Wednesday, May 13, 2009

Swine in the Sea

It was all swine all the time in the news last week, and I saw a woman in the Newark transit station wearing a white surgical mask. She was stepping off a train into a crowd and you could see the terror in her eyes. I wondered if she grew up hearing the same Bible stories I did.

In the eighth chapter of the Gospel of Matthew, it says Jesus ran into these two men who were possessed by demons. They were coming out of the tombs and they were so violent nobody would go near them. But the demons recognized Jesus as the son of God, and they knew he was stronger than they were. So the demons ask Jesus, “Look, if you’re going to cast us out anyway, why don’t you let us enter that herd of swine over there?” Jesus says, “Go ahead.” And off go the demons, out of the men and straight into the swine. What happens next is the pigs go suicidal and run over a steep cliff into the sea and drown.

When I heard that story as a child, I took it literally and wondered something: What happened to the demons after the pigs drowned? Where did they go? You can’t drown a demon. Maybe they left the dead pigs in the water, climbed out and went straight back up the cliff and found those same tormented souls who thought they had been healed. What if they never were healed for good? What if Jesus gave them just a few moments of peace, but then the demons came back -- the swine demons -- more evil and more powerful than before? Maybe they sent the men over the cliff and into the sea, too.

* * *

The first time I ever saw a dead body of a person I knew was at Susie Fuller’s funeral. I sat in the front row of the church with my dad, who was Susie’s doctor. I don’t remember anything about the service except at the end everybody lined up in the aisle between the pews to walk up and see her.

We followed right after the Fullers, so I was standing there with my dad and Doctor Fuller -- Susie’s dad who was my dad’s friend -- and Mrs. Fuller and Susie’s sister Nancy. They all cried and then Nancy said, “Isn’t she cute? Isn’t she just beautiful?”

A couple of nights before that, I had overheard Mom asking Dad how Susie Fuller was doing in the hospital. He said she’d developed pneumonia and it was serious. The next day, I heard at school that Susie had died, but they didn’t say what she died from. They just said she was very sick and the doctors couldn’t save her.

I came home and asked Dad what happened. He said she had died of a lung infection. Then my brother’s friend Scott came over and told my brother and me the truth. Scott said Susie Fuller had taken a whole bottle of pills and killed herself. The Fullers always seemed like a big happy Christian family, and I didn’t know why she would do that.

* * *

My flight from Ecuador into LAX was late and it took a long time to clear customs. When I got out, I looked around for Uncle Jim but he wasn’t there. I finally called him and he said he couldn’t come to the airport.

It was 1979 and the Shah had fled Iran. The Ayatollah Khomeini had taken over and there was chaos in Tehran. The oil markets were disrupted. Gas prices and demand in the West had gone through the roof, and everybody was in a fine panic. In Orange County, California, Uncle Jim couldn’t fill up the Caddy. “You’ll just have to get here the best way you can,” he said.

I had come back to Southern California to attend my college graduation and then head east to start a PhD program in sociology. I had finished my coursework early and spent six months in Ecuador working with a mission. What I did was help the doctors train health promoters in the indigenous Shuar communities. They were trying to convince people to boil drinking water and wash their hands. One of the doctors brought a microscope to the jungle so the people could see microbes on a slide and understand the danger. But my brother Tod[1] said the shamans could see a lot more than microbes by taking Ayahuasca. Bad things happened, and sometimes it was personal; there were people to blame. You couldn’t take blood revenge against a germ.

It took awhile, but I found a taxi to drive me down to Uncle Jim’s house for the price of every last dollar in my wallet. On the way, we passed long lines of cars snaking around the streets waiting to buy gas. I thought to myself, what if it all runs out? I imagined Los Angeles as a vast pedestrian dystopia. No cars, just people running around in an urban jungle; they would have to kill each other for food. Then we left the city and headed up into the canyons. At midnight, we pulled into Uncle Jim’s long driveway. A light came on and Uncle Jim appeared in the door wearing a bathrobe and no toupee. He shook my hand and said he was sorry he hadn’t been able to pick me up. He was whispering, because Aunt Helen and Annie and Kristin were asleep.

