Dr. Daniels writes, and observes, like no other:

No crisis should ever be allowed to slip by without calls for greater public expenditure of doubtful worth, and the Gulf oil spill crisis is no exception to this golden rule of bureaucratic opportunism.

In an editorial in the New England Journal of Medicine for 11 August, titled “Moving Mental Health into the Disaster-Preparedness Spotlight [1],” Drs Yun, Lurie and Hughes (the latter a lawyer, it seems) write:

Surveillance systems for mental health and substance abuse must be strengthened through broader intellectual investment in a conceptual framework and technical requirements.

Long experience of bureaucracies has taught me to mistrust language such as this. There is a lot of connotation in it without much denotation: intellectual investments, conceptual frameworks and technical requirements escape from verbiage generators like oil from defective wells, and end up being even more expensive. Personally I am not sure that technical investments, intellectual frameworks and conceptual requirements would not be at least as good, if not better.

Fortunately for modern bureaucracies, connotation — compassion, caring and the like — is a more powerful generator of funds than (say) likelihood of success. The authors say:

Early action to help with the disaster’s emotional impact may decrease long-term behavioral health problems.

On the other hand, it may not, especially as the long-term behavioral health problems (assuming that behavioral health is itself a defensible concept) are themselves only tentatively known: they may be this, according to the writers of the editorial, or that may be that.

They insinuate ideas like any good advertising copywriter. They talk of “psychological first aid,” for example. What is psychological first aid? Bandages for damaged thoughts, for example? A list leaves us little the wiser. It:

… addresses emotional distress, builds coping skills, connects people with support services, and promotes a return to normal routines.

What is it exactly, to address emotional distress? Emotional distress, I conjure thee to depart this body? It sounds to me either like witchcraft or a kind of wallowing in other people’s dismay.

The authors are keen on building. They want to build coping skills, as I built model cranes with engineering sets when I was a little boy. Another thing they want to build is community resilience. One might have supposed that resilience isn’t the kind of thing that is built. I think it is time a sense of humor, or at least of the ridiculous, was built.

Then there is our old friend cultural sensitivity. It seems that the Vietnamese refugees on the Gulf Coast do not have any counselors. They didn’t have many in Vietnam either, where they suffered things a thousand times worse than the oil disaster, but nevertheless seem to have thrived wherever they have been allowed to build a new life for themselves (to use for a moment the authors’ intellectual framework — or is it their technical requirement?).

Here I could not help but be reminded of a patient of mine who said he suffered terrible whiplash and a severe loss of confidence after a car went into his rear at about five miles an hour. He was too frightened now, and in too great pain, ever to leave the house.

As it happens he was Syrian by origin. “What did you do there in Syria?” I asked. “I was in the army,” he replied. “Any particular branch?” I asked.

In short he was a torturer. Unfortunately he fell foul of his senior officers and ended up at the receiving end of his former activities. But it was the impact of the car behind him at five miles an hour that really ruined his life and turned him into a living wreck.

Oh compensation, what crimes are committed in thy name!


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