Psyched Out

Secondary Adrenal Insufficiency

2009-07-03T11:18:00.000-06:00

For the past four years I've been getting weaker and weaker.

It started out with getting to that serious muscle pain that tells you to quit exercising about ten minutes earlier than usual in my daily workout. I figured I was just pushing myself a little harder than usual. But gradually my workouts got to that pain point sooner and sooner. After 8 or 9 months I just couldn't tolerate it anymore, but I thought it might just be age or something (I was only 38!). It kept getting worse, but I ignored it - I had a more than full time social work job and four year old twins, so the exhaustion seemed understandable. I felt lazy. I was tested for sleep apnea, but didn't have it.

Then one day I couldn't finish grocery shopping, even though I already knew where every resting place in the store was. I sat there crying, feeling like if I took one more step or even stayed standing, I would fall down. I knew there was something seriously wrong that day.

The next time I went shopping, I broke down and used a mobility cart. I felt humiliated, like everyone was staring at me. And I did get glares - I *looked* perfectly healthy but fat. (Now I glare right back - fat people get disabilities too!)

I decided to tell my doctor about the exhaustion again. He suggested we adjust my asthma meds, assuming it was low oxygen levels. A month went by, no change.

For the next 3 years I went to specialists, got tests that all came out normal, and kept getting worse and worse. The thing I kept trying to explain was that I didn't START OUT exhausted, I started with and rapidly regained my usual high energy level. The time between healthy energy and excruciating muscle pain with exhaustion that made me sit down on the floor even in public places got shorter and shorter.

About 2.5 years in, I started having severe muscle pain the day AFTER exertion, just as if I'd been carrying heavy boxes or running 5K's the day before. By 3 years I couldn't stand long enough to sautee mushrooms or take a normal shower. It was (IS) very hard to manage my limited energy because I start out feeling fairly energetic, but quickly tire with minimal exertion.

I switched psych meds in case that was the cause, and lost 40 # in 4 months. I was constantly hot and started sweating a ton, and I have NEVER sweated much. I started eating salt and vinegar chips like they were going out of style and salting my food, which I'd never done - I usually hate salt. I started having excruciating abdominal pain and got my gall bladder out last fall. It took me six weeks to recover from laproscopic surgery, instead of the promised 3 days.

This spring we bought an electric can opener because I would drop the manual one when the burning muscle pain MADE me after a few rotations. My exhaustion level would reach a point I'd only experienced when I'd actually been dying from asthma attacks as a child.

Nobody knew what was happening to me. I was terrified that I was going to die without anyone knowing.

I requested a referral to an endocrinologist, and went to Dr. K who immediately knew that it was SAI when she heard about my 30 years on high dose prednisone and Post Traumatic Stress Disorder from childhood. I also have the classic fat deposit from steroid use called a "buffalo hump." (And seriously, would it KILL them to just say "fat deposit"?) She ordered a bone scan and vit D level, which was 5 out of 60. My bones are fine, thankfully.

Taking steroids isn't an option because they CAUSED the SAI in the first place. Also, because last time I took them I got steroid psychosis. But I can get the vitamin D up where it should be, so I'm concentrating on that. Then I can start the long road toward rebuilding my muscles.

The Time the Condom Broke

2009-06-12T12:31:00.002-06:00

Back in the 1990's, before Ed and I were married, I had an unplanned possible pregnancy. This would be distressing at any time, but I had a neck level spinal injury and my doctors said I couldn't carry a pregnancy without quadriplegia or death resulting. My fiance Ed and I naturally intended to adopt.

Our condom broke in North Carolina Sunday Night, and the Planned Parenthood there was closed. Uninsured, I had no way to pay for a $500 Emergency Room visit. So I had to fly back to Chicago, drive back to Iowa and wait for Student Health to open. Every hour until I could take emergency contraception - called Plan B now and over the counter - meant it was less likely to work. There's a 72 hour window.

I felt so many conflicting emotions. Of course I wanted a baby from the man I loved, and ending the pregnancy felt tragic, so much so that I considered continuing it and taking the risks. Ed and my best friends talked me out of it, but I remained ambivalent emotionally, though not intellectually.

I've always been passionately pro choice, because minority religious beliefs shouldn't enter into medical care. Lots of Christians think that dancing, music, swearing, celebrating holidays, studying science, going to the doctor and playing cards are sinful and should be illegal. I respect their right to their beliefs and practices, but don't believe they have the right to make those activities federally illegal when they are free to abstain from those activities in this country. If they don't want to have abortions nobody will force them. And nobody could force me either way, I was the only one who could decide - entirely appropriate, it is MY body! Now I understood better why anti-abortion and anti- birth control people feel the way they do.

At hour 51, I took Plan B's first pills, knowing they might not work. I wanted Ed's baby inside me. I wanted to stay alive and healthy.

The hormone pills made me even MORE emotional, and I stayed with my friends until the hormone hurricane was over and I could take a pregnancy test. It was negative, as were later tests. Failing tests was actually a relief.

Just another Medical Rant

2009-06-10T11:33:00.000-06:00

As a person who occasionally depends on doctors to save my life, I would prefer that they were required to demonstrate prior to med school admission:

1. An aptitude for UNDERSTANDING medical and scientific research. I really couldn't care less if they are brilliant scientists themselves. I sure as shit don't care if they're good at physics. I want them to know that epidemiology can never establish causation. Correlation does not establish causation. Period. Ever.

I want them to know they need to read their journals weekly, and that they can't rely on the authors' conclusions but need to read the WHOLE paper and draw their own conclusions. The ability to understand basic genetics and MZ vs. DZ twin vs. parental concordance is needed. Knowledge of the relative scientific strengths and weaknesses of quantitative and qualitative research should be firmly in place as well. With rare or currently untreatable illnesses, and even healthy conditions like pregnancy where you can't just randomly assign treatment and no-treatment groups, following a population clinically is both ethical and informative.

2. An ability to LISTEN to what patients say and what they don't say, and draw correct conclusions then check with the patient (and witnesses) to clarify. This can be done in seconds in an emergency. A couple of social work courses in assessment would instill this critical ability.

3. A basic understanding of human psychology, including but not limited to: human developmental stages; motivated behaviors (thirst, sleep, hunger, breathing, pain, pleasure) that are not under a person's control; a class on the biological basis of addiction (neurologically similar to epilepsy) as opposed to psychological dependence (which happens equally with marijuana, hugs, and asthma inhalers), and last but not least the common mental illnesses.

4. Female anatomy, physiology and health (including pregnancy) as a medical norm equivalent to male anatomy, physiology and health.

5. While we're at it, how about a grounding in health (including pregnancy) on which to build a separate and parallel knowledge of pathology. I want doctors to recognize the natural variation in human phenotypes, and the effects that harsh or oppressive environments have on individuals and groups over time.

6. Economics, including a thorough review of the cost of treatment and medication compared to the typical income levels of different populations, so that they will not label poor people "non-compliant".

7. Ethics - so that when they see other doctors abusing or butchering patients, they REPORT them to the police. And so when they are having trouble themselves, they seek help instead of harming patients and relying on other doctors to cover for them.

8. A medical history class detailing health and science fads that are still with us today. Positive fads are important, but aversion fads are critical to understanding that one's own biases can cloud clinical and scientific reasoning.

I'd rather be treated by an English Literature BA or Auto Mechanics AD with those skills than a double major Biochem/Physics undergrad without them. It amounts to ten undergraduate classes at the most, only two semesters even for relative slackers.

And while we're at it, I want working interns, residents and attendings to get at least 8 hours of sleep in 24. I've nearly been killed by doctors who were so sleepy they couldn't have counted to ten if asked. Fortunately, either nurses took over and TOLD the comatose docs what to do, or I was an asshole and demanded a doctor who was competent to make legal decisions, let alone diagnoses and treatment decisions. How can people emerge from even a basic biology class without understanding that humans need sleep?

I guess I needed a rant. Hopefully you did too. :)

"Paul Bart: Mall Cop" Review

2009-05-17T18:56:00.000-06:00

Ugh.

15 minutes into this movie, my slender son walked out of this movie in disgust and anger. "This movie is too mean to fat people!" See, almost all of the people he loves best, including his twin, are fat. Now, there absolutely are funny fat jokes, and those were the ones shown in the preview. Air vent breaking because of fat guy inside - not funny. Fat guy deliberately breaking air vent using his weight to crush mall "terrorists" - hilarious, comedy gold. Even for people the actor's size. I can go to the pool and hear fat people being made fun of, snarked about and hated on. Why should I pay for it?

The breaking point was when bystanders were all "ewww" when they saw a fat woman's stomach during the first fight scene. Seriously. A two for one sale on "fat people are disgusting and untouchable" and "thoughtless, senseless misogyny sold here!"

What should properly be seen as disgusting is the "forty-plus guy falls for girl a few years older than his middle schooler daughter." Creepy. If she were a clinically underweight but lovely thirty year old he fell for and pursued with borderline stalking methods that worked, whoo hoo, good for them. But when it's a teenager, not so much.

Now, I really did want to see this movie due to the actually funny physical comedy in the previews I saw. And I might have been willing to sit through the hateful jokes for the good ones on my own. But when there's too much hate for my 8 year old twins and ther 7 year old friend in the first fifteen minutes, I won't give the producers my money again. As we walked to the parking lot, my daughter K's (slender) friend M complained about how much she is teased for playing with (let alone being best friends with!) a fat girl. K (European American) isn't teased by other kids for befriending M, an African American girl. I'm just sayin'. (And no, this does not mean that fatphobia is the Last Acceptable Prejudice. It's just one reason we deliberately live in a diverse white-flight neighborhood.)

So this sewer rat might taste like pumpkin pie at the end, but I'll never know.

Health Update

2009-04-18T23:50:00.001-06:00

I saw an awesome Rheumatologist who does NOT think that this is lupus, or fibromyalgia or any other specific autoimmune illness that is destined to worsen, but "adrenal fatigue" from being on steroids for thirty years, worsened by the cortisol output from trauma/PTSD reactions. She described it as "tug of war" on my immune system, and basically agreed with the neurologists that it's a clinical picture they often see in long term steroid takers. I certainly don't regret the steroids - I'm alive to complain about pain, after all! Seems like a pretty fair trade to me. :)

Dr. Keys is the first non-psychiatrist I've ever had who even KNEW about the trauma-cortisol link, let alone took a PTSD diagnosis as meaning anything other than "she's probably just imagining things" or "of course she's casting herself as some sort of medical victim" or just "batshit crazy, must be all in her head or an attempt to score narcotics." Plus I was seriously Vitamin D deficient and was prescribed Vit D, and calcium supplements to protect against osteoporosis in my arms - weight is extremely protective for feet, legs and spine because weight bearing exercise is protective no matter how it is acquired. Also, she said not to worry about weight, just eat a variety of foods and exercise like I always have.

Health At Every Size is gaining popularity with Dr.s who read the research - half of people are fit, no weight differences in that. Even the heaviest fit fat people have better health and live longer than unfit "ideal weight" people. (And "overweight" people live longest and are healthiest of all the weight groups. "Ideal weight" people come next, and underweight and obese people trail mildly.)

Gender is a much more important lifespan factor - women are sicker but live over a decade longer on average. Men have fewer illnesses, but those illnesses tend to come late in life and be acute and short rather than chronic and long. There's some thought that chronic illness might even be protective, but it's not established and we really have no idea why women live longer. And yet there's no "War on Maleness" and we don't advise men to have sex reassignment surgery to improve their health, the way some people are convinced to have their stomach and intestines mostly cut out so they can't absorb nutrients and will lose weight. I'm not convinced by the science that it's any more rational. :)

Carrie

2009-04-15T15:58:00.001-06:00

"Carrie" Assessment and Plans

by

Mary Heil

Prof. Rodney Mulder

4/15/2009

Assessment

MEDICAL
Carrie's medical history is minimal by her report, despite a ten plus year substance abuse history and domestic violence until her "after her first child was born." which would seem to imply that her husband physically abused her during pregnancy. She is not forthcoming with medical history details such as whether she practices safe sex when high or uses nicotine. She does not report taking any medication or practicing birth control methods of any kind. Carrie will be referred to a medical doctor for a gynecological exam to rule out AIDS and other STDs as well as cervical cancer potentiated by them. Weight is also an immediate concern - Carrie is severely underweight, only 3 pounds over the anorexia diagnostic level. Weight instability through rapid losses and cycling due to crack use may put her at risk for medical problems, although she reports no weight-associated illnesses in her family history or personal health indicators. Carrie reports that when she uses crack she simply has no appetite and does not eat. She reports no history of otherwise disordered eating. Carrie says that she experiences withdrawal symptoms from crack cocaine use, and her moodiness and jitters are evident. She has a history of blackouts from alcohol beginning at age 16, nine years ago. Crack withdrawal causes her labile mood and shakes, but cardiac effects of withdrawal are not always as evident in women as men. I have referred her to a local gynecologist for a medical examination. Carrie appears willing to seek medical care and take any prescribed medications while in our program.

PSYCHIATRIC
General Observations: Carrie presents today with excellent self care but quiet and withdrawn demeanor. She avoids eye contact and is only getting the treatment she needs because her husband threatened to call CPS on her for neglect of their two children. Her memory, insight and orientation are intact and she poses no immediate danger to herself or others. Carrie gives the overall impression of numb, overwhelmed mood and poor insight into or denial of the serious nature of her substance abuse. She appears shocked, and agrees to my recommendation for inpatient treatment, when we explore how her children could be harmed if she is too intoxicated or crashed to respond to an emergency in the night. Carrie gives a "mild" trauma history of a forced abortion at age sixteen and domestic violence in her marriage, which she minimizes. Carrie reports that she has never had counseling or attended NA or AA, so we have arranged a beginning in her first residential substance abuse program: individual, group, and family available might raise her self esteem, helping the domestic issues.

We plan to provide individual outpatient treatment following her inpatient program, and Carrie feels that this will be adequate. Mood symptoms will be monitored by staff due to the link between depression and substance abuse or dependence, especially crack cocaine. There seems to be no need for a psychiatric referral, but inpatient will monitor symptoms. Carrie appears to have subclinical problems in several areas: mood disturbance, dangerously low (nearly anorexic level) .weight with risky weight cycling due to substance abuse. Formal psychiatric treatment is deferred at this time, but will be reconsidered should the depressive mood prove disruptive to Carrie's substance abuse treatment. If she is diagnosed with depression or another psychiatric illness, Carrie indicates a willingness to take medication if recommended by the physician.

SUBSTANCE ABUSE
Carrie reports that she started drinking as a young adolescent, and snorted cocaine only after she married into wealth. Her report today was enough data to diagnose her with Cocaine Dependence. She had been using cocaine daily for six months, and is visibly experiencing cocaine withdrawal after two days clean with obvious jitters, moodiness and general malaise. She reports use triggers being the kids' behavior, high stress and being at family parties with alcohol. Carrie has tried several times to quit on her own without success. Carrie experienced her first alcohol blackout at age 16 following a forced abortion. Carrie noted heavy alcohol and drug abuse in several generations of her family of origin. Carrie's social roles and functioning have been seriously impaired by her substance abuse: she is neglecting her children, prostituting herself for cocaine and having affairs, there is hostility and tension in her marriage, and her use as a teen cut off her schooling and she has no GED and virtually no job experience as a result. Carrie realized for the first time the potential of hurting her children by using heavily after they are asleep. She consents to attend our residential treatment program for the 30 days her insurance covers. We agree that she will try the very intensive residential treatment first, re-entering this individual program afterward for further intervention. She has private insurance that will cover part of the residential treatment, and the family agrees to self pay for 16 days of inpatient treatment.

FAMLY & SOCIAL
Carrie tells me that she is the middle sister of three, with no brothers. She felt sibling rivalry keenly and acted out with substance abuse and sex from early adolescence to get attention from her parents. Carrie's family is distant at this time, but not intensely hostile. However, she must attend "raucous parties" with drug and alcohol use rampant to get any time with her family at all when they come to New Jersey twice annually. They will not forsake the parties to visit with Carrie. Her present family seems dysfunctional to a moderate degree. Joe was twenty years old when he started to date Carrie at only fifteen, and coupled with the physical abuse early in marriage, resistance to parenting equally, and his family's enmeshed approach with Carrie, there seems to be a dominance issue in their relationship. Emotional abuse is evident, including the threat to call child protective services on Carrie unless she met with me. Carrie feels that she has no privacy in Joe's enmeshed family, which includes the secretary at the family business as well as Joe's intimidating father. Her sister in law Maureen was told by Joe's father to move in to help with the children, but Carrie and Maureen ended up doing drugs together and had the same dealer. The family always sides with Joe, who shares even the most private details of their marriage with his family.

Carrie has a seven year old son, Joseph Jr. (JJ), whose imminent birth caused her to marry Joe despite misgivings. He has been diagnosed with ADHD, and his four year old sister Rachel appears to have it as well. Carrie's addiction and possibly the macho tendencies in Joe – she could hide her drugs in the diapers because he never performed the chore of changing either child. In any case, she is overwhelmed by her rambunctious children and has difficulty setting structure for them to help with the ADHD symptoms and provide a family routine.

Carrie is also apparently sexually preoccupied, having multiple affairs as well as sexually charged arguments with Joe in which they "make up" by having passionate sex. Joe suspects the infidelity but Carrie will not confirm it for fear of breaking up the marriage. She will not consent to couples or family therapy because she fears the issue will come up, even though those therapies might help unify the family more.

LEISURE/RECREATION
Carrie, who comes from a working class background, feels out of place in her upper class neighborhood and avoids forming relationships with neighbors. She does not have friends or family (except Joe and his dad) who don't use substances at this point in her life. Carrie feels confined as a stay at home mother but her lack of a high school diploma or GED severely limits her ability to get jobs. This may be part of the dominance issue in her marriage, since Joe instigated her high school dropping out. She has thoughts of leaving Joe, and they once separated, but the only work she could find was a cocktail waitress job, which paid next to nothing and certainly would not let her raise the children. It also gave her frequent opportunities to drink, if it was a typical tavern job. She does not want to lose custody of her children, which is likely if she divorces Joe given his superior ability to support them and lack of formal substance abuse history.

Carrie's recreation involves drinking, smoking marijuana, snorting cocaine and having sexual affairs with multiple men including her drug dealer in a sex-for-drugs prostitution arrangement. The drugs and drinking were expected and frequent events in her family of origin, which may influence her lack of a role concept without substance abuse involved. Her sister in law uses drugs with Carrie as well, despite Joe's family image of being straight and narrow abstainers. It is normative for mothers of young children to derive some of their leisure/recreation with them, but this does not appear to be the case for either Carrie, Joe or both together. There do not appear to be any family activities going on, or attendance of JJ's or Rachel's school events. It appears that alcohol and drugs provide Carrie's only respite from her stressful, chaotic and powerless life as an isolated stay at home mom without non-using friendships.

EDUCATION/EMPLOYMENT
Carrie

LEGAL & MILITARY
Carrie has no family or personal military background, and no she legal issues relating to substance abuse at least yet. Joe has threatened to turn her in to child protective services for neglect, and even if he doesn't, a divorce and custody battle seem likely.

This area is deferred unless legal issues arise.

DIAGNOSTIC SUMMARY
AXIS I: 304.2 Cocaine Dependence with Physiological Dependence

AXIS II:         799.9             Diagnosis Deferred

AXIS III:                 Deferred

AXIS IV:         V61.10              Partner Relational Problems

V61.20    Parent-Child Relational Problems

AXIS V:                 Current GAF: 45
                              GAF over the past year: 60

DIAGNOSTIC DISCUSSION
Carrie is a 25 year old European American woman who presents today requesting substance abuse treatment following six months of daily powder cocaine use. She agreed to seek treatment because her husband Joe threatened to report her to child protective services for neglect of their children.

Carrie was clearly suffering from physiological withdrawal symptoms including moodiness and shakes from cocaine dependence (DSM 4R AXIS I 304.2).
AXIS II was coded 799.9 Diagnosis Deferred, because Carrie functions very successfully socially when uninfluenced by substances and no signs of personality disorder were present. Axis III was also deferred because Carrie is apparently in good health, but she was referred to a medical doctor because her probable unsafe sex practices during prostitution and affairs, long term alcohol and drug use and physiological withdrawal from cocaine pose numerous health risks. The AXIS IV Diagnosis of Partner Relational Problems and Parent-Child Relational Problems reflects Carrie's addiction related hostility and anger in her relationship with Joe and impaired ability to care for and provide structure to her children JJ and Rachel. Therefore on AXIS V, Carrie seems to fall in the severely impaired Global Assessment of Functioning range of 45, compared with a GAF of 60 in the past year, before she added daily cocaine use to her pre-existing alcohol and marijuana use, which do not appear to rise to the level of dependence at this time.

I believe that Carrie has the strong motivation of potentially losing her children and the unpleasant withdrawal symptoms from cocaine. Carrie is admitted to residential treatment, but her insurance refuses to pay more than seven days. Since her family is wealthy they chose to self pay for the rest of the 30 day course of inpatient treatment. She plans to return to weekly individual therapy with me following her residential treatment. A summary of our mutually agreed on formal treatment goals at intake follow.

TREATMENT PLAN

The first priority is that Carrie has been referred to her primary care physician for an examination today, including her potentially lethal asthma with prescriptions written in the customary way. Carrie seems to be in the action stage in this area of treatment. The physician will also consider a prescription to treat depressive symptoms. The agency, with Carrie's written consent, will keep a copy of all prescriptions and pass any medication scheduled during program hours. There is no risk for HIV infections as Ms.O has been celibate by choice for many years and has tested negative every year for work. Our nurse will track respiratory signs daily and as needed, and therapists will assess Carrie for worsening depression daily. The possible role of depression in her recent relapse will be explored in itself, as well as along with other psychosocial factors.
The second treatment priority addresses the psychosocial path from recovery to relapse and will focus on the substance abuse itself: to help Carrie identify possible triggers for this binge relapse. It appears that she is in the preparation stage and has recently had enough difficulty to produce relapse. She appears to be regrouping and making progress, recognizing the need for treatment and actually seeking it immediately is a positive sign. Initially it appears that depressed mood with less attention to self care and prevention, loosened standards for forming social ties and possibly an unusual vulnerability to known psychological and physiological addiction relapse triggers at work may be the major contributors. Carrie plans to explore these matters during individual and groups therapy.

The third main treatment goal is psychological: to restore Carrie's self esteem and self-confidence through individual and group treatment. She appears quite devastated emotionally by this relapse, although intellectually she recognizes it as part of an episodic illness. Carrie reported feeling discouraged, hypocritical and even incompetent in her professional addictions treatment provider role, which she highly values. These statements point to the contemplation stage, with a need to rebuild Carrie's confidence, self esteem and re-acceptance of existing strengths the goals that can move her toward emotional and physical addiction recovery. Obliquely assigning Carrie leadership roles in the educational portions of treatment may boost her confidence, and reinforcing her naturally emerging leadership role in groups will counter these false beliefs. Individually exploring relapse as a teacher and something that happens to virtually everyone with an addiction may help her accept the event emotionally and neutralize it.

The fourth goal employs Carrie's leisure time and activities, increasing time spent in her supportive, drug-free church activities and daily or more often 12 step group attendance with her few very close friends. Carrie stated that expanding her social circle too much contributed to her relapse because, "I'm attracted to bad people." She will identify strategies and implement a plan of strengthening positive leisure activities.

Carrie is supported by her employer socially and administratively by the 70% of her coworkers who are in addiction recovery themselves. She has an uncharacteristically accepting workplace where she can be open about the need for leave and the purpose. The only treatment issues here are to assist her in filing for FMLA and identify potential work triggers creating plans to manage them during vulnerable times of life.

With respect to Carrie's goal to earn and online Social Work Administration master's degree, exploration of her readiness to start and the effect of stress versus the stress relieving enjoyment of studying will be examined. It does not appear that education has triggered relapse in the past, but this issue still warrants exploration and setting up coping strategies.

Since Carrie has never served in the military and has not experienced legal issues for many years, these areas of treatment are deferred.

Carrie identified her religious faith creating a positive outlook, limiting her social circle to "safe" and trusted individuals including a few close friends, 12 step sponsors and her church family as supports in her recovery. She identified a tendency to be "attracted to bad people" and lack of power over addiction with any use at all as addiction triggers that may or may not be se t off at work. Carrie was open to identifying triggers and using behavioral methods to dampen or eliminate them.

I believe that Carrie's treatment prognosis is excellent. She is a professional substance abuse counselor, very educated and aware of the components of treatment. She was sober for 16 years before this relapse and comes to the program immediately following a four day relapse binge. Carrie is strongly motivated for change, has a deeply held personal faith and a drug-free church family for help, and attends 12 step programs daily. Given her quick action, insight, and willingness to participate in treatment, it seems likely that intensive outpatient therapy will resolve the issues surrounding this brief relapse. If the need emerges for more intensive treatment, Carrie is eligible for our residential treatment program.

Mary Heil, BS LBSW

Rest In Peace, Natasha Richardson

2009-03-19T13:55:00.001-06:00

This is just such a horrible accidental death. She probably just hit her head on her ski. Natasha Richardson was a brilliant actress and fine human being, and her death at such a young age leaving two sons to grow up without her is tragic.

I'm going to riff on some themes from not-good articles, so if anyone doesn't want to read that or might be triggered regarding brain death or emergency medicine please be warned. I'm distressed over coverage because of personal experience with my brother Mike's brain death in the 1980's, and I understand how these public articles and discussions can feel to read. :(

I had an absolutely identical accident in junior high, and the back of the ski gave me a concussion and dislocated 2 of my neck's vertabrae. I had an identical lack of symptoms, and my girl scout leaders were identically advised to take me to the ER and identically refused. For good reason - millions of falls like this happen every year, and only one person dies. It's tragic, but it was an ACCIDENT and nobody did anything wrong. This seems lost on many journalists and commenters - I feel like we've culturally completely lost the acceptance that some things are not in anybody's control, and sometimes there's just no cause to blame anybody. Nobody, least of all Natasha Richardson herself, could have prevented her death.

