Everything You Ever Wanted to Know About Having Cancer

[Content note: medical stuff]

A few weeks/months ago (what is time, anyway?) I invited my friends to ask me absolutely anything they wanted about what it’s like to have cancer. The result was this epically-long Q&A, which was actually quite fun for me to compile. Folks have been saying it’s useful and interesting for them too, so I decided to make it public.

If you have questions you’d like to ask and you know me well enough to know how to reach me, feel free to send them my way and I’ll answer them when I update this. Ask anything you want; if I’m not comfortable answering, I won’t. But you can probably tell from this article that there’s not much I’m uncomfortable answering.

The first set of questions is dated November 23, 2017, so some of the details of my treatment have probably changed.

Continue reading “Everything You Ever Wanted to Know About Having Cancer”

Everything You Ever Wanted to Know About Having Cancer
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How to Avoid Giving Your Cancerous Friend a Panic Attack: An Introduction to the Psychology of Pain

Okay, maybe this is kind of turning into a Cancer Blog.

[Content note: medical stuff]

One of the first things my oncologist said to me at the beginning of this whole wild ride was, “Don’t Google.”

Wise words. For the most part, I haven’t. I’ve used some well-vetted websites (such as the American Cancer Society) to help myself prepare for things, but I’ve never intentionally sought out other types of medical information and narratives.

However, Google being how you access legit medical websites as well as blogs, things have nevertheless found their ways onto my screen that shouldn’t have. Some of this was probably unavoidable; some of it definitely wasn’t, especially when people sent me links or I clicked on them.

There’s a lot I didn’t understand about the psychological side of medicine until recently, but once I did, things started to make sense and I started to notice things I’d never noticed before.

For instance, well-trained doctors and nurses who are not characters in TV shows or moralizing children’s books never say “THIS WILL HURT A LOT.” Actually, they don’t even say, “This will hurt.” They say, “You will feel a pinch.” They say, “There might be a burning sensation at first, but it’ll go away in a few seconds.” They say, “You’ll feel a sting when I numb the area, but after that you won’t feel anything. If you do, tell me.” They say, “Some patients find this uncomfortable. If it’s too much for you, let me know and we’ll see what we can do.”

I started to notice that as much as possible, they stay away from words like “hurt,” “pain,” and anything vague or emotionally-charged.

Then I noticed how my doctor responded when I asked about pain management post-mastectomy. He said, “We use a multi-modal pain management protocol. You get four different medications, one of which is an opioid. We find that when patients return for their one week follow-up, the majority of them voluntarily return the opioids to us, saying that they only took a few of them or never needed them at all.”

Next I asked about chemo side effects. He said, “The main side effect patients experience nowadays is fatigue. Everything else is very well-controlled with medication, so if you’re still experiencing nausea or other side effects, let us know and we’ll add medications to control it or reduce the dose of the chemo. Even with fatigue, it varies. The best way to counteract it is exercise. Try to get yourself moving at least a little bit every day. Most of my patients continue to work during chemo, if not full-time. One of them even ran the Columbus Marathon during her treatment.”

Notice what’s going on?

Whenever the question of pain, discomfort, and side effects comes up, good medical providers do several things:

1) They are honest about what most patients can expect, but
2) They don’t focus on the negative aspects or use emotionally charged language to describe it
3) When most patients can expect a positive outcome, they emphasize that
4) When discussing pain or other side effects, they quickly shift focus to what THEY plan to do to address it.

This is very important, and that’s where the psychology of pain comes in. Research shows that expectations of pain play a huge role in our subjective experience of pain—expect something to hurt a lot, and it probably will; expect it to be tolerable, and it’ll hurt less. That doesn’t mean you’re going to magically feel no pain—we have nerves, after all—but there’s a degree of subjectivity to it and we’re learning that it’s a rather large degree.

Unfortunately, once you’ve become convinced for whatever reason that something is going to be very painful, it’s very difficult to un-convince yourself of that, because at that point your brain’s fear response has sort of taken over. That’s why it’s important to manage what information you receive beforehand so you don’t end up with an expectation of intolerable pain.

And that’s why my doctor told me not to google stuff.

Doctors don’t want patients freaking themselves out with graphic descriptions of painful procedures not just because they want to help you avoid panic attacks and unnecessary stress. It’s also because expecting severe pain can lead to experiencing severe pain. More pain means more pain medications, a greater risk of complications and addiction to those pain medications, a longer recovery time, and a generally all-around shitty experience.

A wonderful book I just read, What Patients Say, What Doctors Hear by Dr. Danielle Ofri, describes this phenomenon and cites research dating back decades. From a Washington Post review of the book:

We’ve known for decades that doctors who offer empathy, build trust and set expectations help their patients fare better. As far back as 1964, a study conducted with abdominal-surgery patients illustrated what Ofri calls the “demonstrable effect of the simple act of talking.” Before surgery, half of the patients were visited by an anesthetist who said pain afterward would be normal and would last a limited amount of time, and explained how patients could relax their muscles to lessen the pain. These patients needed half the pain medication of others who didn’t receive a pain talk. If we are an overmedicated nation, better communication would seem an easy and cheap way to relieve that burden — except that listening takes time, and doctors don’t usually have that.

If doctors don’t always have the time to talk to patients about pain in this calming, practical way, we now have the internet to step in and fill the gap. Sometimes it does this well, but often it does it very poorly.

We all know cognitively that you’re likely to find a disproportionate number of negative stories online because people who have a positive or neutral experience are less likely to take the time to describe it, whether that experience is with a restaurant, lawn care service, book, or medical procedure. We know this, but when you’re scared about your upcoming surgery and you stumble upon some first-person accounts, you’re not thinking of it that way and you can’t think of it that way. The fear response takes over.

Even if the experience being described is quite typical and probably fair to expect, it still does patients like me few favors to read those descriptions. First of all, subjective experiences of pain are, well, subjective. One person’s terrible pain could be my absolutely tolerable pain, and there’s no way to know it. Pretty much everyone has pain after surgery; that’s to be expected. But reading about it can still harm me by causing me to expect more pain than I would’ve otherwise had.

