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Reflection

Other Lessons from the Artemis II Mission.

Now that the astronauts from the Artemis II mission are safely back on Earth, here are more reactions about what we heard and witnessed:

It’s okay to ask questions. The crew aboard Integrity asked mission control many questions. They ranged from confirmation about what they thought they heard, to where they should store items, to repeating of instructions. They did not hesitate to seek clarity whenever possible. They avoided making assumptions.

Mission control often provided guidance in the form of positive reinforcement. It was a pleasure to watch how to shape conversations with ease in short amounts of time. For example, during the lunar flyby, the Science team said things like, “Thank you! The descriptions of the colors you are seeing are really helpful. We look forward to hearing more about colors.” There’s so much packed into those three short sentences. By frequently saying thank you and offering encouragement, the team on Earth was helping to promote good morale among the astronauts. The Science team was also giving positive reinforcement to the astronauts for something they were already doing (describing lunar colors). And the team was giving clear instructions that they wanted more information specifically about colors. One of the best ways we can improve communication is to point out what people are already doing well when they convey information.

The male astronauts can and should be models of masculinity. It was refreshing to see and hear how the male astronauts were working with different team members, in contrast to some males in high positions within the federal government. The astronauts frequently spoke of love, gratitude, and unity. They did not bloviate. They did not make threats; they did not belittle others. All of this might sound soft and squishy, and maybe it is, but these same people were living in close quarters in space, staying calm and communicating clearly when things weren’t going as expected, and enduring stressors that most of us cannot fathom. To execute this mission they were required to practice physical, mental, and emotional discipline for many years.When they asked to name a lunar crater after Commander Wiseman’s deceased wife, they exhibited a humanity and tenderness that we rarely see in our leaders.

The female astronaut can and should be a model of femininity. She was the one who addressed issues with the toilet! Her hair was always aloft because of microgravity, but it didn’t matter. She and her fellow astronauts seemed to treat each other as equals. She didn’t need to wear jewelry, layers of makeup, or fancy clothes to capture people’s attention and respect. Like her male colleagues, she seemed comfortable with who she was, and her self-confidence made her and her work shine.

These were middle-aged people! While none of the astronauts were old, they also were not young. Brains and minds tempered by time, training, and experience are probably better suited for such a profound mission. Those of us who are similar in age to the astronauts now must confront the fact these astronauts underwent a rigorous experience that we, theoretically, could also undertake. So what’s stopping us?

I wish the astronauts had more time to recover before appearing before the audience in Houston. Less than 24 hours after they took a journey around the moon, travelled nearly 25,000 miles per hour through space, and then landed in the Pacific Ocean, they were expected to say something coherent in front of an audience? I hope someone explicitly told them that this public appearance wasn’t for them. It was for their team and the rest of us; everyone wanted to see them alive and well. But it is sure unfair to ask people who just underwent an intense physical and psychological experience to show up and say something as if nothing major had happened to them or us.

May the astronauts find ways to integrate this experience into their lives and have peace. Commander Wiseman correctly noted that only the four of them will understand the experience they just had. This, of course, gives them a deep interpersonal bond that only they can appreciate. However, this can also lead them to feel grief and isolation. They prepared for years for that experience and now it’s over. Most of the people in their lives will never comprehend what they went through. Words are also often insufficient. Throughout the mission, though most often during the lunar flyby, the astronauts said things like, “This is indescribable” and “There are no words”. When we rely on language to communicate external and internal experiences with each other, what do we do when we lack the vocabulary to describe what happened?

The astronauts are people with their own flaws and foibles. Despite that, they have been sources of inspiration for so many. The purpose of the Artemis II mission was to learn more about the moon. This mission also helped us learn more about ourselves and who we can be.

Categories
Education Nonfiction Systems

Artemis II and “That Psych Stuff”.

The Artemis II mission has captivated me. I find myself checking NASA’s Artemis II Live Mission Coverage on YouTube during in-between moments. So much about this mission astonishes me: The fact that a vehicle is hurtling towards the moon! That there are four people inside! All the math used to plan this trip! That those of us still on Earth get to see and hear the astronauts in almost real-time! (This is the kind of reality TV I can support!) It’s all incredible.

