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Op-Talk: When Struggling Families Spark Internet Rage

Written By Unknown on Selasa, 22 Juli 2014 | 13.25

Photo Credit Brenda Ann Kenneally

Brenda Ann Kenneally is a documentary photographer who works in depressed urban environments, often photographing their residents repeatedly over a period of many years. "Upstate Girls," her most recent project, began in 2003 when Ms. Kenneally met a teenager named Kayla in Troy, N.Y. Kayla was fourteen and pregnant and asked Ms. Kenneally if she wanted to photograph her child's delivery.

Ms. Kenneally said yes. She then spent the next ten years taking pictures of Kayla, her children, her lovers, and the loose network of family that connected them. "If there is any art in the images that I have been making in Troy, New York over the past ten years it is that they have heart," Ms. Kenneally wrote in a grant application to fund "Upstate Girls." "The undeniable need for this heart forces us all into a shared emotional narrative and that is the place where I want my work to live."

Last week, Slate's Jordan G. Teicher featured nine of the photographs from "Upstate Girls" in a post initially titled "Life Below the Poverty Line, Troy, N.Y." In one, a child holds out a bottle to be filled with coffee; in another, an overweight boy lies shirtless on a bare mattress, the bedside table beside him stacked with Doritos, an empty soda bottle, and a pile of white bread. Several photos show Kayla and other teenage parents holding small children – a father and his infant son are pictured in a cramped and messy bedroom, and a mother cradles the newborn she'll soon give up for adoption. Kids amuse themselves with video games and knives and pretend to smoke the cigarettes their parents crave.

Ms. Kenneally's forceful images drew a lot of attention. More than eighteen thousand people shared the Slate article on Facebook and hundreds commented on Slate's Facebook page. Another 387 commented on the original post. Tweets criticized the subjects and the photographer.

The comments were harsh. Many expressed outrage that Kayla would smoke while holding her baby. (This photograph, singled out with especially virulent criticism, has since been taken down at Ms. Kenneally's request.) Others remarked that poor people couldn't afford to waste their money on cigarettes, that the houses pictured were filthy and the occupants slovenly, and that the food visible in some shots was unhealthy. Commenters wondered how poor families had money to buy their children video games. There were accusations about welfare checks and snide remarks about contraception.

Some accused Ms. Kenneally of exploiting her subjects. "Is the photographer implying that poor people are too stupid to make intelligent choices?" asked one commenter.

Others defended Ms. Kenneally and her subjects. "Have you no sense of anything but resentment and jealousy? Troy has created/allowed a culture of deprivation to fester. Troy is a part of the USA. Have a little charity in your thinking if not in your comments," one reader wrote. Other commenters pointed to the insidious power of addiction. Some were turned off by the judgmental comments: "If your takeaway from this is the smoking, you're part of the problem. Middle class white people never cease to amaze me with their monumental ignorance," read one comment.

Slate's editor-in-chief, Julia Turner, told Op-Talk that some of the harshest backlash took the publication by surprise: "Commenters had varied responses to the piece. Some felt, as our photo blog editors did, that the photographs offered a compelling portrait of life in straitened circumstances. Others posted ad hominem comments about some of Kenneally's subjects. That was something we didn't anticipate."

Ms. Kenneally told Op-Talk that she was devastated by the response. After the Slate article's publication, she said, she was soon fielding calls from Kayla and others. She was concerned for her subjects: young, vulnerable people who were reading comments on Facebook calling them "trash." She added that social media had changed these subjects' lives: "These guys live on Facebook like they used to live on their front porch."

Ms. Kenneally has long thought about how to protect those she photographs from judgment and derision. She calls herself a "digital folk artist," a kind of "hoarder" who collects historical material and ephemera, including letters sent to and from prison, police records, birth certificates and family snapshots. She invites each of her subjects to make a scrapbook and posts videos of them narrating their own lives. To provide context, she likes to present her photographs in triptychs that contrast today's Troy with historical images of the city, once prosperous thanks to strong iron and textile industries. In the late 19th and early 20th centuries, women worked in factories and were comparatively well off. By 2009, Troy's median per capita income hovered just above twenty thousand dollars a year.

Ms. Kenneally's work points to the trauma of that socioeconomic shift and what she describes as a new culture that has sprung up in its wake. Many of her subjects have grown up while their parents have been incarcerated. Her photographs show evidence of the country's obesity epidemic. The children she has photographed often have trouble cooperating at school. Some have experienced frequent suspensions, been diagnosed with behavioral problems and treated with antipsychotics and antidepressants. Often these children, like many others in Troy, end up in juvenile detention.

In its finished form, "Upstate Girls" will provide this context. Ms. Kenneally plans to exhibit the work at the North-Central Troy Historical Society, a facility she's working to open in a foreclosed house across the street from Kayla's home. A historical timeline will run along the walls. Ms. Kenneally will also publish five books of her photographs, each printed on newsprint so it is affordable. A digital database will accompany a video documentary by Ms. Kenneally and track the use of particular words – "case worker," "parole," "A.D.H.D." – to demonstrate the prevalence of certain vocabulary in that community.

Ms. Kenneally has shared her work on the Internet before – on the Times' Lens blog, on Time's Lightbox, in the Virginia Quarterly Review and as part of a multimedia poetry project for Studio360. (She has also exhibited the work at the Sanctuary for Independent Media, located in Troy.) The online publications drew conflicted comments – one Studio360 commenter wrote, "I'm deeply ambivalent about this video/poem. I love that it allows me to look, uninhibitedly, at people whose eye contact I avoid in real life. But I'm not sure that indulging myself in condescension and curiosity is particularly helpful" – but the response was by and large more thoughtful than what followed the Slate article. Some comments on the Lens blog expressed compassion for the "bleak lives" Ms. Kenneally's subjects were born into and suggested volunteering at after-school programs. (A commenter at Time, however, referred to the subjects as "human garbage.")

The problem with the photographs posted on Slate, Ms. Kenneally argued, was that they lacked context. Worst of all, according to her, was that the Slate headline emphasized the "P word" – "poverty." "When you put a photograph of a young girl doing something and then say the reason is poverty, viewers separate themselves," Ms. Kenneally said. She added that the word "poverty" introduces a moralizing element. "The whole purpose of the project is to find a new way to talk about these social issues," she explained. Without context, Ms. Kenneally said, viewers were cut off from the culture and circumstances that define her subjects' lives.

Ms. Kenneally contacted Mr. Teicher and Ms. Turner about her misgivings. Slate added some links to more information about the work and changed the headline. It now reads, "A New Way to Talk About Poverty in Troy, N.Y." Ms. Turner told Op-Talk, "When the work is portraiture, we strive to be particularly respectful of the relationship the photographer has cultivated with his or her subjects."

Ms. Kenneally said she regretted handing over so much control to Slate: "It was a mistake. Next time I would say which photos could be used and how." She liked Mr. Teicher's text and said it was the "sound-bite culture" of the Internet that triggered the backlash. She also expressed hope that the North-Central Troy Historical Society would encourage greater reflection. Most importantly, she said, it would weave Kayla and her community into the historical record: "I want it to be like, we're here, we exist."


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Opinionator | Draft: What Writers Can Learn From ‘Good Night Moon’

Written By Unknown on Minggu, 20 Juli 2014 | 13.25

Draft is a series about the art and craft of writing.

I gave birth to twins a little more than a year ago, and at the baby showers we received many books: colorful board books, big illustrated books, collections of Sandra Boynton and nursery rhymes and Dr. Seuss, but none multiple times except this one: a board book "Goodnight Moon," a flimsy "Goodnight Moon," a large lap book "Goodnight Moon," and an anthology by the book's author, Margaret Wise Brown. Of course, I thought. It's that one that says good night a lot. I figured I'd read it before, just a story of going around the room saying good night to stuff, and I thought it was popular as a gift because it's so appropriate for bedtime and everybody wants babies to sleep.

But, when I first sat down with the babies, on the bed, nestled into pillows, beginning a sleep routine as recommended by their doctor, I pulled out the big lap book and read it aloud, and by Page 2, it was clear to me that for whatever reason, I had never read this one before. The babies listened in their sleepy baby way, and as the pages turned, I felt a growing excitement — a literary excitement. Not what I expected from this moment. But I was struck and stunned, as I have been before, by a classic sneaking up on me and, in an instant, earning yet again another fan.

