Scrupulosity and religion: another perspective
I haven’t been around in ages, but this topic seemed to fit a lot better over here. And, unlike some other places? Anybody who decides to “give offense” in comments here has fair moderation warning.
This is a long-winded mess, even by the usual standards. But, I did indeed end up distracting myself some with the some of the influences on my own personal mess of OCD scrupulosity. Which I didn’t even recognize as such until the past few years, as different as some of it ends up looking from what usually gets talked about.
As I mentioned, I had also tended to assume that it looked different, in part, because none of it was overtly religious in nature. But, now I am really not so sure about that. It’s hard to separate that out from some cultural influences in general.
I couldn’t help but think of some observations in a paper from Robert K. Thomas, an anthropologist who grew up in a Cherokee speaking home. Some of his writing has come up before here, yeah. It was written in I think 1959, and some of the language used shows it. The other disclaimers from when I posted it before also apply (through the link below).
But, he made some extremely good points in this paper that I hadn’t considered in exactly those terms, around religion in particular. I had actually meant to talk a little about that in a more general context at some point, but I guess this is as good a time as any, while I seem to have the spoons available.
“CHEROKEE VALUES AND WORLD VIEW” BY ROBERT K. THOMAS ›
Quoting more than I had intended, starting with a bit of relevant background info. Given how unfamiliar most readers will be.
Any authority given to one individual to wield over another is immoral according to Cherokee standards. This would be real interference and “giving offense.” [more on that later -U.] In the old aboriginal structures and institutions lack of hierarchy is apparent in the structure themselves. Cherokees have taken over institutions from white culture which, in their form, imply authority. However, they do not work this way in a Cherokee context. The various offices become only positions in their institutions and imply nothing more…
To say “He knows a lot,” is a compliment in Cherokee. Knowledge is almost a commodity and one can be called stingy with “what one knows”… So a man becomes more knowledgeable by experimentation and a kind of “rational” thinking, a very different process from acquiring power…I am not going to belabor this point, but I think one can understand better Cherokee’s reaction to whites and the whole course of recent Cherokee history if one remembers what a “pragmatic,” “rational,” seeking-after-knowledge view of life Cherokees hold.
Then we get to the part that practically had me rolling in the floor when I first read it, because I recognized myself and so many people I know in these observations. When I say a lot of my family is nominally Christian (mostly Methodist or Disciples of Christ), and more than a few of them would strongly object to that characterization? This is exactly what I’m talking about.
He was talking specifically about Oklahoma Cherokee, but so much of the same stuff applies to other people from related cultures. (And also to 16th century Northern Iroquoian people, going by some of Barbara Mann’s observations based on old accounts.) AFAICT more of my family started out Tutelo, but it still applies well.
What really bothers me methodologically is that Cherokees sound so much like other American Indians. You could, almost, substitute the word Cherokee for much of the material present on Navajo values or Chippewa, and so on, around the country. We haven’t the terms to really describe this behavior and thus differentiate, except at a gross level…
The author also made that observation, so yeah.
Cherokees have no real conception of sin although they have been Baptists for over one hundred years. Actions are judged not in relation to the inner man’s relation to some strict prohibition but as to whether his action disrupts the harmony of the group or not. For instance, old Cherokees will say, “Drinking is bad” or in English, “Drinking is a sin.” But, if you pin them down to a case, they will say a man is doing right or wrong in relation to how his action affects the group harmony. A man who drinks and who does not “bother” anyone is not doing wrong. Drinking is wrong, on an abstract level, because usually this is when Cherokees become aggressive. But judgments are made situationally…
Let me just say a word about how Baptist Christianity has affected this philosophy. Cherokee have assumed the basic nature of the universe and interpreted Christianity in this light. What has happened is that Jesus’ moral code has bolstered the old Cherokee values, and, in fact, they have become one and the same thing. But Protestants have failed to put across Protestantism as such because Christianity is presented to another people on too high a level of assumption and as bits of dogma. Cherokees know little about whites and, probably, could not see the connection between the white man’s nature (covert culture) and Protestantism even if they understood the whites. Even some parts of Protestant dogma which Cherokees have understood they have ignored. Consider the Cherokee view of sex relations. They have responded to those things such as Jesus’ morality which makes sense in terms of old Cherokee ideas; have ignored other parts of dogma which did not, except in terms of lip service, and have not even understood that there was a whole different idea of the nature of man and the universe involved in Protestantism. Really to make Cherokees into Baptists you would, in fact, have to remake the individual Cherokee and his whole community.
(Not that some people haven’t been trying for a long time, as witnessed by Daniel Heath Justice on Queer Indians and the Cherokee Nation. Which would seem to demonstrates a rather distressing level of success in at least some respects, at least among the people who even want to run things in Oklahoma since the 1950s when Thomas made these observations. But, I am not necessarily going to assume that the people who want to be in positions of power to where they can meddle are really representative.)
Which kind of leads into something else:
Notes supplied by John Gulick after personal communication with the author.
