Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts

Jan 27, 2024

Three Steps To A Purposeful Year

Before you set goals and resolutions, take some time to reflect on what makes you unique and what kind of life you aspire to.

By Christine Carter

“This year, I want to do something more meaningful. I don’t love my job or where I live, so I’m going to make some changes.”

As a coach, I’m happy when my people are ready for change. But the best first move usually isn’t an outer change to our circumstances—to a new job or city, for example. Pursuing achievements that improve our social status and bring us wealth or fame can be tempting—but people who prioritize those things tend to have lower well-being.

Instead, the best first move is almost always inner work. It’s identifying a vision for the coming year that animates our best selves. When we align our aspirations with our intrinsic interests and values, we tend to increase our well-being and the odds of achieving our goals.

But that task can feel daunting! Here’s how to get started.

Begin from your strengths rather than your weaknesses

Start by identifying some of your unique attributes: those things that make you you. As a coach, I’m most interested in the person you are without the normal social influences of the people around you. This is your intrinsic self, and it can be a compass for you in uncertain times.

Don’t worry if you’ve lost touch with your intrinsic self. We’re surrounded by external influences that shape us from the moment we’re born. Over time, it can be challenging to determine whether our goals and ambitions come from the hopes and expectations of our family, our culture, the media, our social circle—or our deepest sense of self and our truest values.

When we aren’t in touch with our intrinsic selves, our aspirations and goals are often based on external things like our jobs or roles, our appearance, and status-oriented stuff like houses and cars. These things are by nature all fleeting and fragile.

The good news is that your intrinsic self is always within you. It’s your center. You are like the block of marble that Michelangelo carved “The David” statue into. David was always in there, but the marble needed to be chipped away. I believe that, like “The David,” you are already “in there.”

Sometimes that idea—that you are already, always enough—can be tough to swallow. You are probably more in touch with the areas you want to strengthen and grow than the ones where you already feel good enough. But it can be more illuminating to see who you are than it is to lament who you aren’t.

For example, it’s easy for me to look back on the past year and wish I would have done more of some healthy thing, like meditation or yoga. When I focus on my deficiencies (I hardly meditated at all last year! I paid for a membership to a yoga website I barely used!), I feel inadequate and pessimistic about my ability to change. But when I consider my top strengths—zest and gratitude—I can see how my gratitude practices and love of outdoor exercise were enough. And, also, that I can grow these existing strengths. When I begin there, with my strengths, I feel optimistic about the year to come.


It’s counterintuitive, but, in my experience, people don’t tend to grow or accomplish the goals they set for themselves from a place of deficiency or fear that they aren’t good enough. Something liberating happens when we are no longer on the hunt for things to criticize about ourselves.

So allow yourself a moment to set aside the things you’d like to change about yourself and focus on the unique gifts you bring to the world.

Think about what makes you feel alive or at peace

If none of your unique attributes are obvious to you, reflect on times you’ve felt passion in your life, or when you’ve felt a peaceful sense of contentment. Maybe it’s something common, like a passion for helping others, or maybe it is quirky, like having a passion for Star Wars or an ability to identify owl calls. It might not seem all that “important,” but it’s something that energizes you. It doesn’t need to be interesting to anyone other than you. The things my adult children make fun of me for—like my tendency to cite research I’m excited about before I give them unsolicited advice—usually point to what makes me me.

If your passions aren’t obvious, consider what you loved as a child. What did you do before you worried about being judged or good enough—before the world started telling you what you should or shouldn’t like? When did you feel a sense of mystery, adventure, or magic? When did you feel a spark? Similarly, when have you felt fully at peace?

Set an aspiration for how you’d like to live

Can you think of a story or memory about yourself that illustrates some of the passions or unique attributes you’ve identified? What aspects of that story capture something unique about you? You might use one of those stories, or a combination of them, to name something you aspire to. No one else will need to understand it, but it should be meaningful to you.

For example, one of my clients, whom I’ll call Mike, set this aspiration: “I aspire to channel Brother James to inspire others to do hard things.” In our work together, Mike told me about a special relationship with a teacher who’d truly seen his potential and encouraged him to be his best self. In his work now, he feels most energized and motivated when he interacts with his colleagues in the way that Brother James interacted with him. Mike set an aspiration that tapped into the emotional feeling that being with Brother James gave him, one that animated and inspired him to do his best work in the world—and that, in turn, helps him inspire the people he manages at work.

Research by BetterUp, the coaching organization where I’m a leader, found that doing the above aspiration-setting exercise with a coach increased people’s well-being, authenticity, meaning, self-certainty, and life satisfaction. The effect was surprisingly large. (So large that the psychologists Em Reit and Rainy Gu conducting the study reanalyzed the data multiple times to ensure that what they were seeing was correct.)

So this year, before you reach for a familiar resolution or try to make a big change to your circumstances, take a step back and consider what you aspire to. How can you live your life in a way that reflects what makes you unique? From there, you are more likely to set goals and resolutions that help you do your best work and live your best life. -Greater Good 

Oct 28, 2023

Eight Signs Of Lung Cancer

 If you have never smoked or even been raised by smokers, then you would think that you are likely going to be invincible from ending up with lung cancer. However, that is not really the case at all. If there is a genetic component that makes you predisposed to lung cancer, then you are at risk of getting it. The only way to know is either being aware of family members who never smoked or even lived in areas with high pollution getting it or taking a DNA test yourself to see if you are likely to end up with the disease.

The thing with lung cancer is that you will not necessarily know if you have it since the symptoms can come on late, to the point where it has spread. However, there are also signs that show up that are more subtle but can be indicative that you have lung cancer. There are eight subtle signs that you may have lung cancer that you cannot ignore. The signs are:

Shortness Of Breath

You may think that the shortness of breath may be due to allergies, and you may think you have a virus but if you do not have a virus and you have taken allergy medication, and the symptom is not better, you will need it looked at. The shortness of breath could be caused by small tumors growing in the bronchial tubes.

A Persistent Cough

You may also think that a persistent cough is due to allergies or a stubborn cold that won’t go away. However, it is not normal to have a cough that keeps happening because even with allergies, the coughing does stop. And colds do not last too long unless you have a weak immune system. Either way, you need to see your doctor if the cough does not go away.

Rust-Colored Sputum

Are you coughing up bloody sputum? That can be normal if you have a virus or even allergies can do it as the lining of the bronchial tubes can become inflamed and small blood vessels can break. However, at the same time, you can never ignore it if you have been coughing rust-colored sputum for more than a week straight.

Chest Pain That Coincides With Breathing

If you have chest pain that worsens as you breathe deeply, laugh, or cough, then that is not normal. You may think it could be signs of walking pneumonia, and it could be that. However, if you are experiencing chest pain as you breathe deeply, or cough, or laugh, then you will need to see a doctor if it persists. Even if it is a new symptom, you do not want to ignore it because it also can be a sign of pneumonia.

Fatigue

Fatigue can be a sign of numerous ailments, and fatigue alone will not necessarily mean you have lung cancer. However, if the fatigue coincides with some of the other symptoms, then that can be a bad sign.

Loss Of Appetite Or Weight Loss

Like fatigue, loss of appetite, or weight loss alone is not a sign that you have lung cancer. However, if you have any of the other symptoms, that is when you need to worry. Any unexplained weight loss that coincides with or without loss of appetite is a cause for alarm.

Hoarseness

If you all of the sudden experience hoarseness and you don’t smoke, or you have not been ill, or you don’t even have a sore throat, that can be a cause for concern. Especially if it coincides with any of the other symptoms above.

Recurring Respiratory Infections

If you can’t seem to overcome pneumonia or bronchitis, then that is a bad sign that you could have lung cancer. Especially if you have not experienced other ailments that tie in with having a low immune function.

If you have any of these symptoms, even if you don’t have all of them, you must see your doctor so they can run tests on you to see if you have lung cancer. You do not want to get to a point where it becomes advanced. -World Wide News

Overcoming Adversity


Oct 14, 2023

The Missing Link Between Heart Disease And Sleep Problems

By Emily Cooke

A new study suggests sleep problems often experienced by people with heart disease may be caused by damage to a group of nerves that regulate both the heart and the brain.

People with heart disease often develop dreadful sleep problems, and now, scientists have identified a direct link between these conditions for the first time in a new study in mice and human tissues. 

Published Thursday (July 20) in the journal Science, the research shows that heart disease may derail the production of the sleep hormone melatonin in the brain due to damage to a group of nerves that innervate, or plug into, both organs — the superior cervical ganglion (SCG).

Found in the neck, these nerves are part of the autonomic nervous system, which regulates involuntary processes in the body, such as breathing and heart rate. Because nerves originating from the SCG connect to both the heart and the pineal gland — the tiny brain structure responsible for melatonin production — issues with the heart could explain why the body's melatonin-maker falls off track. 

