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Our October 2022 meeting for LMCC took place on Wednesday, October 26 at 5:30pm est in the Greenlaw 509 (relocated from the HHIVE Lab for the evening) and via Zoom.

Image by Katrien De Blauwer from Aviv, "The Politics of 'Insight'" (NYT, 2022)
Image by Katrien De Blauwer from Aviv, “The Politics of ‘Insight'” (NYT, 2022)

For October, we discussed various news articles on a variety of topics that ended up having interesting overlaps and provocative tensions:

 

If you missed the meeting, you can still access the texts on the Readings page of this site.

Although we usually try to record our meetings, due to some technical issues, we were unable to record this particular meeting. However, for recordings of some of our past meetings, click here.

Our next meeting (our final meeting of the fall semester) will take place on Wednesday, November 16 at 5:30pm in the HHIVE Lab, also called Gaskin Library, Greenlaw Hall Room 524. If you can’t attend in person, you can attend in real-time via our usual Zoom link. We will send out an announcement soon with more information for that meeting.

A few reminders and announcements:

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Some key passages:

Block, Stefan Merrill. “A Place Beyond Words: The Literature of Alzheimer’s.” The New Yorker, 20 Aug. 2014, https://www.newyorker.com/books/page-turner/place-beyond-words-literature-alzheimers.

“I didn’t know the lingo then, but my grandmother was already deep into a process scientists call retrogenesis, a cognitive return to birth…. I was neurologically developing as she was neurologically regressing, and that winter we were at a moment of equipoise” (Block, para. 7).

“Turning to fiction for answers is an instinct that I share with other caretakers. While Alzheimer’s has been the subject of many excellent works of journalism and memoir…it is a disease that uniquely thwarts our ability to comprehend it through traditional modes of investigation…. But when I consider my own future in a family predisposed to Alzheimer’s, I’m left with urgent questions that only fiction can answer: What do those late stages feel like? What is it like to lose oneself and still live? Could there be some essential kernel of selfhood that survives until the end? Mid- to late-stage sufferers, lost in their aphasia, can’t explain it to us” (Block, para. 13).

“As baby boomers approach their seventies and Alzheimer’s disease becomes increasingly commonplace, more and more fiction writers are attempting to reach into that obscure space. The arrival of the greatest Alzheimer’s novel yet, Matthew Thomas’s visionary and challenging ‘We Are Not Ourselves,’ seems like a good occasion to reassess the burgeoning genre and determine what its writers can and can’t tell us about the fate of the self as it succumbs to a disease that attacks the very seat of selfhood” (Block, para. 14).

“Nearly every novel I’ve read that attempts to depict the internal experience of Alzheimer’s also attempts to t the disease’s retrogenic symptoms to one sort of sentimental trope: a reckoning with a repressed or unacknowledged truth that must come before acceptance is possible…. Implicit in these stories is an idea like the one my mother had of my Nana’s ‘true self’—an irreducible self still intact behind the disease’s neurofibrillary tangles and amyloid plaques” (Block, para. 18).

“Alzheimer’s, after all, does not just place old memories before an observer; it also profoundly changes both those memories and their observer. And while Alzheimer’s may leave some intrinsic qualities intact—perhaps, as my mother believes, Nana’s joyfulness really was fundamental, brought to full expression by her illness—in these novels, it is more than a few such qualities that survive the disease’s depredations, it is a coherent self, capable of great understanding” (Block, para. 19).

“It’s a critical dilemma in my reading and writing but also a real-life dilemma in a family like mine, with Alzheimer’s in our genes: How do you locate the personhood in someone who is, for neurobiological reasons, no longer the person you knew? Is there a way to be true to medical fact and still find something that is transcendently human?” (Block, para. 20).

“Alzheimer’s, my family came to understand, was a transformative event, one that required us to acknowledge the new needs of a rapidly changing self. This painful awareness is at the heart of the truest Alzheimer’s fiction” (Block, para. 21).

Referring to We Are Not Ourselves by Matthew Thomas: “The pages that follow offer the truest and most harrowing account of a descent into dementia that I have ever read” (Block, para. 26).

