Addicted To Violence

I was sitting at the bedside of a drug-addicted hospital patient at the moment when 19 people were shot in the second-line of the New Orleans Mothers Day parade.  I can still feel her fragile, papery skin on my hands, and the ache of disbelief and sorrow as her slurred, wandering unsentences of denial trailed off into slack-jawed vacant dozing.  As I was documenting the failed attempt at conversation, I saw the headline scroll by on my cell phone screen.  I Googled.

“Too much!” my brain screamed silently. I stared at the news bylines aghast, paralyzed for a moment by sheer amazement, and my breath fled my lungs as if I’d been punched in the chest. “Too much!”   In front of my eyes, the number of injured began to climb, first 12 then 15 then 17.  I felt first a wave of near-hysterical relief that no fatalities were being reported, then a chilling, shuddering repugnance that I could be feeling any relief whatsoever in the face of this horror.

Nurses have a host of ways to cope with emotional trauma at work; it’s a necessity when patients need us to keep our wits about us and our judgment clear.  One of my favorites is to go into a patient’s room and focus on his or her needs while my own internal firestorm abates in the background and the initial flood of panic chemicals subsides.  On this day I returned to my drug-addicted patient and watched as she struggled to lift her eyelids and remember my name, feebly attempting to delude us both into believing that she had an atom of self-control left.

At first I felt frustration rising at the incomprehensible waste of it all, a lifetime of human potential cut short, a family fragmented, a world of dreams unrealized because of the subtle demon of addiction.  But the germ of an idea began to ooze its way around the slammed door of my mind and take shape:  can’t the weaknesses of a culture that celebrates meaningless violence be traced back to the weaknesses that plague the most isolated and powerless of its members?  America has always prided itself on being the land of the free and the home of the brave.  Could the insanity that is wreaking havoc in our streets be the natural result of our being, at heart, cowardly and dependent?

One thing that never fails to amaze me when I work with addicts and those with severe mental illness is how deeply some of them believe they have nothing to lose.  They may have loving families, vibrant personalities, extraordinary intelligence or other gifts, and yet they are convinced that what happens to them is meaningless.  They see no value in their own lives and no obligation to improve or protect the lives of others. Some element of this conviction must exist in the minds of those who would blow up the finish line of a race, shoot into a parade or riddle a schoolroom with bullets.  What troubles me more, though, is how engrossed our culture is with those who have abandoned their own lives and now exercise such a peculiarly strong hold over our own.

What glues us to the TV, watching the same footage of bloodshed and chaos over and over again when a tragedy happens?  What makes us crave information about those who slaughter more than about those who cherish? What is broken in those of us who call ourselves “normal” that we are willing to spend our precious time and money focusing on the devastation of strangers?  Are we becoming like Ancient Rome, so jaded and despairing that we turn away from our own families, our own selves, our own communities to watch slaves fight lions to the death in the arena?

Are our own lives so devoid of excitement or interest that we can only feel satisfied by minute observation of the sufferings of others?  If so, then where exactly is the line between us and those who perpetrate those sufferings? If we are making the news organizations and video game makers and movie/TV producers rich who feed our hunger to experience the adrenalin of violence without getting our own hands dirty, who are we to blame those who can’t resist the urge to step forward and seize their own day in the limelight?

We gravitate towards ringside seats at public tragedy like moths to a flame, or like junkies to a fix.  We rig the game to generate more entertainment for us—we allow poverty, ignorance and discrimination to flourish; we promote deception, intimidation and powermongering as negotiating methods; we turn a blind eye to injustice and oppression of the weakest by the strongest.  Of course there’s violence!  Like a pressure cooker with no safety valve, keep the heat on and it must explode.

My drug-addicted patients have an entire healthcare system in place to help them recover and start a new life.  Yet the majority of them shy away from treatment and eventually succumb to disease or overdose. Doesn’t that sound like our culture at large, unwilling to abandon its cultish fascination with second-hand violence?  Clinging to anything past the point where it hurts others and ourselves is a workable definition of addiction.  We need to look in the mirror and tell ourselves that it’s time to lay our addiction down, time to start preventing tragedy instead of wringing our hands on the way to the TV set.  It’s time to be both free and brave, willing to come out from behind our screens and headsets to experience life as it happens in front of us.

The devastation wrought by addiction on individuals is indescribable.  It destroys people, their families and their communities.  Look at the devastation our addiction to second-hand violence is doing to our society.  Look at the time parents spend away from their children and partners spend away from each other in our fascination with the atrocities of strangers.

