Wednesday, December 19, 2012

Disaster in Newtown

At the moment I am thinking about mental health services. I just read an article in Mother Jones magazine about how PTSD can actually be contagious in a family. Anger and hyper-awareness and nightmares have been passed on from a returned soldier to his wife and eventually his young daughter. This is well documented in the magazine and is by no means unique.

 I am jumping ahead a bit chronologically to the horrific disaster in Newtown Connecticut in which 20 children ages 6 to 7 and four adults were slaughtered with an automatic rifle wielded by a lone gunman who shot his way into an elementary school and fired indiscriminately at a first grade class and some teachers and principal who tried to protect the children. Many of the children had multiple gunshot wounds. The shooter, of course, committed suicide when the police arrived and as is so often the case he was described as a shy misanthropic loner who was protected by his mother (and the mother was the first victim with six bullet wounds while she was lying in bed). As is so often the case in this scenario, the shooter was ignored by his classmates and peers, thought to be shy, and the parent did not seek help for his angst.

We see this over and over with these massacres. A young person, usually male, who has a history of being "on the outs" with his society and probably very resentful of the fact, works up a rage about his life and life in general and wants to strike out at anything and anybody nearby. Usually the victims are chosen at random and have nothing to do with the reasons for the shooter's rage. Rage can sometimes be manifested in writings as in the case of the Unibomber and the Army psychiatrist at Fort Hood.

Mental health services in this country are in a shambles. There are many reasons for this, but perhaps the most cogent is the attitude of the general public towards psychiatry and its practitioners.  It is often held that mental illness or psychological problems are a sign of a weak person or a person who is "weird", and also that the practice of psychiatry in general is laughable and subject to multiple parodies. Certainly people with serious mental illness such as schizophrenia or paranoia can indeed act "weird" or even sociopathic, and the stigma of this kind of behavior is often generalized to anyone with mental health problems. What's more, from my decades of experience dealing with psychiatrists, I have come to believe that many are ineffectual and sometimes even harmful to their patients. On both coasts, I have seen way too many reputable psychiatrists whose idea of therapy is first to make an official diagnosis (for insurance purposes) and then prescribe medication and see the patient infrequently thereafter. One prestigious psychiatrist with a statewide reputation allegedly responded to a patient's initial request for an appointment by setting up the initial visit at the electroshock therapy room. I have known probably three or four psychiatrists who actually perform psychotherapy and when they do, they are often invaluable. But they are in my experience (and I realize this is selection bias) fairly uncommon to actually rare. Psychiatric social workers, in my experience, have a much better record of actually performing useful and effective therapy, usually using what I have seen and what many experts recommend as the most effective technique: "CBT or Cognitive Behavioral Therapy". It's probably more effective than other more traditional forms of therapy and certainly more so in many cases than formal psychoanalysis. What's more, it's goal oriented and much less cumbersome for both therapist and patient.

An equally severe problem is the fact that mental health therapy is often very poorly reimbursed. Insurance plans, understandably, wish to reimburse activities for which there are tangible results, such as surgery. Psychiatry frequently has vague or muddy outcomes and there has never been, in my opinion, a comprehensive, scientifically sound outcomes-analysis which could be used by insurance companies for purposes of funding. Therefore, the benefits are limited in both amount and time and often ridiculously ineffective. Psychiatry stands near the very bottom of the reimbursement pyramid for medical treatments as does psychiatric social work. For that reason, some people who would be very good at the field decide not to enter it. I worked in a drug rehabilitation facility in California where the needs of addicts extended over several weeks of therapy, often inpatient, for which the reimbursement was 3 to 4 days per year. As I say, I do not blame the insurance companies as they want to see results for their money. Nonetheless, because of the stigma involved, the lack of effective therapists, and the poor reimbursement, good mental health service in this country is uncommon and too often ineffective. I feel very strongly that disasters such as the recent school massacre could have been prevented if this were not the case. But it is. So now what do we do?