"Imagine the ganglion as an electrical switchbox," senior author Stefan Engelhardt, a professor of pharmacology and toxicology at the Technical University of Munich, said in a statement. "In a patient suffering from sleep disturbances following a heart disease, you can think of a problem with one wire causing a fire to break out in the switchbox and then spreading to another wire."

The research is "important and timely," Brooke Aggarwal, an assistant professor of medical sciences at Columbia University who was not involved in the study, told Live Science in an email, noting that it "suggests a novel mechanism that may help to explain why those with heart disease are more prone to sleep disturbances." 

She went on to caution, though, that "future prospective studies need to be conducted, as well as clinical trials of any potential treatments stemming from this mechanism."

Struggling to sleep is a common side effect of heart disease — for example, up to 73% of people with heart failure experience symptoms of insomnia. Past studies have shown that melatonin levels are reduced in people with heart disease, but scientists didn't know why. 

In the new study, researchers analyzed human brain tissue samples from deceased heart disease patients and from people without heart disease. This postmortem analysis revealed a reduced number of nerve fiber, or axons in the SCG of people who had heart disease compared with the "heart-healthy" control group. The SCG of the individuals with heart disease were also markedly scarred and enlarged.

In supporting mouse experiments, the team found that immune cells called macrophages, which gobble up diseased and damaged cells, were present in the cervical ganglia of mice with heart disease, and the rodents' nerves showed signs of inflammation and scarring. The mice also had fewer axons in their pineal glands and less melatonin in their blood than healthy mice did. The rodents' circadian rhythms — the internal processes that regulate how the body responds to day and night — were also disrupted, as evidenced by changes in their metabolic rates and activity levels, for example.

Giving mice melatonin completely reversed this disruption, the team found. Additionally, when drugs were used to destroy the macrophages in the rodent's SCGs, their melatonin levels were restored.

Because these analyses were conducted in mice and only 16 humans, the findings "call for further studies" to reveal the mechanisms that drive immune cells to the SCG, the researchers noted in the paper. This may involve studying the nerve cells that link the heart and spinal cord, as well as messenger proteins called cytokines that summon macrophages.

In time, the team believes the study may pave the way for the development of new drugs to treat sleep disturbances caused by heart disease. 

"It will be now pivotal to obtain evidence in a randomized clinical trial to determine whether therapeutic melatonin is indeed effective in treating sleep disorders in patients with chronic heart disease," Engelhardt told Live Science in an email. If it proves effective, "then this could spare many patients the unnecessary side effects that come with standard sleeping pills." -Live Science


Mar 11, 2023

States Restricting Access to Gender-Affirming Care

 By Jack Doyle

From the dark heart of Oklahoma to the editorial desk at the New York Times, things are ROUGH out here for trans people in the United States. And these nine states are trying to make it rougher by attempting to restrict access to gender-affirming care—in multiple cases, the proposed bans would affect trans people of all ages. That’s why I’m going to Canada. Anything to get me away from these nine circles of Hell.

Missouri

Can anyone tell me anything about Missouri? I couldn’t tell you one thing that the state is known for except apparently being the worst. Three bills—SB236, SB49, and SB164—were filed in December 2022 to institute a total ban for transgender care to minors, with an exception for intersex youth. It’s all part of the “Missouri Save Adolescents from Experimentation (SAFE) Act,” because apparently Missouri views trans healthcare as some sort of science experiment gone wrong. A fourth Missouri Senate bill would also prohibit medical professionals from administering puberty blockers and surgeries to anyone under the age of 18. Any physician that “willfully and knowingly” administers aid to trans kids will be subject to prosecution and could lose their medical license. Similarly, parents and guardians who allow their child to receive such care can be reported to state authorities for abuse and neglect. The Missouri Karens are gonna have a field day ratting out their neighbors to the government.

Montana

Montana has nature, that’s about it. Great place to visit, hellhole to live. LC3824,  LC3825, LC3826, and LC3827 are a misguided effort to “protect minors from gender transitions.” One of the proposed bills seeks to limit trans minors from having gender-affirming surgeries. I wish all of the Republicans in Montana’s legislative body would climb onto one of Montana’s beautiful mountain peaks and just … stay there forever.

New Hampshire

New Hampshire, WHAT ARE YOU DOING? YOU ARE RIGHT NEXT TO VERMONT. YOU’RE SUPPOSED TO BE BLUE. WHAT IS GOING ON HERE? The fallen-from-grace state is targeting “gender transition procedures” and seeking to redefine “conversion therapy.” I don’t like the sound of that. An earlier version of the proposed bill aimed to prohibit gender-affirming healthcare for minors and “young adults.” Yikes. Two middle fingers for New Hampshire.

Oklahoma

Oklahoma, you don’t DESERVE the musical that Rogers and Hammerstein wrote about you. NO ONE should be singing about your “waving wheat” or your “surrey with the fringe on top” because you are now officially a TRASH STATE. A bill filed in December 2022 seeks to deny “gender transition procedures” to patients younger than 21 years old, with an exception for intersex youth. This means that Oklahoma will allow you to JOIN THE ARMY before you can change your gender.

The bill will also prevent public funds, including those from the state Medicaid program, from being used to pay for gender-affirming care. It will additionally make an “any medical or surgical service” used to help someone transition a felony offense, punishable by a $100,000 fine and up to a decade in prison.

If that wasn’t bad enough, the bill will also restrict transgender Oklahomans from socially transitioning or legally changing their name or gender marker on state-issued documents. Two middle fingers aren’t enough for you, Oklahoma. I’m flipping you off with my middle toes, too.

South Carolina

Between the rock and the hard place that are North and South Carolina, South Carolina is arguably worse. A South Carolina Senate bill would ban transgender people up to 21 years old from transitioning, and anyone over 21 must provide a referral from both their primary care physician and a licensed psychiatrist diagnosing them with gender dysphoria in order to receive care. So, basically, in South Carolina you aren’t allow to identify as trans; someone else has to identify YOU as trans. A second South Carolina bill would bar physicians from giving trans-related medical care to anyone under 18, with an exception for intersex kids. A third pre-filed measure would change the definition of “gender” to the sex that a person is assigned at birth, effectively eliminating any difference between the terms. This would make it impossible for trans people to change their gender markers on state documents.

Tennessee

I don’t ever wanna Tennessee this state again. Nashville is now Trashville. Them’s the breaks. A measure to prohibit transgender youth under 18 from accessing gender-affirming health care is already working through the Tennessee House of Representatives, and a similar bill is gaining traction in the Senate. The state claims that its legislature has the responsibility to “protect the health and welfare of minors.” I think minors need to be protected from the state of Tennessee.

Texas

Texas, where do I even begin with you? These bills you’re proposing are 20 gallons of shit in a 10-gallon hat. HB42 and HB112 are seeking to designate gender-affirming care for minors as child abuse, and would allow state agencies to open abuse investigations into families that allow their child to pursue gender-affirming care. Another House bill would revoke liability insurance to providers who prescribe medications used to treat gender dysphoria.

Utah

Utah, all I know about you is that you’re dry, dark, and full of Mormons. And that one of your Senate Republicans, Michael Kennedy, has introduced legislation to ban all gender transition surgeries (genital surgeries, top surgery, and breast reductions) for minors with the exception of surgeries for intersex kids. Kennedy, a “family doctor,” argued that gender-affirming healthcare is not necessary for people who experience gender dysphoria, woefully ignoring the consensus view from major medical associations. Kennedy has a track record for this sort of thing, and sponsored a measure to ban trans kids from competing on sports teams or using locker rooms, bathrooms, or showers consistent with their gender identity.

Virginia

Virginia, I think that you’re just mad you’re the northernmost of the southern states and so you compensate by being as conservative as humanly possible to prove that you fit in with the rest of the south. It’s like you have some sort of Napoleon complex about it. A Robert E. Lee complex? Whatever, Virginia, you need therapy. To wit: A proposed measure in Virginia would establish another “SAFE Act” that would effectively ban doctors from providing gender-affirming care to minors. The measure would also bar Virginia’s Department of Medical Assistance Services, which is responsible for the state’s Medicaid program, from providing coverage for gender-affirming procedures for kids under 18. -The Mary Sue 


Feb 11, 2023

How Gaslighting Manipulates Reality

Gaslighting isn’t just between people in a relationship—it involves social power, too.

By Paige L. Sweet

During her 12-year marriage, “Chandra” says, her husband routinely cheated and then told her she was “crazy,” “jealous” and “paranoid” when she produced evidence of his affairs. He often used the word “irrational,” historically a term used to demean women. Chandra worked, went to school and provided all of the care for their children, yet her husband convinced her that she needed him. He would, for instance, intentionally delay paying bills and then blame her when the lights were shut off—a strategy of financial control that made her feel dependent on him. During an hour-long Zoom interview as part of my research, Chandra repeatedly described her ex-husband as a gaslighter.

