The poor ye drug

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I wouldn’t say never.

If family therapy hasn’t helped the child settle down, if the psychotherapy for him or her hasn’t turned things around, if vigorous exercise hasn’t lifted the depression – then I might say go ahead and try an antipsychotic drug for the child.

But when you consider that over 300,000 kids in this country are on some kind of psychotropic medication, I suspect things have run amok.

I’m not alone.  Indeed, there’s a group of public health officials from 16 states who’ve formed a group looking at the problem.  They’ve named this effort, “Too Many, Too Much, Too Young.”

These officials are on to something.  For one thing, their worry is legitimate given results of the new study comparing the use of drugs for poor kids and those given to kids whose families have private insurance.

Here’s this storyl.  Researchers from Rutgers and Columbia found that poor kids are four times more likely to get the drugs than other kids.

What accounts for the disparity?   The researchers speculate that it comes down to money.   Private insurance reimburses more dollars for therapy and does Medicaid. That’s the health insurance most poor children are on.

There’s probably more to it than that.

Primary care doctors do most of the prescribing of psychotropic drugs.   Poor families are less likely to seek out therapists or psychiatrist than other families. And middle-class families likely are more apt to seek counseling or other services from mental health professionals.

For my part, I have several objections to drugging any kids with anti-psychotics willy-nilly.

The drugs have powerful side effects.  They  can cause weight gain.  Lots of it.  They can cause agitation – or lethargy.   If they help at all – often they don’t – many must be taken for a year or more to avoid relapse.   Recent evidence shows the drugs raise the risk of suicide in young people.

In addition,  the drugs often serve as a substitute for therapy and other activities than offer a more permanent answer.

Finally, when you hand a child or teen-ager a drug, you also hand them a diagnosis.   For many kids, that diagnosis becomes a label, even a lifelong label.   That person then naturally internalizes the label.  It’s his or her identity, a handicap than can limit one’s ambitions, talents and dreams.

“Depressed,” “bipolar,” “schizophrenic” becomes “I’m disabled,” “I’m not up to it,” “I won’t try,” “I can’t.”

That’s my quarrel with automatically  treating behavior and mood problems in kids with antipsychotics.

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Rx for the right doc

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He just writes a syndicated newspaper column.  But this doc raises a critical issue when it comes to treating a mental health problem.

Peter Gott, M.D., isn’t a psychiatrist.  But in a recent column, a reader had been advised by his family doctor to take an antidepressant.  The reader worried about serious side effects.

Yes, Dr. Gott said, these medications, while generally safe,  have side effects, some unpleasant.    But before taking an antidepressant, the he advised the reader to consult a psychiatrist.  Why?  Because that specialist has lots more experience dealing with the side effects of these medications.

Maybe that’s not always the case.  After all, family doctors do regularly prescribe psychotropic medications.   Lots of them.  And people with depression, for example, more likely seek out the family doctor for help first.  So the family doctors aren’t lacking in experience.

There are two problems, though.   One is they don’t have the extensive training in a field that’s highly complex.  More important, they’re often so rushed, they don’t spend enough time with the patient to fully understand a patient’s mental health problems.

Research shows that family doctors miss a diagnosis of mental illness in about half the cases.  And when they get it right, they prescribe the wrong medication.  But the answer isn’t for the family doctor to routinely ship every person who seems depressed off to a psychiatrist.

A better approach comes from the University of Michigan’s Depression Center.  For the past year, the center has been overseeing a pilot program for family doctors in Flint, Michigan.   The program takes as a given the rush the typical general practitioner is to see each patient.  So this pilot program has assigned a nurse specialist to advise the family doctor and follow the patient’s treatment throughout its course.

If there’s a shortcoming to this program in Flint, it’s that so many people still fail to discuss mental health problems with the family doctor.  And they sure don’t want talk to a psychiatrist.   This powerful stigma means lots of people suffer when they could be helped.

But Dr. Gott’s open discussion of mental health is the sort of thing that can overcome the stigma.   Truly, there is help.

