Things have not been nearly what they should be emotionally lately, as I seem to be on a roller coaster again. I will grant though, that it is sort of a small child version, rather than the rather hardcore coaster I was on before getting on meds. In particular I have been getting hit with rather serious depression that is punctuated by rather giddy upswings. Not particularly happy upswings mind, more like my typical form of manic, anxious, sad bemusement.
My doctor upped my dosage of Clonidine last month and increased my supply of Xanax, in the hope that getting more sleep would help level things out. I can't say that getting a little more sleep - not so much in the way of hours, but more in the sense of helping me stay asleep - but it didn't really stabilize things. Today was my one month follow up to changing dosages.
So now I am going to try Lamictal. I am a little nervous about it, because I definitely can't afford to be slowed down too much. At the same time, I really need to be able to focus better on school. I am not getting behind at this point, but I am also not managing to stay ahead. Staying ahead has been critically important to me, because when I do, I don't get caught up too badly at the end of the semester, when things suddenly pile up the way they do in a lot of classes.
When I stopped into WalMart to fill my scripts, I found that Lamictal at this dose would cost $83 a month - and if it works, the dosage will go up. Then I decided to call Costco, where I fill my Welbutrin and like the Welbutrin, they can beat the hell out of WalMart. Mind you, they can't beat WalMart for anything else - the difference for the rest of my scripts is nearly $50. But for the Lamictal they will charge $21 - more than $60 savings and about a quarter of the cost at WalMart. And of course the Welbutrin is more than a $100 cheaper at Costco.
So now I am off to Grand Rapids - the only inconvenience in the process, as it is about an hour away. Given the shit I need to get done today, this will rather fuck up my day a bit - but I suppose I will get there. It has just been rather slow going through this damned book response. Of course, it may well help to get going on this new med, so there it is.
Showing posts with label cognition. Show all posts
Showing posts with label cognition. Show all posts
Monday, July 19, 2010
Wednesday, April 14, 2010
The New Asylums: Complete System Failure
I have been meaning to write about this issue for a very long while, but have left it on the burner for so long I forgot about it. Then today in psych class I had it thrust into the forefront rather brutally. Before I go on, I want to share this episode of Frontline from 2005, one that I hadn't actually seen before. I should expect that it won't take long to get the gist of a truly magnificent breakdown of how we manage mental illness in the U.S.
It didn't take very long to provide you with a pretty good idea as to just how truly screwed up this is. Keep in mind Frontline filmed that episode in a prison that is still considered a model for psychiatric care in the prison setting. This is no way to treat people with mental illness, even people who really do need to be locked away from society.
What really makes me angry about our new model for dealing with serious mental illness, is that all the excuses made for closing state institutions are exacerbated by this method of dealing with the seriously mentally disturbed. It is far more expensive to deal with the mentally ill either in prison, or on the streets coasting in and out of jail. The biggest reasoning was expense - but the expense has dramatically increased. It is a huge expense for local communities and ultimately still costs the state more.
On top of this, it is extremely hard for the seriously mentally ill to actually get the help they need and even qualify for. There are "homeless" mentally ill persons who aren't actually homeless. They have a place in a group home and access to care. But then they wander off from home and end up living on the streets - off their meds, hungry and exposed. And there are truly homeless mentally ill persons who aren't getting any help - not because they don't qualify, but because they are not together enough to go out seeking it. And even if they try, the system is not set up to be managed by a paranoid schizophrenic who believes there are people trying to kill her, or someone with bipolar who walked nearly a hundred miles from people who knew him while in a manic phase. That is not the "freedom" that wellmeaning, but ultimately ignorant lobbyists/policy makers were trying to provide with the idea of mainstreaming.
And the local communities - the communities in which people who know and love a particular mentally ill individual lives, are not set up to deal with them. We have had forty plus years to get it together and help these folks and still we are flailing about, failing too many. Even here in MI, where the quality of care provided by county Community Mental Health (CMH) services is generally quite exceptional, we are allowing too many to slip through the cracks. In many places, there is virtually no organization to provide services to the mentally ill. In others, southern California in particular, the services provided are truly abysmal.
And again, the states are still fitting a huge portion of the bill - in many cases a much larger bill than the state hospital system cost.
Michigan is particularly hard hit right now, as we have closed some of our mental health facil...Excuse me, prisons at the same time we have also eviscerated the budgets of the county CMHs. We are dumping these folks onto their local communities and pulling the funding that might have provided services for them. The clinics that manage paroles and people on probation are getting overwhelmed - in many cases with clients who should not be outside of a lockdown facility. Meanwhile, people with less serious mental problems, but who do not have insurance and do not qualify for medicaid are screwed.
Myself for example. I finished with my last therapist about a year ago. I was told that I would see another intern therapist last summer - then that was bumped to the fall...I haven't bothered trying to call again - I know what is happening and know that I am not going to get help. At least I am on meds and not left completely screwed. For more people are worse off than I am. No therapy, no psychiatric services - they won't get help until their mental illness becomes acute and they either commit a crime and end up in prison, or at least get picked up by the cops and pushed through the medicaid requirements.
Please don't think that things are much better elsewhere. For the past several years MI has managed to provide mental health services on a shoestring, that far outstrip the quality of care offered in many other states that have substantially larger budgets per public mental health consumer. It is not like those services have improved as budgets get hit across the U.S. Indeed the quality of care here has not actually suffered that much, we just can't provide that care to the people who desperately need it.
I have some hope that the new healthcare plan is going to help with some of this. The APA has managed to push for some provisions that should improve access to mental health services and they went through. But it is only going to help with people in temporary crisis. People who are dealing with situational mental problems or who exhibit mild symptoms. It is not going to do a damned thing to change our prison and "homeless we can ignore" based system of care for the seriously mentally ill.
Just so we are perfectly clear about this, those scenes where they showed these yellow cages in a half circle - their "group therapy" session - that is not a reasonable way to provide group therapy. Not an effective means for any sort of functional therapy. Punishing inmates for breaking rules they don't understand is not effective therapy. Pretending that there is anything valid about an admission of guilt for rules violation, coming from a guy who is incapable of understanding what he is pleading guilty to is a fucking atrocity.
And remember, the system we got a glimpse of in that video - that is a model system for prison based mental health care. That is worlds apart from what one gets in county lockup or most prisons in the U.S. It gets far, far worse than what we see in that episode of Frontline.
It didn't take very long to provide you with a pretty good idea as to just how truly screwed up this is. Keep in mind Frontline filmed that episode in a prison that is still considered a model for psychiatric care in the prison setting. This is no way to treat people with mental illness, even people who really do need to be locked away from society.
What really makes me angry about our new model for dealing with serious mental illness, is that all the excuses made for closing state institutions are exacerbated by this method of dealing with the seriously mentally disturbed. It is far more expensive to deal with the mentally ill either in prison, or on the streets coasting in and out of jail. The biggest reasoning was expense - but the expense has dramatically increased. It is a huge expense for local communities and ultimately still costs the state more.
On top of this, it is extremely hard for the seriously mentally ill to actually get the help they need and even qualify for. There are "homeless" mentally ill persons who aren't actually homeless. They have a place in a group home and access to care. But then they wander off from home and end up living on the streets - off their meds, hungry and exposed. And there are truly homeless mentally ill persons who aren't getting any help - not because they don't qualify, but because they are not together enough to go out seeking it. And even if they try, the system is not set up to be managed by a paranoid schizophrenic who believes there are people trying to kill her, or someone with bipolar who walked nearly a hundred miles from people who knew him while in a manic phase. That is not the "freedom" that wellmeaning, but ultimately ignorant lobbyists/policy makers were trying to provide with the idea of mainstreaming.
And the local communities - the communities in which people who know and love a particular mentally ill individual lives, are not set up to deal with them. We have had forty plus years to get it together and help these folks and still we are flailing about, failing too many. Even here in MI, where the quality of care provided by county Community Mental Health (CMH) services is generally quite exceptional, we are allowing too many to slip through the cracks. In many places, there is virtually no organization to provide services to the mentally ill. In others, southern California in particular, the services provided are truly abysmal.
And again, the states are still fitting a huge portion of the bill - in many cases a much larger bill than the state hospital system cost.
Michigan is particularly hard hit right now, as we have closed some of our mental health facil...Excuse me, prisons at the same time we have also eviscerated the budgets of the county CMHs. We are dumping these folks onto their local communities and pulling the funding that might have provided services for them. The clinics that manage paroles and people on probation are getting overwhelmed - in many cases with clients who should not be outside of a lockdown facility. Meanwhile, people with less serious mental problems, but who do not have insurance and do not qualify for medicaid are screwed.
Myself for example. I finished with my last therapist about a year ago. I was told that I would see another intern therapist last summer - then that was bumped to the fall...I haven't bothered trying to call again - I know what is happening and know that I am not going to get help. At least I am on meds and not left completely screwed. For more people are worse off than I am. No therapy, no psychiatric services - they won't get help until their mental illness becomes acute and they either commit a crime and end up in prison, or at least get picked up by the cops and pushed through the medicaid requirements.
Please don't think that things are much better elsewhere. For the past several years MI has managed to provide mental health services on a shoestring, that far outstrip the quality of care offered in many other states that have substantially larger budgets per public mental health consumer. It is not like those services have improved as budgets get hit across the U.S. Indeed the quality of care here has not actually suffered that much, we just can't provide that care to the people who desperately need it.
I have some hope that the new healthcare plan is going to help with some of this. The APA has managed to push for some provisions that should improve access to mental health services and they went through. But it is only going to help with people in temporary crisis. People who are dealing with situational mental problems or who exhibit mild symptoms. It is not going to do a damned thing to change our prison and "homeless we can ignore" based system of care for the seriously mentally ill.
Just so we are perfectly clear about this, those scenes where they showed these yellow cages in a half circle - their "group therapy" session - that is not a reasonable way to provide group therapy. Not an effective means for any sort of functional therapy. Punishing inmates for breaking rules they don't understand is not effective therapy. Pretending that there is anything valid about an admission of guilt for rules violation, coming from a guy who is incapable of understanding what he is pleading guilty to is a fucking atrocity.
And remember, the system we got a glimpse of in that video - that is a model system for prison based mental health care. That is worlds apart from what one gets in county lockup or most prisons in the U.S. It gets far, far worse than what we see in that episode of Frontline.
Friday, February 19, 2010
The Intersection of Language, Culture and Cognition
While causality turns into a rather chicken/egg discussion, I suspect that the reality of it is much the same as the reality of that metaphor. While the actual mechanisms that drove the earliest development of language, abstract cognition and rudimentary culture is lost in eons of time, there is a lot that we can surmise. There are even aspects of this question we can probably describe with a great deal of accuracy. Unquestionably, this is an incredibly fascinating discussion.
Over the past few years I have become increasingly interested in the relationship between language and culture. At the same time, I have become interested in the relationship between language and cognition. I have also been very intrigued with the evolution of all three of these, for many years - and as I have been afforded the opportunity to explore the relationships I mentioned, I have become increasingly fascinated by the evolution of all three, in relation to each other.
In a turn that really blasted me into dizzying realms of abstract correlations, I have also become increasingly intrigued by the cultural relativity of psychopathology. I rather latched onto this concept, because for many years - since I was a child really, I have been beset by the idea that mental illness/neurological disorders/cognitive maladaptations are really misnamed. What exactly is it that qualifies the way one person's brain happens to work as mental illness, versus the way another person's brain works as merely being a little "odd?"*
Is it their brain that is screwed up? Or is it their socialization/culturalization - the society in which they live that is so screwed up?
As I have explored the manifestations of atypical neurology in different cultural contexts, I am increasingly convinced that the latter is considerably more of a problem. Assuming it is indeed society that is screwed up, the question becomes; "given the megalithic nature of society, does this distinction even matter?" or "is there really any reasonable solution to be found for this problem?" To the first question, I cannot but respond that yes, this distinction is remarkably important. The answer to the second question though, is much more complicated and largely depends on how one might define "reasonable."
I think that the largest barrier we face is the very nature of science research in our modern culture. In many disciplines we are increasingly running into a situation where the existing paradigm of each discipline to it's own, is becoming less and less feasible. My perception may be biased by the context of my focus, but I suspect that there is no other area where this is becoming more apparent, than in the social sciences. This is largely because the more science oriented practitioners of psychology, sociology and anthropology - even to some degree, philosophy are developing vast areas of overlap. In some cases, it is simply not possible to follow lines of research without input from each.
Yet the culture of science tends to shy from interdisciplinary cooperation, something that causes problems across the board, but which is most insidious in the social sciences. Anthropology, sociology and even psychology are seeing a major battle between those who wish to do hard science and postmodern extremists who believe that hard science is a bourgeois affectation and fallacious because we can never truly "know" anything. At the same time, most of the most practical and important work being done in all three disciplines, requires input from multiple subdisciplines of the others.
As our world continues to shrink, as historical barriers between cultures fade away, we are flying blindly into a world beset by misunderstandings and exploitations that all too often explode into violent conflicts. And the vast majority of these conflagrations can be traced directly to the intersect of language, cognition and culture. Our language, the use, the content - even the very structure of our languages predispose us to various cultural paradigms. Likewise, language predisposes us to various cognitive paradigms. But complicating all of this, our cognitive paradigms predispose us to certain language and cultural paradigms, while our cultural paradigms predispose us to certain cognitive and linguistic paradigms.
There is absolutely no doubt that untangling this web of influence is a herculean and possibly impossible task. While many correlations are blatantly obvious, causations are complicated by the very nature of nature of those correlations. But ultimately the exploration of this conjunction has less to do with untangling the web and everything to do with peripheral benefit. Exploring this intersect would teach us a great deal about who "we" are, who "they" are**, how we can all interact with less friction and who all of us might become.
Over the course of this semester, I have the opportunity to explore some aspects of this confluence. It is my sincere hope that as I work my way through my education, I will be able to functionally explore many more facets of this intersect. This nexus is relevant to my educational, research and career goals. Ultimately this nexus is the forge that shapes all of the pieces of who/what "we" are, and who/what "they" are.
As I produce various projects, I will be posting them here - hopefully in a relatively coherent fashion. This will probably mean shuffling things around, sometimes adjusting previously posted writings and sometimes I will be throwing up short posts like this one, just to get my thoughts together in a relatively coherent fashion.
I should admit now, that I will probably rarely be posting anything that is not related to this relatively broad topic. I will occasionally post personal stuff and will probably throw up stuff that really jumps out at me, but for the most part, I am going to be sticking in this particular direction. While I would really like to post about human sexuality and a host of other topics that interest me, I just don't see myself really having the time and energy. We will just have to see how things go...
*There are actually relatively objective methods for determining this, that was intended as a rhetorical question to make you think...
**I quite purposely left that very vague, because by "we" and "they" I mean several different things. I mean "we" as in individuals, a subcultural collective and a macrocultural collective. I mean "they" as in other individuals, other subcultural collectives and other macrocultural collectives.
Over the past few years I have become increasingly interested in the relationship between language and culture. At the same time, I have become interested in the relationship between language and cognition. I have also been very intrigued with the evolution of all three of these, for many years - and as I have been afforded the opportunity to explore the relationships I mentioned, I have become increasingly fascinated by the evolution of all three, in relation to each other.