After ending the call with Chandra (a pseudonym to protect her privacy and safety), I jotted down notes: confusion, unequal caregiving responsibilities, shame, credibility loss, gender-based insults, verbal abuse. Her experiences are typical of the stories I’ve collected about gaslighting over the past few years. Over time the way Chandra’s ex-husband called her “crazy” and accused her of “overreacting” made her doubt herself as a reliable witness to her own experiences.

But this effect was not produced in a vacuum. Chandra was socially isolated from her friends and family. She was experiencing financial stress as well as a lack of support around balancing child care with her jobs. These vulnerabilities made her less able to resist her husband’s manipulations, and she became psychologically exhausted and entrapped. Chandra questioned her perception of reality, her memory and her ability to interpret events. She wondered if she was crazy.

Gaslighting is broadly defined as a type of psychological abuse that makes someone seem or feel “crazy.” It resembles other forms of psychological abuse and can be thought of as a subset of this larger category. We know that psychological abuse, and “crazy making” in particular, is a core feature of domestic, or intimate partner, violence. It functions in part by convincing victims that what they are experiencing is not real or important and then blames them for their experience.

The result is what sociologist Kathleen Ferraro has called the “surreality” of abusive relationships or what scholar and activist Beth E. Richie refers to as a “hostile social environment.” The word itself comes from a 1930s play called Gas Light that was turned into a 1944 film starring Ingrid Bergman. In it, the protagonist’s husband secretly dims and brightens the gas-powered indoor lights and insists she is imagining it, making her believe she is insane.

Over the past decade the term has become astronomically popular. Partly this is a result of the success of the #MeToo movement, which illuminated how victims of sexual violence and harassment are systemically doubted and discredited when they go public. Commentators have also used it to describe the mind-bending denials of reality coming out of the White House during the Trump presidency. The term “gaslighting” has exploded online among Twitter, Instagram and TikTok users interested in mental health, as well as among political and culture writers and popular psychologists.

But even though everyone seems to be talking about gaslighting, this type of abuse is just starting to be studied using systematic social scientific data. Although we tend to think of gaslighting as a problem between two people in a relationship, it also unfolds as part of an unequal social context. Gaslighting feeds off social vulnerabilities and stereotypes. It entrenches existing power imbalances while fostering new ones. The term is also increasingly used to describe structural racism, sexism, homophobia and ableism. Scholars and activists have used the term “racelighting,” for instance, to name racial microaggressions that undermine the experiences of people of color and the ideologies that cover up these behaviors; a 2021 policy report described race-based gaslighting as “institutionalized in the social fabric.”

Social theorists and writers from marginalized backgrounds have long insisted that social power works by trying to convince us that everything is normal while the conditions surrounding us are discriminatory and oppressive. As psychiatrist Ann Crawford-Roberts and her colleagues argued in 2020, watching George Floyd’s murder by a police officer and then being told his death was the result of preexisting medical conditions is “structural gaslighting.” Our task as sociologists is to follow the elusive, topsy-turvy ways in which social domination operates. We must follow what sociologist Avery Gordon calls the “spells of power” and the way patterns of noncredibility are established. By taking gaslighting seriously, we can learn about the relation between macro-level inequalities and the “micro” forms of silencing and disempowerment that people experience in their everyday lives.

DANGEROUS RELATIONSHIPS

As a sociologist, I’m interested in the social conditions and intimate dynamics that allow gaslighting to occur. In 2021 I set out to use in-depth qualitative research to figure out what makes gaslighting such an immiserating force. To find interview participants, I posted ads on social media defining gaslighting loosely as someone trying to make you “seem or feel crazy.” This recruitment strategy allowed anyone who defined their experiences as “gaslighting” to participate, no matter where or how they experienced it.

After conducting 122 interviews over six months and analyzing the patterns that make up this form of abuse, I became most intrigued by the social contexts where we find gaslighting, and its relation to inequalities around gender, sexuality, class, ability and race. Unsurprisingly, gaslighting does not involve just one of these axes of identity—rather people experience gaslighting intersectionally, meaning that factors such as age, race, gender and sexuality all matter for the way people’s realities are distorted, questioned or denied.

Based on my sample, there appear to be four central relationships or contexts in which gaslighting typically occurs: domestic violence; intimate partners who are not otherwise abusive; parents and other family members; and institutional gaslighting, primarily in the workplace. These forms of gaslighting rely on different dynamics—for example, domestic violence situations often include verbal abuse, whereas workplace gaslighting often has to do with racial discrimination. But they all involve power imbalances. This matters because it teaches us to ask different questions. Not, “Why did this person do that and what should the victim do in response?” But rather, “Who is establishing power and authority and how?” What follows are examples of these four contexts.

The experiences of “Selah” typify the domestic violence type of gaslighting. Selah’s ex-husband questioned her sanity for years, telling her she needed medication and that her family thought she was “unstable.” He once called a crisis mental health team to the house, claiming Selah was suicidal and couldn’t be left alone. After Selah left him and got her own apartment, her husband broke in while she was at work and made himself comfortable. When Selah arrived home, he pretended that nothing was amiss and asked what they were having for dinner. He distorted Selah’s reality (she had left him) by insisting on his own reality (they were still together). He peppered subtle threats throughout their conversation and wouldn’t let her leave the house to get groceries.

This was part of a years-long pattern: Selah’s husband stalked and harassed her each time she tried to leave, until eventually she fled in secret to a domestic violence shelter halfway across the country. This abuse had a sinister quality that made it difficult for Selah to describe what was happening. After all, what’s wrong with your husband coming over and asking what’s for dinner? As Selah explained, “They live in an alternate reality. And they want you to live there with them.”

Around 30 percent of the people I interviewed identified their parents as their primary gaslighters. “Audrey” feels that her mother doesn’t take her mental health problems seriously, insisting that Audrey’s depression and anxiety are not “real,” that she’s just being “lazy,” a “drama queen” and “overreacting.” Audrey has been hospitalized for her mental illness, has attempted suicide, and receives government assistance because her symptoms make her unable to work. Still, Audrey worries that no one will believe her symptoms are real. Audrey told me: “Maybe I am a loser. Maybe I have really poor character. Maybe I’m just whiny.”

Because of these fears, Audrey delays treatment and minimizes her symptoms. Her experiences exemplify a type of gaslighting that tends to start in childhood and persist over long periods. This gaslighting often involves a parent denying a child’s experiences in a way that exacerbates isolation and self-doubt. Here Audrey’s mother controls resources (housing, finances) and wields a significant amount of emotional power over Audrey, a kind of authority rooted in the parent-child relationship.

When “Maya” tried to get her boss to stop telling sexually inappropriate jokes at work, he accused her of “overreacting.” Things got worse, and when she put in her two weeks’ notice, she was asked to leave and not come back. After she filed for unemployment and claimed in the request for unemployment compensation that it was a toxic work environment, her boss—a lawyer—contested her claim with a 500-page document asserting that she had laughed at his jokes, so how could they be offensive? In other words: she must be making it up. He claimed that Maya had gone “bar hopping” during the pandemic, endangering the safety of her co-workers, even though Maya had been pushing for masking at work. “Everything that I was doing to try and keep myself safe, he would twist it around ... to appear that I was doing something nefarious or out of malevolence.” As the only nonwhite person in her office, Maya felt that he used stereotypes of people of color as aggressive to make her out to be a danger to the office.

“Alex,” whose fiancé gaslit her while they were in college, was not fearful of her partner. Unlike the other examples given here, their relationship appeared to be equal. But Alex was constantly made to blame herself for her partner’s actions, and a power imbalance quickly emerged. Alex’s partner would cheat on her and then deny it was happening. When Alex questioned her, she would say that Alex was “jealous” and “possessive” and ask why Alex didn’t value friends and “chosen family” as much as she claimed to. Alex felt confused and guilty; she stopped eating and sleeping. She started a journal in which she wrote down things her partner said to keep a record, fearful that her partner would undermine her memories.

Alex described herself as “dazed” and “numb” during the relationship. She explained that it was hard to identify this experience as “gaslighting” because there was no clear gender-based power differential between her and her same-sex partner. Alex’s experiences typify gaslighting in relationships that are not otherwise abusive, such that the manipulations were subtle and indirect but nonetheless made Alex doubt her ability to interpret reality. Unlike in Selah’s case, verbal abuse, extreme control, threats and physical intimidation were not part of the equation. Instead Alex’s partner gained power in the relationship by using Alex’s own values against her, insisting Alex was being “jealous,” a trait they both believed was toxic. She argued that Alex should be disappointed in herself.

What ties these stories together? Although strategies of abuse vary among cases, they all depend on the mobilization (or creation) of a power imbalance against the victim. The material effects of gaslighting may be more extreme in some cases (Selah received threats to her life; Maya had to leave a job in the middle of a pandemic), but what remains consistent is that controlling resources and narratives is key to how power imbalances are established and reproduced.

