On 'We Need to Fix Mental Healthcare in This Country'

The last several things I've on my Facebook (the NYT column on guns and civil society, the Atlantic's "The Secret History of Guns") been in regards to guns.  Now, a thought on another aspect of the circumstances in this country which contribute to the epidemic of mass murders.

People keep saying 'we need to improve our mental health system.'  This is true.  We've done terrible things to the funding of our state mental institutions and mental health care.  We need to work on our mental health infrastructure.

The oft-posted HuffPost article by Liza Long highlighted a rather interesting fact; it's hard to put someone in an environment where they can get serious treatment for violent psychiatric disorders other than by incarcerating them.  I can't claim to have a better alternative.  I can't say 'this must change.'  But I can say that this seems extremely counter-productive and needs re-evaluating.

But the infrastructure of hospitals and mental health providers is only a part of the American mental health system.  Another critical part is social workers.

I think you'd have a very hard time finding more than a very few social workers in this country who have a workload close to resembling what it's designed to be.  They are hopelessly overloaded.  I reckon it's damn near impossible for a social worker in this country to give most of their cases the time each are due.  The pay is miserable.  The hours (something along the lines of 24/7) are miserable.  The work, while often highly rewarding, can be utterly soul-crushing.  Did I mention the pay is miserable?

How ought we fix this?  Better incentives to work as a social worker?  Better pay? Benefits?

Perhaps.  But I can't see these as being very effective.  Being a case worker is just so incredibly difficult.  So thankless.  So trying.

A whole bunch of the young folks who enter programmes like Teach For America aren't able to carry through for the whole duration of their programme, and even more don't keep on teaching.  Working with at-risk kids can just be so rough.

And teachers are just confronted with the shit that comes up from cracks in the ground.  Social workers are called upon to plunge directly into said shit.

Moreover, history doesn't provide a very promising picture when it comes to maintaining additional investments in our mental health physical or human infrastructure.  Social workers and mental health facilities are often some of the first victims of austerity.

This isn't a very optimistic post.  I don't have solutions.  I might be grossly misunderstanding the situation of social workers in this country.

But the role I've carved out for myself as a participant in our nation's political discourse is not as a solutions man.  It's as a problems man.

Because when you don't understand all the problems, when you don't see all the factors contributing to something being FUBAR, when you don't see all the brushstrokes in the picture and all the stars in the constellation of shit, what hope do you have of finding a decent solution?

To our the leaders of our nation's political institutions and the mental health community, and to the social workers who serve as grunts wading through some of the worst things humanity has to offer; Godspeed.

To Each His (and Her) Own American Dream

I found this GQ article on my Facebook feed.  It's a reporter's account of her experience visiting a so-called 'Patriot Camp.'  The really interesting nugget I found in this article, laid among some rather disturbing evidence of indoctrination.

http://www.gq.com/news-politics/politics/201210/patriot-camp-gq-october-2012?currentPage=1

"After spending a few days in Paxtang, I start to see why some of the people here feel threatened, as though their grip is slipping on a certain way of life, how it's only a matter of time before the chemistry of their town, in all its ineffable Americanness, will be recombinated by the arrival of outsiders, by a globalized economy, by a different set of values. And how fighting to protect all that doesn't seem political to them as much as an act of self-preservation. No one explicitly said anything like this to me. It was just the undercurrent of every prayer, lesson, pledge: We love this. Don't touch it."

I can understand and respect this impulse.  But it is utter foolishness and fantasy to think that the America of yesteryear was the land of uber-freedom, uber-piety, uber-American-ness, and stories of picking-up-by-the-bootstraps prosperity--it sure wasn't for a whole lot of people.  There are many versions of the American memory which tell a far different story; and it's a disservice to these children to give them a historical understanding that conveniently dodges this fact.

The America I believe in is a place where we live and let live.  If you want to live a conservative, pious, Christian, simple small-town life, you're welcome to stake your claim to that American Dream, start digging, and see what you find.  But yours is not the only American Dream, yours is not the only American Fortune, and yours is not the only American Memory.  Others are entitled to stake claims on their own American Dreams.  That dream may be quite different from yours.  And in a country blessed with as much prosperity, power, and wealth as ours, it's downright wrong to demonise the very concept of our society collectively helping out those prospectors who start off much further back on the trail.  And you are not entitled to an American Fantasy which robs other people, people same as you, their own fair shot at their American Dreams.

