Over the weekend, two Walmart stores in Bumfuckland Parish, Louisiana were ransacked by EBT recipients taking advantage of a software glitch that prevented the cash registers from showing balances on their cards. For those of you who have ties to Louisiana or otherwise give a damn about the state as something more than a Cajun-blackened jazz theme park, the affected Walmart stores were specifically in Springhill and Mansfield, two rather obscure towns in the northwestern part of the state (I recall hearing about Mansfield before), not far from the East Texas city of WE ARE MARSHALL.
It can’t be a coincidence that this is a part of the country that isn’t exactly ready for some civics but is definitely ready for some FOOTBALL. You know, Friday Night Lights, and all that. It’s all poignant teenage melodrama, five hundred kilovolt sexual tension under the hot Texas sun, until some poor kid gets concussed or dead or turned into a vegetable, and anyone with a lick of sense has to ask, “What the fuck is wrong with these atavists?”
Now, what does football have to do with the maturation of young people into a competent, self-sufficient yeomanry? To paraphrase Edwin Starr, but barely so, absolutely nothing. Say it again. It’s not that different from war, now, is it? Look: that time you’re spending on the gridiron is time that you aren’t spending at FFA meetings or apprenticing yourself to a beekeeper or starting your own business, but the FFA beekeeper’s apprentice gets less pussy than the quarterback, am I right?
Aight, I indulged in a bit of gratuitous splitting there. Some of these beefcakes are of at least marginal utility to society. Some of them are honest-to-God farm boys, and that kind of thing. They aren’t all just a bunch of meatheads destined for careers in highway robbery (the police) or fraud (insurance, banking, property management). Some of them will do something with their lives besides chain-smoking at the Monroe Greyhound depot while a colleague from the sheriff’s department runs a drug dog over everyone’s luggage and, it’s the damnedest thing, but the cops are all white and I’m just about the only honky out of the ninety-odd people they just marched off two redeye buses to Jackson at 9:30 am.
Perhaps it is significant that these Walmart runs occurred in a state whose government still practices agricultural chattel slavery. I’m just sayin’. The cultural ambiance needed to succor these lifestyles–cotton-picking chain gangs, opportunistic food stamp fraud, FOOTBALL–is pretty consistent, and it ain’t one that Jefferson promoted, except by his own example. Food stamp freeloading goes against everything a good Southerner believes in, i.e., against practically nothing that he practices. Notice that in recently, and barely, less benighted counties whose weaselly governments played tax-credit hardball on the Damn Yankees for a car assembly plant, the whole goddamn Chamber of Commerce is reliably nursing a four-hour erection and fixing to get a hernia in its excitement that, mercy me, we have a factory now, and JOBS! That’s nice. It’s kind of like what I imagine the city boosters in Pittsburgh saying, less histrionically and in a more clipped cadence, in 1885. You probably don’t want to think about what Chattanooga had for its working class before. Hint: dentistry wasn’t a big part of it.
To rephrase this in the floridly moralistic language of conservative high civics, civil rights are contingent on the discharge of civil responsibilities, but it works in reverse, too, maybe even more so. Or in English: the little people ain’t gonna show a lick of responsibility if you don’t give ’em any fuckin’ rights, massa. If the master robs his servants in exchange for their honest labor, surely there will be a decrease in their honest labor. Don’t believe me? It’s in the Bible. Okay, maybe it isn’t; I haven’t checked; but it should be. FYI: the peons making a show of working when the overseer is present with a bullwhip doesn’t count.
That’s why the South has such a large managerial class. Well, that, and because real work is for niggers, right? And then the asshats wonder where all the good Negroes went, and why the remaining ones don’t want to work. Gee, Mrs. O’Hara, maybe General Sherman took all the good ones for himself, or, well, now, you don’t suppose y’all queered the whole thing by treating the help like Amish draft horses past their prime, do you? No, my goodness, there must be an external locus of control when blame is to be assigned. Damn Yankees upset the natural order of things. They always do.
Disturbingly, the real joke is on me and my fellow Yankees. Johnny Reb has spent the last couple of generations exporting that race-to-the-bottom plantation model nationwide.
