This is the last issue of The Public Sphere until September 15, 2010, when The Public Sphere will return from a brief hiatus. Because much of the magazine will stay the same, we will accept submissions until August 15, 2010.

By The Public Sphere | The post Issue № 6 <small> | December 2009</small> appeared first on The Public Sphere.

The healthseeker, health migrant, old lunger, or one “chasing the cure” were all names given to people who took to the road in search of healthier places. Where today when one becomes seriously ill they check into a hospital, the same could not be said of the earlier era. Finding better health was a search for a place where the person felt better. This idea of travel for health was an ancient tradition. Since the sixth century, when Greek and Roman physicians proscribed a sea voyage across the Mediterranean to North Africa for their patients with cardio-pulmonary conditions, the travel therapy remained one of the few options for invalids.

America of the 19th and early 20th centuries was a sickly place. Gastrointestinal ailments caused by bad food and bad water afflicted nearly everyone. Season fevers persisted, especially in humid, riverine locales; precisely the places where most Americans lived. The medical theory that fog and mist was miasma (bad air) persisted well into the 1900s. The major killer, however, was tuberculosis. The disease thrived in most places, especially in conditions of overcrowding, humidity and contaminated air. Mortality rates for TB ran ten to twenty percent overall, and as high as forty percent in urban areas.

Together with Josiah Gregg, two other notable personalities at the end of the century, Teddy Roosevelt and Mark Twain, expressed their own siren calls to “rough it”; that is obtain a tent to live in and pitch it in the forests, prairies and deserts of the American West. Billy Jones in his 1967 book, Healthseekers in the Southwest concluded that “the search for health was a factor second only to the desire for land in attracting permanent settlers to the Southwest; easily 20 percent of those who migrated to the region between 1870 and 1900 were hopeful invalids.” As late as 1904, the International Conference on Tuberculosis issued a declaration stating, “in the failure of any medication and therapy, travel remains the most effective method for combating the disease.”

Two schools of medical thought emerged to channel the healthseekers to certain locales. The heliotherapists, taking their lead from Swiss physician Auguste Rollier, sought places where the solar rays were superior and might be employed to kill bacteria. High mountain retreats offered in Switzerland and the U.S. Rockies competed with the low valley desert communities of southern Arizona and California. U.S. climatologists headquartered in Colorado Springs sought to match patient needs to climate conditions. Individuals in the incipient stage of disease might be directed to high altitudes where heart and lung function would be taxed with the beneficial result of white blood cell creation. Those in the acute stage were directed to low altitudes where weather conditions provided warmer days without extended periods of precipitation.

Both the heliotherapists and the climatologists took a page from the work of Dr. Edward Trudeau at his wilderness sanitarium in the Adirondack Mountains. Trudeau housed his patients in tents, affording them maximum exposure to clean, fresh air. Plenty of good food and absolute rest rounded out the therapy regimen.

Regardless of the intent of the medical practitioners, individual patients often took matters into their own hands and engaged in seasonal migration. Finding the heat of the deserts in summer as oppressive as snow in the highlands during winter, they moved about as need be, always in search of the illusive “maximum level of comfort.” In the absence of a mechanism that might cure their condition, they traveled in search of that place where they seemed to alleviate their ailments. Financial status was not a limiting factor among the minions traveling the west in search of better health. For those with financial means, an industry was rapidly growing throughout the West to compete for their dollars. Hotels, convalescent homes, sanatoria, rest camps, boarding houses; all were sprouting up in towns and villages along the railroad routes. For the indigent healthseeker shanty towns and tent cities had to make due.

This phenomenon was never more evident than in the aftermath of World War I when the federal government faced the daunting task of caring for some 300,000 veterans with a variety of conditions. Among these were victims of poison gas, survivors of the Spanish influenza who had developed secondary conditions, wounded soldiers from the war, and tuberculars. In the name of efficiency, the government concluded that regional treatment centers were the answer.

The veterans had other ideas. In the instance of the southwest regional center located at Livermore, California, some found the proximity to the Pacific Ocean’s damp and the salt air irritating. Levels of precipitation might be disagreeable along with a number of other factors. While technically assigned to the post, men took the initiative to move to more agreeable environs. Hence places like Tucson and Phoenix became inundated with gas victims and tuberculars. The search for comfort paralleled the impulse for survival.

However, not all local populations embraced the healthseekers who sought convalescence in their communities. In the early years, healthseekers that brought investment capital were welcome citizens. The legions of poor and working classes who followed were not. Healthseekers were soon ostracized by those fearful of the highly contagious diseases they carried. Denver, Colorado was an excellent example. Touting its climate as therapeutic, four tuberculosis hospitals opened in the city by the early 1890s. Within a decade, locals were incurring TB in dangerous numbers. Suddenly, the invalids were not longer as welcome. Those already in the Queen City were shunted off to isolated areas.

Some places sought to dissuade the arrival of tuberculars through quarantine or outright prohibition. States on the southern tier appealed to the Federal government to take action. They argued that they suffered an excessive financial burden in being forced to care for the large number of indigent invalids. In 1914, the Shafroth-Calloway Bill was proposed in Congress by nine Southwestern states. Among the bills’ provisions were the use of abandoned military reservations and other government property as tuberculosis sanitariums specifically for indigent patients. Western cities and states would receive financial aid for providing welfare to those arriving from the eastern part of the country without the assistance of their home state. Critics contended that the legislation included no provisions to prevent physicians and other welfare agencies from sending their indigent consumptives West, an argument that helped convince Congress to reject the bill.

Others took a different tact to convince invalids to remain in their home communities; they wrote reports and editorial comments that appeared in magazines and major eastern newspapers. Journalist Samuel Hopkins Adams, contributed several articles, including an influential piece that appeared in McClure’s Magazine in January 1905 in which he lambasted the western health movement, promoting instead the principal element of Dr. Trudeau’s therapy: fresh air. Adams pointed out that fresh air and building ventilation was not the sole purview of the West and argued that, “where a tent is unavailable, a roof or porch will do. . . . Climate, while it may be an aid in some cases, has much less influence on tuberculosis, except in the later stages, than is generally supposed.” Adams and others offered as an alternative to moving west; move out onto your porch. Thus was created the “porch cure.”

