Everything Is Broken

In the summer of 2014, I gave birth to a baby boy. He was born with a perfect Apgar score, after a very easy delivery. But my labor had not been smooth—in fact, throughout the day and a half of contractions, I believed there was something decidedly wrong. I also felt that way as I held him for the first time, and he writhed violently under my hands. In a video taken about 10 minutes after he was born, he can be seen lifting his head up off my chest. “Ooooh, look at how advanced he is!” someone can be heard trilling in the background, before her voice is overtaken by my own. “Don’t do that, love,” I say. Then, to the camera: “Does he seem like he’s in pain to you?”

It took my husband and me three years to understand that in fact I was right that day in the delivery room. Our son was hurt. And it will take him years to heal—longer than it should have, and that is on top of the injustice of the original wound—though I thank God every day that we figured it out.

The first breakthrough came when my husband David remembered a book about brain science he had read a decade earlier, by a doctor named Norman Doidge. It changed our lives, by allowing us to properly understand our son’s injury (and to understand why we couldn’t manage to get a straight answer about it from any of the “experts” we had seen). It’s been a tough road, but from that moment on, we at least knew what to do—and why.

After we ordered, I told Norman I had a question I’d been wanting to ask—and that I wanted his honest answer to it, even if it meant that I had done something wrong. I proceeded to relay to him the entire tale, from the very beginning to that very moment, of what felt to me like our Kafkaesque medical mystery journey.

How was it, I then asked, that it took my husband and me—both children of doctors, both people with reporting and researching backgrounds, among the lucky who have health insurance, and with access through family and friends to what is billed as the best medical care in the country—years to figure this out, and that in the end we only did so basically by accident?

Norman looked at us sympathetically. “I don’t know how else to tell you this but bluntly,” he said. “There are still many good individuals involved in medicine, but the American medical system is profoundly broken. When you look at the rate of medical error—it's now the third leading cause of death in the U.S.—the overmedication, creation of addiction, the quick-fix mentality, not funding the poor, quotas to admit from ERs, needless operations, the monetization of illness vs. health, the monetization of side effects, a peer review system run by journals paid for Big Pharma, the destruction of the health of doctors and nurses themselves by administrators, who demand that they rush through 10-minute patient visits, when so often an hour or more is required, and which means that in order to be ‘successful,’ doctors must overlook complexity rather than search for it ... Alana, the unique thing here isn’t that you fell down so many rabbit holes. What’s unique is that you found your way out at all.”

David and I looked at each other, simultaneously realizing that the after-school special we thought we were in was actually a horror movie. If the medical industry was comprehensively broken, as Norman said, and the media was irrevocably broken, as we knew it was ... Was everything in America broken? Was education broken? Housing? Farming? Cities? Was religion broken?

Let’s say you believe the above to be hyperbolic. You never fell through the cracks of the medical system; as far as you understand it, there are plenty of ways for a resourceful person to buy a home in America these days; you easily met a mate and got married and had as many children as you wanted, at the age you wanted to have them; your child had a terrific time at college, where she experienced nothing at all oppressive or bizarre, got a first-class education that you could easily afford and which landed her a great job after graduation; you actually like the fact that you haven’t encountered one book or movie or piece of art that’s haunted you for months after; you enjoy druggily floating through one millennial pink space after another; it gives you pleasure to interact only with people who agree with you politically, and you feel filled with meaning and purpose after a day spent sending each other hysteria-inducing links; maybe you’ve heard that some kids are cosplaying Communism but that’s only because everyone is radical when they’re young, and Trump voters are just a bunch of racist troglodytes pining for the past, and it’s not at all that neither group can see their way to a future that looks remotely hopeful ... If this is you, congratulations. There’s no need to reach out and tell me any of this, because all you will be doing is revealing how insulated you are from the world inhabited by nearly everyone I know.

If, on the other hand, the idea of mass brokenness seems both excruciatingly correct and also paralyzing, come sit with me. Being on a ship nearly 4 million square miles in area along with 330 million other people and realizing the entire hull is pockmarked with holes is terrifying.

