“To sum up my political philosophy, I am a fiscal conservative with a social conscience.”
-General Colin Powell, My American Journey
The scenario was a tough one. I was working nights as a Hospitalist at my local, community hospital when I learned of an admission at about 3:00 am. The time itself poses a challenge. However, this admission created a challenge far beyond sleep deprivation. I was asked to see a woman in her mid-50s for a condition called rhabdomyolysis. It represents a problem related to muscle crush injury with potential for toxicity to the kidneys because of a breakdown product from the muscle. While there are multiple causes related to falls and trauma, this woman’s etiology was an emotionally charged one. It related to her routine and excessive alcohol abuse. While not an uncommon scenario, this one had a twist. As I took her history regarding her presentation, I was faced with a fact that challenged my level of compassion. The patient had a disability related to her emotional health (or, as they say in the business, she had “mental illness”). As a result of her disability, she was on social security payments for sustenance. She was using those payments to subsidize her alcohol use of 24-48 beers a weekend.
Here we are back at the Adverse Childhood Experiences study (ACE study) done by Dr. Felitti and Dr. Anda regarding the effect of childhood trauma on behavioral choices and chronic medical problems (if not familiar with the study, please take the time to review it). While the study was done nearly 20 years ago, the message has yet to permeate mainstream medical care (either for the physical or financial implications). This patient was receiving federally subsidized payments on a monthly basis and was using them for a self-directed treatment plan leading to ongoing societal costs for her inpatient stay. My natural inclination was to harbor resentment toward the patient for “wasting my tax dollars.” The mind quickly asserts that “it is not fair” that government officials can indiscriminately dole out money without regard to the way the money will be spent by recipients. Finally, knowing that about 1 in 20 adults between the ages of 25 and 64 receive disability benefits, it’s no wonder the tax-paying members of society have little compassion for the process. After a deep breath, I remembered that I had to consider the perspective of the patient. She had endured an undue amount of physical and emotional abuse over the course of her lifetime. I am quite confident she was not enjoying the financial dependence or the hangovers associated with her current situation. While she joked about her weekend alcohol abuse, there was an element of self-defeat in her tone. She was in pain. And, as a result of her pain, society moaned as well.
Is it possible to be fiscally conservative while caring for those in need? Isn’t that that crux of the disagreement between our two current, opposing conservative and liberal ideologies? Who doesn’t know a “conservative” with a social conscience or a “liberal” with fiscal concerns for future generations? We are not all or nothing beings. But what if a solution did exist to align both a fiscally conservative nature and a compassionate draw to care for societal members in need? Sadly, the solution has been ignored by society for nearly the past 20 years in the disregard for the findings of the Adverse Childhood Experiences study. If we believe that “an ounce of prevention is worth a pound of cure” then the solution has been found. We just need to embrace the fact that childhood trauma comes in many forms as it influences all walks of life. It is not selective for gender, race, or financial position (believe it or not, having too much money can be as traumatic as not having enough money). Rather than focus on extending retirement age, decreasing benefits to those truly in need, and raising taxes to pay for an over extended social security disability program, let’s join the Academy on Violence and Abuse in the goal to create trauma free communities. Physically and emotionally healthy children make for physically and emotionally healthy adults. Isn’t it time for society to pay heed to the physical and financial costs of childhood trauma?
About the author:
Dr. James H. Mooney, M.D. is a Hospitalist physician in central Ohio who explores the connection between a person's emotional and physical health.
For more information about:
ACE Study: Center for Disease Control
Academy on Violence and Abuse