About Ouyang Dan
View all posts by Ouyang Dan:
Moderatix note: This post will be United States Military centric, as that is the perspective I offer, and the broken system within which I currently exist and attempt to navigate. Other voices are welcome and experiences appreciated within the context of the conversation, since I can not pretend to know every thing about every military experience from every branch in every country.
Disability issues overlap many facets of life, and one of our goals here at FWD is to bring as many of those to light as possible. One voice I want to offer here is that of the disabled U.S. Veteran. Specifically in feminist circles I feel that the disabled veteran is a voice that is seldom heard, and while hir voice may be part of a very small percentage, sie is facing a unique set of challenges.
One of those challenges is getting a diagnosis and care in the first place. A person gives hir time and life to the military for one of a variety of reasons and find hirself trained for any number of jobs. Sie can travel the world, see exciting places, or be sent off to fight in wars. In the blink of an eye hir world is turned upside down. Suddenly life isn’t what it was before. Hir body/mind/soul are not what they once were, and coming to terms with that is no easy task. If sie is one of the ones who has survived combat injuries or someone who became sick or injured while doing hir job in a Stateside base, sie does what sie has been taught to do…sie makes a routine appointment at the local Military Treatment Facility (MTF) to see her Primary Care Manager (PCM).
Hir PCM might evaluate hir, refer hir out for tests with specialists, or set hir on a merry-go-round of treatments. When the ride stops sie may or may not have any answers, and there may or may not be a Medical Review Board pending to tell hir the terms of the future of hir career.
This is where things get interesting. By interesting, I mean kind of fucked up. One, any or all of those specialists might have diagnosed hir. Those doctors start treating hir accordingly, because while TRICARE (military medical insurance) has its flaws, it kicks a lot of arse, and sie gets the care sie needs, mentally and physically (until her PCM deploys, but that is another post altogether, just you wait!), all under the umbrella of hir diagnosis. But then the Medical Review comes up, and all of hir doctors have to write these recommendations, and suddenly things change in terms of hir care. In hir appointments hir doctors start getting vague about care plans, and start talking around the actual words for hir condition…sie might suddenly feel dismissed or as if hir questions are not being answered.
As we read earlier this year, it isn’t a coincidence that military doctors are getting dodgier than Sarah Palin in an interview. There seems to be pressure to not diagnose active duty personnel while active duty, and it isn’t just PTSD. This service member might have received treatment for months leading up to hir review board only to have hir diagnosis revoked for the board so that the military could discharge hir with a lower rating.
It’s not too hard to understand why this happens. The rating system breaks down a little like this:
A medical team of medical officers somewhere in Officer Land and look at your whole military medical record, and all these nifty letters written by the doctors who have seen you, along with some reports from your Chain of Command (CoC). Based on all of this information they determine whether or not to separate you from the military. They also give you a percentage rating of how disabled they think you are before discharging your from the military (there is also something called Permanent Limited Duty, which I can talk about sometime in another post). It goes 0%-100% (the percentage is ultimately the amount of money they give you and “how disabled” they think you are). Unless they give you at least a 10% rating you get nothing. There is a list somewhere of what constitutes what percentages, and the military’s is different from the VA’s and each branch seems to interpret it differently. Anything between 10 and 20% will grant you a one time award (I love that they use the word “award”, like somehow you have won a prize) based on your pay over the number of years you spent active duty (minus taxes, but including any bonuses you earned). Most medical review boards fall in this range. The magic number seems to be 30%, which gives you a monthly stipend based on the same numbers. This math works all the way up to 100%. After 80%, however, you receive what is called a Medical Retirement, which, regardless of how many years you have served, you retain your full benefits (insurance, commissary, exchange and medical) as if you had retired after 20 years of service. That, I think is the rub. It’s money.
When I had my review, it went a lot like that as well. I could have been Sgt. X (well, Petty Officer X) in the rheumatologist’s office w/ a tape recorder. The same guy who had written in my record that he was treating me for fibromyalgia had written in my medical review that there was no way to know for sure, that I could in fact have fibro, but that I could also have CFS, or PTSD, or just be really depressed, so there was no real answer. His best advice was for a medical discharge and a referral to the VA for follow up care. He also suddenly became angry because I didn’t want to be on Cymbalta, because I didn’t feel the need to be on another anti-depressant when ADs weren’t helping my pain (Lyrica wasn’t out yet, and Cymbalta was a new-ish treatment). When a doctor tells me “I guess you don’t want to get better”, without listening to my concerns I know I have lost a battle.
