On the November issue:

Work Wars

To the Editor:
I wish Barton Swaim had spent more time developing his key argument about the attempt by progressives to delegitimize honest work (“The War on Work,” November). There is such a rich vein to mine here. There are, for example, the Silicon Valley pundits who assert that, within a few years, robots will eliminate the need for human work by doing all the earning for us. There’s also the “Women Should Be Paid for Being Mothers” movement, which goes against more than 50 years of feminist doctrine arguing for greater participation by moms in the corporate workforce.

Instead, Swain spends the second half of his article articulating some familiar but unproven conservative tropes, such as the claim that the private sector is necessarily more productive than public and nonprofit ones because only the free market rewards the creation of useful things.

This argument doesn’t hold up. Consider, for example, airline safety. During my adult years alone, the rate of U.S. airline fatalities has dropped from about 5 deaths per 100 million miles flown in 1975 to an average of under 0.01 (one hundredth of a death) per 100 million miles today.

This fatality-rate reduction of more than 99 percent came thanks to the FAA and NTSB’s highly effective management of air safety, including the FAA’s own air-traffic-control system, the mandating of accident-avoidance devices, and training and maintenance procedures. 

Moreover, we have recently seen the dangers of a supposedly more productive private-sector approach: The FAA has allowed Boeing to handle much of the certification work for its new 737 Max model.  This privatization move may well have contributed to 346 unnecessary deaths.
Peter Blau
Charlotte, North Carolina

Barton Swaim writes:
I thank Peter Blau for reading my essay, but I wonder whether he should read it again. I don’t think I argued anywhere that “the private sector is necessarily more productive than public and nonprofit ones”—a proposition that seems obviously true, since governments and nonprofit organizations don’t produce much of anything, in the ordinary sense of that word. They have other entirely legitimate roles, which I acknowledged.

I was amused, though, to read that Mr. Blau thinks of the aerospace company Boeing as representative of the private sector and the trend toward “privatization.” By most estimates, Boeing is the largest recipient of government subsidies in the world. Private-sector beneficiaries of large-scale “corporate welfare,” as it’s aptly termed, frequently become dysfunctional, entitled, inefficient, and susceptible to distorted incentives. It’s reasonable to conclude—though I admit not strictly provable—that the disasters to which Mr. Blau refers, namely the two crashes of 737 MAX jets in 2018 and 2019, were in some measure the consequence of Boeing’s heavy reliance on government subsidies and concomitant insulation from market pressures. Whatever the truth about Boeing and government regulation, however, I don’t think it affects the argument of my essay.

Revolution No. 2

To the Editor:
Ray Takeyh’s article on the Iranian uprising offers truly outstanding analysis (“A Second Iranian Revolution?” November). I lived and worked in Iran from 1977 to 1979. The parallels between what happened in Iran in 1978 and 1979 and what is taking place in Iran in 2022 are amazing. Iran does not yet have a charismatic figure like Khomeini to unify the opposition. But the rule of the clerics, the Revolutionary Guard, and the Basiji is destined to collapse in the near future. Forty-three years of corruption, incompetence, mismanagement, repression, nepotism, hypocrisy, and greed are catching up to the ruling elite in Iran. The Iranians are demonstrating that they are a great people with a proud history and culture that go back more than 2,000 years.
Tom Kulick
Chepachet, Rhode Island

To the Editor:
The article on the potential Iranian revolution was clearly written by someone who knows Iran well. I was not aware of the full Rex Cinema fire story, and I wonder: Do most Iranians know that Khomeini engineered it? Thanks for publishing this great piece of journalism.
Neil Hokanson
Cardiff-by-the-Sea, California

To the Editor:
Ray Takeyh’s analysis of Iran was one of the most useful and well-written articles on the topic. He got it right—from the Khomeinist revolution to the present. It’s worth adding a point about the reformists in Iran, however. From the presidency of Mohammad Khatami to that of Hassan Rouhani, the so-called reformists were devils in angels’ garb. During their time, execution and extraordinary imprisonment thrived. At the same time, Iranian foreign minister Mohamad Javad Zarif, with his fake smile, humiliated the West as much as he could. Lobbying groups such as NIAC successfully interfered with the political and strategic goals of the U.S. regarding Iran. These parties promoted a colorful and exciting image of the Islamic Republic to Western countries while the regime was engaged in excessive war crimes, executions, and corruption. 

