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 the moon landing, and who benefits if you believe it was faked.

On the moon landing, and who benefits if you believe it was faked.

If you’re worried that you don’t feel enough stress and anxiety, there’s an easy chemical fix for that.  Habitual methamphetamine use will instill intense paranoia. 

In our poetry classes in jail, I’ve talked with a lot of guys who stayed up for days watching UFO shows on TV.  A few were also stockpiling military grade weaponry. One man used strings and pulleys to link his shotgun’s trigger to a doorknob, ensuring that anyone who tried to enter the house would be rudely greeted. 

They’ve dismantled dozens of computers and phones: sometimes out of suspicion, sometimes because there are valuable components. Although they were rarely organized enough to hawk the proceeds of their dissections.

Suffice it to say that, deprived of sleep and dosed with powerful stimulants, their brains became tumultuous places.

Which is why we spend so much time talking about conspiracy theories.

I’ve written several previous essays about conspiracy theories – that the Santa myth teaches people to doubt expertise (children learn that a cabal of adults really was conspiring to delude them); that oil company executives have been conspiring to destroy the world; that, for all the ways Thomas Pynchon’s Gravity’s Rainbow probes at the undercurrents of truth beneath government conspiracy, the text blithely incorporates metaphors from a Disney-promulgated nature conspiracy.

But, with the fiftieth anniversary coming up, the men in my class have been talking more about whether the moon landing was faked.

There’s only so much I can say.  After all, I, personally, have never been to the moon. 

One of my colleagues from Stanford recently conducted molecular biology experiments on the International Space Station, but that’s only zero point one percent of the way to the moon … and she and I were never close enough for me to feel absolutely certain that she wouldn’t lie to me.

Visiting the moon does seem much easier than faking it, though.  Our government has tried to keep a lot of secrets, over the years.  Eventually, they were leaked.

But that line of reasoning is never going to sway somebody. The big leak might be coming soon.

Instead, the strategy that’s worked for me is to get people worried about another layer of conspiracy.

“Let’s just say, hypothetically,” I say, “that we did send people to the moon.  Why would somebody want to convince you, now, that we didn’t?”

When NASA’s project was announced, a lot of people were upset.  Civil rights activist Whitney Young said, “It will cost $35 billion to put two men on the moon.  It would take $10 billion to lift every poor person in this country above the official poverty standard this year.  Something is wrong somewhere.”  (I learned about this and the following quote from Jill Lepore’s excellent review of several new books about the moon landing.)

During John F. Kennedy’s presidential campaign, he argued that we needed to do it anyway.  Despite the challenge, despite the costs.  “We set sail on this new sea because there is new knowledge to be gained, and new rights to be won, and they must be won and used for the progress of all people.

We did reach the moon. But, did we use that knowledge to benefit the rights and progress of all people?  Not so much.

A lot of the guys in jail went to crummy schools.  They grew up surrounded by violence and trauma.  They didn’t eat enough as kids. They’ve never had good medical care.  They’ve struggled to gain traction in their dealings with government bureaucracies … we’ve spent years underfunding post offices, schools, the IRS, the DMV, and, surprise, surprise!, find that it’s arduous interacting with these skeletal agencies.

To keep these men complacent, the people in power would rather have them believe that we didn’t visit the moon.  “Eh, our government has never accomplished much, we faked that shit to hoodwink the Russians, no wonder this is a horrible place to live.”

The fact that people in power are maliciously undermining our country’s basic infrastructure would seem way worse if you realized that, 50 years ago, with comically slapdash technologies and computers more rudimentary than we now put into children’s toys, this same government sent people to the moon. 

Ronald Reagan said, “Government is not the solution to our problem; government is the problem.”  And he was in a position to make his words true – he was the government, so all he had to do was be incompetent.  And then people would hate the government even more, and become even more distrustful of anyone who claimed that good governance could improve the world.

Needless to say, 45 has taken strategic incompetence to a whole new stratosphere.  Beyond the stories of corruption that pepper the news, there’s also the fact that many appointments were never made; there are agencies that, as of July 2019, still don’t have anybody running them.  These agencies will perform worse.

If people knew how good our government used to be, they might revolt.  Better they believe the moon landing was a sham, that the faked photographs are as good as anybody ever got.

Our one and only.

On translation.

On translation.

