Monday, October 31, 2005
I never met Ms. Parks, but the movement that her courageous act inspired touched my life. As a college student at Wesleyan in Connecticut, I answered an appeal from a group called the Northern Student Movement to come down to the D.C. area and help integrate lunch counters and other public facilities along the main Washington-New York highway. A handful of us assembled at the home of historian Howard Zinn in New Haven, and then drove to Howard University in D.C., where we learned freedom songs and received training in nonviolence. The next day we matched up with pairs of black students from Howard and set out for Glen Burnie, MD, a Baltimore suburb. At this time -- it was 1960 or 1961, I don't recall exactly -- the national chains like Woolworths still had separate counters for whites and blacks, and in the local movie theatre, blacks had to sit in the balcony. At the first lunch counter, when our integrated group of four sat in the white section, the place emptied within minutes and all the serving staff seemingly disappeared. We waited for what seemed like an hour. Eventually someone came and took our order: coffee. After a long time, it came. We tasted it carefully, wisely -- they had put salt in it. Still, we counted it a victory: we got served. We moved on to other restaurants, got served in some, got refused and told to leave in others. In the afternoon, about ten of us formed a picket line in front of the movie theatre. Under darkening skies, about 20 to 30 local rednecks gathered around and taunted us. Two sheriff's deputies came and watched. The rednecks took to throwing pennies at us and spitting. It looked like it was going to get ugly. Just then, the clouds opened up and a deluge defused the situation. We all scattered.
A few years later, in 1964, after the civil rights workers Chaney, Schwerner, and Goodman were murdered in Mississippi, there was an appeal for more volunteers to go south to replace them, to send a message that terror would not deter us. I was part of this second wave, arriving on election eve 1964. I stayed until the next spring. I've written something about this experience elsewhere. All the countless scores of us civil rights activists, locals and Northern volunteers alike, were in some measure the children of Rosa Parks.
Marx wrote somewhere that the philosophers have only interpreted the world; the point, however, is to change it. Social change does require people who merely interpret the world, because they help to prepare public opinion. It requires philosophers, preachers, pundits, and many others who act in words. But all these words are nothing, and may be sheer hypocrisy, worse than nothing, without the crystallizing power of a strategically chosen direct action. After all the ink is spilled and the sermons have stopped ringing, someone has to put their body on the line. That was Rosa Parks.
It was particularly delicious to think that here in the Rotunda, the highest place of honor that the capital city knows, the president, prominent senators, and many others from the ruling establishment came to pay homage to someone for breaking the law. In this post 9-11 era, when the Patriot Act and the president's "war on terror" zealots have whipped much of the American public into a sheeplike trance, it was like a breath of fresh air to celebrate someone who was an outlaw in her time and place. This feeling ran strong among many of the more than 30,000 people who waited in the cold and the dark outside the Capitol on Sunday night. Yes, there are laws and customs that are stupid, dishonest, and unconscionable. Yes, it is much easier to obey them and blend in than to stand up to them. But those who have the vision and the courage to challenge the cruel and stupid laws and customs of their time do sometimes receive respect and recognition -- even if it takes fifty years.
The example of Rosa Parks shines far beyond the civil rights movement and the race issue in America. The disability rights movement, for example, acknowledges her act as the inspiration for wheelchair activists fighting for access to buses and other public transportation. Thoughtful advocates of social change generally -- in a broad range of domestic and foreign policy arenas -- cite Rosa Parks as a model. It is a sad but important truth that progress in important matters only comes through acts of resistance and disobedience to entrenched authority. Thank you, Rosa Parks.
We who are in recovery from alcohol and drug abuse should also join in honoring Ms. Parks and in learning from her example. This is true in two senses. Addiction is a stupid and cruel authority entrenched within our own minds. It is surely no coincidence that the words addiction and dictatorship share the same root. To live in an addicted mind means to serve a ruthless despot that manages our lives. Addiction governs what we do with our time, how we choose our friends and associates, how we view and evaluate reality, how we feel and react, virtually everything about us. Addiction is a 1984 of the mind; it is a Big Brother whose self-propaganda turns white into black, lies into truth, down into up, pain into pleasure, death into living, and defeat into victory. Against addiction, sermons and lectures are powerless. Making promises to yourself, making good resolutions, massaging yourself with words of good intention has no effect, and can even delay your liberation. The only thing that begins to work against addiction is a planful act of disobedience. Put the drink down, pour it out; flush the drug down the toilet, take a hammer to the pipe and other paraphernalia and throw them into the trash. When you stop drinking and using, and only when you actually stop, then you begin to sit in the front of the bus of your own mind. Thank you, Rosa Parks.
