Category Archives: blaming

Finally, a Dear Prudence column that isn’t rage-inducing!

In the most recent Dear Prudence live chat on Slate, a reader asked the following:

Negativity: I have had a bad couple of years—intermittent employment,
moved twice, lost a sibling. I’m a pretty positive person, but I’m
having trouble keeping my chin up, since that mainly results in me
taking it on the chin.

I have a friend who asked if I was feeling a little down, and when I
admitted it (something that is hard for me), she basically said it was
my fault, and my negative energy was attracting negative events. I
would not find happiness or get my old lucky life back until I could
learn to accept what fate was trying to teach me.

I don’t know what’s worse, her idea of comfort or the idea that she’s
right. She didn’t used to be crazy, but this New Age stuff has been
her reaction to being unemployed and living on credit cards. What
should I have said?

I could do without the mental-illness shaming (“She didn’t used to be crazy…”), but does this sound familiar to anyone who’s had to endure similar “well-meaning” advice from people who think you can — and should — just “buck up?” And oh my god, SCARY NEGATIVE ENERGY! I’ve covered the fallacies of The Secret and related pablum before here on FWD, so let’s take a look at advice columnist Emily Yoffe’s response:

Emily Yoffe: The Secret and other garbage of that ilk suggests people
abandon friends with problems so that they don’t get “infected” by
their negativity. So you could have said you understand her new set of
beliefs mean you two have to keep your distance and that you wish her
all the best.

I actually think the disease metaphor works well in showing just how ridiculous the notion of an “infection” of negative energy really is. To sum up: The flu is something you can get “infected” with, and it’s not fun. As for negative “energy,”  — if “positive thinking” works so well in combatting anything that’s not sunshine and rainbows and unicorns pooping glitter, why do positive thinkers and Secret devotees insist on dumping people who don’t fit their exact super happy worldview? Either the super POSITIVITY!!11 worldview is incredibly fragile and therefore must never be questioned, or there’s some major cognitive dissonance going on — perhaps both?

Am J Cardiol concern-trolling: “But mobility aids will stop them EXERCISING!”

So I stumble across this at Diabetes.co.uk: Mobility Scooters Can Increase Your Risk of Developing Daibetes and Heart Disease

“O really?”, thought I, “I wonder how well-controlled that scoldy little piece of disability panic was?” So I read on.

However, recent research suggests that mobility scooters can do more harm than good by heightening the risk of diabetes and heart disease .

“More harm than good?”, thought I, “I wonder who measured that? How did they decide which effects outweighed which in the goodness vs. badness stakes?” So I read on.

Astonishingly, a study of scooter users in the U.S.A discovered that almost one in five developed diabetes after buying one to get around.

“Huh”, though I. “One in five, eh? Hm, that doesn’t sound all that different from the baseline prevalence in the population, let alone the older/ill/disabled population.” So I read on.

The research, published in the American Journal of Cardiology, highlights how multiple benefits to patients’ health from being able to get around more easily are being erased by the effects on the cardiovascular system.

“Erased?”, thought I. “Completely wiped out? Huh. Was it the people concerned who decided this, or someone else?” So I read on.

Researchers are urging doctors to consider the risks of scooter use before making recommendations to patients invest in a scooter.

“*Doubletake*”, thought I. “Doctors should consider the risks? Doctors? Not, say, people with disabilities? Just doctors? Doctors should weigh up the risks before offering any options at all? Doctors should decide?” So I read on.

[…] There have even been incidents when scooters have killed individuals.

OMG RANDOM IRRELEVANT SCOOTERPANIC!

Moving on.

They recruited 102 patients, with an average age of 68, who had obtained medical approval for a scooter and monitored their health over six years. Even though patients stated that they felt better physically and mentally, tests demonstrated that 18.7 per cent developed diabetes during the follow-up period.

“Erm”, thought I, “Right then. Sure enough, it was an older population- nearly seventy years old on average. The prevalence of diabetes in the population older than 60 in the USA is 23.1%, and that’s not people who are already ill and have other risk factors. That’s not really a surprising number.”

“I wonder,” thought I, “I wonder how that control group did, the age- and disability-matched control group, the one who didn’t get scooters at the same time?”

OH WAIT.

Yeah, there wasn’t one. No control group.

Just a group of elderly people with cardiac failure, neurologic disease, disabling arthritis, and chronic lung disease. Just a group of people with disabilities trying to eke out a life and getting used as a Lesson To All Of Us about the dangers of sloth.

The abstract is here, in the American Journal of Cardiology. Effect of Motorized Scooters on Quality of Life and Cardiovascular Risk, Brian W Zagol and Richard A. Krasuski, Volume 105, Issue 5, Pages 672-676 (1 March 2010).

This sterling little doctor-centric chastisement does contain one really useful piece of information:

[…] significant physical and psychological improvements in all quality-of-life categories (p <0.001) [...]

I’ll say that again, ‘cos they buried the lead. After getting a scooter, people experienced:

[…] significant physical and psychological improvements in all quality-of-life categories (p <0.001) [...]

