So from 1979 - 1999 mortality rates fell an average of 2% but have risen half a percent per year since then. If I had to guess it could be that the pressures of stagnant incomes, skyrocketing higher health care costs, and more volatile economic conditions could be a bit of a pressure cooker for stress, poor diets, and increased alcohol/drug use.
Adding to that, the authors of the article and the paper are constructing an argument that over-prescription of opiod painkillers is a significant component of the problem.
We started the millennium with a stock market crash, 9/11, the Concord crashed, the Space Shuttle broke up on reentry, two wars kicked off and just when things started calming down... the Great Recession. If you weren't laid off then you probably knew a few people that were. It seemed like everything we had built over the past two decades was failing us all at once.
The 90's seemed like a time when you just watched Seinfeld on Thursday nights and watched your stocks go up in value. The 2000's and on have been a bit more stressful.
The morbidity statistics they are using would break out strokes as a category.
The abstract for the paper says This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis.
In a previous discussion I speculated that military service (and thus combat) could be a contributing factor. It would be interesting to see how many of the suicides and overdoses were people who had experienced combat.
No doubt there. Over prescribing them leads to dependency, then the DEA terrifies doctors into abruptly cutting the doses for those already on them and those patients turn to more sinister alternatives like heroin.
ER doc here. I think that this is absolutely a large contributor of these mortality trends. There are so many more factors than just users turning to IV drugs / overdosing on rx meds though, and I think that's what we're just now finding out -- things like anhedonia that occurs because of neural-level changes in brain wiring due to long-term use of opioids, hyperalgesia (increased sensing of pain) from the same thing, and more and more people developing an illness script around chronic pain that they see themselves as victims of, necesitating ever-escalating doses of analgesia (whether that's in the form of opiates, opioids, alcohol, other substances) to deal with. Really, really big problem that I think we're just waking up to deal with.
Maybe, but the years from 79-99 were hardly stress free and actual standards of living and health care are still well above what they were in the late 70s. Or maybe the rate of improvement in living standards actually contributes more to life expectancy that the absolute level? That seems hard to believe though.
Since the 80s whites as a group have diverged into blue-collar and white-collar groups. The socio-economic index of the blue-collar has been falling, and mortality has thus followed. My assumption the blue-collar group in bigger than the white-collar one, and hence the overall as a group is down. Charles Murray has some literature on this issue. I understand he is hated in Leftist circles, but the general observations have some merit.
Though I'm still on the fence about the validity of the comparison, an argument that I've seen online regarding these stats is that it echoes similar trends in addiction and suicide that manifested in post-USSR Russia, which were arguably driven by an increase in general despair and decline in quality of life. Here's an interesting qualitative description of the phenomenon: http://www.nybooks.com/blogs/nyrblog/2014/sep/02/dying-russi...
Now, back to the contemporary statistics: the correlation between increased mortality and socioeconomic groups 'hardest-hit' by recent economic concerns (globalization, the recession, and income inequality) seems quite clear, but I'm wondering if the correlation with mortality associated with drug poisoning would hold true if the same information were collected about a country with a less dysfunctional approach to narcotics and addiction management. I have a hunch that it wouldn't.
> an increase in general despair and decline in quality of life.
Yet in our own country, suicide is treated as a "mental illness", and rarely does anyone acknowledge the circumstances which make suicide the rational option.
I didn't get the impression that mbrutsch was referring to assisted suicide. Check out the quoted line. He/she was referring to suicide as the rational option for "an increase in general despair and decline in quality of life."
Guess it depends on how you define mental illness- humans have a very strong biological drive to survive.. there's an argument to be made that a thought pattern that contradicts that very basic need is aberrant.
Sir Terry Pratchett decided that he'd rather die while able to make the decision, rather than letting his mind be destroyed by Alzheimer's. (Granted, his passing was natural, but he campaigned eloquently for the right to make such a choice.)
I also knew someone who suffered great pain on a daily basis, and I have a hard time considering his suicide irrational. I knew a guy (a friend of a friend) who, through foolishness in his youth, ruptured three of his spinal discs, and had damaged two other ones. He was in constant excruciating pain. In the trailing decade of his life, he could not get sufficient pain relief to hold a job, could not get/afford treatment because of that, and basically was in a pain-filled hell, as he put it. At some point, after he'd been in near-constant excruciating pain for twenty years, he decided he no longer wanted to live.
I don't think either of these men were mentally ill, or making irrational choices.
Most suicides being attributed to mental illness is one of the great (not necessarily deliberate) deceptions in our society.
There was a great article posted here on HN a while back by a number of highly-regarded psychologists that stated most suicides in men (who make up most suicides in raw numbers) are not actually due to mental illness at all, but rather cultural and philosophical factors combine with certain events in their lives leading to a sense of irreconcilable failure.
Hell, seppuku is a form of ritual suicide that has nothing at all to do with mental illness but it arrived at by a set of personal and moral values.
Even if one is free to commit suicide, he or she is not free from the consequences. At a minimum, suicide is very hard on the loved ones of the deceased. Suicide is not in the same personal choice category as getting a face lift or smoking a little weed.
No man is an island, even if he feels like one sometimes.
Keep in mind that I'm making an ethical and moral argument. To a large degree, whether suicide should be legal is another discussion. To say someone shouldn't commit suicide isn't the same thing as saying it should be a crime to commit suicide.
I recall walking though an assisted living facility and hearing someone say "Please god let me die." over and over.
That's not a place I want to be.
Sure, my preference is immortality of some kind, but at some point choosing non existence seems reasonable. IMO, as soon as you decide everyone get's the right to get off the ride at some point then I think you must also leave that choice up to them.
The only rational argument to promote both suicide prevention for some and suicide assistance for others, is that simply the lives of some people are more valuable than the lives of others.
While in certain 'lifeboat scenarios' that brutal calculus must be undertaken, in general I am uncomfortable telling a class of people the should want to die and another class they should not.
I don't believe "rational" should be conflated with "ideal." Some people have pain inflicted upon them for longer and harder than their tolerance for pain allows. It is not irrational for those poor souls, if all other possible options have been exhausted, to consider and then execute suicide.
In my mind, the people who chose to jump out of windows of the Twin Towers, instead of being engulfed by rapidly encroaching flames, made the only rational choice available at the time.
I think the point of mbrutsch's comment is that part of why mental health is so terrible in the US is that we do a terrible job empathizing with people who suffer from it. Instead of seeing the internal logic of suicide, we force ourselves into a naive optimism. It's the same prudishness that people have with respect to sex.
To engage and promote mental health, it is better to try and see where people are coming from. Admitting that it is a rational option is not necessarily an endorsement. If you think it is, you need to reevaluate why you believe that all things rational are identical with all things good.
> part of why mental health is so terrible in the US is that we do a terrible job empathizing with people who suffer from it
This isn't just a US problem, though it may be worse there in some ways. There's also the problem that "mental health" is not well understood scientifically, yet the medical community acts as though it were. You can thumb through the DSM V and find countless seemingly well-defined "diseases" described using the language of science, yet for few is any underlying cause known and very often the "symptoms" are vague and useless for differential diagnosis. Ultimately all of this is defined by a group of people who have a particular agenda that does not necessarily serve the rights and best interests of the individual being diagnosed as potentially "ill".
That does not mean there is no such thing as a disease of the brain or body that affects behavior, only that anyone who tells you they know what behavior is a sign of disease and what is not, or of which disease it is a sign, or the cause of that disease, much less a proper course of treatment, is usually at best guessing and at worst lying. The psychology and psychiatry communities are roughly where the rest of medicine was in the early 19th century: deeply paternalistic researchers with impressive titles and great big books full of fancy language that amounts to little more than guesswork and superstition, who are nonetheless at least trying to pursue difficult knowledge in what they best understand to be a scientific manner, and a much larger body of clinical practitioners who are for the most part little better than self-serving quacks.
Until that changes in deep and fundamental ways, I'm not ready to condemn anyone to forced treatment, nor to criticize any self-treatment short of criminal injury to others. Medicine couldn't save you from TB in the 19th century (too often, it still cannot), and it may well be that neither can it save you from addiction or myriad other brain diseases today. The solution to that was and is the scientific pursuit of knowledge for the future, not the mockery or damnation of those who decline the usually ineffective (or "heroic", or otherwise horrifying) treatments on offer at the time.
> To engage and promote mental health, it is better to try and see where people are coming from. Admitting that it is a rational option is not necessarily an endorsement. If you think it is, you need to reevaluate why you believe that all things rational are identical with all things good.
Very true. Moreover, people are far too quick to criticize others' decisions as irrational when the other person's value system differs from the critic's. Very often the choices being made are rational in the context of the subject's value system, but the critic cannot or will not understand or accept that the subject does not share his or her values (or indeed that multiple value systems are possible), and so criticizes their choices under their own and concludes that they are irrational. A declaration that someone is irrational says a great deal about the critic but rarely anything much about the subject. Getting past this block is perhaps the most important aspect of useful empathy.
I 100% agree that is problem is most evident in the US. I think that this is a key insight - since a lot of people will argue that the problem is universal and not cultural. It's like the US is the perfect fulfillment of the biopolitical regime.
Someone else commented that our culture is broken - I agreed.
> You can thumb through the DSM V and find countless seemingly well-defined "diseases" described using the language of science, yet for few is any underlying cause known and very often the "symptoms" are vague and useless for differential diagnosis.
To say nothing of the political nature of declaring something as being a disorder or not. Read about the decision to remove homosexuality back in the DSM-III and the decision to remove pedophilia in the DSM-V and realize how highly political these moves were (many professionals aren't even aware of that change in the DSM-V and unless you pay close attention, a reader could easily miss the differences between pedophilia in the DSM-IV-TR and pedophilic disorder in the DSM-V).
I'm not dismissing it entirely, I'm opposing the manner in which it is used by clinicians, politicians, and the judiciary. A work of its nature should be used with the utmost caution and acceptance of its limitations, primarily by researchers. As it is, it's often treated as holy and unappealable writ by the clinical-political-judicial axis.
> You can thumb through the DSM V and find countless seemingly well-defined "diseases" described using the language of science, yet for few is any underlying cause known
That's fairly common in medicine even outside of psychiatry: typically, a set of related symptoms are identified and named, then later -- often many years later -- mechanisms that appear to occur with and likely generate the symptoms are identified and then later -- often many years later again -- root causes are identified for what causes those mechanism to begin operating.
And quite a lot of non-psychiatric medicine is at the first or second stage (and even lots that gets portrayed as being at the third stage sees frequent revisions to the ideas of the "root causes", so its only really at the second stage with efforts being made at the third stage.)
The idea that the absence of knowledge of root causes is something that distinguishes psychiatric medicine from the rest of medicine is only possible in complete ignorance of the rest of medicine, even if it is very commonly the basis of politically motivated rants against psychiatry on the internet.