“While this marvellous novel [We Are Not Ourselves by Matthew Thomas] resists a glibly humanizing attempt to imagine what lies ‘beyond words,’ the need to imagine remains. For all its insight Thomas’s novel ends with the old question unanswered. If ‘we are not ourselves’ in the depths of Alzheimer’s, who are we? After experiencing his own ‘sensation of panicked blankness,’ Connell considers the possibility that he might inherit the disease, and he reassures himself with thoughts of the sensual joys that even Alzheimer’s can’t claim, pleasures that lie outside of selfhood: ‘the mouth-fullness of cannoli cream . . . the comfort of a body squeezed against one’s own’” (Block, para. 30).

“This might be poor compensation, but it is one that I, too, try to believe in. Who knows? Perhaps, after the horror of memory loss passes, there might really be some relief in relinquishing your self and returning to the endless present in which an infant lives. Perhaps late-stage Alzheimer’s is simply unimaginable to those not afflicted with it. Perhaps it is incompatible with language, a place ‘beyond words’” (Block, para. 31).

Aviv, Rachel. “Mental Health in America: The Politics of ‘Insight.’” The New York Times, 20 Sept. 2022, https://www.nytimes.com/2022/09/20/opinion/us-mental-health-insight.html.

“Several years ago, when I was reporting on clinics for people in the earliest stages of psychosis, I met many young patients who were struggling to express what was happening to their minds. They described their condition as disabling, but it was still so new that it had not remade their identities or social worlds. When I asked one woman to describe her symptoms, she told me there was no language. She said, ‘It’s like trying to explain what a bark sounds like to someone who’s never heard of a dog’” (Aviv, para. 1).

“The graduate student studied the definition of schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders and, over time, worried that she was inadvertently bending her own behavior to better fit the bounds of that category. She became self-conscious about the experience of thinking and began to wonder if she heard a soft voice behind each thought, until she felt she was hearing voices, a symptom of the disorder. She was no longer sure what was her authentic experience and what had been suggested to her by experts” (Aviv, para. 3).

“Over the course of their treatment, the patients at these clinics learned new ways of explaining why their lives had changed. They began to use terms like ‘brain disease’ and ‘chemical imbalance.’ Expert explanations replaced their idiosyncratic attempts to make sense of the world” (Aviv, para. 4).

“When these patients could recognize that their unusual experiences were symptoms stemming from disorders in their brains, they were said to have ‘insight’ — a pivotal, almost magical word in psychiatry…. Insight looms large in decisions about whether to hospitalize people against their will, and it is assessed nearly every time a patient enters a psychiatrist’s office” (Aviv, para. 5).

“But the ‘correct attitude’ may depend on culture, race, ethnicity and faith. Studies show that people of color tend to be rated as lacking in insight more than those who are white, perhaps because doctors find their modes of expressing distress unfamiliar, or because these patients have less reason to trust what their doctors say. In the starkest terms, insight measures the degree to which a patient agrees with her doctor” (Aviv, para. 6).

“The correct attitude is also historically contingent” (Aviv, para. 7).

“But while a biological framework has alleviated some kinds of stigma, it has exacerbated others…. The disease came to be seen as static and unyielding, a strike of lightning that couldn’t be redirected” (Aviv, para. 8).

“In creating a shared language, contemporary psychiatry can alleviate people’s loneliness and make frightening experiences legible and communicable, but we may take for granted the impact of its explanations, which are not neutral: They alter the kinds of explanations that count as ‘insight,’ and how we expect our lives to unfold. Psychiatrists still know little about why some people with mental illnesses can lead fulfilling, functional lives and others with the same diagnoses feel as if they are defined and disabled by illness. Answering the question, I think, requires paying more attention to the distance between the psychiatric explanations for illness and the individual stories and languages through which people find meaning themselves. Even if questions of interpretation are secondary to finding effective medical treatment, these stories change people’s lives, sometimes in unpredictable ways, and bear heavily on a person’s sense of self — and the desire to be treated at all. When newly diagnosed people lack insight, this might be because of the severity of the illness, but it may also be because they don’t want to cede control over their identities. Though psychiatrists have worked to pay more attention to the perspectives of patients in recent years, they sometimes treat signs of mental illness without regard for whether they are the source of a person’s distress” (Aviv, para. 9).

“To have a new explanatory framework foisted onto one’s life is not always healing or generative. It can also feel diminishing, a blow to one’s sense of self” (Aviv, para. 10).

