Monday, December 3, 2018

sublime skate

This video is sublime. 

Part of what makes it sublime is that Bianca Chase, the videographer, must be as good a skater as the people she's shooting, given how the camera moves. Another part is these two gorgeous pieces of slow move-your-hips music that I can't even find on Spotify because I am not cool enough except just to watch this video again and again. And... I don't know. Just, look at it yourself. 

Check for a handful of other videos of this (mostly) black rollerskating scene in different parts of the country; and she has some gorgeous photography on her website 

And yes because I am an old white man I found this by starting here and then wondering about here and then somehow the magic of the internet brought me here.

Sunday, October 28, 2018


In my first years as an attending physician, I would sit in a workroom and listen to residents tell me about the patients they saw. And sometimes it was clear that the resident found a patient especially emotionally challenging. And as we got up to go back and see the patient together, I would tell the resident: “OK, let’s go bring the love.”

The way I said it back then had the wry, tossed-off feel of the language of doctors-in-training and doctors-just-done-with-training. In that time of our lives, many of us say things that we mean deeply, in a tone that suggests nothing is all that important. When you’re just starting out, you’ve either got to act like the weight is less than it is, or sink under it.

Later we get used to the idea that everything is important. We accommodate ourselves to the weight of the work. We just say it. And the learners tagging along with me these days can do with that phrase what they will: we’re going to bring the love. Without irony or apology.

Since then, some increasingly serious and earnest version of “bringing the love” has become ever more central to how I think about my practice. And yet I struggle with how to talk about love, and how to express and use it in my work.

For many clinicians, technical prowess is nearly sufficient, and the simple consistency of good customer service makes up the rest of the balance. In fields of medicine that allow for this, clinicians may be more efficient, less exhausted, and at least as useful for their patients, if they lack spiritual aspirations or leave them mainly for family and community. One need not speak of love if you can just show up to work and do the job.

And yet in at least some areas of practice, sufficiency of technique and service seem somehow still not sufficient. People drawn to these areas of practice are often clinicians who seem to feel some kind of calling, some aspiration emerging from a sense of purpose not focused on competencies but on connection.

Such clinicians have the potential to be terrible for their patients. Connection without competency, in the clinical setting, is a pernicious scam.

But let us presume, for the moment, technical competence. What is the rest?

Some portion of the remainder resides in the territory of spiritual love. It has something to do with what bibles of the 16th and 17th century translated as “lovingkindness”, a translation also used for overlapping Hindu and Buddhist concepts. All of them add up to some broad feeling of unconditional compassion.

And yet it is also more specific than that: I search for it deliberately and intensely for my patients in a way that I do not for other people; and in a way that other people do not for my patients. If there is a broad spiritual element of this feeling of love, it is also true that there is some special type of effort required to create this particular love, specific to a professional relationship with a particular person. I seek this kind of love with my patients, and my patients only.

Let us assume I can remove any hint of sexual desire or agenda from the relationship; failing to do so is a betrayal. And not incidentally, since I take care of a patient population with a horrifyingly high prevalence of past and current sexual coercion and violence in their histories, to express a professional love is both dangerous-feeling and also deeply important.

So, it should go without saying, but is nonetheless worth restating: there can be no mixing of types of love. Love, if it is part of why and how I do my work, must be completely compatible with my professional role. Meaning, it is what I should bring to the work regardless of who you are; it is ideally what you get by hiring me for the job of being your doctor. And if the best waiters and bartenders and school bus drivers can bring the love in their daily work, so should I be able to follow their examples.

Still, how do I dare speak of love? Even without sex mixed in, love can feel dangerous and unpredictable. This is because love is mostly perceived as an individual relationship; and indeed, if love claims to be unconditional, it almost never is. There are rules of engagement. You have to follow the rules, or the most important ones anyway, to get the love. 

Even when love is steady, it is difficult for either the giver or receiver of love to distinguish between some hard-to-reach, hard-to-define ideal of enlightened spiritual love on the one hand, and an easily-perceived warm individual relationship. If it’s about two people—and not about a doctor trying to bring love to all of her or his work—then it also has some degree of conditionality, and thus a greater possibility of pain, sewn into it.

Even when love is not painful, it is a drug that some people grab at for longer than is good for them. In this way, a gift of love can expose a bottomless need in its receiver.