Different online sources also have different motivations. I’ve read a few blogs by cancer patients and found most of the accounts there to be pretty neutral and even-handed when it comes to describing cancer treatment. Yes, it sucks, but since these bloggers were documenting their journeys overall, they also described the parts that were okay, and the parts that were just boring, and even the parts that were interesting and better than they expected.

But as soon as you get into first-person narratives being published on websites like Buzzfeed and Slate and whatever, you’re going to see a much more skewed version of things because, as I’m furiously finding out, people love a graphic, miserable cancer narrative. People eat that shit up. Painful medical procedures, disgusting post-op symptoms, bizarre side effects, the works. It gets clicks. It infuriates me.

Even if those experiences are very much real, it doesn’t do someone like me any good to read it. Some patients justify it by claiming that it helps us be better “prepared”—I used to do this too—the fact is that it doesn’t make is better prepared. It makes us less prepared, because it makes us expect the worst and therefore ultimately have a worse experience.

So, when you come across these “raw” and “honest” cancer narratives and you feel the urge to send them to your friend with cancer to help “prepare” them or because you think they might find it validating, take a pause and ask yourself 1) who this is primarily being written for and 2) how exactly this will prepare your friend for what they’re about to face. Put yourself in their shoes. Imagine you’re going through treatment for a deadly illness, and you don’t know if the treatment will even work or how much damage it’ll do to you in the process. Would reading this material help you? If not, it won’t help me either.

What I do find helpful is neutral, matter-of-fact explanations of what I can expect. The best of these have come from my hospital itself, which makes tons of handouts available to patients. Here are some pages from the one they gave me about mastectomy and reconstruction surgery:

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Websites like the American Cancer Society, the National Breast Cancer Foundation, and BreastCancer.org also do this well. When I do google, these are the websites I usually click on.

And in terms of speaking to people, two conversations have made a big difference in calming me down and setting more positive expectations for surgery. One was the appointment in which my doctor told me about how most of the opioid medications get returned within a week. The other was when my mom, who had a c-section twice, told me that post-surgery pain just felt like a very strong muscle ache, as if you’d worked out super hard the day before. That was very reassuring. I am no stranger to strong muscle aches.

In my social circles, we generally value sharing and listening to people’s personal experiences, and we emphasize that everyone’s experience is valid and important and so on. I agree with this, generally. But right now, as I’m going through cancer treatment, everyone’s personal experience is not important to me, and I shouldn’t read and give credence to something just because it’s someone’s personal experience. Doing so can not only give me panic attacks, but literally cause me to feel more pain.

So for the time being, I’m trying to stay away from negative and emotionally-charged accounts of cancer treatments, and my friends can help by not encouraging me to read them. If necessary, I’ll “prepare” myself by talking to my doctors. They have yet to make me regret it.


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How to Avoid Giving Your Cancerous Friend a Panic Attack: An Introduction to the Psychology of Pain

Secular Students Week Guest Post: Tim Kolanko

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Continuing Secular Students Week, I’ve got a guest post from Tim Kolanko, a student activist who was able to use the SSA’s support to bring a speaker to raise awareness of intersex issues and medical malpractice.

I’m Tim Kolanko, President of the Northern Illinois University Secular Student Alliance. A few weeks ago, the national Secular Student Alliance gave my group a grant so we could hold an awesome event, “The Gender Binary and LGBTI People: Religious Myth and Medical Malpractice.” Thanks to their funding, we were able to bring in Dr. Veronica Drantz and two intersex activists to talk about how LGBTI (Lesbian, Gay, Bisexual, Transgender, Intersex) people have been and continue to be victims of medical malpractice purely because they are neither Adams nor Eves.

Psychiatrists, surgeons, endocrinologists, pediatricians, and other medical experts have subjected LGBTI people to bogus and horrific treatments with reckless disregard for patient health and well-being―all the while ignoring the basic tenets of medical ethics and the ever-growing scientific evidence showing LGBTI people to be natural variations. This talk contrasted the scientific evidence with the ongoing medical (mis)treatment of LGBTI people to vividly illustrate the insidious effect of the biblical creation myth.

The event included an hour-long presentation of Dr. Drantz laying out the scientific evidence having to do with sexual development, sexual orientation, and gender identity, arguing that LGBTI people are natural variations. Her presentation was followed by the emotionally powerful personal testimonials of two intersex people that have been harmed by the medical community and society because they are viewed as disordered, not different.

The Project Grant we received from the Secular Student Alliance allowed us to fund not only the speakers, but the video recording of the event! With the help of two on-campus co-sponsors, we were able to put on a successful event. We worked with the my University’s Gender & Sexuality Resource Center and the Women’s, Gender, and Sexuality Studies Program.

Around 40 people took part, despite the severe weather in the area, and we were so excited to be able to network with two large on-campus organizations, which will definitely help for future events!

This event wouldn’t have been possible without the support of the national SSA. Their grant, and their support of our organization, lets us explore the world from a naturalistic point of view, combat the negative connotations associated with being non-religious, and promote critical thinking, reason, and skepticism over faith-based worldviews.

Not only did the SSA give us a grant, but they also provide us with so many free resources and services, like our tabling supplies! They are only able to do this because of the generosity of people just like you.

This week is Secular Students Week, when the SSA is highlighting activism of students like me and my group members. If they get 500 donations this week, they’ll unlock a challenge grant for $20,000!! This money would have a huge impact for groups like mine: help us out by giving today! Even a gift of $5, $10, or $20 can make a big difference: give to the SSA today!

Secular Students Week Guest Post: Tim Kolanko

Herbal Abortions and Editorial Responsibility

Content note: graphic descriptions of abortions and miscarriages

Being both a feminist and a skeptic means walking the fine line of critiquing the way science and medicine are practiced without denying their importance and validity, of empowering individuals who have faced abuse by these institutions without promoting at-best useless and at-worst dangerous pseudoscience to these individuals instead.

