The Diogenes Syndrome

“The sum total of things that could have been avoided.”
West German Chancellor Konrad Adenauer’s definition of history

April 1, 2007

Dear Friends,

Some might suggest that Adenauer’s observation could be the epitaph of the Bush-Cheney years, and barring a miraculous turn-of-events abroad and at home during the remaining twenty-two months, it’s probably a reasonable characterization.

Yet the litany of America’s woes and challenges are never the product of one presidency, one branch, or one party – although if ever there were an Administration that might merit such acclaim, it would be this one.

Sandwiched between the quotidian, gratuitous violence of the Iraq civil war, security and political regression in Afghanistan, the resurgence of Taliban and Al Qaeda forces, the bipolar mood swings of the Iranian predicament, policy lability in the Israeli-Palestinian conflict, the floundering North Korean agreement, stark ineptitude and fumbling chicanery at the Department of Justice, the Abramoff–Congressional scandals, retro-Teapot Dome days at the Department of Interior, indiscriminate use of national security letters, and the low ebb of American goodwill around the globe, something pervasive is happening at home that beckons us to be mindful of Chancellor Adenauer’s observation , and to act before what “could have been avoided” isn’t.

And that brings us to Diogenes the Cynic (412–323 B.C.) -- the Greek philosopher best remembered for wandering the streets of Athens during the day while carrying a lantern and searching for an honest man, among the reasons Plato described him as “Socrates gone mad.”

The Diogenes Syndrome is neither from his philosophical ramblings, nor about his search for an honest man. It’s about the way he lived -- a beggarly fellow who slept in a barrel, engaged in verboten public habits, and is reputed to have initiated the practice of showing displeasure by pointing his middle finger at detractors and foes.

And to characterize such slovenly, derelict behavior, geriatric medicine has given it the name -- “Diogenes Syndrome:”

a behavioral disorder of the elderly . . . extreme self-neglect, domestic squalor, and tendency to hoard excessively . . . associated with self-imposed isolation, refusal of help, and marked indifference or lack of awareness. Diogenes syndrome has been referred to as senile breakdown, social breakdown, senile squalor syndrome, and messy house syndrome.”

The unwelcome truth is that on the eve of its 400th birthday, an unhealthy share of America’s precious assets are beginning to look a lot like Diogenes in his dotage -- unambiguous signs of national “self neglect“ and “domestic squalor,” and a “marked indifference” about this social condition. Telltale signs of “messy house syndrome” -- a leading symptom of “social breakdown.”

Have a look around the house.

Exhibit A: Bldg. 18, Walter Reed Army Medical Center.

Exhibit B: The Veteran’s Administration healthcare system. Bldg. 18 is the canary in a medical mineshaft, warning that a once-sound healthcare system with first-rate physicians and healthcare workers, some outstanding hospitals and cutting edge clinical research (pun intended), has fallen into disrepair -- underfunded and uncared for by the political leadership of both parties and both branches of government for far too long, and woefully neglected by an Administration whose “We support our troops” rhetoric rings hollower and tinnier every day.

Exhibit C: The United States Army. Stretched to the limits of its tensile strength, undermanned, undertrained, underprotected, and underequipped on the battlefield, and grossly ill-served by its former civilian leadership -- factors which give new meaning to putting soldiers in “harm’s way.”

According to a study published this month by the Center for American Progress, -- “Beyond the Call of Duty:”

• 31 of 44 combat brigades have served two or more tours in Iraq or Afghanistan, and 2 have served four tours

• 420,000 troops have been deployed more than once

• 50,000 troops have had “stop-loss” orders, meaning they’ve been prevented from leaving the Army when their enlistment end date arrives

• More than 400,000 National Guard and Reservists have been deployed; 56,000 Army Reserve soldiers have served multiple tours

• By this spring the Army will not have any “ready brigade” because all four brigades of the 82nd Airborne will either be in Iraq or Afghanistan; the same readiness deficit holds true for the Marine Corps

• Units arriving in Iraq are now forced to use equipment left behind by departing units, materiel with which they are unfamiliar and which is battle-fatigued

• 50% of those who serve more than one tour of duty can be expected to suffer from post-traumatic stress disorder.

Exhibit D: New Orleans. It took the unforgiving force of nature to reveal a raw American tableau that shocked Americans and the world community alike. Tens of thousands of citizens lacking the wherewithal to escape the wrath of Katrina were left to their own inadequate devices as the storm struck the city. Then came an unimaginable third-world response by every level of government, compounded by a juvenile power joust between a mayor, governor, and a hapless Administration in Washington DC. And then the even more astonishing aftermath – a federal government response that would make Diogenes incredulous.

It’s true that this was a once-in-a-century occurrence that called for Herculean performance, but then that’s what leadership is all about, isn’t it.

Exhibit E: K-12 public education. The physical and intellectual disrepair of too many schools and school districts is an acute measure of America’s failure to honor its children and invest in its own future. Every day, children and adolescents are arriving at school armed, hungry, pregnant, or unacceptably overweight: school violence, teen pregnancies, dysfunctional families, and obesity are weapons of mass destruction that rival the threat of terrorist attacks.