Whenever anyone points at the man behind the curtain in these situations and states the obvious truth that he’s buck naked and pleasuring himself as if society is an S&M burlesque show put on for his benefit, all the managerial-class freaks come to the yard to intone about some version of the truth that nothing will get done if no one does any work. Well, no shit, Sherlock; I’ve worked on farms, so you don’t have to convince me. What’s alarming, though, is how many of these moralists would totally order the recalcitrant slaves whipped and feel smug about the decision. They don’t say it, nor do they look man enough to personally wield the whip hand, but you can see it in their eyes and hear it in their voices. They don’t actually love the virtue; they secretly hate the virtue. This is why they believe that the work ethic can be enforced only through violence and threats.
Much of this neofeudal cohort applies the same evil illogic and hypocrisy to sex. They insist that the beatings continue until sexual morals improve, but the improvement doesn’t really come. What comes instead is a cultural pastiche of Bible-thumping altar calls, secret pornographic subscriptions, “sex addiction” “support groups,” meth-fueled whoring at the Motel 6, I’m-not-gay-I-just-do-stuff-with-other-guys-sometimes restroom trysts, “purity rings,” hella creepy “purity balls,” threats to murder that boy if he hurts my daughter, widespread ignorance about basic reproductive biology, and sky-high rates of divorce, teen pregnancy, and chlamydia.
Yup, it’s crazymaking for anyone with a hint of philosophical or moral coherence. This sexual hypocrisy has gone viral across the country in evangelical circles, by the way, although it’s usually expressed in a nastier tone by preachers in Georgia or Texas than by those in Colorado. For that matter, a lot of the other calumnies I’ve printed about the Old South can also be applied to scarily large parts of the North; it isn’t for nothing that they call it Pennsyltucky. Some of the genuine old guard Southern gentry, the ones disinclined to curry favor with prim Yankee industrialists, were honest enough to chastise Northerners (and certainly those of the abolitionist ilk) as a bunch of drab, uptight Cromwellian scolds with no appreciation for the rich intellectual and social traditions of the Cavalier as kept alive by the Southern Gentleman. Their assertion of an aristocratic prerogative (“How the hell will we be able to study the classics if we’re forced to pick cotton, or to run a damn steel mill like that cheap Scotch bastard Carnegie? We need slaves”) was much more forthright, and hence easier to demolish on moral grounds, than latter-day managerial-class arguments that work is a Biblical blessing, one that must be made compulsory by restricting welfare benefits and generally starving those who are not duly blessed, or that Bill Clinton is an evil, predatory satyr who–is the microphone off?–needs to fuck me in the ass so that I’m not bending down to the level of Minneapolis airport police sergeants, damn you Monica.
Sure, the reasoning was objectionable, morally bankrupt, ludicrous by any objective standard, but it was easy enough to understand. One didn’t come across as many holier-than-thou hot bottoms with a crank problem in that culture. The gentry didn’t pretend to be workaday yeomen with a deep and abiding love of Jeffersonian democracy. They didn’t so skillfully evade diagnosis by their enemies.
The great sexual hangups of the Christian Right weren’t historically much of a Southern thing, either. On the eve of Griswold v. Connecticut, a line of sectoral demarcation ran along the Ohio and Potomac Rivers, separating the states outlawing contraceptive aids from those at least tacitly allowing them. It was the Southern states that had let it go unsaid; most of the Old Union had gone full-bore Comstock-buggering-the-archbishop moralistic on the sexual habits of their own citizens. More impressively, the Southern Baptist position, official and lay, on abortion didn’t harden until the 1970’s; by Richard Land’s account, the subject barely registered in the sixties.
Of course, this still left plenty of room for Southern sexual hypocrisies, such as that old classic about the virtue of Southern Christian womanhood; ask Emmett Till’s ghost for details. (NB: Honky chicks. Rule doesn’t apply to the dark meat.) And if one wants to reconcile the arguments of Southern gentlemen that a gentleman should be accorded some discretion in the pursuit of his private passions (leaving aside the rapey ones) with the sexual strictures that shall be applied to the public at large, there are two main ways to go about it. One is to expand rights of sexual self-determination until they are universal, much like the present-day franchise, at least when Kris Kobach, Nikki Haley and their ilk aren’t pawing around with it. The other is to clamp down on everyone’s rights and call that freedom. Which of these has become de rigueur in Dixie? Apartheid regimes are inevitably underpinned by authoritarianism, so take your guess.
