medicine

A Sacrifice They're Willing to Make: Mississippi's War on Abortion

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The last remaining abortion clinic in Mississippi is perilously close to shutting down thanks to a new proposed law, Mississippi House Bill 1390. The law would require that all doctors performing abortions be board-certified in obstetrics and gynecology (reasonable), and that they also have admitting privileges at a local hospital (not so reasonable).

The reason that’s not so reasonable is because Jackson, Mississippi, home of the besieged abortion clinic, has two hospitals with Christian affiliations, and any hospital can refuse to grant admitting privileges to a physician for any ol’ reason, such as that said physician is a godless heathen who wants to help women murder their unborn fetuses babies.

To make it even better, the law would give the clinic’s physicians (all of whom are board-certified OB/GYNs but only one of whom has admitting privileges) less than two months to acquire them. As Evan McMurry writes at PoliticOlogy, “This is part of the pro-life’s recent death-by-a-thousand cuts tactic: if they can’t overturn Roe v Wade outright, they’ll make accessing and performing abortions so onerous that the practice will be effectively impossible.”

But of course, as it usually is with these laws, things get even more ridiculous. From the HuffPo article:

The State Senate voted to pass the bill Wednesday, but it was held for further debate on Thursday, when lawmakers had an odd exchange over the bill on the Senate floor. Sen. Kenny Wayne Jones (D-Canton) asked Sen. Dean Kirby (R-Pearl), who chairs the Senate Public Health Committee, whether ending abortions in the state would force women to resort to dangerous, back-alley abortions.

“That’s what we’re trying to stop here, the coat-hanger abortions,” Kirby replied, in reference to the abortions provided at the clinic in Jackson. “The purpose of this bill is to stop back-room abortions.”

Okay, first of all. No reputable doctor performs abortions with a coat hanger. In fact, I’m just going to go out on a limb and amend my statement to say, No doctor performs abortions with a coat hanger.

All of the physicians in question are board-certified in obstetrics and gynecology–a certification that I’m pretty sure Senator Dean Kirby does not have.

Incidentally, you know when dangerous abortions do actually happen? When abortion is made illegal. Research invariably shows this. (I know, I know, Republicans don’t believe in science anyway, but it was worth a shot.)

The truth is that making something illegal, especially if that thing is considered absolutely necessary by many people, does not mean it won’t happen anymore. It just means that it’ll happen out of sight, and therefore without regulation. This is why countries that are more progressive than ours are starting to experiment with drug decriminalization, but that’s a whole other topic.

Drug policy is a different ballgame because, while there are many psychological and societal factors that may lead people to become addicted to drugs, most of us can agree that nobody needs illegal drugs in order to have a decent life. Abortion is another matter, however. Unless conservative lawmakers are willing to provide comprehensive sex education and low-cost (or free) birth control (not to mention end sexual assault), there may not be a way to eliminate the need for abortion. For instance, from a comment on the HuffPo article I linked to:

I live in Mississippi. Yesterday I taught classes in the poorest part of the Delta to pregnant or parenting teens on parenting skills. I would much rather teach classes to teens about safe, effective birth control. The state won’t let me. It doesn’t matter how many facts or statistics I roll out…nobody listens. I am frustrated beyond belief.

So that’s what we’ve got.

Anyway, because politicians in states like Mississippi refuse to provide the resources to prevent abortion from becoming necessary, they must face the fact that women are going to get them whether they’re legal or not. But they don’t face this fact.

In the quote from Senator Kirby, which I provided above, he states that his purpose in making abortion unattainable in Mississippi is to prevent women from having dangerous abortions. So basically, his argument is this: we’re going to restrict women’s access to a safe, standard medical procedure in order to prevent them from obtaining the potentially dangerous, unregulated version of that procedure, despite the fact that restricting the safe thing actually leads to an increase in the use of the dangerous thing.

Kirby’s reasoning makes such a mockery of logic and common sense that I had to read the original quote several times before I understood it.

