George Floyd's Paraganglioma

 Watching just fifteen seconds of the video of the tape of Derek Chauvin with his knee on the neck of George Floyd (which I must say right now is all I have seen of the 9 minutes and 30 seconds of this video) I concluded, "This ought to be a quick trial. All the prosecution has to do is to play this tape at its opening and closing arguments and this cop is guilty for any jury.

"You can believe your eyes."

But then I read the autopsy report and said, "Uh-oh."

As the prosecutor said during his opening, "You will hear about George Floyd's substance abuse, about his hypertension and about all the other things which might have contributed to his death, but he had all those things the day before he was killed and he would have had them for forty years after that day, had Mr. Chauvin not killed him."

And I found that convincing:  Until I read the autopsy report.

Yes, it's true there are a lot of folks wandering around with potentially lethal illnesses who would not die from them any time soon;  if you shoot a person with one of those illnesses, you have still murdered him, caused a premature death.

If a person has asthma, and you handcuff him and throw him into the back of a paddy wagon while he gasps for breath and he's dead by the time you arrive at the police station, dead from asthma, then you are guilty of what I would call "negligent homicide," i.e. you had such reckless disregard for his life that you essentially killed him.

 And what Chauvin did appeared even worse, because he did not simply throw the man into the police car and walk away, he actively pinned the man to the ground until he was...what? Dead? Or unconscious or stopped breathing?

How exactly did Chauvin's knee kill Mr. Floyd? Was the spine fractured and the spinal cord severed? The autopsy says no. There was no sign of trauma to the neck or the spine. No damage to the brain was seen. No bleed into the brain. No blood vessel ruptured, at least not that I saw on the first read, and I will have to go back and read that again.

If he died of a dysrhythmia, there would be no anatomical finding, no structural change to the heart. Dysrhythmia is an electrical event and leaves no visual trace. It's like trying to see a computer monitor screen going zig zaggy once the computer is turned off.

So how did Chauvin's knee kill George Floyd? Did he cut off the air in the trachea? The trachea was undamaged according to the report, although it could have been compressed, presumably, and not been damaged; as the prosecutor said, if you smother a person with a pillow it leaves no physical trace. The prosecutor mentioned this because he knows the defense will point to the absence of trauma to the neck, the trachea, the brain to say it wasn't being held down that killed Mr. Floyd. It was something else.

And what was that something else?

A 4 centimeter paraganglioma, which was discovered at autopsy,  could easily do that. A paragangliomia is a tumor which can secrete "adrenalin" otherwise known as catecholamines, epinephrine, nor epinephrine. This is the "fight or flight" experience, the "adrenalin rush" and it raises the blood pressure, the heart rate and can easily cause a dysrhythmia or a stroke and often causes death, if it happens under circumstances where its presence is unknown.

When I was training I saw two patients admitted to the hospital who died from such a tumor. 

One was admitted overnight to be held in the Cardiac Care Unit until she could have surgery the next morning, a coronary bypass procedure. She had been sent down from Connecticut and admitted to the CCU as a "boarder." Her doctor was a friend of the man who ran the CCU and there were no beds for her elsewhere, so she was "parked" on the CCU for the night until the surgeons could send for her the next morning. 

I was the  intern and I couldn't understand why a person who was not having a heart attack had been sent to the CCU which was explicitly for patients who had  or were having  heart attacks. "She's got connections" my resident told me. "Just tuck her in and the blades will be in before rounds tomorrow and take her off our hands."

But during the night one of the nurses dragged me in to check this patient's blood pressure, which the nurse had got at 240/140. The monitor had shown tachycardia at 120, but when I got in to see the patient her BP was 160/90 and her pulse 95, both high, but not much worse than you might expect in a patient facing a cardiac bypass surgery the next morning. 

The nurses called me a couple of times that night but I could never confirm the high readings they got. I duly entered into my note, "Rule out pheochromocytoma" knowing nobody would ever do it. That evaluation required collection of 24 hour urines and would delay surgery and nobody read my note. 

She was gone when I awoke the next morning for morning rounds. The surgeons had whisked her off to surgery, where several hours later she died in the recovery room with uncontrol able hypertension. The surgery had triggered an explosion in her pheochromocytoma (as a paraganglioma is called when it's in the adrenal gland) and nobody in the recovery room, not the anesthesiologists, not the surgeons had any idea she was harboring that explosive tumor.

Factory of "Adrenalin"

At the Morbidity and Mortality conference a week later, I was called to the stand, so to speak, and the pathology resident read my note: "Several episodes of hypertension/tachycardia reported by nursing staff, which I could not confirm. Rule out pheochromocytoma." And I had written orders for the 24 hour urine collections which were never done because the patient was on the operating room table 4 hours later.

"So why was this work up never done?"  the pathology attending asked me.

"Well," I had to say. "I don't know. She was gone before I got up the next morning."

Of course, that was a major catastrophe and a woman died because nobody knew what they were dealing with. Nobody knew she had this explosive tumor within her. They are rare. 