For seven decades, the country’s intellectual and cultural life was produced and protected by a set of institutions—universities, newspapers, magazines, record companies, professional associations, cultural venues, publishing houses, Hollywood studios, think tanks, etc. Collectively, these institutions reflected a diversity of experiences and then stamped them all as “American”—conjuring coherence out of the chaos of a big and unwieldy country. This wasn’t a set of factories pumping out identical widgets, but rather a broad and messy jazz band of disparate elements that together produced something legible, clear, and at times even beautiful when each did their part.

The strategy of American business, encouraged by neoliberal Democrats and libertarian conservative Republicans alike, has been to lower labor costs in the United States, not by substituting labor-saving technology for workers, but by schemes of labor arbitrage: Offshoring jobs when possible to poorly paid workers in other countries and substituting unskilled immigrants willing to work for low wages in some sectors, like meatpacking and construction and farm labor. American business has also driven down wages by smashing unions in the private sector, which now have fewer members—a little more than 6% of the private sector workforce—than they did under Herbert Hoover.

This was the tinder. The tech revolution was the match—one-upping the ’70s economy by demanding more efficiency and more speed and more boundarylessness, and demanding it everywhere. They introduced not only a host of inhuman wage-suppressing tactics, like replacing full-time employees with benefits with gig workers with lower wages and no benefits, but also a whole new aesthetic that has come to dominate every aspect of our lives—a set of principles that collectively might be thought of as flatness.

Flatness is the reason the three jobs with the most projected growth in your country all earn less than $27,000 a year, and it is also the reason that all the secondary institutions that once gave structure and meaning to hundreds of millions of American lives—jobs and unions but also local newspapers, churches, Rotary Clubs, main streets—have been decimated. And flatness is the mechanism by which, over the past decade and with increasing velocity over the last three years, a single ideologically driven cohort captured the entire interlocking infrastructure of American cultural and intellectual life. It is how the Long March went from a punchline to reality, as one institution after another fell and then entire sectors, like journalism, succumbed to control by narrow bands of sneering elitists who arrogated to themselves the license to judge and control the lives of their perceived inferiors.

The reigning aesthetic of the 20th century was modernism, which articulated in one word the values of the industrial revolution. Modernism and the Machine Age brought with them their own features: Anti-classicalism; anti-Victorianism; the power of science; the absence of filigree; an emphasis on the future over the past, and the valorization of machine production and engineering as the highest forms of human creativity. This new aesthetic soon began to transform all parts of cultural and material existence, from visual art and poetry to fashion and the built environment.

Starting in the second decade of the 1900s, certain Communists began seeing in modernism a potential advertisement for the values of a mass society of industrial workers laboring under the direction of a small group of engineers. In other words, this aesthetic—which whole swaths of the Western world were already in the process of quickly adopting—could also be the perfect delivery mechanism for their political ideology.

Today’s revolution has been defined by a set of very specific values: boundarylessness; speed; universal accessibility; an allergy to hierarchy, so much so that the weighting or preferring of some voices or products over others is seen as illegitimate; seeing one’s own words and face reflected back as part of a larger current; a commitment to gratification at the push of a button; equality of access to commodified experiences as the right of every human being on Earth; the idea that all choices can and should be made instantaneously, and that the choices made by the majority in a given moment, on a given platform represent a larger democratic choice, which is therefore both true and good—until the next moment, on the next platform.

It’s the realm of coffee shops, bars, startup offices, and co-live/work spaces that share the same hallmarks everywhere you go: a profusion of symbols of comfort and quality, at least to a certain connoisseurial mindset. Minimalist furniture. Craft beer and avocado toast. Reclaimed wood. Industrial lighting. Cortados. Fast internet. The homogeneity of these spaces means that traveling between them is frictionless, a value that Silicon Valley prizes and cultural influencers take advantage of. Changing places can be as painless as reloading a website. You might not even realize you’re not where you started.

