27 Haziran 2012 Çarşamba

Journal of medical ethics courts controversy

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Good bioethics will invariably challenge boundaries. As myfriend and colleague Julian Savulescu, Editor of the Journal of medical ethics has found out to his chagrin, publishingcontroversial ethical analyses will lead to very serious personal abuse.[1]His journal published on-line early a paper the authors of which take a stanceon infanticide that is not terribly new or original in bioethics, as Savulescurightly notes. The authors apply these arguments to maternal and family interests.Of course, an argument on infanticide, particularly one that does not rejectinfanticide out of hand, will likely upset some or even most readers. The sameis true, to a smaller extent, for other issues. Bioethics runs occasionally invited guest editorials. A few issuesback we published a guest editorial with a plea to ‘queer bioethics’.[2]Conservative commentators had a field day on the internet with what wasarguably a tame editorial suggesting we should take into consideration patientsbelonging to sexual minority groups. As we have discovered in academic analysesof former US President Bush’s bioethics chief’s indefensible claim that if wefind something repugnant it’s probably morally wrong, feelings of disgust andeven horror are bad indicators of the moral soundness or otherwise of normativeviews, behaviors etc. Otherwise interracial marriages would likely have nevercome about, given how disgusted people were about this possibility just a fewdecades ago.
Good bioethical analyses will continue to challenge and testboundaries we take for granted. In that context it is legitimate to publishpapers discussing infanticide as much as it is legitimate to publish papersdiscussing the participation of doctors in torture under certain circumstances.As Editors of bioethics journals we are interested in sound critical analysis,wherever those analyses take the substantive conclusions of papers in question.At Bioethics we have publishedreligiously motivated analyses as much as we have published papers driven bysecular modi of analysis. We will continue to do so. Savulescu certainly wasright to publish the controversial paper in his journal, especially given thathis peer reviewers indicated that the manuscript in question was worthy ofpublication in the Journal of medicalethics. No doubt there will be critical responses to the article, and that,too, is to be applauded. Arguments in our field cannot be tested by othermeans. It will be important for editors of bioethics journals not to yield toideologically motivated outside pressures. We must not permit self-censorshipto occur in anticipation of outcries by readers who find themselves indisagreement with content we publish. Instead, we encourage our readers tosubmit sound critical responses to analyses we publish. Express your rationaldisagreement in letters to the editor, critical notes, even article-lengthripostes. I cannot think of a bioethics journal that would not welcome yourresponse. Do not expect us, however, to respond to excited hand-waving in nonpeer reviewed outlets or on partisan internet sites. Time is too precious forthis.

[1] J Savulescu.2012. “Liberals are disgusting.’ – In defence of the publication of‘After-birth abortion’. http://blogs.bmj.com/medical-ethics/2012/02/28/liberals-are-disgusting-in-defence-of-the-publication-of-after-birth-abortion/[Accessed February 29, 2012] [2] L Wahlert, AFiester. 2012. Queer bioethics: why its time has come. Bioethics 26(1): ii-iv.

Humanist Bioethics - Is there such a thing?

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I have been (and am) supportive of humanist endeavours pretty much since I decided for myself that atheism is the way to go. So, what about humanist bioethics? Well, it seems to me that any reason-based form of bioethical inquiry, ie one that is not based on religious magic wands of some kind or another actually qualifies as humanist bioethics. That means, of course, that humanist bioethics is more of an umbrella term covering all non-religious approaches to bioethics analysis. Some would argue that humanism is itself a form of speciesism, and that, in my view, is correct. So perhaps humanist bioethics needs a bit of fine tuning and reflection there. Humanist bioethics could be a(n) utilitarian, deontological, virtue ethical or any other secular ethical system of analysis. Indeed, it is perfectly possible for you to engage in humanist bioethics research and publishing, even if you are a committed Christian or Muslim, as long as your Christian convictions (ie the authority of the Bible) or your Islamic convictions (ie the authority of your Koran) don't muddy your critical analysis.

What does this mean for the bread-and-butter controversies in bioethics: Abortion? Euthanasia? Destructive embryonic stem cell research? Well, it's pretty clear from the above that certain types of arguments do not count: Reference to the infinite value of the human being based on claims about 'ensoulment' won't succeed as there ain't any empirical evidence that the human soul exists to begin with. Waving the Christian or Islamic magic wands (aka Bible or Koran) won't bring this soul into existence. Still, the important bit is perhaps, that humanist bioethics, so understood, leaves room for very significant disagreement on many subject matters that bioethicists are concerned about. However, humanist bioethics limits the types of arguments that can legitimately be deployed to those arguments that are not relying on higher God type entities and their authority.

Having attended and lectured during quite a few meetings of atheist and humanist groups, I have often encountered a clear misconception  of what humanist ethics or humanist bioethics could possibly be. All too often there was the assumption that humanist ethics or bioethics would somehow free us from the most reactionary provisions of Christian or Islamic ideologies while offering motherhood and apple pie type solutions to ethical conflict or controversy.  I suspect (!) that empirically that might well be true with regard to standard reactionary mainstream religions' provisions (prohibitions on homosexuality, voluntary euthanasia, etc). Peter Singer pointed out quite rightly in an early chapter of his book Practical Ethics that ethics does not give sexuality specific guidance. Sex as such does not give rise to special ethical issues. Ethics might admonish us not to hurt others while we engage in sexual intercourse, but the prohibition on harming others is not sex related, rather it is an ethical obligation not to harm others that also applies to sex. Secular approaches to ethics or bioethics would very likely free us from conservative religious infringements on personal freedom spaces. Humanists are more likely to ponder about the lives we live here and now as opposed to focusing on an afterlife that we don't think is awaiting us anyhow.


