War Requiem

https://i1.wp.com/news.bbc.co.uk/nol/shared/spl/hi/picture_gallery/07/magazine_faces_of_battle/img/3.jpg

War — the cost of war — seems worth consideration on the occasion of Memorial Day 2010. Perhaps you have seen the movie Brothers. It will be in the same spirit, I hope, that I reflect a bit on the cost that any war brings, however necessary it might be. I will do this by quoting two poems and directing you to some wonderful music using poetry as text.

World War I,  “a war to end all wars” according to President Woodrow Wilson, generated lots of verse. British poets, in particular, found the pity in wartime, and as Wilfred Owen wrote, “the poetry is in the pity.” Owen fought and wrote about fighting, as in a letter to his mother just after his arrival in France:

“I can see no excuse for deceiving you about these 4 days. I have suffered seventh hell.

I have not been at the front.

I have been in front of it.”

The 25 year-old Owen was to die in battle just one week before the armistice on November 11, 1918.

When Benjamin Britten, the pacifist English composer, was commissioned to write music in honor of the reconsecration of Coventry Cathedral in 1962 (which had been destroyed in World War II), it was Owen’s World War I poetry and the Latin Mass for the Dead to which he turned. The piece, for large orchestra (with the addition of a chamber orchestra), three vocal soloists, and chorus, alternately rages against and laments the ravages of wartime.

The War Requiem ends with the Owen poem Strange Meeting, sung at the première by an English tenor and a German baritone, no coincidence as England and Germany fought against each other in both World Wars.

In this poem (excerpted below), the narrator finds himself in the bomb shelter and sleeping quarters below the trenches of the enemy, “down some profound dull tunnel,” as part of a night raid where he encounters dead and dying soldiers. There, he and his enemy recognize their shared human bond:

…Then, as I probed them, one sprang up, and stared
With piteous recognition in fixed eyes,
Lifting distressful hands as if to bless.
And by his smile, I knew that sullen hall
By his dead smile I knew we stood in Hell

“Strange friend, ” I said, “here is no cause to mourn.”
“None,” said the other, “save the undone years, the hopelessness.
Whatever hope is yours, was my life also…
For by my glee might many men have laughed,
And of my weeping something had been left,
Which must die now. I mean the truth untold,
The pity of war, the pity war distilled.
Now men will go content with what we spoiled,
Or, discontent, boil bloody, and be spilled…

I am the enemy you killed, my friend.
I knew you in this dark: for so you frowned
Yesterday through me as you jabbed and killed.
I parried; but my hands were loath and cold.
Let us sleep now…”

The English language changed because of World War I. Phrases and references to the word “trench” became part of common parlance, as in the phrase “in the trenches” which still refers to working at a hard, grinding task; and even the phrase “trench foot,” which led back to a type of frost bite common in the muddy, cold, wet, and verminous condition of those dark places inhabited by the warriors.

Or, how about “trench fever,” a bacterial infection associated with the lice that bred there. The expression “No Man’s Land,” plays back to the space between the trenches — between you and the enemy trench — which could be a few hundred yards. It was the place belonging to “no man” or side in the conflict, and it was the place where no man could easily survive. So too, when one army decided to launch an attack on the other, they had to go “over the top” of the trench and into hostile fire.

But it was to a much earlier use of the trench in warfare that the poet Patrick Shaw-Stewart would refer.

Patrick Shaw-Stewart was born on 17 August 1888 in Wales, and fought as part of the British Expeditionary Force at Gallipoli on the Chersonese peninsula during World War I, not far from the site of the Trojan War.

Gallipoli was a disaster for the British. Shaw-Stewart was on three days leave from the front on the island of Imbros when he wrote the untitled poem that follows. It refers to the Trojan War as represented in The Iliad, so a little background is required to better understand it.

The war began soon after the Trojan prince Paris abducted Helen, the most beautiful woman in the world, but the wife of one of the Greek kings (Menelaus). The Greeks organized their own expeditionary force and followed Helen to Troy so they might retrieve her.

