This is the second post in a three part series aimed at summarizing some of the arguments made at Notre Dame during the Center for Ethics and Culture’s 15th annual conference, this year on poverty. You can read my first post here. In the following post, I’d like to elaborate on the ways in which we are all called in our own vocations to participate in solutions to material and spiritual poverty.
The first breakout session I attended was a panel of medical doctors moderated by bioethics professor William Hurlbut of Stanford University. Each doctor gave insight into the ways the medical field is uniquely challenged with questions of poverty and how doctors should work to reform the system.
Dr. Lauris Kaldjian of the University of Iowa gave the first presentation, entitled “Healthcare Professionals as Advocates for the Poor Patients.” As Kaldjian described, most poor patients unfortunately do not have the funding for necessary treatments. In one instance, a treatment for Hepatitis C, which has an efficacy rate of 80–95%, costs thousands of dollars, which is far outside the price range of the majority of its target patients. In order to provide treatment for said individuals who cannot pay for expensive healthcare procedures, doctors are called upon to be advocates for individuals to medical boards to provide the care at little to no cost. The system is rife with bias and often leads to the subjective misallocation of medical resources. But on the level of the provider, the healthcare demands place doctors in a moral and ethical bind when treating their patients. Clinical decision-making requires of doctors the dual obligation to balance the clinical needs of individual patients with the economic needs of the population. The dual role of care provider and economic allocator leads inevitably to the internal compartmentalization, or the need to act according to context rather than with consistency. By nature of their work, doctors and healthcare providers often face moral fragmentation because of the incommensurability of contrasting moral values that are called upon in each of their two roles.
Kaldjian suggested that in an effort to solve the problem of moral fragmentation in the medical sphere, we must create a division of moral labor. Kaldjian argued for a system with representative advocacy and high role fidelity. This means that separate individuals would be the advocate for care and the decider of allocation in each particular situation. This representative advocacy is opposed to the current separation of moral selves in one individual that must take place when doctors are expected to be advocates for their patients and allocators of resources for the community. The division of moral labor allows for role-specific dialogue that allows doctors to maintain their integrity to their patients while faced with economic constraints to the care they can provide.
In a second talk, the soon-to-be doctor Cliff Arnold spoke on “Psychiatry, Poverty, and the Catholic Worker Movement.” Arnold is closely associated with the Catholic Worker House near Notre Dame, which he described to be “just outside of the psychiatric community,” meaning that the clients at the Worker House are often current or former psychiatric patients. From a both scientific and personal perspective of working at the Catholic Worker House, Arnold argued that the medical care and language used today to describe mental health problems are woefully undercutting the ability to solve psychiatric problems. He illustrated the pathology of the field of psychiatry as a turn toward the medicalization of psychiatric disease. By labeling a condition as a disease, Arnold stated, the medical rhetoric often undermines the resolve that afflicted individuals need for avoiding certain behaviors. In describing genetic predisposition to alcoholism, for example, we weaken the morale of individuals to remain abstinent. The overmedicalization of conditions subliminally germinates a sense of inevitability and simultaneously a sense of exculpation from the guilt of succumbing to the “strictly biological” condition.
Furthermore, Arnold pointed to 1980 as the moment of paradigm shift in the medical narrative of psychiatry. Before 1980, psychiatry attempted to explain problems rather than to categorize them into disease categories. Psychiatric illnesses were thought to be largely caused by environmental factors, and “talk therapy” was the most commonly used approach, among only a few other unsavory “experiments” like electroshock therapy. Today’s model of treatment—the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—instead takes an “atheoretical approach to etiology,” meaning that treatment is provided based on the development of symptoms without consideration of any further causes. This revolution in psychiatry was the result of the pressure to modernize this field of medicine to be in step with other fields which were already committed to the modus operandi of isolating and treating clinically observable symptoms apart from their moral and potentially environmental contexts. Charles Taylor says that we have reconstructed the science of man into the natural sciences model because of its success rates in describing nature itself. However, according to both Taylor and Arnold, the natural science model is not appropriate for assessing the wholeness of human problems, especially relating to psychiatry. A reductio ad absurdum example of this atheoretical approach would be for doctors to one day see smoker’s lung and diagnose the patient with black lung syndrome and try to give them drugs to clear the tar coating of their alveoli, rather than mentioning the fact that it was being caused by cigarettes and ought to be stopped.