But the authors decided to slap a big ol’ “DESPITE” before this statement about how the lives of people with disabilities were improved by appropriate mobility aids, and instead go on to list the way several laboratory parameters became “worse” over time in this group of ill elderly people. In a study with NO. CONTROL. GROUP.

We have absolutely no idea how these laboratory parameters would have fared had the people concerned not obtained mobility scooters. All we know is that their quality of life improved significantly in all domains.

What the study fails to recognise – among other things – is that the alternative to getting about on mobility aids isn’t a day of jaunty strolling; it’s immobility. The alternative to going out sitting on a scooter isn’t a doubles tennis match and a brisk swim followed by a bootscooting class; it’s sitting at home.

But the quality of life of PWD, the lack of alternatives, is dismissed by these concerned medicos as a relatively trivial aside; as just one factor for doctors to consider before deciding whether to withhold their blessing – and their financial rubber-stamp – to mobility aids:

In conclusion, interventions, such as scooters, that improve self-perceived quality of life, can have detrimental long-term effects by increasing cardiovascular risk, particularly insulin resistance. Physicians should carefully weigh such risks before approving their use, as well as ensure healthy levels of activity afterward.

Dudes. Newsflash. You’re not the ones who should be carefully weighing this hypothetical “risk”. We are. And you sitting there planning to deliberately withhold mobility aid funding to the poorest people in the population because you think they might – not will, only might – see their blood glucose tweak a few points? Not ok.

You don’t get to dismiss the importance our self-perceived quality of life (“self-perceived”? Who do you think is the best person to assess our quality of life? You?) with a parenthetical “Despite”. What is important to us is important to us; you don’t get to override that with your misinformed concern-trolling. You don’t get to decide on your own, then inform us what’s important in our lives. You don’t get to exclude us from the conversation. You don’t get to tell us which risks are worth taking.

You don’t have the moral right to immobilise us based on your imposition of your own value system on our lives. You wouldn’t even have that right if this was good research. When it’s fucked-up hand-waving? Put the journal down, and start seeing real people. The people right in front of you, who are looking for independence, the ability to shop, the ability to socialise, the ability to go to the fucking doctor, the choice to have a better life. The life you’re planning to say “no” to.

Shame and Blame with African-Americans and Mental Health: Let the Circle Be Unbroken

Recently, U.S. Surgeon General Dr. Regina Benjamin kicked off a national campaign to tackle mental health in the African-American community. Benjamin explained why a focus on African-Americans is needed: “Mental health problems are particularly widespread in the African-American community. In 2004, nearly 12 percent of African Americans ages 18-25 reported serious psychological distress in the past year. Overall, only one-third of Americans with a mental illness or a mental health problem receive care and the percentage of African Americans receiving services (nearly 7 percent) is half that of non-Hispanic whites.”

Programs focusing on addressing underrepresentation of minority groups in mental health care tend to focus on outreach to and education of the underrepresented group (while this post focuses on historical and structural barriers to African-American participation in the mental health system, these larger concepts are likely applicable to other racial and cultural minorities throughout the world.). The theory seems to be that if individuals knew that they might be experiencing mental health systems and understood how the mental health system could treat and benefit them, they’d start accessing it in droves. This kind of outreach and education is clearly an important part of increasing minority representation in mental health care, but the exclusive focus implies that the primary barriers are the attitudes of individuals who would change their minds if they just had more information. This ignores a lot of problems and lets a lot of bad actors off the hook for institutional barriers and exclusions. In the particular instance of African-American engagement in the mental health system, it is these long-standing oppressions and exclusions which are perhaps most to blame.

A primary issue is that African-Americans are more likely to be subject to a number of forces of oppression and discrimination which can increase trauma and vulnerability to mental health disorders. “Owing to a long history of oppression and the cumulative impact of economic hardship, African Americans are significantly overrepresented in the most vulnerable segments of the population. More African Americans than whites or members of other racial and ethnic minority groups are homeless, incarcerated, or are children in foster care or otherwise supervised by the child welfare system. Proportionally, 3.5 times as many African Americans as white Americans are homeless. African Americans are especially likely to be exposed to violence-related trauma, as were the large number of African American soldiers assigned to war zones in Vietnam. Exposure to trauma leads to increased vulnerability to mental disorders.”

To me, that does not suggest that the primary solution is increasing African-American representation in mental health treatment – it suggests that a primary solution would be to address the structural inequalities that are making African-Americans “significantly overrepresented in the most vulnerable segments of the population.” Maybe a program that focuses on homelessness in the African-American population. Maybe addressing the sentencing disparities for crimes involving cocaine and crack cocaine, and how that contributes to disproportionate and longer incarceration of African-Americans. Or how felony disenfranchisement prevents a staggering number of African-Americans (13% of black adult males!) from participating in our democratic political system. Without addressing these ongoing problems, a disproportionate number of African-Americans will continue to experience trauma and increased vulnerability to mental disorders.