I am less sure about the motherhood and apple pie bits that I have frequently come across during the mentioned atheist meetings, eg human solidarity, tax the rich give to the poor, free tertiary education, public health care, sustainable development, *add any buzzword that engenders a warm feeling in you HERE*. I don't think anyone has as yet systematically investigated whether all varieties of humanist ethics or bioethics would necessarily lead us down that road. I sincerely doubt it.


Archives of Sexual Behavior Reportedly Refuses to Retract Ex-gay Study

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A very significant story was published today in The American Prospect, unfortunately buried in the middle of an introspective story by the writer of the piece. 


It's about Robert Spitzer's 'ex-gay' study. Dr Robert Spitzer is - today - an 80 year old retired psychiatrist whose area of specialisation was sex research. He was, for most of his academic life, affiliated with Columbia University in New York. Spitzer's work has been very influential, he is credited - among others - with having significant influence in the USA on the declassification of homosexuality as a mental illness.  


Spitzer also published a study in the Archives of Sexual Behavior that well and truly made him notorious both among gay activist as well as among the homophobes of the world. The study in question interviewed a sample of gay folks who had undergone 'reparative' therapy aimed at changing their sexual orientation. Spitzer concluded, based on those interviews, that some highly motivated gay people could change their sexual orientation. 


The study has been vigorously criticized over the years, not least because its claims are based on self-reporting of 'ex-gay' folks who usually came from cultural (not to say fanatically religious) contexts where homosexuality was highly frowned upon (that's probably putting it too mildly still). Now, for a gay evangelical Christian to claim after 'reparative therapy; they he or she ain't gay any longer is understandable, given that the homophobic ideology they're hoping to fit into doesn't allow them to be who they are to begin with. It's another story to buy such self-reporting. 


Here's the relevant bit from the American Prospect article. Spitzer is quoted as saying: In retrospect, I have to admit I think the critiques are largely correct,” he said. “The findings can be considered evidence for what those who have undergone ex-gay therapy say about it, but nothing more.” He said he spoke with the editor of the Archives of Sexual Behavior about writing a retraction, but the editor declined.' 


The study in question has been used for many years by anti-gay activists as evidence that homosexual people can change their sexual orientation - and that they're blameworthy if they don't try to do so, given that homosexuality is an 'abomination' or an 'objective disorder' (as one of the churches operating on my university campus will have it). 


I think it's remarkable that the journal that published Spitzer's original findings refuses him the right to publish a retraction notice. We know now from countless examples that self-reported 'ex-gays' turned out to be - surprise, surprise - current gays. 


Addendum: 5:40pm EST - Usually well-informed sources tell me that the Archives of Sexual Behavior does not recall Spitzer's reported request - but it's all off-the-record. This leads to the following questions: 1) Did Spitzer tell the truth in the interview? 2) Did Spitzer actually say what he is reported saying? 3) Is the off-the-record information from the Archives a true reflection of what happened? I certainly don't know.
Addendum: 07:08am EST -The Archives have finally gone on record on this matter.Check out their entirely sensible views on the matter here. Over to Dr Spitzer. 

The German political system's bizarre state of affairs on offended Muslims

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A remarkable article in the German news magazine DER SPIEGEL reports an incident in the German state of North Rhine Westfalia. A bunch of radical rightwingers and a bunch of fundamentalist Muslims ran into each other during a demonstration. The rightwingers clearly intended to provoke the Muslims by showing a Danish cartoon depicting the religious figurehead of Islam in a not particularly favorable pose. As you might recall, when a conservative Danish broadsheet published said cartoon there was a big outcry amongst Muslims (they don't like any depictions of their prophet, neither positive nor negative ones). A lot of people were duly killed by enraged Muslims (including, not unexpectedly, many Muslims). So, when in Germany the rightwing activist group Pro-NRW announced its demonstration and its intention to display the Danish cartoon it knew that its favoured enemy, enraged Muslims, would show up and make complete and militant fools of themselves. and so they did. - Between the two of us, without the help of radical Muslims and anti-Islamophobia leftist counter demonstrators, nobody would have taken notice of the 30 or so pro-NRW demonstrators. But hey, like bulls don't take lightly to red sheets of cloth neither do Muslims or leftists in Germany take kindly to a tiny rightwing group trying to look like they actually have the people on the ground to organise a serious demonstration. Fun was had by all involved: The end result, a whole bunch of seriously injured people, including police officers trying to keep the peace between the two sides.

None of this is terribly newsworthy, of course. Rightwingers (especially rightwing Christians) and fundamentalist Muslims love having goes at each other in Western societies, because the rightwing Christians mistakenly believe they own these places and need to defend them against Muslims wanting to establish Sharia law. It's of course a good idea to defend the secular state against any kind of religiously motivated legislation (lest you want to live in failing states like Iran or pseudo-outfits like the Vatican).

Here's the odd bit. The interior minister of the state where said demonstration took place wants to place restrictions on future demonstrations by the extreme rightwing group. A prohibition on showing the offending Danish cartoon during public demonstrations is in the making. Here is the tortured logic: The Islamic fundamentalists count about 1500 members according to the German security services. There is about 4 million Muslims in Germany that want to have little, if anything, to do with their violence. In order to protect German police officers from their violence it is necessary to prevent the extreme rightwingers from showing the cartoon during their demonstrations.