Carr, Danielle. “Mental Health is Political.” The New York Times, 20 Sept. 2022, https://www.nytimes.com/2022/09/20/opinion/us-mental-health-politics.html?action=click&pgtype=Article&state=default&module=opinion-mental-health-ch1&variant=show&region=MAIN_CONTENT_2&context=op-mhpackage-chapter1nav.

“But are we really in a mental health crisis? A crisis that affects mental health is not the same thing as a crisis of mental health. To be sure, symptoms of crisis abound. But in order to come up with effective solutions, we first have to ask: a crisis of what?” (Carr, para. 3).

“Some social scientists have a term, ‘reification,’ for the process by which the effects of a political arrangement of power and resources start to seem like objective, inevitable facts about the world. Reification swaps out a political problem for a scientific or technical one; it’s how, for example, the effects of unregulated tech oligopolies become ‘social media addiction,’ how climate catastrophe caused by corporate greed becomes a ‘heat wave’ — and, by the way, how the effect of struggles between labor and corporations combines with high energy prices to become ‘inflation.’ Examples are not scarce” (Carr, para. 4).

“In medicine, examples of reification are so abundant that sociologists have a special term for it: ‘medicalization,’ or the process by which something gets framed as primarily a medical problem. Medicalization shifts the terms in which we try to figure out what caused a problem, and what can be done to fix it. Often, it puts the focus on the individual as a biological body, at the expense of factoring in systemic and infrastructural conditions” (Carr, para. 5).

“Once we begin to ask questions about medicalization, the entire framing of the mental health toll of the Covid crisis — an ‘epidemic’ of mental illness, as various publications have called it, rather than a political crisis with medical effects — begins to seem inadequate” (Carr, para. 6).

“Of course, nobody can deny that there has been an increase in mental and emotional distress. To take two of the most common diagnoses, a study published in 2021 in The Lancet estimated that the pandemic had caused an additional 53.2 million cases of major depressive disorder and 76.2 million cases of anxiety disorder globally” (Carr, para. 7).

“I am not arguing that mental illnesses are fake, or somehow nonbiological. Pointing out the medicalization of social and political problems does not mean denying that such problems produce real biological conditions; it means asking serious questions about what is causing those conditions” (Carr, para. 10).

“This principle is what some health researchers mean by the idea that there are social determinants of health: that effective long-term solutions for many medicalized problems require nonmedical — this is to say, political — means” (Carr, para. 11).

“Psychiatric sciences have long acknowledged the fact that stress is causally implicated in an enormous range of mental disorders, referring to the ‘stress-diathesis model’ of mental illness. That model incorporates the well-documented fact that chronic stressors (like poverty, political violence and discrimination) intensify the chance that an individual will develop disorders from depression to schizophrenia” (Carr, para. 13).

“This doesn’t mean that all psychiatric symptoms are caused by stress, but it does mean that a whole lot of them almost certainly are. There is increasingly strong evidence for the idea that chronic elevation of stress hormones has downstream effects on the neural architecture of the brain’s cognitive and emotional circuits… When it comes to mental health, the best treatment for the biological conditions underlying many symptoms might be ensuring that more people can live less stressful lives” (Carr, para. 15).

“And here is the core of the problem: Medicalizing mental health doesn’t work very well if your goal is to address the underlying cause of population-level increases in mental and emotional distress. It does, however, work really well if you’re trying to come up with a solution that everybody in power can agree on, so that the people in power can show they’re doing something about the problem. Unfortunately, the solution that everyone can agree on is not going to work” (Carr, para. 16).

Referring to the opioid addiction crisis: “It is hard to imagine a clearer demonstration of political conditions undergoing the reification switch into a medicalized epidemic than what everyone now knows happened: The despair of the postindustrial underclass was methodically and intentionally milked by pharmaceutical companies for all it was worth. It was so obvious that at last even a political establishment that remains largely indifferent to the poor eventually had to get around to sort of doing something” (Carr, para. 22).

“Solving the mental health crisis, then, will require fighting for people to have secure access to things that buffer them from chronic stress: housing, food security, education, child care, job security, the right to organize for more humane workplaces and substantive action on the imminent climate apocalypse” (Carr, para. 26).

“A fight for mental health waged only on the terms of access to psychiatric care does not only risk bolstering justifications for profiteering invoked by start-ups eager to capitalize on the widespread effects of grief, anxiety and despair. It also risks pathologizing the very emotions we are going to need to harness for their political power to get real solutions” (Carr, para. 27).