In medicine and recovery circles, we ask addicts to lay down the fear and shame that accompany their attachment to their drug of choice.  We encourage them to see their addiction as something that can be overcome by focusing on learning to take care of themselves with respect and compassion.  We support them in becoming self-sufficient, engaged in healthy relationships, active personally and professionally in their communities.  Surely we can do the same for ourselves and break this cycle in which we play the role of the bloodthirsty horde, while the weakest and most broken among us attack the innocent front and center.

A Mouthful on Health Care

We have made such a cult of lethargy and inertia in this country that it is killing us. Our children are so fat their organs start to fail and they are diabetic. Our elders are ravaged by heart disease, joint problems and chronic pain. Our young men and women, who ought to be at their peak of health as strong workers and active parents, are becoming larger and slower with every passing year.

Our bodies know this is wrong. As our nutrition declines and our activity dwindles, our neurochemistry responds to these abuses as if to poison, shutting down neurotransmitters that create feelings of contentment and excitement and enjoyment. The correlation between lifestyle disease and mental health has been pointed out again and again, and yet we allow ourselves to hurtle down the path of physical and emotional ruin simply because we can’t bear to deny ourselves the questionable pleasure of the path of least resistance.

What is wrong with us? Why do we crave, at times to the point of suicide, to spare ourselves any exertion, any change or progress? Why, as a culture, are we hellbent on reaching utter passivity rather than actualization? How do we ignore our own increasing pain and unhappiness in order to continue living mindlessly, drifting and psychically comatose? It’s isn’t leisure, a welcome interlude away from work. It isn’t abundance, whose hallmark is variety. It’s purgatory–narrow, dull and eternally predictable. Boring.

I believe one of the most basic motivators of human behavior is fear. We cringe away instinctively from things with the potential to harm us. This isn’t always a bad thing; healthy fear keeps us safe and prevents complacency.

But in this world we live in, unhealthy fear is breeding everywhere. In the media, tales of disaster–bloody or psychological or both–are available at all hours of the day and night, the true ones often more horrifying than the fictional. We are reminded daily both in our public and private lives that our families are unstable, our livelihoods at risk, our safety nets full of holes. These fears make it very difficult to maintain perspective, and especially to make sound decisions. With all one’s energy directed towards keeping a white-knuckled grip on reality, how can one be expected to feel confident in oneself, to start out in new directions, to change and adapt to gain desired ends? When every negative is presented and thus perceived as a threat, how can we distinguish false threats from true?

The answer is that we can’t. Confused and afraid, we cling to what is comforting and non-risky…bland, sweet foods, pastimes that require only sitting and being entertained, opinions and even dreams that require little introspection and even less curiosity. Because we are conditioned to fear what we don’t know, we take pains to ensure that we don’t explore new ground or question the old. When circumstances align to hurt us, we retreat further into our cocoons of denial and repeat the old self-damaging behavior at breakneck speed and intensity until we regain our comfort zone.

This is the opposite of being human. We are born with ambition–to move, to change, to learn, to understand. We are born to see challenges and to overcome them rather than be overcome ourselves. We are made to look beyond today into the options of the future, and to embrace those options and our role in bringing them to fruition. Yet we don’t do this, and I believe this is the underlying cause of the public health crises in our country.

We are, by and large, a nation of cowerers, as eager to re-affirm our commitment to the status quo as if we could count on it to protect us during the next recession, the next drought, the next banking scandal. And the cowering in our public life reflects an inner cowering that drives, in my opinion, the epidemic of lifestyle-related illness and disability. Instead of blaming doctors and schools and parents and TV, let’s figure out how to encourage people to be unafraid, to trust in themselves, to see the need for change and to act on it.

Then, and only then, will the tide of public health turn. When people are unfrightened enough to step outside their comfort zones, to listen to their own minds and their own bodies instead of blindly subscribing to any voice louder than their own, then they will be free to make the decision to take care of themselves and their children instead of waiting for the other shoe to drop. When people feel empowered socially and politically to reach their full potential, they will take ownership of their health the same way they take ownership of their votes, their education and their work ethic.

