That’s all, folks

I’ve scoured the interwebs and continue to come up empty.  Suffice to say that the US is a predatory, brutal place with a societal culture that promotes predation.  As someone who was committed to patient advocacy, and yet failing miserably when I needed and sought help, I don’t want to lead others on a wild goose chase predicated on false hope and foolish optimism.  Those lead to betrayal, failure and more suffering.

That, in all of this medical mecca town, not a single psychiatrist, psychologist, psychiatric social worker or academic program offers any effective care and treatment to reduce unbearable psychological distress, nor is interested in doing so, speaks for itself.

That no one is interested on this blog or any other in discussing approaches or treatment alternatives sends a clear message.

Only I can find a place on the interwebs where no one else resides and Google turns up no results. WordPress putting all of my blog posts and comments on other WP blogs into spam was also a large factor in stopping.

In how many ways can one be ostracized?  I’ve lost count.  But I also just don’t give a damn anymore. They’ve got me where they want me – disappeared so as not to ugly up the place.

For the all one person (annalaw, that would be you) who read and commented, I am very grateful and appreciative.  I wish you the best in your quest for minimally acceptable care.

The reading list will remain in its messy, disorganized place.

And I will remain in this living hell until I can get myself euthanized and catch up to the social death.

Poverty of Thought

Steve Balt wrote a post about some of his take-away thoughts from the American Psychiatric Association conference.

Commenters responded with thoughtful, illuminating insights about the gestalt of extant American psychiatry.  I was gratified to read that David Healy‘s Pharmageddon book is being cited as important.  He emphasized understanding the history of how capitalistic forces have emerged as the predominant force in shaping psychiatry and in shaping policies and practices which directly affect patient treatment (I refuse to use the word, care, relative to psychiatry and mental illness treatment, because it has specific meaning in the helping professions, and it is absent here.) and patient outcomes.

Steve’s post and your response, along with Emily Deans’ highlights a type of “poverty of thought” rampant in organized psychiatry. One cannot successfully treat people without the people. The old adage, “the surgery was successful but the patient died,” is apt for this field, too.

From assessment – how do you know you’re asking the right, germane, and appropriate questions? (glaring example: asking patients about suicide plans instead of about intolerable psychache and unbearable distressors. The first results in patients’ loss of civil rights and incarceration/observation, etc., the second SHOULD result in an urgent/emergent treatment intervention to lower the levels of immediate distress and to devise a treatment plan to reduce/eliminate the causative distressors. But that would mean knowing the patient, his living conditions and intervening where social justice is required. Ew. Messy. Takes longer than writing a prescription.)

To patient relationships – currently based on legal coercion, deception, and adverserial threat

To treatment – psychotropic medication, invasive surgery, inducing seizures and electrical stimulation, plus a dollop of who-knows-what talk therapy

To outcome goals – treatment adherence (do patients name their goals of being that of treatment adherence? /derisive snorting) which are unrelated to patients’ perceptions and functions in quality of life

Everything. Everything is oriented toward the psychiatrist. These are psychiatrists‘ interests at work. Patients are simply objects upon which to act, and are the means toward psychiatrists’ rewards: professional reimbursement, the source of research funds, the means to publication, and fodder for career recognition and success.

It’s Alice down the rabbit hole or through the looking glass.

It’s wrong.

But that it’s making more psychiatrists increasingly uneasy and uncomfortable is a good thing.  Eventually, that uneasiness will increase until it becomes an unbearable, distressing force, and action will become inevitable, if not impulsive. (Yes, I’m making a sarcastic swipe at extant suicide risk assessment, but I’m not going to advocate for incarcerating the poor psychiatric victims – in this case, the psychiatrists.  Maybe a little cognitive behavioral therapy so that they can recognize their distorted thoughts, and a round of ECT to jolt them out of their depression about their situation…)

Intentional Complications

Empty suit

Because THAT helps to explain this:  the fundamental devolution of the practice of medicine, psychiatry and nursing with the concomitant declining health and welfare of the citizenry in the US.

Truth?  Whose truth?

Branding?

Market share?

Global leadership?

Cui bono?

Harvard.

Substitutions

I follow food and nutrition science to some extent.  This caught my attention:

It’s been a profitable venture for the drug companies, as well as for the professors and their universities. Agriculture schools increasingly depend on the industry for research grants, a sizable portion of which cover overhead and administrative costs. And many professors now add to their personal bank accounts by working for the companies as consultants and speakers. More than two-thirds of animal scientists reported in a 2005 survey that they had received money from industry in the previous five years.