Thank you for your article and your efforts.
Sara Block
London, England

To the Editor:
Thank you for the excellent article by Ray Takeyh on the current upheaval in Iran. The tragic death of Mahsa Amini was the catalyst that unleashed the rage and frustration across a broad cross section of society.

The multitude of indignities that Iranians have had to tolerate for decades under iron-fisted clerical rule just might set off a profound revolution in the months to come. What is potentially troubling is the stark question of whether a new regime in Tehran would be better or worse than the 40-plus years of Islamic rule.

Would a new government absorb lessons from the current order and the prior monarchy?  While the Pahlavi dynasty had its secret police that used repressive methods, Iranians had more freedom, and relations with the West were reasonable. 

One can only hope that any future government would protect individual rights, economic development, the rule of law, and improved relations with the region and the West.  Iranians could choose to chart a better future that would fully respect the legitimacy of Israel and other sovereign nations.
Christian Milord
Fullerton, California

Ray Takeyh writes:
I wish to express my gratitude to the readers who chose to respond to my article. COMMENTARY always has the most discerning of readers. Neil Hokanson raised a point that deserves some elaboration. The Rex Cinema bombing was clearly a turning point in the revolution. And yes, the subsequent trials revealed that it was done by Khomeini’s followers and not the shah’s secret police. However, it must be noted that there is not yet a smoking-gun document showing that Khomeini ordered the bombing. The case against him is circumstantial but convincing.

Cinemas in Iran had been targeted before this. The revolutionaries had bombed about 30 of them. Khomeini detested cinemas and considered them a source of Western cultural pollution. He once mused that “the Muslim people consider such centers to be against the interests of the country and think they ought to be destroyed without the clergy giving any instructions to this effect.” In the summer of 1978, the shah was busy negotiating with more moderate opposition figures about a new national compact that would usher in a constitutional monarchy with elected parliament. The talks were going well and Khomeini and the Islamists needed a spectacular act of violence to derail the talks and radicalize the populace. On the night of August 19, they succeeded.

The Ken Burns Effect

To the Editor:
Ken Burns’s documentary The U.S. and the Holocaust, reviewed by Jonathan Tobin, ignores the numerous ways that the Roosevelt administration appeased Nazi Germany during the 1930s (“How Ken Burns Misuses the Holocaust,” November).

To take one example, from 1934 to 1936, Roosevelt’s State Department and the U.S. Navy warmly welcomed swastika-bedecked German warships, sent to American ports on “goodwill” missions to project a respectable but formidable image of Nazi Germany. Hitler hoped this would ensure American neutrality in a coming war. These missions helped legitimize Hitler’s rearmament program at a time when it was still possible to block it. During these visits, the U.S. Navy, with the cooperation of the State Department, assisted the German warships in conducting target practice and maneuvers at sea. The State Department did not formulate its own foreign policy; it implemented President Roosevelt’s. 

The U.S. Navy high command provided the Nazi officers with tours of U.S. naval facilities. Civic and business groups in many American cities provided a platform for the Nazi warships’ officers, sporting swastika pins, to deliver speeches praising the Third Reich and laced with anti-Semitic invective. Many Jews forcefully protested the Nazi warships’ arrival in their cities. For example, when the Karlsruhe docked in Boston in 1934, Jennie Loitman Barron, head of the Women’s Division of the Boston American Jewish Congress, condemned it as an endorsement of Nazi “persecution and barbarism.” The next year, the Karlsruhe returned bearing 2,000 copies of Mein Kampf, mainly for distribution in the United States. Ignoring thousands of grassroots protestors, a year later the U.S. Navy Department hosted a reception in Washington for the captain and officers of another Nazi warship.  

This and other shameful moves on the part of FDR should never have been omitted from Burns’s six-hour documentary.
Stephen H. Norwood
Professor of History and Judaic Studies,
University of Oklahoma

To the Editor:
Having never written a dull article, Jonathan Tobin continues his habit by dissecting the Ken Burns documentary, The U.S. and the Holocaust. While being unfailingly polite, Tobin manages to expose the cloying political prejudice in everything Burns produces.

No complete documentary of the Holocaust should ignore the saga of the MS St. Louis. In June 1939, the passengers and crew of the MS St. Louis, having been turned away from Cuba, could see the beckoning lights of our eastern seaboard as they searched for a welcoming harbor. One person could have prevented their return to Europe, but
he refused to intervene, thus consigning more than 900 European Jews to the Holocaust. An infinitesimally small percentage of Americans are aware that Franklin Delano Roosevelt turned the ship away from our shore. Had FDR been a Republican, this obscenity would be common knowledge.
Jack Thomson
Bend, Oregon

Jonathan Tobin writes:
Stephen H. Norwood is correct to point out that there were instances in which the Roosevelt administration went out of its way to avoid confrontation with Nazi Germany. In some cases, it could be argued that the administration was engaging in appeasement.

