Archive for January, 2010
I sometimes tune in to different television shows that touch on mental health issues — some that are intended to be informative and, less often, the more sensational offerings — just to see how the issue is approached. A&E’s Hoarders is easily the most successful and most talked about show to cash in on the social sideshow that is televised “mental illness.” Having watched just a couple of episodes, maybe I’ll share my opinion of the show some other time. For the moment, I’ll concern myself with one thing that jumped out at me from one exchange.
On a recent episode, a therapist referred to one person as fitting the “S.I.C.K.” model — a clever little acronym for “Sensitive, Intellectual, Creative and Kind.” She lost me. I cannot understand why someone would choose to attach the word sick to positive traits. I don’t know whether that little gem is in common use in her professional arena or if that’s just something she thinks is clever — a brilliantly reductionist little acronym to keep in her back pocket, just itching to use it on the next guy. Either way, nothing good can come of throwing a word as stigmatizing as sick around so liberally in regard to emotional distress, much less, positive attributes and in general we need fewer labels — not more.
For anyone who thinks I may be taking things too seriously, let’s remember it only took Prozac Nation to make the phrase “chemical imbalance” a household name and an accepted truth, despite its standing squarely in the realm of theory. These are two different things, to be sure, but we must be careful with our words. Simply put, words mean things and when you have a viewing audience of 2.5 million, words mean plenty.
You may have seen the relatively new direct-to-consumer ad from Astra Zeneca for its long acting atypical antipsychotic, Seroquel XR. Creepy and pandering to say the least. I’ve heard a few people say that if you’re not depressed before watching it, you will be after — and isn’t that the point? Like a carefully and corporately crafted emo/indie/whatever hit song, it’s made to strike a chord and sometimes it takes a panel of well payed analysts and some market research to find out how best to strike that chord in a way that shows that the company truly understands how you feel. Look at any one of the current pharmaceutical ads. The focus isn’t so much on selling you the drug as the disease. Once you’ve bought the idea of the disease, you’ll find the drug.
Here, they are positioning their Seroquel XR as a fix for “bipolar depression.” They show scene after dreary scene of miserable looking people who have half faded into the grays and browns of their equally dreary environments, all while an instrumental from Badly Drawn Boy plays in the background. Oddly, one thing that separates this ad from a lot of the others is that it doesn’t switch to bright scenes of people laughing with friends at parties or rolling around in green, sun bathed fields. It stays pretty gray, though one woman does find the strength to get up off the couch. At least in that respect it’s a little closer to reality, considering a lot of people’s experience with this drug and others like it.
Another thing you can’t miss is that the health risk disclaimers take twice as much time as the first part of the ad telling you how great the drug is for treating “bipolar depression.” I’ll be the first to admit that a risk vs benefit scenario can’t be weighed out in seconds of air time but with such a vague diagnosis, based not on objective medical evidence but a nebulous cluster of feelings and behaviors laid out in a questionnaire, one has to wonder when the perceived benefits justify the very real risks. The question may now be more important than ever as we see these drugs being used in increasingly mild situations and in an ever broadening range of indications and demographics. Even with twice the time dedicated to the risks, the likelihood of those risks hasn’t fully been put forth and while they touch on metabolic symptoms and state the need for cholesterol and triglycerides to be checked, the reality is that only about ten percent of doctors prescribing these drugs are looking into metabolic responses by running those tests. With these companies downplaying, often even lying outright about the risks of these drugs to the FDA, prescribing doctors and now — via direct-to-consumer ads — the public, even with their FDA mandated obligations fulfilled, truth in advertising remains questionable at best.
Just as with the ad marketing Abilify as an add-on for “treatment resistent depression,” a viewer who sees this ad would have no reason to see Seroquel as anything but an antidepressant. It’s not an antidepressant though — far from it. It’s an antipsychotic designed to combat the cluster of “symptoms” associated with a diagnosis of schizophrenia — but then, when your product was designed for a perceived illness that affects only 1.1 percent of the population, you have to expand your market somehow.
The ubiquitous art imitates life/life imitates art debate has given way to the more localized art interrupts life/life interrupts art — for me, at least. I suppose like most people who call themselves artists (and I don’t call myself an artist often), I’d love to devote vast amounts of time to drawing and painting. I’d love to immerse myself in the process for days on end, crawling out of my cluttered studio a crumpled, unbathed, paint-covered mess, feeling as though I’d created something huge or at least part of something huge — only to emerge in search of some more life to imitate (or however that goes), and then repeat. In that regard I even envied Henry Darger but that’s not my lot. That’s not my life. I am pulled in other directions, often at once and blessed — truly blessed — with a life to interrupt. So I’m left to find a balance among interests, passions, responsibilities, and obligations. I work on paintings in fits and starts as life allows or when I just have to step away and take a moment.
This show is going to be the distillation of captured moments, stolen hours. Nothing rushed, nothing thrown together. I can’t even say it will be lacking but I know I had hoped to start working larger, varying style and media a little more. I had hoped to carry out some common threads a little longer through a more prolific showing. I will do all of that next time, perhaps for a summer show. Instead it will be a sampling of the images most pressing to me — stripped down to the visual equivalent of the few things you’d say if you only had a moment and maybe that’s a good thing.
When I was 17, I visited a church where I met a lot of amazing people. There was one child that had an incredible voice. His name was Michelin. I don’t mean good for a kid or good for singing in church but the kind of voice that would stop you in your tracks. I remember thinking to myself that if he were born somewhere else his voice would be his meal ticket. He couldn’t possibly be passed over — even in a world where everyone is clamoring to be heard because they think their voice is their ticket to fame, which of course we all learned somewhere we so richly deserve. But he wasn’t born somewhere else. This church was in a small coastal village in Haiti.