Mississippi’s Republican governor, Phil Bryant, had this to say about the proposed law: “This legislation is an important step in strengthening abortion regulations and protecting the health and safety of women. As governor, I will continue to work to make Mississippi abortion-free.”

Wait a minute. First he wants to merely “strengthen” abortion regulations. But then he says he wants to “make Mississippi abortion-free.” That should convince anyone who wasn’t already convinced that this law has absolutely nothing to do with making sure that abortions are performed safely. Rather, it has everything to do with making Mississippi “abortion-free.”

That’s right, he didn’t even try to pretend this was about women’s safety.

In my opinion, the fact that criminalizing abortion leads to dangerous back-alley abortions is the strongest argument for keeping abortion legal. It’s the strongest argument because it doesn’t lean on emotion or ideology. We can argue left and right about when life begins and when fetuses feel pain and whether or not women have the right to choose what to do with their bodies (hint: yes), but we cannot argue with the preponderance of evidence that shows that criminalizing abortion does not prevent abortion. It merely makes it dangerous.

Pro-lifers’ continued refusal to accept this argument says one or both of these things about them:

1. They are unwilling or incapable of accepting and understanding basic facts about economics and decision-making. That is, despite all the evidence showing the negative consequences of the criminalization of abortion, these politicians (and voters) continue to believe that banning abortion would plunge us all into Fun Happy No-Killing-Babies Land.

2. They understand these facts, but just don’t care. This is undoubtedly the worse alternative, because it means that the pain, injury, and even potential death that will come to women who try to obtain illegal abortions are, to borrow from Shrek‘s Lord Farquad, a sacrifice that Republicans are willing to make.

So, ignorance or malice? Take your pick.

A Sacrifice They're Willing to Make: Mississippi's War on Abortion
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Obama the Patriarch

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I usually stay away from commenting on Obama’s presidency because, to be honest, I was just a kid during all the previous presidencies I’ve lived through and really have no comparison to make.

However, a recent statement by Obama has caused me to come out of my apolitical cave and rage. After the FDA made a recommendation that Plan B One-Step, a form of emergency birth control that is available over the counter to anyone over 17, be available to girls under 17 without a prescription as well, Kathleen Sebelius, Obama’s secretary of health and human services, overruled the FDA’s recommendation. This is disappointing enough as is, but then Obama came out in support of her and said the following:

“I will say this, as the father of two daughters: I think it is important for us to make sure that we apply some common sense to various rules when it comes to over-the-counter medicine….And as I understand it, the reason Kathleen made this decision was she could not be confident that a 10-year-old or an 11-year-old going into a drugstore should be able — alongside bubble gum or batteries — be able to buy a medication that potentially, if not used properly, could end up having an adverse effect.  And I think most parents would probably feel the same way.”

As usual when I write about women’s issues, I literally don’t even know where to start with this. First, and perhaps most obviously, I don’t understand why we’re having all this conversation about 10- and 11-year-olds. The change would have applied to all girls under 17, and the majority of teenage girls who might need to buy Plan B are not 10 and 11. Try 15 and 16. If Obama and Sebelius are that concerned about 10- and 11-year-olds specifically, they could’ve asked the FDA to recommend allowing only girls 12 and over to get Plan B without a prescription.

Second, and also very tellingly, if the FDA has deemed Plan B safe for over-the-counter use, who are Sebelius and Obama to assume they know better? Sebelius has a BA in political science and an master’s in public administration; Obama has a BA in political science and a law degree. Unlike many cynics, I don’t necessarily doubt that these two have the knowledge and ability to perform their respective jobs, but I would not trust them over the doctors and researchers who staff the FDA when it comes to medical issues.

Third, Obama immediately reveals what this is really about when he says, “as the father of two daughters…” Understandably, Obama would be worried for his two daughters if they were ever in a position to need Plan B. However, for all of the battling that Obama has had to do with the Far Right of this country, he clearly doesn’t seem to realize that many girls don’t have daddies like Obama who would care for them, be able to afford doctors’ appointments, support their right to get an abortion, and guide them through a decision. For many girls, it would be a choice between obtaining Plan B on their own or being shamed, abused, disowned, and/or forced to carry a baby to term.

