Archive for the ‘mental illness’ category

Guest Post: Michelle Sipics on Air Force Woo, Military Suicide and the Importance of Thinking Straight

February 4, 2009

Please feast your eyes and minds on another very sharp post from guest blogger (and graduate of the MIT Graduate Program in Science Writing) Michelle Sipics.  As always Michelle suffers no fools gladly:

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After an unintentional but undeniably long hiatus, I am back at Inverse Square. My thanks to Tom for not holding my incredibly sporadic guest-posting against me.

This post, like my previous two entries on IS, includes a discussion of mental health. But there’s more to the discussion than that topic alone: there’s also the issue of pseudo-science and its seemingly indefatigable ability to keep creeping into society.

The election of Barack Obama to the presidency of the United States gave great hope to those of us who love and respect science and what it can accomplish for this country and for the world, on both individual and societal levels. His appointment of Steven Chu as Energy Secretary for the new administration was a particularly poignant ray of light after eight years of growing darkness—and while we certainly can’t expect one man to immediately or completely repair the damage that has been done to scientific efforts, many of Obama’s other first steps in office have been promising.

Contrast that, then, with today’s news from the US military: the Air Force plans to train combat personnel to perform acupuncture.

Now, I write this post knowing that so-called “alternative medicine” is often a lightning rod for decidedly irrational discourse. However, I am willing to take a stab (no pun intended, I promise) at calmly explaining why this move by the Air Force sets a bad precedent for military health services, and for the country as a whole.

Just three days ago a new meta-analysis was published in the British Medical Journal, in which the authors examined a host of previous studies on the efficacy of acupuncture in treating pain. There is already a fairly thorough analysis of this paper available over at ScienceBlogs, so I’ll cut right to the chase: there is little to no evidence that the reported effectiveness of acupuncture in treating pain is due to anything more than the placebo effect.

Now, let’s not completely discount the placebo effect. The fact is, if people actually feel better after a treatment—even if the treatment itself is a complete hoax—they’ve experienced some benefit from it, which is fine. But that is hardly enough to advocate pushing something with no proven medical value into combat-stage use in the United States Military. As the chief of the acupuncture clinic at Andrews Air Force base said (yes, the Air Force has an acupuncture clinic), “The history of military medicine is rich in development, and a lot of people say that if the military is using it, then it must be good for the civilian world.”

The slippery slope is plain to see. Well gee, if the military is using it, it must be real!

This particular issue irritated me even more than it might have on its own, as it came on the heels of the Army’s announcement that a record number of suicides occurred among its soldiers last year, far surpassing the civilian suicide rate. The most recent CDC numbers for the US civilian population show about 11 suicides per 100,000 individuals in 2004, while the Army suicides from 2008 are expected to equate to a rate of 20.2 per 100,000 (adjusted to take into account the difference in demographics between enlisted Army personnel and the civilian population). And those numbers don’t include suicides that take place after a soldier finishes his or her enlistment. The Marine Corps has released similar figures.

Why is this so maddening? Well, aside from the fact that knowing that 128 or more Army soldiers killed themselves last year leaves me extremely depressed and full of sympathy for their families, we have this little quote from the Associated Press article:

“Why do the numbers keep going up? We cannot tell you,” said Army Secretary Pete Geren.

Really? You can’t tell us? That’s funny, because one of your psychiatric consultants has identified at least one major problem.

At the Pentagon on Thursday, Col. Elspeth Ritchie, a psychiatric consultant to the Army surgeon general, made a plea for more professionals to sign on to work for the military.

Finally, someone in the military has acknowledged a long-standing problem: there aren’t nearly enough psychiatric professionals. Unfortunately for them, this isn’t actually news. The same statements were made last year, when similar articles appeared about the number of military suicides reported for 2007. And I find it extremely hard to believe that the military, if it really wanted to, couldn’t find a reasonable number of trained professionals to provide psychiatric support for their soldiers—for our soldiers.

