Less our own

Earlier this week The Wall Street Journal reported a front-page story about overprescription of antipsychotics -- drugs intended to treat disorders like schizophrenia and bipolar depression -- in nursing homes. (Journal subscribers can read the story here.) Doctors are using these drugs as an alternative to restraining elderly patients suffering from Alzheimer's and dementia.

The article faults perverse incentives. There is, for example, the fact that federal programs reimburse nursing homes for off-label uses of these medications more readily than they fund caregivers to deal with physically challenging patients. There is also the fact that a well-intentioned law limits physical and chemical restraint of patients. Deprived of old-fashioned restraints, doctors have turned to clever under-the-table uses of drugs to achieve their goal, which is low-cost immobilization of troublesome patients. As with most laws designed to address the human condition, this law did nothing to address the human heart -- nor could it. The deeper and difficult issue here is that we place large numbers of our oldest citizens into containment centers, and not only do we prefer not to be bothered with their physical presence, we want to minimize the costs of their care.

There are, to be sure, many families that simply cannot provide care for their sick and disabled elderly members. They must have professional care. Does it say anything about us as a society, however, that we resort on such a wide scale to institutions for our elderly, and that, as this article makes clear, we restrain or dangerously medicate so many? Some doctors defend the off-label use of these powerful drugs, and there are almost certainly cases where dangerous patients have been rendered less likely to harm others. But then one comes across this passage, about a 96 year-old woman given 90 doses of an antipsychotic drug over a span of six months:

"The woman . . . enjoyed listening to music and getting her nails polished, according to a state report. But when agitated, she banged her hand on the table and sometimes yelled. One aide found it was possible to calm her by offering ice cream and chatting with her, the report said. But other staff gave her the drug Haldol."

She banged on a table, in her confusion. In her torment, she yelled. She could be pacified, with some extra attention. But extra attention means extra work, and a bigger labor expense -- so they drugged her. That seems to capture a trend: the pursuit of selfish convenience over the giving of ourselves. It puts me in mind of Henri Nouwen, the priest and writer who devoted part of his life to the intensive, selfless care of the disabled. He wrote this about Adam, the young man he washed, dressed, fed, and cared for:

"Suddenly I realized that Adam, the weakest among us, created community. He brought us together and his needs, his vulnerability, made us into a true community. . . His weakness became our strength. His weakness made us into a loving community. His weakness invited us to forgive one another, to calm our arguments and to be with him."

I wonder if the opposite is true, if, when we relegate the weakest among us -- the elderly, the unborn, the poor -- to the shadows, we weaken ourselves, and deprive ourselves of love, of peace. It accords with how God works, I think, that he would offer us strength through weakness, through the vulnerable places we make for others in our hearts. It accords with how we work, that we instead view these weak ones as nuisances, and give thanks to a modern society that sanctions casting them out of our homes.

I'm the most selfish of people. I tremble at the thought of devoting, once my children are grown, another twenty years, or more, to caring for helpless human beings. I want to pray that God never calls me to do that. But something inside me wonders, should I be praying the opposite? What miracles might he work in a sinner like me, were I to make myself less my own?