The Pandemic, Scientism, Democracy, and Deliberation

 by Lael Ewy

Jason Blakely's piece in the August, 2023 issue of Harper's on the discontent with science, or, more accurately, scientism, as revealed by the COVID-19 pandemic makes some important points about the misuses of science, especially of the social sciences. Trusting as settled science the various theories of the manner in which people and cultures believe is incredibly problematic and often harmful.

As someone who worked for seven-and-a-half years in the public mental health field, I have seen this close up: psychiatric diagnoses, which, by necessity are based on a consensus (among psychiatrists) of what constitutes acceptable behaviors, feelings, and thoughts, eventually come to be considered "natural forms" that can be studied and treated "the same as any other illness," and so they get treated generally with medication only. This often elides the real-world problems people seeking help actually have, trapping them in loops of ever-increasing medication instead of helping them into better lives by giving them practical solutions to their issues. Often, people subject to medication-only regimens end up with debilitating side-effects such as obesity, type 2 diabetes, tardive dyskinesia, akathisia, and sexual dysfunction--not to mention the traumas associated with involuntary commitment and discrimination due to the psychiatric labels they carry.

Photo credit Ministério da Ciência, Tecnologia e Inovação

So his basic premise is right: scientism is real, and it does real damage, not only in the mental health field, but in poorly-researched areas such as self-help, lifestyle engineering, and public policy.

Blakely's conclusion that democracy was eroded by the reactions of federal, state, and local governments to the COVID-19 pandemic as these entities "imposed" "top-down" "mandates" based on scientistic reasoning, though, doesn't fly. He mentions in passing that America's distrust of science predates the pandemic, but it's also backed up both by ginned up conspiracy theories of those who actually do want to erode democracy here and abroad and by America's deep tradition of religious fundamentalism.

In response to Blakely's accusation, and to be accurate about what happened during the pandemic, however, and how federal, state, and local governments actually handled it, we have to examine if democracy itself broke down.

I contend it did not. When the COVID-19 pandemic washed over the US, I was teaching at a public high school in the small town of Newton, Kansas. It's true that the state's governor, Laura Kelly, did mandate certain public health measures in order to contain the contagion. But the day-to-day realities of her orders were duly deliberated at the local level, and the manner in which USD 373 reacted to these mandates was decided by the elected officials on the school board--by the people's representatives--just as it should be in a representative government.

Likewise, city and county governments kept functioning much as they had before, only over Zoom instead of in person, deciding how to implement the state's guidelines, and they did so effectively, in ways that led to widespread compliance. This is precisely the way elected officials are supposed to act.

And while many of the choices of the state, county, and local, governments were unpopular, they did not substantially change the political makeup of those bodies at the next election: notably, Governor Kelly kept her post--quite an accomplishment for a Democrat in a conservative state. So while we may not have liked what she decided to do, we didn't dislike it so much that we all voted against her.

Blakely expends a lot of words pointing out that decisions about what defines an "essential worker" were the products of scientistic reasoning instead of political deliberation, as if those decisions weren't also those of duly elected officials, including California's Gavin Newsom, who comes under substantial fire from Blakely for his hypocrisy in attending a large social gathering at a high-end restaurant when the rest of the state was locked down. These actions, though, are merely poor politics, not the breakdown of democracy itself, and, as with Laura Kelly, it didn't seem to have upset Newsom's constituents enough to bounce him out of office--something California is known for, as the political demise of Gray Davis shows. Contrast this with the fate of Boris Johnson, whose hypocrisy during the pandemic did lead, in part, to his political downfall. The fact that these two politicians' recent careers had different outcomes indicates not that scientism reigns supreme but that democracy worked as it should in the terms Blakely sets out: two different groups of people made two different decisions about who they wanted in the executive office, based on their own set of values and principles.

Blakely claims that politicians like Newsom used the pandemic to impose their political and ideological perspectives, but, outside the claims of conspiracy-theorists, there's no indication that liberals have long wanted to make people wear masks or have had a standing agenda to shut down the local coffee shop. (Indeed, the liberals I know love the local coffee shops and found ways to support them even during lockdown.) Blakely completely fails to mention which policies politicians wanted to impose and did, which pandemic policies track with ideological commitments, so it's hard to take that particular charge seriously. We can only assume that his mention of churches being shut down during the pandemic is part of some sort of dark liberal agenda, but, while liberals tend to be more skeptical of organized religion that others, I've never known them to want to shut down churches on the whole: the standard liberal view is that faith as a matter of personal choice. That churches were impacted by lockdowns and certain businesses weren't, again, may have been bad decision-making on the part of elected officials, but there's no indication it was part of a larger, nefarious effort to impose liberal ideas.