I hate the health moralism in many of the articles I've seen, "This goes to show she should have been wearing a helmet." or "This shows she should have gone to the hospital with no symptoms." or "it must be malpractice - see what socialized healthcare does." Also, the laughable American neurosurgeon saying "this is why we keep people with possible head injuries 24 hours for observation."

First, I can GUARANTEE that if she had shown up immediately in any US ER, she would've been told to take ibuprofen and discharged immediately with advice to come back if she started to stumble around or slur speech, NOT "kept 24 hours for observation." Her only prayer would have been a typical long wait, but once symptoms appear there's just so little time before brain surgery is futile that she still might not have lived. Most of the surgeons quoted even said so.

Starting when I was 21, my family had to watch my brain dead brother Mike linger for years with no hope of recovery because, "you can't sue us for 'saving his life' but you can for stopping treatment so we won't." (Direct quote from a hospital administrator to my grieving parents, may he burn in hell. But only for a bit, I'm a universalist agnostic, after all.)

Mike and I both had severe asthma, and after watching a movie on a "vegetable" swore a pact to kill each other if it ever happened to us, which frankly was not unlikely given our medical histories. We were maybe 13 and 12. And I didn't follow through on my promise to him, from a blend of cowardice and the knowledge that if I killed him as requested, my parents would just be agonized all over again.

And I can never forgive myself for breaking that promise.

I know intellectually today that I promised when I was too young to understand fully the promise made, and that we didn't regard anyone else's feelings when we made the pact, and even that because Mike was brain dead (presumably unaware) and my parents were not I probably made the "best" choice for everyone else involved.

And none of it changes the magnitude of my betrayal of the person I loved most in the whole world.

Because watching what happens to your brother when bean counters keep the dead artificially alive is disgusting and enraging to a degree that I'm not sure I can express. My funny, loving, cynical, brilliant and occasionally cruel little brother Mike's corpse was mutilated for years by people who swear to preserve health and life (albeit reluctantly by most of them). He was overdosed on antifebrile medications to force his brain stem to regulate body temperature, and steroids to keep him breathing so he couldn't die of an asthma attack. They bloated his body unrecognizably. Because he was brain dead he wasn't "eligible" for physical therapy and his muscles withered and contracted, contorting his limbs. He was often racked with coughing because of opportunistic viruses. I was really outraged when they gave my already dead brother TB treatment that some inner city kid it would actually save desperately needed and would never get because his parents were poor. A recurrence of TB and pneumonia at once finally allowed Mike the peace denied him for six years after his original death. He'd died again and been resuscitated at least 10 times in the interval, all against my parents' wishes.

At least we have laws now that allow families like Natasha Richardson's to stop medical interventions that keep a brain dead beloved family member from dying peacefully. The immediate grief and pain are no less, but I wouldn't wish the prolonged version on any mother's 12 and 13 year old sons. Truly there are things worse than death, but kids shouldn't have to know it.

If you don't have an advanced directive, I urge you to write one and give it to everyone in your family.

Crosspost from Shakesville: Best Compliments Ever

2009-03-18T10:06:00.002-06:00

I'm fat. I've always been fat, Venus of Willendorf Fat. It's seldom stopped me or upset me, but if I could take an otherwise safe pill to be thin, I'd do it. It'd pay for itself in clothing savings. Still, when my (then) kindergarten son wrote a list of his 5 favorite things about me for Mother's Day, and number three was "SOFT" in scraggly capitals, I melted.

Off the cuff, from the prof who inspired me to pursue neuroscience after I was shakily returning to school after 8 years feeling dulled by years of menial jobs: "Oh, I assumed you were heavily influenced by Stephen Jay Gould, you think exactly like him." That was nice to hear, until I took his advice and READ SJG's brilliant science essays from the journal _Nature_, when it became clear how unbelievably awesome that casual comment really was.

From an ex - "Please don't take this wrong, but you could make a LOT of money giving blow jobs like that." I didn't take it wrong. :)

"You sing like an angel, will you sing me to sleep?" A friend I'd just met on a car trip. Sadly, I had been punished and shamed for singing, and pretended I didn't hear her by acting asleep. :( Update: "Wow, you can really sing!" My very first ever BAND mate a few weeks ago when we rehearsed together for the first time. And she's a brilliant and experienced fiddler!!!

And of course, "Will you marry me?" :)

Eugenics Wouldn't Save Money Anyway

2009-03-15T14:08:00.003-06:00

New Orleans, Louisiana Rep. John LaBruzzo (R-Metairie) proposed paying women on welfare $1000 to undergo tubal ligation, a not especially effective, unsafe, surgical (with attendant risks)irreversible method of sterilization. He later added that he would offer the same to men (on welfare?! we don't GIVE adult men welfare in the US, hence massive male homelessness) for vasectomies, which ARE effective, safe and reversible but also carry surgical risks. Just to make this amount clear, $1000 is less than the cost of:

a running used car without mechanical problems within 50 miles of NOLA

ONE month's rent for a 2 BR section 8 apartment in NOLA (remember, women must have at least one child already to qualify for any welfare payment, and zoning typically outlaws sharing a 1 bedroom or studio with a male child) Sorry, no deposit!

one BEDROOM's deposit and first month's rent in a 4 bedroom house in LaBruzzo'a own district of Metairie (with a girl child and wealthy owners willing to rent to the poor)

10 monthly bus passes for a mom and child in NOLA

one part time semester of community college in New Orleans

and very likely one MONTH of groceries for LaBuzzo's three person upper class family

OR - if you doubt that LaBruzzo's ALL ABOUT EUGENICS:

10 years of instantly reversible, non-sterilizing, non-hormonal and non-surgical copper IUD use - with followup gyn exams every other year (should be yearly) - oh, but wait, that wouldn't PUNISH women for being poor!

MEANWHILE:

Paternal abandonment is the top cause of child poverty in the United States.

Rearing children is the top risk factor for poverty in elderly women in the United States, REGARDLESS of marital status or household income before age 65.

The United States is the only G20 nation that does not count the unpaid labor of women caring for the old, the sick or disabled and the young in its GDP. This nation was economically founded on slavery. It is perpetuated by the unpaid labor of women of all ethnicities and races.

Anorexia Nervosa Petition - I'm serious about this!

2009-03-14T23:12:00.002-06:00

Anyone want to petition the American Psychological Association with me to remove the weight requirement from the anorexia nervosa diagnosis in the DSM 5 (psychiatric Diagnostic and Statistical Manual)?

That's right. No matter how malnourished and close to death you are from self-starvation, no matter if you meet every single symptom (what you report) and sign (what the diagnoser observes) of anorexia nervosa, if your BMI is 81% or more of the lowest "healthy" BMI, you can't be diagnosed with Anorexia Nervosa. My local inpatient hospitals take patients off behavioral plans and starvation precautions the second they hit 81% of "Ideal weight" - 82 lbs for someone my height (5'2') and 116 for a person a foot taller than me. Needless to say, this is less than helpful to my patients.

Did you notice that even at starvation level, we're only allowed a THIRTY FOUR POUND difference over a foot of height? That's less than four pounds per inch of (usually) torso.

GROSS OUT WARNING! SKIP the next paragraph if you are squeamish!

Anyone who has ever seen the "human steak" cross sections at the Chicago Museum of Science and Industry (or anywhere else) can appreciate that this is kind of ridiculous. If I had 32" circumference steak that weighed four pounds for my St. Patrick's Day party, people would think I'm a skinflint because I can guarantee it wouldn't be an inch thick.

Not to mention, putting a *weight* requirement in a psychiatric diagnosis would seem bizarre to anyone not bred in our fucked up culture. I mean, there's no requirement that we withhold the bipolar diagnoses from everyone not in the TOP 20% of BMI measures because everybody knows only REALLY fat people are "jolly." (Yes, I'm aware that mania isn't a bit jolly to live through - but it makes as much sense as labeling only REALLY thin people "starving.")

People can be dangerously malnourished at ANY weight - indeed, about half of the "10 fattest people" in a Dimensions article had died of malnutrition/starvation trying to lose weight. Even when the DSM was originally assembled, there were actual medical tests to diagnose malnutrition that were far more accurate than body weight, for crying out loud. Electrolyte levels. Anemia. Micro and macro nutrient deficiencies. Chronic dehydration. You know, all the problems bariatric surgery survivors (I say survivors both because this surgery is often fatal, and because it is deliberate amputation and mutilation of healthy organs.) encounter down the line.

Malnutrition, not weight, needs to be the basis of determining whether dieting has turned into self-starvation.

Of course, that would force psychiatrists and psychologists to acknowledge that the medical framing of self-starvation as pathological behavior for the thin and a "healthy lifestyle" for the fat is unscientific, superstitious and based on hatred rather than reason.

Hell Yes I Want Socialized Health Care - Human Life Should Not Be A Commodity

2009-03-12T00:56:00.002-06:00

The only problem with the govt. purchasing health care from private medical providers is that the privatization of medical care is the main problem. Until the 1980s, medical providers were almost exclusively nonprofit. Insurance had been around for years, but when push came to shove the nuns did not ignore patients bleeding at the threshold as profit hospitals literally do. Much of what is blamed on managed care was in place well before the idea was even developed, let alone impossible to avoid. I saw the for profit take over close up - my mom was a nurse.

The first thing that happened was that doctors had to pay for attendance privileges.

The second thing was that the management required the hospital to RUN OUT of medical supplies before re-ordering. Oh, you needed a stent in your heart NOW? Too bad, we used the last one yesterday and we only order stents on Mondays. As long as your insurance or sister is willing to pay for you to stay another week, you *probably* won't die before next Thursday. Either way, we make more money.

The third thing was drastically cutting nursing care. Patient:nurse ratios skyrocketed. In the newborn nursery, the ratio went from 3 newborns to one nurse (can I get a shout out from triplets' parents on this one?) to 10 to one. Better pray your baby doesn't get sick suddenly - there's nobody with time to notice before that breathing problem causes brain damage.

Laws HAD to be passed mandating for profit hospitals to provide lifesaving (only) treatment to anyone who came in. My mom's hospital literally caused the deaths of refused patients. As long as elderly black people were dying, that was okay with the Quad Cities leadership and press. However, when a white woman pregnant with twins experiencing life threatening complications was told to go to the (nonprofit) university hospital 50 miles away if she wanted treatment, and she died on the way (meaning so did the twins) the press took notice. Again, before managed care. Greed ruined health care all by itself.

Not that managed care has been a good idea - I'm a psychiatric social worker who has watched patient care deteriorate horribly. People transferred from the medical hospital after nearly successful suicide attempts get 3 or 4 days inpatient at most. Antidepressant drugs don't kick in for 4-6 weeks (despite the claims of pharma that it's 2 weeks with newer meds). I'll defend big pharma for a minute though - I don't think Prozac causes suicide. I think releasing suicidally depressed patients after 3 days with a prescription that can't possibly help for another month, and no follow up care, causes suicide completion. Our local community mental health - which privatized under the Bush administration and renamed itself something so vague that nobody could possibly know what they do - doesn't even have a listing under that heading in the phone book.

The vaguely christened a big utilization review committee that challenges every day in the hospital even for INVOLUNTARILY COMMITTED VIOLENT/HOMICIDAL PATIENTS. Homicidal people can't be involuntarily committed unless they have a coherent and workable plan to kill (a) specific person(s) and the realistic ability and tool(s) to do so. Community mental health won't buy meds even for potentially lethal patients. These people are typically way too ill to work, so they seldom have insurance. Antipsychotic medication costs $800-1200 in typical doses to prevent suicide or homicide. Mentally ill people taking medication are less violent than the general population, but untreated psychosis can and does lead to violence and even homicide.

I guess if you're a Republican in a gated community with a gun under your pillow, this doesn't affect you. At least until your son goes to college at Virginia Tech. Or your niece has cancer surgery that removes most of the skin on her back and torso and sent on a trip across the state three hours after general anesthesia because she doesn't have $5000 up front in cash. From a university hospital taken over by for profit investors. Or your 28 year old receptionist dies alone in her apartment of pneumonia after being sent home by the ER, and is found by her 10 year old kid coming home from his weekend with dad.

For profit medicine is a bad idea. For profit insurance/managed care is too. These companies ration care as surely as the Soviet government did. They kill people every day. For money.

It's immoral. It needs to end.

Health care isn't just a human right, it's good for our society. That "illegal" little girl might be the next Jonas Salk and invent the HIV vaccine - if she lives through the leukemia that will only be caught in time if she has access to medical care today, regardless of her parents' immigration status and poverty.

Losing Sanity Points Reading Racist Octuplet Comments

2009-02-02T14:58:00.002-07:00

Ah, the fresh odor of racism floats across the web in news article comments.

Nadya Suleman has a bachelor's degree in child and adolescent development and is currently earning a Master's degree. That's more education than the famous Duggers, who have 20 kids at this point, have earned.

Oh wait! They're WHITE, that totally makes it okay to have as many kids as they can get busy and make.

People are assuming that this highly educated woman is just going to give up her professional status and go on welfare, because her name is not "white" sounding. I have no idea if she is a woman of color or not, but I'm seeing a lot of racism here based on her ethnic sounding name. There are overwhelmingly more white people on welfare than "ethnic" people.

My great grandma had sixteen children who survived to adulthood (at a time with 50% child mortality before age 5), and nobody blinked an eye. Her sister had nineteen surviving children. They were both pregnant and nursing constantly from the time they married in their teens until they reached menopause. As with most contemporary women, unless they died in pregnancy or childbirth before menopause, which happened in about one in 200 pregnancies. Neither one was rich, they were farmers.

Like Ms. Suleman, my ancestors had extended families and supportive neighbors to help them rear their many children. This system works all over the world for many people facing extreme poverty, no birth control and living in conditions that they couldn't begin to imagine in their comfortable racist lives.

Belated and Annotated Bailout Post

2009-01-18T11:33:00.003-07:00

From Holly Sklar's 2006 "Imagine A Country" essay:

"Imagine a country where some of the worst CEOS make millions more in a year than the best CEOs of earlier generations made in their lifetimes. In 1980, CEOs of major companies made an average 45 times the pay of average full time workers. In 1991, when CEOs made 140 times as much as workers, a prominent pay expert said the CEO "is paid so much more than ordinary workers that he hasn't got the slightest clue as to how the rest of the country lives."...In 2005, CEOs made even more - 352 times the pay of average workers." [Emphasis mine]

Bailouts and other forms of corporate welfare, such as tax loopholes and tax shelters that result in both corporations and their CEOs paying a lower tax rate than their regular employees, need to come with an expectation of corporate responsibility. In other words, with the sames "strings attached" as individuals experience. Non profit companies with over fifty employees manage to survive and thrive with restrictions similar to those below.

If we are going to bail companies out or afford special reduced taxation, we need to limit the CEO pay to 10 times the pay of the company's lowest paid full time worker. At the present annual minimum wage earnings of $14,872, CEOs would be paid a minimum of $148,720 annually. It would serve as an incentive to compensate employees better: the individual CEO's salary will rise proportionately as the company's lowest pay rate is increased. That is more than adequate income for people who have driven our economy into the ground, and it would encourage corporations to support raising the minimum wage to a living wage for single parent families with 3 kids, instead of keeping it brutally low. Minimum wage goes up, CEO's wage goes up. Compensation through company shares is a great idea for all employees, so CEOs can enjoy the same number of shares issued to all employees. It will motivate all employees to higher productivity and loyalty to the company.

Companies getting bailouts and tax reductions need to be held to worker-friendly personnel policies as well. They must staff their workforce by hiring their own employees and provide full benefits packages with a minimum of one sick day per month, one week of paid vacation a year, medical insurance with full maternity care included (with contraceptive coverage required) and parity in psychiatric rimbursement and benefits (no restriction on number of treatments, any more than Parkinson's patients would have such limits). Temporary and contract employees can only be used for twelve weeks - the duration of the Family Medical Leave Act. If the company offers paid matenity AND paternity leave, they can extend this period by the number of days of paid leave to ensure they can hold an employee's job. Likewise with paid sick leave. After that bailout companies will need to hire these people as company employees with benefits, or fill the position with another person if and only if the temporary worker was measurably failing to meet job requirements.

In the interest of public health, bailout companies employing food and health workers must provide unlimited paid sick days to employees for airborne or bodily fluid communicable infectious diseases, with a doctor's note required. A reasonable provision for excessive infections would of course be included, it could be managed through the Americans with Disabilities Act guidelines.

WHOO HOO!!! Obama just capped bailout company executive salaries at $500,000 - so close to what I wanted that I'm overjoyed. Non-profits are some of the most dynamic, creative and best run companies in our economy, and executive salaries seldom crack 100K. Despite dire warnings that nobody good would POSSIBLY agree to work at five times that salary, there's a huge reserve of expert executives out there who would be happy to take over. And they are USED to fiscal frugality, which is exactly what we need.

US Poor Children Should Apparently Go Naked

2009-01-08T21:14:00.003-07:00

Check out THIS new law going into effect February 10 - a friend questioned if it could possibly be true because it's so mind-numbingly stupid, based on a complete misunderstanding of actually toxic levels of lead. I'm sure this is due to the outcry over Chinese toys with lead based paint, but STILL. Here's the LA Times report:

CONSUMER SAFETY
Regulators rethink rules on testing children's clothing and toys for
lead The Consumer Product Safety Commission gives a preliminary OK to exempt
some items from testing after complaints of hardship to thrift stores
and sellers of handmade toys.

By Alana Semuels
January 7, 2009

The Consumer Product Safety Commission has given preliminary approval to
changes in new lead-testing rules after complaints that the measures
could have forced thrift stores and sellers of handmade toys to dispose
of merchandise or even go out of business.

If formally adopted, the changes approved on a first vote Tuesday would
grant exemptions to last year's Consumer Product Safety Improvement Act,
which seeks to ensure that products for children do not contain
dangerous amounts of lead.

As currently written, the act would require all products aimed at
children 12 and under to be tested for lead and phthalates starting Feb.
10. Phthalates are chemicals used to make plastics more pliable.

Large manufacturers and retailers say the cost of testing will not be a
burden. But small businesses such as handmade-toy shops and thrift
stores say the requirement would force them to spend tens of thousands
of dollars to test products such as clothing, in which the threat of
lead is almost nonexistent. Many thrift stores said they would be forced
to stop selling children's clothing or close altogether.

The commission's two members (a third seat is vacant) voted tentatively
to exempt:

* Items with lead parts that a child cannot access;

* Clothing, toys and other goods made of natural materials such as
cotton and wood; and

* Electronics that are impossible to make without lead.

The commission also tentatively approved a rule that clarifies how it
determines exclusions from the law.

The vote opens up a 30-day public comment period that will begin when
notice of the rules are printed in the Federal Register. Interested
parties can find out how to submit comments by signing up to receive
e-mail from the CPSC at www.cpsc.gov .

No final rules will be approved until after Feb. 10, when the testing
rules go into effect.

That means retailers and manufacturers who sell untested children's
merchandise would technically be in violation of the new law starting
Feb. 10. Whether federal regulators will enforce the rules -- which
might entail inspections at thousands of secondhand stores and toy shops
across the country -- is another question.

"The CPSC is an agency with limited resources and tremendous
responsibility to protect the safety of families," said Scott Wolfson, a
CPSC spokesman. "Our focus will be on those areas we can have the
biggest impact and address the most dangerous products."

So I went to Snopes, and this outrageous and ridiculous legislation is for
real - and it is unfounded in reality - especially when you know how little
clothing and footwear the exceptions allo. And citizens are not allowed to
formally object until AFTER the law goes into effect. The only reason anyone
knows about this is because Consumer Protection is "considering" relaxing
the restrictions, which have no scientific merit in any case.
I signed up to comment when the agency grants the opportunity.

The "exception" under consideration would still ban (re)selling or
buying the huge majority of children's clothing items. This would effect
everything from thrift stores to grannies who knit baby sweaters and sell
them on eBay to garage sales.

It only allows pure wool, cotton, leather, felt, REAL velvet made with
wool or cotton instead of microfibers, suede, fur, silk, cashmere and
angora - plus lesser known "natural" fiber clothing to be exempted from lead
inspection. Any of which could have the miniscule, completely harmless
lead levels enforced here. These are exponentially lower than the
lowest estimate of any hazardous level of lead. Have you checked the
price of even The cheapest natural fiber (100% cotton) clothing recently?
All mixed fiber or non-"natural" fiber kid's clothes would be illegal
to buy or sell without costly lead inspection. This means all pajamas
for infants and children will be illegal to sell by any individual or
thrift store, since flame retardants are non "natural". All permanent
press, fleece,rayon, microfiber, nylon, acrylic, lycra and polyester
clothing would be illegal for thrift shops or family and small businesses
to sell. Most shoes and boots (including any with velcro closures), socks with
elastic so they will stay up, waterproof coats and snowpants, any gloves or mittens with
thinsulate, most hats and belts and all UNDERWEAR with elastic
waistbands instead of cotton drawstrings, metal zippers and snaps or
buttons made of ivory, wood, metal, stone, or bone. Even glass probably
isn't technically a natural material, since it is artificially created,
and plastic is right out. Indeed, any fitted wrist sleeves, wool and
cotton pants or sweats with elastic waist bands or polyester drawstrings
would be subject to inspection. Can you even begin to imagine the cost
of inspecting all of that clothing, or of legally clothing the under 12
crowd in your family with none of these fabrics available to you second
hand or for sale by a clothing maker you hire? And are diapers
considered clothing? Back to metal pins, metal snaps and non-plastic
buttons on those pure cotton diapers with wool as the only allowable
"waterproof" cover, and I can attest from wearing woolen sweaters in
rain storms that wool soaks all through relatively easily. I'm not concerned about
disposables or plastic/latex covers and toddler accident proof undies,
since I don't see them being handcrafted or resold. How about baby
swaddling blankets? are they clothes or bedding? And wouldn't you think
that metal fasteners are a damn sight more likely to contain trace lead
than cloth?

It's like some cultish cross between fanatic pushers of organic fibers
and Levitican Law observance being enforced by the federal government.
What's next, outlawing shrimp, crab, lobster and tuna? Or forbidding
women from living in their homes every menstrual period until they
undergo ancient Jewish purification rituals - and do we even know what
those rituals involved? Or outlawing visual arts and electronic media
because they are graven images?

This incredibly short sighted, expensive and stupid policy comes at a
time of economic collapse, with unemployment higher than any decade since
the Great Depression, when thrift shops will be more necessary than ever
for struggling families. Even WE routinely buy our kids' clothes at
Goodwill because they grow so fast and clothes are so expensive. And that was
before my job ended last month. We now qualify for subsidized housing because we are
officially low income (which would be nice to move to, if there were subsidized
apartments available in our county). I have no idea how we'll dress our
twins if this law goes into effect even WITH the exceptions. Despite
the fact that the agency could never actually enforce inspections due to
its small size, the legal obligation could still drive thrift shops out
of the children's clothes businesses, and possibly out of business
altogether as usually children's clothing and footwear represent at
least 50% of sales.

I urge everyone reading this who was ever a child to go to the
Commission's website and tell them to revise the restrictions in even
the present amended version under consideration. I'm going to strongly
suggest an exception for all second hand and small businesses or individuals
from ALL of the clothing restrictions. The level of lead here wouldn't harm
a Chihuahua,let alone a human child. What happened to science as the basis of such
regulation, instead of irrational panic?

My answers to an interesting Fairy Tale Princess Survey.

2009-01-07T07:02:00.004-07:00

Pallid Regina (grin) at has a fascinating questionnaire related to her thesis. I strongly encourage everyone who reads this to help her out with your thoughts. Here are mine.

1. Describe a fairy tale princess: what does she look like, what are her primary personality traits?

A fairy tale princess is always stunningly beautiful, with skin as pale as milk, petite and slender build, and evident extreme youth (barely pubertal, usually). Her primary personality traits are focused on a tabula rasa ideal - she is a blank slate without experience or opinions of her own. She is completely "innocent and ignorant." (Jane Austen phrase that I love - if you haven't already read it, check out _Northanger Abbey_'s first chapter for a brilliant mockery of the gothic "princess" ideal, which continues throughout this funny and charming novel.)

The fairy tale princess is perpetually sweet and obedient, even to those who abuse her, she is completely passive. She does not think for herself, but must be guided by others even in completely plain circumstances (think Snow White needing to be told by the pitying servant that she is an assassination target, although she is too beautiful for him to kill her directly as ordered). She is usually a single child and typically wealthy with a few exceptions, so she has minimal exposure to other people (siblings, and especially *male* siblings who might familiarize her with men destroying her innocence) and "real life" (the need to work for a living and ability to gain knowledge). She is a blissfully ignorant sexual commodity.

However, sometimes fairy tale princesses DO develop character. Cinderella is honorable. Snow White is actively kind and helpful. Beauty becomes non-judgmental and accepting of difference.

2. Describe any connection you feel, positively or negatively, to a fairy tale princess or fairy tale princesses in general.

As a very little girl I remember being impressed with the bling surrounding a princess. As a skeptical 10 year old I liked the Little Mermaid because she decided walking on knives for the sake of someone who didn't love her was bullshit, and sensibly returned to the sea where people DID love her. (In fact, when the Disney version that changed the ending came out I was FURIOUS, because it destroyed the entire point of the story.) Mostly I was a tomboy though and didn't have much interest. As a teen I fell in love with Robin McKinley's retelling of Beauty and the Beast, and as an adult with her Deerskin.

3. Which fairy tale princess do you relate to the most?

Cinderella - I was from a working class family and abused by my grandmother. I'm a slob and hate housework. I thought her fairy Godmother was awesome and wished I could have one.

4. Please describe why/how you relate to this princess the most.

I couldn't imagine wealth. Cinderella was actively turning the other cheek and not stooping to her stepmother's level. So she wasn't passive. She was trapped in abusive circumstances she had no power to escape, like I was.

