December 6, 2016

Boss Tweed Versus Boss Tweet: A Nasty Cartoon about the Trump Cabinet Picks

"I don’t care a straw for you newspaper articles, my constituents don’t know how to read, but they can’t help seeing them damned pictures."

-Boss Tweed

"Just tried watching Saturday Night Live - unwatchable! Totally biased, not funny and the Baldwin impersonation just can’t get any worse. Sad."

-"Boss Tweet" (aka Donald Trump)



The first quote at the beginning of my story is attributed to William Magear Tweed, a corrupt politician noted for his cronyism, graft and an unbridled greed that eventually led to his arrest in 1873 and the dismantling of his infamous Tammany Hall in New York. http://www.biography.com/people/boss-tweed-20967991

I first became acquainted with "Boss Tweed’s" Tammany Hall in late nineteenth century New York politics through the drawings of political cartoonist Thomas Nast. As "Boss Tweed," observed, Thomas Nast’s caricatures of his visage were scathing. It is entirely possible that they may have had enough influence on public opinion to have played a role in his eventual ouster from public life. http://www.biography.com/people/thomas-nast-9420600

Recent political events have reignited my interest in the cartoons of Thomas Nast, often referred to as the "father of American political cartoons." These early political cartoons are fascinating for their exquisite narrative details and complex compositions. Unlike cartoons of today, they were complete story lines contained in a single picture. Today cartoons are more like a one-liner, punching out a central idea to be held up to ridicule (We have comedy skits like Saturday Night Live for narratives). In Nast’s cartoons, we get the whole picture of just about every transgression foisted upon the public by ne’er do well politicians and their cronies. It tends to make things a bit jumbled, but interesting. An illustration of Nast’s technique is shown below in the picture of Boss Tweed and his cronies in the guise of predatory birds, ostensibly vultures, picking apart the hapless public.

Because Boss Tweed sounds very much like "Boss Tweet," it occurred to me that it would be interesting to transpose this latter day "Boss" and his recent picks for cabinet appointments on to a Thomas Nast- like nineteenth century cartoon format. Doing so required reading a considerable amount of news and commentary in order to find out what the most fuss was about, then encapsulate all this in one picture. Channeling Thomas Nast from nineteenth century America, I placed the faces of Donald Trump, Mike Pence, Steve Bannon, Jeff Sessions, and Tom Price, on to the bodies of birds. More could be added, of course, but I ran out of bird space!

In my "Boss Tweet" rendition of a Nast style satire, Donald Trump is cast in the role of bird in chief. The "Tweet" part of his title, refers, of course to his favored medium of communication with his supporters. Although it is rather small and difficult to see, his talons grip a padlocked suitcase containing his unreleased income tax returns. In choosing photographic information upon which to base my portrait, I found that our president-elect has offered a treasure trove of unusual facial expressions. Modern cartoonists seem to favor a facial expression that exudes arrogance. I chose the ubiquitous "I can get away with anything" smirk.

"Boss Tweet," in my cartoon, points to vice-president elect Mike Pence. Although volumes can be written about the more dubious aspects of his political leanings, I chose to highlight just one. The "not allowed" circle on his chest refers to his difficulty in accepting same sex unions as a right to be respected and protected.

Peering over Donald Trump’s right shoulder is his pick for Attorney General, Jeff Sessions. Alluding to the racial slurs that cost him a federal judgeship, a tiny, cheering hooded Klansman perches on top of Session’s head. For Mike Pompeo, there has been much commentary written about his Tea Party politics, his stance on tougher interrogation techniques, ties to Koch industries, and his appeal to overturn the Iran nuclear accord. But for the sake of brevity, my cartoon makes reference only to his advocacy for a return to bulk collection of America’s domestic calling record - hence the "CIA Sees You" label and the tearing up of the fourth amendment (protecting citizen’s rights to illegal search and seizure) in the bird’s talons.

Staring out from the background is a caricature of Steve Bannon. Once again, volumes could be written on his ties to disreputable news agencies and propagandistic rambles, but for the purpose of summary, I just place a teapot on his head, alluding to Tea Party politics. While looking over images of Steve Bannon, what struck me was his persistent five o’clock shadow. So this very simple cartoon face features that same stubble, with the teapot having hair stubble as well, just for good measure.

This brings the last cartoon portrait to the pick for Secretary of Health and Human Services, Tom Price. Because Health and Human Services funds Planned Parenthood and Tom Price is purportedly against government funding for Planned Parenthood, birth control, and reproductive rights in general, this does not bode well for the future of women’s health care. Many of those who oppose legal access to abortion services call themselves "Right to Lifers." Since nothing they advocate has anything at all to do with preserving or protecting the lives of adult human beings and may even put these lives in jeopardy, I prefer to call a spade a spade here, as the saying goes, and refer to the new Price is right agency as "The Office of Pregnancy Enforcement." I would not wish to disparage those whose religious beliefs confer personhood to a cluster of fertilized cells. I would argue that this is more of a living thing with a potential to become a person, though, and that in such a case, the life and health of an actual living person takes priority.

But perhaps the most disturbing thing that has come to light about Tom Price’s affiliations is his membership in the Association of American Physicians and Surgeons. This is an organization that has come under fire from mainstream doctors and medical associations for its pseudoscientific proclivities. Most appalling to physicians is the organization’s soft stance on vaccination requirements, citing a link between vaccinations and autism - despite repeated demonstrations that there is no causal link between the two.

http://scienceblogs.com/insolence/2016/11/30/the-new-secretary-of-health-and-human-services-is-a-member-of-a-fringe-medical-organization-heres-what-that-means/

A grass roots effort has been under way for some years now in the United States for parents to assert their rights to refuse childhood vaccinations. This has unfortunately led to a resurgence in potentially deadly childhood diseases such as Pertussis (whooping cough). http://well.blogs.nytimes.com/2016/02/22/why-pertussis-is-making-a-comeback/?_r=0

It would be cause for concern then, and a scarey prospect for the health and welfare of American citizens, to have a "vaccination denier" heading up the agency that is supposed to be protecting us against plagues. At this point, we may not know to what extent the views promulgated by the Association of American Physicians and Surgeons reflect the personal views held by the prospective head of the Health and Human Services, but in keeping with the AAPS’s purported positions, in my cartoon I have Tom Price rolling out the welcome matt for Diphtheria, Pertussis, Tetanus, Zika and Polio. One can only hope that common sense will prevail here, and that the American public will not be put at a significant health risk or the nation at large put at a national security risk. As to the latter, just think of it - an open advertisement from our government that we intend to be sitting unvaccinated ducks. Coooome and get it!

Getting back to Thomas Nast and a borrowed cartoon, one often sees in these nineteenth century drawings images of a hapless public being eaten by something or crushed under the weight of some public policy or indiscretion. For this I submit that twenty-five million dollar wall with Mexico that president-elect Donald Trump has committed to building. So if Mexico won’t pay for it, then who will? A hint here can be found in the arms and legs coming out from underneath the wall with the labels "Tax payers" on them.

This might be the last of my political cartoons. They are actually quite difficult to do! Of course I made the job much more difficult by attempting the complex style of Thomas Nast. Something perhaps only a Nasty woman would think of.

November 29, 2016

Alternative Facebook Icons

My work on my paintings began to slow down, as did my work on my book manuscripts. I found that I was spending more time on Facebook than I would have liked. As I clicked out of my account there the familiar "thumbs up" for "like" icon appeared. For some reason, I started looking at this emblem differently from how I had always seen it before. It had previously had no more consequence to me than a commercial sticker. But looking at it this time I thought, "I can do something with this." I traced it on to a piece of paper directly from my computer screen and transferred it on to ten different sheets of paper. Thus began my "Alternative Facebook Icons" series.

I’ve been making about one a day, posting them on to Facebook along with short explanations. Earlier I had posted icons for "Troll Be Gone," and "Toilet Talker Flusher." I posted my last one, "First Peel off Label," today. I made this one in response to all the labels for people of various socio-political persuasions that are being slung around in social media. I try not to use any of them. I suppose that is why there is a "no entry" mark on the thumbs up hand in this drawing. My drawings in this series are all 8" x 10" in dimensions and done with charcoal and pastel. Some of my friends on Facebook are actually using these as alternative icons when the choices for the real ones are limited.

Since most of the choices, given social media emoticons, encourage emotional reactions, I thought it would be interesting to make fanciful drawing icons that included actions and thoughts instead of emotional reactions to things. Would it make social discourse more thoughtful? Who knows? But they were fun to make and I post them here so others can enjoy them. The others included here are: "Beautiful," "Makes Me Think," "Great Idea!" "I’ll Work on It," "I’ll Study this More in Depth."

