Responses to Our Autumn 2017 Issue

Pain and the Provider

David Brown’s “Opioids and Paternalism” (Autumn 2017) is the best overall article on the opioid crisis that I have ever read. It reveals the true, politically incorrect reality that doctors and nurses deal with on a daily basis. As an
occupational medicine specialist, I deal with pain management and disability issues constantly. The pressure from patients to prescribe opioids can be very strong. I occasionally endure verbal abuse from patients when I tell them that opioids are not medically appropriate in their case. Providers must learn that doing the best medicine often requires them to say no to their patients. I was never taught this skill in medical school, where emphasis was always on being a strong patient advocate.

David Hall
from our website

One major reason for medicine’s struggle with chronic pain is the failure to appraise pain as a complex phenomenon with biological, psychological, and social components. Brown’s article recognizes the association of poverty, anxiety, and depression with chronic pain. When doctors rely upon prescribing pain pills for treatment, they are adopting a simple and reductionist view of human beings. The article mentioned therapists only once. Physical and psychological therapists can establish treatment plans tailored to an individual. Many concepts and strategies can be taught for managing mood, anxiety, pain, and conflict. Of course, the person in pain may prefer the convenience of pill taking over the focus and effort to implement a holistic plan for pain management.

Mitch Boykan
Phoenix, Arizona

So somebody suffering from chronic pancreatitis is best treated with acupuncture and a warm glass of “suck it up”? Are opioids overprescribed for things they shouldn’t be? Sure they are. But at the same time, they’re very difficult for patients suffering from legitimate chronic pain to get. A sympathetic ear isn’t useful to people who are writhing in pain. Nor is being told that their suffering is somehow for their own good. It is not good practice when the patients whose symptoms you refuse to treat commit suicide as a means of escape.

from our website

This is the best article I’ve ever read concerning the opioid crisis, and as a recently retired MD, I have read quite a few of them. There are some sweeping generalizations some may find offensive, but I agree with most of them. The article contributes a historical context not often discussed. I do believe it could have addressed the role of Big Pharma in reassuring physicians that opioids would have little likelihood of doing harm. The economic aspects of the crisis are of interest, including the inadvertent push of welfare recipients onto disability rolls as chronic-pain patients. A recent editorial in The Wall Street Journal blames the expansion of Medicaid enrollment under the Affordable Care Act for at least part of the increase in opioid prescriptions. Basically, more access means more prescriptions?

Eleanor Kennedy
from our website


The Men Who Love Jane

As a man over 60 who came to Jane Austen only in my 50s, I have come to believe that it was the “Colin-Firth-as-Mr.-Darcy” phenomenon that turned Austen from a great novelist beloved by both men and women to a writer for women only (William Deresiewicz, “A Jane Austen Kind of Guy”). My father and brother, for example, both loved Austen’s books many years before Firth appeared in Pride and Prejudice. In earlier times, Alfred, Lord Tennyson, Rudyard Kipling, Winston Churchill, and Harold Macmillan all declared their love and enthusiasm for Austen. Churchill went so far as to say that reading Austen helped him win the Second World War.

Adam Quinan
from our website

In no other age than our stupid one of essentialism would Deresiewicz have to defend his love of Jane Austen. As to Darcy’s sex appeal, well, yes, Colin Firth helped, but only in an obvious, Hollywoodish sort of way. Austen’s Darcy, by contrast, has a sex appeal that runs much deeper—one that isn’t about what he looks like in a wet T-shirt, but rather centers on his “haughtiness.” He’s sexy because he’s a man who knows how to be alone, and indeed would prefer to end up alone than marry a woman he doesn’t love. Such a man doesn’t exist in real life, of course, which only heightens the erotic longing women feel for him.

from our website

The strong emphasis in Deresiewicz’s commentary upon Austen’s characters and their sexuality (or its suppression) is warranted, no doubt. But my own overwhelming attraction to Austen’s works centers chiefly upon her almost unparalleled genius in the English language and its usage. For me, that aspect of her work is nothing less than magical. I am a 78-year-old male. Jane has become my favorite author since I decided to read her this year—simply out of curiosity.

from our website

Deresiewicz argues that women exclude men from their Janeite circles because of their own erotic attachment to her heroes—especially Mr. Darcy, or specifically, Colin-Firth-as-Mr.-Darcy. He also writes that men avoid Austen because of her chick-lit reputation and because, if they do open her books, their very masculinity is threatened. Ultimately, both men and women suffer from these stereotypes. Deresiewicz doesn’t recommend, but I will, his book A Jane Austen Education, which reveals what he learned from Austen’s six novels that made him a better person, and a better man. Deresiewicz is wonderful. Jane Austen is a genius.

Mary Watson
Gig Harbor, Washington


Toppling General Lee

Monuments to Confederates who “lost a war” (Wayne Curtis, “Decommissioning Lee,” Arts) represent an attempt at reconciliation: since the purpose of the Civil War was to force the seceded states back into the union, allowing them to honor their soldiers while accepting defeat was a nod to national reunification. It’s not unprecedented to recognize both sides in a civil war after the dispute has been settled. There are four statues of Oliver Cromwell in the United Kingdom.

Mark Edward Edens
from our website

In describing the removal of the Lee statue, Curtis writes, “Later, many compared the scene to a lynching, and it’s hard to avoid that comparison.” No, it is easy to avoid that inept comparison unless one grossly misunderstands the act of lynching, which is an extralegal, typically racialized public torture and murder by a mob. Statues are not alive and cannot be murdered: the comparison goes downhill from there and insults the victims of lynchings.

from our website

From the French and Russian revolutions to the age of the Taliban and ISIS, fanatics have removed or defaced remnants of the past. Those who care about the past consider these actions barbaric. We in the United States, however, have our own cultural cleansers. Confederate monuments throughout the South are disappearing like snowballs in a warm rain. Some citizens are uneasy with our past and would rather look away. Yet the urge to hide extends beyond monuments. Some cultural artifacts are potentially very dangerous. Books like Gone with the Wind or Tom Sawyer are eloquent reminders of another way of life. Still, some libraries and schools occasionally restrict access to them because they might offend sensitive readers. Some colleges forbid speakers with provocative or unorthodox points of view from their campuses so as to not offend anyone.

No public figure has ever existed without offending someone. Monuments to them are only judged in retrospect, however, when they are dead and harmless. Destroying monuments or hiding them in museums does not change that past. To reject them is a rejection of critical thinking and a glorification of the emotional and irrational. Curtis points out that the art historian Erwin Panofsky sees the monuments as representing “those underlying principles which reveal the basic attitude of a nation, a period, a class, a religious or philosophical persuasion.” The monuments represent a moment in our history, a snapshot of a society. Those who feel vindictive and see hatred in blocks of stone have forgotten the words from Lincoln’s Second Inaugural Address on March 4, 1865: “With malice toward none, with charity for all … let us strive on to finish the work we are in, to bind up the nation’s wounds.” There, too, the speaker was considered offensive and was removed.

B. Rankenburg
Napa, California

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