From childhood, we are told that patience is a virtue and that good things will come to those who wait. And, so, many of us work on cultivating patience.

This often starts by learning to wait for a turn with a coveted toy. As adults, it becomes trying to remain patient with long lines at the Department of Motor Vehicles, misbehaving kids or the slow pace of political change. This hard work can have mental health benefits. It is even correlated with per capita income and productivity.

But it is also about trying to become a good person.

It’s clear to me, as a scholar of religious ethics, that patience is a term many of us use, but we all could benefit from understanding its meaning a little better.

In religious traditions, patience is more than waiting, or even more than enduring a hardship. But what is that “more,” and how does being patient make us better people?

The writings of medieval Islamic thinker Abu Hamid al-Ghazali can give us insights or help us understand why we need to practice patience – and also when not to be patient.

Who was al-Ghazali?

Born in Iran in 1058, al-Ghazali was widely respected as a jurist, philosopher and theologian. He traveled to places as far as Baghdad and Jerusalem to defend Islam and argued there was no contradiction between reason and revelation. More specifically, he was well known for reconciling Aristotle’s philosophy, which he likely read in Arabic translation, with Islamic theology.

Al-Ghazali was a prolific writer, and one of his most important works – “Revival of the Religious Sciences,” or the “Iḥyāʾ ʿulūm al-dīn” – provides a practical guide for living an ethical Muslim life.

This work is composed of 40 volumes in total, divided into four parts of 10 books each. Part 1 deals with Islamic rituals; Part 2, local customs; Part 3, vices to be avoided; and Part 4, virtues one should strive for. Al-Ghazali’s discussion of patience comes in Volume 32 of Part 4, “On Patience and Thankfulness,” or the “Kitāb al-sabr waʾl-shukr.”

He describes patience as a fundamental human characteristic that is crucial to achieving value-driven goals, and he provides a caveat for when impatience is called for.

1. What is patience?

Humans, according to al-Ghazali, have competing impulses: the impulse of religion, or “bāʿith al-dīn,” and the impulse of desire, or “bāʿith al-hawā.”

Life is a struggle between these two impulses, which he describes with the metaphor of a battle: “Support for the religious impulse comes from the angels reinforcing the troops of God, while support for the impulse of desire comes from the devils reinforcing the enemies of God.”

The amount of patience we have is what decides who wins the battle. As al-Ghazali puts it, “If a man remains steadfast until the religious impulse conquers … then the troops of God are victorious and he joins the troops of the patient. But if he slackens and weakens until appetite overcomes him … he joins the followers of the devils.” In other words, for al-Ghazali, patience is the deciding factor of whether we are living up to our full human potential to live ethically.

2. Patience, values and goals

Patience is also necessary for being a good Muslim, in al-Ghazali’s view. But his understanding of how patience works rests on a theory of ethics and can be applied outside of his explicitly Islamic worldview.

It all starts with commitments to core values. For a Muslim like al-Ghazali, those values are informed by the Islamic tradition and community, or “umma,” and include things like justice and mercy. These specific values might be universally applicable. Or you might also have another set of values that are important to you. Perhaps a commitment to social justice, or being a good friend, or not lying.

“Nizamiyyah University Nishapur,” Digital imagining, Dall-E, 2024.

Living in a way that is consistent with these core values is what the moral life is all about. And patience, according to al-Ghazali, is how we consistently make sure our actions serve this purpose.

That means patience is not just enduring the pain of a toddler’s temper tantrum. It is enduring that pain with a goal in mind. The successful application of patience is measured not by how much pain we endure but by our progress toward a specific goal, such as raising a healthy and happy child who can eventually regulate their emotions.

In al-Ghazali’s understanding of patience, we all need it in order to remain committed to our core principles and ideas when things aren’t going our way.

3. When impatience is called for

One critique of the idea of patience is that it can lead to inaction or be used to silence justified complaints. For instance, scholar of Africana studies Julius Fleming argues in his book “Black Patience” for the importance of a “radical refusal to wait” under conditions of systemic racism. Certainly, there are forms of injustice and suffering in the world that we should not calmly endure.

Despite his commitment to the importance of patience to a moral life, al-Ghazali makes room for impatience as well. He writes, “One is forbidden to be patient with harm (that is) forbidden; for example, to have one’s hand cut off or to witness the cutting off of the hand of a son and to remain silent.”

These are examples of harms to oneself or to loved ones. But could the necessity for impatience be extended to social harms, such as systemic racism or poverty? And as Quranic studies scholars Ahmad Ismail and Ahmad Solahuddin have argued, true patience sometimes necessitates action.

As al-Ghazali writes, “Just because patience is half of faith, do not imagine that it is all commendable; what is intended are specific kinds of patience.”

To sum up, not all patience is good; only patience that is in service of righteous goals is key to the ethical life. The question of which goals are righteous is one we must all answer for ourselves.

Liz Bucar, Professor of Philosophy and Religion, Northeastern University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What struck me in their report is how unhappy the Middle East is. The only Middle Eastern country in the top twenty is Kuwait (for the first time in this cycle). Kuwait has oil wealth and is a compact country with lots of social interaction. The high score may reflect Kuwait’s lively labor movement. That sort of movement isn’t allowed in the other Gulf States. The United Arab Emirates came in at 22, and Saudi Arabia at 28.

These countries are all very wealthy and their people are very social and connected to clans and other group identities, including religious congregations.

But everyone else in the Middle East is way down the list.

As usual, Gallup found that the very happiest countries were Scandinavian lands shaped by social democratic policies. It turns out that a government safety net of the sort the Republican Party wants to get rid of actually is key to making people happy.

Finland, Denmark, Iceland, Sweden take the top four spots. Israel, which also has a Labor socialist founding framework, is fifth. The Netherlands, Norway, Switzerland and Luxembourg fill out the top nine.

The Gallup researchers believe that a few major considerations affect well-being or happiness. They note, “Social interactions of all kinds … add to happiness, in addition to their effects flowing through increases in social support and reductions in loneliness.” My brief experience of being in Australia suggests to me that they are indeed very social and likely not very lonely on the whole. Positive emotions also equate to well-being and are much more important in determining it than negative emotions. The positive emotions include joy, gratitude, serenity, hope, pride, amusement, inspiration, awe, and altruism, among others.

Benevolence, doing good to others, also adds to well-being. Interestingly, the Gallup researchers find that benevolence increased in COVID and its aftermath across the board.

They also factor in GDP per capita, that is, how poor or wealthy people are.

Gallup Video: “2024 World Happiness Report; Gallup CEO Jon Clifton”

Bahrain comes in at 62, which shows that oil wealth isn’t everything. It is deeply divided between a Sunni elite and a Shiite majority population, and that sectarian tension likely explains why it isn’t as happy as Kuwait. Kuwait is between a sixth and a third Shiite and also has a Sunni elite, but the Shiites are relatively well treated and the Emir depends on them to offset the power of Sunni fundamentalists. So it isn’t just sectarian difference that affects happiness but the way in which the rulers deal with it.

