Wealth and Health: More Complicated?

It’s no secret that the wealthy in America have better health outcomes than the poor. The disparities can be shocking. It affects quality of healthcare, food, lifespan, and can even affect whether someone will contract an illness after being exposed. There are many conclusions we can draw from this fact (the extreme wealth disparity in our country is not only unethical but is in fact contributing to illness and death, we need universal healthcare, America sucks), but the picture may not be as simple as some articles prefer to paint it as. In fact, the reason that the wealthy are healthier may not simply be because they have access to better healthcare and healthier food, safer environments and less violence, but it may in fact reflect the fact that our society is set up at every level to cater to their needs.

Those who are poor are most often those who are discriminated against for race, gender, sexuality, or disability, things which all contribute to poor health outcomes. Police brutality and the prison industrial complex come down most harshly on people of color. Oddly enough being beaten by the cops and sent to prison aren’t too good for your health. The mentally ill often have their diseases dismissed as “all in your head”, which can lead to loss of jobs, healthcare, housing etc. and bad physical health outcomes. These intersections get ignored when we simply look at class without reminding ourselves that class is affected by other identities.

One article points out that the marshmallow test is associated with positive outcomes later in life, and that those who tend to do poorly on the marshmallow test tend to be poor. But the marshmallow test has been criticized as measuring the skills that make you successful in a white, upper class world, rather than the skills that make you successful in a world where you can’t necessarily trust authority. Most of these studies seem to be indicating that the wealthy are taught the successful ways to navigate the world while the poor are hurt by the way society is set up.

So for those who are poor, you have every right to be pissed off. Society is set up to shorten your life span by creating food deserts, making organic and healthy food more expensive and more time consuming to prepare, by increasing your stress by taking away your choices, by housing you in neighborhoods that are more dangerous and houses that are less healthy, by making gym memberships expensive, and by continuing to not educate or miseducate the poor on what it means to be healthy.

But what can we do? If society is set up to see us fail, how do we take our lives into our own hands and decide WE WILL BE HEALTHY? One of the first things that I’ve found helpful is to reconfigure our conception of our own health: being healthy isn’t just a choice we can make for ourselves personally, it can also be a political statement. I’m sure I’ve posted my favorite Audre Lorde quote here before, but if I haven’t, here it is:

“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

I didn’t mean to put that in big ol’ letters, but I’m going to leave it that way because I think it’s that important. When the poor and oppressed among us live longer and healthier, we actively resist the society that wants us to be so downtrodden we can’t resist. The more we can see our choice to be healthy as a gigantic middle finger to a shitty system, the easier it is to make good choices (or at least I think so). A big part of this is forming communities. Cooking takes time and energy as well as money. If you get together with friends and each cook something, then do a big swap so you have a variety of foods for the week, you’ve saved time, probably money (because bulk is awesome), and you’ve provided yourself with the added benefit of social interaction (shown to be good for your health!).

We can also inform ourselves: information is powerful. Know what kinds of foods make you feel good, understand what a balanced and healthy diet looks like (protip: it does in fact involve some fat and sugar), and understand what healthy exercising habits are (regular, but not compulsive). Share information with each other. If you find something awesome and healthy, tell other people about it (Rock climbing! Fun! Exercise! Woot!). Share resources like low cost clinics for physical and mental healthcare. Support those places! Spend some time volunteering for Planned Parenthood or a local clinic that provides similar low income care.

None of this can change the fact that your environment is out of your hands. But we can look out for each other: if one of us spots mold in another’s apartment, we can research how to get rid of it and the potential health risks. If one person works from home and has tons of friends who don’t have time to cook, maybe their friends can throw a few bucks their way and ask them to cook in bulk. Share EVERYTHING (ok maybe not everything, but recipes, tips, exercises, doctors, good apartments, job leads…your community will give back to you if you give to it).

Remember that statistics don’t mean all of us are doomed. They point towards trends but they can’t predict your individual life. If you want to fight those statistics, here are some resources for low-income healthiness.

1. Fitness resources for low cost

http://www.mayoclinic.org/healthy-living/fitness/in-depth/fitness/art-20047989?pg=1

http://www.webmd.com/fitness-exercise/features/6-ways-build-better-body-budget

http://frugalliving.about.com/od/beautyhealthcare/tp/Frugal_Exercise.htm

2. Healthy food for lower costs

http://www.webmd.com/food-recipes/features/cheap-healthy-15-nutritious-foods-about-2-dollars

http://www.nerdfitness.com/blog/2012/12/27/cheap-and-healthy-food/

3.  Low cost healthcare (this should be easier with Obamacare!). I’m going to put Minnesota resources since that’s what I know.

http://www.health.state.mn.us/clearinghouse/public.htm

http://mn.bridgetobenefits.org/MN_Low_Cost_Health_Care_Directory.html

If anyone is interested, I am willing to host resources here and connect others who are interested in improving their health at a low cost. We can build our own communities that provide the same benefits that having lots of money does for the wealthy.