And love can be a trick: unkept promises of love, and convincing illusions of love, are insidious tools of manipulation and power. Love appears in advertising slogans for everything from all-wheel-drive station wagons to Latin American despots. It is easily grabbed at and waved about by those whose true motives are not love. 

Even leaving aside pain and need and deception, the very idea of love is inevitably vague and imprecise. At best, to speak of love in any of its forms is to risk sentimentality and treacly irrelevance.

In the clinical setting, to talk seriously of love, to organize oneself around love as an idea, is probably an act of hubris. If as a clinician, I say that I want to bring love to my work, how do I explain the accumulated hours of my day in which I was distracted, overwhelmed, barely present, irritated, frustrated? If I fail at love more than I succeed, how much can I pat myself on the back for "bringing the love" when I manage it?

And let me set aside one other form of love. Some of my patients are so deeply soaked in shame, in a feeling of worthlessness. that I feel the need to somehow convince them that they are worthy. If I were a more religious person, I could simply tell them that they are God's children, or that Jesus loves them. I know that even though I was not raised in the church, and am not a church person now, some of how I think about love in my clinical work comes from Christian tradition. But this gesture, even if I were qualified to make it, would risk making the medical visit the tool of evangelism, instead of at the service of the patient. It is not love if I give away buprenorphine to sell Bibles.

But for all this, I find that when I can find my compassion and loving kindness, my sense of love for my fellow human, it does actually influence the relationship and makes me a more powerful and trustworthy clinician. I remember one conversation recently where the person I was talking to was becoming more and more frustrated, focused on achieving a goal he'd come to get me to help him with that I wasn't going to help him with, and I found myself getting into that defensive mode, starting to get ready to push back.

And then I consciously remembered: bring the love.

And I quietly, not so he would notice, took some slow breaths and I looked at him and tried to summon up love for him. And over the next few minutes, the conversation turned. I brought something else to it, something more believable; he visibly calmed and began trusting me just that little bit more; and we ended up talking in a collaborative and more honest way. A close replica of love can certainly serve as a successful clinical tactic. But it is not love if it is just a tactic. For a clinician who can operate this way, one might hope it could become a way of life, a force of spirit and power of intention that moves past the electronic medical record, peels away the billing codes, gets to what's important.

Many clinicians find and work with love in clinical practice from time to time, golden times, complicated times, It is important to many of us. And it is especially important with those who society has pushed aside, the people who stand alone, who have beaten and exploited and abused, who doubt their worth. The people who need the love.

Yet, as I think about all of its problems and caveats, love as a part of clinical practice remains difficult to achieve, and it is undoubtedly full of treachery and problems.

In other words, when love becomes a professional aspiration, I think it should inspire suspicion and skepticism. 

And yet, I still can’t shake the feeling that, on a good day, it’s what I come to work to do.

(...probably to be continued.)

* * *

In a different context, Robin S asserted, 
"Words are so easy to say; you've got to show me love."
Massive early 90s gay club hit. Still a groove to be reckoned with, in my medical opinion.

Tuesday, August 14, 2018

Cat Power: Review of Some Key Points

Cat Power/Chan Marshall: 
  • is releasing her new album on October 5th, the same day that she is playing Boston
  • is probably a pretty complicated person of the kind that Hilton Als and I both tend to adore, perhaps sometimes in an exasperated sort of way
  • might turn her back to the audience when playing sometimes but also knows that sort of thing is absurd
  • and through it all represents some kind of navigation marker for my inner life
  • because she is a genius who writes songs that get under my skin


Saturday, June 16, 2018

sex work, trafficking, and... and... I just hope you can stay alive out there, ok?

A woman in charge of a program for victims of human trafficking came to my clinic for a grand rounds talk recently. She discussed the nature and current definition of human trafficking, and she expressed skepticism about the notion of “sex work”, suggesting that all such work is inherently exploitive. 

In the lives of my disenfranchised patients, desperate in the midst of the demands of extreme poverty and addiction, “trafficking” is a framework that often fits better than “sex work”. I don’t see trades of sex for money working consistently well for the people on the sex side of the exchange. My clinic doesn't see a lot of creative writing majors getting some side money with genteel hotel gigs. And some of my patients have been involved in trafficking situations that are truly horrific, the unique contours of which are, frankly, worthy of more legislative and law enforcement attention than they get.