A second and key issue is the long history of how the psychiatric profession has treated African-Americans in the United States. Diagnoses and treatments for African-Americans have long been rooted in the structural racism of slavery, with early diagnoses of “Negritude” and “Drapetomia” for slaves who fled their masters and recommended treatment of whipping as therapeutic intervention. In 1895, a Georgia psychiatrist popularized the idea that “structured lives led by slaves served as protective factors against insanity” and that slavery protected African-Americans from freedom that would literally make them insane. In the late 1800s and early 1900s, there were separate “colored” institutions for African-Americans, who received little if any treatment services and were subject to horrific tortures and sexual assaults.

A glance at the current mental health system makes it clear those historical problems have not been eradicated. African-Americans are much more likely to be diagnosed with schizophrenia than with affective (mood) disorders, even when displaying the exact symptoms of a white patient diagnosed with affective disorder. This is true even when the diagnosing clinicians included African-Americans well trained about the bias towards schizophrenia diagnoses. Studies suggest this is because clinicians apply entirely separate decision models when diagnosing African-American patients, likely drawing on stereotypes of paranoia and violence that aren’t actually associated either with African-Americans or people with schizophrenia.

There are also significant knowledge gaps in how psychoactive medications affect African-Americans. There is almost no research on ensuring adequate racial representation in psychopharmalogical research, nor on how to ensure that participating patients from various cultural and racial groups give informed consent. This lack of knowledge is affecting the effectiveness of treatment, as existing research shows that “a greater percentage of African Americans than whites metabolize some antidepressants and antipsychotic medications slowly and might be more sensitive than whites,” and can lead to faster responses and more severe side effects when African-Americans are treated with doses commonly used for whites. Despite this, clinicians in psychiatric emergency services commonly administer “both more and higher doses of oral and injectable antipsychotic medications to African Americans than to whites.”

To me, all of this suggests that the psychiatric profession hasn’t really figured out how to provide psychiatric treatment and care of the African-American population with the African-American individual’s best interests in mind. History speaks to using psychiatry to control, torture, sedate, and oppress African-Americans, even creating fictionalized diagnoses to help support the structures of slavery. Add to all of this the multiple barriers preventing access to mental health care even for those who enthusiastically wish to access it – lack of parity for mental health care, lack of health care coverage at all, societal sigma around mental health – and instead of wondering why there’s underrepresentation of African-Americans in the mental health system, I start wondering why there’s as many as there are.

Clearly, a solution focused only on outreach and education to individual African-Americans is doomed to be unsuccessful, because it overlooks the underlying structural issues making African-Americans particularly vulnerable to mental health problems and the historical reality of their exploitation by the mental health system. Even more troubling, though, is that when the access problem is framed as an issue of education to an individual, it allows the blame to be placed squarely on that individual – even if these other, more serious, structural barriers are ignored. That kind of blame is just another addition to the complex system of forces making African-Americans more vulnerable to mental disorders to begin with.

For Cereal, Jessica at Jezebel? PTSD after obstetric assault is “hysterical”?

[WARNING: descriptions of obstetric rape and PTSD]

At Jezebel, Jessica writes: Is Having A Baby A Traumatic Event?

A new survey says that 9% of postpartum women suffer from post traumatic stress disorder. You know, the same disorder that Iraq vets and plane crash survivors get. Something does not compute here,[…]

Have we become so precious and hyper-conscious that something women have been doing for time immemorial is now ranked alongside war as a painful event?[…]

Certainly, having a bowling ball of a baby shooting out your vag isn’t a picnic for anyone, but the hysteria surrounding something so matter-of-fact is troubling.

“Hysteria”. Yes, “hysteria”. She went there. She used the prime misogynist slam against women, blaming wandering uteruses. Unbefuckingllievable.

I’m only surprised there wasn’t a “princess” or a “delicate flower” thrown in there too. Or maybe a few accusations of insurance fraud, hm? That would just put the icing on the hateful cake.

Get back to me when you’ve been stripped, dehumanised, isolated, forcibly starved, and strapped to a table for 12 or more hours during the hardest work of your life. Get back to me when you’ve been subjected to a series of non-emergency procedures on your body with neither consent nor medical justification. Get back to me when you’ve been imprisoned in hospital.

Get back to me when you’ve been held down by two or three people while someone – or more than one someone – pushes their fingers into your vagina while you say “No”. Get back to me when you’ve been screaming “NOOOO! STOP!!!” and been ignored while someone cuts your body open and shoves metal forceps into you. Get back to me when you’ve been strapped to a table and operated on and had your protestations about the anaesthetic not working being ignored. Get back to me when you’re left bleeding and vomiting on a table, without access to help, wondering if you’re bleeding to death, and you’ve had your newborn baby taken away from you without explanation or good reason except an over-the-shoulder “we don’t have enough staff right now”.

Get back to me when you’ve spent months of your life – the months you thought would be a joyful, perhaps sleep-deprived, milky daze – having violent flashbacks and nightmares. Shambling through the day barely able to function, unable to bond with your newborn. Bursting into tears and panic attacks many times a day. Avoiding public places lest you suddenly start sobbing and need to run. Not able to have anyone touch you.