It also seemed to me to be an immediately useful writing tool.

"Goodnight Moon" does two things right away: It sets up a world and then it subverts its own rules even as it follows them. It works like a sonata of sorts, but, like a good version of the form, it does not follow a wholly predictable structure. Many children's books do, particularly for this age, as kids love repetition and the books supply it. They often end as we expect, with a circling back to the start, and a fun twist. This is satisfying but it can be forgettable. Kids — people — also love depth and surprise, and "Goodnight Moon" offers both. Here's what I think it does that is so radical and illuminating for writers of all kinds, poets and fiction writers and more.

First, Brown sets up her terms. We look around the room and learn about it and "meet" all the items in question. The language is direct and clear and the rhythm is just right. The telephone, which we never revisit, is aurally perfect. "In the great green room/ There was a telephone/ And a red balloon."

After we meet the old lady whispering "hush," there is a pause built into the page turn, and the movement begins officially. The title kicks into play. We begin with "Goodnight room" and the pacing slows: the words are fewer, or at least they seem fewer. The cello, I'd say, begins. But even though we are now revisiting the items we've met, we meet new things too, right away. We hadn't greeted the moon earlier, but here it is. Not only that, but Brown allows us to hear of two moons, the real and the virtual, and not to worry about any varied rhyming scheme. When I Googled "Goodnight Moon masterpiece," I came upon a blog post by a reader who was irritated by the moon/moon repetition I had loved. Because they are such different moons! But that post was a reminder of the gentle risk Brown takes there. After the moons, we go through the whole room and our love of repetition is satisfied and we can track the little mouse and see the lights dimming in the illustrations. The page turns are beautifully paced and quite slow.

What a surprise, then, to find that there is a blank page with "Goodnight nobody" out of nowhere, sharing a spread with "Goodnight mush." What a surprise, then, that the story does not end with the old lady whispering "hush" but goes out the window into the night.

Most picture books would close with that old lady — that's the balanced choice. But we see the stars and feel the air — we've been sure we're staying in but now we're floating out. Why? And then back in for the ending of "Goodnight noises everywhere." This, the last page? At first, I looked for another page — why end here? Isn't it a little abrupt? But (after a few more readings), isn't it also the way for us to close our eyes metaphorically with the bunny and be in that state right before slipping off to sleep, that magical drifting moment after floating out with the stars and the air, when we only hear noises and next is sleep? The story has moved so close to the bunny as to become an experiential mirror of his drift and fall. How much deeper and more elegant that is than the neat symmetry we might expect.

For writers, this is all such a useful reminder. Yes, move around in a structure. But also float out of that structure. "Goodnight nobody" is an author's inspired moment that is inexplicable and moving and creates an unknown that lingers. How wonderful that this oddly compassionate moment, where even nobody gets a good night, shows up in the picture book that is the most popular! There is no template, ever. When writing, how do we allow those moments of impulse, of surprise? How do we not censor that kind of leap? (I'd argue for following tangents — for not feeling bound to the topic at hand.) And when to end a story or poem or novel or essay? It's one of the most common questions at readings: "How do you know when it's done?"

How did Brown know? On some level, it had to have been a felt ending, a note she hit that must have seemed right and took confidence and daring to pull off. The reader has time to linger with that end and accept it — it's not the obvious closing note of the music, it's not the fully resolved major chord. But she trusted it. How something ends is so much about a writer training her own instinct and her own sense of that note.

The babies are 14 months old now and I've already read the book probably a hundred times — but these unexpected choices of hers are the ones that keep my interest. I think I have a whole lot of rounds of the book to go, but I feel sure I will never crack open the meaning of "Goodnight nobody," and moments like that make rereading a genuine joy.


Aimee Bender is the author, most recently, of the novel "The Color Master."

A version of this article appears in print on 07/20/2014, on page SR9 of the NewYork edition with the headline: What Writers Can Learn From 'Goodnight Moon'.


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Opinionator | Fixes: When Poverty Makes You Sick, a Lawyer Can Be the Cure

Written By Unknown on Jumat, 18 Juli 2014 | 13.25

Fixes looks at solutions to social problems and why they work.

By early summer 2010, the temperature had already reached 100 degrees in Cincinnati. At Cincinnati Children's Hospital Medical Center, doctors were urging the families of children with asthma to use air-conditioning. One mother handed a piece of paper to her doctor: The child's room did have a window unit, and she was using it. But then the landlord responded — he apparently didn't want to pay the electric bills. Use that air-conditioner, the letter said, and you will be evicted.

Where you work, the air you breathe, the state of your housing, what you eat, your levels of stress and your vulnerability to crime, injury and discrimination all affect your health.

A concerned doctor might have tried to call the landlord to fight the notice. Or, she might have handed the letter over to a social worker. But Cincinnati Children's had something better — it had lawyers. In 2008, the hospital and the Legal Aid Society of Greater Cincinnati set up a medical-legal partnership, the Cincinnati Child Health-Law Partnership or Child HeLP.

A week later, another family came in with the same letter. And the week after that.

"Our lawyers were getting the same problem referred over and over in a short period of time," said Elaine Fink, who is the co-leader of Child HeLP. "They looked at the map ­— they were all in the same neighborhood. They looked to see who owned the buildings. In this case we hit bingo ­— the same owner."

That was the Brooklyn-based NY Group, which held 18 buildings in Cincinnati and one in Dayton. Many tenants in those buildings had ended up at Child HeLP — to get help with mold, water damage, structural perils, rodents or bug infestations.

Child HeLP wrote to NY Group, including in its letters statements by physicians about the health impacts of its legal violations. It sued on behalf of one severely disabled boy with a tracheotomy whose health depended on air-conditioning. The repairs were done in a few weeks.

But the point was not just to help individual patients — it was to improve conditions in the buildings for all tenants. At the same time, NY Group was walking away from the buildings — Fannie Mae foreclosed on all 19 by the end of July. Legal Aid helped tenants to organize and have a voice in the foreclosure process — among other things, they wanted to make sure that the buildings remain subsidized housing.

Ultimately that pressure resulted in widespread repairs, and helped persuade Fannie Mae to sell the buildings to Community Builders, a Boston-based nonprofit that develops and operates good low-income housing (which is maintaining the subsidies). Reconstruction is about to start.

Being poor can make you sick. Where you work, the air you breathe, the state of your housing, what you eat, your levels of stress and your vulnerability to crime, injury and discrimination all affect your health. These social determinants of health lie outside the reach of doctors and nurses.

In the early 1990s, Barry Zuckerman, the chief of pediatrics at Boston City Hospital (now Boston Medical Center), decided he was tired of seeing kids cycling back into the hospital again and again — asthmatic kids who never got better because of the mold in their houses, infants with breathing problems because their apartments were unheated. He'd write letters to the landlord, who ignored them, said Megan Sandel, who was an intern there at the time. Then at a cocktail party, someone listening to his complaints asked Zuckerman: What does the law say?

Zuckerman thought it was an important question. In 1993, he established the Family Advocacy Program with three lawyers to prod landlords, secure government benefits families were entitled to and fight with Medicaid, insurance companies, schools and other bureaucracies.

(Zuckerman deserves his own wing in medicine's hall of innovation — he also co-founded Reach Out and Read, which supplies books and encourages doctors to prescribe them and family reading for kids. And he is co-founder of Health Leads, a program that trains college students to connect patients to food, heat and other basics of health.)

There were few medical-legal partnerships until about five or 10 years ago, but now 231 health care institutions have them, according to the National Center for Medical-Legal Partnership. The largest is New York's LegalHealth, which works in about 20 New York hospitals and is expanding — it will soon have clinics in all 11 of the city's public hospitals.

Medical-legal partnerships are growing in part because of increasing attention to social determinants of health. Talking about inequality means talking about the vicious cycles that keep people poor; one of the most important is the intersection of poverty and health. "And sometimes a new asthma inhaler isn't going to solve the problem," said Martha Bergmark, executive director of Voices for Civil Justice, and until recently director of the Mississippi Center for Justice.