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The tar baby war

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We never got around to telling Obama what we thought.

But that’s the way it often goes in our Unitarian church forum.

We’ve got lots of opinions.  But no easy answers.   Indeed, when I asked whether the country had some other option than invading Afghanistan,  Jim, whose son had served two tours in Afghanistan,  said we should start earlier.  He was thinking of how our country had supported repressive regimes in the Mideast.

Well, yes, I allowed as how that history helps explain the hostility some Muslims feel toward our country.   But back to the issue, should we have invaded Afghanistan in the first place.

My thought was to encourage my class to engage in some moral reasoning.  After all, I had bill the series “Living the moral life.”

Once I brought up morality, Steve pounced and declared that morality had nothing to do with President Obama’s decision to send 30,000 more troops to Afghanistan.

Nothing?    Yes, Steve insisted, it’s all politics.

Several others agreed with Steve.   Don, who tries to follow Norse ethics, reminded us that our country had been attacked so we had every right to retaliate.  An eye for an eye.

So for nearly two hours,  my lively little class debated the pros and cons of injecting morality into a discussion on military strategy.

Meantime, I got the distinct impression several folk hadn’t listened to the president’s speech Tuesday.   In fact, one newscast on PBS went from city to city to get reaction and found only one or two people who had heard the speech.

Are we that disconnected from the two wars the country is still waging?

Some critics have complained that President Obama isn’t asking any sacrifices of Americans.   To be sure, he’s proposed no new taxes, while promising that the increase in troops won’t raise the deficit.

Other critics wonder aloud whether we need to reinstate the draft.  The idea is to spread the burden, spread the pain of these wars.    Hmm.  Bring that up in Congress and see how far it gets you.

But if my class at church ducked the immediate question of this troop surge for Afghanistan, I’ve noted that the columnists and editorial writers don’t seem to have much of an answer, either.

In The Washington Post, one noted, correctly, that the Islamic terrorists don’t need Afghanistan or Pakistan as a base.  They can set up shop in Somalia or someplace else.  Even the United States.    But right now, Bin Laden and his followers remain in that mountainous border between those two countries.

Another writer listed half dozen false assumptions in the president’s decision.

I can’t argue with either criticism.   But frankly, I’ve yet to read or hear any plausible alternative to beefing of allied forces and stick it out.

If President Obama announced a withdrawal now rather than a surge, he would be turning Afghanistan back over to the Taliban.   Not only would the Republicans assail such a decision.   It would betray the Afghans who have been our allies.  They didn’t ask us to invade their country.  We could have construed 9/11 as a major crime and not a war.   That’s how the country dealt with the Oklahoma City bombing.

Imagine that U.S. and allied troops had met more resistance than expected on D-Day, retreated to their boats off the Normandy coast and sailed back to England.  We would have left the French to mercies of the Nazis.

So back to my moral question.  And in my mind, it is a moral question.  What’s the right thing to do here?   I don’t think it’s to abandon the Afghan people to the mercies of the Taliban.

Will the surge allow the president to begin withdrawing U.S. troops by July, 2011?

Well, of course, nobody can say.   If you read the accounts in the New York Times and Washington Post of the debates within the administration, you can see that the president and his top civilian and military officials examined every possible option. In the end, it was unanimous.  Give the surge a fighting chance.

We’re there.  And we’re not leaving any time soon.

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Food for thought

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The red-colored flier was there this morning when I opened the door to get the paper off the porch.

“Hello, neighbors,” the flier announced.

We were instructed to collect canned goods and anything else we’d care to donate to poor families.  We’re to set out these food stuffs on the porch Dec. 5.

It’s the 25th annual Christmas Food Box, which serves 1,000 families in our town each year we’re told in the cheery message.   St. Mary’s soup kitchen, the Bishop Luers High School Key Club and St. Johns Elementary School sponsor this seasonal food drive.  And catching the spirit, I noticed that by mid-day my wife had already filled a shopping bag with canned goods.   It’s amazing what middle class people can live without.

