Lives (And Deaths) Of Quiet Desperation

After years of increasing longevity, studies are showing that the death rate is rising, but only for one group — white Americans between the ages of 45 and 54.  The divergence in the trend lines may be inexplicable, but it is unmistakable.  While death rates are falling in other first-world countries, and for African-Americans and Hispanics in the United States, they are rising for middle-aged whites.

The circumstances of the deaths all point to mental health issues as an underlying cause for the anomaly.  As the Wall Street Journal reports, between 1999 and 2013 deaths from suicide, drug overdoses, alcohol abuse, and chronic liver disease all increased for that population demographic, even as the incidence of other common causes for mortality, such as lung cancer, declined.  The studies also show that the increase in the mental health-related causes of death is particularly notable among middle-aged whites with no more than a high school education, although increases also were observed among better-educated segments of the population, too.

The experts aren’t sure why the mortality trend is affecting this particular group.  Some point to increases in mental health issues among white Americans and musculoskeletal problems that have left people in chronic pain — and therefore ripe for self-medication through alcohol or addiction to powerful painkillers — but those don’t seem like reasons that should target one demographic group to the exclusion of others, or for that matter should affect Americans but not Germans, British, or Canadians.

Other experts say that “economic stress” is the culprit, and that many Americans have reached middle age only to find that they are less well off than their parents, when the “American Dream” we heard about growing up is supposed to result in increases in wealth and happiness from generation to generation.  That rationale might explain why Americans are being affected as opposed to those in other countries — but is belief in the “American Dream” really so profoundly different among different demographic groups that it would explain the different death rates?

In Walden, Henry D. Thoreau wrote:  “The mass of men lead lives of quiet desperation.”  Many of us know people who have succumbed to that desperation, but we aren’t sure precisely why.  We don’t know why they are prone to addiction, or depression, or suicidal thoughts when others in similar circumstances manage to deal with their problems and forge ahead — but these studies indicate that their stories are sufficiently commonplace to create a clear and disturbing statistical trend.

Our grandparents and parents would scoff at the idea that the “American Dream” was a bad thing.  Could it be that its aspirational notions have created expectations that, if unrealized, produce disappointment so crushing that it cannot be borne?  I’m skeptical of that conclusion, but I nevertheless wonder why so many people apparently are so desperately unhappy about their lives, and what we can do to change that trend.

Responding To The Man With The Tinfoil Hat

Yesterday I heard someone describe a person as needing to put on a tinfoil hat.  It was supposed to be a funny put-down — but it really wasn’t very funny to me.

In 1981, when I was fresh out of college and working for U.S. Rep. Chalmers P. Wylie in Washington, D.C. as a legislative aide, one of my jobs was to stay late on weeknights and prepare responses to constituent correspondence.  Mr. Wylie took his job seriously, and he believed that every constituent who took the time to write a letter deserved a thoughtful response.  We would spend hours going through every letter, talking about the response and whether there was something we could do to help.

One of our regular correspondents was a man who, literally, wore a tinfoil hat.  He was a veteran who was convinced that the U.S. government was broadcasting brain waves at him, and he wore a tinfoil hat because he thought it helped.  He wrote letters to try to get Mr. Wylie’s help in stopping the brain wave broadcasts.  I chuckled at his first letter, but they kept coming, usually several a week, and it stopped being funny.  I was worried about what the man might do, but Mr. Wylie said he had been receiving letters from the man for years and he was harmless.  From information in his letters, we learned that the man had been treated at VA hospitals and was an intermittent participant in mental health programs but was suspicious of them, too.

Every week, this poor, tormented man took the time to write a few long letters beseeching us to help him.  Every week we reassured him that there was no evil government program and urged him to please go see a doctor and get medical help.  I felt sorry for him, but there was nothing more we could do . . . and the pleading letters kept coming.

Mental illness is not funny.

Depths Of Depression

The world lost a good man this week.  He ultimately succumbed, as so many have before him, to the ravages of depression, and those who knew him, personally or professionally, are devastated.

Depression is such a terrible, pernicious condition.  It isn’t readily apparent when people are suffering from depression.  It isn’t visible, like a broken leg or a wasting disease.  Often people who are depressed try, successfully, to hide it from casual acquaintances — but the blackness and anguish and despair are always there, brooding and lingering under the surface, ready to pull them down again and again and again, until they just can’t tolerate it any longer.

Those of us who are fortunate, and who don’t suffer from chronic depression, can’t possibly understand what it truly means to be depressed.  It’s like a person who has known only perfect health trying to understand what it is like to live with constant, crippling pain.  You can’t comprehend the life-changing impact of permanent pain until you personally experience sustained physical torment whenever you draw a breath.  For the depressed person, the agony is just as real and just as unbearable.

Because depression doesn’t have physical manifestations, and because many people who suffer from depression are embarrassed by their condition, it’s difficult to measure just how widespread the problem of chronic depression really is.  Some estimate that as many as 1 in 6 Americans suffer from that affliction, with an economic cost of tens of billions of dollars.

But those are just numbers.  The real cost is in the losses suffered by families and friends who lose a loved one.  The real cost is the death of each person who was a good father and husband and friend, an active participant in his community and his workplace and his children’s lives, someone who made a real difference in other people’s lives.  When such special people lose their battle to this dreadful condition, the cost is incalculable.

Cats Can (Literally) Drive You Crazy

I don’t like cats.  I don’t like their skulking, their diffidence, their prissiness, their meowing, their fur — in fact, I don’t like any characteristic or quality of cats.  Give me slobbering, blundering, shallow, happy-to-see-you dogs any day.

