Health

Hormones and (mental and physical) health

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For most women, PMS is an unpleasant but manageable part of their period. But for 5-8% of women (around 80,000 in the UK), their symptoms are so severe they can be fatal.

Laura experienced anxiety and panic attacks into her twenties, and was forced to temp because she couldn’t hold down a job. “Every month I’d get so tired I’d have to sleep 18 hours a day for three days. I started getting suicidal thoughts.”

She was suffering from Severe PMS or, as it is sometimes referred to in the UK, Premenstrual Dysphoric Disorder. The condition is recognised by the NHS.

“PMDD is actually the American Psychiatric Association’s definition of one type of Severe PMS,” says consultant gynaecologist Dr Nick Panay. The UK’s definition is slightly different. “‘Severe symptoms interfere with someone’s ability to function normally.”

This is an important article. Read it:
http://www.bbc.co.uk/bbcthree/item/82dcd957-fb96-422c-b037-ad2645d7d3b7

I mention something similar in my book “We need to talk about this” in relation to a woman whose child was taken from her womb because she was in advanced pregnancy and has bipolar disorder. Hormones can wreak havoc. Blame the hormones, not the women. Don’t punish the women. Support them.

I happen to know a highly intelligent and spunky woman with bipolar disorder. She has a PhD and her own business. She was hospitalized twice. Want to take a guess as to when that happened? Right. When she had her daughter – who is now an adult and doing fantastically well, I might add – and when she was going through menopause.

Cut people some slack. Don’t punish them for their conditions, certainly not when the condition is otherwise highly manageable and well-managed by the woman in question. Punishing someone with bipolar disorder for going through a rough patch is like punishing someone else for having a bad flu.

By the way, Italy has just introduced period leave for women. And in case that makes you wonder about this, the gender pay gap in Italy is lower than in quite a few other European countries.

What Charlie Gard taught me

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No matter how you felt about the situation of Charlie Gard and his parents and about how it was handled, you will likely agree that little Charlie’s life and death have not been in vain. Many bioethics scholars and others – predominantly men, I noticed – have been writing up their feelings and opinions on the matter, analyzing what happened and drawing conclusions. This will benefit future babies like Charlie and future parents like Charlie’s.

Or at least, it should!

Like all those other people, I too want to do a write-up because it will be very enlightening for myself (maybe also for others, because I did a surprising U-turn).

In this post, I will not go into the differences between Britain and other countries. Neither will I discuss the British legal background of the case, but I do want to point out that it must be kept in mind as essentially separate from all other considerations. The law of England & Wales must be adhered to, whether we like it or not, and in many cases that should entice the legal profession to pick up the lead in their arena and endeavor to have laws changed where called for. (Legislature, that is your duty! Step up to the plate.)

I was like just about everybody else. When I first heard about Charlie Gard case, I saw it as a consumerist view of babies. Baby has a defect. Must be fixed. Period.

As a teenager, I saw my mother suffer for many years, wither away and die and it was an immense relief for me that her suffering had ended when she died.

So, no, I am not for the extension of life “at all cost” / “no matter what” because that often is very selfish on the side of everyone who is not the patient in question. Family members and friends have to ask themselves what it is that they want. Do they want to hold on to the person no matter what or do they want that person to be free of pain?

Letting go is part of life, part of growing up, part of… being.

When one door closes, another one opens, in so many ways.

So I felt angry and frustrated toward Charlie Gard’s parents, although I certainly understood their anguish.

Earlier this year, I came up with a definition of what constitutes “a life not worth living” and Charlie Gard’s vulnerable little life fit that definition. Please, stop his suffering and let him pass away, as nature itself considers him not viable and he would surely have passed away a long time ago if it hadn’t been for the care and services provided by Great Ormond Street Hospital. That’s what I thought.

Please, please, please, let him go. Let him gooooooooooooooooooooo! That is what life is about!

But I had also come up with a definition of what harm is, within this context…

Both my definitions were very logical. I found them through play, playing with words, playing with ideas, concepts. They’d surely come across as “chilly” and “cruelly objective” to the “public”.

And then I saw that they clashed.

That’s when I saw that there was no conflict.

Both parties wanted what they thought would be the best for little Charlie.