I don’t recall any church or civic group dropping off canned goods at my house when I was a kid.   I imagine that because my parents belonged to bridge clubs, the Elks and the country club in our northwestern Ohio town people wouldn’t have guessed that my family couldn’t always pay the grocery bill.

I knew it , though.  I knew it because I answered the door when the butcher  announced to me, age 10, that he was taken possession of our 1937 Chevy because Dad hadn’t paid his bill.

It was humiliating.  But my folks didn’t offer to tell their side of the story.  People have their pride you know.   I was left to suffer the shame alone.

For me today, it’s hard to imagine what it’s like not to have enough money to put food on the table for the family.   Yes, there are food stamps.  Yes, Congress recently increased the food stamp allowance.  That’s now up to an average of $133 a month.  Yet for many households, that only gets you through three weeks of the month.  If that.   Then the family turns to food banks – providing one is available in your community.

It’s the story of a very tattered safety net.

The other day, the Department of Agriculture put out some grim figures.  It seems that within the last year or so, the number of households in which children face “very low food security” has jumped from 323,000 to 506,000.   (In the 1960s, we called it hunger; now it’s food insecurity, a way to pretty up human suffering.)

Well, those figures reflect what’s happened with food stamps.  Within two years, we’ve had a 40 percent increase.   That translates into 36 million Americans relying on this bare bones program for their daily bread.

Most of us won’t be surprised that these numbers, in turn, follow the recent increases in unemployment, now over 10 percent throughout the country.

But the families most likely to be in this fix for the long haul, even when jobs are plentiful,  are those headed by single moms.

President Obama wants to end hunger in America by 2015.  That’s his promise. So let’s all write him a letter or send him an e-mail to tell him to be sure and do that.

Meantime, put your canned goods on the porch.  And send a fat check to your local food bank.

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This tragedy keeps on giving

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Lincoln started it.

The soldier might have been shot to death by the enemy.

He might have died when a bridge he was building trapped him underwater.

Or, the soldier might killed himself.

It didn’t matter.  The cause of death didn’t matter.  Under Lincoln’s signature, the soldier’s family got a letter of condolence.  It expressed the president’s sorrow at the family’s loss.  And gratitude for the person’s service.

Presidents after Lincoln followed his practice.  Until President Clinton.  Somehow, the people at the Pentagon then decided the families whose service member committed suicide didn’t hear from the Commander-In-Chief or any expression of sorrow or thanks.

Just recently, one family spoke up.  Their son fighting in Iraq took his own life.  He’d been deployed several times and had seen lots of action.  In his last call home, he tried to explain how distressed he had been.  But his dad, not fully comprehending the son was on the edge, admonished the boy to “be a man.”   Hours after that phone call the son shot himself to death in the latrine.

The front-page story appeared in the Thanksgiving Day edition of The New York Times.

I suppose publication of treating a service suicide as not a death to be honored will prompt the Pentagon to change policy.  From now on, I expect to see  a letter of presidential condolence will be sent to families whose service member killed him or herself.

It’s yet another reason we need news reporters, to see that outrages such as this get publicly aired and ended.  Yet the revelation comes at an awkward time for the  the military.  Recently, it’s been trying to de-stigmatize mental illness.

Treating suicide as an exception by the military reflects public attitudes.  A former student of my daughter’s recently killed himself.   Another teacher protested, “How selfish!”

It’s cruel to judge.  Moreover, it’s likely to be wrong about the person’s reasons for taking his or her own life.    For those nearly 140  soldiers who committed suicide last year, and almost that many in 2009, civilians can only guess at the horrors these young people have seen in battle.

What I’m reasonably sure of is that the person has become terribly distressed and sees no other way out of the psychic pain.  To be sure, suicide is a tragedy.   But it is not a dishonor.   And if it’s a soldier,  a presidential letter of condolence to the family seems totally in order.

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Great therapy on the cheap

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I still get depressed.

Not every day.  Not every week.  Not even every month.

In fact, I haven’t visited a therapist in ages.  I don’t take anti-depressants.