I have two favorites from this series. The first one is "Facebook Fake News Alert," because the duck with the human foot wearing a fake chicken hat and surrounded by a fishy sea is so irreverent. It reminds me of the funny cartoons I used to make as a teenager. My other favorite is "I’m Listening." I made that one in response to situations where social media discourse devolves in to an "all mouths no ears" forum. I think that I like the classic style of drawing on this one.

I do hope that people enjoy these. I had fun making them. I believe that this short series is finished for now - unless I come up with something for "social bubble." Funny where a source of inspiration can spring from!

November 19, 2016

You Know You're a Nerd When....

I take what has happened in my country very seriously.  But sometimes the news has to be balanced with a temporary release from the cares of the world.  To that end, I tried on some self-deprecating humor with this post about my own interests in obscure subjects and my tenacious pursuit of these subjects.  Riffing off of Jeff Foxworthy's "You Know You're a Redneck When...." I decided to poke fun at stuff that I actually have done and call it "You Know You're a Nerd When..."  Here goes:
You know you’re a nerd when:

*You open a shop for your art works on Etsy, then type words in the search bar like, "Pseudo-Dionysis the Aeropagite." Then you wonder why your shop isn’t getting any hits.

*Spell check highlights at least one word in every sentence you write when you know that you’ve spelled the word correctly.

*You think that Game of Thrones refers to the internecine conflicts of sixteenth century Tudor England.

*You do a Google search to find out more about an obscure topic and the only thing that comes up is an article you wrote yourself in 1986.

*A fellow nerd with opposing political views posts a response to your "I voted" post on Facebook by asking if you were celebrating Walpurgisnacht. You get hot under the collar because you know instantly what he is insinuating.

*You consider responding to the above with an equally acerbic comment that perhaps his own vote for Trump was cast by consulting the Malleus Maleficarium.

*Your other friends on Facebook do not jump in on conversations like the above because they are wondering what planet you both are from and spell check is going wild.

*Your idea of a good time with friends is to hold a contest to see who among you can use the most alliterative words in one sentence.

*You name your recently completed sculpture after a molecule you read about in a neurology textbook.

*You then find that the molecule was named after a video game character that you didn’t know about but millions of people around the world were familiar with.

*You often notice on the back flap of library books that you are the only one in the history of the library to have checked that book out.

*You are married to someone who shares the above experience and laughs at your jokes.

*The books you wish to recommend do not appear on "Good Reads."

*You write poetry about the structure and function of the autonomic nervous system.

*You hide jokes written in dead languages in your art work.

*You sing favorite tunes from Peking Opera in the shower.

*You discover Mongolian polyphonic singing on the internet and consider giving that a try as well.

*The most nerdy man on campus is the only one who "gets" your allusion to a specific aria in Offenbach’s Les Contes d’Hoffman in a song you just wrote.

*You write to The Huffington Post to complain about errors in their science articles.

*You write to The New York Times to complain about an error in an op-ed piece. It took reading a law center’s list of 892 organizations in order to ferret out the error.

*Your blog posts have a dedicated international following of twelve people.

*You have delayed filling a prescription medication because you are using the written script as a book mark in Alexander Von Humboldt’s Views of Nature, which you are the only one in the history of the library to have checked out.

*You cook historically accurate meals. Tuesday evening: Pullus Frontanianus from the chapter A Convivium in Ancient Rome, in Phyllis Pray Bober’s book Art, Culture & Cuisine: Ancient and Medieval Gastronomy. You own this great book because you personally knew the author.

*Your doctor’s eyes glaze over when you tell her that your allergy to methyl-paraben should also include local anesthetics in the ester family because these are broken down by the body in to para-amino benzoic acid, which is also a metabolite of methyl-paraben.

*You find that doctors often respond to your questions with "I’ll have to look that up."

*You watch Tavis Smiley at night.

*No matter how much you read, you always know that you are woefully undereducated.

November 16, 2016

The Curse on Social Media

I've been back on social media for a few months now, and find that it is a great tool for keeping up with friends and relatives.  It is also a great way to share creative work.  It is a poor tool, however, for social discourse, especially with those I may not be well acquainted with.   To that end, I started a series of tongue-in-cheek drawings based upon the Facebook "thumbs up" or "like" icon.  My first one was "Troll Be Gone,"  pictured at right.  My next one is "Flush Toilet Talk," at left.  I expound upon the second one here.   This icon can be invoked for profanity-laden posts
. I fortunately won’t have to invoke this much because the few people who read my posts are decent, educated folk. Generally speaking though, with regard to social media, I suppose that some writers, both in the amateur and professional categories, believe that the inclusion of foul words is a great way to emphasize a point. The only thing that it points out to me is an annoyingly limited vocabulary and rather puerile communication skills. I’m not impressed. That’s why I never answer these and never press "share."

I reserve curse words for when I inadvertently step on a sharp object or bump in to a closed door at night. Interesting research in neuro-biology confirms that this does in fact reduce pain. That same research tells us that cursing emanates from the frontal cortex as opposed to the normal language centers of the brain. If I recall correctly, the former area relates to emotion (as does the limbic system) and impulse control. Getting a little political here, since we just elected a leadership that "tweets" from their collective frontal cortexes, I will continue the ultimate subversive act in using only the language center of my brain for public communication.

To be fair, the foul language does come from all sides of the socio-political spectrum. A cursory observation seems to break that down in to the homegrown variety (right) versus the collective share of the pre-fabricated (left). Astoundingly, "potty mouth" traverses educational levels as well. One response I got on Facebook in recent weeks was something to the effect of "****up the a***hole." This rolled off the keyboard in response to the urging of the frontal cortex and into cyberspace from a man in possession of a doctorate in English. Would love to see that dissertation.

What I find also noteworthy about vulgarity in social media is that for English, it is particularly boorish, boring and tedious because it is so limited. Any student of foreign language knows that cursing in other cultures is a goldmine of possibilities, albeit those possibilities mostly having to do with one’s mother. These generally include references to impossible variants in one’s mother’s anatomy, or to being the resultant spawn of various types of biologically impossible animal assignations with one’s mother. I’m not advocating actually adopting these usages, just pointing out how even more pathetic we are with regard to our invectives. We just get the garden variety, "f-you", "f***", "M***f***" and the ubiquitous aforementioned "a***hole." Over and over again - ad nauseam.

To this effect, the words and phrases tend to lose their emotive impact over time due to overuse. They become not only totally meaningless in themselves, but impediments to communication through the accumulated expenditure of trash talk - a dump of unusable verbal toxic waste that one has to plow through in order to get to any reasonable content, if any even remains. Just as there is something totally demoralizing to see a physical landfill of garbage, there is something disconcerting about this verbal landfill in cyberspace. For my part, I’ll refrain from contributing or exponentially emphasizing through passing it on. What else can I say to verbal waste material? Flush you?



 

 

November 12, 2016

Lines of Demarcation on Facebook

This election year was not exactly a banner year for women. In fact, it was a disgraceful year for women. And there was unfortunately plenty of misogyny to go around on all sides of the political and social spectrum. For my part, I spent the days leading up to this historic election by painting "antidotes" to the negative images of women assaulting my sensibilities from all sides: Hillary as the devil sporting fangs and horns, Melania Trump as a vixen.

For supporting Hillary Clinton, I got two hate emails and had negative images of my person pasted up on Facebook. Some suggested that I might be a witch.  One darker one was a faintly veiled threat of assault. But I was equally disheartened by some posts coming from the self-righteous left. The worst of these was what could be interpreted as a racist picture of Melania Trump as "unfit" for the white house. In this picture splice, there were three columns of "respectable" fully clad first ladies, Jackie Kennedy, Nancy Reagan, and Michelle Obama, followed by a picture of a naked Melania Trump inhabiting the last column. Interestingly, not only was Melania naked, but she was half the size of the other women. In this context, it was clear that the woman on the end was considered "not our kind." For my "liberal" friends, it was simply a juxtaposition of what they considered the emblems of decency followed, in contrast, by an evocation of a dark and sinister underworld of female exploitation and submission. I understand that. But for me, the unfortunate juxtaposition was also evocative of something else that might have escaped white middle class notice. The deliberate contrast of larger than life clothed American women with a half sized and naked foreign born Eastern European one resonated in unpleasant ways for me. It struck me as an emblem of American hegemony. It evoked the feeling that they were telling us, "We’re the status quo and you must go." It made walls that hitherto may have been conceptual or psychological suddenly palpable and very real. The woman in the last column was "the other". It is possible that I might not have fully grasped the implications were I not part Eastern European myself and, ironically, had a grandmother named "Melania."