5. What book versions of fairy tale princess stories did you/do you own?

I own Robin McKinley's _Beauty_ and _Deerskin_.

6. What movie versions of fairy tale princess stories did you see in the theatre?

Snow White, when I was very little. I enjoy both Cinderella and Beauty and the Beast as an adult. I hated the Little Mermaid movie.

7. What movie versions of fairy tale princesses did you/do you own?

Beauty and the Beast.

8. In what ways do fairy tale princesses represent positive female role models?

Cinderella, the Little Mermaid and Beauty, even in the original stories, represented honor, kindness, determination, recognizing and learning from mistakes, loving herself, overcoming adversity, accepting others as they are and prizing character over looks to the extent that she could choose a partner that others unjustly rejected.

9. In what ways do fairy tale princesses represent negative female stereotypes?

Where do I even begin?! Beauty = good, not beautiful = evil, dark skinned = ugly AND evil, mature woman = evil. Ignorance and passivity. Greed. Reinforcement of women as a sexual commodity rather than an independent beings. Real or pretended stupidity so as not to outshine the Prince, who is seldom an intellectual giant himself. Women as tricksters. Young = good, old = evil.

10. Would you/do you read fairy tale princess stories to your child?

I read my 7 year old twin daughter and son Cinderella sometimes when they were younger. I plan to introduce them to Mckinley when they are young adults.

11. Would you/do you take your child to see fairy tale princess movies in the theatre?

There aren't any, but we have a dvd of Beauty and the Beast that Katie likes to watch with me once a year or so. She's been too young for the jokes in "Cinderelly" but might be growing into them. I'll consider Ever After when she's a young adult. Teddy isn't really interested in any kind of fiction and never really has been. Even as a preschooler when he would make believe play he would stop in the middle to clarify that he was not REALLY a dragon or puppy or whatever, he was really still himself.

He stopped believing in Santa Claus when he was 4, and showed doubts even at age 3. We feared this would ruin his twin's Christmas, but Katie blithely disregarded his opinion about Santa ("You're just wrong, Teddy.") and continued to believe with all her heart until this year, when she made a smooth transition from Santa as a real person to Santa as a metaphor of generosity and love, which she believes in with all her heart.

12. Would you/do you allow your child to own fairy tale princess movies for repeated viewing?

I let my kids watch the ones I approve of with discussions of the ideas in the movies and how they compare to real life. They don't happen to want to see them more than once every six months to a year. They're at the slapstick age.

13. Describe your first memory of Cinderella.

I think Cinderella was my first introduction to social injustice, I remember being enraged by the treatment she got and loved the idea of a fairy godmother who could make everything right.

14. Describe your current opinion of Cinderella.

Overall I believe that Cinderella is a good portrayal of an honorable and hard working woman who overcomes adversity, both internally and externally. Traditional portrayals of Cinderella as good and deserving due to her sexual attractiveness and the Ugly Steps as evil and undeserving due to their lack of it piss me off, naturally. I emphasize the behavior and not the physique as "ugly" to my kids.

15. Describe your first memory of Snow White.

Loved her red cheeks and brown hair and primary colors dress - I was probably 3 or 4, so that's pretty much it. Oh, she liked to sing like I did. And the dwarves were amusing.

16. Describe your current opinion of Snow White.

She's an idiot who can't recognize danger when it's right in her face. Her calling is to be a servant to dwarves and reform them in a creepy way. Wouldn't actively introduce it to my twins and if they saw it I'd want to talk about the assumptions and implications in the movie.

17. Describe your first memory of Sleeping Beauty.

It's vague I think I only read it once in first or second grade. There was nothing in it to appeal to me at that age.

18. Describe your current opinion of Sleeping Beauty.

This is a straight up sexual allegory involving "malevolent old woman curses baby" and a conquering/hunting/possessing man "saving" the ultimate passive child-bride. Repulsive. I don't think I know anyone who would show this to my kids, but it would piss me off and prompt a discussion that I could probably not resist turning it into a lecture. With the friend first. :)

19. In what ways do you think fairy tale princesses are still relevant in today’s society?

They accurately reflect the patriarchy that still exists, with women as a sexual commodity and men as owners/buyers/determiners of which women go for the highest price. See also racism, ageism, looksism, classism... They're an excellent introduction to what is wrong with that kind of thinking.

20. What else would you like to say about fairy tale princesses?

They are typically nasty, petite and brutish representations of racism, sexism, classism, ageism, pedophilia and a host of other social ills.

On the other hand, several of the traditional princesses appeal to me precisely because they break the mold (albeit not completely), providing important and positive lessons, and/or modern retellings turn them to good account.

Little Mermaid - don't sacrifice or change yourself trying to make someone love you because it's a self betrayal and won't work anyway, choose the people who DO love you over romance.

Cinderella - mean people can imprison your body, treat you harshly, and force you to work for them, but they can never own your spirit and dignity if you don't let them, and good people exist who will love you as you are.

Beauty - form your own opinions of others based on character and not appearance or reputation, choose partners to your own liking and ignore prejudice against those partners.

21. Would it be OK if I asked you follow up questions on your responses?

Sure.

Sub-questionnaire (optional)

1. Do you identify as male or female?

Female

2. What is your age range (under 18; 19-25; 26-30; 31-39; 40-50; 51 & older)?

I'm 41.

3. What is your ethnicity?

White mutt - obviously our families immigrated here at some point, but nobody keeps track of who, where, or when. At a guess based on the degree of generational knowledge loss and the Irish, Dutch, English and German surnames involved I'd say some time after the Civil War but before the 1880's. My dad's dad was born in 1898 and his parents weren't first generation immigrants. My mom's grandpa was an American WWI fighter pilot and barn stormer after the war, which was kind of the James Dean of the Twenties. Great grandma Ruth's parents did NOT approve and they essentially had a shotgun marriage after she came home after ten o'clock one night. Their wedding photo is one of the most beautiful, happy pictures I've ever seen and they were lovebirds right up to my great grandpa Charlie's last breath.

4. What social class do you identify with (poor, middle class, upper class, etc.)?

Both working class and middle class.

5. What country do you live in?

The US.

Fat Women Killed by Doctors' Ignorance Rant

2009-01-06T13:02:00.002-07:00

RANT WARNING!

When training doctors are taught science involving research rather than memorization at all, it is usually epidemiology, which can NEVER establish anything more than a *chance* that there might be a statistically significant correlation between one thing and another. Correlation can never establish causation at all (Did you know that over 80% of child rapists drink water?! See what I mean? Correlation never implies causation.) This is the kind of study all over the news that makes people think that eggs are a wonder food one decade and a Silent Killer the next. BTW, when the correlation is lower that 200%, it means there is no relationship between the studied factors better than chance.

So, "Men who ate kiwi fruit more than twice a month were 198% more likely to have their penises shrivel up and fall off." means exactly the same thing as "Men who ate kiwi fruit more than twice a month were no more likely than other men to have their penises shrivel up and fall off." So feel free to ignore any such media "proof" that there is a magic food or diet. There isn't. We're omnivores who have lived on every possible type and range of foods. Actual malnutrition syndromes like beri beri or scurvy, and toxic exposures as with lead poisoning from food storage jars painted inside with lead based pigments are the exception, not the rule.

Epidemiology is a perfectly sound scientific method: it identifies out of the endless range of possibilities which correlations *might* actually have a causal relationship, and warrant a true scientific test with controlled diverse populations, double blinded so neither researchers nor participants know who gets what. And even when a cause and effect relationship is established in that test, the direction of cause and effect is not established. To do so we must do another true test with proper methods.

There are many things we truly do not know, and it's not malpractice to do your best to treat people with illnesses based on existing observations, even if they are technically guesses and hunches. Qualitative research is just as important as the above quantitative methods, because they can yield important "your mileage may vary" case evidence about individual differences and group differences that can't be quantitatively captured. Quant research can only reflect populations and are biased toward the average - evidence for outliers or any other individuals can't be adequately captured.

Studies linking BMI to cancer in populations can't yield any information at all about an individual's risk of getting cancer based on her BMI. Medical practice is not currently scientfically based for the most part, even when there's good evidence.

For example, in reproductive medicine there would be essentially no episiotomies or circumcisions performed in hospitals if medical practice were truly scientifically based. Episiotomies (cutting the vagina with a scalpel to make more room) CAUSE vaginal/labial/anal tears 90% of the time and worsen them when cut after a tear starts, while outcomes for the babies are just as good for the the mothers without episiotomies, meaning that episiotomies aren't "saving babies' lives". Circumcision has no scientifically significant health benefit at all, it's basically just a cultural genital mutilation ritual. (Which is admittedly up to the parents, many of whom don't regard it in this light.) Some obstetricians simply won't believe the science on either common practice because their approach to medicine uses faith based thinking rather than scientific thinking.

Faith based thinking is wonderful in the proper context, of course. But it has deadly results when used in medicine, where the faith based belief that fat people are less healthy because of their own moral turpitude, the "fact" that they are chronically non-compliant pathological liars because they report that they followed treatment but did not lose weight and that they are less deserving of care because they are perceived as (these are quotes from medical professionals) "repulsive" and "lazy" and "sloppy" and "lacking in self control." If fat people lived morally upright lives eating less food than the WHO and UN call starvation levels, they wouldn't be fat, and moreover they would enjoy all the health benefits that malnutrition brings. Like the scurvy, beri beri, and brain damage caused by malabsorption of necessary nutrients.

Fat Women Being Killed by Doctors Witholding Correct Chemo Doses

2009-01-06T12:39:00.003-07:00

Chemo dosing key to ovarian cancer survival in obese women
Monday, January 05, 2009
DAVE PARKS
News staff writer

Adjusting chemotherapy doses so they are consistent with body weight appears to eliminate higher death rates that have been found among obese women with ovarian cancer, according to a new UAB study.

The study compared survival rates between obese and non-obese women with ovarian cancer.

Earlier studies had found that obese women with ovarian cancer were likely to have shorter survival times than non-obese patients with a similar type and stage of ovarian cancer.

The new study, which is being published in journal Gynocology Oncology, found no statistical difference between obese and non-obese patients who underwent similar surgeries and were given chemotherapy based on their body weight.

"Often chemotherapy dosing is calculated using ideal body weight as a guide," said Dr. Kellie Matthews, an OB/GYN at the University of Alabama at Birmingham and lead author of the study. "We found using actual body weight works best, and it wipes away much of the difference in survival rates between obese and non-obese patients."

Researchers looked at records from 304 patients diagnosed with an aggressive form of epithelial ovarian cancer, and showed that when actual body weight was used in chemotherapy dosing the overall survival was 40 months for non-obese patients and 47 months for obese patients - statistically identical rates when considering the relatively small size of the study.

This life-and-death medical need to dose by the actual woman's actual weight has been known for YEARS with respect to breast cancer. A cancer, I might add, that exists mostly in fat tissue, making dosing based on "ideal weight = lean mass content" less tenable in the first place. Even if muscle absorption vs. fat absorption differ, an ignorant guess/assumption that fat does not absorb chemo meds at all is uncalled for. Doctors persist in dosing fat women inaccurately, despite controlled, double blinded research showing that mis-dosing of chemo is both killing fat people and leading to the assumption that being fat, and not widespread malpractice, is why high weight is linked to cancer deaths.

And practicing medicine without basing it on sound existing science IS malpractice. Yet most med schools teach next to nothing about research and interpretation of it. The "science" classes involve identification of structure and function, a rote memorization of information, which has little to do with the complete scientific method.

Sigh.

Yes We Did

2008-11-15T22:30:00.000-07:00

My Master's Social Work student organization threw a campus election party. Technically it was bipartisan but even most Republican social workers wanted a social worker elected president. :)

About a third of the people attending were African American. I was literally jumping up and down and laughing in gratitude and relief when California was confirmed and Obama became the President Elect. But my joy was NOTHING compared to the heartfelt ecstasy of my AA peers. There were hugs, tears, shouts, prayers of thanksgiving, dancing, wide eyes, cell phone calls to grandparents and relatives overseas and siblings and friends, quotes and an electricity in the air that I have never felt before and never expect to feel again.

Hope. Vindication. Thrill. Community. Idealism. Commitment. Patriotism.

Because Democrats can be patriots too.

Yes we can.

Marketing and Aversion Fads Trump Scientific Evidence Once Again

2008-11-09T13:26:00.001-07:00

Help! Wellness fever has overtaken my workplace, an outpatient psychiatric agency for the severely mentally ill. It is promoted and funded by the manufacturer of one of the atypical antipsychotics which certainly cause significant weight gain without a change in eating habits, and appear to kindle diabetes in people with genetic or health elated predisposition. (ie: I wouldn't take them if I had pancreatitis). The wellness program and its medical supporters claim that both weight and the majority of chronic illnesses can be cured and/or entirely prevented by diet and exercise. As you are well aware, this is simply untrue and not evidence based in the least. My agency touts itself as evidence based, but nobody is looking at the evidence.

For example, one of our nurses presented on "diabesity" in a mandatory meeting. She claimed that the CDC (which she cited on a slide but did not recognize by initials or full name when I cited the finding there that "overweight" BMI is correlated to lower mortality than "healthy weight") proved that 70% of people die from entirely preventable chronic diseases. I asked what diseases those might be, and she said diabetes, hypertension, asthma, cancer and heart attacks are all preventable by a healthy diet and exercise. I asked her for citations or even verbal scientific sources, and she had none, just kept spouting misinformation. I clarified that she was saying that all heart attacks are preventable in this way, and she said yes. I pointed out that every heart quits beating at some point, and that this is in fact not preventable. At all. She just ignored me

Then the pharmaceutical rep introduced their new wellness program, which we are expected not only to enroll in ourselves, but enroll our patients in as well. And everything suddenly made sense. It's a liability defense ploy. If the pharms can convince patients and judges that diabetes is really the patient's fault, and that they did their best to cure them of their evil, underserving ways, they can "prove" in court that the evidence regarding diabetes and it's related consequences are not the medicine's effect, but a personal failure. And...you guessed it! The wellness program is run not by health clinics or professionals, but by a marketing company.

So I emailed the facts (from the very CDC research she cited) to my agency coworkers, especially emphasizing that rising obesity has no correlation with, let alone causation of diabetes. Indeed, as weights have risen, diabetes rates did not change at all from 1988 - 2000, the latest year analyzed, although "obesity" tripled. I also pointed out that there is no evidence from the CDC that diet and exercise have any effect on chronic disease incidence or prevalence. The CDC study that she was referring to showed that 70% of people do die of chronic disease, but there were neither claims nor evidence that these diseases are preventable by exercise and diet, or by anything else for that matter. Chronic disease causing 70% of deaths is good news, since we are no longer dying of malnutrition, infections or infectious diseases, pregnancy and childbirth, diarrhea and other conditions that cause most deaths in poorer countries. It may just mean that people are living long enough to get these (mostly) diseases of aging.

Anyway, this week the newsletter was all about the wellness program. It included tips on how to "prevent" high blood pressure, like avoiding stress (for social workers?!) and eating right and doing exercise 90 minutes a day, excluding any movement related to work and home maintenance. So I sent an email with the American Heart Association research showing the most effective way to "prevent" hypertension is to avoid the misdiagnosis that affects up to 75% of Americans due to miscuffing. I demonstrated who needs an adult large cuff by letting people know that if they wear a medium or larger tee shirt they need a large cuff by AHA standards. I added that this means anyone whose upper arm is wider around than a standard coffee mug.

I received disciplinary warnings for providing the evidence. I was told that it was unprofessional, and that people might feel bad if they miscuff or present inaccurate data at meetings. (Wah! Maybe they should!) And that their medical provider status is more important than the actual scientific evidence from reputable sources. I never claimed medical expertise of any kind, just presented what the CDC and AHA research show. I finally agreed not to to comment publically on the wellness program or to correct misinformation to avoid a written warning.

It makes me sick inside, but I need my job so I can feed my kids more than I need to express my scholarly values, I guess.

You Can't "Have Sex With" a Child.

2008-10-20T22:52:00.002-06:00

The local news at 11 just reported a sting in my area to arrest men who went to a house to "have sex with" a thirteen year old boy or girl (no women showed up to do so apparently, but this was not mentioned). Naturally I immediately fired off an email challenging this language:

"I'm watching your 11 pm news cast, and I have to point out that it is impossible for a man (or woman) to "have sex with" a child. Any sex act with a child is rape, since they are incapable of giving consent. Please change your reporting language to reflect this important truth. This is not inflammatory language, it is simply accurate. Thank you."

I only saw the news because my dad is visiting. I never watch it when he's not here. Maybe it's my civic duty to watch and send this email every single time rape is described as "sex" whether the raped person is a child or an adult. And it's not "alleged rape" either - a rape has occurred, only the identity of the rapist is "alleged."

I sort of thought I was living in the twenty first century and not the nineteenth.

Also, I have to give a shout out to my neighbor Yolanda. Her daughter Marissa is my daughter Katie's best friend. She went along with us to hold Katie's hand while she had her ears pierced tonight. It was dark when she asked if she could come and I told her to ask her mom, and she asked me to walk her over. She said, "My mom told me not to walk home in the dark alone because of stranger danger and the rapist across the street with a red car." (I think that this is a great rule for a six year old who weighs maybe 40 pounds soaking wet. Adult women should be able to walk wherever they please in the dark, because they can weigh their risks.) I am SO FRIGGING HAPPY that another parent called a "child molester" what he is, a rapist.

Most of my psychiatric social work colleagues object when I call "child molesters" rapists. I think it makes them squirm inside. Which it should. Molestation is a euphemism of the worst possible kind. Rape should not be prettied up verbally so we get comfortable talking about it, especially where children are concerned. I would no more say a child was "molested" than that a woman or man was "interfered with." Social workers are like priests, we hear everything, and it's often not easy to handle the degree of evil some people are capable of.

I have a patient whose dad raped her starting when she was ten and continued until he impregnated her at thirteen, at which point her mother and the courts had to believe her - the DNA matched. (I am bound to confidentiality, but there are so many little girls out there in the same situation that this doesn't break it.) Her dad spent a few years in prison. And I mean less than five. For raping a ten year old over and over, until she was thirteen - well, actually until she was fifteen, because CPS didn't see fit to take her out of the home where her dad repeatedly raped and impregnated her and her mother KNEW, while the trial was pending for two years and he was "free on his own recognizance" as the saying goes.

HINT TO CPS: A scumbag who rapes his ten year old until she is thirteen and gets her pregnant doesn't HAVE any FUCKING recognizance. And then there are parents who sell their three year olds for sex in order to smoke a pipe of crack or ten a day. Social workers hear everything. Sometimes I wish I didn't, but most of the time I'm glad that I'm there to tell, sometimes as the first person the victim/survivor can trust. I feel that my knowing about all this evil does the world good in some small way. I am a witness. I can call the deniers and the minimizers on their horrific shit and the consequences of those cover up phrases and actions. Just to clarify, I don't think rape is "better" when an adult experiences it, not at all. But child rape makes me, universalist though I am (I think of heaven, if it exists, as an ER, where the sickest souls are treated first), hope at times that there's a hell.

Weekly Journal 6 - Second, Less Self Absorbed Version

2008-10-06T09:40:00.003-06:00

Writing about liking to sing, however enjoyable, is not what I want to do with this journal, so I'm taking another stab at it. The class discussion stayed focused on respect in different variations. _Crash_ was largely about the need for respect toward one another. Respect can overcome prejudice. Disrespect fuels it. The two qualities are symbiotic, with prejudice leading to disrespect, and disrespect leading to prejudice. One of my clients trains business people about her home continent's different cultures and the expectations and interpretation of behaviors in each. She was telling me about the "eight second rule", which as it turns out is not how long an M&M can be on the floor and still be edible, but a tendency to form our opinions about each other in the first eight seconds. We had an interesting discussion about how social workers and medical workers have to constantly combat that tendency, and how much practice and awareness it takes to do so. This class is helping me explore my biases and prejudices and reminding me that the eight second rule can lead me to places I can't go if I want to be a responsible and respectful social worker.

Weekly Journal 6 - Musical Musings

2008-10-01T20:22:00.003-06:00

Actually, who I am is "A person who thinks of what she really wants to say five minutes later when class is over." :)

I recognize that this isn't unique, but it is frustrating even so. The real problem was how many things I like about myself. Coming from where I've come from, that is definitely against the odds. But it is true now, though it wasn't true for most of my life. And recognizing that "problem" was a joy.

I think if I had a do-over I'd say that I am a singer. Insofar as I have religious feelings, I feel them when I hear music or sing. Other things about me have changed a lot, but I've been passionate about music ever since I can remember. Even before I can remember, actually. At 18 months old I started crying when Bach's Minuet in G was turned off in the middle, and my uncle and aunt turned it back on when they realized I was humming it. Earlier on I sang before I talked. I'm told that I did a great playpen rendition of the Doors' "Come On Baby Light My Fire." Also "Chain of Fools." While dancing with the aid of holding on tight to the edge of the playpen because I couldn't stand on my own yet. I used to make up operas starring our fox terrier Charlie and, naturally, myself. Charlie played a supporting role, because I had to sing his part for him. And make him dance on his back legs by lifting up on his front legs. When my little brothers were old enough to replace Charlie, I directed all of us in musicals based on fairy tales like Goldilocks (I got to be Goldilocks AND Baby Bear - I was a bit of a prima dona). Later on we would learn songs on records and perform them for our parents, and we were FINE on Neil Sedaka's "Breaking Up Is Hard To Do." We even choreographed it.

So it isn't a surprise that my mom was embarrassed and punished me for being a "show off." Working class white people in my part of Iowa did NOT embrace the performing arts. It took a long time to get over the shame, but nothing stopped me from singing when I let my guard down, and humming without knowing I was doing it. One time we were at my Great Grandma Ruth's, and she was sick, and I was singing in the next room. When my mom and grandma shushed me, Great Grandma asked them to turn the radio back on and find out who the singer was. Did I gloat inside? You bet I did! Nothing could stop me from listening all I wanted to, though. I could and can listen to any piece of music I know in my head, even complex pieces like symphonies and madrigals. When I was bored in school, I would just listen to whatever was on my internal soundtrack instead of the lesson. Don't worry, our class is too interesting for that!

I didn't have the right kind of voice for classical music or opera, which disappointed me until I discovered Celtic music in college. I was spellbound. And my voice was PERFECT for folk. Song's not in your range? Just transpose it! Which I could do with no effort. This was bad in chorus, but great in folk. And coming from an abusive background, the stories of betrayal and violence and true love and parted families or lovers resonated. Anger frightens me in person, but I can sing about it and kind of process my own feelings. Celtic music lays it all out there, just like blues and soul and gospel, which I already knew about and loved. My college roommate Lavonne and I listened to Steve Winwood's "Bring Me a Higher Love" about three times every day. And sing along with gusto and volume. I'm surprised we didn't break the tape. Or our RA's spirit. At least we weren't as bad as the guy upstairs who decided that he needed to learn to play Wagner's entire Ring Cycle on the recorder. Flat. At every hour of the day and night.

I know that this must seem like a big digression with little to do with class, but after nearly eight years of twins and work, grad school is for ME. I'm rediscovering myself in major ways as well as discovering other people's viewpoints and experiences. I love my twins, and my husband, and my job. But I miss parts of me that I have set aside since late in my pregnancy. Relationships require compromise when they don't require outright sacrifice. These yield high dividends in love and joy.

But oh is it sweet to stretch my wings again.

I think I'll sign up for that Open Mic in January.

Journal Week 5 - Crash

2008-09-24T17:38:00.003-06:00

I'm looking forward to my diversity experience and group presentation on Rwandan refugees in Grand Rapids.

But what I mostly took away tonight was _Crash_. It's one of the best movies I've ever seen. Definitely the best movie about the impact of racism: _A Time To Kill_ wanted to be this movie, and I enjoyed...well, enjoyed is definitely the wrong word. I appreciated _ATTK_ and it was good. But _Crash_ took the documentation and exploration of racism to a new level. Racism is more than just Black vs. White, or ethnic differences or straightforward and blatant prejudice. Crash captured the complexity of both external and internalized racism. It built up relationships then twisted and even destroyed them. And restored some. The reason I was crying so hard in the scene where Elizabeth is raped, then Lara is nearly shot was that the entire movie to that point hit me each time. There was also a resonance for me with the "successful black sheep" theme involving Graham, for personal reasons.

Maybe I'll be able to add more later, but if I type anymore now, I'll spend all night crying. And I can't do that.

Because right now I need to go hug and kiss my kids.

Journal Week 3 - Individual Experiences with discrimination

2008-09-24T17:36:00.002-06:00

I encountered a lot of sexism and classism growing up working class in a wealthy suburban school district. They compounded each other. Even the most obnoxious administrators and counselors at least conceded that working class boys could benefit from education, the same was not believed of we girls. "You don't need physics to have babies!" quoth my principle when refusing to approve my schedule. "You are cheating and I'm giving you an F." said my history teacher when I wrote for a "what would your life have been like in ancient Greece" essay that it would have been short, given that I only survived birth because doctors had worked out a few months before that blood transfusions could reverse the effects of Rh Factor incompatibility in newborns. And that I was an oldest daughter, who would've been pretty much guaranteed to be exposed, a victim of infanticide, even if I had survived birth. And my academic counselor's observation that "You won't need those college track courses to work at [local factory] so why take them?"

How many Descartes' and Curies have died young picking cotton too slowly and being whipped to death? How many Shakespeares and Angelous have spent their lives mopping floors and writing poetry in secret if they even got the chance to learn reading and writing? How many Beatrix Potters and Mileva Einstein-Marics are still not given credit for their mathematical and scientific accomplishments, regarded as "sounding boards" instead of collaborators, amateurs instead of professionals, incapable of serious intellectual endeavor and valued only as sexual or nurturing peons based on their gender alone?

