Why don't neoliberals love public health?

[Updated in the text July 27].

“... I think this is an important question at issue!”

the former director-general for the Swedish National Institute of Public Health Gunnar Ågren writes in the last blogposting from his time at the National Institute of Public Health.

He thinks the first cut-off point is about whether you shall look upon health as a human right or as a commodity. If you see health as a human right this also implies an obligation to see so all get this right through common measures.

Unfortunately it becomes more and more common with a market-thinking around health where we buy more or less qualified achievements to improve our health in the same way as we, depending on income, can choose to buy shoes or shirts of different qualities and prize-levels.

The second cut-off point is about the view on the market and its ability to solve basic distribution problems and thus health problems too.

This is not a new discussion. Already in the childhood of industrialism dogmatic market advocates were inconsistent with prohibitions against child workers, industrial welfare (safety) and sanitary reforms because this would disturb the supply of labor.

Luckily there were sensible politicians, often influenced by a pressure from below, realizing that protecting laws and a better hygiene in fact was something that promoted both social and economic development.

Unfortunately the blind faith in market forces has come back in today's more globalized world, even though it has gotten a certain blow the last weeks (the financial crisis).

The National Institute of Public Health (in Sweden) is seen as a trade barrier or disturbing element in the market Ågren says.

Reform politics [today] is sometimes synonymous with lifting welfare and protection legislation away.

There is a blind faith in that (parts of) the market wealth shall trickle down on the poor and sick too.

As has become clear for instance by data presented in the Marmot Commission report there is no indication that this theory is right.

On the contrary the evidences for the opposite connection is valid.

Basic welfare, a good education system, basal health care and a good public health means that more people can work, leads to that the productivity increases and the international competitiveness increases.

The third and last cut-off point is about the individual contra the society and the state. A row of health risks lies beyond the individual's control and possibility to take responsibility for. Air pollution, poverty and income inequality are only a few examples on health risks lying beyond the individual's control.

The Institute of Public Health has been seen as something implying guardianship from authorities and something that deprives people from their possibilities taking responsibility for their own life and health.

My comment: But – this institute has never forced any individual to anything?? Maybe forced public authorities? Just come with advices to individuals to which they can take whatever attitude they want?

Ågren continues: Of course the ones representing the public health interest have nothing against that people are taking responsibility, on the contrary, this is praiseworthy (fantastic and something great) but there are limitations in possibilities for taking responsibility for the health.

My comment: Yes, there are things lying beyond individuals' possibilities, but there are also a lot of things we CAN do!!! Something I think Ågren agrees to too. As the Institute does.

And I also wonder, why are some people paralyzed in these respect? And why are some don't caring and taking all sorts of risks, even enormous, challenging risks? However I have my ideas about this.

What can we do about this? What shall we do about this? Shall we do something about this?

I don't think any of those attitudes are irreversible though. We aren't born in this way. We CAN recover from this (but sometimes with a lot of hard work and struggles - and pain). But the best would be if we could prevent them in the first place, by treating our kids with greatest respect! Listen to them and meet them respectfully.

In reality the break through for democracy in Sweden largely was about that representatives for non-governmental movements conquered seats in parliamentary congregations on local, regional and national levels and forced through social protection legislation, a restrictive alcohol policy, ban on child labor, basic industrial safety – mostly in opposition to those in power who used to refer to the individual's freedom because they in their privileged position didn't have any greater needs for protection laws.

How well said! How many with money and power in this world havent' been interested in NOT loosing their power position, even though they retorically speak about freedom? What would actual freedom be? Freedom of choice etc. be?

Ågren thinks that this antagonism still holds.

Just as well as there shall be individual freedom there shall also be rights to create a loyal society with the democracy as tool where people don't have to become exposed to unnecessary health risks and where all have the same rights to best possible health.

There is still a lot to do. Our era's great health risk is the unequal distribution of power, nature resources, access to health care, education, money and influence/ascendency, something we see globally AND in our own country and that deprive many human beings from many healthy years that could be used to pet cats, see grandchildren, read good books, grow roses or why not fight for social justice.

