placebo

In his book, Bad Medicine, David Wootton makes an interesting remark about the symbolism of the stethoscope. It was invented in 1816 by René Laennec out of a problem in gender politics: the norm for female patients of the all male doctor fraternity was to be examined with their clothes on. Thus, the doctor could not lay his head against the chest of the patient and listen to the sound of what was going on inside. Laennec was concerned with phthisis, a nosological category that has now been subsumed as tuberculosis. The stethoscope was a true advance: doctors became much better at diagnosing phthisis. But therein lies the historical burden of Wootton’s book:

“Phthisis no longer exists as a disease: we now call it tuberculosis because we think of it as an infectious

disease caused by a specific micro-organism. The same sounds in  a stethoscope that would once have led to a diagnosis of phthisis now leads to tests to confirm tuberculosis. But there is an important difference between our diagnosis of tuberculosis and Laennec’s diagnosis of phthisis: we can cure tuberculosis (most of the time), while his patients died of phthisis––he died of it himself. Until 1865 (when

Lister introduced antiseptic surgery) virtually all medical progress was of this sort. It enabled doctors to get better and better at prognosis, at predicting who would die, but it made no difference at all to

therapeutics. It was a progress in science but not in technology.”     

The gap between the ability to diagnose and the ability to cure, or even to understand the cause of a disease, or its etiology, is easy to forget. I often edit articles about medicine, or public health, in the pre-twentieth century period. Some of these articles concern the medical culture of native peoples. And even with the best anti-colonialist will in the world, often the authors simply assume that there is a contrast between a rational and curative Western medicine and a ritualistic and non-curative folk medicine. In fact, folk medicine was medicine up into the twentieth century, and often continues to be today. Western medicine as therapy was largely either fraudulent or depended on the placebo effect. The latter is a real effect, of course.

“But the fact that there was no progress––far too little to have any systematic impact on life expectancy––and the fact that medical intervention did more harm than good, does not mean that doctors

did not cure patients. Modern studies of the placebo effect show that it is a mistake to think that there are some therapies that are effective and others which though ineffective work on those who respond

to the placebo effect. Even effective medicine works partly by mobilizing the body’s own resources, by invoking the placebo effect: one estimate is that a third of the good done by modern medicine is

attributable to the placebo effect.

When patients believe that a therapy will work, their belief is capable of rendering it surprisingly efficacious; when doctors believe a therapy will work their confidence is consistently transferred

to the patient. There are all sorts of studies that show this in practice. Thus if a new and better drug comes out, the drug it replaces begins to perform consistently less well in tests, merely

because doctors have lost confidence in it.”

Ah, transference! Surely this is a fact about human nature that goes beyond pharmacopeia.  

the accident

Western man, according to some accounts, was born out of a traffic altercation. It was the same kind of thing you can see any day at the intersection of Wiltshire and Lincoln. Here comes the geezer with the bigass Lincoln, and here comes the young hotshot with the convertible Lexus. The argument about who yields the right of way proceeds to murder, of course, and then a future that includes incest and the fall of a principality for the young hotshot. It is no surprise, to the Gnostic historian (who takes coincidences seriously) that psychoanalysis and the automobile arose at the same time. And thus it is that Western man with the parricide watermark floating in his unconscious takes to the road.  Look for details in Ballard’s Crash.

Myself, I’ve never been much for Western man – I keep saying to Western man, don’t you come around. But imagos to us humans are like mousetraps to the meezes: we are so entranced by the bait that we don’t recognize that we’ve crossed into the danger zone until it is too late. I tried to avoid getting a licence when I came of age, at sixteen, in Georgia because did I want this shit? But peer and parental pressure intervened, and thus, from the Marxo-Freudian viewpoint, the collective reproduced its neurosis in my soul. However, in the course car driver class, there was something that disturbed me, and that I’ve come to dislike more and more: the emphasis on “defensive driving”.

This phrase, as we can immediately see if we are wearing the right glasses, is definitely connected to the change of names that signaled the Cold War from War Department to Defense Department. At that moment, anything was possible. Similarly, driving prudently is one thing, but regarding all fellow drivers as enemies is something else. We must free ourselves from the delusion that we killed pa and slept with ma – that it is Mann gegen Mann und Gott gegen Alles out there on the highway. No, in actual fact, drivers are brothers and sisters. They are a community. We must help one another.

It is rather a paradox that in the age of Identity, the car driver still lacks one. Still lacks, that is, the imaginative community that is, according to Benedict Anderson, the framework for the romantic state – a collective of narratives and symbols that bind a disparate people together.

Yet because a social reality has not be socially constructed in the sense that I can say it is here or there doesn’t mean it doesn’t practically exist. Driving would be massively impossible if we didn’t depend each on the other in our hot little driver’s seats.Yes, of course each is dimly aware that the highways began as military projects and are imbued with a military rationality. But we are more than onward merging soldiers. We do sense a fleeting relationship to one another, although it is rare to express it. Drivers are very quick to label one another cretin, fucking idiot, etc. But where is the gasp of admiration when a particularly elegant solution is enacted to a particularly sticky driving problem?  Driving is a feat, performed in a metal cave at speeds 20 to 30 times one’s normal walker and jogger speeds. We are ballerinas, even though it is as though we have safes and iron balls attached to our ankles.  And we mostly do it well – the parking, the turning, the stopping and starting, the staring ahead through the windshield and the use of a mirror system (upon which our lives depend) that would have fascinated the natural philosophers of the Isle of Laputa.

