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The Great American Delusion: Unequal, Even in Death

I have read and reread 17th century Spanish dramatist Pedro Calderón de la Barca’s La vida es sueño countless times to remind me that my life is an illusion, and that false dreams prevent my waking up — so much so that my illusions become delusions.

The United States is not the greatest nation in the world. This is a dream that prevents change. Americans believe, for example, that they have the best medical care in the world, which is true only if you have money or the standard is the worse.

Our bodies are chemistry labs, and we ignore patterns that are dangerous to society’s health. Everything is cured as long as there is a pill that will cover up or “aleve” the symptom. In the past 50 years, I have seen an increasing number of my students suffering from anxiety and depression. Everyone knows it, but Americans remain ignorant of mental health to the point that I have I heard explanations such as “It’s All a State of Mind.” True but what is causing the pain? Why won’t it go away?

In 2013 the Centers for Disease Control and Prevention (CDC) reported that there were 41,149 suicides in this country, the 10th leading cause of death for Americans. Someone died by suicide every 12.8 minutes. Most were not high profile suicides such as that of Robin Williams, and went unnoticed. TPublic awareness of the risk of suicide poses is similar to some Americans who have a gay child and rationalize it is all a state of mind.

Middle-class Americans live under the illusion that their Health Maintenance Organization (HMO) provider will take care of the pain. They never awaken to the reality that health care in the United States is based on profit, the maintenance or the management of illness, and not the cure.

As I have mentioned the number of my students suffering from depression and anxiety has grown. We know that “Both depression and anxiety carry a high risk of suicide.” Mark Pollack, MD, ADAA President and a Grainger Professor and Chairman, Department of Psychiatry at Rush University Medical Center, says that “More than 90 percent of those who die by suicide have a diagnosable illness such as clinical depression …. often in combination with anxiety or substance use disorders and other treatable mental disorders.”

At CSUN we have a good counseling center that is overwhelmed. Dr. Jose Montes reaches out to students, but a limited staff prevents adequate care for thousands of Latino students lacking insurance. Resources are diverted to programs that benefit the few.

Suicide affects all age groups.  The Centers for Disease Control reports that more people die from suicide than from automobile accidents. The problem is that it is only the tenth leading cause of death in the United States, and Americans seem to be waiting for it to reach the top three for it to become important. The tragedy is that few diseases are as preventable; more than 40,000 deaths a year is not just a state of mind.

I was under the illusion that my family was getting good health care. Over the years I have been a member of Ross Loos, Cigna, Blue Shield and the granddaddy of the HMOs Kaiser Permanente. They all manage health care and do just enough to keep you alive; however, for the most part they are not in the business of curing you. Even prescription drugs are dispensed according to the profit margin with generics used even when ineffective.

At Kaiser the response to mental illness is to try to manage it.  In a recent case, a patient sought help on four separate occasions: he committed himself, pleading with the provider that he needed help, fearing that he would commit suicide. In each instance he was sent to a mental health care facility, kept for three days and released.  They told him to go to a Kaiser Outpatient facility where he would receive care. In each case he went and asked for a psychiatrist. He initially saw one but only to get meds.  He was then assigned to a psychiatric nurse who led classes and group sessions. He was not given individual therapy, although he requested it as did his father.

The patient became discouraged, his cries were ignored and he ceased attending. Meanwhile, his family waited for the next relapse. There was no follow up by Kaiser. Totally discouraged he drifted between his parents’ homes. Kaiser did not respond to complaints and the pain grew intolerable and the young patient jumped off a bridge.

Kaiser is not the only failure. The patient had a brilliant mind. He was a talkative and a happy child until middle school when he grew quiet. The schools did not challenge him; they did not stop bullying although his father complained nothing was done. The failure was the failure to communicate – it was not a state of mind – pain never is. “People do not die from Suicide. They die due to sadness or hurt”

But death does not end the pain for loved ones. Death was very important to Mexican workers and their families.  The principal reasons they joined mutualistas (mutual aid societies) was a burial insurance that insured the socio would not be buried in a potter’s field and that his family would be sent back to Mexico.

Driving along a Southwestern or Mexico highway, you often see makeshift graves marked by crosses and flowers indicating where life had ended. Often people do not have enough money to even cremate the deceased. Today a burial on consecrated ground (a Catholic cemetery) is to too expensive for the average worker. Death has been privatized.

In 2013, the Los Angeles Times wrote “Los Angeles Archdiocese Gutted Cemetery Fund to Pay Sex Abuse Settlements.”  (Feb 11, 2013). Allegedly the Los Angeles Archdiocese gutted cemetery fund to pay sex abuse settlements.  Since at least the 1990s Catholic cemeteries in Los Angeles have leased out mortuary services, and they have been converted into fast food-like franchises.  Just to buy in, it costs $7000 depending on where your new barrio is located. Then the incidentals are tacked on — the total $12,000 or more.

The illusion of a premier or even adequate health system is exposed as a delusion. When medical establishments cannot recognize simple symptoms like a patient losing interest in things he/she used to care about, makes comments “about being hopeless, helpless, or worthless, talks about suicide”, and the system’s response is routine with the psychiatrist prescribing pills, assigning him/her to a class, and has him attend group therapy instead of talking about the causes of the pain then the nightmare begins – and if we can afford it, we move to a new barrio in a green cemetery.  The more you pay, the better the neighborhood.

We are unequal even in death. The only equality is in our dreams.

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RODOLFO ACUÑA, a professor emeritus at California State University Northridge, has published 20 books and over 200 public and scholarly articles. He is the founding chair of the first Chicano Studies Dept which today offers 166 sections per semester in Chicano Studies. His history book Occupied America has been banned in Arizona. In solidarity with Mexican Americans in Tucson, he has organized fundraisers and support groups to ground zero and written over two dozen articles exposing efforts there to nullify the U.S. Constitution.

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