…2. Although the major Cherokee sanction is withdrawal resulting in the social isolation of the offender, the ideal Cherokee interpersonal behavior involves non-interference and leaving other people along [sic]. In the white world-view, the Cherokee ideal itself seems to be a species of social isolation, and therefore the relation between Cherokee sanction and ideal seems paradoxical. Why should the sanction be effective among people who appear to be “rugged individualists” of the Daniel Boone sort?
The answer appears to be that the Cherokee is not a “rugged individualist.” The non-interference ideal does not imply a desire to be socially isolated. Quite the contrary. It is, rather, an orientation to desired relationships in which “sociability” is desired but without assertiveness or aggressiveness.
3. Most specifically, the doctrine of Original Sin, and its implications for human nature, is entirely foreign to Cherokee thinking.
I mostly left that first (#2) observation in, as it relates to how representative the folks who want to be in a position to say who can or cannot even get married, may or may not be. But, I made some other observations on the “without assertiveness” assumption (and non-interference in general) not that long ago, at the very end. That was where the “Strange Exotic Culture” in question referred to umbrella Appalachian culture. But, yeah, there’s not always much distinction for some of us.
I did like how Thomas worked around that at the beginning of this paper. But, he was also approaching it more from the inside.
For instance, you will note that I used the term “offense” rather than “aggression” which has psychological ramifications. “Offense,” to my mind, can be used purely in terms of behavior and ideals without getting into the inner man…But what is “giving offense” in Cherokee terms? It is any situation in which the autonomy of the individual is interfere with. These situations, behavior-wise, would range from areas of over-zealous joking or unsolicited advice to open hostility.
That would seem to cover it a lot better, with fewer assumptions built in, than “aggression”/“assertiveness”.
But, indeed, that good old “low tolerance for paternalistic or prescriptive behavior patterns” (*snerk*) applies very much to how some people insist on using their religious ideas on the people around them. And hierarchical setups with that. The assorted Pentecostals and other fundamentalist types may have some ideas that are goofy as fuck in my estimation, but they are at least fairly egalitarian and don’t go around bugging other people that much.
They’re also thankfully AFAICT still much more popular among the folks back home who feel a need to ride in the rigging of the church, so to speak, than the way more interfering Evangelical movement. I really don’t have much exposure to the more authoritarian approaches there, and continue to be surprised at what some people get up to with that. And think they’re doing right with it 😐 Some very different base assumptions, yes.
And I never really got some of the ideas that other people continue to hurt themselves with pushed at me.
I really don’t give a rat’s ass what other people are thinking, as long as they’re behaving decently and not harming anyone else. Their beliefs are none of my business; their actions are a different matter. As Thomas put it elsewhere:
Even the whites I knew in those days who were sympathetic had a basic misunderstanding of our religion. They were always asking “What do the Indians believe in? Do you have one God? Do you believe in Heaven?” I didn’t know how to explain to them that these are not the important features of the old Cherokee faith; that if you took a poll of Nighthawks you would find a lot of differences in belief; and that most questions of belief are not considered important enough to talk about much. I could see that they saw all religions basically as different belief systems, outside of the person; that one chose voluntarily as one whole consistent thing; and then pledged allegiance to it.
He was coming from a family that never even surface converted, which was the Nighthawks reference there. But, people seem to have mostly carried that basic approach over into their own versions of Christianity. I have also found it confusing when people will speak in the “belief”-heavy terms he mentions.
There’s more rambling along similar lines on this blog. My thinking there has unsurprisingly continued to develop, but the 2012 posts in that tag are still mostly relevant. I also keep finding more words to wrap around the same basic ideas.
Soon up: More rambling to tie this in to what got me going in the first place! Our old friend scrupulosity.
I had a hard time figuring out where to work this in, responding to the first set of Thomas’ observations that I quoted at way more length than I had ever intended. But, as an indication, I personally had no clue that anybody meant anything different by “sin” until after I was in college and read more comparative religions stuff. And it still hurts my brain, on most levels. Missionaries got really frustrated trying to get their ideas about sin across in the Eastern Woodlands in general, and I’m not sure how much of it ever sunk in, in a lot of cases. I was amazed to find out what most of Christianity means by that, if it’s not basically “harmful behavior”. Not even kidding here.
I also wasn’t really aware that monotheism was a thing distinct from some flavor(s) of pan(en)theism. Neither are/were most of my relatives, AFAICT, including the atheists. Frankly, learning more helped me figure out that monotheistic religions were not necessarily my cup of tea. I just couldn’t ignore that “whole different idea of the nature of man and the universe” package, and just keep on going thinking I was basically Christian by default. Sometimes things would probably be easier if that had worked for me.
But, to try to work back around to the point I started out with? My own personal scrupulosity bullshit did indeed have some very different religious/moral foundations to grab onto. And pretty much all of what it did seize on in the Make A Good Person Kit was stuff about not hurting or disappointing other people.
Some of my relatives went the same ways with it, and can get pretty terrible at themselves too. Which is better in a way than driving the people around them bonkers with it, but also…that kinda works against the whole “[h]armonious relations are the norm–the minimum” theme. When that’s already not the situation inside your own head, going into other situations and interacting with other people/the world around you in general. Your own state of mind matters there too. It’s easy to forget that sometimes.
