Author Archives: shrinkrapped

Life and Death Matters

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California’s End of Life Options Act, which allows doctors to write life-ending prescriptions for terminally ill adults who meet strict eligibility requirements, went into effect two years ago. In May, a judge halted the law on a technicality; an appeals court recently reversed that decision. As complicated and lengthy court processes continue to unfold, emotional and legal limbo remains.

“It is an American habit to turn complex moral problems into technical legal reasons,” writes Andrew Solomon in A Death of One’s Own (1995), about his mother’s decision to end her life rather than endure the final excruciating stages of ovarian cancer. Solomon weaves his personal story with an in-depth history of the euthanasia movement before aid-in-dying was legal anywhere in the United States. With unfailing empathy and candor, he explores every nuance of the issue, including how relegating it to the shadows compounds the difficulty. He describes the coded euphemisms his mother used with her doctors to secure what she needed. Solomon, his brother, and their father all whole-if-broken-heartedly supported her choice to die on her own terms at home, surrounded by loved ones. The necessity of secrecy heightened their intense isolation and sadness.

An unequivocal supporter of the right to choose, Solomon is also an unblinking chronicler of the ambivalence, sorrow, and potential risk such choice entails. “There is no question that if euthanasia is legalized it will be abused . . . The question is whether these abuses represent a greater crime against life than does keeping alive people who want to die.”

In the 23 years since A Death of One’s Own was published, much has changed. Seven states (including California) and the District of Columbia now allow some sort of physician-assisted dying. The terminology has also changed: “Death with Dignity” and similar monikers have largely replaced “assisted suicide” or “euthanasia.” Although there are still those who prefer the term “murder,” there is a growing consensus among proponents that existing laws are too narrow, excluding those with conditions such as Alzheimer’s and ALS from seeking legal relief.

What of those who suffer from unremitting psychic distress? Why are people with terminal cancer deemed to have good reason to end their suffering, but people afflicted with chronic depression are not? Here the slippery slope steepens.

Rachel Aviv delves deeply into this disquieting territory in The Death Treatment (2015), about Belgium’s law permitting euthanasia for those suffering from severe and unrelenting psychological distress.

Both Solomon and Aviv are beautiful and compelling writers. Each account illuminates the shadows we must explore to grapple with the awesome complexities of life and death decisions. As California’s End of Life Options Act continues on its topsy-turvy legal course, the imperative to bring into the light what it means to be alive and to die—and who gets to decide–continues.

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What are your thoughts and experiences about this topic? What would you want for yourself?

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(Originally published in the Northern California Society for Psychoanalytic Psychotherapy’s “Impulse”) 

Pre-existing Condition

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I was in Kaiser’s waiting room, scrolling through my phone while listening for my name to be called. Out jumped the news that the Trump Administration was going after the Affordable Care Act again: The Justice Department declared that protecting people with pre-existing conditions from discrimination was unconstitutional.

I am one of the 52 million Americans at risk of losing my health coverage due to this latest assault; I’ve had cancer. I’m fine now, but my trip to Kaiser was for the CT scan I get every year to make sure I stay that way. I will need such follow-up care for the foreseeable future. It’s a similar story for anyone with heart disease, diabetes, depression, and a million other ailments, both major and minor. Before the ACA, my friend’s premature twins could never have gotten health insurance on their own as adults because of their early months in the neonatal intensive care unit. Another friend’s 20-something son was denied health insurance because he had been treated for mild acne as a teenager! Sooner or later, everybody ends up with a pre-existing condition. It’s called life.

Life is what I’ve continued to enjoy thanks to my excellent doctors and post-cancer scans. Normally I’m not anxious as I glide through the CT machine. I feel relieved and grateful to make sure I’m still cancer-free, or if not, to catch and treat it early. As I lie on my back, a soothing voice instructs me when to hold my breath, when to breathe. Normally my intake and release are as relaxed as they are at the end of a yoga class. But not today. After the news, I am hyperventilating. I don’t fear cancer nearly as much as I fear the determination of this President and his Republican enablers to take away my health care.

