Tiger Bones and Vashon Elm

I recently read an article in Quartz about the supposed explosion of vulnerable and endangered fish-part imports to China for 'medicinal purposes' (Guilford 2013). I put this phrase in quotes because it is clear this issue goes far beyond just medicine and to reduce it to a simple procurement practice for China's medical industry is to discredit what else is at stake here; Western medicine v. Traditional Chinese Medicine (TCM), the omnipotence of medical science and 'scientific truth' v. 'traditional medicine' just to name a few. This wasn't a particularly strong article, and so from here I diverge, but it did do a good job of positing TCM against logic (suggesting the two were mutually exclusive) and I feel this juxtaposition is a good jumping off point for discussion. Popular Western discourse and texts that address TCM as an alternative health strategy often take an immediate position of resistance when the animal parts is discussed.  That resistance often divides 'moral' therapeutic options from 'immoral' and 'unnecessary' use of animals and consent to their use only if 'the benefits outweigh the costs', regardless how little these benefits and costs are understood. This need to compartmentalize and crystalize medicine and its justifications may be a little reckless and I think we get ourselves into ideological trouble here if we ignore this misunderstanding. We can recognize the importance of sharks, tigers and seahorses to our eco-system and the global tourism economy but should be able to do so in collaboration with, rather than in opposition to, Traditional Chinese Medicine. 

But it is not just TCM that is being framed as an issue of scientific rationalism and exceptionalism. Threat of species decimation is not reserved solely for over-fishing and poaching but reaches to all other vulnerable biological populations that are capable of exploitation, more often than not by the advanced industrialized world. Unfortunately this advancement does not equate to mutual respect and appreciation between exporter and importer and so those doing the importing of vulnerable populations all too often do so to the detriment of the exporter. Regardless, 'resource talk' is a good discourse to analyze when trying to better understand things like shark fin soup and rhino poaching that persist despite decades of initiatives and 'bans'. Our Western, 'rational' selves hold the sentiment that if there is a viable alternative treatment, further threatening these species is in moral negation with any medicinal benefit offered. This is a big "if" because with the tenuous understanding Western Medicine has of TCM the judgment of what is a "viable alternative" to say, the use of tiger bone for arthritic pain (Bensky, D., Clavey, S. & Stoger, E. 2004) is subject to all manner of contingencies, speculations, disbelief and otherwise unstable beliefs.

Timber imports to the U.S. resonate here along side the vulnerable and endangered fish-part issue in China. Similar to the continued use of vulnerable and endangered species in TCM despite there being Western surrogates (e.g. chemotherapy, radiation, biopharmaceuticals), though there are alternatives to Amazonian hardwoods (e.g. composites), we continue to import the real-deal at harmful rates (Bueno de Camargo 2008). We are Brazil's biggest timber importer and since we have these alternatives readily available, I see nothing more elusive and exotic about fish-part consumption in China compared to deforestation in the Amazon. The Seattle Urban Hardwoods showroom location is a few blocks from my work and I walk by often on my lunch breaks. Filled with furniture made from large slabs and beams of solid wood, the store evokes a timber butcher-shop more than it does a furniture store. While many of the pieces are salvaged locally, using wood in this way and charging what they do (you don't even want to know) provides fuel for the ongoing timber trade that is wiping out forestlands globally.  Some of the woods they use are endangered but were growing with some effort in Washington when they were salvaged; trees grow great and plentiful here which can deceive an otherwise eco-conscious individual. A significant number of elm pieces were claimed from Vashon Island, a tiny island just a short ferry-ride away from the Seattle waterfront. My grandparents lived there on several forested acres while I was growing up. I can only imagine that many of these Vashon pieces were taken directly from their land, eroding away Vashon's jungley charm and making it more welcoming to day-trippers from the city, taking away with them the very authenticity that brought them there in the first place (!). Authenticity matters though. According to Globalwood.org, some towns rebuilding their waterfront boardwalks after Hurricane Sandy choose to re-build with a tried and true Brazilian hardwood, Ipe, over composite or native alternatives, which some towns have chosen, because they did not "offer the same experience" aesthetically. (Wood Products Prices in the U.S., 2013).  This "experience" is what can be culled from the fish-part trade argument as a major source of conflict and perhaps, if left unaddressed, the reason why these species will eventually vanish. 