I have no sympathies for the rightwingers here, but it seems to me as if the German state is caving in to Muslim fundamentalists.  German citizens would - in future - be prohibited from doing things that could offend members of a Muslim fundamentalist sect in the country, lest the Muslims would otherwise go on a rampage injuring police officers and other demonstrators. Freedom of speech is subjugated to concerns about security of the security forces (whose job, among many other obligations, ironically, is to uphold German citizens rights to express even harsh criticism of religious ideologies). I can't wait to hear how the German courts will respond to this interior ministerial edict.

Interesting parallel:  in Jamaica, a Caribbean island state known for its large number of militantly anti-gay Christian citizens, we see the police routinely prohibiting demonstration by gay civil rights groups. Their logic also is that there are so many enraged Christians out there that they couldn't guarantee the safety of the demonstrators (at least - unlike in Germany - they're not concerned about the security of the security forces). Another example of a democratic society caving in to religiously motivated militancy.

The trouble with religious freedom is that it is all too frequently misunderstood as the unrestricted freedom of the religious to run roughshot over everyone else.


Follow-Up on 'Ex-Gay' Story

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Some weeks ago I wrote here about Dr Spitzer, a noted US psychiatrist who penned many years ago a study ostensibly showing that it is possible to change the sexual orientation of homosexual people who wish to do so. His work has since been used by mostly religious fundamentalists for blaming gay people to be what and who they are, and for suggesting myriad bogus conversion schemes (all condemned by professional psychiatric and psychological associations the world all over etc.).

Dr Spitzer noted in an interview that he thinks he misinterpreted what 'ex-gay' homosexuals he interviewed for the purpose of the study told him. There was a big outcry over this. Spitzer claimed that he tried to retract his study but the Archives of Sexual Behavior where he published his work allegedly refused to do so. The Editor of said journal says that that ain't exactly how it happened, but be that as it may, in today's New York Times Spitzer declares in an interview that he has written a Letter to the Editor of the Archives of Sexual Behavior denouncing his own work and that this letter would be published in said journal. A draft of the letter has been leaked some time ago. It ends with an apology to the gay community for the harm done to the gay community by his study's baseless support of 'reparative therapy' for homosexuality.

It takes courage to admit that one is mistaken.

25 Haziran 2012 Pazartesi

$9 Billion in ‘Stimulus’ - 910 Jobs OR 9,000 Millionaires...

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The latest stimulus news is out and it is yet one more confirmation on what a disaster the program is/was:
(CNSNews.com) – The Obama administration distributed $9 billion in economic “stimulus” funds to solar and wind projects in 2009-11 that created, as the end result, 910 “direct” jobs -- annual operation and maintenance positions -- meaning that it cost about $9.8 million to establish each of those long-term jobs. - CNS News
You know what else this money could have been used to do - It could have simply been given to 9,000 Americans in million dollar chunks, in effect creating 9,000 millionaires. 
Worse, the story notes that the $9 billion also created 4,600 indirect jobs, which when added to the direct number is still thousands less than if the Government simply gave the money away as part of a lottery. 
My 2009 post 'Better way to Spend $825 Billion in the Name of Stimulus' notes that instead of using the stimulus money for projects, that it just might be better to simply use it for a lottery where there were 800,000 first prizes of a million dollars each.Would this have been fair? I think it would have been more fair than giving huge amounts of money to politically connected companies like Solyndra who just turned around and burned the cash.
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TIPS for June 25

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Birmingham Mon A, Race 01 #8: COUSIN DEB
Birmingham Mon A, Race 04 #6: SANTAN TALLASSEE
Birmingham Mon A, Race 07 #1: MRK CANARY

Daytona Beach Mon E, Race 03 #4: Jack's Sky Angel
Daytona Beach Mon E, Race 11 #7: Atascocita Meade

Ebro Mon T, Race 05 #7: AMF Puppet

Palm Beach Mon A, Race 07 #4: Magicians Moll


Derby Lane Mon E, Race 06 #5: Giggle Box
Derby Lane Mon E, Race 11 #4: N Bar Cryer
Derby Lane Mon E, Race 14 #6: Mrl Lever Alone

TriState Mon E, Race 14 #2: Manic Mac Elroy

Tucson Mon E, Race 12 #3: Hallo Expect

Dogs to Watch for June 25

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LAVA MATSUI, Birmingham, 06/25/2012, Afternoon, race 11, post #8.
COACH PRINCESS, Birmingham, 06/25/2012, Afternoon, race 13, post #8.

CRS SPIDER WEB, Palm Beach, 06/25/2012, Afternoon, race 6, post #5.

AMF EX PRESIDENT, Southland, 06/25/2012, T, race 4, post #7.

UMR HYDRO, Tri-State, 06/25/2012, Evening, race 13, post #5.
MANIC MAC ELROY, Tri-State, 06/25/2012, Evening, race 14, post #2.
MANI STRONG, Tri-State, 06/25/2012, Evening, race 15, post #7.

Visit trackinfo.com for complete entries and program pages.

Gulf's Kennel of the Week - Libby Racing Kennels

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Trainer Cam Hawkins had the pups flying this week on their way to earning the Kennel of the Week honors. Dominating the racing scene, Libby Racing Kennels tallied 13 wins, 6 seconds, 7 thirds and 5 fourth place finishes earning $9,301.41 in purse money. The top grade AA wins kept rolling with Atascocita Enok, Kells Wild Bill and Palm City Pelton over the 550-yard course and Nina’s Fire Fly claiming victory on Saturday evening over the 660-yard course. Libby Racing Kennels remains solidly in third place of the kennel standings in pursuit of D.Q. Williams Kennel in second and K-Rod Kennel leading the way.

