Command and Convenience

It’s easy to deride philosophy classes.  Few people have jobs as philosophers, so the entire field is easy to dismiss as esoteric navel-gazing, dooming most of its practitioners to lives of unskilled menial labor.  But there are few classes outside my specialization that I found more beneficial than my philosophy courses, because I acquired very valuable skills there.  Philosophy courses present difficult problems, problems that require very careful terms and proofs, and set their students on them to flex and build brain pathways.  Those problems touch on virtually the whole of human experience, between the various classical branches: What is real (metaphysics)?  What is knowledge (epistemology)? What is truth (both)?  What is beauty (aesthetics)?  What is good (ethics)?

And every time my philosophy courses got around to that last question, one particular lump of nonsense would be treated with vastly outsized seriousness: the divine command theory.

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Command and Convenience
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Dysfunction Defined

[TW: chronic illness, depression, suicide]
We are our bodies.
That sounds obvious, but it isn’t.  Cartesian dualism thoroughly infiltrates the English language and many others.  Many of the ways in which we talk about our bodies describe them as things we own, or carry, or inhabit, as though we were somehow distinct from the skeletons and meat.
My sense of my own consciousness is firmly anchored in my eyes.  Everything else is ancillary, a wall of sensation at a distance or a weird intrusion from the outside.  When I dream, I rarely have legs.  My dream avatar pushes itself through crowds with its arms, or it is nothing but disembodied eyes, watching more than participating in the dream’s events.  When I am more than that in dream, I am watching myself do things from the outside, a lucid vantage point on third-person adventure.  In those dreams, my oneiric body is usually someone else entirely: a minotaur, a Mexican woman, a robot.  I don’t have a sense of touch in my dreams, even when I have hands.  Those differences are how I tell when I’m dreaming, or when I’m recalling events that happened in dream: I can’t touch anything, I don’t have feet, and people don’t have faces.  And the world is usually in hazy grayscale with flashes of red or green to indicate the assorted Chekhov’s guns my dream-narrator likes to set up on my behalf.
There may or may not be anything to diagnose in those patterns.  But all of them are illusions, the fantasies of a mind that often feels estranged from and confused by the letters its frontier outposts deliver to it.  For the rest of us, our bodies and minds are not as distinct as my oneiromancer wants me to think they are.  Within this lipid-rimed assembly of motors and struts is a complex of sensors and wires, connections that make the events of the hands and intestines and small of the back as real and immediate as any thought or emotion—and every thought and emotion as real as leaving one’s hand too long on the stove.  The brain is only the largest and foremost organ of the self, anchoring and integrating the activities of all the others.
We are our bodies.
And when those bodies go wrong, it attacks the very definition of us.

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Dysfunction Defined

The Mover Out of Time

It does not take much to demonstrate the impossibility of many gods.  The bigger a god is, the more of the universe its devotees claim is within its sway, the more improbable its powers have to be to make what we do know about the universe compatible with its existence.  A river spirit or trickster that hides your socks when no one is looking has a small effect on reality, and can hide in the statistical noise that keeps our world de facto unpredictable.  A huge god, though, needs to be simultaneously of massive import, so that its influence permeates many facets and phenomena in the world, and utterly minuscule, so that it has an excuse for when it inevitably doesn’t show.  Thus, we get gods defined as controlling the weather, the course of wars, and whether anyone lives or dies, but whose influence is indistinguishable from the sum of the hundred and one worldly factors in and causes of all of these events; gods who can be expelled from their controlling niche by humans having the temerity to document and measure, as if God were mere quantum uncertainty; gods who use mortal movers as their proxies, merely shifting the problem one layer of agents upward with theological sleight of hand.

Christianity, between its native Abrahamic grandiosity and its wholesale lifting of neo-Platonic idealism, offers some of the largest gods.  Many versions of Christianity have gods so massive that they not only inflict weather events on people totally unrelated to whatever ostensibly displeased them, but they also, the soothsayers tell us, transcend time and space.  This god, even Jewish dreamers like to claim, exists outside of and independent of time, such that past, present, and future are all the same to it.  Events at any point in the universe’s progress are like the pages in a book this creature is reading, and flipping backward or forward is as easy for it as the analogy implies.  It created the universe and now sits outside it, a cosmic voyeur that may or may not ever interfere with unfolding events, depending on the version.

It will not surprise my readers, I am sure, to learn that this god is incoherent with both logic and the facts of our universe.