Yet unlike a growing number of medical schools around the country, where administrators have recently tightened rules to better police their faculty’s ties to pharmaceutical companies, the schools of agriculture have largely rejected critics’ concerns about industry cash. Administrators have set few limits on how much corporate money agricultural professors can accept. Faculty work with industry is governed by confidentiality rules that veil it from public view.

In certain ways, the close relationship between animal scientists and pharmaceutical companies has never served the public well. Few animal scientists have been interested in looking at what harm the livestock drugs may be causing to the cattle, the environment, or the people eating the meat. They’ve left most of that work to scientists outside of agriculture, consumer groups, and others who take interest.

But with the introduction of Zilmax, the situation may have reached a tipping point. Critics say some academic animal scientists have become so closely tied to the drug companies that they may be working more in the companies’ interests than in those of farmers and ranchers—the very groups that land-grant universities were created to serve.

Substitute patient for beef cattle and psychiatrist/primary care physician for animal scientist and voila! Patients growing enormous and iatrogenically ill and diseased on second generation antipsychotics, and their physicians so entangled with pharma and medical device industries that they fail to serve patients’ interests.

The Chronicle of Higher Education isn’t usually where I find in depth whistle-blower investigative reporting.  Read the entire article.  It will (or should) make your hair stand on end.

Ethics and malfeasance, anyone?

Social contract. In pieces.

“The only one.”

English: Consequences of whistleblowing, from ...

Update:  NPR just published a compelling story about Mr. Boisjoly, and it includes two audio interviews- one about his whistleblowing and one with his perspective after the fact. Listening to NPR’s Howard Berkes talking With Roger Boisjoly In 1987 is incredibly heartbreaking.

I am ashamed that I have not always intervened to stand with those who stand alone.  Now I am a liability to others.  A pariah is not a help, but just more weight dragging the person farther down the rabbit hole.

Read the NYTimes’ activist obituary, if there is such a thing, and feel just a bit of what this man experienced.

Six months before the space shuttle Challenger exploded over Florida on Jan. 28, 1986, Roger Boisjoly wrote a portentous   memo. He warned that if the weather was too cold, seals connecting sections of the shuttle’s huge rocket boosters could fail. “The result could be a catastrophe of the highest order, loss of human life,” he wrote.

Mr. Boisjoly’s memo was soon made public. He became widely known as a whistle-blower in a federal investigation of the disaster. And though he was hailed for his action by many, he was also made to suffer for it.

Mr. Boisjoly … died in Nephi, Utah, near Provo, on Jan. 6. He was 73. His death was reported only locally at the time. He lived in southwest Utah, in St. George. His wife, Roberta, said he recently learned he had cancer in his colon, kidneys and liver.

But before then he had paid the stiff price often exacted of whistle-blowers. Thiokol cut him off from space work, and he was shunned by colleagues and managers. A former friend warned him, “If you wreck this company, I’m going to put my kids on your doorstep,” Mr. Boisjoly told The Los Angeles Times in 1987.

He had headaches, double-vision and depression, he said. He yelled at his dog and his daughters and skipped church to avoid people. He filed two suits against Thiokol; both were dismissed.

He later said he was sustained by a single gesture of support. Sally Ride, the first American woman in space, hugged him after his appearance before the commission.

“She was the only one,” he said in a whisper to a Newsday reporter in 1988. “The only one.”

His obituary lists family.  I hope they brought him solace and comfort.  Families mostly don’t survive intact. He was only 73.

The sole study (small, Australian) that looked at the health effects of whistle blowing listed 17 of 35 people admitting to suicidality.  The suicide rate couldn’t be ascertained because the study was done in questionnaire format and only used a single sampling. But adverse significant health effects were 100%.