Libya, which is more or less a failed state after the people rose up to overthrow dictator Moammar Gaddafi, nevertheless comes in at 66. There is some oil wealth when the militias allow its export, and despite the east-west political divide, people are able to live full lives in cities like Benghazi and Tripoli. Maybe the overhang of getting rid of a hated dictator is still a source of happiness for them.

Algeria, a dictatorship and oil state, is 85. The petroleum wealth is not as great as in the Gulf by any means, and is monopolized by the country’s elite.

Iraq, an oil state, is 92. Like Bahrain, it suffers from ethnic and sectarian divides. It is something of a failed state after the American overthrow of its government.

Iran, another oil state, is 100. Its petroleum sales are interfered with by the US except with regard to China, so its income is much more limited than other Gulf oil states. The government is dictatorial and young people seem impatient with its attempt to regiment their lives, as witnessed in the recent anti-veiling protests.

The State of Palestine is 103, which is actually not bad given that they are deeply unhappy with being occupied by Israel. This ranking certainly plummeted after the current Israeli total war on Gaza began.

Morocco is 107. It is relatively poor, in fact poorer than some countries that rank themselves much lower on the happiness scale.

Tunisia is one of the wealthier countries in Africa and much better off than Morocco, but it comes in at 115. In the past few years all the democratic gains made during and after the Arab Spring have been reversed by horrid dictator Qais Saied. People seem to be pretty unhappy at now living in a seedy police state.

Jordan is both poor and undemocratic, and is ranked 125.

Egypt is desperately poor and its government since 2014 has been a military junta in business suits that brooks not the slightest dissent. It is 127. The hopes of the Arab Spring are now ashes.

Yemen is 133. One of the poorest countries in the world, it suffered from being attacked by Saudi Arabia and the United Arab Emirates from 2015 until 2021. So it is war torn and poverty-stricken.

Lebanon ranks almost at the bottom at 142. Its economy is better than Yemen’s but its government is hopelessly corrupt and its negligence caused the country’s major port to be blown up, plunging the country into economic crisis. It is wracked by sectarianism. If hope is a major positive emotion that leads to feelings of happiness, it is in short supply there.

Some countries are too much of a basket case to be included, like Syria, where I expect people are pretty miserable after the civil war. Likewise Sudan, which is now in civil strife and where hundreds of thousands may starve.

Poverty, dictatorship, disappointment in political setbacks, and sectarianism all seem to play a part in making the Middle East miserable. The role of the United States in supporting the dictatorships in Egypt and elsewhere, or in supporting wars, has been sinister and certainly has added significantly to the misery. For no group in the region is this more true than for the Palestinians.

Auburn, Al. (Special to Informed Comment) – Peter Attia, M.D. received his medical degree from Stanford University School of Medicine and trained at John Hopkins Hospital in General Surgery and worked at the NIH as a surgical oncology fellow at the National Cancer Institute focusing on immune-based therapies for melanoma. Bill Gifford, a veteran journalist, authored the N.Y. Times bestseller Spring Chicken: Stay Young Forever (or Die Trying). Each of us will one day die. There are two aspects to longevity: first, your chronological lifespan and two, your “healthspan” or how well you live. Most people die as result or effect of the “Four Horsemen,” or chronic diseases, viz., heart disease, cancer, neurogenerative disease (or type 2 diabetes) and related metabolic dysfunction.

Peter Attia (P.) argues that there are three periods or eras in medical history. Medicine 1.0 lasted two thousand years after the death of Hippocrates and dealt with observation and guesswork. Medicine 2.0 has seen its finest hour with fighting COVID-19 yet has made meager progress against what P. names the four Horsemen (heart disease, cancer, metabolic dysfunction, and metabolic syndrome including diabetes and neurodegenerative diseases like Alzheimer’s). Medicine 3.0 suggests that we have an early screening for various diseases. For example, we need to deal with cancer on three fronts: early prevention, more defective and targeted treatments, and accurate and comprehensive detection. The problem is this: we know very little about how cancer begins and why it spreads. In sum, cancer is not one, simple disease, but a condition with “mind-boggling complexity.”  Yet, despite hundreds of billions of dollars spent on research on cancer, death rates have barely moved. We are intervening at the wrong point in time, i.e., well after the disease has progressed. Most diseases have been in our body for several years before they have been detected.  

The main question in this book is this: how can we reduce our risk for disease and death, plus upgrading the quality of our lives as we age? In evaluating new patients, P. asks these basic questions: do we take in too many or two few calories? Are we adequately muscled or under muscled? Are we metabolically healthy or not? If we want to live a long life, we need a tactical plan. P. suggests these five dimensions: exercise, nutrition or diet, sleep, techniques to improve our emotional health, and various supplements, drugs, and hormones or molecules we take in from outside our body. Limitations of space allow me to speak to only three of these dimensions, viz., exercise, nutrition and sleep.

Exercise has the greatest power to determine how one will live out the rest of one’s life. Why so? Exercise retards the onset of chronic diseases, reverses physical decline, gives one more energy, and reverses cognitive decline. Doctors measure cardio-respiratory fitness in terms of VO2 max which is the maximum rate at which one uses oxygen. The good news is this: VO2 max can be increased by training. It’s especially important to strengthen one’s muscles. As a diabetic, I lift weights at the gym four times a week. I also walk vigorously seven days a week and avoid sugar and avoid eating pasta, rice, and heavy carbs. I take no medicine to control my diabetes. The last time I checked my HbA1C score was 5.9. At age 82, I can do twenty-five pushups and can walk with a forty-pound dumbbell in each hand for five minutes. Exercise acts like a drug in that it tells one’s body to produce its own endogenous drug like chemicals. Having strong muscles delays death because it preserves “healthspan” (or the quality of one’s life), as opposed to one’s life span.

Peter Attia with Bill Gifford, OUTLIVE: THE SCIENCE & ART OF LONGEVITY, (New York: Harmony Books, 2023). Click here.

Nutrition has several easy rules. One must eat essential fats, obtain the vitamins and minerals one needs, avoid fructose heavy foods (that likely cause blood- glucose spikes), eat fish, cut down on calories, and avoid pathogens like E. coli and toxins like lead or mercury. No dose of alcohol is healthy; hence I drink one or two bottles of Budweiser Zero Alcohol daily. One should also eat 50 grams of fiber each day. Foods high in protein like eggs have no effect on blood sugar. There’s no one diet for everyone. It depends on one’s health and one’s individual needs. Excess calories contribute to heart disease, cancer, metabolic disorders like diabetes, and Alzheimer’s disease.