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The Mover Out of Time

Politics in the ER: Five ways Doctors Decide You Are a Drug Seeker

On June 26th, I had my gallbladder removed in an attempt to lessen the frequency with which I get pancreatitis. For those unfamiliar, pancreatitis is a condition where for some reason, bile and digestive enzymes back up into the pancreas causing inflammation and pain. In a colloquial sense, my pancreas basically tries to digest itself. The leading causes in North America are alcohol abuse and gallstones.

Three weeks later, I started experiencing extreme pain in my upper abdomen. When the pain reached a level 10, I knew I had to go in to the hospital. What followed was a cumulative 20 days of admission, which included three separate trips to the ER. As sometimes happens, my second and third trip were marked with the stigma of being treated like a drug seeker. This is a snap decision made by doctors that can seriously impact the quality of care you receive.

Even before this I have a lot of experience with ERs and doctors. I have been in and out since I was 18 and began to experience serious joint symptoms. After all my experience, I have a better idea of what doctors look for when determining whether or not you are there legitimately or if you are there to score. The problem is that these are not always within your control.

  1. Visiting multiple hospitals

One of the biggest red flags for drug seeking behaviour is if you have visited multiple different hospitals. This is because people who are looking to get drugs rely on the lack of shared information between hospitals. Someone who has become recognizable in one hospital can avoid that scrutiny by going to a new ER. The problem of course is that you might have a completely legitimate reason for going to different hospitals. Because of where I live, I am closer to the general hospital. This makes it easier for my partner to come visit me and it is also where most of my doctors have their offices. Most but not all. On my first visit on this go-around, I had a follow up with my surgeon the next day. I opted to go to the French hospital where my surgeon was in order to make sure I could still get my follow up. When a day or so after coming back home my symptoms came back, I opted to go to the hospital that knew me better. Unfortunately, this made it seem like I was playing ERs against one another.

People with chronic illnesses, those who move around a lot, the children of divorced joint custody parents, might all find themselves frequenting multiple hospitals for treatment. There are valid reasons to do so, and yet, even when the reason is clear it can be difficult to overcome the suspicion that such a mark on your record creates.

  1. Specificity in Treatment

If you are an addict, there is a good chance that you are addicted to a specific thing. If your drug of choice is Gravol, then Zofran isn’t going to cut it. Same if you prefer morphine to dilaudid or other opiates. In the case of all of these, the method of taking the medication might be as important as what type. If you are specific about what types of medications work for you, and/or the methods, this could suggest to doctors that you are looking for a specific fix. Unfortunately, if you are someone with allergies or conditions known to affect how you metabolize drugs, this can put you on the wrong side of the medical stereotype. React badly to morphine but not dilaudid? Clearly, you just like the high better. Don’t digest oral medication properly? You must just want to get high quicker.

Part of the problem of course is that there are not many other treatments available. Frustrated about the fact that doctors where ignoring what I was telling them, I challenged them to come up with a solution, other than sub-Q dilaudid, that would deal with my pain. The caveat of course being that oral medication doesn’t metabolize properly in my body. I suggested sedation, nerve blockers, patches, a bunch of “other” options all of which were shut down by the doctors. It was only once they realized that they had no other options, that I started receiving regular care.

  1. Mental Illness

I discovered this one when my visit to the weight management clinic was listed as a psychiatric visit. All of a sudden, rather than being asked about what symptoms brought me to the hospital, I was being grilled about what was meant by Psychiatric visit. If you are mentally ill in any way, be it depression, anxiety, any type of cognitive disability, schizophrenia, bipolar disorder, whether treated or not will make your visit more difficult. The assumption is that if there is anything wrong with you mentally, you cannot be trusted to give an accurate assessment of your condition. Your pain? It must be all in your head. It doesn’t matter that you have a diagnosis for Crohn’s, because everyone knows that crazy people are crazy and can’t be trusted.

Many doctors will assume that people with depression or other illnesses want to self-medicate their pain away. Why deal with crippling emotional pain that causes joint pain if you can just take a dilaudid and have it disappear? The fact that the pain caused by depression is just as real as that caused by arthritis is not something that seems to occur to doctors.

  1. Poverty and Stereotypes

If you look poor when you come to the ER, be prepared to face discrimination and assumptions. If you are on disability or welfare, be prepared to have to answer a lot of questions and to be viewed with suspicion. While I have not experienced this personally, if you are a person of colour, you most likely will also face similar levels of suspicion. The stereotypes surrounding poverty and race are such that you always face the risk of being pegged as a drug seeker.