TIPS for June 26

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Birmingham Tue E, Race 04 #6: MAMAS TBONZ
Birmingham Tue E, Race 06 #2: CTW ANNA LANTANA
Birmingham Tue E, Race 09 #3: SUPER DOG DUFFY
Birmingham Tue E, Race 10 #5: DAZZIQ
Birmingham Tue E, Race 11 #5: LK'S PRESTIGE

Daytona Beach Tue E, Race 10 #2: Ak Tin Lizzy

Ebro Tue E, Race 02 #2: Freak N Beauty


Palm Beach Tue A, Race 06 #1: Pg Hottie Tottie
Palm Beach Tue A, Race 07 #4: Skiddy Duchess
Palm Beach Tue A, Race 13 #7: Sonic Trent

Derby Lane Tue E, Race 02 #8: Four Onthe Floor
Derby Lane Tue E, Race 03 #5: Ed N Edwardo
Derby Lane Tue E, Race 04 #4: You Bet I Did

Tucson Tue E, Race 03 #4: Rams Rambunction

24 Haziran 2012 Pazar

Rental Housing Is Increasingly Becoming "Out of Reach" for More And More Americans

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Back in 2008 I wrote about Vanderbilt professor Dr. Melissa Snarr's study in the Nashville area that determined an individual would need to earn  somewhere in the neighborhood of $10.50/hr as the minimum "living wage" in order to be able to afford the most basic of necessities for survival; shelter, food, and basic living expenses.  I chided her a bit back then by asking her to try and live on that wage, but I need to point out here that her purpose was to underscore the bare minimum and provide a reference point when talking about what a living wage should begin to look like for the citizens in our community. Her work and effort was invaluable in raising awareness in the Nashville area and I greatly appreciate her attention and dedication to this critically important issue.

Four years later, the National Low Income Housing Coalition has released a disturbing study that sheds light on the declining availability of rental units for everyone, and for those at the bottom of the earnings ladder, is downright frightening.  For example, in one "map," states are ranked from most to least expensive; Tennessee is ranked 41 out of 52, which sounds good until you discover that in our state you'd need to earn$12.56/hr to afford the average fair market value (fmv) rent of $949 on a two bedroom apartment.  This amount should represent 30% of your total income spent on housing, the typical standard used to determine whether you're even eligible for a unit.

I don't have to tell you that if you're earning $12.56 an hour and paying a grand a month for housing, you're eating beans and ramen and praying you don;t have any 'out of the ordinary" expenses each month.  Thankfully, rents are a smidgen cheaper in the Nashville area but the secondary issue here is shrinking availability due to increasing demand for rental units brought on by the housing crisis.

I've shared the conclusions of the report below to provide you with a quick reference, but if you're a renter, you should read this.  If you're a renter earning less than $18/hr, this should be in your "top ten" things to read this week.  If you earn less than $12/hr, this should be mandatory reading.  You can check out the full article here.

When you finish reading, please consider letting your voice be heard by writing a letter to the editor, or donating to the NLIHC.  The need is tremendous and it's not going to get better anytime soon.  WE will have to force a priority adjustment if we expect to see anything done.

Permanent shelter is a basic human right and the number one priority for every human being. We need to make sure that everyone realizes this.

From "Out of Reach:"

CONCLUSIONS
h is year, as in years past, Out of Reach speaks to a fundamental truth: a mismatch exists
between the cost of living, the availability of rental assistance and the wages people earn
day to day across the country.
With the number of low income renters on the rise, the argument for sustaining
af ordable housing assistance is timely.
•  In 2012, a household must earn the equivalent of $37,960 in annual income to af ord
   the national average two-bedroom FMR of $949 per month.
18
•  Assuming full-time, year-round employment, this translates into a national Housing
   Wage of $18.25 in 2012.
•  h is year the housing wage exceeds the average renter wage, $14.15, by over four
   dollars and is nearly three times the minimum wage.
Despite the great need for af ordable housing units, subsidies for critical af ordable
housing programs continue to face the threat of cuts, as do many social safety net
programs. For FY12, HUD suf ered cuts of $3.7 billion dollars, 9% below FY11 funding
levels. Although HUD estimates that its public housing capital needs are in excess of $25
billion, the Public Housing Capital Fund received 8% lower funding for FY12.
19
 h e HOME
program, key to the production of many new af ordable units at the local level, suf ered
a cut of 38% between FY11 and FY12, a cut that is estimated to result in 31,000 fewer
af ordable rental homes. Meanwhile, the National Housing Trust Fund (NHTF), which
Congress authorized in 2008, remains unfunded. h e NHTF would fund the production
and preservation of homes af ordable to the lowest income households. Funding the
NHTF is NLIHC’s top priority.
An af ordable home, providing stability and shelter, is a basic human need. Expanding
the availability of af ordable housing to address the unmet need of so many low income
Americans should be a top public policy priority.
THE NUMBERS IN THIS REPORT
As in past years, Out of Reach 2012 relies on data from HUD, the U.S. Census Bureau,
the Bureau of Labor Statistics, the Department of Labor, and the Social Security
Administration to make its case. See Appendix A for a detailed explanation of data sources
and methodologies.
h e FMR on which the Housing Wage is based is HUD’s best estimate of what a household
seeking a modest rental unit in a short amount of time can expect to pay for rent and
utilities in the current market. h us, the FMR is an estimate of what a family moving
today can expect to pay for a modest rental home, not what current renters are paying on
average. See Appendix B for information on how HUD calculates the FMR.
Readers are cautioned against comparing statistics in one edition of Out of Reach with
those in another. In recent years, HUD has changed its methodology for calculating FMRs
and incomes. In 2012, the FMR estimates were developed using American Community
Survey (ACS) data as base rents, rather than data from the Decennial Survey. h e new
methodology is thought to be an improvement on past practices, but it can introduce
more year-to-year variability into the data. For this reason and others (e.g., changes to the
metropolitan area dei nitions), readers should not compare this year’s data to previous
editions of Out of Reach and assume that dif erences rel ect actual market dynamics.
Please consult the appendices and NLIHC research staf  for assistance interpreting
changes in the data.
h e data in this report and the additional materials and data can be found online at:
WWW.NLIHC.ORG/OOR/2012