In The Silent Epidemic: Perspectives of High School Dropouts, a report published last spring by Civic Enterprises in association with Peter Hart Research Associates for the Bill & Melinda Gates Foundation, authors John Bridgeland, John DiIulio, Jr. and Karen Burke Morison made these observations:

“Each year, almost one third of all public high school students – and nearly one half of all blacks, Hispanics and Native Americans – fail to graduate from public high school . . .

“This tragic cycle has not substantially improved during the past few decades when education reform has been high on the public agenda . . .

“The decision to drop out is a dangerous one for the student. [They] are much more likely than their peers who graduate to be unemployed, living in poverty, receiving public assistance, in prison, on death row, unhealthy, divorced, and single parents with children who drop out from high school themselves.”

And a USA Today story last June reported that fourteen urban school districts have on-time graduation rates lower than 50%, including Detroit, Baltimore, New York, Milwaukee, Cleveland, Los Angeles, Miami, Dallas, Denver and Houston; and that three graduate fewer than 40%: Detroit (21.7%), Baltimore (38.5%) and New York City (38.9%).

If you haven’t already done so – stop! -- think about this one for a moment: the wealthiest, most powerful nation in the world settles for this kind of performance? Is this the hallmark of a superpower?

It renders that bumper sticker – “It’ll be a great day when the schools have all the money they need, and the Air Force has to hold a bake sale to buy a bomber.”– a bit more trenchant.

Exhibit F: Health care. Where to begin?

Thanks to Len Nichols, a widely respected policy scholar at the New America Foundation, we learn that:

• The Institute of Medicine recently concluded that roughly 20,000 people die each year because they lack access to timely high quality care due to their lack of insurance.

• Employer-sponsored coverage rates among the near poor have declined seven percentage points since 1987, but remain unchanged for those with higher incomes.

• Medicaid actually covers only 42 percent of the poor. The number of uninsured increases one to three million each year.

• We spend 15 percent of GDP on health care, 7 percentage points more than the Organization for Economic Cooperation and Development median, and over twice as much per person as the OECD median. Despite being first in spending, the World Health Organization ranks the performance of the U.S. system at 37th overall. Our life expectancy, for example, is 24th.

• Americans get appropriate care in doctor’s offices only about 55 percent of the time, despite having some of the best physicians, nurses, and hospitals in the world.

• Almost 100,000 Americans die from errors in hospitals each year, and an additional 40,000-80,000 die from poor quality care throughout our system.

Add to that a grim financial forecast from Henry Aaron of the Brookings Institution, one of the country’s preeminent policy scholars on health care; costs are rising 2.5% faster than personal incomes, a rate that would consume 50% of individual income growth by 2020 and 100 % by mid-century.

Exhibit G: America’s crumbling infrastructure. The American Society of Civil Engineers' 2005 Report Card for America's Infrastructure warns that deteriorating infrastructure poses growing risks to personal safety and economic growth. They assessed the condition and capacity of the nation's public works with an overall grade of D, and have estimated that $1.6 trillion is needed over a five-year period to bring the nation's infrastructure to good condition. This includes roads, bridges, dams, levees, highways, airports, drinking water and wastewater facilities and several other categories.

It’s a daunting catalogue of symptoms, and a quick compilation of complex, comprehensive problems that are working their way into the fabric of the American economy and polity. Taken together, these are the unmistakable signs of the “Diogenes Syndrome.”

Like other public policy challenges – global warming and the accumulation of debt, for example – these become irreversible at some point, although just when is always an unknown. What is known is that procrastination makes the fixes more expensive and politically painful.

Someday, after the 43rd President and his Vice President are long gone from office, a new generation of historians will survey the landscape of America in the opening decades of the 21st century and ask how a great nation permitted such a corrosive, erosive run on its physical, human, and moral assets, and why the country turned a blind eye to the onset of this progressive disease.

One response is simply that “stuff happens.”

Another is that it’s a profoundly important reminder of how quickly the best – individuals, institutions, and nations -- can lose their edge.

But we’ve been there before, and the country found its way back.

In a December 1862, one month before signing the Emancipation Proclamation, at a time when the future of the Union hung in the balance, Abraham Lincoln made these remarks to Congress:

“The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise -- with the occasion. As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we shall save our country.”

Leadership of this caliber won’t be forthcoming from this Administration. Their day has come and gone, if not yet their official term of office, and the wreckage of their improvidence and impetuousness is all around us.

And that brings us to the next chapter in our history, and to the question of whether a new day will simply continue the depletion and exhaustion of our human, financial, and natural resources or whether we will find it within ourselves to “think anew, and act anew.”

We are now embarked upon the quadrennial search for a leader, this one more frenzied and front-loaded than any in our history. And the peril of the new primary timetable is that it makes money a bigger determinant of winners and losers than ever before, which weighs in favor of front-runners and conventional wisdom. And that suggests that our future may be “the sum total of things that could have been avoided.”

But perhaps not.

Out there on the horizon are a couple of candidates who show gut-level signs of understanding precisely what Lincoln spoke about 145 years ago. Let us hope that they and we might find common cause so that together “we shall save our country.”

We say this every four years, but every once in a great while it’s the truth:

We have never needed new leadership more than today.

The stakes have never been higher.

The deck has never been more heavily stacked against a new president and a new team.

And the opportunities have never been greater.

Comments

[RL Phares]

BRILLIANT ARTICLE . . . BRILLIANT~! THANKS.

[RL Phares]

BRILLIANT ARTICLE~! BRILLIANT.