If you are a young person with severe symptoms, especially those associated with age, you can pretty much assume you won’t be believed. I went through this when my leg issue was particularly bad and I spent most of my time trying to get answers from doctors who were more interested in giving me Percocet.

If you are a woman, you also run the risk of not having your pain believed. Although this won’t always get you painted as a drug seeker, at times it can. It results in the same lack of treatment however.

  1. Is your pain right?

One of the side effects of living with chronic pain conditions is that you become accustomed to handling pain. Even at a level 10, I have been known to crack jokes and try to lighten the mood. I can compartmentalize my pain long enough to tell doctors clearly what is wrong with me. I can do this, because I deal with pain on a daily basis. I can do it, because humour can help my pain feel less intense. Because I would rather be clear with doctors, even if it means that once they leave, my pain will feel more intense because of those moments of inattention.

It also means that it takes a lot more pain for me to register it. A level 6 pain for me is comparable to a normal person’s 8 or even 10. Often, I don’t judge whether or not I need to go in based on how much pain I am in, but rather based on where it is, whether it is different, or if it doesn’t respond to my usual treatments. When I go in it is because it is beyond my ability to handle it, or something has changed enough to cause concern. I have had days when I was passing significant amounts of fresh blood, where my pain level was lower than normal.

Although these considerations are normal for chronic pain patients, I still have to perform pain the right way in the hospital in order to be taken seriously. Doctors, especially those who don’t specialize in chronic conditions, have no understanding of what it means to live life in pain. Most people cannot really imagine what never ending pain is like.

Most people have had broken or twisted limbs, cuts, illnesses that cause pain, etc. but in all those cases there is an expectation that at some point that pain will be gone. For people with chronic pain, that expectation is not there anymore. We know that every morning we wake up we will still feel pain. The level might change, and we live for the good days where it is low enough not to be noticeable, but ultimately we know that pain can and will be there at any moment. We learn our pain intimately so that we can sometimes know exactly what is going on at any given moment. So much so, that I have walked into ERs before and told the triage nurse that I had pancreatitis. The tests confirmed this too be true. How did I know? Because the pain was in the right spot, the right sharpness, and the right amount of time away from my last Remicade appointment.

Yet despite my intimate knowledge of my body and its aches, the presumption is still that doctors know better. Since there is no way to measure pain level, I have to perform pain when I show up. Grimaces, moans, groans, shifting position, are all ways in which people can convey that they are in pain. Even if I know which position will yield the least amount of pain, I better seem to have to look for that position because otherwise I must not be in enough pain.

If your test results show minimal inflammation, then it doesn’t matter that you say that you are experiencing level 8 pain. Clearly, you are just sensitive and there is nothing seriously wrong. It can’t possibly be that something else is going on. If you are only complaining of level 6 pain, then it must not really be that serious. It doesn’t matter that you have a chronic condition that regularly has levels of pain such that would break most people, because relativity just doesn’t seem to occur to doctors.

During my trip to the hospital this time around, after the third time a doctor decided that my knowledge of my body could not compete with his medical knowledge and that I would obviously respond to Tylenol this time even though sub-q dilaudid was wearing off after minutes, I completely lost it. I couldn’t take it anymore and quite loudly voiced my opinion of this particular doctor’s skill or, in my perception, lack thereof. Despite the fact that I was clearly hurting and upset, Dr. Ken Doll decided that this was the appropriate time to make a comment about how I could not be in that much pain if I had the energy to yell at him. After accusing him of getting on power trips and making patients suffer, making it very clear that I had more knowledge and experience of crohn’s than he could, and that his condescending attitude fell flat when he was talking to a patient who has some medical background, we finally managed to get down to business. Of course after he apologized and made it clear he would listen.

What does it mean?

If you get branded a drug seeker, getting treatment becomes a battle. It doesn’t matter that tests confirm that something is wrong.  The goal of every doctor in your vicinity will be to get rid of you as fast as possible. Most doctors are already nervous about admissions due to the risk of picking up infections during a hospital stay. If they think that you are also drug seeking, then their desire to get rid of you reaches epic proportions. Throwing up everything you eat and drink? Level 10 pain? Well… do you really need to be in the hospital?

On three separate occasions, after explaining to doctors that I have consistently not responded to oral pain medication, I had to prove that this was the case. Not 20 minutes after speaking to doctors I had the nurse show up to tell me that once again doctors were going to try and have me take oral medication. I would then have to wait for an hour to show that it had no effect. It means an hour of rolling around in extreme pain, because they just need to be sure. It means feeling scared to tell the nurse that you need your next dose of pain killers. It means having a timer set so that you can know when it is safe to ask for more, because whether or not you feel pain is no longer the barometer you can use.