The vast majority of low-income Americans have unresolved legal problems: debt, immigration status, custody issues, child care, benefits, back pay, housing, a special education plan for a child — you name it. All of these affect stress levels, which is in itself a health issue, but many have a more direct connection to health.

Medicaid in New York State is now, in some cases, paying for supportive housing. (Medicaid has long bought housing in the form of nursing homes, of course.) This WNYC radio story describes one formerly homeless woman now in a Medicaid-paid apartment. "You could treat her epilepsy until the cows come home, but without an appropriate place to live she was going to be sick," said Bergmark.

Clinics that have medical-legal partnerships approach health differently than others. When doctors have no options for helping patients with the social determinants of health, they tend not to ask about them. With a medical-legal partnership, they do. At Cincinnati Children's, each patient's family is asked: Do you have housing problems? Problems getting your benefits? Are you depressed? Are you unsafe in your relationship? Would you like to speak to a lawyer or social worker about any of these things?

That process can start right away. "We have attorneys and paralegals on site in the primary care center five days a week," said Fink. "Many times we get a legal aid attorney to walk down the hall to talk to family while the child is waiting to get immunizations."

A legal letter can often get a response where a doctor's or social worker's letter does not. The lawyers also save doctors time. "Everyone works at the top of their profession instead of the physician figuring out why mom is going to be evicted tomorrow and what they can do about it," said Ellen Lawton, co-principal investigator at the National Center for Medical-Legal Partnership.

Related
More From Fixes

Read previous contributions to this series.

The reverse is also true: adding doctors makes legal work easier. Lawton said that lawyers' arguments carry more weight when they include a medical opinion. "The health of the kids changes the advocacy conversation," she said. "It goes from 'this is the law and you have to comply' to a conversation that's about community well-being and health. And when you're able to use the clinical viewpoint rather than a legal framework, you're able to resolve the issue much more rapidly."

Most important, a medical-legal partnership goes beyond curing an individual. Child HeLP's actions in Cincinnati's sick buildings made life better for all the families there. "Don't wait for the kids to be sick," said Sandel, who is now the medical director of the national medical-legal partnership center. "Look for the pattern and find what's making kids sick in the first place. The power of the model is moving upstream, going from person to person to population level" — legal action as preventive medicine.

Like other forms of preventive care, medical-legal clinics are a bargain. One striking example: New York City's LegalHealth wrote formal legal demand letters to help adult asthma patients get their apartments cleared of rodents, bugs, mold, water and structural damage. The apartments were fixed. Patients improved, drastically, and there was a 90 percent drop in emergency room visits and hospital admissions. This was achieved by a one-shot intervention that cost an average of $225 per case.

But while society may save money, that's not necessarily true for hospitals — and it's hospitals that make the decisions. Fee-for-service medicine rewards hospitals for more admissions and emergency room usage, not less, and doesn't reimburse hospitals for preventive services such as legal aid. Nor can legal aid lawyers rely on funding from the federal Legal Services Corporation, which never recovered from the Reagan administration's cuts.

Increasingly, though, hospitals are establishing and paying for medical-legal partnerships, despite the lack of reimbursement. (New York City's Health and Hospitals Corporation is paying for part of the expansion of LegalHealth, with other major funding from the Robin Hood Foundation, an anti-poverty group.) One reason is the growing move toward value-based reimbursement instead of fee-for-service — for example, Medicare now rewards hospitals for having low rates of readmission and good scores on safety measures. Nonmedical staff members such as social workers — and lawyers — are becoming a better investment.

Kerry J. Rodabaugh, a gynecologic oncologist at the University of Nebraska Medical Center, started a medical-legal partnership at an earlier job at the Roswell Cancer Center in Buffalo. She studied how often lawyers were able to get patients into insurance or benefit programs, which allows hospitals to be reimbursed for their care. She wrote a paper on the partnership's work and the savings.

At Nebraska, Rodabaugh established a medical-legal partnership in her department.

"In order to get funding for my program I've had to prove a financial benefit," she said. "I've been able to document at my current program a 700 percent return on investment since 2009. When I'm talking to administrators they get very excited." Now U.N.M.C. is expanding these clinics to every department and to its primary care clinics in places with significant poverty.

"So much of child health is the result of poor social and physical living conditions for kids — food on the table, shelter, quality education," said Robert S. Kahn, a pediatrician at Cincinnati Children's who is the medical co-leader of Child HeLP. "So much of what we do in pediatrics is driven by these broader well-being issues for the family. We do much better when we partner with groups that have that as a mission."

Join Fixes on Facebook and follow updates on twitter.com/nytimesfixes. To receive e-mail alerts for Fixes columns, sign up here.

Tina Rosenberg won a Pulitzer Prize for her book "The Haunted Land: Facing Europe's Ghosts After Communism." She is a former editorial writer for The Times and the author, most recently, of "Join the Club: How Peer Pressure Can Transform the World" and the World War II spy story e-book "D for Deception."


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Room for Debate: Holding Peacekeepers Responsible

A Dutch court took the unusual step of holding its government responsible for the deaths of hundreds of Bosnians whom Dutch soldiers in a United Nations peacekeeping force let Bosnian Serbs slaughter.

But does holding peacekeeping troops responsible for the murder of citizens in their care set an appropriately tough standard of conduct, or undermine the likelihood that nations would participate in such missions?

Read the Discussion »
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Opinionator | Private Lives: The Mystery in the Machine

Written By Unknown on Kamis, 17 Juli 2014 | 13.25

Private Lives: Personal essays on the news of the world and the news of our lives.

LOS ANGELES — During the six years I begged my husband to get me pregnant, I kept certain images locked away in a mental hope chest. The first was the moment of conception — one of those lazy Sunday afternoons, post-brunch and newspaper, pre-dinner and a compelling HBO lineup, the two of us resting atop rumpled sheets.

In another snapshot, we're in a delivery room, the kind with soft lighting and birth plans. My parents and brothers and sisters-in-law are out in the hallway and my husband is at my side, his hair tucked inside a blue surgical cap, about to meet our child.

But it was the moment between those two that I held dearest.

Three months into the pregnancy, a sonographer rubs gel on my swollen abdomen and rolls her transducer over it. My husband and I gaze at the black screen as the grainy image of a fetus emerges, its head nearly as large as its tiny sea horse body. And then, a thumping sound, echoing like a signal picked up from deep space. My husband looks from the screen to me, and I can see in his eyes that he finally understands what I have instinctively known for years — that all of our ambitions, world travels and spiritual practices never brought us this close to the mystery.

My longing for a baby didn't kick in until my husband and I married when I was 36. My faith in him combined with the stability of marriage helped me overcome my twin fears of motherhood — suffocation and failure. I knew he'd never much wanted kids, but I stubbornly kept hoping he'd come around, like so many other men I'd heard and read of who started out ambivalent and ended up utterly in love with their children.

He didn't come around. Instead of a sonogram there was a vasectomy, then an open marriage, and finally a divorce.

The grief of the empty womb is electric with fury, a live wire that could spark anytime. At the grocery store, at the post office, upon the first glimpse of a pregnant belly or stroller, a voice in my head roared, "Why am I being wasted?" Like an evil queen in a fable it scanned the offending woman and spat: "Her? Her and not me?" How had she convinced a man to work long hours and do without luxuries in return for the mundane, mammalian joys of wife and child?

I wanted to strangle and claw things. I'd run out to my car, roll up the windows and drive around the block screaming. That way, no one would hear and become alarmed. No one would know that my maternal instinct was neither gentle nor generous. It was fierce, irrational, entitled, and the fact that no helpless infant was coming to save me from my narcissism only magnified the rage. It took less than a minute to scream myself hoarse. Then I'd park the car, walk quietly into my postdivorce apartment and collapse in tears.

The upside of allowing yourself to grieve like a 2-year-old instead of writing in a journal or forming complex sentences with a therapist is that the grief tends to disperse more quickly. Within a year or two I was able to react to pregnant mothers and their offspring like a normal person again — with smiles and coos. I took my vestigial longing over to the local children's hospital and volunteered to play games with the sick kids. Watching the sorrow and barely disguised terror on their parents' faces softened my envy for good.