It is this taste for exoticism that I want to highlight from the exotic fish-part trade in TCM as an attempt to reconcile the East v. West divide we reinforce with evidence-based medicine (or Chinese Elm I-beams) involving double-blind trials and big data. Western Medicine is often framed as being 'backed-up' by data from scientific and clinical trials while TCM is swindled of its legitimacy, 'backed-up' by no less than several millennia of usage and cultivation.  Here's some data of another kind:  A 2008 study on the use of tiger in TCM for medicinal and health tonic (wellness promoting) purposes revealed that although 93% of participants agreed the ban on farmed tiger parts trade should be kept in effect, 43% admitted to using tiger containing products (e.g. plasters, wines) with 71% of this group showing preference for products from wild tigers as opposed to products from farmed tiger, a dangerous partiality if I ever saw one (Gratwicke, B., Mills, J., Dutton, A., Gabriel, G., Long, B., et al. 2008). These attitudes show that the Chinese are aware of and purport to be in support of tiger conservation but nonetheless choose tiger products anyways, a rationality that tends to confound Western media. It is this gap in understanding, on both sides of the Pacific, that will be crucial to a more sustainable management of this issue. This article also suggested that a lot of these products could contain counterfeit tiger bone but that it is difficult to decipher this in the market and, while meaningful nonetheless, is a little outside my argument.  

I only hope this portrait takes away some of the mysticism of TCM believers and their seemingly irrational choices. A deeper understanding is urgently needed, however, as medical pluralism spreads globally and as popular presses, like Quartz, pick up stories for exploitation and exaggeration to the Western public. Reconciling these disparities between suspicion and belief, logic and experience may help throw in to relief the deeply held judgments against believers of an ancient and intricate form of medicine and, just maybe, furniture makers alike.

References

Bensky, D., Clavey, S. & Stoger, E.

     2004     Chinese Herbal Medicine Materia Medica 3rd Ed., Eastland Press: Seattle. 

Bueno de Camargo, Mariane

     2008     United States Markets for Brazilian Plantation Wood. World Forest Institute.

Globalwood.org

     2013     "Wood Products Prices in the U.S.," accessed May 7, 2013,    http://www.globalwood.org/market/timber_prices_2013/aaw20130201f.htm.

                          

Gratwicke, B., Mills, J., Dutton, A., Gabriel, G., Long, B., et al.

     2008     Attitudes Toward Consumption and Conservation of Tigers in China, PLoS ONE 3(7): e2544.

Guilford, Gwynn

     2013    "China is plundering the planet's seas-and it's doing it 12.5 times more than it's telling anybody," Quartz, April 30, 2013, accessed May 4, 2013, http://qz.com/78803.