Puri, Sunita. “Grief about COVID Can Unite Us.” The New York Times, 23 Feb. 2022, https://www.nytimes.com/2022/02/23/opinion/death-grief-covid.html?c.

“More than 930,000 Americans have died of Covid-19. Many survivors still suffer from breathlessness, mind fog and debilitating fatigue. Though everyone was ground down by the continuance of the pandemic, we seem stuck in confusing divisiveness. Some people hesitate to see their elderly parents even when everyone is vaccinated, boosted and masked. Others suggest that it’s time to move on and find a new normal. We don’t have to be so divided. My work in palliative medicine offers a way to grapple with what has happened and to return more fully, together, to a world made smaller by who and what we have lost” (Puri, para. 5).

“It’s natural and perhaps instinctive to want to look away from mortality, to deny its existence or banish it to a shadow world. But before us is an opportunity to examine, rather than bury, the loss and grief around us, even if — especially if — it is not our own” (Puri, para. 6).

“Bearing witness is essential to everything I do in palliative care, be it treating a person’s cancer pain or discussing what matters most to them in their lives. I try to make visible to my patients and colleagues what is hard but necessary to see. Witnessing requires seeing another’s pain as no different from our own. This approach is a powerful way to move through the pandemic together” (Puri, para. 7).

“I have learned to look when I want to look away. I have chosen to stay when I’d prefer to run out of the room and cry. The prelude to compassion is the willingness to see” (Puri, para. 10).

“This magnitude of suffering shook our world. Acknowledging it doesn’t require survivor’s guilt or forever dwelling on the past. We must allow ourselves to be moved by what happened and to understand that it happened, in different ways, to all of us” (Puri, para. 12).

“I don’t believe in ‘moving on’ and ‘finding closure.’ This language distills the messy complexity of grief into tidy sound bites and asks people to leave something behind, bury it or lock it away. The challenge for my patients and their families is the challenge for all of us: Can we instead move forward with grief? Can we find a way to integrate loss into life, to carry it with us? Can we feel tragedy together, without an artificial line between those who are ready to move on and those who can’t see a way out?” (Puri, para. 13).

“We cannot simply be those who grieve and those who look away. To help one another, each of us must reach out, express condolences, write cards and offer to listen. Memorials can remind us that grief has affected people we see at the library or coffee shop. Sometimes we must endure the discomfort of seeing the pain of others without being able to intervene” (Puri, para. 14).

“Our collective grief, varied as our reactions to it may be, can bind us together when it seems like nothing else will. It is one lens through which we can recognize our shared humanity. None of this prevents life from moving forward, but it’s our best shot at bringing everybody along” (Puri, para. 16).

Phillips, Dave. “The Unseen Scars of Those Who Kill via Remote Control.” The New York Times, 15 April 2022, https://www.nytimes.com/2022/04/15/us/drones-airstrikes-ptsd.html.

“There were missile strikes so hasty that they hit women and children, attacks built on such flimsy intelligence that they made targets of ordinary villagers, and classified rules of engagement that allowed the customer to knowingly kill up to 20 civilians when taking out an enemy. Crews had to watch it all in color and high definition” (Phillips, para. 6).

“Drones were billed as a better way to wage war — a tool that could kill with precision from thousands of miles away, keep American service members safe and often get them home in time for dinner. The drone program started in 2001 as a small, tightly controlled operation hunting high-level terrorist targets. But during the past decade, as the battle against the Islamic State intensified and the Afghanistan war dragged on, the fleet grew larger, the targets more numerous and more commonplace. Over time, the rules meant to protect civilians broke down, recent investigations by The New York Times have shown, and the number of innocent people killed in America’s air wars grew to be far larger than the Pentagon would publicly admit” (Phillips, para. 10).

“Drone crews have launched more missiles and killed more people than nearly anyone else in the military in the past decade, but the military did not count them as combat troops. Because they were not deployed, they seldom got the same recovery periods or mental-health screenings as other fighters. Instead they were treated as office workers, expected to show up for endless shifts in a forever war” (Phillips, para. 12).