PATTERNS OF MANIPULATION

Our first task, then, is to reframe the way we think sociologically about abuse: gaslighting, like other forms of intimate violence, is not an incident but a process. Through my research, I’ve found that gaslighting typically unfolds as denial or distortion, isolation, shame, and attacks on credibility. The basic pattern is to deny or occlude, then flip the script. This pattern holds whether the perpetrator of gaslighting is a parent, friend, partner, mentor or boss.

When gaslighting is severe and affects victims’ lives in lasting ways, this pattern occurs in a context of isolation and as part of a power imbalance between the gaslighter and the victim. That imbalance may be the result of widespread social inequalities—for example, between male and female partners or between a white boss and a Black employee. Or it may be naturalized in the family, such as the age and authority differential between parent and child. This is what understanding gaslighting with sociological tools allows us to see: mental manipulation typically relies on existing social patterns of domination.

The classic film example of gaslighting suggests that an abuser intentionally distorts his partner’s sense of reality. My research shows that gaslighting may be unintentional—for example, Audrey doesn’t think her mother gaslights her on purpose. But it can also involve denial of another’s reality. When Selah’s ex showed up at her house and pretended everything was normal, he was denying the reality that she had left him. Alex and Chandra’s ex-partners both denied clear evidence of affairs and then disoriented Alex and Chandra with accusations of jealousy. Maya’s boss denied her experiences of harm in the workplace, distorting her responses to his jokes. Denying someone’s reality and distorting interpretations of past events are key to all forms of gaslighting.

Disorientation and denial are most effective if they take place in a context of isolation. For example, although Alex’s partner did not “isolate” her in the extreme way that many abusers do, the gaslighting occurred while she and her partner were out of the country, where Alex felt alone and out of sorts.

“Imani,” a domestic violence victim, explained that she became isolated because her abuser turned her against her own family. “He would make me think they’re not good for me.... I wouldn’t go down there [to visit family] anymore. [He would say,] ‘Why would you want to be around somebody that wasn’t there for you?’” Imani started to believe that her partner was the only one who loved her, that the rest of the world was against her. She no longer wanted to socialize; she didn’t even want to go outside. Imani’s experiences show how gaslighting turns inward. She came to believe she wanted the isolation.

This is important because isolation prevents victims from hearing a counternarrative to what’s happening in the relationship. For example, as part of institutional gaslighting, Maya’s boss accused her of unethical work practices and forced co-workers to surveil her communications, leaving her alienated and her colleagues suspicious. Domestic violence and institutional gaslighting tend to involve the most extreme forms of isolation. Isolation, as one of my interviewees put it, is the “breeding ground” for gaslighting.

Gaslighting also works by instilling shame, which makes victims feel that the abuse is their fault. “Summer” explained that her partner likes to provoke her into fights. He needles her with insults and stories of his relationships with other women, whom he says are better than her at cooking, at sex, at being a mom. He waits until she starts crying and yelling. “And he stood there, and he goes, ‘You’re acting really crazy right now, and I do not understand why,’” Summer recalled. “And I was like, oh, my gosh, it’s finally happening to me ... I’m tearing things off the wall ... I just could not take it anymore.... And then [he had this] look, pitiful, on his face. He’s like, ‘I was just trying to have a conversation with you.’”

Here Summer’s boyfriend, who has strangled Summer and threatened her with guns, flipped the situation to make her out to be unstable and violent. He then used her intense shame about “going psycho” to threaten that he would tell others about how she acted. Shame is central to gaslighting because it keeps victims trapped in the exhausting cycle of defending themselves against assaults on their integrity.

Shame also weakens a victim’s credibility with themselves and others. The result is what feminist philosophers call “testimonial injustice,” wherein prejudice causes people to withhold credibility from someone’s narrative. Summer’s abuser told his family that she is the one who beats him and lies about it. This strategy of “credibility slashing” is effective even though he is on probation for domestic violence.

Attacks on victims’ credibility often work by appealing to community values, as when “Elyse’s” ex-husband told friends and family that she was acting “ungodly” and out of character after filing for divorce. Making a victim seem unstable in trusted social networks exacerbates isolation.

Victims experience attacks on their credibility across types of gaslighting, although the form of those credibility attacks is specific to the institutional and social context in which gaslighting occurs. These attacks matter for legal proceedings such as divorce (for Elyse) and unemployment filing (for Maya). Attacks on credibility also diminish victims’ ability to trust themselves, to know that what they are experiencing is real. Victims often come to feel that no one will believe them, making them doubt themselves as reliable witnesses.

TAKING GASLIGHTING SERIOUSLY

Despite the consequences of this abuse, “gaslighting” has the makings of a flash-in-the-pan buzzword. The term has plenty of skeptics, especially among academics and commentators who argue that it lacks clarity and is overused. “Gaslighting” is indeed used in fast and loose ways in popular culture, without the rigor of social scientific research to back it up. It’s often wrapped up in self-help culture, which can perpetuate messages that focus on individuals’ actions and reinforce victim blaming. Sometimes it’s conflated with simple lying or with other kinds of emotional abuse such as humiliation.

I agree with many of these criticisms. But mostly I’m relieved that we now have a language to talk about psychological abuse and its links to oppressive structures such as racism and ableism. Learning the term “gaslighting” gave Chandra, a 50-year-old Black woman, a container for identifying real patterns of abuse and discrimination. She’s in a happier marriage now, but her happiness has been hard won: By leaving her ex-husband, seeking out higher-paying jobs, and working with counselors to identify her ex’s abusive behaviors, she was able to regain her autonomy. If people such as Chandra are using “gaslighting” to make sense of confusing and harmful experiences, I think we have a net positive here. After all, there’s nothing precious about a made-up word from a movie—so why not use it to name confusing forms of injustice and to argue for more equal social relationships?

Undeniably, gaslighting is a harmful type of psychological abuse that preys on people’s social vulnerabilities. High rates of psychological abuse reported more generally suggest that researchers should pay closer attention to gaslighting and its lasting effects on victims’ lives, regardless of whether physical violence is also present. One of the clearest patterns to emerge from my research is that the effects of gaslighting are worse for people who lack social networks and structural protections.

Some of those supports are things policy makers could choose to provide. For example, when people have access to a living wage, child care and safe housing, they are less dependent on bad jobs and abusive partners. Would Chandra have stayed with her gaslighting husband for 12 years if she had access to money and child care? Would Audrey’s mother’s gaslighting be so effective if Audrey’s disability benefits paid enough that she could live on her own? People who experience gaslighting around their material vulnerabilities are particularly at risk of staying in bad relationships longer.

Robust social networks of friends, family and neighbors also matter. Generally, the people I interviewed who were able to leave gaslighting relationships quickly had people they could rely on to validate their realities and give them positive counternarratives about their self-worth. Gaslighting is harmful not only because it draws from and exacerbates social inequalities but because it becomes internalized in a context of isolation, making one question one’s sense of self. Coming to doubt oneself as a reliable interpreter of the world does significant damage. But context matters. If social networks and community support are protective, we can rely on one another to prevent or reverse the worst effects of gaslighting. -Scientific America

After Roe: 3 Troubling Trends

 By RIn the early ’90s, my Catholic grade school hosted a guest speaker, a member of the Pennsylvania state legislature. After giving our eighth-grade class a basic civics lesson, he opened the floor to Q&A. And, in the excruciating hour that followed, every last question consisted of some variation of, “What are you doing about abortion?” You see, my classmates and I had been so marinated in anti-abortion rhetoric that we couldn’t understand why someone in his position could waste time with tax codes when there were so many babies to save. By the end of the session, our local representative was visibly shaken. I wonder whether he ever agreed to speak at a parochial school again.

That episode has been at the front of my mind since news broke of the Dobbs decision, “among the Court’s worst decisions in history.” While there would never be a good time for the Supreme Court to take away a half-century-old constitutional right, there could hardly be a worse time than right now, with major news outlets still committed to a pernicious bothsidesism. 

It didn’t take long for the horror of forced-birth policies to become obvious. Less than a month after Dobbs, a 10-year-old rape victim in Ohio had to leave the state to seek an abortion. That story, along with many others, convinced some conservatives to recalibrate their message, even if that meant downplaying or—in the case of senate candidate Blake Masters—denying their anti-abortion stance.

A peculiar assortment of anti-abortion pundits has stepped into this morass. Unlike my classmates, these more sophisticated activists hope to salvage some civility from the shitstorm they helped to create. 

Readers may have already come across op-eds or expert panels calling on the anti-abortion movement to shift its focus from pressuring the Supreme Court to building some kind of abortion-free utopia, where people with unintended pregnancies find the support they need to carry the baby to term. Major outlets have provided space for anti-abortion activists in centrist drag to lament the abruptness of Dobbs as they call for humility and dialogue.

