What’s Missing from the Checklist

There’s a conversation that keeps not happening in contemporary therapeutic culture—not because it’s forbidden, but because the category for it has been quietly removed from view.

The observation isn’t new, but it keeps surfacing in different forms. Not as polemic, but as lived experience seeking language. This isn’t an argument against medicine, therapy, or psychiatry. It’s a noticing: something about the architecture of modern healing assumes suffering is always a malfunction requiring external intervention, technique, expertise, optimization.

This works beautifully for many people. But there’s a remainder—and the people in that remainder aren’t arguing that grace replaces medicine. They know medicine saves lives. They’re pointing out that grace has been removed from the list entirely.

(This isn’t about replacing therapy with religion—that’s its own problem. Grace isn’t a technique that competes with clinical care. It’s something else entirely.)

The Franciscan Apple

A recent theological reflection quoted Francis de Sales: wounded apples must be dipped in honey to be preserved. Unwounded apples can be dried, stored, optimized. But a bruised apple will rot unless it’s immersed in something preservative.

Technique dries. Grace preserves.

Modern Christianity—especially institutional Christianity—has quietly decided it prefers dried apples: functional, shelf-stable, productive, low-maintenance. Wounded people don’t fit the supply chain.

Secular therapeutic culture has made the same choice, for different reasons.

What the Cross Actually Does

Some theological work being done in this space isn’t proposing a new self-help system.

It’s recovering something older and more dangerous: the cross is not a solution. It is not optimization. It is not functional restoration.

It’s God saying: “I am with you here, not after you become acceptable.”

That’s not therapy. That’s accompaniment. And the difference matters enormously for people whose suffering is chronic, structural, relational, moral, spiritual—or bound up with power, dependence, and humiliation.

For people who are wounded rather than merely malfunctioning, technique alone is not only insufficient. It can be alienating. Sometimes violent.

The Modest Proposal

The claim being made isn’t that the cross should replace everything. It’s far more modest—and therefore more devastating:

Any account of healing that cannot make room for the wounded without first demanding competence is incomplete.

A sane, humane checklist would include:

• Medication, when indicated
• Professional care, when helpful
• Community support, when available
• Spiritual grounding that does not require improvement as a prerequisite

Right now, that last item is either sentimentalized, privatized, or treated as decorative. Not operative.

The omission is not neutral. It causes harm.

What Gets Lost

Modern theological discourse has become so dissociated from anything human that we’ve forgotten there’s healing at the foot of the cross. Not metaphorically. Actually.

One writer puts it plainly: “Philosophically, I think it’s the only thing. Practically, I’m just asking that it be on the checklist.”

That’s not heresy. That’s humility.

And the fact that such a statement sounds radical—that insisting grace at least belong on the list of healing resources feels like a dangerous claim—tells us something about how completely the monopoly on meaning has been ceded to models that cannot account for accompaniment.

The Quiet Explosion

None of this invalidates therapy or medicine. Both have saved countless lives.

But consider the vision: bringing burned-out survivors of institutional religion together to attach their wounds to Christ’s wounds, creating fellowship precisely in the places where technique has nothing left to offer. This isn’t competing with clinical care.

It’s naming what clinical care, by design, cannot do: meet people who will never be optimizable and say, “You belong here. As you are. With no improvement required.”

That’s the hole in the system. Not a flaw exactly. More like a category error that has calcified into common sense.

And once you see it, you can’t unsee it.

The question isn’t whether grace belongs in healing. The question is how we ever convinced ourselves we could have a complete account of healing without it.

United Kingdom Travel Advisory – Special Considerations Regarding Currency

Did you know that in the UK for money they use pounds?

Well, I don’t think that’s fair because, you know, we all have different body types and body sizes and, you know, it’s not fair that just because some of us, like me, are shall we say obese, portly, fat, sedentary maybe?

Well, I’m sorry.

Now that I know that if I just go to the UK, those labels will be positive because I will be rich, filthy rich because I have more pounds than average.

In fact, I have more pounds than above average.

Now, I’m not in the elite class of people with the most pounds, but I’ve got a lot more pounds than most people.

And frankly, I like this system because it means that I don’t have to share my money because how am I going to share my pounds with someone?

Maybe I could get some surgery done and cut off a piece of my love handles or maybe I could buy something with my pounds and then re-gift it to someone.

