Search This Blog

Wednesday, July 7, 2010

Racing Right Past the Cause to get to the Cure

The dominant culture in the United States has produced a particular way of approaching problem solving: focus on how to fix the current problem at hand rather than spend time pondering why there is a problem in the first place. Radical thinkers, rabble-rousers, think tanks and the preponderous number of focus groups aside, this “get ‘er done attitude” rooted in trail blazing frontier making American boot strap paradigm is causing American people a great deal of harm. When public resources, research dollars and social investment focuses primarily on finding the cure for medical conditions like autism or MS, diseases like cancer or Alzheimer’s, and mental health issues like ADHD or bi-polar disorder, social responsibility for finding and then addressing the cause(s) of these social ills becomes less of a national priority. If research programs (with direct ties to pharmaceutical companies) cure the problem/disease/mental health concern, the cause doesn’t matter as much, does it? And if a few pharmaceutical companies make a little profit in the process, that’s the way business works, right?

This approach has become culturally normative through a variety of social mechanisms including advertising, demand for “quick” and cheap cures and an increasingly medicalized framework for problem solving everything from the “problem” of aging or menopause, to the issue of children not being able to focus in classrooms. Consequently, wanting to address the cause of a disease can even be seen as being unsupportive of survivors, who laud the medications or medical procedures that have given them a second lease on life. Of course, getting a second chance at life, or being able to live for years after being diagnosed with cancer or HIV, or being able to take a medication that helps regulate serotonin in ways that improve your quality of life are no small things. Especially for those whose lives have been improved and extended. But our focus has shifted to the point where gratitude and positivism are seen as critical tools for survivors, necessary in fact, for their very survival. There is a preponderance of writing about the impact a positive attitude has on people’s recovery. The virtues of lemon-to-lemonade attitudes in patients has been praised by doctors, life coaches, therapists, psychologists and patients alike in everything from news stories and self-help articles to pseudoscientific books and websites. For a fabulous critique of the “science” of positivity check out Barbara Ehrenreich’s new book Bright Sided. This, what I call “survivor culture” focus on a positivity and gratitude that ask people to concentrate their attention on how the disease or condition has improved their life, rather than any on negative effects they may be suffering from. People are told to bring their attention to what a disease or condition has given them and how they have learned to have a fulfilling life in spite of the diagnosis or condition. There is nothing wrong with being positive or practicing gratitude. I want to suggest, however, that the pressure to be positive leaves no room for anger, bitterness, rage, hopelessness and other seemingly “negative” emotions that are normal reactions to life changing and life threatening conditions, many of which could be avoided if there were the political and social will to do so. For example, anger and frustration are reasonable responses to the fact that big agriculture uses 70 % of the international water supply to grow monoculture crops in places where those crops are not meant to grow. This means those businesses need to use pesticide, which in turn pollutes the water, soil, and air. This pollution, in turn, causes enormous collateral damage. Now, consider the increasing numbers of birth defects found in children living near agricultural areas, or declining fertility rates throughout Europe primarily in areas with heavy pesticide use, or how Tasmanian cancer rates increased 200% after heavy use of pesticides. Our bodies are being biologically altered and no one can predict the future impact of these changes. Atrazine, as many people have been made aware through social protests (which have not change how it is being used here in the United Sates) has been linked to lower sperm counts in men in the United States, as well as prostate and ovarian cancer. Which means that if I get ovarian cancer, I may be extremely grateful for the cancer treatment protocols that have been developed and may save my life, but really angry and maybe even a little bitter, that Atrazine is still in widespread use in the United States despite being banned in Europe in 2003. Anger can be a reasonable response. Anger can also be a motivator and tool for social change. Anger at the continued use of Atrazine may prompt me to write letters to my congressperson, organize my community, or get involved in a group fighting to get Atrazine banned in the United States. It may also motivate me to investigate the larger intersections of economic repression, industrial racism and free market expansion in the name of political and social democracy.

Another example of our particular approach to problem solving is to argue that finding a cure is the same as finding the cause—if you can stop cancers from spreading, kill the bacteria that causes MERCA or change brain chemistry to address an emotional disorder, then you have addressed the issue. And there is some merit to this belief--you have addressed that one particular aspect of that particular problem. But that is not the whole picture. Or even the entire problem. When large companies choose to use pesticides that have been proven to cause cancer and the problem is addressed by an increase in cancer research (funded by paramedical companies) to find a cure for the cancer that is linked to that particular toxin, this is an egregious example of racing past the cause to get to a cure. This race continues as funding dollars are funneled into the research and development of medications to treat the side effects of the cancer medication. This toxic cycle may help individuals suffering from cancer live longer with fewer side effects (unless the medications they are prescribed for side effects have side effects) but does little to solve the dilemma of why they, along with many, many other individuals got the cancer in the first place.