I’m not the first to notice these efforts at hand-waving and damage control. The Atlantic’s Elaine Godfrey has written about the anti-abortion advocates who claim to support widening the social safety net, even as their plans seem to lack some key details; Savannah Jacobson of Slate.com has criticized the New York Times for amplifying the voices and overstating the charitable efforts of anti-choice activists; and RD’s Mary E. Hunt has called out the Catholic bishops who, after a post-Dobbs victory lap, released a statement touting their work to support pregnant people. 

My own bullshit detector has picked up a few trends among these “compassionate” anti-abortion types, starting with a specific kind of pearl-clutching that’s become a genre all its own. 

Who, us?

Many of the more polite anti-abortion advocates seem to have only recently noticed how authoritarian and misogynistic their movement is. For example, David French, who’s earned praise as a Trump critic, nevertheless appears unable to see how the movement’s inability to compromise is a feature rather than a bug. 

In a recent interview, French stated that, while he agrees with Dobbs, the case was decided at “a bad time” because “we’ve been polarized” (note the passive voice). Three separate times, he describes anti-abortion trigger laws—abortion bans designed to automatically take effect at the overturn of Roe—as merely “performative,” as though the people who passed them didn’t really mean what they were doing. (They did.) 

A number of others have expressed a similar view, like the panelists in a recent discussion hosted by Georgetown University who lamented the moral “compromises” that anti-abortion activists have made. Others, like Religion News Service columnist Charles C. Camosy, have—either naively or disingenuously—called on the movement to move past Trump, as though the movement could easily shed its racism, hatred of LGBTQI people, and the other hallmarks of Christian nationalism. I found it amusing that a few (like here and here) called on anti-choicers to essentially abandon the former president without actually naming him. 

Even if I were to play along and assume that these experts are sincere, it’s too late for them to notice that the anti-abortion movement might have somehow lost its way. Indeed, the movement has consistently demonstrated that resentment and authoritarianism are among its animating principles. One of the consequences of going down that road is siding with a huckster like Trump, which played the biggest role in the polarization that these pundits find so regrettable. Anti-abortion advocates never hid their anti-democratic tactics, from stealing Supreme Court seats to gerrymandering state legislatures. No one gets to frame the alliance with Trumpism as an “inconvenient truth” that can now simply be reversed without consequences.

We’re here to help!

A second trend I’ve noticed: anti-choicers paying lip service to progressive reforms like subsidized healthcare, while failing to explain whom they’d be willing to vote for, which specific policies they would support, and which policies actually have any realistic chance of being implemented within our lifetimes. 

For example, in a commentary from late 2021 anticipating the fall of Roe, Erika Bachiochi, a fellow at the conservative Ethics and Public Policy Center, suggested that somehow, some way, the pro-life movement can compel the Republican Party to bolster the social safety net. Since then, unfortunately, Rick Scott, head of the National Republican Senatorial Committee, has put forward a Congressional agenda hellbent on gutting social services. In so doing, Scott merely put into words what his party has been trying to do for decades. Meanwhile, Oren Cass, writing for CNN, has touted the Family Security Act, a post-Roe welfare program with no shot at becoming law, and one that would be inadequate if it did. 

Conservative Catholic writer Leah Libresco Sargeant has called for more support for pregnant women. Sounds good, until you listen to this conversation with the New York Times. A surreal moment occurs around the 11-minute mark, when Sargeant is asked how she feels about Dobbs’s potentially devastating impact on poor people. She deflects by talking about how European abortion laws are more restrictive than those in the US. 

The moderator repeats the question, though this callout has been stricken from the transcript for some reason. Sargeant then concedes the moderator’s point—right before doubling down on her opposition to abortion rights. Fellow panelist Michelle Goldberg correctly summarizes Sargeant’s answer as: “I feel bad for you. I want to help you. But at the end of the day, too bad.”

Sergeant’s nebulous position is consistent with the American Solidarity Party, for which she serves on the board of advisors. If you’ve never heard of the American Solidarity Party, that’s because they have no shot at winning an election anywhere. Ever. The party seems to exist for the sole purpose of allowing anti-Trump conservatives to vote with a clearer conscience. 

Anti-abortion advocates in this camp also tend to call for religious organizations to provide the services that pregnant people will need in a post-Roe world. In reality, religious institutions provide a fraction of the services that state and federal governments do, only with no oversight and no accountability. Social Security alone costs over a trillion dollars a year. There’s no possible world in which religious institutions could make a difference, even if they vow to “redouble” their efforts, as the Catholic bishops have done.

These gestures appear to be deliberately meaningless, or hopelessly naive. Is it realistic to expect a kinder, gentler abortion ban from the people who burned everything down to overturn Roe, especially in the states that are the most likely to criminalize the practice? Don’t bet on it. And certainly don’t bet on the bishops threatening to withhold communion from a politician over it. 

No follow-up questions, please

A third trend: as many of the examples above show, anti-abortion “centrists” are a little too coy about what they’re willing to accept in order to maintain the criminalization of abortion. This is especially important to me because the simple question of how exactly we would enforce a ban on abortion is what compelled me to change my mind on the issue. 

Journalists must press these activists harder on where they draw the line; on what their limits would be. There was a brief taste of this in Chuck Todd’s recent discussion with Mallory Carroll of Susan B. Anthony Pro-Life America. Toward the end, Todd asks Carroll if the movement would be better off with the compromise of a 15-week ban—which was at the heart of the Dobbs case—rather than throwing out Roe entirely. Her answer: “Absolutely not.” In a sense, you have to appreciate her candor. But it goes to show that many anti-abortion activists want people who can become pregnant to live with this newly-located Overton window no matter what comes next. Keeping abortion illegal will always be more important to them than alleviating the suffering that an abortion ban would cause. There’s no turning back. 

But the questions shouldn’t stop there. What if the maternal mortality rate goes up? What if the police treat miscarriages as potential homicides? What if Dobbs becomes the template for dismantling other rights? And what about the fascists who’ve been empowered by Dobbs, like Doug Mastriano, who could become the next governor of my home state of Pennsylvania? Would the anti-abortion movement support the person—a Democrat?!—with the best chance of defeating someone like that? Or would they simply rationalize this latest deal with the devil, like they did with Trump? 

The criminalization of reproductive healthcare is a looming disaster, not a mere policy distinction. We should treat it like one, even if it means telling certain people that dialogue with them is a waste of time. Humility and dewy-eyed optimism about conservatives having a change of heart simply aren’t enough. These activists have scored their big victory. Instead of spinning it as a promising new beginning, they should instead spend more time thinking about what they’ve done. -Religion Dispatch

Oct 29, 2022

PrEP Coverage Violates Religious Freedom

U.S. District Judge Reed O'Connor ruled Wednesday that requiring insurance companies to cover medications to prevent HIV transmission violates plaintiffs' rights on religious grounds.

By Christopher Wiggins

A federal judge in Texas has ruled partially in favor of plaintiffs who argued that requiring insurance companies to cover medications for HIV pre-exposure prophylaxis, or PrEP, violates their rights on religious grounds. 

Jonathan Mitchell, who founded a one-person law firm in 2018 intending to challenge decades-old Supreme Court rulings, brought the case Braidwood Management Inc. v. Xavier Becerra in the Northern District of Texas. Becerra is the secretary of Health and Human Services.

In that court, U.S. District Judge Reed O’Conner ruled in favor of plaintiffs who argued that paying for insurance that covers PrEP violates their religious beliefs because PrEP “enable[s and encourages] homosexual behavior.”

In the 42-page ruling, O’Connor writes, “The PrEP mandate violates Braidwood’s rights under [Religious Freedom Restoration Act].”

Mitchell helped draft Texas’s Senate Bill 8, the restrictive 2021 abortion law that made everyday people bounty hunters who could sue anybody they believed may have been involved with the procedure.

O’Connor writes in the ruling that the federal government “outline[s] a generalized policy to combat the spread of HIV, but they provide no evidence connecting that policy to employers such as Braidwood.”

He continues, “Thus, defendants have not carried their burden to show that the PrEP mandate furthers a compelling governmental interest.”

A spokesperson for the Department of Health and Human Services tells The Advocate that “HHS continues to work to ensure that people can access health care, free from discrimination. If individuals feel that they have been denied care, we would encourage them to file a complaint with the Office for Civil Rights.”

George W. Bush appointed O’Connor in 2007. He is no stranger to controversial rulings.

“When it comes to this kind of lawsuit, you have to know the context of where it’s filed,” Harvard Cyber Law Clinic instructor Alejandra Caraballo told The Advocate’s sibling publication Plus recently. “[Conservative attorneys] know how to game the system to get particular judges like ... Reed O’Connor.”

O’Connor also ruled in favor of the plaintiffs’ argument that the U.S. Preventive Services Task Force, or PSTF, which recommends what qualifies as preventative medical care under the Affordable Care Act, is unconstitutional because it “wields a power to compel private action that resembles legislative authority.”

As principal officers, PSTF members must be appointed by the president and confirmed by the Senate, according to O’Connor.