Many years into the conflict, Achilles, the greatest of the Greek warriors, stopped fighting because the leader of the Greeks (Agamemnon) had taken away Achilles’ concubine. Achilles’ rage and his decision not to fight is called “The Wrath of Achilles.” In addition, Achilles knew if he returned to battle he would not survive the war. Despite this, he resumed the fight and turned its tide, with the goddess Athena beside him, both shouting in a trumpet-like, horror-inducing scream to make the Trojans flee.

Achilles and Athena stood at the ditch in front of the wall built by the Greeks to protect their ships. Achilles’ head was surrounded by an aura of flame created by the goddess (to which the poet refers in the heart breaking last stanza), so better to terrify the Trojans, who panicked and ran away.

Shaw-Stewart tells his own Illiad-like war story from the standpoint of his temporary leave from fighting:

I saw a man this morning
Who did not wish to die
I ask, and cannot answer,
If otherwise wish I.

Fair broke the day this morning
Against the Dardanelles ;
The breeze blew soft, the morn’s cheeks
Were cold as cold sea-shells

But other shells are waiting
Across the Aegean sea,
Shrapnel and high explosive,
Shells and hells for me.

O hell of ships and cities,
Hell of men like me,
Fatal second Helen,
Why must I follow thee?

Achilles came to Troyland
And I to Chersonese :
He turned from wrath to battle,
And I from three days’ peace.

Was it so hard, Achilles,
So very hard to die?
Thou knewest and I know not-
So much the happier I.

I will go back this morning
From Imbros over the sea;
Stand in the trench, Achilles,
Flame-capped, and shout for me.

Much like Achilles, Patrick Shaw-Stewart survived the Gallipoli campaign, but not the war.

He was 29 at the time of his death.

Fear of Change: the Therapeutic Implications of Japanese Holdouts

Onoda-young.jpg

Things change. The question is, do we change with them? Or, do we instead, continue to operate by the same outdated rules of conduct.

I often said to my patients that they seemed to be behaving as if the conditions of their early life still existed. They had long since fashioned solutions to problems that they faced many years ago, and continued to use the same solutions, even though those methods of living didn’t fit with their current life situation. It is as if one were born in Alaska, learned to wear multiple layers of heavy clothing and then moved to the tropics without a change of attire. The warm clothes were helpful up North, but are a disaster down South.

What does this have to do with the “Japanese Holdouts of World War II? The answer is that these men lived by an outdated set of rules with heartbreaking consequences.

If you recall your history lessons, you will remember that the Japanese soldiers of that period were trained according to the principles of Bushido, a feudal fighting code that derived from the period of Samurai warriors. Above all else, weakness was condemned and surrender was disgraceful. Death by one’s own hand was seen as preferable to permitting oneself to be captured, so as to avoid both personal disgrace and family shame.

The Allied approach to the war against these very soldiers in the Pacific was one that involved “island hopping.” The strategy passed over certain islands, both to save men and ensure that the Allies would be able  to capture those islands that were of the greatest strategic value. When the Japanese surrender came in 1945, numerous Japanese troops found themselves stranded on out-of-the-way Pacific islands, cut-off from their command, and without the capacity for communicating back home. These men neither knew the war was over nor could imagine that any honorable soldier, let alone their entire nation, would surrender. Some were in small groups who gradually died from disease or starvation; others were, at least eventually, alone.

While many never surrendered and died still waiting for reinforcements that never came, it was not uncommon in the late 1940s and 1950s to read news accounts of isolated Japanese combatants giving themselves up. The photo at the top of this page is of Second Lieutenant Hiroo Onada, who finally surrendered in 1974, and would not do so until his former commanding officer, by then a bookseller, personally ordered him to lay down his arms.  At that point, World War II had been over for nearly 30 years.

Thirty years. Yes, 30 years dedicated to a war that was over and a life of desperation that was no longer required.

