February 25, 2014

Fair Warning: I WILL challenge this kind of bigotry.

It's pervasive, not just on DU but everywhere.

It's damaging, not just to those stigmatized, but to the success of the society that stigmatizes us.

It's insidious, I even catch myself doing it.

It's amorphous and easily disclaimed, which doesn't make it any less real.

I have a chronic brain disease. I am "mentally ill."

I am not a criminal, I am not crippled (other than occasional, private, temporary incapacity that causes me way more pain than it does anyone else.) I am not thoughtless, I am not dangerous.

I am not a Republican, a Libertarian, a Wingnut, a <anyone else whose beliefs offend you so much that you can't think of anything worse to attribute them to than the action of a chronic brain disorder.>

Chronic brain disorders affect nearly one in three people, at some time in their lives, at some degree of acuity. Some of us experience one temporarily, some of us live with one (or more) for life.

Mental illness, chronic brain disorders, distort our thinking by their very nature. It's our brain that is disordered, and that's where we think.

Some of us act on distorted thinking in ways that harm ourselves. A smaller percentage of us act on distorted thinking in ways that harm others. A much smaller percentage. The majority of people who deliberately act to harm others do not have chronic brain disorders, they are not mentally ill.

Many, even most of us, get treatment for our brain disorders. We are in recovery. We understand the effects our disorder has on our thinking and work to overcome them. We deal, on a regular basis, with pain, shame, feelings of inferiority, self-doubt, and self-hatred. We do not need to have those feeling reinforced, they are our familiar companions.

Mental illness is not equivalent to stupidity. It is not equivalent to moral turpitude. It is not equivalent to inferiority. It is not equivalent to criminality. It is not equivalent to evil, thoughtlessness, mental incapacity, etc.

When we here on DU post articles about "[this or that form of anti-social or undesirable action] is a form of mental illness" those articles are rarely making a legitimate point about symptoms of a chronic brain disorder, and how people who suffer from chronic brain disorders experience our illness in the context of our larger humanity.

More often, such articles are an explicit or thinly-veiled way of linking "bad" to "mental illness."

If you look back in history (and not too damn' far,) you can find similar articles about the inferiority and moral turpitude of melanin-advantaged humans. You can find articles equating having two "X" chromosomes to all kinds of inferior and socially undesirable characteristics. You can find articles about the dreadful, unavoidable, social and behavioral sequelae of being sexually-oriented to same-sex or other socially-disapproved gender partners.

And of course, very often, you can find those stigmatized groups stigmatized further by being presumed to suffer from mental illness.

You know what? I'm damn' proud of the fact that every group an oppressive, dysfunctional social system feels the need to marginalize has been presumed to be like me. We are the ones who are different. We are the ones who challenge. We are the ones who provide humanity with the incentive to evolve.

If you look at the roster of humanity's greatest artists, inventors, humanitarians, and idealists, you will find a very high percentage of them with chronic brain disorders.

By assuming that a disease is all we are, you marginalize us. You dehumanize us. By dismissing anything you disapprove of as "a symptom of mental illness," you perpetuate stigma.

If all you know about me is that I'm mentally ill, you don't know me. You are then free to make assumptions about me. Most of them will be wrong, but that won't matter, because after all, the most important thing about me is that I'm mentally ill, right? If you know that, you don't need to know more.

So, fair warning: From now on, when I stumble onto an OP or a subthread that equates "mental illness" with evil, stupidity, etc., either apparently with intent, or thoughtlessly, I WILL challenge that equation. I will do so politely.

But I will do so.

firmly,
Bright

February 23, 2014

Legitimate "Safe Havens" for Bigotry

Because this is DU, let's start by defining a couple of terms:

What is a "safe haven," in this context?
Here we're talking about a venue where a bigoted individual may express their bigoted views to other individuals, without being challenged (verbally or in writing) or experiencing any negative social (as opposed to legal, financial, etc.) sanction for those views.