In my last post I mentioned that the other Melania, my grandmother, came in to the country at a time when Eastern Europeans were considered non-white and even labeled as "unassimilable" (A word fallen so out of use by now that spell check claims it does not exist). The pressures of time and socio-political climate change over the course of the twentieth century saw Eastern Europe, Southern Europe and North Africa slowly, grudgingly, absorbed into the status quo of "white." Yet such assimilation may be tenuous at best, as evinced by the recent "barriers of acceptability" photo of the good ladies and the bad lady. The photo of the clothed good ladies juxtaposed with the naked bad lady brought that recognition to the fore on social media. Although I alluded to the photograph in my own posts I never really took the subject on in full until a more widely read writer and blogger, Shani Raine Gilchrist,  started complaining about it with a little more vim and vigor than I had. I saw that her complaints were amazingly not getting the traction that they should have but I hesitated to point that out, for my experiences with commenting on social matters on Facebook has been mixed indeed. I know first hand now from social media that identifying oneself as coming from one territory and commenting on those from another territory can effectively cause the trolls to come out of Facebook forest, pelt you with cyber-rocks, then stuff you in to a virtual cannon and fire you back to where you came from.

But I bit the bullet, as the saying goes, and made a pithy comment in the writer’s defense explaining how the nude photo of Melania was taken out of its original context for use in a demeaning way and then confessed to having a Melania in my own family. I am glad that I did because I noted a few exhalations of relief, some actual support, and little in the way of trolliness ( a convenient neologism on my part here).

The election year has been draining for us all, totally demoralizing for some of us. But if there is one positive that will come out of it all, it is this: For better or for worse the politics of the year have made very clear where the walls and other boundaries are, but this very visibility offers an opportunity to evaluate those boundaries, trespass them, and to know more clearly who you stand with and what you stand for.

The recent painting at the top of my post is an allegorical portrait of a woman I knew as a child in the 1960's. She was the first in her class, I believe, to attend medical school.

November 10, 2016

Melania Gets a Groundhog

Just off my easel is the next in my series of paintings about interesting women that I have personally known and what influence they may have had. I call this painting, "Melania finds a Groundhog." Many reading this might conclude that I am referring to Melania Trump. Any one of my six brothers looking at this painting will know instantly what exactly it means. It is not a painting of Melania Trump, but a painting of Melania Perik, my grandmother. She came to America just before the Bolshevik Revolution, around 1916. This would have put her arrival time in the period between 1880 and 1924, when folks from Eastern Europe were not considered white, but in the category of an "unassimilable race." The chief eugenicists at the time, Madrian Grant and Charles Davenport, would have identified her as "inferior stock." Over the decades, those epitaphs were dispensed with and the "others" increasingly were drawn in to the status quo. Yet even in these modern times we live in, people here in South Carolina sometimes note that I look just a little different and have a name they can’t pronounce so I get the "what are you?" question. I had to ask myself that same question in looking at the exit poll results that have come out declaring that white women have voted about 53% for Donald Trump for president.

I hate those little boxes that we keep being asked to check. A good many of us have ancestors from here, there and everywhere anyway. The box check makes me feel like I have to submit my genetic makeup to a referendum and vote on it...Irish genes check here...genes bordering on Asia stand aside. The "other" box is increasingly calling my name as a way to retroactively embrace the "unassimilable race" category. Apparently my voting preferences put me there. At other times I feel like drawing my own box, checking it, and labeling it the " none-of-your-dammed-business" category, totally emasculating efforts to throw this back in everyone’s face later. Or maybe I could interpret the word "race" as a marker of how quickly one can move in a sporting event. I would also have to draw my own box here, check it, and write in "very slow."

But getting back to Melania Perik, not Trump. She was decidedly "different." Her name was changed to "Molly" when she came in to the country, in a misguided attempt to hide that difference. It didn’t work. She never assimilated. I don’t think she even became an American citizen. She had skin of pale gold, flat features and very long, straight, black hair. She was always very robust and had a personality that bordered on what seemed akin to Attila The Hun. She lived on a farm in rural New Jersey with her husband Dmitri. I never new Dmitri because he died very young, before I was born. So Melania spent most of her life as a widow, having to handle the farm chores by herself. One such chore entailed keeping marauding animals away from crops. The New Jersey groundhog was the most devastating of these. https://en.wikipedia.org/wiki/Groundhog They can grow up to thirty inches long and can weigh up to thirty-one pounds. That would seem to be intimidating for a small woman like my grandmother, who stood just over four feet tall. Yet she was famous for running down groundhogs and catching them with her bare hands, promptly dispatching them. She did this until she moved off the farm in her mid-eighties.

The rental house Melania moved in to was small but had a parcel set aside for a small garden. No sooner had Melania’s lettuce appeared, however, when so did a large groundhog. She could have dispatched him, as she told me that she was able to run him down and catch him by the tail. Instead she had a different idea. Melania told me that she went to her landlady’s house, holding the groundhog by the tail, rang the doorbell with her free hand. She proudly showed her catch to the landlady when she came to the door. I wish that I could have seen the expression on the landlady’s face.

For some reason, at that moment my grandmother decided that her groundhog hunting days were over. She let that last one live, naming him Moshky. Moshky and Melania shared a garden for the blessed time that they were both able.

October 30, 2016

The Girl With the Brown Striped Pants



It was the summer of 1970. My mother and I were shopping for back to school clothes at the popular bargain clothing store, Robert Hall. Http://triblive.com/neighborhoods/yourmonvalley/yourmonvalleymore/3437771-74/hall-robert-charleroi My eyes lit upon a beautiful pair of pants. They were a rich brown color with gold pin stripes. The soft material was a blend of combed wool. I pointed them out to my mother and she agreed that they were very nice. But she noticed a detail that was socially problematic for the times in which we lived. The zipper was located on the front of the pants.

On line clothing historians claim that pants were generally not acceptable social wear for women and girls until the 1970s. I do recall those that were available at that time and prior often had the zipper placed awkwardly in the back. So that was why, when my mother looked at the pants that I had chosen to dress in for my return to school in the autumn of 1970, she was instantly at odds with style and social anxiety. She pulled the pants towards her and mumbled, "But the zipper is in the front." Nevertheless, she acquiesced, and decided to buy the potentially socially controversial pants.

It was certainly not the first time my mother had provided pants for my school days. Even pre-1970, she and a friend created a few sets of vests and pants. Was the zipper at the side or the back? I cannot recall, but most likely it was on the side. So when did zippers start being placed in the front in women’s pants? I looked a little longer and found at least a few examples.

Looking through sewing patterns for women’s clothing from the late 1960's in an online search, I did find patterns for ladies’ pants that had zippers placed in the front: http://www.rustyzipper.com/shop.cfm?viewpartnum=278809. So clearly they were out there, just perhaps not common.

In the context of the 1970 public school system of Dutch Neck, New Jersey, however, pants of any kind, wherever the zipper was located, were not universally welcome as trappings for girls. This was a restrictive thing for girls in spring and autumn, but could be most unkind in the winter months. To understand this, we have to revisit how the middle of the day was organized in public schools during the late sixties and early seventies. Unlike today, where elementary, middle and high school students are expected to wolf down a meal in twenty minutes and return to class without playground exercise (Childhood obesity anyone?), students back in my day had a forty-five minute lunch period followed by forty-five minutes outdoors in the playground. During the winter, New Jersey could frequently have below freezing temperatures. I recall several single digit temperature readings during our winters on the playground. Try exposing bare legs to that for forty-five minutes. Yet that was what girls were expected to do when they wore skirts to school. Some, like me, would not conform to the skirt wearing rule in any climate, let alone frost-bite inducing weather.

Pants wearing girls were met with ire, however, and I recall this causing controversy at my school. At one point, there were panel discussions organized for students to discuss whether or not girls should be allowed to wear pants to school at all. These were assembled on a stage in our school auditorium and we were all required to attend. I wore pants to every one of these forums. Girls were not allowed to submit their views in this public forum so I simply had to make a fashion statement. I recall one small boy reading his prepared response about pants wearing girls being an affront to his sensibilities. With all the zeal of a budding member of the moral majority, he outlined how the wearing of pants would cause girls to adopt masculine behavior and his stern warnings that they might even become involved in physical fights. (I tried to recall here whether I was wearing pants or a skirt the day I counter-attacked a bully on a school bus). His view was countered by a more liberal leaning boy who decided that comfort, safety and freedom should prevail and that this extended to girl’s attire. There was the pro-pants group and the anti-pants group.

Against this backdrop, I attended school in the autumn of 1970, not only wearing pants, but pants with the infamous zipper in the front. As expected, I was greeted with taunts, jeers, and obscene remarks. These were generally confined, however, to a table of like-minded fellows in my home room class. Boys at other tables just rolled their eyeballs in chagrin at the imbeciles making their sex look bad.