100%

I know – you don’t believe me because you are a GOOD person, and you live in a society with safety nets for this type of thing. But here’s the gist of it:

OBJECTIVE–To examine the response of organizations to “whistleblowing” and the effects on individual whistleblowers. DESIGN–Questionnaire survey of whistleblowers who contacted Whistleblowers Australia after its publicity campaign. SETTING–Australia. SUBJECTS–25 men and 10 women from various occupations who had exposed corruption or danger to the public, or both, from a few months to over 20 years before. RESULTS–All subjects in this non-random sample had suffered adverse consequences. For 29 victimization had started immediately after their first, internal, complaint. Only 17 approached the media. Victimization at work was extensive: dismissal (eight subjects), demotion (10), and resignation or early retirement because of ill health related to victimization (10) were common. Only 10 had a full time job. Long term relationships broke up in seven cases, and 60 of the 77 children of 30 subjects were adversely affected. Twenty nine subjects had a mean of 5.3 stress related symptoms initially, with a mean of 3.6 still present. Fifteen were prescribed long term treatment with drugs which they had not been prescribed before. Seventeen had considered suicide. Income had been reduced by three quarters or more for 14 subjects. Total financial loss was estimated in hundreds of thousands of Australian dollars in 17. Whistleblowers received little or no help from statutory authorities and only a modest amount from workmates. In most cases the corruption and malpractice continued unchanged. CONCLUSION–Although whistleblowing is important in protecting society, the typical organisational response causes severe and longlasting health, financial, and personal problems for whistleblowers and their families. (emphasis throughout is mine)

I know how difficult it is to stand alone and support a person who has been ostracized.  There is real risk to do that.  So like other whistle-blowers, I don’t ask, and I never expect it. Moreover, people will not TOUCH whistle-blowers.  Whistle-blowers are literally toxic. That is why Mr. Boisjoly was so profoundly TOUCHED by Dr. Ride’s gesture.

But, hot damn, Sally Ride stood there and HUGGED him.  In public. If that isn’t a meeting of heroes, I don’t know what is. Funny thing is that she retired from NASA later that year, and in 2002, she was appointed to the Space Shuttle Columbia Accident Investigation Board. Accidents still happened.  Same old boring story – multiple Swiss cheese systems failures because the people advocating for time out and caution were over-ridden by those who gun always for the shareholders’ (lobbyists/politicians and their corporate overlord shareholders) bottom lines.  Sacrifices always have to be made by those who will never come into contact with the bottom feeders liners.

Professor Liam Donaldson, the chief medical officer for England’s National Health System, wrote,

We should “applaud heroes, and hope they are among us, but to base our hope of remedy in ordinary systems on the existence of extraordinary courage is insufficient.”

I’ve pretty much scoured the literature, and no one addresses whistle-blowing, ostracism and suicide.  No one addresses the life ruination, the total and complete losses, and the resultant world goes on while leaving the whistle-blower (and surviving family, if any) in literal limbo.

And really, it’s the perfect crime.  Because it’s like Holmes’ dog that didn’t bark.  No one notices the absence of whistle-blowers.  No one sees them missing in group photos, nor misses their names in employee recognition events, nor has any notion at all about their well-being. Much better than Jimmy Hoffa’s demise with that pesky media and all keeping his name alive and the issues addressed.

Whistle-blowers are disappeared much more cleanly and completely than any CIA black site prison. The torture leaves no mark.

Retaliation against whistleblowers at all time high

English: A woman protesting weak protections f...

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It would be more humane to just kill them instead of the slow excruciating social death that they inflict.

While reporting of the wrongdoing was at an all-time high, so too was the backlash against those employees who blew the whistle, the research revealed. More than 1 in 5 employees who reported misconduct experienced some form of retaliation, which ERC President Patricia J. Harned said spells trouble.

“Retaliation against whistleblowers and pressure on employees to compromise their ethics standards are at or near all-time highs,” Harned said. “These are factors that historically indicate that American business may be on the cusp of a large downward shift in ethical conduct.”

 

Overall, the strength of corporate ethics cultures is at its weakest since 2000, the report said.

Hobbes and the Holidays

Rough Collie named Jack[N.B. This is an old post from a defunct blog whose title I had forgotten.]

Hobbes and I found each other when he was just a large puppy.

At that awkward age – adolescence –  when puppies look like dogs but definitely act like puppies; Hobbes had been given up by his owners. A new baby, and a new apartment, and Hobbes landed with a breed rescue group.

He was produced by an anonymous backyard breeder. You know, the ones looking to make a quick buck with any old dam and sire. You see their ads in the newspaper classifieds and now on the Internet. “Collies, tris and sables, AKC Reg. $150 Parents on premises.”

Translated that means, “I bred the first male I could find to the first female I could find. The American Kennel Club doesn’t care – all that the registration papers mean is that the family tree is known. Not that I give a hoot if it’s a good line of breeding. Vet care? That costs too much. Blind? How would I know? I need some extra cash for the holidays. And people always love puppies. What happens if they don’t get them altered? Why should I care what they do with them after they’re sold. Pet overpopulation? Not MY problem. I have RIGHTS, you know. This is AMERICA!”