Get back to me when you’re hunched in a corner, unable to work, unable to care for yourself, unable to speak, and all anyone can say to you is “All that matters is a live baby”.

I hope you never experience these things. Because they can be horrifying, life-changing, deeply traumatic events. The only promise I can make you is that I won’t call you “precious” or “hysterical” if you’re ever in this terrible position.

Medical assault is assault. Obstetric rape is rape. Trauma is trauma. Some people who have experienced these things get PTSD.

And it’s not up to you, or anyone else, to instruct them that they haven’t – especially in explicitly woman-hating terms.

You don’t get to judge.

No, no, no, no, no.

What is the Real Goal of Fraud Investigations?

California is in the midst of a major budget crisis. The past year has seen immense and drastic cuts to social service budgets throughout the state, including elimination of all state funding ($16 million) to domestic violence shelters (which was later partially restored by legislative action) and near-total decimation of funds for AIDS testing and prevention programs to save $52 million. Even with those catastrophic cuts, the state is still in massive financial difficulty: “The state has a $6.6 billion shortfall in the current fiscal year ending June 30 and is looking at a $12.3 billion hole for the new budget year. There is $1 million in reserve.”

This means that any dollar currently being spent has been extensively reviewed and evaluated and a very conscious decision has been made to prioritize spending in that area. For example, the state is still willing to spend money for California counties to investigate potential fraud in the In-Home Supportive Services (IHSS) program. IHSS is an essential program for many of California’s low-income elderly people and people with disabilities. Through the program, individuals are allotted a certain number of hours of assistance with personal services including bathing and grooming, home services such as cleaning, cooking, and errands including buying groceries and picking up prescriptions. The theory of the program is that assisting people this way allows them to continue living independently in their communities rather than in a long-term care facility, which not only preserves independence and dignity for program recipients, but also is a huge cost-savings measure for the state. If program recipients were to move to long-term care facilities, their costs would almost certainly be paid for by the state’s Medicaid program. And look at the cost differential: “The average cost of a skilled nursing facility is $55,000 a year. The average cost of in-home services in California is $10,000.”

Despite the cost savings realized by this program (I’m beyond the point where I think a state will prioritize and fund a program simply because it’s something that PWDs need to maintain independence and dignity), there have been massive cuts to the benefits portions of IHSS. The hourly wage paid to the home health providers has steadily declined and is now at $8.60 an hour. Needless to say, these extremely low wages make it nearly impossible for a PWD with IHSS benefits to find a home care provider with any kind of training or experience. There have also been steady erosions to the group of individuals who will be eligible for IHSS, with criteria requiring a higher and higher level of disability or functional impairment in order to qualify for the program.

The only area of program funding that has increased is fraud detection, with a grant of $26.5 million to counties to engage in fraud detection. That’s the equivalent of approximately 3 million service hours at the current rate of pay. There are also new requirements in the program that must be met by both recipients and providers in order to receive services: all providers must go through a criminal background check process, including fingerprinting; all program applicants and recipients must be fingerprinted and must place a fingerprint signature on each timesheet submitted for payment. It also requires counties to conduct unannounced home visits.

In the abstract, some of this seems to make sense. We don’t want health providers with criminal backgrounds coming into the homes of vulnerable people and exploiting or harming them. Except that the majority of providers are actually family members or immediate relatives of the PWD and the fingerprints can take up to 9-12 months to be cleared by the state, causing huge delays for PWDs who need vital services and delays in bringing often essential income to low-income families. (Not to mention how low-income people of color are likely disproportionately targeted by law enforcement and subject to criminal penalties.) It also seems reasonable to ensure that scarce service dollars are actually going to people who need and deserve them, rather than people receiving them fraudulently. But there has been a lot of research on IHSS fraud in the past, and it simply does not seem to be very prevalent: an audit released last year (pdf link) found a fraud rate of only 1% in the program. A recent program in Sacramento turned up similarly low levels of program fraud: “The Sacramento County District Attorney, who received more than $3 million from the state for anti-fraud efforts, reported last week that after four months her office had uncovered a total of 19 cases of fraud out of more than 42,000 homecare clients in the County.” That’s a rate of 0.04%. And if we estimate that each of those 19 cases fradulently took $10,000 a year from the state, that $190,000 in fraudulent benefits is dwarfed by the $3 million spent to identify that fraud.

So – these changes and programs are not about protecting recipients. They’re not about preventing widespread rampant fraud. What are they about? Some testimony at a recent legislative hearing sheds some light:

Nancy Jo Riley of San Diego testified that she and her client were “randomly selected” for a fraud investigation last October as part of a new “anti-fraud” initiative by the state. According to Ms. Riley, the agent from the Department of Health Care Services (DCHS) first threatened in a phone call to cut off all IHSS unless she and her client met with him immediately. At the subsequent meeting, the investigator asked her and her client a long series of “humiliating” questions. He then said he could not understand why a person with a severe disability like his should be subject to a fraud investigation in the first place.  He also said that her client, whose hands are frozen in a fist-like position because of his disability, would “probably” be exempted from new fingerprint requirements for homecare consumers.

