Thursday, January 21, 2016

LCDs — Not the lights

Today if you mention LCDs most people think of the bright lights that run on very little energy.  As good  an invention as they are, that’s not what I’m talking about.  What I want to talk about in this post is how it’s human, and even primate nature, to quickly sink to the Lowest Common Denominator — and I’m talking about thoughts and behaviors here, not math.

It has been well documented by many studies that even monkeys, apes and bonobos will get upset when they feel they are begin treated unfairly   When a monkey does a trick and gets some raisins, he may be happy. But then if the monkey next to him does the same trick and he gets a much more desirable banana, it’s been shown that the first monkey is not going to do that trick again unless he gets a banana, even though he’s depriving himself of a few raisins.

That’s what is going on today, all over the world, and I’m not just talking about income and wealth disparity, although that certainly plays a big part.  

I read a few things in the paper the last few days that were upsetting to me.  One is that junior high and high school students are asked what they felt was more important:  personal achievement, their own happiness, or helping others.  22% said helping others. That’s not good.

How many times in this space have I asked the question: “What’s So Funny about Peace, Love and Understanding??”

Here is the answer, and I certainly don’t blame the kids who gave their answers.  They have learned, based upon the world they live in, and I think this is true for kids from Palo Alto to Mumbai, that there are too many people who are just looking out for themselves, and if you offer to help, they will take advantage of you, and treat you like a fool for letting it happen.  If you put an orange on the table and say lets share some fruit, the first person who comes along is likely to run off with the orange and not leave anything behind.  After this happens a couple of time, no one leaves an orange, or even a grape.

What makes it even worse is that this kind of behavior is totally unnecessary.  Perhaps for the first time in this earth’s history we actually have enough food, air, water, housing and video games for everyone to have a reasonable amount.  But the idea of helping others to attain a reasonable quality of life is almost unthinkable because too many people are grabbing everything they can for themselves.

Once this behavior gets started, even if it is just by the small minority that I call the Lowest Common Denominator, then it doesn’t take too long before everyone learns to be defensive.  Everyone is taking and no one is giving.  

You can see it in traffic patterns.  Drive along nicely and cooperatively.  Then a person cuts you off, and then another, and even though it might delay your drip by 1/3 of s second, it just doesn’t feel fair.  So the next time someone tries to cut in right before the off ramp, you don’t let them.  They should wait their turn and  get in line with the rest of us, especially if they’re driving that $55,000 SUV.

Drive carefully my friends.  And maybe next time blow them a kiss instead of flipping the bird. At least they may be confused for a second, and the denominator may get raised a couple of points.

So much stress, so unnecessary.

Wednesday, January 13, 2016

The War on Drugs

I often check the police log of the local newspaper to see if any of my old patients will surprise me.  Last week a patient whom I had not seen for several years was listed as having been arrested for possession of a Class A substance.  This was not a surprise.  The young man had been struggling with many issues involving work, family and school for years.I remember working with his mother when he was a teenager to try and get him services that  would be more intensive than what I could offer him.  But he was a tough kid to work with, so no one put in the time to push for him to get into the very few places that may have been available.  Perhaps the court system will be his best chance of getting into a program.
There has been a lot of publicity over the last couple of years about the over-use and the illegal use of opioids, which has been leading to an increase in addiction and a noticeable  increase in deaths from overdoses.  Now that many of these deaths are of young adult, middle and upper class White people, it has become an “epidemic.” In response to this there have been more calls for restrictions on the use of many opium based pain medications as well as more treatment programs for people struggling with these drugs.  There are also calls to make treatment the alternative to criminal prosecution.

Of course, much of this problem is the result of the disastrous effects of the everlasting “War on Drugs.”  That war should now be regarded as one of the great failures of American war policy, right up there with the invasion of Iraq and Viet Nam. The only people who classify the War on Drugs as having any success are those who favor the mass incarceration of Black people for non-violent crimes, and the private prisons, who have made billions of dollars in profits from these incarcerations.

