inside, but rather than push its host toward calamity, it hides in a corner, sniggering like Gollum, fondling a jewel-encrusted box.

458309472_48b67b8452_z.jpg

Addicts are shuttered in jail.  The walls are concrete.  Fluorescent lights shine nineteen hours a day.  People weathering opiate withdrawal can’t sleep even during those few hours of dark.  The block is noisy, and feels dangerous.  The brain is kept in a constant high-stress state of vigilance.  Often, the only thoughts that a person has enough concentration to formulate are the easy ones.

Thoughts of drugs.

But poems can be treasures.  If given solace long enough to read a poem, our afflicted might find beauty there.  Something for the demon to guard.

We are not helping people if we insist their penitence be bleak.

*

Many thanks to John-Michael, a wonderful poet & teacher. This essay was inspired by a beautiful book he’s working on.