In a turn that really blasted me into dizzying realms of abstract correlations, I have also become increasingly intrigued by the cultural relativity of psychopathology. I rather latched onto this concept, because for many years - since I was a child really, I have been beset by the idea that mental illness/neurological disorders/cognitive maladaptations are really misnamed. What exactly is it that qualifies the way one person's brain happens to work as mental illness, versus the way another person's brain works as merely being a little "odd?"*
Is it their brain that is screwed up? Or is it their socialization/culturalization - the society in which they live that is so screwed up?
As I have explored the manifestations of atypical neurology in different cultural contexts, I am increasingly convinced that the latter is considerably more of a problem. Assuming it is indeed society that is screwed up, the question becomes; "given the megalithic nature of society, does this distinction even matter?" or "is there really any reasonable solution to be found for this problem?" To the first question, I cannot but respond that yes, this distinction is remarkably important. The answer to the second question though, is much more complicated and largely depends on how one might define "reasonable."
I think that the largest barrier we face is the very nature of science research in our modern culture. In many disciplines we are increasingly running into a situation where the existing paradigm of each discipline to it's own, is becoming less and less feasible. My perception may be biased by the context of my focus, but I suspect that there is no other area where this is becoming more apparent, than in the social sciences. This is largely because the more science oriented practitioners of psychology, sociology and anthropology - even to some degree, philosophy are developing vast areas of overlap. In some cases, it is simply not possible to follow lines of research without input from each.
Yet the culture of science tends to shy from interdisciplinary cooperation, something that causes problems across the board, but which is most insidious in the social sciences. Anthropology, sociology and even psychology are seeing a major battle between those who wish to do hard science and postmodern extremists who believe that hard science is a bourgeois affectation and fallacious because we can never truly "know" anything. At the same time, most of the most practical and important work being done in all three disciplines, requires input from multiple subdisciplines of the others.
As our world continues to shrink, as historical barriers between cultures fade away, we are flying blindly into a world beset by misunderstandings and exploitations that all too often explode into violent conflicts. And the vast majority of these conflagrations can be traced directly to the intersect of language, cognition and culture. Our language, the use, the content - even the very structure of our languages predispose us to various cultural paradigms. Likewise, language predisposes us to various cognitive paradigms. But complicating all of this, our cognitive paradigms predispose us to certain language and cultural paradigms, while our cultural paradigms predispose us to certain cognitive and linguistic paradigms.
There is absolutely no doubt that untangling this web of influence is a herculean and possibly impossible task. While many correlations are blatantly obvious, causations are complicated by the very nature of nature of those correlations. But ultimately the exploration of this conjunction has less to do with untangling the web and everything to do with peripheral benefit. Exploring this intersect would teach us a great deal about who "we" are, who "they" are**, how we can all interact with less friction and who all of us might become.
Over the course of this semester, I have the opportunity to explore some aspects of this confluence. It is my sincere hope that as I work my way through my education, I will be able to functionally explore many more facets of this intersect. This nexus is relevant to my educational, research and career goals. Ultimately this nexus is the forge that shapes all of the pieces of who/what "we" are, and who/what "they" are.
As I produce various projects, I will be posting them here - hopefully in a relatively coherent fashion. This will probably mean shuffling things around, sometimes adjusting previously posted writings and sometimes I will be throwing up short posts like this one, just to get my thoughts together in a relatively coherent fashion.
I should admit now, that I will probably rarely be posting anything that is not related to this relatively broad topic. I will occasionally post personal stuff and will probably throw up stuff that really jumps out at me, but for the most part, I am going to be sticking in this particular direction. While I would really like to post about human sexuality and a host of other topics that interest me, I just don't see myself really having the time and energy. We will just have to see how things go...
*There are actually relatively objective methods for determining this, that was intended as a rhetorical question to make you think...
**I quite purposely left that very vague, because by "we" and "they" I mean several different things. I mean "we" as in individuals, a subcultural collective and a macrocultural collective. I mean "they" as in other individuals, other subcultural collectives and other macrocultural collectives.
Monday, January 4, 2010
Gearing up for the winter semester
I took the boys back to their mother on new years, amazed again at the ability of my two and almost eight year old to endure ten hours plus on the road with minimal fuss. I am rather depressed they are gone, talking on the phone every day just doesn't hold a candle to snuggles, reading to them in person, being peed on post bath or even having same two year old wander over to the corner to crap in his diaper five minutes after spending twenty five minutes sitting on his potty holding it in. I will also miss the sledding - post tooth coming out and emergency oral surgery actually included. While it was rather horrific, it is also better now and another experience shared with eldest.
But they are back with momma (for now) and I am getting ready for another semester.
I am really excited about my classes this semester, even the bloody math. I am taking abnormal psych, cross culture communications, American sign language, intermediate algebra and language and culture. The last three are four credit classes, making this an eighteen credit semester. I am a little reticent about the load, but ultimately I think it will be pretty easy going.
Abnormal psych is with a rather brilliant instructor and I can expect to write one paper, tests making up the rest of my grade. I am pretty comfortable with my knowledge of abnormal psych going into this class, so I don't expect any problems with tests and most regular readers of my blog know how I feel about papers...For those who don't - I bloody well love writing papers.
Cross culture communications is an online class - something I have never managed to deal with well before. But the instructor is my instructor for interpersonal communications and he made it clear that he is available personally and that he not only has message board discussions, but actually takes part in them. And most excitingly, there are only two tests (IIRC) and the rest of the grade is pretty much wrapped up in three - yes three papers!!!
I am taking intermediate algebra with the same instructor who taught my remedial algebra class and have every confidence that this will be just as great as that was. He was very instrumental in helping me understand concepts that I have had a totally shit time with in the past. He also is very available before and after class, as well as during rather more extensive office hours than a lot of instructors.
American sign is going to be pretty awesome - I actually dropped it last semester, after a couple of sessions for personal reasons, but have every confidence that this will be a great experience. The instructor is great and given my limited experience with her, someone I can totally deal with. She is very pleasant, very warm - without being saccharine, at the same time she is also very strict - a combination I am very fond of.
Language and culture is something I am really looking forward to for several reasons. First and foremost, I am really looking forward to the instructor - I would have taken any class she happened to be teaching this semester. She is the head of the humanities department and there are several things that I am interested in discussing with her - things she has a fair expertise in. And joy of joys, the only class she is teaching this semester is something I very much wanted to take. I am approaching the study of language from a very science oriented perspective - I think it will be valuable to look at it from a humanities perspective, extremely valuable really. I have been reading Terrence Deacon, who among many other things makes a solid case for approaching symbols/language/icons from a broader angle than science really allows for, when engaging the study of language and cognitive/neurological evolution.
And honestly, I have to admit that I am excited about having the opportunity to write a couple of papers in MLA. There is something rather relaxing about the MLA format - not to say that I don't appreciate APA - I do. But I will totally admit to being something of a whore when it comes to writing styles and there is just something rather sexy about MLA...
With all of my paper writing this semester, I am hoping I will be encouraged to write more blogposts - though they will be rather topical to the papers I happen to be working on at a given point. I know that we will get the parameters for our communication papers within the first week - so those will probably be the first ones that I hit on. I also expect to get the psych paper parameters early on as well. I am not all that sure when the humanities paper parameters will come out, but don't expect them until a specified time before they are due. The paper for sign-language will be available right away, but we won't have the background for it until we are well into the semester (I believe that one might be MLA too!!!).
All in all, I am really looking forward to the upcoming semester. It looks out to be totally big fun and excitement through and through (ok, so I am rather less excited about math, but still)...Good times will be had by all!!!
But they are back with momma (for now) and I am getting ready for another semester.
I am really excited about my classes this semester, even the bloody math. I am taking abnormal psych, cross culture communications, American sign language, intermediate algebra and language and culture. The last three are four credit classes, making this an eighteen credit semester. I am a little reticent about the load, but ultimately I think it will be pretty easy going.
Abnormal psych is with a rather brilliant instructor and I can expect to write one paper, tests making up the rest of my grade. I am pretty comfortable with my knowledge of abnormal psych going into this class, so I don't expect any problems with tests and most regular readers of my blog know how I feel about papers...For those who don't - I bloody well love writing papers.
Cross culture communications is an online class - something I have never managed to deal with well before. But the instructor is my instructor for interpersonal communications and he made it clear that he is available personally and that he not only has message board discussions, but actually takes part in them. And most excitingly, there are only two tests (IIRC) and the rest of the grade is pretty much wrapped up in three - yes three papers!!!
I am taking intermediate algebra with the same instructor who taught my remedial algebra class and have every confidence that this will be just as great as that was. He was very instrumental in helping me understand concepts that I have had a totally shit time with in the past. He also is very available before and after class, as well as during rather more extensive office hours than a lot of instructors.
American sign is going to be pretty awesome - I actually dropped it last semester, after a couple of sessions for personal reasons, but have every confidence that this will be a great experience. The instructor is great and given my limited experience with her, someone I can totally deal with. She is very pleasant, very warm - without being saccharine, at the same time she is also very strict - a combination I am very fond of.
Language and culture is something I am really looking forward to for several reasons. First and foremost, I am really looking forward to the instructor - I would have taken any class she happened to be teaching this semester. She is the head of the humanities department and there are several things that I am interested in discussing with her - things she has a fair expertise in. And joy of joys, the only class she is teaching this semester is something I very much wanted to take. I am approaching the study of language from a very science oriented perspective - I think it will be valuable to look at it from a humanities perspective, extremely valuable really. I have been reading Terrence Deacon, who among many other things makes a solid case for approaching symbols/language/icons from a broader angle than science really allows for, when engaging the study of language and cognitive/neurological evolution.
And honestly, I have to admit that I am excited about having the opportunity to write a couple of papers in MLA. There is something rather relaxing about the MLA format - not to say that I don't appreciate APA - I do. But I will totally admit to being something of a whore when it comes to writing styles and there is just something rather sexy about MLA...
With all of my paper writing this semester, I am hoping I will be encouraged to write more blogposts - though they will be rather topical to the papers I happen to be working on at a given point. I know that we will get the parameters for our communication papers within the first week - so those will probably be the first ones that I hit on. I also expect to get the psych paper parameters early on as well. I am not all that sure when the humanities paper parameters will come out, but don't expect them until a specified time before they are due. The paper for sign-language will be available right away, but we won't have the background for it until we are well into the semester (I believe that one might be MLA too!!!).
All in all, I am really looking forward to the upcoming semester. It looks out to be totally big fun and excitement through and through (ok, so I am rather less excited about math, but still)...Good times will be had by all!!!
Wednesday, December 16, 2009
Adolescents and Addiction
This is my paper on adolescents and addiction. The paper in format with bibliography is available here. I will try to get the next post about talking to kids about drugs up over the next few days. I will also be posting my communications paper on genderism and homophobia, probably tomorrow.
According to the 2008 National Survey of Drug Use and Health, a full 9.3% of youths between the ages of 12 and 17 were current illicit drug users (SAMSHA, 2009). According to the same report the rate of binge drinking in the same age group, was 8.8%, a rate that climbs to 17.2% of 16 and 17 year olds (SAMSHA, 2009). This rate of current illicit drug use indicates a very serious problem in youth today, especially when taken in the context that there is an increasing problem with drug use initiation starting as young as ten years old. Binge drinking is generally considered substance abuse, regular binge drinking is a sign that a given individual is very likely addicted to alcohol.
Substance use in this age group may be correlated with an orientation towards risk taking, arrests, less education, pregnancy and long term substance abuse problems. Even worse, substance use at this age increases the likelihood of psychopathology and stunted neurological development (Lopez, Schwartz, Campo & Pantin, 2008). Although not all adolescent substance use will qualify as addiction, it very often leads to addiction later in life. Regular adolescent substance use often does qualify as addiction.
Dr. Dodes notes that “Addictions are in the mainstream of the human condition (Dodes, 2003, p. 185). Indeed Dr. Dodes asserts that the major difference between addictions and normal human compulsions is the harm and degree of harm caused by the compulsion. Dr. Khantzian and Dr. Albanese assert that the core of most addictions is a desire to self-medicate. They make a very strong case to support the notion that people use substances to compensate for unpleasant feelings, emotions or life situations (Khantzian & Albanese, 2008). Harm reduction pioneer, Dr. Denning with Little and Glickman asserts that there are many reasons people develop what they prefer to call “substance use problems.” They understand that not all substance use is the same and not all of it is abuse or addiction. Most importantly, they believe that the necessary approach is largely determined by the individual (Denning et al.,2004).
Adolescence involves many other factors that have a significant effect on addiction and substance abuse and treatment. With youth comes the developing brain and a lot more mental plasticity. This age range is also the time when many neurological disorders tend to surface. Finally, adolescence is also a time of hormonal changes
that often result in a great deal of emotional and physical distress. When the general life changes of being a teenager are factored in, adolescence significantly complicates an already complicated mental illness (Griswold, Aranoff, Kernan & Khan, 2008).
According to the detailed tables of the 2008 National Survey on Drug Use and Health, 39% of adolescents will have used an illicit drug and 60% will have used alcohol (SAMHSA, 2008). It is clear that not all youth who try illicit drugs and alcohol become regular users or substance abusers. Most adolescents who use substances either use it once or rarely. While no substance use among children and adolescents is safe, it is important to recognize that most youth who try illicit drugs or alcohol will not become habitual substance
users.
There are many dangers to non-regular drug use among children and adolescents. Intoxication often leads to impaired judgment and increased risk taking. The most common risks include attempting to drive under the influence and unsafe sexual behavior which in turn can lead to pregnancy and/or sexually transmitted infections (Wood, Drolet, Fertro, Synovitz & Wood, 2002). Another risk is that youth who use drugs infrequently will increase substance use either during adolescents or in adulthood (Lopez et al., 2008). There is also a significant risk that their substance use will escalate into increasingly risky substances. Finally, there is also the risk of death through overdose, allergic reaction or in the case of single
standard doses of MDMA, by mechanisms we simply don't understand at this time (Kaye, Darke & Duflou, 2009).
Dangerous Use and Abuse
By age 17, 4.6% of youths will have a substance use disorder involving illicit drugs, while 4.9% will have a substance abuse disorder involving alcohol. A full 60-75% of child and adolescent substance abusers will also be diagnosed with another mental disorder (Griswald et al., 2008; SAMHSA, 2008). It is also important to note
that while there is some crossover between illicit drug addiction and alcohol addiction, it is minimal. When the crossover is taken out of the equation 7.6% of youth, 17 and under have or have had substance use disorders (SAMHSA, 2008). To put this in context, in a group of 500 17 year old adolescents, it is very likely that 38 of those kids have experience with substance abuse disorders.
Although figures have gone down significantly since the late 1990s, they have gone down from a significant spike that started in the 1980s (SAMHSA, 2009). There is little indication that there will be a significant drop in substance abuse among youth any time soon. More importantly, the most recent fad in illicit drug use among
children and adolescents is the use of pharmaceuticals (Wood et al., 2002). The use of pharmaceuticals is particularly dangerous, because even youth who have expressed a refusal to use other illicit drugs are often willing to try pharmaceuticals in a recreational context (SAMHSA, 2009). Another serious problem is heroin use, which saw a spike in use from .5% in 1995, to steady out at 1.6% in 2001 (Hopfer, Kurhi, Crowley & Hooks, 2002) and changing little with a rate of 1.5% in 2007 and 2008(SAMHSA, 2008).