But I’ve found the secret to beating depression.   Cheaper than pills.  Lots cheaper than a trip to the therapist.

I jog.  About four days a week, starting out about 7 a.m. I head for our nearby part and cover a little more than four miles.  When I run out of breath, I walk.  And you know what?  When I get back home, any worry, any inkling of depression has melted away.

I was reminded of how I handle depression when I saw the recent New York Times article titled, “Getting mental health care when money is tight.”

Given the current economic climate,  the piece was particularly addressed to persons who had lost their job or feared losing their job.

But the tips could very well help anybody struggling with occasional depression or anxiety.  Even if you’re depression is major, simple things like exercising or finding a support group can help get you moving toward professional help.

Most members of the clergy have been trained to listen to troubled souls.  Pastors and rabbis should spot major problems and connect you with the right professional.

You can talk with your family doctor.  The caveat here is that many medical doctors aren’t very good at diagnosing a mental illness.  Nevertheless, a conversation might well open the door.

If cost truly is an issue, you should know that most people who don’t get help for a mental health problem avoid it because of what they expect to be the cost.  Until recently, health insurance hasn’t been very good about covering such problems.

I should also mention that most communities have agencies, such as Mental Health America and a community mental health center, that can direct you to help – often at minimal cost or even no cost.

Another way to make the connection is by calling the national suicide prevention hotline.  Most of their calls aren’t from persons threatening suicide.  And the persons answering the calls are trained to direct you to somebody who can help.

That number is 1-800-273-TALK.

Through the years, jogging has spared me much heartache.   Meantime, on those many outings, I’ve solved problems, planned books and kept myself in excellent health for a person in his 70s.

You might say I’m a believer.

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The wrong side of history

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I just knew Senate Democrats would stick together and pass the move to bring up health care for debate on the floor.

And I figured Republicans would stand together against holding the debate. No lone member of the Grand Old Party would give the go ahead to this historic debate on a matter that affects all Americans.

Frankly, Americans shouldn’t be surprised.  With few exceptions, Republicans opposed the creation of Social Security.  They opposed Medicare.  They were against Medicaid.  They opposed the Great Society programs, such as food stamps and Head Start.    And in this debate, we’ve heard the most outrageous claims, yes, lies from Republican leaders.  They’ve stoked divisions and fostered ignorance.

That’s been the party of Lincoln since the Great Depression – and before.

You’d think the opponents of health care reform would want to get the issues out for a full, robust debate.  You’d think they’d want a crack at changing things they didn’t like about the bill.   Only one House Republican joined a narrow majority of Democrats to pass the more comprehensive bill.  No GOP help in the Senate.

Well, there’s going to be a debate. It will last through the holidays, maybe into the New Year.  But what should promise to be an inspiring, enlightening exercise in democracy likely will be a replay of the acrimony and demagoguery that have characterized the Republican contribution to this point.   So there you have it.  The GOP, once again, on the wrong side of history.

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No coverage, no care

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I don’t believe it.  Now critics of health care reform claim that the new screening recommendations for breast and cervical cancer claim these are the prelude to rationing health care.

This is too much. Here these independent panel of cancer experts issue their reports completely independent of the legislation moving through Congress. Their recommendations are advisory, not prescriptive.  This is rationing?

You want hear about rationing.  What of those with serious disabilities who don’t qualify for Medicaid. I know persons with a mental illness who get turned down or just don’t apply for the government run program. So they don’t have health insurance. Any. Even if they’re working, it’s likely at low-end wages that don’t come with health insurance.

Besides, Congress can always tell insurance companies they can’t dictate at what age they’ll pay for cancer screening.

As for rationing health care: What do the critics think is going on now?

I just ordered new hearing aids. They cost around $5,000. The aids let a person hear plays, music, TV and what your wife just asked you to do.

Thank goodness, I can afford to buy the new aids. But I won’t get a penny toward this considerable expense from Medicare or from my Medicare Advantage plan.

Yet thousands of elderly persons who have major hearing loss, and have no income beside Social Securitysimply do without. Never mind that this is a real, disabling health problem.

