Helen H. Moore's Blog, page 287

On Youtube there is a war for the soul of Hassidic youth

Menashe; One of Us (Credit: A24/Netflix)

Several years ago, I attended a rooftop party in North Williamsburg alongside a bunch of hipsters who had names like Moshe, Uri, Chaya, and Faige. It didn’t take long for Uri,* a young man wearing a patterned button-down and small, circular glasses, to tell me he’d grown up in a Hasidic community not far from that rooftop.

He’d left because when he came out as gay, his community put him in conversion therapy.

Uri isn’t alone. The recently debuted documentary “One of Us” echoes stories like his that are happening all around Brooklyn, bringing to light extremely insular Hasidic communities for secular viewers. It follows closely on the heels of “Menashe,” which hit movie theaters in July and offers a much different take on Brooklyn’s Hasidim. Both indicate an opening up of a world that people have considered one of the most closed off in the United States.

“One of Us” paints a dark portrait of Brooklyn’s Hasidic communities and what it means to leave them. Created by the makers of “Jesus Camp,” a disturbing documentary about an evangelical Christian summer retreat, “One of Us” follows three people who have or are attempting to leave their insular ultra-orthodox Jewish communities and the obstacles they face.

Hasidim might describe the documentary’s subjects as “OTDs,” an abbreviation for “off the derech,” alluding to former Hasidic Jews who decide to stray from the ultra-religious “path,” or derech in Yiddish. At this month’s Toronto International Film Festival, where the film premiered, viewers got to see some of the more violent reasons for going OTD, from childhood sexual abuse to domestic violence and forced childbearing. (For the rest of us, “One of Us” debuts on Netflix on October 20.)

“Menashe,” meanwhile, tells the fictional but reality-based story of a Hasidic widower who struggles to maintain custody of his only son in a community that doesn’t allow fathers to raise their children alone.

Lauded as “subtly powerful,” “sweet,” “compelling,” and “quiet” by critics, “Menashe” presents a much milder view of Hasidic culture than “One of Us.” While the former doesn’t shy away from the hardships of living in a fundamentally religious community, it is careful not to play into stereotypes and embraces the community it explores — in part by having casted actual Hasidic people in all of their roles (except for the young boy who plays the titular character’s son).

“We never put fake payos [the long strands of hair Hasidic men wear in front of their ears] or fake beards on people,” said the filmmaker, Joshua Weinstein, at a Film Society of Lincoln Center interview. Next to Weinstein during this interview sat Menashe, the Hasidic man who played the movie’s main character. The first-time actor seemed incredibly at ease speaking to a large crowd, though he revealed that a screening of “Menashe” at Sundance had been his first time ever inside a movie theater.

This contradiction sums up how surprising “Menashe” is for those used to understanding Hasidic communities as extremely closed off to outsiders. The filmmakers shot the movie in Borough Park, where, said Weinstein, “people are very nice and very happy to have you there,” but “when you pull out a camera it’s like they’ve never seen a camera before.” Co-writer Alex Lipshcultz added, “All in all it was a pretty welcoming community; we got tossed out of a few locations.”

Ultimately, film served as a pathway into the Hasidic community — not just for the filmmakers, but also for the film’s many viewers. Similarly, film has focused on the passage out of Hasidic communities. Just as, say, LGBTQ youth have been turning to YouTube for years to post and watch videos about struggles no one at home understands, so have OTD people.

Footsteps, an organization that helps OTD people leave their ultra-orthodox communities, has a YouTube channel where it posts videos of its success stories. They’re meant to inspire others to step off the path by fostering an OTD community.

Other OTD people do this independently, like in this little-viewed video by “Pesachology,” where he talks about how OTD people took back the originally derogatory term and attempts to debunk the stereotype that “OTD = at risk.” Then there’s this man, known simply as “Reporter” on YouTube. Driving back from an evening of surfing (during Shabbos, no less) in a California beach town, he slips seamlessly in and out of Yiddish throughout his OTD video, gesturing adamantly with an unlit cigar that he at one point offers to someone else in the car without skipping a beat in his monologue.

More unexpected are the ultra-orthodox who take to YouTube to encourage Hasidim to stay on the derech — the world wide web doesn’t seem like it would be their top choice forum. Nonetheless, YouTube is home to various “instructional” videos with titles like, “How to return a child that has gone off the derech.” In one from 2013, Rabbi Twerski proposes that today’s “hedonistic society,” fueled by the very internet where he posted his video, begets wayward Jews’ hedonistic goals.

So ex- and current Hasidim use the internet to talk derechs. Does this, along with the recent, major films about Hasidim, indicate a growing openness in their communities?

Frieda Vizel, a dirty blond pictured in a white t-shirt and blazer on her website for Visit Hasidim, an organization she founded to let tourists explore Hasidic South Williamsburg, thinks so. Over the several years in which she’s been conducting tours, Vizel’s noticed the community opening up to her, but it’s hard for her to tell if that’s because she’s “more open,” because she’s “been around long enough, or because the community is changing.”

“I think it must be all three,” she told me over the phone in September — an interesting time to visit South Williamsburg, apparently, because of the High Holidays.

One of Vizel’s tours was filmed for “One of Us,” though she’s not sure whether the filmmakers used the footage. The documentarians would’ve had a hard time getting much deeper into the Hasidic community than a Visit Hasidim tour, considering the film exposes an ugly side of the community. On the flipside, Vizel said community members have grown willing to approach her tourists.

Once, at a restaurant where Vizel ends her tour, a woman “wearing a scarf — she seemed really pious,” approached a tourist who’d said she was from Australia and said, “Oh, Australia — you must know Rabbi so and so.” The Australian didn’t, but it made Vizel marvel at a community that still holds “a lot of surprises” for her. For instance, Hasidim who speak to Vizel’s tour group sometimes reveal trips they’ve taken that they might not have even told their families about.

“It’s very common to travel somewhere and not tell anyone,” Vizel explained. Hasidic men need to have access to a pious minion — a group of 10 men to pray with who practice the same level of religion — so if they travel somewhere without that, it’s certainly not something to write home about.

Vizel herself is “technically OTD.” She grew up in the very insular Hasidic Kiryas Joel community of Orange County, New York but eventually attended Sarah Lawrence College and now only goes back to visit her family. “OTDs by definition draw a lot of attention to ourselves . . . because we’re the only ones to speak publicly,” she said. “Everything people know about the community they know about through the filter of those who’ve left.”

While the numbers of visible OTD people are increasing along with the access to outside information and art — thank you, internet — the Hasidic community is also growing (having a mini van’s worth of kids is common), so those numbers are likely proportional. In “One of Us,” a Hasidic woman, Etty attempts to leave her community and her abusive husband, taking her seven children with her. The Hasidim who aim to stop her reason that children in the community serve as “replacements” for the many Jews who died in the Holocaust. From within the community, that must not only be very tough to argue, but also a persuasive reason to continue to procreate.