no health without mental health

Recent news from the NIMH (National Institute of Mental Health) suggests a call for more attention paid to data culled from co-morbidity and mortality studies in both the United States and Sweden (Director's Blog, 3/29/13) to address the alarming life-expectancy rates among those with severe mental illnesses. It goes without saying these two countries have vastly different reverences for and interpretation of good health however (!) these studies both showed increased co-morbidity and mortality rates among those with severe mental illness when compared with the general population. The schizophrenic patients that were the focus of the study in Sweden even saw health care providers more often than the general population, a trend in opposition with what is going on in the U.S., where access to care for those with a severe mental illness is ponderously out of reach. In Sweden, the problem was not with access to treatment but early detection; when detected too late, ischemic heart disease, pulmonary disease and cancers reduced life years in schizophrenic women by 12, men by 15 (Crump et al). Numbers in the U.S., where individuals included in studies have the societal advantage of accessing our notoriously inaccessible mental health care system, are equally macabre, with 8.2 years average years less lived by those with any severe mental illness diagnosis (Druss et al). I'm reading Bad Souls: Madness and Responsibility in Modern Greece (Duke 2012), by Elizabeth Anne Davis right now, who's discerning look at Greece's psychiatric reformation considers 'responsibilities' as they shape the clinical and broader therapeutic encounters between patients and psychiatric staff. These 'responsibilities' employ clinician expertise to diagnose (my use here) deceptive and performantive measures taken by patients that give form to the clinical encounter. Compliance with treatment programs and an interest in self-help are some of the identifiers of a 'responsible' patient and while mental illness itself can impede both of these characteristics, they nevertheless persist as cultural accessories to moral patienthood. These characteristics may also play a role in the lived years reduction among the severely mentally ill. The patients involved in the Swedish study on co-morbidity and mortality, despite the safety net that is universal healthcare, lived significantly shorter lives than the general population because of late detection of non-communicable (arguably 'life style') diseases. In Davis' modern Greece, as in the U.S., patients are held accountable for maintaining treatment, even though in these socio-political spaces health care is not as accessible as it should or could be. Responsibility is emphasized as a means to not only well-being but perhaps even greater care exercised by clinicians (who deal often with unruly patients and/or are held in positions as 'gate-keepers' to care). With Obamacare looming near, can we argue our numbers in co-mortality and co-morbidity studies relating mental health with life years will improve because of access or will early-detection plague us too as a silent precipitator of premature death? With the U.S. psychiatric reform era decades behind us, and a more universal health care system in the near future, are we in a position to learn from both Greece and Sweden in changing these numbers for the better? In what ways will patient responsibility interact with healthcare access to decrease these co-morbidity and mortality rates? In Sweden, early detection certainly remains stubbornly elusive for the mentally ill so we may remain hesitant to see greater access to health care in the US as an agent of longer lives lived. Despite the increased access to healthcare on the horizon, the Swedish study shows us access alone is not enough.



References:

Crump, C., et al.
2013     Comorbidities and Mortality in Persons with Schizophrenia: a Swedish national cohort study.        American Journal of Psychiatry 170 (3): 324-33.

Davis, E.A.    
2012     Bad Souls: Madness and Responsibility in Modern Greece. Durham: Duke.

Druss, B.G., et al.
2011     Understanding Excess Mortality in Persons with Mental Illness: 17-Year Follow up of a Nationally Representative US Survey. Medical Care 49 (6): 599-602.

Thomas Insel
2013     Director's Blog Schizophrenia as a Health Disparity, 3/29.

Images of Difference, Part 4 "Of Clouds and Concrete"

Tubs Sun Salon, nka "Tubs", is a former private spa turned three dimensional street-art canvas that has taken up residence in the U-District since 1982. As the name suggests, it was a public hot-tub spa (and I won't go any further than that) and tanning salon. It closed in 2007 and has remained since a creative space of expression, continually being re-touched with images and words that speak to the character of the city. Since my days in Seattle are numbered, I decided I'd take stock of this peculiar neighborhood icon over the next six months to chronicle its transformation. I will update these regularly and I hope to capture the rapidity of the changes that take place. Seattle rarely stands still for more than a moment so the next six months should prove to be revolutionary to this little wall.

2/24/13

All photography by the author's husband

2/28/13

3/3/13

On a dry day, chalk art can be identified.

There isn't a large amount of refuse left in this empty lot although from time to time a mattress will show up.


{edit 4.22.13-A few days after publishing this blog, a pair of dump trucks barricaded the front of this building and enclosed the whole area in chair-link fencing. Since that time, however, the trucks have not moved and no demolition has commenced. 