It greatly upsets me that many folks in this country seek to intrude on the dreams of others and to hold back the advancement of freedom, equality, and fair opportunity to keep intact their American Dreams of a time long past.  Every child and every adult learns the unpleasant lessons that their lives change and the world changes, and that some dreams of yesterday don't survive the introduction of new demands, priorities, and responsibilities.  As America has grown, we've made it a priority to make the American Dream a possibility to more and more people; to African Americans, to women, to immigrants, Catholics, Jews, and all racial and ethnic minorities.  Today, we're bringing the Dream to more immigrants, to people in poverty, and to people in the LGBTQ community.  With our old expansions brought the death of the dream where women and people of colour were deemed second- and third-class citizens, and the dream that industry could function without having to worry about safety, paying decent wages, or letting children go to school.

Let me have a shot at my American Dream.  Let your neighbour have a shot at his or hers.  Let your countrymen; male, female, gay, straight, black, white, rich and poor, have a shot at theirs.  Because one of the things that distinguished America's Golden Days from those of other countries and peoples is that this is the place where people from all around the world and the country could take their decent shot at prosperity. I want our days to stay golden.

In re Wisconsin

Tuesday's results in the Wisconsin gubernatorial recall election left me rather frustrated and puzzled.  I don't see anyway around it; it's a real setback for progressivism.  But what frustrates me more is what seems to be the sort of discourse which was had in this campaign.  It was a battle of messages so simplistic and foolish as to be intellectually bankrupt.

On the one hand, there's the GOP message of unions being big, evil, exploitative monsters who live large off the taxpayer.  Union members must be lazy, incompetent scum who get far more than they deserve because they muscled politicians into submission.  On the other hand, there's the Democratic message that members of teachers' and state workers' unions are all hard-working angels who do great things for our country (like teachers, who are all so wonderful for putting up with our kids and being the guardians of our future).

Well, you know what?  Even as a solidly-progressive person, I can tell you that both of these ideas are bullshit. No, not all teachers are wonderful.  Speaking of teachers, the intransigence of teachers' unions is a major impediment to improving our nations' schools.  However, when talking about union members, we have to remember that we're talking about human beings.  Human beings who work for a living, have families to provide for, and who are probably pretty decent folk.  They face the same struggles the rest of the American middle class does, and they aren't rolling in dough.  And you can't blame people for advocating for their own self-interest.

Here's my perspective on the matter.  In times of fiscal distress, it's necessary for everyone to tighten their belts.  That means trimming expenses on public employees.  The tough decision might have to be made to lay some people off.  But such a decision must be made with a heavy heart and a recognition of the fact that by reducing pension or healthcare benefits, cutting wages, or cutting jobs, the government is putting a whole lot of hardship on folks who never did anything to deserve it.  To hear people talking derisively and tauntingly about public union employees facing hardship just blows my mind.  Treat it like a necessary evil, dammit.

Unions need to, if they haven't already, step up to the plate and take on whatever burden is appropriate to help carry the society towards fiscal viability.  However, just because unions have been stubborn representatives of their constituents' interests, and just because they have caused some serious problems in how our public services work, does not mean that we should systematically dismantle the systems by which workers can collaboratively advocate for their own interests in negotiating the terms of their employment.

God, I am so sick of this sort of asinine political exchange.

The 'War on Women'

You know, I usually consider myself a reasonable fellow averse to inflamatory terms like 'War on Women.' But I am absolutely flabbergasted at the efforts of GOP institutions across the country to systematically rob women of the rights they are entitled to; the CHOICE of how they want to manage their reproductive health and have families ( see Kansas and Arizona enabling doctors to mislead female patients to prevent an abortion, requiring a woman to be vaginally penetrated by a probe in order to get an abortion, requiring women to carry an non-viable fetus to term), the right to proper healthcare from a trained OB/GYN at a price they can afford to pay(see GOP institutions systematically stripping funding for low-cost women's health services), and the right to earn the same pay that a man does for the same work that he does (see Wisconsin repealing a bill which prohibits discrimination in pay based on gender). I can see nothing else to call this other than a widespread attack on women's rights. Calling this a 'war on women' is not mere disingenuous namecalling. It's a remarkably accurate representation of the attitudes which Republican Party organisations across our land are expressing towards women.

Let me put this in a way that us danglers can understand:

Gentlemen, do you want some old white dude in your state or national capital telling the woman you have sex with what she must do with her body? Do you want a government or employer taking measures to deliberately restrict her ability to have safe, enjoyable sex with you? Do you want your future girlfriends, daughters, and wives to be unable to contribute to their families and their communities in the way that they could if their reproductive organs were located on the outside?

