Friday, March 27, 2020

Coronavirus: Making the moral response to the pandemic

Last night, March 26th, I attended a wonderful and inspiring Facebook Live event of the Poor People's Campaign, which is going digital, given the need for all of us to shelter in place.

This morning I got an email from AMA President Patrice Harris, which said:
The AMA is pressing the President and his administration to use all levers to help you on the front lines, including an urgent appeal to use the Defense Production Act to immediately increase the domestic production of PPE, medical supplies and equipment
We are teaming up with the American Hospital Association and American Nursing Association to get financial assistance for physicians and to urge the public to STAY HOME.
What immediately struck me was how short her list of allies was: AMA, AHA, and ANA are important, but it is clear that we need to go into this fight for a moral response to the pandemic with much more power.  Why isn't the Poor People's Campaign listed as an ally in the fight to save the lives of our health care professional?  One consequence of the inexcusable mismanagement of this epidemic will be the deaths of doctors, nurses, x-ray technicians, respiratory therapists and others who have responded to the moral calling of their professions, but without adequate back-up from the nation.

We have to be acting in a moral manner if we are going to ask them to do so.

Reverend William Barber, who is a leader of the Poor People's Campaign developed the seminal idea of the moral fusion coalition while serving as President of the NAACP in North Carolina.  He observed that there were many small and siloed organizations fighting for justice, each with its own issue.  He asked them to come together, recognizing that they had different issues but a common enemy.  Together those small groups formed the powerful "Moral Monday Movement."  It is an important truth in American history that great victories have been won by coalitions.  The moral fusion coalition is the coalition we need at this moment to fight for us to be on the right side of history.

What are the demands of a moral response to the pandemic?

Who are the organizations that will join this moral fusion coalition?

Coronavirus: Pandemic Prevention

A synopsis of work by Dr. Rodrick Wallace and colleagues, prepared by Robert Fullilove and Mindy Thompson Fullilove, March 27, 2020.  This is for those who want to strengthen their minds.  

We are public health researchers who started studying epidemics in 1986, looking at the AIDS epidemic among Black and Hispanic people in the US.  One of the most important articles to shape the work we have done in public health is A Synergism of Plagues by Rodrick Wallace. This 1988 opus is widely cited in the annals of public health because it demonstrated with careful logic that the HIV/AIDS epidemic in the Bronx was largely driven by public policy decisions and actions. Wallace demonstrates that the decision made by city leaders in 1972  to close 32 fire houses in poor neighborhoods of color in New York City crippled efforts to effectively battle the decade-long epidemic of apartment building fires that followed on the heels of that decision. The city’s inability to mount successful efforts to confront apartment fires in communities such as the South Bronx and Harlem, resulted in a substantial loss of housing and the repeated forced displacement of residents who lost their dwellings in these conflagrations. This loss of housing impacted many members in networks of drug users in these neighborhoods. As network members were constantly forced to move from one dwelling to another, they also formed and reformed syringe-sharing networks where the transmission of HIV infection was substantially facilitated. Dr. Wallace points out that this public policy decision ultimately initiated a chain of events whose end result was an efficient engine for the spreading of AIDS in these communities.

Fire in Harlem.  Photo by Rodrick Wallace 
Similarly, in his current research into the key factors driving the current COVID-19, Dr. Wallace has identified the subtle but significant role that political and economic support of international agrobusiness may have played in our current pandemic. These enterprises rely on techniques to deforest landscapes to make grazing lands for cattle, or to use the same crops on the same soil year after year, thus limiting biodiversity. The loss of biodiversity makes crops in these settings vulnerable to pests and pathogens. To combat these intruders, more and more pesticides and more and more fertilizer must be used to make the land productive. Having usurped Mother Nature’s ability to maintain ecological equilibrium, we have crippled the planet’s ability to create the necessary barriers that can prevent the emergence of a species-ending pathogen. The critical line of defense that biodiversity provides has been substantially weakened.

COVID-19, it is sometimes said tongue in cheek, represents the next step in planet Earth’s efforts to save itself. This virus exploits a number of the most important components of 21st century life. COVID-19 exploits our love of being in large crowds and in the densely populated urban environments we have constructed. It exploits our transportation hubs which move large groups of humans from one part of the planet to another in a matter of hours.  A novel pathogen like this coronavirus leapfrogs from one host to another in a densely populated urban center like New York or New Orleans and can subsequently take its act on the road via the enormous transportation webs of the 21st century. With a significant delay in infected people showing outward signs of infection, the virus moves silently and efficiently, defying screening efforts and producing a long period of time during which infection can be transmitted silently from one to another.

What is to be done? We are left with downstream solutions. If we cannot prevent the generation of such pathogens, the only options open to us will be to do our best to treat those infected. Dr. Wallace suggests that there are other possibilities. An upstream strategy that targets the source of the problem is needed.  Asymmetric warfare, he notes, is the strategy that must be adopted if the forces of public health are to defeat – or at least limit the power of – agrobusiness interests.

In asymmetric warfare, two armies with very different resources and capabilities are pitted against each other. Given that they are not equals on the battlefield, who wins the war? Students of asymmetric warfare are fond of citing Henry Kissinger, the secretary of state under Richard Nixon, who noted that in guerilla warfare, the guerilla wins as long as he/she does not lose, while the modern army loses if it does not win. Losing for the guerilla army means they can fight no more; similarly, if the modern army cannot win and end the conflict, the prospect of endless engagement and battle is the same as a loss. There is no withdrawal, there is only the prospect of interminable battle, which ultimately makes the war a costly, worthless enterprise.