I was reminded of this ever-present tension when I read a book of essays called Listen Up: Voices from the Next Feminist Generationedited by Barbara Findlen. One of the essays was titled “Abortion, Vacuum Cleaners and the Power Within,” and the subject was the author’s negative experiences with what she called “clinical” abortions–that is, abortions performed by someone licensed to perform abortions.

The author, Inga Muscio, describes the several clinical abortions she had: they were painful and terrifying:

Have you any idea how it feels to willingly and voluntarily submit to excruciating torture because you dumbly forgot to insert your diaphragm, which gives you ugly yeast infections and hurts you to fuck unless you lie flat on your back? I had to withstand this torture because I was a bad girl. I didn’t do good, I fucked up. So I had the same choice as before, that glowing, outstanding choice we ladies fight tooth and nail for: the choice to get my insides ruthlessly sucked by some inhuman shit pile, invented not by my foremothers, but by someone who would never, ever in a million years have that tube jammed up his dickhole and turned on full blast, slurping everything in its path.

Muscio, who is very clear about her opinions on “Western medicine” (she at one point refers to it as “that smelly dog who farts across the house and we just don’t have the heart to put out of its misery”), eventually gets pregnant again, and this time she tries something else:

I started talking to my girlfriends. Looking to my immediate community for help led me to Judy, the masseuse, who rubbed me in places you aren’t supposed to rub pregnant ladies. She also did some reflexology in the same vein. Panacea told me where to find detailed recipes for herbal abortifacients and emmenagogues. Esther supported me and stayed with me every day. Bridget brought me flowers. Possibly most important was the fact that I possessed not one single filament of self-doubt. With that core of supportive women surrounding me and with my mind made up, I was pretty much invincible.

So, one morning, after a week of nonstop praying, massaging, tea drinking, talking and thinking, I was brushing my teeth at the sink and felt a very peculiar mmmmbloommmp-like feeling. I looked at the bathroom floor, and there, between my feet, was some blood and a little round thing. It was clear but felt like one of them unshiny Super Balls. It was the neatest thing I ever did see. An orb of life and energy, in my hand.

But lest you think Muscio intends this as a solution just for herself, she concludes, disturbingly:

Concentrating on the power within our own circle of women was once a major focus of the women’s health movement. I think we would benefit from once again creating informal health collectives where we discuss things like our bodies and our selves. If we believed in our own power and the power of our immediate communities, then abortion clinics, in their present incarnation, would be completely unnecessary. Let the fundamentalist dickheads burn all those vacuum cleaners to the ground. if alternative organic abortions were explored and taken more seriously, there wouldn’t be much of an abortion debate. Abortion would be a personal, intimate thing among friends.

Can you say Amen.

I finished the essay feeling confused. Although Muscio explained that “clinical” abortions were painful and felt wrong to her, she did not even attempt to explain her fury at abortion providers (whom she seems to think are all men). She did not explain why (or even whether) a painful and scary medical procedure that aborts a fetus is any different from a painful and scary medical procedure that stops a tooth infection or removes a tumor. Would she advocate “alternative organic” methods for those problems, too?

Her graphic imagery of vacuum cleaners, blood, and gore is never explained or justified in any way. She just doesn’t like the idea of abortions, and this, apparently, is reason enough to let abortion clinics go extinct.

Muscio further erases the fact that women, too, can and do perform abortions, and her implication that only women can understand the female reproductive system is extremely cisnormative (and also simply wrong; any doctor who has spent years studying those organs and operating on them and helping to keep them healthy surely knows more about them than I, a cis woman, do).

But I think I’m most disturbed not by Muscio’s ideas, but by the editor’s decision to publish them in this anthology.

How would a young person, perhaps not very knowledgeable about abortions, perhaps who has grown up being told they are awful and immoral, perhaps in need of (or at risk of needing) an abortion themselves, react to reading this piece? What decisions would they make about their health? I’m wondering if the editor thought about this before choosing to publish the essay.

On one hand, I see the value of publishing and reading all kinds of narratives about reproductive health, including this one. In our rush to portray abortion as a standard, no-big-deal sort of medical procedure, advocates for reproductive rights sometimes lose sight of the fact that, like any other medical procedure, abortion can be terrifying and traumatic completely independently of the fact that it’s so stigmatized.

Fear of medical procedures (and fear of pain) is something that people are expected to magically “outgrow” when they stop being children. Some do, but some don’t. Doctors don’t always know how to respond to adult patients with extreme fear, and often respond without empathy or compassion. This is only one of many reasons some people turn to practitioners of alternative medicine for help.

Understanding this is essential if we are to help people find healthcare that works (both by actually getting them physically better and by treating them with dignity and care). But the essay was presented in the book without any sort of commentary. While the book’s editor isn’t necessarily condoning or supporting the ideas in the essay, she is nevertheless promoting them by giving them wider circulation than they would otherwise have.

People may read the essay and become convinced that prayer and herbal tea can actually abort a fetus, and that getting an abortion performed by a medical professional is always a horrible experience to be avoided at all costs. That someone would end up with an unwanted child is probably the best case scenario of taking Muscio’s advice, as alt-med remedies can be actively harmful and dangerous.

(In fact, in the essay, Muscio elaborates on the specific “herbal remedies” she used. One of them was pennyroyal, which was implicated in the death of a woman who used it to try to induce an abortion. She didn’t know that she had an ectopic pregnancy. In general, the history of herbal abortifacients is, as i09 puts it, terrifying.)

Giving people medically accurate information about reproductive health is a crucial part of progressive activism. While one might argue that left-wing distortions of science and medicine are more well-intentioned than their right-wing counterparts, the end result is absolutely identical: people don’t understand how their bodies really work, how medicine works, which medical interventions are supported by the evidence and which are not. People feel ashamed of seeking out medical care that works.

