Fiddling While Rome Burns

Where I work now, nobody talked about Virginia Tech this week. We were busy, I guess. In one meeting, I blurted out, "Who wants to talk about the Virginia Tech incident?"...nobody did. Later a member of the group said, "You know this place was really involved in Columbine...I think maybe everybody just doesn't want to deal with it again."

I know that the information about the shooter - that he'd been identified by his community as a 'disturbed' person - caused a kaleidoscope of images for me...all the disturbed people I've seen - the ones I'd 'evaluated' and deemed 'dangerous' or 'not dangerous' in the years I've been in public mental health, flashed before my eyes. How many times have I been wrong? What if I'd been the evaluator for this guy? What if I'd turned him loose after his hold expired. yikes.

I tried to inspire interest, at that meeting, by considering our response in a case I'd been involved in there. Recently we had a guy who'd traveled the road from aggravated robbery and drug possession to prison, to state mental hospital, to assisted living facility in the community. We "held the cert" on him - by which is meant that we had a piece of paper that stated he was ordered by the court to receive mental health treatment from us...which made us responsible in some sense for him. In about a week and a half he was staying out all night, taking drugs, and pounding on his mother's door in the middle of the night, demanding money.
I said, "We've got a cert! Put him back in the hospital." The agency said, "this behavior doesn't rise to the level of requiring hospitalization. The guy is making choices. Those choices will have consequences. You can't hospitalize someone for making choices. This is the Recovery Model!!"

The consequences were that within another week, he was evicted from his assisted living home. His social security benefit - which would have paid for the assisted living, was in that awkward moment betwixt in hospital and out, when payments haven't started yet. Our agency was the payee. So our guy had nowhere to live, no money, and a raging drug craving. I felt pretty confident in predicting that given how he'd spend his formative years, his choices would not be helpful ones.

So in the meeting I said, "Isn't this a discussion we need to have? Why do we make these decisions? How do we know we're right?" The evaluators in Virginia were "right" at the time - 2005 - he didn't kill anybody in 2005, after all. But if they'd "treated" him for a while...brought him in, got to know him ... had some human exchanges with him over a period of time ... might not that have changed 2007?

You ever watch "House" on TV? In House, there's 4 doctors who spend days thinking about, talking about, experimenting on, etc. a single patient. The patient's illness is the mystery, and the 4 (or more) doctors are the investigating team, who's sole mission in life is to figure out what's wrong and how to fix it.

If House had seen the shooter in 2005, he and his team would have devoted all their considerable talents to understanding his behavior. They would have dispatched someone to the family home, would have spent extended time with the parents and sister; would have examined the speech problem, diagnosed and treated it; would have CAT scanned his brain; would have observed and interacted with him with concentrated interest for as long as it took. Whatever happened next, the trajectory of the shooter's life would have been changed.

The idea of doing that with every guy that walks through the mental health door is ludicrous. Ha!
Doesn't happen.
Couldn't happen.

The Organization Stress paper describes in great detail why it couldn't happen...having just read it, the events at V Tech appeared to be the real life illustration ... a brutal movie about society's infrastructure failure, due to Organizational Stress.

Our regulations in this area, our evidence based studies, our Recovery Model...are wallpaper - hiding our lack of attention and resources to do work that doesn't result in profit.

So it goes.

Might not matter, if its true that cell phones are causing bee collapse...especially, if Einstein was right in saying that after the bees go, we've all got only 4 years left ourselves.

2BR02B

Self Portrait by Kurt Vonnegut

On Saturday Robert Samuelson had a column in the Rocky Mountain News - The coming clash - Tax hikes for boomers will ignite conflict. Samuelson led with Christopher Buckley's idea in his novel, Boomsday, in which the coming entitlement crisis is solved by paying retirees to kill themselves - a program called Voluntary Transitioning. Volunteers for Voluntary Transitioning could receive a lavish vacation beforehand ("a farewell honeymoon"), courtesy of the government, and their heirs would be spared the estate tax. If only 20 percent of boomers select suicide before the age of 70, "Social Security, Medicare, Medicaid will be solvent. End of crisis."