What are the asymmetric warfare lessons that can be applied to our need to successfully confront this viral pandemic and prevent, if possible, the emergence of the next one? Public health institutions lack the resources to take on agrobusiness directly in the world of finance and have few tools to limit the power that such corporations exercise over legislators, the courts, and the marketplace.

Nonetheless, the aftermath of this pandemic will take place in a world that will have been fundamentally altered by the steps that will have been taken to defeat this threat. There will be an inevitable series of post-mortem investigations into the whys and wherefores of this unprecedented series of tragic events. The inevitable question that will be posed is, “Why did this happen and what can we do to prevent a recurrence? Dr. Wallace asserts that the prevention question will take on particular urgency because, “…in the USA, emergence of a pandemic human analog to African Swine Fever, with a fatality rate of some 50%, seems inevitable.”

The asymmetric strategy here might well be to use the recollection of the terror of this pandemic to force dramatic changes in the way our treatment of Mother Earth has primed the planet for outbreaks such as this. If human activity in the form of agrobusiness has created this threat, the moment may be soon here to create the political will to resist and to enact the strategies that will reduce the threats it poses. The horrors that we are yet to endure with this pandemic will be more than enough motivation for us all to ask the key questions: how did things get out of control and what must be done to insure that this never happens again?

[For even more exercise for your mind: Here's important paper analysis from Dr. Wallace and his colleagues.]  

Wednesday, March 25, 2020

Coronavirus: Just for Today

Successfully settling in to isolation requires a certain suspension of the future, but the idea that we should NOT think deeply about the future (will there even be one?) goes against the grain.  One has to commit to the here-and-now: play games, stream opera, dance your head off, bake -- whatever your thing is, do it with focus.   As one pundit told to me, "We don't want to make people think harder and more broadly at this time."

But, based on the advice of Al-Anon, I think it's OK to use a few brain cells to think.  I take this from the Al-Anon prayer for hard times, "Just for Today. A highly effective guide to managing hard times, it opens with the line, "I can do something for 12 hours that would appall me if I felt I had to keep it for a lifetime." It seems incredibly apt for this period of managed retreat in which we find ourselves.

"Just for Today" has nine sets of suggestions: keep it in the day, be happy, adjust to what is, strengthen my mind, exercise my soul, be agreeable, have a program, have a quiet half hour to myself, and be unafraid.  Notice it's all phrased as "my": the heart of Al-Anon, as you might imagine, is that you can't fix the other person, but you can fix yourself.

The advice of particular interest is this:
Just for today I will try to strengthen my mind. I will study. I will learn something useful. I will not be a mental loafer. I will read something that requires effort, thought and concentration.
The topic I want to propose for deep thought is this: we are in this crisis of pandemic disease because of longterm and profound abuse of the natural world.  Sonia Shah's article in The Nation has the provocative headline, "Think wild animals are to blame for the coronavirus? Think again."  She points to the massive destruction of habitat that caused species to interact in ways they did not before.  She points out,
The problem is the way that cutting down forests and expanding towns, cities, and industrial activities creates pathways for animal microbes to adapt to the human body. 
Adding to the insult of clearing forests and wild places is the widespread introduction of factory farming, which introduces a host of other ecological pressures on living species.  Dr. Robert Wallace has called this process "farming pathogens."  Such farming, by overriding natural protections, accelerates the production of deadly viruses, bacteria and fungi.  Aided by globalization, these germs can easily travel the globe in a few weeks, as coronavirus has done in this pandemic.  While these are difficult -- and often technical -- concepts, understanding that we have to begin to face these longterm dangers is a mind-stretching exercise that is worth some of your mind-strengthening time.  I'm working with Dr. Robert Fullilove of Columbia University Mailman School of Public Health to share the important work that Drs. Rodrick, Deborah and Robert Wallace -- a family of geniuses -- have done on the issue.  Here's the pandemic prevention concept they are putting forward. 

Tuesday, March 24, 2020

Coronavirus: Love, not sheer madness

The Latino Community Foundation, headed by Jacqueline Martinez Garcel -- I'm so proud to say she was my student at Columbia University Mailman School of Public Health -- has launched a campaign to support organizations serving the Latino community, called the "Love, Not Fear Fund."

Its goal is to raise funds for organizations serving the elderly and the most vulnerable in the Latino community in California.  The Fund issued its first grants this past week, helping an array of organizations throughout the state.  
The Fund's beautiful name -- Love Not Fear -- has a message for all of us.  
We can't be afraid that our economy is slipping into a "recession."  We have to LOVE that managed retreat is going to keep us alive. 
We can't be afraid that managed retreat is going on too long.  We have to LOVE every strange day of this epic challenge.
We can't be afraid that our children will miss out on learning.  We have to LOVE that they can learn that the foundation of civilization is to care for one another.
We can't be afraid that we will be damaged by the strain of this.  We have to LOVE that we can (and will) continue to care for one another until everyone can smile again. 
Here's a link to donate to the "Love Not Fear Fund" and to help the Latino Community Foundation mobilize the powerful force of the Latino community to fight for what we LOVE.  