Before stumbling into a life of drug addiction and bank robbery, the protagonist of Nico Walker’s Cherry served in the Army.  He’s miserable overseas, but, to be fair, he was miserable in the United States, too.  He eventually blames all his problems – the drugs, the crime – on a lady friend’s promiscuous behavior while he was in the service.  He takes great pains to describe all the readily-available sexual encounters he forwent to stay true to her, even claiming that he would not think of anyone else while masturbating.

But he does a great job of describing the misery of military service: the trauma is understated, focusing instead on doldrums and drudgery.

Oo!  Ta-ah!  Here come the Warrior Medics!

The refrain was to go on indefinitely, till we were signaled to stop.  That’s how it went.  And from that day on, whenever the company was called to attention (something that happened no less than a million times on a given day), the company cheer was to be recited in its entirety.  No exceptions.  To make matters worse, after a while it got to be expected that the guidon bearer would do the robot throughout the refrain.

So don’t ever join the fucking Army.

Soon, he is in Iraq.  His patrol relies upon interpreters to communicate with anyone they meet.

The patrol leader asked the mustache haji questions about what he was doing out so late and where he was coming from and where he was going.  An interpreter translated.

The car was clean.

The radio said to let the hajis go on their way.

The patrol leader said to the interpreter, “Tell that that from now on they must respect the curfew.  It’s for their own safety.  They could’ve been hurt out here tonight and we don’t want that to happen.”

And the interpreter said something.  As far as what he said, we’d have to trust him.  So that was that.

American soldiers don’t trust the interpreters, feeling sure their sympathies are secretly with the other side.  As it happens, the Iraqis don’t trust interpreters, either.  By translating, the interpreters keep everyone safe because they allow the two sides to communicate – sometimes words can resolve disputes, instead of bullets. 

But the interpreters themselves were endangered.  In Sympathy for the Traitor, literary translator Mark Polizzotti writes:

As recently as 2011, the Armed Forces Journal reported that interpreters in Iraq were “10 times more likely to die in combat than deployed American or international forces,” because neither the troops they were interpreting for nor the enemy they were speaking to had complete confidence in the fidelity of what they were relating.

Both sides assumed that the translators had some hidden agenda or secret loyalty to the other.  There is always the danger, when we speak for someone else, that our own interests will distort whatever message we’d been expected to deliver.

This happens even with my kids.  Our two-year-old says something to me, then I tell my spouse, “She’s worried because you said that … “

“No,” she interjects.

“What?”

mumble mumble garble digger mumble

Well, great, kid.  I misrepresented your intent, but only because I have no idea what you’re trying to say!

When translating literature, there’s an additional difficulty.  Most languages have ways to communicate common human experiences – what can I eat?, how much will it cost me?, how do I get there?  But literature draws upon the whole set of meanings and associations that link words to concepts.  In general, there won’t be a direct equivalent between languages.

In an essay for the New York Review of Books, Perry Link writes that:

In teaching Chinese-language courses to American students, which I have done about thirty times, perhaps the most anguishing question I get is “Professor Link, what is the Chinese word for _______?”

I am always tempted to say the question makes no sense.  Anyone who knows two languages moderately well knows that it is rare for words to match up perfectly, and for languages as far apart as Chinese and English, in which even grammatical categories are conceived differently, strict equivalence is not possible.

Book is not shu, because shu, like all Chinese nouns, is conceived as an abstraction, more like “bookness,” and to say “a book” you have to say, “one volume of bookness.”  Moreover shu, but not book, can mean “writing,” “letter,” or “calligraphy.”  On the other hand you can “book a room” in English; you can’t shu one in Chinese.

And, beyond the fact that languages differ from each other, every reader is unique.  In “Does Talking About Books Make Us More Cosmopolitan?,” Tim Parks writes that:

To exist as a book, the pages with their letters and spaces need a reader.  We may think of books as unchanging material objects, but they only, as it were, happen when read; they have no absolute identity.  And the nature of that reading – an experience extended over many hours, then mulled over for many more, for the book does not cease to happen the moment we turn the last page – will depend, to a large degree, on who the reader is.

I grew up in the United States, speaking only English during the years when my brain would have absorbed new languages most easily, so I read a lot of literature in translation.  This is suboptimal, I know.  I would enjoy a richer experience of humanity if I could read more of our world’s literature in the original.  But my life would be dreadfully impoverished if not for the charitable exertions of many translators, because then I wouldn’t have a chance to read many stories at all.