But nobody got charged with murder.  

Internal Time Bomb

They had put her under a severe physiological stress, surgery. Had someone wrestled her to the ground and put a knee, carefully, on her neck and shouted at her, that tumor might have exploded similarly--it is set off by "stress."  These patients are called "walking time bombs." 

A more accurate description would be an internal bomb with a trip wires--stumble across that trip wire and explosion.

Does any of this exculpate former Officer Chauvin?

Well, yes and no.

It might mean that knee did not choke George Floyd to death. It surely would have been stressful enough to set off that paraganglioma.

So, very possibly, Chauvin held him down while the explosion happened and by the time the police realized Floyd was in trouble, he was like that lady from the CCU now in the operating room and the recovery room. 

George Floyd was walking around with that unexploded ordinance and the stress of his struggles with the police could easily have set that paraganglioma off.  

Can you say that means the cop did not kill George Floyd?  

What I had reacted to when I first saw that clip is the willfulness of the policeman who was determined to show Floyd who was boss, something he and other police had likely done countless times before. Wrestling a big guy to the ground, pinning him down, exerting dominance.

As Carter from "The Wire" shouts from the top of a police car, after a young drug dealer has successfully evaded capture and is hiding in one of the building around the car, "You do not get to win! We are the police! We win!"

I have not seen enough of that video. I have to re read that autopsy report--to see if they stained the ganglioma for catecholamines to prove it was an pheochromocytoma/paraganglioma.

But, at least at this point, I  have reasonable doubt.

Chauvin no doubt was a bully, a man who did not care about the welfare of George Floyd.

The police are often called to deal with unruly men who may harbor all sorts of things in their bodies, in their bloodstream: drugs which exacerbate their unruliness or heart conditions or very rarely, a paraganglioma/pheochromocytoma.

But did Chauvin intend to kill Floyd?

Or was he simply doing what police are taught to do and enjoy doing: subduing some poor guy who carries a  bomb inside him. It may well be Chauvin blundered through a trip wire and set off a bomb, a rare bomb, but deadly, just waiting for something stressful to trigger it.

A female social worker  might have been able to bring George Floyd into the station house, safely, a few days later.  The cop sets off the bomb.

To the police, men like George Floyd may be treated like animals, a steer to be wrestled to the ground and "hog tied."  That's really what Chauvin may be on trial for: acting like "a police."

He may be convicted of murder, but what he may really be guilty of is the arrogance, the disregard, the contempt people see in police. 

PS:  Having said all this, I just watched the Dave Chapelle analysis of this event and am thoroughly convinced: Whether or not George Floyd was killed by his exploding paraganglioma, that explosion would not have happened until someone pinned his neck to the ground for 9 minutes and 30 seconds and if Derek Chauvin has to go to jail for 20 years to send that message to American police, that's worthwhile. 

Winnacunnet High School Goes Forth Boldly into the 21st Century

 

Should Have Been In School

"When I think back on all the crap

I learned in high school,

It's a wonder 

I can think at all."

--Paul Simon, Kodachrome

Women's World Record Holder

Speaking recently with a Winnacunnet senior, a very bright lad with a bright future, Mad Dog was struck by what this student did not know, and by the student's lack of curiosity to find out. 

Mad Dog had asked him about the women's track sensation, Caster Semenya, who had broken all the women's track records in her various events, among them the 800 and 400 meters and broken these times by wide margins. Ms. Semenya's astonishing performances were not, however, the reason for her notice--women's track is not going to compete with the NFL or NHL or the Red Sox anytime soon. What catapulted Ms. Semenya into the headlines, on to Twitter feeds and FOX News, is the assertion she is not a woman at all, but a man competing against women.

Of course, track suits are form fitting and revealing enough to show, at a glance, she does not have any of the male external genitalia.

Looking between her legs, one would think she qualified as a woman, but looking at her shoulders and thighs, one might think again. 

What she has, almost certainly, is an incomplete form of androgen insensitivity syndrome, formerly known as "testicular feminization" syndrome.  In this state the individual makes high levels of testosterone (from internal testicles, which have never descended into a scrotal sack) but when testosterone arrives at the muscle cell or brain cell or fat cell, the receptors on that cell, which ordinarily transport the hormone inside where it can initiate all the cellular processes, protein production etc, simply fails to happen.  

XY chromosome Individuals

Individuals with "complete" insensitivity cannot respond at all to the hormone and because--and here is where you need a key concept--because the human organism will develop along "female lines" in the absence of testosterone (or in the absence of being able to respond to testosterone) the individual looks for all the world like a normal woman, with breasts, hips, fat distribution, i.e. the "phenotype" of a woman. In a sense, one might say, despite having testicles inside, these individuals are the most "female" of all human beings because they cannot respond to male hormone.