Both heroin and recreational pharmaceutical use are particularly dangerous. The potency of heroin is extremely unreliable, which creates an elevated risk of overdose leading hospitalization and death (Merscham, Leeuwen & McGuire, 2009; Hopfer et al., 2002). The danger of pharmaceutical use and abuse, is that pharmaceuticals are usually mixed with other pharmaceuticals and sometimes alcohol
(SAMHSA, 2009). This is particularly dangerous because even if it is a child's first time, the wrong combination can cause serious injury and death. Another significant problem with pharmaceuticals, is that their use is likely more prevalent among children who are not considered “at risk” than any other drug except for alcohol (Johnston, O'Malley, Bachman & Schulenberg, 2009).
risk for substance use disorders. The primary factor is often described as peer pressure, but this is not an accurate description of the actual social pressures involved in initiating substance use. For most substances, the actual peer pressure is to stay away from drugs (Johnston et al., 2009; NIDA, 2003; Wood et al., 2002). Other factors that significantly elevate the risk of substance use and abuse among children and adolescents include socioeconomic status, parental involvement, parental substance use issues, parental abuse, early aggressive behavior and comorbidity (Callaghan, Tavares, Taylor & Veldhuizen, 2007; NIDA, 2003).
Social Pressure
Although general peer pressure seems to be moving in the direction of pressure not to use illicit drugs and even alcohol, it is important to explore the role that social pressures play in child and adolescent drug use. Because the general direction of peer pressure actively discourages illicit drug use, it may be causing some backlash among kids who feel they have been alienated from their general peer group (Griswald et al,, 2008; Dodes, 2003). Adolescents often feel a compulsion to rebel against not only their parents, but against people who ignore them, harass them or whom they perceive are against them in some way (Denning et al., 2004). This creates an inverse sort of peer pressure, directly countering the general
pressure not to use illicit drugs and/or alcohol. While this alone may not initiate substance use, there is more to the equation of social pressure.
Young people who feel like outcasts, tend to congregate with other kids who are like them. Many of the reasons that kids become outcast are factors that also put them at an elevated risk for substance use disorders (Denning et al., 2004; Khantzian & Albanese, 2008), creating a conjunction of elevated risk and inverse social pressure. Thus in an of itself, being a social outcast becomes a significant
risk factor. Kids who have no other elevated risk factors, who become social outcasts are at an elevated risk for that reason alone.
There are other social pressures that come into play. As kids get older, whether they have elevating risk factors or not, become increasingly likely to use alcohol. It is highly available and many children and adolescents witness their parents drinking alcohol, whether the parents drink a lot or are moderate drinkers. Thus while there may still be a general pressure to avoid illicit drugs, as children age the general peer pressure to avoid alcohol fades and often reverses into pressure to drink (Johnston et al,. 2009; SAMHSA, 2008; SAMHSA, 2009).
There is also often peer pressure involved in the abuse of pharmaceutical medications. This is complicated by many children not really perceiving recreational pharmaceutical drug use as being similar to other recreational drug use and abuse (Johnston et al,. 2009). Children and adolescents who sincerely believe that recreational drug use is bad, have no compunctions against the recreational use of pharmaceuticals. Worse, the younger a child is, the more likely it becomes that their initial drug use will be pharmaceuticals. In 2008, more than 5.4% of children ages 12-13 reported having engaged in the recreational use of pharmaceuticals.
Breaking the drug classes down, 5.4% reported using psychotheraputic drugs, 4.5% reported using pain relievers and almost 1% reported using stimulants (SAMHSA, 2008).
C0m0rbidity
There is a great deal of evidence to support the assertion that people with attention deficit disorders are significantly more likely to become substance abusers, than the general population. The comorbidity of ADHD and substance abuse is estimated between 30% and 50% (Gordon, Trulak & Troncale, 2004). While there is no significant difference in the rates of alcohol abuse, persons with ADHD are at significantly higher risk for abusing other drugs and other drugs plus alcohol. The rates of lifetime substance use disorders among persons with ADHD is 52%, compared to persons without ADHD at 27% (Biederman et al, 1995).
The comorbidity of substance use disorders and mood disorders is also very common. About 70% of people diagnosed with bipolar, for example, are tobacco users (NIDA, 2008). An National Institute on Alcohol Abuse and Alcoholism sponsored study found a 40% comorbidity of mood disorders, among people who sought treatment for a substance use disorder (Grant et al., 2004). Though there are still a lot of
questions to be answered about the relationship between substance use disorders and mood disorders, there is no question that mood disorders significantly increase the risk of substance abuse and addiction.
In aggregate, it is estimated that there is somewhere between a 60% and 70% comorbidity between adolescent substance use disorders and other mental illness (Griswold, 2008). While there are some questions about potential misdiagnosis due to comorbidity, the statistics are too significant to be ignored. There is no doubt that there is an extremely significant correlation between substance abuse disorders and other mental disorders.
Family
Parents and family play a very important role in determining whether a child or adolescent will develop a substance use disorder. Parents have a profound impact on their children. Many neurological disorders have a very strong familial connection, especially ADHD (Biederman et al., 2008), which is a major risk factor. The children
of parents with substance use disorders often develop substance use disorders themselves (SAMHSA, 2008). Children and adolescents from families that are economically disadvantaged have an elevated risk for substance use disorders (NIDA, 2003). Children and adolescents who do not have much interaction with their parents also have an elevated risk for substance use disorders (Denning et al., 2004;
Dodes, 2003; Johnston et al., 2009; Khantzian & Albanese, 2008; NIDA, 2003).
Nixon, Mansfield and Thoms did a study of public service announcements that suggested that providing instructional materials for in class activities following the viewing of videos would likely increase the efficacy. While their study was limited in scope, it was more intensive than many studies into the efficacy of substance use prevention measures. They also suggested that targeting youth with specific risk factors and public service announcements that were culturally specific would likely increase the effectiveness of such materials (Nixon, Mansfield & Thoms, 2008).
There is evidence that would suggest that culture specific substance use prevention measures might reduce the incidence of substance use disorders. Developing and implementing prevention programs for the classroom that are specified for the cultures represented, would expose children and adolescents to a variety of programs, while also responding to culturally specific substance use trends (NIDA, 2003).
There is also evidence that peer counseling programs can be an effective preventative tool. Programs that include mentoring are likely to be even more effective, as they discourage adolescent mentors from engaging in behaviors that they are trying to discourage younger children from engaging in. Evidence would suggest that adolescents are significantly more likely to listen to information
about substance use and sexuality that comes from their peers, than when it comes from teachers (Whiston & Sexton, 1998).
substance use free peer group is also very important (Griswold, 2008). It is also important to approach the situation realistically and understand that while sobriety is the ultimate goal, a harm reduction approach is not inappropriate. Complete sobriety may not happen overnight, especially if acute dependence is a factor.
Substance use disorders are often a chronic condition and in recognizing that, an implicit goal of reduction (Ie. Using only at specific times) and management may be the best short term goal (Bukstein et al., 2005; Denning et al., 2004).
Given the significant level of comorbidity, an intensive psychological assessment should be done as early in the intervention process as possible (Dodes, 2003; Griswold, 2008; Khantzian & Albanese, 2008). There is an elevated risk for suicide or other extreme responses to the intervention process (Denning et al., 2004). There is also the possibility that medication will be indicated and with certain disorders, such as bipolar type one. Abstinence from the substance of abuse may trigger an acute response without a pharmaceutical alternative (Khantzian & Albanese, 2008). In such cases there may be very little time in which to make an assessment and determine whether psychopharmacology may be appropriate (Griswald, 2008).
Unfortunately, there are many different types of addiction and substance abuse, each presenting its own unique challenges. Once the intervention has been initiated it is up to the juvenile's doctor, therapist and family to decide on the best course of action (Denning et al., 2004). It is up the the parent's, the child or adolescent
and the professionals to develop a set of goals that the child must stick to. Failure to meet specific goals must be explained by the child or adolescent and appropriate actions must be taken (Dodes, 2002; Khantzian & Albanese, 2008). If the juvenile is on medication, the medication must be closely monitored by parents (Griswald, 2008).
The most important consideration for dealing with an addict or substance abuser, is that they are still a human being. Compassion and empathy are a critical component to recovery. Disrespect and dehumanizing will not help recovery progress. Recovery does not happen because of concepts such as “tough love,”it sometimes happens in spite of those methods (Denning et al., 2004; Dodes, 2002; Khantzian & Albanese, 2008). It is important to remember that a child or adolescent with a substance use disorder is still a child.
According to the 2008 National Survey of Drug Use and Health, a full 9.3% of youths between the ages of 12 and 17 were current illicit drug users (SAMSHA, 2009). According to the same report the rate of binge drinking in the same age group, was 8.8%, a rate that climbs to 17.2% of 16 and 17 year olds (SAMSHA, 2009). This rate of current illicit drug use indicates a very serious problem in youth today, especially when taken in the context that there is an increasing problem with drug use initiation starting as young as ten years old. Binge drinking is generally considered substance abuse, regular binge drinking is a sign that a given individual is very likely addicted to alcohol.
Substance use in this age group may be correlated with an orientation towards risk taking, arrests, less education, pregnancy and long term substance abuse problems. Even worse, substance use at this age increases the likelihood of psychopathology and stunted neurological development (Lopez, Schwartz, Campo & Pantin, 2008). Although not all adolescent substance use will qualify as addiction, it very often leads to addiction later in life. Regular adolescent substance use often does qualify as addiction.
Defining Addiction
Put very basically, addiction is the habitual use of a substance or engaging in a behavior that causes a certain level of harm and which the addict cannot control. That is not a very satisfactory definition however, because it is very vague and ultimately fails to address the understanding that not all addiction is the same (Denning, Little & Glickman, 2004; Dodes, 2003; Khantzian & Albanese, 2008). Although this paper is focusing on substance abuse and addiction, some addictions are not substance based. Some addictions result from unrelated neurological disorders, such as bipolar disorder, schizophrenia, depression and quite commonly attention deficit disorders. Other addictions are the result of a neurochemical propensity for addiction. Still others are simply the result of crisis. This is just a small number of reasons addictions happen. With all of these different causes, it is unreasonable to assume that there is one solution.Dr. Dodes notes that “Addictions are in the mainstream of the human condition (Dodes, 2003, p. 185). Indeed Dr. Dodes asserts that the major difference between addictions and normal human compulsions is the harm and degree of harm caused by the compulsion. Dr. Khantzian and Dr. Albanese assert that the core of most addictions is a desire to self-medicate. They make a very strong case to support the notion that people use substances to compensate for unpleasant feelings, emotions or life situations (Khantzian & Albanese, 2008). Harm reduction pioneer, Dr. Denning with Little and Glickman asserts that there are many reasons people develop what they prefer to call “substance use problems.” They understand that not all substance use is the same and not all of it is abuse or addiction. Most importantly, they believe that the necessary approach is largely determined by the individual (Denning et al.,2004).
Adolescence involves many other factors that have a significant effect on addiction and substance abuse and treatment. With youth comes the developing brain and a lot more mental plasticity. This age range is also the time when many neurological disorders tend to surface. Finally, adolescence is also a time of hormonal changes
that often result in a great deal of emotional and physical distress. When the general life changes of being a teenager are factored in, adolescence significantly complicates an already complicated mental illness (Griswold, Aranoff, Kernan & Khan, 2008).
Adolescent Substance Abuse
Normative UseAccording to the detailed tables of the 2008 National Survey on Drug Use and Health, 39% of adolescents will have used an illicit drug and 60% will have used alcohol (SAMHSA, 2008). It is clear that not all youth who try illicit drugs and alcohol become regular users or substance abusers. Most adolescents who use substances either use it once or rarely. While no substance use among children and adolescents is safe, it is important to recognize that most youth who try illicit drugs or alcohol will not become habitual substance
users.
There are many dangers to non-regular drug use among children and adolescents. Intoxication often leads to impaired judgment and increased risk taking. The most common risks include attempting to drive under the influence and unsafe sexual behavior which in turn can lead to pregnancy and/or sexually transmitted infections (Wood, Drolet, Fertro, Synovitz & Wood, 2002). Another risk is that youth who use drugs infrequently will increase substance use either during adolescents or in adulthood (Lopez et al., 2008). There is also a significant risk that their substance use will escalate into increasingly risky substances. Finally, there is also the risk of death through overdose, allergic reaction or in the case of single
standard doses of MDMA, by mechanisms we simply don't understand at this time (Kaye, Darke & Duflou, 2009).
Dangerous Use and Abuse
By age 17, 4.6% of youths will have a substance use disorder involving illicit drugs, while 4.9% will have a substance abuse disorder involving alcohol. A full 60-75% of child and adolescent substance abusers will also be diagnosed with another mental disorder (Griswald et al., 2008; SAMHSA, 2008). It is also important to note
that while there is some crossover between illicit drug addiction and alcohol addiction, it is minimal. When the crossover is taken out of the equation 7.6% of youth, 17 and under have or have had substance use disorders (SAMHSA, 2008). To put this in context, in a group of 500 17 year old adolescents, it is very likely that 38 of those kids have experience with substance abuse disorders.
Although figures have gone down significantly since the late 1990s, they have gone down from a significant spike that started in the 1980s (SAMHSA, 2009). There is little indication that there will be a significant drop in substance abuse among youth any time soon. More importantly, the most recent fad in illicit drug use among
children and adolescents is the use of pharmaceuticals (Wood et al., 2002). The use of pharmaceuticals is particularly dangerous, because even youth who have expressed a refusal to use other illicit drugs are often willing to try pharmaceuticals in a recreational context (SAMHSA, 2009). Another serious problem is heroin use, which saw a spike in use from .5% in 1995, to steady out at 1.6% in 2001 (Hopfer, Kurhi, Crowley & Hooks, 2002) and changing little with a rate of 1.5% in 2007 and 2008(SAMHSA, 2008).
Both heroin and recreational pharmaceutical use are particularly dangerous. The potency of heroin is extremely unreliable, which creates an elevated risk of overdose leading hospitalization and death (Merscham, Leeuwen & McGuire, 2009; Hopfer et al., 2002). The danger of pharmaceutical use and abuse, is that pharmaceuticals are usually mixed with other pharmaceuticals and sometimes alcohol
(SAMHSA, 2009). This is particularly dangerous because even if it is a child's first time, the wrong combination can cause serious injury and death. Another significant problem with pharmaceuticals, is that their use is likely more prevalent among children who are not considered “at risk” than any other drug except for alcohol (Johnston, O'Malley, Bachman & Schulenberg, 2009).
Risk Factors
There are many factors that can determine whether a child is at an elevatedrisk for substance use disorders. The primary factor is often described as peer pressure, but this is not an accurate description of the actual social pressures involved in initiating substance use. For most substances, the actual peer pressure is to stay away from drugs (Johnston et al., 2009; NIDA, 2003; Wood et al., 2002). Other factors that significantly elevate the risk of substance use and abuse among children and adolescents include socioeconomic status, parental involvement, parental substance use issues, parental abuse, early aggressive behavior and comorbidity (Callaghan, Tavares, Taylor & Veldhuizen, 2007; NIDA, 2003).
Social Pressure
Although general peer pressure seems to be moving in the direction of pressure not to use illicit drugs and even alcohol, it is important to explore the role that social pressures play in child and adolescent drug use. Because the general direction of peer pressure actively discourages illicit drug use, it may be causing some backlash among kids who feel they have been alienated from their general peer group (Griswald et al,, 2008; Dodes, 2003). Adolescents often feel a compulsion to rebel against not only their parents, but against people who ignore them, harass them or whom they perceive are against them in some way (Denning et al., 2004). This creates an inverse sort of peer pressure, directly countering the general
pressure not to use illicit drugs and/or alcohol. While this alone may not initiate substance use, there is more to the equation of social pressure.
