Three Cheers

I have three cheers for media I have found useful and/or informative of late.

1. Cheers for Repower America, http://www.repoweramerica.org/, associated with Al Gore and pushing hard to create a national network of people interested in advocating for the renovation of our energy system into one that is both environmentally and politically sustainable. This is an organization that is promoting the kind of drastic change needed to actually address environmental degradation. And this is a pretty good time to invent new industry.

2. My friend Brent's new blog, http://www.garrulous.org/, where he has begun a series of essays on the last year in which he has survived oral cancer, the end of his relationship with a long-time partner, and further illness in his family. Brent and I have been friends for nearly twenty years and he happens to be a very gifted writer. I encourage anyone with a particular interest in cancer survival, or simply in the mood for a good read to check this one out.

3. The book "The Addict" by Dr. Michael Stein. He is a internist who has, as part of his practice, a buprenorphine clinic. The drug buprenorphine is used to assist opiate addicts in recovery. He writes with clear-eyed honesty about his experiences treating drug addicts with special attention on one young woman. The book really offers insight into addiction that is worth the read.

The joy-side of the information age!!

Happy Fourth of July, Soldier

On the evening of the most recent Fourth of July holiday I was at work in a substance abuse treatment setting. A young man was brought in by his father and was attended by a security guard. The security guard is typical accompaniment for new patients and does not necessarily indicate any behavioral problems with the attendee. I did notice immediately that the young man was huge, like professional football player huge. He was a statistical anomaly of muscle laid over a monster frame. And he was loud.

Within moments it became clear there was a problem. The young man wanted help, but didn't want help in our program. Attempts to explain how the process worked for substance abuse treatment fell on deaf ears because he was too agitated to process auditory information. He explained quickly he was a veteran of the current war in Iraq and had PTSD. This information was either a warning or an excuse for the coming behavior, I do not know which.

He quickly decided he wanted to leave, and bolted when one of the two locked doors was opened for a staff person. Security followed him into the hall and a seasoned staff working the scene identified the man as hostile and perhaps dangerous to the staff and other patients. The staff called for help.

I worked to get the other patients to the safety of their rooms and returned to try to be of some help. I saw that the young man was in the hallway between the two locked doors letting fly the F-bomb and generally posturing in a very threatening manner to the security guard, who was sweating and seemed to be cowering a few feet from the soldier. And just for the record, anyone not fighting heavy weight in the UFC would have been scared shitless, too. Even with a tazer and mase, the first few men to try to control this soldier, if it had come to that, were likely going to the ER with injuries.

This huge, reportedly specially-trained soldier was a kind of physical threat to our safety like I had never seen before. If a human being can be considered a weapon, this young man would be one. And he was making verbal and nonverbal threats.

The staff on the floor were able to deescalate the situation and get the young man to sit down and consider his situation. His father, who had witnessed the scene, but did not seem particularly effective at controlling his son, seemed unhappy with the staff suggestions for the next step. However, the soldier considered his options, made up his own mind, and agreed to get the help he needed in a setting appropriate for him. The situation ended as well as it could.

In all, it took two hours to address the situation and everyone, including the other patients, had been stressed out by the goings on. The young man reported he had been in treatment for PTSD for several months. If his behavior was explainable by the PTSD, then the treatment needed to continue, perhaps for several more years. This guy had a ways to go.

After the fact, I spoke with people who had dealt with him before he came onto our floor as well as the staff on my floor. Most everyone suspected the man had been doping. The steroids would have helped explain his aggression and his unnaturally large size. Others offered that he was a bully who enjoyed frightening us. Whatever the deal with this soldier, we were not equipped in our community setting to deal with his level of threatened violence and probable skill in causing physical harm.

Reintegrating some of the veterans from the Iraq wars may end up being a profoundly difficult challenge. None of us want a repeat of what happened to many Vietnam vets who did not get the psychological treatments or the community support that they needed to successfully begin life again as a civilian. But the challenges we may be facing with these newer vets are quite different in some ways than from previous wars. Access to help has been spotty at best. Even in parts of the country where sophisticated treatments are available, they may not be sufficient for getting these people back on track.The brain trauma many soldiers have sustained has been highly associated with PTSD and treatments for those traumatic brain injuries may not yet be adequate.