And while many of the reactions of governments against the virus were provisional, shifting, imperfect, that was due to the fact that we were still learning about the virus's nature, not because public health measures are bad science, or even scientistic, as Blakely suggests. The science of public health may be imperfect, but it's considerably more solid than those of, say, economics or quantitative policing.

Besides, elected executives have emergency powers for a reason: to deal with genuine existential threats quickly, when the slower deliberations of legislative bodies would not be able to react with due speed. We might not want our elected executives to have these generally limited powers, but history indicates it's better if they do, especially as natural disasters become more common due to climate change. Nobody likes to see the National Guard in their neighborhood, but when a tornado blasts through our community, I'm sure happy they're there. Even Florida governor Ron DeSantis, who rolled back COVID restrictions in his state in a way that led to the deaths of tens of thousands, and whose acts as governor otherwise border on the fascistic, hasn't gone so far as to invoke emergency powers in order to implement his "anti-woke" agenda. He has reserved these for the state's frequent hurricanes and floods, exactly what they were intended for. Indeed, the equally authoritarian Donald Trump did not use the pandemic as an excuse to impose martial law, which would have helped him implement his plan to seize power when he lost the election.

Tellingly, Blakely fails to address the counterfactual, what it would have been like if the various governments had done nothing, allowing individuals and businesses to decide for themselves how to deal with the viral threat. We have a few cases that suggest how bad it could have gotten all over the country. It was only after initial lockdowns that we saw this: notably in the aforementioned Florida and South Dakota. When they loosened restrictions, people died. When New York reacted poorly at first, bodies were stacked in refrigerated trucks. Places where the virus hit hard saw healthcare workers stretched to, and sometimes beyond, their limits. Would it really have made for a healthier democracy to have potentially let millions more die, to have utterly devastated our already stressed healthcare infrastructure? It's easy for Blakely to preach now, after effective vaccines have arrived, but as an "essential worker" in the middle of the worst of it, I went to work every day worried I'd get infected, or, worse yet, that I'd be the vector that led to the death of my elderly mother or my disabled wife.

The world Blakely posits may be more "free," but it would also be considerably more deadly. A precursor exists, sadly, in the AIDS crisis of the 1980s, during which the reaction of the Reagan administration was to do nothing, since, they reasoned, it was "just a gay disease," and the bulk of the electorate didn't care. The fact that it wasn't "just a gay disease" and that it would be morally bankrupt to ignore it even it had been seems to have been lost to history in Blakely's view of things. Thousands of people died, and it led to widespread paranoia not just for gay men but for everyone who was sexually active. It was only when the Surgeon General at the time, C. Everett Koop, went rogue and began to address the issue that people started to have some confidence that safe sex was even possible.

The old adage, often attributed to Oliver Wendell Holmes, that my right to swing my arm ends where the tip of your nose begins is applicable here, but with the complication that the nature of an airborne pathogen exponentially expands the reach of my swing. We're not protecting individual freedoms from governmental mandates in this case but individual rights not to be infected, and possibly killed, because of the selfish choices or the neglect of others. This is an idea that ought to be utterly clear, and in other cases it is: if I pour waste oil into someone else's well, I am clearly liable. But when I pump my viral breath into your airspace, I'm somehow just expressing my freedom?

Had this virus's effects not resembled other ailments such as allergies, colds, and the flu, had it, instead, been, say, a hemorrhagic fever, a supercharged Ebola, few of the conspiracies would have developed and little of the pushback would have happened. Had the ravages of the disease been more visible and clear, perhaps by turning people green or giving them open sores, we would have been clamoring for our elected officials to do something about it, no matter how forceful or dire.

The real victim of the pandemic, I fear, has not been democracy but the very idea of public health itself. The notion that individual health is related to the health of the community has been undermined not just by conspiracy theories but also by those duly elected officials reacting to the pushback Blakely champions by weakening their ability to address public health concerns in a timely manner. Rather than learning about what works and what does not when a democracy is faced with a pandemic, we have decided to disarm against the next, inevitable, viral threat.

It's democracy still functioning, as it should be, but it will lead to disastrous results.

On Woke's Subtle Graces

 by EW Wilder

Writing in the July 2023 edition of Harper's, Ian Buruma makes the following errors:

• He accepts the far rightwing definition of "woke" which, rather than being a blanket term for social justice awareness, more likely has its roots in the need for Black Americans to stay aware of their surroundings in order to avoid trouble (or worse) in the Jim Crow South.

• He conflates Anabaptists' baptism conventions with other Protestant traditions of public confession and implies they are parallel to Catholic confession of sin. The Anabaptist conventions are theologically distinct.

• He argues by analogy that Puritan traditions of "doing the work" equate with contemporary corporate statements on social justice issues.

The latter is at the core of his argument, so let's delve into it.