You know what, this is America, and there is a place in our society for people who want to raise their families in a way that teaches that abortion is never permitted, that a woman's duty is to be more of a homemaker than a breadwinner, and that a woman should have only procreative sex within the context of marriage. But because this is America, each woman gets to decide FOR HERSELF whether she wishes to follow this manner of sexual conduct or whether to teach it to her sons and daughters. You're allowed to call a woman who enjoys recreational sex a slut, because this is America (just like I can call you a misogynistic pig who's probably never made a woman's nether-bits tingle in his whole goddamned life). You're allowed to condemn a woman who has lots of sex with many men a whore, because this is America. You're allowed to tell her that God wants her to save herself for marriage, because this is America. But you can only express those things in your speech and how you raise your family. You aren't allowed to impose it on anyone else.

The legal tradition of this country says that a fetus is not a life, that a person should be entitled to pay and employment commensurate with their work, education, and utility as an employee, not based on their gender, colour, creed, or with whom they want to have mature, adult relations. The GOP must quit trying to circumvent the spirit of our nation's legal tradition with these under-handed jabs at the rights our society decided women were entitled to decades ago.

What grounds do we have to complain that Egypt and Tunisia have elected Islamist governments when this is what we do in our own country?

A Legalised Affront to Medical Ethics

http://www.huffingtonpost.com/2012/02/29/kansas-abortion-bill-governor-sam-brownback_n_1307076.html

Should it pass, Gov. Brownback is set to sign a piece of legislation that, among other things, shields doctors from malpractise suits when they withhold medical information from a pregnant woman in order to prevent an abortion. I will ignore the other absurd provisions of this bill (requiring mothers to hear the fetal heartbeat before getting an abortion, removing tax exemptions for medical providers because they provide abortions, etc.) and the fact that Gov. Brownback has publicly stated that he intends to sign the bill despite not having read it. Nay, I shall focus my attention on something in which I see no reasonable controversy.

Doctors take an oath in order to practise medicine; an oath which obliges them to act in the interests of their patient, avoid actions which would harm their patient, ensure that medical decisions are made at the patient's informed discretion whenever possible, and to give each patient the same high quality of care. This bill is a legalised desecration of the ethical responsibilities to which doctors are bound.

First, and most simply, this legislation permits doctors to restrict their patient's capacity to make informed decisions about their health. It is, in this country, a woman's right to decide whether or not to go through nine months of discomfort, to put herself in a situation which could jeopardise her health, and to either have her abdomen cut open or pass a massive, unwieldy object out of her vagina. It is her decision alone. By withholding information which would be relevant to the patient making an informed decision about whether or not to carry on her pregnancy, the doctor takes this decision into his or her own hands. This is, in itself, a grave violation of medical ethics.

By making this decision, the doctor violates his or her obligation to protect the interests of the patient as the patient sees fit. The patient could very well decide that the risks which a pregnancy poses to her health are too great and that she no longer feels comfortable continuing the pregnancy. One can see that this would be a heart-wrenching decision for the mother, but it is hers alone to make. Our courts have ruled that the father of a fetus does not have standing in preventing its termination. If the fetus' own flesh and blood does not have the authority to prevent abortion, what reason do we have to believe that a doctor should have this right?

This bill also permits doctors to violate their obligation to provide care in a fair and just manner by allowing them to treat women with a lower standard of autonomy. When becoming pregnant, a woman gives up a great deal in order to preserve her health and the health of her fetus. But she makes the choices to give those things up of her own volition, and she in no way surrenders her medical autonomy.

One may argue that the doctor could be justified in withholding information in order to protect the fetus. This argument, however, does not have logical or legal traction. When treating a pregnant woman, the patient is the mother. That is who the law recognises as an autonomous person, and that is who doctor is obligated to serve. The doctor's obligations to the fetus derive from his or her obligations to the mother's wishes that her fetus be healthy. But the doctor has no legal authority to compel the woman to come to OB/GYN appointments, to abstain from tobacco, drugs, and alcohol, or to take care of her body. If the doctor does not have the right to violate the patient's autonomy for the sake of fetal health in this manner, there is no conceivable reason why he or she should have the right to violate the patient's autonomy by mandate these actions on behalf of the fetus, there is no conceivable legal reason why he or she should have the right to do so in regards to whether or not the fetus is carried to term.

Shame on the Kansas legislature for even considering such an abominable affront to medical ethics, and shame on Gov. Brownback for blindly throwing his support behind it.

We learn more every day about Mr. Santorum

http://www.slate.com/articles/health_and_science/human_nature/2012/02/rick_santorum_s_partial_birth_abortion_lie_did_obama_target_the_disabled_.html

*edit: for some reason I can't get the link text to turn a visible colour. Just highlight the space above and you'll see it.
Take a looksie.