Still, although I despise cats, I don’t wish them or their misguided owners ill.  So I was sorry to read that studies are indicating a link between cat ownership and serious mental illness.  The causal chain goes something like this.  Cat feces contains a parasite called Toxoplasma gondii.  Cat owners come into contact with the parasite in the feces when they clean litter boxes.  The parasite then can cause an infection that may produce schizophrenia and lead to suicide.

It’s bad enough that cat lovers are cursed with wanting to have haughty, secretive, unappreciative creatures living in their homes and having to tend to smelly kitty droppings as a result.  It seems grossly unfair that feline fanciers also have to run the risk of going off their rocker, too.

The Ranter Outside The Window

I was in a downtown Cleveland hotel overnight, tossing and turning as I always do while sleeping in a strange bed in a strange place, when I was jarred into consciousness by shouts of a ranting man outside the window.  It’s an unsettling way to greet the day.

Fortunately, I don’t often hear angry voices — and this guy was livid, shouting at the top of his lungs, his furious words, muffled into indistinctness by the window, echoing down the dark streets.  I snuck a peek out the window, lest he see me and train his rage in my direction.  There he was, four stories down, a one-legged man sitting in a wheelchair, gesturing angrily at no one that I could see.  What was he doing on a downtown Cleveland street at that pre-dawn hour?  What had caused his awful, uncontrollable anger?

When Kish and I lived in Washington, D.C., it was shortly after governments had decided to “deinstitutionalize” the former residents of mental asylums.  The streets were filled with homeless people who had nowhere to go and, apparently, only a tenuous grip on reality.  They slept on the subway grates, shuffled along muttering to themselves, and mostly kept to themselves.  One man, however, was always angry and shouted out his madness to every passerby.  We called him the ranter and gave him wide berth.  And, we always wondered:  what made him so filled with rage, and why wasn’t he being helped — as he so clearly needed to be?

It’s disturbing to be awakened by the angry rantings of a stranger when you are in a strange place — but obviously it pales in comparison to the torment that the man in the wheelchair must have been experiencing, as he shouted his frustrations to a world that was trying to ignore whatever it was he was saying.

What Would You Do?

This past week in Columbus there was a tragic story that makes you think about how you would respond if you were confronted with a very difficult situation.

At midnight last Sunday night, a naked man knocked on the door of a West Side home and stood on the porch asking for help.  At the time, the outside temperature was around 20 degrees.  The resident did not let the man in the house, but immediately called police.  The police arrived less than 15 minutes later, talked to the resident, and then looked for the naked man around the house and in the neighborhood but could not find him.  The next morning, the resident noticed blood spots and footprints in the snow and followed them to a backyard shed where the naked man’s body was found.  He apparently died of hypothermia.  It turns out that the man was mentally ill, having been diagnosed with bipolar disorder and schizophrenia, and felt frightened when his clothes were on and “free” when he was naked.

The tragic incident has prompted significant commentary on the Columbus Dispatch website — see here and here — about whether people should have done things differently.  Should the resident have let the man inside his home?  Should the resident have left blankets or clothes on the porch for the naked man to use?  Should neighbors have gone to look for the man?  Was the police search sufficient, in a situation where the frigid temperatures would make the man’s nakedness a matter of life and death?  Should the canine unit or additional police officers have been summoned under the circumstances?

It is hard for me to fault the homeowner.  Under the circumstances, his first obligation is to his family.  It is fair to infer that any person who is naked after midnight in freezing temperatures may be mentally disturbed, and you simply don’t open the door to a potentially disturbed person who might harm your family members.  Calling the police immediately seems like the appropriate response.  I’m not sure I would have thought of putting out blankets or clothing under the unnerving circumstances, before the man disappeared.

I think it also is easy to say that the police should have done more when a death occurs under these kinds of circumstances.  But were the police supposed to conduct a search of every home, garage, and other potential place of shelter on the block?  Wasn’t it reasonable for the police to think that a naked man in distress would be visible and actively seeking help?  Having conducted a search of the immediate area and surrounding neighborhood, the police could reasonably conclude that the man had returned home or found shelter, or that the incident was a bizarre prank that had concluded.

A tragic death such as this one invites Monday morning quarterbacking.  In this case, I’m not sure the criticisms are truly warranted.

One Sick Country?

A recent report by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) concluded that in 2009 approximately 20 percent of American adults had some form of mental illness.  That comes out to 45 million Americans.  The report states that 11 million of those people had a serious illness.  Women reported a higher incidence of mental illness than men, and adults 18-25 reported the highest level of mental illness of any age group.

The SAMHSA numbers are an estimate based on responses to questionnaires given to representative samples.  The overall “any mental illness” statistic purports to include only people who have a “diagnosable mental, behavioral, or emotional disorder,” excluding developmental or substance abuse disorders.  The study’s determination of mental illness in adults was based on modeling the survey participants’ responses to questions on “distress” and “impairment.”  The report suggests increases in the unemployment rate had an impact on the 2009 statistics.

I recognize that many Americans struggle with mental disorders, but I seriously doubt that 1 in 5 Americans has a true diagnosable mental illness.  I suspect that many government studies are structured to produce a result that reveals a problem that needs to be resolved through increased funding and more government-payroll jobs.  The comments of the SAMHSA administrator in response to the 2009 survey results, quoted in the link above, certainly reach that conclusion — that there are many Americans who need help and treatment that aren’t getting it, and through “health care reform” and federal legislation they can get such treatment.