> typically, a set of related symptoms are identified and named, then later -- often many years later -- mechanisms that appear to occur with and likely generate the symptoms are identified and then later -- often many years later again -- root causes are identified for what causes those mechanism to begin operating
Sure, that's still useful. But then it should be used as a catalogue for further study, not a diagnostic tool and certainly not the basis for prescribing treatments that often do more harm than good. And above all, by no means is such an incomplete catalogue appropriate basis for forcibly detaining someone or otherwise dictating what they must or must not do.
Other physicians have, slowly and with difficulty, come to terms with the limits of their knowledge and sometimes even how to communicate those limits to patients. When diagnosis is uncertain or the effectiveness and side effects of treatments poorly understood, advice is (among the better physicians) tempered by an honest effort to convey the risks and benefits given the unknowns. If nothing else, the guidance of Hippocrates still prevails. I don't see that from psychologists or psychiatrists, and the DSM and its current uses form a perfect case study in their hubris. When in doubt, diagnose; when in doubt, treat, whether the patient wishes to be treated or not, with whatever is handy regardless of whether there is any basis to expect it to work. Again, all traits of pre-modern medicine.
If you think I'm being too hard on these disciplines, consider that medicine as a whole -- while I acknowledge its many faults and would not pretend that its understanding or attitudes are anything resembling perfect or complete -- has at least in principle advanced beyond these particular errors. That should offer hope that someday psychology and psychiatry will advance similarly.
It can be a rational options, but for most I'd bet it it's irrational. People are irrational about a lot of things, so I don't see why suicide is exempt.
For the rest of the cases I think of suicide as the ultimate result of mental illness. When someone with cancer dies, we say cancer killed them.
When someone dies of suicide, for most cases it was mental illness that killed them.
The mortality rate for white men and women ages 45-54 with less than a college education increased markedly between 1999 and 2013, most likely because of problems with legal and illegal drugs, alcohol and suicide, the researchers concluded. Before then, death rates for that group dropped steadily, and at a faster pace.
A graph in the article [0] shows a large spike in deaths by poisoning, a modest increase in suicides and chronic liver disease, no change in diabetes, and a decrease in lung cancer. So the authors quasi-conclude that the increase in this demographic is due to underlying psychic pain (tough times post-recession?) that causes people to overdose/die from alcohol poisoning.
There is a weird stat at the bottom of the article - according to the "National Heroin Task Force" (who knew there was such a thing) 110 people overdose on legal/illegal drugs every day. The CDC says that only 6 people die from alcohol poisoning every day. So if we take those stats at face value, which we probably shouldn't because the National Heroin Task Force has an incentive to overblow the problem, then we would conclude that heroin is a much larger problem than alcoholism across this demographic.
One other discrepancy was the author throwing in this strange citation that (supposedly) bemoans the future of Medicare:
"This is the first indicator that the plane has crashed," said Jonathan Skinner, a professor of economics at Dartmouth College, who reviewed the study and co-authored a commentary that appears with it. "I don’t know what’s going on, but the plane has definitely crashed."
It's not often that you see this level of insightful journalism and deep analysis, so I took a moment to savor that nugget of knowledge. Then I wondered - isn't it a "good" thing for the Medicare system if the working class is dying off after contributing to the pot but before taking anything out?
Though it's not a concern within my inner circle, I've studied the War on Drugs and to claim the "National Heroin Task Force" should be baseline accused of "overblowing" the problem shows, well, straight up ignorance. Currently, yes, it's a much more fatal problem than alcoholism. The toxicity of opiate addiction - and the unregulated black market for which to get heroin - is a deadly mixture of factors.
So as painkiller overdoses leveled off at about 16,000 in recent years, heroin deaths skyrocketed from just over 3,000 in 2010 to more than 8,200 in 2013, according to CDC data. Though all heroin users didn't necessarily start with painkillers, it's the transition from painkillers to heroin, Humphreys and other experts say, that led to the recent dramatic spike in heroin abuse.
Below is a link to a Vox article that presents evidence regarding the above quote, and the reason there's a heroin epidemic in the US is because of the overly aggressive (lobbied, and punished for dishonesty in marketing) pharmaceutical industry pushing opiate drugs. Now, with the crackdown on pills, there are wide, wide swaths of the US population who've gone from pills to the horse:
In addition, the war in Afghanistan significantly destabilized one of the world's largest opium producers, leading to much higher supply and thus lower prices. With heroin cheaper and more available, it is more easily seen as an alternative to opiate pharmaceuticals.
Yep, that points to the global aspect of the demand! However, from what I've read over the years of following the "Cartel Wars" down in Mexico, the Cartel De Sinaloa (re: Chapo Guzman and Mayo Zambada) have refined their production techniques to create much better quality heroin than in the past. Thus, they grow their own poppies, refine into heroin, and smuggle in using the routes they previously used for marijuana / cocaine / heroin. Other cartels may not have access to the fields and product, so CDS increases its power.
Cartel De Golfo, more in the cocaine trade. The former Knights Templar in Michochan, methamphetamine production (in part due to dealing with the Chinese - illegal mining in trade for access to precursors). Quite a fascinating development from what I've seen. Where there's profit to be made...
Excessive alcohol use led to approximately 88,000 deaths and 2.5 million years of potential life lost (YPLL) each year in the United States from 2006 – 2010, shortening the lives of those who died by an average of 30 years. Further, excessive drinking was responsible for 1 in 10 deaths among working-age adults aged 20-64 years. The economic costs of excessive alcohol consumption in 2010 were estimated at $249 billion, or $2.05 a drink.
So alcohol causes 10x the amount of deaths per year, and when you factor in economic damages caused by people operating machinery, driving, hurting themselves when drunk it seems like heroin abuse is neither a "much more fatal problem" nor a much more widespread problem than alcoholism. Faster growing, yes.
Care to balance out the statistics of the alcohol deaths with the number of people in the United States who use alcohol? I did a quick search and came up with this via the NIH:
In 2013, 86.8 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.7 percent reported that they drank in the past year; 56.4 percent reported that they drank in the past month... In 2013, 24.6 percent of people ages 18 or older reported that they engaged in binge drinking in the past month
...and, via the 2010 US Census, there are 193,000,000 people between the ages of 18 and 64.
So, if we consider the math, many, many more people consume alcohol than heroin, and as such, 88,000 is a much smaller "fatal problem" than you frame it. So, not as widespread as alcoholism, but much more fatal for those affected. I stand by my assertion that there's no need to "over-state" the heroin problem in the US.
Yeah, I can imagine how it would be extremely stressful and life-shortening to be perpetually worried about money.
Wealth inequality has been rising for a very long time, with all but the highest income brackets stagnating. This isn't sustainable, it's literally causing the serfs to be so stressed that they die or kill themselves because of how few resources they get. We need at least some of these people alive and functioning if our society is to continue.
Forgot to say that these numbers are rarely ever mentioned by the mainstream media (MSM), not to spoil the back-slapping narrative of politicians and their sycophants "See? We stabilized the economy and saved you from a depression" (at the cost of $1T new debt/year).
Not sure why you got downvoted for this, you are entirely right regarding the shyness of the MSM to discuss the actual state of the economy. Part of it is due to the perception of the economy creating the reality of the economy, but it's also much more in line with the government to say that things are rosy.
>62.4% Civilian Labor Force Participation Rate - the lowest in 38 years!
You can't really have it both ways. We can't have automation, competitiveness, efficiency, a move way from the consumerist lifestyle, etc and expect 1970's style employment levels. Not to mention, at lot of the jobs from that era were back-breaking and dangerous manufacturing jobs. These weren't desirable jobs and many of the people who had them did their best to work their way out of them via retraining, college, moving to management, etc.
Keeping everyone employed is just a fool's errand this late in the capitalism game. More "make work" jobs isn't the solution here. Ideally, this is the narrative we need to start spreading. Things like minimum guaranteed income shouldn't be shameful concepts to push.
I agree. The problem is that the right wing (and honestly, the Democratic party too) are going to say that if you support a negative income tax or basic income, you are a communist/socialist/radical/student who is unemployed/poor and doesn't want to work hard (perpetually) to earn your keep, which they view as necessary to be eligible for benefits in society.
The American work ethic is to compete viciously for chances to work hard, for too long, forever, for little in return. It's an unmitigated failure, but people fear change and cling to tradition.
No! They American work ethic has historically been work hard to provide for your family because that's ... what ... you ... do!
It is failing because greed has become the norm. People's attitudes have gone from help your family and friends to help yourself. It has moved away from community to individualism. That's what's changed.
When Andrew decimated south Florida people were in dire straights. Everyone wanted to help. When the convoys of utility workers, food and water were allowed to go in finally, people pulled off the side of the highway and cheered and wept because, finally, help was on its way.
Contrast that to the bumbling eff up that was Katrina. People were falling over themselves trying to blame everyone else for that.
That's the difference now. How we got this way, I don't know. But it's disgusting.
A basic income doesn't fix this. We need an attitude adjustment in this country.
Employer-employee loyalties have also disintegrated during that same time period. I phrase it that way specifically because it is a two-way street, and I haven't done the research to know exactly how it broke down. As an employee, who stay with a company that doesn't invest in my future? As an employer, why invest in an employee that's just going to leave at the first higher offer?
Lack of trust and loyalty is a self-reinforcing pattern that must be broken by someone taking the first step, knowing that they might get burned.
Agree. But I don't think that mutual lack of trust between employers and employees can be fixed, primarily for one reason - executive compensation (which has multiple repercussions):
Many executives are incentivized to maximize short-term "results" at the cost of long term strategy. Once the reality bites (stock is falling, due to lower revenues, due to outdated products), they quickly come up with a "turnaround plan". The stress is on "quickly", so there is no time to re-train existing workforce, which is fired and new people with required skills come in (at a huge price of recruiting costs, ramp-up time, etc).
Executive compensation should not be tied so much to the stock price, as it leads to pump-and-dump tactics, killing companies in the long term and doing a lot of harm to employer-employee relations as well.
It is failing because greed has become the norm. People's attitudes have gone from help your family and friends to help yourself. It has moved away from community to individualism. That's what's changed.
I thought the United States was all about rugged individualism and self-interest? Either way, individualism is not the problem, and has always been a staple of American life. Nor is it "greed" (which has always been present), unless you also define spontaneous order brought by catallaxy to be a form of greed.
The issue is the Protestant work ethic has always been nothing but a feel-good tale that is obviously and demonstrably a plain falsehood, or at best an oversimplification. Of course, it's a part of cultural identity and gives people the fuzzies, so it remains believed due to the illusion of control it brings. Also because people are inclined into thinking in terms of the just-world fallacy, again so as to maintain illusion of control and teleological certainty.
I think rising wealth inequality is underestimated as a cause of suicide in the US. So many statistics indicate that financial stress is rising on the 99%, with no little change in sight.
I suspect large numbers of American lives are being shortened, even if not by outright suicide, through diseases caused by constant stress, mostly economic.