I am personally unqualified to translate any piece of literature, or to judge how well a particular translation conveys the sense of the original, as a native speaker who lived contemporaneously to the author might have understood it.  But I am an experienced reader, and I am the reader’s premier expert on the way literature makes me feel.  Occasionally I find myself musing, despite not knowing how to speak the source language, whether I might rephrase certain passages.  Especially when primed with excellent notes, such as in Hayden Pelliccia’s review of two translations of the Iliad.

The Iliad opens with a word generally translated as “wrath,” yet this is the direct object of the first sentence.  In Greek, this makes sense, but in English we identify subjects and objects based upon their location in a sentence.  Pelliccia writes that

The very first line of the Iliad forces any English-language translator to decide immediately and to declare conspicuously whether he would rather be caught betraying his poet or his own language.

I couldn’t help but draft my own variant:

Wrath, hubric wrath of Achilles

As sung by the goddess

Wrought pain & devastation for the Achaians

Droves hurled to Hades, souls hewn from heroes

Their bodies leavings for dogs, a feast for vultures and crows –

So was His plan fulfilled

Set stirring in that moment

Agamemnon and Achilles

Parted in fury.

Obviously my second line fails to convey what Homer wanted – “sung” has a waft of fate to it, as though this story was preordained by the goddess, whereas Homer exhorts his muse to relate the tragedy after it occurred.  My failure is unsurprising, considering both my lack of Greek and Pelliccia’s assertion that every professional translation available to date has failed as well.  But the experience of translation was a success – another reader might well be dissatisfied with my lines, but creating them changed me for the better.

Although Ezra Pound could not read or speak Mandarin, his translation of classical poetry for Cathay had a huge influence on both his own writing and the subsequent work of other English-language poets.  Although Christopher Logue could not read or speak Greek, his adaptation of the Iliad is a fantastic work of poetry. 

Homer lavished attention on the myriad ways that humans might die upon a battlefield.  And in War Music, Logue interlaces Homeric myth with modern nightmare:

         Drop into it.

Noise so clamorous it sucks.

You rush your pressed-flower hackles out

To the perimeter.

         And here it comes:

That unpremeditated joy as you

The Uzi shuddering warm against your hip

Happy in danger in a dangerous place

Yourself another self you found at Troy –

Squeeze nickel through that rush of Greekoid skum!

Oh wonderful, most wonderful, and then again more wonderful

A bond no word or lack of words can break,

Love above love!

         And here they come again the noble Greeks,

Ido, a spear in one a banner in his other hand

Your life at every instant up for –

Gone.

         And, candidly, who gives a toss?

Dead: pointlessly, unmemorably dead.  By depicting the utter dehumanization of war – “who gives a toss?,” and female captives referred to with just the pronoun she, as in the opening scene when Achilles is enraged because Agamemnon announces that “I shall take his prize she” – he demonstrates just how precious life should be.

Logue knew no Greek, but his Iliad changed my life for the better.

On neural plasticity.

On neural plasticity.

After discussing several forms of parasitic mind control during our poetry class in the local jail, somebody asked – somebody always asks – whether there’s some sort of parasite that makes people want to use drugs.

A few guys looked down at the table and nodded.  People are in there for a variety of reasons – domestic violence, burglary, DWIs, dealing or possession – but no matter the charge, many of the guys in jail were dealing with substance use that got out of hand.

I gave the same answer as always.

“Drugs do it on their own.  Chemicals can remodel your brain to make you want them again.  Like cocaine, it’s a dopamine re-uptake inhibitor, so if something makes you happy after coke, it’ll make you more happy than it would’ve … but your body responds by down-regulating the receptors, and then you’re stuck feeling less happy all the time unless you take it again.”

1024px-Crystal_Meth

But it’s not all bleak.  Drug addiction takes hold because the brain is plastic – our minds change and we want that rush again, potentially to the exclusion of all else – but neural plasticity allows people to recover, too.  Dopamine receptor levels fall during periods of excessive drug use, but they’ll rebound during sobriety … and this rebound should attenuate the desire to use again.

Dopamine_D2_Receptors_in_Addiction.jpg
Repeated exposure to drugs depletes the brain’s dopamine receptors, which are critical for one’s ability to experience pleasure and reward. From Wikimedia Commons.

(Unfortunately, the lecturers in our area’s court-mandated rehab courses have been telling people that, “After you take methamphetamines, it takes eight years of sobriety before your dopamine receptor levels come back.”  This sounds wrong to me – I don’t know the half-life of dopamine receptors, but the timing of sensitization and de-sensitization in conditions like bipolar disorder and antidepressant-induced mania suggests that it’s on the order of a month or so, not years – and it’s definitely unhelpful to say.  If you’re trying to help someone quit taking drugs, you want their goals to be feasible.