Finally, I’m disturbed by the ageist and patriarchal notion that young women are somehow incapable of making their own decisions about sexual health. Yes, children need and should have access to guidance from adults. In a perfect world, every girl would be able to go to her parents for help with something like this. But that’s not the world we live in, and we must make do accordingly. Not only has the FDA already determined that Plan B is safe, but, unlike many medications that are available over the counter to children, you can’t overdose on it or otherwise fuck it up–when you buy it, you only get one.

Furthermore, there are other ways to make sure young teens know what they’re doing when it comes to emergency birth control. For instance, mandate pharmacists to provide an option for girls to privately ask them questions about how to use Plan B. Pharmacists know a lot. Why not use them as a resource?

Much has been made of Obama’s failure (or lack thereof) to support women’s rights, and it’s a debate I don’t normally follow because one can really spin it either way. On this issue, however, I would argue that Obama has definitively failed to support women and girls. Instead, he has promoted the antiquated notion that beliefs trump science when it comes to reproductive rights.

Obama the Patriarch

Antidepressants and Strength of Character

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You're not a bad person if you take any of these roads. I promise.

Spoiler alert: They have nothing whatsoever to do with each other.

There are different levels of stigma surrounding mental illness. There’s the stigma of having a disorder in itself, the stigma of being in treatment for a disorder, and, perhaps most of all, the stigma of that treatment being pharmacological.

People love to hate psychopharmacology, especially antidepressants, the efficacy of which is constantly being questioned (often for good reason). However, I’ve noticed that drugs like antidepressants receive a special type of scorn, one that cannot be based solely on the efficacy mystery.

I’ve found that where mental treatment is concerned, therapy holds some sort of moral superiority over drugs in many people’s eyes. I think many people still feel that mental disorders are spiritual illnesses, not medical ones, and that treating them with a pill is some sort of cop-out. (Imagine the public furor if researchers came up with a pill to, say, erase the feeling of guilt.)

This would explain why, though therapy is still stigmatized–after all, the Ideal Person works out these issues on his or her own–it is considerably less looked down upon than psychotropic medication. Our culture values struggle and hard work so much that even recovering from an illness should be mentally effortful.

What people don’t realize is that there are plenty of perfectly legitimate reasons why someone might choose medication over therapy, at least in the short term. Consider, for instance, the situation I found myself in a month before I began my sophomore year of college. Having spent my entire freshman year growing progressively more depressed, I’d thought that coming home for the summer would magically fix everything. It didn’t. With a month to go, I realized that I felt like I’d rather die than go back to school.

That was when I was first diagnosed with depression, and I think my psychiatrist realized, as did I, that I just didn’t have time to muck around with my feelings–I had to get better quickly, or else going back to school would be more upsetting and stressful than I could handle. So I started taking antidepressants and quickly improved enough to feel like I could deal with being in school. The mucking around with my feelings came later.

Aside from that, I can think of many other reasons medication can at times make more sense than therapy. For example:

  • Financial concerns. Antidepressants cost me $30 a month, while therapy costs $80 for four weekly sessions. That’s a pretty big difference for many people.
  • Time. Some people are at a point in their lives where they literally can’t spare an hour or more a week for therapy. That might sound ludicrous to you, but if you’re a college student, a new parent, or a low-income worker, it probably doesn’t.
  • Availability. Unfortunately, not everyone lives in an area where good therapists are available and accessible (and bad therapists will do more harm than good). This is especially true for members of marginalized communities, who may have a hard time finding therapists who are sensitive to their issues. Not all therapists are as open and accepting as they should be.
  • Insurance. I’m lucky to have a fantastic insurance policy that covers basically everything I’ve ever needed. However, many policies are very picky with regards to therapy (as opposed to medication, which does require a prescription from a person with an MD). For instance, some policies refuse to cover therapy unless there’s an official diagnosis, and you don’t necessarily need to have a diagnosable mental disorder in order to need help. Besides, you can’t be diagnosed without going to a specialist to begin with.
  • Nature of the disorder. Although most mental illnesses obviously involve a psychological component, some do not. For example, many people in temperate climates get Seasonal Affective Disorder (SAD) during the winter months, which is characterized by a low-grade depression as well as various physical symptoms. It’s usually treated with antidepressants or light therapy, which actually has people sit in front of full-spectrum light.
  • Language. Therapy requires people to talk pretty extensively about themselves and their lives, something that would be very difficult for, say, a new immigrant who’s just learning English. Unless such people are able to find a therapist who speaks their native language, it would be pretty hard for them to get anything out of therapy.
  • Comfort. As a future therapist, I obviously wish that everyone were comfortable with the idea of therapy. But not everyone is. That could be because of cultural factors, family attitudes, personality, or negative experiences with therapy in the past. I think that using medication to improve your quality of life while working up the courage to see a therapist is perfectly okay.

I hope that this list shows that making decisions about mental health isn’t that different from making decisions about physical health–it has more to do with personal preferences and practical concerns than with the strength (or lack thereof) of one’s character.

Of course, I do believe that therapy is really important and generally awesome, which is why one of my upcoming posts will be about why I think that everyone (or almost everyone) should see a therapist. Stay tuned.

Antidepressants and Strength of Character

Preventing Depression

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I love it when people who actually know what they’re talking about confirm something I’ve believed for ages.

In this case, a study at the Feinberg School of Medicine (that’s Northwestern’s med school) showed that one out of every four or five college students who come to their school’s health center may be suffering from depression. The study also recommended that colleges should start screening students for depression. This way, they might even be able to pinpoint students with minor depression and help them get treatment before their depression worsens.

Ever since I’ve started seriously reading about psychology and depression, I’ve felt that we should start taking a preventative approach to it–not just in colleges, but everywhere. Depression tends to worsen with time, and even when it does remit on its own, it usually comes back later, with more intensity. Furthermore, distorted thinking patterns seem to precede the development of a full-blown depressive episode, so why not address those earlier rather than later?

For instance, parents take their kids to the doctor to make sure that they’re growing at a normal rate and developing the cognitive abilities they’re supposed to develop–why not also check to make sure that kids aren’t developing negative and maladaptive thinking patterns that could increase their risk for becoming depressed later?

You might think that kids are too young to show definitive patterns, but I think that’s false. My own little brother, who’s eight years old, constantly complains that he’s fat and needs to exercise, despite being underweight for his age. He also says that everyone at school hates him (they don’t) and that his school is awful and should be burned to the ground (and various other sentiments that have gotten him sent to the principal’s office before). Perhaps most importantly, he also has a pervasive family history of depression.

The unfortunate truth is that society views mental illnesses as fundamentally different from physical illnesses. One is a straightforward matter–you go to a doctor for checkups, and if something is wrong, you receive treatment. The other is for some reason shrouded in mystery, and people generally don’t go seek help for it until they’re already barely functioning.

As recent scientific developments are beginning to show, however, it may be that all mental illnesses actually have a physical basis. More and more psychologists and psychiatrists (notably, Peter D. Kramer of Listening to Prozac fame) are starting to take this view. If they’re right, it follows that we should try to take a preventative approach in treating mental illness, not a palliative one.

However, many people still have negative attitudes about the idea of psychological screening. One of the students quoted in the article linked to above said that these screenings are a bad idea because someone could just “be having a bad day” and–oh, the horrors–get recommended for counseling. First of all, however, counseling isn’t exactly the same as taking antibiotics or getting a spinal tab. Second, that just means that we need to develop better depression screening tools, not that we shouldn’t screen for it at all.

In college especially, conditions like depression can take a turn for the worse rather quickly, as evidenced by the several suicides we’ve had on campus while I’ve been a student here. Every time a tragedy like that occurs, friends and family are often quoted as saying that they “never saw it coming.” Maybe a professional psychologist would’ve.

Preventing Depression