(From Wingspread, WI): I first posted on Jan. 8, 2003, so tomorrow will be the second birthday of this blog. I’ve posted every weekday since then, except when I’ve been away on vacation with my family. There have been 514 entries, total. I’ve already told the story of how I started, but in brief: I was asked to moderate an academic panel on “community in cyberspace.” The panelists included Eugene Volokh, Glenn Reynolds, Jack Balkin, and Amitai Etzioni. Although I knew about blogging, I didn’t know that Reynolds and Volokh had hugely popular blogs–which is why they had been invited for the panel. I hastily wrote introductions based on their university web pages, which only mentioned their scholarly and teaching interests. But the conversation turned to blogging, naturally, and I decided to get into the game. Etzioni and Balkin also started their blogs within a month of that panel.

In the last year, some of my favorite moments were: learning that a college class had been assigned to read my post on what it means to be civic; suddenly getting a fair amount of attention for a mini-essay (“What’s wrong with the left, and what to do about it?”); receiving a Christmas card from a reader; and having three academic articles accepted for publication that were entirely composed of assembled blog entries. Speaking of “community in cyberspace,” I’ve also enjoyed my regular commenters and reciprocal visits to their blogs–for instance, Prairie Weather, Brad Rourke, Eli Edwards, In Medias Res, Mike Weiksner, Rick Emrich, Nick Beaudrot, and Anjali Taneja.

Today I’m going to Wingspread, the Johnson Foundation’s retreat center near Racine, Wisconsin. It’s a beautiful building designed by Frank Lloyd Wright. The nonpartisan youth voting folks will gather there to discuss what to do next. Young people turned out in 2004; we need to keep them engaged. I hope to post something substantive later, but right now, I have to catch my plane.

Rekha Mirchandani has written a fascinating short essay with the somewhat forbidding title, “Battered Women’s Movement Ideals and Judge-Led Social Change in Domestic Violence Courts.” It’s in The Good Society, which is unfortunately not online.

Domestic violence courts are an example of specialized judicial bodies; other examples include drug courts, mental health courts, and community courts. These bodies have been created since the 1980s to increase efficiency by streamlining the resolution of many similar cases. For example, all drug cases in a particular community may go to the “drug court.” Each type of court is also a response to a social movement that has demanded special attention to its issue. A third motive for creating such courts is to combine punishment with counseling and other services.

Thus domestic-violence courts were created to increase efficiency but also in response to demands from the women’s movement. Feminists argued that battery was a deep (but remediable) social problem, arising because people viewed masculinity in terms of “power and control” and therefore excused criminal behavior when it occurred within households. Feminists sought domestic violence courts as a way to ensure that their concerns were addressed.

As Mirchandani notes, we often assume that there’s a tradeoff between efficiency (on one hand) and moral thoughtfulness, discretion, and dialogue (on the other). Domestic-violence courts achieve marked gains in efficiency by standardizing the treatment of similar cases and delegating most tasks to prosecutors and clerks. Defendants who plead guilty are moved rapidly through a series of steps from plea-bargaining to counseling and mandatory community-service, overseen but not personally managed by the judge. As a result, judges are able to devote their time to crafting the overall process, listening to victims and defendants, and making statements at appropriate times.

For example, a judge may tell a victim who is present in court, “Nothing justifies the use of force. … You do not need to take responsibility for what he did. He has to appreciate what he did.” The judge may also tell a group of convicted fathers that domestic violence tends to recur in families. Thus, “You can make a big difference for your family now and for your child’s family later and down on through the generations. It’s a big responsibility. It’s a big contribution to the community.” (By the way, I hope that judges listen as well as lecture.)

In short, the gains in efficiency that come from standardization allow the legal system (a) to respond effectively to a legitimate demand for more attention to domestic violence; and (b) to engage in a dialogue with defendants and victims, using ideas that first developed within a social movement and were later endorsed by a democratic government. Mirchanandi concludes, “In domestic violence courts, we see the values of efficiency and the values of social change, traditionally conceived as oppositional, coexisting pleasantly and effectively side by side.”

