Sunday, June 25, 2017

Time for a New Prescription

Dr. John Sarno died on June 22, 2017, at the age of 93.  He was a physician who observed that much pain was psychosomatic in origin.  As American medicine has largely rejected the idea that feelings can cause sensations in the body, he was ostracized by the profession.  Happily, his books – including Healing Back Pain: The Mind-Body Connection – reached millions of people in many countries and helped them heal themselves. 

“All the Rage,” a documentary about his work collectively directed by Michael Galinsky, Suky Hawley, and David Beilinson, has just been released by RUMUR.  It arrives at a moment when the medically preferred method of pain treatment has triggered an epidemic of opioid addiction that is estimated to have taken 59,000 lives in 2016 alone. 

It is time for humility.  

As physicians, we swore the Hippocratic Oath, to “first do no harm.” It seems to me a reasonable corollary when we have done harm is “to admit harm and change course.”  

But, some will say, Dr. Sarno’s ideas are not supported by data.  That is a red herring.  The data about opioids have not been as thorough as one might presume, especially given the frequency with which they’ve been prescribed.  Indeed, one widely cited study of the safety of opioids for pain turns out to be a letter to the editor published in a medical journal, not the hallowed randomized controlled clinical trial one would have expected.  At this point, new findings are emerging every week, shedding light on the ways in which opioids work to produce dependence and addiction. The evolving story suggests we must use these drugs with great caution. 

By contrast, there is more than enough data about the reality of the mind-body connection and the effectiveness and safety of the mind-body interventions for us to move forward with confidence.  However, as is often the case, sound “data” are ignored.  This has been true for a long time: scientific breakthroughs are resisted for reasons that have nothing to do with the soundness of the intervention.  The British Navy, for example, ignored for 50 years the advice that limes could prevent scurvy among seamen.  Many suffered unnecessary death and disability during that period.

The opioid epidemic offers a remarkable opportunity to go in a new direction in the treatment of pain and in the embrace of the mind-body connection.  State legislatures are busy restricting opioid prescribing.  Change must happen, but what?  What a perfect moment to go see “All the Rage,” pick up one of Dr. Sarno’s books, and try a new prescription! 

Wednesday, June 21, 2017

The Assassination of Beale Street

I started studying urban renewal in 1994, when I first met David Jenkins, who'd been displaced from the Eastwick neighborhood of Philadelphia when he was eleven.  In 1995, I went to Roanoke, VA, for the first time, visiting with Mary Bishop, journalist extraordinaire, who had written the classic article, "Block by Block, Street by Street," about urban renewal in her city.  I got to talk to many of the people she'd interviewed. Those first exposures to the story of urban renewal were followed by many others.  I pulled my analysis together in my 2004 book, Root Shock: How Tearing Up City Neighborhoods Hurts America and What We Can Do About It.  In the years since, I've heard many more urban renewal stories, and their similarity has struck me.  You might say, that I got used to the stories and they didn't strike the same chord of horror that the first ones had. Indeed, I thought I'd heard it all.

But then I encountered the story of Beale Street in Eugene J. Johnson and Robert D. Russell, Jr.'s book, Memphis: An Architectural History.  They open their discussion of the story by saying, "Beale Street today [they were writing in 1988] is one of the saddest examples of what urban renewal did to cities. It stands isolated in a green desert of grass that grows where once a thriving, or least throbbing, black community lived and gave sustenance to one of the greatest centers of black culture in the United States."