There is also this, quoting again from the original paper:
This system gives very little tangible reward to the individual for being a “good Cherokee.” Harmonious relations are the norm–the minimum–rather than some goal to be reached. And violations of this ethic are punished by the above sanctions which, though diffuse, are severe to one raised to be sensitive to others. To achieve rewards in this system one must be a “super Cherokee” in all of these respects–almost an unobtainable goal for the average human being. And the rewards are once again very diffuse–being held in esteem by other Cherokees. One almost has to be a Christ-like figure to be held “beloved” by the Cherokees.
He got pretty scathing there, as someone who was raised that way too. But, I can’t say it’s wrong. Not a lot of cookies handed out, and it can be hard to tell when you’re doing it right. People aren’t actively avoiding you, or you don’t think they are? Maybe you’re doing it right. Maybe. Can you really know, though? You probably need to try harder.
That ’“pragmatic,” “rational,” seeking-after-knowledge view of life’ can also turn not so beneficial if you’re already prone to overthinking certain things. In an unbalanced way.
And, that stuff is about as easy to get twisted around as the Don’t Hurt/Disappoint God stuff a lot of other people have been exposed to through more “pure” versions of certain monotheistic theological approaches.
Especially if you’re dealing with some people who have an investment in thinking you’re causing problems which are really not on you. That can mess with your head, especially if you are already prone to scrupulosity.
Another instance of how this basic philosophy works in all aspects of life is that Cherokees look around to find out what persons involved in a bad situation caused the bad situation. As I said in a paper before, if you believe that your good fortune depends on your harmonious relations with other people, then you find the person who caused your bad luck.
Another exaggerated version, but yeah. That kind of approach can work out in a balanced way that’s good for everyone involved. Or, it really really can NOT. Depending on what the people involved are bringing into the situation. Very much like what I had to say recently about multigenerational/extended family living situations. Closely related subjects, yes. (Ha.)
Like with about anything else, this whole philosophical bundle can get used in various ways. Some of them more helpful than others.
But, in any case? There are some significant differences in base assumptions about How Things Work and How To Human, depending on the culture you’re looking at.
And, when it comes to how mental health issues are liable to look and best be managed in a person’s life? That really, really matters. A lot. If you don’t take those factors into account, you’re just not going to understand anything too well. And you may do way more harm than good.
On partners
Army Dancing -Le Tigre – Deceptacon
Which mostly started running through my head because of the title, but “let me hear you depoliticize my rhyme”. 😉 Plus, these guys are priceless. I can’t help but wish the military spent more time dancing, and less on what they’re getting such a huge chunk of the budget to do.
I’d thought about trying to write something on this topic before, but these related pieces from The Guardian were a good prompt:
Comment of the week: problems with the word ‘partner’
And the one it’s drawn from, which I hadn’t seen previously: When I mention my ‘partner’, what do you assume?
I persistently get sucked into reading comments on sites like this even though I’m so often sorry I did, and I wish I were surprised at the number suggesting that the unprofessional behavior of the creepy bank employee Bella Qvist mentions must have been totally OK. But, on to the main point: using the term “partner”.
Even though I’m legally married to a person of what most people assume to be the appropriate gender, I often choose to refer to him as my partner. There are a number of reasons for this, and I’ll list a few off the top of my head:
- When this comes up, the gender and/or marital status of either one of us is generally nobody else’s legitimate business. If it’s actually relevant, that can be clarified.
- I don’t personally consider our relationship to be heavily based on gender. My partner must not to any great extent, either, since my “coming out” as nonbinary-probably-agender didn’t faze him at all: same person, regardless of labels applied.
- All of the other choices readily available in English are chock full of gendering, and by default misgender anybody with a nonbinary gender or none at all. Being called “wife” or talking about my “husband” makes me uncomfortable. They also carry an awful lot of other social baggage that I just don’t want to associate with (more on that coming up).
- Ditto for the built-in heterocentric assumptions. Do not need. I may be a presumed woman married to a presumed man, but that does not automatically mean anyone in the relationship is heterosexual. My partner is cis and het–as far as he can be without caring that much about how I identify–but nobody else can magically know about that by looking at either one of us. Even if it were their business, in the first place.
- I am not using the term to be misleading, no matter what someone else assumes based on my use of it.
- In some settings, I prefer not to rub other people’s noses in the fact that I am legally married, while they still can’t have recognized marriages to their partners. For some people, the lack of legal equality is an understandably sore point, and it would be just plain rude to keep reminding them of it in conversation.
That’s probably not even all the reasons, but it will do for now.
This is a draft I mothballed for a couple of weeks, because I wasn’t sure where to go with it. But, something I read earlier helped prompt me to work on it again.
The major reason I prefer to think of my marriage as a partnership–besides usually referring to it that way, dealing with other people–is that I want to live in a more equal partnership than most of the versions of “marriage” on offer. It’s that simple.
From one exchange in comments on Clarissa’s My Feminist Journey, Part II:
So gender in Slavic countries is less, “women are fragile objects that need to be cared for by capable men”, and more, “men are immature children, and women just have to shut up and tolerate their bullshit”?