Arguing by analogy is always fraught, and while it's true that vestiges of Puritanism can be found throughout American secular culture, chances are the corporate statements Buruma excoriates are more public relations stunts than they are any expression of real ideological of even political positions. Rightly, Buruma points out the widespread hypocrisy of these statements, coming as they do from companies—such as Amazon—that have a poor history of giving a rip about their workers. But hypocrisy is a longstanding part of corporate life. If Buruma is scandalized by giant companies saying they support #BLM while simultaneously funneling money to the campaigns of racist politicians, wait until he discovers the falseness of their statements that "employee safety is our highest priority" or that clearly terrible customer policies are being implemented "to better serve you."

The only people who are scandalized or even surprised by the hypocrisies of the boardroom aren't, well, "woke" enough to write comprehensively about the subject.

Later in the essay, Buruma puts scare quotes around "'structural'" racism, as if redlining, Jim Crow laws, and race-based gerrymandering never existed, or, indeed, in the case of the latter, don't continue to plague us.

He ends up noting that Democrats, if they want to win, need to de-emphasize social justice issues in their campaigns, lawmaking, and public statements in favor of economic ones. But this is also hardly profound; it was the basis of Bernie Sanders's campaign strategy, after all, and it was a popular enough stance for establishment Democrats with strong corporate ties to quash the Sanders campaign in 2016. So, at best, Buruma's essay is about a decade too late. At worst, though, it helps feed the rightwing hate machine, which, as Ron DeSantis's politics embody, is actively using "woke" as a wedge issue.

Buruma's stance, though, also elides a very serious problem: a lot of White working and middle class Americans are, quite simply, racists. I'm not sure what Buruma's life has been like, but, as a cis/het/middle-class White guy from the Great Plains, I can attest to the fact that racist attitudes are both common and open in all-White spaces, especially informal ones. Behind the barn, over lunch or coffee, at family gatherings, when White people of my demographic get together, jokes about Black and Brown people are often thrown around like a baseball in a game of catch. It's ugly, but it's true.

And the fact that certain swing voters went for Barack Obama once or even twice does not make them not racist. Obama worked for years on making his personal brand acceptable to the White power base, the white electorate. Putting Joe Biden on the ticket, a man who openly used terms like "clean" and "articulate" to describe Obama, was a strategy to appeal to voters who would themselves use those terms to describe an "acceptable" Black person. Like Bill Cosby before him and Clarence Thomas now, Obama knew how to play the White man's game, and he was rewarded for it. It also helped that the economic collapse of 2008 made a message of "hope" and "change" resonate. That many of these same voters reverted to vote for the clearly racist Donald Trump eight years later just adds evidence to the idea that a deeply racist White middle-America is happy to use a Black man to get what it wants and is happy to return to form when it senses that the Other is getting too "uppity."

Buruma goes on to note that globalization has benefited those he deems, in a distortion of Protestant tradition, "the Elect," and that he is among them. He contends that these so-called Elect benefit from virtue-signaling. I admit that I have no idea who his "Elect" are or how they differ from the people (many of them Jewish) the far right deem "the elite" (or, if you're Donald Trump "the a-leet"). Professors and other academics are supposedly part of this cohort, but, as one of their number, I don't see how globalization has helped or hurt me very much one way or the other. The internationalism Buruma cites—the ability for academics to cross international boundaries to collaborate—seems indistinguishable from jet travel, something theoretically more open to the coal miners who once made close to six figures a year than to underpaid profs. But virtue-signaling and benefiting from global trade are unrelated: just ask Rupert Murdoch. Oil companies seeking new markets, manufacturers looking to outsource, and the largely (and vocally) libertarian tech industry looking for cheaper coders from overseas, not to mention uber-wealthy investors looking for a tax dodge, seem to all have benefited from globalization more than anyone else. Few of these entities have a history of even paying lip service to social justice issues, unlike retailers, whose presence in local communities creates a need to appeal to local populations. Retailers, while globalization has allowed them to offer cheaper products, can't offshore their workforce, and they have been among the first to raise starting wages in the years since the pandemic.

Counter to what Buruma seems to think, so-called "wokeism" actually has benefited me as an instructor at a small college, and in practical terms. I serve a diverse student body, and I have to run classrooms and virtual spaces in which Black, immigrant, and LGBT+ people feel safe alongside the White, cis, het, and native born. Besides, this stuff is real: not only is structural racism still alive and well in our congressional districting, gay and trans kids still get bullied, their lives and bodies continue to be sanctioned against by rightwing state and local governments and school boards, and women's representation and wages still lag in business and tech fields.