I am going to give an extensive quote from Johnson and Russell, because the book is currently out-of-print, and it might be difficult for people to read it in the original.  That said, I hope the University of Tennessee Press reissues this marvelous work!
By 1964 the Memphis Housing Authority (MHA) had prepared a masterplan for whole Beale Street area, which it announced in an eight-hundred page report that suggested that Beale had to be destroyed to be saved.  No one, of course, read the whole report.  It was accompanied by a curious public relations brochure, short and east to read, that illustrated all of the street's great monuments that were not black.  Left out were pictures of the famous saloons, which the tet did mention, and of the pawnshops that clogged the block between Main and Second, which the report did not mention.  The brochure contained the ominous statement: 'Beale Street has been permitted to deteriorate to a point where little remains, from a practical standpoint, of its lively past.'
Consultants for the plan were Walter A.J. Ewald and Associates, who had submitted their report in 1963.  They envisioned a Beale Street surrounded by new shopping malls.  That is, they had decided, at the very beginning of the project, to tear down the surrounding community of houses and small businesses and replace them with a cordon sanitaire of shops, arranged like those in a suburban mall.   
The project, of course, was sheer pie in the sky.  There was no money to fund it, and there were no businesses lining up to open shops in those devoutly-dreamed surrounding malls.  In 1964 the city told MHA to go ahead with an application for a federal grant, and in winter 1968 the project was still under not-very-urgent discussion.  In April 1968, however, Martin Luther King, Jr., was murdered at the Lorraine Motel, just a few blocks from Beale.  That assassination lead to the assassination of Beale Street.  In November 1969, with almost miraculous alacrity, HUD set aside $11,000,000 to fund the Beale Street Urban Renewal Program, and in June 1970, a HUD undersecretary flew into town to announce another grant of $14,000,000 for renovation.  The bulldozers were already at work.  By the time they got through, all but about 65 of the 625 buildings that had stood on the 113 acres of the renewal area were gone.  If decimation takes one in ten, what should we call an act that leaves one in ten?  Fifteen hundred residents were displaced to other parts of the city.  (emphasis added)
Johnson and Russell go on to describe the destruction of the block between Second and Main, once occupied by pawnshops, forever insulating Main from Beale.  That was followed by a long period of languishing, during which most of the remaining buildings fell apart.

This story is astounding on many levels, among them these:

  • By 1968, urban renewal was widely discredited -- it was shut down in 1973; 
  • By 1968, urban renewal was widely known as "Negro Removal" -- no black community would have seen it as a salve for the wound of losing Dr. King;
  • By cutting off the support of the Beale Street community, the city undermined the integrity of Main Street, which has struggled to survive.  
This is a story that should be told in the National Civil Rights Museum, now installed in the Lorraine Motel, right there in the Beale Street Neighborhood.  Linking the destruction of black neighborhoods to Civil Rights will help everyone understand the new phase of the struggle that started in 1949, with the passing of the Federal Housing Act, and continues to this day in Memphis and elsewhere.  The Beale Street neighborhood is slowly being converted into the kind of "approved uses" the planners dreamed of in 1963.  It has no room for the former poor and black residents.  

Looking west toward the Beale Street neighborhood from the Lorraine Motel.  Vacant lots still apparent.



 



Wednesday, April 26, 2017

Promoting a Culture of Health in the American City

In March, I had the pleasure of presenting my experiences with the new Robert Wood Johnson Foundation program, "Culture of Health."  I've been involved with three projects in this program, which is designed to create a nationwide commitment to health for all.  I'm a member of an "Interdisciplinary Research Leader" team, joining Derek Hyra and Dominic Moulden to look at "Making the Just City."  I'm a core team member of the Orange NJ Culture of Health in NJ initiative called "Healthy Orange."  I'm also an advisor to the Civic Hall Labs project using digital media to address civic engagement and civic cohesion.  I've found the Culture of Health programs to have a lot of freedom to tackle issues that American public health has long ignored, including issues of social structure and issues of pathways to health that include housing, jobs and education.

Monday, April 17, 2017

The New Market on Main

Yesterday was Easter Sunday, and David Chapin, my Main Street buddy, and I went first to see the cherry blossoms in Newark's Branch Brook Park.  He was astounded at the number of trees, any grove of which would have been cause for pride.  Everybody was out, it being Easter, and 89 degrees, and the Cherry Blossom Festival.  It didn't matter to any of us that the cherries's had passed the prime of bloom -- it was THE day to be in the park.
I proposed that we get some food and cook at my house.  In looking up the directions to Whole Foods, the new Whole Foods in Newark popped so we decided to go see it.  It is in the old Hahne's Department Store building, vacant for decades, but finding new life.  The Whole Foods is an anchor for the new mixed use neighborhood the planners are developing in that area.  We walked in and David was impressed by palatial size and cornucopia of food.  I'm more used to suburban Whole Foods -- it didn't seem that different from the store I usually go to in West Orange.  Except of course, place is everything, and looking out the massive windows onto Military park, being in the heart of downtown Newark in a place I visited as a child but lose to me for a long long time, was very special.
New Whole Foods Market on Broad Street in Newark
A market is a critical anchor institution for a new urban neighborhood.  It could be a little bodega, or palace of food, like Whole Foods.  It is essential to the life and good feeling to be able to walk to grab something for dinner, especially as a city densifies, and parking becomes impossible.  Its other virtues -- creating a crossroads of neighborhood -- should not be overlooked.
As David was getting some roasted red pepper hummus for our snack, I saw a guy wearing a tee shirt that said, "We out." -- Harriet Tubman.  I am doing a project called "400 years of inequality," which calls for an observance of 1619, when the first Africans arrived in Jamestown to be sold into bondage. What better tee shirt that than one?  I debated asking him if I could take his picture, but eventually worked up my courage.  I explained the project and the tee-shirt guy and his friend were immediately intrigued and starting sharing their projects -- including bike tours of the Central Ward.  They also explained that the tee shirt was one of many connecting current expressions to historic figures.  they pulled up the shirt for Rosa Parks, which says, "Nah."
Paul in his tee shirt.