I know that there are compelling reasons to publish this essay as is. I can understand why the author of this book might’ve done it. But I wouldn’t. It seems irresponsible.

~~~

P.S. Many of the other essays in the book were actually pretty cool. Here are my favorite quotes.

Herbal Abortions and Editorial Responsibility

Viewing History Skeptically, Part 2: Beauty

Joan Jacobs Brumberg's "The Body Project"
One of the first things one learns in a college-level history or sociology course is that the ways we define and think about various human attributes and qualities—sexual orientation, mental illness, gender, race, virginity—are never static. They vary geographically and temporally, and even though it may seem that the way we currently conceptualize a particular aspect of human experience is the “right” one, the one that’s accurate and supported by the research evidence, that’s pretty much what people always think.

This is what I discussed in a previous post, where I promised to write some followups about specific examples of this sort of thing. So here we go!

Beauty is a good example of shifting cultural attitudes—not only in the sense that beauty standards have changed over the decades, but also in terms of what meaning and significance we attribute to beauty as a quality. In her book The Body Project: An Intimate History of American Girls, Joan Jacobs Brumberg discusses these shifting meanings. Brumberg notes in her chapter on skincare that in the 19th century, acne and other facial blemishes were considered a sign of moral or spiritual impurity. In fact, many people believed that people got blemishes as a result of masturbating, having “promiscuous” sex, or simply having “impure” thoughts. She writes, “In the nineteenth century, young women were commonly taught that the face was a ‘window on the soul’ and that facial blemishes indicated a life that was out of balance.”

By the mid-20th century, however, Americans had already started to think of beauty very differently. Brumberg writes of perceptions of acne in the postwar period:

Although acne did not kill, it could ruin a young person’s life. By undermining self-confidence and creating extreme psychological distress, acne could generate a breakdown in social functioning. Acne was considered dangerous because it could foster an “inferiority complex,” an idea that began to achieve wide popularity among educated Americans.

Facial blemishes were no longer considered a sign of inner weakness or impurity; they were a potentially dangerous blow to a young person’s self-esteem. They were something to be dealt with swiftly, before they could cause any serious damage:

In magazines popular with the educated middle class, parents were urged to monitor teenagers’ complexions and to take a teenager to a dermatologist as soon as any eruptions appeared: “Even the mildest attack is best dealt with under the guidance of an understanding medical counselor.” Those parents who took a more acquiescent view were guilty of neglect: “Ignoring acne or depending upon its being outgrown is foolish, almost wicked.”

Whereas worrying about one’s appearance and trying to correct it was once viewed as improper for young women, it was now considered acceptable and even productive. Even state health departments issues pamphlets urging young people to make sure that they are “as attractive as nature intended you to be.” It was understood that beauty was an important and necessary quality to have, not only because it opened doors for people but because it was just another aspect of health and wellbeing.

Today, our views on beauty seem much more rife with contradictions. Obviously beauty is still important. Women (and, to a lesser but growing extent, men) are still encouraged and expected to spend money, time, and energy on improving their appearance. We know from research that the halo effect exists, and that lends a certain practicality to what was once viewed as a frivolous pursuit—trying to be beautiful.

At the same time, though, we insist that beauty “doesn’t matter,” that “it’s what’s on the inside that counts.” It’s difficult for me to imagine a modern middle-class parent immediately rushing their child to the dermatologist at the first sign of pimples; it seems that they would be more likely to encourage the child to remember that “beauty is only skin deep” and that one’s “real friends” would never make fun of them for their acne. (Of course, I grew up with no-nonsense immigrant parents who rejected most forms of conformity, so maybe my experience was different.) Nowadays, costly medical interventions to improve teenagers’ looks are more associated with the upper class than the middle class, and we tend to poke fun (or shudder in disgust) at parents who take their children to get plastic surgery and put them on expensive weight loss programs.

It appears that our culture has outwardly rejected—or is in the process of trying to reject, amid much cognitive dissonance—the idea that beauty is a good way to judge people, that it reveals anything about them other than how they happen to look thanks to genetics or their environment. No longer do we consider beauty a sign of purity and spiritual wellbeing, as in the Victorian era, or of health and social success, as in the postwar years.

Of course, that’s just outwardly. Although we’re loath to admit it, beauty still matters, and people still judge others by their appearance, and we still subscribe to the notion that anyone can be beautiful if they just try hard enough (which generally involves investing a sufficient amount of money). While people are likely to tell you that beauty is a superficial thing that shouldn’t matter, their actions suggest otherwise.

An interesting contrast to this is Brazil, where plastic surgery, or plástica, is generally covered by the state healthcare system. As anthropologist Alexander Edmonds describes, many in Brazil believe that beauty is a “right” that everyone deserves, not just those who can afford it. One surgeon says:

In the past the public health system only paid for reconstructive surgery. And surgeons thought cosmetic operations were vanity. But plástica has psychological effects, for the poor as well as the rich. We were able to show this and so it was gradually accepted as having a social purpose. We operate on the poor who have the chance to improve their appearance and it’s a necessity not a vanity.

Brazilians, too, have been influenced by Alfred Adler’s concept of the “inferiority complex,” and in this sense the meaning of beauty in that context is similar to that in postwar America, although with a few differences. Like Americans in the 1950s, many Brazilians believe that improving one’s appearance is an important form of healthcare that heightens self-esteem and confidence. It’s not a matter of vanity.

However, unlike Americans, Brazilians (at least the ones profiled in Edmonds’ study) believe that self-esteem is important for the poor as well as for those who are better-off. In the United States people tend to scoff at the idea that people living in poverty need (let alone deserve) entertainment, pleasure, or really anything other than what they need to survive, and in the postwar years the focus on adolescents’ appearance seemed to be confined to the middle and upper class. But in Brazil it’s accepted as a “right”–a right to be beautiful.