Writers in the West also contributed missives about migrating for health. Warner Watkins, a Phoenix physician contributed an article, “Ignorance or Malpractice,” to a 1909 issue of the Journal of the American Medical Association. Watkins blasted Eastern doctors who sent “patients of meager means with advanced cases of consumption” to Arizona. He pointed out that “each winter the Associated Charities of this city [Phoenix] is swamped with such a class of patients and the county hospital is filled with them and our potter’s field is a veritable monument to the guilt of all practitioners who are guilty of such malpractice.” Consumption was a term used to describe the withering away of the body and the difficulty in maintaining weight that was common among tuberculars. However, given the limitations of medical diagnostics of the time, consumption was also used to describe a range of respiratory ailments including lung cancer, emphysema, asthma, chronic bronchitis and sinusitis.

Journalist and historian Sharlot Hall in her article, “The Burden of the Southwest” appearing in Out West (January1908), spoke of “a strangely careless disregard of details, an iridescent illusion” created about Arizona. She wrote of an all too familiar situation for the healthseeker. “He goes out, too often, with a light pocket to a strange place, to seek work which he is not able to do for the sake of a climate about which he knows nothing.” Hall was one of the very few to point out that conditions in the west were especially difficult for females. She advised women that bringing sufficient financial resources was a must to insure a good place to live and adequate fresh food. The most likely employment available to women was of the domestic variety, which was not likely to provide the rest necessary to recovery and recuperation.

As the 1920s commenced, many western communities sought to attract other migrants, just not indigent healthseekers. Thus Western writers re-inscribed their locales. Instead of being the place of last resort when a person had one foot in the grave, the West became a site of youthful vim and vigor. Instead of going out West to regain health, one traveled there to retain good health. The new marketing approach targeted the healthy tourist, rather than the sickly immigrant. The tourist and retiree took over as the seasonal migrants. The snowbirds had arrived.

Why did the healthseeker movement last so long and, by some accounts, continues on today? Science prior to the mid-twentieth century offered only personal observation to support the travel therapy, and the individual in most cases engaged in multiple relocations. In fact, a hard science discovery inadvertently led to greater dislocation of invalids. In 1882 when German physician Robert Koch discovered the tubercle bacteria as the cause of tuberculosis, he disproved the conventional wisdom that the disease was passed through heredity. Where a family might keep a loved one who suffered the disease as “God’s will,” they were more likely to evict one who incurred the disease through moral failings. Overwhelmingly, one started down the road to health and traveled to a specific location because they read a testimonial touting the life saving aspects of that place.

And what of today? The U.S. West is still attractive as a location for retirees and seasonal migration. The climate, particularly during winter, has not changed. Some desire to live close to the Mexican border so as to access cheaper drugs, medical services, and therapies unavailable in the U.S. Some travel to places where folk remedies are more accessible (and less scrutinized). The medical industry has reached new heights in diagnostics, drug and physical therapies, new technology, and health maintenance mechanisms. At the same time, diseases like tuberculosis have mutated into drug resistant varieties, particularly among the HIV/AIDS community. The cost of conventional care is rising and some individuals are increasingly resistant to institutional and regulatory dictates. Are we merely connecting health and place in a newer, more technological fashion in the telecommunications era, or are we preparing for a return to the physically wandering healthseeker?

By Alex Jay Kimmelman | The post When the U.S. West was a Place to Find Health appeared first on The Public Sphere.

Exceptionalism is the idea that U.S. society, politics, and economics are unique and better than other societies and peoples. U.S. political culture has a long history of exceptionalism dating back to colonial America. Puritan leaders, such as John Winthrop, viewed the Massachusetts Bay Colony as “a city on a hill with the eyes of the world upon them.” The Puritan goal was to create a model of Christian morality. Theocracy gave way to broadening conceptions of freedom, which eventually led to an irreparable relationship with Great Britain. The Founders articulated their conceptions of freedom using universal language, which was focused on all of humanity, rather than just citizens of the U.S.A. This was remarkable considering how this little group of colonies broke away from the most powerful empire in the world; success was far from likely. Thomas Jefferson began the Declaration by placing the American Revolution “in the course of human events” and explaining that when rebellions occur, reasons had to be provided. The Founders justified the rebellion through dedication to certain natural rights premised on the notion that all “men” were created equal. Essentially, the one thing all human beings have in common is that we are not God, so all people, including government, must respect basic human rights. The Founders believed they were making a grand statement for all people whose government infringed on their natural rights, not just colonial Americans in 1776. The U.S. remains unique in having natural rights written into the country’s founding document, including the right to rebel if government infringes on these rights. To this day U.S. leaders regularly invoke the imagery of “a city on a hill” in speaking about the exceptional character of the U.S. experience.

A second way exceptionalism is manifested through U.S. foreign policy. The U.S. first embraced democracy promotion during World War I under Woodrow Wilson, who famously stated “the world must be made safe for democracy.” This quote is revealing because it highlights the belief that the world must be adapted to suit U.S. political beliefs and values, rather than the other way around. The U.S. emerged as a major superpower after World War II and emerged as the world superpower after the Cold War. From a Western perspective democracy’s major ideological rivals, fascism and communism, were severely discredited after the three major conflicts of the twentieth century. Exceptionalist elements of U.S. political culture now believe that the U.S.’s unique path to the top demonstrates that U.S.-style democracy and capitalism constitute the best of all types of social order. This is personified in President George W. Bush’s 2003 State of the Union, where he stated that “Americans are a free people who know that freedom is the right of every person and the future of every nation.” The exceptionalism of the U.S. tradition is now connected with the geo-political realities of U.S. military and economic power. The U.S. views itself as the model of democracy in an era of globalization where major powers have profound impact on the world at large.

Exceptionalism provides a useful perspective through which to better understand the contemporary healthcare debate given its historical prominence in U.S. development and culture. Senate Republicans, such as Senate Minority Leader Mitch McConnell, Orrin Hatch, Jim DeMint, and Richard Shelby, have argued that the U.S. has the best healthcare system in the world, as did George W. Bush, and President Barack Obama’s rival in the 2008 election, John McCain. These arguments have created controversy and confusion. One of the few things that Republicans and Democrats agree on is that healthcare reform is needed. Major differences emerge over how to do this. How can the U.S. healthcare system simultaneously be the best in the world and be in need of reform? Conservatives inherently want to conserve the pace of change. One way to articulate and justify this political behavior is to laude the status quo, which in this case, is the current healthcare system. One tactical way to do this is to hyperbolize the effectiveness of the current system, which particularly resonates with many U.S. citizens because of the role of exceptionalism in U.S. political culture. The inverse approach has been adopted as well. In addition to lauding the status quo, the enemy, Barack Obama in this case, has been demonized. Prominent examples include Representative Joe Wilson’s unprecedented shout of “you lie” during a presidential address before Congress and popular conservative talk show host Rush Limbaugh comparing Obama to Hitler. “Going negative” and criticizing political rivals is not new. Importantly, however, these criticisms have more traction and can be more outlandish, when framed in a belief that U.S. healthcare is exceptional, so that whoever seeks to change the status quo, threatens national well-being, and is deserving of harsh criticism.