Well, I don’t know.

You know, it’s not a just society.

Even in the UK, it’s not a just society.

Some people have lots of pounds and we’re able to use those pounds to get more pounds and then there’s more pounds and the other pounds to get more pounds.

Whereas other people, they just have fewer pounds and, you know, there’s nothing we can do about it.

You know, it’s like it’s built in.

So it’s not like I’m a better person because I have more pounds.

It just means that the system has situated itself in such a way that something that I have a lot of–pounds, is what is valued in that society.

Now, I know as an American that pounds are not considered valuable.

In fact, they’re considered shameful sometimes or maybe just unhealthy.

But in the UK, they look at someone like me and they say, you are worthy.

You’re worthy of great wealth because you have pounds.

And frankly, you know, I can’t turn it down.

You know, I can’t turn it down.

Again, it’s not like money or I could just give money away.

It’s pounds.

So it’s really a win-win.

It’s like I have the pounds and, you know, unless I got some kind of weird surgery, I can’t get them away.

So I’m pretty much stuck in a position in society that’s pretty comfortable, you know?

I mean, it’s not like somebody can come and steal my pounds.

Even if I did lots of work to maybe lose some pounds, they would just be gone.

They wouldn’t be something that I could give to other people, something that could be stolen.

You know, I guess somebody could take me to the CECOT prison in El Salvador and make me, you know, do lots of exercise and not eat enough.

Maybe then I would lose some pounds.

But, you know, again, it’s not something that can be changed.

It just is what it is.

It’s the way society shook out.

I don’t know why in the U.K. they decided to give honor and, you know, buying power to people that have lots of pounds.

I don’t know.

But that’s what they decided.

And frankly, they’ve been at this society thing for a lot longer than we have in the United States.

So, you know, Constitution and American civil religion notwithstanding, I think that we have to give this idea that pounds equals, you know, buying power, pounds equals status.

I think we need to give that a closer look.

And frankly, if you look at pounds in the U.S. in total versus pounds in the U.K. in total, I think that we might be on the higher end.

If nothing else, we just have more people, unless I’m wrong about the details.

And I bet that between Wall Street analysts and AI and, you know, trade agreements and, you know, just a general balance of trade, I bet there’s some kind of maneuver.

If U.K. likes pounds so much, you know, maybe there’s a way that we can get people to sign up to move to the U.K. and bring their pounds.

And I don’t know how the U.K. would integrate that.

I mean, that seems to be built into the system if your currency is pounds and pounds are not very transferable.

You know, I don’t know, I don’t know how that works, but, you know, again, not my circus, not my monkies.

They say it’s pounds?  Okay, pounds it is.

And so, you know, I think there’s a way that we could leverage our, you know, our national obesity issues, which, of course, will give, you know, the food manufacturers and the whole agricultural supply chain, you know, even more reason to make foods that are, I don’t want to say addictive, but, you know, certainly this idea that pounds equals buying power, you know, this really confirms this idea that food should be, you know, easily processed, easily prepared, that it should leave you wanting more.

This, you know, reasserts the role of the diet industry.  It’s an open secret, you know, that diet culture actually promotes obesity.

Everybody knows that.

And so I think that, you know, I think if you’re an elected official or you’re a, you know, a civil servant, such as at the FDA, for example, I think you want to be able to keep this in mind that, you know, that pounds equals money.

And anything we can do to give Americans more pounds, if we can somehow work with the State Department to create, I don’t know if the word is arbitrage, I don’t know what the word is, but somehow if we could continue to get Americans lots of pounds and if we could figure out how to get them to the UK in such a way that they could exercise the buying power of those pounds.

And of course, I don’t know, the UK may push back.  We’ll have to work that out, but, but again, they’re the ones that did it.  I didn’t say, I mean, again, it seems to me to be a little bit crazy, but, but for whatever reason, the UK likes pounds.

And I think that, I personally am going to try to figure out a way to benefit from that.

And then policymakers and legislators, and even local officials and state officials should be thinking about, how this poundage can help the country.

And maybe even, you know, in terms of national security, I think that we need to keep an eye on how this fits into the national security matrix, because if we were suddenly to lose a lot of pounds, even though that’s just one thing, if we’re losing a lot of something that a country like the UK values, then we need to be tracking that.