Also, there are new dangers to people trying to heal their minds as well as their bodies after tours, particularly repeated tours, in Iraq including availability of drugs and other substances that have been manufactured by drug companies to be of help and make money, but have ended up being just another albatross on the shoulders of soldiers. And those are legal drugs available through docs, which doesn't begin to address illegal drugs and booze. Even the seemingly innocuous activity of playing video games has known negative neurological effects as it can activate the parts of the brain associated with aggression.

We need a strong VA system that can take these soldiers in and help them get better. There must also be the expectation that they do learn how to be in the world again in non-violent ways. We need them to contribute in positive ways to our nation and in our communities both for the betterment of us all, but very importantly, in order that their lives and what they have been through have meaning and purpose.

I would hate to think of the soldier who shut down my workplace for a couple hours becoming a drag on society. Instead, I hope he keeps up the work on healing his psychological and substance abuse issues and goes on to become an invaluable member of his community. It would not be fair to him and to the service he provided our country if he is lost to the war wounds that we cannot see. I hope very much that he gets better and gets on with it.

His apparent ability to make a tough call to accept help even when he knew someone he loved might not understand or agree may have been a sign of his internal fortitude. That could be the strength he learns to draw upon when life gets tough and scary instead of the threat of his brute, physical force.

Misadventures in Clothsline Hanging

I decided recently to return to the tradition I learned from both my grandparents and, for a few years, my parents, of hanging washed clothes on the clothesline during the summer. Having grown up in the Pacific Northwest, there was really no point trying to use the clothesline in the spring, fall or winter. It used to rain a lot during those seasons.

Currently, I live in Minnesota and, though moderated, our winters are still long and below freezing. I can imagine the protest I would get from my family for freezing the laundry. But now it is warm and sunny most of the time, a perfect time to begin utilizing the natural, clean energy sources of wind and solar power to cut down on my electric bill, and perhaps help out a tiny bit in the global problem of excessive CO2 emissions.

So I loaded up the kids in the car and headed to one of those home and garden megastores. Having made it through the parking lot safely with the kids, and through the first temper tantrum when my youngest saw the only available car-shopping cart hybrid so popular among the under 3 years demographic, snatched up by another mother/child duo, we were in the store. I asked for help locating the detractable clotheslines I saw on-line and was so impressed by. Just think of the convience, I could pull it across the yard when there was laundry and detract the ugle thing into a tiny eye nuisance descretely screwed into the side of the garage when the laundry was done.

I found what I was looking for, but instantly became suspicious. It was a plastic number made in China. I was recently burned after purchasing a couple very simple contraptions for around the house that broke within weeks. These products became just more plastic garbage after their brief lives that included being manufactured thousands of miles away, shipped using huge amounts of petro products, finally to arrive in my home, where they were of use for a profoundly brief moment then shipped off to their final resting places for something like an eternity. Screw that.

I bought instead a length of rope and some wooden clothspins, leaving the store with five dollars worth of materials that will likely be with me to my dying day and hopefully not too long afterward.

Once home my kids watched with wonder then anticipation, "What is she doing and do I get some of that rope to play with?" It took a few minutes to put up the clothesline and the extra length of rope I lent them to play with until such a time as I need it for another clothesline or to tie one of my cats to the ski rack on my car (kidding).

I washed a load in my washer in cold and was actually excited about hanging the laundry. It was a sweltering hot day and I expected to be able to get all the laundry washed and dried in a few hours. I pinned the laundry to the line and took off with the family for a couple hours on an outing. We got back tired and cheerful. I quickly unpinned the laundry and dropped it in the basket.

That night we had a terrific storm which dumped inches of much needed rainwater. I enjoyed the stormy weather and slept comfortably. The next morning I looked outside at my new clothesline while sipping coffee and generally feeling optimistic about my new environmentally-conscious choices. And then I noticed it, the laundry basket with a day's worth of wash sitting atop a soaking lawn, uncovered.

I later mentioned the fiasco to my sister who noted that it is a challenging thing indeed to change one's habit. How right. Next time I'll remember to bring the laundry in from the rain.

"Awake now, it is time again"

I enjoyed the Bill Moyers interview with poet W.S. Merwin aired last night on PBS. One of the quotes read from Merwin's poetry was the one above, "Awake now, it is time again." This was a line in a poem about, in part, the ancient tradition in Macedonia of women singing the land awake again after a long winter.