Revolutions, civil wars, genocide, world war, more genocide – men suffered more and died in greater numbers than women. This distribution of gender roles is a result. Men are a precious commodity that has to be fought over and protected. But they are a commodity nonetheless. Commodities don’t deserve respect or being treated like people.
You may notice that neither model offered there is exactly balanced, or fair to anyone involved.
Now, I did not grow up expecting to have to put up with a lot of the kinds of specific examples of lousy behavior she mentions in the post, but yeah: “As a little girl, I always listened in on the stories adult women shared. The leitmotif of those stories was the perennial need to put up with things.” It’s also been at least 150 years since men were disproportionately targeted where I grew up, but I hadn’t even thought of that as a possible factor in some social dynamics developing as they have. Interesting to think about, at least.
Then there is this, from My Feminist Journey, Part I:
This was when my fate as a woman who would never consider sacrificing herself was sealed. Unfortunately, the majority of other grandmothers forgot to hold similar conversations with their daughters. The generations of women who came of age in the twenties and the forties, who survived the Civil War, the World War, Stalin, starvation and genocide, who destroyed traditional gender roles and never looked back, forgot to mention to their daughters that strength and resilience had to be accompanied with self-respect.
As a result, they brought up a generation of women who thought that since they were strong, it was only logical for them to sacrifice themselves for their weak and helpless children and men.
The historical reasons and some dynamics there may have been very different in the Ukraine, but hells to the yeah. I also suspect that things may have skewed more this way in my own culture, with the constant influence of patriarchal BS getting pushed for centuries. Traditional roles may have changed, but in some different directions from different starting points.
My mother had a pretty serious martyr complex going, in general, and she was (thankfully less-than-usually) raised in a way that made her feel like she needed to put up with two emotionally abusive husbands who just did not pull their own weight in a lot of ways. I grew up thinking that was a normal state of affairs.
I still have to horselaugh at the idea that some kind of organized “misandry” is a major social problem. But, my mom honestly had very low expectations and opinions of men in general, and I grew up hearing that working yourself into the freaking ground was just what women needed to do. I have no idea how she developed that idea, since that was definitely not the way things worked in their house. But, my grandfather got an out on being basically a large, obstructive, useless pet mostly on the basis that he was raised almost entirely by women, so learned to do better. 😐 I guess she needed to keep telling herself that pessimistic stuff, in order to continue putting up with some of the behavior she did out of her own spouses.
So, on a personal level, I really do not want more encouragement to live like that, and feel somehow compelled to martyr myself in a relationship. That was one of the big reasons why I didn’t want to get legally married in the first place, besides having lived through a really horrible divorce as the child/pawn. That would be besides not accepting that the state has any business deciding whose relationships are somehow legitimate. And, yeah, my mother’s response to my saying that I never planned to get married was the bad kind of fatalism: it’s basically inescapable, one of these days. She may have been right with that, since I did end up following the path of least resistance and getting legally married to a man for immigration purposes. But, that does not mean that I have to live in the same kind of relationship she was basically trying to doom every AFAB person to. (There’s not much more charitable way to put it, honestly.)
But, it’s not just her; I wish it were. She may have been presenting a particularly unappealing version of endless work and self-sacrifice, but I have heard too many other older women talking about their husbands like they were annoying giant toddlers who couldn’t really be expected to do any better. And, indeed, apparently gaining some benefit from their own roles in that.
To quote Violet Socks again, from an old comment on her blog;
It’s also my culture, so I know it. (In its original locale, I might add.) And it’s a functional matriarchy in many ways. My own family is a matriarchy. That’s just how life is. Women are strong and smart and they hold everything together. They’re wise and practical and reliable and they just get shit done.
Yeah. I’m coming from, AFAICT, a more explicitly Native subset of the same culture, and that maybe makes it even more so.
(I was trying to find another thing from Gyasi Ross that I could have sworn was on his old WordPress blog, but ran across this more recent one instead: Mother’s Day, Superwoman Complex, and Getting Better: Loving Native People Better, v. 2. Again, the dynamics are a little different in Blackfoot country, but some of it sounds way too familiar.)
And that’s all well and good, as long as it stays somewhat balanced. And it doesn’t turn into a situation where you’ve got someone in the family getting shit done, so nobody else has to take responsibility for much of anything. I have met too many people raised with those kinds of dynamics, and I have run like hell from more than one who obviously expected me to take over running their lives (usually in cooperation with Mama). I have had one guy’s grandma try to recruit me to take over caring for him and managing the rather extensive farming operations he was set to inherit, in a classic kind of “ensure social welfare for someone who is just not up to that, through trying to get him married to Superwoman who can do it for him”. Just, no. Even if I had liked him in that way, and it wouldn’t have been a total freaking disaster to put me in charge of that kind of thing as bad as I am with finances, no. In a way it’s flattering in retrospect to have gotten picked as a successor, but I am sorry she spent most of her own life like that.
