There is a certain wisdom in Yogi Berra’s observation that, “It is deja vu all over again.” When I was practicing I would frequently have that thought as I was trying to manage a patient with a chronic disease. Whether the problem was CHF, poorly controlled diabetes, or COPD, each new episode or exacerbation of the illness was often very similar to a previous episode.  My job was to help my patient understand that there were lessons to be learned from each flare that might help to prevent the next one. That’s an easy message to articulate, but the execution was very hard when the change that was needed ran counter to a long standing habit, or required a fundamental change in some critical relationship. 

 

I believe that there is an element of truth that is applicable to our current national distress in the union of deja vu and concepts of chronic disease management. Our nation has been in this moment before. This moment is rooted in a chronic pre existing congenital condition.  To our recurrent peril, we have ignored and resisted resolving our problem through many “flares.” Our condition has been a continuing cause of pain and suffering for four hundred years.  Just as a patient with a chronic disease often tries to ignore their medical condition, we have ignored and denied the many ways in which we all suffer from our collective congenital racism, and the chronic long term disadvantage to us all of the unearned benefits that we bestow on the accident of being born white. 

 

Flares or exacerbations of symptoms in chronic disease are often a  response to an unexpected stress, some change in the underlying pathology, or some failure of management or compliance. Like some patients with a chronic disease, our nation has some long standing, even “congenital problems.” Also, like many patients with a chronic disease we have developed some habits or made some choices that have further compromised our congenital weakness. Like many patients with chronic conditions, there are choices that we could make that would improve our health, but we just haven’t been able to accept the advice from our “doctor” and move toward the better health that would result if we could admit and act on the need to change.

 

I apologize for the lame comparison between the events of the last week and an exacerbation or flare of symptoms in a patient with a chronic condition, but I feel like “I’ve seen this movie before.” The picture of the burning building in the header for this post was not taken in Minnesota, Boston, or Washington sometime in the last few days. The picture is from the riots and burning in Detroit in the summer of 1967. Just like there is much to learn from the Pandemic of 1918 as we seek to manage and survive the COVID-19 pandemic, I think there is reason to re examine the riots of 1967, and what we should have learned and done then to resolve a disease or condition that was already 350 years old.

 

Fundamentally, things look pretty much the same now as then, despite the intervening 53 years. We are still failing to find the will to manage our real root cause problem, the true origin of our distress, our congenital defect, our pre existing condition, the unequal way we treat people driven by the randomness of their heritage. Detroit was the most distinctive of 159 “race” riots that exploded across our cities in 1967. The “autopsy” or case review of that summer was the Kerner Commission.  I don’t usually lift quotes from Wikipedia, although it is a favorite source of mine, but this time I will  because the Wikipedia summary of the findings of the Kerner Commision are worth repeating. Pardon my bolding of the thoughts that resonate with me, and seem applicable to this moment. 

 

The report became an instant bestseller, and over two million Americans bought copies of the 426-page document. Its finding was that the riots resulted from black frustration at the lack of economic opportunity. Martin Luther King Jr. pronounced the report a “physician’s warning of approaching death, with a prescription for life.”

The report berated federal and state governments for failed housing, education and social-service policies. The report also aimed some of its sharpest criticism at the media. “The press has too long basked in a white world looking out of it, if at all, with white men’s eyes and white perspective.”

The report’s most famous passage warned, “Our nation is moving toward two societies, one black, one white—separate and unequal.” The report was a strong indictment of white America: “What white Americans have never fully understood but what the Negro can never forget — is that white society is deeply implicated in the ghetto. White institutions created it, white institutions maintain it, and white society condones it.”

Its results suggested that one main cause of urban violence was white racism and suggested that white America bore much of the responsibility for black rioting and rebellion. It called to create new jobs, construct new housing, and put a stop to de facto segregation in order to wipe out the destructive ghetto environment. In order to do so, the report recommended for government programs to provide needed services, to hire more diverse and sensitive police forces and, most notably, to invest billions in housing programs aimed at breaking up residential segregation.

 

The Kerner Commission report was published in March of 1968 in time for Dr. Martin Luther King,Jr to make his comment: a “physician’s warning of approaching death, with a prescription for life” before his own life was taken in Memphis in April. 

 

In a time like this when we have no effective national leadership, it is good that we once did have two men of great wisdom and moral authority. In retrospect, the two men who have tried the hardest to lead us toward a resolution of our national preference for a divided society, Abraham Lincoln, and Martin Luther King, Jr., were both assassinated as thanks for their efforts. Lincoln told us that “a house divided against itself cannot stand.” Standing in front of Lincoln’s Memorial, in August of 1963, one hundred years after Lincoln’s attempt to rectify our “original sin,”  Dr. King used his “I have a dream speech” to call for the payment of the debt that would then allow us to move forward together as one nation. From the Montgomery bus boycott of 1955-6 until he was killed in Memphis in 1968, Dr. King tried to lead us out of the collective dysfunction of a history of slavery and white supremacy that were the shameful foundations of our economic success, and toward a future built on the mutual benefit of the universal equality in justice and opportunity that were implied in our founding ideas.