Public opinion is a second way to consider the impact of exceptionalism in the opposition to healthcare reform. Access to healthcare, a major concern of Democrats, does not resonate with broader U.S. culture to the same degree that it does in the Democratic party, even though Democrats received widespread support in the 2006 and 2008 elections. People in the U.S. predominately view poverty as the result of individual failures; this view contrasts to much of Europe, whose people predominately view poverty as the result of structural problems, such as the lack of education or the lack of opportunity. The U.S. view constrains reform efforts because people who are financially successful are considered exceptional and thus more deserving of healthcare coverage than financially challenged Americans, who are blamed for being poor and their inability to gain or purchase healthcare coverage. These attitudes reflect a form of Social Darwinism,. In the nineteenth century, Social Darwinists, such as Herbert Spencer and William Graham Sumner, justified economic inequality as a natural product of competition and used this belief to advocate limited government involvement in social activity, and such attitudes linger in U.S. public exceptionalist sentiments. Not surprisingly, the U.S. has the most limited welfare state in the West. In turn, people in the U.S. are divided over whether the federal government should make sure all U.S. citizens and legal residents have healthcare coverage, again in sharp contrast to European countries, all of which have an increased federal role in healthcare to ensure access.

The divisions that now plague healthcare reform in the U.S. run much deeper than this moment. U.S. political culture is inherently resistant to political change that questions the exceptional nature of how people in the U.S. live and seek to build a more collective understanding of the public good. The U.S. has not decided whether it wants to remain committed to the welfare state, pursue a long term process of deregulation and privatization, or continue shifting back and forth in a highly polarized fashion. Greater understanding and appreciation for the cultural dynamics influencing this situation helps explain why opposition to healthcare reform has been so contentious. Conventional and scholarly examinations of opposition to healthcare reform would be well-served by greater discussion of the role of U.S. political culture. The final bill, regardless of the specific form, will likely raise a new and important set of questions, the answers to which will determine whether a movement toward a more European style welfare state is truly progressive or moving the U.S. away from the exceptionalism that made the country what it is today. This will inevitably shape and be shaped by U.S. political culture, no matter how exceptional and enlightened we think we are.

By Luke Perry | The post U.S. Exceptionalism and Opposition to Healthcare Reform appeared first on The Public Sphere.

“Ask your doctor if medical advice from a television commercial is right for you.”
—Bumper sticker slogan ((www.northernsun.com))

At a the annual conference for the Society for the Scientific Study of Sexuality last year, I heard a researcher describe how the pharmaceutical industry “jukes the stats”—that is, crunches numbers creatively in order to persuade the public that their products actually accomplish their stated tasks.  This researcher, Dr. Duryea, offered a succinct finding: Antidepressant manufacturers go to great lengths to disguise the fact that people kill themselves during the “wash out” phase of antidepressants.  Once participants stopped taking certain antidepressants (and, in clinical trials, before they resumed taking them again), those taking the antidepressants had an increased risk of suicide compared to their pre-drug state.  Of course, since these users were not technically ingesting the drug during this “wash out” phase, the pharmaceutical industry convinced the FDA that antidepressants did not increase the risk of suicide—a creative interpretation with a potentially fatal cost to those who blindly take these drugs. ((Duryea, E. J. (2008, April). What every sexuality specialist should know about ‘sexual numeracy’: How we present quantitative information is important. Paper presented at the annual meeting of the Society for the Scientific Study of Sexuality, Western Region, San Diego, CA.))

I bring up this anecdote because it is one of many in a long list of such problems that occur in the U.S. today surrounding the issue of “lifestyle drugs”—drugs one takes not just for a temporary cure to an ailment (in the way Penicillin kills bacterial infections), but rather, as a response to lifelong, forever ailments (e.g., depression, anxiety, high cholesterol, acid reflux, impotence, and so on).  As anyone who has watched television commercials in the last decade can imagine, the pharmaceutical industry expends enormous sums of money to encourage consumers to “ask their doctor” about a host of drugs, nearly all of which advertise “lifestyle” remedies.  Get erections that last for days!  No more burping up acid after eating mountains of salty, fatty, chemical-laden food!  Stop feeling anxious despite chronic sleeplessness and slaving away at your vacationless McJob!  And, like all advertising ploys—particularly ones where astronomical sums of money are expended—it works.  Not only do people in the U.S. tolerate direct-to-consumer advertising (note that, within the Western world, the U.S. is alone in such a practice), but we indeed do consume more and more lifestyle drugs each year, making us the most medicated, and pharmaceutically-profitable, society around.

So how do we explain this phenomenon?  What about the U.S. lends itself to this perfect synthesis of self-medication, corporate greed, and pharmaceutical horsepower?  I propose that to tackle such a question, we must consider three separate entities: first, the invention of sickness, whereby normal aspects of daily life get branded as illness, like inventing female Viagra because women may not always desire sex; second, our refusal to live with the most basic elements of the human condition, as evidenced by the multi-billion dollar antidepressant industry; and third, our nearly reckless disregard for common sense, as evidenced by a host of lifestyle drugs, particularly Viagra for men.  It is not just that those in the U.S. have been duped, or that the pharmaceutical industry wields uncanny powers, or that we largely cannot decipher the difference between self-generated needs and manufactured needs (all true); additionally, at its most basic level, people in the U.S. have embraced a new wave of pharmaceutical personality sculpting, ((This phrase was first used in Zita, J. (1998). Prozac feminism. Body talk: Philosophical Reflections on sex and gender. New York: Columbia University Press.)) a philosophy arguing that pharmaceuticals can compensate for our unfulfilled desires and needs.

