“Let Them Die“? – The Dangers of Losing Compassion

Thebody small

This article was originally posted on TheBody.com on David's blog "Riding the Tiger: Life Lessons from an HIV-positive Therapist"


O for God's sake
they are connected
                -Muriel Rukeyser “Islands”

    Several widely-televised incidents recently exemplified the harsh and frightening polarization we are experiencing in our society.  The first was at the Republican debate at the Reagan Presidential Library where the audience spontaneously clapped and cheered when Governor Rick Perry's record of 234 executions was discussed.   The second was a clear shout from the audience of "let them die" when Representative Ron Paul was asked hypothetically if he would treat an uninsured individual who required medical attention.   For me, these were stunning moments of disbelief.

    Themes of independence, personal responsibility, and self-sufficiency have long been at the core of American culture and, overall, I believe they have served us well.  But they have been balanced and tempered by a belief in a role for government that provides services and infrastructure beyond the capabilities of any single individual. Indeed, a functioning democracy surely relies upon a degree of empathic feeling among its citizens.  From a medical point of view, anyone who states they can take care of themselves (and that they will have nothing to do with the needs of others) has either had astoundingly good luck in terms of health or is so blinded by ideology that they have become delusional.

    What does this mean for HIV?   Is it realistic for anyone to be able to pay for their own medications?  Most persons with HIV have experienced periods when they were too weak to care for themselves.  Should they be abandoned?  Earlier this year, I heard a nationally- prominent HIV/AIDS advocate state that every year in Washington, for 25 years, he has believed that politicians would ultimately do the right thing in terms of AIDS funding.  He stated that this year, for the first time, this might not be the case, and that indeed essential funding and the lives are in jeopardy. 

    Ironically, self-sufficiency has been central to the AIDS epidemic.  In the 1980s and 1990s, when government was not responding, we at the grassroots level took matters into our own hands.  We were the ones who cared for the sick, who sat with them when their families turned their backs, and who did not let them die alone.  It was demand from the bottom up that fueled services and drug research, and it was persons living with the virus who gave our own bodies for drug trials.

    It seems now that large (and growing) segments of our society have come to view basic compassion, the emotional capacity to experience another’s pain, as a character defect, yet it is an essential element of what makes us human. Neuroscience is beginning to provide some intriguing clues about compassion.   Each of us has "mirror neurons" in our brain that allow us to emotionally simulate and actually experience the pain of others, which causes us to feel empathic distress.  That is, at some level we experience the emotions of others as if they were happening to us.  Such feelings are thought to motivate pro-social behavior.   These mirror neurons have been observed in both primates and other species, including birds.  And while they certainly play a role in imitation and learning, they appear to have an emotional component as well.

    This begs the question: how can there be applause about executions and shouts of "let them die" if we have these mirror neurons that promote compassion?  Buddhists might say it concerns the self-centered focus that flows from the fundamental delusion of believing one is a "separate self," essentially disconnected from others.    This doesn’t have to be the case.  Intriguing scientific research utilizing fMRI studies is beginning to map out areas of the brain that are activated by compassion.  This research is documenting the increased capacity of experienced meditators (>10,000 hours) to rid themselves of a “self-focused delusion” and thereby understand their integral connection with others and experience more intense compassion for other persons.

    When individuals see themselves as essentially separate from others, normal "empathic distress" can actually trigger memories of emotionally painful or upsetting events from their own past.  This can, in turn, motivate them not to experience painful compassion for someone else but actually throw up a defensive posture that reinforces separateness and disconnection from others. 

    When empathic distress is very intense, it can move someone entirely out of a compassionate mode, according to Martin Hoffman (a theorist in this area).  Other factors that negatively impact the ability of empathic distress to translate into compassion include familiarity bias (identifying strongly only with an “in-group”) which inhibits identifying with the experiences of someone who is “different,” and habituation (repeated exposure to distress over time).   

    What does all this mean for the HIV/AIDS community?  I believe we have to continue our grassroots tradition of activism.  Stigma blossoms where there is invisibility and silence.   Such callous and immoral shouts as "let them die" need to be challenged.   The destructive myth that we are all separate from one another, and that anyone experiencing HIV (or any illness, for that matter) is on their own, will lead to further stigma, cuts in essential funding, and deaths.   It also contributes to the fallacy that our destinies, as individuals and as a society, are not inextricably bound together.

