Sunday 23 May 2010

old habits die hard

Up, Down, Appendices.

Michelangelo DavidGiraffeMiss America Rima FakihAlek WekAlek WekAlek WekBan Ki Moon Michaëlle JeanYoung Buddhist Monk - he looks worried to me.David Horsey - Ship of State
who is this Krugman guy I wonder? can he be trusted? dunno ... can't say ... but one thing for certain, you secular shit-head know-nothings, depression is not a 'disease' (!)

when asked by Lisa Grainger, "How often do you fly?" she said, "Often once or twice a week, for work," and to, "Do you offset your carbon?" Alek Wek replied, "What’s that? Oh, planting trees. Yes, I agree with that. We survived on natural resources, so we should take care of the earth. When I leave home, I do things like switching off the heat and lights."

They're rioting in Africa,
They're starving in Spain,
There's hurricanes in Florida,
And Texas needs rain.

The whole world is festering with unhappy souls.
The French hate the Germans, the Germans hate the Poles.
Italians hate Yugoslavs, South Africans hate the Dutch.
And we don't like anybody very much.

But we can be tranquil and thankful and proud,
For man's been endowed with a mushroom-shaped cloud,
And we know for certain that some lovely day
Someone will set the spark off
And we will all be blown away.

They're rioting in Africa,
There's strife in Iran.
What nature doesn't so to us
Will be done by our fellow man.

     Sheldon Harnick, 1955.

We Will All Go Together When We Go, Tom Lehrer, 1959.
We'll Meet Again, Vera Lynn, 1942.

1. The Old Enemies, Paul Krugman, Nay 23 2010.
2. Depression common in seniors’ facilities, study finds, André Picard, Nay 20 2010.
3. On the Verge of ‘Vital Exhaustion’?, Benedict Carey, May 31 2010.

The Old Enemies, Paul Krugman, Nay 23 2010.

So here’s how it is: They’re as mad as hell, and they’re not going to take this anymore. Am I talking about the Tea Partiers? No, I’m talking about the corporations.

Much reporting on opposition to the Obama administration portrays it as a sort of populist uprising. Yet the antics of the socialism-and-death-panels crowd are only part of the story of anti-Obamaism, and arguably the less important part. If you really want to know what’s going on, watch the corporations.

How can you do that? Follow the money — donations by corporate political action committees.

Look, for example, at the campaign contributions of commercial banks — traditionally Republican-leaning, but only mildly so. So far this year, according to The Washington Post, 63 percent of spending by banks’ corporate PACs has gone to Republicans, up from 53 percent last year. Securities and investment firms, traditionally Democratic-leaning, are now giving more money to Republicans. And oil and gas companies, always Republican-leaning, have gone all out, bestowing 76 percent of their largess on the G.O.P.

These are extraordinary numbers given the normal tendency of corporate money to flow to the party in power. Corporate America, however, really, truly hates the current administration. Wall Street, for example, is in “a state of bitter, seething, hysterical fury” toward the president, writes John Heilemann of New York magazine. What’s going on?

One answer is taxes — not so much on corporations themselves as on the people who run them. The Obama administration plans to raise tax rates on upper brackets back to Clinton-era levels. Furthermore, health reform will in part be paid for with surtaxes on high-income individuals. All this will amount to a significant financial hit to C.E.O.’s, investment bankers and other masters of the universe.

Now, don’t cry for these people: they’ll still be doing extremely well, and by and large they’ll be paying little more as a percentage of their income than they did in the 1990s. Yet the fact that the tax increases they’re facing are reasonable doesn’t stop them from being very, very angry.

Nor are taxes the whole story.

Many Obama supporters have been disappointed by what they see as the administration’s mildness on regulatory issues — its embrace of limited financial reform that doesn’t break up the biggest banks, its support for offshore drilling, and so on. Yet corporate interests are balking at even modest changes from the permissiveness of the Bush era.

From the outside, this rage against regulation seems bizarre. I mean, what did they expect? The financial industry, in particular, ran wild under deregulation, eventually bringing on a crisis that has left 15 million Americans unemployed, and required large-scale taxpayer-financed bailouts to avoid an even worse outcome. Did Wall Street expect to emerge from all that without facing some new restrictions? Apparently it did.

So what President Obama and his party now face isn’t just, or even mainly, an opposition grounded in right-wing populism. For grass-roots anger is being channeled and exploited by corporate interests, which will be the big winners if the G.O.P. does well in November.