(Let us not forget all the other people who have made this trip possible: The janitors who have kept NASA facilities clean so all staff can think and work in sanitary spaces. The culinary specialists who prepared healthy meals for the astronauts. The accountants who ensured that the mechanics got paid for their work. So many people!)

Within the first day or two, conversations between Houston mission control and the astronauts included the phrase “psychological conferences”. I wondered, “What does this mean?”

When I was in psychiatry residency, a Very Important Person with an Uppity Title at the university hospital was a psychiatrist. When he gave lectures, he routinely shared this perspective:

Psychiatrists have one of the most important jobs in the hospital. Say there are three people in the emergency department. One person is having a heart attack. The second person has a gunshot wound. The third person is trying to grab objects, screaming that they want to kill themselves. Which patient will be the top priority?

(dramatic pause)

The third patient will be the top priority. No one else in the emergency department will be able to receive care safely until that person is de-escalated.

The first time I heard this, I admittedly thought it was self-serving. What a way to puff up psychiatry. However, having witnessed and experienced similar situations, there is truth to what he said.

An emergency department is an enclosed space on Earth with exits to the outdoors. What happens if someone becomes escalated in a capsule in space, thousands of miles from their home planet?

My admiration for NASA has only increased upon finding all the published materials they have about cognition, behaviors, and psychiatric disorders, which are part of their compendium of human system risks. There’s a logic diagram:

NASA master logic diagram that describes risk of adverse cognitive or behavioral conditions and psychiatric disorders; open link to see full text

There are likelihood and consequence ratings to measure “Risk of Adverse Cognitive or Behavioral Changes and Psychiatric Disorders Leading to In-mission Health and Performance and Long-term Health Effects“:

chart that show likelihood and consequence ratings for space missions of varying distances and durations; open link to see full table

The accompanying 222-page report describes a “behavioral health and performance operational psychology” group that works along the spectrum of prevention, early intervention, and mitigation for astronauts. It looks like flight crews receive robust training in psychological skills (e.g., conflict management, stress management, education about psychology). Further support happens during flight, which we are witnessing now. These include—ah ha!—private psychological conferences, social support from Earth, cognitive monitoring, sleep and circadian rhythm support, team cohesion and care, and looking out the windows. (The authors included the comment, “NASA flight psychiatrists and psychologists have reported that during debriefings astronauts state that they did not realize how important ‘that psych stuff’ was until after they were on the [International Space Station].” This is the story of every psychiatrist and psychologist.)

Furthermore, there are reports about the intersecting psychological risks of “extended duration of isolation and confinement, greater distances from Earth, as well as increased exposures to radiation and altered gravity”. These are well outside the scope of my expertise, but there are lessons from space medicine (!) that NASA has already encouraged all of us on Earth to adopt:

graphic from NASA that describes the CONNECT acronym about how to cope with loneliness (community openness, networking, needs, expeditionary mindset, countermeasures, training)

I wish we didn’t have to rely on astronauts to make psychological skills like mindfulness, cognitive restructuring, and maintaining healthy routines sexy, but we’ll take the role models where we can find them!

May the Artemis II voyage be safe and successful. May other people in positions of power and authority learn the patience, cooperation, and discipline from the entire NASA team that made this mission possible.

Categories
COVID-19 Public health psychiatry Seattle

StoryCorps Interview.

I wasn’t familiar with StoryCorps until I received an invitation to record with them. They were looking for people who were front-line workers during the Covid-19 pandemic. Once I learned that the recording would be archived in the Library of Congress, I signed up.

Here’s the recording of the interview. It’s about 48 minutes long.

I still believe that most people don’t want to hear anything about the pandemic. Prior to the recording, I have said little about it. (My conversation partner in the recording has been a close friend of mine for over 20 years. Almost everything I shared during our recording she had never heard before.)

There was a time when I literally could not say anything about it: my mind would go blank, my chest would tighten, and no speech would come out.

“I don’t know,” I’d finally say. The blankness—how expansive it was, how it encompassed everything—was overwhelming.