A former co-teacher tattooed “Day By Day” on his arm because quitting forever seemed impossible, but getting through one more day without drugs sounded like something he could do.  He’s now weathered five years of single days.  But if I felt like garbage and an instructor told me, “You’ll only feel like this for eight more years!”, I’d give up immediately.)

I don’t really understand Scientology – all my current knowledge comes from a single episode of South Park and a few minutes spent skimming through the Wikipedia article – but I was intrigued by the practice of using “E-meters” to measure a person’s cognitive development in the faith.  It made me wonder whether the sort of person who was interested in biofeedback and numerical metrics – somebody who tracks steps with a Fitbit or the gasoline saved on a Prius console – could use self-administered polygraphs for cognitive behavioral therapy.

800px-Scientology_e_meters_green_black_cropped
An E-meter.

It’s well-known that polygraphs are fallible – you can fail them when you’re telling the truth, and you can learn to pass them while lying – but I imagine that the easiest ways to pass a polygraph is to convince yourself that whatever you’re saying is true.  There many physiological correlates to dishonesty – skin voltage, electroencephalogram patterns, eye movement, vocal tones – and by convincing yourself to earnestly believe whatever you happen to be saying, you could pass any of them.

Because you can cheat, U.S. courts generally don’t trust the results of lie detector tests.  In the pursuit of justice, cheating would be bad.  But as self-administered therapy, cheating is the whole point.  You cheat at lying until the lie becomes the truth.

“I like myself and I am worthy of love and self-respect.”

Rig up your polygraph and say something like that until the machine stops dinging you.  Do it daily.  Your brain is plastic, designed to learn and change.  Your words will become true.

On Finn Murphy’s “The Long Haul” and our dying towns

On Finn Murphy’s “The Long Haul” and our dying towns

In Jason Shiga’s Empire State, the protagonist decides he will “see America” by traveling from Oakland, CA to New York City on a bus.  Everyone derides the plan as foolish – he’ll see only the great big slab of I-80 and some gas stations – but, because he’d kept his plan secret to surprise a friend, nobody warns him until it’s too late.

Professional movers, however, take occasional breaks from the highway to navigate their trucks down treacherous suburban streets.  It’s those excursions into the world where people actually live that lets movers understand America.  Crisp descriptions of those excursions make Finn Murphy’s The Long Haul: A Trucker’s Tales of Life on the Road a charming read.

Murphy’s experience criss-crossing the United States has also give him a sharp perspective on our economy.  His political analysis is both more accurate and more concise than what’s been written by most academic researchers:

9780393608717_p0_v2_s192x300.jpgThe next day I picked up I-94 west and stopped for the night in Ann Arbor.  In college towns – like Chapel Hill, Boulder, Iowa City, Missoula, Austin, Madison, and Oxford, Mississippi, to name a few – all of a sudden, instead of unemployment, meth labs, and poverty, there are real jobs. As far as I can figure, the only places left in America that can boast of vibrant downtowns are college towns and high-end tourist towns.  In the rest of the country the downtowns were hollowed out when nobody was looking.  You might think it’s only your town that’s been ruined by sprawl, but it’s happened everywhere.  You’ve got the new CVS, the Walmart, the Home Depot on the fringes, while the old downtown is either empty or the buildings have a Goodwill store, an immigration law office, and an “antiques” store, meaning junk.  The chains on the outskirts provide the nine-dollar-an-hour jobs and wire the day’s receipts to Bentonville or New York every night.

I hate it personally, but we deserved what we got.  We wanted the eight-dollar sneakers and the forty-five-cent tube socks.  We didn’t consider that maybe it’d be a better bargain to pay twenty dollars for sneakers and buy them from the neighbor who owns the shoe store downtown and stocks sneakers made in Maine.

It’s too late now.  The game’s been won by companies who don’t give two shits about community character or decent jobs.  Congratufuckinglations, America!  We did the deal.  Now we’ve got an unlimited supply of cheap commodities and unhealthy food and crumbling downtowns, no sense of place, and a permanent underclass.

If a tourist poster of America were made with some verisimilitude, it would show a Subway franchise inside a convenience-store gas station with an underpaid immigrant mopping the floor and a street person at the traffic light holding a cardboard sign that reads ANYTHING HELPS.

