{"id":2210,"date":"2020-02-04T10:00:04","date_gmt":"2020-02-04T09:00:04","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=2210"},"modified":"2020-01-24T10:53:45","modified_gmt":"2020-01-24T09:53:45","slug":"a-legacy-of-collateral-suffering","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2020\/02\/04\/a-legacy-of-collateral-suffering\/","title":{"rendered":"A Legacy of Collateral Suffering"},"content":{"rendered":"

Review of Am\u00e1<\/em> (USA, 2018), directed by Lorna Tucker, and produced by Bullfrog Films <\/strong><\/p>\n

Written by Professor Robert Abrams, Weill Cornell Medicine <\/strong><\/p>\n

Am\u00e1<\/em>, a powerful and disturbing documentary, tells the hitherto little-known story of the systematic relocation and involuntary sterilization of Native American women in the United States between 1960 and 1980. In a moving series of interviews, women individually tell how they were isolated, misled, controlled and mutilated, damaged both physically and psychologically in ways that could never be relieved or reversed.<\/p>\n

To what end did these women suffer? A partial answer is presented at the point in the film when Dr. Reimert Ravenholt is introduced and interviewed. Dr. Ravenholt is a now-retired physician-epidemiologist with a passion for family planning. After receiving his MPH from University of California at Berkeley in 1956, Dr. Ravenholt embarked on a career focused on family planning and population control as tools to promote health and quality of life in developing countries and in impoverished pockets of the U.S. In an alumni newsletter of the School of Public Health at Berkeley, he cited, as one of the most pressing of the world\u2019s public health problems, \u201cexcessive population growth and access to family planning.\u201d[1]<\/a> He then went on to apply his policies to the sweeping 1965 \u201cWar on Poverty\u201d legislation of U.S. President Lyndon Johnson.<\/p>\n

A Population Reference Bureau summary of Dr. Ravenholt\u2019s work in the 1970s referred to him as a \u201cpopulation program stalwart,\u201d which indeed he was.[2]<\/a> The article went on to explain that \u201cRavenholt created a family-planning juggernaut that provokes both praise and disdain\u2026. He dazzled people with his brilliance one moment and shocked them with his myopic ethnocentrism the next.\u201d Ravenholt viewed \u201ctoo many people\u201d as the crux of the problem; and his remedy was equally straightforward: greater availability of family planning.<\/p>\n

So it is easy enough to view Dr Ravenholt as a prototype of the single-minded crusader who accomplishes much but leaves behind an unintended legacy of collateral suffering. There is an inherent arrogance in the concept of \u201cnoblesse oblige,\u201d the inferred responsibility of privileged or educated people to act with generosity and nobility toward those less privileged, as if, by virtue of their racial, economic or educational levels, disadvantaged citizens cannot appreciate what is in their own or society\u2019s best interests. In the same vein, a comment attributed to Sigmund Freud warns that disastrous clinical outcomes of psychotherapy often derive from the analyst\u2019s conviction that only he or she can \u201csave\u201d the patient by radical or heroic interventions.<\/p>\n

In Am<\/em>\u00e1<\/em>, Jean Whitehorse, a Navajo woman now 63 years old, tells her life story. A victim of Dr. Ravenholt\u2019s policies, Jean was separated from her family at age 5 and sent to a harsh Native American school where she was punished for speaking her own language and forbidden to see her family. She describes how later, as a young woman with one daughter, she was given a hysterectomy without her knowledge or consent during emergency surgery for an appendectomy, at that time a widespread practice; other women, mostly poor members of racial minorities, were allowed only minutes before emergency C-sections to consent for hysterectomies or tubal ligations. Longer periods for reflection between consent and birth-control surgeries had been in fact mandated by law, but were never enforced. These practices occurred in especially large numbers through the 1970s in major urban teaching institutions, such as Los Angeles County Hospital, that treated and financially benefitted from Federal largesse by sterilizing large numbers of indigent (and indigenous) women. The film further suggests that these educational and population growth policies, applied with particular zeal to Native Americans throughout the Western and Southwestern U.S. and generously funded by Federal and State legislation, amounted to nothing less than a genocidal attack on a whole people and a culture.<\/p>\n

The simplistic prescription of policy makers at the time was that \u201cresources divided by population equals happiness,\u201d not taking into account that the concept of happiness in traditional Native American culture has less to do with resources than with family and children. The policies also led to profound individual suffering. One woman in Am<\/em>\u00e1 <\/em>described the painful feelings of shame, remorse, powerlessness, and depression caused by the involuntary forfeiture of such a fundamental personal choice as the decision to bear children. The very title of the film, Am<\/em>\u00e1<\/em>, meaning \u201cmother,\u201d highlights the centrality of the experience of motherhood in Navajo and other Native American cultures and thereby emphasizes the deeply personal losses\u2014self-determination, autonomy, spiritual wholeness\u2014that had been imposed upon defenseless victims under the euphemistic rubric of the \u201cWar on Poverty.\u201d<\/p>\n

This film makes the case for skepticism about the prospects of improving the world through a single lens, that is, attacking complex problems such as poverty or a lack of basic healthcare by using a process of social engineering directed to one aspect in isolation, and most critically, doing so in the absence of a moral compass. To this viewer, the highlight of Am<\/em>\u00e1 <\/em>comes near the end, when Dr. Ravenholt, having been confronted by Lorna Tucker, the film director, with incontrovertible evidence of the human cost of his projects, chokes away tears upon appreciating the devastation wrought in the pursuit of his life\u2019s work. In Am<\/em>\u00e1<\/em> the viewer is repeatedly exposed to the consequences of a misguided social agenda, a bitter object lesson in how not to conduct an ethical public health campaign.<\/p>\n