Of course, I must acknowledge that military men and women are under extraordinary stress, finding themselves in situations every day that I already know I wouldn’t be able to deal with. They’re away from their families for extended periods of time; they’re in unfamiliar environments; they’re given responsibility for other human lives, whether friendly colleagues, foreign enemies, or innocent civilians. That is an overwhelming and probably indescribable amount of pressure. Even with the best treatment in the world, it’s not likely that all military suicides can be prevented. But we have to do better than this.

Now, I don’t want to be one of those writers who says, “Why is our tax money funding acupuncture when it could be paying for more psychiatric specialists to prevent suicides?!” That’s not how things work in reality, and it’s a pointless argument. But it does concern me that we have two known problems here: physical injuries in Air Force personnel, for which the action being taken is to fund and expand the practice of pseudo-science; and suicide risk in Army (and general Military) personnel, for which the action being taken is… issuing reassuring press release statements?

Acknowledging a problem is only the first step to solving it, and acknowledging it repeatedly without taking additional action doesn’t get you any more points. Instead of hearing yet another, “Yes, we recognize that the high suicide rate of our troops is a problem” statement from the Army, how about an acknowledgement from the Air Force that they’re spending taxpayer dollars on unproven magic needle technology that stands no chance of providing actual therapeutic benefits for anyone in our military?

Image:  David Loong, “One Can Buy Snake Oil Tablets in Marrakech,” 2006.  Reproduced under a Creative Commons ShareAlike 2.o license.

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Brain pets: Rebecca Skloot/Service Animal division

January 12, 2009

So I’m a little late with this, given that Rebecca published this very nice piece of work a week ago in the NY Times Sunday Magazine.

The quick summary:  there is a legal battle shaping up over the use of an increasingly diverse set of species to provide services for a range of conditions that extends well beyond the familiar image of a dog helping a blind person.  Think a guide horse (a very small one) for a blind woman, a parrot for a man suffering from psychotic episodes, and so on.

Most of the piece concerned distinctions that divide those who are helped by such animals don’t make, and that those concerned with issues of health or safety or sheer unfamiliarity in the control of public spaces do.  Is an animal a therapy animal — which do not have guaranteed access to public spaces under the Americans with Disabilities Act — or a service animal, performing a defined task, which do?  Should the ADA be amended to limit the permitted animals to, basically, dogs? Read the work for the details.

All I want to add here is that beyond the fascinating story lines of the emergence of a variety of animals who can now be used to respond to human hardship and the legal argument that such advances have produced, there is a second just-below-the-surface message in Rebecca’s piece.  Two out of the  three human-service animal partnerships that profiled there involve animals that respond to the overt symptoms of mental disturbance — the parrot mentioned above, and  a monkey who has been trained to ameliorate agoraphobia and anxiety attacks.

Both of those animals would be denied service animal status under proposed changes to the ADA law, and the parrot has already been banned — and has become the focus of an ongoing dispute — from a dental school where the parrot’s owner gets (or got) his teeth cleaned.

The subtext here is pretty obvious and it runs through Rebecca’s piece, though it is not its overt focus:  mental conditions are not “real” diseases or disabilities.  Their symptoms manifest as behavior, and, of course, behavior is a choice.

Except, of course, it’s not.  I started this blog with a story about the importance of understanding the material reality of the conditions that produce mental symptoms, derangements of the mind.   The arguments being made against the two people whose stories Rebecca tell are ones based on the notion that mental conditions — if they exist (sic!) — may require therapy, but are not subject to the same kind of daily, task based support that we can so clearly recognize in the relationship between a blind person and their horse (or dog).

And that, to keep this short, is the real message here.  It’s not that the argument over whose interests triumph is trivial one — whether that claims of public health or the avoidance of disruption trump those of the people receiving aid from a range of animal helpers on the other.  It’s just that behind this real public and legislative battle is the deeper question of how willing we are to accept the fact that mental illness or discomfort is “real” in the same way that we accept the reality of a clearly physical condition like blindness.

There’s a much longer argument here, all the way back to brain-mind dualism. But if you understand the mind as phenomenon of the material structure we call brain (and more — the sensory systems and all that; bear with me though in the cartoon version for simplicity’s sake), then however you work your view of the matter from there, the notion that mental disorders are qualitatively different from “obviously” physical ones breaks down.