Actually this is not an entirely new idea. Kurt Vonnegut wrote about something much like it in God bless you, Mr. Rosewater. Early on in the novel, we are told about Kilgore Trout's novel - 2BR02B, in which "he hypothecated an America in which almost all of the work was done by machines, and the only people who could get work had three or more Ph.D's. There was a serious overpopulation problem, too.
All serious diseases had been conquered. So death was voluntary, and the government, to encourage volunteers for death, set up an purple-roofed Ethical Suicide Parlor at every major intersection, right next door to an orange-roofed Howard Johnson's. There were pretty hostesses in the parlor, and Bara-Loungers, and Muzak, and a choice of fourteeen painless ways to die."

Kurt Vonnegut died this week. Thank heavens he'd already written a bunch of books...enough, I hope, to keep me going to the end. There's nothing like the comfort of finding a compatible point of view - the feeling of being understood and accepted. Thank heavens for Kurt Vonnegut! and Bon Voyage! Sorry we didn't have either the Ethical Suicide Parlors or the Farewell Honeymoon ready yet. Sometimes good ideas take a while to mature.

I finally got to the end of the article - The Sanctuary Model part - and Sandra Bloom's solution is not nearly so neat and easy as either of those ideas. "It is clear that there is no subset of traumatized people for whom we can build new structures, new institutions that will more adequately suit their needs. The world is a traumatized place, and underlying what we now consider "normal" society are basic assumptions, beliefs, policies, and behavior that if not transformed are certain to doom the entire species - and very possibly all living things - to utter annihilation. Like it nor not, the coming years will determine whether or not reason can harness our biological urges with sufficient power to curb the self-destructiveness that threatens our very survival." 2BR02B, indeed.

Here are some pictures by Kurt Vonnegut -

Thanks, Kurt Vonnegut, and Farewell!! Hope to catch you on the other side! (Plan to wait for the farewell honeymoon, tho.)

Silent Studying

The silence is deafening, Social Work Fairy, but I can only assume that readers are all taking time to read the "Organizational Stress..." article before commenting. I know that's what I've been doing. I confess I'm going awfully slowly....faster now that I printed a copy...I hate reading long stuff on a computer screen...can't get comfortable....

I've gotten as far as "Lack of Basic Safety"...still have things like "Increased Authoritarianism" and "Impaired Cognition and Silencing of Dissent" ahead of me. It is so amazing to read this description of our very own madhouse in this paper from Philadelphia! Obviously, the problems here are the problems throughout the entire mental health system. We are not uniquely disadvantaged....we are the norm! Holy Cow.

Did you notice the early reference to Maxwell Jones? Maxwell Jones was a prime mover in the founding of the madhouse! And the description of the organization!... how about this: "...unhealthy organizations have a great deal in common. There is a general air of degradation and a sense that everything is always falling apart; one must be very careful to make sure that it does not fall on you. There is a general lack of energy, low motivation, and low morale among the people in the organization. ..... Standards tend to be low and norms are disrupted, unclearly stated, and unmonitored. There is a great deal of individual unhappiness, dissatisfaction, and complaining, but the complaining is usually indirect and frequently takes the form of gossip or rumors that in a circular way tends to lead to more dissatisfaction......The atmosphere of routine boredom and unhappiness is interspersed with periods of crisis....Learning from the past does not appear to happen.....Change efforts are met with a passive resistance that tends to chase off competent leaders, leaving less confident and competent leadership in its wake. There is a lack of transparency and an air of secrecy, even about events that could easily be aired publicly and openly. Ultimately, this is an envionment that leads to dishonesty and ethical deterioration." (pg. 19)

Now if that's not the madhouse, what is?

I'd like to skip ahead in my reading to "Sanctuary: A Parallel Process of Recovery"...but I haven't. That will have to wait until next week. But it does give me hope. Someone has taken the time to think the problem through - to provide a good analysis of what's happened, and to propose at least one possible solution. It helps to overcome my tendency to just be overwhelmed in the face of such complex problems. One doesn't have to be overwhelmed...one can come up with solutions...