With information to counter that belief, like “One of Us” and the many OTD-centric videos on YouTube, such arguments will become less compelling for Hasidim who are primed to stray from the path. Increased access to information never fails to radically transform a society, and films like “One of Us” and “Menashe” as just the beginning of this shift taking place in Brooklyn’s Hasidic communities.

After all, there’s a trend toward Hasidim becoming more “open to cooperating with outsiders,” said Vizel. “‘Menashe’ is foreshadowing . . . [There’s a] latent creative energy that’s in the community . . . I’m sure we’re going to start seeing more and more of that seep out into secular culture.”

And perhaps, with it, more OTD people doing the same.

*Name changed to protect identity.

A DACA recipient’s mission to help other Dreamers

Manny Villarreal (Credit: LaRissa Lawrie)

Manny Villarreal is known among those at Wichita State University for being as actively involved on campus as possible and for his mentoring of and advocating for DACA recipients like himself.

Villarreal was born in Guadalupe Victoria in Durango, Mexico and brought to Kansas on a travel visa when he was four. But his Kansas-community ties began long before that, with his grandparents: his grandfather worked for Boeing, while his grandmother worked for St. Francis Hospital during the 1970s.

For Villarreal, Kansas is home.

“I didn’t feel the full effect of being undocumented until I was a senior in high school,” he said. “I was limited on the things I could do and not do. I always knew the barrier on traveling, but when college came around, I didn’t know I couldn’t apply for most scholarships, and some other states didn’t allow undocumented students to go to college.”

He decided to attend Butler County Community College, after being awarded enough scholarships to cover tuition. While there, he earned two associate degrees as well as enrolled in the DACA program before transferring to Wichita State University.

“The week Donald Trump got elected, I was driving on the highway and the people inside the car next me started following me and screaming ‘Trump, Trump, Trump’ at me,” Villarreal said. “I didn’t necessarily feel scared for my life, but it made me scared of the changes that were going to start happening.”

Those changes became official September 5 when United States Attorney General Jeff Sessions announced the Deferred Action for Childhood Arrivals (DACA) program was being rescinded.

The program — implemented in 2012 under the Obama administration — provided 800,000 undocumented immigrants, brought to the U.S. as children, work authorization and other benefits. The current administration has initiated a wind-down process of the program and has given Congress a six-month grace period to decide whether to protect DACA recipients, or “Dreamers,” from deportation.

Everyone who knows Villarreal speaks highly of him. Crystal Abasolo, one of Villarreal’s high school teachers, described Manny as a motivated and determined student.

“Manny came from a underprivileged home, but he was very determined to change that for himself,” Abasolo said.

Villarreal, a senior electrical engineering major, works as an intern at an electrical engineering firm.

“I literally googled ‘highest paying job,’ because my parents sacrificed a lot for me. If I’m going to do something, I’m going to go as far and beyond as I can,” Villarreal said. “I feel motivated to pursue something that one day I can give back to my children. I want my kids to feel proud that their dad is an engineer.”

Manira Rani, one of the Villarreal’s first engineering instructors at Wichita State, said that Manny brightens her classroom.

“I’ve known Manny since 2015 when he first took a class from me,” Rani said. “In the classroom, he’s really good — he participates, he’s helpful to his peers and he makes the class fun.”

Alicia Martinez Newell, Director of Engineering Student Engagement, asked him to be a peer mentor to first year engineering students after she noticed his volunteer work with the Society of Hispanic Professional Engineers and the Hispanic American Leadership Organization.

“One of the things I saw in Manny was that he was really engaged in everything he became involved in, and I saw that he had that natural leadership ability within his character,” said Newell. “He does a phenomenal job mentoring students, especially those who are first generation and underrepresented.”

One of Villarreal’s specific mentoring goals is to reach out to DACA students who may be struggling.

“I talk to DACA students that feel that they’re in the shadows, who have no one to look up to. I want people to see that I was undocumented, and I struggled and have reached my goals. I want undocumented students to see me and realize that this is something that they can overcome,” said Villarreal.

Joshua Villa, a longtime friend and fraternity brother of Villarreal, has seen that mentoring and hard work first hand.

“Manny mentors anyone that he can talk to – incoming freshman, transfer students – any chance he gets to share his experiences, the do’s and don’ts of college and ways to improve as a university,” said Villa. “He’s a hard worker, he has a great GPA, he’s constantly busy with classes and work but still finds time to sit down and talk to people.”

It has not always been easy for Villarreal. He describes feeling like he is occasionally caught between two worlds.

“I feel stuck sometimes. There’s sometimes I want to focus on my own culture, but in reality, the more I know about my own culture the less valued I feel here in the U.S., ” Villarreal said.

That feeling compounded when Villarreal married his long time girlfriend, Andrea, last year. The two had known each other since middle school and started dating in high school.

“People are always going to think that he’s using me, but I pushed him to get married. We started dating when we were 15 years old, and it’s really sad that people view the negative and try to water down the love that we have,” said Andrea Villarreal.

Even though Villarreal is now a legal resident, he is still passionate about defending DACA and helping DACA students. He was one of about 50 people who attended a DACA Solidarity Rally held at Wichita State on September 12.

“For the majority of us Dreamers, our parents struggled and sacrificed a lot to get us here, but we didn’t have a choice to come here or not,” said Villarreal. “At the end of the day, America is the only country we’ve ever known. DACA students want to work, go to college, better themselves and make America better.”

Tom Price promises to repay cost of private jets

Tom Price (Credit: AP/Carolyn Kaster)

Health and Human Services (HHS) Secretary Tom Price admitted he regret his actions on Thursday afternoon and pledged to reimburse taxpayer funds after he was caught using private jets to attend both business meetings as well as more extravagant endeavors that included a trip to a property he owns on an island to eat lunch with his son.

Price’s tab, which was funded with taxpayer money, exceeded at least $400,000, but he said that “the taxpayers won’t pay a dime for my seat on those planes,” in a statement on Thursday.

“Today, I will write a personal check to the U.S. Treasury for the expenses of my travel on private charter planes,” the statement said. He did add however that “all of this travel was approved by legal and HHS officials.”

“Despite this,” the statement said. “I regret the concerns this has raised regarding the use of taxpayer dollars.”

He continued, “it is clear to me that in this case, I was not sensitive enough to my concern for the taxpayer.”

Price’s statement also said that he has “fought for the taxpayers” his entire political career. “I know as well as anyone that the American people want to know that their hard-earned dollars are being spent wisely by government officials.”

The apology comes after an investigation was launched into Price’s actions by HHS’s inspector general late last week. Price said that to ensure his remarks are taken seriously he will continue to “cooperate fully with the OIG, and internal review.”