I myself have not listened to the recording and don’t expect that I will anytime soon. Even though the recording was nearly an hour, it still wasn’t enough time. (Enough time for what?) Working as the medical director during the pandemic was the hardest thing I’ve ever done in my professional career. I am thankful that I was given the chance to talk about it.

If one person, 100 years from now, before, during, or after another pandemic, benefits from hearing my experiences, then it will have been worth it. May they learn from my experiences and errors.

Categories
Lessons Nonfiction Policy Systems

How to Avoid Becoming an Agent of Social Control: Communist China.

The Year of the Horse has arrived! How delighted I was to see the New York Times show Lunar New Year Across America (free gift link). I remain struck with how representation matters. It is some kind of dazzling to see people who look like me in a major newspaper celebrating the same holidays I do! (For the past few years, Asian representation has looked more like this. I admire R. Kikuo Johnson’s art, though that vibe is the antithesis of the joy and connection of Lunar New Year.)

With Lunar New Year festivities about over, it’s time to talk about China using psychiatrists as agents of social control. There are many similarities between China and the Soviet Union (see the post I wrote about Anatoly Koryagin). The Human Rights Watch and Geneva Initiative on Psychiatry describes this in Dangerous Minds: Political Psychiatry in China Today and its Origins in the Mao Era.

In the Soviet Union, the government passed laws that recognized “anti-Soviet” speech and activities as crimes. In China, “political dangerousness” was incorporated into Chinese psychiatric diagnoses. This creation of “political-psychiatric dangerousness” allowed psychiatrists to detain people for psychiatric reasons. It also resulted in law enforcement charging people with crimes, amplifying

the more intractable problem of the Chinese authorities’ longstanding insistence upon viewing the peaceful expression of dissident or nonconformist viewpoints as constituting “political crimes” that must be sternly punished by law.

The authors further note:

most of these people should not have been arrested or brought for forensic psychiatric evaluation (formal or otherwise) in the first place, since in the overwhelming majority of recorded cases their only “offense” was to have expressed views or beliefs which served to offend the political sensitivities of the Chinese Communist Party.

Like psychiatrists in the Soviet Union, Chinese psychiatrists shifted clinical definitions:

individual mental problems soon came to be seen, in simplistic and reductionist fashion by the ultra-Maoists, as being not merely reflective of, but actually caused by, incorrect or deviant political thinking on the part of the sufferer.

One of the Chinese psychiatrists, Yang Desen, was a whisteblower. He said:

Eventually, [the ultraleftists] began claiming that the real reason people became mentally ill was that their heads were filled with an “excess of selfish ideas and personal concerns” and that it was the product of “an extreme development of individualism.

Believe in the wrong political system and the authorities believe there is something wrong with your mind.

Psychotic disorders were most associated with this political and psychiatric dangerousness:

the most frequent diagnosis made by police psychiatrists in this context is of either “schizophrenia” or “paranoid psychosis” leading to the following kinds of “crimes” by the alleged sufferers: “sending reactionary letters,” “writing reactionary slogans,” “petitioning and litigating,” “shouting reactionary slogans” and “spreading rumors to delude the masses.”

Mental acrobatics are necessary to argue that these individuals were dangerous to others. But, once the government defines anti-government speech as a crime and evidence of a mental illness, a warped internal coherence follows. The “police psychiatrists” concluded:

Cases of political crime created by the mentally ill usually exert a highly negative influence in society and have extensive ramifications. They take up large amounts of human and material [police] resources and pose a definite disruptive threat to the normal functioning of state offices and to the political stability of the country.

Ideas are potent. It’s hard for one person to kill hundreds of people at once. The police never have to worry about that problem. It’s far easier for one person to introduce ideas to hundreds of people at once through books, radio, and television (and, these days, social media!). Even a man silently holding a sign on the street has the potential to “infect” dozens of people. A government ruled by fear, not confidence, wants to quash the expression of diverse ideas.

Like in the Soviet Union, the goal of detention wasn’t humane treatment. There was “a very high patient-to-doctor and nurse ratio, severe underfunding by the government, and serious lack of capacity leading to a dense overcrowding of inmates” and

the form of psychotherapy actually used from early 1996 onwards consisted of increasingly intense political indoctrination sessions in which mental patients were exhorted to cure themselves by studying the works of Mao and adopting a “proletarian” political outlook.

