In 1729 Jonathan Swift suggested we stew, roast, bake, or boil the excess of poor children who were clearly becoming a drain on society’s resources. Not to mention their filthy, begging hands and faces were detracting from the quaint storefronts of beautified down towns and the general, picturesque landscapes of a country. His solution was touted as a win for all; sustainable, fiscally responsible, wholesome and preventative as he argued this would allow ‘the breeders’ to go on producing as many children as their heart’s desired without the burden of having to care for their offspring past the age of one. Sadly, an estimated 31% of the population are now vegetarian and an additional 3% are vegan, until they get full time jobs and realize working people don’t have the time to dedicate to soaking their nuts. Therefore Jonathan’s well-intended solution might not be so swift after all. It’s too bad he died before The Great Hunger as he might’ve seen a reprieve in offers for his proposal. Thankfully Charles Dickens came along and gave us Scrooge; Are there no prisons? Are there no workhouses? Yes! And thank god. Prisons, it turns out are even more profitable than the cosmetics industry. They might be second cousins. The united states annual budget for prisons is $80 billion according to the Committee for a Responsible Federal Budget. A prison nonprofit says we’re actually spending $182 billion. I’m not sure where the extra profits come from; maybe it’s celery? One other source says our current leader has gracious plans to go either private or condo, probably for aesthetic reasons since old prisons are really lacking in curb appeal, thread-count and natural lighting. Money Watch calls this a real winner. Cha-ching! Meanwhile proposed cuts to national mental health funding, a whopping $17.9 billion, could be diverted to a chain of Swift Deli’s. I might be a marketing genius; we could put the Swift Deli’s right inside the condo-prisons and make dough hand over fist. I’ll lose faith in humanity if I keep going. What if awakening backed by science is actually cheaper than human bologna?
Two years ago my doctor asked if I was a veteran while going over the results of a cortisol test. For 24 hours all I could eat was boiled shrimp and brown rice. No problem since I’m great at mild starvation. Once in the morning, twice in the middle of the day and once before bed I had to find sanitary locations to blow into plastic tubes which I then Fed-exed to a lab. It felt indulgent, silly and foreign but I suddenly found myself with the best health insurance I’d ever had and went to a naturopath desperate to cure my anemia. Seven years of i.v iron infusions were taking a toll both on my body and my budget. While working on a psych unit for a county hospital my hemoglobin dropped to 8. Granted, I was also going through a divorce at the time, but building a day treatment program as the primary clinician responsible for upwards of twenty acute psych patients, five groups a day, five days a week may have been a contributing factor. My annual take home pay was roughly $34,000, barely enough for rent on my studio apartment and giant student loan payments to a dark lord named Sallie. The program itself cleared a million dollars in the first year. In order to get approval for a half time social worker to share the load, I was tasked with being the sole provider of intake assessments, group, individual and family therapy, discharge planning and all the glorious documentation for an undetermined amount of time as part of demonstrating to a man who looked like Captain America that we’d successfully exceeded capacity and could afford a little help. Please sir, I want some more. During that time I was assaulted twice. Thankfully the bites and scratches didn’t break the skin since I have a phobia of vaccines. As for the clump of hair ripped out of my head, in fairness it was falling out on its own anyway. After relocating 3000 miles in pursuit of a living wage, with the intention of Restoring Sanctuary, the work got harder which I saw as an opportunity to get better at finding solutions. In the first year I responded to crisis that made national headlines. Adding to the stress of the response, which for me lasted over 3 months, a blizzard had dumped an absurd amount of snow in a town with loose definitions of the word plow. Tip of a Titanic iceberg. I was doing everything I knew to stay well in an unwell system but it wasn’t enough to leverage the flood.
I was diagnosed with something called adrenal fatigue. It sounded like a fake diagnosis used to sell expensive supplements, which it is, but apparently there’s also a valid, medical reason for why I found myself crying in front of the dishwasher. My cortisol was spiking all day and plummeting at night to the point where my body was unable to regulate itself; like parents of newborns, combat soldiers, ER nurses, cashiers, police officers, med students, all of Wall Street, oppressed and minority groups, the daily lives of people living in poverty and anyone experiencing a chronic episode of trauma. Bonus points if your trauma took place in childhood. Extra bonus points if the trauma’s inter-generational. Isn’t that all of us since capitalism is built on the exploitation of self and other and human history has had zero chapters entitled Word Peace? The CEO works the people of the company so hard eventually everyone’s heart explodes. If that’s true trauma-informed awareness and applications don’t have to live silos. So why do they? We’ve been tricked into believing we’re fighting for scare resources. The cure for comparative suffering is compassion which despite being limitless, is hard to find when we’re sick, tired and being asked to do more and more with less and less, especially by someone who lives in a bigger house and has nicer shoes.
I was beyond exhausted but couldn’t sleep and when I did, I found myself having nightmares about work or stuff I needed to work on which had been triggered by work; incident reports, the Gargoyle, crisis response, witnessing a fatality when I was 3, losing a case manager to home visit that went horribly wrong, daily exposure to human suffering charted across a spreadsheet in the form of capitation targets, remembering that time I was homeless, biopsychosocial assessments audited along a checklist of administrative rules or an actual human being sitting in front of me telling their story.