I do not need to live with–and feel responsible for–someone who acts like a giant bearded preschooler who expects to be taken care of and coddled while I run myself into the ground, any more than I need to live in the kind of “complimentarian” relationship pushed by some religious groups. (*barf*) You may be credited with more agency and autonomy and get more lip service paid to respect in the first case, but yeah. That is still no way to live. And some version of these kinds of roles are what I have come to associate with “marriage”, per se. There are certainly other ways to do it, but I have no clue how, in a “when roles have you” kind of way.
Honestly, I don’t know that it’s not just time to trash the whole institution and start over with something not as ruined by your pick of prescriptive BS roles and expectations.
What I do want is a partnership with someone who acts like a responsible adult. Things may not always work out as I’d like, on the ground–and I still have to stay aware and try not to fall into acting like my mother by default–but that is the goal. Thinking of it as a partnership helps with that.
Every0ne’s mileage will obviously vary there.
Cognitive problems, and treating yourself decently
I’m working on a couple of other posts, but here’s something that’s actually very relevant to a lot of things lately, which I just posted elsewhere. (Not least, why I haven’t been able to write very much lately.)
AND I AM REMINDED AGAIN TO TRY TO TREAT MYSELF AT LEAST AS WELL AS I WOULD A TOTAL STRANGER.
Reblogging two things just now having to do with seizures reminded me again that a lot of the “Cannot brain today” fog I’ve been experiencing is most likely an aftereffect of when I was regularly having multiple seizures a day, several years ago. (I thought it might be temporal lobe epilepsy, but it seems to have been coming totally from fucked-up electrolytes from celiac deficiencies.) I hadn’t even thought of this in a while, probably because of the damned brain fog and frustration! *facepalm*
One of the best descriptions I’ve seen, in an epilepsy context: Brain Fog. A couple of years ago, it was to this level:
From the brain fog link, I ended up trying the Online Cognitive Screening Test from University of Florida, out of curiosity, the other night. The results were both encouraging and, erm, really not. On one hand, yeah, I’m not just imagining that the brain fog is a significant problem; OTOH, scoring 1st-3rd percentile “very low” on an assessment intended for people with Alzheimer’s when you’re tired is more than a little demoralizing. 😦 Not that verbal memory and task switching are my strong points at the best of times; I’ve been hesitant to retry it when just “normally” fatigued. But, again on the brighter side, maybe I’m not coping so badly (and/or Not Trying Hard Enough) after all. *wry smile*
Not surprisingly, that also helped bring to my attention just how much crap I’d internalized about the value so often placed on being able to demonstrate certain kinds of “intelligence”. Erm, yeah, not so important—and not at all to your basic worth as a person. That even applies to me. Usually I don’t feel like I have that much extra to prove because of the “but you’re so smart!” expectations and autistic unevenness in abilities anymore, but sometimes it still sneaks up to bite.
The fog has improved some since then, but it’s still a major problem, with pain making it worse.
That hasn’t happened at all for (I think) at least a year and a half now—with no bitten insides of the mouth or other signs of night seizures either—but every seizure does damage.
And kicking yourself over the Cannot Brain really doesn’t help. I’ve been in a similar place before from intracranial swelling, and it probably will improve to some extent with time and patience. Even if it doesn’t, getting impatient with yourself over things you cannot control doesn’t help at all. Perfectionism sucks, even when you have only learned to apply it to yourself.
Coping With Mild Traumatic Brain Injury
Traumatic Brain Injury Survival Guide
As the “intracranial swelling” link above suggests, I ran into enough “there’s nothing wrong, and you should just feel lucky to be alive!” denialism before that I only found out more about this stuff as an adult, and still haven’t been able to talk about it much because I was made to feel so ashamed of even admitting that I might possibly have some cognitive problems from it. If you know someone who has experienced some kind of injury–even if it wasn’t the spectacularly obvious skull-cracking kind, and even if you can’t see many of the problems they’re experiencing with their own brain (which nobody else can)–PLEASE do not act that way toward them. It’s about the least helpful thing you could possibly do, it can make people feel horrible about themselves, and it’s likely to reduce their ability to cope when they’re already having a rough time. And they might end up needing to write stuff like this a couple of decades later, yeah.
If you think they should feel terrible about having cognitive problems and other symptoms from a brain injury, you should just stay the hell away from them, and pretty much everyone else who is not that awful–until or unless you fix your own problems there.
A related pair of links. I can’t help but feel like I’m sounding like a broken record lately, but too much of my life lately has been revolving around dealing with the aftermath of this kind of stuff.
* Ignorance about sickle cell disease is no excuse for poor NHS care
“Sarah Mulenga’s death from a sickle cell crisis was a needless tragedy. Emergency staff must treat sufferers with respect”
This week an inquest into the death of Sarah Mulenga ruled that failures to follow basic procedures by London Ambulance staff contributed to her death two years ago. The two trainee paramedics called to attend to Sarah’s sickle-cell crisis in January 2011 failed to carry out a basic set of observations, treated her rudely and refused to take her to hospital because she had soiled herself. Another ambulance had to be called 45 minutes later, by which time her condition had deteriorated; she later died in hospital.