One female classmate came over to me and confessed that she and her mother had seen the very same pants I was wearing when they had gone to Robert Hall over the summer. They had come to the same conclusion that the brown pants with the gold pin stripes were stylish but intimidating with that zipper in the front. Lois, my classmate, admitted that she too, admired the pants and had wanted them badly but neither she nor her mother could muster up the courage to buy them. Lois asked me after that, how I could bear all the taunts and verbal abuse from the boys. I quickly pointed out to her that they were a very vocal minority.

"Give it a few days....a week tops." I told her. "The boys will see that I’m not intimidated, that their jeering is getting them nowhere, and then they’ll get bored with it and stop." This turned out to be correct. The jeering boys seemed to come to some sort of epiphany after a few days that they were making idiots of themselves because I wasn’t frazzled and they were indeed getting nowhere.

I never mentioned the incident to my mother, my sister, or to my six brothers. I did not wish my mother to feel that she had made an error in purchasing the pants with the zipper in the front and I felt strongly that this was my battle to fight and win.

I’ve often wondered where this early fighting nature and self confidence emanated from.

Perhaps my early proclivity for wearing pants and having that fighting tenacity was more in the genes than in the jeans. A recent genetic test indicated that my mixed Irish, British and Eastern European (Ukranian) ancestry was seasoned with a touch of Greek - one percent to be exact. Recent cultural historians have speculated that the Greek Amazons were most likely genuine and that their migrations can be tracked in to what is now Ukraine. Knowledge of their clothing can be ascertained by looking at their images depicted on ancient pottery. Looking these over I am struck by the standing figure of an Amazon wearing pants! https://bellatory.com/fashion-industry/A-History-of-Trousers-and-Pants-in-Western-Culture

My holding out for my right to dress in comfort and style had a ripple effect throughout my middle school. In the weeks and months that followed, girls started wearing more pants, and pants with zippers side, back or audaciously in the front. And at the year’s end, on the very stage where that unseemly and unfair panel discussion about the rights of girls to wear pants took place, I performed in a play that required me to wear trousers and carry a play rifle. I got a standing ovation after my performance.

Whatever the reason for being so tenacious, looking back, I realize that this small feat of trail blazing could not have been accomplished were I not in an environment in which there were just enough broad minded and democratic adults to allow someone like me to squeak through arbitrary barriers and help pave the way just a little for others to follow. Thank you.

September 26, 2016

The Iris Apfel in Golda Finch

Earlier this summer, I watched an extraordinary interview with Iris Apfel on PBS. Iris Apfel was 94 at the time of the interview and was encouragingly ambulatory and cogent. Actually, she was much more than that. Ms. Apfel, a fashion icon, had amassed a large collection of fabrics, fashion, jewelry and art, which she spoke about in loving detail with a strong sense of individual will. The collection was sumptuous, idiosyncratic yet bold. Here was a woman who most definitely knew her own mind.

What stuck with me most about the interview with Iris Apfel was her modesty with regard to herself and how that played out in her accumulation of the stuff of embellishment. Her reason for the embellishment of both self and environment was to celebrate colors, textures and style despite being physically plain herself.

I thought back on this interview yesterday as I worked on a painting for a book cover. The book, Woodland Harmonies, is an as yet unpublished manuscript by writer and artist Kristina Miller. In consultation with the writer, we decided that the best subject for a color cover was her story about Golda Finch. In the story, this female goldfinch made an elaborate nest, full of all the shiniest objects that she could find. As the story goes, Golda Finch’s desire to embellish her surrounding was on account of her own plainness as a female bird with duller coloring than her male counterpart. For this reason it was somewhat of a challenge to paint, because I wanted to convey the idea of the decorative nest but also did not want to overwhelm the bird in the nest either. So I made certain that Golda Finch herself was adorned but not erased. In keeping with the aesthetic of Iris Apfel, I included small bits of costume jewelry in the nest. I also decided to keep the background gold as well, drawing upon the art of Japanese enamels and the paintings of Gustav Klimpt.

I then did something that I almost never do. I took a picture of the painting while it was still wet on my easel and sent it to my client. That turned out to be fortuitous because she wrote back that although the painting was quite pretty, I had placed a male goldfinch in the nest. How had I done that? I wondered. For some reason I painted in the bold yellow colors and black crest of the male where the greenish hues of the female were supposed to be. I can only assume that I had unconsciously painted in the drab bird's desire to be bright!
  Fortunately because the painting was still wet I could wipe off the black cap on the bird’s head and tone down the feathers to a light olive green. A little glazing tweaked the colors and shading so that the duller bird was offset by the dark portions of the nest and the collected jewels highlighted. The revised version is pictured at right.

September 22, 2016

Finished!

Finished!

For the past three weeks, I set myself to my annual challenge of registering a work for the South Carolina State Fair that exists only in imagination. To make this especially challenging I register late and start a complicated and time consuming work. This year I called the painting "Silver Reach." Calculating about a week of drying time, I did indeed finish the work in time to submit it.

The painting, "Silver Reach" features a figure with extended arms. My husband gladly posed for the preliminary sketches. The long format of a figure with extended arms was initially inspired by a relief sculpture found in the collection of the Ashmolean Museum in Oxford. This sculpture depicts a man extending his arms outwards to indicate a fathom - a traditional unit of measurement. http://www.ashmolean.org/ash/faqs/q002/

My painting is a somewhat modified version of the fathom because only one hand is fully extended. The other is a fist. I did this for the most part in order to fit the figure in to the allotted forty-eight inches of my canvas, but it also imparts a greater sense of action to the subject.

To make this painting especially challenging, both the background and the figure’s garment were created not by blended paint but by tesselations configured as a mosaic. The background is formed as an opus vermiculatum style Roman mosaic, in units of square tesserae. The interior strokes of paint are smaller and longer, like the glass filati used to make micromosaics.

This is probably the first time that I created a painting in the style of a mosaic. Considering how long it took, it might be the last time!

 

September 17, 2016

Silver Reach

Back to being an artist! These past few weeks I have been working on a painting in a format that is unusual for me. I generally paint vertical works. I am not certain as to why - perhaps it is because it is the usual format for a book. Or it may be that they appear to take up less space on a wall. So it is was unusual to dream about a very long, skinny painting of a man with this arms outstretched and facing left. In the painting, the man was wearing a white shirt and painted on a background of silver, grey and white tesselations. He was reaching towards small squares of color on the periphery.

I woke up and decided that I would paint this for real. But it would take some weeks of planning. I had to buy the canvas, the heavy duty stretcher bars. I made the canvas 18" x 48", sized it with rabbit skin glue, two coats of primer, and a ground stippled in white, grey and silver. The canvas was so narrow that just a yard of cotton duck canvas allowed room for five smaller canvases. I was able to just fit in two sixteen inch squares and three eleven by fourteen inch canvases.

Since the figure in my dream bore a resemblance to my husband, I asked him to pose in that position and he obliged. Using composite photographs and templates, his visage eventually came in to being. The tesselations in the background and around the periphery of the painting turned out to be much harder edged than I had originally envisioned but I decided to keep them that way for the time being.

Taking a break from the painting, I took an outing and chanced upon a blue, white and grey feather flitting across the concrete walk. I decided to add this to the painting, adhering it with a dab of silver paint. Placed below the figure’s closed hand, it would appear to be an object clutched at and missed or perhaps never caught in the first place. This simple object might turn out to be the most evocative part of the painting - something I didn’t intend or have a hand in making.

I am in the last phase of painting - the figure’s clothes. I am hoping that I can keep the design mostly white and still have it show up against the silver background.

August 28, 2016

Packing Up Brain's Diseases of The Nervous System

My essays on gender bias in medicine are finished for the time being, as I pack up Donaghy’s Brain’s Diseases of the Nervous System and prepare canvases for painting. It may seem odd that an artist would read neurological textbooks, books on medical history and articles in law journals. But few people seemed to be questioning what appeared to me to be a basic misunderstanding of women’s health, and there seemed to be little to no redress for the resulting injuries and injustices. So I thought to squeak about it a bit.

Before putting these findings to rest, at least for now, I would like to make it clear that sexism, like racism, is an evil institution. As an evil institution it is not necessarily the struggle of man against woman per se. I can attest to this because in my research thus far, most proponents of equal treatment in health care for women were men, and I dutifully included their books and articles in my bibliography upon my last writing. A PDF file that was the most short sighted, and most potentially destructive to the health of women was in fact authored by a woman. Fortunately, woman on woman crime was not always the case as evinced by Professor Diane O’Leary’s scholarly articles and popular webinars on the role of misdianosis of somatoform disorders in diagnostic delay and denial of care: http://www.chronicpainpartners.com/webinar/free-webinar-head-problem-psychogenic-diagnosis-ehlers-danlos-patients/

The struggle for equal rights and fair treatment is a fight against a destructive ideology that may be shared across gender lines.