I am not claiming genius, or comparing myself to those beacons of knowledge. I'm just questioning how much better off we would be, locally and globally, if institutionalized racism and classism and sexism and materialism weren't still the order of the day.

Journal Week 4 - Discrimination and white privilege

2008-09-24T17:26:00.003-06:00

I didn't learn about white privilege from a class or assigned readings. I learned about it from my fun and friendly and brilliant and beautiful college roommate Lavonne. She was from Chicago and we had almost everything in common. Except white privilege. Lavonne was African American. Being friends with her changed my life and my perception of myself. I had mostly identified myself by class, but hanging around Lavonne made me acutely aware of my whiteness and the many things I took for granted that she could not. Like not being followed by security in stores. And having food servers skip over her to ask me what I wanted. And being able to get my hair wet if it rained. Which I usually did, because Lavonne would confiscate my umbrella if an unexpected fall of rain happened. :)

When people are new to the fat acceptance movement, they often say that fat phobia is "the last acceptable prejudice." Sometimes I get sick and tired of enlightening them, but I keep on doing it. To honor Lavonne. Even though I had to drop out of college after my second semester and move back to my home town, and we lost touch, I will never forget what I learned from her and honor it.

Journal Week 2 - In God We Trust

2008-09-24T16:27:00.003-06:00

I have to say my main response to the discussion tonight was that wow, are people ignorant of really basic US history. I don't expect people to know about the plague that killed 90% of the eastern coast's Native Americans, so that settlers were able to just move into the dead people's towns complete with already built houses with already planted corps and stores of food. High school classes never teach kids about it. Or most of the harrowing details of the slave trade, starting with our old buddy Christopher Columbus. Chris and his sailors enslaved inhabitants of the societies he "discovered." And just don't get me started on "discoveries" of places and things that everyone already living there knew all about - hint: if someone who already lives there is guiding you to it and showing you, you haven't discovered anything. Much like being shown Einstein's theory of relativity in seventh grade does not mean that I, Mary Heil, have discovered relativity. Back to Columbus, he ordered the slaves' hands cut off if they failed to give over their daily quota of gold. Even children. And there's always the failure to discuss the abandonment of the freed slaves after the civil war, with repracussions now.

But I have to draw the line at "The Founding Fathers were fleeing religious persecution."

First of all, the religious persecutions of the "pilgrims" who settled Plymouth (150 years BEFORE the Founders were twinkles in their mothers' eyes)consisted of fines equivalent in price to speeding tickets today. Just like today, if you didn't pay your ticket you might end up in jail for a couple of days. And these folks were rich - they usually went to "jail" at a boarding house instead of a real jail with poor people. It wasn't exactly the Inquisition. When you consider that people could be and routinely were hanged for stealing food when they had none to feed their children, it really puts that "persecution" in perspective. And any amount of religious persecution the pilgrims suffered pales beside religious persecution of slaves. Nobody in England was getting gang raped and whipped to death for practicing her religion, but slaves could be and were. Calling fines persecution is an insult to African Americans and First Nations people.

This is not and was deliberately meant not to be a "Christian nation." Roughly a fourth of the Founders were NOT Christian. Which is why the Constitution/Bill of Rights emphasizes religious freedom, abolishes a national religion and a includes a requirement that there be no religious test for political office. The Founders were pissed off because could be survielled, searched and stolen from by British soldiers, imprisoned indefinitely without charges (England STARTED habeas corpus in the 1215 Magna Carta, but ignored it in colonies) and taxed outrageously without representation in parlaiment, meaning that they had no legal recourse to protest and right these wrongs. They were not fleeing religious persecution. Most of them weren't fleeing anything, they had been born here.

Okay, I need to put the kids to bed. Rant over.

Except to say that King George the Second of the USA has pretty much restored all of the depredations that the Founders rebelled against.

Weekly Journal Week 1

2008-08-31T08:34:00.006-06:00

Expect this Journal entry to be somewhat disorganized and random. I'm having all kinds of different responses to the experience of application, admission, financial aid and now at last the first week of class. This is my first class in 11 years, and I'm overjoyed to be in grad school. After being the first person in the history of my extended family privileged to attend college and earn a Bachelor's degree, I'm aiming to be the first of many generations to come to have a Master's degree as well.

I earned my psychology BS at a competitive and very serious program in a huge research oriented public university. I can count on one hand the number of times I heard a joke in class and more than slightly smiled. Spending an hour and a half in class belly laughing nonstop is quite a contrast. I love it though, and it confirms that GVSU is the perfect school for me. Of all the imaginings of what grad school would be like, I never envisioned gasping-for-breath laughing playing a part!

I have worked pretty hard at cultural competency in my social work practice as well as life in general. I recognize that my life as a middle class white woman is extremely privileged in most ways. Most of the white people I encounter either don't recognize or completely reject white privilege. I don't have to dress up to be accepted as a peer by most people. I don't get speeding tickets if I drive through the "wrong" town/part of town at 1mph (or 0 mph) over the speed limit. I can travel to rural Michigan areas without fear. Recently a work friend moved to Caledonia, and an African American work friend said sadly that she won't be able to go to the new house, because it might not be safe for her.

I live in a white flight neighborhood and cherish the diversity my twins are growing up with. I grew up in an all white school district in Iowa. My twins' schoolmates are of every race, and it definitely helps them naturally learn that all people deserve respect and civil rights.

Last summer I went to a "neighborhood meeting" of all white renters and (mostly) landlords airing their mostly racist grievances, except one AA woman. She attended and pointed out the total lack of police service her small son received when a teenager pushed him off his bike in front of an officer in a SQUAD CAR 10 feet away who didn't help the child. Nobody but me seemed to believe that her six year old really encountered any discrimination. After several people complained fearfully about "gang activity" I had to explain that 5 black boys laughing in a front yard is NOT a gang, any more than 5 white boys. The police at least backed me up on that one. I have a good deal more in common with my mostly African American neighbors than with most local middle class white people. I share the working class background, the experience of being poorer than most of my classmates growing up, and many of the same non-CRC values such as expressing emotions openly.

When we needed to find a daycare provider fast while the kids were 3, the white sitters in our area were all kind of anal retentive. One said that she made the (preschooler) kids walk at least three miles a day regardless of the weather. Another told us that our twins must have been lying to us when they reported that their immediately-fired babysitter spanked Teddy on the bare bottom for a peeing accident on the carpet, and that J--- "broke my penis." She said, "Oh, kids will make those things up to get out a situation." One even criticized our barely potty trained son because "You should stand up to pee, like other boys. Boys don't sit down like girls." Hello, sexism! Love that implication that being like a girl is a bad thing. Brenda, our African American daycare provider since then, is a degreed early education teacher who worked Head Start programs for over ten years before having her youngest child. We're really lucky she decided to stay at home with Dontrell, because Katie and Teddy have really benefited from her care and education. They were more than prepared to start kindergarten.

I still have a lot of areas to work on, though. I know very few people of Asian descent or immigration. I'm vaguely aware of very different family structures than are typical in other Michigan families. I know not to lump all Latinos together, but I don't know much about different Latino populations. I despise corporate welfare thriving while most of my clients can't afford medication or safe housing with their disability income.I am prejudiced against rich people, and aware that I need to work on this. One example and I'll stop writing! This is from a recent post I wrote on my blog:

Privelege Overflowing Like A Shit Filled Toilet

I work with a new client who has gone from making six figures and having three jaguars to being on disability ($1300/mo). He comes from an EXTREMELY wealthy family in the richest suburb in my state. His siblings are emotionally supportive and one of his brothers is his payee, but they don't help him financially at all despite stunning personal wealth. Someone in the hospital told him and his sister that my agency would pay for all his medication, which is a blatant falsehood. Now he and his family are FURIOUS. They refuse to believe that medical providers are not liable for providing him free medication. The sister's husband is a malpractice attorney, and they keep threatening to sue. I'm silently thinking, "Knock yourselves out. Nobody has a responsibility to pay for his medication except him. I personally hate that, but that's the way it is until we have universal health care."

I explained that I don't like it when homeless and indigent people can't get the medicine they need and live in fear and anxiety and depression and psychosis. I don't like it when it happens to formerly wealthy people either. I used my standard social work line, "All the people I work with are equally important to me." This works for both people who have self esteem trouble or depression (meaning "You are just as important") and with extremely entitled or narcissistic people (meaning "You are not more important").

So I spent an hour and a half of my life that I'll never get back saying "no" to people who would not accept that because basically nobody has ever said no to them before in their whole lives. Among the things said to me (followed by my internal reaction in ALL CAPS just to demonstrate how I was screaming replies in my head while apparently patient and calm.)

"This is just reverse discrimination."

UM, HELLO, THERE IS NO SUCH THING AS REVERSE DISCRIMINATION.

""If he were a black woman he'd get his medication from you for free." I did raise my voice a little saying, "Absolutely not!"

ABSOLUTELY NOT. AT LEAST A THIRD OF MY PATIENTS GO WITHOUT DESPERATELY NEEDED MEDICATION BECAUSE THEY ARE POOR BUT DON'T QUALIFY FOR MEDICAID OR MEDICARE. RACE AND GENDER ARE NOT RELEVANT IN THAT AREA. NOBODY GETS SPECIAL TREATMENT OR SPECIAL SERVICE FROM ME, INCLUDING YOU. SORRY IF HEARING NO AND COPING WITH IT IS NOT A SKILL YOUR PARENTS TAUGHT YOU. IT'S OFTEN HARDER TO LEARN IN ADULTHOOD.

"I didn't think we had welfare anymore."

YEP, THAT WOULD BE THE EXACT PROBLEM YOUR BROTHER IS HAVING AS WE SPEAK.

AND YOU'RE THE FUCKERS WHO VOTED TO DISMANTLE OUR SOCIAL SAFETY NET. YOU'RE ALSO THE ONES WHO VOTED IN AND INVESTED IN FOR PROFIT HEALTH CARE AND INSURANCE. AND THEN VOTED RESTRICTIONS FOR PERSONAL BANKRUPTCY WHEN THOSE FOR PROFIT MEDICAL BILLS MORE THAN DOUBLED IN COST, MAKING THE MAJORITY OF FILERS DECLARE BANKRUPTCY BECAUSE OF MEDICAL BILLS.

"[Psych hospital] and Community Mental Health and you are liable if you don't give him free medications and he gets sick again. You are responsible for guaranteeing his well-being."

HE IS RESPONSIBLE FOR HIS OWN WELL-BEING. BLOOD KIN, WHEN THEY EXIST, GENERALLY STEP UP TO THE PLATE AND HELP THEIR DISABLED LOVED ONES. IF YOU WON'T, NOBODY ELSE CAN. DID I MENTION THAT YOU'RE THE FUCKERS WHO MADE DAMN SURE OF IT? BY DESTROYING THE ALREADY MEAGER SOCIAL SAFETY NET. REAGAN, BUSH, W AND YOU ARE TOTALLY RESPONSIBLE FOR THIS SITUATION.

Okay, venting over! Time to go to bed. :)

"Mental Illness and Murder"

2008-08-20T16:17:00.002-06:00

Mental Illness and Murder

Contrary to popular belief, homicide due to mental illness is declining, at least in England and Wales:

The rate of total homicide and the rate of homicide due to mental disorder rose steadily until the mid-1970s. From then there was a reversal in the rate of homicides attributed to mental disorder, which declined to historically low levels, while other homicides continued to rise.

I have no doubt that in England and Wales, where there is universal health care and mentally ill individuals are able to take their medication because it is affordable or free, homicides committed by MI people have declined.

I've been a psychiatric social worker for 15 years, and I can tell you EXACTLY why other industrialized countries have lower rates of murder by severely mentally ill people - universal healthcare with parity between "physical" and "mental" illnesses. (Since all "mental" illness is actually physical, there should be no distinction made.)

Even US statistics show that mentally ill people are LESS violent than the general population when treated with medication. But effective antipsychotics tend to cost $800-2000 per month. Even the "wealthiest" people on SSI Or SSDI (disability) have entire incomes under $1200/month. Those $1200/month folks made six figures when working, BTW. The typical disabled MI person gets $200-500/ month for rent, food, medicine, utilities, transportation, and physical care necessities such as soap and shampoo and toilet paper. Even the lowest income medicaid recipient usually has a a monthly "spend down" (like a deductible) often EXCEEDING their actual monthly income. Living expenses are not considered when figuring spend down either. And medicare folks don't fare much better, their medicine is paid for (with a copay) for several months, then they hit a "donut hole" where medicare doesn't pay another cent until they have spent $2000-10,000 of their own income on the medication before medicare kicks back in. Again, living expenses are not considered and the demanded contribution often exceeds the person's actual income. You do the math.

Most mentally ill people, especially those who have hurt others when off medications, desperately want treatment. Virtually every murder by a mentally ill person is caused by all of us neglecting them and refusing them necessary healthcare. We can court order violent people for mandatory treatment all we want, but if they can't afford the medicine they aren't GETTING effective treatment. Even the most violently criminally insane person effectively has NO access to the treatment that would control their symptoms and prevent tragedies. Until we change that, innocents will suffer and die. And we will all be culpable.

Privelege Overflowing Like A Shit Filled Toilet

2008-08-10T08:56:00.002-06:00

I work with a new client who has gone from making six figures and having three jaguars to being on disability ($800/mo). He comes from an EXTREMELY wealthy family in the richest suburb in my state. His siblings are emotionally supportive and one of his brothers is his payee, but they don't help him financially at all despite stunning personal wealth. Someone in the hospital told him and his sister that my agency would pay for all his medication, which is a blatant falsehood. Now he and his family are FURIOUS. They refuse to believe that medical providers are not liable for providing him free medication. The sister's husband is a malpractice attorney, and they keep threatening to sue. I'm like, Knock yourselves out. Nobody has a responsibility to pay for his medication except him.

I explained that I don't like it when homeless and indigent people can't get the medicine they need and live in fear and anxiety and depression and psychosis. I don't like it when it happens to formerly wealthy people either. I used my standard social line, "All the people I work with are equally important to me." This works for both people who have self esteem trouble or depression (meaning "You are just as important") and with extremely entitled or narcissistic people (meaning "You are not more important").

So I spent an hour and a half of my life that I'll never get back saying "no" to people who would not accept that because basically nobody has ever said no to them before. Among the things said to me (followed by my internal reaction in ALL CAPS just to demonstrate how I was screaming replies in my head while apparently patient and calm.)

"This is just reverse discrimination."

UM, HELLO, THERE IS NO SUCH THING AS REVERSE DISCRIMINATION. THERE IS MUTUAL RACISM, BUT THAT'S NOT DISCRIMINATION.

""If he were a black woman he'd get his medication from you for free." I did raise my voice a little saying, "Absolutely not!"

ABSOLUTELY NOT. AT LEAST A THIRD OF MY PATIENTS GO WITHOUT DESPERATELY NEEDED MEDICATION BECAUSE THEY ARE POOR BUT DON'T QUALIFY FOR MEDICAID OR MEDICARE. RACE AND GENDER ARE NOT RELEVANT. NOBODY GETS SPECIAL TREATMENT, INCLUDING YOU. SORRY IF HEARING NO AND COPING WITH IT IS NOT A SKILL YOUR PARENTS TAUGHT YOU. IT'S OFTEN HARDER TO LEARN IN ADULTHOOD.

"I didn't think we had welfare anymore."

YEP, THAT WOULD BE THE EXACT PROBLEM YOUR BROTHER IS HAVING AS WE SPEAK.

AND YOU'RE THE FUCKERS WHO VOTED TO DISMANTLE OUR SOCIAL SAFETY NET. AND YOU'RE ALSO THE ONES WHO VOTED IN AND INVESTED IN FOR PROFIT HEALTH CARE AND INSURANCE. AND THEN VOTED RESTRICTIONS FOR PERSONAL BANKRUPTCY WHEN THOSE FOR PROFIT MEDICAL BILLS DOUBLED IN COST, MAKING THE MAJORITY OF FILERS DECLARING IT BECAUSE OF MEDICAL BILLS.

"[Psyh hospital] and Community Mental Health and you are liable if you don't give him free medications and he gets sick again. You are responsible for guaranteeing his well-being."

HE IS RESPONSIBLE FOR HIS OWN WELL-BEING. BLOOD KIN, WHEN THEY EXIST, GENERALLY STEP UP TO THE PLATE AND HELP THEIR DISABLED LOVED ONES. IF YOU WON'T, NOBODY ELSE CAN. DID I MENTION THAT YOU'RE THE FUCKERS WHO MADE DAMN SURE OF IT? BY DESTROYING THE ALREADY MEAGER SOCIAL SAFETY NET. REAGAN, BUSH, W AND YOU ARE TOTALLY RESPONSIBLE FOR THIS SITUATION.

Okay, venting over.

On This Date In History

2008-08-09T20:13:00.001-06:00

8/9/74 - *

I was six and had my tonsils removed in a vain hope that it would help my asthma. I was still pretty groggy from the anasthesia, so a nurse was holding a cherry popsicle while I eagerly swallowed to numb the pain.

My parents and the nurse where all captivated by the TV. The nurse pushed the popsicle a little to far and VOILA!

I threw up during Nixon's resignation speech.

My Democratic, union member parents were thrilled. So was the nurse, and pretty much everyone on the peds unit, all union. People kept on sticking their heads in the room and saying, "You know, I wanted to throw up too!" I was a hospital superstar!

Random Weight Loss Thoughts.

2008-08-05T18:30:00.003-06:00

So I've lost 31 pounds unintentionally after starting a medication that typically causes weight gain. Not so for me. Some of you are likely aware of the effect SSRIs for depression have on libido. Eradicate it. It's possible to have sex. It can feel nice when it happens. But there's not a shred of desire most of the time. Something that was a delight before, that you wanted and looked forward to and initiated at half a chance just isn't interesting anymore. There's no desire.

That's what happened to my totally moderate and intuition driven appetite for food. It's just gone - disappeared entirely. I am mildly hungry when I wake up. I get my cini minis and coke "breakfast of champions" and then I just don't get hungry. Around ten at night I get mildly hungry. I eat a frozen entree and go to bed. My shorts are literally falling off. I had to exchange them once for a smaller size, and a couple of weeks later THOSE are literally falling off. I can't exchange those, I've worn them. I had to buy safety pins (which incidentally they don't even pretend is a baby item anymore, it's shelved in the miscellaneous aisle)to pin them on my body.

Naturally the weight is all coming off my hips, proportionately small, instead of the SHELF OF FAT above my belly button. It's like the biggest muffin top ever. And it has never gone away. When I couldn't afford food other than rice for a year and got bronchitis and pneumonia and couldn't afford my asthma medicine and walked five miles each way to work and weighed 140? Still there. Nice big twin pregnancy belly? No cute preggo belly for me - still there. I completely accept my body and love a good many parts of it. Including an eraser sized mole on my left forearm, which sort of tells me that I'm ME - it's a little spot of uniqueness. Medical staff have offered to remove it because they could technically get away with a melanoma "biopsy" due to the size. I've always said no thanks.

Now, I'm nowhere near losing my supersize cred. I still weigh 275. I don't imagine that loss of appetite is going to take me out of my set point range. I have bunches of coworkers counting points and having a biggest loser type contest. And I think I've lost more weight than any of them. I just don't talk about it to them. Kind of like I can't join in the women's social ritual complaining about husbands. "Wow, my husband would never do that! You married an asshole." is not in the script. :)

I admit that I'm enjoying it. I can feel the difference in my dance-induced osteo-arthritic knee. I can fit into a pair of bright beach print capris I love again. If I lose another ten pounds I'll probably be able to shop for pants at Target. My shirt size is never going down due to my nice strong linebacker shoulders. I've never been the kind of fat activist who would pass up a legitimate and low side affect treatment. You know, one that doesn't cause weight gain like dieting does. Being fat is part of my identity, but if it were treatable I would happily take a pill, just like I take one for depression, which many consider "character building." Uh, yah, fuck that.

I don't see one coming down the pike in the next hundred years anyway. Phenotypes are had to medically hack. Look at Michael Jackson. Besides which, I am no more likely to be less at risk of high blood pressure because I'm a socially acceptable weight, than Michael J is as an African American, regardless of how much he has lightened his skin and changed his nose. Because cosmetic changes do not trump genotype. Attempts to increase and decrease height have mostly been failures, and when they work the side effects are usually grave problems themselves. Weight is as heritable as height, and runs in biological but not adoptive families. It's not about food intake, it's about the natural and healthy variation in body size. People can look at Danny DeVito and Kareem Abdul Jabar and accept that HUGE healthy variation. Tall people have more strokes. Short people die when airbags deploy and smother them. Life only ends in one way - death. And it is too short to obsess about appearance when there are people to love and good work to do and fun to be enjoyed.

20th Century Dowry

2008-07-30T17:09:00.002-06:00

Cast you mind back to the year 1997. Before the world wide web really got on its feet. Before the DotCom bubble. Before Y2K (remember Y2K?) Most believe that dowries were an ancient tradition left behind when we carved a country out of colonial territory. Not so, my child.

In 1997 the custom of a dowry was alive and well in my parents' living room. The blueberry muffins had been consumed, the bird stuffed and safely in the oven and since we were all adults we had slept in late and waited for the food preparation before approaching the Christmas tree. For an all adult Christmas there were a LOT of presents on the tree skirt and overflowing onto the wooden floor. This gave rise to curiosity and fear that the haul wouldn't fit in our cars for the trip back home.

Now,despite my Venus of Willendorf figure (which was never criticized at home)I dated steadily through high school and my extremely prolonged work-wait-go back for a semester of my college career, then do it all again. My family didn't like my first boyfriend, largely due to the fact they had no idea that HE was preserving my virginity because we both wanted out of our birthplace. We shared the fear of an unwanted pregnancy that would doom us to stay. He was the one putting on the brakes though. I was all "what comes next"?! As an adult I became belatedly grateful for the care and probity of my high school boyfriend. He went off to college and broke up with me that Christmas, presumably because he wanted to broaden his horizons with a grown woman. I didn't understand why at the time and was heartbroken.

Less than a year later I found the (I thought) love of my life. We got engaged, we got busy at a hotel, where the staff thought we'd just gotten married. When we left, the hotel sign, directly on my mom's route to and from work, their big message board said "Congratulations Mary and ------!" I completely freaked out. I was actually scared to go home. Thanks to common names and the fact that mom was not going to notice a sign she passed every day, the maelstrom I was expecting never formed. I lied about our date activities and as far as I know she never doubted me. We were engaged for about 48 hours when he called me from the marine boot camp he had joined without talking to me about it. I wrote letters faithfully because I just couldn't break up when the poor guy was in boot camp. He came home hating and scorning women. It took too long for me to realize that he had changed forever, but when I broke up with him I really thought I could never love again.

Soon after my 19 year old brother had an asthma attack and was dead on arrival at the hospital, driven in by his frat brothers when the ambulance didn't come. Medical staff resuscitated him but he was brain dead. My boyfriend of the time and I felt happy just dating, with no plans to get hitched. I wanted children, he didn't, so we dated in a gloriously carefree manner. My parents did like him but my mom didn't understand why I would date someone I didn't plan to marry. "If you don't want to get married you should break up and play the field." Things turned sour when my brother's recovery was beyond hope, and my boyfriend who was Ba'hai thought my grief was excessive and self indulgent.

I got engaged again to a guy who turned out to be a jerk, but love is blind.. My mom and dad really liked him, he was a rich computer guy and outwardly pretty impressive. I moved across the country with him when he got a new job. Three months after our engagement he dumped me after I had already come back from a Christmas trip back home. I got my old job back, and my friend's only question was, "What day this week would it suit you to be picked up?" When I returned a few months later to move my belongings, my friend found the "Mary pros and cons" list that he'd left in plain sight. I wasn't even tempted to look.

My mom convinced my dad to pay off my college account, and I was able to return to school in earnest. I still had to work 60 hours a week while attending full time, but I got to go straight through to graduation this time. I met my husband on the Internet through a bulletin board (sort of like a list serve now). He was in grad school, I had my busy undergrad/work schedule. We lived 22 hours apart. Neither us had time to date in person, but passionate love letters can be sent 24/7. When introduced my family ADORED him. Which brings us back to Christmas 1997 and the dowry.

I admit I was greedily looking at all the gifts spread across the floor. We passed out presents one at a time. I got a sweater, Ed got the top of the line fastest modem around. Brother got a modest gift certificate to Best Buy, Ed got an obviously expensive watch. Dad got new slippers, Ed got a new down parka. Mom got a blue dress that reminded my parents of one dad gave her when they were dating, Ed got an electrical gadget that I forget specifics on. There was a second round of presents, after which a bunch of presents remained. Ed got them all. The only dowry gift Ed didn't get was a fine young goat.

I can only assume it worked, because on the Fourth of July ed proposed to me in the midst of the fireworks. We have the happiest marriage around, too. Maybe dowries SHOULD come back into style. Worked for me!

My donation letter to the Obama campaign

2008-07-29T18:54:00.003-06:00

This campaign cycle has been a dream come true in its way. Many excellent candidates, two front runners whom I respect and like. The Democrats? With two impressive candidates late in the race? Will Rogers is doing the snoopy dance in his grave.

We need to undo the damage the Bush administration has done. Starting with restoring friggin HABEAS CORPUS to our rule of law. Following the Geneva Conventions and the joining the world court so that we can put American war criminals behind bars. Although I can see the reluctance, since the court frowns on war profiteering and invading sovereign nations unprovoked. Lying to start a seemingly endless war. Oh wait, we won the war in Iraq four years ago, President Bush said so. There is no war against Iraq - we Americans are all culpable for a brutal military occupation blatantly torturing captives and targeting civilians.

I am glad Barack Obama is our nominee, because he has unfailingly voted against war, military occupations in Afghanistan and stealing the lives of countless civilians, both living and the dead. And Barack nearly always takes the high ground in any manner of competition.