Arnold concluded his remarks with a three-pronged description of the failure of modern psychiatry. First, it excludes considerations of virtue. That is, the psychiatric treatment model does not consider growth in moral virtue as a necessary or possible avenue for ameliorating a psychiatric condition. For example, a child with conduct or behavior disorder in his first grade classroom might be immediately prescribed with antipsychotic meds as a child. In the immediate, he is subdued and able to maintain his behavior throughout high school while he is on the medication under the auspices of his parents and the school. However, when he graduates high school, our once first grader with bad behavior is now an adult who is likely to come off of the medication. Now as an adult, his moral growth has been completely stunted. By being in a constant state of sedation, he was not afforded the opportunity to form internal habits and wrestle with the virtue of self-control as a child. The example translates into many examples of the way adults try to find quick solutions to a child’s behavior, rather than seeking long term solutions that understand the habitual anthropology of man.
Secondly, Arnold argued, psychiatric discourse ignores personhood in its method of treatment. The prison system is a revolving door for mentally ill patients, and the particular return rate of individuals is negatively correlated with the degree of communal support an inmate receives after release from the psych ward. Medical treatment regimes do not include the need for reciprocity and love in the healing process of a mental disorder, or the need for man to be in a community, and thus the resolve of each patient is weakened on his or her own. And lastly, today our medical approaches to psychiatric disorders would never broach the topic of reliance on faith in God for healing. Its value is self-explanatory, but our politically correct, value-agnostic society would never allow for such language in the medical discourse, and the rates of mental health are ever rising.
The founder of the Catholic Worker movement in 1933, Dorothy Day, advocated for the building of a society “in which it is easier for people to be good.” Arnold claims that our approach to mental health and psychiatric disorders fails to create such a society by bracketing and ignoring genuine aspects of human personhood. The poor are disproportionately affected by the failings of our psychiatric medicine. But we could only begin to reincorporate human elements into patient care if we move away from a payment scheme that only understands outputs and results in terms of money.
Arguing again for a reality check about the amount of prescriptions that are written for various psychological disorders, Arnold told the audience, “The antidote to loneliness is love—an active, virtuous love.” We have to reach outside our natural sciences mentality if we seek to solve rather than treat psychiatric disorder.
The role of education, particularly Catholic education, was another player in the conference’s discussion of the problems of poverty and proposed solutions. In a presentation on the statistics about education in Chile, Archbishop Fernando Chomalí Garib of Concepción, Chile, illustrated the essential nature of education as a vehicle of social change and mobility in impoverished populations. While the number of Chilean children who pursue education continues to rise from 100,000 to nearly one million in the past several decades, Archbishop Chomalí asserted that a child can only receive the quality of education proportionate to the amount of money his father makes, which presents major limitations to its effects.
Following the archbishop, Professor Nicole Garnett of Notre Dame continued the education discussion by presenting the past, present, and future of the Catholic school system. She began with the lamentation that we are treated the closing and merging of Catholic schools with the “hospice mentality”: That is, as long as we make them comfortable as they decline and close, it won’t be such a big deal. Further, as a whole, the American and even Catholic population has taken the demise of the relevance of Catholic schools as a given rather than as a tragedy, and few are fervently fighting for their survival. Why don’t Catholic schools seem relevant anymore? What will be lost if we allow the largest education chain created in the nineteenth century just to die?
In an answer to that question, Garnett suggested several chief losses to American education if we euthanize Catholic schools. First, educational pluralism will be diminished. Against a Protestant backdrop, Catholic schools were formed to provide a countercultural witness and an authentically religious educational experience to immigrant children. In these religious schools, the joy of vocation is modeled for the children every day. Furthermore, Catholic schools are known incubators of social capital. Catholic schools are the single most effective anti-poverty intervention that has ever been conceived. Not only do students tend to move up income brackets, but neighborhoods are also impacted by the stabilizing institution. By measuring neighborhood changes after Catholic schools close down, researchers have noted that communities become less socially cohesive and more dangerous in the years following the closure. Catholic schools serve to reduce the disorder and provide stability that allows a community to flourish and thrive.
To make these Catholic schools viable on a political level, attorney Shavar Jeffries added to Garnett’s remarks that we need increased school choice and competition. The heavily regulated lockstep micromanagement of public schools hinders improvement and hurts kids in urban environments who are marshaled into the nearest numbered school on the brink of dilapidation. Bureaucratic school systems do not have the autonomy to be in the best interest of the students, while Catholic and charter schools do have the necessary flexibility and adaptability to work on educating their particular students. George W. Bush once described the cornerstone of his presidency to be combatting “the soft bigotry of low expectations,” especially in educational contexts in which the achievement gap between the rich and poor is only increasing. The reality is that students don’t drop out of college because they aren’t ready for college, but rather because they aren’t prepared for college. Jeffries argued that reform should be focused on making more good seats available for students, and this approach requires more than just money and resources but dedicated individuals willing to put in the hard work it takes to educate children.