But biology does not always read the textbook and there are some folks who can respond partially to the hormone, say at muscle cells and bone cells, but not in other cells, say in the pathways which cause testicles to descend into a scrotal sac, and the primordial genital tissue to fuse or not fuse into a vagina and labia. Ms. Semenya is likely here.

Whether a developing fetus travels down the path toward "girl" or "boy" depends on a symphonic sweep of different instruments working in harmony: The X and Y chromosomes are playing; factors which cause the regression of internal female structures (tubes and ovaries); secondary hormones which cause the fusion of tissues into a scrotum and the descent of testicles to that sac all have to chime in, at the right moments, so that when the baby pops out, at a glance, the nurse or doctor can announce, "It's a girl!"

Long ago, in antediluvian times, Mad Dog was so fascinated by all this and by what can go wrong with all this, he was swept away into a career--but he realizes not everyone is so enthralled, and in fact many people find the whole thing disgusting, bizarre, weird and unappetizing. So the fact a Winnacunnet high school student was uninterested is no condemnation of Winnacunnet High School or of this particular student, it simply is an observation.

The trouble arises when discussions about "transgenders" or "gender identity" or "gender fluidity" arise, in the community, or at school, or in the legislature, and people who had no interested in the biology, or even the philosophy of sex, gender and sexual identity now try to offer their uninformed opinions. 

And, in a larger sense, there is the question of how we are preparing our sixteen year olds for the 21st century world.

Another topic for which Mad Dog has been beating the drum is the United States Constitution.  

The Second Amendment is something many people about town wave in your face, but few can actually recite that single sentence which constitutes the 2nd Amendment, and fewer still can comment on the fact that nowhere else in the Constitution do its authors ever stop to explain the "why" of an article or amendment. They don't say, "freedom of speech being the fundamental basis for democracy, Congress shall make no law abridging freedom of speech." But they do say, "A well regulated militia being necessary to the security of a free state..." 

So the authors of the Constitution, curiously, stop to explain WHY Congress should not mess with the right of well regulated militiamen should be allowed to keep their flintlocks above the mantle at home, but that is the only place they do explain the why.

As for the separation of church and state, the framers never pause to give a history of why church and state ought to be separate, they simply say, "This is the wall between the two: Deal with it." 

Of course, people who seek to undermine the 1st Amendment say, "separation of church and state" is a phrase that never appears in the Constitution, and then they grin moronically,  as if they had just won the argument and been appointed to the Supreme Court. 

Justice Robert Jackson SCOTUS

When Mad Dog talks about the Constitution with graduates of, and even teachers at Winnacunnet he wonders what sort of discussions are going on within those walls. 

On March 9, the annual voting for local offices and on warrant articles took place at Winnacunnet. Standing outside the school, in a roped off area for "visibility" was the customary line up of people holding signs with the names of candidates so voters can see those, and possibly remember the names long enough to vote for those candidates for School Board, Zoning Board, Financial Board.  

A cluster of men and women held signs at the far end of this line advocating "Vote Yes" on warrant article such and such, to fund school teachers or teachers' unions or something. Mad Dog walked to the farthest end of the line, separating himself by a few yards and held up his own sign, like one of those crazy people who walk down sidewalks with a sign that say, "Repent! The End is Near." 

On that far end of the line, Mad Dog imagined himself to be like Captain Joshua Chamberlain, anchoring the far end of the Union line at Gettysburg, in place to defend the entire Union battle line, the Union, the nation and its future. 

Mad Dog's sign said, "Congress Shall Make No Law Respecting the Establishment of Religion."  

This was deservedly ignored by passers-by, some of whom looked at Mad Dog out of the corners of their eyes, trying to see if they recognized this mad monk, despite his face mask and hat which left only his eyes and his body posture as clues to his identity.  They deviated ever so slightly, to keep a safe distance between themselves and this Mad Dog, on their way into the polls. 

Eventually, a kindly woman holding a sign on a wooden pole, which could have served as a club if a weapon were needed, stepped over to Mad Dog and asked what was on his sign. He turned it to her so she could read it, which she did. He could hear her reading out loud quietly, behind her face mask, murmuring "Respecting the Establishment" and finally she asked what this was all about. 

"It's the First Amendment," Mad Dog said. "Of the United States Constitution."

"I taught the First Amendment!" the woman cried out.

Mad Dog was not sure whether she meant, "Of course, it's the First Amendment! I know that! Anyone would know that!" or "Oh! You don't say? Is that the First Amendment? Well, isn't that a coincidence! I taught that in class!"

She asked why Mad Dog would stand shivering in the cold to hold up a sign with the First Amendment printed on it.

Mad Dog explained about the warrant article which violated the first amendment by writing a check from the town bank account to the bank account of the Catholic Sacred Heart School.  

He expected her to ask why his sign did not say: "This is the First Amendment. Remember this when you vote on Warrant Article #4!"  Then Mad Dog was prepared to say that he had faith in Hampton voters that they would see the obvious relevance when they came to vote on that warrant article and they needed no more.

"I never liked that warrant article," the lady said.