If this sounds familiar, it should: it’s the same formula the right has been using for a generation. Use identity politics to whip up the base; then, when the election is over, give priority to the concerns of your corporate donors. Run as the candidate of “real Americans,” not those soft-on-terror East coast liberals; then, once you’ve won, declare that you have a mandate to privatize Social Security. It comes as no surprise to learn that American Crossroads, a new organization whose goal is to deploy large amounts of corporate cash on behalf of Republican candidates, is the brainchild of none other than Karl Rove.

But won’t the grass-roots rebel at being used? Don’t count on it. Last week Rand Paul, the Tea Party darling who is now the Republican nominee for senator from Kentucky, declared that the president’s criticism of BP over the disastrous oil spill in the gulf is “un-American,” that “sometimes accidents happen.” The mood on the right may be populist, but it’s a kind of populism that’s remarkably sympathetic to big corporations.

So where does that leave the president and his party? Mr. Obama wanted to transcend partisanship. Instead, however, he finds himself very much in the position Franklin Roosevelt described in a famous 1936 speech, struggling with “the old enemies of peace — business and financial monopoly, speculation, reckless banking, class antagonism, sectionalism, war profiteering.”

And that’s not necessarily a bad thing. Roosevelt turned corporate opposition into a badge of honor: “I welcome their hatred,” he declared. It’s time for President Obama to find his inner F.D.R., and do the same.

Depression common in seniors’ facilities, study finds, André Picard, Nay 20 2010.

New research suggests up to 42 per cent of resident seniors suffer from the disease

A startling 44 per cent of the quarter-million seniors living in residential-care facilities are suffering from clinical depression, a new study shows.

Researchers found that 26 per cent of residents of nursing homes, personal care homes and long-term care facilities have been diagnosed with depression and another 18 per cent have clear symptoms but no documented diagnosis of depression.

“This study sheds light on the size of this problem,” Nancy White, manager of home and continuing care development at the Canadian Institute for Health Information. “But I think the larger message is that we shouldn’t accept depression as normal in residential care. It is an illness that can be treated.”

In fact, the data show that two-thirds of seniors who had a diagnosis of depression showed few symptoms, suggesting that they were being treated effectively.

On the other hand, those who had symptoms of depression and were not being treated were three times more likely to suffer from a bevy of problems, including poor sleep, isolation, loss of appetite and difficulty communicating.

“In seniors, depression tends to manifest itself with a lot of physical symptoms like this, not necessarily with tears and sadness,” said Marie-France Tourigny-Rivard, an Ottawa psychiatrist who chairs the seniors’ advisory committee of the Mental Health Commission of Canada.

She said the new data point to a need to take the issue of depression – and mental health generally – more seriously in seniors, especially those in institutional care. She cautioned, however, against jumping to the conclusion that large numbers of residents are depressed because of their living conditions. “You can’t assume that living in a nursing home causes depression,” she said.

“Rather, we need to understand that the factors that lead people to live in a residential care setting – physical illness, dementia, loss of a spouse, reduced mobility, etc. – are the same ones that can trigger depression,” Dr. Tourigny-Rivard said.

She said there are two common misperceptions that result in seniors being grossly under-diagnosed and under-treated for depression: 1) the belief that aging is, in itself, depressing and; 2) the notion that that older adults with mental-health problems – whether they have long-term issues or are newly diagnosed – cannot recover.

Dr. Tourigny-Rivard stressed, however, that depression is treatable regardless of a person’s age, with medication, psychotherapy and peer support.

The study, which involved 50,000 seniors in Nova Scotia, Ontario, Manitoba, Saskatchewan and Yukon, is one of the largest and most detailed ever conducted in the residential care setting. All the participants underwent the same standard test for depression, using an assessment tool called RAI-MDS 2.0. The approach has already been adopted by eight provinces and territories.

“This is going to make it a lot easier to collect information, to compare it and to determine if interventions work,” Ms. White said.

Ultimately, data will be available right down to the individual nursing home level and, theoretically, it could be published for public consumption if the provinces so choose.

Nationwide, there are an estimated 250,000 seniors living in institutional-care settings. The data suggest that more than 100,000 of them are suffering from clinical depression.

The number of people living in nursing homes and similar institutions is expected to soar as Baby Boomers hit their senior years. People over the age of 65 currently make up 12 per cent of the population; that number is projected to grow to 20 per cent by the year 2020.

On the Verge of ‘Vital Exhaustion’?, Benedict Carey, May 31 2010.

Decades ago modern medicine all but stamped out the nervous breakdown, hitting it with a combination of new diagnoses, new psychiatric drugs and a strong dose of professional scorn. The phrase was overused and near meaningless, a self-serving term from an era unwilling to talk about mental distress openly.

But like a stubborn virus, the phrase has mutated.

In recent years, psychiatrists in Europe have been diagnosing what they call “burnout syndrome,” the signs of which include “vital exhaustion.” A paper published last year defined three types: “frenetic,” “underchallenged,” and “worn out” (“exasperated” and “bitter” did not make the cut).

This is the latest umbrella term for the kind of emotional collapses that have plagued humanity for ages, stemming at times from severe mental difficulties and more often from mild ones. There have been plenty of others. In the early decades of the 20th century, many people simply referred to a crackup, including “The Crack-Up,” F. Scott Fitzgerald’s 1936 collection of essays describing his own. And before that there was neurasthenia, a widely diagnosed and undefined nerve affliction causing just about any symptom people cared to add.

Yet medical historians say that, for versatility and descriptive power, it may be hard to improve upon the “nervous breakdown.” Coined around 1900, the phrase peaked in usage during the middle of the 20th century and echoes still. One recent study found that 26 percent of respondents to a national survey in 1996 reported that they had experienced an “impending nervous breakdown,” compared with 19 percent from the same survey in 1957.

“‘Nervous breakdown’ is one of those sturdy old terms, like ‘melancholia’ and ‘nervous illness,’ that haven’t really been surpassed, although they sound antiquated,” the historian Edward Shorter, co-author with Max Fink of the book “Endocrine Psychiatry: Solving the Riddle of Melancholia,” said in an e-mail message.

Never a proper psychiatric diagnosis, the phrase always struck most doctors as inexact, pseudoscientific and often misleading. But those were precisely the qualities that gave it such a lasting place in the popular culture, some scholars say. “It had just enough medical sanction to be useful, but did not depend on medical sanction to be used,” said Peter N. Stearns, a historian at George Mason University near Washington, D.C.

A nervous breakdown was no small thing in the 1950s or ’60s, at least by the time a person arrived at a doctor’s office. Psychiatrists today say that, most often, it was code for an episode of severe depression — or psychosis, the delusions that often signal schizophrenia.

“I don’t remember people who got that label ever using it as their own complaint — it was very much stigmatized,” said Dr. Nada L. Stotland, a former president of the American Psychiatric Association and a professor at Rush Medical College in Chicago, who began practicing in the 1960s. “Whether it was ‘nervous exhaustion’ or ‘nervous breakdown,’ anything that sounded psychiatric was stigmatized at that time. It was shameful, humiliating.”

The vagueness of the phrase made it impossible to survey the prevalence of any specific mental problem: It could mean anything from depression to mania or drunkenness; it might be the cause of a bitter divorce or the result of a split. And glossing over those details left people who suffered from what are now well-known afflictions, like postpartum depression, entirely in the dark, wondering if they were alone in their misery.

But that same imprecision allowed the speaker, not medical professionals, to control its meaning. People might be on the verge of, or close to, a nervous breakdown; and it was common enough to have had “something like” a nervous breakdown, or a mild one. The phrase allowed a person to disclose as much, or as little, detail about a “crackup” as he or she saw fit. Vagueness preserves privacy.

Dr. Shorter said that the term “nervous” has traditionally been a “weasel word” for mental troubles, implying that the cause was something physical beyond the person’s control — their damaged nerves, not their mind. And a breakdown, after all, is something that happens to cars. It’s a temporary problem; or at least, not necessarily chronic.

Through the ages, every generation has attributed its own catchall diagnosis to larger cultural changes. Industrialization. Modernization. The digital age. The 19th-century philosopher William James reportedly called neurasthenia, from which he claimed to suffer himself, “Americanitis,” in part the result of the accelerating pace of American life. So it was with breakdowns. The causes were largely external — and recovery a matter of better managing life’s demands.

“People accepted the notion of nervous breakdown often because it was construed as a category that could handled without professional help,” concluded a 2000 analysis by Dr. Stearns, Megan Barke and Rebecca Fribush. The popularity of the phrase, they wrote, revealed “a longstanding need to keep some distance from purely professional diagnoses and treatments.”

Many did just that, and returned to work and family. Others did not. They needed a more specific diagnosis, and targeted treatment. By the 1970s, more psychiatric drugs were available, and doctors directly attacked the idea that people could effectively manage breakdowns on their own.

Psychiatrists proceeded to slice problems like depression and anxiety into dozens of categories, and public perceptions shifted, too. In 1976, 26 percent of people admitted seeking professional help, up from 14 percent in 1947, according to Dr. Stearns’s analysis. And “nervous breakdown” began to fade from use.

The same fate may or may not await “burnout syndrome,” which for now has backing from some doctors and medical researchers. But it has another 30 years to outlast the classic “breakdown.”

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