I woke up the next morning to the smell of strong coffee, and went downstairs to find Uncle Jim reading the newspaper. He looked up over his glasses. “So tell me about this field you’re going to study in graduate school. What is medical sociology? What is it good for?”

“Well,” I said, “It’s a science that looks at health problems and medical care from a social perspective.”

“OK, give me an example. What is something I could find out from medical sociology?”

I pondered his question for a moment. “It’s like . . . why poor people have higher rates of depression,” I ventured.

“But I already know that,” Uncle Jim countered. “I can tell you that right now, and save you the trouble of getting a PhD from Yale.”

I laughed and felt embarrassed. Uncle Jim went on. “I’ll give you a sociology problem,” he said. “It’s right here in Southern California. When we moved out from Minneapolis years ago, this was a safe place. Now the crime rate is going way up. And parts of south Los Angeles -- don’t even think about going there. It's too dangerous. There are people in the streets up there who would just as soon shoot you as look at you. Some of them have machine guns. It’s crazy. What about that, Mister Sociologist?”

By then, the morning sun was streaming through the windows of the family room. In the corner, Kristin was practicing the piano. She had white blonde hair and tiny fingers and looked like an angel.

* * *

We spotted Jodie one day, bouncing across the quad on Old Campus. She had on a faded denim jacket and was smoking a cigarette. She tossed her hair out of her face every couple of seconds. My friend said, “That’s Jodie Foster.”

Toward the end of theory class on a Tuesday in early spring, somebody came to the door and said, “Reagan’s been shot.” Everybody went to watch TV and find out what had happened. There was a lot of confusion. Al Haig, the Secretary of State, thought the Constitution had put him charge at the White House and said so on national TV. Reagan’s press secretary, Jim Brady[2], had been shot, too. Frank Reynolds on ABC News announced that Brady had died. Then they got to the surgeon who was operating on Brady, and the surgeon said, “Nobody told me and the patient.”

Before long, a bizarre backstory was unspooling and the national media descended on New Haven. TV trucks were parked on the street between Old Campus and the Green. They said John Hinckley, the shooter, was somehow involved with Jodie Foster. The reporters were all trying to find someone who knew her -- maybe even someone who knew Hinckley.
Was he her boyfriend?

Then it turned out Hinckley was just crazy. The media trucks all left and everything got back to normal. I headed over to Urban Hall and passed J.C. coming down Prospect as usual. His hair and beard were growing long and he was wearing sandals and a tunic.

J.C. was supposedly one of the smartest graduate students they ever had in the Divinity School. He knew six languages, counting Greek and Hebrew. Then he disappeared for two years to write his dissertation. When he returned, he had a thousand pages. And he announced to his Committee that he was the reincarnation of Jesus Christ.

The Pharisees and the Sadducees on the Yale faculty held a kangaroo court and threw J.C. out of the graduate program. That proved his point beyond any doubt. He took to wandering around New Haven prophesying. He said he would be crucified on his thirty-third birthday, on the Green, by the faculty of the Department of Religious Studies. There were cruel jokes about J.C. People laughed and said the Divinity School had expelled Jesus.

Eventually, I didn’t see J.C. anymore. I imagine he faded in with the other homeless men looking for a steam grate on a cold night on Chapel Street. People walked on by.

After three years in New Haven, I traveled to Ecuador to do a study of missionaries. I collected stories of divine calling -- people telling me on tape how God had literally spoken to them and told them to go to the mission field. When I came back after a year of fieldwork, I made a presentation to the mental health seminar. One of the postdocs gave me a hard time. He was a young psychiatrist named Wayne Fenton, and he stopped me right in the middle of my reading of one of the best
Call narratives in my collection.

“So what is this?” Wayne asked rhetorically. “Is he hearing a voice in his head? Is this an auditory hallucination? A delusion of some kind?”

“Well, you’re a psychiatrist, Wayne,” I replied. “What do you think?”