This was an extreme and tragic case. But many sickle cell anaemia patients have felt a similar lack of emergency care within the NHS…
Often emergency staff do not have basic knowledge of the disease. But ignorance about sickle cell disease is not an excuse for NHS staff to fail patients. “The NHS has a duty to deliver the same quality and standard of care regardless of how uncommon or unknown a patient’s disease,” says John James, chief executive of the Sickle Cell Society.
Speedy response and urgent treatment, most often with painkillers, is critical in a sickle crisis. Severe crises can lead to major organ failure of heart, lungs, kidneys and liver. Even in hospitals that have detailed procedures for chronic patients, these are often ignored by A&E doctors hesitant to give high levels of painkillers.
“The problem for emergency staff is that they can’t get their head round the level of painkillers you need to control the crises,” says 41-year-old Delroy Efemini, a sufferer. In 2005 he attended his local hospital A&E in crisis. A known patient there, he was subjected to hours of waiting and only given over-the-counter painkillers. In excruciating pain he took a cab to another hospital but staff at the first hospital called through and told them to refuse him treatment. He was then forced to return to the first hospital and was finally admitted having spent over 12 hours without any pain relief. “Going to hospital is a gamble for sickle patients”, says Efemini. “All the time you’re just praying that the nurse or doctor who knows you is on duty, otherwise you’re screwed.”
Another patient I know was, in severe crisis, refused oxygen, pain relief and fluids nine times.
Later that day she suffered a pulmonary embolism and went into cardiac arrest. She almost died in intensive care.
“If this disease purely affected white people, this simply would not be the case,” says John James. He believes that stereotypes surrounding black people and drugs lead to patients being treated suspiciously and their requests for pain relief ignored. “The first thing they think when you ask for controlled opiates is that you’re a druggie”, says Efemini.
I hadn’t even had reason to think about it before, but I’m not at all surprised that it’s a much rarer problem in the UK, even with a decent amount of relatively recent immigration from the Caribbean and assorted African countries. As someone pointed out in comments there, with the major concentration of Black immigration being in and around London, they have even less excuse for treating people here badly out of ignorance.
Even coming from a part of Virginia with a much lower percentage of Black people in the population than in the regions which used to have slavery-based economies, there seems to be much more awareness that sickle cell is a thing. I know a couple of people back home who have it–and probably more who just haven’t had reason to mention it. I wouldn’t be surprised if people in crisis often still get lousy care, but they’re less likely to act like you can’t even possibly know what you’re talking about, and must be just making up a disorder, when you’re having a crisis. And the people in the ER have probably seen it before, multiple times, even if they then decide anyway that you’re some kind of drug-seeking fraud.
I don’t have any personal experience with sickle cell, but it sounds like flat-out torture, either way.
It’s appalling, and I am sure that racism plays a big part there, especially in its continuing to be viewed as some exotic condition that’s so vanishingly rare you don’t even need to learn anything about it. Though, I honestly have no reasonable expectation of any better quality of care for something like that. The lack of respect is the big thing, in general, and the differential respect based on racism and other xenophobia ain’t going to help.
Which leads us to this one, with commentary previously shared on Tumblr. I also expect that xenophobia is part of the problem here, too, with the amount of anti-Eastern European immigrant sentiment going. I think I’ve gotten some different treatment at times, even being an apparently middle-class, usually light-skinned native speaker of a colonial version of English (and thus about as “acceptable” as immigrants get). There’s also the “pushy American” stereotype to deal with, when I’ve really had more problems with being assertive for self-protection. But, all of that’s a complication on top of the main problems with the system.
NHS: POLES, PARACETAMOL AND THE MYTH OF HEALTH TOURISM ›
The language barrier is usually raised first, when people are asked why they’d go private, but I think that’s out of politeness. Certainly Alicja, 25, who paid £60 to see a dermatologist in Tooting for her eczema, sounded less than plausible when she explained: “I wasn’t sure that I would be able to understand a GP. Medical language can be quite specific.” (her English was perfect).
The dermatologist elaborated: “I wouldn’t want to make a generalisation, but where language isn’t a problem, there is sometimes disappointment. GPs don’t refer people to specialists. There must be a reason for that, and I guess it’s economical.”
Piotr Miklewski, a 29-year-old practice manager from PMC in Ealing, said: “There is this stereotype that the UK prescribes paracetamol for everything.”
Wiki, 29, who broke her rib ice-skating, said: “And they don’t x-ray you. In Poland, you would always be x-rayed for a broken rib in case it was endangering your lung”. She added, “The doctor told me to take a paracetamol”…
Personally speaking, I would never knock the NHS for its paracetamol name, the reputation it has for never referring anybody, never prescribing antibiotics, never scanning anyone and trying not to waste x-rays. It makes us sound thrifty and stoic.
But if we think people are travelling here to make the most of our health service, we’re dreaming.
This is the kind of thing I’m talking about, when I talk about managed care on steroids.
Yes, I’m another foreign ingrate daring to criticise the way the system works. Theoretical universal access to health care is an excellent thing, and everybody should have that; that definitely doesn’t mean there’s no room for improving how the system actually works on the ground. [I also forgot to add that I was, indeed, very glad to have ready free access to health care as soon as I entered the UK on a fiancée visa. That doesn’t mean this motivated me to come, even from a country that’s renowned for spotty, extremely unequal access to the most expensive healthcare in the world.]