Let’s begin with the case of female Viagra.  Six years ago, pharmaceutical efforts to repackage the success of Viagra into a female-friendly version began in earnest.  First, Pfizer attempted to replicate the powerhouse success of male Viagra with a simple goal: create physiological arousal in women, simulate lubrication and swelling responses, and (voila!) women would achieve orgasm in unprecedented numbers, thereby ending their relatively higher rates of “sexual dysfunction.”  Unfortunately, this did not come to pass as expected.  The big problem?  Women who became aroused physiologically still did not choose to initiate or submit to sex with their (male) partners.  Unlike male Viagra—where physiological arousal and desire for sex allegedly worked more in tandem—female Viagra successfully achieved physiological arousal but failed to generate mental arousal or motive for sex.  Women with aroused vaginas still said no.  This frustrated Pfizer to the point where, during one interview with the New York Times, researchers declared, “Although Viagra can indeed create the outward signs of arousal in many women, this seems to have little effect on a woman’s willingness, or desire, to have sex…Getting a woman to connect arousal and desire…requires exquisite timing on a man’s part and a fair amount of coaxing.  ‘What we need to do is find a pill for engendering the perception of intimacy.’” ((Harris, G. (2004, February 28). Pfizer gives up testing Viagra on women. The New York Times, C-1.))

Perhaps said in jest, this statement nevertheless perfectly illuminates the first of three problems that contribute to the age of pharmaceutical personality sculpting: illnesses are invented, often for profit, by industries that have a serious investment in making people believe they are sick when they are not.  In a for-profit healthcare industry where sickness is money, invented sickness makes even more money.  Case in point, a recent psychological study by Jan Shifren and her colleagues found that, though 43.1% of women reported feeling that they had some form of sexual dysfunction, less than half felt troubled by this fact. ((Shifren, J. L., Monz, B. U., Russo, P. A., Segreti, A., & Johannes, C. B. (2008). Sexual problems and distress in United States women: Prevalence and correlates. Obstetrics & Gynecology, 112(5), 970-978.)) Rather than rely upon women’s self-description, the pharmaceutical industry instead convinces women through conversation and commercials that their inconsistent sexual desire is a defect, and that their bodies are imperfect and in need of drug treatments to “repair” their “dysfunctional” libidos.  We live in an age where illness makes profit, and where the invention of “disorders” improves the economic bottom-line of the health care industry. Such profit-driven health care requires the consumer to imagine these invented illnesses as real. Unless people learn to call out and resist such inventions, pharmaceutical personality sculpting will become the mainstay of the industry.

Step two in the process of selling people on lifestyle drugs involves an almost laughably ill-advised premise: convince people that the human condition no longer entails sadness, anxiety, depression, loneliness, social unease, lost erections, ups and downs in libido, and grief.  Indeed, the antidepressant industry has swooped in during a time when we have a lot to be unhappy about: unprecedented class warfare (the top 1% of U.S. earners now make more than the bottom 95% combined!), new and insidious forms of sexism (women’s desires usurped by the whims of patriarchy, ongoing failure of the Equal Rights Amendment, increasing reports of eating disorders and body dysmorphia, alarmingly high rates of women faking orgasm, national failure to recognize working mothers’ needs, and so on), rampant and shameless forms of racism (states retaining rights to block interracial marriages, anti-Obama rhetoric latching onto anti-socialist rhetoric throughout the nation, erosion of communities of color, overrepresentation of men of color sent to Iraq, etc.), and, in essence, a whole lot of things to be anxious, depressed, and un-aroused about!

Again, denying the difficulties of human existence seems to be a peculiarly U.S. phenomenon.  Along with their ironic taste for high cholesterol foods, plentiful red wine, and good health, the French (yes, the French!) construct tragedy as an unavoidable process of the human existence.  It is entirely remarkable that people in the U.S. want to manufacture an existence without such tragedy, yet this is exactly what antidepressant manufacturers count on.  They make a bargain, albeit without full consent: Take these drugs and you’ll feel less—both positive and negative.  Those on antidepressants report exactly this: they feel less sadness, they can get out of bed in the morning, and they can go to work and walk their dogs and enjoy modest pleasures.  However, they no longer feel the same happiness they once felt either.  They are dampened down, as the clinical literatures say.  The antidepressant industry wants to trick us out of experiencing ourselves as fully human, as fully engaged in the process of being alive.  How bad for business if we accepted that, when people die, grief is a horrendous, sometimes long, and certainly painful process, but one that we need to experience in order to process death. What a blow to their bottom line if people in this country started considering what their anxiety at work meant about their job satisfaction?  What a downer to the share holders’ stock portfolios if we stopped to consider that feeling bad might propel us to take action in order to feel better?  After all, aren’t we at least a little bit suspicious that Prozac and Zoloft and Wellbutrin create obedient, gracious, mellow, toned-down citizens, ready for the work of tolerating gender inequities, pay inequities, class inequities, and race inequities?  What if people instead confronted their reasons for being upset, depressed, and anxious?

Which brings us to the third point: The pharmaceutical industry relies upon our most basic denial of common sense, intuitive wisdom, and self-affirmation.  Consider the recent discussions about the paradoxes of the modern food industry.  As Michael Pollan has pointed out, we have lost touch with common sense about eating because the food industry has systematically done three things.  First, the food industry has asserted a singular, authoritative knowledge of what kinds of food make us healthy.  Second, it has extracted, via “nutritionism,” the elements of food that yield health without considering the interplay between enzymes and vitamins within a whole piece of food (e.g., Eat Omega-3s! ((Pollan, M. (2009). In defense of food: An eater’s manifesto. New York: Penguin.)) Don’t worry if it comes from actual salmon or fish oil tablets!  It’s all the same!).  Third, the food industry has assaulted our common sense by forcing us to rely upon their definitions of “healthy food” at the expense of what our grandmothers and great-grandmothers already knew to be true (e.g., we eat processed boxes of chemical goo that claim to be “low fat” and “enriched with vitamins” rather than simply eating an apple or a carrot or a head of lettuce in the produce aisle).  The same process has occurred with other elements of health, particularly mental health.  Rather than considering the ways that our unhappiness, anxiety, and grief stem from elements in our lives that deserve our attention, “experts” feed us insights about how pill-popping and pharmaceutical personality sculpting will come to the rescue.