Yes, can all people do this in this world? Do all people have those choices? Does it always have with their lack of responsible taking to do? Or with things beyond the possibilities that are presented for them in the society where they live? Can all people do this in our own western societies ether? Who can and who can not, and why?

Ågren retired last fall and here is his farewell speech (in Swedish).

And here a blogposting by Ågren on "The Globalization Board – a neoliberal think tank.” About the Globalization Board.

Also read the article "Equality of What?" by the British researchers Richard Wilkinson and Kate Pickett and Paul Krugman in "Why markets can't cure healt Care."

Cynicism and moral…

We have been told (brainwashed with the propaganda) that all people are misusing the systems. The ones in the highest positions in the society have shown little or no moral or solidarity when there has been financial crisis the last almost two decades.

In many people this leads to resignedness and dejectedness:

“What can one do? You can’t do anything!”

This dejectedness in turn leads to cynicism in (too) many people.

“If all other people do, why shouldn’t I?”

and that’s bad and dangerous? How is this for the whole system and the world?

But from where does these feelings stem actually?

Is it the child’s hopelessness? The child’s feelings that it had no options? Feelings of powerless and helplessness? And the child didn’t have any options; it just HAD to find itself in her/his situation. But an adult usually have much more options. Some therapists for instance mean that we have options where we don’t believe we have (also see here about Past Reality Integration Therapy). But those feelings say something about our childhood and the helplessness then. Things we haven't gotten the opportunity or help to integrate.

In some people it just leads to dejectedness (a sort of paralysis and a feeling that it’s no idea trying to change anything, because everything is beyond my power) and in others to a cynicism:

“If other people, why can’t I…?”

People who are less harmed react differently? They act on things and do this in a more constructive and efficient way?

That "the power" is abusing its power (wherever it occurs) is no excuse for other people to do the same I think. Who shall set good examples? And that we have been abused once is no excuse either for us abusing other people or systems I think.

And this (strong) tendency in many people (because of their early history) is also used (quite cynically and deliberately) by propagandists walking the power's errands!? The phenomenon of polarizing and splitting people in dividing and ruling. Also something we were taught early in life by our parents probably, who used this method to make their children obedient and submissive.

Children’s and adults’ needs…

the first snow a couple of weeks ago.

Thought further after the former posting about raising methods...

What are the child’s needs? What needs does it have to get filled to develop as optimally as possible? That is to develop to a living human being. A human being capable of forming a life he/she wants that isn’t destructive or self-destructive.

Yes, a child needs more than food and shelter. It needs emotional safety, reassurances of different kinds… And emotional needs are essential for survival!

The needs that didn’t get filled early in life will cause bigger or smaller problems later in life. Either for the individual itself and/or for other people, the extent or scale of problems the individual causes depends on the power he/she gets. Many exercise power on a micro level and some on a macro (addition November 17: the latter on a micro too, because usually those people also have families).

And some are so paralyzed so they direct everything towards themselves in different ways.

But it is possible to recover and heal to an extent so you can live a deeply meaningful life – I am sure. However, a big problem is the societal denial; the lack of talk about those things, I would assert or maintain! And the denial not least about how common those things probably are to different degrees! AND HOW HARMFUL they in fact are! WHAT they are actually causing. But if you have been a living dead more or less your whole life, from earliest childhood, you don’t know what you are missing or lacking either. And you don’t know what you are forwarding either! And maybe you don't want to know what you are forwarding...

If more people started to admit to those things I think this would be the only help many people would need! But not the only help for all. But it would be a help for the most harmed too. And a few are so harmed so you maybe can’t help them at all? As some of the worst serial killers and alike?

And what would real, adult needs be? How many of us really know?

And once again it also struck me that people have to be allowed to express themselves with the language and words they have: that not only the "educated" with a perfect grammar are allowed to write or express themselves!!! Is this actually contempt for weakness, i.e, contempt for the small child you once were, who didn't have the words yet of natural reasons, but needed to express feelings and emotions in some way. And in what ways?

Some of us need to search for the words really when we try to write about and investigate those things... For some (or maybe many) it's difficult to put these things in words!?? But it can be very important we try nevertheless. And why do we care about people looking down on our struggles and our imperfectness??? To be honest...