“The PSTF members indisputably fail that constitutional requirement,” he writes.

The ruling dismissed a claim that challenged the preventive mandate outright.

O’Connor’s solution could potentially jeopardize free access to other services, including cancer screenings, medical screenings for pregnant women, and some counseling services across the country. 

Under the constitution, he found the Health Resources and Services Administration and the Advisory Committee on Immunization Practices to be empowered appropriately to address preventive services under the ACA. 

O'Connor's ruling is not surprising to seasoned observers.

A coalition of conservative groups sued the Equal Employment Opportunity Commission to allow them to discriminate based on religious grounds, and O’Connor ruled in 2021 that they could proceed. This was despite the Supreme Court extending employment protections for LGBTQ+ people a year earlier. In addition, O’Connor struck down Obama-era health insurance protections for LGBTQ+ people and ruled the Affordable Care Act was unconstitutional (the Supreme Court later reversed O’Connor’s rulings). 

“You can file in a certain office, and you can get guaranteed a judge — and those judges have been stacked — that isn’t just conservative; these judges are reactionary,” Caraballo said. “So [lawyers] can be explicitly homophobic in their complaint and say, ‘Hey, this is our religious belief.’”

In August, O’Connor granted Mitchell’s motion to rename the case from Kelley v. Xavier Becerra to Braidwood Managment Inc. v. Xavier Becerra because of bad publicity the case had received after The Advocate reported news of the matter in July.

Legal experts have expressed outrage at the ruling.

Political scientist and Georgia State Law School professor Anthony Michael Kreis warns that this is the opening salvo in a mission to remove LGBTQ+ rights. –Advocate

Monkeypox Being Spread Through Sex

Chris Johnson

Amid fears monkeypox would spread at an increased rate at the end of summer as gay men gather in close quarters for dance parties and other celebrations, health experts are starting to emphasize that the current outbreak isn’t spreading through minimal skin-to-skin contact, such as brushing up against a fellow shirtless dance partner, but rather through sexual activity and overwhelmingly among men who have sex with men.

With reported cases of monkeypox in the United States this week reaching 15,505, according to data from the Centers for Disease Control, a number of health experts who spoke to the Blade talked about outright declaring monkeypox a sexually transmitted disease as part of this messaging — although they acknowledge such a label would have pros and cons.

Juan Carlos Loubriel, senior director of community health at the D.C.-based Whitman-Walker Health, was among the health experts making the distinction between the negligible risks of transmitting monkeypox through brief skin-to-skin contact as opposed to sexual activity.

“I’ll say that we need to provide the real facts to our community that indicates right now that the majority of the cases are sexually transmitted, right?” Loubriel said. “So transmission is not occurring by casual touch, right? That’s what we know as of today … So the majority of the cases [are] by prolonged skin-to-skin contact, and during sex there is a lot of skin-to-skin contact.”

As health experts at large are beginning to make a distinction in how the disease is transmitted, the Biden administration has also taken up messaging that downplays the risk of monkeypox transmission through minimal skin-to-skin contact.

Demetre Daskalakis, who is the face of the LGBTQ outreach for the Biden administration as deputy coordinator of the White House monkeypox task force, made colorful remarks Friday during a conference call with reporters downplaying the risk of contracting monkeypox through brief contact, quoting a senior policy adviser at the CDC who has studied LGBTQ health issues.

“I think I’m going to quote my friend Robbie Goldstein that sex involves friction, and friction seems to be how this happens,” Daskalakis said. “So, I think, that from the perspective of events, the real risk at an event is low. Of course, you have to gauge that risk based on what you’re doing, so if there’s a lot of clothes out dancing and friction, that could be a mechanism of transmission, but just brushing by someone, I’ve said this many times before, just brushing by someone is probably low or no risk.”

Asked by the Blade during the call about any consideration on declaring monkeypox a sexually transmitted disease, Daskalakis said it’s “really important that the decision around monkeypox and whether it’s designated happen thoughtfully from the perspective of other implications.”

“What’s really important from the perspective of our communication on the ground is that our harm reduction and safer sex guidance really does mention the importance of sexual transmission or the associated transmission of the virus, and also provides guidance necessary, like reminding people that condoms may have a role — not necessarily the full role — in preventing monkeypox, but also reminds folks that skin-to-skin contact in the context of sex can be really a part of how transmission occurs,” he said.

The messaging is consistent with new studies finding cases of monkeypox are overwhelmingly the result of sexual activity. According to a recent report by NBC News, an increasing amount of scientific evidence — such three studies published in peer-reviewed journals, as well as reports from national, regional, and global health authorities — has indicated “experts may have framed monkeypox’s typical transmission route precisely backward.”

“[A]n expanding cadre of experts has come to believe that sex between men itself — both anal as well as oral intercourse — is likely the main driver of global monkeypox transmission,” the NBC News report says. “The skin contact that comes with sex, these experts say, is probably much less of a risk factor.”

With evidence the monkeypox outbreak is overwhelmingly being transmitted through sexual activity and risks from skin-to-skin contact virtually non-existent, experts say discussion on whether or not to label the virus as a sexually transmitted disease are ongoing and controversial.

On one hand, designating monkeypox as a sexually transmitted disease would give the public a clearer idea about the way it’s being transmitted to allay concerns and enable the public to take appropriate precautions. On the other hand, as seen during the height of HIV/AIDS crisis, an emphasis on monkeypox being transmitted among men who have sex with men may have the effect of stigmatizing the community (and the sexual activity) as being responsible for the outbreak.

Loubriel said the issue of whether or not monkeypox should be messaged more as a sexually transmitted disease is “a very good question and also a very big debate around public health, even within the public health sector.”

“The only reason we cannot say it is just sexually transmitted is because we know as a fact that it can be spread by other various avenues like touching clothing, bedding with an infected person or towels being used by someone with monkeypox, potentially contact with respiratory secretions,” Loubriel added. “So that is why it’s probably not been named as a sexually transmitted infection.”

Joseph Lee, a professor of health education at East Carolina University who studies health inequities among LGBTQ people, said there’s “real tension” in finding the right messaging, which he said would strike a balance between being factual while not being stigmatic of the marginalized community affected by monkeypox.

“We see when we have messaging that goes to the general public…that messaging about how a particular group is doing worse triggers negative stereotypes and makes people feel less at risk than they are,” Lee said. “And really importantly, it makes the group at the worst end of that problem feel sometimes like they’re feeling fatalistic or they can’t do anything to protect themselves. You almost feel like you have to give up and you’re just going to get it anyway because the messaging is so clear, how much it’s impacting your community.”

Lee, however, praised communications on monkeypox from the Centers for Disease Control & Prevention, saying the agency has “very useful guidance about promoting equity in monkeypox communication that I actually really like.”

Key points in the guidance, Lee said, is messaging that monkeypox can affect anyone, while going through some of the ways the virus is being transmitted and ways the public can protect itself. The guidance, Lee said, follows the right strategy of articulating a message to the general public, then adding more specific messages about protection against the disease and risk to the communities most vulnerable.

“That’s sort of their big picture strategy that I think is actually the right strategy,” Lee concluded. “How well everyone’s implementing it across the country in our messy, somewhat broken public health system is another question.” -Washington Blade

Sep 10, 2022

Experiences With The Monkeypox Vaccine

By Lily Wakefield

Queer people who have had the monkeypox vaccine have said they have been relying on social media and the LGBTQ+ community to access accurate information.

Of the more than 18,000 global cases confirmed by the World Health Organization, 98 per cent have been among gay and bi men, and other men who have sex with men.

Across the world, smallpox vaccines are being used to prevent monkeypox, but because of the unprecedented nature of the recent outbreak, they are in short supply.

PinkNews spoke with three UK-based queer people who have had their smallpox/ monkeypox vaccine about access, stigma, and the murky nature of public health messaging.

Mark, a gay man in London, said he was able to access a vaccine through his regular sexual health clinic as he was already part of its PrEP programme.

He was contacted by the clinic and was able to get his vaccine a few days later.

For Mark, accessing information about monkeypox was fairly straightforward: “I did work in public health, so I kind of spotted it quite early on… I’d never really heard of monkeypox before.

“I saw loads of stuff from the Terrence Higgins Trust, loads of social media stuff. That was just really good to see people putting my mind at rest.

“Like yeah, I don’t want to get it, but if I did get it, it’s very unlikely to sort of floor me. So I think it was a case of doing some of my own research.”

However, Son, another London-based gay man, has felt let down by public health messaging surrounding monkeypox.

“I don’t think I have had enough information from the NHS,” he told PinkNews.

“All the information I got on monkeypox was on Twitter, from people who work in that sexual health space, or the gay community, the LGBTQ+ community.”

To access his vaccine, Son relied on information from his friends and local queer community.

“I’m in a WhatsApp group where people were sharing information about the vaccine,” he said.

When available slots came up at London clinics, the group would alert each other, and after repeatedly refreshing a page, he managed to book an appointment.