Then, last year, my heart started acting strangely. Each evening after dinner as I sat down to read or watch a movie, it would flutter fast and hard up into my throat like a hiccup, making me cough. This happened five or six times an hour until I fell asleep. My doctor said it was might be a mitral valve prolapse. She ran an EKG on which the technician noted "Borderline left atrial enlargement" and made a cardiologist appointment for me. I didn't want to Google that and try to decode what it meant. I forced myself to wait for the echocardiogram.

In the waiting room, a half-dozen septuagenarians, mostly men, some attached to portable oxygen tanks, read magazines while their wives filled out paperwork. A technician called my name and led me into a room marked "Echo," where a cushioned table stood next to the same kind of machine I'd seen in the movies.

"That looks like a sonogram machine," I said.

"It is," she said, smiling. "An echocardiogram is just a sonogram of your heart."

I climbed onto the table and lay on my left side. She affixed several electrodes to my chest, dimmed the lights, smeared a little gel onto my skin, and rolled the hand-held transducer alongside and underneath my left breast, instructing me when to inhale and when to hold my breath.

"Hold, hold, just a little longer," she urged as she zeroed in on a spot and hit a button to save the image. "Beautiful shot." That's what you want to hear when someone is photographing your heart: beautiful shot.

"You must be a swimmer," she said, eyes still on the screen. "You can hold your breath a long time."

"Yes," I said. I badly wanted to look up at the picture, but I couldn't bring myself to look that closely at my beating, bloody heart. I kept my eyes on my knees.

Then she turned the sound on.

There were clicks, lots of clicks, as if she had pried open a grandfather clock, and also a surge of liquid flowing wildly between pauses. Like water rushing over a falls in gusts.

My eyes widened. "Why is it so fast?" I asked.

"Those are your valves," she said. "They open and close several times with each heartbeat."

"And that liquid sound is the blood?"

"Yes, blood filling and leaving each ventricle."

She saw the tears gathering.

"I'm telling you," she said, putting her free hand on my arm, "I've been photographing the human heart for 20 years. It's made a believer out of me."

"It's amazing," I said. "I mean… what starts it? What keeps it beating?"

"That's the million-dollar question," she said. "But something had to create this." She snapped another image as my valves clicked open and shut like miraculous little dams.

"O.K., hon, you're all done." She turned off the volume and removed the electrodes. "You can get dressed, and your doctor will call you next week with the results."

It turned out that my heart was normal. Its reason for giving off extra beats would remain unknown to me, as would the grainy image of its chambers pulsing with a thirst both perpetual and fleeting.

But I do know one thing: I didn't need a baby to get me any closer to the mystery. We couldn't escape the mystery if we tried.


Robin Rinaldi is the author of the forthcoming memoir "The Wild Oats Project."


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Opinionator | The Stone: Discrimination Is Un-Christian, Too

Written By Unknown on Selasa, 15 Juli 2014 | 13.25

The Stone is a forum for contemporary philosophers and other thinkers on issues both timely and timeless.

Much to the chagrin of women's rights advocates, Hobby Lobby has won its legal battle — but claims of "victory" for religious freedom must be emended. Make no mistake: This is no victory for the freedom to exercise Christian principles. Though employers like Hobby Lobby are now free to deny women access to contraceptives through their employer-subsidized health plans on the basis of religious objection, they will be violating their own purported Christian principles if they do. While Christians are not compelled by their faith to engage in religious practices that impose upon the freedoms of others, they are compelled — by their belief that all persons, men and women, are created in the image of God — to oppose discrimination.

Employers are now free to deny women access to contraceptives through their employer-subsidized health plans, though they will be violating their own purported Christian principles if they do.

Some corporations that have objected to the contraceptive requirements of the Affordable Care Act, like Hobby Lobby, claim that they do not wish to discriminate against women by denying them access to contraceptives generally, and that their opposition is merely to abortion. However, their understanding of which medications act as abortifacients rests on an outdated understanding of medical science and is at odds with the facts of the matter. Use of these contraceptive methods is not tantamount to abortion, and moreover, providing women with access to safe, reliable contraceptives for free drastically reduces the actual abortion rate.

It is likely that women will ultimately retain coverage, anyhow, though religious employers are now able to legally withhold it. The Supreme Court assumed in Burwell v. Hobby Lobby that the government has a compelling interest in ensuring that women have full access to preventive care. It appears that a majority of the court believes that this interest is compelling. The issue still under real legal dispute is how that coverage will be provided.

One suggestion is that the Obama administration extend to closely held, for-profit corporations the same accommodation already in place for religiously affiliated nonprofits. If a corporation objects, on religious grounds, to covering contraceptives in its health plan, it can fill out a two-page form, with five questions (two of which are providing a signature and the date), self-certifying that it meets the requirements for religious accommodation. By submitting this form, employees will be provided contraceptive coverage directly from their insurance company rather than through their employer.

This very exemption, however, currently faces its own legal threat from some Christian religious organizations, which claim that notifying the government of their objections to contraceptive use is itself religiously objectionable, as doing so will "trigger" the provision of coverage by a third party. The University of Notre Dame and Wheaton College are among several institutions that have brought such challenges. There is very little sense to be made of claims that your freedom of religion is substantially burdened by someone else's providing services that you do not want to provide yourself. This suggests that the legal challenges are not merely aimed at allowing corporations to abstain from facilitating behavior they deem immoral but instead are seeking to effectively prevent women from engaging in that "immoral" behavior by keeping financial barriers for women, and administrative barriers for the government, in place.

This is economic coercion. Opponents to the contraceptive mandate have insisted that women remain free to purchase whatever health care services they choose, but this is woefully insensitive to the reality that low-income women and families face. For these women, there is a very large difference between what is available to them for purchase in principle and in effect. It is easy for those who do not regularly face desperate decisions due to financial insecurity or medical complexities to forget the difference. An intrauterine device, for example, can cost a low-income full-time worker more than a month's wages. For some women, this is both the safest and most effective medical option, yet hopelessly unaffordable.

This kind of economic coercion is distinctly at odds with Christian principles. There is only one incident described in the Christian scriptures where Jesus is represented as employing coercive force, and it was not used to prevent people from engaging in sin. It was used, instead, to prevent people from dishonoring God by exploiting religious practice for personal gain. The gospels describe Jesus' reaction to those who sought to profit from the Passover pilgrimage to the temple as fierce: "And making a whip of cords, he drove them all out of the temple, with the sheep and oxen. And he poured out the coins of the money-changers and overturned their tables. And he told those who sold the pigeons, 'Take these things away; do not make my Father's house a house of trade.'" This is where corporations that claim their operations constitute religious practice of the Christian faith ought to take note.

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Hobby Lobby offered coverage for some of the contraceptives it now claims its religious faith forbids it to have any association with, until shortly after the Becket Fund for Religious Freedom asked it if it would be interested in filing suit. The company continues to profit from investments in the manufacturers of the "objectionable" contraceptives through the 401(k) plan it offers its employees. Recently, Hobby Lobby has faced legal trouble for false advertising. It has built a fortune, in large part, by selling goods manufactured in China, infamous for its poor labor conditions and related human rights violations. These are the practices of a corporation that will emphasize the Christian faith of its owners when convenient and profitable, but set that faith aside when it would be costly to do otherwise.

Hobby Lobby is not the only corporation which has objected to the law through what seems to be quite selective applications of Christian principle. Offering health care coverage as called for by the Affordable Care Act is morally permissible according to the Catholic philosophical tradition, and the sincerity of institutions like the University of Notre Dame is questionable.

The more pressing question religious corporations should ask themselves is whether denying women comprehensive health care while providing it to men, and so failing to respect women's inherent dignity and equality, is consistent with their religious values. Since the Supreme Court focused on the practical effects at stake (that is, whether women would be able to obtain coverage elsewhere, and thus by a less restrictive means) rather than on the expressive function of the law, Hobby Lobby is now free to discriminate in its provision of health care. But the question remains, why would it want to?

Kathryn Pogin will enter the graduate program in philosophy at Northwestern University in the fall.


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Opinionator | The Stone: Do I Have the Right to Be?

Written By Unknown on Minggu, 06 Juli 2014 | 13.26

The Stone is a forum for contemporary philosophers and other thinkers on issues both timely and timeless.