The science – in – public connection here is thus, I think, obvious.  If neuroscience gives a view of mental life based in a material understanding of brain and the ills to which it is heir, and practical medicine shows us how to ameliorate some of its ills, then the denial of working methods to make living with such conditions possible is not simply a matter of competing interests, but is an act of cruelty to people being forced to suffer when simple means of easing suffering are available.

Image:  Berthe Morisot, “Girl with a Greyhound,” 1893

With Apologies to …

July 16, 2008

….Brad Delong (and to you readers, for whom this post was promised yesterday)…

UPDATE: Arrrgh. More apologies to all here. Brain bubbles affected my attribution of small pox vaccination to Jonas Salk, who, of course, invented the first effective polio vaccine. Edward Jenner performed the first smallpox vaccinations with a cowpox preparation in 1796. I conflated the two in my head as I have been thinking about the fact the difficulties faced in eradicating polio, compared with the success of the anti small pox campaign — which in fact formed the prompt for this post on the latest reported polio case in Pakistan. I regret the error.

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Why oh why can’t we have a David Brooks-free press corps, at least when it comes to bloviating about science?

In his most recent column, Brooks writes (under the pretentious and meaning-free headline, “The Luxurious Growth”) that the research community has grown “more modest about what we are close to knowing and achieving.”

That is, Brooks is once again channeling what “science” thinks — and he’s wrong, of course.

Headline writers may have made the kinds of claims he decries, that genetics would soon explain all of human behavior, but I can’t recall any scientist involved in, say, the genetics of alcoholism, claiming a single gene-behavior connection. Instead, fifteen seconds on Google turns up lots of statements like this.

Alcoholism is a complex, genetically influenced disorder. Multiple phenotypes – measurable and/or observable traits or behavior – contribute to the risk of developing alcoholism, particularly disinhibition, alcohol metabolizing patterns, and a low level of response (LR) to alcohol.

In other words: scientists have known as they do their research that individual studies of particular measurable and or observable phenomena will not produce a synoptic view of any complex behavior. Brooks knows this too. After all, with a magisterial air of explaining the hard truths to resistant materialists, he writes that

It’s now clear that one gene almost never leads to one trait. Instead, a specific trait may be the result of the interplay of hundreds of different genes interacting with an infinitude of environmental factors. must know this too — I can’t believe he’s that bloody ignorant, though perhaps I’m just too much of a polyanna here.

Again — this is a revelation only to those who haven’t been paying attention for years. And I do think that Brooks knows that as well. But if he does, that means he has an ulterior motive for claiming that once arrogant science has learned humility — and he does, the usual one that data-averse ideologues acquire: nasty scientists who seek material explanations are evil:

Starting in the late 19th century, eugenicists used primitive ideas about genetics to try to re-engineer the human race. In the 20th century, communists used primitive ideas about “scientific materialism” to try to re-engineer a New Soviet Man.

And Jonas Salk, that commie, used his “primitive ideas” to invent a smallpox polio vaccine, the key step in what has become the first ever may yet, I hope, become the second eradication of a human viral pathogen….and so on; this is an old and stupid back and forth.

Brooks wants to say that there are other sources of insight into the human condition — that “novels and history can still produce insights into human behavior that science can’t match.”

I’m not sure what he means by “match,” in this case. I suppose we don’t need science to say that happy families are all alike (you sure about that, Leo?) or that England’s Catholic King James II fell not due simply to his religion but because of his political ineptitude. But such insights, no matter how valuable are of a different quality, a different explanatory timber, than that which has investigated, for example, something as material and as essential to the human condition as the evolution of tool use.

But again — I fear it gives Brooks too much credit to engage the debate at this level. His goal is not to examine honestly the power and limits of scientific inquiry into human nature. The goal is to devalue the enterprise to the point that inconvenient facts can be ignored. Brooks gives the game away about half way through the piece. He writes that

There is the fuzziness of the words we use to describe ourselves. We talk about depression, anxiety and happiness, but it’s not clear how the words that we use to describe what we feel correspond to biological processes. It could be that we use one word, depression, to describe many different things, or perhaps depression is merely a symptom of deeper processes that we’re not aware of. In the current issue of Nature, there is an essay about the arguments between geneticists and neuroscientists as they try to figure out exactly what it is that they are talking about.