“I think you need to put these stories in context. You’re
not a psychiatrist. You’re a sociologist, right? But you’re pulling these out and reading them to a group of mental health experts, and it makes these people all sound crazy. They’re not crazy. They all believe the same thing. It’s their culture. This is just the way they talk.”

“So do you think God really
is talking to them?” I asked.

“What I think doesn’t matter,” Wayne said. “What matters is the frame they put around it -- what it means to them as a group. And that’s what you have to do, too, if you’re going to write about them.”

I heard a voice, very clearly, saying, “Go, prepare yourself, and serve me.” But I was so disappointed in myself. I said, “Lord, how can you go on with me? I have been a Christian for several years now, but such a poor Christian.” And the answer was immediately there: “It doesn't matter what you are, or what you do. It depends upon my grace. My grace can do it in you.” And then I heard it again: “Go, prepare yourself, and serve me.” I said, “I understand that, but I have a family. I have two children, and I am an only son. I am responsible for my parents when they get older. Lord, at this moment I cannot leave. Economically there is no way, and I have made commitments.” You see, my understanding of missions was that it meant a whole life. I never thought about going for a short time. And then I got the answer: “Whosoever wants to save his life will lose it. But whoever gives it, for my name and the gospel, will save it.”

-- Missionary in Quito, 1982 (quoted in Swanson J.
Echoes of the Call: Identity and Ideology Among American Missionaries in Ecuador. New York: Oxford University Press, 1995.)
* * *

The topic of preventing violence came up over lunch in the cafeteria at Old Red. Chuck Holzer was telling Tom Hoeksema[3] about his statistical model for predicting rates of need for mental health services in the community. One of the variables in Chuck’s equation was violence.

“You can’t predict violence,” Tom said. “There are too many variables and unknowns.” Tom was a professor of preventive medicine and community health.

“That’s a discouraging view, Tom,” I said, “and if you’re right, then how do you stop violence? Are you saying it’s all just random?”

“Of course not,” Tom said. “Prediction and prevention are two different things. You can’t predict who is going to jump off the Golden Gate Bridge, either. But you could build a higher fence and stop anybody.”

“So, they’ll just find another bridge,” I argued. “Or a gun.”

“Maybe, or maybe not,” Tom said. “If they have to go find some other bridge, hopefully by that time they’ll think twice -- or get help. And even if you can’t change somebody's intent or cure the illness, you can reduce the harm it does.”

Then I brought up the case from Grand Rounds in psychiatry. Chuck had been there, but not Tom. I told Tom about it. I’d been assigned to chair the program that month, and the topic I picked was mental health and religion. The Galveston police had brought a woman to the ER who had attacked her pastor in church with a lead pipe.

The psychiatry resident on call thought at first the patient was psychotic, but the next day she seemed completely well. There was no hint of confusion or thought disturbance -- except for one small thing. The patient said she had been possessed by a demon the previous night, and that the demon knew the pastor was about to cast it out in the name of Jesus. It was an act of self-preservation, the woman said. It was the demon who had picked up the pipe and taken a swing at the pastor. That’s when the authorities were called.

When I heard about the case, I convened an expert panel to discuss it in Grand Rounds. The resident who had seen the patient in the ER asked if we could invite the pastor to serve on the panel. I agreed. The pastor came, and he was an East Texas fundamentalist preacher straight out of central casting. He stood up to speak, and began by reading a passage from a thick Bible:
“You wrestle not against flesh and blood, but against principalities and powers of the air.”

Twenty minutes later the pastor was rising into a full sermonic screed. He averred that all emotional problems and disturbances of the mind were the work of Satan -- these issues had Satan written all over them. And the only force strong enough to deal with Satan was God. Human life was a crucible of cosmic struggle. So open your eyes.

The chairman of my department was a biological psychiatrist and he glanced over at me with a look on his face that said one thing:
Get this man off the stage of my Grand Rounds. So I walked up on the stage and gently indicated to the pastor that we were out of time. Then I had to sum things up for the students.