Then they started to talk about their delight in the Whole Foods, and how it was creating a safe space for Newark intellectuals to encounter each other, and promote a conversation about the future of the city.  They credited Mayor Ras Baraka with this great step forward.  And it was so resonant with the experience in the community-supported general store in West River, Vermont.

Friday, April 14, 2017

Main Streets Finding Their Way

Mary Newsom's excellent coverage of the North Carolina Main Street Conference examines the work of a main street program that has been supporting the state's cities and towns as they try to get their Main Streets to work.  This is hard work, and it takes cooperation and a vision.  I saw this work in process in Mount Morris, NY, a few years ago.  People there were benefitted from a major investor who wanted to help bring the Main Street back.  But that is only the beginning of the work.  Then it takes people ready to roll up their sleeves and get to back on their specific dreams and ideas.  But the point I want to make here is that people usually connect the demise of Main Street with the rise of the Malls.  We rarely make the much more important association to deindustrialization.  North Carolina, like Virginia, had lots of mills making furniture, for example, and these nearly all folded as industry went overseas for cheaper labor.  Beth Macy has told this story in her amazing book, Factory Man, about a factory owner who chose to fight and thereby saved a town.  People need money to spend in order for Main Street to really prosper and we should never forget that.  

Wednesday, April 12, 2017

Livelihoods in lively 'hoods

William Morrish is a professor at Parsons The New School for Design in the Design and Urban Ecology program.  I asked him to look at "artifact sheets" I'd made about Main Street from my study.  There were 63 sheets all together, including the list of the 135 cities I've visited to date.  When I arrived at his office yesterday, I saw all the sheets taped to the wall, with words highlighted, drawings added -- the sheet on Times Square even had a piece of tracing paper over it with a drawing of the mega screen on it.

Main Street Artifact Sheets on the wall at Professor Morrish's office

He walked me slowly through the sheets and as we talked, connections began to emerge.  The aerial photo of Orange NJ before the highway went through was like the painting by Ralph Fasanella, dense with life and work and providing the energy for Main Street.  The signs of exclusion -- Elmo boxed in in Times Square, the old neon of a Jersey City restaurant and the markers of private property in LA -- were connected.  And in those spaces of exclusion/inclusion we could see the ways in which life was unfolding, with its the passages -- the wedding scene and a time we went to pray at a temple in Kyoto -- and its daily delights, like the wonderful pastrami in Newark.  The singular pulsing, dynamism of life, which finds such an important point of organization on Main Street, lifted off the page, for us to see, as we followed Bill's remarkable chain of association along the wall.  I went home, not stunned by the myriad images that singularly fascinated and baffled me, but refreshed by the unity of life.

This morning's reading from the Center for Action and Contemplation was "Love thy neighbor AS thyself."  Cynthia Bourgeault wrote, "There are not two individuals out there, one seeking to better herself at the price of the other, or to extend charity to the other; there are simply two cells of one great Life.  Each of them is equally precious and necessary.  And as these two cells flow into one another, experiencing that one Life from the inside, they discover that 'laying down one's life for another' is not a loss of one's self but a vast expansion of it -- because the indivisible reality of love is the only True Self."

Fascinating to experience 62 artifact sheets intertwining to make one reality of Main Street, as people need to make one intertwining of collective life.

Sunday, April 9, 2017

The Myth of the "Myth of Main Street"

Louis Hyman's "Myth of Main Street" in today's New York Times is itself a myth that deserves to deconstructed.  First he argues that, for the past hundred years, Main Street has not been what people thought, which is that:
Main Street is a place but it is also an idea. It’s small-town retail. It’s locally owned shops selling products to hardworking townspeople. It’s neighbors with dependable blue-collar jobs in auto plants and coal mines. It’s a feeling of community and of having control over your life. It’s everything, in short, that seems threatened by global capitalism and cosmopolitan elites in big cities and fancy suburbs.
The reality was, he contends, that chain stores arrived in the 1920s, ending local commerce and this myth of Main Street.  Industrial jobs sought cheaper labor overseas and they're not coming back.  Only people in Brooklyn and affluent suburbs who have lots of disposable income can have Main Street.  The rest of the country would do well to accept employment on on-line platforms like Upwork.

