ONE ON ONE RESPECT

One element of federation theory – a political construct this blog has promoted as a guide in formulating a civics curriculum – is the goal to achieve a federated citizenry – hence the name of the construct.  By wishing this characteristic on a populous, one is aiming at encouraging a sense among a people that they view each other as partners.  In turn, that reflects an ideal and that ideal holds that if an advantage befalls one citizens, it befalls all of them.  And the same can be said of disadvantages.

          Before one can approach such an ideal realistically, a lot must be in place – one does not intelligently just think that all his/her fellow citizens’ interests, their honesty, and their general aims are honorable enough and fall in line to reasonably allow such a feeling of federation to bloom.  But that does not preclude that one can hold such a view as a worthy goal worthy of one working toward approaching; all this while knowing that complete achievement, if not impossible, is very difficult.

          With this general sense or goal, to meaningfully influence a polity, those who seek it have several areas to address but none more important than how citizens interact.  This is a wide field of human behavior and bits of information concerning it can be found in analyzing many sorts of interactions between and among a nation’s populous – both within the citizenry and among the nation’s resident population.

          One area where such information can be “culled” would be how people behave in challenging settings such as when they interact with their doctors.  Ostensibly, that relationship can and should be a cooperative one.  Tort law recognizes that relationship as doctors having legal responsibilities toward their patients and some call this relationship an example of a fiduciary duty. 

And, to wit, there is a great deal of case law in which the main topic is either alleged or proven are in cases of negligence charged against doctors.  One can judge such incidences – as these tort cases – as falling woefully short of the ideal stated above in which federated relationships are formed.

          In this area, the writer, Malcolm Gladwell,[1] shares interesting and relevant information. On the surface, this blogger assumed that a lawsuit involving medical practice reflects poor doctoring or, at least, that a patient perceives that poor doctoring occurred in his/her treatment.  Gladwell disabuses his readers of such a notion in its purer version.

          It turns out that malpractice is not the main factor in determining whether a lawsuit results from a treatment.  As a matter of fact, poor treatment has little to do with it.  And that fact is what makes this insight relevant to the concern of this posting; i.e., how a people advance toward being federated.  Bottom line, it turns out, it is those doctors who are ranked as highly skilled who are more apt to be sued than lower skilled ones.  Actually, many, if not most, poor physicians never see the inside of a courtroom as a defendant in a tort action.

          Yes, a patient who goes to court feels or actually has suffered poor medical service which has resulted in harm, but, as Gladwell claims, something else is involved.  And that something has to do with the personal interaction between a doctor and his/her patient.  Citing the work of Wendy Levinson, one can find that how a patient and doctor speak to each other is a better predictor of whether such servicing will lead to legal action than the doctoring that has taken place.

          For example, according to Levinson, on average, “un-sued” doctors – in this case surgeons – would talk to their patients for three more minutes than surgeons who got sued.  That difference is reported as being 18.3 minutes as opposed to 15 minutes.  But what seems more important is the tenor of the conversations.

           Psychologist Nalini Ambady listened to the tapes of conversations produced by Levinson and with sophisticated analysis, judged whether the conversations could be seen as having “warmth, hostility, dominance, and anxiousness …”[2]  That psychologist concluded, from the analysis she conducted of the taped conversations, that she could accurately determine which surgeons were going to be sued and which were not.  Who were the unfortunate ones?

          They were the surgeons that, surprisingly, sounded dominant.  One tends, this blogger believes, to associate dominance with expertise, something, one suspects, is a good thing when it comes to surgery.  But it turns out that more important is a tone of concern that a surgeon projects.  In turn, a patient reads certain qualities into how the surgeon converses.  Most important – more important than expertise – is respect and caring which is communicated by the softer tone. 

When things go bad, it seems patients are more apt to hold back on legal action if they feel the medical treatment was conducted with respect and this blogger feels that says something in how people get to feel federated with other people.  If one is apt to place such importance on respect and perceived caring in terms of medical services – getting operated no less – then how important is it in everyday interactions?  The obvious answer is very. 

Gladwell writes:  “It isn’t necessary, then, to know much about how a surgeon operates in order to know his[/her] likelihood to being sued.  What you need to know is the relationship between that doctor and his patients.”[3]  One can paraphrase this conclusion to make a broader point.  It isn’t necessary, then, to know much about how a citizen reflects on his/her citizenry in order to know his/her likelihood to being federated.  What one needs to know is the relationship among his/her fellow citizens.  Is it based on caring and respect?  If so, federation is possible.

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[1] Malcolm Gladwell, Blink:  The Power of Thinking without Thinking (New York, NY:  Bay Back Books, 2005).

[2] Ibid., 42.

[3] Ibid., 41.