Domestic-violence courts are only helpful to the extent that the feminist theory of violence is valid–as I think it is. Drug courts may be less helpful, because their ethical assumptions may be misplaced. (One can even imagine a “problem-solving court” that embodied awful values and allowed a judge to hector cowed defendants with mere prejudices.) However, from the perspective of democratic theory, it is important to recognize that a system can become more responsive and more intentionally ethical as a result of being made more efficient.

My family and I are going to Belgium today. We’ll stay in Bruges and I’ll commute to a conference at the University of Tillburg on “The Ethical Implications of Ultrafast Communications.” From Belgium, we’ll go directly to Macon, GA for Christmas. I clearly need a break from computers, so I won’t go online (let alone blog) until December 27 or so. Until then, I wish you happy holidays and leave you with some genuine Flemish phrases to translate:

(And they call this a foreign language?)

I’m reading Anne Fadiman’s The Spirit Catches You and You Fall Down, the story of an epileptic Hmong girl and the cultural misunderstandings and outright tragedies that result when she is treated by American doctors. The book is rich, complex, and moving. Among its many themes, the one that interests me most is the role of trust in medicine?and by extension, in all professions and disciplines.

American doctors are right: epilepsy isn’t caused by a spirit that makes people fall down, but rather by electro-chemical “storms” in the brain. They are right, too, that giving an epileptic infant an elaborate set of medications can reduce the chances of severe seizures, thereby improving her odds of normal cognitive development and survival.

However, in order to follow doctors’ advice, one must understand it (a difficult matter when complicated prescriptions are written in English and constantly changed, and the parents speak only Hmong and cannot read in any language). One must not only understand but also trust what the doctors say. I would recommend trusting physicians because I believe that their knowledge of disease is based on cumulative, peer-reviewed, basic science, double-blind clinical trials, and other methods that strike me as reliable. I have a general sense that they are motivated by the best interests of their patients. I am impressed that the particular doctors in Anne Fadiman’s book are well-trained, hard-working, and have chosen to serve largely indigent populations at high cost to themselves.

However, imagine that you arrived in a strange foreign country basically against your will and had to decide whether to treat your suffering baby daughter as the local doctors advised. These experts do not even pretend to understand epilepsy fully, let alone know how to cure it. Each procedure and medication that they prescribe is painful and invasive; hardly any are expected to produce a noticeable positive effect while you watch. There is an obvious correlation between the horrible tasting medicines that they make you give your child and her painful symptoms, so it seems likely that the former cause the latter. When you leave your baby at the hospital, she frequently comes back distinctly worse, having suffered terribly.

The physicians expect a high degree of respect, deference, and gratitude, but they don?t visit your home or inquire about your beliefs and values. During emergencies, you usually find yourself meeting a whole new set of doctors, or reencountering ones who don?t remember anything about you. Their expectation of deference can easily be taken as mere arrogance, especially when they threaten you with loss of custody since you are allegedly abusing your child by not following their rules. They believe in the drugs and procedures that they prescribe?not because these things work in ?real time??but because they have put their trust and faith in other authorities: drug companies, medical researchers, med-school professors. These authorities are complete strangers to you. Why should you put more faith in the powers that the doctors trust than in the unseen powers you learned about as a child?

I don?t assume that Anne Fadiman is a perfectly reliable narrator, a transparent window through which we can observe Hmong culture and follow the true story of Lia Lee. I once spent a single evening tutoring Hmong people for the US Citizenship Exam, and my friend, a White graduate student who had learned Hmong, expressed some polite reservations about Fadiman?s account. (He was mainly concerned, I think, that she had won a monopoly position as the interpreter of Hmong-Americans to other Americans). However, no one is perfect, and Fadiman is a remarkable observer. More to the point, the story of Lia Lee would be profoundly credible and disturbing even if it were pure fiction (which it certainly isn?t). Trust is fragile, hard to earn and easy to squander. High-tech machines and chemicals cannot improve our health unless we trust them. Modern medical professionals have mechanisms for engendering trust, ranging from their white lab coats and titles to conflicts-of-interest rules and double-blind clinical trials. These ?mechanisms? do not, however, include getting to know their patients as human beings or listening to alternative explanations. Many of us will continue to trust doctors because we are strongly committed to the general epistemology of scientific research. But we cannot observe the research itself, so our faith is actually in institutions, not in science. If the institutions are corrupt or have bad priorities, then our faith is foolish. This is why the increasing pace of scandal in medical research is so troubling.