And Mad Dog thought, to himself, saying nothing, so as to not provoke a fight, but thinking, silently:  "But did you teach your students to recognize when that Amendment was violated and to stand up and oppose such violations?"

Apparently, somewhere along the line, graduates of Winnacunnet were not taught such things.

The Thing About The Law

 

From Everson v School Board, United States Supreme Court, 1947

Mr. Justice JACKSON, dissenting.

. In fact, the undertones of the opinion, advocating complete and uncompromising separation of Church from State, seem utterly discordant with its conclusion yielding support to their commingling in educational matters. The case which irresistibly comes to mind as the most fitting precedent is that of Julia who, according to Byron's reports, 'whispering 'I will ne'er consent,'- consented.'

Great Boar's Head--O. Youngblood

Mad Dog, not being a lawyer, thought  the idea of the town of Hampton writing a check to a religious institution, namely  Sacred Heart School, was so absurd he could hardly find words to express his incredulity.

But he recently received a phone call from Gene Policinski of the Freedom Forum Institute, a group connected to the now defunct Newseum, which advocates for First Amendment Rights which led him to a new understanding of how obvious truths can fail to persuade.

Mr. Policinski pointed out that every analysis must begin with the facts and Mad Dog had to admit he was not sure he had ALL the facts.  Mad Dog did have the letter written from the principal of Sacred Heart to the citizens of Hampton and Seabrook which stated:

These funds are applied towards non-religious textbooks, school supplies, technology, testing materials and school nurse services and supplies for our SHS students that reside in Hampton.

Mr. Policinski said that there is some case law which allows for public funds to be given over to religious institutions if those institutions are doing social work which is not religious in nature: e.g. some churches run programs for ex convicts trying to re enter society, or soup kitchens to distribute food to the needy. "Government cannot do everything," Mr. Policinski noted and when the churches provide such non denominational services local governments have been allowed to compensate them.

Of course, Mad Dog replied, the uses of these funds as the principal outlined are simply to cover operating expenses of the school, and every religious school has ordinary expenses like heating the school, cleaning it, janitorial services but covering these operating expenses is simply no different than asking villagers to support the monastery or the abbot, i.e. it is state support of an established religion.

Justice Robert Jackson

Justice Jackson addresses this point directly:

I should be surprised if any Catholic would deny that the parochial school is a vital, if not the most vital, part of the Roman Catholic Church. If put to the choice, that venerable institution, I should expect, would forego its whole service for mature persons before it would give up education of the young, and it would be a wise choice. Its growth and cohesion, discipline and loyalty, spring from its schools. Catholic education is the rock on which the whole structure rests, and to render tax aid to its Church school is indistinguishable to me from rendering the same aid to the Church itself.

It is of no importance in this situation whether the beneficiary of this expenditure of tax-raised funds is primarily the parochial school and incidentally the pupil, or whether the aid is directly bestowed on the pupil with indirect benefits to the school. The state cannot maintain a Church and it can no more tax its citizens to furnish free carriage to those who attend a Church The prohibition against establishment of religion cannot be circumvented by a subsidy, bonus or reimbursement of expense to individuals for receiving religious instruction and indoctrination.

Note well: Justice Jackson is not saying that the only prohibition of state funding for religious schools is a prohibition of funding religious instruction. He is saying when the core purpose of a school is to inculcate religious values and teaching, it does not matter whether the school also teaches math and good citizenship, it is fundamentally a part of the church and whatever social value it has unrelated to its religious mission is irrelevant. A school can be many things, but a Catholic school is simply one organ in a religious organism.

The principal of Sacred Heart School says the money helps fund technology, presumably computer technology and testing materials, expenses religious and non religious schools share. So she is admitting the town is funding general operating expenses of her religious institution.

So it is clear, despite Mr. Policinski's admonition this area of state support for church functions is highly controversial, with wise people on both sides, the fundamental arguments have been in place since the 1947 case Everson v School Board.  Justice Jackson was writing in dissent; the Court found that in the case of a New Jersey town providing bus service to deliver Catholic students to a Catholic school, this was permissible because the town offered to pay for transportation to all students to any school in town. But in Hampton's case, the funds are directed specifically to the Sacred Heart School.

Some have argued that the state of New Hampshire requires a school nurse in every school and that the use of the funds for a school nurse is simply the town providing funds for something every student in Hampton, whether in Church school or public school deserves. But the school principal admits the funds are used for more than the nurse and in any case, it's clear if you run a Catholic school, you have to provide for the safety and comfort of the students--heat, clean classrooms, materials--and you are asking the town to reimburse you for a necessity of school life in this case.

Reading the opinions of the Supreme Court in this case, Mad Dog is reminded that in law, even the most obvious assertions are argued over, presumably because this is what judges and lawyers love to do. So in the Everson case many paragraphs were spent on the argument that the tax supporting the school buses for Catholic schools was an illegal seizure of property of the non Catholic taxpayer to be used for a purpose for which he did not approve, which of course is ridiculous as the justices finally noted, because that would prevent any government from doing anything if a single taxpayer objected.