I can personally back up the hesitation to refer or order diagnostic testing, to the point that it reminded me of being uninsured in the US, when suddenly you don’t need all the expensive tests. (There is some happy medium there.) I didn’t get sent for any nutrient status testing or bone scans, or referred to a gastroenterologist—as is standard practice elsewhere—after the celiac not-quite-diagnosis. He also didn’t send me for all the usual tests to diagnose that. Nobody even suggested supplements. Some complications, like fractures and hypocalcemia seizures and lots of misery from severe deficiencies, may have been avoidable if that had happened. That particularly lazy, pennywise GP fouled it up in the records so that I also can’t get low-cost gluten-free food on prescription, which I didn’t think was an accident at the time. And still don’t. That one also wouldn’t refer me to a dermatologist over something I was concerned might be skin cancer. (Good thing it seems not to have been.) The next one left me on the cheapest first-line drug for type 2 diabetes, even though I had constant diarrhea and other nasty side effects for almost a year (until I just went off it myself, and stopped going there), and that malabsorption really crashed my health on top of the celiac.
Our local hospital is bottom of the barrel, with very poor CQC ratings and abysmal patient satisfaction ratings, especially for the A&E/ER department. They’re actually being sued by a bunch of people for human rights violations now. I can believe all of that. The only trip I’ve made there for a knee injury that had me throwing up from pain, my partner and I had to repeatedly insist that they x-ray it (yes, my kneecap was indeed cracked)—then sat for a couple more hours, with the dry heaves over a no doubt germy trash can my partner had to grab for me to barf into, before they came back and sent me away. With no pain relief at any point (on Christmas Eve, so I couldn’t even buy the paracetamol/Tylenol) and my ankle wrapped up. It was a good thing I already had a cane, because nobody gave me any crutches or anything, with a cracked kneecap and that leg giving out with much weight on it. I was happy to get out of the place by then, anyway. I couldn’t make this shit up if I tried. The total farcical absurdity is rather funny in retrospect—almost the comic epitome of bad ER care—but not at all at the time. And that was with someone else there advocating for me.
[And I could go on with the personal examples, but chose not to bore people unnecessarily.]
But, the thing is, similar experiences have turned stereotypical among people who aren’t as used to that kind of thing, when pretty much every hospital in England is rated better than ours. Some systemic problems there, yeah. And it’s a decent bit of the reason I’ve been having to avoid medical care. I just don’t trust them to place priority on my wellbeing over cost-cutting, even more with the austerity funding cuts [and galloping attempts at privatizing everything now going on].
If I weren’t really concerned about language issues (when communication is already hard when I’m sick or in pain), I’d honestly be tempted to try a Polish clinic. [There are also Swedish dentists and probably medical clinics, with no concerns about language barriers there beyond the disability-related ones. I actually had to get tickled at a couple of ads for dentists in some Swedish Chamber of Commerce publication Mr. U was getting, with not so subtle “looking for the quality of care you expect?” messages.] I’ve seriously considered trying to find a private GP, anyway; good thing we can just about afford it, even though AFAICT that would also mean paying for prescriptions which are technically free under the NHS because diabetes.
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When I was uninsured or on Medicaid, I was previously used to getting treated with more respect than has been usual under the NHS. (Never mind when I had good insurance coverage through both parents.) And I still had some pretty bad experiences in the US system. Part of the problem, IME, is that under the HMO-on-steroids setup, there is much less incentive to treat people with respect. Where else are they going to go, if you treat them like crap? People also seem more used to putting up with those good old “paternalistic or prescriptive behavior patterns”# which particularly rub me the wrong way. Those too often include acting like you can’t possibly know anything about your own body, as illustrated by the sickle cell bullshit.
I try not to criticise the system too much in front of British people, because that does come across as rude and ungrateful. (Similar goes for the weather. 😉 ) I even hesitate to write about it much, not wanting to come across like some kind of jerk. But, I do get tired of hearing all the “Thank goodness for the NHS!”, even in cases where the treatment would not be covered. (Yes, I did have to comment on that one.) I imagine that some of them will be in for surprises when they need treatment for anything more complicated than a sore throat.
In some cases, it seems to be a weird chauvinistic symbol; look at the bizarre Olympic opening ceremony dance thing. I can’t help but think that some of the points in Fred Clark’s Theodicy and foreign policy: The U.S. is not omnipotent, also apply here, with the “ultimate goodness” and the whole house of cards falling down if you admit that any part of what they’re doing sucks.
I don’t hear the rah-rah stuff so much from people who do regularly need to deal with the system as it exists. That’s a big difference with the rah-rah approach: I will readily admit that the way the system in the US works for the vast majority of people is totally busted, and the people resisting real reforms to make it more accessible and generally less crappy should be ashamed of themselves for aiding and abetting the harm being done by a busted system. Which is unlikely to happen, yeah. Real reform, or their being ashamed, for that matter. 😦
I’m pretty sure that there isn’t a health care system anywhere in the world that couldn’t stand some kind of improvement.