Friday, November 4, 2011


Remember Reaganomics and trickle-down? Well, the Republicans not only remember it but they are still advocating it.

The idea that reducing taxes will increase business revenue and therefore improve the economic status of the country has been a long-standing tenet of Republican policy.

Well, it doesn't work. Even David Stockman, Reagan's Old Budget Director, admits it now. Finally we have adequate evidence to establish that reducing government expenditures actually hurts the economy and that downsizing government costs tens of thousands if not hundreds of thousands of jobs.

The proof is summarized in a marvelous article in the latest Mother Jones magazine, by Kevin Drum, entitled "Rich People Create Jobs!".

I would like to quote the article here but it is copyrighted and I'm a little uncertain about my legal obligations here.

But if you possibly can, get a copy of it and read the article. If you still believe in Reaganomics after this I don't think anyone can convince you of the truth. But many Republican leaders still feel that they would love to, in the words of Grover Norquist, "shrink government until it's small enough to drown in the bathtub". We may actually see this work if the Republicans continue to build their power and that, my friends, is a very, very scary proposition.

Tuesday, October 25, 2011

Can Democrats and Republicans Agree on anything?

The impasse in Washington is as strong as ever. Democrats stand for helping the poor and unfortunate and curtailing the excesses of commercialism, whereas Republicans stand for encouraging private enterprise and increasing individual wealth. But enough of that – we all know it.

There is one area, in my opinion, that can be a bridge of peace between the two parties. That is the field of government regulation. Republicans hate regulation and Democrats feel it is essential to prevent runaway capitalism, such as the housing fiasco. So where could we meet in the middle?

Here's an idea which I would like to share with you. I agree with the Democrats that regulation is essential as there are too many people who will do anything to make money. I agree with the Republicans that regulations are onerous, time-consuming, and stifle enterprise.

Regulations are written by lawyers for lawyers and they try to plug all the possible loopholes with verbiage and multiple details. This leads to documentation which is extremely voluminous and hard to read and what's more it is full of jargon and acronyms.

No matter how detailed and carefully drafted a regulation becomes, there are teams of lawyers that can find loopholes and exploit them. Large corporations hire such teams and they have been quite successful in finding loopholes. Individuals are saddled with the same regulations but do not have the resources to exploit them. What's more, many regulations are counterintuitive and – dare I say – plain stupid. I refer the reader to a fine book entitled "The Death of Common Sense" by Philip Howard, an Atlanta attorney, for discrete examples of such stupidity.

What's more, the people who design and distribute regulations seem to have forgotten that ordinary humans have to read them and fill out forms. The regulations that I have seen in the health field epitomize this problem. Acres of singlespaced fine print interspersed with blocks to fill in, multiple pages requiring full personal identification on each, and the like. Just the appearance of some of the forms to fill out is daunting.

It seems to me that this is one problem that could be worked on by both sides and the result would be favorable to big business and to small business alike. There is plenty of talent in this country and it is waiting to be tapped. Here is a great spot to begin.

For example, my suggestion would be gradually to do away with regulations and forms and substitute regulation by humans instead. I know, I know. Humans can be arbitrary, selfish and capricious if not downright dishonest and we don't want people like that regulating us. So here's an idea to mull over: yes, have regulators who watch over what we all do and check to be sure that we are not breaking the law or going against the best interests of society. But not regulators who intimidate and are power-hungry and intransigent. How to do that?

Criminologists tell us that the best deterrent to crime is not the severity of punishment but the likelihood of getting caught. What's more, the current climate of regulation seems to be "gotcha" when a law is broken or a regulation flouted. To me, that is counterproductive. I would like to see regulators have the ability and skill to carefully monitor the enterprise to which they are assigned and when they find a deviation or a tendency to act against laws or the good of society issue a simple and nonthreatening warning: "this is not something you should be doing. Please stop it."; then they continue watching and if the activity is not stopped they issue a somewhat more ominous "you are still doing it and you are going to be in trouble if you continue it".