Young people who feel like outcasts, tend to congregate with other kids who are like them. Many of the reasons that kids become outcast are factors that also put them at an elevated risk for substance use disorders (Denning et al., 2004; Khantzian & Albanese, 2008), creating a conjunction of elevated risk and inverse social pressure. Thus in an of itself, being a social outcast becomes a significant
risk factor. Kids who have no other elevated risk factors, who become social outcasts are at an elevated risk for that reason alone.
There are other social pressures that come into play. As kids get older, whether they have elevating risk factors or not, become increasingly likely to use alcohol. It is highly available and many children and adolescents witness their parents drinking alcohol, whether the parents drink a lot or are moderate drinkers. Thus while there may still be a general pressure to avoid illicit drugs, as children age the general peer pressure to avoid alcohol fades and often reverses into pressure to drink (Johnston et al,. 2009; SAMHSA, 2008; SAMHSA, 2009).
There is also often peer pressure involved in the abuse of pharmaceutical medications. This is complicated by many children not really perceiving recreational pharmaceutical drug use as being similar to other recreational drug use and abuse (Johnston et al,. 2009). Children and adolescents who sincerely believe that recreational drug use is bad, have no compunctions against the recreational use of pharmaceuticals. Worse, the younger a child is, the more likely it becomes that their initial drug use will be pharmaceuticals. In 2008, more than 5.4% of children ages 12-13 reported having engaged in the recreational use of pharmaceuticals.
Breaking the drug classes down, 5.4% reported using psychotheraputic drugs, 4.5% reported using pain relievers and almost 1% reported using stimulants (SAMHSA, 2008).
C0m0rbidity
There is a great deal of evidence to support the assertion that people with attention deficit disorders are significantly more likely to become substance abusers, than the general population. The comorbidity of ADHD and substance abuse is estimated between 30% and 50% (Gordon, Trulak & Troncale, 2004). While there is no significant difference in the rates of alcohol abuse, persons with ADHD are at significantly higher risk for abusing other drugs and other drugs plus alcohol. The rates of lifetime substance use disorders among persons with ADHD is 52%, compared to persons without ADHD at 27% (Biederman et al, 1995).
The comorbidity of substance use disorders and mood disorders is also very common. About 70% of people diagnosed with bipolar, for example, are tobacco users (NIDA, 2008). An National Institute on Alcohol Abuse and Alcoholism sponsored study found a 40% comorbidity of mood disorders, among people who sought treatment for a substance use disorder (Grant et al., 2004). Though there are still a lot of
questions to be answered about the relationship between substance use disorders and mood disorders, there is no question that mood disorders significantly increase the risk of substance abuse and addiction.
In aggregate, it is estimated that there is somewhere between a 60% and 70% comorbidity between adolescent substance use disorders and other mental illness (Griswold, 2008). While there are some questions about potential misdiagnosis due to comorbidity, the statistics are too significant to be ignored. There is no doubt that there is an extremely significant correlation between substance abuse disorders and other mental disorders.
Family
Parents and family play a very important role in determining whether a child or adolescent will develop a substance use disorder. Parents have a profound impact on their children. Many neurological disorders have a very strong familial connection, especially ADHD (Biederman et al., 2008), which is a major risk factor. The children
of parents with substance use disorders often develop substance use disorders themselves (SAMHSA, 2008). Children and adolescents from families that are economically disadvantaged have an elevated risk for substance use disorders (NIDA, 2003). Children and adolescents who do not have much interaction with their parents also have an elevated risk for substance use disorders (Denning et al., 2004;
Dodes, 2003; Johnston et al., 2009; Khantzian & Albanese, 2008; NIDA, 2003).
Prevention
There are many ideas about preventing juvenile substance use disorders. Public service announcements, parental education, peer counseling, large scale local and national government programs in public schools, school assemblies, “scared straight” programs that introduce at risk youth to prisoners, and myriad after school programs. A significant problem with all of these measures, is that there is little evidence to support the efficacy of most of these preventative measures. The studies that have been done would suggest that certain changes to current approaches might be warranted.Nixon, Mansfield and Thoms did a study of public service announcements that suggested that providing instructional materials for in class activities following the viewing of videos would likely increase the efficacy. While their study was limited in scope, it was more intensive than many studies into the efficacy of substance use prevention measures. They also suggested that targeting youth with specific risk factors and public service announcements that were culturally specific would likely increase the effectiveness of such materials (Nixon, Mansfield & Thoms, 2008).
There is evidence that would suggest that culture specific substance use prevention measures might reduce the incidence of substance use disorders. Developing and implementing prevention programs for the classroom that are specified for the cultures represented, would expose children and adolescents to a variety of programs, while also responding to culturally specific substance use trends (NIDA, 2003).
There is also evidence that peer counseling programs can be an effective preventative tool. Programs that include mentoring are likely to be even more effective, as they discourage adolescent mentors from engaging in behaviors that they are trying to discourage younger children from engaging in. Evidence would suggest that adolescents are significantly more likely to listen to information
about substance use and sexuality that comes from their peers, than when it comes from teachers (Whiston & Sexton, 1998).
Intervention
Parents are an extremely important component to the treatment of juvenile substance use disorders. Children and adolescents with substance use problems are especially vulnerable and need a lot of support from their family and community. Family counseling is especially important, as is parental sobriety. The development of asubstance use free peer group is also very important (Griswold, 2008). It is also important to approach the situation realistically and understand that while sobriety is the ultimate goal, a harm reduction approach is not inappropriate. Complete sobriety may not happen overnight, especially if acute dependence is a factor.
Substance use disorders are often a chronic condition and in recognizing that, an implicit goal of reduction (Ie. Using only at specific times) and management may be the best short term goal (Bukstein et al., 2005; Denning et al., 2004).
Given the significant level of comorbidity, an intensive psychological assessment should be done as early in the intervention process as possible (Dodes, 2003; Griswold, 2008; Khantzian & Albanese, 2008). There is an elevated risk for suicide or other extreme responses to the intervention process (Denning et al., 2004). There is also the possibility that medication will be indicated and with certain disorders, such as bipolar type one. Abstinence from the substance of abuse may trigger an acute response without a pharmaceutical alternative (Khantzian & Albanese, 2008). In such cases there may be very little time in which to make an assessment and determine whether psychopharmacology may be appropriate (Griswald, 2008).
Unfortunately, there are many different types of addiction and substance abuse, each presenting its own unique challenges. Once the intervention has been initiated it is up to the juvenile's doctor, therapist and family to decide on the best course of action (Denning et al., 2004). It is up the the parent's, the child or adolescent
and the professionals to develop a set of goals that the child must stick to. Failure to meet specific goals must be explained by the child or adolescent and appropriate actions must be taken (Dodes, 2002; Khantzian & Albanese, 2008). If the juvenile is on medication, the medication must be closely monitored by parents (Griswald, 2008).
The most important consideration for dealing with an addict or substance abuser, is that they are still a human being. Compassion and empathy are a critical component to recovery. Disrespect and dehumanizing will not help recovery progress. Recovery does not happen because of concepts such as “tough love,”it sometimes happens in spite of those methods (Denning et al., 2004; Dodes, 2002; Khantzian & Albanese, 2008). It is important to remember that a child or adolescent with a substance use disorder is still a child.
Saturday, August 15, 2009
A Fucking Brilliant Time to be Human
It is easy to get caught up in the bad, sometimes outright evil perpetrated by us humans. In just the last 150 years, we have wreaked more destruction than this planet has seen since the dinosaurs went extinct. We still see human rights violations across the globe, sometimes perpetrated by our own "enlightened" governments. In so many ways, us humans kind of suck ass. And in such an ass sucking existence, it is easy to forget the truly wondrous, awe inspiring achievements we have made. It is also easy to forget that many of us are struggling against this ass sucking, to make our home more tolerable, more livable and above all, more humane.
But we are also the people who have managed to cure diseases that were almost certain death and/or maiming, just a scant eighty years ago. We are a people who have managed to find ways to extend the mortality of the general public, even as we have thrown more abuses to our bodies than our ancestors ever dreamed possible. And whatever problems there are for those of us without health insurance, even the poor are able to get unprecedented access to lifesaving medical care - imperfect as that access is.
And we are a people who decided to point a telescope at absolutely nothing, to see what might be there - how fucking brilliant is that? And what we discovered - images that have been traveling towards our position in space, since billions of years before this planet was born of fire, gravity and debris - the very star-stuff that makes up not only this planet, but everything we are and everything we see - every material we work with. Images that help us to comprehend, just a little, of what our universe consists of - billions, upon billions, upon billions of other galaxies. Not solar systems and stars - but fucking galaxies. Numbers that are so staggering, as to be incomprehensible, yet are comprehended just a little, when we look at nothing and notice thousands of galaxies, in just that tiny speck of nothing out there.
We are also the people who managed to send people outside our precious blanket of atmosphere, to walk on an extra-planetary body. That it is our own moon, our own planet's satellite does not detract from the awesome wonder of having sent a human to step foot on another chunk of rock, hurling through space. And we have people up there right now, outside our atmosphere - living and working on a space station of human construction.
And we managed to send vehicles to another planet altogether, to see what is there, learn about one of our close neighbors and see what it looks like up close and personal. We have seen image after image, sent by these probes and seen a landscape that was invisible before, that is not only visible, but has been altered ever so slightly, by our proxy presence there.
We are, to our cores, explorers. We absolutely have to go out and check things out. We simply can't stand not knowing what is around that next bend, what is under that rock - what is at the bottom of that miles deep ocean trench, what is such staggeringly huge distances away from us. We are insatiably curious creatures, with an almost inherent desire to know what there is to know and when we have managed to learn that, we want to know some more. And today, this day, this fraction of a blink of an eye, we are seeing more, learning more - knowing more than ever before and that knowing is coming at us at an accelerated rate.
To think, just moments ago, we were tiny, four legged creatures, trying desperately to evade the smaller scavenger dinosaurs - those old guard rulers of this planet earth, who would shortly be dead and gone. A moment later we were struggling against all odds to survive, to adapt to a constantly changing earth - spending less time in trees and enough time walking in the ground, that our hind hands turned into feet and lost their opposable digits. Moments after that, our brains growing with our increasingly protein rich diet, we started to communicate verbally. In a mere blink of an eye, we went from these tiny, innocuous creatures, to what we are today - so insignificant and small - our entire existence an infinitesimal footnote in the history of our infinitesimal planet, in the backwater of our tiny little galaxy.
And yet we are here!!! Much like the Whos, on that speck of dust, in Seuss's Horton Hears a Who. We shout out to our galaxy and to our universe that we are here, with an unspoken, "we will soon be there. We are no longer bound to this single piece of rock, this starship Earth. We are going places and somehow, someday, if we survive, we will go further and further - because we are fucking human and that is what humans do. We want to know, we need to know, we absolutely must know - more.
If we manage to survive, imagine what we will be in another blink of the eye - where we will go, what we will become. Dream, in this universe of virtually infinite wonder and beauty, of what tomorrow may look like - that you may truly want for a tomorrow, another blink of the eye. Dream of what our ancestors may be - as alien as we would be to our own early hominid ancestors? Dream of tomorrows without limit, so that when you focus on today, you have a purpose.
Dream, because you are human and humans must explore - even the places and times that can only be explored in our dreams
But we are also the people who have managed to cure diseases that were almost certain death and/or maiming, just a scant eighty years ago. We are a people who have managed to find ways to extend the mortality of the general public, even as we have thrown more abuses to our bodies than our ancestors ever dreamed possible. And whatever problems there are for those of us without health insurance, even the poor are able to get unprecedented access to lifesaving medical care - imperfect as that access is.
And we are a people who decided to point a telescope at absolutely nothing, to see what might be there - how fucking brilliant is that? And what we discovered - images that have been traveling towards our position in space, since billions of years before this planet was born of fire, gravity and debris - the very star-stuff that makes up not only this planet, but everything we are and everything we see - every material we work with. Images that help us to comprehend, just a little, of what our universe consists of - billions, upon billions, upon billions of other galaxies. Not solar systems and stars - but fucking galaxies. Numbers that are so staggering, as to be incomprehensible, yet are comprehended just a little, when we look at nothing and notice thousands of galaxies, in just that tiny speck of nothing out there.
We are also the people who managed to send people outside our precious blanket of atmosphere, to walk on an extra-planetary body. That it is our own moon, our own planet's satellite does not detract from the awesome wonder of having sent a human to step foot on another chunk of rock, hurling through space. And we have people up there right now, outside our atmosphere - living and working on a space station of human construction.
And we managed to send vehicles to another planet altogether, to see what is there, learn about one of our close neighbors and see what it looks like up close and personal. We have seen image after image, sent by these probes and seen a landscape that was invisible before, that is not only visible, but has been altered ever so slightly, by our proxy presence there.
We are, to our cores, explorers. We absolutely have to go out and check things out. We simply can't stand not knowing what is around that next bend, what is under that rock - what is at the bottom of that miles deep ocean trench, what is such staggeringly huge distances away from us. We are insatiably curious creatures, with an almost inherent desire to know what there is to know and when we have managed to learn that, we want to know some more. And today, this day, this fraction of a blink of an eye, we are seeing more, learning more - knowing more than ever before and that knowing is coming at us at an accelerated rate.
To think, just moments ago, we were tiny, four legged creatures, trying desperately to evade the smaller scavenger dinosaurs - those old guard rulers of this planet earth, who would shortly be dead and gone. A moment later we were struggling against all odds to survive, to adapt to a constantly changing earth - spending less time in trees and enough time walking in the ground, that our hind hands turned into feet and lost their opposable digits. Moments after that, our brains growing with our increasingly protein rich diet, we started to communicate verbally. In a mere blink of an eye, we went from these tiny, innocuous creatures, to what we are today - so insignificant and small - our entire existence an infinitesimal footnote in the history of our infinitesimal planet, in the backwater of our tiny little galaxy.
And yet we are here!!! Much like the Whos, on that speck of dust, in Seuss's Horton Hears a Who. We shout out to our galaxy and to our universe that we are here, with an unspoken, "we will soon be there. We are no longer bound to this single piece of rock, this starship Earth. We are going places and somehow, someday, if we survive, we will go further and further - because we are fucking human and that is what humans do. We want to know, we need to know, we absolutely must know - more.
If we manage to survive, imagine what we will be in another blink of the eye - where we will go, what we will become. Dream, in this universe of virtually infinite wonder and beauty, of what tomorrow may look like - that you may truly want for a tomorrow, another blink of the eye. Dream of what our ancestors may be - as alien as we would be to our own early hominid ancestors? Dream of tomorrows without limit, so that when you focus on today, you have a purpose.
Dream, because you are human and humans must explore - even the places and times that can only be explored in our dreams
Monday, July 27, 2009
Autism, Racism, Menstruation and More!!!!
You may have noticed the last couple of posts happen to be rather innocuously and generically titled "Library Unit X: Cultural Anthropology. As I was going through and finishing these short papers, it occurred to me that the assignment as given, produces short papers that are not unlike blog posts - in fact they are a lot like blog posts. Or at least they are like blog posts that I would produce if I didn't say fuck with some regularity...
