Showing 1 - 10 of 182 annotations tagged with the keyword "Racism"

The Beauty in Breaking

Harper, Michele

Last Updated: Sep-18-2020
Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Beauty in Breaking is the memoir of an African American physician who, in her own words, has “been broken many times” (p. xiii).  

Despite maintaining a veneer of affluence, the author, her mother and siblings live in constant fear of being battered by her father. Following one particularly vicious attack, she accompanies her injured brother to the local emergency room. That day she serendipitously discovers her calling: “As my brother and I left the ER, I marveled at the place, one of bright lights and dark hallways, a place so quiet and yet so throbbing with life. I marveled at how a little girl could be carried in cut and crying and then skip out laughing” (p. 18).  

Much later, the author (Michele Harper) undergoes a shattering breakup and divorce. She endures disappointments at work, some of which, regrettably, can only be explained by the color of her skin.    

As she picks herself up time and time again, Harper discovers her inner resilience: “The previously broken object is considered more beautiful for its imperfections” (p. xiii). She learns from the experience of her own suffering to develop compassion in her clinical work. The bulk of the Beauty in Breaking is devoted to case studies of the author’s clinical encounters with patients in the emergency room.

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Dr. Futurity

Dick, Philip

Last Updated: Jun-29-2020
Annotated by:
Brinker, Dustin

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Jim Parsons is a physician living in an alternate 2012, one equipped with technology mildly superior to our own. While on his way to work, his car is abducted from the road and thrown off the natural path of life as we know it, both physically and temporally. Parsons finds himself in the distant future, roughly three centuries from his own, in a monoethnic society of young beings that resulted after generations of war led by people of color against the white domination of the A.D. era. The true ideology of the society is revealed when Parsons saves the life of a political radical, a proponent of the re-outlawed women’s suffrage. As he is taken into custody and processed for the crime of preserving life, the leader of the society, Al Stenog, describes the societal fetishization of death resulting from government-controlled population limits. Natural birth has been outlawed, enforced via early sterilization of males and a strictly monitored, equivalent exchange of deaths and births. Genetic material is selected via a tribal selection process based upon quantifiable measures of beauty and intelligence, whereby the fertile matriarch of the dominant tribe becomes the Mother Superior from whom eggs are harvested. The eugenic ideology extends into one’s conception of self—those currently living believe themselves to be genetically inferior to the zygotes housed in the government’s central repository. As a result, the society is described as being an amalgamation of all races of color whose average age is 15.

Stenog exiles Parsons to Mars, but his transport is intercepted by the masterminds behind his time travel. This group, now the genetically dominant tribe, explains their motive—the revival of their ideological patriarch. He has been cryogenically preserved for 35 years following an arrow to the heart. Parsons manages to save his life, but the patriarch is shortly thereafter found dead, his heart once again pierced with an arrow. It is revealed that the tribe intends to systematically eradicate all European colonization efforts in history, intending to halt centuries of white oppression; the patriarch had been stabbed during his attempt to begin the tribe’s crusade with the elimination of Sir Francis Drake in 1579. Returning to that time, Parsons discovers two startling facts: Stenog had traveled back to replace Drake, implying that all colonizers were from the future, and Parsons was the true killer of the patriarch, albeit accidentally. Despite the ensuing fallout involving much time travel, Parsons is returned to his own time, spared from temporal exile by his future children spawned from the impregnation of the Mother Superior.

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Responding to a shortage of doctors in rural areas in 2013, Dr. Virji, a Muslim, moved from the urban East coast to a small town in Minnesota.  Welcomed at first, he and his family began, after Trump's election in 2016, to experience withdrawal, suspicion, and outright racism in his own and neighboring towns, despite having established solid, trusting relationships with patients.  His children were being ostracized in school.  Discouraged, he took steps to accept a job in Dubai, but changed his mind after a local pastor invited him to speak in her church to correct common misconceptions about Muslims and to engage his neighbors in deeper dialogue about their differences and commonalities.  The lecture was so successful, he took it further into other towns and parts of the country.  He has stayed in Minnesota and witnessed change because of this invitation and his candid, open-hearted response. 