Within two months of joining President Donald Trump’s administration, Price reportedly asked a White House official to tell the president that he wanted to reopen HHS’s executive dining room, which was closed after it was deemed an unnecessary expense.

Hugh Hefner’s real progressive legacy isn’t sexual, it’s racial

Hugh Hefner, Harold Washington and Sidney Poitier (Credit: AP/Suzanne Hanover)

The death of Hugh Hefner means different things to different people. In some eyes, he’s an icon, who ushered in a sexual revolution. To others his legacy is built on the bodies of women and misogyny. Certainly, many of his non-editorial activities were questionable as well.

But in one important realm, Hefner was undeniably progressive. Over many decades and in many ways, he used his platform and wallet to challenge race-based stereotypes and push forward racial justice.

“I felt from a very early age that there were things in society that were wrong, and that I might play some small part in changing them,” Hefner said to CBS Los Angeles in 2011. Indeed, he did.

Playboy may have become famous for the high-quality nudes of beautiful women, but the men’s magazine had a long history of publishing black writers and thinkers. In the first-ever interview conducted in its pages, Alex Haley spoke to Miles Davis. Hefner said that in the 1962 interview Davis “didn’t talk so much about music, he talked about wishes and equality.”

As in all of Haley’s work, racial justice was at the forefront with his Davis interview, and that tradition continued through his other work for the magazine. Dr. Martin Luther King Jr.’s longest print interview appeared in the magazine in January 1965. Hefner’s son, Cooper Hefner, told the Telegraph, “that the last article ever written by Martin Luther King before his assassination was published in Playboy. He added “that a special edition was published in Braille for Ray Charles.”

Before “The Autobiography of Malcolm X,” changed lives, Haley first interviewed Malcolm X in Playboy. The writer also interviewed Muhammad Ali, Sammy Davis Jr., Jim Brown and Quincy Jones for the magazine.

As Jemele Hill tweeted today and many echo: “I read Playboy for the articles. Seriously.” Playboy demonstrated how the deliberate and thoughtful journalism and space for black writers continues to be a priority when last June, Playboy hosted an interview between sports journalist and activist Bomani Jones and author Ta-Nahisi Coates.

Hefner also featured black artists on his TV programs as far back as 1959. The Civil Rights Act did not pass until 1964, so race-based discrimination was not just alive, but legal at the time. Ella Fitzgerald, Nat King Cole, Sammy Davis Jr., Tina Turner, all appeared on Hefner’s various Playboy shows over the years, bringing black faces into homes across the country.

Black models showed up in the pages of Playboy, too. In 1965, Jennifer Jackson was the magazine’s first black playmate of the month. More history was made in 1971, when Darine Stern became the first black model to pose for the cover, rocking nudity and an afro. While, yes, the majority of centerfold and models have been and continue to be white, Hefner offered a more colorful vision of the feminine ideal than many.

In 1961, comedian Dick Gregory performed at the Playboy Club in Chicago in front of an all-white audience. Invited by Hefner, Gregory said he was paid five times the wages he was getting at the time. Three years later, Gregory would again work with Hefner, this time on something far more serious.

The publisher donated $25,000 to use as a reward in helping Gregory uncover the bodies of slain civil rights activists James Chaney, Andrew Goodman and Mickey Schwerner. Hefner said he was also instrumental in funding Jesse Jackson’s Rainbow PUSH Coalition.

Hefner’s attention and advocacy for civil rights was telling of his understanding of the reach and power of popular culture. As Keli Goff of The Daily Beast writes, “Hefner deftly used culture and his pocketbook to help transform the way underrepresented groups are viewed and, as we are seeing right now, culture is often the battlefield on which America’s ideological wars are fought.” Black entertainers, artists and writers had a stage, but white readers also had access to often radical ideas and people through Playboy.

Hugh Hefner’s legacy — like almost anyone’s — is complicated. He was undoubtedly compromised and limited in many aspects of his life. Praise for him can’t be, and shouldn’t be, all encompassing.

But when it came to racial equality, Hefner was ahead of the pack, listening to and amplifying black voices well before social justice became mainstream. At the very least, Hef deserves credit for that.

How Trump and Democrats could cut a deal on taxes

(Credit: AP/Evan Vucci)

Here they go again. Despite the Republicans’ control of the presidency and both houses of Congress, their internal divisions keep on frustrating their plans to accomplish anything of consequence.

So, the most polarizing GOP president since Abraham Lincoln has come up with a startling work-around: Cut deals with the Democrats on selected major matters, including funding the government, raising the debt limit and, perhaps soon, legalizing the Dreamers.

Tax reform

The next big test is tax reform. If (when) Mitch McConnell and Paul Ryan can’t deliver the goods, could President Trump and the Democrats find common grounds on taxes?

We know what tax reform means to the President and congressional Republicans — much lower taxes for corporations and other businesses; lower taxes for individuals and households, especially on their investment income and an end to the pesky estate tax.

The problem for Republicans is not their relentless itch to cut taxes for businesses and wealthy people, which is a given for the GOP. The catch is that their current agenda would cost the Treasury several trillion dollars.

Their preferred ways to pay for at least a part of it, by paring corporate tax preferences and personal deductions for mortgage interest and state and local taxes, only aggravate the party’s internal divisions.

Could Trump win on taxes (hugely) by cutting another deal with Democrats? He went along with virtually everything that Nancy Pelosi and Chuck Schumer asked for to seal the previous agreements. What might the Democrats demand on taxes?

Democrats’ wish list

Since Democrats typically favor more federal spending, their traditional wish-list on taxes is heavy on ways to raise revenues rather than options for cutting them. That predilection could provide a basis for another agreement of convenience: Cut taxes the way that President Trump wants and pay for it the way that Democrats want.

For years, many Democrats have called for an end to “deferral,” the tax provision that lets multinational companies delay paying any U.S. tax on their foreign earnings, usually for years and sometimes in perpetuity.

It’s the opposite of the GOP’s call for a “territorial” tax system that would permanently exempt from U.S. tax any income that American businesses earn outside the United States.

Tax deferral matters most to the subset of companies that are most successful in worldwide markets — think of the internet and software giants, big pharma and brands like Coca Cola.

If both sides are prepared to cast them aside, there might be a deal that trades a lower corporate tax rate for the prompt taxation of foreign earnings.

It doesn’t make much sense economically: Since most other countries have “territorial” tax systems, deferral helps level the playing field on taxes for U.S. companies in foreign markets.

Make America Great Again

But economics doesn’t seem to matter much anymore — and consider that the White House could trumpet rolling back deferral as a powerful way to Make America Great Again by convincing companies to produce more goods and services at home and Democrats could sell it as a way to keep jobs in America.