But how many years, if any, have you given up to a thread-bare, bankrupt strategy of living that has long since outlived its usefulness?. And, more to the point, how many more will you endure? When will you realize that your “solution” has now become the problem?

In my psychotherapy practice I saw numerous variations on this theme. People who were abused or neglected  or criticized as children and who continued to live in terror of disappointing others. Those who found substance abuse the only available way of treating the depression or anxiety they experienced when they were young, and who continued to do so. People who avoided challenges because they were scared of failure, having failed many times in the past. Individuals who wore a chip on their shoulder, forever sensitive to insults and injuries that reminded them of long ago attacks, but now were only injurious in their imagination. And those poor souls who expected rejection because of past rejection. Like the Japanese holdouts, the years pass but the fear doesn’t, and the possibility of satisfying relationships and happiness slips away.

If you still are responding to the present as if it were the past, with solutions that solve little (even if they were once necessary), then it is time to change your life. The barricade of your life’s defenses might be protecting you only from the phantom of an enemy who lives within you, not on the other side of the fortification.

A good therapist is likely to be able to help you develop a new way of living, one more appropriate to the world as it is, not the world as it was; to set aside and heal old wounds.

Is it time?

What is the continuation of your old way of living costing you?

The war, your personal war, might just be over and you don’t know it.

Moms on Mother’s Day

Nurturing, caring, loving, concerned, patient, compassionate, expressive, reliable, watchful, tender, giving, interested, independent, graceful, affectionate, accepting, enthusiastic, encouraging, strong, wise, and kind

or

preoccupied, worried, stressed, indifferent, cold, selfish, shrill, overwhelmed, judgmental, angry, impulsive, erratic, hard, numb, inconsistent, weak, troubled, vain, dependent, clumsy, clueless, and cruel.

As a parent and as a child, here’s hoping you came out and come out on the right side of this.

https://i2.wp.com/upload.wikimedia.org/wikipedia/commons/thumb/e/ea/Caravaggio_FlightIntoEgypt_detail_Mary_and_Child.jpg/256px-Caravaggio_FlightIntoEgypt_detail_Mary_and_Child.jpg

Rest on the Flight Into Egypt (detail) by Caravaggio

Sex and (S)ex-pectations

Sexual performance.

There, I said it. Of all the things men hate to talk about in any realistic detail, this is it, with the possible exception of colonoscopies. Oh, young men in the cloistered confines of a locker room will talk about their prodigious sexual performance; occasionally, those self-proclaimed exploits even bear some resemblance to the truth. But, too often, the male of the species wants his male acquaintances to believe that he is some sort of super-hero, capable of great feats of stamina, if not strength, that are well-beyond his actual capacity.

In reality, the fact that the sexual organ of the man can be observed by his partner contributes to the performance anxiety of many men. Even those males who are relatively secure might wonder how they compare to other men.

My purpose here is to provide a bit of grounding, just a little bit of the truth, so that you or your lover do not need to feel inadequate. To wit:

1. It is infrequent for any couple to be able to sustain intercourse for more than 12 to 15 minutes.

2. More typically, the intercourse lasts from two to seven minutes.

3. The entire sexual encounter typically takes from 15 to 45 minutes.

4. Even among sexually content and well-matched couples, less than 50% of the sexual encounters are optimal.

5. There is a great deal of variability here, and things like timing, affection for one another, alcohol or drug abuse, age, time of day, stress, and physical problems all play their part and influence what happens.

There. I hope you don’t feel so bad.

If you’d like to know more, you might want to consult various of the publications of Metz and McCarthy including Coping with Premature Ejaculation and Coping with Erectile Dysfunction.

The image comes from the Dancehouse Theatre’s “Kiss Bike Kiss” at the Manchester Bike Culture Festival of 2008.The author is Echomrg and it is sourced from Wikimedia Commons.

