Monday, December 17, 2012

Shutting Down The Pump

Digby seems to have figured out something, a truth that dare not be spoken.  She began a post Saturday with a medical story from mid 19th century Great Britain.  In 2003, Kathleen Tuthill wrote

British doctor John Snow couldn’t convince other doctors and scientists that cholera, a deadly disease, was spread when people drank contaminated water until a mother washed her baby’s diaper in a town well in 1854 and touched off an epidemic that killed 616 people.
Dr. Snow believed sewage dumped into the river or into cesspools near town wells could contaminate the water supply, leading to a rapid spread of disease.

In August of 1854 Soho, a suburb of London, was hit hard by a terrible outbreak of cholera. Dr. Snows himself lived near Soho, and immediately went to work to prove his theory that contaminated water was the cause of the outbreak.

“Within 250 yards of the spot where Cambridge Street joins Broad Street there were upwards of 500 fatal attacks of cholera in 10 days,” Dr. Snow wrote “As soon as I became acquainted with the situation and extent of this irruption (sic) of cholera, I suspected some contamination of the water of the much-frequented street-pump in Broad Street.”

Dr. Snow worked around the clock to track down information from hospital and public records on when the outbreak began and whether the victims drank water from the Broad Street pump. Snow suspected that those who lived or worked near the pump were the most likely to use the pump and thus, contract cholera. His pioneering medical research paid off. By using a geographical grid to chart deaths from the outbreak and investigating each case to determine access to the pump water, Snow developed what he considered positive proof the pump was the source of the epidemic... Snow was able to prove that the cholera was not a problem in Soho except among people who were in the habit of drinking water from the Broad Street pump. He also studied samples of water from the pump and found white flecks floating in it, which he believed were the source of contamination.

On 7 September 1854, Snow took his research to the town officials and convinced them to take the handle off the pump, making it impossible to draw water. The officials were reluctant to believe him, but took the handle off as a trial only to find the outbreak of cholera almost immediately trickled to a stop. Little by little, people who had left their homes and businesses in the Broad Street area out of fear of getting cholera began to return.

Dr. Snow did not filter the water, nor cleanse it in any way.  It was still contaminated- but people stopped dying.   Human nature was not altered but behavior was transformed because the pump was shut down.  

Just as Dr. Snow met with resistance when he advocated a practical step to deal with an emergency, thee is considerable reluctance by politicians now to take  plainly necessary action. On Sunday's Up With Chris Hayes, The Nation contributor and MSNBC host began yet another extraordinary segment (video below) by observing

So there can be political pressure responding to this tragedy.  One thing I can see playing out and I can already see it a little bit- if you look at the way the Virginia legislature responded to Virginia Tech- Virginia is a state where you can't do anything about guns because of the politics there, there was this focus on mental health.

Of course there was, because focusing on mental health is an effective way of avoiding the big issue (and one more easily modified by public policy), gun control.  Stressing mental health adroitly switches the conversation to one requiring public officials to regulate firearm sale, possession, and use to one concentrating on the individual.  It is one not likely to offend an organized interested group, such as the NRA or the Gun Owners of America.   As a more comforting path, it is particularly tempting, a concept explained by one of Albert Camus' characters when he remarked

Do you know that the firing squad stands only a yard and a half from the condemned man? Do you know that if the victim took two steps forward his chest would touch the rifles? Do you know that, at this short range, the soldiers concentrate their fire on the region of the heart and their bullets make a hole into which you could thrust your fist? No, you didn't know all that; those are things that are never spoke of.  For the plague-stricken their peace of mind is more important than a human life.  Decent folks must be allowed to sleep easy o'nights, mustn't they?  Really it would be in shockingly bad taste to linger on such details.

Though Hayes in the segment added "focusing on mental health is great," he probably, and should have, meant "seriously addressing" mental health.  Keeping firearms out of the hands of the mentally ill is essential but, as Hayes went on to explain, a focus on mental health can lead to profiling people in the name of protection against terrorism.  Further, the distinction between the mentally ill and the mentally healthy can be relatively small and open to interpretation, and the ability to correct (or even alleviate) emotional disturbance is unhappily limited.   Psychiatrists, moreover, often disagree with each other and laypeople often describe as "crazy" an individual whose ideas they find absurd or outrageous.

So going down that road of obsession over mental health can lead us to a dead end while precious time is wasted.   Digby recounts circumstances in Australia, which suffered several massacres from 1984 to 1986, which bear similarity to our own.  In Port Arthur in 1986, "thirty five people were killed and 21 wounded when a man with a history of violent and erratic behaviour beginning in early childhood opened fire on shop owners and tourists with two military style semi-automatic rifles."   In response, serious gun control measures were enacted. Predictably

This did not solve the problem of mental illness or end the primitive capacity of human beings to commit murder and mayhem. Those are huge problems that their society, like all societies, is still grappling with every day. But it did end the epidemic of mass shootings. They have not had even one since then. 

The lesson is this: End the epidemic and then we can --- and must --- talk about root causes and mental health facilities and our violent culture. But first things first --- shut down the damned pump.

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