Case in point: A friend of mine once dated a man who had erectile dysfunction with onset in his early 20s.  All physiological tests came out normal, indicating that doctors could find no physiological reason why he had erectile dysfunction.  He tried Viagra for four or five years, with decreasingly successful outcomes.  He had a more and more difficult time becoming erect, and often could not get an erection even in the most stimulating of circumstances.  Viagra eventually stopped working entirely (as it often does).  The man sought out psychological therapy to discuss his distress about his seemingly inexplicable erectile dysfunction.  Frustrated by his lack of success at relying upon Viagra, he eventually discovered, during the course of a multi-year therapy, that his lifelong incestuous relationship with a family member—one in which he consistently became aroused in situations of potential punishment and shame—had contributed greatly to his current erectile dysfunction.  Indeed, all of the signs pointed to his traumatic sexual history as a culprit to his current dysfunction.  He had begun to masturbate at work, and could get aroused only right before his boss walked in on him.  He had asked his partner to have sex in crowded movie theaters, subway cars, and park benches.  He could never become aroused while at home in bed with her.  During this course of treatment, he began a slow and difficult recovery, disentangling his associations with shameful early life experiences and replacing them with healthier models of consensual, non-punitive sex.  I tell this story because it represents, most basically, a truth that should seem obvious to most people if they consider common sense: erectile dysfunction, like most “illnesses” treated by lifestyle drugs, is rooted in a person’s reality, and without addressing that reality, the drugs simply mask the underlying issues.

Yet, we in the U.S. continue to perfect our skills at denying common sense to the point of rapidly dismissing the real rootedness of our psychological problems in the reality of our existences. We do this with food and we do this with mental health.  We eat fewer and fewer apples because food-industry consultants have told us to eat fiber-enhanced apple-flavored fruit-roll-ups.  We deal less and less with the complexities of our psychological lives because “scientists” have told us that a pill will solve the problems of our brain chemistry and will repair our wounded histories.  We rarely stop to consider why unhappiness pervades our culture because the “experts” have told us that it not only is possible to medicate this away, but is in fact medically sound to do so!  This all comes at a great cost, personally, socially, and culturally.  A generation raised on Lean Cuisine and Paxil has learned to condition away the intuition of mind and body.  As a consequence, we do not recognize what tastes good any longer because experts have successfully tricked our taste buds into believing we are eating “butter” when we aren’t.  We do not recognize that unhappiness can have positive, affirming, enriching results on our lives (as in, motivation toward something else—a new partner, a new job, activism on behalf of oppressed groups, and so on) because we have become susceptible to marketing campaigns selling us on the fundamental lie that life is pleasant.  We have already begun selling women on the promise of pharmaceutically terminating menstruation for “convenience” and trimming their labias in order to generate better orgasms, despite known tissue damage and reduced sensation from such surgeries.  Just last week, advertisements promoted a new “mint” that will disguise the vagina’s natural smell.  We sculpt and trim, tweak and prune.  This comes at a considerable cost, as individuals, as a society, and as a potentially toxic contagion within the global community.  Until we seriously challenge the impact and reach of the pharmaceutical industry, these assaults on our most basic ways of being human will continue in earnest.

By Breanne Fahs | The post Lifestyle drugs and the new wave of pharmaceutical personality sculpting appeared first on The Public Sphere.

Television documentaries such as Jump Britain have described this activity as ‘urban ballet’ given the sense of ceremony or ‘Tai-Chi’ like deliberation which comes with the performed movements. On a more realistic level, and one away from the television cameras, however, it appears as a hybridized leisure activity – incorporating elements from gymnastics and break-dancing to enable elegant and graceful movement over ‘obstacles’ found in the urban environment. Having studied a group of Parkour enthusiasts for the past couple of years in Nottingham, UK (NottsPK) I have become as intrigued by their ‘sport’ as I have been with public reactions. Because Parkour takes place mostly in urban space, it has been seen as a kind of reclaiming of the streets. Although this is undoubtedly true, it is the reclaiming of the body which I find of particular interest and the implications this has for health. Before expanding on this further though, we should take a brief historical look at how the body has been used elsewhere to construct identity.

Many socially marginalised groups have positively employed the phrase, ‘The personal is political’ for celebrating their identities. Within sections of the gay community this is best exemplified in the ‘hanky code’ whereby different coloured bandanas signal individual sexual preferences and interests. Encoding sexual activities enables conversations to develop in which they are ‘talking’ rather than ‘listening’. I see this as a political act,  taking control of your own identity. The resulting sense of self is visual and proud and, in its defiant construction around sex, celebrates [and subverts] a common prejudice used to marginalise gay men.

Similarly the feminist movement in the early 1970s attempted to reclaim ownership of the body through the politics of abortion, ‘access’ and diet. Taking control of the body and using it as a boundary enabled a certain level of self-control, particularly in relation to identity.

By this logic, voluntary mistreatment of the body must also be thought of as political and personal expression. Nowhere is this better exemplified than in the MTV spin off show Jackass. (1996 – ) The programme revolves around a group of men recording a series of humiliating and dangerous pranks on camcorder such as BMX jousting, shark hugging or being shot at. The group leader, Johnny Knoxsville, warns with subtle irony ‘Do not try this at home.’ This bodily mistreatment clearly struck a chord with the public as Jackass: The Movie (2002) grossed US $64 million.

While Jackass may be read as another example of the ‘levelling-down’ process, an analysis of the body in Jackass provides an alternative explanation. Using the body as a cultural text, self harm and mutilation give material expressions to certain cultural anxieties, like the supposed ‘crisis of masculinity,’ and are a basic inversion of the destructive machismo which epitomised 1980s classics such as the Rambo and Rocky films. Both explanations are plausible, but Jackass also entails a rational assessment of risk. As people encounter greater daily intervention into their lives from bureaucratic forms of governance, such as ‘health and safety’ legislation and the whole ‘culture of blame’ which this has created, the message of Jackass is simple:  This is my body and it is the one thing which you can’t control, so sit back and watch me smash bottles over my head and fire nails into my arse.

I situate Parkour within this tradition of bodily empowerment and as a more nuanced reaction to similar anxieties. In Jackass the body is treated with contempt, as something expendable, which could be seen as indicative of a wasteful capitalist modernity. In Le Parkour we see an inversion of these values so that self-preservation, finesse and agility are favoured. The goal is to move as fluidly between objects with the minimum of fuss and hopefully no injury. Through this experience a kind of oneness is achieved with the body, mind and environment.