Health Care Reform and Unintended Consequences: A Prediction

Health care reform has been necessary for a long time. But having said that, I’d like to give you an example of how the expected changes might lead to some unfortunate results, as well as some that are helpful.

My example will focus on Medicare. Everyone knows that Medicare is expensive for the government and that it will ultimately suck the life out of the national economy if costs are not restrained. One way to restrain costs is to require physicians to accept lower fees for their services, something that Medicare has struggled to do for a while, even before passage of the recent health care legislation. Providers are already getting paid less than they were a few years ago, but even more extensive mandated annual changes have been regularly rescinded by the Congress. If they are actually accomplished in the future, Medicare would pay out still less to those same MDs, Ph.Ds, and other health care professionals.

What will happen when reduced fees become more significant? Some healers will decide that it is financially unwise to see patients who are covered by Medicare. They will drop out of the Medicare panel of providers. The greater the fee reductions, the smaller the number of physicians available to see Medicare patients, while at the same time the number of individuals covered by insurance is increasing, led by the large expected additions to the rolls of the insured because of recently passed health care reform legislation.

Let’s say you are the following person: someone covered by Medicare who doesn’t have the cash to pay for treatment out of your own pocket, who also has a medical problem or concern that cannot wait very long. The good news in this hypothetical example is that your MD still accepts Medicare. But when you call your doctor’s office, you are told that you can’t have an appointment for four months—again, hypothetically speaking. The problem and the pain aren’t getting any better in this period of time, maybe they are even getting worse. So what should you do?

First, you will probably try to find another medic who accepts your insurance and has a nearer-term appointment for you. But given the anticipated shortage of people who do take Medicare patients, it will be unlikely.

Eventually, however, you will do what any sensible person would do once the problem becomes really acute—and what your doctor’s office will probably advise you to do under the circumstances—go to the emergency room of your local hospital.

Since emergency room care is notoriously expensive and since the condition might be harder to treat because you waited, this will only serve to drive up the amount of money spent on health care, something that the intended reduction in doctor fees was expected to reverse. Whether the decrease at one end will outweigh the increase at the other, I do not know.

And, instead of the growing number of  people who had no health insurance being the impetus for the increased use of the ER, it will now be people with health insurance who are using it more because they have no other readily available alternatives.

I don’t have a handy solution to this problem. My hunch is that there is some amount by which doctor’s fees can still be cut before they start dropping out of the Medicare system in large numbers. It may be that only trial and error will determine exactly how much cutting is possible before producing the unintended consequences I’ve described. The good news, however, is that where there is a high demand for services, eventually supply does catch up, although in the case of producing more docs it will takes years to do so.

Surely, there will be many more unintended consequences of health reform just around the corner. Some might actually be beneficial, but certainly not all. The system we have is not working well for many of our fellow-citizens, so the status quo is not a good answer. Doubtless, once legislators hear enough complaints about problems such as the one I’ve described, they will attempt to alter the system further. How long it takes before we get something that works well is unknown. It is likely that we will eventually have a two-tiered system: a universal, government-run insurance plan on one side, and some number of pretty rich people simply paying for health services out of their own pockets on the other.

In the short run, all of this reminds me of an old joke Woody Allen told at the end of one of his nightclub routines.

It went something like this:

I’d like to leave you with a positive message.

But I can’t think of one.

Would you take two negative messages?

Jackie Robinson, Ford Frick, and the National Health Reform Debate

https://i0.wp.com/blogs.dallasobserver.com/sportatorium/Jackie%20Robinson.jpg

With even one eye shut and one ear covered it would have been hard to miss all of the acrimony expressed by and toward our elected representatives in recent days. And, some are saying, that this is unprecedented—this loss of civility, this frank hatred, including acts of vandalism and threats of murder.

Many are decrying the failure of some Republican politicians to rebuke the hate-mongers in an unconditional and decisive fashion, as Republican Representative John Boehner has: “I know many Americans are angry over this health insurance bill, and that Washington Democrats just aren’t listening. But, as I’ve said, violence and threats are unacceptable. That’s not the American way. We need to take that anger and channel it into positive change.”