But the only party with a real interest in this – one that didn’t clash with the wishes of the medical staff at GOSH – were Charlie’s parents.

Forgive me, please, for having accused you of a consumerist view of your child at first.

If Charlie had lived, he would be part of YOUR life now – not the hospital’s – and you were willing to accept anything that would have meant, it seems.

Who am I to judge a “vegetable” not worth of living?

Who am I to judge a being able of experiencing joy – and pain – as a life not worth of living?

Isn’t it true that ALL LIVES experience joy and pain?

Isn’t it true that this is LIFE?

I wrote the above after having consumed a considerable quantity of rum. Nothing bad about that! Below are my very (sober and) logical considerations.

Homelessness, housing duty and vulnerability

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Today is the third of three days at the Supreme Court that focus on homelessness, housing duty and vulnerability (or rather, priority).

courthouseThe three cases are:
– Hotak (Appellant) v London Borough of Southwark (Respondent)
– Johnson (Appellant) v Solihull MBC (Respondent)
– Kanu (AP) (Appellant) v London Borough of Southwark (Respondent)

(Interveners in all three cases:
Equality and Human Rights Commission, Shelter, Crisis and the Secretary of State for Communities and Local Government.)

What is it all about? Predominantly 189(1)(c) in the Housing Act 1996:

189 Priority need for accommodation.

(1) The following have a priority need for accommodation—

(a) a pregnant woman or a person with whom she resides or might reasonably be expected to reside;

(b) a person with whom dependent children reside or might reasonably be expected to reside;

(c) a person who is vulnerable as a result of old age, mental illness or handicap or physical disability or other special reason, or with whom such a person resides or might reasonably be expected to reside;

(d )a person who is homeless or threatened with homelessness as a result of an emergency such as flood, fire or other disaster.

(2) The Secretary of State may by order—

(a) specify further descriptions of persons as having a priority need for accommodation, and

(b) amend or repeal any part of subsection (1).

(3) Before making such an order the Secretary of State shall consult such associations representing relevant authorities, and such other persons, as he considers appropriate.

(4) No such order shall be made unless a draft of it has been approved by resolution of each House of Parliament.

Hotak is a pretty straightforward case, at first sight; the two other cases are less clear. Hotak concerns two brothers, one of which (Sifatullah) would certainly be considered vulnerable if the other one (Ezatullah) had not said that he would look after his brother. The brothers were living in a friend’s flat in Southwark, but told to leave because of overcrowding. Ezatullah’s immigration status at the time, however, made him ineligible for housing assistance.

Southwark did give the brothers temporary housing while it made its mind up. It decided that Sifatullah was unintentionally homeless, and eligible for assistance, yet did not consider him vulnerable in terms of in priority need of housing because his brother was looking after him. This is where the case went off the rails.

If Sifatullah were a pregnant woman, unintentionally homeless (as it is called), and eligible for assistance, whether the person with whom she resides or might reasonably be expected to reside supports her or not makes no difference, as one of the lawyers highlighted on Monday.

Another one pointed out that the law does not contain an element of comparison. A person’s own condition makes him or her relatively vulnerable when on the street, and the law had the intention of preventing and eliminating all homelessness. This would mean that a) there is no such thing as “an ordinary street-homeless person” (used by Southwark to compare Sifatullah against) and b) one could say that being homeless in itself already points toward a person being less able to fend for himself or herself, as homelessness is not the norm in this country.

It looks like the practice of the application of this legislation – carried out by the decision-making housing officer – has been moving toward comparing a blind applicant with street-homeless blind applicants, deaf applicants with street-homeless deaf applicants, mentally ill applicants with street-homeless mentally ill applicants, applicants with substance abuse with homeless people with substance abuse.

More specifically, practice seems to be more and more relying on the premise that all homeless persons are, almost by definition, street-homeless mentally ill and/or substance abusers and/or physically ill, deserving no special protection (in Johnson, for instance). The law was not intended that way. The law does not even say anything like this.

The pregnant woman, however, is never compared with other pregnant women to determine her vulnerability. The same applies to any persons who have lost their home in a flood.

“Ideas about vulnerability are perhaps most often applied by those in more powerful positions to define those in less powerful ones.” (Kate Brown)