And so the conch has been sounded for committed and strong leaders who have a vocation in education to take on the work of these schools. With a dedicated principal and pastor combination, a strong identity and mission, and an increased effort to reach out to immigrant children, many Catholic schools can be revitalized. St. Teresa of Avila reminds us that “Christ has no hands but ours,” and it is this human initiative that makes the stuff of miracles. The Catholic school system has earned its place at the education reform table, and it is up to us to make sure we have a hand in the reform.
In the last section of this post, I’d like to address a couple of points about ways in which our daily choices outside of our particular vocations should be informed by a sense of innate poverty that is the condition of the human person. A panel session entitled “Blessed Are the Poor in Spirit” served to point out the subtleties about how we live our daily lives, even when our vocation is not to a life of material poverty.
In writer Michael Bradley’s presentation, entitled “Asceticism Contra Mundum,” he argued that we are all on a lifelong pursuit toward purity of heart. Charity, chastity, and orthodoxy: That is, right love, right sexuality, and right faith are goods rightfully sought by the heart. Bradley drew the comparison to C. S. Lewis’ fictional novel Till We Have Faces, in which the protagonist comes to the realization that the gods won’t speak to them or see them face to face until they have faces themselves. It is purity of heart in the Christian context that allows not just looking at but also gazing between God and man to exist. Bradley turned to the Eastern paradigm to demonstrate the perfection of the heart in three stages: (1) passion, which in the Eastern tradition is considered unqualifiably negative and base, (2) asceticism, a period of discipline or training to serve as an antidote to the unrest of the passions, and finally (3) apatheos, which unrelated to its English cognate, means impassible passion. It is apatheos which describes the pure heart, one that can embrace asceticism joyfully as part of a process of discovering our own identity. Bradley argued that the paradigm of asceticism allows us to live uprightly and discover our own faces, our own vocations. It is a transformative remedy of our own maladies and a reflection of the Cross.
We should feel the call toward asceticism as a serious spiritual and moral calling. Though vocational asceticism isn’t the calling to material poverty for all of us, it ought to be a part of consciousness when we make daily consumer choices. The beauty of Christian asceticism is that it doesn’t call for disdain or repudiation for the material, but rather for the vices that are associated with the material. In On Liturgical Asceticism, author David Fagerberg says tersely, “It was never money, sex, or beer that the ascetic opposed, it was avarice, lust, and drunkenness.”
As the spiritual is often reflective of the physical, seemingly achieving spiritual poverty without material poverty presents additional difficulties to individuals. Macarena Pallares of the Intercollegiate Studies Institute also presented a paper related to the call to poverty that is present in every vocation, called “Native Poverty and Tragicomic Grace in Catholic Literature and Thought,” coauthored by Travis LaCouter. Pallares described the tragicomic personalism that is the Church’s vision of the poor in spirit and the ways in which Christian fiction can properly show the drama of the tragicomic Christian paradox. Divine grace is tragic because God enters into human fallenness and is open to the contingency of human free will. As humans made in the image and likeness of God, we should likewise seek to assume the posture of a begger—one who is open to receiving a gift. The experience with our own native poverty will bring us closer to the disposition of the Christian vision, which is oft distorted in the disorienting nature of freedom.
Pallares presented a counterexample to demonstrate the task of Christians to understand and assume a disposition of openness and poverty of spirit. Lucretia, the Roman heroine who committed suicide in the face of the shame of rape, did so, Pallares argued, because she was unable to express her inner conscience and was left only to act physically to demonstrate her purity. Christians on the other hand are faced with tragedy of a far more personal nature and must be able to communicate the secrets of their inner conscience with one another and be sensitive to anthropological truths about man’s nature. Christian fiction helps us to mimic and understand the internal narrative of the Christian vision in a way that seeks to emphasize rather than rewrite the reality of our own native poverty and dependence on God.
Without the daily acknowledgement of poverty, either as we see it on the streets or in the depths of our heart, we are failing to see the reality of our world and of ourselves. Without the openness of a poor beggar, we can hardly expect to find our true nature and see God face to face as the pure of heart.