By many accounts, the South is progressing from Apartheid to an ever more colorblind oligarchy, a sort of Chile with black people. Usually these accounts omit terms like oligarchy, as if the South is really egalitarian after all, and in comparison to the craziest Yankee cases (New York City, Santa Clara County) it certainly is, but the ancient hierarchical nastiness is implicit enough for anyone who’s paying attention. A few years ago, human resources asshats at the Jim Beam bottling plant got into trouble for asking white employees, too (I infer) to report their menstrual periods for the purpose of determining bathroom break privileges, so God bless America.
It isn’t Whitey; it’s Bougie. And progress, or so we’re to believe. Under normal Southern social conventions, and I’m speaking very broadly here, to encompass everything above Aunt Polly’s Crank-n-Cock Doublewide Crystal Whorehouse, that would be considered a shockingly rude thing to ask a lady. “Antisocial” would be considered a mainstream assessment. But it’s different when it’s asked in a professional setting of the help. The help dasn’t give massa any backsass; it wouldn’t be fitting. In a sense, Jim Beam’s draconian HR policy is a throwback to the days before Bacon’s Rebellion, before interracial class solidarity first freaked out the planters enough to throw civic bones to the poor whites in the form of dispensation to join in the abuse of black slaves. Put a bit more honestly, if with less strict technical accuracy, on the Jim Beam bottling line, everyone’s a nigger.
This Jim Beam menstrual police donnybrook is just the tip of the iceberg. Thanks mainly to labor unions, civil society in the North had a lead of several decades over the South in cracking down on managerial depravity, until a swath of mostly Southern states started a Red Queen’s Race of tax incentives, “right to work” unionbusting schemes, and the like, throwing American labor relations into a cocked hat. Once again, it’s that authoritarian impulse to degrade everyone to the same wretched lowest common denominator, with massa and his enforcers on top, ruling the roost. Mob goons might well have buried Sam Walton in concrete, Jimmy Hoffa style, on orders from the United Food and Commercial Workers had he tried to build his retail empire from Chicago or Philadelphia instead of Bentonville. This is why, even if they’re generally a bit off, the lifer dogs at Safeway don’t look servile. They know that the union is ready to seriously fuck shit up for the company if management gets too disagreeable.
There are exceptions, certainly, but as a rule of thumb, this sort of labor assertiveness is a Nawth’n thang. A Southern man don’t need a UFCW organizer around, anyhow, or a moralizing Canadian whiner with grating vocals. Sam Walton said things to his “associates” for which he would rightly have been sucker-punched in most Milwaukee bars. Upcountry Arkies just don’t have that kind of gumption. They don’t have that kind of workman’s pride or self-respect.
Consciously, they’re yeomen, but subconsciously, they’re peasants. It’s a gnarly combination. A conscious peasantry is obnoxious, but mainly in the sense of being rather coarse. Just as with a conscious gentry in its proclamations of highbrow cultural heritage and resultant need for slave labor, a conscious peasantry knows that it’s poor and ignorant, so it either accepts its lot or, probably less often, tries to meaningfully improve itself. The subconscious peasantry produces much weirder social pathologies, such as proud cracker shtick. What I refer to is the irrational, reptilian, butthurt-assuaging (heh) insistence by unhealthy, dirt-poor illiterates living in tar paper shacks that, no, seriously, we’re self-sufficient and how dare you suggest that we need to go on the dole. Okay, how about because pops has black lung, the lot of you have serious dental problems, and y’all are living in a squalid trailer in the middle of a flood plain, and you’re already up to your eyeballs in government relief, so how about y’all just admit to it like adults?
To be very clear, my most infuriating encounters with cracker pride did not take place in Kentucky, and they didn’t even involve genuine crackers. The problem is that this rugged individualist bullshit is so pervasive in the United States that no amount of education, literacy or distance from Appalachia can protect against it when one is a back-to-the-land bullshit artist surrounded by other dirty hippies and enablers of various stripes, and when one is also broke, clinically narcissistic, and in hock to every relative and friend who has more money than Old Scotch Parsimony in a cumulative amount of several hundred thousand dollars. This is how one ends up declining unsolicited, unconditional offers of financial help following a completely accidental and unforeseeable leg fracture, choosing instead to go into crushing credit card debt, while simultaneously manipulating one’s friends and family to invest in a worthless class of private stock, followed by emergency grants from some of the same relatives to avoid foreclosure on a half-million dollar business property and buy a new car. Ooh, look at us, we’re Jeffersonian mountain people, beholden to no one! Yeah, and I’ll haul your asses into court if I hear of you insinuating to my parents that I’m a fuck-up again.