Since their several dozen failed attempts at repealing the Affordable Care Act, Republicans in Congress and the White House have waged a relentless sabotage campaign. In a cruel and cynical ploy, Republican legislators repealed the mandate–the least popular aspect of the ACA–in last year’s hastily passed tax bill. The mandate’s undoing is now the rationale for eliminating the highly popular provision that prohibits excluding or jacking up the rates of people with pre-existing conditions.

The DOJ’s move will take a while to reverberate through the courts, but the uncertainty it creates will drive up premiums even more, furthering Trump’s goal of imploding the law he hates largely because it’s his predecessor’s signature domestic achievement.

Will this risky gambit work for the Republicans? Maybe not. It turns out people like having access to treatment if it’s not called “Obamacare.” Protecting healthcare has been the #1 issue on voters’ minds across the country, and this has translated into Democratic victories.

So rather than hyperventilating, I’m going to work hard to elect people who want to make America well again. I’m voting as if my life depends on it. Because it does.

Getting Through the Vote

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The enthusiasm gap that has bedeviled Democrats has now morphed into a volcanic eruption of enthusiasm. Here in California, not only are volunteers swarming the state to turn out voters, so many candidates are running in our Top-Two primary that there’s a risk they’ll split the vote and ensure Republican victory in November. Unforced errors and circular firing squads–The Democratic Party’s specialty.

To make sense of this hot mess, a group of us gathered last week to go over the ballot. We are a group keenly interested in politics, and pride ourselves on being well-informed and civically engaged. Here is a sample of our thoughtful decision-making process:

“Our kids were on the same soccer team, and he seems like a nice guy.”

“She donated a kidney to her sister.”

“I don’t like his hair.” (This last one was from me, critiquing Gavin Newsom’s coiffure. At least I was fine with Hillary’s hair.)

What does it portend for our democracy when you can’t distinguish between our group, low-information voters, and a bunch of chimpanzees throwing darts at a sample ballot? And even if we knew who we wanted to vote for, it was nearly impossible to find the right name: 27 people are running for governor, and 32 for U.S. Senator!

Actually, I did do a little research. The more I learned, the more indecisive I became. “I not only lack the courage of my convictions,” I lamented to our host. “I lack convictions!”

As usual, Auto-Correct had the last word: When I emailed the above photo to myself from my iPhone, my subject line–“Gotv”--appeared as “Gotcha.”

Let’s hope tomorrow’s election doesn’t turn into the worst kind of “Gotcha.” And although possibly my persuasive skills leave something to be desired, be sure to get out and vote.

 

 

 

Tall Trees

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I can’t abide anything having to do with Ronald Reagan, but secretly I’ve long shared one of his sentiments.

“If you’ve seen one redwood, you’ve seen them all,” he reputedly said in 1966. Actually, as my extensive research for this blog post revealed, it was Governor Pat Brown who gussied up Reagan’s anti-conservationist statements into the catchy quote we’ve all come to know and love. What Reagan actually said, in a speech to the Western Wood Products Association, is: ”I mean, if you’ve looked at a hundred thousand acres or so of trees — you know, a tree is a tree, how many more do you need to look at?”

The following year, as different factions fought over the fate of northern California’s coastal redwoods, Reagan had this to say about our oldest and tallest trees: “I saw them; there is nothing beautiful about them, just that they are a little higher than the others.”

I guess Ronald Reagan would not be what you’d call a tree-hugger. A vista gal myself, neither am I.

It’s not like I haven’t tried. In my 20s, I spent the 4th of July weekend backpacking with friends in Redwood National Park. It was fine, if you like sleeping on a gravel bar in the middle of a river, unable to see much of the sky because of all those damn trees.

I was never chomping at the bit to return. But my husband, in some weird nostalgic do-over of family vacations from his youth, has long been lobbying to visit Redwood National Park. What’s a wife in desperate search of birthday present ideas to do?

So we came, we went, we loved it. Maybe it’s the wisdom that comes with age, maybe it’s that the rhododendrons were coming into bloom, maybe it’s sleeping in a king-sized bed instead of a river bed.

