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LOVE FOR SALE: the trouble with professional caregivers 04/04/2011

Posted by ALT in Mental Health News.
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Remember Dr. Levin?  He was the psychiatrist featured in the New York Times a few weeks back as a case study in the new, industrialized form of psychiatric care that is increasingly becoming the norm: he describes himself as similar to “a good Volkswagen mechanic” and offers his many clients 15 minute in-and-out appointments, which start off with a symptoms checklist, move on abruptly to diagnosis, and finish with prescription(s) for psychotropics.  There simply isn’t time for exchanging pleasantries – like the patient’s actual name – or for suggesting alternatives to medication like talk therapy or mind-body healing practices. 

LOOK OUT: Dr. Levin isn’t a scary singularity, and neither is psychiatry as a field. 

The article describing him was part of a series (Doctors INC), in which the NYT is documenting a similar shift that is happening across all fields of Western medicine.  A shift from individualized, long term care of a small number of patients (50-60) taking place in modest clinical practices (maybe even home-based!) to industrialized, “efficient,” high volume traffic of literally thousands of patients taking place in hospitals.

In the series’ most recent article, “More Physicians Say No to Endless Workdays,” we see this theme as it plays out in a single family composed of three generations of doctors.  Grandpa had a private, mostly home-based practice (Grandma used to boil urine samples on the stove!).

"Grandma, why does dinner smell like Kevin's diaper?"


Father had a private practice but spent most of his hours at the office and was always on call; and finally Daughter, Dr. Kate Dewar, is working in a hospital emergency room, a salaried doctor for a private corporation.

She cites several reasons for the shift – in her current position she is never on call, she has the opportunity to perform more “interesting procedures… collect[ing] rare and difficult interventions like merit badges,” and she can “fix stuff and move on,” not having to worry about pesky follow-up or long term care. 

But Ms. Dewar’s primary motivating factor was the birth of her twins in February.  As a salaried ER doctor working for a corporation, she can work fewer hours, spending more time with her children. 

Understandable.  And admirable!

But wait…

“Look, I’m as committed to being a doctor as anyone. I went back to work six weeks after my boys were born. I love my job,” said Dr. Kate Dewar. “But I was in tears walking out of the house that first day. I’m the mother of twins, and I want to be there to feed them, play games with them or open presents with them on Christmas morning. Or at least I want the option to do those things without fearing I’ll be called back to the hospital.”

The pain of that first week’s separation was lessened somewhat because she worked in the hospital’s new pediatric emergency department. “I felt better knowing that at least I was taking care of somebody else’s babies even if I couldn’t be with mine,” she said.

(from the NYT article “More Physicians Say No to Endless Workdays;” emphasis added)

I thought she wanted to spend more time with her kids?  At 6 weeks old, her babies are still well inside the gestation period, three pre-natal trimesters plus the post-natal “fourth trimester.”  Put simply, though they’re not physically connected by umbilical cord anymore, they still make up a mother-baby dyad.  Those babies need mama.  24/7.  And mama needs them, too.  It’s biological, instinctual. 


The Vicious Cycle

So this is how the vicious social services cycle begins.  Instead of directing her instinctive surge of mothering energy towards her own children, Dr. Dewar directs it – for profit – towards the children of strangers [probably using some of the profits to hire a professional caregiver to direct inferior mothering energy at her own children]. Finding themselves out-of-place and re-placed in the professional setting, the mothers of Dr. Dewar’s surrogate, hospitalized children will then be forced to redirect their own energies, starting a double-edged chain reaction: all of the mothers continuously frustrated by failed attempts to mother other things (not the children they were designed to care for) and none of the children benefiting from the highly personalized and unconditional-love-charged energy of their own mothers.

When professionals take the place of parents, everyone suffers – biological parents, children; the surrogate (professional) parents, their charges, and their true (biological) children.   No one is completely free to give the gift nature designed us all to give [unconditional love!]; no one fully experiences the benefits of such an amazing gift successfully given/received.  Will the defecit created in all of these [physically, emotionally, spiritually] frustrated  folks pave the way for more social “services” later in life?  It’s a strong possiblity. 

No matter how well paid, professionals simply can’t love children like biological parents can.  And love is what a baby needs, above all else — even the most critical condition, premature baby.  Skin-to-skin contact.  The reassuring voices of people baby knows well (though she has only recently been able to see them, she’s been hearing their every word for the past nine months!). 

Love.  Free.  Unconditional.  Forever.

Agoraphobia: Reaction to the true tragedy of the commons? 02/12/2011

Posted by ALT in Historical Context, Philosophy/Spirituality.
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1 comment so far

Economists describe a theoretical “tragedy of the commons” as the supposed tendency individual humans have to exploit commonly held resources until they are all used up (so selfish!).  As usual, economists’ opinions of humans are pretty low.

"Yup, that's a typical human all right."

Really, this theory is historically dishonest; there are numerous examples of societies peacefully and agreeably maintaining common resources (such as a grazing area for cattle) but only a few of the common resources being eaten up by selfishness – and most occur after the advent of industrialization (and are brought about not by the commoners, but by an oppulent business class).

No, the true disappearance of the commons was precipitated by the industrial revolution.  Common lands once open to all were “enclosed,” ie fenced in, to push peasant workers away from rural agriculture and towards urban centers where their labor could be utilized in factories.  It began in Britain (fearless leader of the industrial revolution that it was) and then continued on in any other place that chose, or was forced, to follow their “shining example.”

A little closer to home, you can look at the invention of barbed wire and the great enclosing of the West as the last step in deleting the tradition of commonly held land that the Native peoples of this continent had been carrying on for centuries.

Thus the great process of isolation and individuation (brought about in part by the Industrial Revolution) –what I call the true tragedy of the commons– began.

Now to be in a public space, such as a coffeeshop or a town plaza, buying something (anything!) is a necessary first step — it justifies your existence in a private, consumerism-driven place.  What are the consequences for the mental health of people who no longer have a common place to just be, without feeling compelled to buy anything?

In pre-industrial societies, common land between houses and workshops existed automatically — so it was never neccessary to make a point of it… But in a society with cars and trucks, the common land which can play an effective social role in knitting people together no longer happens automatically.  Those streets which carry cars and trucks at more than crawling speeds, definitely do not function as common land… The common land has two specific social functions.  First, the land makes it possible for people to feel comfortable outside their buildings and their private territory, and therefore allows them to feel connected to the larger social system–though not necessarily to any specific neighbor.  And second, common land acts as a meeting place for people…

The common land between buildings may have a deeper psychological function, which remains important, even when people have no relation to their neighbors.  In order to portray this function, imagine that your house is separated from the city by a gaping chasm, and that you have to pass across this chasm every time you leave your house, or enter it.  The house would be disturbingly isolated; and you, in the house, would be isolated from society, merely by this physical fact.  In psychological terms, we believe that a building without common land in front of it is as isolated from society as if it had just such a chasm there.

There is a new emotional disorder — a type of agoraphobia — making its appearance in today’s cities.  Victims of this disorder are afraid to go out of their houses for any reason… We speculate… that this disorder may be reinforced by the absence of common land, by an enviornment in which people feel they have no ‘right’ to be outside their own front doors.  If this is so, agoraphobia would be the most concrete manifestation of the breakdown of common land. 

(from A Pattern Language: Towns, Buildings, Construction, p 337-338)


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