Democrats also generally favor taxing the investment income of wealthy Americans at the same rates as the wages and salaries of everyone else. Their call for an end to lower tax rates for capital gains, interest and dividends, of course, is the opposite of the GOP’s current economic faith and tax plans.

Nevertheless, perhaps Trump and the Democrats could agree to raise the tax rate on capital income to the level of labor income in exchange for lowering the tax rates on all income.

If Reagan did it…

Wall Street Republicans would hate it, but some in the GOP might just remember that it’s precisely what Ronald Reagan did in 1986.

There is also a variation on this deal based on Democratic support for higher payroll taxes on high-income people. Schumer and Pelosi might be willing to trade lower personal tax rates, especially at the top, for subjecting capital income to the payroll tax.

This deal would also require tinkering with Social Security to ensure that payroll tax payments on capital income did not figure into the size of a taxpayer’s subsequent Social Security benefits.

But Democrats could also insist that the Treasury divide the additional revenues between the Social Security Trust Fund and the funding for lower personal tax rates.

This scenario may seem far-fetched until you consider that it would give Trump the opportunity to claim credit for lowering tax rates and saving Social Security.

Unlikely scenarios

In the end — and perhaps it’s a good thing — none of these scenarios is likely to happen for two reasons.

The Republicans probably will split over tax reform, but the odds they can stick together are greater on taxes than healthcare: It’s always easier to agree on how to give away money than on how to take it away.

Beyond that, agreeing on taxes would require more imagination and nerve by the White House, and probably Democratic leaders too, than either has displayed recently.

Nevertheless, the bare possibility of collaboration on taxes between President Trump and the Democrats reminds us that governing can divide a political party and being in opposition can unite it.

As care shifts from hospital to home, guarding against infection falls to families

Angela Cooper arrived home from work to discover her daughter’s temperature had spiked to 102 degrees — a sign that the teenager, who has cancer, had a potentially deadly bloodstream infection. As Cooper rushed her daughter to the hospital, her mind raced: Had she done something to cause the infection?

Cooper, who works at a Chevy dealership in Iowa, has no medical background. She is one of thousands of parents who perform a daunting medical task at home — caring for a child’s catheter, called a central line, that is inserted in the arm or torso to make it easier to draw blood or administer drugs.

Central lines, standard for children with cancer, lead directly to a large vein near the heart. They allow patients with cancer and other conditions to leave the hospital and receive antibiotics, liquid nutrition or chemotherapy at home. But families must perform daily maintenance that, if done incorrectly, can lead to blood clots, infections and even death.

As more medical care shifts from hospital to home, families take on more complex, risky medical tasks for their loved ones.

But hospitals have not done enough to help these families, said Dr. Amy Billett, director of quality and safety at the cancer and blood disorders center at Dana-Farber Cancer Institute/Boston Children’s Hospital.

“The patient safety movement has almost fully focused all of its energy and efforts on what happens in the hospital,” she said. That’s partly because the federal government does not require anyone to monitor infections patients get at home.

Even at the well-resourced, Harvard-affiliated cancer center, parents told Billett in a survey that they did not get enough training and did not have full confidence in their ability to care for their child at home.

The center was overwhelming parents by waiting until the last minute to inundate them with instructions — some of them contradictory — on what to do at home, Billett said.

An external central line, which ends outside the body, must be cleaned every day. Caregivers have to scrub the hub at the end of the line for 15 seconds, then flush it with a syringe full of saline or anticoagulant.

If caregivers don’t scrub properly, they can flush bacteria into the tube, and — whoosh — the bacteria enter a major vein close to the heart, Billett said. One father, noting that the hub looked dirty, scrubbed it with a pencil eraser, sending three types of bacteria into his child’s bloodstream, she said.

Learning the cleaning steps was “very nerve-wracking,” recalled Cooper, whose 18-year-old daughter, Jaycee Gray, has had a central line since April to receive treatment for anaplastic large-cell lymphoma, a rare type of blood cancer.

“You can scrub and scrub and scrub, and it doesn’t feel like it’s clean enough,” she said. Parents must keep track of other rules, too, like covering up the central line before the child gets in the shower and changing the dressing if it gets dirty or wet.

Monitoring Infection Cases At Home

Bloodstream infections associated with central lines lead to thousands of deaths each year inside hospitals, costing billions of dollars, according to the Centers for Disease Control and Prevention. Research has also shown these infections are largely preventable: Hospitals have slashed infection rates when staff follow the CDC’s standardized safety steps.

But researchers recently discovered that more kids with central lines are getting bloodstream infections at home. In a three-year study of children with cancer and blood disorders at 15 hospitals, 716 such infections took place outside the hospital, compared with 397 inpatient infections. This is partly because children with central lines spend much less time in hospitals than not.

These hospitals belong to a national collaborative of 20 pediatric cancer centers, organized through the Children’s Hospital Association, that aims to keep kids out of the hospital by training families, visiting nurses and clinic staff on handling central lines.

At one of the hospitals, Johns Hopkins in Baltimore, researchers discovered that patients as young as 8 were cleaning their own central lines at home, even though the hospital had designed its training materials for adults.

Cooper said that when her daughter developed the fever July, she immediately started wondering if she was to blame: “It’s really hard,” she said. “I don’t want to put her in the hospital.”

When doctors confirmed that Jaycee had a bloodstream infection, Cooper asked them what caused it. Days later, after interviews and tests, no one knew for sure.

Jaycee was transferred to Children’s Hospital & Medical Center in Omaha, Neb., one of the other hospitals in the collaborative, where nurse Amanda Willits works with families to identify the likely causes of infections and practice safe techniques. Willits said the bacteria probably came through the skin, but there’s no sign Cooper is to blame, and Cooper demonstrated her line-care technique perfectly.

Jaycee spent four days in an isolated room at the hospital, two hours away from home. Doctors warned her that if the bacteria had colonized the plastic of her central line, she might have to go through surgery to have it removed and replaced.

As it turned out, Jaycee didn’t need surgery; she recovered with antibiotics. But about four times out of 10, children who get these infections do need their lines surgically removed, according to research by pediatric oncologist Dr. Chris Wong Quiles at Dana-Farber/Boston Children’s.

Looking at 61 patients there, Wong Quiles tackled basic questions that researchers don’t have national data on: When patients get these infections at home, what happens to them, what does it cost and how often do they die?

Wong Quiles found that in 15 percent of cases, children ended up in the intensive care unit. Four children died. Their median hospital stay was six days, and their median age was 3.

These episodes also cost a lot. Wong Quiles found that median hospital charges were $37,000 per infection. That’s not counting professional fees from hospital staff; the cost of going home with antibiotics and possibly nursing care; or the cost to families from losing days of work to be at the hospital with their kids.