    Ironically, despite my anger, I have some level of compassion for these rigidly self-focused, "self-reliant" people.   While this certainly doesn't mitigate their destructive potential, I believe that anyone who applauds executions or shouts "let them die" is, at some emotional level, in pain.   They might benefit from the words of the Dalai Lama: "if you want others to be happy, practice compassion…if you want to be happy, practice compassion."     
   

David Fawcett Receives Who’s Who in Florida Prevention Award

David Fawcett PhD, LCSW, has been honored with the "Who's Who in Florida Prevention Award" in recognition of his leadership in both substance abuse and HIV/AIDS prevention.   The Florida Office of Drug Control named individuals recognized for their leadership at the annual statewide Prevention in Florida Conference in Orlando in early October.  This award acknowledges the accomplishments and dedication of individuals and groups within Florida’s prevention community.  Dr. Fawcett's nomination specifically recognized a decade of leadership working to strengthen individuals and families, especially within the LGBT community.

Dr. Fawcett has worked on a number of community projects, including serving as Chair of the South Florida Methamphetamine Task Force, which fostered community partnerships to address the methamphetamine crisis through training of professionals and creation of an infrastructure for prevention and treatment.  He was a founder of Meth and Men South Florida, a program of Sunserve, which continues to provide sliding-scale individual and group therapy for substance abuse within the LGBT community.  He also serves on the Board of Governors of the Broward County Commission on Substance Abuse; the Clinical Advisory Board of Sunserve; and recently was Program Co-Chair of the 2010 National Gay Men's Health Summit, a five-day event that drew nearly 500 people from around the nation to address concerns related to the health and wellness of gay men. 

Dr. Fawcett frequently makes presentations on topics of HIV and substance abuse both locally and nationally, most recently at the US Conference on AIDS.  He has been in private practice and created and now facilitates the "Connections" group for gay men at Fusion, a drop-in center funded by the Broward County Health Department.  The weekly "Connections" group is open to all and provides a rare opportunity for gay men to discuss a variety of topics, including body image, self-esteem, intimacy, relationship skills, stress reduction, and many more.  

NATIONAL GAY MEN’S HEALTH SUMMIT TO BE HELD IN FORT LAUDERDALE AUGUST 25 – 29

IndexB_02

Hundreds of gay men and their allies from throughout the country and beyond will gather on August 25 – 29, 2010, at the Sheraton Fort Lauderdale Airport and Cruise Port Hotel to participate in the 2010 National Gay Men’s Health Summit. The theme of the event is  “Creating a Brighter Future: The Next Decade of Gay Men’s Health” and will be held jointly with the 9th annual Southeast Regional Gay Men’s Health Summit.   Over 250 gay men (as well as, bi, trans men, other men who have sex with men and their allies) will gather to reflect on and celebrate gay men’s lives while working on a brighter future for gay men’s health and wellness.

The summit is open to all and registration has been underwritten for residents of Dade, Broward, and Palm Beach Counties by the Broward County Health Department and the Florida Department of Health.   Pre-summit workshops begin on Wednesday, August 25, and include a panel featuring an intergenerational dialog around gay youth, adults, elders and ancestors; another focusing on body image and weight issues; and a gay men’s leadership institute.

The formal summit begins on Thursday, August 26, and concludes on Sunday, August 29, and features a number of plenary speakers and nearly 70 workshops on topics as diverse as addictions, mental health, HIV, wellness, dating and relationships, and spirituality.  Many of the workshops will address special topics and populations, such as HIV negative youth of color, building community among Hispanic gay men, return to work issues for those on disability, and addictions recovery.  The summit is designed to promote social interaction and fun.  A significant number of the workshops are experiential, such as laughter yoga or meditation, and are intended to be edgy, such as the impact of GRINDR on our community and the use of social media to improve gay health and wellness.  Besides casual interaction with gay men from around the country (and beyond), there will organized social events such as a show and a pool party.

The gay men’s health movement grew from an interest in expanding the scope of gay men’s health beyond (but certainly including) HIV to a full range of other issues that impact our health and wellness.  At the Summit, gay men and their allies will have frank and open dialogue about race, racism, identity and gender politics, aging and class. We will discuss these and other domains and paradigms for thinking about gay men’s health. Our conversations will cover the broad spectrum of interests for gay men with key focus on strengths-based organizing, emerging issues, and other hot topics.
One of the key challenges facing gay men is to ensure that we continue to be involved in the strategizing and implementation phases of Health Care Reform. Another key challenge is to develop creative funding strategies and work alongside key policy makers while we simultaneously work with fellow advocates to shape policy such as ADAP and the National HIV/AIDS Strategy.

