Plagues and empires

Plagues and empires | Aeon

What can the decline of the Roman Empire and the end of European feudalism tell us about COVID-19 and the future of the West?The Peasants’ Revolt of 1381. The miniature illustrates, right, rebels entering London in 1381; left, the slaying of Sir Robert Salle by rebels at Norwich; and, centre background, the killing of Wat Tyler, the peasants’ leader, before the king at Smithfield. From Recueil des chroniques et anchiennes istories de la Grant Bretaigne by Jean de Wavrin. Courtesy Bibliothèque Nationale de France, MS français 78, f. 96rJohn Rapley

is a political economist at the University of Cambridge, as well as a senior fellow at the Johannesburg Institute for Advanced Study. His latest book is Twilight of the Money Gods: Economics as a Religion and How it all Went Wrong (2017). He lives in London and Johannesburg.

Brought to you by Curio, an Aeon partner

Edited by Sam Haselby

13 July 2021 (aeon.co)

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Early in 2020, after a mysterious coronavirus emerged out of China and then raced across the globe, a quiet new year took a screeching turn. Stark images of ventilated patients in Italian hospital hallways soon filled our newsfeeds. Panic erupted across the West. One after another, governments that had been telling their citizens everything was fine suddenly screamed at everyone to shelter in place and avoid all human contact. It felt like the modern world had just met its Black Death.

With no living memory of such scenes, Western audiences reached for the timeless literature of apocalypse to make sense of it all. But whereas ancient traditions of end times blamed spiritual causes for the collapse of civilisations, we, being the moderns that we are, opted for what we imagined to be a ‘scientific’ discourse – the so-called genre of collapsology. Although some modern scholars, such as Edward Gibbon, Oswald Spengler and Arnold Toynbee, retained essentially spiritual explanations for civilisation decline, while embedding them in empirical ground, those who would shape our interpretation of COVID-19 came from a different tradition, one that took inspiration from Thomas Malthus’s 1798 thesis about the natural consequences of human development.

Neo-Malthusians credited environmental feedback loops, not moral failings, for regime collapse. In the 1960s and ’70s, works by Paul Ehrlich and Donella Meadows et al argued that the world’s population was growing so fast it would soon outstrip resource supplies, leading to (among other things) widespread food shortages. More recently, Jared Diamond wrote of the role that environmental depletion and diseases played in the fall of civilisations, and his theory that the collapse of Easter Island resulted from overexploitation of the natural environment has enjoyed particular resonance. For its part, the COVID-19 pandemic revived old theories about the role that diseases played in regime collapse, and we were reminded that plagues had laid low the Roman Empire and destroyed European feudalism.

Except, that wasn’t what happened. At least, not quite the way supposed.

The thesis that environmental stresses cause regime collapse remains a topic of great debate. We can start just with the cases mentioned above. The alarmist warnings in the 1970s about overpopulation soon gave way not to concerns about food shortages, but about the problems caused by global overproduction of food, which was driving down food prices and accelerating the urbanisation of the developing world. Regarding Diamond’s book about Easter Island, pretty much from the get-go it faced strong criticism for its questionable evidence. For similar reasons, many historians of the Roman Empire doubt that the plague played a part in its downfall. As for the Black Death, in much of Europe it didn’t end feudalism but actually reinforced it. More generally, measured by the scale of the loss in human life as a proportion of the total population in the affected areas, 19th-century epidemics of cholera, and the flu pandemic of 1918, all took a far greater toll in the Western world than COVID-19. Yet you’d be hard-pressed to find hints of regime stress in response to any of them.

Still, the scholars who make a case for the civilisational impact of epidemics might be on to something. For starters, the link between empires and disease is quite strong, with cholera, tuberculosis, syphilis, bubonic plague, smallpox and other diseases all fanning out across the trade routes of empire. Tellingly, when one contrasts the responses to the COVID-19 pandemic of, say, China and Western countries, it seems plausible that this pandemic could hasten the relative decline, if not the fall, of the West. But given that China and the West confronted the same plague, why have the outcomes differed so wildly? Fortunately, history offers some insights.