SAMHSA May Just Have Nailed It With Latest Iteration: A Working Definition Of Recovery

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It has been a long, challenging road for SAMHSA to travel to reach the point where a definition of "Recovery" was at a point that it could be shared and it's conceivable that there will be additional changes in the future.  The reason for this is that the term "recovery" means different things to different people and groups, depending upon which field you are seeking to define it in.  It's a difficult definition to nail down and if you notice, what you'll find here are a set of principles that just about everyone in fields where Recovery is something individuals strive for can agree upon.

The latest iteration has encompassed everything I could possibly think of around my own recovery and I cannot thank SAMHSA enough for having the courage and the ability to share it in a way that helps everyone align with a set of governing principles.  But SAMHSA didn't arrive at this alone, and a another heartfelt "Thank You" goes out to the thousands of individuals like me, who struggled with a personal challenge and were able to move beyond it, then shared the most harrowing parts of the journey with the rest of us so that we too could overcome, find strength and courage in the story and the journey, and embark upon our own road to recovery as well.

Thanks to every single one of you who helped me help myself to a new lease on life, love, and the pursuit of my own happiness and fulfillment.




SAMHSA’s Working Definition of Recovery Updated

23 MARCH 2012 4 COMMENTSWritten By: Paolo del Vecchio, Acting Lead, Recovery Support Strategic Initiative, Acting Director CMHSIn December 2011, SAMHSA released a working definition of recovery and a set of guiding principles.  The December release of this definition represented the culmination of a lengthy process that began with an August 2010 Dialogue Meeting and ended with a formal public engagement process (via the SAMHSA Feedback Forum) in August 2011.  At the time SAMHSA released the working definition, we indicated that we would continue dialogue with the field to refine the definition and principles.  Based on additional stakeholder input, SAMHSA is now issuing a slightly revised working definition and principles.The revised working definition and principles give more emphasis to the role of abstinence in recovery from addictions, and indicate that an individual may be in recovery from a mental disorder, a substance use disorder, or both.   The revised definition is below.SAMHSA appreciates the many thoughtful comments and suggestions received throughout the period of developing and vetting the definition and principles.  SAMHSA will disseminate the working definition and principles as a resource to policy-makers, systems administrators, providers, practitioners, consumers, peers, family members, advocates, and others.   The definition and principles are intended to help with the design, measurement, and reimbursement of services and supports to meet the individualized needs of those with mental disorders and substance use disorders.+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++SAMHSA’s Working Definition of Recovery fromMental Disorders and/or Substance Use DisordersThe Substance Abuse and Mental Health Services (SAMHSA) recognizes there are many different pathways to recovery and each individual determines his or her own way. SAMHSA engaged in a dialogue with consumers, persons in recovery, family members, advocates, policy-makers, administrators, providers, and others to develop the following definition and guiding principles for recovery.  The urgency of health reform compels SAMHSA to define recovery and to promote the availability, quality, and financing of vital services and supports that facilitate recovery for individuals.  In addition, the integration mandate in title II of the Americans with Disabilities Act and the Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999) provide legal requirements that are consistent with SAMHSA’s mission to promote a high-quality and satisfying life in the community for all Americans. Recovery from Mental Disorders and/or Substance Use Disorders:  A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.Through the Recovery Support Strategic Initiative, SAMHSA has delineated four major dimensions that support a life in recovery:
  • Health:  overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing.
  • Home:  a stable and safe place to live;
  • Purpose:  meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
  • Community:  relationships and social networks that provide support, friendship, love, and hope.
 Guiding Principles of Recovery Recovery emerges from hope:  The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.  Hope is internalized and can be fostered by peers, families, providers, allies, and others.  Hope is the catalyst of the recovery process.Recovery is person-driven:  Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals.  Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.Recovery occurs via many pathways:  Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds  including trauma experiences  that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual.  Recovery pathways are highly personalized.  They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches.  Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks.  Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families. Abstinence from the use of alcohol, illicit drugs, and non-prescribed medications is the goal for those with addictions.  Use of tobacco and non-prescribed or illicit drugs is not safe for anyone. In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.Recovery is holistic:  Recovery encompasses an individual’s whole life, including mind, body, spirit, and community.  This includes addressing: self-care practices, family, housing, employment, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, transportation, and community participation.  The array of services and supports available should be integrated and coordinated.Recovery is supported by peers and allies:  Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery.  Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community.  Through helping others and giving back to the community, one helps one’s self.  Peer-operated supports and services provide important resources to assist people along their journeys of recovery and wellness.  Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths.  While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different.  Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.Recovery is supported through relationship and social networks:  An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change.  Family members, peers, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations  including values, traditions, and beliefs  are keys in determining a person’s journey and unique pathway to recovery.  Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.Recovery is supported by addressing trauma:  The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues.  Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.Recovery involves individual, family, and community strengths and responsibility:  Individuals, families, and communities have strengths and resources that serve as a foundation for recovery.  In addition, individuals have a personal responsibility for their own self-care and journeys of recovery.  Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery.  Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery.  Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.Recovery is based on respect:  Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery.  There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.SAMHSA has developed this working definition of recovery to help policy makers, providers, funders, peers/consumers, and others design, measure, and reimburse for integrated and holistic services and supports to more effectively meet the individualized needs of those served.Many advances have been made to promote recovery concepts and practices.  There are a variety of effective models and practices that States, communities, providers, and others can use to promote recovery.  However, much work remains to ensure that recovery-oriented behavioral health services and systems are adopted and implemented in every state and community.  Drawing on research, practice, and personal experience of recovering individuals, within the context of health reform, SAMHSA will lead efforts to advance the understanding of recovery and ensure that vital recovery supports and services are available and accessible to all who need and want them.