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This illuminating and disturbing book explores how various forms of white supremacy became expressed in policies, laws, and elected officials, such as Donald Trump. Physician and sociologist Metzl details social changes in Missouri, Tennessee, and Kansas, where white Americans backed changes that, ironically, dramatically harmed them with gun suicides, school dropouts, worse healthcare, and shorter life spans. For Metzl, “Whiteness” refers not to skin color but to a political and economic system of white privilege.

Metzl's thesis that: “Trump supporters were willing to put their lives on the line in support of their political beliefs” was, in fact, a sort of “self-sabotage” (pp. 5-6). While a conservative political movement fostered white racial resentment, largely in lower-income communities, the mainstream GOP did its part by crafting policies against the Affordable Care Act, higher taxes, and restrictions on guns. An atmosphere of polarization and political stasis grew. Metzl writes: “Compromise, in many ways, coded as treason” (p. 11).  

Metzl focuses on the examples of Missouri, Tennessee, and Kansas to “suggest how the racial system of American fails everyone” (pp. 16, 20). He visits each state, leading focus groups, interviewing formally and informally, reading newspapers, and inductively formulating concepts that seem to explain the nonsensical behavior of rejecting helpful programs. For example, because “risk” in Missouri has become a code name for possible attacks by black people, white people buy guns, especially when restrictions are removed. Many white men feel that a gun (or many guns) restores their privilege, but suicide of white males, often low-income, goes up. Metzl’s statistics and charts show contrasts with other states with stricter laws and lower suicide rates. He calls for preventive medicine to lower such deaths.  

For Tennessee, the Affordable Care Act offered many benefits to poor or middle-income people, but Republicans (and especially Trump) attacked it as big government over-reach, socialism, exorbitant cost, a program that would help minority people, for example “welfare queens.” “Cost” became a proxy for the “we don’t like it,” even when the economics would be favorable for good healthcare for all. Blacks were generally in favor of ACA, but white blue-collar men swore by their independence and autonomy. Neighboring Kentucky accepted ACA, and ten graphs included in the book clearly chart the better outcomes for Kentucky in such areas as insurance coverage, death rates, and seeing a doctor.  

Metzl returns to Kansas, where he grew up and recalls the pride Kansans had in their state. Republican Governor Sam Brownback enacted massive tax cuts with large reductions to state services and school funding, an “experiment” in “epic defunding.” The GOP, Tea Party, Koch brothers, and “trickle down” theories all played a part in benefiting the wealthy financially, while minority and lower-income groups paid more. Infrastructure, such as roads, suffered. Untested charter schools collected wealthy white students, while public schools plunged in funding, test scores, and graduation rates (see 17 graphs). Since education is a predictor of health, there are and will be long-term costs to Kansans, especially for minority groups.  

Metzl attacks the “Castle Doctrine” (“a man’s home is…”) as a symbol of narcissism, individualism, and as a risk for all citizens when social structures are abandoned. He closes with some hopeful examples of social change for the better.

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Annotated by:
Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

In Ladysitting, novelist and memoirist Lorene Carey writes candidly and reflectively about the year and a half she cared for her century-old, ferociously independent paternal grandmother. The experience became a critical moment for personal and familial discovery. Carey’s intensive caregiving began when Nana Jackson could not be discharged from the hospital to the house where, for decades, she had lived by herself. Growing up, Carey enjoyed enchanted weekends of indulgence in Nana’s sunlit suburban home in South Jersey, a respite from her family’s life in urban West Philadelphia. Partly in gratitude for those weekends, partly from a sense of duty, Carey made physical, emotional, and spiritual space for Nana in the home she shared with her husband, a minister, and their teenage daughter. Along with Carey’s own artistic, community, and professional commitments, she also maintained the property management business that her grandmother ran until her confinement. Carey’s decision to become Nana’s primary caregiver brought momentary satisfactions along with overwhelming frustrations.  

Carey’s narrative agilely transitions between present encounters with Nana Jackson and the past: her own past and her African- and Caribbean-American relations’. By doing so, Carey tries to make sense of the complicated woman in her care, herself, and relationships within her family. She discovered generations of mostly “free-people-of-color,” several financially and politically successful, whose ambitions confronted Reconstruction, the Jim Crow South, the migration north, and the “lynchings [that] made sure that every gain would be paid for in blood and money, if not by [her family], then by other black people, somewhere.” How might that history, Carey asks, help her understand her family’s generations of divorces (including her own), alcoholism, deceptions, estrangements, and the elusive efforts of one generation to build on the accomplishments of the others?   