After my review board findings came back (10% if you are nosy), my doctors seemed to have a shift in my care. I was receiving less pain management care (well, less pharmaceutical) and the focus was more on mental health. My review board found that I was too depressed to continue with active duty service, oh, and Trichotillomania sounded weird, I guess, so they tossed that on there, even though no one gave a fuck about it before. Pretty much all of my care was to be managed through Mental Health (which, should be noted, is in no way a slam on mental health. In my case, it was not the treatment I needed, even though for some people it is what they need), which made my physical needs very difficult to acquire while I was still active duty. Yes, I was depressed, but I was depressed because I was in so much pain that I was having a hard time dealing with life and a child, and because no one was listening to me. I was not in pain because I was depressed. No one seemed to be interested in the sequence of events. Before my review board findings I had a PCM, a neurologist, a rheumatologist, a chiropractor, an internal specialist, and a pain management specialist all convinced that all signs point to fibromyalgia. Afterward you could have dropped a pin in room of crickets for the voices that came to my defense.
After my discharge I began the process of filing the VA claim. It is pretty much the exact same process, minus the stuff from the CoC. Oh, and it takes longer. Hmmm. I wonder why that is.
I firmly believe in my heart that military doctors (and doctors employed by the military) are being pressured to push us out the door and to let the VA sort us out because it is easier on the budget. The Armed Forces Committee seems content to thank soldiers by one-lining them out of the fiscal year’s planning, and it pisses me off. When I was given my board findings and told to sign off on it I was able to glance at the list of others who had been reviewed with my own. I remember seeing at least a dozen names with finding for PTSD or other things that are “invisible”, all with a 10% or lower finding. Brothers and sisters who have served their country, and this is the thanks we get when shit didn’t go as planned. I know that this is happening to many service members, military wide. I know that this is happening because our disabilities are invisible and easy to dismiss. Veterans are slipping through the cracks, and Congress and the DoD is not only letting it happen, but damn well encouraging it.
This is the first in what will hopefully be a series of posts on navigating disability in the military health care system.
I am a pop-culture junkie. If you have been playing along at home long enough this is common knowledge. I have been a big fan of House, M.D. since it’s poorly lit pilot. I am simultaneously appalled and amused by his crass behavior. Even the best feminist in me laughs and fairly inappropriate moments.
I have seen and read plenty of critques concerning Dr. House and his manner. I have chewed out my share of doctors for acting like him as if it makes them seem clever. He is a character that is worth critiquing on many levels and for many reasons from many points of view.
What I haven’t seen is a lot of criticism of the characters assembled around House. From Dr. Wilson, or Dr. Cuddy, or the myriad staff members he has had around him (yes, even Dr. Cameron-Chase) I have watched for nigh on five seasons now as all of the people who claim to care about him have done little more than chastise and concern troll his life. Most notably, his addiction to Vicodin as his chosen method of pain management.
A repeated theme throughout the series has been watching person after person in House’s life try to trick or otherwise convince him that he should quit taking Vicodin and learn how to deal with his pain. They constantly badger him about his addiction, and will go to great lengths to get him to quit taking his pain medication.
Only a person who has never experienced chronic pain would dare criticize a person for their pain management.
Because, like it or not, Dr. Gregory House is managing his pain. Sure, he is an addict. There is little argument there. The character admits it freely. In his own words he says that he takes a lot of pills because he is in a lot of pain. Whatever your feelings on narcotic medication it is a proven method for making intense and chronic pain manageable, and a down side to that is that narcotic drugs can in fact be dependency and/or addiction forming. The presence of an addiction does not take away the fact that the pain beneath it is real. When a doctor and a patient together decide to pursue pain management via narcotics such as Vicodin they will weigh the pros and cons of such treatment. One of the cons that is weighed is the fact that a person can develop an addiction to a drug and a tolerance that will probably mean their intake will increase over time. As with any course of treatment the costs must be weighed with the benefits.
House is able to function as a result of the Vicodin to which he has become addicted. He is able to be independent in moving and living, not housebound (no pun intended) by his pain. He is able to hold down his job and do it with the skill through which he receives his notoriety. His course of pain management gives him a life and independance that many of us living with pain or other disabilities are hoping to achieve. It might not make him a happy ray of sunshine all the time, but neither does living in agonizing pain all of the time.