Sleep is undoubtedly the best medicine for one’s brain. Our brain works well when we are unconscious as we process memories, thoughts and emotions, hence dreams. Sleep influences one’s memory, cognitive function, and emotional equilibrium. Sleep also staves off Alzheimer’s disease. P. suggests we sleep between seven and a half to eight- and one-half hours a night. One night of bad sleep has a negative effect on our physical and cognitive performance and wreaks havoc on our metabolism. Sleep deprivation increases insulin resistance by up to a third. Higher stress levels make us sleep poorly and cause glucose to be released from the liver. Less than six hours of sleep is associated with a 20 percent higher risk of a heart attack. Chronic bad sleep causes dementia and Alzheimer’s disease. P. notes that alcohol impairs sleep quality more than any other factor. Trazadone works well to help one sleep. The exact dose depends on the individual. Fifty milligrams or even less improves one’s sleep quality without grogginess the next day.

In sum, I give high marks to this study by P. He gives us forty pages of references and a helpful index. In sum, this book took my breath away. Highly recommended!

A Grand Jury empaneled by Special Prosecutor Jack Smith has issued an indictment (full text here) against Donald John Trump on four counts,

Smith delivered a statement, saying, “Today, an indictment was unsealed charging Donald J. Trump with conspiring to defraud the United States, conspiring to disenfranchise voters, and conspiring and attempting to obstruct an official proceeding. The indictment was issued by a grand jury of citizens here in the District of Columbia and sets forth the crimes charged in detail. I encourage everyone to read it in full.”

This indictment follows a federal indictment for mishandling classified documents and an indictment by the Manhattan district attorney on election fraud involving the payment of hush money to a porn star and a Playboy model to prevent voters from learning about his simultaneous affairs with the two women while his wife Melania was pregnant with their son Barron.

Although the four charges are specific, the over-all implication of the most recent indictment is that Trump set in motion complex machinery in order to overthrow the lawfully elected government of the United States, the first time a US president has behaved this way. Who else wanted to see the US government fall? King George III, Jefferson Davis, Adolf Hitler. Trump joins this rogue’s gallery. Smith’s indictment goes into the details of a meticulous plot to prevent the electoral college from voting Joe Biden in and to prevent Congress from certifying the win, which involved setting up fake electors, pressuring state ballot counters, threatening Vice President Mike Pence, and encouraging an armed insurrection at the Capitol.

I wrote in early 2017 even before Trump was inaugurated about the dangers I saw of his sort of personality assuming the presidency, and it seems to me that I was prescient. In the light of this indictment it is worth revisiting my thoughts in that essay, in which I may have coined the term “psychopathocracy.” Now you see what I meant:

“We are now on the brink of a new form of government, undreamed of by Aristotle, who spoke of monarchy, aristocracy and democracy. We are headed to a psychopathocracy, which has something in common with the degraded form of classical regime types that Aristotle warned against (he thought monarchy can deteriorate into despotism, aristocracy into oligarchy, and democracy into demagoguery). Psychopathocracy is the rule of persons who lack a basic ability to empathize with others, to feel their pain or to feel guilty about harming them.

“Psychopathocracy is different from mere bad policy. We can all disagree about the direction of government or particular initiatives. Often people backing a policy that harms others do not understand the harm, or think it is averting a greater harm. It isn’t true that all high politicians are psychopaths who don’t care about injury being done to people. And high politicians have put in programs like social security that have lifted millions of elders out of poverty over decades. They did it because they cared about people.

“About 1% of the population is comprised of born psychopaths. The condition of a lack of conscience and inability to empathize with the pain of others or feel remorse may well be a condition one is born with, and in a third of cases can be tested for with an MRI scan. It is thought that another 5 percent of the population loses its ability to empathize through brain damage, trauma or other sorts of physical or psychological injuries.

“It is further thought that about 12% of the population is easily manipulated by psychopaths into pyschopath-like behavior or ideas. This 18% of the population is potentially extremely dangerous. They do not have a feedback loop for emotional or physical distress. They are the sort of people who would run somebody over and flee the scene without calling for medical help for the victim.

“Psychopaths in power are dangerous because of their inability to feel the pain of others. George W. Bush and Dick Cheney set of a chain of events in motion that left hundreds of thousands of Iraqis dead, and they displaced from their homes (i.e. made homeless) 4 million of Iraq’s then 30 million people. This is not to mention the 4,486 Us troops killed the 500,000 wounded physically or psychologically). They set up a chain of events that led to a dangerous cult, Daesh (ISIS, ISIL) taking over 40% of Iraqi territory. But if you ask them if they regret what they did, they so ‘no.’ And I think they are being honest. They cannot empathize with the victims they helped create.

“Politicians who want to deprive people of their health care so as to lower taxes on billionaires, who want to make women bear the babies of their rapists, who want to torture helpless prisoners, who want to burn fossil fuels for profit when they endanger the planet, who want to carpet bomb or nuke millions of non-combatants to get at a few guerrillas– these are psychopaths.

“Psychopaths are not necessarily criminal or violent, though there are four times as many psychopaths in prison as in the general population. All serial killers are psychopaths. Fraudsters like Bernie Madoff are psychopaths.

“CEOs of corporations and successful politicians are also disproportionately likely to be psychopaths. Robert Hare developed a 20-point checklist for the condition, which, however, does not exactly overlap with the definition in DSM-V, the description of mental conditions put out by the American Psychiatric Association. Hare did some of his research in prisons and so his checklist is skewed a bit for criminal activity.

“You don’t need to be a psychologist to recognize that Donald J. Trump and several nominees to his incoming administration exhibit obvious signs of psychopathy. Having psychopaths in the White House is not unprecedented. It seems pretty obvious that Dick Nixon, a pathological liar who actually derailed the 1968 peace negotiations with Vietnam to keep his rival Hubert Humphrey from looking good to the voters, had this condition. Untold American soldiers and Vietnamese peasants died so Nixon could be president.

“What is remarkable about Trump and his cronies is that their hatred is raw and broad-spectrum. Mexican-Americans, African-Americans, Muslim-Americans, white liberals (coded by the Neo-Nazis as N-lovers) and some of them don’t like Jews very much. That is, they seem to hate an absolute majority of the American population.

“Trump’s psychopathy is evident in his exaggerated estimation of himself, his need constantly to troll the public for stimulation, his superficial charm, his need to lie, his inability to feel remorse or guilt, his emotional shallowness, his promiscuity and lack of impulse control and serial sexual assault, his use of bankruptcy to avoid paying his creditors and his attraction to a business like casinos which preys on people (many games in casinos are skewed for the House at rates of 11% and on up even to 20%). Trump is more disciplined and single-minded about his career than most psychopaths manage, but otherwise he seems a classic case. He also suffers from a distinct but related condition, of narcissistic personality disorder.