Le Parkour can be thought of as an urban philosophy as it has a clearly defined manifesto but rather than having one specific ideology, it is formed out of multiple narratives drawn from a wide range of influences such as fantasies, escapism, cult icons, films, books, comics etc. It also extends into philosophies of self-improvement and self-awareness drawn from both the West and the East. In many ways this is emblematic of many new forms of modern identity which have grown out of internet forums and chat rooms; thus Parkour as philosophy is a kind of cultural sponge which is able to absorb information and influences without ever losing its shape.

This is possible because Parkour centres around emotive rather than factual language and thereby opens itself to interpretation and play e.g. one word which pops up more than others is ‘fluidity’, which itself implies the ability to change and transform smoothly. For fluidity to be achieved, participants must overcome four obstacles: mental, social, martial and family.

The mental obstacle – and perhaps the most difficult of them all – entails conquering your fears and gaining the necessary mental strength and confidence to make a particular jump. As different movements vary in complexity and risk so too the rate at which strength and confidence are perfected depends individually. Working together as part of a large cooperative helps as each group member is able to guide and reassure the other. When one member performs a particularly risky jump it then motivates another to try.

Overcoming mental obstacles leads to a certain degree of confidence arguably will translate into other areas of personal life. It is for this reason that Le Parkour can be seen as a philosophy of self-help and realization. The underlying message is if you can make a jump which seemed impossible, what is to stop you from sorting out emotional and mental problems in other areas of your life.

It should be noted that some movements are clearly built upon physical agility and power and therefore easier for older, taller and more disciplined bodies to achieve. Self- confidence in itself is not enough. But the fact that you are able to realise these limitations of your own volition is important as it is only by emotionally relating to something that we are able to fully comprehend it. Far too often in life restrictions are imposed on people without allowing them to discover for themselves. It is perhaps for this reason that Parkour enthusiasts on forums such as Urban Freeflow, turn to the wisdom of movie idols such as Bruce Lee. ‘If you always put limits on what you can do, physical or anything else, it’ll spread over into the rest of your life. It’ll spread into your work, into your morality, into your entire being. There are no limits.’

Le Parkour is described as ‘the way’ on the UF website, which suggests that it is a particular way of perceiving reality. While Parkour’s ideologies are influenced by films such as The Matrix (1999) these may also have had a physical influence as well. One thing which The Matrix, comic super heroe’s such as Batman and Spiderman, and computer games all have in common is that the characters can do super human things with their bodies as they swing and fly through the metropolis. Technology has been criticised for creating inertia, obesity and an artificiality in everyday human existence. Yet could it not be the case that engaging in such fantasies has inspired individuals to redefine and expand the limits of human potential? Le Parkour in trying to overcome mental objects and achieve seemingly impossible movements seeks to reverse the potentially negative effect of technology while heightening human experience and the body in the process.

As Le Parkour is performed in public space, individuals must be prepared to overcome certain social obstacles or stigmas such as people staring, pointing, ridiculing etc. In letting go of inhibitions and ignoring negative comments by passersby (who are rare I should point out) can lead to more confidence in other areas of life. However, in my experience it is the observers rather than the participants who go through the real anxiety. On numerous occasions I’ve seen people try to coerce one of them down from a wall because they might injure themselves only to be shocked when they exit with such panache.

Martial obstacles come in the form of authority figures who move participants on because they’ll ‘cause damage’ or are unwittingly on ‘private property’. As frustrating as this may be, the group I studied never argued back or were rude. Arguing with authority figures who weren’t listening because they were ‘just doing their job’ was seen as a waste of time and stopped them from doing what they were here to do. It was easier to just move somewhere different.

Contemporary sub-cultures like Le Parkour are often described in terms of moral decay whereby social regulation has broken down, metanarratives have crumbled, and youth have been left to run wild. But Le Parkour clearly refutes such claims. In explaining their ‘art’ to law enforcement agencies, they are learning to reason. They are also learning humility, tolerance, and understanding, thereby re-embedding a sense of order in a supposedly atomised and increasingly fragmented society. Indeed, they are actively encouraged to show concessions towards authority figures in arguments over space as in effect they are ambassadors for this relatively new discipline. Failure to be civil could lead to the activity being banned in certain areas and thereby ruining it for other enthusiasts.

Perhaps the most formidable of hurdles to overcome is the negative attitude of relatives, in particular parents. This can be intensified by negative representation in the media which tend to favour the more extreme aspects of the discipline rather than the more everyday practise that I witnessed. But you only need to watch this group of kids working with each other to realise that everything is calculated risk and clearly well thought out and planned before anything serious is attempted. Similarly, there are endless videos and training advice on the UF website. As one member of the group once pointed out to me, ‘my mum’s just glad I’m not doing drugs or getting’ in fights’.

The ability to persuade loved ones to trust and support the decisions you make with your life helps to develop communication and reasoning skills which will spread into all areas of lived experience. These may seem like a new set of values but really all recreational activities, in particular sports, promote a certain degree of friendship, fair play, respect, team work, problem solving etc. However what differentiates this urban sport from more traditional sports is that it is built around cooperation rather than competition.

Risk clearly has an important role to play in Le Parkour as it has to be managed to minimise injury and courted to fully enjoy the extreme experience. But what it really offers participants is the opportunity to draw a thick line between life and death. There are many false or thin risks in modernity which have made death appear ubiquitous: killer bugs in hospitals, terrorism, GM and processed food, overzealous health and safety intervention, etc. The list is endless – but such ‘risks’ make everything seem to be a potential danger.

Le Parkour reacts against this gross and perhaps inevitable trivialisation of knowledge. The constant intervention by the state and its systems ‘for our own good’ (and often it is), has meant alternative forms of expression and self diagnosis have emerged. As history has proven time and time again, how we use our body and the boundaries it enables us to make are as integral to our mental and physical health as they are to our identity.

By James K. Walker | The post Le Parkour: The Body as Politics appeared first on The Public Sphere.

This isn’t exactly how it happened.

I fell in love, first with the mountains, then with a woman. And it ended. But it didn’t end quickly, in one fell swoop, or a nice quick chop. The love faded like the furniture, piece by piece. This is the love of the woman I’m talking about. My love of the mountains never vanished even if the jagged outline of a ridgeline or a range no longer appears on my horizon. It took a whole week for my furniture to disappear. It took 18 months for that love to evaporate.