It's a disturbing thought: All of us are alive today thanks at least partly to some mass atrocity that was committed in the past. This is because war crimes, crimes against humanity, genocide and ethnic cleansing invariably affect who is born after them. Who knows how many of us can claim, "Even if the Holocaust had not occurred, I would still have been born"? And if you can, perhaps because you were conceived before 1933 or shortly afterward without having been influenced in some way by the effects of Hitlerism, what about the Crusades or slavery in America? Anyone who reflects on the unjust death of others will be surprised at how much his or her own right to be is put in question, to the point where his or her place on this earth can appear as a usurpation. This might not be obvious at first so let's slow down a bit.

Wars and atrocities play a part in who is born after them.

Many philosophers agree that who we are is dependent, at least in part, on our origins. Consider your own identity as a case in point. You have the distinctive property of having grown from the particular fertilized egg from which you in fact grew. (I am here ignoring the various religious doctrines of ensoulment, which would suggest that your soul exists before being infused into a body.) The fertilized egg was formed by the union of two cells deriving from your biological parents, who conceived you at time X. If they had conceived a child earlier or later, it wouldn't be you. It wouldn't be you because it wouldn't be developmentally continuous with the actual fertilized egg from which you arose. This has far-reaching implications; it means that if at any time in the past an event occurred that interfered with the relation between the egg and the sperm whose fusion produced you, you would not have been born.

I think we fail to appreciate how radically contingent our lives really are. The reason appears that psychologically we have a great deal of trouble imagining ourselves not in existence. Freud says that we cannot imagine our own death because whenever we try to do so we find that we survive ourselves in the role of spectator. For the same reason, I would suggest, we have a hard time imagining not being born, which amounts to saying that every one of us believes he or she would have been born no matter what. But it should be obvious that you and I are merely, as Silenus the satyr said to Midas, "children of chance." The funniest commercial of the current FIFA World Cup ("Boom") shows a local hospital in Spain brimming with very pregnant couples and newborns. The nurses are naturally baffled, with one asking, "What was going on nine months ago?" Cut back to Spain's historic 2010 World Cup win and the joyous celebration of Spanish fans whose exuberance and fervor spill over into passionate embraces and kisses. The 30-second commercial deftly illustrates how a single event ("Because Fútbol") can literally create a baby boom.

Sometimes events prevent people from being born. Most have heard of the "grandfather paradox." The paradox comes from a 1943 science fiction story by René Barjavel called "Le Voyageur Imprudent" (The Imprudent Traveler), and describes a time traveler who goes back to the time before his grandfather had married and killed him. A result is that the time traveler was never born, so how was he able to travel through time and kill his grandfather?

The time traveler, however, does not need to kill his grandfather to wipe himself out of existence, for as we said children conceived at different times would be in fact different children. All he has to do is distract his grandfather long enough to alter the timing of the conception of his grandfather's child, and poof! He vanishes. Given that men produce about 1,500 sperm per second and that the particular sperm that succeeded in fertilizing the egg from which our time traveler's parent came was in competition with about 400 million released on average during sex, I should think a loud thud on Gram and Gramps's bedroom door at just the right moment should do the trick.

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The mathematician and meteorologist Edward Lorenz coined the phrase "Butterfly Effect" to refer in chaos theory to the manner in which small occurrences (like the flutter of a butterfly's wings) can have enormous consequences that appear to be random (like the weather). When the initial conditions include a tumultuous event like ethnic cleansing or genocide, we can reasonably assume that the consequences are such that within 100 to 200 years there would be no one living who would have been alive had the mass atrocity not occurred. I call it the "Barbarism Effect."

It is not just that genocide, for example, effectively deprives the world of future progeny that the victims would have had had they not been murdered, which is true. It also sets up a sequence of events in which an entirely different set of people end up being born. Unlike most actions whose remote consequences diminish to zero, like the furthermost ripples of a pond after a pebble has been thrown into it, altering when children are conceived or to whom they are conceived has repercussions that steadily increase over time. The consequences of a different set of marriages, births, accidents, road gridlocks, crimes, FIFA World Cup winners, businesses, books, inventions and scientific discoveries increase exponentially the further we progress along time's arrow. The changes would be so profound — remember we are talking here about mass killing in history affecting conceptions in so many ways — that the probability of your being born would be effectively zero.

But this poses a very profound and uncomfortable moral problem that we would nevertheless do well to ponder. Nietzsche once surmised that anyone who had ever wanted to relive a moment of joy was committed to affirming the idea of reliving the entirety of his or her life up to that point. Why? Because Nietzsche, a dyed-in-the-wool determinist, believed that the present instant of joy is made possible by all the events in one's past that caused it. As he lyrically put it, "All things are enchained with one another, bound together by love." For Nietzsche this is a splendid thing, for it gives us the power to redeem the past. It ultimately enables us to justify those moments of pain and suffering in our past that are now seen as necessary links in the chain of cause and effect leading to the present affirmation of joy — a case of "I didn't like it at the time, but it all turned out for the best and I wouldn't change it for the world."

I had always solaced myself with Nietzsche's idea of looking back at one's life and affirming all of it, even the bad parts, which are indispensable conditions for whatever happiness my life currently contains, until one day it dawned on me that if I am to say "yes" to those events in the past that caused me to suffer but which are causally necessary for my life's being lived as I live it now, then I must also say "yes" to those events that have caused others to suffer as well.

But who can do this? Who can maintain in good conscience that the Holocaust or slavery was justified because otherwise he or she, or anyone else currently living for that matter, wouldn't have been born. (Nietzsche notoriously maintained that the only justification of the French Revolution — including the Reign of Terror — was that it produced Napoleon.) Whose natural narcissism is so extreme that he or she can justify the unjustifiable suffering of innumerable innocent lives? The Jewish philosopher Emmanuel Levinas was more discerning: "What is most natural becomes the most problematic. Do I have the right to be? Is being in the world not taking the place of someone?"

Peter Atterton is a professor of philosophy at San Diego State University. He is the author of several books, including "Animal Philosophy: Essential Readings in Continental Thought" and "Radicalizing Levinas."

A version of this article appears in print on 07/06/2014, on page SR8 of the National edition with the headline: Do I Have the Right to Be?.


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Opinionator | Fixes: At a YMCA Near You, a Course for a Diabetic Nation

Written By Unknown on Jumat, 04 Juli 2014 | 13.26

Fixes looks at solutions to social problems and why they work.

Oralia Barrios knew she'd gotten heavy, but she didn't realize how heavy until she went to the doctor last year. At 5-foot-2, she weighed 190 pounds. And her doctor at the Open Door Family Medical Center in Port Chester, N.Y., had bad news: her blood sugar was too high. Her A1c test showed that her hemoglobin level was 5.9, making her pre-diabetic.

We know how to prevent diabetes. But the U.S, medical system, with its twisted priorities, doesn't cover prevention.

"I heard that, and I went to pieces," she said. In 2002, her father had died of diabetes-related kidney failure. "He was diabetic for a long time," she said. "He had high blood pressure and was nearly blind. He suffered a lot — and we suffered with him." He was 52 when he died — 15 years older than Barrios is now.

Unlike her father, however, Barrios could get effective help. The YMCA in nearby Rye is one of 128 YMCAs across the country running the Diabetes Prevention Program. The Y coordinates patient groups at various sites, including at Open Door. Barrios' doctor sent her to Rolando Alvarez, a patient advocate at Open Door, who was starting a new group at the clinic for people who were pre-diabetic. It was a big commitment, Alvarez said — she would have to attend a weekly meeting for four months, and a monthly meeting for the rest of the year.

Barrios joined a Spanish-language group with four other women. They met around a conference table at Open Door. Alvarez used the Program's formal curriculum: What are healthy foods? How can I be active? What can I do besides eat to alleviate stress? How can I eat healthy food when I eat out ? How do I deal with setbacks? Participants were given a calorie and fat counter book, and had to record everything they ate.

A lot of it was conversation, though — the women helping each other. The most useful thing she learned, Barrios said, was how to say "no" in a way that was courteous but firm. Some of the women took Zumba or yoga classes together. Barrios started walking and biking, and learned to build more exercise into her job as a housekeeper. "I used to wait to collect all the towels and bring them upstairs together. Now I bring them upstairs one by one — I go up and down those stairs with energy."