An exogenous shock must encounter a vulnerability to bring down a regime

Let’s return to the Black Death of 14th-century Europe. The thesis that the plague ended feudalism starts with the fact that Europe’s labour supply dropped suddenly and sharply. This then augmented the bargaining power of the labouring classes, altering their relations to the nobility. But as mentioned, in much of Europe, and particularly in the east, the nobility responded by then reinforcing feudal bonds. However, in other places, the legal system permitted the renegotiation of the relationship between lords and producers. For example, in England, the evolution of Common Law had created a framework that made it possible for land tenure to change from feudal to market-based relations. As a result, when the Black Death caused an agrarian crisis, English society produced new forms of tenancy, thereby accelerating the decline of feudalism. In effect, English feudalism had a vulnerability to exogenous shock that was not present in other parts of Europe.

As it happens, the thesis that an exogenous shock must encounter a vulnerability to bring down a regime happens to fit the case of the Roman Empire. Recent historiography attributes that empire’s fall not to plagues but to the Hunnish invasions. Importantly, though, the sudden incursion of the Huns didn’t itself signal the Roman Empire’s collapse. The Huns emerge into the historical record in the 4th century, but it would be another century before they toppled the empire – which is to say, the exogenous shock alone didn’t change anything. Until well into the 5th century, the Romans dealt with the Huns as they had always done with frontier invaders, using a combination of repression and negotiation to neutralise the threat. But in the mid-5th century, at around the time of the empire’s greatest economic output, its reckless expansionism multiplied the conflicts on its borders, such that it could no longer concentrate its firepower on one foe. Thus, the vulnerability did not result from Rome’s internal weakening, as the Gibbon thesis had maintained. It actually came at the point when the empire was at its peak in both economic output and, it would appear, hubris.

That an empire’s strength might actually be its weakness, creating vulnerabilities to exogenous shocks that didn’t exist in earlier stages of its history, bears consideration in light of the comparatively poor performance of Western countries in dealing with the COVID-19 pandemic. Even more importantly, it could help us chart the likely long-term geopolitical impacts of the pandemic. While far more devastating in human lives, the 1918 flu pandemic did little economic harm to Western societies. In contrast, COVID-19 plunged today’s West into an economic slump that will set back growth, in some cases by years, hastening its decline relative to China and much of the erstwhile global periphery. All told, the same exogenous shock, a very different outcome: COVID-19 seems to have found a vulnerability that did not exist in the West in 1918 – and does not exist in much of the Western world’s former periphery.

When the COVID-19 pandemic hit and countries went into lockdown, markets crashed. To keep their markets and economies afloat, Western governments began raining cash, borrowing trillions of dollars and adding an average fifth of gross domestic product to national debts. The result was dramatic. Instead of the feared New Great Depression, Western economies by and large experienced short recessions, followed by sharp rebounds. Markets, meanwhile, scaled unprecedented heights. The economic firepower of the Western world was shown to be seemingly limitless. When contrasted with the relatively modest expense incurred by governments in response to the 1918 flu pandemic, observers noted how much more Western countries could now do than before. Richer than ever, and with deep pools of capital, governments enjoyed the luxury of being able to spend heavily to protect their citizens and preserve their economies.

But if that appears to be a sign of strength, it might also reveal a weakness. Consider an analogy. I once had a conversation with an Irish colleague in which I marvelled at how, in the space of little more than a generation, Ireland had transformed from a poor country into a rich one. ‘Correction,’ he said, ‘we’re a high-income country, we’re not yet rich,’ going on to explain that it would take many more generations to actually accumulate the wealth in endowments, investment funds and the like that characterise rich countries. And the thing about wealth is that, when you have it, you have to keep spending to preserve it. Suppose, for example, that one year you earned $1 million. You could spend it, enjoying the high life, but running the risk alluded to by my colleague – that, if in the next year you lost your job or business, you’d be back down to zero. So instead, you could invest it, say, by building a house. That way you’d have capital you could live off if hard times returned. But you’d also have incurred other expenses – repair bills, utility charges, property taxes, decorating costs, and the need to buy and replace furnishings.

