Wednesday, June 15, 2016

The Limits of Sympathy

Makers, not "takers"

This morning, on NPR a story about some Boston facilities to treat opioid addicted people told of how heroin addicts do not like being revived with naloxone because the drug blocks the receptors for heroin and precipitates an acute drug withdrawal, so typically the addict, once revived, bolts of of the facility in search of another dose of heroin.  

There are other problems not addressed by naloxone:  typically the heroin addicts pop benzodiazepams like Valium, and other drugs, once the high from the heroin ebbs, to prolong the good feeling, so they often arrive at the facility with slow pulse and low blood pressure which are not induced by the heroin but by the follow up drugs.

They interviewed some of these sad souls.  I used to see people addicted to heroin when I was training in a big city hospital, but much more often, we'd see alcohol addicts and we certainly saw nicotine addicted people.

As Chris Christie noted, nobody ever told him or his family that his mother should be denied help when she developed lung cancer because she had been a smoker and brought her disease on herself--we respond to the need, and hate the sin, but not the sinner.

On the other hand, anyone who has been on the front lines of this sort of care and gotten to know addicts as they repeatedly present themselves for help knows the sense of anger one develops as people return for help time and time again. 

Mrs. von Doenhoff, my high school history teacher used to bark, "The only right you have in life, is the right to starve!"  We thought she was a sort of neo Nazi at worst or a Republican, at best.

But there comes a point where you have to ask, am I part of the problem? This is the concept of the "enabler."

Is the "heroin epidemic" something government ought to believe is its responsibility to solve?

The assumption in every news report is that we owe care to these "patients."  The focus is always on how little or how much money the government has appropriated for the care of these afflicted citizens. The story has been, oh, look how we are failing these unfortunate countrymen. 

Perhaps the question ought to be: Ought we be doing more...or less?

Where the decisions must be made

There are reports concerning housing violent mentally ill people at a prison rather than at a hospital facility in New Hampshire.  Apparently, if you house them at a prison the state cannot collect federal dollars for health care, but it may still be cheaper because the prison is already constructed where new construction would be needed for construction on hospital grounds.  But where do people who bite the attendants or who try to strangle their keepers belong? What do we owe them? What do we owe society when it comes to protecting normal citizens from their homicidal fellow citizens?

This is the nerve Mr. Trump tweaks when he shouts President Obama cares more about the rights of perpetrators than he cares about the people they harm.  We have to worry less about who we might hurt, Mr. Trump says, and we ought to care more about who they have hurt. In Trump's case, the "they" are Muslims, all Muslims, but this rhetoric comes from the same well--we are the victims, not them.  I've not heard Mr. Trump talk about heroin addicts, but I would be surprised if he expressed much sympathy for them. He might blame their addiction on President Obama, of course, since Obama is the source of every problem, according to Mr. Trump. 

Looking out for the wretched refuse of American life

When we say healthcare should be a right, I do think of Mrs. von Doenhoff. Healthcare may be a right, but does that give someone the right to wake me from sleep, drag me out to an emergency room to treat the tenth overdose of a man who has no intention of doing anything but seeking his next high?  Someone has to pay people to render care which citizens claim as a right. 

This is the sort of thing Democrats should be discussing. Heaven knows, Republicans have already discussed and decided these issues. 

But where are we, as "liberals" when it comes to the management of society's dependent, failed citizens?


  1. Mad Dog,
    To your question of whether we, as a society, should be doing more or less for the addicted among us, I would argue in many states, including NH, it would be difficult to imagine providing less. Treatment beds are few and far between and there are long waiting lists to fill the ones we do have. Still, despite this lack of treatment options, the addicted are often subject to criticism for not giving recovery their best effort-which they of course should. But then shouldn't we also have some responsibility in giving our best effort to providing treatment to facilitate that recovery? It always seems to circle back to the question of deserving-do these people-these addicts and the mentally ill- truly deserve the same dedication to treatment as the physically ill? We talk about pulling out all the stops in order to fight heart disease, Alzheimer's and cancer yet there has not been a similar response to fighting addiction. Well that is until recently when they started dropping like flies around us and those dropping were no longer just the poor. Now we feel forced to step up our game, at least somewhat..

    That's not to say there isn't often frustration and an overwhelming urge to shake the addicted individual and yell "Fly right". However, the non compliant patient is a frustration to care givers and family members both in the physical and mental health arenas. Whether it's the heart patient that doesn't exercise, the diabetic that fails to eat properly or the alcoholic that pours another drink-all test the patience of those around them. The difference is that usually only in the treatment of mental illness and addiction is discontinuing treatment seriously considered. Rarely if ever do we provide the same level of resources to the treatment of mental illness and addiction as we do to physical ailments-yet they both can be equally debilitating...

    As for housing the mentally ill in prisons-that simply is or should be unacceptable. Public outcry would be loud and swift were it to be suggested that the next time the hospital emergency room is to capacity we trot the overflow over to the prison infirmary. It would be unthinkable to treat the physically ill in that locale -so why is it an option for the mentally ill..

  2. Ms. Maud,

    Agree with every syllable.
    One problem is the underlying and tacit belief that treatment of mental illnesses from schizophrenia to bipolar to addiction is ineffective.
    Whether this is true or not, it drives the discussion.

    Mad Dog