I saw an impressive spirit in the people there. One can’t help but notice the contrast between our country and theirs. I think of how much we value stuff and status, about our connection to things and their connection to our happiness. We live in a country in which it’s commonplace to diagnose ourselves as depressed or having any number of anxiety disorders over matters like career advancement and wealth management while elsewhere people are singing “alleluia” with bare feet, torn and ill-fitting clothes and empty stomachs. That’s not to say it’s all smiles in Haiti — that there’s a flood of joy amidst poverty. They are without question burdened and weary but for most, their burdens are different from ours. Our consuming has gone past need, past waste and into competition. We’re personally affected when our favorite restaurant closes. If we don’t know where our next meal is coming from, it’s because we can’t decide not because there is nothing to eat. The jobs we can’t stop complaining about afford us enough food to get fat. Then we complain about that.
I remember standing at the foot of a bed shared by several children in a hut made of discarded branches, old signs and scraps of whatever could be made useful. It was no bigger than my bedroom back home and 12 people lived there. Outside people drank from small streams of dirty water, had little to eat and their country was falling apart beneath them. Still they went to church on Sunday, sang, danced and praised God for what little they had and asked Him for enough to really get by — to just be okay.
Now some people have lost everything. People that had only meager scrap huts have lost them. People who had only missions for food and schools for purpose have lost them. People who literally had nothing but each other have lost even that. Port-au-Prince was desperate when I saw it years ago and it was grand when compared to the villages. Now it is rubble.
I rode my bicycle home from work last night. Nearing home, I found myself looking up at all of the houses in my neighborhood — wondering what made someone buy one house over another. Was it the size, the style, the yard? Maybe they bought that house for its original woodwork and stained glass. The more I looked at the houses, the more they looked the same. They serve the same purpose, they offer the some protection and at night they all blur together and look more alike than different — and at least for one more night they are all still standing.
This child is in his New Missions school uniform, standing in front of what’s left of a classroom. I think it’s the one I stayed in but it’s hard to tell. They were built simply and probably fairly uniformly. I remember being thankful for the sturdiness of the shelter when the winds got strong.
• • •
While text message donations are easiest and still useful, they apparently are also delayed by as much as 90 days due to billing cycles and technicalities. That’s an eternity in this situation but it’s better than nothing and it’s better than never. Text “YELE” to 501501 to donate $5 to Yele or “HAITI” to 90999 to donate $10 to the Red Cross.
You offered them as martyrs but that was not your right
God’s instruments of change sometimes walk beneath our sight
Ballydowse — Open the Record
A year and a half after Esmin Green died on Kings County Hospital’s waiting room floor as a direct result of staff negligence, a settlement has been agreed upon which will allow a federal judge to monitor Kings County Hospital. Esmin’s death may have been a turning point but Kings County’s psychiatric ward had already been called a “chamber of filth, decay, indifference and danger” in legal filings which were under way well before Esmin’s involuntary commitment and death. That lawsuit was filed by Mental Hygiene Legal Service, the New York Civil Liberties Union and the law firm Kirkland & Ellis. Unfortunately, it takes more than a lawsuit for most Americans to take notice so we had to actually watch someone die before turning the spotlight onto Kings County.
From the NY Times:
In a 45-minute conference call on Thursday with Judge Kiyo A. Matsumoto of Federal District Court in Brooklyn, lawyers for the city, the federal government and the patients confirmed that they had agreed on a consent decree that would require changes at the hospital and a timeline for enacting them. The conference call was broadcast in the courtroom.
The judge indicated that she was prepared to sign the agreement, even as she expressed some reservations, saying that some parts seemed “vague” and “ill defined.”
Hopefully with this agreement, we can expect some real, immediate and measurable changes. People only seem to act when someone is watching. Still, I’m not exactly encouraged by parts of the agreement being “vague” and “ill defined.” In light of the fact that KCHC staff failed to adhere to existing policy and even falsified reports, I question their willingness and ability to truthfully and effectively report to an outside overseeing body.
Judge Matsumoto could modify the agreement before signing it, lawyers said, and indeed, during the conference call on Thursday, the judge expressed concerns about what she saw as somewhat flabby language.
She noted that the settlement called for the hospital to meet “generally accepted standards” for psychiatric diagnoses, a goal that seemed to underwhelm the judge, who said it was “obvious.”
Judge Matsumoto criticized another section that called for mental health treatment plans to be assessed and revised “when appropriate.”
“O.K.,” the judge said tartly. “How do we decide?”
She pushed the parties to submit progress reports to the court sooner and more frequently than they had envisioned.
Judge Matsumoto would function as the enforcement agent for the decree and would have the power to hold the city in contempt or impose other penalties if the decree’s provisions were violated.
Hopefully Judge Matsumoto can cut through that flab and get to the heart of the matter, making the necessary changes before signing the agreement. When systemic neglect and abuse is allowed to continue and worsen for years, only to be exposed by death on tape, we should be demanding more than vague talk about “accepted standards.” Fortunately, Judge Matsumoto seems to be of the mind to see it through. I sincerely hope she does. I’m glad to see she’s pushing for more timely and more frequent progress reports but how gradually are we willing to allow things to change and again, how much can we trust the integrity of those reports? These are matters that need to be addressed.
In the end, it shouldn’t take paperwork, compliance and transparency policies and administrative oversight to motivate people in the field of “care” to act as though they care. If you need a court order to tell you to pick someone up when they’ve fallen face first onto cold, dirty tile, then you are not only ill qualified to work in a hospital setting but to call yourself human. We can make all the clerical and administrative changes in the world to enact outward change but we will never be able to legislate decency, respect and dignity.