As someone who spent seven-and-a-half years working alongside the public mental health system, I have seen how economic inequality can impact lives in a massively negative way. Generational poverty is more often the cause of mental health problems than the result of it. But as most progressives realize, addressing economic inequality alone won't solve all social justice issues. There was, after all, a strong Black middle class even when much of America was segregated, and the sexual orientation of Apple CEO Tim Cook didn't stop eleven gay kids who live in a wealthy suburb of my home town from attempting suicide one recent fall semester due to bullying at school and lack of acceptance at home.

Instead of just ceding the "woke" ground to the rightwing, just as liberals have ceded faith and finance and free speech, the left needs to start doing what it used to do: it needs to start educating the public. The rightwing has spent four decades filling the radio airwaves and cable TV signals with its vitriol and hate, while the left has largely sat on its hands. The left needs to raise consciousness; it needs to be unapologetic about issues of gender and race and sexual orientation as well as about issues of economic inequality. This messaging needs to be accurate and frequent and clear.

Indeed, if there's one thing that Americans admire more than anything else, a quality that surpasses ideology and identity in the American mind, it's confidence. Trump won not because he had anything substantive to say—he still doesn't—but because he spouts his nonsense and lies with utter conviction. This is the lesson that we on the left need to learn: not that we need to be less woke, but that we need to be righteous in our commitment to the cause. 

 

Photo credit: "woke" by Bob Larsen 

Night Moves

 

Some of my earliest memories are of lost sleep, of the circadian disruption of fluorescent lights in a hospital hallway, of the clutching fear of knowing that my chest would soon be cut open, my heart stopped, my blood given over to a lifeless machine. The constancy of the needles and the nurses' cold hands brought me back to where I was: alive and awake, always awake. A few years later, a leg injury put me in traction for weeks, the days punctuated by the taste of cherry Jell-O, not cherry at all but the chemical burn of the fake stuff, the scent of which I burped all night long as I watched the merry-go-round of locally made airplanes whirl away the hours atop the restaurant next door.

In my life after, sleep was disrupted by nightmares of being trapped, of wandering those hospital halls unable to escape, dreams of not breathing, of being breathed for by the machines. It's hard to sleep when the landscape of slumber is full of such terrors.

The news, now, is full of studies on the ways sleeplessness kills: both fast in accidents and slow in chronic health problems: heart disease, diabetes, hypertension, cancer, dementia. The irony in my case is that the very invasive surgery that fixed the heart condition I was born with set the sleep cycles that, 45 years later, will potentially wreck my heart.

What cures also kills.

Aside from shift work, there are not many jobs someone who is more awake at 3:00 a.m. than at 3:00 p.m. can successfully pursue. I've managed to manipulate academe to offer up enough flexibility for an afternoon nap, but being assigned an evening class just exacerbates the problem. Getting used to even less sleep is possible, though the TV doctors don't recommend it.

I've stopped talking to my GP about my lack of sleep. She's recommended melatonin, and, from a medical perspective, I'm sure she isn't wrong.

But at this point, my weird sleep cycles are something of an identity: I'm not sure who I'd be without these early morning workouts, without these predawn runs, without seeing the world at 4:00 a.m. in all its stark, dark beauty.

When Frost wrote that he was "acquainted with the night," he was writing what he knew, but he was also writing about an alternative way of knowing. Certainly, we can read that poem as addressing depression, but it's also about the way the night and darkness reorient us toward our inner lives. The darkness reminds us that we have one and that it does more emotional an even intellectual work than we're generally aware of.

The brash, daytime world is for extroverts, and there's part of me that's ready to let them have it. It's full of aggression and bad driving, thoughtlessness and acting for the sake of action. When I hear the coyotes bray in the nature park nearby, I'm slightly frightened, as any human might be, but I'm also sympathetic: yes, brothers, yes. I understand the longing in your keening lamentation.

Against Against Trauma 2

Parul Sehgal makes some points I agree with in her “Critic at Large” column in the January 3/10, 2022 issue of The New Yorker: yes, the trauma explanation of character development in narrative fiction is overdone, and, yes, good writing creates an air of mystery; it’s subtle, complex, and presents individuals whose stories we can believe in. It’s also true that not everyone has the same reaction to trauma: yes, post-traumatic growth is possible (though her assertion that it’s the norm is questionable).

In fact, I am an example of post-traumatic growth.

But along the way, like Will Self in his screed against trauma in Harper’s, and whose name she drops and whose work hers largely replicates, Sehgal manages to be utterly dismissive of the lives and real experiences of actual trauma survivors. Like Self, she goes so far as to question trauma’s legitimacy while complaining about the trauma theory of Cathy Caruth, implying, ironically in true postmodern fashion, that trauma is a modern invention, the product of obscure 19^th century medical musings about train travel (to which again, I react with a visceral “WTF???”) that just happened to have ballooned in the 20^th century, by some historical accident, in order to explain away the experiences of war veterans and survivors of sexual abuse.