Well, unfortunately, angry words and angry actions are really nothing new in “The Land of the Free and the Home of the Brave.” You will find them on both the political left and the political right within living memory: the violent “Weather Underground” of the Vietnam War era, The Black Panthers, the lynchings of blacks in the period between the end of the Civil War and the passage of Civil Rights legislation, the hate crimes against gays, the gauntlet of verbal abuse shouted at black children trying to integrate the schools of Mississippi and Alabama in the mid-20th century, the bombing of abortion clinics; the Oklahoma City bombing; the assassinations of JFK, Martin Luther King, and Robert Kennedy; and on and on.

But, every so often in the midst of all this angst—this stuff that makes one despair about the human condition—someone stands up and does something remarkable; something that makes you proud to be an American, and hopeful about the future of the human race.

Turn the page of your history book back to 1947 and to Jackie Robinson of the Brooklyn Dodgers, the first black man permitted to play in the Major Leagues in the 20th century. What follows is heavily dependent upon (and quotes from) Jules Tygiel’s Baseball’s Great Experiment: Jackie Robinson and His Legacy.

Robinson faced a revolt by some of his own teammates who attempted to organize a petition against him. Kentucky-born Pee Wee Reese, who was to become a great friend and supporter of Robinson, later remembered, “In the park that I grew up in, there were no blacks allowed. Blacks got in the back of the buses, they had a special fountain to drink from. I don’t guess that I ever shook the hand of a black person.” Reese expected Robinson to fail because white people in his part of the country always believed that Negroes had no guts.

“You hear this all your life, you believe it.”

The petition died aborning because most of the players would have no part of it, and because of threats from management. But the bigoted sentiments were still there for Robinson to deal with. His teammate Kirby Higbe was asked on a radio interview how he’d come by such a strong arm. His answer? From pelting Negroes with rocks.

Dodger manager Leo Durocher laid down the law: “I don’t care if a guy is yellow or black, of if he has stripes like a f___in’ zebra. I’m the manager of this team and I say he plays.”

The Philadelphia Phillies were the worst of the race-baiters. Led by Alabaman Ben Chapman, the Phillies showered unspeakable derision on Robinson in their first series with the Dodgers early in the 1947 season.

According to Harold Parrott, “At no time in my life have I heard racial venom and dugout abuse to match the abuse that Ben sprayed on Robinson that night. Chapman mentioned everything from thick lips to the supposed extra-thick Negro skull…(and) the repulsive sores and diseases he said Robinson’s teammates would become infected with if they touched the towels or combs he used.”

Chapman knew that Robinson couldn’t fight back because of the disruption that would cause, the very thing that many predicted and used as an excuse to defend the segregation of the Major Leagues. Everyone soon came to know that Robinson, who received varsity letters in four sports at UCLA, was a sitting duck. “Plenty of times I wanted to haul off when somebody insulted me for the color of my skin,” Robinson later said. “But I had to hold to myself. I knew I was kind of an experiment…The whole thing was bigger than me.”

One teammate thought that Robinson, the sole black on the field, was the loneliest man he had ever seen. Red Barber, the Dodger’s radio announcer, said that Robinson was the only man he had ever seen who could actually play better when he was angry.

The death threats flooded in—the people who wrote that they would be carrying a rifle into the ball park to kill him. Opponents tried to spike him, pitchers threw at his head and body. Even his Southern teammates received hate-mail for allowing themselves to take the field with a “n____r.”

But Robinson’s teammates stood up to Ben Chapman and the Phillies. Fellow Alabaman Eddie Stanky called Chapman a coward. Meanwhile the St. Louis Cardinals baseball team plotted a May strike against Robinson and the Dodgers. Ford Frick, the National Baseball League President, quashed the strike and faced down the Cardinals:

If you do this you will be suspended from the League. You will find that the friends you think you have in the press box will not support you, that you will be outcasts. I do not care if half the league strikes. Those who do it will encounter strict retribution. They will be suspended, and I don’t care if it wrecks the National League for five years. This is the United States of America, and one citizen has as much right to play as another.