Empires also entail ongoing costs. The richer an empire becomes, the more it must spend to preserve that wealth. As the Roman Empire expanded into virgin lands, it built up the massive estates that enabled it to accumulate its endowment of capital, much of which survives to this day in roads, ruins and aqueducts. But those lands were virgin only to the Romans. Other people already lived there, and as they were beaten back or enslaved by the Romans, resistance to the empire inevitably grew. Rebellions were thus a constant feature of frontier life. That created the need for a standing military and the tax revenues to sustain it.

For most of the history of its empire, Rome was able to concentrate military forces on comparatively disorganised and weak opponents and, coupled with diplomatic measures such as subsidies, thereby neutralise the threats. However, as the empire grew richer, not only did it make more enemies, but those enemies had the capacity to more effectively withstand Roman assaults because they’d been increasingly exposed to Roman military and administrative technologies, and had accumulated wealth from trading across the imperial frontier (the Vindolanda tablets revealed just how much of a frontier garrison’s food was sourced from across the frontier). The very wealth of the empire was what had produced this vulnerability.

Today’s immigration bolsters Western capital, plugging the labour shortages that are emerging

The modern West shows a similar arc. At the time of the 1918 pandemic, most of the world outside Europe and its then ‘white dominions’ (Canada, Australia, New Zealand) and the former colonies of the United States were either colonies of one of the European empires, notionally independent but in an economically subservient status (China, Latin America), or struggling to resist Western assimilation (Japan, the Ottoman Empire). Nationalism was embryonic in the Asian and African colonies, but it would be the 1930s, and especially during the Second World War, before it began to significantly challenge European dominance. In terms of its share of global output, the West was still rising, its peak to come only after the war when the US used a set of institutions (NATO, the World Bank and IMF, the United Nations) to effectively unify Western countries into a confederal empire – a model not unlike that used in the late Roman Empire, in fact. The flow of capital in the world economy came from the global periphery to the West. Firms in New York, London, Paris and other Western cities banked the surpluses. Meanwhile, the population of the Western world was young and growing, meaning that the vast majority of its people were either in or about to enter the workforce. In short, the West was still ascendant, and busily accumulating its wealth.

At the turn of the millennium, the West (developed OECD countries) accounted for four-fifths of global economic output. Since then, with the erstwhile periphery of the global economy rapidly rising as the net flow of capital shifted in its favour for the first time, that share has been declining, suggesting that the highwater mark reached 20 years ago was in fact the peak of the West. Some contemporary commentators, recalling that the wealth of the peak Roman Empire attracted the barbarian invasions, warn that we face a similar fate today if we don’t act urgently. Spotting the foe among immigrants from the global periphery, Right-wing politicians who want to close the borders find support from scholars such as Niall Ferguson, who, in accounting for Islamist terrorism in Western countries, has written that immigrants today resemble the invaders of Rome in that they ‘have coveted [Europe’s] wealth without renouncing their ancestral faith … Like the Roman Empire in the early 5th century, Europe has allowed its defences to crumble.’ This, he says, ‘is exactly how civilisations fall’. It sounds reasonable but it’s not true.

Invasion was the proximate cause of one civilisation’s fall, not the underlying cause. To begin with, the argument that modern immigration amounts to an exogenous shock is feeble at best. The invasions that toppled Rome were large-scale military assaults organised by external actors. Today, aside from a very small share of illegal immigration, the influx is fragmented and managed almost entirely by the importing state. If you doubt how extensive that state’s control is, spend a day with an undocumented immigrant. More importantly, the invasions of antiquity seized capital, especially when the invaders obtained land and any loot they could find. Today’s immigration actually bolsters Western capital, plugging the labour shortages that are emerging amid ageing populations.

The more significant analogy is to the vulnerability to exogenous shock that comes from having accumulated so much wealth. The location of that vulnerability today is entirely different, though. Over the previous generation, as economic growth has slowed in Western countries, wealth has started growing faster than income. And whereas wealth once depended on income, now for much of the population income depends on wealth. This is especially true for the share of the population that is retired, which in Western societies averages around a fifth. Since a drop in wealth entails a loss of income for wealth-holders, that gives the state a very strong incentive to preserve the value of that wealth. This incentive is further strengthened by the fact that the retired share of the population tends to be the most engaged in politics (illustrating Machiavelli’s rule that today’s losers constitute a more formidable political constituency than tomorrow’s winners).

