Treating Celibacy

A short documentary covers the debate over sexual surrogates for disabled people:

James Hamblin sides with the disabled seeking sexual contact:

Near the end many of us will pay for people to help us walk, put food in our mouths, change our diapers. We’ll lose our relationships that afford close physical contact. Once a neuromuscular disease leaves someone incontinent, we as physicians can offer little to restore their abilities. The same is true when a stroke leaves a patient unable to chew his own food. We often can’t restore these basic, humanizing parts of people. There is value in seriously considering every human element that can be preserved. Surrogacy does not replace a loving relationship, and it shouldn’t be expected to. We don’t refuse the help of a physical therapist because it won’t be as good as having never gotten hit by a bus to begin with. When real love is on the table, take it. When the table is missing, or someone’s axed the legs, then there are surrogates.

A fallacy of modern medicine is that anything less than perfect health or complete recovery is failure, or at least concession. Another is that accepting help and treatment admits weakness. As doctors we spend a lot of our time managing expectations. With chronic illness and old age, the job is most often about making the best of imperfect circumstances. Is sexual surrogacy necessarily so removed from invoking the help of any health professional? The grey areas are expansive, but so is the potential.

Putting The Black Market Out Of Business

Keith Humphreys wonders how states with legal cannabis will deal with illegal cannabis operations:

Law enforcement officials in Colorado and Washington will soon be grappling with the question of how to police illicit sales and production of cannabis after the legal cannabis market is in place. The logical approach would be to prioritize illicit market enforcement immediately after legalization takes effect. The enforcement and resultant busts would be coupled with press releases full of head-shaking quotes along the lines of “I can’t understand why people keep engaging in crime now that recreational marijuana is legally available”. Such tactics would help undermine the black market by driving people into the legal cannabis market.

Alison Holcomb, author of Washington state’s legalization law, responds in the comments section

1. Washington’s new marijuana law dedicates $5 million annually off the top of the new marijuana excise tax for administration and enforcement by the state’s primary regulatory agency;

2. As with the repeal of alcohol Prohibition, consumer demand will shift and likely have a greater impact on the black market than policing; and

3. Before the passage of Washington’s new marijuana law, the overwhelming majority of state marijuana law enforcement — 90% of marijuana arrests — was for simple possession, not manufacture or delivery. Now that simple possession is legal for adults 21 and older, significant policing hours have been freed up and could, should local jurisdictions so desire, be refocused to enforcement against unlicensed marijuana producers and distributors.

Face Of The Day

AFGHANISTAN-UNREST-BOMBINGS

An injured Afghan child is treated at a hospital after a roadside bomb in the Obe district of Herat province on July 9, 2013. The bomb killed 12 women, four children and one man travelling in a three-wheel minivan, officials said, adding that at least seven other passengers were wounded. By Aref Karimi/AFP/Getty Images.

United Against Solitary

Approximately 30,000 prisoners have entered the third day of what might be the largest hunger strike in California’s history. The strike, which has spread to Washington state, has already left ten prisoners under medical observation. Abby Ohlheiser provides context:

While the California prison system has a less than stellar reputation on a handful of issues–many of which trace back to its astonishing overcrowding–the striking prisoners are focusing their message on improving conditions for those locked in solitary confinement. Last October, Mother Jones published a must-read on solitary in California, written by Shane Bauer, one of the three hikers kept in an Iranian solitary confinement cell for 26 months. Spoiler: Bauer thought California’s conditions were worse.

Julianne Hing adds:

The United Nations has found that just 15 days in solitary confinement violates human rights standards and can do irreperable psychological harm to a person, according to a lawsuit filed by the Center for Constitutional Rights. Yet hundreds of California inmates have been in indefinite isolation for more than a decade, according to Amnesty International.

Lauren Kirchner reports that some prisoners have expressed solidarity with GTMO detainees. In the midst of the ongoing force-feeding controversy, Robin Abcarian notes:

In California, according to hunger strike protocols released by the Department of Corrections, no prisoner will be forced to eat at any time if he makes it clear in advance that that is his wish. In California, a prisoner has the right to starve himself to death. It shouldn’t have to come to that.

Way Behind The Scenes

[youtube http://youtu.be/L88YCw0bCyk]

Kate Dries spotlights Wadjda, Saudi Arabia’s first feature film directed by a woman:

It’s the story of a 10-year-old girl named, yes, Wadjda, living in Riyadh, Saudi Arabia. She’s described as “sarcastic, funny and streetwise,” all reasons that she decides to compete in a Koran memorization competition at her school to win money to buy a bicycle. To make the movie, the filmmaker Haifaa Al-Mansour dealt with the kind of obstacles that would make an entertaining movie itself: because men and women are not allowed to interact in public in Saudi Arabia, she says “It was a major obstacle to go out in the street and talk to my actors.”

How she adjusted:

[Mansour] spent much of her time directing from the back of a van. “I could only go outside with my film crew when we had permission, so it was difficult,” she says. She frequently had to rely on walkie-talkies and watching scenes unfold on a monitor to direct her actors. “It made me realize the need to rehearse and to develop an understanding for each scene before we shot it.”

Dries notes:

Recall that it was only a few months ago that riding a bicycle was even allowed for women in Saudi Arabia.