Brooks takes as evidence of ignorance the fact that different disciplines argue about terms. By that token, as of 1900, the state of play on the nature of matter would have led us to conclude the issue was intractable. Chemists had used the concept of atoms as real material objects to enormous theoretical and practical advantage since the days of Dalton and Berzelius — that is for a century or so.

Histories written from a physicists point of view, by contrast, commonly date the confirmation of the reality of atoms from Einstein’s 1905 papers on molecular dimensions and on Brownian motion. So — I guess for a century all those chemists had no idea what they are talking about.

In fact, of course, there are valuable, vital working definitions of depression, and they are involved in the still imperfect, but real body of knowledge that identifies clinical depression as a material illness of the brain. That understanding is what permits interventions — chemical and surgical — that dramatically reduce human suffering in many cases. Cherry picking disciplinary debates may give the appearance of deep disagreement – but doing so, as Brooks does, is really just garden-variety intellectual dishonesty. Put it another way: acknowledging limits to knowledge is not the same thing as denying the power of the same body of knowledge up to that limit.

But, of course, that’s what Brooks needs to do if he is to make his real point:

This age of tremendous scientific achievement has underlined an ancient philosophic truth — that there are severe limits to what we know and can know; that the best political actions are incremental, respectful toward accumulated practice and more attuned to particular circumstances than universal laws.

Nice sleight of hand, eh? Brooks is back to his most comfortable role, masquerading as the honest broker, while anyone in hearing better hang on to his/her wallet. The con takes place in incremental steps. Limits to knowledge become “severe” — that is, forseeably unsurmountable. Sez who? Sez Mr. Brooks, of course. Trust him — he speaks so nicely and has a marvelous tan.

And then…we are supposed to pass over the lack of logical connection…that due to such scientific lacunae, it is a philisophical truth (no limits to knowledge for those emerging from the cave, eh?) that political incrementalism is best.

This is more than a logical idiocy. It is historical nonsense as well. Incrementalism is good sometimes — perhaps most of the time. But consider: It would have been respectful, of course, not to dismiss the loving succour of King George III, but John Adams, no incrementalist at the moment of truth, persuaded his compatriots otherwise. Humans have owned slaves since earliest human memory; surely, respect for accumulated practice makes the 14th amendment a travesty. Peculiar circumstances can be invoked to justify polygamy and child marriage — and yet it seems possible to object on a range of more abstract and universal grounds, and so on….

That is — Brooks wants to be able to pick and choose, based on criteria known only to him, what change meets some ill-defined criteria of respect and particularity. This is nothing more than a cartoon version of what some conservatives say conservatism is about (though the last few years might give an honest man pause about the incompatibilty of this flavor of conservatism and power). Brooks would rather not have to defend it in detail (see revolution, American in the paragraph above), so instead he comes up with a parody of scientism and hopes that it sounds grand enough to deflect scrutiny.

As Delong says so often, why, oh why, can’t we do better than this codswallop.

That is all.

Image: Vincent van Gogh, “Sorrow,” 1882. Location: Wallsall Museum and Art Gallery, the Garman Ryan Collection. Source: Wikimedia Commons.

Guest Post: Michelle Sipics on Trouble in the Zoo…

June 19, 2008

With this post Inverse Square launches what I hope will be an expanding part of its repertory. The goal of this blog is to probe the intersection of science and public and daily life. That’s a big beat, the biggest — and it is much more than any one person could hope to cover.

So with the following work, Inverse Square’s first guest post we see the beginnings of what I would like to see become a community of insight into the ways science penetrates our experience at every level.

Your poster, Michelle Sipics, knows what she’s talking about in the piece below (and much besides). After deciding that her two degrees in computer engineering from Drexel weren’t enough, she came to MIT to join the Graduate Program in Science Writing, where she spent a good part of her year working on issues of geriatric mental health. Right now she’s writing and thinking in her beloved Philadelphia — and lending her formidable intelligence, wit, and style to all of us over here in the first of what I hope will be many future conversation-starters. (I don’t need to add, but I will, that Michelle was one of those students that make teachers want to keep teaching.)