So where does this leave us?

There is no doubt the Hampton law is unconstitutional. The current Supreme Court with six of nine justices Catholic, may not see it this way, but the case should be brought. Citizens should be seen arguing in the library, the hardware store, on street corners about this because it is a matter of whether or not we believe in the Bill of Rights in Hampton. 

A Single Wrong Idea

 

Watching the Netflix Australian melodrama/saga "A Place to Call Home,"  Mad Dog has been swept along by the characters in a way he hasn't felt since "Downton Abbey" but the experience is the flip side of the Downton coin: In Downton the Earl of Grantham is constantly pulled back toward doing the kind and just thing rather than what the requirements and expectations of class and orthodoxy demand. 

In Call Home, we see no such concession to the humane, as the members of this particular upper crust family are slowly eaten alive by the strictures and misapprehensions imposed by class and virulent disdain for the underclass and the reviled minorities.

The central plot follows Bridget Sarah Adams, a woman born to a Catholic mother devout unto Hellfire and her gradual entanglement with the Bligh family at their estate suitably named Ash Park, and it is a place deep in the ashes of a world of the walking dead, cremated but unaware of it.

Of all the conflicts explored, the most raw and explosive is the homosexuality of the much beloved son, James, on whom the continuance of the dynasty depends. This is 1955, and the idea shared by virtually all the males of that era is that homosexuality is:

1. Disgusting

2. A perversion 

3. A disease in need of cure.

The women are, on the whole, much more open to the idea that male homosexuals should be accepted for their "nature," but various among them are appalled, scandalized, until at some point James' wife realizes there is more to the man than his sexual predilection and she embraces the soul of her husband rather than rejecting the problem his sexuality presents.

But this is not a blog post about "A Place  To Call Home." It's about the idea that  "single wrong idea" can drive the  prolonged, excruciating, wrong headed effort  to "cure" James of his homosexuality.

As has been said before by homosexuals: "Who would want to be born this way?" James emphatically wants to be attracted not to men but to women. He agrees, initially to undergo any treatment which can change him. 

The doctors who are very sure of the correctness of their approach, using first electroshock/convulsive (ECT) therapy and then proposing frontal lobotomy. The physician in charge makes Nurse Ratched of "One Flew Over the Cukoo's Nest" look like Mary Poppins. 

James' father reacts viscerally to the revelation his son is a homosexual. He has only recently learned James tried to commit suicide and now he knows why, and the father says, "Perhaps it would have bene better for everyone if you had succeeded." But father is brought to his senses by Sarah and James' wife, Livvy. 

Father has signed James into the clinic and only father can liberate James from it, but he does not know exactly what goes on in the efforts to exorcise James' demons, although Sarah is able to identify some clues: the bruises from the restraints on wrists and legs, the burn marks on the temples from the ECT.  

As viewers, we are spared no details as James is "treated' and suffers under the "care" of the doctor and the staff. This is some of the most excruciating TV ever screened.

Watching all this unfold in 2021, now that most people accept the notion homosexuality is not a "disease" which demands "therapy" we cringe, and we are outraged at the doctors who are so officious, so sure, so wrong.

But I saw something more, something I know others do not see. I saw this as a representation of what we are seeing in 2021 in another sort of clinic, where a single wrong idea drives suffering and despair: The Transgender Clinic.

The "single wrong idea" hypothesis about gender dysphoria is that this is a condition in which the basic nature of the problem is very much like that of the homosexual, an inexplicable root nature which causes some people to feel they were assigned the wrong gender by their parents, their doctors, their society. "I'm a girl trapped in the body of a boy." 

The argument is made that like homosexuality, "gender dysphoria" is simply a matter of "nature" and like homosexuality, this unalterable fact should be accepted, embraced and nurtured, and of course, something everyone would agree with: the person suffering should not be made to suffer more, but should be helped in whatever way we can. 

The "single wrong idea" concept was actually first explored not about gender dysphoria or homosexuality but about another type of person altogether:  It is the operative mode for the treatment of anorexia nervosa. Few would argue that the 18 year old woman, who is five feet six inches tall and weighs 85 pounds, and looks at herself standing naked before the mirror and says, "I am so fat!" perceives her situation correctly. She suffers from what the psychiatrist Paul McHugh calls, a "wrong idea" which dominates her life and frequently leads to death.

McHugh notes that few people would argue with the doctor who tells the anorexia nervosa patient she has a wrong idea about what is wrong with her. 

Paul McHugh, MD

McHugh arrived at Johns Hopkins Hospital years ago to chair the department of Psychiatry and was asked to coordinate the psychiatric services for the Hopkins Transgender Medicine Clinic and he discovered that roughly 40% of its patients committed suicide within three years of being enrolled in the clinic. He promptly put a hold on the Department of Psychiatry's participation until he could explore just what was happening in the Transgender Clinic. The more he investigated, the more disturbed he became.