But in case you’re as stubborn and stupid as I was, or can’t make the trek yourself, here are some pictures to enjoy.

A non-Boy Scout on Boy Scout Trail:

Coastal Trail (with a stop at Hidden Beach), Lagoon Creek to Klamath Overlook:

 

 

 

Starbucks: Teachable Moment

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Many years ago, back when the corporate coffee giants started to swallow up neighborhood cafes, I saw a bumper sticker that said, “Friends Don’t Let Friends Drink Starbucks.” A similar sentiment was resurrected recently with #BoycottStarbucks. The hashtag went viral after a Philadelphia Starbucks manager called the police when two black men in the store asked to use the restroom without buying anything.  The call led to the men’s arrest, which led to national outrage.

I don’t usually go to Starbucks, because I sip my daily café au lait while reading the paper at my local café. But I’ve always had a soft spot for Starbucks, preferring their milky brew over the stronger stuff my friends like. I made one such friend blanch when I told her my favorite nightcap is a mix of 1% milk, water, and a spoonful of instant decaf thrown into the microwave. When it comes to coffee, I am more Philistine than aficionado.

But my affection for Starbucks runs deeper than taste, or lack thereof. As I’ve written before, I like that the company offers a decent wage, healthcare, and some education benefits to its employees. I even liked their widely mocked initiative a few years back to start conversations about race by having baristas scrawl “Race Together” on their cups. Better a clumsy attempt to engage on difficult terrain rather than no engagement at all. As a white woman, I know just how easy it is to steer clear of the topic altogether.

Nonetheless, I ventured into this avoided territory a few days ago. Coming back from my morning walk, I passed a black man who was standing on the side of the road, shaking his head at a super-sized SUV blocking a driveway and extending into the street.

“Man, who would park like this?” he said. “They’re gonna get a ticket, particularly in this neighborhood.”

We were in perhaps the most exclusive town in one of California’s most affluent counties. The blocked driveway led to a leafy estate behind a stone wall.

“Oh, is this your neighborhood?” the man added. “Do you like it here?”

I assured him it wasn’t my neighborhood,  that I was only walking through. (I failed to mention that I live in the next town over, where the houses go for a mere $1-5 million.) I hastened to add that although it was pretty here, I didn’t like how the residents walled themselves off from everyone else while using all the other towns’ services.

The man continued to speculate about how long it would take before somebody called the police and the SUV was ticketed.

“Actually,” I began, and this is where I ventured more deeply into my own clumsy conversation about race. “I bet you have more chance of being ticketed as a black man than this car does.”

He threw back his head in laughter. Then he asked my opinion about the Starbucks incident, saying he thought the company’s response and pledge of training was a good thing.

“I don’t like that Starbucks has been scapegoated,” I said. “This is not a Starbucks thing, That lets white people like me off the hook. It’s a societal problem that happens everywhere.”

“Happens to me all the time,” the man said. “Remember Rodney King? Same thing happened to me long before, only there were no video cameras back then.” He was stopped in Tennessee for driving while black by police, who shot him when he reached for something.

I said something about how terrible that was, how it was a good thing all these police abuses were being captured on smartphones now.

“Yeah, but we sued that police department and won because of course there was no gun!”

I expressed surprise that he was old enough to drive long before Rodney King; he looked so young.

“How old do you think I am?” he had me guess. I was way under.

“I’m fifty!” the man exulted. “You’ve heard that expression, ‘Blacks don’t crack?” Except for President Obama, he cracked, they put him through so much.”

We commiserated over how much we missed Obama.

“I’m JT,” he stuck out his hand. “I’m the foreman on the work crew here.”

I introduced myself, we shook hands, and said maybe we’d see each other again. I looked for him today on my walk. No JT. No blocked driveways. A lot of wealthy white people living in mansions where black and brown people labor. A lot of wealthy white women walking by. Still, JT and I both enjoyed our conversation.