Mr. Santorum has, for years, claimed based on unreliable figures that almost all late-term abortions are terminating healthy, normal pregnancies. Now, he does a complete 180 in order to perform the mental gymnastics linking the healthcare law's requirement of free coverage of prenatal testing to culling the disabled.

Mr. Santorum's dishonesty is not what concerns me the most here. What concerns me the most is that this man, who by some cosmic joke is the front-runner for the Republican nomination, is making it such that it would be hard for a Democrat to give him the respect of a handshake. How can this man expect to meet any cooperation from Democrats in Congress if he were to come into office? How can this man expect to shake President Obama's hand and engage him as a reasoned political interlocutor when debate season comes around?

Most of all, when this is how he energises his supporters, how can he expect them take defeat (assuming God grants us that good fortune) as orderly, civilised, and reasonable participants in the political process?

Senators McCain and Obama fought a rough race for President. But in the face of a substantial contingent of his party which was xenophobic, reactionary, and downright batty (think that Grandma who said to McCain that Obama was an Arab, which we all know is a synonym for Muslim), Mr. McCain ensured that his campaign would not besmirch our nation's democratic process by putting itself on a pedestal of anger and venom from which it could not step down.

Mr. Santorum has managed to put itself on such a pedestal many stories high, and it's not even general election season yet.

A Modest Proposal for the Protection of our Nation's Greatest Persons

The Virginia Legislature recently passed a bill which requires women to have an ultrasound exam and look upon the 'person' inside them before they are permitted to terminate their pregnancy. This exam is done by penetrating the woman vaginally with an ultrasound probe. While there is no conceivable medical reason why the patient would need an object inserted into her vagina, Governor Bob McDonnell is expected to sign the bill so that a woman can have “more information” before making what is a very important decision.

I applaud the Commonwealth's efforts to stem the murder of these 'persons' using means which can arguably be termed 'rape.' Indeed, I call upon the Commonwealth and the Federal Government to take action against the legislation which enables the slaughter which takes place all to commonly in this country.

The legislation I speak of, of course, is Chapter 7 of Title 11 of the US Code, which codifies the abominable practise of Chapter 7 bankruptcy; the 'liquidation' of a corporate person.

Year after year, Congress and the Supreme Court fail to find the moral courage to take on this silent campaign of murder. But there is nothing we can do about that. We can, however, follow the lead of brave Virginia by placing arbitrary, useless, and invasive medical procedures in front of those who would seek to end a corporate life.

I call upon the Commonwealth of Virginia, along with the Federal and all state governments to adopt the following set of rules;

• Corporate officials who seek to initiate Chapter 7 bankruptcy procedures must submit to a rectal exam by a doctor

• The exam must be performed as said corporate officials are looking into the eyes of the shareholders and employees of said corporation so they may have all the information they need to make their decision

• If it is found that the bankruptcy substantially resulted from the management choices of a venture capital firm, the executives of said firm must undergo a rectal examination in the same manner

I'm sure you have grown tired of women getting abortion after abortion as a matter of convenience, so they can continue their promiscuous and stretchmark-free lifestyles. Similarly, I have had enough of corporate executives coasting away on their golden parachutes as they leave their charges behind to be torn apart by the bloodthirsty wolves of the Securities and Exchange Commission, the Commodity Futures Trading Commission, the United States Treasury, Federal Bankruptcy courts, and other such fiends. I can stand the slaughter no more!

Some corporation-butcher apologists might plead, “But what if the bankruptcy was the result of a criminal act, such as fraud or theft?” To these people, I say that for every hapless CEO who has a criminal like Bernie Maddoff savage his company's finances, there are at least 5 others whose financial security infrastructures and accounting were so loose and skimpy, they were basically asking for it.

Because of the constitutional prohibition on the retroactive application of law, we will not be able to force those who have facilitated Chapter 7 bankruptcy to face justice for their crimes against the Almighty Dollar. If we could, though, I would call upon the Surgeon General to administer an anal probe to Mitt Romney for every corporation which Bain Capital drove into the ground on his watch.

Ladies and gentlemen, I dream of an America with corporate boardrooms full of tightened sphincters and where they make their decisions carefully. I dream of an America where those companies who will invest their assets with any sharp-looking start-up owner or innovator, who lack proper financial protection, and who say 'it was just a one-quarter-stand,' are made to face the consequences of their decision by feeling the icy-cold touch of a lubricated probe between their legs.