At this point, the regulator notifies a superior body of what is going on rather than taking any individual action himself and the superior body then, being aware, is prepared to take an action. This will eliminate individual insolence and hubris because the regulator does not have the power to punish but only to observe and warn. but of course the regulator's warnings are based on specific laws or the intent of legislation as interpreted by his superiors and by the Congress.

Of course, this is a very crude and inchoate beginning to the discussion but I want to get opinions from those better prepared to deal with the question than I so please contribute!

Monday, September 5, 2011

WImpy Democrats?

Well, the President's popularity is dropping, and I think I know why. He needs a strong dose of Trumanism. I read in the latest issue of Mother Jones a good rationale for his strangely wimpy response to vicious and largely telling attacks on his leadership. His strategy seems to be: appease the Repubs as much as possible to squeeze through whatever reforms and upgrades he can. To an extent, he can show success, such as the earned income tax credit, maintenance of unemployment compensation, avoidance of the catastrophe looming around the debt ceiling, and the like. But the price he is paying could cost him a second term and if the Repubs ever get control of the White House, let alone the Senate, it's back to the 19th century, and the gradual undoing of all the reforms of both Roosevelts. I suppose that our country could survive that, but what a country it would become. Robber barons in complete charge, a wider gulf between rich and poor, cheating and manipulation on every side, and perhaps even a class war.
So I think that his choice, though understandable, is disastrous. It''s time for him to get on national TV and call the country to the fray. If the people who said "I don't vote because........" were to get themselves to the polls, the problem would take care of itself. The lunatic fringe would be drowned in a sea of truly enlightened patriotism and common sense. Our president needs to say that the mess we are in is the direct result of lax government regulation, not too much government. That can be proven.

The current Tea Party would bring catastrophe to the country if their anarchic message were to carry. No more clean water, clean air. Acid rain. Clear cutting our national forests, Coal smoke everywhere. No minimum wage. More jobs sent overseas. Stock manipulation galore, not to mention commodities and energy. I could go on and on.

But will he speak out? I seriously doubt it. And thus the outcome of the next election is also seriously in doubt, and all the folks who sit on their hands in November will get what they deserve and take the rest of us along with them.

Tuesday, August 23, 2011

Our friends the Republicans

The more I study the current crop of Republicans the more convinced I am that there is one common trait which seems to run in the majority: selfishness. It was well characterized by the British in the comment "I'm all right Jack – the hell with you".

Republicans seem to feel that if they are fortunate, hard-working, and skilled enough to have a good life or what they think is a good life, they should denigrate and scoff at those who were not fortunate or hard-working or skilled or all of the above.

They point out that this attitude is what made this country great and the more I think about it the more I agree with them. During most of the 19th century expansion, development and industrial growth were in the hands of single-minded entrepreneurs whose only goal was success in their endeavor and cared little if at all for the people they brushed aside or stepped on in the process.

But the side effects were disastrous, leading to a severe and deprived underclass, labor strife up to and including attempted murder of factory owners (such as Henry Clay Frick), and a dramatic gulf between the very rich and the working poor. The Republican Theodore Roosevelt recognized this social disaster and began the process of government regulation which has been expanded ever since as the entrepreneurs found more and more devious and clever ways of getting around regulation.

So the Republicans would like to return to those days with no income tax and little regulation so that they could again trample on the less fortunate, aggressive or ambitious of our citizens, without a single thought of what got them to be successful and whether it was indeed morally justifiable.

From the standpoint of creating a great nation, the Republican state of mind was extraordinarily effective but from the standpoint of creating a just and smoothly working society is totally disastrous and that's where we stand today, on the brink of a disintegrating social contract. The Democrats are not very effective in countering this since some of the emphasis of the party is controlled by plaintiff's attorneys whose primary goal is tort litigation against industry and its leaders rather than support of and aid to the working poor, the disabled, the mentally disturbed and deficient, and the chronically ill and dis-functional.

