A Cure for Poverty? The indigent depressed are among the most disabled population in the country. Depression is the consequence of constitutional vulnerability activated by psychosocial stress; in the most significantly traumatized population, simply put, you don’t have to have much predisposing vulnerability at all to become depressed. The author contends that depression, in a sense, “hides in plain sight” in our lower socioeconomic strata. It may be harder to recognize dysfunction; there is often no previous higher level of functioning from which to decline. Helplessness is endemic and fate passively accepted.

This has led a small movement of therapists to advocate extremely assertive treatment, “pressing insight into them, often through muscular exhortation.” The simple labelling of the affliction — “to be given the idea of depression is to master a socially powerful linguistic tool” — can be transformative. Medication might be an expeditious addition to such assertive outreach but the proper recipients are less likely to be identified, and it is less likely to be taken consistently, as it must to be effective, without immediately observable effect, or to be continued after relief is gained.

Advocates of such assertive treatment take the position that “people whose condition can be
improved through treatment should receive it whether they want to or not. It is
their view that those who resist treatment place an unconscionable and
unnecessary burden on society.” The author contends that the disorders that receive coerced treatment are the “noisy” ones, notably schizophrenia and mania, where social disruption occurs. I don’t think it’s exactly their “noisiness” that’s determinative, but rather the fact that we think the capacity for insight, including the ability to recognize that one is ill, and the judgment to seek treatment, are palpably impaired by the brain process in these illnesses. The mental health and judicial systems are generally comfortable coercing treatment when, as a result of such a process, a danger to the patient herself or others is posed.

At the other extreme are literal civil libertarians whose position is that treatment should never be coerced.With nonpsychotic illnesses such as depression, unless the person poses a threat we usually feel they have an absolute right to the freedom to choose not to be treated. But perhaps the dividing line is arbitrary. Nonpsychotic illnesses such as severe depression also impair insight into need for treatment and the wherewithal to seek it; is it cruel to leave them untreated? New York Times Magazine

Scientists consider protocol for massive asteroid impact: “A group of scientists is working on a standardized protocol for dealing with the possibility
of a comet or massive asteroid striking the Earth, saying humans can do more than the dinosaurs ever could before a colossal impact
precipitated their extinction 65 millions years ago.” Nando Times

More on how much slack Li’l George catches from the Washington press corps. “The truth is, this new President has done things with relative impunity that would have been huge uproars if they had occurred under Clinton. Take it from someone who made a living writing about those uproars..There is no well-coordinated corps of agrieved and methodical people who start each day looking for ways to expose and undermine a new president… It is Bush’s good fortune that the liberal equivalent of this conservative coterie does not exist.” Washington Post

AA Unmasked: “For 66 years, AA has been the refuge of last resort for millions of desperate alcoholics who have hit
bottom. AA has always been free for the taking, and as testament to its revolutionary Twelve Steps,
its program has been successfully adapted over the years to over 40 12-step fellowships. But
throughout AA’s 66 years runs a history of mistreatment of non-alcoholic addicts and dually addicted
alcoholics that is not in keeping with AA’s own criteria for membership and the spiritual principles the
program espouses.” The Village Voice I’m not sure I agree with this essay that AA ought to embrace drug abusers’ problems. The central importance of identification to the self-help process, the vastly different societal attitude toward alcohol use as opposed to drug addiction, and often the demographic differences between the drug-addicted and the alcoholic all argue for ‘separate but equal’ programs. A drug abuser can attend AA — the ‘steps’, which include acknowledging powerlessness, asking for help, taking things one day at a time, etc., are the same — especially if the more suitable NA meetings are not available enough, but I advise those who do to listen to the alcohol recovery talk as analogy, rather than attempt to explicitly engage the group around their drug abuse issues. The dually-addicted (alcohol and drugs) are the losers in this process, of course.