Sehgal traipses through the by now expected avenues of Freud and the DSM’s definition of PTSD—which she gets wrong, by the way: the current DSM does not acknowledge traumatic events as etiology but defines PTSD in purely symbolic terms. Sehgal does the de rigueur bashing of Bessel van der Kolk and the standard invocation of Shakespeare, all while studiously avoiding the voices of the traumatized except to expressly dismiss calls for the online collection of their stories.

For traumatized people like me, this comes as no surprise. Sehgal is just yet another prominent and well-regarded person brushing off our experiences or redefining them in ways that suit her purposes. She doesn’t speak for me any more than the DSM committee does or Bessel van der Kolk does or the writers of Ted Lasso do. The fact that trauma is having its day in popular culture right now is no reason to deny its reality; the fact that most of the writing about trauma is bad is no reason to throw the whole concept away.

Indeed, there are whole genres dedicated to unrealistic depictions of romantic relationships and science and war, but their existence does not mean that people never fall in love or do groundbreaking research or engage in combat, still less that those are modern inventions—just read the Greeks! Sure, not every scripted drama should use trauma as character development, just as not every home decorating show shouldn’t feature shiplap; for a while they all did, though, and, the case remains, shiplap is an actual thing.

Amid Sehgal’s calls for more subtlety, she also commits the fallacy at the heart of most explanations of trauma by the untraumatized, vacillating between “Oh, poor baby!” at one moment and “Just get over yourself!” at another. (To her discredit, Sehgal settles on the latter.) The truth is even more subtle and complex than Sehgal seems to be able to understand: you can be both forever changed by trauma and you can grow from it. I have spent 45 years learning from my traumatic experiences, but I also still get triggered. These seemingly paradoxical responses might make for good writing, but they wouldn’t be believed, either by editors at major publications like The New Yorker or by critics like Sehgal.

This paradox is only one of many reasons I’ve spent those 45 years avoiding dealing with “my trauma” (scare quotes Sehgal’s) in my writing; another (maybe more important) one is that trauma doesn’t define me as a person or as an artist. That Sehgal would approve of that is immaterial; her own opinion is invalidated, in my mind, by her dismissive tone and lack of a desire to understand what the lived experiences of trauma are really like.

Imagine, if you will, if an “able-bodied” (scare quotes mine, this time) writer presumed to know everything about the life and experiences of a wheelchair user or, as is the case here, merely dismissed these experiences as a cheap way to develop a character. It wouldn’t work— neither The New Yorker nor Harper’s would never publish it. Yet that is precisely what Sehgal and Self do in their essays on trauma.

We should also make a distinction Sehgal fails to make: legitimate criticism of an overused trope is one thing, but the kinds of trauma stories people share or create for therapeutic purposes are not intended to be great art, and they should not be read that way. That they do not rise to the level of complexity and sophistication she expects is no fault against them, and faulting them on artistic terms is simply cruel to those creating them. They exist solely for the purposes of healing and validation by the individuals who create them and by their peers, not for critics to leverage in lamentation over the way a trauma subplot has hijacked her favorite show on Apple TV .

Here’s my take on it: if you’ve never experienced trauma—and I mean real wake-up-in-the-middle-of-the-night-screaming trauma, not just the a-sad-thing-once-happened-to-me-once trauma—don’t write about it. That’s my advice if you’re a critic, a journalist, a novelist, a poet, a show-runner, a researcher, a therapist.

Just stay the fuck away from it.

If for whatever reason you feel you have to, privilege the voices of actually traumatized people, consult them in a genuine way in the creation of your work. Bring them in. It will be scary, yes, but anything less merely perpetuates the damage.

The Problems with 988

A lot of reporting has been done on the purported boons of the new national 988 mental health crisis line. It promises to reduce the number of 911 calls on those experiencing internal distress, and, it is hoped, thereby reduce the number of people sent to jail inappropriately or traumatized or shot by cops showing up for a crisis instead of more helpful mental health professionals. The idea is that people experiencing extreme states of mind or psychological crises will “get the help they need” instead of criminal records and go on to lead fulfilling, productive lives.

There are numerous problems with this assumption. Let’s start at the point of crisis and go from there.

1. Calling 988 does not guarantee that a mental health professional will show up at your door.

That would only be the case in communities with an available crisis response team (CRT), which, geographically speaking, is a small fraction of the nation at this time (see The Takeaway podcast below), and even then, there’s no guarantee they meet national standards. In communities so served, CRTs may or may not be adequate in number or staffing to meet the needs of every 988 call deemed a true crisis. The trigger is generally “threat to self or others,” as determined by the 988 staff member who takes the call. Ideally, most calls will not result in a crisis being determined, and people will be referred to other services—a representative from NAMI, speaking recently on The Takeaway, estimates that 95% of callers will not be deemed to be in crisis, though it’s unclear where she got this statistic; a federal survey suggests 61% of crisis call outcomes were voluntary/collaborative.