The text book that I found to be the most problematic for women with initially unexplained, and sometimes even explained neurological disease was, however, written by men. I had read Brain’s Diseases of the Nervous System back in 2013 and noted that the chapter on Psychologically Determined Illnesses was gender discriminatory and laced with a veritable plethora of antiquated pejoratives against women. The book was otherwise a rich tome of historical and scientific information. The chapter on reflexes was particularly fascinating and I had written about this subject at the time. As to the sexism expressed in the book, I did not attend to that back in 2013 because it came to my attention that I did not have the latest edition of Brain’s Diseases of the Nervous System. Times change and textbooks become updated with new information, and new evaluations. I will wait, I thought at the time, to obtain the later edition of Brain’s Diseases of the Nervous System, in order to check and see if the misogynous chapter is removed.

Three years later this giant textbook arrived through inter-library loan. It arrived in poor condition. The spine had been broken and was held together by rubber bands. I wondered to myself if this was perhaps an indication that the sexism remained intrenched in this heavy book. Had an irate nurse read Donaghy’s comments on "hysterical nurses," and reacted to it by stomping on the book? After checking out of the library and taking the injured textbook home, I immediately turned to the chapter in question. It had not been altered. It had just as many misogynist references as before. Oh well. He had his chance to rectify, tone down the rhetoric, make amends, and failed to do so. In this way Brain’s Diseases of the Nervous System became added fodder for my satirical drawings and wry writing. (I am at work now on a drawing depicting how a gender -biased medical professional might conceptually view a woman’s brain. )

How does sexism insinuate itself into mainstream medical literature and remain there unchallenged? And can it be changed? As usual, I looked to precedent to find an instance where a sexist remark in a medical text book was changed and how this was accomplished. A good case study here is Campbell’s Urology. In the 1978 -1985 editions, Interstitial Cystitis is included in a chapter entitled "Psychosomatic Conditions in Urology." Women were most likely to suffer from this disease which was described as follows:

"Interstitial Cystitis may present the end stage in a bladder that has been made irritable by emotional disturbance...a pathology for the discharge of unconscious hatreds."

Through extensive patient advocacy work and the Interstitial Cystitis Association, founded by Dr. Vicki Ratner, the description was eliminated from the 1986 edition of Campbell’s Urology.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708558/

It took many dedicated, rational men and women to get the emotional spontaneous generation theory of medicine for women removed from Campbell’s Urology. That was one comment removed with great effort. How much effort would it take to for the nineteen similar comments with regard to women removed from Donaghy’s Brains Diseases of the Nervous System.? It would depend upon good patient advocacy and some common sense neurologists.

August 25, 2016

"Its All in Her Head" Part Three: Misdiagnosis and Gender Bias in Medicine

Its All in Her Head: Medicine, Gender Bias, and the Misattribution of Somatoform Disorders- Part Three

My ongoing project, an illustrated treatise on factors leading to diagnostic delays in rare disease, is slowly moving forward. For most illustrations and essays, I devote one chapter per factor. But in the case of mistakenly attributing disease to character flaws, malingering or some other psychological origin, the outcry on the part of patients and their families was assuredly the loudest and most painful. Emotions on the subject run the highest for those who have had a loved one injured or killed by this mistake. For this reason I decided to look more deeply in to the matter and do some extra reading. A number of serious problems came to my attention. What a person such as myself, with no power or influence in the matter, can actually hope to accomplish by way of advocating solutions is problematic.

Phrenological Overlay 11" x 14" Pencil on Paper

A stand up comedian, who also happens to be an Ehlers-Danlos patient, once quipped, and I am paraphrasing here, that "doctors who have been brainwashed by a secret cult to believe that disease is spontaneously generated by emotions should be avoided." In studying the origins of somatoform disorder theories along with the arguments for and against them, my computer files and library shelves have become full of articles and books on the subject. Despite all these documents from learned professors that debate the pros and cons of these theories, nothing has ever measured up to that pithy barb by the comedian. Comedians have a special talent for reducing complex social constructs down to dense kernels of satirical observations. It is a powerful tool - enabling people to laugh while questioning entrenched authority.

My drawing, "Phrenological Overlay," visually encapsulates the words of the satirist; brainwashing, cult, spontaneous generation. The theories outlined within the head are displayed in juxtaposition with erroneous theories that had ardent proponents in years past; phrenology, spontaneous generation, Galen’s four humours, and the beliefs of the nineteenth century hydropaths.

Most nineteenth century phrenology heads are males in profile, the significant bumps in the skull outlined and labeled. For the overlay of somatoform theories on this model, I changed the gender of the subject. The reason for this is that women are believed to be ten times more likely, or to some, almost entirely, the gender to exhibit psychogenic, or somatoform illness. Many of these beliefs with regard to gender have been promulgated in part by studies that, upon closer inspection, are built upon conjecture and bias. One illustration of this is a Dutch study that gave questionnaires to both male and female patients which included a check list of so called "somatic" illnesses like headaches, body aches, etc. Although the questionnaire was given to both male and female patients, it included questions about menstruation. Since any affirmative answer (i.e. "Yes" to "Do you have painful periods?), was considered "evidence" of somatic symptom disorder, the test was inherently skewed towards women. Indeed, one could just as easily bend the results towards the male sex by giving a questionnaire to both sexes that leaves out female complaints but includes symptoms relating to prostate disease, or scarring from shaving a beard, etc. One has to wonder why "painful periods" or any painful symptom, for that matter, should automatically be attributed to psychogenic illness anyway, as the possible physical causes for such pain are myriad. But our researchers do not seem to be particularly bothered by that.

Other sources of bias against females can come from accepted authorities. For example, in the twelfth edition of Brain’s Diseases of the Nervous System, edited by Michael Donaghy, Donaghy authors a fifteen page chapter entitled "Psychologically Determined Disorders." In this chapter, these "psychologically determined disorders," are said to affect women almost exclusively. His phrases such as "predominantly women" and "usually female," are relentless hammered home, not once, not twice, but nineteen times over the course of a fifteen page chapter. It was particularly disheartening for me to read Donaghy’s evaluations coming down hard on nurses. I do wonder if he includes male nurses. Probably not. What is curious about this chapter is that there was no scientific substantiation for these conclusions, only what appears to be the subjective opinion of an authority figure - Donaghy himself. Thus a gender bias can become deeply ingrained early on in the careers of medical students, and perpetuated by those who interpret data through this distorted lens over the course of a career. No closer scrutiny. No questions asked.

Donaghy does go on to state, interestingly, that misdiagnosis of somatoform disorder is a possibility, but one that has been greatly reduced in recent years due to the advent of more sophisticated diagnostic tools. This is a classic example of how correlational evidence is misconstrued as causation. What we actually have is a claim that a misdiagnosis of somatoform disorder is unlikely in tandem with the observation that in recent years there have been more technological developments in the hardware of diagnostic medicine. One does not necessarily cause the other. Yet no other hypotheses for the purported decline in misdiagnosis has been considered. We may do well to evaluate alternative hypotheses for the claim that misdiagnosis of somatoform disorders is rare, considering that the American Association of Autoimmune diseases reports a misdiagnosis rate of illness being caused by psychological factors as being over fifty percent. And, as reported earlier, the Ehlers Danlos study recently reported a misdiagnosis rate of ninety-seven percent. These findings are in stark contrast to the often quoted Donaghy misdiagnosis rate of five percent. Clearly there is something amiss. And because misdiagnosis leads to lack of care, injury and premature death, it would be wise to consider alternative explanations as to why many in the medical profession believe that the misdiagnosis rate is too low to be concerned about, when other studies indicate that it is in fact alarmingly high.

The answer to the question may lie in how data on misdiagnosis of somatoform or other psychologically determined illnesses was collected. Some studies indicating a low rate of misdiagnosis were not studies at all but a consensus of physician self reporting. That would probably be as useful an evaluation tool as ascertaining the crime rate in a given country over the course of five years by tabulating the number of criminals that turned themselves in to the authorities over that course of time. Other studies conducted were a review of records on patients whose symptoms were initially attributed to psychological factors to see if at some point a physical cause was found which resulted in the initial diagnosis being overruled. There are two problems with that type of study: it is open ended in that it cannot account for the eventual discovery of physiological causation. It also does not account for the practice of adding on instead of replacing a diagnosis. In the latter case, all patients whose physical illness is considered a "co-morbid" condition to a psychological one are not counted. In truth, the only insight these types of investigations may have to offer is just how hard it is for a psychological diagnosis to be expunged from a patient’s record, as adding on a physical illness instead of replacing the initial psychological explanation virtually guarantees that the officially reported rate of misdiagnosis will be practically nil. On the other hand, the studies that demonstrate a high rate of error in misdiagnosing physical illness as psychological begin from studying patients with established conditions and tracing their histories back to the original misdiagnosis.