What threatens that wealth, which is held largely in real estate and pension funds, is not a foreign invasion whose purpose is to seize those assets, as happened to Rome. For all the talk of fearmongering and xenophobia, we would have to be facing something like organised raids by undocumented immigrants hacking into share-registries and appropriating the assets of pension funds for Ferguson’s analogy to be remotely apt. Nor for that matter is the threat a disease outbreak that reduces the agricultural income of land, as was the case for Europe’s medieval nobility. The coronavirus pandemic ravaged Western people and societies but, as has been much discussed, the performance of stock markets has continued to be great for owners. Nevertheless, in the response of markets to the year’s events, there might be a clue to the vulnerability of the West, one that COVID-19 helped to expose and possibly exacerbate.

Consider the difference between market crashes today and those of history. When in 1929 the stock market collapsed, the Great Depression followed. Then, after the massive government wartime spending that John Maynard Keynes himself said was the first major successful experiment with fiscal stimulus, the economy took off. But it wouldn’t be until the 1950s that the stock market returned to the levels it had reached in 1929.

In contrast, over the past 30 years or so, Western countries have used a different set of tools when addressing market crashes, be they in stocks, bonds or real estate. They have pumped monetary stimulus directly into asset markets, and have targeted fiscal stimulus less at protecting incomes than at preserving asset values by, for example, bailing out banks or providing tax breaks for property purchases. After all, governments had committed themselves to the neoliberal dogma of fiscal prudence and were, if anything, cutting spending. So, while the economy has chugged along sluggishly, asset markets have repeatedly bounced right back. Those two outcomes might not be unrelated to one another. By inflating asset values, monetary stimulus amid fiscal austerity raises fixed costs and steers investment away from productive activities, thereby inhibiting economic growth. In other words, whereas government stimulus programmes once kickstarted economic growth, today they tend to protect accumulated wealth. Western societies spend a lot of money just to stay rich.

COVID-19 did not topple the West. But it might have hobbled it in its competition with the global South

The massive fiscal and monetary response to the COVID-19 pandemic looks no different. When Western economies were forced into lockdown, their governments borrowed some $17 trillion in order to keep businesses and consumers afloat, and to shore up asset values. For now, the size of the tab doesn’t overly concern economists. Western countries have carried higher debt loads in the past and, with interest rates expected to remain ultra-low for years, the cost of servicing the debt remains very manageable. The problem, rather, is what the debt is used for.

Returning to the analogy of the million-dollar year and the house you built with it, the difference between fiscal stimulus then and fiscal stimulus now is arguably the difference between taking out a loan to add a sundeck or swimming pool to the house, and taking out a loan to repair flood damage. The first will augment the house’s value, the second merely preserves it. Last year’s massive stimulus was not designed for a new era of economic growth. It was heavily oriented towards just keeping businesses and the economy afloat. But the risk is that, by bailing out many firms that added little dynamism to the economy, Western countries will lock in a Japanification of the economy, a syndrome that first emerged after Japan’s 1989 crash, characterised by chronic anaemic economic growth. In the global periphery, debt-fuelled investment tends to increase output and productivity more than is the case in Western countries, where much borrowing is essentially geared to keeping us in the lifestyles to which we’ve grown accustomed. The odds are therefore good that the response to the pandemic will only reinforce the long-term trend, of future growth being increasingly skewed towards the periphery. COVID-19 did not topple the West. But it might have hobbled it in its competition with the rising economies of the global South, most of which were once colonies of, or subservient regimes to, Western countries.

The wealth of the Roman imperial economy lay in land. Owned by the 10th of society that comprised the nobility, its revenues were taxed to support the military, whose job it was to protect the asset from outsiders. The wealth of today’s Western economy lies in financial markets, and is owned mostly by the top 10th of society that belong to the global 1 per cent. A wider group than one might suppose, since it includes almost any homeowner with a defined benefit pension, this is effectively the modern nobility. Although it faces no threat from invasion, the cost to society of preserving it in its current state might be getting as onerous as that of the late Roman Empire.