What's wrong with this argument, which seems so logical and to fit the facts so perfectly?

I want to point out three fallacies in this common way of thinking: only the rich have (need) Main Street; platforms like Upwork are a satisfactory substitute; and industrial jobs will not come back.

First, it is not true that only those with lots of disposable income have Main Streets.  New Jersey is lucky in our 550 towns and cities which have lots of Main Streets.  Having visited many of them, I can attest to seeing wonderful Main Streets in poor cities.  Orange, NJ, which is one of the core cities in my study, has one of the most active Main Streets.  Nothing fancy about it, as the middle class of Orange will tell you.  But it's kept busy because it's got great bus service, lots of people of live nearby and can walk there, and a range of products and services that those people need.  Furthermore, it's got those other trump cards of Main Street: churches, banks, the library, the post office, and a Rec Center in the former women's Y.  And what people get when they get to Main Street is not just cheap shopping (though it has that).  They get to see their city, strolling by, and they can enjoy its messages and its processes.  Walmart is nearby, ultra-cheap, and very popular, but a dismal experience that cannot nourish the soul as Main Street can.  Herb Way's historic photo of Orange Main Street captures this nourishment and could be replicated today.

Main Street, Orange, NJ by Herb Way
Second, we know about piecework from dire experience.  Jane Addams, founder of Chicago's great settlement, Hull House, wrote about the women and children laboring at home, in poor light and at all hours to finish the pieces of work that had been given to them.  Fighting the horrors of piecework was one of the great battles of unionization in this nation.  That the collapse of industry has driven us back to this primitive form of work is catastrophe for working people, and part of the reason they voted for Trump, to escape this horror.  I do not see Trump actually forwarding the agendas of the aggrieved working class, but working people at least made a statement about their agendas.  The NYT's story on Uber described one man who worked fulltime for Uber and Lyft and made $20,000 before expenses.  This "new sharing economy" is a new form exploitation of working people, another dead-end, and not a solution to what people in the abandoned cities and towns need for recovery.

Third, it is true that Main Street floats on our money, directly as purchases and indirectly as taxes.  When we don't have any money, Main Street flounders.  Pittsburghers describe the absolute collapse of their Main Streets as Big Steel left town and people moved to the Sun Belt in a desperate search for work.  This massive diaspora out of a beloved city is, so they tell me, the reason there are Steelers bars (and Steelers fans) all over the country.  Those industrial jobs, the pundits say, will never come back.  This is an absurb proposition, that a nation of 300 million people will never again make the goods it needs, but will always have to import everything from overseas.  This is an untenable state and it will fall apart.  Indeed, small manufacturing can be found all over and somebody somewhere is plotting the re-industrialization of the nation even as I write this.  It is too logical not to be inevitable.  When that happens, Main Streets will rise again, as they rose in the first place.  This would happen more quickly, were there sound national policy to support this.

In order to understand why industrial jobs can come back to our country, it is essential to have a deeper analysis of why they left than just "cheaper labor."  John Ullmann, Rodrick Wallace and others have pointed out that the crisis of de-industrialization in our nation was precipitated by the Cold War.  This is not obvious to anyone, at first, as the Cold War seems to be about fighting Communism, not ruining our economy.  The link is militarization, the threat of power, that was at the heart of how the Cold War was "fought."  In order to militarize, we took a huge proportion of our scientific and technical person-power out of domestic industry and put them to work on making weapons.  Within a decade of doing this, we had fallen behind Japan and other nations.  Soon our industries, which had not kept up in the constant process of innovation, were assigned to scrapheap and the factories moved overseas.

When it is not "fate" but "policy" that has caused a problem, we can imagine that another -- more sound -- policy can fix the problem.  While the reindustrialization of the United States is a difficult process, the alternative model of most Americans trying to make a living on piecework is so absolutely intolerable it makes the alternative seem like a walk in the park.

Main Street is worth it: the street, our imagination of the street, and the "Main Street" that stands for the 99%, almost all of us, we're worth it.