But I’m even more concerned with the plight of another ‘dual-diagnosis’ clientele, those dually diagnosed with alcohol and a major mental illness. AA groups have usually proven themselves undiscriminating about the differences between self-administered drugs of abuse and therapeutic drugs used for major mental illnesses under a doctor’s supervision. Countless patients have reported to me that, needing appropriate treatment both for their alcoholism and their psychiatric illness, they are caught between a rock and a hard place, needing to attend AA but slammed by its blanket condemnation of ‘mood-altering drugs’. Different AA groups have diferent degrees of enlightenment on this issue, and I’ve given patients permission to be choosy in this regard. I suppose I shouldn’t be surprised about this attitude within AA, since it is reflective of a general societal attitude that the psychiatrically ill rely on drugs to feel better because they lack the willpower or resolve to get over their difficulties on their own.

By the way, if you’re interested in how AA works (or doesn’t), think about trying to find a copy of visionary Gregory Bateson’s 1971 essay ‘The Cybernetics of “Self”: A Theory of Alcoholism’, which appeared in his now-out-of-print Steps to an Ecology of Mind (1972) and was reprinted in the exhaustive 1992 The Restoration of Dialogue: Readings in the Philosophy of Clinical Psychology edited by Ronald B. Miller.

Patients Embrace New Generation of Imaging Machines. Claustrophobia has made many patients, and imaging centers, flock to open MRI scanners. Critics say that this is an entrepreneurial phenomenon and patients do not realize that engineering limitations (on the strength of the magnetic field generated in the open machines, as compared with the conventional closed confining ones) make the scans far less accurate, defeating the advantages of MRI. New York Times

“You have a bona fide story here. It’s the first
federal execution in nearly 40 years and
the biggest crime in U.S. history.” Story of McVeigh’s Death Gives Journalists Pause: ‘(M)any news people are grappling with the question of what exactly so many of them
will be doing in Terre Haute that morning (of May 16th). For even as a satellite-dish invasion of
the prison property begins later this week, producers and news executives say
they are determined to observe the solemnity of the occasion and keep it from
taking on a carnival atmosphere.

“There is nothing extravagant and nothing excessive,” said Phil Alongi, a senior
producer for NBC News in charge of logistics for Terre Haute, who nonetheless
will be sending 40 technicians, producers and reporters for it. “We’re trying to
be very sensitive to all the folks who will be affected. This is a very hard story to
cover: a person is dying. We’re not going to get into all that anchor booth stuff,
with the lighting and who has the most of what.” New York Times My prediction? Carnival atmosphere will prevail; the media circus is inevitable.

Borneo’s apes face extinction as jungle shrinks. “Environmentalists say that in the past decade, the number of apes on Borneo and nearby
Sumatra islands has halved to about 25,000. Within another 10 years, they are likely to be
extinct if the government does not act urgently.

But swift action to protect the environment is not of the highest concern to Indonesian politicians at
the moment. The economy is in tatters; a political crisis is occupying leaders, and communal
fighting is gripping much of the world’s fourth-most-populous country.

Throughout this sprawling archipelagic country, loggers are wiping out centuries-old tropical rain
forests, much of them illegally, as fast as the trees can be chain-sawed. Even national parks, the
last sanctuaries for many species, are being destroyed.” Here’s a blink to the Balikpapan Orangutan Survival Foundation, for those who might think efforts on behalf of the survival of the ‘gentle apes’ are perhaps at least as worthy as those on behalf of their less gentle cousins. Toronto Globe and Mail

Professor set to ‘control’ wife by
cyborg implant. “Surgeons are preparing to create the first husband and wife
cyborgs: they intend to implant computer chips in a British
professor and his wife to see if they can communicate
sensation and movement by thought alone.” I don’t know if it’s just the way The Times covered it, but the wife’s comments on being part of such a momentous event seem pretty prosaic. She is worried about going under anaesthesia for the implant procedure, and she says she agreed to do it because she didn’t want her husband linked up to another woman. Perhaps the ‘control’ issue in that marriage is settled even without a chip implant? The Sunday Times