Monday, March 23, 2020

Coronavirus: The Pandemic and The Seven Sins

A perspective on the pandemic written by Robert Sember and Mindy Thompson Fullilove, March 22, 2020. 

On October 20, 2019, Rev. Dr. William Barber II delivered a homily at Riverside Church in observance of the 400th anniversary of the first Africans arriving at Jamestown to be sold into bondage.  His sermon, entitled “Stolen Hands, Stolen Lands,” enacted a trial of the United States  (you can find a transcript of the sermon here).  He presented the following seven charges, or sins, that America had committed as it sought to justify slavery and prevent the eradication of its harms: bad biology, sick sociology, political pathology, corruptible courts, evil economics, militia madness, and heretical ontology.  His explication of the historical appearance of these actions provided a sound basis for linking the harms of slavery to the crisis of the coronavirus pandemic now sweeping the world.  As the pandemic hits America, we believe that the seven sins are titling us toward worse case scenarios. These need to be understood and fought by a moral fusion coalition.  

The novel coronavirus, COVID19, was identified December 31, 2019, as the cause of a new upper respiratory illness, characterized by cough, fever, and shortness of breath.  As cases accumulated, it became clear that the illness was highly infectious and deadly, causing respiratory distress.  The initial outbreak in Wuhan, China, was briefly hidden by the government, but as cases and deaths mounted the nation instituted population-level quarantine, eventually affecting 750 million people.  The nation sent supplies and health care workers to Wuhan and its surrounding province, which was most severely affected.  New hospitals were built in as little as two days, providing space for the care of those who could not remain at home.  Clinicians and other scientists worked around the clock to describe the virus, including sequencing its genome and immediately sharing this information with the world (including the CDC in the USA), and describing the clinical features of the disease and the outcomes for the first hundreds of patients.  These efforts helped to contain the epidemic: at the time of this writing, only a few new cases were being reported. As of March 22, 2020, China had experienced 81,093 cases and 3,270 deaths.  

As the rest of the world watched this unfold, societies took different steps in their response.  South Korea identified its first case in mid-January and immediately instituted a full array of public health measures, including widespread testing, contact tracing and population-level quarantine for hot spots, effectively containing the epidemic to one city.  Italy was slower to respond, and was quickly overwhelmed: the number of deaths there from coronavirus surpassed those in China on March 19, 2020.  

The United States also had its first case in January. More like Italy than South Korea, the US made minimal use of the early days of the epidemic to prepare effectively.  In particular, the US bungled early efforts at disseminating tests for the virus, making it impossible to deploy much of the rest of the epidemic control tool kit.  Cases spread, following the classic geography of hierarchical diffusion, spatial contagion and network diffusion.  President Donald Trump repeatedly claimed that the epidemic was not a problem, praised himself and his administration for their successes, and declared that, like the flu, it would disappear with warmer weather.  Thus his administration dallied while infection spread silently and exponentially, by March 15th reaching the point of inflection at which the number of cases began to shoot up and those with advanced infection to overwhelm the hospitals.  As of this writing there were 22,000 known cases in the United States, but, because of the failure to implement widespread testing, there are probably 10 times that number, or 220,000.  Models suggest that we may see 2.2 million infections in the weeks to come.  

We turn from this short history to examine the ways in which Reverend Barber’s iteration of America’s seven sins reveals how we come to be on this terrible path of excess death, economic distress and loss of faith in government. To illustrate the concepts, we have selected examples of each of the seven sins; there are many others that could be included in this list.

1. As evidence of bad biology we have a litany of denials, distractions, falsehoods, and arrogant magical thinking that led the CDC to turn down the WHO’s offer to provide test kits, only to find that its self-designed tests were faulty.  The resulting delay hampered public health workers’s efforts to develop an accurate map of where and how infections were growing locally, regionally, and nationally.  This bad biology continues in the failure of the federal government to implement, in a timely manner, the full panoply of public health containment efforts.  Then, prematurely thrust into the mitigation phase of the epidemic, we faced and continue to face equivocation regarding the production and distribution of PPE and ventilators and the building of temporary hospitals. Reports suggest that the administration is more interested in adhering to its “small government” and “free market” ideology than using the resources at its disposal.  Instead, we are offered the promise of treatments, even cures, that lack the evidence-base to support such claims.  Testing potential therapies and vaccines is essential but premature, exaggerated, and unfounded claims of efficacy is not helpful.  Equivocation fuels ambivalence and confusion.  This contributes to the “don’t worry and carry on” attitude some are practicing as they ignore calls for social distancing and gather for recreation and worship.

2. The formulation, “China Virus,” is subjecting us to yet another episode in this administration’s spectacle of othering.  By casting an entire nation or population as the cause of the epidemic, the president and his apologists have dashed weeks of efforts by local officials to combat anti-Chinese racism and the falsehoods upon which those ideas and practices rest.  This sick sociology will surely make us sicker in body, in spirit, and in community.  Thus, in addition to addressing the legitimate challenges of this moment, we also have to deal with these efforts to blame the epidemic away and set peoples against one another.  