Looking at how Americans in the past viewed beauty, as well as how people in other cultures view it, exposes the contradictions in our own thinking about it. Our outward dismissal of beauty as vain and unimportant clashes with our actual behavior, which suggests that beauty is quite important. This tension probably emerged because we have abandoned our earlier justifications for valuing beauty, such as the Victorian view of beauty as a sign of morality and the postwar view of beauty as a vital component of health. Now that we know that beauty has nothing to do with morality and relatively little to do with health, we’re forced to declare that it “doesn’t matter.” But, of course, it does.

 

Viewing History Skeptically, Part 2: Beauty

Who Is To Blame For A Suicide?

Yesterday I was driving around in my hometown and listening to the radio. The DJs did a segment on the suicide of Jacintha Saldanha, a nurse in a hospital where Kate Middleton was being treated, who was pranked by some radio DJs and tricked into giving out Middleton’s medical information.

The DJs on my hometown station put a caller through and asked for her opinion. She said that it’s not at all the DJs’ fault that Saldhana clearly had issues and that they shouldn’t have lost their jobs because of what happened. Furthermore, it was “irresponsible” of Saldhana to kill herself and leave this whole mess behind.

Lesson one: never listen to the radio in Dayton, Ohio.

Lesson two: people have a lot of trouble with grey areas and blurry lines.

(Of course, I mostly knew both of these things already.)

It seems to be very difficult for people to form an opinion on this tragedy that isn’t extreme. Some say that the DJs were just doing their jobs, the prank was completely harmless, just a bit of fun, and Saldanha was messed up and crazy. Others say that the DJs are terrible people and should be blamed for Saldanha’s suicide. The latter seems to be the minority opinion.

I don’t think that the truth always lies between two extremes. In this case, though, I feel that it does.

Suicide is a complex phenomenon and the suffering that causes it–and that is caused by it–makes it even more difficult to comprehend. A particularly painful fact that the friends and families of people who kill themselves sometimes have to face is the fact that suicide often has a trigger. Sometimes, that trigger is other people.

I remember reading a young adult novel called Thirteen Reasons Why a few years ago. The novel is very serious for a YA book, and the premise of it is that a teenage girl, Hannah, has killed herself and left behind a set of audio recordings in which she explains to every person who was implicated in her mental troubles what it was that they did.

One was addressed to a guy who found a poem she wrote and spread it all over the school. Another was to a guy who took photos of her through her bedroom window. By the end of the book you get a picture of a girl who was just completely used and marginalized by almost everyone she interacted with.

And yet–this is the part that some readers, judging from the reviews, didn’t get–Hannah is not supposed to be a wholly sympathetic character. You’re meant to feel sorry for her, but her actions are meant to make you uncomfortable. The tapes she leaves behind seem a bit vindictive. And at the end you learn that two of the major triggers for her suicide were that she failed to stop a rape at a party and that she allowed her friend to drive drunk–and hit and kill someone.

So, who’s to blame for Hannah’s suicide? Her classmates were cruel, yes. But they didn’t know what she was going through. And she could’ve saved herself a lot of guilt had she intervened and stopped the rape and the car accident, but can you really expect a terrified teenage girl to do that?

The point of the book, to me, is this: you can’t blame anyone. It’s comforting to think that you can, but you just can’t.

Similarly, the Australian DJs who pranked Saldanha could not have known what would happen. In fact, even now we don’t really understand. Although she reportedly left a suicide note, we don’t know what it says, and we don’t know what kinds of personal struggles she might’ve had leading up to her death. To their credit, the DJs have said that they’re heartbroken and sorry.

But blaming Saldanha is sick and cruel.

And while I don’t blame the DJs for her death, I still think they shouldn’t have done it.

The thing is, we live in a world that presumes that everyone is “strong” and mentally healthy and capable of dealing with whatever life throws at them without falling apart. This is why people like Saldanha are blamed and exhorted to “just work on their issues,” even after they’ve died.

We assume that people are always capable, for instance, of refusing repeated sexual advances, ignoring social coercion and proselytism, dealing with mental health issues without ever being taught how, overcoming pervasive racial inequality, facing the humiliation (and, sometimes, terror) of street harassment, suffering through targeted online hate campaigns, refusing to believe it when magazines tell them they must be thin, and so much more. We expect them to do all this without anger, because anger is “counterproductive.” So, of course, is mental illness.

We expect people to conform to an ideal that includes emotional strength, confidence, and resilience, and we refuse to concede that few people are able to live up to this ideal all of the time. How much do we expect a person to bravely, stoically handle? I’m not sure there is a limit.

The DJs assumed, whether consciously or not, that Saldanha would either see through the prank or be able to deal with the international attention she would receive for falling victim to it. As it turned out, she was not.

At The Daily Beast, Kent Sepkowitz writes:

With the recent focus on bullying sparked by suicides of young people who were hectored as outcasts, a new or newly articulated risk factor for suicide has gained currency: humiliation. Though certainly related to hopelessness and to real or threatened financial embarrassment, humiliation is its own very private experience, with its own equally private triggers. How and why certain events might brutally transgress honor and dignity in one person yet the same events barely touch the next, remains inscrutable. In this particular tragedy, it seems a sense that she was being publicly ridiculed—humiliated—somehow pushed Ms. Saldanha over the edge, an edge previously defined and maintained by her tremendous pride in her work.

Why do we expect people to deal with public humiliation for our own entertainment?

I would hope that rather than limiting the discussion to what these particular DJs should or should not have done, we expand it to talk about the exploitation and degradation that modern media thrives on. That these DJs would even think to go through such trouble to obtain someone’s private medical information is ridiculous. That there is a market for that information is ridiculous. I’ve long believed that celebrity gossip is unethical, but when it sets off a chain of events that ends in a suicide, that becomes even more apparent to me.

Not only is it impossible to blame any individual person in this awful story, but to do so would be to miss the point. Something in our culture–in the ways we relate to each other and in the ways we expect each other to be strong–is broken.

If I absolutely had to lay blame on something, it would be that.

Who Is To Blame For A Suicide?

Save the People, Not the Boobies: The Ethics of Breast Cancer Awareness

Few ad campaigns make me as misanthropic as the breast cancer awareness ones I’ve been seeing at an especially high volume for the past month:

There’s also this video (NSFW).

I hate these campaigns for many reasons. First of all, they make breast cancer all about boobs. Yes, it has “breast” in the name, but reducing an illness as complex and life-shattering as breast cancer into a cutesy “save the boobies!” campaign seems callous and inappropriate.

I’m not sure everyone would even agree that the prospect of losing your breasts is the worst thing about breast cancer, and yet that’s what these campaigns almost universally target. It’s not the “boobies” or “ta-tas” that need to be saved–it’s the human beings who have breast cancer.

It’s even worse when the campaigns are created by and/or targeted at men and involve that hint-hint-nudge-nudge assumption that men should care about breast cancer because men love tits. Never mind that men can get breast cancer too, and never mind that men care about breast cancer not (just) because they care about boobs, but also because they care about their friends, girlfriends, wives, mothers, sisters, daughters, and etc. who might get breast cancer, or who already have.

Campaigns like these also completely ignore women who have chosen (or been forced to) undergo mastectomies. If breast cancer research and awareness is all about “saving the boobies,” does losing your breasts mean you’ve lost the fight?

This preoccupation with breasts is probably what inspires awful ads like this one by the Cancer Patients Aid Association, an Indian NGO:

The text at the bottom reads, “One out of every eight women develops breast cancer in her lifetime. Early detection helps recovery. Get yourself examined before it’s too late.” So there you have it. If you get a mastectomy, you’re “making yourself ugly.”

This is all to say nothing of Susan G. Komen for the Cure, the hypocrisy and reactionism of which should by now be well-known. (Incidentally, the former Komen executive who was responsible for that move was not content with merely that; she just had to write a book-length screed against Planned Parenthood, as well.) This unethical organization seems to be the beneficiary of most (if not all) of the sexualized ads I’ve seen. I still refuse to give them a single cent, which is difficult given how easy it is to accidentally pick up one of those pink-ribbon-branded products at the grocery store.

On the bright side, this is a great opportunity to explain what feminists mean when we prattle on about “objectification” and “sexualization,” which are closely related concepts that often (but not always) occur together. Objectification is the reduction of a person to their body parts (usually the sexual ones; hence the frequent co-occurence of objectification and sexualization). An advertisement that objectifies women might show, for instance, a single female leg in front of a flashy car, or a woman lying in a martini glass–literally like an object to be consumed. Sometimes men are objectified too, but that seems to be rarer. Ads that objectify people often don’t show their faces (or eyes), thus making them seem less like people and more like bodies.

Sexualization, meanwhile, is when a person (again, usually a woman) is represented in such a way as to arouse the viewer or otherwise connote sex when the actual purpose of the representation has nothing to do with sex at all. You wouldn’t call pornography “sexualization” because the purpose of pornography is to depict sexual acts and to be arousing. But when an advertisement designed to sell cars or alcohol–or solicit donations for breast cancer research–portrays women in a sexual way, that’s sexualization.

The objectification and sexualization of women in the media has a great deal of negative effects, both on an individual level–for the people who view them–and on a cultural level. Check out the work of Jean Kilbourne if that interests you.

However, I am not a marketing expert. If I were, and if I were charged with designing an ad campaign that elicits as much attention and donations for breast cancer research as possible, there’s a good chance I would feel compelled to create an ad like this, because there’s a good chance that this is the kind of ad that works best.

Hence the misanthropy I mentioned earlier. Marketing people know what they’re doing. If this is really the best way to get people to pay attention to this important cause, I would say that not using ads like these is even more unethical than using them–at least until we shift our culture enough that we don’t need them anymore. But that still means that we’re choosing the lesser of two evils. I would rather more money went to breast cancer research than less, but I would also rather we stopped reducing women to their erogenous zones in our media.

After all, I don’t agree with this rubbish that men are “programmed” or “hardwired” by biology to be obsessed with breasts, at least not to the level that our society seems to think they are. As I already discussed when I wrote about public breastfeeding, the sexualization of breasts is not universal to all cultures and time periods. Even if “sex sells,” breasts don’t necessarily have to always be part of “sex,” and I think it would be beneficial to our society if they were not.

For the record, whether straight men’s love of boobs is entirely biological or not, I don’t think there’s anything wrong with it, as long as it doesn’t infringe upon public policy or trivialize serious illnesses. Besides, you can totally be an awesome (male) feminist and a boob enthusiast at the same time.

Edit: Here’s a great article that basically makes my point for me.

Save the People, Not the Boobies: The Ethics of Breast Cancer Awareness

Abortion and Suicide: A Spurious Link

In South Dakota, it is now legal to require doctors to tell women seeking abortions that they are putting themselves at risk for suicide.

This move is brilliant from a PR standpoint. Unlike banning certain types of abortions entirely or, say, forcing women to undergo invasive screenings that are medically unnecessary, this seems completely apolitical when you first look at it. Don’t people deserve to be informed if they may be increasing their risk for suicide? Don’t we all agree that suicide is a Bad Thing?

However, something tells me that this is actually another attempt to scare women out of (what should be) a normal, socially acceptable medical procedure.

First of all, the inconvenient truth here is that credible research consistently shows little or no link between abortion and poor mental health. One 2008 study reviewed the literature and found that the only studies that seemed to show such a link had very flawed methodology, whereas the studies that were well-designed showed no links. (Damn liberal academics!) And here’s another study that showed no such links. And here’s a thorough debunking of a study that did claim such links:

Most egregiously, the study, by Priscilla Coleman and colleagues, did not distinguish between mental health outcomes that occurred before abortions and those that occurred afterward, but still claimed to show a causal link between abortion and mental disorders.

In other words, that study actually tried to use mental health pre-abortion to confirm a hypothesis about mental health post-abortion. This is simply not how you do science. And it’s especially bad here, because according to the American Psychological Association, guess what the best predictor of mental health post-abortion is?

