Tuesday, January 24, 2012

About dementia

I have a theory about dementia - start with the left and right brain injury studies, how people make up different stories from the same input with the different sides of the brain. Then add very slight losses of vision and hearing. Something doesn't 'look right' and the mind quickly compensates, instead of investigating makes a story. The stories begin to trump 'common sense' and the mind likes them, saves them for the next confusion. That orientation gets embedded. Think about the overly suspicious, transmitters embedded in their teeth, merchants always cheating them, ... The neutral investigative option has been lost.

So early losses of peripheral vision, tinnitus, dulling of touch and taste and balance create confusion with explanation, the mind creates and keeps an explanation, and dementia develops as the story is expanded and the compensating physiology fails.
If the chosen story is questioned, the person might become irritable; if the chosen story fails to meet the situation, the person might become impatient.  Because it is too contradictory and so very uncomfortable to hold in one's thoughts a story that doesn't conform to what the senses are saying and it's easier to ignore the senses than change the story.


A few weeks later, NYT is reporting this:

After Graeber

I'm reading David Graeber's Debt.  I wonder if part of the Axial Age convergences were also the result of human brain development, evolving physiological consciousness as well as general literacy, needs sufficiently met, minds sufficiently sophisticated to begin to ponder abstractions, spirit, exchange, morality, obligation, and to codify both market and moral rules for governing and for religion.

Sunday, January 22, 2012

To my medical specialists

I'm working very hard at closure, winding down, … evaluating how best to spend my assets – time and money. I'd like to deteriorate and die in peace, gradually withdrawing interventions and maintenance. It feels very wearying and disrespectful to have others wanting for me what I do not want for myself.

Proper preparation time

It takes longer than six months to get ready to die. Yet we disallow preparations, insist on tests and treatments and repairs.  HHS/ SAMHSA is watching pain medication prescribing (does that more impact we on Medicare, Medicaid, … ? Another obstacle for seniors ?) Now we don't want POLST's signed in advance. There's something frightening and controlling. It seems to me one should be preparing these documents at 18, reviewing periodically, …

Wednesday, January 18, 2012

Integrated Health

Integrating Health

ADLs (Activities of Daily Living) is professional shorthand for functioning, measuring things we normally do for self-care and for independent living. Examples of basic and related tasks, are bathing, marketing, paying bills … Services are provided (sometimes) depending on the need for help to do these things. *

I want to introduce another lens, EDLs (Experiences of Daily Living). EDLs are not so much about doing as about feeling, not about activities but the emotions involved in those activities. What support can people be given who are not so good in the skills of interaction, getting satisfaction, feeling connected, moving past … ?

Experiences of daily living

Baseline Out of Range

Disappointment Despair
Irritation Rage
Appreciation Adoration
Connection Compulsion
Enjoyment Immersion
Surprise Suspicion
Pleasure Preoccupation
Satisfaction Surfeit
Apprehension Aggression
Regret Despair
Disappointment Doom
Annoyed Angry
Delighted Ecstatic
Ashamed Cutting
Cross Furious
Happy Cheated
Content Bitter
Major focus on others Major focus on self
Ability to balance, rebound, modulate Quick move to extreme; unable to get back to baseline



Monday, January 16, 2012

The disturbance of loss without a story

The disturbance of loss without a story

There is often sadness, only sadness, hidden sorrow, old unrecognized unresolved grief. Why did I learn that I couldn't mourn? And what is unresolved here? I'm thinking about grief no one owns, inherited grief, grief without connected meaningful objects, unresolvable except maybe through exorcism-like ceremonies … loss without a story.

  • She was interior, tears wet on her cheeks. I reached out my arms to comfort and be held. She patted me with a hug and turned away. Her father had just died and I was two. My two grandmothers died and my dog ran away, all in those early years, and I learned boundaries on grief.  We had moved to new space: I had lost the familiar.  Before I was ten the father across the street and the father next door died. I watched how uneasy my parents were with the wives' grief.  My mother's sister moved from the room next door across the country, I skipped a grade and lost a friend.  And this was during World War II. There was whispering at the news and a blue fund-raising tin on the kitchen shelf and assimilation and Josh Liebmann died. Phyllis' father died and I went to the shiva and didn't know what to say or how to be. Richard died and his mother's grief scared those around her and I couldn't cry because Marshall didn't cry . The toy man died shoveling, our age, I could only write a note. Bess died and Marshall didn't cry and I couldn't cry because Marshall didn't cry and when at the service he plucked a daisy from her coffin, I cried and sobbed and got locked up again.
  • After, alone, I used to cry every day in Los Angeles watching the children like mine, not mine, leave school and after Al died I was in Los Angeles with Victoria and couldn't stop crying. And with Vickie there I turned a somersault and cried and cried. Then I put my face underwater in the tub and opened my eyes.

  • The new baby loses the womb, the dying elder loses even breath, and in between is always change, each difference a loss and a gain. I learn the disturbance of not having.

    Sunday, January 15, 2012

    No tents in Santa Cruz

    90 uniformed law enforcers, black clothes, riot masks, spray canisters, sticks, enforcers gathered from the contiguous counties to augment the locals surrounded the remnants of the outdoor occupiers, chased away most, arrested some, dismantled and hosed down the camp. Some were ready to go. Around the corner bedrolls and gear filled the back seats and up over the rear window or a few sedans and vans, old plates, new plates, out of state plates. The next night 50 walked with purpose and rhythm across Water St to the jail, through the jail driveways, their noise protest drumming and clanging. By Blaine St, as I leaned against the rock and cement retaining wall, I could feel the strumming on the metal pickets in the tremble of the rocks themselves, A full moon watched.


    I see the goal of Occupy as bringing sufficient attention to the structural disarray. After the 99% all are clearly observing the messes and the impacts, then it will be time for ideas and actions towards new methods. And there are not leaders because leaders are about following, followers delegating responsibility and risk to another, and then going along. Occupy is about shared responsibility for actions and results and a continuous individual duty to oversee and adjust the common structures to which we consent.

    Whose interest?

    I was reading an article about ethics. The dilemma below seemed to me to fit nicely with the concerns about hospitalizing peers, calling the police, force, and maybe open up a way to think about it:

    “Whose interests am I holding at the moment? … I don't think you can pursue everyone's interests at the same time. So whose interests are we going to hold paramount?”

    So if someone is harming others, it seems clear to me that the community ought to be protected – police, hospital, talking down, …

    If someone is unable to care for themselves, can peers tide the person over or does this need long term intervention. Are we intervening in the interest of the individual or ourselves, not willing to see the deterioration, or the community, a social good?

    And then, the hardest one, if someone is or wants to harm themselves. In whose interest do we intervene?

    Licensed practitioners have a legal duty; Second Story*, because of it's funding and integration in the System of Care, has almost a full legal duty. Individuals may want to pass on the responsibility to the system, not want to be responsible. Intellectually, I believe my life is mine to care for or dispose of – in practice it becomes not as clear about when to intervene or whether to.
    * http://secondstoryhouse.org/about.html