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.
Monday, April 18, 2005 at 6:31PM