Walk-up registration is available beginning at 10:00am on Wednesday, August 25.

Volunteering Can Make You Healthy and Happy

    Volunteering

Did you know that giving your time and effort on behalf of someone else can actually improve your mood and overall health?  Although it sounds too good to be true, that is the conclusion of a number of studies on a variety of populations from around the world.  Scientists are still unraveling the specifics, but there are some intriguing clues documenting the health benefits of volunteering.

    First, there are positive physical health effects.  Volunteering was associated with reduced mortality risk in a number of studies, especially in persons aged 60 and over, although the benefits appear to hold true for all ages.    Simply put, persons who consistently give their time on behalf of others lived longer than those who did not.  More surprisingly, the health status of the volunteer didn’t matter.  Even if they had a serious medical condition themselves, volunteering provided a protective factor for their own physical wellbeing.

     Volunteering was also associated with increased positive emotions and a significantly-improved  sense of purpose.   It increased access to social and psychological resources which countered negative moods such as depression and anxiety.  People who volunteered reported a greater degree of overall happiness, with improved social support and cohesion that benefits both the individual and the community.  Finally, volunteering has been shown to improve self-satisfaction and mastery of new skills, both of which reinforce a positive self-image.

    These studies also reveal interesting ways to maximize the positive effects of service work.  The total number of volunteer hours per week was not as important as consistency and length of service.  That is, just one hour a week was more effective at promoting the health and wellness of the volunteer than lots of hours, as long as it was consistent over a period of months or even years.    Studies also revealed that there are health benefits even if the service work is informal and privately arranged, such as spending time with a homebound neighbor each week.  Volunteer work doesn’t have to be “official” to benefit, just consistent.

    In the end, these studies showed that “mattering” was the crucial link between volunteering and wellbeing.  By moving beyond our own needs and helping others, we begin to make a difference and “matter” to both our community and ourselves, and we get the bonus of being healthier and happier.

David Fawcett, PhD, LCSW   

This article first appeared in Out in the News, Volume 3, Issue 1 (February-March 2010), a publication of the Broward County Health Department, S-Men Campaign for a Safer, Healthier Community.

A Different Longtime Companion: Reflections on World AIDS Day 2009

 David Fawcett, PhD, LCSWRed_ribbon


It was 1982 when my friend Andrew developed an odd pneumonia that put him in the hospital and ran through his body with such ferocity that he was dead in three days.  My friends and I were stunned, until it soon happened again – this time with another acquaintance who survived longer, but ultimately succumbed to an illness the New York Times called “GRID,” gay-related immune deficiency.  GRID soon became AIDS, and one by one almost all of my friends became sick.

Thus began a journey that continues to this day, first marked by terror, then sadness, then overwhelming grief, and then by sheer determination as we stepped up to care for each other.  My life as a thirty-something gay men in New York was quickly transformed from exuberance in the aftermath of Stonewall to determination marked by caretaking and political advocacy. 

The energy on streets in the Village and the Upper West Side, once both high-spirited and sexually charged, became heavy with sadness.   Many men simply disappeared as the disease confined them to their homes, or their friend’s homes, or hospital wards.  Many died.  Others were out using the patchwork of services that began to develop in response to the crisis.  The streets were filled with the odd sight of thin men with wide terrified eyes walking awkwardly with canes.   I vividly recall one very cold winter day when I helped one frail young man struggle across Seventh Avenue through slippery frozen slush on his way to St. Vincent’s.

Despite persistent optimism and a strong sense of spirituality, for me the eighties became a human tragedy.  My life was entwined with AIDS at every level: intimate, social, and community.  As we lost one friend after another there was nothing to do but go forward, caring for those who were dealing not only with physical illness but also struggling with the emotional pain of rejection and stigma.  And AIDS kept coming.

One price we paid, among many, was never really stopping to grieve because so much needed to be done.  We hardened our emotions and our resolve – there was simply too much to do.    Men of my generation live with a great wound that, for many, remains unacknowledged and unexpressed.  We need to heal, even in the face of the ongoing epidemic.