Barrios crash dieted while she waited for the class to start, and lost 22 pounds. By three months into the class, she had lost 23 more, and her blood sugar returned to normal levels. She has now gained back some weight, but it's not because her diet is slipping — she's five months pregnant.

As anyone who has ever dieted knows, Barrios' journey is remarkable. Changing a lifestyle is very, very hard. But the journey of the Diabetes Prevention Program itself is just as remarkable. In 2002, the New England Journal of Medicine published results of a randomized controlled trial comparing two interventions designed to keep people at high risk for Type 2 diabetes from developing the disease. Participants who took the drug metformin had a 31 percent lower incidence of developing diabetes than people who took a placebo. But far more effective was a lifestyle-change program: participants met individually with nutritionists, exercise physiologists or behavioral psychologists weekly for six months, plus monthly classes afterwards.

This group had a 58 percent lower incidence rate — so effective that the study was stopped early, and all participants offered classes.

These were great results. But dozens, maybe hundreds, of papers on successful programs are published every year. "I'm around this type of research a lot: wow! this works! — and then it never goes anywhere," said Ronald Ackermann, director of the Center for Community Health at Northwestern University Feinberg School of Medicine. This one looked particularly unpromising. Hiring professionals for a year's worth of training is expensive. And it's preventive medicine that the U.S. medical system, with its twisted priorities, doesn't cover. And one-on-one programs can't reach a lot of people. There are 86 million prediabetics among Americans over 20. Of Americans over 65, only 23 percent are not prediabetic or diabetic. The problem is big — but this intervention seemed destined to be small.

Yet 11 years after the study was published, the Diabetes Prevention Program helped Oralia Barrios to climb out of the danger zone. More than 20,000 people have done the program, and it has the potential to reach enough people to make a significant difference in America's diabetes epidemic.

So how did the Diabetes Prevention Program grow? Here are the steps.

Discover what people should do. Type 2 diabetes, the kind that's epidemic, can be prevented most of the time by eating right and exercising. This was not a mystery; lack of knowledge wasn't the obstacle.

Get people to do it. The obstacle was getting people to actually make these changes — and the news in the study was that people can be helped to make them. Research published this year of those participants in the original showed that while there was falloff, there was falloff in every group — but the program group was still better off. In other words, the gains persisted.

The next big breakthrough came with the addition of the YMCA. Ackermann, then at Indiana University's School of Medicine, had worked with the Y in Seattle on a previous research project. In 2003, he and Dr. David Marrero began a study with two YMCA sites in Indianapolis. The control group got normal testing and counseling. At the other Y, the staff was trained in the Diabetes Prevention Program curriculum — adapted for use in group classes. After six months, the program participants had lost 6 percent of their body weight, while the control group members lost only 2 percent, and the differences lasted.

This study was proof-of-concept of several steps necessary for scale-up.

Get people to do it cheaply. Hiring health professionals to counsel patients individually was expensive — a patient's first year cost $1400. But the Y does it for $275 to $325. They hired good facilitators — who made a lot less money than nutritionists or psychologists — and then trained them in the Diabetes Prevention Program curriculum. Numerous studies have since shown that outcomes are the same.

Group classes that use the huge national network of YMCA have proven to be effective in fending off the disease.

Get lots of people to do it cheaply. The more significant savings came from switching to group classes — a way to treat many times the people for the same cost. We've long known that groups are effective at helping people lose weight — at every kind of behavior change, really. "The group model combines all these ingredients we know are essential and does it in a way that you get the support and assistance you need," said Michele Heisler, a professor of internal medicine and health behavior and health education, at the University of Michigan's School of Public Health.

Systematically get lots of people to do it cheaply. "The discussion was: how do we create a national program?" said Ackermann. "It wasn't that we thought it's not a good idea to do this in a church basement. GM and Ford wanted to do worksite groups. But we wanted a national approach."

The YMCA had the national structure to spread the program and train facilitators. It focuses on health, knows how to reach low-income people and has thousands of branches. Eighty percent of Americans live within five miles of a Y, and Y's are in or near many neighborhoods that suffer the most from diabetes. "If the Y couldn't do it — well, we couldn't think of another national organization," said Ackermann.

Today, YMCAs in 41 states run program group classes. Half meet at Ys, and the other half meet in places such as libraries, church basements and health centers.

Participants' average weight loss at the end of the year-long program is 6.1 percent of their body weight. But averages can mislead — a few successes like Barrios can distort them. Alvarez's first class was cancelled because not enough people enrolled. And in the second class he ran, only two of the seven participants met the goal of losing 7 percent of their weight and exercising 150 minutes per week.

The day I visited Alvarez's group, which was in its maintenance phase, talking about strategies for dealing with setbacks, only Juana Damián was there. (I spoke to Barrios later by phone.) "They get through the weekly classes fine," Alvarez said. "But with maintenance, they'd like to come but it's more difficult. Since its once a month, they might forget. And work will always come first."

Damián is his most consistent participant. She, like Barrios, lost a lot by crash dieting before the class began. She hasn't lost much more, though — one big reason is the stress of caring for her mother, who is paralyzed from a diabetes-related stroke. But the class has helped her maintain a loss that otherwise might have evaporated.

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Get someone to pay for it. A work in progress. The Y charges $429 for the program (there are scholarships) — but it should be free. Diabetes is an expensive disease. A 2010 report from UnitedHealth Group says that its average cost to cover a person with no chronic disease is $4,400 per year. For a diabetic with no symptoms, $11,700. With complications: $20,700.

Another study calculates the cost savings over 10 years if Medicare covered participation in the diabetes program and three to five percent of senior participated: $1.3 billion. Such coverage would also result in a million fewer diabetes cases over 10 years.

The American health system doesn't much care. Obamacare has brought piecemeal progress (see here and here) towards expanding and getting coverage for the program, but in general neither Medicaid, Medicare nor most private insurers cover prevention — although this is starting to change with Obamacare's Accountable Care Organizations.

In 2009, the Centers for Disease Control convened a meeting with diabetes experts, YMCA officials and representatives of various insurance companies to discuss what it would take to get coverage. The Y offered a deal: pay for performance. It proposed that insurers only pay when participants attend classes and lose weight. United Healthcare became the first to accept; now 28 different insurers cover the program. Sen. Al Franken has introduced a bill that would have Medicare cover the program as well.

"There is a change in the conversation nationally," said Jonathan Lever, vice president for health strategy and innovation at the YMCA of the USA. "For ACOs, this is attractive. Prevention is a topic. But it's not happening in a systematic way. We're knocking at the door. But the jury's still out on whether systems will align to make it possible."

Join Fixes on Facebook and follow updates on twitter.com/nytimesfixes. To receive e-mail alerts for Fixes columns, sign up here.

Tina Rosenberg won a Pulitzer Prize for her book "The Haunted Land: Facing Europe's Ghosts After Communism." She is a former editorial writer for The Times and the author, most recently, of "Join the Club: How Peer Pressure Can Transform the World" and the World War II spy story e-book "D for Deception."


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Opinionator: The Rise and Fall (and Rise) of Salmon P. Chase

Written By Unknown on Kamis, 03 Juli 2014 | 13.26

Disunion follows the Civil War as it unfolded.

On July 4, 1864, four days after President Abraham Lincoln had surprised him by accepting his resignation, Treasury secretary Salmon P. Chase confided to his diary, "I am too earnest, too antislavery … [and] too radical."

Chase surely possessed each of these attributes – in excess – but they had little to do with his unexpected exit from Lincoln's "team of rivals." Rather, it was much more personal. Chase's oft-repeated threat to quit had tested the forbearance of a beleaguered president once too often. Out of patience, Lincoln ended his tenure with the observation that "you and I have reached a point of mutual embarrassment in our official relation which it seems cannot be overcome, or longer sustained."