I’ve had more conversations since, with white friends. How we are never questioned when using the restroom, at Starbucks or anywhere else. How we are emerging from the oblivion our privilege provides, horrified to see the extent of racial injustice.  How Starbucks isn’t the problem: we are.

It’s not much. But it’s something.

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Thoughts on what happened at Starbucks?

 

 

 

Here We Are Again: Guns and Mental Illness

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It’s an ordinary school day. Kids and teachers go in and out of the office, phones ring. Then a young man with an assault weapon walks in.

That’s how “DeKalb Elementary,” an Oscar nominee based on a 2013 Georgia incident, begins. As I watched, I thought what a wonderful counselor the office worker would make at the crisis hotline where I consult. Remaining calm and empathetic to the gunman throughout, she defuses a dangerous situation without anyone being harmed.

The day after I saw the film, a young man with an AR-15 walked into a Florida high school and killed 17 people.

We cannot rely on words to stop guns any more than we can rely on armed “good guys.” I juxtapose the two events and my work with at-risk people not to apportion credit or blame, but to illustrate different facets of the debate about mental illness that invariably arises whenever these tragedies occur.

We absolutely need more funding for mental health. Yet what’s often proposed after mass shootings is counterproductive. Donald Trump suggests bringing back institutions to contain the threat. Less inflammatory mental health “solutions” aim to identify and remove “monstrous” people—not their guns–from circulation. Mental health professionals already must report those at imminent risk of hurting themselves or others. Stigmatizing mental illness and enlisting clinicians as wide-net detainers makes people less, not more, likely to seek treatment. Blaming gun violence on the mentally ill overlooks the fact that they account for a tiny fraction of gun homicides and are far more likely to be the victims rather than the perpetrators of violence. It also ignores the biggest threat: guns.

Two days after seeing “DeKalb Elementary,” and the day after the Parkland massacre, I consulted at the crisis hotline. I told the staff how much the film reminded me of them and the unsung, heroic work they do. Counselors listen, assess for risk, and, like the office worker in the film, connect calmly and empathetically to enlist that aspect of the person’s ambivalence that leans toward safety rather than destruction. Outside resources are utilized when there is imminent danger, but usually the internal resources of human connection and compassion are enough to defuse a volatile situation.

Mass shootings and the fear they evoke can cloud assessment and intervention.  Callers are often hostile, distraught, vaguely menacing. Violence is notoriously difficult to predict; thoughts, feelings, and fantasies are not the same as action. Parkland illustrates not only the importance of being vigilant about danger, but the vigilance of making sure we are not overreacting from anxiety to enact ineffectual preventive detention.

Mental health interventions are most effective early on. Guns in the picture indicate that the window for optimal engagement has already closed. A culture that promotes more guns as the solution, not the problem, suggests collective, not individual, pathology.

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This piece originally appeared in “Impulse,” an online publication of the Northern California Society for Psychoanalytic Psychotherapy

 

Enough

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It’s surprising how affecting a pair of shoes can be. Particularly when they’re empty, and when they’re one of 17 pairs representing the students and faculty killed at Marjory Stoneman Douglas High School in Parkland, Florida, on Valentine’s Day.

These empty shoes, bereft of those who normally wore them, were on the steps of my town’s high school as part of a student-led nationwide walkout to protest Congress’s failure to do anything to stop gun violence.

There have been 17 shootings on school grounds in the United States so far in 2018, 208 since Columbine. Including that initial 1999 rampage, which shocked the nation and defined the country today’s teenagers know, more than 200 have been killed. This does not count the additional 29 assailants who died, all but two of whom turned their guns on themselves. Far more have been injured and traumatized.

A dispassionate account of these incidents, most of which never rise to the level of national attention, makes for sobering reading. Most of the victims are young, but so are most of the attackers—too young to even be called gunmen (almost all are male). One six-year-old boy fatally shot his six-year-old classmate. So many of the incidents arise out of arguments, and have nothing to do with the usual false narratives of lone nuts, terrorists, and other bad guys. It’s easily accessible guns—not mental illness or monsters–that turn mundane hot-headedness deadly.