This line resonated very deeply with me as being an expression of such ancient intelligence. These women called out what they knew, that they were a part of this natural world, and all that was in it began again anew.

Although I love the big ideas, it occurs to me that I need to live the small ones. Moyers and Merwin talked in the interview about tossing and turning at night awake with the terrible knowing of the world they leave behind them. Moyers in particular spoke about being haunted by the thought of his grandchildren inheriting a terrific mess.

Of the multitude messes, one is most immediate: the degradation of our environment. Being married to a biologist, I am continually aware of the burgeoning research. Having lived in the far north for a few years and still having friends there, I hear of the climactic changes so obvious to them and predicted decades ago by the scientific modeling of the greenhouse effect. I know that our industrial complex has reached a level of interaction with our ecological systems where a recursive cycle is under way and is gaining momentum.

If all industrial pollutants were to stop being added into the system today, the effects of what we have already done would continue for generations. To continue as we are is expediting the process and making a solution less likely. We're shutting our life support system off on ourselves.

Folly. Human folly is so well known throughout the entirety of recorded human history and one assumes, as long as humans have walked upright, we cannot hope to escape it entirely. But this particular folly could pull the curtain on us entirely. Human drama cannot continue without the Good Earth as stage.

There may or may not be big answers to this mess. But there are small answers everywhere. It is a matter of the very mundane, the way in which we live. I am in the process of remembering what I knew as a child, what I was taught by my grandparents. I am learning to see my small yard as a solution to the problems of my lifestyle. I am researching ways I can reduce the impact my family is having on the environment within our economic realities.

I have begun with modest projects. I'll write about this ongoing process of relearning how to be in the world in a more careful and sustainable way. Please, anyone reading this with simple ideas on how to better align our lifestyles with ecological realities, respond to my blog. Changing lifestyles is no easy matter. It will take inspiration and commitment.

Need for Long Term Care of Mentally Ill Unmet for Decades

Having worked with people living with serious mental illness for several years, I have seen the sad cycle many of their lives rotate through. During times of severe impairment due to psychotic episodes, severe depression, and/or extreme substance abuse, people with chronic mental illness will often find assistance in local hospitals. The staff will help them get stabilized on medications and sober then send them to outpatient programs that often are short of duration. Within weeks or months, many will be suffering again with serious symptoms and unable to care for themselves or make good decisions.

I first worked with the children of people with serious mental health and substance abuse problems. Unfortunately, many people who are unable to care for themselves have children that they cannot take care of either. Many of these children end up in the truly unhappy and often utterly dysfunctional child welfare system. I have seen families where the children of mentally ill people grow up and suffer with mental illness and themselves have children who are put into the foster care system. It's a devastating cycle for those in it and can be deeply saddening for those professionals who work with the families.

It is a system of perfect madness.

During the 1980s, under the leadership of Ronald Reagan, state run institutions lost federal funding and the hospitals that provided long term care for mentally ill people went by the wayside. Community programs were supposed to take their place and provide less restrictive environments so that people with mental illness could interact with the community. Unfortunately, this variation on the "pull yourself up by your bootstraps" theme has failed to address the serious needs of millions of people. Many of the people who previously lived in state facilities are now basically homeless. This situation presents many dangers both for people with mental illness, and often to family and community members when some of these people become violent.

We need a system like whole cloth that sanely addresses the needs of people with mental illness. For those most afflicted, on-going, life-long care is simply needed. Finding funding for this kind of care is a tough task, especially right now. The U.S. systems for resource distribution aren't even managing to get basic health care to millions of children, let alone sophisticated mental health care to the chronically mentally ill. We have such a distance to go back towards our humanity when it comes to the care of our most vulnerable.

But I argue that the emergency only care many people with mental illness receive is extremely costly as well. One of my current patients is in a facility that costs thousands of dollars a day and is designed for acute, short-term care. Unable to find appropriate housing, he's been at our unit for weeks. As with anything else, failure to plan often ends up more costly in the end.

Our nation needs determined leadership in the field of psychiatric care.There are highly effective and economical systems being developed to address the needs of the nation's very large elderly population. Perhaps we in the mental health field could borrow some of these ideas.