This group falls into that category of “under-insured.” And if you add these folk to the nearly 50 million who have no health insurance, you can tack a few more million.

Medicare rations care. Private health insurance rations care, whether you pay or your employer.

Without health insurance, millions of people don’t get health care, at least not when they need it.

Without health insurance, thousands die needlessly ever year.

This is what the debate should focus on. This is what it’s all about. And the lack of health care in a country so rich, so blessed in a thousand ways, is a national disgrace.

For my part, the issue isn’t the cost of health care reform. It’s not the public option. It’s not the deficit. (AS if Iraq didn’t.) It’s about people. It’s about people needing help. It’s about people get sick. It’s about people become disabled. It’s about everyone who doesn’t have health insurance crying out for help and no one, no one is listening.

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Nov. 18: suicide prevention

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Maybe it’s because we nearly lost my son at age 16 to suicide.  How lucky we were.

Stories about the high rate of suicide among soldiers hit home. By the end of  2008, it was 140 active duty men and women.  By mid-November this year, it’s 140, though the Pentagon reports the rate has slowed. Then this week our granddaughter got word that a high school classmate, an honors student, and a former Spanish student of my daughter, killed himself at college.

No doubt, we’ll be talking about the suicide rate in the military at Friday’s meeting of our county’s Suicide Prevention Council. I well remember encouraging our coroner to organize just such a group.  I wrote editorials praising him when he followed through. But it was only the sort of response that Surgeon General David Satcher had called for that year.  Then, retired from the paper, I joined the council, now composed of physicians, a sheriff’s deputy, counselors and advocates.  Our most public event featured Mike Wallace of “60 Minutes” telling his story of depression and thoughts of suicide to an audience of 700 people at Indiana Purdue University.

But for all the meetings and the efforts to train people on suicide prevention, our suicide rate hasn’t changed much.  On any given year, we lose about 30 people, of various ages, to suicide.  That works out to the national average of 10 per 100,000.   That’s more than some countries, fewer than others.

We naturally assume that the recent horrors of combat explains the current high rate within the army.  But the rate is higher among long-time veterans than the civilian population.  

A few years ago, the air force was able to cut that service’s suiciderate, nearly in half.  The psychiatrist who designed the program told me that the main feature was to train officers who managed the airmen and women.  The officers were educated to know when those serving under them were having emotional problems, depression, anxiety and so forth.

By extension, it’s always seemed that training managers and teachersin civilian life along the same lines help avert tragedy.  The watchword is to identify the problems, then see that the person suffering getsprofessional help.

The side benefit is that the more people who are trained in suicide prevention, the better we can combat the stigma. Every community should tackle suicide as a major public health issue, just as we’ve attempted to do in Fort Wayne.   I’ve interviewed a number of family members whose loved ones have committed suicide.  They never comprehend it.  They never really get over it.  I want to say that a suicide always has more than one victim.  

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Ft. Hood – Aftermath

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For starters, here’s my take on Maj. Nidal Malik Hasan’s rampage at Fort Hood:

There’s no evidence so far that he was part of a conspiracy.  There’s no evidence that any jihadi fighter put him up to the killings. Exchanging e-mails with a radical imam in Yemen doesn’t cut it.   There’s no evidence that the military or FBI was negligent in not questioning him for his contacts with a radical Muslim cleric in Yemen. (A  Nor is there evidence that he acted with the thought of changing his upcoming deployment to Afghanistan or any broader U.S. policy.

There is, however, plenty of evidence that Hasan was a deeply troubled man with bizarre ideas, largely living in isolation from others.  Add to that mixture Hasan’s fascination with radical Islam and you can begin to understand how he was able to carry out this unprovoked, murderous rampage.

I recall covering the case of young Joe Corcoran in Fort Wayne.  Acquitted at 16 of murdering his parents, eight years later, he turned an automatic rifle on his older brother and three friends at his sister’s home.   Joe, later assessed as paranoid schizophrenic, explained, “I thought they were talking about me.”

A sick mind can explain a lot of the world’s evil.

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