It took Carey ten years to research and reflect on that question. And then to write, hoping “to clear away the rage, uncover the simple grief, stored in the muscles that seized up then and cannot remember how they were before, and to convince us both, Nana and myself, that she has left this plane. And to forgive.”  

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This is a gripping, informative, and well-researched book about human blood. An accomplished journalist, Rose George, covers a variety of topics, largely in the U.S., Britain, and Canada but also in Nepal, India, and South Africa. She describes many current issues, provides historical background, and speculates on future technologies, such as replacement of blood by other fluids. There are nine sections:

 “My Pint”  While the book’s title refers to the author's volume of blood, this chapter’s title refers to a single pint she is donating. We read about blood supply (donated and stored blood) in the U.S. and—by contrast—in India.

“The Most Singular and Valuable Reptile” refers to the leech. This arresting chapter describes both historical and  modern uses of leeches to gather blood from humans. She visits a company called Biopharm in Wales where leeches are raised and prepared for shipment to medical clinics and hospitals.  

 “Janet and Percy” is a historical chapter focusing on Dame Janet Maria Vaughan, a central figure in creating the Blood Transfusion Service in England during WWII and Percy Oliver, who guided its predecessor, the London Blood Transfusion Service.  

“Blood Borne.”  This chapter describes Khayelitsha, South Africa, “the ugly backside of Cape Town” (p. 100): a place of poverty, crime, rape, sexual predation, and HIV. While rich nations provide assessment and treatment for people with HIV, poor nations have many citizens infected with the virus and, over time, rising rates of infection. 

 “The Yellow Stuff” describes the plasma portion of blood; it can be frozen (as FFP) and used as a filler for bleeding or trauma patients. Unlike blood—which can only be given without payment—plasma can be collected from paid donors. It is a largely traded commodity, part of a multi-billion dollar industry worldwide. Plasma carries Factor VIII, a crucial protein for clotting blood; hemophiliacs lack this and are at risk for death by bleeding externally or internally. Some plasma has been tainted, for example by HIV.

“Rotting Pickles.”  In Western Nepal (and other places), menstruation is taboo. George writes, “We are in a minority among species, and among mammals, to bleed every month.” She reviews historical views of women’s periods, mostly negative. Worldwide, there are many taboos, but also some educational efforts for public health that are helpful in impoverished areas.  

 “Nasty Cloths.” This tells the unusual story of an Indian man named Muruga, “a poorly educated workshop helper” who became a leader in creating sanitary protection for menstruating women. Worldwide, the feminine hygiene industry is some $23 billion. George also reviews related history, including Toxic Shock Syndrome from tampons.  

 “Code Red.” Bleeding is often a fatal factor in trauma, even with the best efforts to transfuse blood into the patient, unit after unit. George observes open chest techniques at a resuscitation. She reviews breakthroughs in blood typing, component therapy, and “buddy transfusions.”  

“Blood like Guinness: The Future.” George starts with images from the past: vampires, human drinkers of blood, past and, even, present. She interviews a purveyor of the concept that “young blood” is healthier than older blood. Can there be, discovered or created, blood substitutes that also save lives? 