Illness and diseaseNations and empiresGlobal history

Your partner’s infidelity needn’t be a relationship catastrophe

Your partner’s infidelity needn’t be a relationship catastrophe | Psyche

Photo by Gueorgui Pinkhassov/Magnum Photos

Dylan Seltermanis a senior lecturer in psychology at the University of Maryland. He blogs on The Resistance Hypothesis at Psychology Today.

Edited by Lucy Foulkes

13 July 2021 (psyche.co)

For the vast majority of people, infidelity is a socially and emotionally devastating betrayal. ‘Cheating’ in monogamous romantic relationships is almost universally viewed as immoral, and is a leading predictor of divorce. It’s also the subject of countless books, films and songs. From Nathaniel Hawthorne’s novel The Scarlet Letter (1850) to the Oscar-nominated film Closer (2004), infidelity is as captivating as it is upsetting.

Yet, for all its ubiquity, infidelity is tricky to define, in part because the boundaries of monogamy vary from couple to couple. It could include kissing, sex or emotional intimacy with someone who’s not your significant other. It could also include flirting or ‘sexting’ – sending sexually explicit photos or messages to someone else. The common thread is that whatever the romantic or sexual interactions, they are in violation of an exclusivity agreement within the primary relationship. Put simply, within each couple, most people know infidelity when they see it.

Infidelity is so painful, in part, because people interpret it as a threat to their relationship. That is, people believe that their partner’s cheating is a sign that something is wrong, and this leads to the emotional turmoil of rejection, jealousy and mistrust. There is scientific evidence to back this up: when people feel unsatisfied or uncommitted in their relationship, they’re more likely to cheat. Some researchers have called this the deficit model of infidelity, which can also include motivations of neglect, conflict, anger and a desire for revenge.

But is this always true? Does all infidelity stem from relationship problems? Research assessing why people have sex more generally shows that people can come up with hundreds of reasons – 237 to be exact. Common reasons involve pleasure and intimacy. But sometimes people are motivated to have sex in order to boost their own or another’s self-esteem, to impress others, to relieve stress, to get a job/promotion, because of a bet or dare, to gain more sexual experience, to explore one’s sexual orientation, or even to feel closer to God. Given the varied and complex motivations for sex, perhaps motivations for infidelity are also more diverse than they first appear?

Reasons for infidelity included being on vacation, highly stressed or drunk

With my colleagues Justin Garcia and Irene Tsapelas in 2017, we ran a study to find out. We recruited 495 young adults (average age 20) who had recently cheated on their partner, and asked them what had motivated them to do it; in a later exercise, we asked them what kinds of things they did, said and felt with their affair partners. Just over half of our participants were women, and most (88 per cent) were heterosexual and unmarried (96 per cent). Given the difficulties with providing a universal definition of infidelity, we let participants determine what counted as infidelity for themselves; nearly everyone (94 per cent) said that their indiscretion involved sexual contact. We told participants that they could give as many motivating factors as needed.

Many of the reasons they gave were based on relationship problems with their primary partners, as predicted by the deficit model. For example, participants reported a lack of love or commitment towards their partners, sexual dissatisfaction, and feelings of neglect and anger. But, as we anticipated, some reasons for infidelity were more about the individual and the context they were in. This included situational factors (such as being on vacation, highly stressed or drunk), esteem boosting (wanting to gain social status, feel more attractive or assert independence), and sexual variety (wanting more partners and experiences).

Importantly, we asked participants to rate how strongly each factor played a role, and these individual factors were often more important than the relationship-problem variables. Fewer than half of participants said they felt motivated by anger, and sexual dissatisfaction was the least cited reason by women, and second least for men. Meanwhile, more than half of all respondents said they cheated to boost their own self-esteem, and the majority of participants said they felt motivated by situational factors or a personal desire for sexual variety. (Of course, people could give multiple reasons for their infidelity at the same time, so some participants might have felt relationship and individual motivations in parallel.)