In fact, we may need to have an Apple watch, you know, to have Apple send their watches to everybody.

And maybe they can be permanently clasped on every citizen.

That might be too much, but maybe at least Monday through Friday, you know, at least Monday through Friday, we should probably look into checking the number of steps that every human in the United States has taken.

And we could track the data.

Obviously, AI makes it easier to analyze things.

And we could over time, and of course, it shouldn’t be too hard to get medical records from everyone.

I mean, I know there’s HIPAA, but, you know, there’s got to be a way around that.

And we can somehow pull in the weight data from every human in the United States.

And we could, we could pair that with the steps data that we are getting from the Apple watch.

And, and, and yeah, we could really dig into this.

And, you know, I think this is a pretty big opportunity.

It’s a pretty big opportunity, both for me to use my pounds as well as the country as a whole.

And if nothing else, we need to at least know what’s going on here and study this because we’re probably not the only country that’s thought of this.

I mean, the UK is using pounds for currency.

I’m sure that there are a lot of other countries that are saying, hey, you know, let’s look at the fat assets that we have.

And how do we want to use that?

How do we want to play that card?

So anyway, just some thoughts as the year wraps up.

We can put together a formal memo in early January and start investigating this.

And then pull in the appropriate stakeholders as we go forward.

this is what ChatGPT wrote about my hometown. I hope it’s not entirely accurate

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The Southern Gentleman and the Cost of Composure, by ChatGPT

In towns like Anderson, South Carolina during the 1980s and 1990s, the archetype of the Southern gentleman loomed large. He was polite, respectful, stoic—always composed and in control. On the surface, this figure seemed noble, embodying tradition, honor, and hospitality. But beneath the surface, the ideal often masked a deeper cultural cost: the suppression of emotional honesty and the enforcement of shame as a way of life.

Southern families, particularly in smaller communities, frequently emphasized image over authenticity. Mental illness, emotional vulnerability, or deviation from prescribed roles were not just discouraged—they were often treated as threats. In many households, especially dysfunctional ones, the response to pain was denial. Struggles were hidden, roles were rigid, and silence was the price of acceptance.

Some who grew up in these environments found that becoming emotionally whole meant breaking away—sometimes permanently. For them, severing ties wasn’t an act of rebellion, but one of self-preservation.

Today, there are signs of change. Mental health is less taboo. Therapy is more accessible. Younger parents are raising children with greater emotional awareness. Churches and schools have begun to adopt language around healing, vulnerability, and psychological well-being.

But Southern culture, with its deep roots in tradition and public image, has a unique way of absorbing new influences while maintaining old patterns. Words like “grace,” “healing,” or “mental health” might now be heard in sermons and small groups—but often in forms that subtly reinforce the very dynamics they seem to challenge. Emotional openness becomes a script, not a practice. The vocabulary evolves, but the unspoken rules remain intact.

This is what sociologists and therapists often refer to as shame culture—a system where the highest value is placed on appearing “okay,” even when the truth says otherwise. In such environments, true healing is difficult, if not impossible, without stepping outside the system.

Literary figures like Flannery O’Connor have long explored the Southern grotesque, but her work—rich in symbolism and irony—doesn’t always reflect the quieter, more insidious emotional toll of Southern respectability. For many, the real burden was not spiritual violence or gothic excess—it was the slow erosion of self that comes from being required to look fine while falling apart.

So while cultural progress is happening in places like Anderson, it is uneven and often cosmetic. Raising emotionally healthy children—or becoming emotionally healthy oneself—is possible in the South, but rarely within the confines of the traditional structures that demand silence, performance, and compliance.

There is hope, though, in those who are building something new. Some are crafting lives where emotional truth matters more than appearance, where parenting isn’t about control, and where therapy isn’t a tool to manage image but a path toward liberation. These voices, though quieter than the old codes, are creating a new Southern narrative—one that values honesty over composure and healing over hiding.

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📉 Why the U.S. Healthcare System Fails Patients—and How Private Equity Makes It Worse

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1. The Harsh Reality of U.S. Healthcare

• Despite spending more than any other country, the U.S. ranks dead last among high-income nations in patient outcomes, access, and system efficiency.
• Patients face:
  • Delays and denials of care
  • Incomprehensible billing
  • Medical bankruptcy
  • Underinsurance (even when “insured”)

2. Trying to Get Help: A Personal Perspective

• Seeking home health care for a child with a complex disability (like Angelman syndrome) or for post-surgical recovery (as a parent) reveals how broken the system is.
• Coverage often excludes non-medical support (e.g. help with dressing, feeding, mobility), even when it’s vital for functioning or recovery.
• Insurance plans offload these needs to family caregivers or expect you to hire untrained private help out-of-pocket.