It had been an unlikely partnership from the start. In 1860, Chase's presidential ambitions were second to none. A staunch anti-slavery man, he had held a Senate seat and the Ohio governor's chair, and in one contemporary's words "looked as you would wish a statesman to look." A widower three times over, the aloof, pious Chase had few friends, lived a life governed by unshakable routine, eagerly sought moral perfection and had no apparent sense of humor. Noted one contemporary, he knew "little of human nature" and was "profoundly ignorant of men." Salmon Chase, in short, was Abraham Lincoln's polar opposite.

The last of Lincoln's three rivals for the presidency to be offered a cabinet post – William H. Seward was named secretary of state and Edward Bates attorney general – Chase was initially inclined to decline the offer because Lincoln had failed "to tender me the Treasury Department with the same considerate respect which was manifested toward Mr. Seward and Mr. Bates." He finally accepted in March 1861.

Photo Treasury Secretary Salmon P. ChaseCredit Library of Congress

Chase proved a remarkably able and innovative manager of the Union's finances. He won congressional approval for a national banking system to provide a stable national currency and create a ready market for government bonds. Sale of the latter enabled the federal government to pay the staggering costs of over $3 billion (over $5 trillion today) for four years of fighting. Working with Jay Cooke & Company, Chase managed the sale of $500 million in government bonds. He also introduced the greenback demand note, the first federal currency.

Chase's failings lay in his aspirations, not his performance. Convinced he was the ablest man in the cabinet, he also believed he was Lincoln's superior as both an administrator and statesman. His dream of occupying the White House never deserted him, and he sought to further his ambitions in ways small and large. Responsible for the design of paper currency, for example, he had no compunction about placing his own face on the $1 bill. After all, he told one confidant, he had placed Lincoln's on the 10!

But Chase's mischief could be more serious. In the last months of 1862, he played the major role in precipitating crises that twice threatened the fragile stability of Lincoln's cabinet. This much lauded "team of rivals" was in reality riven by clashes driven more by personality than ideology. As the historian David Donald has observed, Chase and Navy Secretary Gideon Welles both distrusted Seward, who they believed failed to grasp the dangers the war posed. Edwin M. Stanton, the secretary of war, was irascible and secretive, and worked well only with Chase, with whom he enjoyed a 20-year friendship. Welles — "Father Neptune" to his colleagues as well as the president — was a sometimes comical figure, while Caleb Smith, the interior secretary, seemed to all a figure of no account. Postmaster General Montgomery Blair bore particular animus toward Chase and Stanton, and seemed primarily self-interested. Only Bates enjoyed cordial relationships with all of his colleagues.

The stunning defeat of Union Gen. John Pope's Army of Virginia at the Second Battle of Bull Run In late August 1862 precipitated the first of these crises. In league with Stanton, Chase tried to force Lincoln to cashier Gen. George B. McClellan over his apparent refusal to reinforce Pope's army. In an extraordinary "remonstrance" to the president, they warned of "the destruction of our armies" should "George B. McClellan be continued in command." Chase, Stanton, Smith and Bates endorsed the document, while Welles and Blair expressed their support but chose not to sign it. Seward was out of town.

At a fractious cabinet meeting on Sept. 2, the president overrode their objections. While not unsympathetic to his cabinet secretaries' concerns, Lincoln argued that only McClellan could "reorganize the army and bring it out of chaos."

Despite the Union's success at Antietam a few weeks later, Lincoln did remove McClellan from command of the Army of the Potomac in November, only to see his replacement, Ambrose Burnside, preside over a Union debacle at Fredericksburg. News of this latest defeat provoked a mutiny among Senate Republicans, who were convinced (due in no small part to Chase's machinations) that Lincoln's management of the cabinet and embrace of Seward's conservative ideas were hobbling the Union war effort.

On Dec. 16 and 17, 31 Republican senators caucused to express their frustrations and anger with the Lincoln administration, directing most of their venom at Seward. A concerned Lincoln met with a delegation of nine Republican senators for several hours on the nights of Dec. 18 and 19, both to listen and to defend his administration. With his cabinet members (except Seward, who had submitted his resignation) in attendance at the second meeting, Lincoln contended that while the cabinet did not meet regularly, it was informed of most major issues and generally acquiesced to the decisions that were made.

Lincoln then put his Treasury secretary, whom he knew to be at the bottom "of all the mischief," on the spot. Would he support the president? Chase somewhat reluctantly said yes, but sought to save face with the senators present by noting that the cabinet was not asked to discuss many important issues. The other cabinet members had little to say, and the meeting ended inconclusively, well after midnight.

The following morning Lincoln summoned Chase again, along with Welles and Stanton, because, he said, this "matter is giving me great trouble." Chase responded that he had decided to resign. Seizing the letter from his hand, the president exclaimed, "This cuts the Gordian knot. … I can dispose of this subject now without difficulty. I see my way clear." His same-day refusal to accept the resignations of either Chase or Seward defused the crisis by signaling his willingness to listen to both moderate and radical Republicans.

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Fort Sumter

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The cabinet crisis greatly diminished the Treasury secretary's standing: Stanton confessed that he "was ashamed of Chase," while Senator William P. Fessenden of Maine (who would succeed Chase in the cabinet) fulminated at the Treasury secretary's deliberate sacrifice of "his friends to the fear of offending his & their enemies."

But Chase's loss of face after the 1862 cabinet crisis did little to blunt his presidential aspirations. He continued to fill the 15,000 patronage jobs at his disposal with loyalists and maintained a regular correspondence with supporters throughout the North. Well aware of these activities, Lincoln had "determined to shut his eyes to all these performances… [because] Chase made a good secretary." The president also recognized that he had his Treasury secretary under control, for Chase could neither be overly critical within the cabinet nor resign and appear unpatriotic.

But Chase continued to maneuver, and the battle looming over reconstruction policy in late 1863 and early 1864 bolstered his support among radicals unhappy with the administration. It looked increasingly like Chase might make a run for the White House.

Early in 1864, the campaign committee for Chase headed by Senator Samuel C. Pomeroy of Kansas, issued two pamphlets critical of Lincoln. Too critical, in fact. Even Lincoln's staunchest opponents found the publications too much, and the so-called "Pomeroy Circular" (http://www.fofweb.com/History/HistRefMain.asp?iPin=E14252&SID=2&DatabaseName=American+History+Online&InputText=%22Abraham+Lincoln%22&SearchStyle=&dTitle=Pomeroy+Circular&TabRecordType=Historical+Document&BioCountPass=309&SubCountPass=342&DocCountPass=132&ImgCountPass=79&MapCountPass=18&FedCountPass=&MedCountPass=97&NewsCountPass=0&RecPosition=36&AmericanData=Set&WomenData=&AFHCData=&IndianData=&WorldData=&AncientData=&GovernmentData=) in particular – which asserted that Lincoln's candidacy was doomed – proved so embarrassing to Chase that he aggressively distanced himself from the piece.

But it wasn't enough; the pamphlet, in one contemporary's words, "had utterly annihilated the pretensions and prospects of Mr. Chase." Within weeks his opponents coalesced in support of Lincoln in the fall election, and Chase announced that he would not be a candidate.

In the wake of these events, Chase once again tendered his resignation in a long letter filled with self-justifications. By now, Lincoln's fabled patience was threadbare. His first response to Chase's letter, a terse promise to "answer a little more fully when I can find the leisure to do so," (http://quod.lib.umich.edu/l/lincoln/lincoln7/1:434?rgn=div1;submit=Go;subview=detail;type=simple;view=fulltext;q1=Chase) was followed six days later by a muted vote of confidence — "I do not perceive occasion for a change."

But the occasion for a change would soon arrive, prompted by the politics of patronage. In late June 1864, Chase sought to replace a well-respected assistant treasurer in New York with a clearly unqualified candidate of suspect political loyalty. Lincoln, fearing an "open revolt" among Republicans, urged Chase to select from among three alternative candidates. (http://quod.lib.umich.edu/l/lincoln/lincoln7/1:910?rgn=div1;submit=Go;subview=detail;type=simple;view=fulltext;q1=Chase) Chase rejected them and instead persuaded the incumbent to withdraw his resignation. When Chase sought a meeting with Lincoln, he was rebuffed "because the difficulty does not, in the main part, lie within the range of a conversation between you and me."