I wrote the above while sitting waiting for two hours in the DMV in Santa Monica. Then I paid my dues, got a photo made of myself that makes me look like I’m on serious crack, and passed the test with its sometimes irrelevant questions – who cares what percentage of alcohol in your blood makes you legally intoxicated? I’ve never met the drinker yet who took blood samples between cocktails.  The DMV is a bordel, an immense waste, and I have a distinct feeling that never in its history has someone sat in one of its plastic scoop seats and had the best day of his or her life. But at least we are in this together, eh?

I hate having to write posts about another fucking war

As in the run up to the invasion of Iraq, the world war ii analogy has been let loose to justify the bombing/whatever of Syria.

Famously, there are huge problems with arguments by analogy. But if we brush those to one side, for a second, the biggest problem with the perpetually recurring analogy to WWII is that it is an analogy of form that represses the content of the analogon. But as any Hegelian or Freudian can tell you, it is the destiny of the repressed to return.

World War IIs are not cheap. They require, for one thing, an immense mobilization of the population. In the U.S., all males between 18 and 30 had to sign up for the selective service. Taxes were hiked to the world war I level, and they did not substantially fall again until 1960. The occupations that ended the war were manned at a militarily appropriate level. The end of the war itself caused a fallout among the victorious allies, which led to a series of wars during the long cold war period.

In brief, the analogy should show us that World War IIs aren’t cheap.

This, however, is not a conclusion that the hawk establishment in D.C. wants to face. Partly this is due to the fact that this establishment is conservative, and true World War IIs – which involve the mass mobilization of people – lead, usually, to socialistic programs in peace time – in healthcare, education and housing.

Mostly, however, this is due to the fact that the hawks in D.C. have a very incomplete grasp of the dialectic of war in modern times.

Alas, those hawks are in power. In Iraq, it was obvious from the get go that the force invading Iraq was about a fourth of the size it should be. Furthermore, the Bush administration had, with the logic of a mad candy store operator, decided to hold a war and cut taxes at the same time.

Now, even before the war in Iraq took place, there were people – myself for instance – who knew that the whole thing was fucked from a military point of view. In other words, if the military-humanitarian intervention (to use that oxymoron for a moment) was serious, then its means would have to be serious. And if the means were serious, the domestic population of Americans in whose name the war was hatched would have to sacrifice, and not fatten themselves on SUV tax discounts.

I’ll quote myself, from 2006, re Iraq:

This [ a passage from an analysis of Iraq by Tom Ricks, a wapo reporter] misses the bloody crux, the structure, the very moral economy of the American way of warfare. If forces are kept to a minimum and if force is proportioned to some threshold point beyond which you antagonize the population, you will, inevitably, suffer much higher casualties. If American soldiers winnow through a village, looking only for insurgents, they are much likely to be injured or killed than if they plow through the village in the balls out, mega-American way. And the soldiers know that. The American soldier has been trained to think that the preservation of his life is the prime objective. He has been raised in the spirit of McLellan, and advances with the firepower of Grant, which is why America always wins the wars that it loses. This is why the American soldier is good in a battlefield situation such as presented itself in WWII, or in the First Gulf War, and entirely sucks at counterinsurgency. And will always suck. Because the higher risk brings with it the question: what am I doing here? Since American interests have nothing to do with the Iraq war – it was commenced and continued solely to serve the vanity of a small D.C. clique – the only way to keep waging it as what it is in reality – the usurpation of American forces for mercenary purposes on the part of a power mad executive – is to wage it with as few American deaths as possible. The Bush doctrine converges with the Powell doctrine – overwhelming force = lucrative contracts to war contractors + lack of visible sacrifice to the Bush base.

The logic here is inexorable. Either a greater number of Americans die, or a greater number of Iraqis die. Americans have decided to pretend that the greater the number of Iraqi deaths, the more the Americans are winning. That, of course, is bullshit. Which is why the argument that the U.S. troops should stay in for humanitarian reasons is bullshit – the logic of American strategy will continue to maximize the number of Iraqi deaths, or it will have to face the repulsion of American public opinion as American deaths go racheting up. It won’t do the latter. The rulers actually fear the American population in their nasty, prolonged wars. Fear that the population doesn't want to fight. This is their worry. This is what they work at. Both parties, it goes without saying. This is what all the bogus talk about "will" is about.”