Referencing the hours-long queues for a monkeypox vaccine drop-in clinic held last week at London’s Guy’s and St Thomas’ Hospital, he added: “I was lucky I didn’t have to queue for that long.”

Despite his disappointment with official sources, Son said he was grateful that the queer community was so ready to offer support and information: “I think it’s fantastic that so many people are mobilising and messaging around the community for people to get the vaccine… I think we’ll be entering another pandemic, if we’re not careful.

“So I think it’s extremely important to be mindful of what’s going on.”

He added: “We are actually the ones who are doing everything in our power to protect the community.”

Drawing on his background working in public health, Mark said that he suspects the lack of direct messaging from the government and NHS might be intentional, as the LGBTQ+ is likely to listen better to more trusted sources – their own community and charities that represent them.

However, he does feel that messaging has been very “London-centric”.

He said: “I don’t know whether that’s just because there’s a risk model, because there’s obviously a lot of GBMSM [gay, bisexual and men who have sex with men] in London compared to Bristol, for example.

“But I’ve seen people saying ‘I’m not sure how to access the vaccine in Manchester’, for example. It seems to be done in a very localised way.”

One person who has accessed the monkeypox vaccine who is neither a London resident nor a queer man is Melissa, a polyamorous trans woman in Devon.

“I’m polyamorous and I’m and I’m bi,” she told PinkNews.

“One of my partners is a bi man who plays on the gay and bisexual men who have sex with men scene.

“We’re all very careful – I have my main relationship, and then when we’re doing anything sexual with anyone else we take PrEP, use condoms, check into the sexual health clinic for the things that can be picked up that you can’t prevent and we’ve got the full set of vaccines for hepatitis and HPV.

“We are at risk, but we mitigate against those risks. Because I have PrEP for on-demand use for when I am seeing other people, then the clinical guidelines that the sexual health clinics are using at the moment are pretty much the same as for PrEP.

“If they’ll give you PrEP, they’ll give you the monkeypox vaccine.”

For men like Son, there is some fear about how accessing the vaccine, and monkeypox in general, could be weaponised against queer men, like “another HIV or AIDS epidemic”.

But for Melissa, the stigma surrounding monkeypox pales in comparison to stigma she experiences simply existing in the UK.

Sounding resigned, she said: “I’m out fully as a trans woman in all of my life, I’m poly, which is far more stigmatising… It’s comparative stigmas.” -Pink News

Aug 27, 2022

Fighting Monkeypox

Clinics that treat sexually transmitted infections are on the front lines of the rapidly growing monkeypox outbreak.

By Liz Szabo, Lauren Weber and Kaiser Health News

Clinics that treat sexually transmitted diseases—already struggling to contain an explosive increase in infections such as syphilis and gonorrhea—now find themselves on the front lines in the nation’s fight to control the rapidly growing monkeypox outbreak.

After decades of underfunding and 2½ years into a pandemic that severely disrupted care, clinic staffers and public health officials say the clinics are ill-equipped for yet another epidemic.

“America does not have what it needs to adequately and totally fight monkeypox,” said David Harvey, executive director of the National Coalition of STD Directors. “We are already stretched to capacity.”

Monkeypox—a cousin of smallpox—is not technically considered a sexually transmitted infection. But it spreads through close contact and is now being transmitted largely through networks of men who have sex with men.

Because the current monkeypox outbreak causes blisters or pimples on the genitals, many patients are seeking care for what appears to be herpes, syphilis, or another sexually transmitted infection. Patients often prefer to seek care anonymously at public clinics, rather than visit their primary care doctors, because of the stigma of sexually transmitted infections.

Although most people with monkeypox recover on their own in two to four weeks, about 10% need hospital care, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine.

The degree of complications from monkeypox “has been much higher than any of us expected,” said Dr. Mary Foote, an infectious diseases expert at the New York City Department of Health and Mental Hygiene, who spoke July 14 during a webinar presented by the Infectious Diseases Society of America. In addition to severe pain, some people with monkeypox are at risk of permanent scarring. Foote said the pain can be excruciating, making it difficult for patients to swallow, urinate, or have bowel movements.

Sexual health clinics have been stretched so thin that many lack the staff to perform such basic duties as contacting and treating the partners of infected patients.

These clinics are some of the most neglected safety nets of the nation’s tattered public health system, which has less authority and flexibility to fight outbreaks today than before the covid-19 pandemic.

With 1,971 monkeypox cases reported since May in the United States—and about 13,340 around the world—doctors warn the epidemic may have grown too large and diffuse for them to contain.

Dr. Shira Heisler, medical director of the Detroit Public Health STD Clinic, said she’s proud of the quality of care she provides but simply doesn’t have time to see every patient who needs care. “We just don’t have the bodies,” she said. “It’s a total infrastructure collapse.”

Funding from the Centers for Disease Control and Prevention to prevent sexually transmitted infections has fallen by almost 10% since 2003, to $152.5 million this year, even though syphilis cases alone have more than quadrupled in that time. Taking inflation into account, that funding has fallen 41% since 2003, according to an analysis by the National Coalition of STD Directors.

Meanwhile, hundreds of local and state health professionals who trace the origins, track the trajectory, and stop the spread of cases reported by sexual health clinics have quit or been replaced since the pandemic began. Some left due to burnout, and others were driven from their jobs by critics protesting unpopular policies on masks and lockdowns. Some federal grants to strengthen the public health workforce are just now being rolled out.

Data reporting systems have not been updated during the pandemic, in spite of glaring inadequacies it helped reveal. Public health workers still use fax machines to deal with monkeypox cases in Florida and Missouri, public health officials told KHN.

“Even with the advantages of having a test and a vaccine, we still haven’t invested enough in the public health system in order for us to respond quickly enough,” said Dr. Tao Kwan-Gett, Washington state’s chief science officer. Many people “will tell you we have the best health care system in the world. But I think the covid-19 pandemic, as well as [the monkeypox] outbreak, shows that the system is broken and needs fixing.”

The White House is distributing hundreds of thousands of monkeypox vaccines now, releasing additional doses as they become available, for a total of nearly 7 million doses within the next year.

But Hotez said those vaccine shipments “may not be sufficient.”

Some cities are running out of doses shortly after opening their doors. In New York City, where monkeypox cases have tripled in the past week, the vaccine rollout has been plagued by technical glitches; the vaccine website has crashed at least twice. San Francisco officials said their city is also running low on vaccine supply.

Monkeypox vaccines can effectively prevent infection in people before they’re exposed to the virus.

Experts believe vaccines may help prevent infection after exposure, as well. But they’re most effective if administered within four days after close contact with a monkeypox patient, said Dr. Trini Mathew, medical director of antimicrobial stewardship and infection prevention and control at Beaumont Hospital in Taylor, Michigan. Vaccines given between four and 14 days of exposure may reduce symptoms but not prevent the disease.

Yet the battered public health system isn’t built for speed.

Although monkeypox tests have become easier to access in recent days, some public health systems don’t have enough staff to quickly locate and test patients’ partners. And because most health professionals have never managed a case of monkeypox, patients often must make multiple visits before being accurately diagnosed.

Contacting exposed people becomes more complicated if they live across the county or state line, which can require coordinating an outbreak response with additional health departments, said Shawn Kiernan, chief of the communicable disease section for Virginia’s Fairfax County Health Department.

Decades of budget cuts have led many sexual health clinics to limit their hours of operation, making it harder for patients to receive care.

Public health departments have lost key members of their teams in recent years, including highly trained nurses and outreach specialists.

A 2020 KHN-AP analysis found that at least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a tattered workforce to confront America’s public health needs — and that was before covid hit. That investigation found only 28% of local public health departments have statisticians or epidemiologists, the disease detectives who investigate the source and trajectory of infectious outbreaks. More than 2.4 million sexually transmitted infections were reported in 2020, according to the CDC.

“I don’t think any health department in America could handle all the STIs that get reported to them,” Kiernan said.

The federal government has spent billions of dollars fighting the covid pandemic, and some covid-related grants will be used to expand the overall public health workforce.

But the CDC and Congress often designate funds for specific purposes, said Lori Tremmel Freeman, head of the National Association of County and City Health Officials. “If you have somebody working on covid, you can’t just reassign them to monkeypox using the same bucket of money,” Freeman said.

And in some states, that money hasn’t yet reached public health departments or sexual health clinics.

The CDC gave Michigan millions of dollars to strengthen its public health workforce, but the Michigan Legislature appropriated only a portion of the money. Heisler wrote to multiple state legislators begging them to free up the remaining funds. None replied to her.

Public health workers say they hope monkeypox will be a wake-up call.

“I hope this drives home the need for more investing in public health infrastructure,” said Kwan-Gett of the Washington state health department, “because without that investment, this is just going to happen again and again.” -POZ

New York’s Polio Crisis


How a polio case in New York — and genetic evidence of under-the-radar spread — affects US risk and global eradication efforts.

