All Jokes Aside, What Do I think About the Book “Caste: The Origins of Our Discontents?”

I just finished reading Isabel Wilkerson’s book, “Caste: The Origins of Our Discontents.” It was a painful read because it talks about racism in America, which is a part of my lived experience. Wilkerson’s compares it to the Nazi persecution of the Jews and the caste organization in India. The chapter on the pillars of caste make sense to me.

When I reached the last section (not at all “final” by any means), which is called “Awakening,” I was not surprised that there were no prescriptions or outlines or action plans for how to eliminate caste in any culture. It turns out that we’re all responsible for becoming aware of how we all are complicit in some way with maintaining caste divisions in society. And the word Wilkerson used for how to begin is “empathy,” or somehow becoming conscious of that tendency and to replace it with understanding.

As Wilkerson emphasizes, empathy isn’t sympathy or pity. Empathy is walking a mile in someone else’s shoes, as the song goes. But she goes a step further and uses the term “radical empathy.” It’s difficult to define concretely. It goes beyond trying to imagine how another person feels, going the extra mile and learning about what the other person’s experience. It’s not about my perspective; it’s about yours. It’s not clear exactly how to make that deep connection. She uses terms like “spirit” which may or may not resonate with a reader searching for a recipe or a cure.

Politics turns up in the book. How could it not? I’m going to just admit that I wanted to make this post humorous somehow, especially after I saw Dr. H. Steven Moffic’s article in Psychiatric Times about whether psychiatrists are to act in the role of “bystanders” or “upstanders” in the present era of political and social turmoil. He specifically mentioned the Goldwater Rule, which is the American Psychiatric Association Ethics Annotation barring psychiatrists from making public statements of a diagnostic opinion about any individual (often a politician) absent a formal examination or authorization to make any statements. The allusion to a specific person is unmistakable.

But, as a retired psychiatrist, I’m aware that my sense of humor could be deployed as a defense mechanism and it would certainly backfire in today’s highly charged political context. I’m not sure whether I’m a bystander or an upstander.

Sena and I had a spirited debate about whether America has a caste system or not. I think it’s self-evident and is nothing new to me. I suspect that calling racism (which certainly exists in the United States) a form of casteism would not be altogether wrong. Wilkerson mentions a psychiatrist, Sushrut Jadhav, who is mentioned in the Acknowledgments section of her book. Jadhav is a survivor of the caste system in India. I found some of insights on caste and racism in web article, “Caste, culture and clinic” which is the text of an interview with him.

His answers to two questions were interesting. On the question of whether there is a difference between the experience of racism and caste humiliation, he said “None on the surface” but added that more research was needed to answer the question adequately. And to the question of whether it’s possible to forget caste, he said you have to truly remember it before you can forget it—and it’s important to consider who might be asking you to forget it.

This reminded me of the speech in the movie “Guess Who’s Coming to Dinner,” said by John Prentice (played by Sidney Poitier) to his father:

“You’ve said what you had to say. You listen to me. You say you don’t want to tell me how to live my life? So, what do you think you’ve been doing? You tell me what rights I’ve got or haven’t got, and what I owe to you for what you’ve done for me. Let me tell you something. I owe you nothing! If you carried that bag a million miles, you did what you were supposed to do because you brought me into this world, and from that day you owed me everything you could ever do for me, like I will owe my son if I ever have another. But you don’t own me! You can’t tell me when or where I’m out of line, or try to get me to live my life according to your rules. You don’t even know what I am, Dad. You don’t know who I am. You don’t know how I feel, what I think. And if I tried to explain it the rest of your life, you will never understand. You are 30 years older than I am. You and your whole lousy generation believes the way it was for you is the way it’s got to be. And not until your whole generation has lain down and died will the deadweight of you be off our backs! You understand? You’ve got to get off my back! Dad. Dad. You’re my father. I’m your son. I love you. I always have and I always will. But you think of yourself as a colored man. I think of myself as a man. Hmm? Now, I’ve got a decision to make, hmm? And I’ve got to make it alone. And I gotta make it in a hurry. So, would you go out there and see after my mother?”

 And there was this dialogue that Sena found on the web, which was similar to that of John Prentice. It was a YouTube fragment of a 60 minutes interview in 2005 between actor Morgan Freeman and Mike Wallace. Wallace asked Freeman what he thought about Black History Month. Freeman’s answer stunned a lot of people because he said he didn’t want Black History Month and said black history is American history. He said the way to get rid of racism was to simply stop talking about it. His replies to questions about racism implied he thought everyone should be color blind. John Prentice’s remarks to his father are in the same vein.

I grew up thinking of myself as a black person. I don’t think there was any part of my world that encouraged me to think I was anything different. I think Wilkerson’s book is saying that society can’t be colorblind, but that people can try to walk a mile in each other’s shoes.