The assignment was to read seven articles and write a two page paper about each, summarizing the article, tying it to something we discussed in class and providing our response to it. It was not meant to be formal, instead being more about how each article made us feel - what we gleaned from it, how it changed our perspective or if it did. As it occurred to me that I was writing papers that would make decent blog posts, it also occurred to me that I am exceedingly busy and unable to write much. So I have a total of seven of these papers and wanted to throw this post in there to make sure that there was something to reference them, that has a less generic title - especially before I post the next one, which happens to delve into a rather more important issue.
I didn't make the next one the first one I posted, because I wanted to have a moment to draw some attention to it and the fact that this anthropology class has done rather a lot to further alter my attitude about certain aspects of primitive cultures and the West. I have long held the understanding that primitive does not equal savage and uncivilized. But that attitude has evolved considerably over the course of this cultural anthropology class. Because I am learning that one, these primitives are in many ways far more "civilized" than those of us in the West and two, I am not nearly as "enlightened" and close to free of bigotry as I thought I was. This is not to say that I didn't accept that I had some underlying bigoted undertones - it is a rare person in the West who doesn't. But I thought I was pretty good about that sort of thing.
In the next post, which will probably go up later this morning or sometime this afternoon, I will delve into the systemic bigotry of Western society. In the paper, I was not terribly clear and wanted to clear it up here, just as I intend to clear it with my instructor. When I describe the arrogant culturalist tendencies of Westerners - I am absolutely not trying to exclude myself from that picture. Because even though this class has sent me a little bit further in the right direction, I am a product of my culture and all that entails - the good, the bad and the exceedingly arrogant.
The assignment was to read seven articles and write a two page paper about each, summarizing the article, tying it to something we discussed in class and providing our response to it. It was not meant to be formal, instead being more about how each article made us feel - what we gleaned from it, how it changed our perspective or if it did. As it occurred to me that I was writing papers that would make decent blog posts, it also occurred to me that I am exceedingly busy and unable to write much. So I have a total of seven of these papers and wanted to throw this post in there to make sure that there was something to reference them, that has a less generic title - especially before I post the next one, which happens to delve into a rather more important issue.
I didn't make the next one the first one I posted, because I wanted to have a moment to draw some attention to it and the fact that this anthropology class has done rather a lot to further alter my attitude about certain aspects of primitive cultures and the West. I have long held the understanding that primitive does not equal savage and uncivilized. But that attitude has evolved considerably over the course of this cultural anthropology class. Because I am learning that one, these primitives are in many ways far more "civilized" than those of us in the West and two, I am not nearly as "enlightened" and close to free of bigotry as I thought I was. This is not to say that I didn't accept that I had some underlying bigoted undertones - it is a rare person in the West who doesn't. But I thought I was pretty good about that sort of thing.
In the next post, which will probably go up later this morning or sometime this afternoon, I will delve into the systemic bigotry of Western society. In the paper, I was not terribly clear and wanted to clear it up here, just as I intend to clear it with my instructor. When I describe the arrogant culturalist tendencies of Westerners - I am absolutely not trying to exclude myself from that picture. Because even though this class has sent me a little bit further in the right direction, I am a product of my culture and all that entails - the good, the bad and the exceedingly arrogant.
Wednesday, July 22, 2009
Loving Book Memes Even More...
Update HERE!!!!
It turns out there are some very self assured motherfuckers on Cath@vwxynot?'s blog, who think that because they didn't fall out of a frakking sailboat, that they haven't been tagged with this meme!!!11!!!1! So chall (I don't care if you're a godless fucking Swede - we still want that list, even if half of it won't be in Americanish), T. Joseph and Mrs. Ch - you are now officially fucking tagged!!!!111!!!!
There have been some interesting discussion arising from this little book meme that we managed to bust out of the confines of FaceBook (which I have managed to get into again - but only because I got "friended" by someone I don't think I've seen or heard from since about 4th grade)...Stephanie wonders why so many of the folks who have outies instead of innies, seem to like 1984, while it was distinctly missing from the lists of most of the innie types. And also...Why The Fuck Does Anyone like that shit!!!!111@!!?????@???!?//!! (Ok, she didn't put it quite like that, because that would be more like something I would do, not Stephanie, but still...
And in comments there, Greg was lamenting the fact that so many people decided to forgo the rules - as he saw it. Only he wasn't talking about my horrifying decision to go all ADHD, when reading his initial post and making a rather longer list. He felt that folks were listing books that might not have had that much of an impact. He gave a three part criteria - A. did I read this a long time ago and B. can I tell you significant detail about what was in the book, and C. does at least some of this detail still matter......
I actually did a lot of discussing 1984 over there and would heartily recommend you check it out...I also responded to Greg, but less adequately than I like. While I can say that for the most part, everything on my list fits Greg's ABC, that is only because I didn't consider posting Don't Remember, But Fuck All Was That Important To Me... Because honestly, some of the most influential books I have read - the ones that really stuck with me, are the ones that I mostly remember by their affect on me. Ones that I may have a few vague images of (I am one of those people who totally animates everything he reads) and nothing more - except the vivid recollection of how it changed my thinking.
I only listed a few children's books for this reason. It's not that there weren't many more (although I still am frakking pissed that I didn't get the Chronicles of Narnia down there) of those children's books that really mucked with my mind - there were a lot more of them. There were, for example, a couple of other books that had much the same message that Matilda did for me. One of them came quite a bit earlier than Matilda, and was much more inclined towards the theme of financial poverty, with intellectual, creative and emotional wealth, being superior to the opposite. Haven't the slightest clue what it was called and seem to recall that at some point financial wealth is also acquired, but that is a couple books on and is entirely secondary to the all important wealth of mind and heart.
I believed then and still today, that love and mind are far more important than material wealth - not to say that material wealth isn't important...But in all honesty, if it were just me - no kids, no Juniper - I would be perfectly content with barely enough. Live in a small studio, with a small space to sleep carved out of the piles of books - along with a small space to sit and eat and write...I am entirely confident that I could have been satisfied with that. But kids and the most beautiful and brilliant lover a man could ever dream of having in his life, this is not such a laudable goal in life. So when I will never be an old women and I shall never where purple...
And there are other books that I simply can't remember, that nevertheless are still a part of my life and who I am. For example, before Encyclopedia Brown, there were other boy detectives and similar adventurers who sparked my sense of justice. Characters who drove solidly home the notion that justice is more important than most anything - including at times, the rules or the law. That underlying the rules and the laws - some of which might actually contradict it, was an evermore important code of conduct - code of justice. And that sense, that drive for justice that began when I read a book at about six or seven, eventually evolved into a pretty absolute belief in the rule of law, true justice and a firm reliance on my moral framework. The absolute I hold these to now, was sparked when I read that now forgotten book at six or seven - though the principles have evolved considerably and matured a great deal in the last twenty-six, twenty-seven years.
So really, my list would have been fleshed out nicely with about eight or nine; Don't Remember, But Fuck All Was That Important To Me...I would even have been willing to give up some of the books on that list to include those.
It turns out there are some very self assured motherfuckers on Cath@vwxynot?'s blog, who think that because they didn't fall out of a frakking sailboat, that they haven't been tagged with this meme!!!11!!!1! So chall (I don't care if you're a godless fucking Swede - we still want that list, even if half of it won't be in Americanish), T. Joseph and Mrs. Ch - you are now officially fucking tagged!!!!111!!!!
There have been some interesting discussion arising from this little book meme that we managed to bust out of the confines of FaceBook (which I have managed to get into again - but only because I got "friended" by someone I don't think I've seen or heard from since about 4th grade)...Stephanie wonders why so many of the folks who have outies instead of innies, seem to like 1984, while it was distinctly missing from the lists of most of the innie types. And also...Why The Fuck Does Anyone like that shit!!!!111@!!?????@???!?//!! (Ok, she didn't put it quite like that, because that would be more like something I would do, not Stephanie, but still...
And in comments there, Greg was lamenting the fact that so many people decided to forgo the rules - as he saw it. Only he wasn't talking about my horrifying decision to go all ADHD, when reading his initial post and making a rather longer list. He felt that folks were listing books that might not have had that much of an impact. He gave a three part criteria - A. did I read this a long time ago and B. can I tell you significant detail about what was in the book, and C. does at least some of this detail still matter......
I actually did a lot of discussing 1984 over there and would heartily recommend you check it out...I also responded to Greg, but less adequately than I like. While I can say that for the most part, everything on my list fits Greg's ABC, that is only because I didn't consider posting Don't Remember, But Fuck All Was That Important To Me... Because honestly, some of the most influential books I have read - the ones that really stuck with me, are the ones that I mostly remember by their affect on me. Ones that I may have a few vague images of (I am one of those people who totally animates everything he reads) and nothing more - except the vivid recollection of how it changed my thinking.
I only listed a few children's books for this reason. It's not that there weren't many more (although I still am frakking pissed that I didn't get the Chronicles of Narnia down there) of those children's books that really mucked with my mind - there were a lot more of them. There were, for example, a couple of other books that had much the same message that Matilda did for me. One of them came quite a bit earlier than Matilda, and was much more inclined towards the theme of financial poverty, with intellectual, creative and emotional wealth, being superior to the opposite. Haven't the slightest clue what it was called and seem to recall that at some point financial wealth is also acquired, but that is a couple books on and is entirely secondary to the all important wealth of mind and heart.
I believed then and still today, that love and mind are far more important than material wealth - not to say that material wealth isn't important...But in all honesty, if it were just me - no kids, no Juniper - I would be perfectly content with barely enough. Live in a small studio, with a small space to sleep carved out of the piles of books - along with a small space to sit and eat and write...I am entirely confident that I could have been satisfied with that. But kids and the most beautiful and brilliant lover a man could ever dream of having in his life, this is not such a laudable goal in life. So when I will never be an old women and I shall never where purple...
And there are other books that I simply can't remember, that nevertheless are still a part of my life and who I am. For example, before Encyclopedia Brown, there were other boy detectives and similar adventurers who sparked my sense of justice. Characters who drove solidly home the notion that justice is more important than most anything - including at times, the rules or the law. That underlying the rules and the laws - some of which might actually contradict it, was an evermore important code of conduct - code of justice. And that sense, that drive for justice that began when I read a book at about six or seven, eventually evolved into a pretty absolute belief in the rule of law, true justice and a firm reliance on my moral framework. The absolute I hold these to now, was sparked when I read that now forgotten book at six or seven - though the principles have evolved considerably and matured a great deal in the last twenty-six, twenty-seven years.
So really, my list would have been fleshed out nicely with about eight or nine; Don't Remember, But Fuck All Was That Important To Me...I would even have been willing to give up some of the books on that list to include those.
Thursday, June 4, 2009
Are All Men Capable of Rape?
There has been a lot of interesting discussion going on over at Greg Laden's. He has now gone to three posts (one, two, three) and the discussion is pretty heated. I really didn't have time to engage yesterday and don't have a whole lot today. But I think that there are a lot of very important points to be made about this. I'll start with my first comment on this thread and expand a bit...
My gut reaction to this is that it's total bullshit. I want it to be bullshit - almost need it to be. But I then consider the recent discussions about torture and my acceptance that while the circumstances are far-fetched (i.e. on a scale with getting struck by lightening three times, each time standing in the same spot) I can think of hypothetical situations in which I would not only condone torture, but wouldn't hesitate to engage in it myself.
Humans are quite complicated animals. Human minds are incredible and incredibly adept at rationalizing, compartmentalizing and in extreme stress, breaking. The closer humans get to the primitive mind, the more likely they are to engage in what we would consider reprehensible acts. When people are required to break their social conditioning, such as soldiers are required to do - is it any surprise that some of them will break with it more completely? And when people never receive certain types of social conditioning - acts that we find repugnant naturally happen.
There are people in the U.S. who commit egregious acts of violence every day without consideration for anyone or anything around them. They simply don't care who else might get hurt while they play their stupid little games, that carry such dire potential consequences. I believe absolutely and without reserve, that the actions of such people are immoral. But I also accept that such people do not operate with the same social conditioning that I do, nor do they exist in the same social context that I exist in. More importantly, they are not operating under the same moral frame that I operate from. While I don't believe that it excuses their behavior, I accept that just because they don't operate under the same moral framework that I do, doesn't mean or even imply that they are inherently amoral. They do have a moral frame and probably do fairly well at operating within that framework.
These are people who commit egregious and repugnant acts not because their conditioning was broken somewhere along the line, but because their conditioning allows for the behaviors that most of us find repugnant. And this is very much the case with people who commit egregious and repugnant acts such as rape, within the framework of cultures that accept rape as a matter of course. This is also the case with people who would condition children to fight as soldiers or commit acts of terrorism. All of these behaviors are repugnant and our macro-society has a responsibility to try to put an end to such behaviors. But it is important to recognize that we are not up against people who are behaving badly, according to their cultural norms. We are in fact, up against the cultural norms that accept these behaviors - it is an entirely different battle.
Now I think that the simple fact that there are cultures where these sorts of behaviors are well within social norms is adequate evidence in itself, that all men are capable of rape, that all people are as a baseline, capable of all sorts of repugnant behaviors. The bottom line is that morality is largely, if not entirely contextual. Change the context, change the development, change the cultural norms and humans are capable of all manners of atrocity. History and contemporary societies are proof of that. The fact that there are even sub-cultures in the western world that commit atrocities is proof of that.
But what about the other end of this discussion? Because the question is not; "Are all men capable of rape, if their social context is one wherein rape is a cultural norm?" The question is; "Are all men capable of rape?" which implies all men, as we exist within any social context. This is a much tougher question - not because it doesn't have a very simple answer, but because that simple answer rides atop a rather complex set of variables and because it is extremely difficult to approach this question objectively. The simple answer? Yes, all men are capable of rape, all men, regardless of the social context or cultural norms they were raised in.
But contrary to what some seemed to be saying over at Greg's blog, I think that it is important to recognize another simple concept and I believe this recognition is entirely relevant to the discussion at hand. All humans, regardless of the social context or cultural norms in which they were raised, are capable of all sorts of atrocities - given the right set of variables. It is important to recognize this, because without that added context, we're presented with the implication that the potential to contradict our social and cultural conditioning and commit acts that are contrary to our own moral framework is somehow gender specific. This is not a masculine characteristic, it is a human characteristic. Indeed rape is not just an act committed by men, women can and do, engage in acts of rape too - and for the same spectrum of reasons that men do.
So really, the question should be stated; "Are all humans capable of rape?" And we have already gotten the simple answer - but what of the reasoning behind that answer?
Being a very creative and abstract thinker, I can in fact conceive of situations in which I would torture another human being. I can also conceive of situations in which I could be driven to commit murder, including premeditated, first degree murder. I can conceive of situations that would drive me to steal and even possibly harm a completely innocent human in the process. I can also conceive of situations in which I could be driven to commit acts of terrorism, though this belongs right up there with murder and possibly even torture, in terms of likelihood. I can conceive of these not because I don't believe all of these things to be immoral, or because I am somehow morally deficient. I can only conceive of these hypothetical situations because I have an incredibly active and creative imagination.
But no matter how abstract my thinking, no matter how creative I can be, no matter how actively I try to conceive of it, I simply cannot conceive of a situation in which I would rape anyone. I don't think that most people can and I think that's a good thing. I also suspect that this is why many people get very upset at the idea that someone would tell them that they are capable of rape - or for that matter, anything that I listed above. It is important to recognize three things.