On June 29, Chase once again resigned and this time Lincoln accepted. (http://quod.lib.umich.edu/l/lincoln/lincoln7/1:922?rgn=div1;submit=Go;subview=detail;type=simple;view=fulltext;q1=Chase) "I thought I could not stand it any longer," the president confided to his secretary John Hay. Official Washington was aghast at the news. "In Congress and on the street there is a general feeling of depression and gloom," noted Hay. When the entire Senate Finance Committee descended on the White House to protest, Lincoln stood firm, reading to them each of Chase's previous letters of resignation, as well as his responses, and noting that the tension between the two men had become such that they "disliked to meet each other." When Gov. John Brough of Ohio offered to mediate the dispute, Lincoln replied, "This is the third time he has thrown this at me, and I do not think I am called on to continue to beg him to take it back…. I reckon you had better let it alone this time."

Chase's downfall proved short lived. In December Lincoln appointed him to the Supreme Court to succeed Chief Justice Roger Taney, who had died two months earlier. In a letter to his fiancée, Lincoln's other secretary, John Nicolay, wrote that "no other man than Lincoln would have had … the degree of magnanimity to thus forgive and exalt a rival who had so deeply and unjustifiably intrigued against him. It is," he continued, "only another … illustration of the greatness of the President, in this age of little men."

The stage for the amendment's passage in the House was set. Enter Mr. Spielberg.

Follow Disunion at twitter.com/NYTcivilwar or join us on Facebook.


Sources: Michael Burlingame, "Abraham Lincoln: A Life"; David Herbert Donald, "Lincoln"; Doris Kearns Goodwin, "Team of Rivals: The Political Genius of Abraham Lincoln"; Burton J. Hendrick, "Lincoln's War Cabinet"; Philip Shaw Paludan, "The Presidency of Abraham Lincoln"; Ronald C. White Jr., "A. Lincoln: A Biography."


Rick Beard, an independent historian and exhibition curator, is co-author of the National Park Service publication "Slavery in the United States: A Brief Narrative History."


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Opinionator: I Couldn’t Turn My Abortion Into Art

Private Lives: Personal essays on the news of the world and the news of our lives.

I had just turned 22 and I had the self-esteem of a squashed toad. This may explain why I was having an affair with a married 36-year-old sound mixer whom I'd met on a film shoot a couple of months earlier.

I'd had only one serious boyfriend by this time and recently had been asked for the first time, "Can I buy you a drink?" by a man. (He was an actor in a film I'd worked on the summer before; he asked everybody that question, but still it felt like progress.) Somehow, by that tender age, I had convinced myself that I should take what I could get. So I took the married sound mixer.

And then, a few months later, I rolled out of bed at an unreasonably early hour and vomited.

This didn't seem as big a problem to me as it might have for other young women. This was the mid-1990s. Reared on protest marches, I had a NOW poster affixed to my bedroom wall. I was an unwavering believer in the fierce rhetoric of pro-choice. And now: a poster child.

In addition, in college I had essentially majored in experimental feminist video. I could make art out of anything.

I called my boss — a pretty, perpetually single 35-year-old art director — and confided my situation. She gave me the name of a clinic on Park Avenue. "Whatever you do, don't go alone," she said.

I called. I made an appointment for the next day and checked the price: $350 — slightly more than a week's pay.

The money intimidated me but the mission didn't. Not only was this the right I'd marched for, it was an opportunity. It could provide material for the kinds of film I'd voraciously consumed in college, in which women transformed their most traumatic experiences into emotionally stirring and awareness-raising images: Margie Strosser's "Rape Stories" or "The Body Beautiful" by Ngozi Onwurah, about a mother undergoing a radical mastectomy. An abortion today, a debut at Sundance tomorrow.

The next day was perfect movie material. A blizzard had hit New York City, shutting down the trains. I did something that I considered extravagant at that time: I called a car service. I added it to the mental tally, the bill I'd present to the married man when he returned from working on a film overseas.

I stuffed my Ricoh Hi8 video camera in my backpack, and I went alone.

The driver was Middle Eastern, from some hot and weather-less country, but he did a fair job of steering into the skids. He kept asking me why I was going out in such weather.

"I have to go to the doctor," I kept telling him.

"Why? You don't look sick."

"I have to have a procedure."

"What? What procedure?"

Finally, I told him. Why not? I was proud and un-conflicted. I was exercising my right. I was making a video.

He pulled over to the side of the road, right there on the Brooklyn Bridge — not only illegal but dangerous. "Please don't kill the baby," he said. "Please don't kill the baby."

"What are you doing?"

"Don't kill the baby." He wouldn't move the car, though horns blared all around us.

"Keep driving! I have an appointment!" I shook his headrest. This was not part of the script.

"Please don't kill the baby," he said again, turning around to face me. He had beautiful big brown eyes — almost black. "I will take care of you and the baby. I work two jobs."

"Drive," I told him.

"You are going by yourself?" he asked.

I said, "Drive."

He drove. The camera wasn't on. I didn't have any of it on tape.

At the clinic's counter, the receptionist asked me what I'd come for. I said, "Um …"

"Termination of pregnancy?" she asked in her best would-you-like-fries-with-that voice. I nodded.

They gave me pamphlets, a paper gown and paper slippers. They sat me in a room filled with women, one of whom told me she'd been there eight times before. "They used to have terry cloth," she said, lifting her toes in the paper slippers. It had never occurred to me that people had serial abortions, but it confirmed my expectations: abortion — safe, legal, no big deal.

Photo Credit Bianca Bagnarelli

Yet as I looked around the room, my expectations began to shift. This wasn't the liberating environment I'd expected to enter. The uncomplicated message of those protests led me to think that legal abortion would be light. Lite. I wasn't prepared for the saturnine cloudiness of the room, all those sad-looking women burying their faces in tabloid magazines.

The video camera stayed sleeping in my lap.

Nurses led me and 10 other women into a room where they talked to us about our anesthetic options — local or general — and had us sign forms. Everyone opted for general except for me. "I want local," I said. I showed the woman from the clinic my video camera. "I want to be awake and I want to record it." I said this with a now wavering smile.

She took me aside and informed me that I could not use my video camera in the operating room for legal reasons, and that they did not approve of local anesthesia.

"Why are you giving me the option, then?" I asked.

"We have to," the woman said. For legal reasons.

My hands shook, the camera wobbling in my grasp. I was freezing inside my paper gown. I checked the "general" box on the form. I put the camera in my bag.

The first thing I thought when I awoke from the anesthesia was that I'd never be pregnant again, that I had just squandered my only chance at motherhood. I was sobbing — I had arisen from the depths of the medication this way — as they rolled me into the recovery room where the other women were lying, almost all of them with a friend or partner or relative to brush their hair back or offer them ice chips. I could not stop crying, big heaves and gulps of it. The nurse came over at first to soothe me and then to quiet me.

"You're upsetting the other girls," she said.

"It hurts."

She sent the doctor over. "Sometimes we have to massage the womb," he said, inserting his hand inside me and pressing. This did not stop the crying, but eventually it stopped the pain.

Or, at least, it stopped the physical pain. The begging cabdriver and the woman on her ninth abortion and the shocking suction in my womb: It was too traumatic for me to make art of. Or maybe it was just that I wasn't a good enough artist to transform that level of trauma into something that others could learn from and use. I had been taught that a woman's right to choose was the most important thing to fight for, but I hadn't known what a brutal choice it was.

I took a car service home, too, where my brother and his girlfriend met me and we ordered in. "We would have gone with you," they said, "if you'd asked."

"I was going to make a video," I said. Reacting to the way my hands still shook, they tended to me as if I'd just walked miles in that blizzard. I knew then I'd never be a filmmaker.

About motherhood, though, I was wrong. Fifteen years later, happily coupled with a wonderful man, I gave birth to my first daughter; I now have two. I don't wish I had a 20-year-old. I didn't want that baby, with that man. Abortion rights, yes, I'll always support them, but even all these years later, I wish the motto wasn't "Never again," but "Avoid this if there's any way you possibly can, even if it's legal, because it's awful."

I wish that someone had alerted me to the harshness of the experience, acknowledged the layers of regret that built and fell away as the months and years passed. I want my daughters to have the option of safe and legal abortion, of course. I just don't want them to have to use it.


Lisa Selin Davis is a writer in Brooklyn.


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