In other words, when a person cheats, it can be as much about them as an individual as it is about their partner – possibly even more about the cheating individual. This is further supported by our evidence that people who report individual/situational factors for infidelity tend to have different, less intimate affairs. They had affairs that were shorter, involved fewer public dates (eg, going out to dinner) and less intimacy (eg, saying ‘I love you’); these affairs also involved less emotional and sexual satisfaction. These people also didn’t want their infidelity to affect their primary relationship: they were more likely to keep their affairs a secret and remain with their partners in the long run.

Clearly, some people seem to cheat for reasons other than being unhappy with their relationship. Our study focused primarily on young, unmarried adults, but this finding has been supported by research with other samples. An earlier study by Shirley Glass and Thomas Wright, for example, found that 56 per cent of men and 34 per cent of women who’d had extramarital sex rated their marriage as either ‘happy’ or ‘very happy’. As we wrote in our 2020 paper, ‘not all infidelities are created equal.’

There’s room for couples to learn and grow after it happens, even if it causes a period of distress

This finding throws a wrench into the folk wisdom about infidelity. Of course, many affairs and indiscretions do happen because there are serious problems in the original relationship, and it causes so much pain that it signals an irreparable end. But in other cases, if we know that people cheat for reasons that aren’t about their relationships, then maybe infidelity doesn’t have to be the tremendous disaster we expect it to be. Any instance of cheating can be deeply painful, but maybe it isn’t worth ending a 20-year marriage or breaking up a family over, especially if the infidelity wasn’t motivated by any fundamental problem in the original relationship.

Perhaps the negative effects that result from affairs are, in part, a self-fulfilling prophecy. If people believe that all infidelity is extremely immoral, then they expect the consequences of it must be dire. But if we adjust our mindset to view cheating as a more moderate problem, there’s a lot of room for couples to learn and grow after it happens, even if it causes a temporary (and sometimes considerable) period of distress.

One way to reduce the harm caused by infidelity, and to better understand why it happens, is for couples to have more frank conversations about what monogamy means to them before any cheating happens. Research has highlighted that couples routinely miscommunicate about monogamy or exclusivity, and some couples disagree about whether they even had an agreement to be exclusive in the first place. More explicit and honest conversations about relationship boundaries might stop some behaviours being viewed as infidelity at all, thus reducing their impact. Some couples, for example, agree to ‘consensual nonmonogamy’, in which sexual and/or emotional intimacy with other people is not considered a violation of their relationship.

A more nuanced understanding of infidelity might also be important for couples in the aftermath of affairs. People often describe infidelity as traumatising, but perhaps it doesn’t have to be. Instead, couples might benefit from seeing it as a stressor – a stressful challenge to work through – rather than a catastrophe. Indeed, some therapists and relationship experts argue that, if you and your partner are open and honest about nonmonogamy, it need not be much of a stressor at all.

It might help to remember that, regardless of whether you and your partner maintain a lifelong monogamous relationship, it’s likely that both of you will have romantic or sexual fantasies about other people from time to time. When it comes to your partner, this might be upsetting to think about. But remember that those feelings might not indicate anything about the quality of your relationship. Of course, people can control what they do in response to those feelings and, in many relationships, acting on them will have negative, long-lasting consequences. But in other cases, it might be more helpful to remember that many people will periodically have desires for others and, at the same time, still love their partner deeply. And that’s a comforting thought.

When two punk bands came to a psychiatric hospital, beautiful chaos ensued

13 July 2021 (aeon.co)

Born in the New York City punk explosion of the 1970s, the music of the influential band the Cramps was built on guttural yells, dissonant electric guitar clangs and a not-insignificant amount of LSD. While the Cramps were regulars at the iconic Manhattan venue CBGB, their most famous show was held in Napa, California alongside the San Francisco-based band the Mutants – and played, for free, to an audience of psychiatric patients at the Napa State Hospital. Featuring archival footage of the Cramps’ 1978 performance captured by the San Francisco-based production company Target Video, the short documentary We Were There to Be There recalls how the unique gig came together and generated a chaotic and joyful musical moment – for band members and audience alike. From the Cramps’ performance at the film’s centre, the US directors Mike Plante and Jason Willis craft a broader exploration of San Francisco’s explosive 1970s art scene, as well as the lasting negative impact of US government efforts to defund and privatise mental healthcare over the past several decades.