Bringing In A Checklist Engineer

In Boston, Billett and Wong Quiles have enlisted extra staff and resources to try to help parents. The hospital hired a “checklist engineer” to clean up inconsistent messaging and created family-focused videos, flip charts and pocket-size brochures about handling central lines.

Now, patients and families start learning central line care five to 10 days before discharge, instead of just one or two days, Billett said. Parents first practice on a dummy called Chester Chest, then demonstrate their skills on their child.

Even after this training, bringing a child with cancer out of the hospital still felt scary, said Megan Kelley, whose 8-year-old daughter, Bridget, is being treated there for leukemia.

“It felt like bringing a newborn baby home — we’ve never done this before,” said Kelley, who lives in Quincy, Mass., with her husband, Dan, and their three daughters.

Bridget and her family have managed to avoid infection since she was first discharged last December.

Along the way, the family got support and was spot-checked: The hospital keeps track of who was trained and that person’s skill level, and sends a nurse home to see how the caregiver handles the line.

This approach to patient safety — helping families at home through standardized learning tools, hands-on training and tracking skill development — could have broad applications for caregivers of patients young and old, Billett said.

Some early work at Johns Hopkins has shown success: The hospital found a dramatic reduction in outpatient bloodstream infection rates after it trained families, home health nurses and clinic staff.

These infections “can exact such a harsh toll on some of our most vulnerable patients,” said Dr. Michael Rinke, who led that research and now works at Montefiore Medical Center in New York. “Preventing even one of these can help a kid have an important out-of-hospital time, and have an important being-a-kid experience.”

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

How to understand the rise of German right-wing populists

AfD (Alternative for Germany) chairwomen and party's faction leader in the German state parliament of Saxony, Frauke Petry, right, and the faction's media policy spokeswomen, Kirsten Muster, left, talk as they arrive for a press conference in Berlin, Germany, Tuesday, April 18, 2017. (AP Photo/Michael Sohn) (Credit: AP)

The Alternative for Germany (AfD), the right wing upstart of German politics, will enter the national parliament for the first time after taking 12.6% of the vote in the 2017 election.

The party is barely five years old and was but a newborn when the last election took place (in 2013). It polled 4.7% then, narrowly missing the 5% vote share needed to gain representation in the federal parliament.

In the four years since, the AfD has transformed itself. It was once led predominantly by professors who were deeply worried about the future of the euro but is now a broad church of right-wing naysayers. Indeed, the party’s name stems from Angela Merkel’s now famous observation that there was no alternative to the policies her government put in place in a bid to save the euro at the height of the financial crisis.

The AfD argued that there were alternatives and the party was born to try and illustrate just what those alternatives where.

The party’s transformation away from its euro-focused roots has been a radical one. As the eurocrisis dropped in salience, the AfD’s popularity fell and it was in all probability destined to drift into insignificance. Then came the refugee influx of 2015 and 2016. The party’s response to Merkel’s open door policy has rendered it almost unrecognisable from the one that Bernd Lucke and his fellow euroscpetics founded in April 2013.

Fishing on the right

For one thing, a number of AfD politicians use firebrand rhetoric the type of which modern Germany has not heard before. Frauke Petry, arguably the party’s most well-known figure, claimed in January 2016 that there were situations where German border officials could legitimately shoot refugees trying to get over the border.

There are also those such as Bjoern Hoecke who look to relativise Germany’s past, just as there are many who are strongly anti-Muslim. Opposition to Merkel’s policies towards refugees nonetheless remains the galvanising force that keeps the party together. In that sense, the AfD has echoes of the National Front in France and other hard right actors across Europe.

The AfD is, however, a rather more complicated beast than that. Although many of the eurosceptics who founded the party have long since left, their influence has not vanished completely. One of the AfD’s two ‘leading candidates’ for the 2017 election, Alice Weidel, for example, is a 38-year-old lesbian who used to work for Goldman Sachs. She speaks fluent Mandarin and spent six years in China writing a PhD on the Chinese pension system. She is certainly not the archetypal leader of a far-right party.

At the big table

Now that it will sit in the federal parliament, the AfD needs learn how to deal with the challenges of real world political life inside the Bundestag. It has plenty of members who have plenty to say. It is not short of chiefs. But in the Bundestag it needs to find what the Germans call “Sachpolitiker” – MPs who can master detailed briefs inside parliamentary committees. It needs to show it can do politics just as well as it can talk about it. For a parliamentary party that will have very little experience of life inside the political institutions that will prove a challenge.

The big question for the AfD now is how it will perform in 2021. Radical parties can find the mundane world of parliamentary politics stultifying. The AfD has no chance of having to actually exercise power – all of Germany’s parties have long since said that they won’t work with it – but its politicians will have to illustrate that they develop a common line on a whole range of policy issues that have up until now played insignificant roles in the party’s development.

The rise of the AfD is a shock to the German system. Many Germans are deeply uneasy at the thought of a party to the right of the CDU sitting in parliament. Yet the AfD’s biggest challenge is still to come.

Daniel Hough, Professor of Politics, University of Sussex

How getting a drink can be dirty business

(Credit: AP)

Have you ever thought about what might tag along when you add ice or a lemon slice to your drink? When lemons and ice are served in beverages, they not only bring flavor or a flourish. They can also carry bacteria and viruses.

Ice can be a nice addition to a beverage, but it also can be contaminated with microorganisms, even before it’s turned into ice. While water used to make ice is expected to meet the same sanitary standards as drinking water, history tells us this is not always the case.

Back in 1987, contaminated ice served at a football game in Philadelphia between the University of Pennsylvania and Cornell and a few other smaller gatherings caused 5,000 people to become sick in a four-state outbreak of Norovirus. Contaminated ice was also responsible for a 1991 cholera epidemic in Latin America that caused nearly 8,000 illnesses and 17 deaths.

In addition to the hazard of making ice from contaminated water, ice and lemons can pick up bacteria from various surfaces, including ice makers, cutting boards, hands or utensils.

We study food science and how to keep food, including ice and slices of fruit, safe for consumption. As part of this work we conducted experiments to determine if handling lemons and ice could transfer bacteria. After all, ice and lemon are often added to beverages – and ice is almost universal in coolers used at tailgates, cookouts and other outdoor events.

The results just might make you sick.

How bad is it?

The bad news was that when hands were contaminated with E. coli , the bacteria were transferred to wet lemons and ice 100 percent of the time. If the lemons were dry, the bacteria were transferred 30 percent of the time.

These findings are consistent with a previous study reporting found that 69 percent of lemons slices used in drinks from 21 restaurants sampled in the Paterson, NJ area were carrying bacteria or fungi associated with human contamination.

It’s even worse for ice.

More bacteria were transferred to ice from hands or scoops than was transferred to lemons – up to 67 percent from hands and 83 percent from scoops!

What if I just fix my own drink?