“We’ve heard some different ideas today about the cause of this woman’s distress,” I said. “But let me just add this. To all of you in training to be mental health professionals, if you think this patient is mentally ill -- and your only evidence of that is her unusual belief that she was possessed by a demon -- then you must conclude that her pastor is mentally ill, too. And so is everybody else in their church, because they all believe the same thing.”

I finished telling my Grand Rounds story and looked over at Tom. “That’s an amazing case,” he said. “But it proves my point. With all that going on, there’s no way you could have predicted she was going to strike the pastor with a lead pipe. It’s just a good thing she didn’t have a gun.”

A couple of weeks later, on a cold and misty morning in Galveston, the phone rang and it was Grandma Swanson. Her voice was trembling. She said that something terrible had happened in the family. Kristin had come home for Christmas after her first semester away at Westmont. She went to a sporting goods store and bought a shotgun. She told the clerk it was a gift for her dad. When she got home, she went out behind the house. That’s where Uncle Jim found her. Later, he found the note that said she wanted to be with God.

* * *

I think I was reviewing a manuscript on a Monday afternoon in September, and I moused over on the screen to check my e-mail. There was a message from somebody at NIMH. It was about Wayne Fenton. The obituary in the Washington Post came out the next day:

Wayne S. Fenton, 53, a National Institute of Mental Health administrator who as an expert on schizophrenia devoted himself to making life better for those with severe mental illnesses, was found dead Sept. 3 in his office in north Bethesda. Montgomery County police have charged a 19-year-old patient he had seen that day.

Dr. Fenton built a reputation as an accomplished clinician, researcher, administrator and practitioner who often tackled the most difficult cases. A fiercely committed and patient professional, he combined his skills to benefit a segment of the mental-health population that he felt did not always get the necessary care.

His goal was singular and unselfish, his colleagues said: He wanted to help people with schizophrenia become functioning members of society.

In a 2002 article in The Washington Post, Dr. Fenton lamented the lack of appropriate care for those with schizophrenia. “All one has to do is walk through a downtown area to appreciate that the availability of adequate treatment for patients with schizophrenia and other mental illnesses is a serious problem in this country.

"We wouldn't let our 80-year-old mother with Alzheimer's live on a grate,” he said. “Why is it all right for a 30-year-old daughter with schizophrenia?”

-- Washington Post, September 5, 2006

* * *

If Hurricane Ike messed up everything in its path, one of the things in its path was Chuck Holzer. His house was flooded. He had a prized collection of hundreds of irreplaceable books, and he lost them. He was a tenured professor of psychiatry at the University of Texas Medical Branch, and he lost that too. The university said they were eliminating Chuck’s position under conditions of “financial exigency.”

I talked to Chuck and he said he was trying to put things in perspective. That’s when he told me that Tom Hoeksema had died. Tom’s life was falling apart. One day Tom left the office early and went home and shot himself.

I looked up Tom’s obituary in the newspaper, and it just said he “died at his home after a lengthy illness.” It said he was survived by his wife of thirty-three years and a son who lived in Austin. In lieu of flowers, the family invited memorials to the Boy Scouts of America, the Lions Club Crippled Children’s Camp, the building fund at the Lutheran church, or the charity of your choice.

* * *

You can wear a mask.
You can pass a law.
You can build a higher wall
on the Golden Gate.
You can walk on by and
pretend it only happens
to the men who live in tombs
at the beck of demons.

* * *

[1] Tod later obtained a PhD from the University of Chicago Divinity School and became a professor of Amazonian religious history at Arizona State University.

[2] Jim Brady survived the traumatic brain injury inflicted by John Hinckley’s gunshot, and became a passionate advocate of firearms control legislation. In 1994, the federal Brady Act (P.L. 103 -159) was passed into law, requiring federally licensed firearms dealers to conduct background checks and impose a waiting period of up to five days for all people attempting to purchase handguns. The law was intended to limit access to firearms by people presumed to be dangerous -- including felons, fugitives, illegal residents, and people who have been adjudicated “mental defectives” or have been committed involuntarily to psychiatric institutions.

[3] I have used a pseudonym, for reasons that may seem ironic, given the point of this essay.