The US government has yet to outlaw free speech (and may we work together to prevent this from happening!).

May we continued to recognize and insist on the value of free speech. May we all continue to act with courage, even as those in power have tantrums and rely on violent tactics. Let us use the power that we do have. Everyday heroes may be nameless to you, but they are everywhere: people with integrity who are doing the right thing within their six-foot radius of influence. You can be one of them, too.

Categories
Homelessness Policy Public health psychiatry

More on the Government’s Potential Use of Psychiatry.

There has been increasing amounts of conflict and violence within the United States. It saps attention and energy; of course people feel irritable and glum. This can lead to pronouncements that things will never get better, we’re doomed, etc.

Oliver Burkeman (I recommend his newsletter with enthusiasm!) quotes futurist and environmentalist Hazel Henderson and then himself comments:

“… if we can recognise that change and uncertainty are basic principles… we can greet the future… with the understanding that we do not know enough to be pessimistic.” You can take a crisis very seriously indeed without fooling yourself that you know the worst outcome is certain.

Please keep that in mind as we proceed here.

I haven’t forgotten about China’s use of psychiatrists as agents of social control. There’s stuff happening now in the United States that warrants concurrent commentary. It’s still important to know what has happened in the past. If you are itching to learn more and can’t wait for me, you can read the report from Human Rights Watch and Geneva Initiative on Psychiatry entitled Dangerous Minds: Political Psychiatry in China Today and its Origins in the Mao Era. The themes are similar to what we’re already learned together here.

The internet has been to good to me. I recently reconnected with an internet friend from the days of intueri. (Longtime readers will understand what that means.) This person has attended the protests in Minneapolis; from them I learned about Riot Medicine. Written by an anarchist medic, this manual “for practicing insurrectionary medicine” describes how medics can work in atypical settings. During protests, traditional emergency medical services may not be available. (For example, law enforcement may delay or block vehicles from entering a scene. We already know federal agents did this in Minneapolis.) It includes a short section on “Psychological Care”. It’s a summary of Psychological First Aid (introduced in my last post).

If you want to learn more about ICE Watch and Community Defense, whether in the context of protests or not, I strongly recommend this free training. What I most appreciated about the webinar was its lack of histrionics. The trainers emphasized serving as observers and avoiding escalations. Keeping a cool head is a valuable superpower during these times of dismay.

Within the deluge of actions from the federal government was this announcement: Secretary Kennedy Announces $100 Million Investment in Great American Recovery. The stated goal is to “solve long-standing homelessness issues, fight opioid addiction, and improve public safety by expanding treatment that emphasizes recovery and self-sufficiency”. This includes a new initiative:

The Safety Through Recovery, Engagement, and Evidence-based Treatment and Supports — or STREETS — Initiative will fund targeted outreach, psychiatric care, medical stabilization and crisis intervention, while connecting Americans experiencing homelessness and addiction to stable housing with a clear focus on long-term recovery and independence.

The funding attached to this is a mere $100 million. The language of this initiative is vague, so maybe $100M is enough. But if this is meant to fund a comprehensive plan for the entire nation, that sum won’t do.

Tucked further down in the announcement is this:

Secretary Kennedy also announced the $10 million Assisted Outpatient Treatment (AOT) grant program to support adults with serious mental illness. AOT is a civil court-ordered, community-based outpatient mental health treatment program for adults with serious mental illness who are unable to engage with conventional outpatient treatment and are unlikely to be able to live safely in their community.

AOT already exists in many jurisdictions, including here in Seattle-King County. While there is some evidence that AOT improves treatment adherence and reduces hospitalizations, more evaluation is needed to explain how this happens.

When I saw this news, I wondered if this was another step to use psychiatry as an agent of social control. The executive order to “end crime and disorder on America’s streets” conflates mental illnesses, substance misuse, homelessness, and crime. Now there’s funding announcements for homelessness services and court-ordered, community-based outpatient psychiatric services.

Maybe this is confirmation bias. My skepticism about the federal government’s intentions, though, is a reaction to what has already happened. May hope spring eternal and may the worst outcome never come to pass.