By any appraisal of the huge amount of time, money and the destruction of social fiber that has resulted from the War on Drugs will quickly reveal that the entire effort was worse than a failure.  There have been so many destructive  effects that still are undermining American health, safety and quality of life.

Here is a partial list of that pain and suffering this war as caused:

— the criminalization of acts that, if they hurt anyone at all, hurt the person using the drugs.
— that resulted in people being put in jail instead of getting treatment
— that resulted in them using jobs, and not being able to find new ones
—  often these people were deprived of getting driving licenses or voting
— they became burdens to their families
— they were regarded as weak willed, losers and worse
—  this kind of social rejection often led to the return to addiction
Despite the huge amount of time, money and effort devoted to fighting the War on Drugs the actual use of drugs never really diminished.  Illicit drugs are still widely used and distributed. They are distributed by illegal means, mostly being drug cartels.  The money goes to support illegal efforts and make criminals rich.  It is lost to the economy.  It is not taxed.  Thus it is a negative economic benefit. 

Those are the obvious failures. There are many secondary failures that have resulted from these policies.
— The amount of time, money and resources that police department have spent fighting a crime that did not have to be a crime
— a result of this was the development of  greater 
 adversarial conditions between the police and many people who would have trusted them.
— this led to a in a militarization of the the police
— the development of SWAT Teams to chase drug dealers

Also: a big increase in gun violence is related to the vast sums of money earned by drug dealers, the wars over their territories, the use of informants, and the entire unlawful importing, selling, buying and using of drugs.
None of that was necessary.

All of this has been a major factor in the corruption of governments in many countries around the world, especially in South and Central America, as well as many American local police forces.   The American addiction of drugs that are illegal has brought billions of dollars to huge illegal cartels.  There have been countless thousands of deaths in drug wars between cartels, in wars with police and armies, and of many people who were just in the wrong place, or innocent families who had relatives on the wrong team. It has helped to set a climate of corruption, opposition and distrust in many societies, especially in our own, as otherwise law abiding people learn to oppose the police. The need too afford illegal drugs has lead to many robberies and burglaries, even among family members.

The money from illegal drugs has financed revolutions in many countries included Columbia, Afghanistan and ISIS.  
The war on drugs has torn apart families.  The ideas of “Just say no” and “Tough Love”, would never have been necessary if taking drugs had never become a crime, and considered a moral disgrace. 
Treatments for drug “offenders” were much less effective and much more punitive than they would have been without the overlay of legal consequences. Mandated treatments are still a great expense to taxpayers and to the individuals involved.  They often set up requirements that make it difficult to hold on to a job, and they are often a waste of time and money since so many people are forced into treatments when they do not feel that is what they want to do.
Pharmaceutical companies were very active in combatting illegal drugs while promoting their own drugs.  Those lines became blurred and remain blurred today.  They want to sell a lot of pain-killers, but don’t want to be responsible for addictions.  They market drugs that they said would help learning, behavior and mood. But they were against other drugs that people knew made them feel happier or perform better. It is never clear how much drug manufacturers fight against the underground buying and selling of the drugs they manufacture. The pervasive message that a drug will make you feel better, no matter what the problem, has certainly become well established in our culture. People seek drugs for better health, performance and pleasure.  It is not clear why some are legal and some are not.

This is just a partial list of the harm done to people, their families, their communities, the country and the world by the War on Drugs.  This war, like almost all wars was started for political reasons.  The underlying factors were fear and racism.  One of the original fears were the fears of the changes that were happening in the sixties.  People were standing up to their government saying they didn't want to go to war.  Other people were asking for equal rights for women and minorities, especially African Americans.   The status quo was being threatened.  The people who were threatening were the hippies, Blacks and women.  They seemed to be the ones who like to take drugs. It became a big issue of the culture wars.
In just the last four years, since many of the older white people who were threatened are now busy carrying guns, and a non-threatened younger generation is more tolerant, changes are occurring.  There is finally a movement to look at the imbalance in prison sentences that have sent Black people to prison for crack, while white people who use powered cocaine get probation. The legalization of marijuana is slowly becoming acceptable, but there will be many disputes over who gets the money.