When we move away from exploring the larger causes of a disease, or when, why and how a new diagnosis is introduced—examining the history, development and genealogy, if you will, of the disease and then addressing the disease from all these various and overlapping points—we risk perpetuating damage. If, for example one were to explore the root causes of cancer, one would discover that the majority of cancers are linked to environmental factors. It would make sense then to focus research, time, money and social investment in addressing these environmental root causes. To be sure many epidemiologists, scientists, doctors and community advocates are doing just this kind of work. But most major and mainstream research and social investment (time energy, volunteering, donations,) tend to focus on supporting survivors of cancer and helping to cure those with cancer with new medications and treatment protocols. This is fantastic. Survivors need support. But the focus is imbalanced. There are no pink ribbon campaigns for the causes of cancer. I have never seen a race to “beat the cause”. Perhaps a race to prevent asbestos exposure, or to fund the cost of moving families who live near nuclear dump sites but can’t afford to relocate, in order to prevent generational cancer clusters from appearing in the first place. Survivors should have races and campaigns. I am not suggesting that we stop these things. I am, however, proposing that we widen our lens and that funding and social support are expanded to include the identification and eradication of the primary causes of social ills. This approach, of course, asks one to examine systemic and institutional factors as well as individual factors. If environmental factors are one of the primary causes of cancer, then it would make sense to hold marathons, races, and pink ribbon campaigns to remove toxic substances from our foods, toys, and common household cleaning supplies. Maybe an orange ribbon campaign to stop the dumping of nuclear waste in economically disenfranchised neighborhoods and dumping in neighborhoods with predominantly residents of color living in them. It makes sense, so why doesn’t it happen?

When I worked for a small non-profit, occasionally a development consultant would donate their time to help our staff and board of directors learn how to develop campaign strategies, promote and market our “message”. What came up again and again, was that the more complex an issue was, the more we had to break it down into small manageable and digestible pieces—the 30 second message, the elevator speech, the two sentence mission statement. The more factors or intersectionalitites an organization was trying to address, the more complicated the issue, the more development consultants recommend a “focus on the solution.” Our group was reminded time and time again that donors (read: foundations) wanted to see “results”. We learned that you are expected to narrow down the problem to a single issue and then offer (and produce results with empirical evidence) a positive solution. This focus on results and positive solutions has its roots in the same “get ‘er done” frontier mentality model that pushes us to find the cure rather than get into the dirty, mucky realm of the causes. This approach narrows rather than widens the lens through which issues/problems/diseases/diagnosis are examined. This approach, focused primarily of “results” or “solutions”, informs the quality and kinds of questions that are asked, the quality and kinds of research that is funded and the kinds and quality of responses that are offered to social ills. This type of focus moves us away from exploring the complicated root causes of things primarily because most often the root causes are not neat, digestible, positive 2-sentence solutions. What’s more, having a focus on “solutions” also disregards or minimizes the importance of process. Process is important. How we get to a solution matters tremendously. Who is involved, who’s voices are heard, who’s view point is seen or listened too, how the solution is transcribed, documented, implemented, disseminated, shared (or not), distributed, communicated, how redress is handled, how conflict and disagreement are handled, all of this matters. The idea that the solution or result takes precedence over everything else is just one way of approaching problem solving. It happens to be the dominant model in the Untied States, not by participatory choice or majority consent, but by a history of dis-inclusion, oppression, marginalization and at times violent repression.

This approach, problem solving by focusing on and prioritizing a solution rather than exploring multiple and intersecting causes and valuing results more than process can do a lot of damage. The kinds of questions that arise when one is focused on a cure rather than exploring the complexity of possible causes can actually cause harm. When children are unable to focus in school, the primary question proposed by mainstream media, why are our children unable to focus? Is answered by 30-second, 2-sentence solution focused statements. This has produced a few different results, one of which is the over medication of school children who may be suffering less from a neurological disorder so much as from social and environmental changes. The predominant answer for the past decade to the question why can’t our children focus in school? has been medical rather than social in nature, looking at individual children, then diagnosing and prescribing a cure in the form of medication. And as for the side effects of the medications? More medication. This is an interesting route—this diagnostic paradigm. And it is one path for questions, investigations and solutions. There are, of course, other paths to take. There is not much mainstream and well-funded research being done, that I am aware, of that explores the intersections of an increasing student-teacher ratio, the decrease in physical activity—both in and out of school—an increase in sugary and corn syrup filled foods in many school diets and the increasing behavioral issues of inattention. Instead we race for the cure. We figure out what the problem is: inattention. We diagnosis it: ADHD. And we cure it: with medication. This approach has been helpful for some teachers and parents and children who struggle to sustain focus and attention in classrooms. And that is wonderful. Who would argue that helping a child who has trouble paying attention, is forgetful or even unmanageable is a bad thing? I certainly would not. But, when we do not balance this with a focus on the causes, and we use this as the primary and in many cases only approach, we are not dealing with the entire picture. And when we are not dealing with the entire picture, important details and facts get missed. When important details are missed, people and communities tend to suffer. There are huge testimonials and new bodies of research documenting the negative and often dangerous impact on children who are given stimulants, antidepressants and antipsychotic medication. Check out Overdosed America by John Abramson. It’s a great book by a medical doctor examining the impact big pharmaceutical companies are having on medical and mental health approaches to diseases and diagnosis.