However, if a CRT is not available, cops will show up, just like in the bad old days before 988, and it’s possible they will (re)traumatize you by tackling you, tasing you, handcuffing you, or, determining that you’re a threat to them, shooting you. This is more likely if you’re a person of color.

The way the members of this team treat you may or may not be appropriate for your situation or helpful to you: some CRTs may include, for example, a peer support worker, who is likely to understand what you’re going through, having experienced something similar. However, as someone who used to train peer support workers and support peer-to-peer program implementation, I can say that peer support workers are often dismissed by their co-workers and their opinions or actions overridden by mental health professionals who assume, by virtue of superior education or sane status, to know better. Even if your CRT has a peer support worker, there’s a good chance they won’t be allowed to do their job.

Indeed, crisis response is often an opportunity for coercion in the mental health field, and coercion generally just makes the problem worse. As the Intentional Peer Support model points out, it’s often better to take a non-coercive approach to crisis situations. But in the US, we’re stuck in an action-hero mindset that we must save people with direct action, even if we destroy half of Gotham in the process.

2. Often, people in crisis have been “get[ting] the help they need,” and it hasn’t helped. In fact, the help sometimes foments the crisis.

I read about mental health systems in which CBT, DBT, and other therapies are available, but I live in Kansas, and I don’t see that, except for privately insured people who are good at self-advocacy. What I do see in the public system are infantilizing and insulting psychosocial education groups and possibly helpful supported education and supported employment programs. Above all, though, what I see are psych meds—lots and lots of psych meds—a panoply of psychoactive substances doled out in massive doses and with almost ubiquitous polypharmacy.

These meds, while sometimes helpful, often have low efficacy (sometimes little better than placebo), and often have devastating and sometimes permanent side-effects. Switching meds when one doesn’t work for you is difficult, if not impossible for many: a person for whom I provide informal peer support was threatened by per prescriber with involuntary commitment to a state hospital if she didn’t stop asking for a change in medications, even though the side-effects of the ones she was on made it impossible for her work. (She was literally falling asleep on her feet at her retail job.) And this did not happen to her in the bad old days of Cuckoo’s Nest-level maltreatment. This happened last year, in 2021.

Side effects and few options, then, often lead people to stop taking their meds or to reject treatment to the degree they can; often people quit cold turkey. Or their prescibers actually listen to them but take them off of meds too quickly. Quitting or switching psych meds is always a perilous time, with withdrawal effects sometimes mimicking the very symptoms that got the person the diagnosis to begin with, and with others ranging from nausea and dissociation to “brain zaps,” which can last for weeks or months. In other words, the med merry-go-round can lead directly to, you guessed it, a mental health crisis.

988 advocates are relying on the very system that may have played a part in creating the crisis to fix the crisis. They are also assuming the appropriateness of crisis “care.”

3. Crisis “care” is often the source of trauma or retraumatization.

A few communities have short-term crisis centers. In Kansas, the three major metropolitan centers—Wichita, Topeka, and the Kansas City metro area—have short term crisis centers where people can cool off and get support and services for the 24-48 hours a mental health crisis generally lasts. These centers are much less coercive than traditional residential treatment (aka “psychiatric incarceration” to its critics) and tend to cost less and be preferred by users.

They’re also almost always full.

A handful of communities in the US are served by peer-run respite centers that house people for a week or more, and even fewer have short-to-medium-term residences run on the Soteria model.

Most places in the US have none of these things, which means a trip to the psych ward of the local hospital or to a state psychiatric hospital. In Kansas, you have two options for the latter, Osawatomie or Larned, and, as above, they are mostly full most of the time.

Based on my work in them, there you’ll find a situation little different from the way things were 45 or 50 years ago, only now you’ll stay for a few weeks instead of a few years. But it’s still involuntary commitment: you can’t leave until they say you can, and forced medication, seclusion, and physical restraint are common. And a trip to the state hospital is incredibly disruptive to a person’s life. If you’re single and live alone, as is the case with many who have long-term mental health challenges, during the weeks you’re there, you may lose your job, fall behind on rent and lose your housing, and lose any romantic relationships you may have formed. Your pets may die or be taken away, and if you have kids, they may be taken into the foster care system.

Recall that the peer I described above was threatened with a trip to the state hospital? All this is why. Mental health providers know the problems these facilities create, and they use the fear of them as leverage.

Further, there’s growing evidence that involuntary commitment in residential facilities actually increases suicidality, even when the severity of people’s distress is taken into account.