a curse on quiet

There is one phrase we would run into constantly while apartment hunting – a phrase that would always put a clammy hand on my heart. The phrase was: its very quiet. Invariably, as we were being shown around this or that apartment in Los Angeles, which when last I looked held more than 2 million people, the selling point of quiet would come up. I’d immediately have a Gaslight flashback, the Victorian medical man with the florid moustache hiding his louche London night life of underage prostitutes and gambling under the veneer of the vest, suit, and checkbook, bringing his Ingrid Bergmanesque wife, a quiet lass, to his suburban retreat. He’s a strong advocate of vivisection, this guy, and the streets all about have suffered a mysterious epidemic of dognapping that has made them even quieter. Ingrid, of course, is diagnosed by her husband as needing rest and quiet  - o so much quiet. She needs to eat the unpalatable gruel brought by the serving girl who shows a little too much bodice…

Such, at least, are my associations. In truth, I am not a naïve – I know race code when I hear it, and often quiet simply means that no person of color is going to flood the zone with the oeuvres complets of Biggie Smalls at 2 in the morning. We are, the subtitles in this conversation go, among us white folk. This in itself is rather disgusting. But the subtext is not the full text, for there is something in being quiet – in the quiet of “the country in the city” (also a phrase that was thrown at us) which is utterly sincere. You may live in the city, but who wants to, well, live in the city?

As a matter of fact, I do. One of the small, tangible joys of our apartment in Paris is hearing, from our bed, the faint noise of people in cafes coming in through the window. Singing, or conversing loudly, or just being generally drunk and happy. This to me makes me feel, romantically, like I am living in the great city, the mecca for those with more boho tastes. Of course, it is the Marais, so boho is pretty fake, but still.

Last night, after our exhausting two week troll through the ads, and after having had our credit checked out, our intestines measured, and our criminal record examined by Interpol, the Pinkertons, and the NSA, we finally were able to settle into our living quarters here on 9^th street in Santa Monica for our first night. It was a great night, partly because Adam seemed to love sleeping here (a sure sign!) and partly because you could hear the noise of traffic on Wilshire, which is the next street up. The sea breeze was blowing – a bit too much, we have to get a thicker coverlet! – and there was a city quiet entering the room.

In actuality, country quiet is not a noiseless matter of people shutting themselves in houses and closing the door – it is a matter of horses neighing, dogs barking, coyotes howling in the distance (I was living in Pecos, New Mexico at the time – plenty of coyotes) and, of course, the occasional drunk wandering home from our local bar, the so called “bloody bow” – the Rainbow Club. Of course, that occasional drunk was sometimes yours truly, but still.

I pity the poor emigrant

Like Bob Dylan, I pity the poor emigrant. Especially when the poor emigrant is me – although poor is not the precise word. Poor conjures up the guy who struggles up from the hold, where half of his fellow travelers have died of the potato famine, who is thrown by some savage matelot into the line to be processed by a customs official on Ellis Island, a creep with leering eyes who changes  his name and gives him an official paper proclaiming him eligible for exploitation by his Darwinian  betters and has him and his four cardboard suitcases kicked out into the street, where he picks himself up and finds a job as a stringman in a windowshade factory for ten cents an hour, 26 hours a day. As we know, in just one hundred twenty years, such is the miracle of America, his great great grandchildren have risen to have degrees, hundreds of thousands of dollars in student debt, and great jobs as salesmen at designer pillow boutiques, or slinging escargot, for hedgefund geniuses, 26 hours a day, in some of our finest restaurants, and using their disposable income to gentrify selected streets in Astoria.

Such is not my plight, however. Emigrating to Los Angeles has its own meatgrinder aspect. One of them is the omnipresence of cars. I was prepared, or so I thought, for this. My life has not be a car-crossed one – the last time I owned a vehicle, an unfortunate AMC matador that bit me in the ass and died of a broken block, was more than twenty years ago. And before my tragic tete a tete with the Matador, I sufficed largely by driving borrowed vehicles, when I had to, and using my legs (walking, biking) to crawl across my environs at all other times. It worked! It even worked in Paris, where there is certainly a crazy car culture but where things tend to cuddle together, houses, apartments, stores, theaters and cafes, so that you can pretty much get to them in five minutes at a leisurely gait.

We have put all our money down on a place in Santa Monica, and are now planning our next big play: a car. So far, Hertz, an awful rental company, has been providing us our car, something called a Senta. I’ve read that the new generation, the generation that is so happily serving our financial elite in its off hours, has grown disaffected with the car.  I of course am older than the ancient mariner, so I remember when the names of different kinds of cars were known to my schoolmates, and could even be recognized at a distance. This is something I have never been good at. What others see as, for instance, an Acura or a Golf or some similarly ridiculous monikor, will appear to me as the small gray car or the larger blue car or whatever color the car happens to be. I only remember the car type I bought back in the day because it was such a pain in the ass. This Senta is a pain in the ass, too – this is one of the literal problems of driving aimlessly all over Los Angeles in search of the basics. This is what emigrants do – we search for the basics. Grocery stores, mattress stores, baby furniture shops, coffee places with wifi, etc. etc. The emigrant spends his first weeks not, as he imagined, lolling in the sun on the beach, but in a prolonged state of sticker shock among the big ticket items that are supposed to form the context of his domestic world.