Another brutal and stupid dictatorship that many people encounter in early recovery is the "my way or the highway" recovery authority. Whether a self-appointed guru or a paid professional, they think they have The Answer and they're going to push it down your throat, "for your own good." They may pose as helpers, gurus, and wise counselors, but they are psychological thugs and cutthroats who know next to nothing about recovery and care nothing about you. Inside their soul burns a big ego fire, and you are nothing but fuel. When a newly recovering person encounters this sort of bully, the easiest and most natural response is to go out and drink and use. "If this is recovery, I prefer addiction." Please, friend, don't go there. The best revenge against recovery gangsters is to stay sober. Ignore them, or tell them off if it makes you feel better, but by all means stay sober. If you relapse, they'll gloat: "I told you so!" If you stay sober without them and despite them, you challenge their world view in the most fundamental, irrevocable manner. If you stay sober, you deflate them and shrink their malignant flame. If you stay sober, you help others like yourself who come after you to recognize that recovery must sometimes begin with defiance of established authority. Thank you, Rosa Parks.
Thursday, February 24, 2005
“Here’s a range of treatment options. What do you want to do?” That, according to Bruce Fuchs, the director of the Office of Science Education at the National Institute of Health, is what physicians today are likely to tell the patient. (Newsweek, Jan. 31 2005, p. 9). Presenting patients with a choice of treatment paths and letting the patient choose reflects the growing sense of responsibility that people have for participating in planning their own medical care. “Medicine is less paternalistic than it used to be,” said Dr. Fuchs in another recent interview. A lot of people “recognize they need to be more active participants in their health care.”
For the contemporary physician, giving the patient a choice is nothing less than an ethical obligation. The American Medical Association’s ethics advisor put it this way:
Each individual has the right to determine what medical treatment he or she will receive, including what life-sustaining treatment will be provided for a terminal condition. It is the physician’s responsibility to advocate for the patient’s right to choose any therapy, including alternative or nontraditional treatments, that reasonably may be expected to improve the patient’s quality of life. Source.
Breach of the doctor’s obligation to give the patient a choice of treatment options may constitute actionable negligence. One current text on the law of medical malpractice puts it this way:
In order to obtain the patient’s informed consent, the doctor must tell the patient not only about the alternatives that the doctor recommends, but also about all medically reasonable alternatives that the doctor does not recommend. A doctor does not comply with the duty of informed consent by disclosing only the treatment alternatives that the doctor recommends. Accordingly, the doctor must discuss all medically reasonable courses of treatment, including non-treatment, and the probable risks and outcomes of each alternative. By not discussing these alternatives, the doctor breaches the patient’s right to make an informed choice and effectively makes the choice for the patient. Source.
Giving the patient a range of alternatives and letting the patient choose is not merely a formal legal exercise. It’s good medicine. Behavioral scientists have long known that treatment which the patient chooses tends to work better than the same treatment when the patient does not choose it. The key is that choice enhances motivation. Source. “A fascinating study found that blood donors perceived significantly less discomfort when they were allowed to select the arm from which the blood would be drawn. The lesson is clear: people are happier and more comfortable when they believe they have some control over a process, particularly an uncomfortable one. Often the control handed over is largely symbolic (as in the choice of arm). In other cases, it’s very real: the medical profession has long recognized the value of allowing the patient to make an informed choice about alternative treatments for cancer and heart disease. These are extremely important, high-stakes decisions, and great value is gained by including the patient in the decision. He or she feels less helpless, less hopeless, and more committed to making the process work.” Source.
What does all this have to do with recovery from addiction? About ninety per cent of the current providers of treatment for addiction in the U.S. subscribe to the teaching that addiction is a disease, on a par with diabetes, heart disease, and cancer. But most of those same addiction treatment providers appear unaware of the basic ethical and motivational approach that real physicians today use in the treatment of patients with real diseases.
Real physicians give patients a choice of treatment options, including options that the physician doesn’t personally recommend. Rare is the addiction treatment program where this principle is observed. In most of them, “range of options” means only the choice between the “Big Books” of AA or of NA. Many treatment providers do not know that there are secular treatment and support group options, and when presented with this information, they do not want to hear it. Such counselors are incapable of conducting the kind of informed discussion of pros and cons of different alternatives that is required today in the real treatment of real diseases.
The real medical model of disease treatment requires obtaining the patient’s informed consent. Few and far between are the addiction treatment programs where informed consent is part of the professional vocabulary. Much more common in the addiction treatment business is the view that the addicted patient does not have the capacity to give informed consent, so that the treatment provider not only may, but must make the choice of treatments for the patient. Therefore, when the addiction patient asks about options or declines to follow the provider’s recommendations, the patient is “in denial” and the provider is justified in applying pressure until the patient “surrenders.”
In real medicine, the authoritarian, nonconsensual approach used in many addiction treatment programs today would be considered unethical, unprofessional, and liable to be prosecuted as malpractice. It’s high time that the addiction treatment field caught up with modern medicine and recognized that patients have rights, including the right to a choice of treatments. Giving patients a choice and involving them as participants in their own treatment yields substantially better results in the treatment of diabetes, heart disease, and cancer. Honoring the addicted patient’s choice among treatment alternatives will yield similar improvement in treating the disease of addiction.