It’s like East Kentucky, but with more books, and marginally less duct tape. In pretty much every US county benefiting from net federal outlays, this rugged individualism rhetoric is a fraud perpetrated to cover local asses. Maybe it helps build sympathy in wealthier, more functional areas, too, but I’m pretty sure most urban liberals regard it as a ridiculous act; there are fairly compelling cultural reasons why SWPL regard public relief payments to our Highlanders as something akin to feeding zoo animals, albeit ones that they don’t visit. “Multiculturalism” rhetoric as it applies to crackers is mushheaded dissembling; hardcore cracker culture is so blatantly dysfunctional, not to mention so notoriously opposed to anything urban or cultured, that vanishingly few bougies seriously believe that it should not be consigned to the dustbin of history seventy years ago. The same SWPL routinely give more latitude to blacks for engaging in very similar sorts of caterwauling, all too often unto violence, an undue latitude that Thomas Sowell critiqued in (duh!) Black Rednecks and White Liberals.
The big caveat to the notion of blacks as crackers, as a people who were merely birthed into that brotherhood by another mother, is that at the trashy lower levels, where the critique really counts, they don’t show any of that cracker pride in nonexistent self-sufficiency, at least not in an obvious economic sense. Blacks are reliably excoriated by an exceptionally wide swath of the right wing for submitting to dependency on the government. This may be because they tend not to talk a loud game about self-reliance while discreetly suckling at the gubbyment tit, as is routine in more easily sunburnt counties from Kentucky to Utah. It could be that the real problem for the right isn’t that they’re dependent, but that they’re shameless. (For the most depraved fringe of the right, the problem is their race; it really is because they’re black.) In the general sense of rough-and-tumble dipshittery and easily wounded pride, however, the black underclass is crackers on PCP.
At the same time, it’s widely argued that Here Comes Honey Boo-Boo is not just shitty television, but a harbinger of the white lower class’s convergence with black lower-class norms. The thing is, even among whites, the work ethic and conservative sexual ethics were never quite as popular as they’re made out to be. One might get booted from polite society by pearl-clutching enforcers for saying, “Any honest man will admit that he’d rather bang a cheerleader in the greenbelt and then have a tall boy than work in a factory all day and spend his free time in a Bible-based recovery small group. Let me rephrase that: any honest Idaho senator will admit that he’d rather get buttfucked by the sheriff in the greenbelt and then have a tallboy….” If you’re drunk and oblique enough, however, you might be able to get away with the homo stuff in impolite society; the drinking is a given, and the straight sex, too, as long as it isn’t blatantly pedo. Even in times of pervasive official religiosity, many people didn’t take church diktats very seriously, and ours are days of waning religiosity, including among poor whites, a cause for much hand-wringing in the religion-for-thee-but-not-for-me school of conservatism.
Ultimately, it’s impossible to perfectly calibrate the social controls needed to ensure a thrifty working class. In times of blatantly rising inequality and falling equity, forget it. Since religion isn’t well positioned to enforce compulsory r-strategic breeding on the masses, maybe social inertia and welfare checks will do so, but if you’re looking for sexual officiousness as part of the package, go abuse yourself, like Anthony Comstock did as a young man. It ain’t happening. It’s either extolling Bristol Palin as an exemplar of shining young motherhood or going hard retro and castigating her as a ruined slut; “both” is not an option, if it ever was.
If you want the lower classes to be aspirational, television offers them some great ideas. Most of these involve lawsuits. Paradoxically, it is the poor, not the rich, who are more familiar with an obscure abdominal implant called transvaginal mesh. This did not come about because there was a bitchin’ abdominal surgery special on the Discovery Channel, or because VAGINA! No. The reason these poor laymen, many of them broadly ignorant, have heard of transvaginal mesh is that it is allegedly defective, subject to a class-action lawsuit (of indeterminate merit), and hence a likely source of its manufacturer’s MONEY MONEY MONEY MONEY! MON-AYYY!