And so Hobbes, his extra long collie muzzle ducking toward his tail, shyly allowed me to hoist him into my car and off for the ride home.

He was so shy, this tall, dark and handsome collie. I didn’t know that collies came in colors other than the TV issue “Lassie sable and white with a white stripe on the face.” But Hobbes had a rich dark brown coat with subtle highlights of sable eyebrows and sable legs and white stockings on his elegant and incredibly nimble feet.

By the time we arrived home from the foster family‘s house, Hobbes had crawled into the front seat and was leaning against my side very politely. We were fast friends as he bounded out of the car.

I learned of the official collie burp. It’s produced solemnly and with dignified presence. It’s subtle, yet distinctive, to purebred collies.

I learned of the fondness of a collie for a cool floor on which to luxuriate. Collies stretch from their noses to their tail tips, and Hobbes was masterful at his stretching.

And I learned of the collie’s absolute love and enjoyment of all things snow-related. Want to throw snowballs? Call a collie to be your partner. Snow Angels? Make that snow collies, too! Call a collie in from the snow, and you will find a collie with a large ball of snow attached to his nose. His face will have an open smile exuberance about it, or perhaps a hint of a pout for curtailing such wonderful fun!

Hobbes had an affinity to watch over his very own herd of cats, most of which were older and sedate. In the first Spring we were together, I have several pictures of Hobbes posing before newly blossoming daffodils, when in each subsequent picture; a tabby cat face a la the Cheshire Cat emerges from the yellow conga line of swaying daffodils. And then Sir Cedric Cecilwycke Tabby Cat (pronounce that with a “Thufferin’ Thuccotash” lisp), approaches the posing Hobbes for first a friendly nose to nose sniff, and then on the last frame, a very friendly full body cat rub on Hobbes, to which Hobbes is bent over Sir Cedric looking for all the world to be his biggest best friend and protector.

Later, when it became clear that a retriever Hobbes was not, the veterinarian checked his eyes and with alarming directness, instructed us to make an urgent appointment to see a referring veterinary specialist at once. He thought Hobbes was developing a large brain tumor at age two. I had visions of dealing with a very untimely demise of a much-loved dog.

At the visit with Dr. Wyman, the nation’s foremost canine ophthalmologist, I nervously held a calm and polite Hobbes during the eye examination. As he gently supported Hobbes’ long muzzle, Dr. Wyman, without anything other than sincerity, soothed to Hobbes, “You are SUCH a fine gentleman.” And I knew exactly what he meant.

There was good news and not so good news. Hobbes had not a brain tumor, but he was blind. And he had been since birth. In collies, there is a condition where the cells that hold the retina in place fail, that in mammals turn wavelengths into vision; Hobbes had failed to develop the supporting structure. And so with the retina fallen flat into the eye orbit, there was nothing on which the wavelengths to convert to vision. Dr. Wyman stated that categorically, Hobbes was blind and always had been.

I was giddy with relief. For this dog had already been through obedience classes and had passed with flying colors. Hobbes was titled as a CGC – Canine Good Citizen, and that, he was! How he knew where to place his feet and his body, I could never tell. But until his last day, he was unerring in his footing. He ran with the horses, avoided the goofy goats, and herded the chickens and rabbits, all without a single misstep.

Hobbes was such a gentle and sensitive soul, and he served as a greeter and big brother to uncounted animals who came into rescue and later the animal sanctuary that was founded in his honor. He was directly responsible for the rescue, retirement and rehoming of many animals that had been deemed unadoptable and un-savable.

Early on, Hobbes enjoyed car rides, and he went with me everywhere. As he gradually became more of a homebody, I often had to seek him out, as he stayed out of the general hubbub of younger and more energetic animals.

Over the past month, the other two eldest collies – both rescued from awful abuse situations and taken to high kill shelters, died after fading. Hobbes had been very connected with them, and I held my breath to see if he would survive his grieving for them.

We – the rescued dogs and I – celebrated his 13th birthday on December 22, and I knew that he hadn’t much time left with me here. Without much hearing left and with increasingly unsteady legs, he still enjoyed rooting for a passing bicyclist, but he was slowing a bit more each day.

On Christmas Eve, I insisted that he sleep inside, rather than on the three-season porch, as was his wont.