“You might not even realize you’re not where you started.” The machines trained us to accept, even chase, this high. Once we accepted it, we turned from willful individuals into parts of a mass that could move, or be moved, anywhere. Once people accepted the idea of an app, you could get them to pay for dozens of them—if not more. You could get people to send thousands of dollars to strangers in other countries to stay in homes they’d never seen in cities they’d never visited. You could train them to order in food—most of their food, even all of their food—from restaurants that they’d never been to, based on recommendations from people they’d never met. You could get them to understand their social world not as consisting of people whose families and faces one knew, which was literally the definition of social life for hundreds of thousands of years, but rather as composed of people who belonged to categories—“also followed by,” “friends in common,” “BIPOC”—that didn’t even exist 15 years ago. You could create a culture in which it was normal to have sex with someone whose two-dimensional picture you saw on a phone, once.

The Obama administration could swiftly overturn the decision-making space in which Capitol Hill staff and newspaper reporters functioned so that Iran, a country that had killed thousands of Americans and consistently announces itself to be America’s greatest enemy, is now to be seen as inherently as trustworthy and desirable an ally as France or Germany. Flatness, frictionlessness.

The biological difference between the sexes, which had been a foundational assumption of medicine as well as of the feminist movement, was almost instantaneously replaced not only by the idea that there are numerous genders but that reference in medicine, law or popular culture to the existence of a gender binary is actually bigoted and abusive. Flatness.

The internet tycoons used the ideology of flatness to hoover up the value from local businesses, national retailers, the whole newspaper industry, etc.—and no one seemed to care. This heist—by which a small group of people, using the wiring of flatness, could transfer to themselves enormous assets without any political, legal or social pushback—enabled progressive activists and their oligarchic funders to pull off a heist of their own, using the same wiring. They seized on the fact that the entire world was already adapting to a life of practical flatness in order to push their ideology of political flatness—what they call social justice, but which has historically meant the transfer of enormous amounts of power and wealth to a select few.

Because this cohort insists on sameness and purity, they have turned the once-independent parts of the American cultural complex into a mutually validating pipeline for conformists with approved viewpoints—who then credential, promote and marry each other. A young Ivy League student gets A’s by parroting intersectional gospel, which in turn means that he is recommended by his professors for an entry-level job at a Washington think tank or publication that is also devoted to these ideas. His ability to widely promote those viewpoints on social media is likely to attract the approval of his next possible boss or the reader of his graduate school application or future mates. His success in clearing those bars will in turn open future opportunities for love and employment. Doing the opposite has an inverse effect, which is nearly impossible to avoid given how tightly this system is now woven. A person who is determined to forgo such worldly enticements—because they are especially smart, or rich, or stubborn—will see only examples of even more talented and accomplished people who have seen their careers crushed and reputations destroyed for daring to stick a toe over the ever multiplying maze of red lines.

So, instead of reflecting the diversity of a large country, these institutions have now been repurposed as instruments to instill and enforce the narrow and rigid agenda of one cohort of people, forbidding exploration or deviation—a regime that has ironically left homeless many, if not most, of the country’s best thinkers and creators. Anyone actually concerned with solving deep-rooted social and economic problems, or God forbid with creating something unique or beautiful—a process that is inevitably messy and often involves exploring heresies and making mistakes—will hit a wall. If they are young and remotely ambitious they will simply snuff out that part of themselves early on, strangling the voice that they know will get them in trouble before they’ve ever had the chance to really hear it sing.

As with Communists and modernism, there was nothing inevitable about the match. Most consumers don’t know that by using internet-based (or -generated) platforms—by buying from Amazon, by staying in an Airbnb, by ordering on Grubhub, by friending people on Facebook—that they are subscribing to a life of flatness, one that can lead directly into certain politics. But they are. Seduced by convenience, we end up paying for the flattening of our own lives. It is not an accident that progressive ideas spread faster on the internet. The internet is a car that runs on flatness; progressive politics—unlike either conservatism or liberalism—are flatness.

I’m not looking to rewind the clock back to a time before we all had email and cellphones. What I want is to be inspired by the last generation that made a new life-world—the postwar American abstract expressionist painters, jazz musicians, and writers and poets who created an alternate American modernism that directly challenged the ascendant Communist modernism: a blend of forms and techniques with an emphasis not on the facelessness of mass production, but on individual creativity and excellence.