The teaky futon was the first to go, and my kitchen table was the hardest to let go. It was the first piece of furniture I had bought in Salt Lake and I carted it everywhere: from the South Temple apartment to our house on the West Side to the 9^th & 9^th cottage. A modest pine table with two hinged leaves, it had been painted multiple times and partially sanded. The leaves had stretches of green and white paint on them while red and yellow paint twisted down the legs. My dad and I had found it at an art gallery consignment shop, and, with a little elbow grease, we unearthed matching chairs in the bowels of the shop. I sold the table and chairs for a crumble of cash to a half-drunk guy in his 20s.

With the furniture gone, the cottage reminded me of what it felt like when I moved in. This place had radiated potential. Here was a humble place where someone could make a life or recover from a past one. The shower had good water pressure, and the kitchen had a gas stove. Windows dotted the east, south, and west walls. The neighborhood boasted a park, a coffee shop, a yoga studio, and killer burritos. The basement provided ample storage space. There was a porch and screen door off the living room. The backyard was fenced. I had even started a compost pile. But sometimes it’s not enough to have everything in place.

The one thing that remained in the cottage was the Delta Sky Kennel, Prufrock’s home for the next several hours. I had purchased the kennel a month ago, and Pruf and I had been practicing. First, we worked on simply being in the kennel. I’d coax him in with a treat and close the door. We worked up to Pruf spending 30 minutes or more in the kennel while I was in the other room or out on a quick errand. But, now, our last morning in Salt Lake, our beloved Salt Lake, I went full-bore with him. I scooped him into the kennel, slammed the door, and prepared him for takeoff. The rumpled brown carpet offered just the right amount of resistance. We didn’t sail across the floor; instead, we bumped along, much like, I told my dog, flying over the merciless Wasatch. Wrestling the kennel across the floor, I pushed, pulled, and shimmied. I dragged it in circles, I rocked it side-to-side, I pounded on the top, I rattled the sides. I even howled. I just didn’t want him to be scared. I didn’t want him to be as scared as I was.

Natalie chuckled when she walked in on me whirling around my dog. I had said goodbye to everyone else, leaving my best friend Natalie to the final hours. We had met through a yoga workshop and had built our friendship from the ground up: funny emails at first, followed by more personal ones, and eventually, we found the courage to hang out in person. Over “B & N,” beer and nachos, we listened to each other cry, offering up yoga pointers—“Try 10 minutes of bound lotus every day for a month to break bad habits”—and relationship counsel—“She’s really missing out on life by not going with you.” While nine a.m. was too early for B & N, we could at least have coffee and eggs at the Avenues Bakery, a prime brunch spot in my old neighborhood.

It’s hard to say what the Avenues Bakery was more famous for: its tasty food or its unforgivable service. Waiting 10 minutes for a cup of coffee was routine. The wait staff was young, pierced, and inked, and as they clotted behind the counter in their black T-shirts and aprons, glaring off into the distance, it was clear that they had better things to do. The well-intentioned middle-aged couple who ran the bistro bakery had studied in France and were trying to import a foodie culture to a homogenous city whose idea of fine cuisine extended little beyond green Jell-O. They sponsored wine tastings, scrambled local farm-fresh eggs, served up a mouth-watering assortment of tortes, tarts, and other tangy confections, and yet they consistently hired a slow, surly staff. This questionable combination of the earnest and the disenfranchised made any meal there a dangerous proposition.

Shortly after nine, the Saturday crowds had yet to appear at the Avenues Bakery. Natalie and I easily found a table by the window, and our coffee arrived within a few minutes of our order. The Bakery covered half a block on South Temple, a wide boulevard with cast iron streetlamps, ancient trees, and Gothic “gentile” churches. The windows spread almost from floor to ceiling, making this place a prime people-and-car-watching venue. My first couple of years in Salt Lake, when I was in grad school, I had lived just three blocks away, between the Presbyterian church and the Catholic cathedral. Once a week, usually after my seven o’clock seminar, I would treat myself to take-out. Picking up the turkey-and-brie panini on my way home from the university, I’d pass the evening stretched out on the floor, with plenty of beer and a weepy Lifetime movie, my books, notebooks, packets, papers, and handouts circling me. No dog yet, no lover yet, just all those words.

Over huevos rancheros and rosemary toast, Natalie regaled me with the latest Buchi family drama. This time, her younger siblings were torpedoing her efforts to resurrect Grandma Marge’s famous Christmas Eve Pajama-Waffle party. I fixed on Natalie’s story, laughing on cue, because I had gotten tired of saying goodbye. I commiserated on cue, inhaling and nodding, because there were too many questions I couldn’t answer, not even to myself. There was only the thin thread of something I knew. The thread was enough to hold on to, but if I tugged too hard or tried to pull myself up, it would snap. And so I explained sparingly but ached excessively. If it hurts so bad, then something here must matter. But if that were true, if something—or someone—here mattered, then why would I leave?

But, I could commiserate for only so long. Together, we had to face the unavoidable: I was leaving. Bumping over our words, we tried to explain what it meant to know each other. I thanked her for taking care of me during the six months of the so-called “separation” from my lover. I wished I had said more, but the thread tightened in my throat. Natalie thanked me for dragging her outside to play in the dead of winter. We laughed about our final excursion, just last week. Natalie and her husband Sam joined Prufrock and me on the Shoreline trail after a snowfall. The fresh snow tempted me. “I want to roll down this hill,” I announced, uncertain, for a moment, of my own sanity because the hill in question was really the side of a mountain. Natalie and Sam looked at each other and shrugged. “Let’s do it,” Sam said in his honey-velvet voice. Praying we didn’t lose our keys, we dove off the ridge, belly-flopping on the snow. And then we slid. And the momentum of the slide sent our legs up and over our heads. And then we tumbled. And we went faster and faster until the tumbled turned into a roll. Rolling over and over until we plowed to a stop at a gully full of scrub oak. Drunk on vertigo and Utah’s famous champagne powder, we tried to stand up. And we fell over. And we tried again. And we fell over again. Piece by piece we pulled ourselves back up the hill, wobbling, cackling, and chucking snowballs at each other. And then we did it again. And again. And again. All three of us were thirty, and we flew and fell, over and over, with the grace and promise of a child, someone not yet disappointed, not yet afraid of the rocks, lying in wait under the thin veil of snow.

