The Book of Job

“The problem of evil, the main obstacle to monotheism in the Judeo-Christian tradition, is the task of attempting to reconcile all the bad things that seem to occur in the world with the belief that God, an all-good, all-powerful, and all-loving deity, exists.”  (from Philosophy:  An Introduction Through Literature by Kleiman and Lewis, 1990)

As a Freshman in college I took Introduction to World Literature. One of the required readings was from the bible, the book of Job.  What followed was a reawakening of my then dormant religious curiosity.  From prior Sunday school experience, I had characterized the bible as a series of myths, fables and fairy tales, much of which stretched the limits of credulity.  But Job was different.  It offered no easy answers, no easy outs.  Instead, it posed difficult, seemingly unanswerable questions. As author William Safire (1929—2009) said, “I started my journey into this book with doubt in my faith and have come out with faith in my doubt."

Imagine the courage of those who many centuries ago chose to include Job in scripture.  They were unafraid to question belief.  They must have believed religion would inevitably be strengthened, not weakened, by wrestling with this troubling story.  The book of Job made it possible for me to question, to doubt, and once again bring religious study into my life.

God is the most problematic character in Job.  God is the magisterial creator whose works and whose ways exceed human understanding.  But God is also a god who treats human life as a toy and an experiment, a god that could as well be Zeus, the powerful, amoral, vain and all too human god of the Greeks. Psychoanalyst Carl Jung (1875—1961), wrote about Job, noting God’s duality.  “God is at odds with himself . . . He is total justice, and also its total opposite . . . (toward Job) God displays no compunction, remorse, or compassion, but only ruthlessness and brutality.”

I too wonder about God’s duality.  IF, as it says in Genesis, we are created in God’s image; and IF as rabbinic sages tell us, we are created with a dual nature, the inclination to do good and the inclination to do evil; then does it follow that God too must have a dual nature?

Job dares to demand from God an answer.  Unquestioning acceptance of his situation is intolerable.  He craves knowledge and seeks explanation.  Job, in his personal suffering, wants to know “Why?” God responds by challenging Job to look beyond self to a greater whole, a whole beyond human grasp.  Job’s appeal to God is answered magisterially but also evasively.  Nevertheless, in the end, Job is redeemed for having questioned.  He is rewarded for having sought an honest relationship with God.

The book of Job offers a response to blind faith, orthodoxy and fundamentalism.  Job’s three ‘consolers’ are the voices of dogma.  They speak the prevailing beliefs of their time. God reprimands them for giving Job conventional, pious, and ultimately errant responses regarding the cause of his suffering.  Maybe they were chastised for lecturing Job on God’s behalf when, as friends, they should have offered comfort.  Maybe their duty at that moment was not to God, but to their suffering fellowman.

The book of Job probes from many perspectives, often arguing back and forth within itself.  It offers no answers.  It refutes complacent self-assuredness.  Job, written in antiquity, speaks to modern man:

We must not accept blindly.

We must not preach literally.

There may be no answers.

It is every generation’s obligation to ask the questions.

Becoming Adult

One is not yet an adult when all that is right in life is a personal achievement,
but all that is wrong is another's fault.

One is not yet an adult who demands unconditional acceptance,
but commands change in others.

If one is ready to blame,
then one must also give credit and praise.

If one accepts credit,
then one must accept responsibility for fault.

If one demands acceptance,
one must be accepting of others.

If one commands change in others,
one must allow for change in self.

Chiggers

Yesterday, I forgot to use DEET.  Today, I’m paying the price. 

I grew up in Colorado.  Never heard of a chigger until I moved to Kansas and learned the hard way. Once, when covered in bites, I was inspired to write poetically about my experience. My first and only published poem can be found in the August 12^th, 1992 edition of The Manhattan Mercury.  With minor revisions. I bring you An Ode to Chiggers, by Gary Boxer.

Walking on a nature outing,

I knew not about little mites.

I wore shorts, no socks, just sandals.

Became host to small parasites.

Barely seen by the naked eye,

A pinhead’s size and no bigger.

I have a rash and itch like hell!

I curse upon little chiggers.

Red bugs, harvest mites, are names that mean chigger.

Their scientific family’s Trombiculidae*,

Of which there are maybe hundreds of species,

Thriving in Kansas heat and humidity.

A chigger is not an insect.

To spiders and ticks it‘s cousin.

Adults arise from winter’s sleep,

Covered with velvet red fuzz on.

From adults come eggs, then larvae.

Grasses and plants are home bases.

I walk, they jump on for a ride,

And crawl up to private places.

Injecting enzymes in dermis,

Invasive behavior indeed,

And from allergic reaction,

Comes protein ooze on which they feed.

I prefer a mosquito bite.

I react to them just barely.

The places they bite are smallish,

Itchy maybe, intimate rarely.

A local chigger is but a nuisance.