Stress increases the risk for rheumatism...

Lars Alfredsson.

Yes, stress can cause different sorts of rheumatism, not only rheumatoid, but also for instance polymyalgia rheumatica, which a person near to me maybe has. A person probably suffering from longterm stress, and with a history of child abuse of different kinds. Abuse that is denied, or in parts recognized but considered having no real significance for this person's life, from that person herself, and probably many around her.

Thought of blogging about something I thought was interesting, from a Swedish site called Suntliv.nu. I want to start with relating to the content in the article:

Low control at work increases the risk for rheumatoid arthritis. A new Swedish study shows that the one who doesn’t decide over her/his work situation runs the risk of getting rheumatoid arthritis. It’s an endemic disease with over 50,000 people stricken by it in Sweden (with a population of 9 million people). Women are more often stricken than men.

“We have found clear connections between the disease and works where you can’t control your situation,”

the Swedish professor Lars Alfredsson says.

Other factors for getting ill are smoking and low education.

The researchers have also found some unexpected connections, namely between stress at work and rheumatoid arthritis.

The ones with low space for (own) decisions have a 60 % higher risk of being stricken.

The researchers also classified people in different professions after how low respective high control they have and compared people in professions with low control with people with high control concerning the risk of getting ill.

In that investigation they showed that it is 30 % higher risk for people in professions with low control to get ill.

Stress causes inflammation they mean and think it’s possible that stress makes inflammation come up.

Studies abroad has shown that the ones stricken with rheumatoid arthritis often have had a period of stress or experienced something revolutionary before the debut of the disease.

The researchers have also asked the participants about different sorts of stress and are now analyzing the connections between stress, results which are going to become presented later.

The study is also about interplay between inheritance and milieu.

My loud thinking around this article: I read this article after I had blogged about the young woman Veronika with rheumatoid arthritis whose psychiatrists didn’t believe her when she said she had been raped, and who showed to have been sexually abused as a child too.

I also came to think of two men I know of who got rheumatism as adults, one after a divorce in middle age and the other when he had passed 75 I think. The latter also got heart problems at the same time. I wonder over the latter and the relation he lives in and possible stress in that relation, a relation that easily could make you feel a little out of control?

The latter man was spanked as a child I think. Something he doesn’t seem to really question or view as wrong, or really rebel against. Something that was natural then and "what all parents did” because they "didn’t know better"?

I think I have read somewhere about connections between spanking and rheumatism too.

Thinking loudly, and trying to put something in words I am not really capable of putting in words yet. Being in a relation or maybe situation feeling a low control could also be a feeling that is fooling a person... Because he or she can actually have the power to leave it in may cases. But is feeling stuck and power and helpless, maybe even feels paralyzed (as the child ones was). Early feelings that are triggered in the present and feels so real so the person doesn’t see any alternatives, truly doesn’t see them. But those feelings stemming from early events in this persons life aren’t just to control. As we think we can. And are nothing to moralize over...

Summer reflections...

more pictures here.

Questioning and seeing things as wrong makes one less inclined to passing the same things forward. Realising that the treatment one received wasn’t deserved due to ones character.

A long time ago I had a piano-teacher who had severe problems with stage fright. So he started to study psychology on distance. He meant that bad self-confidence isn’t something inherited!

“I am that sort of person! That’s my character!”

The implications of that – which are they? There’s nothing I can do! I have to live with this! One push the responsibility away, doesn’t one? I can’t do anything! And adults between one perhaps can stand it? And help the other person overcoming this hopefully. But parent-child between how is this? Who has to take responsibility actually?

I am bad, wrong! I was and still am the guilty one for the bad treatment I received! I am to blame myself.

Oh, I get so tired.

What does this lead to??

There is a self-destructiveness I can get so furious at!!!

Totally paralyzed! Paralyzed by all guilt!

“To the ground bent!”

a mother used to say. The child(ren) felt extremely guilty!!?? Responsible! As if they should go in as counselors or therapists? And on top not add to that burdening!