3. As indicated above, a political pathology fuels bad biology, sick sociology, and the other structures named by Rev. Barber.  This crisis underscores the costs of the political calculus underlying attacks on the Affordable Care Act and related efforts to extend medical care to all in this country.  Conservative forces are exploiting this crisis to further diminish women's reproductive rights by designating abortions "elective" and, therefore "nonessential" surgical procedures that must be delayed.  This administration’s budget proposals have also repeatedly included sizeable cuts to the CDC (The CDC’s staff has decreased by 591 positions, or 5.4%, from December 2016 through March 2019) and NIH, and then there is the confusion and lack of knowledge in the executive branch regarding whether and how the directorate for global health security and biodefense on the National Security Council (NSC) was either eliminated or reorganized.  The Obama administration established this position in response to the Ebola crisis wake-up call.  The debates regarding what actually happened to this position underscore a basic lack of planning and preparedness.  And, we see political pathology in the emerging stories of how certain politicians used their insider knowledge to leverage their own profiteering by claiming that the crisis was not a crisis while selling off their investments ahead of the inevitable plummet in the stock market.

4. Contestations regarding the responsibilities and accountability of the state can be arbitrated by the courts.  The current administration has been very clear, however, that this is not its understanding of the function of the courts, which it is aggressively populating with ideological purists.  Corruptible courts are more likely to obey than dissent.  And so, under the guise of this crisis, while other arms of the justice department work to promote social distancing and other practices that will help curtail and eventually end this crisis, immigration and deportation hearings continue.  The crisis is already being used to heighten border restrictions and to restrict asylum claims.  Reports are also emerging that while the administration is not using its vast emergency powers to accelerate production and distribution of essential emergency equipment--devolving those responsibilities to the atomized albeit well meaning efforts of the private sector and already overburdened state governments--it is keen to use the crisis to push for controversial policy changes, including the ability to ask chief judges to detain people indefinitely without trial during emergencies.

5. The economy is heading for recession, and here we show how this is linked to evil economics.  Millions are facing unemployment and production and consumption flows are severely curtailed.  The path plotted by politicians, industry, and corporations as the way through this will reveal what is considered the country’s priority.  While a proposed corporate tax cut promises to compound income inequality, this crisis has afforded us the opportunity to elevate consideration of long-standing economic crises that have either been continually ignored or deferred: homelessness, a growing part-time and, therefore, precarious workforce, real estate speculation, student loan debt, rising rents as a result of national corporate consolidation of rental properties, food insecurity, digital divides, etc.  The culture of greed and exploitation is endemic to our society as evidenced by the hundreds of thousands of people who took it upon themselves to hoard hand sanitizer, masks, and other supplies or to market counterfeit products so that they could use fear and panic to coerce consumers to pay exorbitantly inflated prices.  Similarly with the hoarding of food by those who have the disposable income and “me first” inclinations to do so.  The images of revelers permitted to celebrate spring break on the beaches of Florida at risk of spreading infection further throughout the nation was another sign of evil economics.

We also see evil economics at play in the vastly skewed value we place on labor in our society: the service workers that are now cleaning, driving buses and trains, delivering mail and packages, and stocking shelves struggle to make ends meet at the best of times and usually only do so by working more than one job. 

6. Violence is a time honored strategy for dealing with a crisis.  Militia madness is what lies behind racist maneuvers, such as intentionally referring to the Novel Coronavirus or COVID-19 as the “China Virus.”  Violence is done when the number of people incarcerated in prisons that are often already beyond capacity is not reduced, and when individuals and families continue to be detained and deported.  We enter this crisis as a country that is deeply and violently divided. Our militia madness ensures that many are excessively armed and will be ready, as they have been in the past, to act to preserve the power and privilege of the few.  Gun manufacturers and gun merchants are thriving in this crisis as people purchase new and additional weapons and stock up on ammunition convinced that things will get so bad that only the violent will come through.  Given the history of this militia madness it is hard not to think that this fear may be a wish.

7. In Rev. Barber’s review of the history of inequality, heretical ontology, the notion that inequality is at the very heart of our nation, functions as the system’s bedrock and its blueprint.  To succumb to heretical ontology is the greatest defeat of all for it means that we both accept and collude in the production and enforcing of inequality.  This belief blinds us to other ways of being and relating to others, including the realization that we are all in this together, that as we act to protect others we are protecting ourselves.  To manifest the tenderness imminent in shared vulnerability means that we affirm that everyone is worthy, valuable, and deserving.  Inequality, such as the assumption that extraordinary measures are not required to protect homeless men and women from the risks of infection, is heretical, a betrayal of our shared life.  Medical professionals are going to find themselves in fiercely difficult situations in the coming weeks as they determine how best to use limited resources.  They will likely be accused of rationing care when, in fact, it is actually the existing rationing of inequality managed through bad biology, sick sociology, political pathology, corruptible courts, and evil economics that undergirds this all.  

We outline this analysis in the spirit with which Rev. Barber presented his sermon on the seven charges against the United States on October 20, 2019.  He framed this call to account for the legacy of slavery and settler colonialism as an opportunity for “learning from the sins of the past so that we might embrace a better future.”  This current crisis is another opportunity to take up this work.  Indeed, the word “crisis” is derived from the Greek word “krisis,” used to name that "turning point in a disease" when a patient could get better or worse.  It's a critical moment.  As we work to prevent illness, care for and heal those who are ill, accompany with compassion and mourn those who do not survive, so must we attend to the social ills of inequality that shape this time of crisis.  This is a political “turning point” and a “critical moment” for justice.  