Across studies, prior mental health emerged as the strongest predictor of postabortion mental health. Many of these same factors also predict negative psychological reactions to other types of stressful life events, including childbirth, and, hence, are not uniquely predictive of psychological responses following abortion.

That’s right. Shockingly enough, the best predictor of mental health is, well, past mental health. And poor mental health predicts poor response to all sorts of stressful events, of which abortion is only one example. Another one being, for instance, childbirth!

Compounding the bad science here is that, unlike physical side effects,suicide isn’t something that just happens to you suddenly and without warning. People don’t just suddenly wake up one morning and decide to kill themselves. Suicidality is a complex process that involves factors like genetics, family history, environment, social support, mental illness, and life circumstances. For instance, here are some things that, according to research, actually increase one’s statistical risk for suicide:

As you can probably surmise, not all of these correlations are also causations. While mental illness and drug addiction can actually cause suicidal behavior, being intelligent and being LGBT probably cannot. In the latter case, the causative culprit seems to be (surprise surprise) institutionalized discrimination and homophobia. Before I get too off-topic, let me point out the irony in the fact that, despite this well-known risk faced by LGBT youth, I don’t see any of these pro-lifers advocating for an end to homophobia.

That’s why something tells me that nothing about this court ruling actually has anything to do with suicide prevention.

Although the court’s ruling does at least acknowledge that abortion probably doesn’t cause suicide, it nevertheless states that “conclusive proof of causation is not required in order for the identification of a medical risk.” This is probably true, but it only makes sense from a physical health standpoint. If studies show that people who get a certain elective medical procedure are much more likely to, say, experience headaches or nausea or numbness, you don’t necessarily need a causative study to conclude that there’s a reasonable chance that these symptoms were caused by the procedure (assuming, of course, that there was no illness present that might be causing them). Furthermore, there’s a difference between saying “This procedure may cause you to experience cramps and headaches” and saying “This procedure may cause you to kill yourself.”

The truth is, mental health doesn’t work that way. A person who gets an abortion might experience mental side effects because of the stress of having gotten pregnant accidentally and been forced to decide what to do, perhaps without the support of a partner or family. Furthermore, any invasive medical procedure can be stressful and worrying for many people–especially one like abortion, which is consistently portrayed as more painful and dangerous than it really is.

And this is all made even more complicated by the fact that the faulty studies in question were actually studying mental health before the abortion. Perhaps a person with poor mental health is more likely to seek an abortion in the first place–say, if they feel that they aren’t mentally capable of raising a child at the moment.

Ultimately, decisions about what to tell a patient should be left up to the people who know most: doctors (with, of course, a reasonable amount of regulation to prevent malpractice). If a doctor can tell that a person seeking an abortion is going through a lot of mental distress, then that doctor may want to gently recommend counseling and perhaps give out some hotline numbers–and training doctors to recognize signs of mental health troubles is always a good thing.

But doctors should not be mandated to fearmonger to their patients. They should especially not be mandated to serve a pro-life agenda.

Abortion and Suicide: A Spurious Link

A Sacrifice They're Willing to Make: Mississippi's War on Abortion

The last remaining abortion clinic in Mississippi is perilously close to shutting down thanks to a new proposed law, Mississippi House Bill 1390. The law would require that all doctors performing abortions be board-certified in obstetrics and gynecology (reasonable), and that they also have admitting privileges at a local hospital (not so reasonable).

The reason that’s not so reasonable is because Jackson, Mississippi, home of the besieged abortion clinic, has two hospitals with Christian affiliations, and any hospital can refuse to grant admitting privileges to a physician for any ol’ reason, such as that said physician is a godless heathen who wants to help women murder their unborn fetuses babies.

To make it even better, the law would give the clinic’s physicians (all of whom are board-certified OB/GYNs but only one of whom has admitting privileges) less than two months to acquire them. As Evan McMurry writes at PoliticOlogy, “This is part of the pro-life’s recent death-by-a-thousand cuts tactic: if they can’t overturn Roe v Wade outright, they’ll make accessing and performing abortions so onerous that the practice will be effectively impossible.”

But of course, as it usually is with these laws, things get even more ridiculous. From the HuffPo article:

The State Senate voted to pass the bill Wednesday, but it was held for further debate on Thursday, when lawmakers had an odd exchange over the bill on the Senate floor. Sen. Kenny Wayne Jones (D-Canton) asked Sen. Dean Kirby (R-Pearl), who chairs the Senate Public Health Committee, whether ending abortions in the state would force women to resort to dangerous, back-alley abortions.

“That’s what we’re trying to stop here, the coat-hanger abortions,” Kirby replied, in reference to the abortions provided at the clinic in Jackson. “The purpose of this bill is to stop back-room abortions.”

Okay, first of all. No reputable doctor performs abortions with a coat hanger. In fact, I’m just going to go out on a limb and amend my statement to say, No doctor performs abortions with a coat hanger.

All of the physicians in question are board-certified in obstetrics and gynecology–a certification that I’m pretty sure Senator Dean Kirby does not have.

Incidentally, you know when dangerous abortions do actually happen? When abortion is made illegal. Research invariably shows this. (I know, I know, Republicans don’t believe in science anyway, but it was worth a shot.)

The truth is that making something illegal, especially if that thing is considered absolutely necessary by many people, does not mean it won’t happen anymore. It just means that it’ll happen out of sight, and therefore without regulation. This is why countries that are more progressive than ours are starting to experiment with drug decriminalization, but that’s a whole other topic.

Drug policy is a different ballgame because, while there are many psychological and societal factors that may lead people to become addicted to drugs, most of us can agree that nobody needs illegal drugs in order to have a decent life. Abortion is another matter, however. Unless conservative lawmakers are willing to provide comprehensive sex education and low-cost (or free) birth control (not to mention end sexual assault), there may not be a way to eliminate the need for abortion. For instance, from a comment on the HuffPo article I linked to:

I live in Mississippi. Yesterday I taught classes in the poorest part of the Delta to pregnant or parenting teens on parenting skills. I would much rather teach classes to teens about safe, effective birth control. The state won’t let me. It doesn’t matter how many facts or statistics I roll out…nobody listens. I am frustrated beyond belief.