Now, nearly thirty years later, AIDS continues to create suffering.   For many, it has lost its urgency.  A new generation has grown up with the disease and new medications, and view it as a manageable illness, but it is relentless and continues to demolish lives.  Long term survivors have developed an acceptance of the unknown.  They have given their bodies to drug trials and dealt with multiple losses, either through the death of partners and friends, or alienation from family.  Ironically, they now face a new wave of heart, liver and kidney disease as a result of the medications that have kept them alive. 

We need to remain vigilant about AIDS.  We need to advocate for new treatment alternatives like rectal microbicides and redesigned prevention efforts.  We need to remain informed and fight complacency.  We need to end the stigma that surrounds AIDS to this day, undermining both prevention and treatment.  Mostly, on this World AIDS Day, we need to remember the pain, the lessons, the courage, and the successes of the past and use them to renew and reenergize our continued work to end AIDS once and for all.  

DON’T BE INVISIBLE – JOIN “THE COUNT”

CountLogo

Did you ever wonder about the LGBTQ population where you live? How many of us are there? How old (or young) are we? What races and ethnicities do we represent? What is the status of our health, or our households, or our finances?

Today it is impossible to determine the answers to these questions, but if you live in Broward County that’s about to change. This summer you will be able to participate in an online census for the gay, lesbian, and transgender community called “The Count.” The collected data will finally give us a statistical presence that not only provides an awareness of our numbers but also assembles information that can be used for public policy and funding decisions. The census is a collaborative effort that includes the United Way, Sunserve, the GLCC, Broward House, and the Broward County Department of Health. This is the first effort to quantify and document information about our community.

Why is this important? One key reason is that it will enable better funding for health care, social services, and other vital resources. For example, as Chair of the South Florida Methamphetamine Task Force, I have been frustrated in applying for funds that could provide additional treatment services because there is no specific data on the pervasiveness of substance abuse among Broward’s LGBT population. In the case of meth, we know there is a serious problem but grant makers want specifics, and documenting how many people are affected, their other health concerns (like HIV or Hepatitis), or their treatment needs is impossible because there is no data. This seriously affects our ability to get funding to help the community. If we aren’t seen or heard, we will be overlooked.

Many of my psychotherapy clients express frustration about what they perceive to be a lack of community. This census is an important step in affirming that we are not only here, but that we will be seen, heard, and counted.

“The Count” will go live this summer, but you can register now on the site to be notified about updates.

High Anxiety

    For three hours the finger never stopped.  It grabbed a lock of dark hair, expertly spun it around four or five times, rolled it between thumb and finger for a few seconds, released it, and then began the process all over again.  I witnessed this strange behavior from my airplane seat, captive to the nervous antics of the passenger in front of me.  Only the top of his tortured head was visible, along with that relentless finger.

    The poor guy was in the throes of an anxiety disorder called Trichotillomania (use that in a sentence and impress your friends!), an irresistible urge to pull one’s hair.    And he wasn’t the only one with symptoms of anxiety.  We were all traveling on a recent day when yet another financial giant had collapsed, there was a general mood of uneasiness, and it seemed that we were all being pulled helplessly into very frightening territory.  At the airport the mood was somber, people were unusually quiet, and many stood around watching the television monitors broadcasting endless bad news and dire warnings.

    It seemed that Mel Brook’s joke about the very, very nervous really captured what we were all experiencing and it reminded me of some basic skills I teach patients to help them deal with anxiety.  I thought it would be useful to list a few of them here.
    

    1. What can I control?
     A great deal of energy gets consumed compulsively worrying about things in the past, things in the future, and generally things over which we have no control.  This is frustrating as well as emotionally and physically harmful. It is very useful to determine where you actually have some influence over any given situation.  It may be that choices are truly limited, but there is usually something we can do to assert a sense of empowerment.  Even the act of making lists to organize our plans can help us regain a sense of control.       

    2. Take action, then let go of the results
     Once you determine where you can be effective take deliberate action.  Don’t shoot from the hip, but also be wary of becoming paralyzed, a trap experienced by many people experiencing anxiety.  Remember that doing nothing is in fact an action, and the results may not be in your best interest.  Once you’ve done what you can do, monitor the results and re-evaluate where you go from there.  Twelve step programs utilize the Serenity Prayer which captures this beautifully: 

         God grant me the serenity 
         to accept the things I cannot change; 
         courage to change the things I can;
         and wisdom to know the difference.     