Nevertheless, FDR’s approach is not analogous to that of figures such as Stanley Baldwin and Neville Chamberlain who had a genuine faith in appeasing Adolf Hitler. FDR was clear-eyed in his understanding of the threat that Nazism posed to the West. He also understood that the American people would not tolerate involvement in another European war unless the United States was attacked. 

A fair assessment of Roosevelt’s record must embrace both these truths. Ken Burns is far too interested in burnishing FDR’s legacy and using history to buttress contemporary Democratic talking points about immigration policy. And that’s a major reason that his documentary falls so far short of the mark.

I thank Jack Thomson for his generous comments about my work. While he is right to say that not enough Americans know about the tragic saga of the St. Louis, it is also true that Ken Burns did give this episode prominent mention in The U.S. and the Holocaust.

Do Meds Work?

To the Editor:
As a psychiatrist for the past 40 years, I appreciated Bertie Bregman’s review of Andrew Scull’s book Desperate Remedies (“Does Psychiatry Work?” November). I applaud Dr. Bregman for recognizing the painful reality of psychiatric diseases and for declining to buy into the “myth of mental illness” narrative made famous by one of my residency teachers, the late Dr. Thomas Szasz. I also agree with Dr. Bregman that there are significant problems with the reliability and validity of many disease categories in the DSM-5—which in no way diminishes the reality of illnesses such as schizophrenia or bipolar disorder.

My concern, however, is that Dr. Bregman’s brief discussion of psychiatric medication (a huge and daunting topic) oversimplifies several complex issues. To his credit, Dr. Bregman notes that “the good news is that the tools we have—therapy and drugs—often help, sometimes a lot.” Indeed, this is so. He adds, however, “There’s a big placebo effect. In many cases, the patient would likely have improved anyway.” He also writes, “When it comes to devastating psychiatric illnesses such as schizophrenia and bipolar disease, the new drugs are no better than the old…. When it comes to more ubiquitous illnesses such as anxiety, depression, eating disorders, post-traumatic stress disorder, and substance abuse, even the best drugs we have are barely better than placebos.”

Such broad generalizations are not helpful, and a detailed examination of each of the drugs and disease categories Dr. Bregman mentions would require a short textbook. There have been many refinements of psychiatry’s somatic treatments over the past 20 to 30 years. With respect to schizophrenia, the development of the atypical antipsychotic drug, clozapine, led to greatly improved outcomes for patients who had not responded to many other antipsychotic medications. I have witnessed almost miraculous restoration of function in many clozapine-treated patients. Unfortunately, this medication is underutilized in current psychiatric practice. With respect to bipolar disorder, it is probably true that no recent medications have proven vastly superior to the “gold standard,” lithium. But it is important to point out that lithium—which is also underutilized—has been proven effective not only in stabilizing bipolar disorder, but also in reducing suicide rates among bipolar-disordered patients. This is a success story rarely noted by psychiatry’s critics.

With respect to major depression, there is much misunderstanding regarding antidepressants and the so-called placebo effect. The most recent data show that antidepressant treatment is robustly superior to placebos for patients with major depression, though in a fairly small subgroup of patients—about 15 percent of the total cohort of subjects. That figure is derived from clinical studies using only one antidepressant for a short period of time. In actual clinical practice, we can achieve remission in a much higher percentage of depressed patients by using various augmentation strategies and multiple medication trials. Finally, the development of non-medication treatments, such as transcranial magnetic stimulation, and the use of unconventional antidepressants, such as ketamine, are also proving effective in the treatment of depressive disorders.

To be sure, psychiatric diagnosis and treatment are far from ideal, and—as Dr. Bregman points out—there remain many barriers to the effective delivery of psychiatric services. But there is a good deal of optimism in the field, which continues to attract an increasing number of medical-school graduates to psychiatry residency programs. In short, there are good reasons to see the glass as “half full” when it comes to psychiatry’s progress.
Ronald W. Pies, M.D.,
Professor Emeritus of Psychiatry,
SUNY Upstate Medical University;
Clinical Professor of Psychiatry,
Tufts U. School of Medicine

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