What about those lemons held at the drink station, the slices just waiting for you to stab with a fork or just grab it with your fingers and then to plunge into your tea?

Restaurant self-service drink stations often have lemon slices sitting out for customers to place in their beverages. These specimens are open to several possible contamination opportunities.

First, the lemons can become contaminated with bacteria when being cut into slices. That is, the person slicing them can spread bacteria. Or, they may pick up bacteria from a cutting board.

A second and more likely scenario is when customers reach into the bowl to pick up a lemon slice, they spread bacteria from their hands to the lemons.

Making matters worse, the lemons are sometimes open to the air and may or may not be kept cold. In our study we found that when lemons were inoculated with E. coli they increased in population over five times when held at room temperature from four to 24 hours. So a day of people reaching into the bowl for lemon slices might result in a microorganism party.

Don’t count on alcohol to be antiseptic

Some people may wonder: Doesn’t alcohol take care of any contamination problems?

Not really. In another study, pathogens frozen in ice then allowed to melt were not killed even in 80-86 proof mixtures of Scotch and soda or tequila. In most beverages, many of the pathogenic bacteria in the ice survived long enough to get into the drink once the ice melted.

So alcoholic and acidic drinks are not guaranteed protection from bacteria that may get into your drink from ice or other garnishes.

As with most food safety issues, common sense and good sanitary practices win the day. The chance of getting sick from your drink is slim, but it does happen. Since food service workers are the primary source for contamination from norovirus, hepatitis A and certain other bacterial pathogens, it is good to be aware of restaurant sanitation ratings as well as how your food is handled.

Thus, watch who is putting what into your drink. There might be something riding on that lemon you don’t want.

Paul Dawson, Professor of Food Science, Clemson University and Wesam Al-Jeddawi, Ph.D. Student in Food Technology, Graduate Teaching Assistant, Graduate Research Assistant and Product Testing Laboratory Analyst, Clemson University

 

Not in our name

(Credit: Getty/Spencer Platt/Michael Reaves)

Few people grow up with more exposure to and respect for the American flag than military brats — the children of people serving in the Army, Navy, Air Force, Marines and Coast Guard. Growing up in the Army, I remember hearing the distinctive BOOM of the cannon as the flag was raised at reveille and lowered at retreat in the evening, accompanied by a bugler playing “To the Colors.” Everyone on the post was expected to cease whatever they were doing upon hearing the cannon and bugle call. Little league games came to a halt. People stopped jogging, or working in the garden. People walking from the commissary to their cars carrying bags of groceries stopped. If they were close enough to hear the cannon, people driving their cars stopped and got out. We stood facing the flag — we all knew what direction to turn to face the flag on the post — and placed our hands over our hearts. Officers and noncoms and enlisted soldiers saluted. Civilians were not expected to join in this military tradition, but many did.

Stopping at reveille and retreat was expected of you, but it wasn’t required. I don’t recall ever seeing anyone corrected by the MP’s for failing to stop and face the flag at retreat. Facing the flag with your hand over your heart wasn’t done because of a law. It was done out of respect. And if the United States military could treat respect for the flag that way on Army posts like Fort Leavenworth in Kansas, or Air Force bases like Bergstrom Airbase in Texas, or at Naval installations like Norfolk Naval Station in Virginia, or at Marine bases like Camp Pendleton in California, then it should sure as hell be good enough for the National Football League at its zillion dollar stadiums around the country, and good enough for our so-called commander in chief — who managed to corral five draft deferments and wrangled a 4-F judgement for “bone spurs” on his heels — when he showed his respect for the flag by avoiding service during the war in Vietnam.

Respect can’t be required. By its nature, it has to be earned. You don’t stand up with your hand over your heart to show respect for the American flag because it’s a piece of red, white and blue cloth. You show respect for what the flag stands for. It stands for us. It stands for the United States of America. The flag stands for what is done in our name. When you lose respect for what’s done in our name, you ought to be able to show that disrespect by refusing to stand. By refusing to place your hand over your heart. By refusing, in effect, to salute the symbol of what we stand for because you don’t stand for it anymore.

That’s exactly what Colin Kaepernick did back in 2016 the first time he didn’t stand for the showing of the colors and playing of the National Anthem before an NFL football game. He told a reporter, Steve Wyche, that he couldn’t stand and salute a flag that stood for a country where police brutality against young African American men was tolerated, if not condoned. He did this not long after the killings of Alton Sterling in Louisiana and Philando Castile in Minnesota. Coming on the heels of the police killings of Sandra Bland and Freddie Gray in 2015, and the killings of 12-year-old Tamir Rice, Michael Brown and Eric Garner in 2014, Kaepernick’s very public protest could hardly have been surprising. There had been street protests around the country against every single police killing. I guess what made Kaepernick’s different was that the protests hadn’t interrupted people’s Sunday afternoon Buffalo chicken wing gobbling over at the local sports bar, or Barcalounger beer-swilling down in the man cave.

A few months after Kaepernick took a knee during the National Anthem, a study published by the Journal of American Health showed that black men were three times more likely to be killed “by legal intervention” than white men. Latino men were nearly twice as likely to be killed in the same circumstance. So Kaepernick wasn’t protesting a few cop killings of black men. He wasn’t protesting a trend. He was protesting an extraordinary, disgusting fact about this country. According to data collected by the Washington Post and The Guardian and analyzed by the Huffington Post, 223 black Americans were killed by police in the year after Kaepernick first began his protest. The number could be higher, because the race of the victim in police shootings has not been confirmed in 160 more killings, according to the Post.

What’s easy to forget, or to ignore altogether, is that every one of these killings was done in our name. And not only in our name, but under our flag. It’s common for police departments to make wearing an American flag part of the police uniform, usually as a shoulder patch. Every soldier, sailor and airman I came across in Iraq and Afghanistan was wearing an American flag shoulder patch. So a lot of killing that we might not approve of is being done in our name and under our flag. Kaepernick just chose to point that out by refusing to stand for the flag during the playing of the national anthem during football games last year.

His protest has been joined by a whole lot of other NFL players this year. That fact caught the attention of the president of the United States, who decided to take the time out of his busy schedule this week to make his displeasure apparent. A week after Hurricane Maria slammed into Puerto Rico, leveling houses, flooding whole towns, flattening thousands of acres of crops, and knocking out power to the entire island’s population of 3.4 million, and two weeks after Hurricane Irma caused similar if not worse damage to the U.S. Virgin Islands, inflicted extraordinary flooding and wind damage on Florida and left 75 dead, and three weeks after Hurricane Harvey dumped torrential rains flooding southern Texas and Louisiana leaving hundreds of thousands homeless and without power, our president unleashed no less than 22 tweets critical of protests by NFL players and coaches over the weekend. He devoted exactly five tweets to the plight of Puerto Rico, three of which were snarkily dismissive of the island’s infrastructure and limping economy.