These rules are an effort to make it harder for people to get services or to continue receiving services. They are an effort to erect barriers to service so substantial that PWDs cannot surmount them. They designed to humiliate and shame recipients for their disability status, to force them to prove themselves, their disabilities, and their functional impairments over and over again. They don’t even make sense from a cost perspective, as they spend far more in detection than is saved by the fraud they ostensibly prevent. They’re not targeting people who are fraudulently receiving services. They are targeting the very people the program is supposed to help.

The Opposite of “Disabled” is Not “Employable”

According to the United State government, disability is “the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” Or, in non-regulatory terms, disability is when a physical or mental impairment will last at least a year and will make someone unable to work. The ability to work is right there in the definition. A person who cannot work is disabled. If that person can work, they are not disabled. Disability and employability are mutually exclusive states of being.

That definition comes from the Social Security Administration and is applied to people applying for disability benefits, basically a wage replacement program to compensate for the salary the person cannot earn – so the focus on employability makes some sense. But more and more, I see this framework for defining and evaluating disability applied outside the benefits context, in deciding if someone is “‘really’ disabled.” It’s also notable that these wage replacement programs are the most commonly known and discussed form of disability-based benefits – while I’m used to seeing articles about how to handle the Supplemental Security Insurance (SSI) program, I rarely see coverage of programs from the Department of Rehabilitations, which provides vocational training and support to PWDs. And the false equivalence of disability and unemployability is problematic for a lot of reasons.

  • There are a whole lot of people with disabilities who are not employed due to problems with the economy and with employers who discriminate against PWDs when hiring or fail to sufficient accommodate PWDs while employed. Assuming that unemployment is due solely to a person’s disability status, rather than systemic stigma and discrimination, places the responsibility for finding and keeping a job solely on the shoulders of the PWD. This shifts focus entirely away from the employers who have ultimate power over whether an individual is going to have a job. Take a look at employment statistics for the federal government itself, where “the severely disabled represent 0.94 percent of the government’s workforce.” And despite those low numbers, the government has no problem telling people that unemployment is a disability issue.
  • When disability is defined as an inability to work, that overlooks an enormous segment of people with disabilities. About 37% of PWDs in the United States are employed – 8,581,869 people. But their ability to work does not negate or erase their disabilities. Those disabilities continue to exist and implying they do not lets employers off the hook for acknowledging and accommodating those disabilities in the workplace. It is already easy for an employer to overlook an informal request for accommodation or demand overbroad access to private medical files to “prove” whether or not the requesting employee “actually” has a disability in response to an accommodation request. It’s impossible to say how many employed PWDs have successfully requested and received needed accommodations relative to those who have been too intimidated to ask or had employers unwilling to fulfill their legal obligation to provide accommodations. But I would venture to guess that it’s quite difficult and involves risk for the individual employee. The stereotype that people who can work are not disabled and do not “really” need or deserve accommodation only encourages this behavior.
  • In our society, employability is often equated with worth and value on a fundamental level. In the current bad economy, lots of people have been losing their jobs, and half of them feel that being unemployed has changed their lives for the worse. Being unemployed is seen as shameful, humiliating, a sort of failure to grow up and develop into a “real person.” Obviously, having “disabled” be seen as a synonym for something with those negative connotations does a disservice to people in both groups.

For Cereal, Cute Overload?

A periodic feature in which we highlight some of the more ableist posts and comments in the blogosphere – the things that made us throw up our hands and ask “FOR CEREAL???”

I’m late on this one, but that doesn’t make me any less upset. Cute Overload is one of the best and most regular suppliers of the cuteness I so often need to take the edge off the day, but it’s becoming increasingly problematic. They have a continuing series called Cats n Racks, featuring photos of kittens placed in cleavage, usually cutting off the woman’s head. Recently the site posted a picture of a extremely wrinkled puppy with lots of excess skin and compared it to Eleanor Roosevelt (described here at Filthy Grandeur). She also points out a recent photo of a wallaby titled “The New Slave Girl, She Intrigues Me,” captioned with what sounds an awful lot like a rape fantasy.

Not content to settle for racist and sexist, the site went for a hat trick and added ableist to their list! In their post reviewing the ten most popular posts of 2009, number five is a photo of a bunny with a long forelock brushed over one eye, called “Emo Bun.”

a small grey bunny looking to the side, with a long forelock of fur falling over one blue eye.

The text reads “On June 18, Stephanie N. took a minute from cutting herself to send us this awesome shot, an emotional bunneh.” The alt-text for the photo of the bunny reads “No Mom I was NOT cutting myself!”