“Many of the people around Trump, who speak for him on television, who are tapped to advise him on national security, on the environment, on issues like net neutrality, also exhibit clear signs of psychopathy. Since only about 3 million Americans are born psychopaths, the idea that a whole group of them is moving into power in Washington together is pretty scary. And remember that some 38 million Americans are so ethically and emotionally fragile that they will easily fall under the spell of the psychopaths. That is, if directed to beat up members of minorities, they will gladly do so.

“Since about a third of psychopaths can now be diagnosed with an MRI for brain abnormalities, maybe it is desirable that candidates for high office in business and government be scanned: Psychcentral writes, a “study found that [cold-blooded psychopathic] offenders displayed significantly reduced grey matter volumes in the anterior rostral prefrontal cortex and temporal poles compared to [impulsive psychopathic] offenders and healthy non-offenders.”

“Until such scanning can be carried out, the safest thing is to assume that someone who talks and acts like a psychopath is one.

“You cannot reason with a psychopath, you cannot shame such a person or appeal to their better instincts. There is no point in writing open letters to them. The usual way of dealing with politicians who develop some wild ideas in the course of their search for voters and campaign funds will not work.

“The only thing you can do is recognize their damaged character and try to protect yourself and others from it. When they encourage minorities to be beaten up, we have to stop that. When they encourage universities to put professors on trial, we have to reject that. When they begin beating drums for war, we have to try to avert it. Pressuring the normal people in Congress can be done (they responded quickly to angry telephone calls about plans to weaken ethics requirements for people in congress).”

And don’t forget that those figures include dead and wounded Americans, too. Most of us, however, have little awareness of any of this. If you live outside the archipelago of American military bases that extends across this country and the planet — an estimated 750 of them outside the U.S. on every continent except Antarctica — it’s easy enough not to meet stressed-out military service members and their families. It’s easy enough, in fact, not to grasp just how America’s wars of this century rippled out to touch military communities.

In recent times, those bases have become ever more difficult for the public to enter and often aren’t close to the cities where so many of us live. All of this means that, if you’re a civilian, the odds are you haven’t met the grieving spouses of the soldiers who never came home or the shaken children of the ones who did, forever changed, sometimes with amputated limbs or post-traumatic stress disorder (PTSD). I’m thinking of the ones with those far-off gazes and the pain they have to deal with in their heads, their limbs, their backs.

Personally, I find it overwhelmingly hard to write about such human-shaped holes in our disturbed world. That’s probably why the Costs of War Project has a 35-person (and counting) team of journalists, physicians, social scientists, and other experts to portion out the research and the pain that goes with it as they deal with the fact that the monumental death and injury counts they’ve produced are likely to be underestimates.

As I write this, my chest tightens and my breath gets short, reminding me that some realities are impossible to contemplate without a physical reaction. And I begin to understand why so many Americans, including those not in the military — an estimated 50 million in fact! — experience chronic pain. New York Times columnist Nicholas Kristof is writing a stunning series of pieces reporting on what many in the public-health world term “diseases of despair” like depression, suicidality, and addiction. A significant portion of those Americans don’t have injuries that are detectable via X-rays, CT scans, MRIs, or the like. Often, pain is linked with major depression, other symptoms of PTSD, or anxiety. Something is happening in the minds of Americans that’s not easily traceable in the body because its causes may lie in our wider world. 

The Costs of War on the Homefront

Know one thing: in the U.S., so many of us do feel the painful results of our disastrous distant wars of this century, whether we know it or not. For instance, ever more Americans attend crumbling, understaffed schools, drive on roads in disrepair, and go to hospitals and health clinics (not just Veterans Administration ones with their seemingly endless waiting lists!) that don’t have enough doctors and mental-health therapists to meet our needs. Arguably, a major culprit is the war on terror. To take just one example, we could have fully staffed and equipped our whole healthcare system and made it significantly more pandemic resilient had we spent just a fraction of the $8 trillion or more this country put out for our foreign wars.   

And the sting of war on our society doesn’t end with decrepit infrastructure, but extends to civil liberties and human rights. For example, our police are armed to the teeth with military-grade weaponry and other equipment provided by an overfed Pentagon and in this century have grown more aggressive towards unarmed people here at home.

And believe me, pain from American war-making is felt elsewhere, too, often all too directly in the dozens of countries around the world where the U.S. arms and trains militaries, continues to fight counterinsurgency wars, and runs prisons and intelligence operations. There are the air strikes and shootings, the father or brother who can no longer be the breadwinner because he was collateral damage in a drone strike, the millions of displaced and malnourished people — many of them mothers with children — in countries where Washington has supported authoritarian regimes in questionable counterinsurgency wars. 

Pain That Is Difficult to Trace

Given global events since those 9/11 attacks, it shouldn’t be surprising that pain is so frequently experienced by people in our military communities. Somewhere between 31% and 44% of active-duty American soldiers report chronic pain of some sort. That’s significantly higher than in the general population. And no surprise in this either: veterans are about 40% more likely to report chronic pain than non-veterans.

Chronic pain is, in fact, part of a category of neurological conditions that ranks as the fifth most common source of disability for service members treated at on-installation clinics and hospitals. Worse yet, military pain-related diagnoses have been growing. Back pain, neck pain, knee pain, migraines, and chest pain are becoming the norm.

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As a military spouse and a therapist who has treated many soldiers and veterans, I’ve all too often observed how such pain, while sometimes untraceable to a visible source, is all too real — real enough, in fact, to immobilize some soldiers, or even keep them from successfully stringing together sentences. (And while I’ve seldom found that commonly recommended medication treatments truly alleviate such pain in a sustainable way, I have watched it subside over time thanks to the sorts of things that also boost mental health — talk therapy, exercise, and deepening friendships.)

Of course, military communities aren’t the only places where such pain is commonplace. It’s also experienced all too often by poor Americans without college degrees, especially women and people of color — in other words, the most vulnerable slices of our American pie.

The portraits in Kristof’s pieces reveal some surprising findings about pain. First, the amount of pain you experience depends not just on the physical injury that may show up on an X-ray or CT scan or, in the case of soldiers, the wound you got, but on what you think and feel. Two-thirds of people with depression have unexplained chronic pain, for example. Doctors have even discovered that some people reporting knee pain have no discernable anatomical problem.

By the same token, the brain has a certain ability to heal or ameliorate pain. In some cases, through the use of “mirror therapy,” people have been able to ease pain from an amputated limb or “phantom limb” by looking repeatedly at the intact one and somehow creating the impression that they’re okay.

Some people, military or not, with chronic depression, anxiety, or PTSD symptoms like exaggerated startle reflexes or sleep problems experience greater sensitivity to pain if they get physically injured again. Their brains, it turns out, have been trained by trauma to believe something’s wrong with their bodies.