Agreed entirely. It's not impossible for the media outlets to obliquely admit this (either via articles like the OP or other "wow this economy sucks" style articles) but getting an article which synthesizes both the cause and the effect into one package is hard because it's perceived as pessimistic and contrary to the "the US economy is strong" propaganda.
People feel that things were better 10 years ago. They were still getting squeezed then, too, but it wasn't nearly as bad as today. I predict that suicide/mental illness rates for people entering their 30s are quite poor right now as well, given the student loan burden and lack of traction regarding jobs or wealth generation.
What has inequality got to do with it? The 24/7 issue is whether people have a decent life day to day. Why is the existence of insanely rich Mrs X a cause of suicide? Of course there is an issue, especially in the US, whereby wealth translates into power. No more office boy to president! There seems to be reluctance to tackle this but that's up to Americans. Assuming you believe inequality is a bad thing in itself, you can only counter it by taking money from the rich. One does wonder however whether taking money from a hard-working entrepreneur and giving even more of it to an organization that has run up astronomical debts already (most Western governments) - to dole out to others is such a smart move. Opportunities here for fresh thinking.
And since when has anybody really benefited in the long run from being given money. Give me a multiple of my income and I'll down tools and do something interesting but not necessarily economically productive.
It isn't wealth inequality or the existence of "insanely rich" per se, it's the ever-growing sector of Americans who are excluded from wealth and who no longer see any realistic hope of changing that through their own efforts. It's the latter view that is a growing suicide motivator, IMHO.
There have been many studies that have shown that while extreme cases of wealth disparity do cause unhappiness (I'm talking extreme poverty) most of the time it is not the case. This is discussed in laymen and great length in the documentary "Happy.
There is some indication that certain forms of non-chronic adrenaline producing stress (even life threatening ... ie sky diving) may help prevent depression (I'll find a reference shortly).
I honestly believe that increased opioid usage is playing a huge part here and not wealth (at least through my own observations). In fact wealth and health care availability might actually be stimulating opioid usage (ie getting pills from doctors).
While it would be virtually impossible to argue that the rich aren't getting richer, it is because they're capturing most of the gains. That means for the rest of us schmucks, stasis is the name of the game. In the presence of shortened lives and relative economic stagnation, are you arguing that people are effectively dying of jealousy?
I can totally understand why individuals with substance abuse problems give up in their early 50's and commit suicide, as I personally have felt this tug at times.
It is very difficult, both emotionally and financially, to look back at a life of wrecked relationships and blown opportunities and not feel an intense disgust with yourself and a deep fear about the future.
Also, there is simply no place for you in society anymore. In your 50's, you are almost completely judged by your status in life; your house, your cars, your relationships...someone fighting addiction for 30 years will have little to none of this.
Even super close old friends eventually give up on you and stop returning calls.
I often say these days the only real regrets I have in life is hurting those who loved me due to my substance abuse lifestyle.
Painful to read. Addiction lives in a gray area of free will. Although people make bad decisions and we all need to own our mistakes, there is a good chance that most of the time you were just along for the same crappy ride as your family and friends. You are in the unfortunate position of having to bear the brunt of the guilt.
This is why I'm largely against drug liberalization. Pot and maybe MDMA sure, but everything else, probably best left illegal. I could see exceptions for psychedlics for medical use, but not the kind of thing you would buy at the corner store, but administered by a doctor.
The hysterical "legalize everything" crowd has probably set back sane drug reform for decades. I don't think these people remotely understand how addiction ruins lives and families and how hard it is to get out of it.
There are two things that I see often confused: legalization vs decriminalization and to me they mean different things.
The problem is the users and the traders are often lumped together (and sure there are users that trade too). Tackle the traders but leave the users alone. This will still drive up prices and will still force some people into crime (but other crimes than mere possession) but it would be a good first step towards treating substance abuse (and that includes alcohol by the way) as a personal problem rather than a crime.
That does not automatically translate into 'crack and heroin should be available at the corner store'. Nor does it translate into a free pass for traders or producers.
One of the reasons that such a model still has problems.
(Just to be clear, I don't actually like that model. I just find it interesting that it even exists when the general view for illegal transactions are that sellers are worse than buyers.)
There are people that can handle alcohol just fine and there are people that can't. I tried to imply that I was talking about the second group by adding the word 'abuse'.
Having the occasional beer should definitely not be criminalized and I'm the last person that would suggest so, in fact I think that no substance abuse should be criminalized as should be clear from reading the above comment.
Except in your case users and "traders or producers" would end up being the same people. If you can't buy x drug but can google how to make it, its not a short step to cooking the drug and selling your excess to others. When you're an addict you're probably not holding down a real job so selling becomes very tempting.
I believe most dealers are users/addicts themselves now with our current policies, so going after the supply chain will only make this worse.
>and that includes alcohol by the way
We already tried making the production of alcohol illegal and it led to a lot of poisonings and blindness.
I think my approach is still superior. If we legalize the LEAST harmful of illegal recreation drugs, then there will be a harm reduction option for people who would otherwise do harder drugs. You can hunt down meth in the ghetto or go to the store and get high on pot. I imagine most will do the latter. The serious drug users in my life actually never got off drugs. They just got on safer drugs like pot.
The "legalize everything" crowd still makes no sense.
It's because people understand how addiction ruins lives that they want to medicalize the problem instead of criminalizing it.
When you criminalize something, you push it underground and make it harder to treat; and when you do "treat" it, you do so with ineffective things like prison.
Except that "criminalize everything" makes it worse. By definition it creates crime (directly and indirectly), and the people who do need help are more likely to go to jail than to see a doctor.
Alcohol itself is kind of an accident. If it was invented today we would never legalize it. First
- I partake and don't have a problem if other people do, and
- I don't think prohibition on any level would work with alcohol.
However I can't imagine how much better off humans would have been if it never existed or was completely toxic to us.
I sometimes wonder if there is still a mindset passed on from the 20's and 30's prohibition era that alcohol is illegal and therefore cool/badass. Before that was it just a way of life or was it always like this? I constantly hear family members and other grown adults talk about it like its the greatest thing ever. All of their social events revolve around it and it's just so cool to talk about drinking and getting drunk. It really drives me mad. These aren't raging alcoholics either (at least most of them). Isn't there a lot more to life than alcohol? Why does everyone want me to drink with them so badly? I might honestly enjoy trying various craft beers and such if everyone's obsession with the stuff didn't annoy me so much. /rant
Sometimes people like doing it because it lowers inhibitions and allows them to be more of their real selves. In that case they are bandaiding their own repression.
Wasn't alcohol (also accidentally) integral to making water potable? If I remember correctly it took quite a long time to realize that heating the water was what was actually sterilizing it.
Yeah I guess you're right. I just meant that it would probably have been a big win for humanity if it wasn't addictive (to some) and intoxicating.
Not preaching as I am am far from a non drinker, it's just that as you get older you see more the nasty side and less of the fun side. Your hard partying pals from college have either transitioned into light drinkers or sad dependent stumbling cautionary tales.
Yeah, I actually think we would have been better off without it as well. On a related note, I stopped drinking a while ago and I don't miss it at all. But I really wish it wasn't such a sin to avoid it. I'm not opposed to drinking so I'll have a token beer but I just don't find it appealing.
A lot of these same "legalize everything" people want a lot of money put into rehabilitation programs. Also, making this stuff illegal hasn't exactly proven to make it difficult to get- in fact, the highest growing segment of drug use for quite some time is prescription drugs, but even the full-on-illegal stuff isn't difficult to get in most neighborhoods.
For what it's worth, I'm more on the "decriminalize" side(ie, no jail time for simple possession, heavier fines/time for the sale/smuggling of significant quantities). Also, my own view may be biased from the fact that a parent was addicted to prescription opioids.
This is like saying we'll give matches to children but build more fire stations.
Just getting addicted is social harm and hard to recover from. Most addicts claims its a daily fight for the rest of their lives. I don't think millions (billions?) of dollars pushed into rehab programs are remotely as effective as trying to keep it out of the hands of would-be users.
Also, it makes more sense to address the mental issues addicts might be trying to self-medicate for instead of handing them a jug of meth and telling them to go have a good time.
>quite some time is prescription drugs
I imagine as we continue crack down on bullshit "pain clinics" this stuff is going to go way down. We're already seeing it Florida and elsewhere as legislation is catching up to corrupt doctors. I don't know why people make this sounds like its a given and will never change. The recent rise of prescription opiate abuse is well know and is being reigned back in.
>I don't think millions (billions?) of dollars pushed into rehab programs are remotely as effective as trying to keep it out of the hands of would-be users.
Considering the effectiveness of prohibition is a rounding error away from 0, it wouldn't take much for rehabilitation to be better.
I know this is a serious subject but I'm having a good laugh about this supposed "jug of meth". We should also prevent people from injecting any more than 3 marijuanas, I've heard it can kill you.
> This is like saying we'll give matches to children but build more fire stations.
This is an awful analogy unless you're looking to prove my point.
You can't possibly outlaw matches- they have too many common-good uses, and regulating their use and trade would be impossible even if you somehow made the first person guaranteed to be qualified to have one.
Prescription drugs are exactly the same way- and furthermore, short of actually inspecting every inch of every person/vehicle that comes in the country(and keeping vigilant watch of everything else), there's no way to seriously crack down on it(which btw, this entirely violates America's constitution, and I bet several other countries would have similar problems).
And even then, it wouldn't work, because how do we keep someone from giving it to a family member, or a friend? And how do we keep them from giving it to someone else? After all, even if the pain clinics are gone, that doesn't mean the abuse isn't happening. In my parent's case, they didn't go to a pain clinic- they had a dedicated physician prescribing it, one they had seen for years beforehand.
So we've got something that so far hasn't worked to the tune of billions and billions of dollars, would cost exponentially more money to do significantly better while also eroding basic human rights, then finally still won't completely solve the problem.
Or we just spend less money, not completely screw up the very concept of human rights, and clean up the mess leftover from the fact that people are human.
---
And hell, this is all assuming we even know of every drug that'll ever be created, which is obviously not true. So what happens when the next "crushing cold medication together in a bowl to get high" happens? Somehow do a check on all of those things, or simply let them go to the already set-up facility that exists to handle said problem?
I believe that drugs should be liberalized. I don't believe this because I think that drugs are totally cool and don't cause problems, I believe this because I think that loosening drug laws will cause fewer problems overall, including fewer problems due to drug addiction.
From what I can see, people who want to keep drugs illegal believe that behavior always moves in the direction of the law. Nobody is naive enough to believe that outlawing something will stop it completely, but a lot of people believe that outlawing something reduces its incidence. That seems to be the approach taken by drug prohibitionists, and looks like it's your approach as well. It boils down to, X is bad, so we want to reduce the incidence of X, so let's outlaw X.
The problem is that outlawing something doesn't always reduce it. The experience of countries like Portugal is that loosening drug prohibition reduces drug addiction.
Addiction ruins lives predominantly because of the way society reacts to it.