The mechanism at play here is a crass one: if you get hurt, you get a payday. It’s your right; name it and claim it. Can I get an Amen for that? In fairness, these ambulance chasers are shysters, but they aren’t running a Tammany Hall racket in God’s Holy Name. They’re honest enough to proceed on the obvious premise that they deal solely in temporalities, to leave the really twisted shakedowns of the desperate, striving poor to exceptionally depraved men of the cloth. Their shtick isn’t about God’s favor upon His people; it’s about how Social Security denied your disability claim for whiplash and mesothelioma after your transvaginal mesh got torn in a collision with an asbestos truck, and you need to protect your rights. Call 1-800-WIN-WIN-1 right now.
Then call the Scooter Store for your power chair, at little or no cost to you. You deserve these things. They’re your rights, you know.
Perhaps any critique of this sort of aggressive sponging is inherently conservative. It seems that liberalism in any sense–the pursuit of happiness, the social safety net, license–wouldn’t want to be the bitch killing these mooches’ vibe, while conservatism would be alarmed at the immoral incentives, the upset of the natural and healthy order of things, and the profligate end-stage waste enabled by this worldview. I generally fall to the left, but watching ads for that shit on downmarket TV shows, I feel the stirring of an inclination to go full Thomas Sowell on the advertisers and the target demographic alike for ruining a good thing with their sloth and avarice. It just isn’t the stuff of a functional, productive society. More likely, it’s the stuff of restive grievance-mongers looting the local Korean corner shops and beating the shit out of an innocent white trucker because some cops were just acquitted of assault in the line-of-duty beating of a black suspect who, as news reports conveniently omitted, was high out of his mind on PCP and fighting with the ambulance crew after his beating. There certainly isn’t a direct line from the Madison County, Illinois civil jury pool and its free-money-for-the-people school of jurisprudence to Reginald Denny, but there’s a certain consistency of philosophy at play. Call it free stuff and retribution for black poors.
Since that downmarket, heavily black demographic (NB: not ghetto gangbanger underclass, which is awfully scarce in the jury pool) is not all about personal responsibility, the conservatives manning the ramparts are all about personal responsibility. Super-duper all about it. Personal irresponsibility is ruining America, so personal responsibility will save it.
This sounds like a swell plan until you look at all the structural stuff. The United States isn’t exactly a society where honest labor surely brings prosperity. Yeah, sometimes it does, or a twenty-year veteran fry cook might just get deeper and deeper into debt to payday lenders trying to make rent for her good-for-nothing slumlord. A country that believes in hard work and opportunity does not make the inflation of housing costs, euphemized as “recovery” or some such rubbish, its official policy.
There’s a Calvinist theological explanation for this that I don’t mind using, even though I adhere more or less to Roman Catholicism: works are a testimony to faith and membership in the Elect. (Calvinists are more in-your-face about it than Catholics, in any event.) Here we have a policy, eternal real estate inflation, that screws over the very people who need to work hardest to succeed, by making it difficult to impossible for them to afford decent housing. This policy does not reward work; it rewards speculative rent-seeking. Adam Smith regarded this as worse-than-useless parasitism, albeit in much more tedious language; the American political class regards its virtue as Gospel truth. Our true faith, not the one we preach but the one we live as a polity, is not in honest labor but in first-past-the-post extortion of all stragglers, leavened with a dose of fraud. Amway truly is the American way. All the angels and saints of the DeVos family, pray for us.
Consider mesothelioma, that disease they won’t shut up about on the boob tube. It isn’t exactly the result of coal miners being highly esteemed and looked after by their societies in recognition of their contribution to civilization. Coal mining with Chinese characteristics is the traditional and typical of mine-engineering glorious history and culture of oops we just entombed like a hundred eighty guys in a roof collapse, actually, two-twenty; please enjoy with fortune cookie and lucky Powerball numbers. (Hey, you get iPods and shit out of the deal.) American mining history is one of Molly Maguires and West Virginia crackers (the labor-oriented kind) going up against psychopathic company goons. Dennis Rader and Jeffrey Dahmer would have had fun in the strikebreaking business, and management would have used John Muhammad and Lee Malvo as sharpshooters, assuming they hired Negroes. (Hiring black strikebreakers is apparently standard practice on the Portland waterfront to this day, with or without raccoons being thrown over the perimeter fence by racist Longshoremen.) You have to figure that the average Oxycontin-addled trailer family on disability fraud in backwoods West Virginia has more experience with mesothelioma than the DeVos family. Hell, bring me a single living DeVos family member with mesothelioma, and I’ll buy you a couple pints of Woodchuck. (I’m cheap. It’s the Scots, my maternal grandmother’s people. They weren’t exactly crackers, but they sure acted it.) My guess is that the lot of them are too busy using church networks to scam goobers to work in the mines.