Dr. Dan Fisher: "when we are disconnected and lose touch with our feelings, we die inside."

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The work that I do today provides me with a unique and incredible opportunity to work with some of the greatest minds in the Behavioral Health field.  That in itself is humbling enough, but some of the folks I get to work alongside are preeminent leaders in various specialties within the field, and the opportunity for learning is frankly endless.

(Left: Dr. Fisher, 3rd from left: lauren Spiro
Image courtesy:  http://ncmhr.org/  )
Take Dr. Daniel "Dan" Fisher and Lauren Spiro as examples.  I first heard of Dan a few years ago while attending an Alternatives conference out in sunny California. Dan is the Executive Director of the National Empowerment Center (NEC) and is a key subcontractor on many of the tasks associated with the Bringing Recovery Supports to Scale, Technical Assistance Center Strategy (BRSS TACS) contract I currently help to direct for the Center for Social Innovation.

I heard of Lauren Spiro around the same time - which is no surprise once you know both of them as they're like brother and sister fighting together against common challenges in our work- and I have been an avid supporter of them both since I discovered them.  I also work closely with Lauren, (who is the Director of the National Coalition for Mental Health Recovery,)  on the BRSS TACS contract, and am continually impressed not only with her incredible knowledge around peer involvement in the mental health field, but with her joyous yet consummately professional approach to everything she is involved in.

Okay, enough of my starry eyed gushing, but you have to understand, from my perspective, Dan and Lauren are people who have not only brought gargantuan change to the way in which we peers are viewed and involved in our recovery, but they continue to battle every day against political, social and medical forces (not to mention trying to have a life somewhere in the middle of all that), in order to provide those of us who are coming after them with a solid foundation upon which we are able to continue building.  This is no easy task, folks, you can believe that, and to make matters worse, there ain't a lot of money being tossed our way, either. Think of the Peer movement as the flea on the flea that is Behavioral Health that is living on the ass of the elephant that is Primary Health.   That Dan and Lauren have been even modestly successful in such an environment is phenomenal.  That they've been able to help motivate change in the field is monumental.

On to my reason for writing this in the first place; Dan and I were chatting by phone the other day and were discussing community dialogue and the Dialogical approach as a method to increase the ability of connection and success in working with our peers, our clients, our colleagues and our community.

Dan went on to write a brilliant piece on his own understanding and evolution towards the use of Dialogical recovery and I not only enjoyed it immensely, it resonated so loudly with my own experiences, both my personal recovery journey and the journeys I've helped others embark upon, that I wanted to share an excerpt here. I encourage you to check it out in its entirety when you can spare 5 minutes, because I think it's applicable for everyone.  And if you work with folks dealing with substance use and/or mental health challenges, you'll definitely want to hear what Dan has to say, as it may change the way you engage with your clients and those supporting your clients:

From Dialogical Recovery of Life (Dr. Dan Fisher)

It seems that all of us in this society need to recover from the constricting effect of isolation and the black and white thinking that separates us from our feelings.  Implementing recovery needs to occur beyond the clinical context. Recovery principles and culture needs to be adopted throughout society because every relationship we engage in has the capacity to enhance or degrade our recovery by nourishing or smothering our life force.
I think that a major aspect of bringing recovery to society is through understanding and practicing dialogical relationships in every day life. This might be considered a type of community dialogue. I have carried out several training programs here in Mass. based on six basic principles of dialogue (the first 4 come from Isaacs, 1999, the 5th from my own experience and the sixth from Yankolivich, 1999):
1. Listening deeply together
2. Suspending our own beliefs, going beyond categorical thinking
3. Respecting and valuing differences and the wholeness of each of us
4. Speaking from our deepest truth, from our heart
5. Connecting on a heart to heart level
6. Valuing each other’s humanity deeply enough to see we are all equals
But why are these principles of dialogue so important. Because they create a space that we all want and need. A psychological space in which we experience our life more fully. On the other hand, the top down monological world of everyday life in the present is killing our life forces within and between us. To this degree, the green movement, the recovery movement in mental health , and the dialogue movement have a common unifying goal: to create a society which nourishes the life force in each and every living being through dialogical relationships.
(Read the entire piece here)

A Whirlwind Month In Washington DC

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Well hell, it seems like I'm rarely able to find enough time to even post here anymore, and that is beginning to suck for me. 