I would like to wrap up with a request - a unity ticket with Hilary Rodham Clinton as Vice Presidential candidate. Please consider making this Democratic campaign doubly historic and doubly strong.

Perfect Month

2008-07-28T21:32:00.002-06:00

So July has been pretty spectacular for me. I was asked to contribute to a best-selling author's next book. I was asked to audition for a lead singer in a wedding/funeral band - not my style, but a very nice compliment. I found an experienced vw mechanic who does side work who fixed my driver side window, which has not been able to open for over a year. The dealership wanted $270 just to LOOK at it. Then $400/window. Three were broken. We don't have TWELVE HUNDRED to pay to the dealership. Carl did the job for $185/window. So we are getting one replaced each month.

Then there's grad school. The whole process has been so easy that I'm worried that I've missed something important and they'll say I can't start. Every time I get mail from the university I have a sinking feeling that this is going to be the letter that breaks the bad news to me. And of course they are all mundane.

And the financial aid system is so simple and straightforward that it seems too good to be true. File your FAFSA when doing your taxes, it is automatically sent to the school. When you are accepted, the financial aid is managed by that department. A few weeks later you get an award letter that shows the amount approved and you drop an email to confirm that you need that aid. You sign a promissary note online and go through entrance counseling at the aid website and take the most obvious quiz ever written. Twenty questions which basically all have the same answer - yes, this is a loan and I know I have to pay it back. There's a HINT on several questions, the funniest being the hint that lists the four kinds of repayment types, when the question is how many types they are. So if you can count to four, you're golden. A few weeks after that get a university bill with nothing due because they automatically apply your aid and direct deposit the difference into your checking account.

Back when I started college (in the 80's) you had to get student loans on your own through your credit union or bank. In my freshman year the person in charge of submitting the paperwork didn't do it, so I never got my aid that year, and the credit union would not replace the aid amount with their own loan. One time I got my aid check saturday and got a notice Monday that congress had passed a bill that retroactively canceled it and I had to return the whole amount. Good thing that school's registrar office was closed on the weekends, or I would have been totally screwed. I withdrew from classes, worked hard and saved for another semester out of pocket.

Th difference is amazing and it seems a little *too* smooth.I'm getting financial aid that covers tuition, books, permits, and supplies with room to spare and save for the summer term.

I hate this quasi-paranoid feeling, waiting for the other shoe to drop. I'll believe I've really made it when the money's in the bank and the first week of classes goes by uneventfully.

Why it's great to have 7 year olds.

2008-07-28T21:16:00.002-06:00

I sing the twins to sleep every night. PS2boy said:

"Mama, no one sings better than you."

This has set a plan in motion to hide all vocal-inclusive music from his knowledge.

Then he can't change his mind. :)

Hellokittygirl has started singing along on The Cuckoo. She can't carry a tune in a bucket, but she LOVES to sing. Which is more important, in my book. I'm not sure if it's just her age and in a few more years she'll be able to sing on pitch. I'm definitely going to look into instruments and lessons. Everyone on DH's side can play various instruments. On my side we're all singers who are hopelessly incompetent with instruments, possibly because of the "fuck this 'learning to play' thing, I can sing it right away by ear and transpose it to my range without trying" factor. The partly bitten off right index finger doesn't help much either. Surgery saved the hand, but that finger is not what it used to be. I have trouble double clicking, let alone playing a string instrument.

Wedding Love

2008-07-07T15:24:00.004-06:00

*

Ed and I did a JP courthouse wedding for insurance reasons. We both took a couple of hours off work and a couple of best friends. As I was about to leave work, one of my favorite supervisees asked where I was going, and I casually said "I'm getting married, and I'll be back at about 3:00. When I returned there was a bottle of champagne at my workspace. The marriage vows were very moving, to my surprise. We kissed and went back to work.

Then we had the big church wedding, funding courtesy of my mom's modest inheritance. She immediately told me she wanted spend every penny on my wedding. Her mother was a cruel and abusive person, both of us had PTSD from being in Grandma's care. I'm very aware that I was an awful teen and both of us had mental illness, and psychiatry was not on my parents' blue collar radar. So our wedding planning and splurging reflected a mom/daughter love story. One of my best friends is one of the best seamstresses in Chicago, so THE DRESS was central to this. It put $2000 in my friend's pocket for designing and making a custom, unique dress for me. We sat down and had a long talk with Julia and she sketched out a few ideas. First I wanted to wear my mom's dress, but it didn't fit my shape. And my mom had bad associations because her mom got the cheapest dress possible instead of one that my mom wanted. Julia awesomely asked, "How about we include some of the wonderful lace and make it part of of the dress. Donna, how would you feel if you could rip the dress apart for me and just give me the lace?" My mom was glowing at the suggestion. So we sat in the hotel room and with my grandma's abusive "present" and ripped it it apart in malicious glee. I can't find the words to express how healing it was, bonding us together and drawing us closer. If you can exorcise a dress,then that's what we did. Mom and I picked out the cloth for the new dress. It took a long time, Julia assured me that when I saw the right fabric, I would just KNOW. (sort of like with the groom). And I did, cream brocaded roses. I am what one of my queer friends calls a "heterosexual dyke" - no make up, no hairstyling beyond a single braid, knew more about cars than Ed, resolute feminist, not shaving because I damn well have the right to be a mammal. Julia noted that Ed brought out my lurking "girly" side, so she sketched up a renaissance-sexy-fifties-silk and brocade dress. Then she made it come true. My mom drove four hours to every fitting and we had a blast together. We shopped for food and cake, looked at reception places, picked favors and flowers.The process broke down emotional walls and healed much of the pain we had inflicted on each other when I was a teen.

It was a good thing we did all the planning together, because the day before my wedding mom had a stroke. I lied to her to get her to the hospital and held her hand during painful procedures. I missed the rehearsal and dinner. I missed greeting Ed as he got to Chicago. I missed my mom at the wedding. We were going to to cancel the ceremony, but mom could shake her head "no" all though her speech was gibberish. She tried to check out against medical advice to come to the wedding, but Ed's mom Ruth talked her out of it. when no one else could, because she alone could understand the anguish of missing her daughter's wedding. Someone put a cell phone on the alter so that my mom could hear the wedding. And I had fought against videotaping the wedding ("A wedding is a sacrament, not a sitcom.") and my brother finally convinced me. Because he won that argument, the whole wedding party was able to go straight to mom's hospital room so she could see the wedding on video immediately. So we missed part of our reception as well. We wanted to cancel the honeymoon, and our friends and parents convinced us that mom was out of danger and we could keep in contact on the phone. So we went but with heavy hearts.

Mom died in 2006, the day she was discharged from the hospital after several months in a coma due to a one in three million disease. The doctors had said that mom was not sick anymore and just needed nursing home and rehab for the paralysis from being in a coma for so long. She was transferred to the nursing home and literally a few hours later she died alone.

Ed and I have an extremely happy marriage and twin raising enterprise. She missed their first day at kindergarten.

I still miss my mom every day.

I'M ACCEPTED!!!

2008-04-19T15:02:00.002-06:00

I just got my Masters of Social Work acceptance letter today. It is dated the day after my interview - I guess my feeling that I aced the interview was right. I'm so happy I could burst. Everyone was telling me I was a shoe-in, but I was still unsure of myself. I'll write more later when I can think straight again. :) :) :)

Interview News

2008-04-14T15:20:00.002-06:00

When I called to schedule this morning, they wanted me to come in TODAY! So I explained to my boss, canceled appointments and rushed home to get ready. I'm VERY glad I got all my shopping done yesterday! I put on my new dress, pearl necklace and dress shoes, dug my purse up from the depths of the coat closet and had time for a hair style before the meeting. I'm TERRIBLE at doing my hair, and they stylist even made it look a little "fallen" as if I'd done it this morning. *grin*

The interview itself started with a case study, which fortunately for me was mental health based. Having actual social work experience was very useful for that little challenge! Then they took me to a big table in the back and I sat there alone wondering if ten people were really going to interview me. It was festive though, there were two bunches of balloons and an empty punch bowl, looked like they were going to have a party and lent a congenial atmosphere to the department.

The head of admissions came and introduced herself and said, "I'm taking you to a little room where we're going to put you on the hot spot." In fact, the interviewers were challenging but supportive. They listened carefully without interrupting and asked follow up questions. They asked me to reconcile my desire to do research with my Cs in math, and I just told them that I know it's a weakness, and that I definitely need a research partner who is good with math, but I know this about myself. I did tell them that I have depression and it contributed to my switch from case manager to floater. I hope that doesn't disqualify me, but I don't think it will.

They transitioned from asking questions to explaining the course of study, a double masters with Public Administration and the global learning program which lets students take study trips to nations around the world. At that point they both slipped and said "when" instead of "if", with the head adding "IF" with a smile and a bit of a twinkle in her eye. They complimented me on several of my answers and said they were impressed with the passion in my social justice essay.

Overall it was a great experience and I'm glad I had no time to fret about it. I feel very good about the interview and I will be surprised if I am not accepted, which is way more confident than I've felt to this point. I'm off to buy stationary for thank you notes!

GVSU Called!

2008-04-11T15:56:00.002-06:00

I HAVE AN INTERVIEW!!!!

Luckily, my phone was dead so I got the message just now, after the work day. I'm sure I would have sounded like a blithering idiot who just won the lottery. Now I can call back pretending that I have some sort of calm dignity. She won't SEE me bouncing up and down while I schedule.

I have the hugest grin on my face right now!

Now I have to go shopping for a dress or suit.

Reason Cannot Save You From Insanity

2008-04-10T15:45:00.002-06:00

My husband forwarded me the following blog post. This is the clearest example I've ever seen of undiagnosed paranoid schizophrenia. Note the intelligent, cogent and rational description of this unfortunate person's life in the past five months. This shows the degree to which altered perceptions can affect the ill individual. One of the least understood things about psychosis is that the perceptions are real, just faulty. People feel the puffs of air and see the skin color changes and can't tell delusions from the truth. There is absolutely no qualitative difference for most folks. It takes most people with schizophrenia years, even decades, to learn which perceptions are correct and which are symptomatic, and it amounts to memorization of the symptomatic content. The perceptual reality of the symptoms never goes away unless medication successfuly eradicates it. This poor person is sleeping on a desk in the living room because they are so afraid of the bedroom now.

I noticed something that I share with this person. Since the onset of the muscle problems I analyze every glitch of my body as potentially part of what is going on. I'm hot a lot of the time now - is it related to the muscle problem, perimenopause, or a side effect of my new medicine? Are those muscle twitches normal? Have I always had them and just never paid special attention? Everything is potentially part of the experience of illness (or in this person's case, perceived torment.)

I'm quoting this in its entirety. I would love to offer a gentle but firm explanation of what it going on to the individual, but comments are closed. Most of the comments were cruel, but a few were kind and sensible. I hope this person has loved ones around to help them get treatment.

This article describes harassment and barrage of assaults I have been
experiencing on my body during the past five months.

I am an American citizen, an immigrant of Middle Eastern origin. I
have been living in the US for 35 years; I am non-religious; my
politics tend in general towards left-of-center. Around the beginning
of the Iraq war, years 2003 and 2004, I expressed on Internet forums
- mostly on this site - my opposition to the Iraq war in strong
language and talked about George W. Bush in unflattering terms which
are commonly heard now but were not so commonly heard then.

The precise beginning date of the series of events I will talk about
is uncertain because only towards the end of November 2007, I realized
that I was being drugged and walked backwards in my mind and traced
the start of this approximately to the beginning of that month ...

To explain: During a normal night of sleep, one goes thru a process.
The precise instant one falls asleep is not clearly marked to one's
own consciousness but one is aware of the different stages of sleep
one goes thru during the nite. There are periods of deep sleep and no
apparent consciousness, and periods of dreaming and times of semi-
awaking and becoming aware of such things as the bed and sounds coming
from outside etc and then falling asleep again and going thru these
stages possibly several times. And in the morning, because of the
awareness of having gone thru these stages, we are aware of time
having passed thru the nite.

By contrast: I have been operated on under general anesthesia two
times. The experience of general anesthesia is not like sleeping at
all; it is total absence of awareness; one might describe it as
destruction of time; it is as if one did not exist during the time
while one was under.

Somewhere towards the end of November, I said to myself, I am not
going to sleep; I am being knocked out. This had been going on for
several weeks but it did not hit my consciousness because the
possibility of such a fantastic thing as noxious gases being injected
into my living space was so totally outside the horizon of my
expectations.

Because, if somebody had talked to me a year ago in the way I am
writing now, I would have said this guy sounds like a paranoid nutcase.

Going back to the past four months, unfortunately, I have not kept a
diary and can only give an account of events in inexact time specs.

I believe the assault on my body started with a test on me as a guinea
pig of a "sleep gas". This is only one of the things I have been
subjected to in the past 4 months. Let me list them:

1) First, more details on the "sleep gas": Once I became aware of
it, I paid attention to how it worked. A typical situation: I am
walking around totally awake and not tired, then I sit down to watch
TV for a bit in my usual spot on the couch. I may or may not feel a
faint draft of air on my face; then, quite suddenly, I feel tired and
sleepy. Then, the effect depends on how I respond to this. If I take
this as a signal that it is time to go to sleep, I actually do go to
sleep and this is what I had been doing the earlier weeks of
November. (Parenthetically, throughout most of my adult life, I
suffered from insomnia and going to sleep had been a big struggle for
me, that is, until November 2007!)
If, on the other hand, I quickly get up and move away from the
spot on the couch, the effect dissipates; I am back to being awake and
untired again! Now, in my experience, this is a neat trick. One
might shake oneself out of sleepiness with coffee and cold fresh air
etc but tiredness does not go away so easily.

2) Now the waking part: I seem to breathe cold air, or more
precisely, I experience what feels like a splash of cold air on my
face and this is followed by palpitations in the chest. This is how I
was woken up. Also, this is how I was prevented from resting.
Another typical situation: I come from work eager to read a
magazine. I set up my pillows on the bed to rest against. Then, the
light blinks, I feel the cold air against my face followed by the
palpitation in the chest. I get up and leave the bedroom.

3) When I was still using my bedroom, I remember waking gasping for
air and running to the window and being able to breathe only with my
face out the window. It was as if something other than air had been
filling my lungs. This happened only for one or two times after which
I stopped using my bedroom. For the past 2-3 months, I sleep in the
living room on my desk; this puts my head on a level against the open
window and I use a fan to drive in fresh air from the outside against
my face.

4) "Dirty air": Not that I can see the dust or anything but I feel
an accumulation of gunk in the back of my throat and on my tongue.
During the times I was subjected to this particular torture, the furs
on my cats were covered with a shiny gunk and they kept licking their
tongues.

5) A particularly severe attack: I believe it is administered via an
injected gas; it may start with something like the bursting of a
bubble on my temple. Followed by a sickness lasting from a few hours
to a day. Symptoms: finding myself forced to breathe fast, numbness
on the extremities, for long periods afterwards, feeling my lungs
constantly with discomfort on each breath and chest pain that
sometimes take over entire one half of my chest.

6) Equally severe, administered via my car (not in my townhouse).
Burning in the lungs, pain with breathing, feeling as if I am about to
faint. This also lasts several hours. And I actually have a sample
of the substance that caused this. I found an object that looked like
a piece of sponge in front of my garage. I picked it up; it was
covered with a soot-like powder. I brought it near my nose to see if
it had a scent. Subsequently, for several hours, I experienced the
above symptoms with one additional symptom: the skin on my finger
turned white in an area the size of a dime where I had touched the
stuff. This was not a case of the skin being covered with dirt or
powder; the skin itself turned white and remained so even after
washing for several hours. I imagine, about half a dozen times, such
a piece of sponge was placed on my engine allowing the piece to burn
with the heat of the engine with the vapors wafting into the passenger
compartment. In one of these occasions I had a movie theater staff
call the medics and they found nothing except that my pulse rate was
and stayed at a high level. This was attributed to my being excited
even though I was not so.

7) Tinnitus: Ringing in the ears. Now, this is not internally
generated. I believe this is achieved by some sort of electomagnetic
wave or near-inaudible sound wave. The reason: the effect is
localized to specific spots I tend to occupy in my home, for example,
sitting in front of the computer. If I move away quickly when the
ringing starts, it subsides over half a minute to a minute of time.

The general strategy seems to be not to throw all of these at me at
the same time but to sort of alternate between different types of
torment.

I never thought I was that important but somebody seems to have seen
it fit to spend an awful lot of concentrated effort and money to
displace me. All these occurrences are not the work of an ordinary
person and the team that is harassing me has access to locksmith
expertise, veterinary expertise, electricians' expertise and and air-
conditioning expertise. I will spare the reader details on all of
these areas for now.

The overall goal seems to be to drive me away and, if that fails, to
drive me crazy, and if that fails, to make others think me crazy if I
start to talk about this admittedly fantastic stuff that is happening
to me.

There are other effects that are difficult to distinctly describe.
There is a lot here that I have not written about. This has been my
life in the past four months. There are days when it feels like I am
walking around feeling drugged and wearing a helmet of a headache. It
may just be a general unwellness resulting from living under torture.

Just When You Say You Hate Something...

2008-04-06T18:17:00.001-06:00

...it turns out not to be true!

We started the twins in swim lessons a couple of weeks ago. I got jealous because I love playing in the water and swimming. So yesterday I bought a family pass when we went swimming. And a minor miracle happened.

In the water, I can be active and play with my kids like I used to. For two hours with a few rest breaks. We played tag and monkey in the middle and raced across the all shallow pool, with me handicapped by only walking and not swimming. And it was FUN!

I love exercise under these conditions. It's mild and not aerobic, but it's a few more hours of exercise than I've been getting for months. I'm gonna use that family pass until the lifeguards get sick of seeing us. :)

Bad Fatteh is Doing It Wrong

2008-04-06T15:31:00.002-06:00

I'm way behind on this fatosphere discussion, but I wanted to comment on it.

I don't believe that there are "good fatties" - we are all, by simply existing, transgressive in a way that our society is extremely keen to punish. Fat is portrayed as sinful, out of control, non-conforming and willfully unhealthy. We are the "welfare queens" of the aughts, lazy and expensive and contributing nothing to our country.

We are a diverse community, of course, and not a monolith of bad traits as we are portrayed. Through chance and choices we have various levels of health, and that's true of any group of humans. There is value in challenging stereotypes, and very fit fat people do that because the stereotypes are false and reality is complex.

If anyone is a bad fatty, I am. I eat whatever I please whenever I please, until I'm full and sometimes till I'm stuffed and sleepy. I haven't even tried to diet in years, because for me as for 90% of people they made me gain weight. I seldom exercise anymore because of the muscle thing. My favorite activities are sedentary, and I have no plans to change that. I loathe athletic pursuits, and hate virtually all forms of exercise. My PTSD used to give me awesome pain tolerance because I would just dissociate, but now that I've recovered I'm a wuss. I hate pain, and exercise hurts. I'm a size 32 pushing 34. i'm a smidge under 300 pounds. I AM the headless fatty in news reports, except my head is attached to my body. And it has a double chin!

What's more - I don't give a shit. I love myself just the way I am. Do I wish I had a lot of choices in clothes like thinner people? Sure I do. Do I wish I were a good athlete (noting of course that not all thin people are athletes)? Sure I do, more ways to entertain myself would be cool. Does my weight exacerbate the muscle thing and the dance injury in my knee? Of course, that's physics. Would I enjoy blending in and not facing discrimination based on my weight? Yes, I would. And yet I like myself and feel like a lovable and competent person despite being fat. Because I am. And that's not going to change.

Birthday Thoughts

2008-03-31T12:24:00.002-06:00

My birthday has been great so far.

I took the day off work which is doubly fun because the last day of the month is always hectic and I end up working way late, and today I would have been stuck in pouring down rain.

I slept in til noon.

I read all my blogs.

I am having time ALL ALONE, a luxury beyond description.

While I slept, my house was cleaned for me. Getting a house cleaner has meant less money for restaurant meals or birthday gifts, but it makes daily life unbelievably better.

I have a deliriously happy life, one that I could never have dreamed could be this happy.

It's not perfect - my mom and my brother Mike and my friend Brandon aren't here to share it, but it's as good as life gets I think.

Even the rain is positive, because it's a glorious spring rain driving away the snow. As good as sunshine, it it's way.

I am blessed.

Social Obesity

2008-03-19T12:46:00.004-06:00

As I was discussing addiction with respect to benzodiazepenes with Ed, I stumbled on a great truth that may lead to obesity war success. You see with opiates and benzos and nicotine there are large groups of people who can take them socially and never become addicted. In fact, addiction is very infrequent and there is evidence that some people become addicted more easily than others. And eating food is EXACTLY like abusing nicotine and opiates and benzos. We know that ostracizing people works on addictions, and obesity is simply an ADDICTION TO UNNECESSARY FOOD. Funneling billions into the war on drugs and tobacco has ended addiction in people who matter to politicians. But how can this apply to an EPIDEMIC of obesity?

The war on obesity will make everything okay by eliminating the "socially obese" who are only fat when they go dancing, have surgery or experience panic attacks. The socially obese only gain weight to fit in and be cool. Like the "weekender" cocaine user, they can cut an lean and mean figure in a power suit during the business week, while BALLOONING into fatness for relaxation and fun after work and on weekends. It's scienterrific fact that FAT IS CONTAGIOUS to people who don't live with the obese "index" person, just as influenza is contagious to friends who live across the country but not to members of the "index" person's own household.

The socially obese, like social smokers who can take or leave tobacco products, simply need to be convinced that they can stop eating permanently with the support of medical professionals. And they need motivation. Americans are far too accepting of obesity. We coddle the obese by legalizing businesses that sell them clothing that fits and even food itself. We respect their dignity by never including their faces in photographs of their shameful, disgusting bodies in the media. We protect them from embarrassment by excluding them from the public eye in the movies and especially politics. And the radical "fat acceptance" advocates aren't grateful, even when we make an exception and legitimize their view by letting them debate obesity experts like Meme Roth on national television.

Social obesity must be stopped. People who become obese to fit in need the strongest possible reminders that obesity is a TRAGIC CHOICE taken up to gain social approval. We must emphasize that eating is a choice and they can stop if they really want to, and don't fall for peer pressure to remain obese. Only hatred can improve their health.

Thanks and Update

2008-03-19T12:06:00.002-06:00

Thanks to all of you who have given me support online and off. It has cheered me up quite a bit.

I have my disability placard and I'm grateful for it. I only use it if I need to because no other parking spots are reasonably close. I still feel better for the most part fighting the physical decline instead of giving in to it. The fight just keeps getting harder though. As I contemplate possibly not being able to walk anymore I appreciate more than ever the independence it brings and the blessing that it is.

I went to my psych NP and so far the cross taper is going well, although there's no sign that the muscle thing is getting better. Unfortunately, I can't just decide to stay on this class of medicines and be physically disabled, it turns out. J is concerned that they might affect my smooth muscle as well as skeletal. Which includes my heart muscle. :( She did say that it is too soon to tell. At least I've got a proven record of not getting addicted to benzos when I took a modest dose for three years. They didn't prevent anxiety like the atypicals do, but they did treat it effectively.

I'm struggling with doubts that the medication is the real culprit, and wondering what the next step is in searching for a diagnosis. I need to bring up the scooter issue with my PCP, but I'm still afraid that he'll think I'm hypochondriac or lazy because I'm fat. Maybe I'll just have Ed come with me. I hate that I feel like I need someone to vouch for me, but that's the reality. It sure throws my feminism for a loop though. I suppose that if Ed were in the same condition he would want me there. I do think Krista is right that there is medical discrimination toward middle aged women, especially if they are fat.

Tired of pain and fatigue

2008-03-14T21:01:00.003-06:00

I haven't written about the muscle pain and immediate fatigue lately, but they haven't gone away either. I just don't like to focus on it. My PCP Dr. Armstrong told me last time I went that we might never know what is causing it. I guess I sort of felt he had given up on me, so I stopped going. He sent me to an neurologist last fall but I had a completely normal exam and the neuro didn't seem to *listen* to me very well. I told him about muscle pain of a seven-of-ten-scale after about two minutes of movement such as walking, carrying, holding or standing, and he suggested a fifteen minute long bicycling test to see if my muscles would act funny. I felt like crying. I was too embarrassed to point out that in this condition I wouldn't be able to tolerate exercising that long. He told me I have an umbellical hernia that needs surgery base on the fact that my muffin toppy belly pooches up when I go from lying to sitting. I can't imagine having a foot long hernia with no pain at any time, it just doesn't make sense.

Anyway, we took a vacation to New Mexico for Christmas and the travel really wiped me out despite the fact that I buckled and asked for wheelchair escorts at each airport. I'm glad I did. I was exhausted during the whole trip, and it took at least a week to recover physically when we returned. I feel like I'm ninety. I worked with a physical therapist for five weeks without improvement.

I feel like I'm in the middle of a fixed delusion about conspiracy and nobody can believe what I say or accept my reality. I've entertained the notion that my pain tolerance is just decreasing with age or fatness, but no other person I know of my weight or age seems to be having these problems. I've asked my NP/Psychiatrist for a disability placard, and she's signing off for one. She thinks it is the risperdal, so I'm switching to seroquel. She doesn't know if this would get better if I stop risperdal, but she thinks it may stop progressing.

So here I am, 18 months after I started having trouble with my 45 minute workouts. At this point I get burning muscle pain and cramping sensations (but not spasms) in my legs and back when standing or walking for over a minute. I get cramping in my arms if I hold the phone, or carry a water bottle or push a grocery cart. Sometimes my legs or feet cramp for a long time after a short walk of maybe thirty yards from the parking lot to my desk. My muscles also get stiff more easily, making it doubly painful to walk after resting. I am often exhausted at the end of the day. I have to sit down to sautee mushrooms because I can't stand for the four minutes it takes without significant pain that forces me off my feet. I have begun sitting in inappropriate social circumstances where everyone else is standing. At the psych hospital's nursing station, or in an AFC home where a client is touring. I'm in enough pain walking that I look longingly at mobility scooters and wheelchairs online.