Common diagnoses that have seeped into household parlance tend to reinforce this notion for many. Medical categories like fibromyalgia and irritable bowel symptom make pain sound as though it’s related to something tangible, except that all too often, it’s “just” pain.

It’s hardly a surprise anymore that the go-to treatment for pain in America is opioids, and look where that’s left us — with an epidemic of addiction and deaths to the tune of tens of thousands of lives lost yearly. Somehow, that approach to dealing with pain brings me back to the way the U.S. fought “terrorism” after the 9/11 attacks — with our own brand of terror (war!) globally and, indeed, it not only proved all too addictive but so much more costly to us and so many others on this planet than the original blow.

The Phantom Limb of American Society

If this comparison seems kind of out there to you, that’s my point. The problems experienced by Americans in pain are often all too hard to pin down, because at least in part they derive from survival guilt at having watched fellow soldiers getting blown to pieces by improvised explosive devices, or your parents dying from Covid because their jobs as janitors didn’t allow them to quarantine, or intense loneliness in a pandemic that made high school a virtual solo performance for all too many students. And get this: you don’t even need to go through one of those nightmarish scenarios personally to be in pain. Just hearing about economic insecurity in our world can exacerbate whatever aches you have.

This makes me wonder what it was like for so many to watch the recent coverage of Congress reaching the precipice over whether to raise the debt ceiling so that the government could pay its bills. How did it affect already struggling people to contemplate imminent economic catastrophe in the form of potentially soaring interest rates, inflation, job loss, and potential cutoffs in social services like healthcare? As a therapist who relies heavily on state-funded health insurance for my income and whose spouse is a soon-to-be veteran, I can’t help but scoff at congressional representatives who claim to be supporting our military by insisting on raising already astronomic Pentagon funding yet higher, while trying to gut the very systems that would let even a family as privileged as mine make ends meet once a soldier finishes his or her service.

Now look a little farther out if you want to be anxious. Most Americans don’t realize that our forever wars have been funded almost entirely by borrowing. A fundamental reason why we have to talk about a debt ceiling and continue to borrow ever more money to pay bills like those due for Medicare, Medicaid, and food stamps is war. One key reason why we need to worry at all about making college graduates start paying their exorbitant loans back again is… yes, our debts from war-making. Notice a theme here?

Of course, war means that the remedies for pain that have proven to be most effective in the long run are not as available to those who experience the most pain. Exercise, certain types of talk therapy, and community are key and yet can be all too sparsely available to those working multiple jobs and struggling to pay their bills, not to mention those being shipped from base to base amid the grinding pace of military life.

In the meantime, military families and veterans are left to pay the costs of war directly via just about every kind of stress and distress imaginable. I remember someone I knew at one military post. A person of color and a veteran of the Vietnam war, he’d often be outside his house in the early mornings and evenings, smoking weed in order to alleviate leg pain that was untraceable to any particular injury. What he did talk about frequently were his painful memories of shooting at rural, dark-skinned villagers in Vietnam who resembled his own farmworker family in the U.S. when he was growing up. Trauma and pain were his frequent travel companions and yet the source of his pain remained unidentifiable in his small, fit body.  

As then-President Donald Trump had banned or suspended the entry of people from eight different majority Muslim nations (as well as other refugees) to this country, I knew life wasn’t easy for him. He was, after all, often mistaken for a Muslim, called racial slurs, and told by passersby to go back where he came from. And even so many years later, that veteran and all too many soldiers like him may still not find a healthy part of our country to look at in order to convince themselves that life indeed will be okay.

Yes, there are all too many sick parts of our land, including a shaky social safety net, the hate and violence that continue to spread, and the long lines to get anywhere near a doctor or therapist. Contemplating all of this can be like gazing at a phantom limb that still smarts, even as so many of the original injuries — from 9/11 to our disastrous military response to it — seem all too forgettable to so many of us. Sad to say, but it’s vital that we remember the costs of war not only for ourselves but for those millions of people out there who experienced the — in every sense — wounds we inflicted in the name of an injured America in our nightmarish war on terror. Otherwise, don’t be surprised if we do it again.

Copyright 2023 Andrea Mazzarino

Via Tomdispatch.com

Seven hours is the ideal amount of sleep for people in their middle age and upwards, with too little or too much little sleep associated with poorer cognitive performance and mental health, say researchers from the University of Cambridge and Fudan University.

Sleep plays an important role in enabling cognitive function and maintaining good psychological health. It also helps keep the brain healthy by removing waste products. As we get older, we often see alterations in our sleep patterns, including difficulty falling asleep and staying asleep, and decreased quantity and quality of sleep. It is thought that these sleep disturbances may contribute to cognitive decline and psychiatric disorders in the aging population.

In research published today in Nature Aging, scientists from the UK and China examined data from nearly 500,000 adults aged 38-73 years from the UK Biobank. Participants were asked about their sleeping patterns, mental health and wellbeing, and took part in a series of cognitive tests. Brain imaging and genetic data were available for almost 40,000 of the study participants.

By analysing these data, the team found that both insufficient and excessive sleep duration were associated with impaired cognitive performance, such as processing speed, visual attention, memory and problem-solving skills. Seven hours of sleep per night was the optimal amount of sleep for cognitive performance, but also for good mental health, with people experiencing more symptoms of anxiety and depression and worse overall wellbeing if they reported sleeping for longer or shorter durations.

The researchers say one possible reason for the association between insufficient sleep and cognitive decline may be due to the disruption of slow-wave – ‘deep’ – sleep. Disruption to this type of sleep has been shown to have a close link with memory consolidation as well as the build-up of amyloid – a key protein which, when it misfolds, can cause ‘tangles’ in the brain characteristic of some forms of dementia. Additionally, lack of sleep may hamper the brain’s ability to rid itself of toxins.

The team also found a link between the amount of sleep and differences in the structure of brain regions involved in cognitive processing and memory, again with greater changes associated with greater than or less than seven hours of sleep.

Having a consistent seven hours’ sleep each night, without too much fluctuation in duration, was also important to cognitive performance and good mental health and wellbeing. Previous studies have also shown that interrupted sleep patterns are associated with increased inflammation, indicating a susceptibility to age-related diseases in older people.

Professor Jianfeng Feng from Fudan University in China said: “While we can’t say conclusively that too little or too much sleep causes cognitive problems, our analysis looking at individuals over a longer period of time appears to support this idea. But the reasons why older people have poorer sleep appear to be complex, influenced by a combination of our genetic makeup and the structure of our brains.”

The researchers say the findings suggest that insufficient or excessive sleep duration may be a risk factor for cognitive decline in ageing. This is supported by previous studies that have reported a link between sleep duration and the risk of developing Alzheimer’s disease and dementia, in which cognitive decline is a hallmark symptom.

