Psyched Out

Dear Ms. Principal,

We're concerned about the "red ribbon" program the school is
engaging in. Is the school teaching the children that all alcohol,
tobacco, and drug use is bad?

Tobacco is unhealthy but legal. We don't smoke and we hope our kids
don't choose to, but hope they will make an intelligent choice
about it, and doubt that signing a pledge in first grade is going
to help them make an intelligent choice as teenagers. If anything,
signing pledges because everyone else is doing it is going to have
the effect of teaching them to "go along with the group" with
regards to drugs and alcohol when they're teenagers... and their
peers might be a "group" which would push them in the opposite
direction at that time!

Drinking alcohol -- communion wine -- is part of a sacrament for
Catholics. I doubt the school intends to have the children pledge
not to be Catholics like other members of the family. Of course
we also drink moderately outside of church, and we don't think
that there is anything wrong with that either.

Both of us take drugs every day, such as Singulair for a
respiratory condition. We hope the kids are not being taught
that this is wrong, and that they should never take medicine?

Many drugs are illegal in one context and legal in another.
Oxycontin is a harmful and addictive street drug but also a
beneficial painkiller when used under medical supervision.

We're not really happy with the way this is being
addressed -- and we're not sure that it is possible to give
the issue of harmful and addictive substances the treatment
it deserves with first graders.

But we'd be willing to give it a shot. I work with substance
abuse every day in my social work position, and would be willing
to come into the classroom and talk about the nature of addiction,
with questions and answers, to try to give the kids a simple but
compassionate understanding of the issue.

Is that something that the school would be interested in? We'd be
much happier with that kind of education than children signing
pledges which they don't understand. (They don't understand them.
We asked them if they understood what they signed.)

What do you think about these issues? We would be interested in
discussing them with you.

Sincerely,

Mary and Ed

Psychotic Disparity: Low Income Women and Mental Health Treatment in Pregnancy
by Mary H

An often overlooked issue of social justice is the disparity in treatment given to impoverished uninsured/publicly insured and wealthier privately insured women who experience psychosis during pregnancy. An impoverished, pregnant and actively psychotic woman is among society's most vulnerable citizens. Yet doctors sometimes hesitate to prescribe the exact same medication for potentially deadly psychosis that they give for inconvenient nausea during pregnancy, leaving pregnant women committed in locked facilities, untreated and fully psychotic for many weeks.

Psychosis is the most severe form of mental illness, often robbing its sufferers of even the ability to perceive it as a disease with treatment available. Suicide is a serious risk among psychotic patients, with research showing a 4-10% death rate. Compared to pregnant women treated with antipsychotic medication, women diagnosed with psychosis without medication had four times the risk of psychiatric relapse and hospitalization. Psychiatrically hospitalized psychotic women experience markedly worse pregnancy outcomes. They have twice the rate of stillbirth, infant death, premature birth, low birth weight and small for gestational age babies compared to psychotic women treated outpatient. All antipsychotics are proven safe throughout pregnancy, several are used to treat nausea. Mood stabilizers for manic psychosis are safe after the first trimester, and one mood stabilizer, Lamictal, is shown to be safe even then. Try to imagine a middle class woman with private insurance committed and left untreated, and the primary cause of this social injustice is clear: social class.

Wealthier, privately insured women enjoy several key benefits from their social status and personal power. They often have better access to information about their illness and medications before pregnancy and more access to other pregnant women with psychosis through the internet. Privately insured women obviously have better access to health care and more choices. Privately insured women tend to have more collaborative relationships with their doctors, more time in office visits and they are free to “doctor shop” if they are denied treatment with medication by one physician. Certainly many poor women enjoy rich social networks and supportive partners, but overall these benefits are more available to richer women. If a doctor does try to commit a privately insured wealthy woman, she is likely to have a medical guardian to approve medications when she cannot consent to treatment herself due to the psychosis.

Several solutions could improve care for impoverished uninsured/publicly insured women. Improved education for both doctors and women of childbearing age could be provided along with the popular campaign giving information about postpartum mental health. Universal health care would resolve some disparity in care because many more doctors would accept a national insurance and discrimination based on ability to pay would be greatly reduced. Finally, community efforts to establish volunteer medical guardians for psychotic women that do not depend on intact families, perhaps through Le Leche League and local childbirth assistants, would prevent a woman from being incarcerated rather than medically treated unless she chooses that path before she becomes ill.

An often overlooked issue of social justice is the disparity in treatment given to impoverished uninsured/publicly insured and wealthier privately insured women who experience psychosis during pregnancy. An impoverished, pregnant and actively psychotic woman is among society's most vulnerable citizens. Yet medication treatment is at times withheld in favor of long term committment for this population due to a blend of limited choice as well as poor access to care and information.

Psychosis is the most severe form of mental illness, often robbing its suffererss of even the ability to perceive it as a disease with treatment available. Suicide is a serious risk among psychotic patients, with research showing a 4-10% death rate. Compared to women treated with antipsychotic medication, women previously diagnosed with psychosis without medication had four times the risk of psychiatric relapse and hospitalization. Psychiatricallly hospitalized psychotic women experience notably worse pregnancy outcomes. They have twice the rate of stillbirth, infant death, premature birth, low birth weight and small for gestational age babies compared to psychotic women treated outpatient.