So that’s what we’ve got.

Anyway, because politicians in states like Mississippi refuse to provide the resources to prevent abortion from becoming necessary, they must face the fact that women are going to get them whether they’re legal or not. But they don’t face this fact.

In the quote from Senator Kirby, which I provided above, he states that his purpose in making abortion unattainable in Mississippi is to prevent women from having dangerous abortions. So basically, his argument is this: we’re going to restrict women’s access to a safe, standard medical procedure in order to prevent them from obtaining the potentially dangerous, unregulated version of that procedure, despite the fact that restricting the safe thing actually leads to an increase in the use of the dangerous thing.

Kirby’s reasoning makes such a mockery of logic and common sense that I had to read the original quote several times before I understood it.

Mississippi’s Republican governor, Phil Bryant, had this to say about the proposed law: “This legislation is an important step in strengthening abortion regulations and protecting the health and safety of women. As governor, I will continue to work to make Mississippi abortion-free.”

Wait a minute. First he wants to merely “strengthen” abortion regulations. But then he says he wants to “make Mississippi abortion-free.” That should convince anyone who wasn’t already convinced that this law has absolutely nothing to do with making sure that abortions are performed safely. Rather, it has everything to do with making Mississippi “abortion-free.”

That’s right, he didn’t even try to pretend this was about women’s safety.

In my opinion, the fact that criminalizing abortion leads to dangerous back-alley abortions is the strongest argument for keeping abortion legal. It’s the strongest argument because it doesn’t lean on emotion or ideology. We can argue left and right about when life begins and when fetuses feel pain and whether or not women have the right to choose what to do with their bodies (hint: yes), but we cannot argue with the preponderance of evidence that shows that criminalizing abortion does not prevent abortion. It merely makes it dangerous.

Pro-lifers’ continued refusal to accept this argument says one or both of these things about them:

1. They are unwilling or incapable of accepting and understanding basic facts about economics and decision-making. That is, despite all the evidence showing the negative consequences of the criminalization of abortion, these politicians (and voters) continue to believe that banning abortion would plunge us all into Fun Happy No-Killing-Babies Land.

2. They understand these facts, but just don’t care. This is undoubtedly the worse alternative, because it means that the pain, injury, and even potential death that will come to women who try to obtain illegal abortions are, to borrow from Shrek‘s Lord Farquad, a sacrifice that Republicans are willing to make.

So, ignorance or malice? Take your pick.

A Sacrifice They're Willing to Make: Mississippi's War on Abortion

Obama the Patriarch

I usually stay away from commenting on Obama’s presidency because, to be honest, I was just a kid during all the previous presidencies I’ve lived through and really have no comparison to make.

However, a recent statement by Obama has caused me to come out of my apolitical cave and rage. After the FDA made a recommendation that Plan B One-Step, a form of emergency birth control that is available over the counter to anyone over 17, be available to girls under 17 without a prescription as well, Kathleen Sebelius, Obama’s secretary of health and human services, overruled the FDA’s recommendation. This is disappointing enough as is, but then Obama came out in support of her and said the following:

“I will say this, as the father of two daughters: I think it is important for us to make sure that we apply some common sense to various rules when it comes to over-the-counter medicine….And as I understand it, the reason Kathleen made this decision was she could not be confident that a 10-year-old or an 11-year-old going into a drugstore should be able — alongside bubble gum or batteries — be able to buy a medication that potentially, if not used properly, could end up having an adverse effect.  And I think most parents would probably feel the same way.”

As usual when I write about women’s issues, I literally don’t even know where to start with this. First, and perhaps most obviously, I don’t understand why we’re having all this conversation about 10- and 11-year-olds. The change would have applied to all girls under 17, and the majority of teenage girls who might need to buy Plan B are not 10 and 11. Try 15 and 16. If Obama and Sebelius are that concerned about 10- and 11-year-olds specifically, they could’ve asked the FDA to recommend allowing only girls 12 and over to get Plan B without a prescription.

Second, and also very tellingly, if the FDA has deemed Plan B safe for over-the-counter use, who are Sebelius and Obama to assume they know better? Sebelius has a BA in political science and an master’s in public administration; Obama has a BA in political science and a law degree. Unlike many cynics, I don’t necessarily doubt that these two have the knowledge and ability to perform their respective jobs, but I would not trust them over the doctors and researchers who staff the FDA when it comes to medical issues.

Third, Obama immediately reveals what this is really about when he says, “as the father of two daughters…” Understandably, Obama would be worried for his two daughters if they were ever in a position to need Plan B. However, for all of the battling that Obama has had to do with the Far Right of this country, he clearly doesn’t seem to realize that many girls don’t have daddies like Obama who would care for them, be able to afford doctors’ appointments, support their right to get an abortion, and guide them through a decision. For many girls, it would be a choice between obtaining Plan B on their own or being shamed, abused, disowned, and/or forced to carry a baby to term.

Finally, I’m disturbed by the ageist and patriarchal notion that young women are somehow incapable of making their own decisions about sexual health. Yes, children need and should have access to guidance from adults. In a perfect world, every girl would be able to go to her parents for help with something like this. But that’s not the world we live in, and we must make do accordingly. Not only has the FDA already determined that Plan B is safe, but, unlike many medications that are available over the counter to children, you can’t overdose on it or otherwise fuck it up–when you buy it, you only get one.

Furthermore, there are other ways to make sure young teens know what they’re doing when it comes to emergency birth control. For instance, mandate pharmacists to provide an option for girls to privately ask them questions about how to use Plan B. Pharmacists know a lot. Why not use them as a resource?

Much has been made of Obama’s failure (or lack thereof) to support women’s rights, and it’s a debate I don’t normally follow because one can really spin it either way. On this issue, however, I would argue that Obama has definitively failed to support women and girls. Instead, he has promoted the antiquated notion that beliefs trump science when it comes to reproductive rights.

Obama the Patriarch