3 IDF soldiers from the same unit kill themselves within weeks of the Gaza ceasefire

This is messed up

In the weeks after Israel and Hamas agreed to an open-ended ceasefire, three Israeli soldiers decided to end their lives with their own weapons. And what was especially striking about their suicides was that all served in the same unit, the Givati Brigade, which had a reputation for its ruthless ferocity, considerable bravery, and the use of Old Testament religiosity to justify the merciless operations of its commander, Colonel Ofer Winter.

So why did it happen?

A contributing factor, according to Staff Sergeant J., who served in the Givati Brigade in the middle of the last decade, and does not want to be named, is that secular Israelis are now avoiding the military or declining to continue after mandatory service. “Those who do continue feel a religious and political duty,” he says. This has been discussed as a concern by Israeli academics and analysts for years.

The staff sergeant said that when he was in the Givati Brigade in 2007 or so, it was “openly secular.” He recalls “there was a group who had come from the yeshiva,” but “often they were uncomfortable… they felt sidelined.” As secular Israelis left, however, the vacancies were filled by settlers, he said.

Could any of this, or some of this, or none of this have affected the decision of three Givati soldiers to take their own lives? The Daily Beast reached out to several post-traumatic stress disorder specialists for their analysis.

“It is strange that they hadn’t seen a mental-health counselor,” said Mooli Lahad, an Israeli psychiatrist and psychotrauma specialist with over three decades of experience. He was citing reports that the Givati soldiers hadn’t received treatment. “This isn’t common for the IDF,” he said.

Lahad stressed that suicide usually has to do with pre-existing issues, such as depression, and an accumulation of factors can lead to a sense of hopelessness, which counseling helps to prevent.

“Sometimes, if there is a particularly macho culture, seeking help for depression or PTSD is seen as showing weakness, which is discouraged,” Lahad said. “If there’s a commander who thinks God is whispering in his ear, this can make things even more difficult.”

The article also speaks of religious radicalization of the Israeli military due to the role of fundamentalist settlements. 

Less force, more service

How much of this is applicable in Saskatoon.  The vision for the future of Toronto Police.

“What I see is the traditional model, which has outlived its utility and relevance,” Mukherjee said of a system that has historically relied on uniformed police officers heavily equipped with hardware, where the bulk of training is in use of force.

“The need out there has changed,” he said, adding that 80 per cent of the work police are now called on to do isn’t crime fighting per se. Officers are instead dealing with the safety of young people, domestic violence issues, and people suffering mental health issues.

Mukherjee envisions organizational shifts that could involve hiring youth workers, domestic violence workers and social workers. And that could even include taking guns away from some (or many) police officers.

“My vision of the police organization is it is actually a network of many different services,” Mukherjee said. The human rights facilitator is keenly interested in the approach to policing in the United Kingdom, thought to be at the forefront of innovation.

These are not simple changes.

During Thursday’s interview, Mukherjee noted that two years ago he pushed for zero deaths in police interactions with the mentally ill and was told by top brass it was “impractical.” (In a report released last week, retired judge Frank Iacobucci also called for a goal of “zero deaths,” one of several recommendations Blair said would “gather momentum” and not dust.)

This would be a fascinating discussion to have because I see the Saskatoon Police force working in both ways.  While I am not sure how much value the SWAT assault vehicle they have is, they do have a lot more hardware now than they did before.  How much does a police force need?  How much social work should they be doing?  Interesting questions.

Why We Don’t Like Stories in Which the Mentally Ill Heroine Recovers

Basically people who recover undermine how psychiatry is practiced now.

The story of modern psychiatry, for many, is triumphant one. The quick-and-dirty history goes like this: Human ingenuity and scientific advances led us from the dark ages of hydrotherapy and solitary confinement to cognitive-behavioral therapy and expertly prescribed medications. While we used to believe the mentally ill were unwell as a result of wayward behavior or demonic possession, we now know that psychic anguish is the result of brain chemistry and nurture, and we’re working harder to analyze the former. We moved, in other words, from mental illness as a moral failure to mental illness as a medical condition.