I'm losing my ability to stand and walk and nobody knows why. It seems to be getting worse again, and I'm starting to fear for my job, which is periodically active. Nobody knows why. None of the tests come back abnormal. All the evidence says that I'm making it up, but I'm not.

It's starting to feel like a slow nightmare I can't wake up from.

I know I sound like a whiney toddler, but sometimes I just have to say it or I'll burst.

Advice to New Case Managers

2008-03-02T15:03:00.005-07:00

Documentation of necessity and progress are vital to our continued ability to help our clients. This requires specific description of the psychiatric condition and a complex understanding of progress that is unique to health care. Think in medical terms - progress is not a simple matter of continued improvement, like it is in other endeavors. Compare our work to keeping a person in respiratory distress alive. Interventions promote progress regardless of the severity of the condition or response in the patient. Medical progress is made when the patient is cured (rare), assessed, correctly understood/diagnosed, stabilized, prevented from relapsing, prevented from declining more than they have, recovered from an existing bad outcome, hospitalized for more intense treatment and in the worst case scenario given the best treatment possible until death (rare for us). Our interventions help clients make progress through continued stability at any severity of baseline, mitigation or prevention of symptom or substance abuse relapse, referral to more intense treatment and assistance in recovery from a bad outcome. Progress can be slow and is seldom sudden and earthshaking. Sometimes progress is improvement, yes. But more often it is standing still (maintaining stability) or taking two steps back instead of ten, and sometimes it is falling off the cliff then putting the pieces back together. Suggestions for documenting progress follow.

Opening – What is happening today, with an emphasis on the positive. If you are working on a problem that won’t seem to go away, it’s known as following through. Following through is very esteemed by readers. An intervention is positive when it is presented as identifying improvements to be made, for example. Anything can be phrased positively because you can put a problem in terms of how it is being addressed. You can present a client’s urge toward self harm positively in terms of a worse situation in the past or in terms of what you did to help identify it and act to help them cope or get appropriate inpatient care.

Analysis – Put what is happening now in context of the whole, emphasizing progress made over time. Mention the day’s goal and how it was either met or re-evaluated when surprises cropped up or exchanged for a more pressing goal. Mention the bigger goal that this is part of and pick a time frame that shows progress or work toward solutions. Mention the person centered goal as well and how today’s goal moves you toward it. You determine the time frames and contexts, so you are always able to put this in a positive manner as well. You are never truly stuck because you are always assessing, monitoring, linking to resources or treatment,introducing interventions or building on previous interventions.

Conclusion – How today leads to tomorrow or simplifies the goal or does something to help the client. Once again you choose the details and can direct the focus and attitude. Think of this as the main idea about progress you want the reader to come away with.

Fat Accptance and Family/Marriage Therapy

2008-02-25T16:10:00.003-07:00

Over at Shapely Prose, Dr. Sheila Addison is looking for recommended reading for a class she is teaching on size acceptance in family/marriage therapy.

This was my input, and I encourage you to head over there and add your own!

Kate Harding's "Don't You Realize That Fat Is Unhelathy" and "The Fantasy of Being Thin" are definitely two of the best introductions to size acceptance I've ever read.

"Big Big Love" is an excellent book dealing with sexual relationships and self acceptance. I think in Marriage and family counseling you would come across a LOT of entitled fat hatred on the part of partners and parents who are not fat. Or parents who are fat and fantasize that they can "save" their child from fatness by shaming them and telling them nobody will find them attractive. Seriously, any partner who feels justified in harassing or leaving someone based on weight (no matter how acceptable and encouraged fat hatred has become) has issues of their own. They might also just use weight as the best tool to push the partner away so they aren't the "bad guy".

Fat?SO! Was also very formative for me, long before there was a fatosphere. Junkfood Science articles are extremely rational and evidence based analyses of the cultural hysteria that is the obesity epidemic and the science showing that fat is not the killer it is purported to be.

The best thing to emphasize is that fat people are no different from thin people or other social groups subject to prejudice (positive or negative). You cannot tell anything about a fat person by looking at their body. NOTHING. As with other groups, make no assumptions about your client and instead listen to them. If there are deep issues with eating or body image, they will emerge. The fact that they do not usually indicates that there are none, not deep denial. If someone tells you they eat less than their thin friends, believe them. If someone tells you that his insecurities as a father have little to do with size and everything to do with the way his parents *treated* him for his size, believe him. If food and size never come up, don't force the issue. If you must address weight because it does come up,do so in an accepting manner that is HAES and size positive. Keep things about psychological and behavioral issues and stay out of medical issues. Frame weight in terms of other prejudices to clarify how hurtful and unacceptable mistreatment of fat partners/parents/children really is. If you wouldn't say it about race or religion, it's prejudice and you're behaving rudely.

This is Important

2008-02-23T17:56:00.002-07:00

Krista has been commenting here for a little while, and this weekend I got a chance to read her blog too. She linked to her best friend's blog, and her best friend had reposted this. Please take the time to read it. You won't be sorry.

A lot has been said about how to prevent rape.

Women should learn self-defense. Women should lock themselves in their houses after dark. Women shouldn't have long hair and women shouldn't wear short skirts. Women shouldn't leave drinks unattended. Fuck, they shouldn't dare to get drunk at all.

instead of that bullshit, how about:

if a woman is drunk, don't rape her.
if a woman is walking alone at night, don't rape her.
if a women is drugged and unconscious, don't rape her.
if a woman is wearing a short skirt, don't rape her.
if a woman is jogging in a park at 5 am, don't rape her.
if a woman looks like your ex-girlfriend you're still hung up on, don't rape her.
if a woman is asleep in her bed, don't rape her.
if a woman is asleep in your bed, don't rape her.
if a woman is doing her laundry, don't rape her.
if a woman is in a coma, don't rape her.
if a woman changes her mind in the middle of or about a particular activity, don't rape her.
if a woman has repeatedly refused a certain activity, don't rape her.

if a woman is not yet a woman, but a child, don't rape her.
if your girlfriend or wife is not in the mood, don't rape her.
if your step-daughter is watching tv, don't rape her.
if you break into a house and find a woman there, don't rape her.
if your friend thinks it's okay to rape someone, tell him it's not, and that he's not your friend.

if your "friend" tells you he raped someone, report him to the police.
if your frat-brother or another guy at the party tells you there's an unconscious woman upstairs and it's your turn, don't rape her, call the police and tell the guy he's a rapist.

tell your sons, god-sons, nephews, grandsons, sons of friends, daughters - tell everyone it's not okay to rape someone.

don't tell your women friends how to be safe and avoid rape.
don't imply that she could have avoided it if she'd only done/not done x.
don't imply that it's in any way her fault.
don't let silence imply agreement when someone tells you he "got some" with the drunk girl.
don't perpetuate a culture that tells you that you have no control over or responsibility for your actions. You can, too, help yourself.

If you agree, repost it. It's that important.

How Soon They Forget

2008-02-23T09:53:00.005-07:00

A certain person who shall remain unnamed but whom I happened to marry about ten years ago told me he had a picture of me and turned his laptop around to reveal this.

A couple of FACTS are called for here.

1. Hours after I am peacefully dreaming, this unnamed person is typically still on the internet.

2. My charms and beauty would have remained entirely unknown to him if it hadn't been for someone being wrong on...well it wasn't exactly the internet as we know it.

Before the world wide web, back in the mists of time, when dinosaurs roamed the earth there were scarcely known rooms called student computer labs, exclusively in the actual computer science building. There were computers there, unlike in dorms or libraries or apartments. And those computers could link to electronic bulletin boards through an ill defined process that non-computer people did not worry their little heads about. It came to pass that the university upgraded and would actually sell the monitor, keyboard and 300 baud modem to students. Amongst all the men buying them was the occasional nubile woman taking an assembly back to her apartment. There she could read intelligent and not-so -intelligent discourse on all manner of subjects, and give her own pithy responses.

In the course of time a misguided user named Skullhacker wrote a post so mind-numbingly ignorant that one such woman could not help correcting him. When she hit enter and returned to the forum, she found a remarkably similar response to Skullhacker. "What an intelligent person!" she thought, "I must high five them!" So she did. It emerged that this intelligent person was male. And lo, he did not ask her what color her panties were. This passed for gentlemanly behavior on what would become today's internet. So she continued X messaging him when she was online. Intellectually stimulating and amusing conversations followed, and those conversations became more stimulating over time.

A day came when the pair decided a telephone conversation would be enjoyable and smoother that X messaging. And lo, the man asked the woman if she was really over eighteen in a frightened and disapproving tone, the which concern pleased the woman and helped her believe that she was not speaking to a predator. And she offered to send a copy of her driver's license before they spoke again, and the gentleman said no, that was okay. The woman and the man continued their long distance telephone conversations, and there was much rejoicing in the AT&T billing department.

Time passed, and hesitant planning for a meeting in person ensued. The man was visiting friends up north over New Year's, and the woman was house sitting in a big city a few hours away. The woman made many dampened braids in her waist length golden hair, the better to lure the man when her hair was let down into a mass of waves. And it worked. And they attempted to get it on, but the friend's refrigerator made loud banging noises and they were afraid it would wake other people up, and they did not want an audience, and besides they were nervous.

And they traveled to the big city to house sit together, and life got better until Trent the Bondage Kitty made his appearance. And the big city was FUCKING COLD with temperatures below zero and famous winds. So they had little to do besides snuggle and make an occasional shivering one block journey to Boston Chicken for sustenance. And Boston Chicken turned out to be SO ROMANTIC!tm They decided that they were fond of each other in the face of glaring evidence that they were both already head over heels in love, in an attempt to be prudent and cautious.

They returned to their now lonely homes. They wrote and called. They visited when they could afford it. The man moved back north to be about eight hours away instead of 22. The woman moved to the big city to be about three hours away instead of eight. That year he came home with her for Christmas and her mother bestowed upon him a dowry of clothing, watches and a higher baud modem. Soon the man proposed on one knee under the fireworks. The woman danced around and said yes.

And ten years later all the man can do is mock the woman playfully for obsessing over the internet.

Bastard. :)

I love you Sweetie! Thanks for reminding me how we met.

Facelift

2008-02-18T17:42:00.001-07:00

I changed my template to a less stodgy appearance. I like elegance and all, but I also like fun and goofiness, so the polka dots seemed to fit. Hope you like it, I sure do!

Stomach Mutilation in Children

2008-02-17T12:02:00.002-07:00

Riolriri at She Dances On The Sand pleads to know if she is the only person opposed to bariatric surgery in children. This is my reply.

You are not alone.

I am uncomfortable with any cosmetic surgery in children who are not severely disfigured. I think surgeons should wait until teens are at least at the age of consent. I think ethical ones do.

When it comes down to it, though, other cosmetic surgeries are not as dangerous as bariatric surgery. They do not have a 2% perioperative mortality rate (within 30 days of surgery) 4.6% mortality within a year. They do not cause beri beri, with permanent neurological damage. They do not cause peripheral neuropathy. They do not limit the amount of fluid one can drink when exercising or feverish, promoting dehydration. They don't cause chronic vomiting and malabsorbtion of what does stay down.

These surgeries are extremely dangerous for even adults, but adults have a right to mutilate themselves if they want.

Parents should not have free reign to mutilate their children for the sake of appearance. Hell, I oppose circumcision on this ground. And circumcision doesn't cause devastating malnutrition which can stunt growth and result in lifelong neurological damage.

For details on the actual mortality risks of obesity as opposed to bariatric surgery, see this brilliant post from Sandy on Junkfood Science on the actual risks of dying from obesity.

Neat and Trim - an Improved Background & Goals

2008-02-11T17:31:00.000-07:00

My professor friend Chad gave me a great critique, and this is the result - much better!

“So you're the one with the human bites!” exclaimed the hospital orderly as he wheeled me to physical therapy. My social work career had just been severed as surely as the nerves in my partially detached finger. Like my finger, it healed and regained function with time.

I had chanced into social work on a paraprofessional level eight years before. A job sorting clothes for Goodwill Industries led to promotion when I excelled at supervising my disabled coworkers. Now a job coach, I trained, supervised and worked alongside people with developmental, physical and psychiatric disabilities in a community based vocational rehabilitation program. Vocational rehabilitation provided a good grounding in social work skills. I learned assessment techniques, wrote individual service plans, developed time management skills, supervised people in groups while focusing on their individual needs and goals, and adapted to a wide range of community settings.

Meanwhile, I faced my own challenges. My blue collar parents had never personally known anyone with a college degree and certainly never considered sending a girl to a university. My high school counselors were no more enthusiastic about helping blue collar girls go to college. However, the flood of university recruitment letters after my college board exams had their effect. I blossomed in the dorms, took upper division classes for fun, and flirted with theater before settling on psychology. Then the money ran out. I was determined to continue my education but I would not be eligible for financial aid based on my own income for five years. So like many others, I worked and watched my friends from high school have fun on campus and finish college.

At last my turn came, and I returned to my studies with focus and maturity. My first psychology advisor at the University of Iowa told me to quit school if I needed to work for a living because I couldn't do both well. I firmly believed I could prove him wrong. Serious illness in 1994 affected two grades, but I retook the classes and did well. During my senior year I took loans out, worked fewer hours, made the dean's list both semesters. Ten years after I had begun, I picked up my diploma at the post office and cried for joy in my freezing car.

Armed with my shiny new Bachelor of Science degree and Goodwill's 1996 Employee of the Year award, I became ambitious. In Chicago I found a job life coaching a man who had severe autism. Two weeks into the job I was preventing “Mr. B” from banging his head on the wall when he attacked, biting me all over and nearly taking off my right index finger. Six police finally restrained him, but not before one of them was also bitten. Following surgery and extensive physical therapy I prepared to enter the workforce again.

Injured and humbled, I needed a break from social work. I worked in construction, supervised scorers of standardized tests and chauffeured for a remarkable disability advocate. I got married, birthed twins and moved my family to Grand Rapids. After eighteen months as a stay at home mom, I longed for the comparative peace and low stress of social work. I had emotionally healed from the attack and decided I would give my career another try. Touchstone Innovare hired me in 2002 and I have worked there since.

My five years at Touchstone have widened my skills and perspective. We treat people with serious psychiatric illness and co-occurring substance abuse. The majority of my clients at Touchstone live in crushing poverty. Most are jobless, many are homeless and few have steady incomes or medical insurance. Ingenuity is needed to help fill needs for medication and housing when those resources are absent or pending. My intellect has been challenged as I apply current research in psychology to treatment. Successfully developing treatment plans with individuals requires creativity and the ability to integrate knowledge of psychiatric diseases with unique personal and environmental factors. Teamwork and constructive criticism are valued at Touchstone, and I have learned to consult with peers and supervisors regularly, improving my clinical judgment. Outreach to unengaged clients has honed my investigative and rapport-building skills.

I have established and maintained therapeutic rapport with hundreds of people with psychiatric disabilities, but I lack the necessary education to fulfill my career goals. A master's degree in social work from Grand Valley State University would give me the knowledge and credentials to practice social work at an advanced level. I could work intensively with women experiencing mental illness during pregnancy and postpartum. Poor women face challenges in getting adequate and humane psychiatric treatment and I would like to help solve that problem.

Grand Valley State University stands out as the best choice for me. It compares favorably to other programs in important ways. I would not need to move my family to another part of the country, find another job, and build a new network of supports to attend. Grand Valley has been highly recommended to me by coworkers who are alumni. The emphasis on social justice and diversity appeals to me because I share it. GVSU offers part time study completed during the day, which would allow me to spend more time with my family than a night program would.

The most compelling reason to choose GVSU is the chance to study with faculty members whose areas of expertise would be very helpful to me. Joan Borst could teach me much about addressing barriers to health care. Dianne Green-Smith's focus on family therapy, pregnancy and infant adoption dovetails with my interest in reproductive health. I find David Lehker's study of male parenting important because he could expand my knowledge of men's reproductive lives. Shelley Shuurman's work in parenting issues and advocacy could be valuable to me since I want to develop advocacy methods myself. No other MSW program I have considered can compare with Grand Valley State University in terms of professors who could foster my professional development.

I once thought that being bitten by a client would ruin my social work career. Time and a sincere dedication to helping others brought me the strength and courage to return to the work I love. Earning an MSW at Grand Valley State University would seal that choice and prepare me for advanced practice. I hope you will invite me into your department.

Background & Goals Grad Essay

2008-02-11T08:23:00.000-07:00

“So you're the one with the human bites!” exclaimed the hospital orderly as he wheeled me to physical therapy. My social work career had just been severed as surely as the nerves in my partially detached finger. Like my finger, it healed and regained function with time.

I had chanced into social work on a paraprofessional level eight years before. A job sorting clothes for Goodwill Industries led to promotion when I excelled at supervising my disabled coworkers. Now a job coach, I trained, supervised and worked alongside people with developmental, physical and psychiatric disabilities in a community based vocational rehabilitation program. In the 1980's sheltered workshops flourished and placing workers with disabilities at regular businesses radically challenged the status quo. I was proud to be one of the first job coaches in Iowa promoting diversity in the workplace and visibility of a stigmatized group. Vocational rehabilitation provided a good grounding in social work skills. I learned assessment techniques, wrote individual service plans, developed time management skills, supervised people in groups while focusing on their individual needs and goals, and adapted to a wide range of community settings. Early on I emphasized basic social skills such as saying “please” or “excuse me” and zipping one's own coat, since many of my employees had led isolated lives in institutions or at home before coming to Goodwill. Employed in teams at stores, hotels, factories and museums my workers approached jobs usually regarded as menial with dignity and enthusiasm.

Meanwhile, I faced my own challenges. My blue collar parents had never personally known anyone with a college degree and certainly never considered sending a girl to a university. My high school counselors were no more enthusiastic about helping blue collar girls go to college. However, the flood of university recruitment letters after my college board exams had their effect. My parents could only afford loans for three semesters, and I will always be grateful to them for financing those despite their doubts about the utility of college. I blossomed in the dorms, took upper division classes for fun, and flirted with theater before settling on psychology. Then the money ran out. I was determined to continue my education but I would not be eligible for financial aid based on my own income until age twenty four. So like many others, I worked and watched my friends from high school have fun on campus and finish college.

At last my turn came, and I returned to my studies with focus and maturity. My first psychology advisor at the University of Iowa told me to quit school if I needed to work for a living because I couldn't do both well. I had gained confidence as a social worker and firmly believed I could prove him wrong. I did encounter stumbling blocks as I worked up to 60 hours weekly and studied full time for six semesters. At the end of spring semester 1994 I fell ill and did not recover in time to finish two incompletes, resulting in F grades. I later retook the classes and did well. I believe that the lesson I learned about respecting my limits and overcoming mistakes taught me more about life success than passing would have. In addition, I only earned C's in classes that I would have sought tutoring in given time and money, which lowered my overall GPA to 3.11. In my psychology major I earned a 3.76 GPA. During my senior year I took loans out, worked fewer hours, made the dean's list both semesters and earned a 4.08 GPA in my final classes. Ten years after I had begun, I picked up my diploma at the post office and cried for joy in my freezing car.

Armed with my shiny new Bachelor of Science degree and Goodwill's 1996 Employee of the Year award, I became ambitious. I went to the big city and found a job working with a man who had severe autism living in a specialized group home. I said goodbye to good friends and Goodwill, and moved to Chicago. Two weeks into the job I was preventing “Mr. B” from banging his head on the wall when he attacked, biting me all over and nearly taking off my right index finger. Six police finally restrained him, but not before one of them was also bitten. Following surgery and extensive physical therapy I prepared to enter the workforce again.

Injured and humbled, I needed a break from social work. Several years passed. I worked in construction, supervised scorers of standardized tests and chauffeured for a remarkable disability advocate, keeping a foot in the door for social work by volunteering with her group of disabled teen girls, the Empowered Fe-Fes. I got married, birthed twins and moved my family to Grand Rapids. After eighteen months as a stay at home mom to infant twins, I longed for the comparative peace and low stress of social work. I had emotionally healed from the attack. I missed professional work and decided I would give my true career another try. Touchstone Innovare hired me in 2002 and I have worked there since.

My five years at Touchstone have widened my skills and perspective. Although the main focus is treating people with serious psychiatric illness, co-occurring substance abuse is common. The majority of my clients at Touchstone live in crushing poverty. Most are jobless, many are homeless and under half have steady incomes or medical insurance. Ingenuity is needed to help fill needs for medication and housing when those resources are absent or pending. My intellect has been challenged as I apply current research in psychology to treatment of individuals in an evidence based manner. Successfully developing treatment plans with individuals requires creativity and the ability to integrate knowledge of psychiatric diseases with unique personal and environmental factors. Electronic record keeping and resulting high standards have improved my documentation skills, allowing me to form thorough and accurate client files. Teamwork and constructive criticism are valued at Touchstone, and I have learned to consult with peers and supervisors regularly to my clients' benefit. I gained an awareness of my strengths and weaknesses which has promoted objectivity and successful treatment approaches. Outreach to unengaged clients has honed my investigative and rapport-building skills.

I have established and maintained therapeutic rapport with hundreds of people with psychiatric disabilities, but I lack the necessary education to fulfill my career goals. A master's degree in social work from Grand Valley State University would give me the knowledge and credentials to practice social work at an advanced level. This would afford an opportunity to work with women experiencing mental illness during pregnancy and postpartum. (See social justice essay.) Poor women face challenges in getting adequate and humane psychiatric treatment and I would like to help solve this problem. Completing graduate work at GVSU could enable me to pursue that goal through several possible avenues. It would allow me to address the problem individually by giving therapy to women in that situation. I could network with fellow students in the macro program and develop a community agency specializing in mental health services for women in their reproductive lives. Or I could pursue further academic work, earn a Ph.D. and research reproductive mental health needs on a state or national level.

Grand Valley State University stands out as the best choice for me. It compares favorably to other programs I have looked at in important ways. GVSU operates in and contributes extensively to my community through faculty activities and the education of new generations of social workers. I would not need to move my family to another part of the country, find another job, and build a new network of supports to attend,a major consideration. Grand Valley has been highly recommended to me by coworkers who are alumni. Your high quality social work program with an unapologetic emphasis on social justice and diversity appeals to me because I want to right inequality and prejudice to the best of my ability. GVSU offers part time study completed during the day, which would allow me to spend more time with my family than a night program would. Your program allows specialized micro study, allowing me to focus on the area where my personal skills fit best but maintain contact with peers with administrative talents.

The most compelling reason to choose GVSU is the chance to study with faculty members whose areas of expertise would be very helpful to me. Joan Borst could teach me much about addressing barriers to health care. Dianne Green-Smith's focus on family therapy, pregnancy and infant adoption dovetails with my interest in reproductive health. I find David Lehker's study of male parenting important because he could expand my knowledge of men's reproductive lives. Similarly, Shelley Shuurman's work in parenting issues and advocacy could be valuable to me since I want to develop advocacy methods myself. No other MSW program I have considered can compare with Grand Valley State University in terms of professors who could foster my development in my particular area of interest.

I once thought that being bitten by a client would ruin my social work career. Time and a sincere dedication to helping others brought me the strength and courage to return to the work I love. Earning an MSW at Grand Valley State University would seal that choice and prepare me for advanced practice. I hope you will invite me into your department.

Social Justice Essay for Grad Application

2008-02-11T08:16:00.000-07:00

An often overlooked issue of social justice is the disparity in treatment for psychosis during pregnancy between poor or underinsured women and middle class privately insured women. An impoverished, pregnant and actively psychotic woman is among society's most vulnerable citizens. Yet doctors often will not prescribe the same medications for potentially deadly psychosis that they give for inconvenient nausea in pregnancy. This leaves pregnant women committed in locked facilities for weeks or months untreated, fully psychotic and incapable of directing their own medical tereatment. Incarceration is not treatment.

Psychosis is the most severe form of mental illness, often robbing its sufferers of recognition that they are ill. 4-10% of psychotic patients commit suicide. Unmedicated pregnant psychotic women run four times the risk of psychiatric hospitalization as those who take antipsychotics. Hospitalized women have twice or more the rate of stillbirth, infant death, premature birth and low birth weight. Antipsychotics are proven safe throughout pregnancy; several are routinely used to treat nausea. Mood stabilizers are safe after the first trimester, and one is proven safe throughout. The fact that middle class women with private insurance are not routinely committed and left untreated indicates that the lack of treatment of impoverished women is a case of social injustice, not prudent medicine.

This travesty could end. Widespread advocacy and education on the safety of antipsychotics and risks of witholding them would protect doctors and benefit patients. Networking could link women with doctors who will prescribe medications during pregnancy. Volunteer medical guardians enforcing the treatment preferences of psychotic women incapable of consent could be provided. Universal health care could reduce discrimination based on insurance and give poor women access to doctors with ethical treatment standards. This would prevent a woman from being held in a locked unit rather than medically treated until she gives birth, simply because she is poor.

Time Flies. Also, Random Weather Thoughts.

2008-02-10T17:44:00.000-07:00

So apparently it's been almost three months of silence here. I have been binging on other people's blogs and ignoring my own. Maybe I should feel guilty, but I've lived with myself for a long time and have come to accept certain character flaws. :)

We've been having a lot of snow days here, and I'm hoping to have ANY vacation time left come April. There was a sixty car pile up in my state today, and the roads are packed snow frozen over with a layer of ice. It's very dangerous driving.

I watched most of a program on the Little Ice Age from the 14th to 19th centuries, and going over what happens with just a bit of a temperature drop (4 degrees F) makes me aware of the devastation a similar temperature rise could do. Massive drought for years on end, increased storms, killing off of staple crops. In the first part of the little ice age it rained virtually every day for five years straight in England. Many thousands of people died from starvation because it killed the grain crops they depended on.