The Fortuitous Connection Between the Meyer Lemon and James Thurber

Sena bought some Meyer Lemons today, which we had not heard of until she saw them on TV on the QVC network. She bought them for a fish dinner.

I was curious about the Meyer Lemon. We’ve never eaten them before. People say they’re sweeter than regular lemons. It’s a hybrid between a lemon and an orange.  I did a little digging on the web and found a little background about them, which curiously connects to James Thurber in a roundabout way.

Anyway, an explorer and employee of the U.S. Department of Agriculture named Frank Nicholas Meyer introduced the fruit to the United States in 1908 after he collected them while traveling in China. It was named after him although the fruit had been growing in China for millennia. Meyer was an immigrant to America from Amsterdam in 1901 and became a citizen in 1908, modifying his name from Frans Nicolaas Meijer to Frank Nicholas Meyer.

Meyer is also credited with the discovery that the Chestnut blight disease was originally imported to America from trees in China. He collected fungus specimens which were identified as the cause of the disease which was killing chestnut trees in America in 1904.

That gets us to the connection of Meyer lemons to the writer James Thurber, although I confess the connection is indirect. Thurber wrote a short story, “The Car We Had to Push” which was published in the 1945 collection, The Thurber Carnival.

Part of the story is about a character named Cousin Zenas, who died of—yep, you guessed it, the Chestnut blight. Now, even though the story is in a copyrighted book, the full text turns up in a couple of blogger sites. I found one copy of The Thurber Carnival you might be able to borrow and read for free on the Internet Archive. Don’t believe the Google Gemini Artificial Intelligence bot, which always intrudes itself at the top of my web searches. You can’t get the book as a free pdf from “The Project Gutenberg website,” which I suspect is a confabulation.

Anyway, the Meyer Lemon tastes great and Sena was able to squeeze a lot of juice out of one small Meyer lemon. You can even eat the rind. She bought a bag of 5 of them which cost $7.00, and they were little compared to the large ones she saw on the QVC network.

They’re a great accent to a fish and hush puppies’ dinner. The sauce is made with Miracle Whip, by the way.

Black History Month 2025 ASALH Theme

This is Black History Month and the Association for the Study of African American Life and History (ASALH) theme this year is African Americans & Labor.

When I look back on my youth, I think of my time learning on the job to be a survey crew technician and drafter for a consulting engineer company in Mason City, Iowa, Wallace Holland Kastler Schmitz & Co. (WHKS & Co.).

I was probably not the first black person to work for WHKS & Co. One other black person who was one of very few role models for African Americans was a guy named Al Martin, who I’ve posted about before.

My time there was in the 1970s and there were not many job opportunities open to minorities. I learned more than just the skills specific to the job. I learned that I could succeed in life, which was valuable later on. I developed the confidence to seek other opportunities which included going to medical school and becoming a physician.

Although racism was not absent at WHKS & Co., there was just enough open-mindedness to support my ambition to move forward in life despite the barriers to success in society that existed.

I think the ASALH theme for Black History Month in 2025 is vital to reflect on in the present day. People from all walks of life can relate to this.

Carter G. Woodson is considered the father of Black history and was the founder of Black History Month.

My Mt. Rushmore Dream

Lately, I’ve been anticipating my eventual immortalization as a sculptured stone bust on Mt. Rushmore. Hopefully, this will be fairly soon because I’m not getting any younger.

Among my many inventions is the internet. Don’t believe Al Gore, although he has persuaded others about his role in the development of what I argue should properly be called the world wide web. I’ve invented a lot of other things which I’ll tell you more about just as soon as I make them up.

Before I forget it, I want to tell you what I just noticed last night while I watching one of my favorite X-Files episodes, “War of the Coprophages.” I guess I never noticed that the cockroach invasion was about Artificial Intelligence (AI). It was the scientist, Dr. Ivanov, who mentioned it first and I just missed it the first few hundred times I saw the show.

Dr. Ivanov clearly thought that anybody who thought extraterrestrials would be green and have big eyes was probably crazy. Traveling across galaxies through wormholes and whatnot would tear humanoid organisms apart. The practical approach would be to send AI robots instead. You could see Mulder cringe at that idea. The little robot that kept edging closer to Mulder made him nervous and when he asked Dr. Ivanov why it did that, his reply was “Because it likes you.”

That doesn’t exactly fit with Ivanov’s other idea about extraterrestrials, which is that they would focus on important tasks like getting enough food, procreating, etc. without getting all emotional about them. Ironic that Dr. Ivanov made an AI robot that gets a crush on a sesame seed munching UFO hunter like Mulder.