One, the fact that the potential exists, does not make anyone a bad person. It doesn't reflect on who you are as an individual, nor does it reflect on your social conditioning. More importantly, it doesn't somehow imply that you are ever going to commit such acts - most of us never do. Indeed, it is unlikely in the extreme that anyone who has been firmly socially and culturally conditioned to believe that these are horrible things to do are ever going to do them, unless there is a pathological basis for such behavior. This potential reflects on no one as an individual - rather, this potential is simply a part of what it means to be human. Being human means that we are all susceptible to being driven to commit heinous acts.
Two, being unable to conceive of a hypothetical situation in which one would be capable of committing any of these atrocities is not the result of being incapable - it is merely a failure of imagination. And as I say, there is nothing wrong with that failure of imagination. I can conceive of hypothetical situations that make my stomach churn and has, on occasion, caused me to lose a lot of sleep - something I can ill afford as a baseline insomniac. In all honesty, I would much prefer a failure of imagination under the circumstances.
Third and I think ultimately the most important. This potentiality does not reflect on one's morality. That this potential exists does not signify a breakdown in one's moral framework. But just as important, the fact that this potential is so very unlikely, does not mean that one has a firm, reasonable or even coherent moral framework. Ultimately, it is outside the realm of moral frames and is actually dependent on social and cultural conditioning. This is not to say that one's moral frame is inherently separate from the potential to commit egregious acts. Rather, the potential for committing egregious acts is not inherently dependent on one's moral frame.
I do have one last point to address, because I think that Greg is way off track. In his post; Is there a rape switch?, He makes this comment, in reference to an old term paper by one of his students:
Now a reasonable reading of this discussion will show that this is not something that Greg is saying as an absolute. Indeed, it is clear that he is willing to be convinced otherwise, though he strongly suspects that this is the case. I am going to answer the question in the title and respond to the idea in this quote with an emphatic and resounding; No, this is complete and absolute bullshit.
A person does not move from having the potential, to being the thing, unless they actually commit the act. The fact that a lot of people who end up fitting a similar set of variables commit acts of rape, does not mean that everyone who fits those variables is a rapist. It simply means that those who don't rape, require a different set of variables to become a rapist.
Lets look at another egregious act and a set of variables that will often cause people to commit that egregious act. A man or women is in love with someone and they get married. They have, or believe they have a very strong relationship with their partner, built on mutual trust and respect. They also have a very close friend with whom they have a different sort of relationship, but one that is also built on mutual trust and respect. One day this person comes home unexpectedly and find their partner and their best friend in their bed, having sex. This particular set of variables quite often leads the betrayed party to have a psychotic break and murder one or both of the people who have betrayed them, in a fit of rage.
Does that mean that everyone who fits those variables is a murderer, even if they don't actually kill anyone?
Not at all. It merely means that people who don't commit murder under those circumstances, require a different set of variables to become a murderer.
I'm sorry Greg, but unless and until a person actually commits the act, they only have the potential to commit the act. Until the specific variables that will cause them to act are met, they are in fact, incapable of committing the act.
My gut reaction to this is that it's total bullshit. I want it to be bullshit - almost need it to be. But I then consider the recent discussions about torture and my acceptance that while the circumstances are far-fetched (i.e. on a scale with getting struck by lightening three times, each time standing in the same spot) I can think of hypothetical situations in which I would not only condone torture, but wouldn't hesitate to engage in it myself.
Humans are quite complicated animals. Human minds are incredible and incredibly adept at rationalizing, compartmentalizing and in extreme stress, breaking. The closer humans get to the primitive mind, the more likely they are to engage in what we would consider reprehensible acts. When people are required to break their social conditioning, such as soldiers are required to do - is it any surprise that some of them will break with it more completely? And when people never receive certain types of social conditioning - acts that we find repugnant naturally happen.
There are people in the U.S. who commit egregious acts of violence every day without consideration for anyone or anything around them. They simply don't care who else might get hurt while they play their stupid little games, that carry such dire potential consequences. I believe absolutely and without reserve, that the actions of such people are immoral. But I also accept that such people do not operate with the same social conditioning that I do, nor do they exist in the same social context that I exist in. More importantly, they are not operating under the same moral frame that I operate from. While I don't believe that it excuses their behavior, I accept that just because they don't operate under the same moral framework that I do, doesn't mean or even imply that they are inherently amoral. They do have a moral frame and probably do fairly well at operating within that framework.
These are people who commit egregious and repugnant acts not because their conditioning was broken somewhere along the line, but because their conditioning allows for the behaviors that most of us find repugnant. And this is very much the case with people who commit egregious and repugnant acts such as rape, within the framework of cultures that accept rape as a matter of course. This is also the case with people who would condition children to fight as soldiers or commit acts of terrorism. All of these behaviors are repugnant and our macro-society has a responsibility to try to put an end to such behaviors. But it is important to recognize that we are not up against people who are behaving badly, according to their cultural norms. We are in fact, up against the cultural norms that accept these behaviors - it is an entirely different battle.
Now I think that the simple fact that there are cultures where these sorts of behaviors are well within social norms is adequate evidence in itself, that all men are capable of rape, that all people are as a baseline, capable of all sorts of repugnant behaviors. The bottom line is that morality is largely, if not entirely contextual. Change the context, change the development, change the cultural norms and humans are capable of all manners of atrocity. History and contemporary societies are proof of that. The fact that there are even sub-cultures in the western world that commit atrocities is proof of that.
But what about the other end of this discussion? Because the question is not; "Are all men capable of rape, if their social context is one wherein rape is a cultural norm?" The question is; "Are all men capable of rape?" which implies all men, as we exist within any social context. This is a much tougher question - not because it doesn't have a very simple answer, but because that simple answer rides atop a rather complex set of variables and because it is extremely difficult to approach this question objectively. The simple answer? Yes, all men are capable of rape, all men, regardless of the social context or cultural norms they were raised in.
But contrary to what some seemed to be saying over at Greg's blog, I think that it is important to recognize another simple concept and I believe this recognition is entirely relevant to the discussion at hand. All humans, regardless of the social context or cultural norms in which they were raised, are capable of all sorts of atrocities - given the right set of variables. It is important to recognize this, because without that added context, we're presented with the implication that the potential to contradict our social and cultural conditioning and commit acts that are contrary to our own moral framework is somehow gender specific. This is not a masculine characteristic, it is a human characteristic. Indeed rape is not just an act committed by men, women can and do, engage in acts of rape too - and for the same spectrum of reasons that men do.
So really, the question should be stated; "Are all humans capable of rape?" And we have already gotten the simple answer - but what of the reasoning behind that answer?
Being a very creative and abstract thinker, I can in fact conceive of situations in which I would torture another human being. I can also conceive of situations in which I could be driven to commit murder, including premeditated, first degree murder. I can conceive of situations that would drive me to steal and even possibly harm a completely innocent human in the process. I can also conceive of situations in which I could be driven to commit acts of terrorism, though this belongs right up there with murder and possibly even torture, in terms of likelihood. I can conceive of these not because I don't believe all of these things to be immoral, or because I am somehow morally deficient. I can only conceive of these hypothetical situations because I have an incredibly active and creative imagination.
But no matter how abstract my thinking, no matter how creative I can be, no matter how actively I try to conceive of it, I simply cannot conceive of a situation in which I would rape anyone. I don't think that most people can and I think that's a good thing. I also suspect that this is why many people get very upset at the idea that someone would tell them that they are capable of rape - or for that matter, anything that I listed above. It is important to recognize three things.
One, the fact that the potential exists, does not make anyone a bad person. It doesn't reflect on who you are as an individual, nor does it reflect on your social conditioning. More importantly, it doesn't somehow imply that you are ever going to commit such acts - most of us never do. Indeed, it is unlikely in the extreme that anyone who has been firmly socially and culturally conditioned to believe that these are horrible things to do are ever going to do them, unless there is a pathological basis for such behavior. This potential reflects on no one as an individual - rather, this potential is simply a part of what it means to be human. Being human means that we are all susceptible to being driven to commit heinous acts.
Two, being unable to conceive of a hypothetical situation in which one would be capable of committing any of these atrocities is not the result of being incapable - it is merely a failure of imagination. And as I say, there is nothing wrong with that failure of imagination. I can conceive of hypothetical situations that make my stomach churn and has, on occasion, caused me to lose a lot of sleep - something I can ill afford as a baseline insomniac. In all honesty, I would much prefer a failure of imagination under the circumstances.
Third and I think ultimately the most important. This potentiality does not reflect on one's morality. That this potential exists does not signify a breakdown in one's moral framework. But just as important, the fact that this potential is so very unlikely, does not mean that one has a firm, reasonable or even coherent moral framework. Ultimately, it is outside the realm of moral frames and is actually dependent on social and cultural conditioning. This is not to say that one's moral frame is inherently separate from the potential to commit egregious acts. Rather, the potential for committing egregious acts is not inherently dependent on one's moral frame.
I do have one last point to address, because I think that Greg is way off track. In his post; Is there a rape switch?, He makes this comment, in reference to an old term paper by one of his students:
The switch being on does not mean that rape will happen. It simply means that the man (with the switch on) is now a rapist, whether he actually rapes or not (but he probably will), and when the switch is off, he is not (so he probably won't).
Now a reasonable reading of this discussion will show that this is not something that Greg is saying as an absolute. Indeed, it is clear that he is willing to be convinced otherwise, though he strongly suspects that this is the case. I am going to answer the question in the title and respond to the idea in this quote with an emphatic and resounding; No, this is complete and absolute bullshit.
A person does not move from having the potential, to being the thing, unless they actually commit the act. The fact that a lot of people who end up fitting a similar set of variables commit acts of rape, does not mean that everyone who fits those variables is a rapist. It simply means that those who don't rape, require a different set of variables to become a rapist.
Lets look at another egregious act and a set of variables that will often cause people to commit that egregious act. A man or women is in love with someone and they get married. They have, or believe they have a very strong relationship with their partner, built on mutual trust and respect. They also have a very close friend with whom they have a different sort of relationship, but one that is also built on mutual trust and respect. One day this person comes home unexpectedly and find their partner and their best friend in their bed, having sex. This particular set of variables quite often leads the betrayed party to have a psychotic break and murder one or both of the people who have betrayed them, in a fit of rage.
Does that mean that everyone who fits those variables is a murderer, even if they don't actually kill anyone?
Not at all. It merely means that people who don't commit murder under those circumstances, require a different set of variables to become a murderer.
I'm sorry Greg, but unless and until a person actually commits the act, they only have the potential to commit the act. Until the specific variables that will cause them to act are met, they are in fact, incapable of committing the act.
Sunday, May 17, 2009
Criminal Stupidity
I really despise incompetent morons who decide to charge people money to fuck up their homes. Every time I turn around and look at the shit the criminally, pathologically stupid son of a bitch who worked on my parent's home did, I get more and more angry.
But the stupidity on their roof really takes the trophy for ridiculously fucking stupid. What he did around their chimney is so egregiously incompetent, that I doubt anyone reading this blog would think that it would actually shed water. I am quite confident that any one of you would have managed a far better job of it - I don't care if you're blind and missing one arm - you simply could not screw it up as bad as this idiot did.
This is a level of stupid that should land people in jail.
But the stupidity on their roof really takes the trophy for ridiculously fucking stupid. What he did around their chimney is so egregiously incompetent, that I doubt anyone reading this blog would think that it would actually shed water. I am quite confident that any one of you would have managed a far better job of it - I don't care if you're blind and missing one arm - you simply could not screw it up as bad as this idiot did.
This is a level of stupid that should land people in jail.
Wednesday, April 29, 2009
Ya Think (bloody damned morons)
I needed a little break from my final paper, so I thought I would take the moment to share this little nugget of wisdom I found in The Cognitive Therapy of Substance Abuse. Keeping in mind that this is in the context of the first session with a new client:
What irritates me about this example, is not simply that it's so completely absurd, it's that there are a host of more subtle mistakes that a therapist could make that aren't shown. For example, I could see a therapist saying the following, especially if said therapist was new to this and rather nervous:
Do you see the problem ? It's subtle and could actually turn out to be language use that the client will be comfortable with. But there is no way that the therapist can know that in the very first conversation with a client - especially a client who is a substance abuser. Even when they were the one to initiate contact, drug abusers are notoriously reticent about help seeking. Quite often the first session is going to be the only session - even if the therapist does everything right. So this first session is walking in eggshells - you will not get a second chance to fix any mistakes you make.
"...where things went wrong." is the problem statement. Yes, they are there because something is very wrong and presumably things went wrong somewhere. Odds are pretty damned good that if they're in your office, they even know that things went wrong somewhere and assume that you know this too. The problem is that verbalizing this smacks of judgment. The client may well decide you believe that they are wrong as a person. Even if they don't go to that extreme, it is likely to both anger them and flare up their shame response. One simple word like that can easily cut the chances that the client will return in half.
I don't want to give the impression that this book is horrible. Actually I think it does a fairly admirable job, though I disagree rather strongly with some of the base assumptions of the authors. It is a book intended to be supplemental material for the practicing cognitive therapist who is getting involved in treating substance abusers and addicts. Ultimately, this is really my problem with the aforementioned scenario - while the example they give should be absolutely obvious to anyone who was able to become an accredited cognitive therapist, the example I provide might not be as obvious. And while making a "wrong" statement to any patient should be avoided in initial sessions (with most clients, at all), it is especially critical when dealing with addicts. If an example of what not to say under the circumstances were necessary, it would make far more sense to use one that is more subtle - a reminder to reinforce what the cognitive therapist has already learned, probably repeatedly, over the years they've spent in school.
As a complete aside, I will note that under pressure and feeling rather crappy, I have managed to smoke only three cigarettes thus far today. Although my Joni Mitchell station on Pandora is helping an awful lot. That and my e-cig...
For example, the cognitive therapist would be ill-advised to speak in the following manner:I'm sorry, but if you are honestly stupid enough that it would ever cross your mind that saying anything at all like this to any patient would be reasonable, you really need to find a career that doesn't involve cognitive therapy of any kind. And if you are stupid enough that you would consider saying that to an addict you would actually like to see get help, you really need to consider a career that doesn't put you in a position to be a risk to others - like pressing buttons that go bing.
"We're going to be examining your thinking processes, to understand the kinds of cognitive distortions that lead you to engage in maladaptive behaviors such as drug abuse and antisocial behaviors."
What irritates me about this example, is not simply that it's so completely absurd, it's that there are a host of more subtle mistakes that a therapist could make that aren't shown. For example, I could see a therapist saying the following, especially if said therapist was new to this and rather nervous:
"So John, what I'd like to do is explain a little bit about how cognitive therapy. I'd like you to feel free to ask me any questions you might have about this type of treatment, so don't be shy. We're going to try to understand how you see things, how you feel about your life, who you are - about using drugs. This is important, because it can give me a good idea of where your coming from and where things went wrong. This will also start to help you understand yourself a little better and help you turn your life around in a direction you would be more satisfied with."
Do you see the problem ? It's subtle and could actually turn out to be language use that the client will be comfortable with. But there is no way that the therapist can know that in the very first conversation with a client - especially a client who is a substance abuser. Even when they were the one to initiate contact, drug abusers are notoriously reticent about help seeking. Quite often the first session is going to be the only session - even if the therapist does everything right. So this first session is walking in eggshells - you will not get a second chance to fix any mistakes you make.