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Exit West

Hamid, Mohsin

Last Updated: Oct-22-2018
Annotated by:
Redel-Traub, MD, Gabriel

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Exit West, a novel by Mohsin Hamid, follows two young lovers as their (unnamed) Middle Eastern city descends into war. The story is an intimate look into how quickly war can warp the quotidian routines of daily life. It begins by introducing us to its protagonists. Nadia is a fiercely independent and thoroughly modern woman; she lives alone, rides her vespa around and listens to jazz records. Saeed is perhaps a bit more traditional—he lives with his parents—but is still a typical university student (he brings a joint to one of his and Nadia’s early dates.) The city is a cosmopolitan one, if not a bit outdated. However, as Nadia and Saeed’s relationship deepens, the initial hints of insurgency become apparent: drones and helicopters buzz constantly overhead, a night curfew is implemented, the window with a nice view becomes a liability as gunfire breaks out. The city descends bit by bit into all out war. As this happens, rumors of magical doors that whisk people away to distant lands begin to circulate. Nadia is keen to find one of these doors; Saeed is hesitant to leave in part because his parents are unwilling to join them. Eventually with growing violence in the city, the couple decides to enter a door and together are transported to Mykonos where they join hundreds of other migrants and refugees from all over world who are living in makeshift homes. The second half of Hamid’s novel follows the couple’s life as refugees, traveling from Greece to England and eventually to the USA. Hamid portrays the psychological cost of exile, loss and dislocation—a cost which slowly drives Nadia and Saeed apart.

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This important and much needed book describes the psychological difficulties of doctors in training and in practice and the woeful lack of support to them from teachers, colleagues, and institutions. When there are over 50 percent of doctors suffering burnout (or depression, even suicide), shouldn't we see and ameliorate this "significant public health crisis" (p. 263)?
Carolyn Elton is a vocational psychologist who has spent the last 20 years working with doctors in England and the U.S.  She has worked with over 600 doctors in a wide variety of specialties. 
  
 
Introduction: “Medicine in the Mirror”
Elton starts with a real-life email from a desperate medical student. She cites examples of med. students who commit suicide, studies of depressed doctors, and surveys that show impacts on medical care for all of us when it is given by doctors suffering from poor morale.

Ch. 1, "Wednesday's Child" discusses young doctors suddenly thrown into clinical practice; many are unready for the stress, and many training programs do not support them sufficiently.

Ch. 2,  "Finding the Middle." Many senior doctors are inhospitable to young doctors, especially those trained in other countries, for example India. There’s hope for sharing and support in  Schwartz Rounds, where staff (clinical and nonclinical) meet and discuss issues.

Ch. 3,  "Which Doctor." We learn that many troubled doctors have chosen the wrong specialty for them, often because of a specific illness in their families. They should have more time to chose or, even, to change specialties.

Ch. 4, "Brief Encounter."  Psychological concepts of transference and counter-transference are helpful in understanding sexual issues (examining patients' sex organs, homosexuality, sexism, inappropriate humor, attraction to a patient, even past sexual abuse). Many of these are common but so taboo that they are ordinarily—and unfortunately—not discussed in training. 


Ch. 5, “Role Reversal.” The book’s title “also human” is front and center here, because doctors become sick, injured, or otherwise compromised so that they must have medical assistance. Regrettably, other doctors often dismiss such problems or even blame the doctor for causing them or not overcoming them. Further, doctors often try to avoid a sick role. Psychological dilemmas and physical disabilities are often stigmatized.

Ch. 6, “Leaky Pipes.” Women doctors are often ill-treated, especially in surgery, where “surgical culture embodies masculinity” (p. 152). Women wishing to have children and family life in general are seen as slackers. Women doctors often “leak out” from hospital work to part-time community-based roles.


Ch. 7, “Risky Business.” Once again, we read that there is bias against Asian, black, disabled, or female doctors.  Specific examples and studies from social science make this dramatically clear. This unfortunate dynamic makes careers in medicine for such doctors “psychologically risky” (p. 192).

Ch. 8, “No Exit.” For many reasons it is hard to quit medical school, later training, or work in medicine, even when this is the best choice. Doctors often feel pain, even guilt when patients die, and they have little support.

Ch. 9, “Natural Selection.” Reviewing many problems already discussed, Elton summarizes: “sometimes the dream of training as a doctor turns out to be a nightmare in reality” (p. 229).  There’s bias in selection of students, reliance on tests with limited accuracy, insensitivity to the whole person, and inappropriate retention of students who should not become doctors. The Darwinian chapter title is ironic; much of the medical world as structured today is not natural.

Epilogue, “There’s No Such Thing as a Doctor.” This arresting subtitle brings us back to the personhood of doctors, who have psychological needs right along with the rest of us. Regrettably, “doctors’ psychological needs are denied, ignored, not thought about. Unmet” (p. 258). Sexism and racism are common. Lister’s reforms took a long time but are now pervasive and standard; can we similarly expand better care for doctors?  “Improving the emotional well-being of the medical workforce requires interventions that tackle three interconnected levels—the individual, the organization, and the culture of medicine as a whole” (p. 265).

