Tag Archives: opinions

The problem with “crazy.”

A friend on Facebook pointed me to a scary firsthand account of a random shooting. It’s terrifying, and I’m glad that the author and bystanders weren’t badly hurt. But the article bothered me. Quite a bit, actually.

He says (bolding mine):

“All things considered, I’m really lucky. Not only am I alive and didn’t witness him shooting himself, as so many did, I have extremely supportive family and friends, I have an understanding employer, and I have resources to talk to.

The shooter was mentally ill and wasn’t so lucky. The lesson I’m taking away from this is that we need to make mental health a priority in ourselves and in our communities. Support your local mental health organizations in whatever ways you can, financially and by forcing politicians to take the issue more seriously.”

I don’t know the details of this incident and can’t speak as to the mental health of this particular shooter, but I’m seriously uncomfortable with the way we tend to jump to analyze shooters’ motives (often after they’re dead) and so often conclude that they must have been mentally ill. Some undoubtedly are, whether they were diagnosed by a therapist or diagnosed posthumously after examination of their personal effects and interrogation of their family and friends. But some of these guys are just angry assholes with a score to settle with the world.

I have absolutely no problem with the rest of that particular post. I agree wholeheartedly that there needs to be a change in how we deal with mental illness as a civilized society. But we shouldn’t be doing it because of all these dangerous “mentally ill” people shooting up our schools.

We should be doing it for the anorexics who think their skeletal bodies are still too fat. For those with anxiety disorders severe enough to keep them shut up in their homes. For those plagued by addictions and compulsions that have taken over their lives. For those who are so deeply depressed that they can’t see a way out of the darkness except to take their own lives.

It should be obvious that we need to increase funding for mental health resources. It should not take tragedies to make that happen.

I don’t think it’s hyperbole to say that everyone knows someone with a mental health issue. Mental illness is more than schizophrenia (and schizophrenia isn’t the devil it’s often made out to be, either). The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a standard published by the American Psychiatric Association to serve as a reference for the definitions of mental disorders. Take a moment and have a look at their list of mental disorders, then think about all the people you know. Do you know someone with autism? Alzheimers? Bipolar disorder? Depression? These are legitimate mental illnesses. People living with any one of the DSM’s list of disorders would be better served by better public awareness of the realities of mental health issues, as opposed to the scary stuff we see about “crazy people” on TV.

I don’t know what to call the people with a broken moral compass and a need for vengeance or notoriety. “Mentally ill” or “crazy” are convenient and do have a ring of truth, because what adult human being of sound mind could walk into a school and murder children? We need a way to express that there must be something wrong with these people; they’re not like the rest of us. But we need a better way. When “mentally ill” is used as an explanation for reprehensible behavior, it takes that label out of its medical context and makes it into something so much more dangerous. We need to encourage people to get help, not keep them quiet around their families and teachers and doctors for fear that they’ll be labeled. Because we’ve made “crazy” a dangerous label.

I Can’t Keep Quiet

I was going to write something nice today. I wanted to write a tribute to America for the Fourth of July, just as I did for Canada on its big day earlier this week. But I’m too angry.

People ask me all the time whether I plan on becoming an American citizen. My answer has always been “when I feel that I can take the oath, and mean it.”

This is the Oath of Citizenship, which everyone must recite before being officially naturalized (bolding mine):

I hereby declare, on oath, that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince, potentate, state or sovereignty, of whom or which I have heretofore been a subject or citizen; that I will support and defend the Constitution and laws of the United States of America against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I will bear arms on behalf of the United States when required by the law; that I will perform noncombatant service in the armed forces of the United States when required by the law; that I will perform work of national importance under civilian direction when required by the law; and that I take this obligation freely without any mental reservation or purpose of evasion; so help me God.

I cannot, at this time, assert that I have no mental reservations about bearing true faith and allegiance to the United States and its constitution and laws.

Why?

State after state after state after state1 is enacting laws that restrict access to abortion, “to protect women’s health.” The aim of these laws is to close clinics, cut funding, and add hoops for doctors and their patients to jump through, making abortion all but impossible for women in those states.

At the same time, these politicians work to restrict access to contraception and remove sex education from schools. And without paid maternity leave, without adequate protections against being fired for their pregnancy, without affordable childcare, how are these women, pregnant when they don’t want to be, supposed to cope?

What of the 20% of American women who are uninsured? Or those who have insurance with no maternity coverage? Do the legislators outlawing abortion want to see these women bankrupt from the emergency C-section delivery of a baby they already knew they couldn’t afford, in the most expensive health-care system in the world?

How can I love a country that is comfortable treating its women this way?

I’m mad. I’m so very very angry. I take all of this intensely personally, because I am a woman. I don’t want an abortion. I can’t imagine ever wanting one. But that should be my decision. It’s always a difficult decision to make, bringing with it lifelong emotional baggage, and most people aren’t happy about resorting to abortion. But sometimes it’s the only way out of a bad situation. And taking that option away and trapping someone in that bad situation, without offering any alternative help, is inhumane.

To make it all the more insulting, the overwhelming majority of these decisions regarding women’s bodies and reproductive rights are being made by men.

