Riffing off A Powerful Message

A week’s worth of (medicated) sleep, and my noggin can at least process a few thoughts, here and there. 1 boring old man published an important post titled, A Powerful Message.  He chronicled the increasing clamor of psychiatry to use a neural circuitry model as evidence of psychopathologic causality and therefore an avenue for research and treatment.  I had noticed this, too, with increasing alarm and a sense of deja vu. I yammered a bit in a comment:

As a long time critical care nurse and educator, I witnessed an enormous transition in thinking about the care and treatment of myocardial infarctions (heart attacks). Care and treatment initially and historically was focused on complete bed rest and inactivity – up to and including only allowing room temperature food and drink lest cold irritate the vagus nerve. As the plumbing and electrical circuitry interface with the muscle stimulation and perfusion became more well known, treatments became more aggressive – getting patients up and moving right away, reperfusing coronary arteries and stenting them, ablating lesions, etc. Then the focus spotlighted statin use for prevention, concomitant with pharma DTC advertising and KOLs. Only recently has any of this been questioned, and lo and behold, stenting and preventive statin use may not do anything at all in terms of disease prevention.

Not for nuthin’ has clinical depression been found to coexist and correlate with heightened morbidity and mortality with of heart disease.

Patient stays in critical care units for heart attacks (MIs) went from 7-10 days to 1-2. Of course, patient education, diet teaching, stress management, socioeconomic assessment went out the window. In other words, self management and quality of life factors were ignored and abandoned. Patients are sent home with prescriptions, stents, pacemakers, automatic internal defibrillators and all manner of coronary hardware, and sometimes followup appointments. They are not linked to case managers, community resources and psychosocial supports.

The forces of capitalism, free markets and decreasing corporate regulation have converged to erode worker protections, environmental protections, food safety, community development (corporations receiving tax breaks, outsourcing jobs to other countries and pulling up stakes, leaving communities dying on the vine), and overall, contributing to the deterioration of social life and community throughout the US.  Vicious and poisonous politics have contaminated the well of civil discourse.

Whither health and well-being?

Here, my collegiate roots show.  Case Western Reserve University’s Frances Payne Bolton School of Nursing and the Department of Nursing Education, Teachers College, Columbia University, both were founded on the critically important work of nurses who established, grew, and nurtured public health and psychiatric nursing theory and practice.  My education was based on the principles and practices of Lillian Wald, Hildegard Peplau, Virginia Henderson, Isabel Hampton Robb (yes, the Robbs of Johns Hopkins and later, Lakeside Hospital of Case Western Reserve – this hospital was noted by Flexner in his famous Report on Medical Education, for serving as an exemplar), and Mary Adams, pioneer in gerontologic nursing and later a Dean at her home state, South Dakota’s State University School of Nursing.  These names will mean nothing to almost all members of the public, physicians, and sorry to say, nurses.

But I hope you’ll click on the links because their work has critical importance and influence on the individual, family and community health and well-being of Americans today. What you will see is their universal concern with the immediate and larger social and community environments which affect health and well-being of the targeted patient populations.

Physicians, nurses and indeed, all members of the (licensed, ergo, regulated) helping professions have an obligation to address, influence and lead policy and programming which are congruent with and supportive of a healthy environment and social life.  Those include wages which allow adults to work a single job and provide for safe shelter, clean water and air, nutritious fresh whole foods, reliable transportation, access to education and natural recreational facilities and adequate protective clothing for themselves and dependents.  It means assuring clean air and potable water.  It means assuring access for all to basic communicable disease prevention: vaccines, safe food, zoonoses prevention.  It means worker protections which promote tolerable physical and psychological stress levels.  It means protections for whistleblowers – rewarding workers for upholding ethical business, research and professional ethics.  It means promoting civil discourse and discouraging ostracism – whether that be racism, bullying, intimidation or any other type of behavior which is exclusionary.

Embracing the classical virtues and publicly upholding the inherent worth of every person will lead more to health and well-being than any pill, potion, invasive treatment or state of the art assessment tool.

The bottom line:  Each and every member of a helping profession by the social contract is an agent for social change.  Without that, patient treatment is devoid of care. And treatment will only palliate and blunt symptoms, rather than address disease and distress causality. Futile, impotent and, ultimately, destructive. Like this, perhaps:



Update:  I found this Berenice Abbott photo of  a NY railroad in the Met’s online collection, so you get an added treat.  If you aren’t familiar with Abbott’s work, consider this an invitation to “meet” her.

Today’s press release:  obesity accounts for 21% total US healthcare spending.

The Cornell study reports that an incurs medical costs that are $2,741 higher (in 2005 dollars) than if they were not obese. Nationwide, that translates into $190.2 billion per year, or 20.6 percent of national health expenditures. The study appeared in the January issue of the (31:1). Previous estimates had pegged the cost of obesity at $85.7 billion, or 9.1 percent of national health expenditures.

“Historically we’ve been underestimating the benefit of preventing and reducing obesity,” said lead author John Cawley, professor of policy analysis and management in the College of and professor of economics. “Obesity raises the risk of cancer, stroke, heart attack and diabetes. For any type of surgery, there are complications with anesthesia, with healing [for the obese].”

HT Dr. Grumpy

What does that have to do with addressing suicidality causes?

Many of the distressors associated with psychache have to do with social connectedness.  Social connectedness is intregral in the immediate environment. What comprises a healthy, socially conducive environment?

Natural green spaces: parks, trails, gardens and safe places to experience them.

That means sidewalks, bike trails, cleared paths.

Adequate lighting, places to rest, benches, beaches, tables.

Access to fresh, potable water.

Access to places that provide fresh, whole foods – grocers, restaurants, farmstands, foodtrucks, delivery services – at affordable prices.

Access to educational and entertainment media suitable for all ages, cultures and customs – that would be the public library via walking, bike and public transportation.

Access to clean, fresh air – via public health regulations, and state and federal regulations on pollutants.

See where this is leading?

Back to the pump handle  – public health measures provide the biggest bang for the healthcare buck.  It’s all about making a healthy environment – one which promotes natural interaction by people in a healthful and pleasing environment – the default mode.

If Lillian Wald were here today, she would be doing the very same things she did almost 100 years ago in New York City.

People who are obese are, for them most part, uncomfortable. But they are responding to  a culture of immersion in faulty food cues. Their suffering is largely preventable, and public health is the way to go.  Regulate food producers, marketers and manufacturers. Remove advertising for manufactured food products from TV and print sources.  Invest in public transportation, pedestrian and bicycling infrastructure and services.  Regulate clean air, water and substances pollution.

In the US, it is incredibly difficult to find public places and spaces which encourage natural civil discourse. Culture is built around commerce, and indeed, today, politicians refer to Americans as consumers and not fellow citizens. People speak of “going to the mall, hanging out in bars, and going shopping” much more than any other activity where they would naturally come into contact with others.  There are very few venues in which people can casually meet and interact with others.  Almost all communal gatherings in the US are passive – attending movies, concerts and other events require no interaction or active participation. People remain isolated and alone even among large crowds.

It’s not rocket science – it’s basic humane infrastructure and service.