What does "legitimate" refer to, here?
In this case, we're talking venues where the Constitution protects your right to seek legal redress for a given sanction by any legal authority, or for a challenge or sanction by any individual who is violating your right to privacy.

If y'all want to debate the definition of "bigotry," I'd sure appreciate you taking it to another thread, because I'm going with a very rough definition, based on an old AA analogy: "If one person tells you you're being a horse's ass, laugh it off. If two people tell you, count your legs. If three people tell you, buy a saddle."

The point here being, that there are "safe havens" for bigotry. Places where the Constitution guarantees that no one can challenge your bigoted opinions, no one can sanction you, you and your bigoted pals can yuk it up and share grotesque little self-justifying circle jerks in perfect freedom, untainted by the profound ignorance, stupidity, ill-will, and inferiority of those who differ with you. Here are those safe havens:

Your own private dwelling, residential or recreational property, or any property where you are not providing an accommodation deemed "public" under the law (such as a restaurant, real estate agency, etc.) You want to invite your bigot pals along to trash <preferred "other" here> over coffee or a beer? Not only can you do so, but you can ask any dissenters to leave or refuse to serve coffee/beer/whatever to anyone who disagrees in perfect justification under the protection of the Constitution. No dissenting voices allowed: Safe haven.

Any public accommodation where no other persons except you and your bigot buddies are present, and/or where your activities constitute no conceivable denial to others enjoying the same accommodation. You go to a park, no one else is around, the Constitution guarantees your right to whoop it up and holler about how awful those <preferred "other" here> folks are: Safe haven. Other people arrive at the next picnic table? Keep yer damn' voices down and don't make any overhearable remarks, gestures, etc., that might interfere with their enjoyment of the public accommodation, period: No safe haven.

Please note, once again, the definition of "safe haven." You are free to express your bigoted views and opinions anywhere except in other peoples' safe havens; the Constitution protects your right to do so. However, you may (and hopefully will) experience challenges to those views, often by the very <preferred "other" here> you despise, and they are not obliged to shut up, be nice, "respect" your views (I love that one...) or otherwise accommodate you. If your bigotry prevents individuals from enjoying equal access to public accommodations, you can also expect legitimate legal challenges and/or sanctions.

As bigots of all varieties are increasingly learning these days, venues formerly assumed to be safe havens-- conventions, professional societies, educational institutions, sports arenas, news and entertainment media, etc.-- are NOT safe havens.

Deal with the challenge(s) and/or take your booboo lip elsewhere.

irritatedly,
Bright

February 17, 2014

The Pain Profiteers

The system that deals with Americans' health has morphed, during the course of my own lifetime, from a flawed but focused system with limited resources but admirable motivations, to a twisted, crazy, free-for-all steel cage match between greedy sociopaths scrabbling for dollars.

Context first:

In post-WWII America, the health care system was enjoying a convergence of fortuitous circumstances:

• Decades of research based in Universities, hospitals, and government-funded laboratories was in the process of paying off, yielding serious, widespread benefits that improved both longevity and quality of life. Vaccines reduced childhood mortality by a major percentage, antibiotics, techniques and equipment developed for battlefield medicine were being adapted to improve all kinds of surgical outcomes and keep septicemia and bacterial killers at bay.
  
  
• Expanded (government) funding of public health, among other factors, had facilitated the growth of a primary health care services network, improving the quality and availability of emergency rooms, hospital care, childhood immunization, professional training and education for health care workers, and other benefits. It wasn't enough, but it was better than America had EVER had.
  
  
• Additional hospital and primary care capacity was largely based on nonprofit and government infrastructure- in most communities all hospitals were either "county" or "city" hospitals, or charitable hospitals run by a religious or fraternal order. They suffered chronically from underfunding and limited capacity, but they were there to heal and to improve community health. That was their purpose.
  
  
• Health Insurance --a relatively new concept-- was largely structured either as a nonprofit (Blue Cross) or as a mutual benefit (non-shareholder, non-publicly traded) corporation. IOW, its primary goal was to balance premiums and payments across the largest possible pool of participants, to benefit those participants.
  