See anyone there with a uterus? I sure don’t.

Why are the anti-choice bills passing? Why does everyone keep electing people whose values and opinions are stuck in the 1950s? Why aren’t we managing to keep a grip on the rights already afforded to us in a Supreme Court decision made FORTY years ago? Why aren’t we fighting for paid parental leave, adequate and accessible health insurance, and more flexibility towards pregnant women and parents in our workplaces? Why are American women putting up with this bullshit? Why aren’t more people angry?

I bet you do, buddy.

I bet you do, buddy.

I don’t know what to do with all of my frustration. Not all of this legislation affects me personally, of course. I live in a different state with a different political climate. But I feel that I have a responsibility to stand in solidarity with all the women who are affected.  I don’t get to vote in this country unless and until I become a citizen, but I can put my money where my mouth is. I can donate to organizations that fight to keep choices open for women.

Whatever small sound my voice makes in this world, I add it to the chorus of strong and wonderful women who will not be controlled.

1. I stopped at four states because I was getting angry reading the articles and needed to back off to keep my blood pressure at a safe level. But there are plenty more, if you care to look into it.

Professionalism

A friend recently pointed me to this article about the professional responsibility and ethics that come into play when a healthcare professional is faced with treating a patient in a way that goes against their own beliefs. Since I’m a member of one of those professions, I thought I’d share my perspective.

When you commit yourself to a healthcare career, you don’t have much control over what kinds of patients you will see. Yes, a doctor can choose to specialize in obstetrics or urology, and a nurse can choose to work at a retirement home because he or she doesn’t like dealing with children. But you don’t get to decide what kind of care your patients will get based on their politics, their religion, or their life choices. You can encourage a patient to quit smoking, but you can’t give someone subpar care for their emphysema even if you feel, deep inside, that they brought it upon themselves.

Doctors take an oath to do no harm, and while I don’t know if others in the healthcare professions do the same, I can say that the overwhelming majority of those I’ve known in those positions take immense pride in their work and treat all patients with great care and respect. Those who triage their patients by anything other than medical urgency quickly lose the respect of their peers. Or they lose their jobs.

That’s why it bothers me when I read things like this, from Twitter right after the Boston Marathon suspect was taken to the hospital:

Now that the 2nd suspect is caught and in the hospital, what’s preventing a Doctor/Nurse from injecting “go fuck yourself” serum?

Frankly, the very concept is offensive to me, and I think I speak for the vast majority of medical and allied health professionals. Of course the medical team isn’t going to enjoy some vigilante justice and “accidentally” give him the wrong care to watch him die. And that’s not just because so many people are watching, or because the police have instructed them to keep him alive. It’s their job to keep him alive. Every single person who comes through those doors will be given 100% of their effort, because that’s how a trauma emergency room works. It doesn’t matter if you’re a four-year-old who was hit by a car, or the drunk driver who hit him. You’re a broken body, and they will do everything they can to put you back together.

I had a colleague who once told me that the lab he worked in years ago used to receive and test specimens from smaller medical facilities every day, because the smaller places didn’t have labs of their own. When he found out that one of them was an abortion clinic, he refused to have anything to do with those specimens, saying that running the tests would go against his religious beliefs. He’d have had nothing at all to do with the actual abortion process, mind you. The specimens he would have been testing would have been for the women’s blood counts and chemistries: tests no different from what you’d have done at your annual physical. Astonishingly, his coworkers and employer had no problem with his decision, and accommodated him. I couldn’t help but wonder what would happen at our current employer if he was faced with a similar situation. We didn’t deal with abortion clinics, but we did have several operating rooms and sometimes there were D&C’s on the operating schedule – with no way to know whether they were being done after miscarriages or planned abortions, would he refuse to crossmatch blood for those patients if they hemorrhaged on the table? To be fair, I never saw him refuse any specimen while I worked with him, so maybe his attitudes had changed by then. I didn’t probe further, because an ideological debate has a right time and a right place, and an evening shift in a busy laboratory is neither of those things.

The fact remains, though, that he did refuse care to patients based on a conflict between their decisions and his religious beliefs. It wasn’t direct care, it wasn’t emergency life-saving care, but it was still a massive breach of professionalism. And he got away with it. No disciplinary action, no reminder that a patient is a patient and a test is a test and you don’t get to choose like that.

I’m equally appalled by pharmacists who refuse to dispense the legal, FDA-approved Plan B contraceptive pill despite the patient’s valid prescription. Like my former coworker, they get away with it. As long as someone else can fill the prescription, they can keep their conscience clean. And I think that’s bullshit. Pure, unadulterated bullshit. Your obligation as a pharmacist is to dispense medications to patients. You don’t get to decide not to give out Plan B because you’re opposed to the idea, just like you can’t refuse someone their diabetes pills because you think they should be exercising more and eating better, and you don’t want to be an enabler. If you want to be a pharmacist and you want to avoid ever having to give out contraceptives, go work in hospice care or geriatrics.

It’s simple. You have an obligation, when you work in health care, to do your absolute best for each and every patient you interact with. If you’re not able and willing to do that, because your personal beliefs get in the way, then you need to find a new job.