If addicts were provided with what they need a whole slew of society driven live ruining will go away.
If you step away from all the moralising you'll realise its better to simply pay addicts off. Society won't crumble because of it, in fact a lot of the problems will go away. A minority of the at 10-15% of people with addictive personalities will find a way to get high and you can nothing about that.
Addiction is a medical problem and should be treated like it.
It gets tricky when you have a family member that is in a spiral. You are trying to do anything you can to keep them going long enough in the hopes they will wake up one day and be ready to come back. Not the most rational thing in the world. Eventually we will be able to "vaccinate" people to wipe out the addictive channels in the brain humans will be in a good spot.
> Also, there is simply no place for you in society anymore. In your 50's, you are almost completely judged by your status in life; your house, your cars, your relationships...someone fighting addiction for 30 years will have little to none of this.
Much of the country is not that way. My father in law is that age, and I think very few people in his community would judge him by that standard. He's a prominent member of a popular foodie Facebook group in his town, to the point where people stop him in the street and take selfies with him. In his community, that's a much bigger deal than owning a Porsche.
Almost all of my wife's side of the family (from coastal Oregon) is like that. Most of her cousins are doing great things with food, art, or in the church, and people praise them for that. When they ask what we do (we're both corporate attorneys), they nod politely. I am sure they would be horrified--rather than impressed--to hear how much we spend on rent.
A former drug abuser starting over at 50 has a fighting chance at finding a "place in society" when that society cares more about how you contribute your time than about your accumulated wealth.
This is a good point, and I'm finding on re-reading my comment that I was too flippant. I do think the point stands that it is easier for younger people to find their place without existing expertise or relationships, but certainly it's easier to build status in some communities than others.
> He's a prominent member of a popular foodie Facebook group in his town, to the point where people stop him in the street and take selfies with him. In his community, that's a much bigger deal ...
You are kinda making my point for me, aren't you?
Notice I included the "your relationships" constraint.
I've yet to experience the "Hey, you were all messed up heroin a few years ago weren't you? Let's selfie..."
I don't mean to minimize the struggle of reintegrating. But I also don't think it's fair to paint all of society with the same, broad, brush. There are communities where people will care more about the food drive someone organized last week than the opportunities they squandered 30 years ago. And there are also communities where you'll never find a place if you get off the track.
And I agree...I certainly never meant to imply that it is impossible to reform your image, so to speak, and to find some sort of place to "fit in" again.
Obviously, AA/NA, volunteering, and perhaps even church groups are all potential ways to build social connections after a lifelong struggle with addiction.
But please, don't minimize too much how one's destroyed self-image affects one's motivation to begin anew, esp. in your 50's.
I have to agree especially with your third third paragraph. I am finding that friends of mine are picking up drugs and alcohol again at around age 50 even though they became sober post college. I suspect it is the emotional pain of poor life choices, feeling irrelevant, and no savings due to not being as educated as the new economy demands.
I lost a friend suicide and what perplexes me is why to do depressed people gravitate towards depressants like alcohol and Vicodin?
I have spent tens of thousands of dollars on my mental health and well being. Everything from multi-year therapy to prescription drugs to supplements to expensive exercise classes to self-help retreats. And in the last couple years I've been using testosterone (prescribed) to help me keep up my energy levels.
And they have helped me a lot. On a day-to-day basis I feel better than I did at 25.
Nonetheless I must be constantly vigilant lest my depression and alcoholism return.
I really feel for people who don't have the money for those things. If I ever became super-wealthy I would focus my philanthropy on mental health. If your brain is working at suboptimal level, it's really difficult to improve your life situation.
* Therapy off and on for about 20 years. I got something from all of it but the last five years in particular has been great. Currently I only go a few times a year, but for about a year I went once a week. $135 per session.
* Various prescription drugs, the most impactful of which has been Zoloft. Bit also Chantix to quite tobacco and Antabuse to help me with alcoholism
* Membership in mastermind groups - some business-oriented, others geared toward personal development. Usually there is at least one meetup/retreat involved. In 2013-15 I did one retreat per quarter. That group cost me about $10,000 a year in dues plus travel.
* Fitness classes - $150/month for the last five years or so
* Quality of life stuff like owning a luxury car, living in a beautiful place, international travel at least once a year, and so on.
Great list of stuff and makes think I need to do more of that, with the only possible exception being the prescription drugs.
How did Zoloft have such a great impact on you? Can you describe what you felt like off of it vs on it and how it changes you in a positive way? I'm very curious (and curious to know if it would benefit me long term).
I had tried Effexor, Proxac and Wellbutrin over the years with modest success. About five years ago, when I was going through a super-bad depression, my sister mentioned that she had tried and liked Zoloft. So I asked for that and have been off and on with it (currently on) since then.
It makes a huge difference. My mind doesn't wander into dark places as much, and when it does I'm able to redirect my thoughts somewhere else.
Also, with Zoloft I don't feel like I'm "on" something. I just feel normal.
The downside is it pretty much makes orgasm impossible, though I can temporarily get that back if I go off it for a couple days. This year I resolved to stay on it for all of 2015, because in the past I would often do it for 7-8 months, think "I feel great!" and wean myself off. I'll re-evaluate next spring.
Also, some supplements I take make a significant difference in energy levels. I was diagnosed with adrenal fatigue around the same time I started Zoloft. I did a saliva test and it turns out my cortisol is very low in the morning, making it hard to get out of bed and get going. The biggest impacts there seem to be from Rhodiola Rosea and DHEA, but I also take fish oil, B vitamins (see below) and a couple other things.
I also got a genetic test and found that I have the [heterozygous MTHFR mutation[(http://doccarnahan.blogspot.com/2013/05/mthfr-gene-mutation-...), and I take Deplin for that, though I believe non-prescription forms are available. That also seems to help with energy levels.
And I also do an annual-ish [SpectraCell](http://www.spectracell.com/) test through a local practitioner. From that we discovered that my B vitamins and testosterone were low (I'm in my late 40s so the testosterone change is not a surprise). I actually just completed another test and will get the results next week.
Finally, in the last three weeks I cut out all sugar and simple carbs. I've done that in the past but allowed a weekly "cheat day" that inevitably led me to fall off the wagon. This time I am very strict and I feel as energetic as I ever have in my life.
I don't thing cutting out sugar all by itself is the answer. Rather it's a combination of all these things that helps me develop the discipline and willpower around diet and exercise. Cutting out sugar does seem to prevent afternoon fatigue and general mood swings.
I think that your perspective on what others value deeply is a root belief that can lead to a life of substance abuse.
Others are not as cruel as you imagine them to be. You are the one holding yourself to this unkind standard. Yes there are some who are happy to join you in this belief, but that does not make it any less harmful or less your own choice.
There is no inherent command to look for reasons to continue to feel that you are not worthwhile. There are other things to discover that are equally as convincing if you give them a look.
I think it's a big challenge of culture. Substance abuse is a problem that becomes a symptom. Part of the issue I think is cultural ideas about mental health. American culture is strongly focused on good and bad, strength of will and weakness, and where to place blame. Both the person with the addiction and the rest of society are affected by this culture.
When you become addicted to a substance, it's like it becomes revealed to society that you're a weak person. Like weakness is part of your identity. A good person is strong, a good person has the strength of will to not abuse substances. You're not a good person.
When you look back at your life, you see the same faults and have the same regrets. You think of yourself as a weak person.
The problem with those sorts of ideas is they reinforce the behavior that leads to things like substance abuse. They isolate you, they make you lose motivation, they make you act in a self destructive manner because you think you are the kind of person who should.
These are cultural elements that are present everywhere but relatively stronger in American culture. It really likes to put people into boxes, quite literally. People who commit a crime are considered criminals. The crime can be pretty minor, but maybe it sends you to jail. Criminals are bad, and people who go to jail are bad. Good people won't interact with bad people. You can lose your job, you can lose the ability to find another, you can lose your home, you can lose your ability to find another. But good people don't care, bad people go to jail. Bad people need to be punished. Bad people don't deserve our attention. Bad people don't deserve our money.
Other cultures are a bit less polarized. The need to brand someone good or bad isn't as strong. If you commit a crime, you go to jail, but you're treated like a person, you're given opportunities to correct some of the issues that sent you there, you're released in a manner that tries to help integrate you into the rest of society. American culture sees things like this and gets very angry. How dare you spend MY tax dollars on feeding THOSE bad people nice food, and give them comfortable beds!? How dare you help bad people fix their problems when good people fix their problems themselves?
A person who abuses substances needs to be helped. It's a problem that is self-reinforcing and really need some external support to break. The issue is that to ask for help identifies you as weak. It lets out the "secret" that you're not good enough, you don't have that imaginary "indomitable will" that good people have that keep them from doing bad things. The person feels this and is afraid to ask, and society feels this and will punish you for doing so.
It's like how mental health issues, like suicide attempts can go into your police file and keep you from being allowed to cross the border. These sorts of cultural impacts cause people to be afraid to look for help, and not just be afraid, but be punished for looking for help.
I think for the person in that situation, there's very little you can do to change the rest of society. But I think you can change your own mind, and I don't mean you can buck up and use that indomitable will to shrug off your addiction. I mean, you can recognize that you aren't a bad person or a weak person. You're not significantly different than your neighbor, it's just that you had a different set of circumstances 30-40 years ago and ended up learning a different set of habits and coping behavior. Had they been exposed to the same things and presented the same circumstances, they could be in your shoes.
You can identify the small things in life that are important, and you can look towards what is needed to make your life a bit more like that. It doesn't even have to be getting rid of your addiction, it could be that you want to keep your home tidy, it could be that you want to eat breakfast ...
My wife's parents both passed in this group. Her father died of heart attack in 2001, but was heavy into cocaine and speed-drinking. Her mother recently passed last year of a heart attack, but was on methadone for opiate addiction and had sclerosis of the liver. Both of their death certificates list heart attack as the cause of death.
I have to wonder how many of these opiate and poison related deaths are being cherry picked to hide other more common cause of deaths like heart disease.
They do mention it. They suggest that those types of ailments are increasing, but not at a pace that would explain these deaths.
"...the study clearly shows they are not the result of diseases such as lung cancer or diabetes, which are declining and increasing slowly, respectively."
They are examining trends in morbidity data. Presumably, those causes of death did not show the same rise that is shown in the causes of death that they are calling attention to.
That is, the paper would mention it if the population in question had seen an unusual rise in deaths from cardiovascular diseases and cancers.
I wonder if the next generation will sneer when watching circa 2015 clips of people boozing at virtually every social outing, like we do when we see old clips of people smoking everywhere.
It may be the impact to others that gave smoking it's stigma compared to alcohol. Smoke drifts through the air and leaves a pungent smell in clothing. For non-smokers, this can be far more impacting than alcohol when both substances are consumed in moderation.
Right, but it wasn't the modern form of smoking a lot every day as a habit, as far as I can tell, but more of an occasional thing. That's what I tried to cover, vaguely, with "for the most part." Smoking a little bit isn't too bad, it's when you're inhaling multiple cigarettes every day that you really have trouble.