However, the AI robots in the show are cockroaches which love to eat dung. In other words, they’re full of crap.

Moving right along, although I didn’t invent it, there’s a card game called schnapsen that Sena and I are trying to relearn. It’s kind of a break from cribbage. It’s a trick taking game with just a 20-card deck. We play the version that doesn’t allow you to look at your cards to see how many points you have so you can tell when you can close the deck or go out, meaning you have the 66 points to win. You have to remember how many points you’ve won in tricks. I think it’s a good way to keep your memory sharp.

Let’s see; I’ve lost every game so far, but that doesn’t mean I won’t end up with my bust on Mt. Rushmore.

Keep Hope Alive

Just a reminder, Isabel Wilkerson will be giving her presentation, ” “Caste: How the hierarchy we have inherited restricts our humanity” from noon to 1 p.m. Wednesday, Feb. 5, in Prem Sahai Auditorium (room 1110) in the Medical Education and Research Facility.

I’m about halfway through her book, “Caste: The Origins of Our Discontents.” It’s a very difficult read, as I anticipated. It’s full of horrendous descriptions of what those in lower castes suffered, whether from the time of the Nazis, India, or America. I can read it only for a short while and then I have to put the book down and take a break. I get so I feel like I need an inspirational lift.

And it just happened the other night. I heard a poem on TV I’ve heard before, “I am Somebody.” Although it was written in the 1950s by Reverend William Holmes Borders, a civil rights activist and senior pastor at Wheat Street Baptist Church, it was recited by Reverend Jesse Jackson in 1963.

I remember seeing Reverend Jackson cry the night Barack Obama was elected President in 2008. I never heard the original speech Reverend Jackson gave in 1988, during the second time he was running for President himself.

I think it was probably because I was focused on starting medical school at The University of Iowa. I began my studies in August of 1988 in what was then the summer enrichment program for minority students.

One of Reverend Jackson’s speeches contained the other memorable cry, “Keep hope alive!” You can hear it and read the transcript.

You must not surrender! You may or may not get there but just know that you’re qualified! And you hold on and hold out! We must never surrender!! America will get better and better.

Keep hope alive. Keep hope alive! Keep hope alive! On tomorrow night and beyond, keep hope alive! I love you very much. I love you very much. —Rev. Jesse Jackson, 1988.

Artificial Intelligence in Managing Messages from Patients

I ran across another interesting article in the JAMA Network about Artificial Intelligence (AI) with respect to health care organization managing messages from patients to doctors and nurse. The shorthand for this in the article is “in-basket burden.” Health care workers respond to a large number of patients’ questions and it can lead to burnout. Some organizations are trying to test AI by letting it make draft replies to patients. The results of the quality improvement study were published in a paper:

English E, Laughlin J, Sippel J, DeCamp M, Lin C. Utility of Artificial Intelligence–Generative Draft Replies to Patient Messages. JAMA Netw Open. 2024;7(10):e2438573. doi:10.1001/jamanetworkopen.2024.38573

One of the fascinating things about this is the trouble we have naming the problems with misinformation that AI has. We tend to use a couple of terms interchangeably: hallucinations and confabulation. Whatever you call it, the problem interferes with communication between health care workers and patients.

Dr. English describes the interference as a “whack-a-mole” issue, meaning every time they think they got the hallucination/confabulation problem licked, the AI comes up with another case of miscommunication.

Just for fun, I did a web search trying to find out whether “hallucination” or “confabulation” fit the AI behavior best. Computer experts tend to use the term “hallucination” and neuropsychologists seem to prefer “confabulation.” I think this community chat site gives a pretty even-handed discussion of the distinction. I prefer the term “confabulation.”

Anyway, there are other substantive issues with how using AI drafts for patient messaging affects communication. I think it’s interesting that patients tend to think AI is more empathetic than medical practitioners. As Dr. English puts it: “This GPT is nicer than most of us,” and “And ChatGPT, or any LLM, isn’t busy. It doesn’t get bored. It doesn’t get tired.” The way that’s worded made me think of a scene from a movie:

OK, so I’m kidding—a little. I think it’s important to move carefully down the path of idealizing AI. I think back to the recent news article about humans teaching AI how to lie and scheme. I remember that I searched the web with the question “Can AI lie?” and getting a reply from Gemini because I have no choice on whether or not it gives me its two cents. I’m paraphrasing but it said essentially, “Yes, AI can lie and we’re getting better with practice.”

I like Dr. English’s last statement, in which she warns us that AI can be a fun tool which clinicians need to have a healthy skepticism about. It may say things you might be tempted to gloss over or even ignore, like:

“I’ll be back.”