All of this is made even more distressing because there is an example of other ways to deal with drug use and abuse, and it has proved very successful.  For the past fifteen years Portugal has decriminalized all drug use. The problem was shifted from the justice system to the health department. 

- “If someone is found in the possession of less than a 10-day supply of anything from marijuana to heroin, he or she is sent to a three-person Commission for the Dissuasion of Drug Addiction, typically made up of a lawyer, a doctor and a social worker. The commission recommends treatment or a minor fine; otherwise, the person is sent off without any penalty. A vast majority of the time, there is no penalty.” —
Since the drugs are available and affordable, and having them is legal, then their is no crime, so the crime rate is way down. There is no secondary crime, such as robberies.  The police will help you if you get sick or want treatment.  The user is not viewed as morally or psychologically deficient.  
And, not surprisingly, the rate of drug abuse has decreased over the years, and so did the spread of HIV.

Unfortunately, it is too late for my former patient to get treatment without having an arrest record to haunt him.  But recently, there are signs that people are realizing that there may be a better approach.  Like everything political in this country, change will not come easily or swiftly. So much depends on awareness, and then of changing the flow of money.  Many people, from drug makers and growers, illegal cartels, corrupt officials, drug companies and diversion programs are making money from the current system.  It will take working with families, courts, police, doctors, drug users and others in the health system to bring about change.  
Eventually, things will change.  The changes in our culture will continue, even if many people fear the unknown.  But our societies ideas about what is helpful, what is healthy, what is legal, and what is pleasurable are evolving. Also, new substances will be developed that will help blur all the lines.  

Until all of that is sorted out, take good care of yourselves and each other.

Wednesday, January 06, 2016

What Next for Sammy?

The last post, the one about Sammy, is about a kid who had an unstable beginning, had a mother who spent years pleading for help, and she is still searching today. His problems are complex and multi-determined, so no one treatment will work for him. Drugs only made things worse, as he really got to like Xanax and Klonipin, so he stole them from his mother, and anyone else who had them.  Psychotherapy was difficult.  Perhaps if I was able to see him three times a week, but his mother couldn’t get him to me that often and insurance wouldn’t pay for that.
A treatment plan that may have worked would have been if he could have been placed in a therapeutic day school, beginning in around third grade when his difficulties became obvious.  He didn’t need to be sent away, and that would have probably made things worse.  But if he could have lived with his mother and brother, and gone to a school with small classes and counseling, where, over time, people would have gotten to know him.  it would have given him a much better chance.
There are three or four schools like that around here. By around here I mean an hour to two hours away.  They would have been expensive for the town, and those special schools filled up early. The town and an advocate would have had to push hard and often to get him in.  But since the school regarded Sammy’s mother as a pain in the ass, and thought that her family was just trash, they were not going to give Sammy what he needed.
The mental health system didn’t offer much.  He didn’t need to be hospitalized, so it was up to me, out there by myself, to do what I could. I was able to get him into a couple of special classes, mostly for academic help, but as I said he was a tough kid to bond with, so the teachers gave up quickly.

Now that he is in his early twenties his problems are considered criminal.  He was caught with a Class A substance.  That means he was arrested.  The criminal justice system may be the only place that he will get treatment.  With so many over-dosing happening now in New England the courts are trying to find more treatment options for people with addictions. But someone will have to determine if he is “motivated.”  Really, it should be part of the job of the treatment program to find a way to get him motivated, and to care about himself.  But that is a much more complex task.

As  it is now Sammy is just another casualty of the “War on Drugs.” The “War on Drugs” now ranks with other recent wars in American history, such as Viet Nan and the invasion of Iraq, as worse than a total failure. 

I’ll discuss that next time.

Saturday, January 02, 2016

Another Year is Here!

The end of one year and the beginning of a new one seems to bring out a moment of reflection and evaluation in a lot of folks.  I am grateful for that as several of my patients from years back have taken the time to send me a message.  They usually just say that they remember me, and that I was helpful.  Some say more than that, giving me credit for things I don’t remember saying, or for transformations that happened during the time that they were in therapy.  I certainly enjoy reading those messages.  