Imagine the first Europeans to encounter it. "What is this?" "Tobacco, sir" "What do you do with it?" "Why, roll it up, stick it in your face, and light it on fire"
They have become this mythical creature in political rhetoric along with "small business owners". A lot of stuff is done and claimed in their name. Little of it becomes true, but the rhetoric of appealing to "hard working men and women" never fails.
None of my relatives do. They eat that stuff up, because the alternative is to admit that they're a mediocre bunch that hasn't risen one iota above the wealth or social status of their predecessors, despite their derision for poor people of color for not climbing that same social ladder.
You need to be a lot more than "academically gifted" to make it in today's America. In fact, "academically gifted" probably means you have crushing student debt.
See: unemployment rate among Americans with a four year degree, or any college experience at all for that matter. The unemployment rate is hyper low.
That unemployment rate is half that of the European Union, as is the unemployment rate across the board in the US.
More people in the US are moving up from middle skill jobs to higher skill, better paying jobs, than are falling from middle skill to lower skill jobs:
If you want to talk about crushing debt, see: Canada, Australia, UK, Japan, Sweden, Norway, Finland, Denmark, Netherlands - all of which have worse household debt to income levels than the US (including the student debt in the equation). Canada's household debt to income ratio, as one example, is now nearly twice that of the US. Denmark's is three times that of the US; Norway's is over twice that of the US.
The US also has a lower share of adults still living with their parents compared to most of Europe. In some cases, dramatically lower (Portugal is 44% vs 14% for the US).
The US has one of the highest median incomes, and median disposable incomes. Higher than: Germany, UK, France, Spain, Italy, etc.
The US has a higher median net household wealth level than Germany or Sweden.
The US median student debt among people with any student debt, is $13,000. Household debt to income levels have been falling for six straight years, and are back to normalized levels last seen during the boom days of the 1990s.
What you're claiming, doesn't hold up under any scrutiny.
Statistics are fun. Obviously getting a degree is important and will set you ahead of someone without - saying there is no problem with America's higher education market is not something I can agree with.
Most complaints about student debt being super high either relate to law/medical school or the cost of Ivy League/SLA schools on the east coast.
College is expensive, and it's bad, but private schools are an order of magnitude more expensive; the popular narrative typically ignores public schools which cost roughly 50-80K for an undergraduate degree, depending on location. Private schools run around 200K+ at full cost, I believe.
I personally sucked up a fairly large of debt because I made several poor choices. This is not the case, in general, for my peers, who chose better.
The state school I attended 15 years ago cost $24,000 per year for out of state students. Middle of the road (academically) universities then, were running in the 30's, with Ivy Leagues in the 40's (per year) - It is much higher now.
"We need better antidepressants. We need antidepressants that create reliable, stable euphoria, not just an absence of debilitating depression that struggles to beat placebo.
But we need more than that. We need positive eugenics. We need to raise the IQ of the average human at least one standard deviation.
But the hedonic treadmill will grind on, and sustainable euphoric antidepressants might be impossible. And that will still leave 50% of the population miserable that they are in the bottom half."
And here you have made the case for a dystopia by suggesting that the human condition can and should be medicated away for the purposes of compliance. We already have a population that is heavily psychotropic drug-reliant in order to function, and the results aren't great. Stable euphoria is possible, just take up heroin injection.
The argument for eugenics is also problematic/impossible. The low IQ people are just as human as the high IQ people, and they can't simply be bred out peacefully because, surprise, the smarter people get the fewer children they have.
To offer a bit of perspective, I'd consider looking at societies that are less status-driven than the US as proof that blasting the public with medication isn't necessary with the economic/political tools of today. There are plenty of other places (Denmark or Nepal being good examples) where happiness is quite high, inequality is quite low, and the pyramid of status is much shorter and wider. People frequently want a sensation of fairness more than relative status; this is good especially because relative status is amorphously framed by the individual.
EDIT: I have read some of the literature at the website cited, and find it to be largely philosophically spurious techno-fantasy. On a very long view, we may need to address the question of abolishing human suffering entirely (an extremely optimistic speculation), but it's a premature conversation to have because the road between here and there will change the nature of the problem.
Maybe we need a way of life that doesn't drive us all to depression in the first place. Get out of the house, into the wild once in a while. Move, play, exercise with a purpose instead of those dreadful torture chambers of stationary bikes and mills. They used to put criminals on treadmills as punishment!
And increase socialization to a daily activity. No more trudging to a faceless cubicle, then trudging home to an empty flat for some TV time. Then drugs to sleep, and drugs to wake up again.
We need no antidepressants; we need to stop actively inducing depression!
I was surprised to read through all this and not see a more direct mention of the likely triad of causes for this phenomenon: debt, divorce, and dependents.
I really wish that the whole Rat Park experiment this video relies on had been true, and a cure for addiction was that easy, but as I understand it the scientist behind the Rat Park experiment falsified the data to spark a public debate.
The idea was great, but further studies failed to reproduce the original results and all major science journals rejected the paper.
We are not making it easier to handle this big issue of addiction by relying on fals or unreproducible data.
It's not all doom and gloom, there's still confirmation that environment and drug addiction are linked. Here's a link to the rat park experiment that touches on this topic,
https://en.m.wikipedia.org/wiki/Rat_Park
Do you have a source that thoroughly supports the debunking of the Rat Park experiment? This is the first I'd heard that it was unreproducible and the result of falsified data.
It's a little terrifying that this needs to be said. We are now operating under the assumption that if you are white, then your life can't be bad in any way and you have money to burn.
"This is the first indicator that the plane has crashed,” said Jonathan Skinner, a professor of economics at Dartmouth College, who reviewed the study and co-authored a commentary that appears with it. “I don’t know what’s going on, but the plane has definitely crashed."
This basically sums up my fears. Whatever is going on, economics is at the root of it.
How much of this is due to the economy? The people in this group, surely, are finding it harder to get well paying jobs. It is much harder to find a middle income job working with your hands now than it was 20, 30 years ago.
What did this group's wages do during this same time period? Something had to push them to this. I am guessing this is it.
People with no college experience, are basically the only group not participating in the rebounded economy. In fact the only demographics that are actually losing jobs to immigrants in net, are lower class whites and blacks. Their job opportunities have been seriously harmed by the immigration influx. It makes perfect sense you would see a decline in their well being accordingly (especially considering the US has a weaker welfare state in sheer benefits volume, including for mental health, versus much of western Europe).
Vaguely reminds me of the chapter on suicides in Tipping Point (iirc). I wonder if this can be explained in a similar fashion instead of by macro trends?
The generation of "middle-aged whites" (which the article describes as being aged 45-54 between 1999 and 2013) probably doesn't get enough credit. So... lack of college education is a common denominator in many of their deaths. But people keep forgetting the information economy came after we had our hefty physical infrastructure.
Alcohol and drug abuse are how people self-medicate when they can't afford expensive / professional medical care. We're only barely starting to scratch the surface of this problem with AHA; but for many of the "uneducated" people in this generation who were/are employed in construction / physical labor... it probably seems like too little too late.
"While the death rate for African Americans is still greater than the rate for whites, the turnaround among whites is shocking because of the advantages they enjoy, said David Weir..."
Is this just reversion to the mean? That is, is the death rate for working-class white people simply converging to to the death rate for African Americans?
If so, that's the most horrible way to end white privilege :(
No, because we have explanations for what's causing it: suicides, drinking, drugs.
It likely includes the large increase in pill overdoses by that white demographic since the mid to late 1990s. It's something that whites in the US seem to abuse more than any other group of people in any other country. Doctors in the US have become drug addiction facilitators.
Further, historically American whites had among the highest life expectancy, between 1800-1970 - right until the obesity explosion left Americans trailing behind. So what reversion to the mean? Reversion would be that American whites drop the obesity, go back to 1970 weight levels, and live five years longer.
No, a "reversion to the mean" is a statistical error caused by small sample sizes. For obvious reasons, you're not likely to see it when looking at death statistics for a population in the tens of millions. There's a clear hypothesis here for a real effect.
Unless you are using a different meaning of 'reversion to the mean' than I am familiar with, it's not a statistical error and has nothing to do with the size of the sample. 'Regression to the mean' happens when you have an imperfect correlation between two data fields.
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[ 3.2 ms ] story [ 222 ms ] threadIf this is supposed to be sarcasm, I'm missing it.
We started the millennium with a stock market crash, 9/11, the Concord crashed, the Space Shuttle broke up on reentry, two wars kicked off and just when things started calming down... the Great Recession. If you weren't laid off then you probably knew a few people that were. It seemed like everything we had built over the past two decades was failing us all at once.
The 90's seemed like a time when you just watched Seinfeld on Thursday nights and watched your stocks go up in value. The 2000's and on have been a bit more stressful.
The abstract for the paper says This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis.
( http://www.pnas.org/content/early/2015/10/29/1518393112.abst... )
So strokes probably don't explain it.
In a previous discussion I speculated that military service (and thus combat) could be a contributing factor. It would be interesting to see how many of the suicides and overdoses were people who had experienced combat.
The article details the increasing causes of mortality in this group.
http://cbsnews1.cbsistatic.com/hub/i/2014/07/01/98ca03d6-2e2...
Source:
http://www.cbsnews.com/news/the-states-with-the-worst-prescr...
http://www.modernmethod.com/send/files/military-vs-pain.png
Now, back to the contemporary statistics: the correlation between increased mortality and socioeconomic groups 'hardest-hit' by recent economic concerns (globalization, the recession, and income inequality) seems quite clear, but I'm wondering if the correlation with mortality associated with drug poisoning would hold true if the same information were collected about a country with a less dysfunctional approach to narcotics and addiction management. I have a hunch that it wouldn't.
Yet in our own country, suicide is treated as a "mental illness", and rarely does anyone acknowledge the circumstances which make suicide the rational option.
One can argue that oppression and malaise are driving people to despair. It's another argument entirely to say that wasting a life makes sense.
I also knew someone who suffered great pain on a daily basis, and I have a hard time considering his suicide irrational. I knew a guy (a friend of a friend) who, through foolishness in his youth, ruptured three of his spinal discs, and had damaged two other ones. He was in constant excruciating pain. In the trailing decade of his life, he could not get sufficient pain relief to hold a job, could not get/afford treatment because of that, and basically was in a pain-filled hell, as he put it. At some point, after he'd been in near-constant excruciating pain for twenty years, he decided he no longer wanted to live.
I don't think either of these men were mentally ill, or making irrational choices.
There was a great article posted here on HN a while back by a number of highly-regarded psychologists that stated most suicides in men (who make up most suicides in raw numbers) are not actually due to mental illness at all, but rather cultural and philosophical factors combine with certain events in their lives leading to a sense of irreconcilable failure.
Hell, seppuku is a form of ritual suicide that has nothing at all to do with mental illness but it arrived at by a set of personal and moral values.