FOR CEREAL, CUTE OVERLOAD? I’ve written at length about my issues with the term “emo” elsewhere, but beyond that, the multiple references to cutting are 100% non-negotiably inappropriate. Having an undeniably cute bunny whine about cutting minimizes and dismisses the very real pain of people who do self-injure. It implies that self-injury is a choice as superficial and changeable as a trendy hairstyle and that it’s done to fit into a trend. It’s not funny. And it’s certainly not cute.

Stigma Hurts Everyone

I read an interesting post recently, from a self-described “functioning alcoholic” discussing the possibility of treating alcoholism with pharmaceutical drugs. While there’s no successful pharmaceutical treatment at this time, there are a few things in development and it’s seeming increasingly probable that the drug companies will focus research and development efforts on coming up with something.

More interesting to me than the potential treatment itself were the issues raised in the post about concerns raised by this treatment possibility – because all of the concerns seem to be based on observations of how psychiatric medications have been implemented and viewed since their development. (These issues also obviously apply to pharmaceutical treatments for other conditions, including fibromyalgia, migraines, etc.)  The issues raised by the author of the original post include:

  • “Is it appropriate to battle a chemical addiction with another chemical?” This is parallel to the often-voiced concern about whether chemical/medication-based treatment is an appropriate response, or if it will just replace the symptoms of mental illness with dependency on psychiatric drugs.
  • “Won’t the pharmaceutical companies “define alcoholism down” in an attempt to get the broadest possible consumer base for their products?” – This is parallel to the concerns about encouragement to overdiagnose mental health conditions such as ADHD and depression in order to broaden the market for pharmaceutical interventions. It also draws from concerns about advertising Abilify and other psych drugs directly to consumers through TV and print marketing.
  • “Is life really worth living if you’re sober all the time?” – while the original author clearly intends this as a joke, I find it similar to arguments I’ve heard that “messing with someone’s emotions” through pharmaceutical intervention will inherently result in significant changes to that person’s personality and identity. This seems similar, in that it questions whether life will be the same if such a fundamental component of their self is being affected by pharmaceutical treatments.
  • “One of the arguments against a medicine-based treatment of alcoholism is that while it may certainly curtail the physical addiction it does nothing to address the underlying reasons why someone might choose to drink—anxiety, depression, an unwillingness to be in the world without some kind of sedating agent to take the edge off of existence.” This idea is often used to argue that medication-based psych treatment alone is insufficient, and must be combined with some kind of psychotherapy to effectively address the underlying emotional issues driving the mental illness. It is also sometimes used to suggest that taking medication alone is “cheating,” by mitigating the symptoms of underlying trauma or disorder without addressing the root causes, allowing the patient to ignore the root causes and eventually causing greater harm.
  • “I’m not unsympathetic to the argument that a certain amount of drinking is just fine. I know plenty of folks who drink almost as much as I do and manage to keep it all together. Why castigate their actions or make them think they need “treatment” for what could be considered just another lifestyle choice?” This parallels many of the discussions regarding what constitutes a mental illness and ties into the ideas of “neuroatypicality,” where a person’s mental functioning is described as different than typical mental functioning, without a value judgment as to whether typicality is better or worse than atypicality. It also references the underlying conception that being labeled as someone who could benefit from pharmaceutical treatment is shameful or stigmatizing, a judgment which would surely spread to those on the borders of atypicality.

I found all this fascinating because, while I’m used to hearing these arguments and issues raised in the mental health treatment context,  it’s clear that they are permeating our society and discourse beyond their direct application to mental illness.  Here, the spectre of passing out ADHD drugs in every elementary school classroom is being raised as a potential concern in the as-yet hypothetical development of a treatment for alcoholism – a serious condition which can lead to significant health consequences up to and including death.

To me, this says that addressing these issues – the misinformation, the stigma, and the bad acts of pharmaceutical companies – is important not only to people with mental illness, but also to the groups who could benefit from pharmaceutical developments and interventions yet to be developed. It is clear that these issues are so significant that they could discourage people from supporting or even considering the possibility of future treatments that could potentially help millions.

Lines in the Sand: Daly, Showalter and Tactics of Exclusion

The second-wave radical feminist theologian and professor Mary Daly died earlier this month, and there has been a veritable outpouring of eulogies from various feminist blogs.

Few of these eulogies have acknowledged Daly’s transphobia and racism.

I do not deny that Daly was an important figure in second-wave feminism, but to mourn her passing without a nod to her work’s more problematic aspects, or explorations of these aspects, are, to put it mildly, not good. In particular, the intense, hateful transphobia found in some of her writing, and her issues with unexamined white privilege and racism — which both QueenEmily at Questioning Transphobia and Sungold at Kittywampus cover very well in recent posts — strikes many as both deeply disturbing and an old pattern that has, and continues to, rear its grotesque head in certain segments of contemporary feminism. I include myself among those who are deeply troubled by Daly’s transphobic sentiments and her questionable record when it came to examining the entrenched racism and issues surrounding white privilege in the second-wave feminist movement.