"...where things went wrong." is the problem statement. Yes, they are there because something is very wrong and presumably things went wrong somewhere. Odds are pretty damned good that if they're in your office, they even know that things went wrong somewhere and assume that you know this too. The problem is that verbalizing this smacks of judgment. The client may well decide you believe that they are wrong as a person. Even if they don't go to that extreme, it is likely to both anger them and flare up their shame response. One simple word like that can easily cut the chances that the client will return in half.
I don't want to give the impression that this book is horrible. Actually I think it does a fairly admirable job, though I disagree rather strongly with some of the base assumptions of the authors. It is a book intended to be supplemental material for the practicing cognitive therapist who is getting involved in treating substance abusers and addicts. Ultimately, this is really my problem with the aforementioned scenario - while the example they give should be absolutely obvious to anyone who was able to become an accredited cognitive therapist, the example I provide might not be as obvious. And while making a "wrong" statement to any patient should be avoided in initial sessions (with most clients, at all), it is especially critical when dealing with addicts. If an example of what not to say under the circumstances were necessary, it would make far more sense to use one that is more subtle - a reminder to reinforce what the cognitive therapist has already learned, probably repeatedly, over the years they've spent in school.
As a complete aside, I will note that under pressure and feeling rather crappy, I have managed to smoke only three cigarettes thus far today. Although my Joni Mitchell station on Pandora is helping an awful lot. That and my e-cig...
Friday, April 24, 2009
Wherein DuWayne Rants About the #$@&ing Drug Laws
Before I start, I would really like to recommend that you take a listen to Gabriela Montero. I recently discovered her whilst listening to one of my Pandora stations and her playing made me weep for the beauty and the passion with which she throws herself into her variations and compositions. Gabriela is a wholly remarkable pianist, a child prodigy who has matured into brilliant and nuanced composer. And she is also great stress relief...
I have had a not so grand day today. It started well enough, though not as productively as I might have wished. And I had a fantastic visit with the doctor, where we discussed my meds and how the new regimen has been working out. We decided to double my dose of Wellbutrin, from 100mg in the morning to 100mg in the morning and another at lunch (something I was going to do a couple weeks ago, but chose to wait because he wanted to see me to add the extra dose). I was actually feeling pretty damned good when I left the doctor's office - almost three and I had only smoked two cigarettes all day.
How quickly things can change. Today I discovered just how fragile a thing, this thing that is my calm and collect self.
More...
The fucking war on drugs put me on the verge of a nervous fucking breakdown today. Though I was heading that way when I went to get my scripts filled in the first place.
My fucking Wellbutrin costs eighty-six fucking dollars as a fucking generic. Eighty-six dollars!!! And the version I am taking is not available much cheaper anywhere - including mail order. I very nearly started crying in the fucking store when they told me that. I'm working on getting help with my scripts through the state, but the wheels turn slowly. My folks are helping out some, but that just stresses me out more, because I don't want to be a fucking burden on them at thirty-two years old. I was frustrated and angry and decided to hold off on that one to see if I could find to cheaper elsewhere, or if there might be another option for finding Bupropion for less, but in the same dose as I've been taking.
No such luck, this time around.
So I decide to get it filled and owe my parents even more. Fucking yeah for me!!! I headed back to Wal-Mart and handed the women at the window the script, having completely forgotten that I had been told earlier (when I dropped off the others) that they were out of that one anyways. The women at the window punched it all into the computer and told me it would be about twenty minutes, so I sat down to wait. After about half an hour, the women who had originally taken my scripts came out to remind me that they were out of that particular dosage of Wellbutrin. Mind you, the women who had taken the script had seen me sitting there several times, while helping other fucking customers - never once occurred to her to let me know that I couldn't get my fucking drug. Nor did they consider just fucking calling me to tell me - if they hadn't noticed (they are usually really good about calling for stuff like that and they weren't very busy).
What the fuck does this have to do with the war in drugs, you ask?
I had a check with me, written for the total cost of all three of my scripts. And even though another Wal-Mart has the Welbutrin, I couldn't pay for it at the one I was in. So I had to transfer the other two to the other fucking pharmacy as well. The only problem being that Clonidine and Ritalin are controlled fucking substances and they can't be called in. They can't be faxed over and apparently, they can't even get them ready in anticipation of the fucking paper script being brought in. Nor can they be refilled - every month, my doctor has to write another script for me.
Of course I had wasted nearly half an hour sitting in fucking Wal-Mart before I became aware that I would have to go to another store - about half an hour across town. And not only would I have to run over there to get them, I would have to fucking wait there while they filled my other two scripts - because we have the most ridiculous fucking drug laws ever. Mind you, it was close to dinner time and a friend of mine was joining us. I was about fifteen minutes late when it was all over with. (Though I did get a text from the most beautiful and brilliant women in the world, who just seems to know when a text from her is going to take the edge off of stressful situations - thanks Juniper)
My problems today and with getting more than thirty days worth of my meds at a time, are far from the only egregious intrusion that our draconian drug laws have thrust into medicine. Because of course, there is also the war on pain management to be considered. You know, the war in which not only patients who doctor shop and fraudulently acquire multiple scripts for the same pain killers (often times to sell them) got to jail, but even doctors who appear to be over prescribing and patients who are engaged in a good faith pain management regimen with their (only) prescribing doctor.
I am so fucking tired of this paternalistic fucking bullshit! This has gotten beyond fucking ridiculous - went beyond that point fucking years ago. The war on drugs interferes with the ability of doctors to care for patients, therapists to freely help drug addicts and substance abusers and patients to have reasonably simple and rather less costly access to their medications.
Fuck You drug warriors - Every MotherFucking One of You!!!
I have had a not so grand day today. It started well enough, though not as productively as I might have wished. And I had a fantastic visit with the doctor, where we discussed my meds and how the new regimen has been working out. We decided to double my dose of Wellbutrin, from 100mg in the morning to 100mg in the morning and another at lunch (something I was going to do a couple weeks ago, but chose to wait because he wanted to see me to add the extra dose). I was actually feeling pretty damned good when I left the doctor's office - almost three and I had only smoked two cigarettes all day.
How quickly things can change. Today I discovered just how fragile a thing, this thing that is my calm and collect self.
More...
The fucking war on drugs put me on the verge of a nervous fucking breakdown today. Though I was heading that way when I went to get my scripts filled in the first place.
My fucking Wellbutrin costs eighty-six fucking dollars as a fucking generic. Eighty-six dollars!!! And the version I am taking is not available much cheaper anywhere - including mail order. I very nearly started crying in the fucking store when they told me that. I'm working on getting help with my scripts through the state, but the wheels turn slowly. My folks are helping out some, but that just stresses me out more, because I don't want to be a fucking burden on them at thirty-two years old. I was frustrated and angry and decided to hold off on that one to see if I could find to cheaper elsewhere, or if there might be another option for finding Bupropion for less, but in the same dose as I've been taking.
No such luck, this time around.
So I decide to get it filled and owe my parents even more. Fucking yeah for me!!! I headed back to Wal-Mart and handed the women at the window the script, having completely forgotten that I had been told earlier (when I dropped off the others) that they were out of that one anyways. The women at the window punched it all into the computer and told me it would be about twenty minutes, so I sat down to wait. After about half an hour, the women who had originally taken my scripts came out to remind me that they were out of that particular dosage of Wellbutrin. Mind you, the women who had taken the script had seen me sitting there several times, while helping other fucking customers - never once occurred to her to let me know that I couldn't get my fucking drug. Nor did they consider just fucking calling me to tell me - if they hadn't noticed (they are usually really good about calling for stuff like that and they weren't very busy).
What the fuck does this have to do with the war in drugs, you ask?
I had a check with me, written for the total cost of all three of my scripts. And even though another Wal-Mart has the Welbutrin, I couldn't pay for it at the one I was in. So I had to transfer the other two to the other fucking pharmacy as well. The only problem being that Clonidine and Ritalin are controlled fucking substances and they can't be called in. They can't be faxed over and apparently, they can't even get them ready in anticipation of the fucking paper script being brought in. Nor can they be refilled - every month, my doctor has to write another script for me.
Of course I had wasted nearly half an hour sitting in fucking Wal-Mart before I became aware that I would have to go to another store - about half an hour across town. And not only would I have to run over there to get them, I would have to fucking wait there while they filled my other two scripts - because we have the most ridiculous fucking drug laws ever. Mind you, it was close to dinner time and a friend of mine was joining us. I was about fifteen minutes late when it was all over with. (Though I did get a text from the most beautiful and brilliant women in the world, who just seems to know when a text from her is going to take the edge off of stressful situations - thanks Juniper)
My problems today and with getting more than thirty days worth of my meds at a time, are far from the only egregious intrusion that our draconian drug laws have thrust into medicine. Because of course, there is also the war on pain management to be considered. You know, the war in which not only patients who doctor shop and fraudulently acquire multiple scripts for the same pain killers (often times to sell them) got to jail, but even doctors who appear to be over prescribing and patients who are engaged in a good faith pain management regimen with their (only) prescribing doctor.
I am so fucking tired of this paternalistic fucking bullshit! This has gotten beyond fucking ridiculous - went beyond that point fucking years ago. The war on drugs interferes with the ability of doctors to care for patients, therapists to freely help drug addicts and substance abusers and patients to have reasonably simple and rather less costly access to their medications.
Fuck You drug warriors - Every MotherFucking One of You!!!
Saturday, April 18, 2009
In Which DuWayne Discusses HisTherapy
This last Friday, was my last session with the therapist I have been seeing. Her internship is up and I am probably going to be out of therapy until June.
I am very grateful for the experience that I had in eleven sessions with Theresa and can state categorically, that she is one hell of a therapist who will serve her clients well. I was rather reticent in the beginning and she admitted yesterday, that she was as well - for some of the same reasons. For my part, I was concerned about her lack of experience and the fact that she's a women. She was concerned because she believes that I am more intelligent than her and that I would find therapy more effective with a male therapist.
I have been trying to figure out how to explain the methods used in my therapy with Theresa and keep running into something of a wall with it. The reason is that the therapy was by needs, rather unconventional - utilizing a great many tools that are not generally used together. The diversity of the problems that I need to deal with make any singular approach simply impossible.
The first thing we did was to define the issues I am dealing with and my goals. This was excruciating, to put it mildly. We discussed a great many, very difficult issues in a very short time and explored issues that I was mostly unaware of. The biggest issues were figuring out where the cognitive problems end and the neurochemical issues begin and helping me recognize my emotions. The former is not something that can be accomplished with absolute accuracy. What we were really trying to do is help define broadly, the parameters of my neurochemical issues. The latter was and is, far more of a problem. When I first walked in the door, I knew that I needed to learn to deal with my emotions more effectively - instead of just shoving them away, into the recesses of my mind. What I understand now, is that I have very little grasp of my emotions.
On top of all this, we were also dealing with the nuts and bolts of managing the situation with my family and my reaction to it. This was in part, the hardest aspect of therapy to deal with - mainly because it really was what caused the realization that I have very little grasp of my emotions. It was also the hardest, because the situation with my family has been so absolutely insane.
In working out the parameters of my neurological issues and their interface with my cognitive issues, Theresa really probed my understanding of managing cognitive issues. Not necessarily in direct context to my own experience, but in a more generalized context. She then probed for how I've been dealing with a lot of my problems - what has helped and what has not. Finally, we delved into my experience as a child - not so much what was happening around me (though that was explored some as well) but what was happening in my head. Through this we were able to make some reasonable assumptions about where this therapy should be focused and also where my discussion with my doctor should be focused.
Exploring my problems with emotion was considerably more complicated. This is also where Theresa's ability as a therapist really shined. It's not that I was purposefully skirting the issue, it was just very hard to bring me to the place that I could actually see what's been going on. She had to ask a lot of questions, sometimes pretty much the same question - restated after we had managed to work out another point. She had a very good grasp of what was going on, but due to a need for me to figure it out myself, we had to get there the hard way.
Like any effective therapy, it was entirely based on asking the right questions and through that leading me to figure out what the hell is going on. When the problems being discussed are as diverse as my own, a baseline difficult task becomes huge issue. And to make it far more difficult for Theresa, I came into therapy with a few beliefs about who and what I am, that turned out to be entirely wrong. I truly believed that I had a pretty solid grasp on my emotions - I just didn't think that I was really capable of many of the emotional responses to various situations, that I saw in most of the people around me. While it the context in which it was said is important, alexithymia came up and I wasn't the one who mentioned it. She was clear that she didn't think this was a perfect descriptive, only that based on our discussions, she saw some alexithymic tendencies in me and the way that I manage my emotions.
One of the very few times she actually pointed something out to me directly, was when I came in and told her that the short-form assessment I had taken at the doctor's office had claimed that I suffer depression. This was certainly news to me and my surprise at this was pretty obvious. She then pointed out that when I was very young, I had desperately wanted to die - that when I got over wanting to die, I then moved to simply not caring if I died. Then she asked me how I felt about dying now, to which I responded that I don't want to. It finally sunk in when she asked me why I no longer wanted to die, which I explained was because of the boys...Not because I had somewhere developed a desire to live, but because I have children who need a dad. Just to make sure, she was clear that most people, even people who aren't really afraid to die, want to live and would really rather put off death - excepting those who get particularly old, or who suffer some debilitating disease or injury.
No, I'm really not a moron. This does however segue well into another important focus of my therapy - my own little world, the world that I built for myself when I was really young and wanted to die so badly. The world that I built as a form of self-medicating. The world that I thought was no longer a factor, after an early version of it shattered when I was thrown out of my church so many years ago. The world that has continued to be a huge aspect of my life since I was nine or ten, though it has seen a great deal of remodeling over the years.
A great deal of my life is spent inside my head. There is a rich and diverse universe to experience there, where I will never run out of ideas to explore, sculptures of words and music to explore and occasionally attempt to express on the outside and completely abstract mindscapes to ride, like a helicopter ride over the most beautiful landscapes this planet of ours has to offer. I have always been pretty capable of occupying myself for extended periods of time, with minimal external stimuli (I basically did just that when I spent a little more than a month in the woods once, completely isolated from human contact).
A side effect of spending this time in my head, has been my presumption of self-awareness and my ability to compartmentalize. Combined with my ability to feel at all, I firmly believed that I really understood my emotions and what I was capable of. I just believed that I wasn't really suited to feeling the way a lot of other people seem to manage.
I am not setting a course to vacate my head though. It is an important aspect of who and what I am. I am working on spending less time there and deconstructing some of the more prohibitive aspects of my own little world. Mostly, I am trying to learn who and what I really am - learn how to feel what I am really feeling and embrace it in all it's glory, horror, pain and ecstasy. I am trying to learn what DuWayne is actually capable of feeling. Thankfully, outside the parameters of therapy, I have found the most remarkable help with that.
One of the earliest discussions that came up, one that's pretty relevant, was about my belief that I am incapable of feeling romantic love, the same way most people do. I believed that I am incapable of loving a women the way women should be loved. I explained that the reason I had been so keen on my children's mom, is because I thought she was pretty much the same. I have since discovered I am very, very wrong. And while there are issues to iron out, Juniper is all about working it out together and loving me, in spite of my rather fucked problems with feeling, which she is aware of.