On Christmas Day, his gaze was unfocused, and his breathing was shallow and rapid. I knew that he was quickly leaving.

So with plenty of hugs and a liberal dose of tears, I released him to travel on and join his friends, Toby and Dumpling and Napoleon, as memories of exquisitely beautiful and sensitive souls. And on Christmas night, I buried his body next to his other collie buddies and planted daffodil bulbs to remind me of other times and gentle breezes and young collie cavorting.

I miss my dear friend terribly, and I am so grateful that I had such a wonderful collie friend in Hobbes, the throwaway blind collie. But how I long for just one more time to find a long collie muzzle resting on my leg, demanding a pat and a smooch.

Fuggeddiboudit

Cut up rat

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Previously I noted that disparate studies suggest that incessantly assessing suicide risk without providing distressor relief may actually kindle – make worse – suicidality.  Over the recent past this has been my experience. The chief source of “treatment” such as it is, is by serving as a lab rat in studies.  I have been subjected to incredibly intrusive and distressing assessments on a very frequent basis.  I haven’t responded to any of the treatments and have instead had side effects including a liver injury from one – where the CRO (for profit contracted research organization) and IRB disappeared into the ether and left me to my own devices.

Last week I served as a subject that I thought wouldn’t involve distress or harm because I needed $$ to pay for treatment I received as a result of the liver injury.  Well, the assessment was awful to the extent that I called a crisis hotline – was treated to a rude and dismissive response and then the crisis provoker hung up on me. “Just read a book,” she commanded.  And,
“I’ve never been suicidal,” she crowed.

I lost time after that – a few days at least.  Apparently I threw the phone away, which makes sense.  No one calls me, and it isn’t needed since no one responds to calls for help, either.  One cost reduced.

I’m withdrawing from the other studies.  I can’t tolerate the distress.

I used to blog to try to stay current in health policy and clinical practice, but I’m too far gone to do that or to care.

So I’m signing off at this juncture with a link to what looked to be a thoughtful and fairly comprehensive report about the state of suicidality “treatment” in the US with some Western countries’ best practices thrown in.

And a plea to offer a humane death for those of us ostracized by you.  There’s a difference in wanting to hurt oneself and desiring a peaceful death. I failed at finding a means to the latter, and am forced to resort to the former.  That is cruel and unusual punishment for being deemed a worthless freak.

Predictions

Honestly.  In the conflation department, I keep reading comments about how much a need there is to have a reliable tool to predict suicides.  Well, that ain’t happenin’ until there is effective, available and safe treatment which reduces distressors.  Otherwise, all of the rewards and incentives are lined up squarely against anyone admitting suicidality, let alone seeking incarceration quaintly and deceptively referred to as containment and hospitalization, applied emotional trauma, humiliation and intrusiveness which is all the “standard of care” does in the US, at least, when someone admits to suicidality.

I have been explicitly instructed by three psychiatrists on how to dodge a suicidality assessment in order for us to play charades:  me, so that I escape imprisonment and them to escape legal risk and actually intervening to alleviate my distress.  So why in the world would I seek out any “help” at all when it is clear that there is none to be had?  Sheer lunacy, (irony alert).

And so, the world goes on without me. Silence punctuated by external noise. Unending hell. No reason to get up, go anywhere, do anything. There is no intervention for ostracism.  Untouchable, literally untouchable. Enduring social death until physical death.  Hurry up, already.

For those who have friends and family, a recent large scale study examined some of the factors involved in them not intervening or providing help when people close to them are suicidal:

As the suicidal process unfolds, significant others are required to make a series of complex decisions about what is happening and what, if anything, they should do about it. They must collect and weigh evidence from a range of sources, correctly decipher and assess the significance of both signs and countersigns, identify the appropriate actions to take, and then summon the courage to take them. Risks are involved at every stage; cherished relationships are at stake. Significant others must weigh the danger of doing nothing against the perceived dangers of saying or doing “the wrong thing.”

Experts agree that a clear and unambiguous warning message is a prerequisite for effective disaster planning and crisis management.29 Our data suggest that, in a suicidal crisis, members of the family and social network may not always receive a clear and unambiguous warning message. This may be because the person fails to give out a clear enough distress signal or because distress signals are given but significant others cannot decode them correctly at the time  Equally, they may not be able to bring themselves to accept that anything is seriously wrong or that suicide is a possibility. Writing in another context, about clinical identification of child abuse, one author comments: “[It] is a difficult intellectual and emotional exercise. . . The biggest barrier to diagnosis is the existence of emotional blocks in the minds of professionals.”30 The emotional blocks that can operate in clinical practice are magnified many times in close personal relationships, where every word or action may be emotionally charged and gauging the right response is critical. Our findings suggest that those very relationships, generally believed to be a protective factor for suicide,31 32 may sometimes heighten risk by acting as barriers to both awareness and intervention.