I should probably mention at this point that I do not mean to appropriate or co-opt the struggles of trans* folks in any way, although my cis privilege will most likely be unintentionally reflected at points in this piece. Though the struggles of trans* people, trans feminists and PWDs and disabled feminists are not the exact same, some exclusionary tactics of certain cisgendered feminists and those of abled feminists sometimes take similar forms, especially within the mainstream feminist movement. The oppression of trans* folks and PWDs in cis, abled culture intersect in a number of ways; this post, however, barely scratches that surface. I believe that the many issues present in Daly’s work–as well as the reaction to her death around the blogosphere–can serve as just one entry point to discussions of the similarities in oppression(s) that trans* people and PWDs face. There are also clear differences, among them the fact Daly used language that can only be called genocidal, while many other feminists of her generation did not advocate such an extreme path when it came to keeping certain individuals out of feminism. I will be focusing on feminism’s exclusion of trans* and PWDs as reflected in the work of two very influential second-wave feminists here, but there is, of course, much more to these stories.

Daly’s penchant for exclusion and outright hatred (particularly of trans* individuals) couched in oddly phrased academic rhetoric unfortunately brings to mind another famous second-waver’s similar issues with people (particularly women) with disabilities. Princeton scholar Elaine Showalter — best known for bringing feminist literary theory to the fore in the academy at a time when such a discipline was, for the most part, inconceivable — dismissed disabling conditions like Chronic Fatigue Syndrome, Gulf War Syndrome and mental health issues such as Dissociative Identity Disorder (referred to in the text as Multiple Personality Disorder) in her 1997 book Hystories.

In Hystories, Showalter attempted to debunk “modern media epidemics” such as the aforementioned disabilities as well as more traditionally disproven phenomena such as alien abduction and satanic ritual abuse. In the book’s chapter on Chronic Fatigue, Showalter rather disingenuously declared that she did not want to “disparage the suffering” of people with such conditions only a few pages before she called CFS an extension of Western “fin de siecle [end of the century] anxiety.” She followed this stunning assertion with the claim that the Western news media was primarily responsible for making CFS into an escalating “psychogenic epidemic” (117, 131).

Like Daly’s severe opinion of trans* people as dupes of the medical industry (which Kittywampus cites in her post), Showalter also seemed to be taken with the idea that people with CFS are somehow being duped into thinking that they are ill because of the media focus on their condition. She wrote that many CFS patients and their defenders are “hostile to psychiatric or social explanations” of the condition, and that many of them react in a way that is not friendly to the labeling of CFS as “psychiatric” (128). However, the reactions of these same patients make sense if considered from a non-abled perspective. Showalter also seemed completely mystified by these “hostile” reactions. If CFS is just a manifestation of “fin seicle anxiety,” as she contended (adding that “emotions have tremendous power over the body”) she seemed to push the conclusion — without any scientific or medical proof — that many people with CFS have somehow been brainwashed into believing they have it; thus, the media-driven “hysterical epidemic” has worked.

Nowhere are feminists with Chronic Fatigue Syndrome or related conditions consulted; the not-so-feminist implication here is that feminists with Chronic Fatigue Syndrome either do not exist or are just victims of a “hysterical” media-led epidemic and therefore cannot be “real” feminists. This is similar to how trans* feminists were erased, excluded and castigated by Daly as somehow not “real” women or feminists, and as benefiting from patriarchy in a way that “real” women and feminists could not. To put it crudely: This is exclusionary bullcrap, and it does not do trans* people, people with disabilities, feminists who fit either (or both) of these categories, or the feminist movement as a whole any favors whatsoever.

Exclusion is not radical. It has never been radical. It is, in fact, extraordinarily status-quo. No one should be able to arbitrarily pick and choose who “belongs” in the feminist movement and who does not, especially if those who are being excluded because of their gender identity, sexual identity or disability actively identify as feminist. Feminism should be for a wide variety of people; exclusion, however, is something that is not — and has never been — very  feminist.

Author’s note: I will be moderating this thread with an iron fist; please have the courtesy to not try to tell me how Daly really was an ally to trans* folks, or how Showalter didn’t mean what she said about CFS *that* way, or that either author’s influence on the feminist movement somehow excuses their hatred and bigotry. Thank you.

[Cross-posted to Ham.Blog]

SSRIs, Violence, Walking, and Dogs

Recently a link was making the rounds on Tumblr about how SSRI anti-depressants caused violent and homicidal reactions in people (h/t to the lovely Cara for making sure we saw it). I was largely ignoring it because, frankly, there’s a lot of unproductive discussions about whether SSRIs, or anti-depressants in general, or even psychotropic drugs as a whole, are teh most awesome things ever! or an evil tool of big pharma or poisoning our children or should be put in the water supply to help the population at large. And my attitude towards psych treatment, whether it be therapy or medication or anything else, is pretty similar to my attitude about religion: everyone has the right to make their own determinations about their treatment and whether they would or would not like to take psych meds, and just as my atheism doesn’t make someone else’s faith any less valid, I can support someone’s decision to reject psych meds without lessening my own right to believe they help me personally. (To extend that, I support anyone’s right and decision to pursue or not pursue any kind of treatment, to identify as they feel appropriate, and to reject the whole framework and basis of psychiatry.)