At first glance, the carrying-on about transvaginal mesh sounds like it might be an opportunistic scam: waaaaah, my cootie, the mesh hurts, the mesh broke my vagina again, gimme some money. The trial lawyers will certainly get some money out of the ordeal, realistically a lot more than the affected patients, and that seems unfair if the class action is meritorious, since in that case it wasn’t the lawyers who suffered structural damage to their vaginas or whatever the surgeons tried to mesh up around their vaginas. Truthfully, I’m not interested in researching the details right now (just writing this essay will probably be a ten-hour job), although y’all are free to post any relevant literature summaries, etc. in the comments. Even if I did plunge in (as he said) and try to make sense of the literature, I probably wouldn’t be able to figure out who’s being straight and who’s fibbing. It’s probably a bit of each on both sides. That’s why the expert witnesses can afford to shop at Whole Foods. I can figure, though, that since the mesh is implanted in the abdominal cavity to separate various organs that were slopping together due to internal injuries, it damn well had better be well designed, engineered, and constructed, and the surgeons implanting it had damn well better do the job right. Cosmo may disagree, but we’re dealing with higher stakes than an improperly applied tampon.
And what if something goes wrong? First, sure as the sunrise, the hospital and the manufacturer will be pointing at each other. The American medical malpractice culture is not conducive to humility or efficient truth-finding; hasty ass coverage in a cruelly adversarial free-for-all is the name of the game, and those fuckers are in it to win it. Second, and at least as important for the patient, she will likely have no idea of what the hell really happened. She probably won’t have the technical knowledge to know where to start looking, and the hospital, her insurer (if any), and the mesh manufacturer will probably be too busy trying to soak one another to give her a hint. Basically, she has to pray for ethical clinicians on her surgical or post-op teams. Clinicians are sometimes crooked, but medical device manufacturers and insurers are consistently crooked as hell, iinsurers doubly so, and unencumbered by the oaths of practice afflicting nurses, physicians, and surgeons.
Yet it’s much, much more than an ethical minefield. Complicated medical cases always are. An uneducated patient is hapless in these circumstances.
It’s extremely easy to lose sight of just how difficult it is for patients who are poor, uneducated, or both to navigate medical care. They inhabit a different intellectual world. For one thing, they often have no idea of the underlying sociology of the clinical world. They don’t understand how doctors and nurses think. On many shows, the target demographic for these transvaginal mesh personal injury ads is the same target demographic that considers becoming ITT Tech-trained medical transcriptionists because they’ll “get to work in the prestigious medical field!” It occurs to me that this is really code for “you’ll get to marry a rich doctor!” The gals haven’t a fucking clue. From a purely interpersonal standpoint, hanging out with the kind of clinician who went into practice for the “prestige” sucks because that ilk is a bunch of self-absorbed boors trying to assuage their own insecurities. Even if a hardscrabble social climber from the wrong side of the tracks is in it just for the money, or the “prestige,” she’ll need to do better than that. With luck, cute bimbo game will land Pretty Woman a narcissistic internist with secret gambling debts. Docs who don’t make clowns of themselves have options.
This doesn’t just apply to MD’s, either. I know dozens of hospital staff socially: physicians, RN’s, unit clerks, psychologists, social workers. I hang out with them from time to time; I’m a psychiatrist’s son, in case you wonder how I got this way. These psych ward alumni are usually classier than whatever narcissists and drama queens among my own peers are free and interested in chilling that night, so don’t hate the player, hate the game. Anyway, these hospital employees are consistently indifferent to social status. They associate freely and naturally with colleagues of nominally lower or higher status because they recognize that the difference is merely one of scope of practice, and they consistently regard prestige as a hobbyhorse of their most disturbed and incompetent colleagues. They regard socially-climbing vo-tech alumni interested in the prestige of health care as something like barnacles attached to a leaky ship, although they would be loath to say such awful things about ships or marine invertebrates.