That’s the good part of the year’s end transition.  The more upsetting part is that when one patient contacts me to say good things, it reminds me of some of the other people I was seeing at the same time.  Memories get linked the way.  I don’t like how much my memories of the people I didn’t help that much overshadow the good feelings I get from those who did well.

Yesterday, I went through that whole cycle while sitting here at my desk as the early sunset came pouring through the window, making reading on my computer screen difficult. A message from one person led to to search for the name of another.  I quickly found what I expected. He was arrested last year for the possession of a Class A substance.

“Sammy” was a young man I saw about five years ago.  He was sixteen the last time we met. He was brought to see me by his mother, who I had been seeing at the time.  He was very ambivalent about coming.  He wasn’t the ideal psychotherapy candidate. He was untrusting.  He couldn’t make eye-contact. He was almost non-verbal.  If he spoke at all it was in one word sentences.  Two words made a paragraph.

All of this he came by honestly.  His father had drifted away when the boy was about four. The father had a drug problems of his own, and probably many other problems in addition.  His mother was very hard-working, very depressed and she herself had come from a family that was so messed-up it would take about sixteen pages to just give an overview.  So, when she would get involved with some men who wanted to save her it was never good for her children.  A couple of the men were especially harsh on Sammy, who was sullen, disrespectful, and not very cooperative.

I could go on and on, and I should actually, but no one reads two-hundred page blog posts. But the message is that “mental health issues” are very complex.  They don’t lend themselves to clear, consistent solutions.  Sammy was the kind of kid who, if I really wanted to help him I should have taken him home.  I could have said to my wife, “Hey, this is Sammy.  We are going to wash him, feed him, and keep him with us for five to ten years.  We will sand end him to school here, where there is a good school system, and we will go to school once or twice a month to make sure we are on working together.  We will try to limit his time playing video games and then try to help him make one or two friends.  We will try and protect him from being bullied, and show him that he is talented and capable.  We will try to make sure he smokes only a limited amount of pot.

It probably would have also helped if his mother came to live with us on weekends so he would know that she didn’t abandon him. If he went to be with her on weekends those two days would have probably undone whatever was gained during the five days he stayed with us.

But I din’t take him home. I have this rule about not taking any patients home. Even if I did I don’t know how successful an intervention it would have been. I’m not his uncle.  His uncle is in jail.

I did go to several meetings at his school.  I tried to get one of the school counselors to see him because his mother was having so much difficulty to get away from work in order to get him to my office. The school essentially told me that they didn’t like him because he was sullen, withdrawn and difficult.  Essentially, they blamed him for having all of his problems. and even encouraged him to drop out and go away.

These memories bother me.  When I read about people who are homeless, or people being shot by police for brandishing a stick or having a lump in their pocket, I think about Sammy.  When I know that there are thousands of young men getting thrown into jail, or dying in messy apartments of drug over doses, I think about all of the Sammys I’ve seen.

The underlying causes are probably genetic, partially.  Certainly abuse, poverty, and lack of supervision and encouragement don’t help.  The lack of resources, support, and concern by the community adds to the problem.  Then his difficulties get defined as a crime which makes everything worse. 

So now I don’t know.  I don’t know if he is in jail or just on probation.  I don’t know if he will be scared enough, or get enough support to stay our of further trouble. Can he get a job and make enough money to support himself?  Is he capable of having any kind of real relationship with anyone?  
I know that he really never did anything wrong, or actually hurt anyone. He’s not a criminal unless being poor, depressed, confused, bullied and pushed aside is a crime. I know that his mother still cares.  She is still out there trying to get him into a rehab, but the beds are full and the treatment is short.

The rest of the world doesn’t really care about him and all of the Sammys.  They are difficult and embarrassing.  Eventually they just get swept up and put in the trash. The real problem is that treatment is too complex, and more importantly, too expensive.

I know I tried.  But it wasn’t enough.