That said, I thought it might be useful to take a look at this article to discuss some of the issues I see in a lot of these arguments and discussions. The basic gist of the article is to publicize an archive of “3,500 crime related news reports linked to the use of SSRI antidepressants … Pharma and the FDA may still be agnostic about SSRIs causing violence but 700 murders, 200 murder-suicides and 47 postpartum depression cases, including the 2006 case of Andrea Yates who drowned her five children on Effexor, don’t lie.” The article describes the site as “more of a public service than the FDA which has yet to withdraw the drugs named in the 3,500 stories–or even call them dangerous,” so the clear goal of the article is to encourage prohibition of SSRIs as a class.

That’s a pretty broad goal to be supported by such thin and unconvincing evidence – and that’s my problem with these kinds of arguments. Whenever I talk about these kinds of science articles, I often use the same phrase: “correlation does not equal causation.” This means that although two variables may be very closely associated, there’s not enough information to figure out which of them causes the other, or even if the two are related by anything more than chance and coincidence. A simple example is that everyone who orders food at McDonald’s is a human. Can we assume that if a dog walked into McDonald’s and ordered food, it would magically transform into a human because of the correlation between ordering at McDonald’s and being human? No.

To unpack this further, let’s look at the fact that a lot of people who walk in my neighborhood have dogs. I know some people who got dogs specifically in order to encourage themselves to do more walking – so the dog is influencing how often they walk. However, I also know people who do a lot of running or hiking and got a dog to keep them company on their outings – so their walking/running influenced their having a dog. So does being a person who walks outdoors make you more likely to get a dog, or does having a dog make you more likely to walk outdoors? We just do not have enough information to figure that out. This means my observations of walkers and dogs should not justify a public policy to issue dogs to every household to ensure people walk outdoors.

To extend this to the SSRI stories, there’s not enough evidence for us to determine if people who are not violent or homicidal become so when they are given SSRIs, or whether people who are already violent or homicidal are likely to be given SSRIs for treatment. And that’s a very important thing to be absolutely clear on when we’re talking about having the FDA eliminate an entire class of anti-depressants that some (including me) rely on for treatment.

There’s a couple other factors in the dog analogy that I also see at play in this SSRI story:

  • Observer bias: I think dogs are pretty cute, so when I’m out and about, I tend to notice pedestrians with dogs more than I do pedestrians without dogs. So if I see 10 pedestrians and 4 of them have dogs, I’m much more likely to notice and remember the dog people and think that the majority of pedestrians have dogs. Similarly, self described “anti-SSRI advocates” are more likely to notice and prioritize instances where SSRIs occur with violent behavior.
  • Who is observed: I happen to live two blocks from the most popular dog park in town, so people from miles away drive here in order to hike with their dogs. There are a lot of trails that don’t allow dogs and if I lived right next to one of them, I’d likely see a lot more walkers who are dogless. So I’m not looking at the entire population of walkers and dog owners when I’m observing a connection between those two characteristics – I’m looking at a population more likely to suggest to me that the two are connected. Similarly, the SSRI stories are drawn entirely from crime reporting. Stories about people who take SSRIs and do not engage in violent, homicidal, or otherwise criminal behavior are not going to be in a crime story – so the archive is looking at a subset of SSRI-takers that is more likely to confirm their perception that SSRIs cause criminal behavior.
  • Interpreting evidence to fit desired results: when growing up, I tried out the “dogs will make me walk and exercise more” argument on my parents. This is because I wanted to get a dog, and I was trying to put together any argument I could to support that conclusion – I had started with the conclusion instead of with the evidence. Some of the stories mentioned in the article make me wonder if the SSRI stories suffer from the same problem. One of the quoted stories is “Lynyrd Skynyrd harmonicist Mike Caruso’s remark that, ‘the doctor put me on Cymbalta. That turned me manic.'” To me, giving an anti-depressant to someone with undiagnosed bipolar and triggering manic behavior is a very different argument than if taking the SSRI created violent or homicidal behavior that hadn’t previously existed in the person.

In order to convince me that SSRI used caused these behaviors in people who otherwise would not display them, I would want to see a clinical study where people were observed before and after starting SSRI treatment and a control group was also monitored while not having SSRI treatment. Those kinds of scientific studies are the only way to meaningfully determine whether the two variables have any kind of causal relationship.[1] And without that data, this article does a lot more harm than good – by reinforcing existing perceptions that criminals are all mentally ill and by shaming or scaring people who take and benefit from SSRIs.

[1] I should note that requests for data and scientific studies are often used to invalidate or minimize reported personal experiences from marginalized groups, an academic privilege argument of sorts. I do and continue to credit individual experiences where SSRI treatment caused specific behaviors for that individual, but I feel very uncomfortable making blanket decisions about whether or not these drugs should be available at all, for anyone, based on third party descriptions of the experiences of others.