(re)commitments to mental health

     I've been thinking a lot about deinstitutionalization lately and what the communities that the mentally ill and intellectually challenged were released to have actually done in the aftermath. Access to care is a complication of our community mental health system today; cost, stigma and lack of providers are all major contributing factors here. My online discussion forum research on psychiatric patients has shown that this lack of care has driven some to seek admittance in institutions rather than have an aversion toward them and with the significant amount of foresight needed to accord with insurance guidelines. This is of course a dynamic phenomenon among this patient group and fear of hospitalization is still very salient in the discussions. 

    Almost 50 years ago, JFK addressed Congress in a message on mental illness and mental retardation (intellectually challenged). He stressed prevention and alleviation and was eager to propose 'cure' as an expected outcome of better mental health care, a view that would be considered rather chimerical today. In the contemporary, 'cure' is a much more precarious concept in the discourse on mental illness and neurodiversity at large. Positing institutional care as 'cold' and the community model as 'warm', JFK was right to see that a radical change of attitude, as well as policy, was in order but without the insight that 50 years of semi-effective initiatives on mental health have brought us, he lacked the sobriety toward therapeutic efficacy we now have. 

     At the time, this "problem unpleasant to mention, easy to postpone, and despairing of solution" was well due for national action but with a clear objective. Today, we know cure doesn't hold as an end goal and ideals are truly individualized. The hopes for today's mentally ill and intellectually challenged are the best possible alleviation of symptoms and a life with the least amount of disruptions and the most fulfilling. These are graduated rather than polarizing; successes include better employment prospects, a drug with less side effects and an overall better understanding of the brain to lessen stigma. These are goals I see as reasonable and better adapted to increase social integration rather than the elimination of these afflictions. Curative philosophies seem to miss what is so important in our approach to any measure of diversity; acceptance of difference to better face the challenges of today rather than trying to avoid difference altogether. The neurodiverse movement would abhor this exclusionary attitude and argue this is part of why stigma is so persistent. Some would argue that mental diversity is a gift and one should appreciate coming into contact with it (this is a more radical stance). What JFK said, however, was brave. He was brave to make it a priority within that sociopolitical moment and brave to point out the failings of the system as it stood.

     Last August, Barack Obama signed an executive order that outlined a strategy to alleviate mental health issues among military service members. His order addresses mental illness in a comprehensive manner and acknowledges, in many ways, the unique social circumstances PTSD and TBI (traumatic brain injury) patients face. Military service is truly a self-sacrifice that couples with an emotional burden civilians sometimes escape. Obama too has been brave for his actions in this sociopolitical climate. In the aftermath of the major shootings under his administration he has called for an attention to mental health access at a time when the link between mental illness and violence is contested at best and national anxiety clouds around the more tangible harm done by guns and physical violence rather than the internal harm these shooters have undoubtedly endured.  It requires a certain boldness to address such a disruption to our evolutionarily adaptive bulwark of emotional defense. It is, perhaps, an acknowledgment of a failing of society, the recognition of which can be dangerous. For now, the danger remains unseen, hidden in the cortical layers and incredibly versatile nuclei of the human brain. Now is the time to unearth that danger and confront the crisis with collaboration from the mentally ill and policy makers alike. Mental illness is a complicated experience, one that remains vague in its causation and obscure in its phenotype so let us proceed with the caution and sensitivity required to face such uncertainty.

References:

Barack H. Obama
      2012    Executive Order: Improving Access to Mental Health Services for Veterans, Service             Members and Military Families, August 31.

John F. Kennedy
     1963     Special Message to the Congress on Mental Illness and Mental Retardation., February 5.