Entomologists just take or leave her.

But beware the Oriental chigger,

They carry Tsutsugamushi fever.

As I write this blog it is meant to be

About thoughts in my head that are hatching.

But it’s hard to write intelligently,

While I’m sitting here itching and scratching.

Revenge on chiggers my mission in life,

I bought Diazinon insecticide.

Attach to the hose, spray the grass amply,

The problem can forthwith be rectified.

I fear my meter and rhyme are uneven.

My poetic talent is nothing to tout.

Try hard as I may to rewrite lines smoothly,

I put bugs in, but I can’t get the bugs out.

Thinking and rhyming on Kansas fauna,

I’ll write about more pests that invade us.

Perhaps a future blog will be about

Noisy but innocuous Cicadas.

The point of this is trivial, I know,

As I try to sum up didactically.

But unlike most blogs that I have written,

Here’s advice to be applied practically.

When walking in Kansas summer it’s best

To wear stockings, long pants and use bug spray.

Wading amid the tall prairie grasses

Chiggers are predators and you’re their prey.

Now as I bring this ode to conclusion,

One last thing about chigger venomy,

Knowing firsthand discomfort it causes,

I don’t wish it on my worst enemy.

*some sources suggest the family Trombididae

My Father

“It is, I believe, the greatest generation any society has ever produced.”                          (Tom Brokaw, 1940 --) 

My father was born in Kansas City on May 4^th, 1919.  He was the middle of three sons born to immigrant parents.  His mother died when he was 5 years old.  He subsequently moved from town to town as his father went from job to job.  When his father couldn’t afford otherwise, he and his brothers were sent back to K.C. to live with aunts and uncles. 

During the Great Depression, when my father was 16 years-old, he moved to Houston, finding work as a shoe salesman. He discovered he was good at it.  He then briefly attended the University of Texas but had to leave school abruptly in order to avoid trouble from a gambling scheme gone bad. 

He subsequently enlisted in the Army.  He was stationed in San Francisco when Pearl Harbor was attacked.  He applied and was accepted into Officer Candidate School.  He joined the Army Air Corp and completed training as a B-17 bombardier.  It was during his training at Lowry AFB in Denver where he met my mother. 

In the months preceding D-Day, my father flew 25 missions over France and Germany.  Among his honors, he earned the Air Medal, the Distinguished Flying Cross, and the Purple Heart.  He served in a unit that had over 40% casualties.  When on leave, his plane and crew were shot down. 

My father and mother married in Oct. 1944.  Shortly thereafter, my father was honorably discharged from the service.  Back in Denver, he opened Boxer’s Steak House.  He and his older brother ran the restaurant for twenty years. Initially the restaurant did well but began to fail in its final ten years. 

When I was approximately 12 years old, my father sold the restaurant.  A few years later he opened The Antique Trader, finding success in the antique and used furniture business. He was never happier than when he was in one of his stores or at an auction.  The stores were open seven days-a-week.  Unless forced to do so, he never took a day off.  He didn’t want to.  He continued working every day well into his 80’s. 

My parent’s marriage lasted over 60 years, but it was not a happy marriage, at least not while I was growing up. My father was the classic workaholic, though for him his work was his play.

As a young child I remember my father teaching me how to catch a ball and how to ride a bike.  I remember him asking me my spelling words and checking my homework.  As I got older, we interacted less and less.  There were never any arguments or harsh words spoken between my father and me.  But neither were there any meaningful heart-to-heart conversations.  Once, when my father nearly died from an ulcer, he wrote down his feelings about me and my sister, expressing his love.  Ordinarily, he never shared his feelings.  My sister and I were at a loss to know what to do with his new-found demonstrativeness. However, once recovered he quickly reverted to his old self. 

When in High School, or home from college, I would occasionally work at the store driving the delivery truck.  My father would get very short and impatient with me.  The message was clear. I was not going to continue in the family business.  My sister and her husband would fill that role.  I was expected to continue my education. 

I tried at times, in his last years, to engage my father in dialogue.  My effort was hindered by his refusal to wear a hearing aid.  I would start the conversation. “What did you say?”, was his usual response.  I had some evidence to suggest that his poor hearing was, in part, selective and that he could hear better than he let on.

My father was largely about three traumas; the death of his mother, the depression, and the war.  He learned to build a protective wall, always in control and never allowing himself to get too close. He could be very generous, but he could never accept the generosity of others. He was afraid to love and was uncomfortable being loved. He was self-contained, finding fulfilment in his work, but not in his family.

My father’s wall could not be breached, not by me.  He died October 15^th, 2012.

ADHD and Medication

I wear glasses.  As far as I know, my eyes are healthy. They are not sick or diseased.  However, I am significantly myopic and must wear my glasses in order to function effectively.  My glasses are a tool that makes my life much more manageable.  However, my glasses don’t do my work for me.  I must still do that.

