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don't think of an elephant - or - changing the frame on the schiavo debate

I've been reading Don't Think of an Elephant! Know Your Values and Frame the Debate -- the Essential Guide for Progressives" by George Lakoff. I've been trying to apply Lakoff's theories to the Schiavo case, because I see this dissonance between "don't let poor terri starve to death" and socially conservative fiscal policies: "cut taxes on the rich and cut spending, except for on defense."

The religious conservatives are doing a fantastic job of framing the debate on Schiavo; it's how they're getting away with espousing these "culture of life" policies that are so at odds with their fiscal policies. The religious right has framed the debate as "Activist judges are starving and thirsting poor Terri to death." This frame sets up the opposing position as, "We should let people starve and thirst to death," and, "This woman with a vacant grin in a flower nightgown should die." If we (the progressives) accept the religious conservatives frame on the debate, we sound like heartless villains.

Let's consider another frame for the debate, a frame in which this story began more than twenty years ago, not fourteen. Why did a woman in her twenties have a sudden traumatic loss of oxygen to the brain? Could this have been prevented?

Twenty years ago, a young woman named Theresa struggled with her weight and self-esteem. In high school, she weighted 200 pounds, then quickly lost 50 pounds. This rapid weight loss was a symptom of her bulimia, a sometimes-fatal eating disorder. When she went to college and got married, her health stabilized, but after a few years the eating disorder re-emerged. We don't know, today, whether she was being treated for the eating disorder, or what sort of treatment she was in, but we do know that whatever help she was getting wasn't enough. Like many other people with eating disorders, her compulsive behaviors seriously threatened her health. People with bulimia, by definition, alternate between overeating and restricting food, far beyond the behaviors of a normal dieter, and sometimes beyond the limits of human physiology. In 1990, Theresa's compulsive behaviors had caused such damage to her body that her heart could no longer supply blood to her brain. Much of the cortex of her brain died due to hypoxia; only the central, ancient parts of the brain survived.

An eating disorder caused a massive decline in Schiavo's physical health over the course of several years. The state of the art in treatment of eating disorders calls for a combination of social, behavioral, psychiatric, and physical methods, including frequent monitoring of vital signs. Changes in physiology, such as those that surely presaged Schiavo's injury, are corrected before they become life-threatening. Affordable, available, effective health care would have improved Schiavo's health. I do not know what, if any, treatment Schiavo received for her eating disorder, but I do know this: a large fraction of adolescents and young adults do not have any health insurance, let alone access to comprehensive mental health insurance. The Schiavo case should be an object lesson in the risks we face as a society without guaranteed medical treatment for all who are ill, regardless of their ability to pay.

A few years after Schiavo's injury, her family sued her doctor for malpractice. Their suit was successful, and they were awarded over one million dollars, 70% of which was placed in trust for Schiavo's care. Tort reform, as favored by the president and his party, would cap this amount. What would Schiavo's care have been like without this award? Schiavo's case demonstrates that large awards for medical malpractice are sometimes necessary.

The collapse fourteen years ago damaged huge portions of her brain. Look at this CT scan of Schiavo's brain. Her head is full of fluid where her brain used to be. How different would this debate be if this picture of her destroyed brain was shown every time the flower-nightgown-vacant-grin video was shown?

And finally -- she was born with the name Theresa Schindler. Calling her by the diminutive of her first name, as much of the media has done, enforces the idea that there is a person there, and even connotates a child. The media does not usually refer to full-grown adults with diminutives of their first names.

By allowing the conservatives to frame the debate, by allowing their nomenclature and images to infect all media discussions of the Schiavo situation, the progressives have lost a tremendous opportunity to increase awareness of mental illness, to argue for universal health care, to fight tort reform... and we have let the religious right villainize us again.

How many people with eating disorders are "starving and thirsting themselves to death" in the United States today? How many children go to school hungry because their parents can't afford to feed them? How many communities in Africa lack a safe water supply? The conservatives say the strong should take care of those who cannot take care of themselves. I'm glad Schiavo's heart has finally stopped beating. Now let's see what we can do about the millions of people who lack the kind of care that would have prevented this woman's tragedy.

Reader Comments (4)

At a Berkley lecture last week, Lakoff said not to use the word "she" when referring to Schiavo, as even thet denotes personhood.

3.31.2005 at 06:22 PM | Unregistered Commentercoturnix

You make a very interesting case and I agree with some of your points. However, you suddenly fall into the same pitfall as the rest, you frame, when the issues touch on things that fit within your own political frame. For example - the family sued the doctor for malpractice. Why did they do that? Was there really a case for this? Several other Schiavo reports have clearly pointed out that the husband was not blameless, was controlling and hounded this woman regarding her weight. In cases of bulimia, adequate social support in the home is essential for success of any therapy. So why sue the doctor? And how does it follow that the amount awarded was reasonable?

Another issue that you almost touch upon but really pass over in favor of the argument that young people should have insurance but can't afford it, is that having insurance is actually not enough. It is not enough because most insurance (especially ones that are offered on college campuses) DO NOT SUPPORT ANY KINDS OF ROUTINE EXAMES OR PREVENTIVE CARE! What is even more interesting is that some studies suggest that people without insurance tend to be more careful with their health and actually take care of themselves more. This is NOT an argument in favor of some people never having a insurance, but simply a suggestion that the current insurance system has some very serious flaws.

In general, American medicine is actually guided more by insrance rules than by the decisions of the doctors themselves (see an article on this in the latest issue of the New Yorker if interested). What could have saved Theresa is some form of preventive care in between the two bulimia episodes (this is common), which was likely not covered by her insurance. Insurance only pays for you if you get sick. It does not help you stay healthy, if you happen to be. If you are healthy, you are their cash cow and there is no way they will want to spend money on you. In the long run this can backfire (i.e. 15 years on life-support while people closest to you battle out their ideology).

Yet the question remains - exactly why did the second bulimia episode occur? The causes will never be known, but if you are going to frame your piece around the fact that this disease can be deadly, it may be useful to attempt speculating about the causes.

4.1.2005 at 06:14 AM | Unregistered CommenterQ

One more thing. The size of the malpracitce suite award may have done a lot of damage to the case of this woman. 1. Her family was able to keep her on life-support for 15 years (and find two doctors that 15 years later actually claimed she could come back with therapy). 2. It created a rift between the people who were taking care of her. Maybe the money was the root of all evil after all.

4.1.2005 at 06:16 AM | Unregistered CommenterQ

"We sound like heartless villains..."

You got that right! Heartless and sick. And misinformed.

E.g., your point about tort reform is dead wrong (excuse the expression). Nobody argues that actual damages for long-term care, rehabilitation or other expenses should be capped (only non-economic damages). And the malpractice suit in this case had nothing to do with the cause of Terri Schiavo's condition; the claim was that a doctor who examined her for fertility treatments should have detected her potasium deficiency and informed her.

Terri Schiavo wasn't sick and she wasn't dying. Such noted right-wingers as Ralph Nader, Jesse Jackson and Tom Harkin spoke out against the injustice that was done to her. (Yes, "her".)

4.6.2005 at 06:09 PM | Unregistered CommenterAnonymous

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