The assumptions surrounding drug seeking behaviour are such that they create a barrier between patients and doctors. This barrier makes it impossible for patients to be honest with doctors.  Even documented diagnoses are not enough to protect you. It doesn’t matter that I have a known diagnosis of Crohn’s. It doesn’t matter that I have had surgery. It doesn’t matter that I have had pancreatitis 6 times and that every occurrence of it makes relapse more likely. Every trip to the ER is an intricate dance where doctors decide whether I am worthy of treatment.

Politics in the ER: Five ways Doctors Decide You Are a Drug Seeker

Confessions of a Bagman 2: Three More Things I Learned Collecting Beer Cans for Money

The first two things and the introductory statement are here.

____________________________

3.     You Develop a Weird Relationship with Homeless People

Humans, especially Western humans, produce enough refuse that there really is more than enough to go around.  There are still places where it’s harder or much, much easier to collect lots of it at once, though, and those spots get “claimed” very quickly.  A kind of turf system is at work in the scavenging game, and people like me were competing with every other kind of vagrant for the same prime trash-collecting spots.  There’s no “turf war,” or even negotiating over territory.  If you get good enough at collecting in one area, it stops being lucrative for the other people who were doing it, and they leave on their own for less contentious places.  On the handful of occasions that I met someone else who visited my building for refuse that the tenants helpfully left bagged by the outside door, it was always tense.  Were we sizing each other up to see who would keep this area as theirs?  I tried to give them some of what I found whenever this happened, because I knew most of them would be much worse off than I was.  They’d never outdo my collection efforts, though—I could afford to come to that room daily with a shopping cart, and they showed up occasionally with a bicycle, or just bags.

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Confessions of a Bagman 2: Three More Things I Learned Collecting Beer Cans for Money

Confessions of a Bagman 1: Two Things I Learned Collecting Beer Cans for Money

As some of you may know, Ania and I spent a long time in a very difficult financial situation.  Between when she needed to stop formal employment for health reasons and very recently, we officially had only my income for our survival.  Unfortunately, that income was not quite sufficient for our fixed expenses, let alone buying groceries, so we had to scramble to make the necessary extra money…every month…for over a year.  We did what we could to reduce our expenses and put off a lot of eventually necessary purchases until her Ontario Disability Support Payments began, including writing expensive things like seafood almost completely out of our diets, but there was no getting around the need for more money.  As I am legally prevented from taking on much employment by my visa status (and it would have been a bad idea for my schooling anyway), a lot of this fell on her, and she did her level best to sell art and food and run errands for our neighbors, all the while looking for work she would survive doing.  For my part, I took on the unenviable task of collecting alcohol containers to return for deposit.  And in the year and change I spent doing that, I learned a few things.

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Confessions of a Bagman 1: Two Things I Learned Collecting Beer Cans for Money

Shifty Lines: The Western Arctic

Earth is a huge planet, far larger and impossibly more complicated than any fantasy realm.  Its vastness is often concealed from us, particularly in the way that common map projections section the Pacific Ocean and stretch and warp Asia.  One region has the opposite problem—common maps make it look far larger and wider than it is.  The Arctic Ocean is the world’s smallest, surrounded by landmasses so close together that, in colder times, every one of them was linked by a single mass of ice.  The eastern Arctic is defined by Russia steamrolling over a multiplicity of indigenous peoples speaking languages from numerous families.  The western Arctic, by contrast, is the story of two specific tribes expanding, colliding, and deciding how best to maneuver around one another: the Norse and the Inuit.

And because North American map-readers can’t seem to make heads or tails of that one huge island next to Canada in particular, it’s worth a look.

Map of North Atlantic showing Greenland, Ellesmere Island, Iceland, the Faroe Islands, and the surrounding area.

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Shifty Lines: The Western Arctic

Black Humor in White Hats

For those who have been in hermetic seclusion for the past year or so, Cards Against Humanity is a crowd-funded spin on the popular card game Apples to Apples.  Rather than the decidedly benign associations Apples to Apples is meant to evoke, Cards Against Humanity banks on the violent, the sexual, the political, the religious, the sacrilegious, and every flavor of bizarre deviance its assortment of writers can muster.  Instead of simple word associations, the game comes with question or fill-in prompts and a variety of often lengthy answers.  The possibilities range from the tragicomic:
I drink to forget...sobbing into a Hungry Man frozen dinner.
…to the surreal:
In 1000 years, when paper money is but a distant memory, uppercuts will be our currency.