Like them, our aim should be to take the central, unavoidable and potentially beneficent parts of the Flatness Aesthetic (including speed, accessibility; portability) while discarding the poisonous parts (frictionlessness; surveilled conformism; the allergy to excellence). We should seek out friction and thorniness, hunt for complexity and delight in unpredictability. Our lives should be marked not by “comps” and metrics and filters and proofs of concept and virality but by tight circles and improvisation and adventure and lots and lots of creative waste.

And not just to save ourselves, but to save each other. The vast majority of Americans are not ideologues. They are people who wish to live in a free country and get along with their neighbors while engaging in profitable work, getting married, raising families, being entertained, and fulfilling their American right to adventure and self-invention. They are also the consumer base for movies, TV, books, and other cultural products. Every time Americans are given the option to ratify progressive dictates through their consumer choices, they vote in the opposite direction. When HBO removed Gone with the Wind from its on-demand library last year, it became the #1 bestselling movie on Amazon. Meanwhile, endless numbers of Hollywood right-think movies and supposed literary masterworks about oppression are dismal failures for studios and publishing houses that would rather sink into debt than face a social-justice firing squad on Twitter.

This disconnect between culturally mandated politics and the actual demonstrated preferences of most Americans has created an enormous reserve of unmet needs—and a generational opportunity. Build new things! Create great art! Understand and accept that sensory information is the brain’s food, and that Silicon Valley is systematically starving us of it. Avoid going entirely tree-blind. Make a friend and don’t talk politics with them. Do things that generate love and attention from three people you actually know instead of hundreds you don’t. Abandon the blighted Ivy League, please, I beg of you. Start a publishing house that puts out books that anger, surprise and delight people and which make them want to read. Be brave enough to make film and TV that appeals to actual audiences and not 14 people on Twitter. Establish a newspaper, one people can see themselves in and hold in their hands. Go back to a house of worship—every week. Give up on our current institutions; they already gave up on us.

At the lowest point with my son—the moment when I was convinced something was deeply wrong, and that I would never be able to fix it—my husband found himself on a reporting trip, where he encountered the head of an illustrious yeshiva. I had been sending David desperate texts all afternoon, and at one point his own anguish became obvious. “What’s your son’s name?” the rabbi asked, and David told him it was Elijah. “Ah, the prophet of unlikely redemption,” he said, smiling. “With them, the good news is almost as hard as the bad.”

An example of “brokenness” in the medical field can be shown by what we’ve gone through over the virus.

Doctors who use ivermectin, or hydroxychloroquine with zinc, have recovery rates of 100%. But despite an order from the president allowing their use —why should this require an order from the president?— they have been effectively banned through the back door, as hospitals and doctors are threatened, as pharmacies refuse to fill prescriptions, as the major information media shut down any mention of them.

1) Once people accepted the idea of an app, you could get them to pay for dozens of them—if not more.
Nope. I don't pay for dozens of apps. I scrutinize my spending on apps to things I see a real enduring value in.

2) You could get people to send thousands of dollars to strangers in other countries to stay in homes they’d never seen in cities they’d never visited.
Nope.

3) You could train them to order in food—most of their food, even all of their food—from restaurants that they’d never been to, based on recommendations from people they’d never met.
No.

4) You could get them to understand their social world not as consisting of people whose families and faces one knew, which was literally the definition of social life for hundreds of thousands of years, but rather as composed of people who belonged to categories—“also followed by,” “friends in common,” “BIPOC”—that didn’t even exist 15 years ago.
No.

5) You could create a culture in which it was normal to have sex with someone whose two-dimensional picture you saw on a phone, once.
Ewww...

Its official. I'm a troglodyte. And a proud one!

Agreed. Fantastic piece.

To see how far we’ve fallen, look at how many people here can’t even grasp the point of it.

Everything’s a mess. All of our institutions are broken beyond repair. Anything we were raised to trust has been corrupted and turned against us. Most people in any position of power almost anywhere are either corrupt or incompetent or a combination of both.