Doctors often hesitate to prescribe medications for potentially deadly psychosis when they prescribe the exact same medication for inconvenient nausea during pregnancy. With the exception of mood stabilizers, all antipsychotics are safe throughout pregnancy. Even mood stabilizers are safe after the first trimester, and one mood stabilizer, Lamictal, is shown to be safe even in the first fourteen weeks. In uninsured/publicly insured inpatient and outpatient psychiatrists have been known to withhold pregnancy safe antipsychotic medications, instead leaving pregnant women committed, untreated and fully psychotic for many weeks. Try to imagine a middle class woman with private insurance treated this way, and the primary cause of this social injustice is clear.: social class.

Wealthier, privately insured women enjoy several key benefits from their social status and personal power. They often have better access to information about their illness and medications before pregnancy and more access to other pregnant women with psychosis through the internet. Poor women usually have limited public and no home access to the internet. Privately insured women obviously have better access to health care and more choices. In addition, privately insured women tend to have more collaborative relationships with their doctors, more time in office visits, more liklihood of consults, and they are free to “doctor shop” if they are denied treatment with medication by one physician. Very few doctors accept medicaid,or take uninsured patients, and in any place but a large city there may be only one game in town. Certainly many poor women enjoy full and rich social networks and supportive partners, but overall these benefits are more availible to richer women. If a doctor does try to commit a privately ensured wealthy woman without offering treatment instead of containment, richer women are more likely to have people in their lives to authorize treatment when the actively psychotic woman cannot consent to treatment herself.

Several low cost solutions could improve care for impoverished uninsured/publicly insured women. Improved education for both doctors and women of childbearing age could be provided along with the popular campaign giving information about postpartum mental health. Universal basic health care would resolve some of the disparity in care because all women would be publicly insured and many more doctors would accept a national insurance. Discrimination based on ability to pay would be greatly reduced. Finally, community efforts to establish medical guardians for psychotic women that do not depend on intact families or present fathers, perhaps through groups Le Leche League and local childbirth assistants would prevent women from being incarceated rathed than medically treated unless the lack of medication was the woman's choice before she became psychotic.

I'm working on a social justice essay for my graduate school application. Please give me input. :)
More will be coming later. Here's part one of a one page double spaced essay.


An often overlooked issue of social justice is the disparity in treatment given to publicly and privately insured women who experience psychosis during pregnancy. This disparity has existed in all five states where I have practiced, and may very well be a national trend. An impoverished, pregnant and actively psychotic woman is among society's most vulnerable citizens. Yet treatment is at times withheld in favor of incarceration for this population due to a blend of limited choice, poor access to care and defensive medicine. This despite the fact that medications for psychosis are as safe as or safer than medicines routinely prescribed for nausea and hay fever.

Psychosis is the most severe form of mental illness, often robbing its targets of even the ability to perceive its nature as a disease with treatment available. Suicide is a serious risk among psychotic patients, with research showing a 4-10% death rate. Hay fever and nausea in pregnancy are rarely, if ever, deadly. Compared to women treated with antipsychotic medication, women previously diagnosed with an episode of psychosis who did not take medication had four times the risk of psychiatric relapse and hospitalization. Women who are pregnant during psychiatric hospitalization experience notably worse pregnancy outcomes. They have twice the rate of stillbirth, infant death, premature birth, low birth weight and small for gestational age babies.


So what do you think so far?

I had my very first ever salon facial today.

Oh.

My.

Word.

I had a stressful day at work. I'd heard that facials are pretty relaxing and I was going for a haircut anyway, so I decided to get one on the spur of the moment. So I left work early with the help of coworkers and checked myself in at Panopoulos Salon. I knew nothing about facials and figured you sat in the chair and had some nice cream put on your face.

I am now regretting my tomboyish ways and bitterly resentful that nobody told me what a facial is REALLY like. Pure bliss, that is. So I'm going to share what actually happens.

I was led to a small dim room with a luxuriously made up bed that was really a cushy massage table. The blanket was velvety and textured over crisp sheets. I changed into a wrap for my top half to allow for shoulder massage. I climbed under the covers and relaxed until the gentle young woman doing the facial knocked and entered. A warm steam blower wafted moist air toward my face as my hands were massaged and placed in warming mitts. Relaxingly schlocky Victorian music played on Celtic instruments quietly set the tone. Fragrant cleansers, toners, deep scrubs with apricot pit or similar emollient (amid other lotions I can't identify) pampered my face in turn, separated by removals done with a steaming washcloth after it had rested on my face soothingly. With every application my tight, tense muscles loosened and softened. Then followed a facial and shoulder massage that must have lasted 20 or 30 minutes. I was a puddle of grateful ectoplasm by the time the final moisturizer went on.

After everything that has been going on, discovering a wholly unimagined pleasure in life came as a joyful surprise. It astonished and deeply affected me. This has cheered me and chased off some of my mounting depression. Ahhh, I needed that!

I do not have cancer!

I do not have an unusual form of emphysema!

I don't know what IS going on, but that beats the hell out of having cancer.