School shootings account for a tiny fraction of the 33,000+ (and rising) annual gun deaths in the United States, and schools remain among the safest places to be. Too many kids have more to fear in dangerous neighborhoods and volatile homes or, if they’re young men of color, from police. All mass shootings, including highly publicized tragedies in nightclubs, workplaces, churches, concerts, and Congressional ballgames and meet-and-greets, account for only two percent of firearm fatalities. Almost two-thirds of all gun deaths are suicides. Research by the Harvard School of Public Health and Everytown for Gun Safety consistently shows that guns in the home are far more likely to increase the risk of injury, especially but not exclusively when domestic abuse occurs. States that have more guns (and less restrictive gun laws) tend to have more gun injuries and deaths than states that don’t. Whether we’re talking about suicide, homicide, or accident, limiting access to guns saves lives,

When we widen the scope of gun violence beyond the school shootings that understandably horrify us, we see, if we care to, the grotesque number of casualties—38,658 gun deaths in 2016, the last year for which CDC data are available. That’s a lot of pairs of empty shoes.

But it is those kids in schools—the post-Columbine generation—whose grief and rage now galvanize a nation. They are not activists for arming teachers, turning schools into prisons, or rounding up the mentally ill. They want politicians to stop cowering before the NRA and commonsense gun safety regulations, and they won’t stop until they get them.

“We are only 24 percent of the population, but we are 100 percent of the future!” The girl leading the walkout I attended exclaimed through her tears.

Her fellow classmate urged everyone to vote. The students paid tribute to the lives that would never be lived, the contributions that will never be made by students just like them. Too many empty shoes. But the kids still here are stepping in and stepping up. It is our sacred duty to step, walk, march, run, speak out—and vote—alongside them.

Does Love Trump Hate?

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Love trumps hate. It’s a nice sentiment, but is it true? Arguably, fear and anger are stronger motivators, and bipartisan to boot: Trump capitalized on those passions to propel himself to electoral college victory, and fear and anger are also fueling the strong opposition that’s emerged since his election.

So what’s love got to do with it? Listening, connecting, empathy—the small and steady force that goes to work on hearts and minds like water on rock. That’s the spirit behind the canvassing I’m doing each month with Swing Left. We travel outside our deep blue bubble to engage with people in the nearest swing district to try to turn a red House seat blue. Door-to-door canvassing is like phone banking with exercise—moving down the list of people who mostly don’t answer. But when they do, something small and miraculous happens: listening, connecting, caring about the other person.

We ask people about their local concerns, how they’re feeling about the direction of the country. Talking to people helps me curb my own tendencies toward writing off those with different viewpoints. Of course we are trying to identify votes for Democrats in the mid-terms. But we also seek to understand what matters to people. I can assure you, it is not the Russians, or Trump’s tweets, or shutting down the government (a move that generally generates disgust, not kudos).  Mostly, people are concerned with traffic, healthcare costs, jobs. Danica Roem, the Democrat who unseated a long-term Republican in Virginia’s House of Delegates last fall, understood this. She may have won a place in history by being an out transwoman, but she won her campaign by focusing on fixing the congestion on Route 28.

She also won because of voter turnout: the highest statewide in 20 years for an off-year race, with the youth vote doubling in less than a decade.

Which brings us back to love and hate. Love’s opposite is not hate but indifference. We hear it all the time: “It doesn’t matter.” “Both parties are the same.” “My vote doesn’t count.” “Nothing will change.” Political demoralization is rampant across party lines, and it’s easy to understand why people who feel that politicians are indifferent to them are indifferent to voting.

The silver lining to the 2016 election is that many people who have never before participated in politics now see that elections have consequences, the outcomes are not the same, and that their involvement matters very much.

A sign I saw at this year’s San Francisco Women’s March sums it up:

This past election was not determined by Trump voters.

It was not determined by Democrats.

It was determined by non-voters.

Love won’t trump Trump and his GOP enablers. Voting will.

