Boston, my heart is with you, and Rayne’s checklist looks good to me. I know how hard this can be when you’re doing your best with someone you love and respect and whose dignity you want to support and defend.

You haven’t said anything about your conversations with him. Does he grasp your concerns? How does he react to them? How did he suddenly get to the point of withdrawing PoA?

One more thing: once you get a lawyer and get him writing letters, let the lawyer do the talking. The doctor calls and wants to talk? Tell the doctor to talk to the lawyer; the doctor’s blown it when it comes to talking to you. Doctors are not above trying, like 3 year olds, to play one parent off against the other.

I would just like to say two things in regard to the state of mental health care in the United states.

1) cognitive behavioral therapy when combined with medications is overwhelmingly the most empirically supported approach to most psychiatric disorders. Group therapy works, skills training works, ptsd treatments like Prolonged Exposure therapy and EMDR as well at TF CBT. Bottom line is that the meds are being ordered but the therapy is not being ordered or paid for in the same way the meds are. (and what this does is creates an over reliance on meds and quick fix promises and an under reliance on therapy which costs more up front but has shown to “decrease” the quantity of drugs needed to maintain stability over time).

2) This perpetuates a self fulfilling prophecy for those on disability simply so they can afford their meds. (and I know so many). In my work of running skills oriented groups CBT and DBT individual therapy, plus trauma work…I can state that we often had to battle with docs to allow our clients to decrease meds even after months of stability. We simply wanted our clients to be able to document for themselves either the need to take these meds or the ability to decrease them. This position was not popular in medical model psych treatment centers.

It’s like a disability factory which insures years of multiple new and very expensive psych meds. Every time a new med comes out we see our clients being switched instead of discussions about how they might use their skills to improve their lives. It’s maddening. Let’s just adjust the meds. But…hello?? could we encourage them to use their wise mind…or try some other skill. Could we act as if their pain CAN be regulated by them not just by meds?? Well, not if the drug reps have anything to say about it.

It’s just one more of those super schizmogenic loops. Less therapy means more meds and increased and maintained dependence. I am not anti medicine I just think the research shows that therapy with meds is the most effective treatment for most mental health problems. Therapy works but sometimes takes longer. Meds often over medicate to such a degree that the only thing that has changed is the clients ability to advocate for themselves. Often times the client becomes so drugged up that they stop complaining.

It’s the area of healthcare that I think needs an awful lot of work systemically.

Get a lawyer.

Have the lawyer send letters to the doctors about the way they are treating your father, (a) demanding full copies of his medical records (you should be entitled to them at nominal or no cost, depending on your state) and (b) demanding that the doctors work together to minimize the amount and number of drugs they are feeding your father. Having the lawyer couch the letter in the professional-to-professional terms of “my clients suspect their father is being overmedicated and/or overtreated more to line your pockets than to give their father reasonable care, and I would appreciate your help in resolving this suspicion” – the lawyer does not have to state this explicitly (and probably shouldn’t – the mere existence of the letter will give them pause and should communicate that message) – is the way I would approach this.

There are few things a doctor hates more than a letter from a lawyer inquiring about a patient on behalf of the patient’s family. That’s because it signifies a fundamental failure of communication between doctor and patient/POA for the patient.

It’s a seriously fucked-up system when you have to go this far, but it appears to me that these clowns are milking your dad and his insurance.

And who said free advice from a lawyer wasn’t worth the price….

You have to remember that doctors of all stripes are inculcated from day one of medical school to fear, loathe and hate lawyers. The few doctors who both never run into lawyers in an adversarial situation and hold no animus against lawyers are those who recognize that the vast majority of situations where the lawyers get called in are when the doctor has failed not at medicine, but at communicating.

Good communication avoids a world of problems.

Of course, as in any profession, there are the few doctors who look at patients not as patients but as income sources, and nothing will avoid the problems that obtain from the way they conduct their practices. Them’s the ones who it’s fun to litigate against, if only b/c they scream so loudly.

“You’ve described how the AA culture can become matriarchal at small scale, because of the need of the granny; I wonder how, and in how many generations it takes before the culture moves from this invisible matriarchy? (Good gravy, Tyler Perry makes a mint off parody of this premise…)

And is this why Barbara Jordan could be so very open as a politician, at a time when her male counterparts might run into resistance? Not that she was an actual granny, but as a woman she was less of a threat?”