Many times I’ve talked about my eyesight and my glasses to children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and who are about to begin medication. I point out the parallels, comparing my near-sightedness to their poor focus, comparing my glasses to the medication they will soon begin taking. I explain to them that, as far as I can tell, they are healthy.  They are not sick or diseased.  However, they cannot focus very well and like my glasses there are medicines to help them to function more effectively.  Medications are a tool given to make life, especially school life, much more manageable.  But, as with my glasses, I remind kids that they still have to put forth the effort. Medication may help to improve attention, but little else.  Making good choices, having a good attitude and working hard is up to them.  Medication may help to make it easier to complete the task, if they so desire, but it never does the work.

As a father and grandfather, the decision to prescribe medication was never made lightly.  I knew of many children whose lives were transformed for the better with the proper use of medication.  However, I knew just as many children who did not need medication or who did poorly when medication was tried. I saw that the use of medication required more than adherence to “evidence-based” algorithms. Rather than get trapped into the polarized and politicized view that medication was either wonderful or awful I knew that each child had to be carefully, meticulously evaluated. When all the information was gathered and considered, I then would ask myself, “If this were my child?”

I remember diagnosing a 5^th grader with ADHD and starting him on medication.  A few weeks later he came to my office excited to tell me how school was going.

“Dr. Boxer, it’s been great!  I’m getting my work done.  The teacher’s not yelling at me any more.”

I smiled and said, “That’s great.”

He then looked at me, pointed his finger and said with a serious expression, “But Dr. Boxer, I want you to know something.”

“What’s that?”

“Dr. Boxer, it was one-tenth the medicine and nine-tenths me.”

I asked him to explain.

“Well, Dr. Boxer, the medicine helped me to sit still and pay attention, but I still had to do all the work.”

I nodded and told him, “You’re right.”

Often there are misconceptions or magical thinking associated with medication.  Some parents and children come hoping that medication will make the problems go away. Some come expecting a fix or a cure.  However, at least for ADHD, if improvement is to occur, it is both the medication and the patient effort.  One-tenth to nine-tenths is about the right ratio.

Very Interesting

“My experience is what I agree to attend to.  Only those items which I notice shape my mind – without selective interest experience is an utter chaos.”  (William James, 1842—1910)

Once-a-year I taught an interesting class, a class about ‘interesting’.  It started when I became aware how often I heard that word come out of the mouths of medical students and trainees.  “Dr. Boxer, I have an interesting case to discuss.”  I became interested in ‘interesting’.  I heard the word so often that I figured that it must mean something very important, it being used so frequently by so many.

Tell me you have an ‘interesting case’, and you’re telling me to pay attention.  I am about to hear something good, something worthy of my time and reflection. You’re also reassuring me of your consideration.  You would never take up my time with something mundane or boring. Tell me that something is ‘interesting’, I will likely invest my time and mental energy.  Actually, if you tell me that something is 'interesting', you are hoping I will find it to be so.  You may or may not.

‘Interesting’ has a positive valence but is not final judgment.  If it is ‘interesting’ it is worthy of attention, observation and scrutiny, but it does not predetermine good or bad, right or wrong.

Calling something ‘interesting’ creates a dichotomy.  If there are interesting cases, there must also be uninteresting cases. Maybe there is not a dichotomy but a spectrum from most- interesting to least-interesting.  Of course, that opens the possibility of an inverse spectrum, least-boring to most-boring.

Is ‘interesting’ an inherent feature of the observed or a subjective impression of the observer?  Answer, yes.  What makes something interesting?  Answer, multiple factors:

·         Biology, including instinct, intelligence, talent and temperament, factors into what is selectively interesting to us as humans.

·         Psychology, factors into what is selectively interesting.  Called ‘confirmation bias’ we select that which supports our beliefs and exclude that which refutes or challenges us to think otherwise.

·         Development plays a role.  What is interesting to an infant is different from what is interesting to a toddler.  What is interesting to an adolescent is different from what is interesting to an adult.

·         Experience, the cumulative narrative of our past, our family, our education, and our social environment, factors into what, for us, is interesting.

‘Interesting’ has a physiologic component, a state of arousal and an orientation towards something. ‘Interesting’ has emerged evolutionarily.   It might be said that the sun is interesting to a plant. I know from personal experience, that a mayfly is interesting to a trout.  Certainly, a ball of yarn is interesting to a cat. Advertisers are experts at identifying and exploiting that which is interesting to the human species.

Humans, especially, seem vulnerable to disorders of interest – too much, too little, inconsistent, misdirected, inappropriate, or pathological.

The world is far too vast, far too busy, and far too complex to be experienced fully.  Our lives our governed through the lenses of selective interest.  We ask, we listen, we see, and we understand according to our interest.  To avoid “utter chaos” we, by necessity, select and then filter out the rest.  Think about it.  It’s really kind of interesting.