Before you break out a violin lets talk about dessert. Have you ever had a slice of flourless chocolate cake? If human service were a dessert it would be a rich, bittersweet, flourless chocolate cake. If you eat more than a modest slice of this dense beast you will most certainly get sick but taken in slow, thoughtful and savored bites the experience might change your life for good. I can think of no better metaphor. I was crashing hard cause I’d had way too much. Let them eat cake! Oublie Marie! Heartless bitch; such is the perspective of those encased in walls of solitary perspective like palaces or projects. Speaking of prisons, we might each be living in different, less globally profitable cages of silence, invisibility, misunderstanding and lack of access not just to bread or beds but to each other. I don’t understand the burden of being royalty any more than they understand the daily lives of peasants. The naturopath suggested I quit my job immediately. She had a friend who worked at ‘some dog food company. You could probably make like $80K a year doing easy stuff.’ What? A cushy job? So this is what happens when you have connections? I briefly imagined sitting in a quiet office learning how to brand and market gourmet kibble. After a few minutes my soul told me it would quickly shrivel up and die if I took one step closer to this well intended but awful prescription. In fairness my doctor is incredibly kind and willingly worked with my choices. There are many ways we can choose to get out but going through is the only choice I know of that gets us to the other side. I love human service, what I don’t love are the lack of boundaries, awards for codependence and general toxicity building up in a system designed by division. Essentially it’s sick because we’re sick; a parallel process requiring a triple dose of cure; yours, mine, ours.
If everyone swept their own doorstep the whole world would be clean.-Swedish Proverb
In order for each of us to tidy up our own stoop, everyone needs a stoop, maybe arms, legs, eyes and some kind of broom. Last time I checked the DG sells brooms for a dollar. They’re not the best and a dustpan costs extra, but it’ll basically get the job done. Sounds simple enough but life being less than simple means we can get sick, hurt, kicked out, hired to clean someone else’s stoop and are then too tired to clean our own or go broke which would then require help from a neighbor to maintain our threshold.
Fifteen percent of the world are disabled, according to WHO. Roughly 40 million Americans are disabled according to PEW. Your level of ability is decided by YOU. Therefore participation in Swedish proverbs may vary which is why we need public services; people to do everything from making coffee to coffins. Along the spectrum from cradle to grave are multiple opportunities to invest in each other so more of us could be considered for the Lawn of the Month Club; public education, health insurance, mental health clinics, addictions recovery, restorative justice, birth control, non-violent communication, trauma-informed journalism, affordable housing and free manure. Instead we continue to invest in war, punishment and Ben & Jerry’s which have made hospitals, jails and mental health clinics very busy, underfunded and therefore understaffed.
This year Massachusetts proposed a mandate that would enforce patient caps for nurses. The proposal is being met with angry mobs of hospital execs who say there aren’t enough nurses to implement the mandate, some nurses are already taking excessive Diet Coke breaks and the costs to hire more help could force some centers to close. What is to become of Downton? I wonder how much the angry execs make? And now I shall be burned at the stake. Massachusetts. Salem. Anyway, back to cake and cortisol. We’re being asked to do more with less which is not only burning out a shrinking workforce, it’s leading to a decline in the quality of service, resulting in poor outcomes and a sicker, under-educated, underdeveloped population, not to mention fatal errors. According to a study conducted by Johns Hopkins medical errors are the third leading cause of death in the United States. Roughly 250,000 people die receiving healthcare in part because we, as healthcare providers, spend more time staring at computer trying to find a billing code than we spend looking at our patient. I suppose the five guys who run everything might enjoy lording over a world full of graveyards and prisons but for now there’s still hope.
Thanks to ACE’s research we’re gathering data on the prevalence and impact of childhood trauma, how it can set us up for a shortened life full bad choices we wouldn’t be making if someone would just show us a better way. No doc, we’re not all veterans but each of us are fighting our own war. My naturopath was the first doctor who cried when I told her about my childhood. While I was grateful and even taken aback by her compassion, it also made me feel…diminished? guilty? embarrassed? at first. I might’ve felt stronger if she’d high fived me and hit me with a splash of Gatorade. Instead I went back to therapy and started drinking holy basil. Together we got my anemia into remission and my hormones more balanced. We’re all works in progress.
In support of caseload caps and other forms of building workforce resilience, why not make cortisol testing part of the process? Instead of measuring productivity against capitation targets established by the man behind the curtain, set insurance rates against staff ratio determined by the toll the service takes on providers, while simultaneously investing in widespread resilience building through the theory and practice of trauma-informed care; a term many within the movement find limiting. The Collective Compassion Movement? Sane Solutions for a Septic World? How to be Human Initiative? Suggestions are welcomed.
The stress of modern capitalism isn’t limited to healthcare and doesn’t only affect service providers. If factories aren’t collapsing on top of us while we stitch together the fabric of our lives, our partner is leaving us for the plastic surgeon. I’ve only ever cleaned mansions but I’m guessing they’re lonely place to live.
Either way it wouldn’t hurt to establish a new measure of profit. We’re doing it backwards and feeling the pain. Flip the script. We say who, we say when, we say how much, but only if you’re in private practice or Kit DeLuca. Managed care is the industrial strength version human service. Wear gloves. It stings. Lots of organizations have workplace wellness tests and incentives like walking groups (I hide and smoke in the shrubbery.), healthy lunch clubs (I eat salad in front of you and binge all night.), hydration challenges (I pee in pools?) and personal health assessments which come with things like free first aid kits. Your blood pressure’s through the roof. Here’s a band-aid. Exactly.
Fortunately, we can amuse ourselves with satire until the powers that be start cutting equitable slices of cake.
ps: I feel horribly guilty writing 2000 words of something that isn’t my book but this piece wouldn’t budge till I got it out. Hooray for Saturday and Sunday.
pps: A fascinating article from the New York Times on Holocaust survivors and how their levels of norepinephrine matched war veterans. New rabbit hole research.