But if you zoom in on the late 1940s through the early ’60s, a different battle is being waged—a battle between those who believed mental illness was biologically located in the brain, and those who thought mental illness was a matter of emotional disturbance. Back then, those intent upon transforming psychiatry into a reputable science (as opposed to a touchy-feely art) worked tirelessly to develop new methods of medical intervention for the mentally ill. The best-known method was “psychosurgery” (aka lobotomy), which was introduced by neurologist Egas Moniz in 1936. In 1949, Moniz won the Nobel Prize for his work on psychosurgery, and by 1951, the operation had been performed close to 20,000 times.1
Contrast this obsession with the physical brain—slicing it, shocking it, or tranquilizing it—with the ethos held by Chestnut Lodge, the elite private institution where Joanne Greenberg began treatment in 1948. The clinicians at Chestnut Lodge fervently believed that no patient, however psychotic, was impervious to psychotherapy. The champion of this viewpoint was the Lodge’s most famous employee, the gifted psychoanalyst Frieda Fromm-Reichmann. Fromm-Reichmann was Greenberg’s primary analyst and, in both the novel and in real life, led her from insanity to wellness. In the book, Fromm-Reichmann is “Dr. Fried,” and Greenberg so positively depicted the humble German that for years she received letters from struggling fans desperate to track down Dr. Fried and undergo analysis with her. 

Fromm-Reichmann immediately recognized something special in her teenaged patient: Greenberg was quick-witted, well-read, and seemed to retain an appetite for life that many of the doctor’s older, chronically ill patients had lost long ago. Greenberg’s symptoms were often referred to as “florid”—interpretable, extravagant, and suffused with meaning, like a story. When Joanne was struggling, Fromm-Reichmann openly empathized. When she began to retreat, the doctor begged to follow. “Take me along with you,” Dr. Fried tells Deborah during a session. She insisted to her young patient that they must pose a united front. “I believe that you and I,” Greenberg has her say in Rose Garden, “can beat this thing.” And, together, that’s just what they did.

This narrative is a little too pat for our contemporary sensibilities. Perhaps that’s why the book is not as well known as, say, Sylvia Plath’s The Bell Jar. (The Bell Jar still sells briskly; the fiftieth-anniversary paperback edition is ranked 1,730 on Amazon, compared to Rose Garden’s 21,792.2) But Rose Garden does not appeal for another reason: It’s easier to think of the psychiatry of yore as entirely backward and as the poetic casualties of it—Plath, Arbus, Sexton—as victims of that ignorance. Their tragic stories, paradoxically, make us feel more secure in the march of psychiatric progress.

The demise of these women—and the subsequent autopsy of past mental healthcare failures that their paper trails encourages—permits us to rest serenely in the knowledge that the world is moving steadily toward a more scientific, humane psychiatry. But, one has to wonder if this is entirely the case. Frieda Fromm-Reichmann spent four years with Joanne Greenberg; she hiked up to the Disturbed Ward to see patients when they were lying limp in restraints. Now, psychiatrists evaluate patients for 45 minutes before diagnosing them and sending them off to fill prescriptions, and many patients go months between appointments. Efficiency is the goal here; medication the cure, meaningful human connection a distant second priority. It is increasingly rare to find a psychiatrist who also performs talk therapy, despite its many proven benefits.

This might be an even greater tragedy with regard to treatment of schizophrenia, where holistic treatment—that is, one that recognizes both the medical and the emotional components and allows for feedback between the two—might hold particular promise. According to Dr. Allen J. Frances of Duke Medical School and the author of Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, “Cognitive therapy and social skills therapy are very valuable in treating schizophrenia, but they are rarely available.” And the idea of “complete recovery” is downplayed.

If you are a regular reader of this blog, you know that my wife Wendy has struggled with depression for most of her life.   As she has written about before, like many others, she was sexually abused for an extended period growing up and it took a toll on her as she has grown older. It has never gone away and returns with a vengeance each and every summer and causes chaos and pain around here until fall.

This is the process we have to go through to get help.

She needs to go to her family doctor who prescribes depression medication and then writes a referral to the psychiatrist.  Since that is a year to two year wait, she goes back to her family doctor who ups her medication, ups it again, ups it again and then realizes it doesn’t work.  So then she is weaned off her medication and then the doctor does it again.  If that doesn’t work.  Repeat.

Finally she gets to see the psychiatrist (18 months later), she walks in, explains her situation, he tells her she has PTSD and then gives her a prescription for a stronger medication.  Out in 10 minutes.  

That medication may or may not work.  If not, she can go back and is back out in five minutes with a new prescription.  If it does work, it works for about 8 months and then when she tries to go back, she is told that her file is closed.  She needs another referral (and a year wait).

That is what is covered by Saskatchewan Health.  What she really needs is talk therapy as well which is not covered by Saskatchewan Health and runs over $100 a session.   Since it isn’t part of her health care or any kind of continuum of care, the therapist and psychiatrist don’t talk which means that once summer went spent thousands on therapy that did nothing because Wendy’s medication was off.