….critical errors in judgment often result from the so-called “normalcy bias,” defined as the tendency of people who have never experienced a catastrophe to disregard ominous signs and behave as if nothing is wrong. The strong desire for everything to be normal inclines people to believe that it is, even in the face of evidence to the contrary.33 Our findings suggest that this same principle may operate at the private level, particularly in the context of family life. The cycles of avoidance model, proposed by Biddle et al to account for non-help seeking for mental distress, provides an alternative framework that also fits our data well.   Our data show that lay people may go to considerable lengths to avoid pathologising the distress of those close to them; their thresholds are repeatedly pushed back by powerful emotions, especially fear of the consequences (for themselves, as well as for the distressed person) of acknowledgment and intervention.

National Distress Is A National Disgrace

I remember the Tuesday in September.  The morning was crisp, clear and with eye-watering bluest of blue skies.  I had already finished morning barn chores and was in the house having coffee, checking the net and listening to the tee vee.  For the next three hours, I watched the sky overhead where normally the aircraft were in their final landing pattern turnaround to the local metropolis’ airport gradually clear of all thing winged and rotored.  The silence and stillness was ominous and dreadful, even though the sounds of nature could finally be heard as intended.

The US on that day, could have moved forward by examining the hows and whys of terrorism.  It could have held steady on the solid bedrock of tolerance and inclusion, dignity and respect for all.  It could have made conditions permanently inhospitable to terrorism by not condoning and allowing bigotry, bullying and alienation.

But instead, the US was led by the nose in exactly the opposite direction by Dick Cheney, ostensibly the president in deed if not in title, George W Bush who never had a single edifying thought, but instead sought retaliation, retribution and revenge for deeds real and imagined, the Cabinet of fundamentalist Christians and lobbyist-tainted hangers-on – power and control mongers all, a Supreme Court which is firmly Corporatist and devoid of human decency, a media which is commercially bought and paid for to produce “what the viewer wants” – meaning what the viewer watches/reads that leads to advertising revenue, and a willfully ignorant citizenry which indeed paid attention to all of the above and neglected to apply critical thinking and adequate skepticism to the calls for war, violence, national paranoia, suspicion and a (permanent) suspension of the rights guaranteed in the Constitution.

Instead of building a welcoming and open society, we have let it go to wrack and ruin.  Instead of educating thinking productive citizens, we have trained a nation of gullible test takers.  Instead of building on the classical virtues, we have a nation of individuals that don’t know the first thing about voluntary cooperation, collaboration and compassion for the greater good and for our fellow humans.

We could have spent our dollars on research, new technologies, renewable energy, professional growth and development, infrastructure renewal and development and transportation growth.  We could have invested in our citizenry with healthcare, education, healthy-based communities and in the liberal and fine arts.

Instead, we have funded wars, terrorism, global arms, an enormous, off the books contracted spy industry, state-sponsored violence and government disruptions.  We have criminalized mental illness.  We have made prisons the largest growth industry in the US. We have made over one third of Americans too poor to afford necessary health care.  We have turned out a generation of Americans who are ill prepared to be engaged and informed citizens and who do not have the ability to be successful in a trade or profession.  We have neglected everything from the air we breathe to the food we eat, the water we drink to the ground in which our crops are grown.

We have gone from a two party political system to a one party, corporatocracy.  There isn’t any point in voting, as there is no one to vote FOR as a legitimate representative of the constituency.

We are constantly surveilled via cameras, data bases and undisclosed programs and organizations.  We are extolled to “see something, say something”.  Everyone has been made into an out group. We are prompted every day in many ways to be “alert, be aware” and be suspicious of everyone and everything around us.

On this day of reflection, I mourn for the lives lost on September 11, 2001, as well as for all of the lives lost in Iraq, Afghanistan, & Pakistan by both military and civilians.  I mourn for those affected by any act of terrorism.  I mourn for alienated people who react to ostracism with extremism.  I mostly mourn for the loss of the Republic.  Franklin said that it would last only “if you can keep it”.  But none of us did, and it’s gone.