A persistent failure to account for initially misinterpreting physical symptoms in a patient as being psychological may not only have implications in individual care, but also in the way gender differences in disease manifestations in general are evaluated in research. Indeed, it may have played a subtle role in how a recent finding by Duke University was interpreted. Briefly, their findings demonstrated that women worsened twice as fast as men in cognitive decline in Alzheimer’s disease. These findings could be explained genetically or environmentally. When these findings were first published in 2015, no one offered a possible causal social factor; that a male patient complaining of cognitive and/or neurological problems would have his complaints taken seriously and attended to promptly, while a female patient with the same complaints would have these complaints attributed to psychological causes, resulting in delayed treatment and a more advanced disease state once these problems might finally be recognized as physiological. Of course these female patients would decline faster!

The nineteenth century system of phrenology, developed by Franz Joseph Gall, sought to map out a person’s psychic proclivities by reading the bumps on his head, then consulting a chart which explained which bump meant what depending upon where it was located on the head. Similarly, the theories of somatic symptom disorder rely on a diagnosis through arbitrarily assigned lists of "signs" such as chest pain, limb pain, headaches, dizziness, blurred vision, etc. - about fifteen in all. The more symptoms that a patient demonstrates from the list, the higher her score on a somatic symptom scale. The various words on the head in my drawing, "Phrenological Overlay," contains the popular acronym for Multiple Unexplained Symptom Patient, or MUSP. Other expressions; hypochondriasis, conversion disorder, somatic symptom disorder, functional, hysteria, bodily distress syndrome, are all in the same basic family. "Heart Sink" and "Frequent Attender," are the more pejorative terms that are purportedly still in use.

There are various schools of thought as to why so many terms abound to describe essentially the same thing. The patronizing view is that terms for illnesses believed to be psychogenic in origin end up becoming, over time, pejorative in vernacular usage. So newer, "cleaner" terms have to keep being invented so that these patients do not become the stigmatized victims of a coarse and crude world that "misunderstands" them. Others contend that the multiple terminology is a duplicitous attempt on the part of the medical profession to fool a patient in to accepting a psychiatric diagnosis because on the surface it doesn’t sound like one, although the meaning is clear to the doctor and every other colleague that reads the patient’s chart. This cover is invariably blown, however, when the "treatment" for pain and symptoms is a referral to a psychologist. Along similar lines of reasoning, still other historians of medicine contend that all these terms are continued attempts at keeping the quaint Victorian concept of "hysteria" alive, well, and conveniently cloaked in order for it to perpetually sneak in the back door of medicine. And then there is the ever popular "follow the money" theory. More psychogenic labels for more patients adds up to increased revenues from psychotropic drugs to swell the coffers of the pharmaceutical industry and end up eventually in the pockets of the CEO’s of said companies. And some contend that it is simply a well-oiled excuse to get out of doing extra work for patients with complex problems who would require more than five minutes of time.

My phrenology head includes three other phrases that bear explanation. The phrase around the eye, "Hypervigilance" refers to a patient being aware of her symptoms and having these symptoms take up an inordinate amount of time. How much awareness and how much time is involved in order for this to be considered yet another "sign" of somatic symptom disorder is up to the clinician to determine. I would have to say that the more severe pain is, the more aware one is likely to be of it. Chronic illness is time consuming. A diabetic has to be vigilant about blood sugar. A heart patient has to monitor blood pressure and diet. Some would call these behaviors pathological. I would call them responsible and normal. In his book, Saving Normal, the insider maverick psychiatrist, Dr. Allen Francis warns about the potential for the invention of somatic symptom disorder in DSM-V to pathologize normal reactions to physiological disease. This is why I have playing dice turned up to the number five in the four corners of my drawing.

The last two phrases, "Resistant to Reassurance" and "Refusal to Drink the Koolaid," are positioned at the front and back of the head. I include these because, in typical circular justification, an expression of skepticism on the part of a patient when told that her symptoms are psychogenic (or whatever term might be popular that day), is considered further "evidence" of somatoform illness. I could have used the term "skepticism" on the phrenology head, but local use of the idiomatic expression "Drink the Koolaid" is more colorful and darkly satirical.

The stylized water flowing from the top of my drawing, "Phrenological Overlay," alludes to the "brainwashing" first expressed by my comedian patient, yet can concomitantly refer to the nineteenth century practice of hydropathy. Hydropathy was invented by a German peasant farmer. It entailed, at least initially, running around an open field and taking cold showers at various stations. Hypdropathy expanded into a popular form of therapy both in Great Britain and the United States with established brick and mortar schools. To underscore how even scientists with a sound education and forward thinking philosophies can come under the spell of fads, Charles Darwin was an enthusiastic proponent and practitioner of hydropathy. Of course, considering the time in which Darwin lived, one cure was probably as good as another, and cold showers were most definitely one of the less invasive of these - beats bloodletting.

The remaining sections in the background of "Phrenological Overlay" refer to the four humors, first proposed by Galen in ancient Greece. These were; yellow bile, black bile, blood and phlegm. A disease state was thought to result from an imbalance of these four bodily fluids - hence the popular therapy of bloodletting. These fluids were also thought to be tied to human passions and behaviors, as evinced by the survival, but not often used, words such as "phlegmatic" to denote a slow and stolid temperament. Are there any ill-tempered people still described as "bilious" these days? Considering the fact that the old humors date back to ancient history, concepts of a body/emotional continuum is nothing new. Whether one speaks of old beliefs like spontaneous generation and the humors, or more newly minted magical thinking like somatic symptom disorder theory, the end effects are much the same: an untreated and oftentimes mistreated patient.

Are there solutions to what some say is a virtual epidemic of misdiagnosis of physical disease as psychological? There have been some proposed solutions. One proposed solution is to stop pharmaceutical companies from continuing to advertise their wares directly to consumers, with the assumption here that the problem is being fueled in part by consumer demand. I’m not certain that this is the major cause of the problem, though. And this would do little to stem the tide of overdiagnosis unless drug companies marketing to consumers is discontinued along with drug companies providing economic incentives for doctors, in the form of gifts and payments, to prescribe psychotropic and other drugs. (This continues to be monitored by the department of justice’s website ProPublica, Dollars for Docs). Another more radical proposal I have heard and once read about, is to do away completely with the profession of psychiatry and other professionals from behavioral sciences, blaming them for having mucked things up so badly in the first place for continuing to reinvent hysteria as a viable explanation for physical symptoms. That would be an absolute disaster though, for then where would people with serious illnesses like schizophrenia or bi-polar disorder go to seek help? And it is precisely often professionals in the field of behavioral sciences who may overturn a psychiatric diagnosis initially made by untrained or misinformed healthcare providers. There are, however, as the saying goes, "too many cooks in the broth." Not only can psychiatrists as well as psychologists make psychological diagnoses, but those trained in social work do. So do neurologists, as they are also board certified in psychiatry. As to the last class of diagnosticians, we can already see by perusing the aforementioned "Psychologically Determined Disorders" chapter of the neurology textbook, Brain’s Diseases of the Nervous System, what a debacle this is for women. The potential for misdiagnosis extends well beyond the traditional groups responsible for such evaluations, however. The American Medical Association is working hard to eliminate pain as a vital sign due to a misguided attempt at stemming over prescribing opiate based pain relief as well as to reduce negative patient reports on survey forms (i.e. "I did not get adequate treatment for pain relief"). At the same time, psychiatric evaluations are becoming more routine in patient intake evaluation forms. Many intake, or screening forms, no matter what the medical specialty, has a psychiatric evaluation section for the clinician to fill out. The dentist who examined my gum recession had to fill out a psychiatric evaluation section on the dental examination form. He was confused by it and actually asked me what he should write there. The technician whose sole training and responsibility was putting dilating drops in to my eyes had to also fill out a psychiatric evaluation section in my eye exam report. Why? One might as well have the person responsible for changing the oil in your car also tick off a few boxes on a form assessing your anxiety level as the expended oil is replaced with clean oil.

Compounding the psychological fishing expedition promulgated in many areas of health care, along with the discouragement from asking patients to evaluate their level of physical pain, or even report it at all, and the potential for error is profound. Any patient can be psychologically evaluated at any time by anyone in the medical system regardless of whether or not it is even remotely pertinent, and then have this evaluation become a permanent part of a patient’s medical record to taint all future evaluations. And if a patient happens to appear tense or irritable from pain that is not even considered in initial review, then a psychological diagnosis will prevail. To her credit, the previously mentioned eye drop technician noticed during her intake evaluation that I appeared very stiff and asked me if I was in pain. I told her that indeed I was in great pain from the muscle spasms in my upper back and neck due to my illness. I suppose that information is what made her decide to give me a clean slate on psychiatric evaluations. But there was nothing in her report about pain. There were no boxes on the evaluation form for that. The obvious solution here is to keep pain as a vital sign, and eliminate over screening for psychological illness by those with no training in this area.