This is all to say that what we’re dealing with here is a gaping philosophical chasm. If you regard clinical practice as a cross between “Grey’s Anatomy” and “Days of Our Lives,” you lose. If you’re unaware that a real-life book of anatomy by a real-life Mr. Gray preceded the quasieponymous television show, you lose. If you regard Dr. Oz as “your doctor” and you haven’t gone under his knife, once again, you lose. That way lies stoopid, my friend. Teh stoopid compounds itself, eventually reaches critical mass, and becomes nigh impossible to escape. You don’t want to be on the wrong side of that chasm. Mind the gap.
It’s hard enough for medically savvy patients and their families to secure adequate medical care. A few years ago, a family friend said goodbye to me and my parents after dinner, informing us that he had an inoperable melanoma metastasis to the liver. This determination wasn’t made by whomever was on duty that night for cancer ‘n such at the Kit Carson-Sheepfucker High Plains Memorial Medical Center; it was made by a Stanford surgeon in consultation about a patient who was being monitored by a joint Stanford/UCSF tumor board. The surgeon’s concern, a perfectly valid one, was that the tumor was nearly the size of a softball and very close to the porta hepatica, so that an entire lobe of the liver would have to be removed to get clean margins and there would be a significant risk of exsanguination if one of the hepatic arteries were accidentally cut. The problem was that our friend’s alternative was a certain untimely death from internal strangulation over a period of weeks or months. After searching frantically for another few weeks, he found a surgeon who was willing to operate, and the surgery was completed successfully and without complications. He wouldn’t be alive today if he and his wife hadn’t spent several weeks asking around, and if they hadn’t known where to ask.
That’s the kind of thing that can happen to an exceptionally well-informed and well-connected patient under world-class care. If you see employment at the bottom of the hospital heap as “prestigious” because you’re around doctors, that’s most likely not the level of care that you’ll be getting for your own melanoma metastasis. FYI. You just won’t know how to navigate Rumsfeld’s much-derided known unknowns, let alone his unknown unknowns. There are a lot of these in medicine, especially for the patient.
Things get hairier if the patient has been addled by pharmaceutical advertising or pop medicine. I once heard Dr. Oz wax breathless about something called “NEAT: Non-Exercise Activity Thermogenesis.” It’s basically where instead of being a lazy shit and taking the elevator, you take the stairs, but it isn’t exercise because all you did was take the stairs, so it isn’t like a whole lot of exercise at once. He carried on about this nonsense without the faintest hint of irony. The guy is a boarded, practicing cardiac surgeon, and yet there he was on the boob tube, promoting an objectively false claim about exercise not really being exercise as a sort of positive-thinking psy-op on his audience, comporting himself like a village idiot bragging about how he had just learned about a bunch of Greek and science and stuff. One would certainly hope that he’s merely a histrionic charlatan; the scary prospect is that on some level he has started to believe his own bullshit. At least Oz, however, can fall back on his very rigorous, very grounded medical training if he gets sick of his own pseudoscience. The presumable majority of his audience that sincerely believes his bullshit and hangs on his every word is hopeless.
Patients and loved ones without an existing fund of medical knowledge who are worried about the quality of their care are in a bad spot. Even if they have the good sense to figure that Oz is probably a publicity-seeking blowhard, they’ll still have a hard time discerning legitimate medical advice from illegitimate, let alone detecting inadvertent flaws in legitimate advice. There are just too many variables. It gets worse when the prohibitive cost of even basic medical care in the United States is factored in. One result is a large population that uses WebMD as its primary care physician and occasionally splurges on visits to non-virtual physicians. The real docs tend to find this annoying, understandably so if they’re competent and their patients are misinformed by half-cocked cursory readings of secondary medical literature.
There is, however, a little-discussed flip side to this relationship, in which physicians who are incompetent and grandiose, or maybe just too harried to pay attention, don’t like being pwned by laymen who can read secondary medical literature competently enough to point out errors in their diagnosis or treatment. The patient will probably get the same haughty, dismissive treatment for second-guessing a competent physician’s reasonable judgment as for second-guessing an incompetent’s unreasonable judgment, so it’s hard to know whether or not it’s a false positive. All patients and their loved ones can do is rely on their laymen’s understanding of complicated medical literature and their gut intuition. It’s all they have in their fight to hold an entrenched, licensed medical establishment accountable for their care. They’re often left with an inchoate sense that something just isn’t right about that doctor. They can’t explain it, but they’re pretty sure that he’s doing something wrong. They’re at the mercy of the medical establishment not to dismiss them as a bunch of ignorant cranks. It could be that the doctor is inadvertently making a mistake that could only be pinpointed by an outside professional board of inquiry, but someone usually has to get dead in spectacular fashion before that happens. It took dozens of patient deaths before serial murderer nurse Charles Cullen was arrested.