This could all be nicely taken care of by the voters, especially those who do not want to see our country deteriorate into the situation we found in the 19th century. But I keep hearing, from people who would agree with the above, that they have "given up on politics" and are not interested in redressing the problem at the ballot box. Talk about your self fulfilling prophecies! There are so many nonvoters whose hearts are in the right place but who sincerely believe that politics is merely a game and they're not playing. That attitude is so scary it makes my hair stand up and it is a major cause for the mess we are in now. I don't know what can be done about it except to express my opinion, so there it is. What do you think?

Wednesday, February 11, 2009

Christian Hypocrisy?

I have no quarrel with Christians who are trying to follow Christ's teachings, albeit with many failings, as long as they don't start trying to change society to fit their ideals. Then they become hypocrites.

For example, those who say that the Bible is the given word of God, and that everything written in it is to be taken literally, then claim to be following God's commands, and are praying to a group in a church or on TV. Then they flout the command in Matthew 6:5 -

"And when you pray, do not be like the hypocrites, for they love to pray standing in the synagogues and on the street corners to be seen by men. I tell you the truth, they have received their reward in full.
But when you pray, go into your room, close the door and pray to your Father, who is unseen. Then your Father, who sees what is done in secret, will reward you.
And when you pray, do not keep on babbling like pagans, for they think they will be heard because of their many words.
8 Do not be like them, for your Father knows what you need before you ask him."

And those with worldly goods, who claim to be devout Christians, and flout the command in Matthew 6:19 -

"Do not store up for yourselves treasures on earth, where moth and rust destroy, and where thieves break in and steal.
But store up for yourselves treasures in heaven, where moth and rust do not destroy, and where thieves do not break in and steal.
For where your treasure is, there your heart will be also."

So TV evangelists, who scoot around in private jets and live in palatial surroundings (whether or not the title is in their name) are, by Jesus' own words, hypocrites. So why do Christians treat them otherwise? And wealthy citizens who profess to be devout Christians, are likewise.

Monday, July 7, 2008

Advertising, Bribery and the First Amendment

I have almost stopped watching network TV. Once in a while I'll catch an important sports event, but that's about it. Network news is marginally interesting at best, scheduled programming is boring to revolting, but the real reason I have stopped is advertising. Not only are the advts. creeping
up on program content in length and number (most egregious is the number posted just before the weather forecast on the news) but their material is more and more nauseating. One of the reasons that I watch international soccer is that there's no stoppage of play and thus no advts. can sneak in.

Advts. are not only upsetting of themselves but they destroy the carefully crafted mood of good drama. How can you follow a demonstration of major grief or anguish or terror with a smarmy housewife pitching floor wax with a stupid grin?

Anyway, commercials are here to stay. And anyone who can stand them should be able to watch. But, then, why the ineffectual and ludicrous regulations about content? Take the clearly mandated ones about automobile leasing. First, the hype. Then come the legally required facts about the lease, printed in dirty grey, 10-pitch lettering, scrolled at unreadable speed. Or on the radio, spouted by a trained pitchman at half volume like a tobacco auctioneer. No wonder our government is regarded as a toady to commercial interests. Here's proof all can see or hear every day. Whom are we kidding? It's literally nauseating.

And drug ads. As a retired physician I have been as guilty as most in accepting largesse from Big Pharma and believing some of what I am told without confirming through scientific studies and double-checking the claims. But I'm not proud of it, and would be delighted if all ads. for prescription drugs, and all pitches to physicians were to stop. It's dead wrong and it's dangerous.

But there is the First Amendment. Corporations are as free as individuals to speak out on any (well, almost any) subject. I would love to see a law banning marketing of prescription drugs, both to patients and to physicians. But I fear that such a law would be unconstitutional.

I would love to see the FTC really force advertisers to comply with the spirit of regulations, not just their letter, and stop the hypocrisy. But as long as the electoral process is like an auction of influence and power to the highest bidder, that ain't gonna happen either.