By Miranda Dixon-Luinenburg

For the first time in almost a decade, a case of polio was confirmed in the United States. Health officials in New York’s Rockland County discovered the case last month in an unvaccinated 20-year-old, decades after polio was eliminated from the US in 1979. On August 12, New York City health authorities reported that they had detected the polio virus in the local wastewater system, indicating that the virus was likely circulating under the radar in the city.

With the country and public health system already struggling under the weight of Covid-19 and monkeypox, this news comes as an unpleasant surprise, and instantly raises questions. How did this happen? Who else is at risk? What does it mean that the Rockland case was a vaccine-derived strain, and what are the implications for the global efforts to fully eradicate polio?

What is polio?

Polio, short for poliomyelitis, is caused by the poliovirus, an enterovirus that can infect the nervous system. Symptoms can range from those similar to the flu (sore throat, fever, and fatigue), to a more severe infection of the spinal cord causing meningitis and even paralysis. But unlike the flu, the poliovirus multiplies mainly in the intestines, and it chiefly spreads when people don’t wash their hands after using the bathroom. Polio is highly contagious, at least to the unvaccinated, particularly in areas with poor sanitation and water safety.

From the first documented US outbreak in 1894 until vaccines were developed in the 1950s, polio was one of the most feared childhood diseases. Thousands of children were left paralyzed with every summer outbreak. The most vulnerable were children under the age of 5.

But those victims were the exception; three-quarters of patients infected with the poliovirus show no symptoms at all. For most of the remaining quarter, the illness never progresses beyond flu-like symptoms. In roughly one in 25 patients, however, the virus spreads to the nervous system and causes meningitis. About one in eight of the meningitis cases — or approximately 0.5 percent of total polio cases — will have permanent damage to their nerves that leaves them paralyzed. There was and is no known cure, only supportive  treatments including the iron lung — since replaced by more advanced ventilators — and physical therapy.

The threat of polio changed permanently when two vaccines were discovered in short succession: an injected, inactivated vaccine by Dr. Jonas Salk in 1955, and a live-attenuated vaccine, taken orally, by Dr. Albert Sabin in 1961. Both vaccines are very effective, granting 99 percent immunity to infection. Sabin’s oral vaccine was eventually adopted widely in the US, and polio cases dropped drastically in the 1960s and 70s, until the wild virus was stamped out entirely in the country.

The US was ahead of the curve — a global vaccination campaign began in earnest in 1988, a few years after smallpox was declared eradicated in 1980. The US switched to the slightly safer inactivated, injected vaccine in 2000, and the shots are still recommended to all children on the standard childhood vaccine schedule. Worldwide, thanks to ongoing public health efforts, hundreds of millions of children receive the oral vaccine every year, and the original wild virus has been driven out of all but a handful of countries.

Where did this case come from?

Since community spread of polio was eliminated from the US around 1980, all infections have come from other countries that still have the disease. Genetic sequencing shows that the recent case was a vaccine-derived poliovirus strain. This means the circulating virus isn’t from one of the few remaining pockets of endemic wild poliovirus, but rather from one of the many more countries with polio outbreaks that mutated from an oral, live-attenuated vaccine — which is not the vaccine currently used in the US.

Polio vaccines fit into one of two types: inactivated or live-attenuated. Live-attenuated vaccines, like the combined measles, mumps, and rubella vaccine recommended to all US children, contain a modified, weakened strain of a pathogen that doesn’t cause illness in humans, but still triggers an immune response that protects against the original strain. The oral vaccine used in the most at-risk countries is live-attenuated. Inactivated vaccines, like the polio vaccine currently used in the US, contain only dead virus material, and may need a longer series of booster shots to stimulate the immune system enough to grant long-lasting and full immunity.

Although the live-attenuated poliovirus vaccine almost never causes polio itself — except in the less than one in a million cases when a child is severely immunocompromised — the fact that it contains a live virus inevitably carries some risk, unlike inactivated vaccines. When live-attenuated polio vaccines are given in a community that contains a high fraction of unvaccinated people, the modified virus can infect others, and with enough generations of spread, it can — very rarely — mutate back into a new virulent strain. It’s essential to public health efforts to make sure enough people get vaccinated, to protect against both the wild virus and the possibility of new vaccine-derived strains.

Ironically, the fact that most polio cases are asymptomatic or mild — along with an incubation period that can take up to 30 days before symptoms appear — makes polio particularly challenging for contact tracing and public health containment efforts. The only way to keep the virus suppressed is by achieving herd immunity, which for polio requires vaccinating about 80 percent of the population.

Who is at risk?

For most people in the US, the newly discovered polio case hasn’t raised the risk at all. Rockland County’s public health department believes that the patient is no longer contagious.

The poliovirus can be detected in stool samples, and also in wastewater monitoring, which looks for evidence of viral genetic material in sewage. On August 1, the New York State Department of Health reported that the Rockland polio case was genetically linked to samples of the virus collected in sewage in Jerusalem and London, though the department stressed that the results do not automatically imply the patient had traveled to either location. The Rockland public health department was able to use sewage samples collected earlier for Covid-19 monitoring, and found poliovirus in samples there from June that are genetically connected to the current case.

Given how common asymptomatic cases are and the long incubation period, it’s possible there are other unrecognized cases in the Rockland area. Those may still be infectious, but the odds are against it spreading far. As of 2019, over 90 percent of US children were fully vaccinated against polio on schedule, well above the herd immunity threshold, and this figure has held steady for decades. Infants 4 months or older will usually have received two doses, which already provides 90 percent immunity.

Rockland County, though, has a lower vaccination rate than the rest of the country; it was the site of a 2018-2019 measles outbreak, and currently only 60 percent of 2-year-olds there are fully vaccinated against polio, compared to the national average of 90 percent. The New York State Department of Health is now urging all unvaccinated people, those who haven’t completed their polio vaccine series, and pregnant people to get vaccinated. In the month since the polio case was discovered, ​​the Rockland clinic administered almost 400 vaccine doses. People in the Rockland area who were vaccinated as children but are worried they may have been exposed should schedule a booster shot.

The new wastewater evidence that the polio virus may be circulating in New York City prompted health officials to urge all unvaccinated New Yorkers to get polio shots as soon as possible. That’s especially true for young children, who are most vulnerable to polio — almost 14 percent of New Yorkers between 6 months and 5 years old are unvaccinated, putting them at additional risk.

Officials in London, where the polio virus has also been found in wastewater, have gone a step further, making all children between 1 and 9 years old eligible for polio booster shots.

What does this mean for the global eradication effort?

While the US remains protected against polio, the same can’t be said of some more at-risk developing countries where the virus is still active.

After his work developing the oral vaccine, Sabin campaigned for a worldwide eradication effort in the 1960s, and in 1972 donated all of his vaccine strains to the World Health Organization in the hope of reducing the manufacturing cost. Despite recent efforts to introduce the slightly safer inactivated vaccine worldwide, most lower- and middle-income countries still use the oral vaccine.

The global eradication program has been a huge success overall, with total worldwide polio cases declining by more than 99.99 percent since the program started in 1988. But the closer eradication gets, the harder reaching the finish line becomes. When hundreds of millions of doses of oral vaccine are given every year, even the very low risk of a dose spawning a new vaccine-derived strain adds up. Most of the polio cases that have been detected in African countries like Nigeria and Yemen are vaccine-derived. Interruptions in vaccination coverage due to military conflicts and the Covid-19 pandemic likely increased the risk of vaccine-derived variants spreading unchecked.

Despite the risks inherent to live-attenuated vaccines, the oral vaccine has significant advantages, particularly for public health campaigns in developing countries. Each dose costs as little as 12 cents, compared to about $2 per dose for the inactivated vaccine, and because it’s given in drops under the tongue, it doesn’t require needles or trained professionals to administer. Live-attenuated vaccines in general also provide stronger and longer-lasting immunity than inactivated vaccines.

And early on, the infectiousness of the oral vaccine strain was actually considered a plus, since children not reached by health workers could potentially catch the weakened strain from others, ending up immune. In theory, as long as the vaccination campaign reached enough people in the community, the spread would fizzle out long before the virus had a chance to mutate back to virulence in humans.

Phasing out the oral vaccine, which would eliminate the source of new polio variants, will likely be needed to reach full eradication, but replacing the oral vaccine with the full schedule of booster shots needed to grant immunity isn’t yet possible. Even if the funding and personnel were available, the total global supply of inactivated vaccines is far too low to cover the hundreds of millions of children still at risk.

With monkeypox having been recently declared a public health emergency of international concern by the WHO, and the ever-present threat of future pandemics on the horizon, the global effort against polio is more important than ever to ensure that polio will never again be that kind of worldwide threat. Maintaining and ideally increasing the vaccination rate in the US will protect the country in the meantime, and support the worldwide push for eradication by denying polio a foothold. –VOX