The NHS is a very good idea in theory, but in practice things just don’t always work out so well. And too many people don’t even want to look at how the system could be improved–which is far from a unique situation, and maybe more frustrating because of that.
First, a rather important post, as shared yesterday on G+: Chronic Fatigue Syndrome and Celiac Disease »
As soon as I read this info, the first thought that went through my mind was how similar the CFS symptoms seemed to how I would feel if I had to go back to eating gluten again. Joint pains, “brain fog,” fatigue, and enlarged lymph nodes were all chronic problems which I experienced in the months before my Celiac diagnosis…
The bottom line is that you or a loved one have been diagnosed with chronic fatigue syndrome, please make sure that Celiac Disease has been excluded. I tried to search the medical literature for information linking CFS with non-celiac gluten sensitivity, but in usual fashion, there has been no research looking for a link between the two problems.
Similar goes if you are experiencing symptoms like these, and it’s getting treated as “all in your head”. (As mine were for better than a decade.) All the counseling and antidepressants in the world aren’t going to “fix” nutritional deficiencies, nor actual#CFS .
I got diagnosed with #fibromyalgia in college, with some added bone pain and neuromuscular problems from chronic deficiencies on top of what this blogger mentions; this is not unusual among people with undiagnosed #celiac . Neither is totally inadequate treatment once you do get diagnosed with either non-celiac thing, sad to say.
I’m actually still having some problems with this stuff, but that’s after about 30 years of malabsorption before figuring out what was going on. (A major reason I haven’t been around much lately.) Just knowing what’s happening makes things feel a lot less hopeless, besides equipping you to actually deal with the base problem.
ETA: I forgot to add that I have to suspect that something like this is going on in the majority of cases where people end up with syndromal diagnoses of exclusion. They usually test for a few things perceived to be relatively common problems, then stop there out of frustration. There’s something going on there that they could do a lot better at treating, if they actually found out what it was. Which is definitely not to say that CFS and fibromyalgia are not “serious”, in and of themselves. Rather the reverse.
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I would also like to add this, now that I have tracked down the post (source article linked there):
Besides the frustrating antivax theme hurting people, I can’t help but hope that this bit filters into the diagnostic trenches:
“Adolescent girls are the group most often affected by chronic fatigue syndrome”
It’s enough of a problem with adults, but this is maybe also the demographic most likely to have such a cluster of “vague” symptoms dismissed as a psych problem, based on bias/laziness/shedloads of assumptions which are anything but evidence-based. This can also be extremely harmful.
As I’ve written about here before, vitamin D deficiency is an appalling common and un/misdiagnosed problem, even without malabsorption complicating things. I never did get that link post done on the links between low vitamin D levels and chronic pain/fatigue, but there has been a decent bit of research there (to the point that trying to collect a good sample was kind of overwhelming). And sometimes “fibromyalgia” symptoms and back pain are the main presenting symptoms of celiac. Maybe I can put something together before too long. But, yeah, it’s only classified as a vitamin at all for historical reasons, and the vast majority of people don’t get much in their diets even if they can absorb it fine. It’s actually a hormone, which affects every system.
If a deficiency isn’t recognized and treated, that can cause you a variety of serious problems, up to and including death.
And another BBC story posted six hours ago, which I ran across looking for something on another absolutely horrible case* which did result in death: Too much sun cream results in Leicestershire boy’s rickets:
Chris Head, from Lutterworth, always had factor 50 sunscreen on when he played outside blocking the sunlight from his skin.
His mother Suzi said she was shocked to discover her precautions had resulted in a painful condition for her son.
So much for some sources that claim rickets is not painful. (How would that even work?!) I’m sorry these things keep happening, but also glad that there’s more awareness now that guidelines on avoiding UV exposure are really horribly inappropriate in a climate where the majority of White adults (and IIRC all the non-White ones tested in that large study) are deficient.
Another study, in which “deficiency” as defined is probably “profound deficiency that will give you bone density and other severe health problems” (“< 10 microg/L”==10 ng/mL; the ranges in the above graphic are actually running on the low side by current knowledge): Vitamin D concentrations in an UK inner-city multicultural outpatient population. I just ran across that one, and couldn’t resist throwing it in. I don’t want to sound like one of the unbalanced vitamin D as panacea folks, but yeah. That really does no doubt contribute to a lot of chronic health problems and suffering, which are totally treatable if properly diagnosed.
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* I haven’t been able to write more about that one, but it was an absolute clusterfuck of medical malpractice and racism, resulting in the death of a baby and his (young, dark-skinned) parents getting convicted of killing him. The poor mother’s own vitamin D levels were so low, at 16, that the child was born with basically no bone minerals–and nobody believed her when she kept taking him for medical attention because something obviously wasn’t right with him failing to thrive and crying in pain all the time. (She could not have been healthy at all, herself, even before a pregnancy and nursing using so many resources.) That article I picked barely goes into the horribleness there, but it’s easy enough to find more. Including speculations that similar keeps happening, with at least one study happening into how many children assumed to have been beaten to death may have really died from complications of severe rickets.
OK, I am probably not going to try to write more about that in future. My eyes are starting to bug out of my head, as it is.