 

…to the darkly political:
This is the way the world ends / this is the way the world ends / not with a bang, but with former president George W. Bush.

 

…to combining all three in the kind of humor trifecta one usually has to find in webcomics with just the right comedic je ne sais quois:
Lifetime presents I Am Doing Kegels Right Now: The Story of Glenn Beck convulsively vomiting as a brood of crab spiders hatches in his brain and erupts from his tear ducts.

 

This is a crab spider.
A crab spider from South Carolina, USA.
This game is fun.
When I play CAH, my favorite combinations are always the bizarrely sexual ones that involve weird props, historical or mythological figures, and/or horrible things happening to world-renowned racist clown Glenn Beck.  I also have a soft spot for two-part answer prompts.  When, “in M. Night Shyamalan’s new movie, Bruce Willis discovers that Justin Bieber had really been Glenn Beck catching his scrotum on a curtain hook all along,” I thrive.  But I also get a kick out of answers that sound like what real-world horrible people might say if they didn’t speak in dog-whistles, or that are only a little more absurd than things they’ve actually said:
1: White people like...not giving a shit about the third world. 2) When I'm in prison, I'll have...an honest cop with nothing left to lose smuggled in. 3) Whipping it out...is a slippery slope that leads to...exchanging pleasantries.

 

Not to mention things so cartoonishly overwrought that they’d be rejected as quips from Skeletor or Droopy Dog:
1) Next from J. K. Rowling: Harry Potter and the Chamber of...Auschwitz. 2) I drink to forget...a lifetime of sadness.

 

A game of Cards Against Humanity creates a different, insulated context for all of these things.  Almost anything that happens during a CAH session would be wildly inappropriate in any other, and most of it would get someone ostracized from even marginally progressive company thereafter.  But inside a game of CAH, the point is to produce satirical, absurdist commentary on and parody of the world’s awfulness, preferably via accusing it of using its collection of high-tech sex toys to sex up Bert and Ernie while the Buddha and Abraham Lincoln arm-wrestle for sloppy seconds.  Used properly, Cards Against Humanity is a way to rob the world’s evil of some of its power, by making it the subject of humor and declaring this or that villain’s antics the same kind of ludicrous as Pac-Man uncontrollably guzzling cum.  Rush Limbaugh and Ken Ham are essentially real-life cartoon characters as it is—Cards Against Humanity only holds them to that standard.
The problem is, this particular segment of the humor-scape is where it’s very, very easy to do harm, and even easier to hit nerves.  This game’s default options include (or included; see below) a number of unsavory punchlines that become much worse when paired with certain question cards:
1) What ended my last relationship? Date rape. 2) It's a pity that kids these days are all getting involved with...black people. 3) Major League Baseball has banned...the profoundly handicapped...for giving players an unfair advantage.

To say nothing of the chance of encountering something personally significant in such a jagged game, and having to explain a reaction other people would rightly not have.  The best CAH sessions I’ve been part of include the stipulation that if a player doesn’t understand a reference, finds something personally hurtful, or otherwise can’t find the humor in a particular answer card, they can trade it and discard or return the old one, no questions asked.

Cards Against Humanity has been rightly criticized for too often punching down rather than up, and treating the existence and difficulties of many real-world marginalized groups as the stuff of mirth.  This has the exact opposite effect from the scenarios discussed above, and is a major detriment to the pleasure that many groups derive from this game.  Perhaps no card in the series is more notorious for this attribute than the “passable transvestites” card in the original set, showing all the tact and class of Grand Theft Auto and inspiring a rather graphic disposal from at least one CAH fan.  The creators of Cards Against Humanity are aware of this failing and, to their credit, periodically purge cards from the game’s massive accumulated archive as they reconsider whether they cross the line from edgy to cutting.  This willingness to admit that finding a particular Cards Against Humanity combination hurtful isn’t the same thing as lacking a sense of humor, “looking to be offended,” or some other strawman of typical progressive attitudes means that the Cards Against Humanity team understands the role that their game plays in our ecosystem.  Here’s hoping that the “the profoundly handicapped” card is part of that same rejected set.  (Of course, there are other factors at play that could make one queasy about participating in this game or buying it, of a different nature.)

Cards Against Humanityhas earned its place among the pantheon of progressive party games, and I look forward to further opportunities to use CAH to laugh instead of rage or weep at the world’s injustices.
Also, the the custom expansion Ania and I put together contains numerous more than capable replacements for all the old cards that tend toward marginalization.  Just saying.
Black Humor in White Hats