I also want to point out that this shift in accountability and responsibility from cause to cure does not, ultimately, serve those grappling with these issues. Finding a cure for cancer or medication that can help children focus is a noble cause, but if social investment is pointed only in that direction, the harm will continue, profits from curing the diseases and diagnosis which result from the harm will continue, and those working to discover, manufacture, advertise and distribute a cure will continue to make money. Lots of money. So much money, I would argue that there could even be an impetus to create a disease in order to get money to research and manufacture a cure. Consider the new disorder of low female libido and the new cure, female Viagra. The possibility that women may have lower sex drives because, here in the United States, they are working longer hours, while still struggling to sustain families, under financially instable conditions, is not, as far as I am aware, on any research agenda. There are no large-scale research projects (that I have been able to find) on how work culture in the United States may affect sex drive in women. If there are, such studies they are not being shared with mainstream America in major news networks. No pharmaceutical company has invested research dollars to look at the potential link between economic depression and sex drive. They won’t because that will not produce a product for them to sell. No product, no profit. And they do have big profit margins to sustain, as pharmaceutical companies enjoy the highest profit margin of any industry. There are no mainstream research programs looking into the possible ways that chemicals and toxins like Atrazine, over use of medications like anti-biotics, and the long-term effects of psychopharmacology are impacting our biology. There are links between anti-depressants and lower sex drive and there is more and more data showing that medications as well as pesticides are showing up in our drinking water. In Texas, toxicologists found high levels of Prozac in tissues of every fish they sampled. No need for a Prozac prescription I suppose, but it makes you wonder what eating fish might be doing to the sex drives of women in the lone star state.

Consider another example. The associations between childhood sexual abuse and adult mental health issues like depression, addiction, anxiety, as well as personality disorders like Borderline Personality Disorder have long been established. Recently leaders in the field of trauma work attempted to introduce a new diagnosis, Developmental Trauma Disorder (DTD) into the newest publication of the Diagnostic and Statistical Manual of Mental Disorders or DSM (the manual published by the American Psychiatric Association which covers all mental health disorders for both children and adults). DTD is a diagnosis that encompasses the complex reality and varied symptomatic expression of traumatic experience. Despite over a decade of well-documented research, the inclusion of DTD was denied. The justification for the denial was that since the symptoms captured by DTD were already included in the DSM under other diagnostic categories, for example, anxiety, depression, hypersomnia, nightmares, panic attacks, substance abuse, addiction, self-harm, and mood swings there was no need for a new diagnosis. What is missing in this argument is that the approach of treating individual symptoms using individual diagnosis with different treatment protocols does nothing to hold space for the complex reality of trauma. Consider an interview with four leaders in the treatment of child trauma.
“Approaching each of these problems piecemeal, rather than as expressions of a vast system of internal disorganization, runs the risk of losing sight of the forest in favor of one tree,” said Bessel van der Kolk.“ What you call someone has large implications for how you treat someone, even though you may be describing the same phenomenology [using different terms].”

He (van der Kolk) noted, for instance, that because of the emotional dysregulation that traumatized children frequently display—as well as self-harming behaviors they may adopt as a coping mechanism—they are too often diagnosed with bipolar disorder and treated exclusively with drugs and behavior management

If children are diagnosed with ADHD without considering social and contextual possibilities for their behaviors we risk doing harm. If children are diagnosis with bipolar disorder because they become dysregulated as a result of trauma, we risk re-traumatizing them. And in both cases we do not get to the cause of their behaviors nor the root of the issue. Three separate diagnoses do not add up to a complete picture or whole experience as the current approach in mental health would have families, patients, mental health advocates and clinicians alike believe. Got depression, anxiety and restless leg syndrome? You will get three different medications rather than addressing the root and entire constellation which might reflect a disregulated biological system impacted by long-term fight, flight or freeze response to traumatic experiences. This type of individual focused and cure oriented treatment based approach leads to more diagnosis, more medication and more profits for pharmaceutical companies, and not necessarily a more complex understanding of people’s experiences. I do not want to disparage diagnostic tools, or new diagnosis. The world of mental health and the ability to accurately diagnosis and provide medications for people suffering has been radically helpful for many, many people. But many people working in mental health, doctors and counselors alike seem to have bought into the false belief that psychology and psychiatry are objective because they are utilizing a scientific and medical framework. Both psychology and psychiatry utilize science and scientific research to be sure, but to argue and act as if they are objective is to justify racing for a cure and treatment while blatantly ignoring or minimizing complex root causes.

If it seems easier to focus on a cure, this is because it often is. Root causes are often tangled, messy places where intersections of multiple factors complicate and impact each other. We are complex creatures, we humans. And we have to resist the lure of quick fixes, easy answers and cures that offer us a way out of having to think about the mucky reality behind, under and woven inside an issue/problem/disease. And we must actively choose to do this again and again, because the pull to focus on a quick 30-second sound bite and “results” is strong, especially when the causes are complicated and the sound bites sexy. But the 30-second sound bite and quick cure does all of us harm in the long run. None of us benefit in the long term from racing