 

Dr. King’s “The Other America” is a speech that is less well known than the “I Have A Dream” speech. It was delivered at Stanford in 1967. In the speech Dr. King explains the origin of a race riot.

 

“And I must say tonight that a riot is the language of the unheard. And what is it America has failed to hear? … It has failed to hear that the promises of freedom and justice have not been met. And it has failed to hear that large segments of white society are more concerned about tranquility and the status quo than about justice and humanity.”

 

Do not take that statement as an endorsement by Dr. King of rioting as a path to the resolution of the problems of racism, police violence against African Americans, healthcare disparities, and the economic inequity that were the components of the experience of Black Americans in 1967, and that remain largely unmodified or resolved today. In 1967, Dr. King published a book entitled Where Do We Go from Here: Chaos or Community? In which he wrote:

 

“The ultimate weakness of violence is that it is a descending spiral begetting the very thing it seeks to destroy, instead of diminishing evil, it multiplies it … Through violence you may murder the hater, but you do not murder hate. In fact, violence merely increases hate. Returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars.”

 

Like many patients with a chronic disease who fail to act on sound medical advice, under the influence of Lyndon Johnson who was more concerned with Vietnam, we ignored the recommendations of the Kerner Commision which were, to use Dr. KIng’s analogy, “a prescription for life.” I recommend that you scan the specific recommendations of the Kerner Commission. They are remarkably on point. We would be living in a different America, and it is likely that George Floyd and many other black men and women would be alive, if there had been a concerted effort to implement the recommendations. I would draw your attention to Section V.  POLICE AND THE COMMUNITY. There are five major areas in Section V. Each of those 5 areas has multiple recommendations for implementation. Here is the first section. When you read the recommendations, ask yourself if there is any evidence in what happened to George Floyd that the Kerner Commission’s wisdom had been adopted as a “prescription for life” in the police department of Minneapolis. How often does a frustrated clinician disdainfully label a patient with a chronic disease as “non compliant” because they failed to fill a prescription? How often does that joint failure of the clinician and patient lead to readmission? Here is the first of five broad recommendations from the Kerner Commission for changes in police policy and procedures:

 

1) The Need for change in police operations in the ghetto to ensure proper conduct by individual officers and to eliminate abrasive practices.

a) Police misconduct, including 1) indiscriminate stops and searches, 2) Physical abuse, and 3) Harassment and “contemptuous and degrading verbal abuse,” or discourtesy, must be curtailed. 

b) Police departments must develop rules prohibiting such misconduct and vigorously enforce it. 

c) Police commanders must be aware of what takes place in the field and take firm steps to correct abuses. 

d) Departments must use greater care in selecting police for ghetto areas, and place the best, not the worse, officers there. Screening procedures must be developed along with better training and incentives or bonuses.

e) Officers with bad reputations among residents in minority areas should be reassigned to other areas. 

f) New Patrol practices must be designed to increase the patrolman’s knowledge of the ghetto. Motorized patrol should be more limited. 

 

Perhaps the term “ghetto” is one that we try to avoid these days, but the scene of George Floyd’s homicide by Minneapolis police officer Derek Chauvin and his partners in the crime was the predominantly black neighborhood on the south side of the city. Over the intervening 52 years there may have been some superficial changes in Minneapolis, but they did not seem to penetrate all the way down to Officer Chauvin and his partners. As they say “res ipsa loquitur,” the situation speaks for itself, perhaps we are all as guilty as Officer Chauvin because collectively we did not correct the problem or remove Officer Chauvin from where he could injure us all. Racism persists, as manifested by the actions of some policemen across the country because white America has failed to make the end of racism our highest priority. We may not consider ourselves to be racist, but we let it persist. We are not as anti racist as we are anti smoking, or anti drunk driving. Not only has racism persisted, but the “dog whistles” of racism have been effectively used by at least three presidents, Richard Nixon. Ronald Reagan, and Donald Trump, to great political advantage. 

 

President Trump’s lack of moral leadership, his obvious inability to effectively express empathy, and his belligerent calls for military action, are more likely to exacerbate the problem than to solve it. After the president’s rant on yesterday’s call with all fifty governors, Charlie Baker the Republican Governor of Massachusetts was obviously offended as the Boston Globe reported:

 

“I heard what the president had to say today about dominating and fighting,” Baker said, unprompted, during his daily COVID-19 press briefing, referring to a conference call earlier in the day during which Trump urged governors to use force against the recent wave of protests — including in Boston — in the wake of George Floyd’s death.