I know of a girl, around 12 who had got measles. She got a slight ache in her joints (phalanxes) in connection with the disease. The girl was actually 13 because at this time we had switched from driving on the left side of the road to the right. Her mother should drive her to the nurse, and was so nervous so she almost drove in the ditch! So paralysed. So the child almost had to hold her mother’s hand, comforting and calming HER!!!

Addition in the evening: searching on the web I found this article “The Prize we pay for shaming little boys,” In this it stands for instance:

“Sulzer, in 1748, explains that humiliation of children is key to producing obedient citizens who are willing to submit to the laws and rules of reason once they are their own masters, since they are already accustomed not to act in accordance with their own will (Miller, 1990, p. 10). Dependence on authority plus the intense shaming of children produced the generation of Germans who obediently followed Hitler into the second World War and found their emotional release in carrying out its atrocities./…/

What surprised me most, though, was that the German people I have spoken with about this deliberate and immoral cruelty either do not know these facts or have only a hazy awareness of this period in German history. When I first attempted to discuss this with German colleagues and friends, I was bewildered by their reaction. These well educated and knowledgeable people knew nothing of these chapters in their own history. Generally, they expressed amazement, a hazy familiarity with the details or simply uncomfortable refusal to talk with me about what was clearly a forbidden subject./…/

The reluctance of Germans to ‘know about’ what was done to them after the fighting was over reminds me of those three little monkeys: See No Evil, Hear No Evil and Speak No Evil. In my twenty years as a psychotherapist treating survivors of childhood trauma, I am familiar with this tendency of those who were once helpless to minimize the impact abuse has had on their lives. It is the same with my abused clients who trivialize the beatings of their childhood, saying they deserved to be hit, that they were very bad children. People who have been traumatized tend to normalize their traumatic situations.

It is hard for humans to accept that they were powerless to protect themselves from deliberate mistreatment. They are much more likely to take the blame for having been abused. For example, people who have been sexually abused as children tend to blame themselves, at least unconsciously, for somehow causing the abuse by being too sexy or too bad. Part of therapy is to help them realistically assess what was done to them and to what degree they are responsible for the shame they feel. (Of course, children bear no actual responsibility for being abused.) A first step in healing, then, is to accept that you were hurt by the trauma./…/

How, Gilligan asks, can a person who does not experience any feelings himself know that others have feelings or be moved by the feelings of others./…/

Fathers' contempt for their sons produces men who believe they are worthless, who are hyper-vigilant to signs of disdain, who are defensively ready to attribute negative intent to others, and who find a quick fix for making themselves worthwhile by degrading those less powerful than themselves, such as their wives. They believe they can make themselves feel some worth by making someone else lower than themselves.

In Bierman's programme, therapeutic procedures based on Eugene Gendlin's Focusing enable the participants to work through their own remembered physical or emotional abuse. The men are encouraged to let their feelings happen, to resist telling themselves what they should feel and to stop judging their feelings. They are taught to quietly put their attention into the part of their body where they usually have their feelings. They are instructed to let go controlling and to simply follow what is happening inside. For most of us the physical sensation connected to a feeling occurs as a tight knot in the stomach, a choking in the throat or a heaviness in the chest. Bierman trains the men to pay attention to these physical body signals which provide a way into unconscious knowing (Gendlin, 1996)./…/

In the methods of schwarze pedagogik, the child never experiences hatred for the father. When it is not possible to admit and express hatred for a parent, the rage gets projected onto others. As with Ralph Bierman's battering men, those who are weak and vulnerable (the way the batterer was as a child) become targets for this pent up rage. The adult who is filled with rage and shame becomes the perpetrator making others feel the way he felt when he was helpless.

This shame/violence cycle clearly played itself out when Germans who had been traumatized in childhood took out their rage on Jews and others who reminded them of themselves when they were helpless children. They projected onto others all their own ‘bad’ qualities which they had never been able to accept in themselves. Jews became dirty, greedy schemers, plotting to overthrow the rightful authorities. Concentration camp guards had the perfect opportunity to restage their own childhood traumas. Prisoners were helpless to defend themselves or to escape.