Rev. Barber foreshadows this juncture by punctuating his review of the history of racist ideologies and practices with James Baldwin’s incontrovertible challenge: “We made the world we’re living in and we have to make it over again.”  In this period of crisis, we confront a most American of paradoxes: our deeply exercised capacity for, on the one hand, discrimination, exclusion, privilege, and dehumanization--we are not, as some in power claim, “all in this together”--and, on the other, the spirit of justice, equity, emancipation, and horizontalism--indeed we are “all in this together” if our intention is our collective wellbeing.  Within this paradox lie crucial questions of spirit and being, existential questions, questions of community and society.  We have an opportunity to look at who we are and to envision who we might become.  “I am committed to working with you all to build a moral fusion coalition in the 21st century,” declared Rev. Barber as he concluded his sermon.  Then he asked: “Is there anybody else in here ready to build?”

Sunday, March 22, 2020

Coronavirus: Getting through this moment

A perspective developed with the advice and help of Lourdes Rodriguez, Nupur Chaudhury, and the Cities Research Group of the University of Orange

I’m a social psychiatrist, which means that I study the way social structures affect mental health.  In the course of my life, I’ve had the opportunity to get up close and personal with a series of epidemics that struck the inner-city in the 1980s and 1990s.  That era of “mad” plagues – as the kids used to say – included AIDS, crack, violence related to crack, mental illness related to violence, multi-drug resistant tuberculosis, asthma and obesity.  Just as that was calming down, 9/11 shook things up again.  The stress, trauma and sheer cussedness of those times gave me lots of opportunity to learn about the structure, function and outcome of social upheaval. 

One of the aspects of churning that is essential to know is that each moment is different from the last – we are moving through a rapidly changing space of interaction and we are responding to what the moment presents.  Each moment is new and largely unpredictable.  It is similar to the feeling I had in the Loma Pieta Earthquake of 1989 – the World Series Earthquake – when the building was moving beneath my feet and each second was different from the last.  Then it stopped and we could crawl through stairways to the streets.  Where the next thing happened.  And so it went for months, ending for me when I moved back to New Jersey, onto solid ground. 

We are in this process of rapid change from one unknown to another, and we are and will be behind on getting our bearings.  There is, I have learned from watching many of these, a strategy for getting through this that will help to stabilize or least calm us as we are going through this.  When we are calm, we can tend to others, and they can tend to others and we can all get through this. 

This strategy, which our team at the Community (now Cities) Research Group developed in 2001-2002 following the collapse of the Twin Towers, is called “collective recovery.”  We identified four crucial group tasks in collective recovery:
      Learn, and

We must remember history, in this case, that massive disasters have happened before.  As one sage put it, the Renaissance followed the Bubonic Plague.  We must show respect for all people.  It is easy to stigmatize and discriminate, but those actions intensify the disaster and push us away from recovery.  We must learn.  We have never seen this situation before, therefore we must be “citizen scientists” studying what it is about.  And we must examine the ecological situation for clues about its deeper origins.  Finally, we must connect.  At every moment, we need to deepen, expand and strengthen our connections to others.  This was never truer than in this moment when physical distance is the core of pandemic management.

In this phase of the pandemic, we can use collective recovery principles for “getting through the disaster.” In public health parlance, this is secondary prevention, in which we try to limit the harms unleashed by a destructive process.

Getting through the disaster
Turn on the Love
The first part of getting through a disaster is to recognize the difference between love and fear.  This might seem obvious – and perhaps it is – but there is a lot of each floating around.  Fear is normal in such situations but must be contained and minimized because 1) it doesn’t help and 2) it can really hurt.  Fear let loose on the self becomes panic, let loose on others becomes stigma and worse. 

Love, on the other hand, is profoundly useful in these situations.  It empowers us to do our best for ourselves, our families and our world.  People in disasters have a built-in need to “do something” to help.  This has gotten our species through many a hard time, and it is needed now.  Fear turns off love, makes us want to retreat from the threat.  Love turns off fear and helps us approach the need that is presented to us.

An example of love at work: a man in Pennsylvania was getting ready to close his distillery as a non-essential business, when he became angry at reports of skyrocketing prices of hand sanitizer. The distiller realized he could make hand sanitizer with the alcohol he had on hand and give it away for free or for at-will donations. 

Turning on the love keeps you from overreacting and restores your calm in those moments when you need it most.

Pay attention to this week’s needs
Our needs change every day in a disaster situation.  While going through the aftermath of 9/11, I found that the cover of New York Magazine was the best indicator of the feeling tone of the city.  They really had their ears to the ground.  I learned from them that I could do that, too.  Each of us can do “citizen science” by watching our social media feed, seeing what the newspapers are reporting, and listening to the emotions our friends and family are sharing.  A meme from NY Week 1 said, “Relationships aren’t cancelled.”  Another from NY Week 2 said, “It’s time to change from your daytime pajamas to your nighttime pajamas.” 

In this process, let go of the issues of last week – New Yorkers aren’t frantically buying toilet paper in week 2, they’re hysterical about working at home with kids out of school, or worse, of losing their income because they CAN’T leave home while the kids are out of school.  Or they’re hysterical because they must go to work and there are no adequate protections in place, the complaints reported by those working for UPS and Amazon.