  
• Maybe most important of all-- with the exception of over-the-counter nostrums and yellow pages displays for specialists? There was virtually NO advertising of health care products and services. There were public health ad campaigns about getting kids immunized, not spreading disease, good hygeine practices, etc. But no million-dollar Madison Avenue campaigns to convince everyone that they had SYMPTOMS!! That must be TREATED!! EXPENSIVELY!! NOW!!

Who was getting rich off sick people when I was a kid? Well, sure, there were some.

• A lot of docs who got into medicine because they wanted to become wealthy and respected members of their community, with premium country-club memberships and plenty of clout.
  
  
• Manufacturers of popular over-the-counter remedies such as aspirin, topical disinfectants, etc. were doing pretty well though by the standards of today's Pharma it was mere chicken feed.
  
  
• Manufacturers of major durable medical equipment were doing pretty well, too, selling x-ray machines, EKGs, autoclaves, surgical suite furniture, lab analysis equipment, etc. But because most of their customers were either government or charitable hospitals, or groups of independent physicians in private practice, there wasn't a gigantic profit margin. The market, while growing, wasn't subject to the kind of hype-fueled explosion we now see whenever some expensive new technology rolls out of the R&D labs.

But our attitudes about health and health care were different, too. "Preventive care" was largely limited to an annual once-over from your doctor, plus immunizations for kids. There was less expectation that every physical discomfort was a symptom of a problem you could identify if you just kept doing tests, and solve if you just kept trying pills and surgeries.

The bad side of that was the number of people who died because they didn't get early care for treatable conditions-- gee, that happens today, too. The good side of it was less vulnerability to "over-diagnosing" and "over-treating." There was less of today's tendency to expensively pathologize normal human ills that people mostly recover from on their own anyway.

Another down side: Plenty of mediocre and careless medical professionals got away with mediocre and careless practices that we'd label malpractice today. The upside of that? A good doctor then wasn't afraid to say, "There's not much we can do except try to make the symptoms less painful while it runs its course." That saved a lot of people a lot of money, stress, and painful side effects, even while it resulted in some unnecessary deaths.

I think we had better immune systems back then. Current science is starting to agree, recommending that people lighten up on the anti-bacterial soap, allow their kids to be exposed to minor ailments, etc.

It wasn't utopia. Rural accessibility was limited to (if you were lucky) a town doctor in the town nearby, and a hospital at the county seat. There were plenty of scary diseases we had no tools for and no idea how to treat. Plenty of things were virtual death sentences, then, that (if you're lucky enough to have money and access now) are no big deal now.

But between 1900 and 1955, average US life expectancy increased from 47.3 years to 69.8 years, a gain of 22.5 years.

Between 1955 and 2010 it increased to 81 years, a gain of 11.2 years.

Currently, in comparison to other wealthy nations, we rank near the bottom in longevity as well as other significant health indicators.

So what happened?

It started in the sectors where there was already profit: Pharmaceuticals and medical equipment. A few big breakthroughs (much of the R&D for which was publicly supported or subsidized in various ways) resulted in exploding profit margins. The money attracted the bottom-feeders and remoras of capitalism: The demand producers.

You know who they are. Their job is to convince vast numbers of consumers that they NEEEEEEED something.

Never did they have an easier job. What's simpler to sell than pain relief?

Not just the pain of illness itself... but the pain of worrying about illness. The pain of not knowing whether that shortness of breath is just overweight and overexertion, or the Big One that's gonna kill ya tomorrow.

Not to mention the very real pain associated with the fully justified fear that when we do need care, when something threatens our lives, we won't be able to get the help we need.

From there it was all downhill.

As soon as the profiteers realized the magnitude of the fat pickings to be made from human pain, they started transforming the system. Insurance companies went for profit. Corporations bought out hospitals and transformed them into profit centers. Big Pharma and the Medtech industries ramped up their R&D and hired more remoras to fuel more demand.