I'll see if I can dig the article up.
No man is an island, even if he feels like one sometimes.
Keep in mind that I'm making an ethical and moral argument. To a large degree, whether suicide should be legal is another discussion. To say someone shouldn't commit suicide isn't the same thing as saying it should be a crime to commit suicide.
That's not a place I want to be.
Sure, my preference is immortality of some kind, but at some point choosing non existence seems reasonable. IMO, as soon as you decide everyone get's the right to get off the ride at some point then I think you must also leave that choice up to them.
Can a terminally ill child choose to die? What if they have a significant life long illness that isn't terminal?
What if they have no illness?
Not saying it is impossible to work out all of these problems, I've just never seen anyone do so.
While in certain 'lifeboat scenarios' that brutal calculus must be undertaken, in general I am uncomfortable telling a class of people the should want to die and another class they should not.
In my mind, the people who chose to jump out of windows of the Twin Towers, instead of being engulfed by rapidly encroaching flames, made the only rational choice available at the time.
To engage and promote mental health, it is better to try and see where people are coming from. Admitting that it is a rational option is not necessarily an endorsement. If you think it is, you need to reevaluate why you believe that all things rational are identical with all things good.
This isn't just a US problem, though it may be worse there in some ways. There's also the problem that "mental health" is not well understood scientifically, yet the medical community acts as though it were. You can thumb through the DSM V and find countless seemingly well-defined "diseases" described using the language of science, yet for few is any underlying cause known and very often the "symptoms" are vague and useless for differential diagnosis. Ultimately all of this is defined by a group of people who have a particular agenda that does not necessarily serve the rights and best interests of the individual being diagnosed as potentially "ill".
That does not mean there is no such thing as a disease of the brain or body that affects behavior, only that anyone who tells you they know what behavior is a sign of disease and what is not, or of which disease it is a sign, or the cause of that disease, much less a proper course of treatment, is usually at best guessing and at worst lying. The psychology and psychiatry communities are roughly where the rest of medicine was in the early 19th century: deeply paternalistic researchers with impressive titles and great big books full of fancy language that amounts to little more than guesswork and superstition, who are nonetheless at least trying to pursue difficult knowledge in what they best understand to be a scientific manner, and a much larger body of clinical practitioners who are for the most part little better than self-serving quacks.
Until that changes in deep and fundamental ways, I'm not ready to condemn anyone to forced treatment, nor to criticize any self-treatment short of criminal injury to others. Medicine couldn't save you from TB in the 19th century (too often, it still cannot), and it may well be that neither can it save you from addiction or myriad other brain diseases today. The solution to that was and is the scientific pursuit of knowledge for the future, not the mockery or damnation of those who decline the usually ineffective (or "heroic", or otherwise horrifying) treatments on offer at the time.
> To engage and promote mental health, it is better to try and see where people are coming from. Admitting that it is a rational option is not necessarily an endorsement. If you think it is, you need to reevaluate why you believe that all things rational are identical with all things good.
Very true. Moreover, people are far too quick to criticize others' decisions as irrational when the other person's value system differs from the critic's. Very often the choices being made are rational in the context of the subject's value system, but the critic cannot or will not understand or accept that the subject does not share his or her values (or indeed that multiple value systems are possible), and so criticizes their choices under their own and concludes that they are irrational. A declaration that someone is irrational says a great deal about the critic but rarely anything much about the subject. Getting past this block is perhaps the most important aspect of useful empathy.
Someone else commented that our culture is broken - I agreed.
To say nothing of the political nature of declaring something as being a disorder or not. Read about the decision to remove homosexuality back in the DSM-III and the decision to remove pedophilia in the DSM-V and realize how highly political these moves were (many professionals aren't even aware of that change in the DSM-V and unless you pay close attention, a reader could easily miss the differences between pedophilia in the DSM-IV-TR and pedophilic disorder in the DSM-V).
One may as well dismiss diagnosis of plague during the Black Death because germ theory had not been discovered yet.
That's fairly common in medicine even outside of psychiatry: typically, a set of related symptoms are identified and named, then later -- often many years later -- mechanisms that appear to occur with and likely generate the symptoms are identified and then later -- often many years later again -- root causes are identified for what causes those mechanism to begin operating.
And quite a lot of non-psychiatric medicine is at the first or second stage (and even lots that gets portrayed as being at the third stage sees frequent revisions to the ideas of the "root causes", so its only really at the second stage with efforts being made at the third stage.)
The idea that the absence of knowledge of root causes is something that distinguishes psychiatric medicine from the rest of medicine is only possible in complete ignorance of the rest of medicine, even if it is very commonly the basis of politically motivated rants against psychiatry on the internet.
Sure, that's still useful. But then it should be used as a catalogue for further study, not a diagnostic tool and certainly not the basis for prescribing treatments that often do more harm than good. And above all, by no means is such an incomplete catalogue appropriate basis for forcibly detaining someone or otherwise dictating what they must or must not do.
Other physicians have, slowly and with difficulty, come to terms with the limits of their knowledge and sometimes even how to communicate those limits to patients. When diagnosis is uncertain or the effectiveness and side effects of treatments poorly understood, advice is (among the better physicians) tempered by an honest effort to convey the risks and benefits given the unknowns. If nothing else, the guidance of Hippocrates still prevails. I don't see that from psychologists or psychiatrists, and the DSM and its current uses form a perfect case study in their hubris. When in doubt, diagnose; when in doubt, treat, whether the patient wishes to be treated or not, with whatever is handy regardless of whether there is any basis to expect it to work. Again, all traits of pre-modern medicine.
If you think I'm being too hard on these disciplines, consider that medicine as a whole -- while I acknowledge its many faults and would not pretend that its understanding or attitudes are anything resembling perfect or complete -- has at least in principle advanced beyond these particular errors. That should offer hope that someday psychology and psychiatry will advance similarly.
The vast majority of suicides don't qualify, but we shouldn't say it's always irrational any more than we should say it's always rational.
For the rest of the cases I think of suicide as the ultimate result of mental illness. When someone with cancer dies, we say cancer killed them.
When someone dies of suicide, for most cases it was mental illness that killed them.
Because suicide is mostly a symptom of mental ill health - although sometimes the person isn't in contact with services and doesn't have a diagnosis.
A graph in the article [0] shows a large spike in deaths by poisoning, a modest increase in suicides and chronic liver disease, no change in diabetes, and a decrease in lung cancer. So the authors quasi-conclude that the increase in this demographic is due to underlying psychic pain (tough times post-recession?) that causes people to overdose/die from alcohol poisoning.
There is a weird stat at the bottom of the article - according to the "National Heroin Task Force" (who knew there was such a thing) 110 people overdose on legal/illegal drugs every day. The CDC says that only 6 people die from alcohol poisoning every day. So if we take those stats at face value, which we probably shouldn't because the National Heroin Task Force has an incentive to overblow the problem, then we would conclude that heroin is a much larger problem than alcoholism across this demographic.
One other discrepancy was the author throwing in this strange citation that (supposedly) bemoans the future of Medicare:
"This is the first indicator that the plane has crashed," said Jonathan Skinner, a professor of economics at Dartmouth College, who reviewed the study and co-authored a commentary that appears with it. "I don’t know what’s going on, but the plane has definitely crashed."
It's not often that you see this level of insightful journalism and deep analysis, so I took a moment to savor that nugget of knowledge. Then I wondered - isn't it a "good" thing for the Medicare system if the working class is dying off after contributing to the pot but before taking anything out?
[0] https://img.washingtonpost.com/rf/image_1484w/2010-2019/Wash...
So as painkiller overdoses leveled off at about 16,000 in recent years, heroin deaths skyrocketed from just over 3,000 in 2010 to more than 8,200 in 2013, according to CDC data. Though all heroin users didn't necessarily start with painkillers, it's the transition from painkillers to heroin, Humphreys and other experts say, that led to the recent dramatic spike in heroin abuse.
Below is a link to a Vox article that presents evidence regarding the above quote, and the reason there's a heroin epidemic in the US is because of the overly aggressive (lobbied, and punished for dishonesty in marketing) pharmaceutical industry pushing opiate drugs. Now, with the crackdown on pills, there are wide, wide swaths of the US population who've gone from pills to the horse:
http://www.vox.com/2015/10/1/9433099/opioid-painkiller-heroi...
Cartel De Golfo, more in the cocaine trade. The former Knights Templar in Michochan, methamphetamine production (in part due to dealing with the Chinese - illegal mining in trade for access to precursors). Quite a fascinating development from what I've seen. Where there's profit to be made...
So alcohol causes 10x the amount of deaths per year, and when you factor in economic damages caused by people operating machinery, driving, hurting themselves when drunk it seems like heroin abuse is neither a "much more fatal problem" nor a much more widespread problem than alcoholism. Faster growing, yes.
http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
In 2013, 86.8 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.7 percent reported that they drank in the past year; 56.4 percent reported that they drank in the past month... In 2013, 24.6 percent of people ages 18 or older reported that they engaged in binge drinking in the past month
...and, via the 2010 US Census, there are 193,000,000 people between the ages of 18 and 64.
So, if we consider the math, many, many more people consume alcohol than heroin, and as such, 88,000 is a much smaller "fatal problem" than you frame it. So, not as widespread as alcoholism, but much more fatal for those affected. I stand by my assertion that there's no need to "over-state" the heroin problem in the US.
Wealth inequality has been rising for a very long time, with all but the highest income brackets stagnating. This isn't sustainable, it's literally causing the serfs to be so stressed that they die or kill themselves because of how few resources they get. We need at least some of these people alive and functioning if our society is to continue.
- 62.4% Civilian Labor Force Participation Rate - the lowest in 38 years! (http://data.bls.gov/timeseries/LNS11300000)
- 9M people on Disability Insurance, double the number in 1995 and six times the number in 1970 (http://fortune.com/2015/10/08/disability-insurance-unemploym...)
I see despairing articles about the state of the American middle class in the media all the time.
In fact, this very article is from the mainstream media.
You can't really have it both ways. We can't have automation, competitiveness, efficiency, a move way from the consumerist lifestyle, etc and expect 1970's style employment levels. Not to mention, at lot of the jobs from that era were back-breaking and dangerous manufacturing jobs. These weren't desirable jobs and many of the people who had them did their best to work their way out of them via retraining, college, moving to management, etc.
Keeping everyone employed is just a fool's errand this late in the capitalism game. More "make work" jobs isn't the solution here. Ideally, this is the narrative we need to start spreading. Things like minimum guaranteed income shouldn't be shameful concepts to push.
The American work ethic is to compete viciously for chances to work hard, for too long, forever, for little in return. It's an unmitigated failure, but people fear change and cling to tradition.
It is failing because greed has become the norm. People's attitudes have gone from help your family and friends to help yourself. It has moved away from community to individualism. That's what's changed.