Note that I labelled the weeks by place, as we aren’t all on the same page.  Epidemics travel along a geographical hierarchy, meaning they get to the flyover states from the coast cities – there is a lag.  The lag is often interpreted as “it can’t happen here.”  Don’t buy that line of reasoning.  Use the time to listen to what other places are going through, then buy carefully.  You might skip the toilet paper craze and spend your time planning balanced menus.  I didn’t have an appreciation of variety, but you could learn from my mistake.  And be sure to get lots of Vitamin C, D, and zinc tabs to have on hand. 

The point of this citizen science is that you need to respond to this week’s challenges.  Start numbering the weeks with your group and sharing what you think are the big issues.  Then, together, look for strategies to solve the problems.  And know that the problems are time limited.  This week’s problems will be solved, or they will go away.  We don’t know why there was a run on toilet paper, but we can let that issue go and focus on the challenge of home-schooling our whole child-age population.  Did you ever think what a blessing the US has so many homeschoolers who’ve been doing this for a while?  What a resource in this moment!

Fight injustice
It is essential to fight the injustices that are being perpetrated at this moment in history.  As I noted earlier, injustice undermines secondary prevention, and expands the harms of the disaster.  Justice – love made visible – is the great force limiting the harm this pandemic will visit upon us.  There is injustice all around and there has been a sustained outcry against it, which we can all join.  We need unemployment insurance for everyone laid off, including all the “gig” workers without benefits.  It doesn’t matter if Uber drivers are so-called “independent” contractors: at this time, they’re out of work and need our help. 

We must turn on the money needed by people who will be or have been put out of work. For the most powerful force fighting injustice, I recommend connecting to the Poor People’s Campaign, which is launching a national effort for a moral response to the pandemic, and relying on guidance from key leaders in public health. 

It is also important that local organizations use their clout and their websites to share trusted public health information and ways to access resources.  Where I live, we’re using a health coalition website to address these needs.  It is a source known in the local community and the many coalition partners can all help with linkages and web development support.

Extend and strengthen your network
The US is a very fractured nation.  We are divided by race, class, gender, sexual orientation, region, political party, Coke vs. Pepsi: you name it, we’re divided by it.  This pandemic has fallen on a very weak body politic.  We aren’t looking out for one another.  Furthermore, our most important leaders have exploited our division to build their political power, which they are continuing to do as we move through this disaster. 

Our networks are formed within our groups, with all-too-few ties that might link one group to another.  While we must care for our families and our group – church, school and neighborhood – we must also seek to reach across division to help others who are different from ourselves.  This is the hardest thing to do in our society.  We have found, however, that every one of us has some connection across groups and each of these is unique.  By pooling our out-group connections, we can build a much wider set of relationships.  And if those people reach out, it becomes bigger still.  It’s like repurposing the webs of infection as the webs of protection.  In webs of infection, we want to cut face-to-face closecontact, increasing physical distance.  In webs of protection, we reach across the divisions to provide succor to everyone, eliminating social distance.  This is the moment to go through every single contact you have – even if you don’t remember who it is! – and send a note saying, "How are you holding up?"  Doing so may connect you to someone who needs a hand or who may be able to help you get through this time.

As one example, Doug Farrand, who heads the Music Department at the University of Orange, sent the UofO leadership a photo of a little boy named Jordan whistling while standing next to his drawing of himself whistling.  It felt to me like a window into another world and it lifted my spirits enormously that Doug was Jordan’s music teacher.  I can, in return, share with them, the ways in which I’m working with the team that cleans my house to implement mutual safety.  Doug doesn’t know my team, but I know it will lift his spirits to hear about this collaborative work we’re undertaking.  

We, the people, are very big and very powerful, if we but knew it. 

Build a personal foundation of spirit
We need spiritual support in these times.  In the aftermath of 9/11, our collective recovery work took us to labyrinths and art sessions, hikes and meditation.  On the first anniversary – September 11, 2002 – we spent the afternoon on the stairs at Union Square, sitting in the sun, and taking in the impromptu festival that was unfolding there. 

There is spirit everywhere – that is the point of spirit.  We need to pause to remember that!  We can build our confidence in spirit in many ways.  It could be that you choose to darn all the socks in your house, remembering all the places those socks took you and all the places they will take you.  It could be that you will practice trumpet, as Doug has been doing, very pleased with the sound he’s been getting.  It could be that you want to read War and Peace, as people convened by Yiyun Li are doing.  I am taking daily photos of my lilac bush, documenting its coming into bloom. I love this time of year, as I always think of Whitman’s line, “when lilacs last by the dooryard bloom’d.”  It reminds me that this time next year I will look back at all the things that I couldn’t see and couldn’t imagine, like this pandemic and who knows what else? 

Spirit is one resource that is available to each of us, no matter how rich or poor, sick or well.  My teacher, Dr. Michael O. Smith, once told me that anyone could sit on a bench, recognize the harms of addiction, and stop using drugs.  He was then working in the South Bronx at the height of the synergistic plagues of disinvestment, crack cocaine, AIDS and poverty. 

An invitation
Along with my colleagues at the University of Orange, and the Cities Research Group, I extend an invitation to you to join us in a journey of collective recovery.  We will be annotating the weeks and reminding ourselves and you to REMEMBER, RESPECT, LEARN AND CONNECT, as we move through this disaster with LOVE.