 

 

 

Crumbs

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A recent AP story about how people are starting to see a bit more money in their paychecks reveals the scam at the heart of the GOP tax overhaul. One woman notes that she is now earning an extra $1.50 per pay period. I assumed that must be a typo, until the article explained that this amounted to $78 more per year.  A man whose paycheck boost covers two-thirds of his increased healthcare cost enthuses, “I have heard time and again that the middle class is getting crumbs, but I’ll take it!”

Actually, the middle class is getting screwed.

Unstated in the article, or in the massive GOP snow job touting this “reform,” is that the wealthiest individuals and corporations will pocket the lion’s share—not just in dollars, but in percentages. According to NPR and the Tax Policy Center, households making $1 million or more per year will get an average tax cut of $69, 660, or a 3.3 percent increase in income. Those making under $100,000 will average a tax cut of just under $1,000, a paltry 0.1-1.8 percent increase. The trivial amounts with which the Republicans are attempting to buy off ordinary Americans end in a few years, whereas slashed corporate tax rates on wealthy companies are permanent. There’s also no mention that tax cuts for the super-rich are funded by targeting blue states, healthcare, and many other programs Americans depend on. These include Social Security and Medicare, which House Speaker Paul Ryan has already vowed to go after next. His rationale? To curb the deficit, which he and his cronies have just enthusiastically exploded by massively cutting taxes for millionaires and billionaires.

Speaking of Paul Ryan, he evidently saw the same AP story I did. He didn’t think $1.50 was a typo, though, or cause for horror. Instead, he saw it as something to celebrate, tweeting about it as a success story. Ryan deleted the tweet after being roundly attacked for it.

He may try to cover his tracks, but Republicans can’t erase the truth. Their motto is, “Let them eat crumbs.”

We shouldn’t swallow it.

Once in a Super Blue Blood Moon

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Since my husband and I failed to transform our lives with the life-transforming solar eclipse last August, we vowed to do better the next time big events involving celestial bodies occurred. At least if it wasn’t too much hassle.

This morning, we West Coast denizens were promised front-row seats to the trifecta of a blue moon/super blood moon/total lunar eclipse practically on our doorstep. So we set our alarm for 5:00 a.m., not much of a sacrifice for a middle-aged couple up several times a night to pee anyway.

Our weather app had predicted clouds from 4:00 in the morning on, so I was hopeful that we could glance out the window and go back to bed. I was already on a winning streak, having convinced my husband that no, we did not have to drive to a faraway high point and hike up a trail in the dark for a good view. Really, standing in front of our house and looking west should suffice. As a compromise, I had agreed to drive three minutes to a reasonably good vantage point if the eucalyptus trees on our hillside blocked the view. Assuming there was a view, if our weather app was wrong. Which it usually is.

When the alarm went off at 5:00, I awoke from a dream in which I was getting a commendation of some sort. I volunteered to put on my robe to see if the cloud cover had materialized. My dream became reality as my husband murmured from under the warm covers, “Thank you, you’re my hero.”

I could see through the living room window that the night sky was crystal clear, so as promised I made the extra effort to go down to the street in front of our house. Sure enough, there was the moon. Pretty spectacular, as the photo at the top suggests. Except that’s the street lamp at the end of our cul-de-sac.

This is what the super moon/blue moon/total lunar eclipse actually looked like at its awe-inspiring peak:

In order to get out of the street lamp’s glare, we hopped in the car and whizzed up the hill three minutes to a better vantage point. There we had an unobstructed view of a small orange-ish orb covered by a brownish smudge (see above). It looked nothing like the on-line photos that had lured us into becoming celestial gawkers at such an ungodly hour. Those showed the moon looking like a gigantic red clown’s nose blotting out the sky. Damned cheaters using filters and special lenses instead of an old iPhone or the naked eye!

It was too late to crawl back into bed, so we got on with our day. Life transformation would have to wait. Possibly until later tonight, when we resume binge-watching Season 3 of “Outlander,” where not only lives but centuries are routinely transformed. Claire and Jamie: Talk about celestial bodies.