Professor Barbara Sahakian from the Department of Psychiatry at the University of Cambridge, one of the study’s authors, said: “Getting a good night’s sleep is important at all stages of life, but particularly as we age. Finding ways to improve sleep for older people could be crucial to helping them maintain good mental health and wellbeing and avoiding cognitive decline, particularly for patients with psychiatric disorders and dementias.”

The research was supported by the National Key R&D Program of China, the Shanghai Municipal Science and Technology Major Project, the Shanghai Center for Brain Science and Brain-Inspired Technology, the 111 Project, the National Natural Sciences Foundation of China and the Shanghai Rising Star Program.

Reference
Li, Y, Sahakian, BJ, et al. The brain structure and genetic mechanisms underlying the nonlinear association between sleep duration, cognition and mental health. Nature Aging; 28 Apr 2022l DOI: 10.1038/s43587-022-00210-2

The text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright ©University of Cambridge and licensors/contributors as identified.

Via Cambridge University Research

Featured image h/t Pixabay.

Its authors highlight, “Legitimate grievances such as state predation; discrimination; exclusion from political structures, systems, and processes; historical or collective trauma; intergroup conflict; and oppression are at least as likely to contribute to a person’s engagement in violent extremism as ideology.” Associated drivers include shame and humiliation. The authors describe a negative feedback loop that must be disengaged.

“….trauma can lead to significant barriers to building social bonds, empathy, and a sense of belonging due to the erosion of trust and the neurobiological changes in brain function and processing that occur as a result. And people who have engaged in violent extremism likely have been traumatized across several dimensions.”

Trauma can alter “threat detection and vigilance and emotion regulation processes, which may make some people more aggressive or more inclined to violence.”

The specific role of post-traumatic stress as a contributing factor to the violence in the US over the last year is not precisely quantifiable. What is clear is that the pandemic and quarantine measures (however necessary the latter), their devastating impacts on the economy, and violent abuses of state power are mass trauma events.

The overrepresentation of current and former members of the military among the Capitol insurrectionists is attributable to several variables, of which post-traumatic stress may be a significant one, in addition to traumatizing propaganda and disinformation specifically targeting them.

Improving basic subsistence conditions for those who have been left most vulnerable by the state of the economy, along with vaccine deployment and efforts to hold disinformation operatives accountable, are clear top priorities to help stabilize the country. A closely related and similarly pressing question is how to address the mental health pandemic precipitated by events over the last year especially. If this problem is not adequately addressed, the negative feedback loop of trauma and engagement in violent extremism could exacerbate already severe political instability in the US.

A scientific paper on psychedelic-assisted psychotherapy, published in the Journal of Psychedelic Studies, offers potential solutions based on clinical and neuroscientific analysis. Its authors note “correlational, experimental and longitudinal evidence that provides direct links between psychedelic use and empathic functioning.”

Another report published in the International Journal of Neuropsychopharmacology concluded that psilocybin, the psychoactive compound in “magic mushrooms”, significantly increased emotional empathy, defined as the ability to not merely intellectually comprehend another person’s emotional state but to actually experience it. This is essential to bridging racial and other divisions that have generated much of the impetus behind political instability in the US.

Natural psychedelics such as psilocybin mushrooms have been used by indigenous cultures throughout the world for millennia, including for peace-building. Rooted in these traditions, Decriminalize Nature is an inspiring grassroots movement working to establish bubbles of legal protection from federal statutes that prohibit the use of psychedelic plants and fungi. It has had policy successes in Oakland, Denver, Santa Cruz, Ann Arbor, Washington DC, and Oregon. DN has the potential to help effect a cultural shift in favor of more accessible, community-based solutions to the interrelated fear, hatred, racism, trauma, political radicalization, and violent extremism plaguing the country. Partnership with indigenous healers, therapists, and peace-builders who are experienced in creating spaces for dialogue and psychedelic-assisted healing will be critical to its success.

—-

Bonus Video added by Informed Comment:

Harvard Medical School: “Psychedelic Medicine: From Tradition to Science”

There’s no doubt that 2020 was difficult for everyone and tragic for many. But now vaccines against COVID-19 are finally being administered – giving a much needed hope of a return to normality and a happy 2021.

However, months of anxiety, grief and loneliness can easily create a spiral of negativity that is hard to break out of. That’s because chronic stress changes the brain. And sometimes when we’re low we have no interest in doing the things that could actually make us feel better.

To enjoy our lives in 2021, we need to snap out of destructive habits and get our energy levels back. In some cases, that may initially mean forcing yourself to do the things that will gradually make you feel better. If you are experiencing more severe symptoms, however, you may want to speak to a professional about therapy or medication.

Here are six evidenced-based ways to change our brains for the better.

1. Be kind and helpful

Kindness, altruism and empathy can affect the brain. One study showed that making a charitable donation activated the brain’s reward system in a similar way to actually receiving money. This also applies to helping others who have been wronged.

Volunteering can also give a sense of meaning in life, promoting happiness, health and wellbeing. Older adults who volunteer regularly also exhibit greater life satisfaction and reduced depression and anxiety. In short, making others happy is a great way to make yourself happy.

2. Exercise

Exercise has been linked with both better physical and mental health, including improved cardiovascular health and reduced depression. In childhood, exercise is associated with better school performance, while it promotes better cognition and job performance in young adults. In older adults, exercise maintains cognitive performance and provides resilience against neurodegenerative disorders, such as dementia.

What’s more, studies have shown that individuals with higher levels of fitness have increased brain volume, which is associated with better cognitive performance in older adults. People who exercise also live longer. One of the very best things that you can do to reboot your brain is in fact to go out and get some fresh air during a brisk walk, run or cycling session. Do make sure to pick something you actually enjoy to ensure you keep doing it though.

3. Eat well

Nutrition can substantially influence the development and health of brain structure and function. It provides the proper building blocks for the brain to create and maintain connections, which is critical for improved cognition and academic performance. Previous evidence has shown that long-term lack of nutrients can lead to structural and functional damage to the brain, while a good quality diet is related to larger brain volume.

One study of 20,000 participants from the UK-Biobank showed that a higher intake of cereal was associated with the long-term beneficial effects of increased volume of grey matter (a key component of the central nervous system), which is linked to improved cognition. However, diets rich in sugar, saturated fats or calories can damage neural function. They can also reduce the brain’s ability to make new neural connections, which negatively affects cognition.

Therefore, whatever your age, remember to eat a well-balanced diet, including fruits, vegetables and cereal.

4. Keep socially connected

Loneliness and social isolation is prevalent across all ages, genders and cultures – further elevated by the COVID-19 pandemic. Robust scientific evidence has indicated that social isolation is detrimental to physical, cognitive and mental health.

One recent study showed that there were negative effects of COVID-19 isolation on emotional cognition, but that this effect was smaller in those that stayed connected with others during lockdown. Developing social connections and alleviating loneliness is also associated with decreased risk of mortality as well as a range of illnesses.