In other words, a call to 988 may not be preventing a suicide; it may merely be delaying one. And it may make one more likely.

As an alternative to hospitalization, many communities have implemented assisted outpatient treatment (AOT) or assertive community treatment (ACT) programs. But as these Orwellian titles suggest, these schemes merely bring the hospital into the community; they are sentences, not services, as the people involved have no choice but to participate (or the choice is these programs or the state hospital—which isn’t really much of a choice at all). These programs may be less acutely traumatizing, but they are still coercive by nature, and they rely on the “meds first and meds mostly” approach that has been the mainstay of mental health treatment for the past 40 years. The point is to keep you in the community and on your meds—to “stabilize” you and reduce your symptoms—not to foster actual recovery or return you to the driver’s seat of your life’s direction.

I am not saying that 988 is a bad idea; I am saying that it is attached to a set of mental health systems that are fundamentally and philosophically ill-equipped to actually help people (re)gain control over their lives and their life trajectories after a mental health crisis. 988 may appear to solve problems for the worried families and friends of suffering people and to those interested in “cleaning up” the places where people in frequent crisis end up—homeless encampments, shelters, local jails. But it won’t reform the system itself, the very system that has been failing these same suffering people over and over again.

The Book of Useless Similes

 

The Book of Useless Similes

As mingle as whale

As dance as cardigan

As drama as sedge

Lucerne like negritude

Immolation like a frankfurter

A tickle like a garbage can

As Helvetica as Norwich

Grackle like tincture

As forest as glimmer

Nuke like tanager

Restless as pao

Gerrymandered like tone deaf

As cuttlefish as dustbunny

As antiquated as iguana

As spiked as notion

As flow as tintype

As boom as purchase

Color like catastrophe

Bean like electron cloud

As theater as marzipan

As Lorelei as rampart

As banana as Ibrahim

A torture like dispensation

Noodle like armature

Release like burrow-owl

Awl like teenager

As orchard as tuna

Dispel like anchorite

Foil like turtledove

Orbit like omicron

Levity like fashionshow

Chow-chow like framework

Tank like harbinger

Naturalize like Waukesha

Titillate like evidence

As crucifix as divertimento

Rally like roadkill

Simper like jargon

As fumarole as switchback

Damage like corn pop

As Pope as wool

As ape as Cornwall

As dent as mote

As random as fizz

As extramarital as ecosphere

As rigid as rhyme

As Grendel as architecture

Wax like lung

Trash like hemisphere

Theory like bantam

Exoskeleton like Eeyore

As grain as noodle

As dark as sphagnum

As deer as ice

As sap as archway

As negative as sheep

As tankard as braincase

As murder as metaphor

As racial as burl

As noticeable as abstract

As cereal as Argonaut

As quince as abbey

As orchard as lamprey

As damage as wrinkle

Mendacious as barbecue

Undercurrent like prioritize

Aluminum as fuck

Dance like midwife

Enter like cheese

Roof like albatross

Essence like goat

Rumble like mountain

Excel like Snodgrass

Empire like larch

Resemble like Enoch

Enable like sassafras

Scandal like toenail

Edge like freedom

Mark like attitude

Darken like analog

As tablet as nature

As circumvent as Mercedes

As righteous as crackle

As duet as earnest

As favored as chicle

As numinous as apple

As effort as cheddar

As music as refuse

As numerous as legislate

As match as wrangle

As tank as tab

As roots as tangle

As masticate as satellite

As matrimony as escarole

Binnacle like marshmallow

Dirty as semaphore

Oceanographical like woodlouse

As silence as foeder

As dingle as damsel

As mandible as follicle

Trash like Hecuba

Mope like calliope

Creche like hinterland

Mind as potting shed

Dredge like nuclear

Crash like ambergris

Reckon like rock tumbler

Fragment like neutralize

Act like oscillate

Divine as doorknob

Flambeaux as rationalize

Timber as lubricated

Vape like singleton

Ask like ethanol

Oil like origin

Titrate like estimable

Grant as famish

As tire as strawberry

motive as cephalopod

tangent as miso

regent as woke

turbid as photoreceptor

reveant as nacho

foolish as stank

metaphorical as oak

staggering as puerile

risible as mud

credence as croquet

dirigible as snowflake

veritable as otters

rigid as consideration

cabbage as fame

similar as nosebleed

tackle like dank

frame like foreskin

crab like Toledo

orange like lapdog

rape as nuclear

tangle like grandiloquence

toodle like ice cream

as fascist as lux

as lurid as matchstick

as crawdad as calcium

as echo as mandible