What we are told is that Wendy’s condition will be with her for the rest of her life and she just needs to keep taking her medication.  In some ways that may be correct but the reality is that it doesn’t have to be as bad as it is or as costly if we spent the resources to treat mental illness like we do other illnesses.  I think that is what makes people so uncomfortable, we know we can do better but do not because of a shortage of psychiatrists and clinical psychologists in our system.  Heck we don’t even benchmark mental illness treatment in Saskatchewan.  How do we hope to get better when we don’t define success?

It’s been a frustrating process to see Wendy struggle like this.  Her public presence like many is far different then her private one and I have been more than willing to move to get her treatment.  We have explored selling the house and our stuff and moving south to the United States but the equity in our house won’t touch long term treatment costs.  So like a lot of families and people who struggle with depression, we stay and try our best to work in the cycle of madness and fight the assumption that mental illness can’t he cured.

Poverty’s Toll on Mental Health

This is discouraging

One of the most insidious effects of living in high-poverty, chronically disadvantaged neighborhoods is the severe strain these areas have on residents’ mental and emotional health. New research shows that poverty imposes a psychological burden so great that the poor are left with little mental “bandwidth” with which to perform everyday tasks.

The constant anxiety and stress resulting from witnessing and experiencing trauma and violence in distressed neighborhoods, negotiating the sacrifices and trade-offs caused by food insecurity, living in unstable housing conditions, struggling to pay bills, and dealing with numerous other worries burn up cognitive capacity that could otherwise be used for productive activities like navigating public assistance systems, providing for an entire family on a limited budget, and helping children with schoolwork.

For children, the long-term mental health effects of poverty are even more alarming. In addition to occupying cognitive resources needed for education (arguably the clearest path out of poverty), poverty is toxic to children. Persistent stress and exposure to trauma trigger harmful stress hormones that permanently affect children’s brain development and even their genes. The damage to childhood development is so severe that medical professionals now describe the early effects of poverty as a childhood disease.

Because of the debilitating cognitive effects of poverty on both adults and children, clinical mental health services are a central component of the Urban Institute’s Housing Opportunities and Services Together (HOST) demonstration. HOST is testing an intensive, dual-generation, case management model for children and adults who live in public and mixed-income communities suffering from concentrated poverty, chronic violence, and low levels of trust and social cohesion. HOST’s coordinated and comprehensive place-based intervention aims to stabilize whole families and improve a range of educational, health, and employment outcomes.

Baseline survey data from the first two HOST sites—Chicago’s Altgeld Gardens, a large public housing development that has high rates of crime, and Portland’s mixed-income New Columbia and Humboldt Gardens—clearly illustrate a relationship between distressed neighborhoods and mental health. Rates of elevated worry among HOST adults in both sites are up to six times higher than rates among adults nationwide, and depression among adults in the Portland site is nearly four times more prevalent. Even more disturbing, youth in the Chicago HOST site experience long-term anxiety and worry at levels seven times higher than those of youth nationwide.

In other words for many youth, even if they escape the economic impact of poverty, the mental health part of it remains.

Your Brain on Poverty: Why Poor People Seem to Make Bad Decisions

And why their “bad” decisions might be more rational than you’d think.  From a comment on the research from Gawker that kind of sums it all up.

I make a lot of poor financial decisions. None of them matter, in the long term. I will never not be poor, so what does it matter if I don’t pay a thing and a half this week instead of just one thing? It’s not like the sacrifice will result in improved circumstances; the thing holding me back isn’t that I blow five bucks at Wendy’s. It’s that now that I have proven that I am a Poor Person that is all that I am or ever will be. It is not worth it to me to live a bleak life devoid of small pleasures so that one day I can make a single large purchase. I will never have large pleasures to hold on to. There’s a certain pull to live what bits of life you can while there’s money in your pocket, because no matter how responsible you are you will be broke in three days anyway. When you never have enough money it ceases to have meaning. I imagine having a lot of it is the same thing.

Poverty is bleak and cuts off your long-term brain. It’s why you see people with four different babydaddies instead of one. You grab a bit of connection wherever you can to survive. You have no idea how strong the pull to feel worthwhile is. It’s more basic than food. You go to these people who make you feel lovely for an hour that one time, and that’s all you get. You’re probably not compatible with them for anything long-term, but right this minute they can make you feel powerful and valuable. It does not matter what will happen in a month. Whatever happens in a month is probably going to be just about as indifferent as whatever happened today or last week. None of it matters. We don’t plan long-term because if we do we’ll just get our hearts broken. It’s best not to hope. You just take what you can get as you spot it.

I have written about this before and at the end of the day, this seems to sum it all up better than I ever have.  Make sure you read the entire post at The Atlantic.