It is very condescending for a person who is not living in pain to assume that they know better than that person how to manager hir pain. The way that I see House’s collegues and the people who could pass for his friends treat him over his addiction and the way he manages his pain strikes too close to the way I feel most doctors and friends of those of us living in chronic pain will treat us.
Criticize the way he behaves to his subordinates. Criticize the way he treats those closest to him. But if you don’t know what it is like to live with chronic pain, don’t criticize his decisions as to how he manages his pain. If it’s not your body, frankly, it’s not your business.
Originally posted at random babble…
Welcome to Ableist Word Profile, a (probably intermittent) series in which staffers will profile various ableist words, talk about how they are used, and talk about how to stop using them. Ableism is not feminism, so it’s important to talk about how to eradicate ableist language from our vocabularies. This post is marked 101, which means that the comments section is open to 101 questions and discussion. Please note that this post contains ableist language used for the purpose of discussion and criticism; you can get an idea from the title of the kind of ableist language which is going to be included in the discussion, and if that type of language is upsetting or triggering for you, you may want to skip this post.
Someone walks into my kitchen for the first time looking for something they will more than likely find the cupboards nicely arranged. I like things with the labels facing out, neatly lined up, dressed to the front. I like to have like items together (my cooking items are in a separate area from my baking items, and snacks, to begin to scratch the surface) to make it easier to find things. Our Korean apartment is smaller than we are used to in some areas, so being organized is a must when it comes to storage. We have Tupperware canisters lining the counter tops with frequent used and bulk items in easy reach, and also in the fridge w/ the produce already prepped. When we bring meat home from the market we divide it into portions and vacuum seal it before storing it. Some of this is for space sake, some of it is because I like to cook and will use spoons I sometimes steal from elsewhere to do so, and having the kitchen arranged as such makes that easier. I have had more than one guest wander through the kitchen chuckling and mention to me how OCD it is (which really doesn’t make sense if you think about the acronym).
No. My kitchen is clean. It is neat. It is sometimes meticulous (when the dishes are done), it is user friendly, well organized, color coded, over-the-top arranged, even. My aunt would say you could eat off of my floors (some days, but we do have a seven year old).
OCD, or Obsessive Compulsive Disorder, isn’t just the tendency to keep things all tidy like Mary Poppins on a sugar rush. It doesn’t mean that you like your clothes hung in chromatic order or your socks folded a certain way, or even that you sort your M&M’s into color groups before eating them. It isn’t your friend with her dust free home or Bree VanDeKamp hair or Emily Gilmore six-inch tapers.
It does mean that you tend to have thoughts (obsessions) that intrude into your mind and make you extremely uncomfortable, because you know that they are unreasonable. Some people have thoughts where they hurt themselves or their loved ones. When I was much younger I once had repeated visions of shoving a corkscrew into my eye while at the bar where I was working. Understandably it was bothersome, and actually there were times that it worried me to tears, because I knew I wasn’t going to shove a corkscrew into my eye, and I couldn’t figure out why my brain was giving me that picture. People often engage in repetitive actions (compulsions) to alleviate the stress of these thoughts. I wiped bar glasses and liquor bottles until they were spotless, and later at home plucked my eyebrows into oblivion because they were never quite symmetrical. I brushed my teeth until my gums bled…anything to keep my mind off of that fucking corkscrew. In your mind you know that having washed your hands or brushed your teeth fifteen times before school has probably already taken care of any germs (and skin or enamel), but you can’t get the thoughts of those germs gone. So you brush, or you wash. And you still think your hands are covered in bacteria or you can feel your teeth rotting in your head (even though you know it isn’t true). So you wash again…and you miss that first class…even though you know better.
It overcomes your life. OCD isn’t just some cute little habit you have of always placing everything on your desk perpendicularly or always lining shoes by the door. It actually interferes with your life and how you are able to live it.
When I was in college I knew that I wasn’t going to blow up my apartment. My rational mind was well aware of that fact, even though I could see the building on fire and me standing outside of it. But after cooking, when I had to leave for class, I had to go over to the gas stove and turn all of the dials on to make sure I had turned them off…even if I hadn’t used them. The oven too. I just couldn’t stand the thought of leaving the gas on and having something happen to my roommate while she slept. Then I would grab my bag…and even though I knew I had just. checked. the. damned. knobs. I had to go back and check them again. After this I might get out the door and lock it, but then I’d have to go back in and check again. The next time I might make it all the way down to the main door of the building. “What if you missed one? You could blow up the whole building!”. Back up three flights of stairs, unlock the door, and check the knobs again. Of course they were fine, just like the last three fucking times I checked. That didn’t stop me from having to go back two more times, once after thawing my car, and once after I had actually left the parking lot, made an illegal U-turn, and gone back. I kept seeing the whole building go up like a giant bonfire on a July evening in Michigan.