The National League will go down the line with Robinson whatever the consequence. You will find that if you go through with your intention that you will have been guilty of madness.

As I said earlier, we have been here before, in this dark place in America that seems to surface especially in difficult economic times or in times of change, of which we have both just now. America is changing today, just as it was changing in 1947, and that metamorphosis brings out the worst in some of us. But the courage of people like Jackie Robinson, and the decisive confrontation of unfairness by people like Ford Frick, are heartening.

At the 1948 Democratic National Convention, Senator Hubert H. Humphrey made an impassioned speech in advocacy of a strong civil rights plank that failed to become a part of the Democratic Party’s platform in that year’s election. His words are worth remembering, as he recalled the founding of the nation in 1776:

To those who say, ‘we are rushing this issue of civil rights,’ I say we are 172 years late. To those who say, ‘this issue of civil rights is an infringement on states rights,’ I say that the time has arrived for the Democratic party to get out of the shadow of state’s rights and walk forthrightly into the bright sunshine of human rights.

Eventually most of Robinson’s skeptical teammates and competitors came to think differently and act differently than they had, at least to the point of accepting that blacks had as much right to play the “Great American Pastime” as they did. Still, the animosity did not end immediately.

As noted by Stuart Miller in the April 25, 2010 New York Times, Robinson continued to be the target of pitched balls in those days before batting helmets. In his first eights seasons he was lower than third in HBP (Hit By Pitches) only once. Moreover, the handful of blacks then in the National League—people like Monte Irvin, Sam Jethroe, George Crowe, Billy Bruton, Ernie Banks, and Hank Thompson—were similarly treated. In the American League, Larry Doby, Luke Easter, and Minnie Minoso found it no different.

Time passed, the hard-line bigots left the game, and others who were more open and less shocked and offended by integration took over the field of play. When Ernie Banks joined the Chicago Cubs in 1953, management saw to it that he join the club at the same time as (and roomed with) Gene Baker, so as to avoid the issue of having one black man and one white man live together.

It took 10 years from the time of Robinson’s debut for the Philadelphia Phillies to allow a black man into a Major League uniform, with the Detroit Tigers behind them. The last to integrate was the Boston Red Sox squad in mid-1959.

Along the way America changed too, for the better. And one must believe that the voices of the fulminating, frustrated few on the political landscape today will eventually be replaced by those who are less self-righteous and more in control of their emotions.

As a therapist it is impossible to do my work without believing that people can change.

It doesn’t always happen, of course.

But it happens more than enough to keep pitching.

Therapist Humor

https://i1.wp.com/upload.wikimedia.org/wikipedia/commons/thumb/b/b1/Laughing.jpg/500px-Laughing.jpg

It seems that the psychiatrist and his wife found themselves unexpectedly alone at home on a Sunday afternoon. The youngest of their children, the only one living with them, had departed for an event anticipated to keep him away for a few hours. And so, the long married couple decided that love in the afternoon was in the offing.

But, much to their surprise, the teenager returned a good deal earlier than planned — in the middle of everything. Their bedroom had two doors, and they quickly sprang up to lock them both, so that the boy wouldn’t catch them in an embarrassing situation.

Just then, their offspring yelled to see if they were home.

No answer.

He ran up the stairs and tried the near door of their bedroom, once again calling for them.

No answer.

He ran around to try the far door of the bedroom, again knocking and turning the door handle, still loudly crying their names.

No answer.

Finally, he stopped moving, staying in front of the far bedroom door.

This time, he called not for them, but yelled something a bit different.

“What, sex makes you deaf?”

The above image, Laughing, was created by Eric Ward and is sourced from Wikimedia Commons.