My therapist was excited when I initially told her about Juniper and was positively thrilled when I told her that I had told Juniper I love her. And while there are definite logistical issues that complicate our relationship, it has it's advantages for a person who is as broken as I am - offering a chance to explore feeling and understanding it, without the pressure of my lover being with me most of the time. At the same time, we both get the support that can only come from someone who loves you so much that it hurts - and both of us need that support.
I am far from done with therapy. I doubt that I will ever not be in therapy, though the focus and needs will change with time and context. I am a firm believer in those who work as psychotherapists should always be seeing a therapist for their own sake. And I am going through a hell of a run with school that is only going to be more challenging - not to mention the situation with my kids is not going to get easier any time soon. I need the help maintaining, above and beyond learning how to be not broken. But I am definitely in a much better place than I was when I first walked through the door and sat down with Theresa to talk.
And I have a supporter and teacher who provides me with something that no amount of therapy could begin to challenge. A remarkable, brilliant woman who accepts my love and beyond reason loves me as desperately as I do her.
I am very grateful for the experience that I had in eleven sessions with Theresa and can state categorically, that she is one hell of a therapist who will serve her clients well. I was rather reticent in the beginning and she admitted yesterday, that she was as well - for some of the same reasons. For my part, I was concerned about her lack of experience and the fact that she's a women. She was concerned because she believes that I am more intelligent than her and that I would find therapy more effective with a male therapist.
I have been trying to figure out how to explain the methods used in my therapy with Theresa and keep running into something of a wall with it. The reason is that the therapy was by needs, rather unconventional - utilizing a great many tools that are not generally used together. The diversity of the problems that I need to deal with make any singular approach simply impossible.
The first thing we did was to define the issues I am dealing with and my goals. This was excruciating, to put it mildly. We discussed a great many, very difficult issues in a very short time and explored issues that I was mostly unaware of. The biggest issues were figuring out where the cognitive problems end and the neurochemical issues begin and helping me recognize my emotions. The former is not something that can be accomplished with absolute accuracy. What we were really trying to do is help define broadly, the parameters of my neurochemical issues. The latter was and is, far more of a problem. When I first walked in the door, I knew that I needed to learn to deal with my emotions more effectively - instead of just shoving them away, into the recesses of my mind. What I understand now, is that I have very little grasp of my emotions.
On top of all this, we were also dealing with the nuts and bolts of managing the situation with my family and my reaction to it. This was in part, the hardest aspect of therapy to deal with - mainly because it really was what caused the realization that I have very little grasp of my emotions. It was also the hardest, because the situation with my family has been so absolutely insane.
In working out the parameters of my neurological issues and their interface with my cognitive issues, Theresa really probed my understanding of managing cognitive issues. Not necessarily in direct context to my own experience, but in a more generalized context. She then probed for how I've been dealing with a lot of my problems - what has helped and what has not. Finally, we delved into my experience as a child - not so much what was happening around me (though that was explored some as well) but what was happening in my head. Through this we were able to make some reasonable assumptions about where this therapy should be focused and also where my discussion with my doctor should be focused.
Exploring my problems with emotion was considerably more complicated. This is also where Theresa's ability as a therapist really shined. It's not that I was purposefully skirting the issue, it was just very hard to bring me to the place that I could actually see what's been going on. She had to ask a lot of questions, sometimes pretty much the same question - restated after we had managed to work out another point. She had a very good grasp of what was going on, but due to a need for me to figure it out myself, we had to get there the hard way.
Like any effective therapy, it was entirely based on asking the right questions and through that leading me to figure out what the hell is going on. When the problems being discussed are as diverse as my own, a baseline difficult task becomes huge issue. And to make it far more difficult for Theresa, I came into therapy with a few beliefs about who and what I am, that turned out to be entirely wrong. I truly believed that I had a pretty solid grasp on my emotions - I just didn't think that I was really capable of many of the emotional responses to various situations, that I saw in most of the people around me. While it the context in which it was said is important, alexithymia came up and I wasn't the one who mentioned it. She was clear that she didn't think this was a perfect descriptive, only that based on our discussions, she saw some alexithymic tendencies in me and the way that I manage my emotions.
One of the very few times she actually pointed something out to me directly, was when I came in and told her that the short-form assessment I had taken at the doctor's office had claimed that I suffer depression. This was certainly news to me and my surprise at this was pretty obvious. She then pointed out that when I was very young, I had desperately wanted to die - that when I got over wanting to die, I then moved to simply not caring if I died. Then she asked me how I felt about dying now, to which I responded that I don't want to. It finally sunk in when she asked me why I no longer wanted to die, which I explained was because of the boys...Not because I had somewhere developed a desire to live, but because I have children who need a dad. Just to make sure, she was clear that most people, even people who aren't really afraid to die, want to live and would really rather put off death - excepting those who get particularly old, or who suffer some debilitating disease or injury.
No, I'm really not a moron. This does however segue well into another important focus of my therapy - my own little world, the world that I built for myself when I was really young and wanted to die so badly. The world that I built as a form of self-medicating. The world that I thought was no longer a factor, after an early version of it shattered when I was thrown out of my church so many years ago. The world that has continued to be a huge aspect of my life since I was nine or ten, though it has seen a great deal of remodeling over the years.
A great deal of my life is spent inside my head. There is a rich and diverse universe to experience there, where I will never run out of ideas to explore, sculptures of words and music to explore and occasionally attempt to express on the outside and completely abstract mindscapes to ride, like a helicopter ride over the most beautiful landscapes this planet of ours has to offer. I have always been pretty capable of occupying myself for extended periods of time, with minimal external stimuli (I basically did just that when I spent a little more than a month in the woods once, completely isolated from human contact).
A side effect of spending this time in my head, has been my presumption of self-awareness and my ability to compartmentalize. Combined with my ability to feel at all, I firmly believed that I really understood my emotions and what I was capable of. I just believed that I wasn't really suited to feeling the way a lot of other people seem to manage.
I am not setting a course to vacate my head though. It is an important aspect of who and what I am. I am working on spending less time there and deconstructing some of the more prohibitive aspects of my own little world. Mostly, I am trying to learn who and what I really am - learn how to feel what I am really feeling and embrace it in all it's glory, horror, pain and ecstasy. I am trying to learn what DuWayne is actually capable of feeling. Thankfully, outside the parameters of therapy, I have found the most remarkable help with that.
One of the earliest discussions that came up, one that's pretty relevant, was about my belief that I am incapable of feeling romantic love, the same way most people do. I believed that I am incapable of loving a women the way women should be loved. I explained that the reason I had been so keen on my children's mom, is because I thought she was pretty much the same. I have since discovered I am very, very wrong. And while there are issues to iron out, Juniper is all about working it out together and loving me, in spite of my rather fucked problems with feeling, which she is aware of.
My therapist was excited when I initially told her about Juniper and was positively thrilled when I told her that I had told Juniper I love her. And while there are definite logistical issues that complicate our relationship, it has it's advantages for a person who is as broken as I am - offering a chance to explore feeling and understanding it, without the pressure of my lover being with me most of the time. At the same time, we both get the support that can only come from someone who loves you so much that it hurts - and both of us need that support.
I am far from done with therapy. I doubt that I will ever not be in therapy, though the focus and needs will change with time and context. I am a firm believer in those who work as psychotherapists should always be seeing a therapist for their own sake. And I am going through a hell of a run with school that is only going to be more challenging - not to mention the situation with my kids is not going to get easier any time soon. I need the help maintaining, above and beyond learning how to be not broken. But I am definitely in a much better place than I was when I first walked through the door and sat down with Theresa to talk.
And I have a supporter and teacher who provides me with something that no amount of therapy could begin to challenge. A remarkable, brilliant woman who accepts my love and beyond reason loves me as desperately as I do her.
Thursday, April 9, 2009
Mood Disorders in Men: My New Paper
For the full document, including cover, abstract, references and appendix, click here. The following is the body of the paper.
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Mood Disorders in Men:
Gender Constructs and Diagnostic/Treatment Failures
There is no question that women are diagnosed with affective mood disorders at much higher rates than men. Granted the absolute rates of depression in women are a source of contention, but multiple studies show that women are diagnosed with major depression and dysthemia at rates double those of men. A great deal of study has gone into investigating the reasons for this, from biology to oppression and other social conditions, even certain personality factors. Yet the causes of these higher rates of depression and mood disorders have continued to elude researchers (Blehar & Oren, 1997, p.2). It is not unreasonable to assume, based on these findings, that there simply must be something unique to women, causing this disparity.
Very few psychologists and fewer researchers have considered the idea that rather than being a women's issue, this disparity might just be a men's issue. It would seem rather difficult to figure out just what's fueling this disparity, without looking at why men aren't diagnosed with depression at nearly the rates women are. It would be incredibly hard to find the causal relationship that explains higher rates of depression in women, if the base assumptions driving that research are mistaken in the first place. But given the disparate focus of most gender studies on women and women's issues, it's unsurprising that this seemingly obvious avenue of investigation is mostly lost in the mix.
The Gender Gap Fallacy
The sentiments expressed by Drs. Blehar and Oren are very consistent with the assumptions of mainstream, modern psychology and women's studies. In their 2003 paper, The Depression Gender Gap, Ronald Immerman and Wade Mackey actually claim that there is a consistent evolutionary history at work in these higher rates of depression in women. Because they found that the median ratio of depression between men and women, in several countries was close to 2:1, they claim this is just a part
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of what it means to be human. Yet when we look at their own table, we see that while the figures do come to that median, the ratio is far from consistent.
Figure 1. Site of survey and female to male ratio of prevalence of depression across nations and communities. Note that three communities listed are expatriate communities in the UK. Note. From Immerman, R. S., & Mackey, W. C. (2003, February). The depression gender gap: a view through a biocultural filter. Genetic, Social, and General Psychology Monographs, 129(1), 5-35. Retrieved March 8th, 2009 from the Michigan E-Library, http://mel.org/
Avoiding the obvious logical fallacies that drive the entire notion of evolutionary psychology that Immerman and Mackey dive into, there remains the important question of how men fit into this equation. Because the underlying assumption that women experience depression at such significantly higher rates than men, is called into question by Berger, Levant, McMillan, Kelleher and Sellers (2005), finding that “ men who score higher on measures of gender role conflict and traditional masculinity
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ideology tend to have more negative attitudes toward psychological help seeking.” This is probably due the higher rates of alexythima (difficulty experiencing, thinking about and expressing emotions) in men with high rates of gender role conflict (A. R. Fischer & Good, 1997). When the population of comparison, in this case men, are unlikely to seek help for or even recognize that they have a problem, they are also unlikely to be diagnosed with affective mood disorders. While these papers don't indicate rates of depression in men, they certainly call into question the disparity in the rates of depression between women and men.
The Problem of Help Seeking and Diagnosis
More disturbing than the tangential impact these papers have on the question of gender disparity and mood disorders, are the implications for men and help seeking. The evidence indicates that there is a substantial segment of the population that has serious problems even recognizing they might have psychological problems, much less seeking help. The problem is further complicated by generalized diagnostic criteria which are predicated on the understanding that the patient can identify and describe their various emotional states. Without compensating for undiagnosed alexythima, or gender conflict induced emotional disassociation, patients with potentially serious mood disorders will inevitably be misdiagnosed, undiagnosed or the severity of the diagnosis may be seriously understated.
Mariola Magovcevic and Michael E. Addis , of Clark University have taken the initial steps in the development of a masculine depressive index (appendix) to help diagnose depression in men who tend to adhere closely to masculine norms (2008). The methodology is a significant improvement over that of previous studies because the subjects were screened in for a recent (last three months) depressogenic events, but the authors are also very clear about the limitations of this study. There is a great deal more work to be done to develop a coherent and comprehensive diagnostic criteria for depression in men and this study didn't look at any other affective mood disorders.
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The obvious isn't always so obvious and therein lies a great deal of trouble when it comes to dealing with the problems of encouraging help seeking, improving diagnostic criteria and treatment protocols – this is very new territory. While traditionally the ratio of depression from men to women has been assumed to be about 2:1, the ratio of bipolar diagnosis, for example, has been fairly even ( Blehar & Oren, 1997, p.2). The implications of higher rates of unipolar depression in men than previously thought, would imply that the rates of bipolar disorder are also higher than previously thought. Yet none of the articles cited in this paper and few of the articles read while preparing to write this paper discuss the possibility of higher rates of any affective disorders besides depression.
The Gender Gap in Gender Studies
Though there have been several solid studies that have indicated these higher rates of depression in men, there has been very little popular discussion of the findings. The assumption that women experience significantly higher rates of depression than men is still a fundamental premise of most women's studies programs. Not because the studies indicating otherwise are flawed, or because they are being willfully ignored. Rather, they just haven't been noticed. This really shouldn't come as any surprise to those involved in gender studies, especially men's studies. While virtually every college with a psychology department has a women's studies program, there are very few that have a specific men's studies program and there are no graduate men's studies programs in the U.S. An exhaustive web search for men's studies texts, yields less than a dozen academic journals. In contrast, a cursory web search turns up more than fifty core women's studies journals.
The most important implication of this evidence is the critical need for more focus on men's studies for the sake of the mental health of a large segment of society. But there is a secondary implication here. The findings discussed here have significant relevance to the study of depression in women. First, it provides evidence that the disparity in diagnosis is considerably different than
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traditionally considered. Second, this research points to the importance of gender specific diagnostic and treatment models for depression and other affective mood disorders. It also makes a reasonable argument for investigating whether gender specific approaches might be appropriate for other neurological issues.
Men's Studies and Society
There is a broader social implication to the studies discussed here. Archetypal male gender constructs and gender role conflicts are just as abusive to men, as they often are to women. They foster emotional repression, health care problems, obsession with achievement and power, problems with sexual and affectionate behaviors, and homophobia. GRCs often create an outright fear of anything that could be mistaken as feminine in nature ( Magovcevic & Addis, 2008, p118; Blazina, Settle & Eddins, 2008, p70). Aside from the impact of archetypal male gender constructs and GRCs on the mental health and wellbeing of some men, there is also the impact on the rest of society to consider.
Yet while there are a great number of women studying female gender constructs and developing methods for women to transcend archetypal female gender constructs, very few men are studying masculine gender constructs. There are unfortunately, more women involved in men's studies than there are men. This is not to speak poorly of the women who are working in the fields of men's studies or to disparage their work. It ultimately speaks poorly of men for not stepping up and dealing with problems of masculinity and men.
The same gender conflicts that drive many men to emotional disassociation are probably largely responsible for this gender gap in men's studies. It is important to recognize that the underlying archetypal male gender constructs are a continuum, not a dichotomy (Tremblay & L'Heureux, 2005, p56). Even though most men avoid the extremes of GRCs, most men still fall somewhere along that spectrum and experience to some degree many of the problems discussed above. This means that while
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the manifestation may not be as extreme as those discussed above, they are often prohibitive nonetheless.
Deconstructing Gender
Women's studies are very important and the focus of gender studies on women's studies is understandable – most of the people involved in gender studies are women. But it is important to recognize that the lack of focus on men's studies affects women and even impacts feminine gender constructs and the socialization of women. The ramifications of masculine gender constructs have a profound affect on everyone, as do gender constructs across the spectrum. From the health and mental wellbeing of men, to the impact of GRCs and even the average masculine norms on society as a whole. The time has long since passed for an increased focus on male gender constructs that goes beyond looking at whats wrong and focuses on how to make it right.
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