Some time ago, when my ol friend, mentor and former boss Will "Big Willy C" Connelly informed me that he would be leaving his position as supervisor of an outreach team for a training gig, I told him that the farther up the chain he climbed in the administration world, the less connected he'd actually be to those that the administration actually served.  BWC has come full circle today, as he has left that administrative/training position to take over a Street Outreach team for Pathways to Housing here in Washington DC! 

But I digress.

My point above was just to illustrate how easy it is to get sucked into the paper pushing portion of the work we do and lose sight of what all that paper, all those meetings, all the phone conferences, all the travel, all the political wrangling, all the collaboration (and efforts to get peeps together to collaborate), and all the strange hours one spends trying to get it all together in a coherent way is actually for. 

So for the past couple of weeks, I've been in DC with those who are actually doing work.  Not that I'm not doing work, but, as so many of my colleagues say, the folks we're working with here this week and the last are where the "rubber meets the road."

Last week, it was working with the 20 grantees of the Mental Health Transformation Grant (MHTG) program at their annual Grantee meeting hosted by Policy Research Associates.  Have to say, the folks at PRA are some outstanding pros who approach what they do with more professionalism and passion than just about any other group I've met at this level, and my respect for them and what they bring to the table is off the charts. 

Most noteworthy of that meeting however, was the 3rd day session that the BRSS TACS MHTG Consumer Advisor, Ray Bridge, coordinated and led.  This opportunity allowed the Consumer Leaders of each grant recipient to bring their suggestions and ideas for our annual Consumer Leadership Forum.  These are some very smart, very passionate, and very energized folks who know what we're trying to do is not simply transform the Behavioral Health community; they see it as a civil rights movement as well.  A comment in a session with the Leaders continues to stand out in my mind (I'm paraphrasing a bit here, but you'll get the jist): "Unlike previous civil rights battles, we are the first group of people who've been oppressed by the larger community through a label of oppression placed upon us by them, rather than by some physical trait that immediately stands us apart, such as color."

Give it a sec and let that sink in.  She's saying here that we've been oppressed through stigma based on the labeling of the community, rather than because we are noticeably "different" than they are at first glance. Hadn't ever thought about it this way before, and it was a stunning realization for me.


We left that meeting last Friday with enough consensus and detail to begin planning in earnest for the upcoming Consumer Leadership Forum, and jetted back to our humble locales for the weekend.

This week, the C4 gang has been in Reston, a subbie of the DC area, to host the first annual Policy Academy under the BRSS TACS contract.  This year, we've brought 8 state teams together from around the country to devise a plan for integrating mental health and addiction services within their communities, and work together to help transform behavioral health in their respective states.  One bright spot of many for me was to see Tennessee at this academy, and this is particularly important given that for many of the state's most marginalized, services are damned hard to find, let alone come by.  So it is with a lot of personal commitment and passion that I work with my colleagues on the execution side to do whatever I can to ensure that the folks from TN, as well as Texas, Ohio, Vermont, and the others all have what they need to get immediately down to work with no distractions typical in most start-up efforts.

This week has had some very long days as we've worked to make it happen, but those long hours appear to have paid off based on the comments we've been receiving as feedback.  One thing I've discovered as I've worked with my company to make  system transformation more than just a dream is that the task itself is enormous, for reasons frankly mostly unrelated to providing the actual services to folks in an integrated fashion.  There's a philosophical divide that permeates these efforts, and there's a tremendous amount of ignorance on both sides as to what the other is doing, saying, and defining. Finding common ground and commonalities between Addiction and Mental Health is a priority, but it ain't easy. 

Perhaps most problematic is the definition of Recovery itself.  This is not a new dispute, and to its credit, SAMHSA has spent years trying to find something that works for everyone.  Their current working definition, "A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential," seems to capture the essence, but I have to warn you that by the time you read this, it's possible that it may have changed, so I wouldn't quote this definition unless you confirm it at their site.  
Now, you'd think, if you were on the outside looking in and didn't actually have to really invest a lot of time on one side of the issue or the other in the finesse of the definition, that this would cover it.  But the understanding of Recovery is different depending on which group - Addiction or Mental Health - you ask, and the reason for that is...well...because recovery is viewed through lenses unique to each cohort and there's no simple bridge because of the philosophical divide between them.
So just trying to come up with an understanding of what it means to be "in recovery" versus "recovered" versus "recovery" becomes not only a monumental task, but also a challenge to get folks aligned enough to move forward beyond it.  If ya can't define it, it's pretty hard to create policies around it.  
I've been sprouting gray hairs by the hundreds over the past several months around things like this, and adding hundreds more on a weekly - and sometimes daily - basis just trying to race around the corners of my learning curves on literally dozens of topics. This of course does not take into account a role as a Project Director that demands skillsets not yet necessarily locked down by yours truly.  
It's a rare time indeed when I have the luxury of putting down random synaptic firings here on ye ol Stone Soup Station, and that I've deviated so far from the "Homelessness" focus of this blog doesn't help incentivize me to continue writing.
So I may have to redefine the parameters of this blog, even though ultimately the conditions and symptoms and situations of mental illness and addiction often underlie homelessness.  The sheer scope of my  involvement in ending homelessness has become so large as to almost remove the issue of homelessness per se from the picture.  
The words I spoke to Big Willy C years ago seem to be more appropriate for me now than for him..... 

The Finest Advocacy Guide For Affordable Housing I've Ever Seen

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Colleague and friend Mark Allison has some long-term experience ensuring that Housing is considered a basic human right.  Along with his job at the Center for Social Innovation, Mark is also a Board member for the National Low Income Housing Coalition and has been working with the group for a very long time. The Coalition recently published the 2012 Advocates Guide to Housing and Community Development Policy, and I have to say, they hit a Grand Slam with this and it couldn't have been more timely, or more needed.