Patients at Hopkins who believe themselves to be female but  born male underwent surgery to remove the penis, testicles and to construct a cavity which could function as a workable vagina by the Department of Urology. General surgery augmented breast size. Endocrinology provided estrogen and progesterone hormones. Psychiatry spoke with the patients and learned about their reactions to what had been done and to support their "transition."

McHugh became the focus of intense fury for questioning the program and ultimately opposing it. He was accused of homophobia, transgender-o-phobia, a hate monger and of being an agent of the Pope determined to undermine liberating therapy.

Medical students at Hopkins shunned him, refused to speak to him. The internet went wild making him a pariah, as if he wished to harm the patients who sought care at the Transgender Clinic. 

McHugh bore all this recrimination with a sigh, and responded that he was pretty sure, in the end, as time passed he was the one who would be sleeping well at night, not his critics and certainly not the doctors who ran these clinics.

In "A Place to Call Home" he would have been helping James limp out of the sexual deviance treatment clinic, a place ruled by a wrong idea.

Mad Dog sees that people who believe they have a transgender problem are different from homosexuals in one crucial way: Homosexuals do not need therapy to achieve a life of happiness--all they need is to be left alone, not tormented by others. But the transgender patient cannot achieve his/her goal alone; he/she needs hormones, sometimes surgery, in short he/she needs the cooperation of a physician and is, therefore, a patient.

And the "single wrong idea" concept is inverted in the case of the transgender clinic and the conversion therapy clinic for homosexuals: In the case of the conversion clinic the medical authorities were trying to destroy something in the patient; in the case of the transgender clinic, the medical authorities are trying to "affirm" the patient is correct. But each clinic got it wrong. And each clinic committed substantial harm to those who sought help there. 

Mad Dog knows he does not understand what drives the problem in transgender patients. He does not know if it is a single cause or a final common pathway coming from many directions. He does know there are certain well studied cases of patients who have certain biochemical abnormalities which makes them unable to make adequate levels of male hormone while in utero, during "the first puberty" and these folks wind up playing with toy guns and chasing boys around the playground as "tomboys" who never really felt like girls. And there are the 5 alpha reductase deficient people who "grow a penis" at puberty. So there are some known biochemical reasons for gender confusion.  But patients at Transgender Clinics can be screened for all that. And the vast majority have no identifiable biochemical abnormality.

At the most recent conference Mad Dog attended on Transgender Medicine the head of one of the largest clinics was asked about his clinic's suicide rate. "About 40%," he said, with a shrug, "Pretty much what every other clinic sees."

"My God!" thought Mad Dog. What other form of therapy would be allowed to go forward with a number like that?  If clinics for coronary artery bypass surgery or gastric bypass surgery had a 40% mortality rate, would they be allowed to continue?

Mad Dog has no answers. He only knows McHugh is not wrong. He sees this is a topic which even at an Endocrine Society meeting, that ultimate shrine of dispassionate analysis, academia all rational discussion is blown out of the water and emotions from the transgender clinic doctors, nurses, patient advocates stamp out all other questions and discussion. We have, pretty much, what you see in the clinic to treat the "depravity and perversion" in "A Place Called Home."

McHugh would say the person suffering from the feeling he/she has been assigned the wrong gender is suffering from a single wrong idea, just as a patient with anorexia nervosa is.  Thus, he would resist the request to cut off penises, to institute hormone therapy.  Is he correct? Mad Dog does not know. 

But one thing Mad Dog does know is that Clinics can be shops of horror. 

Afghanistan Bacha Bazi and the Long Good-bye

 

Six years ago, I read an article about Bacha Bazi, the practice of Afghanistan military officers chaining young boys to their beds and raping them.

I say, "practice' because this is something which was common, widespread and longstanding in the official Afghan army. 

It was just something the Afghan officers liked to do when the moved into a town. 

Why they preferred boys is anyone's guess. I prefer not to think about it. 

Dan Quinn, an American Army officer, and his soldiers could hear the screams from the children drifting down to  his quarters, and  he finally confronted an Afghan officer and beat the daylights out of him, for which Quinn was court marshalled. He had been ordered to allow the Afghans to maintain their local customs and to not interfere with a culture he did not understand.

Dan Quinn could not stomach bacha bazi

Quinn did not understand the United States Army tolerating child rape by the allies we were fighting to keep in power. He was drummed out of the Army.

Bacha Bazi culture

This took me back to college, where anthropology courses spawned discussions about whether it is appropriate to impose on other cultures the values in our own culture. Are there some basic values common to all mankind or are cultures so different as to make all values "relative?"

I don't know: for me, I would have thought raping children chained to beds all night long would qualify as something all cultures would decry, but apparently not. 

Dexter Filkins

This is a problem with "nation building" if we are building a nation in our own image, as we tried to do in Vietnam and again in Afghanistan.