Therefore, loneliness and social isolation are increasingly recognised as critical public health issues, which require effective interventions. And social interaction is associated with positive feelings and increased activation in the brain’s reward system.

In 2021, be sure to keep up with family and friends, but also expand your horizons and make some new connections.

5. Learn something new

The brain changes during critical periods of development, but is also a lifelong process. Novel experiences, such as learning new skills, can modify both brain function and the underlying brain structure. For example juggling has been shown to increase white matter (tissue composed of nerve fibers) structures in the brain associated with visuo-motor performance.

Similarly, musicians have been shown to have increased grey matter in the parts of the brain that process auditory information. Learning a new language can also change the structure of the human brain.

A large review of the literature suggested that mentally stimulating leisure activities increase brain-reserve, which can instil resilience and be protective of cognitive decline in older adults – be it chess or cognitive games.

6. Sleep properly

Sleep is an essential component of human life, yet many people do not understand the relationship between good brain health and the process of sleeping. During sleep, the brain reorganises and recharges itself and removes toxic waste byproducts, which helps to maintain normal brain functioning.

Sleep is very important for transforming experiences into our long-term memory, maintaining cognitive and emotional function and reducing mental fatigue. Studies of sleep deprivation have demonstrated deficits in memory and attention as well as changes in the reward system, which often disrupts emotional functioning. Sleep also exerts a strong regulatory influence on the immune system. If you have the optimal quantity and quality of sleep, you will find that you have more energy, better wellbeing and are able to develop your creativity and thinking.

So have a Happy New Year! And let’s make the most of ourselves in 2021 and help others to do the same.

Barbara Jacquelyn Sahakian, Professor of Clinical Neuropsychology, University of Cambridge; Christelle Langley, Postdoctoral Research Associate, Cognitive Neuroscience, University of Cambridge, and Jianfeng Feng, Professor of Science and Technology for Brain-Inspired Intelligence , Fudan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Featured illustration: Shutterstock.

( Tomdispatch.com) – In our new era of nearly unparalleled upheaval, as a pandemic ravages the bodies of some and the minds of nearly everyone, as the associated economic damage disposes of the livelihoods of many, and as even the promise of democracy fades, the people whose lives were already on a razor’s edge — who were vulnerable and isolated before the advent of Covid-19 — are in far greater danger than ever before.

Against this backdrop, many of us are scanning the news for any sign of hope, any small flicker of light whose gleam could indicate that everything, somehow, is going to be okay. In fact, there is just such a flicker coming from those who have been through the worst of it and have made it out the other side.

I spoke with Rafael Rodriguez of Holyoke, Massachusetts, on a sweltering Thursday afternoon in late July. He had already spent hours that day on Zoom and, though I could feel his exhaustion through our pixilated connection, he was gracious. His salt-and-pepper beard neatly trimmed, he nodded gently in answer to my questions. “Covid-19 has made it more and more apparent how stigmatizing it is to be less fortunate,” he said. As we spoke, the number of Americans collecting unemployment benefits had just ticked up to around 30 million, or about one in every five workers, with nearly 15 million behind on their rent, and 29 million reporting that their households hadn’t had enough to eat over the preceding week. Rodriguez is an expert in what happens after eviction or when emergency aid dries up (or there’s none to be had in the first place) — what becomes, that is, of those in protracted isolation and despair.

Drug-overdose deaths were up 13% in the first seven months of this year compared to 2019, according to research conducted by the New York Times covering 40% of the U.S. population. More than 60% of participating counties nationwide that report to the Overdose Detection Mapping Application Program at the University of Baltimore saw a sustained spike in overdoses following March 19th, when many states began issuing social-distancing and stay-at-home orders. This uptick arrived atop a decades-long climb in drug-related fatalities. Last year, before the pandemic even hit, an estimated 72,000 people in the United States died of an overdose, the equivalent of sustaining a tragedy of 9/11 proportions every two weeks, or about equal to the American Covid-19 death toll during its deadliest stretch so far, from mid-April to mid-May.

What people do in the face of protracted isolation and despair is turn to whatever coping strategy they’ve got — including substances so strong they can be deadly.

“I think of opioids as technologies that are perfectly suited for making you okay with social isolation,” said Nancy Campbell, head of the Department of Science and Technology Studies at Rensselaer Polytechnic Institute and author of OD: Naloxone and the Politics of Overdose. Miraculously, an opioid overdose can be reversed with the medicine naloxone, commonly known by the brand name Narcan. But you can’t use naloxone on yourself; you need someone else to administer it to you. That’s why Campbell calls it a “technology of solidarity.” The solidarity of people looking out for one another is a necessary ingredient when it comes to preserving the lives of those in the deepest desolation.

Yet not everyone sees why we should save people who knowingly ingest dangerous substances. “I come from a small town in northeastern Pennsylvania and I have a large extended family there,” Campbell told me. She remembers a family member asking her, “Why don’t we just let them die?”

Any of us can answer that question by imagining that the person who just overdosed was the one you love most in the world — your daughter, your son, your dearest friend, your lover. Of course you won’t let them die; of course it’s imperative that they have another chance at life. There are people like Rafael Rodriguez who have dedicated themselves to ensuring that their neighbors have access to naloxone and other resources for surviving the absolute worst. One day, naloxone may indeed save someone you love. Perhaps it already has.

Another technology of solidarity has recently become commonplace in our lives: the face mask. Wearing such a mask tells others that you care about their well-being — you care enough to prevent the germs you exhale from becoming the germs they inhale, and then from becoming the germs they exhale in the company of still others. Face masks save lives. The face mask is a technology of solidarity. So is naloxone. And so is empathy.

“The Sheer Power of Being With Someone in the Moment”

As Rafael Rodriguez slowly told his astonishing story, I could see on my computer screen a spartan office behind him and a single bamboo shoot, its stem curled beneath a burst of foliage. When he was younger, he said, he used food as his coping mechanism for an embattled life, over-eating to the point where doctors worried he would die. Then, at age 23, he underwent gastric bypass surgery and lost a dramatic amount of weight. The doctors were pleased, but now his only means of coping with life’s hardships had been taken away. When three of his dearest family members died in rapid succession, he began drinking. Eventually he sought something that could help him stay awake to keep drinking, and so he started using cocaine. Later on, he needed something that could ease him off cocaine in order to sleep.

“That’s where heroin came into my life,” he told me.

Using that illegal drug left him feeling ashamed, though, and soon he found himself pulling away from his remaining family members, becoming so isolated that, in 2005, he fell into a long stretch of homelessness. Only after he had spent almost a year in a residential rehabilitation facility and gotten a job that left him surrounded by supportive colleagues did Rodriguez begin to name the dark things in his past that had driven him to use drugs.

“No one ever knew that I was sexually assaulted as a child,” he explained. After years in recovery, he is now in possession of a commanding insight. During the most troubled years of his life, he was punishing himself for someone else’s grim actions.