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Summary:

This is an important contribution that analyzes, critiques, and aims to correct structural inequalities (racism, sexism, capitalism) that influence contemporary medicine, with particular attention to the technical influences of computers, “big data,” and underlying values of neoliberalism, such as individualism, exceptionalism, capacity, and progress through innovation.  

Introduction: Theorizing Communicative Biocapitalism
Banner writes, “biocapitalism is comprised by the new economies and industries that generate value out of parts of human bodies” (p. 12). Parts include DNA, ova, and organs, but there’s also data from medical care, where patients are reduced to their physical bodies and/or to their “digital status” in medical records, research, even personal information volunteered on the Web, all which is indicated by the term “communicative.” As an example, Banner cites the large realm of patient on-line groups that are exploited by large companies as free labor, thus reducing the voice of the patients. Approaches of narrative medicine and medical humanities have not dealt with digital health, market forces, and the implied power relationships. Perhaps the new subfield of health humanities has promise to do so, if not also captive to “the logic of the market” (p. 17).   

Ch. 1. Structural Racism and Practices of Reading in the Medical Humanities
Banner writes, “Medical racism is a product of structural and institutional racism” (p. 25). She finds that current approaches from interpretive reading are insufficient because “the field’s whiteness has contoured its hermeneutics” (p. 25). Instead of the “reading-for-empathy” model, we should read for structures of racism, sexism, privilege, as well as economic and political inequality. She illustrates such reading with texts by Junot Dìaz, Audre Lourde, and Anatole Broyard.  

Ch. 2. The Voice of the Patient in Communicative Biocapitalism
 Patients have flocked to networking websites, voluntarily posting much personal information. Banner analyzes how technocapitalists mine these sites for data to use or sell. Patients’ information, given voluntarily, amounts to free labor and, even, work-arounds for companies that avoid expensive double-blind controlled studies. Rhetoric for these sites speak misleadingly of the “patient voice,” “stakeholder,” or “story sharing” and hide the exploitation involved. The chapter is specific for websites, drugs, and drug companies.  
Banner discusses (1) the “feminized labor” involved with sites for fibromyalgia and chronic fatigue syndrome (both “contested diagnoses”) and (2), more abstractly, the medicalization of the clinical gaze on patients who participate in websites and yearn for “an imagined state of purity,” and/or “an ableist vision of norms and reparative medicine” (p. 61). Overall, the digitalized-patient voice is colonized by forces of whiteness and should be decolonized. She discusses writing by Octavia Butler and Linda Hogan, both women of color.

Ch. 3. Capacity and the Productive Subject of Digital Health
This fascinating chapter describes and critiques “digital self-tracking,” or the use of devices such as Fit-Bits that help create and maintain the so-called “Quantified Self” (or “QS”). Banner finds this fad within the tradition of the Enlightenment (Ben Franklin) so that “exact science” may “optimize” individuals by being “responsibilitized” in a “self-sovereign” way. QS users understand that “Everything is data” (p. 83). She argues that this trend emphasizes “masculine objectivity” while “disavowing debility” (p. 85). Collected data may contribute to a “worried well” status or conditions of “precarity” or “misfitting.” She writes, “QS practice remains an inscription of the self as a self-surveillor, engaged in masculinized practices of neoliberal self-management” (p. 91). She discusses the technologies of the devices Scanadu, Melon, and Scarab. She provides and interprets photos of visual arts representations by Laurie Frick, who is a “self-tracker.”  

Ch. 4. Algorithms, the Attention Economy, and the Breast Cancer Narrative
Banner discusses Google Analytics, later Alphabet, which includes Calico and Verily, which have partnered with pharmaceutical companies. Such combinations of algorithms, capitalism, and media aim to capture the public’s attention, especially online. Messaging about breast cancer becomes reductive, emphasizing medical solutions, not prevention, and it avoids discussion of causes such as environmental pollution. Some critics decry “pinkification” of breast cancer. Public stories, such as Angelina Jolie’s, emphasize individual empowerment, a “hegemonic construction of illness”’ (p. 112), and these are amplified by mass media, both print and electronic. More diverse messages would value “heterophily over homophily” (p.121).   