Their captors, urged on by the state, indulged in humiliating defenseless Jews. In fact, every German's repetition compulsion seems to have found a place in the hierarchy of terror which characterized the Nazi period. Men who had once been shamed as children now had the opportunity to demand from others, the cadaver-like obedience their fathers had exacted. They, in turn, gave automatic, unthinking obedience to their masters in The Third Reich's hierarchy of terror./…/

This paper deals with shaming in the childhood of Germans. But this is not specifically a German problem. It is a problem throughout the world. It is my hope that once we better understand the underlying causes of violence, we will be able to find some solutions.

How do we protect little boys from being shamed and abused by their fathers? This is a generational problem. It is self-perpetuating. Men who have been abused and shamed by their fathers tend to shame and abuse their small boys. As a society, we must find ways of cutting into this cycle of abuse where fathers humiliate their boys and passive mothers stand by without interfering on behalf of the children. But before we will be able to do this, we will have to accept whatever we ourselves experienced as children, as well as the ways in which we act out of our own traumatic experience.”

See this with “Evilness and responsibility…”; how badly we even became treated this is no excuse for what we do, how we behave, “Evilness and violence…” and “Anger, outbursts…” And postings on the label manipulation.

Hysteria…

Jean Martin Charcot.

Peter Währborg also writes about hysteria in his book (a book which is in Swedish, so the text below is my amateur translation and interpretation of his text), at page 87-88 in a chapter called “Neocortical stress reactions.”

He writes that stress influences the behaviour. Memory, concentration, attention and other neuropsychological functions deteriorate during stress. During severe stress an even more pronounced reduction of higher mental and cortical functions can occur. This state has been described by Jean Martin Charcot (also see here about him) in the end of the nineteenth century and fascinated one of his visitors, namely Sigmund Freud.

This state is called hysteria. Wärhborg writes that it is a state whose physiology is almost unknown. It can be described as a sort of mental “playing dead reaction” (apparent death).where an active as well as a passive symptomatology can appear. In the former case symptoms like paralysis (förlamning), dumbness (stumhet), disequilibrium (balansrubbning) and vomiting appear. Passive symptoms are reduced feelings (nedsatt känsel), blindness, deafness, tunnel vision, failing off of smell (bortfall av lukten) and insensitiveness for pain. Characterized by what the French psychologist and prominent pupil to Charcot, Pierre Janet, once described as “la belle indifference.”

Easily influenced (påverkbarhet) without critical thinking, i.e., suggestibility and earlier occurrence (förekomst) of similar episodes are other important clues to this diagnosis.

Hysteria is characterized by a symptom-picture which is nearly related to the neocortical function. Often these symptoms appear swift as a lightning, not seldom in connection with a trauma for which the individual is lacking strategies handling. One can always discuss if hysteria shall be seen as a stress related syndrome he writes.

Judith Lewis Herman writes about hysteria, Charcot and Freud in her book "Trauma and Recovery - From Domestic Violence to Political Terror", see for instance the chapter “A Forgotten History.”

It starts with (page 7):

“The study of psychological trauma has a curious history – one of episodic amnesia. Periods of active investigation have alternated with periods of oblivion. Repeatedly in the past century, similar lines of inquiry have been taken up and abruptly abandoned, only to be discovered much later. Classic documents of fifty or one hundred years ago often read like contemporary works. Though this field has in fact an abundant and rich tradition, it has been periodically forgotten and must be periodically reclaimed.”

And I wonder if the drive theory can occur in other clothing during history too? More or less disguised? Even today? All sorts of ideas about what is driving people... Ideas that are defences rather?

A boss said:

"You are flexible [extremely stretchable??], innovative, don’t get stuck in a problem but try to see/seek solutions, you take own initiatives, are working independently… You have a broad ground to stand on."

Phew...

Feelings of help/powerlessness...

I ought to do other things than writing... I am going to be at work the whole afternoon. Need to practice myself... Too.

But have thought about the topic help/powerlessness...

What are those feelings about? Are they the child's feelings once? From a state when the adult WAS power/helpless?? And she (he) takes this with her/him into adult life... And this feeling (reaction) is expressed (especially) in certain circumstances?