What’s in its place is a worn out shell filled with a people made very weak and seemingly still without a will and the means to try to take it back.

This is a demoralized people, and more and more of its inhabitants are becoming hopeless about it because of their seeming helplessness and the betrayal by those who promised, hope, change, transparency and equality.

And as more citizens are deemed to be burdensome by politicians (failure to extend unemployment, criminalization of homelessness, retrenchment of Medicaid and SCHIP, the general promotion of ostracism), will the national collective perception of thwarted belongingness propel civil unrest or violence?

I bring this up because as the two fundamental conditions for people to choose to act on suicidal ideation, on a large scale, I wonder what actions people might take when these conditions become intolerable to bear. Kip Williams discusses the final phase of ostracism when coping has failed to produce re-inclusion and affiliation as resignation (ostensibly to one’s fate as permanently ostracized – ed).

This is when people who have been ostracized are less helpful and more aggressive to others in general,” he said. “It also increases anger and sadness, and long-term ostracism can result in alienation, depression, helplessness and feelings of unworthiness.”

Williams is trying to better understand how ostracized individuals may be attracted to extreme groups and what might be the reactions of ostracized groups.

“These groups provide members with a sense of belonging, self-worth and control, but they can fuel narrowness, radicalism and intolerance, and perhaps a propensity toward hostility and violence toward others,” he said. “When a person feels ostracized they feel out of control, and aggressive behavior is one way to restore that control. When these individuals come together in a group there can be negative consequences.”

Demoralization

This post is essentially an interim reference list. Demoralization is arguably the most important concept in suicidality that you’ve never heard of.

Demoralization and remoralization: a review of these constructs in the healthcare literature Margaret J Connor, Jo Ann Walton

Nursing Inquiry

Nursing Inquiry

Volume 18, Issue 1, pages 2–11, March 2011

The Social Separation Syndrome
Reprinted from Survival International Review Vol. 5, No. 1(29):13-15, 1980.
G. N. Appell
Brandeis University

Engel and his collaborators have been concerned with the related question: Why do people fall ill or die at the time they do? And they have identified a psychological pattern that appears associated with disease

onset that they call the Agiving up–given up complex@. Five characteristics are identified with this complex (Engel 1968): (1) the giving up affects, i.e. helplessness or hopelessness; (2) a depreciated image of the self; (3) a loss of gratification from relationships or roles in life; (4) a disruption of the sense of continuity between past, present, and future; and (5) a reactivation of memories of earlier periods of giving up.

Pubmed search for demoralization

The term demoralization was first used in the psychiatric literature by Jerome Frank in the 1970s (i.e., “the chief problem of all patients who come to psychotherapy is demoralization . . . the effectiveness of all psychotherapeutic schools lies in their ability to restore patient morale”)1(p271) and represented a persistent failure of coping with (internally or externally induced) stress; Frank believed demoralization left one feeling impotent, isolated, and in despair. This conceptualization was congruent with the psychodynamic approach of the Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM-II),2 in which all disorders were considered reactions to environmental events. Frank defined the symptoms of anxiety and depression as direct expressions of demoralization.1
However, in 1975, Schildkraut and Klein3 defined demoralization as a state separate from depression. Whereas patients with depression experienced anhedonia, patients with demoralization lost their sense of efficacy. In the 1980s and 1990s, Frank and De Figueiredo further refined the meaning of demoralization.4 The term demoralization remained distinct from depression and was characterized by 2 states: distress and a sense of incompetence that results from an uncertainty about which direction to take. Individuals with depression and those with anhedonia cannot act (even if they know the proper direction to take).
Curr Psychiatry Rep. 2010 Jun;12(3):229-33.

Differentiation between demoralization, grief, and anhedonic depression.

Source

Department of Veterans Affairs, Central Arkansas Veterans Healthcare System, 4300 West 7th Street, 116T/LR, Little Rock, AR 72205-5484, USA. marcus.wellen@va.gov

Abstract

Demoralization is a phenomenon in which a patient reaches a state of subjective incompetence, hopelessness, and helplessness that can lead to that devastating moment in which he or she feels the only recourse left is to give up. This article reviews the medical literature regarding the current understanding, importance, and impact of demoralization. In addition, using the key characteristics of demoralization, this article attempts to compare and contrast demoralization with anhedonia and grief.