Naturally, this escalated to a food fight as the profit pie couldn't possibly expand quickly enough to fill all of the greedy gullets. "Healthcare Misers" were invented, ostensibly to rein in the madness, but in reality to ensure that the profit shares were channeled into this sector's coffers or that. Scratch a "cost control" mechanism, and you'll find a bottom line needing black ink, mostly in the private sector.

Then the Pain Profiteers and their tame remoras and their Healthcare Miser puppets went after the dollars controlled by the public sector. Spend here, cost-control there, and buy some legislators to push your agenda.

I know of only one way to end this madness:

Put most of the Pain Profiteers out of business, and put strict limits and controls on the rest.

Until we do that, we're stuck viewing the disgusting spectacle of their grotesque banquet at our expense.

polemically,
Bright

February 3, 2014

The Tip of the Iceberg: PSH & the Opioid Epidemic

Like pretty much everyone else who's seen a few films over the last couple of decades, I was delighted with Philip Seymour Hoffman's acting skills. He racked up some amazing credits over two decades. I looked forward to seeing him mature and develop further. I thought he'd end up with one of those enduring, amazing careers like Paul Newman or Kirk Douglas, icons of my youth.

I didn't know he was 23 years in recovery from alcohol/drug addiction that overtook him at a very early age.

Twenty-three years, clean and sober.

Relapse can happen to anyone, and all too frequently does. We're starting to learn more about why, but that doesn't make it any easier to avoid.

Still... twenty-three years...

What, then?

Sometime in 2012 he began taking prescription opioids. I can't find any information on the "why" of that. A lot of people get prescribed these substances for conditions like back pain, oral pain connected to dental work, post-surgical pain, a whole raft of conditions. Ironically, we're learning now that with the exception of cancer pain, opioids may not be the best treatment strategy for chronic pain: They tend to lose effectiveness and sometimes even increase sensitivity to pain.

Maybe Hoffman was prescribed his first course of opioids. There was a great deal of hype (from pharmaceutical companies, natch!) about how "safe" they are, how non-addictive (yes, seriously, they MADE THAT CLAIM!) when 'used as directed', etc.

Maybe he wasn't prescribed them. Maybe he got them from a friend after complaining about pain. Maybe he believed the hype, assumed he could just take them for a short time to deal with a temporary condition.

Maybe he "relapsed by intent," and took them hoping/assuming the hype was true, and they wouldn't grab him as hard as "street" opiates, and he'd be able to kick them easier.

Except the hype wasn't true. Those "safe" prescription opioids are highly addictive, all too often lethally so.

Mr. Hoffman knew he was in trouble. He tried treatment in 2012.

In 2006, reflecting on the addiction that drove him into recovery in the first place, he said “I think back at that time, if I had the money, that kind of money and stuff, I would have died.”

This time he had the money.

He's not the only prescription opioid addict to make the switch to heroin. The painful truth about opioid addiction is that the brain adapts very quickly to the "high" sensation of any specific opiate, and it loses the ability to satisfy the craving. So they increase amounts. They look to other forms of opioids, to return to that potent "high" state.

And that quality of opioid addiction makes the struggle to quit all the more hazardous. A period of abstinence can decrease tolerance, sometimes drastically so, a phenomenon called the "kindling effect." Dosing themselves at the level they last used without even feeling the effects much becomes a lethal overdose.

The pharmaceutical industry, in its manic greed for profits, has preyed on chronic pain sufferers for a long time. In the past couple of decades they've ramped up the process, developing ever more potent tropes on the basic opioid analgesic mechanism, and carefully avoiding any research and testing that might contradict their claims of "safety." They've touted it for every kind of pain from acute cancer pain (the original justification for the medications) to chronic back pain, to temporary post-root canal pain.

We are now dealing with the consequences of the resulting opioid epidemic.

I wish I could say that the end is in sight, that we're on this one, that we're even making a dent in slowing the spread of the damage. But alas, I'm afraid that we're only seeing the tip of the iceberg.

sadly,
Bright