Directors: Mike PlanteJason Willis

Website: Field of Vision

GYNECOLOGIST SPEAKS OUT ON IMPORTANCE OF GENDER-INCLUSIVE LANGUAGE IN HER PRACTICE

By Dr. Staci Tanouye (intheknow.com)

Dr. Staci Tanouye is an In The Know wellness contributor. Follow her on Instagram and TikTok for more.

As a gynecologist, it’s inevitable that every Instagram post I write or TikTok I create using gender-inclusive language elicits countless comments like:

“You mean ‘women,’ right?”

“Why can’t you say the word ‘woman?’”

“What do you have against women?”

“Why do you want to dehumanize women?”

“Why do you hate mothers?”

“Why are you trying to erase women?”

Let me be clear: No one is trying to erase women.

And yes, my job as a gynecologist is to provide the best care I can to all women. But, my job is also to provide the best care to all people with vulvas, vaginas, uteri, ovaries, breasts or any combination of the aforementioned. Because everyone deserves access to safe, non-judgmental healthcare. But we are far from reaching that goal.

My exam room is incredibly intimidating at baseline. Patients are expected to come in, drop trou, discuss all their most intimate concerns and then display every physical part of themselves that they have been taught to be embarrassed about. No one looks forward to going to the gynecologist!

As professionals, it is the duty of all OB-GYNs to strive to create an environment of support and comfort to decrease the incredible anxiety that our exam rooms provoke. And traditionally, we have taken that to mean: make it even more gendered, more woman-only, more pink, pretty and delicate. More exclusive.

But with exclusivity comes, well, exclusion. And with this hyper-gendered environment, we are often excluding already marginalized groups and creating a bigger healthcare divide.

There is a long history of healthcare discrimination against members of the LGBTQIA+ community. They are less likely to seek healthcare when needed due to inequities in access and fear of discrimination, which leads to poorer health outcomes.

The 2015 National Transgender Discrimination Survey of over 27,000 individuals found that 23% of transgender people did not see a doctor when they needed to due to fear of being mistreated because of their identity. And an updated study in 2019 demonstrated that 18% of all LGBTQIA+ people avoid getting health care due to fear of discrimination.

How can we improve the health of a community that fears bias and discrimination from our offices? A community that fears their identities won’t be respected by the very people who are supposed to keep them healthy?

From a systematic review by Hottes, et al in 2016, 20% of LGBTQIA+ people reported at least one suicide attempt, while various studies of transgender people report anywhere from 26 to 47% have attempted suicide at some point in their lives. Gender-diverse people also have higher rates of homelessness and are more likely to be victims of intimate partner violence.

While there are many societal interventions that can be enacted to improve the health of gender-diverse people, one of the easiest for everyone to adopt is simply using gender-inclusive terms and language that affirms a person’s identified gender. A study by Dr. Stephen Russell in 2018 shows that the use of chosen names and preferred pronouns decreases the risk of depression and suicide. In fact, studies have shown that transgender young adults who were able to use their chosen names and pronouns had a 71% reduction in depression, a 34% decrease in suicidal thoughts and a 65% decrease in suicide attempts. 

Even being able to use their chosen name in only one context was associated with a 29% reduction in suicidal thoughts.

A simple adjustment in language can make a huge difference.

Inclusive and respectful language literally saves lives. Inclusive language and inclusive action support all patients. 

And remember: Inclusion of all is exclusive of none.

Inclusivity means that you can still identify as a woman or a mother, or as a man or a father.

Inclusivity is not threatening to you, but being non-inclusive may be life-threatening to someone else.

If you found this article useful, learn about three dangerous sexual health myths making the rounds on TikTok.

(Contributed by Janet Cornwell, H.W., m.)