A LACK OF PRODUCTIVE CONCERN

This blog has often made the claim that since the years following World War II, this nation has shifted from holding federalism – as a mental construct describing and explaining its governance and politics – as the dominant construct in favor of the natural rights construct.  Its writer has hinted at evidence through many postings that support this claim.  Most of that evidence has been anecdotal. 

In the political science literature, this writer is not aware of reductionist studies – studies that have delineated relevant variables in independent/dependent hypothetical formats which are then tested – concerning this claim.  He has cited the work of respected theoretical scholars that report on the role federalism has played in American politics – e.g., Daniel J. Elazar.  Their work, in turn, is based on empirical as well as historical studies. 

But despite this state, this blog writer feels he can cite the work of social scientists, respected social commentators, and respected journalists when their work seems to support or refute this claim.  He believes the journalist, Sam Quinones, provides, in his book reviewing the explanatory elements of the opioid crisis,[1] evidence that seem to indicate that the social/political landscape of the US has gone through serious transformation in the history of this nation since World War II.

This posting limits its commentary to Quinones’ introduction to his review of what he found to be the current conditions in the US.  What seems to have particularly changed in America is the segments of the population that is being victimized by illicit use of drugs.  This blogger remembers when he was young, what constituted the nation’s drug problem.  During the fifties, the problem was an urban one and, in terms of heroin, was limited to jazz musicians.

Since then, of course, a lot has happened.  In terms of drugs, the sixties saw an upshot of drug taking – mostly marijuana and psychedelics – among college students.  Then there were soldiers coming home from Vietnam with heroin addictions – the drug was easily obtained in that country.  Later, there was the popularity of cocaine and crack.  But all of that has, in the US, been by-passed in terms of the numbers of users and in terms of the extent of health issues including deaths resulting from the use of opioids.

Today, that class of drugs accounts for more deaths than car accidents which was the major cause of accidental deaths for decades.  Easily, one can see how Quinones judges this more current scourge of opioids – in the form of pain killers and heroin – as the worse one this nation has ever experienced.  And yet, until recently and still to a certain extent, this tragedy has been relatively invisible.  And that not only refers to its rate of incidence, but also in terms of its victims – knowledge of who and where they are.

It is true that the incidence of opioid consumption seems to be concentrated in certain areas, but these areas of numerous and one can consider this plague a truly national one.  Some of the areas where kids are dying include the Rust Belt of Ohio, the Bible Belt of Tennessee, and areas of Southern California including Mission Viejo and Simi Valley. 

Cities hit by this drug epidemic vary; they include Salt Lake City, Indianapolis, and Albuquerque.  Clustered cases can be found in northwestern states, southern states, and mid-western states – Oregon, Minnesota, Oklahoma, and Alabama.  And in these areas, there are numerous deaths, but also, for each death, there are hundreds of addicts.

That’s an idea of the where; here’s the who:

Kids got hooked in college and died there.  Some of these addicts were from rough corners of rural Appalachia.  But many more were from the U.S. middle class.  They lived in communities where the driveways were clean, the cars were new, and the shopping centers attracted congregations of Starbucks, Home Depot, CVS, and Applebee’s.  They were the daughters of preachers, the sons of cops and doctors, the children of contractors and teachers and business owners and bankers.

          And almost every one was white.[2]

          And what is the connection of this tragedy to the claim that this nation has drifted from federalist thinking?  A federalist based political culture might not have totally avoided the growth of this epidemic.  During years in which federalism was dominant, the nation suffered from an alcohol epidemic.  No, the number of deaths attributed to that earlier problem does not compare, but the nation’s experiment with Prohibition was not initiated without cause. 

But that problem was faced and known among the general population – even Tocqueville wrote of local efforts to address it back in the 1830s.  He wrote:  “Societies are formed which regard drunkenness as the principal cause of the evils under which the State labours, and which solemnly bind themselves to give a constant example of temperance.”[3]  Under a nation with a federalist outlook, such a problem would not be allowed to hide.

Yes, of late, one can find news items concerning the opioid crisis.  Most of them have to do with the legal liabilities facing drug companies that aggressively marketed these opioid products.  Much rarer are stories of local communities facing the problem and actively combatting it – at least on the national news broadcasts.  In that demonstrable apathy, one finds a significant negative effect that the shift away from federalism represents.  This social problem needs, if not demands, a more communal and collaborative approach to face its challenges, challenges that include treatment, law enforcement, counseling, and moral support.

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[1] Sam Quinones, Dreamland:  The True Tale of America’s Opiate Epidemic (New York, NY:  Bloomsbury Publishing, 2015).

[2] Ibid., 7 (Kindle edition).

[3] Alexi de Tocqueville, “Political Structure of Democracy,” in Alexis de Tocqueville:  On Democracy, Revolution, and Society, eds. John Stone and Stephen Mennell (Chicago, IL:  Chicago University Press, 1980/1835), 78-101, 78-79.