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When my gracious host first offered to let me guest-post on this blog, one thing worried me more than anything else: what would I write about? Could I come up with topics that would interest readers, generate discussion, and actually be informative simultaneously? Sometimes even attaining two out of three is difficult enough.

But earlier today, as I was browsing through my bookmarks to make sure that none were garbled during my transition to the lovely and fabulously improved Firefox 3 (note: they all survived), I came across an article that I bookmarked several months ago in a state of severe agitation. It was a story from my local paper, The Philadelphia Inquirer, with the somewhat self-explanatory but still vague headline “Philly Zoo deals with aging animals.”

I could lie and say that I don’t know what made me click on this headline and read the article. Yes, I like animals, and I’ve been to the Philly Zoo–as zoos go, it’s not bad, and I went there with my cousin’s kids a few years back. But I’m not particularly interested in animals or zoos. Instead, I clicked on the link because I had a vague impression that something infuriating was waiting for me in the article, and I admit it: I sometimes enjoy getting fired up. Hey, sometimes getting angry about something is the first step toward improving a situation.

So, I clicked. And what did I find out? Well, let’s look at a few excerpts:

A few weeks ago, Philadelphia Zoo keeper Mandy Fischer heard a small cough.

It was Spot, 25, a grandmother and matriarch of her group of spectacled langurs.

X-rays and ultrasound showed that the elderly Asian primate is not just losing her teeth. She has advanced cardiac disease.

Ok. That might not seem terribly interesting, but here’s why it caught my attention: we’re talking about a zoo monkey who was given–without having to file paperwork, wait a month for a doctor’s appointment, or fight an insurance company to have a claim paid–X-rays and an ultrasound. If you read on, you’ll find out about a giraffe that gets arthritis pills hidden inside bananas. An emu (24-year-old “Mrs. Emu”) gets anti-inflammatory medication to treat her arthritis. And then we find this little three-sentence, three-paragraph gem:

Philadelphia has adapted living spaces for the elderly.

A tree kangaroo that could no longer climb her pole got handrails and ramps.

A snow leopard with failing vision got brighter lights.

You might still be wondering why this article irritates me so much. Well, it’s not the article that irritates me; it’s the fact that animals are getting immediate medical attention and treatment while elderly human beings have to fight to be seen by a doctor, struggle to pay for life-saving medications, and find a way to cope with diseases like Alzheimer’s, which the doctors and researchers that I’ll collectively refer to as “science” can’t claim to understand. Let me be clear: this is not a rant against scientists or doctors. Most of them are doing their best to keep up with the impending massive increase in the elderly population in this country as the Boomers turn 65, and are fighting against a lack of funding and–at least until recently–a general lack of interest in geriatric research. This is also not a rant against zoos, zookeepers, animal lovers or the animals themselves. The zookeepers are just doing their jobs, trying to keep the animals healthy; and the animals have a right to be kept healthy, I’m sure. But if a monkey can get arthritis medication, why is it so difficult for elderly human patients to receive good medical care? As the linked Washington Post article states, “The quality of care received by vulnerable elderly Medicare, Medicaid patients is barely acceptable.” To wit:

The study found that vulnerable elderly patients — those at risk of death or functional decline — received only 65 percent of tests and other diagnostic evaluations and treatments recommended for a number of illnesses and conditions, including diabetes and heart disease.

And less than a month after running the homegrown story about the Philly Zoo animals, the Philly press picked up an AP story detailing the impending crisis (note to AP: I came up with that phrase before I noticed that it was part of a quote in your story; please don’t sue me) in geriatric health care. In brief: there’s a shortage of geriatric specialists; there’s a shortage of available training; most of the people who DO work in the field are underpaid and stressed with a workload of too many patients; and Medicare doesn’t allow for a lot of the treatment and care that its patients require.