AboutFace photo courtesy of National Center for PTSD

The Great Gun Debate

     My heart broke when I heard of the Newtown, CT shooting back in December. As an anthropologist, one of the things I try to understand are the reasons for killing or otherwise harming other humans. Killing children, especially 6 and 7 year olds, is a little harder for me to wrap my head around, although it certainly serves its cultural purposes, but a masacre at an elementary school proved challenging to the point of heartbreak. What most bothers me about this incident are the future lives of the surviving children, their siblings and all other children who were profoundly altered by this event face. I lament over the psychological trauma these children faced so needlessly. Six years old is a very young age to be confronted with such bare truths of humanity as delusions, matricide, murder and suicide. Learning to cope with this incident may be one of the bravest things these children ever do. I have been writing my graduate school application essays and so I've spent some time over the last few months interrogating my own childhood memories to find what experiences may have precipitated my interest in medical anthropology. I asked myself why I was interested in illness and health in the way that I am and why I choose a non-clinical career path.  Illness touched my family when I was very young and persisted throughout my entire upbringing but it wasn't something always talked about. Perhaps I search for a deeper understanding of illness through medical anthropology to counteract the lack of understanding I felt growing up. The doctors showed their concern for my mother and treated her aggressively but with care. The 'care' she received at her general hospital was exemplary, I make no mistake, but even though we traveled the 100 miles or so to get great advanced care, I always felt a little bereft of support on the car ride home.  We still drove home with the illness (it was chronic but sustainable with frequent treatments) and brought it back to our home. It never left us and all that time in between trips to the hospital it was seldom attended to, checked up on or inquired about. That was all dealt with in the personal while the illness was addressed in the clinical and never the two should meet. This consistent lack of understanding, on all sides, left me wanting to know more about illness and not just in the clinical sense but in the meaning sense. The greater meaning behind things eluded me growing up as what information is provided to children can be abridged to fit curriculum or doctrine. Hepatitis was always learned about in association with drug abuse and carried a moral weight. My mother contracted it through a blood transfusion however and this reasoning was never morally mediated. Junkies got Hep C, not mommies.
     I wonder now about the Newtown children and how they now face the monumental task of making sense of and giving meaning to a mass-shooting at their elementary school. Will they be supported in their quest for information? I want to distinguish here between explanation and comprehension and the greater organizational feats our minds accomplish when we find meaning in  traumatic events. That Adam Lanza took his own life, and therefore his voice and story, I regret because much is lost here in way of understanding, which is immensely valuable in therapeutic contexts. How do you begin to explain to a traumatized 8 year old that abnormalities in Lanza's brain contributed to his attack? How do you explain brain abnormalities in general? Show them diagnostic images?  Detail how neurons can communicate in different ways in different brains? Would this help them understand Lanza's actions without instilling a lasting doubt of the mentally ill in their minds? How would one venture to explain that the very video games they (or more likely their older siblings) play contributed to Lanza's violence? These questions are delicate and have no absolute answers whatsoever, making this job of helping children understand such events precarious, to say the least. The clinicians and therapists that have been working with, and will work with, these children are a courageous group indeed to take on such an assignment.
     Obviously, a more engaged conversation about guns can serve to both prevent future shootings, or so suggested, and to lessen the trauma associated with gun killings. Gun violence, if 'solved', cannot provide the answer as killing is much more complex than method and motive alone.  At the very least, I hope the great debate that remains will give rise to a new application of philosophy and a better national understanding of ethics. Whatever we point our finger to or place blame upon, change is expected and needed but any change will fail if understanding isn't broadened. It will, I hope, influence the lives of those surviving children in ways that are healing and restorative. Perhaps the shooting in Newtown will give rise to a new generation of anthropologists that study links between mental illness and violence or gun culture. Without a doubt, this experience will change their world perspectives and I argue we should begin a national conversation about how these perspectives can be seen for the good rather than for the bad. My hopes for these children are that they are brought to a more dynamic understanding of human nature, in all its disturbing truth, and gain a new understanding of the world like I did. Such an understanding can become an advantage later in life and I truly hope it will be for the Newtown children and all those who were traumatized by this incident.

In memoriam: Sandy Hook Elementary School, Newtown, CT. 12/14/12