Trump, apparently, for reasons which are not clear, simply told his deputies to "Just get the fuck out" of Afghanistan.

This is the one thing Trump got right in 4 years, not that I give him credit for that--it was just part of the package-- he just was simple minded enough to not overthink anything, as Obama did with Afghanistan.

Dexter Filkins, who has a piece about Afghanistan in this week's New Yorker, spoke  on the New Yorker podcast and he noted that after 20 years there is now an urban part of Afghanistan with people with cell phones, big buildings, women who are lawyers and doctors and judges but once the Americans leave, the only armed people may be the Taliban and whoever the Americans left behind in the military, and it's anyone's guess how they will lean. 

So there is a population which would want to fight the Taliban. 

The only question is whether female lawyers and doctors will be enough to fight off the guys in the black turbans. 

Whatever happens, however, it will not be our problem. We cannot fight in a culture we cannot stomach. 

Fighting for the 1st Amendment in Hampton, NH: Church/State Separation on Life Support

 

"Congress shall make no law respecting the establishment of Religion..."

--First sentence of the Bill of Rights, First Amendment, Constitution of the United States

To the Editor:

The Sacred Heart School community would like to extend a sincere thank you to the Hampton voters and Seabrook voters who supported our child benefit service (CBS) funds article. The yes vote from the Hampton voters on the warrant article guarantees Sacred Heart School’s continued support for the Hampton students. The no vote from Seabrook was close and we hope for success from the Seabrook voters in March 2020.

These funds are applied towards non-religious textbooks, school supplies, technology, testing materials and school nurse services and supplies for our SHS students that reside in Hampton.

We’d also like to express our gratitude to the budget committees and school boards of each town for recommending and supporting the CBS funding for the Sacred Heart School students from each respectful [sic] town.

A sincere thank you for your continued support.

Teresa Morin Bailey

Principal

Sacred Heart School

The principal's argument is not different from the general who says, "For those who object to war making, your tax dollars will go only for the gasoline for our tanks, not for the ordinance or bullets."

--Mad Dog 

Before mention even of freedom of speech, the First Amendment begins with admonition to keep church and state separate.

Not lost on those 18th century bewigged founding fathers was the blood soaked history of church and state in Europe, of its effects in the New World where Spanish galleons filled with pilfered silver and gold blessed by the Church, sailed from the conquered civilizations of Mexico and South America. 

Those who oppose the separation of church and state see it as an attack on the Church.

After all, if the Church is a force for good, an expression of God's will on earth, why would you ever want to limit its effects on government?

The problem, of course, is when human beings seek to speak for God, who has  remained resolutely silent throughout human history, then trouble has often, if not always, followed. 

Advocates of the separation of church and state, like Jefferson, were unconvinced that any man, whether pope or Protestant, actually had a special line to the mind of God. 

Even today, Mad Dog questions not the goodness of religion, but the ultimate arrogance of any man who claims God speaks to him and not to Mad Dog.

Mad Dog has no doubt churches enrich the lives of many of his fellow citizens, and he wishes them the best. 

Churches can be a force for conscience. After all, Martin Luther King, Jr. was first and foremost a minister and he spoke of conscience.

Frederick Douglass, A secular voice

But churches have, since early times, gone beyond theological concerns of saving souls to the practical concerns of feeding the poor, offering care to the sick, founding soup kitchens and hospitals. When church enters the greater sphere of social action, they lose one aspect of their special status and they have to play by the rules established for anyone and everyone who seeks to have an effect in society.

Every year, the citizens of Hampton have ignored the wisdom of the First Amendment and voted to draw a check from the public town treasury and deliver it to the bank account of the Sacred Heart School, a wholly owned subsidiary of the Catholic church, on the grounds of the Miraculous Medal church, on Route 1.

Mad Dog wishes to say immediately and publicly if you look at the rolls of contributors to Sacred Heart, those who have written checks to Sacred Heart, you will find his name (Not signed as "Mad Dog" but under his birth certificate legacy name.) Mad Dog wishes the school well and hopes it thrives. But he insists the school be treated as any other charity, supported not with taxpayer funds, but with private donations written by individual citizens.

You may ask how it would be different if the town of Hampton decided by warrant article every year it would contribute to Catholic Charities.  That would make all the difference to Mad Dog. If the town wrote checks to the Jewish Defense Fund,  the Muslim Anti Defamation League, the ACLU, the Shriners Hospitals, the Sierra Club, the ASPCA, Mad Dog would not object, if that's what the town people vote to do.

But there are certain things you cannot vote on in America and those are spelled out in the Constitution. That is, in one sense, what the Constitution is all about: These things cannot be voted on. You want to change these things, you have to amend the Constitution.

There were laws, local laws, which made slavery, and then segregated schools legal, which provided a legal framework for these. But that's why we amended the Constitution (13th) to end involuntary servitude and that's why the Supreme Court ruled in Brown v Board of Education: it didn't matter whether local laws in Alabama said separate but equal schools were just fine. Alabama could not vote for segregated schools because Alabama's wishes violate the Constitution, which embodies the sense of justice and of right and wrong of the rest of the nation. If you are part of this nation, you have to cleave to certain agreed upon principles.