On the other hand, there are some exceptions. An easy example might be when strippers have organized into unions recognized by law as collective bargaining units. That’s “sex work” by any measure. (And the progenitor of “always look for the union label” jokes by sex worker advocates.) And there are independent sex workers who don't owe their earnings to anyone else but themselves: are they victims?

It’s sometimes tempting to think that sex workers who don’t use a "trafficking" frame are just fooling themselves—allowing their rhetoric to conceal the systems of exploitation (direct and indirect) around them; or, even more commonly in this debate perhaps, using empowerment rhetoric as a way of justifying their involvement in an economy that is inherently disempowering. It’s hard to argue against the idea that the economy of sex work is mostly built on attitudes that are inherently exploitive. 

But I liked this article from The New Yorker, following some sex worker advocates at a protest recently. People using the “sex work” frame are angry that people using the “trafficking” frame have shut off one way that sex workers could regulate and control their economic lives and their physical safety, with laws that are aimed at internet trafficking.

I’d consider myself a feminist or at least an aspiring feminist, but I’m no feminist theorist. In this space, the tangles of political philosophy and difficult choices about regulation, safety, and societal values are deep and difficult. But being
from San Francisco—where union strippers and others schooled me in a “sex work” frameI can at least stay in the space of, its complicated. And I hope we can let the experiences of the people with whom we work—whether they are sex workers, victims of trafficking, or both—guide how we think about the economics of sex. 

I know of cases where the internet has been used as a tool of brutality. But I also have heard people's stories of getting into cars or trucks and finding themselves in mortal danger, where my inner reaction has been, maybe a web site might be a better way to do this? Some of the stories I’ve heard from street work have made me want to start internet skills classes for people who are "doing sex work" or "being trafficked", or both. Which is why I worry about whether a law to go after traffickers might instead be endangering the people whose bodies are actually on the line.

I missed the SOSTA/FESTA debate until it was too late to make a difference. With a 97-2 vote in the Senate, clearly a lot of people missed it. Most of the people arguing against this approach were people who cared about the rights of tech companies and internet sites, not sex workers. But now we're left with the world we're left with, which, websites or no websites, continues to be violent against women. Websites or not, the system continues to be stacked more heavily against people who do sex work, or are trafficked, or both, than it is against the people whose money creates markets for sex.

At least some of the people who are operating in a feminist philosophical framework but describing sex work as "trafficking" have a utopian end goal: the end of exploitation and of exploitive sexual and economic relationships. On larger goals like that, I am a pessimist. On small goals--like the idea that by slightly modifying elements of a terrible world, we can make it slightly less horrific--I am an optimist. I find that this inclination, more than any greater philosophical framework, gives me a particular sympathy for the "sex work" frame. 

And at the same time, where I actually work and live, my patients who find themselves in the sex economy (primarily because of their relationship to the drug economy) are, in fact, much more "trafficked" than employed. In my small corner of the world, I don't presently know any "sex workers", and I do know a number of "victims of trafficking." A change in jargon alone won't transform that brutal reality. 

Still... maybe a web skills class?

Thursday, June 7, 2018

mu receptor mixtape: music for the weight room of the residential treatment facility

K.D. LANG constant craving

LAURA MVULA overcome


SOLANGE cranes in the sky


RUDIMENTAL not giving in



IBEYI river

LIZZO truth hurts

MISSY ELLIOTT i'm better

STORMZY blinded by your grace


bonus track, off theme:
IBEYI me voy

Sunday, April 8, 2018

Where love lives

At its best,
house music aspires to become the pop music of the beloved community
--an insistently multicultural and welcoming space.

After Chicago-born house music and its Detroit cousin, techno, had migrated to Europe, they merged into "electronic dance music" (EDM). Along the way house and techno were being shipped back to the United States for consumption by white kids. Big raves and festivals full of kids high on Ecstasy (MDMA) kept some of the utopian aspirations of original house music, but in the service of high-priced tickets sold in white areas of the country.

From living in the Bay Area in the late 80s and early 90s, I remember both strains of this movement: the more-straight-than-not "rave" scene that eventually morphed into Burning Man and EDM festivals and dot-com money; and the gay clubs, spreading the original house music faith that had grown and flourished in the gay world without having to migrate to Europe and back.