The average layman will have neither the knowledge nor the confidence to properly call his useless but well-groomed physician a bumptious quack. Besides, if he complains, he will probably do so under the din of a consensus that that’s just how things work around here. There’s a lot of bumptious quackery in medicine. After a point, it becomes background noise.
These contexts may sound crazy to lifelong bougies. Chronic debt, atavism, untreated medical problems, substandard care, predation, fraud: seriously? Yeah. Seriously. If it comes as a shock, you just haven’t been paying any attention to the poors. Even from a distance an observant bougie can fill in quite a few of the blanks.
Under conservative high civics, these poors should be sniffing out incentives to behave and striving for an upwardly mobile, if modest, middle class existence as respectable citizens. Of course. That must be why they’re bombarded with basketball and football broadcasts, ads for gambling (pardon me: “gaming,” since pawning one’s family heirlooms for bettin’ money is just a game; by the way, so is Russian Roulette), and intractably crass popular songs about seducing bitches with bling and whatnot. Disturbingly, shady-ass for-profit trade schools and the Armed Forces are practically the only advertisers promoting bourgeois aspirations to the lower classes. Think about it: this is a culture in which diploma mills are beacons of prudence and the goddamn Army is one of the less atavistic options. Everything else is about going hard or going home (to what, a freeway overpass?). In the parlance of the very imitable Chad Kroeger, they all just wanna be big hip-hop stars (because it would be racist to dog on some bitch-ass-ho-you-my-nigga “artist” for being worse than Nickelback). They can’t conceive of an orderly climb into the middle class, which would be too “white” by the standards of the black underclass in any event, but they’re totally down with an abrupt transition from ghetto poverty to fame and fortune. After all, it’s gone swimmingly for Allen Iverson and Michael Vick, and even better for O. J. “give me back my fucking stuff” Simpson.
The reasoning at play here is incomprehensible to the middle classes or to old money. These people live in an ambient culture in which there is almost no sense of prudence or of a middle ground between chronic poverty and obscene wealth. This isn’t just true of the black lower classes; it’s true of a surprising number of low-class whites, too, as Fred Reed describes on occasion. When these people come into money, they tend to waste it in ways that horrify the established middle classes and bemuse the old money elites, like Michael Jackson did with the Neverland Ranch, the shopping sprees, and propofol administrations from his private “cardiologist.”
In this entire context, the Walmart EBT runs were a piker’s play. These were generationally poor people, I have to assume, living in a historically very unequal and inequitable part of a country that as a whole is hurtling headlong into banana republicanism yet again, and brainwashed for their entire lives by encouragements to aspire to crass wealth. Of all the antisocial ways they could have reacted to these influences, all they did in this case was to go on impulsive $400-700 grocery runs en masse after friends told them that the EBT system had gone goofy and brought Christmas in October. Family grocery bills in the low hundreds are not at all uncommon, so we aren’t dealing with really crazy outliers here, even though we are dealing with an unusual windfall.
These shopping sprees are reminiscent of a story about an Afghan villager who, when asked what he’d do if he were awarded the $25 million bounty on Osama bin Laden’s head, said that he’d buy a whole bunch of goats, maybe even seven thousand. These windfall shoppers were leagues away from their favorite celebrities in terms of shopping habits. One lady had a forty-nine cent balance on her EBT card. Mark my words, more than a few of them needed badly needed groceries.
Sure, these opportunistic runs on Walmart were not admirable. They were crass, unbecoming, and short-sighted. They were herds of pigs trampling the clover fields. The line employees and store managers who had to clean up and restock piles of abandoned merchandise after EBT card limits started registering again absolutely did not deserve to be left with such a haphazard, bizarre mess.
As a civic matter, the whole thing was atrocious. But civics wasn’t what caused it. The indignation directed at this feeding frenzy is largely premised on the unstated expectation that shoppers should act like responsible, upstanding yeomen. I certainly agree that they should, since that’s the sort of civility that makes society livable. But y’all weren’t trying to raise up a yeomanry in the first place, now were you? No. The real goal was something more servile and compliant: a peasantry.
Congratulations. You have one.