#

Most of The Long Haul is more chipper than the passage I’ve excerpted above – Murphy discusses how he chose his career, the basic principles of long-haul driving and packing other people’s belongings, the zen of hard manual labor, and what it meant to finally let go of his own anger and enjoy his time on this planet.  Both K and I loved the book.

But I wanted to share the passage above.  I’ve written previously about common misconceptions regarding “free-market capitalism” – a quick summary being that although the phrase “free-market capitalism” is used so commonly that most people sense intuitively what it means, it doesn’t actually mean anything.  To have a market, it cannot be free.  (This idea is explained succinctly in the beginning of Robert Reich’s Saving Capitalism – you can read an excerpt in the essay linked above.)

As a handful of business owners and CEO destroy the social fabric of the United States, they depend upon government intervention to help them do it.  They need the government to enforce payment on certain types of contracts, but not others.  They need the government to prevent certain actions that lower others’ property values – I’ll be punished if I set fire to your building – but not others – I won’t be punished if I dump so much poison that your neighboring property becomes un-usable.

Our country’s particular set of rules & regulations have allowed a small number of people to accomplish what used to be the work of many.  Instead of a factory with 100 human workers, a foreman oversees 10 robots.  The foreman gets paid more than the prior workers, but most of their salary now goes to the factory owner.  And those 100 people who would have worked in the factory are mired in despair.  Some get service jobs.  Others take drugs.  We get the “unemployment, meth labs, and poverty” that Murphy described.

And even the relative prosperity of the main street in college towns is fragile.  In Bloomington we have several blocks with bookstores, comic shops, restaurants, bars, a public library, banks, clothing boutiques and smokeshops and the like.  But in the past few weeks, an escalating conflict between the police and people without houses has kept shoppers away from the downtown.

Herald Times front page
A recent front page from the local newspaper.

Indiana is in many ways a heartless state, so our little town is one of the few places where people in need can receive services.  Bloomington always has more poverty than you might expect for a city of just 100,000.  Of late, Bloomington is also a destination city for drug use: between the heroin cut with fentanyl and the wide variety of supposed THC analogs sold as “spice,” the ambulances have been responding to upwards of ten overdoses per day.

In jail the other day, T. told me,

“It’s getting to the point where heroin and meth are easier to find than pot.  When I got out of prison, I was three years clean, and I thought I was gonna make it … but I was walking by the Taco Bell and somebody handed me a rig, all loaded up and ready to go.”

G. said,

“It’s really hard to avoid it now.  It’s spread to places you really wouldn’t expect.  Like I remember ten years ago, the whole middle class crowd was doing the usual, some pot, some psychedelics, you know.  But now people from those circles, they’re shooting meth, they’re using H.”

T. said,

“You talk to somebody, they’re like, yeah, I got it all, what you need, what you need.  But you ask for pot, they’re like, naw, I don’t know where to get that.”

J. said,

“Okay, okay, these overdoses, you know?  Trust me, I’m a real spice-head, I smoke a lot of that shit, and these overdoses, they’re all just people, they don’t know how to handle it.  You can’t just jump in, you know, and smoke like I smoke.”

I asked him, “If pot were legal, would you smoke it.”

“Hell yeah I’d smoke pot.”

“No no, sorry, I mean, if pot were legal, would you smoke spice?”

The guys all laughed.  “Nobody would touch that shit.”

And yet.  In our town, now, people with all their belongings line main street.  The hospital spends some thirty thousand dollars a day sending the ambulance there for overdoses.  The cops hold their roll call several times a day in the public park where unhoused people used to sleep.  Occasionally a dozen or so people will be hauled into jail: they lose all their possessions.

And people who had been spending money at the little shops feel afraid to go downtown.  The places are all losing money … and when the money goes, compassion starts fading too.

It doesn’t take much for even a college town to become the post-apocalyptic husk that Murphy has seen spread all over our country.  Which is sad, especially since it wouldn’t take that much to help people – our most dire need is a guaranteed basic income, probably coupled to a public works program.  Instead we’ve settled for rampant inequality.  But harms that start elsewhere won’t stay elsewhere.

*******

post-script: in the time between when this essay was written & when it was posted, the crowds of unhoused people have disappeared from Bloomington’s main street.  And, two blocks away, the 280-bed county jail has had over 320 people locked inside for weeks.  Somehow, this doesn’t seem like a long-term solution.