Ch. 5.  Against the Empathy Hypothesis
Drawing on several commentators, Banner critiques the notion of empathy as a goal for caregivers as condescending to the patient and suspect when allied with productivity and efficiency for institutions. Further, the notion of “resilience” (in a “bleed” of neoliberal rhetoric into health humanities) has been misused in applied literature, parallel to notions of self-help and self-management. Some hermeneutics still support values of “state and capitalism” and ignore writers of color. Banner discusses the work of African-American poet Claudia Rankine, some of whose work is “postlyric,” and J. M. W. Turner’s painting “The Slave Ship” that illustrates “necropolitics.”  

Conclusion
Throughout the book Banner illustrates reading “for structure” in her interpretation of texts and visual images but also in medical institutions and practices and, still further, in the enormous and pervasive world of government forms and programs, big data, computers, and beyond. She finds structures of capitalism, sexism, and neoliberalism within existing “heteropatriarchal, ableist, and racist frameworks” (p. 154) despite claims of neutrality. She urges medicine and the humanities to develop new methods. She mentions specific collectives and communities that now challenge such norms (such as Gynepunk and CureTogether), and she calls for thinkers in many disciplines to confront demeaning technology and to “engender spaces in which care is more just, and more humane” (p. 156).      

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This powerful—even disturbing—book examines the state of Louisiana, a home of the Tea Party, multiple polluting industries (oil, chemicals), environmental degradation, bad health for all, including children, and politics and economics that favor corporations not local business. 

In Part One, “The Great Paradox,” sociologist Hochschild interviews locals, attends civic events, sits in cafes, and listens to stories. Bit by bit she understands that right-leaning people believe in Republican notions of less governmental regulation despite suffering from the ill effects of living in “red” states, even individual counties, that are the most polluted in the U.S. (pp. 79-80).  She calls this disparity “the great paradox.” Locals call a portion of the Mississippi between Baton Rouge and New Orleans “Cancer Alley” (p. 62), but there is no popular demand for control of pollution.

Part Two, “The Social Terrain” discusses history. Earlier, Louisiana had economies of fishing and farming in tune with the landscape. New industries, including Big Oil changed all that, with promises of jobs and wealth for all—neither of which occurred, because oil is largely mechanized, and wealth went to corporations, some headquartered in other countries. Further, there was not just pollution but also large sinkholes and the BP Horizon blow-out of 2010. Problems of on-going pollution were ignored by the Press, especially Fox news, and the “Pulpit” (evangelistic Christianity) took the longer view, urging continued human exploitation of nature, patience for ultimate rewards, and the hope that “the rapture” would ultimately save the most worthy Christians.

Part Three is “The Deep Story and the People in it.” Hochschild formulates an unspoken but motivating narrative of values in Louisiana. This metaphoric story represents deep feelings, including urges for a success that is always thwarted. In the story, there is a long line of white, Christian people, mostly male, often with limited education, waiting in line patiently to climb a hill. On the other side is a good job, wealth, security, and reward for the long waiting. Tragically, there are “line cutters,” symbolized by President Obama and other blacks who had various preferments, but also women, also immigrants, also refugees, even the brown pelican, the Louisiana state bird that needs clean water and fish to survive. The people in line feel betrayed. Where is progress toward the American Dream? Fair play? There is hatred toward the line cutters, and loyalty toward the similar people in line and the industries that will save them. Pollution is unfortunate but a necessary cost.

“Going National” is the fourth part. Hochschild reviews the plantations of the South that not only brutalized slaves but also caused poor whites to move to non-productive land, while the wealthy always improved their lot. People from the North were (and are) suspect, with policies of integration, abortion, gun control, etc. The North cut in line. People in Louisiana became “strangers in their own land” and therefore glad to support not only Governor Bobby Jindal (who “left the state in shambles,” p. 232) but also Trump who would “make American great again.” The “strangers” have gone national in the U.S. and even in some other countries. Hochschild drafts two short “letters,” one to the liberal left and the other to the Louisiana people. She suggests that the two polarized groups have more in common than they currently imagine.  



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