That's one reason that I'm opposed to eating local. I don't care if sometimes people choose to do it, but I am concerned that Congress is considering making it a requirement for public schools. Being able to eat tomatoes in February is one of the marvels of modern living. If I were eating local, there basically wouldn't be vegetables after October and before June. How that's healthier is beyond me.

We need to join the rest of the world in the global effort to minimize damage to the ozone layer and prepare for global warming. I was neutral for some time but I'm convinced at this point that it is happening, though I'm not entirely convinced that we are causing it. The little ice age happened without human input. This is clearly a version of Pascal's wager, though. Even if we don't believe in global warming, the prudent course is to believe in it and behave as if it does exist.

Meme School _ Learning to add images

2007-11-17T17:43:00.000-07:00

Here's a popular meme in the fat rights community. The rules: Type the answer to the questions into google images and post your favorite from the first page.

1. Age at next birthday

2. A place you'd like to travel:

3. Your favorite place:

4. Your favorite objects:

5. Your favorite food: (This one's a tie)

6. Your favorite animals:

7. Your favorite color:

8. Town where you were born:

9. Town where you live:

10. Name of a past pet:

11. First name of a past love:

12. Best friend's nickname:

13. Your screen name/nickname:

14. Your first name:

15. Your middle name:

16. Your last name:

17. Bad habit of yours:

20. Your college major:

Response to the School's Draconian Drug & Alcohol Propaganda

2007-10-23T20:06:00.000-06:00

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

Okay, I'm a Tiny Bit Obssessive, Possible Final Draft: Please Give Feedback

2007-10-16T09:05:00.000-06:00

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.

Stll Rough, but Complete and Improving

2007-10-16T07:55:00.000-06:00

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.

Entrance Essay Part One

2007-10-13T18:02:00.000-06:00

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?

Losing My Facial Virginity

2007-10-09T17:30:00.000-06:00

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!

Wonderful News

2007-10-09T17:28:00.000-06:00

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.

A Letter to a Local DanceYoga Studio

2007-09-30T21:01:00.000-06:00

I was at the point of signing up my twins for the next available kids
yoga dance class. Fortunately, I looked at the general class calendar
and noted your hostility toward fat people before I made that mistake.
The suggestion that the point of exercise is to get rid of that "jelly
belly" or "lose that belly by belly dancing" rather than to increase
fitness is disturbing. You have assured me through your class
descriptions that my daughter would not be welcome in your classes.

Current nutrition and fitness research includes an approach known as
Health At Every Size (HAES). You might want to look into it if you
don't want to alienate potential customers.

Mary -------

Worry

2007-09-25T19:15:00.000-06:00

I am scared of what is happening to my body.

Of what is happening to me.

Despite getting up at 5:30 every other morning to work out, albeit at a pathetic half of my usual (is it really former already?) pace, I am making grocery decisions based on which store has the best motorized scooter carts. I'm in burning pain during workouts, exhausted afterward and sore the next day as if I'm pushing myself hard instead of slacking.

I'm getting tested for cancer and emphysema.

For months I've been struggling with thoughts that I am making a mountain out of a molehill and hence won't be believed. I'm over that now. There's really something wrong besides laziness or deconditioning or hypochondria. I wish I could go back to the comfort of doubting myself.

I Feel Pretty and Witty and Famous!

2007-08-29T15:55:00.000-06:00

Thanks to Susan Palwick for publishing Haunted and Ashamed in Grand Rounds this week, and to Sandy Szwarc for all of her praise and for linking Psyched Out from the best science blog I've ever read, Junkfood Science. I feel honored by their recognition, especially considering that I adore both of their blogs and read both every time they post.

UPDATE:

My stress test and a CT revealed no heart disease or cornonary artery disease. I do have a pulmonary nodule but after confirming that I have never smoked Dr. Godling seemed unworried and told me he'll be monitoring it every six months to be sure nothing's wrong, but they are usually benign. If he's not worried I'm not. I am upping my asthma meds and being scheduled to see a neurologist.

HIPAA Hoopla

2007-08-07T15:51:00.000-06:00

So someone at work anonymously posted the following NYT article
at work the other day, with pertinent sections highlighted. It addressed the culture of secrecy and frustration in the health care community since HIPAA has been ridiculously overinterpreted. This panic has been going on since about 2000. Even when it would benefit a patient, I can't talk to their relatives or partners who *regularly attend appointments with them* without a signed release "because of HIPAA." Check this out:

Hipaa was designed to allow Americans to take their health insurance coverage with them when they changed jobs, with provisions to keep medical information confidential. But new studies have found that some health care providers apply Hipaa regulations overzealously, leaving family members, caretakers, public health and law enforcement authorities stymied in their efforts to get information.

Experts say many providers do not understand the law, have not trained their staff members to apply it judiciously, or are fearful of the threat of fines and jail terms — although no penalty has been levied in four years.

Some reports blame the language of the law itself, which says health care providers may share information with others unless the patient objects, but does not require them to do so. Thus, disclosures are voluntary and health care providers are left with broad discretion.

The unnecessary secrecy is a “significant problem,” said Mark Rothstein, chairman of a privacy subcommittee that advises the Department of Health and Human Services, which administers Hipaa. “It’s drummed into them that there are rules they have to follow without any perspective,” he said about health care providers. “So, surprise, surprise, they approach it in a defensive, somewhat arbitrary and unreasonable way.”

I have believed what I've been told about HIPAA requirements, but apparently the extent of the law has been exaggerated. We take HIPAA privacy so far that we aren't even allowed to use full patient names in our internal emails to need to know staff. It's not like I'm going to argue with our corporate compliance officer, who can fire me. But it's good even in the abstract to know that the law isn't as short sighted and harmful as we've all been led to believe.

Why my doctor is a superhero. Nay, a godling!

2007-08-01T19:36:00.000-06:00

I was nervous all morning and downright anxious by the time I got to the office. Would my usually fat friendly doctor dismiss my problem as weight when my weight has been steady?

All the worry was in vain. Dr. A was his usual thoughtful, kind self. He listened to me seriously, thought, wrote out some referrals and explained that he was having me checked for heart trouble. Oh, and he tossed in a mammogram too because I'm forty now. Yippee. :/ So I got six tubes of blood and two xrays taken today and have appointments being made for me for the other tests. His description of the stress test relieved me somewhat because he said all they do is get your heart beating at a high rate and then you're done. He also said he had one and it was hard for him and everybody else he knew.

And then he said things no doctor has ever said before as far as I can tell from personal experience, media and the fatosphere.

"Weight is only a very minor risk factor for heart disease."

"Overweight people know they're overweight, why should I harp on it?"

" I only really address it with people when they are in immediate danger of dying. And there is only one disease that's true of, fatty liver disease."

"When I was just out of medical school I practiced with a doctor who didn't treat overweight people for their problems. He just said, 'You're fat. Lose weight.' That was so wrong."

So he officially No Ordinary Mortal. :)

Formerly Hidden Symptoms

2007-07-31T20:22:00.000-06:00

My DH helped me put together this list for the doctor tomorrow, in case I get too embarrassed to talk about my health issues. One of the things I'm doing to cope with my shame and embarrassment is to blog it and kind of out myself. The best cure for shame is sunlight, I've found. Hiding it makes shame stronger, exposing it shrinks it back to a manageable feeling. So here's what I'm ashamed of: 1. I have to pause during even fairly trivial exertion, like walking out to the car after shopping. 2. There is some shortness of breath with it, but nothing like asthma. 3. My stamina has gotten progressively worse since last year. I was working out at Curves for the past year and had to quit because I was able to do less and less. It's gotten so bad that I'm getting some sit down home exercise videos to keep working out at a level I can handle. 4. A similar thing afflicted mom at about the same age. It was never looked into or explained; she was diagnosed with COPD about 10-15 years later, but was never really treated for it. They sent her to some special COPD-oriented exercise classes, which helped a lot, but insurance wouldn't pay for it, and it was too expensive to continue. 5. It's all-over-body weakness: exhaustion affecting upper body as well as lower, torso as well as extremities, not a matter of just the muscles that were exercising. At time it is so bad that lying down would be better than sitting down for dealing with it. 6. But overall energy level isn't affected at all -- once rested, it's easy to get back to normal. Overall I feel energetic and healthy. 7. There is no *general* fatigue affecting all of life -- *only* with exertion. Not even a lasting fatigue from exertion; after a rest, everything is back to normal. 8. It's all about stamina. Now was that so bad to admit? :)

Haunted and Ashamed

2007-07-30T17:16:00.000-06:00

My mom's middle age overflowed with health issues dismissed as weight,and her death at age 63 was a result of one of them. I might write more about that in another post. Because my immediate concern is that history is repeating itself. When she was about 35, she started wearing out easily with minor exertion. She was increasingly slower and more out of breath doing everyday activities such as walking from the parking lot into a store. She was naturally told that it was because she was fat and dismissed. Like most fat women, mom was full of self hatred over her size. This went on for fifteen years until she had a stroke and was sent to specialists after recovering. One specialist noted her exhaustion upon exercise and diagnosed her with COPD, but DIDN'T TREAT HER FOR IT! He did refer her to exercise classes for people with similar symptoms, which she benefited from, but insurance stopped paying for it and it was about $400 per session. My parents could not afford it. So mom's condition was ultimately still ignored. Now at age 40 it is happening to me. It's actually been coming on for over a year but it's getting bad. I can barely stay on my feet for grocery shopping. I have to stop and rest, ideally sitting down, during a short walk of a block or two. I feel ninety years old. I actually had to stop my regular Curves workout because of the fatigue getting worse and worse. And it's bringing up fear and shame that I thought I'd overcome. I've scheduled an appointment with my fat friendly doctor about it. I'm petrified that he'll dismiss it as a weight problem. This is actually unlikely, but as much as I trust him there will likely be other fat hating medical staff involved if he sends me for some kind of workup. I feel humiliated at being such a stereotype of a fat person as doctors usually view us. I'm not sure I can stand the embarrassment of going through a stress test that I am sure to fail spectacularly. I am dreading the contempt of the testers as they view me as lazy and weak willed. It brings back all of the hatred of my gym teachers watching me struggle and fail to be athletic, and encouraging other kids to tease me while I tried my best. And of course the best possible outcome is that it really is my weight. Because the other things it could be are not pretty. So I fear either outcome. The only thing that is making me go through with it is paranoia. And the only fact I know about my mom's bio dad other than that he abandoned her as an infant is that he died of a heart attack in his fifties. Mom saw his obituary in the paper. So I'm facing my fears and seeing the doctor. The price is shame and embarrassment and the dread of humiliations to come. This despite my devoted fat acceptance activism and basic belief that my size is okay and not biologically subject to change. My family did not teach me to hate myself or put me on constant diets. I looked at magazines and in the mirror in seventh grade and decided with a shrug that the beauty rules did not apply to me, so I focused on things I could control like my education and music. So I'm even feeling ashamed of my shame. I don't know what to do with all of this emotion, but I thought people might be interested how quickly my fat acceptance falters when I am faced with the hatred promoted by the "obesity epidemic" warriors.

Decloaking

2007-07-30T15:36:00.000-06:00

I started this as an anonymous blog, but I haven't really written anything requiring that anonymity. So I'm putting myself out there. Rather than freeing me to post whatever I wanted, the anonymity focused my blog too narrowly and made me reluctant to write about some of the things I care about. I didn't want to risk blowing my cover. Which made my posts infrequent and cautious. That's about to change.

I'm a dedicated social worker, but there's more to me than my job. I've decided to add my voice to the fatosphere, for one thing. There are few enough of us as it is. So this is officially a fat acceptance and health at every size (HAES) blog now. And I have deeply held moral and political convictions that I would like to write about. I've expressed some of them rather indirectly as they apply to work, but that's not the same as a straightforward political post.

Thanks to those of you who have read my blog even when I was slacking, your comments have meant a lot to me.

Antisocial Blues

2007-06-03T15:43:00.000-06:00

So, one of my best friends at work is truly talented at working with antisocial patients, and therefore has a large number on her caseload because this is a rare talent. They've actually started purposely giving her almost all patients like this because she's so good. Because she's one of my best friends at work, she is always swinging by and saying, "By the way, Mr. L needs some help from you."

Now, I am NOT gifted with antisocial people. I was abused by someone that I suspect was antisocial, though she never encountered the mental health system. So I have poor boundaries with them that I have to watch carefully. They kind of intimidate me and when they say jump it's hard for me to react appropriately instead of responding, "how high?" Even when I'm maintaining boundaries, though, antisocial people just irritate me. It's the lies that get to me. They tend to lie incessantly and badly. Not even badly as much as indifferently. They just don't care enough to come up with plausible lies. And nothing is ever their fault or responsibility. So they expect you to do everything for them instead of putting forth some personal effort. And when you don't give special service, they threaten you. They sometimes, but definitely not always, have a charming facade that immediately disappears when things stop going their way.

I'm sure I'm stereotyping antisocial people here and some are not like this, but I tend to call em like I see em.

The Thirteenth Tale

2007-05-19T15:37:00.000-06:00

I loved it, captivating prose and a rollicking gothic plot. It was largely about the love of reading itself and what it means to be a reader. One of the best things about eighteenth and nineteenth century novels is that in addition to the plot working itself out there is usually an accompanying examination of the human condition. _Pride and Prejudice_ examines personal honor. _Jane Eyre_ examines the line between originality and insanity. _The Idiot_ examines humanity and divinity. This novel has that quality. If you want to read a contemporary author who resembles older writers, Diane Setterfield is your woman.

I'm joining a book club this week, and I had never heard of _The Thirteenth Tale_ because I'm very ignorant about contemporary writers. I know there ARE writers now who are every bit as good as Jane Austen or George Eliot, I just don't know who they are or how to find out about them. So I'm joining a pair of book clubs.

In addition to the introduction to contemporary authors the clubs will provide, joining will revive two aspects of MY life that have lain dormant for about seven years. As you can imagine, baby and toddler and preschool twins take up a lot of time. They are time vampires. I'm only just beginning to have time to read again. Also, the move to Michigan means I have no friends who are mine alone. My husband's friends are wonderful people and I love them, but none of them is a friend that I made on my own. I'm hoping to become friends with some of my book club peers. Even if that doesn't happen, I will at least be socializing with people who have a common interest, which is no bad thing.

The Full Forty

2007-05-19T15:18:00.000-06:00

So this week I started working full time again. My body is unhappy with getting up hours before the usual time, but not as unhappy as I'd dreaded. This week I have been going to bed mostly on time. Except when I was reading _The Thirteenth Tale_ and I could barely pull myself away. More about that in the next post.

I had some concern that I wouldn't have enough to do to fill forty hours a week. I had forgotten how much busier mornings are than afternoons. In addition, people who were not giving me afternoon work before are now doing it because I'm more likely to be able to schedule something at six hours' notice than at one hour's notice. With a whole day available it is much simpler to fit things in, because many tasks are flexible in their timing.

But the highlight of the week was puking in a patient's yard while helping her pack for inpatient care. I have never puked outdoors before, because I don't get alcohol poisoning now and didn't get it in college either. Since I was not intoxicated, I was aware of the social milieu and therefore profoundly embarrassed. To use a social work word, it was "inappropriate." The patient was so nice about it that I was doubly ashamed of myself. She said something about rain being in the forecast and being sure it would be gone by the time she got home. Isn't it funny how some people while ill are gracious even when they feel irritable, and some people are uncivil when they are at the height of health?

True Beauty

2007-05-10T17:58:00.000-06:00

My twins brought Mother's Day presents home from school today. This is the first time since they are in kindergarten this year. The gifts were in white lunch bags with flowers drawn on them and attached was a list of words and phrases they wrote about me.

My daughter's says "MOM: Mom love me, hug,kiss me, lic me, MOM." I am not sure if she meant like or lick by "lic", but this is a disclaimer that I do not lick my children on a regular basis. Occasionally we play puppies and there is a positive history of licking involved, I admit. I have no dignity while playing. My son's says, "MOM: loves me, soft, happ, lisins, MOM." Notice the adorable use of the double p in place of a y.

Inside were cardboard picture frames with bean seeds pasted on (they are growing beans at school) and pictures of the kids in them. And chunky handmade bowls about the diameter of a pop can. They have all kinds of plans for what I am to put in these bowls, and they're so proud of their work in making them.

I have never seen works of art so beautiful to my heart.

Scary or Violent

2007-05-09T16:19:00.000-06:00

Kim commented on the post Bounty Hunting asking if I run into scary or violent situations as a psychiatric social worker. I encounter scary situations from fairly often, but violent situations much less frequently. The neighborhoods I go to are often violent ones, but by avoiding after school hours, not making eye contact and so on I manage. If I'm really uncomfortable with where I'm going or who I'm seeing, I find someone else to go with me, and I always carry my phone. The social workers who end up dead usually work for Child Protective Services. After all, the adults they encounter are usually violent against children in the first place. And people get very angry and very dangerous over custody issues.

I'd like to emphasize that although people with paranoia can become violent, they are more often too terrified of other people even to defend themselves properly from the violence they encounter (on the streets when homeless, for example). Usually if I go out "bounty hunting" and a person is paranoid they hide and don't answer the door. And those people who are having violent or homicidal inclinations are typically not directing them at social workers. Usually their feelings are focused on individuals who play a bigger role in their lives. People with violent ideation are generally hospitalized rapidly before things get out of hand. Even patients who are potentially violent most often have disorganized thinking too severe to plan and carry out crimes. Not every violent person with a mental illness commits violence due to their illness, but that is another post for another time.

The time I encounter violent tendencies is when I am assessing someone for hospitalization, and we do that in pairs if a person has any assaultive history. I've encountered a fist raised at me, a person advancing on me looking dangerous and talked people down from homicide while other staff kept watch on me. But typically I get what I need for a petition (for involuntary hospitalization) before things get actually risky. The law has protections for patients in case we make a mistake in assessing someone's risk level. Every petitioned patient has a hearing where staff have to prove to a judge that the person really needs to be in a locked psychiatric unit.

When in treatment, mentally ill people are not more violent than the general population. Of course you can't force medication into a patient's body against their will unless they are court ordered for hospitalization. My agency can only put people back in the hospital, we ourselves can't compel treatment. Outpatient people can always refuse.

The only time I was actually attacked involved an autistic adult, not a mentally ill person. That was bad. He bit through the nerves of one finger but didn't manage to sever it, and I got bites over my scalp, hands and chest. My hand with the bitten finger grew to about double its size with infection and I had to have surgery to save the hand. Human bites are much worse than animal bites, all the nurses and doctors assured me. I was something of a hospital superstar. Random staff would encounter me and say, "So you're the one with the HUMAN BITES, huh? How did that happen?" It happened while with another staff I was trying to cushion his head from banging against the wall, and being autistic once he started biting he couldn't stop. The other staff person locked me in the room with him while she called 911, which didn't help. Fifteen years with mentally ill people, no problem. One month with an autistic adult - BAM! I'm sure most autistic adults are safe as well, this is just my experience.

18 Hour Graffiti

2007-05-05T21:25:00.000-06:00

Thing One has been at work interior decorating for us again. I noticed that our printer has been written on in red eighteen hour lipstick. You know, the kind that is more or less a dye for your lips. I know it is Thing One, despite Thing Two's name being the content of the graffiti, because Thing One has a record of being devious. She has actually left notes stating, "Thing Two Did This" on some of her more creative enterprises. Sadly for her, she leaves a trail of evidence during her shady pursuits. That, and Thing Two is something of a tattler. A very happy tattler with endless opportunities to tattle because his sister is mischievous. We're hoping that these outlaw activities are an early sign of scientific genius or something, pathetic as that is. And maybe Thing Two will be an intrepid reporter. Maybe.

Anyway, if anyone out there knows of a good makeup remover that is printer safe and effective on eighteen hour lipstick, please put it in the comments. I always just let ithe lipstick wear off.

Decisions, Decisions

2007-05-03T18:06:00.000-06:00

Today I was pulled aside by the head of HR and given a choice of continuing to work part time in an administrative position and working full time in my current position. They are eliminating the part time position I work in so as to concentrate the hours now worked by various people into one full time position. I've liked working part time since last October, when I was offered this position. I've been able to spend time with my kids in the morning before their afternoon kindergarten starts.

The part time administrative position would be at the same wage, and would still include client contact as I would be helping people sign up for benefits. But it just wouldn't be the same as real clinical contact. And I'm fairly sure I'd dislike it. I don't especially enjoy filling out forms or playing phone tag with hostile Medicaid and SSDI bureaucrats. I don't want to BE a bureaucrat.

I love Love LOVE my current job, generally helping out and finding people who need treatment but aren't coming in. It's clinical without having the quadrupled work load that the case management job acquired last fall. I don't have a case load. I might have to borrow one if somebody goes on maternity or disability leave, but it wouldn't stay mine for more than a couple of months at the outside.

This offer has made me realize just how much I value the job I'm doing now. Enough to go back to full time.

Double Standards For Not Working

2007-05-01T18:38:00.000-06:00

So I have two neighbors who for different reasons invoke a social work reaction outside of my job.

One is, as far as I can judge with a practiced eye, involved in substance abuse of unknown breadth. He came to our door at 3 AM recently and told a spectacular, rambling and obvious lie in order to get beer money. He certainly has issues with alcohol, and let's just say his parties draw a crowd that is kinda questionable. Last summer someone at one of his parties shat a gun at someone else right outside our house. No, actually he shOt a gun, but the typo gave me such a vivid and hilarious mental image that I decided to share. Anyhow, we have not been accustomed to gunfire in our neighborhood and don't want to become accustomed to it.

The other has been struggling with debilitating muscle atrophy for over a year and has recently been diagnosed with ALS (Lou Gherig Disease), which I would not wish on my worst enemy, let alone my lovable and kind neighbor. Through the past year she has gradually lost strength and function, but she has never asked for help. When I found out, I spent a whole day scouring the internet for resources she could use and passed them on immediately. She is self employed and has no insurance, and the only drug to treat ALS is $1000 a month. I looked for patient assistance programs, but found none. ALS is an "orphan" disease and the medication is therefore expensive because few people need it.

The point is that I get impatient and dismissive with neighbor #1, but I'm willing to spend half my weekend helping neighbor #2. I genuinely believe that substance abuse is a medically treatable and blameless condition, which causes much suffering for users and their families. I treat people with substance abuse all the time at work. Yet in my personal life I am biased, it appears. I'm more willing to help the sick neighbor I like better. I wonder if this off the clock double standard is a luxury that I should even permit myself. I have always prided myself in being able to separate home from work, to give myself the mental rest that helps me face the work week. Why am I now making an exception?

Bounty Hunting

2007-04-30T20:18:00.000-06:00

Today is the last day of the month, which for yours truly means a frantic last ditch attempt to see our psychiatric patients who are missing in action. Either because they are very ill and have lost contact, very well and have blown us off, living in a different place now while not seeking treatment or simply uninterested. I try to see these people throughout the month, it's one of my main duties. So Last Day MIA's are the hardest to find, and I often spend the day in a very sad state of working hard while getting nothing accomplished. (MIA is NOT what we actually say, we have a convoluted and politically correct phrase in real life.) True, each try counts as an attempt to make contact and makes our Community Mental Health (CMH) happier if they read the records, but ideally I actually treat the people so we actually get paid. With CMH, these attempts are required weekly but not paid - only direct time is billable. One of my coworkers compared us to Dog the Bounty Hunter with substantial accuracy.

Naturally, I can't tell anyone (other than the patient) who answers the door where I'm from, since that would break confidentiality by revealing where the person was getting treatment from, or in this case not seeking treatment from. Now, these are poor people who usually live in neighborhoods where my white middle classness is out of place. People are suspicious of me, expecting that I am serving legal papers or selling something or asking for political contributions. So roommates and family members are not amused or willing to tell their mentally ill associate that I am there without a darn good reason which I cannot give. Even if I know the patient has signed releases to various people, I can't tell who they are when they answer the door unless they tell me their name, which virtually never happens. In any case, MIA patients tend not to have releases to anyone because of social isolation and/or an unwillingness to designate their roommate at the crack house as a participant in their treatment.

Worst of all are the people who you KNOW aren't there anymore, but you have to continue going to their (former) house weekly until CMH decides not to reauthorize them anymore, which can take up to a year. This is a total waste of time that we are not even paid for and which takes time away from people who are actually living where they say they do and needing treatment.

Bounty hunters don't have to do that. Maybe I should change careers. I bet bounty hunting pays more than social work, too!

For Profit Healthcare and Patient Needs

2007-04-29T18:10:00.000-06:00

I recently read about ultra luxury psychiatric retreats that cost over a thousand dollars a day and treat people with anxiety and depressive disorders for longer than a few days. One opinion in the post was that anyone who could be trusted with a phone cord in their room should not be inpatient, let alone staying for a week or two. People staying there were characterized as the "worried well", not people whose genuine psychiatric problems we should take seriously. The argument implied was that this is beyond the standard of care in public hospitals billing insurance, and that was a bad thing. As a mental health professional and a psychiatric patient who needs inpatient care at times, I'm not so sure.

Surely these "retreats" are private pay, profit based organizations of the most obvious kind. But at least they deliver quality care to those who can afford it. Full hour sessions with psychiatrists. Occupational therapy. Group therapy. Relaxation exercises based on Eastern practices (which I take to mean yoga and meditation). Time to form therapeutic rapport with staff treating you. Time for medications to start working. Reasonable assurance that your roommate is not a former murderer who will attempt or carry out murder on you during your stay. (Based on a True Story from my years as a social worker.) Adequate staffing at all, for that matter. Finally, time to stay while you sort out your immediate crisis and transition from crisis to a period when you can plan your life with clarity.

That's an excellent standard of care, compared to the typical level paid for by insurance at the average psychiatric unit. There, you may see your psychiatrist five minutes a day. Nurse staffing is skeletal, and there is nobody to interact meaningfully with as the need arises. Except other patients, which has some benefit but also evident drawbacks, such as other patients not being psychiatric professionals most of the time. Stays limited to two or three days if you are not psychotic, although antipsychotic medications kick in weeks faster than depression and anxiety medications. No real treatment on weekends. And that potentially deadly roommate who does not get one on one staffing.