And this is referring to general health care; it doesn’t even discuss the dire state of affairs that is geriatric mental health in the US. I’ll leave most of the details on that situation for another post, but if I may briefly quote from a document I prepared as a student back in 2006, I will point out that several years ago, Anita Rosen, then-chair of the Mental Health and Aging network of the American Society on Aging, addressed the Policy Committee to the White House Conference on Aging, and pointed out drastic shortages in the number of professionals specializing in geriatric mental health:

[Rosen] reported that as of 2002, only 5 percent of social work practitioners listed aging as their primary area of expertise, and that only 1,115 Masters-level social work students specialized in aging. In contrast, the [National Institute on Aging] issued a report nearly 20 years ago emphasizing the need for 60,000 to 70,000 social workers specialized in aging by 2020. Despite two decades of warning, experts fear that the actual numbers will fall drastically short of the predicted need.

Why? Rosen lists bias and stereotyping as major issues, both for aging and for mental health. And it gets worse:

Rosen also cited shortages in the number of psychiatrists providing specialized care for the elderly. At the time of her testimony to the White House conference, less than 7 percent of the 38,691 practicing psychiatrists in the U.S. specialized in aging. According to Rosen, given the existing trends in medical schools and the retirement of current practitioners, there will be 5,682 older adults with psychiatric disorders for every one geriatric psychiatrist in America by the year 2030.

Meanwhile, kangaroos get ramps and handrails, emus get X-rays and arthritis medication, and I get really, really ticked off.

Image: August Macke, “Great Zoological Garden, Triptychon,” 1913. The reproduction is part of a collection of reproductions compiled by The Yorck Project. The compilation copyright is held by Zenodot Verlagsgesellschaft mbH and licensed under the GNU Free Documentation License. Source: Wikimedia Commons.

Talking the Mental Illness Talk–OK. Walking the Walk?…

June 10, 2008

…Not so much, according to Michelle S.

Responding to my recent post on the Iraq War suicides and what they can tell us about the question of brains-and-minds, one of my favorite commenters (and a former student, much admired and much missed) weighs in from a position of much greater knowledge than I possess on issues of brains and mental illness. Michelle knows what she’s talking about and says it better than I could — so here is what she has to say:

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I would love to think that some hope is justified here. Unfortunately, I don’t think that’s the case.

While it’s a major development (no pun intended) that the military is finally starting to take PTSD and other brain-related maladies seriously, I don’t think they’re anywhere near the level of understanding or action that is necessary to make any real progress. It’s one thing to admit that something exists–or at least sort of admit that it exists–but another to really do something about it. Admittedly, some of the military leaders seem to be trying. On the other hand, a lot of soldiers are still afraid to admit that they might be suffering from a mental illness.

Hell, plain old civilians are afraid to admit it, and for good reason in some cases, I might add. Stigma is far from gone in the US. As a country we offer sympathy and support for anyone suffering from an illness of the heart, the lungs, the kidneys, whatever, but the brain is still different to us somehow. We manage to forget that it is still an organ, albeit a really darned complicated one.

Then there’s the problem of mental illness in general–in fact, nearly any brain-related problem–being grossly misunderstood. I actually had a young mother say to me once, in regard to her two year old, “He’s so moody! I’m just terrified that he might be bipolar!” Dear, your child is not bipolar. He’s two. His “mental illness” is that he is a two year old. (And, I’m sure, by the time he’s five she’ll have him on ritalin–but NO ONE wants me to get started down that road.)

The public needs good, solid information about what mental illness is. The MSM has yet to provide that, in my opinion. Meanwhile, schizophrenics in particular continue to be demonized, even while they’re forced to live in a society that only treats mental illness as an afterthought. Have you heard even one Presidential candidate address the near-crisis that is geriatric mental health in the US? Ok, I’m preaching on a topic that is dear to my heart here, I know, but come ON–experts in that field are shouting at the top of their lungs about this problem. They have been for years. Why is no one listening? Why is insurance coverage for mental health such a joke?

Perhaps things are starting to improve. Perhaps the brain as a whole, with all of its complex subtleties, capabilities and limitations, will get the attention it needs and deserves. I hope that your hope is justified. But I think (and therefore I am–maybe) we’re a long way off.

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Image:  Francisco de Goya, detail from No. 62 in the series Los Caprichos, 1799. Source:  Wikimedia Commons.