Two articles have stuck in my mind after reading the newspapers this weekend, with both of them involving mental health issues that continue to dog us as a culture and which seem unsolvable, most of the time.
The first article, Young, Obese and in Surgery, appeared in Saturday's NYT, and is a very sad story about a young woman in Bensonhurst, Brooklyn who was teased for being "fat" as long as she can remember. By age 17, after much frustration, was seriously considering weight-loss surgery. This young woman allowed The New York Times to follow her for a year as she prepared for and subsequently had an operation to help stop the weight gain. She then embarked on a quest to lose weight, navigating challenges to her morale, her self-image and her relationships with family members and friends.
In Dec. 2010, she had her bariatric surgery, the popular Lap-Band type, in which a silicone band isinserted around the stomach which then is constricted to make the patient feel full quickly and thus stop eating. Incidentally, the maker of the Lap-Band is seeking permission from the Food and Drug Administration to market it to patients as young as 14, four years younger than is now allowed. Her doctor had told her that, going by the averages, she could expect to lose about 40 percent of her excess weight, or 70 to 80 pounds.
Child Health Plus, a state insurance plan for low-income families, covered the $21,369 cost. Medicaid in almost every state and many private health plans now cover bariatric surgery, often more readily than diet or exercise plans.
Over the six months following the surgery, she went down from 251 to 237. And by this November, she was at a place where she had regained half of what she had lost. According to the article, he does not want to reveal how much she weighs, but admits that she is fighting constant hunger, and her progress is slow.
The article pointed out that the long-term effectiveness of weight-loss surgery, particularly stomach banding the procedure that this young woman had, is still questionable. And the push toward surgery on the young has brought some resistance from doctors who say it is too drastic to operate on patients whose bodies might still be developing and who have not been given much time to lose pounds on their own.
This patient’s procedure, called laparoscopic adjustable gastric banding, constitutes about 39 percent of all bariatric surgeries. The other two main types are Roux-en-Y gastric bypass, which involves stapling the stomach into a tiny pouch and rearranging the bowel, and sleeve gastrectomy, which involves removing most of the stomach and turning what is left into a thin tube.
The risks of all the operations have declined, partly because surgeons are now more experienced and using less-invasive techniques, like laparoscopy, but also because they are beginning to operate on thinner, healthier patients.
One in 2,000 gastric banding patients, or 0.05 percent, and 1 in 900 gastric bypass patients die during or immediately after surgery, according to William Encinosa, a senior economist at the federal Agency for Healthcare Research and Quality who analyzed 161,000 surgical records for 2009. For open — not laparoscopic — bypass surgeries, studies have put the death rate within 30 days as high as 2 percent. About 1 percent of banding patients and 3 percent of bypass patients develop major complications, like blood clots or perforation of the bowel, he said.
The second article, found in the Sunday NYT in the Blog section called The Stone, was titled "In the Cave: Philosophy and Addiction", and written by Peg O'Connor, who teaches philosophy and gender, women, and sexuality studies at Gustavus Adolphus College. Dr. O'Connor introduces the notion of addiction as a subject of philosophical inquiry.
She says in the article, "I am a philosopher, yes, but I am also an alcoholic who has been sober for more than 24 years ― only the last four of them as part of a recovery program. I am often asked how I got and stayed sober for those first 19 years; it was because of philosophy, which engendered in me a commitment to living an examined life, and gave me the tools and concepts to do so. My training in moral philosophy made it natural for me to wrestle with issues of character, responsibility, freedom, care and compassion in both work and life."
"Philosophy has always been about the pursuit of knowledge, but one that included the higher aim of living a good and just life. This pursuit has involved examining the nature of just about everything. Socrates’s guiding question was “what is it?”
It is a remarkable essay and you can read it for yourself. It addresses an issue that I think is an essential element of both O'Connor's struggle with alcoholism as well as the sad story about obesity and weight-loss. At its core is the issue of causality.
What is it, indeed. What is obeisity (or alcoholism, or "fill in the blank")? In both of these terrible illnesses, the lack of an answer to the question being asked has resulted, I believe, in the responsibility being thrown back on the afflicted person with a resounding "ITS YOUR FAULT" And we act as if they don't really want to live a good and just life.
It's your fault that you have this problem, that you can't stop, that you can't use the help offered, that we are spending so much money trying to help you, that you relapse, that you have ruined your life and on and on and on. With alcoholism and addicton, we eventually just lock them up or put them out on the streets. We are ashamed of them. But if we can, though, we make money on them, even if we don't have a clue what we are dealing with. At least that's where we start until the funding runs out. Will we eventually criminalize obesity?
The philosophers and the scientists need to start talking to each other.