 

TO THE EDITOR: Dr. Slavney’s stimulating article, “DiagnosingDemoralization in Consultation Psychiatry,” is a valuable additionto the ongoing debate on demoralization.1 Dr. Slavney statesthat demoralization is a normal response to adversity and thathe disagrees with my proposal to substitute “demoralization”for “severity of psychosocial stressors” as Axis IV in the DSM.Although demoralization may, at times, be understandable, asin the cases described by Dr. Slavney, the view I proposed isthat demoralization is always abnormal. It is because demoralizationis abnormal that it requires treatment (psychotherapy). I proposedthat demoralization be conceptualized as involving two states:distress (which some other authors have called “demoralization,”incorrectly in my opinion) and subjective incompetence. Althougheach of these two states may be normal by itself, their overlapwould constitute demoralization, which is always abnormal. Demoralizationis thus viewed as a boundary phenomenon, that is, a state thatoccurs within the individual and at the boundary with the environment,something akin to inflammation.

World Psychiatry. 2005 June; 4(2): 96–105.
PMCID: PMC1414748
Copyright World Psychiatric Association
DAVID M. CLARKE,1 DAVID W. KISSANE,1 TOM TRAUER,1 and GRAEME C. SMITH1

We’re # 1? Nope – #38 and dropping

What does overall life expectancy have to do with upstream distressors?  This BBC article does a good job at listing many of the ills that result from US style westernized culture.

Risk factors

Source: University of Washington

Unsurprisingly, many of the risk factors tend to be behaviors which involve  self-medicating and self-soothing for perceived stress, anxiety and depression.  Some are related to living in poor quality neighborhoods lacking accessible and affordable fresh whole foods and green natural spaces to walk, sit, play and socialize.  Some are results of poor work and school environments, where long periods of enforced near immobility induce ill health.

All of the listed risk factors are malleable, modifiable and can be replaced with healthier choices.  But some of those alternatives needs must be supported by national, state and local policies and funding.  Fat chance of that happening in Tea Partier America.

Scientific American must have been channeling along the same lines in its Myths piece.

Myth #3 speaks to the notion that access to healthcare is a primary determinant of health.  Not so.

Access to health care is only one of several factors that play an important role in determining how healthy people are. Several studies suggest that easily being able to obtain medical care does not play as big a role as education, lifestyle, income and modern housing, along with sanitation (pdf) and vaccinationin determining why some folks are healthier than others.

Where the availability of health care makes the biggest difference to the health of any group is when people have regular access to general or primary care clinicians, who are able to take care of most of the medical problems people face most of the time. Good nursing care is particularly important for people with multiple chronic conditions.

Unemployment and Suicide

The BBC posted an article “linking” a significant increase in European suicides to a concomitant rise in unemployment.

The financial crisis “almost certainly” led to an increase in suicides across Europe, health experts say.

The analysis by US and UK researchers found a rise in suicides was recorded among working age people from 2007 to 2009 in nine of the 10 nations studied.

The increases varied between 5% and 17% for under 65s after a period of falling suicide rates, The Lancet reported.

Researchers said investment in welfare systems was the key to keeping rates down.

Beyond the distress unemployment creates via loss of work role, loss of dignity, loss in family roles, social class loss, etc., the underlying stress is that of fearing the loss of survival.  No income equals no food, no shelter, no clothing, no fresh water, no safety.  In agricultural societies, people could literally eke out an existence from the land and create shelters from the landscape.  Not so in industrial societies where homelessness has literally been criminalized and legislated into invisibleness.  There is literally nowhere to escape to.Researchers have demonstrated that when people feel trapped and intolerably distressed, their risk for suicide heightens. Where does one go when there is nowhere to go?

Addressing unemployment and living wage accessibility for all is a key upstream issue.  Employment and living wage conditions should correlate with lower suicide rates in working age individuals.

Self management strategies: Bicycling

Self-management and self-mastery strategies and lifestyle activities are protective against distress.  To that end, when I run across evidence supporting them, I’ll address them here.

The NYTimes produced an excellent column about the many diverse benefits of bicycling. Individual health, reduced particulate pollution, decreased motor vehicle infrastructure burden and economic advantages are all addressed.

Yet cars impose major social costs: their use contributes to global warming, traffic congestion, accident fatalities and sedentary lifestyles.

Bicycle use is good for both people and the planet. In a country afflicted by obesity and inactivity, people who get moving become healthier. Riding a bike to work or to do errands is far cheaper than joining a gym. Cutting back on gas consumption improves air quality, reduces dependence on imported oil and saves money.