I think the culture can change in just a few generations — witness the absence of many tea-baggers in their 20’s and 30’s. The younger Southerners, the children of the demonstrating generation, have a reasonable expectation of working side by side with Black Americans, probably shared some school experience, and may even have friendships across racial lines that are not defined by the older social order. They expect to share restaurants, public toilets, state parks and all the rest, and they have developed accomodating behavior. If only to more or less keep the peace, they have reserved Confederate Battle Flag waving to an inside room in their home. I know it seems slow, but as someone who was in the movement back in the 60’s, I see profound differences. People no longer assume that all whites, even in the South, share the prejudices. Many fewer people, even strong racists, advertise themselves in company where they don’t have prior knowledge of attitudes. But at heart it is a generational thing — I think it takes 2 to 3 generations, depending on the degree of social identity the first generation had with racial superiority in all its glory. For comparative purposes, I would point out that by the mid 60’s, German young people no longer held strong residual anti-Semitic attitudes. They might not have appreciated the victors efforts to de-Nazify them, but they were pretty thoroughly de-Nazified.

The role of Black Women does, I believe, depend on a deeper aspect of culture. Black Women in Slavery, and in post-Slavery America, held the family together as head of household. Given the rate of births out of wedlock, this is very much still the case, as Social Services law until a decade or so ago, generally served only single parent families. Black Women comprehend this from what they see as children. They tend to stay in school to graduation, much more likely to go to college, and even today, earn more than men, as they are much less likely to be unemployed for long stretches. This gives them a natural sort of authority and economic power in families. Barbara Jordan is an excellent example of this even though she never married — but so too are Ellie Holmes Norton, Barbara Lee, Maxine Waters, and others. The best example of all was Fannie Lou Hammer. Could barely read, but that was one powerful mama. It could be that Michelle Obama will be a change agent in this respect. She can’t help but play the supportive wife role. The two of them may inspire a generation from now, a different black family style.

Black Church. The first hundred pages of Taylor Branch’s Three Volume bio of Martin Luther King and his times — “Parting the Waters” is the first Volume, — is a delicious introduction to Black Churches. Branch wanted to set the environment out of which King emerged, and while I can be picky about other things he did with the bio, that hundred pages or so is some of the best writing anywhere on Black Church Culture. He follows this up in other places in the biography, (I recommend the whole 2100 pages), but I can’t recommend anything else quite as good.

By the way, late last night I was surfing C-Span, and caught the late broadcast of part of Walter Cronkite’s Memorial Service. After Obama spoke, (it was in Lincoln Center), a New Orleans style funeral jazz band showed up, and did the slow strut to the Grave, and then the faster strut back (Variations on ‘St. James Infirmary’ followed by ‘Ain’t gonna study War No More”) up and down the aisles of the opera house. Mixed up with some CBS Executives, other newscasters, World War II and Korean and Vietnam Vets on whom he reported, a vet from the Civil Rights Movement, and two US Presidents (Clinton and Obama), Uncle Walter got quite a send-off. When you see the fairly smooth mixing of these styles, you can see why those who thought the golden years were when whites and blacks were not permitted to appear on the same stage, are rubbed raw with anger. I think the Jazz Band should be archived at C-Span.

“In re: Black Church — I’ll have to check out Taylor Branch’s work, thanks for the suggestion. I hope it covers the schism between the Protestant and Catholic AA communities, as it very much does have political impact even two generations after the migration of AA populations from Catholic portions of the south to a more Protestant north. Could see it but couldn’t put my finger on it until the church affiliations were pointed out. (And then how do you get both groups to cross over and pull together to vote for the same piece of legislation…definitely not monolithic.)”

I think it useful to look at the Catholic/Protestant AA differences (and I would not call it a split, more just differences), in the overall context of Religion in the US and its response to slavery, abolitionism, and ultimately post civil war settlements, and then 100 years later to the Civil Rights Movement.

Most Protestant Churches went into schism over these issues, only being reunited in the late 30’s and post WWII. Methodists split three ways in the 1840’s and 50’s. Methodist Church South, stood behind Slavery. Methodist Episcopal Church, took a nuanced anti-Slavery position, but looked down its’ nose at Abolitionists. Wesleyan Methodist got the evangelicals and the Abolitionists, but post Reconstruction, they put all the Black Methodist Churches into the Central Jurisdiction, with their own bishops and all — for all intents and purposes a segregated semi-denomination. Central Jurisdiction was only modified in the 1970’s, the fear is that other Jurisdictions would not elect Black Bishops, so parts of it are retained. Black Methodist Churches are members, for different purposes, of two Jurisdictions.