Childhood Surgery and Mental Health

When I was about five years old, I underwent a major invasive surgery. I don’t talk about it often because it wasn’t exactly dinner table appropriate: I had problems when I was a child with UTIs because my urine would reverse along my urinary tract if I didn’t pee. Yup, refluxing urine. Sexy. It had the potential to give me serious bladder infections throughout my life, and wasn’t responding to antibiotics, so in order to keep me from being in pain often and really fucking up my urinary tract, the doctor reimplanted my ureter to a better location so my urine would stay in my fucking bladder and out of my god damn kidneys.

Lovely right?

Now at the time it seemed like it was just an unpleasant experience. It happened and it hurt and I was utterly miserable for about four days of my life. I remember not really eating or sleeping at all. I remember puking a lot the first day because they couldn’t get my pain meds right. I remember peeing a lot of blood. That’s about it. I moved on. I continued my life and I didn’t think about it very often except that every time I drove past the Children’s Hospital in my city I shuddered and told my parents to get me away from the “Dreaded Hospital”.

Until a few months ago when my therapist asked if there was any trauma in my past. I shook my head, sure that my childhood was normal and safe. She pushed a bit, asking about violence or loss or surgery. Surgery? Surgery counts as trauma? Yes, apparently it does, and often leads to PTSD in children (particularly invasive surgeries such as the one I had and surgeries that require multi-day stays at the hospital).

I’ve spent some time poking around the interwebs looking for more information about surgery and trauma, about what sorts of effects surgery can have, about why surgery is considered a trauma, and I’ve been having a really hard time finding much qualitative information that might shed some light on the connections between my severe dissocciative tendencies, my depression, my anxiety, and my surgery.

As someone whose natural impulse about things is to learn about them, to get information, to explore them from every angle, having an event in my past that I cannot research is unsettling to say the least. But more than that, I find it worrisome that the only resources I can find for parents of kids who are going to be going through surgery seem to be geared either at sudden and extreme accidents or towards cancer.

It seems to me that once again mental health concerns are being ignored, even in a situation where someone is already receiving medical care and should be under close supervision of doctors. Why is there not a mental health professional involved every time someone goes under the knife? It’s a scary proposition, even if you’re prepped and feel fairly comfortable. In addition, based upon my own experiences, I would hazard a guess that even if a child does not show immediate signs of PTSD after a surgery, there is a possibility that it could affect their mental health in years to come. Having someone around to teach them strong coping skills and help them process the experience could save the medical industry lots of money in the future (imagine if they hadn’t had to provide me 3 years of eating disorder treatment. Huzzah!) and potentially lessen a great deal of emotional pain for people who have internalized lots of fear and anxiety without realizing it.

It’s becoming more and more clear with research into neuroscience and neuropsychology that the experiences that we have as children deeply affect our brains. Even a limited amount of isolation can affect a brain for years into the future. Surgery can be isolating, it can be painful, it can force a child to deal with mortality, it can be overwhelming, and it can be confusing. These things can change the brain.

Typically a kid is coddled a bit after something like surgery, so you might not see the effects right away: they would be supported, they would have their needs taken care of, they’d have mom and dad around. This means they’re not going to be in a high stress environment where they might need coping skills. It’s only when they’re put into a situation that requires coping skills, or even a situation that feels remotely like their surgery experience that those effects might begin to pop up.

This is pure conjecture on my part, because as I said before I couldn’t find much by way of information, but I suspect that having something like this in one’s past would significantly increase one’s susceptibility to mental illness in the future, as well as potentially create some intense anxieties or fears that aren’t totally rational. Imagine that I’ve been seeing mental health professionals for over five years talking about anxieties and depression, and never once did they think to ask me whether I’d undergone any sort of serious medical experience. It took until this year for someone to even consider that having that trauma in my past might be related or might help me understand. 3

Why are mental health and physical health so bifurcated? Especially given the research that we’re finding that suggests that our brain is deeply connected with all sorts of other body systems, and that we rely on the same chemicals and hormones for all sorts of things, why on earth aren’t we integrating our treatment of mental and physical health? Why aren’t we sharing medical records between our mental health care providers and our physical health care providers?