And where did that low standard of care come from? For-profit hospitals and insurance carriers, of course. They don't pay or charge as much as the retreats, but managed care and profit seeking hospitals have sheared the quality of care away. This happens on medical units too. Just consider the isolated frail elderly person getting outpatient surgery when it is known that there will be nobody to care for them at home. Insurers do not even provide parity coverage for mental health treatment, which increases the problem. So the standard step down units of fifteen years ago that provided separate levels of care for critically ill/dangerous patients and patients transitioning from crisis to outpatient care are gone. Staffing is pared to a minimum to cut costs. Psychiatrist time is deemed too expensive for patients to do any meaningful work or understand their medications. Admission criteria ban the seriously but not dangerously mentally ill from inpatient care entirely, as if there can be no benefit to inpatient treatment beyond incarceration. Since the for profit health care trend began twenty years ago, the quality of all patient care has taken a nosedive. Due to non-parity, psychiatric patients are hit hardest of all.

I Second That Emotion

2007-01-13T18:31:00.000-07:00

Last week work was marked by two emotional events.

The first was a mix of impatience, shame and boredom brought about by "team building exercises." Apparently playing the sort of games usually confined to parties, especially showers, builds teams in some managerial minds. They involved standing up while connected, hula hoops, little cardboard rafts the size of trade paperbacks, being TIED UP and blindfolds. I wouldn't have been surprised if "toilet paper brides" had been on the agenda. I blew out my right knee dancing during college, so I had to sit out several of the more physically challenging ones, thank God. Anyway, I suppose much of it was fun, but we all have work to do to meet impossible standards set by the people who sent us to play games. It was not all fun, though. First, sitting out reminded me of not being picked for teams in gym, which is not a place I yearn to revisit. Second, some of the games required uncomfortable close physical proximity. I'm not shy about touching, but that wasn't the problem. The problem was other people being forced to touch me when they would never choose to do so if permitted a choice. You see, I'm fat. Not "Oh Rubens would have painted you and considered you a perfect beauty." Not big boned or stocky or plump. I am Venus of Willendorf fat. And inevitably, given our culture's obsession with fat people as evil and ugly and unhealthy and disgusting, there were people who would not touch me and looked nauseated at the very thought. I was tied to one of these people for about twenty minutes. They leaned away from me and wouldn't make eye contact. It was the worst humiliation I have felt in a long time. Let me make it clear that I bathed and deoderized and perfumed lightly immediately before coming in. And brushed my teeth. I do not smell bad, and most people grabbed on and held tight when the games called for it with entirely positive vibes. I come by my weight not through excessive eating, but by heritage. My farmer great grandmothers in photographs appear fat and healthy from the hard physical labor they performed about eighteen hours a day for their entire lives. I am virtually never ashamed of my body, but I felt burning shame that day. Even though there is nothing to be ashamed of. Even though weight is more heritable than height (.80 correlation vs .70 among identical twins reared apart). Even though the softness of my body is a delight to most who have touched it, and I am beloved not despite but partly because of my body. I felt the shame and humiliation and embarrassment about my very self that white privilege usually shields me from. The war on obesity is too much waged as a war on fat people, and discrimination is ugly in any form. But I will not be ashamed of my shame, because that would deny just what my status is in this culture. As a fat activist, I need to point out that pariah effect and fight its causes. The snapshot of fat hatred I got shook me pretty badly though.

The second emotion was terror. I go about my job usually in blithe oblivion to the risks, which I am so used to that I take them for granted. Once I observed to Dear Husband that I would never, ever want to work with electrical wires, because it is too dangerous. His reaction was that most people would be scared to work with actively homicidal people on a regular if infrequent basis. Mentally ill people are no more violent than the general population when they are in treatment. But of course my job often involves people who have stopped treatment because of medication side effects or poverty or simple disbelief that they are ill and not really persecuted. I've treated violent, even homicidal, patients from time to time when they are actively coming into the agency. However, much the more frequent case involves going out to find and reach out to people who haven't come in or called or let us know if they're alive for a certain period of time. I've talked about the dangers of poverty in this population before, and one of the most pronounced dangers is that they cannot afford housing outside of extremely dangerous neighborhoods. Mostly if you keep to yourself and avoid eye contact you are not bothered by the often intoxicated and angry neighbors. Still, going into an apparently abandoned house in these neighborhoods you know what you could be up against, even if it doesn't come to your consciousness at the time. Picture standing in front of a dilapidated two flat with a "For Rent" sign and a slightly ajar outer door. Suddenly while climbing a pitch dark rickety, steep stair case with no banister, I felt blinding panic and realized I could die in this place in this instant if someone answered the door and gave me even a nudge. It was pure terror, and after knocking once I could not help running down the steps, out of the house and back to my car. I jumped in, and I believe I did not actually peal off, but that might not be true.

Happy About The New Year

2007-01-02T20:42:00.000-07:00

Maybe I'm not so much happy about 2007 as relieved that 2006 is over. Last January my husband was so ill with depression he needed partial hospitalization, and one of the heads of his company essentially threatened to fire him when I wouldn't give medical details over the phone.

Literally the day after DH got out of the hospital program, my mom went to the ICU in my home state because she could not breathe. She refused intubation, but when she fell unconscious from oxygen deprivation my father had her intubated. I rushed home because she was dying. She made it through but did not improve, and eventually she went to a university hospital where she was diagnosed with a 1 in 3 million disease. She was sedated all this time due to her intubation. When she finally woke up, she had a trache and was still on a ventilator. I made the seven hour drive every weekend that I could, taking a lot of time off work. All the stress triggered some depression and I became less functional. After months of chemotherapy and intensive care, my mom recovered from the initial illness fairly well but was left paralyzed from muscle atrophy. Her breathing remained touchy. She was released to a nursing home for rehab a little too early, and died that night after her long and brave struggle.

My best friends from another town were there for me at the funeral. One of them said, "The reward for a job well done is a harder job after this life." Five weeks later he died while on his dream vacation with his wife, leaving behind a teenaged son and his disabled wife, both of whom I'm extremely close to. Another funeral and more trips to the home state to comfort them. And this happened while I was on leave for depression already.

After enormous job stress I decided to quit my job, but backed out at the last minute despite a quadrupled work load. I tried my best to meet the new expectations. And I did meet most of them, by working a lot of overtime and falling behind on paperwork. Then I got suspended because my license lapsed when my mom was dying and I didn't notice. The relief was enormous and some of my psychiatric issues resolved, but I returned to work after I renewed my license. Then one day it was just too much and I resigned. The head of HR persuaded me to go on indefinite leave instead, and I was called back after a week for a part time position without a caseload. This luck lasted about six weeks, then the job requirements were changed so that I'll have to carry a full caseload if anyone goes on leave for longer than a short specified time. Mind you, I'll only have half the hours to manage the caseload. Argh.

Well, I'll cross that bridge when I come to it, but generally speaking I'm welcoming the new year with open arms. I pray that it will not be as eventful as 2006.

Christmas Meme

2006-12-19T18:18:00.000-07:00

I took up the Emergiblog challenge on this meme.

1. Hot Chocolate or Egg Nog? Hot chocolate all the way. And we're not talking instant either. Preferably with steamed milk and plenty of peppermint flavor and real whipped cream. I once bought a boyfriend an espresso maker for Christmas so I'd be able to steam my own milk.

2. Does Santa wrap presents or just sit them under the tree? Due to having twins, previous years are a little hazy, but this year Santa is wrapping in special Santa only wrapping paper.

3. Colored lights on tree/house or white? White lights are solemnly beautiful, colored lights are festive. Both.

4. Do you hang mistletoe? I already get all the kisses I want. :)

5. When do you put your decorations up? Usually a week or two past Thanksgiving. Thing 1 was the Decorations Dictator this year, Thing 2 played a video game most of the time.

6. What is your favorite holiday dish? Homemade sage stuffing. In the bird, even better. My father (Yes dad, I'm talking about you!) in his later years has developed a paranoid belief that stuffing from the bird is dangerous due to reports a few years back recommending that you take the stuffing out to store it. So I make a pan for him and enjoy mine despite dire warnings and shakings of the head.

7. Favorite Holiday memory? Singing Christmas carols, especially carolling in neighborhoods and nursing homes. I also love gathering with my husband's musical family and singing them in the living room until we run out of songs to sing.

8. When and how did you learn the truth about Santa? I was in second grade, and I was pissed about being lied to all that time. I was the oldest, and my parents ensured my silence on the subject thusly: "Ever notice how the Santa presents are the BEST presents? Well, if the boys didn't believe in Santa, those presents might disappear every year. We're sure you'll make the right decision on whether to tell your brothers, dear."

9. Do you open a gift on Christmas Eve? No, but we bake cookies to give to Santa.

10. How do you decorate your Christmas Tree? Colered lights and white lights. Break proof ornaments until the twins are a little older. Pine cones and wooden stars, gold angels and bright red mini gift boxes. A strand of gold beads and those floss covered ornaments in primary colors plus some beautiful purple ones that look glass but aren't. Candy canes hangind on branches. I grab one and eat it once in awhile, nobody else in the house likes them.

11. Snow! Love it or Dread it? Love snow, hate bitter cold.

12. Can you ice skate? *rolls on floor laughing* That would be a no.

13. Do you remember your favorite gift? Tobor - a little walking robot (and yes, you did just notice that Tobor is Robot spelled backwards) as I'm something of a technophile. My mom gave up on dolls and got me the robot that year. The previous year I had asked for a really-crawls doll to mom's delight. Unfortunately, it was soon evident that I wanted to open her up and find out how she crawled. Very disillusioning for mom, I'm sure.

14. What’s the most important thing? Celebrating the birth of Jesus. Being a birth junkie only adds to my enjoyment of this holiday. Also honoring my mom's memory as this is our first Christmas since she died.

15. What is your favorite Holiday Dessert? Pumpkin pie with real whipped cream, tied with Spritz cookies.

16. What is your favorite holiday tradition? Blueberry muffins on Christmas morning - but after the presents to be merciful to the children who woke up at 5 AM wanting to open them.

17. What tops your tree? The most vulgar, gaudy light up star with colored light in the center and white on the outside you can imagine. I love my dignified gold star, but there is nothing more gloriously beautiful to five year olds than our "church window" light up star.

18. Which do you prefer giving or Receiving? Giving! These Santa years are fun and we tend to splurge on the kids and put our gifts on the back burner for now.

19. What is your favorite Christmas Song? Longest duration - Oh Come All Ye Faithful. As a child I had a wind up angel that played it. Current favorite - A Virgin Most Pure. Favorite to sing to the kids - The Friendly Beasts. But I have at least twenty that I love pretty equally. I'm way into traditional Christmas music.

20. Candy canes, Yuck or Yum? Passion sums it up nicely. I still long for the inch diameter foot long ones I had as a preteen. I would feel silly buying one as an adult, although I gues I could pass it off as a parent thing. Hmmm...

Christmas Song Meme

2006-12-03T20:06:00.000-07:00

Got this one from Fat Doctor, who tagged everyone reading her blog. My top five Christmas songs, in no particular order:

Wexford Carol
The First Noel
A Virgin Most Pure
O Come All Ye Faithful
Silent Night

I'm also fond of other non-standard Christmas carols such as Watts Cradle Song, Tomorrow Shall Be My Dancing Day and the Cherry Tree Carol. It's hard to pick just five top ones, because I have a very steady affection for so many. Maybe I'll share more lyrics as the season continues.

Anyway, consider yourself tagged if you have a blog and haven't done this one yet.

Staying In Bed

2006-11-29T16:59:00.000-07:00

It turns out that part of staying in bed and feeling like I couldn't face anything Sunday was a virus. I threw up multiple times at work the next day and went home early. I was hoping that feeling physically better would put the whole thing behind me. I woke up today feeling better from the virus but still depressed. It's so overwhelming, the inertia that I experience at these times. I just lay there. I know it's not healthy, I know the best thing is to crawl out from under the covers and face the perfectly unspectacular and easy day. And it's not at all like I usually feel when I don't want to get out of bed. I have my too late nights like anyone else where I regret watching the huge tumor removal program all the way to the end. When I'm depressed I tend to wake up completely before the usual time. Then I lay there feeling helpless and weak and stupid. After all these years. After all of my professional experience. Despite every positive thing in my wonderful life. None of it matters when the feelings come roaring back like a waterfall I'm plunging over. It's so impersonal, it has nothing to do with my circumstances, it's not connected to my life. When the depression really hits cognitive behavioral therapy (CBT) stops working. It has what I believe to be a fundamental flaw: the assumption that depressed feelings arise solely from deep seated but erroneous beliefs or thought patterns. I experience depression as a wave of negative emotions and physical symptoms that can cause superficial negative thoughts. I don't think that I'm a bad or weak or helpless person at all. I have too much experience with this illness to let it interfere with my deep seated thought patterns. I just feel bad and weak and helpless while knowing that those things are untrue. It's definitely the feeling affecting my thoughts, and not the other way around. CBT has done a lot for me in the past when I was learning to cope with actual wrong beliefs (example: "if I feel bad then I am bad"), but it has had reduced effectiveness as I have grown more skilled and knowledgeable. CBT does not address the physical and emotional side of depression well. If its premise that thoughts cause mood and not the other way around, once learned it would prevent recurrance of depression, which it most definitely does not.

Did I mention that depression makes you self centered? It does. As soon as I muddle through this bout I'll return to more interesting subjects, I promise.

Depression

2006-11-26T14:18:00.000-07:00

So apparently it's not bright to taper down on psych meds a few weeks before Thanksgiving when your mom and one of your best friends died this year. Come all ye young ladies take warning by me, and all that. I barely made it out of bed by three today. Some of it was sleep, but lots of it was just being stuck there too scared to face life. Did I mention that depression sucks and I HATE it. In the abstract it's good because it helps me understand the people I work with a little better, it makes me able to say hey, I've been in the psych hospital too and I know how it is. Hidden fact of psych hospitals - they are meat markets. Of all the wrong places to be lookin' for love, you would think this one would be obvious. But people have a deep need for understanding and affection that transcends logical thought, I guess. And you're usually not at your most sensible while on the unit anyway. Anyway, after several decades of dealing with depression I know how to handle it, it never really gets better when I'm having it.

Dilemma Part I

2006-11-19T12:29:00.000-07:00

I've recently cut back to part time at work both to spend this last year of extra time with my twins, and to enable me to go back to school. I'm torn between getting an advanced degree in social work and going into nursing. This post and the next will explore the options.

If I go for social work I could do research on the needs of women with mental illness who are pregnant. The undertreatment of pregnant women can be shocking. OBs don't want to treat them because they are mentally ill, and psychiatrists don't want to treat them because they're pregnant. Women here are locked up for months with no psychiatric treatment until they have babies. Now, I don't mean any disrespect to women who choose that route with their private pay insurance and chosen physicians. Some psychiatric medications certainly have proven adverse effects on unborn children, such as neural tube defects and cleft palate, because some are class X. An insightful and educated woman with the advice of her doctor might well forego them. I'm concerned about often indigent women who have limited choices in doctors and treatment centers and little insight into their mental illness. They don't get second opinions. They don't get doctors who know them personally and are in any position to advocate for them. I don't blame this on physicians at all, I'm aware of the vastly different working conditions and institutional rules they are subject to. And doctors who do advocate treatment are bucking the system at great risk. I'm primarily concerned about the trend to prescribe class B and C medications for non-lethal conditions which are not psychiatric, but not for non-lethal psychiatric conditions. Hay fever should be treated, but schizophrenia is too mild?! What about of giving them Clozaril (B) or Haldol (C) instead of locking them up? After all, we could lock up women to keep them away from allergens. But we don't. Because we respect that they deserve treatment for their legitimate illness. Maybe if I could do research on outcomes women with severe mental illness will be treated more humanely.

Holiday Leave Reversal

2006-11-17T16:40:00.000-07:00

Our supervisor announced that the holiday staffing level has gone back to 50% now. It turns out that the other team's supervisor had been granting half level staffing all along. So I'm glad to say it was just a mistake. This supervisor has only been in her position for two weeks, so she deserves the benefit of the doubt. I have never wanted to supervise people, even though I've done it in the past. Simple mistakes can generate so much trouble. And you can't avoid people you don't like if you're supervising them. I do clinical work with people I don't like all the time, of course. I treat child molesters and psychopaths, after all. And I'm totally willing in that clinical setting to put aside my dislike and provide the best care possible. That's not personal, and my job isn't to like people. It is to provide a steady stream of agape to them and allow them to work on their skills and self-knowledge. I suppose the same is true of a regular supervisor, I just don't like it as much.

Aaargh!

2006-11-16T20:41:00.000-07:00

Thing Two takes his vitamin religiously every night. He will even remind us to give it if we forget. So far, so good. Thing One refuses vitamins, but since she mostly eats fruits and veggies I don't mind. Unfortunately, the reason Thing 2 is so biddable is that he is terrified he will get scurvy. I'm not sure where he got this idea, but I believe that Spongebob Squarepants and ghost pirates might be involved somehow. In any case, Thing 2 firmly believes that if he misses a vitamin, he will immediately come down with scurvy. He is not clear on the symptoms or treatments. He seems very sure that it is terribly painful. I cannot confirm or deny this since nobody in my family has had scurvy since the eighteenth century. I guess with all of my medical blog reading I could find out, but I'm trying to avoid the topic and just offer increasingly impatient reassurance. Okay, I admit I did use his fear to try to get him to eat any kind of plant based food at all, but he rejected the fruit idea out of hand. Thing 2 either saw through my plot or just thinks I'm lying about sailors and hardtack and limes to the rescue. He's probably spending his whole recess at kindergarten spreading rumours of scurvy to his classmates while debunking inconvenient historical facts.

Changes

2006-11-15T16:13:00.000-07:00

Recently I changed jobs at the agency I work for, and had to give up my caseload. Okay, I GLEEFULLY gave up my caseload, for the most part. But there are always special people you work with. They touch you in a soft spot others don't reach, or make a lot of progress, or would be friend material if you weren't treating them. The patient I met with today did all three. J is a perfect example of how anyone at all can get a devastating mental illness. She has an advanced degree in a helping field, has been a social worker herself in the past and is one of the most intelligent, intellectual people I have ever met. J came to our town after getting an offer of employment based on her advanced degree. After she had moved, it fell through. She was completely isolated in a new place with no support system, no money, and rapidly declining mental health. J lost everything when she got sick. Her symptoms are a mixture of several diagnoses, although she is assigned two specific ones. The DSM is shifty sometimes, but more about that another time.

J has a sense of humor that helps her cope with her multiple psychiatric and physical illnesses. She has gone through major surgeries and chronic pain. Living at a terrifying residential hotel in the tenderloin of the town, she joked about what the streets should be named. Worried over her college aged child making bad life choices, she referred to the kid as a specific and fitting cartoon character. Watching her use the coping skill of humor against all odds was a touching and impressive experience.

A few people are always devastated by a change in social workers. It happens to everyone who works in the field, and you have to accept that when you work hard with someone when they are struggling and needing support that they might miss you a lot when you don't anymore. So I'm not saying any of this because I have some kind of ego trip or savior complex going on here. J was devastated when I stopped working with her. Despite an established need for frequent appointments, she has not been scheduling them much and has not come in for over a month to meet with her new worker. When I was assigned to do some work with her, she responded to my calls when she hadn't been returning calls from her new worker.

Her new worker and I met with her today. Her sense of humor was gone. She could barely look me in the eye. She did open up when we used especially validating techniques, but she was clearly doing much worse than she was before.

It is hard not to feel guilty.

One of the ways I avoid burnout is to not play the guilt game. I cannot change another person's life, they must do it alone. Supported, encouraged, assisted, but alone. I know this, but sometimes I still feel it despite all my experience in my field. I would like to be able to magically make lives better, to have precisely this amount of professional attachment and not a whit more. To not feel.

Perhaps I am a better social worker because I do feel.

State of the Union

2006-11-10T15:33:00.000-07:00

I met with a new patient today at the psychiatric hospital he's staying in. This is the fancy hospital in a ritzy suburb that prefers housewives with depression to, well, OUR patients. This is not to minimize the problems of depressed housewives. I've BEEN a depressed housewife and it sucks rocks and can interfere profoundly with parenting. But our patients are usually psychotic and have often self mutilated or overdosed or have experienced other things that typical mentally ill people don't. We are the bottom of the barrel. Our patients are the people left behind by the traditional psychiatric and disability systems. They are often homeless, needing foster care or stuck in the worst pits of housing projects with predatory landlords and neighbors. Sometimes they are too ill to bathe or change clothes and they just smell really bad. They are people that the typical suburban person would cross the street to avoid on most occasions. They seldom have any income, and when they do it is often only $200 a month. Not enough to get even the most basic housing in a residential motel or boarding house, let alone pay for food and medicine. Some of our most vulnerable patients are forced into homelessness because adult foster care is not paid by the state like child foster care. Instead, a person has to have about $800 a month to get into one. It used to be less but now people with SSI or SSDI have premiums of around a hundred dollers taken out of their checks for medicare premiums. Plenty of people in foster care are left homeless once the qualify for medicare, unless they have a very proactive human services worker. But those workers have caseloads of 600 people or more. They usually don't return phone calls from clients, let alone do anything that will help them. They're just too overwhelmed. But they do better than the general public and legislators. Nobody cares about the suffering of our patients. They don't acknowledge their existence mostly. It can get very frustrating. What am I saying? Not frustrating - heart breaking.

I Should Be Thankful, Apparently

2006-11-06T08:58:00.000-07:00

I was about to start a shower when Thing 1 knocks on the door and says that she has to go potty. I let her in, and as I'm turning on the water she adds, "Don't worry, I won't laugh at you."

"Why would you laugh at me?"

"I already said I won't."

"Yes, but is there anything funny about me that I should know about?"

"I *said* I won't laugh at you."

Flush. Sound of exiting child.

I am left wondering.

Neighborly Chat

2006-11-05T19:49:00.000-07:00

I visited my next door neighbor to ask a favor today, and sat down to chat. She loves visits, and the price of addressing even the smallest remark to her is a sort of mandatory invitation to "come in and sit down." She's a wonderfully generous woman in her mid fifties or so. S has helped us out in many small ways, and we have a regular habit of sharing food we've overbought and can't use up. She lives with her daughter and son in law and their toddler while the kids are working their way through college. S immediately agreed to watch our twins, Thing 1 and Thing 2, during our teacher conference this week. Now, I had known that S had started falling down a lot last year about this time and had seen a neurologist and undergone medical testing. I have been praying for her and wondering if she had a diagnosis yet, but felt awkward about asking straght out. In retrospect I guess that expressing concern would not count as prying but I'm a somewhat shy person. Today S told me that she'd had an MRI with a suspiscion of MS but some doubt. She then said that her primary care doctor knew the head of neurology at a large academic center and sent the MRI to him. He ruled out MS but suggested she come to Big City to be tested for the rarer things it could be. S then said that her grandfather died of an undiagnosable (at the time, before modern imaging) muscle wasting disease. All his doctors could say was that it was not ALS. Sharon showed me the muscle wasting in her hand and wrist that was not present last year and that she had never mentioned before. S works for herself and has never been able to afford health insurance. She is hoping she can afford a trip to Big City at all, let alone any part of the medical care. It makes me wish we could adopt her and put her on our insurance. The whole situation seems so grim. This scenario is played out hourly among the tens of millions of uninsured Americans, and it breaks my heart. As a psychiatric social worker, it's probably easy to guess that I'd support universal health care. If seeing what I see daily hadn't convinced me, I'm sure this would.

2006-11-04T11:17:00.001-07:00

P came in to see me for an annual assessment last week. She was afraid that if she completed this paperwork with me she would never see her regular case manager again. P lives in fear each day. She is afraid of invaders, afraid that others are investigating her, afraid that her grown children will be attacked. As is often the case with my patients, P lives a reality that makes it difficult to tell if she experiences obsessive anxiety or psychotic delusions. Obsession grabs whatever is going on in real life and amplifies it. Psychosis distorts reality, it causes perceptual changes that lead people to misinterpret whatever is going on. P spent most of her life being violently attacked by both family and strangers. She is also poor because of her inability to work. So she really does live in an incredibly bad neighborhood. The kind of apartment complex she can afford will rent to anyone. She lives near drug dealers, child molesters and violent criminals. There's an old joke that it isn't paranoia if they really are out to get you. But of course most people with psychosis are very poor, and do live where predators lurk. So is she simply obsessively anxious about the reality she has lived, or suffering from paranoia when she just happens to have a background where people really were out to get her? Successful treatment relies on figuring out the difference. Different medications work to alleviate different symptoms. Different therapy approaches work best with obesession and paranoia. I learn things just by talking to P for an hour that make me favor anxiety over delusions. P is open about her fears, able to discuss them with the understanding that they are extreme. She does not try to provide evidence of the reality of her fears. She reports events that trigger her symptoms that are likely. Noisy neighbors at the crack house down the hall instead of hearing the radio reporter telling her personally that she is about to be robbed is a sign that her perceptions are correct. In my workplace only the doctors diagnose, but forming my own judgement helps me write an assessment that will help others ask the right questions and try the non-medicine treatment approaches that are likely to work. In the end though, I could be wrong either way - she could have both!

For Starters

2006-11-03T15:42:00.000-07:00

I'm a busy psychiatric social worker and mom whose admiration of other bloggers has encouraged me to try one of my own. Here you'll find a mishmash of work stories, cute kid stories, jokes, birth junkie opinions, mental health musings and other random thoughts. Naturally, the work stories are fictionalized accounts without identifying information. As a treater who is also a patient I'm a big believer in HIPPA. I wouldn't mind my own psychiatrist or therapist posting stories about me as long as they were fictionalized, so I'll do the same for others. Fair warning, if you think you recognize yourself or someone else, you don't.