So how do we bring this about? By marginalizing those who seek to control others by fear. By teaching our children and our adults to think for themselves, to question and to evaluate critically what they hear and see and believe. Arm our citizens with solid education, and an environment of free speech. Require them to spend time with persons of different races, gender, socioeconomic class and religion. Encourage them to ask questions. Give every American a working knowledge of anatomy, physiology, nutrition, sleep hygiene and lifetime fitness skills. And the raise the minimum wage so that a person can make ends meet on 40-hour weeks and have time to exercise, cook healthful meals, rest and spend time with family and engaged in his or own interests.

Want to make people healthier in this county? Treat them as your comrades, your fellow-marchers in the challenge of approaching old age and extinction with grace and courage. Don’t frighten them or threaten them or bully them. Make sure they have affordable, local sources of nutritious food, safe neighborhoods to walk or bicycle in, work policies that allow regular doctor visits and health coverage that protects them from losing their life and their livelihood over a single illness and actively promotes health literacy and preventive care, including complementary medicine where appropriate.

The health care crisis is the effect of decades of playing upon the fears of the disempowered by the oligarchy of those trying to consolidate power into their own hands. Reverse that consolidation and you will have a population taking charge not only of their health, but of their families, their livelihoods, their schools, their legislatures and their economy large and small. We are paying a staggeringly high price in lost productivity, wasted health services and increased costs simply because we refuse to allow people the personal power necessary to motivate them to own the care of their own bodies. This is a sign that immediate change is needed, not in the health care system alone, but in the entire apparatus of political power distribution and information dissemination. Change these to reflect unilateral concern for the welfare of those most likely to be ignored or even harmed, and these very souls will be the ones who first make the changes necessary to enjoy both physical and emotional health and to making vibrant, creative lives in society at large.


May Day and Medicaid Expansion

Last night I went to see one of my favorite musicians, Billy Bragg, in a splendidly rabble-rousing musical plea for social justice and political equality. Today is International Workers Day, celebrating the achievements of millions of working people who struggled and continue to struggle to equalize the balance of power in the workplace (balance requires equal weights on each side of the fulcrum, after all).  What better time to think about healthcare in this country?

During the week I work for a nonprofit Medicaid HMO, supervising a case management team working directly with the poorest and sickest of Medicaid recipients to help them manage their healthcare.  We provide education, transportation and social service referrals, and facilitate improved provider access and authorization processing.   We collaborate with providers to promote free flow of information between patient and doctor, and between doctors.  Our goal is to empower people to be mindful and effective in managing their healthcare, improving their quality of life and reducing costs by minimizing waste.  And it works, driving costs down by a minimum of 10% for each target population in the last year (I speak for my program alone, since I am ignorant of others).  It’s single-payer healthcare, driven by a monthly per-capita fee that must be stretched to cover all medical expenses for the aggregate.    Expenses increase along with the acuity of patient needs, so the most sensible way to manage costs is to figure out interventions to reduce acuity (prevention, early detection, timely access, chronic disease management, effective discharge planning, etc.), and then to implement those interventions in the most efficient manner possible.  Everybody wins.  And the beauty of doing it in a single-payer system is that interventions can be implemented across the board, touching all members of the targeted populations, and protected by provider agreements and state contracts.

Is it always pretty? No.  But it’s a hell of a lot prettier than what’s available to the uninsured working poor.   Aside from federally-funded clinics (FQHCs) or charitable agencies, there is nowhere that an uninsured person working a minimum-wage job can afford to pay for a primary doctor’s visit, let alone any lab work or medications.   Expansion of Medicaid, one of the possibilities made available to states by Obamacare, would allow these hardworking, responsible adults to maintain their lives when assaulted by illness.   Under the current system, a competent, able-bodied worker may be lost to the workforce by something as simple as inability to pay for antibiotics for a case of strep throat which can, if left untreated, have deadly complications.  Business coalitions that advocate for employers of low-wage staff (janitorial, grocery, etc.) are clamoring for Medicaid expansion so that their employees can remain productive, saving the enormous costs of onboarding new employees.  Another step toward a single-payer system?  Sure, but how does that hurt the people with private insurance?  Until the single-payer model comes into direct competition with the existing private insurance structure, there is no real conflict, right?  Everyone wins if the poor are receiving basic primary healthcare in a cost-controlled managed-care environment instead of receiving preventable, high-cost treatment at the cost of the population as a whole. 

Some of us whose lives are deeply entwined with this issue think the benefit to our society if everyone embraced single-payer healthcare would far outweigh the inconveniences.  But that’s a discussion for another day.