One other possible solution to the misdiagnosis of psychogenic causes for pain and other symptoms would be to solicit the help and support of agencies who must foot the bill for these mistakes. Health care insurance agencies come to mind. It would be easy to make the case that psychogenic misdiagnosis costs them billions of dollars. This would include for instance, denial of timely biopsies which would have excised a cancer before it could take hold and spread. In these instances, the insurance company might have only had to pay for a local anesthetic and a pathology reading. Instead they had to pay for anesthesia, an operating room, and a hefty surgery bill. The same could be said for the patient accused of drug seeking behavior, missing entirely a slow growing brain tumor, or the patient accused of attention seeking behavior, delaying early intervention for a treatable condition and resulting in million dollar drug treatments. Or consider the patient who spent nearly two decades on disability, accruing medical bills due to being denied care on account of a somatoform diagnosis. In the last case, a timely, accurate diagnosis and a blood thinner would have prevented the accrued injuries and expense. These cases, and they are unfortunately legion, are as tragic as they are costly. Yet insurance companies and health care agencies labor under the notion that labeling hard to diagnose patients with psychogenic, or somatoform illness and subsequent denial of referrals for further testing is a useful system of triage that saves money. Perhaps someone, somewhere, somehow, can demonstrate clearly that this is generally not the case. It will take well documented case histories but in the end this may be well worth the effort.

Rethinking medical service and remuneration is in order. Most professionals such as lawyers, consultants, designers, and contractors, are paid when a service is rendered. The drain is stopped up, we pay the plumber when he fixes it. There is a hole in the roof, we pay the carpenter to fix it. Yet people with undiagnosed injuries will have to pay for a medical consult or an expensive ER visit regardless of whether the service of actually fixing the problem was rendered or not. I read of a patient who had been sent to the ER by her doctor not once, not twice, but three times, obtaining the necessary emergency surgery only on the third attempt. Everyone was paid, however, for the previous two ER visits. As Lawrence Afrin, M.D. pointed out in his book published earlier this year, Never Bet Against Occam, there is actually no economic incentive in getting down to root causes of medical symptoms when they require extra care or effort. Dr. Afrin does go on to explain how this iron rice bowl form of unearned rewards is what feeds in to handing out the "all in your head" or somatoform diagnosis so freely. It is an easy way to get out of actually thinking and doing work, and one that a "stressed" and overbooked clinician will be too tempted to eagerly embrace as a fail safe solution.

A clinician will be paid the same amount if he solves the problem, tries but does not solve the problem, makes no attempt to solve the problem, and even if he causes more problems through misdiagnosis. It has always been a bee sting in my brain that I had to pay the same to doctors who took time, problem solved, and worked hard on my behalf as to those who did nothing or were even abusive. It bothers me that conscientious providers pick up the slack for their lazier counterparts. In an improved system, there should be rewards for work well done. For now, my own sliding scale includes gifts, letters of recognition and thanks, donations towards research support, and perhaps a signed book for my hard working doctors.

Finally, some rethinking of how certain precepts are promulgated in medical training and medical literature with regard to the ease with which mislabeling physiological disease happens in the first place is most assuredly in order. Dr. Frances Allen considers this a daunting task, akin to a "David and Goliath" struggle. For now it feels more like throwing a teaspoon of reason against a tidal wave of irrationality.

Bibliography:


Afrin, Lawrence B., M.D. Never Bet Against Occam: Mast Cell Activation Disease and the Modern Epidemics of Chronic Illness and Medical Complexity. Bethesda: Sisters Media, LLC, 2016.

Barnum, Richard., M.D. "Problems with diagnosing Conversion Disorder in response to variable and unusual symptoms." Adolesc Health Med Ther. 2014; 5: 67-71. Apr 17, 2014.

Donaghy, Michael, ed. Brain’s Diseases of the Nervous System. Twelfth Edition. Oxford: Oxford University Press, 2009.

Ferman, J., Ham, D., " EDS World-Wide Survey: Presentation of Detailed Results." Webinar, EDS Awareness Survey, Cincinnati, May 17, 2016.

Finch, Michael. Law and the Problem of Pain. Cincinnati. University of Cincinnati Law Review, Volume 74. Winter 2005.

Frances, Allen J. M.D. Saving Normal An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. New York: HarperCollins Publishers, 2013

Hughes, Brian M. Rethinking Psychology: Good Science, Bad Science, Pseudoscience. London: Palgrave, 2016

Niemi, Laura. Young, Liane. "When and Why We See Victims as Responsible. The Impact of Ideology on Attitudes Towards Victims." Personality and Social Psychology Bulletin (2016): Sep;42
(9): 1227-42.

Pocinki, Alan G., M.D., "Pseudopsychiatric symptoms in EDS." Paper presented at the Ehlers-Danlos National Foundation Learning Conference, Providence, August 2 - 3, 2013.

Tadesse, MS, RN. Identifying and Treating Somatic Symptom Disorder in the Primary Care Setting. PDF Oregon Health & Science University

Webster, Richard. Why Freud Was Wrong: Sin, Science, and Psychoanalysis. New York: BasicBooks, a division of HarperCollins, 1995

August 23, 2016

The Book of Marvelous Cats is Launched

The work on my book You Look Great! Making Invisible Disease Visible: Drawing Out Ehlers-Danlos has slowed in recent weeks due to the need to proof my publication of a light-hearted book of rhymes for the cat, The Book of Marvelous Cats. It is a little odd to be working on something so strange and sad in tandem with a small humor book. I suppose that balance is a good thing, though. The first book requires nitpicking research, reading patient testimonies, and organizing information. It appeals to the scientist in me (Yes, I did study science in college before switching to art, and later to Chinese). The second book, the rhymes for the cat, only requires imagination and a sense of the ridiculous. The only thing that the books do share is my detailed pencil illustrations.

The Book of Marvelous Cats is now available to the public and today I celebrate that.
The book is available now on Lulu.  It should be available through Amazon in about six weeks!
https://www.lulu.com/shop/search.ep?keyWords=janet+kozachek&type

July 15, 2016

The Sensational Psychosomatic Witchcraft Trials: Evaluating Somatic Symptoms and Initially Unexplained Pain


It has been a considerably long hiatus since I have posted material on this blog site. My apologies to anyone who follows this collection of art and essays. The reason for my long delay has been because I found that my work on factors leading to diagnostic delays in rare disease patients had required so much research that much of my time had been devoted to that. And what started as a catalogue of drawings relating to my own journey through the health care system eventually became more like a heavily diagramed forty -five page tome. The catalogue turned book project is entitled "You Look Great! Making Invisible Disease Visible: Drawing Out Ehlers-Danlos. What spurred on this escalation of drawings and writing was the incorporation of data and details submitted by fellow Ehlers-Danlos patients as well as a recent survey on patients by the Ehlers-Danlos Awareness group.

This dovetailed nicely with the chapter I began to write on over psychologizing medical illness as a factor in diagnostic delays. What testimonies revealed was shocking, as this has proven to be the most lethal of all factors in causing patients preventable harm and has probably been the most significant factor in causing diagnostic delays. My work on this has led to a conversation with Diane O’Leary, former director of the Coalition for Diagnostic Rights, who, in tandem with The Ehlers Danlos Awareness Group, produced an informative webinar on misdiagnosis of somatoform disorders in patients with medical illness, with particular emphasis on Ehlers-Danlos. http://www.chronicpainpartners.com/?s=&presenter_name=oleary-diane-phd&presenter_topic=all&presenter_location=all&speciality=all&submit=Search&post_type=webinar This was particularly pertinent for this patient sub group as the most recent survey by Ehlers-Danlos Awareness discovered that fully 97% of patients had their pain initially attributed to psychogenic factors, costing them years or even decades of untreated pain. And in a cruel irony, according to Team Inspire ( a patient advocacy group) and a recent publication in the Boston Globe, the current epidemic of addiction to illegally acquired pain medications has had a negative impact upon obtaining legally prescribed adequate relief for those patients whose pain has finally been identified. https://www.bostonglobe.com/metro/2016/06/18/the-other-side-america-war-opioids/i9YYLR0bGWFdP9z1T1pwjI/story.html This will be more fully addressed in a subsequent essay as the dual epidemics of chronic pain and drug addiction is a complex conversation fraught with misunderstanding and misinformation due to highly emotional rhetoric and political posturing.

