Psyched Out

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.

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.

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?

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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!

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.