I was two hours late for class.
I was obsessed with numbers. If I had pieces of something I couldn’t eat it unless it could be divided into odd-numbered groups of odd numbers. My weight became an obsession, which isn’t at all uncommon in people with OCD, and no matter how much I lost I was certain that I was disgusting and fat and gross to everyone who saw me. I actually measured “ins” and “out”, and I will leave you to those pleasant details all on your own.
Years of therapy later I am able to find myself in a place where I can control my OCD, and I have come a long way in managing it. This isn’t true for everyone, because each of us are unique and what worked for me isn’t going to work for the next person. I am by no means “cured”, but there is something to be said for being in a stable home environment for the first time in my whole life that has turned the corner for me. There are things that will cause me to slip…
Some other fun facts about OCD.
There are some lesser known offshoots, such as Trichotillomania and Dermatillomania. These conditions begin with the same intrusive thoughts, but instead manifest with compulsive hair pulling and skin picking. I have both of these conditions. The hair pulling left me with little to no eyebrows, and an embarrassing bald spot on the back of my head that covered nicely with a military style bun. Without babbling on as I am wont to do, it was another thing I had to work through with a mental health professional (and one awesome esthetician). The skin picking is still a challenge, and as stress in my life heightens so does that. This is the most embarrassing of my anxiety issues because this leaves the most obvious marks on my face. My arms I can hide with long sleeves. Even though I am incredibly aware of the marking and scarring left, most people don’t notice it, unless they are very close to me, and even then most don’t unless I am comfortable enough around them that they have actually seen me doing said picking.
So, I believe we can see why the usage of OCD is ableist here: it isn’t some funny quirk. You are trying to be witty. I get that. But your witty words mean things about my life, parts of my life that I have worked to overcome, and which people I know are still living with daily and that just isn’t funny. It isn’t something we close up in a cupboard and laugh about with friends*. It is a daily struggle for people who absolutely know that they are doing things that are unreasonable to help them cope with the anxiety of things that they also know are unreasonable. We slog through it, grind it down over years, beat it back, and work our asses off to gain chunks and pieces of our lives back from it. That is no joke to us. It is extremely ableist for a person who is in control of their thoughts and actions to appropriate this term to mean that someone is really particular about the way they like things.
So, no, your very tidy friend is not OC. Unless sie is. And then, ha ha, sie probably doesn’t appreciate having hir life poked at.
*OK, you got me. Sometimes we do. But that is our right, not yours.
Moderatrix note: This post is the love child of my coming to terms with a need and actual want of pills.
When discussions arise of disability, especially, it seems, of invisible disabilities, someone will almost always jump in and start harping about Big Pharma and how they have certainly invented our illness or disorder just to sell us or get us hooked on some new fancy drug. Or, they will insist that we are just addicts who refuse to find ways to manage our pain.
And for some of us it is a type of shaming that is hard to get out of our heads. For me, personally, I have let not just that, but some people actually convince me that pills were so bad that sometimes I convince myself that I can manage my life without them. It usually takes a significant event (which I will leave out of this little anecdote b/c someone that I know reads this blog thinks these things are his business, but I assure you, they are not) to remind me and make me realize that I not only need them, but that it is in my, and my family’s best interest for me to use them.
I saw a doctor recently who took the time to have a real conversation with me about my health, my Fibro and my care. It was incredible and refreshing. She gently insisted and reminded me that I need to take some medications, and together we decided that, yes, some of them don’t hinder me, but actually give me parts of my life back. That while addiction and dependency are different things, real concerns, and things to consider, they are things that we need to weigh against the benefits of taking medications. She took the time to discuss side effects, interactions, whether I would need to take multi-vitamins, that I would need to watch my calcium intake (to avoid getting stones), and discussed lifestyle changes that I have either already made or would need to make to improve my quality of life, and that of my family’s. This is the kind of thing that needs to happen between pain patients, chronic illness patients, and pretty much any patient who needs to take medications and their doctors.Read more: Where I jump in and defend pills…