Friday, March 20, 2020

Coronavirus: How distorted thinking will kill us and what that has to do with slavery

I was heartbroken by the front page of the Times today:

These headlines outline the crisis of bad thinking that we are in, but let me draw your attention to a few indicators.
  1. The government knew that something like this pandemic could happen and that the nation was unprepared.  We did not get prepared.  
  2. Health care workers have been decrying the shortage of personal protective equipment, but the nation has not revved up production.
  3. Unemployment claims are surging, but President Trump asked the states to suppress the numbers.
  4. People are working to find a "silver bullet" but not employing proven "magic strategies."
  5. And (not shown) a story about rightwing people in Louisiana who scoffed at the coronavirus until one of their own got seriously ill from it.  
I could go on, as could anyone who's been following the news and updates from public health and medicine.  I think, however, that I've proven the point that we are managing this pandemic in a fashion that will increase its devastation to our population.  

I promised to say how this bad thinking is related to slavery, which might have puzzled you as a claim. 

For the past four years, I have worked with a consensus group of organizations on a project called, "400 Years of Inequality."  Our project issued a call in 2018 for the nation to observe 2019 as the 400th anniversary of the first Africans landing at Jamestown to be sold into bondage. Observances were carried out all across the US, in small churches and large concert halls. 

We focused on "inequality" because we saw that as an egregious and enduring harm of slavery that entrained the whole nation.  We were honored to have the Reverend Dr. William Barber II offer the homily at a solemn occasion held at Riverside Church, called "Stolen Lands, Stolen Hands."  He centered his homily on the identification of "seven sins" committed to justify slavery.  These include: bad biology and sick sociology.  He emphasized that we have not scrubbed these distorted ways of thinking from our schools and universities or from our government or our population.  

Philosopher Robert Fullilove had this to say about distorted thinking:
Logicians teach us that, if the premises of thinking are incorrect -- for example, if people postulate that some are not the equals of others -- then they will make conclusions based on these premises that are logically correct (they will have formed a "valid argument"). But here is tricky part: "valid" is not the same as "true."  That does not mean, in other words, that their conclusions will be illogical.  People can make logical arguments beginning with false premises, but sound logic does not make the conclusions we derive from untrue premises to be true.  
And that is the trap that we find ourselves in at this moment.  We are working from false premises and arriving at "valid" but wrong conclusions. It is killing us.  

One immediate step: sign the Poor People's Campaign petition for a "Moral Response to COVID19." Led by Reverend Dr. Barber, this "moral fusion" campaign invites all of us to recognize that inequality harms us all and to fight against it.  

Wednesday, March 18, 2020

Coronavirus: Managed Retreat

Some years ago, after Hurricane Sandy, I was a consultant to Rebuild by Design, a project to get architects, engineers and designers to think how to build back in the best manner.  One of the other consultants, Dr, Klaus Hans Jacob, talked about the need for "managed retreat" from the shore in the face of rising sea levels.  As I was a consultant on the psychiatry of displacement, I argued that such shifts were very difficult, and likely to fall unequally on the poor.  In my post today I want to talk about managed retreat and tomorrow I'll turn to inequality.

In situation analysis, which is a method for assessing the current state of affairs, it is essential to "name the moment."  In the face of a highly infectious and fatal virus for which there is no vaccine and no cure, public health leaders have clearly stated that we must retreat, shelter in place, until the rate of infection tapers off.  We are now in the process of "managed retreat."  The key here, as Dr. Jacobs explained to the Rebuild by Design teams, is that it must be managed, and need not be feared.

To manage a retreat of this magnitude, several processes are essential.

First, we must ensure that all people have the fundamental requirements for supporting human life, for those familiar with Maslow's hierarchy this are the foundation for life.

Health care must be in place for the 20% of those infected who will have serious illness.  As the potential numbers will overwhelm the US health care system, it is essential that excess temporary capacity be created. Tents and temporary hospitals will be key to managing this part of the retreat. 
It is also essential that everyone with a mild illness weather it out at home with as good a plan as possible.  I was lucky, when I was ill with an undefined illness that did not include cough or fever, that my brother, Josh Thompson, gave me sound advice on vitamin supplements (Vitamin C every couple of hours, Vitamin D 4000 IU, zinc tabs often for a few days than once a day, and Zarbee's elberberry cough medicine).  These and other symptomatic aids can help -- it has been advised to keep your cell phone handy in case it gets worse.  Lots and lots of fluids, recommended every doctor I consulted. 
Food has to be provided.  Delivery should be expanded.  Free food must be made easily accessible for people who need it.  And supermarkets have to be stocked to the best of our ability. 
Money has to continue to flow. Over the second half of the 20th century, Big Business did its best to destroy the wages, protections and benefits of workers, leaving half the work force at the mercy of gig employment, scraping along with no cushion.  That half of the workforce is likely to be un- or underemployed in the next period of time.  This is a grave part of the retreat that we must manage.  Extending unemployment benefits to all would be a sound first step.  Suspending utility cut-offfs (and reconnecting those who've been disconnected) and evictions are also essential protections. 
Housing is essential.  Governor Gavin Newsome of California was reportedly buying hotels to house the homeless -- there are 30,000 or so in the state.

Second, there is one other element of managed retreat that I think is also foundational, confidence, or morale, as social psychiatrists like me like to say.

Confidence is essential: we must have faith in ourselves.  We are retreating so that we can come back and fight another day.  My father, Ernest Thompson, was forced to retreat from his civil rights organizing during the McCarthy Era in the 1950s.  He and his colleagues vowed to "retreat to the ghetto and come back strong,"  They did -- building powerful political movements around the US.  We must support the morale of the population.  Demoralization can kill as surely as a virus can.  