When Andrew decimated south Florida people were in dire straights. Everyone wanted to help. When the convoys of utility workers, food and water were allowed to go in finally, people pulled off the side of the highway and cheered and wept because, finally, help was on its way.
Contrast that to the bumbling eff up that was Katrina. People were falling over themselves trying to blame everyone else for that.
That's the difference now. How we got this way, I don't know. But it's disgusting.
A basic income doesn't fix this. We need an attitude adjustment in this country.
Lack of trust and loyalty is a self-reinforcing pattern that must be broken by someone taking the first step, knowing that they might get burned.
Many executives are incentivized to maximize short-term "results" at the cost of long term strategy. Once the reality bites (stock is falling, due to lower revenues, due to outdated products), they quickly come up with a "turnaround plan". The stress is on "quickly", so there is no time to re-train existing workforce, which is fired and new people with required skills come in (at a huge price of recruiting costs, ramp-up time, etc).
Executive compensation should not be tied so much to the stock price, as it leads to pump-and-dump tactics, killing companies in the long term and doing a lot of harm to employer-employee relations as well.
I thought the United States was all about rugged individualism and self-interest? Either way, individualism is not the problem, and has always been a staple of American life. Nor is it "greed" (which has always been present), unless you also define spontaneous order brought by catallaxy to be a form of greed.
The issue is the Protestant work ethic has always been nothing but a feel-good tale that is obviously and demonstrably a plain falsehood, or at best an oversimplification. Of course, it's a part of cultural identity and gives people the fuzzies, so it remains believed due to the illusion of control it brings. Also because people are inclined into thinking in terms of the just-world fallacy, again so as to maintain illusion of control and teleological certainty.
I suspect large numbers of American lives are being shortened, even if not by outright suicide, through diseases caused by constant stress, mostly economic.
People feel that things were better 10 years ago. They were still getting squeezed then, too, but it wasn't nearly as bad as today. I predict that suicide/mental illness rates for people entering their 30s are quite poor right now as well, given the student loan burden and lack of traction regarding jobs or wealth generation.
It isn't wealth inequality or the existence of "insanely rich" per se, it's the ever-growing sector of Americans who are excluded from wealth and who no longer see any realistic hope of changing that through their own efforts. It's the latter view that is a growing suicide motivator, IMHO.
There is some indication that certain forms of non-chronic adrenaline producing stress (even life threatening ... ie sky diving) may help prevent depression (I'll find a reference shortly).
I honestly believe that increased opioid usage is playing a huge part here and not wealth (at least through my own observations). In fact wealth and health care availability might actually be stimulating opioid usage (ie getting pills from doctors).
Rather, it's stagnating wages and declining economic outlooks which are negatively impacting the 99%.
It's important to separate these things, because the landscape of policy solutions are dramatically different.
It is very difficult, both emotionally and financially, to look back at a life of wrecked relationships and blown opportunities and not feel an intense disgust with yourself and a deep fear about the future.
Also, there is simply no place for you in society anymore. In your 50's, you are almost completely judged by your status in life; your house, your cars, your relationships...someone fighting addiction for 30 years will have little to none of this.
Even super close old friends eventually give up on you and stop returning calls.
I often say these days the only real regrets I have in life is hurting those who loved me due to my substance abuse lifestyle.
The hysterical "legalize everything" crowd has probably set back sane drug reform for decades. I don't think these people remotely understand how addiction ruins lives and families and how hard it is to get out of it.
The problem is the users and the traders are often lumped together (and sure there are users that trade too). Tackle the traders but leave the users alone. This will still drive up prices and will still force some people into crime (but other crimes than mere possession) but it would be a good first step towards treating substance abuse (and that includes alcohol by the way) as a personal problem rather than a crime.
That does not automatically translate into 'crack and heroin should be available at the corner store'. Nor does it translate into a free pass for traders or producers.
I prefer the Swedish model used to handle prostitution. Selling is legal, buying is the crime.
(Just to be clear, I don't actually like that model. I just find it interesting that it even exists when the general view for illegal transactions are that sellers are worse than buyers.)
Give me a break. Having the occasional beer is not substance abuse and shouldn't be criminalized.
Having the occasional beer should definitely not be criminalized and I'm the last person that would suggest so, in fact I think that no substance abuse should be criminalized as should be clear from reading the above comment.
I believe most dealers are users/addicts themselves now with our current policies, so going after the supply chain will only make this worse.
>and that includes alcohol by the way
We already tried making the production of alcohol illegal and it led to a lot of poisonings and blindness.
I think my approach is still superior. If we legalize the LEAST harmful of illegal recreation drugs, then there will be a harm reduction option for people who would otherwise do harder drugs. You can hunt down meth in the ghetto or go to the store and get high on pot. I imagine most will do the latter. The serious drug users in my life actually never got off drugs. They just got on safer drugs like pot.
The "legalize everything" crowd still makes no sense.
When you criminalize something, you push it underground and make it harder to treat; and when you do "treat" it, you do so with ineffective things like prison.
Except that "criminalize everything" makes it worse. By definition it creates crime (directly and indirectly), and the people who do need help are more likely to go to jail than to see a doctor.
However I can't imagine how much better off humans would have been if it never existed or was completely toxic to us.
Sometimes people like doing it because it lowers inhibitions and allows them to be more of their real selves. In that case they are bandaiding their own repression.
But mostly, it's because it's fun.
Anti drink was a social movement in the US for quite some time before it was law:
https://en.wikipedia.org/wiki/Temperance_movement
Not preaching as I am am far from a non drinker, it's just that as you get older you see more the nasty side and less of the fun side. Your hard partying pals from college have either transitioned into light drinkers or sad dependent stumbling cautionary tales.
For what it's worth, I'm more on the "decriminalize" side(ie, no jail time for simple possession, heavier fines/time for the sale/smuggling of significant quantities). Also, my own view may be biased from the fact that a parent was addicted to prescription opioids.
Just getting addicted is social harm and hard to recover from. Most addicts claims its a daily fight for the rest of their lives. I don't think millions (billions?) of dollars pushed into rehab programs are remotely as effective as trying to keep it out of the hands of would-be users.
Also, it makes more sense to address the mental issues addicts might be trying to self-medicate for instead of handing them a jug of meth and telling them to go have a good time.
>quite some time is prescription drugs
I imagine as we continue crack down on bullshit "pain clinics" this stuff is going to go way down. We're already seeing it Florida and elsewhere as legislation is catching up to corrupt doctors. I don't know why people make this sounds like its a given and will never change. The recent rise of prescription opiate abuse is well know and is being reigned back in.
Considering the effectiveness of prohibition is a rounding error away from 0, it wouldn't take much for rehabilitation to be better.
By that analogy, does that mean that you want to throw children in jail for using matches?
But we're remarkably okay with doing this for people who have ADD/ADHD.
This is an awful analogy unless you're looking to prove my point.
You can't possibly outlaw matches- they have too many common-good uses, and regulating their use and trade would be impossible even if you somehow made the first person guaranteed to be qualified to have one.
Prescription drugs are exactly the same way- and furthermore, short of actually inspecting every inch of every person/vehicle that comes in the country(and keeping vigilant watch of everything else), there's no way to seriously crack down on it(which btw, this entirely violates America's constitution, and I bet several other countries would have similar problems).
And even then, it wouldn't work, because how do we keep someone from giving it to a family member, or a friend? And how do we keep them from giving it to someone else? After all, even if the pain clinics are gone, that doesn't mean the abuse isn't happening. In my parent's case, they didn't go to a pain clinic- they had a dedicated physician prescribing it, one they had seen for years beforehand.
So we've got something that so far hasn't worked to the tune of billions and billions of dollars, would cost exponentially more money to do significantly better while also eroding basic human rights, then finally still won't completely solve the problem.
Or we just spend less money, not completely screw up the very concept of human rights, and clean up the mess leftover from the fact that people are human.
---
And hell, this is all assuming we even know of every drug that'll ever be created, which is obviously not true. So what happens when the next "crushing cold medication together in a bowl to get high" happens? Somehow do a check on all of those things, or simply let them go to the already set-up facility that exists to handle said problem?
From what I can see, people who want to keep drugs illegal believe that behavior always moves in the direction of the law. Nobody is naive enough to believe that outlawing something will stop it completely, but a lot of people believe that outlawing something reduces its incidence. That seems to be the approach taken by drug prohibitionists, and looks like it's your approach as well. It boils down to, X is bad, so we want to reduce the incidence of X, so let's outlaw X.
The problem is that outlawing something doesn't always reduce it. The experience of countries like Portugal is that loosening drug prohibition reduces drug addiction.
If addicts were provided with what they need a whole slew of society driven live ruining will go away.
If you step away from all the moralising you'll realise its better to simply pay addicts off. Society won't crumble because of it, in fact a lot of the problems will go away. A minority of the at 10-15% of people with addictive personalities will find a way to get high and you can nothing about that.
Addiction is a medical problem and should be treated like it.
http://www.ericberne.com/games-people-play/alcoholic/
https://archive.org/details/TheGamesPeoplePlay
Much of the country is not that way. My father in law is that age, and I think very few people in his community would judge him by that standard. He's a prominent member of a popular foodie Facebook group in his town, to the point where people stop him in the street and take selfies with him. In his community, that's a much bigger deal than owning a Porsche.
Almost all of my wife's side of the family (from coastal Oregon) is like that. Most of her cousins are doing great things with food, art, or in the church, and people praise them for that. When they ask what we do (we're both corporate attorneys), they nod politely. I am sure they would be horrified--rather than impressed--to hear how much we spend on rent.
You are kinda making my point for me, aren't you?
Notice I included the "your relationships" constraint.
I've yet to experience the "Hey, you were all messed up heroin a few years ago weren't you? Let's selfie..."
Obviously, AA/NA, volunteering, and perhaps even church groups are all potential ways to build social connections after a lifelong struggle with addiction.
But please, don't minimize too much how one's destroyed self-image affects one's motivation to begin anew, esp. in your 50's.
Stay well.
I lost a friend suicide and what perplexes me is why to do depressed people gravitate towards depressants like alcohol and Vicodin?
And they have helped me a lot. On a day-to-day basis I feel better than I did at 25.
Nonetheless I must be constantly vigilant lest my depression and alcoholism return.
I really feel for people who don't have the money for those things. If I ever became super-wealthy I would focus my philanthropy on mental health. If your brain is working at suboptimal level, it's really difficult to improve your life situation.
* Therapy off and on for about 20 years. I got something from all of it but the last five years in particular has been great. Currently I only go a few times a year, but for about a year I went once a week. $135 per session.
* Various prescription drugs, the most impactful of which has been Zoloft. Bit also Chantix to quite tobacco and Antabuse to help me with alcoholism
* Membership in mastermind groups - some business-oriented, others geared toward personal development. Usually there is at least one meetup/retreat involved. In 2013-15 I did one retreat per quarter. That group cost me about $10,000 a year in dues plus travel.
* Fitness classes - $150/month for the last five years or so
* Quality of life stuff like owning a luxury car, living in a beautiful place, international travel at least once a year, and so on.