Just Got Isabel Wilkerson’s Book: “Caste: The Origins of Our Discontents”

I just got a copy of Isabel Wilkerson’s book “Caste: The Origins of Our Discontents.” I read her other book, “The Warmth of Other Suns” years ago. It won a Pulitzer Prize.

I read the first section, “Toxins In The Permafrost And Heat Rising All Around.” It brought back memories of the 2016 Presidential Election, which I won’t discuss in any detail. It does seem ironic now.

I have no doubt that “Caste” will be an uncomfortable read, like Wilkerson’s first one and like Michele Norris’s book, “Our Hidden Conversations.”

Just a reminder, Isabel Wilkerson is scheduled to speak as part of Dr. Martin Luther King, Jr. events on February 5, 2025 at the University of Iowa Medical Education and Research Facility (MERF); Prem Sahai Auditorium. General admission is free although it’s a ticketed event, more information here.

Update on the Cribbage Go Rule and More!

I just discovered a little more about the Go Rule in Cribbage. It turns out that it’s easy to over think it. I found a few websites that state it more clearly than what I have recently found and posted about last Friday, January 17th.

Probably the simplest explanation is a pdf document of rules for cribbage available for free.

“A player who cannot play without exceeding 31 does not play a card but says Go, leaving his opponent to continue if possible, pegging for any further combinations made…. Bringing the total to exactly 31 pegs 2, but if the total is 30 or less and neither player can lay a card without going over 31, then the last player to lay a card pegs one for the go or one for last.”

There are a couple of YouTube videos with clear instructions about how to play cribbage. Both are less than 30 minutes long and entertaining. One of them is called “How to Play Cribbage Properly”. The video is well done, in my opinion. The only mistake he made was pointed out by a viewer who noticed he made a minor goof on demonstrating how to peg between two imaginary players “Attenborough” and Bowie.” He just switched the names of the players. It really doesn’t affect the actual demonstration of pegging points.

The other YouTube is also well done and demonstrates the rules of cribbage in a game between a guy and his father, titled “A Game of Cribbage.” Only once is the word “Go” mentioned although they played it according to the rule above.

Testing the New Snow Removal Tools!

We finally got enough snow to test the new shovels today. Recall we have a cordless electric snow shovel and a snow pusher plow shovel with a 36-inch blade. The battery-powered model is a 48V 16-inch Voltask.

I was a little surprised to learn how powerful the electric shovel is. It comes with two batteries. It has a safety button which you have to press at the same time you pull the trigger. It comes with lights so if you ever want to clear snow after dark, you could do that. Of course, there’s no heavy lifting and it’s easy to push. It can throw snow a long way and you can also direct it left or right. It’s like a vacuum in reverse.

Sena selected the Voltask and save a lot of money. There were other models that were priced in the 400–500-dollar range which didn’t have the features the Voltask has.

The snow plow of course, is a simple tool—just the way I like them. The narrow 36-inch blade makes snow clearing quick and there is also no heavy lifting. Spraying a little snow and ice repellent on the blade cuts down on buildup as you work.

I still prefer a shovel.

Is Edinburgh Manor in Iowa Haunted?

I have no idea whether an old former county home in Jones County is one of the most haunted places in the Midwest or Iowa or the USA. And I wouldn’t be saying that if Sena and I had not watched a TV show called “Mysteries of the Abandoned” (broadcast on the Science Channel) which aired a 20-minute segment about Edinburgh Manor the other night.

Supposedly, Edinburgh Manor started off as a county poor farm back in the 1800s, which didn’t do well and then quickly declined into an asylum for the mentally ill. When a couple bought the old place after it closed sometime between 2010 and 2012, they started to report having paranormal experiences and it was then off to the races for the place to become a haunted attraction, for which you can buy tickets for day passes and overnight stays.

There’s a 10-minute video by a newspaper reporter who interviews the wife and which shows many video shots of the house. I can’t see any evidence that it’s on the National Register of Historic Places.

What this made me think of was the Johnson County Historic Poor Farm here in Iowa City, which is on the National Register of Historic Places. We’ve never visited the site, but you don’t pay admission and the tone and content of the information I found on the website is nothing like what’s all over the web about Edinburgh Manor. There are no ghosts tickling anybody at the Johnson County Historic Poor Farm.

There’s a lot of education out there about the history of county poor farms in general. In Johnson County, Chatham Oaks is a facility that houses patients with chronic mental illness and it used to be affiliated with the county home. It’s now privatized. The University of Iowa department of psychiatry used to round on the patients and that used to be part of the residents training program (including mine).

I found an hour-long video on the Iowa Culture YouTube site about the history of Iowa’s county poor farms. It was very enlightening. The presenter mentioned a few poor farms including the Johnson County site—but didn’t say anything about Edinburgh Manor.