And the GOP...?

Lyndon Johnson used to tell a story about a candidate for County Commissioner in East Texas. He's falling far behind, and so he asks his campaign manager what he should do. "Well," his campaign manager advises, "why don't you say your opponent likes to fuck pigs?" The candidate protests, "But he doesn't, does he?" And the campaign manager answers, "No, but can you picture him denying it?"

Let's leave economic and social policy to the side for the moment. We'll have plenty of time for high-minded discussions about substance in the months to come. For now, I'd like to talk about political culture. Specifically, the Republican Party's political culture.

Can we at least agree on this much? The most egregious demagoguery of the past 60 years has come from the Republicans. This is a separate issue from the validity of their political philosophy or the efficacy of their governing praxis; this solely addresses the way the party approaches the competitive aspect of its business. Is there any reader out there, Republican or Democrat, who would deny that the party that gave us ~~Martin Dies and~~ Joseph McCarthy and the young Richard Nixon and Charles Colson and Ted Agnew and Lee Atwater and Karl Rove and the Swiftboaters and Sarah Palin and Joe the Plumber has been the more willing to deploy fear, suspicion, and prejudice, and to attempt to destroy personal reputations, in order to manipulate the electorate?

I'm not talking about the mere existence of these people; of course both parties have their nut-wings. I'm talking about the willingness of the party's establishment to pander to them, to embrace and utilize them. Upright, respectable Republicans have often, in the past, privately recoiled from the pitchfork brigade in their midst; Eisenhower found McCarthy despicable and Nixon distasteful, for example, and Nixon himself, during his presidential years, held Agnew in contempt. George H. W. Bush restricted Atwater's machinations to the times he regarded himself as being in "campaign mode," an implicitly unsavory state of existence from which he tried to distance himself when no election was in the immediate offing.

But with the arguable exception of Lyndon Johnson's "Daisy" ad, I can't think of anything comparable to the ad hominem red meat the Republicans have been willing to throw to their base as an integral component of their political strategy. They may have disdained these people when they were in their sitting rooms and salons, but they found them invaluable in the arena.

The current birther nonsense is the latest manifestation. It isn't so much that this mindless drivel, repeatedly disproved with incontrovertible documentation and rendered implausible by the promptings of simple common sense, persists in the nutosphere. One expects lunacy from guys who live in their parents' basements and spend their days staring at computer screens. What's distressing is the unwillingness of respectable or at least influential public figures, the Sean Hannitys and Rush Limbaughs and Liz Cheneys and G. Gordon Liddys, not to mention twelve sitting members of Congress, to disavow it. They must know better. They do know better. They often phrase their suspicions in coy ways that prove they know better but are trying to squeeze a few drops of political advantage out of it just the same.

Something troubling has happened to the Republican Party in the last twenty years or so, and it demonstrates why these tactics are always a bad idea, even if they win you the occasional election. The respectable, responsible wing of the Republican Party, the wing that for decades thought it could use its crazies but still control them, has been unhorsed. The crazies are in the saddle. The sorry spectacle of the noble John McCain forced continually to kowtow to the religious right wing honchos of his party during last year's presidential campaign, and his evident although only intermittent pain at being confronted with what he had thereby unleashed; the transparent and pusillanimous eagerness of Mitt Romney in pursuit of his party's approval to disavow almost everything he has ever stood for in public life; the willingness of putatively serious conservative pundits to defend and even laud the indefensible and incoherent Sarah Palin; the reduction of a once-proud political philosophy to a set of simple-minded bromides and shibboleths, combined with vitriolic, dishonest, and irrelevant personal attacks on the other side...these bespeak a party that has lost not only its way, but its soul. If you're willing to keep on telling your supporters that the other side fucks pigs, at some point they may actually believe it, and beyond that, they may think pig-fucking is what elections are about.

So why should Democrats do anything other than celebrate? The Republicans, after all, seem to be in total disarray. Isn't that good news for the party in power? It isn't. For one thing, in a democracy, a skilled and plausible opposition keeps a government on its toes. It keeps it honest. It forces it to examine policy decisions with more rigor. But more important, someday -- and if President Obama's economic recovery program isn't successful, it could be as soon as 2012 -- the Republicans are going to win back the presidency. They could regain control of Congress sooner than that. When the party in power is perceived as having failed, voters in democracies have historically shown themselves willing to take a chance on the opposition even if they feel deep misgivings about it. The results can be relatively benign, or even better than benign. It's the sentiment that elected Franklin Roosevelt in 1932, Margaret Thatcher in 1979 and Ronald Reagan in 1980, all figures of mistrust prior to their elevation. The election of a well-born and genial cipher to the premiership in Britain next year doesn't promise to be catastrophic. But the results in Italy in 1922 and Germany in 1932 weren't nearly so innocuous.

I'd much rather be governed by a party the policies of which I deplore but one that governs responsibly, competently, and with respect for the Constitution, than by a theocratic cabal dictated to by its own most rabid supporters, mistrustful of facts, demonizing of its opponents, and scornfully dismissive of all points of view that diverge from its own. You can argue with the former, you can debate it, you can contest elections with it. Sometimes you will win and sometimes you will lose, but the victories and the defeats will be over matters of real consequence. When, instead, political battles are deliberately waged by one side over red-herrings that arouse passion and irrational anger, when they are fought over the contrived question of whether one candidate personally freed a convicted rapist for a weekend furlough, or went to Moscow as a student in order to enlist as a Soviet spy, or somehow faked his heroism in Vietnam, or is a Muslim or a socialist or an illegal alien, then we have ventured into the realms of pig-fucking. It debases all public discourse. No one finally benefits from that, not even the victors.

Should you drink more coffee? Should you take melatonin? Can you train yourself to need less sleep? A physician’s guide to sleep in a stressful age.

During residency, I worked hospital shifts that could last 36 hours, without sleep, often without breaks of more than a few minutes. Even writing this now, it sounds to me like I’m bragging or laying claim to some fortitude of character. I can’t think of another type of self-injury that might be similarly lauded, except maybe binge drinking. Technically the shifts were 30 hours, the mandatory limit imposed by the Accreditation Council for Graduate Medical Education, but we stayed longer because people kept getting sick. Being a doctor is supposed to be about putting other people’s needs before your own. Our job was to power through.

The shifts usually felt shorter than they were, because they were so hectic. There was always a new patient in the emergency room who needed to be admitted, or a staff member on the eighth floor (which was full of late-stage terminally ill people) who needed me to fill out a death certificate. Sleep deprivation manifested as bouts of anger and despair mixed in with some euphoria, along with other sensations I’ve not had before or since. I remember once sitting with the family of a patient in critical condition, discussing an advance directive—the terms defining what the patient would want done were his heart to stop, which seemed likely to happen at any minute. Would he want to have chest compressions, electrical shocks, a breathing tube? In the middle of this, I had to look straight down at the chart in my lap, because I was laughing. This was the least funny scenario possible. I was experiencing a physical reaction unrelated to anything I knew to be happening in my mind. There is a type of seizure, called a gelastic seizure, during which the seizing person appears to be laughing—but I don’t think that was it. I think it was plain old delirium. It was mortifying, though no one seemed to notice.