I am thinking both about grown ups feeling incapable of doing anything! Paralyzed (mentally) and totally helpless. I can't do anything... etc. And thinking that

"It's my character! (I can't do anything)"

But from where do these feelings (maybe or most probably) origin from? From the small child, who was badly treated, maybe even very badly treated?? Laughed at, scorned, shouted at, treated "violently", maybe even sexually abused (or "at least" improperly touched) etc. etc. etc.

Truths one don't want to admit to? Truths about ones own parents!?? How they actually were, how it actually was!!??

These things are also shown on a societal level? People thinking it's no idea at all to try to influence!! For instance by voting in elections!! Mistrusting politicians. But this is horrible!!

Where do this lead?

A certain sort of people goes on voting, and the ones still voting are to a high degree those voting on extreme parties (nationalist, "xenophobic" parties)???

So where has this child abuse led?? People paralyzed? Thinking they have no power?? Not capable of intervening? On any level maybe? Not even on a familial, by protecting weaker for instance? Incapable of leaving abusive relations? etc. etc. etc.

But were we born this way? So incapable of doing something, of acting, reacting??

Yes, the parents were complete, perfect?? In difference to ones children? Even to ones now grown up children struggling to deal with their own!!!?? They are much less complete than the old and dead parents were or ever became? They were angels, or??? And what they did one can belittle and minimize in comparison to how one treats and handle ones grown up children's misses, and imperfection!?? Because the difference is enormous?? Ones own children are shit compared to ones parents?? Sacrificing ones own children on the altar of -what? (but of course these children are now grown up, and thus they have responsibility for their own stuff).

Some (maybe not so few?) in power uses this (both unconsciously and consciously, and also deliberately)?? For instance in politics! Playing on this? Relying on this? Even using this with no scruples??

Yes, Naomi Klein is right: Information (and a greater and greater awareness of these facts, about the roots to those things, the simple answers??) are shock resistance?? And hopefully also a protection against abuse, even abuse on a political level??

And have a long way to go still myself... I don't say I handle this good... I struggle with these things myself...

Addition: and it is always possible to find people who have had it worse, so when am I entitled to complain??

And I am also very critical to the help that is offered; you are (only) learned to cope and/or to change a dysfunctional behavior to a functional... Because it is still forbidden to question ones parents?? And I came to think about what Jenson wrote about Dan... He wasn't capable of stopping from following a woman (compulsively) that had abused him when he saw her until he got access to things in his early history thanks to a good therapy? After that he had no problems at all when he met this woman!

And I know of a woman aware that her mother pulled her kids hair, and that she got severely spanked, but these memories hasn't changed anything? She can talk about this, but with few emotions connected!?? No rebellion or real questioning what her mother did. And probably no realization how this felt actually?? The rage (etc.) that would have been adequate?? (and did the father protect his kids against this???).

Because it isn't only about remembering?? You have to be helped to see it as wrong and to question it!!?? Yes, maybe even get permission doing this?? By a helper, expert!?? Realizing it wasn't your fault, you didn't deserve it. And question what this actually was supposed to teach one? And what one learned from this actually and what t has led to, all the possible consequences?? But this is probably extremely painful...

And I also know of man reacting at his own father who humiliated his children in front of other on one (or a few) occasions, but this realization didn't protect this father from doing the same thins with his own kids later!!??

So pure memories aren't enough?

Today the knowledge exists that perhaps didn't exist then... And all has those options! Even (old) parents...

"But it happened so long ago! I have went on with my life!!"

To avoid the feelings of vulnerability one can use anger or deny ones needs... And thus get a sense of power. A power one maybe don't need to exercise or demonstrate today!? Because today one has the power one didn't have then. Knowing what is what: what my anger is about... That's the problem... So it is used more productively... Because of course there are reasons today to get angry - too!! But if I am acting on something pas it's risk I behave destructively or self-destructively!?? And in a way that gains noone and even can become harmful??

Denying ones needs is also so sad and maybe even tragic many times? Trying to fill ones childhood needs instead of ones grown up needs!?? How much hasn't that costed? And still costs?

Help/powerlessness is about the past usually?? Except for extreme circumstances??