I gave my chapter on over psychologizing illness a darkly satirical title: The Sensational Psychosomatic Witchcraft Trials. My experience and research on the subject opened up dark and scarey avenues so the title seemed apt. My drawing for this chapter, posted above, is one of my more detailed entries. I have excerpted my chapter from this book below: 

"In the days of the Malleus, if the physician could find no evidence of natural illness he was expected to find evidence of witchcraft: today if he cannot diagnose organic illness, he is expected to diagnose mental illness."
-Dr. Thomas Szasz


Throughout history, humankind has attributed misunderstood physical phenomena, especially manifestations of peculiar physical symptoms in a person, to metaphysical causes. When superstition ruled the day, people with misunderstood diseases were most likely burned as witches or thought to be possessed by the devil. While medical science has slowly chipped away at superstition, physical illness that cannot readily be explained through routine medical tests is treated with suspicion that often results in accusations of hypochondriasis, psycho-somatic, or "functional" disorders. Many of these are considered "a diagnosis of exclusion." Considering the fact that there are over 6000 rare disorders, 25,000 genes in the human genome with only a fraction of these understood, and millions of viruses, a "diagnosis of exclusion" is somewhat specious. Indeed it is more often used a diagnosis of convenience for the uninterested or suspicious and a diagnosis of a feeling of exhausted possibilities in those who are. It is convenient because it saves time, saves money, and requires the least amount of effort. It is convenient for getting rid of patients with difficult to diagnose conditions and those a practitioner might find annoying or troublesome. Much of the current literature devoted to explaining the so-called somatoform conditions is controversial as there is no hard scientific evidence that somatoform conditions even exist. Compounding the problem is that the recently revised (2013) Diagnostic and Statistical Manual of Mental Disorders V relaxed the criteria for diagnosis to such an extent (a person can receive a psychiatric diagnosis merely for being physically ill for more than six months and being concerned about it) that critics such as psychiatrist Dr. Allen Frances described this trend as "a mindless and irresponsible course."
 
The patient with invisible disease, such as Ehlers-Danlos, is particularly vulnerable to having his or her symptoms attributed to psychological causes. In the most recent Ehlers-Danlos Awareness World Wide survey, 97% of patients, prior to their diagnosis, reported that medical professionals attributed their symptoms as emanating from psychological rather than organic causes. This is unfortunate, for it delays diagnosis and treatment, prolongs pain and disability, and in some cases may even be instrumental in causing, through negligence, preventable death. Another unfortunate consequence of this particularly troublesome type of mis-diagnosis is that there is a legitimate place for some forms of behavioral therapy in medicine and psychological support in chronic pain diseases that is undermined by a patient’s being "burned" by previously inappropriately applied labels.
Many years ago, I had the unfortunate but very informative experience of witnessing a parade of criminals towards their public execution. The event took place in northern China, what used to be known as Manchuria. I was out shopping downtown and walking back home when I saw a mob of people coming towards me. As I was swallowed up by this mass of humanity I saw two trucks that they were crowding around. The first truck carried the criminals, the truck behind them a firing squad. I still recall vividly the man with the shotgun who had dark sunglasses on.
The mob continued to push forward, skipping gleefully and smiling in cheerful anticipation of seeing criminals shot to death. I was desperately pushing in the opposite direction, so as not to be physically present when this event would take place. Fortunately, my persistent bodily pressure against this tide of humanity eventually met with success. I managed to press my way clear to an opening on the road home. I had never been happier to see a clearing on a street.
Before getting to this clearing, however, I had to pass close by the pick up truck that carried the criminals. There were three of them slated for execution that day. The criminals were made to wear heavy placards over their heads, which hung down half the length of their bodies. Their names were scrawled at the top of these placards. An "x" was painted over each name. Beneath their crossed out names their crimes were painted in bold black ink. Number one: Murderer. Number Two: Rapist. Number Three: Thief.
In the truck immediately behind the prisoners the People’s Liberation Army men in their green uniforms squatted with their rifles held upright. It was a compelling scene. I looked in to the face of the thief destined to die shortly. It was a face of utter exhaustion, bereft of his humanity, his spark of life already psychically crossed out with his name.
I thought of this execution parade I had witnessed so many years ago as I wrote about the plight of patients labeled with conversion, or somatoform diagnoses on the road to seeking help for their very real and very painfully debilitating diseases. For this kind of labeling is like an execution. It can mean an end to the life of finding a diagnosis. The death of a possible treatment.
Indeed, much of the writing in this regard from health care professionals encourages the use of such labels to discourage a patient from continuing to seek help and contrives to end the possibility of health care institutions and future practitioners from providing it. It is appears to disproportionally affect women and invoked as a convenient way of cutting costs.
In my illustration, "The Somatizer Witchcraft Trials," the three central figures parallel the three convicted criminals from my Manchurian tale. The figures personify the underworld nature that is felt by navigating the healthcare system in pursuit of a diagnosis. To this end I have placed names on the placards they wear to allude to characters in literature and myth who have traveled to the underworld; Beatrice from Dante’s Divine Comedy, Persephone from Greek myth, and Inama from Mesopotamia. Like the criminals from my Manchurian tale, their names are crossed out and their crimes are printed below, effectively replacing their humanity with a negative label.
The theme of a triad permeates the composition. In Dante, as well as in pictural scenes of The Last Judgement, there is a division into the three spheres of Paradisio (heaven), Purgatorio (purgatory), and Inferno (Hell). The three figures stand in the central panel, purgatorio, awaiting judgement. They stand precariously on a trap door during their trial, which their accusers can open to the gates of Hell. The accusers are represented by pointing, authoritative hands emanating from Paradisio, or the heavenly strata. The iconography of the pointing hands was influenced by the semantics used in medical literature describing somatoform conditions as diagnoses that are almost never wrong and generally irrefutable. In faith-based, rather than science-based reasoning, patients are sometimes told that they can make this kind of diagnosis real and get well as a consequence simply by believing in it strongly enough.
In a genuine health diagnosis, a patient is told that he or she "has" a certain condition. But a common preface to somatoform disorder is "You are," as in "You are a somatizer," or "Your are a hypochondriac." That is not the language of rational medicine. That is the language of accusation. The totalitarian tone of such accusations is further emphasized by the hands in the drawing being large and overpowering - god like in their assertions.

At the lower strata of my drawing rests Hell, to which non-believers are relegated. Hell, here, is not without its notes of irony. The commonly parsed medical reassurance, "Its all just stress," floats menacingly in the smoke above the flames.
The condemned go through the fire and are turned into little blackened cookies that are then eaten by a satanic monster in the corner of Hell. The creature’s visage was adapted by my observations of tomb figurines and relief sculptures from Tang Dynasty tombs in China.
As a final caveat to this little sojourn through witchcraft trials and purgatories I should like to note that in my experience thus far, the doctors who subscribed to "conversion disorder" theories of initially unexplained symptoms were, thankfully, in the minority. But a strident and powerful minority they were, which may not bode well for the future of health care if this evolves in to a systemic problem. When, or if they do gain the upper hand, it is my hope that reason will eventually prevail, and that there will be enough practitioners of rational science who also listen to the better angels of conscience. A willing few to push against the gleeful mob of those who would accuse instead of admitting that they don’t have all the answers.

The Somatizer Witchcraft Trial 24" x 18" Pencil On Paper
We have determined by how our judgement sits
That you are guilty of being a somatizer witch
You have hexed your body to believe in its pain
by the poisonous spells from your wicked brain
You claim that an allergy caused your rash
Confess that its witchcraft or you’ll get the lash
You say that you hurt from a swollen aorta
We know that it is goblin conversion disorder
You have no proof that you have migraine
You are a hyper vigilant succubus, its very plain
There is no such thing as collagen defects
only spells and a hypochondriasis hex
You are sentenced to mental retraining devotional
To learn that your pain is only emotional
Believe in your guilt and you will get well
Deny it and you will burn in Hell
 
 
 
 


 
 

 
Bibliography

Barnum, Richard., M.D. "Problems with diagnosing Conversion Disorder in response to variable and unusual symptoms." Adolesc Health Med Ther. 2014; 5: 67-71. Apr 17, 2014.

Ferman, J., Ham, D., " EDS World-Wide Survey: Presentation of Detailed Results." Webinar, EDS Awareness Survey, Cincinnati, May 17, 2016.

Frances, Allen J. M.D. Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder: Medical illness will be mislabeled as a News:mental disorder www.psychologytoday.com/blog Jan 16, 2013.

Pocinki, Alan G., M.D., "Pseudopsychiatric symptoms in EDS." Paper presented at the Ehlers-Danlos National Foundation Learning Conference, Providence, August 2 - 3, 2013.