The document is about 255 pages long and if you have any interest at all in helping to end homelessness in our country but don't have a clue where to start, what the priorities are, what is available, or all of the above, this guide should be required reading. 

I've copied just the 2012 Policy Agenda for the Coalition below to give you a taste of what they're up to, and I encourage you to download the pdf, print it out, and read it cover to cover.  Then get busy, because there is a lot of work to be done. 

There work is so important, and this guide is so valuable, that I immediately sent them a contribution.  If you can, please send the Coalition a donation of $10 or more dollars.  They need it, they earn it every day, and the work they are doing is critical to ending homelessness in our country. 



National Low Income Housing Coalition
2012 Policy Agenda
NLIHC supports all policy initiatives that advance our mission and our goals.
Mission:
NLIHC is dedicated solely to achieving socially just public policy that assures people with the lowest incomes in the
United States have affordable and decent homes.
Our three goals are:
• To preserve existing federally assisted homes and housing resources.
• To expand the supply of low income housing.
• To establish housing stability as the primary purpose of federal low income housing policy.

In 2012, NLIHC will focus its resources proactively on the policy objectives listed below, while monitoring the policy environment and responding to emerging issues as needed.
National Housing Trust Fund (NHTF)
• Obtain funding for the NHTF of at least $5 billion a year, with a goal of $30 billion a year for 10 years.
• Advance Ellison bill on Mortgage Interest Deduction reform and funding for the NHTF.
• Monitor and influence federal housing finance reform legislation to protect the statutory authority for the NHTF and to emsure that dedicated funding for NHTF is in final bill.
• Develop and advance legislation to direct 20% of profits of Federal Home Loan Banks into NHTF after they have reached required levels of reserves.
• Develop and advance legislation to 1) move statutory authority for NHTF to more compatible and less vulnerable section of the federal code, and 2) ensure rents for NHTF units are affordable for all extremely low income (ELI) households.
• Advance S. 489 and H.R. 1477 to fund NHTF through proceeds of Troubled Asset Relief Program (TARP).
• Advocate for publication of NHTF rule in timely manner.

Balanced Housing Policy
• Advance Ellison bill on Mortgage Interest Deduction reform to create mortgage interest credit and funding for NHTF.
• Monitor and influence federal housing finance reform legislation to ensure balanced attention to both rental housing and mortgaged housing.

Housing Choice Vouchers
• Advance Section 8 Savings Act without Moving to Work (MTW), time limits, or minimum rent increases.
• Develop and advance legislation to incentivize state and regional voucher administration.
• Advocate for increase in incremental vouchers and ensure full funding for all current vouchers in FY13 HUD budget.
• Monitor Small Area Fair Market Rent demonstration.

Preservation of Public and Assisted Housing
• Advocate for full funding of project-based Section 8 contracts and the operating accounts. Advocate for sufficient funding to meet annual capital costs of public housing and increased funding to address the public housing capital needs backlog.
• Advocate for enactment of Rental Assistance Demonstration program.
• Oppose expansion of MTW in absence of resident protections.
• Advance legislation to require unique identifier for each and every federally assisted housing property, and to establish a national preservation inventory.
• Advocate for tools and resources for residents and advocates to work on preservation of public and assisted housing.
• Support administrative reforms to protect existing units.

Federal Budget
• Advocate for the highest possible FY13 appropriations for HUD and USDA Rural Housing, while ensuring sufficient funding to preserve all existing low income housing resources and prevent loss of units affordable to or rental assistance
for ELI households.
• Advocate for sufficient funding for U.S. Census.
• Explore moving all rent assistance programs to mandatory side of budget.
• Oppose deficit reduction plans that do not include increased revenues.
• Oppose cuts to discretionary and mandatory programs that will cause harm to low income people.
• Oppose across-the-board cuts.
• Advance Ellison bill on Mortgage Interest Deduction reform and funding for the NHTF.

Foreclosure Intervention
• Advance legislation to make permanent the Protecting Tenants in Foreclosure Act (PTFA).
• Monitor and influence implementation of PTFA by federal agencies and GSEs.
Disaster Housing
• Advance S. 1630, the Disaster Recovery Act of 2011 (Stafford Act reform).
Planning for Just Communities
• Monitor and influence improvements to the Consolidated Plan process.
• Monitor and influence the regulations to Affirmatively Further Fair Housing.
• Develop and advance legislation to incentivize state and regional voucher administration.

Housing Plus Services
• Monitor and influence implementation of HEARTH Act.
• Monitor and influence implementation of Section 811 and Section 202 legislation.
• Advance H.R. 3254, Affordable Communities Employment Act of 2011 (Section 3).

30% for the 30% Low Income Housing Tax Credits (LIHTC)
• Develop and advance legislation to require that a minimum 30% of units subsidized by LIHTC be affordable to and occupied by ELI households.
• Protect LIHTC in context of any tax reform and deficit reduction legislation.

HOME
• Develop and advance legislation to require that a minimum of 30% of units subsidized by HOME funds be affordable to and occupied by ELI households.
• Advocate for HOME funding of at least $2 billion.

Federal Home Loan Banks
• Develop and advance legislation to require that a minimum of 30% of units subsidized by Affordable Housing Program funds be affordable to and occupied by ELI households.

The time is NOW to let your voice be heard.  Read the Advocate's Guide, support the Coalition, and get busy.  Thousands of people are depending on it.