“I know I should be surprised when I hear incendiary words like this from him — but I’m not,” Baker said during his opening remarks Monday afternoon.

“At so many times during these past several weeks when the country needed compassion and leadership the most, it was simply nowhere to be found,” he continued. “Instead, we got bitterness, combativeness, and self interest. That’s not what we need in Boston. That’s not what we need right now in Massachusetts. And it’s definitely not what we need across this great country of ours either.”

 

I voted for a Republican for governor once about forty years ago. Today, I would vote for anyone, no matter what their party is, who could be as spontaneously straightforward and honest in so few words as Governor Baker was yesterday. Whether we are fighting a pandemic or fighting racism, we need effective leadership that we don’t assassinate at every level of society. 

 

The article points out that Baker has had much to say over the weekend about the benefits of peaceful public demonstrations. Last Friday he said in reference to the death of George Floyd:

 

“We hope people protest peacefully, but honestly, it’s — a moment like that and an event like that, I can’t imagine why people wouldn’t want to get out on the streets and make a point about it,” 

 

The protest in Boston began as a peaceful demonstration on Sunday, but by midnight many of the stores on Newbury Street in upscale Back Bay were burned and looted, and Baker had called out the National Guard, but Baker maintained his empathy and perspective as the article reports:

 

…While he said the “criminals and cowards” who “tarnished that night’s peaceful protest” would see their day in court, Baker condemned all “shapes and sizes” of injustice, from daily offenses to the country’s history of “discriminatory federal housing policy.”

“They’re all unacceptable,” he said. “Every instance of discrimination. Every attempt to use race as a tool. Every offhand slant among community members or in a workplace. But injustice experienced at the hands of a public institution that’s supposed to be rooting this out, that can often be the most despicable act of all.”

Baker said the cumulative effect of experiencing such injustices can rob people of their hope, destroy their sense of safety, and over time incite anger.

“Fear, anger, and hopelessness experienced alone is a dead end,” Baker said. “But there are avenues that do lead to progress. Last night, I saw tens of thousands of people unite to continue the work to build a way forward for everyone who feels trapped in that dead end. By an order of magnitude, we can add up the number of people who want to build on progress and do well for one another [and] dwarfs those who want to do the opposite.”

 

That is a statement that contains understanding and hope. I know that in a country that frequently demonstrates that it values property over people, and profits over quality and safety, that it takes courage for any politician to express any understanding of the emotions that explode into a destructive act. When “the rule of law” becomes a racial dog whistle that can be used to enhance white wealth while disregarding the persistent burdens of minorities then we may see riots. As Dr. KIng said:

 

“And I must say tonight that a riot is the language of the unheard. And what is it America has failed to hear? 

 

A week ago it would have been hard to imagine what might push COVID-19 out of the headlines. My son who is a trial attorney in Florida sees a connection between the exacerbations of personal concerns brought on by COVID-19 and the riots that have evolved out of the peaceful demonstrations. It does not take much for people to erupt in frustration over the lack of resolution of a problem that has held them back for four hundred years when suddenly they experience COVID-19 with the frustration and fear associated with the stagnation of life under stay at home orders. Their personal concerns about the risk of becoming a coronavirus victim, the economic losses that they already incurred, and the knowledge that these new stresses will probably persist for years to come on top of the chronic inequities they tolerate, and  the continuing threats to their young men and women from the police that they have borne for so long would be enough to cause many of us to erupt in anger. Perhaps COVID-19 will also be the event that reveaals that we can no longer tolerate our nation’s persistent national disease, our preexisting, or congenital condition—racism borne from a sense of a white superiority that continues to ignore much of the suffering and disease that it can both cause and ignore. 

 

When leadership fails we must look for new leadership that has the courage to try again to address the root cause problem that makes us continually vulnerable to the progression of our national disease. We need a national leader who will act on Charlie Baker’s current observations, and the diagnosis from over fifty years ago by Dr. King that racism is our root cause problem.  Racism was the destructive virus Dr. King diagnosed when he said:

 

“What white Americans have never fully understood but what the Negro can never forget — is that white society is deeply implicated in the ghetto. White institutions created it, white institutions maintain it, and white society condones it.”

 

As we contemplate all of the changes we should seek to create in the “new normal” after we survive the COVID-19 pandemic, a good place to begin our analysis would be to revisit the Kerner Commission report. If we don’t begin to incorporate what life’s lessons teach us in our plans for the future, we will surely see more riots, more pandemics, and more shared dispare in our future.