The Work Of The World’s Poor

The International Labor Organization (ILO) found that Pakistan’s unemployment rate is 5.2 percent and India’s is 4.2 percent. But Kenny argues that developing countries’ low unemployment rates are misleading:

The majority of Pakistan’s and India’s populations work in small-scale farming or are “self employed” in informal microenterprises. That’s true across much of the developing world. The National Bureau of Economic Research’s Rafael La Porta and Andrei Shleifer suggest that, in the poorest countries, more than two-thirds of the labor force is working on the family farm or is in the informal sector.

Farms managed by the world’s poorest people tend to be small and inefficient—demanding a lot of labor for little output. That’s why families farming them make up the bulk of the world’s population living on less than $1.25 a day. The majority of enterprises run by the world’s poorest are shops and kiosks making a few sales a day—general stores, tailor shops, telephone booths, or fruit or vegetable businesses. In India, data collated by MIT’s Abhijit Banerjee and Esther Duflo suggest the average shop run by people living in poverty makes a profit of just $133 a year. That low productivity helps to explain why, even though only around 200 million people in the world are considered unemployed by the ILO, 1.3 billion workers lived in families below the $2-a-day poverty line.

The Church And Obamacare

The Catholic Health Association now fully backs the new law’s provisions:

In June of last year, CHA strongly criticized–as did the U.S. Conference of Catholic Bishops–the way the Department of Health and Human Services had attempted to accommodate the concerns of religious employers who objected to the mandate. The USCCB is still not (and may never be) happy with the rule. But CHA now believes HHS has addressed their concerns.

“It was important for our members to achieve resolution of this issue in time for them to negotiate their insurance renewals and with the assurance they would not have to contract, provide, pay or refer for contraceptive coverage,” Sr. Carol Keehan, president of CHA, told me. “We are pleased that that has been achieved with this accommodation.”

When Is A Kid Truly Transgender?

Transgender Child In Washington, DC

The blogger Gendermom shares her story:

When I tell people that my [five-year-old] son is now my daughter, the responses are remarkably predictable. Faces cloud with confusion. People seem to wonder if they’ve heard me correctly. Or they suggest that it’s probably a phase, or that my son is just gay. They tell me that their little boy used to try on his big sister’s dresses, too, but not to worry–it all worked out okay in the end.

They are generally very kind and curious. But I can tell that the idea of my child is entering their consciousness like a visitor from an alien galaxy. They walk away from our conversations with stunned and thoughtful looks on their faces, as if they’re thinking, “Did she really just say that?” The problem I encounter most often is not one of prejudice, but of incredulity.

Earlier this year, Beth Schwartzapfel investigated the issue at length, centering on the controversial Canadian psychologist Kenneth Zucker, who would likely clash with Gendermom:

It’s now widely accepted that no amount of therapy can change a person’s sexual orientation, and Zucker says he would not try to do so. But gender identity and sexual orientation are not the same thing.

Sexual orientation is a matter of whom you are sexually attracted to. Gender identity is more elemental: It’s who you feel in your bones that you are. Zucker’s critics say that most transgender children know precisely who they are. “These kids come out very early and say, ‘Mommy, I’m in the wrong body,’” Schreier says.

Sure, Zucker says, but that doesn’t make it a fait accompli. Children’s gender identity is plastic and malleable, he says, shaped and formed by the world around them, by the feedback they receive, by the emotional resonance of the things they do, by their personal relationships, even by the clothes they wear. If this is true, then it should be possible for these kids to change.

Zucker is quick to point out that his clinic has referred more than 60 kids for the medical interventions required to begin their transitions; a paper he wrote on the subject was, in fact, the first such study published in North America. By age 11 or 12, he concedes, trans kids are typically “locked in” to their gender identity, and for them, “I very much support that pathway, because I think that is going to help them have a better quality of life.”

But it’s different, he says, for younger kids. “If a child can grow up and feel comfortable in his or her own skin that matches their birth sex,” Zucker argues, “then you avoid the complexity of fairly serious surgical treatments. Penectomy and castration are not the same thing as having mild and minor cosmetic surgery. Lifelong hormonal therapy. It’s serious.”

Previous Dish on transgender kids here, here, here, and here.

(Photo: Five-year-old Tyler, known until last fall as Kathryn, gets a haircut from his dad at their suburban Washington, D.C., home on March 12, 2012. Tyler’s insistence on being a boy started at the early age of 2. By Nikki Kahn/The Washington Post via Getty Images)

Immigration Reform Flatlines?

Brian Beutler can’t find a pulse:

[Republicans] could drag this out for months before settling on terms of eventual citizenship. Democrats could fold on “triggering” the citizenship guarantee — or come to terms with the GOP on something that could be sold as both a “trigger” and a guarantee. Boehner could step up, break the Hastert rule, probably lose his job. But these are all pretty implausible scenarios. Particularly given how averse House Republicans and movement folks have become even to highly conservative legislation that they recognize as a potential vehicle for compromise.

Josh Marshall agrees that “Comprehensive Immigration Reform does, increasingly, look dead.” He wants those who are killing the bill called out:

Too often, whether it’s on taxes or immigration reform or anything else certain parties have a strong interest in fuzzing up what’s actually happening – most often the party that feels like it’s on the wrong side of public opinion. And that leaves bills to just die because in some very fuzzy broad brush way ‘the House’ or ‘the Senate’ couldn’t get it passed.

But there’s no House or Senate. For these purposes, these are simply helpful fictions. Or in this case unhelpful fictions. People only really know what’s going on when you get down to the nitty gritty and say, it didn’t happen because these seven people – naming names – decided to vote against it or decided it wouldn’t get a vote.