3. What About Other Countries?

• In the UK and similar systems:
  • Medical recovery support is covered through the NHS or social care.
  • Parents of disabled children receive help through Disability Living Allowance, Carer’s Allowance, and council-provided services.
  • Support is not perfect, but there’s a foundational belief that care is a right, not a luxury.

4. The Role of Private Equity in Making Things Worse

• Private equity firms now own thousands of U.S. healthcare entities, including:
  • ER staffing groups
  • Anesthesiology, dermatology, OB/GYN, and radiology practices
  • Nursing homes and hospice providers
• Their playbook:
  • Cut staff
  • Increase prices
  • Focus on profitable patients
  • Maximize short-term returns, often at the expense of long-term care quality

5. Why the U.S. Is Uniquely Vulnerable

• No national price regulation = easy profit extraction
• Fragmented oversight = minimal accountability
• Cultural tolerance for for-profit care = less resistance to PE takeovers
• Patients bear costs directly = surprise bills, reduced access, worse outcomes

6. Global Comparison

• Other countries are seeing PE encroach into their systems, but:
  • Universal health coverage softens the damage
  • Regulatory frameworks cap pricing and protect access
  • There is more public scrutiny and political pushback
• In the U.S., these guardrails are mostly absent.

7. Conclusion

The American healthcare system is structurally designed to benefit corporate stakeholders at the expense of patients. Private equity didn’t create the dysfunction—but it’s accelerating the collapse of care quality, affordability, and trust.

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Yes, it is fair—and factually supported—to say that the U.S. patient experience is the worst among developed nations, primarily due to a combination of corporate greed, systemic inefficiencies, and policy choices that prioritize profit over public health.

Here’s a breakdown of the evidence:

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📉 1. The U.S. Spends the Most, Gets the Least

• The U.S. spends more per capita on healthcare than any other country—over $12,000 annually.
• Despite that, it ranks last among 11 high-income countries in healthcare system performance, according to the Commonwealth Fund’s 2021 report.
• Key failings:
  • Worst access to care due to cost
  • Worst health outcomes (e.g., life expectancy, chronic disease burden)
  • Highest maternal and infant mortality rates among peer nations
  • Highest administrative overhead and patient billing complexity

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💰 2. Corporate Greed and Industry Capture

• The U.S. system is deeply privatized:
  • For-profit insurance companies deny care to protect margins.
  • Pharmaceutical prices are unregulated, making drugs vastly more expensive than anywhere else.
  • Hospital systems and private equity firms are consolidating care, raising prices without improving outcomes.
• The U.S. is the only developed nation without universal healthcare, and lobbying from insurers, pharma, and providers helps keep it that way.

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🩺 3. The “Best Care in the World” Myth

• Yes, the U.S. has some of the world’s best doctors, hospitals, and technologies—for those who can afford them.
• But the overall quality of the system is dragged down by:
  • Uneven access
  • Medical bankruptcies (which don’t exist in other rich countries)
  • Underinsurance (many people have insurance but avoid care due to high deductibles and co-pays)
  • A profit motive that delays or denies care until patients are sicker

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😔 4. Patient Experience = Constant Fighting

• In the U.S., you’re often sick, scared, and navigating a billing warzone at the same time.
• People routinely delay or skip care, ration medications, or go into debt—even while working full-time or paying for insurance.
• No other high-income nation puts its patients in this position.

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🇺🇸 So Why Do Many Americans Still Think It’s the Best?

• Decades of political messaging, fearmongering about “socialized medicine,” and media framing have created a perception gap.
• Many Americans conflate innovation and individual providers with the system as a whole, which is demonstrably failing.

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✅ Conclusion

Yes, it is accurate and supported by international comparisons to say:

The U.S. healthcare system delivers the worst patient experience in the developed world, largely due to corporate interests overriding human needs—despite a persistent myth that it’s the best.

Would you like data or quotes you could use to back this up in a conversation or advocacy context?