But in San Francisco's gay world, during the time I was there, the sweet house music eventually morphed into something else as users' experience of MDMA was wearing off and some started migrating to crystal meth. The music became less hopeful.

Both the "rave" world and the house music of gay clubs kept an optimistic "love the world" vibe for a while, but utopian music doesn't translate to utopian economics. What I always heard, back in the days that I knew people who knew such things, was that if the club promoters weren't dealing drugs directly, they were taking a percentage from the dealers. Since there would be dealing in the club, some promoters reasoned, they might as well reduce conflict and unpredictability by granting a monopoly to a particular vendor, and getting some of the money back. Everyone wins, right? And whether in the gay world or the straight world, house music was never a liquor-heavy scene. So you either had to make money from high admission fees, or some other way.

MDMA lost its luster for people after repeated uses; and crystal was there as the next step. That's the economics of neurotransmitters. MDMA just wore off eventually, meaning that people developed a tolerance and couldn't keep getting pleasure from it. Most drugs do that. But a drug like crystal (aka methamphetamine) keeps some people going back to it, hungry for it. It starts owning people. And that means they keep paying, and paying, and paying. Financially, a club that's all about MDMA-fueled happy vibes isn't going to survive when the scene, and the money, has moved on. If the drug economy has moved on and you're getting a cut from the revenue, your DJs better follow suit.

I think about all of this when I listen to house classics like "Good Life" or "Where Love Lives", music that is so sweet, made for a dance floor that is happy and embracing. There were promoters, and drug dealers; like everywhere else, there was money changing hands. Every flowering utopia carries within it the seeds of its own harsh replacement.

But before that happened, there were people on a dance floor, happy. And you can't take that away from the music, or the DJs, or the people who were there.

*  *  *

One of the things I adore about The Black Madonna is that her tatooed-librarian exterior extends to a nearly scholarly sensibility about house music and dance music generally. Check her Spotify playlist, "History of the World", for instance.

And listen to this late-eighties/early-nineties pair of house music classics; in my own personal history, this is what the clubs in San Francisco sounded like before meth hit. Before the darkness came.

Saturday, April 7, 2018

Sunday, March 18, 2018

Thursday, March 15, 2018

While Hilton Als has Culture, you're just reading stuff on the internet

Hilton Als might be my favorite critic. 

I love not that he loves Tiffany Haddish (who the f*** doesn't? what are you, some kind of freakin Nazi? do you hate America? Tiffany Haddish, everyone!) but the way he loves Tiffany Haddish, the way he breaks down what makes her work.

And I love that he loves women like Rickie Lee Jones and the point at which he decides he likes her is this album called Ghostyhead

This was when Rickie Lee Jones decided to use hip-hop beats and tour with a DJ. The only time I saw Rickie Lee Jones in concert was when she was on the Ghostyhead tour, and most of her fans seemed like they were like, uh... huh? And my reaction was: holy crap! Rickie Lee Jones! 

I mean, I'd associated some of her songs with the coffee shop and then the used bookstore where I used to work, when growing up in the same neighborhood where Lady Bird works at her coffee shop in Sacramento. And she was always a wierdo--great used bookstore music, really--but on Ghostyhead she turned into a completely differently wierd and awesome experimenter. And Hilton Als, you look this up on the Internet and he says, 
Sacrifice is a somewhat antiquated notion as it applies to the contemporary artist, but I use it defiantly in regard to Ms. Jones; she could not have recorded this album without having given something up and survived it, with wit.
Hilton Als is a man who believes deeply in Culture; he believes in people who take art seriously, and take making art seriously. As a critic should. I've stopped having that faith apparently, because when was the last time I actually finished a fiction book, but, I love Hilton Als for keeping the faith.

Ladies and Gentlemen, Tiffany Haddish, and Culture:

Tuesday, March 13, 2018

Naloxone paper response

I'm posting a response to Doleac and Mukherjee's paper on the moral hazard of naloxone. I think the paper is wrong, but I tried to be smarter about it on my second look at it than on my first. (Which inspired irrationally inflamed tweets; now I'm sticking to rational inflammation.)

Here are the links to the files:

Main response: a lengthy discussion of the paper.

Appendix: a brief discussion of the idea of "moral hazard" and why, even though it's a jargon term and not a description of a person, it still bugs me in this context.

* * *

And because it would not be a Mu Receptor Mixtape post without a musical addition, I attach: