Review: “My Age of Anxiety” by Scott Stossel

My review ran in The Seattle Times Jan. 17, 2014:

 

Scott Stossel’s new book on his lifelong struggle with severe anxiety is outstanding in the fullest sense of that word. “My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind” (Knopf, 400 pp., $27.95) is both conspicuous and superior within its genre. Stossel, who also wrote a fine biography of Sargent Shriver, brings his dogged fact-digging skills to this work, which is peppered with humor and humility, remarkably balanced — and generous to the point of philanthropy with his deeply personal, hard-won knowledge.

Plus, the man is a lovely writer.

If I sound surprised, I am. So many mainstream books on mental health insist on leading the reader into one revival meeting or another — where Big Pharma is a pill-pushing Satan or the best lifeguard on the beach; where the ubiquitous reference guide, “The Diagnostic and Statistical Manual of Mental Disorders” (DSM-5 came out in 2013), is a helpful tool or an insidious guide that unnecessarily labels thousands more people as mentally ill.

Stossel, in contrast, answers questions about the fitness of various diagnostics and treatments with the only truth: It depends.

 

See the rest of the review on the Seattle Times Books page.

The war in utero.

Who knew? It turns out that Washington state law forbids the paying of surrogate mothers. I learned this today by reading a piece in The Seattle Times about efforts to change that law.

Funny, isn’t it, how so many people spend energy keeping tabs on womb traffic, but fall down on the job when it comes to reproductive choices and health?

–From the minute abortion became legal, the fight was on to turn back the clock.

–When a vaccine became available for the sexually transmitted HPV virus that can cause cancer, some factions argued that it would encourage promiscuity. (I guess the day Viagra hit the market those sex police were off attending a workshop on clinic-bombing techniques.)

–Big HMOs and many private docs alike do not routinely offer women screening for sexually transmitted diseases. The subject may not come up at all in an annual physical, and not even in a medical visit intended to address some other gynecological issue.

The bill proposed in Washington is not a bad one. There are many reasons to worry about hiring women to bear children, especially the potential for exploitation. NOW and other women’s rights groups say this law will protect surrogates, which of course is a good thing.

But underneath the legal debate, I believe, lurks our society’s ambivalence about giving women full and private control of their reproductive abilities.

 

 

Blame the victim, create the victim. We do both.

The story about the aftermath of an attack on a CBS newswoman in Tahir Square and the obituary for B.N. Nathanson, the famous abortion defender-turned-opponent don’t bear any similarities on the surface. But both reveal the power of provocative views spoken loud.

After Lara Logan was separated from her news crew, beaten and assaulted by a mob, a number of  bloggers, Tweeters and “columnists” took her to task for being there in the first place. And we’re not talking about anonymous idiots; these are commentators with big, visible platforms. (No, I’m not going to link to them. )

New York Times columnist Maureen Dowd, who quickly went after the hateful Logan-bashing writers, as did Kim Barker, ProPublica journalist, also writing for the NYTimes. Other writers are still responding with articulate anger. One of the common points is that Logan is being punished for her sex and looks (attractive, blonde female); more than one writer points out that no one would berate a man for being mobbed and sodomized.

There are two reasons for this kind of blame-the-victim spewing: The spewer is a publicity-seeking fuckwit willing to use any shocking rhetoric to stand out. Or, s/he needs to believe that evil things happen for reasons, e.g. you get raped  if you’re too pretty. The reality of random hate crimes is too frightening to acknowledge. (There is now actually debate over whether Logan was raped or “just” sexually assaulted.)

Now, Nathanson. This intelligent activist doctor had a lot to do with legalizing abortion and moving it from a back-alley butcher’s job to the safe medical procedure that is the right of every woman. Later, upset by the large numbers of procedures he carried out and supervised, he spoke up as an opponent to the procedure. In both incarnations he wielded great power over public opinion. He founded what became the powerful pro-choice group NARAL and he gave the anti-abortion faction their favorite line when he pointed out a fetus’s “silent scream” while narrating a sonogram of an abortion in progress.

The other similarity between these news stories is that they reveal the only-sometimes-veiled misogyny that still exists in our society. Nathanson was okay with abortion as long as not many women exercised their right to make decisions about their own bodies, lives and health. Commentators (and others who silently agree and don’t challenge them) mouth politically correct sentiments about women being equal to men in the world of journalism, until they get a chance to berate them for being too attractive, too female, and for asking for trouble.

In both cases, I wonder how this sexism would hold up if the tables were turned: The hate-blogger gets left alone with an angry mob or the anti-choicer is told that he cannot elect a medically safe surgery, but must instead sneak off with a fistful of cash to a dangerous, illegal appointment.

Truvada: the underachieving drug.

Let’s pretend there’s a drug that helps minimize effects of lung cancer in people close to death. Call it Inqui. (“Inn-kwee.” Derived from the Latin word for “unfair.”)

Inqui has been around for a few years. Researchers and docs familiar with the drug know it also works well as a preventative for lung cancer if taken daily.

Yet, that knowledge has not resulted in widespread use of Inqui as a prophylactic. Here are a few of the reasons:

–Testing drugs on well people is tricky.

–Anti-American protesters don’t want it tested on poor people in other countries.

–The drug company making it would rather not give it to un-sick people, because live people tend to sue when things go wrong, whereas dead people do not.

And, perhaps most significantly, because politically active healthy nonsmokers are violently opposed to giving the drug to people who smoked. Those people knew the risks and did not seek help to quit using nicotine or breathing second-hand smoke, so screw them.

This would be outrageous. Right?

Yet this is pretty much the case with Truvada, a drug prescribed to people infected with HIV, as described in “An AIDS Advance, Hiding in the Open,” by Donald G. McNeil Jr. in The New York Times.

As he put it:

“The delay [in selling Truvada for prevention] turns out to be a combination of scientific caution and the fiery politics of AIDS. While a medical advance can be made by a momentary flash of inspiration or luck — as legendarily happened with penicillin — proving that it works can take forever. And that is particularly true with AIDS, a disease surrounded by visceral fears, longstanding prejudices and the potential for huge profits.”

Good thing lung cancer affects straight people, otherwise “Inqui” as preventative wouldn’t have seen the light of day either.

Pretty in pink. Yeah, but it’s still cancer.

For some time now, I’ve wondered what it is that seems wrong to me about the breast-cancer awareness barrage — all the pink on the NFL gridiron; the rallies, the walks, the t-shirts, the slogans. Surely it’s a good thing to make people more aware of this disease, right?

Well, yes. But there’s more to it than that. A piece by Peggy Orenstein in The New York Times answers my question: Anything that gets more women to do exams is good…and promoting open conversation about cancer is very good. But the pep rally nature of all of this has also obscured some of the realities. Orenstein had breast cancer. She writes:

“But a funny thing happened on the way to destigmatization. The experience of actual women with cancer…got lost. Rather than truly breaking silences, acceptable narratives of coping emerged, each tied up with a pretty pink bow. There were the pink teddy bears that, as Barbara Ehrenreich observed, infantilized patients in a reassuringly feminine fashion. “Men diagnosed with prostate cancer do not receive gifts of Matchbox cars,” she wrote in her book “Bright-Sided.”

Alternatively, there are what Gayle Sulik, author of “Pink Ribbon Blues,” calls “She-roes” — rhymes with “heroes.” These aggressive warriors in heels kick cancer’s butt (and look fab doing it). Like the bear huggers, they say what people want to hear: that not only have they survived cancer, but the disease has made them better people and better women. She-roes, it goes without saying, do not contract late-stage disease, nor do they die.”

Orestein describes a wave of new attention-getting t-shirts and slogans, meant to attract and educate young women. Some really are funny and clever. (“Save the Ta-Tas” made me laugh, I admit it.) But there’s a real danger that this disease becomes a big pink event, especially for those younger women. Orenstein writes:

“I hate to be a buzz kill, but breast cancer is just not sexy. It’s not ennobling. It’s not a feminine rite of passage. And, though it pains me to say it, it’s also not very much fun. I get that the irreverence is meant to combat crisis fatigue, the complacency brought on by the annual onslaught of pink, yet it similarly risks turning people cynical. By making consumers feel good without actually doing anything meaningful, it discourages understanding, undermining the search for better detection, safer treatments, causes and cures for a disease that still afflicts 250,000 women annually (and speaking of figures, the number who die has remained unchanged — hovering around 40,000 — for more than a decade).”

I don’t think Orenstein wants the breast-cancer walks to stop, and I don’t think she’s claiming that all women share her view. Many feel empowered and supported by this movement. But she does a great service when she asks that we remember that this is a disease, not an ad campaign.

Deep end of the gene pool.

Often when I read some fascinating piece in The New York Times about mental health, addiction or behavior…I look up and see reporter Benedict Carey’s byline on it. The piece headlined “Genes as Mirrors of Life Experiences” in the online edition is the latest one to catch my eye.

The piece is about “epigenetics” — the study of how our life experiences and surroundings affect gene function. This is all new to me — and mind-boggling stuff. I long ago came to understand how my paternal forebears’ addictions took up residence in my genes’ neighborhood, but this? Whoa.

Carey writes:

“In studies of rats, researchers have shown that affectionate mothering alters the expression of genes, allowing them to dampen their physiological response to stress. These biological buffers are then passed on to the next generation: rodents and nonhuman primates biologically primed to handle stress tend to be more nurturing to their own offspring, and the system is thought to work similarly in humans.

Epigenetic markers may likewise hinder normal development: the offspring of parents who experience famine are at heightened risk for developing schizophrenia, some research suggests — perhaps because of the chemical signatures on the genes that parents pass on….”

The children of Holocaust survivors, offspring of veterans with Post-Traumatic Stress Disorder, descendants of successful, happy folks…all those genes carry their own back story, it seems.

Read the whole story here.

Hosed.

If you are in America, make it to your 50s, and have some combination of insurance, alarm about inevitable personal decline, relevant family history and inability to ignore physician edicts, you will probably have a colonoscopy.

No matter what you read or hear, you will wish you could avoid this procedure; if for no other reason than it seems just plain wrong to pay a stranger to do this.

Afterward, you will become one of the veterans who assure others it is a walk in the park. Armed with two gallons of lemon Gatorade and a stack of reading material, the prep is tolerable. The procedure is easier to navigate than an appointment for a root canal. If you’ve given birth, this will not slow you down at all. You’ve been on the beaches of Normandy; this is a parking ticket.

One nagging question remains unanswered. If they don’t find anything wrong in there, how do you actually know they did anything?

The oxymoronic “conscious sedation” works so well that you don’t remember anything that proves the procedure took place. They wheeled you in and next thing you knew, a nice nurse is offering you some apple juice and handing you your clothes. Other than a mad scramble for a BLT and a large chocolate milkshake, the aftermath is uneventful.

What if–as my mother (of blessed memory) used to insist about NASA’s  space program in the 1960s—they faked the whole thing on a sound stage?

We may all be part of a conspiracy much larger than we can imagine. And what with the slashed budgets at daily newspapers, it might be awhile before anyone gets the goods on this one.

End of life prose.

This is a remarkably good article about dying. Don’t get all squeamish now, just buck up and read it.

It’s hard to believe that with all the talk about advance directives, patient rights, hospice and other related topics, there is anything new to say. Yet, as this New Yorker article by Atul Gawande shows, this is a subject with nuances inside of nuances. It is a rare view inside a doctor’s brain, as honest as anything you’ve read.


This is your brain on my blog.

Clip this article, get a sharp pin, and attach it to the shin/arm/other appendage of anyone whose life will be better if they understand how drug/alcohol abuse works.

And, as long as you’re going to that much trouble…make a few copies and leave them in every exam room, waiting area and restroom at your medical-care facility. Some of the folks there need to know about the real science behind addiction.

Give Mom a check, and she’ll spend it on rent.

This post by Paula Span on The New Old Age blog in The New York Times is intriguing. It makes sense, but who knew Social Security had this effect so quickly?

(I’ve excerpted, then edited it down. See the whole piece here.)

In the late 1800’s and early 1900’s, almost 70 percent of elderly widows lived with an adult child; by 1990, that proportion had plummeted to 20 percent, according to the Census Bureau.

Economists Robert F. Schoeni of the University of Michigan and Kathleen McGarry, now at Dartmouth College, investigated this phenomenon, using more than a century of Census data showing where elderly widows resided…they pinpointed the year the big change began: 1940. After that, the graph depicting the percentage of widows living with children resembles a ski slope: down, down and down some more, until by 1990 more than 60 percent of widows lived ALONE.

So what happened in 1940? The economists, testing various hypotheses, found a far simpler explanation.

In 1935, President Franklin D. Roosevelt signed the Social Security Act. In 1940, the monthly checks began to flow. And even those tiny checks — Ida May Fuller of Ludlow, Vt., got the first one, for $22.54 — were enough to allow widows, who had historically high poverty rates, to remain in their homes. As Social Security benefits rose and reached a larger proportion of the elderly, the trend toward remaining at home accelerated.

The single greatest factor driving this immense cultural shift, in other words, was economic. Once elders no longer had to move in with their children to survive, most opted not to.

“When they have more income and they have a choice of how to live, they choose to live alone,” Ms. McGarry said. “They buy their independence.”

Review: “The Pain Chronicles” by Melanie Thernstrom

An excerpt from my latest book review in the Seattle Times:

Pain, most of the time, makes sense. It happens for a clear reason: Break a leg and it’s going to hurt.

Even booming migraines and ruptured discs have a kind of logic. That’s “acute pain,” and it warns us something’s wrong. When the broken things abate or mend, the pain quits.

Melanie Thernstrom is concerned with a very different animal: one that lives on long after it has served its purpose and “transforms into the pathology of chronic pain.” That “pathology” bit is important, because this isn’t just pain that lasts longer, it’s the body’s failure to return to normal.

Chronic pain, Thernstrom notes, is like a security alarm that never quits ringing, so itself becomes the problem.

She writes from personal experience, having suffered for years from pain of various intensities and locations, especially of shoulder and neck. Pain that imprisoned her and either baffled doctors or was shrugged off by them.

For the rest of my review in the Seattle Times, click here.

[Full title: "The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering" (Farrar, Straus and Giroux, 328 pp.]

All the news that fits. And solves.

I’ve only read some of the stories and ads in three sections in Sunday’s New York Times (Book Review, Business and Week in Review) and here’s what I’ve already learned:

Most new fiction is deeply flawed. A five-line letter from Ronald Reagan to his old actress friend Kitty Carlisle Hart is worth $6,100. Whales and dolphins are as smart as we are, and probably nicer. Congo is still the rape capital on earth. Congress still has absolutely no balls when it comes to regulating Wall Street. Our cellphones are built with materials that are obtained at human cost. Author Danielle Steele and legal pot growers in Colorado work harder than the rest of us. Camile Paglia says “female Viagra” pharmaceuticals will not cure the sexual malaise blanketing America.

It seems so clear:

Send sexually disappointed whiners to witness real problems in Congo.  Sell collections of witless Presidential missives as e-books in order to fund the increased cost of cruelty-free cellphone manufacturing. Deploy the hyper-prolific Ms. Steele to the pot-growing operations for one week. Swear in Ms. Paglia, stand her up in front of Congress, and let her spell it out for them: No balls, no glory.

If that last thing doesn’t work, vote for a whale or a dolphin next time.

Death on our own terms: Don’t be squeamish, read this.

This is the best-written newspaper or magazine piece I’ve read in a very long time.

The headline is “What Broke My Father’s Heart,” and writer Katy Butler rewinds her family story to describe what happens when technology–in this case a pacemaker–keeps someone alive beyond the capacity of the mind (and parts of the body) to live anything resembling a normal life.

Anyone who has had to make decisions about serious surgical options and other interventions knows, as Butler describes, how easy it is to just nod, gulp and do the first thing the doctor suggests. Anyone who has come up against the task of putting a loved one’s Health Care Directive or end-of-life preferences into play has brushed up against the experiences behind this New York Times Sunday Magazine piece.

It sounds simple enough on the sunny side of serious illness., then wham. The doctor, and maybe all your family and friends, say go for the chemo. The transplant. The pacemaker. The goal is almost always more time; more technology. Doctors aren’t gods (and most don’t want to be), but it takes a lot of gumption to face one down and demand to hear about other choices…or maybe even to be left alone. And it takes information, determination and an advocate (sometimes more than one) to push back against the health care establishment  (hospital, insurance, Medicare) and just say no to the protocol.

Oregonians, the beneficiaries of right-to-die law, tend to think a care directive is a solution, as do a lot of other people. Don’t want to be kept alive by extraordinary measures? Well, fine. Oops, what about the EMTs who must do mouth-to-mouth resuscitation? What about the medical team that shocks your heart back into action? Then there’s hydration, food-in-a-tube, ventilators. Oy. And here most of us get antsy when a waiter gives us five salad-dressing choices.

When that ludicrous scare campaign threatening “death squads” was being waged against health care reform, I wondered how many of the yammerers  were currently caring for someone who, like Butler’s father, had gone from a vibrant, intelligent and happy individual to a confused, sick and pain-plagued prisoner. His wife became a prisoner too, something he would have clearly done anything in his power to prevent, had he been offered that choice.

This couple had the stuff that’s supposed to help: a strong relationship with a good, sensitive primary care doc and plenty of dough. This is bad, bad news for all who get medical care only from the Emergency Room and who pay it off for years or slap it on the already overloaded Visa card.

I think there’s an excellent chance that Butler’s article might help change things for the better.  We boomers are living longer. It’s up to us how to define what that means, and that requires a lot of thought and clear instructions to each other ahead of time.

Big Pharma: Dare to dream.

Enough already with the anxiety abating, hormone-replacing, artery-cleaning, pain-killing, erection-creating drugs.

What the big pharmaceutical companies need to make and sell is an inhaler that can instantly wipe out a bad dream that lingers. (Just the dream, mind you. Not deleting the to-do list or the multiplication tables.)

A starter dose would deal with basic I-forgot-to-go-to-class-all-semester dreams and holy-shit-no-brakes-in-the-car episodes. Stronger time-release formulas would handle repeating dreams involving giant spiders, rotary-dial telephones in emergencies and divorce demands involving loss of all the good towels.

This nightmare-eraser would soon be on every bedside table in America.

High-risk sleepwalking

When I read “Raiding the Refrigerator, but Still Asleep” by Randi Hutter Epstein in The New York Times, I immediately had two questions:

1. Whoa! Do people actually binge eat in their sleep?

2. Do people do this in poor countries, or just in places where there’s a lot of extra food sitting around?

Epstein’s good reporting and respectful treatment of this makes one take it seriously:

“Consequences of nighttime eating can include injuries like black eyes from walking into a wall or hand cuts from a prep knife, or dental problems from gnawing on frozen food. On a deeper level, many sleep eaters feel depressed, frustrated and ashamed. Upwards of 10 percent of adults suffer from some sort of parasomnia, or sleep disorder, like sleepwalking or night terrors. Some have driven cars or performed inappropriate sexual acts — all while in a sleep-induced fog.”

There’s another thing I wonder about: Why don’t such nocturnal wanderings include chores? Does anyone fold laundry while sleepwalking? Clean out the spice cabinet? Give the dog his ear drops? Vote on health-care legislation?

Wait, nix that last question. I know the answer. 212 members of the US House of Representatives sleepwalked through a vote on March 21. Fortunately 219 of their colleagues were wide awake.

Holsters and health care.

Mississippi Gov. Haley Barbour has answered a question that’s been nagging at me: What’s really behind the strong opposition to the health care plan?

I know that some people worry that changes in insurance regulations will erode the coverage they already have. I’m convinced that out-and-out racism plays a role and that some opponents are more interested in seeing President Obama fail than taking care of their neighbors.

But these things don’t explain the fiery anger, the bold willingness to stand up in front of the entire world and say NO to better care for more Americans, including millions of children, hardworking adults and folks with chronic conditions that can be labeled “preexisting.”

Barbour’s now much-quoted remark about guns turned the light bulb on over my head:

“I do not believe the United States government has a right, it has the authority or power to force us to purchase health insurance any more than, in the name of homeland security, they can force every American to have to buy a gun,” the governor said.”

Setting aside for the moment that this statement is historically inaccurate (look up the Second Militia Act of 1792 in which folks were indeed required to go forth and get guns), Barbour’s sound byte speaks volumes. On some level these opponents simply do not believe that decent health care is something every person needs, therefore they see no reason to create laws that ensure its delivery. They see health care as an option, a luxury; something that people elect to have, like the premium cable package.

Here’s what I’d like to see: A running ticker like the ones in Times Square that report stock prices. Only this one would chart each visit to a doctor or medical facility by an elected official who votes on health care measures, state or federal.

Consider this: rental credits = coverage

The kneecapping may be over between enemies fighting over health care reform, but lesser shin-kicking will continue.

We’ve got some miles to go before these changes to our health care system and insurance industry are really “historic” as is being said. For now, it’s a live battle.

There’s plenty of good news, however. Reform that gets more kids covered or keeps folks with preexisting conditions in the fold is long overdue. Somewhere, the late Sen. Ted Kennedy can be proud.

One big worry, it seems to me, is the continued reliance on the workplace as the host for insurance.

Obviously it makes sense for most people to get coverage through employers, but alternative models would put new safety nets in place. We’ll have the infrastructure to do this. The new reform package includes a plan for health-coverage exchanges/marketplaces where consumers not covered by employers can “shop” for their insurance. Why not expand this plan?

One way to do that: Create small renter tax credits and allow taxpayers to cash ‘em in for coverage plans in those new marketplaces.

My neighbors down the street are a case in point. Yes, they will be helped by the new reforms–with a chronically ill adult, a young-adult employed part-time and a child, they have several vulnerabilities addressed by the plan just passed. But they aren’t out of the woods yet. The head of the household is retired, so traditional employer-based coverage is not in place. He is not old enough for Medicare yet.

Because the family rents a house, they don’t get the tax break that we get for paying interest on a mortgage. Now that the American dream of homeownership at any cost has proven to be something of a nightmare, perhaps it’s the ideal time to revisit a structure that rewards only “owners” versus reliable renters–and to do so in a way that allows people like my neighbors to have a real stake in their health care coverage.