as credible as pork-pie

as trashy as ileum

as nurture as crème brûlée

as notated as piston-ring

as various as smooth-bore

as paper as crowd

as vapid as lasso

as Dreamsicle as crease

as vegetable as facile

as shell as mark

as marl as dark

as pile as snack

as feral as rich

as rice as rock

as sand as maybe

as meat as joy

as plane as vapor

as wrench as rude

as bark as trash

as wire as sanctified

as wide as warship

as super as promotional

as weave as famous

as shadow as garrulous

as granular as magic

as drive as plastic

as muffin as static

as square as title

as gospel as lye

as quick as candle

as suspension as miracle

as branch as backing

as pincer as lens-cap

as massy as dial-tone

as database as ton

as wreck as headphone

as leather as tendon

as adaptable as mammary

premium as stain

verdant as brand

damnable as coffee

woolen as boys

as salt as abstraction

as melt as lobster

as quail as concentrate

as madrigal as bonesetter

as burble as blurb

as tincture as toast

as silicate as femur

as tummy as ratio

as linger as honey

as peristalsis as rotophone

as member as mouse

as crested as rubber

as tangent as Phocis

as Goethe as grab

as massive as ass

as cytokine as lambic

as neutral as gas

as passion as particle

as moon as noon

as missile as treacle

as terror as tan

as limber as acid

as purple as vision

as languid as linguine

as lungfish as asteroid

as maybe as badger

as pulpit as masticate

as random as roach

as diverse as purse

as famished as pardon

as nascent as dragon

as still as suggestion

as ranch as rein

as rat as rind

as dark as fool

as whet as wine

as tool as mandible

as hawk as heel

as maker as leave

as janky as pain

as matter as mule

as clog as happening

dirt like manservant

franks like astrology

pine like happening

corn like igneous

patch like rattle

frame like verses

bang like batter

time like exegesis

writhe like leases

vapid like vapor

torpor like hangman

biscuit like louver

wrench like tankard

as grass as gross

as murder as dust

as maker as Johnson

as fragile as antfarm

as deciduous as toast

as lingering as Maastricht

as taken as lizard

as fragmentary as star

as ricochet as barbie

as fantasy as nose ring

as guava as chessboard

as laggard as maple

as doggerel as fantasy

as womb as bomb

as wonder as target

 as how as milk

coast like turnip

trouble like marmoset

credible like Range Rover

miscreant as seat

dank as receiver

doctor as limestone

merchant as crossroads

wrangle as memory

timely like Sunday

as master as nutritive

as far-fetched as longitude

as wicked as femur

as coffee as campaign

as walk as stopwatch

as tease as tarsal

as vapid as electrolyte

as tensile as harbinger

as treacle as Dorchester

as pean as fiction

dirt like lacquer

as flake as floe

as rasher as shoe

as rose as marzipan

as ester as fine

as roll as hope

as axe as timekeeping

as rushed as ramps

as terror as marshmallow

as tincture as atavism

as whorl as donkey

as black-hole as baby

as divot as doubt

as fidget as fade

as pancake as vapid

as cocktail as simian

as refracted as dissidence

as magic as granular

as pyre as people

as fool as need

as drip as fashion

as dig as skin tag

as callous as kerning

as boil as brute

as whole as mingle

as scotch as blanket

as fragment as tease

as muscle as fedora

as wish as wisdom

as madam as fame

as glad as gland

as picture as funnel

as hammock as funeral

as Bambi as Manhattan

 as yank as yes

as motor as murder

as peace as pie

as neutral as sentence

as if as ask

as meat as nurse

as neat as further

as dream as dropsy

as distant as Steve

as linger as permanent

as mass as carpet

as dingo as Django

as barter as fate

as raucous as mimsy

as wimple as neutron

as sandy as crayon

as maple as rambunctious

as facile as dude

as Lamord as Wasatch

file like massacre

ring like turpentine

assimilate like orange juice

asymptote like fumble

tribulate like Donkey Kong

revert like sincerity

recapitulate like Maybelline

tender like two-dimensional

effort like cheese

endoscope like leviathan

femur like fumarole

tankard like Disneyland

scintillate like flex

deviate like underwear

pimple like hazelnut

twaddle like Rosemarie

phantom like tin

loom like lumberjack

tease like Tuesday

purchase as windpower

zip as holeshot

sample as “Free Bird”

wander as mush

banter as Matterhorn

butter as bachelor

doula as Montana

value as Rigel

sizzle as rot

as rat as umbrage

as feasted as brow

as moon as murder

as plastic as power

as deft as donut

as bourgeois as rust

as ramshackle as trident

as dark as stopper

as chopped as cheese

as classy as membrane

as ransom as stoat

as burdened as flour

as fancy as lodestone

as ripped as rimmer

as tangled as twist

as binge as Labrador

as fight as mansion

as glass as Benjamin