For the folks of Hampton, New Hampshire, their violation of the 1st amendment has been reaffirmed annually. 

There are reasons for this:

1. It's never been actively or vigorously challenged. In Seabrook, vociferous objections were raised, but Hampton was unmoved. 

2. The mechanisms for challenging this offense have been limited. There is only one day when 20 pages of warrant articles are discussed and if you miss that day, tough luck. And even then, there is no guarantee you can prevail.

3. Sad to say, there is simply not the intellectual substrate in Hampton to form a grounding for the debate. A school teacher from Hampton, when asked his opinion about the funding of a religious school by public funds replied, "Well, the separation of church and state has never been absolute in American history." 

Mad Dog was not given the opportunity to press him on this, but presumably he's talking about the Pledge of Allegiance ("one nation, under God") and "In God We Trust" on the coins and the fact that Congress has a chaplain. But there is no instance where the federal government writes a check to the account of any church for the purpose buying books, or for that matter for plowing the church's parking lot, or painting its classrooms. All expenses of running a school, even if they are the ordinary expenses of upkeep are the responsibility of the church.

Obadiah Yougblood, Water Street Bridge

The principal of Sacred Heart notes that books bought with town money were non religious in nature, which is entirely beside the point.  As is the funding of a school nurse by town money. Just as paying for heating oil, maintaining the plumbing, keeping the flower beds and plowing the parking lot, all are expenses which ought to be born by anyone seeking to run a school. As soon as the taxpayer's dollars go into a church bank account to fund this stuff, the taxpayer is now paying for church activity, just as sure as the townspeople in Henry VIII's England paid to support first the Catholic Church and then the Church of England.

It does not matter how the principal of Sacred Heart School earmarks town funds, whether she is careful to segregate money spent for secular, administrative purposes from money spent on religious topics. The fact is, once the money is provided for costs in the school, the school nurse, for poor student scholarships, that frees up money to continue the religious aspects of the school. 

The principal's argument is not different from the general who says, "For those who object to war making, your tax dollars will go only for the gasoline for our tanks, not for the ordinance or bullets."

That the citizens of Hampton, many of whom were educated in Hampton public schools, cannot recognize the conflict of voting to write a religious institution a check from public funds suggests the citizens have not been provided with a sufficient education. 

Waving about the letters "RSA" or any other letters to justify the expense of public funds on religious institutions ignores the fact that there have always been laws to justify unjust or unconstitutional actions. 

In 1974 a New Hampshire man taped over the "Live Free or Die" motto on his license plate and was arrested. The Supreme Court said he had the right to do that in Wooley v Maynard . Citing a case from 1943, when children refused to say the pledge allegiance in school, Justice Jackson (who later presided at the Nuremberg trials) wrote,  

“If there is any fixed star in our constitutional constellation, it is that no official, high or petty, can prescribe what shall be orthodox in politics, nationalism, religion, or other matters of opinion or force citizens to confess by word or act their faith therein."

Thus an action by a single, humble Granite Stater pushed a principle to the ultimate test. In doing so, he demonstrated that he ought not be compelled to do something, in this case to display a sentiment, with which he did not agree. Like funding Sacred Heart, there was no poster child for this case. Nobody was harmed by the license plate motto and the citizens of New Hampshire saw no reason to take action to remove it. But it offended this citizen's sense of the Constitution which guarantees freedom of speech and by extension guarantees that you cannot be compelled to speak in a manner you abhor or to display a symbol--symbolic speech--which you reject.

Here was a man, a humble citizen, who understood the importance of the First Amendment, which separates church from state, which forbids government from limiting freedom of speech or imposing speech upon its citizens and which protects a free press and affirms the right of people to assemble and to confront the government with complaints (grievances).  All that is in the First amendment and every citizen of Hampton ought to know why, what the history was, why the founders put all this into the First Amendment. 

And so it is that Mad Dog is deeply offended by the annual payment to the coffers of the Catholic Church in Hampton.  Mad Dog contributes from his own personal account to that very same church, but for the town to do this is an offense to the first amendment and if the townsfolk do not understand why that is, then Mad Dog would suggest they spend that $65,000 (up from $45,000) on a course on the whys and wherefores of the First Amendment to be taught in all the schools, Marston, The Academy and Winnacunnett.

UPDATE:  MARCH 10, 2021

2179 CITIZENS OF HAMPTON VOTED TO AWARD $65,000 FROM THE TOWN BANK ACCOUNT TO THE SACRED HEART SCHOOL OF THE MIRACULOUS MEDAL CATHOLIC CHURCH.

805 CITIZENS VOTED FOR THE FIRST AMENDMENT.

ONCE AGAIN: HAMPTON EMBRACES THEOCRACY.