How did Zoloft have such a great impact on you? Can you describe what you felt like off of it vs on it and how it changes you in a positive way? I'm very curious (and curious to know if it would benefit me long term).
It makes a huge difference. My mind doesn't wander into dark places as much, and when it does I'm able to redirect my thoughts somewhere else.
Also, with Zoloft I don't feel like I'm "on" something. I just feel normal.
The downside is it pretty much makes orgasm impossible, though I can temporarily get that back if I go off it for a couple days. This year I resolved to stay on it for all of 2015, because in the past I would often do it for 7-8 months, think "I feel great!" and wean myself off. I'll re-evaluate next spring.
Also, some supplements I take make a significant difference in energy levels. I was diagnosed with adrenal fatigue around the same time I started Zoloft. I did a saliva test and it turns out my cortisol is very low in the morning, making it hard to get out of bed and get going. The biggest impacts there seem to be from Rhodiola Rosea and DHEA, but I also take fish oil, B vitamins (see below) and a couple other things.
I also got a genetic test and found that I have the [heterozygous MTHFR mutation[(http://doccarnahan.blogspot.com/2013/05/mthfr-gene-mutation-...), and I take Deplin for that, though I believe non-prescription forms are available. That also seems to help with energy levels.
And I also do an annual-ish [SpectraCell](http://www.spectracell.com/) test through a local practitioner. From that we discovered that my B vitamins and testosterone were low (I'm in my late 40s so the testosterone change is not a surprise). I actually just completed another test and will get the results next week.
Finally, in the last three weeks I cut out all sugar and simple carbs. I've done that in the past but allowed a weekly "cheat day" that inevitably led me to fall off the wagon. This time I am very strict and I feel as energetic as I ever have in my life.
I don't thing cutting out sugar all by itself is the answer. Rather it's a combination of all these things that helps me develop the discipline and willpower around diet and exercise. Cutting out sugar does seem to prevent afternoon fatigue and general mood swings.
Others are not as cruel as you imagine them to be. You are the one holding yourself to this unkind standard. Yes there are some who are happy to join you in this belief, but that does not make it any less harmful or less your own choice.
There is no inherent command to look for reasons to continue to feel that you are not worthwhile. There are other things to discover that are equally as convincing if you give them a look.
When you become addicted to a substance, it's like it becomes revealed to society that you're a weak person. Like weakness is part of your identity. A good person is strong, a good person has the strength of will to not abuse substances. You're not a good person.
When you look back at your life, you see the same faults and have the same regrets. You think of yourself as a weak person.
The problem with those sorts of ideas is they reinforce the behavior that leads to things like substance abuse. They isolate you, they make you lose motivation, they make you act in a self destructive manner because you think you are the kind of person who should.
These are cultural elements that are present everywhere but relatively stronger in American culture. It really likes to put people into boxes, quite literally. People who commit a crime are considered criminals. The crime can be pretty minor, but maybe it sends you to jail. Criminals are bad, and people who go to jail are bad. Good people won't interact with bad people. You can lose your job, you can lose the ability to find another, you can lose your home, you can lose your ability to find another. But good people don't care, bad people go to jail. Bad people need to be punished. Bad people don't deserve our attention. Bad people don't deserve our money.
Other cultures are a bit less polarized. The need to brand someone good or bad isn't as strong. If you commit a crime, you go to jail, but you're treated like a person, you're given opportunities to correct some of the issues that sent you there, you're released in a manner that tries to help integrate you into the rest of society. American culture sees things like this and gets very angry. How dare you spend MY tax dollars on feeding THOSE bad people nice food, and give them comfortable beds!? How dare you help bad people fix their problems when good people fix their problems themselves?
A person who abuses substances needs to be helped. It's a problem that is self-reinforcing and really need some external support to break. The issue is that to ask for help identifies you as weak. It lets out the "secret" that you're not good enough, you don't have that imaginary "indomitable will" that good people have that keep them from doing bad things. The person feels this and is afraid to ask, and society feels this and will punish you for doing so.
It's like how mental health issues, like suicide attempts can go into your police file and keep you from being allowed to cross the border. These sorts of cultural impacts cause people to be afraid to look for help, and not just be afraid, but be punished for looking for help.
I think for the person in that situation, there's very little you can do to change the rest of society. But I think you can change your own mind, and I don't mean you can buck up and use that indomitable will to shrug off your addiction. I mean, you can recognize that you aren't a bad person or a weak person. You're not significantly different than your neighbor, it's just that you had a different set of circumstances 30-40 years ago and ended up learning a different set of habits and coping behavior. Had they been exposed to the same things and presented the same circumstances, they could be in your shoes.
You can identify the small things in life that are important, and you can look towards what is needed to make your life a bit more like that. It doesn't even have to be getting rid of your addiction, it could be that you want to keep your home tidy, it could be that you want to eat breakfast ...
It might not be too late to apologise to some of those you feel suffered, if they're still around.
Good luck for the future, and remember that those who know you now are lucky in every way :)
I have to wonder how many of these opiate and poison related deaths are being cherry picked to hide other more common cause of deaths like heart disease.
The US has an obesity epidemic right now and it has huge risks for some of these health issues:
1. high blood pressure
2. diabetes
3. heart disease
4. cancer
5. ulcers
Yet absolutely no mention of this in any of the stats or the issues which may be contributing to early deaths of this segment of the population.
"...the study clearly shows they are not the result of diseases such as lung cancer or diabetes, which are declining and increasing slowly, respectively."
That is, the paper would mention it if the population in question had seen an unusual rise in deaths from cardiovascular diseases and cancers.
It may be the impact to others that gave smoking it's stigma compared to alcohol. Smoke drifts through the air and leaves a pungent smell in clothing. For non-smokers, this can be far more impacting than alcohol when both substances are consumed in moderation.
Imagine the first Europeans to encounter it. "What is this?" "Tobacco, sir" "What do you do with it?" "Why, roll it up, stick it in your face, and light it on fire"
It is a bad time for those that are not academically gifted.
See: unemployment rate among Americans with a four year degree, or any college experience at all for that matter. The unemployment rate is hyper low.
That unemployment rate is half that of the European Union, as is the unemployment rate across the board in the US.
More people in the US are moving up from middle skill jobs to higher skill, better paying jobs, than are falling from middle skill to lower skill jobs:
http://i.imgur.com/WLJ73C7.png
If you want to talk about crushing debt, see: Canada, Australia, UK, Japan, Sweden, Norway, Finland, Denmark, Netherlands - all of which have worse household debt to income levels than the US (including the student debt in the equation). Canada's household debt to income ratio, as one example, is now nearly twice that of the US. Denmark's is three times that of the US; Norway's is over twice that of the US.
The US also has a lower share of adults still living with their parents compared to most of Europe. In some cases, dramatically lower (Portugal is 44% vs 14% for the US).
The US has one of the highest median incomes, and median disposable incomes. Higher than: Germany, UK, France, Spain, Italy, etc.
The US has a higher median net household wealth level than Germany or Sweden.
The US median student debt among people with any student debt, is $13,000. Household debt to income levels have been falling for six straight years, and are back to normalized levels last seen during the boom days of the 1990s.
What you're claiming, doesn't hold up under any scrutiny.
College is expensive, and it's bad, but private schools are an order of magnitude more expensive; the popular narrative typically ignores public schools which cost roughly 50-80K for an undergraduate degree, depending on location. Private schools run around 200K+ at full cost, I believe.
I personally sucked up a fairly large of debt because I made several poor choices. This is not the case, in general, for my peers, who chose better.
But we need more than that. We need positive eugenics. We need to raise the IQ of the average human at least one standard deviation.
But the hedonic treadmill will grind on, and sustainable euphoric antidepressants might be impossible. And that will still leave 50% of the population miserable that they are in the bottom half."
And here you have made the case for a dystopia by suggesting that the human condition can and should be medicated away for the purposes of compliance. We already have a population that is heavily psychotropic drug-reliant in order to function, and the results aren't great. Stable euphoria is possible, just take up heroin injection.
The argument for eugenics is also problematic/impossible. The low IQ people are just as human as the high IQ people, and they can't simply be bred out peacefully because, surprise, the smarter people get the fewer children they have.
To offer a bit of perspective, I'd consider looking at societies that are less status-driven than the US as proof that blasting the public with medication isn't necessary with the economic/political tools of today. There are plenty of other places (Denmark or Nepal being good examples) where happiness is quite high, inequality is quite low, and the pyramid of status is much shorter and wider. People frequently want a sensation of fairness more than relative status; this is good especially because relative status is amorphously framed by the individual.
EDIT: I have read some of the literature at the website cited, and find it to be largely philosophically spurious techno-fantasy. On a very long view, we may need to address the question of abolishing human suffering entirely (an extremely optimistic speculation), but it's a premature conversation to have because the road between here and there will change the nature of the problem.
And increase socialization to a daily activity. No more trudging to a faceless cubicle, then trudging home to an empty flat for some TV time. Then drugs to sleep, and drugs to wake up again.
We need no antidepressants; we need to stop actively inducing depression!
Denmark's ranking for number of suicides is much lower than the US.
Especially divorce.
However % of out-of-wedlock births have continued to rise.
Anecdotally and statistically, it seems like 'Family Court' findings are the major cause for a precarious-to-struggling decade long stretch of life.
https://www.youtube.com/watch?v=ao8L-0nSYzg
The idea was great, but further studies failed to reproduce the original results and all major science journals rejected the paper.
We are not making it easier to handle this big issue of addiction by relying on fals or unreproducible data.
I guess the propaganda has worked.
This basically sums up my fears. Whatever is going on, economics is at the root of it.
Kudos to the authors and journal for providing a full PDF immediately. Boo to the Washington Post for not linking.
What did this group's wages do during this same time period? Something had to push them to this. I am guessing this is it.
The generation of "middle-aged whites" (which the article describes as being aged 45-54 between 1999 and 2013) probably doesn't get enough credit. So... lack of college education is a common denominator in many of their deaths. But people keep forgetting the information economy came after we had our hefty physical infrastructure.
Alcohol and drug abuse are how people self-medicate when they can't afford expensive / professional medical care. We're only barely starting to scratch the surface of this problem with AHA; but for many of the "uneducated" people in this generation who were/are employed in construction / physical labor... it probably seems like too little too late.
Is this just reversion to the mean? That is, is the death rate for working-class white people simply converging to to the death rate for African Americans?
If so, that's the most horrible way to end white privilege :(
It likely includes the large increase in pill overdoses by that white demographic since the mid to late 1990s. It's something that whites in the US seem to abuse more than any other group of people in any other country. Doctors in the US have become drug addiction facilitators.
Further, historically American whites had among the highest life expectancy, between 1800-1970 - right until the obesity explosion left Americans trailing behind. So what reversion to the mean? Reversion would be that American whites drop the obesity, go back to 1970 weight levels, and live five years longer.