Pruf danced around us, darting up the hill and down. Reaching his haunches up in the air, he stretched his paws forward and barked, his black ears waving. He licked Sam’s face, sat on my belly, and nipped at Natalie’s heels. He taunted us for being slow and dizzy and showed us how to run and kick up powder at the same time. My dog taught me how to love the mountains. I hoped he’d forgive me for taking him away. Another space lost.

The server cleared our plates and twisted his lips in something like a smile. Natalie and I drained our coffee cups empty and settled the bill. We still had time.

On the way to the airport, I asked Natalie to drive me around town, my last chance to lock my eyeballs on this city. From the Bakery, we headed north through the Avenues neighborhood, and I marveled at the cozy arts and crafts bungalows with their recessed porches and the fanciful Queen Anne’s. We worked our way up to 11^th Avenue and then headed west, winding around City Creek Canyon. The road hugged close to the steep, towering land. We swayed from side to side at every bend. Pruf began to stir. He stood up, his claws clicking against the plastic floor of the kennel. His tail thumped and he whinnied. Turning circles in the kennel, Pruf’s whinnies grew into full-fledged barks. He wanted to get out and run. I wanted to get out and run. I thought about the moose, deer, elk, coyotes, bobcats, magpies, jackrabbits, and rattlesnakes I had seen in this canyon. We had seen in this canyon. This was our place, and when the car made the last bend in the road, the canyon vanished. Defeated, Pruf pancaked on the plastic floor. The car continued on its course. As we made our way out North Temple, passing the Red Iguana, I asked Natalie to take me by the house. We still had time.

I hadn’t seen it in a year, since my lover had sold it. We idled at the curb. “Wow,” Natalie exhaled, “it’s so cute.” Except for that storm door, I thought. But I was also glad that the new Mission-style front door was protected. It took us two contractors and three months to get that door from the factory in Tennessee. The living room window, with the BB-gun bullet holes in it, had been replaced with a monolithic plate of glass. We had wanted to repair that window—which had snowflake stickers over the holes when we bought the house—but we didn’t want to do what these people had done. We didn’t want to swap one giant plate of glass, albeit with small holes, for another, equally unattractive plate of glass, however solid. Somehow, we wanted that window to be able to open, to offer us some fresh air, but we couldn’t figure out how. We left it the way it was, snowflake stickers and all, for the full four years of our shared life.

The front yard was still intact. We spent every weekend of August 2004 digging up with the front, just the two of us, armed only with a shovel whose handle was splintering and a pick ax. Hours and hours passed as we wedged the blunt shovel into the sun-baked sod and wielded the ax overhead. Thirsty and tired at the end of the hot afternoon, my lover and I stumbled to the Red Iguana and sought refuge in cold Coronas and homemade mole. That August was the only time in my life I ever looked forward to Monday mornings. At work, I could rest, recharge, recover, my muscles twitching, my eyelids heavy.

I made more than she did and that fall, I spent my money on plants. Silver fountain grass, yucca, Japanese blood grass, saltbush, Russian sage, feather reed grass, and blue fescue. The front yard was spare but textured. The violet blossoms of the Russian sage sparkled next to the corduroy bricks of the house. The pointed yucca and billowing saltbush took over the southwest corner of the yard. The silver fountain and feather reed grasses reached high as their plumes bobbed in the wind. Struggling to find their footing in the rocky soil, the fescue and blood grass kept their bold colors close to the ground. But, it was the zebra grass that enthralled me the most. The tall, broad blades alternated from base to tip between a rich but pale green hue and a neutral fawn color. Like a tiger-striped kitty or my own speckled blue heeler, this grass was nature’s version of a rugby shirt, the Fair Isle sweater, argyle socks. Patterns released by genes, no elaborate stitching required.

Next to the zebra grass, there was a spot in my heart for the Alpine Blue Spruce, a young evergreen we had planted in front of the living room window. We had told ourselves we planted the tree there to block the late-day western sun. But really we had planted it to prevent passer-bys from seeing the snowflake stickers and their sister BB holes. We named the tree Bruce, Bruce the Blue Spruce. He was a squat Christmas tree, tinged with smoky blue, and we loved him. When you look at something you love every day, you don’t really notice that it’s changing. Bruce looked the same every day, but we told each other that he was getting bigger. “Look at him, now,” she’d say to me. “He’s getting so tall! In a few years, we may have to prune him. In 10 years, we’re going to have so much shade in the front yard.” Today, on this bitter, drab December morning, Bruce did look taller. My throat swelled and my jaw tightened. In 10 years, that will be an enormous tree. In one year, the space in my heart for her will contract so smoothly that I won’t even notice until it’s almost closed. This isn’t exactly how it happens.

At the airport, Natalie gave me a gift, a candle. “For meditation,” she said. We watched Pruf and his kennel get wheeled away. We hugged goodbye.

The plane to Atlanta was empty. I scooted over to a window seat. Pruf’s kennel sat on the tarmac, next to a ramp. I could see his black nose pressed up against the holes. The ground crew sweet-talked him as they loaded the kennel on the ramp. His tail flickered. He disappeared into the cargo hold. I closed my eyes.

By Hope Miller | The post Breakfast: December 2007 appeared first on The Public Sphere.

When you cough, I hand you a napkin, remind you to cover your mouth,
Coach you in swallowing. I take your hand, gently, as she would have done,
Help you rise from your chair, steady your hesitant steps.
You are like petals folding into their calyx, or a hibiscus closing for the night.
I admire the young mother who coaxed this bud into bloom,
Who intuited from slender wisps of hope the man you might become.

Now as our world shrinks to a table for two,
The taste of butter your sole residual joy,
I remember how you could spin me in a waltz,
Turn on the sun with a moonlight kiss,
Harbor me within your encircling arms.
I feel sure you cannot unbecome what you became.
What you have been, you are.

I must intuit, as your mother did, what you need and feel.
Once you said fervently, “With all my being I love you.”
Now the words will not come, yet I believe them.
Even as my heart grows heavy with fearful tears,
I read your smile, and strangely find content.

She has done well by you,
The woman whose love you did not have to earn,
Who guided your toddler steps uphill,
Releasing you when your manly stride
Assured her all was well.
May I do equally well by you, holding your hand to guard against a fall,
Helping you gently down the shadowy slopes,
Releasing you when the evening petals close
And the music from the stars
Assures me all is well.

© 1999 by Helen Heightsman Gordon

By Helen Heightsman Gordon | The post Close Parentheses (The Last Love Song) appeared first on The Public Sphere.