Portugal famously decriminalized all substance use in 2001 and multimedia journalist Susana Ferreira has written that its groundbreaking model was built on an understanding that a person’s “unhealthy relationship with drugs often points to frayed relationships with loved ones, with the world around them, and with themselves.” The root problem, in other words, is seldom substance use. It’s disconnection and heartache.

In 2016, Rodriguez was hired by the Western Massachusetts Recovery Learning Community in Holyoke, where heroin use constituted a crisis long before opioid addiction registered as a national epidemic. Rodriguez now dedicates himself to supporting others in their recovery from the trauma that so often underlies addiction. And while tight funding and staffing limitations have led many community organizations across the country to reduce services during the pandemic period, the Recovery Learning Community has sought to expand to meet increasing need. When state restrictions capped the number of people the organization could allow into its indoor spaces, Rodriguez and his team improvised, offering services outside. They prepared bagged lunches, set up outlets so people could charge their phones, and distributed hand sanitizer and bottled water. And they continued to offer compassion and peer support, as they always had, to people wrestling with addiction.

Helping those in the midst of painful circumstances, Rodriguez says, isn’t about knowing the right thing to say. It’s about “the sheer power of just being with someone in the moment… being able to validate and make sure they know they’re being heard.”

In many situations, he adds, he has helped people without uttering a word.

Criminalization Versus “Any Positive Change”

It’s something of an understatement to say that, in the United States, empathy has not been our go-to answer for addiction. Our cultural tendency is to regard signs of drugs or the persistent smell of alcohol as marking users as outcasts to be avoided on the street. But medical science tells us that addiction is actually a chronic relapsing brain disease, one that often takes hold when a genetic predisposition intersects with destabilizing environmental factors such as poverty or trauma.

Regardless of the science, we tend to respond unkindly to folks in the throes of addiction. In her book Getting Wrecked: Women, Incarceration, and the American Opioid Crisis, Dr. Kimberly Sue describes a complex and corrupt system of prosecutors, forensic drug labs, prisons, and parole and probationary systems in which discipline is meted out primarily to low-income people, disproportionately of color, who use illegal substances. An attending physician at Rikers Island in New York, Sue is also the medical director of the Harm Reduction Coalition. The philosophical opposite of criminalization, “harm reduction” is an international movement, pioneered by people who have used or still use such drugs, to reduce their negative consequences.

“Treat people with dignity and respect, respect people’s bodily autonomy” was the way Sue described to me some of harm reduction’s core tenets. In this country, we typically expect folks to cease all substance use in order to be considered “clean” human beings. Harm reduction instead espouses a kind of compassionate incrementalism. “Any positive change,” from the decision to inject yourself with a sterile needle to carrying naloxone, is regarded as a stride toward a healthier life.

In tandem with its decision to decriminalize all substance use, Portugal put harm reduction at the heart of its national drug policies. And as of 2017 (the most recent year for which data are available), nearly two decades after that country’s groundbreaking move, the per-capita rate of drug-related fatalities in the U.S. stood 54 times higher than in Portugal.

Now, the pandemic has made addiction even more dangerous. In addition to inflicting the sort of widespread hardship that can drive people to opioids (or even greater doses of them) and to take their chances with the potent synthetic opioid fentanyl, Covid-19 has stymied efforts by Dr. Sue and others to provide effective guidance and care. In normal times, opioid users can at least protect themselves from dying of an overdose by using their drug in the company of others, so that someone can administer naloxone if it becomes necessary. Now, however, that safety mechanism has been fatally disrupted. While social distancing saves lives, stark solitude can be deadly — both as further reason for using such drugs and because no one will be present with the antidote. Referring to naloxone as a miracle medicine, Sue said that there is no medical reason why people should die of an opioid overdose.

“The reason they die is because of isolation.”

Rx: Friendship

Back in March, one of the first recommendations for reducing the transmission of the coronavirus was, of course, to stay home — but not everyone has a home, and when businesses, restaurants, libraries, and other public spaces locked their doors, some people were left without a place even to wash their hands. In Holyoke, Rafael Rodriguez and his colleagues at the Recovery Learning Community, along with staff from several other local organizations, rushed to city officials and asked that a handwashing station and portable toilets be installed for the many local people who live unhoused. Rodriguez sees such measures not only as fundamental acts of humanity, but also as essential to any viable treatment for addiction.

“It’s really hard to think about recovery, or putting down substances, when [your] basic human needs aren’t being met,” he said. In the midst of extreme summer heat, he pointed out that there wasn’t even a local cooling center for people on the streets and it was clear that, despite everything he had seen in his life, he found this astonishing. He is now part of a community movement that is petitioning the local city government for an emergency shelter.

“When you have no idea where you’re going to rest your head at night, using substances almost becomes a survival tactic,” he explained. “It’s a way to be able to navigate this cruel world.”

Meanwhile, Dr. Sue continues to care for her patients whose maladies are often rooted in systemic injustice and the kind of despair that dates back to their early lives. Affirming that substance use is indeed linked to frayed relationships, she told me that, in this pandemic moment of isolation, what drug users most often need is a sense of connection with others.

“How do I prescribe connection?” she had asked during our phone call. “How do I prescribe a friend?”

Several days later, while writing this article, I left the air-conditioned space in which I was working and walked a couple of blocks to run some errands. In the stifling midday sun, I saw a woman sitting on the ground. I realized I’d seen her before and guessed that she was homeless. Her arms and face were inflamed with a rash. She said something to me as I passed. At first, I didn’t catch it. Her words were garbled and she had to repeat herself several times before I understood.

She was asking for water.

I blinked, nodded, and went into a nearby drug store where I grabbed a water bottle, paid in a few seconds at self-checkout, and gave it to her. And yet, if I hadn’t been working on this article, I might not have done that at all. I might have passed right by, too absorbed in my life to realize she was pleading for help.

Amid the sustained isolation of a global pandemic whose end is nowhere in sight, I asked Rafael Rodriguez what lessons could be learned from people who have long experienced isolation in their lives.

“My hope is that, as a society, we gain some empathy,” he replied.

Then he added, “Now that’s a big ask.”

Mattea Kramer, a TomDispatch regular, is at work on a novel about a waitress’s love affair with a prescription pill.

Follow TomDispatch on Twitter and join us on Facebook. Check out the newest Dispatch Books, John Feffer’s new dystopian novel (the second in the Splinterlands series) Frostlands, Beverly Gologorsky’s novel Every Body Has a Story, and Tom Engelhardt’s A Nation Unmade by War, as well as Alfred McCoy’s In the Shadows of the American Century: The Rise and Decline of U.S. Global Power and John Dower’s The Violent American Century: War and Terror Since World War II.

Copyright 2020 Mattea Kramer

Via Tomdispatch.com