Having facilities that can address a spectrum of functioning levels as they have in retirement communities could work. People in these communities have options for fully independent living through end of life care in one facility. A comparable facility for people with mental illness could function similarly except people may be able to live in different sections at different times during their illness. For example, people stable on their meds could live in less restrictive environments, but people whose symptoms become more severe or who abuse substances are moved to more restrictive environments.

Innovative answers are out there. This, like the other issues that need to be addressed in our country, requires great will to support follow through.

Domestic Terrorism

If it is legally established that the killer of Dr. Tiller, a man who provided legal abortions in Kansas, was motivated to kill Dr. Tiller because of his profession, then the killer should be charged with terrorism. If this is the case and he isn't charged with terrorism as well as murder, it will be an injustice.

Dr. Tiller was attending church when shot and killed. He had survived a previous murder attempt ten years ago. The killings of physicians who perform legal, safe, medical procedures including abortions are blatant acts of terrorism because they have a political objective. It is a heinous act of violence against an individual and a message to other medical professionals who provide women's health services that religious fundamentalists often find objectionable.

Just as people killing in the name of Allah is of particular offense against humanity, so too is killings that find their inspiration in the religious texts of Christianity. We, as Americans, should come out strongly against anyone who would seek to terrorize our citizens. The networks that provide information on doctors who perform abortions to individuals considering and/or planning violence need to come under serious review by federal agencies and prosecuted vigorously. Terrorism, whether foreign born or domestically grown must be rejected on every level.

Add Meaning to "Family Values"

Social progressives have in front of us a time of real opportunity for having our positions more accurately represented within the political and cultural milieus. Further, this opportunity allows us to influence public policy and popular culture currently and in the future. Simply put, we have the floor- politically, socially and, I argue, morally.

It is the latter that I focus on here. Towards the end of bringing about a broadening and deepening of the dominant culture's understanding of and sanctity for human life, I suggest we shift then expand the meaning of the language put forward by the politically right of center folks over the past thirty years. Specifically, I believe we need to adopt the term "family values" and define it in a meaningful way for the twenty-first century.

If we are to be effective in shifting the direction of our political, economic and environmental systems, we must shift the idea of "family values" off of its fundamentalist Christian foundation and secure it as a cornerstone of secular cultural, political and economic values. Lets simplify the meaning of "Family Values" to family values, the valuing of families. If we adopt this shift of meaning, the public policies and private choices become less convoluted and more direct. When facing questions on such varying topics as tax code, marriage eligibility, school funding initiatives, or cause for war, we need to begin with two questions, "Does this serve our families?" and "Does this serve my family?"

Answering these simple questions will often become a complex endeavor, as the two answers may sometimes conflict. But at least we would have a clear focus on the conflicts as they arise. And the resolutions to conflicts would likely have a far greater humanitarian emphasis than we would otherwise have.

Certainly, answering these questions with the previous definition of family values has incited great eruptions of deep pain in many families. The previous definition of family values has little to do with the welfare of many families and everything to do with serving an ancient and often vague doctrine followed in a very specific way by a minority of Americans. A befuddling task indeed is serving this answer.

Focusing the debates on all manner of issues addressed in the political and economic sphere to answer "How does this serve our families," and "How does this serve my family," incidentally, would also clear up the Gay marriage issue. Does allowing Gays to marry cause immediate harm to my or other families? This question invites concrete answers that may help dispel the ether of religious doctrine that confuses the mind and seems to leave people unable to discern the difference between an idea and the agreed-upon "reality" that, by definition, must be shared in order to be valid.

Answering the questions, "Does this serve our families," and "Does this serve my family," may also lead us to conclusions that many among the more liberal left may find disconcerting. For example, does massive expenditures on failing individuals and failing families always make sense? Are there times when supporting the programs that benefit the higher functioning individuals and families make more sense when answering "Does this serve our families," even if the answer conflicts with the more individually focused, "Does this serve THIS family."

For example, does dumping hundreds of thousands, even millions of dollars attempting to rehabilitate wayward individuals end up hurting the school programs that promote and support excellence in our communities when push comes to shove in the local government budget debates? Are there far less expensive ways to treat low-functioning individuals and families in a community setting?

Huge issues face the Gen Xers and those younger than us. Our strength is definitely our creativity. We have to come up with and follow through on the big answers, but we must ask the right questions before we can even begin. Let's ask the right questions, lets start with our families. And lets adapt family values to mean actually working on projects and policies that demonstrate our valuing of families.