“Under unrelenting stress, several former [drone] crew members said, people broke down. Drinking and divorce became common. Some left the operations floor in tears. Others attempted suicide. And the military failed to recognize the full impact. Despite hundreds of missions, Captain Larson’s personnel file, under the heading ‘COMBAT SERVICE,’ offers only a single word: ‘none’” (Phillips, para. 13).

“‘In many ways it’s more intense,’ said Neal Scheuneman, a drone sensor operator who retired as a master sergeant from the Air Force in 2019. ‘A fighter jet might see a target for 20 minutes. We had to watch a target for days, weeks and even months. We saw him play with his kids. We saw him interact with his family. We watched his whole life unfold. You are remote but also very much connected. Then one day, when all parameters are met, you kill him. Then you watch the death. You see the remorse and the burial. People often think that this job is going to be like a video game, and I have to warn them, there is no reset button’” (Phillips, para. 15).

“Because he [Capt. Kevin Larson] was not a conventional combat veteran, there was no required psychological evaluation to see what influence his war-fighting experience might have had on his misconduct [using and distributing illegal psychedelic drugs]. At his trial, no one mentioned the 188 classified missile strikes or the funeral he had targeted. In January 2020, he was quickly convicted” (Phillips, para. 19).

“But in December 2016, the Obama administration loosened the rules [for drone strikes] amid the escalating fight against the Islamic State, pushing the authority to approve airstrikes deep down into the ranks. The next year, the Trump administration secretly loosened them further. Decisions on high-value targets that once had been reserved for generals or even the president were effectively handed off to enlisted Special Operations soldiers. The customer increasingly turned drones on low-level combatants. Strikes once carried out only after rigorous intelligence gathering and approval processes were often ordered up on the fly, hitting schools, markets and large groups of women and children” (Phillips, para. 29).

“Squadrons did little to address bad strikes if there was no pilot error. It was seen as the customer’s problem. Crews filed civilian casualty reports, but the investigative process was so faulty that they rarely saw any impact; often they would not even get a response” (Phillips, para. 34).

“The Air Force has no requirement to give drone crews the mental health evaluations mandated for deployed troops, but it has surveyed the drone force for more than a decade and consistently found high levels of stress, cynicism and emotional exhaustion. In one study, 20 percent of crew members reported clinical levels of emotional distress — twice the rate among noncombat Air Force personnel. The proportion of crew members reporting post-traumatic stress disorder and thoughts of suicide was higher than in traditional aircrews” (Phillips, para. 41).

“Seeing just one strike that causes unexpected civilian deaths can increase the risk of PTSD six to eight times, he [Air Force psychologist Wayne Chappelle] said. A survey published in 2020, several years after the strike rules changed, found that 40 percent of drone crew members reported witnessing between one and five civilian killings. Seven percent had witnessed six or more” (Phillips, para. 43).

“But crews said the [human performance] teams were only modestly effective. The stigma of seeking help keeps many crew members away, and there is a perception that the teams are too focused on keeping crews flying to address the root causes of trauma. Indeed, a 2018 survey found that only 8 percent of drone operators used the teams, and two-thirds of those experiencing emotional distress did not” (Phillips, para. 48).

“Beyond their modest standard pensions, veterans with combat-related injuries, even injuries suffered in training, get special compensation worth about $1,000 per month. Mr. Miller [Bennett Miller, former intelligence analyst] does not qualify, because the Department of Veterans Affairs does not consider drone missions combat” (Phillips, para. 58).

“A growing number of combat veterans use the psychedelic drugs illicitly, amid mounting evidence that they are potent treatments for the psychological wounds of war. Both MDMA and psilocybin are expected to soon be approved for limited medical use by the Food and Drug Administration” (Phillips, para. 63).

“In Las Vegas, the civilian authorities were willing to forgive Captain Larson, but the Air Force charged him with a litany of crimes — drug possession and distribution, making false statements to Air Force investigators and a charge unique to the armed forces: conduct unbecoming of an officer. His squadron grounded him, forbade him to wear a flight suit and told him not to talk to fellow pilots. No one screened him for PTSD or other psychological injuries from his service, Ms. Larson said, adding, ‘I don’t think anyone realized it might be connected’” (Phillips, para. 65).

Note: Featured image above is from Puri, “Grief about COVID Can Unite Us” (NYT, 2022). Illustration by Lizzie Gill; photograph by Maskot via Getty.

 

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