    3. Identify your safe place
 Think of this as your “safe word” when life’s scenes gets a little too intense.  Select a place you can imagine in your mind that is soothing, calming, and comforting.  It can be the beach, or the woods, or a mountaintop – whatever works for you.  Anchor this spot in your imagination with as many specifics as you can: What time of day is it? What is the season and the temperature?  Is there a breeze?  What colors do you see? Are there sounds?  Can you smell grass, or leaves, or the sea?  Once you have determined your safe place, practice going there until it becomes effortless.  It works because your mind can only focus on one thing at a time and it’s easily distracted.  Spending a few seconds there can have remarkable physiological and emotional effects, actually calming nerves, reducing blood pressure, even averting panic attacks.  I use this when working with patients who have experienced trauma – it’s powerful. 

     Like it or not, anxious situations seem here to stay.  The more tools we have to deal with them, the more we’ll be able to move through life with some sense of serenity, not to mention (at least for some) a full head of hair. 
 

SOUTHEAST REGIONAL GAY MEN’S HEALTH SUMMIT TO BE HELD IN FORT LAUDERDALE

Gmhs2003_altlogo     While all eyes were on Denver in recent weeks, nearby Boulder was approaching the tenth anniversary of another historic convention: the first National Gay Men’s Health Summit. In 1999, hundreds of gay men gathered in Colorado for workshops and community-building that focused on gay men’s health and wellness. The Summit was a grassroots effort bringing together like-minded gay men and their allies to both acknowledge our problems and find solutions that drew on our creativity and honored our ability to help each other when nothing or no one else was forthcoming, as we famously did when AIDS struck our communities.

The gay men’s health movement grew out of resistance to a national trend of increasing moralistic condemnation of gay men and lesbians. This was further compounded by an unintended consequence of the AIDS crisis: a persistent reframing of gay men, their sex, and their lives in negative, pathological terms. This negativity pervaded even well-meaning efforts, such as HIV prevention programs, which were often based on fear and control, and which, ironically, have been rejected by many gay men resulting in a rapid increase of high risk sexual behavior.

The image of the flawed homosexual is both internalized by gay men themselves and is expressed in all types of media. Out-of-control gay men are often inaccurately portrayed as a menace to the society (remember the new strain of drug-resistant HIV set off by the promiscuous gay meth addict in New York? Or the panic about MRSA carried by gay men and spreading into society-at-large in San Francisco? Both proved false.)

The gay community certainly has serious problems ranging from addiction to epidemics of sexually transmitted diseases, but portraying us and everything we do as pathological, or at best sadly pitiful, is increasingly destructive. The LGBTQ community has an amazing gift for healing both ourselves and our communities. The gay men’s health movement seeks solutions grounded in affirmative concepts of health and wellness.

At the closing in Boulder back in 1999, a call went out to continue these gatherings both at a national and regional level. The call was heeded and now the seventh Southeast Regional Gay Men’s Health Summit will take place in Fort Lauderdale from November 7–9.  Nearly 200 men from around the southeastern United States are expected to converge for networking, workshops, and a lot of fun during this exciting weekend.

 

These are gay and bisexual men of diverse backgrounds, who share a common interest in promoting better physical, spiritual and mental health. Participants will represent urban, suburban, and rural areas from throughout the southeast. Men of color, gay youth, and gay men who have never before participated in formal health promotion efforts are especially invited to join the Summit.  The program will include plenary sessions, workshops, and social activities designed to increase health awareness and a greater sense of community.

 

Break out sessions will be organized around four conference tracks: health and prevention, community building, relationships, and personal development. Workshop topics range from serious to light, including sex and intimacy in crystal meth recovery, living with HIV, spirituality and the gay community, and one called “You call that a swimmer’s build?” about “creativity” in Internet profiles. There will be several plenary dinners with nationally-known speakers, including Chris Bates, Director of Health and Human Services Office of HIV/AIDS Policy in Washington, D.C.

Would you like to participate? Workshop proposals can be submitted online until September 22. There are a number of scholarships available to make the Summit affordable to everyone. See the website for registration and scholarship details.

In my practice I hear a nearly-universal complaint about a lack of community outside bars and clubs. Here is an opportunity to have a great time and experience other gay men in an affirmative and powerful weekend. Join us!

Southeast Regional Gay Men’s Health Summit

November 7-9, 2008

Embassy Suites Hotel

1100 Southeast 17 Street

Fort Lauderdale, Florida 33316