Sunday Meeting on July 18

SUNDAY MEETING 7/18/2021

Bohm Dialogue – Spontaneity Conversation 2.0Ben Gilberti

11:00 am Pacific/Noon Mountain/1:00 Central/2:00 Eastern

https://us02web.zoom.us/j/332275676   

These talks are presented by contribution:
Contribution — The Prosperos 

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Jonathon Winters Documentary on PBS

mari quintana Not sure what year this came out, checked IMDB, but didn’t see something that fit. do YOU know? to plug another documentary, check out Certifiably Jonathan, which is up on youtube as of now, its’s quite funny!

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Swing Time – WCPM

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(Inspired by William P. Chiles)

Nothing Left

By Red Hawk

Nothing interests me anymore.
The days crawl by like
worms after a hard rain and
I can sit here on my screened porch
from dawn until dark, doing nothing
just watching the shadows move
from one tree to the other until
everything in bathed in a pale dark,
like my empty heart.
Sports used to interest me but they have
been completely corrupted by greed
and a brutal distain for the fans.
The newspaper once held some hope for me
because of the funnies, but no more:
Calvin and his tiger were the last breath
of true madness and common idiocy
left in the waste of the simply stupid.
TV is one crushing bore after another
interspersed with deafening commercials
duller than the worst shows.
I sit here on my screened porch and
all of a sudden here she comes again.
Every day this beautiful woman with
long brown hear nearly to her gorgeous butt
comes walking. Today she has on tight shorts
and her legs are splendidly muscled, the
calves curved and bulging, the thighs
2 tapering pillars of tanned flesh so fine
I can almost feel the hairs with my lips
and then she is gone over the hill.
Where was I? Oh, yes
nothing interests me
anymore.

–Red Hawk, The Art of Dying

What does 2 Corinthians 1:20 mean?

2 Corinthians 1:20, ESV: “For all the promises of God find their Yes in him. That is why it is through him that we utter our Amen to God for his glory.”

Paul is answering the charge from some in Corinth that he selfishly changed his travel plans to visit them, saying both “yes” and “no” to his commitments at the same time. Paul’s defense is as serious as the accusation is frivolous.

First, he has insisted he was not saying “yes” and “no” at the same time, but that in Christ, the answer is always “yes.” Now he adds that all the promises of God find their “yes” in Christ. In other words, all of God’s Old Testament promises are fulfilled in Jesus. Christ is the “yes” to every one of them.

Paul, who represents Christ and does His work, seems to be saying that even his change of travel plans reflects the “yes” found in Jesus. Motivated to be as Christ to the Corinthians, Paul altered course to serve them better. He acknowledged God’s leading and responded by saying “amen” to God for His glory. Just as the Corinthians themselves affirmed Christ as God’s “yes,” Paul agreed with and affirmed God’s will for him in Christ by holding off on his return visit to Corinth.

(bibleref.com)

St. John of the Cross coming into the unknown

Juan de la Cruz

“I came into the unknown
and stayed there unknowing
rising beyond all science.

I did not know the door
but when I found the way,
unknowing where I was,
I learned enormous things,
but what I felt I cannot say,
for I remained unknowing,
rising beyond all science.

It was the perfect realm
of holiness and peace.
In deepest solitude
I found the narrow way:
a secret giving such release
that I was stunned and stammering,
rising beyond all science.

I was so far inside,
so dazed and far away
my senses were released
from feelings of my own.
My mind had found a surer way:
a knowledge of unknowing,
rising beyond all science.

And he who does arrive
collapses as in sleep,
for all he knew before
now seems a lowly thing,
and so his knowledge grows so deep
that he remains unknowing,
rising beyond all science.

The higher he ascends
the darker is the wood;
it is the shadowy cloud
that clarified the night,
and so the one who understood
remains always unknowing,
rising beyond all science.

This knowledge by unknowing
is such a soaring force
that scholars argue long
but never leave the ground.
Their knowledge always fails the source:
to understand unknowing,
rising beyond all science.

This knowledge is supreme
crossing a blazing height;
though formal reason tries
it crumbles in the dark,
but one who would control the night
by knowledge of unknowing
will rise beyond all science.

And if you wish to hear:
the highest science leads
to an ecstatic feeling
of the most holy Being;
and from his mercy comes his deed:
to let us stay unknowing,
rising beyond all science.”

― St. John of the Cross