Climbing out of this hole won’t be easy and may well be impossible. I think she’s right that we have to create our way out of it.

And they all, the quiet ones, live their lies of invisible anxiety, shadows of the lives that might have been.
They die in silence, not screaming against their oppressors but acquiescing to the heel upon their head as their due.
There are some, a few, not many, who seek to be more, to struggle against the tyranny of complacency.
We need brave souls who will wake up to the horror that surrounds us and say in a loud and death defying voice, “no more.”

I agree. The best medicine I ever practiced was as a Family Nurse Practitioner and contravened normal hospital and clinc protocols. No 10 minute visits period. No huge pharmacy bills for them either. Lots of time spent exploring what it meant “to be them”. Lots of time spent mutually figuring out what would work.
I often went to their homes because they needed that kind of care and concern. I did cervical exams on their beds with a set of stirrups I designed to be accommodated by their beds. In three years of happy hard work I had 3500 patients. Yes, my hours were long and I often went long distances, but the results made them happy. Me too.
The local MDs were generous with their supplies and no doc ever turned down one of my patients when I asked them to help him or her.
My clinic was philanthropic eleemosynary. It had to be as 90-something percent of the people were poor, very poor.

I thought I had died and gone to heaven until some doctor MD-types decided to buy the medicaid/medicare contract in the area and we NPs were booted out.

Now I go to the VA and I have had some excellent docs work with me. And I have had some I wouldn’t give you a plugged nickel for. It seems like luck of the draw, sadly enough.
No one at the VA gives a damn what we the sick, weak and lame think. With some outstanding exceptions, it just plows blindly on with conventional medicine and out of date ideas. It is as broken as any institution I have had anything to do with in all my 80+ years.

“This disconnect between culturally mandated politics and the actual demonstrated preferences of most Americans has created an enormous reserve of unmet needs—and a generational opportunity. Build new things! Create great art! Understand and accept that sensory information is the brain’s food, and that Silicon Valley is systematically starving us of it. Avoid going entirely tree-blind. Make a friend and don’t talk politics with them. Do things that generate love and attention from three people you actually know instead of hundreds you don’t. Abandon the blighted Ivy League, please, I beg of you. Start a publishing house that puts out books that anger, surprise and delight people and which make them want to read. Be brave enough to make film and TV that appeals to actual audiences and not 14 people on Twitter. Establish a newspaper, one people can see themselves in and hold in their hands. Go back to a house of worship—every week. Give up on our current institutions; they already gave up on us.”

I hope people of her generation and younger read this.

Yet the life expectancy keeps going up.

Also, the medical profession responds to the wants of the consumers. Those wants takes a wholle heck of a lot of money and resources to manage.

Plus cherry picking dates is disengenous. For instance, in the 1970s who could afford to stay alive on dialysis which was a developing and very expensive treatment (Still is). Enter Medicare/Medicaid that the voters agreed to since they elect our representatives. Not as simple or cynical as you think.

Broken lines broken strings
Broken threads broken springs
Broken idols broken heads
People sleeping in broken beds
Ain’t no use jiving
Ain’t no use joking
Everything is broken.

Broken bottles broken plates
Broken switches broken gates
Broken dishes broken parts
Streets are filled with broken hearts
Broken words never meant to be spoken
Everything is broken.

Seem like every time you stop and turn around
Something else just hit the ground
Broken cutters broken saws
Broken buckles broken laws
Broken bodies broken bones
Broken voices on broken phones
Take a deep breath feel like you’re chokin’
Everything is broken.

Everytime you leave and go off someplace
Things fall to pieces in my face
Broken hands on broken ploughs
Broken treaties broken vows
Broken pipes broken tools
People bending broken rules
Hound dog howling bullfrog croaking
Everything is broken.

I believe they discovered his ailment and hopefully found the right treatment. I got the impression she wanted to keep it close to the vest while still illustrating her point.

Thank you. Our society has been so dumbed down by screen use instead of reading that many would rather snark than think.

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