The smallest Baptist Denomination in the US is American Baptist — just about 2% of the Baptist population. But it is also the richest, because it got and controls all the Rockefeller Money, and the Rockefeller Family for more than a century has been very much out front and in the lead on racial issues and movement building. Took the lead in finding, selecting and financing high quality Theological Education for Blacks — back to late 19th Century, built schools — Morehouse-Spellman is actually named for John D. Rockefeller’s wife. King’s own education was pure Rockefeller Baptist, Morehouse, then on to Crozer near Philly, and then on to Boston University for his PhD. All Rockefeller Endowed Baptist Schools. All this had a profound effect on the Black Baptist Churches, particularly in the South — but also on the professionally educated black middle class before and during movement days (which I date as beginning in the mid 30’s, and lasting into the 1970’s). The Southern Baptist Convention, largest of all, and the General Baptist Convention (Billy Graham has been major leader), have never gotten a dime from the Rockefellers or anyone they influence in the Foundation world. And it is important to know the quality of Schools this Black Baptist – American Baptist partnership that is about 5% of all Baptists supports. Well, start with the University of Chicago, add Colgate, Vanderbuilt, Duke. And you might as well realize that virtually all the land in the southern part of Manhattan is owned in trust by American Baptists, Presbyterians and Episcopalians — not the buildings, just the land, which is under 99 year leases to those who built all the Financial District Buildings. Rents go to Colleges and endowed Hospitals. Since the end of Reconstruction all these Protestant Mainline Churches have committed a significant part of this endowment to Black Education, either in their own colleges, or in Historic Black Colleges they Control.

Episcopalians had few black members in the North, but some in the South. It was the one Protestant Denomination that managed not to schism over Abolitionism. (looks like they might over gender). Black Episcopalian Churches were largely treated as “Missions” by their Bishops, as many never became self supporting parishes. Having not rocked the boat on slavery or abolitionism, they stayed even keel right up into the 60’s, and it was largely a revolt of Seminarians that changed things then. Good school to study in this respect for Episcopal History is Trinity College in New Haven CT.

For a good description of the United Church of Christ’s process vis a vis race, I really recommend Andy Young’s autobiography. “An Easy Burden: The Civil Rights Movement and the transformation of America”. Young was raised in New Orleans, was educated in an all-black Congregational Church private academy until college, and then was eventually ordained as a UCC Minister while working with King in SCLC. He tracks well the complex history of the New England Congregational Abolitionists who built black churches and schools in the South — a few, such as in NO pre-Civil War, most during Reconstruction. Young wrote his analysis of the UCC/Congregationalist impact on African Americans some time before the world ever heard of Barack Obama or Rev. Wright — but knowing that Young’s denomination, and the black sub-set of it eventually became so noticed — I really recommend his description of it. The UCC, because it has a very weak central goverance (they are Congregationalists after all) never had a schism, but also did not own Wall Street Land in Trust, or build large Universities. But Dillard in NO is UCC at least in origin, and played a major role in training K-12 teachers for black schools during the Segregation era, when teacher training in black state colleges was weak.

Understanding the Roman Catholic history vis a vis Race in the US is a very complex matter, largely because what is true of one region is not really true of another. The RC’s didn’t take any position on Abolitionism pre-Civil War. They had a theology of Slavery quite distinct from Protestantism — which really didn’t condemn Slavery, but sought to impose a fairly heavy set of moral conditions on it, conditions mostly derived from the Spanish and Portuguese practice, which somewhat differed from the practice in the American-Anglo South. Most Protestants did not preference the religious conversion of African Slaves — Roman Catholics more or less made conversion almost a condition of Slave Ownership. Ive read through some marvelous instruction for the wives of slave owners, advising them on conditional baptism of slave babies, and how to teach basic catachism on a plantation circa 1835. (It is one of the few Catholic examples I know of where a woman was advised to take on certain priestly responsibilities.) At any rate, in general, Catholics did not build instutitions for Black Catholics — parish schools, high schools, colleges or hospitals — though one Religious Order did train and supply black priests to parishes. For the most part, Catholic Colleges and Universities were totally segregated, pretty much north and south, until about 1961. At that time Archbishop Cody, (later Cardinal in Chicago, then Bishop in NO), unilaterally integrated everything without prior discussion or preperation, and he excommunicated anyone who did Racist trash talk. In contrast, Father Hesburgh had a huge problem at Notre Dame — integrating the Football team was easy, no problem with superior game-winning players, but the classrooms and the social milue of an Irish Tribal Society was a very different story. But from 1957 onward, Hesburgh was the Hierarchy’s designated leader on this in the US, so if you follow his efforts you get an excellent view of how things went. He was up against the combined resentments of all the white ethnic groups with Catholic Identity — Polish, German, Italian, Latin American, Hungarian, Irish, all of whom had acquired some fairly strong racial prejudices as a result of their American Experience.

By the way — if you recall the Notre Dame Speech Obama did in June, note that he gave a huge call out to Father Theodore Hesburgh, now retired as Notre Dame President, very old, and sitting off to the side. I am sure he had much to do with that invitation, and with the determination the school showed to go through with the speech, and manage the protest. I would suggest those protests are just part of a series that includes uncivil behavior during a joint session of congress and an effort to censor an address to school children. It is all about Race, within a construct of both Class and Caste, and it is a massive effort to make Obama de-legitimate. I got my fingers crossed — thus far Barack Obama has mastered all the tricks they have thrown at him.