Naming the moment "managed retreat" is to distinguish it sharply from "recession" or "depression."  This is a temporary situation.  Epidemics rise and fall -- we have to wait out the worst of the storm.  Our economy is large, Paul Krugman says, and vital (I highly recommend his NYT column and newsletter).  The economy will bounce back when we can return to the streets.  For one thing, having sat in our houses for days, if you're anything like me, we will all have a list of things to be improved or fixed.  I'm off to Valley Hardware first thing.

Tuesday, March 17, 2020

Coronavirus: Sheltering for Seniors

Today, my doctor, Dr. Debra Goldson-Prophete, who is one of the best doctors in New Jersey, counseled me on COVID19.  She quoted Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Disease, who has been "Unbought and Unbossed" since the height of the AIDS epidemic -- a man I trust.  According to him, Dr. Goldson said, "People 70 and over -- well, you're 69 but same thing -- need to shelter in place for the next four months.  By that I mean, no church, no supermarkets, no malls, no large dinner parties, no little children."

First of all, I know that this epidemic is going to go on for a while, and I have said as much to friends and family.

Second of all, I know what applies to them applies to me.

But -- there's always a but -- I've been sheltering in my house since I got sick last Wednesday, which is to say five days ago.  It's been OK, but to hear that 4 months (or so) stretch ahead of me was a shock.  I was daunted by the prospect.  As a psychiatrist, I try to think positively and to find solutions. I knew that I was facing a "place problem,"  so I turned to the psychology of place.  I had a hunch that the clue to my issue was in the first (unpublished) book that I wrote on the topic, Moving Lines: Understanding the Psychology of Place.  It is a book of stories of people facing an array of situations and their efforts to manage their dilemmas.

Happily, the book was not in any of my storage units (which are reminiscent of the final scene in Raiders of the Lost Ark), but on a shelf in my home office.  In flipping through the pages, I was struck by how entangled we are with the settings in which we live, learn and work.  It is a constant and dynamic exchange.  Though we think in terms that indicate separation, it is interpenetration which is the order of the day.  That said, people have strategies for place problems, including strategies for "sheltering in place."  Naming such a situation is always a challenge -- are we imprisoned? on retreat? an extra long Sabbath? For me, "marooned" comes to mind.  In African American history, maroons were escaped slaves who went to live in isolated places, sometimes for years at time.  The word has a connotation of resistance and survival.

In Moving Lines I wrote about two stories of people marooned, stories that were remarkable in their similarity, though the events transpired decades ago and continents apart.  One was the story of 16 African American men who were sent to the Great Lakes Naval Training Center during World War II to be considered for promotion to officer status, the first black men to be so honored, the other of Israeli soldiers who were captured in 1967 and confined for two years in an Egyptian prison.*  Each group was sequestered, and had to find the way forward, facing danger on the one hand and honor on the other.  The methods they chose were remarkably similar -- even down to the language they used to describe they experiences --and included: having a goal to reflect well on their people, establishing democracy, identifying and employing all the talents in the group, and working hard.

Each group achieved success.  Among the accomplishments of the Israelis was that one of them translated The Hobbit into Hebrew so that they could all enjoy it; that work became an official translation of the book.  The African American sailors ensured that all 16 were able to be considered as officers.  Thirteen, known as the "Golden Thirteen," were promoted to officer.  In my first paper on the psychology of place, published in the American Journal of Psychiatry in 1996, I named the process these groups used "empowered collaboration."

Some doomsayers are suggesting that we will be forever injured by the social distance we must employ during this period of fighting coronavirus. But that is not what the psychology of place teaches us.  It teaches us that we are in a dynamic exchange with our place.  We can manage this retreat from daily life using empowered collaboration and exit sound in mind and with remarkable accomplishments.

We 70+ can lead the way, showing the nation(s) how to enact empowered collaboration.  I think these are the key steps for each of us individually:

  1. No moping.  My father used to say to me, "You're old enough to know better."  Certainly true by now! 
  2. Make a schedule.  Nothing gets accomplished that's not on a list -- a great exaggeration but these are extraordinary times.
  3. Name your goal.  Who do you want to make proud and how?  
  4. Get busy.  
I don't think it matters if you set out to mend all the socks in your house, improve your baking, or write a book.  What does matter is that you find your buddies, and you support one another in moving forward.  Your buddies don't have to be 70+ -- it could be your 17 year old granddaughter.  They just have to agree to the following:
  1. Be a democratic group. 
  2. Ask one another about your talents and share your skills.
  3. Take it one day at time, and keep it in the day.
For my part, I plan to write a short handbook for my students in the next four months. If you are thinking you'd like to write a book, I invite you to join me via the University of Orange Digital Campus which we are setting up in the next couple of weeks. 

Join me.  I guarantee that, by using empowered collaboration, we can emerge from this managed retreat stronger than we ever were.

And I want to remind you that we are not staying at home simply to be safe ourselves.  We are the most vulnerable group and the hardest to save.  When we get sick, it takes enormous resources.  By staying healthy, we preserve the limited supply of health care for the younger people, as we should.  

*For those interested in reading more, check out: The Golden Thirteen and Seasons of Captivity.