His base may be gobbling up the red meat he’s dishing out with his obviously racist tweets against NFL players, but the rest of the country isn’t. A recent Washington Post/ABC News poll showed that 66 percent of the country believes that Trump has done more to divide the country than unite it, which is just the way he wants it. Trump seems to be making a calculated bet. By conflating the NFL protests with disrespect for the flag rather than the statement against racism and police violence against blacks, Trump appears to be stoking the fires of the culture war in an attempt to shore up his base. After languishing in the mid 30’s for months, Trump got his first bump last week with two polls putting his approval rating at 42 percent, with his disapproval around 55 percent. But he’s been up in the polls before.

One of Trump’s tweets praised NASCAR because none of its drivers took a knee during the playing of the national anthem before this week’s race. But NASCAR races, especially in the south, are notorious for the number of confederate flags on display by fans. It hardly bears mentioning that you don’t show respect for the American flag by flying the flag symbolizing the side which started a war to defend slavery. You don’t show respect for the American flag by issuing childish threats and risking a nuclear war with North Korea that might kill a whole bunch of soldiers, sailors and airmen who will fight such a war under that flag. You don’t show respect for the American flag by lying over and over and over and over again about the involvement of your staff with elements of a hostile power, Russia, in your campaign for the presidency, and you sure as hell don’t show respect for our flag by being involved with Russia in the first place. You don’t show respect for the flag by attempting to pass legislation that would strip tens of millions of American citizens, including many veterans and their families, of health care. And you don’t show respect for the flag by defending white supremacists and Nazi sympathizers who marched by torchlight, waved swastikas, and ran down and killed a counter protester by saying that they included “some fine people,” at the same time you challenge NFL owners to deal with protestors this way: “get that son of a bitch off the field right now, he’s fired.” Donald Trump, however, believes he needs to do these things and say these things to feed red meat to crowds in Alabama and shore up his base.

But that’s the thing about red meat: if you leave it out too long, it spoils.

Donald Trump isn’t “crazy” — but America might be having a breakdown

(Credit: Getty/Salon)

Allen Frances doesn’t think Donald Trump is crazy. This is not comforting news.

Last winter, the former chair of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Task Force and the department of psychiatry at Duke University School of Medicine wrote a widely circulated letter to The New York Times affirming that as the man who “wrote the criteria” that define narcissistic personality disorder, Trump doesn’t seem to be suffering from it. Instead, as he suggests in his new book, 45 is just “a bad person.” Which is worse.

In his new book, “Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump,” Frances suggests that it’s America that’s the psychologically distressed party here — and offers his insights on what it takes to become “rational again.” He spoke to Salon recently about why we make bad choices and how the best results can come from the worst crises.

LISTEN:

You were working on this book even before the election; you have a lot to say about the disorder that we seem to be collectively suffering from as a nation right now. What changed for you, then, about this book and about the story after November eighth?

Everything as a society that we were doing wrong, Trump accentuated in a way unimaginably worse than I could conceived. The problems that I spotted going into the election have become exponentially worse since.

You get called upon a lot as a person who is an expert on mental disorders, and particularly narcissistic personality disorder, to comment on Trump’s state of mind. You have bucked expectations about him and about diagnosing him. Tell me why that is?

It’s a great mistake to confuse bad behavior with mental illness. Trump is one of the worst people we could possibly imagine as President, but that doesn’t mean he’s mentally ill. When we confuse the two, it’s a terrible insult to those people who really are mentally ill. They’re mostly nice well-meaning people who don’t do harm. He’s a bad person, not well-meaning, very selfish, who does lots of harm.

It also distracts us. Trump is a terrible political problem for America — in some ways the greatest threat to democracy that we’ve had since the Civil War. He is a terrible environmental threat to the whole world. Millions of people can die in the global warming that he’s encouraging. What we’re seeing with three monster hurricanes in just two weeks, this is just a signal, a warning of what the future can hold. We have billions of people living in low-lying areas that will be in harm’s way, and Trump is doing everything a human being can do to make global warming worse.

If we spend our time thinking about what’s his diagnosis, we won’t be focusing on what’s more important: How do we contain this guy? We have to have Congress, we have to have the courts, the press, and most importantly we have to have the people stand up to Trump and direct us back to national sanity.

One of the things that you say early on in the book — that is definitely not consoling to many of us reading it — is [it’s important to distinguish] someone who is mentally ill from someone who may just be a bad person, and, as you say, is not mature. What you’re really looking at is someone who has not matured and who is operating at a level of selfishness.

I think the two best ways to understand the daily drama of Donald Trump — and this daily drama, by the way, has been going on his entire life; there’s nothing new in any of this. He’s the most transparent person maybe in the history of the world. You don’t have to be a psychologist to understand Donald Trump. The two best ways of understanding him are to think spoiled child. Think, a very selfish, spoiled four-year-old in a grown man’s body. The other thing that helps [with] understanding him is think, reality show impresario. Trump isn’t playing to the good-government crowd. He’s playing to the reality show crowd. The daily dramas get him amazing TV ratings [and an] incredible number of social network followers. He’s a man who loves attention, positive or negative, and he’s received more attention than any human being, perhaps in the history of the world, for doing outlandish things. They work for him. We shouldn’t expect rational government from a man who doesn’t care much about rational government, is too ignorant to provide it and has an unstable approach to life that has his latest impulse be his governing principle.

We shouldn’t label that “mental illness.” We should realize what it is, and the solutions to this won’t be removing him from office on psychiatric grounds, as someone suggested. It’s never going to work. The solution will either be impeachment, which I think will have its own set of problems, or Congress come into the play and containing him. We should have bills passed [that get] his fingers [off] the nuclear button. It shouldn’t be that he wakes up in the middle of the night and instead of tweeting, calls the general and starts a nuclear war. We need to have Congress make clear that there is a protocol for making vital decisions, that we can’t trust to someone with the immaturity of Donald Trump.

As you say in the book, crazy doesn’t matter. That’s one of the things that you make very clear. The crazy-not-crazy is not relevant to his performance or his actions.

I’m sure you have seen this a lot, much more than I, in the people that you talk to: This administration, and particularly this person, reminds a lot of us of people that we have known in our own personal lives. He’s creating distress in a lot of us on a very individual level, as a reminder of parents, of co-workers, of bosses. What do you say to those people who say, “But wait, but he reminds me of this terrible person in my past, and it’s bringing up a lot of stuff for me and a lot of my own distress?”

I have to say that in my own personal life, which stands a lot of difficult people and many, many, many thousands of patients, I have never met anyone as disturbing as Donald Trump. I’ve never met anyone as selfish, as impulsive, as dangerous as Donald Trump. I think that most of us have experience with difficult people, but we should put him in a separate category.