It’s hard to express how frustrated I am about this, as it feels like an important element of my own health has been hidden from me, as if a doctor had found a gene that put me at a severe risk for cancer and neglected to mention it to me (I do recognize that when I was 5 the research on neuropsychology was nowhere what it is today, so it’s not as if I’m holding a grudge, but rather just feeling confused and hurt that with more information I perhaps could have avoided some of the shit that has been in my life in the past three years). I never thought that this could be an important element of my mental health, but the moment it was mentioned it clicked into place.

The feeling I feel when I am bored, when I feel useless, when I feel alone, is the same feeling I get when I think of my surgery. It’s hard to explain the sense that comes over me when I remember those days because it’s so visceral as to be nonverbal. That says something to me about its importance in grounding many of my other emotions and experiences of emotions. I feel as if I’m wavering away from myself when I think about it, but I can see my body stilling, the panic bubbling through my chest. My teeth clench. I lose the sense of my whole body. I remember the dark, the night, lying in bed unable to sleep with no one there, no one to speak to, nothing to do. It feels like it won’t ever end, it goes on forever because I can’t do anything. It hurts. I remember how much it hurt. I remember trying desperately to stay awake when they were putting me under, a bit confused about what was happening, but knowing that I wanted to keep talking to the people around me. I don’t want to go to sleep, I don’t want to go to sleep, but now hurts and I just have to sit in it because there’s no way out.

When I think about that, it’s hard not to see just how badly that experience hurt me, how it told me that my body was probably broken, how it told me that there was something wrong with me and that the only way to be safe was to always keep my mind safe and perfect.

I just wish I had known that I could think about it or talk about it or process it earlier. I wish I hadn’t kept it tucked away for 17 years. I wish someone had helped me. I don’t know that there’s a taboo around surgery, but I certainly think there’s a silence around it. I wish there were more people talking about their experiences, more ways I could find some sense of community or solidarity.

If anyone has more resources about these connections I’d love to see them, but until then I simply want to say that if anyone else wants to talk or needs support I’d love to hear from them.

DSM V and Diagnostic Woes

THE NEW DSM IS OUT AND I HAVE A COPY OF IT! For those who don’t know, the DSM is the Diagnostic and Statistical Manual, essentially the bible of Psychology. It’s what’s most often used to diagnose someone, and if you want insurance to cover treatment you generally need a DSM diagnosis. They’ve been in the midst of some pretty contentious updates for a long time, but I now have my hands on the brand new copy of the DSM-V.  Mmmm, tasty.

 

Of course when I got ahold of it I spent a good half an hour paging through and self-diagnosing, but after that diversion, I moved over to the eating disorder section to see what updates had actually gotten through and how they had phrased them. I was happy to see the inclusion of Binge Eating Disorder, as well as Night Eating Disorder and Purging Disorder as new categories in the manual, but when I looked back at our old favorite anorexia I was…annoyed.

 

One of the most contentious points in the DSM IV was the weight criterion for anorexia. While this has been removed from the current version and replaced with the following: “a significantly low body weight in the context of age, sex, developmental trajectory and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or, for children and adolescents, less than that minimally expected,” there is a scale to determine the severity of the disorder. This scale is entirely based on BMI, with the caveat that a psychologist can make adjustments if necessary. And I must say that the numbers listed on that scale are INSANE. To be considered a moderate case, your BMI needs to be between 16 and 17.  My BMI has never been even close to that. While I generally dislike numbers, and I am going to insert a HUGE TRIGGER WARNING right here, when I was at my worst I literally would go for a week without eating at times. I never ate two days in a row. I was seriously ill. However my body weight never dropped into what would be considered technically underweight by the BMI scale. I would have been considered a mild case, even if I had gained the diagnosis at all (as it stands I was diagnosed with EDNOS because of the weight criterion in the DSM IV).

 

We have gone over and over the harms that come from including weight as a criterion of an eating disorder. First and foremost, it keeps people from getting treatment until they’re already too sick, which is unhelpful to everyone involved. It ignores how different bodies react to starvation. It ignores that people’s weight can fluctuate throughout the disorder or treatment. It’s simply unrealistic. But more than anything, I feel like it shames those people who never get that diagnosis. It tells them that their pain and suffering wasn’t real unless they hit the magical BMI of 17 marker. And I am so disappointed in the writers of the DSM that they would ignore all of the feedback they’ve received from the eating disorder community and still include BMI criteria for anorexia. I’m so disappointed that after all the research and stories and experiences that people have shared that illustrate that an eating disorder is not about weight, we still have to reduce to such. And most of all I’m disappointed that until the next rewrite, more individuals will be stuck trying to navigate a system that reduces them to their weight, even as it’s trying to convince them that they should stop doing that.