I think that the best way to deal with the stress of Donald Trump is to act. Don’t get into arguments with the people who support him. Don’t sit around the TV set screaming.

Part of the motivation [for me in] writing the book, I’ve always been a political missing-in-action person. I’ve never done the right thing. I’m shamefully inactive in all the political turmoil in my life. This is not a moment to be a summer soldier. I think everyone in America, as a citizen, has the responsibility to save our country from what may be one of its most perilous moments, and to save our world from what may be a trigger point towards a global warming we won’t be able to reverse. People need to demonstrate, people need to see their Congresspeople, people need to prepare for the 2018 and 2020 elections. This is the most important moment in American history for hundreds of years. Sitting on the sidelines is not an option.

You really delved into how we got to this point in the book. That’s what a big part of this book really is. It’s about us as a nation and the onus on us, and how so much of our history has prepared us for this terrible moment that we’re experiencing right now.

You devote a whole chapter to the series of delusions that we operate under, and about our compulsion or our tendency towards optimism and how optimism can be a very dangerous thing.

Optimism has been a wonderful thing in American history. It helped us to be the greatest country in the world. It can also blind us to the reality of our situation. The population of the world has tripled in my lifetime. Every single trouble spot in the world . . . whenever you read an article about a place that’s having a civil war, a mass migration or pestilence or famine, every one of those places in the world is troubled because the population has increased three or four times in just 50 or 60 years. We’re running out of resources. We couldn’t support seven billion people on this tiny little planet if we hadn’t discovered that we have energy power within oil 200 years ago, but that oil is running out. What’s going to happen when we don’t have that source of energy that’s cheap and readily available? We’re just spoiling our environment in every conceivable way, on land, in the sea and most dramatically in the air with the carbon load that we’re placing that’s insupportable.

Only the most irresponsible of parents can see the situation clearly and not worry about their children and their grandchildren when we hand off the world to them that would be much worse than the world that we inherited. I think the point of the book started well before Trump was [elected]. We have a responsibility to the future, to be thinking not just about our current selfish concerns. We have to be conserving the earth, conserving the air we breathe, conserving the oil and water that is necessary for our current population. We have to do right not just by the present but also by the future.

Trump is a consumer and an encourager of consuming, and every single policy of everyone who he’s appointed to office is directed towards making the worst decisions for the future because of opportunistic political gain in the present. The idea of the book before Trump was, let’s wake up and be responsible people. The idea after Trump is, he should be shock treatment. He can either be the tipping point to horrors in the future or he can wake us up to the irresponsibility of our past and current behavior. The post-Trump world can either be a dark age or one of renewed enlightenment.

You were very frank that you yourself didn’t fully understand how — you were looking at this campaign a year ago and wondering, how anyone could possibly fall for this guy? How people were actually buying what this guy was selling? It took you a moment to really step out of that and see what is the experience of people and what are the fears. Because that’s the other thing that is really triggering this moment in our history. It’s fueled by delusional hope that things will not get worse, but also fear that things are really terrible.

He’s a con-man, a snake oil salesman and reality show host. He plays on people’s fears; he plays on people’s angers very successfully. People who think he’s crazy don’t realize that in many ways he’s crazy like a fox. He didn’t get there completely by accident. He’s totally incompetent as a President, but very competent in marshaling people who are upset with the way their lives were going. I think the most important message here is that the people who voted for Trump were absolutely right to feel the system was leaving them out. America used to be a worker’s paradise; it’s become a worker’s hell. The small towns in America are disappearing. Stores are boarded up. They can’t recruit doctors. They can’t keep school teachers. The country, a large part of it, is suffering greatly. The inequality in our country has become obscene.

The 20 richest people in America have more wealth than half the country. 20 people have more wealth than half the country. The message is real. The Democratic Party has been remarkably inept in connecting with its natural voters. The Republican Party has sold propaganda very successfully, and Trump is the epitome of someone who is the worst possible messenger for a reasonably important message. He’s a false prophet. Every move he’s made has betrayed the people who voted for him. I think that the hope over the next months will be that his falling popularity, from 45 percent to 35 percent, that we’ll see a gradual erosion of people who realize that he was not the man they thought he was. That the hope they rested in him [was] misplaced, a buyer’s remorse, and he will become more and more isolated in office and as a result, will be able to do less damage.

If you were looking at America as a single entity that is suffering right now and is in great emotional psychological distress, if America were a patient, would you be able to say, “Yes, there is a course to healing. There is a course to restore balance and some sort of mental equilibrium?”

The best results I’ve gotten in my life have been in the emergency room, seeing people often for very brief periods of time in the worst crisis in their lives. Years later they would come up and say, “Doc, you remember what you said to me? That changed my life.” I’ve treated people for 14 years and had no impact. I’ve seen people for five minutes at a special time in their life where they could hear a message that previously they couldn’t hear, maybe they couldn’t hear the week later. I think our country is in distress. The cover of my book has an upside down American flag, a universal signal of lethal distress. Our country is in distress. My hope is that this will end the pattern of delusional denial that for these last 30 or 40 years has led us away from our responsibilities to the future, away from our responsibilities to the rest of the world.

The book also focuses on why we make bad decisions. We have wired into our brains the capacity to make the dumbest decisions. We’re very smart creatures. We can make remarkably dumb decisions and display remarkably selfish behaviors.

If we can extend the altruism that’s in-built in the human constitution but usually focuses only on the family and the tribe, if we can realize that the world is now one tribe with the human species at risk and we do not gain by following “America first” policies that makes some other culture lose. It’s a game where if they lose we will ultimately lose as well.

If we can become rational again, if we can become generous to people and the rest of the world and to our children, I think there’s reasonable hope that this could be a turning point much for the better. I would much prefer to have Trump as the grotesque representation of radical right policies that control Washington than I would like to have Pence or Ryan. Impeachment in the short run has appeal because it takes his finger off the nuclear button. But in the long run, Trump is a grotesque representation of very, very dangerous policies, and the people who would replace him would be much more plausible in pursuing a course that would, in the long run, be terrible for America.

That we can, as humans, be more easily deceived, is what you’re saying, by someone who seems so overtly dangerous, that has the appearance of something more catastrophically dangerous. In some ways that garb can actually make us a little bit safer.

Yeah, I think that wolves in sheep clothing are more dangerous than wolves in wolves clothing. Trump may just be the kind of shock treatment America needs.

I hope you are right, and I want to thank you so much for talking to me today doctor. The book is extremely sobering, but like I said, ultimately very hopeful. As a parent, I share your deep concerns and also your deep hope and this call to action that we are all called to. I really appreciate that you have taken the conversation in a direction of not laying blame or not looking for explanations, but really looking for solutions. That’s what I think this book is really calling us to do, so thank you for that.

Thank you. It’s actually wonderful talking to you.